ABSTRACT
Background: After two years of COVID in which activities were reduced due to the pandemic and each one's life was affected by restrictions and limitations, the Sickle Cell Disease (SCD) Association in Padova teamed up with the Sickle Cell Group at the Pediatric Hematology Oncology and Bone Marrow Transplant Unit to celebrate the Sickle Cell Disease world day by organizing an online meeting with children/youths and their families. Theme of the meeting was: "My Life with SCD: poems, pictures and writings express our view on disease and care". Aim(s): One of the goals of this meeting was to create an opportunity for individuals with SCD to meet and have a constructive discussion with each other about the disease and express their feelings after two years of pandemic. Method(s): One month before the meeting children, teenager and parents were asked to sharer with the organizing team any drawing, painting, poem, writing, that they felt could express their feelings or experience of the disease itself or how it affected their life, or their experience in the hospital. The materials received were organized in a power point presentation and At the meeting, families were able to see a PowerPoint presentation with the poems, drawings, writings. Each author had the choice to personally share their production or have it read out loud by a member of the team. Free time to comment or share experiences was given. Result(s): 20 children, teenagers and parents participated. Countries of origin (Nigeria, Ghana, Congo, Albania, Italy), religious background (catholic, muslim, no religion, other) were different as well as disease genotype (HbSS, HbSC, HbSBdegree), severity or treatment received (Hydroxyurea, transfusion, Hematopoietic stem cell transplantation -HSCT, none). Drawings and writings regarded experience with the disease (mechanism of action, admissions), feelings experienced (fear, hope, light at the end of the tunnel), aspirations (sports) and gratitude (to the social and medical team, to parents) (Figure 1). Surprisingly, families who had a child having undergone HSCT, reported on the need and importance to talk about this experience for years after the event and made a request of a support goup. Finally, all families underlined the need to meet again soon to discuss together issues related to personal experience with SCD, even via web. of discussion with each other and with the drepanocytosis group;and that throug the online telematics platform it is still possible to involve all families, listening and trying to comfort them on doubts and perplexities about the disease, In conclusion, it can be said that after two years of pandemic, in our setting, online meeting can help patients and families reconnect with each other and activities can be planned to aid experiences and feelings. Patients' associations and Health Care Teams can collaborate in this area.
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Introduction: The second wave of coronavirus disease 2019 (COVID-19) in India was characterised by rapid surge in cases, higher rates of hospitalisation and mortality. Acute kidney injury (AKI) is a common complication of severe COVID-19 infection and has been associated with increased morbidity and mortality. The pathophysiology and risk factors of AKI in COVID –19 is inadequately studied especially in the setting of the second wave. There is scarcity of data from India regarding incidence, risk factors and outcome of AKI in critically ill COVID-19 patients. Methods: This was a prospective observational study conducted during the second wave of COVID-19 at a teaching hospital in south India. All the adult patients (>18 years old) with COVID-19 confirmed by a positive reverse-transcriptase-polymerase-chain reaction (RT-PCR) test and admitted to the intensive care unit (ICU) were included in this study. Severe COVID-19 was defined as SpO2 <94% in room air, PaO2/FiO2 <300 mm Hg, respiratory rate >30/min or lung infiltrates>50%. The study was conducted from 1st April 2021 to 31st July 2021. AKI was defined according to KDIGO (Kidney Disease: Improving Global Outcomes) criteria. Patients who were on maintenance dialysis prior to admission and those without a positive COVID RT PCR report were excluded. All patients were followed up until discharge or death as applicable. Results: A total of 76 patients were admitted during the study period. 74 were included in the study (Figure 1). The average age of the patients was 55.6 ± 13.8 years. 78.4% of the patients were male. 34 (45.9%) of 74 patients developed AKI. Out of them 47.1% had stage 1 AKI, 17.6% had stage 2 AKI, 11.8% had stage 3 AKI and 23.5 % had stage 3 AKI requiring dialysis. When the baseline characteristics were compared between those who developed AKI versus those who did not develop AKI, the former had more co-morbidities as indicated by higher Charlson co-morbidity index (CCI score) p=0.001, higher proportion of diabetes mellitus (p=0.01) and pre-existing chronic kidney disease (CKD) (p= 0.04). The patients who developed AKI had more severe illness with 41.1% of them requiring non-invasive ventilation (NIV) and 44.1% mechanical ventilation (p= 0.001 and p= 0.04 respectively). 50% of patients who developed AKI required inotropic support as compared to 20% of those without AKI (p=0.007). Serum lactate dehydrogenase (LDH) and serum ferritin were significantly elevated in patients who developed AKI as compared to those who did not develop AKI (Figure 2). On stepwise multivariate regression analysis, presence of diabetes mellitus (OR (95% CI): 6.8 (1.50-30.96), p=0.013), serum LDH >/= 386 (OR (95% CI): 12.38 (1.66-92.46) p= 0.014, serum ferritin >/=835 (OR (95% CI): 3.84 (0.86-17.14) p=0.07 and delay from symptom onset to admission in days (OR (95% CI): 3.55 (0.89-14.15), p=0.07 were independent risk factors for development of AKI in our study population. The overall mortality rate of the study population was high at 56.7%, with 64.7% in the AKI group and 50% in the non- AKI group (p=0.20) Fig 1: Details of study population [Formula presented] Fig 2: Box and whisker plots of serum LDH and serum ferritin in those with AKI and those without AKI [Formula presented] [Formula presented] Conclusions: There is high incidence of AKI in critically ill patients of COVID-19 admitted to ICU. Diabetes mellitus, high serum LDH and serum ferritin were found to be independent predictors for AKI development. No conflict of interest
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Objective: This article analyzes the factual-legal situation of the vulnerability of homeless people in the technological age of the 21st century in the context of the Pandemic caused by COVID-19. It discusses the causes and effects of this reality, directing the analysis on the legal consequences, notably in the constitutional principle field, derived from the absence of public policies of housing and health in facing the pandemic crisis Methodology: This research is analytical, qualitative and based on scientific articles, specialized doctrines, people reports and published news and government platforms Results: It is considered the importance of the analysis of the causes of increased vulnerability in relation to people of street situation, highlighting the need for preventive measures constitutive in public policies that effect the right to housing and health, and prevent systematic violation of constitutional principles. It is concluded, therefore, the existence of national legislative acquis on the subject, but a scenario of disdain in its governmental application. Contributions: the main contribution of the work is to identify the growing number of people living on the streets so that the public authorities address this manifest situation of vulnerability and develop health and housing policies that they import, the safeguarding of lives that do not have physical and factual conditions for measures to prevent the spread of the pandemic. It is a warning to the scenario of the deep invisibility of those who die in the dark of the streets. © 2021, Centro Universitário Curitiba - UNICURITIBA. All rights reserved.
ABSTRACT
SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection clinical course can present its own manifestations, but it can also exacerbate those of pre-existing diseases or cause manifestations that simulate said pathologies. Cardiovascular, cancer or rheumatological diseases are examples of this. These types of pathologies share risk factors for poor prognosis and death due to infection, the possibility of developing long-term complications, and they imply a challenge when establishing follow-up and treatment measures requiring multidisciplinary assessment. Therefore, our objective was to raise the difficulties in the short and long-term follow-up of this type of patients and to evaluate how the pandemic affects their treatment. The pandemic has changed the usual medical practice, promoting new forms of patient follow-up, such as telemedicine, imposing a hierarchy of the need for face-to-face care and procedures, forcing budget items to be reallocated to be able to deal with it, with consequences that are likely to it will have to be analyzed in the long term.