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HF: heart failure, MI: myocardial infarction. Data labels display absolute number of patients.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nathalia Conci Santorio, Francisco Akira Malta Cardozo, Rodrigo Freddi Miada, Fabio Grunspun Pitta, Caio de Assis Moura Tavares, Fabio Cetinic Habrum, Henrique Trombini Pinesi, Iuri Resedá Magalhães, Maria Clara Saad Menezes, Bruno Caramelli, Daniela Calderaro" "autores" => array:11 [ 0 => array:2 [ "nombre" => "Nathalia Conci" "apellidos" => "Santorio" ] 1 => array:2 [ "nombre" => "Francisco Akira Malta" "apellidos" => "Cardozo" ] 2 => array:2 [ "nombre" => "Rodrigo Freddi" "apellidos" => "Miada" ] 3 => array:2 [ "nombre" => "Fabio Grunspun" "apellidos" => "Pitta" ] 4 => array:2 [ "nombre" => "Caio de Assis Moura" "apellidos" => "Tavares" ] 5 => array:2 [ "nombre" => "Fabio Cetinic" "apellidos" => "Habrum" ] 6 => array:2 [ "nombre" => "Henrique Trombini" "apellidos" => "Pinesi" ] 7 => array:2 [ "nombre" => "Iuri Resedá" "apellidos" => "Magalhães" ] 8 => array:2 [ "nombre" => "Maria Clara Saad" "apellidos" => "Menezes" ] 9 => array:2 [ "nombre" => "Bruno" "apellidos" => "Caramelli" ] 10 => array:2 [ "nombre" => "Daniela" "apellidos" => "Calderaro" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222002605?idApp=UINPBA00004N" "url" => "/18075932/000000760000000C/v1_202211191031/S1807593222002605/v1_202211191031/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1807593222002587" "issn" => "18075932" "doi" => "10.6061/clinics/2021/e3511" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "258" "copyright" => "CLINICS" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by/4.0/" "subdocumento" => "fla" "cita" => "Clinics. 2021;76C:" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL ARTICLE</span>" "titulo" => "Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Thais T. Fink, Heloisa H.S. Marques, Bruno Gualano, Livia Lindoso, Vera Bain, Camilla Astley, Fernanda Martins, Denise Matheus, Olivia M. Matsuo, Priscila Suguita, Vitor Trindade, Camila S.Y. Paula, Sylvia C.L. Farhat, Patricia Palmeira, Gabriela N. Leal, Lisa Suzuki, Vicente Odone, Magda Carneiro-Sampaio, Alberto José S. Duarte, Leila Antonangelo, Linamara R. Batisttella, Guilherme V. Polanczyk, Rosa Maria R. Pereira, Carlos Roberto R. Carvalho, Carlos A. Buchpiguel, Ana Claudia L. Xavier, Marilia Seelaender, Clovis Artur Silva, Maria Fernanda B. Pereira" "autores" => array:30 [ 0 => array:2 [ "nombre" => "Thais T." "apellidos" => "Fink" ] 1 => array:2 [ "nombre" => "Heloisa H.S." 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"apellidos" => "Leal" ] 15 => array:2 [ "nombre" => "Lisa" "apellidos" => "Suzuki" ] 16 => array:3 [ "nombre" => "Vicente" "apellidos" => "Odone" "sufijo" => "Filho" ] 17 => array:2 [ "nombre" => "Magda" "apellidos" => "Carneiro-Sampaio" ] 18 => array:2 [ "nombre" => "Alberto José S." "apellidos" => "Duarte" ] 19 => array:2 [ "nombre" => "Leila" "apellidos" => "Antonangelo" ] 20 => array:2 [ "nombre" => "Linamara R." "apellidos" => "Batisttella" ] 21 => array:2 [ "nombre" => "Guilherme V." "apellidos" => "Polanczyk" ] 22 => array:2 [ "nombre" => "Rosa Maria R." "apellidos" => "Pereira" ] 23 => array:2 [ "nombre" => "Carlos Roberto R." "apellidos" => "Carvalho" ] 24 => array:2 [ "nombre" => "Carlos A." "apellidos" => "Buchpiguel" ] 25 => array:2 [ "nombre" => "Ana Claudia L." "apellidos" => "Xavier" ] 26 => array:2 [ "nombre" => "Marilia" "apellidos" => "Seelaender" ] 27 => array:2 [ "nombre" => "Clovis Artur" "apellidos" => "Silva" ] 28 => array:2 [ "nombre" => "Maria Fernanda B." "apellidos" => "Pereira" ] 29 => array:1 [ "colaborador" => "HC-FMUSP Pediatric Post-COVID-19 Study Group" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222002587?idApp=UINPBA00004N" "url" => "/18075932/000000760000000C/v1_202211191031/S1807593222002587/v1_202211191031/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">COMMENTS</span>" "titulo" => "COVID-19 and strongyloidiasis: what to expect from this coinfection?" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carolina Victoria Marcitelli Pereira, Giovanna Ribeiro Achur Mastandrea, Ana Clara Cassine de Souza Medeiros, Ronaldo Cesar Borges Gryschek, Fabiana Martins de Paula, Marcelo Andreetta Corral" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Carolina Victoria Marcitelli" "apellidos" => "Pereira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] ] ] 1 => array:3 [ "nombre" => "Giovanna Ribeiro Achur" "apellidos" => "Mastandrea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "Ana Clara Cassine de Souza" "apellidos" => "Medeiros" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "Ronaldo Cesar Borges" "apellidos" => "Gryschek" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">II</span>" "identificador" => "aff2" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">III</span>" "identificador" => "aff3" ] ] ] 4 => array:3 [ "nombre" => "Fabiana Martins de" "apellidos" => "Paula" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">II</span>" "identificador" => "aff2" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">III</span>" "identificador" => "aff3" ] ] ] 5 => array:4 [ "nombre" => "Marcelo Andreetta" "apellidos" => "Corral" "email" => array:1 [ 0 => "mcorral@prof.unisa.br" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">II</span>" "identificador" => "aff2" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">III</span>" "identificador" => "aff3" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Faculdade de Medicina, Universidade Santo Amaro, Sao Paulo, SP, BR" "etiqueta" => "I" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Laboratorio de Investigacao Medica (LIM06-Laboratorio de Imunopatologia da Equistossomose), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR" "etiqueta" => "II" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Secao de Helmintologia, Instituto de Medicina Tropical (IMT), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR" "etiqueta" => "III" "identificador" => "aff3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 887 "Ancho" => 1503 "Tamanyo" => 121642 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Timeline of the main events related to SARS-CoV-2 and <span class="elsevierStyleItalic">S. stercoralis</span> coinfections.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para10" class="elsevierStylePara elsevierViewall">Strongyloidiasis is a parasitic infection caused by the intestinal nematode <span class="elsevierStyleItalic">Strongyloides stercoralis</span>. It is a chronic and asymptomatic parasite in most immunocompetent individuals. In immunocompromised patients, especially those undergoing corticotherapy, the disease can progress to advanced stages, such as hyperinfection syndrome and disseminated disease (<a class="elsevierStyleCrossRef" href="#bib1">1</a>). Corticosteroids are metabolized in the liver to chemical compounds structurally similar to ecdysone and are used by helminths for oviposition and larval ecdysis stimulation, promoting an accelerated autoinfection cycle (<a class="elsevierStyleCrossRef" href="#bib2">2</a>).</p><p id="para20" class="elsevierStylePara elsevierViewall">The coronavirus disease (COVID-19) pandemic remains a health challenge for society worldwide. The advancing knowledge of the physiopathology suggests that a rapid replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may lead to an exacerbated immune response involving many cytokines (cytokine storm), triggering a severe inflammatory response in the lungs. Using corticosteroids and anticoagulants in such cases has produced beneficial results (<a class="elsevierStyleCrossRefs" href="#bib3">3-5</a>), with dexamethasone and methylprednisolone being used most frequently (<a class="elsevierStyleCrossRefs" href="#bib6">6–7</a>).</p><p id="para30" class="elsevierStylePara elsevierViewall">The impact of the COVID-19 pandemic on <span class="elsevierStyleItalic">S. stercoralis</span> infection remains to be elucidated. However, there are few reports of severe strongyloidiasis in patients with COVID-19 after undergoing treatment with corticosteroids (<a class="elsevierStyleCrossRefs" href="#bib8">8-12</a>); currently, only six cases of coinfection with <span class="elsevierStyleItalic">S. stercoralis</span> and COVID-19 have been reported (<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>). Clinical data of these patients are incipient or partial; however, generally, the majority of the reported cases tended to be in male individuals (66.7%), with an average age of 61.3 years. These individuals were admitted to the hospital for COVID-19 treatment, were released from the hospital, and returned after 22.8 days on average with skin signs and symptoms, such as dermatitis, followed by respiratory and intestinal manifestations. The diagnosis of <span class="elsevierStyleItalic">S. stercoralis</span> infection was confirmed by parasitic stool examination in one case (16.7%), enzyme-linked immunosorbent assay in two (33.3%), microscopic stool and serological methods in two (33.3%), and microscopic sputum in one (16.7%).</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><p id="para40" class="elsevierStylePara elsevierViewall">Different therapeutic regimens (<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>) were used to treat SARS-CoV-2 infection with methylprednisolone and dexamethasone. In parallel with corticosteroids, antiviral drugs were also used. For <span class="elsevierStyleItalic">S. stercoralis</span> infection, ivermectin was used in 50% of the patients, albendazole in 16.7%, and the combination of both in 33.3%. All patients survived COVID-19 and strongyloidiasis. It is important to highlight that 83.3% of the described cases occurred in non-endemic areas (<a class="elsevierStyleCrossRef" href="#bib1">1</a>,<a class="elsevierStyleCrossRef" href="#bib13">13</a>) for <span class="elsevierStyleItalic">S. stercoralis</span> infection, possibly indicating a link to immigration flows.</p><p id="para50" class="elsevierStylePara elsevierViewall">Oliveira (<a class="elsevierStyleCrossRef" href="#bib6">6</a>) reported the importance of the identification of <span class="elsevierStyleItalic">S. stercoralis</span> infection using diagnostic methods for parasite detection, especially cultures, or even serological screening. Once the helminth parasite is detected, anti-helminthic treatment is recommended before corticosteroid therapy is administered. De Wilton et al. (<a class="elsevierStyleCrossRef" href="#bib5">5</a>) proposed an algorithm for screening the risk of <span class="elsevierStyleItalic">S. stercoralis</span> exposure in patients samples with COVID-19 at a hospital in England. In general, all patients who had travelled or immigrated from endemic areas and those with a high risk of <span class="elsevierStyleItalic">S. stercoralis</span> infection underwent a diagnostic test and treatment with ivermectin. Although England is not considered an endemic area for <span class="elsevierStyleItalic">S. stercoralis</span> infection, there is a concern about the development of severe forms of this parasitosis when associated with corticosteroid therapy, especially in immigrants.</p><p id="para60" class="elsevierStylePara elsevierViewall">Unlike in the countries that reported cases of coinfection, the reality of strongyloidiasis in Brazil is distinct, with an estimated occurrence varying between 5.5% and 20% based on the microscopic parasitic examination of stool. When other diagnostic methods are analyzed, these numbers may be significantly higher since directly detecting larval forms is not needed (<a class="elsevierStyleCrossRef" href="#bib13">13</a>,<a class="elsevierStyleCrossRef" href="#bib14">14</a>). Pandemic situations, such as COVID-19, bring awareness to the scientific community worldwide to the need for studies on other non-viral infectious agents for the prevention of fatal consequences of possible associations. In this scenario, the possibility of asymptomatic infection by <span class="elsevierStyleItalic">S. stercoralis</span> becoming symptomatic and severe with the use of corticosteroids is evident.</p><p id="para70" class="elsevierStylePara elsevierViewall">There is a need to apply and to implement more sensitive and specific diagnostic techniques for strongyloidiasis that could be used in immunocompetent and immunocompromised individuals (<a class="elsevierStyleCrossRef" href="#bib5">5</a>,<a class="elsevierStyleCrossRef" href="#bib6">6</a>). The public health systems need to consider the construction and validation of a diagnostic protocol. Many diagnostic methods have been reported in the literature (<a class="elsevierStyleCrossRef" href="#bib15">15</a>) based on the direct detection of the parasite by agar plate culture or molecular methods, or even the indirect detection of antibodies, antigens, or immune complexes; however, none of these methods are available in the Brazilian national health system, only for research. Therefore, strongyloidiasis continues to be considered one of the most neglected parasitic diseases worldwide. The rapid identification of positive cases could minimize the occurrence of severe cases resulting from coinfection; in Brazil, this would demonstrate the real situation of the condition in the country since it has high incidence rates of this important parasitosis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara" id="cenpara10">No potential conflict of interest was reported.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 887 "Ancho" => 1503 "Tamanyo" => 121642 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Timeline of the main events related to SARS-CoV-2 and <span class="elsevierStyleItalic">S. stercoralis</span> coinfections.</p>" ] ] ] 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Year/Month | Html | Total | |
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2024 November | 8 | 0 | 8 |
2024 October | 35 | 29 | 64 |
2024 September | 34 | 20 | 54 |
2024 August | 47 | 16 | 63 |
2024 July | 40 | 18 | 58 |
2024 June | 34 | 16 | 50 |
2024 May | 52 | 13 | 65 |
2024 April | 26 | 16 | 42 |
2024 March | 28 | 15 | 43 |
2024 February | 27 | 18 | 45 |
2024 January | 26 | 15 | 41 |
2023 December | 17 | 25 | 42 |
2023 November | 24 | 22 | 46 |
2023 October | 32 | 28 | 60 |
2023 September | 20 | 21 | 41 |
2023 August | 39 | 4 | 43 |
2023 July | 31 | 26 | 57 |
2023 June | 45 | 10 | 55 |
2023 May | 57 | 3 | 60 |
2023 April | 51 | 3 | 54 |
2023 March | 37 | 2 | 39 |
2023 February | 35 | 1 | 36 |
2023 January | 20 | 6 | 26 |
2022 December | 18 | 8 | 26 |
2022 November | 6 | 2 | 8 |