RESUMO
INTRODUCTION: In the genesis of coronavirus disease (COVID-19), there is a process of endotheliitis associated with thrombotic changes, no studies have reported the use of acetylsalicylic acid (ASA) as a possible therapeutic approach. Statins could potentiate the ASA therapy. METHODS: This is a series of 14 cases with a laboratory-confirmed diagnosis of COVID-19. All patients underwent the ASA therapy. Those who had risk factors for vascular disease also underwent the high-potency statin therapy. When symptoms were totally or practically resolved, patients were discharged and advised to continue medications for a complementary time, according to the clinical evolution of each patient. RESULTS: The mean age of monitored patients was 48.6 years. A total of 78.6% patients presented with at least one comorbidity, which could have contributed as a risk factor for a poor prognosis in the evolution of COVID-19. Four patients had secondary bacterial infections; three patients needed hospitalization. None of the cases progress to stage III, and all patients had remission of symptoms, with 100% survival. CONCLUSIONS: the process of endothelial dysfunction in COVID-19 involves disseminated thrombosis, initially microvascular and later expansion into larger vessels. ASA could act as a secondary prophylaxis and prevent thrombosis from developing and reaching stage III of the disease. As this was a case series, we cannot provide definitive conclusions; however, this study allows us to formulate hypotheses and support clinical trials to evaluate benefits of the ASA therapy in the treatment of COVID-19.
Assuntos
Aspirina/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Inflamação/tratamento farmacológico , Isquemia/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Trombose/tratamento farmacológico , Betacoronavirus , COVID-19 , Comorbidade , Endotélio/efeitos dos fármacos , Endotélio/patologia , Humanos , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Tratamento Farmacológico da COVID-19RESUMO
In patients with Chronic Rheumatic Carditis, active carditis is an often underdiagnosed condition. Rheumatic attacks promote the aggravation of existing lesions, leading to a deterioration of the patient's clinical condition. Thus, reducing the morbidity and mortality of the disease depends, in part, on controlling relapses through secondary prophylaxis. Underdiagnosis is due in part to the occurrence of subclinical rheumatic attacks. This study was carried out with data from patients who were diagnosed with Chronic Rheumatic Carditis and who underwent cardiac surgery for valve replacement or repair, without clinical or laboratory evidence of rheumatic outbreak. A fragment of myocardium was sent for histopathological analysis. Data on the frequency of histopathological alterations compatible with a rheumatic outbreak were analyzed. After analysis, 80% of patients showed changes compatible with inflammatory activity. Of these, 87.5% had lymphocytic infiltrate; 25% had Aschoff's nodules. The most frequent histopathological findings of chronic disease were myocardial hypertrophy in 56.7% of patients and fibrosis in 53.3% (AU).
Nos pacientes com Cardite Reumática Crônica, a cardite em atividade é uma condição frequentemente subdiagnos-ticada. Os surtos reumáticos promovem o agravamento das lesões já existentes, levando a uma deterioração da condição clínica do paciente. Dessa forma a redução da morbimortalidade da doença depende, em parte, do contro-le de recidivas a partir da profilaxia secundária. O subdiagnóstico deve-se em parte a ocorrência de surtos reumáti-cos subclínicos. Este estudo foi realizado com dados dos pacientes que tiveram o diagnóstico de Cardite Reumática Crônica e foram submetidos à cirurgia cardíaca para troca ou plastia valvar, sem evidência clínica ou laboratorial de surto reumático. Um fragmento de miocárdio foi enviado para análise histopatológica. Foram analisados os dados de frequência de alterações histopatológicas compatíveis com surto reumático. Após análises, 80% dos pacientes apresentaram alterações compatíveis com atividade inflamatória. Desses, 87,5% apresentavam infiltrado linfocitá-rio; 25% apresentavam nódulos de Aschoff. Os achados histopatológicos de doença crônica mais frequentes foram hipertrofia miocárdica em 56,7% pacientes e fibrose em 53,3% (AU).
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Febre Reumática , MiocarditeRESUMO
COVID-19 is a new disease that has brought a great impact on global morbidity and mortality. There have been increasingly frequent reports of persistent symptoms and/or clinical manifestations attributed to COVID-19 after the acute phase of the disease. In this article, we present a case of post-COVID-19 telogen effluvium in a 39-year-old hypertensive and obese patient who looked for medical attention due to massive hair loss. Previous history of moderate COVID-19 4 months ago. After investigation and exclusion of other possible causes of telogen effluvium well established in the literature, the condition was attributed to the previous episode of COVID-19. Persistent fever, the cytokine storm, and the entire immunological cascade of COVID-19 can lead to apoptosis of the keratinocytes of the hair follicles, initiating the catagen phase early followed by the telogen phase with a consequent capillary release. Late symptoms possibly secondary to COVID-19 should receive attention and interest from the medical and scientific community. As it is a new disease, whose late consequences are not yet fully known/elucidated, careful observation and careful clinical follow-up of these patients are recommended (AU)
A COVID-19 eÌ uma doença nova que vem provocando grande impacto na morbimortalidade mundial. Relatos de persistência de sintomas e/ou manifestaçoÌes cliÌnicas atribuiÌdas aÌ COVID-19 após a fase aguda da doença tem sido cada vez mais frequentes. Neste artigo, apresentamos um caso de efluÌvio teloÌgeno poÌs COVID-19 em um paciente de 39 anos, hipertenso e obeso, que procurou atendimento meÌdico devido aÌ queda volumosa de cabelos. Histórico preÌvio de COVID-19 moderada há 4 meses. Após investigação e exclusão de outras possíveis causas de efluÌvio teloÌgeno bem estabelecidas na literatura o quadro foi atribuído ao episoÌdio preÌvio de COVID-19. É possiÌvel que a febre persistente, a tempestade de citocinas e toda a cascata imunológica da COVID-19 possam levar aÌ apoptose dos queratinócitos dos foliÌculos capilares, iniciando, assim, precocemente a fase catágena seguida pela fase telógena com consequente liberação capilar. Sintomas tardios possivelmente secundários à COVID-19 devem ser alvo de atenção e interesse da comunidade meÌdica e científica. Por se tratar de uma doença nova, cujas consequências tardias ainda não se encontram completamente conhecidas/ elucidadas, recomenda-se a observação atenta e o seguimento cliÌnico criterioso desses pacientes (AU)
Assuntos
Humanos , Masculino , Adulto , Citocinas , Infecções por Coronavirus , Alopecia , Febre , Sistema ImunitárioRESUMO
ABSTRACT: COVID-19 is a new disease, whose several atypical clinical manifestations began to be observed with the evolution of the pandemic, and have been investigated to understand the pathophysiology of the disease. In this article, the objective is to describe a case of angioedema in COVID-19, considered an atypical manifestation, and rarely described in the literature. The case is of a 55-year-old patient who sought medical attention for a complaint of intermittent fever for four days. On the seventh day, he manifested angioedema in the left zygomatic projection and the right subpalpebral region. The patient had no history of angioedema earlier in life. The following day, he presented a regression of the angioedema concerning the previous day. After this period, the patient progressed well and became asymptomatic. The RT-PCR laboratory test performed on the first days of manifesting symptoms was positive for SARS-CoV-2. We correlate the onset of angioedema with the possible endotheliitis present in the disease, which has been evidenced by the observation of severe endothelial injury associated with the intracellular presence of the virus in several histopathological studies of patients with COVID-19. Also, possible deregulation of the Kininogen-Kallikrein-Kinin System (KKKS) could explain this manifestation, as SARS-CoV-2 binds to the ACE2 receptor, which is responsible for degrading kinins, such as bradykinin. (AU)
RESUMO: A COVID-19 é uma doença nova, cujas diversas manifestações clínicas atípicas começaram a ser observadas com a evolução da pandemia e foram investigadas com o objetivo de compreender a fisiopatologia da doença. Neste artigo, o objetivo é descrever um caso de angioedema no COVID-19, considerado manifestação atípica e raramente descrito na literatura. O caso é de um paciente de 55 anos que procurou atendimento médico por uma queixa de febre intermitente há quatro dias. No sétimo dia, manifestou angioedema na projeção zigomática esquerda e na região subpalpebral direita. Não tinha histórico de apresentar angioedema. No dia seguinte, ele apresentou regressão do angioedema em relação ao dia anterior. Após esse período, o paciente progrediu bem e tornou-se assintomático. O teste laboratorial de RT-PCR realizado nos primeiros dias de manifestação dos sintomas foi positivo para SARS-CoV-2. Correlacionamos o início do angioedema com a possível endotelite presente na doença, o que foi evidenciado pela observação de lesão endotelial grave associada à presença intracelular do vírus em vários estudos histopatológicos de pacientes com COVID-19. Além disso, uma possível desregulação do sistema Cininogênio-Calicreína-Cinina poderia explicar essa manifestação, já que o SARS-CoV-2 se liga ao receptor ACE2, responsável pela degradação de cininas, como a bradicinina. (AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Bradicinina , Infecções por Coronavirus , Endotélio , Pandemias , SARS-CoV-2 , AngioedemaRESUMO
Abstract INTRODUCTION: In the genesis of coronavirus disease (COVID-19), there is a process of endotheliitis associated with thrombotic changes, no studies have reported the use of acetylsalicylic acid (ASA) as a possible therapeutic approach. Statins could potentiate the ASA therapy. METHODS: This is a series of 14 cases with a laboratory-confirmed diagnosis of COVID-19. All patients underwent the ASA therapy. Those who had risk factors for vascular disease also underwent the high-potency statin therapy. When symptoms were totally or practically resolved, patients were discharged and advised to continue medications for a complementary time, according to the clinical evolution of each patient. RESULTS: The mean age of monitored patients was 48.6 years. A total of 78.6% patients presented with at least one comorbidity, which could have contributed as a risk factor for a poor prognosis in the evolution of COVID-19. Four patients had secondary bacterial infections; three patients needed hospitalization. None of the cases progress to stage III, and all patients had remission of symptoms, with 100% survival. CONCLUSIONS: the process of endothelial dysfunction in COVID-19 involves disseminated thrombosis, initially microvascular and later expansion into larger vessels. ASA could act as a secondary prophylaxis and prevent thrombosis from developing and reaching stage III of the disease. As this was a case series, we cannot provide definitive conclusions; however, this study allows us to formulate hypotheses and support clinical trials to evaluate benefits of the ASA therapy in the treatment of COVID-19.