A INCIDÊNCIA DA HEMORRAGIA DIGESTIVA ALTA EM PACIENTES PEDIÁTRICOS APÓS USO DE ANTI-INFLAMATÓRIOS NÃO ESTEROIDAIS

INTRODUCTION: Upper Gastrointestinal Bleeding (OGH) in children is a clinical condition in which its causes are rarely reported in the literature, but studies demonstrate a correlation between prolonged or continuous use of non-steroidal anti-inflammatory drugs (NSAIDs) and the incidence of cases in pediatrics. OBJECTIVES: The present study seeks to analyze, through a bibliographic review, more in-depth studies and analyzes on the prolonged use of NSAIDs and the incidence of HGA in underage patients. METHODOLOGY: Bibliographic review carried out from June to July 2023. Literature searches were carried out in the PubMed and Scientific Electronic Library Online (SciELO) databases. 238 articles were found and after applying inclusion and exclusion criteria, 18 articles were selected to form the collection. RESULTS: The different studies analyzed demonstrate that although NSAIDs are predictors of damage to the gastric mucosa, they tend to play an indirect role in causing Upper Gastrointestinal hemorrhage. In this sense, in the majority of cases studied, patients have another risk factor for this complication - given a pre-existing intestinal injury, correlated with self-medication, especially medication administration without the correct dosage by parents/guardians. CONCLUSION: The mechanism of injury caused by NSAIDs is already known, however, there are still disagreements on the subject in question. It is essential that parents or guardians pay attention to the ideal dosage prescribed by doctors, respecting the medication administration interval, thus avoiding its irregular use and, therefore, its more vigorous consequences on the NSAID and HGA correlation in children, since which are highly complex cases and may require urgent care and hospitalization.INTRODUÇÃO: Hemorragia Gastrointestinal Alta (HGA) em crianças é uma condição clínica na qual suas causas são pouco relatadas na literatura, porém estudos demonstram correlação entre uso prolongado ou contínuo de anti-inflamatórios não esteroidais (AINES) com a incidência de casos na pediatria. OBJETIVOS: O presente estudo busca analisar por meio de uma revisão bibliográfica estudos e análises mais aprofundados sobre o uso prolongado de AINES e a incidência de HGA em pacientes menores de idade. METODOLOGIA: Revisão Bibliográfica realizada no período de junho a julho de 2023. As buscas da literatura foram feitas nas bases de dados PubMed e Scientific Electronic Library Online (SciELO). Foram encontrados 238 artigos e após aplicação de critérios de inclusão e exclusão, 18 artigos foram selecionados para a composição da coletânea. RESULTADOS: Os diferentes estudos analisados demonstram que apesar dos AINES serem preditores de lesão na mucosa gástrica, tendem a exercer papel indireto na causa de hemorragia Gastrointestinal Alta. Nesse sentido, a maioria dos casos estudados os pacientes possuem outro fator de risco para referida complicação- haja vista uma lesão intestinal pré-existente, correlacionado a automedicação, sobretudo, a administração medicamentosa sem a posologia correta por pais/responsáveis. CONCLUSÃO: O mecanismo de lesão pelo de AINES já é conhecido, porém, ainda existem divergências sobre o assunto em questão. É imprescindível que os pais ou responsáveis atentem-se à posologia ideal prescrita por médicos, respeitando o intervalo de administração do medicamento, evitando assim o seu uso irregular e, portanto, suas consequências mais vigorosas sobre a correlação AINES e HGA em crianças, uma vez que são casos de alta complexidade podendo precisar de atendimento e internação de urgência

ANÁLISE COMPARATIVA DO EIXO INTESTINO-CÉREBRO: RELAÇÃO ENTRE DISBIOSE E DEPRESSÃO.

OBJECTIVE: The present study seeks to analyze the intestine-brain axis through scientific literature, focusing on the transition of nutritional patterns, seeking a relationship between dysbiosis and depression. METHODOLOGY: Bibliographic review carried out from June to July 2023. Literature searches were carried out in the PubMed and Scientific Electronic Library Online (SciELO) databases. 209 articles were found and, after the inclusion criteria, 21 studies were selected to be included. RESULTS: The different studies analyzed indicate that the microbiota can be affected by several factors, such as probiotics, diet, antibiotics and dietary factors. As a result, changes in the microbiota, known as dysbiosis, can lead to dysregulation of the gut-brain axis and cause changes in mood, as well as depression. Therefore, it is necessary to carry out studies to better understand the gut-brain axis, with an emphasis on the relationship between dysbiosis and depression, in order to provide a better quality of life for such patients. CONCLUSION: It is necessary to balance care in the face of daily hyperactivity, associated with a reduction in negligence regarding diet, sleep quality and regular exercise, in order to control bacterial proliferation. In this sense, there is evidence that the microbiota directly interferes with the CNS, both in the prevention of diseases such as colorectal cancer, but being a causal factor in chronic inflammatory diseases, ulcerative colitis and Crohn's disease. Thus, the microbiome is a system that is evolving and maturing through the different stratifications of life.OBJETIVO: O presente estudo busca analisar por meio da literatura científica o eixo intestino-cérebro, com foco na transição dos padrões nutricionais, buscando relação da disbiose e depressão. METODOLOGIA: Revisão Bibliográfica realizada no período de junho a julho de 2023. As buscas da literatura foram feitas nas bases de dados PubMed e Scientific Electronic Library Online (SciELO). Foram encontrados 209 artigos e selecionados, após os critérios de inclusão, 21  estudos para compor. RESULTADOS: Os diferentes estudos analisados apontam que a microbiota pode ser afetada por diversos fatores, tais como, probióticos, dieta, antibióticos e fatores alimentares. Com isso, a alteração da microbiota, a disbiose, pode levar à desregulação do eixo intestino-cérebro e causar mudanças no humor, além de quadros depressivos. Assim, é necessário que se tenha estudos para melhor compreender o eixo intestino-cérebro, com ênfase na relação da disbiose com a depressão, a fim de proporcionar uma melhor qualidade de vida a tais pacientes. CONCLUSÃO: Faz-se necessário, equilibrar o cuidado perante a hiperatividade diária, associando-se a diminuição das negligências com relação a dieta, qualidade do sono e prática de exercícios regulares, a fim de controlar a proliferação bacteriana. Nesse sentido, há evidencias que a microbióta interfere diretamente o SNC, tanto na prevenção de doenças como o Cancer colorretal, mas sendo fator causal nas Doenças Inflamatórias crônicas, Colite Ulcerativa e Doença de Crohn. Dessa forma, o microbioma é um sistema que está em evolução e amadurecimento por meio das diferentes estratificações da vida

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Núcleos de Ensino da Unesp: artigos 2011: volume 3: tecnologias da informação e comunicação e material pedagógico

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Long-term neurological symptoms after acute COVID-19 illness requiring hospitalization in adult patients: insights from the ISARIC-COVID-19 follow-up study

in this study we aimed to characterize the type and prevalence of neurological symptoms related to neurological long-COVID-19 from a large international multicenter cohort of adults after discharge from hospital for acute COVID-19

Sex differences in post-acute neurological sequelae of SARS-CoV-2 and symptom resolution in adults after coronavirus disease 2019 hospitalization: an international multi-centre prospective observational study

: Although it is known that coronavirus disease 2019 can present with a range of neurological manifestations and in-hospital complications, sparse data exist on whether these initial neurological symptoms of coronavirus disease 2019 are closely associated with post-acute neurological sequelae of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2; PANSC) and whether female versus male sex impacts symptom resolution. In this international, multi-centre, prospective, observational study across 407 sites from 15 countries (30 January 2020 to 30 April 2022), we report the prevalence and risk factors of PANSC among hospitalized adults and investigate the differences between males and females on neurological symptom resolution over time. PANSC symptoms included altered consciousness/confusion, fatigue/malaise, anosmia, dysgeusia and muscle ache/joint pain, on which information was collected at index hospitalization and during follow-up assessments. The analysis considered a time to the resolution of individual and all neurological symptoms. The resulting times were modelled by Weibull regression, assuming mixed-case interval censoring, with sex and age included as covariates. The model results were summarized as cumulative probability functions and age-adjusted and sex-adjusted median times to resolution. We included 6862 hospitalized adults with coronavirus disease 2019, who had follow-up assessments. The median age of the participants was 57 years (39.2% females). Males and females had similar baseline characteristics, except that more males (versus females) were admitted to the intensive care unit (30.5 versus 20.3%) and received mechanical ventilation (17.2 versus 11.8%). Approximately 70% of patients had multiple neurological symptoms at the first follow-up (median = 102 days). Fatigue (49.9%) and myalgia/arthralgia (45.2%) were the most prevalent symptoms of PANSC at the initial follow-up. The reported prevalence in females was generally higher (versus males) for all symptoms. At 12 months, anosmia and dysgeusia were resolved in most patients, although fatigue, altered consciousness and myalgia remained unresolved in >10% of the cohort. Females had a longer time to the resolution (5.2 versus 3.4 months) of neurological symptoms at follow-up for those with more than one neurological symptom. In the multivariable analysis, males were associated with a shorter time to the resolution of symptoms (hazard ratio = 1.53; 95% confidence interval = 1.39-1.69). Intensive care unit admission was associated with a longer time to the resolution of symptoms (hazard ratio = 0.68; 95% confidence interval = 0.60-0.77). Post-discharge stroke was uncommon (0.3% in females and 0.5% in males). Despite the methodological challenges involved in the collection of survey data, this international multi-centre prospective cohort study demonstrated that PANSC following index hospitalization was high. Symptom prevalence was higher and took longer to resolve in females than in males. This supported the fact that while males were sicker during acute illness, females were disproportionately affected by PANSC

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity

Background The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries.Methods The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria.Results A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)).Conclusion Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes