ABSTRACT
Objective: To describe demographics, clinical, and respiratory mechanics (including ventilatory management details) of patients admitted to the Intensive Care Unit (ICU) with severe COVID-19 and to evaluate the effectiveness of gas exchange variables, ventilatory parameters, and ICU illness severity scores in predicting 28-day mortality. Design: Single-center retrospective cohort study. Setting: Portuguese medical-surgical ICU. Patients: Adults sequentially admitted to the ICU, from March 18 to May 12, 2020, with critical COVID-19 requiring invasive mechanical ventilation (IMV) for over 48 hours. Interventions: None, due to study design. Measurements and results: Data regarding positioning, positive end-expiratory pressure (PEEP), driving pressure, static lung compliance, and lowest daily arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) ratio throughout the first 5 days of . ICU admission were collected from daily ventilatory assessment charts. The median ICU length of stay was 11.3 days and median IMV duration was 9.5 days. The 28-day mortality was 12.1%. When comparing non-survivors and survivors, significant differences were found regarding Simplified Acute Physiology Score (SAPS) II (48.5, IQR 14.0 vs. 32.0, IQR 11.0, p=0.004), PaO2/FiO2 ratio before endotracheal intubation (101.3, IQR 22.5 vs. 174.1, IQR 9.5, p=0.01) and throughout ICU stay. Over 90% of patients were submitted to prone positioning. Use of low PEEP levels and maintenance of low driving pressures in patients whose overall compliance was low as possible. Conclusions: Significant differences were found regarding SAPS II and PaO2/FiO2 ratios between survivors and non-survivors, eliciting further investigation as potential mortality predictors. With the second wave of the pandemic taking shape, sharing previous experience is crucial to further coordinate efforts internationally.
ABSTRACT
Aims Several Gastroenterology Societies created recommendations in order to reduce any non-essential exposure to thesevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. The purposes of this paper are 1) to evaluate thenational gastroenterologists' perspective of the impact of COVID-19 and 2) to evaluate the impact of the reorganization ofthe Gastroenterology department of Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E) during COVID-19 Pandemic. Methods For the 1 purpose, an online survey of 32 questions was distributed to gastroenterologists nationwide. For the2 purpose the authors conducted a retrospective analysis of some endoscopic procedures performed at theGastroenterology Department of CHVNG/E between March 16 and May 8 during the years 2019 and 2020. Results 67 gastroenterologists have answered our survey between April 15th and May 5th 2020, mostly females (53.7 %)and 55 to 65 years-old group was the most prevalent (25.4 %). Only 14.9 % were residents. 86.6 % worked in a hospital with COVID-19 patients, with 16.4 % assigned to assist those patients. All the departments had suffered modifications. 90 %of the residents affirmed that their activity has changed mainly endoscopic practice, and 64.2 % respondents agreeing withan internship extension. 94 % declared to have non-essential endoscopic procedures postponed. 85.1 % maintained in-person medical visits, 88.1 % were already having remote consultations and 11.9 % did not have any clinical visit. In ourgastroenterology unit, the number of endoscopic procedures had decreased 73.1 % from 2019 to 2020. Conclusions The advent of the COVID-19 outbreak has led to important changes among Gastroenterology activities inPortugal, and national gastroenterology units are complying with the recommendations. Furthermore, PortugueseGastroenterologists believed that the decrease in endoscopic activity can compromise residents' education and training. Thegastroenterology department at CHVNG/E has shown a significant reduction in the number of endoscopic proceduresperformed during the same period from 2019 to 2020.
ABSTRACT
Background: In March 2020, the Brazilian Ministry of Health (MoH) announced COVID-19 countrywide community transmission and issued guidelines on social distancing measures. Using real life data, we aimed to analyze the impact of COVID-19 on HIV care in Brazil, and summarize the actions taken by the MoH to guarantee proper health care for people living with HIV (PLWHIV). Methods: We obtained MoH electronic records, from January-October 2019/2020, on HIV self test (HIVST), viral load (VL), CD4+ T counts (CD4), genotyping, and antiretroviral (ART) prescription, including post- (PEP) and pre-exposure (PrEP) prophylaxis. We used descriptive statistics to quantify COVID-19 impact on HIV care in Brazil and compared indicators of both years by unpaired T-tests. Results: In April 2020, PEP and PrEP dispenses fell 57% and 53%, respectively, when compared to January, and new PrEP users dropped 70%. Four months supplies provision and telemedicine resulted on 64% and 53% increase on PEP and PrEP dispenses and 288% rise on new PrEP users in October, when compared to April. The number of HIVST distributed by MoH and PLWHIV who had the first CD4 and VL before ART initiation dropped 35% and 48%, respectively, when comparing April to January 2020, reflecting the pandemic impact on HIV diagnosis. In return, MoH recommended HIVST for key/ priority populations, pregnant women, patients with TB, STI, viral hepatitis, immunossupressed, or hospitalized due to respiratory syndrome. When comparing to April, HIVST distribution raised 95% in October and the number of PLWHIV who had the first CD4 and VL before ART initiation was 56% higher, in September. When comparing 2020 to 2019, the number of PLWHIV who started ART and those that had the first CD4 and VL before ART initiation was 29% and 48% lower in April 2020, respectively;but 18% and 15% in September. Considering January-October, the proportion of PLWHIV overdue for ART dispensation raised 11% and ART dispense for 30 days dropped 53% in 2020;but increased 27% and 105%, for 60 and 90 days, respectively. The use of telemedicine, annual VL for those clinically stables, and 90-days ART supply held link to public health services and viral load suppresion. Conclusion: PLWHIV are vulnerable during COVID-19 pandemic due to compromised immune system or care continuum interruption by community containment measures. Monitoring of HIV care indicators associated to timely actions is an effective way to overcome COVID-19 pandemic challenges and guarantee proper health care for PLWHIV.