Banca de DEFESA: LAILA CHEIBUB COSTA RODRIGUES

Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.
STUDENT : LAILA CHEIBUB COSTA RODRIGUES
DATE: 08/04/2024
TIME: 19:00
LOCAL: CPF- Sede ( meet.google.com/kpn-kysa-jzr )
TITLE:

 Evalutionary clinical aspects of patients admitted with COVID-19 in Teixeira de Freitas – BA 

KEY WORDS:

SARS-CoV-2; Hospital Sobrasa; Teixeira de Freitas. 

PAGES: 41
BIG AREA: Ciências da Saúde
AREA: Medicina
SUBÁREA: Clínica Médica
SPECIALTY: Doenças Infecciosas e Parasitárias
SUMMARY:

With a high transmissibility rate, the COVID-19 pandemic presented high morbidity and mortality in a short period, challenging clinical practice regarding effective and safe treatment around the world. Since the beginning of the pandemic, different drug therapies have been tested at different stages of SARS-CoV-2 infection. Of which, Methylprednisolone - a potent anti-inflammatory steroid, and Tocilizumab - an antiinterleukin 6 (IL-6) monoclonal antibody, reduced deaths and length of stay in clinical trials. The objective of the study was to analyze the clinical evolution and performance of corticosteroids and Tocilizumab in patients hospitalized with COVID-19. A retrospective cohort study was carried out on patients with COVID19 admitted to Hospital Sobrasa de Teixeira de Freitas - Bahia. Medical records were reviewed in order to obtain the most relevant demographic and clinical-evolutionary data. Data were tabulated in Microsoft® Excel and analyzed in IBM SPSS Statistics 21. For descriptive analyses, absolute or relative frequencies were used with 95% confidence intervals. The test was used to verify the associations of proportions in the different categories of the variables analyzed. The study was approved by the Human Research Ethics Committee of the Federal University of Southern Bahia, under protocol number 63275922.4.0000.8467. From March 2020 to May 2021, 530 patients were included, of which 354 (66.79%) were men and 176 (33.21%) women, in a predominant age group between the 3rd and 5th decades of life, and an average of 54.37 ± 11.3 years. Regarding signs and symptoms, 519 (97.92%) were symptomatic and the majority presented cough 378 (71.32%), dyspnea 294 (55.47%), fever 321 (60.57%) and myalgia 129 (24.34%). Two hundred and eighty-one (53%) patients presented one or more comorbidities, of which systemic arterial hypertension and diabetes mellitus were present in 192 (36.23%) and 103 (19.43%) cases, respectively. Regarding diagnosis, 302 (56.98%) patients underwent the RT-PCR, 33 (6.23%) the rapid TR-antigen test, 11 (2.08%) the TRantibody test for SARS-COV 2 and seven (1.32%) the serological test for SARS-COV 2 (ELISA, CLIA or immunofluorescence). The diagnosis of infection based on clinical and epidemiological criteria was demonstrated in 177 (33.4%) patients. Regarding the length of stay in the ward, 374 (70.57%) were hospitalized for less than 5 days, 146 (27.55%) between 5 and 10 days and 10 (1.89%) for 10 days or more. Of the 31 (5.85%) patients admitted to the Intensive Care Center, 11 (35.48%) remained hospitalized for less than 5 days, 13 (41.94%) between 5 and 10 days and seven (22.58% ) for more than 10 days. During hospitalization, 232 (43.77%) patients used ventilatory support, of these, 186 (80.17%) used only a nasal catheter and 12 (5.17%) were intubated. Computed tomography was performed in 506 (95.47%) patients, of which 243 (48%) had between 25-50% pulmonary involvement, 180 (35.57%) values greater than 50% and 83 (16.04 %) values less than 25%. In total, 523 (98.68%) patients used corticosteroids, of which 328 (61.89%) used Methylprednisolone, 77 (14.53%) Dexamethasone, 19 (3.58%) Prednisolone and 11 (2 .08%) of Prednisone. Tocilizumab was prescribed in 94 (17.74%) cases. The isolated use or combination of antimicrobials was observed in 63 (13.37%) cases. Regarding the length of stay, of the patients who only used corticosteroids, 237 (55.34%) stayed for less than 5 days, 173 (40.33%) between 5 and 10 days, and 19 (4.33%) for more than 10 days. Of those who used corticosteroids and tocilizumab during hospitalization, 38 (41.30%) stayed for less than 5 days, 49 (53.26%) between 5-10 days, and 5 (5.43%) for more than 10 days . Ventilatory support was necessary in 180 (41.96%) of patients who used only corticosteroids, and not necessary in 249 (58.04%), while it was necessary in only 48 (52.1%) of patients who used corticosteroids and  tocilizumab, and not necessary in 44 (47.83%). As for laboratory tests, the group that used corticosteroids and Tocilizumab combined presented a higher index of Creactive Protein (138 vs. 81.9), Lactate dehydrogenase (379.6 vs. 341.2) and Ferritin (1134.1 vs. 852.3), at admission, compared to the group that used only corticosteroids (p<0.001). Regarding clinical evolution, 509 (96.04%) recovered and were discharged from the hospital, 6 (1.13%) died and 12 (2.26%) were transferred to field hospitals or neighboring municipalities. The survival of study patients was significantly associated with the use of Methylprednisolone both by uni (p=0.41) and multivariate analysis (p=0.36). Expanding knowledge regarding clinical practice and understanding the therapeutic potential of corticosteroids and Tocilizumab in infected individuals are relevant for decision-making in the hospital environment, as well as the adoption of public health measures that minimize the impacts of the disease. 

COMMITTEE MEMBERS:
Interna - 1241733 - CLARA MONICA FIGUEREDO DE LIMA
Presidente - 1822195 - DELIO JOSE MORA AMADOR JUNIOR
Externa ao Programa - 1294737 - ERIKA MARIA SAMPAIO ROCHA - nullExterno à Instituição - LUIZ HENRIQUE SANTOS GUIMARAES - UFRB