José Otávio Costa Auler

Background: The Vasoactive-Inotropic Score (VIS) quantifies pharmacological hemodynamic support after pediatric cardiac surgery, but bedside calculation requires multi-step manual arithmetic. We describe the development and preliminary evaluation of VISCalc, a low-cost web-based VIS calculator. Methods: VISCalc was developed in sequential phases in a pediatric cardiac intensive care unit in São Paulo, Brazil. Usability was assessed with the System Usability Scale (SUS) among 15 physicians. Arithmetic fidelity was verified in ten retrospective clinical cases independently calculated by three blinded evaluators and in 12 predefined synthetic cases covering all six VIS drugs. Results: The mean SUS score was 73.3 ± 8.5, indicating good usability. VISCalc returned the correct VIS in all ten clinical cases and 12 synthetic cases, whereas 29/30 manual calculations (96.7%) were correct. The tool stores successive VIS values and displays a time-course graph without requiring patient identification. Direct out-of-pocket expenses were below US$450. Conclusion: A structured, low-cost development process produced a bedside VIS calculator with good perceived usability and exact arithmetic fidelity. Its effects on calculation time, errors during routine use, and clinical outcomes should be evaluated prospectively.

Hemorrhagic shock (HS) leads to systemic hypoperfusion, impaired tissue oxygenation, and multi-organ dysfunction, including central nervous system (CNS) injury. Guanosine and inosine, purine nucleosides with neuroprotective and anti-inflammatory properties, have demonstrated beneficial effects in models of neurotoxicity, ischemia, and septic shock. This study evaluated the acute effects of guanosine and inosine in fluid resuscitation, focusing on brain energy metabolism, neuroinflammatory mechanisms, and hemodynamic responses in a porcine model of HS. Thirty pigs (25–30 kg) underwent controlled hemorrhage to achieve a target mean arterial pressure (MAP) of 40 – 45 mmHg, maintained for 60 min. Animals were randomized into three resuscitation groups: Lactated Ringer’s solution (LR), LR + guanosine (1 mmol/L), and LR + inosine (1 mmol/L), administered over 15 – 20 min. Hemodynamic, metabolic, and neuronal parameters were monitored for 440 min post-HS, with serial blood and cerebrospinal fluid (CSF) sampling to assess glutamate, lactate, glucose, neuron-specific enolase (NSE), and inflammatory cytokines. HS induced metabolic acidosis, increased CSF glutamate levels, and elevated proinflammatory cytokines (IL-1β, TNF-α, IFN-γ, IL-8). Guanosine and inosine reduced glutamate levels more rapidly than LR alone and attenuated IL-1β and TNF-α elevations. Inosine resuscitation improved MAP, systemic vascular resistance index (SVRI), and end-diastolic volume index (EDVI), suggesting enhanced hemodynamic stabilization. Guanosine and inosine modulated neuroinflammatory and metabolic responses in HS, reducing excitotoxicity and inflammatory cytokine release. Inosine also demonstrated hemodynamic benefits. These findings support further investigation into their therapeutic potential in shock resuscitation.

Resumo Fundamento: Pacientes submetidos à cirurgia cardíaca podem estar expostos à hipoperfusão tecidual e metabolismo anaeróbico. Objetivo: Verificar se os biomarcadores de hipoperfusão tecidual têm valor preditivo para permanência prolongada na Unidade de Terapia Intensiva (UTI) em pacientes com disfunção ventricular esquerda submetidos à cirurgia de bypass da artéria coronária. Métodos: Após aprovação pelo comitê de ética institucional e assinatura do termo de consentimento, 87 pacientes com disfunção ventricular esquerda (fração de ejeção Resumo Fundamento: Pacientes submetidos à cirurgia cardíaca podem estar expostos à hipoperfusão tecidual e metabolismo anaeróbico. Objetivo: Verificar se os biomarcadores de hipoperfusão tecidual têm valor preditivo para permanência prolongada na Unidade de Terapia Intensiva (UTI) em pacientes com disfunção ventricular esquerda submetidos à cirurgia de bypass da artéria coronária. Métodos: Após aprovação pelo comitê de ética institucional e assinatura do termo de consentimento, 87 pacientes com disfunção ventricular esquerda (fração de ejeção

Introdução A Síndrome Carcinoide (SC) é uma síndrome paraneoplásica frequentemente diagnosticada em pacientes com tumores neuroendócrinos (TNEs) associados com secreção de fatores humorais. Esses fatores incluem a serotonina (5-HT), a qual parece ser a substância mais comum associada à síndrome, além de histamina, calicreína, prostaglandinas e taquicininas. Entre os pacientes diagnosticados com TNEs localizados no duodeno e intestino delgado, cerca de 20% irão desenvolver SC durante o acompanahmento. A presença de SC está fortemente associada com maior grau e estágio [...] Introdução A Síndrome Carcinoide (SC) é uma síndrome paraneoplásica frequentemente diagnosticada em pacientes com tumores neuroendócrinos (TNEs) associados com secreção de fatores humorais. Esses fatores incluem a serotonina (5-HT), a qual parece ser a substância mais comum associada à síndrome, além de histamina, calicreína, prostaglandinas e taquicininas. Entre os pacientes diagnosticados com TNEs localizados no duodeno e intestino delgado, cerca de 20% irão desenvolver SC durante o acompanahmento. A presença de SC está fortemente associada com maior grau e estágio

The current pandemic of COVID-19 caused thousands of deaths and healthcare professionals struggle to properly manage infected patients. This review summarizes information about SARS-CoV-2 receptor binding dynamics and intricacies, lung autopsy findings, immune response patterns, evidence-based explanations for the immune response, and COVID-19-associated hypercoagulability.