Cardiovascular comorbidities and immune-response dysregulation are associated with COVID-19 severity. We aimed to explore the key immune cell profile and understand its association with disease ...progression in 156 patients with hypertension that were hospitalized due to COVID-19. The primary outcome was progression to severe disease. The probability of progression to severe disease was estimated using a logistic regression model that included clinical variables and immune cell subsets associated with the primary outcome. Obesity; diabetes; oxygen saturation; lung involvement on computed tomography (CT) examination; the C-reactive protein concentration; total lymphocyte count; proportions of CD4+ and CD8+ T cells; CD4/CD8 ratio; CD8+ HLA-DR MFI; and CD8+ NKG2A MFI on admission were all associated with progression to severe COVID-19. This study demonstrated that increased CD8+ NKG2A MFI at hospital admission, in combination with some clinical variables, is associated with a high risk of COVID-19 progression in hypertensive patients. These findings reinforce the hypothesis of the functional exhaustion of T cells with the increased expression of NKG2A in patients with severe COVID-19, elucidating how severe acute respiratory syndrome coronavirus 2 infection may break down the innate antiviral immune response at an early stage of the disease, with future potential therapeutic implications.
Background:
Cardiovascular comorbidities such as hypertension and inflammatory response dysregulation are associated with worse COVID-19 prognoses. Different cytokines have been proposed to play ...vital pathophysiological roles in COVID-19 progression, but appropriate prognostic biomarkers remain lacking. We hypothesized that the combination of immunological and clinical variables at admission could predict the clinical progression of COVID-19 in hypertensive patients.
Methods:
The levels of biomarkers, including C-reactive protein, lymphocytes, monocytes, and a panel of 29 cytokines, were measured in blood samples from 167 hypertensive patients included in the BRACE-CORONA trial. The primary outcome was the highest score during hospitalization on the modified WHO Ordinal Scale for Clinical Improvement. The probability of progression to severe disease was estimated using a logistic regression model that included clinical variables and biomarkers associated significantly with the primary outcome.
Results:
During hospitalization, 13 (7.8%) patients showed progression to more severe forms of COVID-19, including three deaths. Obesity, diabetes, oxygen saturation, lung involvement on computed tomography examination, the C-reactive protein level, levels of 15 cytokines, and lymphopenia on admission were associated with progression to severe COVID-19. Elevated levels of interleukin-10 and interleukin-12 (p70) combined with two or three of the abovementioned clinical comorbidities were associated strongly with progression to severe COVID-19. The risk of progression to severe disease reached 97.5% in the presence of the five variables included in our model.
Conclusions:
This study demonstrated that interleukin-10 and interleukin-12 (p70) levels, in combination with clinical variables, at hospital admission are key biomarkers associated with an increased risk of disease progression in hypertensive patients with COVID-19.
Training methods based on small-sided game (SSG) seem to promote physiological and tactical benefits for soccer players as they present characteristics more specific to the game. Thus, the main ...objective of the present study was to analyze the hormonal, biochemical, and autonomic parameters in an acute manner and the recovery dynamics (up to 72 h after) in a SSG.
Thirteen professional female soccer players participated in the study (18.8 ± 0.8 years, body mass 59.4 ± 6.2 kg, and height 1.68 ± 0.05 m). During and after the SSG session (4 min × 4 min separated by 3 min of passive interval and 120 m
coverage per player), autonomic modulation was analyzed in the time and frequency domains using heart rate variability, and blood samples (5 ml) were collected before (0 h) and after (10 min and 24, 48, 72 h) the SSG for biochemical and hormonal analysis.
The SSG induced an increase effect for LF (low frequency) (92,52%;
) and a decrease effect for HF (high frequency) values (-65,72%;
), after 10 min of recovery. The LF/HF increase after 10 min of recovery (386,21%;
). The RMSSD (square root of the mean squared differences of the successive N-N intervals) and pNN50 (measure of the number of adjacent NN intervals which differ by more than 50 ms) values presented a decrease effect 10 min after SSG (61,38%;
-90%;
). The CK (creatine kinase) values presented no changes 10 min after SSG. The LDH (lactate dehydrogenase) values presented an increase effect 10 min after the SSG (19,22%;
). Both testosterone and cortisol concentrations presented the same behavior after SSG, where no alterations were observed with after 10 min (<0,37%;
).
The SSG promoted significant cardiovascular stress that was restored within the first 24 h of recovery. Parasympathetic parameters continued to increase while sympathetic parameters declined significantly during the 72 h of recovery. In addition, the reduced game did not alter biochemical or hormonal responses during the 72 h.
Congenital toxoplasmosis is a public health problem in Brazil. This study aimed to determine risk factors associated with congenital toxoplasmosis in Minas Gerais which is the second largest ...Brazilian State based on number of inhabitants, and its territorial extension is larger than that of France.
Population-based case-control study to assess the association between congenital toxoplasmosis and maternal exposure to infection risk factors. The study included mothers/children participating in the Minas Gerais Newborn Screening Program. The cases consisted of 175 mothers of infected children, and the controls consisted of 278 mothers of children without suspected infection. The associations were assessed through binomial logistic regression with p ≤ 0.05.
The variables associated with lower probability of toxoplasmosis were: older mother age (OR = 0.89; CI95% = 0.85-0.93), higher level of education (OR = 0.85; CI95% = 0.78-0.92), access to potable water (OR = 0.21; CI95% = 0.08-0.51), and home with flush toilet (OR = 0.18; CI95% = 0.04-078). The variables associated with higher probability of infection were: cats in the neighborhood (OR = 2.27; CI95% = 1.27-4.06), owning or visiting homes with domestic cats (OR = 1.90; CI95% = 1.09-3.31), handling the soil (OR = 2.29; CI95% = 1.32-3.96), and eating fresh meat not previously frozen (OR = 3.97; CI95% = 2.17-7.25). After stratification according region of residence (rural or urban/peri-urban), home with flush toilet and consumption of treated water were protective against the disease only in the rural stratum.
In Minas Gerais, congenital toxoplasmosis has been associated with poor socioeconomic conditions. Considering maternal exposure to sources of Toxoplasma gondii, the predominating risk factors were those related to the ingestion of oocysts. It is expected that these results will contribute to development of a program for prevention of congenital toxoplasmosis adapted to the reality of the population of Minas Gerais. The differences between populations living in rural and urban areas regarding the main risk factors for toxoplasmosis point to the need of considering regional specificities in planning strategies to control congenital toxoplasmosis.
Fungal opportunistic infections have increased in recent decades due to the increase in the immunosuppressed patients and the indiscriminate use of antifungals. In Brazil, a country with the greatest ...biodiversity in the world, studies that seek new antifungals from natural sources have been stimulated. Protium ovatum Engl., belongs to the Burseraceae family and is a shrub tree found mainly in Brazil, in the Cerrado biome, and has medicinal, food and aromatic uses. This study aims to investigate the chemical composition and the anti-Malassezia furfur and anticandidal activities of essential oils (EOs) from Protium ovatum ripe fruit (RF-EO) and unripe fruit (UF-EO). The EOs antifungal activities were determined by microdilution broth methodology. GC-FID and GC-MS analyses showed that limonene, α-pinene and myrcene were the major components of both EOs. MIC values of RF-EO and UF-EO against M. furfur were 375 and 1500 µg/mL, respectively. RF-EO exhibited MIC values between 62.5 and 250 µg/mL while UF-EO was slightly active (> 1000 µg/mL) against Candida species. In addition, RF-EO showed antibiofilm activity against Candida species and was not toxic to C. elegans larvae. This study suggests that EOs from P. ovatum could be an alternative therapeutic option for infectious diseases caused by M. furfur and Candida species.
It remains uncertain whether acetylcysteine prevents contrast-induced acute kidney injury.
We randomly assigned 2308 patients undergoing an intravascular angiographic procedure with at least 1 risk ...factor for contrast-induced acute kidney injury (age >70 years, renal failure, diabetes mellitus, heart failure, or hypotension) to acetylcysteine 1200 mg or placebo. The study drugs were administered orally twice daily for 2 doses before and 2 doses after the procedure. The allocation was concealed (central Web-based randomization). All analysis followed the intention-to-treat principle. The incidence of contrast-induced acute kidney injury (primary end point) was 12.7% in the acetylcysteine group and 12.7% in the control group (relative risk, 1.00; 95% confidence interval, 0.81 to 1.25; P=0.97). A combined end point of mortality or need for dialysis at 30 days was also similar in both groups (2.2% and 2.3%, respectively; hazard ratio, 0.97; 95% confidence interval, 0.56 to 1.69; P=0.92). Consistent effects were observed in all subgroups analyzed, including those with renal impairment.
In this large randomized trial, we found that acetylcysteine does not reduce the risk of contrast-induced acute kidney injury or other clinically relevant outcomes in at-risk patients undergoing coronary and peripheral vascular angiography.
http://www.clinicaltrials.gov. Unique identifier: NCT00736866.
Abstract Background Transcatheter aortic valve implantation (TAVI) has established itself as the preferential strategy to approach severe aortic stenosis. Information on procedural improvements and ...nationwide results obtained with the technique throughout the past decade are unknown. Objectives To assess the temporal variation of the demographic profile, procedural characteristics, and in-hospital outcomes of patients undergoing TAVI procedures at the Rede D’Or São Luiz. Methods Observational registry comprising 29 national institutions, comparing the characteristics of the TAVI procedures performed from 2012 to 2017 (Group 1) to those performed from 2018 to 2023 (Group 2). The statistical significance level adopted was p < 0.05. Results This study assessed 661 patients, 95 in Group 1 and 566 in Group 2, with a mean age of 81.1 years. Group 1 patients had a higher prevalence of New York Heart Association functional class III or IV and STS risk score > 8%. In addition, they more often underwent general anesthesia, transesophageal echocardiographic monitoring, and access through femoral dissection. Group 2 patients had a higher success rate of the TAVI procedure (95.4% versus 89.5%; p = 0.018), lower mortality (3.9% versus 11.6%; p = 0.004), and less often needed permanent pacemaker implantation (8.5% versus 17.9%; p = 0.008). Conclusions The 10-year temporal trends analysis of the TAVIDOR Registry shows a reduction in patients’ clinical complexity over time. Furthermore, the advance to minimalistic implantation techniques, added to the technological evolution of the devices, may have contributed to the favorable outcomes observed among those whose implantation occurred in the last 5 years studied.
Resumo Fundamento O implante percutâneo de bioprótese valvar aórtica (TAVI) consolidou-se como opção terapêutica da estenose aórtica de grau importante. Dados sobre as características evolutivas dos procedimentos e dos resultados obtidos com a técnica ao longo da última década, em escala nacional, são desconhecidos. Objetivos Analisar a tendência temporal referente ao perfil demográfico, características dos procedimentos e desfechos hospitalares de pacientes submetidos a TAVI na Rede D’Or São Luiz. Métodos Registro observacional envolvendo 29 instituições nacionais. Comparou-se características dos procedimentos realizados de 2012 a 2017 (Grupo 1) e de 2018 a 2023 (Grupo 2). Foram considerados significantes os resultados com valor de p < 0,05. Resultados Foram analisados 661 casos, 95 pertencentes ao Grupo 1 e 566 ao Grupo 2. A média de idade foi 81,1 anos. Observou-se no Grupo 1 maior prevalência de pacientes em classe funcional III ou IV e escore de risco > 8%. Foi mais frequente o emprego de anestesia geral, monitorização ecocardiográfica transesofágica e via de acesso por dissecção. Maior taxa de sucesso do procedimento (95,4% versus 89,5%; p = 0,018) foi aferida em implantes efetivados a partir de 2018, assim como menor mortalidade (3,9% versus 11,6%; p = 0,004) e necessidade de marcapasso definitivo (8,5% versus 17,9%; p = 0,008). Conclusões A análise temporal de 10 anos do Registro TAVIDOR demonstra uma queda na complexidade clínica dos pacientes. Além disso, o avanço para técnicas de implante minimalistas, somadas à evolução tecnológica dos dispositivos, podem ter contribuído para desfechos favoráveis dentre aqueles cujo implante ocorreu no último quinquênio.
INTRODUCTIONThis epidemiological household survey aimed to estimate the prevalence of the current and past SARS-CoV-2 infections in Ribeirão Preto, a municipality of southeast Brazil. METHODSThe ...survey was conducted in two phases using a clustered sampling scheme. The first phase spanned May 1-3 and involved 709 participants. The second phase spanned June 11-14, 2020, and involved 646 participants. RESULTSDuring the first phase, RT-PCR performed on nasopharyngeal swabs was positive at 0.14%. The serological tests were positive in 1.27% of the patients during the first phase and 2.79% during the second phase. People living in households with more than five members had a prevalence of 10.83% (95%CI: 1.58-74.27) higher than those living alone or with someone other. Considering the proportion of the positive serological test results with sex and age adjustments, approximately 2.37% (95%CI: 1.32-3.42) of the population had been cumulatively infected by mid-June 2020, which is equivalent to 16,670 people (95%CI: 9,267-24,074). Considering that 68 deaths from the disease in the residents of the city had been confirmed as at the date of the second phase of the survey, the infection fatality rate was estimated to be 0.41% (95%CI: 0.28-0.73). Our results suggest that approximately 88% of the cases of SARS-CoV-2 infection at the time of the survey were not reported to the local epidemiological surveillance service. CONCLUSIONSThe findings of this study provide in-depth knowledge of the COVID-19 pandemic in Brazil and are helpful for the preventive and decision-making policies of public managers.
Transcatheter aortic valve implantation (TAVI) has established itself as the preferential strategy to approach severe aortic stenosis. Information on procedural improvements and nationwide results ...obtained with the technique throughout the past decade are unknown.BACKGROUNDTranscatheter aortic valve implantation (TAVI) has established itself as the preferential strategy to approach severe aortic stenosis. Information on procedural improvements and nationwide results obtained with the technique throughout the past decade are unknown.To assess the temporal variation of the demographic profile, procedural characteristics, and in-hospital outcomes of patients undergoing TAVI procedures at the Rede D'Or São Luiz.OBJECTIVESTo assess the temporal variation of the demographic profile, procedural characteristics, and in-hospital outcomes of patients undergoing TAVI procedures at the Rede D'Or São Luiz.Observational registry comprising 29 national institutions, comparing the characteristics of the TAVI procedures performed from 2012 to 2017 (Group 1) to those performed from 2018 to 2023 (Group 2). The statistical significance level adopted was p < 0.05.METHODSObservational registry comprising 29 national institutions, comparing the characteristics of the TAVI procedures performed from 2012 to 2017 (Group 1) to those performed from 2018 to 2023 (Group 2). The statistical significance level adopted was p < 0.05.This study assessed 661 patients, 95 in Group 1 and 566 in Group 2, with a mean age of 81.1 years. Group 1 patients had a higher prevalence of New York Heart Association functional class III or IV and STS risk score > 8%. In addition, they more often underwent general anesthesia, transesophageal echocardiographic monitoring, and access through femoral dissection. Group 2 patients had a higher success rate of the TAVI procedure (95.4% versus 89.5%; p = 0.018), lower mortality (3.9% versus 11.6%; p = 0.004), and less often needed permanent pacemaker implantation (8.5% versus 17.9%; p = 0.008).RESULTSThis study assessed 661 patients, 95 in Group 1 and 566 in Group 2, with a mean age of 81.1 years. Group 1 patients had a higher prevalence of New York Heart Association functional class III or IV and STS risk score > 8%. In addition, they more often underwent general anesthesia, transesophageal echocardiographic monitoring, and access through femoral dissection. Group 2 patients had a higher success rate of the TAVI procedure (95.4% versus 89.5%; p = 0.018), lower mortality (3.9% versus 11.6%; p = 0.004), and less often needed permanent pacemaker implantation (8.5% versus 17.9%; p = 0.008).The 10-year temporal trends analysis of the TAVIDOR Registry shows a reduction in patients' clinical complexity over time. Furthermore, the advance to minimalistic implantation techniques, added to the technological evolution of the devices, may have contributed to the favorable outcomes observed among those whose implantation occurred in the last 5 years studied.CONCLUSIONSThe 10-year temporal trends analysis of the TAVIDOR Registry shows a reduction in patients' clinical complexity over time. Furthermore, the advance to minimalistic implantation techniques, added to the technological evolution of the devices, may have contributed to the favorable outcomes observed among those whose implantation occurred in the last 5 years studied.
Resumo: Introdução: Nefropatia induzida por contraste (NIC) após intervenção coronária percutânea (ICP) em pacientes com taxa de filtração glomerular (TFG) ≥ 60 mL/min, estimada pela equação de ...Cockcroft‐Gault (C‐G), não é infrequente. O objetivo desse estudo foi avaliar a capacidade da equação CKD‐EPI (Chronic Kidney Disease Epidemiology Collaboration) em predizer NIC em indivíduos sem disfunção renal significativa basal pela fórmula C‐G. Métodos: Incluídos pacientes submetidos a ICP entre 2008‐2013, com TFG basal ≥ 60 mL/min pela equação de C‐G. Estes indivíduos foram divididos em dois grupos, conforme ocorrência ou não de NIC. Para todos os casos, foi calculada a TFG basal conforme a equação do CKD‐EPI. Resultados: A amostra consistiu de 140 pacientes. A TFG C‐G basal foi de 87,5 ± 21,3 mL/min e de 77,1 ± 15,0 mL/min/1,73 m2 para CKD‐EPI. NIC ocorreu em 84,6% dos pacientes com TFG CKD‐EPI basal < 60 mL/min/1,73 m2, contra 51,1% daqueles com TFG CKD‐EPI basal ≥ 60 mL/min/1,73 m2 (p = 0,021). Indivíduos masculinos ou com peso corporal elevado apresentaram mais frequentemente TFG CKD‐EPI basal < 60 mL/min/1,73 m2. Contraste não‐iônico e TFG CKD‐EPI basal ≥ 60 mL/min/1,73 m2 foram fatores protetores à ocorrência de NIC. Em indivíduos com creatinina < 1,0 mg/dL, o achado de TFG superestimada por C‐G, mas não pelo CKD‐EPI, foi mais frequente (sensibilidade de 100,0%; especificidade de 52,0%). Conclusões: Em pacientes sem disfunção renal por C‐G, submetidos a ICP, o achado de TFG CKD‐EPI < 60 ml/min/1,73 m2 implicou em maior chance de NIC, principalmente entre indivíduos do sexo masculino e de maior massa corpórea. Abstract: Introduction: Individuals with glomerular filtration rate (GFR) ≥ 60 ml/min/1.73 m2 estimated by the Cockcroft‐Gault formula (CG) who undergo percutaneous coronary intervention (PCI) frequently develop contrast‐induced nephropathy (CIN). This study aimed to assess whether individuals with significant renal impairment assessed by the Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) formula, but not by CG, more often develop CIN following PCI than those without renal impairment by either formula. Methods: In this cross‐sectional study analyzing patients with baseline CG GFR ≥ 60 ml/min/1.73 m2 before PCI, subjects were divided into two groups according to CIN occurrence. Baseline CKD‐EPI GFR was calculated for all patients. Results: We analyzed 140 patients. Baseline GFR was 87.5 ± 21.3 and 77.1 ± 15.0 ml/min/1.73 m2 for CG and CKD‐EPI, respectively. CIN occurred in 84.6% of individuals with baseline CKD‐EPI GFR < 60 ml/min/1.73 m2 vs. 51.1% of those without. Males and those with higher body mass index were more likely to present baseline CKD‐EPI GFR < 60 ml/min/1.73 m2 (p = 0.021). Non‐ionic contrast agent use and baseline CKD‐EPI GFR ≥ 60 ml/min/1.73 m2 were protective factors against CIN. Greater amounts of contrast agent and acute coronary syndrome were associated with higher CIN risk. In subjects with serum creatinine < 1.0 mg/dl, GFR was more likely to be overestimated by CG, but not by CKD‐EPI (sensitivity 100.0%; specificity 52.0%). Conclusion: In patients undergoing PCI without renal dysfunction by CG, a finding of CKD‐EPI GFR < 60 ml/ min/1.73 m2 was associated with a higher probability of CIN, especially among men and those with higher body mass index. Palavras‐chave: Intervenção coronária percutânea, Taxa de filtração glomerular, Meios de contraste, Keywords: Percutaneous coronary intervention, Glomerular filtration rate, Contrast media
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