Objectives: To examine the longitudinal prevalence and recovery of olfactory, gustatory, and oral chemesthetic deficits in a sizable cohort of SARS-CoV-2 infected persons using quantitative testing. To determine whether demographic and clinical factors, mainly the medications used after the COVID-19 diagnosis, influence the test measures. Methods: Prospective cohort in a hospital with primary, secondary, tertiary, and quaternary care. Patients with confirmed COVID-19 were tested during the acute infection phase (within 15 days of initial symptom, n = 187) and one (n = 113) and 3 months later (n = 73). The University of Pennsylvania Smell Identification Test, the Global Gustatory Test, and a novel test for chemesthesis were administered at all visits. Results: During the acute phase, 93% were anosmic or microsmic and 29.4% were hypogeusic. No one was ageusic. A deficit in oral chemesthesis was present in 13.4%. By 3 months, taste and chemesthesis had largely recovered, however, some degree of olfactory dysfunction remained in 54.8%. Remarkably, patients who had been treated with anticoagulants tended to have more olfactory improvement. Recovery was greater in men than in women, but was unrelated to disease severity, smoking behavior, or the use of various medications prior to, or during, COVID-19 infection. Conclusions: When using quantitative testing, olfactory disturbances were found in nearly all SARS-CoV-2 infected patients during the acute infection phase. Taste or chemesthetic deficits were low. Olfactory impairment persisted to some degree in over half of the patients at the 3-month follow-up evaluation, being more common in women and less common in those who had been treated earlier with anticoagulants. Level of Evidence: 3
Introdução: Em 2019 e 2020 o mundo foi afetado pela pandemia da coronavírus (COVID-19) - uma emergência de saúde pública, conforme a Organização Mundial da Saúde (OMS). A resposta ao aumento no número de infecções e mortes foi o fechamento de diversos ambientes e a imposição do distanciamento social, fato que alterou os locais de interação e vivência dos estudantes universitários. Objetivos: Evidenciar e compreender os reflexos psicossociais, especialmente a depressão, em virtude da doença e do cenário pandêmico. Métodos: Trata-se de revisão literária narrativa. Foram encontrados 234 artigos, na base dados PUBMED e PubMed Central com as palavras-chave “students”; “depression”; “quarantine”; “coronavirus infections”. Foram excluídos artigos que não trataram de depressão, estudantes ou que não abordavam estudantes universitários ou não diferenciaram as populações no estudo, restando 14 artigos. Resultados: Foram observados diversos impactos na vida dos estudantes universitários, como também a queda no desempenho estudantil no ensino superior e o agravamento de sintomas depressivos com o confinamento, (P<0,001) em especial naqueles infectados (P<001). O maior sedentarismo, a redução da prática de exercício físico, tempo de sono, piora da dieta auxiliaram no aumento dos sintomas depressivos. O comportamento foi alterado com aumento da reclusão, percepção de risco, e ideação suicida (P<0,001). Discussão: o cenário pandêmico aumentou os índices de depressão entre estudantes universitários, bem como a falta de adesão ao tratamento dos que já possuíam a doença. O confinamento, o sedentarismo, o maior número de horas em tela, de notícias pelas mídias, a piora da alimentação e a frustração dos estudantes diante da realidade acadêmica estão todos relacionados ao aumento dos quadros depressivos. São necessários novos estudos que envolvam a depressão e os estudantes universitários. Raros são os estudos longitudinais, como também, intervencionistas, apesar de ambos serem essenciais para que as intervenções pelo sistema de saúde sejam eficazes e convenientes, não apenas nesta, mas também em próximas pandemias possíveis.
Introduction: Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) was first detected in December 2019 in the city of Wuhan, China, and has since taken on worldwide proportions. It is known that individuals with Coronavirus disease-19 (COVID-19) have systemic clinical manifestations. Among the multisystemic effects, cerebral venous thrombosis (CVT) is responsible for high mortality rates. In this sense, understanding the association between CVT and SARS-CoV-2 infection directly impacts the disease's morbidity and mortality. Methodology: Literature review in the PubMed and Embase databases, with the following search terms: “COVID-19”, “SARS-CoV-2”, “Venous thromboembolism”, “Thrombosis”, “Cerebral Venous Thrombosis”, “Intracranial Sinus Thrombosis” and “Cranial Sinus Thrombosis”. The selected articles were written in English, which addressed the various aspects of COVID-19. Results and discussion: CVT are a rare complication of COVID-19, with an incidence between 0.02 to 1% of hospitalized patients. However, it can reach about 75% of mortality in affected individuals. Pathophysiology seems to be associated with the state of hypercoagulability and the systemic inflammatory process resulting from viral infection. Thus, recent studies show a consensus on the early anticoagulation of patients affected by the virus, to reduce mortality in these cases. However, the differences between the types of anticoagulation, Low Molecular Weight Heparin (LMWH), Unfractionated Heparin (UFH), Dabigatran have not yet been well established, although there is a predilection for the use of LMWH. Also, thrombectomy is a therapeutic intervention option that should be evaluated, due to the risk of additional endothelial injury from the use of stent retrievers. Conclusion: Although it has a relatively low incidence, CVT aggravates the condition and increases the risk of death for patients with COVID-19. Because of this, early diagnosis and evaluation of therapeutic options for CVT are essential for the development of clinical management.
Background: Traumatic brain injury (TBI) is the main cause of death among individuals between 1 and 44 years of age, and severe TBI is associated with a mortality rate between 30% and 70%. In this context, randomized clinical trials have studied medications to reduce morbidity in severe TBI, one of which is Amantadine. This drug acts on the increase of extracellular dopamine and as an NMDA antagonist. Objectives: Developing a systematic review of systematic reviews to evaluate the efficacy of Amantadine in reducing morbidity in patients with severe TBI. Methodology: The search was conducted in the PubMed, Embase, Cochrane Library, and Portal Regional BVS databases. Results: Eleven systematic reviews were included. The literature review of 7 articles demonstrated the efficacy of treatment with Amantadine in the following clinical aspects after TBI: aggression, irritability, agitation, mood, and attention deficit. On the other hand, one article did not consider the use of Amantadine significantly beneficial, due to increased agitation in critically ill patients, suggesting that there is worsening of the condition in individuals with cognitive, executive, memory, and attention symptoms. Therefore, three studies reported that there was not enough evidence for the use of this drug in patients with severe TBI. Conclusions: The results are heterogeneous. However, this study found good efficacy of Amantadine for cases of agitation/aggression in severe TBI and in cases of diffuse axonal lesion that compromises the glutamate pathways.
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