RESUMO
Sporotrichosis is the most frequent subcutaneous or implantation mycosis in Latin America, and its transmission occurs as a result of traumatic inoculation into the skin by organic matter containing the thermodimorphic fungi of the genus Sporothrix. Although cutaneous forms are more common, another important site is the osteoarticular system, whose hematogenous involvement is commonly associated with disseminated forms, especially in people who have an immunosuppressive condition, such as HIV/AIDS, chronic steroid use, and alcohol abuse. We present two cases of osteoarticular sporotrichosis of the knee caused by Sporothrix brasiliensis and followed up at our institution, with different outcomes. In the cases presented here, aging, anatomical sites, comorbidities, subtherapeutic serum levels, low adherence to treatment, and late diagnosis for different reasons may explain the observed outcomes. Early diagnosis of Sporothrix infection is critical in preventing complications, including death. We also highlight the importance of multidisciplinary follow-up and adherence to treatment for a favorable outcome.
RESUMO
A pandemia da COVID-19 trouxe desafios para o monitoramento de usuários de anticoagulantes, sobretudo idosos, sendo o telemonitoramento uma alternativa para dar continuidade aos cuidados para esses pacientes. O presente estudo teve como objetivo descrever a experiência do telemonitoramento de idosos usuários de anticoagulantes na pandemia da COVID-19. Trata-se de estudo referente ao serviço farmacêutico de telemonitoramento de idosos (≥60 anos) em uso de anticoagulantes orais em ambulatório de geriatria privado (Belo Horizonte). Idosos tiveram parâmetros de efetividade e segurança dos anticoagulantes monitorados mensalmente por telefone (abr-dez/2021). Problemas identificados geraram intervenções ao paciente ou equipe multiprofissional. Ao total 425 idosos foram incluídos no serviço. A maioria usava apixabana (189;41,9%), rivaroxabana (146;34,4%) e varfarina (47;11,1%). Observou-se média de idade de 82,1 anos, maioria feminina (65,2%), maioria com alto risco de vulnerabilidade (69%), e incidência de 9,9% de COVID-19. Realizou-se 219 intervenções relativas à varfarina (média de 4,6 intervenções/paciente); referiram-se à solicitação de exame de RNI (57,5%), orientações em saúde (19,6%), alteração da dose (redução - 10,5%; aumento - 5,9%; suspensão - 0,6%), ou encaminhamento (5,9%). Usuários de outros anticoagulantes não apresentaram alterações nos parâmetros acompanhados. Onze idosos sofreram quedas e 10 demandaram internação por eventos tromboembólicos ou hemorrágicos. Não houve diferença estatisticamente significativa nas proporções de internação entre usuários de varfarina ou outros anticoagulantes (p=0,314). Acompanhar idosos usuários de anticoagulantes é importante, sobretudo considerando-se o alto nível de fragilidade identificado e os riscos tromboembólicos e não-tromboembólicos que a COVID-19 traz. O telemonitoramento foi importante, permitindo realização de múltiplas intervenções.
The COVID-19 pandemic brought challenges to the monitoring of anticoagulant users, especially older adults, making telemonitoring an alternative to provide continuity of care for these patients. The present study aimed to describe the experience of telemonitoring of older anticoagulant users during the COVID-19 pandemic. This is a descriptive study concerning the telemonitoring pharmaceutical service for older adults (≥60 years old) using oral anticoagulants in a private geriatric outpatient clinic (Belo Horizonte). Older people had parameters of effectiveness and safety of anticoagulants monitored monthly by telephone (Apr-Dec/2021). Identified problems generated interventions for the patient or the multidisciplinary team. A total of 425 older adults were included in the service. Most used apixaban (189;41.9%), rivaroxaban (146;34.4%) and warfarin (47;11.1%). There was a mean age of 82.1 years, mostly female (65.2%), most at high risk of vulnerability (69%), and an incidence of 9.9% of COVID-19. There were 219 interventions related to warfarin (average of 4.6 interventions/patient); including requests for an INR test (57.5%), health guidelines (19.6%), dosage change (reduction - 10.5%; increase - 5.9%; suspension - 0.6%), or referral (5.9%). Users of other anticoagulants did not show alterations in the monitored parameters. Eleven older adults suffered falls and 10 required hospitalizations due to thromboembolic or hemorrhagic events. There was no statistically significant difference in hospitalization rates between users of warfarin or other anticoagulants (p=0.314). Monitoring older anticoagulant users is important, especially considering the high level of frailty identified and the thromboembolic and non-thromboembolic risks that COVID-19 brings. Telemonitoring was important, allowing for multiple interventions to be performed.
