Article
Endocrinology & Metabolism
Arno Teblick, Jan Gunst, Greet Van den Berghe
Summary: Critical illnesses increase cortisol levels and can lead to adrenal crisis if not adequately treated. Prolonged dependence on vital organ support in critically ill patients can result in central adrenal insufficiency, which may contribute to lingering vasopressor need and encephalopathy.
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
(2022)
Review
Biochemistry & Molecular Biology
Ioannis Ilias, Alice G. Vassiliou, Chrysi Keskinidou, Charikleia S. Vrettou, Stylianos Orfanos, Anastasia Kotanidou, Ioanna Dimopoulou
Summary: Sepsis leads to dysregulated cortisol secretion, resulting in abnormal cortisol levels in the blood. Initial stages of the condition show elevated cortisol levels due to increased secretion from the adrenal glands, but as the disease progresses, cortisol levels may decline due to impaired adrenal function. The dysregulation of cortisol secretion in sepsis impairs the body's ability to mount an appropriate inflammatory response, contributing to the pathophysiology of the disease.
Article
Critical Care Medicine
Chun-Sing Huang, Travis Miles, Brice Thomas, S. Rob Todd, Chad T. Wilson, James Suliburk
Summary: The study demonstrates extreme variability in the diagnosis and management of CIRCI, with most providers acknowledging a knowledge gap in the diagnosis of CIRCI and the role of corticosteroids in hemorrhagic shock. Few providers are using adjunctive mineralocorticoids in septic shock, although recent level 1 evidence have shown a survival benefit. These responses reflect an opportunity for national improvement in the management of CIRCI.
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED
(2021)
Article
Critical Care Medicine
Vidushi Sood, Linda Rogers, Sandhya Khurana
Summary: Oral corticosteroid (OCS) use in severe asthma is still common despite advances in treatment, but monoclonal antibodies have been developed to reduce OCS-treated exacerbations. Strategies for managing endocrine complications associated with OCS use include identifying OCS-dependent patients, optimizing OCS dose, tapering OCS based on asthma control criteria, assessing adrenal axis integrity, and managing corticosteroid-related comorbidities.
Review
Medicine, General & Internal
M. Gurnell, L. G. Heaney, D. Price, A. Menzies-Gow
Summary: Secondary adrenal insufficiency often results from excessive exogenous corticosteroid therapy, particularly oral corticosteroids. Biologic therapies offer a potential solution for reducing or eliminating maintenance OCS in severe asthma, but there is a need for further clinical trials to define strategies for early identification and treatment of AI, as well as safe OCS withdrawal in routine practice.
JOURNAL OF INTERNAL MEDICINE
(2021)
Article
Critical Care Medicine
Andrew Menzies-Gow, Mark Gurnell, Liam G. Heaney, Jonathan Corren, Elisabeth H. Bel, Jorge Maspero, Timothy Harrison, David J. Jackson, David Price, Njira Lugogo, James Kreindler, Annie Burden, Alex De Giorgio-Miller, Kelly Padilla, Ubaldo J. Martin, Esther Garcia Gil
Summary: This study evaluated the impact of reducing oral corticosteroids after initiating benralizumab treatment on patients with severe eosinophilic asthma. The study found that with a personalized dosage reduction algorithm, most patients were able to successfully reduce or eliminate the use of oral corticosteroids, and the treatment was safe.
LANCET RESPIRATORY MEDICINE
(2022)
Review
Endocrinology & Metabolism
Alice R. Hill, Joanna L. Spencer-Segal
Summary: Treatment for critical illness often focuses on short-term physical recovery, but recent research suggests long-term risks of cognitive impairment and psychiatric disorders in survivors, potentially linked to glucocorticoid levels. Elevated glucocorticoids can cause structural changes in the hippocampus and prefrontal cortex, impacting memory and cognition in critical illness survivors.
Article
Endocrinology & Metabolism
Carla Bizzarri, Donatella Capalbo, Malgorzata Gabriela Wasniewska, Federico Baronio, Anna Grandone, Marco Cappa
Summary: This study summarized the clinical practice standards for adrenal crisis and investigated the prevalence of suspected/incipient adrenal crisis in children with adrenal insufficiency. The results showed that the number of adrenal crisis episodes varied among children using different treatment modalities and different age groups. Therefore, parental education and switching to parenteral hydrocortisone when necessary are essential for preventing adrenal crisis in children.
FRONTIERS IN ENDOCRINOLOGY
(2023)
Article
Pediatrics
Vijay Srinivasan, Jan Hau Lee, Kusum Menon, Jerry J. Zimmerman, Melania M. Bembea, Michael S. D. Agus
Summary: This study aims to develop consensus criteria for endocrine dysfunction in critically ill children by assessing the association of various biomarkers with clinical outcomes. The results suggest that specific measures of glucose, thyroid function, and adrenal function can be used to evaluate endocrine dysfunction.
Article
Immunology
Yiming Zhang, Yan Li, Na Sun, Hanqi Tang, Jun Ye, Yang Liu, Quan He, Yangyang Fu, Huadong Zhu, Chengyu Jiang, Jun Xu
Summary: The NETosis pathway is top-ranked in patients with SCAP caused by different pathogens, providing a potential therapeutic strategy. Additionally, a higher occurrence of transcriptional read-through is associated with a worse outcome in patients with SCAP.
FRONTIERS IN IMMUNOLOGY
(2022)
Letter
Medicine, General & Internal
Jan O. Friedrich, Elisa Gouvea Bogossian
Summary: In a trial evaluating the efficacy of hydrocortisone in treating community-acquired pneumonia, researchers found a nearly 50% lower 28-day mortality rate in the hydrocortisone group compared to the placebo group. They also observed a higher incidence of septic shock in the placebo group. The trial did not allow the use of open-label glucocorticoids, which may have contributed to the higher mortality rate in the placebo group.
NEW ENGLAND JOURNAL OF MEDICINE
(2023)
Article
Immunology
Chia-Hua Wu, Ling Guo, Dan Hao, Qian Wang, Xiang Ye, Misa Ito, Bin Huang, Chieko Mineo, Philip W. Shaul, Xiang-An Li
Summary: This study used SF1CreSR-BIfl/fl mice as a model of relative adrenal insufficiency (RAI) to reveal the risk of death associated with RAI in sepsis and demonstrate that RAI is an endotype of sepsis characterized by persistent hyperinflammatory response. Furthermore, they found that GC treatment is beneficial for mice with RAI but harmful for mice without RAI. Therefore, this study supports a precision medicine approach in sepsis therapy, selectively applying GC treatment for patients with RAI.
FRONTIERS IN IMMUNOLOGY
(2023)
Review
Endocrinology & Metabolism
Shien Chen Lee, Elizabeth S. Baranowski, Rajesh Sakremath, Vrinda Saraff, Zainaba Mohamed
Summary: Adrenal insufficiency is a group of congenital and acquired disorders that result in inadequate steroid production by the adrenal glands. Its clinical features vary with age and cause, with common symptoms including drowsiness, fainting, and hypothermia caused by hypoglycemia. Recognizing hypoglycemia as a symptom of adrenal insufficiency is crucial for preventing sudden deaths.
FRONTIERS IN ENDOCRINOLOGY
(2023)
Review
Endocrinology & Metabolism
Lies Langouche, Arno Teblick, Jan Gunst, Greet Van den Berghe
Summary: Based on recent insights, the classical concept of an activated hypothalamus-pituitary-adrenocortical axis in response to critical illness is in need of revision. Peripheral adaptations play a more significant role in maintaining increased systemic cortisol availability and action in response to critical illness than centrally activated cortisol production and secretion. These adaptations include suppressed cortisol metabolism, alterations in expression of certain proteins, and negative feedback inhibition at the pituitary level. Prolonged critical illness may lead to central adrenal insufficiency.
Review
Medicine, General & Internal
Soledad Sosa, Karina Danilowicz, Leonardo F. L. Rizzo
Summary: This review discusses the pathophysiological changes of the adrenal axis during critical illness, emphasizing the limitations of using cosyntropin stimulation test for diagnosis and treatment of adrenal insufficiency in critically ill patients.
MEDICINA-BUENOS AIRES
(2021)
Article
Critical Care Medicine
Pedro Kurtz, Leonardo S. L. Bastos, Fernando G. Zampieri, Gabriel R. de Freitas, Fernando A. Bozza, Marcio Soares, Jorge I. F. Salluh
Summary: This retrospective cohort study analyzed data from 165 ICUs in Brazil from 2011 to 2020. The study found that hospital outcomes of stroke admissions worsened during the COVID-19 pandemic, particularly among patients with ischemic stroke and young patients with hemorrhagic stroke.
Review
Critical Care Medicine
Pedro Povoa, Luis Coelho, Felipe Dal-Pizzol, Ricard Ferrer, Angela Huttner, Andrew Conway Morris, Vandack Nobre, Paula Ramirez, Anahita Rouze, Jorge Salluh, Mervyn Singer, Daniel A. Sweeney, Antoni Torres, Grant Waterer, Andre C. Kalil
Summary: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Biomarkers can be used as indicators for infection, dysregulated host response, treatment response, and can aid in prognosticating patient risk. Over 250 biomarkers have been identified and evaluated, but none can accurately differentiate between sepsis and sepsis-like syndrome.
INTENSIVE CARE MEDICINE
(2023)
Article
Infectious Diseases
Bianca B. P. Antunes, Amanda A. B. Silva, Patricia H. C. Nunes, Ignacio Martin-Loeches, Pedro Kurtz, Silvio Hamacher, Fernando A. Bozza
Summary: The objective of this study was to compare the differences in antimicrobial use between COVID-19 and non-COVID-19 patients, and to compare two commonly used metrics for antimicrobial use: Defined Daily Dose (DDD) and Days of Therapy (DOT). The study found that COVID-19 patients had a higher use of broad-spectrum antimicrobials in the ICU, and overall, the DDD metric overestimated antimicrobial use compared with the DOT metric.
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
(2023)
Article
Infectious Diseases
Ana Paula Santos, Guilherme Loureiro Werneck, Ana Paula Razal Dalvi, Carla Conceicao dos Santos, Paulo Fernando Guimaraes Morando Marzocchi Tierno, Hanna Silva Condelo, Bruna Macedo, Janaina Aparecida de Medeiros Leung, Jeane de Souza Nogueira, Ludmila Malvao, Rafael Galliez, Roberta Aguiar, Roberto Stefan, Sabrina Modena Knackfuss, Elisangela Costa da Silva, Terezinha Marta Pereira Pinto Castineiras, Roberto de Andrade Medronho, Jose Roberto Lapa e Silva, Rogerio Lopes Rufino Alves, Luis Cristovao de Moraes Sobrino Porto, Luciana Silva Rodrigues, Afranio Lineu Kritski, Fernanda Carvalho de Queiroz Mello
Summary: This study evaluated the effectiveness of Bacillus Calmette-Guerin (BCG) vaccine as a tool against SARS-CoV-2 based on the concept of trained immunity. A multicenter, double-blinded, randomized clinical trial recruited health care workers (HCWs) in Brazil. The incidence rates of COVID-19, clinical manifestations, absenteeism, and adverse events among HCWs receiving BCG vaccine (Moreau or Moscow strains) or placebo were compared. BCG vaccine-mediated immune response before and after implementing specific vaccines for COVID-19 (CoronaVac or COVISHIELD) was analyzed using Cox proportional hazard and linear mixed effect modeling.
INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
(2023)
Article
Infectious Diseases
J. P. Cola, T. Nascimento do Prado, K. B. A. Alves, J. R. Lapa e Silva, A. Trajman, J. E. Golub, R. E. Chaisson, E. L. N. Maciel
Summary: The study analyzed the factors associated with non-completion of tuberculosis preventive therapy (TPT) in Brazil. It found that individuals aged 15-60 years, using isoniazid, and belonging to the Black/mixed race were more likely to not complete the preventive therapy.
INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE
(2023)
Article
Immunology
Suelen Silva Gomes Dias, Tamires Cunha-Fernandes, Luciana Souza-Moreira, Vinicius Cardoso Soares, Giselle Barbosa Lima, Isaclaudia G. Azevedo-Quintanilha, Julia Santos, Filipe Pereira-Dutra, Caroline Freitas, Patricia A. Reis, Stevens Kastrup Rehen, Fernando A. Bozza, Thiago M. Lopes Souza, Cecilia J. G. de Almeida, Patricia T. Bozza
Summary: Zika virus infection is associated with adult neurological disorders and congenital diseases. The virus regulates lipid metabolism pathways, leading to lipid droplet accumulation in neural cells. Inhibition of DGAT-1 reduces virus replication and inflammation, suggesting targeting lipid metabolism may be a potential anti-ZIKV treatment strategy.
JOURNAL OF NEUROINFLAMMATION
(2023)
Article
Critical Care Medicine
Carla B. Rynkowski, Vanessa Hegele, Pedro Henrique Rigotti Soares, Monica Lopes Tonello, Leticia Peterson, Frederico Klein Gomes, Alejandro A. Rabinstein, Leonardo S. L. Bastos, Ricardo Turon, Bruno Goncalves, Cassia Righy, Fernando A. Bozza, Pedro Kurtz
Summary: This study investigated the effects of tranexamic acid on long-term functional outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH). The results showed that the use of tranexamic acid before aneurysm occlusion did not improve the functional outcomes of aSAH patients.
NEUROCRITICAL CARE
(2023)
Article
Multidisciplinary Sciences
Artur T. L. R. Queiroz, Caian N. Vinhaes, Eduardo Fukutani, Akshay F. Gupte, Nathella Pavan Kumar, Kiyoshi R. Fukutani, Maria B. Arriaga, Timothy Sterling, Subash Babu, Sanjay Gaikwad, Rajesh Karyakarte, Vidya Mave, Mandar Paradhkar, Vijay B. Viswanathan, Amita Gupta, Bruno Andrade, Hardy Kornfeld, Alice M. S. Andrade, Marina C. Figueiredo, Vanessa Nascimento, Juan Manuel Cubillos-Angulo, Hayna Malta-Santos, Jessica Reboucas-Silva, Adriano Gomes-Silva, Saulo R. N. Santos, Andre Ramos, Pedro Brito, Carolina A. S. Schmaltz, Alysson G. Costa, Leandro Sousa Garcia, Brenda K. de Sousa Carvalho, Bruna P. de Loiola, Francine P. Ignacio, Maria C. Lourenco, Elisangela C. Silva, Mayla Mello, Alexandra B. Souza, Michael S. Rocha, Aline Benjamin, Adriana S. R. Moreira, Jamile G. de Oliveira, Solange Cavalcante, Betina Durovni, Marcelo Cordeiro-Santos, Afranio L. Kristki, Valeria C. Rolla, Jose R. Lapa-e-Silva, Kim West, Vandana Kulkami, Nikhil Gupte
Summary: Diabetes mellitus (DM) increases tuberculosis (TB) severity. Blood gene expression of adults with pulmonary TB was compared in individuals with or without DM from Brazil and India. The study found that the differentially expressed genes varied for each condition (DM, TB, and TBDM), and no pattern classified any one group across all sites. However, pathways associated with insulin resistance, metabolic dysfunction, diabetic complications, and chromosomal instability were positively correlated with glycohemoglobin in TBDM patients.
SCIENTIFIC REPORTS
(2023)
Article
Public, Environmental & Occupational Health
Mariana Araujo-Pereira, Betania M. F. Nogueira, Renata Spener-Gomes, Anna C. C. Carvalho, Flavia Marinho Sant'Anna, Marina C. Figueiredo, Megan M. Turner, Afranio L. Kritski, Marcelo Cordeiro-Santos, Valeria C. Rolla, Timothy R. Sterling, Bruno B. Andrade, Alice M. S. Andrade, Vanessa Nascimento, Juan Manuel Cubillos-Angulo, Hayna Malta-Santos, Jessica Reboucas-Silva, Saulo R. N. Santos, Andre Ramos, Pedro Brito, Carolina A. S. Schmaltz, Alysson G. Costa, Leandro Sousa Garcia, Brenda K. de Sousa Carvalho, Bruna P. de Loiola, Adriano Gomes-Silva, Francine P. Ignacio, Maria C. Lourenco, Elisangela C. Silva, Mayla Mello, Alexandra B. Souza, Beatriz Barreto-Duarte, Michael S. Rocha, Aline Benjamin, Adriana S. R. Moreira, Jamile G. de Oliveira, Solange Cavalcante, Betina Durovni, Jose R. Lapa-e-Silva
Summary: This study assessed whether the severity of anemia in TB patients prior to treatment was a risk factor for an unfavorable outcome. The results showed that moderate/severe anemia was associated with death, indicating the need for close monitoring of these patients.
JOURNAL OF INFECTION AND PUBLIC HEALTH
(2023)
Article
Rehabilitation
Thiago Araujo de Melo, Fernando Silva Guimaraes, Jose Roberto Lapa e Silva
Summary: This study found that gait speed, handgrip strength, and functional independence measure are strongly associated with acute readmission rates after ICU stay. These measures accurately predict unplanned readmission within 30 days, with each 0.1 m/s lower gait speed increasing the odds of readmission by 10%.
PHYSIOTHERAPY RESEARCH INTERNATIONAL
(2023)
Editorial Material
Critical Care Medicine
Jorge Salluh, Leticia Kawano-Dourado
INTENSIVE CARE MEDICINE
(2023)
Letter
Critical Care Medicine
Igor Tona Peres, Guilherme Fonseca Ferrari, Amanda Quintairos, Leonardo dos Santos Lourenco Bastos, Jorge Ibrain Figueira Salluh
INTENSIVE CARE MEDICINE
(2023)
Editorial Material
Medicine, General & Internal
Waasila Jassat, Luis Felipe Reyes, Daniel Munblit, Janice Caoili, Fernando Bozza, Madiha Hashmi, Michael Edelstein, Cheryl Cohen, Carlos A. Alvarez-Moreno, Bin Cao
Article
Medicine, General & Internal
Maria Carolina Paulino, Catarina Conceicao, Joana Silvestre, Maria Ines Lopes, Hernani Goncalves, Claudia Camila Dias, Rodrigo Serafim, Jorge I. F. Salluh, Pedro Povoa
Summary: Subsyndromal delirium (SSD) in the Intensive Care Unit (ICU) is associated with increased morbidity and unknown post-discharge functional and cognitive outcomes. A multicenter study found that early SSD patients experienced a decline in cognitive abilities at 3 months after discharge, but showed improvement at 6 months. Therefore, preventing and identifying SSD during ICU stays is crucial.
JOURNAL OF CLINICAL MEDICINE
(2023)