High incidence of obstructive sleep apnea in long COVID-19 patients

Introduction: There is a physiological plausibility for obstructive sleep apnoea (OSA) being a factor to long COVID-19 symptoms: OSA activates the renin-angiotensin-aldosterone system and angiotensinconverting enzyme 2, which is the entry receptor SARS-CoV-2 in the cells. The aim of this study is to identify the incidence of obstructive sleep apnea in long COVID-19 patients. Method(s): Observational cohort, cross-sectional study of post- COVID-19 symptomatic patients, admitted in the out patient post COVID-19 clinic in Portimao Hospital (Portugal), from july 2021 to december 2021. Inclusion criteria: >=18 years;previous COVID-19 at least six months before the initial study protocol evaluation, confirmed by a positive real-time reverse-transcription polymerase chain reaction on a nasopharyngeal swab.;persistent symptoms after cure criteria defined by WHO. Exclusion criteria: Patients who had a concomitant neurological disorder;patients who were on invasive mechanical ventilation and patients with persistent fatigue symptoms in the 6 months before SARS-CoV 2 infection. The OSA diagnosis was assessed using portable monitoring device type III (in-home polygraphy), between the 6-7th months after the diagnosis of COVID-19. The OSA severity was performed using the American Academy of Sleep Medicine scoring criteria. Result(s): A total of 88 patients attended the post-COVID-19 consultation, 24 patients meet the exclusion criteria and 64 patients were enrolled: 28,1% (18) had mild COVID-19, 17,2% (11) moderate and 54,7% (35) severe acute disease. The average age was 56 years, the BMI was 29 Kg/m2 and 56% were men. We found a OSA incidence of 75% (48). The distribution of OSA severity was: 50% (24) mild, 29% (14) moderate and 21% (10) severe. In this group of post COVID-19 patients with OSA, the median age and BMI was the same of the total enrolled patients, and 58% were men. Conclusion(s): There is a high incidence of OSA, in long COVID-19 patients. The knowledge of this risk is essential to establish the follow up and investigation protocol for postcovid-19 patients.

TETRAPARESIA FLÁCIDA APÓS TRANSPLANTE AUTÓLOGO DE MEDULA ÓSSEA: RELATO DE CASO

Objetivo: Relatar um caso de tetraparesia flácida após início do esquema vacinal em paciente submetida a transplante de medula óssea (TMO) autólogo para tratamento de linfoma não Hodgkin. Relato do caso: Trata-se de uma mulher parda, de 32 anos, com histórico de linfoma não Hodgkin, hipertensão arterial e diabetes mellitus tipo 2, submetida a TMO em abril/2020 que, após iniciar regime vacinal de rotina pós-TMO, em outubro/2020, evoluiu com sintomas sistêmicos inespecíficos, caracterizados por febre não aferida, náuseas e vômitos. Nenhum quadro infeccioso foi detectado naquele momento. Cerca de 12 dias mais tarde, a paciente passou a apresentar quadro sensitivo-motor caracterizado por parestesia e paresia ascendentes, inicialmente em pés, com progressão para o abdome e mãos em 24 horas, além de disfagia para líquidos e diplopia. Familiares relatavam ainda alguns episódios de síncope nos últimos dois dias anteriores à consulta médica e sudorese extrema e intermitente na região da face. A paciente foi admitida em unidade de terapia intensiva onde foram verificadas hipotonia generalizada, arreflexia global, disautonomia e dissociação proteíno-citológica na análise do líquido cefalorraquidiano, estabelecendo-se o diagnóstico de Síndrome de Guillain-Barré (SGB). Foram descartados quadros infecciosos, inclusive COVID-19, assim como a recidiva do linfoma. Três dias depois houve deterioração da função respiratória com necessidade de intubação orotraqueal e ventilação mecânica. Optou-se por tratamento com plasmaférese (cinco sessões em dias alternados com troca de uma volemia plasmática por sessão). Os efeitos colaterais ao procedimento foram um pequeno hematoma em local de inserção do acesso venoso e distúrbios eletrolíticos moderados, corrigidos sem dificuldade. A recuperação motora foi rápida e a paciente recebeu alta hospitalar após 20 dias de internação, deambulando sem apoio e mantendo-se livre de quaisquer sequelas sensitivo-motoras durante o seguimento. Discussão: paralisias flácidas progressivas são condições frequentes em departamentos de urgência, mas que ainda constituem relevante desafio diagnóstico. Na maioria das vezes a SGB está associada a uma resposta imunológica a um estado infeccioso prévio, porém, em alguns raros casos, pode se desenvolver após imunizações ou transplante de medula óssea. A plasmaférese é tão efetiva quanto a infusão de imunoglobulinas no tratamento da SGB, embora com mais efeitos colaterais em potencial como hipotensão, sepse, reações transfusionais e problemas relacionados ao acesso vascular. Os resultados tendem a ser superiores quando a plasmaférese é iniciada nos primeiros sete dias do surgimento dos sintomas, melhorando a força muscular, diminuindo a necessidade de ventilação mecânica e acelerando a recuperação dos pacientes com SGB grave. Conclusão: a rápida progressão sintomática apresentada pela paciente e a excelente resposta clínica após a instituição da plasmaférese reforçam a importância de um diagnóstico precoce pois, com a terapia adequada é possível atingir uma reversão completa das manifestações e evitar danos neurológicos permanentes.

MULTI-DIMENSIONAL INEQUALITY AND COVID-19 IN BRAZIL

The paper presents empirical evidence from Brazil on the bidirectional relationship between inequality and the Covid-19 crisis: Racial, regional and income inequalities have both aggravated the pandemic and been exacerbated by it. The paper provides a measure of social risk factors to Covid-19, which is positively associated with the number of Covid-19 cases across Brazilian states. This is complemented by a discussion of the country's inequalities in access to healthcare and in the incidence of comorbidities, which elucidates observed disparities in the need of a ventilator and in the number of deaths by Covid-19. Finally, our empirical analysis suggests that the substantive fiscal effort in the country and particularly the implementation of the cash relief program Auxilio Emergencial neutralized the short-term increase in wage disparities but has been insufficient to neutralize the cost of multi-dimensional structural inequalities on Brazil's death tolls.

Evidence that high temperatures and intermediate relative humidity might favor the spread of COVID-19 in tropical climate: A case study for the most affected Brazilian cities.

This study aimed to analyze how meteorological conditions such as temperature, humidity and rainfall can affect the spread of COVID-19 in five Brazilian (São Paulo, Rio de Janeiro, Brasília, Manaus and Fortaleza) cities. The cities selected were those with the largest number of confirmed cases considering data of April 13. Variables such as number of cumulative cases, new daily cases and contamination rate were employed for this study. Our results showed that higher mean temperatures and average relative humidity favored the COVID-19 transmission, differently from reports from coldest countries or periods of time under cool temperatures. Thus, considering the results obtained, intersectoral policies and actions are necessary, mainly in cities where the contamination rate is increasing rapidly. Thus, prevention and protection measures should be adopted in these cities aiming to reduce transmission and the possible collapse of the health system.

The decrease in the physical activity levels during the COVID-19 social distancing period

Aim: Social distancing policies to combat the pandemic of COVID-19 directly impacted the physical activity (PA) index of the population. This study aimed to analyze the factors associated with insufficient leisure-time PA and the changing behavior of residents of the city of Sao Paulo, the epicenter of the pandemic in Brazil. Method(s): The questionnaire used in this research was made available online and included questions on demographics and physical activity. A total of 1.096 adult residents of Sao Paulo completed the questionnaire between July 8th and August 8th, 2020. Result(s): For individuals who were already physically active before the restrictions, a total of 55.8% of the sample kept insufficiently active during the quarantine. Factors such as education, working conditions, and direct relationship with Covid-19 care were associated with decreased leisure-time PA practice, impacting 57.6% of the sample, especially females. People with less formal education, those who possibly changed their routines to working from home, and those who were directly connected to Covid cases were not able to maintain a daily PA routine. Conclusion(s): The data presented here warn about the impacts of the pandemic on engagement in PA, suggesting the need for incentives from intersectoral public policies on sports, leisure, and health to perform these activities. Copyright © 2022 Universidade Estadual Paulista - UNESP. All rights reserved.