The clinical relevance of oliguria in the critically ill patient : Analysis of a large observational database

Funding Information: Marc Leone reports receiving consulting fees from Amomed and Aguettant; lecture fees from MSD, Pfizer, Octapharma, 3 M, Aspen, Orion; travel support from LFB; and grant support from PHRC IR and his institution. JLV is the Editor-in-Chief of Critical Care. The other authors declare that they have no relevant financial interests. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.publishersversionPeer reviewe

SARS-CoV-2 as an Oncolytic Virus Following Reactivation of the Immune System: A Review

The effects SARS-CoV-2 inflicts on human physiology, especially in patients who developed COVID-19, can range from flu-like symptoms to death, and although many lives have been lost during the pandemic, others have faced the resolution of aggressive neoplasms that once proclaimed a poor prognosis following traditional treatments. The purpose of this review was to analyze several fortunate case reports and their associated biomolecular pathways to further explore new avenues that might provide oncological treatments in the future of medicine. We included papers that discussed cases in which patients affected by COVID-19 suffered beneficial changes in their cancer status. Multiple mechanisms which elicited a reactivation of the host’s immune system included cross-reactivity with viral antigens and downregulation of neoplastic cells. We were able to identify important cases presenting the resolution/remission of different aggressive neoplasms, for which most of the time, standard-of-care treatments offered little to no prospect towards a cure. The intricacy of the defense mechanisms humans have adopted against cancer cells through the millennia are still not well understood, but SARS-CoV-2 has demonstrated that the same ruinous cytokine storm which has taken so many lives can paradoxically be the answer we have been looking for to recalibrate the immunological system to retarget and vanquish malignancies

SARS-CoV-2 as an Oncolytic Virus Following Reactivation of the Immune System: A Review

The effects SARS-CoV-2 inflicts on human physiology, especially in patients who developed COVID-19, can range from flu-like symptoms to death, and although many lives have been lost during the pandemic, others have faced the resolution of aggressive neoplasms that once proclaimed a poor prognosis following traditional treatments. The purpose of this review was to analyze several fortunate case reports and their associated biomolecular pathways to further explore new avenues that might provide oncological treatments in the future of medicine. We included papers that discussed cases in which patients affected by COVID-19 suffered beneficial changes in their cancer status. Multiple mechanisms which elicited a reactivation of the host’s immune system included cross-reactivity with viral antigens and downregulation of neoplastic cells. We were able to identify important cases presenting the resolution/remission of different aggressive neoplasms, for which most of the time, standard-of-care treatments offered little to no prospect towards a cure. The intricacy of the defense mechanisms humans have adopted against cancer cells through the millennia are still not well understood, but SARS-CoV-2 has demonstrated that the same ruinous cytokine storm which has taken so many lives can paradoxically be the answer we have been looking for to recalibrate the immunological system to retarget and vanquish malignancies

The Clinical Significance of High Antimicrobial Resistance in Community-Acquired Urinary Tract Infections

Background. Urinary tract infections (UTIs) affect up to 150 million individuals annually worldwide, mainly due to Escherichia coli (E. coli) and Klebsiella. The emergence and spread of multidrug-resistant (MDR) bacteria are increasing, representing one of the biggest threats for human health. The objective of our study was to describe antimicrobial patterns of resistance and identify risk factors associated with MDR uropathogens. Methods. We conducted a cross-sectional study in 296 patients with community-acquired UTI who underwent clinical and microbiologic analysis, and clinical associations to MDR uropathogens were investigated. Findings. Microbiological analysis included E. coli (55%), ESBL-E. coli (26%), Enterococcus (6%), Klebsiella (5%), and others (8%). Higher frequencies of MDR bacteria were found among ESBL-E. coli, with resistance to ampicillin (100%), ceftriaxone (96%), gentamicin (57%), ciprofloxacin (89%), and TMP/SMX (53%). However, they were sensitive to fosfomycin (6.6%), nitrofurantoin (1.3%), and carbapenems (0%). Fosfomycin MIC90 for ESBL-E. coli was 5.78 μg/mL. The only clinical variable with significant association to ESBL producers was the presence of comorbidities: hypertension and type 2 diabetes mellitus with an OR (95%CI) of 2.51.3−4.9p<0.01 and 2.81.2−6.7p<0.05, respectively. Conclusions. In the majority of cases, resistance rates to commonly prescribed antimicrobials in UTIs were high, except for fosfomycin, nitrofurantoin, and carbapenems. To provide appropriate treatment, both the identification of risk factors and the uropathogen would be important. An active surveillance in UTIs in the community is required since the proportion of ESBL producers is increasing

Rheumatoid Arthritis and miRNAs: A Critical Review through a Functional View

Rheumatoid arthritis (RA) is a systemic autoimmune disease with severe joint inflammation and destruction associated with an inflammatory environment. The etiology behind RA remains to be elucidated; most updated concepts include the participation of environmental, proteomic, epigenetic, and genetic factors. Epigenetic is considered the missing link to explain genetic diversification among RA patients. Within epigenetic factors participating in RA, miRNAs are defined as small noncoding molecules with a length of approximately 22 nucleotides, capable of gene expression modulation, either negatively through inhibition of translation and degradation of the mRNA or positively through increasing the translation rate. Over the last decade and due to the feasibility of the identification of miRNAs among different tissues and compartments, they have been proposed as biomarkers for diagnosis, prognosis, and response to treatment in different pathologies. Nevertheless, miRNAs seem to be important regulators of networks instead of single genes; their hypothetical use as biomarkers needs to rely on a functional integrative description of their effects in the biological process of autoimmune conditions which until now is missing. Therefore, we underwent a bibliographic search for review and original articles related to miRNAs and their possible implications in rheumatoid arthritis. We found 48 different studies using the key words “miRNAs” or “micro-RNAs” and “rheumatoid arthritis” with restriction of publication dates from 2011 to 2016, in humans, using the English language. After a critical reading, we provide in this paper a functional view with respect to miRNA biogenesis, interaction with targets that are expressed in specific cells and tissues, during different stages of inflammatory responses associated with RA, and recognized specific areas where miRNAs might also have a pathogenic role but remain undescribed. Our results will be useful in designing future research projects that can support miRNAs as biomarkers or therapeutic targets in RA

Evaluation of frequency of antibodies against ciclic citrullinated peptide (aCCP) in sera of patients with rheumatoid factor test request.

A região do Distrito Mineiro de Ametista do Sul, situada no Estado do Rio Grande do Sul, destaca-se por ser uma importante fornecedora de ametista para o mercado nacional e internacional. O quartzo incolor (cristal de rocha) que ocorre associado à ametista, ainda que com pouco valor comercial, possui significativo potencial para obtenção da cor verde (prasiolita) a partir da exposição à irradiação gama. Para avaliar a potencialidade de geração de prasiolita do quartzo incolor proveniente dessa região, realizou-se inicialmente o cálculo do Fator Ametista por meio dos de espectros no infra-vermelho. Os valores de 1,13 a 1,68 indicam satisfatória disposição para a obtenção da cor verde posteriormente à exposição às doses de radiação de 900 kGy. As principais bandas de absorbância identificadas foram 3381 cm-1, 3433 cm-1, 3441 cm-1, 3585 cm-1 e 3595 cm-1, que se relacionam com as ligações AlSi-OH/Na+, FeSi-OH/H+ e Si-OH, descritas na literatura como relacionadas às causas de cor. A presença de água molecular nas amostras analisadas, apresentaram variações entre 0,09 a 0,18%. As doses de 200 e 900 kGy foram utilizadas para a irradiação das amostras de quartzo incolor, resultando na cor verde em diferentes tonalidades, verde muito claro, claro e escuro. No entanto, não foi observada uma relação direta entre as tonalidades de cor e as doses de irradiação aplicadas. Em determinadas amostras com seções mais fraturadas não houve acréscimo de cor, tornando-as verde incipiente ou persistindo o incolor. Porém para amostras mais límpidas, houve alteração para cor verde homogênea. O estudo não identificou proporcionalidade entre a dose de exposição à irradiação com a intensidade da cor, tampouco com a porcentagem de água molecular nas amostras.The Ametista do Sul Mining District, located in Rio Grande do Sul State (Brazil), is an important supplier of amethyst for the national and international market. Colorless quartz (rock crystal) that occurs in association with amethyst, which has a little commercial value, usually has a significant potential for obtaining green color (prasiolite) after exposure to gamma irradiation. In order to evaluate the potential for prasiolite generation from colorless quartz of this region, the Amethyst Factor was initially calculated using infrared spectra. Values from 1.13 to 1.68 indicate a satisfactory disposition to obtain the green color after exposure to radiation doses of 900 kGy. The main absorption bands Identified were 3381 cm-1, 3433 cm-1, 3441 cm-1, 3585 cm-1 and 3595 cm-1, which are linked to AlSi-OH/Na+, FeSi-OH/H+ and Si-OH bonds, described in literature as related to origin of color in quartz. Molecular water in the analyzed samples varied between 0.09 and 0.18%. The doses of 200 and 900 kGy were used for irradiation of colorless quartz samples, resulting in green color in different hues (very light, light and dark green). However, it was not observed a direct relationship between the color intensity and the applied irradiation doses. Some samples with several fractured sections, did not generate nice green color, turning to an incipiente green or persisting as colorless quartz. However, in clear samples, there was observed a color change to na homogeneous green color. The study did not identify a proportionality between irradiation exposure doses and the color intensity, and also with the percentage of molecular water in the samples