COVID-19
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Comunidade Temática criada com o objetivo de disponibilizar de forma mais rápida e abrangente a produção científica do Sistema FMUSP-HC sobre COVID-19 e os diversos aspectos da pandemia.
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How Can COVID-19 Influence the Evolution of Patients with Acute Coronary Syndromes?
(2024) SOEIRO, Alexandre de Matos
The Use of the Oxygenation Stretch Index to Predict Outcomes in Mechanically Ventilated PatientsWith COVID-19 ARDS
(2023) ROLDAN, Rollin; BARRIGA, Fernando; VILLAMONTE, Renan; ROMANI, Franco; TUCCI, Mauro; GONZALES, Arturo; WONG, Paolo; ZAGACETA, Jorge; BROCHARD, Laurent
BACKGROUND: In ARDS caused by COVID-19 pneumonia, appropriate adjustment of physiologic parameters based on lung stretch or oxygenation may optimize the ventilatory strategy. This study aims to describe the prognostic performance on 60-d mortality of single and composite respiratory variables in subjects with COVID- 19 ARDS who are on mechanical ventilation with a lung-protective strategy, including the oxygenation stretch index combining oxygenation and driving pressure (Delta P). METHODS: This single-center observational cohort study enrolled 166 subjects on mechanical ventilation and diagnosed with COVID-19 ARDS. We evaluated their clinical and physiologic characteristics. The primary study outcome was 60-d mortality. Prognostic factors were evaluated through receiver operating characteristic analysis, Cox proportional hazards regression model, and Kaplan-Meier survival curves. RESULTS: Mortality at day 60 was 18.1%, and hospital mortality was 22.9%. Oxygenation, DP, and composite variables were tested: oxygenation stretch index (P-aO2 /F-IO2 divided by Delta P) and Delta P 3 4 + breathing frequency (f) (Delta P 3 4 + f). At both day 1 and day 2 after inclusion, the oxygenation stretch index had the best area under the receiver operating characteristic curve (oxygenation stretch index on day 1 0.76 (95% CI 0.67-0.84) and on day 2 0.83 (95% CI 0.76-0.91) to predict 60-d mortality, although without significant difference from other indexes. In multivariable Cox regression, Delta P, PaO2 /FIO2, Delta P 3 4 + f, and oxygenation stretch index were all associated with 60-d mortality. When dichotomizing the variables, Delta P >= 14, P-aO2 / F-IO2 >= 152 mm Hg, Delta P x 4 + f >= 80, and oxygenation stretch index < 7.7 showed lower 60-d survival probability. At day 2, after optimization of ventilatory settings, the subjects who persisted with the worse cutoff values for the oxygenation stretch index showed a lower probability of survival at 60 d compared with day 1; this was not the case for other parameters. CONCLUSIONS: The oxygenation stretch index, which combines P-aO2 /F-IO2 and DP, is associated with mortality and may be useful to predict clinical outcomes in COVID-19 ARDS.
Cold Atmospheric Helium Plasma in the Post-COVID-19 Era: A Promising Tool for the Disinfection of Silicone Endotracheal Prostheses
(2024) SILVA, Diego Morais da; NASCIMENTO, Fellype Do; MILHAN, Noala Vicensoto Moreira; OLIVEIRA, Maria Alcioneia Carvalho de; CARDOSO, Paulo Francisco Guerreiro; LEGENDRE, Daniel; AOKI, Fabio Gava; KOSTOV, Konstantin Georgiev; KOGA-ITO, Cristiane Yumi
Despite the excellent properties of silicone endotracheal prostheses, their main limitation is the formation of a polymicrobial biofilm on their surfaces. It can cause local inflammation, interfering with the local healing process and leading to further complications in the clinical scenario. The present study evaluated the inhibitory effect of cold atmospheric plasma (CAP) on multispecies biofilms grown on the silicone protheses' surfaces. In addition to silicone characterization before and after CAP exposure, CAP cytotoxicity on immortalized human bronchial epithelium cell line (BEAS-2B) was evaluated. The aging time test reported that CAP could temporarily change the silicone surface wetting characteristics from hydrophilic (80.5 degrees) to highly hydrophilic (<5 degrees). ATR-FTIR showed no significant alterations in the silicone surficial chemical composition after CAP exposure for 5 min. A significant log reduction in viable cells in monospecies biofilms (log CFU/mL) of C. albicans, S. aureus, and P. aeruginosa (0.636, 0.738, and 1.445, respectively) was detected after CAP exposure. Multispecies biofilms exposed to CAP showed significant viability reduction for C. albicans and S. aureus (1.385 and 0.831, respectively). The protocol was not cytotoxic to BEAS-2B. CAP can be a simple and effective method to delay multispecies biofilm formation inside the endotracheal prosthesis.
Cardiovascular Safety of Azithromycin in Patients Hospitalized With COVID-19: A Prespecified Pooled Analysis of the COALITION I and COALITION II Randomized Clinical Trials
(2024) FURTADO, Remo H. M.; SILVA, Pedro G. M. Barros e; FONSECA, Henrique A. R.; SERPA-NETO, Ary; CORREA, Thiago D.; GUIMARAES, Helio P.; PEREIRA, Adriano J.; OLIVATO, Guilherme B.; ZAMPIERI, Fernando G.; LISBOA, Thiago; JUNQUEIRA, Debora L. M.; LAPA, Maura G.; MONFARDINI, Frederico; DAMIANI, Lucas P.; ECHENIQUE, Leandro S.; GEBARA, Otavio E.; HOFFMAN FILHO, Conrado R.; POLANCZYK, Carisi A.; ROHDE, Luis E.; AMAZONAS, Roberto; MACHADO, Flavia R.; AVEZUM, Alvaro; AZEVEDO, Luciano C. P.; VEIGA, Viviane C.; ROSA, Regis G.; LOPES, Renato D.; CAVALCANTI, Alexandre B.; BERWANGER, Otavio
The cardiovascular safety from azithromycin in the treatment of several infectious diseases has been challenged. In this prespecified pooled analysis of 2 multicenter randomized clinical trials, we aimed to assess whether the use of azithromycin might lead to corrected QT (QTc) interval prolongation or clinically relevant ventricular arrhythmias. In the COALITION COVID Brazil I trial, 667 patients admitted with moderate COVID-19 were randomly allocated to hydroxychloroquine, hydroxychloroquine plus azithromycin, or standard of care. In the COALITION COVID Brazil II trial, 447 patients with severe COVID-19 were randomly allocated to hydroxychloroquine alone versus hydroxychloroquine plus azithromycin. The principal end point for the present analysis was the composite of death, resuscitated cardiac arrest, or ventricular arrhythmias. The addition of azithromycin to hydroxychloroquine did not result in any prolongation of the QTc interval (425.8 +/- 3.6 ms vs 427.9 +/- 3.9 ms, respectively, mean difference -2.1 ms, 95% confidence interval -12.5 to 8.4 ms, p = 0.70). The combination of azithromycin plus hydroxychloroquine compared with hydroxychloroquine alone did not result in increased risk of the primary end point (proportion of patients with events at 15 days 17.2% vs 16.0%, respectively, hazard ratio 1.08, 95% confidence interval 0.78 to 1.49, p = 0.65). In conclusion, in patients hospitalized with COVID-19 already receiving standardof-care management (including hydroxychloroquine), the addition of azithromycin did not result in the prolongation of the QTc interval or increase in cardiovascular adverse events. Because azithromycin is among the most commonly prescribed antimicrobial agents, our results may inform clinical practice. Clinical Trial Registration: NCT04322123, NCT04321278.
You knew you had to be there, it had to be done: Experiences of health professionals who faced the COVID-19 pandemic in one public hospital in Spain
(2023) RODRIGUEZ-MADRID, Maria Nieves; PASTOR-MORENO, Guadalupe; ALBERT-LOPEZ, Enrique; PASTOR-VALERO, Maria
IntroductionThe COVID-19 pandemic highlighted the lack of a government contingency plan for an effective response to an unexpected health crisis. This study uses a phenomenological approach to explore the experience of healthcare professionals during the first three waves of the COVID-19 pandemic in a public health hospital in the Valencia region, Spain. It assesses the impact on their health, coping strategies, institutional support, organizational changes, quality of care, and lessons learned. MethodsWe carried out a qualitative study with semi-structured interviews with doctors and nurses from the Preventive Medicine, Emergency, and Internal Medicine Services and the Intensive Care Unit, using the Colaizzi's 7-step data analysis method. ResultsDuring the first wave, lack of information and leadership led to feelings of uncertainty, fear of infection, and transmission to family members. Continuous organizational changes and lack of material and human resources brought limited results. The lack of space to accommodate patients, along with insufficient training in treating critical patients, and the frequent moving around of healthcare workers, reduced the quality of care. Despite the high levels of emotional stress reported, no sick leave was taken; the high levels of commitment and professional vocation helped in adapting to the intense work rhythms. Healthcare professionals in the medical services and support units reported higher levels of stress, and a greater sense of neglect by their institution than their colleagues in managerial roles. Family, social support, and camaraderie at work were effective coping strategies. Health professionals showed a strong collective spirit and sense of solidarity. This helped them cope with the additional stress and workload that accompanied the pandemic. ConclusionIn the wake of this experience, they highlight the need for a contingency plan adapted to each organizational context. Such a plan should include psychological counseling and continuous training in critical patient care. Above all, it needs to take advantage of the hard-won knowledge born of the COVID-19 pandemic.
A novel insight on SARS-CoV-2 S-derived fragments in the control of the host immunity (vol 13, 8060, 2023)
(2023) BASTOS, Thais Sibioni Berti; PAULA, Andre Guilherme Portela de; LUZ, Rebeca Bosso dos Santos; GARNIQUE, Anali M. B.; BELO, Marco A. A.; ETO, Silas Fernandes; FERNANDES, Dayanne Carla; FERRARIS, Fausto Klabund; PONTES, Leticia Gomes de; FRANCA, Tabata Takahashi; BARCELLOS, Leonardo Jose Gil; VERAS, Flavio P. P.; BERMEJO, Pamela; GUIDELLI, Giovanna; MANEIRA, Carla; MELLO, Fellipe da Silveira Bezerra de; TEIXEIRA, Gleidson; PEREIRA, Goncalo Amarante Guimaraes; FERNANDES, Bianca H. Ventura; SANCHES, Paulo R. S.; BRAZ, Helyson Lucas Bezerra; JORGE, Roberta Jeane Bezerra; MALAFAIA, Guilherme; CILLI, Eduardo M. M.; OLIVIER, Danilo da Silva; AMARAL, Marcos Serrou do; MEDEIROS, Renata J. J.; CONDINO-NETO, Antonio; CARVALHO, Luciani R. R.; MACHADO-SANTELLI, Glaucia M. M.; CHARLIE-SILVA, Ives; GALINDO-VILLEGAS, Jorge; BRAGA, Tarcio Teodoro
Endovascular treatment of cerebral sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia
(2024) WELLER, Johannes; KRZYWICKA, Katarzyna; MUNCKHOF, Anita van de; DORN, Franziska; ALTHAUS, Katharina; BODE, Felix J.; POGGIO, Monica Bandettini di; BUCK, Brian; KLEINIG, Timothy; CORDONNIER, Charlotte; DIZONNO, Vanessa; DUAN, Jiangang; ELKADY, Ahmed; CHEW, Beng Lim Alvin; GARCIA-ESPERON, Carlos; FIELD, Thalia S.; LEGAULT, Catherine; MARTIN, Mar Morin; MICHALSKI, Dominik; PELZ, Johann; SCHOENENBERGER, Silvia; NAGEL, Simon; PETRUZZELLIS, Marco; RAPOSO, Nicolas; SKJELLAND, Mona; ZIMATORE, Domenico Sergio; AARON, Sanjith; KAMMEN, Mayte Sanchez van; SOUSA, Diana Aguiar de; LINDGREN, Erik; JOOD, Katarina; SCUTELNIC, Adrian; HELDNER, Mirjam R.; POLI, Sven; ARAUZ, Antonio; CONFORTO, Adriana B.; PUTAALA, Jukka; TATLISUMAK, Turgut; ARNOLD, Marcel; COUTINHO, Jonathan M.; GUENTHER, Albrecht; ZIMMERMANN, Julian; FERRO, Jose M.
Introduction: There is little data on the role of endovascular treatment (EVT) of cerebral venous sinus thrombosis (CVST) due to vaccine-induced immune thrombotic thrombocytopenia (VITT). Here, we describe clinical characteristics and outcomes of CVST-VITT patients who were treated with EVT. Patients and methods: We report data from an international registry of patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 6 March 2023. VITT was defined according to the Pavord criteria. Results: EVT was performed in 18/136 (13%) patients with CVST-VITT (92% aspiration and/or stent retrieval, 8% local thrombolysis). Most common indications were extensive thrombosis and clinical or radiological deterioration. Compared to non-EVT patients, those receiving EVT had a higher median thrombus load (4.5 vs 3). Following EVT, local blood flow was improved in 83% (10/12, 95% confidence interval [CI] 54-96). One (6%) asymptomatic sinus perforation occurred. Eight (44%) patients treated with EVT also underwent decompressive surgery. Mortality was 50% (9/18, 95% CI 29-71) and 88% (8/9, 95% CI 25-66) of surviving EVT patients achieved functional independence with a modified Rankin Scale score of 0-2 at follow-up. In multivariable analysis, EVT was not associated with increased mortality (adjusted odds ratio, 0.66, 95% CI 0.16-2.58). Discussion and conclusion: We describe the largest cohort of CVST-VITT patients receiving EVT. Half of the patients receiving EVT died during hospital admission, but most survivors achieved functional independence.
Health equity, care access and quality in headache - part 1
(2024) TANA, Claudio; RAFFAELLI, Bianca; SOUZA, Marcio Nattan Portes; TORRE, Elena Ruiz de la; MASSI, Daniel Gams; KISANI, Najib; GARCIA-AZORIN, David; WALISZEWSKA-PROSOL, Marta
Current definitions of migraine that are based mainly on clinical characteristics do not account for other patient's features such as those related to an impaired quality of life, due to loss of social life and productivity, and the differences related to the geographical distribution of the disease and cultural misconceptions which tend to underestimate migraine as a psychosocial rather than neurobiological disorder. Global differences definition, care access, and health equity for headache disorders, especially migraine are reported in this paper from a collaborative group of the editorial board members of the Journal of Headache and Pain. Other components that affect patients with migraine, in addition to the impact promoted by the migraine symptoms such as stigma and social determinants, are also reported.
Sex differences in cerebral venous sinus thrombosis after adenoviral vaccination against COVID-19
(2023) SCUTELNIC, Adrian; MUNCKHOF, Anita van de; KRZYWICKA, Katarzyna; KAMMEN, Mayte Sanchez van; LINDGREN, Erik; CORDONNIER, Charlotte; KLEINIG, Timothy J.; FIELD, Thalia S.; POLI, Sven; LEMMENS, Robin; MIDDELDORP, Saskia; AARON, Sanjith; BORHANI-HAGHIGHI, Afshin; ARAUZ, Antonio; HOVINGA, Johanna A. Kremer; GUENTHER, Albrecht; PUTAALA, Jukka; WASAY, Mohammad; CONFORTO, Adriana Bastos; SOUSA, Diana Aguiar de; JOOD, Katarina; TATLISUMAK, Turgut; FERRO, Jose M.; COUTINHO, Jonathan M.; ARNOLD, Marcel; HELDNER, Mirjam R.
Introduction: Cerebral venous sinus thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is a severe disease with high mortality. There are few data on sex differences in CVST-VITT. The aim of our study was to investigate the differences in presentation, treatment, clinical course, complications, and outcome of CVST-VITT between women and men. Patients and methods: We used data from an ongoing international registry on CVST-VITT. VITT was diagnosed according to the Pavord criteria. We compared the characteristics of CVST-VITT in women and men. Results: Of 133 patients with possible, probable, or definite CVST-VITT, 102 (77%) were women. Women were slightly younger [median age 42 (IQR 28-54) vs 45 (28-56)], presented more often with coma (26% vs 10%) and had a lower platelet count at presentation [median (IQR) 50x10(9)/L (28-79) vs 68 (30-125)] than men. The nadir platelet count was lower in women [median (IQR) 34 (19-62) vs 53 (20-92)]. More women received endovascular treatment than men (15% vs 6%). Rates of treatment with intravenous immunoglobulins were similar (63% vs 66%), as were new venous thromboembolic events (14% vs 14%) and major bleeding complications (30% vs 20%). Rates of good functional outcome (modified Rankin Scale 0-2, 42% vs 45%) and in-hospital death (39% vs 41%) did not differ. Discussion and conclusions: Three quarters of CVST-VITT patients in this study were women. Women were more severely affected at presentation, but clinical course and outcome did not differ between women and men. VITT-specific treatments were overall similar, but more women received endovascular treatment.
The Hierarchy of Communication Needs: A Novel Communication Strategy for High Mistrust Settings Developed in a Brazilian COVID-ICU
(2024) FORTE, Daniel Neves; STOLTENBERG, Mark; RIBEIRO, Sabrina Correa da Costa; ALMEIDA, Ingrid Maria (Mia) Olsen de; JACKSON, Vicki; DAUBMAN, Bethany-Rose
Context: The COVID-19 pandemic presented unique challenges for health care systems. Overcrowded units, extreme illness severity, uncertain prognoses, and mistrust in providers resulted in a ""pressure cooker"" where traditional communication strategies were often insufficient.Objectives: Building on well-studied traditional communication interventions, neurobiology principles were used to create a novel communication strategy designed in the COVID-ICU to respond to the unique communication needs of patients within the context of a high mistrust setting.Methods: The hierarchy of communication needs recognizes three specific levels of communication that are essential within high-emotion and low-trust settings. The first level is to establish trust. The second level is to resonate with patients' emotions, helping to reduce arousal and improve empathy. The third level includes the more traditional content of disclosing prognostic information and shared decision-making. When facing communication challenges, clinicians are taught to move back a level and reattune to emotions and/or reestablish trust.Discussion: The COVID pandemic revealed the shortcomings of a primarily cognitive communication style. The hierarchy of communication needs emphasizes trust building, and emotional resonance as prerequisites of effective cognitive discussions, resulting in more effective clinician-patient communication that more fully incorporates cultural humility and better meets the needs of diverse patient populations. Additional research is needed to further develop this strategy and evaluate its impact on patient experience and outcomes.