Patients with severe COVID-19 may have endothelial dysfunction and a hypercoagulable state that can cause skin damage. In the presence of external pressure on the tissues, the local inflammatory process regulated by inflammatory cytokines can increase and prolong itself, contributing to the formation of pressure injury (PI). PI is defined as localized damage to the skin or underlying tissues. It usually occurs as a result of intense and/or prolonged pressure in combination with shear. The aim of the study is to perform a narrative review on the physiological evidence of increased risk in the development of PI in critically ill patients with COVID-19.In patients with severe COVID-19 a pattern of tissue damage consistent with complement-mediated microvascular injury was found in the lungs and skin of critically ill COVID-19 patients, suggesting sustained systemic activation of complement pathways. Theoretically, the same thrombogenic vascular changes related to COVID-19 that occur in the skin also occur in the underlying tissues, making patients less tolerant to the harmful effects of pressure and shear. Unlike the syndromes typical of acute respiratory illnesses and other pathologies that commonly lead to intensive care unit admission, COVID-19 and systemic viral spread show that local and systemic factors overlap. This fact may be justified by current epidemiological data showing that the prevalence of PI among intensive care unit patients with COVID-19 was 3 times higher than in those without COVID-19. This narrative review presents physiological evidence to suggesting an increased risk of developing PI in critically ill patients with COVID-19.Abbreviations: ACE2 = angiotensin-converting enzyme 2, AP = alternative complement pathway, ARDS = acute respiratory distress syndrome, C4d = complement component 4d, C5b-9 = complement membrane attack complex, CoVs = coronaviruses, ECM = extracellular matrix, eNOS = endothelial nitric oxide sintetase, ICU = intensive care unit, IL-1 = interleukin-1, IL-10 = interleukin-10, IL-1alpha = interleukin-1alpha, IL-1beta = interleukin-1beta, IL-6 = interleukin-6, LP = lectin complement pathway, MASP-2 = mannose-binding protein-associated serine protease 2, MBL = mannose-binding lectin, NOX2 = NADPH oxidase 2, PAI-1 = plasminogen activator inhibitor 1, PI = pressure injury, PubMed = Public Medline, RAAS = renin-angiotensin-aldosterone system, SARS-CoV = severe acute respiratory syndrome-related coronavirus, SciELO = Scientific Electronic Library Online, TNF-alpha = alpha tumor necrosis factor.

Introduction: Pressure injury is 1 of the most common pressure related injuries in patients admitted to the intensive care unit. In individuals with darker skin tones, skin assessment protocols appear to be less effective, resulting in early damage from pressure. Bedside assessment measures using ultrasound and infrared thermography (IRT) have been studied to identify pressure injuries. Patient concerns: A 58-year-old dark-skinned male was admitted to the intensive care unit due to an ischemic stroke. Diagnosis: The visual evaluation of the skin took place on the second day after admission to the intensive care unit (before 48 hours). The patient had a whitish erythema on the left heel (LH) and a large bloody blister on the right heel. There were no signs of color change on the sacrum skin. Interventions: We performed 3 skin evaluations of the sacrum and calcaneus using ultrasound and IRT. Outcomes: Changes in the temperature of the target regions (sacrum, right heel and LH) were observed. The right heel showed higher mean temperatures than the LH in all evaluations. In the first evaluation of the sacrum region, the average temperature was lower (-1.3°C) than in the second and third evaluation (1°C). In the calcaneus, the mean temperature range (right heel - LH) showed a difference of (3.5°C) in the first evaluation, a difference of (1.4°C) in the second evaluation, and a difference of (1.7°C) in the third evaluation. Ultrasound images of the selected regions showed abnormal tissue patterns - edema - since the first evaluation. Conclusion: These findings indicate that the regions with deep tissue injury on ultrasound evaluation were compatible with the regions of abnormal temperatures in the IRT. IRT could identify regions of pathological process, which could be confirmed by abnormal ultrasound findings. Well-designed, randomized research with a larger sample could verify if the combination of these assessment techniques could be used as a potential method for early detection and evaluation of pressure injuries.

Photodynamic therapy today is becoming an important role in the healing of lacerated tissues, since it has therapeutic resources capable of accelerating this process. One treatment option is the clinical phototherapy, and Photodynamic Therapy (PDT) is being widely used. This study aims to evaluate the effect of PDT on the healing of skin wounds in rats. We used a sample of 39 male rats Wistar divided into three groups, a control, a PDT-treated green and red with the last PDT. After 24 hours before the surgical incisions, PDT was used in both groups for 6 minutes and was evaluated in histological level, the inflammatory reaction and the repair process. The results showed that the granulation tissue was more developed in the irradiated group than in the control group and the amount of chronic inflammatory cells (monocytes, macrophages, lymphocytes and plasma cells) predominated with green phototherapy. The epithelialization in the wound margins and scarring with better quality occurred with red PDT (640 nm), which the higher deposition was of collagen. However, phototherapy not collimated of 640 nm (red) resulted in better anti-inflammatory effects. Given these answers with phototherapy not collimated green (525 nm) and red (640 nm), we conclude that the use of these

Background: Photodynamic therapy (PDT) is the generation of cytotoxic agents through the dynamic interaction between a photosensitizer excited by light at a specific wavelength. When associated with phthalocyanines, they are efficient in incorporating target cells and exhibiting high rates of triplet generation. This study aimed to characterize PDT associated with the phototherapeutic agent Phthalomethyl D, developed by the authors, in the process of repair, healing and immune improvement for possible application against SARS-CoV-2. Methods: Sixty-nine mice were used, divided into 2 groups: GI, treated with ILIB laser, without a phototherapeutic agent, and subjected to surgery for viral induction; GII, same as GI plus association of Phthalomethyl D. They were divided into subgroups and reevaluated at 7, 14, and 21 days, and then divided into 3 subgroups of 6 animals each, subjected to treatment at 24 h, 48 h, 72 h, 5 and 7 days. Results: Both groups had a high rate of partial incision closure and acute inflammatory control. Microscopically, there was a greater amount of amorphous fundamental substance, fibrocytes, fibroblasts, and giant cells and reduction in the number of keratinocytes, in the amount of keratin, and epidermal thickness in GII than in GI. Conclusions: PDT with Phthalomethyl D stimulates the processes of healing/repair and immunomodulation during viral infection, initially favoring the inflammatory response and, after

Background: The present work aims to characterize the profile of patients with stroke treat at a hospital located in the Region of the Mata of Minas Gerais, Brazil, considering the findings of the clinical vocal tract, kind of stroke, age and gender of such patients. Methodology: To obtain data, the clinical profile of 133 patients with a clinical or tomography diagnosis of stroke was analyzed, and the results were presented in percentage. For quantitative data average and analysis the tests were done with associations that held χ 2 test, and for significance it was considered p < 0.05. Results: From the total of patients, 63 were women, accounting for 47.4% and the other 52.6% were males. Clinically, they were characterized with the highest percentage for ischemic stroke (89.4%) compared to the hemorrhagic type (10.6%). Most of them were referred for computed tomography (86.5%) and remained hospitalized for an average of 6.496 ± 7.372 days. Similar percentages were obtained in the analysis of the population in question, when considering if they had (54.1%) or not (49.6%) any damage in their speech, language skills or swallowing. There were different types of disabilities in patients with stroke. Men with an average age of 69.8 ± 13.9 presents mostly ischemic stroke, and the majority of patients with stroke had hemiplegia and abnormalities of the vocal tract, dysphasia, and aphasia. While older patients had an ischemic stroke and were presented with left hemiplegia, the younger ones suffered from hemorrhagic strokes that caused a disability characterized as right hemiplegic. Conclusion: Our results show important conclusions regarding the clinical evolution of the vocal tract of patients who suffered strokes during the period of the analysis, being useful 83for better comprehension of how the vocal tract from these patients evolved according to the kind of stroke, sex and age also allowing a contraposition with other future statistics periods available in literature. It can also be pointed out the difficulties in diagnosing the stroke and the concern with the immediate care, but not with its continuance or with its multidisciplinary approach, giving an evident life risk through dysphasia and the increase of permanent damage when there isn't an appropriate work done with the patients.