Radiological and functional pulmonary complications in patients recovered from COVID-19

Background: The COVID-19 disease caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which appeared at the end of 2019 in Hubei Province, Wuhan Region of the People's Republic of China. Objective: To determine radiological and functional pulmonary complications in patients recovered from COVID-19. Methods: We included observational studies, studies of radiological and functional pulmonary complications related to COVID-19 in patients discharged from hospital, studies of available text and studies in English and Spanish. A formal narrative synthesis of the collected data was carried out; no formal statistical synthesis was carried out. The synthesis focused on qualitative analysis. The methodological quality of the articles was assessed using the quality assessment tools of the National Heart, Lung, and Blood Institute. Results: In this systematic review it was observed that the functional pulmonary complications that the patients manifested were: 45.05 % of impaired diffusion capacity (DLCO), 30.1 % of restrictive pattern (FEV1) and 20.4 % of obstructive pattern (FEV1/FVC). Radiological complications were: 59.7% ground-glass opacity (GGO), 18.75% consolidation, 9.3% bronchiectasis, 6% thickening of the underlying pleura, 3.9% thickening of the interlobular septum, 3.83% crazy-paving and 0.96% pleural effusion. Conclusion: This review concludes that post-COVID-19 infection patients showed impaired lung and radiological functions, with DLCO and GGO being the most important.

Inhibidores del SGTL-2 en pacientes con insuficiencia cardiaca y fracción de eyección reducida con o sin diabetes: revisión sistémica

Objective: To determine the benefits of SGLT-2 inhibitors in patients with heart failure and reduced ejection fraction with or without diabetes. Methods: This systematic review included experimental studies, studies of SGLT-2 inhibitors in patients with heart failure with reduced ejection fraction with or without diabetes. A formal narrative synthesis of the data collected in English and Spanish. The summaries focused on qualitative analysis. The quality of evidence for each outcome was determined according to the Grading of Recommendations Assessmet, Developmet and Evaluation (GRADE) methodology. Results: In general, the primary events in patients with heart failure with reduced ejection fraction of the SGLT-2 inhibitor group were lower compared to the placebo group (IR:0.65; 95% CI 0.64-0.80; p=0.40). Results from cardiovascular death in the SGLT-2 inhibitor group were lower than in the placebo group (IR: 0.60; 95% CI 0.40-0.70; p=0.50). Adverse outcomes in patients in the SGLT-2 inhibitor group were lower than the placebo group (37% vs 42%, respectively) from the various studies. Conclusion: SGLT-2 inhibitors improve cardiovascular disorders, including heart failure with reduced and preserved ejection fraction, and also reduce cardiovascular morality in patients with or without diabetes.Objetivo: Determinar los beneficios de los inhibidores del SGLT-2 en pacientes con insuficiencia cardiaca y fracción de eyección reducida con o sin diabetes. Métodos: En esta revisión sistemática se incluyeron estudios experimentales, estudios de los inhibidores de SGLT-2 en pacientes con insuficiencia cardiaca con fracción de eyección reducida con o sin diabetes. Se realizo una síntesis narrativa formal de los datos recogidos en español e inglés. Las síntesis se centraron en el análisis cualitativo. La calidad de evidencia para cada desenlace se determinó según la metodología Grading of Recommendations Assessmet, Developmet and Evaluation (GRADE). Resultados: En lo general, los eventos primarios en los pacientes con insuficiencia cardiaca con fracción de eyección reducida del grupo de los inhibidores de SGLT-2 fueron menores respecto al grupo placebo (IR:0.65; IC del 95%: 0.64-0.80; p=0.40). Los resultados por muerte cardiovascular en el grupo de los inhibidores del SGLT-2 fueron menores respecto al grupo placebo (IR: 0.60; IC del 95%: 0.40-0.70; p=0.50). Los resultados adversos en los pacientes del grupo de los inhibidores del SGLT-2 fueron menores que el grupo placebo (37% vs 42%, respectivamente) de los diversos estudios. Conclusión: Los inhibidores del SGLT-2 mejoran las alteraciones cardiovasculares, incluida la insuficiencia cardiaca con fracción de eyección reducida y preservada, además reducen la moralidad cardiovascular en pacientes con o sin diabetes

Complicaciones cardiovasculares de la COVID-19 en pacientes hospitalizados, revisión sistemática de la literatura

IBackground: The COVID-19 disease caused by the virus, SARS-CoV-2, began in the Wuhan region of the People's Republic of China at the end of 2019, causing complications and mortality in hospitalized patients. Objective: To systematically review the literature on the cardiovascular complications of COVID-19 in hospitalized patients. Methods: Observational studies, studies on cardiovascular complications in hospitalized patients for COVID-19, studies with available texts and, studies in English and Spanish were included. A narrative synthesis of the collected data was carried out, without a formal statistical analysis. In addition to qualitative analysis of the main reported pathologies and clinical manifestations, the study quality tool of the United States National Institutes of Health was used. Results: In this study it was observed that 50.6% of the patients infected by SARS-CoV-2 suffered some cardiovascular comorbidity (43.5% arterial hypertension (HTA) and 19.8% diabetes mellitus). The complications of COVID-19 in infected patients were: (44.1%) venous thromboembolism, (32%) acute myocardial infarction (AMI), (19.2%) myocarditis, (16.3%) arrhythmia and (11.2%) cerebrovascular disease. Conclusion: The main cardiovascular effects in patients infected by SARS-COV-2 were myocarditis, acute myocardial infarction (AMI), venous thromboembolism, cerebrovascular disease (CVD).Antecedentes: La enfermedad del COVID-19 causado por el virus, SARS-CoV-2, comenzó en la región de Wuhan de la República Popular de China, a finales del 2019, generando complicaciones y mortalidad en pacientes hospitalizados. Objetivo: Revisar la literatura de manera sistemática sobre las complicaciones cardiovasculares de la COVID-19 en pacientes hospitalizados. Métodos: Se incluyeron estudios observacionales, estudios sobre complicaciones cardiovasculares en pacientes hospitalizados por COVID-19, estudios con textos disponibles y estudios en idioma inglés y español. Se realizó una síntesis narrativa de los datos recopilados, sin un análisis formal estadístico. Además, de análisis cualitativo de las principales patologías y manifestaciones clínicas notificadas. Se empleo la herramienta de la calidad del estudio de los Institutos Nacionales de Salud de los Estados Unidos. Resultados: En esta revisión se observó que el 50.6 % de los pacientes infectados por el SARS-CoV-2, padecieron alguna comorbilidad cardiovascular (43.5 % hipertensión arterial (HTA) y 19.8 % diabetes mellitus). Las complicaciones del COVID-19 en pacientes infectados fueron: (44.1 %) tromboembolismo venoso, (32 %) infarto agudo de miocardio (IMA), (19.2 %) miocarditis, (16.3 %) arritmia y (11.2 %) enfermedad cerebrovascular. Conclusión: Los principales efectos cardiovasculares en pacientes infectados por el SARS-COV-2 fueron miocarditis, infarto agudo de miocardio (IAM), tromboembolismo venoso, enfermedad cerebro vascular (ECV)

Covid-19: Effects of Azithromycin/Hydroxychloroquine/Ivermectin in ambulatory and hospitalized patients

Introducción: A finales de 2019, surgió el brote de un nuevo coronavirus que desencadenó el síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2), originado en la provincia de Hubei, ciudad de Wuhan, República Popular de China, provocando una pandemia global y una amenaza para la salud pública. Objetivo : Esta revisión sistemática tiene como objetivo determinar los efectos de la azitromicina, hidroxicloroquina e ivermectina en pacientes ambulatorios y hospitalizados con covid-19. Métodos: Realizamos una búsqueda bibliográfica en Pub Med / MEDLINE hasta el 4 de junio de 2021, las estrategias de búsqueda se evaluaron utilizando el programa Manual Cochrane de revisiones sistemáticas. Se utilizó el programa Mendeley para gestionar las referencias bibliográficas. Resultados:En la búsqueda inicial se registraron 832 estudios, de los cuales se incluyeron 17 publicaciones. Además, incluimos un artículo secundario de la búsqueda adicional de los 17 artículos. La azitromicina y / o hidroxicloroquina aumentan la mortalidad y provocan eventos adversos en comparación con los grupos de atención habitual (27% vs 25%, OR = 0,98, IC 95% = 0,58-1,74, p = 1,00) e ivermectina con respecto al grupo control en la resolución de síntomas (82% vs 79%) y eventos adversos (52% vs 56%), de varios estudios. Conclusiones: la calidad de la evidencia sobre la efectividad y ventajas de la azitromicina, hidroxicloroquina e ivermectina en el tratamiento del COVID-19 en pacientes ambulatorios y hospitalizados es baja

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2