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Lesão Miocárdica e Prognóstico em Pacientes Hospitalizados com COVID-19 no Brasil: Resultados do Registro Nacional de COVID-19 COVID19 COVID 19 COVID-1 Brasil COVID1 1 COVID-
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Barbosa, Hannah Cardoso
; Martins, Maria Auxiliadora Parreiras
; Jesus, Jordana Cristina de
; Meira, Karina Cardoso
; Passaglia, Luiz Guilherme
; Sacioto, Manuela Furtado
; Bezerra, Adriana Falangola Benjamin
; Schwarzbold, Alexandre Vargas
; Maurílio, Amanda de Oliveira
; Farace, Barbara Lopes
; Silva, Carla Thais Cândida Alves da
; Cimini, Christiane Corrêa Rodrigues
; Silveira, Daniel Vitorio
; Carazai, Daniela do Reis
; Ponce, Daniela
; Costa, Emanuel Victor Alves
; Manenti, Euler Roberto Fernandes
; Cenci, Evelin Paola de Almeida
; Bartolazzi, Frederico
; Madeira, Glícia Cristina de Castro
; Nascimento, Guilherme Fagundes
; Velloso, Isabela Vasconcellos Pires
; Batista, Joanna d’Arc Lyra
; Morais, Júlia Drumond Parreiras de
; Carvalho, Juliana da Silva Nogueira
; Ruschel, Karen Brasil
; Martins, Karina Paula Medeiros Prado
; Zandoná, Liege Barella
; Menezes, Luanna Silva Monteiro
; Kopittke, Luciane
; Castro, Luís César de
; Nasi, Luiz Antônio
; Floriani, Maiara Anschau
; Souza, Maíra Dias
; Carneiro, Marcelo
; Bicalho, Maria Aparecida Camargos
; Lima, Maria Clara Pontello Barbosa
; Godoy, Mariana Frizzo de
; Guimarães-Júnior, Milton Henriques
; Mendes, Paulo Mascarenhas
; Delfino-Pereira, Polianna
; Ribeiro, Raquel Jaqueline Eder
; Finger, Renan Goulart
; Menezes, Rochele Mosmann
; Francisco, Saionara Cristina
; Araújo, Silvia Ferreira
; Oliveira, Talita Fischer
; Oliveira, Thainara Conceição de
; Polanczyk, Carisi Anne
; Marcolino, Milena Soriano
.
Resumo Fundamento As complicações cardiovasculares da COVID-19 são aspectos importantes da patogênese e do prognóstico da doença. Evidências do papel prognóstico da troponina e da lesão miocárdica em pacientes hospitalizados com COVID-19 na América Latina são ainda escassos. Objetivos Avaliar a lesão miocárdica como preditor independente de mortalidade hospitalar e suporte ventilatório mecânico em pacientes hospitalizados, do registro brasileiro de COVID-19. Métodos Este estudo coorte é um subestudo do registro brasileiro de COVID-19, conduzido em 31 hospitais brasileiros de 17 cidades, de março a setembro de 2020. Os desfechos primários incluíram mortalidade hospitalar e suporte ventilatório mecânico invasivo. Os modelos para os desfechos primários foram estimados por regressão de Poisson com variância robusta, com significância estatística de p<0,05. Resultados Dos 2925 pacientes [idade mediana de 60 anos (48-71), 57,1%], 27,3% apresentaram lesão miocárdica. A proporção de pacientes com comorbidades foi maior nos pacientes com lesão miocárdica [mediana 2 (1-2) vs. 1 (0-20)]. Os pacientes com lesão miocárdica apresentaram maiores valores medianos de peptídeo natriurético cerebral, lactato desidrogenase, creatina fosfoquinase, N-terminal do pró-peptídeo natriurético tipo B e proteína C reativa em comparação a pacientes sem lesão miocárdica. Como fatores independentes, proteína C reativa e contagem de plaquetas foram relacionados com o risco de morte, e neutrófilos e contagem de plaquetas foram relacionados ao risco de suporte ventilatório mecânico invasivo. Os pacientes com níveis elevados de troponina apresentaram um maior risco de morte (RR 2,03, IC95% 1,60-2,58) e suporte ventilatório mecânico (RR 1,87;IC95% 1,57-2,23), em comparação àqueles com níveis de troponina normais. Conclusão Lesão cardíaca foi um preditor independente de mortalidade hospitalar e necessidade de suporte ventilatório mecânico em pacientes hospitalizados com COVID-19. COVID19 COVID 19 COVID-1 doença escassos COVID19. 19. COVID19, 19, 3 cidades 2020 invasivo robusta p005 p 0 05 p<0,05 292 idade 6 4871, 4871 48 71 , (48-71) 57,1%, 571 57,1% 57 57,1%] 273 27 27,3 12 (1-2 vs 020. 020 20 . (0-20)] cerebral desidrogenase fosfoquinase Nterminal N terminal própeptídeo pró independentes RR 203 03 2,03 IC95 IC 1,602,58 160258 1,60 2,58 58 1,60-2,58 1,87IC95% 187IC95 1,87 87 1,87;IC95 1,572,23, 157223 1,57 2,23 23 1,57-2,23) normais COVID1 COVID- 202 p00 p<0,0 29 487 4 7 (48-71 57,1 5 27, (1- 02 (0-20) 2,0 IC9 602 1,602,5 16025 160 1,6 258 2,5 1,60-2,5 87IC95 1,87IC95 187IC9 187 1,8 8 1,87;IC9 572 1,572,23 15722 157 1,5 223 2,2 1,57-2,23 p0 p<0, (48-7 57, (1 (0-20 2, 1,602, 1602 16 1, 25 1,60-2, 87IC9 1,87IC9 187IC 18 1,87;IC 1,572,2 1572 15 22 1,57-2,2 p<0 (48- ( (0-2 1,602 1,60-2 87IC 1,87IC 1,572, 1,57-2, p< (48 (0- 1,60- 1,572 1,57-2 (4 (0 1,57-
Abstract Background Cardiovascular complications of COVID-19 are important aspects of the disease’s pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. Objectives To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. Methods This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. Results Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. Conclusion Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients. COVID19 COVID 19 COVID-1 diseases disease s prognosis scarce inhospital hospital Registry 3 cities MarchSeptember March September 2020 variance p005 p 0 05 p<0.05 2925 925 2,92 6 4871, 4871 48 71 , [48-71] 571 57 57.1 men, men men) 273 27 27.3 12 [1-2 vs 02. 02 . [0-2]) peptide dehydrogenase phosphokinase Nterminal N terminal probrain pro Creactive C reactive predictors RR 203 03 2.03 95 1.602.58 160258 1.60 2.58 58 1.60-2.58 187 87 1.87 1.572.23, 157223 1.57 2.23 23 1.57-2.23) COVID1 COVID- 202 p00 p<0.0 292 92 2,9 487 4 7 [48-71 5 57. 27. [1- [0-2] 20 2.0 9 602 1.602.5 16025 160 1.6 258 2.5 1.60-2.5 18 8 1.8 572 1.572.23 15722 157 1.5 223 2.2 1.57-2.23 p0 p<0. 29 2, [48-7 [1 [0-2 2. 1.602. 1602 16 1. 25 1.60-2. 1.572.2 1572 15 22 1.57-2.2 p<0 [48- [ [0- 1.602 1.60-2 1.572. 1.57-2. p< [48 [0 1.60- 1.572 1.57-2 [4 1.57-
2.
Severe acute respiratory syndrome coronavirus 2 infection among healthcare workers in a tertiary public hospital in Curitiba, Brazil
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Spalanzani, Regiane Nogueira
; Genelhoud, Gustavo
; Raboni, Sonia Mara
; Almeida, Sergio Monteiro de
; Pereira, Luciane Aparecida
; Rotta, Indianara
; Cavalli, Barbara Maria
; Moreira, Francielli Brusco
; Dino, Carolina Lumi Tanaka
; Takahashi, Gislene Reche de Almeida
; Cognialli, Regielly Caroline Raimundo
; Spiri, Beatriz Sanada
; Bochnia-Bueno, Lucas
; Oliveira, Jaqueline Carvalho de
; Adamoski, Douglas
; Gradia, Daniela Fiori
; Bonatto, Ana Cláudia
; Wassem, Roseli
; Alves, Juliana Mazini
; Padilha, Raquel da Silva
; Brasil, Vitor Jorge Woytuski
; Almeida, Bernardo Montesanti Machado de
; Nogueira, Meri Bordignon
.
Revista da Sociedade Brasileira de Medicina Tropical
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ABSTRACT BACKGROUND: We aimed to describe the clinical characteristics of coronavirus disease 2019 (COVID-19) among healthcare workers (HCWs) in Curitiba, Brazil. METHODS: Upper respiratory samples from 1077 HCWs were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse transcription polymerase chain reaction from June 16, 2020 to December 9, 2020. RESULTS: Overall, 32.7% of HCWs were infected. The positivity rates in symptomatic and asymptomatic HCWs were 39.2% and 15.9%, respectively. Hospital departments categorized as high-risk for exposure had the highest number of infected HCWs. CONCLUSIONS: Early diagnosis and isolation of infected HCWs remain key in controlling SARS-CoV-2 transmission because HCWs in close contact with COVID-19 patients are more likely to be infected than those who are not.
3.
Characteristics and outcomes of patients with COVID-19 admitted to the ICU in a university hospital in São Paulo, Brazil - study protocol
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Ferreira, Juliana C.
; Ho, Yeh-Li
; Besen, Bruno A.M.P.
; Malbuisson, Luiz M.S.
; Taniguchi, Leandro U.
; Mendes, Pedro V.
; Costa, Eduardo L.V.
; Park, Marcelo
; Daltro-Oliveira, Renato
; Roepke, Roberta M.L.
; Silva Jr, João M.
; Carmona, Maria José C.
; Carvalho, Carlos Roberto Ribeiro
; Hirota, Adriana
; Kanasiro, Alberto Kendy
; Crescenzi, Alessandra
; Fernandes, Amanda Coelho
; Miethke-Morais, Anna
; Bellintani, Arthur Petrillo
; Canasiro, Artur Ribeiro
; Carneiro, Bárbara Vieira
; Zanbon, Beatriz Keiko
; Batista, Bernardo Pinheiro De Senna Nogueira
; Nicolao, Bianca Ruiz
; Besen, Bruno Adler Maccagnan Pinheiro
; Biselli, Bruno
; Macedo, Bruno Rocha De
; Toledo, Caio Machado Gomes De
; Pompilio, Carlos Eduardo
; Carvalho, Carlos Roberto Ribeiro De
; Mol, Caroline Gomes
; Stipanich, Cassio
; Bueno, Caue Gasparotto
; Garzillo, Cibele
; Tanaka, Clarice
; Forte, Daniel Neves
; Joelsons, Daniel
; Robira, Daniele
; Costa, Eduardo Leite Vieira
; Silva Júnior, Elson Mendes Da
; Regalio, Fabiane Aliotti
; Segura, Gabriela Cardoso
; Marcelino, Gustavo Brasil
; Louro, Giulia Sefrin
; Ho, Yeh-Li
; Ferreira, Isabela Argollo
; Gois, Jeison de Oliveira
; Silva Junior, Joao Manoel Da
; Reusing Junior, Jose Otto
; Ribeiro, Julia Fray
; Ferreira, Juliana Carvalho
; Galleti, Karine Vusberg
; Silva, Katia Regina
; Isensee, Larissa Padrao
; Oliveira, Larissa dos Santos
; Taniguchi, Leandro Utino
; Letaif, Leila Suemi
; Lima, Lígia Trombetta
; Park, Lucas Yongsoo
; Chaves Netto, Lucas
; Nobrega, Luciana Cassimiro
; Haddad, Luciana
; Hajjar, Ludhmila
; Malbouisson, Luiz Marcelo
; Pandolfi, Manuela Cristina Adsuara
; Park, Marcelo
; Carmona, Maria José Carvalho
; Andrade, Maria Castilho Prandini H De
; Santos, Mariana Moreira
; Bateloche, Matheus Pereira
; Suiama, Mayra Akimi
; Oliveira, Mayron Faria de
; Sousa, Mayson Laercio
; Louvaes, Michelle
; Huemer, Natassja
; Mendes, Pedro
; Lins, Paulo Ricardo Gessolo
; Santos, Pedro Gaspar Dos
; Moreira, Pedro Ferreira Paiva
; Guazzelli, Renata Mello
; Reis, Renato Batista Dos
; Oliveira, Renato Daltro De
; Roepke, Roberta Muriel Longo
; Pedro, Rodolpho Augusto De Moura
; Kondo, Rodrigo
; Rached, Samia Zahi
; Fonseca, Sergio Roberto Silveira Da
; Borges, Thais Sousa
; Ferreira, Thalissa
; Cobello Junior, Vilson
; Sales, Vivian Vieira Tenório
; Ferreira, Willaby Serafim Cassa
.
OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital’s electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.
https://doi.org/10.6061/clinics/2020/e2294
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4.
The plant cell cycle: Pre-Replication complex formation and controls
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Brasil, Juliana Nogueira
; Costa, Carinne N. Monteiro
; Cabral, Luiz Mors
; Ferreira, Paulo C. G.
; Hemerly, Adriana S.
.
Abstract The multiplication of cells in all living organisms requires a tight regulation of DNA replication. Several mechanisms take place to ensure that the DNA is replicated faithfully and just once per cell cycle in order to originate through mitoses two new daughter cells that contain exactly the same information from the previous one. A key control mechanism that occurs before cells enter S phase is the formation of a pre-replication complex (pre-RC) that is assembled at replication origins by the sequential association of the origin recognition complex, followed by Cdt1, Cdc6 and finally MCMs, licensing DNA to start replication. The identification of pre-RC members in all animal and plant species shows that this complex is conserved in eukaryotes and, more importantly, the differences between kingdoms might reflect their divergence in strategies on cell cycle regulation, as it must be integrated and adapted to the niche, ecosystem, and the organism peculiarities. Here, we provide an overview of the knowledge generated so far on the formation and the developmental controls of the pre-RC mechanism in plants, analyzing some particular aspects in comparison to other eukaryotes.
https://doi.org/10.1590/1678-4685-gmb-2016-0118
2748 downloads
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