ABSTRACT Unvaccinated identical twins developed bilateral anterior uveitis soon after the onset of coronavirus disease 2019 symptoms. During follow-up, both patients developed choroiditis, and one twine developed posterior scleritis and serous retinal detachment. Prompt treatment with oral prednisone ameliorated the lesions, and no recurrence was observed at the 18-month follow-up. Choroiditis may rarely be associated with severe acute respiratory syndrome coronavirus 2 infection, and it responds well to corticosteroid therapy. Although the exact mechanism is unknown, we hypothesize that the virus may act as an immunological trigger for choroiditis. 201 symptoms followup, followup follow up, up follow-up choroiditis detachment lesions 18month month 18 followup. up. infection therapy unknown 20 1

The coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a profound impact on global health and socio-economic conditions. To date, various vaccines have been administered worldwide in an effort to curb the spread of the virus. Despite vaccination efforts, there have been complications. Existing antiviral drugs have shown limited effectiveness, prompting the use of computational methods to understand the dynamics of the virus and develop suitable treatments. The current study focuses on using biocompatible para-sulfonato-calix[4]arenes to dock against two key proteins of SARS-CoV-2, namely ribonucleic acid (RNA)-dependent RNA polymerase, and helicase. Docking results indicate a strong binding affinity of these compounds to the target proteins, with higher scores compared to commonly used medications. Molecular dynamics (MD) simulation validates the docking results, showing stable protein-ligand complexes over time. The compounds are also screened for absorption, distribution, metabolism, and excretion properties and toxicity, suggesting their potential as lead candidates for inhibiting the virus’s key proteins. However, further in vivo and in vitro studies are recommended to confirm these findings. COVID19 COVID 19 (COVID-19 pandemic SARSCoV2, SARSCoV2 SARSCoV SARS CoV , (SARS-CoV-2) socioeconomic socio economic conditions date efforts complications effectiveness treatments parasulfonatocalix4arenes parasulfonatocalixarenes para sulfonato calix 4 arenes 2, SARS-CoV-2 RNAdependent dependent polymerase helicase medications MD (MD proteinligand protein ligand time absorption distribution metabolism toxicity viruss s However findings COVID1 1 (COVID-1 (SARS-CoV-2 parasulfonatocalix SARS-CoV- (COVID- (SARS-CoV- SARS-CoV (COVID (SARS-CoV

RESUMEN Introducción: el SARS-CoV-2 desde el 2020 generó innumerables desafíos. El decúbito prono se utilizó para mejorar la oxigenación, y la terapia nutricional se adaptó para cubrir los requerimientos y reducir complicaciones. Objetivos: evaluar la tolerancia de la nutrición enteral y su adecuación energética en pacientes ventilados en decúbito prono con infección por SARS-CoV-2, en sala respiratoria del Departamento de Cuidados Intensivos Adultos del Hospital de Clínicas-Facultad de Ciencias Médicas - Universidad Nacional de Asunción, de marzo a julio 2021. Metodología: estudio observacional, descriptivo, retrospectivo, de corte transversal, de casos consecutivos, con información obtenida de fichas de pacientes de terapia intensiva, que recibieron soporte nutricional en posición prona. Se tomaron datos demográficos, clínicos y nutricionales. Se evaluó la tolerancia nutricional durante la posición prona, definiéndola como la presencia de un volumen de residuo gástrico < 500 mL cada 6 h.. La adecuación energética fue determinada teniendo en cuenta el porcentaje cumplido de la prescripción nutricional. Resultados: se reclutaron 41 pacientes. El 60,9 % eran hombres; la mediana de edad fue 55 años (RIC=23). Las principales comorbilidades fueron obesidad (57,3 %) e hipertensión arterial (43,9 %). El 85,4 % presentó buena tolerancia gástrica en posición prono, con residuo gástrico menor a 500 ml. El porcentaje de adecuación energética fue de 84 %. Conclusión: la terapia nutricional enteral en decúbito prono fue bien tolerada por la mayoría de nuestros pacientes, posibilitando alcanzar los requerimientos nutricionales indicados.

ABSTRACT Introduction: SARS-CoV-2 since 2020 has generated countless challenges. Prone position was used to improve oxygenation, and nutritional therapy was adapted to meet requirements and reduce complications. Objectives: evaluate the tolerance of enteral nutrition and its energetic adequacy in ventilated patients in the prone position with SARS-CoV-2 infection, in the respiratory room of the Adult Intensive Care Department of the Hospital de Clínicas - Facultad de Ciencias Médicas - Universidad Nacional de Asunción, from March to July 2021. Methodology: observational, descriptive, retrospective, cross-sectional study of consecutive cases, with information obtained from records of intensive care patients, who received nutritional support in a prone position. Demographic, clinical and nutritional data were taken. Nutritional tolerance was evaluated during the prone position, defining it as the presence of a volume of gastric residue < 500 mL every 6 h. Energy adequacy was determined taking into account the percentage fulfilled of the nutritional prescription. Results: 41 patients were recruited. 60.9 % were men; the median age was 55 years (IQR=23). The main comorbidities were obesity (57.3 %) and high blood pressure (43.9 %). 85.4 % had good gastric tolerance in the prone position, with gastric residue less than 500 ml. The percentage of energy adequacy was 84 %. Conclusion: enteral nutritional therapy in the prone position was well tolerated by the majority of our patients, making it possible to achieve the indicated nutritional requirements.

Abstract During the pandemic, there were a lot of lockdowns that brought changes to the population’s daily routine, reducing social interactions, changing work and study methods, isolating the family at their home, which brought changes to family dynamics. These changes sparked the interest of nursing students in carrying out a research study. Starting from the question: What is the role of the dog in the family dynamics in times of pandemic? and the objective: identify the guardians’ perceptions about the role of the dog in the family dynamics in a period of confinement, a qualitative, exploratory, and descriptive study was carried out, collecting data through a focus group with six guardians from different families. Bardin’s protocol was used to analyze and process the data. Three categories emerged in this study, highlighting the benefits in terms of mental health, physical and psychological well-being of the family with the presence of the dog, its importance in strengthening family ties and the lessons learned from adopting the dogs. We conclude that, in nursing, it is necessary to highlight the presence of the dog in the family since it brings benefits to its dynamics. pandemic populations population s routine interactions methods home question objective confinement qualitative exploratory families Bardins Bardin health wellbeing well being dogs

Resumo Com o confinamento imposto pelo SARS-CoV-2, houve mudanças na dinâmica familiar. Para os estudantes de enfermagem este foi um assunto que gerou interesse em investigar. Partindo da questão: Qual o papel do cão na dinâmica familiar em tempo de pandemia? e do objetivo: identificar as perceções dos tutores sobre o papel do cão na dinâmica familiar num período de confinamento, enveredámos por um estudo qualitativo, descritivo, com recurso a focus group e amostra de seis membros de famílias diferentes. O tratamento e análise de dados seguiu o protocolo de Bardin. Identificámos que a existência de cão numa família influencia a sua dinâmica através dos benefícios obtidos quer a nível da saúde mental e bem-estar psicológico, quer a nível da saúde física. Igualmente, destacaram-se vantagens, apesar de algumas desvantagens. O vínculo afetivo entre cão e família, advém da reflexão sobre legislação portuguesa, proteção dos direitos dos animais, responsabilidades dos tutores e configuração familiar. Concluímos que na enfermagem, é necessário relevar a presença do cão na família uma vez que traz benefícios para a sua dinâmica. Esta torna-se uma visão inovadora quando pretendemos contribuir para a manutenção da saúde familiar focada nas necessidades de cada indivíduo, família e comunidade. SARSCoV2, SARSCoV2 SARSCoV SARS CoV 2, 2 SARS-CoV-2 investigar questão pandemia objetivo qualitativo descritivo diferentes Bardin bemestar bem estar psicológico física Igualmente destacaramse destacaram se vantagens desvantagens portuguesa animais tornase torna indivíduo comunidade SARS-CoV- SARS-CoV

Abstract This study aimed to analyze the role of nurses in hospital management in the face of COVID-19. The study had a qualitative, descriptive, and exploratory approach. The setting was a hospital that was completely transformed to care for patients with COVID-19. At the time of data collection, ten nurses managed the services, and all participated in the semi-structured interview. After thematic analysis, the data were presented in three categories, representing the elements of Donabedian’s triad: structure, process, and result. Category 1 highlighted the hospital structure reconfiguration based on material and people management; category 2 addressed the work process restructuring to achieve goals with safety and quality; and category 3 focused on nurses’ experiences in describing the results achieved and expected. The analysis highlighted the importance of teamwork, involvement, and adaptation of managers in the face of the challenges of a new and life-threatening disease, scarce resources, and the complexity of human relationships in the crisis. In transformational leadership, these nurses encouraged behavior change, professional growth, and resilience. COVID19. COVID19 COVID 19. 19 COVID-19 qualitative descriptive approach collection services semistructured semi structured interview categories Donabedians Donabedian s triad result quality expected teamwork involvement lifethreatening life threatening disease resources crisis leadership change growth resilience COVID1 COVID-1 COVID-

Resumo Objetivou-se analisar a atuação dos enfermeiros na gestão hospitalar frente à COVID-19. O estudo teve uma abordagem qualitativa, do tipo descritivo e exploratório. O cenário foi um hospital que se transformou totalmente para atendimento de pacientes com COVID-19. No momento da coleta de dados, dez enfermeiros estavam à frente da gestão dos serviços, e todos participaram da entrevista semiestruturada. Os dados, após análise temática, foram apresentados em três categorias representativas dos elementos da tríade de Donabedian, ou seja, estrutura, processo e resultado. A categoria 1 realçou a reconfiguração da estrutura hospitalar a partir da gestão de materiais e das pessoas; a categoria 2 abordou a reestruturação do processo de trabalho para alcance das metas com segurança e qualidade; e a categoria 3 focou nas experiências dos enfermeiros na descrição dos resultados alcançados e esperados. A análise evidenciou a importância do trabalho em equipe, do envolvimento e da adaptação do gestor diante dos desafios da doença nova e ameaçadora da vida, dos recursos escassos e da complexidade das relações humanas na crise. Na liderança transformacional esses enfermeiros incentivaram a mudança de comportamento, o crescimento profissional, e resiliência. Objetivouse Objetivou COVID19. COVID19 COVID 19. 19 COVID-19 qualitativa exploratório dados serviços semiestruturada temática Donabedian seja resultado pessoas qualidade esperados equipe vida crise comportamento profissional resiliência COVID1 COVID-1 COVID-

Abstract This article is a critical reflexivity approach of our own ethnographic research on SARS-CoV-2 infection carried out during 2020-2021. Experiences, narratives, interpretations and policies for the diagnosis and control of the circulation of the virus in three cities of different urban scale in Argentina are analyzed here. Carried out in the post-pandemic, our analysis aims to converge experiences, tellings and policies to make significant contributions to the study and understanding of the health phenomenon from social anthropology, offering recommendations for the planning and management of future and probable confinements. We conclude that our contribution as social scientists is the understanding of the health phenomenon within the framework of structural inequalities, emerging the need to plan prevention due to confinement at micro, meso and macro social scales. SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- 20202021. 20202021 2020 2021. 2021 2020-2021 Experiences narratives here postpandemic, postpandemic post pandemic, pandemic post-pandemic experiences anthropology confinements inequalities micro scales SARS-CoV 2020202 202 2020-202 202020 20 2020-20 20202 2020-2 2020-

Resumen Este artículo es un ejercicio de reflexividad sobre investigaciones etnográficas propias de la infección por SARS-CoV-2 realizadas en 2020-2021. Se analizan aquí experiencias, narrativas y políticas de diagnóstico y control de la circulación del virus en tres ciudades de diferente escala urbana de Argentina. Realizado en la postpandemia, nuestro análisis se propone aportar al estudio del fenómeno sanitario desde la antropología social, ofreciendo recomendaciones para la planificación y gestión de futuros y probables confinamientos. Concluimos que nuestra contribución como científicas sociales es la comprensión del fenómeno sanitario en el marco de desigualdades estructurales, emergiendo la necesidad de planificar la prevención por confinamiento a escalas micro, meso y macro sociales. SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- 20202021. 20202021 2020 2021. 2021 2020-2021 experiencias Argentina postpandemia social confinamientos estructurales micro SARS-CoV 2020202 202 2020-202 202020 20 2020-20 20202 2020-2 2020-

ABSTRACT Introduction: Although most individuals recover after acute infection by SARS-CoV-2, others may suffer from persistent symptoms with potential medium and long-term consequences on the performance of activities and participation, with possible implications for their fitness for work. Objective: To analyze the persistence of symptoms twelve months after SARS-CoV-2 infection, and the perception of the performance level in activities and participation in life situations, of workers in a company of the industrial sector in the Aveiro Region. Methodology: An observational study, developed in an Occupational Health Service of an industrial company in the region of Aveiro, including workers with positive SARS-COV-2 RT-PCR/TRAg test, between October/2020-January/2022. After signaling the infection, the Occupational Health Team applied a questionnaire collecting sociodemographic variables, a list of common symptoms during the acute phase of infection by SARS-COV-2, and the perceived functionality assessed by the Portuguese version of WHODAS 2.0-PT12 (where '12 points' means the most functionality). At twelve months, they filled out another list of persistent symptoms after SARS-CoV-2 infection and again WHODAS 2.0-PT12. Data analysis included descriptive statistics and univariate and multivariate linear regression. The analysis was conducted with the software JASP 0.16.3. Results: Eighty-five workers were infected with SARS-CoV-2, with a mean age of 36.1± 9.8years, 77.7% were male, 36.7% had higher education and 17.7% reported at least one chronic condition. At twelve months, thirty workers (35.3%) reported persistent symptoms, with fatigue (27.7%) and arthralgia (14.4%) being the most mentioned. The mean WHODAS 2.0 in the two evaluation moments was 19.2±8.0 vs 15.7±5.0. Significant associations between WHODAS 2.0 items and persistent symptoms of fatigue, headache, cough, myalgia, arthralgia, and previous chronic disease were found. Conclusions: Persistent symptoms twelve months after acute SARS-CoV-2 infection have repercussions on workers' self-perception of performance in some activities and participation in life situations. The occupational health team can implement continuous surveillance of the infected worker's health, assess the presence of persistent symptoms of this infection, and implement an individualized rehabilitation program, which minimizes the impact of the persistence of symptoms on their work performance, and in activities and participation in life situations.

RESUMO Introdução: Embora a maioria dos indivíduos recupere após a infeção aguda por SARS-CoV-2, outros podem apresentar sintomas persistentes com potenciais consequências a médio e longo prazo no desempenho de atividades e participação, com eventuais implicações na sua aptidão para o trabalho. Objetivo: Analisar a persistência de sintomas aos doze meses após infeção por SARS-CoV-2 e perceção do nível de desempenho em atividades e participação em situações de vida de trabalhadores do setor industrial numa empresa da Região de Aveiro. Metodologia: Estudo observacional, desenvolvido num Serviço de Saúde Ocupacional de uma empresa industrial da região de Aveiro, incluindo trabalhadores com teste SARS-COV-2 RT-PCR/TRAg positivo, entre outubro/2020-janeiro/2022. Após sinalização da infeção, a Equipa de Saúde Ocupacional aplicou um questionário recolhendo as variáveis sociodemográficas, uma lista de sintomas comuns durante a fase aguda da infeção por SARS-COV-2 e a funcionalidade percebida avaliada pela versão portuguesa da WHODAS 2.0-PT12 (onde '12 pontos' significa a maior funcionalidade). Aos doze meses, preencheram outra lista de sintomas persistentes após a infeção por SARS-CoV-2 e novamente a WHODAS 2.0-PT12. A análise dos dados incluiu estatística descritiva e regressão logística univariada e multivariada. A condução da análise foi realizada com o software JASP 0,16.3. Resultados: Oitenta e cinco trabalhadores encontravam-se infetados com SARS-CoV-2, com idade média de 36,1±9,8anos, 77,7% eram do sexo masculino, 36,7% possuíam escolaridade superior e 17,7% relataram pelo menos uma condição crónica. Aos doze meses, trinta trabalhadores (35,3%) relataram sintomas persistentes, sendo a fadiga (27,7%) e artralgia (14,4%) os mais mencionados. A média da WHODAS 2.0 nos dois momentos de avaliação foi 19,2±8,0 vs 15,7±5,0. Foram encontradas associações significativas entre os itens da WHODAS 2.0 e os sintomas persistentes fadiga, cefaleia, tosse, mialgia, artralgia e doença crónica prévia. Conclusões: Os sintomas persistentes doze meses após a infeção aguda por SARS-CoV-2 têm repercussão na autoperceção do desempenho em algumas atividades e participação em situações de vida dos trabalhadores. A equipa de saúde ocupacional deve realizar a vigilância contínua da saúde do trabalhador infetado, avaliando a presença de sintomas persistentes desta infeção e poderá implementar um programa de intervenção individualizado, que minimize o impacto da persistência dos sintomas no seu desempenho laboral, assim como, em atividades e participação em situações de vida.

Resumen Introducción: La mielitis transversa (MT) es una enfermedad inflamatoria desmielinizante que se presenta con disfunción motora, sensitiva y autonómica, de forma aguda o subaguda. La MT asociada al COVID-19 se ha escrito en un escaso número de pacientes. Caso clínico: Se presenta el caso de un masculino de 15 años previamente sano, quien cursaba con un cuadro respiratorio y que desarrollo un deterioro neurológico súbito que involucro un síndrome medular completo localizado en el nivel cérvico dorsal, con paraparesia simétrica que progreso a la paraplejia, con disfunción sensitiva desde el nivel medular de T3, disfunción de esfínteres y deterioro ventilatorio que requirió manejo avanzado de la vía aérea. Su resonancia magnética fue compatible con mielitis transversa aguda. Se descartaron causas inflamatorias y no inflamatorias de la patología. Además, se obtuvo un resultado positivo de SARS-COV-2. Se inició tratamiento con pulsos de metilprednisolona y plasmaféresis, con una evolución insidiosa. Conclusión: El COVID-19 es una causa infrecuente de MT y debe sospecharse cuando otras causas han sido descartadas.

Abstract Background: Transverse myelitis (TM) is a demyelinating inflammatory disease that presents with motor, sensory, and autonomic dysfunction, which may be acute or subacute. COVID-19-associated TM has been described in a scarce number of patients. Clinical case: A 15-year-old previously healthy male patient with respiratory disease before his neurological deterioration presented to the emergency room after developing a complete medullary syndrome located at the cervical-dorsal level, with ascending and symmetric paraparesis that rapidly progressed to paraplegia, with sensory dysfunction from the T3 level, sphincter dysfunction and sudden ventilatory deterioration that required mechanical ventilation. Magnetic resonance imaging was compatible with acute TM. Inflammatory and non-inflammatory etiologies were discarded. In addition, a positive severe acute respiratory syndrome coronavirus 2 test was obtained. Treatment included steroid pulses and plasmapheresis, with an insidious evolution. Conclusion: COVID-19 is an infrequent cause of TM and should be suspected when other etiologies have been ruled out.

Abstract Introduction: Acute kidney injury (AKI) occurs frequently in COVID-19 patients and is associated with greater morbidity and mortality. Knowing the risks of AKI allows for identification, prevention, and timely treatment. This study aimed to identify the risk factors associated with AKI in hospitalized patients. Methods: A descriptive, retrospective, cross-sectional, and analytical component study of adult patients hospitalized with COVID-19 from March 1 to December 31, 2020 was carried out. AKI was defined by the creatinine criteria of the KDIGO-AKI guidelines. Information, regarding risk factors, was obtained from electronic medical records. Results: Out of the 934 patients, 42.93% developed AKI, 60.59% KDIGO-1, and 9.9% required renal replacement therapy. Patients with AKI had longer hospital stay, higher mortality, and required more intensive care unit (ICU) admission, mechanical ventilation, and vasopressor support. Multivariate analysis showed that age (OR 1.03; 95% CI 1.02–1.04), male sex (OR 2.13; 95% CI 1.49–3.04), diabetes mellitus (DM) (OR 1.55; 95% CI 1.04–2.32), chronic kidney disease (CKD) (OR 2.07; 95% CI 1.06–4.04), C-reactive protein (CRP) (OR 1.02; 95% CI 1.00–1.03), ICU admission (OR 1.81; 95% CI 1.04–3.16), and vasopressor support (OR 7.46; 95% CI 3.34–16.64) were risk factors for AKI, and that bicarbonate (OR 0.89; 95% CI 0.84–0.94) and partial pressure arterial oxygen/inspired oxygen fraction index (OR 0.99; 95% CI 0.98–0.99) could be protective factors. Conclusions: A high frequency of AKI was documented in COVID-19 patients, with several predictors: age, male sex, DM, CKD, CRP, ICU admission, and vasopressor support. AKI occurred more frequently in patients with higher disease severity and was associated with higher mortality and worse outcomes. Introduction (AKI COVID19 COVID 19 COVID-1 identification prevention treatment Methods descriptive retrospective crosssectional, crosssectional cross sectional, sectional cross-sectional 31 202 out KDIGOAKI KDIGO guidelines Information records Results 93 4293 42 42.93 6059 60 59 60.59 KDIGO1, KDIGO1 1, KDIGO-1 99 9 9.9 therapy stay (ICU ventilation OR 1.03 103 03 95 1.02–1.04, 102104 1.02–1.04 , 02 04 1.02–1.04) 2.13 213 2 13 1.49–3.04, 149304 1.49–3.04 49 3 1.49–3.04) DM (DM 1.55 155 55 1.04–2.32, 104232 1.04–2.32 32 1.04–2.32) CKD (CKD 2.07 207 07 1.06–4.04, 106404 1.06–4.04 06 4 1.06–4.04) Creactive C reactive CRP (CRP 1.02 102 1.00–1.03, 100103 1.00–1.03 00 1.00–1.03) 1.81 181 81 1.04–3.16, 104316 1.04–3.16 16 1.04–3.16) 7.46 746 7 46 3.34–16.64 3341664 34 64 0.89 089 0 89 0.84–0.94 084094 84 94 oxygeninspired inspired 0.99 099 0.98–0.99 098099 98 Conclusions predictors outcomes COVID1 COVID- 20 429 42.9 605 6 5 60.5 KDIGO- 9. 1.0 10 10210 1.02–1.0 2.1 21 14930 1.49–3.0 1.5 15 10423 1.04–2.3 2.0 10640 1.06–4.0 10010 1.00–1.0 1.8 18 8 10431 1.04–3.1 7.4 74 3.34–16.6 334166 0.8 08 0.84–0.9 08409 0.9 09 0.98–0.9 09809 42. 60. 1. 1021 1.02–1. 2. 1493 1.49–3. 1042 1.04–2. 1064 1.06–4. 1001 1.00–1. 1043 1.04–3. 7. 3.34–16. 33416 0. 0.84–0. 0840 0.98–0. 0980 1.02–1 149 1.49–3 104 1.04–2 106 1.06–4 100 1.00–1 1.04–3 3.34–16 3341 0.84–0 084 0.98–0 098 1.02– 14 1.49– 1.04– 1.06– 1.00– 3.34–1 334 0.84– 0.98– 1.49 1.04 1.06 1.00 3.34– 33 0.84 0.98 1.4 3.34 3.3 3.

RESUMO Introdução: Lesão renal aguda (LRA) ocorre frequentemente em pacientes com COVID-19 e associa-se a maior morbidade e mortalidade. Conhecer riscos da LRA permite a identificação, prevenção e tratamento oportuno. Este estudo teve como objetivo identificar fatores de risco associados à LRA em pacientes hospitalizados. Métodos: Realizou-se estudo descritivo, retrospectivo, transversal e de componente analítico de pacientes adultos hospitalizados com COVID-19 de 1º de março a 31 de dezembro, 2020. Definiu-se a LRA pelos critérios de creatinina das diretrizes KDIGO-LRA. Informações sobre fatores de risco foram obtidas de prontuários eletrônicos. Resultados: Dos 934 pacientes, 42,93% desenvolveram LRA, 60,59% KDIGO-1 e 9,9% necessitaram de terapia renal substitutiva. Pacientes com LRA apresentaram maior tempo de internação, maior mortalidade e necessitaram de mais internações em UTIs, ventilação mecânica e suporte vasopressor. A análise multivariada mostrou que idade (OR 1,03; IC 95% 1,02–1,04), sexo masculino (OR 2,13; IC 95% 1,49–3,04), diabetes mellitus (DM) (OR 1,55; IC 95% 1,04–2,32), doença renal crônica (DRC) (OR 2,07; IC 95% 1,06–4,04), proteína C reativa (PCR) (OR 1,02; IC 95% 1,00–1,03), admissão em UTI (OR 1,81; IC 95% 1,04–3,16) e suporte vasopressor (OR 7,46; IC 95% 3,34–16,64) foram fatores de risco para LRA, e que bicarbonato (OR 0,89; IC 95% 0,84–0,94) e índice de pressão parcial de oxigênio arterial/fração inspirada de oxigênio (OR 0,99; IC 95% 0,98–0,99) poderiam ser fatores de proteção. Conclusões: Documentou-se alta frequência de LRA em pacientes com COVID-19, com diversos preditores: idade, sexo masculino, DM, DRC, PCR, admissão em UTI e suporte vasopressor. LRA ocorreu mais frequentemente em pacientes com maior gravidade da doença e associou-se a maior mortalidade e piores desfechos. Introdução (LRA COVID19 COVID 19 COVID-1 associase associa se identificação oportuno Métodos Realizouse Realizou descritivo retrospectivo º 3 dezembro 2020 Definiuse Definiu KDIGOLRA. KDIGOLRA KDIGO LRA. KDIGO-LRA eletrônicos Resultados 93 4293 42 42,93 6059 60 59 60,59 KDIGO1 1 KDIGO- 99 9 9,9 substitutiva internação UTIs OR 1,03 103 03 95 1,02–1,04, 102104 1,02–1,04 , 02 04 1,02–1,04) 2,13 213 2 13 1,49–3,04, 149304 1,49–3,04 49 1,49–3,04) DM (DM 1,55 155 55 1,04–2,32, 104232 1,04–2,32 32 1,04–2,32) DRC (DRC 2,07 207 07 1,06–4,04, 106404 1,06–4,04 06 4 1,06–4,04) PCR (PCR 1,02 102 1,00–1,03, 100103 1,00–1,03 00 1,00–1,03) 1,81 181 81 1,04–3,16 104316 16 7,46 746 7 46 3,34–16,64 3341664 34 64 0,89 089 0 89 0,84–0,94 084094 84 94 arterialfração arterial fração 0,99 099 0,98–0,99 098099 98 proteção Conclusões Documentouse Documentou COVID19, 19, preditores associouse associou desfechos COVID1 COVID- 202 429 42,9 605 6 5 60,5 9, 1,0 10 10210 1,02–1,0 2,1 21 14930 1,49–3,0 1,5 15 10423 1,04–2,3 2,0 20 10640 1,06–4,0 10010 1,00–1,0 1,8 18 8 1,04–3,1 10431 7,4 74 3,34–16,6 334166 0,8 08 0,84–0,9 08409 0,9 09 0,98–0,9 09809 42, 60, 1, 1021 1,02–1, 2, 1493 1,49–3, 1042 1,04–2, 1064 1,06–4, 1001 1,00–1, 1,04–3, 1043 7, 3,34–16, 33416 0, 0,84–0, 0840 0,98–0, 0980 1,02–1 149 1,49–3 104 1,04–2 106 1,06–4 100 1,00–1 1,04–3 3,34–16 3341 0,84–0 084 0,98–0 098 1,02– 14 1,49– 1,04– 1,06– 1,00– 3,34–1 334 0,84– 0,98– 1,49 1,04 1,06 1,00 3,34– 33 0,84 0,98 1,4 3,34 3,3 3,

ABSTRACT Introduction: Primary immunodeficiencies (PID) manifest as increased susceptibility to infectious diseases and are associated with significant morbimortality. COVID-19 has a variable clinical presentation, with unpredictable impact on immunocompromised patients. Knowing how this population responds to vaccination may be important to adjust future approaches. Objectives: To analyse immunological response to anti-COVID-19 vaccination in patients with PID. Methods: Prospective study of a population of patients with PID, followed in an Immunoallergology Unit, who were vaccinated against COVID-19. Clinical records were consulted to assess demographic, clinical, and laboratory data. Determination of total immunoglobulin G (IgG) and IgG SARS-CoV-2 before vaccination and serial measurement of IgG anti-spike after vaccination was performed. Results: Twenty patients were included, 55% female, with a mean age of 36,8±13,1 years old, 60% with common variable immunodeficiency (CVID), 30% selective antibody deficiency, and 10% X-linked agammaglobulinemia (XLA). In CVID patients, the median CD19 basal count was 180 cells/μL (IQR, 60;372). Twelve patients with CVID/XLA were under replacement treatment with subcutaneous gammaglobulin. All patients presented negative pre-vaccinal serology, with a median total IgG of 419 mg/dL (IQR, 238;896); IgG anti-spike after the primary vaccinal scheme was positive in 75% [median 796 AU/mL (IQR, 107;3772)]. Concerning CVID subpopulation: IgG anti-spike was positive in 67% after the primary vaccinal scheme, 75% before the booster dose, and 100% afterward. Lower counts of CD19 cells correlated with lower levels of IgG anti-spike (95% CI=0.117-0.898; p=0.023). No patient reported significant adverse reactions to vaccination. Conclusions: Anti-COVID-19 vaccination showed good response and safety in patients with PID. In the CVID subpopulation, more severe cases with lower counts of CD19 cells presented lower antibody titles after vaccination. Booster dose enhanced immune response, suggesting the need for additional inoculations to ensure sustained protection against COVID-19.

RESUMO Fundamentos: As imunodeficiências primárias (IDP) manifestam-se por suscetibilidade aumentada a doenças infeciosas e estão associadas a elevada morbimortalidade. A COVID-19 tem apresentação clínica variável, com impacto imprevisível nos doentes imunocomprometidos. Conhecer a resposta à vacinação desta população poderá ser importante para adequar medidas no futuro. Objetivos: Analisar a resposta imunológica à vacinação contra a COVID-19 em doentes com IDP. Métodos: Estudo prospetivo de uma população de doentes com IDP, seguidos numa unidade de Imunoalergologia, vacinados contra a COVID-19. Consulta dos processos clínicos para colheita de dados demográficos, clínicos e laboratoriais. Determinação de imunoglobulina G (IgG) total e IgG SARS-CoV-2 antes da vacinação e doseamentos seriados de IgG anti-spike após vacinação. Resultados: Incluídos 20 doentes, 55% do sexo feminino, com idade média 36,8±13,1 anos, 60% com imunodeficiência comum variável (IDCV), 30% deficiência seletiva de anticorpos e 10% agamaglobulinemia ligada ao X (ALX). Nos doentes com IDCV, a contagem basal de células CD19 mediana foi 180 células/μL (IIQ, 60;372). Realizavam terapêutica de substituição com gamaglobulina subcutânea 12 doentes com IDCV/ALX. A serologia pré-vacinal foi negativa em todos os doentes, a IgG total mediana foi 419 mg/dL (IIQ, 238;896) e a IgG anti-spike após esquema vacinal primário foi apositiva em 75% [mediana 796 AU/mL (IIQ, 107;3772)]. Na subpopulação com IDCV: a IgG anti-spike foi positiva em 67% após esquema vacinal primário, 75% antes da dose de reforço e 100% após reforço. Níveis mais baixos de células CD19 correlacionaram-se com valores inferiores de IgG anti-spike (95% IC=0,117-0,898; p=0,023). Nenhum doente reportou reações adversas significativas à vacinação. Conclusões: A vacinação contra a COVID-19 apresentou boa resposta e segurança nos doentes com IDP. Na subpopulação com IDCV, formas mais graves com contagens reduzidas de células CD19 apresentaram títulos mais baixos de anticorpos após vacinação. A dose de reforço potenciou a resposta imune, sugerindo a necessidade de inoculações adicionais para conferir proteção sustentada contra a COVID-19.

Abstract Objective: To evaluate if the comorbidity and coinfections presented by SARS-CoV-2 infection vs. COVID-19 impact our Mexican children. Method: Prospective and observational study that included the 2020-2021 peak influenza season. All patients with a diagnosis of infection by SARS-CoV-2 vs. COVID-19 who were admitted to the Hospital Infantil de Mexico were analyzed. Real-time RT-PCR for SARS-CoV-2 was performed in all patients, determining E, RdRp and RP genes and protein N, as well as RT-PCR for detection of respiratory viruses. Results: The inclusion criteria were met by 163 patients. The group with the highest risk of becoming ill was adolescents (40.4%), followed by schoolchildren and preschoolers (21.4% and 19.6% of the cases, respectively). There were three cases with viral coinfection: two (1.2%) with parvovirus B-19 and one (0.6%) with herpes type I; another two (1.2%) showed bacterial coinfection. The main comorbidity were obesity, acute lymphoblastic leukemia and arterial hypertension. Regarding mortality, we only had four cases (2.4%). Conclusions: Obesity, cancer, hypertension, heart disease and diabetes are comorbidity present in our patients, as referred to in literature, but not coinfections. In our study, we did not have any associated mortality related to comorbidity.

Resumen Objetivo: Evaluar el impacto de la comorbilidad y de las coinfecciones presentadas por la infección por SARS-CoV-2 vs. COVID-19 en niños mexicanos. Método: Estudio prospectivo y observacional que comprendió la temporada alta de influenza 2020-2021, analizando todos los pacientes con diagnóstico de infección vs. enfermedad por SARS-CoV-2 vs. COVID-19 que ingresaron al Hospital Infantil de México. Se realizó en todos RT-PCR en tiempo real para SARS-CoV-2, determinando gen E, gen RdRp, gen RP y proteína N, y RT-PCR multiplex para detección de virus respiratorios. Resultados: Los criterios de inclusión los cumplieron 163 pacientes. El grupo con mayor riesgo de enfermar fueron los adolescentes (40.4%), seguidos de los escolares y preescolares (21.4% y 19.6% de los casos, respectivamente). Hubo tres casos con coinfección viral: dos (1.2%) con parvovirus B-19 y uno (0.6%) con herpes tipo I; hubo otros dos (1.2%) con coinfección bacteriana. La principal comorbilidad correspondió a obesidad, leucemia linfoblástica aguda e hipertensión arterial. En cuanto a mortalidad, solo hubo cuatro casos (2.4%). Conclusiones: Obesidad, cáncer, hipertensión, cardiopatías y diabetes constituyen la comorbilidad en nuestros pacientes, como se refiere en la literatura, no así las coinfecciones. En nuestro estudio no hubo casos de mortalidad relacionada con la comorbilidad.

Paediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) has been reported globally since the outbreak of the coronavirus disease. The syndrome shares similarities with Kawasaki disease (KD). The manifestation of oral changes in both PIMS-TS and KD warrants that the oral health practitioner has an awareness of these conditions to facilitate timely management.

RESUMEN Introducción. El sobrepeso y la obesidad infantil constituyen un problema de salud pública. El inicio de la pandemia por COVID-19 pudo haber favorecido esta patología. El puntaje Z del índice de masa corporal (Z-IMC) es un indicador aceptado para su diagnóstico y seguimiento. Objetivo. Evaluar si la prevalencia de sobrepeso y obesidad, y el Z-IMC en niños de 2 a 5 años aumentó durante la pandemia. Población y métodos. Estudio de cohorte retrospectiva. Se incluyeron pacientes asistidos en efectores públicos de salud del Gobierno de la Ciudad Autónoma de Buenos Aires (GCABA), de 2 a 5 años de edad, con registro de peso y talla en dos consultas, antes y después de haber comenzado el aislamiento social preventivo y obligatorio (ASPO). Se registró estado nutricional (Z-IMC) y variación del Z-IMC entre ambas consultas. Resultados. Se evaluaron 3866 sujetos, edad promedio 3,4 ± 0,8 años; el 48,1 % fueron mujeres. El intervalo promedio entre consultas fue 14,3 ± 2,5 meses. La prevalencia de sobrepeso/obesidad aumentó del 12,6 % (IC95% 11,6-13,6) al 20,9 % (IC95% 19,6-22-2); p <0,001, al igual que el Z-IMC (0,4 ± 1,1 vs. 0,8 ± 1,3; p <0,001). Conclusión. La prevalencia de sobrepeso y obesidad, y el Z-IMC en niños de 2 a 5 años aumentó significativamente durante la pandemia.