Ultrasound findings in severe COVID-19: a deeper look through the carotid arteries.

Objective: To investigate vascular and perivascular abnormalities in the carotid arteries using ultrasound, as well as to evaluate their association with mortality and clinical variables in hospitalized patients with coronavirus disease 2019 (COVID-19). Materials and Methods: This was a prospective study in which 53 hospitalized patients with severe COVID-19 were evaluated and underwent carotid ultrasound. We documented the carotid ultrasound findings in these patients. Clinical, demographic, laboratory, and imaging features were analyzed and compared by statistical analysis to detect correlations between them. Results: Carotid ultrasound demonstrated luminal surface irregularity in 29 patients (55%), carotid plaques in 30 (57%), perivascular infiltration in four (8%), and increased intima-media thickness (IMT) in 31 (58%). Of the 31 patients with increased IMT, 19 (61%) died, and the association between increased IMT and COVID-19-related mortality was significant (p = 0.03). Logistic regression showed that the risk of death was 85% in patients who had increased IMT in combination with acute kidney injury at admission or a history of chronic kidney disease (p < 0.05). Conclusion: In hospitalized patients with severe COVID-19, carotid ultrasound can show increased IMT, luminal surface irregularity, carotid plaques, and perivascular infiltrates. The combination of increased IMT and kidney damage appears to increase the risk of death in such patients.

Objetivo: Investigar anormalidades vasculares e perivasculares nas artérias carótidas por meio de ultrassonografia e avaliar sua associação com mortalidade e variáveis clínicas em pacientes hospitalizados com COVID-19. Materiais e Métodos: Neste estudo prospectivo, 53 pacientes hospitalizados com COVID-19 grave foram avaliados e submetidos a ultrassonografia de carótida. Descrevemos os achados ultrassonográficos de carótida nesses pacientes. As correlações de características clínicas, demográficas, laboratoriais e de imagem foram analisadas e comparadas por meio de análise estatística. Resultados: A ultrassonografia carotídea demonstrou irregularidade da superfície luminal em 29 pacientes (55%), placas carotídeas em 30 pacientes (57%), infiltração perivascular em quatro pacientes (7,5%) e aumento da espessura médio-intimal (EMI) em 31 pacientes (58%). Dos pacientes com EMI aumentada, 19 (61%) morreram, com associação observada entre EMI aumentada e mortalidade por COVID-19 (p = 0,03). Um modelo de regressão logística mostrou que a probabilidade de óbito foi de 85% em pacientes com EMI aumentada e história de nefropatia crônica ou lesão renal aguda na internação (p < 0,05). Conclusão: Aumento da EMI, irregularidade da superfície luminal, placas carotídeas e infiltrados perivasculares foram encontrados na ultrassonografia carotídea em pacientes hospitalizados com COVID-19 grave. O aumento da EMI associado a danos nos rins pode aumentar o risco de morte.

Ultrasound findings in severe COVID-19: a deeper look through the carotid arteries / Achados ultrassonográficos na COVID-19 grave: um olhar aprofundado baseado nas artérias carótidas

Abstract Objective: To investigate vascular and perivascular abnormalities in the carotid arteries using ultrasound, as well as to evaluate their association with mortality and clinical variables in hospitalized patients with coronavirus disease 2019 (COVID-19). Materials and Methods: This was a prospective study in which 53 hospitalized patients with severe COVID-19 were evaluated and underwent carotid ultrasound. We documented the carotid ultrasound findings in these patients. Clinical, demographic, laboratory, and imaging features were analyzed and compared by statistical analysis to detect correlations between them. Results: Carotid ultrasound demonstrated luminal surface irregularity in 29 patients (55%), carotid plaques in 30 (57%), perivascular infiltration in four (8%), and increased intima-media thickness (IMT) in 31 (58%). Of the 31 patients with increased IMT, 19 (61%) died, and the association between increased IMT and COVID-19-related mortality was significant (p = 0.03). Logistic regression showed that the risk of death was 85% in patients who had increased IMT in combination with acute kidney injury at admission or a history of chronic kidney disease (p < 0.05). Conclusion: In hospitalized patients with severe COVID-19, carotid ultrasound can show increased IMT, luminal surface irregularity, carotid plaques, and perivascular infiltrates. The combination of increased IMT and kidney damage appears to increase the risk of death in such patients.

Resumo Objetivo: Investigar anormalidades vasculares e perivasculares nas artérias carótidas por meio de ultrassonografia e avaliar sua associação com mortalidade e variáveis clínicas em pacientes hospitalizados com COVID-19. Materiais e Métodos: Neste estudo prospectivo, 53 pacientes hospitalizados com COVID-19 grave foram avaliados e submetidos a ultrassonografia de carótida. Descrevemos os achados ultrassonográficos de carótida nesses pacientes. As correlações de características clínicas, demográficas, laboratoriais e de imagem foram analisadas e comparadas por meio de análise estatística. Resultados: A ultrassonografia carotídea demonstrou irregularidade da superfície luminal em 29 pacientes (55%), placas carotídeas em 30 pacientes (57%), infiltração perivascular em quatro pacientes (7,5%) e aumento da espessura médio-intimal (EMI) em 31 pacientes (58%). Dos pacientes com EMI aumentada, 19 (61%) morreram, com associação observada entre EMI aumentada e mortalidade por COVID-19 (p = 0,03). Um modelo de regressão logística mostrou que a probabilidade de óbito foi de 85% em pacientes com EMI aumentada e história de nefropatia crônica ou lesão renal aguda na internação (p < 0,05). Conclusão: Aumento da EMI, irregularidade da superfície luminal, placas carotídeas e infiltrados perivasculares foram encontrados na ultrassonografia carotídea em pacientes hospitalizados com COVID-19 grave. O aumento da EMI associado a danos nos rins pode aumentar o risco de morte.

COVID-19 and obesity: the meeting of two pandemics

ABSTRACT COVID-19 and obesity are two pandemic diseases that the world is currently facing. Both activate the immune system and mediate inflammation. A sequence of disease phases in patients with severe COVID-19 results in a cytokine storm, which amplifies the subclinical inflammation that already exists in patients with obesity. Pro-inflammatory cytokines and chemotactic factors increase insulin resistance in obesity. Therefore, a greater systemic inflammatory response is establishe, along with an increased risk of thrombotic phenomena and hyperglycemic conditions. These changes further impair pulmonary, cardiac, hepatic, and renal functions, in addition to hindering glycemic control in people with diabetes and pre-diabetes. This review explains the pathophysiological mechanisms of these two pandemic diseases, provides a deeper understanding of this harmful interaction and lists possible therapeutic strategies for this risk group.

COVID-19 and obesity: the meeting of two pandemics.

COVID-19 and obesity are two pandemic diseases that the world is currently facing. Both activate the immune system and mediate inflammation. A sequence of disease phases in patients with severe COVID-19 results in a cytokine storm, which amplifies the subclinical inflammation that already exists in patients with obesity. Pro-inflammatory cytokines and chemotactic factors increase insulin resistance in obesity. Therefore, a greater systemic inflammatory response is establishe, along with an increased risk of thrombotic phenomena and hyperglycemic conditions. These changes further impair pulmonary, cardiac, hepatic, and renal functions, in addition to hindering glycemic control in people with diabetes and pre-diabetes. This review explains the pathophysiological mechanisms of these two pandemic diseases, provides a deeper understanding of this harmful interaction and lists possible therapeutic strategies for this risk group.

Espectros luminosos no desenvolvimento de plântulas de Curcuma longa cultivadas in vitro / Luminous spectrum in the development of in-vitro Curcuma longa seedlings / Espectros luminosos en el desarrollo de plántulas de Curcuma longa cultivadas in vitro

Curcuma longa é uma espécie asiática perene e rizomatosa com grandes propriedades medicinais, alimentícias e ornamentais. No processo micropropagativo carece de muitas informações dentre a faixa espectral mais adequada ao seu desenvolvimento. Sendo assim, o objetivo desse trabalho foi avaliar diferentes filmes espectrais no desenvolvimento de plântulas de C. longa cultivadas in vitro. Para tanto, brotações de C. longa foram inoculadas em meio Murashig e Skoog e suplementado com 30 g/L de sacarose, 6,5 g/L de ágar 4, 44 µM/L de Benzil aminopurina (BAP) e 1,08 µM/L ácido naftaleno acético (ANA). O pH do meio foi ajustado para 5,8. Os brotos foram submetidos a diferentes intensidades e qualidade espectral de luz: branco, vermelho, amarelo, azul e verde. As plântulas foram mantidas em sala de crescimento em luz constante de 25C° e fotoperíodo de 24 horas por 145 dias. Foram avaliadas características morfológicas e anatômicas. Os resultados obtidos demonstraram que as diferenças espectraris propiciaram diferenças no desenvolvimento das plântulas de C. longa e também na contaminação in vitro. O diâmetro da base das plântulas, a massa seca e fresca da parte área e raiz foram influenciadas pelas diferentes faixas espectrais, sendo que de modo geral os filmes, amarelo e branco foram os que propiciaram maiores valores para essas características. Já o filme verde foi o que menos favoreceu o ganho de massa das plântulas, além disso, alta taxa de contaminação foi observada na presença desse filme.

Curcuma longa is a perennial Asiatic rhizomelic species with important medicinal, food and ornamental properties. However, its micro-propagation process lacks information regarding the most adequate spectral range for its development. Thus, this work aimed to evaluate different spectrum films in the development of in vitro C. longa seedlings. In order to do this, C. longa sprouts were inoculated in Murashig and Skoog media supplemented with 30 g/L of sucrose, 6.5 g/L of agar 4, 44 µM/L of benzylaminopurine (BAP) and 1.08 µM/L naphthalene acetic acid (ANA). The pH was adjusted to 5.8. Sprouts were put under different light spectrum intensity and quality: white, red, yellow, blue and green. The seedlings were maintained in a growth room with constant light at 25 ºC and a 24-hours photoperiod for 145 days. Morphological and anatomical characteristics were analyzed. The results demonstrated that spectral differences propitiated differences in the development of C. longa seedlings, and also in the in vitro contamination. The seedling base diameter, aerial and root dry and fresh mass were influenced by the different spectral ranges, with the yellow and white ranges being those that resulting the highest values for each characteristic. The green spectrum was the least favorable for the seedling regarding mass gain, as well as presenting the highest contamination rate.

Curcuma longa es una especie rizomélica asiática perenne con grandes propiedades medicinales, alimenticias y ornamentales. En el proceso de micropropagación no se dispone de informaciones sobre el rango espectral más adecuado para su desarrollo. Así, el objetivo de ese trabajo fue evaluar distintos espectros en el desarrollo de plántulas de C. longa cultivadas in vitro. Para esto, se inocularon los brotes de C. longa en medio Murashig y Skoog suplementados con 30 g/L de sacarosa, 6,5 g/L de agar 4, 44 µM/L de Benzilaminopurina (BAP) y 1,08 µM/L de ácido naftaleno acético (ANA). El pH de lo medio fue ajustado para 5.8. Los brotes fueron sometidos a diferentes intensidades y calidad de espectro luz: blanco, rojo, amarillo, azul y verde. Las plántulas se mantuvieron en un salón de crecimiento con luz constante a 25ºC y fotoperiodo de 24 horas durante 145 días. Se evaluaron características morfológicas y anatómicas. Los resultados obtenidos demostraron que las diferencias espectrales propiciaron diferencias en el desarrollo de plántulas de C. longa y sobre la contaminación in vitro. El diámetro de la base de las plántulas, la masa seca y fresca de la parte aérea y raíces fueron influenciadas por los diferentes rangos espectrales, siendo que el amarillo y el blanco fueron los que propiciaron valores más altos para esas características. La película verde fue la menos favorable a la plántula en gano de masa, además, alta tasa de contaminación se ha observado en la presencia de esa película.