Introdução/Objetivo O SARS-COV-2 mostrou-se uma grave ameaça à saúde global. O grande número de infectados desencadeou altas taxas de mortalidade e sobrecarga do sistema de saúde. O prognóstico da doença é muito variável e dependente de diversos fatores. Dessa forma, neste trabalho buscou-se identificar a mortalidade dos pacientes por covid-19 admitidos nas Unidades de Terapia Intensiva em um hospital brasileiro, bem como suas características clínicas e epidemiológicas. Métodos Trata-se de pesquisa observacional, transversal, retrospectiva, descritiva e pretende analisar o desfecho de mortalidade em pacientes COVID-19, no Hospital Geral da Fundação Universidade de Caxias do Sul. Os critérios de inclusão foram período de internação entre 1 de abril de 2020 e 30 de abril de 2021, idade maior de 18 anos, internação em UTI adulto por no mínimo 24 horas e testagem positiva para COVID-19. Foram avaliados dados como o sexo, comorbidades prévias e tempo de internação em UTI. Resultados Foram avaliados 170 pacientes, sendo que 55,5% do sexo masculino. A idade média foi 59 anos - 57 para mulheres e 61 para homens. 55% evoluiram a óbito em decorrência de complicações da infecção, 33% do homens e 21% mulheres. A idade média para mulheres foi de 62 anos e para os homens, 64 anos. O tempo de internação em UTI até o óbito foi em média 16 dias (13 para mulheres e 16 para homens). Desses pacientes, 87% possuiam comorbidades, sendo as três mais prevalentes a hipertensão arterial sistêmica (59%), a obesidade (41%) e o diabetes mellitus (40%). Conclusão Podemos inferir que o desfecho mais prevalente foi o óbito. Desses, o perfil mais prevalente foi de homens idosos. Os pacientes do sexo masculino que necessitaram de internação em UTI e foram a óbito, possuíam idade mais avançada do que os pacientes do sexo feminino. Concluímos que uma elevada porcentagem de pacientes com o desfecho de óbito possuíam pelo menos uma comorbidade associada, sendo as mais frequentes a hipertensão arterial, a obesidade e a diabetes.

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Background: spasticity affects up to 90% of multiple sclerosis (MS) patients, being a major cause of disability. Repetitive transcranial magnetic stimulation (rTMS) appears to be a potential treatment, but literature is scarce. Objectives: to evaluate the effects of combined rTMS and physical therapy for spasticity in MS patients. Methods: relapsing-remitting MS patients suffering from lower limb spasticity were included. The rTMS protocol consisted of 20 sessions of 18 trains of 50 stimuli at 5Hz and at 100% of rest potential threshold, with 10 seconds per train and 40 second pauses, amounting for 900 pulses (15 minutes) with a Neurosoft- MS/D double coil. Optimal coil positioning was determined by motor responses in the contralateral soleus muscle. The physical therapy protocol included active exercising – stationary bicycle, step climbing with partial weight suspension – followed by mild gradual resistance exercising for knee extension and hip and foot flexion, proprioceptive exercises and active stretching. The primary outcome was improvement on the Modified Ashworth Scale (MAS) score at baseline and 4 weeks after treatment. Results: five female patients were recruited. At the 4-week follow-up, 4 out the 5 patients had a significant improvement regarding spasticity. There was a reduction in mean MAS score from 2.30 to 1.42. Patient 1 had a MAS score reduction from 2 to 1 (50%). Patient 2 from 3 to 1 (66%), patient 3 from 4 to 3 (25%) and patient 4 from 0.5 to 0.125 (75%). Conclusion: combined rTMS and physical therapy protocols presents as a beneficial treatment modality for MS spasticity.

Female patient, 61 years-old, heavy smoker, and heavy drinker, sought care because of watery diarrhea, severe weight loss (around 40 pounds), alteration of mental state, and skin rash. She presented with signs of dementia (blurry speech, mental confusion, and amnesia) and severe malnutrition. Initial investigation had shown anemia (hemoglobin = 8.5 g/dL), low albumin (2.05 g/dL), and an increase of liver enzymes (GGT = 450 U/L and alkaline phosphatase = 287 U/L). Serological tests for syphilis, HIV, hepatitis C virus, and hepatitis B virus were negative. Parasitological stool examination and fecal leukocyte tests were normal, anti-transglutaminase IgA and IgG antibodies were negative, and she had a normal oral lactose tolerance test. Colonoscopy was performed, showing normal mucosa with a normal anatomopathological study of colon biopsies. The skin rash, tough, was very relevant for the case: hyperpigmentation, scaling, and skin thickening on the face, upper chest, and upper and lower limbs-areas exposed to sunlight (Figs. 1, 2). A presumptive diagnosis of pellagra was made by the clinical gastroenterology team. Supplementation of nicotinamide in the dose of 50 mg QID was began and maintained for 28 days, with resolution of diarrhea and of the skin rash, a substantial weight gain, and a considerable improvement of mental status. Because in Brazil there is no commercial nicotinamide presentation, it was used 20 daily tablets of complex B vitamins, which contain 10 mg of nicotinamide each. The patient was discharged with maintenance supplementation of complex B vitamins and a plan for treatment of alcoholism. Pellagra is a disease caused by the deficiency of niacin (vitamin B3), first described in 1735 by the Spanish physician Gaspar

Pemphigoid Gestational (PG), an uncommon autoimmune bullous dermatosis of pregnancy, stands out between the specific dermatological diseases of the gestational period. Despite being self-limited and benign, it has a significant impact on women's health, both physiologically and psychologically. In addition, it promotes pathological changes that can be complicated during pregnancy. This paper reports the case of a pregnant patient with blistering lesions throughout the whole body. The diagnostic hypothesis initially involved PG and the specific treatment with corticosteroids was initiated, but after the anatomopathological result of the biopsy there has been diagnostic confusion with drug hypersensitivity, since clinical and histological manifestations were exuberant for both pathologies. As the lesions recurred in the puerperium, due to the corticoid abstention that was administered for the treatment of the differential diagnosis, a diagnostic review with immunofluorescence was made and confirmed PG. It is important to establish a correct diagnosis therefore, in order to improve the quality of care offered to the mother-baby binomial.