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Patients with Severe Acute Respiratory Syndrome due to COVID-19 in an emergency department

Abstract

The current Covid-19 pandemic has affected more than 920,000 people and killed more than 46,000 worldwide. Most affected patients have a mild condition, but a small percentage, from the percentage point of view, but large in absolute numbers, may have a severe acute respiratory syndrome (SARS), with fever, cough, pulmonary infiltrates and hypoxemia, and may progress for respiratory failure and need for mechanical ventilation. The Emergency Service of Hospital das Clínicas, Faculty of Medicine, University of São Paulo (HCFMUSP) is the current reference center for the treatment of patients with the most severe form of the disease. Our team is responsible for the initial care of these patients and, therefore, is well positioned to produce the knowledge necessary for a better understanding and treatment of this disease. In this way, we created this project, which consists of four subprojects. The first subproject aims to determine whether serum markers of the inflammatory response can predict, individually or in combination, the evolution of patients with SARS by Covid-19 for respiratory failure. The second seeks to determine whether pulmonary ultrasound is a viable alternative for assessing respiratory function in these patients. The third is a clinical trial with a drug already used in other clinical situations and which may be useful in preventing respiratory failure in patients with Covid-19 pneumonia. Finally, the fourth focuses on statistical and stochastic models, which can improve and guide the care of these patients. The study will be conducted at the Emergency Service of HCFMUSP, which is the gateway to the vast majority of patients with SARS by Covid-19. Patients with severe acute respiratory syndrome who do not require mechanical ventilation at admission will be included. In subprojects 1 and 2, these patients will only be followed up, without intervention, performing laboratory and ultrasound exams. In subproject 3, patients will be divided into two groups, one receiving NAC and the other placebo. In all three subprojects, the outcome will be mortality and the need for mechanical ventilation.In this pandemic moment, the search for a better understanding of the disease and treatments that can reduce the need for mechanical ventilation in these patients is extremely urgent and these are exactly the objectives of our project. (AU)

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Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
SAAD MENEZES, MARIA CLARA; MULLER VEIGA, ALICIA DUDY; DE LIMA, THAIS MARTINS; KUBO ARIGA, SUELY KUNIMI; BARBEIRO, HERMES VIEIRA; MOREIRA, CLAUDIA DE LUCENA; SARDINHA PINTO, AGNES ARAUJO; BRANDAO, RODRIGO ANTONIO; MARCHINI, JULIO FLAVIO; ALENCAR, JULIO CESAR; MARINO, LUCAS OLIVEIRA; GOMEZ, LUZ MARINA; SARAIVA CAMARA, NIELS OLSEN; SOUZA, HERALDO P. Lower peripheral blood Toll-like receptor 3 expression is associated with an unfavorable outcome in severe COVID-19 patients. SCIENTIFIC REPORTS, v. 11, n. 1 JUL 27 2021. Web of Science Citations: 0.
NETO, FELIPPE LAZAR; MARINO, LUCAS OLIVEIRA; TORRES, ANTONI; CILLONIZ, CATIA; MEIRELLES MARCHINI, JULIO FLAVIO; GARCIA DE ALENCAR, JULIO CESAR; PALOMEQUE, ANDREA; ALBACAR, NURIA; BRANDAO NETO, RODRIGO ANTONIO; SOUZA, HERALDO POSSOLO; RANZANI, OTAVIO T.; TEAM, COVID REGISTRY. Community-acquired pneumonia severity assessment tools in patients hospitalized with COVID-19: a validation and clinical applicability study. Clinical Microbiology and Infection, v. 27, n. 7 JUL 2021. Web of Science Citations: 1.
GARCIA DE ALENCAR, JULIO CESAR; MOREIRA, CLAUDIA DE LUCENA; MULLER, ALICIA DUDY; CHAVES, CLEUBER ESTEVES; FUKUHARA, MARINA AKEMI; DA SILVA, ELIZABETH APARECIDA; SILVA MIYAMOTO, MARIA DE FATIMA; PINTO, VANUSA BARBOSA; BUENO, CAUE GASPAROTTO; LAZAR NETO, FELIPPE; GOMEZ, LUZ MARINA GOMEZ; SAAD MENEZES, MARIA CLARA; MEIRELLES MARCHINI, JULIO FLAVIO; MARINO, LUCAS OLIVEIRA; BRANDAO NETO, RODRIGO ANTONIO; SOUZA, HERALDO POSSOLO; GRP, COVID REGISTER. Double-blind, Randomized, Placebo-controlled Trial With N-acetylcysteine for Treatment of Severe Acute Respiratory Syndrome Caused by Coronavirus Disease 2019 (COVID-19). Clinical Infectious Diseases, v. 72, n. 11, p. E736-E741, JUN 1 2021. Web of Science Citations: 6.

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