ABSTRACT
Objectives: We aimed at examining whether patients with rheumatological conditions receiving chronic hydroxychloroquine therapy are at a lower risk of developing SARS-CoV-2 infection than those not receiving hydroxychloroquine. Method(s): This historical cohort study included information of all patients aged 18 years or older with rheumatoid arthritis, systemic lupus erythematosus, or associated rheumatological conditions (based on International Classification of Diseases, 10th edition, diagnostic codes). A propensity score was calculated for each patient, and each patientwho was receiving hydroxychloroquine was matched to two patients who were not receiving hydroxychloroquine (controls). The primary endpoint was the proportion of patients with PCR-confirmed SARS-CoV-2 infection among those receiving chronic hydroxychloroquine versus the propensity-matched patients not receiving chronic hydroxychloroquine in 2021. Result(s): 322 patients receiving hydroxychloroquine and 645 patients not receiving hydroxychloroquine were included in the primary analysis. The incidence of active SARS-CoV-2 infections during the study period did not differ between patients receiving hydroxychloroquine and patients not receiving hydroxychloroquine ( [0 3%] vs 78 [0 4%] of 21406;odds ratio 0 79, 95% CI 0 52-1 20, p = 0 27). There were no significant differences in secondary outcomes between the two groups of patients who developed active SARS-CoV-2 infection. For all patients in the study, overall mortality was lower in the hydroxychloroquine group than in the group of patients who did not receive hydroxychloroquine (odds ratio hydroxychloroquine was not associated with the development of active SARS-CoV-2 infection (odds ratio 0 79, 95% CI 0 51-1 42) Conclusion(s): Hydroxychloroquine was not associated with a protective effect against SARS-CoV-2 infection in a large group of patients with rheumatological conditions.
ABSTRACT
Case report Introduction: The COVID-19 pandemic has generated an inexorable cost to governments and a high mortality in general terms, the vaccination process is the only effective strategy to reduce morbidity and mortality in general, however, such administration is not without risks. Case presentation: Female patient of the seventh decade who is vaccinated against COVID-19 and 4 days after the second dose of vaccine against COVID-19 begins to present purpuric lesions that begin in the lower limbs and progressively ascend to the trunk associated with intense arthralgias, abdominal pain and nausea, presents macroscopic rectal bleeding, is admitted finding platelet counts lower than 10 thousand platelets, the diagnosis of a Henoch Scholein purpura associated with a vaccine against COVID-19 was confirmed no requiring specific immunosuppressive therapy with resolution at 21 days. The triggering mechanisms are being studied and described as similar to immunological thrombocytopenia due to heparins. Antibodies against platelet factor 4 have been reported so far. The test known as PIFPA (PF4-induced flow cytometry-based platelet activation) is a cytometric test with high sensitivity and specificity, only available in specialized laboratories, being described for the moment as the only test that allows the detection of immunological thrombocytopenic phenomena secondary to vaccination against COVID-19. Discussion(s): The present case constitutes the appearance of a Henoch Scholein Purpura, a rare pathology with a wide repertoire of triggering events, with infections and vaccine reactions among the main triggers. The present vaccine reaction is rare, being the specific anecdotal, until now there are very few descriptions in the literature about this type of vaccine reaction, which is why it is decided to publish it, mentioning the most recent scientific evidence available on this area. It is noteworthy that these are rare reactions that should not make us underestimate continuing with vaccination campaigns as the best strategy to prevent the advance of this pandemic.
ABSTRACT
Introduction: In patients infected by SARS-CoV-2, acute respiratory failure is secondary to acute respiratory distress syndrome. However, in these patients other acute complications have been detected in the differential diagnosis, such as spontaneous pneumothorax. Description: From a sample of 306 patients with COVID-19, 11 were found complicated with spontaneous pneumothorax and one of them, in addition, with spontaneous pneumomediastinum, two conditions very rarely associated with this infection. Methodology: Observational cohort study to determine the frequency and factors associated with spontaneous pneumothorax or pneumomediastinum in patients with a diagnosis of COVID-19 admitted between june 2020 and june 2021. Result(s): Of the total sample of 306 patients, the main affected gender was the male. Measures of central tendency such as mean (60.8 years), mode (40.9-80.7) were used and the Chi-square test was applied to appreciate statistical value between the various variables to be correlated. When correlating the variables, mortality occurred mainly in the age group over 60 years p <0.0007. COPD as antecedent p <0.0004, ROX index less than 4.88 p <0.0001, PAFI less than 100 mm Hg p <0.003. The mortality found was 8 of the 11 patients. Conclusion(s): The occurrence of pneumothorax is a serious complication in this patient population and is associated with greater severity, although it has not yet been established due to the limited evidence available, case reports so far indicate that mortality appears to be higher compared to those in they do not develop pneumothorax.
ABSTRACT
Introduction: The role ofcoinfections in patients with COVID-19 has been dismissed, and their role in their prognosis and outcomes is unknown. Materials and Methods: Retrospective study of 306 adults infected by SARS-CoV-2 by antigenic or molecular test. The main objective was to evaluate the role of nosocomial coinfections in patients with COVID-19, follow-up from July 2020 to January 2021. Results: There was a higher frequency of the male gender 78 % in relation to the female 22 %, the accumulated mortalities in the presence of infection nosocomial for those under 60 were 5 (14.7 %), between 60 and 70 (28.57 %) and those over 70 years old 73 (59.8 %), showing that in those over 70 years old it doubles those between 60 and 70 and triples those under 60 years of age, all analyzes showing statistical significance, p<0.005. Discussion: The present study showed an adequate correlation between the presence of nosocomial infection and higher mortality in those who presented it, especially those older than 70 years. Conclusions: Coinfection at the time of diagnosis of COVID-19 is relatively frequent. The implicit mortality that nosocomial infections have in the COVID-19 patient makes it necessary to review care protocols and carry out epidemiological and hospital surveillance activities in these patients. Such findings could be essential to define the role of empirical antimicrobial therapy or prevention strategies. Administration at the time of suspicion of a co-infection, always in an individualized manner and based on the profiles of each health institution. © 2022 Academia Nacional de Medicina. All rights reserved.
ABSTRACT
Background: COVID-19 disease can cause a wide variety of long-term health problems, including impaired lung function, reduced exercise performance, and decreased quality of life. Objectives: Our study aimed to investigate the efficacy, feasibility and safety of pulmonary rehabilitation in patients with COVID-19 and to compare the results between patients with a mild / moderate and severe / critical course of the disease. Methodology: Patients in the post-acute phase of a mild to critical course of COVID-19 admitted to a comprehensive pulmonary rehabilitation program were included in this prospective and observational cohort study, 43 patients were included in the study (20 with mild / moderate COVID and 23 with severe / critical COVID-19). Main measures: Several measures of exercise performance, 6-minute walking distance, lung function (forced vital capacity (FVC)), and quality of life (36-question short-format health survey (SF-36 )). Results: Results: At admission, the patients had a reduced walking distance (mild: median 401 m, interquartile range (IQR) 335-467 m;severe: 108 m, 84-132 m), a deteriorated FVC (mild: 72 % ,;severe: 35%,) and a low SF-36 mental health score (mild: 52 points, severe: 32 points. The patients received sessions adjusted to their physical capacities, the patients of both subgroups improved in the test of 6 minute walk (mild / moderate: +54 m, severe / critical: +117 m, both p <0.002), FVC (mild / moderate: + 8.9%, p = 0.004;severe / critical: + 12, 4%, p <0.003) and mental component SF-36 (mild / moderate: +6.8 points, p = 0.062;severe / critical: +16.7 points, -p <0.005). Conclusions: An exercise program Well structured results in a benefit in the areas of aerobic capacity, lung volumes and quality of life, in this sense it is recommended to expand population samples to be able to apply our protocol to other centers in charge in the rehabilitation of COVID-19 patients. Key Words: Exercise, Coronavirus, Rehabilitation.