ABSTRACT BACKGROUND: The cause of oropharyngeal dysphagia in patients with coronavirus disease (COVID-19) can be multifactorial and may underly limitations in swallowing rehabilitation. OBJECTIVE: Analyze the factors related to dysphagia in patients with COVID-19 immediately after orotracheal extubation and the factors that influence swallowing rehabilitation. DESIGN AND SETTING: A retrospective study. METHODS: The presence of dysphagia was evaluated using the American Speech-Language Hearing Association National Outcome Measurement System (ASHA NOMS) scale and variables that influenced swallowing rehabilitation in 140 adult patients who required invasive mechanical ventilation for >48 h. RESULTS: In total, 46.43% of the patients scored 1 or 2 on the ASHA NOMS (severe dysphagia) and 39.29% scored 4 (single consistency delivered orally) or 5 (exclusive oral diet with adaptations). Both the length of mechanical ventilation and the presence of neurological disorders were associated with lower ASHA NOMS scores (odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.74–0.87 P < 0.05; and OR: 0.13, 95% CI: 0.61–0.29; P < 0.05, respectively). Age and the presence of tracheostomy were negatively associated with speech rehabilitation (OR: 0.92; 95% CI: 0.87–−0.96; OR: 0.24; 95% CI: 0.80–−0.75), and acute post-COVID-19 kidney injury requiring dialysis and lower scores on the ASHA NOMS were associated with longer time for speech therapy outcomes (β: 1.62, 95% CI, 0.70–3.17, P < 0.001; β: −1.24, 95% CI: −1.55–−0.92; P < 0.001). CONCLUSION: Prolonged orotracheal intubation and post-COVID-19 neurological alterations increase the probability of dysphagia immediately after extubation. Increased age and tracheostomy limited rehabilitation. BACKGROUND COVID19 COVID 19 (COVID-19 OBJECTIVE COVID-1 SETTING study METHODS SpeechLanguage Speech Language 14 48 >4 h RESULTS total 4643 46 43 46.43 severe 3929 39 29 39.29 single orally exclusive adaptations. adaptations . adaptations) odds OR [OR] 080 0 80 0.80 95 CI [CI] 074087 74 87 0.74–0.8 0.05 005 05 013 13 0.13 0.61–0.29 061029 61 respectively. respectively respectively) (OR 0.92 092 92 0.87–−0.96 087096 96 0.24 024 24 0.80–−0.75, 080075 0.80–−0.75 , 75 0.80–−0.75) postCOVID19 postCOVID post post-COVID-1 β (β 162 62 1.62 070317 70 3 17 0.70–3.17 0.001 0001 001 124 −1.24 −1.55–−0.92 155092 55 0.001. 0.001) CONCLUSION COVID1 (COVID-1 COVID- > 464 46.4 392 39.2 [OR 08 8 0.8 9 [CI 07408 7 0.74–0. 0.0 00 01 0.1 0.61–0.2 06102 6 0.9 09 0.87–−0.9 08709 0.2 02 08007 0.80–−0.7 postCOVID1 post-COVID- 16 1.6 07031 0.70–3.1 0.00 000 12 −1.2 −1.55–−0.9 15509 (COVID- 46. 39. 0. 0740 0.74–0 0.61–0. 0610 0.87–−0. 0870 0800 0.80–−0. post-COVID 1. 0703 0.70–3. −1. −1.55–−0. 1550 (COVID 074 0.74– 0.61–0 061 0.87–−0 087 0.80–−0 070 0.70–3 −1 −1.55–−0 155 07 0.74 0.61– 06 0.87–− 0.80–− 0.70– − −1.55–− 15 0.7 0.61 0.87– 0.80– 0.70 −1.55– 0.6 0.87 −1.55 −1.5

Abstract Background Progressive multifocal leukoencephalopathy (PML) - immune reconstitution inflammatory syndrome (IRIS) in people living with HIV/AIDS (PLWHA) has been rarely described in low- and middle-income countries. Objective To describe the prevalence of PML-IRIS among PLWHA with PML and its main features in a tertiary hospital in Brazil. Methods We performed a retrospective cohort study. We included PLWHA with PML-IRIS patients admitted at Instituto de Infectologia Emílio Ribas, São Paulo, Brazil, between 2011 and 2021. We retrieved information on neurological manifestations, neuroimaging findings, treatments, and outcomes. Results We identified 11 (11.8%) PML-IRIS cases among 93 patients with definite PML. Eight (73%) cases were men and had a median (IQR) age of 41 (27–50) years. Seven (63.6%) patients developed unmasking PML-IRIS and 4 (36.4%) had paradoxical PML-IRIS. The median (IQR) time from initiation of combined antiretroviral therapy (cART) to IRIS diagnosis was 49 (30–70) days. Ten (90.9%) patients received corticosteroids. There were 4 (36%) in-hospital deaths and 3 were associated with hospital-acquired pneumonia. Among the 7 (64%) patients who survived, 5 (71.5%) had sequelae at discharge. One year after the PML-IRIS diagnosis, 6 (54.5%) patients were alive. Conclusion The prevalence of PML-IRIS was 11.8%. Most patients had unmasking PML-IRIS. In-hospital mortality and morbidity were high. One-year survival was similar to that described in some high-income countries. (PML (IRIS HIVAIDS HIV AIDS (PLWHA low middleincome middle income countries PMLIRIS Brazil study Ribas Paulo 201 2021 manifestations findings treatments outcomes 1 11.8% 118 8 (11.8% 9 73% 73 (73% IQR (IQR 27–50 2750 27 50 (27–50 years 63.6% 636 63 (63.6% 36.4% 364 36 (36.4% PMLIRIS. IRIS. cART (cART 30–70 3070 30 70 (30–70 days 90.9% 909 90 (90.9% corticosteroids 36% (36% inhospital hospitalacquired acquired pneumonia 64% 64 (64% survived 71.5% 715 71 (71.5% discharge 54.5% 545 54 (54.5% alive Inhospital In high Oneyear highincome 20 202 11.8 (11.8 (73 27–5 275 2 (27–5 63.6 (63.6 36.4 (36.4 30–7 307 (30–7 90.9 (90.9 (36 (64 71.5 (71.5 54.5 (54.5 11. (11. (7 27– (27– 63. (63. 36. (36. 30– (30– 90. (90. (3 (6 71. (71. 54. (54. (11 ( (27 (63 (30 (90 (71 (54 (1 (2 (9 (5

Resumo Antecedentes A síndrome inflamatória de reconstituição imune (SIRI) da leucoencefalopatia multifocal progressiva (LEMP) em pessoas vivendo com HIV/Aids (PVHA) foi raramente descrita em países de baixa e média renda. Objetivo Descrever a prevalência da SIRI-LEMP- em PVHA com LEMP e suas principais características em um hospital no Brasil. Métodos Foi realizado um estudo de coorte retrospectivo. Incluímos PVHA com SIRI-LEMP admitidos no Instituto de Infectologia Emílio Ribas, São Paulo, Brasil, entre 2011 e 2021. Recuperamos informações sobre manifestações neurológicas, neuroimagem, tratamento e desfecho. Resultados Identificamos 11 (11,8%) casos de SIRI-LEMP entre 93 pacientes com LEMP definitiva. Oito (73%) casos eram homens e a mediana de idade (amplitude interquartile - AIQ) foi de 41 (27–50) anos. Sete (63,6%) pacientes desenvolveram SIRI-LEMP “desmascarada” e 4 (36,4%) casos apresentaram SIRI-LEMP “paradoxal”. A mediana de tempo (AIQ) desde o início da terapia antirretroviral combinada (cART) até o diagnóstico de SIRI foi de 49 (30–70) dias. Dez (90,9%) pacientes receberam corticoide. Houve 4 (36%) óbitos intra-hospitalares e 3 foram associados à pneumonia hospitalar. Dos 7 (64%) pacientes que sobreviveram, 5 (71,5%) ficaram com sequelas na alta. Um ano após o diagnóstico de SIRI-LEMP, 6 (54,5%) pacientes estavam vivos. Conclusão A prevalência de SIRI-LEMP foi de 11,8%. A maioria dos pacientes apresentava SIRI-LEMP “desmascarada”. A mortalidade e morbidade hospitalar foram altas. A sobrevida em 1 ano foi semelhante à descrita em alguns países de alta renda. (SIRI (LEMP HIVAids HIV Aids (PVHA renda SIRILEMP Brasil retrospectivo Ribas Paulo 201 2021 neurológicas neuroimagem desfecho 11,8% 118 8 (11,8% 9 definitiva 73% 73 (73% amplitude AIQ 27–50 2750 27 50 (27–50 anos 63,6% 636 63 (63,6% desmascarada “desmascarada 36,4% 364 36 (36,4% paradoxal. paradoxal . “paradoxal” (AIQ cART (cART 30–70 3070 30 70 (30–70 dias 90,9% 909 90 (90,9% corticoide 36% (36% intrahospitalares intra hospitalares 64% 64 (64% sobreviveram 71,5% 715 71 (71,5% SIRILEMP, LEMP, 54,5% 545 54 (54,5% vivos desmascarada. altas 20 202 11,8 (11,8 (73 27–5 275 2 (27–5 63,6 (63,6 36,4 (36,4 “paradoxal 30–7 307 (30–7 90,9 (90,9 (36 (64 71,5 (71,5 54,5 (54,5 11, (11, (7 27– (27– 63, (63, 36, (36, 30– (30– 90, (90, (3 (6 71, (71, 54, (54, (11 ( (27 (63 (30 (90 (71 (54 (1 (2 (9 (5

RESUMO Introdução: A hepatite C pode ser definida como uma doença infecciosa, que se desenvolve por uma atividade inflamatória, que pode gerar um comprometimento no Sistema Nervoso Central, podendo ocasionar prejuízos cognitivos e sintomas de depressão. Objetivo: O objetivo deste estudo foi verificar o desempenho cognitivo de pacientes com hepatite C crônica antes e após o tratamento com simeprevir, sofosbuvir e daclatasvir. Métodos: Foi realizado um estudo prospectivo em três etapas: antes, logo após o tratamento e seis meses depois. Foram avaliados 58 pacientes em acompanhamento clínico no Instituto de Infectologia Emílio Ribas, em São Paulo, Brasil. Foram utilizados os seguintes instrumentos: questionário sociodemográfico, Escala de Lawton, Inventário de Depressão de Beck e uma bateria de testes neuropsicológicos que avaliaram: função intelectual, memória, atenção, função executiva e velocidade motora e de processamento). Para análise estatística, foram utilizadas as análises descritas (média, frequência e desvio padrão), qui-quadrado e ANOVA. Resultados: A maioria dos participantes era do sexo masculino (n=30, 51,7%), com média de 58,23±8,79 anos, escolaridade média de 9,75±4,43 anos. Comparando os resultados das avaliações neuropsicológicas (antes, logo após a finalização dos medicamentos e seis meses), observou-se melhora significativa em relação à aquisição de novos conhecimentos (p=0,03), memória visual tardia (p=0,01) e tendência em relação a atenção alternada (p=0,07). Conclusão: O tratamento do vírus da hepatite C melhorou o desempenho cognitivo, principalmente em relação à memória.

ABSTRACT Background: Hepatitis C can be defined as an infectious disease that develops an inflammatory activity, which may cause an impairment in the central nervous system, may cause cognitive impairments and symptoms of depression. Objective: The objective of this study was to verify the cognitive performance of patients with chronic hepatitis C before and after treatment with simeprevir, sofosbuvir, and daclatasvir. Methods: A prospective study was carried out in three stages: before, right after treatment, and six months after. Fifty-eight patients under clinical follow-up were evaluated at the Emílio Ribas Infectology Institute, in São Paulo, Brazil. The following instruments were used: sociodemographic questionnaire, Lawton’s Scale, Beck’s Depression Inventory, and a battery of neuropsychological tests that evaluated: intellectual function, memory, attention, executive function, and motor and processing speed). For statistical analysis, the analyses described (mean, frequency, and standard deviation), chi-square, and ANOVA were used. Results: Most of the participants were male (n=30, 51.7%), with a mean of 58.23±8.79 years, mean schooling of 9.75±4.43 years. Comparing the results of neuropsychological evaluations (before, just after completion of drugs, and six months), a significant improvement was observed in relation to the acquisition of new knowledge (p=0.03), late visual memory (p=0.01), and tendency towards alternate attention (p=0.07). Conclusion: The treatment of the hepatitis C virus improved cognitive performance, especially in relation to memory.