Highlights Laboratory changes reflect systemic inflammation and impairment in patients. Lymphopenia can be used to discriminate against patients at risk for SARS. Changes in hemostatic patterns are associated with complications of COVID-19.
SUMMARY COVID-19, caused by SARS-CoV-2, can present respiratory complications that often lead patients to depend on mechanical ventilation (MV) for several days. It is known that Pneumonia Associated with Mechanical Ventilation (PAMV) is frequent in patients who use this equipment for a long time. As a consequence of COVID-19, its prolonged use can lead to a worse prognosis for the patients. For this reason, in addition to the insufficiency of devices for mechanical ventilation to meet the current demand, it is necessary to adopt measures aimed at preventing complications that may aggravate the patient’s clinical condition and, consequently, increase the average hospital stay and the respective hospital care costs. Therefore, the objective of this study was to discuss, in a concise and practical way, and based on the available literature, the importance of adopting adequate oral hygiene protocols for patients on mechanical ventilation. Based on the data obtained, it was identified that the adoption of effective oral hygiene measures, especially under the supervision of dental professionals, can contribute to the reduction of morbidity and mortality associated with MV, resulting in greater availability of mechanical ventilation equipment. Since such equipment is in great demand during the COVID-19 pandemic, the knowledge and implementation of effective oral hygiene measures will undoubtedly have an impact on improving the quality of care offered to patients, therefore benefiting all those in critical health conditions and assisted in ICUs.
Iron is an essential chemical element for human life. However, in some pathological conditions, such as hereditary hemochromatosis type 1 (HH1), iron overload induces the production of reactive oxygen species that may lead to lipid peroxidation and a change in the plasma-membrane lipid profile. In this study, we investigated whether iron overload interferes with the Na,K-ATPase activity of the plasma membrane by studying erythrocytes that were obtained from the whole blood of patients suffering from iron overload. Additionally, we treated erythrocytes of normal subjects with 0.8 mM H2O2 and 1 μM FeCl3 for 24 h. We then analyzed the lipid profile, lipid peroxidation and Na,K-ATPase activity of plasma membranes derived from these cells. Iron overload was more frequent in men (87.5%) than in women and was associated with an increase (446%) in lipid peroxidation, as indicated by the amount of the thiobarbituric acid reactive substances (TBARS) and an increase (327%) in the Na,K-ATPase activity in the plasma membrane of erythrocytes. Erythrocytes treated with 1 μM FeCl3 for 24 h showed an increase (132%) in the Na,K-ATPase activity but no change in the TBARS levels. Iron treatment also decreased the cholesterol and phospholipid content of the erythrocyte membranes and similar decreases were observed in iron overload patients. In contrast, erythrocytes treated with 0.8 mM H2O2 for 24 h showed no change in the measured parameters. These results indicate that erythrocytes from patients with iron overload exhibit higher Na,K-ATPase activity compared with normal subjects and that this effect is specifically associated with altered iron levels.
Objectives: to evaluate the morbidity and mortality profile and factors associated with death due to severe acute respiratory syndrome (SARS) by COVID-19 in pregnant and postpartum women. Methods: this is a quantitative and retrospective research that analyzed the SIVEP-gripe Database (Influenza Epidemiological Surveillance Information System), from 01/01/2020 to 04/01/2021. All pregnant women and postpartum women diagnosed with SARS caused by COVID-19 in the State of Minas Gerais were included. After the descriptive analysis of the hospitalizations profile, the association between different exposure variables and the occurrence of death was evaluated. Results: of the 227 records obtained, 94.3% required hospitalization. Among hospitalizations in the Intensive Care Unit, 29.8% used invasive ventilatory support. Fifteen deaths were recorded. The most frequent clinical manifestations were: cough and fever; the predominant comorbidities were cardiovascular disease and diabetes mellitus. The variables “ICU stay”, “use of ventilatory support” and “heart disease” were associated with the occurrence of deaths. Conclusions: hospitalization was necessary for most pregnant women with SARS and the presence of previous heart disease increased the risk of death. Knowing the SARS morbidity and mortality profile is important in the definition of public health strategies aimed at reducing the impacts of COVID-19 during pregnancy and the puerperium.
Iron is a chemical element that is active in the fundamental physiological processes for human life, but its burden can be toxic to the body, mainly because of the stimulation of membrane lipid peroxidation. For this reason, the action of iron on many ATPases has been studied, especially on P-ATPases, such as the Na,K-ATPase and the Ca-ATPase. On the Fe-ATPase activity, the free iron acts as an activator, decreasing the intracellular Fe and playing a protection role for the cell. On the Ca-ATPase activity, the iron overload decreases the enzyme activity, raising the cytoplasmic Ca and decreasing the sarco/endoplasmic reticulum and the Golgi apparatus Ca concentrations, which could promote an enzyme oxidation, nitration, and fragmentation. However, the iron overload effect on the Na,K-ATPase may change according to the tissue expressions. On the renal cells, as well as on the brain and the heart, iron promotes an enzyme inactivation, whereas its effect on the erythrocytes seems to be the opposite, directly stimulating the ATPase activity, or stimulating it by signaling pathways involving ROS and PKC. Modulations in the ATPase activity may impair the ionic transportation, which is essential for cell viability maintenance, inducing irreversible damage to the cell homeostasis. Here, we will discuss about the iron overload effect on the P-ATPases, such as the Na,K-ATPase, the Ca-ATPase, and the Fe-ATPase.
Objective Coronavirus disease 2019 (COVID-19) is a disease caused by a newly discovered coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which usually leads to non-specific respiratory symptoms. Although pregnant women are considered at risk for respiratory infections by other viruses, such as SARS and Middle East respiratory syndrome (MERS), little is known about their vulnerability to SARS-CoV-2. Therefore, this study aims to identify and present the main studies on the topic, including the postpartum period. Methods In this narrative review, articles were searched in various databases, organizations, and health entities using keywords compatible with medical subject headings (MeSH), such as: COVID-19, pregnancy, vertical transmission, coronavirus 2019, and SARS-CoV-2. Results The review of the scientific literature on the subject revealed that pregnant women with COVID-19 did not present clinical manifestations significantly different from those of non-pregnant women; however, there are contraindicated therapies. Regarding fetuses, studies were identified that reported that infection by SARS-CoV-2 in pregnant women can cause fetal distress, breathing difficulties and premature birth, but there is no substantial evidence of vertical transmission. Conclusion Due to the lack of adequate information and the limitations of the analyzed studies, it is necessary to provide detailed clinical data on pregnant women infected with SARS-CoV-2 and on the maternal-fetal repercussions caused by this infection. Thus, this review may contribute to expand the knowledge of professionals working in the area as well as to guide more advanced studies on the risk related to pregnant women and their newborns. Meanwhile, monitoring of confirmed or suspected pregnant women with COVID-19 is essential, including in the postpartum period.
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