Elevated IL-18 predicts poor prognosis in critically ill COVID-19 patients at a Brazilian hospital in 2020-21.

Background: A dysregulated inflammatory response contributes to decline in patients with COVID-19. This cross-sectional study evaluated biomarkers of unvaccinated patients admitted to the intensive care unit of a hospital in Fortaleza, Brazil. Methods: Twenty cytokines were quantified upon hospital admission; clinical and laboratory data were analyzed, as well as sociodemographic data, to search for an association with clinical outcomes, including fatal (n = 40) or recovered cases (n = 38). Results: Fatal cases exhibited significantly higher levels of IL-18 (p = 0.009); deceased patients were older (p = 0.0001), had a lower number of platelets (p = 0.0063) and higher neutrophil-lymphocyte ratio (p = 0.0230) than those who recovered. Conclusion: These findings indicate that IL-18 is a possible marker to predict poor prognosis in critically ill patients with COVID-19.

Urinary tubular biomarkers as predictors of death in critically ill patients with COVID-19.

Aim: To evaluate the prediction capacity of urinary biomarkers for death in critically ill patients with COVID-19. Methods: This is a prospective study with critically ill patients due to COVID-19 infection. The urinary biomarkers NGAL, KIM-1, MCP-1 and nephrin were quantified on ICU admission. Results: There was 40% of death. Urinary nephrin and MCP-1 had no association with death. Tubular biomarkers (proteinuria, NGAL and KIM-1) were predictors of death and cut-off values of them for death were useful in stratify patients with worse prognosis. In a multivariate cox regression analysis, only NGAL remains associated with a two-mount survival chance. Conclusion: Kidney tubular biomarkers, mostly urinary NGAL, had useful capacity to predict death in critically ill COVID-19 patients.

ACUTE KIDNEY INJURY CAUSED BY Crotalus AND Bothrops SNAKE VENOM: A REVIEW OF EPIDEMIOLOGY, CLINICAL MANIFESTATIONS AND TREATMENT / Lesão renal aguda causada pelo veneno das cobras Crotalus e Bothrops: revisão da epidemiologia, das manifestações clínicas e do tratamento

SUMMARY Ophidic accidents are an important public health problem due to their incidence, morbidity and mortality. An increasing number of cases have been registered in Brazil in the last few years. Several studies point to the importance of knowing the clinical complications and adequate approach in these accidents. However, knowledge about the risk factors is not enough and there are an increasing number of deaths due to these accidents in Brazil. In this context, acute kidney injury (AKI) appears as one of the main causes of death and consequences for these victims, which are mainly young males working in rural areas. Snakes of the Bothrops and Crotalus genera are the main responsible for renal involvement in ophidic accidents in South America. The present study is a literature review of AKI caused by Bothrops and Crotalus snake venom regarding diverse characteristics, emphasizing the most appropriate therapeutic approach for these cases. Recent studies have been carried out searching for complementary therapies for the treatment of ophidic accidents, including the use of lipoic acid, simvastatin and allopurinol. Some plants, such as Apocynaceae, Lamiaceae and Rubiaceae seem to have a beneficial role in the treatment of this type of envenomation. Future studies will certainly find new therapeutic measures for ophidic accidents. .

RESUMO Os acidentes ofídicos são importante problema de saúde pública devido à incidência, morbidade e mortalidade. Aumento do número de casos tem sido registrado no Brasil nos últimos anos. Vários estudos apontam para a importância do conhecimento das complicações clínicas e do tratamento adequado desses acidentes. Entretanto o conhecimento dos fatores de risco não é suficiente, e existe número crescente de óbitos devido a esses acidentes no Brasil. Neste contexto, a injúria renal aguda (IRA) aparece como uma das principais causas de óbito e sequela nestas vítimas, que são principalmente homens trabalhadores de zonas rurais. Os gêneros Bothrops e Crotalus são os principais responsáveis pelo envolvimento renal nos acidentes ofídicos na América do Sul. O presente estudo faz uma revisão da literatura sobre a IRA causada pela picada das serpentes dos gêneros Bothrops e Crotalus em suas diversas características, enfatizando a abordagem terapêutica mais adequada para estes casos. Estudos recentes tem sido realizados para a busca de terapias complementares para o tratamento dos acidentes ofídicos, incluindo o uso de ácido lipóico, sinvastatina e alopurinol. Algumas plantas, como a Apocynaceae, Lamiaceae e Rubiaceae parecem ter papel benéfico no tratamento destes envenenamentos. Estudos futuros irão certamente encontrar novas estratégias terapêuticas para os acidentes ofídicos. .

Epidemiologicalpprofile of snakebite accidents in a metropolitan area of northeast Brazil / Perfil epidemiologico dos acidentes por picada de cobra em regiao metropolitana do nordeste do Brasil

SUMMARY The aim of this study was to describe the epidemiological profile of snakebite accidents reported by the toxicological assistance center in Fortaleza, Ceará, Brazil. Database information on snakebite accidents was analyzed regarding the period from January 2003 to December 2011. A total of 1063 cases were found. The accidents occurred during the rainy months (March, April and May), in urban areas (52.3%), affecting individuals younger than 50 years and predominantly among males (70.7%). The lower limbs were the most frequently affected body area (33.7%). Most accidents involved non-venomous snakes (76.1%). The genus Bothrops was the main one involved in venomous accidents (83%). It is expected that this study can be used as the substrate to improve healthcare surveillance and implementing better measures for the treatment of this population. .

RESUMO O objetivo deste estudo é descrever o perfil epidemiológico dos acidentes ofídicos atendidos e notificados ao Centro de Assistência Toxicológica (CEATOX), em Fortaleza, Ceará, Brasil. Foram analisadas informações sobre os acidentes ofídicos relativos ao período compreendido entre janeiro de 2003 a dezembro de 2011, por meio de banco de dados. Os resultados demonstraram 1063 casos notificados ao CEATOX, Ceará. Os acidentes ocorreram principalmente em meses chuvosos (março, abril e maio), em áreas urbanas (52,3%), em uma faixa etária menor de 50 anos, acometendo predominantemente o sexo masculino (70,7%). Os membros inferiores foram os locais mais afetados (33,7%). A maior parte dos acidentes envolveu serpentes não peçonhentas (76,1%). O gênero Bothrops foi o maior responsável pelos acidentes com serpentes peçonhentas (83%). Espera-se que os dados da casuística obtida sirvam de ferramenta para o planejamento de medidas de saúde voltadas para prevenção e atendimento mais adequado da população em estudo. .