The Physician Surprise Question in the Emergency Department: prospective cohort study.

Objectives: This study aims to test the ability of the surprise question (SQ), when asked to emergency physicians (EPs), to predict in-hospital mortality among adults admitted to an emergency room (ER).

Methods: This prospective cohort study at an academic medical centre included consecutive patients 18 years or older who received care in the ER and were subsequently admitted to the hospital from 20 April 2018 to 20 October 2018. EPs were required to answer the SQ for all patients who were being admitted to hospital.

Timing to Intubation COVID-19 Patients: Can We Put It Off until Tomorrow?

Background: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the association between intubation day and mortality in COVID-19 patients.

Methods: We performed a unicentric retrospective cohort study considering all COVID-19 patients consecutively admitted between March 2020 and August 2020 requiring invasive mechanical ventilation.

Use and misuse of biomarkers and the role of D-dimer and C-reactive protein in the management of COVID-19: A post-hoc analysis of a prospective cohort study.

Objective: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and these complications can lead to a poorer prognosis. This study aimed to evaluate the association and temporal trends of D-dimer and C-reactive protein (CRP) levels with the incidence of venous thromboembolism (VTE), hospital mortality, and costs among inpatients with COVID-19.

Reactive airways dysfunction syndrome following inhalation of hydrogen chloride vapor.

Hydrogen chloride is available commercially as an anhydrous gas or an aqueous solution, hydrochloric acid. Exposure to this gas has been associated with the development of reactive airways dysfunction syndrome. However, there are few published reports.

Lung ultrasound score predicts outcomes in COVID-19 patients admitted to the emergency department.

Background: During the COVID-19 pandemic, creating tools to assess disease severity is one of the most important aspects of reducing the burden on emergency departments. Lung ultrasound has a high accuracy for the diagnosis of pulmonary diseases; however, there are few prospective studies demonstrating that lung ultrasound can predict outcomes in COVID-19 patients. We hypothesized that lung ultrasound score (LUS) at hospital admission could predict outcomes of COVID-19 patients.

Awake Prone Positioning in COVID-19 Hypoxemic Respiratory Failure: Exploratory Findings in a Single-center Retrospective Cohort Study.

Background: Awake prone positioning has been widely used in patients with COVID-19 respiratory failure to avoid intubation despite limited evidence. Our objective was to evaluate if prone positioning is associated with a reduced intubation rate when compared to usual care.

Methods: This was a retrospective cohort study in the emergency department of a large quaternary hospital in Sao Paulo.

Double-blind, Randomized, Placebo-controlled Trial With N-acetylcysteine for Treatment of Severe Acute Respiratory Syndrome Caused by Coronavirus Disease 2019 (COVID-19).

Background: A local increase in angiotensin 2 after inactivation of angiotensin-converting enzyme 2 by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may induce a redox imbalance in alveolar epithelium cells, causing apoptosis, increased inflammation and, consequently, impaired gas exchange. We hypothesized that N-acetylcysteine (NAC) administration could restore this redox homeostasis and suppress unfavorable evolution in patients with coronavirus disease 2019 (COVID-19).

Methods: This was a double-blind, randomized, placebo-controlled, single-center trial conducted at the Emergency Department of Hospital das Clínicas, São Paulo, Brazil, to determine whether NAC in high doses can avoid respiratory failure in patients with COVID-19.

First-attempt intubation success and complications in patients with COVID-19 undergoing emergency intubation.

Objectives: To evaluate the first-attempt success rates and complications of endotracheal intubation of coronavirus disease 2019 (COVID-19) patients by emergency physicians.

Methods: This prospective observational study was conducted from March 24, 2020 through May 28, 2020 at the emergency department (ED) of an urban, academic trauma center. We enrolled patients consecutively admitted to the ED with suspected or confirmed COVID-19 submitted to endotracheal intubation.

Euglycemic Diabetic Ketoacidosis in Pregnancy.

The clinical presentation of diabetic ketoacidosis in pregnancy (DKP) is similar to that observed in nonpregnant women, although reports suggest the presenting blood glucose level may not be as high. It is hypothesized that lower, maternal fasting glucose levels are a result of both the fetus and the placenta consuming glucose. We report the case of a 38-year-old woman gravida 2, para 0, abortion 1 with type 1 diabetes who had euglycemic diabetic ketoacidosis and review the literature on DKP, with a focus on diagnosis, treatment, and monitoring of the mother and fetus.

Choline and Fructooligosaccharide: Non-alcoholic Fatty Liver Disease, Cardiac Fat Deposition, and Oxidative Stress Markers.

This study investigates the treatment of non-alcoholic fatty liver disease (NAFLD) in rats with choline and fructooligosaccharide (FOS). The healthy control group received standard diet. The other three groups consisted of animals with NAFLD.

Low educational status, smoking, and multidisciplinary team experience predict hospital length of stay after bariatric surgery.

Objective: The objective of the present study was to identify new risk factors associated with longer hospitalization following bariatric surgery.

Methods: Patient clinical, social, and biochemical data in addition to multidisciplinary team experience were analyzed in a cohort that included all patients undergoing bariatric surgery at our hospital. The primary outcome was length of hospital stay (LOS).

Doctorate in cardiology at FM-USP Heart Institute from 1994 through 2004: defense and publication.

Background: A study evaluated the relationship between the defense of dissertations and their publication within the realm of the entire Medical School of the University of São Paulo (FM-USP). The existence of differences among different areas of knowledge and the time between defense of dissertations and their publication is questioned.

Objective: To characterize publications related to dissertations defended in graduate courses of the Heart Institute (InCor) of the University of São Paulo Medical School (FM-USP).

A ventricular thrombus mimicking a tumour.

Primary cardiac tumours are a rare occurrence in clinical practice. Mural or pedunculated thrombi are other infrequent findings. These are usually associated with underlying heart disease, present in the left atrium or occupying aneurysms in the ventricular wall, usually the apex.

Refeeding syndrome, an undiagnosed and forgotten potentially fatal condition.

Refeeding syndrome (RFS) has been well described but is also a frequently forgotten and undiagnosed complication in clinical practice, which, if untreated, may lead to death. Patients who are more prone to developing RFS are those with at least one of the following conditions: BMI <16 kg/m(2), a recent unintentional weight loss >15%, very little nutritional intake for >10 days, and/or low plasma concentrations of potassium, phosphate or magnesium before feeding; and those with at least two of the following conditions: BMI <18.5 kg/m(2), a recent weight loss >10%, very little nutritional intake for >5 day, and/or a history of alcohol abuse or drug use, including insulin, chemotherapy or diuretics.

Specificity of modified Drosophila mariner transposons in the identification of Leishmania genes.

Genetic manipulation of the protozoan Leishmania has led to a better understanding of the survival and development of these pathogens within their hosts. The association of the Leishmania genome sequencing information with the ability of transposons to introduce or destroy phenotypes allows a global perspective on the role and importance of genes in cellular pathways. Herein we report the construction and testing of mariner transposable elements carrying the neomycin phosphotransferase, green fluorescent protein, or beta-glucuronidase genes as reporters for translational fusion events.