Prevalence of Coronavirus Disease 2019 in the Brain-Dead Candidates for Transplantation and Uncommon Manifestations of the Infection

2021 ◽  
Vol 17 ◽  
Author(s):  
Mohsen Aliakbarian ◽  
Rozita Khodashahi ◽  
Atefe Vakilian ◽  
Hamid Reza Naderi ◽  
Mandana Khodashahi ◽  
...  
Keyword(s):  
Brain Death ◽  
Laboratory Data ◽  
Clinical Information ◽  
Demographic Characteristics ◽  
Significant Difference ◽  
High Prevalence ◽  
Brain Dead ◽  
The Brain ◽  
Test Result ◽  
Pcr Test

Aim: This study aimed to evaluate the prevalence of Coronavirus Disease 2019 (COVID-19) positive cases meeting clinical brain death criteria; moreover, it was attempted to assess the uncommon manifestations of the infection in this study. Materials and Methods: This retrospective observational study was conducted on all brain-dead patients who were referred to the emergency department of hospitals in Mashhad, Iran, from February to October 2020. The demographic characteristics, clinical information, and laboratory data were collected and recorded in a researcher-made checklist. Results: In general, 70 patients were included in this study. The PCR test result was positive for COVID-19 in 54% of the patients, and syncope was reported in 16.1% of the cases (n=10). Furthermore, the majority of the patients (52.9%) showed central nervous system (CNS) hemorrhagic manifestations. A comparison was made between the patients with positive and negative PCR test result in terms of syncope; accordingly, there was a significant difference between them in this regard (χ2=4.5; P=0.03). The CNS hemorrhagic manifestations were significantly higher in patients with positive PCR compared to those with negative PCR (χ2=4.57, P=0.03). Moreover, the grand glass opacity and pleural effusion were the most common findings of the chest computed tomography in brain-dead patients with COVID-19. Conclusion: Due to the high prevalence of COVID-19 among brain-dead patients, it seems that syncope attack should be regarded as one of the possible symptoms of COVID-19. Moreover, syncope as a result of COVID-19 may itself cause traumatic events. It is worth mentioning that CNS hemorrhagic manifestations have been reported in more than half of the patients with brain death.

Plasma profiles of IL-6-like and TNF-like activities in brain-dead dogs

1991 ◽  
Vol 261 (5) ◽  
pp. R1133-R1140
Author(s):  
T. S. Huber ◽  
M. J. Kluger ◽  
S. P. Harris ◽  
L. G. D'Alecy
Keyword(s):  
Arterial Pressure ◽  
Brain Death ◽  
Operative Procedure ◽  
Systolic Arterial Pressure ◽  
Treated Group ◽  
Significant Elevation ◽  
Lps Challenge ◽  
Significant Difference ◽  
Brain Dead ◽  
The Brain

The progression to somatic death after brain death is poorly understood. The role of tumor necrosis factor (TNF) and interleukin-6 (IL-6) in this progression is unknown. TNF-like and IL-6-like plasma activities were assayed in a canine model of brain death in the presence and absence of a lipopolysaccharide (LPS) challenge (0.22 micrograms/kg). Bioassays for TNF-like and IL-6-like activities used WEHI and B9 cell lines, respectively. Brain death was induced by elevating and maintaining intracranial pressure above systolic arterial pressure. Anesthesia and the operative procedure did not cause a significant increase of either cytokine. Brain death (n = 8) itself did not cause a significant elevation of either cytokine compared with the sham brain-death control (n = 6) despite a significant decrease in mean arterial pressure (35 +/- 3 vs. 115 +/- 5 mmHg at 5 h). The brain-dead group treated with LPS (n = 6) responded with a significant elevation in IL-6-like and TNF-like activities compared with the vehicle-treated group. The rise of IL-6-like activity in response to LPS was greater in the brain-dead group than in the sham brain-dead group (n = 3); no significant difference was noted for the TNF-like response. We conclude that the progression to somatic death after brain death cannot be explained by increases in circulating TNF-like or IL-6-like activities.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Clinical motivation for31P MRS studies on the myocardial energy metabolism of brain dead cats

2003 ◽  
Vol 17 (2-3) ◽  
pp. 503-510
Author(s):  
G. J. Brandon Bravo Bruinsma ◽  
C. J. A. Van Echteld
Keyword(s):  
Energy Metabolism ◽  
Brain Death ◽  
Hemodynamic Instability ◽  
High Energy ◽  
Exclusion Criterion ◽  
High Energy Phosphates ◽  
Myocardial Energy Metabolism ◽  
Brain Dead ◽  
The Brain ◽  
Death Group

Hemodynamic instability of the brain dead potential heart donor is an exclusion criterion for heart donation for transplantation. Based on the results of myocardial biopsies it has been reported that brain death-related catecholamine induced damage of the heart causes depletion of high-energy phosphates which could explain contractile dysfunction. Our group has shown in a series of31P MRS experiments in cats that neither the onset of brain death, nor the hemodynamic deterioration which follows, nor its treatment with high dosages of dopamine affect the heart energetically as expressed by PCr/ATP ratios. However, after cardioplegic arrest and explantation, an initial and prolonged lower ATP content and an anomalous higher PCr/ATP ratio in the brain death group was found when compared with controls during long-term unperfused cold storage of the hearts. During subsequent reperfusion of the hearts, ATP and PCr levels in the brain death group were lower than in controls but equal partial recovery of PCr/ATP ratios was observed in both groups. It was concluded that PCr/ATP ratios need to be interpreted with great caution. Secondly, brain death-related hemodynamic instability is not related to significant changes of myocardial energy metabolism. Thirdly, brain death does affect the myocardial energy metabolism but the impact became apparent only during hypothermic storage and subsequent reperfusion of the donor heart.

Challenges to the Determination of Death by Neurological Criteria

2019 ◽  
Vol 19 (4) ◽  
pp. 583-599
Author(s):  
Tadeusz Pacholczyk ◽  
Stephen Hannan ◽  
Keyword(s):  
Brain Death ◽  
Determination Of Death ◽  
Ethical Concerns ◽  
Diagnostic Practices ◽  
Testing Potential ◽  
Brain Dead ◽  
Testing Protocols ◽  
The Brain ◽  
Apnea Testing

Ethical concerns regarding the conceptual framework for the determination of death by neurological criteria, including several clinical and diagnostic practices, are addressed. The significance of a diagnosis of brain death, diagnostic criteria, and certain technical aspects of the brain-death exam are presented. Standard and ancillary tests that typically help achieve prudential certitude that an individual has died are indicated. Ethical concerns surrounding interinstitutional variability of testing protocols are evaluated and considered, as are potential apnea-testing confounders such as hypotension, hypoxemia, hypercarbia, and penumbra effects during ancillary testing. Potential adjustments to apnea-testing protocols involving capnography, thoracic impedance monitors, or spirometers to assess respiratory efforts are discussed. Situations in which individuals determined to be brain dead “wake up,” or fail to manifest the imminent cessation of somatic functioning typically seen when supported only by a ventilator, are also briefly reviewed.

scholarly journals MO858BIOCHEMICAL CHARACTERIZATION AND SURVIVAL OF PATIENTS URGENT-START HEMODIALYSIS DURING COVID-19 PANDEMIC: EXPERIENCE IN A GUATEMALAN CENTER

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Celso Mazariegos ◽  
José Vicente Sánchez Polo
Keyword(s):  
Vascular Access ◽  
Prognostic Markers ◽  
Laboratory Data ◽  
World Health ◽  
Future Studies ◽  
Kaplan Meier ◽  
High Fatality Rate ◽  
Significant Difference ◽  
Test Result

Abstract Background and Aims The Coronavirus Disease 2019 (COVID-19) pandemic has greatly impacted the world health system, affecting almost 20 million people with a high fatality rate, mainly patients with comorbidities including patients with chronic kidney disease (CKD) in all its stages and renal replacement therapy. The aim of the present study was to evaluate the biochemical characteristics of the patients who urgent-start hemodialysis during the pandemic and additionally to evaluate their survival. Method Patients urgent-start hemodialysis were taken during the months of August to November 2020, the admission laboratory data was recorded, including the test to determine SarsCov-2, and Kaplan-Meier survival analysis was applied taking in it counts variables such as sex, professional who placed the vascular access, COVID-19 test result and evaluation by nephrology in the pre-dialysis clinic. Results 92 patients were including in the analysis, 65% male, the nephrologist placed the vascular access in 54% of the patients, 71% had a negative result in the COVID-19 test and 55% had no evaluation in the pre-dialysis clinic. Among the biochemical results was found BUN 95.3mg/dl (SD 38.1), sCr 10.3mg/dl (SD 6.3), Na 130.6mg/dl (SD 7.5), K 5mmol/L (SD 1.1), Ca 7.8mg/dl (SD 1), P 6.5mg/dl (SD 3.3), uric acid 8.3mg/dl (SD 10) and PTH 279pg/ml (SD 267). As prognostic markers of infection by COVID-19, the following results were found WC 12.3k/UL (SD 9.3), hemoglobin 9.35g/dl (SD 2.5), hematocrit 28.7% (SD 9.4), platelets 291mcL (SD 137), sedimentation 75mm/hr. (SD 37), CRP 81.8mg/L (SD 113.8), interleukin-6 232-6pg/ml (SD 838.8), ferritin 1074.3mg/ml (SD 825.3), D dimer 4.3mcg/dl (SD 11.2), lactate dehydrogenase 322U/L (SD 255) and procalcitonin 6.5ng/ml (SD 16.8). When evaluating survival with the Kaplan-Meier analysis, no statistically significant difference was found when analyzing the variable presence of COVID-19 infection (Figure 2 - p: 0.89), sex (Figure 3 - p: 0.54), professional who placed vascular access (Figure 4 - p: 0.1), and the pre-dialysis evaluation (Figure 5 - p: 0.33), having a survival in general of 77% at 3 months (Figure 1). Conclusion The present study found a 77% survival rate in patients with urgent-start hemodialysis. There are no other documented data in Guatemala, which is why it provides guidelines for future studies in the country. Among the variables taken, no one was found that would determine a better survival, including SarsCov-2 infection. It will be necessary to carry out more studies with greater follow-up, more patients and more centers to carry out a better analysis.

scholarly journals Clinical and subclinical characteristics of brain-dead donors for liver transplantation in Viet Duc University Hospital

2021 ◽  
Vol 63 (4) ◽  
pp. 36-41
Author(s):  
Thanh Khiem Nguyen ◽  
◽  
Hong Son Trinh ◽  
Gia Anh Pham ◽  
Ham Hoi Nguyen ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Complete Blood Count ◽  
University Hospital ◽  
Standard Group ◽  
Electrolyte Disorders ◽  
Significant Difference ◽  
Liver Procurement ◽  
Brain Dead ◽  
Time Of Admission ◽  
The Brain

Since 2010, 49 cases of liver transplants from brain-dead donors were performed at Viet Duc University Hospital. This study is a descriptive cross-section cohort study with a combined analysis of retrospective and prospective occurrences of a series of cases of liver procurement from brain-dead donors in Viet Duc University Hospital from March 2010 to March 2020. The results of this study showed several features: the average age of the brain-dead donors was 29.8±10.9 (18-69), donors were mostly male (7.17/1, 87.8%), and the main cause of brain death was head trauma. Clinically, 40.8 and 63.3% of the subjects were hypothermic and diagnosed with diabetes insipidus, however, the subjects were all well resuscitated before procurement. Therefore, haemodynamic indices and temperatures were maintained at stable levels and there was no statistically significant difference. In subclinical aspects, haemoglobin and platelet levels decreased significantly but remained within the target criteria during resuscitation while blood sodium levels increased significantly during resuscitation when compared with levels at the time of admission (p<0.001) thus corresponding to diabetes insipidus. In general, 44.90% of donors were within the ideal standard, and in the extended standard group, the highest rate was electrolyte disorders (32.65%). In conclusion, there are many variations in clinical and paraclinical body signs as well as homeostasis in the brain-dead donors. Of these signs, the most prominent were changes in haemodynamics, temperature, urine output, complete blood count, blood clotting, and blood sodium levels. These are all factors that are included in the criteria to consider the selection of a liver donor.

Medicine, Technology, and Religion Reconsidered: The Case of Brain Death Definition in Israel

2018 ◽  
Vol 44 (2) ◽  
pp. 186-208 ◽  
Author(s):  
Sky Edith Gross ◽  
Shai Lavi ◽  
Hagai Boas
Keyword(s):  
Brain Death ◽  
Scientific Community ◽  
Ethical Considerations ◽  
Medical Expertise ◽  
Religious Doctrine ◽  
Scientific Rhetoric ◽  
Truth Claims ◽  
Brain Dead ◽  
Scientific Ethos ◽  
The Brain

The introduction of respiratory machines in the 1950s may have saved the lives of many, but it also challenged the notion of death itself. This development endowed “machines” with the power to form a unique ontological creature: a live body with a “dead” brain. While technology may be blamed for complicating things in the first place, it is also called on to solve the resulting quandaries. Indeed, it is not the birth of the “brain-dead” that concerns us most, but rather its association with a web of epistemological and ethical considerations, where technology plays a central role. The brain death debate in Israel introduces highly sophisticated religious thought and authoritative medical expertise. At focus are the religious acceptance and rejection of brain death by a technologically savvy group of rabbis whose religious doctrine––along with a particular form of religious reasoning––is used to support the truth claims made from the scientific community (brain death is death) but challenge the ways in which they are made credible (instrumental rather than clinical). In our case, brain death as “true” death is made religiously viable with the very use of technological apparatus and scientific rhetoric that stand at the heart of the scientific ethos.

scholarly journals Gerência do cuidado de enfermagem ao paciente em morte encefálica

2019 ◽  
Vol 13 (4) ◽  
pp. 1124
Author(s):  
Aline Lima Pestana Magalhães ◽  
Roberta Juliane Tono de Oliveira ◽  
Saulo Fabio Ramos ◽  
Milene Mendes Lobato ◽  
Neide Da Silva Knihs ◽  
...  
Keyword(s):  
Brain Death ◽  
Patient Care ◽  
Organ Donation ◽  
Nursing Care ◽  
Organ Procurement ◽  
Physical Structure ◽  
Structured Interviews ◽  
Recursos Humanos ◽  
Brain Dead ◽  
The Brain

RESUMO Objetivo: compreender a gerência do cuidado de enfermagem aos pacientes em morte encefálica na perspectiva de enfermeiros atuantes no processo de doação e transplantes de órgãos. Método: trata-se de estudo qualitativo, fundamentado na Teoria Fundamentada nos Dados, com 25 enfermeiras. Obtiveram-se os dados por meio de entrevistas semiestruturadas individuais e se empregou a codificação aberta, axial e seletiva para análise dos dados. Resultados: emergiram-se duas categorias a partir da análise dos dados: << Observando as dificuldades relacionadas a gerência do cuidado de enfermagem ao paciente em morte encefálica >> e << Compreendendo as ações realizadas pela equipe de enfermagem na gerência do cuidado ao paciente em morte encefálica >>. Destacaram-se como dificuldades a limitação da estrutura física, recursos humanos e materiais. Enfatizaram-se pelos enfermeiros a monitorização e o suporte hemodinâmico, controle glicêmico e de diurese como ações necessárias para a gerência do cuidado ao paciente em morte encefálica. Conclusão: compreende-se que a gerência do cuidado ao paciente em morte encefálica requer entendimento para além das esferas técnicas sendo necessária a desmistificação do significado da doação de órgãos para manutenção de uma nova vida em outro alguém. Descritores: Obtenção de Tecidos e Órgãos; Transplante de Órgãos; Cuidados de Enfermagem; Cuidados Críticos; Morte Encefálica; Papel do Profissional de Enfermagem.ABSTRACT Objective: to understand the management of Nursing care to patients in brain death from the perspective of nurses working in the process of organ donation and transplants. Method: this is a qualitative study, based on the Data Based Theory, with 25 nurses. The data were obtained through individual semi-structured interviews and the open, axial and selective coding was used for data analysis. Results: two categories emerged from the analysis of the data: "Observing the difficulties related to the management of nursing care to the brain dead patient" and "Understanding the actions performed by the nursing team in the management of the brain dead patient's care. The limitations of physical structure and human and material resources were highlighted as difficulties. Monitoring and hemodynamic support, glycemic control and diuresis as necessary actions for the management of patient care in brain death were emphasized by the nurses. Conclusion: it is understood that the management of patient care in brain death requires understanding beyond the technical spheres, and it is necessary to demystify the meaning of organ donation for the maintenance of a new life in another person. Descriptors: Tissue and Organ Procurement; Organ Transplantation; Nursing Care; Critical Care; Brain Death; Nurse’s Role.RESUMEN Objetivo: comprender la gestión del cuidado de enfermería a los pacientes en muerte encefálica en la perspectiva de enfermeros actuantes en el proceso de donación y trasplantes de órganos. Método: se trata de un estudio cualitativo, fundamentado en la Teoría Fundamentada en los Datos, con 25 enfermeras. Se obtuvieron los datos por medio de entrevistas semiestructuradas individuales y se empleó la codificación abierta, axial y selectiva para análisis de los datos. Resultados: surgieron dos categorías a partir del análisis de los datos: << Observando las dificultades relacionadas a la gestión del cuidado de enfermería al paciente en muerte encefálica >> y << Comprendiendo las acciones realizadas por el equipo de enfermería en la gestión del cuidado al paciente en muerte encefálica >>. Se destacaron como dificultades la limitación de la estructura física, recursos humanos y materiales. Se enfatizaron por los enfermeros el monitoreo y el soporte hemodinámico, control glucémico y de diuresis como acciones necesarias para la gestión del cuidado al paciente en muerte encefálica. Conclusión: se comprende que la gestión del cuidado al paciente en muerte encefálica requiere entendimiento más allá de las esferas técnicas siendo necesaria la desmitificación del significado de la donación de órganos para el mantenimiento de una nueva vida en otro. Descriptores: Obtención de Tejidos y Órganos; Trasplante de Órganos; Atención de Enfermería; Cuidados Críticos; Muerte Encefálica; Rol de la Enfermera.

scholarly journals High prevalence of symptoms among Brazilian subjects with antibodies against SARS-CoV-2

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ana M. B. Menezes ◽  
Cesar G. Victora ◽  
Fernando P. Hartwig ◽  
Mariângela F. Silveira ◽  
Bernardo L. Horta ◽  
...  
Keyword(s):  
Recursive Partitioning ◽  
Antibody Test ◽  
Demographic Characteristics ◽  
Tree Analysis ◽  
High Prevalence ◽  
Using Data ◽  
Test Result ◽  
Rapid Antibody

AbstractSince the beginning of the pandemic of COVID-19, there has been a widespread assumption that most infected persons are asymptomatic. Using data from the recent wave of the EPICOVID19 study, a nationwide household-based survey including 133 cities from all states of Brazil, we estimated the proportion of people with and without antibodies for SARS-CoV-2 who were asymptomatic, which symptoms were most frequently reported, number of symptoms and the association with socio-demographic characteristics. We tested 33,205 subjects using a rapid antibody test previously validated. Information was collected before participants received the test result. Out of 849 (2.7%) participants positive for SARS-CoV-2 antibodies, only 12.1% (95% CI 10.1–14.5) reported no symptoms, compared to 42.2% (95% CI 41.7–42.8) among those negative. The largest difference between the two groups was observed for changes in smell/taste (56.5% versus 9.1%, a 6.2-fold difference). Changes in smell/taste, fever and body aches were most likely to predict positive tests as suggested by recursive partitioning tree analysis. Among individuals without any of these three symptoms, only 0.8% tested positive, compared to 18.3% of those with both fever and changes in smell or taste. Most subjects with antibodies against SARS-CoV-2 are symptomatic, even though most present only mild symptoms.

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