ABSTRACT
BACKGROUND AND OBJECTIVES: COVID-19 related inflammation, endothelial dysfunction and coagulopathy may increase the bleeding risk and lower efficacy of revascularization treatments in patients with acute ischemic stroke. We aimed to evaluate the safety and outcomes of revascularization treatments in patients with acute ischemic stroke and COVID-19. METHODS: Retrospective multicenter cohort study of consecutive patients with acute ischemic stroke receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021, tested for SARS-CoV-2 infection. With a doubly-robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS: Of a total of 15128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19. 5848 (38.7%) patients received IVT-only, and 9280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted odds ratio [OR] 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour (OR 2.47; 95% CI 1.58-3.86) and 3-month mortality (OR 1.88; 95% CI 1.52-2.33).COVID-19 patients also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION: Patients with acute ischemic stroke and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 treated patients. Current available data does not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in COVID-19 patients, or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring and establishing prognosis.
ABSTRACT
Para compreender melhor a percepção de desgoverno e o sentimento de desamparo que se alastraram no Brasil sob a Covid-19, este artigo examina dois momentos históricos relativos à interface peste-desamparo, das perspectivas psicanalítica e política. O primeiro momento trata do entrelaçamento entre vida e obra de Freud e culmina com sua experiência com a pandemia da gripe espanhola, em 1920; o segundo, trabalha a forma pela qual estamos lidando com o advento da pandemia do coronavírus, desde março de 2020, que — até o momento em que escrevo este artigo (janeiro de 2022) — matou mais de 600 mil brasileiros e trouxe o luto para mais de cinco milhões de famílias no mundo. A hipótese deste trabalho assevera que o sentimento de desamparo que estamos vivenciando desvela o negacionismo e o desgoverno que, inclusive, põem em xeque o estado democrático de direito no país.
Resumos To better understand the widespread perception of misgovernment and helplessness in Brazil during the COVID-19 pandemic, this article examines two historic moments referring to the interface between plague and helplessness, from the psychoanalytic and political perspectives. Firstly, it addresses the intertwining between Freud's life and work, culminating with his experience during the Spanish flu pandemic, in 1920. Secondly, it analyses the measures put in place to combat the coronavirus pandemic, since March 2020, which — until the moment I am writing this article (January 2022) — killed more than 600,000 Brazilians and left more than five million families around the world in mourning. This paper asserts that the feeling of helplessness unveils a state of denialism and misgovernment, which calls into question the Brazilian rule of law.
Pour mieux comprendre la perception répandue de la mauvaise administartion et de l'impuissance au Brésil pendant la pandémie de Covid-19, cet article examine deux moments historiques liés à l'interface peste-impuissance, du point de vue psychanalytique et politique. Premièrement, il traite de l'imbrication entre la vie et l'œuvre de Freud, qui culmine avec son expérience pendant la pandémie de grippe espagnole en 1920. Deuxièmement, il analyse les mesures misen en place pour combattre la pandémie du coronavirus, depuis mars 2020, qui — jusqu'au moment de la rédaction de cet article (janvier 2022) — a fait plus de 600 000 victimes brésiliennes et endeuillé plus de cinq millions de familles dans le monde. Cet essai affirme que le sentiment d'impuissance dévoile un état de négationnisme et de mauvaise gouvernance, qui remet en question l'État de droit et la démocratie au Brésil.
Para comprender mejor la percepción del desgobierno y del sentimiento de desamparo en Brasil durante la crisis del Covid-19, este artículo examina dos momentos históricos relacionados con la interfaz peste-desamparo, desde un punto de vista psicoanalítico y político. El primer momento trata del entrelazamiento entre la vida y la obra de Freud y culmina con su experiencia con la pandemia de gripe española en 1920. El segundo momento se refiere a la forma en que estamos lidiando con el advenimiento de la pandemia de Coronavirus desde marzo de 2020 que, al momento de redactar este artículo (enero de 2022), ha causado más de 600.000 víctimas brasileñas y dejado más de cinco millones de familias en todo el mundo. Este ensayo se basa en el supuesto de que el sentimiento de desamparo que experimentamos se debe a la negación del Covid y al desgobierno. Además, estas dos razones han representado una amenaza para el estado de derecho y la democracia en Brasil.
ABSTRACT
Para compreender melhor a percepção de desgoverno e o sentimento de desamparo que se alastraram no Brasil sob a Covid-19, este artigo examina dois momentos históricos relativos à interface peste-desamparo, das perspectivas psicanalítica e política. O primeiro momento trata do entrelaçamento entre vida e obra de Freud e culmina com sua experiência com a pandemia da gripe espanhola, em 1920; o segundo, trabalha a forma pela qual estamos lidando com o advento da pandemia do coronavírus, desde março de 2020, que — até o momento em que escrevo este artigo (janeiro de 2022) — matou mais de 600 mil brasileiros e trouxe o luto para mais de cinco milhões de famílias no mundo. A hipótese deste trabalho assevera que o sentimento de desamparo que estamos vivenciando desvela o negacionismo e o desgoverno que, inclusive, põem em xeque o estado democrático de direito no país.
Resumos To better understand the widespread perception of misgovernment and helplessness in Brazil during the COVID-19 pandemic, this article examines two historic moments referring to the interface between plague and helplessness, from the psychoanalytic and political perspectives. Firstly, it addresses the intertwining between Freud's life and work, culminating with his experience during the Spanish flu pandemic, in 1920. Secondly, it analyses the measures put in place to combat the coronavirus pandemic, since March 2020, which — until the moment I am writing this article (January 2022) — killed more than 600,000 Brazilians and left more than five million families around the world in mourning. This paper asserts that the feeling of helplessness unveils a state of denialism and misgovernment, which calls into question the Brazilian rule of law.
Pour mieux comprendre la perception répandue de la mauvaise administartion et de l'impuissance au Brésil pendant la pandémie de Covid-19, cet article examine deux moments historiques liés à l'interface peste-impuissance, du point de vue psychanalytique et politique. Premièrement, il traite de l'imbrication entre la vie et l'œuvre de Freud, qui culmine avec son expérience pendant la pandémie de grippe espagnole en 1920. Deuxièmement, il analyse les mesures misen en place pour combattre la pandémie du coronavirus, depuis mars 2020, qui — jusqu'au moment de la rédaction de cet article (janvier 2022) — a fait plus de 600 000 victimes brésiliennes et endeuillé plus de cinq millions de familles dans le monde. Cet essai affirme que le sentiment d'impuissance dévoile un état de négationnisme et de mauvaise gouvernance, qui remet en question l'État de droit et la démocratie au Brésil.
Para comprender mejor la percepción del desgobierno y del sentimiento de desamparo en Brasil durante la crisis del Covid-19, este artículo examina dos momentos históricos relacionados con la interfaz peste-desamparo, desde un punto de vista psicoanalítico y político. El primer momento trata del entrelazamiento entre la vida y la obra de Freud y culmina con su experiencia con la pandemia de gripe española en 1920. El segundo momento se refiere a la forma en que estamos lidiando con el advenimiento de la pandemia de Coronavirus desde marzo de 2020 que, al momento de redactar este artículo (enero de 2022), ha causado más de 600.000 víctimas brasileñas y dejado más de cinco millones de familias en todo el mundo. Este ensayo se basa en el supuesto de que el sentimiento de desamparo que experimentamos se debe a la negación del Covid y al desgobierno. Además, estas dos razones han representado una amenaza para el estado de derecho y la democracia en Brasil.
ABSTRACT
BACKGROUND: Multisystem Inflammatory Syndrome in Children (MIS-C) is a life-threatening complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which manifests as a hyper inflammatory process with multiorgan involvement in predominantly healthy children in the weeks following mild or asymptomatic coronavirus disease 2019 (COVID-19). However, host monogenic predisposing factors to MIS-C remain elusive. METHODS: Herein, we used whole exome sequencing (WES) on 16 MIS-C Brazilian patients to identify single nucleotide/InDels variants as predisposition factors associated with MIS-C. RESULTS: We identified ten very rare variants in eight genes (FREM1, MPO, POLG, C6, C9, ABCA4, ABCC6, and BSCL2) as the most promising candidates to be related to a higher risk of MIS-C development. These variants may propitiate a less effective immune response to infection or trigger the inflammatory response or yet a delayed hyperimmune response to SARS-CoV-2. Protein-Protein Interactions (PPIs) among the products of the mutated genes revealed an integrated network, enriched for immune and inflammatory response mechanisms with some of the direct partners representing gene products previously associated with MIS-C and Kawasaki disease (KD). In addition, the PPIs direct partners are also enriched for COVID-19-related gene sets. HLA alleles prediction from WES data allowed the identification of at least one risk allele in 100% of the MIS-C patients. CONCLUSIONS: This study is the first to explore host MIS-C-associated variants in a Latin American admixed population. Besides expanding the spectrum of MIS-C-associated variants, our findings highlight the relevance of using WES for characterising the genetic interindividual variability associated with COVID-19 complications and ratify the presence of overlapping/convergent mechanisms among MIS-C, KD and COVID-19, crucial for future therapeutic management.
Subject(s)
COVID-19 , SARS-CoV-2 , Child , Humans , COVID-19/complications , COVID-19/genetics , Genetic Predisposition to Disease , Systemic Inflammatory Response Syndrome/genetics , ATP-Binding Cassette TransportersABSTRACT
With the onset of the SARS-CoV-2 pandemic in early 2020, health services and personnel adapted their resources to mitigate and control the outbreak. These needs inevitably led to adaptations in most medical and surgical departments, including in our Vascular Surgery department. As we are facing a second outbreak of this pandemic, with unpredictable outcomes and repercussions in health services, it is crucial to learn from previous experiences and share strategies to perform the best care to our patients, despite the restrictions that have been imposed. Through this paper, we review the adaptations in Centro Hospitalar Universitário Lisboa Norte and particularly in our department to overcome the pandemic. We also assess the impact of these changes in our activity and compare with the experience of other fellow surgeons. With an upcoming second outbreak, it is crucial to learn from this and other departments’ experiences to overcome a potential health crisis.