Generalidades, aspectos clínicos y de prevención sobre COVID-19: México y Latinoamérica
Abstract: El virus SARS-CoV-2 es un coronavirus, identificado por primera vez a finales del 2019 en Wuhan, China en personas con neumonía severa, el cual se propagó alrededor del mundo ocasionando la pandemia por la COVID-19 y 2, 530, 712 fallecimientos alrededor del mundo, posicionando a México en el tercer lugar de decesos. La infección puede generar una gran variedad de manifestaciones clínicas debido a la presencia de su receptor, ACE2, en las células del sistema respiratorio, intestinal, cardiovascular, renal, hepá… Show more
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Cited by 4 publications
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Background: Coronaviruses are enveloped RNA viruses that are widely distributed among humans and other mammals and birds causing respiratory, enteric, liver, and neurological diseases. At the end of December 2019, a group of patients with pneumonia of unknown etiology were registered, where a new virus called SARS-CoV-2 was later presented, and the disease it causes, COVID-19. The main clinical manifestations of this virus are fever, dry cough, dyspnea and acute respiratory stress. Many subjects have mild symptoms, such as headache, non-productive cough, fatigue, myalgia, and anosmia. The recovery time from this disease and the reasons why the sequelae it leaves vary so much between patients is still unknown. Symptoms and clinical manifestations after SARS-CoV-2 / COVID-19 infection have appeared in many survivors and are similar to those of fatigue after Severe Acute Respiratory Syndrome. The most commonly reported symptoms are fatigue, anxiety, joint pain, ongoing headache, chest pain, dementia, depression, and dyspnea. The NICE guideline defines post-COVID-19 syndrome as the set of signs and symptoms that develop during or after an infection compatible with COVID-19 that continues for more than 12 weeks and is not explained by an alternative diagnosis. Post-COVID-19 syndrome has the characteristic that its symptoms cause a disability, which is why it generates a great impact on the individual, the care, and rehabilitation units. Purpose: The objective of this report is to present a clinical case of a patient with the post-COVID-19 syndrome and its management. Materials and methods: This is a 57-year-old female patient, with a previous history that in June 2021 began with a clinical picture consisting of asthenia, adynamia, anosmia, ageusia, headache, myoarthralgia, nausea, cough chest and lumbar pain, for which the PCR test for SARS-CoV-2 was performed, which was positive, his clinical picture worsened at home, for which he consulted an emergency service in the city of Palmira, Valle del Cauca (Colombia). Subsequently, they conclude through paraclinical SARS-CoV-2 infection plus bacterial pneumonia due to Klebsiella pneumoniae, for which she is transferred to the hospitalization room and treatment with antibiotics is started, however, At the beginning of July, the patient maintained hemodynamic and ventilatory stability, without cardiovascular support, but still with minimal ventilatory support, with oximetry goals, so it was decided to start the gradual withdrawal of sedatives in favor of spontaneous modes of mechanical ventilation. On July 6, the patient tolerates extubation with the transition to non-invasive mechanical ventilation and a decision was made to transfer to hospitalization. Then, on July 15, a patient was seen in acceptable general conditions, with support even by nasal cannula, on physical examination with attenuated vesicular murmur with declining rales, for which it was decided to discharge. Results: Currently, the patient manifests 15 symptoms 4 months after her discharge from the clinic. Conclusions: The post-COVID-19 patient must have an individual and comprehensive rehabilitation, which takes into account their needs, since this syndrome varies from person to person, it must be an early rehabilitation so as not to decrease the functionality of the patient, and does not deteriorate their physical or mental health. The great challenge identified in the midst of the pandemic is that work must be done to build an improved and strengthened health system, where true integration and coordination between levels of care, primary care, and hospital care is achieved.
Background: Coronaviruses are enveloped RNA viruses that are widely distributed among humans and other mammals and birds causing respiratory, enteric, liver, and neurological diseases. At the end of December 2019, a group of patients with pneumonia of unknown etiology were registered, where a new virus called SARS-CoV-2 was later presented, and the disease it causes, COVID-19. The main clinical manifestations of this virus are fever, dry cough, dyspnea and acute respiratory stress. Many subjects have mild symptoms, such as headache, non-productive cough, fatigue, myalgia, and anosmia. The recovery time from this disease and the reasons why the sequelae it leaves vary so much between patients is still unknown. Symptoms and clinical manifestations after SARS-CoV-2 / COVID-19 infection have appeared in many survivors and are similar to those of fatigue after Severe Acute Respiratory Syndrome. The most commonly reported symptoms are fatigue, anxiety, joint pain, ongoing headache, chest pain, dementia, depression, and dyspnea. The NICE guideline defines post-COVID-19 syndrome as the set of signs and symptoms that develop during or after an infection compatible with COVID-19 that continues for more than 12 weeks and is not explained by an alternative diagnosis. Post-COVID-19 syndrome has the characteristic that its symptoms cause a disability, which is why it generates a great impact on the individual, the care, and rehabilitation units. Purpose: The objective of this report is to present a clinical case of a patient with the post-COVID-19 syndrome and its management. Materials and methods: This is a 57-year-old female patient, with a previous history that in June 2021 began with a clinical picture consisting of asthenia, adynamia, anosmia, ageusia, headache, myoarthralgia, nausea, cough chest and lumbar pain, for which the PCR test for SARS-CoV-2 was performed, which was positive, his clinical picture worsened at home, for which he consulted an emergency service in the city of Palmira, Valle del Cauca (Colombia). Subsequently, they conclude through paraclinical SARS-CoV-2 infection plus bacterial pneumonia due to Klebsiella pneumoniae, for which she is transferred to the hospitalization room and treatment with antibiotics is started, however, At the beginning of July, the patient maintained hemodynamic and ventilatory stability, without cardiovascular support, but still with minimal ventilatory support, with oximetry goals, so it was decided to start the gradual withdrawal of sedatives in favor of spontaneous modes of mechanical ventilation. On July 6, the patient tolerates extubation with the transition to non-invasive mechanical ventilation and a decision was made to transfer to hospitalization. Then, on July 15, a patient was seen in acceptable general conditions, with support even by nasal cannula, on physical examination with attenuated vesicular murmur with declining rales, for which it was decided to discharge. Results: Currently, the patient manifests 15 symptoms 4 months after her discharge from the clinic. Conclusions: The post-COVID-19 patient must have an individual and comprehensive rehabilitation, which takes into account their needs, since this syndrome varies from person to person, it must be an early rehabilitation so as not to decrease the functionality of the patient, and does not deteriorate their physical or mental health. The great challenge identified in the midst of the pandemic is that work must be done to build an improved and strengthened health system, where true integration and coordination between levels of care, primary care, and hospital care is achieved.
From coronaviruses to coronaviruses
The official history of the discovery of human coronaviruses dates back to 1965, when the first coronavirus B814, which has now been lost, was isolated on the organ culture of the trachea of a human embryo from the nasal swabs of a patient with acute respiratory disease. However, this date can only be an intermediate stage on its the long evolutionary path. Paleovirological studies have shown that coronaviruses could have appeared as early as the Stone Age - in the Upper Paleolithic era, and East Asia is called their place of origin a region that is well known to virologists as the source of many highly pathogenic influenza viruses and new coronaviruses, such as SARS-CoV, MERS-CoV, and SARS-CoV-2. This makes us take a different look at the seeming innocence of seasonal coronaviruses that circulated before 2002, when a human pathogenic virus appeared that caused SARS. This also fits well into the assumption about the coronavirus nature of the 1889 Russian flu pandemic. Today, four seasonal coronaviruses and three new, pathogenic for humans are known. Two seasonal coronaviruses (229E and NL63) belong to the genus Alphacoronavirus, 2 others (OC43 and HKU1) and three new coronaviruses (SARS, MERS and SARS-CoV-2) belong to the genus Betacoronavirus. In this review, we have focused on the extreme points seasonal coronaviruses and pandemic SARS-CoV-2. We tried to draw an analogy between them and identify the main features that distinguish them. From the point of view of epidemiology and clinic, they have in common only the airborne transmission route, characteristic of all respiratory viruses, and the ubiquitous distribution, the nature and intensity of which were not significantly affected by the influenza epidemics/pandemics. Seasonal coronaviruses continued to circulate even during the COVID-19 pandemic, when the majority of the other respiratory viruses had largely disappeared. Significant differences between seasonal coronaviruses and SARS-CoV-2 can be traced in the symptoms, severity and pathogenesis of the diseases they cause. At the structural level, they have a lot in common. These are taxonomic proximity, morphology, structure, physicochemical properties of virions, organization of the genome, the main stages of virus replication, etc. What made SARS-CoV-2 such aggressive? The few differences in the size of viral particles and viral genome that have been identified to date, the use or not of hemagglutinin esterase to penetrate the virus into a sensitive cell, attachment to different cell receptors cannot explain the significant difference in the severity of the infection caused by seasonal or pandemic coronavirus. Most likely, they are based on delicate molecular mechanisms that have yet to be discovered.
El objetivo del artículo fue revisar la literatura disponible sobre el SARS-CoV-2 relacionada con la consulta y atención ginecológica que surgió en 2020 y primer semestre de 2021. La metodología consistió en una revisión en las bases de datos electrónicas Pubmed, SciELO, Elsevier y Redalyc; así como en el buscador Google Académico, extendido a las referencias de los artículos encontrados. En términos de resultados, las consultas ginecológicas han sido restringidas a la asistencia a embarazadas, urgencias, pacientes oncológicas y posoperatorios. Han disminuido las revisiones de rutina y los tratamientos de fertilidad; las mujeres deben asistir sin acompañantes a la clínica, por su seguridad y la de todos; se redujo al mínimo su permanencia en el centro de salud, así como la duración de las visitas. Como conclusión, los centros de salud están siendo atendidos solo por el personal indispensable, guardando la protección exigida según la normativa, para cubrir la atención médica especializada; y se ha extremado la desinfección sistemática tanto de los consultorios como de las instalaciones de diagnóstico y tratamiento, incluidos los respectivos aparatos y equipos de alta tecnología; los ginecólogos especialistas deben estar conscientes del incremento en los casos de contagio con COVID-19 y, por ello, es importante estar preparados.
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