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BackgroundThe COVID-19 pandemic has brought uncertainties to rheumatology practice, mainly related to the possibility of triggering disease activity after infection in immune mediated rheumatic diseases (IMRD). To date, there are few data in the literature specifically evaluating this issue.ObjectivesEvaluate the disease activity in IMRD patients after 6 months of the infection, compared to pre infection status.MethodsReumaCoV Brasil is a longitudinal study performed at 35 study centers designed to follow-up IMRD patients for 6 months after clinical or laboratorial COVID-19 diagnosis (cases), comparing with patients with IMRD who had not had the infection at the time of inclusion (controls). Demographic data such as age, sex, comorbidities, clinical characteristics, treatment, evolution of COVID-19 and disease activity status were collected using a Research Eletronic Data Capture (REDCap) database on three consecutive visits (inclusion and 6 months). The analysis was carried out on the four diseases with the highest inclusion number in the study: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA). In addition to specific disease activity assessment metrics, we used patient's global assessment of disease activity (PGA), ranging from 0 to 10, at all visits, with 0 being no activity and 10 being intense activity. All conclusions were drawn considering the significance level of 5%. This study was registered at the Brazilian Registry of Clinical Trials—REBEC, RBR-33YTQC. All patients read and signed the informed consent form before inclusion.ResultsBetween May 2020 and January 2021, 2032 patients were included in the registry, and of these, 1322 patients (721 cases and 601 controls), completed 6 months of follow-up, being 550 SLE (42.0%), 497 RA (37.6%) and 176 SpA (13.3%) and 99 (7.4%) PsA. Most patients were female (82.0%);the median age was 46.7 (13.8). Disease activity at the time of enrollment, according to the PGA, was similar between cases and controls, except for patients with RA and AS, where it was higher in controls. After the follow up time, no worsening of activity was observed in any of the diseases evaluated in the case group (Table 1). Despite this, worsening of disease symptoms after COVID-19 was reported by 23.3%, 24.6%, 25.0% and 25.8% of patients with SLE, RA, AS and PsA respectively, not related with disease activity.ConclusionIn patients with IMRD, no worsening of disease activity was observed after COVID-19 in this cohort of Brazilian patients. Despite this, many patients noticed worsening of symptoms, possibly associated not with the triggering of the activity, but with the so-called long COVID syndrome.Table 1.Comparison of disease activity, according to PGA, comparing disease activity status at inclusion and after 6 months of follow up, in cases and controlsINCLUSIONAFTER 6 MONTHSCasesControlsp-valueCasesControlsp-valueSLE2 (0-4,5)2 (0-4)0,8102 (0-5)2 (0-4)0,172RA3 (1-5)4 (2-6)0.0013 (1-5)3 (1-5,5)0,731AS2 (0-5)4 (1-6)0,0022 (0-5)3,5 (1-6)0,044PsA2 (0-4)2 (0-5)0,8162 (0-5)2 (0-5)0,939*Median and interquatile range;Student t test;CI 95%AcknowledgementsReumaCoV Brasil researchers, Brazilian Society of Rheumatology and National Council for Ccientific and Technological Development.Disclosure of InterestsNone Declared.
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Objectives: To assess protein and energy intake and duration of venous-venous ECMO in critically ill patients with covid-19 Methods: We conducted a retrospective observational analysis on the intensive care units of a large tertiary private teaching Hospital. Adult patients admitted to intensive care unit (ICU) with laboratory confirmed SARS-CoV-2 (RT-PCR), cannulated on venous-venous ECMO and on exclusive enteral feeding were included. Data between march 2020 and june 2021 were collected. Weight and height data were acquired at the time of admission in ICU. Body mass index (BMI) was subsequently calculated. We obtained delivery and adequacy of nutrition data from a enteral nutrition form routinely filled out by nutritionists during hospitalization. Other data were obtained from electronic medical record. For statistical analysis of the data, we used SPSS version 13.0. Result(s): This cohort included 39 patients. 27 (69.2%) were men, mean age was 50 (+/- 12) years and 11 (28,2%) had more than 60 years. The more prevalent comorbidities were obesity in 22 (56%), hypertension in 20 (51,3%) and diabetes in 6 (15,4%) patients. The mean time on ECMO was 24.7 +/- 15.2 days. 29 patients (74%) died. Regarding nutritional support, the average protein intake was 0,9 +/- 0.4 g/kg/day and calories 13.9 +/- 5.2 cal/kg/day. No statistically significant association was observed between the nutritional intake and the duration on ECMO and clinical outcomes of patients. Conclusion(s): There was a high mortality in our cohort. Center;s inexperience may have played a role in these results, in addition to other factors. We observed a high prevalence of obesity. Neither energy nor protein intake were associated with the duration of ECMO and clinical outcomes. These results are similar to other recent observational studies where an insufficient energy and protein intake did not affected mortality or other outcomes. Our small sample and study design prevents a definitive conclusion on the subject. Thus, we propose further studies to elucidate the role of adequate nutrional strategies to improve outcomes and reabilitation of patients on ECMO.
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Objectives: At the beginning of the pandemic, it was believed that severe SARS-CoV2 infection would induce lifelong immunity and that reinfections would be unlikely. However, several cases of reinfection were documented in previously infected patient and the waning humoral immunity has raised significant concerns. Accordingly, long-term and durable vaccineinduce antibody protection against infection have also become a challenge, as several breakthroughs of COVID-19 have been identified in individuals partially or fully vaccinated. This study describes the incidence, the characteristics of severe COVID-19 infections requiring ECMO occurred after vaccination and the presence of side effects related to the vaccine. Method(s): EuroECMO COVID is a prospective, multicenter, observational study, developed by the EuroELSO, based on data from patients aged >=16 years who received ECMO support for refractory COVID-19 during the pandemic in 204 centers. The analysis investigates the survival of vaccinated patient, the associations between management-related variables, the incidence of vaccination during the different pandemic phases, the type of vaccines and the possible side effects. Result(s): Immunosuppressed patients are susceptible to reinfection even after being naturally infected or receiving a full vaccination. Ineffective antibody production, due to relatively ineffective vaccines, inadequate number of doses or the time after vaccination are involved in the pathogenesis of postvaccination infections. This population was found to have a partial immunity due to an inadequate number of doses and an overlapped time from vaccination and SARS-CoV2 incubation with PCR results after being vaccinated. Several manifestations of SARS-CoV2 infection are similar to vaccine-induce side effects and mild symptoms can be presented both as an adverse reaction after vaccination and a result of infection. In this subgroup no side effects were attributable to the vaccine. Conclusion(s): Vaccination does not entirely prevent SARS-CoV2 but will lead to less morbidity and mortality, as demonstrated by less need of ICU and ECMO care. In addition, the partial immunity for inadequate doses of vaccine or through the evolution of new variants demonstrated the importance of further analysis to differentiate the possible causes of waning humoral immunity.
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In the COVID-19 pandemic, access to data on the disease has become strategic for controlling public health measures. Faced with the health emergency, a large volume of data needed to be minimally organized and made available in a quick and automated way, composing the open government data. After two years of a pandemic and in order to present an overview of the publication of open data by the federal government of Brazil, on COVID-19, this study sought to evaluate the open government data made available through the Application Programming Interface (API). The methodology involved the identification of datasets on COVID-19 in Brazil, in Application Programming Interface, until April 2022, the analysis of the documentation and the evaluation using the DGABr metric. The evaluation considered the five perspectives of the metric that measures fundamental elements about the open government data, essential for interoperability and consequently reuse of the data and was based on the published documentation. As results, the open government data on COVID-19, made available in Application Programming Interface, presented a good score in the metric, reaching level 4. This result indicates that the use of APIs was an important and agile technological resource for the organization and availability of open government data, promoting its reuse. However, it is important to highlight that this availability to society was late, it needs constant improvements, mainly in technical issues such as the connection of data with other sources, and that the effective reuse actions were limited to data visualization panels on COVID-19.
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This chapter will discuss four rescue therapies-prone positioning, extracorporeal membrane oxygenation (ECMO) and CO2 removal (ECCO2R), inhaled nitric oxide (INO), and renal replacement therapy (RRT)-and their role in the management of critically ill patients with COVID-19. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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Sedation in patients with coronavirus severe acute respiratory distress syndrome (SARS-CoV-2) is a challenge. Deep sedation favors adaptation to mechanical ventilation, promotes tolerance to hypercapnia and may reduce the risk of self-extubation, but it is not always necessary. It is essential to individualize sedation and analgesia, always prioritizing pain control. In situations of persistent ventilatory asynchrony, need for deep sedation, prone ventilation or persistently high plateau pressures, continuous infusion of a neuromuscular blocker is required, which should be used for up to 48 hours. The weaning process can be difficult, and the association of antipsychotics and alpha-2 agonists is indicated. Key words: SARS-CoV-2, sedation, analgesia, myorelaxants, weaning, mechanical ventilation, alpha-2 agonists, propofol. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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In this work, SARS-CoV-2 infectivity after UV-C exposure of porous and non-porous surfaces was assessed under controlled environment conditions. The irradiance of a setup of UV-C lamps, placed indoors was studied in detail as a function of the geometry and the distance to the surface. In the presence of living beings, the external UV-C lamps are turned off, and the UV-C lamps mounted inside the disinfection chamber are kept active, allowing a continuous air disinfection and a decreased risk of indoor transmission. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.
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Introduction: COVID-19 may lead to heterogeneous needs for ventilator therapy, whether oxygen therapy (OT), noninvasive ventilation (NIV), high-flow nasal catheter (HFNC) or their combination (NIV + HFNC). The purpose of the study was to describe, retrospectively, the mortality rate, intensive care unit length of stay (ICU-LOS) and time to orotracheal intubation of COVID-19 patients under OT, NIV, HFNC or combined (NIV + HFNC). A retrospective cohort study was done analyzing official medical data from March 2020 up to July 2021. (CAAE: 52534221.5.0000.5249). Method(s): The inclusion criteria were age > 18 years-old, and positive swab test for COVID-19 or computed tomography consistent of COVID-19. The exclusion criteria were hospital LOS less than 3 days, patients whose therapy (OT, NIV, HFNC or NIV + HFNC) lasted less than 48 h, and missing data about the outcome variables. The primary outcome was mortality rate, while secondary outcomes were ICU-LOS and time to orotracheal intubation. Chi-Square test was used to assess mortality rate. The Mann-Whitney U test was applied to assess differences in ICU-LOS and time to orotracheal intubation (p < 0.05). Result(s): Overall, 1371 patients were enrolled. 880, 120, 35, and 148 patients were submitted to OT, NIV, HFNC or NIV + HFNC, respectively. The mortality rates were 8.4%, 29.6%, 22.2%, and 33.2% for OT, NIV, HFNC or NIV + HFNC, respectively (p < 0.001). The ICU-LOS was higher in NIV + HFNC (median [IQR] 15 days [16]) than NIV (9 days [10]) and OT (4 days [5], p < 0.001). The time to orotracheal intubation was higher in NIV (6 days [6]), HFNC (6 days [4.5]), and NIV + HFNC (6 days [6]) than OT (2 days [4]), p < 0.001. Mortality rate and ICU-LOS were higher in those patients requiring the combination of NIV and HFNC. Conclusion(s): Although the type of ventilator therapy may be associated to increased mortality rate and ICU-LOS, we cannot assure causality due to exploratory nature of the retrospective study, but a marker of severity.
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Obesity is associated with several diseases, including mental health. Adipose tissue is distributed around the internal organs, acting in the regulation of metabolism by storing and releasing fatty acids and adipokine in the tissues. Excessive nutritional intake results in hypertrophy and proliferation of adipocytes, leading to local hypoxia in adipose tissue and changes in these adipokine releases. This leads to the recruitment of immune cells to adipose tissue and the release of pro-inflammatory cytokines. The presence of high levels of free fatty acids and inflammatory molecules interfere with intracellular insulin signaling, which can generate a neuroinflammatory process. In this review, we provide an up-to-date discussion of how excessive obesity can lead to possible cognitive dysfunction. We also address the idea that obesity-associated systemic inflammation leads to neuroinflammation in the brain, particularly the hypothalamus and hippocampus, and that this is partially responsible for these negative cognitive outcomes. In addition, we discuss some clinical models and animal studies for obesity and clarify the mechanism of action of anti-obesity drugs in the central nervous system.Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.
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COVID-19 is one of the pandemic diseases that has hit the world including Sri Lanka. He has a virus that became the target of bids to stop its spread. Including the implementation of health protocols, to provide information about the spread of the virus emergency response, detection services for suspicious persons infected with the virus, and programs to contain the spread of the virus ensuring that the whole of Sri Lanka gets vaccinated. Here, the research focuses on the minimal spread of the face mask in the office e nvironment a n i dentification system that uses a deep learning model that prioritizes object recognition for the identification o f e mployees w ho w ear a f ace m ask and detects social distancing and crowd gathering, if any if there is a violation, it will inform via a voice notification. L oss o f Smell after the next component. One person can use one disposable card to check the smell of sniffing. E ach d isposable c ard has QR codes, and all QR codes are encrypted by adding data. The user scans the QR code on their ticket and then scratches off and smelled the smelling area and selected the corresponding scent on the disposable card. Employee company attendance is a proposed automated attendance system using facial recognition. Because it requires minimal human influence a nd o ffers a high level of accuracy and marking employee attendance and employee body temperature measurement, facial recognition will appear to be a practical option. This system aims to provide a high level of protection. Automated Attendance systems that detect and recognize are safe, fast, and time-consuming savings. This technique can also be used to identify an unknown person. © 2022 IEEE.
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Do extreme events have a significant effect about textual sentiment? The purpose of this article is to highlight the need to correct the estimation of indicators of economic uncertainty. The indicators were constructed from textual data about the perspective of extreme events. For this purpose, based on data extracted from the minutes of mee-tings of the Monetary Policy of eighteen Central Banks, we estimated two variables of perception of economic uncertainty: the first using only a traditional sentiment dictio-nary and the second incorporating terms associated with the extreme event (COVID- 19 Pandemic) in its word list. Initial results show that there is a significant effect of COVID-19 on the estimation of the perception of economic uncertainty;this effect acts as an accelerator that potentiates its impact. It was evident that incorporating conjunctural issues - be it local or global - is indispensable when performing sentiment analysis in texts during extreme events. Moreover, failing to take conjunctural issues into account throughout the estimation process can result in variables with biased in-formation. © 2023 The Authors
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The pandemic context that devastated teaching in Portugal, placing students and teachers only connected by a screen, made emotions emerge in students, making the accompanying teachers more attentive. In this study, we present the results obtained from the general objective: to identify the emotions present in students in the emerging context of the COVID-19 pandemic. Data were collected from teachers of the 2nd and 3rd cycles of basic education (n = 377), through a questionnaire survey that contained an open question, asking teachers to write about the challenges encountered in managing students' emotions. The webQDA® software was used for the analysis and interpretation of qualitative data. The main results show that the identification of emotions by teachers was not, systematically, unanimous, and also differs according to the length of service. A school that is, for many, a place of well-being and good practices, since teachers play the role of "psychologist without training, just to listen to students”, was one of the conclusions. Thus, the monitoring carried out by teachers with more or less time of service, even at a distance, was relevant, considering that pedagogy was (re)invented. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Osmotic demyelination syndrome (ODS) is a rare but serious condition that is hypothesized to be a result of rapid correction of hyponatremia, with a catastrophic prognosis. The foci of demyelination may occur in either the pontine area or within the white matter of the cerebral hemispheres, which denotes a specific clinical presentation. We present the case of a post-COVID-19 patient who was diagnosed with ODS with typical clinical and radiological characteristics of both forms: central pontine myelinolysis and extrapontine myelinolysis. The clinical assessment of ODS encompasses a variety of differential diagnoses, including stroke, neuroinfection, neoplasia, and other demyelinating diseases. A specific characteristic of ODS is the delayed clinical manifestation after the hyponatremic state. Furthermore, it is noteworthy that there might be discrepancies between the clinical manifestations and the neuroimaging findings. The association between COVID-19 and ODS is unclear at the moment, although it can possibly be explained by the viral infection through multiple mechanisms such as renal dysfunction, diarrhea, or vomiting. ODS should be considered in cases of hyponatremia and neurological deterioration during the course of COVID-19 infection. Despite the fact that early detection and treatment of this syndrome can reduce the risk of short-term mortality and long-term disability, they do not guarantee complete recovery.
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The fatality prediction in hyperinflammation diseases like COVID-19 is a challenge. We show here that FTIR could probe the degree of IgG glycosylation discriminating subpopulations of COVID-19 patients depending on their degree of severity. © Optica Publishing Group 2022 The Authors.
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Objective. This online cross-sectional research aimed to analyze the role of attitudes towards conjugal coexistence, during the period of quarantine, as a justification of the relationship between ideologies based on traditionalism and the acceptance of psychological abuse on women. Method. For this purpose, 260 women from different regions of Brazil were studied. Results. The results showed positive and significant effects (mediated effect =.14;SE =.04;95% CI.05;.22), suggesting that women who endorse more traditionalist ideologies use more justifications, through quarantine, and are more accepting of psychological abuse. This same relationship occurred in the direct and indirect strategies of psychological abuse. Therefore, this study presented preliminary evidence about a possible reinforcer of psychological abuse.
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Objective. Adapt the COVID Stress Scales (CSS), gathering psychometric evidence, and to verify the pattern of relationship with anxiety compared to COVID-19. Method. Two studies were carried out with participants from different Brazilian states. In the first (n = 423) the exploratory factor analysis suggested a pentafactorial structure. In the second (n = 300), a confirmatory factor analysis was performed, testing a pentafactorial model. Evidence of convergent and discriminant validity was gathered. Pearson's correlation (r) was performed, which showed positive and statistically significant relationships between anxiety and stress in the face of COVID, indicating validity based on external measure. Results. Satisfactory internal consistency was found in both studies. It is concluded that the CSS is valid and reliable and can assist in the assessment of individuals with stress caused by the COVID pandemic and its correlated factors.
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The fatality prediction in hyperinflammation diseases like COVID-19 is a challenge. We show here that FTIR could probe the degree of IgG glycosylation discriminating subpopulations of COVID-19 patients depending on their degree of severity. © Optica Publishing Group 2022 The Authors.
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Methods: This is a case series, carried out from March to July 2020, with data recorded in the nutritional monitoring records of patients hospitalized with COVID-19. The variables analyzed were: demographic (age and sex);clinical (comor-bidities, underlying disease and outcome), anthropometric, biochemical and nutritional support. Results: The sample consisted of 102 patients, 65.7% had the severe acute respiratory syndrome, the main underlying disease observed was heart disease (23.5%) and 69.3% of patients were discharged from the ICU. Regarding nutritional variables, approximately 50% of patients received enteral feeding and 73.3% started early. Concerning biochemical markers, patients who died had higher C-reactive protein (CRP)/albumin ratios (p=0.024) and CRP concentrations (p=0.012) when compared to those who progressed to dis-charge from the ICU. In addition, it is observed that the eld-erly (adjusted HR = 3.62;95%CI 1.19 - 10.97) and early ini-tiation of enteral nutritional therapy (adjusted HR = 10.62;95%CI 2.41 - 46 .87) were factors related to ICU discharge. Conclusion: Monitoring the inflammatory process using different markers seems to be a good parameter for the clinical evolution of these patients. In addition, the benefits of early enteral nutrition therapy may be associated with better clinical outcomes and reduced complications during hospitalization.
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Introducao: Todos os servicos de saude foram impactados durante a pandemia de COVID-19, os servicos de hemoterapia, que dependem de doadores voluntarios, sofreram com a necessidade de isolamento da populacao e pelo medo do contagio ao vir doar, tambem por doadores infectados e maior numero de transfusoes em pacientes com complicacoes da COVID-19. As outras patologias com necessidade de transfusao ainda existiam e os bancos de sangue tiveram que se reorganizar para buscar ativamente os doadores e atender as medidas necessarias para evitar o contagio, como nao causar aglomeracoes, distanciamento entre as cadeiras do doador e uso de mascara e alcool gel. Objetivos: Avaliar o perfil do doador de sangue do servico de hemoterapia do Hospital Marcio Cunha durante o periodo critico da pandemia de COVID-19. Materiais e Metodos: estudo descritivo, retrospectivo e quantitativo, realizado no servico de hemoterapia atraves de avaliacao do relatorio de producao Hemoterapica - Hemoprod, dos meses de maio 2020 a julho 2021, periodo com elevado numero de obitos por COVID-19 no Brasil. Resultados e Discussao: Nos meses de maio/20 a julho/21 foram entrevistados 12.154 candidatos, sendo 9.449 aptos para doacao de sangue total, media de 629 doadores/mes. A maior parte das doacoes foi espontanea (55,6%), seguida de reposicao e apenas uma doacao autologa no periodo. Em relacao ao tipo de doador;69,7% doaram pela primeira vez;29,5% de forma esporadica e apenas 0,7% de repeticao. A maioria dos doadores foi do genero masculino (58,2%) com idade acima de 29 anos (67,7%). A principal causa da inaptidao na triagem foi descrito como outras (20%), sendo mais comum o uso de medicamentos que impedem a doacao e procedimentos endoscopicos nos ultimos seis meses;3,65% apresentavam hematocrito abaixo do necessario;2,8% hipotensao e 1,04% comportamento de risco para doenca sexualmente transmissivel. No que se refere a triagem sorologica, 221 doadores apresentaram sorologia positiva (2,3%) sendo 47% anti-HBc total reagente, 45.8% sifilis;2,7% anti-HCV;1,8% HBsAg e HTLV e 0,9% HIV. Quanto ao perfil imunohematologico 41,8% foram do grupo O positivo e 28,7% A positivo, sendo os mais frequentes e 9,9% foram O negativo. No periodo foram produzidos 9.323 concentrados de hemacias e transfundidos 6.826 e produzidos 8.948 concentrados de plaquetas e transfundidos 3.983. Conclusao: Nao ha substituto para sangue humano, por isso os servicos de hemoterapia dependem dos doadores voluntarios para manter o estoque de hemocomponentes. No periodo da pandemia houve menor numero de doacoes e maior necessidade de transfusoes em decorrencias das complicacoes da COVID-19. O banco de sangue do Hospital Marcio Cunha atendeu as medidas sanitarias para evitar o contagio e utilizou de estrategias de captacao de doares para tentar diminuir o impacto para o setor assistencial, no periodo analisado o numero de doacoes foi suficiente para atender a demanda transfusional, fato tambem relacionado a reducao de cirurgias eletivas. Copyright © 2022
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Objetivos: A COVID-19 apresenta alta taxa de infectividade e um amplo espectro clinico no qual, aproximadamente 3%-20% dos infectados necessitam de internacao hospitalar sendo destes, 10%-30% cuidados intensivos. A forma grave parece estar associada a um descontrole da resposta imune do hospedeiro, desta forma, a caracterizacao do perfil imune e fundamental para a definicao prognostica e terapeutica. Materiais e Metodos: Estudo prospectivo realizado de maio de 2020 a maio de 2021, recrutou adultos com COVID-19 grave internados em UTI, para a avaliacao de 17 citocinas. Foram realizadas coletas laboratoriais na admissao na UTI (D0) e apos, a cada 4 dias por no maximo, 20 dias. O grupo controle incluiu doadores de sangue voluntarios. O desfecho primario avaliado foi a sobrevida livre de Ventilacao Mecanica (VM). Este projeto foi aprovado pelo Comite de etica. Resultados: Nos 62 pacientes avaliados a idade mediana foi de 58,7 anos, houve uma predominancia no sexo masculino (74.2%), e alta prevalencia de comorbidades. A taxa de mortalidade foi de 8%, sendo 55% a necessidade de suporte ventilatorio invasivo. Dentre as citocinas avaliadas, se destacaram os niveis sericos elevados de Granzima B, Perforina e sFAS (FAS soluvel) nos doentes em relacao aos controles. Os valores medianos de Granzima B no D0 foram maiores quanto menor o tempo de sintomas. A avaliacao no D0 atraves da curva ROC, demonstrou um papel preditivo nos niveis de Perforina, Granzima B e sFAS para a evolucao para VM. Nao obstante, os niveis de sFAS no decorrer da internacao apresentaram correlacao direta com pior desfecho sendo um potencial marcador prognostico. Discussao: A apoptose ocorre atraves de 3 mecanismos: mediada por granulos (granzimas e perforinas);citotoxicidade atraves de Fas-FasL;e citotoxicidade atraves do ligante TRAIL. Maucourant et al. documentaram no diagnostico de COVID-19 grave, o aumento nos niveis de Perforina, representando a resposta celular NK. Alem disso, foi descrito que no decorrer da infeccao ha uma reducao da citotoxicidade NK, decorrente da exaustao imune. Em nossa amostra, os niveis no D0 destas 2 moleculas se relacionaram a gravidade, alem disso, foi possivel observar o aumento de Granzima B relacionado a precocidade dos sintomas, desta forma, indicando uma reducao evolutiva. O receptor FAS e seu Ligante (FASL), integrantes da familia TNF, sao responsaveis pela apoptose das celulas infectadas no inicio da infeccao e, mais tardio, dos linfocitos maduros auto-reativos. As formas soluveis dos receptores regulam de forma competitiva as suas particulas de membrana (inibicao). No entanto, sFAS e sFASL parecem ter papeis diferentes conforme a patologia e o momento da infeccao, podendo inibir seus receptores transmembrana ou desenvolver funcoes analogas. Andre et al. encontraram uma relacao direta dos niveis de sFASL no COVID-19 grave com Fas-FasL linfocitarios, a linfopenia e o pior prognostico. Sendo responsaveis, portanto, pela apoptose de linfocitos T ativados. Diante disso, avaliaram o uso de um inibidor de caspase-1 para bloquear o Fas, o qual aumentou a resposta antiviral. Conclusao: O sFAS e um potencial biomarcador para a avaliacao preditiva prognostica, desta forma, nossos dados sugerem que as vias da apoptose devem ser estudadas a fim de confirmar estes dados e ainda, explorar seu potencial como alvo terapeutico. Copyright © 2022