The complexity of respiratory disease associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: from immunopathogenesis to respiratory therapy

Amazon FoundationState University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.Federal University of Pará. Center for Tropical Medicine. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil / Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Covid-19, a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, may present with polymorphic symptomatology and subclinical, neurological, gastrointestinal, dermatological, renal and severe acute respiratory manifestations. The diffuse alveolar damage caused by the disease presents with fibrin deposition, oedema, lymphocytic inflammatory infiltrate, destruction of epithelial cells, hyaline membrane formation and occasional angiogenesis formation of microthrombi. A common radiological finding is bilateral ground glass opacity, present even in mild cases. Severe cases occur mainly among the elderly and individuals with underlying comorbidities. Here, we provide an overview of the pathophysiology of the disease associated with SARS-CoV-2 infection, interaction of the virus with the immune system, and subsequent dysfunctional immune response, essential for progression of Covid-19. We also discuss the role of the nervous system as a possible aggravating agent of the respiratory condition and propose a protocol for airway management based on the pathophysiological and immunological characteristics of the disease. Finally, we highlight the implications of such approaches for future therapeutic intervention

Doppler ultrasonography: A non‐invasive method used to diagnose and follow up patients with chronic hepatitis C

National Health and Medical Research Council (61856616.1.3001.5172)Universidade Federal do Pará. Núcleo de Medicina Tropical. Belém, PA, Brazil.Universidade Federal do Pará. Núcleo de Medicina Tropical. Belém, PA, Brazil / Santa Casa de Misericórdia. Belém, PA, Brazil.Universidade Federal do Pará. Núcleo de Medicina Tropical. Belém, PA, Brazil / Universidade do Estado do Pará. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Santa Casa de Misericórdia. Belém, PA, BrazilUniversidade Federal do Pará. Núcleo de Medicina Tropical. Belém, PA, Brazil / Universidade do Estado do Pará. Belém, PA, Brazil / Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Background and Aim: This study aimed to investigate the association between the findings of Doppler ultrasonography and transient elastography using FibroScan and to determine the cut-off points, sensitivity, and specificity of resistance indices, and pulsatility of the hepatic vessels to predict significant hepatic fibrosis. Methods: This is a transversal, observational, and analytical study that includes 30 patients with chronic hepatitis C who were admitted at a public referral hospital. Transient elastography and ultrasonographic data were collected, and the linear association between these methods was evaluated using the Pearson test. Various Doppler velocimetric indices were compared according to the presence/absence of significant (≥ F2) fibrosis. Results: There was a moderate-strong linear association between the FibroScan data and the Doppler velocimetric indices and splenic index in the hepatic vessels; the mean values of the indices differed between groups with absent/mild (F0/F1) and significant (≥ F2) hepatic fibrosis. There was an association between the monophasic and biphasic wave pattern of the suprahepatic veins and the stratification of hepatic fibrosis estimated by the values of kilopascal in FibroScan. Conclusion: Doppler ultrasonography is a non-invasive method used to evaluate liver fibrosis, and it presents acceptable sensitivity/specificity for the prediction of fibrosis ≥ F2 in patients with chronic hepatitis C