Clinical Characteristics and Survival Analysis in Frequent Alcohol Consumers With COVID-19

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection can generate a systemic disease named coronavirus disease­2019 (COVID-19). Currently, the COVID-19 pandemic has killed millions worldwide, presenting huge health and economic challenges worldwide. Several risk factors, such as age, co-infections, metabolic syndrome, and smoking have been associated with poor disease progression and outcomes. Alcohol drinking is a common social practice among adults, but frequent and/or excessive consumption can mitigate the anti-viral and anti-bacterial immune responses. Therefore, we investigated if patients with self-reported daily alcohol consumption (DAC) presented alteration in the immune response to SARS-CoV-2. We investigated 122 patients with COVID-19 (101 male and 46 females), in which 23 were patients with DAC (18 men and 5 women) and 99 were non-DAC patients (58 men and 41 women), without other infections, neoplasia, or immunodeficiencies. Although with no difference in age, patients with DAC presented an increase in severity-associated COVID-19 markers such as C-reactive protein (CRP), neutrophil count, and neutrophil-to-lymphocyte ratio. In addition, patients with DAC presented a reduction in the lymphocytes and monocytes counts. Importantly, the DAC group presented an increase in death rate in comparison with the non-DAC group. Our results demonstrated that, in our cohort, DAC enhanced COVID-19-associated inflammation, and increased the number of deaths due to COVID-19.

Consensus on the diagnostic and therapeutic management of chronic spontaneous urticaria in adults - Brazilian Society of Dermatology

Abstract: Background: Urticarias are frequent diseases, with 15% to 20% of the population presenting at least one acute episode in their lifetime. Urticaria are classified in acute ( ≤ 6 weeks) or chronic (> 6 weeks). They may be induced or spontaneous. Objectives: To verify the diagnostic and therapeutic recommendations in chronic spontaneous urticaria (CSU), according to the experience of Brazilian experts, regarding the available guidelines (international and US). Methods: A questionnaire was sent to Brazilian experts, with questions concerning diagnostic and therapeutic recommendations for CSU in adults. Results: Sixteen Brazilian experts answered the questionnaire related to diagnosis and therapy of CSU in adults and data were analyzed. Final text was written, considering the available guidelines (International and US), adapted to the medical practices in Brazil. Diagnostic work up in CSU is rarely necessary. Biopsy of skin lesion and histopathology may be indicated to rule out other diseases, such as, urticarial vasculitis. Other laboratory tests, such as complete blood count, CRP, ESR and thyroid screening. Treatment of CSU includes second-generation anti-histamines (sgAH) at licensed doses, sgAH two, three to fourfold doses (non-licensed) and omalizumab. Other drugs, such as, cyclosporine, immunomodulatory drugs and immunosuppressants may be indicated (non-licensed and with limited scientific evidence). Conclusions: Most of the Brazilian experts in this study partially agreed with the diagnostic and therapeutic recommendations of the International and US guidelines. They agreed with the use of sgAH at licensed doses. Increase in the dose to fourfold of sgAH may be suggested with restrictions, due to its non-licensed dose. Sedating anti-histamines, as suggested by the US guideline, are indicated by some of the Brazilian experts, due to its availability. Adaptations are mandatory in the treatment of CSU, due to scarce or lack of other therapeutic resources in the public health system in Brazil, such as omalizumab or cyclosporine.

Atopic dermatitis in adults: clinical and epidemiological considerations / Dermatite atópica em adultos: considerações clínicas e epidemiológicas

OBJECTIVE: Atopic dermatitis (AD) is a chronic inflammatory disease causing intense pruritus, and with typical clinical features. There are few epidemiological studies concerning AD in adults, as well as little information about its prognostic. The aim of this study was to evaluate the clinical and epidemiological course of adults with AD. METHODS: 80 patients aged above 18 years (mean age = 29 years) were selected (30 males and 50 females) and interviewed about hospitalization, systemic corticoid usage, age of AD onset, and personal and/or familial history of atopy. Disease severity was evaluated through the Scoring Atopic Dermatitis (SCORAD) tool. Laboratory examination included IgE serum levels and eosinophil blood count. RESULTS: 71 out of 80 patients referred association with respiratory symptoms (18 had asthma, 17 had rhinitis, and 36 had both conditions); nine out of 80 patients denied any respiratory disease. AD patients were divided in mild (n = 25), moderate (n = 30), and severe (n = 25); 56% had one or more hospitalizations due to AD. A positive association was found between IgE serum levels, eosinophil blood count, and disease severity. CONCLUSION: Adult AD represents a clinical challenge that needs to be better characterized, since it can be misdiagnosed and interferes with the patient's social and personal life. The association of skin and respiratory atopic disease is frequent, and laboratory parameters such as circulating IgE levels and eosinophil blood count may be helpful to assess disease severity.

OBJETIVO: Dermatite atópica (DA) é uma doenc¸a inflamatória crônica com prurido intenso e características clínicas típicas. Há poucos estudos epidemiológicos a respeito da DA em adultos, bem como pouca informação disponível sobre o seu prognóstico. O objetivo do presente estudo é avaliar as características clínicas e o curso epidemiológico dos adultos com DA. MÉTODOS: Foramselecionados 80 pacientes com idade acima de 18 anos (média de idade = 29 anos, 30 homens e 50 mulheres), que foram entrevistados sobre: internações, uso de corticóide sistêmico, idade de início da DA, história pessoal e/ou familiar de atopia. A gravidade da doença foi avaliada de acordo com o SCORing Atopic Dermatitis (SCORAD). A avaliação laboratorial incluiu dosagem sérica de IgE e contagem sanguínea de eosinófilos. RESULTADOS: 71 dos 80 pacientes referiram associação com sintomas respiratórios (18: asma, 17: rinite alérgica e 36: ambas as condições); nove dos 80 indivíduos negaram qualquer sintoma respiratório. Os pacientes com DA foram divididos em DA leve (n = 25), moderada (n = 30) e grave (n = 25); destes, 56% tiveram uma ou mais internações por conta da doença. Verificou-se uma associação entre níveis séricos de IgE, contagem sanguínea de eosinófilos e gravidade da doença. CONCLUSÃO: A DA do adulto representa um desafio clínico que necessita ser melhor caracterizado, uma vez que pode ser erroneamente diagnosticada, e interfere diretamente na vida social e pessoal dos pacientes. A associação entre manifestação respiratória e cutânea é frequente, e parâmetros laboratoriais como níveis de IgE circulante e contagem sanguínea de eosinófilos podem ser úteis para acompanhar a gravidade e evolução da doença.