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COVID-19 is characterized by pronounced hypercytokinemia. The cytokine switch, marked by an imbalance between pro-inflammatory and anti-inflammatory cytokines, emerged as a focal point of investigation throughout the COVID-19 pandemic. However, the kinetics and temporal dynamics of cytokine release remain contradictory, making the development of new therapeutics difficult, especially in severe cases. This study collected serum samples from SARS-CoV-2 infected patients at 72 h intervals and monitored them for various cytokines at each timepoint until hospital discharge or death. Cytokine levels were analyzed based on time since symptom onset and patient outcomes. All cytokines studied prospectively were strong predictors of mortality, particularly IL-4 (AUC = 0.98) and IL-1β (AUC = 0.96). First-timepoint evaluations showed elevated cytokine levels in the mortality group (p < 0.001). Interestingly, IFN-γ levels decreased over time in the death group but increased in the survival group. Patients who died exhibited sustained levels of IL-1β and IL-4 and increased IL-6 levels over time. These findings suggest cytokine elevation is crucial in predicting COVID-19 mortality. The dynamic interplay between IFN-γ and IL-4 highlights the balance between Th1/Th2 immune responses and underscores IFN-γ as a powerful indicator of immune dysregulation throughout the infection. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer (BC) is the most common cancer among women globally. Vitamin D has been considered a protective factor; however, its relationship with any aspect of the disease remains controversial. Methods: A cross-sectional, single-center clinical study was conducted between 2015 and 2018, including 141 women diagnosed with BC and 239 women in the control group, with mean ages of 43.1 and 41.7 years, respectively (p = 0.103). Serum levels of vitamin D and lipid profile were measured. Clinical and nutritional data were obtained through interviews and medical records. Results: The vitamin D dosage presented an average value of 25.5 ng/mL and 31.0 ng/mL in the case and control groups, respectively (p < 0.001). The vitamin D cut-off point for discriminating the presence of BC was 27.45 ng/mL. Additionally, low-density lipoprotein cholesterol levels were higher in the case group (121.4 mg/dL) compared to the control group (110.7 mg/dL) (p = 0.002), whereas high-density lipoprotein cholesterol levels were lower in the case group (47.6 mg/dL) compared to the control group (53.3 mg/dL) (p = 0.001). Alcohol consumption was significantly higher in the case group than in the control group (2.7 vs. 5.3 doses/day; p < 0.001). Conclusion: The results indicate a significant association between lower vitamin D levels and BC, persisting after multivariate analysis (p < 0.001). These findings could inform prevention strategies, highlighting the importance of maintaining adequate vitamin D levels and potentially identifying a risk group. [ABSTRACT FROM AUTHOR]

The Coronavirus Disease 2019 (COVID-19) pandemic posed various challenges to the healthcare system and disease management. This study aimed to describe changes in the clinical characteristics and outcomes of hospitalized patients during the first year of the COVID-19 pandemic in a city in southern Brazil. This prospective study was carried out in two tertiary care private hospitals in Curitiba. A total of 1151 patients hospitalized between March 2020 and March 2021 were included. We identified three epidemiological critical periods of the pandemic and compared patients' characteristics and the frequencies of oral intubation, intensive care unit (ICU) admission and mortality. Continuous variables were analyzed by variance analysis model (ANOVA) or the Kruskal–Wallis nonparametric test and categorical variables by the chi-square or Fisher's exact test. Models for univariate and multivariate logistic regression analysis were adjusted to identify the factors associated with mortality. All p-values were two-tailed and p<0.05 was considered statistically significant. The average age of the patients was 58 years and 60.9% (n = 701) were males. The most prevalent comorbidities were systemic arterial hypertension, diabetes and obesity. There were no significant variations in the demographic characteristics and previous comorbidities of the patients for the different periods of analysis. Mortality was positively associated with the age ≥65 years and the presence of one or more cardiometabolic comorbidities (p<0.001). March 2021 was the most important critical period of the pandemic since there were higher frequencies of patients admitted later in the course of the disease, with desaturation and more symptoms at hospital admission (p<0.001). There was also an increase in the duration of hospital stay (p<0.001) and the frequencies of all critical outcomes for this period: oral intubation (p<0.001), ICU admission (p = 0.606) and mortality (p = 0.001). Our key findings revealed that, although there were no statistically significant differences between the subgroups of hospitalized patients over time in terms of demographic characteristics and comorbidities, the course of COVID-19 was significantly more severe for patients admitted to the hospital at the end of the first year of the pandemic in Brazil. [ABSTRACT FROM AUTHOR]

Objective: We published a list of "must-know" routine EEG (rEEG) findings for trainees based on expert opinion. Here, we studied the accuracy and inter-rater agreement (IRA) of these "must-know" rEEG findings among international experts., Methods: A previously validated online rEEG examination was disseminated to EEG experts. It consisted of a survey and 30 multiple-choice questions predicated on the previously published "must-know" rEEG findings divided into four domains: normal, abnormal, normal variants, and artifacts. Questions contained de-identified 10-20-s epochs of EEG that were considered unequivocal examples by five EEG experts., Results: The examination was completed by 258 international EEG experts. Overall mean accuracy and IRA (AC1) were 81% and substantial (0.632), respectively. The domain-specific mean accuracies and IRA were: 76%, moderate (0.558) (normal); 78%, moderate (0.575) (abnormal); 85%, substantial (0.678) (normal variants); 85%, substantial (0.740) (artifacts). Academic experts had a higher accuracy than private practice experts (82% vs. 77%; p = .035). Country-specific overall mean accuracies and IRA were: 92%, almost perfect (0.836) (U.S.); 86%, substantial (0.762) (Brazil); 79%, substantial (0.646) (Italy); and 72%, moderate (0.496) (India). In conclusion, collective expert accuracy and IRA of "must-know" rEEG findings are suboptimal and heterogeneous., Significance: We recommend the development and implementation of pragmatic, accessible, country-specific ways to measure and improve the expert accuracy and IRA., (© 2023 International League Against Epilepsy.)

Background: The extent of cardiac damage associated with aortic stenosis has important prognostic implications after transcatheter aortic valve replacement (TAVR). However, the role of tricuspid regurgitation (TR) in this clinical setting is still unclear., Objectives: To explore the association between TR and mortality in patients undergoing TAVR and assess changes in TR severity post TAVR and its relationship with short and mid-term mortality., Methods: Relevant databases were searched for articles published from inception until August 2020. Out of 414 screened studies, we selected 24 that reported the degree of TR pre or post TAVR. The primary outcome was all-cause mortality, and random effects meta-analysis models were conducted (at a significance level of 5%)., Results: Seventeen studies reported associations between pre-TAVR TR and all-cause mortality (> 45,000 participants) and thirteen accessed TR severity post TAVR (709 participants). Moderate/severe baseline TR was associated to higher all-cause mortality both at 30 days (HR 1.65; 95% CI, 1.20-2.29) and 1.2 years (HR 1.56; 95% CI, 1.31-1.84). After TAVR, 43% of patients presented a decrease of at least one grade in TR (30 days, 95% CI, 30-56%), sustained at 12.5 months in 44% of participants (95% CI, 35-52%). Persistence of significant TR was associated with a two-fold increase in all-cause mortality (HR 2.12; 95% CI, 1.53-2.92)., Conclusions: Significant TR pre TAVR is associated with higher mortality. Although TR severity may improve, the persistence of significant TR post TAVR is strongly associated with increased mortality. Our findings highlight the importance of a detailed assessment of TR pre and post TAVR and might help identify patients who may benefit from more careful surveillance in this scenario.

Objective: to assess the epidemiological profile of traffic accident victims in the setting of the Coronavirus Disease 2019 (COVID-19) pandemic and analyze the admissions throughout the different levels of restriction (flags), as well as compare the results with the pre-pandemic period., Methods: a cross-sectional study was performed, with probability sampling, in a trauma center in Brazil. Medical records of patients involved in traffic accidents from June 2020 to May 2021 were evaluated. Aside from epidemiological characteristics, variables such as the current flag, the trauma mechanism, the resulting injuries, and the Revised Trauma Score (RTS) were also considered. Data were compared between three different flag periods and the proportion of consultations during the pandemic was compared with that from pre-pandemic time (December 2016 to February 2018)., Results: it was observed that 62.2% of the patients were victims of motorcycle accidents, 77.5% were male, and the mean age was 33 ± 12.4 years. The mean and median RTS were 7.5 and 7.8, respectively. Statistical difference was stated when comparing the number of visits per day between the yellow and red flags (p=0.001) and orange and red flags (p=0.016). A significantly lower number of consultations for traffic accidents was observed in the pandemic when compared to the pre-pandemic period., Conclusions: the epidemiological profile of the study consisted mostly of young men who were victims of motorcycle accidents. There was a lower incidence of admissions during red flag periods and a lower proportion of consultations throughout the survey when compared to the pre-pandemic period.

Background: Reduction of LDL-cholesterol (LDL-c) levels is the cornerstone in risk reduction, but many high-risk patients are not achieving the recommended lipid goals, even in high-income countries., Objective: To evaluate whether patients seen in the city of Curitiba public health system are reaching LDL-c goals after an acute myocardial infarction (AMI)., Methods: This retrospective cohort explored the data of patients admitted with AMI between 2008 and 2015 in public hospitals from the city of Curitiba. In order to evaluate the attainment of the LDL-c target, we have used the last value registered in the database for each patient up to 2016. For those who had at least one LDL-c registered in the year before AMI, percentage of reduction was calculated. The level of significance adopted for statistical analysis was p<0.05., Results: Of 7,066 patients admitted for AMI, 1,451 were followed up in an out-patient setting and had at least one evaluation of LDL-c. Mean age was 60.8±11.4 years and 35.8%, 35.2%, 21.5%, and 7.4% of patients had LDL-c levels ≥100, 70-99, 50-69 and <50 mg/dL, respectively. Of these, 377 patients also had at least one LDL-c evaluation before the AMI. Mean LDL-c concentrations were 128.0 and 92.2 mg/dL before and after AMI, with a mean reduction of 24.3% (35.7 mg/dL). LDL-c levels were reduced by more than 50% in only 18.3% of the cases., Conclusion: In the city of Curitiba public health system patients, after myocardial infarction, are not achieving adequate LDL-c levels after AMI.