Veno-venous extracorporeal membrane oxygenation in patients with SARS-CoV-2 pneumonia in Brazil: a case series

OBJECTIVE

The world has been suffering from the COVID-19 pandemic. Some COVID-19 patients develop severe viral pneumonia, requiring mechanical ventilation and measures to treat refractory hypoxemia, such as a protective ventilation strategy, prone positioning, and the use of veno-venous extracorporeal membrane oxygenation (VV-ECMO). We describe a case series of 30 COVID-19 patients who needed VV-ECMO at the Hospital Alemão Oswaldo Cruz, located in the city of São Paulo, Brazil.

METHODS

We included all patients who required VV-ECMO due to COVID-19 pneumonia between March of 2020 and June of 2021.

RESULTS

Prior to VV-ECMO, patients presented with the following median scores: SOFA score, 11; APPS score, 7; Respiratory ECMO Survival Prediction score, 2; and Murray score, 3.3. The 60-day-in-hospital mortality was 33.3% (n = 10).

CONCLUSIONS

Although our patients had a highly severe profile, our results were similar to those of other cohort studies in the literature. This demonstrates that VV-ECMO can be a good tool even in a pandemic situation when it is managed in an experienced center.

Toxic effects of two essential oils and their constituents on the mealworm beetle, Tenebrio molitor

The study identified insecticidal effects from the cinnamon and clove essential oils in Tenebrio molitor L. (Coleoptera: Tenebrionidae). The lethal concentrations (LC50 and LC90), lethal time, and repellent effect on larvae, pupae, and adults of T. molitor after exposure to six concentrations of each essential oil and toxic compounds were evaluated. The chemical composition of the cinnamon oil was also determined and primary compounds were eugenol (10.19%), trans-3-caren-2-ol (9.92%), benzyl benzoate (9.68%), caryophyllene (9.05%), eugenyl acetate (7.47%), α-phellandrene (7.18%), and α-pinene (6.92%). In clove essential oil, the primary compounds were eugenol (26.64%), caryophyllene (23.73%), caryophyllene oxide (17.74%), 2-propenoic acid (11.84%), α-humulene (10.48%), γ-cadinene (4.85%), and humulene oxide (4.69%). Cinnamon and clove essential oils were toxic to T. molitor. In toxic chemical compounds, eugenol have stronger contact toxicity in larvae, pupae, and adult than caryophyllene oxide, followed by α-pinene, α-phellandrene, and α-humulene. In general, the two essential oils were toxic and repellent to adult T. molitor. Cinnamon and clove essential oils and their compounds caused higher mortality and repellency on T. molitor and, therefore, have the potential for integrated management programs of this insect.

Clinical characteristics and long-term progression of young patients with acute coronary syndrome in Brazil

Objective

In Brazil, there are few descriptions in the literature on the angiographic pattern and clinical characteristics of young patients with acute coronary syndrome, despite the evident number of cases in the population. The objective of this study was to evaluate which clinical characteristics are most closely related to the acute coronary syndrome in young patients, and what long-term outcomes are in this population.

Methods

This is a prospective observational study with 268 patients aged under 55 years with acute coronary syndrome, carried out between May 2010 and May 2013. Data were obtained on demographics, laboratory test and angiography results, and the coronary treatment adopted. Statistical analysis was presented as percentages and absolute values.

Results

Approximately 57% were men and the median age was 50 years (30 to 55). The main risk factors were arterial hypertension (68%), smoking (67%), and dyslipidemia (43%). Typical pain was present in 90% of patients. In young individuals, 25.7% showed ST segment elevation. Approximately 56.5% of patients presented with a single-vessel angiographic pattern. About 7.1% were submitted to coronary bypass surgery, and 42.1% to percutaneous coronary angioplasty. Intrahospital mortality was 1.5%, and the combined event rate (cerebrovascular accident/stroke, cardiogenic shock, reinfarction, and arrhythmias) was 13.8%. After a mean follow-up of 10 months, mortality was 9.8%, while 25.4% of the patients had new ischemic events, and 37.3% required readmission to hospital.

Conclusion

In the short-term, young patients presented with mortality rates below what was expected when compared to the rates noted in other studies. However, there was a significant increase in the number of events in the 10-month follow-up.

Intracardiac embolization of inferior vena cava filter associated with right atrium perforation and cardiac tamponade

Insertion of inferior vena cava filters has been well established in literature, reducing occurrence of pulmonary embolism after an episode of deep venous thrombosis in patients with contraindication to anticoagulation. There are a small number of complications related to procedure and embolization is rare. In this context, we described a case of intracardiac embolization associated with cardiac tamponade.

The effects of nutrients and secondary compounds of Coffea arabica on the behavior and development of Coccus viridis

Phytochemicals may modify the food quality, reduce a plant's palatability to insects, or defend against pests. This work aimed to study 1) relationships between the nitrogen and potassium levels given to plants in nutritive solutions and the foliar phytochemical concentrations, 2) the effect of nutrients and secondary compounds of Coffea arabica on the behavior of Coccus viridis, and 3) tolerance of C. arabica to losses. Deficient, normal, and excessive nitrogen and potassium fertilization treatments were used. Each treatment had two plants (one infested and one noninfested plant). The contents of phytochemicals in the infested plants' leaves and their dry matter of roots, stems, and leaves as well as the total contents in noninfested plants, were determined. The adults and nymphs of C. viridis were counted for 60 d in all treatments. It was verified that elevated nitrogen and potassium levels in the nutritional solutions led to increased of nymphs and adults of C. viridis to the coffee plants over time. Potassium and nitrogen had both direct and indirect effects on C. viridis. The direct effect was because of the increase of the nitrogen content in the leaves. The indirect effect instead was because of reductions in the caffeine and chlorogenic acid contents in the leaves. This is the first study to show relationship nutrient levels of coffee phytochemicals in response to herbivory by scale insects. Caffeine and chlorogenic acid applied on coffee leaves stimulated the locomotory activity of the green scale, thus reducing their feeding compared with untreated leaves. The elevation of caffeine and chlorogenic acid levels in coffee leaves affect this generalist insect by stimulating the locomotion of crawlers.

Economic injury level for the coffee berry borer (Coleoptera: Curculionidae: Scolytinae) using attractive traps in Brazilian coffee fields

The currently existing sample procedures available for decision-making regarding the control of the coffee berry borer Hypothenemus hampei (Ferrari) (Coleoptera: Curculionidae: Scolytinae) are time-consuming, expensive, and difficult to perform, compromising their adoption. In addition, the damage functions incorporated in such decision levels only consider the quantitative losses, while dismissing the qualitative losses. Traps containing ethanol, methanol, and benzaldehyde may allow cheap and easy decision-making. Our objective was to determine the economic injury level (EIL) for the adults of the coffee berry borer by using attractant-baited traps. We considered both qualitative and quantitative losses caused by the coffee borer in estimating the EILs. These EILs were determined for conventional and organic coffee under high and average plant yield. When the quantitative losses caused by H. hampei were considered alone, the EILs ranged from 7.9 to 23.7% of bored berries for high and average-yield conventional crops, respectively. For high and average-yield organic coffee the ELs varied from 24.4 to 47.6% of bored berries, respectively. When qualitative and quantitative losses caused by the pest were considered together, the EIL was 4.3% of bored berries for both conventional and organic coffee. The EILs for H. hampei associated to the coffee plants in the flowering, pinhead fruit, and ripening fruit stages were 426, 85, and 28 adults per attractive trap, respectively.

Leaf alkaloids, phenolics, and coffee resistance to the leaf miner Leucoptera coffeella (Lepidoptera: Lyonetiidae)

Coffee (Coffea spp.) alkaloids (caffeine and related methylxanthines) and phenolics (caffeic and chlorogenic acids) have recognized pestistatic/pesticidal activity and mediate insect-plant interactions. The present investigation assessed the resistance of 12 coffee genotypes to the leaf miner Leucoptera (= Perileucoptera) coffeella (Guérin-Méneville & Perrottet) (Lepidoptera: Lyonetiidae) and correlated such results with the leaf content of coffee alkaloids and phenolics that probably play a role in the interaction between coffee and this leaf miner. The levels of chlorogenic and caffeic acid, caffeine, and related methylxanthines were measured and quantified in leaf extracts of these genotypes before and 7 d after their infestation by the leaf miner. Some coffee genotypes (Coffea canephora L. and Coffea racemosa Lour. and its hybrids with Coffea arabica L.) exhibited high pesticidal activity (100% mortality) toward the L. coffeella, indicating their antibiosis resistance. However, there was no correlation between this activity and the leaf levels of coffee alkaloids and phenolics. Curiously, infestation by L. coffeella leads to a nearly four-fold decline in the leaf levels of chlorogenic acid, which does not affect this pest species but may affect other generalist species. Indeed, chlorogenic acid sprayed on coffee leaves stimulated locomotory activity of the green scale Coccus viridis (Green) (Hemiptera: Coccidae), thus minimizing their feeding in contrast with the absence of this polyphenol. Therefore, reduction of chlorogenic acid levels in coffee leaves due to leaf miner infestation seems to also favor infestation by generalist insects, such as the green scale.