ABSTRACT
Neurological manifestations are common in COVID-19, the disease caused by SARS-CoV-2. Despite reports of SARS-CoV-2 detection in the brain and cerebrospinal fluid of COVID-19 patients, its still unclear whether the virus can infect the central nervous system, and which neuropathological alterations can be ascribed to viral tropism, rather than immune-mediated mechanisms. Here, we assess neuropathological alterations in 24 COVID-19 patients and 18 matched controls who died due to pneumonia / respiratory failure. Aside from a wide spectrum of neuropathological alterations, SARS-CoV-2-immunoreactive neurons were detected in specific brainstem nuclei of 5 COVID-19 subjects. Viral RNA was also detected by real-time RT-PCR. Quantification of reactive microglia revealed an anatomically segregated pattern of inflammation within affected brainstem regions, and was higher when compared to controls. While the results of this study support the neuroinvasive potential of SARS-CoV-2, the role of SARS-CoV-2 neurotropism in COVID-19 and its long-term sequelae require further investigation.
ABSTRACT
Apesar de atingirem padrões de alta clínica, pacientes com COVID-19 não retomam as atividades cotidianas devido à incapacidade, sendo o processo de reabilitação de interesse dos serviços de saúde e sociedade. Objetivos:Descrever o nível de funcionalidade do paciente pós-COVID-19 e resultados de um processo de reabilitação multidisciplinar.Métodos: Estudo observacional, descritivo, de abordagem quantitativa, relativo à avaliação das demandas e processo de reabilitação interdisciplinar. Resultados: 22 pacientes participaram do estudo, idade 48,46 anos (±12,63), 50% homens, sendo que 81,8% apresentavam comorbidades e 95,5% sobrepeso ou algum grau de obesidade. Todos apresentaram diminuição na QV (SF36) e não alcançaram a distância média esperada para o teste de 6 minutos, 20 pacientes apresentaram dispnéia para realizar as atividades cotidianas e 21 apresentaram limitação na Escala de Status Funcional pós-COVID-19 (PCSF). O resultado do processo de reabilitação com 20 pacientes, mostrou na comparação antes e depois, diferenças significativas na força muscular (,000) PeakFlow Meter (,000), Berg (,000), Barthel (,001), teste 6 minutos para freqüência cardíaca (,002) e distância percorrida (,000). Na SF-36 para os domínios de Estado Geral da Saúde (,058) e Aspectos Emocionais (,194) a diferença não foi significativa. Para as variáveis ordinais houve diferença significativa para PCSF (,000) e dispnéia (,000).Conclusão: O estudo aponta que a incapacidade do paciente teve maior correlação na entrada do serviço com o tempo de internação e que um processo de reabilitação interdisciplinar melhora na funcionalidade e QV do paciente com sequelas de COVID-19.
Despite reaching clinical discharge standards, patients with COVID-19 do not resume daily activities due to disability, and the rehabilitation process is of interest to health services and society. Objectives:To describe the post-COVID-19 patient's level of functionality and the result of a multidisciplinary rehabilitation process. Methods:observational, descriptive study, with a quantitative approach, related to the assessment of demands and interdisciplinary rehabilitation process. Results:22 patients participated in the study, age 48.46 years (±12.63), 50% were men, 81.8% had comorbidities and 95.5% were overweight or had some degree of obesity. All of them had a decrease in QoL (SF36) and did not reach the average distance expected for the 6-minute test, 20 patients had dyspnea to perform daily activities and 21 had limitations on the Post-Covid Functional Status Scale(PCSF). The result of the rehabilitation process with 20 patients, showed in the comparison before and after, significant differences in muscle strength (.000) Peak Flow Meter (.000), Berg (.000), Barthel (.001), 6-minute test for heart rate (.002) and distance traveled (.000). In the SF-36 for the General Health Status (.058) and Emotional Aspects (.194) domains, the difference was not significant. For the ordinal variables, there was a significant difference for post-COVID-19 Functional Status Scale (PCFS)(.000) and dyspnea (.000). Conclusion:The study points out that the patient's disability had a greater correlation at the entrance of the service with the length of hospitalization and that an interdisciplinary rehabilitation process improves the functionality and QOL of the patient with sequelae of COVID-19.