Resumo Objetivo: Investigar anormalidades vasculares e perivasculares nas artérias carótidas por meio de ultrassonografia e avaliar sua associação com mortalidade e variáveis clínicas em pacientes hospitalizados com COVID-19. Materiais e Métodos: Neste estudo prospectivo, 53 pacientes hospitalizados com COVID-19 grave foram avaliados e submetidos a ultrassonografia de carótida. Descrevemos os achados ultrassonográficos de carótida nesses pacientes. As correlações de características clínicas, demográficas, laboratoriais e de imagem foram analisadas e comparadas por meio de análise estatística. Resultados: A ultrassonografia carotídea demonstrou irregularidade da superfície luminal em 29 pacientes (55%), placas carotídeas em 30 pacientes (57%), infiltração perivascular em quatro pacientes (7,5%) e aumento da espessura médio-intimal (EMI) em 31 pacientes (58%). Dos pacientes com EMI aumentada, 19 (61%) morreram, com associação observada entre EMI aumentada e mortalidade por COVID-19 (p = 0,03). Um modelo de regressão logística mostrou que a probabilidade de óbito foi de 85% em pacientes com EMI aumentada e história de nefropatia crônica ou lesão renal aguda na internação (p < 0,05). Conclusão: Aumento da EMI, irregularidade da superfície luminal, placas carotídeas e infiltrados perivasculares foram encontrados na ultrassonografia carotídea em pacientes hospitalizados com COVID-19 grave. O aumento da EMI associado a danos nos rins pode aumentar o risco de morte.

Abstract Objective: To investigate vascular and perivascular abnormalities in the carotid arteries using ultrasound, as well as to evaluate their association with mortality and clinical variables in hospitalized patients with coronavirus disease 2019 (COVID-19). Materials and Methods: This was a prospective study in which 53 hospitalized patients with severe COVID-19 were evaluated and underwent carotid ultrasound. We documented the carotid ultrasound findings in these patients. Clinical, demographic, laboratory, and imaging features were analyzed and compared by statistical analysis to detect correlations between them. Results: Carotid ultrasound demonstrated luminal surface irregularity in 29 patients (55%), carotid plaques in 30 (57%), perivascular infiltration in four (8%), and increased intima–media thickness (IMT) in 31 (58%). Of the 31 patients with increased IMT, 19 (61%) died, and the association between increased IMT and COVID-19–related mortality was significant (p = 0.03). Logistic regression showed that the risk of death was 85% in patients who had increased IMT in combination with acute kidney injury at admission or a history of chronic kidney disease (p < 0.05). Conclusion: In hospitalized patients with severe COVID-19, carotid ultrasound can show increased IMT, luminal surface irregularity, carotid plaques, and perivascular infiltrates. The combination of increased IMT and kidney damage appears to increase the risk of death in such patients.

ABSTRACT COVID-19 and obesity are two pandemic diseases that the world is currently facing. Both activate the immune system and mediate inflammation. A sequence of disease phases in patients with severe COVID-19 results in a cytokine storm, which amplifies the subclinical inflammation that already exists in patients with obesity. Pro-inflammatory cytokines and chemotactic factors increase insulin resistance in obesity. Therefore, a greater systemic inflammatory response is establishe, along with an increased risk of thrombotic phenomena and hyperglycemic conditions. These changes further impair pulmonary, cardiac, hepatic, and renal functions, in addition to hindering glycemic control in people with diabetes and pre-diabetes. This review explains the pathophysiological mechanisms of these two pandemic diseases, provides a deeper understanding of this harmful interaction and lists possible therapeutic strategies for this risk group.

Racional: Sobrepeso e obesidade estão associados à síndrome metabólica e obesidade abdominal, aumentando o risco de diabete melito tipo 2 e doenças cardiovasculares. No Brasil, ainda não há dados precisos sobre a prevalência destas alterações, principalmente entre pessoas que estão realizando algum tipo de atividade física em ambientes públicos; também não há programas de educação e prevenção da obesidade. Objetivo: Investigar a prevalência da obesidade e síndrome metabólica em frequentadores de um parque em Recife. Métodos: Realizou-se um estudo prospectivo, transversal e descritivo, onde 619 indivíduos foram avaliados e estratificados por perfil definido em protocolo específico, apresentando as seguintes características: sexo feminino (50,1%) e média de idade = 50,6 ± 14,8, havendo predomínio entre 50 e 59 anos (26,8% dos casos) e de indivíduos com ensino superior (68%) e renda familiar entre 4 e 10 salários mínimos (29,2%). Resultados: Prática regular de exercícios físicos foi relatada por 78% das pessoas e foi constatado ainda que 70,7% apresentavam excesso de peso: 45% com sobrepeso e 25,7% obesidade, dos quais 20,7% com obesidade grau I, 3,9% com grau II e 1,1% com grau III. A prevalência de síndrome metabólica foi de 4,3%, com predomínio nos homens (6,3%). Hipertensão arterial e diabetes mellitus tipo 2 foram detectados em 17,8% e 5,5%, respectivamente. Devido a influência da obesidade na ocorrência de diabetes mellitus 2 e síndrome metabólica, foi constatado que esta associação não é significativa para as duas condições (p=0,014 e 0,017, respectivamente). Conclusão : Os achados demonstram elevada prevalência de sobrepeso e obesidade da população avaliada, e síndrome metabólica em 4,3%, apesar do relato de que 70% dos transeuntes realizavam atividade física regular.

Background - Overweight and obesity are associated with metabolic syndrome and abdominal obesity, thereby increasing the risk of type 2 diabetes mellitus and cardiovascular diseases. In Brazil, there are still no precise data on the prevalence of these disorders, especially among individuals who carry out some kind of physical activity in public spaces and there are no education and prevention programs for obesity. Aim: To investigate the prevalence of metabolic syndrome and obesity among park users. Methods: A prospective, cross-sectional, descriptive study was conducted with 619 individuals assessed and stratified by profile according to a specific protocol. The group was characterized as follows: female (50.1%) and mean age =50.6±14.8, with predominance of individuals aged between 50 and 59 years (26.8%) and with higher education (68%) and a household income of between 4 and 10 minimum wages (29.2%). Results: Regular physical exercise was reported by 78% of the individuals and it was found that 70.7% were nevertheless of above normal weight: 45% overweight and 25.7% obese, of whom 20.7% had obesity grade I, 3.9% grade II and 1.1% grade III. The prevalence of metabolic syndrome was 4.3%, mostly in men (6.3%). Arterial hypertension and type 2 diabetes mellitus were detected in 17.8% and 5.5%, respectively. In view of the influence of obesity on the occurrence of type 2 diabetes mellitus and metabolic syndrome, it was found that this association was not significant for the two conditions (p=0.014 and 0.017, respectively). Conclusion : The findings demonstrate a high prevalence of overweight and obesity in the studied population, and metabolic syndrome in 4.3%, despite the fact that 70% reported engaging in regular physical activity.