PURPOSE: This study assessed medication patterns for inpatients at a central hospital in Portugal and explored their relationships with clinical outcomes in COVID-19 cases. METHODS: A retrospective study analyzed inpatient medication data, coded using the Anatomical Therapeutic Chemical classification system, from electronic patient records. It investigated the association between medications and clinical severity outcomes such as ICU admissions, respiratory/circulatory support needs, and hospital discharge status, including mortality (identified by ICD-10-CM/PCS codes). Multivariate analyses incorporating demographic data and comorbidities were used to adjust for potential confounders and understand the impact of medication patterns on disease progression and outcomes. RESULTS: The analysis of 2688 hospitalized COVID-19 patients (55.3% male, average age 62.8 years) revealed a significant correlation between medication types and intensity and disease severity. Cases requiring ICU admission or ECMO support often involved blood and blood-forming organ drugs. Increased use of nervous system and genitourinary hormones was observed in nonsurvivors. Corticosteroids, like dexamethasone, were common in critically ill patients, while tocilizumab was used in ECMO cases. Medications for the alimentary tract, metabolism, and cardiovascular system, although widely prescribed, were linked to more severe cases. Invasive mechanical ventilation correlated with higher usage of systemic anti-infectives and musculoskeletal medications. Trends in co-prescribing blood-forming drugs with those for acid-related disorders, analgesics, and antibacterials were associated with intensive interventions and worse outcomes. CONCLUSIONS: The study highlights complex medication regimens in managing severe COVID-19, underscoring specific drug patterns associated with critical health outcomes. Further research is needed to explore these patterns.
COVID-19 , Inpatients , Humans , Male , Middle Aged , Female , Retrospective Studies , Anti-Bacterial Agents , Drug Utilization
BACKGROUND: The aftermath of the COVID-19 pandemic continues to affect millions worldwide, resulting in persisting postvirus complaints and impacting peoples' quality of life. Long COVID, characterized by lingering symptoms like fatigue and mental illness, can extend beyond a few months, necessitating further research to understand its implications. OBJECTIVE: This study aims to quantify the degree of physical and psychological fatigue in patients following COVID-19 infection and examine its correlation with mental health disorders. METHODS: Using a consecutive nonrandom sampling technique, we will conduct a prospective cohort multicenter observational study in 5 Portuguese hospitals. Symptomatic adult patients with previous COVID-19 attending follow-up consultations will be enrolled. We will include patients who had mild, moderate, and severe acute disease. We will assess clinical outcomes related to COVID-19, including the type of respiratory support such as high-flow nasal cannula, noninvasive ventilation, and invasive mechanical ventilation. The exclusion criteria will include previous severe psychiatric disorders confirmed by a psychiatrist; refusal or inability to respond to the questionnaire; concomitant neurological disorder; persistent fatigue symptoms during the 6 months before infection; and the need for invasive mechanical ventilation during COVID-19 infection due to a high prevalence of postintensive care syndrome. Our primary outcome is the prevalence of fatigue in patients with post-COVID-19 depression and/or anxiety, as measured by the Chalder Fatigue Scale (CFQ-11) and the Hospital Anxiety and Depression Scale (HADS). The secondary outcomes will include an assessment of health-related quality of life via the EQ-5D questionnaire and an exploration of the prevalence of symptoms of posttraumatic stress disorder (PTSD) using the 14-item Posttraumatic Stress Scale (PTSS-14). We will also examine the association between mental health symptoms and the severity of acute COVID-19. The post-COVID-19 data will be collected at least 6 months after the positive test and no longer than 9 months during the clinical appointment. RESULTS: We expect our multicenter study on patients post COVID-19 to reveal a significant link between mental illness symptoms and both physical and psychological fatigue. Patients with heightened depression and anxiety may report increased levels of fatigue. Additionally, we expect to find persistent PTSD symptoms in a subset of participants, indicating the enduring psychological impact of the virus. CONCLUSIONS: This study may underscore the need for integrated care addressing physical and mental health in patients post COVID-19. The observed connections emphasize the importance of considering mental well-being for long-term health outcomes. Despite study limitations, our findings contribute valuable insights for future treatment strategies and highlight the necessity for comprehensive mental health support in post-COVID-19 care. This research provides valuable insights into the mental health implications of COVID-19 and its impact on post-COVID-19 fatigue and the overall well-being of affected individuals. TRIAL REGISTRATION: ClinicalTrials.gov NCT05323318; https://clinicaltrials.gov/study/NCT05323318. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/51820.
O aneurisma da artéria poplítea é o mais frequente dos aneurismas periféricos verdadeiros. Embora seja assintomático, apresenta complicações isquêmicas por embolia ou trombose. A correção deste aneurisma pode ser cirúrgica convencional, com técnica e prognóstico bem estabelecidos, ou endovascular, técnica inovadora e menos invasiva. A reperfusão do saco aneurismático excluído, apesar de rara, está relacionada à intensa circulação colateral. Relatamos um caso de aneurisma de poplítea, que após dois anos de exclusão apresentou fluxo no saco aneurismático com sintomatologia, sendo tratado por técnica endovacular alternativa.
The popliteal artery aneurysm is the most frequent of the peripheral aneurysms. Although asymptomatic, it can complicate with severe limb ischemia due to embolization or thrombosis. The surgical correction presents well-established techniques and results, while the less invasive endovascular therapy is still evolving. The recurrence is very rare and can be related to collateral artery refilling. We report a recurrent popliteal artery aneurysm after two years of conventional ligation and bypass surgery, in which an alternative endovascular strategy was successfully applied.
Humans , Aneurysm/diagnosis , Popliteal Artery/anatomy & histology , Embolization, Therapeutic/nursing , Catheterization, Peripheral/methods , Time Factors
A incidência de pseudoaneurisma após cateterismo via femoral varia entre 0,1 a 2,0 por cento em procedimentos diagnósticos e 5 por cento em terapêuticos. São descritos tratamentos para pseudoaneurismas desde o método conservador até a intervenção com cirurgia convencional. Nos casos de pseudoanerismas de tamanho médio, o tratamento não invasivo, com compressão com duplex scan ou injeção de trombina/fator de coagulação XIII, é o de escolha. Neste artigo, relatamos dois casos de pseudoaneurisma pós-cateterismo terapêutico, em que foi realizado tratamento combinado utilizando-se técnicas endovascular e de cirurgia aberta. A associação dessas duas modalidades terapêuticas possibilitou a redução de perdas sanguíneas comparando-se à cirurgia convencional isolada, além de minimizar o trauma cirúrgico e reduzir o tempo de internação.
The incidence of femoral postcatheteriation pseudoaneurysm ranges from 0.1 to 2.0 percent in diagnostic procedures to 5 percent in therapeutic procedures. There are several treatment options for pseudoaneurysms, from conservative management to conventional surgical intervention. For medium-sized pseudoaneurysms, ultrasound-guided compression repair or percutaneous injection of thrombin/coagulation factor XIII are the treatments of choice. In this paper, we describe two cases of post-therapeutic catheterization pseudoaneurysm, in which endovascular and conventional surgery were combined. The association of these two modalities of treatment decreased blood loss in comparison with conventional surgery alone, besides reducing surgical trauma and hospital stay.
Humans , Male , Female , Middle Aged , Diabetes Mellitus/diagnosis , Lower Extremity , Aneurysm, False/diagnosis , Catheterization/methods , Echocardiography, Doppler/nursing , Iatrogenic Disease
