Clinical profile and severity predictors of coronavirus disease 19 infection in a reference center from southern Brazil: a cross-sectional study.

OBJECTIVES: The coronavirus disease pandemic has become a major global health crisis since 2019. Recent data show the association of diabetes, hypertension, and obesity with poor related outcomes in coronavirus disease infection. This descriptive study aimed to identify the clinical and laboratory parameters in patients with acute respiratory syndrome and confirmed severe acute respiratory syndrome coronavirus 2 infection. METHODS: In this cross-sectional study, we analyzed data of 409 patients admitted to a referral hospital in Rio Grande do Sul, Brazil, with coronavirus disease infection confirmed by reverse transcription polymerase chain reaction. Clinical, laboratory, and imaging data were collected retrospectively from electronic medical records using a template with the variables of interest. RESULTS: The average age was 64 years (52-73), and the body mass index was 27 kg/m² (22.1-31.2). Hypertension, diabetes, and obesity were observed in 58, 33, and 32% of the patients, respectively. Patients admitted to an intensive care unit were older [66 years (53-74) vs. 59 years (42.2-71.7)], with significantly higher impairment on chest computed tomography [75% (50-75) vs. 50% (25-60)] and received higher doses of corticosteroid therapy [39.4 mg (14.3-70.3) vs. 6 mg (6-14.7)]. Hematological parameters were lower in critically ill patients, with greater differences observed on the fifth day of hospitalization [hemoglobin 11.5 g/dL (9.5-13.1) vs. 12.8 g/dL (11.5-14.2), platelets 235,000 µL (143,000-357,000) vs. 270,000 µL (192,000-377,000), and lymphocytes 900 µL (555-1,500) vs. 1,629 µL (1,141-2,329)]. C-reactive protein levels and kidney function were also worse in intensive care unit patients. The mortality rate was significantly higher in the intensive care unit compared to the basic care unit (62.8 vs. 12.2%). CONCLUSION: Our findings suggest that metabolic and cardiovascular comorbidities, as well as abnormal hematological parameters, are common findings among patients with severe respiratory syndrome related to coronavirus disease.

Clinical profile and severity predictors of coronavirus disease 19 infection in a reference center from southern Brazil: a cross-sectional study

SUMMARY OBJECTIVES: The coronavirus disease pandemic has become a major global health crisis since 2019. Recent data show the association of diabetes, hypertension, and obesity with poor related outcomes in coronavirus disease infection. This descriptive study aimed to identify the clinical and laboratory parameters in patients with acute respiratory syndrome and confirmed severe acute respiratory syndrome coronavirus 2 infection. METHODS: In this cross-sectional study, we analyzed data of 409 patients admitted to a referral hospital in Rio Grande do Sul, Brazil, with coronavirus disease infection confirmed by reverse transcription polymerase chain reaction. Clinical, laboratory, and imaging data were collected retrospectively from electronic medical records using a template with the variables of interest. RESULTS: The average age was 64 years (52-73), and the body mass index was 27 kg/m² (22.1-31.2). Hypertension, diabetes, and obesity were observed in 58, 33, and 32% of the patients, respectively. Patients admitted to an intensive care unit were older [66 years (53-74) vs. 59 years (42.2-71.7)], with significantly higher impairment on chest computed tomography [75% (50-75) vs. 50% (25-60)] and received higher doses of corticosteroid therapy [39.4 mg (14.3-70.3) vs. 6 mg (6-14.7)]. Hematological parameters were lower in critically ill patients, with greater differences observed on the fifth day of hospitalization [hemoglobin 11.5 g/dL (9.5-13.1) vs. 12.8 g/dL (11.5-14.2), platelets 235,000 μL (143,000-357,000) vs. 270,000 μL (192,000-377,000), and lymphocytes 900 μL (555-1,500) vs. 1,629 μL (1,141-2,329)]. C-reactive protein levels and kidney function were also worse in intensive care unit patients. The mortality rate was significantly higher in the intensive care unit compared to the basic care unit (62.8 vs. 12.2%). CONCLUSION: Our findings suggest that metabolic and cardiovascular comorbidities, as well as abnormal hematological parameters, are common findings among patients with severe respiratory syndrome related to coronavirus disease.

Hemoptise / Hemoptysis

A hemoptise é frequentemente encontrada na prática clínica, sendo uma manifestação presente em numerosas doenças. Pode ser uma emergência respiratória com potencial risco de morte, podendo indicar grave doença intratorácica. Este artigo visa realizar revisão bibliográfica sobre hemoptise, enfatizando os principais diagnósticos diferenciais, avaliação laboratorial, imaginológica e manejo.

Hemoptysis is frequently encountered in clinical practice, and may be the presenting symptom of a number of diseases. It can be a respiratory emergency with the potential risk of death and indicate severe underlying disease. This article aims to review literature on hemoptysis, emphasizing the differential diagnosis, laboratory evaluation, imaging and management.

Imuno-histoquímica na prática clínica / Immunohistochemistry in the practical clinic

A imuno-histoquímica, ao longo das três últimas décadas, revolucionou o campo da patologia e a visão sobre variados temas da atuação médica. A técnica, complementar à coloração de hematoxilina e eosina, mostrou-se indispensável não apenas para a pesquisa de laboratório, mas também na prática clínica. Seu espectro de atuação inclui a definição diagnóstica, a determinação de fatores prognósticos e índices proliferativos, a identificação de microorganismos, células, estruturas ou materiais, e a imunofarmacologia, cada vez mais relevantes na identificação da sensibilidade de diferentes tipos de câncer a drogas específicas. O entendimento das bases de sua técnica, bem como de suas aplicações e limitações, a torna ferramenta importantíssima no auxílio diagnóstico. A boa indicação permite que a técnica contribua para a resolução da dúvida diagnóstica em questão. A imuno-histoquímica destaca-se também na elucidação do sítio primário de neoplasias metastáticas, um dos mais desafiadores diagnósticos da medicina atual.

Diagnóstico e terapêutica do câncer com sítio primário desconhecido / Diagnosis and therapeutical of the cancer with unknow primary site

Apesar de o Câncer de Sítio Primário Desconhecido (CSPD) não ser um dos mais prevalentes na clínica médica, sabe-se que o diagnóstico e o tratamento de pacientes com tal patologia são um dilema. Mesmo com os recentes avanços na imunohistoquímica, na tecnologia de imagens e no surgimento de novas drogas antineoplásicas, a maioria dos pacientes é relativamente resistente ao tratamento sistêmico e apresenta uma pequena sobrevida. Compreender a apresentação clínica, a histopatologia, conhecer as formas de investigação diagnóstica, bem como as possibilidades de tratamento desta patologia tão diferenciada e que mexe com a ansiedade do médico, faz parte da formação de muitas especialidades da medicina.

Adesão ao tratamento de manutenção em asma (estudo ADERE) / Compliance with maintenance treatment of asthma (ADERE study)

OBJETIVO: Avaliar a adesão ao tratamento preventivo de asma persistente moderada e grave. MÉTODOS: Médicos de vários Estados do país foram contactados para selecionar asmáticos persistentes moderados ou graves, maiores de doze anos. Os pacientes receberam salmeterol/fluticasona 50/250 µg diskus durante 90 dias (sendo orientados a retornarem as embalagens ao final do estudo para conferência da dosagem total utilizada). Receberam telefonemas da equipe do estudo no início e ao final de 90 dias para que fosse avaliada a adesão. Foi considerado como aderente ao tratamento o asmático que utilizou no mínimo 85 por cento das doses prescritas. As variáveis estudadas foram sexo, idade, cor, estado civil, escolaridade, tabagismo atual, outras atopias, co-morbidades, gravidade da asma, uso de outras medicações e número de hospitalizações por asma. RESULTADOS: Foram incluídos 131 pacientes oriundos de quinze estados, com taxa geral de adesão de 51,9 por cento. Houve diferença significativa na adesão quanto à gravidade da asma (maior adesão nos casos graves; p = 0,02). Não houve diferença estatisticamente significativa nas demais variáveis. CONCLUSÃO: A taxa geral de adesão ao tratamento de manutenção da asma foi baixa.

OBJECTIVE: To determine the rate of compliance with preventive treatment of moderate and severe persistent asthma. METHODS: Physicians at various medical centers across the country were invited to nominate patients for participation in the study. Inclusion criteria were being over the age of 12 and presenting moderate or severe persistent asthma. Participating patients received salmeterol/fluticasone 50/250 µg by dry powder inhaler for 90 days and were instructed to return the empty packages at the end of the study as a means of determining the total quantity used. In order to evaluate compliance, a member of the research team contacted each patient via telephone at the study outset and again at the end of the 90-day study period. Asthma patients were considered compliant with the treatment if they used at least 85 percent of the prescribed dose. The following variables were studied: gender, age, race, marital status, years of schooling, smoking habits, other atopic conditions, comorbidities, asthma severity, use of other medication and number of hospital admissions for asthma. RESULTS: A total of 131 patients from fifteen states were included. The overall rate of compliance was found to be 51.9 percent. There was a significant difference in compliance in relation to asthma severity: compliance was greater among patients with severe persistent asthma than among those with moderate persistent asthma (p = 0.02). There were no statistically significant differences among any of the other variables. CONCLUSION: The overall rate of compliance with maintenance treatment of asthma was low.

Compliance with maintenance treatment of asthma (ADERE study).

OBJECTIVE: To determine the rate of compliance with preventive treatment of moderate and severe persistent asthma. METHODS: Physicians at various medical centers across the country were invited to nominate patients for participation in the study. Inclusion criteria were being over the age of 12 and presenting moderate or severe persistent asthma. Participating patients received salmeterol/fluticasone 50/250 microg by dry powder inhaler for 90 days and were instructed to return the empty packages at the end of the study as a means of determining the total quantity used. In order to evaluate compliance, a member of the research team contacted each patient via telephone at the study outset and again at the end of the 90-day study period. Asthma patients were considered compliant with the treatment if they used at least 85% of the prescribed dose. The following variables were studied: gender, age, race, marital status, years of schooling, smoking habits, other atopic conditions, comorbidities, asthma severity, use of other medication and number of hospital admissions for asthma. RESULTS: A total of 131 patients from fifteen states were included. The overall rate of compliance was found to be 51.9%. There was a significant difference in compliance in relation to asthma severity: compliance was greater among patients with severe persistent asthma than among those with moderate persistent asthma (p = 0.02). There were no statistically significant differences among any of the other variables. CONCLUSION: The overall rate of compliance with maintenance treatment of asthma was low.