Predicting the outcome of death by CALL Score in COVID-19 patients

SUMMARY OBJECTIVE: The aim of this study was to assess the performance of the CALL Score tool in predicting the death outcome in COVID-19 patients. METHODS: A total of 897 patients were analyzed. Univariate and multivariate logistic regression analyses were conducted to determine the association between characteristics of the CALL Score and the occurrence of death. The relationship between CALL Score risk classification and the occurrence of death was also examined. Receiver operating characteristic curve analysis was performed to identify optimal cutoff points for the CALL Score and the outcome. RESULTS: The study revealed that age>60 years, DHL>500, and lymphocyte count ≤1000 emerged as independent predictors of death. Higher risk classifications of the CALL Score were associated with an increased likelihood of death. The optimal CALL Score cutoff point for predicting the death outcome was 9.5 (≥9.5), with a sensitivity of 70.4%, specificity of 80.3%, and accuracy of 80%. CONCLUSION: The CALL Score showed promising discriminatory ability for death outcomes in COVID-19 patients. Age, DHL level, and lymphocyte count were identified as independent predictors. Further validation and external evaluation are necessary to establish the robustness and generalizability of the CALL Score in diverse clinical settings.

Detection of the presence of Epstein−Barr virus and cytomegalovirus using polymerase chain reaction in patients with chronic kidney disease

Background: Chronic kidney disease (CKD) is an advanced and irreversible renal failure that contributes to increased mortality worldwide. Patients who undergo dialysis are more susceptible to developing infections due to their general condition. Epstein-Barr virus (EBV) and Cytomegalovirus (CMV) are associated with oral and systemic manifestations. The most modern and accurate technique to detect the presence of these viruses is polymerase chain reaction (PCR), which can predict viral reactivation even before the onset of symptoms and identify subclinical infections. This study aimed to detect the presence of Epstein-Barr virus (EBV) and Cytomegalovirus (CMV) in patients with chronic kidney disease (CKD) undergoing hemodialysis using real-time polymerase chain reaction (PCR). Methods: An epidemiological and observational case-control study was conducted. Two groups were considered (case group: patients on hemodialysis from the Nephrology Services of the Hospital das Clínicas of UFPE and Hospital Maria Lucinda and control group: healthy patients without CKD from the Department of Stomatology of the UFPE to evaluate the viruses presence using the real-time PCR technique. Results:Of the hemodialysis patients (n=54), 29 (53.70%) tested positive for CMV and only 10 (18.51%) for EBV, while in the healthy group (n=55), eight (14.54%) were positive for EBV and none for CMV. In neither group were systemic characteristics or oral manifestations observed due to the presence of viruses. Conclusion: The EBV and CMV viruses have a higher prevalence in hemodialysis patients. However, these patients did not present oral or systemic manifestations. (AU)

Uso clínico do rituximabe em doenças autoimunes / Clinical use of rituximab for autoimmune diseases

Doenças autoimunes são doenças universais, e os diagnósticos e tratamentos primários são habitualmente iniciados por clínicos em enfermarias ou ambulatórios, antes de serem encaminhados a especialistas. Além disso, pacientes em uso de biológicos internados em hospitais gerais têm sido cada vez mais frequentes na prática clínica. Conhecer o perfil de segurança, as indicações e os efeitos colaterais dessas drogas deve ser preocupação dos clínicos. Neste trabalho, foi realizada revisão de literatura sobre terapia biológica com rituximabe no tratamento das principais doenças autoimunes sistêmicas da prática clínica: artrite reumatoide, lúpus eritematoso sistêmico, vasculites relacionadas aos anticorpos anticitoplasma de neutrófilo, púrpura trombocitopênica imune e espondilite anquilosante. (AU)

AutoimmunAutoimmune diseases are universal diseases and primary diagnosis and treatment are typically initiated by internists in wards or outpatient clinics before being referred to specialists. In addition, patients on use of biologicals hospitalized in general hospitals have been increasingly common in clinical practice. Knowing the safety profile, the indications, and the side effects of these drugs should be a concern for the internists as well. In this study, the literature review was performed on biological therapy with Rituximab for treating the main systemic autoimmune diseases of clinical practice: rheumatoid arthritis, systemic lupus erythematosus, anti-neutrophil cytoplasmic antibody-associated vasculitides, immune thrombocytopenic purpura, and ankylosing spondylitis. (AU)

Combined genotypes of the MBL2 gene related to low mannose-binding lectin levels are associated with vaso-occlusive events in children with sickle cell anemia

Abstract Sickle cell anemia (SCA) presents heterogenous clinical manifestations that cannot be explained solely by alterations to hemoglobin (Hb); other components such as endothelial adhesion, thrombosis and inflammation may be involved. The mannose-binding lectin (MBL) has an important role in innate immunity and inflammatory diseases. In this report, we describe an association between MBL2 polymorphism related to low production of serum MBL and the frequency of vasoocclusive events (FVOE) in children ≤ 5 years old with SCA (p = 0.0229; OR 5.55; CI 1.11-27.66). Further studies are needed to explore the role of low MBL2 in the pathophysiology of vasoocclusive events in SCA.