Infección y reinfección SARS-CoV-2 y vacunación contra COVID-19 en estudiantes de medicina UCV, 2020-2023 / SARS-CoV-2 infection and reinfection and vaccination against COVID-19 in UCV medical students, 2020-2023

Introducción: La pandemia de COVID-19 afectó significativamente al personal de salud, los estudiantes de medicina tuvieron alta exposición a la infección y reinfección. El objeto del estudio fue determinar la infección y reinfección por SARS-Cov-2 y la cobertura vacunal en los estudiantes de medicina de 1ro a 6to año en el período de enero-febrero 2023. Metodología: Estudio de corte transversal por encuesta vía electrónica. Muestra aleatoria polietápica por azar simple y conglomerados estratificados por nivel académico. Proyecto avalado por La Comisión Nacional de Bioética. Resultados: Se recolectaron 224 respuestas, reportando 334 episodios de infección por SARS-CoV-2, 19 % presentó al menos un episodio de infección en 2020, 40 % en 2021 y 41 % en 2022. El 75,4 % reportó haber estado infectado y reinfectado; de estos, el 70 % presentó entre 2 y 5 reinfecciones. En el 37 % de los episodios se confirmó, por reacción en cadena polimerasa (PCR, por sus siglas en inglés) o prueba de antígenos. Los estudiantes de internado rotatorio y 5to año se infectaron más que los de 1ro a 3er año (p= 0,0037). La vacunación alcanzó 96 % de los estudiantes, la mayoría recibió 2 o más dosis de refuerzo, los alumnos de 4to a 6to año con un número mayor de dosis (p= 0,0067). Las hospitalizaciones fueron bajas 4 %. Conclusiones: las infecciones y reinfecciones son frecuentes en los estudiantes de medicina; la mayoría no presenta complicaciones graves, los estudiantes del área clínica están más expuestos y están mayormente vacunados, que los estudiantes de preclínica.

Introduction: The COVID-19 pandemic significantly impacted healthcare personnel, with medical students having high exposure to infection and reinfection. The study aimed to determine the infection and reinfection rates of SARS-CoV-2 and the vaccination coverage among medical students from 1st to 6th year during the period of January-February 2023. Methodology: This was a cross-sectional study using an electronic survey. A multi-stage random sample was taken with simple random sampling and clusters stratified by academic level. The project was approved by the National Bioethics Commission. Results: A total of 224 responses were collected, reporting 334 episodes of SARS-CoV-2 infection. Nineteen percent reported at least one episode of infection in 2020, 40 % in 2021, and 41 % in 2022. Seventy-five point four percent reported having been infected and reinfected; of these, 70 % had between 2 and 5 reinfections. In 37 % of the episodes, the infection was confirmed by polymerase chain reaction (PCR) or antigen test. Internship students and 5th-year students were more infected than those in 1st to 3rd year (p=0.0037). Vaccination coverage reached 96 % of the students, with most receiving 2 or more booster doses; students in the 4th to 6th years had a higher number of doses (p=0.0067). Hospitalizations were low at 4 %. Conclusions: Infections and reinfections are frequent among medical students; most do not present severe complications. Clinical area students are more exposed to infection and are more vaccinated compared to preclinical students.

Ataxia cerebelosa aguda y COVID-19: presentación de un caso clínico / Ataxia cerebelosa aguda y COVID-19: presentación de un caso clínico

COVID-19 es una enfermedad viral principalmente respiratoria y/o gastrointestinal. Las manifestaciones neurológicas tienen una frecuencia variable en pediatría. Presentamos un varón de 10 años de edad, previamente sano, que presentó una ataxia cerebelosa durante un cuadro agudo de COVID-19. El SARS-CoV-2 fue detectado por hisopado nasofaríngeo por antígeno y RPC. El LCR fue normal y el cultivo bacteriológico y estudio viral fueron negativos. La TC y RM encefálica fueron normales. No requirió tratamiento específico y tuvo una evolución favorable, con resolución completa de los síntomas neurológicos al mes. Debe considerarse la infección por SARS-CoV-2 como un diagnóstico diferencial entre las causas de ataxia cerebelosa aguda, según la situación epidemiológica.

COVID-19 is a disease that mainly produces respiratory and/or gastrointestinal symptoms. Neurological manifestations occur with a variable frequency in children. We present a previously healthy 10-year-old boy who presented acute cerebellar ataxia during an acute COVID-19. SARS-CoV-2 was detected in a nasopharyngeal sample by antigen and PCR. The CSF was normal, the bacteriological culture and the viral PCR were negative. CT of the brain and gadolinium MRI of the brain were normal. He did not require specific treatment and had a favorable evolution, with complete resolution of neurological symptoms at one month. SARS-CoV-2 infection should be considered as a differential diagnosis between the causes of acute cerebellar ataxia, according to the epidemiological situation.

El enigma del coronavirus - La variante BA.2.86 del SARS-CoV-2 - Lo nuevo sobre el COVID prolongado - Vacunas - Premios Nobel

El coronavirus ha continuado paseándose por el mundo con nuevas variantes, algunas consideradas de preocupación. Las hospitalizaciones aumentaron en algunas partes con la variante BA.2.86, especialmente en personas mayores obesas o con morbilidad, pero han disminuido, así como los fallecimientos. Las mujeres que gestaron mediante técnicas de reproducción asistida tuvieron similar morbilidad que quienes gestaron espontáneamente, pero con más resultados maternoperinatales adversos en aquellas de mayor edad, con embarazos múltiples, nuliparidad, índice de masa corporal >30. Los niños que nacieron al inicio de la pandemia mostraron un microbioma de diferente composición que quienes nacieron antes de la pandemia, lo que pudiera afectar su salud más adelante en la vida. Las personas que presentan COVID prolongado, un cuarto de ellas sufre secuelas en órganos y sistemas, con limitación y años perdidos de actividades, así como posibilidad de muerte prematura. El COVID prolongado ocurre más en mujeres entre 35 y 49 años y en quienes tienen menos ingresos económicos. Podrían desarrollar diabetes tipo 2. Habría interacciones directas entre el SARS-CoV-2 y proteínas mitocondriales esenciales en la producción de energía. El ARN viral ha sido detectado en lesiones ateroescleróticas coronarias y la espiga ha sido hallada en huesos del cráneo, meninges y cerebro. Las vacunas contra el coronavirus protegen a las gestantes y sus recién nacidos a través de transferencia placentaria y la lactancia. En la población, la inmunidad protectora de la infección y de las vacunas declina con el tiempo y se requerirá nueva vacunación con una regularidad aún no determinada.

The coronavirus has continued to move around the world with new variants, some of which are of concern. Hospitalizations increased in some places with the BA.2.86 variant, especially in obese or morbid elderly people, but have decreased, as have deaths. Women who gestated by assisted reproductive techniques had similar morbidity as those who gestated spontaneously, but with more adverse maternal-perinatal outcomes in those older, with multiple pregnancies, nulliparity, body mass index >30. Children born at the beginning of the pandemic showed a different microbiome composition than those born before the pandemic, which could affect their health later in life. Among people with long COVID, a quarter of them suffer organ and system sequelae, with limitation and lost years of activity, as well as the possibility of premature death. Long COVID occurs more in women between 35-49 years of age and in those with lower income. They could develop type 2 diabetes. There would be direct interactions between SARS-CoV-2 and mitochondrial proteins essential in energy production. Viral RNA has been detected in coronary atherosclerotic lesions and the spike has been found in skull bones, meninges and brain. Coronavirus vaccines protect pregnant women and their newborns through placental transfer and lactation. In the population, protective immunity from infection and vaccines declines over time and new vaccination will be required at an as yet undetermined regularity.

El enigma del coronavirus - Consecuencias de la infección por el SARS-CoV-2 en el ser humano El cerebro - Gestante y recién nacido

El virus SARS-CoV-2 sigue replicándose. Sus nuevas variantes no estarían causando las muertes y hospitalizaciones graves de los años 2020 a 2022, por lo que la Organización Mundial de la Salud (OMS) ha declarado el final del estado de emergencia sanitaria. Hasta el 24 de mayo de 2023, el tablero de coronavirus de la OMS señala más de 766 millones de casos confirmados, y cerca de 7 millones de muertes en el mundo, con mayor concentración en Europa, Pacífico Occidental y América (especialmente en los E.E. U.U. y Brasil). Europa y China se preparan para los nuevos avances del virus. Por ello se recomienda precaución sanitaria y cumplir con la vacunación y refuerzos, así como elaborar nuevas vacunas. Se comenta sobre la fragilidad de los ensayos aleatorios publicados en los primeros dos años de la pandemia, así como los recientes hallazgos de cuáles enfermos con COVID podrían desarrollar COVID prolongado. Es de importancia conocer los nuevos alcances sobre la afectación del coronavirus sobre la gestante, el feto y neonato y el seguimiento inicial de los últimos.

The SARS-CoV-2 virus continues to replicate. Its new variants would not be causing the deaths and serious hospitalizations of the years 2020-2022, so the World Health Organization (WHO) has declared the end of the state of health emergency. Until May 24, 2023, the WHO coronavirus dashboard shows more than 766 million confirmed cases, and about 7 million deaths in the world, with greater concentration in Europe, Western Pacific, and America (especially the U.S.A. and Brazil). Europe and China prepare for new virus breakthroughs. Therefore, health precaution is recommended, as well as compliance with vaccination and boosters, and the development of new vaccines. We comment on the fragility of randomized trials published in the first two years of the pandemic, as well as recent findings of which patients with COVID could develop long COVID. It is important to know the new scopes on the affectation of the coronavirus on the pregnant woman, the fetus and the neonate and the initial follow-up of the latter.

Effects of the COVID-19 pandemic on the behavior and physical health of dogs in Rio de Janeiro state: Reflections on the quality of life of dogs and their owners.

The COVID-19 pandemic changed the routines of people, consequently changing the daily lives of their pets. Behavioral and emotional changes caused by the stress resulting from restrictions of social isolation and their consequences in the human-animal relationship have been discussed. However, there are still no studies that identify the factors that affect behavior and which are the most susceptible groups. The purpose of this study is to identify behavioral and emotional changes on dogs during the COVID-19 pandemic and their effects on the quality of life of animals and their owners. The methodology used was online questionnaires, which were posted on social networks aimed to dog owners in Rio de Janeiro state, Brazil. The results showed that age, sex, dog size, type of home, and restrictions imposed differently affected the type of behavioral change. However, the most frequent type of change was the worsening of previous conditions. Neutered behaviors directly interfered in the lives of owners and their pets, as owners managed the situation and sought information without guidance from a veterinarian, with the possibly consequence of worsening the situation in the future. Veterinarians should actively investigate behavioral changes that have occurred through anamnesis to avoid abandonment and instability in the human-animal relationship.

COVID-19 spatialization by empirical Bayesian model in São Paulo, Brazil.

The new Acute Respiratory Syndrome, COVID-19, has affected the health and the economy worldwide. Therefore, scientists have been looking for ways to understand this disease. In this context, the main objective of this study was the spatialization of COVID-19, thinking in distinguishing areas with high transmissibility yet, verifying if these areas were associated with the elderly population occurrence. The work was delineated, supposing that spatialization could support the decision-making to combat the outbreak and that the same method could be used for spatialization and prevent other diseases. The study area was a municipality near Sao Paulo Metropolis, one of Brazil's main disease epicenters. Using official data and an empirical Bayesian model, we spatialized people infected by region, including older people, obtaining reasonable adjustment. The results showed a weak correlation between regions infected and older adults. Thus, we define a robust model that can support the definition of actions aiming to control the COVID-19 spread.

Agreement between diagnostic methods for SARS-CoV-2 infection in children seen at the Emergency Department of a children's hospital. / Concordancia entre métodos diagnósticos de infección por SARS-CoV-2 en niños asistidos en el departamento de urgencias de un hospital pediátrico.

INTRODUCTION: Rapid antigen tests (RAgTs) for SARS-CoV-2 are considered adequate for diagnosis at the point of care. Our objective was to establish the agreement between reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and RAgTs in the pediatric population. POPULATION AND METHODS: All patients aged 1 month to 17 years and 11 months seen at the Emergency Fever Unit of a children's hospital between 6-11-2021 and 10-3-2021 were recruited. The Panbio COVID-19 Ag® test (Abbott Diagnostic) was compared to the reference method RT-qPCR (as per the protocol suggested by the United States Centers for Disease Control and Prevention). RESULTS: A total of 6491 patients were included. The prevalence of COVID-19 was 2.8%. Symptoms were observed in 92.1%. Sensitivity, specificity, and the kappa index of agreement for the RAgT were 71.0%, 99.9%, and 0.813, respectively. The kappa index and the RAgT sensitivity were significantly higher in the group aged 13-17 years (0.89 and 82.4%, respectively) compared to the groups aged 0-5 and 6-12 years. This may be due to the lower viral load observed in patients younger than 12 years. CONCLUSIONS: Although RAgTs shorten the time to result and improve the isolation strategy for COVID-19 patients, their sensitivity in children younger than 12 years or asymptomatic children is not within the recommended ranges, especially during periods of low disease prevalence.

Introducción. Los inmunoensayos de detección rápida de antígenos (TRA) del SARS-CoV-2, son considerados adecuados para el diagnóstico en el punto de atención. El objetivo fue conocer la concordancia entre la reacción en cadena de la polimerasa en tiempo real con transcriptasa inversa (RT-qPCR, por su sigla en inglés) y los TRA en población pediátrica. Población y métodos. Se reclutaron todos los pacientes entre 1 mes y 17 años 11 meses de edad atendidos en la Unidad Febril de Urgencia de un hospital pediátrico entre el 11 de junio y el 3 de octubre de 2021. Se utilizó el TRA Panbio COVID-19 Ag® (Abbott Diagnostic) y, como método de referencia, la RT-qPCR (según el protocolo de los Centros para el Control y la Prevención de Enfermedades). Resultados. Se incluyeron 6491 pacientes. La prevalencia de COVID-19 fue del 2,8 %. El 92,1 % de los sujetos presentaron síntomas. La sensibilidad, la especificidad y el índice kappa de concordancia para el TRA fueron del 71,0 %, 99,9 % y 0,813, respectivamente. El índice kappa y la sensibilidad del TRA fueron significativamente mayores en el grupo de 13 a 17 años (0,89 y 82,4 %, respectivamente) cuando se los comparó con los grupos de 0 a 5 y de 6 a 12 años. Esto podría deberse a la menor carga viral observada en los pacientes menores de 12 años. Conclusión. Si bien los TRA permiten acortar el tiempo de obtención de los resultados y mejorar la estrategia de aislamiento de pacientes con COVID-19, la sensibilidad en niños menores de 12 años o asintomáticos no se encontraría dentro de los rangos recomendados, sobre todo en períodos de baja prevalencia de la enfermedad.

An algorithm to predict the need for invasive mechanical ventilation in hospitalized COVID-19 patients: the experience in Sao Paulo.

BACKGROUND: We aimed to characterize patients hospitalized for coronavirus disease 2019 (COVID-19) and identify predictors of invasive mechanical ventilation (IMV). METHODS: We performed a retrospective cohort study in patients with COVID-19 admitted to a private network in Sao Paulo, Brazil from March to October 2020. Patients were compared in three subgroups: non-intensive care unit (ICU) admission (group A), ICU admission without receiving IMV (group B) and IMV requirement (group C). We developed logistic regression algorithm to identify predictors of IMV. RESULTS: We analyzed 1,650 patients, the median age was 53 years (42-65) and 986 patients (59.8%) were male. The median duration from symptom onset to hospital admission was 7 days (5-9) and the main comorbidities were hypertension (42.4%), diabetes (24.2%) and obesity (15.8%). We found differences among subgroups in laboratory values obtained at hospital admission. The predictors of IMV (odds ratio and 95% confidence interval [CI]) were male (1.81 [1.11-2.94], P=0.018), age (1.03 [1.02-1.05], P<0.001), obesity (2.56 [1.57-4.15], P<0.001), duration from symptom onset to admission (0.91 [0.85-0.98], P=0.011), arterial oxygen saturation (0.95 [0.92- 0.99], P=0.012), C-reactive protein (1.005 [1.002-1.008], P<0.001), neutrophil-to-lymphocyte ratio (1.046 [1.005-1.089], P=0.029) and lactate dehydrogenase (1.005 [1.003-1.007], P<0.001). The area under the curve values were 0.860 (95% CI, 0.829-0.892) in the development cohort and 0.801 (95% CI, 0.733-0.870) in the validation cohort. CONCLUSIONS: Patients had distinct clinical and laboratory parameters early in hospital admission. Our prediction model may enable focused care in patients at high risk of IMV.

Concordancia entre métodos diagnósticos de infección por SARS-CoV-2 en niños asistidos en el departamento de urgencias de un hospital pediátrico / Agreement between diagnostic methods for SARS-CoV-2 infection in children seen at the Emergency Department of a children's hospital

Introducción. Los inmunoensayos de detección rápida de antígenos (TRA) del SARS-CoV-2, son considerados adecuados para el diagnóstico en el punto de atención. El objetivo fue conocer la concordancia entre la reacción en cadena de la polimerasa en tiempo real con transcriptasa inversa (RT-qPCR, por su sigla en inglés) y los TRA en población pediátrica. Población y métodos. Se reclutaron todos los pacientes entre 1 mes y 17 años 11 meses de edad atendidos en la Unidad Febril de Urgencia de un hospital pediátrico entre el 11 de junio y el 3 de octubre de 2021. Se utilizó el TRA Panbio COVID-19 Ag® (Abbott Diagnostic) y, comométodo de referencia, la RT-qPCR (según el protocolo de los Centros para el Control y la Prevención de Enfermedades). Resultados. Se incluyeron 6491 pacientes. La prevalencia de COVID-19 fue del 2,8 %. El92,1 % de los sujetos presentaron síntomas. La sensibilidad, la especificidad y el índice kappa de concordancia para el TRA fueron del 71,0 %, 99,9 % y 0,813, respectivamente. El índice kappa yla sensibilidad del TRA fueron significativamentemayores en el grupo de 13 a 17 años (0,89 y 82,4 %,respectivamente) cuando se los comparó con los grupos de 0 a 5 y de 6 a 12 años. Esto podría deberse a la menor carga viral observada en los pacientes menores de 12 años. Conclusión. Si bien los TRA permiten acortar el tiempo de obtención de los resultados y mejorar la estrategia de aislamiento de pacientes con COVID-19, la sensibilidad en niños menores de 12 años o asintomáticos no se encontraría dentro de los rangos recomendados, sobre todo enperíodos de baja prevalencia de la enfermedad.

Introduction. Rapid antigen tests (RAgTs) for SARS-CoV-2 are considered adequate for diagnosis at the point of care. Our objective was to establish the agreement between reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and RAgTs in the pediatric population. Population and methods. All patients aged 1 month to 17 years and 11 months seen at the Emergency Fever Unit of a children's hospital between 6-11-2021 and 10-3-2021 were recruited. The Panbio COVID-19 Ag® test (Abbott Diagnostic) was compared to the reference method RT-qPCR (as per the protocol suggested by the United States Centers for Disease Control and Prevention). Results. A total of 6491 patients were included. The prevalence of COVID-19 was 2.8%. Symptoms were observed in 92.1%. Sensitivity, specificity, and the kappa index of agreement for the RAgT were 71.0%, 99.9%, and 0.813, respectively. The kappa index and the RAgT sensitivity were significantly higher in the group aged 13­17 years (0.89 and 82.4%, respectively) compared to the groups aged 0­5 and 6­12 years. This may be due to the lower viral load observed in patients younger than 12 years. Conclusion. Although RAgTs shorten the time to result and improve the isolation strategy for COVID-19 patients, their sensitivity in children younger than 12 years or asymptomatic children is not within the recommended ranges, especially during periods of low disease prevalence.

Update on the diagnosis, management and treatment of fever of unknown origin: review article and case report / Actualización en el diagnóstico, manejo y tratamiento de la fiebre de origen desconocido: artículo de revisión y reporte de caso

INTRODUCTION Actually, there are more than 200 different causes of unknown fever, it is necessary for the doctor to identify the most prevalent causes of unknown fever in our Clinical boar. PRESENTATION A 52-year-old male patient with no history of chronic diseases, which was received in the Emergency Service of the Hospital San Pablo, Coquimbo, on 02/03/20 began a clinical picture characterized by fever up to 39 ºC associated with diaphoresis, evaluated several times in primary health care without response to symptomatic treatment. He denies dyspnea, cough, sputum production, headache, muscle weakness, myalgia, fainting, decreased visual acuity, nausea, vomiting, chest pain, abdominal pain, diarrhea, constipation, altered bowel movements, weight loss, dysuria, bladder tenesmus, pain lumbar, skin lesions. As relevant information, the patient reports having taken amoxicillin/clavulanate for 2 days on his own account. DISCUSSION Physicians should be aware of the rare extent of an unusual presentation of knowledge origin fever, probably associated with Still disease, as well as medical options for treatment. The literature does not conclude on a gold standard for the method of approach. CONCLUSION In our case, the etiological agent that could cause Fever of unknown origin (FUO) was Sars cov-2 given the presence of elevated inflammatory factors and acute phase proteins and the presence of neutrophilic infiltration

Efeito da pandemia por Covid-19 nos cuidados de indivíduos com distrofia muscular de Duchenne / Covid-19 pandemic's effect on the care of individuals with Duchenne muscular dystrophy

INTRODUCTION: Since December 2019, the scientific community has been mobilized to contain the COVID-19 pandemic. Although individuals with Duchenne Muscular Dystrophy (DMD) have restrictive lung disease, risk of immunosuppression and associated cardiomyopathy, they are not considered to be a risk group for COVID-19. DMD is a neuromuscular, genetic and progressive disease, with early childhood development. In order to manage the disease, multidisciplinary follow-up is necessary to improve this patient's quality of life. OBJECTIVE: Identify the impact of the pandemic on the care of patients with DMD and its repercussions. METHOD: This is a cross-sectional, quantitative and descriptive study. The sample consisted of patients diagnosed with DMD aged between 4 and 18 years, followed up at the neuropediatrics service. Data collection was carried out by an interview with those responsible for the patient and evaluation of the medical records, using a questionnaire. Statistical analysis was descriptive using central tendency and dispersion measures. RESULTS: Among the 44 patients included, the median age was 12 years and the predominant type of gene mutation was deletion (56.8%). The median age of first symptoms was 4 years. Thirteen patients had contact with family members positive for COVID-19 and tested positive for the disease. Eleven received the vaccine against COVID-19. Medical followups suffered a great reduction in the pandemic period, as well as respiratory and motor physiotherapy. CONCLUSION: The pandemic interfered with multidisciplinary care for patients with DMD. As a chronic and degenerative disease, individuals with DMD require ongoing care, which was interrupted by the pandemic scenario.

INTRODUÇÃO: Desde dezembro de 2019, a comunidade científica está mobilizada para a contenção da pandemia pela COVID-19. Embora indivíduos portadores de Distrofia Muscular de Duchenne (DMD) apresentem doença pulmonar restritiva, risco de imunossupressão e cardiomiopatia associada, não são grupo de risco para a COVID-19. DMD é doença neuromuscular, genética e progressiva, de início na infância. Para manejo da doença, faz-se necessário acompanhamento multidisciplinar para melhora da qualidade de vida. OBJETIVO: Identificar o impacto da pandemia nos cuidados aos pacientes com DMD e suas repercussões. MÉTODOS: Trata-se de um estudo transversal, quantitativo e descritivo. A amostra foi composta por pacientes com diagnóstico de DMD com idade entre 4 e 18 anos acompanhados no serviço de neuropediatria. A coleta de dados foi realizada por entrevista com responsáveis e avaliação do prontuário, a partir de um questionário. A análise estatística foi descritiva com uso de medida de tendência central e dispersão. RESULTADOS: Dentre os 44 pacientes incluídos, a mediana de idade foi de 12 anos e o tipo de mutação gênica predominante a deleção (56,8%). A mediana de idade dos primeiros sintomas foi de 4 anos. Treze pacientes tiveram contato com familiares positivos para COVID-19 e testaram positivo para a doença. Onze receberam a vacina contra COVID-19. Os acompanhamentos médicos sofreram grande redução no período pandêmico, bem como a fisioterapia respiratória e motora. CONCLUSÃO: A pandemia interferiu nos atendimentos multidisciplinares aos pacientes com DMD. Como uma doença crônica e degenerativa, os indivíduos com DMD necessitam de cuidados contínuos, o que foi interrompido pelo cenário pandêmico.

Impacto de la rehabilitación cardiopulmonar en paciente con secuelas poscovid-19 Reporte de caso clínico

El SARS-CoV-2 es un virus de la familia Coronaviridae que posee un ácido ribonucleico envuelto y monocatenario positivo. Este virus ha sido el responsable de una suma considerable de muertes a nivel mundial, y produce la enfermedad llamada covid-19, esta ocasiona compromisos multisistémicos en los pacientes, de los cuales la gran mayoría resulta con secuelas en el músculo esquelético, cardiocirculatorias, y pulmonares. La rehabilitación cardiopulmonar es un programa con múltiples componentes que pueden revertir las condiciones fisiopatológicas que sean consecuencias por el virus SARS-CoV-2. Los autores describen su experiencia con un caso clínico, con un paciente de 53 años, que ameritó internamiento por más de un mes, con diagnóstico de covid-19 -neumonía de focos múltiples con sobreinfección bacteriana-, y que durante su estadía requirió ventilación mecánica asistida, eventualmente, con traqueostomía, y que a su egreso se mantenía con dependencia de oxígeno suplementario, así como marcada disnea y sarcopenia. El paciente fue referido para rehabilitación pulmonar poscovid-19, y tras 12 semanas de rehabilitación el paciente es egresado del programa en aire ambiente, con capacidad para realizar ejercicio de moderada a alta intensidad, con saturación superior a 95 %, además de una marcada mejoría en los resultados de capacidad funcional. La rehabilitación cardiopulmonar es un programa multifacético, con diferentes componentes que logran una atención integral, capaz de recuperar al paciente para que logre su adherencia, no solo en su estado físico, sino también en su entorno psicosocial, de tal manera que se reintegra a la sociedad y se disminuyen los costos por atención y tratamientos médicos.

Summary SARS-CoV-2 is a virus of the Coronaviridae family, which has a positive single-stranded, enveloped ribonucleic acid. This virus has been responsible for a considerable number of deaths worldwide, and produces the disease called covid-19, which causes multisystemic compromise in patients, resulting in a vast majority with skeletal muscle, cardiocirculatory, and pulmonary sequelae. Cardiopulmonary rehabilitation is a program with multiple components that can reverse the pshysiopathological conditions that are consequences of the SARS-CoV-2 virus. The authors describe their experience with a clinical case, a 53-year-old patient, who required hospitalization for more than a month, diagnosed with covid-19 -Multiple focus of pneumonia with bacterial infection-, and who required ventilation during hospitalization. mechanically assisted, eventually with tracheostomy, and that at discharge remained dependent on supplemental oxygen, as well as marked dyspnea and sarcopenia. The patient was referred for postcovid-19 pulmonary rehabilitation, and after 12 weeks of rehabilitation the patient is discharged from the program in room air, with the ability to perform moderate to high intensity exercise, saturation greater than 95%, and with marked improvement. in VO2 max and 6MWT results. Cardiopulmonary rehabilitation is a multifaceted program, with different components that achieve comprehensive care, capable of recovering the patient so that he achieves his adherence, not only in his physical state but also in his psychosocial environment, reintegrating him into society and reducing the costs for medical care and treatment.

Risks and Benefits of Breastfeeding in COVID-19: Integrative Literature Review / Riscos e benefícios da amamentação na COVID-19: Revisão integrativa da literatura

Abstract Objective The present article seeks to consolidate existing knowledge on breastfeeding during the SARS-CoV-2 pandemic. Data source Articles from 2020 and 2021 collected from the PubMed, CAPES, Virtual Health Library, Google Scholar, SciELO, and UpToDate databases were analyzed. Books and government documents published in the last decade (2010-2020) were also consulted. Study Selection Sixteen works were used in the present study. The date of publication and discussion of SARS-CoV-2 transmission through breastmilk were the inclusion criteria. Thus, articles containing repeated information or with no relevance to add to the production were excluded. Data collection comprised critical reading and synthesis of the main information obtained on the subject, which were performed for the preparation of the present study. The research took place in the period from March 27 to April 2, 2021. Synthesis of the data Breast milk has diverse benefits for both the nursing mother and the infant. The presence of viral RNA by real-time polymerase chain reaction (RTPCR) in milk from disease-positive mothers has been detected in a few cases, and infant infections in these conditions suggest oral transmission of maternal or third-party origin. The virulence of the novel coronavirus in human milk is not confirmed, while significant amounts of exclusive antibodies are. Conclusion Lactation in the context of COVID-19 has shown greater benefits than risks of vertical transmission. Therefore, it should be encouraged when possible.

Resumo Objetivo O presente artigo procura consolidar os conhecimentos existentes sobre o aleitamento materno durante a pandemia do SARS-CoV-2. Fonte de dados Foram analisados os artigos de 2020 e 2021 recolhidos dos bancos de dados PubMed, CAPES, Biblioteca Virtual de Saúde, Google Scholar, SciELO e bases de dados UpToDate. Livros e documentos governamentais publicados na última década (2010-2020) também foram consultados. Seleção de estudos Dezesseis obras foram utilizadas no presente estudo. A data de publicação e discussão sobre a transmissão do SARS-CoV-2 através do leite materno foram os critérios de inclusão. Assim, foram excluídos os artigos que continham informações repetidas ou sem relevância para a produção. Coleta de dados Para a preparação do presente estudo, foram realizadas leituras críticas e síntese das principais informações obtidas sobre o tema. A pesquisa ocorreu no período de 27 de março a 2 de abril de 2021. Síntese dos dados O leite materno tem diversos benefícios tanto para a mãe quanto para o lactente. A presença de RNA viral por reação em cadeia de polimerase em tempo real (RT-PCR, na sigla em inglês) no leite de mães positivas foi detectada em alguns casos, e as infecções infantis nestas condições sugerem transmissão oral de origem materna ou de terceiros. A virulência do novo coronavírus no leite humano não está confirmada, enquanto quantidades significativas de anticorpos exclusivos sim. Conclusão A lactação no contexto da COVID-19 mostroumaiores benefícios do que os riscos de transmissão vertical. Por conseguinte, deve ser encorajada sempre que possível.

PipeCoV: a pipeline for SARS-CoV-2 genome assembly, annotation and variant identification.

Motivation: Since the identification of the novel coronavirus (SARS-CoV-2), the scientific community has made a huge effort to understand the virus biology and to develop vaccines. Next-generation sequencing strategies have been successful in understanding the evolution of infectious diseases as well as facilitating the development of molecular diagnostics and treatments. Thousands of genomes are being generated weekly to understand the genetic characteristics of this virus. Efficient pipelines are needed to analyze the vast amount of data generated. Here we present a new pipeline designed for genomic analysis and variant identification of the SARS-CoV-2 virus. Results: PipeCoV shows better performance when compared to well-established SARS-CoV-2 pipelines, with a lower content of Ns and higher genome coverage when compared to the Wuhan reference. It also provides a variant report not offered by other tested pipelines. Availability: https://github.com/alvesrco/pipecov.

Justificativa e limitações da SpO2/FiO2 como possível substituta da PaO2/FiO2 em diferentes cenários pré-clínicos e clínicos / Rationale and limitations of the SpO2/FiO2 as a possible substitute for PaO2/FiO2 in different preclinical and clinical scenarios

RESUMO Embora a PaO2/FiO2 derivada da gasometria arterial continue sendo o padrão-ouro do diagnóstico de insuficiência respiratória aguda, a SpO2/FiO2 tem sido investigada como potencial substituta. Esta revisão narrativa apresenta o estado da literatura pré-clínica e clínica sobre a SpO2/FiO2 como possível substituta da PaO2/FiO2 e para uso como marcador diagnóstico e prognóstico; ainda, é fornecida uma visão geral da oximetria de pulso e suas limitações, além da avaliação da utilidade da SpO2/ FiO2 como substituta da PaO2/FiO2 em pacientes com COVID-19. Ao todo, foram encontrados 49 estudos comparando SpO2/FiO2 e PaO2/ FiO2 com base em uma estratégia de pesquisa mínima. A maioria dos estudos foi realizada em recémnascidos, alguns foram realizados em adultos com síndrome do desconforto respiratório agudo, e outros foram realizados em outros cenários clínicos (incluindo poucos em pacientes com COVID-19). Há certa evidência de que os critérios de SpO2/FiO2 podem substituir a PaO2/FiO2 em diferentes cenários clínicos. Isso é reforçado pelo fato de que devem ser evitados procedimentos invasivos desnecessários em pacientes com insuficiência respiratória aguda. É inegável que os oxímetros de pulso estão cada vez mais difundidos e podem proporcionar um monitoramento sem custos. Portanto, substituir a PaO2/FiO2 pela SpO2/FiO2 pode permitir que instalações com recursos limitados diagnostiquem a insuficiência respiratória aguda de maneira objetiva.

ABSTRACT Although the PaO 2/FiO 2 derived from arterial blood gas analysis remains the gold standard for the diagnosis of acute respiratory failure, the SpO2/FiO2 has been investigated as a potential substitute. The current narrative review presents the state of the preclinical and clinical literature on the SpO2/FiO2 as a possible substitute for PaO2/FiO2 and for use as a diagnostic and prognostic marker; provides an overview of pulse oximetry and its limitations, and assesses the utility of SpO2/ FiO2 as a surrogate for PaO2/FiO2 in COVID-19 patients. Overall, 49 studies comparing SpO2/FiO2 and PaO2/FiO2 were found according to a minimal search strategy. Most were conducted on neonates, some were conducted on adults with acute respiratory distress syndrome, and a few were conducted in other clinical scenarios (including a very few on COVID-19 patients). There is some evidence that the SpO2/ FiO2 criteria can be a surrogate for PaO2/FiO2 in different clinical scenarios. This is reinforced by the fact that unnecessary invasive procedures should be avoided in patients with acute respiratory failure. It is undeniable that pulse oximeters are becoming increasingly widespread and can provide costless monitoring. Hence, replacing PaO2/FiO2 with SpO2/FiO2may allow resourcelimited facilities to objectively diagnose acute respiratory failure.

Análise clínica, imunológica e microbiológica da associação entre periodontite e COVID- 19: um estudo caso-controle / Clinical, immunological, and microbiological analysis of the association between periodontitis and COVID-19: a case-control study

Esse estudo avaliou os parâmetros clínicos, imunológicos e microbiológicos em indivíduos com COVID-19 e controles, explorando se a inflamação causada pela periodontite contribui para ocorrência e gravidade de desfechos adversos da COVID19. Indivíduos do grupo caso [exame de transcriptase reversa da reação em cadeia da polimerase (RT-PCR) positivo para coronavírus da síndrome respiratória aguda grave-2 (SARS-CoV-2)] e controles (RT-PCR negativo para SARS-CoV-2) foram submetidos à avaliação clínica e periodontal. Níveis salivares de fator de necrose tumoral alfa, interleucina (IL)-6, IL-1ß, IL-10, osteoprotegerina, ativador de receptor do fator nuclear Kappa-B ligante (RANKL), armadilhas extracelulares de neutrófilos (NET) e biofilme dental foram analisadas em dois tempos. Dados de desfechos relacionados à COVID-19 e comorbidades foram extraídos dos prontuários clínicos. Noventa e nove casos de COVID-19 e 182 controles foram incluídos para análise. Periodontite foi associada com maior número de hospitalizações (p=0.009), maior número de dias na unidade de terapia intensiva (UTI) (p=0.042), maior admissão na unidade de terapia semi-intensiva (UTSI) (p=0.047), e elevada necessidade de uso de oxigenação suplementar (p=0.042). Após ajuste das variáveis de confusão, periodontite resultou em 1.13 vezes mais chance de hospitalização. Níveis salivares de IL-6 (p=0.010) estavam aumentados em indivíduos com COVID-19 e periodontite. Periodontite foi associada com elevados níveis RANKL e IL-1ß após o fim da infecção por COVID-19. Não foram observadas alterações significativas nas cargas bacterianas dos periodontopatógenos Porphyromona gingivalis, Aggregatibacter actinomycetemcomitans, Tanerella forsythia, e Treponema denticola durante e após a infecção. Periodontite foi associada à piores desfechos da COVID-19 (hospitalização, uso de oxigênio suplementar, dias na UTI e admissão na UTSI), sugerindo a relevância do cuidado periodontal para reduzir a carga sistêmica de inflamação. Entender a relação entre a infecção por SARS-CoV-2 e condições crônicas que podem influenciar os desfechos da doença, como a periodontite, é importante para potencialmente prevenir complicações da COVID-19.

This study investigated the clinical, immunological, and microbiological parameters in individuals with coronavirus disease (COVID-19) and controls, exploring if periodontitis-driven inflammation contributes to the occurrence and severity of COVID19 endpoints. Case [positive reverse transcriptase- polymerase chain reaction (RTPCR) for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)] and control (negative RT-PCR for SARS-CoV-2) individuals underwent clinical and periodontal assessment. Salivary levels of tumoral necrosis factor alpha, interleukin (IL)-6, IL-1ß, IL-10, osteoprotegerin, receptor activator of nuclear factor Kappa-B (RANKL), neutrophil extracellular traps, and subgingival biofilm were analysed at two time-points. Data on COVID-19-related outcomes and comorbidity information were assessed from medical records. Ninety-nine cases of COVID-19 and 182 controls were included for analysis. Periodontitis was associated with more hospitalization (p=0.009), more days in the intensive care unit (ICU) (p=0.042), admission to the semi-ICU (p=0.047), and greater need for oxygen therapy (p=0.042). After adjustment for confounders, periodontitis resulted in a 1.13-fold increase in the chance of hospitalization. Salivary IL-6 levels (p=0.010) were increased in individuals with COVID-19 and periodontitis. Periodontitis was associated with increased RANKL and IL-1ß after the end of COVID19 infection. No significant changes were observed in bacterial loads of the periodontopathogens Porphyromona gingivalis, Aggregatibacter actinomycetemcomitans, Tanerella forsythia, and Treponema denticola during and after the infection. Periodontitis was associated with worse outcomes from COVID-19 (hospitalization, use of oxygen, days at ICU and admission to semi-ICU), suggesting the relevance of periodontal care to reduce the burden of overall inflammation. Understanding the crosstalk between SARS-CoV-2 infection and chronic conditions such as periodontitis that can influence the disease outcome is important to potentially prevent complications of COVID-19.

Impacto del manejo del control y convivencia social con base seroprevalente SARS CoV2 en pandemia, Colombia / Impact of control management and social coexistence based on SARS CoV2 seroprevalence in pandemic, Colombia

La proporción de personas asintomáticas representó en gran parte la causa de contagios al principio de la pandemia por SarsCov2. La población general seguía una misma ruta diagnóstica y medidas de mitigación de contagios, no obstante, no fue ni suficiente ni amplio, por lo que en retrospectiva se cuestiona su sentido científico.

The proportion of asymptomatic people largely accounted for the cause of infections at the beginning of the SarsCov2 pandemic. The general population followed the same diagnostic route and infection mitigation measures, however, it was neither sufficient nor comprehensive, so in retrospect its scientific meaning is questioned.

Experiência perceptiva e o sentido da vida em psicólogos voluntários que atendem por telepsicologia no contexto da pandemia de Covid-19: um estudo em Viktor Frankl / Perceptual experience and the meaning of life in volunteer psychologists working via telepsychology in the context of the Covid-19 pandemic: a study on Viktor Frankl

Em meio ao surgimento da pandemia de Covid-19 a psicologia precisou se adequar, prestando atendimento através de Telepsicologia. Vários profissionais uniram-se para prestar atendimento voluntariamente e desafios precisaram ser superados. A construção deste projeto deu-se a partir de pesquisa, análise e coleta de informações e percepções de psicólogos voluntários que atenderam de maneira virtual a população durante a pandemia. Objetivo geral: desvelar compreensivamente a percepção e o sentido da vida para psicólogos voluntários que atuaram por meio da Telepsicologia no contexto da pandemia de Covid-19. Objetivos específicos: descrever a experiência perceptiva de psicólogos voluntários que atenderam pela Telepsicologia no contexto da pandemia de Covid-19. Identificar qual o sentido da vida para esses profissionais e quais as estratégias de enfrentamento utilizadas no cuidado de si. Método: Trata-se de um estudo descritivo com abordagem qualitativa e respaldo da fenomenologia existencial de Merleau-Ponty. O marco filosófico, conceitual e teórico usado é o da Logoterapia de Viktor Frankl. Após a aprovação do projeto pelo Comitê de Ética em Pesquisa (CEP) e com publicação do parecer consubstanciado, CAAE: 39944620.8.0000.5243, iniciou-se o estudo. Foi empregado um questionário semi estruturado e auto aplicável, repassado através de email e pela mídia social WhatsApp, utilizando-se da técnica de snowball. A coleta dos dados ocorreu entre os meses de abril e junho de 2021, encerrando-se quando da percepção de saturação dos dados. As questões levantadas abrangeram os seguintes aspectos: conhecimento e preparo para atender de forma remota, motivação e o sentido dado a experiência de atendimento voluntário e o cuidado de si e a espiritualidade. O cenário da pesquisa foi totalmente virtual. Resultados: Foram identificadas três categorias: Conhecimento e preparo para atender pela telepsicologia; Percepção e sentido da vida através do altruísmo e vivência de dificuldades e Estratégias de enfrentamento e a espiritualidade no trabalho voluntário. Doar-se como voluntário é dar uma resposta a um chamado interior, independente de religião. Prestar atendimento psicológico é ter, acima de tudo, uma postura diante da vida, em que apesar das dificuldades, consegue-se elaborar as dores e construir estratégias de superação utilizando-se da espiritualidade como fonte de auxílio. Conclusão: Os resultados validam as questões da pesquisa, mostrando que o voluntário apreende o significado da conjuntura vivida e consegue extrair o sentido do que representa o ato de acolher o outro. A espiritualidade foi apontada como fundamental para o bem estar existencial e, com seu auxílio, o profissional encontra um sentido para sua vida, fato que o impulsiona a continuar em seu trabalho. A identificação de certas dificuldades técnicas permitiu desenvolver um produto que contemple checar a segurança dos atendimentos virtuais. Limitações: A coleta de dados foi realizada em um curto período. Observou-se uma evidente lacuna de conhecimento na literatura sobre o tema.

Amid the outbreak of the Covid-19 pandemic, psychology had to adapt, providing care through Telepsychology. Several professionals got together to provide volunteer assistance and challenges had to be overcome. The construction of this project was based on research, analysis and collection of information and perceptions of volunteer psychologists who provided virtual services to the population during the pandemic. General objective: to comprehensively unveil the perception and meaning of life for volunteer psychologists who worked through Telepsychology in the context of the Covid19 pandemic. Specific Aims: To describe the perceptual experience of volunteer psychologists who worked with telepsychology in the context of the Covid-19 pandemic. To identify the meaning of life for these professionals and the coping strategies used in self-care. Method: This is a descriptive study with a qualitative approach and supported by Merleau-Ponty's existential phenomenology. The philosophical, conceptual and theoretical framework used is Viktor Frankl's Logotherapy. After the project was approved by the Research Ethics Committee (CEP) and with the publication of the consubstantiated opinion, CAAE: 39944620.8.0000.5243, the study began. A semistructured and self-applicable questionnaire was used, sent by e-mail and by the social media WhatsApp, using the snowball technique. Data collection took place between April and June 2021, and ended when data saturation was reached. The questions covered the following aspects: knowledge and preparation to attend remotely, motivation and meaning given to the experience of volunteer service, and self-care and spirituality. The research scenario was entirely virtual. Results: Three categories were identified: Knowledge and preparation to attend by telepsychology; Perception and meaning of life through altruism and experience of difficulties and Coping strategies and spirituality in volunteer work. To donate yourself as a volunteer is to respond to an inner calling, regardless of religion Providing psychological care is, above all, having an attitude towards life, in which, despite the difficulties, it is possible to elaborate the pain and build strategies for overcoming them, using spirituality as a source of help. Conclusion: The results validate the research questions, showing that the volunteer grasps the meaning of the situation he goes through and is able to extract the meaning of what the act of welcoming the other represents. Spirituality was pointed out as fundamental to the existential well-being, and with its help, the professional finds meaning to his life, a fact that impels him to continue his work. The identification of certain technical difficulties allowed the development of a product that includes checking the safety of virtual assistance. Limitations: The data collection was entirely virtual and carried out in a period of severe measures of social isolation. An evident knowledge gap was observed in the literature on the subject.

En medio del surgimiento de la pandemia del Covid-19, la psicología necesitaba adaptarse, brindando servicio a través de la Telepsicología. Varios profesionales se unieron para brindar atención de forma voluntaria y hubo desafíos que superar. La construcción de este proyecto se basó en la investigación, análisis y recopilación de información y percepciones de psicólogas voluntarias que brindaron asistencia virtual a la población durante la pandemia. Objetivo general: develar de manera integral la percepción y sentido de vida de psicólogas voluntarias que trabajaron a través de la Telepsicología en el contexto de la pandemia de la Covid-19. Objetivos específicos: describir la experiencia perceptiva de psicólogas voluntarias que cursaron Telepsicología en el contexto de la pandemia de la Covid-19. Identificar el sentido de la vida de estos profesionales y qué estrategias de afrontamiento se utilizan en el autocuidado. Método: Se trata de un estudio descriptivo con abordaje cualitativo y sustentado en la fenomenología existencial de Merleau-Ponty. El marco filosófico, conceptual y teórico utilizado es el de la Logoterapia de Viktor Frankl. Luego de que el proyecto fuera aprobado por el Comité de Ética en Investigación (CEP) y con la publicación del dictamen fundamentado, CAAE: 39944620.8.0000.5243, se inició el estudio. Se utilizó un cuestionario semiestructurado y autoaplicado, transmitido por correo electrónico y redes sociales WhatsApp, utilizando la técnica de bola de nieve. La recolección de datos se realizó entre abril y junio de 2021, finalizando cuando se percibió saturación de datos. Las preguntas planteadas abarcaron los siguientes aspectos: conocimiento y preparación para brindar cuidado a distancia, motivación y significado que se le da a la experiencia de cuidado voluntario y autocuidado y espiritualidad. El escenario de la investigación fue totalmente virtual. Resultados: Se identificaron tres categorías: Conocimiento y preparación para atender a través de la telepsicología; Percepción y sentido de la vida a través del altruismo y la vivencia de dificultades y Estrategias de afrontamiento y espiritualidad en el voluntariado. Entregarse como voluntario es dar respuesta a una llamada interior, independientemente de la religión. Brindar atención psicológica es, ante todo, tener una actitud ante la vida, en la que, a pesar de las dificultades, sea posible elaborar el dolor y construir estrategias de superación utilizando la espiritualidad como fuente de ayuda. Conclusión: Los resultados validan las preguntas de investigación, mostrando que el voluntario aprehende el sentido de la coyuntura vivida y logra extraer el sentido de lo que representa el acto de acoger al otro. La espiritualidad fue identificada como fundamental para el bienestar existencial y, con su ayuda, el profesional encuentra un sentido a su vida, hecho que lo impulsa a continuar en su trabajo. La identificación de ciertas dificultades técnicas permitió el desarrollo de un producto que incluye la verificación de la seguridad de los servicios virtuales. Limitaciones: La recolección de datos fue completamente virtual y se llevó a cabo en un período de severas medidas de aislamiento social. Había una brecha de conocimiento evidente en la literatura sobre el tema.

Programa alternativo de evaluación externa de calidad para serología de SARS-CoV-2: calidad en tiempos de pandemia / Alternative external quality assessment programme for SARS-CoV-2 serology: quality in pandemic times

Resumen Para el control de la pandemia por COVID-19 es indispensable contar con ensayos confiables para la detección de anticuerpos anti-síndrome respiratorio agudo severo por coronavirus 2 (SARS-CoV-2). Por este motivo el Laboratorio de Serología y la Residencia de Bioquímica Clínica del Hospital Garrahan desarrollaron el primer Programa Piloto Alternativo de evaluación externa de la calidad para serología de SARS-CoV-2 en la Argentina, destinado a evaluar comparativamente el desempeño de los métodos disponibles de los participantes con el fin de asegurar resultados confiables y clínicamente útiles. El esquema constó de 4 envíos con 5 muestras cada uno, con reactividad variable contra SARS-CoV-2 en las que se evaluaron anticuerpos totales, IgG e IgM. Participaron 21 laboratorios, tanto públicos como privados, de la Provincia y de la Ciudad de Buenos Aires de forma gratuita. Informaron metodología utilizada y resultados. Al finalizar cada entrega se enviaron los reportes individuales y se realizó un informe final global con los resultados totales del ciclo. El mismo se llevó a cabo a lo largo del segundo semestre de 2020. Se informó un total de 643 resultados, 239 de anti- SARS-CoV-2 IgM, 365 de IgG y 39 de anticuerpos totales. Se observó mayor concordancia en las metodologías anti-SARS-CoV-2 IgG que en las IgM. ELISA/ COVIDAR fue la metodología más utilizada para IgG y ELFA/bioMérieux para IgM. El espectro de metodologías fue amplio. El programa fue útil para asegurar la calidad de los resultados y brindó a los participantes el marco necesario para emitir resultados confiables y armonizados.

Abstract For the control of COVID-19 pandemic it is essential to have reliable tests for the detection of antibodies against severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2). For this reason, the Serology Laboratory and the Residence of Clinical Biochemistry of Hospital Garrahan developed the first Alternative Pilot Programme for external quality assessment for SARS-CoV-2 serology in Argentina, aimed at comparatively evaluating the actuaperformance of the available methods of the participants using different anti-SARS-CoV tests in order to ensure reliable and clinically useful results. The scheme consisted of 4 deliveries with 5 samples each throughout the second semester of 2020, with variable reactivity against SARS-CoV-2 in which total antibodies, IgG and IgM were evaluated. Twenty one public and private laboratories participated in the Province and the City of Buenos Aires for free. The methodology applied and the results were informed. At the end of each delivery, individual reports were sent and a final global report was made with the total results of the cycle. A total of 643 results were reported, 239 for anti-SARS-CoV-2 IgM, 365 for IgG and 39 for total antibodies. There was greater agreement in the anti-SARS-CoV-2 IgG methodologies than in IgM. ELISA/COVIDAR was the most frequently used methodology for IgG and ELFA/bioMérieux for IgM. The spectrum of methodologies was wide. The programme was useful to ensure the quality of the results, providing the participants with the necessary framework to issue reliable and harmonised results.

Resumo Para o controle da pandemia de COVID-19, é imprescindível a existência de testes confiáveis para a detecção de anticorpos anti síndrome respiratória aguda grave por coronavírus 2 (SARS-CoV-2). Por esse motivo o Laboratório de Sorologia e a Residência de Bioquímica Clínica do Hospital Garrahan desenvolveram o primeiro Programa Piloto Alternativo de avaliação externa da qualidade para sorologia de SARS-CoV-2 na Argentina, com o objetivo de avaliar comparativamente o desempenho dos métodos disponíveis dos participantes para garantir resultados confiáveis e clinicamente úteis. O esquema consistiu em 4 remessas com 5 amostras cada uma, com reatividade variável contra SARS-CoV-2 em que foram avaliados anticorpos totais, IgG e IgM. Participaram 21 laboratórios públicos e privados da Província e da Cidade de Buenos Aires que participaram em forma gratuita. Eles relataram a metodologia utilizada e os resultados. Ao final de cada entrega, foram enviados relatórios individuais e foi feito um relatório final global com os resultados totais do ciclo. Ele foi realizado ao longo do segundo semestre de 2020. Um total de 643 resultados foram relatados, 239 de anti-SARS-CoV-2 IgM, 365 de IgG e 39 de anticorpos totais. Foi observada maior concordância nas metodologias anti-SARS-CoV-2 IgG do que nas IgM. ELISA/COVIDAR foi a metodologia mais utilizada para IgG e ELFA/bioMérieux para IgM. O espectro de metodologias foi amplo. O programa foi útil para garantir a qualidade dos resultados, proporcionando aos participantes o enquadramento necessário para a emissão de resultados confiáveis e harmonizados.

Esteroides y COVID-19: una revisión de la evidencia en crecimiento durante la pandemia / Steroids and COVID-19: a review of growing evidence during the pandemic

El mecanismo específico por el cual los esteroides actuarían sobre la inflamación pulmonar sostenida, así como la definición del mejor fármaco a utilizar e incluso la duración adecuada del tratamiento, siguen siendo objetivo de estudio de los ensayos clínicos en curso. Como médicos clínicos, creemos que las potentes propiedades antiinflamatorias de los esteroides sintéticos están bien definidas, y aún falta evidencia definitiva de que otras estrategias antiinflamatorias proporcionen una mejor eficacia, al menos en el COVID-19. Aunque los esteroides sintéticos comparten una marcada acción antiinflamatoria y escasos efectos mineralocorticoides, su bioequivalencia y diferentes cinéticas deben considerarse cuidadosamente, debido a la elevada variabilidad de la farmacocinética individual, uso y prescripción adecuada de estos fármacos, ya que pueden desencadenar efectos adversos diversos que podrían impactar negativamente el curso clínico del paciente con COVID-19. Además, muchos de los fármacos actualmente considerados en el manejo del paciente con esta patología pueden potenciar la vida media y la aparición de efectos adversos de los corticoesteroides, o algunos efectos adversos de estos otros fármacos pueden simular complicaciones asociadas al uso de corticoesteroides, lo que podría conllevar a una suspensión precoz e inoportuna de los mismos. Números estudios clínicos y artículos basados en revisiones narrativas han servido de guías para los médicos clínicos en medio de esta pandemia, sin embargo, sus resultados deben interpretarse con cautela. Por estas razones, hemos realizado un análisis con base en el sistema GRADE de estos estudios para contrastar la información incluida en los estudios clínicos y minimizar el error de análisis(AU)

e specific mechanism by which steroids would act on sustained lung inflammation, as well as the definition of the best drug to use and the appropriate treatment duration remain to be the objectives of ongoing clinical trials. As clinicians, we believe that the potent anti-inflammatory properties of synthetic steroids are well defined and definitive evidence that other anti-inflammatory strategies provide better efficacy is still lacking, at least in COVID-19. Although synthetic steroids share a pronounced anti-inflammatory action and few mineralocorticoid effects, their bioequivalence and different kinetics should be considered, due to the high variability of individual pharmacokinetics, the appropriate use and prescription of these drugs, given that they could trigger various effects that could negatively impact the clinical course of the patient with COVID-19. In addition, many of the drugs currently considered in the management of the patient with this disease can enhance the half-life and appearance of adverse effects of corticosteroids and some adverse effects of these other drugs can simulate complications associated with the use of corticosteroids, which could lead to an early and untimely suspension of them. Numerous clinical studies and study articles based on narrative reviews have served as guides for clinicians in the midst of this pandemic; however, the results of these should be interpreted with caution. For these reasons, we have performed an analysis based on the GRADE system of these studies to contrast the information included in the clinical studies and minimize the error of analysis(AU)