Epidemiological and clinical characteristics of COVID-19 in a Brazilian public hospital.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has become a major health concern worldwide. In that context, the understanding of epidemiological and clinical features associated with the disease and its severity is crucial for the establishment of strategies aimed at disease control and remedy. AIM: To describe epidemiological features, signs, symptoms, and laboratory findings among severely ill COVID-19 patients from an intensive care unit in northeastern Brazil as well as to evaluate predictor factors for disease outcomes. METHODS: This is a prospective single-center study that evaluated 115 patients admitted to the intensive care unit in a northeastern Brazilian hospital. RESULTS: The patients had a median age of 65.60 ± 15.78 years. Dyspnea was the most frequent symptom, affecting 73.9% of the patients, followed by cough (54.7%). Fever was reported in approximately one-third of patients and myalgia in 20.8% of the patients. At least two comorbidities were found in 41.7% of the patients, and hypertension was the most prevalent (57.3%). In addition, having two or more comorbidities was a predictor of mortality, and lower platelet count was positively associated with death. Nausea and vomiting were two symptoms that were predictors of death, and the presence of a cough was a protective factor. CONCLUSION: This is the first report of a negative correlation between cough and death in severely ill severe acute respiratory syndrome coronavirus 2-infected individuals. The associations between comorbidities, advanced age, and low platelet count and the outcomes of the infection were similar to the results of previous studies, highlighting the relevance of these features.

Perspective of immigrants on personal and family integration in brazilian society / Perspectiva de los inmigrantes sobre la integración personal y familiar en la sociedad brasileña / Perspectiva de imigrantes sobre a integração pessoal e familiar na sociedade brasileira

ABSTRACT Objective: to describe the experiences of immigrants and their families related to integration in Brazil. Method: this is a descriptive study, with a qualitative approach, carried out in a municipality in southern Brazil. The informants were 13 immigrants who had lived in Brazil between six months and five years and who were able to communicate in Portuguese, English or Spanish. Data were collected between May and November 2021, through semi-structured interviews, audio-recorded and subjected to thematic content analysis. Results: the 13 participants were aged between 27 and 65 years (mean age 36 years), nine of whom were women, seven from Venezuela and the others from countries in South, Central America and Africa. Three categories emerged which show the adversities experienced, especially in relation to jobs (low wages, labor exploitation, non-recognition of academic titles), communication difficulties and distance from family. On the other hand, they also show satisfaction with public safety, health care and the possibility of personal and professional development. To maintain family unity and their origins, people in an immigration situation financially help members who could not migrate, make typical foods and use the native language in the home environment. Conclusion: integration into Brazilian society is permeated by challenges, namely the absence/distance from family of origin and/or constituted, lack of understanding of language, work and financial problems and social support network weakness. However, immigrants seek to maintain an adequate family functioning based on the support of institutions and the maintenance of the culture of origin.

RESUMEN Objetivo: describir las experiencias de los inmigrantes y sus familias con respecto a la integración en Brasil. Método: estudio descriptivo, con abordaje cualitativo, realizado en un municipio del sur de Brasil. Los informantes fueron 13 inmigrantes que habían vivido en Brasil entre seis meses y cinco años y que podían comunicarse en portugués, inglés o español. Los datos fueron recolectados entre mayo y noviembre de 2021, a través de entrevistas semiestructuradas, grabadas en audio y sometidas a análisis de contenido temático. Resultados: los 13 participantes tenían entre 27 y 65 años (edad media 36 años), nueve de los cuales eran mujeres, siete de Venezuela y los demás de países de América del Sur, Central y África. Emergieron tres categorías que muestran las adversidades vividas, especialmente en relación al trabajo (bajos salarios, explotación laboral, no reconocimiento de títulos académicos), dificultades de comunicación y distanciamiento familiar. Por otro lado, también muestran satisfacción con la seguridad pública, la atención de la salud y la posibilidad de desarrollo personal y profesional. Para mantener la unidad familiar y sus orígenes, las personas en situación de inmigración ayudan económicamente a los miembros que no pudieron migrar, elaboran comidas típicas y utilizan la lengua materna en el ámbito familiar. Conclusión: la integración en la sociedad brasileña está permeada por desafíos, a saber, la ausencia/lejanía de la familia de origen y/o constituida, la falta de comprensión del idioma, los problemas laborales y financieros y la debilidad en la red de apoyo social. Sin embargo, los inmigrantes buscan mantener un adecuado funcionamiento familiar basado en el apoyo de las instituciones y el mantenimiento de la cultura de origen.

RESUMO Objetivo: descrever as vivências de imigrantes e suas famílias relativas à integração no Brasil. Método: estudo descritivo, com abordagem qualitativa, realizado em município no Sul do Brasil. Os informantes foram 13 imigrantes que residiam no Brasil entre seis meses e cinco anos e que conseguiam se comunicar em português, inglês ou espanhol. Os dados foram coletados entre maio e novembro de 2021, mediante entrevistas semiestruturadas, audiogravadas e submetidas à análise de conteúdo temática. Resultados: os 13 participantes tinham idades entre 27 e 65 anos (média de 36 anos), sendo nove mulheres, sete provenientes da Venezuela e os demais de países da América do Sul, Central e África. Emergiram três categorias as quais mostram as adversidades experienciadas, sobretudo em relação a empregos (baixos salários, exploração de mão de obra, não reconhecimento de títulos acadêmicos), dificuldades de comunicação e distância da família. Por outro lado, mostram também a satisfação com a segurança pública, assistência à saúde e possibilidade de desenvolvimento pessoal e profissional. Para manter a união familiar e suas origens, as pessoas em situação de imigração ajudam financeiramente os membros que não puderam migrar, fazem comidas típicas e utilizam o idioma nativo no ambiente domiciliar. Conclusão: a integração à sociedade brasileira é permeada por desafios, nomeadamente pela ausência/distância da família de origem e/ou constituída, não compreensão do idioma, problemas laborais e financeiros e fragilidade na rede de apoio social. Contudo, os imigrantes buscam manter um adequado funcionamento familiar a partir do apoio de instituições e da manutenção da cultura de origem.

Influence of the COVID-19 pandemic in the gastrointestinal oncology setting: An overview.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been impacting healthcare in various ways worldwide and cancer patients are greatly affected by the coronavirus disease 2019 (COVID-19) pandemic. The reorganization of the health facilities in order to supply the high demand resulting from the aforementioned infection as well as the social isolation measures led to impairments for the diagnosis and follow-up of patients with gastrointestinal cancers, which has had an impact on the prognosis of the oncologic patients. In that context, health authorities and organizations have elaborated new guidelines with specific recommendations for the management of individuals with gastrointestinal neoplasms during the pandemic. Of note, oncologic populations seem to be more susceptible to unfavorable outcomes when exposed to SARS-CoV-2 infection and some interactions involving virus, tumor, host immune system and anticancer therapies are probably related to the poorer prognosis observed in those COVID-19 patients. Moreover, vaccination stands out as the main prevention method against severe SARS-CoV-2 infection and some particularities have been observed regarding the seroconversion of vaccinated oncologic patients including those with gastrointestinal malignancies. In this minireview, we gather updated information regarding the influence of the pandemic in the diagnosis of gastrointestinal neoplasms, new recommendations for the management of gastrointestinal cancer patients, the occurrence of SARS-CoV-2 infection in those individuals and the scenario of the vaccination against the virus in that population.

From Helicobacter pylori infection to gastric cancer: Current evidence on the immune response.

Gastric cancer (GC) is the result of a multifactorial process whose main components are infection by Helicobacter pylori (H. pylori), bacterial virulence factors, host immune response and environmental factors. The development of the neoplastic microenvironment also depends on genetic and epigenetic changes in oncogenes and tumor suppressor genes, which results in deregulation of cell signaling pathways and apoptosis process. This review summarizes the main aspects of the pathogenesis of GC and the immune response involved in chronic inflammation generated by H. pylori.

Non-pharmacological management of pediatric functional abdominal pain disorders: Current evidence and future perspectives.

Functional abdominal pain disorders (FAPDs) are an important and prevalent cause of functional gastrointestinal disorders among children, encompassing the diagnoses of functional dyspepsia, irritable bowel syndrome, abdominal migraine, and the one not previously present in Rome III, functional abdominal pain not otherwise specified. In the absence of sufficiently effective and safe pharmacological treatments for this public problem, non-pharmacological therapies emerge as a viable means of treating these patients, avoiding not only possible side effects, but also unnecessary prescription, since many of the pharmacological treatments prescribed do not have good efficacy when compared to placebo. Thus, the present study provides a review of current and relevant evidence on non-pharmacological management of FAPDs, covering the most commonly indicated treatments, from cognitive behavioral therapy to meditation, acupuncture, yoga, massage, spinal manipulation, moxibustion, and physical activities. In addition, this article also analyzes the quality of publications in the area, assessing whether it is possible to state if non-pharmacological therapies are viable, safe, and sufficiently well-based for an appropriate and effective prescription of these treatments. Finally, it is possible to observe an increase not only in the number of publications on the non-pharmacological treatments for FAPDs in recent years, but also an increase in the quality of these publications. Finally, the sample selection of satisfactory age groups in these studies enables the formulation of specific guidelines for this age group, thus avoiding the need for adaptation of prescriptions initially made for adults, but for children use.

Helicobacter pylori infection: How does age influence the inflammatory pattern?

The inflammatory pattern during Helicobacter pylori (H. pylori) infection is changeable and complex. During childhood, it is possible to observe a predominantly regulatory response, evidenced by high concentrations of key cytokines for the maintenance of Treg responses such as TGF-ß1 and IL-10, in addition to high expression of the transcription factor FOXP3. On the other hand, there is a predominance of cytokines associated with the Th1 and Th17 responses among H. pylori-positive adults. In the last few years, the participation of the Th17 response in the gastric inflammation against H. pylori infection has been highlighted due to the high levels of TGF-ß1 and IL-17 found in this infectious scenario, and growing evidence has supported a close relationship between this immune response profile and unfavorable outcomes related to the infection. Moreover, this cytokine profile might play a pivotal role in the effectiveness of anti-H. pylori vaccines. It is evident that age is one of the main factors influencing the gastric inflammatory pattern during the infection with H. pylori, and understanding the immune response against the bacterium can assist in the development of alternative prophylactic and therapeutic strategies against the infection as well as in the comprehension of the pathogenesis of the outcomes related to that microorganism.

Bem-estar psicológico e coping em estudantes de enfermagem durante a quarentena pela COVID-19 / Nursing students' psychological well-being and coping during the COVID-19 quarantine / Bienestar psicológico y afrontamiento (coping) en estudiantes de enfermería durante la cuarentena por la COVID-19

Resumo Enquadramento: A crise pandémica da COVID-19 acarretou mudanças na vida académica dos estudantes do ensino superior, o que poderá afetar o seu bem-estar psicológico. Objetivo: Analisar a relação entre estratégias de coping utilizadas e o bem-estar psicológico em estudantes de enfermagem durante a quarentena pela COVID-19. Metodologia: Estudo transversal, descritivo-correlacional, utilizando uma amostra de 136 estudantes. Colheita de dados online, com recurso à Escala de Medida de Manifestação de Bem-estar Psicológico e à Brief COPE. Resultados: Os estudantes dos últimos anos de curso utilizam mais frequentemente a estratégia de coping suporte instrumental (p = 0,015) e emocional (p = 0,009), apresentam ainda, maiores níveis de bem-estar psicológico (p = 0,012). As alterações no rendimento familiar estão associadas ao bem-estar psicológico (p = 0,024), assim como as estratégias de coping religião (r = 0,36; p ≤ 0,01), reinterpretação positiva (r = 0,47; p ≤ 0,01) e humor (r = 0,37; p ≤ 0,01). Conclusão: As estratégias de coping adotadas pelos estudantes parecem estar relacionadas com o bem-estar psicológico durante a quarentena.

Abstract Background: The COVID-19 pandemic crisis has brought about changes in the lives of higher education students that may influence their psychological well-being. Objective: To analyze the association between nursing students' coping strategies and their psychological well-being during the COVID-19 quarantine. Methodology: Cross-sectional, descriptive-correlational study using a convenience sample of 136 students. Data were collected online using the Portuguese version of the Échelle de Mesure des Manifestations du Bien-être Psychologique and the Brief COPE. Results: Students in the last years of their undergraduate studies used the instrumental support (p = 0.015) and emotional support (p = 0.009) coping strategies more often and had higher levels of psychological well-being (p = 0.012). Psychological well-being is associated with household income changes (p = 0.024), as well as with religion (r = 0.36; p ≤ 0.01), positive reframing (r = 0.47; p ≤ 0.01), and humor (r = 0.37; p ≤ 0.01) coping strategies. Conclusion: Students' coping strategies seem to be associated with their psychological well-being during the COVID-19 quarantine.

Resumen Marco contextual: La crisis provocada por la pandemia de la COVID-19 produjo cambios en la vida académica de los estudiantes de educación superior, que pueden afectar su bienestar psicológico. Objetivo: Analizar la relación entre las estrategias de afrontamiento utilizadas y el bienestar psicológico en estudiantes de enfermería durante la cuarentena por la COVID-19. Metodología: Estudio transversal, descriptivo-correlacional, con una muestra de 136 estudiantes. La recopilación de datos se realizó en línea mediante la Escala de Medición de la Manifestación del Bienestar Psicológico y el Brief COPE. Resultados: Los estudiantes de los últimos cursos utilizan con más frecuencia la estrategia de afrontamiento apoyo instrumental (p = 0,015) y emocional (p = 0,009), y también tienen mayores niveles de bienestar psicológico (p = 0,012). Los cambios en los ingresos familiares se asocian con el bienestar psicológico (p = 0,024), así como con las estrategias de afrontamiento religión (r = 0,36; p ≤ 0,01), reinterpretación positiva (r = 0,47; p ≤ 0,01) y estado de ánimo (r = 0,37; p ≤ 0,01). Conclusión: Las estrategias de afrontamiento adoptadas por los estudiantes parecen estar relacionadas con el bienestar psicológico durante la cuarentena.

Relationship between Th17 immune response and cancer.

Cancer is the second leading cause of death worldwide and epidemiological projections predict growing cancer mortality rates in the next decades. Cancer has a close relationship with the immune system and, although Th17 cells are known to play roles in the immune response against microorganisms and in autoimmunity, studies have emphasized their roles in cancer pathogenesis. The Th17 immune response profile is involved in several types of cancer including urogenital, respiratory, gastrointestinal, and skin cancers. This type of immune response exerts pro and antitumor functions through several mechanisms, depending on the context of each tumor, including the protumor angiogenesis and exhaustion of T cells and the antitumor recruitment of T cells and neutrophils to the tumor microenvironment. Among other factors, the paradoxical behavior of Th17 cells in this setting has been attributed to its plasticity potential, which makes possible their conversion into other types of T cells such as Th17/Treg and Th17/Th1 cells. Interleukin (IL)-17 stands out among Th17-related cytokines since it modulates pathways and interacts with other cell profiles in the tumor microenvironment, which allow Th17 cells to prevail in tumors. Moreover, the IL-17 is able to mediate pro and antitumor processes that influence the development and progression of various cancers, being associated with variable clinical outcomes. The understanding of the relationship between the Th17 immune response and cancer as well as the singularities of carcinogenic processes in each type of tumor is crucial for the identification of new therapeutic targets.

Transmission of severe acute respiratory syndrome coronavirus 2 via fecal-oral: Current knowledge.

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in more than 93 million cases and 2 million deaths in the world. SARS-CoV-2 respiratory tract infection and its main clinical manifestations such as cough and shortness of breath are well known to the scientific community. However, a growing number of studies have reported SARS-CoV-2-related gastrointestinal involvement based on clinical manifestations, such as diarrhea, nausea, vomiting, and abdominal pain as well as on the pathophysiological mechanisms associated with coronavirus disease 2019. Furthermore, current evidence suggests SARS-CoV-2 transmission via the fecal-oral route and aerosol dissemination. Moreover, studies have shown a high risk of contamination through hospital surfaces and personal fomites. Indeed, viable SARS-CoV-2 specimens can be obtained from aerosols, which raises the possibility of transmission through aerosolized viral particles from feces. Therefore, the infection by SARS-CoV-2 via fecal-oral route or aerosolized particles should be considered. In addition, a possible viral spread to sources of drinking water, sewage, and rivers as well as the possible risk of viral transmission in shared toilets become a major public health concern, especially in the least developed countries. Since authors have emphasized the presence of viral RNA and even viable SARS-CoV-2 in human feces, studies on the possible fecal-oral coronavirus disease 2019 transmission become essential to understand better the dynamics of its transmission and, then, to reinforce preventive measures against this infection, leading to a more satisfactory control of the incidence of the infection.

Oncolytic virus therapy in cancer: A current review.

In view of the advancement in the understanding about the most diverse types of cancer and consequently a relentless search for a cure and increased survival rates of cancer patients, finding a therapy that is able to combat the mechanism of aggression of this disease is extremely important. Thus, oncolytic viruses (OVs) have demonstrated great benefits in the treatment of cancer because it mediates antitumor effects in several ways. Viruses can be used to infect cancer cells, especially over normal cells, to present tumor-associated antigens, to activate "danger signals" that generate a less immune-tolerant tumor microenvironment, and to serve transduction vehicles for expression of inflammatory and immunomodulatory cytokines. The success of therapies using OVs was initially demonstrated by the use of the genetically modified herpes virus, talimogene laherparepvec, for the treatment of melanoma. At this time, several OVs are being studied as a potential treatment for cancer in clinical trials. However, it is necessary to be aware of the safety and possible adverse effects of this therapy; after all, an effective treatment for cancer should promote regression, attack the tumor, and in the meantime induce minimal systemic repercussions. In this manuscript, we will present a current review of the mechanism of action of OVs, main clinical uses, updates, and future perspectives on this treatment.

Highlighting COVID-19: What the imaging exams show about the disease.

Coronavirus disease 2019 (COVID-19), a global emergency, is caused by severe acute respiratory syndrome coronavirus 2. The gold standard for its diagnosis is the reverse transcription polymerase chain reaction, but considering the high number of infected people, the low availability of this diagnostic tool in some contexts, and the limitations of the test, other tools that aid in the identification of the disease are necessary. In this scenario, imaging exams such as chest X-ray (CXR) and computed tomography (CT) have played important roles. CXR is useful for assessing disease progression because it allows the detection of extensive consolidations, besides being a fast and cheap method. On the other hand, CT is more sensitive for detecting lung changes in the early stages of the disease and is also useful for assessing disease progression. Of note, ground-glass opacities are the main COVID-19-related CT findings. Positron emission tomography combined with CT can be used to evaluate chronic and substantial damage to the lungs and other organs; however, it is an expensive test. Lung ultrasound (LUS) has been shown to be a promising technique in that context as well, being useful in the screening and monitoring of patients, disease classification, and management related to mechanical ventilation. Moreover, LUS is an inexpensive alternative available at the bedside. Finally, magnetic resonance imaging, although not usually requested, allows the detection of pulmonary, cardiovascular, and neurological abnormalities associated with COVID-19. Furthermore, it is important to consider the challenges faced in the radiology field in the adoption of control measures to prevent infection and in the follow-up of post-COVID-19 patients.

Vaccine development against Helicobacter pylori: from ideal antigens to the current landscape.

Introduction: The interest of the world scientific community for an effective vaccine against Helicobacter pylori infection arises from its high prevalence and association with many diseases. Moreover, with an immunological response that is not always effective for the eradication of the bacteria and an increasing antibiotic resistance in the treatment of this infection, the search for a vaccine and new therapeutic modalities to control this infection is urgent.Areas covered: We bring an overview of the infection worldwide, discussing its prevalence, increasing resistance to antibiotics used in its therapy, in addition to the response of the immune system to the infection registered so far. Moreover, we address the most used antigens and their respective immunological responses expected or registered up to now. Finally, we address the trials and their partial results in development for such vaccines.Expert opinion: Although several studies for the development of an effective vaccine against this pathogen are taking place, many are still in the preclinical phase or even without updated information. In this sense, taking into account the high prevalence and association with important comorbidities, the interest of the pharmaceutical industry in developing an effective vaccine against this pathogen is questioned.

Chronic myeloid leukemia-from the Philadelphia chromosome to specific target drugs: A literature review.

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm and was the first neoplastic disease associated with a well-defined genotypic anomaly - the presence of the Philadelphia chromosome. The advances in cytogenetic and molecular assays are of great importance to the diagnosis, prognosis, treatment, and monitoring of CML. The discovery of the breakpoint cluster region (BCR)-Abelson murine leukemia (ABL) 1 fusion oncogene has revolutionized the treatment of CML patients by allowing the development of targeted drugs that inhibit the tyrosine kinase activity of the BCR-ABL oncoprotein. Tyrosine kinase inhibitors (known as TKIs) are the standard therapy for CML and greatly increase the survival rates, despite adverse effects and the odds of residual disease after discontinuation of treatment. As therapeutic alternatives, the subsequent TKIs lead to faster and deeper molecular remissions; however, with the emergence of resistance to these drugs, immunotherapy appears as an alternative, which may have a cure potential in these patients. Against this background, this article aims at providing an overview on CML clinical management and a summary on the main targeted drugs available in that context.

Simultaneous circulation of zakat, dengue, and chikungunya viruses and their vertical co-transmission among Aedes aegypti.

The outbreaks caused by the Aedes aegypti-transmitted dengue virus (DENV), zakat virus (ZIKV), and chikungunya virus (CHIKV) result in a significant impact to the health systems of tropical countries. Furthermore, the occurrence of patients coinfected by at least two of these arboviruses is an aggravating factor in that scenario. On this basis, surveillance tools such as the Rapid Index Survey for Aedes aegypti (LIRAa) are used to estimate vector infestation in order to improve the prediction of human outbreaks. Ae. aegypti eggs were collected in the city of Vitória da Conquista, in Bahia State, Brazil, and subsequently hatched into larvae, which were analyzed in pools or individually for the presence of DENV, ZIKV, and CHIKV by molecular biology methods. The detection data for arboviruses were crossed with the LIRAa obtained in each region of the study city. Thirty larvae pools were analyzed, and fourteen (46.6%) of them were detected positive for DENV, ZIKV, and/or CHIKV. Among the individually analyzed larvae (n = 30), nine (30%) were positive for any of these arboviruses, and four (13.3%) were simultaneously coinfected by DENV and ZIKV. Furthermore, there was a positive correlation between the detection of circulating arboviruses and LIRAa. The simultaneous Ae. aegypti larvae infection by two different arboviruses is an unprecedented finding. This result suggests the occurrence of a vertical arboviruses co-transmission from the female mosquito to its offspring in nature. The occurrence of concomitant circulation of DENV, ZIKV, and CHIKV in Ae. aegypti from a single study region is another finding of this article. Finally, LIRAa seems to not only estimate vector infestation but also to predict circulation of arboviruses.

Association of Obesity with Depressive Symptomatology, Eating Habits, Interleukin-8 and Cortisol in a Young Population.

Obesity is the result of a complex combination of psychological, biological, and environmental factors. In this work, we evaluate whether obesity is related to eating habits, depressive symptomatology, as well as interleukin-8 and cortisol. A descriptive cross-sectional study was carried out in 232 university students. All youths were surveyed to determine their eating habits and depressive symptomatology. Anthropometric measures and a blood sample were taken to determine its biochemical profile and its concentration of interleukin-8 and cortisol. The results show that interleukin-8 increase in the overfat group. The altered eating behaviors were frequent in the studied group; they were associated with the presence of obesity and the variation of interleukin-8 and cortisol. Besides, we found correlations of interleukin-8 with age, glucose, and lipid profile in the overfat group. In conclusion, these results indicate that high adiposity is related to changes in the concentrations of interleukin-8 and eating habits, confirming that obesity is the consequence of a complex network of various factors.

COVID-19 gastrointestinal manifestations: a systematic review.

INTRODUCTION: The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has greatly challenged public health worldwide. A growing number of studies have reported gastrointestinal (GI) symptoms. We performed a systematic review of GI symptoms associated with coronavirus disease 2019 (COVID-19) as well as of the serum levels of biomarkers related to liver function and lesion in SARS-CoV-2-infected individuals. METHODS: We surveyed relevant articles published in English, Spanish, and Portuguese up to July, 2020 in the PubMed, MEDLINE, SciELO, LILACS, and BVS databases. Moreover, we surveyed potentially important articles in journals such as the NEJM, JAMA, BMJ, Gut, and AJG. RESULTS: This systematic review included 43 studies, including 18,246 patients. Diarrhea was the most common GI symptom, affecting 11.5% of the patients, followed by nausea and vomiting (6.3%) and abdominal pain (2.3%). With regard to clinical severity, 17.5% of the patients were classified as severely ill, whereas 9.8% of them were considered to have a non-severe disease. Some studies showed increased aspartate transaminase and alanine aminotransferase levels in a portion of the 209 analyzed patients and two studies. CONCLUSIONS: Our results suggest that digestive symptoms are common in COVID-19 patients. In addition, alterations in cytolysis biomarkers could also be observed in a lesser proportion, calling attention to the possibility of hepatic involvement in SARS-CoV-2-infected individuals.

Helicobacter pylori infection: Beyond gastric manifestations.

Helicobacter pylori (H. pylori) is a bacterium that infects more than a half of world's population. Although it is mainly related to the development of gastroduodenal diseases, several studies have shown that such infection may also influence the development and severity of various extragastric diseases. According to the current evidence, whereas this bacterium is a risk factor for some of these manifestations, it might play a protective role in other pathological conditions. In that context, when considered the gastrointestinal tract, H. pylori positivity have been related to Inflammatory Bowel Disease, Gastroesophageal Reflux Disease, Non-Alcoholic Fatty Liver Disease, Hepatic Carcinoma, Cholelithiasis, and Cholecystitis. Moreover, lower serum levels of iron and vitamin B12 have been found in patients with H. pylori infection, leading to the emergence of anemias in a portion of them. With regards to neurological manifestations, a growing number of studies have associated that bacterium with multiple sclerosis, Alzheimer's disease, Parkinson's disease, and Guillain-Barré syndrome. Interestingly, the risk of developing cardiovascular disorders, such as atherosclerosis, is also influenced by the infection. Besides that, the H. pylori-associated inflammation may also lead to increased insulin resistance, leading to a higher risk of diabetes mellitus among infected individuals. Finally, the occurrence of dermatological and ophthalmic disorders have also been related to that microorganism. In this sense, this minireview aims to gather the main studies associating H. pylori infection with extragastric conditions, and also to explore the main mechanisms that may explain the role of H. pylori in those diseases.

Immunotherapy - new perspective in lung cancer.

Lung carcinoma is associated with a high mortality worldwide, being the leading cause of cancer death. It is mainly classified into squamous non-small cell lung cancer (NSCLC), non-squamous NSCLC, and small cell lung cancer. However, such malignancy has been increasingly subdivided into histological and molecular subtypes to guide treatment. Therapies can be used in adjuvant and palliative settings. Regarding immunotherapy, it has been widely tested in both first or subsequent palliative lines. In this sense, drugs such as pembrolizumab, nivolumab, atezolizumab, ipilimumab, avelumab, and durvalumab have been assessed in large studies. Some of these trials have also studied these medicines in adjuvant and in maintenance therapy. In recent years, advances in immunotherapy have raised the hope that the unfavorable prognosis observed in several affected individuals can be changed. Immunotherapy has increased the overall survival in squamous NSCLC, non-squamous NSCLC, and small cell lung cancer. However, it has added to the oncology practice some side effects that are unusual in standard chemotherapy and require special clinical support. In order to show how immunotherapy is being applied in the treatment of lung carcinoma, we reviewed the main studies in adjuvant and palliative scenarios. What is the better scheme? What is the better combination? What is the better dose? When should we use immunotherapy? Does programmed cell death ligand 1 expression significantly interfere in immunotherapy efficiency? Some of these questions have already been answered, while others require more investigations.

Nephrotoxicity in cancer treatment: An overview.

Anticancer drug nephrotoxicity is an important and increasing adverse drug event that limits the efficacy of cancer treatment. The kidney is an important elimination pathway for many antineoplastic drugs and their metabolites, which occurs by glomerular filtration and tubular secretion. Chemotherapeutic agents, both conventional cytotoxic agents and molecularly targeted agents, can affect any segment of the nephron including its microvasculature, leading to many clinical manifestations such as proteinuria, hypertension, electrolyte disturbances, glomerulopathy, acute and chronic interstitial nephritis, acute kidney injury and at times chronic kidney disease. The clinician should be alert to recognize several factors that may maximize renal dysfunction and contribute to the increased incidence of nephrotoxicity associated with these drugs, such as intravascular volume depletion, the associated use of nonchemotherapeutic nephrotoxic drugs (analgesics, antibiotics, proton pump inhibitors, and bone-targeted therapies), radiographic ionic contrast media or radiation therapy, urinary tract obstruction, and intrinsic renal disease. Identification of patients at higher risk for nephrotoxicity may allow the prevention or at least reduction in the development and severity of this adverse effect. Therefore, the aim of this brief review is to provide currently available evidences on oncologic drug-related nephrotoxicity.

COVID-19 gastrointestinal manifestations: a systematic review

Abstract INTRODUCTION: The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has greatly challenged public health worldwide. A growing number of studies have reported gastrointestinal (GI) symptoms. We performed a systematic review of GI symptoms associated with coronavirus disease 2019 (COVID-19) as well as of the serum levels of biomarkers related to liver function and lesion in SARS-CoV-2-infected individuals. METHODS: We surveyed relevant articles published in English, Spanish, and Portuguese up to July, 2020 in the PubMed, MEDLINE, SciELO, LILACS, and BVS databases. Moreover, we surveyed potentially important articles in journals such as the NEJM, JAMA, BMJ, Gut, and AJG. RESULTS: This systematic review included 43 studies, including 18,246 patients. Diarrhea was the most common GI symptom, affecting 11.5% of the patients, followed by nausea and vomiting (6.3%) and abdominal pain (2.3%). With regard to clinical severity, 17.5% of the patients were classified as severely ill, whereas 9.8% of them were considered to have a non-severe disease. Some studies showed increased aspartate transaminase and alanine aminotransferase levels in a portion of the 209 analyzed patients and two studies. CONCLUSIONS: Our results suggest that digestive symptoms are common in COVID-19 patients. In addition, alterations in cytolysis biomarkers could also be observed in a lesser proportion, calling attention to the possibility of hepatic involvement in SARS-CoV-2-infected individuals.