Caracterização de uma população pediátrica de baixa renda vivendo acima de 2.500 m. s. n. m. positiva para SARS-COV-2
Resumo
A infecção com o novo SARS-COV-2 impactou toda a sociedade de várias maneiras, incluindo crianças. O comportamento desta doença em uma população pediátrica de baixa renda localizada acima de 2.500 m. s. n. m. é descrito. Este é um estudo transversal retrospectivo entre março e outu- bro de 2020 em Bogotá, envolvendo crianças entre 1 mês e 14 anos com rt-pcr positiva para SARS-COV-2. Foram estudados antecedentes, características sociodemográficas, clínicas, laboratoriais, radiológicas e evolutivas, agrupando os pacientes de acordo com a gravidade e analisando sua sig- nificância (p < 0.05). Como resultado, foram obtidos 416 casos, sendo 43.3 % assintomáticos, 46.6 % sintomáticos leves, 8.9 % graves e 1.2 % críticos. Dos pacientes em pronto-socorro, os menores de 1 ano foram os mais frequentes (56.79 %) e os que mais internaram (35.8 %). O tempo entre o início dos sintomas e a consulta foi em média de 2 dias, sendo o diagnóstico mais frequente nos pacientes não internados a rinofaringite (58.97 %), e nos internados foi a bronquiolite (50 %). A mediana do tempo de internação para todo o grupo foi de 4 dias, que foi estendida para 7 dias para aqueles que necessitaram de UTI. A hospitalização está associada, entre outras causas, a índices nutricionais < 2 DP, taquipneia, desconforto respiratório, hipoxemia, linfopenia (nos maiores de 2 anos) (p < 0.05), não influenciando a superlotação ou o nível socioeconômico. Após o estudo, foi possível concluir que a doença geralmente é muito mais branda em crianças do que em adultos, diferindo destes em fatores predisponentes, fatores para clínicos e evolução. No entanto, algumas variáveis demográficas, clínicas e laboratoriais podem estar associadas à maior gravidade nesse grupo populacional.
Downloads
Referências
Jartti T, Smits HH, Bonnelykke K, Bircan O, Elenius V, Konradsen JR, et al. (2019). Bronchiolitis needs a revisit: Distinguishing between virus entities and their treatments. Allergy. [Internet]. 2018 oct; 74(1): 40-52. https://doi.org/10.1111/all.13624
Zimmermann P, Curtis N. Coronavirus infections in children including COVID-19 An overview of the epidemiology, clinical features, diagnosis, treatment and prevention options in children. The Pediatric Infectious Disease Journal. [Internet]. 2020 may; 39(5): 355-368. Disponible en: https://journals.lww.com/pidj/Fulltext/2020/05000/Coronavirus_Infections_in_Children_Including.1.aspx https://doi.org/10.1097/INF.0000000000002660
American Academy of Pediatrics. Coronavirus, incluido el SARS. En: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: Informe 2012 del Comité de Enfermedades Infecciosas. Elk Grove Village, IL. American Academy of Pediatrics; 2012: pág 291-294. DOI: https://doi.org/10.1542/9781581108026-part03-coronavirus
MinSalud. Lineamientos para la prevención, diagnóstico, manejo y control de casos de Influenza. Bogotá: Subdirección de Enfermedades Transmisibles Dirección de Promoción y Prevención Dirección de Epidemiología y Demografía: 2018. https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/lineamientos-prevencion-diagnostico-manejo-control-casos-influenza.pdf
Kursat Azkur A, Akdis M, Azkur D, Sokolowska M, van de Veen W, Brüggen MC, et al. Immune response to SARS-CoV-2 and mechanisms of immunopathological changes in COVID-19. Allergy. [Internet]. 2020 may; 75(7): 1564-1581. https://onlinelibrary.wiley.com/doi/10.1111/all.14364 https://doi.org/10.1111/all.14364
Kohn Loncarica G, Fustiñana A, Díaz Rubio F, Jara- millo Bustamante JC, González-Dambrauskas S, Vásquez-Hoyos P, et al. Recommendations for the initial management of multisystem inflammatory syndrome temporally related to COVID-19, in children and adolescents. Arch Argent Pediatr. 2020; 118(6):e514-e526. https://www.sap.org.ar/docs/publicaciones/archivosarg/2020/v118n6a15e.pdf https://doi.org/10.5546/aap.2020.eng.e514
Deville JG, Song E, Ouellette CP. COVID-19. Clinical manifestations and diagnosis in children. [Citado 17 ene. 2021]. Disponible en: https://www.uptodate.com/contents/covid-19-clinical-manifestations-and-diagnosis-in-children
Cendel FJ, Barreiro P, San Román J, Abanades JC, Barba R, Barberán J, et al. Recommendations for use of antigenic tests in the diagnosis of acute SARS-CoV-2 infection in the second pandemic wave: attitude in different clinical settings. Rev Esp Quimioter. [Internet]. 2020 oct; 33(6): 466-48. 4. https://seq.es/wpcontent/uploads/2020/10/candelENG19oct2020.pdf https://doi.org/10.37201/req/120.2020
Molina Gutiérrez MA, Ruiz Domínguez JA, Bueno-Barriocanal MB, Lavisier BM, López López Caracterización de una población pediátrica de escasos recursos que habita por encima de 2500 m. s. n. m. positiva para SARS-COV-2
R, Martín-Sánchez J, et al. Impacto de la pande- mia COVID-19 en urgencias: primeros hallazgos en un hospital de Madrid. An Pediatr (Barc). [Inter- net]. 2020 nov; 93(5): 313-322. https://doi.org/10.1016/j.anpedi.2020.06.021
Alcindor ML, Alcindor F, Richard KE, Ajay G, Denis AM, Dickson DM, et al. COVID-19 Management in pediatrics. The Journal for Nurse Practitioners. [Internet]. 2021 may; 17(5): 528-535. https://doi.org/10.1016/j.nurpra.2021.02.010
Alcaldía Mayor de Bogotá, Secretaria de Salud. Salu- Data. [Internet]. [Citado 19 feb. 2021]. Disponible en: https://saludata.saludcapital.gov.co/osb/
Martínez C, Serrano H, Mattar S, Faccini-Martínez AA, Contreras V, Galeano K, et al. SARS-CoV-2 in a tropical area of Colombia, a remarkable conversion of presymptomatic to symptomatic people impacts public health. ReseachSquare. [Internet]. 2020 nov; 1-13. https://assets.researchsquare.com/files/rs111785/v1/e8c30205-2154-4a8e-8621-f9fbb8f06be7.pdf ?c=1631862356
Instituto de Evaluación Tecnológica en Salud, Asociación Colombiana de Infectología. Consenso colombiano de atención, diagnóstico y manejo de la infección por SARS-CoV-2/ covid-19 en establecimientos de atención de la salud. Bogotá: Carlos Humberto Saavedra Trujillo; 2020. http://www.iets.org.co/archivos/853-2765-1-pb.pdf
https://doi.org/10.22354/in.v24i3.851
Benavides RI, López ME, López LP. Diferencias entre niños y adultos por el nuevo coronavirus 2019, SARS-CoV-2/COVID-19. Rev Latin Infect Pediatr. 2020:. 33(4):165-173. DOI: https://doi.org/10.35366/96845
Álvarez P, Larios P, Toro L, Acevedo V, Arancibia F, Cárdenas L, et al. Recomendación para la sospecha, manejo y seguimiento del compromiso cardiovascular en pacientes con Síndrome Inflamatorio Multisistémico en Pediatría asociado a COVID-19 (PIMS-TC). Declaración de posición de la Sociedad Chilena de Pediatría (sochipe) y Sociedad Chilena de Cardiología y Cirugía Cardiovascular (sochicar). Rev Chil Pediatr. [Internet]. 2020 ago; 91(6): 982- 990. https://scielo.conicyt.cl/pdf/rcp/v91n6/0370-4106-rcp-rchped-vi91i6-3215.pdf https://doi.org/10.32641/rchped.v91i6.3215
Shen KL, Yang YH, Jiang RM, Wang TY, Zhao DC, Jiang Y, et al. Updated diagnosis, treatment and prevention of COVID-19 in children: experts' consensus statement (condensed version of the second edition). World J Pediatr. [Internet]. 2020 apr; 16(3): 232- 239. Disponible en: https://link.springer.com/article/10.1007 %2Fs12519-020-00362-4 https://doi.org/10.1007/s12519-020-00362-4
Kar SK, Verma N, Saxena SK. Coronavirus Infection Among Children and Adolescents. Coronavirus Disease 2019 (COVID-19). En: Series Editor Shailendra K. Saxena. Coronavirus Disease 2019 (covid-19). Luxemburgo: Springer. Chapter 7 p:71-79. 2020 Apr 30:71-9. https://doi.org/10.1007/978-981-15- 4814-7_7
Fernandes DM, Oliveira CR, Guerguis S, Eisenberg R, Choi J, Kim M, et al. Severe acute respiratory syndrome Coronavirus 2 clinical syndromes and predictors of disease severity in hospitalized children and youth. J Pediatr. [Internet]. 2020 mar; 230(10): 23-31. https://www.jpeds.com/article/S0022-3476(20)31393-7/fulltext https://doi.org/10.1016/j.jpeds.2020.11.016
Chang TH, Wu JL, Chang LY. Clinical characteristics and diagnostic challenges of pediatric covid-19: a systematic review and meta-analysis. Journal of the Formosan Medical Association. [Internet]. 2020 may; 119(5): 982-989. https://www.ncbi.nlm. nih.gov/pmc/articles/PMC7161491/ https://doi.org/10.1016/j.jfma.2020.04.007
Callejas D, Echevarría JM, Carrero Y, Rodríguez Morales AJ, Moreira R. The SARS-CoV-2 pandemic in Latin America: the need for multidisciplinary approaches. CurrTrop Med Rep. [Internet]. (2020 nov; 7:120-125. Disponible en: https://link.springer. com/article/10.1007%2Fs40475-020-00219-w DOI: https://doi.org/10.1007/s40475-02000219-w https://doi.org/10.1007/s40475-020-00219-w
Centers for Disease Control and Prevention. SARS-CoV-2-Associated Deaths Among Persons Aged <21 Years - United States, February 12-July 31, 2020. Atlanta: Bixler D, Miller AD, Mattison CP, Taylor B, Komatsu K, Peterson-Pompa X, et al; 2020. Disponible en: https://www.cdc.gov/mmwr/volumes/69/wr/mm6937e4.htms_cid=mm6937e4_w
Public Health Scotland. What explains the spatial variation in covid-19 mortality across Scotland? [Internet]. [Citado 7 nov. 2020]. Disponible en: https://www.publichealthscotland.scot/media/2814/spatial-variation-in-covid-19-mortality-in-scotland-english-september2020.pdf
Lone NI, McPeake J, Stewart NI, Blayney MC, Chan- Seem R, Donaldson L, et al. Influence of socioeconomic deprivation on interventions and outcomes for patients admitted with covid-19 to critical care units in Scotland: a national cohort study. Lancet Reg Health Eur. [Internet]. 2021 feb; 1:100005. Disponible en: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(20)30005-3/fulltext
https://doi.org/10.1016/j.lanepe.2020.100005
Chouduri JA, Ogden LG, Ruttember AJ, Thomas DSK, Todd JK, Simoes EAF. Effect of altitude on hospitalizations for respiratory syncytial virus infection. Pediatrics. [Internet]. 2006 feb; 117(2): 349-356. Disponible en: https://publications.aap.org/pediatrics/article-abstract/117/2/349/68457/Effect-of-Altitude-on-Hospitalizations-for?redirectedFrom=fulltext https://doi.org/10.1542/peds.2004-2795
Wang VJ, MD, Cavagnaro CS, Camargo CA, Mansbach JM. Altitude and environmental climate effects on bronchiolitis severity among children presenting to the emergency department. J Environ Health. [Internet]. 2012 oct; 75(3): 8-15. Disponible en: https://neha.org/sites/default/files/pd/JEH10-2012-Feature-Altitude-Climate-Effects.pdf
Caliendo AM, Hanson KE. Coronavirus disease 2019 (covid-19). [Internet]. [Citado 17 ene. 2021]. Disponible en: https://www.uptodate.com/contents/covid-19-diagnosis#:~:text=In%20February%202020%2C%20the%20World,of%20COVID%2D19%20 is%20evolving
Khatami F, Saachi M, Tamehri-Zadeh SS, Sadat-Aghamir Z, Namazi-Shabastari A, Oliveira-Reis L, et al. A meta analysis of accuracy and sensitivity of chest ct and rt-pcr in covid-19 diagnosis. Sci Rep. [Internet]. 2020 dic; 10(1): 22402. Disponible en: https://www.nature.com/articles/s41598-020-80061 DOI: https://doi.org/10.1038/s41598-020-80061-2
Carlotti APCP, de Carvalho WB, Johnston C, Gi- lio AE, de Sousa-Marques HH, Ferranti JF, et al. Update on the diagnosis and management of co- vid-19 in pediatric patients. Clinics. [Internet]. 2020 nov; 75:e2353. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7688073/ DOI: https://doi.org/10.6061/clinics/2020/e2353
Wehl G, Laible M, Rauchenzauner M. Co-infection of SARS-CoV-2 and influenza A in a pediatric patient in Germany. Klin Padiatr. [Internet]. 2020 jul; 234(4): 217- 218. DOI: https://doi.org/10.1055/a-1163-7385
Manrique-Abril FG, Agudelo-Calderon CA, González-Chordá VM, Gutiérrez-Lesmes O, Téllez-Piñerez CF, Herrera-Amaya G. (Modelo sir de la pandemia de covid-19 en Colombia. Rev. Salud Pública. [Internet]. 2020; 22(2): 1-9. Disponible en: http://www.scielo.org.co/pdf/rsap/v22n1/0124-0064-rsap-22-01-e185977.pdf DOI: https://doi.org/10.15446/rsap.v22n2.85977
Cui X, Zhao Z, Zhang T, Guo W, Guo W, Zheng J, et al. A systematic review and meta-analysis of children with Coronavirus Disease 2019 (covid-19). J Med Virol. [Internet]. 2021; 93(2): 1057-1069. Disponible en: https://
https://doi.org/10.1002/jmv.26398
Organización Mundial de la Salud. Report of the who-China Joint Mission on Coronavirus Disease 2019 (covid-19), 16-24 February 2020. Ginebra: World Health Organization; 2020. Disponible en: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf Accessed 9 March 2020.
Götzinger F, Santiago-García B, Noguera-Julián A, Lanaspa M, Lancela L, Calò-Carducci F, et al. covid-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health. [Internet]. 2020 sept; 4(9): 653-661. Disponi- ble en: https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30177-2/fulltext#%20 DOI: https://doi.org/10.1016/S2352-4642(20)30177-2
Fernández Sarmiento J, De Souza D, Jabornisky R, González GA, Arias-López MP, et al. Paediatric inflammatory multisystem syndrome temporally associated with covid-19 (pims-ts): a narrative review and the viewpoint of the Latin American Society of Pediatric Intensive Care (slacip) Sepsis Committee. bmj Paediatr Open. [Internet]. 2021 feb; 5(1): e000894. Disponible en: https://bmjpaedsopen.bmj.com/content/5/1/ DOI: https://doi.org/10.1136/bmjpo-2020-000894
Rankin D, Talj R, Howard LM, Halasa NB. Epidemiologic trends and characteristics of sars-CoV-2 infections among children in the United States. Curr Opin Pediatr. [Internet]. 2021 feb; 33(1): 114- 121. Disponible en: https://journals.lww.com/co-pediatrics/Abstract/2021/02000/Epidemiologic_trends_and_characteristics_of.16.aspx DOI: https://doi.org/10.1097/MOP.0000000000000971
Bolaños-Almeida CE, Espitia-Segura OM. Clinical and epidemiological analysis of covid-19 children cases in Colombia pediacovid. Pediatr Infect Dis J. [Internet]. 2021 ene; 40(1): e7-e11. Disponible en: https://journals.lww.com/pidj/Fulltext/2021/01000/Clinical_and_Epidemiologic_Analysis_of_COVID_19.2.aspx DOI: https://doi.org/10.1097/INF.0000000000002952
Ludvigsson JF. Systematic review of covid-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. [Internet]. 2020 jun; 109(6): 1088- 1095. Disponible en: https://onlinelibrary.wiley.com/doi/10.1111/apa.15270 DOI: https://doi.org/10.1111/apa.15270
Cifuentes MP, Rodriguez-Villamizar LA, Rojas-Botero ML, Fernandéz-Niño J. Socioeconomic inequalities associated with mortality for covid-19 in Colombia: a cohort nationwide study. J Epidemiol Community Health. [Internet]. 2021 mar. Disponible en: https://jech.bmj.com/content/75/7/610 DOI: https://doi.org/10.1136/jech-2020-216275
Centers for Disease Control and Prevention. Corona- virus disease 2019 in children-United States, February 12-April 2, 2020. (2020). Atlanta: cdc covid-19 Response Team; 2020. Rep. 69: 422-426. Disponible en: https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e4.htm DOI: https://doi.org/10.15585/mmwr.mm6914e4
Antúnez-Montes OY, Escamilla-MI, Figueroa-Uribe AF, Arteaga-Menchaca E, Lavariega-Saráchaga M, Salcedo-Lozada P, et al. covid-19 and multisystem inflammatory syndrome in Latin American children. A multinational study. Pediatr Infect Dis J. [Internet]. 2021 ene; 40(1): e1-e6. Disponible en: https://journals.lww.com/pidj/Fulltext/2021/01000/COVID_19_and_Multisystem_Inflammatory_Syndrome_in.1.aspx DOI: https://doi.org/10.1097/INF.0000000000002949
Kim J, Giroux M, Kim JE, Choi YK, Gonzalez-Jimenez H, Lee JC, et al. The moderating role of childhood socioeconomic status on the impact of nudging on the perceived threat of coronavirus and stockpiling intention. J Retail Consum Serv. [Internet]. 2021 mar; 59: 102362. Disponible en: https://www.sciencedirect.com/science/article/pii/S0969698920313709?via%3Dihub DOI: https://doi.org/10.1016/j.jretconser.2020.102362
Storch de Gracia P, Leoz-Gordillo I, Andina D, Flo- res P, Villalobos E, Escalada-Pellitero S, et al. Espectro clínico y factores de riesgo de enfermedad complicada en niños ingresados con infección por SARS-CoV-2. An Pediatr (Barc). [Internet]. 2020 nov; 93(5): 323-333. Disponible en: https://www.analesdepediatria.org/es-espectro-clinico-factores-riesgo-enfermedad-articulo-S1695403320302836 DOI: https:// doi.org/10.1016/j.anpedi.2020.07.025
Centers for Disease Control and Prevention. Investigative criteria for Suspected Cases of SARS-CoV-2 Reinfection (ICR) [Internet]. [Citado 29 oct. 2020]. Disponible en: https://www.cdc.gov/coronavirus/2019-ncov/php/invest-criteria.html
Instituto Nacional de Salud. Evaluación de casos sospechosos de SARS-CoV-2. [Internet]. [Citado 23 ene. 2021]. https://www.ins.gov.co/BibliotecaDigital/infografia-ins-20-10-2020-reinfeccion.jpg
Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. SARS-CoV-2 infection in children. N Engl J Med. [Internet]. 2020 abr; 382(17): 1663-1665. Disponible en: https://www.nejm.org/doi/10.1056/NEJMc2005073 DOI: https://doi.org/10.1056/NEJMc2005073
Munro APS, Faust SN. covid-19 in children: cu- rrent evidence and key questions. Curr Opin Infect Dis. [Internet]. 2020 dic; 33(6): 540-547. Disponible en: https://journals.lww.com/coinfectiousdiseases/Abstract/2020/12000/COVID_19_in_children__current_evidence_and_key.16.aspx DOI: https://doi.org/10.1097/QCO.0000000000000690
Ouldali N, Yang DD, Madhi F, Levy M, Gaschignard J, Craiu I, et al. Factors associated with severe SARS-CoV-2 infection. Pediatrics. [Internet]. 2021 mar; 147(3): e2020023432. Disponible en: https://publications.aap.org/pediatrics/article-abstract/147/3/e2020023432/33235/Factors-Associated-With-Severe-SARS-CoV-2?redirectedFrom=fulltext DOI: https://doi.org/10.1542/peds.2020-023432
Beth F, Son M, Friedman K. Coronavirus disease 2019 (covid-19): Multisystem inflammatory syndrome in children (mis-c) clinical features, evaluation, and diagnosis. [Internet]. [Citado 01 feb. 2021]. Disponible en: https://www.uptodate.com/contents/covid-19-multisystem-inflammatory-syndrome-in-children-mis-c-clinical-features-evaluation-and-diagnosis.
Kosmeri C, Koumpis E, Tsabouri S, Siomou E, Makis A. Hematological manifestations of SARS-CoV-2 in children. Pediatr Blood Cancer. [Internet]. 2020 dic; 67(12): e28745. Disponible en: https://onlinelibrary.wiley.com/doi/10.1002/pbc.28745 DOI: https://doi.org/10.1002/pbc.28745
González-Dambrauskas S, Vásquez-Hoyos P, Camporesi A, Díaz-Rubio F, Piñeres-Olave BE, Fernández-Sarmiento J, et al. Pediatric Critical Care and covid-19. Pediatrics. [Internet]. 2020 sept; 146(3): e20201766. Disponible en: https://publications.aap.org/pediatrics/article/146/3/e20201766/36700/Pediatric-Critical-Care-and-COVID-19 DOI: https://doi.org/10.1542/peds.2020-1766
Torres-Viñas VN, Fernández-Sarmiento J, Mulett-Hoyos H, Acevedo-Sedano L, Vásquez-Hoyos P, Sarmiento MP, et al. Declaración consenso de la Asociación Colombiana de Medicina Crítica y Cuidados Intensivos (AMCI) para atención y manejo del paciente pediátrico con sospecha o confirmación de infección severa por SARS-CoV-2. Acta Colomb Cuid Intensivo. [Internet]. 2020 dic; 20(1); 113-127. Disponible en: https:/www.sciencedirect.com/science/article/pii/ S0122726220300860 DOI: https://doi.org/10.1016/j.acci.2020.09.005
Del Borrello G, Giraudo I, Bondone C, Denina M, Garazzino S, Linari C, et al. SARS-CoV-2 associated coagulopathy and thromboembolism prophylaxis in children: a single centre observational study. J Thromb Haemost. [Internet]. 2021 feb; 19(2): 522-530. DOI: https://doi.org/10.1111/jth.15216
Xia W, Shao J, Guo Y , Peng X, Li Z, Hu D. Clinical and ct features in pediatric patients with covid-19 infection: different points from adults. Pediatr Pulmonol. [Internet]. 2020 may; 55(5):1169-1174. Disponible en: https://onlinelibrary.wiley.com/doi/10.1002/ppul.24718. DOI: https://doi.org/10.1002/ppul.24718
Wu Q, Xing Y, Shi L, Li W, Gao Y, Pan S, et al. Coinfection and Other Clinical Characteristics of covid-19 in Children. Pediatrics. [Internet]. 2020 jul; 146(1): e20200961. Disponible en: https://publications.aap.org/pediatrics/article/146/1/e20200961/37028/Coinfection-and-Other-Clinical-Characteristics-of DOI: https://doi.org/10.1542/peds.2020-0961
Kim D, Quinn J, Pinsky B, Shah NH, Brown I. Rates of co-infection between sars-CoV-2 and other respiratory pathogens. jama. [Internet]. 2020 may; 323(20): 2085-2086. Disponible en: https://jamanetwork.com/journals/jama/fullarticle/2764787. DOI: https://doi. org/10.1001/jama.2020.6266
López-Pérez JJ, Galán-Gutiérrez G, Lancheros-Delgadillo D, Olarte N, Valderrama A. Caracterización de la enfermedad respiratoria baja en pacientes menores de 5 años, hospitalizados en un centro de 3o nivel. Revista Med. [Internet]. 2016; 24(2): 47-57. DOI: https://doi.org/10.18359/rmed.2640
Ridao-Redondo M. Bronquiolitis y bronquitis. Pediatr Integral. [Internet]. 2021; XXV(1): 21-28. Disponible en: https://www.pediatriaintegral.es/publicacion-2021-01/bronquiolitis-y-bronquitis/
Perone G. The determinants of covid-19 case fatality rate (cfr) in the Italian regions and provinces: an analysis of environmental, demographic, and healthcare factors. Sci Total Environ. [Internet]. 2021 feb; 755(1): 142523. Disponible en: https://www.sciencedirect.com/science/article/pii/S0048969720360526?via%3Dihub. DOI: https://doi.org/10.1016/j.scitotenv.2020.142523
Accinellia RA, Leon-Abarca JA. At high altitude co- vid-19 is less frequent: the experience of Peru. Arch Bronconeumol. [Internet]. 2020 nov; 56(11): 747-763. Disponible en: https://www.sciencedirect.com/science/article/pii/S0300289620302180?via%3Dihub DOI: https://doi.org/10.1016/j.arbr.2020.09.004
Cunha-Fernandes JS, Siqueira da Silva R, Christófaro-Silva A, Campos-Villela D, Amaral-Mendoça V, Rodrigues-Lacerda AC. Altitude conditions seem to determine the evolution of covid-19 in Brazil. Scientifc Reports. [Internet]. 2021 feb; 11: 4402. Disponible en: https://www.nature.com/articles/s41598-021-83971-x. DOI: https://doi.org/10.1038/s41598-021-83971-x
Copyright (c) 2022 Revista Med
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
