Predictive Value of Myocardial injury in Patients with COVID-19 Admitted to a Quaternary Hospital in the City of Rio de Janeiro

Abstract Background In Brazil the factors involved in the risk of death in patients with COVID-19 have not been well established. Objective To analyze whether elevations of high-sensitivity troponin I (hTnI) levels influence the mortality of patients with COVID-19. Methods Clinical and laboratory characteristics of hospitalized patients with COVID-19 were collected upon hospital admission. Univariate and binary logistic regression analyzes were performed to assess the factors that influence mortality. P-value<0.05 was considered significant. Results This study analyzed192 patients who received hospital admission between March 16 and June 2, 2020 and who were discharged or died by July 2, 2020. The mean age was 70±15 years, 80 (41.7%) of whom were women. In comparison to those who were discharged, the 54 (28.1%) who died were older (79±12 vs 66±15years; P=0.004), and with a higher Charlson´s index (5±2 vs 3±2; P=0.027). More patients, aged≥60years (P <0.0001), Charlson´s index>1 (P=0.004), lung injury>50% in chest computed tomography (P=0.011), with previous coronary artery disease (P=0.037), hypertension (P=0.033), stroke (P=0.008), heart failure (P=0.002), lymphocytopenia (P=0.024), high D-dimer (P=0.024), high INR (P=0.003), hTnI (P<0.0001), high creatinine (P<0.0001), invasive mechanical ventilation (P<0.0001), renal replacement therapy (P<0.0001), vasoactive amine (P<0.0001), and transfer to the ICU (P=0.001), died when compared to those who were discharged. In logistic regression analysis, elevated hTnI levels (OR=9.504; 95% CI=1.281-70.528; P=0.028) upon admission, and the need for mechanical ventilation during hospitalization (OR=46.691; 95% CI=2.360-923.706; P=0.012) increased the chance of in-hospital mortality. Conclusion This study suggests that in COVID-19 disease, myocardial injury upon hospital admission is a harbinger of poor prognosis.

"It's My Responsibility to Care for Him, My Household, and the Society": Gendered Roles and the COVID-19 Outbreak

Although the COVID-19 pandemic, its ensuing lockdowns, and the accelerated rate of pandemic outbreaks in the last six (6) years have resulted in burdening household realities for all. There seems to be an increasing and bruising reality for the feminine role. Therefore, this article examined the extent of the increasing realities, vulnerabilities and burden on women and girls during the COVID-19 pandemic globally. The radical feminist theorisation was found most suitable in analysing some of the experiences women and girls encountered during other epidemics and the COVID-19 pandemic. Using the systematic review of articles on the PubMed and ScienceDirect databases between 2014-2020;findings showed that the COVID-19 and other epidemics outbreaks have heightened the roles of women and girls within and outside households and have resulted in increased economic realities, increased vulnerabilities to infections, increased mortality rates due to conflicts, violence and displacements;the inability of the girl-child to focus on home-schooling via the e-learning platforms as a result of the increased burden of household activities amongst others. These gendered roles and stereotypes accrued to women and girls took another dimension during the COVID-19 outbreak, especially as the world experienced partial and total lockdown. Hence, this study recommended the dire need for community engagement and sensitisation to better educate women and men about possible risk factors and shared responsibility for preventive actions against future pandemics. Finally, data disaggregation on these gender demands and realities in the household is important to create platforms to generate further discussions.