Coronavirus Disease 2019 Infection and Early Diagnosis of Macrophage Activation Syndrome: A Case Report of a 62 year old man.

A 62-year-old man presented with a history of fever, headache, anosmia, ageusia, and diarrhea for 9 days. A clinical and epidemiological diagnosis of infection with the novel coronavirus was made. After symptom refractoriness, the second step involves using human intravenous immunoglobulin. Early diagnosis of macrophage activation syndrome (MAS) involves observation of the refractory nature of clinical support treatment associated with biochemical changes to the patient's baseline characteristics, suggesting the relevance of a favorable clinical outcome of weaning from artificial life support when there is an early suspicion of a diagnosis of MAS secondary to coronavirus disease 2019 infection.

Coronavirus Disease 2019 Infection and Early Diagnosis of Macrophage Activation Syndrome: A Case Report of a 62-year-old man

ABSTRACT A 62-year-old man presented with a history of fever, headache, anosmia, ageusia, and diarrhea for 9 days. A clinical and epidemiological diagnosis of infection with the novel coronavirus was made. After symptom refractoriness, the second step involves using human intravenous immunoglobulin. Early diagnosis of macrophage activation syndrome (MAS) involves observation of the refractory nature of clinical support treatment associated with biochemical changes to the patient's baseline characteristics, suggesting the relevance of a favorable clinical outcome of weaning from artificial life support when there is an early suspicion of a diagnosis of MAS secondary to coronavirus disease 2019 infection.

Avaliação da relação neutrófilo/linfócito como indicador prognóstico em pacientes sépticos de unidades de terapia intensiva de Recife-PE / Evaluation of neutrophil-to-lymphocyte ratio as a prognostic indicator in septic patients in intensive care units in Recife-PE

Introdução: Sepse é uma síndrome de resposta inflamatória sistêmica associada a foco infeccioso e às disfunções orgânicas. Sabe-se que, no processo infeccioso, a resposta do hospedeiro consiste no aumento do número de neutrófilos e na redução do número total de linfócitos. O índice neutrófilo/linfócito (N/L) é uma ferramenta facilmente calculável a partir do hemograma, e tem sido utilizada como indicador prognóstico em diversas condições patológicas. Esta pesquisa visa avaliar o valor prognóstico das médias da relação neutrófilo-linfócito em pacientes sépticos em unidades de terapia intensiva de Recife-PE, Brasil. Metodologia: Foram coletados de registros em prontuário eletrônico os hemogramas de admissão, do segundo dia (D2) e sétimo (D7) dias após internamento em unidades de terapia intensiva (UTI). A relação neutrófilo/linfócito foi calculada pela divisão entre os valores absolutos das contagens celulares. As médias encontradas foram comparadas com: dias de internamento em UTI, tempo de ventilação mecânica, tempo de droga vasoativa e mortalidade em 28 dias. Resultados: O valor médio da relação N/L que teve correlação com mortalidade em 28 dias foi de 14,2 no D1 (p = 0,011) e 15,9 no D7 (p < 0,001). Ao avaliar-se o risco relativo de mortalidade em 28 dias quando os subgrupos foram reunidos em pacientes sem infecção (N/L < 5) e com infecção (N/L = 5), o oddsratio em D1 foi de 12,0; e em D7 foi de 15,8. Conclusão: O valor da relação N/L na avaliação de pacientes sépticos guarda correlação com mortalidade em 28 dias, e valor médio acima de 14 aumenta consideravelmente este risco.

Introduction: Sepsis is a syndrome of systemic inflammatory response associated with infectious outbreak and organ dysfunctions. In the infectious process, the host response is known to increase the number of neutrophils and to reduce the total number of lymphocytes. The neutrophil-to-lymphocyte ratio (NLR) can be easily calculated from the blood count and has been used as a prognostic indicator in several pathologic conditions. This study aimed to evaluate the prognostic value of NLR in septic patients in intensive care units (ICUs) in Recife-PE. Methods: Blood counts on ICU admission and on day 2 (D2) and day 7 (D7) after ICU admission were collected from electronic medical records. The NLR was calculated by dividing the absolute values of cell counts. The resulting averages were compared with length of ICU stay, duration of mechanical ventilation, duration of vasoactive drug use, and 28-day mortality. Results: The mean NLR that correlated with 28-day mortality was 14.2 on D1 (p=0.011) and 15.9 on D7 (p<0.001). In the analysis of the relative risk of 28-day mortality for the subgroups of patients without infection (NLR < 5) and with infection (NLR = 5), the odds ratio was 12.0 on D1 and 15.8 on D7. Conclusion: The value of the NLR in the evaluation of septic patients correlates with 28-day mortality, and mean values above 14 significantly increase this risk.

Optimization and Application of Electrochemical Transducer for Detection of Specific Oligonucleotide Sequence for Mycobacterium tuberculosis.

In this study, the electropolymerization of 4-hydroxyphenylacetic acid (4-HPA) over graphite electrodes (GE) was optimized, aiming its application as a functionalized electrochemical platform for oligonucleotides immobilization. It was investigated for the number of potential cycles and the scan rate influence on the monomer electropolymerization by using cyclic voltammetry technique. It was observed that the polymeric film showed a redox response in the region of +0.53/+0.38 V and the increase in the number of cycles produces more electroactive platforms because of the better electrode coverage. On the other hand, the decrease of scan rate produces more electroactive platforms because of the occurrence of more organized coupling. Scanning electron microscopy (SEM) images showed that the number of potential cycles influences the coverage and morphology of the electrodeposited polymeric film. However, the images also showed that at different scan rates a more organized material was produced. The influence of these optimized polymerization parameters was evaluated both in the immobilization of specific oligonucleotides and in the detection of hybridization with complementary target. Poly(4-HPA)/GE platform has shown efficient and sensitive for oligonucleotides immobilization, as well as for a hybridization event with the complementary oligonucleotide in all investigated cases. The electrode was modified with 100 cycles at 75 mV/s presented the best responses in function of the amplitude at the monitored peak current values for the Methylene Blue and Ethidium Bromide intercalators. The construction of the genosensor to detect a specific oligonucleotide sequence for the Mycobacterium tuberculosis bacillus confirmed the results regarding the poly(4-HPA)/GE platform efficiency since it showed excellent sensitivity. The limit of detection and the limit of quantification was found to be 0.56 (±0.05) µM and 8.6 (±0.7) µM, respectively operating with very low solution volumes (15 µL of probe and 10 µL target). The biosensor development was possible with optimization of the probe adsorption parameters and target hybridization, which led to an improvement in the decrease of the Methylene Blue (MB) reduction signal from 14% to 34%. In addition, interference studies showed that the genosensor has satisfactory selectivity since the hybridization with a non-specific probe resulted in a signal decrease (46% lower) when compared to the specific target.

Electrochemical enzymatic fenitrothion sensor based on a tyrosinase/poly(2-hydroxybenzamide)-modified graphite electrode.

This paper reports the electrosynthesis and characterisation of a polymeric film derived from 2-hydroxybenzamide over a graphite electrode and its application as an enzymatic biosensor for the determination and quantification of the pesticide fenitrothion. The material was analysed by scanning electron microscopy and its electrochemical properties characterised by cyclic voltammetry and electrochemical impedance spectroscopy. The enzyme tyrosinase was immobilised over the modified electrode by the drop and dry technique. Catechol was determined by direct reduction of biocatalytically formed o-quinone by employing the flow injection analysis technique. The analytical characteristics of the proposed sensor were optimised as follows: phosphate buffer 0.050 M at pH 6.5, flow rate 5.0 mL min-1, sample injection volume 150 µL, catechol concentration 1.0 mM and maximum inhibition time by fenitrothion of 6 min. The biosensors showed a linear response to pesticide concentration from 0.018 to 3.60 µM. The limit of detection and limit of quantification were calculated as 4.70 nM and 15.9 nM (RSD < 2.7%), respectively. The intra- and inter-electrode RSDs were 3.35% (n = 15) and 8.70% (n = 7), respectively. In addition, water samples spiked with the pesticide showed an average recovery of 97.6% (±1.53).