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Carmo TA, Ferreira IBB, Menezes RC, Pina MLT, Oliveira RS, Telles GP, Machado AFA, Aguiar TC, Caldas JR, Arriaga MB, Akrami KM, Filgueiras Filho NM, Andrade BB. Calibration and validation of the Pneumonia Shock Score in critically ill patients with SARS-CoV-2 infection, a multicenter prospective cohort study. Front Med (Lausanne) 2022; 9:958291. [PMID: 36045919 PMCID: PMC9420902 DOI: 10.3389/fmed.2022.958291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background Prognostic tools developed to stratify critically ill patients in Intensive Care Units (ICUs), are critical to predict those with higher risk of mortality in the first hours of admission. This study aims to evaluate the performance of the pShock score in critically ill patients admitted to the ICU with SARS-CoV-2 infection. Methods Prospective observational analytical cohort study conducted between January 2020 and March 2021 in four general ICUs in Salvador, Brazil. Descriptive statistics were used to characterize the cohort and a logistic regression, followed by cross-validation, were performed to calibrate the score. A ROC curve analysis was used to assess accuracy of the models analyzed. Results Six hundred five adult ICU patients were included in the study. The median age was 63 (IQR: 49–74) years with a mortality rate of 33.2% (201 patients). The calibrated pShock-CoV score performed well in prediction of ICU mortality (AUC of 0.80 [95% Confidence Interval (CI): 0.77–0.83; p-value < 0.0001]). Conclusions The pShock-CoV score demonstrated robust discriminatory capacity and may assist in targeting scarce ICU resources during the COVID-19 pandemic to those critically ill patients most likely to benefit.
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Affiliation(s)
- Thomas A. Carmo
- Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
| | - Isabella B. B. Ferreira
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
| | - Rodrigo C. Menezes
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Márcio L. T. Pina
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
| | | | - Gabriel P. Telles
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
| | | | | | | | - María B. Arriaga
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Kevan M. Akrami
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Divisions of Infectious Diseases and Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Nivaldo M. Filgueiras Filho
- Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
- Núcleo de Pesquisa, Ensino e Comunicação, Hospital de Cidade, Salvador, Bahia, Brazil
| | - Bruno B. Andrade
- Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- *Correspondence: Bruno B. Andrade
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2
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Menezes RC, Silva RLO, Arriaga MB, Ferreira IBB, Carmo TA, da Silva VR, Otero ML, Gobatto ALN, Agareno S, Filgueiras Filho NM, Akrami KM, Andrade BB. A prospective comparison between multidisciplinary healthcare providers' clinical examination and a validated pain scale. Front Pain Res 2022; 3:960216. [PMID: 36034751 PMCID: PMC9411743 DOI: 10.3389/fpain.2022.960216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Unrecognized pain in the Intensive Care Unit (ICU), due to inadequate assessment and therapeutic management, is associated with increased morbidity and mortality. Despite the availability of validated pain monitoring tools, such as the Critical-Care Pain Observational Tool (CPOT), these scales are not commonly used in clinical practice, with healthcare professionals often relying on their clinical impression. Our study aims to determine the agreement between the pain examination performed by ICU professionals and the CPOT. Methods Prospective cohort study that included critically ill patients and physicians, nurses and physiotherapists from an ICU in Bahia, Brazil. During bedside clinical rounds, the CPOT score was applied to assess the pain of hospitalized patients, and health professionals were interviewed to ascertain their perception of the patient's pain for a maximum of five consecutive days. Correlations were assessed using the Spearman rank tests. Hierarchical cluster analysis was employed to show the results of CPOT score and pain assessment by healthcare professionals at each study time. And the Kappa statistic was calculated to assess the agreement between the CPOT score vs. the pain assessment by healthcare providers. Results One hundred one patients were included in the study with median age of 74 years (IQR 61.5–83.5), a predominance of women (55.4%) and a median SAPS 3 score of 45 (IQR 39.5–53.0). The correlation between the professional's pain assessment and the CPOT were mostly statistically significant, ranged from negligible to weak, being the highest index obtained in the evaluation of nurses on day 5 (Kappa index = 0.43, p = 0.005). Physician assessments were significant only in day 1. On the presence of pain, the professionals' assessments and CPOT revealed mild to a moderate agreement. Conclusion Healthcare professional's pain assessment displayed a weak positive correlation with a validated pain scale and poor agreement amongst members of the ICU team, particularly when the pain was felt to be absent. Thus, this study highlights the importance of routine tools for pain assessment in the ICU for all members of multidisciplinary teams.
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Affiliation(s)
- Rodrigo C. Menezes
- Universidade Federal da Bahia, Faculdade de Medicina da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
| | - Raissa L. O. Silva
- Universidade Salvador (UNIFACS), Faculdade de Medicina, Salvador, Bahia, Brazil
| | - María B. Arriaga
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
| | - Isabella B. B. Ferreira
- Universidade Do Estado da Bahia (UNEB), Departamento de Ciências da Vida, Salvador, Bahia, Brazil
- Intensive Care Unit, Hospital de Cidade, Salvador, Bahia, Brazil
| | - Thomas A. Carmo
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
- Universidade Salvador (UNIFACS), Faculdade de Medicina, Salvador, Bahia, Brazil
| | - Victor R. da Silva
- Universidade Salvador (UNIFACS), Faculdade de Medicina, Salvador, Bahia, Brazil
| | - Matheus L. Otero
- Universidade Salvador (UNIFACS), Faculdade de Medicina, Salvador, Bahia, Brazil
| | | | - Sydney Agareno
- Intensive Care Unit, Hospital de Cidade, Salvador, Bahia, Brazil
| | - Nivaldo M. Filgueiras Filho
- Universidade Salvador (UNIFACS), Faculdade de Medicina, Salvador, Bahia, Brazil
- Universidade Do Estado da Bahia (UNEB), Departamento de Ciências da Vida, Salvador, Bahia, Brazil
- Intensive Care Unit, Hospital de Cidade, Salvador, Bahia, Brazil
| | - Kevan M. Akrami
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
- Division of Infectious Diseases and Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Bruno B. Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
- Universidade Salvador (UNIFACS), Faculdade de Medicina, Salvador, Bahia, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
- *Correspondence: Bruno B. Andrade
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Martinez Viedma MDP, Panossian S, Gifford K, García K, Figueroa I, Parham L, de Moraes L, Nunes Gomes L, García-Salum T, Perret C, Weiskopf D, Tan GS, Augusto Silva A, Boaventura V, Ruiz-Palacios GM, Sette A, De Silva AD, Medina RA, Lorenzana I, Akrami KM, Khouri R, Olson D, Pickett BE. Evaluation of ELISA-Based Multiplex Peptides for the Detection of Human Serum Antibodies Induced by Zika Virus Infection across Various Countries. Viruses 2021; 13:1319. [PMID: 34372525 PMCID: PMC8310037 DOI: 10.3390/v13071319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/18/2021] [Accepted: 07/06/2021] [Indexed: 01/02/2023] Open
Abstract
Zika virus (ZIKV) is a mosquito-borne Flavivirus with a positive-sense RNA genome, which are generally transmitted through the bite of an infected Aedes mosquito. ZIKV infections could be associated with neurological sequelae that, and otherwise produces similar clinical symptoms as other co-circulating pathogens. Past infection with one member of the Flavivirus genus often induces cross-reactive antibodies against other flaviruses. These attributes complicate the ability to differentially diagnose ZIKV infection from other endemic mosquito-borne viruses, making it both a public health issue as well as a diagnostic challenge. We report the results from serological analyses using arbovirus-specific peptides on 339 samples that were previously collected from 6 countries. Overall, we found that our multiplexed peptide-based ELISA was highly efficient for identifying ZIKV antibodies as early as 2 weeks post infection, and that it correlates with microneutralization, plaque reduction neutralization tests (PRNTs) and commercial tests for ZIKV in previously characterized samples. We observed that seropositivity varied by patient cohort, reflecting the sampling period in relation to the 2015-2016 ZIKV outbreak. This work evaluates the accuracy, specificity, and sensitivity of our peptide-based ELISA method for detecting ZIKV antibodies from geographically diverse regions. These findings can contribute to ongoing serological methods development and can be adapted for use in future studies.
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Affiliation(s)
| | | | - Kennedy Gifford
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, UT 84602, USA;
| | - Kimberly García
- Instituto de Investigacion en Microbiologia, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras; (K.G.); (I.F.); (L.P.); (I.L.)
| | - Isis Figueroa
- Instituto de Investigacion en Microbiologia, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras; (K.G.); (I.F.); (L.P.); (I.L.)
| | - Leda Parham
- Instituto de Investigacion en Microbiologia, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras; (K.G.); (I.F.); (L.P.); (I.L.)
| | - Laise de Moraes
- Institute Goncalo Moniz, Fiocruz Bahia, Salvador 40296-710, Brazil; (L.d.M.); (L.N.G.); (V.B.)
| | - Lillian Nunes Gomes
- Institute Goncalo Moniz, Fiocruz Bahia, Salvador 40296-710, Brazil; (L.d.M.); (L.N.G.); (V.B.)
| | - Tamara García-Salum
- Departmento de Enfermedades Infecciosas e Inmunología Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago H955+8Q, Chile; (T.G.-S.); (C.P.); (R.A.M.)
| | - Cecilia Perret
- Departmento de Enfermedades Infecciosas e Inmunología Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago H955+8Q, Chile; (T.G.-S.); (C.P.); (R.A.M.)
| | - Daniela Weiskopf
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037, USA; (D.W.); (A.S.); (A.D.D.S.)
| | - Gene S. Tan
- J. Craig Venter Institute, La Jolla, CA 92137, USA; (M.d.P.M.V.); (G.S.T.)
- Department of Medicine, Infectious Diseases Division, University of California San Diego, La Jolla, CA 92037, USA
| | - Antônio Augusto Silva
- Hospital Universitário-Universidade Federal do Maranhão, São Luís 65000-000, Brazil;
| | - Viviane Boaventura
- Institute Goncalo Moniz, Fiocruz Bahia, Salvador 40296-710, Brazil; (L.d.M.); (L.N.G.); (V.B.)
- Faculdade de Medicina da Bahia-Universidade Federal da Bahia, Salvador 40000-000, Brazil; (K.M.A.); (R.K.)
| | | | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037, USA; (D.W.); (A.S.); (A.D.D.S.)
- Department of Medicine, University of California San Diego, La Jolla, CA 92037, USA
| | - Aruna Dharshan De Silva
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037, USA; (D.W.); (A.S.); (A.D.D.S.)
- Genetech Research Institute, Colombo 00800, Sri Lanka
- Department of Paraclinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana 10390, Sri Lanka
| | - Rafael A. Medina
- Departmento de Enfermedades Infecciosas e Inmunología Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago H955+8Q, Chile; (T.G.-S.); (C.P.); (R.A.M.)
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ivette Lorenzana
- Instituto de Investigacion en Microbiologia, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras; (K.G.); (I.F.); (L.P.); (I.L.)
| | - Kevan M. Akrami
- Faculdade de Medicina da Bahia-Universidade Federal da Bahia, Salvador 40000-000, Brazil; (K.M.A.); (R.K.)
- Department of Medicine, University of California San Diego, La Jolla, CA 92037, USA
| | - Ricardo Khouri
- Faculdade de Medicina da Bahia-Universidade Federal da Bahia, Salvador 40000-000, Brazil; (K.M.A.); (R.K.)
| | - Daniel Olson
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Brett E. Pickett
- J. Craig Venter Institute, La Jolla, CA 92137, USA; (M.d.P.M.V.); (G.S.T.)
- J. Craig Venter Institute, Rockville, MD 20850, USA;
- Department of Microbiology and Molecular Biology, Brigham Young University, Provo, UT 84602, USA;
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Carmo TA, Filgueiras Filho NM, Andrade BB, Akrami KM. Reply to Reyes et al. Clin Infect Dis 2021; 72:e444-e445. [PMID: 32770185 DOI: 10.1093/cid/ciaa1142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Thomas A Carmo
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil
| | - Nivaldo M Filgueiras Filho
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil.,Curso de Medicina, Universidade do Estado da Bahia, Salvador, Bahia, Brazil.,Hospital de Cidade, Núcleo de Ensino e Pesquisa e Comunicação, Salvador, Bahia, Brazil
| | - Bruno B Andrade
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Salvador, Brazil.,Curso de Medicina, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil.,Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Kevan M Akrami
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Bahia, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.,Division of Infectious Diseases and Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, California, USA
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5
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Carmo TA, Ferreira IB, Menezes RC, Telles GP, Otero ML, Arriaga MB, Fukutani KF, Neto LP, Agareno S, Filgueiras Filho NM, Andrade BB, Akrami KM. Derivation and Validation of a Novel Severity Scoring System for Pneumonia at Intensive Care Unit Admission. Clin Infect Dis 2021; 72:942-949. [PMID: 32146482 PMCID: PMC7958772 DOI: 10.1093/cid/ciaa183] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/26/2019] [Accepted: 03/05/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Severity stratification scores developed in intensive care units (ICUs) are used in interventional studies to identify the most critically ill. Studies that evaluate accuracy of these scores in ICU patients admitted with pneumonia are lacking. This study aims to determine performance of severity scores as predictors of mortality in critically ill patients admitted with pneumonia. METHODS Prospective cohort study in a general ICU in Brazil. ICU severity scores (Simplified Acute Physiology Score 3 [SAPS 3] and Sepsis-Related Organ Failure Assessment [qSOFA]), prognostic scores of pneumonia (CURB-65 [confusion, urea, respiratory rate, blood pressure, age] and CRB-65 [confusion, respiratory rate, blood pressure, age]), and clinical and epidemiological variables in the first 6 hours of hospitalization were analyzed. RESULTS Two hundred patients were included between 2015 and 2018, with a median age of 81 years (interquartile range, 67-90 years) and female predominance (52%), primarily admitted from the emergency department (65%) with community-acquired pneumonia (CAP, 80.5%). SAPS 3, CURB-65, CRB-65,and qSOFA all exhibited poor performance in predicting mortality. Multivariate regression identified variables independently associated with mortality that were used to develop a novel pneumonia-specific ICU severity score (Pneumonia Shock score) that outperformed SAPS 3, CURB-65, and CRB-65. The Shock score was validated in an external multicenter cohort of critically ill patients admitted with CAP. CONCLUSIONS We created a parsimonious score that accurately identifies patients with pneumonia at highest risk of ICU death. These findings are critical to accurately stratify patients with severe pneumonia in therapeutic trials that aim to reduce mortality.
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Affiliation(s)
- Thomas A Carmo
- Universidade Salvador, Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Fundação José Silveira, Salvador, Brazil
| | | | - Rodrigo C Menezes
- União Metropolitana para o Desenvolvimento da Educação e Cultura, Salvador, Bahia, Brazil
| | - Gabriel P Telles
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | | | - Maria B Arriaga
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Fundação José Silveira, Salvador, Brazil
- Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Kiyoshi F Fukutani
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Fundação José Silveira, Salvador, Brazil
- Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
| | - Licurgo P Neto
- Hospital de Cidade, Intensive Care Unit, Salvador, Bahia, Brazil
| | - Sydney Agareno
- Hospital de Cidade, Intensive Care Unit, Salvador, Bahia, Brazil
| | - Nivaldo M Filgueiras Filho
- Universidade Salvador, Salvador, Bahia, Brazil
- Universidade do Estado da Bahia, Salvador, Bahia, Brazil
- Hospital de Cidade, Núcleo de Ensino e Pesquisa e Comunicação, Salvador, Bahia, Brazil
| | - Bruno B Andrade
- Universidade Salvador, Salvador, Bahia, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative, Fundação José Silveira, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
- Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Kevan M Akrami
- Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Divisions of Infectious Diseases and Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla, California, USA
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6
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Amaral EP, Vinhaes CL, Oliveira-de-Souza D, Nogueira B, Akrami KM, Andrade BB. The Interplay Between Systemic Inflammation, Oxidative Stress, and Tissue Remodeling in Tuberculosis. Antioxid Redox Signal 2021; 34:471-485. [PMID: 32559410 PMCID: PMC8020551 DOI: 10.1089/ars.2020.8124] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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] [Indexed: 02/06/2023]
Abstract
Significance: Excessive and prolonged proinflammatory responses are associated with oxidative stress, which is commonly observed during chronic tuberculosis (TB). Such condition favors tissue destruction and consequently bacterial spread. A tissue remodeling program is also triggered in chronically inflamed sites, facilitating a wide spectrum of clinical manifestations. Recent Advances: Since persistent and exacerbated oxidative stress responses have been associated with severe pathology, a number of studies have suggested that the inhibition of this augmented stress response by improving host antioxidant status may represent a reasonable strategy to ameliorate tissue damage in TB. Critical Issues: This review summarizes the interplay between oxidative stress, systemic inflammation and tissue remodeling, and its consequences in promoting TB disease. We emphasize the most important mechanisms associated with stress responses that contribute to the progression of TB. We also point out important host immune components that may influence the exacerbation of cellular stress and the subsequent tissue injury. Future Directions: Further research should reveal valuable targets for host-directed therapy of TB, preventing development of severe immunopathology and disease progression. Antioxid. Redox Signal. 34, 471-485.
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Affiliation(s)
- Eduardo P Amaral
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Caian L Vinhaes
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Curso de Medicina, Faculdade de Tecnologia e Ciências (FTC), Salvador, Brazil
| | - Deivide Oliveira-de-Souza
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Curso de Medicina, Faculdade de Tecnologia e Ciências (FTC), Salvador, Brazil
| | - Betania Nogueira
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Curso de Medicina, Faculdade de Tecnologia e Ciências (FTC), Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Kevan M Akrami
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.,Division of Infectious Diseases and Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, California, USA
| | - Bruno B Andrade
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Curso de Medicina, Faculdade de Tecnologia e Ciências (FTC), Salvador, Brazil.,Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Brazil.,Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
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7
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Vinhaes CL, Araujo-Pereira M, Tibúrcio R, Cubillos-Angulo JM, Demitto FO, Akrami KM, Andrade BB. Systemic Inflammation Associated with Immune Reconstitution Inflammatory Syndrome in Persons Living with HIV. Life (Basel) 2021; 11:life11010065. [PMID: 33477581 PMCID: PMC7831327 DOI: 10.3390/life11010065] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 12/19/2022] Open
Abstract
Antiretroviral therapy (ART) has represented a major advancement in the care of people living with HIV (PLWHH), resulting in significant reductions in morbidity and mortality through immune reconstitution and attenuation of homeostatic disruption. Importantly, restoration of immune function in PLWH with opportunistic infections occasionally leads to an intense and uncontrolled cytokine storm following ART initiation known as immune reconstitution inflammatory syndrome (IRIS). IRIS occurrence is associated with the severe and rapid clinical deterioration that results in significant morbidity and mortality. Here, we detail the determinants underlying IRIS development in PLWH, compiling the available knowledge in the field to highlight details of the inflammatory responses in IRIS associated with the most commonly reported opportunistic pathogens. This review also highlights gaps in the understanding of IRIS pathogenesis and summarizes therapeutic strategies that have been used for IRIS.
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Affiliation(s)
- Caian L. Vinhaes
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil; (C.L.V.); (M.A.-P.); (R.T.); (J.M.C.-A.); (K.M.A.)
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 40210-320, Brazil;
- Bahiana School of Medicine and Public Health, Bahia Foundation for the Development of Sciences, Salvador 40290-000, Brazil
| | - Mariana Araujo-Pereira
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil; (C.L.V.); (M.A.-P.); (R.T.); (J.M.C.-A.); (K.M.A.)
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 40210-320, Brazil;
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador 40110-100, Brazil
| | - Rafael Tibúrcio
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil; (C.L.V.); (M.A.-P.); (R.T.); (J.M.C.-A.); (K.M.A.)
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 40210-320, Brazil;
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador 40110-100, Brazil
| | - Juan M. Cubillos-Angulo
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil; (C.L.V.); (M.A.-P.); (R.T.); (J.M.C.-A.); (K.M.A.)
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 40210-320, Brazil;
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador 40110-100, Brazil
| | - Fernanda O. Demitto
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 40210-320, Brazil;
| | - Kevan M. Akrami
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil; (C.L.V.); (M.A.-P.); (R.T.); (J.M.C.-A.); (K.M.A.)
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 40210-320, Brazil;
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador 40110-100, Brazil
- Divisions of Infectious Diseases and Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, CA 92093, USA
| | - Bruno B. Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil; (C.L.V.); (M.A.-P.); (R.T.); (J.M.C.-A.); (K.M.A.)
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador 40210-320, Brazil;
- Bahiana School of Medicine and Public Health, Bahia Foundation for the Development of Sciences, Salvador 40290-000, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador 40110-100, Brazil
- Curso de Medicina, Centro Universitário Faculdade de Tecnologia e Ciências (UniFTC), Salvador 41741-590, Brazil
- Correspondence: ; Tel.: +55-71-3176-2264
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8
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Ahmed HY, Papali A, Haile T, Shrestha GS, Schultz MJ, Lundeg G, Akrami KM, For The Covid-Lmic Task Force. Pragmatic Recommendations for the Management of Anticoagulation and Venous Thrombotic Disease for Hospitalized Patients with COVID-19 in Low- and Middle-Income Countries. Am J Trop Med Hyg 2021; 104:99-109. [PMID: 33432908 PMCID: PMC7957232 DOI: 10.4269/ajtmh.20-1305] [Citation(s) in RCA: 1] [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: 10/06/2020] [Accepted: 12/23/2020] [Indexed: 12/19/2022] Open
Abstract
New studies of COVID–19 are constantly updating best practices in clinical care. Often, it is impractical to apply recommendations based on high-income country investigations to resource limited settings in low- and middle-income countries (LMICs). We present a set of pragmatic recommendations for the management of anticoagulation and thrombotic disease for hospitalized patients with COVID-19 in LMICs. In the absence of contraindications, we recommend prophylactic anticoagulation with either low molecular weight heparin (LMWH) or unfractionated heparin (UFH) for all hospitalized COVID-19 patients in LMICs. If available, we recommend LMWH over UFH for venous thromboembolism (VTE) prophylaxis to minimize risk to healthcare workers. We recommend against the use of aspirin for VTE prophylaxis in hospitalized COVID-19 and non–COVID-19 patients in LMICs. Because of limited evidence, we suggest against the use of “enhanced” or “intermediate” prophylaxis in COVID-19 patients in LMICs. Based on current available evidence, we recommend against the initiation of empiric therapeutic anticoagulation without clinical suspicion for VTE. If contraindications exist to chemical prophylaxis, we recommend mechanical prophylaxis with intermittent pneumatic compression (IPC) devices or graduated compression stockings (GCS) for hospitalized COVID-19 patients in LMICs. In LMICs, we recommend initiating therapeutic anticoagulation for hospitalized COVID-19 patients, in accordance with local clinical practice guidelines, if there is high clinical suspicion for VTE, even in the absence of testing. If available, we recommend LMWH over UFH or Direct oral anticoagulants for treatment of VTE in LMICs to minimize risk to healthcare workers. In LMIC settings where continuous intravenous UFH or LMWH are unavailable or not feasible to use, we recommend fixed dose heparin, adjusted to body weight, in hospitalized COVID-19 patients with high clinical suspicion of VTE. We suggest D-dimer measurement, if available and affordable, at the time of admission for risk stratification, or when clinical suspicion for VTE is high. For hospitalized COVID-19 patients in LMICs, based on current available evidence, we make no recommendation on the use of serial D-dimer monitoring for the initiation of therapeutic anticoagulation. For hospitalized COVID-19 patients in LMICs receiving intravenous therapeutic UFH, we recommend serial monitoring of partial thromboplastin time or anti-factor Xa level, based on local laboratory capabilities. For hospitalized COVID-19 patients in LMICs receiving LMWH, we suggest against serial monitoring of anti-factor Xa level. We suggest serial monitoring of platelet counts in patients receiving therapeutic anticoagulation for VTE, to assess risk of bleeding or development of heparin induced thrombocytopenia.
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Affiliation(s)
- Hanan Y Ahmed
- Division of Pulmonary and Critical Care Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alfred Papali
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
| | - Tewodros Haile
- Division of Pulmonary and Critical Care Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gentle S Shrestha
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Marcus J Schultz
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand.,Department of Intensive Care, Amsterdam University Medical Centers, Location 'Academic Medical Center', Amsterdam, The Netherlands
| | - Ganbold Lundeg
- Critical Care and Anaesthesia Department, Mongolian National University of Medical Sciences, Ulan Bator, Mongolia
| | - Kevan M Akrami
- Divisions of Infectious Disease and Critical Care Medicine, University of California San Diego, San Diego, California.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
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9
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Shetty VU, Brotherton BJ, Achilleos A, Akrami KM, Barros LM, Checkley W, Cobb N, Maximous S, Misango D, Park C, Taran S, Lee BW. Pragmatic Recommendations for Therapeutics of Hospitalized COVID-19 Patients in Low- and Middle-Income Countries. Am J Trop Med Hyg 2020; 104:48-59. [PMID: 33377451 PMCID: PMC7957231 DOI: 10.4269/ajtmh.20-1106] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/17/2020] [Indexed: 12/15/2022] Open
Abstract
The therapeutic options for COVID-19 patients are currently limited, but numerous randomized controlled trials are being completed, and many are on the way. For COVID-19 patients in low- and middle-income countries (LMICs), we recommend against using remdesivir outside of a clinical trial. We recommend against using hydroxychloroquine ± azithromycin or lopinavir-ritonavir. We suggest empiric antimicrobial treatment for likely coinfecting pathogens if an alternative infectious cause is likely. We suggest close monitoring without additional empiric antimicrobials if there are no clinical or laboratory signs of other infections. We recommend using oral or intravenous low-dose dexamethasone in adults with COVID-19 disease who require oxygen or mechanical ventilation. We recommend against using dexamethasone in patients with COVID-19 who do not require supplemental oxygen. We recommend using alternate equivalent doses of steroids in the event that dexamethasone is unavailable. We also recommend using low-dose corticosteroids in patients with refractory shock requiring vasopressor support. We recommend against the use of convalescent plasma and interleukin-6 inhibitors, such as tocilizumab, for the treatment of COVID-19 in LMICs outside of clinical trials.
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Affiliation(s)
- Varun U. Shetty
- Critical Care Medicine Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Brian Jason Brotherton
- Critical Care Medicine Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Internal Medicine, Kijabe Medical Center, Kijabe, Kenya
| | - Andrew Achilleos
- Department of Critical Care, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Kevan M. Akrami
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Divisions of Infectious Disease, University of California San Diego, San Diego, California
- Critical Care Medicine, University of California San Diego, San Diego, California
| | - Lia M. Barros
- Department of Cardiology, University of Washington Medical Center, Seattle, Washington
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Natalie Cobb
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington Medical Center, Seattle, Washington
| | - Stephanie Maximous
- Division of Pulmonary Allergy Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David Misango
- Department of Anaesthesiology and Critical Care Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Casey Park
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto, Canada
| | - Shaurya Taran
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto, Canada
| | - Burton W. Lee
- Division of Pulmonary Allergy Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - for the COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU)
- Critical Care Medicine Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Internal Medicine, Kijabe Medical Center, Kijabe, Kenya
- Department of Critical Care, Sunnybrook Health Sciences Center, Toronto, Canada
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
- Divisions of Infectious Disease, University of California San Diego, San Diego, California
- Critical Care Medicine, University of California San Diego, San Diego, California
- Department of Cardiology, University of Washington Medical Center, Seattle, Washington
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington Medical Center, Seattle, Washington
- Division of Pulmonary Allergy Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Anaesthesiology and Critical Care Medicine, Aga Khan University Hospital, Nairobi, Kenya
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto, Canada
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland
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10
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Maximous S, Brotherton BJ, Achilleos A, Akrami KM, Barros LM, Cobb N, Misango D, Papali A, Park C, Shetty VU, Schultz MJ, Taran S, Lee BW. Pragmatic Recommendations for the Management of COVID-19 Patients with Shock in Low- and Middle-Income Countries. Am J Trop Med Hyg 2020; 104:72-86. [PMID: 33350378 PMCID: PMC7957233 DOI: 10.4269/ajtmh.20-1105] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/27/2020] [Indexed: 12/15/2022] Open
Abstract
As some patients infected with the novel coronavirus progress to critical illness, a subset will eventually develop shock. High-quality data on management of these patients are scarce, and further investigation will provide valuable information in the context of the pandemic. A group of experts identify a set of pragmatic recommendations for the care of patients with SARS-CoV-2 and shock in resource-limited environments. We define shock as life-threatening circulatory failure that results in inadequate tissue perfusion and cellular dysoxia/hypoxia, and suggest that it can be operationalized via clinical observations. We suggest a thorough evaluation for other potential causes of shock and suggest against indiscriminate testing for coinfections. We suggest the use of the quick Sequential Organ Failure Assessment (qSOFA) as a simple bedside prognostic score for COVID-19 patients and point-of-care ultrasound (POCUS) to evaluate the etiology of shock. Regarding fluid therapy for the treatment of COVID-19 patients with shock in low-middle-income countries, we favor balanced crystalloids and recommend using a conservative fluid strategy for resuscitation. Where available and not prohibited by cost, we recommend using norepinephrine, given its safety profile. We favor avoiding the routine use of central venous or arterial catheters, where availability and costs are strong considerations. We also recommend using low-dose corticosteroids in patients with refractory shock. In addressing targets of resuscitation, we recommend the use of simple bedside parameters such as capillary refill time and suggest that POCUS be used to assess the need for further fluid resuscitation, if available.
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Affiliation(s)
- Stephanie Maximous
- 1Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Brian Jason Brotherton
- 2Department of Internal Medicine, Kijabe Medical Center, Kijabe, Kenya.,3Critical Care Medicine Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew Achilleos
- 4Department of Critical Care, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Kevan M Akrami
- 5Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.,6Divisions of Infectious Disease and Critical Care Medicine, University of California San Diego, San Diego, California
| | - Lia M Barros
- 7Department of Cardiology, University of Washington Medical Center, Seattle, Washington
| | - Natalie Cobb
- 8Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington Medical Center, Seattle, Washington
| | - David Misango
- 9Department of Anaesthesiology and Critical Care Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Alfred Papali
- 10Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
| | - Casey Park
- 11Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto, Canada
| | - Varun U Shetty
- 3Critical Care Medicine Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Marcus J Schultz
- 12Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,13Nuffield Department of Medicine, Mahidol University, Bangkok, Thailand.,14Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Shaurya Taran
- 11Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto, Canada
| | - Burton W Lee
- 1Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,15Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland
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11
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Leverone NA, Ramnath VR, Munce D, Raphelson JR, Ma J, Akuthota P, Tomaszewski C, Sell RE, Crotty Alexander LE, Akrami KM, Malhotra A. Critical Care Education in a Pandemic through Tele-ICU. ATS Sch 2020; 2:29-33. [PMID: 33870321 PMCID: PMC8043279 DOI: 10.34197/ats-scholar.2020-0132br] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/02/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Venktesh R. Ramnath
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
| | | | | | | | - Praveen Akuthota
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
| | - Christian Tomaszewski
- Department of Emergency Medicine, University of California San Diego Health, San Diego, California
| | - Rebecca E. Sell
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
| | - Laura E. Crotty Alexander
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
- Pulmonary Critical Care Section, Veterans Affairs San Diego Healthcare System, San Diego, California; and
| | - Kevan M. Akrami
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
- Faculdade de Medicina da Bahia, Universidade da Bahia, Salvador, Brazil
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
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12
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Akrami KM, de Nogueira BMF, do Rosário MS, de Moraes L, Cordeiro MT, Haddad R, Gomes LN, de Pádua Carvalho I, dos Reis Pimentel E, de Jesus Silva J, de Oliveira Francisco MVL, de Siqueira IC, Farias D, Barral-Netto M, Barral A, Boaventura V, Khouri R. The re-emergence of Zika in Brazil in 2020: a case of Guillain Barré Syndrome during the low season for arboviral infections. J Travel Med 2020; 27:taaa165. [PMID: 32941627 PMCID: PMC7649381 DOI: 10.1093/jtm/taaa165] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 12/25/2022]
Abstract
Zika virus cases in Brazil have diminished since emergence in 2015. We report Guillain Barré Syndrome caused by Zika and possible Chikungunya co-infection during an expected low arboviral season. This case highlights the importance of clinical vigilance for Zika in those with neurological syndromes outside typical arboviral season.
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Affiliation(s)
- Kevan M Akrami
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Division of Infectious Diseases and Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, CA, USA
| | - Betania Mara Freitas de Nogueira
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | | | - Rodrigo Haddad
- Faculdade de Ceilândia, Universidade de Brasília, (FCE-UnB), Brasília, Brazil
| | | | | | | | | | | | | | | | | | | | - Viviane Boaventura
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Ricardo Khouri
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
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13
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Menezes RC, Ferreira IBB, Carmo TA, Telles GP, Pugas PLD, Otero ML, Arriaga MB, Fukutani KF, Neto LP, Agareno S, Filgueiras Filho NM, Akrami KM, Andrade BB. Are prognostic tools losing accuracy? Development and performance of a novel age-calibrated severity scoring system for critically ill patients. PLoS One 2020; 15:e0240793. [PMID: 33147243 PMCID: PMC7641388 DOI: 10.1371/journal.pone.0240793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/03/2020] [Indexed: 11/25/2022] Open
Abstract
Objective This study aimed to assess the performance of a commonly used ICU severity score (SAPS3) and determine whether an alternative scoring system may be more accurate across all age strata. Methods Retrospective cohort study in a general ICU in Brazil. A secondary analysis was performed with clinical and epidemiological data, present in the first 24 hours of unit admission. Then, a binary logistic regression, followed by cross-validation, was made to develop a novel prognostic tool. ICU mortality was the primary outcome evaluated. Results A total of 3042 patients were included over the study period between August 2015 and July 2018 with a median age of 67 ± 18.4 years. SAPS3 performed fairly in prediction of ICU mortality, particularly in the 80 years or older subset. Multivariable regression identified variables independently associated with mortality that were used to develop the Age Calibrated ICU Score (ACIS) tool that performed similarly to SAPS3 across age categories, being slightly superior in the very elderly population (AUC 0.80 vs 0.72). Conclusions The ACIS offers a robust and simple tool to predict ICU mortality, particularly in an increasingly elderly critical care population.
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Affiliation(s)
- Rodrigo C. Menezes
- Hospital de Cidade, Núcleo de Pesquisa, Ensino e Comunicação, Salvador, Brazil
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Isabella B. B. Ferreira
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
| | - Thomas A. Carmo
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
| | - Gabriel P. Telles
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
| | - Paula L. D. Pugas
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
| | - Matheus L. Otero
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Maria B. Arriaga
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Kiyoshi F. Fukutani
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Bahia, Brazil
| | - Licurgo P. Neto
- Hospital de Cidade, Intensive Care Unit, Salvador, Bahia, Brazil
| | - Sydney Agareno
- Hospital de Cidade, Intensive Care Unit, Salvador, Bahia, Brazil
| | - Nivaldo M. Filgueiras Filho
- Hospital de Cidade, Núcleo de Pesquisa, Ensino e Comunicação, Salvador, Brazil
- Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
- Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
| | - Kevan M. Akrami
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Division of Infectious Diseases and Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, California, United States of America
| | - Bruno B. Andrade
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
- * E-mail:
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14
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Otero ML, Menezes RC, Ferreira IBB, Issa FL, Agareno G, Carmo TA, Arriaga MB, Fukutani KF, Pamplona Neto L, Agareno S, Filgueiras Filho NM, Akrami KM, Andrade BB. Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections. Infect Drug Resist 2020; 13:2811-2817. [PMID: 32848430 PMCID: PMC7430765 DOI: 10.2147/idr.s264276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/28/2020] [Accepted: 07/05/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Evaluate host and pathogen factors associated with mortality in those with hospital acquired infections (HAI) in a tertiary intensive care unit in Brazil. Methods Observational and analytical cohort single center study in a general intensive care unit (ICU) in Northeastern Brazil between January 2016 and August 2018, including those over 18 years of age admitted to the ICU found to have a HAI. Results A total of 165 patients were included, with a mean age of 72 years and male predominance (53.3%) and observed mortality of 46%. Mortality in those with HAI was significantly associated with older age, increased ICU length of stay and readmission to the ICU in univariate analysis. Multivariate analysis revealed that development of septic shock and obtundation during ICU admission was significantly associated with an increased risk of death (OR: 6.94, 95% CI 1.23–39.27, OR: 2.48, 95% CI 1.17–5.29, respectively). A trend towards mortality risk was noted in those with increased age and prior cardiovascular disease. Surprisingly, mortality risk was independent of site of infection, type of pathogen and antibiotic resistance. Furthermore, having more than one HAI over the course of the ICU admission did not impact mortality. Conclusion Risk of death in those with HAI is associated with obtundation and septic shock, in addition to vasopressor use. Host factors, rather than pathogen-specific characteristics or infecting site, impact risk of death related to HAI in the ICU.
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Affiliation(s)
- Matheus L Otero
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil
| | - Rodrigo C Menezes
- Curso de Medicina, União Metropolitana Para o Desenvolvimento da Educação e Cultura (UNIME), Salvador, Bahia, Brazil
| | | | - Francine L Issa
- Curso de Medicina, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | - Gabriel Agareno
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil
| | - Thomas Azevedo Carmo
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil
| | - María B Arriaga
- Curso de Medicina, Universidade do Estado da Bahia, Salvador, Bahia, Brazil.,Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
| | - Kiyoshi F Fukutani
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil
| | | | - Sydney Agareno
- Hospital Da Cidade, Intensive Care Unit, Salvador, Bahia, Brazil
| | - Nivaldo M Filgueiras Filho
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil.,Universidade Do Estado Da Bahia (UNEB), Salvador, Bahia, Brazil.,Hospital Da Cidade, Intensive Care Unit, Salvador, Bahia, Brazil
| | - Kevan M Akrami
- Division of Infectious Diseases and Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, California, USA
| | - Bruno B Andrade
- Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Bahia, Brazil.,Curso de Medicina, Universidade do Estado da Bahia, Salvador, Bahia, Brazil.,Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Bahia, Brazil.,Escola Bahiana De Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
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15
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Telles GP, Ferreira IBB, Carvalho de Menezes R, do Carmo TA, David Pugas PL, Marback LF, Arriaga MB, Fukutani KF, Neto LP, Agareno S, Akrami KM, Filgueiras Filho NM, Andrade BB. Comparison of a modified Sequential Organ Failure Assessment Score using RASS and FOUR. PLoS One 2020; 15:e0229199. [PMID: 32084199 PMCID: PMC7034824 DOI: 10.1371/journal.pone.0229199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 02/01/2020] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE ICU severity scores such as the Sequential Organ Failure Assessment (SOFA) determine neurologic dysfunction based on the Glasgow Coma Scale, a tool that may be limited in a critically ill population. It remains unknown whether alternative methods to assess for neurologic dysfunction, such as FOUR and RASS, are superior. This study aimed to determine the predictive performance of a modified SOFA tool in a large Brazilian ICU cohort. DESIGN Prospective cohort single center study. SETTING Mixed surgical and medical ICU in Salvador, Bahia, Brazil between August 2015 and December 2018. PATIENTS All acutely ill ICU admissions, other than postoperative patients or those with insufficient data, were eligible for study inclusion. MEASUREMENTS AND MAIN RESULTS 2147 patients were admitted to the ICU, of which 999 meeting inclusion criteria were included in the final analysis with a median age of 72 years (IQR 58-83) and a female predominance 545 (54%). The SOFA score using GCS, RASS and FOUR for the neurologic component performed marginally in the ability to predict general ICU mortality (SOFAGCS AUC 0.74 vs SOFARASS AUC 0.71 and SOFAFOUR AUC 0.67), with SOFAFOUR performing significantly lower compared to either SOFARASS and SOFAGCS (p<0.04, p<0.004 respectively). All three scores demonstrated decreased discriminate function in the mechanically ventilated population (SOFAGCS AUC 0.70 vs SOFARASS AUC 0.70 and SOFAFOUR AUC 0.55), though SOFAFOUR remained significantly worse when compared to SOFAGCS or SOFARASS (p = 0.034, p = 0.014, respectively).. Furthermore, performance was poor in a subset of patients with sepsis (n = 145) at time of admission (SOFAGCS AUC 0.66 vs SOFARASS AUC 0.55 and SOFAFOUR AUC 0.56). CONCLUSION Modification of the neurologic component in the SOFA score does not appear to improve mortality prediction in the ICU.
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Affiliation(s)
| | | | | | | | | | | | - Maria B. Arriaga
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | - Sydney Agareno
- Intensive Care Unit, Hospital de Cidade, Salvador, Bahia, Brazil
| | - Kevan M. Akrami
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Division of Infectious Diseases and Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, California
- * E-mail: (BBA); (KMA)
| | - Nivaldo Menezes Filgueiras Filho
- Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil
- Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil
- Intensive Care Unit, Hospital de Cidade, Salvador, Bahia, Brazil
- Hospital de Cidade, NEPC, Salvador, Bahia, Brazil
| | - Bruno B. Andrade
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
- União Metropolitana para o Desenvolvimento da Educação e Cultura (UNIME), Salvador, Bahia, Brazil
- Instituto Gonçalo Moniz, FIOCRUZ, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- * E-mail: (BBA); (KMA)
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de Souza Lima Bitar Y, Neto MG, Filho JAL, Pereira LV, Travassos KSO, Akrami KM, Roever L, Duraes AR. Comparison of the New Oral Anticoagulants and Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: Systematic Review and Meta-Analysis. Drugs R D 2019; 19:117-126. [PMID: 31055767 PMCID: PMC6544604 DOI: 10.1007/s40268-019-0274-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Indexed: 11/26/2022] Open
Abstract
Introduction New oral anticoagulants (NOACs) are approved for use in nonvalvular atrial fibrillation (AF). Objectives This study aimed to evaluate the efficacy and safety of NOACs compared with warfarin in AF and valvular heart disease (VHD). Methods We identified randomized controlled trials (RCTs) and post-hoc analyses comparing NOACs and warfarin in AF and VHD, including biological and mechanical heart valves (MHV). Through systematic review and meta-analysis, with the aid of the “Rev Man” program 5.3, the primary effectiveness endpoints were stroke and systemic embolism (SE). The primary safety outcome was major bleeding, and the secondary outcome included intracranial hemorrhage. Data were analyzed using risk ratios (RRs) and 95% confidence intervals (CIs), and heterogeneity was assessed using the I2 statistic. Results Six RCTs were included, involving 13,850 patients with AF and VHD. NOACs significantly reduced the risk of stroke/SE (RR 0.78; 95% CI 0.66–0.91; P = 0.002) and intracranial hemorrhage (RR 0.51; 95% CI 0.33–0.79; P = 0.003) and lowered the risk of major bleeding (RR 0.77; 95% CI 0.58–1.02; P = 0.07) compared with warfarin. Conclusions The efficacy and safety of NOACs as thromboprophylaxis for AF and VHD are similar to those of warfarin. Electronic supplementary material The online version of this article (10.1007/s40268-019-0274-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yasmin de Souza Lima Bitar
- Medical School of Federal University of Bahia, UFBA/FAMEB, XV de novembro Square, s/n-Largo do Terreiro de Jesus, Salvador, Bahia, 40025-010, Brazil.
| | | | | | | | | | - Kevan M Akrami
- Department of Medicine, University of California San Diego, San Diego, USA
| | - Leonardo Roever
- Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Andre Rodrigues Duraes
- Medical School of Federal University of Bahia, UFBA/FAMEB, XV de novembro Square, s/n-Largo do Terreiro de Jesus, Salvador, Bahia, 40025-010, Brazil
- General Hospital Roberto Santos, Salvador, Bahia, Brazil
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Durães AR, de Souza Lima Bitar Y, Filho JAL, Schonhofen IS, Camara EJN, Roever L, Cardoso HEDP, Akrami KM. Rivaroxaban versus Warfarin in Patients with Mechanical Heart Valve: Rationale and Design of the RIWA Study. Drugs R D 2019; 18:303-308. [PMID: 30293126 PMCID: PMC6277324 DOI: 10.1007/s40268-018-0249-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 11/16/2022] Open
Abstract
Introduction Mechanical heart valves (MHV) are extremely durable, but they require permanent use of anticoagulation to prevent thromboembolic events. The only approved therapeutic options are vitamin K antagonists (VKAs), such as warfarin. As a drug class, clinical management is difficult, therefore new alternatives need to be evaluated. Methods RIWA is a phase II/III, prospective, open-label, randomized, pilot study designed to investigate oral rivaroxaban 15 mg twice daily compared with dose-adjusted warfarin for the prevention of stroke (ischemic or hemorrhagic) and systemic embolism in patients with MHV, from August 2018 to December 2019. Patients will undergo transesophageal echocardiography at the beginning and the end of the study (follow-up time 90 days). On an explanatory basis, all events will be analyzed, including stroke, peripheral systemic embolism, valve thrombosis, significant bleeding and death. Discussion Warfarin and similar VKAs are standard therapy for patients with an MHV. Even with the appropriate use of therapy, the incidence of thromboembolic events is high at 1–4% per year. Furthermore, bleeding risk is significant, ranging from 2 to 9% per year. The new frontier to be overcome in relation to use of the new oral anticoagulants is undoubtedly in patients with MHV. A significant portion of people with MHV worldwide will benefit if noninferiority of these new agents is confirmed. Trial Registration ClinicalTrials.gov identifier: NCT03566303. Recruitment Status: Recruiting. First Posted: 25 June 2018. Last Update Posted: 25 June 2018.
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Affiliation(s)
- André R Durães
- General Hospital Roberto Santos, Salvador, Bahia, Brazil. .,Federal University of Bahia, Medical School-UFBA/FAMEB, XV de novembro Square, s/n-Largo do Terreiro de Jesus, Salvador, BA, 40025-010, Brazil.
| | - Yasmin de Souza Lima Bitar
- Federal University of Bahia, Medical School-UFBA/FAMEB, XV de novembro Square, s/n-Largo do Terreiro de Jesus, Salvador, BA, 40025-010, Brazil
| | | | | | - Edmundo J N Camara
- Federal University of Bahia, Medical School-UFBA/FAMEB, XV de novembro Square, s/n-Largo do Terreiro de Jesus, Salvador, BA, 40025-010, Brazil
| | - Leonardo Roever
- Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | | | - Kevan M Akrami
- Division of Infectious Disease, Department of Medicine, University of California, San Diego, San Diego, CA, USA
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Nogueira BMF, Rolla VC, Akrami KM, Kiene SM. Correction: Factors associated with tuberculosis treatment delay in patients co-infected with HIV in a high prevalence area in Brazil. PLoS One 2018; 13:e0202292. [PMID: 30089165 PMCID: PMC6082544 DOI: 10.1371/journal.pone.0202292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Nogueira BMF, Rolla VC, Akrami KM, Kiene SM. Factors associated with tuberculosis treatment delay in patients co-infected with HIV in a high prevalence area in Brazil. PLoS One 2018; 13:e0195409. [PMID: 29624603 PMCID: PMC5889181 DOI: 10.1371/journal.pone.0195409] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 03/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Worldwide, about 11% of Tuberculosis (TB) cases occur in people living with HIV (PLHIV) and it is the leading cause of death in this population. An important step towards reducing the incidence and mortality of TB in PLHIV is to reduce the time from onset of symptoms to treatment. Factors related to TB treatment delay therefore need to be understood. METHODS Using data from a prospective cohort study of patients diagnosed with TB at the National Institute of Infectious Disease, at the Oswaldo Cruz Foundation, Rio de Janeiro, Brazil we conducted a survival analysis to identify factors associated with patient and health care treatment delay. In our analysis we included patients who were co-infected with TB and HIV (n = 201). Patients were followed during the course of their TB treatment and information regarding duration of symptoms, sociodemographics and clinical characteristics were collected at the baseline visit. RESULTS The median time from onset of initial symptoms to prescription of TB treatment (total delay) was 82 days. From initiation of symptoms to first visit at INI clinic (patient delay), the median was 51 days. From first visit to initiation of treatment (health care delay) the median was 16 days. Illiteracy was associated with greater patient delay [Hazard Ratio (HR) = 2.25, CI 95% 1.29-3.94]. Having had a previous episode of TB (HR = 0.53, CI 95% 0.37-0.74) and being married (HR = 0.71, CI 95% 0.54-0.94) were inversely related to patient delay. Illiteracy was also associated with greater health care delay (HR = 2.83, CI 95% 1.25-5.47) in contrast to high viral load (HR = 0.37, CI 95% 0.24-0.54) and weight loss greater than 10% (HR = 0.54, CI 95% 0.37-0.8), both of which were inversely related to health care delay. CONCLUSIONS This study highlights the existence of factors that lead to greater risk of delayed treatment of TB among patients co-infected with HIV and TB. These include factors that can be assessed through targeted interventions which have implications for improving treatment outcomes and, through reduced duration of infectiousness, reduce the incidence of TB in Brazil.
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Affiliation(s)
- Betânia M. F. Nogueira
- Division of Epidemiology and Biostatistics, San Diego State University, San Diego, California, United States of America
| | - Valéria C. Rolla
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Kevan M. Akrami
- Division of Infectious Diseases, University of California San Diego, La Jolla, California, United States of America
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, San Diego State University, San Diego, California, United States of America
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