Hospitalizations and deaths of children and adolescents with Severe Acute Respiratory Infection due to COVID-19 during the epidemiological year of 2020.

This study aimed to analyze the profile of hospitalizations and factors associated with the deaths of children and adolescents with severe acute respiratory infection (SARI) caused by SARS-CoV-2 nationwide. The study comprised 6,843 children and adolescents hospitalized in 2020 who tested positive for COVID-19, based on data from the Influenza Epidemiological Surveillance Information System. Sociodemographic and clinical profiles, hospitalization frequency, lethality and recovery rates were analyzed. The outcome was recovery or death. The 6,843 children and adolescents comprised 1.9% of SARI hospitalized cases (n = 563,051). Of these, 57.7% developed critical SARI and 90% survived. Comorbidities were present in 40.8%, especially asthma, immunodepression, and neurological and cardiovascular diseases. The main symptoms were fever, cough, dyspnea, respiratory distress, and low oxygen saturation. Among those with critical SARI, 91.4% died. There was a higher frequency of children, especially those under five years of age and of mixed ethnicity. The highest hospitalization frequency occurred in the Southeastern and Northeastern regions, the highest recovery rates in the Southeastern and Southern regions, and the highest lethality rates in the Northern and Northeastern regions. Deaths were associated with ages ranging from 12 to 19 and being under one year of age, living in the Northern and Northeastern regions, progression to critical SARI, and having immunosuppression and cardiovascular disease. In contrast, asthma was associated with lower death rates. The frequency of complications and mortality rates caused by SARS-Cov-2 in the pediatric population are relevant, as well as the severity of the epidemic in the social inequality context and the health services' frailty.

Completeness of notifications of severe acute respiratory syndrome at the national level and in a regional health care in the state of Minas Gerais, during the COVID-19 pandemic, 2020. / Completude das notificações de síndrome respiratória aguda grave no âmbito nacional e em uma regional de saúde de Minas Gerais, durante a pandemia de COVID-19, 2020.

OBJECTIVE: To analyze the completeness of notifications of severe acute respiratory syndrome cases on the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) during the COVID-19 pandemic, on the national database and on the Regional Health Center database of the state of Minas Gerais, Brazil, in 2020. METHODS: This was a descriptive study of the completeness of sociodemographic variables and those related to etiology, clinical condition, evolution and diagnostic criteria of SIVEP-Gripe. The level of completeness was classified as excellent (> 95%), good (90% to 95%), regular (80% to 90%), poor (50% to 80%) or very poor (< 50%). RESULTS: The percentage of variables with excellent completeness was only 18.1% on the national database, and 27.8% on the regional database. CONCLUSION: Both SIVEP-Gripe databases presented low completeness, making it necessary to improve the work process and routine training of professionals aimed at the correct filling.

Survival of patients with diabetes mellitus hospitalized for acute respiratory syndrome due to COVID-19.

Given the magnitude of COVID-19 and the increase in hospitalization cases for severe acute respiratory syndrome (SARS), especially among patients with diabetes mellitus, it is essential to understand the epidemiological aspects inherent to the disease and the worsening of cases. Thus, this study aimed to analyze the survival of patients with diabetes mellitus hospitalized for SARS due to COVID-19 in different regions of Brazil. This is a longitudinal study, carried out based on data reported in the Influenza Epidemiological Surveillance Information System during the year 2020. The number of patients with diabetes mellitus among the hospitalized cases of SARS due to COVID-19 in the different regions of Brazil and the lethality rate among them were identified. A comparison of patient profiles of those who survived or did not survive and the Cox regression analysis were performed to evaluate the factors associated with shorter survival of patients. It was found that 51.4% of patients hospitalized with SARS due to COVID-19 had diabetes, and the case lethality rate among them was 45.0%. The Northeastern and Northern regions presented a higher proportion of patients with diabetes mellitus (56.5% and 54.3%, respectively) and a higher lethality rate (53.8% and 59.9%, respectively). The mean survival time of cases with diabetes mellitus hospitalized for SARS due to COVID-19 was estimated to be 35.7 days (0.5 days). A lower survival rate was observed among residents of the Northeastern and Northern regions with skin color reported as non-white, who required admission to Intensive Care Units and invasive mechanical ventilation, and presented respiratory symptoms such as dyspnea, respiratory distress and an oxygen saturation lower than 95%. It is concluded that diabetes mellitus was responsible for the high occurrence and lethality, mainly in the Northeastern and Northern regions, among non-white patients and those with greater clinical severity, which reinforces the importance of taking measures aimed at supporting this population.

Factors associated with the lethality of patients hospitalized with severe acute respiratory syndrome due to COVID-19 in Brazil.

Due to the high rates of transmission and deaths due to COVID-19, understanding the factors associated with its occurrence, as well as monitoring and implementing control measures should be priority actions in health surveillance, highlighting the use of epidemiological surveillance information systems as an important ally. Thus, the objectives of this study were to calculate the mortality rate of hospitalized patients with severe acute respiratory syndrome due to COVID-19 and to identify factors associated with death, in the period corresponding to epidemiological weeks 01 to 53 of the year 2020. This was a longitudinal study, using the national influenza epidemiological surveillance information system database, routinely collected by healthcare services. The sociodemographic and clinical characteristics of 563,051 hospitalized patients with severe acute respiratory syndrome due to COVID-19 in the five regions of Brazil were analyzed. Cox regression was performed to assess factors associated with patient death during hospitalization. The national lethality rate was 35.7%, and the highest rates of lethality occurred in the Northeast (44.3%) and North (41.2%) regions. During the hospital stay, death was associated with older age (Hazard Ratio-HR = 1.026; p<0.001); male sex (HR = 1.052; p<0.001); living in the North (HR = 1.429; p<0.001), Northeast (HR = 1.271; p<0.001) or Southeast regions of Brazil (HR = 1.040; p<0.001), presenting any risk factor (HR = 1.129; p< 0.001), the use of invasive (HR = 2.865; p<0.001) or noninvasive (HR = 1.401; p<0.001) mechanical ventilation devices. A high case lethality rate was evidenced in patients with severe acute respiratory syndrome due to COVID-19, however, deaths were not evenly distributed across the country's regions, being heavily concentrated in the Northeast and North regions. Older male patients living in the North, Northeast, or Southeast regions of Brazil, who presented any risk factor and were submitted to the use of invasive or noninvasive mechanical ventilation devices, presented a higher risk of evolving to death.

Analysis of the service telessaúde-COVID in a municipality of Minas Gerais. / Análise dos atendimentos realizados pelo telessaúde-COVID em um município de Minas Gerais.

OBJECTIVE: to analyze the sociodemographic and clinical profile of patients treated by the remote care service "Telessaúde-COVID" and the factors associated with positive results for COVID-19. METHODS: an exploratory and analytical study, carried out based on the analysis of patient records treated by a remote care service called "Telessaúde-COVID". Characteristics of the patients treated and variables related to the service's functioning were evaluated. A descriptive, inferential analysis was performed by logistic regression. RESULTS: 1,854 new patients were evaluated and an estimate of 8,630 visits. Female patients were predominant (60.9%), aged between 20 and 59 years (75.9%). The most frequent signs and symptoms were: headache (41.8%), cough (33.3%) and runny nose (30.0%). Of the total number of patients, 66.4% were reported as suspected case of COVID-19 and 14.5% tested positive for COVID-19. The age of 60 years or more was more common among confirmed cases (26.6%). Most patients (80.4%) did not require face-to-face assistance. Confirmed cases of COVID-19 were associated with the age of the patients (OR 1,020; IC95% 1,007 - 1,032); home contact with a confirmed/suspected case (OR 1,902; IC95% 1,178 - 3,070); presence of nausea/vomiting (OR 2,403; IC95% 1,148 - 5,029) and changes in smell (OR 2,827; IC95% 1,294 - 6,176). CONCLUSION: "Telessaúde-COVID" was relevant in the management and notification of cases, avoiding the search for face-to-face consultations without clinical indication. Among the suspected cases, positivity for COVID-19 was associated with aging, history of home contact, gastrointestinal and olfactory symptoms.

OBJETIVOS: Analisar o perfil sociodemográfico e clínico dos pacientes atendidos pelo serviço de atendimento remoto "Telessaúde-COVID" e os fatores associados aos resultados positivos para COVID-19. MÉTODOS: Estudo exploratório e analítico, realizado com base na análise dos registros de pacientes atendidos por um serviço de atendimento remoto intitulado "Telessaúde-COVID". Foram avaliadas características dos pacientes atendidos e variáveis relacionadas ao funcionamento do serviço. Realizou-se análise descritiva e inferencial, com utilização da regressão logística. RESULTADOS: Foram avaliados 1.854 novos pacientes e estimados 8.630 atendimentos. Houve predomínio de pacientes do sexo feminino (60,9%) e da faixa etária de 20 a 59 anos (75,9%). Os sinais e sintomas mais frequentes foram: cefaleia (41,8%), tosse (33,3%) e coriza (30,0%). Do total de pacientes, 66,4% foram notificados como casos suspeitos de COVID-19 e 14,5% apresentaram resultado positivo para COVID-19. A idade igual ou superior a 60 anos foi mais frequente entre os casos confirmados (26,6%). A maioria dos pacientes (80,4%) não necessitou de atendimento presencial. Os resultados positivos para COVID-19 estiveram associados à idade dos pacientes (Odds Ratio - OR 1.020; intervalo de confiança - IC95% 1.007 - 1.032); contato domiciliar com caso positivo ou suspeito (OR 1.902; IC95% 1.178 - 3.070); presença de náuseas/vômitos (OR 2.403; IC95% 1.148 - 5.029) e alterações no olfato (OR 2.827; IC95% 1.294 - 6.176). CONCLUSÕES: O Telessaúde-COVID foi relevante na condução e notificação dos casos atendidos, evitando a procura por consultas presenciais sem indicação clínica. Entre os casos suspeitos, a positividade para COVID-19 associou-se a idosos, história de contato domiciliar, sintomas gastrointestinais e olfatórios.

"COVID toes": A meta-analysis of case and observational studies on clinical, histopathological, and laboratory findings.

BACKGROUND: Coronavirus disease (COVID-19) is related to several extrapulmonary disorders; however, little is known about the clinical, laboratory, and histopathological characteristics of pernio-like skin lesions associated with COVID-19 infection. OBJECTIVE: To evaluate and summarize the clinical, laboratory, and histopathological characteristics of pernio-like lesions reported in the literature. METHODS: We conducted a search of the PubMed, SciELO, and ScienceDirect databases for articles published between January 1, 2020 and November 30, 2020, following the PRISMA recommendations (PROSPERO registration ID: CRD42020225055). The target population was individuals with suspected or laboratory-confirmed COVID-19 with pernio-like lesions. Observational studies, research letters, and case/series reports were all eligible for inclusion. Observational studies were evaluated using a random-effects model to calculate the weighted mean prevalence, overall mean, and 95% confidence interval. We evaluated case studies using the chi-square test for dichotomous variables and the Mann-Whitney test for continuous variables. RESULTS: A total of 187 patients from case reports and 715 patients from 18 observational studies were included. The mean age of patients was 16.6 years (range 14.5-18.8). Feet were affected in 91.4% (87.0-94.4%) of patients in observational studies. The proportion of patients with a positive RT-PCR test was less than 15%. Lesion topography and morphology were associated with age. CONCLUSION: Lesions mostly occurred in pediatric patients, and the morphological characteristics tended to differ between pediatric and non-pediatric populations. There is a possible multifactorial component in lesion pathophysiology. The non-positivity of laboratory tests does not exclude an association with COVID-19. Pernio-like lesions may be a late manifestation of COVID-19.