Síndrome inflamatória multissistêmica em crianças infectadas por coronavírus: uma revisão integrativa / Multisystemic inflamatory syndrome in children infected by coronavirus: an integrative review / Síndrome inflamatorio multisistémico en niños infectados por coronavirus: una revisión integradora

Durante a pandemia de COVID-19, foram observadas manifestações atípicas em pacientes pediátricos em diversas regiões do mundo, e o conjunto desses sintomas caracterizou uma nova patologia denominada Síndrome Inflamatória Multissistêmica em Crianças (MIS-C), ou Síndrome Inflamatória Multissistêmica Pediátrica Temporariamente associada ao COVID-19 (PIMS- TS). O objetivo desta revisão foi analisar as manifestações clínicas e as possíveis complicações relacionadas a tal quadro inflamatório. Foi realizada uma busca por artigos científicos nas bases de dados Embase, PubMed e Web of Science, por meio da combinação dos descritores "MIS-C", "PIMS- TS" e "COVID-19". Após a análise dos artigos encontrados, e considerando critérios de inclusão e exclusão, foram selecionados 15 estudos para compor esta revisão. A maioria dos estudos mencionaram complicações gastrointestinais, cardiovasculares, respiratórias e mucocutâneas. Ademais, foram encontrados marcadores que indicavam estado inflamatório generalizado e coagulopatia. Assim, concluiu-se que MIS-C provavelmente é uma síndrome manifestada após a infecção por SARS-CoV-2, podendo ocasionar quadros mais graves, mas com baixas taxas de mortalidade.

During the COVID-19 pandemic, atypical manifestations were observed in pediatric patients in different regions of the world, and the set of these symptoms characterized a new pathology called Multisystemic Inflammatory Syndrome in Children (MIS-C), or Pediatric Multisystemic Inflammatory Syndrome Temporarily associated with COVID-19 (PIMS-TS). The purpose of this review was to analyze the clinical manifestations and possible complications related to such an inflammatory condition. A search for scientific articles was carried out in the databases Embase, PubMed and Web of Science, by combining the descriptors "MIS-C", "PIMS-TS" and "COVID-19". After analyzing the articles found, and considering inclusion and exclusion criteria, 15 studies were selected to compose this review. Most studies mentioned gastrointestinal, cardiovascular, respiratory and mucocutaneous complications. In addition, markers were found that indicated generalized inflammatory status and coagulopathy. Thus, it was concluded that MIS-C is probably a syndrome manifested after infection by SARS-CoV-2, which can cause more severe conditions, but with low mortality rates.

Durante la pandemia de COVID-19 se observaron manifestaciones atípicas en pacientes pediátricos de diferentes regiones del mundo, y el conjunto de estos síntomas caracterizó una nueva patología denominada Síndrome Inflamatorio Multisistémico en Niños (SMI-C), o Síndrome Inflamatorio Multisistémico Pediátrico Asociado Temporalmente a COVID-19 (SIPM-TS). El propósito de esta revisión fue analizar las manifestaciones clínicas y las posibles complicaciones relacionadas con dicha condición inflamatoria. Se realizó una búsqueda de artículos científicos en las bases de datos Embase, PubMed y Web of Science, combinando los descriptores "MIS-C", "PIMS- TS" y "COVID-19". Tras analizar los artículos encontrados, y teniendo en cuenta los criterios de inclusión y exclusión, se seleccionaron 15 estudios para componer esta revisión. La mayoría de los estudios mencionaron complicaciones gastrointestinales, cardiovasculares, respiratorias y mucocutáneas. Además, se encontraron marcadores que indicaban un estado inflamatorio generalizado y coagulopatía. Así pues, se concluyó que el SMI-C es probablemente un síndrome que se manifiesta tras la infección por el SARS-CoV-2, que puede causar cuadros más graves, pero con bajas tasas de mortalidad.

Perfil epidemiológico de óbitos decorrentes da Covid-19 em um município do sudoeste do Paraná / Epidemiological profile of death resulting from Covid-19 in a municipality in southwest of Paraná / Perfil epidemiológico de las muertes por Covid-19 en un municipio del suroeste de Paraná

Introdução: No final do ano de 2019 surgiu na China uma doença infectocontagiosa de característica respiratória e alto grau de disseminação até então desconhecida. No Brasil o primeiro caso de Covid-19 foi confirmado no final de fevereiro de 2020 e a primeira morte em meados de março. Segundo dados da plataforma Coronavírus Brasil, em 17 de março de 2021, houve registro de 11.603.535 casos confirmados e 282.127 óbitos. Objetivo: Descrever o perfil de pessoas que morreram tendo como causa básica do óbito a Covid-19, em um município do Sudoeste do Paraná, entre os anos de 2020 e 2021. Metodologia: Trata-se de um estudo transversal, descritivo, documental de caráter quantitativo que foi realizado na prefeitura municipal de Francisco Beltrão. Resultados: Houve prevalência de óbitos em pacientes do sexo masculino, idosos, com presença de alguma comorbidade associada, sendo hipertensão a mais citada (50,8%). Os sintomas mais prevalentes foram tosse (74,4%), dispneia (56,3%) e saturação < 95% (48,3%), necessitando ainda de hospitalização em algum período da doença (94,1%), sendo os leitos de Sistema Único de Saúde os mais procurados (74,4%). Quanto à taxa de ocupação 49,6% dos casos necessitou apenas de leitos de enfermaria e 42% unidades de terapia intensiva. Discussão: Diversas pesquisas apontam que o sexo masculino é o mais acometido por condições graves de saúde, devido à demora na busca de assistência médica. No que se refere à idade, neste estudo, a prevalência de óbitos se deu entre 71 e 75 anos (15,1%) o que justifica que o envelhecimento é um fator de risco elevado para complicações da doença. Durante a análise dos dados, notou- se que grande parte dos pacientes que tiveram como desfecho o óbito, possuíam algum fator associado, dentre os mais citados, verificou-se a Hipertensão Arterial Sistêmica (50,8%) Diabetes Mellitus (24,8%), doenças cardiovasculares (23,9%) e obesidade (14,7%). No que diz respeito à hospitalização, nesse estudo notou-se que 74,4% da amostra foram hospitalizadas em leitos de SUS, 18,5% em hospitais particulares e 7,1% não possuíam essa informação. Conclusão: É possível observar a importância do estudo epidemiológico para identificar o perfil da população em risco, podendo auxiliar no planejamento do atendimento, rastreamento e controle da doença, além de conhecer a evolução da patologia, a fim de buscar ações adequadas para seu enfrentamento.

Introduction: At the end of 2019, a previously unknown infectious disease with respiratory characteristics and a high degree of dissemination emerged in China. In Brazil the first case of Covid-19 was confirmed in late February 2020 and the first death in mid-March. According to data from the Coronavirus Brazil platform, as of March 17, 2021, 11,603,535 confirmed cases and 282,127 deaths were recorded. Objective: To describe the profile of people who died with Covid-19 as the underlying cause of death in a city in southwestern Paraná between the years 2020 and 2021. Methodology: This is a cross-sectional, descriptive, documental, quantitative study carried out at the Francisco Beltrão City Hall. Results: There was a prevalence of deaths in male patients, elderly, with the presence of some associated comorbidity, hypertension being the most cited (50.8%). The most prevalent symptoms were cough (74.4%), dyspnea (56.3%) and saturation < 95% (48.3%), requiring hospitalization in some period of the disease (94.1%), and the Unified Health System beds were the most sought (74.4%). As for the occupancy rate, 49.6% of the cases required only ward beds and 42% intensive care units. Discussion: Several studies show that men are the most affected by serious health conditions, due to the delay in seeking medical assistance. Regarding age, in this study, the prevalence of deaths was between 71 and 75 years (15.1%), which justifies that aging is a high risk factor for disease complications. During data analysis, it was noted that most patients who died had some associated factor, among the most cited were systemic arterial hypertension (50.8%), diabetes mellitus (24.8%), cardiovascular diseases (23.9%) and obesity (14.7%). Regarding hospitalization, in this study it was noted that 74.4% of the sample were hospitalized in SUS beds, 18.5% in private hospitals, and 7.1% did not have this information. Conclusion: It is possible to observe the importance of the epidemiological study to identify the profile of the population at risk, which can help in planning care, tracking and control of the disease, besides knowing the evolution of the pathology in order to seek appropriate actions for its confrontation

Introducción: A finales del año 2019 apareció en China una enfermedad infecto- contagiosa de característica respiratoria y alto grado de diseminación desconocida hasta entonces. En Brasil se confirmó el primer caso de Covid-19 a finales de febrero de 2020 y la primera muerte a mediados de marzo. Según los datos de la plataforma Coronavirus Brasil, hasta el 17 de marzo de 2021, había 11.603.535 casos confirmados y 282.127 muertes. Objetivo: Describir el perfil de las personas fallecidas con Covid-19 como causa subyacente de muerte en una ciudad del sudoeste de Paraná entre los años 2020 y 2021. Metodología: Se trata de un estudio transversal, descriptivo, documental de carácter cuantitativo que se realizó en la prefectura municipal de Francisco Beltrão. Resultados: Hubo una prevalencia de muertes en pacientes masculinos, de edad avanzada, con presencia de alguna comorbilidad asociada, siendo la hipertensión la más citada (50,8%). Los síntomas más prevalentes fueron la tos (74,4%), la disnea (56,3%) y la saturación < 95% (48,3%), requiriendo hospitalización en algún periodo de la enfermedad (94,1%), siendo las camas del Sistema Único de Salud las más solicitadas (74,4%). En cuanto a la tasa de ocupación, el 49,6% de los casos sólo necesitaban camas de sala y el 42% unidades de cuidados intensivos. Discusión: Varias investigaciones señalan que el género masculino es el más afectado por las condiciones de salud graves, debido al retraso en la búsqueda de asistencia médica. En cuanto a la edad, en este estudio, la prevalencia de muertes se produjo entre los 71 y los 75 años (15,1%), lo que justifica que el envejecimiento sea un factor de riesgo elevado para las complicaciones de la enfermedad. Durante el análisis de los datos, se observó que la mayoría de los pacientes que fallecieron tenían algún factor asociado, entre los más citados estaban la Hipertensión Arterial Sistémica (50,8%), la Diabetes Mellitus (24,8%), las enfermedades cardiovasculares (23,9%) y la obesidad (14,7%). En lo que respecta a la hospitalización, en este estudio se observó que el 74,4% de la muestra estaba hospitalizada en camas del SUS, el 18,5% en hospitales privados y el 7,1% no tenía esta información. Conclusión: Es posible observar la importancia del estudio epidemiológico para identificar el perfil de la población en riesgo, pudiendo ayudar en la planificación de la atención, el rastreo y el control de la enfermedad, además de conocer la evolución de la patología, con el fin de buscar las acciones adecuadas para su enfrentamiento.

Multi-Organ Histopathological Changes in a Mouse Hepatitis Virus Model of COVID-19.

Infection with SARS-CoV-2, the virus responsible for the global COVID-19 pandemic, causes a respiratory illness that can severely impact other organ systems and is possibly precipitated by cytokine storm, septic shock, thrombosis, and oxidative stress. SARS-CoV-2 infected individuals may be asymptomatic or may experience mild, moderate, or severe symptoms with or without pneumonia. The mechanisms by which SARS-CoV-2 infects humans are largely unknown. Mouse hepatitis virus 1 (MHV-1)-induced infection was used as a highly relevant surrogate animal model for this study. We further characterized this animal model and compared it with SARS-CoV-2 infection in humans. MHV-1 inoculated mice displayed death as well as weight loss, as reported earlier. We showed that MHV-1-infected mice at days 7-8 exhibit severe lung inflammation, peribronchiolar interstitial infiltration, bronchiolar epithelial cell necrosis and intra-alveolar necrotic debris, alveolar exudation (surrounding alveolar walls have capillaries that are dilated and filled with red blood cells), mononuclear cell infiltration, hyaline membrane formation, the presence of hemosiderin-laden macrophages, and interstitial edema. When compared to uninfected mice, the infected mice showed severe liver vascular congestion, luminal thrombosis of portal and sinusoidal vessels, hepatocyte degeneration, cell necrosis, and hemorrhagic changes. Proximal and distal tubular necrosis, hemorrhage in interstitial tissue, and the vacuolation of renal tubules were observed. The heart showed severe interstitial edema, vascular congestion, and dilation, as well as red blood cell extravasation into the interstitium. Upon examination of the MHV-1 infected mice brain, we observed congested blood vessels, perivascular cavitation, cortical pericellular halos, vacuolation of neuropils, darkly stained nuclei, pyknotic nuclei, and associated vacuolation of the neuropil in the cortex, as well as acute eosinophilic necrosis and necrotic neurons with fragmented nuclei and vacuolation in the hippocampus. Our findings suggest that the widespread thrombotic events observed in the surrogate animal model for SARS-CoV-2 mimic the reported findings in SARS-CoV-2 infected humans, representing a highly relevant and safe animal model for the study of the pathophysiologic mechanisms of SARS-CoV-2 for potential therapeutic interventions.

The lethal internal face of the coronaviruses: Kidney tropism of the SARS, MERS, and COVID19 viruses.

The kidney is one of the main targets attacked by viruses in patients with a coronavirus infection. Until now, SARS-CoV-2 has been identified as the seventh member of the coronavirus family capable of infecting humans. In the past two decades, humankind has experienced outbreaks triggered by two other extremely infective members of the coronavirus family; the MERS-CoV and the SARS-CoV. According to several investigations, SARS-CoV causes proteinuria and renal impairment or failure. The SARS-CoV was identified in the distal convoluted tubules of the kidney of infected patients. Also, renal dysfunction was observed in numerous cases of MERS-CoV infection. And recently, during the 2019-nCoV pandemic, it was found that the novel coronavirus not only induces acute respiratory distress syndrome (ARDS) but also can induce damages in various organs including the liver, heart, and kidney. The kidney tissue and its cells are targeted massively by the coronaviruses due to the abundant presence of ACE2 and Dpp4 receptors on kidney cells. These receptors are characterized as the main route of coronavirus entry to the victim cells. Renal failure due to massive viral invasion can lead to undesirable complications and enhanced mortality rate, thus more attention should be paid to the pathology of coronaviruses in the kidney. Here, we have provided the most recent knowledge on the coronaviruses (SARS, MERS, and COVID19) pathology and the mechanisms of their impact on the kidney tissue and functions.

Letalidade da COVID-19 entre profissionais de saúde no Pará, Brasil / Lethality of COVID-19 among healthcare professionals in Pará, Brazil / Letalidad por COVID-19 entre profesionales de salud en Pará, Brasil

Objetivo: analisar a letalidade da COVID-19 por sexo e idade entre os profissionais de saúde do Estado Pará, Brasil. Método: estudo epidemiológico e observacional, com utilização de dados secundários públicos sobre casos e óbitos acumulados por COVID-19 e dados demográficos, entre março e outubro de 2020. O número de casos e óbitos por COVID-19 ocorridos entre profissionais de saúde foram comparados em relação à idade e ao sexo pelo teste qui-quadrado, seguido por regressão logística pelo método Backward Stepwise de Wald. Resultados: entre os 15.332 casos confirmados de COVID-19, 70,3% eram do sexo feminino e 61,3% com idade entre 30 a 49 anos (39,2±11,6 anos). Registraram-se 97 óbitos, com uma taxa de letalidade de 0,6%. A probabilidade de óbito foi 52,8 vezes (20,7-134,5) e 4,0 vezes (2,5-6,2) maior entre jovens e homens quando comparados às demais notificações. Conclusão: a taxa de letalidade entre os profissionais de saúde é alta, especialmente entre homens jovens. Este é um alerta sobre os impactos da doença entre os trabalhadores da saúde e suscita ao poder público, especificamente ao setor saúde melhores condições de trabalho e políticas de saúde do trabalhador.(AU)

Objective: to analyze the lethality of COVID-19 by sex and age among health professionals in the state of Pará, Brazil. Method: epidemiological and observational study, using public secondary data on cases and deaths accumulated by COVID-19 and demographic data, between March and October 2020. The number of cases and deaths by COVID-19 that occurred among health professionals were compared in relation to age and sex using the chi-square test, followed by logistic regression using Wald's Backward Stepwise method. Results: among the 15,332 confirmed cases of COVID-19, 70.3% were female and 61.3% aged between 30 and 49 years (39.2 ± 11.6 years). 97 deaths were recorded, with a fatality rate of 0.6%. The probability of death was 52.8 times (20.7-134.5) and 4.0 times (2.5-6.2) higher among young men and men when compared to other reports. Conclusion: the lethality rate among health professionals is high, especially among young men. This is an alert about the impacts of the disease among health workers and raises the public authorities, specifically the health sector, better working conditions and worker health policies.(AU)

Objetivo: analizar la letalidad de COVID-19 por sexo y edad en profesionales de la salud en el estado de Pará, Brasil. Método: estudio epidemiológico y observacional, utilizando datos secundarios públicos sobre casos y defunciones acumulados por COVID-19 y datos demográficos, entre marzo y octubre de 2020. Se comparó el número de casos y defunciones por COVID-19 ocurridos entre profesionales de la salud en relación con edad y sexo usando la prueba de chi-cuadrado, seguida de regresión logística usando el método de Wald Backward Stepwise. Resultados: entre los 15.332 casos confirmados de COVID-19, el 70,3% eran mujeres y el 61,3% tenían entre 30 y 49 años (39,2 ± 11,6 años). Se registraron 97 muertes, con una tasa de letalidad del 0,6%. La probabilidad de muerte fue 52,8 veces (20,7-134,5) y 4,0 veces (2,5-6,2) más grande entre hombres y jóvenes en comparación con otros informes. Conclusión: la tasa de letalidad entre los profesionales de la salud es alta, especialmente entre los hombres jóvenes. Se trata de una alerta sobre los impactos de la enfermedad entre los trabajadores de la salud y plantea a las autoridades públicas, específicamente al sector salud, mejores condiciones laborales y políticas de salud laboral.(AU)

Relação da COVID-19 com o Índice de Desenvolvimento Humano / Relationship of COVID-19 with the Human Development Index

Síntese de evidências e análise exploratória acerca da relação entre IDHs e a evolução da pandemia da COVID-19 nos municípios do estado de Goiás. Para essa análise utilizou-se dados referentes à situação da COVID-19 nos municípios de Goiás, utilizando-se de IDH dos Municipíos de Goiás no site do IBGE, IDH dos Bairros de Goiânia, Populações estimadas para 2019, números de casos e óbitos por município do Estado de Goiás, Painel de Acompanhamento da Covid da Secretaria de Estado da Saúde de Goiás (SES-GO); números de internações nas unidades do SUS pelo Argos, agrupado por município, residência dos paciente; números de internações pelo SIVEP, agrupado por município de residência dos pacientes. Para calcular a precisão utilizou-se a métrica Coeficiente de Determinação (r²). No que se refere à correlação, obteve-se os índices de correlação do IDH com as diferentes variáveis apresentadas no gráfico de calor. Conclui que não há, até o momento, consonância da literatura científica acerca da relação entre o IDH e indicadores epidemiológicos da COVID-19. Serão necessários mais estudos e metodologias diferentes de modo a aferir a influência das diferentes variáveis

Evidence synthesis and exploratory analysis on the relationship between HDIs and the evolution of the COVID-19 pandemic in the municipalities of the state of Goiás. For this analysis, data referring to the situation of COVID-19 in the municipalities of Goiás were used, using HDI of the Municipalities of Goiás on the IBGE website, HDI of the Neighborhoods of Goiânia, Estimated populations for 2019, number of cases and deaths by municipality of the State of Goiás, Covid Monitoring Panel of the State Health Department of Goiás (SES-GO ); number of admissions to SUS units by Argos, grouped by municipality, patient residence; number of admissions by SIVEP, grouped by municipality of residence of patients. To calculate the precision, the Coefficient of Determination (r²) metric was used. With regard to the correlation, we obtained the correlation indices of the HDI with the different variables presented in the heat graph. It concludes that, to date, there is no consonance in the scientific literature on the relationship between the HDI and COVID-19 epidemiological indicators. More studies and different methodologies will be needed in order to assess the influence of different variables

Aplicación de un modelo cubano predictivo de mortalidad en pacientes graves por covid-19 en Lombardía, Italia / Application of a Cuban mortality-predictive model in seriously-ill patients with Covid-19 in Lombardy, Italy

RESUMEN Introducción: la neumonía por covid-19 es la enfermedad infecciosa que ha revolucionado al mundo en los últimos meses. El diagnóstico pasa por varios momentos: el cuadro clínico, la analítica sanguínea y las imágenes. La estratificación del riesgo de muerte es muy importante para optimizar los recursos. Objetivos: validar un modelo matemático cubano predictivo de mortalidad en pacientes ingresados por covid-19. Materiales y métodos: estudio de cohorte con 191 pacientes, que ingresaron graves en el Hospital Mayor de Crema, en la provincia de Cremona, región de Lombardía (Italia), en el período de abril a mayo de 2020. El universo estuvo constituido por 191 pacientes, y no se tomó muestra alguna. Las variables fueron: edad, estado del paciente, niveles de creatinina plasmática, frecuencia respiratoria, frecuencia cardiaca, presión arterial, niveles de oxígeno y de dióxido de carbono en sangre, valor del sodio y de hemoglobina. Resultados: mortalidad del 22 % en pacientes graves y críticos, con media de la edad (grupo 1: 59 años) (grupo 2: 73 años); t-Student = 0,00. Test de Hosmer-Lemenshow (0,766) con elevado ajuste. Sensibilidad = 93 %. Área bajo la curva = 0,957. Porcentaje de aciertos en la regresión logística de 86,4 % y en la red neuronal de 91,2 %. Media del modelo por grupos (grupo 1: 4 458) (grupo 2: 2 911) t-Student = 0,00. Conclusiones: el modelo demostró ser muy útil en el flujograma de pacientes atendidos con la covid-19. Permitió detectar tempranamente (a los cinco días del ingreso) los pacientes con alto riesgo de muerte y discriminar aquellos que no tendrían este riesgo, de manera que pudieran ser tratados en unidades de cuidados mínimos (AU).

ABSTRACT Introduction: COVID-19 pneumonia is an infectious disease that has revolutionized the world in the last months. The diagnosis goes thought several moments: clinical features, blood analytic and images. Death risk stratification is very important to optimize resources. Objective: to validate the Cuban mathematic predictive model of mortality in patients admitted due to COVID-19. Materials and methods: cohort study with 191 seriously-ill patients who were admitted to Maggiore di Crema Hospital, Cremona, Lombardy region, Italy, in the period April-May 2020. The universe were 191 patients and no sample was chosen. The variables were: age; patient's status; plasma creatinine levels; respiratory rate; heart rate; arterial pressure; blood oxygen and carbon dioxide levels; values of sodium and hemoglobin. Results: 22 % of mortality in seriously-ill and critical patients, with average age in Group 1: 59 years, in Group 2: 73 years; t-Student = 0.00. Hosmer-Lemenshow test (0.766) with high adjustment. Sensitivity= 93 %. Area below the curve=0.957. Success percentage in logistic regression of 86.4 % and 91.2 % in the neuronal net. Model media per groups: Group 1= 4 458; Group 2= 2 911, t-Student = 0.00. Conclusions: the model showed to be very useful in the flow chart of patients attended with COVID-19. It allowed to early detect the patients at high death risk five days from admission and discriminating those who were not at risk, in a way that they could be treated in minimal care units (AU).

Treatment of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and coronavirus disease 2019 (COVID-19): a systematic review of in vitro, in vivo, and clinical trials.

Rationale: Coronavirus disease 2019 (COVID-19) has spread worldwide and poses a threat to humanity. However, no specific therapy has been established for this disease yet. We conducted a systematic review to highlight therapeutic agents that might be effective in treating COVID-19. Methods: We searched Medline, Medrxiv.org, and reference lists of relevant publications to identify articles of in vitro, in vivo, and clinical studies on treatments for severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19 published in English until the last update on October 11, 2020. Results: We included 36 studies on SARS, 30 studies on MERS, and 10 meta-analyses on SARS and MERS in this study. Through 12,200 title and 830 full-text screenings for COVID-19, eight in vitro studies, 46 randomized controlled trials (RCTs) on 6,886 patients, and 29 meta-analyses were obtained and investigated. There was no therapeutic agent that consistently resulted in positive outcomes across SARS, MERS, and COVID-19. Remdesivir showed a therapeutic effect for COVID-19 in two RCTs involving the largest number of total participants (n = 1,461). Other therapies that showed an effect in at least two RCTs for COVID-19 were sofosbuvir/daclatasvir (n = 114), colchicine (n = 140), IFN-ß1b (n = 193), and convalescent plasma therapy (n = 126). Conclusions: This review provides information to help establish treatment and research directions for COVID-19 based on currently available evidence. Further RCTs are required.

Covid-19 - vulnerabilidade e letalidade / Covid-19 - vulnerability and lethality

Até o final da primeira semana de janeiro de 2021, a pandemia da infecção causada pelo novo coronavírus (SARS-CoV-2) acometeu, aproximadamente, 86 milhões de pessoas e provocou cerca de 2 milhões de mortes no mundo inteiro (WHO, 2021). No mesmo período, o Brasil contabilizou cerca de 8 milhões de pessoas contaminadas e 200 mil óbitos confirmados por COVID-19 (BRASIL, 2021). Mesmo após tantos casos, óbitos e tempo decorrido desde o início da pandemia, ainda há muito o que ser esclarecido a respeito da COVID-19 (SIGNORELLI e ODONE, 2020), sendo necessário olhar atento tanto à vulnerabilidade de grupos específicos; quanto à incidência, gravidade e letalidade da doença

By the end of the first week of January 2021, the pandemic of infection caused by the new coronavirus (SARS-CoV-2) affected approximately 86 million people and caused about 2 million deaths worldwide (WHO, 2021). In the same period, Brazil counted approximately 8 million people infected and 200,000 confirmed deaths by COVID-19 (BRAZIL, 2021). Even after so many cases, deaths and time elapsed since the beginning of the pandemic, there is still to be clarified about COVID-19 (SIGNORELLI and ODONE, 2020), and is necessary to look at both the vulnerability of specific groups; as to the incidence, severity and lethality of the disease

El impacto de la Covid-19 en la población mayor dependiente en España con especial referencia al sector residencial / The impact of COVID-19 on the elderly dependent population in Spain with special reference to the residential care sector

Resumen Este artículo tiene como objeto analizar la crisis de la atención residencial en España en el contexto de la Covid-19 y su impacto en una elevada mortalidad y el abandono de la población usuaria. Se analizan sus causas inmediatas, mediatas y estructurales. De manera específica se analiza la precariedad en el empleo en las residencias a lo largo de la pasada década como una de las principales causas explicativas de la crisis estructural de las residencias. El enfoque teórico de análisis es el modelo de atención integral y centrada en la persona (AICP) basado en la autonomía de las personas y en la centralidad de sus derechos. La metodología combina el análisis cuantitativo en lo referente al empleo junto con una metodología cualitativa basada en el análisis de documentos y debates. El artículo concluye proponiendo una reforma integral de los cuidados de larga duración que incluya tanto un cambio en la atención residencial bajo la forma de pequeñas unidades de convivencia, como un reforzamiento de la atención en el domicilio y la comunidad en cuanto preferencia creciente la población mayor. La combinación óptima de la atención residencial y domiciliaria es la propuesta básica de este trabajo.

Abstract The objective of this study is to analyze the residential care crisis in Spain in the context of the COVID-19 pandemic and its impact on high mortality and abandonment of the user population. The direct, indirect and structural causes are analyzed. Specifically, precarious employment in residences over the past decade was analyzed as one of the main explanatory causes of the structural crisis of nursing homes. The theoretical focus of analysis is the comprehensive and person-centered care (CPCC) model based on the autonomy of people and the centrality of their rights. The methodology combines a quantitative analysis of employment and a qualitative analysis of documents and debates. The study concludes by proposing a comprehensive reform of long-term care that includes both a change in residential care in the form of small cohabitation units and reinforcement of care in the home and the community as a growing preference for the elderly population. An optimal combination of residential and home care is the basic proposal of this work.

More than just a common cold: Endemic coronaviruses OC43, HKU1, NL63, and 229E associated with severe acute respiratory infection and fatality cases among healthy adults.

Respiratory viral infection can cause severe disease and hospitalization, especially among children, the elderly, and patients with comorbidities. In Brazil, the official surveillance system of severe acute respiratory infection (SARI) investigates influenza A (IAV) and B (IBV) viruses, respiratory syncytial virus (RSV), adenovirus (HAdV), and parainfluenza viruses (hPIV 1-3). In Rio Grande do Sul (RS), Brazil, many fatalities associated with SARI between 2013 and 2017 occurred among patients without underlying diseases and for whom the causative agent had not been identified using official protocols. This cross-sectional study analyzed the presence of coronaviruses (HCoV), bocavirus (HBoV), metapneumovirus (hMPV), and rhinovirus in patients who died of SARI despite not having comorbidities, and that were negative for IAV, IBV, RSV, HAdV, and hPIV. Nasopharyngeal aspirates/swabs from patients were used for nucleic acid extraction. The presence of HCoVs OC43, HKU1, NL63, and 229E; HBoV; hMPV; and rhinovirus was assessed by quantitative reverse transcription-polymerase chain reaction. Clinical data were also analyzed. Between 2013 and 2017, 16 225 cases of SARI were reported in RS; 9.8% of the patients died; 20% of all fatal cases were patients without comorbidities and for whom no pathogen was detected using standard protocols. Analysis of 271 of these cases identified HCoV in nine cases; HBoV, hMPV, and rhinovirus were detected in 3, 3, and 10 cases, respectively. Of note, patients infected with HCoV were adults. Results reinforce the importance of including coronaviruses in diagnostic panels used by official surveillance systems because besides their pandemic potential, endemic HCoVs are associated to severe disease in healthy adults.

Seasonal Human Coronavirus Respiratory Tract Infection in Recipients of Allogeneic Hematopoietic Stem Cell Transplantation.

BACKGROUND: Little is known about characteristics of seasonal human coronaviruses (HCoVs) (NL63, 229E, OC43, and HKU1) after allogeneic stem cell transplantation (allo-HSCT). METHODS: This was a collaborative Spanish and European bone marrow transplantation retrospective multicenter study, which included allo-HSCT recipients (adults and children) with upper respiratory tract disease (URTD) and/or lower respiratory tract disease (LRTD) caused by seasonal HCoV diagnosed through multiplex polymerase chain reaction assays from January 2012 to January 2019. RESULTS: We included 402 allo-HSCT recipients who developed 449 HCoV URTD/LRTD episodes. Median age of recipients was 46 years (range, 0.3-73.8 years). HCoV episodes were diagnosed at a median of 222 days after transplantation. The most common HCoV subtype was OC43 (n = 170 [38%]). LRTD involvement occurred in 121 episodes (27%). HCoV infection frequently required hospitalization (18%), oxygen administration (13%), and intensive care unit (ICU) admission (3%). Three-month overall mortality after HCoV detection was 7% in the whole cohort and 16% in those with LRTD. We identified 3 conditions associated with higher mortality in recipients with LRTD: absolute lymphocyte count <0.1 × 109/mL, corticosteroid use, and ICU admission (hazard ratios: 10.8, 4.68, and 8.22, respectively; P < .01). CONCLUSIONS: Seasonal HCoV after allo-HSCT may involve LRTD in many instances, leading to a significant morbidity.

Systematic rapid living review of the impact of the COVID-19 pandemic on cancer survivors: update to August 27, 2020.

BACKGROUND: The COVID-19 pandemic has resulted in drastic changes in the global healthcare delivery landscape and has had practical repercussions for cancer survivors. This systematic rapid living review has been undertaken to synthesise the available knowledge regarding the impact of the COVID-19 pandemic in a timely manner. This initial rapid review will present the findings of literature published up to August 27, 2020. DESIGN: A systematic search of PubMed, Scopus and Google Scholar databases was conducted to identify all articles, available in English language, regarding the impact of the COVID-19 pandemic on cancer survivors published between December 2019 and August 27, 2020. The search strategy employed the following search strings: "covid-19 OR coronavirus OR sars-cov-2" with "cancer survivors OR cancer survivorship". RESULTS: The database search yielded 1639 articles, of which 19 were included. Of the 19 selected articles, there were 12 expert opinion articles, two literature reviews, two prospective cohort studies, one retrospective cohort study, one descriptive study and one pooled meta-analysis that comment on the impact of the COVID-19 pandemic on the physical wellbeing (16 articles), psychosocial wellbeing (15 articles) and financial wellbeing of cancer survivors (3 articles). CONCLUSIONS: Limited definitive evidence exists regarding the impact of the COVID-19 pandemic on cancer survivors. Currently available literature provides preliminary indications of wide-ranging impacts of the pandemic on cancer survivors with respect to the requirement to adapt to new means of healthcare delivery as well as their physical, psychosocial and economic wellbeing. The pandemic has left survivors dealing with the consequences of rigorous cancer treatment in the context of new challenges related to social isolation, financial hardship and uncertainty with respect to their ongoing care. Additional rigorously designed research initiatives are required to elucidate the impact of the pandemic on cancer survivors.

COVID-19: estudo seccional de casos suspeitos internados em um hospital federal do Rio de Janeiro e fatores associados ao óbito hospitalar / COVID-19: estudio seccional de casos sospechosos ingresados a un hospital federal de Rio de Janeiro, Brasil, y factores asociados a óbito hospitalario / COVID-19: a cross-sectional study of suspected cases admitted to a federal hospital in Rio de Janeiro, Brazil, and factors associated with hospital death

Objetivo: Descrever o perfil clínico-epidemiológico dos casos suspeitos de COVID-19 internados em hospital federal do Rio de Janeiro, RJ, Brasil, e identificar fatores associados ao óbito. Métodos: Estudo seccional, utilizando dados da vigilância epidemiológica local até a Semana Epidemiológica 27 de 2020. Empregou-se regressão logística. Resultados: Foram incluídos 376 casos internados suspeitos de COVID-19, dos quais 52,9% eram mulheres, 57,4% tinham 50 anos ou mais de idade e 80,1% exibiam comorbidades. Foram confirmados para COVID-19 195 casos (51,9%), cuja letalidade (37,9%) foi maior, comparada à dos descartados (24,2%). Na análise ajustada, associaram-se ao óbito, nos casos confirmados, ter 50 a 69 (OR=11,65 - IC95% 1,69;80,33) e 70 ou mais anos (OR=8,43 - IC95% 1,22;58,14), apresentar neoplasia (OR=4,34 - IC95% 1,28;14,76) e usar suporte ventilatório invasivo (OR=70,20 - IC95% 19,09;258,19). Conclusão: Houve elevada prevalência de comorbidades e letalidade; os principais fatores associados ao óbito foram idade, presença de neoplasia e suporte ventilatório invasivo.

Objetivo: Describir el perfil clínico-epidemiológico de casos sospechosos de COVID-19 ingresados en hospital federal de Río de Janeiro, RJ, Brasil, y factores asociados al óbito. Métodos: Estudio transversal utilizando datos de la vigilancia epidemiológica local de casos sospechosos hospitalizados hasta la Semana Epidemiológica 27 de 2020 y regresión logística. Resultados: Se incluyeron 376 casos, de los cuales 52,9% era de mujeres, 57,4% tenía 50 años o más, 80,1% tenía comorbilidades. Se confirmó para COVID-19 un 51,9% . Los casos confirmados tuvieron una mayor letalidad (37,9%) que los descartados (24,2%). La mortalidad ajustada en los confirmados fue mayor en los grupos de edad de 50 a 69 años (OR=11,65 - IC95% 1,69; 80,33), 70 años o más (OR=8,43 - IC95% 1,22;58,14), con neoplasia (OR=4,34 - IC95% 1,28;14,76) y uso de soporte ventilatorio invasivo (OR=70,20 - IC95% 19,09;258,19). Conclusión: La mayor mortalidad se asoció con personas de edad avanzada, con neoplasias y uso de soporte ventilatorio invasivo.

Objective: To describe the clinical and epidemiological profile of suspected COVID-19 cases admitted to a federal hospital in Rio de Janeiro, RJ, Brazil, and to identify factors associated with death. Methods:This was a cross-sectional study using local epidemiological surveillance data as at epidemiological week 27 of 2020 and logistic regression. Results: 376 hospitalized suspected COVID-19 cases were included; 52.9% were female, 57.4% were 50 years old or over and 80.1% had comorbidities. 195 (51.9%) COVID-19 cases were confirmed and their lethality was higher (37.9%) than among discarded cases (24.2%). In the adjusted analysis, death among confirmed cases was associated with being in the 50-69 age group (OR=11.65 - 95%CI 1.69;80.33), being aged 70 or over (OR=8.43 - 95%CI 1.22;58.14), presence of neoplasms (OR=4.34 - 95%CI 1.28;14.76) and use of invasive ventilatory support (OR=70.20 - 95%CI 19.09;258.19). Conclusion: High prevalence of comorbidities and lethality was found; the main factors associated with death were being older, neoplasms and invasive ventilatory support.

Letalidade e características dos óbitos por COVID-19 em Rondônia: estudo observacional / Letalidad y características de los óbitos debidos a COVID-19 en Rondônia: un estudio observacional / Lethality and characteristics of deaths due to COVID-19 in Rondônia: an observational study

Objetivo: Descrever as características dos óbitos por COVID-19 no estado de Rondônia. Métodos: Estudo descritivo, com dados do Sistema Estratégia de Informatização do Sistema Único de Saúde Vigilância Epidemiológica (E-SUS-VE), notificados entre 1º de janeiro e 20 de agosto de 2020. Foram aplicados testes estatísticos (qui-quadrado e procedimento de Marascuilo), considerando-se como diferenças significantes quando os testes apresentaram p-valor <0,05. Resultados: Foram notificados 184.146 casos suspeitos, dos quais 49.804 foram confirmados como COVID-19, e 1.020 evoluíram para óbito (letalidade 2,1%). Observaram-se diferenças significantes estatisticamente entre as faixas etárias e a letalidade (p-valor <0,001); maior letalidade quanto maior a idade (procedimento de Marascuilo, significativo na comparação entre maiores de 60 anos com as demais faixas etárias); maior óbito no sexo masculino (letalidade de 2,7%); e maior letalidade entre as pessoas de cor preta (3,0%). Conclusão: Em Rondônia, observou-se maior letalidade entre idosos, homens e pessoas pardas e pretas.

Objetivo: Describir las características de los óbitos debidos a COVID-19 en Rondônia. Métodos: Estudio descriptivo, con datos del Sistema de Estrategia de Computación del Sistema Unificado de Salud de Vigilancia Epidemiológica (E-SUS-VE), notificados entre el 1 de enero y el 20 de agosto de 2020. Se aplicaron pruebas estadísticas (procedimiento Chi-cuadrado y Marascuilo), considerando significativas cuando las pruebas presentaron valor p<0,05. Resultados: se notificaron 184.146 casos sospechosos, con 49.804 confirmados como COVID-19 y 1.020 muertes (letalidad 2,1%). Se observaron diferencias estadísticamente significativas entre grupos de edad y letalidad (valor p <0,001); a mayor edad mayor letalidad (procedimiento de Marascuilo, significativo en la comparación entre mayores de 60 años con los otros grupos de edad); mayor óbito en el sexo masculino (letalidad del 2,7%); y mayor letalidad entre la raza negra (3,0%). Conclusión: En Rondônia, hubo una mayor letalidad entre los adultos mayores, hombres y pardos y negros.

Objective: To describe the characteristics of deaths due to COVID-19 in the state of Rondônia. Methods: This was a descriptive study, with data from the Brazilian National Health System Epidemiological Surveillance System Computerization Strategy (E-SUS-VE, notified between January 1 and August 20, 2020. Statistical tests (Chi-square and Marascuilo procedure) were applied, where differences were considered to be significant when p< 0.05. Results 184,146 suspected cases were reported, of which 49,804 were confirmed as COVID-19, and 1,020 died (lethality 2.1%). Statistically significant differences were observed between age groups and lethality (p-value <0.001); lethality was greater as age increased (Marascuilo procedure, significant in the comparison between the over 60s and the other age groups); death was higher among males (2.7% lethality); and lethality was higher among Black people (3.0%). Conclusion: Lethality was greater among the elderly, males and people of brown and black skin color in Rondônia.

Isolamento social rígido durante a pandemia de COVID-19 em um estado do nordeste brasileiro / Aislamiento social rígido durante la pandemia de COVID-19 en un estado del nordeste brasileño / Rigid social isolation during COVID-19 pandemics i n a state of brazilian northeast

Resumo Objetivo: Analisar a tendência temporal da incidência, mortalidade, cobertura de enfermarias e leitos de terapia intensiva e rígido isolamento social no estado do Ceará e correlacioná-los. Métodos: Estudo ecológico, cuja variável de desfecho foi a taxa de mortalidade. Os preditores foram a incidência, a taxa de ocupação de enfermarias e leitos de terapia intensiva e a taxa de isolamento social. Foi realizada uma regressão linear múltipla considerada significativa quando p <0,05. Resultados: Observou-se tendência de aumento da incidência e mortalidade por COVID-19 no estado do Ceará (p = 0,01). Por outro lado, observou-se tendência de diminuição na ocupação de enfermarias e leitos de terapia intensiva (p = 0,02). A taxa de isolamento social diminuiu significativamente durante o período (p = 0,001). Na regressão linear múltipla, o isolamento social manteve-se inversamente relacionado à mortalidade pela COVID-19 (β = -0,08; p = 0,02). Conclusão: Verificou-se o efeito do rígido isolamento social durante a pandemia de COVID-19. A implementação antecipada do mesmo, com outras ações de saúde pública, mostrou-se relevante para garantir a continuidade de seus benefícios.

Resumen Objetivo: Analizar la tendencia temporal de la incidencia, mortalidad, ocupación de enfermerías y camas de terapia intensiva y el rígido aislamiento social en el estado de Ceará y correlacionarlos. Métodos: Estudio ecológico, cuya variable de criterio de valoración fue el índice de mortalidad. Los predictores fueron la incidencia, el índice de ocupación de enfermerías y camas de terapia intensiva y el índice de aislamiento social. Se realizó una regresión lineal múltiple considerada significativa cuando p < 0,05. Resultados: Se observó una tendencia de aumento de la incidencia y mortalidad por COVID-19 en el estado de Ceará (p = 0,01). Por otro lado, se observó una tendencia de reducción de ocupación de enfermerías y camas de terapia intensiva (p = 0,02). El índice de aislamiento social se redujo significativamente durante el período (p = 0,001). En la regresión lineal múltiple, el aislamiento social se mantuvo inversamente relacionado con la mortalidad por COVID-19 (β = -0,08; p = 0,02). Conclusión: Se verificó el efecto del aislamiento social rígido durante la pandemia de COVID-19. La implementación anticipada de esta medida, junto con otras acciones de salud pública, demostró ser relevante para garantizar la continuidad de sus beneficios.

Abstract Objective: This study aimed to analyze the temporal trend of incidence, mortality, coverage of wards and intensive care beds, and rigid social isolation in the Ceará State and correlate them. Methods: Ecological study, which outcome variable was the mortality rate. Predictors were incidence, occupation rate of bed wards and intensive care beds, and social isolation rate. It was performed a multiple linear regression considering significant when p<0.05. Results: It was observed an increasing trend of incidence and mortality by COVID-19 in the Ceará State (p=0.01). On the other hand, it was seen a decreasing trend in the occupation of wards and intensive care beds (p=0.02). The social isolation rate significantly decreased during the period (p=0.001). In the multiple linear regression, social isolation remained inversely related to mortality by COVID-19 (β=-0.08; p=0,02). Conclusion: It was seen the effect of rigid social isolation during the COVID-19 pandemics. The anticipated implementation of it, with other public health actions, showed relevance to guarantee the continuity of its benefits.