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1.
BMC Infect Dis ; 21(1): 19, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407229

RESUMO

BACKGROUND: Exotoxins secreted from Staphylococcus aureus or Streptococcus pyogenes act as superantigens that induce systemic release of inflammatory cytokines and are a common cause of toxic shock syndrome (TSS). However, little is known about TSS caused by coagulase-negative staphylococci (CoNS) and the underlying mechanisms. Here, we present a rare case of TSS caused by Staphylococcus simulans (S. simulans). CASE PRESENTATION: We report the case of a 75-year-old woman who developed pneumococcal pneumonia and bacteremia from S. simulans following an influenza infection. The patient met the clinical criteria for probable TSS, and her symptoms included fever of 39.5 °C, diffuse macular erythroderma, conjunctival congestion, vomiting, diarrhea, liver dysfunction, and disorientation. Therefore, the following treatment was initiated for bacterial pneumonia complicating influenza A with suspected TSS: meropenem (1 g every 8 h), vancomycin (1 g every 12 h), and clindamycin (600 mg every 8 h). Blood cultures taken on the day after admission were positive for CoNS, whereas sputum and pharyngeal cultures grew Streptococcus pneumoniae (Geckler group 4) and methicillin-sensitive S. aureus, respectively. However, exotoxins thought to cause TSS, such as TSS toxin-1 and various enterotoxins, were not detected. The patient's therapy was switched to cefazolin (2 g every 8 h) and clindamycin (600 mg every 8 h) for 14 days based on microbiologic test results. She developed desquamation of the fingers on hospital day 8 and was diagnosed with TSS. Conventional exotoxins, such as TSST-1, and S. aureus enterotoxins were not detected in culture samples. The serum levels of inflammatory cytokines, such as neopterin and IL-6, were high. CD8+ T cells were activated in peripheral blood. Vß2+ population activation, which is characteristic for TSST-1, was not observed in the Vß usage of CD8+ T cells in T cell receptor Vß repertoire distribution analysis. CONCLUSIONS: We present a case of S. simulans-induced TSS. Taken together, we speculate that no specific exotoxins are involved in the induction of TSS in this patient. A likely mechanism is uncontrolled cytokine release (i.e., cytokine storm) induced by non-specific immune reactions against CoNS proliferation.


Assuntos
Síndrome da Liberação de Citocina/complicações , Choque Séptico/complicações , Infecções Estafilocócicas/complicações , Staphylococcus aureus/isolamento & purificação , Staphylococcus/isolamento & purificação , Streptococcus pneumoniae/isolamento & purificação , Idoso , Antibacterianos/administração & dosagem , Hemocultura , Cefazolina/administração & dosagem , Clindamicina/administração & dosagem , Síndrome da Liberação de Citocina/tratamento farmacológico , Citocinas/sangue , Feminino , Humanos , Testes de Sensibilidade Microbiana , Choque Séptico/tratamento farmacológico , Escarro/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Resultado do Tratamento
3.
BMC Infect Dis ; 20(1): 817, 2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33167878

RESUMO

BACKGROUND: Gastrointestinal (GI) mucormycosis is a rare and often deadly form of mucormycosis. Delayed diagnosis can lead to an increased risk of death. Here, we report a case of GI mucormycosis following streptococcal toxic shock syndrome in a virologically suppressed HIV-infected patient. CASE PRESENTATION: A 25-year-old Thai woman with a well-controlled HIV infection and Grave's disease was admitted to a private hospital with a high-grade fever, vomiting, abdominal pain, and multiple episodes of mucous diarrhea for 3 days. On day 3 of that admission, the patient developed multiorgan failure and multiple hemorrhagic blebs were observed on all extremities. A diagnosis of streptococcal toxic shock was made before referral to Siriraj Hospital - Thailand's largest national tertiary referral center. On day 10 of her admission at our center, she developed feeding intolerance and bloody diarrhea due to bowel ischemia and perforation. Bowel resection was performed, and histopathologic analysis of the resected bowel revealed acute suppurative transmural necrosis and vascular invasion with numerous broad irregular branching non-septate hyphae, both of which are consistent with GI mucormycosis. Peritoneal fluid fungal culture grew a grayish cottony colony of large non-septate hyphae and spherical sporangia containing ovoidal sporangiospores. A complete ITS1-5.8S-ITS2 region DNA sequence analysis revealed 100% homology with Rhizopus microsporus strains in GenBank (GenBank accession numbers KU729104 and AY803934). As a result, she was treated with liposomal amphotericin B. However and in spite of receiving appropriate treatment, our patient developed recurrent massive upper GI bleeding from Dieulafoy's lesion and succumbed to her disease on day 33 of her admission. CONCLUSION: Diagnosis of gastrointestinal mucormycosis can be delayed due to a lack of well-established predisposing factors and non-specific presenting symptoms. Further studies in risk factors for abdominal mucormycosis are needed.


Assuntos
Trato Gastrointestinal/microbiologia , Doença de Graves/complicações , Infecções por HIV/complicações , Mucormicose/complicações , Rhizopus/genética , Choque Séptico/complicações , Infecções Estreptocócicas/complicações , Streptococcus pyogenes/isolamento & purificação , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , DNA Fúngico/genética , Evolução Fatal , Feminino , Infecções por HIV/virologia , Humanos , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Mucormicose/microbiologia , Choque Séptico/diagnóstico , Choque Séptico/microbiologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Síndrome , Tailândia
6.
A A Pract ; 14(9): e01287, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32909713

RESUMO

Methemoglobinemia is a rare disorder of the blood in which there is an increase in methemoglobin, which occurs when hemoglobin is present in the oxidized form. Methemoglobin impairs hemoglobin's ability to transport oxygen, produces functional anemia, and leads to tissue hypoxia. We report the successful management of a case of refractory hypoxia due to acutely acquired methemoglobinemia in a patient undergoing treatment for coronavirus disease 2019 (COVID-19) pneumonia. The cause of methemoglobinemia in this patient remains unknown. Hypoxia and methemoglobinemia did not respond to methylene blue and required administration of packed red blood cell transfusions.


Assuntos
Infecções por Coronavirus/complicações , Hipóxia/etiologia , Metemoglobinemia/complicações , Pneumonia Viral/complicações , Insuficiência Respiratória/etiologia , Lesão Renal Aguda/complicações , Lesão Renal Aguda/terapia , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Corynebacterium , Infecções por Corynebacterium/complicações , Infecções por Corynebacterium/terapia , Síndrome da Liberação de Citocina/complicações , Inibidores Enzimáticos/uso terapêutico , Transfusão de Eritrócitos , Hematínicos/uso terapêutico , Humanos , Hidroxocobalamina/uso terapêutico , Hidroxicloroquina/uso terapêutico , Hipóxia/terapia , Masculino , Metemoglobinemia/terapia , Azul de Metileno/uso terapêutico , Pandemias , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/terapia , Pneumonia Viral/tratamento farmacológico , Terapia de Substituição Renal , Insuficiência Respiratória/terapia , Choque Séptico/complicações
7.
Lancet ; 396(10250): 545-552, 2020 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-32828186

RESUMO

BACKGROUND: Patients with sepsis-induced cardiomyopathy with cardiogenic shock have a high mortality. This study assessed venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for sepsis-induced cardiogenic shock refractory to conventional treatments. METHODS: In this retrospective, multicentre, international cohort study, we compared outcomes of 82 patients (aged ≥18 years) with septic shock who received VA-ECMO at five academic ECMO centres, with 130 controls (not receiving ECMO) obtained from three large databases of septic shock. All patients had severe myocardial dysfunction (cardiac index 3 L/min per m2 or less or left ventricular ejection fraction [LVEF] 35% or less) and severe haemodynamic compromise (inotrope score at least 75 µg/kg per min or lactic acidaemia at least 4 mmol/L) at time of inclusion. The primary endpoint was survival at 90 days. A propensity score-weighted analysis was done to control for confounders. FINDINGS: At baseline, patients treated with VA-ECMO had more severe myocardial dysfunction (mean cardiac index 1·5 L/min per m2vs 2·2 L/min per m2, LVEF 17% vs 27%), more severe haemodynamic impairment (inotrope score 279 µg/kg per min vs 145 µg/kg per min, lactataemia 8·9 mmol/L vs 6·5 mmol/L), and more severe organ failure (Sequential Organ Failure Assessment score 17 vs 13) than did controls, with p<0·0001 for each comparison. Survival at 90 days for patients treated with VA-ECMO was significantly higher than for controls (60% vs 25%, risk ratio [RR] for mortality 0·54, 95% CI [0·40-0·70]; p<0·0001). After propensity score weighting, ECMO remained associated with improved survival (51% vs 14%, adjusted RR for mortality 0·57, 95% CI [0·35-0·93]; p=0·0029). Lactate and catecholamine clearance were also significantly enhanced in patients treated with ECMO. Among the 49 survivors treated with ECMO, 32 who had been treated at the largest centre reported satisfactory Short Form-36 evaluated health-related quality of life at 1-year follow-up. INTERPRETATION: Patients with severe sepsis-induced cardiogenic shock treated with VA-ECMO had a large and significant improvement in survival compared with controls not receiving ECMO. However, despite the careful propensity-weighted analysis, we cannot rule out unmeasured confounders. FUNDING: None.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Choque Cardiogênico/terapia , Choque Séptico/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Bases de Dados Factuais , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Qualidade de Vida , Estudos Retrospectivos , Choque Cardiogênico/etiologia , Choque Cardiogênico/mortalidade , Resultado do Tratamento
8.
JAMA ; 324(7): 642-650, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32809003

RESUMO

Importance: The combination of ascorbic acid, corticosteroids, and thiamine has been identified as a potential therapy for septic shock. Objective: To determine whether the combination of ascorbic acid, corticosteroids, and thiamine attenuates organ injury in patients with septic shock. Design, Setting, and Participants: Randomized, blinded, multicenter clinical trial of ascorbic acid, corticosteroids, and thiamine vs placebo for adult patients with septic shock. Two hundred five patients were enrolled between February 9, 2018, and October 27, 2019, at 14 centers in the United States. Follow-up continued until November 26, 2019. Interventions: Patients were randomly assigned to receive parenteral ascorbic acid (1500 mg), hydrocortisone (50 mg), and thiamine (100 mg) every 6 hours for 4 days (n = 103) or placebo in matching volumes at the same time points (n = 102). Main Outcomes and Measures: The primary outcome was change in the Sequential Organ Failure Assessment (SOFA) score (range, 0-24; 0 = best) between enrollment and 72 hours. Key secondary outcomes included kidney failure and 30-day mortality. Patients who received at least 1 dose of study drug were included in analyses. Results: Among 205 randomized patients (mean age, 68 [SD, 15] years; 90 [44%] women), 200 (98%) received at least 1 dose of study drug, completed the trial, and were included in the analyses (101 with intervention and 99 with placebo group). Overall, there was no statistically significant interaction between time and treatment group with regard to SOFA score over the 72 hours after enrollment (mean SOFA score change from 9.1 to 4.4 [-4.7] points with intervention vs 9.2 to 5.1 [-4.1] points with placebo; adjusted mean difference, -0.8; 95% CI, -1.7 to 0.2; P = .12 for interaction). There was no statistically significant difference in the incidence of kidney failure (31.7% with intervention vs 27.3% with placebo; adjusted risk difference, 0.03; 95% CI, -0.1 to 0.2; P = .58) or in 30-day mortality (34.7% vs 29.3%, respectively; hazard ratio, 1.3; 95% CI, 0.8-2.2; P = .26). The most common serious adverse events were hyperglycemia (12 patients with intervention and 7 patients with placebo), hypernatremia (11 and 7 patients, respectively), and new hospital-acquired infection (13 and 12 patients, respectively). Conclusions and Relevance: In patients with septic shock, the combination of ascorbic acid, corticosteroids, and thiamine, compared with placebo, did not result in a statistically significant reduction in SOFA score during the first 72 hours after enrollment. These data do not support routine use of this combination therapy for patients with septic shock. Trial Registration: ClinicalTrials.gov Identifier: NCT03389555.


Assuntos
Corticosteroides/uso terapêutico , Ácido Ascórbico/uso terapêutico , Insuficiência de Múltiplos Órgãos/prevenção & controle , Choque Séptico/tratamento farmacológico , Tiamina/uso terapêutico , Corticosteroides/efeitos adversos , Adulto , Idoso , Ácido Ascórbico/efeitos adversos , Infecção Hospitalar , Quimioterapia Combinada , Feminino , Humanos , Hiperglicemia/induzido quimicamente , Hipernatremia/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Escores de Disfunção Orgânica , Modelos de Riscos Proporcionais , Choque Séptico/complicações , Tiamina/efeitos adversos , Falha de Tratamento
9.
Zhonghua Gan Zang Bing Za Zhi ; 28(7): 553-556, 2020 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-32791788

RESUMO

Patients with severe liver disease are prone to bacterial and fungal infections, and then develop toxic shock. The onset of the disease may be insidious, but the disease progresses rapidly with a high fatality rate. Current research results show that special conditions such as translocation of intestinal flora and immune paralysis in patients with severe liver disease are susceptible factors for infection and toxic shock. Furthermore, it is currently recognized that the treatment of severe liver disease complicated with toxic shock must be treated with antibiotics and maintenance of hemodynamic stability. Other treatments, such as hydrocortisone and strict glycemic control, are quite controversial and may not necessarily reduce mortality. Herein, we summarize the epidemiology, susceptibility factors; diagnosis and management strategies of severe liver disease complicated with toxic shock, highlighting the characteristics of toxic shock under the background of severe liver disease, so as to detect, prevent and treat septic shock in patients with severe liver disease as early as possible to reduce the fatality rate.


Assuntos
Hepatopatias , Choque Séptico , Antibacterianos/uso terapêutico , Humanos , Hepatopatias/complicações , Hepatopatias/tratamento farmacológico , Choque Séptico/complicações , Choque Séptico/tratamento farmacológico
10.
Am J Med Sci ; 360(4): 329-337, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32631574

RESUMO

Methylene blue (MB) is considered to be the first synthetic medication ever used in humans. There are many indications for MB, including vasoplegic shock. Nitric oxide (NO), the central mediator of sepsis, promotes vasoplegia by enhancing the guanylate cyclase cyclic guanosine monophosphate second messenger system, the effect of which is attenuated by MB. Therefore, the use of MB represents a unique pharmacologic approach towards treating the underlying pathophysiology of vasoplegia in sepsis. There are numerous reports of the successful use of MB in refractory shock in the literature. This manuscript describes the historical aspects of the identification of NO as the endothelial derived relaxation factor and its role in the pathogenesis of vasoplegia in septic shock. An analysis of the existing evidence for the use of MB as an inhibitor of NO in vasodilatory shock is provided. The adverse effects associated with the use of MB and an approach to optimal dosing in septic shock are also addressed.


Assuntos
Azul de Metileno/uso terapêutico , Óxido Nítrico/antagonistas & inibidores , Choque Séptico/tratamento farmacológico , Vasoplegia/tratamento farmacológico , Humanos , Azul de Metileno/administração & dosagem , Azul de Metileno/efeitos adversos , Choque Séptico/complicações , Choque Séptico/metabolismo , Vasodilatação/efeitos dos fármacos , Vasoplegia/etiologia , Vasoplegia/metabolismo
11.
Rev Infirm ; 69(260-261): 28-29, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32600592

RESUMO

The amputation of multiple limbs is a rare but serious consequence of septic shock. It concerns young and active populations. The aim of rehabilitation is to enable patients to regain their independence and former everyday life. An overview of this specific care is presented here through a clinical case.


Assuntos
Amputação/reabilitação , Choque Séptico/complicações , Choque Séptico/cirurgia , Humanos
12.
Cell Mol Immunol ; 17(9): 992-994, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32620787
13.
DNA Cell Biol ; 39(9): 1723-1729, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32700971

RESUMO

Sepsis-related mortality and morbidity are major health care problems worldwide. More effort is required to identify factors associated with adverse outcome. Evaluate the prognostic capacity of tumor necrosis factor (TNF), kidney injury molecule (KIM), and lactate and TNF-α-308 G > A gene polymorphism for prediction of 28 days-intensive care unit (ICU) mortality. TNF-α-308 G > A single nucleotide polymorphisms was detected by real-time-PCR on 112 had septic shock and 88 were septic. Serum TNF-α and urinary KIM were assessed by enzyme-linked immunosorbent assay. This study included 200 critically ill patients, 125 (62.5%) of them died within 28 days in ICU (nonsurvivors). Frequencies of TNF-308 G > A was (70.7) GG, (28) GA and (1.3) AA in survivors versus (85.6) GG, (12) GA and (2.4) AA for nonsurvivors, revealed significant association with ICU mortality but not sepsis severity (p = 0.15) or sepsis-induced acute kidney injury (AKI). In contrast, urinary KIM-1 revealed significant association with sepsis severity (p = 0.036) and AKI (p = 0.0001), but not 28-days ICU mortality. The relative risk of death in patients with GG genotype was 2.5 mainly in ICU younger male patients (odds ratios 24 and 4.9, p = 0.001). The genotype GG and GA were significantly associated with [increased urinary KIM-1 (0.29 ± 0.1) (p = 0.0001), terminal creatinine (1.67 ± 0.8) (p = 0.0001)] and [increased terminal urea (109 ± 0.001) (p = 0.001) and basal serum TNF (60 ± 0.001) (p = 0.0001)], respectively. In linear regression analysis, AKI 0.0001 (0.4-0.67), basal serum TNF 0.04 (0.0001-0.04), and TNF-308 GG 0.007 (0.05-0.33) were associated with 28 days ICU mortality [p value (95% confidence interval)]. The same results were observed for initial urea 0.024 (0.0001-0.003) and lack of diuretic usage 0.0001 (0.35-0.7) mainly in septic patients. Major frequency of TNF-308 G > A polymorphism (mainly in young age male patients), AKI and serum TNF were associated with increased risk for 28 days-ICU mortality. Furthermore, sepsis severity was influenced by TNF and urinary KIM-1, which reflects in AKI.


Assuntos
Lesão Renal Aguda/genética , Polimorfismo de Nucleotídeo Único , Choque Séptico/genética , Fator de Necrose Tumoral alfa/genética , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/patologia , Adulto , Fatores Etários , Idoso , Estado Terminal , Feminino , Receptor Celular 1 do Vírus da Hepatite A/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Choque Séptico/complicações , Choque Séptico/patologia , Fator de Necrose Tumoral alfa/sangue
15.
Rev Soc Bras Med Trop ; 53: e20200050, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32578711

RESUMO

In the present study, we report the incidence of septic shock syndrome associated with methicillin-resistant Staphylococcus aureus in a child who initially presented influenza-like illness and developed septic shock shortly after 48 h of hospitalization, and eventually died within a few hours of the onset of sepsis. S. aureus isolated from the blood culture was characterized as the community-associated strain carrying the staphylococcal cassette chromosome mec (SCCmec) type IV element. Therefore, it is important to better understand the community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections and their potential association with influenza for early diagnosis and successful treatment of this fatal disease.


Assuntos
Influenza Humana/diagnóstico , Staphylococcus aureus Resistente à Meticilina , Choque Séptico/microbiologia , Infecções Estafilocócicas/microbiologia , Evolução Fatal , Humanos , Lactente , Influenza Humana/complicações , Choque Séptico/complicações , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico
17.
Medicine (Baltimore) ; 99(20): e20235, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443357

RESUMO

INTRODUCTION: The evaluation of the functional status of blood vessels, especially the arterial system, plays a very important role in the judgment of the condition of septic shock patients and the guidance of resuscitation programs and the judgment of the therapeutic effect. We aimed to design an observational study protocol to explore the correlation of peripheral arterial pulse/resistance index, organ function and inflammation in patients with septic shock. METHODS AND ANALYSIS: A total of 60 patients with septic shock in the Affiliated Hospital of Southwest Medical University from June 2020 to September 2020 and 20 healthy volunteers will be enrolled. Total of 60 patients with septic shock will be randomly divided into 20 groups by lot method. Group 1: fluid resuscitation; Group 2: fluid resuscitation + norepinephrine; Group 3: fluid resuscitation + norepinephrine + ulinastatin; Group 4: healthy control group. Fluid resuscitation is an early goal-directed fluid resuscitation in which norepinephrine is adjusted by a senior intensive care unit specialist for clinical presentation and ulinastatin is pumped at 20,000 U/h. Index including vascular ultrasound, inflammatory factors, organ function will be collected and analyzed. DISCUSSION: Existing studies on septic shock focus on hemodynamics of the heart, brain, and kidney, while the differences in blood flow between peripheral blood vessels and protective renal vessels may be consistent, and imaging analysis is still lacking. This study protocol aims to explore the correlation of peripheral arterial pulsation index/resistance index, organ function, and inflammation in patients with septic shock. TRIAL REGISTRATION: Chinese Clinical trial registry: ChiCTR2000031565.


Assuntos
Pressão Sanguínea/fisiologia , Imunidade Inata/fisiologia , Choque Séptico/fisiopatologia , Adulto , Correlação de Dados , Feminino , Hidratação/métodos , Hidratação/normas , Hidratação/estatística & dados numéricos , Glicoproteínas/uso terapêutico , Voluntários Saudáveis/estatística & dados numéricos , Humanos , Inflamação/complicações , Inflamação/fisiopatologia , Masculino , Norepinefrina/uso terapêutico , Escores de Disfunção Orgânica , Estudos Prospectivos , Choque Séptico/classificação , Choque Séptico/complicações , Resultado do Tratamento , Inibidores da Tripsina/uso terapêutico , Vasoconstritores/uso terapêutico
18.
Chest ; 158(2): e55-e58, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32335068

RESUMO

We report the case of an 88-year-old man with coronavirus disease 2019 (COVID-19) who presented with ARDS and septic shock. The patient had exquisite BP sensitivity to low-dose angiotensin II (Ang-2), allowing for rapid liberation from high-dose vasopressors. We hypothesize that sensitivity to Ang-2 might be related to biological effect of severe acute respiratory syndrome coronavirus 2 infection. The case is suggestive of a potential role for synthetic Ang-2 for patients with COVID-19 and septic shock. Further studies are needed to confirm our observed clinical efficacy.


Assuntos
Angiotensina II/metabolismo , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Choque Séptico/tratamento farmacológico , Idoso de 80 Anos ou mais , Angiotensina II/efeitos dos fármacos , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/metabolismo , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/metabolismo , Choque Séptico/complicações , Choque Séptico/metabolismo
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