Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

3,4-diidroquinazolin-4-onas e 1H-benzo[d]imidaz?is : planejamento utilizando hibrida??o molecular, s?ntese e atividade inibit?ria sobre o crescimento de Mycobacterium tuberculosis

Submitted by PPG Biologia Celular e Molecular ([email protected]) on 2018-01-16T11:14:58Z No. of bitstreams: 1 FERNANDA_SOUZA_MACCHI_DIS.pdf: 4481387 bytes, checksum: 59f26900156a5b5c1a267893bdc6f655 (MD5)Approved for entry into archive by Caroline Xavier ([email protected]) on 2018-01-26T12:32:00Z (GMT) No. of bitstreams: 1 FERNANDA_SOUZA_MACCHI_DIS.pdf: 4481387 bytes, checksum: 59f26900156a5b5c1a267893bdc6f655 (MD5)Made available in DSpace on 2018-01-26T12:40:54Z (GMT). No. of bitstreams: 1 FERNANDA_SOUZA_MACCHI_DIS.pdf: 4481387 bytes, checksum: 59f26900156a5b5c1a267893bdc6f655 (MD5) Previous issue date: 2017-11-22Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPESUsing the classical hybridization approach series of 1H-benzo[d]imidazoles and 3,4-dihydroquinazolin-4-ones were synthesized and evaluated as inhibitors of Mycobacterium tuberculosis growth. Chemical modifications and structure-activity relationship studies yielding potent antitubercular agents with minimum inhibitory concentration values in submicromolar range. Further, the synthesized compounds were active against drug-resistant strains and were devoid of apparent toxicity to HepG2, HaCat, and Vero cells. In addition, some 3,4-dihydroquinazolin-4-ones showed low risk of cardiac toxicity, no signals of neurotoxicity or morphological alteration in zebrafish (Danio rerio) models. Therefore, these data denote that this class of molecules may furnish candidates for future development of novel anti-TB drug alternatives.Usando a abordagem cl?ssica de hibrida??o molecular, s?ries de 1H-benzo[d]imidaz?is e 3,4-diidroquinazolin-4-onas foram sintetizadas e ensaiadas como inibidores de crescimento de Mycobacterium tuberculosis. Modifica??es qu?micas e estudos de rela??o estrutura-atividade nos conduziram a potentes agentes antituberculose com valores submicromolares de concentra??o inibit?ria m?nima. Os compostos sintetizados tamb?m foram ativos contra cepas resistentes ? f?rmacos e demonstraram desprovida citotoxicidade aparente em c?lulas HepG2, HaCat e Vero. Al?m disso, algumas 3,4-diidroquinazolin-4-onas apresentaram baixo risco de toxicidade card?aca, e nenhum sinal de neurotoxicidade ou altera??o morfol?gica em modelo de peixe-zebra (Danio rerio). Sendo assim, os resultados indicam que essa classe de mol?cular pode fornecer condidatos para o desenvolvimento futuro de novos f?rmacos contra a tuberculose

Effect of LPS on the Viability and Proliferation of Human Oral and Esophageal Cancer Cell Lines

The esophagus and mouth tumors are very frequent malignancies worldwide. Lipopolysaccharides (LPS) are capable of regulating gene expression of pro-inflammatory cytokines by binding to toll-like receptor 4 (TLR4). Recent studies show that LPS can increase the migration ability of human esophageal cancer cell line HKESC-2 by increasing its adhesion properties. However, the effect of LPS has not been tested on viability of human esophageal and oral cancer cells. This study aimed to determine the action of LPS on the cell proliferation and viability in OE19 (adenocarcinoma) and OE21 (squamous carcinoma) cell lines, representative of human esophageal cancer, and HN30 cell line, representative of human oral carcinoma. LPS was used as treatment to OE19 and OE21 cells, and PgLPS (Porphyromonasgingivalis lipopolysaccharide) to HN30 cells. Viability was assessed by MTT assay and proliferation by cell counting. TLR4 expression was evaluated by real-time PCR. LPS at higher concentrations decreased significantly cell viability in both cell lines, adenocarcinoma (OE19) and squamous esophageal carcinoma (OE21) at different times of treatment. In addition, both cell lines, OE19 and OE21, expressed TLR4 receptor. Taken together, our data demonstrated that LPS at high concentrations might contribute to tumor death, in agreement with previously data

Synthesis and Antimycobacterial Activity of 3-Phenyl-1H-indoles

Tuberculosis has been described as a global health crisis since the 1990s, with an estimated 1.4 million deaths in the last year. Herein, a series of 20 1H-indoles were synthesized and evaluated as in vitro inhibitors of Mycobacterium tuberculosis (Mtb) growth. Furthermore, the top hit compounds were active against multidrug-resistant strains, without cross-resistance with first-line drugs. Exposing HepG2 and Vero cells to the molecules for 72 h showed that one of the evaluated structures was devoid of apparent toxicity. In addition, this 3-phenyl-1H-indole showed no genotoxicity signals. Finally, time-kill and pharmacodynamic model analyses demonstrated that this compound has bactericidal activity at concentrations close to the Minimum Inhibitory Concentration, coupled with a strong time-dependent behavior. To the best of our knowledge, this study describes the activity of 3-phenyl-1H-indole against Mtb for the first time

Is Low Non-Lethal Concentration of Methylmercury Really Safe? A Report on Genotoxicity with Delayed Cell Proliferation.

Human exposure to relatively low levels of methylmercury is worrying, especially in terms of its genotoxicity. It is currently unknown as to whether exposure to low levels of mercury (below established limits) is safe. Genotoxicity was already shown in lymphocytes, but studies with cells of the CNS (as the main target organ) are scarce. Moreover, disturbances in the cell cycle and cellular proliferation have previously been observed in neuronal cells, but no data are presently available for glial cells. Interestingly, cells of glial origin accumulate higher concentrations of methylmercury than those of neuronal origin. Thus, the aim of this work was to analyze the possible genotoxicity and alterations in the cell cycle and cell proliferation of a glioma cell line (C6) exposed to a low, non-lethal and non-apoptotic methylmercury concentration. Biochemical (mitochondrial activity) and morphological (integrity of the membrane) assessments confirmed the absence of cell death after exposure to 3 μM methylmercury for 24 hours. Even without promoting cell death, this treatment significantly increased genotoxicity markers (DNA fragmentation, micronuclei, nucleoplasmic bridges and nuclear buds). Changes in the cell cycle profile (increased mitotic index and cell populations in the S and G2/M phases) were observed, suggesting arrest of the cycle. This delay in the cycle was followed, 24 hours after methylmercury withdrawal, by a decrease number of viable cells, reduced cellular confluence and increased doubling time of the culture. Our work demonstrates that exposure to a low sublethal concentration of MeHg considered relatively safe according to current limits promotes genotoxicity and disturbances in the proliferation of cells of glial origin with sustained consequences after methylmercury withdrawal. This fact becomes especially important, since this cellular type accumulates more methylmercury than neurons and displays a vital role protecting the CNS, especially in chronic intoxication with this heavy metal

Cell survival after exposure to methylmercury (MeHg) for 24h.

<p>Cellular viability of cells intoxicated with increased concentrations (panel A) and number of viable and non-viable cells in control and cells exposed to 3 μM (panel B). Insets show micrographs (40X and 100X). Data are expressed as mean ± SEM (n = 4–9). One-way ANOVA followed by <i>post-hoc</i> Tukey test (panel A) and Student’s t-test between control and MeHg groups (panel B) were performed. *P < 0.01 <i>vs</i> all groups.</p

Genotoxicity detected after 24h of exposure to 3 μM of methylmercury (MeHg).

<p>DNA fragmentation was analyzed by comet assay (panel A) and indexes of micronuclei, nucleoplasmic bridges and nuclear buds were analyzed by cytokinesis-block micronucleus assay (panel B). Insets show micrographs (100X). Data are reported as mean ± SEM (n = 6). Student’s t-test between control and MeHg groups was performed. *P < 0.01 <i>vs</i> control.</p