Multiplex cytokine profile from dengue patients: MIP-1beta and IFN-gamma as predictive factors for severity

<p>Abstract</p> <p>Background</p> <p>Dengue virus pathogenesis is not yet fully understood and the identification of patients at high risk for developing severe disease forms is still a great challenge in dengue patient care. During the present study, we evaluated prospectively the potential of cytokines present in plasma from patients with dengue in stratifying disease severity.</p> <p>Methods</p> <p>Seventeen-cytokine multiplex fluorescent microbead immunoassay was used for the simultaneous detection in 59 dengue patients. GLM models using bimodal or Gaussian family were determined in order to associate cytokines with clinical manifestations and laboratory diagnosis.</p> <p>Results</p> <p>IL-1β, IFN-γ, IL-4, IL-6, IL-13, IL-7 and GM-CSF were significantly increased in patients with severe clinical manifestations (severe dengue) when compared to mild disease forms (mild dengue). In contrast, increased MIP-1β levels were observed in patients with mild dengue. MIP-1β was also associated with CD56+NK cell circulating rates. IL-1β, IL-8, TNF-α and MCP-1 were associated with marked thrombocytopenia. Increased MCP-1 and GM-CSF levels correlated with hypotension. Moreover, MIP-1β and IFN-γ were independently associated with both dengue severity and disease outcome.</p> <p>Conclusion</p> <p>Our data demonstrated that the use of a multiple cytokine assay platform was suitable for identifying distinct cytokine profiles associated with the dengue clinical manifestations and severity. MIP-β is indicated for the first time as a good prognostic marker in contrast to IFN-γ that was associated with disease severity.</p

The role of corticosteroids in severe community-acquired pneumonia: a systematic review

Submitted by Sandra Infurna ([email protected]) on 2019-04-04T12:26:57Z No. of bitstreams: 1 JorgeIF_Salluh_etal_IOC_2008.pdf: 215501 bytes, checksum: fb18fede448c1eb9f08f5dc05c97d47c (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2019-04-04T12:37:41Z (GMT) No. of bitstreams: 1 JorgeIF_Salluh_etal_IOC_2008.pdf: 215501 bytes, checksum: fb18fede448c1eb9f08f5dc05c97d47c (MD5)Made available in DSpace on 2019-04-04T12:37:41Z (GMT). No. of bitstreams: 1 JorgeIF_Salluh_etal_IOC_2008.pdf: 215501 bytes, checksum: fb18fede448c1eb9f08f5dc05c97d47c (MD5) Previous issue date: 2008Instituto Nacional de Câncer. Unidade de Cuidados Intensivos. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunofarmacologia. Rio de Janeiro, RJ, Brasil.Hospital de São Francisco Xavier. Centro Hospitalar de Lisboa Ocidental. Unidade de Terapia Intensiva Médica. Lisboa, Portugal.Instituto Nacional de Câncer. Unidade de Cuidados Intensivos. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunofarmacologia. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunofarmacologia. Rio de Janeiro, RJ, Brasil.Introduction: The purpose of this review was to evaluate the impact of corticosteroids on the outcomes of patients with severe community-acquired pneumonia (CAP). Methods: We performed a systematic MEDLINE, Cochrane database, and CINAHL search (1966 to November 2007) to identify full-text publications that evaluated the use of corticosteroids in CAP. Results: An initial literature search yielded 109 articles, and 105 studies were excluded after the first analysis. We found four studies eligible for analysis. On the basis of their results, the use of corticosteroids as adjunctive therapy in severe CAP should be categorized as a weak recommendation (two studies) and a strong recommendation (two studies) with either low- or moderate-quality evidence. However, no evidence of adverse outcomes or harm is present in the evaluated studies. Conclusion: According to the GRADE system, available studies do not support the recommendation of corticosteroids as a standard of care for patients with severe CAP. Further randomized controlled trials with this aim should enroll a larger number of severely ill patients. However, in patients needing corticosteroids, it may be reasonable to conclude that corticosteroid administration is safe in patients with severe infections receiving antimicrobial therapy

Chest computed tomography findings in severe influenza pneumonia occurring in neutropenic cancer patients

OBJECTIVE: To describe the chest computed tomography findings for severe influenza H1N1 infection in a series of hospitalized neutropenic cancer patients. METHODS: We performed a retrospective systematic analysis of chest computed tomography scans for eight hospitalized patients with fever, neutropenia, and confirmed diagnoses of influenza H1N1. The clinical data had been prospectively collected. RESULTS: Six of eight patients (75%) developed respiratory failure and required intensive care. Prolonged H1N1 shedding was observed in the three mechanically ventilated patients, and overall hospital mortality in our series was 25%. The most frequent computed tomography findings were ground-glass opacity (all patients), consolidation (7/8 cases), and airspace nodules (6/8 cases) that were frequently moderate or severe. Other parenchymal findings were not common. Five patients had features of pneumonia, two had computed tomography findings compatible with bronchitis and/or bronchiolitis, and one had tomographic signs of chronicity. CONCLUSION: In this series of neutropenic patients with severe influenza H1N1 infection, chest computed tomography demonstrated mainly moderate or severe parenchymatous disease, but bronchiolitis was not a common feature. These findings associated with febrile neutropenia should elicit a diagnosis of severe viral infection

An ecological study

Funding Information: This work is part of the Grand Challenges ICODA pilot initiative, delivered by Health Data Research UK and funded by the Bill & Melinda Gates Foundation and the Minderoo Foundation. This study was also supported by the National Council for Scientific and Technological Development (CNPq), the Coordination for the Improvement of Higher Education Personnel (CAPES) - Finance Code 001, Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro (FAPERJ), the Pontifical Catholic University of Rio de Janeiro. OR is funded by a Sara Borrell grant from the Instituto de Salud Carlos III (CD19/00110). PM acknowledges suppor from the CNPq (Grant 311519/2022-9). OR acknowledges support from the Spanish Ministry of Science and Innovation and State Research Agency through the \u2018Centro de Excelencia Severo Ochoa 2019-2023\u2019 programme (CEX2018-000806-S) and support from the Generalitat de Catalunya through the CERCA programme. All authors carried out the research independently of the funding bodies. The findings and conclusions in this manuscript reflect the opinions of the authors alone. Funding Information: SH and FAB are funded by the CNPq and FAPERJ. PM is funded by CNPq (422470/2021-0) and FAPERJ (E-26/211.645/2021 and E-26/201.348/2022). OR is funded by a Sara Borrell fellowship from the Instituto de Salud Carlos III (CD19/00110), acknowledges support from the Spanish Ministry of Science and Innovation and State Research Agency through the \u2018Centro de Excelencia Severo Ochoa 2019\u20132023\u2019 programme (CEX2018-000806-S), support from the Generalitat de Catalunya through the CERCA programme and received a research grant from the Health Effects Institute for research unrelated to this manuscript. OR was also a member of the Data Safety Monitoring Board in the REVOLUTION and STOP-COVID trials, testing treatments against COVID-19, and is currently a member of the Data Safety Monitoring Board of the RENOVATE trial, testing respiratory support strategies in patients with acute respiratory hypoxaemic failure. Publisher Copyright: © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.Objectives No consensus exists about the best COVID-19 vaccination strategy to be adopted by low-income and middle-income countries. Brazil adopted an age-based calendar strategy to reduce mortality and the burden on the healthcare system. This study evaluates the impact of the vaccination campaign in Brazil on the progression of the reported COVID-19 deaths. Methods This ecological study analyses the dynamic of vaccination coverage and COVID-19 deaths in hospitalised adults (≥20 years) during the first year of the COVID-19 vaccination roll-out (January to December 2021) using nationwide data (DATASUS). We stratified the adult population into 20-49, 50-59, 60-69 and 70+ years. The dynamic effect of the vaccination campaign on mortality rates was estimated by applying a negative binomial regression. The prevented and possible preventable deaths (observed deaths higher than expected) and potential years of life lost (PYLL) for each age group were obtained in a counterfactual analysis. Results During the first year of COVID-19 vaccination, 266 153 517 doses were administered, achieving 91% first-dose coverage. A total of 380 594 deaths were reported, 154 091 (40%) in 70+ years and 136 804 (36%) from 50-59 or 20-49 years. The mortality rates of 70+ decreased by 52% (rate ratio [95% CI]: 0.48 [0.43-0.53]) in 6 months, whereas rates for 20-49 were still increasing due to low coverage (52%). The vaccination roll-out strategy prevented 59 618 deaths, 53 088 (89%) from those aged 70+ years. However, the strategy did not prevent 54 797 deaths, 85% from those under 60 years, being 26 344 (45%) only in 20-49, corresponding to 1 589 271 PYLL, being 1 080 104 PYLL (68%) from those aged 20-49 years. Conclusion The adopted aged-based calendar vaccination strategy initially reduced mortality in the oldest but did not prevent the deaths of the youngest as effectively as compared with the older age group. Countries with a high burden, limited vaccine supply and young populations should consider other factors beyond the age to prioritise who should be vaccinated first.publishersversionpublishe

addressing vaccine inequity in socially vulnerabilised communities

VacinaMar\u00E9 was a multi-institutional initiative, and funders had no role in the study\u2019s design, the collection, analysis, and interpretation of data, the writing of the manuscript, or the decision to submit the manuscript for publication. Funding Information: The authors thank the Redes da Mar\u00E9 for all their support and the efficient strategies for community engagement and communication during the pandemic. The authors also thank the Presidency of FIOCRUZ for the enthusiastic support in all moments and the Unidade de Apoio ao Diagn\u00F3stico da Covid-19 (UNADIGFIOCRUZ) for supporting the testing diagnosis. The Vacina Mar\u00E9 initiative was funded by Fiocruz and an unrestricted grant from Todos Pela Sa\u00FAde fund. AABS acknowledges funding from CAPES Print (88887.899318/2023-00). OTR acknowledges funding from the END-VOC Project (Horizon 2021\u20132024), funded by the European Union under grant agreement no. 101046314. OTR acknowledges support from the Spanish Ministry of Science and Innovation through the Centro de Excelencia Severo Ochoa 2019\u20132023 programme (CEX2018-000806-S) and from the Generalitat de Catalunya through the Centres de Recerca de Catalunya (CERCA) programme. Funding Information: The authors thank the Redes da Mare for all their support and the efficient strategies for community engagement and communication during the pandemic. The authors also thank the Presidency of FIOCRUZ for the enthusiastic support in all moments and the Unidade de Apoio ao Diagn\u00F3stico da Covid-19 (UNADIGFIOCRUZ) for supporting the testing diagnosis. The Vacina Mar\u00E9 initiative was funded by Fiocruz and an unrestricted grant from Todos Pela Sa\u00FAde fund. AABS acknowledges funding from CAPES Print (88887.899318/2023-00). OTR acknowledges funding from the END-VOC Project (Horizon 2021-2024), funded by the European Union under grant agreement no. 101046314. OTR acknowledges support from the Spanish Ministry of Science and Innovation through the Centro de Excelencia Severo Ochoa 2019-2023 programme (CEX2018-000806-S) and from the Generalitat de Catalunya through the Centres de Recerca de Catalunya (CERCA) programme.publishersversionpublishe

Lipid droplet levels vary heterogeneously in response to simulated gastrointestinal stresses in different probiotic Saccharomyces cerevisiae strains

AbstractTo exert their therapeutic action, probiotic Saccharomyces cerevisiae strains must survive harsh digestive environments. Lipid droplets accumulate in cells which undergo stress-inducing situations, supposedly having a protective role. We assessed lipid droplet levels, either naturally accumulated or induced in response to digestive challenges, of probiotic strains S. boulardii, S. cerevisiae A-905, S. cerevisiae Sc47 and S. cerevisiae L11, and of non-probiotic strains S. cerevisiae BY4741 and S. cerevisiae BY4743. Strains 905 and Sc47 had lower and higher lipid droplet levels, respectively, when compared to the remaining strains, showing that higher accumulationof these neutral lipids is not a feature shared by all probiotic Saccharomyces strains. When submitted to simulated gastric or bile salts environments, lipid droplet levels increase in all tested probiotic strains, at least for one to the induced stresses, suggesting that lipid droplets participate in the protective mechanisms against gastrointestinal stresses in probiotic Saccharomyces yeasts

Effects of descending positive end-expiratory pressure on lung mechanics and aeration in healthy anaesthetized piglets

INTRODUCTION: Atelectasis and distal airway closure are common clinical entities of general anaesthesia. These two phenomena are expected to reduce the ventilation of dependent lung regions and represent major causes of arterial oxygenation impairment in anaesthetic conditions. The behaviour of the elastance of the respiratory system (E(rs)), as well as the lung aeration assessed by computed tomography (CT) scan, was evaluated during a descendent positive end-expiratory pressure (PEEP) titration. This work sought to evaluate the potential usefulness of E(rs )monitoring to set the PEEP in order to prevent tidal recruitment and hyperinflation of healthy lungs under general anaesthesia. METHODS: PEEP titration (from 16 to 0 cmH(2)O, tidal volume of 8 ml/kg) was performed, and at each PEEP, CT scans were obtained during end-expiratory and end-inspiratory pauses in six healthy, anaesthetized and paralyzed piglets. The distribution of lung aeration was determined and the tidal re-aeration was calculated as the difference between end-expiratory and end-inspiratory poorly aerated and normally aerated areas. Similarly, tidal hyperinflation was obtained as the difference between end-inspiratory and end-expiratory hyperinflated areas. E(rs )was estimated from the equation of motion of the respiratory system during all PEEP titration with the least-squares method. RESULTS: Hyperinflated areas decreased from PEEP 16 to 0 cmH(2)O (ranges decreased from 24–62% to 1–7% at end-expiratory pauses and from 44–73% to 4–17% at end-inspiratory pauses) whereas normally aerated areas increased (from 30–66% to 72–83% at end-expiratory pauses and from 19–48% to 73–77% at end-inspiratory pauses). From 16 to 8 cmH(2)O, E(rs )decreased with a corresponding reduction in tidal hyperinflation. A flat minimum of E(rs )was observed from 8 to 4 cmH(2)O. For PEEP below 4 cmH(2)O, E(rs )increased in association with a rise in tidal re-aeration and a flat maximum of the normally aerated areas. CONCLUSION: In healthy piglets under a descending PEEP protocol, the PEEP at minimum E(rs )presented a compromise between maximizing normally aerated areas and minimizing tidal re-aeration and hyperinflation. High levels of PEEP, greater than 8 cmH(2)O, reduced tidal re-aeration but increased hyperinflation with a concomitant decrease in normally aerated areas

Sepsis is a major determinant of outcome in critically ill HIV/AIDS patients

Submitted by Fábio Marques ([email protected]) on 2018-11-22T17:00:57Z No. of bitstreams: 1 Sepsis is a major determinant of outcome in HIV_Beatriz_Grinsztejn_INI_Lapclin-AIDS_2010.pdf: 326444 bytes, checksum: 176fa7e5a33453c31a87f95cfc16a782 (MD5)Approved for entry into archive by Regina Costa ([email protected]) on 2018-11-22T18:05:13Z (GMT) No. of bitstreams: 1 Sepsis is a major determinant of outcome in HIV_Beatriz_Grinsztejn_INI_Lapclin-AIDS_2010.pdf: 326444 bytes, checksum: 176fa7e5a33453c31a87f95cfc16a782 (MD5)Made available in DSpace on 2018-11-22T18:05:13Z (GMT). No. of bitstreams: 1 Sepsis is a major determinant of outcome in HIV_Beatriz_Grinsztejn_INI_Lapclin-AIDS_2010.pdf: 326444 bytes, checksum: 176fa7e5a33453c31a87f95cfc16a782 (MD5) Previous issue date: 2010Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Unidade de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Unidade de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Unidade de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Unidade de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Unidade de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil.New challenges have arisen for the management of critically ill HIV/AIDS patients. Severe sepsis has emerged as a common cause of intensive care unit (ICU) admission for those living with HIV/AIDS. Contrastingly, HIV/AIDS patients have been systematically excluded from sepsis studies, limiting the understanding of the impact of sepsis in this population. We prospectively followed up critically ill HIV/AIDS patients to evaluate the main risk factors for hospital mortality and the impact of severe sepsis on the short- and long-term survival