Is the vitamin D status of patients with COVID-19 associated with reduced mortality? A systematic review and meta-analysis.

To conduct a systematic review and meta-analysis of studies assessing the association between serum vitamin D status and mortality in patients with COVID- 19. We searched PubMed and Embase for studies addressing the association of serum vitamin D levels and COVID-19 mortality published until April 24, 2022. Risk ratios (RRs) and 95% confidence interval (CIs) were pooled using fixed or random effects models. The risk of bias was assessed using the Newcastle-Ottawa Scale. The meta-analysis included 21 studies that measured serum vitamin D levels close to the date of admission, of which 2 were case-control and 19 were cohort studies. Vitamin D deficiency was associated with COVID-19 mortality in the overall analysis but not when the analysis was adjusted to vitamin D cutoff levels < 10 or < 12 ng/mL (RR 1.60, 95% CI 0.93-2.27, I2 60.2%). Similarly, analyses including only studies that adjusted measures of effect for confounders showed no association between vitamin D status and death. However, when the analysis included studies without adjustments for confounding factors, the RR was 1.51 (95% CI 1.28-1.74, I2 0.0%), suggesting that confounders may have led to many observational studies incorrectly estimating the association between vitamin D status and mortality in patients with COVID-19. Deficient vitamin D levels were not associated with increased mortality rate in patients with COVID-19 when the analysis included studies with adjustments for confounders. Randomized clinical trials are needed to assess this association.

Is the vitamin D status of patients with COVID-19 associated with reduced mortality? A systematic review and meta-analysis

ABSTRACT To conduct a systematic review and meta-analysis of studies assessing the association between serum vitamin D status and mortality in patients with COVID- 19. We searched PubMed and Embase for studies addressing the association of serum vitamin D levels and COVID-19 mortality published until April 24, 2022. Risk ratios (RRs) and 95% confidence interval (CIs) were pooled using fixed or random effects models. The risk of bias was assessed using the Newcastle-Ottawa Scale. The meta-analysis included 21 studies that measured serum vitamin D levels close to the date of admission, of which 2 were case- control and 19 were cohort studies. Vitamin D deficiency was associated with COVID-19 mortality in the overall analysis but not when the analysis was adjusted to vitamin D cutoff levels < 10 or < 12 ng/mL (RR 1.60, 95% CI 0.93-2.27, I2 60.2%). Similarly, analyses including only studies that adjusted measures of effect for confounders showed no association between vitamin D status and death. However, when the analysis included studies without adjustments for confounding factors, the RR was 1.51 (95% CI 1.28-1.74, I2 0.0%), suggesting that confounders may have led to many observational studies incorrectly estimating the association between vitamin D status and mortality in patients with COVID-19. Deficient vitamin D levels were not associated with increased mortality rate in patients with COVID-19 when the analysis included studies with adjustments for confounders. Randomized clinical trials are needed to assess this association.

COVID-19 vaccines: Update of the vaccines in use and under development.

The ongoing COVID-19 pandemic has imposed a series of challenges on the scientific community. One of the biggest was the development of safe and effective vaccines in record time, which could be achieved through a global effort. A topic of great discussion has been the technology surrounding these vaccines: ranging from the well-known inactivated virus vaccines to the latest RNA vaccines. As vaccines became available, another point also came into question: their efficacy and effectiveness against the original Wuhan strain and its variants. Among the numerous variants, 5 of them (Alpha, Beta, Gamma, Delta and, more recently, Omicron) gained greater prominence due to their epidemiological relevance. In this scenario, with numerous variants and several vaccine options, scientific information can often be mismatched. This review aims to provide an overview of the efficacy, effectiveness, and safety of 11 vaccines in use or under development against the original Wuhan strain and the variants of concern identified by the World Health Organisation (WHO). Simultaneously, we aim to explore possible scenarios that can be expected shortly regarding new variants and vaccines. Overall, COVID-19 vaccines have satisfactory efficacy and loss of effectiveness against SARS-CoV-2 variants, especially the Omicron strain.

La pandemia de COVID-19 en curso ha impuesto una serie de dificultades a la comunidad científica. Una de las mayores ha sido el desarrollo de vacunas seguras y efectivas en tiempo récord, lo cual ha podido lograrse mediante un esfuerzo global. Una cuestión objeto de gran discusión ha sido la tecnología que rodea a estas vacunas, que fluctúa entre las bien conocidas que contienen virus inactivados, a las últimas vacunas basadas en ARN. A medida que se fue disponiendo de vacunas, también surgió otro punto en cuestión: su eficacia y efectividad contra la cepa originaria de Wuhan y sus variantes. Entre estas, cinco de ellas (Alfa, Beta, Gama, Delta y, más recientemente Ómicron) ganaron mayor importancia debido a su relevancia epidemiológica. En este escenario, con numerosas variantes y diversas opciones de vacunas, la información científica puede verse a menudo desfasada. El objetivo de esta revisión fue aportar una visión general sobre la eficacia, efectividad y seguridad de once vacunas en uso o en desarrollo contra la cepa originaria de Wuhan y las variantes preocupantes identificadas por la Organización Mundial de la Salud (OMS). De manera simultánea, otro objetivo es explorar los posibles escenarios que pueden preverse a corto plazo en cuanto a las nuevas variantes y vacunas. En general, las vacunas contra la COVID-19 tienen una eficacia y una pérdida de efectividad satisfactorias contra las variantes del SARS-CoV-2, especialmente la cepa Ómicron.

Acute kidney injury associated with dengue virus infection: a review / Injúria renal aguda associada à infecção pelo vírus da dengue: uma revisão

Abstract Acute kidney injury (AKI) is one of the least studied complications of dengue, but it carries high mortality rates and prolonged hospital stay. Due to the severity of this complication, the risk of developing chronic kidney disease (CKD) and the increasing number of dengue cases reported worldwide, particularly in the tropical and subtropical regions of Africa, Southeast Asia and South America, including Brazil, we embarked on this narrative review, aimed to update the epidemiology of AKI associated with dengue, elucidate the main pathophysiological mechanisms of AKI caused by the dengue virus infection, as well as discuss useful information on the prevention and management of AKI in patients with dengue.

Resumo A injúria renal aguda (IRA) é uma das complicações da dengue menos estudadas, mas que acarreta altas taxas de mortalidade e prolongamento do tempo de internação. Devido à gravidade dessa complicação, ao risco de desenvolvimento de doença renal crônica (DRC) e ao número crescente de casos de dengue relatados no mundo, particularmente nas regiões tropicais e subtropicais da África, Sudeste Asiático e América do Sul, incluindo o Brasil, foi proposta esta revisão narrativa que objetivou atualizar a epidemiologia da IRA associada à dengue, elucidar os principais mecanismos fisiopatológicos da IRA causada pela infecção do vírus da dengue, assim como discutir informações úteis sobre a prevenção e o manejo da IRA em pacientes com dengue.

Acute kidney injury associated with dengue virus infection: a review.

Acute kidney injury (AKI) is one of the least studied complications of dengue, but it carries high mortality rates and prolonged hospital stay. Due to the severity of this complication, the risk of developing chronic kidney disease (CKD) and the increasing number of dengue cases reported worldwide, particularly in the tropical and subtropical regions of Africa, Southeast Asia and South America, including Brazil, we embarked on this narrative review, aimed to update the epidemiology of AKI associated with dengue, elucidate the main pathophysiological mechanisms of AKI caused by the dengue virus infection, as well as discuss useful information on the prevention and management of AKI in patients with dengue.

Impact of physical and functional fitness on mortality from all causes of physically independent older adults.

OBJECTIVE: To provide reference values for functional fitness tests (PFFT) and verify the capability of these tests alone and grouped into a general index (GFFI-6), to predict mortality from all causes, during seven years of follow-up of physically independent older adults. METHODS: The sample consisted of 422 older adults, evaluated at baseline using six PFFTs, as well as sociodemographic, behavioral, anthropometric, and comorbidity variables. Mortality from all causes was followed for seven subsequent years. The sample was subdivided into four groups according to sex and age. Performances in the PFFT and GFFI-6 tests were ranked into "low", "regular", and "high". RESULTS: Cox proportional regression, with the adjustment of variables, indicated that the Unipedal Balance Test (BAL), Body Agility (AGI), Sit and Stand-up (SIT-SD) tests, and GFFI-6 were able to significantly predict mortality, indicating that older adults with "low" performance have, respectively, a 2.7 (CI=1.54-4.89, p = 0.01), 4.2 (CI=2.10-8.41), 2.5 (CI=1.44-4.65, p = 0.01), and 4.7 (CI=2.10-10.81, p<0.01) times higher risk of death, compared to older adults with "high" performance. CONCLUSION: BAL, AGI, and SIT-SD tests alone and tests grouped in the GFFI-6 were strong predictors of all-cause mortality in physically independent older adults.

Proton pump inhibitors use and risk of chronic kidney disease and end-stage renal disease.

INTRODUCTION: A possible association between long-term proton pump inhibitors (PPI) use and chronic kidney disease (CKD) has been recently described. Due to the potential health risk of this association, in the absence of proper clinical trials, we have decided to carry out a systematic review followed by meta-analysis. EVIDENCE ACQUISITION: PubMed, Cochrane Library, and Lilacs databases were searched. Studies that reported an association between PPI use and CKD or End-stage Renal Disease (ESRD) published until December 23, 2019, were included. All selected studies present high quality according to the New-Castle-Ottawa. The risk ratio (RR) and confidence interval (CI) were pooled using a random-effects model in CKD outcome analysis and fixed effects model for ESRD. A total of 10 observational studies were selected. EVIDENCE SYNTHESIS: Compared to patients who did not use PPI, the RR for CKD associated with PPI use was 1.35 (95% CI 1.15-1.56) with P<0.001, and the RR for ESRD associated with PPI use was 1.49 (95% CI 1.41-1.56) with P<0.001. CONCLUSIONS: This study indicates the presence of a significant association between PPI use and an increased risk of CKD and ESRD and reiterates the need for the medical prescription of this class of drugs to be made following the guidelines of the FDA.