Long-term outcomes for epidemic viral pneumonia survivors after discharge from the intensive care unit: a systematic review

ABSTRACT Objective To review the long-term outcomes (functional status and psychological sequelae) of survivors of critical illnesses due to epidemic viral pneumonia before the COVID-19 pandemic and to establish a benchmark for comparison of the COVID-19 long-term outcomes. Methods This systematic review of clinical studies reported the long-term outcomes in adults admitted to intensive care units who were diagnosed with viral epidemic pneumonia. An electronic search was performed using databases: MEDLINE®, Web of Science™, LILACS/IBECS, and EMBASE. Additionally, complementary searches were conducted on the reference lists of eligible studies. The quality of the studies was assessed using the Newcastle-Ottawa Scale. The results were grouped into tables and textual descriptions. Results The final analysis included 15 studies from a total of 243 studies. This review included 771 patients with Influenza A, Middle East Respiratory Syndrome, and Severe Acute Respiratory Syndrome. It analyzed the quality of life, functionality, lung function, mortality, rate of return to work, rehospitalization, and psychiatric symptoms. The follow-up periods ranged from 1 to 144 months. We found that the quality of life, functional capacity, and pulmonary function were below expected standards. Conclusion This review revealed great heterogeneity between studies attributed to different scales, follow-up time points, and methodologies. However, this systematic review identified negative long-term effects on patient outcomes. Given the possibility of future pandemics, it is essential to identify the long-term effects of viral pneumonia outbreaks. This review was not funded. Prospero database registration: (www.crd.york.ac.uk/prospero) under registration ID CRD42021190296.

Predictors of prolonged ventilator weaning and mortality in critically ill patients with COVID-19 / Preditores de desmame ventilatório prolongado e mortalidade em pacientes críticos com COVID-19

ABSTRACT Objective: To identify factors associated with prolonged weaning and mortality in critically ill COVID-19 patients admitted to ICUs and under invasive mechanical ventilation. Methods: Between March of 2020 and July of 2021, we retrospectively recorded clinical and ventilatory characteristics of critically ill COVID-19 patients from the day of intubation to the outcome. We classified the patients regarding the weaning period in accordance with established criteria. A logistic regression analysis was performed to identify variables associated with prolonged weaning and mortality. Results: The study involved 303 patients, 100 of whom (33.0%) had a prolonged weaning period. Most of the patients were male (69.6%), 136 (44.8%) had more than 50% of pulmonary involvement on chest CT, and 93 (30.6%) had severe ARDS. Within the prolonged weaning group, 62% died within 60 days. Multivariate analysis revealed that lung involvement greater than 50% on CT and delay from intubation to the first separation attempt from mechanical ventilation were significantly associated with prolonged weaning, whereas age and prolonged weaning were significantly associated with mortality. Conclusions: Prolonged weaning can be used as a milestone in predicting mortality in critically ill COVID-19 patients. Lung involvement greater than 50% on CT and delay from intubation to the first separation attempt from mechanical ventilation were identified as significant predictors of prolonged weaning. These results might provide valuable information for healthcare professionals when making clinical decisions regarding the management of critically ill COVID-19 patients who are on mechanical ventilation.

RESUMO Objetivo: Identificar fatores associados ao desmame prolongado e à mortalidade em pacientes críticos com COVID-19 admitidos em UTI e sob ventilação mecânica invasiva. Métodos: Entre março de 2020 e julho de 2021, registramos retrospectivamente as características clínicas e ventilatórias de pacientes críticos com COVID-19 desde o dia da intubação até o desfecho. Os pacientes foram classificados quanto ao período de desmame de acordo com critérios estabelecidos. Foi realizada análise de regressão logística para identificar variáveis associadas ao desmame prolongado e à mortalidade. Resultados: O estudo incluiu 303 pacientes, 100 dos quais (33,0%) apresentaram período de desmame prolongado. A maioria dos pacientes era do sexo masculino (69,6%), 136 (44,8%) apresentaram mais de 50% de acometimento pulmonar na TC de tórax, e 93 (30,6%) apresentaram SDRA grave. No grupo desmame prolongado, 62% foram a óbito em 60 dias. A análise multivariada revelou que o acometimento pulmonar maior que 50% na TC e a demora na primeira tentativa de retirada da ventilação mecânica após a intubação apresentaram associação significativa com o desmame prolongado, enquanto a idade e o desmame prolongado apresentaram associação significativa com a mortalidade. Conclusões: O desmame prolongado pode ser utilizado como marco na predição de mortalidade em pacientes críticos com COVID-19. O acometimento pulmonar maior que 50% na TC e a demora na primeira tentativa de retirada da ventilação mecânica após a intubação foram identificados como preditores significativos de desmame prolongado. Esses resultados podem fornecer informações valiosas para os profissionais de saúde na tomada de decisões clínicas sobre o manejo de pacientes críticos com COVID-19 e em ventilação mecânica.

Clinical and imaging features of adult influenza B viral pneumonia / 中国医师杂志

Objective:To analyze the clinical and imaging characteristics of adult patients with influenza B viral pneumonia and improve the understanding of influenza B viral pneumonia in clinicians.Methods:The clinical data of adult patients with influenza B virus pneumonia were collected from January 2021 to December 2022 in the fever clinic of Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University. The clinical symptoms, blood routine results and lung computed tomography (CT) results were analyzed and summarized.Results:The clinical data of 24 adult patients with influenza B virus pneumonia were collected. The time from onset to treatment was (2.7±0.3)d. All patients had fever, and 14 of them had body temperature >39 ℃. Blood routine and procalcitonin levels were normal, while C-reactive protein levels were elevated [(56.28±32.35)mg/L]. Oxygen saturation was normal (≥95%). The pulmonary CT findings were mostly small flake ground glass shadows distributed on one side, and some of them were cord shadows caused by interstitial lesions.Conclusions:Influenza B virus infection can also cause pneumonia, but is relatively limited and has a good prognosis.

Características clínicas de pacientes hospitalizados con infección por Covid-19 en la Clínica SOMA de Medellín, Colombia / Clinical characteristics of hospitalized patients with Covid-19 infection at the SOMA Clinic in Medellín, Colombia / Características clínicas de pacientes hospitalizados com infecção por Covid-19 na Clínica SOMA em Medellín, Colômbia

Objetivo: el virus SARS-COV-2 llegó a Medellín el 9 de marzo del 2020, afectando hasta el 8 de octubre 2021 a 397.395 personas en esta ciudad. Este estudio busca describir el comportamiento clínico de los pacientes hospitalizados en la Clínica SOMA en el periodo entre julio 1 de 2020 y enero 31 de 2021, así como identificar variables clínicas y paraclínicas asociadas a su ingreso a UCI y la mortalidad. Metodología: cohorte retrospectiva con datos de historias clínicas de adultos admitidos en la Clínica SOMA por Covid-19 entre julio 1 de 2020 y enero 31 de 2021. Resultados: se identificaron 849 individuos adultos con Covid-19, de los cuales 326 fueron hospitalizados (38.4%), la mortalidad fue del 13%. Los factores más asociados a severidad fueron la disnea, hipertensión arterial, enfermedad cardiovascular, dímero D elevado, deshidrogenasa láctica, linfopenia y una mayor edad. Conclusiones: nuestro estudio evidenció un comportamiento similar al descrito en otros estudios en el mundo frente a variables al ingreso por Covid-19, que se asocian con peores desenlaces clínicos.

Objective: SARS COV-2 virus arrived in Medellin on March 9, 2020, affecting 397 395 people in Medellin by Oct 8, 2021. This study aims to describe the clinical behavior of patients hospitalized in SOMA Clinic between July 1st, 2020, and January 31st, 2021, and to identify clinical and paraclinical variables associated with ICU entry and mortality. Methodology: retrospective cohort with data from medical records of all patients over 18 years of age admitted to the SOMA Clinic for Covid-19 between July 1st, 2020, and January 31st, 2021. Results: 849 patients with Covid-19 consulted the emergency room of the SOMA Clinic, out of which 326 were hospitalized (38.4%) with a mortality of 13%. Dyspnea, hypertension, cardiovascular disease, elevated D-dimer values, lactic dehydrogenase, and lymphopenia and older age were associated with severity. Conclusions: like other studies worldwide, we evidenced clinical and paraclinical parameters at entry that are associated with worst clinical outcomes in a SARS-COV-2 infection.

Objetivo: o vírus SARS-COV-2 chegou a Medellín em 9 de março de 2020, afetando 397.395 pessoas nesta cidade até 8 de outubro de 2021. Este estudo busca descrever o comportamento clínico dos pacientes internados na Clínica SOMA no período entre 1º de julho de 2020 e 31 de janeiro de 2021, bem como identificar variáveis clínicas e paraclínicas associadas à sua admissão na UTI e mortalidade. Metodologia: coorte retrospectiva com dados de prontuários de adultos internados na Clínica SOMA por Covid-19 entre 1º de julho de 2020 e 31 de janeiro de 2021.Resultados: foram identificados 849 indivíduos adultos com Covid-19, dos quais 326 foram hospitalizados (38,4%), a mortalidade foi de 13%. Os fatores mais associados à gravidade foram dispneia, hipertensão arterial, doença cardiovascular, D-dímero elevado, desidrogenase lática, linfopenia e idade avançada. Conclusões: nosso estudo mostrou um comportamento semelhante ao descrito em outros estudos no mundo frente às variáveis na admissão por Covid-19, que estão associadas a piores desfechos clínicos.

CT imaging features and risk factors of secondary bronchiolitis obliterans in children with adenovirus pneumonia / 中国医师杂志

Objective:To investigate the high-resolution CT features and risk factors of secondary bronchiolitis obliterans (BO) in children with adenovirus pneumonia.Methods:In this study, a case-control study method was adopted, and 44 children with BO secondary to adenovirus pneumonia in Dongguan Children′s Hospital Affiliated to Guangdong Medical University from January 2015 to October 2020 were selected as the observation group, and 45 children with simple adenovirus pneumonia during the same period were selected as the control group. The differences in the chest high-resolution CT imaging characteristics of the two groups of children were compared. The risk factors of secondary BO in children with adenovirus pneumonia were analyzed by single factor and multiple factor logistic regression.Results:In the lung CT examination of children in the observation group, the detection rates of mosaic perfusion sign, bronchial wall thickening, bronchiectasis, lung consolidation and clear lung were significantly higher than those in the control group, and the difference was statistically significant (all P<0.05); Logistic regression model showed that prolonged heat course, high heat peak, mechanical ventilation treatment and prolonged mechanical ventilation time were independent risk factors of secondary BO children with adenovirus pneumonia (all P<0.05). Conclusions:Children with BO secondary to adenovirus pneumonia have typical high-resolution CT features, which is of high practical value for clinical diagnosis. Prolonged heat course, high heat peak, mechanical ventilation treatment and prolonged mechanical ventilation were independent risk factors of secondary BO in children with adenovirus pneumonia.

The value of CT signs combined with radiomics in the differentiation of COVID-19 from other viral pneumonias / 中华放射学杂志

Objective:To explore the classification performance of combined model constructed from CT signs combined with radiomics for discriminating COVID-19 pneumonia and other viral pneumonia.Methods:The clinical and CT imaging data of 181 patients with viral pneumonia confirmed by reverse transcription-polymerase chain reaction in 15 hospitals of Yunnan Province from March 2015 to March 2020 were analyzed retrospectively. The 181 patients were divided into COVID-19 group (89 cases) and non-COVID-19 group (92 cases), which were further divided into training cohort (126 cases) and test cohort (55 cases) at a ratio of 7∶3 using random stratified sampling. The CT signs of pneumonia were determined and the radiomics features were extracted from the initial unenhanced chest CT images to build independent and combined models for predicting COVID-19 pneumonia. The diagnostic performance of the models were evaluated using receiver operating characteristic (ROC) analysis, continuous net reclassification index (NRI) calibration curve and decision curve analysis.Results:The combined models consisted of 3 significant CT signs and 14 selected radiomics features. For the radiomics model alone, the area under the ROC curve (AUC) were 0.904 (sensitivity was 85.5%, specificity was 84.4%, accuracy was 84.9%) in the training cohort and 0.866 (sensitivity was 77.8%, specificity was 78.6%, accuracy 78.2%) in the test cohort. After combining CT signs and radiomics features, AUC of the combined model for the training cohort was 0.956 (sensitivity was 91.9%, specificity was 85.9%, accuracy was 88.9%), while that for the test cohort was 0.943 (sensitivity was 88.9%, specificity was 85.7%, accuracy was 87.3%). The AUC values of the combined model and the radiomics model in the differentiation of COVID-19 group and the non-COVID-19 group were significantly different in the training cohort ( Z=-2.43, P=0.015), but difference had no statistical significance in the test cohort ( Z=-1.73, P=0.083), and further analysis using the NRI showed that the combined model in both the training cohort and the test cohort had a positive improvement ability compared with radiomics model alone (training cohort: continuous NRI 1.077, 95 %CI 0.783-1.370; test cohort: continuous NRI 1.421, 95 %CI 1.051-1.790). The calibration curve showed that the prediction probability of COVID-19 predicted by the combined model was in good agreement with the observed value in the training and test cohorts; the decision curve showed that a net benefit greater than 0.6 could be obtained when the threshold probability of the combined model was 0-0.75. Conclusion:The combination of CT signs and radiomics might be a potential method for distinguishing COVID-19 and other viral pneumonia with good performance.

Chest computed tomography in COVID-19 pneumonia: a retrospective study of 155 patients at a university hospital in Rio de Janeiro, Brazil / Tomografia computadorizada de tórax na pneumonia por COVID-19: estudo retrospectivo de 155 pacientes em um hospital universitário no Rio de Janeiro, Brasil

Abstract Objective: To define diagnostic criteria for coronavirus disease 2019 (COVID-19) on computed tomography (CT); to study the correlation between CT and polymerase chain reaction (PCR) testing for infection with severe acute respiratory syndrome coronavirus 2; and to determine whether the extent of parenchymal involvement and the need for mechanical ventilation are associated with the CT findings and clinical characteristics of patients with COVID-19. Materials and Methods: This was a retrospective study of 155 patients with COVID-19 treated between March and May 2020. We attempted to determine whether the CT findings correlated with age and clinical variables, as well as whether the need for mechanical ventilation correlated with the extent of the pulmonary involvement. Results: On average, the patients with COVID-19 were older than were those without (mean age, 54.8 years vs. 45.5 years; p = 0.031). The most common CT finding (seen in 88.6%) was ground-glass opacity, which correlated significantly with a diagnosis of COVID-19 (p = 0.0001). The CT findings that correlated most strongly with the need for mechanical ventilation were parenchymal bands (p = 0.013), bronchial ectasia (p = 0.046), and peribronchovascular consolidations (p = 0.012). The presence of one or more comorbidities correlated significantly with more extensive parenchymal involvement (p = 0.023). For the diagnosis of COVID-19, CT had a sensitivity of 84.3%, a specificity of 36.7%, and an accuracy of 73.5% (p = 0.012 vs. PCR). Conclusion: The patterns of CT findings are useful for the diagnosis of COVID-19 and the evaluation of disease severity criteria. The presence of any comorbidity is associated with greater severity of COVID-19.

Resumo Objetivo: Definir os critérios diagnósticos da COVID-19 na tomografia computadorizada (TC), estudar a concordância entre a TC e o PCR e determinar a associação da extensão do envolvimento parenquimatoso e ventilação mecânica com os achados tomográficos e características clínicas da amostra. Materiais e Métodos: Estudo de 155 pacientes com COVID-19 atendidos entre março e maio de 2020. Tentamos determinar se os achados da TC se correlacionavam com a idade e variáveis clínicas, bem como se a necessidade de ventilação mecânica se correlacionava com a extensão do envolvimento pulmonar. Resultados: A faixa etária dos pacientes com COVID-19 (54,8 anos) foi maior do que a dos pacientes sem a doença (45,5 anos) (p = 0,031). Opacidades em vidro fosco foram as alterações mais frequentes (88,6%; p = 0,0001). Bandas parenquimatosas (p = 0,013), ectasia brônquica (p = 0,046) e consolidações peribroncovasculares (p = 0,012) foram mais frequentes nos pacientes que necessitaram de ventilação mecânica. Pacientes com comorbidades apresentaram envolvimento parenquimatoso mais extenso (p = 0,023). A TC apresentou sensibilidade de 84,3%, especificidade de 36,7% e acurácia de 73,5% (p = 0,012). Conclusão: Os padrões de TC são úteis para o diagnóstico de COVID-19 e avaliação dos critérios de gravidade da doença. Pacientes com comorbidades estão associados a condições clínicas mais graves.

Coronavírus: mini revisão / Coronavirus: mini review

Pandemias surgem de tempos em tempos, acometem muitos países e impactam em muitas áreas além da saúde pública, desde sociais até econômicas. O surgimento desta pandemia de coronavírus na China, alerta para o fato da aproximação do homem com o meio ambiente, havendo a possibilidade de transmissão de doenças por vetores primários e intermediários ao homem. Frente a novas doenças, precisamos entender sua epidemiologia, sua patologia e cura (ou, o melhor que estiver disponível para o seu tratamento). O coronavírus surgiu como doença a partir de um mercado na China, como tantos existem mundo afora. O avanço desta pandemia mostrou que não estávamos preparados para ela, que pela primeira vez uma gripe transmitida por morcegos atingiu globalmente a saúde pública. Esta mini revisão procura mostrar um pouco do entendimento do coronavírus e do seu caminho até o epitélio pulmonar, iniciando, ali sintomas que podem ser insidiosos a até uma síndrome de angústia respiratória aguda

Pandemics arise from time to time, present im many countries and impact in many areas beyond public health, from social and economic areas. The emergence of this coronavirus pandemic in China, warns of the fact that the approximation of the man with the environment, the possibility of transmission of diseases from primary and secondary hosts to man. Facing emergence diseases, we must understand the epidemiology, the pathology and the treatment of this (or the best available for your treatment). The coronavirus emerged as a disease in a market in China, like so many exist worldwide. The advance of this pandemic shows us that we are not prepared for it, that for the first time a strain of influenza swept across all humanity and their health public systemn. This mini review seeks to show a little understanding of the coronavirus and your way to the pulmonary epithelium, starting symptoms that can be insidious to even an acute respiratory distress syndrome.

Comorbidities and in-hospital death of viral pneumonia adults admitted to SUS (2002-2015)

ABSTRACT OBJECTIVE To identify demographic and clinical characteristics of adult patients hospitalized in the Brazilian Unified Health System (SUS) due to viral pneumonia and investigate the association between some comorbidities and death during hospitalization. METHODS This retrospective cohort study was conducted with secondary data of adults admitted to SUS due to viral pneumonia between 2002 and 2015. Patient profile was characterized based on demographic and clinical variables. The association between the ten Elixhauser comorbidities and in-hospital death was investigated using Poisson regression models with robust standard errors. Results were quantified as incidence rate ratio (IRR) with 95% confidence intervals (CI), and we built five models using successive inclusion of variables blocks. RESULTS Hospital admissions for viral pneumonias decreased throughout the study period, and it was observed that 5.8% of hospitalized patients had an in-hospital death. We observed significant differences in demographic and clinical characteristics by comparing individuals who died during hospitalization with those who did not, with the occurrence of one or more comorbidities being more expressive among patients who died. Although not considered risk factors for in-hospital death, chronic pulmonary disease and congestive heart failure were the most common comorbidities. Conversely, IRR for in-hospital death increased with other neurological disorders, diabetes, cancer, obesity, and especially with HIV/AIDS. CONCLUSIONS Individuals presenting with pulmonary and cardiovascular diseases require proper attention during hospitalization, as well as those with other neurological diseases, diabetes, cancer, obesity, and especially HIV/AIDS. Understanding the influence of chronic diseases on viral infections may support the healthcare system in achieving better outcomes.

Epidemiological characteristics and disease spectrum analysis of outpatients in the dermatology department of a hospital in Wuhan during the COVID-19 epidemic / 中华皮肤科杂志

Objective:To investigate epidemiological characteristics of outpatients and disease spectrum in the dermatology department during the COVID-19 epidemicMethods:A retrospective comparison of outpatient visits, gender, age and disease types in the dermatology department of Wuhan No.1 Hospital was performed between COVID-19 epidemic period (from 23th January 2020 to 15th April 2020) and the same period in 2019. Enumeration data were analyzed by Pearson′s chi-square test.Results:During the COVID-19 epidemic, the number of outpatient visits to the dermatology department of the hospital decreased markedly, and the average daily number of outpatient visits (236 visits/day) was only 8.81% of that during the same period in 2019 (2 678 visits/day) ; the ratio of male to female patients was reversed from 1∶1.37 in 2019 to 1.16∶1 in 2020; the proportions of patients aged 0-6, 7-12, 13-17 and 18-45 years significantly decreased compared with those in 2019 (all P < 0.001) , and the proportions of patients aged 46-69 and > 69 years significantly increased (both P < 0.001) . During the COVID-19 epidemic, there were 171 types of skin diseases in the dermatology outpatient department, and the number of disease categories decreased compared with that during the same period in 2019 (442 types) ; the number of patient visits for allergic skin diseases, erythematous papulosquamous skin diseases, viral infectious skin diseases and bacterial infectious skin diseases significantly increased compared with that during the same period in 2019 (all P < 0.001) , while the number of patient visits for sebaceous and sweat gland disorders, pigmented skin diseases and physical skin diseases significantly decreased (all P < 0.001) . Conclusion:Compared with the same period in 2019, the number of outpatient visits, patient sex ratio, age distribution and disease types in the dermatology department have undergone marked changes during the COVID-19 epidemic, and this study provides a reference for healthcare workers in dermatology department to respond to various epidemics and natural disasters in the future.

Lung lesion burden found on chest ct as a prognostic marker in hospitalized patients with high clinical suspicion of COVID-19 pneumonia: a brazilian experience

OBJECTIVE: To investigate the relationship between lung lesion burden (LLB) found on chest computed tomography (CT) and 30-day mortality in hospitalized patients with high clinical suspicion of coronavirus disease 2019 (COVID-19), accounting for tomographic dynamic changes. METHODS: Patients hospitalized with high clinical suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a dedicated and reference hospital for COVID-19, having undergone at least one RT-PCR test, regardless of the result, and with one CT compatible with COVID-19, were retrospectively studied. Clinical and laboratory data upon admission were assessed, and LLB found on CT was semi-quantitatively evaluated through visual analysis. The primary outcome was 30-day mortality after admission. Secondary outcomes, including the intensive care unit (ICU) admission, mechanical ventilation used, and length of stay (LOS), were assessed. RESULTS: A total of 457 patients with a mean age of 57±15 years were included. Among these, 58% presented with positive RT-PCR result for COVID-19. The median time from symptom onset to RT-PCR was 8 days [interquartile range 6-11 days]. An initial LLB of ≥50% using CT was found in 201 patients (44%), which was associated with an increased crude at 30-day mortality (31% vs. 15% in patients with LLB of <50%, p<0.001). An LLB of ≥50% was also associated with an increase in the ICU admission, the need for mechanical ventilation, and a prolonged LOS after adjusting for baseline covariates and accounting for the CT findings as a time-varying covariate; hence, patients with an LLB of ≥50% remained at a higher risk at 30-day mortality (adjusted hazard ratio 2.17, 95% confidence interval 1.47-3.18, p<0.001). CONCLUSION: Even after accounting for dynamic CT changes in patients with both clinical and imaging findings consistent with COVID-19, an LLB of ≥50% might be associated with a higher risk of mortality.

Chest computed tomography in the diagnosis of COVID-19 in patients with false negative RT-PCR / Tomografia computadorizada de tórax no diagnóstico de COVID-19 em pacientes com resultado falso-negativo na RT-PCR

ABSTRACT Objective To evaluate the role of chest computed tomography in patients with COVID-19 who presented initial negative result in reverse transcriptase-polymerase chain reaction (RT-PCR). Methods A single-center, retrospective study that evaluated 39 patients with negative RT-PCR for COVID-19, who underwent chest computed tomography and had a final clinical or serological diagnosis of COVID-19. The visual tomographic classification was evaluated according to the Consensus of the Radiological Society of North America and software developed with artificial intelligence for automatic detection of findings and chance estimation of COVID-19. Results In the visual tomographic analysis, only one of them (3%) presented computed tomography classified as negative, 69% were classified as typical and 28% as indeterminate. In the evaluation using the software, only four (about 10%) had a probability of COVID-19 <25%. Conclusion Computed tomography can play an important role in management of suspected cases of COVID-19 with initial negative results in RT-PCR, especially considering those patients outside the ideal window for sample collection for RT-PCR.

RESUMO Objetivo Avaliar o papel da tomografia computadorizada de tórax em pacientes com COVID-19 que apresentaram reação em cadeia da polimerase via transcriptase reversa (RT-PCR) inicial falsamente negativa. Métodos Estudo retrospectivo de centro único que avaliou 39 pacientes com RT-PCR negativa para COVID-19, submetidos à tomografia computadorizada de tórax e que tiveram diagnóstico final clínico ou serológico de COVID-19. A classificação tomográfica visual foi avaliada de acordo com o Consenso da Radiological Society of North America e o software desenvolvido com inteligência artificial para detecção automática de achados e estimativa de probabilidade de COVID-19. Resultados Na análise tomográfica visual, somente um deles (3%) apresentou tomografia computadorizada classificada como tendo resultado negativo, 69% foram classificados como típicos e 28% como indeterminados. Na avaliação com uso de software, somente quatro (cerca de 10%) tiveram probabilidade de COVID-19 <25%. Conclusão A tomografia computadorizada pode desempenhar papel importante no manejo de casos suspeitos de COVID-19 com RT-PCR inicialmente negativa, principalmente levando-se em consideração os pacientes que estão fora da janela ideal para coleta de amostra para RT-PCR.

Propuesta de un protocolo de rehabilitación pulmonar en pacientes supervivientes de COVID -19 / Proposal for a pulmonary rehabilitation protocol in patients surviving COVID-19 / Proposta de um protocolo de reabilitação pulmonar em pacientes sobreviventes da COVID -19

Resumen: La enfermedad por coronavirus 2019 (COVID-19) causada por el virus SARS-CoV-2 es una nueva enfermedad caracterizada por generar daño pulmonar y compromiso de múltiples tejidos y órganos de todo el cuerpo. Algunos de los pacientes que presentan la infección ameritan manejo intrahospitalario con soporte de O2 y medidas adicionales que pueden incluir inmovilización prolongada en UCI. Los pacientes que presentan cuadros moderados o severos y sobreviven a la enfermedad pueden presentar deterioro y disfunciones a largo plazo, incluyendo fibrosis pulmonar, miocardiopatía, lesión renal, hepática, de nervio periférico y todas las complicaciones derivadas de hospitalizaciones en UCI. Se considera que la intervención en rehabilitación pulmonar reviste gran importancia, especialmente en la etapa de recuperación, y debe realizarse, principalmente, con los objetivos de mejorar la disnea, la debilidad muscular severa y la fatiga, a fin de promover la independencia funcional y aumentar la calidad de vida, de manera que se disminuye así la ansiedad y la depresión.

Abstract: Coronavirus disease 2019 (COVID-19) caused by SARS-COV-2 virus is a new disease characterized by generating lung damage and compromising multiple tissues and organs throughout the body. Some of the patients with the infection should need intrahospital management with O2 support and additional measures that may include prolonged ICU immobilization. Patients who have moderate or severe conditions and survive the disease, could experience long-term impairment and dysfunction, including pulmonary fibrosis, cardiomyopathy, renal, hepatic and peripheral nerve injury, and all complications arising from hospitalizations in the ICU. It is considered that intervention in pulmonary rehabilitation is particularly important, especially at the recovery stage, and should be performed mainly with the objectives of improving: dyspnea, severe muscle weakness and fatigue, in order to promote functional independence and increase quality of life, so that anxiety and depression are diminished.

Resumo: A doença por coronavírus (COVID-19), causada pelo vírus SARS-COV-2, é uma nova doença caracterizada por gerar dano pulmonar e comprometimento de múltiplos tecidos e órgãos de todo o corpo. Alguns dos pacientes que apresentam a infecção merecem atendimento intra-hospitalar com suporte de O2 e medidas extraordinárias que podem incluir imobilização prolongada na UTI. Os pacientes que apresentam quadros moderados ou graves e sobrevivem à doença podem apresentar deterioração e disfunções em longo prazo, incluindo fibrose pulmonar, miocardiopatia, lesão renal, hepática, de nervo periférico e todas as complicações derivadas de internações em UTI. Considera-se que a intervenção em reabilitação pulmonar ganha grande importância, especialmente na etapa de recuperação, e deve realizar-se principalmente com o objetivo de melhorar a dispneia, a debilidade muscular grave e a fatiga, a fim de promover a independência funcional e aumentar a qualidade de vida, para que assim a ansiedade e a depressão diminuam.

Caracterización del comportamiento de las infecciones respiratorias agudas. Provincia Cienfuegos. Primer trimestre 2020 / Characterization of acute respiratory infections behavior. Cienfuegos Province. First quarter 2020

RESUMEN Fundamento: debido a la pandemia actual de COVID 19, es importante conocer las esencialidades tipificadoras de las infecciones respiratorias agudas en general para futuros estudios en que COVID 19 constituirá una categoría de la taxonomía de aquellas, a tener en cuenta. Objetivo: caracterizar las infecciones respiratorias agudas en la provincia Cienfuegos del 1 de enero al 31 de marzo del 2020. Métodos: la población estudiada fue los habitantes de la provincia de Cienfuegos. Las principales variables de estudio consideradas fueron: grupos de edades, municipios de residencia, demanda de consultas médicas, semanas estadísticas, variación temporal de las tasas, su tendencia, gravedad de evolución clínica, ingresos y fallecidos por infecciones respiratorias graves, brotes y vigilancia epidemiológica. Los métodos y técnicas estadísticas utilizadas fueron, de la estadística descriptiva: las frecuencias absolutas y relativas, las medias, las tasas, los incrementos y disminución de las tasas, el corredor endémico y su tendencia. Resultados: las esencialidades tipificadoras fueron: su mayor incidencia en menores de cinco años de edad y adultos de 60 años y más; la principal causa de muerte fue por neumonía adquirida en la comunidad; los virus circulantes identificados fueron sincitial respiratorio, parainfluenza, influenza A no subtipificado y coronavirus. La tendencia es ascendente. Conclusiones: el comportamiento de las infecciones respiratorias agudas se encontró dentro de los parámetros esperados, excepto que a partir de la semana once existió un incremento de las atenciones médicas, lo cual pudiera relacionarse con las pesquisas y acciones de vigilancia.

ABSTRACT Foundation: due to the current pandemic of COVID 19, it is important to know the categorizing essentialities of acute respiratory infections in general for future studies in which COVID 19 will constitute a category of the taxonomy of those to be taken into account. Objective: to characterize acute respiratory infections in the Cienfuegos province from January 1 to March 31, 2020. Methods: the population studied was the population of the Cienfuegos province. The main study variables considered were: age groups, municipalities of residence, demand for medical consultations, statistical weeks, rates temporal variation, their trend, severity of clinical evolution, admissions and deaths from severe respiratory infections, outbreaks and epidemiological surveillance. Statistical methods and techniques used were, from descriptive statistics: absolute and relative frequencies, means, rates, increases and decreases in rates, the endemic corridor and its trend. Results: the characterizing essentialities were: its highest incidence in children under five years of age and adults 60 years and over; the leading cause of death was from community-acquired pneumonia; the identified circulating viruses were respiratory syncytial, parainfluenza, unsubtyped influenza A, and coronavirus. The trend is upward. Conclusions: the behavior of acute respiratory infections was within the expected parameters, except that from week eleven there was an increase in medical care, which could be related to the inquiring and surveillance actions.

Neumonía grave de evolución tórpida en paciente joven con prueba molecular negativa para nuevo coronavirus / Severe Pneumonia Of Torpid Evolutión In A Young Patient With A Negative Molecular Test For A New Coronavirus

La enfermedad por coronavirus originada en el año 2019 (COVID-19), se ha diseminado rápidamente en todo el mundo produciendo estragos en el sistema de salud y la sociedad. Se reporta el caso de un varón de 26 años de edad con antecedentes de asma y obesidad, que retornó de EE.UU y acudió a emergencia con síntomas respiratorios, hipoxemia e infiltrado intersticial en la radiografía de tórax, se decide internamiento en sala de aislamiento, la prueba molecular RT-PCR de hisopado nasofaríngeo resultó negativa, por lo que fue traslado a una sala de emergencia común. El manejo inicial fue conservador, sin embargo el paciente evolucionó desfavorablemente requiriendo soporte ventilatorio, pero fallece al quinto día de internamiento. Se recibió un segundo resultado positivo para SARS-CoV-2 al día siguiente de fallecido el paciente, siendo una de las primeras víctimas jóvenes en el Perú.

The coronavirus disease originated in the year 2019 (COVID-19), has spread rapidly throughout the world, wreaking havoc on the health system and society. We report the case of a 26-year-old man with a history of asthma and obesity, who returned from the US and went to the emergency room with respiratory symptoms, hypoxemia and interstitial infiltrate on chest radiography, he was admitted to the isolation room The nasopharyngeal swab RT-PCR molecular test was negative, so he was transferred to a common emergency room. Initial management was conservative, however the patient evolved unfavorably requiring ventilatory support, but died on the fifth day of hospitalization. A second positive result for SARS-CoV-2 was received the day after the patient died, being one of the first young victims in Peru.

Caracterización de pacientes con COVID-19 grave atendidos en un hospital de referencia nacional del Perú / Description of patients with severe COVID-19 treated in a national referral hospital in Peru

RESUMEN Con el objetivo de describir las manifestaciones de pacientes con enfermedad por coronavirus 2019 (COVID-19), se evaluaron variables sociodemográficas, antecedentes, manifestaciones clínicas y radiológicas, tratamientos y evolución en pacientes que ingresaron por emergencia, del 6 al 25 de marzo de 2020, al Hospital Nacional Edgardo Rebagliati Martins en Lima. Se registraron 17 pacientes: el 76% eran varones, edad promedio de 53,5 años (rango de 25 a 94); el 23,5% había regresado del extranjero; 41,2% referido de otros establecimientos de salud; 41,2% ingresó a ventilación mecánica; falleció el 29,4% (5 pacientes). Los factores de riesgo detectados fueron adulto mayor, tener hipertensión arterial y obesidad; los principales síntomas, tos, fiebre y disnea; los hallazgos de laboratorio frecuentes, proteína C reactiva elevada y linfopenia; la presentación radiológica predominante, el infiltrado pulmonar intersticial bilateral. Se reporta una primera experiencia en el manejo de pacientes con diagnóstico de la COVID-19 grave en el Perú.

ABSTRACT In order to describe manifestations from patients with coronavirus disease 2019 (COVID-19), sociodemographic variables such as, previous medical history, clinical and radiological manifestations, treatments and evolution of patients were evaluated. This took place from March 6th to 25th, 2020, in the "Edgardo Rebagliati Martins" National Hospital in Lima. Seventeen patients were registered: 76% were male, with an average age of 53.5 years (range 25-94); 23.5% had returned from abroad; 41.2% were referred from other health facilities; 41.2% were admitted to mechanical ventilation; 29.4% (5 patients) died. The risk factors detected were: advanced age, arterial hypertension and obesity. The main symptoms detected were: cough, fever and dyspnea. Frequent laboratory findings were: elevated C-reactive protein and lymphopenia. The predominant radiological presentation was bilateral interstitial lung infiltrate. A first experience in the management of patients diagnosed with severe COVID-19 in Peru is reported.

Diagnóstico etiológico de la neumonía: un problema en la práctica clínica pediátrica / Etiological diagnosis of pneumonia: a problem of pediatric clinical practice

Resumen La neumonía en niños es causa frecuente de morbilidad y mortalidad, especialmente en países de bajos ingresos; es indispensable proporcionar una adecuada conducta terapéutica, idealmente orientada por etiología, pues la principal consecuencia de no establecer un diagnóstico etiológico preciso es el abuso de antibióticos. La evaluación clínica y radiológica son los pilares básicos para el diagnóstico de neumonía, y el conocimiento del comportamiento epidemiológico de los gérmenes y los biomarcadores ayudan a su aproximación etiológica. Se revisaron aspectos prácticos sobre el diagnóstico de la neumonía en niños, abordando criterios clínicos y epidemiológicos (edad y género), reactantes de fase aguda, hallazgos radiológicos y modelos de predicción etiológica utilizados como herramientas para la diferenciación de neumonía bacteriana de viral en menores de 18 años, en escenarios donde no se dispone rutinariamente de técnicas más precisas para diagnóstico rápido, como aquellas de tipo inmunológico o moleculares. MÉD.UIS.2020;33(1):39-52.

Abstract Pneumonia in children is a frequent cause of morbidity and mortality, especially in low-income countries. Due to this, it is indispensable to get a right therapeutic behavior, ideally focused by etiology, because the main consequence of not establishing an accurate etiological diagnosis is the abuse of antibiotics. The radiologic and clinic evaluations are basic pillars for pneumonia diagnosis and the knowledge in epidemiological behavior and biomarkers is very useful for an etiological approximation. Practical aspects were reviewed about pneumonia diagnosis in children, addressing clinic and epidemiological criteria (age and gender), acute phase reactants, radiological findings and etiological prediction models used as tools for differentiation between viral and bacterial pneumonia in children under 18 years old, in scenarios where it is not possible to find techniques for a right diagnostic, as those of immunologic and molecular types. MÉD.UIS.2020;33(1):39-52.

Clasificación clínica y tratamiento temprano de la COVID-19. Reporte de casos del Hospital de Emergencias Villa El Salvador, Lima-Perú / Clinical classification and early therapy for COVID-19. Cases reported from Hospital de Emergencias Villa el Salvador, Lima-Peru

RESUMEN La enfermedad producida por el SARS-CoV-2 constituye una pandemia declarada con alta contagiosidad y letalidad en grupos de riesgo. En menos de tres meses la humanidad ha tenido que lidiar con este virus sin saber mucho de su patogenia y tratamiento. Se presentan cinco casos atendidos en el Hospital de Emergencias Villa El Salvador (HEVES) en Lima, Perú. Se destaca la importancia de la clasificación clínica en cuatro estadios: leve, moderado, severo y crítico y revisamos el tratamiento antiviral, inmunomodulador y antitrombótico consecuente a tal clasificación. La terapia antiviral con hidroxicloroquina y azitromicina obtuvo resultados favorables en cuatro casos: sobre todo, cuando se inició en los primeros días de enfermedad. Sin embargo, su eficacia es aún controversial y se esperan resultados de ensayos clínicos aleatorizados. Mientras tanto, su uso en fase temprana de la enfermedad, en estadios leves o moderados, debería mantenerse.

ABSTRACT The disease caused by SARS-CoV-2 is a pandemic characterized for being highly contagious and lethal in groups at risk. In less than three months, mankind had to fight against this virus without knowing its pathogenicity and therapy. We present the experience with five cases seen in the Hospital de Emergencias Villa el Salvador in Lima, Peru, and we emphasize the importance of the clinical classification of the disease in four stages: mild, moderate, severe, and critical. We reviewed the current antiviral, immunomodulatory, and antithrombotic therapy approaches. Antiviral therapy using hydroxichloroquine and azithromycin led to favorable outcomes in four cases, particularly when it was early instituted. Nonetheless, its efficacy is still controversial and results from randomized clinical trials are eagerly awaited. Meanwhile, its use during the early phases of mild or moderate disease should be maintained.

Neumonía atípica y COVID-19 durante la pandemia. A propósito de casos manejados exitosamente a domicilio / Atypical pneumonia and COVID-19 during the pandemic. Regarding cases successfully managed at home / Pneumonia atípica e COVID-19 durante a pandémica. Em relação aos casos gerenciados com sucesso em casa

Resumen: Un nuevo virus emergió a finales del año pasado en Wuhan, China, lo que ocasionó una pandemia de enormes proporciones que se ha extendido por todo el planeta cobrando miles de vidas humanas. Su forma grave, la neumónica, puede alcanzar criterios de SIRPA y se asocia con una elevada mortalidad. Se discute un posible sobreuso de ventiladores mecánicos por una no del todo apropiada selección de casos en los hospitales en el contexto de un nuevo padecimiento, con una fisiopatología no bien comprendida y una alta posibilidad de lesión pulmonar asociada al ventilador, así como su eventual manejo domiciliario en casos bien seleccionados. En tiempos de pandemia, el ingreso a la UCI debe ser estrictamente sensato y razonado.

Abstract: A new virus emerged at the end of last year in Wuhan, China, causing a huge pandemic that has spread across the planet, taking thousands of human lives. Its severe form, pneumonia, can meet ARDS criteria and is associated with high mortality. A possible overuse of mechanical ventilators is discussed due to a not entirely appropriate selection of cases in hospitals in the context of a new condition with a poorly understood pathophysiology and a high possibility of ventilator-associated lung injury, as well as its eventual home management in well selected cases. In times of pandemic, admission to the ICU must be strictly sensible and reasoned.

Resumo: Um novo vírus surgiu no final do ano em Wuhan, na China, causando uma pandemia de enormes proporções que se espalhou por todo o planeta, levando milhares de vidas humanas. Sua forma grave, pneumonia, pode atender aos critérios da ARDS e está associada a alta mortalidade. Um possível uso excessivo de ventiladores mecânicos é discutido devido a uma seleção não totalmente apropriada de casos em hospitais no contexto de uma nova doença com uma fisiopatologia pouco compreendida e uma alta possibilidade de lesão pulmonar associada ao ventilador, bem como seu eventual tratamento domiciliar em casos bem selecionados. Em tempos de pandemia, a admissão na UTI deve ser estritamente sensata e fundamentada.