Critically ill SARS-CoV-2 patients display lupus-like hallmarks of extrafollicular B cell activation

Abstract/IntroductionA wide clinical spectrum has become a hallmark of the SARS-CoV-2 (COVID-19) pandemic, although its immunologic underpinnings remain to be defined. We have performed deep characterization of B cell responses through high-dimensional flow cytometry to reveal substantial heterogeneity in both effector and immature populations. More notably, critically ill patients displayed hallmarks of extrafollicular B cell activation as previously described in autoimmune settings. Extrafollicular activation correlated strongly with large antibody secreting cell expansion and early production of high levels of SARS-CoV-2-specific antibodies. Yet, these patients fared poorly with elevated inflammatory biomarkers, multi-organ failure, and death. Combined, the findings strongly indicate a major pathogenic role for immune activation in subsets of COVID-19 patients. Our study suggests that, as in autoimmunity, targeted immunomodulatory therapy may be beneficial in specific patient subpopulations that can be identified by careful immune profiling.

Reconstrução facial: mensuração da espessura dos tecidos moles que recobrem a face / Facial reconstruction: measurement of the soft tissue´s thickness that covers the face

Reconstrução facial forense é uma técnica utilizada com a finalidade de reconhecimento e posterior identificação, nas situações em que inexiste uma identidade atribuível ao esqueleto submetido à perícia médico-legal. Objetivou-se neste estudo mensurar as espessuras de tecidos moles que recobrem a face em cadáveres que deram entrada no Instituto Médico Legal (IML) de Guarulhos no período de setembro de 2010 a setembro de 2011. Foram efetuadas mensurações de 49 pontos anatômicos da face em cadáveres com menos de 24 horas do óbito; tais mensurações foram analisadas por meio do teste t com p bicaudal. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da FOUSP (protocolo 144/2010). Um total de 100 cadáveres foi estudado, sendo 64 do sexo masculino e 26 do sexo feminino. Eles pertenciam majoritariamente à faixa etária de 41 a 60 anos. Optou-se por utilizar nomenclatura em língua inglesa com a finalidade de facilitar comparações com trabalhos internacionais

Dos 49 marcos mensurados, apenas cinco apresentaram um p menor que 0,05, ou seja, para os seguintes pontos as medidas entre homens e mulheres não são as mesmas quando comparadas em relação ao sexo: upper lip margin (p=0,006), superior labius sulcus (p=0,006), stomion (p=o,001), lateral orbits direito (p=0,008) e chelion esquerdo (p=0,009). Os pontos anatômicos analisados permitiram estabelecer parâmetros mais precisos de espessuras faciais aplicáveis na reconstrução facial de cadáveres da população brasileira. Além disso, os marcos anatômicos analisados permitiram a construção de uma tabela com finalidade de reconstrução facial forense.

Forensic facial reconstruction is a technique that has the aim of recognition and identification, in situations in which a known identity of the sketelon submetted to medico-legal procedures is not available. The objective of the study was to study the soft tissue thicknesses that cover the face of autopsied corpses that were sent to Guarulho´s Medical-Legal Institute from September 2010 to September 2011. Measurements of 49 anatomic references were performed in the face of corpses with less than 24 hours of death; data were analysed using t test with bicaudal p. The project was approved by the University of São Paulo´s School of Dentistry Ethics Committee (protocol number 144/2010). One hundred corpses were studied, being 64 male and 26 female. They were mainly 41 to 60 years old. Among all the 49 studied anatomic references, just five presented a p value lower than 0.05, that is, these references showed differences between sex: upper lip margin (p=0.006), superior labius sulcus (p=0.006), stomion (p=0,001), right lateral orbits (p=0.008) and left chelion (p=0.009). The studied anatomic references allowed to establish more precise parameters of the faces thicknesses that can be applied in corpses facial reconstructions in the Brazilian population, and some anatomic references presented a higher discriminant Power with regard to sex. Furthermore, the anatomic landmarks offered information to a reference table with the objective of forensic facial reconstruction.