Is the efficacy of remdesivir so different from that of lopinavir-ritonavir in severe COVID-19? The answer by real time-PCR: a narrative review.

This letter discusses the efficacy of current antiviral therapy used in severe COVID-19 infection. Since the first severe cases were documented, several antiviral options have been studied as adjuncts to standard supportive care [1, 2]. Firstly, the combination of lopinavir-ritonavir resurrected from SARS and MERS outbreaks and soon abandoned after the publication of several trials like the randomized controlled trial RECOVERY, which concluded that it was not associated with reductions in 28-day mortality, duration of hospital stay, or risk of progression to invasive mechanical ventilation or death [3]. Remdesivir is currently the only antiviral agent approved for the treatment of COVID-19. It is recommended for use in hospitalized patients who require supplemental oxygen. However, it is not routinely recommended for patients who require mechanical ventilation due to the lack of data showing any benefit at this advanced stage of the disease [4-6].

Kawasaki-like Syndrome as an Emerging Complication of SARS-CoV-2 Infection in Young Adults.

BACKGROUND: Kawasaki-like syndrome occurring in children during the COVID-19 pandemic has been labelled multisystem inflammatory syndrome in children (MIS-C) by the CDC and paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) by the ECDC. CASE REPORT: We report the case of an 18-year-old male patient presenting with a 72-hour history of abdominal pain, fever, erythematous skin rash, vomiting and diarrhoea. Examination showed he also had shock and he was first thought to have oedematous cholecystitis. SARS-CoV-2 infection was also diagnosed. He was admitted to the ICU, and echocardiography showed cardiac dysfunction, with a low ejection fraction and low cardiac index. High-sensitivity troponin serum levels were elevated. The patient received inotropic and vasopressor support. As he fulfilled several criteria for MIS-C/PIMS-TS, he was administered acetylsalicylic acid, corticosteroids and immunoglobulin, with a good clinical response. CONCLUSION: This case emphasizes how this severe presentation of COVID-19 can easily be misdiagnosed if the clinician is less aware of this syndrome in younger patients. LEARNING POINTS: SARS-CoV-2 infection is a diagnostic challenge in some patients with atypical clinical presentations, who may have MIS-C/PIMS-TS.Physicians should be aware of this condition when evaluating teenagers and young adults with COVID-19.

Hipercalcemia paraneoplásica de carcinoma anaplásico da tireoide / Paraneoplastic hypercalcemia of anaplastic thyroid carcinoma: case report

A hipercalcemia deve ser considerada no diagnóstico diferencial de alterações neuropsiquiátricas agudas. Em 90% dos casos, a etiologia corresponde a hiperparatireoidismo primário ou neoplasias. Valores séricos superiores a 14mg/dL e sintomáticos são frequentemente tradutores de causa maligna. O carcinoma anaplásico da tireoide consiste em um tumor indiferenciado, com progressão rápida e prognóstico reservado, que evolui, em alguns casos, a partir de lesões tireóideas preexistentes, benignas ou malignas (desdiferenciação). Embora a apresentação clínica mais frequente destes tumores consista no desenvolvimento de massa cervical, eles podem ser diagnosticados no esclarecimento etiológico de metástases ou síndromes paraneoplásicos. A hipercalcemia, associada à neoplasia, pode ocorrer em contexto de metástases ósseas, com libertação de citocinas, ou por mecanismo humoral, mediada pela proteína relacionada ao hormônio hormônio paratireóideo (PTHrP). Os autores descrevem o caso de uma mulher de 85 anos, com antecedentes de bócio multinodular benigno, internada para esclarecimento etiológico de hipercalcemia grave, com manifestações neuropsiquiátricas, diagnosticando-se, após avaliação, carcinoma anaplásico da tireoide. O caso foi abordado em reunião multidisciplinar, optando-se por limitação terapêutica a cuidados paliativos. A doente faleceu 3 meses após o diagnóstico.(AU)

Hypercalcaemia should be considered in the differential diagnosis of acute neuropsychiatric disorders. In 90% of the cases, the etiology corresponds to primary hyperparathyroidism or neoplasms. Serum values above 14mg/dL and symptomatic are often indicative of a malignant cause. The anaplastic thyroid carcinoma consists of an undifferentiated tumor, with rapid progression and poor prognosis, which in some cases progresses from pre-existing benign or malignant thyroid diseases (dedifferentiation). Although the most frequent clinical presentation of these tumors consists of the development of a cervical mass, they can be diagnosed in the etiological clarification of metastases or paraneoplastic syndromes. Neoplasm-associated hypercalcaemia may occur in the context of bone metastasis, with release of cytokines, or through a humoral mechanism, mediated by the parathyroid hormone (PTHrP)-related protein. The authors describe the case of an 85-year-old woman with a history of multinodular benign goiter, hospitalized for etiological elucidation of severe hypercalcaemia with neuropsychiatric manifestations, with a final diagnosis of anaplastic thyroid carcinoma, after the diagnostic evaluation. The case was approached in a multidisciplinary meeting, and the therapeutic limitation to palliative care was chosen. The patient died 3 months after the diagnosis.(AU)

General continuum approach for dissipative systems of repulsive particles.

We propose a general coarse-graining method to derive a continuity equation that describes any dissipative system of repulsive particles interacting through short-ranged potentials. In our approach, the effect of particle-particle correlations is incorporated to the overall balance of energy, and a nonlinear diffusion equation is obtained to represent the overdamped dynamics. In particular, when the repulsive interaction potential is a short-ranged power law, our approach reveals a distinctive correspondence between particle-particle energy and the generalized thermostatistics of Tsallis for any nonpositive value of the entropic index q. Our methodology can also be applied to microscopic models of superconducting vortices and complex plasma, where particle-particle correlations are pronounced at low concentrations. The resulting continuum descriptions provide elucidating and useful insights on the microdynamical behavior of these physical systems. The consistency of our approach is demonstrated by comparison with molecular dynamics simulations.

Aplasia medular transitória associada a infecção por parvovírus B19 / Transient aplastic crisis caused by Parvovirus B19 infection

O parvovírus B19 é um eritrovírus humano com tropismo para as células progenitoras da medula óssea, sendo responsável por um grande espectro de manifestações clínicas, desde infecções assintomáticas até crises aplásicas graves. Os autores apresentam o caso de uma mulher de 40 anos, com história de anemia ferropênica por menorragias, que desenvolveu quadro clínico com febre, cefaleias, petéquias e, osteriormente, exantema nas pernas, associado à hipoplasia medular com redução transitória da contagem de todas as linhagens celulares hematológicas. A suspeita de infecção aguda por parvovírus B19 foi confirmada pela detecção de anticorpos IgM antiparvovírus B19 no sangue periférico, por meio de teste imunoenzimático (ELISA). Os achados do mielograma no 5o dia após a admissão, apesar de haver ainda tão só recuperação parcial das linhagens celulares hematológicas no sangue periférico, revelaram linhagens celulares medulares normais. A paciente teve recuperação espontânea, apenas com terapêutica de suporte.

Parvovirus B19 is a human erythrovirus with tropism for erythroid progenitor cells. It is responsible for a wide range of clinical manifestations, from asymptomatic infections to severe aplastic crises. The authors present the case of a 40 year-old female patient with history of iron-deficiency anemia from menorrhagia who presented with fever, headache, petechiae,and later,rash on lower limbs, associated with medullary hypoplasia and transient decrease of all hematologic cell lines.The suspicion of acute Parvovirus B19 infection was confirmed by the detection of anti-Parvovirus B19 IgM antibodies through Enzyme-Linked Immunosorbent Assay (ELISA). Although there was only partial recovery of the hematologic cell lineage in peripheral blood, findings on myelogram 5 days after admission showed normal hematopoietic cell lines. The patient had spontaneous recovery only with supportive treatment.

Propriedades dos fios de NiTi superelásticos termicamente ativados – uma revisão literária / Properties of thermally activated superelastic NiTi archwires – a literature review

A utilização de fios de níquel-titânio superelásticos (NiTi) consiste em uma nova opção disponível no mercado mundial para tratamentos ortodônticos, o que torna necessária a reunião de informações que possa auxiliar na tomada de decisões dos ortodontistas quanto à sua utilização ou não, conforme o caso clínico a ser trabalhado. Diante disso, são apresentadas, nesta revisão de literatura, algumas informações científicas sobre os fios de NiTi termicamente ativados, bem como suas propriedades físicas, suas diferenças entre carga e deflexão, e os resultados de alguns testes realizados. São discutidos aspectos quanto à melhor fase de utilização desses fios e, dentre as marcas que estão disponíveis no mercado, quais são as mais adequadas para a utilização nas diferentes fases de tratamento.

Superelastic nickel-titanium (NiTi) archwires are a brand new marketable option for orthodontic treatment, which makes the discussion of scientific information regarding their use essential in helping professionals to plan and perform evidence-based treatments. Therefore, this literature review ponders scientific information related to thermally activated superelastic NiTi archwires, taking into account their physical properties, the differences between load and deflection and the results of some accomplished studies. The moment best indicated for their application and, among the available trademarks, the most suitable ones for each treatment phase are mainly discussed.

[Globalization, international trade, and health equity]. / Inequidades de acceso a la información e inequidades en salud.

Globalization and international trade are having an increasingly evident impact on the day-to-day duties of the health sector, and the phenomenon has aroused a great deal of interest among governments, nongovernmental organizations, international organizations, and the mass media. Up to this point the heated and polemical debate on the subject has seriously hindered objective discourse on the health implications of globalization and international trade. This piece examines the possible impact of the two processes on health in the Region of the Americas, in order to foster policies for equity that are adopted within the framework of public health in the Americas. The piece considers the relationships among globalization, trade, and health in general and then focuses on the special case of trade in health goods and services. The piece looks at the possible impact on health equity of the agreements for integration and free trade that are being negotiated in the Americas. The piece concludes with a summary of the activities that the Pan American Health Organization has been carrying out in this area.

Globalización, comercio internacional y equidad en materia de salud / Globalization, international trade, and health equity

Globalization and international trade are having an increasingly evident impact on the day-to-day duties of the health sector, and the phenomenon has aroused a great deal of interest among governments, nongovernmental organizations, international organizations, and the mass media. Up to this point the heated and polemical debate on the subject has seriously hindered objective discourse on the health implications of globalization and international trade. This piece examines the possible impact of the two processes on health in the Region of the Americas, in order to foster policies for equity that are adopted within the framework of public health in the Americas. The piece considers the relationships among globalization, trade, and health in general and then focuses on the special case of trade in health goods and services. The piece looks at the possible impact on health equity of the agreements for integration and free trade that are being negotiated in the Americas. The piece concludes with a summary of the activities that the Pan American Health Organization has been carrying out in this area

Gasto y financiamiento en salud: situacion y tendencias / Health spending and financing: the current situation and trends

Being knowledgeable about national health expenditures and sources of financing is essential for decision-making. This awareness also makes it possible to evaluate the equity of allocation and the efficiency of utilization of these resources. Changes in the financing have been a substantial component of health sector reform in the Americas. The goal has shifted from merely one of financial sustainability to simultaneously seeking equitable access to quality services. In this article the PAn American Health Organization (PAHO) presents a proposal for analyzing and designing a policy on health financing. The aim of the policy is to identify the mix of financing mechanisms most likely to simultaneously produce financial sustainability, equity, access, and efficiency. The PAHO proposal combines traditional mechanisms for generating resources (public funds from taxes, as well as private health insurance, national health insurance, and user fees) with complementary subsidy mechanisms for vulnerable groups. Health financing strategies ought to explicitly consider the financing both of care for individuals and of health interventions for the general public good, for which public financing is the most equitable and efficient approach (AU)

Gasto y financiamiento en salud : situacion y tendencias / Health spending and financing : the current situation and trends

El conocimiento del gasto nacional en salud y su financiamiento es esencial para la toma de decisiones respecto a los recursos del sector de la salud y permite evaluar la equidad y la eficiencia con que se asignan y utilizan estos recursos. Las modificaciones en el financiamiento del sector de la salud han sido un componente sustancial de los procesos de reforma del sector en las Americas. El objetivo explicito ha pasado de uno que buscaba exclusivamente la sostenibilidad financiera a otro que busca, simultaneamente, el acceso equitativo a servicios de calidad. La Organizacion Panamericana de la Salud presenta una propuesta de analisis y diseno de la politica de financiamiento del sector cuyo proposito es identificar la combinacion de mecanismos de financiamiento que mejor permita lograr los objetivos de sostenibilidad financiera, accesibilidad, equidad y eficiencia. La propuesta consiste en combinar los mecanismos tradicionales de generacion de ingresos (gasto publico via impuestos, seguros privados de salud, seguros nacionales de salud y cobro a los usuarios) con mecanismos complementarios de subsidios destinados a compensar a los grupos vulnerables de los efectos de las barreras financieras que reducen su demanda de atencion en salud. Las estrategias de financiamiento del sector deben considerar de modo explicito el financiamiento de la atencion a las personas y de las intervenciones en el campo de la salud con caracteristicas de bienes publicos. Para estas ultimas se propone el financiamiento publico como el mas eficiente y equitativo

Gasto y financiamiento en salud: situacion y tendencias / Health spending and financing: the current situation and trends

El conocimiento del gasto nacional en salud y su financiamiento es esencial para la toma de decisiones respecto a los recursos del sector de la salud y permite evaluar la equidad y la eficiencia con que se asignan y utilizan estos recursos. Las modificaciones en el financiamiento del sector de la salud han sido un componente sustancial de los procesos de reforma del sector en las Americas. El objetivo explicito ha pasado de uno que buscaba exclusivamente la sostenibilidad financiera a otro que busca, simultaneamente, el acceso equitativo a servicios de calidad. La Organizacion Panamericana de la Salud presenta una propuesta de analisis y diseno de la politica de financiamiento del sector cuyo proposito es identificar la combinacion de mecanismos de financiamiento que mejor permita lograr los objetivos de sostenibilidad financiera, accesibilidad, equidad y eficiencia. La propuesta consiste en combinar los mecanismos tradicionales de generacion de ingresos (gasto publico via impuestos, seguros privados de salud, seguros nacionales de salud y cobro a los usuarios) con mecanismos complementarios de subsidios destinados a compensar a los grupos vulnerables de los efectos de las barreras financieras que reducen su demanda de atencion en salud. Las estrategias de financiamiento del sector deben considerar de modo explicito el financiamiento de la atencion a las personas y de las intervenciones en el campo de la salud con caracteristicas de bienes publicos. Para estas ultimas se propone el financiamiento publico como el mas eficiente y equitativo

Being knowledgeable about national health expenditures and sources of financing is essential for decision-making. This awareness also makes it possible to evaluate the equity of allocation and the efficiency of utilization of these resources. Changes in financing have been a substantial component of health sector reform in the Americas. The goal has shifted from merely one of financial sustainability to simultaneously seeking equitable access to quality services. In this article the Pan American Health Organization (PAHO) presents a proposal for analyzing and designing a policy on health financing. The aim of the policy is to identify the mix of financing mechanisms most likely to simultaneously produce financial sustainability, equity, access, and efficiency. The PAHO proposal combines traditional mechanisms for generating resources (public funds from taxes, as well as private health insurance, national health insurance, and user fees) with complementary subsidy mechanisms for vulnerable groups. Health financing strategies ought to explicitly consider the financing both of care for individuals and of health interventions for the general public good, for which public financing is the most equitable and efficient approach.