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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.
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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.
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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.
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BACKGROUND AND AIMS: Acute renal failure in hospitalized patients for COVID- 19 occurs in 3%-28% and is a poor prognostic factor. The mechanisms of renal involvement are not completely clarified. However, it has been evaluated that the presentation of renal failure increases adverse outcomes. METHOD: Prospective observational study of all the cases that were admitted for COVID-19 between January and December 2021. Clinical and analytical data of kidney complications in patients with COVID-19 were collected. RESULTS: A total of 306 patients with a mean age of 70.2 years, 75.1% men and with previous chronic kidney disease in 29.7% were analyzed. A total of 50.8% had severe pneumonia or acute respiratory distress syndrome and 22.9% required admission to the ICU. Proteinuria was registered in 77.6% and hematuria in 67.6%. A total of 20.9% of the patients required renal replacement therapy. Renal failure was of prerenal etiology in 59.2%, acute tubular necrosis in the context of sepsis in 23.5%, glomerular in 8.1% and due to tubular toxicity in 9.2%. The median stay was 15 days, and 31.7% died. Patients who developed kidney failure during admission had higher C-reactive protein, LDH, and D-dimer values, more severe lung involvement, more need for ICU admission, and greater need for renal replacement therapy. CONCLUSION: Hypovolemia and dehydration are common causes of acute kidney injury in COVID-19 patients. Those who develop renal complications have a worse pulmonary, renal and systemic prognosis profile. We point out that monitoring an individualized management of blood volume can be decisive in preventing worse outcomes.
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We present the case of a 36-year-old female patient with a history of recent infection by COVID 19 with mild symptoms who started with bullous dermal lesions that evolved into ulcers with necrotic background without improvement with antihistamines and topical corticosteroids, a skin biopsy was taken which reported leukocytoclastic vasculitis, it is considered secondary to recent infection by COVID 19, for which medical management is given with subsequent improvement. © 2022 The Authors
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Context: Currently, infection by the SARS-CoV-2 virus predominantly generates a respiratory infection, which can lead to acute and late complications, as well as mild or severe sequelae. A complication that has been evidenced is the state of hypercoagulability, such as pulmonary thromboembolism (PE) or deep vein thrombosis (DVT). Clinical case: We present the case of a patient with a recent history of COVID-19 infection who consulted for dyspnea and pain in the left hemithorax, complementary images were taken showing a large cavern at the right pulmonary base and an electrocardiogram suggestive of pulmonary thromboembolism, a CT scan was taken with protocol for PET that confirms it and smear microscopies that report positive for pulmonary tuberculosis coinfection. Discussion and conclusions: The formation of prothrombotic phenomena by COVID-19 has become a frequent complication, however, the coinfection of tuberculosis and COVID-19 is rare, this is due to a process of amplification of the deregulated immune response called «cytokine storm», which activates latent and hidden infections, in addition the use of immunosuppressive drugs in COVID-19 can lead to an expression of tuberculosis. Tuberculosis infection should be suspected in an endemic environment together with persistence of symptoms after the resolution of the viral infection, symptomatic cases before the acute viral process or in cases of atypical radiographic findings;in these cases, HIV infection or infection should be ruled out. another bacterial coinfection.