{"id":15390,"date":"2020-04-28T17:04:36","date_gmt":"2020-04-28T17:04:36","guid":{"rendered":"https:\/\/sbpt.org.br\/portal\/?p=15390"},"modified":"2020-04-28T17:04:36","modified_gmt":"2020-04-28T17:04:36","slug":"resumo-cientifico-covid-8","status":"publish","type":"post","link":"https:\/\/sbpt.org.br\/portal\/resumo-cientifico-covid-8\/","title":{"rendered":"COVID-19: resumos de artigos selecionados &#8211; parte 8"},"content":{"rendered":"<p style=\"text-align: justify\">Os artigos selecionados para resumo em 24\/04 tratam do dano alveolar difuso encontrado na necr\u00f3psia de pacientes com COVID-19, a&nbsp;patobiologia das tr\u00eas fases distintas do SARS-CoV-2 e sobre a possibilidade de acometimento do sistema nervoso central (SNC) pelo novo coronav\u00edrus.<\/p>\n<p style=\"text-align: justify\">Conte\u00fado oferecido com o apoio da GSK.<\/p>\n<p style=\"text-align: justify\"><a href=\"https:\/\/www.nature.com\/articles\/s41379-020-0536-x\" target=\"_blank\" rel=\"noopener\"><strong>Pathological study of the 2019 novel coronavirus disease (COVID-19) through postmortem core biopsies<\/strong><\/a><\/p>\n<p><strong>Resumo<\/strong><\/p>\n<p style=\"text-align: justify\">Os autores conduziram o presente estudo no Hospital Zhongnan da Universidade de Wuhan, China. Conforme salientado por este grupo de pesquisadores, h\u00e1 escassez de estudos envolvendo necropsias de pacientes falecidos por COVID-19. Por isso, foram realizadas <em>core<\/em> bi\u00f3psias <em>post mortem<\/em> de f\u00edgado, pulm\u00f5es e cora\u00e7\u00e3o em 4 pacientes com diagn\u00f3stico de COVID 19 que tiveram desfechos fatais. As principais observa\u00e7\u00f5es foram:<\/p>\n<ul style=\"text-align: justify\">\n<li>Os 4 pacientes falecidos (idades entre 59 e 81 anos) eram portadores de comorbidades, sendo que cada um apresentava ao menos uma das seguintes condi\u00e7\u00f5es: leucemia linfoc\u00edtica cr\u00f4nica (LLC), rim transplantado, cirrose, hipertens\u00e3o e diabetes.<\/li>\n<li>Todos os pacientes apresentavam pneumonia bilateral caracterizadas tomograficamente por infiltrados em vidro fosco. Nas avalia\u00e7\u00f5es por imagens pr\u00f3ximas aos \u00f3bitos consolida\u00e7\u00f5es passaram a ser visualizadas.<\/li>\n<li>As imagens em vidro fosco na tomografia de t\u00f3rax representam a fase exsudativa inicial da pneumonia pela COVID-19.<\/li>\n<li>Aspecto comum a todos os pacientes foram as manifesta\u00e7\u00f5es de <u>dano alveolar difuso<\/u>. Altera\u00e7\u00f5es relacionadas a este diagn\u00f3stico histopatol\u00f3gico se basearam no encontro de membrana hialina, exsudatos com fibrina, les\u00e3o epitelial e hiperplasia de pneum\u00f3citos tipo II. No caso com danos mais avan\u00e7ados detectou-se hemorragia alveolar, necrose fibrin\u00f3ide em pequenos vasos, al\u00e9m de sinais inflamat\u00f3rios sugestivos de broncopneumonia bacteriana associada.<\/li>\n<li>A pesquisa de coronav\u00edrus por RT-PCR foi positiva em alguns pacientes no cora\u00e7\u00e3o, f\u00edgado e pulm\u00e3o, n\u00e3o obrigatoriamente encontrada de forma simult\u00e2nea.<\/li>\n<li><em>Core<\/em> bi\u00f3psia do cora\u00e7\u00e3o foi obtida somente em dois pacientes, tendo sido encontrada discreta fibrose focal e leve hipertrofia mioc\u00e1rdica, achados possivelmente ocasionados pelas doen\u00e7as de base.<\/li>\n<li>O f\u00edgado apresentou dilata\u00e7\u00e3o sinusoidal leve, achado inespec\u00edfico em pacientes gravemente enfermos nos estados terminais. Demais altera\u00e7\u00f5es foram atribu\u00eddas \u00e0s doen\u00e7as pr\u00e9vias de cada caso.<\/li>\n<\/ul>\n<p style=\"text-align: justify\">Os autores conclu\u00edram que o achado pulmonar principal \u00e9 dano alveolar difuso, sem fibrose pulmonar nos casos analisados. E que novos estudos com maior n\u00famero de pacientes s\u00e3o necess\u00e1rios para o alcance de entendimento mais amplo sobre a patog\u00eanese da COVID-19.<\/p>\n<p style=\"text-align: justify\"><strong>Refer\u00eancia:<\/strong><\/p>\n<ol>\n<li style=\"text-align: justify\">TIAN, S. Pathological study of the 2019 novel coronavirus disease (COVID-19) through postmortem core biopsies. Modern Pathology Apr 14, 2020 Mar 30. org\/10.1038\/s41379-020-0536-x.<\/li>\n<\/ol>\n<p><a href=\"https:\/\/www.nature.com\/articles\/s41379-020-0536-x\" target=\"_blank\" rel=\"noopener\">Clique aqui para ler o artigo na \u00edntegra<\/a>.<\/p>\n<hr>\n<p style=\"text-align: justify\"><a href=\"https:\/\/erj.ersjournals.com\/content\/55\/4\/2000607\" target=\"_blank\" rel=\"noopener\"><strong>PATHOGENESIS OF COVID-19 FROM A PATHOBIOLOGIC PERSPECTIVE.<\/strong><\/a><\/p>\n<p style=\"text-align: justify\"><strong>Resumo<\/strong><\/p>\n<p style=\"text-align: justify\">O artigo publicado na ERJ em abril de 2020 descreve a patobiologia das 3 distintas fases do SARS-CoV-2, como veremos a seguir:<\/p>\n<p style=\"text-align: justify\"><strong>Fase 1<\/strong>: Assintom\u00e1tica (1-2 dias iniciais)<\/p>\n<ul style=\"text-align: justify\">\n<li>O v\u00edrus SARS-CoV-2 aparentemente se liga \u00e0s c\u00e9lulas epiteliais da cavidade nasal e inicia sua replica\u00e7\u00e3o atrav\u00e9s da liga\u00e7\u00e3o ao receptor ACE2.<\/li>\n<li>H\u00e1 propaga\u00e7\u00e3o viral local, por\u00e9m a resposta imune inata \u00e9 limitada.<\/li>\n<li>Pode ser detectado pelo Swab nasal.<\/li>\n<li>Carga viral baixa, por\u00e9m s\u00e3o pacientes infectantes.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Fase 2<\/strong>: Resposta das vias a\u00e9reas superiores e vias a\u00e9reas condutoras (pr\u00f3ximos dias subsequentes)<\/p>\n<ul style=\"text-align: justify\">\n<li>O v\u00edrus migra para as vias a\u00e9reas condutoras e come\u00e7a a resposta imune inata mais robusta.<\/li>\n<li>Detec\u00e7\u00e3o por Swab nasal, escarro e marcadores da resposta inata.<\/li>\n<li>A doen\u00e7a j\u00e1 \u00e9 clinicamente manifesta.<\/li>\n<li>80% dos indiv\u00edduos contaminados manifestar\u00e3o a forma leve da doen\u00e7a, e poder\u00e3o ser tratados em casa, com sintom\u00e1ticos.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Fase 3: <\/strong>Hip\u00f3xia, opacidades tipo vidro fosco e progress\u00e3o para S\u00edndrome de Ang\u00fastia Respirat\u00f3ria Aguda (SARA).<\/p>\n<ul style=\"text-align: justify\">\n<li>20% dos indiv\u00edduos ter\u00e3o infiltrado pulmonar e progredir\u00e3o para esta fase.<\/li>\n<li>Aproximadamente 2-5% ter\u00e3o doen\u00e7a muito grave.<\/li>\n<li>O v\u00edrus agora chega \u00e0s unidades de troca gasosa, infectando e destruindo os Pneum\u00f3citos tipo II, geralmente nas \u00e1reas perif\u00e9ricas e subpleurais.<\/li>\n<li>O resultado \u00e9 Dano Alveolar Difuso (DAD), com forma\u00e7\u00e3o de membrana hialina rica em fibrina levando a um ciclo de dano\/reparo aberrante podendo culminar em fibrose mais rapidamente que outras formas de SARA.<\/li>\n<li>A recupera\u00e7\u00e3o exigir\u00e1 vigorosa resposta imune inata e adquirida e regenera\u00e7\u00e3o epitelial.<\/li>\n<\/ul>\n<p style=\"text-align: justify\">Refer\u00eancia:<\/p>\n<ol style=\"text-align: justify\">\n<li style=\"text-align: justify\">MASON, R.J. et. al. PATHOGENESIS O COVID-19 FROM A PATHOBIOLOGIC PERSPECTIVE. Eur Respir J 2020; in press. doi.org\/10.1183\/13993003.00607-2020<\/li>\n<\/ol>\n<p style=\"text-align: justify\"><a href=\"https:\/\/erj.ersjournals.com\/content\/55\/4\/2000607\" target=\"_blank\" rel=\"noopener\">Clique aqui para ler o artigo na \u00edntegra.<\/a><\/p>\n<hr>\n<p style=\"text-align: justify\"><a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1002\/jmv.25728\" target=\"_blank\" rel=\"noopener\"><strong>The neuroinvasive potential of SARS<\/strong><strong>\u2010<\/strong><strong>CoV-2 may play a role&nbsp;<\/strong><strong>in the respiratory failure of COVID<\/strong><strong>\u2010<\/strong><strong>19 patients<\/strong><\/a><\/p>\n<p style=\"text-align: justify\"><strong>Resumo<\/strong><\/p>\n<p style=\"text-align: justify\">Os autores desse artigo de revis\u00e3o alertam para a possibilidade de acometimento do sistema nervoso central (SNC) pelo SARS-CoV-2, fundamentada nas manifesta\u00e7\u00f5es cl\u00ednicas compat\u00edveis e analogia com estudos pr\u00e9vios com o SARS-CoV e MERS-CoV. Seguem as principais considera\u00e7\u00f5es:<\/p>\n<ul style=\"text-align: justify\">\n<li>An\u00e1lise gen\u00f4mica mostra que o SARS-CoV-2 tem a ancestralidade dos \u00dfcoronavirus (assim como MERS-CoV e SARS-CoV) e compartilha sequ\u00eancia altamente hom\u00f3loga com a SARS-CoV.<\/li>\n<li>Pacientes com COVID-19 podem apresentar manifesta\u00e7\u00f5es cl\u00ednicas compat\u00edveis com envolvimento neurol\u00f3gico, como cefaleia, n\u00e1useas, v\u00f4mitos e rebaixamento do n\u00edvel de consci\u00eancia.<\/li>\n<li>Estudos anteriores com SARS-CoV e MERS-CoV mostraram acometimento do c\u00e9rebro e tronco cerebral.<\/li>\n<li>Alguns coronav\u00edrus t\u00eam capacidade de dissemina\u00e7\u00e3o neuronal, via conex\u00f5es sin\u00e1pticas, para o centro cardiorespirat\u00f3rio medular, advindos de mecanoreceptores e quimiorreceptores dos pulm\u00f5es e vias a\u00e9reas perif\u00e9ricas. Esta manifesta\u00e7\u00e3o pode danificar o centro respirat\u00f3rio medular e comprometer o controle ventilat\u00f3rio.<\/li>\n<li>Considerando-se a similaridade entre SARS-Cov e SARS-CoV-2, alerta-se para o acometimento do SNC no COVID-19 que pode, decorrente da disfun\u00e7\u00e3o do controle ventilat\u00f3rio neuronal, tornar mais desfavor\u00e1vel a evolu\u00e7\u00e3o da insufici\u00eancia respirat\u00f3ria.<\/li>\n<li>Estima-se ser de 8 dias a mediana de lat\u00eancia entre o in\u00edcio dos sintomas da COVID-19 e o desenvolvimento da insufici\u00eancia respirat\u00f3ria com indica\u00e7\u00e3o de UTI. Esse per\u00edodo seria suficiente para a invas\u00e3o do SNC.<\/li>\n<li>Observa\u00e7\u00f5es recentes relatam doen\u00e7a cerebrovascular e deteriora\u00e7\u00e3o do n\u00edvel de consci\u00eancia, em pacientes com formas graves da COVID-19.<\/li>\n<\/ul>\n<p style=\"text-align: justify\">Refer\u00eancia:<\/p>\n<ol style=\"text-align: justify\">\n<li>YAN\u2010CHAO, LI. Et al. The neuroinvasive potential of SARS\u2010CoV-2 may play a role in the respiratory failure of COVID\u201019 patients. J Med Virol. 2020;1\u20134. https:\/\/doi.org\/10.1002\/jmv.25728, Accepted: 24 February 2020 DOI: 10.1002\/jmv.25728.<\/li>\n<\/ol>\n<p><a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1002\/jmv.25728\" target=\"_blank\" rel=\"noopener\">Clique aqui para ler o artigo na \u00edntegra.<\/a><\/p>\n<hr>\n<p style=\"text-align: center\">Apoio:<\/p>\n<p><a href=\"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/11\/GSK_LOS_PORTUGUESE_RGB.png\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-11208\" src=\"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/11\/GSK_LOS_PORTUGUESE_RGB-300x264.png\" alt=\"\" width=\"75\" height=\"66\" srcset=\"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/11\/GSK_LOS_PORTUGUESE_RGB-300x264.png 300w, https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt-portal\/wp-content\/uploads\/2018\/11\/GSK_LOS_PORTUGUESE_RGB.png 403w\" sizes=\"auto, (max-width: 75px) 100vw, 75px\" \/><\/a><\/p>\n<!-- AddThis Advanced Settings generic via filter on the_content --><!-- AddThis Share Buttons generic via filter on the_content -->","protected":false},"excerpt":{"rendered":"<p>Os artigos selecionados para resumo em 24\/04 tratam do dano alveolar difuso encontrado na necr\u00f3psia de pacientes com COVID-19, a&nbsp;patobiologia das tr\u00eas fases distintas do SARS-CoV-2 e sobre a possibilidade de acometimento do sistema nervoso central (SNC) pelo novo coronav\u00edrus. Conte\u00fado oferecido com o apoio da GSK. Pathological study of the 2019 novel coronavirus disease [&hellip;]<!-- AddThis Advanced Settings generic via filter on get_the_excerpt --><!-- AddThis Share Buttons generic via filter on get_the_excerpt --><\/p>\n","protected":false},"author":3,"featured_media":15145,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"ngg_post_thumbnail":0,"footnotes":""},"categories":[68],"tags":[117,118,155,778],"class_list":["post-15390","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-noticias","tag-coronavirus","tag-covid-19","tag-gsk","tag-sars-cov-2"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>COVID-19: resumos de artigos selecionados - parte 8<\/title>\n<meta name=\"description\" content=\"Os artigos selecionados para resumo em 24\/04 tratam do dano alveolar difuso encontrado na necr\u00f3psia de pacientes com COVID-19, a\u00a0patobiologia das tr\u00eas fases distintas do SARS-CoV-2 e sobre a possibilidade de acometimento do sistema nervoso central (SNC) pelo novo coronav\u00edrus.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/sbpt.org.br\/portal\/resumo-cientifico-covid-8\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"COVID-19: resumos de artigos selecionados - parte 8\" \/>\n<meta property=\"og:description\" content=\"Os artigos selecionados para resumo em 24\/04 tratam do dano alveolar difuso encontrado na necr\u00f3psia de pacientes com COVID-19, a\u00a0patobiologia das tr\u00eas fases distintas do SARS-CoV-2 e sobre a possibilidade de acometimento do sistema nervoso central (SNC) pelo novo coronav\u00edrus.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/sbpt.org.br\/portal\/resumo-cientifico-covid-8\/\" \/>\n<meta property=\"og:site_name\" content=\"sbpt.org.br\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/pneumosbpt\" \/>\n<meta property=\"article:published_time\" content=\"2020-04-28T17:04:36+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/sbpt.org.br\/portal\/wp-content\/uploads\/2020\/04\/covid-destaque.png\" \/>\n\t<meta property=\"og:image:width\" content=\"350\" \/>\n\t<meta property=\"og:image:height\" content=\"255\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"Comunica\u00e7\u00e3o SBPT\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pneumosbpt\" \/>\n<meta name=\"twitter:site\" content=\"@pneumosbpt\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Comunica\u00e7\u00e3o SBPT\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. tempo de leitura\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/resumo-cientifico-covid-8\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/resumo-cientifico-covid-8\\\/\"},\"author\":{\"name\":\"Comunica\u00e7\u00e3o SBPT\",\"@id\":\"https:\\\/\\\/sbpt.org.br\\\/portal\\\/#\\\/schema\\\/person\\\/adba7f33cf32721354590c6f0eb852d4\"},\"headline\":\"COVID-19: resumos de artigos selecionados &#8211; 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