Clinical characteristics and outcomes of COVID-19 patients with preexisting dementia: a large multicenter propensity-matched Brazilian cohort study.

BACKGROUND: Although dementia has emerged as an important risk factor for severe SARS-CoV-2 infection, results on COVID-19-related complications and mortality are not consistent. We examined the clinical presentations and outcomes of COVID-19 in a multicentre cohort of in-hospital patients, comparing those with and without dementia. METHODS: This retrospective observational study comprises COVID-19 laboratory-confirmed patients aged ≥ 60 years admitted to 38 hospitals from 19 cities in Brazil. Data were obtained from electronic hospital records. A propensity score analysis was used to match patients with and without dementia (up to 3:1) according to age, sex, comorbidities, year, and hospital of admission. Our primary outcome was in-hospital mortality. We also assessed admission to the intensive care unit (ICU), invasive mechanical ventilation (IMV), kidney replacement therapy (KRT), sepsis, nosocomial infection, and thromboembolic events. RESULTS: Among 1,556 patients included in the study, 405 (4.5%) had a diagnosis of dementia and 1,151 were matched controls. When compared to matched controls, patients with dementia had a lower frequency of dyspnoea, cough, myalgia, headache, ageusia, and anosmia; and higher frequency of fever and delirium. They also had a lower frequency of ICU admission (32.7% vs. 47.1%, p < 0.001) and shorter ICU length of stay (7 vs. 9 days, p < 0.026), and a lower frequency of sepsis (17% vs. 24%, p = 0.005), KRT (6.4% vs. 13%, p < 0.001), and IVM (4.6% vs. 9.8%, p = 0.002). There were no differences in hospital mortality between groups. CONCLUSION: Clinical manifestations of COVID-19 differ between older inpatients with and without dementia. We observed that dementia alone could not explain the higher short-term mortality following severe COVID-19. Therefore, clinicians should consider other risk factors such as acute morbidity severity and baseline frailty when evaluating the prognosis of older adults with dementia hospitalised with COVID-19.

Estudo epidemiológico da evolução de neonatos com hipertireotropinemia no Estado de Minas Gerais: Brasil / Epidemiologic study of the newborns evolution with hyperthyrotropinemia in the State of Minas Gerais: Brazil

Introdução: no exame sérico os valores de TSH acima de 10 ?Ul/mL e de T4 livre (T4L) baixo confirmam o diagnóstico do hipotireoidismo congênito, e as crianças deverão ser tratadas. Contudo, se houver elevação discreta do TSH (5,6 a 10 µUI/mL) e T4L normal, o recém-nascido (RN) apresenta quadro de hipertireotropinemia (HT) neonatal, que pode ser transitório ou permanente, e deve permanecer em acompanhamento clínico rigoroso. Objetivos: verificar a evolução de crianças triadas pelo Programa de Triagem Neonatal de Minas Gerais (PTN-MG) com HT. Métodos: estudo do tipo coorte retrospectivo. Analisaram-se os dados obtidos pelo ?teste do pezinho?, disponibilizados pelo banco de dados do Núcleo deAções e Pesquisa em Apoio Diagnóstico (NUPAD). Resultados: no período de 2000 a 2010,125 RNs apresentaram HT. Desses, 48% normalizaram os níveis de TSH no período médio de 20 meses. Já os outros 52% não normalizaram o TSH no período estudado e por isso foram mantidos em acompanhamento. Conclusões: mesmo que os níveis de TSH tenham se normalizado em 48% dos casos, concedendo alta a esses RNs, o tempo para esse desfecho foi significativo (cerca de 20 meses). Nesse período, pode haver alterações nos exames, muitas vezes com necessidade de tratamento com reposição hormonal, sendo, portanto, fundamentalo seguimento por meio de consultas e dosagens hormonais periódicas.

Introduction: in the serum exam TSH values above 10 ?Ul / mL and free T4 (FT4) low confirm the diagnosis of congenital hypothyroidism, and children should be treated. However, if mild elevation of TSH (5.6 to 10 ?UI / mL), normal FT4, the newborn (NB) has a hyperthyrotropinemia (HT) frame neonatal, which can be temporary or permanent, and should remain in rigorous clinical monitoring. Objects: to check the progress of children screened by the Newborn Screening Program of Minas Gerais (LWA-MG) withHT. Methods: this is a retrospective cohort study. We analyzed the data obtained by ? heel prick test ? provided by the Core Database Action and Research in Support Diagnostics (NUPAD). Results: from 2000 to 2010, 125 newborns had HT. Of these, 48% had a normal TSH levels in an average period of 20 months. As for the other 52% did not normalizeTSH during the study period and were therefore kept in accompaniment. Conclusions: Even though TSH levels have become normal in 48% of cases providing high for these RNs, this time to endpoint was significantly (about 20 months). During this period there may be changes in the exams, often requiring treatment with hormone replacement, and is therefore essential to follow through periodic consultations and hormone levels.