Background: Evidence on the optimal time to initiate antiretroviral therapy (ART) in the presence of toxoplasmic encephalitis (TE) is scarce. We compared the impact of early vs. delayed ART initiation on mortality and neurologic complications at discharge in a Brazilian population co-infected with HIV and TE.Methods: We retrospectively evaluated data from 9 years of hospitalizations at a referral center in Manaus, Amazonas. All ART-naïve hospitalized patients were divided into early initiation treatment (EIT) (0-4 weeks) and delayed initiation treatment (DIT) (>4 weeks). The groups were compared using chi-square test and mortality at 16 weeks.Results: Four hundred sixty nine patients were included, of whom 357 (76.1%) belonged to the EIT group. The median CD4⁺ lymphocyte count and CD4⁺/CD8⁺ ratio were 53 cells/mm³ and 0.09, respectively. Mortality rate and presence of sequelae were 4.9% (n = 23) and 41.6% (n = 195), respectively. Mortality was similar between groups (p = 0.18), although the EIT group had the highest prevalence of sequelae at discharge (p = 0.04). The hazard ratio for death at 16 weeks with DIT was 2.3 (p = 0.18). The necessity for intensive care unit admission, mechanical ventilation, and cardiopulmonary resuscitation were similar between groups.Conclusion: In patients with AIDS and TE, early ART initiation might have a detrimental influence on the occurrence of sequelae.

Background: The timely management of rapidly evolving epidemiological scenarios caused by disease outbreaks is crucial to prevent devastating consequences. However, delayed laboratory diagnostics can hamper swift health policy and epidemic response, especially in remote regions such as the western Brazilian Amazon. The aim of the article is to analyze the impact of the COVID-19 pandemic on the volume and characteristics of emergency medical services (EMS) in Manaus, focusing on how the pandemic affected sensitive indicators such as response time and the use of advanced life support ambulances. Additionally, the study seeks to understand how changes in prehospital EMS patterns, triggered by the pandemic, could be utilized as health surveillance tools, enabling a more rapid response in epidemic scenarios. Methods: This retrospective, descriptive study included data from the SAMU (Serviço de Atendimento Móvel de Urgência) medical records between January and June 2020. Results: A total of 45,581 calls resulted in mobile units being dispatched during this period. These patients were predominantly male (28,227, 61.9%), with a median age of 47 years (IQR 30–67). The median response time significantly increased during the pandemic, reaching a median of 45.9 min (IQR 30.6–67.7) (p < 0.001). EMS calls were reduced for trauma patients and increased for other medical emergencies, especially respiratory conditions, concomitantly to an escalation in the number of deaths caused by SARS and COVID-19 (p < 0.001). The employment of advanced life support ambulances was higher during the pandemic phase (p = 0.0007). Conclusion: The COVID-19 pandemic resulted in a temporary disorder in the volume and reason for EMS calls in Manaus. Consequently, sensitive indicators like the response time and the employment of advanced life support ambulances were negatively affected. Sudden prehospital EMS pattern changes could play an important role in health surveillance systems, allowing for earlier establishment of countermeasures in epidemics. The impact of the COVID-19 pandemic on prehospital EMS and its role in health surveillance should be further explored.

Post-acute COVID-19 syndrome (PACS) is characterized by the persistence of one or more symptoms after the acute phase, leading to physical disabilities. This study aims to investigate whether the functional capacity and respiratory function 120 days post-COVID-19 differed according to the level of respiratory support needed during hospitalization in acute COVID-19 in the pre-vaccine rollout period. We followed up with 118 COVID-19 hospitalized patients in the acute phase until 120 days post-acute disease, with patients split into a Non-Invasive Oxygen Therapy Group (OTG, n = 72), Invasive Mechanical Ventilation Group (IMV, n = 12), and Room Air Group (RAG, n = 34), assessing the body composition, respiratory muscle strength, pulmonary function, functional capacity, and muscle strength at the follow-up visit. In total, 54 individuals (45.8%) were female, with a median age of 48 years old (IQR: 41–58). We found that the group with IMV was older (p < 0.001), had more admissions to the ICU (p < 0.001), and had longer hospital stays (p < 0.001). There were no statistically significant differences between groups (OTG, IMV, and RAG) for the spirometry function (p = 0.31), DASI score (p = 0.77), manovacuometry (MIP p = 0.74; MEP p = 0.23), 6MWT (p = 0.43), and handgrip (p = 0.19) outcomes. At D120, the IMV group had an important loss of body muscle mass (BMM) and a higher BMM than RAG (p = 0.02). Reduction in MIP (p = 0.01) and MEP (p = 0.02) in the IMV group and OTG group when compared to the RAG was also observed. Functional outcomes at 120 days from COVID-19 hospitalization were not found to be associated with the levels of oxygen supplementation during acute disease in this group of participants.

Introducción: En niños con distrofia muscular (DM) es frecuente la demora del desarrollo psicomotor. Esta entidad forma parte del diagnóstico diferencial de neonatos y lactantes con hipotonía muscular, una anamnesis completa y un examen neurológico detallado permiten levantar la sospecha diagnóstica. Su abordaje y tratamiento rehabilitador oportuno forman parte de estrategias multidisciplinarias encaminadas a velar la salud integral del niño con DM. Descripción del caso: Paciente varón, 8 años, remitido a Teletón a los 7 meses por retraso en los hitos del desarrollo. La evaluación inicial reveló control cefálico deficiente e hipotonía de 4 extremidades. Inició un programa de rehabilitación pediátrica individualizado, logrando control cefálico a los 13 meses y marcha a los 30 meses. A los 6 años, fue capaz de correr e inició la escolarización. El seguimiento mostró hiperlordosis lumbar, marcha en puntillas, signo de Gowers positivo, hipotonía generalizada y fuerza muscular de la cintura escapular y pélvica disminuida. Se ordenaron pruebas neuroelectrofisiológicas y serológicas (Creatinfosfokinasa total y transaminasas), con resultados consistentes con DM. En enero de 2023, el paciente de 7 años se convirtió en usuario de silla de ruedas, requiriendo mayor asistencia en las actividades cotidianas, continuando en la escuela y en tratamiento rehabilitador. Conclusión: Las distrofias musculares constituyen patologías degenerativas cuya sospecha clínica y diagnóstica pueden ser difíciles. A pesar de la progresión natural de la enfermedad, el abordaje rehabilitador se centra en la neuroestimulación, aumentando la independencia, facilitando los cuidados domiciliarios, reduciendo las complicaciones y proporcionando una mejor calidad de vida.