Infusion of convalescent plasma is associated with clinical improvement in critically ill patients with Covid-19: a pilot study

ABSTRACT Background: The ideal treatment of coronavirus disease (COVID)-19 has yet to be defined, but convalescent plasma (CoPla) has been successfully employed. Objective: The objective of the study was to study the safety and outcomes of the administration of CoPla to individuals with severe COVID-19 in an academic medical center. Methods: Ten patients were prospectively treated with plasma from COVID-19 convalescent donors. Results: Over 8 days, the sequential organ failure assessment score dropped significantly in all patients, from 3 to 1.5 (p = 0.014); the Kirby index (PaO2/FiO2) score increased from 124 to 255, (p < 0.0001), body temperature decreased significantly from 38.1 to 36.9°C (p = 0.0058), and ferritin levels also dropped significantly from 1736.6 to 1061.8 ng/ml (p = 0.0001). Chest X-rays improved in 7/10 cases and in 6/10, computerized tomography scans also revealed improvement of the lung injury. Decreases in C-reactive protein and D-dimer levels were also observed. Three of five patients on mechanical ventilation support could be extubated, nine were transferred to conventional hospital floors, and six were sent home; two patients died. The administration of CoPla had no side effects and the 24-day overall survival was 77%. Conclusions: Although other treatments were also administered to the patients and as a result data are difficult to interpret, it seems that the addition of CoPla improved pulmonary function.

COVID-19: plasma de convaleciente en la sala de Clínica Médica del Hospital Gral. de Agudos "Dr. Cosme Argerich" en Buenos Aires / Convalescent plasma in Internal Medicine Ward from Hospital Argerich in Buenos Aires

Se presentan los resultados de seguridad y evolución clínica de 87 pacientes que recibieron plasma de convaleciente en la sala de Clínica Médica del Hospital Argerich en Buenos Aires. Tres pacientes tuvieron sobrecarga de volumen. Hubo 33 pases a Terapia Intensiva (37,9%) y 21 casos requirieron asistencia respiratoria mecánica (24,1%). Fallecieron 18 pacientes (20,7%). Tres de ellos por limitación del esfuerzo terapéutico y 15 en Terapia Intensiva. La mortalidad en Terapia Intensiva fue del 45,4%. Hubo solo 10 casos que recibieron plasma dentro de las 72 horas del comienzo de síntomas: de ellos, 1 caso de asistencia respiratoria y 1 fallecido; entre 72 horas y una semana recibieron plasma 25 casos con 26,9% de asistencia respiratoria y 20% de mortalidad, y de los 50 pacientes que recibieron mas allá de la primera semana, 25,4% requirieron de asistencia respiratoria y 24% fallecieron. Nuestra serie no pudo demostrar efecto beneficioso en la administración temprana de plasma y no fue diseñada para medir eficacia. El procedimiento fue bien tolerado en la gran mayoría de los pacientes

We present here the results of safety and clinical outcome of 87 patients that received convalescent plasma transfusion in the internal medicine ward of Hospital Argerich in Buenos Aires. Three patients developed transfusion-associated circulatory overload. Thirty-three patients were admitted to Intensive Care Unit (37,9%) and 21 cases required mechanical ventilation. Eighteen patients died (20,7%), 3 of them due to limitation of therapeutic effort and 15 in ICU. The mortality in ICU was 45,4%. Ten patients received plasma within 72 hs from the onset of symptoms. Of them, 1 case required mechanical ventilation and died. Twenty-five patients received plasma between 4 and 7 days from onset of symptoms, with a mortality rate of 20% and 26,9% of mechanical ventilation. Fifty patients received plasma past the 7 days from onset of symptoms, with a mortality rate of 24% and 25,4% of mechanical ventilation. Our series could not prove positive effects in the early administration of plasma and it was not designed to measure effectiveness. The procedure was well tolerated by most of the patients

Influência do cuidador informal na reabilitação do idoso em pós-operatório de fratura de fêmur proximal / Influencia del cuidador informal en la rehabilitación de las personas mayores en postoperatorio de la fractura del fémur proximal / The influence of informal caregivers on the rehabilitation of the elderly in the postoperative period of proximal femoral fracture

RESUMO Objetivo Verificar a influência do cuidador informal na independência funcional de idosos no pós-operatório de fratura de fêmur proximal por quedas. Método Revisão integrativa, cujo corpus de análise reuniu 23 artigos, entre 2002 e 2012, das bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Scientific Electronic Library Online, Cumulative Index to Nursing and Allied Health Literature, US National Library of Medicine e Scopus. Resultados Predominaram estudos com autoria de chineses e enfermeiros. A análise dos estudos evidenciou que as quedas seguidas por fraturas promovem a dependência de idosos e, consequentemente, a sobrecarga aos cuidadores, demonstrando o binômio idoso dependente-cuidador necessitar de apoio no processo de reabilitação. Conclusões Os cuidadores informais ainda precisam ser inseridos no planejamento e capacitados para o cuidado pelos profissionais da saúde, uma vez que influenciam positivamente a independência funcional no pós-operatório.

RESUMEN Objetivo Verificar la influencia del cuidador informal en la independencia funcional de ancianos en postoperatorio de fractura proximal de fémur por caídas. Método Revisión integradora, cuyo análisis se reunieron 23 artículos, entre 2002 y 2012, en las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Cumulative Index to Nursing and Allied Health Literature, US National Library of Medicine e Scopus. Resultados Predominaron estudios con autores chinos y enfermeros. El análisis de los estudios evidenció que las caídas que producen fracturas promueven la dependencia de ancianos y, consecuentemente, sobrecarga en los cuidadores, demostrando la dupla anciano dependiente-cuidador necesidad de apoyo en el proceso de rehabilitación. Conclusiones Los cuidadores informales necesitan inserción en la planificación, además de capacitación para cuidados por parte de profesionales de salud, toda vez que influyen positivamente en la independencia funcional durante el postoperatorio.

ABSTRACT Objective To analyze the influence of informal caregivers on the functional independence of older adults in the postoperative period of proximal femoral fracture due to falls. Method It is an integrative review of a corpus for analysis that gathered 23 articles, between 2002 and 2012, from databases "Literatura Latino-Americana e do Caribe em Ciências da Saúde" (Latin-American and Caribbean Health Sciences Literature in Health Sciences), Cumulative Index to Nursing and Allied Health Literature, US National Library of Medicine and Scopus. Results There was a predominance of studies by Chinese authors and nurses. The analysis of the studies evidenced that falls followed by fractures lead to dependence of older adults and, consequently, an overload to caregivers. Moreover, older adults and caregivers showed a need for support in the rehabilitation process. Conclusions Informal caregivers still need to be included in care planning and to be qualified for such care by health professionals, since they positively influence functional independence in the postoperative period.

Suplementação mineral e vitamínica em doenças crônicas e de convalescença / Mineral and vitamin supplementation in chronic diseases and convalescence

A síndrome de fadiga crônica (SFC) é uma condição clínica que, apesar de muito prevalente, tem tratamento controverso. A suplementação com substratos como glutamina e vitaminas pode atuar como adjuvante terapêutico. Os autores descrevem um medicamento que pode atender essa finalidade, composto por glutamina 200mg, glutamato de cálcio 250mg, cloridrato de piridoxina 20mg e fosfato de ditetraetilamônio 6mg. São descritas também as ações de cada um dos componentes, e como podem auxiliar na terapêutica da SFC e em períodos de convalescença em diversas condições.

The chronic fatigue syndrome (CFS) is a clinical condition which, although highly prevalent, treatment is controversial and supplementation of substrates such as glutamine and vitamins can act as therapeutic adjuvant. A drug composition that can serve this purpose, the composition is glutamine 200mg, 250mg calcium glutamate, 20mg pyridoxine hydrochloride and phosphate ditetraetilammonium 6mg is described. Also described the actions of each component and how they can assist in the treatment of CFS and in periods of convalescence from various other conditions described.