Effect of Remote Ischaemic Conditioning on the inflammatory cytokine cascade of COVID-19 (RIC in COVID-19): a Randomized Controlled Trial

© The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Purpose Patients hospitalized with COVID-19 may develop a hyperinflammatory, dysregulated cytokine “storm” that rapidly progresses to acute respiratory distress syndrome, multiple organ dysfunction, and even death. Remote ischaemic conditioning (RIC) has elicited anti-inflammatory and cytoprotective benefits by reducing cytokines following sepsis in animal studies. Therefore, we investigated whether RIC would mitigate the inflammatory cytokine cascade induced by COVID-19. Methods We conducted a prospective, multicentre, randomized, sham-controlled, single-blind trial in Brazil and South Africa. Non-critically ill adult patients with COVID-19 pneumonia were randomly allocated (1:1) to receive either RIC (intermittent ischaemia/reperfusion applied through four 5-min cycles of inflation (20 mmHg above systolic blood pressure) and deflation of an automated blood-pressure cuff) or sham for approximately 15 days. Serum was collected following RIC/sham administration and analyzed for inflammatory cytokines using flow cytometry. The endpoint was the change in serum cytokine concentrations. Participants were followed for 30 days. Results Eighty randomized participants (40 RIC and 40 sham) completed the trial. Baseline characteristics according to trial intervention were overall balanced. Despite downward trajectories of all cytokines across hospitalization, we observed no substantial changes in cytokine concentrations after successive days of RIC. Time to clinical improvement was similar in both groups (HR 1.66; 95% CI, 0.938–2.948, p 0.08). Overall RIC did not demonstrate a significant impact on the composite outcome of all-cause death or clinical deterioration (HR 1.19; 95% CI, 0.616–2.295, p = 0.61). Conclusion RIC did not reduce the hypercytokinaemia induced by COVID-19 or prevent clinical deterioration to critical care.Peer reviewe

Cross sectional study on the food consumption of patients with type 1 diabetes and their family members

Orientadores: Maria Cândida Ribeiro Parisi, Denise Engelbrecht Zantut WittmannDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Avaliou-se a relação entre consumo alimentar de portadores de diabetes tipo 1 (DM1) seguidos em serviço de referência e de suas respectivas famílias. Trata-se de um estudo transversal no qual foram avaliados concomitantemente o consumo alimentar (Recordatório de 24 horas), o perfil nutricional (Índice de Massa Corporal), assim como, o nível socioeconômico de famílias e pacientes DM1. O controle glicêmico foi classificado pelo índice de hemoglobina glicada (HbA1c). Houve correlação positiva entre o consumo alimentar dos pacientes e familiares/acompanhantes para o consumo de carboidratos, proteínas e lipídios. O tempo de diagnóstico, tempo de acompanhamento no serviço, nº de avaliações da glicemia capilar, dose de insulina Kg/dia e parentesco dos familiares/acompanhantes mostraram-se relevantes sobre a HbA1c. O consumo alimentar tanto de pacientes quanto de familiares foi semelhante, inadequado e discordante das recomendações estabelecidas. Maior tempo de diagnóstico, maior tempo de acompanhamento no serviço, maior nº de avaliações da glicemia capilar, influenciaram positivamente a HbA1c. O parentesco sobre a HbA1c demanda mais estudos enfocando a influência parental no tratamento do Diabético tipo 1 adultoAbstract: To evaluate the relationship between dietary intake of patients with type 1 diabetes (T1D) followed in reference to their families and service. Cross-sectional study in which were concomitantly evaluated the dietary intake (24-hour recall), the nutritional status (body mass index), as well as the socioeconomic status of families and T1DM. Glycemic control was classified by the index of glycated hemoglobin (A1C). There was a positive correlation between inadequate dietary intake of patients and family members / caregivers to the consumption of carbohydrates, proteins and lipids. The time of diagnosis, follow-up time in the service, number of reviews of capillary blood glucose, insulin dose kg / day and kinship of family members / caregivers were relevant on HbA1c. Dietary intake of both patients and relatives was similar, inappropriate and discordant set of recommendations. Delayed diagnosis, longer follow-up in the service, the greater number of assessments of blood glucose, HbA1C positively influenced. Kinship on A1C demand more studies focusing on parental influence in the treatment of type 1 diabetic adultMestradoClinica MedicaMestra em Clínica Médic

Food consumption, nutritional knowledge of patients with type 1 diabetes and the risk ratio for cardiovascular disease

Orientadores: Maria Cândida Ribeiro Parisi, Denise Engelbrecht Zantut WittmannTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Objetivo: O objetivo deste trabalho foi avaliar o consumo alimentar, conhecimento nutricional de pacientes com diabetes tipo 1, bem como as ferramentas de estratificação de risco para doença cardiovascular desta população, seguidos em serviços públicos e privado de referência, e sua a relação com fatores de risco para Doença Cardiovascular. Metodologia: Estudo transversal no qual foram avaliados concomitantemente o consumo, conhecimento nutricional e a relação destes com o risco para desenvolvimento de doença cardiovascular em pacientes com Diabetes Mellitus Tipo 1 atendidos e seguidos no Serviço de Diabetes da Disciplina de Endocrinologia do Departamento de Clínica Médica da Faculdade de Ciências Médicas da Universidade Estadual de Campinas e em consultório particular, que seguem concomitantemente acompanhamento nutricional. O protocolo utilizado foi constituído de coleta dos dados nutricionais (peso, estatura, circunferência da cintura e circunferência do pescoço) e clínicos (Hemoglobina glicada, perfil lipídico (Colesterol total e frações) triglicérides, PCR (Proteína C-Reativa) e microalbuminúria) mais recentes a data da entrevista, além da avaliação do conhecimento nutricional por instrumento validado para a população brasileira, composição da dieta e avaliação da presença de risco para doença cardiovascular segundo duas ferramentas de estratificação de risco cardiovascular, entre os anos de 2015 e 2017. Resultados: Foram avaliados 124 pacientes, sendo elegíveis 106 para o Artigo 1 e 102 para o Artigo 2. Os achados encontrados são apresentados em 2 artigos. Artigo 1: Do total da amostra selecionada, 62% eram do sexo feminino, com idade média de 32 anos (QI 24; 43). Houve diferença entre estratificação do Risco Cardiovascular (RCV) entre as duas calculadoras que foram utilizadas, onde encontramos que 65,82% dos pacientes classificados como de baixo risco para Doença Cardiovascular (DCV) de acordo com o Steno foram identificados como intermediários (30, 38,00%) e alto risco (35,44%) pela Calculadora para Estratificação de Risco Cardiovascular (CRSC). A análise também destacou diferença na elegibilidade para indicação de uso de estatina de acordo com a estratificação de risco das ferramentas. Artigo 2: Encontramos associação entre alta ingestão de colesterol com o alto risco cardiovascular. A ingestão de colesterol, valor percentual representativo do Valor Energético Total (TEV), foi maior no grupo de Alto Risco Cardiovascular. A ingestão alimentar atual de carboidratos, proteínas, gordura total, gordura monoinsaturada, gordura poliinsaturada e fibra foram semelhantes nos três grupos de pacientes classificados de acordo com o Risco Cardiovascular (RCV) e atendeu às recomendações para a população com diabetes. O conhecimento nutricional foi moderado, sem diferenças entre as três estratificações segundo Steno e sem correlação com o Risco Cardiovascular. Conclusões: As ferramentas CRSC e Steno avaliaram e estratificaram a mesma população com DM1 de forma divergente. Verificamos que a ferramenta CRSC classificou a maioria da amostra como de alto risco. Devido a esse resultado, a elegibilidade para o uso de estatinas mostrou diferenças quando comparada à ferramenta Steno, a qual apresentou avaliação e propostas de tratamento menos agressivas em reação à prescrição de estatinas em pacientes com DM tipo 1. Quanto ao consumo alimentar, observou-se maior ingestão de colesterol no estrato RCV mais alto em comparação com o estrato de baixo risco, não sendo observada nenhuma associação com demais macronutrientes avaliados ou com o conhecimento nutricional. O conhecimento nutricional, classificado como moderado, não influenciou o risco cardiovascularAbstract: Objective: The objective of this study was to evaluate food consumption, nutritional knowledge of patients with type 1 diabetes, as well as the risk stratification tools for cardiovascular disease in this population, followed by public and private reference services, and their relationship with factors risk factors for Cardiovascular Disease. Methodology: Cross-sectional study in which consumption, nutritional knowledge and their relationship with the risk of developing cardiovascular disease were simultaneously assessed in patients with Type 1 Diabetes Mellitus treated and followed at the Diabetes Service of the Endocrinology Department of the Department of Clinical Medicine of Faculty of Medical Sciences of the State University of Campinas and in a private practice, which follow nutritional monitoring at the same time. The protocol used consisted of collecting nutritional data (weight, height, waist circumference and neck circumference) and clinical (glycated hemoglobin, lipid profile (total cholesterol and fractions) triglycerides, CRP (C-Reactive Protein) and microalbuminuria) more recent the date of the interview, in addition to the assessment of nutritional knowledge by a validated instrument for the Brazilian population, composition of the diet and assessment of the presence of risk for cardiovascular disease according to two cardiovascular risk stratification tools, between the years 2015 and 2017. Results: 124 patients were evaluated, 106 being eligible for Article 1 and 102 for Article 2. The findings are presented in 2 articles. Article 1: Of the total sample selected, 62% were female, with a mean age of 32 years (IQ 24; 43). There was a difference between stratification of Cardiovascular Risk (CVR) between the two calculators that were used, where we found that 65.82% of patients classified as low risk for Cardiovascular Disease (CVD) according to Steno were identified as intermediaries (30, 38.00%) and high risk (35.44%) by the Cardiovascular Risk Stratification Calculator (CRSC). The analysis also highlighted a difference in eligibility for the indication of statin use according to the risk stratification of the tools. Article 2: We found an association between high cholesterol intake and high cardiovascular risk. Cholesterol intake, a percentage value representative of the Total Energy Value (TEV), was higher in the High Cardiovascular Risk group. The current food intake of carbohydrates, proteins, total fat, monounsaturated fat, polyunsaturated fat, and fiber were similar in the three groups of patients classified according to Cardiovascular Risk (CVR) and met the recommendations for the population with diabetes. Nutritional knowledge was moderate, with no differences between the three stratifications according to Steno and no correlation with Cardiovascular Risk. Conclusions: The CRSC and Steno tools differently evaluated and stratified the same population with DM1. We found that the CRSC tool classified most of the sample as high risk. Due to this result, the eligibility for the use of statins showed differences when compared to the Steno tool, which presented less aggressive evaluation and treatment proposals in reaction to the prescription of statins in patients with type 1 diabetes. As for food consumption, a higher cholesterol intake was observed in the higher RCV stratum compared to the low-risk stratum, with no association with other evaluated macronutrients or nutritional knowledge. Nutritional knowledge, classified as moderate, did not influence cardiovascular riskDoutoradoClinica MedicaDoutora em CiênciasCAPE

Correction to: RIC in COVID-19—a Clinical Trial to Investigate Whether Remote Ischemic Conditioning (RIC) Can Prevent Deterioration to Critical Care in Patients with COVID-19 : RIC in COVID-19—a Clinical Trial to Investigate Whether Remote Ischemic Conditioning (RIC) Can Prevent Deterioration to Critical Care in Patients with COVID-19 (Cardiovascular Drugs and Therapy, (2021), 10.1007/s10557-021-07221-y)

Publisher Copyright: © 2021, Springer Science+Business Media, LLC, part of Springer Nature.The original article has been corrected. Author “Dereks M. Yellon” should be “Derek M. Yellon.”

RIC in COVID-19—a Clinical Trial to Investigate Whether Remote Ischemic Conditioning (RIC) Can Prevent Deterioration to Critical Care in Patients with COVID-19

Funding for this study was provided by grants from the Thompson Family Trust, The Hatter Cardiovascular Institute, Mancherje-Potash Foundation, and the Fundação de Apoio a Pesquisa do Estado de São Paulo (FAPESP). Publisher Copyright: © 2021, The Author(s).Purpose: Coronavirus disease 19 (COVID-19) has, to date, been diagnosed in over 130 million persons worldwide and is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several variants of concern have emerged including those in the United Kingdom, South Africa, and Brazil. SARS-CoV-2 can cause a dysregulated inflammatory response known as a cytokine storm, which can progress rapidly to acute respiratory distress syndrome (ARDS), multi-organ failure, and death. Suppressing these cytokine elevations may be key to improving outcomes. Remote ischemic conditioning (RIC) is a simple, non-invasive procedure whereby a blood pressure cuff is inflated and deflated on the upper arm for several cycles. “RIC in COVID-19” is a pilot, multi-center, randomized clinical trial, designed to ascertain whether RIC suppresses inflammatory cytokine production. Methods: A minimum of 55 adult patients with diagnosed COVID-19, but not of critical status, will be enrolled from centers in the United Kingdom, Brazil, and South Africa. RIC will be administered daily for up to 15 days. The primary outcome is the level of inflammatory cytokines that are involved in the cytokine storm that can occur following SARS-CoV-2 infection. The secondary endpoint is the time between admission and until intensive care admission or death. The in vitro cytotoxicity of patient blood will also be assessed using primary human cardiac endothelial cells. Conclusions: The results of this pilot study will provide initial evidence on the ability of RIC to suppress the production of inflammatory cytokines in the setting of COVID-19. Trial Registration: NCT04699227, registered January 7th, 2021.Peer reviewe

Adiposidade em adolescentes e obesidade materna Relationship between maternal obesity and adiposity in adolescents

OBJETIVO: Descrever a relação entre adiposidade na adolescência e obesidade materna. MÉTODOS: Foi realizado estudo transversal com 660 indivíduos de 8 a 18 anos, de ambos os sexos, matriculados em uma escola pública e outra privada do município de São Paulo. A coleta de dados foi realizada por meio de entrevista, medidas antropométricas e inquérito alimentar. A adiposidade na adolescência foi mensurada a partir do índice de massa corporal e, por meio de análise de regressão, verificou-se sua relação com a obesidade materna, ajustada por sexo, idade, estágio de maturação sexual, valor energético total da dieta, atividade física, sedentarismo, peso ao nascer e escolaridade materna. RESULTADOS: Dos adolescentes estudados, 64,7% eram do sexo feminino. A média (desvio-padrão) de idade foi de 12,4 (1,80), variando de 8 a 17 anos. Verificou-se maior prevalência de excesso de peso e obesidade entre os indivíduos do sexo masculino, não sendo observada associação significativa entre estado nutricional e sexo. Após ajuste pelas covariáveis, detectou-se que filhos de mães obesas têm risco quatro vezes maior de ser obesos, quando comparados aos adolescentes filhos de mães não obesas. CONCLUSÃO: Conclui-se que a obesidade materna representa fator de risco importante para o desenvolvimento da obesidade na adolescência.<br>OBJECTIVE: This study aimed to describe the relationship between teenager's adiposity and maternal obesity. METHODS: A cross-sectional study was done with 660 teenagers aged 8 to 18 years, of both genders, students of private and public schools of São Paulo. The data were collected by interviews, anthropometric measurements and food intake records. Teenagers' adiposity was determined by body mass index and regression analyses was used to verify its relationship with maternal obesity adjusted for gender, age, stage of sexual development, energy intake, physical activity, sedentary lifestyle, birth weight and mother's education level. RESULTS: Most (64.7%) of the teenagers were female. The mean age was 12.4 years (SD=1.80), aged 8 to 17 years. The prevalence of obesity and overweight was higher in boys. No statistical difference was found between nutritional status and gender. After the adjustments, the data show that children of obese mothers were 4 times more likely to be at risk of obesity than children of normal weight mothers. CONCLUSION: Maternal obesity is a great risk factor for adolescent obesity