Background Steroid use for COVID-19 is based on the possible role of these drugs in mitigating the inflammatory response, mainly in the lungs, triggered by SARS-CoV-2. This study aimed at evaluating at evaluating the efficacy of methylprednisolone (MP) among hospitalized patients with suspected COVID-19. Methods Parallel, double-blind, placebo-controlled, randomized, phase IIb clinical trial was performed with hospitalized patients aged ≥ 18 years with clinical, epidemiological and/or radiological suspected COVID-19, at a tertiary care facility in Manaus, Brazil. Patients were randomly allocated (1:1 ratio) to receive either intravenous MP (0.5 mg/kg) or placebo (saline solution), twice daily, for 5 days. A modified intention-to-treat (mITT) analysis was conducted. The primary outcome was 28-day mortality. ClinicalTrials Identifier NCT04343729. Findings From April 18 to June 16, 2020, 647 patients were screened, 416 randomized, and 393 analyzed as mITT, MP in 194 and placebo in 199 individuals. SARS-CoV-2 infection was confirmed by RT-PCR in 81.3%. Mortality at day 28 was not different between groups. A subgroup analysis showed that patients over 60 years in the MP group had a lower mortality rate at day 28. Patients in the MP arm tended to need more insulin therapy, and no difference was seen in virus clearance in respiratory secretion until day 7. Conclusion The findings of this study suggest that a short course of MP in hospitalized patients with COVID-19 did not reduce mortality in the overall population.

Although high mortality has been reported in many COVID-19 studies, very limited postmortem information from complete autopsies is available. We report the findings in the adrenal glands in 28 autopsies with confirmed SARS-CoV-2 infection. Microscopic lesions were identified in the adrenal glands in 12/28 patients (46%). Seven cases showed necrosis, generally ischemic; four showed cortical lipid degeneration; two showed hemorrhage; and one unspecific focal adrenalitis. Vascular thrombosis in one patient and focal inflammation in association with other findings in three patients were observed. No case presented adrenal insufficiency. In conclusion, adrenal lesions are frequent in patients with severe COVID-19. The lesions are mild but could contribute to the lethal outcome.

SARS-CoV-2 affects mainly the lungs, however, other manifestations, including neurological manifestations, have also been described during the disease. Some of the neurological findings have involved intracerebral or subarachnoid hemorrhage, strokes, and other thrombotic/hemorrhagic conditions. Nevertheless, the gross pathology of hemorrhagic lesions in the central nervous system has not been previously described in Brazilian autopsy cases. This study aimed to describe gross and microscopic central nervous system (CNS) pathology findings from the autopsies and correlate them with the clinical and laboratory characteristics of forty-five patients with COVID-19 from Manaus, Amazonas, Brazil. Forty-four patients were autopsied of which thirty-eight of these (86.36%) were positive by RT-PCR for COVID-19, and six (13.3%) were positive by the serological rapid test. Clinical and radiological findings were compatible with the infection. The patients were classified in two groups: presence (those who had hemorrhagic and/or thrombotic manifestations in the CNS) and absence (those who did not present hemorrhagic and/or thrombotic manifestations in the CNS). For risk assessment, relative risk and respective confidence intervals were estimated. Macroscopic or microscopic hemorrhages were found in twenty-three cases (52,27%). The postmortem gross examination of the brain revealed a broad spectrum of hemorrhages, from spots to large and confluent areas and, under microscopy, we observed mainly perivascular discharge. The association analyses showed that the use of corticosteroid, anticoagulant and antibiotic had no statistical significance with a risk of nervous system hemorrhagic manifestations. However, it is possible to infer a statistical tendency that indicates that individuals with diabetes had a higher risk for the same outcome (RR = 1.320, 95% CI = 0.7375 to 2.416, p = 0.3743), which was not observed in relation to other comorbidities. It is unknown whether the new variants of the virus can cause different clinical manifestations, such as those observed or indeed others. As a result, more studies are necessary to define clinical and radiologic monitoring protocols and strategic interventions for patients at risk of adverse and fatal events, such as the extensive hemorrhaging described here. It is imperative that clinicians must be aware of comorbidities and the drugs used to treat patients with COVID-19 to prevent CNS hemorrhagic and thrombotic events.

Between April and July 2020, and, therefore, prior to the broad recommendation of corticosteroids for severe COVID-19, a total of 50 full autopsies were performed in Manaus. We confirmed two invasive cases of aspergillosis through histopathology and gene sequencing (4%) in our autopsy series. The confirmed invasive aspergillosis incidence seems much lower than expected based on the “probable and possible” definitions, and an individualized approach should be considered for each country scenario. Interestingly, a prolonged length of stay in the intensive care unit was not observed in any of the cases. Timely diagnosis and treatment of fungal infection can reduce mortality rates.

ResumoObjetivou-se neste artigo, relatar as experiências de monitoria na disciplina Gestão em Saúde e Enfermagem I, tendo em vista a educação semipresencial. Trata-se de um estudo descritivo, do tipo relato de experiência, realizado a partir da vivência de discentes na monitoria de uma disciplina semipresencial. A experiência de monitoria constituiu-se como uma iniciação à docência, em que o monitor passou a conhecer as atividades inerentes à prática docente, sob orientação. Ser monitor em uma disciplina semipresencial proporcionou conhecer de forma mais detalhada essa modalidade que proporciona flexibilidade no processo de aprendizagem, incentivo ao desenvolvimento de novas competências digitais, como a autonomia, a automotivação, a reflexão crítica, a capacidade de análise e a tomada de decisões diante de situações-problema, o trabalho em equipe, o uso de diferentes linguagens e o fazer colaborativo. Conclui-se que a experiência da monitoria contribuiu tanto para a formação acadêmica do monitor, como para o andamento da disciplina semipresencial, favorecendo a comunicação e o desenvolvimento das atividades virtuais e presenciais. AbstractThe objective of this article is to relate how to experience monitoring in the discipline Health Management and Nursing I, with a view to semi-presential education. It´s about a descriptive study, the type of experience report, carried out from the experience of students in the monitoring of a semipresential subject. The monitoring experience was an initiation to teaching, in which the monitor came to know the activities inherent to teaching practice, under guidance. Being a monitor in a semi-presential discipline provided a more detailed knowledge of this modality, which provides flexibility in the learning process, encouraging the development of new digital skills, such as autonomy, self-motivation, critical reflection, analysis and decision-making skills. in the face of problem situations, teamwork, the use of different languages and collaborative action. It is concluded that the experience of monitoring contributed both to the academic training of the monitor, as well as to the progress of the semi-presential discipline, favoring communication and the development of virtual and faceto-face activities. ResumenEl objetivo de este artículo es relacionar cómo experimentar el monitoreo en la disciplina Gestión de Salud y Enfermería I, con miras a la educación semipresencial. Estudio descriptivo, enfoque informe de experiencia, realizado a partir de la experiencia de los estudiantes en el monitoreo de una disciplina semipresencial. La experiencia de monitoreo fue una iniciación a la enseñanza, en la cual el monitor llegó a conocer las actividades inherentes a la práctica docente, bajo orientación. Ser un monitor en una disciplina semipresencial proporcionó un conocimiento más detallado de esta modalidad, que proporciona flexibilidad en el proceso de aprendizaje, fomentando el desarrollo de nuevas habilidades digitales, como la autonomía, la automotivación, la reflexión crítica, e...

Background: The use of corticosteroids may help control the cytokine storm occurring in acute respiratory failure due to the severe form of COVID-19. We evaluated the postacute effect of corticosteroids used during the acute phase, such as impairment in pulmonary function parameters, on day 120 (D120)-follow-up, in participants who survived over 28 days.Methods: This is a parallel, double-blind, randomized, placebo-controlled phase IIb clinical trial carried out between April 18 and October 9, 2020, conducted in hospitalized patients with clinical–radiological suspicion of COVID-19, aged 18 years or older, with SpO2 ≤ 94% on room air or requiring supplementary oxygen, or under invasive mechanical ventilation (IMV) in a referral center in Manaus, Western Brazilian Amazon. Intravenous methylprednisolone (MP) (0.5 mg/kg) was given two times daily for 5 days to these patients. The primary outcome used for this study was pulmonary function testing at day 120 follow-up visit.Results: Out of the total of surviving patients at day 28 (n = 246) from the Metcovid study, a total of 118 underwent satisfactory pulmonary function testing (62 in the placebo arm and 56 in the MP arm). The supportive treatment was similar between the placebo and MP groups (seven [11%] vs. four [7%]; P = 0.45). At hospital admission, IL-6 levels were higher in the MP group (P < 0.01). Also, the need for ICU (P = 0.06), need for IMV (P = 0.07), and creatine kinase (P = 0.05) on admission also tended to be higher in this group. In the univariate analysis, forced expiratory volume on 1st second of exhalation (FEV1) and forced vital capacity (FVC) at D120 follow-up were significantly higher in patients in the MP arm, being this last parameter also significantly higher in the multivariate analysis independently of IMV and IL-6 levels on admission.Conclusion: The use of steroids for at least 5 days in severe COVID-19 was associated with a higher FVC, which suggests that hospitalized COVID-19 patients might benefit from the use of MP in its use in the long-term, with less pulmonary restrictive functions, attributed to fibrosis.Trial Registration:ClinicalTrials.gov, Identifier: NCT04343729.

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Objetivo: Analisar os efeitos das ações educativas sobre adesão dos profissionais da saúde à higienização das mãos, em hospital universitário. Métodos: Pesquisa descritiva-documental, a partir de levantamento de dados do Serviço de Controle das Infecções Relacionadas à Assistência à Saúde, sobre a adesão à higiene das mãos de janeiro a agosto de 2018. Resultados: Foram analisadas 1371 oportunidades nas unidades de internação do hospital. Realizada uma comparação dos registros de observação direta da adesão à higiene das mãos, considerando as oportunidades nas quais os profissionais de saúde utilizaram água e sabão ou álcool gel a 70% ou não aderiram à prática de higienização das mãos. A maioria dos profissionais não higienizou as mãos no momento indicado (χ2 = 14,544; p valor = 0,0423). O comportamento dos mesmos não mudou, tendo se mantido o hábito de não higienizar as mãos nos cinco momentos básicos (χ2 = 4,933; p valor = 0,1768). Conclusão: Torna-se imprescindível reforçar a prática de higiene das mãos nos serviços de saúde, na tentativa de mudar a cultura prevalente entre os profissionais de saúde, como também o desenvolvimento de metodologias que possam resultar no aumento da adesão dos profissionais de saúde às práticas de higienização das mãos.