ICU admission of cancer patients should be based on potential chance of recovering from the acute problem. Clinical predictor for mortality could support this purpose (UIN: researchregistry3484).
The pandemic distribution of SARS-CoV-2 together with its particular feature of inactivating the interferon-based endogenous response and accordingly, impairing the innate immunity, has become a challenge for the international scientific and medical community. Fortunately, recombinant interferons as therapeutic products have accumulated a long history of beneficial therapeutic results in the treatment of chronic and acute viral diseases and also in the therapy of some types of cancer. One of the first antiviral treatments during the onset of COVID-19 in China was based on the use of recombinant interferon alfa 2b, so many clinicians began to use it, not only as therapy but also as a prophylactic approach, mainly in medical personnel. At the same time, basic research on interferons provided new insights that have contributed to a much better understanding of how treatment with interferons, initially considered as antivirals, actually has a much broader pharmacological scope. In this review, we briefly describe interferons, how they are induced in the event of a viral infection, and how they elicit signaling after contact with their specific receptor on target cells. Additionally, some of the genes stimulated by type I interferons are described, as well as the way interferon-mediated signaling is torpedoed by coronaviruses and in particular by SARS-CoV-2. Angiotensin converting enzyme 2 (ACE2) gene is one of the interferon response genes. Although for many scientists this fact could result in an adverse effect of interferon treatment in COVID-19 patients, ACE2 expression contributes to the balance of the renin-angiotensin system, which is greatly affected by SARS-CoV-2 in its internalization into the cell. This manuscript also includes the relationship between type I interferons and neutrophils, NETosis, and interleukin 17. Finally, under the subtitle of “take-home messages”, we discuss the rationale behind a timely treatment with interferons in the context of COVID-19 is emphasized.
Nutritional depletion is commonly observed in patients undergoing surgical treatment for a gastrointestinal malignancy. An appropriate nutritional intervention could be associated with improved postoperative outcomes. The study was aimed to determine the effect of a program of gastrointestinal rehabilitation and early postoperative enteral nutrition upon complications and clinical outcomes in patients who experienced gastrointestinal surgery for cancer. This is a prospective study (2013 January-2015 December) of 465 consecutive patients submitted to gastrointestinal surgery for cancer and admitted to an Oncological Intensive Care Unit. The program of gastrointestinal rehabilitation and early postoperative enteral nutrition consisted on: (1) general rules: pain relive, early mobilization, antibiotic prophylaxis, deep vein thrombosis prophylaxis and respiratory physiotherapy; and (2) gastrointestinal rules: gastric protection, control of postoperative nausea and vomiting, early nasogastric tube remove and early enteral nutrition. The most frequent surgical sites were colorectal (44.9%), gynecological with intestinal suturing (15.7%) and esophagus/stomach (11.0%). Emergency surgery was performed in 12.7% of patients. The program of intestinal rehabilitation and early postoperative enteral nutrition reduced major complications (19.2 vs. 10.2%; p = 0.030), respiratory complications (p = 0.040), delirium (p = 0.032), infectious complications (p = 0.047) and gastrointestinal complications (p < 0.001). Intensive care unit mortality (p = 0.018), length of intensive care unit stay (p < 0.001) and length of hospitalization (p < 0.001) were reduced as well. A program of gastrointestinal rehabilitation and early postoperative enteral nutrition is associated with reduced postoperative complications and improved clinical outcomes in patients undergoing gastrointestinal surgery for cancer.
ObjectiveThis study sought to determine the influence of postoperative complications
on the clinical outcomes of patients who underwent thoracic and
gastrointestinal cancer surgery.MethodsA prospective cohort study was conducted regarding 179 consecutive patients
who received thorax or digestive tract surgery due to cancer and were
admitted to an oncological intensive care unit. The Postoperative Morbidity
Survey was used to evaluate the incidence of postoperative complications.
The influence of postoperative complications on both mortality and length of
hospital stay were also assessed.ResultsPostoperative complications were found for 54 patients (30.2%); the most
common complications were respiratory problems (14.5%), pain (12.9%),
cardiovascular problems (11.7%), infectious disease (11.2%), and surgical
wounds (10.1%). A multivariate logistic regression found that respiratory
complications (OR = 18.68; 95%CI = 5.59 - 62.39; p < 0.0001),
cardiovascular problems (OR = 5.06, 95%CI = 1.49 - 17.13; p = 0.009),
gastrointestinal problems (OR = 26.09; 95%CI = 6.80 - 100.16; p <
0.0001), infectious diseases (OR = 20.55; 95%CI = 5.99 - 70.56; p <
0.0001) and renal complications (OR = 18.27; 95%CI = 3.88 - 83.35; p <
0.0001) were independently associated with hospital mortality. The
occurrence of at least one complication increased the likelihood of
remaining hospitalized (log-rank test, p = 0.002).ConclusionsPostoperative complications are frequent disorders that are associated with
poor clinical outcomes; thus, structural and procedural changes should be
implemented to reduce postoperative morbidity and mortality.
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