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Costa FC, Gomes LG, de Lima TM, Bortolotto LA, Hong V, Verardino R, de Souza Rocha M, Ueda SKN, de Miranda MC, de Souza HP, Latronico AC, Mendonca BB, Bachega TASS. Cardiovascular risk in women with nonclassical congenital adrenal hyperplasia. J Clin Endocrinol Metab 2024:dgae155. [PMID: 38466890 DOI: 10.1210/clinem/dgae155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/29/2024] [Accepted: 03/08/2024] [Indexed: 03/13/2024]
Abstract
CONTEXT The outcomes related to cardiovascular risk (CVR) in patients with nonclassical form of congenital adrenal hyperplasia (NCAH) are unknown, especially those related to therapeutic options, including low doses of glucocorticoids (GCs) or oral contraceptive pills. OBJECTIVES to analyze CVR by markers of atherosclerosis in females with nonclassical form according to therapeutic options. DESIGN AND SETTING a cross-sectional study at a tertiary center. PATIENTS AND METHODS Forty-seven females with NCAH (33.4 ± 10 years) were subdivided into: G1 (n = 28) treated with dexamethasone (0.14 ± 0.05 mg/m2/day); G2 (n = 19) with oral contraceptive pills; and G3 (30 matched controls). CVR was analyzed through serum lipids, HOMA-IR, inflammatory cytokines levels and quantitative image evaluations (pulse wave velocity-PWV, endothelial function by flow mediated dilatation-FMD, carotid intima media thickness-CIMT and visceral fat-VAT by abdominal tomography. RESULTS There were no statistically significant differences in BMI, HOMA-IR, HDL-cholesterol, or triglyceride levels among groups (p > 0.05). Serum interleukin-6 levels were higher in G1 than in G2 (p = 0.048), and interleukin-8 levels were higher in G1 than in G2/3 (p = 0.008). There were no statistically significant differences in VAT, PWV, FMD or CIMT among groups (p > 0.05). In multivariable regression analysis, there was no statistically significant association between glucocorticoid dose and evaluated outcomes. CONCLUSION Adult females with NCAH did not show increased CVR using methodologies for detection of precocious atherosclerosis. Although patients receiving dexamethasone therapy had increased IL-6 and 8 levels, these data were not associated with radiological markers of atherosclerosis. Our cohort was composed of young adults and should be reevaluated in a long-term follow-up.
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Affiliation(s)
- Fernanda Cavalieri Costa
- Laboratório de Hormônios e Genética Molecular- LIM/42, Unidade de Adrenal, Hospital das Clínicas, Departamento de Clínica Médica, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Larissa Garcia Gomes
- Laboratório de Hormônios e Genética Molecular- LIM/42, Unidade de Adrenal, Hospital das Clínicas, Departamento de Clínica Médica, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thais Martins de Lima
- Laboratório de Emergências Clínicas (LIM 51), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Aparecido Bortolotto
- Instituto do Coração (InCor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Valeria Hong
- Instituto do Coração (InCor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Renata Verardino
- Instituto do Coração (InCor) - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Manoel de Souza Rocha
- Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Serli Kiyomi Nakao Ueda
- Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Mirela Costa de Miranda
- Laboratório de Hormônios e Genética Molecular- LIM/42, Unidade de Adrenal, Hospital das Clínicas, Departamento de Clínica Médica, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Heraldo Possolo de Souza
- Laboratório de Emergências Clínicas (LIM 51), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ana Claudia Latronico
- Laboratório de Hormônios e Genética Molecular- LIM/42, Unidade de Adrenal, Hospital das Clínicas, Departamento de Clínica Médica, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Berenice Bilharinho Mendonca
- Laboratório de Hormônios e Genética Molecular- LIM/42, Unidade de Adrenal, Hospital das Clínicas, Departamento de Clínica Médica, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Tania A S S Bachega
- Laboratório de Hormônios e Genética Molecular- LIM/42, Unidade de Adrenal, Hospital das Clínicas, Departamento de Clínica Médica, Disciplina de Endocrinologia e Metabologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Theotonio dos Santos LF, Barbeiro HV, Barbeiro DF, de Souza HP, Pinheiro da Silva F. Antimicrobial peptides and other potential biomarkers of critical illness in SARS-CoV-2 patients with acute kidney injury. AMPAKI-CoV study. Physiol Rep 2024; 12:e15945. [PMID: 38328863 PMCID: PMC10851028 DOI: 10.14814/phy2.15945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/09/2024] Open
Abstract
Antimicrobial peptides (AMPs) constitute a complex network of 10-100 amino acid sequence molecules widely distributed in nature. While over 300 AMPs have been described in mammals, cathelicidins and defensins remain the most extensively studied. Some publications have explored the role of AMPs in COVID-19, but these findings are preliminary, and in vivo studies are still lacking. In this study, we report the plasma levels of five AMPs (LL-37, α-defensin 1, α-defensin 3, β-defensin 1, and β-defensin 3), using the ELISA technique (MyBioSource, San Diego, CA, United States, kits MBS2601339 (beta-defensin 1), MBS2602513 (beta-defensin 3), MBS703879 (alpha-defensin 1), MBS706289 (alpha-defensin 3), MBS7234921 (LL37)), and the measurement of six cytokines (tumor necrosis factor-α, interleukin-1β, interleukin-6, interleukin-10, interferon-γ, and monocyte chemoattractant protein-1), through the magnetic bead immunoassay Milliplex® and the MAGPIX® System (MilliporeSigma, Darmstadt, Germany, kit HCYTOMAG-60 K (cytokines)), in 15 healthy volunteers, 36 COVID-19 patients without Acute Kidney Injury (AKI) and 17 COVID-19 patients with AKI. We found increased levels of α-defensin 1, α-defensin 3 and β-defensin 3, in our COVID-19 population, when compared to healthy controls, along with higher levels of interleukin-6, interleukin-10, interferon-γ, and monocyte chemoattractant protein-1. These findings suggest that these AMPs and cytokines may play a crucial role in the systemic inflammatory response and tissue damage characterizing severe COVID-19. The levels of α-defensin 1 and α-defensin 3 were significantly higher in COVID-19 AKI group in comparison to the non-AKI group. Furthermore, IL-10 and the product IL-10 × IL-1B showed excellent performance in discriminating AKI, with AUCs of 0.86 and 0.88, respectively. Among patients with COVID-19, AMPs may play a key role in the inflammation process and disease progression. Additionally, α-defensin 1 and α-defensin 3 may mediate the AKI process in these patients, representing an opportunity for further research and potential therapeutic alternatives in the future.
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Affiliation(s)
| | - Hermes Vieira Barbeiro
- Laboratório de Emergências Clínicas, Faculdade de MedicinaUniversidade de São PauloSão PauloBrasil
| | - Denise Frediani Barbeiro
- Laboratório de Emergências Clínicas, Faculdade de MedicinaUniversidade de São PauloSão PauloBrasil
| | - Heraldo Possolo de Souza
- Laboratório de Emergências Clínicas, Faculdade de MedicinaUniversidade de São PauloSão PauloBrasil
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Mochetti MM, Silva EGP, Correa AAF, Cabette MR, Perissinotti IN, E Silva LOJ, Pessoa ADS, de Oliveira RC, da Silva LFF, de Souza HP, de Alencar JCG. Neuron-specific enolase at admission as a predictor for stroke volume, severity and outcome in ischemic stroke patients: a prognostic biomarker review. Sci Rep 2024; 14:2688. [PMID: 38302568 PMCID: PMC10834412 DOI: 10.1038/s41598-024-53080-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/27/2024] [Indexed: 02/03/2024] Open
Abstract
An ideal blood biomarker for stroke should provide reliable results, enable fast diagnosis, and be readily accessible for practical use. Neuron-specific enolase (NSE), an enzyme released after neuronal damage, has been studied as a marker for brain injury, including cerebral infarction. However, different methodologies and limited sample sizes have restricted the applicability of any potential findings. This work aims to determine whether NSE levels at Emergency Department (ED) admission correlate with stroke severity, infarcted brain volume, functional outcome, and/or death rates. A systematic literature review was performed using PubMed, Embase, and Scopus databases. Each reviewer independently assessed all published studies identified as potentially relevant. All relevant original observational studies (cohort, case-control, and cross-sectional studies) were included. Eleven studies (1398 patients) met the inclusion criteria. Among these, six studies reported a significant correlation between NSE levels and stroke severity, while only one found no association. Four studies indicated a positive relationship between infarcted brain volume assessed by imaging and NSE levels, in contrast to the findings of only one study. Four studies identified an association related to functional outcome and death rates, while three others did not reach statistical significance in their findings. These data highlight that NSE levels at ED admissions proved to be a promising tool for predicting the outcome of ischemic stroke patients in most studies. However, they presented high discrepancies and low robustness. Therefore, further research is necessary to establish and define the role of NSE in clinical practice.
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Affiliation(s)
- Matheus Menão Mochetti
- Curso de Medicina, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brazil.
| | | | | | | | - Iago Navas Perissinotti
- Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Adriano de Souza Pessoa
- Departamento de Ciências Biológicas, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brazil
| | - Rodrigo Cardoso de Oliveira
- Departamento de Ciências Biológicas, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brazil
| | | | - Heraldo Possolo de Souza
- Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Júlio César Garcia de Alencar
- Curso de Medicina, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, Brazil
- Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Koike MK, Barbeiro DF, Souza HPD, Machado MCC. Does fasting protect liver from ischemia and reperfusion injury? Acta Cir Bras 2023; 38:e384723. [PMID: 37878985 PMCID: PMC10592748 DOI: 10.1590/acb384723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/13/2023] [Indexed: 10/27/2023] Open
Abstract
PURPOSE To evaluate local and systemic effects of 24-hour fasting in liver ischemia and reperfusion injury. METHODS Twenty-one adult male Wistar rats (330-390 g) were submitted to 60 minutes of hepatic ischemia followed by 24 hours of reperfusion. Before the day of the experiment, the animals fasted, but free access to water was allowed. Two groups were constituted: Control: non-fasted, that is, feeding ad libitum before surgical procedure; Fasting: rats underwent previous fasting of 24 hours. Hepatic ischemia was performed using vascular clamp in hepatic pedicle. At 24 hours after liver reperfusion, blood and tissue samples were collected. To analysis, liver lobes submitted to ischemia was identified as ischemic liver and paracaval non-ischemic lobes as non-ischemic liver. We evaluated: malondialdehyde levels, hepatocellular function (alanine aminotransferase, aspartate aminotransferase activities, and both ratio), cytokines (interleukins-6, -10, and tumor necrosis factor-alpha), hepatic ischemia and reperfusion injury (histology). RESULTS Malondialdehyde measured in non-ischemic and ischemic liver samples, hepatocellular function and cytokines were comparable between groups. Histological findings were distinct in three regions evaluated. Microvesicular steatosis was comparable between 24-hour fasting and non-fasted control groups in periportal region of hepatic lobe. In contrast, steatosis was more pronounced in zones 2 and 3 of ischemic liver samples of fasting compared to control groups. CONCLUSIONS These data indicates that fasting does not protect, but it can be also detrimental to liver submitted to ischemia/reperfusion damage. At that time, using long fasting before liver surgery in the real world may be contraindicated.
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Affiliation(s)
- Marcia Kiyomi Koike
- Universidade de São Paulo - School of Medicine - Department of Clinical Medicine - São Paulo (SP) - Brazil
| | - Denise Frediani Barbeiro
- Universidade de São Paulo - School of Medicine - Department of Clinical Medicine - São Paulo (SP) - Brazil
| | - Heraldo Possolo de Souza
- Universidade de São Paulo - School of Medicine - Department of Clinical Medicine - São Paulo (SP) - Brazil
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Garcez FB, Garcia de Alencar JC, Fernandez SSM, Avelino-Silva VI, Sabino EC, Martins RCR, Franco LAM, Lima Ribeiro SM, Possolo de Souza H, Avelino-Silva TJ. Association Between Gut Microbiota and Delirium in Acutely Ill Older Adults. J Gerontol A Biol Sci Med Sci 2023; 78:1320-1327. [PMID: 36869725 PMCID: PMC10395556 DOI: 10.1093/gerona/glad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Indexed: 03/05/2023] Open
Abstract
Our aim was to investigate the association between gut microbiota and delirium occurrence in acutely ill older adults. We included 133 participants 65+ years consecutively admitted to the emergency department of a tertiary university hospital, between September 2019 and March 2020. We excluded candidates with ≥24-hour antibiotic utilization on admission, recent prebiotic or probiotic utilization, artificial nutrition, acute gastrointestinal disorders, severe traumatic brain injury, recent hospitalization, institutionalization, expected discharge ≤48 hours, or admission for end-of-life care. A trained research team followed a standardized interview protocol to collect sociodemographic, clinical, and laboratory data on admission and throughout the hospital stay. Our exposure measures were gut microbiota alpha and beta diversities, taxa relative abundance, and core microbiome. Our primary outcome was delirium, assessed twice daily using the Confusion Assessment Method. Delirium was detected in 38 participants (29%). We analyzed 257 swab samples. After adjusting for potential confounders, we observed that a greater alpha diversity (higher abundance and richness of microorganisms) was associated with a lower risk of delirium, as measured by the Shannon (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.60-0.99; p = .042) and Pielou indexes (OR = 0.69; 95% CI = 0.51-0.87; p = .005). Bacterial taxa associated with pro-inflammatory pathways (Enterobacteriaceae) and modulation of relevant neurotransmitters (Serratia: dopamine; Bacteroides, Parabacteroides: GABA) were more common in participants with delirium. Gut microbiota diversity and composition were significantly different in acutely ill hospitalized older adults who experienced delirium. Our work is an original proof-of-concept investigation that lays a foundation for future biomarker studies and potential therapeutic targets for delirium prevention and treatment.
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Affiliation(s)
- Flavia Barreto Garcez
- Laboratorio de Investigacao Medica em Envelhecimento (LIM 66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Departamento de Medicina, Hospital Universitario, Universidade Federal de Sergipe, São Cristóvão, Brazil
| | - Júlio César Garcia de Alencar
- Laboratorio de Investigacao Medica em Emergencias Clinicas (LIM 51), Departamento de Clínica Médica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Vivian Iida Avelino-Silva
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Faculdade Israelita de Ciencias da Saude Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Ester Cerdeira Sabino
- Departamento de Molestias Infecciosas e Parasitarias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Parasitologia Medica (LIM 46), Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roberta Cristina Ruedas Martins
- Laboratório de Parasitologia Medica (LIM 46), Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Lucas Augusto Moysés Franco
- Laboratório de Parasitologia Medica (LIM 46), Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Heraldo Possolo de Souza
- Laboratorio de Investigacao Medica em Emergencias Clinicas (LIM 51), Departamento de Clínica Médica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Thiago Junqueira Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM 66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Faculdade Israelita de Ciencias da Saude Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Damiano RF, Rocca CCDA, Serafim ADP, Loftis JM, Talib LL, Pan PM, Cunha-Neto E, Kalil J, de Castro GS, Seelaender M, Guedes BF, Nagahashi Marie SK, de Souza HP, Nitrini R, Miguel EC, Busatto G, Forlenza OV. Cognitive impairment in long-COVID and its association with persistent dysregulation in inflammatory markers. Front Immunol 2023; 14:1174020. [PMID: 37287969 PMCID: PMC10242059 DOI: 10.3389/fimmu.2023.1174020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023] Open
Abstract
Objective To analyze the potential impact of sociodemographic, clinical and biological factors on the long-term cognitive outcome of patients who survived moderate and severe forms of COVID-19. Methods We assessed 710 adult participants (Mean age = 55 ± 14; 48.3% were female) 6 to 11 months after hospital discharge with a complete cognitive battery, as well as a psychiatric, clinical and laboratory evaluation. A large set of inferential statistical methods was used to predict potential variables associated with any long-term cognitive impairment, with a focus on a panel of 28 cytokines and other blood inflammatory and disease severity markers. Results Concerning the subjective assessment of cognitive performance, 36.1% reported a slightly poorer overall cognitive performance, and 14.6% reported being severely impacted, compared to their pre-COVID-19 status. Multivariate analysis found sex, age, ethnicity, education, comorbidity, frailty and physical activity associated with general cognition. A bivariate analysis found that G-CSF, IFN-alfa2, IL13, IL15, IL1.RA, EL1.alfa, IL45, IL5, IL6, IL7, TNF-Beta, VEGF, Follow-up C-Reactive Protein, and Follow-up D-Dimer were significantly (p<.05) associated with general cognition. However, a LASSO regression that included all follow-up variables, inflammatory markers and cytokines did not support these findings. Conclusion Though we identified several sociodemographic characteristics that might protect against cognitive impairment following SARS-CoV-2 infection, our data do not support a prominent role for clinical status (both during acute and long-stage of COVID-19) or inflammatory background (also during acute and long-stage of COVID-19) to explain the cognitive deficits that can follow COVID-19 infection.
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Affiliation(s)
- Rodolfo Furlan Damiano
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Cristiana Castanho de Almeida Rocca
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | | | - Jennifer M. Loftis
- Research & Development Service, VA Portland Health Care System, Portland, OR, United States
- Departments of Psychiatry and Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States
| | - Leda Leme Talib
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Pedro Mário Pan
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Edecio Cunha-Neto
- Departamento de Cínica Médica, Universidade de São Paulo FMUSP, São Paulo, SP, Brazil
- Institute for Investigation in Immunology/National Institutes for Science and Technology (iii/INCT), São Paulo, Brazil
| | - Jorge Kalil
- Departamento de Cínica Médica, Universidade de São Paulo FMUSP, São Paulo, SP, Brazil
- Institute for Investigation in Immunology/National Institutes for Science and Technology (iii/INCT), São Paulo, Brazil
| | - Gabriela Salim de Castro
- Cancer Metabolism Research Group, Department of Surgery and LIM 26, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil
| | - Marilia Seelaender
- Cancer Metabolism Research Group, Department of Surgery and LIM 26, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil
| | - Bruno F. Guedes
- Departamento de Neurologia, Universidade de São Paulo FMUSP, São Paulo, Brazil
| | | | | | - Ricardo Nitrini
- Departamento de Neurologia, Universidade de São Paulo FMUSP, São Paulo, Brazil
| | - Euripedes Constantino Miguel
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Geraldo Busatto
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Orestes V. Forlenza
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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7
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Gil S, Gualano B, de Araújo AL, de Oliveira Júnior GN, Damiano RF, Pinna F, Imamura M, Rocha V, Kallas E, Batistella LR, Forlenza OV, de Carvalho CRR, Busatto GF, Roschel H, Segurado A, Perondi B, Morais AM, Montal A, Letaif L, Fusco S, da Silva MFR, Rocha M, Marcilio I, Rios IC, Kawano FYO, de Jesus MA, Kallas ÉG, Carmo C, Tanaka C, de Souza HP, Marchini JFM, Carvalho C, Ferreira JC, de Oliveira MS, Guimarães T, dos Santos Lázari C, da Silva Duarte AJ, Sabino E, Magri MMC, Barros-Filho TEP, Francisco MCPB. Post-acute sequelae of SARS-CoV-2 associates with physical inactivity in a cohort of COVID-19 survivors. Sci Rep 2023; 13:215. [PMID: 36604523 PMCID: PMC9813883 DOI: 10.1038/s41598-022-26888-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to determine whether Post-acute Sequelae of SARS-CoV-2 Infection (PASC) are associated with physical inactivity in COVID-19 survivors. This is a cohort study of COVID-19 survivors discharged from a tertiary hospital in Sao Paulo, Brazil. Patients admitted as inpatients due to laboratory-confirmed COVID-19 between March and August 2020 were consecutively invited for a follow-up in-person visit 6 to 11 months after hospitalization. Ten symptoms of PASC were assessed using standardized scales. Physical activity was assessed by questionnaire and participants were classified according to WHO Guidelines. 614 patients were analyzed (age: 56 ± 13 years; 53% male). Frequency of physical inactivity in patients exhibiting none, at least 1, 1-4, and 5 or more symptoms of PASC was 51%, 62%, 58%, and 71%, respectively. Adjusted models showed that patients with one or more persistent PASC symptoms have greater odds of being physically inactive than those without any persistent symptoms (OR: 1.57 [95% CI 1.04-2.39], P = 0.032). Dyspnea (OR: 2.22 [1.50-3.33], P < 0.001), fatigue (OR: 2.01 [1.40-2.90], P < 0.001), insomnia (OR: 1.69 [1.16-2.49], P = 0.007), post-traumatic stress (OR: 1.53 [1.05-2.23], P = 0.028), and severe muscle/joint pain (OR: 1.53 [95% CI 1.08-2.17], P = 0.011) were associated with greater odds of being physically inactive. This study suggests that PASC is associated with physical inactivity, which itself may be considered as a persistent symptom among COVID-19 survivors. This may help in the early identification of patients who could benefit from additional interventions tailored to combat inactivity (even after treatment of PASC), with potential beneficial impacts on overall morbidity/mortality and health systems worldwide.
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Affiliation(s)
- Saulo Gil
- grid.11899.380000 0004 1937 0722Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, School of Physical Education and Sport, School of Medicine FMUSP, University of Sao Paulo, Av. Dr. Arnaldo, 455, Pacaembu, São Paulo, SP Brazil ,grid.11899.380000 0004 1937 0722Rheumatology Division, Faculdade de Medicina FMUSP Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, SP Brazil
| | - Bruno Gualano
- grid.11899.380000 0004 1937 0722Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, School of Physical Education and Sport, School of Medicine FMUSP, University of Sao Paulo, Av. Dr. Arnaldo, 455, Pacaembu, São Paulo, SP Brazil ,grid.11899.380000 0004 1937 0722Rheumatology Division, Faculdade de Medicina FMUSP Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, SP Brazil
| | - Adriana Ladeira de Araújo
- grid.11899.380000 0004 1937 0722Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Gersiel Nascimento de Oliveira Júnior
- grid.11899.380000 0004 1937 0722Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, School of Physical Education and Sport, School of Medicine FMUSP, University of Sao Paulo, Av. Dr. Arnaldo, 455, Pacaembu, São Paulo, SP Brazil ,grid.11899.380000 0004 1937 0722Rheumatology Division, Faculdade de Medicina FMUSP Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, SP Brazil
| | - Rodolfo Furlan Damiano
- grid.411074.70000 0001 2297 2036Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP Brazil
| | - Fabio Pinna
- grid.11899.380000 0004 1937 0722Otorrhinolaringoly Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, University of São Paulo, São Paulo, Brazil
| | - Marta Imamura
- grid.411074.70000 0001 2297 2036Instituto de Medicina Física e de Reabilitação, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- grid.411074.70000 0001 2297 2036Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil ,grid.411074.70000 0001 2297 2036Laboratório de Genética e Hematologia Molecular, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Esper Kallas
- grid.11899.380000 0004 1937 0722Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil ,grid.411074.70000 0001 2297 2036Departamento de Clínica Médica, Laboratório de Imunologia Clínica e Alergia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Linamara Rizzo Batistella
- grid.411074.70000 0001 2297 2036Instituto de Medicina Física e de Reabilitação, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Orestes V. Forlenza
- grid.411074.70000 0001 2297 2036Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP Brazil
| | - Carlos R. R. de Carvalho
- grid.11899.380000 0004 1937 0722Departamento de Cardio-Pneumologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Geraldo Filho Busatto
- grid.411074.70000 0001 2297 2036Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, School of Physical Education and Sport, School of Medicine FMUSP, University of Sao Paulo, Av. Dr. Arnaldo, 455, Pacaembu, São Paulo, SP, Brazil. .,Rheumatology Division, Faculdade de Medicina FMUSP Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, São Paulo, SP, Brazil.
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8
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Sierra APR, Martínez Galán BS, de Sousa CAZ, de Menezes DC, Branquinho JLDO, Neves RL, Arata JG, Bittencourt CA, Barbeiro HV, de Souza HP, Pesquero JB, Cury-Boaventura MF. Exercise Induced-Cytokines Response in Marathon Runners: Role of ACE I/D and BDKRB2 +9/-9 Polymorphisms. Front Physiol 2022; 13:919544. [PMID: 36117688 PMCID: PMC9479100 DOI: 10.3389/fphys.2022.919544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/24/2022] [Indexed: 11/24/2022] Open
Abstract
Renin-angiotensin system (RAS) and kallikrein-kinin system (KKS) have a different site of interaction and modulate vascular tone and inflammatory response as well on exercise adaptation, which is modulated by exercise-induced cytokines. The aim of the study was to evaluate the role of ACE I/D and BDKRB2 +9/−9 polymorphism on exercise-induced cytokine response. Seventy-four male marathon finishers, aged 30 to 55 years, participated in this study. Plasma levels of exercise-induced cytokines were determined 24 h before, immediately after, and 24 h and 72 h after the São Paulo International Marathon. Plasma concentrations of MCP-1, IL-6 and FGF-21 increased after marathon in all genotypes of BDKRB2. IL-10, FSTL and BDNF increased significantly after marathon in the genotypes with the presence of the −9 allele. FSTL and BDNF concentrations were higher in the −9/−9 genotype compared to the +9/+9 genotype before (p = 0.006) and after the race (p = 0.023), respectively. Apelin, IL-15, musclin and myostatin concentrations were significantly reduced after the race only in the presence of −9 allele. Marathon increased plasma concentrations of MCP1, IL-6, BDNF and FGF-21 in all genotypes of ACE I/D polymorphism. Plasma concentrations of IL-8 and MIP-1alpha before the race (p = 0.015 and p = 0.031, respectively), of MIP-1alpha and IL-10 after the race (p = 0.033 and p = 0.047, respectively) and VEGF 72 h after the race (p = 0.018) were lower in II homozygotes compared to runners with the presence of D allele. One day after the race we also observed lower levels of MIP-1alpha in runners with II homozygotes compared to DD homozygotes (p = 0.026). Before the marathon race myostatin concentrations were higher in DD compared to II genotypes (p = 0.009). Myostatin, musclin, IL-15, IL-6 and apelin levels decreased after race in genotypes with the presence of D allele. After the race ACE activity was negatively correlated with MCP1 (r = −56, p < 0.016) and positively correlated with IL-8, IL-10 and MIP1-alpha (r = 0.72, p < 0.0007, r = 0.72, p < 0.0007, r = 0.47, p < 0.048, respectively). The runners with the −9/−9 genotype have greater response in exercise-induced cytokines related to muscle repair and cardioprotection indicating that BDKRB2 participate on exercise adaptations and runners with DD genotype have greater inflammatory response as well as ACE activity was positively correlated with inflammatory mediators. DD homozygotes also had higher myostatin levels which modulates protein homeostasis.
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Affiliation(s)
| | - Bryan Steve Martínez Galán
- Interdisciplinary Post-Graduate Program in Health Sciences, Institute of Physical Activity and Sports Sciences, Cruzeiro do Sul University, São Paulo, Brazil
| | - Cesar Augustus Zocoler de Sousa
- Interdisciplinary Post-Graduate Program in Health Sciences, Institute of Physical Activity and Sports Sciences, Cruzeiro do Sul University, São Paulo, Brazil
| | - Duane Cardoso de Menezes
- Interdisciplinary Post-Graduate Program in Health Sciences, Institute of Physical Activity and Sports Sciences, Cruzeiro do Sul University, São Paulo, Brazil
| | | | - Raquel Leão Neves
- Department of Biophysics, Federal University of Sao Paulo, São Paulo, Brazil
| | | | | | | | | | - João Bosco Pesquero
- Department of Biophysics, Federal University of Sao Paulo, São Paulo, Brazil
| | - Maria Fernanda Cury-Boaventura
- Interdisciplinary Post-Graduate Program in Health Sciences, Institute of Physical Activity and Sports Sciences, Cruzeiro do Sul University, São Paulo, Brazil
- *Correspondence: Maria Fernanda Cury-Boaventura,
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9
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Busatto GF, de Araujo AL, Castaldelli-Maia JM, Damiano RF, Imamura M, Guedes BF, de Rezende Pinna F, Sawamura MVY, Mancini MC, da Silva KR, Garcia ML, Sumita N, Brunoni AR, da Silva Duarte AJ, Burdmann EA, Kallas EG, Cerri GG, Nitrini R, Bento RF, Rocha VG, de Souza HP, Miguel EC, de Carvalho CRR, Forlenza OV, Batistella LR. Post-acute sequelae of SARS-CoV-2 infection: relationship of central nervous system manifestations with physical disability and systemic inflammation. Psychol Med 2022; 52:2387-2398. [PMID: 35521752 PMCID: PMC9151630 DOI: 10.1017/s0033291722001374] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite the multitude of clinical manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC), studies applying statistical methods to directly investigate patterns of symptom co-occurrence and their biological correlates are scarce. METHODS We assessed 30 symptoms pertaining to different organ systems in 749 adults (age = 55 ± 14 years; 47% female) during in-person visits conducted at 6-11 months after hospitalization due to coronavirus disease 2019 (COVID-19), including six psychiatric and cognitive manifestations. Symptom co-occurrence was initially investigated using exploratory factor analysis (EFA), and latent variable modeling was then conducted using Item Response Theory (IRT). We investigated associations of latent variable severity with objective indices of persistent physical disability, pulmonary and kidney dysfunction, and C-reactive protein and D-dimer blood levels, measured at the same follow-up assessment. RESULTS The EFA extracted one factor, explaining 64.8% of variance; loadings were positive for all symptoms, and above 0.35 for 16 of them. The latent trait generated using IRT placed fatigue, psychiatric, and cognitive manifestations as the most discriminative symptoms (coefficients > 1.5, p < 0.001). Latent trait severity was associated with decreased body weight and poorer physical performance (coefficients > 0.240; p ⩽ 0.003), and elevated blood levels of C-reactive protein (coefficient = 0.378; 95% CI 0.215-0.541; p < 0.001) and D-dimer (coefficient = 0.412; 95% CI 0.123-0.702; p = 0.005). Results were similar after excluding subjects with pro-inflammatory comorbidities. CONCLUSIONS Different symptoms that persist for several months after moderate or severe COVID-19 may unite within one latent trait of PASC. This trait is dominated by fatigue and psychiatric symptoms, and is associated with objective signs of physical disability and persistent systemic inflammation.
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Affiliation(s)
- Geraldo F. Busatto
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Adriana Ladeira de Araujo
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - João Mauricio Castaldelli-Maia
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
- Departamento de Neurociências, Centro Universitário da Faculdade de Medicina do ABC, São Paulo, SP, Brasil
| | - Rodolfo Furlan Damiano
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Marta Imamura
- Departamento de Medicina Legal, Etica Medica e Medicina Social e do Trabalho, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Bruno F. Guedes
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Fabio de Rezende Pinna
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Marcio Valente Yamada Sawamura
- Departamento de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Márcio C. Mancini
- Unidade de Obesidade e Síndrome Metabólica, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Katia R. da Silva
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Michelle L. Garcia
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Nairo Sumita
- Departamento de Patologia Clínica, LIM/03 – Laboratório de Medicina Laboratorial, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Andre Russowsky Brunoni
- Departamento de Clínica Médica, LIM/27 – Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alberto J. da Silva Duarte
- Departamento de Dermatologia, Laboratório de Dermatologia e Imunodeficiências, LIM-56, Faculdade de Medicina e Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brasil
| | - Emmanuel A. Burdmann
- Departamento de Clínica Médica, LIM/12 – Laboratório de Pesquisa Básica em Doenças Renais, Disciplina de Nefrologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Esper G. Kallas
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Giovanni G. Cerri
- Departamento de Radiologia, Faculdade de Medicina, LIM/44, Laboratório de Ressonância Magnética em Neurorradiologia Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ricardo Nitrini
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Ricardo F. Bento
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
- Divisão de Otorrinolaringologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Vanderson Geraldo Rocha
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Divisão de Clínica Médica I do ICHC, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Heraldo Possolo de Souza
- Departamento de Clínica Médica, Disciplina de Emergências Clínicas, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Euripedes C. Miguel
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Carlos R. R. de Carvalho
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Orestes V. Forlenza
- Departamento e Instituto de Psiquiatria, Laboratório de Neurociências – LIM-27, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Linamara Rizzo Batistella
- Departamento de Medicina Legal, Etica Medica e Medicina Social e do Trabalho, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
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10
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Busatto GF, de Araujo AL, Castaldelli-Maia JM, Damiano RF, Imamura M, Guedes BF, Pinna FDR, Sawamura MVY, Mancini MC, da Silva KR, Garcia ML, Sumita N, Brunoni AR, da Silva Duarte AJ, Burdmann EA, Kallas EG, Cerri GG, Nitrini R, Bento RF, Rocha VG, de Souza HP, Miguel EC, de Carvalho CRR, Forlenza OV, Batistella LR. Post-acute sequelae of SARS-CoV-2 infection: relationship of central nervous system manifestations with physical disability and systemic inflammation - CORRIGENDUM. Psychol Med 2022; 52:2400. [PMID: 35757988 PMCID: PMC9981469 DOI: 10.1017/s0033291722001799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Geraldo F Busatto
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Adriana Ladeira de Araujo
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - João Mauricio Castaldelli-Maia
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
- Departamento de Neurociências, Centro Universitário da Faculdade de Medicina do ABC, São Paulo, SP, Brasil
| | - Rodolfo Furlan Damiano
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Marta Imamura
- Departamento de Medicina Legal, Etica Medica e Medicina Social e do Trabalho, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Bruno F Guedes
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Fabio de Rezende Pinna
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Marcio Valente Yamada Sawamura
- Departamento de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Márcio C Mancini
- Unidade de Obesidade e Síndrome Metabólica, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Katia R da Silva
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Michelle L Garcia
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Nairo Sumita
- Departamento de Patologia Clínica, LIM/03 - Laboratório de Medicina Laboratorial, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Andre Russowsky Brunoni
- Departamento de Clínica Médica, LIM/27 -Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alberto J da Silva Duarte
- Departamento de Dermatologia, Laboratório de Dermatologia e Imunodeficiências, LIM-56, Faculdade de Medicina e Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brasil
| | - Emmanuel A Burdmann
- Departamento de Clínica Médica, LIM/12 - Laboratório de Pesquisa Básica em Doenças Renais, Disciplina de Nefrologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Esper G Kallas
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Giovanni G Cerri
- Departamento de Radiologia, Faculdade de Medicina, LIM/44, Laboratório de Ressonância Magnética em Neurorradiologia Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ricardo Nitrini
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Ricardo F Bento
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
- Divisão de Otorrinolaringologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Vanderson Geraldo Rocha
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Divisão de Clínica Médica I do ICHC, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Heraldo Possolo de Souza
- Departamento de Clínica Médica, Disciplina de Emergências Clínicas, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Euripedes C Miguel
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Carlos R R de Carvalho
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Orestes V Forlenza
- Departamento e Instituto de Psiquiatria, Laboratório de Neurociências - LIM-27, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Linamara Rizzo Batistella
- Departamento de Medicina Legal, Etica Medica e Medicina Social e do Trabalho, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
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11
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Ferreira JC, Moreira TCL, de Araújo AL, Imamura M, Damiano RF, Garcia ML, Sawamura MV, Pinna FR, Guedes BF, Gonçalves FAR, Mancini M, Burdmann EA, da Silva Filho DF, Polizel JL, Bento RF, Rocha V, Nitrini R, de Souza HP, Levin AS, Kallas EG, Forlenza OV, Busatto GF, Batistella LR, de Carvalho CRR, Mauad T, Gouveia N. Clinical, sociodemographic and environmental factors impact post-COVID-19 syndrome. J Glob Health 2022; 12:05029. [PMID: 35939273 PMCID: PMC9359428 DOI: 10.7189/jogh.12.05029] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Sociodemographic and environmental factors are associated with incidence, severity, and mortality of COVID-19. However, little is known about the role of such factors in persisting symptoms among recovering patients. We designed a cohort study of hospitalized COVID-19 survivors to describe persistent symptoms and identify factors associated with post-COVID-19 syndrome. Methods We included patients hospitalized between March to August 2020 who were alive six months after hospitalization. We collected individual and clinical characteristics during hospitalization and at follow-up assessed ten symptoms with standardized scales, 19 yes/no symptoms, a functional status and a quality-of-life scale and performed four clinical tests. We examined individual exposure to greenspace and air pollution and considered neighbourhood´s population density and socioeconomic conditions as contextual factors in multilevel regression analysis. Results We included 749 patients with a median follow-up of 200 (IQR = 185-235) days, and 618 (83%) had at least one of the ten symptoms measured with scales. Pain (41%), fatigue (38%) and posttraumatic stress disorder (35%) were the most frequent. COVID-19 severity, comorbidities, BMI, female sex, younger age, and low socioeconomic position were associated with different symptoms. Exposure to ambient air pollution was associated with higher dyspnoea and fatigue scores and lower functional status. Conclusions We identified a high frequency of persistent symptoms among COVID-19 survivors that were associated with clinical, sociodemographic, and environmental variables. These findings indicate that most patients recovering from COVID-19 will need post-discharge care, and an additional burden to health care systems, especially in LMICs, should be expected.
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Affiliation(s)
- Juliana Carvalho Ferreira
- Divisao de Pneumologia, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil.,Intensive Care Unit, AC Camargo Cancer Center, São Paulo, Brasil
| | - Tiana C Lopes Moreira
- Departamento de Patologia, LIM/05- Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Adriana Ladeira de Araújo
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Marta Imamura
- Instituto de Medicina fisica e Reabilitação do Hospital das Clinicas, Departamento de Medicina Legal, Etica Médica e Medicina Social e do Trabalho, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Rodolfo F Damiano
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Michelle L Garcia
- Divisao de Pneumologia, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
| | - Marcio Vy Sawamura
- Departamento de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Fabio R Pinna
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Bruno F Guedes
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Fabio A Rodrigues Gonçalves
- Departamento de Cardiopneumologia, Laboratório de Cirurgia Cardiovascular e Fisiopatologia da Circulação, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Marcio Mancini
- Unidade de Obesidade e Síndrome Metabólica, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Emmanuel A Burdmann
- Departamento de Clínica Médica, LIM/12 - Laboratório de Pesquisa Básica em Doenças Renais, Disciplina de Nefrologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Jefferson Lordello Polizel
- Departamento de Ciências Florestais-ESALQ/USP, Laboratório de Métodos Quantitativos, Universidade de São Paulo, Piracicaba, SP, Brasil
| | - Ricardo F Bento
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil.,Divisão de Otorrinolaringologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Vanderson Rocha
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Divisão de Clínica Médica I do ICHC, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Ricardo Nitrini
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Heraldo Possolo de Souza
- Departamento de Clínica Médica, Disciplina de Emergências Clínicas, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Anna S Levin
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Esper G Kallas
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Orestes V Forlenza
- Departamento e Instituto de Psiquiatria, Laboratório de Neurociências - LIM-27, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Geraldo F Busatto
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil.,Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Linamara R Batistella
- Instituto de Medicina fisica e Reabilitação do Hospital das Clinicas, Departamento de Medicina Legal, Etica Médica e Medicina Social e do Trabalho, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Carlos R Ribeiro de Carvalho
- Divisao de Pneumologia, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil
| | - Thais Mauad
- Departamento de Patologia, LIM/05- Laboratório de Poluição Atmosférica Experimental, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Nelson Gouveia
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
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12
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Cesar Machado MC, Filho RK, el Bacha IAH, de Oliveira IS, Ribeiro CMDF, de Souza HP, Parise ER. Post-COVID-19 Secondary Sclerosing Cholangitis: A Rare but Severe Condition with no Treatment Besides Liver Transplantation. Am J Case Rep 2022; 23:e936250. [PMID: 35978523 PMCID: PMC9394546 DOI: 10.12659/ajcr.936250] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Patient: Male, 66-year-old
Final Diagnosis: Secondary sclerosing cholangitis
Symptoms: Jaundice
Medication: —
Clinical Procedure: —
Specialty: Critical Care Medicine • Infectious Diseases
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13
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Cristina-Oliveira M, Meireles K, Gil S, Cavalcante de Assis F, Geber-Júnior JC, Shinjo SK, Souza HPD, Santana ANDC, Swinton PA, Drager LF, Gualano B, Roschel H, Peçanha T. Carotid intima-media thickness and flow-mediated dilation do not predict acute in-hospital outcomes in hospitalized patients with COVID-19. Am J Physiol Heart Circ Physiol 2022; 322:H906-H913. [PMID: 35333112 PMCID: PMC9037392 DOI: 10.1152/ajpheart.00026.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Studies have suggested a potential role of endothelial dysfunction and atherosclerosis in the pathophysiology of COVID-19. Herein we tested whether brachial flow-mediated dilation (FMD) and carotid intima-media thickness (cIMT) measured upon hospital admission are associated with acute in-hospital outcomes in hospitalized COVID-19 patients. A total of 211 hospitalized patients with COVID-19 were submitted to assessments of FMD and mean and maximum cIMT (cIMTmean and cIMTmax) within the first 72 hours of hospital admission. Study primary outcome was a composite of intensive care unit admission, mechanical ventilation, or death during the hospitalization. These outcomes were also considered independently. Thrombotic events were included as a secondary outcome. Odds ratios (OR) and confidence intervals (CI) were calculated using unadjusted and adjusted multivariable logistic regression models. Eighty-eight (42%) participants demonstrated at least one of the composite outcomes. cIMTmean and cIMTmax were predictors of mortality and thrombotic events in the univariate analysis (cIMTmean and mortality: unadjusted OR 13.0[95%CI 1.7-105], P=0.015; cIMTmean and thrombotic events: unadjusted OR 13.0[95%CI 1.7-93]; P=0.013; cIMTmax and mortality: unadjusted OR 8.3[95%CI 1.3-53]; P=0.026; cIMTmax and thrombotic events: unadjusted OR 12.0[95%CI 2.0-74]; P=0.007). However, these associations were no longer present after adjustment for potential confounders (P=0.06-0.79). Additionally, FMD% was not associated with any outcome. In conclusion, cIMT and FMD are not independent predictors of clinical outcomes in hospitalized patients with COVID-19. These results suggest that subclinical atherosclerosis and endothelial dysfunction may not be the main drivers of COVID-19 complications in hospitalized COVID-19 patients.
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Affiliation(s)
- Michelle Cristina-Oliveira
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.,Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Kamila Meireles
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.,Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Saulo Gil
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.,Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fábio Cavalcante de Assis
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Departament of Emergency Medicine, Faculdade de Medicina, Universidade de Brasília, DF, Brazil.,Unidade de Hipertensão, Disciplina de Nefrologia e Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - João Carlos Geber-Júnior
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Samuel Katsuyuki Shinjo
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Heraldo Possolo de Souza
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Paul A Swinton
- School of Health Sciences, Robert Gordon University, Aberdeen, United Kingdom
| | - Luciano F Drager
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Escola Superior de Ciências da Saúde do Distrito Federal - ESCS, DF, Brazil
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.,Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.,Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Tiago Peçanha
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.,Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Institute of Sport, Department of Sport and Exercise Sciences, Faculty of Science and Engineering, grid.25627.34Manchester Metropolitan University, Manchester, UK
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14
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Alencar J, Marina Gómez Gómez L, Cortez AL, Possolo de Souza H, Levin AS, Salomão MC. Performance of NEWS, qSOFA, and SIRS Scores for Assessing Mortality, Early Bacterial Infection, and Admission to ICU in COVID-19 Patients in the Emergency Department. Front Med (Lausanne) 2022; 9:779516. [PMID: 35308539 PMCID: PMC8924424 DOI: 10.3389/fmed.2022.779516] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/08/2022] [Indexed: 12/20/2022] Open
Abstract
SARS-CoV-2 infection has a wide spectrum of presentations, from asymptomatic to pneumonia and sepsis. Risk scores have been used as triggers for protocols that combine several interventions for early management of sepsis. This study tested the accuracy of the score SIRS, qSOFA, and NEWS in predicting outcomes, including mortality and bacterial infection, in patients admitted to the emergency department (ED) during the COVID-19 pandemic. We described 2,473 cases of COVID-19 admitted to the ED of the largest referral hospital for severe COVID-19 in Brazil during the pandemic. SIRS, qSOFA and NEWS scores showed a poor performance as prognostic scores. However, NEWS score had a high sensitivity to predict in-hospital death (0.851), early bacterial infection (0.851), and ICU admission (0.868), suggesting that it may be a good screening tool for severe cases of COVID-19, despite its low specificity.
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Affiliation(s)
- Julio Alencar
- Departamento de Emergência Médica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luz Marina Gómez Gómez
- Departamento de Emergência Médica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Andre Lazzeri Cortez
- Departamento de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Heraldo Possolo de Souza
- Departamento de Emergência Médica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Departamento de Emergência Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Anna Sara Levin
- Departamento de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Matias Chiarastelli Salomão
- Departamento de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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15
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Barroso WA, Serra MB, Abreu IC, Barbeiro HV, Fiamoncini J, de Alvarenga JFR, de Souza HP, de Lima TM. Banana green peels extract protects against nonalcoholic fatty liver disease in high-fat-fed mice through modulation of lipid metabolism and inflammation. Phytother Res 2022; 36:951-962. [PMID: 35018684 DOI: 10.1002/ptr.7366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 12/18/2022]
Abstract
We investigate the effect of the banana green peels extract (BPE) as a preventive treatment against NAFLD in high-fat diet fed mice. Mice received daily doses of 100 or 250 mg/kg of BPE for 12 weeks along with the high-fat diet. BPE reduced weight gain (p < .0001), adipose tissue hypertrophy (p < .0001), and improved glucose homeostasis (p < .0001). Plasma levels of glucose-dependent insulinotropic polypeptide, triglycerides, total cholesterol, LDL-cholesterol, non-esterified fatty acids, aspartate and alanine transaminase, leptin, and resistin were decreased in BPE treated mice (p < .05). BPE effects on lipid metabolism were associated with decreased gene expression of lipogenic enzymes and increased expression of enzymes related to fatty acid and cholesterol degradation (p < .05). Plasma and liver bile acid (BA) profiles were modulated by BPE, with positive correlations between specific BA and UCP-1, CPT-1 and PGC-1β expression in brown adipose tissue (p < .05). BPE reduced hepatic steatosis and inflammation, possibly due to reduced p65 NF-κB nuclear translocation (p < .05) and modulation of oxidative stress (p < .05). These data indicate that BPE is a source of phytochemical compounds with promising effects toward the prevention of metabolic disorders associated with obesity.
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Affiliation(s)
| | - Mariana Barreto Serra
- Emergency Medicine Department, Medical School, University of São Paulo, São Paulo-SP, Brazil
| | - Iracelle Carvalho Abreu
- Physiological Sciences Department, Laboratory of Research and Post-graduation in Pharmacology (LPPF), Federal University of Maranhão, São Luís, Brazil
| | - Hermes Vieira Barbeiro
- Emergency Medicine Department, Medical School, University of São Paulo, São Paulo-SP, Brazil
| | - Jarlei Fiamoncini
- Food Research Center (FoRC), Department of Food Science and Experimental Nutrition, School of Pharmaceutical Sciences, University of São Paulo, São Paulo-SP, Brazil
| | - José Fernando Rinaldi de Alvarenga
- Food Research Center (FoRC), Department of Food Science and Experimental Nutrition, School of Pharmaceutical Sciences, University of São Paulo, São Paulo-SP, Brazil
| | | | - Thais Martins de Lima
- Emergency Medicine Department, Medical School, University of São Paulo, São Paulo-SP, Brazil
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16
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de Sousa CAZ, Sierra APR, Martínez Galán BS, Maciel JFDS, Manoel R, Barbeiro HV, de Souza HP, Cury-Boaventura MF. Time Course and Role of Exercise-Induced Cytokines in Muscle Damage and Repair After a Marathon Race. Front Physiol 2021; 12:752144. [PMID: 34721075 PMCID: PMC8554198 DOI: 10.3389/fphys.2021.752144] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/13/2021] [Indexed: 12/19/2022] Open
Abstract
Endurance exercise induces an increase in the expression of exercise-induced peptides that participate in the repair and regeneration of skeletal muscles. The present study aimed to evaluate the time course and role of exercise-induced cytokines in muscle damage and repair after a marathon race. Fifty-seven Brazilian male amateur marathon finishers, aged 30–55 years, participated in this study. The blood samples were collected 24 h before, immediately after, and 24 and 72 h after the São Paulo International Marathon. The leukogram and muscle damage markers were analyzed using routine automated methodology in the clinical laboratory. The plasma levels of the exercise-induced cytokines were determined using the Human Magnetic Bead Panel or enzyme-linked immunosorbent assays [decorin and growth differentiation factor 15 (GDF-15)]. A muscle damage was characterized by an increase in plasma myocellular proteins and immune changes (leukocytosis and neutrophilia). Running the marathon increased interleukin (IL)-6 (4-fold), IL-8 (1.5-fold), monocyte chemoattractant protein-1 (2.4-fold), tumor necrosis factor alpha (TNF-α) (1.5-fold), IL-10 (11-fold), decorin (1.9-fold), GDF-15 (1.8-fold), brain-derived neurotrophic factor (BDNF) (2.7-fold), follistatin (2-fold), and fibroblast growth factor (FGF-21) (3.4-fold) plasma levels. We also observed a reduction in musclin, myostatin, IL-15, and apelin levels immediately after the race (by 22–36%), 24 h (by 26–52%), and 72 h after the race (by 25–53%). The changes in BDNF levels were negatively correlated with the variations in troponin levels (r = −0.36). The variations in IL-6 concentrations were correlated with the changes in follistatin (r = 0.33) and FGF-21 (r = 0.31) levels after the race and with myostatin and irisin levels 72 h after the race. The changes in IL-8 and IL-10 levels had positive correlation with variation in musclin (p < 0.05). Regeneration of exercise-induced muscle damage involves the participation of classical inflammatory mediators, as well as GDF-15, BDNF, follistatin, decorin, and FGF-21, whose functions include myogenesis, mytophagia, satellite cell activation, and downregulation of protein degradation. The skeletal muscle damage markers were not associated to myokines response. However, BDNF had a negative correlation with a myocardial damage marker. The classical anti-inflammatory mediators (IL-10, IL-8, and IL-6) induced by exercise are associated to myokines response immediately after the race and in the recovery period and may affect the dynamics of muscle tissue repair.
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Affiliation(s)
- Cesar Augustus Zocoler de Sousa
- Interdisciplinary Post-graduate Program in Health Sciences, Institute of Physical Activity and Sports Sciences, Cruzeiro Do Sul University, São Paulo, Brazil
| | | | - Bryan Steve Martínez Galán
- Interdisciplinary Post-graduate Program in Health Sciences, Institute of Physical Activity and Sports Sciences, Cruzeiro Do Sul University, São Paulo, Brazil
| | - Jaqueline Fernanda de Sousa Maciel
- Interdisciplinary Post-graduate Program in Health Sciences, Institute of Physical Activity and Sports Sciences, Cruzeiro Do Sul University, São Paulo, Brazil
| | - Richelieau Manoel
- Interdisciplinary Post-graduate Program in Health Sciences, Institute of Physical Activity and Sports Sciences, Cruzeiro Do Sul University, São Paulo, Brazil
| | | | | | - Maria Fernanda Cury-Boaventura
- Interdisciplinary Post-graduate Program in Health Sciences, Institute of Physical Activity and Sports Sciences, Cruzeiro Do Sul University, São Paulo, Brazil
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17
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Muñoz Fernandez SS, Garcez FB, Alencar JCGD, Cederholm T, Aprahamian I, Morley JE, de Souza HP, Avelino da Silva TJ, Ribeiro SML. Applicability of the GLIM criteria for the diagnosis of malnutrition in older adults in the emergency ward: A pilot validation study. Clin Nutr 2021; 40:5447-5456. [PMID: 34653825 DOI: 10.1016/j.clnu.2021.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Acutely ill older adults are at higher risk of malnutrition. This study aimed to explore the applicability and accuracy of the GLIM criteria to diagnose malnutrition in acutely ill older adults in the emergency ward (EW). METHODS We performed a retrospective secondary analysis, of an ongoing cohort study, in 165 participants over 65 years of age admitted to the EW of a Brazilian university hospital. Nutrition assessment included anthropometry, the Simplified Nutritional Assessment Questionnaire (SNAQ), the Malnutrition Screening Tool (MST), and the Mini-Nutritional Assessment (MNA). We diagnosed malnutrition using GLIM criteria, defined by the parallel presence of at least one phenotypic [nonvolitional weight loss (WL), low BMI, low muscle mass (MM)] and one etiologic criterion [reduced food intake or assimilation (RFI), disease burden/inflammation]. We used the receiver operating characteristic (ROC) curves and Cox and logistic regression for data analyses. RESULTS GLIM criteria, following the MNA-SF screening, classified 50.3% of participants as malnourished, 29.1% of them in a severe stage. Validation of the diagnosis using MNA-FF as a reference showed good accuracy (AUC = 0.84), and moderate sensitivity (76%) and specificity (75.1%). All phenotypic criteria combined with RFI showed the best metrics. Malnutrition showed a trend for an increased risk of transference to intensive care unit (OR = 2.08, 95% CI 0.99, 4.35), and severe malnutrition for in-hospital mortality (HR = 4.23, 95% CI 1.2, 14.9). CONCLUSION GLIM criteria, following MNA-SF screening, appear to be a feasible approach to diagnose malnutrition in acutely ill older adults in the EW. Nonvolitional WL combined with RFI or acute inflammation were the best components identified and are easily accessible, allowing their potential use in clinical practice.
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Affiliation(s)
| | - Flavia Barreto Garcez
- Geriatrics Division, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Julio César García de Alencar
- Disciplina de Emergencias Clínicas, Departamento de Clínica Médica, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Karolinska University Hospital, Stockholm, Sweden
| | - Ivan Aprahamian
- Geriatrics Division, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - John Edward Morley
- Division of Geriatric Medicine, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Heraldo Possolo de Souza
- Disciplina de Emergencias Clínicas, Departamento de Clínica Médica, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | | | - Sandra Maria Lima Ribeiro
- Nutrition Department, School of Public Health, University of Sao Paulo, São Paulo, Brazil; School of Arts, Science, and Humanity, University of Sao Paulo, São Paulo, Brazil
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18
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Busatto GF, de Araújo AL, Duarte AJDS, Levin AS, Guedes BF, Kallas EG, Pinna FR, de Souza HP, da Silva KR, Sawamura MVY, Seelaender M, Imamura M, Garcia ML, Forlenza OV, Nitrini R, Damiano RF, Rocha VG, Batisttella LR, Carvalho CRRD. Post-acute sequelae of SARS-CoV-2 infection (PASC): a protocol for a multidisciplinary prospective observational evaluation of a cohort of patients surviving hospitalisation in Sao Paulo, Brazil. BMJ Open 2021; 11:e051706. [PMID: 34193506 PMCID: PMC8249176 DOI: 10.1136/bmjopen-2021-051706] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION COVID-19 may lead to persistent and potentially incapacitating clinical manifestations (post-acute sequelae of SARS-CoV-2 infection (PASC)). Using easy-to-apply questionnaires and scales (often by telephone interviewing), several studies evaluated samples of COVID-19 inpatients from 4 weeks to several months after discharge. However, studies conducting systematic multidisciplinary assessments of PASC manifestations are scarce, with thorough in-person objective evaluations restricted to modestly sized subsamples presenting greatest disease severity. METHODS AND ANALYSES We will conduct a prospective observational study of surviving individuals (above 18 years of age) from a cohort of over 3000 subjects with laboratory-confirmed COVID-19 who were treated as inpatients at the largest academic health centre in Sao Paulo, Brazil (Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo). All eligible subjects will be consecutively invited to undergo a 1-2-day series of multidisciplinary assessments at 2 time-points, respectively, at 6-9 months and 12-15 months after discharge. Assessment schedules will include detailed multidomain questionnaires applied by medical research staff, self-report scales, objective evaluations of cardiopulmonary functioning, physical functionality and olfactory status, standardised neurological, psychiatric and cognitive examinations, as well as diagnostic laboratory, muscle ultrasound and chest imaging exams. Remaining material from blood tests will be incorporated by a local biobank for use in future investigations on inflammatory markers, genomics, transcriptomics, peptidomics and metabolomics. ETHICS AND DISSEMINATION All components of this programme have been approved by local research ethics committees. We aim to provide insights into the frequency and severity of chronic/post-COVID multiorgan symptoms, as well as their interrelationships and associations with acute disease features, sociodemographic variables and environmental exposures. Findings will be disseminated in peer-reviewed journals and at scientific meetings. Additionally, we aim to provide a data repository to allow future pathophysiological investigations relating clinical PASC features to biomarker data extracted from blood samples. TRIAL REGISTRATION NUMBER RBR-8z7v5wc; Pre-results.
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Affiliation(s)
- Geraldo Filho Busatto
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | | | - Alberto José da Silva Duarte
- Departamento de Dermatologia, Laboratório de Dermatologia e Imunodeficiências, Faculdade de Medicina e Instituto de Medicina Tropical de São Paulo, Sao Paulo, Brazil
| | - Anna Sara Levin
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Bruno Fukelmann Guedes
- Instituto Central, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, Sao Paulo, Brazil
| | - Esper Georges Kallas
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
- Departamento de Clínica Médica, Laboratório de Imunologia Clínica e Alergia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Fabio Rezende Pinna
- Instituto Central, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, Sao Paulo, Brazil
- Departamento de Oftalmologia e Otorrinolaringologia, Laboratório de Otorrinolaringologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Heraldo Possolo de Souza
- Departamento de Clínica Médica, Laboratório de Emergências Clínicas, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Katia Regina da Silva
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | | | - Marilia Seelaender
- Departamento de Cirurgia, Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Marta Imamura
- Instituto de Medicina Física e de Reabilitação, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Michelle Louvaes Garcia
- Departamento de Cardio-Pneumologia, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Orestes Vicente Forlenza
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Ricardo Nitrini
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Rodolfo Furlan Damiano
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Vanderson Geraldo Rocha
- Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
- Laboratório de Genética e Hematologia Molecular, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Linamara Rizzo Batisttella
- Instituto de Medicina Física e de Reabilitação, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
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19
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Brandão Neto RA, Marchini JF, Marino LO, Alencar JCG, Lazar Neto F, Ribeiro S, Valente FS, Rahhal H, Marina Gomez Gomez L, Bueno CG, Faria CC, da Cunha VP, Padrão E, Velasco IT, Possolo de Souza H. Correction: Mortality and other outcomes of patients with coronavirus disease pneumonia admitted to the emergency department: A prospective observational Brazilian study. PLoS One 2021; 16:e0248327. [PMID: 33662001 PMCID: PMC7932119 DOI: 10.1371/journal.pone.0248327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Monfort-Pires M, U-Din M, Nogueira GA, de Almeida-Faria J, Sidarta-Oliveira D, Sant'Ana MR, De Lima-Júnior JC, Cintra DE, de Souza HP, Ferreira SRG, Sapienza MT, Virtanen KA, Velloso LA. Short Dietary Intervention with Olive Oil Increases Brown Adipose Tissue Activity in Lean but not Overweight Subjects. J Clin Endocrinol Metab 2021; 106:472-484. [PMID: 33180910 DOI: 10.1210/clinem/dgaa824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The brown adipose tissue (BAT) is a potential target for the treatment of obesity and metabolic disorders. Its activation by cold exposure or adrenergic drugs can increase systemic insulin sensitivity and improve lipid metabolism; however, little is known about the effects of specific dietary components on BAT activity. OBJECTIVES We asked if a short-term (4 weeks) dietary intervention with olive oil could modify BAT activity in lean and overweight/obese volunteers. DESIGN This was a 4-week open clinical trial in which all participants underwent a dietary intervention with extra-virgin olive oil supplementation. As the initial intake of olive oil was controlled all the participants were controls of themselves. RESULTS The intervention resulted in significant increase in blood monounsaturated fatty acid levels, which was accompanied by increased BAT activity in lean but not in overweight/obese volunteers. In the lean group, an increase in leptin was detected after the intervention, and low leptin values at the beginning of the study were predictive of greater BAT activity after intervention. In addition, increase in leptin concentration was associated with increased BAT activity. Three known endogenous mediators of BAT activity, secretin, fibroblast growth factor 21 (FGF21), and 12,13-dihydroxy-9Z-octadecenoic acid (12,13-diHOME) were increased by intervention in lean, whereas only secretin and FGF21 were increased in subjects with excessive weight. CONCLUSION This study provides clinical evidence for the impact of monounsaturated fatty acids on BAT activity and an advance in the understanding of the beneficial health effects of olive oil.
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Affiliation(s)
- Milena Monfort-Pires
- Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Mueez U-Din
- Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Guilherme A Nogueira
- Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Juliana de Almeida-Faria
- Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Davi Sidarta-Oliveira
- Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Marcella Ramos Sant'Ana
- Nutritional Genomics Laboratory, LabGeN, School of Applied Sciences, UNICAMP, Limeira, São Paulo, Brazil
| | - José C De Lima-Júnior
- Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Dennys E Cintra
- Nutritional Genomics Laboratory, LabGeN, School of Applied Sciences, UNICAMP, Limeira, São Paulo, Brazil
| | | | - Sandra R G Ferreira
- Department of Epidemiology, School of Public Health - University of São Paulo, São Paulo, SP, Brazil
| | - Marcelo Tatit Sapienza
- Division of Nuclear Medicine, Department of Radiology and Oncology, Medical School of University of São Paulo (FMUSP), São Paulo, Brazil
| | - Kirsi A Virtanen
- Turku PET Centre, Turku University Hospital, Turku, Finland
- Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland (UEF), Kuopio, Finland
| | - Licio A Velloso
- Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Brandão Neto RA, Marchini JF, Marino LO, Alencar JCG, Lazar Neto F, Ribeiro S, Salvetti FV, Rahhal H, Gomez Gomez LM, Bueno CG, Faria CC, da Cunha VP, Padrão E, Velasco IT, de Souza HP. Mortality and other outcomes of patients with coronavirus disease pneumonia admitted to the emergency department: A prospective observational Brazilian study. PLoS One 2021; 16:e0244532. [PMID: 33411707 PMCID: PMC7790269 DOI: 10.1371/journal.pone.0244532] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/13/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The first cases of coronavirus disease (COVID-19) in Brazil were diagnosed in February 2020. Our Emergency Department (ED) was designated as a COVID-19 exclusive service. We report our first 500 confirmed COVID-19 pneumonia patients. METHODS From 14 March to 16 May 2020, we enrolled all patients admitted to our ED that had a diagnosis of COVID-19 pneumonia. Infection was confirmed via nasopharyngeal swabs or tracheal aspirate PCR. The outcomes included hospital discharge, invasive mechanical ventilation, and in-hospital death, among others. RESULTS From 2219 patients received in the ED, we included 506 with confirmed COVID-19 pneumonia. We found that 333 patients were discharged home (65.9%), 153 died (30.2%), and 20 (3.9%) remained in the hospital. A total of 300 patients (59.3%) required ICU admission, and 227 (44.9%) needed invasive ventilation. The multivariate analysis found age, number of comorbidities, extension of ground glass opacities on chest CT and troponin with a direct relationship with all-cause mortality, whereas dysgeusia, use of angiotensin converting enzyme inhibitor or angiotensin-ii receptor blocker and number of lymphocytes with an inverse relationship with all-cause mortality. CONCLUSIONS This was a sample of severe patients with COVID-19, with 59.2% admitted to the ICU and 41.5% requiring mechanical ventilator support. We were able to ascertain the outcome in majority (96%) of patients. While the overall mortality was 30.2%, mortality for intubated patients was 55.9%. Multivariate analysis agreed with data found in other studies although the use of angiotensin converting enzyme inhibitor or angiotensin-ii receptor blocker as a protective factor could be promising but would need further studies. TRIAL REGISTRATION The study was registered in the Brazilian registry of clinical trials: RBR-5d4dj5.
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Affiliation(s)
- Rodrigo A. Brandão Neto
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Julio F. Marchini
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lucas O. Marino
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Julio C. G. Alencar
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Felippe Lazar Neto
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Sabrina Ribeiro
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fernando V. Salvetti
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Hassan Rahhal
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luz Marina Gomez Gomez
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Caue G. Bueno
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carine C. Faria
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Victor P. da Cunha
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Eduardo Padrão
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Irineu T. Velasco
- Emergency Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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22
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Garcia de Alencar JC, Pinheiro Costa MG, Brandao Neto RA, de Souza HP. A Hidden Complication of Pigtail Catheter Insertion. Clin Pract Cases Emerg Med 2020; 4:90-91. [PMID: 32064437 PMCID: PMC7012549 DOI: 10.5811/cpcem.2019.11.44913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/25/2019] [Accepted: 11/11/2019] [Indexed: 11/11/2022] Open
Abstract
Pigtail catheters have emerged as an effective and less morbid alternative to traditional chest tubes for evacuation of pleural air. Rare complications in the literature have been reported. We report a case of a 92-year-old male who presented with dyspnea and shock, noted to have a pneumothorax requiring tube thoracostomy. Computed tomography demonstrated pigtail within the lung parenchyma. We discuss the implications of this occurrence.
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Oliveira CCM, Novaes HMD, Alencar AP, Santos IS, Damasceno MCT, Souza HPD. Effectiveness of the Mobile Emergency Medical Services (SAMU): use of interrupted time series. Rev Saude Publica 2019; 53:99. [PMID: 31800916 PMCID: PMC6863106 DOI: 10.11606/s1518-8787.2019053001396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/09/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the performance of the Mobile Emergency Medical Services (SAMU) in the ABC Region, using myocardial infarction as tracer condition. METHODS The analysis of interrupted time series was the approach chosen to test immediate and gradual effects of the intervention on the study population. The research comprised adjusted monthly time series of the hospital mortality rate by myocardial infarction in the period between 2000 and 2011. Data were extracted from the Mortality Information System (SIM), using segmented regression analysis to evaluate the level and trend of the intervention before and after its implementation. To strengthen the internal validity of the study, a control region was included. RESULTS The analysis of interrupted time series showed a reduction of 0.04 deaths per 100,000 inhabitants in the mortality rate compared to the underlying trend since the implementation of the Emergency Medical Services (p = 0.0040; 95%CI: -0.0816 - -0.0162) and a reduction in the level of 2.89 deaths per 100,000 inhabitants (p = 0.0001; 95%CI: -4.3293 - -1.4623), both with statistical significance. Regarding the control region, Baixada Santista, the difference in the result trend between intervention outcome and post-intervention control of -0.0639 deaths per 100,000 inhabitants was statistically significant (p = 0.0031; 95%CI: -0.1060 - -0.0219). We cannot exclude confounders, but we limited their presence in the study by including control region series. CONCLUSIONS Although the analysis of interrupted time series has limitations, this modeling can be useful for analyzing the performance of policies and programs. Even though the intervention studied is not a condition that in itself implies effectiveness, the latter would not be present without the former, which, integrated with other conditions, generates a positive result. SAMU is a strategy that must be expanded when formulating and consolidating policies focusing on emergency care.
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Affiliation(s)
- Cátia C Martins Oliveira
- Fundação Oswaldo Cruz. Instituto René Rachou. Coordenação da Agenda 2030. Belo Horizonte, MG, Brasil
| | - Hillegonda Maria Dutih Novaes
- Universidade de São Paulo. Departamento de Medicina Preventiva. Programa de Pós-Graduação em Saúde Coletiva. São Paulo, SP, Brasil
| | - Airlane Pereira Alencar
- Universidade de São Paulo. Instituto de Matemática e Estatística. Departamento de Estatística. São Paulo, SP, Brasil
| | - Itamar S Santos
- Universidade de São Paulo. Faculdade de Medicina. Departamento de Clínica Médica. São Paulo. São Paulo, SP, Brasil
| | - Maria Cecilia T Damasceno
- Faculdade de Medicina do ABC. Faculdade de Medicina. Departamento de Clínica Médica. São Paulo, SP, Brasil
| | - Heraldo Possolo de Souza
- Universidade de São Paulo. Faculdade de Medicina. Departamento de Clínica Médica. São Paulo. São Paulo, SP, Brasil
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24
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de Alencar JCG, da Silva GW, Ribeiro SCDC, Marchini JFM, Neto RAB, de Souza HP. Euglycemic Diabetic Ketoacidosis in Pregnancy. Clin Pract Cases Emerg Med 2019; 4:26-28. [PMID: 32064418 PMCID: PMC7012570 DOI: 10.5811/cpcem.2019.9.43624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/12/2019] [Accepted: 09/06/2019] [Indexed: 01/23/2023] Open
Abstract
The clinical presentation of diabetic ketoacidosis in pregnancy (DKP) is similar to that observed in nonpregnant women, although reports suggest the presenting blood glucose level may not be as high. It is hypothesized that lower, maternal fasting glucose levels are a result of both the fetus and the placenta consuming glucose. We report the case of a 38-year-old woman gravida 2, para 0, abortion 1 with type 1 diabetes who had euglycemic diabetic ketoacidosis and review the literature on DKP, with a focus on diagnosis, treatment, and monitoring of the mother and fetus.
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25
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Modolin MLA, Cintra W, Rocha RI, Camargo CP, Giuliani NDR, Souza HPD, Barbeiro HV, Gemperli R. Analysis of inflammatory and metabolic biomarkers in patients submitted to abdominoplasty after bariatric surgery. Acta Cir Bras 2019; 34:e201900506. [PMID: 31166465 PMCID: PMC6583934 DOI: 10.1590/s0102-865020190050000006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/12/2019] [Indexed: 01/22/2023] Open
Abstract
Purpose: To evaluate the serum variations of Interleukins (Il) and CPR of abdominoplasties in post-bariatric patients and, to equate the homeostasis (HOMA) from the variations of glycemia and insulin to evolute the metabolic modifications. Methods: Fourteen women were submitted to abdominoplasties with weight loss after a gastroplasty. Levels of IL4, IL6, IL10, CRP, glycemia and insulin were obtained during the pre-operative, trans-operative, 24 hours post, 7th and 14th postoperative days. Results: The IL4 was higher at 24 hours post-surgery, and after a moderate decrease, it remained high until the 14th day. The IL6 and CRP had an expressive increase during the trans-operative period. The CRP remained high, and the IL6 decreased on the 7th and 14th days. The IL10 increased during the transoperative period, and it posteriorly decreased to lower levels in comparison to the pre-operative period. The already increased glycemia during the pre-operative period was even higher during the trans-operative and then, returned to preliminary values on the 7th and 14th days after surgery. The HOMA accompanied the insulin. Conclusion: The inflammatory and glycemic serum levels decrease after abdominiplasty in obese post-bariatric patients.
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Affiliation(s)
| | - Wilson Cintra
- Clinics Hospital, Medical School, USP, São Paulo, SP, Brazil
| | | | | | | | | | | | - Rolf Gemperli
- Clinics Hospital, Medical School, USP, São Paulo, SP, Brazil
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26
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Barroso WA, Abreu IC, Ribeiro LS, da Rocha CQ, de Souza HP, de Lima TM. Chemical composition and cytotoxic screening of Musa cavendish green peels extract: Antiproliferative activity by activation of different cellular death types. Toxicol In Vitro 2019; 59:179-186. [PMID: 31018149 DOI: 10.1016/j.tiv.2019.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/12/2019] [Accepted: 04/17/2019] [Indexed: 12/26/2022]
Abstract
Musa cavendish, commonly known as banana, is a fruit with nutritional and therapeutic properties. We investigated the chemical composition and in vitro cytotoxic effect of M. cavendish green peel extract (MHE) on cancer cells for the first time. The compounds characterization was performed by HPLC-UV/Vis and FIA-ESI-IT-MSn. We investigated in vitro cytotoxic effect of Musa cavendish green peels extract (MHE) in HepG2, A-375, MCF-7 and Caco-2 cancer cells. We evaluated the effect of MHE on proliferation of different cell lines through apoptosis, necrosis, mitochondrial membrane potential (MMP) and reactive oxygen species (ROS) content determination. We identified 12 compounds from different classes in the extract, including derivatives of phenolic acids, aglycone flavonoids, glycoside flavonoids and catecholamines. Our results indicate that MHE exerts, after 48 h treatment, an accentuated antiproliferative effect from the dose of 100 μg/mL in all cell lines tested. In HepG2 cells, these effects were related to the induction of cell death, both necrotic and apoptotic, and remarkable changes in cell morphology. Depolarization of MMP and high ROS content were also observed in the cells in a dose-dependent manner. Our results show that MHE may be used as a source of new drugs with anticancer activity.
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Affiliation(s)
- Wermerson Assunção Barroso
- Emergency Medicine Department, Medical School, University of São Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, São Paulo CEP 01246-903, Brazil.
| | - Iracelle Carvalho Abreu
- Physiological Sciences Department, Laboratory of Research and Post-graduation in Pharmacology (LPPF), Federal University of Maranhão, São Luís - Maranhão. University City, Bacanga Campus, Av. dos Portugueses, 1966, Vila Bacanga, Maranhão CEP 65085-580, Brazil
| | - Larissa Sousa Ribeiro
- Physiological Sciences Department, Laboratory of Research and Post-graduation in Pharmacology (LPPF), Federal University of Maranhão, São Luís - Maranhão. University City, Bacanga Campus, Av. dos Portugueses, 1966, Vila Bacanga, Maranhão CEP 65085-580, Brazil
| | - Cláudia Quintino da Rocha
- Department of Chemistry, Laboratory of Advanced Studies in Phytomedications (LEAF), Federal University of Maranhão, São Luís - Maranhão. University City, Center for Exact Sciences and Technology, Bacanga Campus, Av. Dos Portugueses, 1966, Vsila Bacanga, Maranhão CEP 65085-580, Brazil
| | - Heraldo Possolo de Souza
- Emergency Medicine Department, Medical School, University of São Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, São Paulo CEP 01246-903, Brazil
| | - Thais Martins de Lima
- Emergency Medicine Department, Medical School, University of São Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, São Paulo CEP 01246-903, Brazil
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Fiamoncini J, Fernandes Barbosa C, Arnoni Junior JR, Araújo Junior JC, Taglieri C, Szego T, Gelhaus B, Possolo de Souza H, Daniel H, Martins de Lima T. Roux-en-Y Gastric Bypass Surgery Induces Distinct but Frequently Transient Effects on Acylcarnitine, Bile Acid and Phospholipid Levels. Metabolites 2018; 8:metabo8040083. [PMID: 30477108 PMCID: PMC6316856 DOI: 10.3390/metabo8040083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/08/2018] [Accepted: 11/17/2018] [Indexed: 02/07/2023] Open
Abstract
Roux-en-Y gastric bypass (RYGB) is an effective method to achieve sustained weight loss, but the mechanisms responsible for RYGB effects have not yet been fully characterized. In this study, we profiled the concentrations of 143 lipid metabolites in dry blood spots (DBS) of RYGB patients. DBS from obese patients (BMI range 35⁻44 kg/m²) were collected 7 days before, 15 and 90 days after the surgery. LC-MS/MS was used to quantify acylcarnitines, phosphatidylcholines, sphingomyelins and bile acids. RYGB caused a rapid increase in acylcarnitine levels that proved to be only transient, contrasting with the sustained decrease in phosphatidylcholines and increase of sphingomyelins and bile acids. A PLS-DA analysis revealed a 3-component model (R² = 0.9, Q² = 0.74) with key metabolites responsible for the overall metabolite differences. These included the BCAA-derived acylcarnitines and sphingomyelins with 16 and 18 carbons. We found important correlations between the levels of BCAA-derived acylcarnitines and specific sphingomyelins with plasma cholesterol and triacylglycerol concentrations. Along with the marked weight loss and clinical improvements, RYGB induced specific alterations in plasma acylcarnitines, bile acid and phospholipid levels. This calls for more studies on RYGB effects aiming to elucidate the metabolic adaptations that follow this procedure.
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Affiliation(s)
- Jarlei Fiamoncini
- Department of Food Science and Experimental Nutrition, School of Pharmaceutical Sciences, University of São Paulo, 05508-060 São Paulo, Brazil.
- Nutrition and Food Sciences, Technische Universität München, 85354 Freising-Weihenstephan, Germany.
| | | | | | | | | | - Tiago Szego
- Instituto CIGO, 05508-060 São Paulo, Brazil.
| | - Barbara Gelhaus
- Nutrition and Food Sciences, Technische Universität München, 85354 Freising-Weihenstephan, Germany.
| | - Heraldo Possolo de Souza
- Laboratório de Emergências Clínicas (LIM 51), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 05508-060 São Paulo, Brazil.
| | - Hannelore Daniel
- Nutrition and Food Sciences, Technische Universität München, 85354 Freising-Weihenstephan, Germany.
| | - Thais Martins de Lima
- Laboratório de Emergências Clínicas (LIM 51), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 05508-060 São Paulo, Brazil.
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Barbeiro HV, Machado MAC, de Souza HP, da Silva FP, Machado MCC. Reduction of venous pressure during the resection of liver metastases compromises enteric blood flow: IGFBP-1 as a novel biomarker of intestinal barrier injury. Clinics (Sao Paulo) 2017; 72:645-648. [PMID: 29160429 PMCID: PMC5666439 DOI: 10.6061/clinics/2017(10)10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/12/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Disruption of the intestinal barrier and bacterial translocation commonly occur when intestinal blood flow is compromised. The aim of this study was to determine whether liver resection induces intestinal damage. METHODS We investigated intestinal fatty-acid binding protein and insulin-like growth factor binding protein levels in the plasma of patients who underwent liver resection. RESULTS We show that liver resection is associated with significant intestinal barrier injury, even if the Pringle maneuver is not performed. CONCLUSION We propose the use of insulin-like growth factor binding protein-1 as a novel biomarker of intestinal damage in such situations.
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Affiliation(s)
- Hermes Vieira Barbeiro
- Departamento de Emergencias Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | - Heraldo Possolo de Souza
- Departamento de Emergencias Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fabiano Pinheiro da Silva
- Departamento de Emergencias Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcel Cerqueira César Machado
- Departamento de Emergencias Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Sirio Libanes, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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29
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Barroso WA, Victorino VJ, Jeremias IC, Petroni RC, Ariga SKK, Salles TA, Barbeiro DF, de Lima TM, de Souza HP. High-fat diet inhibits PGC-1α suppressive effect on NFκB signaling in hepatocytes. Eur J Nutr 2017; 57:1891-1900. [DOI: 10.1007/s00394-017-1472-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
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30
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Pinheiro da Silva F, Cataldi TR, de Lima TM, Starzynski PN, Barbeiro HV, Labate MTV, CéMachado MCC, de Souza HP, Labate CA. Proteomic profiling identifies N-acetylmuramoyl-l-alanine amidase as a novel biomarker of sepsis. Biomark Med 2016; 10:1225-1229. [PMID: 27911590 DOI: 10.2217/bmm-2016-0184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Sepsis is a critical condition that leads to high mortality and is the most common cause of death in intensive care units. Despite exhaustive efforts by the scientific community, a reliable biomarker for diagnosis, evolution and prognosis of sepsis is still lacking. Results & methodology: Here, using high-throughput proteomics, we describe N-acetylmuramoyl-l-alanine amidase as a novel candidate for differentiating infectious and noninfectious inflammatory syndromes. DISCUSSION & CONCLUSION This is the first description of N-acetylmuramoyl-l-alanine amidase as a biomarker that can be used alone or in conjunction with other biomarkers to facilitate the diagnosis of sepsis in the critically ill.
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Affiliation(s)
| | - Thais Regiani Cataldi
- Escola Superior de Agricultura 'Luiz de Queiroz', Department of Genetics, Laboratório Multiusuários Centralizado de Genômica Funcional Aplicada à Agropecuária e Agroenergia, University of Sao Paulo, Piracicaba, Brazil
| | | | | | | | - Monica Teresa Veneziano Labate
- Escola Superior de Agricultura 'Luiz de Queiroz', Department of Genetics, Laboratório Multiusuários Centralizado de Genômica Funcional Aplicada à Agropecuária e Agroenergia, University of Sao Paulo, Piracicaba, Brazil
| | | | | | - Carlos Alberto Labate
- Escola Superior de Agricultura 'Luiz de Queiroz', Department of Genetics, Laboratório Multiusuários Centralizado de Genômica Funcional Aplicada à Agropecuária e Agroenergia, University of Sao Paulo, Piracicaba, Brazil
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31
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Hamasaki MY, Barbeiro HV, de Souza HP, Machado MCC, da Silva FP. sRAGE in septic shock: a potential biomarker of mortality. Rev Bras Ter Intensiva 2016; 26:392-6. [PMID: 25607269 PMCID: PMC4304468 DOI: 10.5935/0103-507x.20140060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 11/13/2014] [Indexed: 01/10/2023] Open
Abstract
Objective To evaluate and understand the clinical implications of the plasma levels of a
soluble isoform of a receptor for advanced glycation end products (sRAGE) in
different stages of sepsis. Methods Serum sRAGE values in patients who were divided into intensive care unit control,
severe sepsis, septic shock and recovery from septic shock groups were
statistically analyzed to assess quantity (Kruskal-Wallis), variability (Levine
test) and correlation (Spearman rank test) with certain inflammatory mediators
(IL-1 α, IL-6, IL-8, IL-10, IP-10, G-CSF, MCP-1, IFN-γ and
TNF-α). Results No changes in sRAGE levels were observed among the groups; however, the septic
shock group showed differences in the variability of sRAGE compared to the other
groups. A positive correlation with all the inflammatory mediators was reported in
the septic shock group. Conclusion sRAGE levels are associated with worse outcomes in patients with septic shock.
However, a statistical correlation analysis with other proinflammatory cytokines
indicated that the pathways leading to those outcomes are different depending on
the sRAGE levels. Future studies to elucidate the pathophysiological mechanisms
involving sRAGE in models of sepsis are of great clinical importance for the safe
handling of this biomarker.
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Affiliation(s)
- Mike Yoshio Hamasaki
- Disciplina de Emergências Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
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da Silva FP, Preuhs Filho G, Finger E, Barbeiro HV, Zampieri FG, Goulart AC, Torggler Filho F, Panajotopoulos N, Velasco IT, Kalil J, de Souza HP, da Cruz Neto LM, Rodrigues H. HLA-A*31 as a marker of genetic susceptibility to sepsis. Rev Bras Ter Intensiva 2015; 25:284-9. [PMID: 24553509 PMCID: PMC4031872 DOI: 10.5935/0103-507x.20130049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 10/31/2013] [Indexed: 12/04/2022] Open
Abstract
Objective The HLA haplotype has been associated with many autoimmune diseases, but no
associations have been described in sepsis. This study aims to investigate the HLA
system as a possible marker of genetic sepsis susceptibility. Methods This is a prospective cohort study including patients admitted to an intensive
care unit and healthy controls from a list of renal transplant donors. Patients
with less 18 years of age; pregnant or HIV positive patients; those with
metastatic malignancies or receiving chemotherapy; or with advanced liver disease;
or with end-of-life conditions were excluded. The DNA was extracted from the whole
blood and HLA haplotypes determined using MiliPlex®
technology. Results From October 2010 to October 2012, 1,121 patients were included (1,078 kidney
donors, 20 patients admitted with severe sepsis and 23 with septic shock).
HLA-A*31 positive subjects had increased risk of developing sepsis (OR 2.36, 95%CI
1.26-5.35). Considering a p value <0.01, no other significant association was
identified. Conclusion HLA-A*31 expression is associated to risk of developing sepsis.
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Affiliation(s)
- Fabiano Pinheiro da Silva
- Universidade de São Paulo, Departamento de Emergências Clínicas, São PauloSP, Brasil, Departamento de Emergências Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Germano Preuhs Filho
- Universidade de São Paulo, Instituto do Coração, Departamento de Imunologia, São PauloSP, Brasil, Departamento de Imunologia, Instituto do Coração, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Eduardo Finger
- Laboratórios Salomão Zoppi, São PauloSP, Brasil, Laboratórios Salomão Zoppi - São Paulo (SP), Brasil
| | - Hermes Vieira Barbeiro
- Universidade de São Paulo, Departamento de Emergências Clínicas, São PauloSP, Brasil, Departamento de Emergências Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Fernando Godinho Zampieri
- Universidade de São Paulo, Departamento de Emergências Clínicas, São PauloSP, Brasil, Departamento de Emergências Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Alessandra Carvalho Goulart
- Universidade de São Paulo, Departamento de Emergências Clínicas, São PauloSP, Brasil, Departamento de Emergências Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Francisco Torggler Filho
- Universidade de São Paulo, Departamento de Emergências Clínicas, São PauloSP, Brasil, Departamento de Emergências Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Nicolas Panajotopoulos
- Universidade de São Paulo, Instituto do Coração, Departamento de Imunologia, São PauloSP, Brasil, Departamento de Imunologia, Instituto do Coração, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Irineu Tadeu Velasco
- Universidade de São Paulo, Departamento de Emergências Clínicas, São PauloSP, Brasil, Departamento de Emergências Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Jorge Kalil
- Universidade de São Paulo, Instituto do Coração, Departamento de Imunologia, São PauloSP, Brasil, Departamento de Imunologia, Instituto do Coração, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Heraldo Possolo de Souza
- Universidade de São Paulo, Departamento de Emergências Clínicas, São PauloSP, Brasil, Departamento de Emergências Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Luiz Monteiro da Cruz Neto
- Universidade de São Paulo, Departamento de Emergências Clínicas, São PauloSP, Brasil, Departamento de Emergências Clínicas, Universidade de São Paulo - USP - São Paulo (SP), Brasil
| | - Hélcio Rodrigues
- Universidade de São Paulo, Instituto do Coração, Departamento de Imunologia, São PauloSP, Brasil, Departamento de Imunologia, Instituto do Coração, Universidade de São Paulo - USP - São Paulo (SP), Brasil
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Zampieri FG, Park M, Ranzani OT, Maciel AT, de Souza HP, da Cruz Neto LM, da Silva FP. Anion gap corrected for albumin, phosphate and lactate is a good predictor of strong ion gap in critically ill patients: a nested cohort study. Rev Bras Ter Intensiva 2015; 25:205-11. [PMID: 24213083 PMCID: PMC4031845 DOI: 10.5935/0103-507x.20130036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/22/2013] [Indexed: 11/29/2022] Open
Abstract
Objective Corrected anion gap and strong ion gap are commonly used to estimate unmeasured
anions. We evaluated the performance of the anion gap corrected for albumin,
phosphate and lactate in predicting strong ion gap in a mixed population of
critically ill patients. We hypothesized that anion gap corrected for albumin,
phosphate and lactate would be a good predictor of strong ion gap, independent of
the presence of metabolic acidosis. In addition, we evaluated the impact of strong
ion gap at admission on hospital mortality. Methods We included 84 critically ill patients. Correlation and agreement between the
anion gap corrected for albumin, phosphate and lactate and strong ion gap was
evaluated by the Pearson correlation test, linear regression, a Bland-Altman plot
and calculating interclass correlation coefficient. Two subgroup analyses were
performed: one in patients with base-excess <-2mEq/L (low BE group - lBE) and
the other in patients with base-excess >-2mEq/L (high BE group - hBE). A
logistic regression was performed to evaluate the association between admission
strong ion gap levels and hospital mortality. Results There was a very strong correlation and a good agreement between anion gap
corrected for albumin, phosphate and lactate and strong ion gap in the general
population (r2=0.94; bias 1.40; limits of agreement -0.75 to 3.57).
Correlation was also high in the lBE group (r2=0.94) and in the hBE
group (r2=0.92). High levels of strong ion gap were present in 66% of
the whole population and 42% of the cases in the hBE group. Strong ion gap was not
associated with hospital mortality by logistic regression. Conclusion Anion gap corrected for albumin, phosphate and lactate and strong ion gap have an
excellent correlation. Unmeasured anions are frequently elevated in critically ill
patients with normal base-excess. However, there was no association between
unmeasured anions and hospital mortality.
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da Silva FP, Machado MCC, Sallet PC, Zampieri FG, Goulart AC, Torggler Filho F, Barbeiro HV, Velasco IT, da Cruz Neto LM, de Souza HP. Neuropeptide downregulation in sepsis. Inflammation 2014; 37:142-5. [PMID: 24005899 DOI: 10.1007/s10753-013-9722-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Neuropeptides are an extremely conserved arm of neurobiology. Despite their effects as neurohormones and neurotransmitters, a multitude of other effects have been described, putting in evidence their importance as regulators of immune responses, such as chemotaxis, oxidative burst, pro-inflammatory signaling, and many others. The effects of neuropeptides in the pathophysiology of sepsis, however, remain poorly investigated. A prospective cohort study to investigate the effects of neuropeptides in sepsis was carried out. Here, we describe that neuropeptides are downregulated during septic shock. We propose that it may be a protective mechanism of the host to avoid further inflammatory injury.
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Zampieri FG, Ranzani OT, Sabatoski V, de Souza HP, Barbeiro H, da Neto LMC, Park M, Pinheiro da Silva F. An increase in mean platelet volume after admission is associated with higher mortality in critically ill patients. Ann Intensive Care 2014; 4:20. [PMID: 25520853 PMCID: PMC4265891 DOI: 10.1186/s13613-014-0020-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 05/23/2014] [Indexed: 12/29/2022] Open
Abstract
Background Platelet activation and consumption are common in critically ill patients and are associated with poorer prognosis. Mean platelet volume is a simple surrogate for platelet activation, with higher MPV being associated with worse clinical condition on a large array of clinical diagnoses. We therefore aimed to investigate associations between changes in platelet count and mean platelet volume (MPV) with prognosis and inflammatory cytokine values in critically ill patients. Methods This study prospectively included 84 critically ill patients. Patients were stratified into four groups according to proportional changes in MPV (ΔMPV24h) and platelet count (ΔPlat24h) in the first 24 hours after admission. Mortality between groups was compared using the χ2 test. Logistic regression was performed using hospital mortality as outcome and Simplified Acute Physiology Score (SAPS 3), ΔPlat24h and ΔMPV24h as covariates. Concentrations of the following inflammatory mediators were measured using Miliplex® technology: IL1β, IL6, IL8, IL10, epidermal growth factor, vascular endothelial growth factor, TNFα and IFNα. Cytokine concentrations were compared between groups using the Kruskal-Wallis test with Bonferroni correction. Results Patients in whom MPV increased and platelet count decreased had higher mortality rates (46%). According to logistic regression, ΔMPV24h was independently associated with increased mortality (OR 1.28 per 1% increase; 95% CI 1.08 to 1.48). No strong associations between inflammatory mediators and changes in MPV and platelet count were found. Conclusion An increase in MPV after admission to an ICU is independently associated with higher hospital mortality.
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Affiliation(s)
- Fernando G Zampieri
- Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil ; Laboratory of Medical Investigation 51 (LIM 51), Faculty of Medicine, University of São Paulo, São Paulo, Brazil ; Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Otavio T Ranzani
- Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Viviane Sabatoski
- Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Heraldo Possolo de Souza
- Laboratory of Medical Investigation 51 (LIM 51), Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Hermes Barbeiro
- Laboratory of Medical Investigation 51 (LIM 51), Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luiz Monteiro Cruz da Neto
- Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Marcelo Park
- Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Fabiano Pinheiro da Silva
- Laboratory of Medical Investigation 51 (LIM 51), Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Pinheiro da Silva F, Zampieri FG, Barbeiro HV, Filho FT, Goulart AC, Jorgetti V, Velasco IT, da Cruz Neto LM, de Souza HP. Decreased parathyroid hormone levels despite persistent hypocalcemia in patients with kidney failure recovering from septic shock. Endocr Metab Immune Disord Drug Targets 2014; 13:135-42. [PMID: 23270481 DOI: 10.2174/1871530311313020001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 12/08/2012] [Accepted: 12/10/2012] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Hypocalcemia is a common and poorly understood finding in critically ill patients. The current study was designed to assess the association of ionized calcium, vitamin D, phosphorus and Parathyroid hormone levels in a cohort of patients with and without kidney dysfunction admitted for sepsis or non-infectious causes. METHODS Prospective cohort clinical and biochemical study. RESULTS We confirmed that hypocalcemia and hypovitaminosis D are a common finding in critically ill patients. Parathyroid hormone levels significantly rise in septic shock. In the recovery phase, however, despite persistent hypocalcemia, Parathyroid hormone levels abruptly decrease in patients with kidney dysfunction, but not in patients with normal renal function. CONCLUSIONS The systemic inflammatory response syndrome probably leads to inappropriately high Parathyroid hormone levels during septic shock. In the recovery phase, Parathyroid hormone levels decrease, but calcium levels remain low, displaying evidence that the parathyroid is not responding as expected. Since Parathyroid hormone receptors and calcium-sensing receptors have been described in immune cells and other cell types, we propose that these effects may have a plethora of other deleterious effects, with important implications to the pathogenesis of septic shock.
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Pinheiro da Silva F, Medeiros MCR, Santos ÂBGD, Ferreira MA, Garippo AL, Chammas R, Caldini E, Velasco IT, Possolo de Souza H, Machado MCC. Neutrophils LL-37 migrate to the nucleus during overwhelming infection. Tissue Cell 2013; 45:318-20. [DOI: 10.1016/j.tice.2013.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 04/08/2013] [Accepted: 04/23/2013] [Indexed: 11/25/2022]
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Cury V, Moretti AIS, Assis L, Bossini P, Crusca JDS, Neto CB, Fangel R, de Souza HP, Hamblin MR, Parizotto NA. Low level laser therapy increases angiogenesis in a model of ischemic skin flap in rats mediated by VEGF, HIF-1α and MMP-2. J Photochem Photobiol B 2013; 125:164-70. [PMID: 23831843 DOI: 10.1016/j.jphotobiol.2013.06.004] [Citation(s) in RCA: 352] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 05/10/2013] [Accepted: 06/10/2013] [Indexed: 11/24/2022]
Abstract
It is known that low level laser therapy is able to improve skin flap viability by increasing angiogenesis. However, the mechanism for new blood vessel formation is not completely understood. Here, we investigated the effects of 660 nm and 780 nm lasers at fluences of 30 and 40 J/cm(2) on three important mediators activated during angiogenesis. Sixty male Wistar rats were used and randomly divided into five groups with twelve animals each. Groups were distributed as follows: skin flap surgery non-irradiated group as a control; skin flap surgery irradiated with 660 nm laser at a fluence of 30 or 40 J/cm(2) and skin flap surgery irradiated with 780 nm laser at a fluence of 30 or 40 J/cm(2). The random skin flap was performed measuring 10×4 cm, with a plastic sheet interposed between the flap and the donor site. Laser irradiation was performed on 24 points covering the flap and surrounding skin immediately after the surgery and for 7 consecutive days thereafter. Tissues were collected, and the number of vessels, angiogenesis markers (vascular endothelial growth factor, VEGF and hypoxia inducible factor, HIF-1α) and a tissue remodeling marker (matrix metalloproteinase, MMP-2) were analyzed. LLLT increased an angiogenesis, HIF-1α and VEGF expression and decrease MMP-2 activity. These phenomena were dependent on the fluences, and wavelengths used. In this study we showed that LLLT may improve the healing of skin flaps by enhancing the amount of new vessels formed in the tissue. Both 660 nm and 780 nm lasers were able to modulate VEGF secretion, MMP-2 activity and HIF-1α expression in a dose dependent manner.
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Affiliation(s)
- Vivian Cury
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
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39
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Pinheiro da Silva F, Zampieri FG, Barbeiro DF, Barbeiro HV, Goulart AC, Torggler Filho F, Velasco IT, da Cruz Neto LM, de Souza HP, Machado MCC. Septic shock in older people: a prospective cohort study. Immun Ageing 2013; 10:21. [PMID: 23742671 PMCID: PMC3685530 DOI: 10.1186/1742-4933-10-21] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 06/02/2013] [Indexed: 11/10/2022]
Abstract
Background Septic shock is the first cause of death in Intensive Care Units. Despite experimental data showing increased inflammatory response of aged animals following infection, the current accepted hypothesis claims that aged patients are immunocompromised, when compared to young individuals. Results Here, we describe a prospective cohort study designed to analyze the immune profile of this population. Conclusion Older people are as immunocompetent as the young individual, regarding the cytokines, chemokines and growth factors response to devastating infection.
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Rios ECS, Moretti AIS, Souza HPD, Velasco IT, Soriano FG. Reposição volêmica com soluções salinas em pancreatite e perfil hepático de proteínas apoptóticas e de choque térmico. Rev Bras Ter Intensiva 2012; 24:326-33. [PMID: 23917928 PMCID: PMC4031807 DOI: 10.1590/s0103-507x2012000400006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 10/31/2012] [Indexed: 11/21/2022] Open
Abstract
Objective Liver failure can occur as a consequence of the systemic inflammation after acute
pancreatitis. We assessed the effect of volume repositioning with hypertonic
saline solution or normal saline on hepatic cytokine production and the expression
of heat-shock proteins and apoptotic proteins after acute pancreatitis. Methods Wistar rats were divided in four groups: C - control animals that were not
subjected to insult or treatment; NT - animals that were subjected to acute
pancreatitis and received no treatment; normal saline - animals that were
subjected to acute pancreatitis and received normal saline (NaCl 0.9%); and HS -
animals that were subjected to acute pancreatitis and received hypertonic saline
solution (NaCl 7.5%). Acute pancreatitis was induced by retrograde transduodenal
infusion of 2.5% sodium taurocholate into the pancreatic duct. At 4, 12 and 24 h
following acute pancreatitis induction, TNF-alpha, IL-1-beta, IL-6 and IL-10,
caspase-2 and -7, Apaf-1, AIF and HSP60 and 90 were analyzed in the liver. Results Casp2 decreased in the normal saline and hypertonic saline groups (p<0.05
versus. C) at 12 h. Apaf-1, AIF and HSP90 remained unchanged.
At 4 h, Casp7 increased in the NT group (p<0.01 versus C),
although it remained at the baseline levels in the reperfused groups. HSP60
increased in all of the groups at 4 h (p<0.0.001 vs. C).
However, the hypertonic saline group showed lower expression of HSP60 than the
normal saline group (p<0.05). Hypertonic saline solution maintained the
production of cytokines at normal levels. Volume reperfusion with normal or
hypertonic saline significantly modulated the expression of Casp7. Conclusion Volume replacement with hypertonic or normal saline was effective in reducing
caspase 7. However, only hypertonic solution was capable of regulating cytokine
production and HSP60 expression at all time points.
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Machado MCC, Barbeiro HV, Pinheiro da Silva F, de Souza HP. Circulating fatty acid binding protein as a marker of intestinal failure in septic patients. Crit Care 2012; 16:455. [PMID: 23130611 PMCID: PMC3672560 DOI: 10.1186/cc11653] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Hort MA, Schuldt EZ, Bet ÂC, DalBó S, Siqueira JM, Ianssen C, Abatepaulo F, de Souza HP, Veleirinho B, Maraschin M, Ribeiro-do-Valle RM. Anti-Atherogenic Effects of a Phenol-Rich Fraction from Brazilian Red Wine (Vitis labrusca L.) in Hypercholesterolemic Low-Density Lipoprotein Receptor Knockout Mice. J Med Food 2012; 15:936-44. [DOI: 10.1089/jmf.2011.0333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Mariana Appel Hort
- Department of Biochemistry, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Department of Pharmacology, Biological Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Elke Zuleika Schuldt
- Department of Pharmacology, Biological Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Ângela Cristina Bet
- Department of Pharmacology, Biological Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Silvia DalBó
- Department of Pharmacology, Biological Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Jarbas Mota Siqueira
- Department of Pharmacology, Biological Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Carla Ianssen
- Laboratory of Plant Morphogenesis and Biochemistry, Agricultural Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Fátima Abatepaulo
- Laboratory of Medical Investigations, University of São Paulo, São Paulo, Brazil
| | | | - Beatriz Veleirinho
- Department of Pharmacology, Biological Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Marcelo Maraschin
- Laboratory of Plant Morphogenesis and Biochemistry, Agricultural Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Rosa Maria Ribeiro-do-Valle
- Department of Pharmacology, Biological Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Assis L, Moretti AIS, Abrahão TB, de Souza HP, Hamblin MR, Parizotto NA. Low-level laser therapy (808 nm) contributes to muscle regeneration and prevents fibrosis in rat tibialis anterior muscle after cryolesion. Lasers Med Sci 2012; 28:947-55. [PMID: 22898787 DOI: 10.1007/s10103-012-1183-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 08/02/2012] [Indexed: 11/25/2022]
Abstract
Muscle regeneration is a complex phenomenon, involving replacement of damaged fibers by new muscle fibers. During this process, there is a tendency to form scar tissue or fibrosis by deposition of collagen that could be detrimental to muscle function. New therapies that could regulate fibrosis and favor muscle regeneration would be important for physical therapy. Low-level laser therapy (LLLT) has been studied for clinical treatment of skeletal muscle injuries and disorders, even though the molecular and cellular mechanisms have not yet been clarified. The aim of this study was to evaluate the effects of LLLT on molecular markers involved in muscle fibrosis and regeneration after cryolesion of the tibialis anterior (TA) muscle in rats. Sixty Wistar rats were randomly divided into three groups: control, injured TA muscle without LLLT, injured TA muscle treated with LLLT. The injured region was irradiated daily for four consecutive days, starting immediately after the lesion using an AlGaAs laser (808 nm, 30 mW, 180 J/cm(2); 3.8 W/cm(2), 1.4 J). The animals were sacrificed on the fourth day after injury. LLLT significantly reduced the lesion percentage area in the injured muscle (p<0.05), increased mRNA levels of the transcription factors MyoD and myogenin (p<0.01) and the pro-angiogenic vascular endothelial growth factor (p<0.01). Moreover, LLLT decreased the expression of the profibrotic transforming growth factor TGF-β mRNA (p<0.01) and reduced type I collagen deposition (p<0.01). These results suggest that LLLT could be an effective therapeutic approach for promoting skeletal muscle regeneration while preventing tissue fibrosis after muscle injury.
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Affiliation(s)
- Lívia Assis
- Laboratory of Electrothermophototherapy, Department of Physiotherapy, Federal University of São Carlos, São Carlos, SP, Brazil
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Rios ECS, Moretti AS, Velasco IT, Souza HPD, Abatepaulo F, Soriano F. Hypertonic saline and reduced peroxynitrite formation in experimental pancreatitis. Clinics (Sao Paulo) 2011; 66:469-76. [PMID: 21552675 PMCID: PMC3072010 DOI: 10.1590/s1807-59322011000300019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 11/17/2010] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES In this study, we tested the hypothesis that hypertonic saline exerts anti-inflammatory effects by modulating hepatic oxidative stress in pancreatitis. INTRODUCTION The incidence of hepatic injury is related to severe pancreatitis, and hypertonic saline reduces pancreatic injury and mortality in pancreatitis. METHODS Wistar rats were divided into four groups: control (not subjected to treatment), untreated pancreatitis (NT, pancreatitis induced by a retrograde transduodenal infusion of 2.5% sodium taurocholate into the pancreatic duct with no further treatment administered), pancreatitis with normal saline (NS, pancreatitis induced as described above and followed by resuscitation with 0.9% NaCl), and pancreatitis with hypertonic saline (HS, pancreatitis induced as described above and followed by resuscitation with 7.5% NaCl). At 4, 12, and 24 h after pancreatitis induction, liver levels of inducible nitric oxide synthase (iNOS), heat-shock protein 70, nitrotyrosine (formation of peroxynitrite), nitrite/nitrate production, lipid peroxidation, and alanine aminotransferase (ALT) release were determined. RESULTS Twelve hours after pancreatitis induction, animals in the HS group presented significantly lower iNOS expression (P<0.01 vs. NS), nitrite/nitrate levels (P<0.01 vs. NS), lipid peroxidation (P<0.05 vs. NT), and ALT release (P<0.01 vs. NS). Twenty-four hours after pancreatitis induction, nitrotyrosine expression was significantly lower in the HS group than in the NS group (P<0.05). DISCUSSION The protective effect of hypertonic saline was related to the establishment of a superoxide-NO balance that was unfavorable to nitrotyrosine formation. CONCLUSIONS Hypertonic saline decreases hepatic oxidative stress and thereby minimizes liver damage in pancreatitis.
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Amorim BS, Ueta CB, Freitas BCG, Nassif RJ, Gouveia CHDA, Christoffolete MA, Moriscot AS, Lancelloti CL, Llimona F, Barbeiro HV, de Souza HP, Catanozi S, Passarelli M, Aoki MS, Bianco AC, Ribeiro MO. A TRbeta-selective agonist confers resistance to diet-induced obesity. J Endocrinol 2009; 203:291-9. [PMID: 19713219 PMCID: PMC3133532 DOI: 10.1677/joe-08-0539] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Thyroid hormone receptor beta (TRbeta also listed as THRB on the MGI Database)-selective agonists activate brown adipose tissue (BAT) thermogenesis, while only minimally affecting cardiac activity or lean body mass. Here, we tested the hypothesis that daily administration of the TRbeta agonist GC-24 prevents the metabolic alterations associated with a hypercaloric diet. Rats were placed on a high-fat diet and after a month exhibited increased body weight (BW) and adiposity, fasting hyperglycemia and glucose intolerance, increased plasma levels of triglycerides, cholesterol, nonesterified fatty acids and interleukin-6. While GC-24 administration to these animals did not affect food ingestion or modified the progression of BW gain, it did increase energy expenditure, eliminating the increase in adiposity without causing cardiac hypertrophy. Fasting hyperglycemia remained unchanged, but treatment with GC-24 improved glucose tolerance by increasing insulin sensitivity, and also normalized plasma triglyceride levels. Plasma cholesterol levels were only partially normalized and liver cholesterol content remained high in the GC-24-treated animals. Gene expression in liver, skeletal muscle, and white adipose tissue was only minimally affected by treatment with GC-24, with the main target being BAT. In conclusion, during high-fat feeding treatment with the TRbeta-selective agonist, GC-24 only partially improves metabolic control probably as a result of accelerating the resting metabolic rate.
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Affiliation(s)
- Beatriz S Amorim
- Biological Science Course, CCBS, Presbyterian University Mackenzie, Rua da Consolação, 930 Prédio 38, Curso de Biologia, São Paulo, SP 01302-907, Brazil
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de Andrade CR, Fukada SY, Olivon VC, de Godoy MAF, Haddad R, Eberlin MN, Cunha FQ, de Souza HP, Laurindo FRM, de Oliveira AM. Alpha1D-adrenoceptor-induced relaxation on rat carotid artery is impaired during the endothelial dysfunction evoked in the early stages of hyperhomocysteinemia. Eur J Pharmacol 2006; 543:83-91. [PMID: 16828078 DOI: 10.1016/j.ejphar.2006.06.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 05/27/2006] [Accepted: 06/02/2006] [Indexed: 11/20/2022]
Abstract
Hyperhomocysteinemia is a known risk factor for cardiovascular diseases, but the underlying mechanisms of this pathology are complex. We aimed to evaluate the effect of hyperhomocysteinemia in vasorelaxations induced by alpha(1D)-adrenoceptor agonists. Vascular reactivity of rat carotid artery to the alpha-adrenoceptor agonist, phenylephrine, was enhanced in hyperhomocysteinemia. Mechanical removal of endothelium did not modify the carotid responsiveness to phenylephrine, compared to control. Phenylephrine induces endothelium-dependent relaxation, in the presence of 5-methyl urapidil (alpha(1A)-adrenoceptor antagonist). We hypothesised that endothelial-relaxant alpha(1)-adrenoceptors are impaired by hyperhomocysteinemia. Incubation with prazosin (selective alpha(1)-adrenoceptor antagonist) or BMY7378 (8-[2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl]-8-azaspiro[4,5]decane-7, 9-dione dihydrochloride) (selective alpha(1D)-adrenoceptor antagonist), similarly inhibited phenylephrine-induced relaxations in both control and hyperhomocysteinemic carotids. Immunohistochemistry showed enhanced immunoreactivity for eNOS and iNOS in hyperhomocysteinemic rats. In carotid arteries from hyperhomocysteinemic rats there was a decrease in superoxide dismutase activity and enhanced superoxide anion production. We conclude that alpha(1D)-adrenoceptors mediate endothelium-dependent relaxation triggered by phenylephrine in rat carotid artery and affect the final tone. Furthermore, the enhanced phenylephrine-induced contraction in carotid artery due to hyperhomocysteinemia is endothelium-dependent and involves a loss of the inhibitory effect of relaxant alpha(1D)-adrenoceptors by reducing NO biodisponibility.
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MESH Headings
- Adrenergic alpha-Agonists/pharmacology
- Adrenergic alpha-Antagonists/pharmacology
- Animals
- Carotid Arteries/drug effects
- Carotid Arteries/metabolism
- Carotid Arteries/physiopathology
- Disease Models, Animal
- Dose-Response Relationship, Drug
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/metabolism
- Endothelium, Vascular/physiopathology
- Enzyme Inhibitors/pharmacology
- Hyperhomocysteinemia/chemically induced
- Hyperhomocysteinemia/metabolism
- Hyperhomocysteinemia/physiopathology
- Male
- NG-Nitroarginine Methyl Ester/pharmacology
- Nitric Oxide/metabolism
- Nitric Oxide Synthase/antagonists & inhibitors
- Nitric Oxide Synthase/biosynthesis
- Phenylephrine/pharmacology
- Piperazines/pharmacology
- Prazosin/pharmacology
- Rats
- Rats, Wistar
- Receptors, Adrenergic, alpha-1/drug effects
- Receptors, Adrenergic, alpha-1/metabolism
- Superoxide Dismutase/metabolism
- Superoxides/metabolism
- Vasoconstriction/drug effects
- Vasodilation/drug effects
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Affiliation(s)
- Claudia Roberta de Andrade
- Department of Pharmacology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Souza HPD. A via de sinalização CD40/CD40L na sepse grave. Rev Assoc Med Bras (1992) 2003. [DOI: 10.1590/s0104-42302003000100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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