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  1. Article: Timing to Intubation COVID-19 Patients: Can We Put It Off until Tomorrow?

    de Alencar, Júlio César Garcia / Sternlicht, Juliana Martes / Veiga, Alicia Dudy Muller / Marchini, Julio Flávio Meirelles / Ferreira, Juliana Carvalho / de Carvalho, Carlos Roberto Ribeiro / Marcilio, Izabel / da Silva, Katia Regina / Cobello Junior, Vilson / Felix, Marcelo Consorti / Gomez, Luz Marina Gomez / de Souza, Heraldo Possolo / Mauá, Denis Deratani / Emergency Usp Covid Group / Hcfmusp Covid-Study Group

    Healthcare (Basel, Switzerland)

    2022  Volume 10, Issue 2

    Abstract: Background: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying ... ...

    Abstract Background: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the association between intubation day and mortality in COVID-19 patients.
    Methods: We performed a unicentric retrospective cohort study considering all COVID-19 patients consecutively admitted between March 2020 and August 2020 requiring invasive mechanical ventilation. The primary outcome was all-cause mortality within 28 days after intubation, and a Cox model was used to evaluate the effect of time from onset of symptoms to intubation in mortality.
    Results: A total of 592 (20%) patients of 3020 admitted with COVID-19 were intubated during study period, and 310 patients who were intubated deceased 28 days after intubation. Each additional day between the onset of symptoms and intubation was significantly associated with higher in-hospital death (adjusted hazard ratio, 1.018; 95% CI, 1.005-1.03).
    Conclusion: Among patients infected with SARS-CoV-2 who were intubated and mechanically ventilated, delaying intubation in the course of symptoms may be associated with higher mortality.
    Trial registration: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068).
    Language English
    Publishing date 2022-01-21
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2721009-1
    ISSN 2227-9032
    ISSN 2227-9032
    DOI 10.3390/healthcare10020206
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Lower peripheral blood Toll-like receptor 3 expression is associated with an unfavorable outcome in severe COVID-19 patients.

    Menezes, Maria Clara Saad / Veiga, Alicia Dudy Müller / Martins de Lima, Thais / Kunimi Kubo Ariga, Suely / Vieira Barbeiro, Hermes / de Lucena Moreira, Claudia / Pinto, Agnes Araujo Sardinha / Brandao, Rodrigo Antonio / Marchini, Julio Flavio / Alencar, Julio Cesar / Marino, Lucas Oliveira / Gomez, Luz Marina / Olsen Saraiva Camara, Niels / Souza, Heraldo P

    Scientific reports

    2021  Volume 11, Issue 1, Page(s) 15223

    Abstract: The role of innate immunity in COVID-19 is not completely understood. Therefore, this study explored the impact of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection on the expression of Pattern Recognition Receptors (PRRs) in ... ...

    Abstract The role of innate immunity in COVID-19 is not completely understood. Therefore, this study explored the impact of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection on the expression of Pattern Recognition Receptors (PRRs) in peripheral blood cells and their correlated cytokines. Seventy-nine patients with severe COVID-19 on admission, according to World Health Organization (WHO) classification, were divided into two groups: patients who needed mechanical ventilation and/or deceased (SEVERE, n = 50) and patients who used supplementary oxygen but not mechanical ventilation and survived (MILD, n = 29); a control group (CONTROL, n = 17) was also enrolled. In the peripheral blood, gene expression (mRNA) of Toll-like receptors (TLRs) 3, 4, 7, 8, and 9, retinoic-acid inducible gene I (RIGI), NOD-like receptor family pyrin domain containing 3 (NLRP3), interferon alpha (IFN-α), interferon beta (IFN-β), interferon gamma (IFN-γ), interferon lambda (IFN-λ), pro-interleukin(IL)-1β (pro-IL-1β), and IL-18 was determined on admission, between 5-9 days, and between 10-15 days. Circulating cytokines in plasma were also measured. When compared to the COVID-19 MILD group, the COVID-19 SEVERE group had lower expression of TLR3 and overexpression of TLR4.
    MeSH term(s) Aged ; COVID-19/blood ; COVID-19/diagnosis ; COVID-19/genetics ; COVID-19/therapy ; Female ; Gene Expression Regulation ; Humans ; Male ; Middle Aged ; Prognosis ; Respiration, Artificial ; Toll-Like Receptor 3/blood ; Toll-Like Receptor 3/genetics
    Chemical Substances Toll-Like Receptor 3
    Language English
    Publishing date 2021-07-27
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-021-94624-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Endothelial injury in COVID-19 and septic patients.

    Hokama, Larissa Tami / Veiga, Alicia Dudy Müller / Menezes, Maria Clara Saad / Sardinha Pinto, Agnes Araujo / de Lima, Thais Martins / Ariga, Suely Kunimi Kubo / Barbeiro, Hermes Vieira / Barbeiro, Denise Frediani / de Lucena Moreira, Claudia / Stanzani, Gabriela / Brandao, Rodrigo Antonio / Marchini, Julio Flavio / Alencar, Julio Cesar / Marino, Lucas Oliveira / Gomez, Luz Marina / Souza, Heraldo P

    Microvascular research

    2021  Volume 140, Page(s) 104303

    Abstract: Systemic inflammatory response, as observed in sepsis and severe COVID-19, may lead to endothelial damage. Therefore, we aim to compare the extent of endothelial injury and its relationship to inflammation in both diseases. We included patients diagnosed ...

    Abstract Systemic inflammatory response, as observed in sepsis and severe COVID-19, may lead to endothelial damage. Therefore, we aim to compare the extent of endothelial injury and its relationship to inflammation in both diseases. We included patients diagnosed with sepsis (SEPSIS group, n = 21), mild COVID-19 (MILD group, n = 31), and severe COVID-19 (SEVERE group, n = 24). Clinical and routine laboratory data were obtained, circulating cytokines (INF-γ, TNF-α, and IL-10) and endothelial injury markers (E-Selectin, Tissue Factor (TF) and von Willebrand factor (vWF)) were measured. Compared to the SEPSIS group, patients with severe COVID-19 present similar clinical and laboratory data, except for lower circulating IL-10 and E-Selectin levels. Compared to the MILD group, patients in the SEVERE group showed higher levels of TNF-α, IL-10, and TF. There was no clear relationship between cytokines and endothelial injury markers among the three studied groups; however, in SEVERE COVID-19 patients, there is a positive relationship between INF-γ with TF and a negative relationship between IL-10 and vWF. In conclusion, COVID-19 and septic patients have a similar pattern of cytokines and endothelial dysfunction markers. These findings highlight the importance of endothelium dysfunction in COVID-19 and suggest that endothelium should be better evaluated as a therapeutic target for the disease.
    MeSH term(s) Aged ; Aged, 80 and over ; Biomarkers ; Blood Cell Count ; C-Reactive Protein/analysis ; COVID-19/blood ; COVID-19/complications ; COVID-19/pathology ; COVID-19/physiopathology ; E-Selectin/blood ; Endothelium, Vascular/pathology ; Female ; Humans ; Interferon-gamma/blood ; Interleukin-10/blood ; Male ; Middle Aged ; Retrospective Studies ; SARS-CoV-2 ; Sepsis/blood ; Sepsis/complications ; Sepsis/pathology ; Sepsis/physiopathology ; Severity of Illness Index ; Systemic Inflammatory Response Syndrome/blood ; Systemic Inflammatory Response Syndrome/etiology ; Systemic Inflammatory Response Syndrome/physiopathology ; Thromboplastin/analysis ; Tumor Necrosis Factor-alpha/analysis ; von Willebrand Factor/analysis
    Chemical Substances Biomarkers ; E-Selectin ; IL10 protein, human ; SELE protein, human ; Tumor Necrosis Factor-alpha ; von Willebrand Factor ; Interleukin-10 (130068-27-8) ; Interferon-gamma (82115-62-6) ; C-Reactive Protein (9007-41-4) ; Thromboplastin (9035-58-9)
    Language English
    Publishing date 2021-12-13
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80307-8
    ISSN 1095-9319 ; 0026-2862
    ISSN (online) 1095-9319
    ISSN 0026-2862
    DOI 10.1016/j.mvr.2021.104303
    Database MEDical Literature Analysis and Retrieval System OnLINE

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