ABSTRACT
Diabetes mellitus (DM) is a metabolic disease characterised mainly by signs and symptoms derived from increased serum glucose or hyperglycemia. The coronavirus disease 2019 (COVID-19) pandemic affected the entire world with reports of severe prognosis in diabetic patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and high hospital admissions in the intensive care unit (ICU) compared to non-diabetic patients. The objective of the bibliographic review was to evaluate and describe some of the biochemical mechanisms that lead to severe prognosis in patients with DM infected by the SARS-CoV-2 virus through a systematic search for information in different databases. The results showed that the high ICU admission with a severe prognosis of diabetic patients infected by the virus was due to excessive inflammation that causes acute respiratory distress syndrome, cytokine storm, severe pneu-monia, impaired immunity, and hyperglycemia. The virus enters the cell mainly through the endocytic and non-endosomal pathway;the central cellular receptors involved in the mechanisms are insulin receptors (IR), glucose transporter type 2 (GLUT-2), dipeptidyl peptidase-4 (DPP4), glucose transporter type 4 (GLUT-4), glucose converting enzyme angiotensin 2 (ACE2), and the serine transmembrane protease co-receptor 2 (TMPRSS2) essential for viral propagation. The increased susceptibility to devel-oping COVID-19 in diabetic patients is due to the overexpression of ACE2, and serious complications are increased at the microvascular and macrovascular levels, such as nephropathies, neuropathies, and cardiovascular diseases.
ABSTRACT
The COVID-19 pandemic caused many changes in the social context, including the need for isolation and social distance. Schools needed to innovate so that education was not interrupted. State governments have adopted Remote Emergency Education. This type of teaching brought more difficulties in accessing education for Inclusive Education students. The reality of students target audience of special education, in this remote education scenario, guided the development of a literature review research with the aim of understanding how inclusive education students are being assisted during the pandemic period. The results highlight that the lack of technological access made it very difficult for these students to reach remote learning. On the other hand, the pandemic has enabled greater collaboration between the family and the school, which is enriching for the target audience of special education, which has more support from the family in the teaching-learning process.
ABSTRACT
This article aims to analyze the distribution of deaths by COVID-19 in Brazilian municipalities and its relationship with socioeconomic aspects (income) until the data of July 14, 2020. A methodology was based on the selection of spatial autocorrelation based on the Global Index Moran and the Local Moran Index (LISA) in its univariate and bivariate forms. A univariate form was used to investigate the distribution of the Mortality Rate by COVID-19 (CMD), while the bivariate form was used to verify spatial autocorrelation between the variables TMC (dependent variable) and MHDI Income (independent variable) in Brazilian municipalities until the data of July 14, 2020. The results show the presence of clusters formed from groups of municipalities with high CMD values, mainly in the North and Northeast regions of Brazil. In addition, a negative autocorrelation was found between the variables TMC and MHDI Income, with emphasis on large territorial portions of the North and Northeast regions. The number of cases of COVID-19 in a geographical area and the income of its population are essential factors for understanding the distribution of habits related to this disease.
ABSTRACT
Background and aims: The Coronavirus Disease Pandemic - 2019 (COVID-19) represents, to date, the greatest public health challenge of the 21st century. Stroke, on the other hand, is nationally the main cause of disability, accompanied by a considerable and costly number of hospitalizations. This paper questions the impact of COVID-19 on stroke notifications. Methods: Articles were searched using the descriptors: Ischemic Stroke;Hemorrhagic Stroke;Cerebrovascular events;COVID-19 and Brazil. The research platforms were Pubmed, Scielo, Virtual Health Library and DataSUS. Results: Since the beginning of the pandemic in Brazil, in March 2020, there has been a reduction of approximately 20% in the number of stroke cases reported compared to 2019. This reality is consistent with the international scenario of possible underreporting and reduced demand for medical care in mild and intermediate cases. Although, according to medical societies of national specialties, COVID-19 does not change the recommendations for the management of patients with stroke, the result of this context may be a late start of care, loss of the therapeutic window and worsening of stroke outcomes in the country. The attention to safety protocols and the importance of telemedicine for pre-hospital care was also highlighted. Conclusion: Given the decrease in the number of cases of stroke, there is an alert regarding underreporting and delay in care, problems already present in the national scenario that may be potentiated by the pandemic, where the concern with COVID-19 overlaps with other diseases, which may increase the damage (in the short and long term) to public health.
ABSTRACT
Background and aims: Although it primarily damages the respiratory system, COVID-19 can also develops with neurological conditions such as stroke. This study aims to describe a case report of a patient with ischemic stroke related to COVID-19. Methods: Male, 44 years old, with untreated diabetes, admitted to emergency with left hemiplegia and dysarthria. Patient had flu-like symptoms 11 days ago and was diagnosed with COVID-19. Auscultation revealed bilateral bases rhonchi. Normotensive, oxygen saturation: 94%, glycemia: 241mg/dl, increased lactate and CRP;hemogram, D-Dimer and coagulogram unchanged. Brain CT demonstrated no evidence of hemorrhagic injury. Chest CT revealed bilateral lung involvement with ground-glass opacities. The patient remained hospitalized for 21 days and was discharged still with motor deficits. Results: The literature suggests that the mechanisms of ischemic stroke associated with COVID-19 are multiple, highlighting the cytokine storm and coagulation dysfunction. Increased lactate and CRP suggest an acute inflammatory activity;however, the patient did not exhibit high levels of D-dimer, platelet or coagulogram changes. Strokes associated with COVID-19 occur mainly in elderly patients and critically sick. Patients with mild clinical presentation of the disease have an incidence of strokes less than 1%. Although the patient does not have the risk factors mentioned above, diabetes may represent a predisposing factor of the neurological complication. Conclusion: Patients with mild respiratory conditions may present severe neurological complications, possibly due to the association between previous comorbidity and coagulopathy from COVID-19. The strokes associated with COVID-19 may present greater mortality and disability when compared to cases unrelated to COVID-19.
ABSTRACT
The positive effects of breastfeeding on the health of infants and mothers are largely established. It is generally recommended that a mother should breastfeed exclusively for at least 6 months. Sometimes, however, this is not possible owing to a maternal disease. The purpose of this review was to understand the possibility and the mechanisms of transmission of viral agents to breastfed infants when the mother is infected and to evaluate whether and when breastfeeding can be harmful and, therefore, a real contraindication exists. In order to produce this narrative review, an extensive literature search was conducted on PubMed. The query included "breastfeeding", "mother to child" and "transmission" as keywords and a filter for publication date - from 2014 to 2019. Additionally, the bibliography of the selected articles was reviewed to identify further pertinent studies, which were then included. Only the following maternal infections were found to represent an absolute contraindication to breastfeeding: Human Immunodeficiency Virus and Human T-Lymphotropic Virus, because of their possible transmission via milk, and Ebola Virus, in which transmission to the child seems to be linked more to the close proximity relationship itself than the presence of the virus in human milk. Other viruses - Herpes Simplex Virus, Varicella Zoster Virus and Hepatitis C Virus - constituted a source of contraindication only in specific high-risk circumstances. To date, for the remaining viruses reviewed in this paper - including Severe Acute Respiratory Syndrome Coronavirus 2, no evidence exists that warrants contraindication of breastfeeding. Health professionals who deal with pregnant and puerperal women, such as obstetricians, pediatricians or family medicine doctors, must be aware of these particularities in the management of breastfeeding women in order to provide correct information and better take care of their patients and their respective infants.
ABSTRACT
The COVID-19 pandemic has quickly and radically transformed health systems worldwide. The challenges are imposed by the need for social distance, remote management of less severe cases, and the constant need for updating health care professionals and the population with reliable information. We aim to describe the experiences and developments of a Brazilian telehealth public service during the pandemic. Numerous tools have been developed and made available, to be used in an integrated manner, by both health professionals and the general public. Those included a chatbot for guidance, a teleconsultation platform combined with a telemonitoring system, a teleconsulting service, and a tele-education program. The TNMG services appear to be efficient and robust during the health crisis of COVID-19, through different tools and methodologies focused on both professionals and users of the health systems. © 2021 The authors and IOS Press.
ABSTRACT
This article aimed to identify, in the context of the aviation structure, the initial routes of entry of COVID-19 into Brazil in each Brazilian state. From the survey of epidemiological data about the first cases of COVID-19 recorded in each Brazilian state, airport and air transport information, the initial routes for insertion and dissemination of COVID-19 were identified and spatialized. The results showed that the main initial routes of transmission and dissemination of this disease in Brazil are of international origin, mainly from the European continent and national origin, especially from the states of Sao Paulo and Rio de Janeiro. The way in which COVID-19 was introduced in Brazil and its initial dissemination was directly related to the direction of the flows of convergent people and goods to the main management centers in the country, mainly through air transport.
ABSTRACT
BACKGROUND: To report a pilot experience of telemedicine in ophthalmology in open-care modality (i.e. direct video call), in a confinement period due to the COVID-19 pandemic. METHODS: Descriptive study of the demographic and clinical characteristics of patients attended in a 10-week confinement period. Reported satisfaction of the participating patients and doctors was evaluated through an online survey. RESULTS: In the 10-week period, 291 ophthalmologic telemedicine consultations were performed. The main reasons for consultation were inflammatory conditions of the ocular surface and eyelids (79.4%), followed by administrative requirements (6.5%), non-inflammatory conditions of the ocular surface (5.2%), strabismus suspicion (3.4%) and vitreo-retinal symptoms (3.1%). According to previously defined criteria, 22 patients (7.5%) were referred to immediate face-to-face consultation. The level of satisfaction was high, both in doctors (100%) and in patients (93.4%). CONCLUSIONS: Open-care modality of telemedicine in ophthalmology during the pandemic period is a useful instrument to filter potential face-to-face consultations, either elective or emergency, and potentially reduce the risk of COVID-19 infection.
Subject(s)
COVID-19/epidemiology , Ophthalmology/statistics & numerical data , Pandemics , Quarantine , SARS-CoV-2 , Telemedicine/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Eye Diseases/diagnosis , Eye Diseases/drug therapy , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Ophthalmology/standards , Ophthalmology/trends , Patient Satisfaction , Pilot Projects , Practice Guidelines as Topic , Referral and Consultation/statistics & numerical data , Surveys and Questionnaires , Telemedicine/standards , Telemedicine/trends , Time Factors , Young AdultABSTRACT
INTRODUCTION: The Prone Position (PP) is generally used in cases of Acute Respiratory Insufficiency (IRPA), in patients with Acute Respiratory Distress Syndrome (ARDS) and in invasive mechanical ventilation, in order to improve oxygenation, but it can be used useful in cases of mild IRPA, using the need for invasive mechanical ventilation and complications associated with the ventilator. OBJECTIVES: To describe or report the case of using the prone position (PP) in patients with spontaneous ventilation with mild respiratory failure secondary to COVID-19. METHODS: this is a case of a patient diagnosed with COVID-19, with an IRPA level, with dyspnea, cough, hypoxemia and desaturation, which includes treatment techniques that use a prone position protocol for two hours, twice a day for the entire hospital stay. RESULTS: The patient presented hypoxemia (SpO2-94% and PO2-62.9), associated with a food (Borg 6) on admission, having received improvements in food (Borg 4) and 96% saturation in pulse oximetry after 24 hours from the beginning of the protocol and after 48 hours it improves the gasometric and SpO2 and PaO2 values of 96.5% and 80.6 mmHg, respectively. CONCLUSION: The prone position in patients on spontaneous ventilation, with respiratory failure secondary to COVID-19 is safe and can be used as adjunctive therapy to treatment in this patient profile. © 2020, BAHIANA - School of Medicine and Public Health. All rights reserved.