The risk factors for coronavirus disease 2019 (COVID-19) severity are still poorly understood. Considering the pivotal role of the gut microbiota on host immune and inflammatory functions, we investigated the association between changes in the gut microbiota composition and the clinical severity of COVID-19. We conducted a multicenter cross-sectional study prospectively enrolling 115 COVID-19 patients categorized according to: (1) the WHO Clinical Progression Scale—mild, 19 (16.5%); moderate, 37 (32.2%); or severe, 59 (51.3%), and (2) the location of recovery from COVID-19—ambulatory, 14 (household isolation, 12.2%); hospitalized in ward, 40 (34.8%); or hospitalized in the intensive care unit, 61 (53.0%). Gut microbiota analysis was performed through 16S rRNA gene sequencing, and the data obtained were further related to the clinical parameters of COVID-19 patients. The risk factors for COVID-19 severity were identified by univariate and multivariable logistic regression models. In comparison to mild COVID-19 patients, the gut microbiota of moderate and severe patients have: (a) lower Firmicutes/Bacteroidetes ratio; (b) higher abundance of Proteobacteria; and (c) lower abundance of beneficial butyrate-producing bacteria such as the genera Roseburia and Lachnospira. Multivariable regression analysis showed that the Shannon diversity index [odds ratio (OR) = 2.85, 95% CI = 1.09–7.41, p = 0.032) and C-reactive protein (OR = 3.45, 95% CI = 1.33–8.91, p = 0.011) are risk factors for severe COVID-19 (a score of 6 or higher in the WHO Clinical Progression Scale). In conclusion, our results demonstrated that hospitalized patients with moderate and severe COVID-19 have microbial signatures of gut dysbiosis; for the first time, the gut microbiota diversity is pointed out as a prognostic biomarker of COVID-19 severity.
Risk factors for COVID-19 disease severity are still poorly understood. Considering the pivotal role of gut microbiota on host immune and inflammatory functions, we investigated the association between changes in gut microbiota composition and the clinical severity of COVID-19. We conducted a multicentre cross-sectional study prospectively enrolling 115 COVID-19 patients categorized according to: 1) WHO Clinical Progression Scale - mild 19 (16.5%), moderate 37 (32.2%) or severe 59 (51.3%); and 2) location of recovery from COVID-19 - ambulatory 14 (household isolation; 12.2%), hospitalized in ward 40 (34.8%) or intensive care unit 61 (53.0%). Gut microbiota analysis was performed through 16S rRNA gene sequencing and data obtained was further related with clinical parameters of COVID-19 patients. Risk factors for COVID-19 severity were identified by univariate and multivariable logistic regression models.In comparison with mild COVID-19 patients, the gut microbiota of moderate and severe patients has: a) lower Firmicutes/Bacteroidetes ratio, b) higher abundance of Proteobacteria; and c) lower abundance of beneficial butyrate-producing bacteria such as Roseburia and Lachnospira genera. Multivariable regression analysis showed that Shannon index diversity (odds ratio [OR] 2.85 [95% CI 1.09-7.41]; p=0.032) and C-Reactive Protein (OR 3.45 [95% CI 1.33-8.91]; p=0.011) were risk factors for COVID-19 severe disease (a score of 6 or higher in WHO clinical progression scale).In conclusion, our results demonstrated that hospitalised moderate and severe COVID-19 patients have microbial signatures of gut dysbiosis and for the first time, the gut microbiota diversity is pointed out as a prognostic biomarker for COVID-19 disease severity.
A fratura do fémur está associada a importante morbimortalidade, sendo que menos de metade dos doentes regressam ao seu nível prévio de autonomia. Uma abordagem multidisciplinar permite uma reabilitação funcional imediata, bem como melhor gestão de comorbilidades, prevenção de fraturas secundárias e das quedas. Objetivos: apresentação da casuís-tica de 3 meses de uma unidade de Ortogeriatria. Material e métodos: Descreve-se a demografia dos doentes admitidos, grau de dependência funcional, comorbilidades, intercorrências, tempo de internamento, mortalidade e destino à data de alta. O ganho de funcionalidade no internamento foi também avaliado. Resultados: De outubro/2015 a janeiro/2016 foram admitidos 66 doentes após cirurgia de fratura proximal do fémur. Média de idades foi 82,94±6,93 anos; 86% eram mulheres. O tempo de internamento foi de 7,8±4,697 dias, sendo o tempo médio para realizar cirurgia de 3±3,374 dias. Quanto ao grau de funcionalidade prévio 47% eram Katz A; à admissão 85% tinham mRankin ≤3. Identificaram-se vá-rias comorbilidades em 89% dos doentes; nas intercorrências, a mais frequente foi a anemia (53%). Houve um ganho na funcionalidade relativamente à admissão na unidade de 75,8% e em relação ao estado funcional anterior ao evento de 19,7%. Setenta e um porcento dos doentes tiveram alta para o domicílio; a taxa de mortalidade foi de 1,52%. Conclusões: A unidade demonstrou eficiência no controlo das comorbilidades, reduzidas complicações e baixa mortalidade. Registou-se um ganho funcional comparando com a admissão em 3 em cada 4 doentes e em relação ao estado basal prévio em 1 em cada 5 doentes. Palavras-chave: fratura fémur, ortogeriatria, geriatria, reabilitação INTRODUÇÃOA fratura do colo do fémur é frequente nos indivíduos idosos, sendo uma das complicações mais graves da osteoporose.1 É mais comum em mulheres, estimando-se que uma em cada três mulheres com mais de 80 anos irá sofrer uma fratura do colo do fémur ao longo da vida 2 . Estão geralmente associadas a traumatismos de baixa frequência e o tratamento de primeira linha é cirúrgico. 1,3Estão descritas taxa de mortalidade variáveis em fase aguda (5 a 10%) 1,4 . Ao fim de um ano estima-se que 10 a 20% destes doentes possam falecer, metade apresenta alguma perda funcional e apenas 30% dos doentes tenham recuperado a sua capacidade funcional para os níveis prévios aos da ocorrência da fratura 3 No sentido de otimizar o tratamento e reabilitação dos doentes com fratura do fémur foram criadas unidades de Ortogeriatria. Estas unidades funcionais permitem uma abordagem multidisciplinar orientada para a reabilitação funcional imediata, bem como para a gestão de comorbilidades, prevenção de fraturas secundárias e das quedas ABSTRACTHip fracture is associated with important morbimortality; less than half of the patients go back to the same functional degree. A multidisciplinary approach can enable immediate functional rehabilitation, better treatment of comorbidities and prevention of secondary fractures and falls. Objectives: to describe the ca...
Mediterranean spotted fever has long been considered as a benign disease, but associated with septic shock and encephalitis, becomes malignant and potentially fatal. We present the case of a 77 year-old man admitted into the emergency room after tick bite in abdominal region and fever 39.6°C. After admission, a maculopapular rash appears with the achievement of palms and soles associated with behavioral changes and adult respiratory distress syndrome. In intensive care CSF examination revealed 6 nuclear elements and a protein level of 94 mg/dL, and electroencephalogram supported the existence of encephalitis. Rickettsia serology by indirect immunofluorescence showed IgG> 1/640 and IgM=1/80. Septic shock, responded to antibiotic therapy and patient was discharged to long term care. This case demonstrates that a benign and common disease suffered a poor outcome owing to the accelerated clinical course with acute onset and rapid deterioration.
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