ABSTRACT
Introdução/Objetivo: A pandemia do Coronavirus colocou a posição prona em evidência como uma ferramenta de auxílio no manejo de hipoxemias graves. No entanto, de modo análogo ao relatado em outras situações que utilizam a manobra, tais como neurocirurgias e cirurgias ortopédicas, chama a atenção que pacientes ventilados mecanicamente na unidade de terapia intensiva (UTI) em posição prona costumam apresentar níveis séricos mais elevados de Creatina-fosfoquinase (CPK) posteriormente. Assim, o objetivo do presente estudo foi avaliar a diferença entre valores de CPK sérica antes e após a pronação em pacientes diagnosticados com COVID-19 em uso de ventilação mecânica na UTI. Método: Estudo analítico em que 15 pacientes graves com diagnóstico de COVID-19 foram avaliados quanto a seus níveis séricos de CPK antes e depois de serem pronados. Todos os pacientes tinham resultado positivo para COVID-19 e estavam em ventilação mecânica na UTI. Os dados sobre os níveis séricos de CPK foram coletados até 24 horas antes e após o posicionamento dos pacientes em prona. Em seguida, o Teste do Sinal para Pares Combinados (unilateral) foi usado para testar a hipótese de aumento dos níveis séricos de CPK até 24 horas após a posição prona. A significância estatística foi estabelecida em p < 0,05. Resultados: O presente estudo teve tamanho amostral de 15 pacientes, todos em posição prona: 8 mulheres (53,33%) e 7 homens (46,67%), com mediana de idade de 51 anos. Nesse contexto, 12 pacientes (80%) apresentaram aumento dos níveis séricos de CPK até 24 horas após o posicionamento, o que, após ser testado com o Teste de Sinal de Pares Combinados (unilateral), resultou em uma diferença significativa entre os níveis séricos de CPK antes e após a manobra (p valor = 0,0176). Conclusão: Houve um aumento estatisticamente significativo nos níveis séricos de CPK até 24 horas após o posicionamento em prona de pacientes com COVID-19 ventilados mecanicamente na UTI. Mais estudos devem avaliar se e como esses achados podem afetar os resultados clínicos desses pacientes, especialmente considerando o papel da CPK nos desfechos de paciente com COVID-19.
ABSTRACT
Background: The novel SARS-CoV-2 coronavirus disease 2019 (COVID-19) has disrupted health care systems worldwide since December 2019 causing atypical pneumonia and affecting multiple body organs. In Latin America, COVID19 had its first case in the megacity of São Paulo, Brazil, thus being the starting point and epicenter of this disease. In this context, prostate cancer (PC) is the most common nonskin cancer among men and its preventive healthcare is substantial to public health surveillance. Additionally, PC raises particular interest during COVID-19 outbreak as PC androgen-deprivation therapies have shown to mitigate SARS-CoV-2 infection, which suggests an association between SARS-CoV-2 and PC cells. Thus, the consequences of the COVID-19 outbreak on male genital cancers care remain inconclusive and will probably be felt for decades. This study aimed to determine the impact of pandemic on the incidence of hospital admissions (HA) due to malignant neoplasms of male genital organs in the city of São Paulo, Brazil. Methods: This is a cross-sectional study of the HAs due to malignant neoplasms of male genital organs in the city of São Paulo comparing the outbreak period (January-June 2020) and a pre-pandemic corresponding period of the years 2017-2019. Data were obtained from the Brazilian Unified Health System - Hospital Information System database according to the chapter II of the International Classification of Diseases - 10th revision (ICD10). Linear regression was used to analyze the relationship between the incidence of HAs and time (months). Results: A significant reduction in HAs due to malignant neoplasms of male genital organs was observed in PC, but not other malignant neoplasms of male genital organs during the outbreak period (JanuaryJune 2020). PC (-19, CI -36 to -1) showed to be remarkably affected while other male genital cancers (-1, CI -5 to 3) did not (Table). Conclusions: Our findings seem to be associated to delayed oncological care delivery to PC during the lockdown and health system disruption. Further studies are required to evaluate the impact of the ongoing pandemic in malignant neoplasm of male genital organs, particularly PC, in order to strategically corroborate public health actions for implications of COVID-19 pandemic.
ABSTRACT
Background: The novel coronavirus disease 2019 (COVID-19) pandemic has disrupted health care systems worldwide. In Brazil, the disease had its first case in the city of São Paulo, thus being the starting point and epicenter of this disease in Latin America. Neurological features are currently well recognized in COVID-19 indicating the neurotropic nature of the virus and include anosmia, myalgia, myositis, encephalitis, meningitis, cerebrovascular disease, Guillain-Barré syndrome, and postinfectious myelitis. CNS tumors though relatively rare (> 2% of all cancers) are a relevant source of cancer-related morbimortality worldwide. Although studies have reported higher COVID-19 severity in cancer patients, the consequences of the pandemic on health care for CNS tumors remain inconclusive and will probably be felt for decades. This study aimed to determine the impact of pandemic on the hospital admissions (HA) due to CNS tumors in the city of São Paulo, Brazil. Methods: This is a cross-sectional study of the HAs due to CNS tumors in the city of São Paulo comparing the outbreak period (January-June 2020) and a prepandemic corresponding period of the years 2017-2019. Data were obtained from the Brazilian Unified Health System - Hospital Information System database according to the chapter II of the International Classification of Diseases - 10th revision (ICD-10). Linear regression was used to analyze the relationship between the incidence of HAs and time (months). Results: A significant reduction in HAs due to CNS tumors was observed during the outbreak period (January-June 2020). Benign neoplasm of brain and other parts of CNS (-2, CI -2 to -1) and malignant neoplasm of brain (-5, CI -7 to -3) showed to be remarkably affected (see table). To our knowledge, this is the first scientific report of significant reduction of HAs due to CNS tumors during COVID-19 era. Conclusions: Our findings seem to be associated to delayed oncological diagnose and care to CNS tumor patients during the lockdown and health system collapse. A rebound helpseeking effect as well as more severe complications may present in the post- pandemic. Further studies are needed to evaluate the impact of the ongoing pandemic in CNS neoplasms in order to strategically corroborate public health actions for short- and long-term implications of COVID-19 pandemic.