Impacto da pandemia COVID-19 em gestações complicadas por diabetes tipo 1, tipo 2 e gestacional em atendimento em serviço de referência do Sul do Brasil

Em março de 2020, a Organização Mundial de Saúde declarou o surto de COVID-19 uma pandemia global. Medidas de higiene, isolamento social e uso de máscaras foram estabelecidas, impactando na rotina e no estilo de vida das pessoas. Os sistemas de saúde passaram por um desafio sem precedentes e o mundo sofreu rupturas econômicas e sociais devastadoras. Para avaliar os efeitos indiretos dessa pandemia no cuidado de mulheres com gestações complicadas por diabetes gestacional ou pré-existente, dois estudos foram realizados. Um ´painel de transversais com dados coletados de prontuários eletrônicos de 235 gestantes com diabetes tipo 1, tipo 2 ou gestacional, comparou o período pandêmico de setembro de 2020 a março de 2021, com seis meses anteriores à pandemia em 2019. Não houve diferença entre os grupos nos parâmetros objetivos de cuidado avaliados, como por exemplo, o número de consultas com especialistas durante o pré-natal. Os riscos de hipoglicemia neonatal e de bebês pequenos para a idade gestacional foram maiores no grupo com pré-natal antes da pandemia (RR 4,04; IC 95% 1,37 - 11,98, p = 0,012, e RR 4,29; IC 95% 1,93 - 9,54, p <0,001, respectivamente). Adicionalmente, um estudo transversal avaliou 79 mulheres com gestações complicadas por hipertensão e/ou diabetes. Ansiedade e depressão foram avaliados pelo State-Trait Anxiety Inventory e pelo Patient Health Questionnaire, e as prevalências encontradas para esses transtornos mentais foram de 79,7% e 59,2%, respectivamente. Menor suporte social associou-se a pontuações mais altas em ambas as escalas. Apesar dos impactos econômicos, sociais e estruturais da pandemia de COVID-19, os parâmetros de cuidado materno foram semelhantes em mulheres grávidas com diabetes atendidas neste período, em comparação com aquelas atendidas anteriormente; alguns resultados neonatais importantes melhoraram durante a pandemia. Gestantes com diabetes e hipertensão apresentaram altos níveis de ansiedade e sintomas depressivos durante a pandemia. Faz-se necessário o desenvolvimento de estratégias para mitigar os efeitos indiretos do COVID-19 na saúde mental desta população.In March 2020, the World Health Organization has declared the COVID-19 outbreak a global pandemic. Measures of hygiene, social isolation and the use of face masks were established, impacting people's livestyle and routine. Health systems underwent an unprecedented challenge, economic and social disruptions were devastating. To evaluate the indirect effects of this pandemic on the care of women with pregnancies complicated by gestational or pre-existing diabetes been assisted in a public university hospital in the South of Brazil, and on their maternal-fetal outcomes, two studies were elaborated. A cross-sectional panel data with information collected from electronic medical records from 235 pregnant women with type 1, type 2, or gestational diabetes; six months preceding the pandemic in 2019 were compared with the COVID-19 period from September 2020 to March 2021. There was no difference in objective care parameters, such as the number of appointments with specialists during prenatal care, between groups. Risks of neonatal hypoglycemia and small for gestational age were higher in the group with prenatal care before the pandemic (RR 4.04; 95% CI 1.37 – 11.98, p=0.012; RR 4.29; 95% CI 1.93 – 9.54, p<0.001, respectively). Additionally, a cross-sectional study evaluated 79 women with pregnancies complicated by hypertension and/or diabetes. Anxiety and depression were accessed by the State-Trait Anxiety Inventory and the Patient Health Questionnaire, prevalences found of these mental health disorders were 79.7% and 59.2%, respectively. Lower social support was correlated with higher scores on both scales. Despite the economic, social, and structural impacts of the COVID-19 pandemic, parameters of maternal care were similar in pregnant women with diabetes assisted during this period, compared to those assisted before; surprisingly, some important neonatal outcomes improved during the pandemic. Pregnant women with diabetes and hypertension presented high levels of anxiety and depressive symptoms during the pandemic. Strategies to mitigate COVID-19 indirect effects on mental health of this unique population are needed

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Benefits of water intake on kidney function in older adults: protocol for a randomized controlled trial

OBJECTIVE: The goal of this study is to evaluate the benefits of an increase in water intake guided by a mathematical formula (per kg of body weight) on kidney function in older adults. METHODS: Older adults (&ge; 65 years old) cared for at the Internal Medicine Unit of a tertiary hospital will be randomized to receive or not guidance on water intake (30 mL/kg per day) after initial assessment of kidney function. After 14 days, participants will be reevaluated through clinical and laboratory examinations. Patients with uncompensated disease will be excluded. The main outcomes will be glomerular filtration rate and laboratory measures such as serum and urinary osmolality, sodium, urea, 24-h urine volume and serum creatinine, uric acid, and copeptin. The Mini Nutritional Assessment (MNA) questionnaire will be applied to participants at each visit. Categorical variables will be described as numbers of cases (%) and compared using the \u3c72 test whereas continuous variables will be analyzed with Student’s t-test in relation to baseline measures. The Generalized Estimating Equations (GEE) method will be performed to assess differences over time and between groups. This study was approved by the Institution’s Research Ethics Committee (grant number 16-0153) and is in accordance with the Declaration of Helsinki. EXPECTED RESULTS: By increasing water intake (ml/Kg) we expect to provide an improvement in kidney function in older population assessed by serum creatinine and cystatin-c applied to eGFR formulas. RELEVANCE: Many conditions, both organic and behavioral, can contribute to chronic dehydration states in older adults. To mention, decreased ability to concentrate urine, reduced kidney mass, blood flow, and glomerular filtration rate (GFR) along with changes in sensitivity to hormones such as renin, vasopressin and natriuretic peptide can generate water imbalance, leading to dehydration. For being simple and inexpensive, this strategy may be broadly used and bring several health benefits to older adults.</p