RESUMO
We report a second case of methemoglobinemia and non-autoimmune hemolytic anemia after contracting the SARS-CoV-2 infection in the absence of an identifiable eliciting drug. A 35-year old male without previous known comorbidities was admitted after he was diagnosed with the COVID-19 infection and had large pulmonary involvement. Seven days later, he desaturated but was without any signs of respiratory distress. A check of arterial blood gas revealed normal partial pressure of oxygen and follow-up tests confirmed a methemoglobinemia diagnosis. Over the next few days, hemolysis was established after decreased levels of hemoglobin and increased levels of indirect bilirubin and lactate dehydrogenase. A hemolytic anemia investigation panel came back normal, including G6PD. A second G6PD test was ordered at the 5-month follow-up appointment and revealed decreased levels. Clinicians should thus be aware of possible false negative tests when testing for G6PD during hemolytic crisis. In addition, whether the COVID-19 infection alone would be responsible for this chain of events remains a challenging question.
RESUMO
Objetivo Analisar a adesão ao tratamento de pacientes com DM2. O Diabetes Mellitus tipo 2 (DM2) acomete muitos pacientes de forma crescente e tem se tornado um grande problema de saúde pública. É uma síndrome metabólica que resulta em acúmulo de glicose nosangue acarretando complicações a longo prazo. . Métodos Foi realizada uma análise dos prontuários de pacientes diabéticos, na faixa etária de 40 a 60 anos, cadastrados em seis UBS's de Alfenas - MG, para seleção da amostra. Aplicou-se um questionário que abrange aspectos socioeconômicos, relacionados à patologia do paciente e à aderência ao tratamento medicamentoso. Ao final de cada entrevista, foi aferida glicemia capilar ao acaso. Resultados Os dados coletados mostraram que 72% dos entrevistados são do sexo feminino e 37% se encaixam na faixa etária entre 56 e 60 anos. 50% dos participantes relatam ter escolarização até o fundamental 2, sendo que apenas 3% apresenta renda familiar maior que 4 salários mínimos. A análise do tratamento indicou que 93% dos entrevistados fazem tratamento medicamentoso e 45% usam metformina como monoterapia. Sobre o tratamento não medicamentoso, 52% relatam fazer dieta alimentar e/ou atividade física. A minoria dos entrevistados (28%) é aderente aos tratamentos propostos. Conclusão Os resultados evidenciam uma deficiência nas ações de saúde propostas pelas UBS de Alfenas - MG. Portanto, há necessidade de acompanhamento multidisciplinar desses pacientes para que haja uma melhor aderência ao tratamento proposto com consequente melhora da qualidade de vida e redução da morbimortalidade causada pela doença
Objective To analyze adherence to treatment of patients with DM2. Diabetes Mellitus type 2 (DM2) affects many patients and has increasingly become a major public health problem. It is a metabolic syndrome that results in accumulation of glucose in the blood and leads to long-term complications. Methods All the registered population in six health centers of Alfenas - MG, aged 40 to 60 years was used to calculate the sample. Applied a questionnaire covering socio-economic aspects, related to the patient's pathology and adherence to drug treatment. At the end of each interview, capillary blood glucose was measured at random. Results The data collected showed that 72% of respondents are female and 37% fit the age range between 56 and 60 years. 50% of the participants report having reached elementary school 2, with only 3% having a family income greater than 4 minimum wages. The treatment analysis indicated that 93% of the interviewees are medicated and 45% use metformin with monotherapy. Regarding non-medicated treatment, 52% report doing diet and/or physical activity. The minority of respondents (28%) adhered to the proposed treatments. Conclusion The results have shown a deficiency in the health actions proposed by the UBS of Alfenas - MG. Therefore, there is a need for a multidisciplinary and more detailed follow-up of these patients for having a better adherence to the proposed treatment with consequent improvement of the quality of life and reduction of the morbimortality caused by the disease