Abstract:
INTRODUCTION:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been caused the greatest pandemic of our century. Many of the deaths related to it are due to a systemic inflammatory response, which has been called 'cytokine storm'. OBJECTIVES:We developed a comprehensive review of the pathophysiology mechanisms of COVID-19 and of the rationale for drugs and therapeutics that have been tested in clinical trials. METHODS:A narrative review of the literature was conducted using PubMed, SciELO, Bireme, Google Scholar and ClinicalTrials. RESULTS:SARS-CoV-2 has evolutive mechanisms that made it spread all around the globe, as a higher latency period and a lesser lethality than other coronaviruses. SARS-CoV-2 causes a delay in the innate immune response and it disarranges the immune system leading to an overwhelming inflammatory reaction (the 'cytokine storm'). In this scenario, high levels of interleukins (IL), notably IL-6 and IL-1, create a positive feedback of chemokines and immune responses, and powers pulmonary and systemic tissue damage, leading to capillary leakage and SARS, the main cause of death in patients with COVID-19. On 17 July 2020, there were 1450 entries on ClinicalTrials.gov of ongoing studies on COVID-19. The mechanisms of the main therapeutic approaches were comprehensively reviewed throughout the text. Therapies focus on blocking viral entry (remdesivir, umifenovir, among others) and blocking of immune system for cytokine storm control (IL-1 and IL-6 inhibitors, glucocorticoids, convalescent plasma, among others). CONCLUSIONS:Understanding of action mechanisms of SARS-CoV-2 enables us to direct efforts on effective therapeutic targets. This comprehensive review helps to interpret the clinical results of the several trials ongoing.
journal_name
Postgrad Med Jjournal_title
Postgraduate medical journalauthors
Mélo Silva Júnior ML,Souza LMA,Dutra REMC,Valente RGM,Melo TSdoi
10.1136/postgradmedj-2020-138791subject
Has Abstractpub_date
2020-10-02 00:00:00eissn
0032-5473issn
1469-0756pii
postgradmedj-2020-138791pub_type
杂志文章,评审abstract::This review examines the appropriate timing of intervention in acute pancreatitis. In gallstone pancreatitis, it is now clear that cholecystectomy during the primary admission carries no greater risk of complications than delayed cholecystectomy and enables earlier recovery to normal activity. This course of action pr...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/pgmj.69.813.509
更新日期:1993-07-01 00:00:00
abstract::We report three cases of a distinctive palmar-plantar erythema associated with the treatment of non-Hodgkin's lymphoma and acute myeloid leukaemia. The rash is characterized by a painful, sharply demarcated, intense erythema of the palms and/or soles followed by bulla formation, desquamation and healing. The eruption ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.66.773.242
更新日期:1990-03-01 00:00:00
abstract:BACKGROUND:Sarcoidosis is a chronic, multisystem disease characterised by non-necrotising granulomatous inflammation of unknown aetiology. Most commonly, the lungs, lymph nodes, skin and eyes are affected in sarcoidosis; however, nervous system involvement occurs in approximately 5%-15% of cases. Any part of the nervou...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2016-134475
更新日期:2017-07-01 00:00:00
abstract::We report the case of a 58 year old man in whom an unusually prolonged infection with Toxoplasma gondii was the presenting feature of an underlying non-Hodgkin's lymphoma. This case demonstrates the particular usefulness of the IgM ELISA test in monitoring disease activity. ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.64.757.883
更新日期:1988-11-01 00:00:00
abstract::In a routine adult gastroenterological practice, seventeen (15%) of 123 patients had small-intestinal biopsies which were neither normal nor were completely flat as found in classical coeliac disease. Some of these had a possible cause for the mild mucosal abnormality, but in six there was no other apparent cause and ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.53.617.134
更新日期:1977-03-01 00:00:00
abstract::The efficacy of ranitidine (150 mg twice daily) and cimetidine (200 mg three times daily and 400 mg at night) in the short-term healing of duodenal ulcer has been assessed in a randomized controlled trial involving 106 patients. There were 3 drop-outs. Forty-two out of 53 patients (79%) treated with ranitidine had hea...
journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/pgmj.59.688.88
更新日期:1983-02-01 00:00:00
abstract::With the introduction of the New Deal and the Calman Report, the duration of higher specialist training will be halved. We have examined the effect of reduced on-call rotas on exposure to relatively uncommon out-of-hours emergencies in cardiothoracic surgery. Operations for post-infarction ventricular septal defect, a...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.75.884.351
更新日期:1999-06-01 00:00:00
abstract:BACKGROUND:Sleep deprivation and fatigue from long-shift work impacts doctors' personal safety, inhibits cognitive performance and risks clinical error. The aim of this study was to assess the sleep quality of surgical trainees participating in European Working Time Directive-compliant training rotations within a UK de...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2018-135795
更新日期:2020-09-01 00:00:00
abstract::In 17 patients with essential hypertension administration of labetalol alone resulted in a significant reduction in supine systolic and diastolic blood pressure of 14% and 17%, respectively. Seven patients attained a diastolic pressure less than equal to 95 mmHg. A significant postural fall in systolic blood pressure ...
journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章
doi:
更新日期:1980-01-01 00:00:00
abstract::A patient with the unusual post mortem finding of myocardial metastatic carcinoid tumour without classical valvular or endocardial carcinoid disease is described. This rare occurrence may represent an aggressive type of carcinoid tumour, with metastatic disease occurring before the development of classical fibrous val...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.72.854.751
更新日期:1996-12-01 00:00:00
abstract::This short overview discusses circadian rhythms observed in cardiovascular events such as myocardial ischaemia and myocardial infarction, which occur most frequently in the morning. Changes in the frequency of occurrence seem to be related to, and may result from, circadian rhythms in factors such as heart rate, blood...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:
更新日期:1991-01-01 00:00:00
abstract::Current maintenance immunosuppressive regimens for transplantation are based on three classes of drugs: corticosteroids, immunophilin-binding agents (eg, cyclosporin and tacrolimus), and antimetabolites (eg, azathioprine and mycophenolate). Drugs from the various classes inhibit the immune system at different points a...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.73.861.386
更新日期:1997-07-01 00:00:00
abstract::A patient with alcoholic cardiomyopathy is described in whom cardiovascular function capacity and radiological heart size fluctuated widely with periods of heavy drinking and abstinence. On two occasions, cessation of drinking resulted in clinical recovery from severe degrees of congestive failure and in complete reve...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.60.700.151
更新日期:1984-02-01 00:00:00
abstract::When plasma renin activity is related to sodium balance as evaluated from urinary sodium excretion, a physiological index of normality is obtained along with the ability to detect subtle variations in renin secretion. This has made it possible to correlate more closely the antihypertensive action of propranolol with t...
journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章,评审
doi:
更新日期:1976-01-01 00:00:00
abstract::Elective root replacement in Marfan syndrome has improved life expectancy in affected patients. Three forms of surgery are now available: total root replacement (TRR) with a valved conduit, valve sparing root replacement (VSRR) and personalised external aortic root support (PEARS) with a macroporous mesh sleeve. TRR c...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2013-305132rep
更新日期:2016-02-01 00:00:00
abstract::Although an extensive literature exists on factors controlling sodium excretion in animal experimental models of heart failure, the relevance of these to the human condition remains largely unexplored. Increased renal sympathetic stimulation is considered responsible for heightened urinary sodium retention. Stimulatio...
journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章
doi:
更新日期:1992-01-01 00:00:00
abstract::Some antifungal agents have been tested qualitatively in various associations against species of Candida, Cryptococcus and Torulopsis. The method used was the channel test and the results are confirmed by comparison with the serial dilution test in agar. The antagonism in vitro with the combination of amphotericin B i...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.55.647.683
更新日期:1979-09-01 00:00:00
abstract::Leuco-erythroblastosis has many known associations (Burkett, Cox and Fields, 1965; Weick, Hagedorn and Linman, 1974; Retief, 1964), but the only ones related to drug therapy are the well established response to haematinics (Burkett et al., 1965) and one possible case following anti-epileptic therapy (Retief, 1964). Th...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.53.621.391
更新日期:1977-07-01 00:00:00
abstract::Two cases of patients with ischaemic colitis requiring operative treatment are presented. Both had received a commonly used psychotropic drug in large dosage before the acute episode. Evidence is produced which may link the drugs used with the condition of ischaemic colitis. ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.60.706.564
更新日期:1984-08-01 00:00:00
abstract::In this study we have examined the ability of senior house officers in the Accident and Emergency (A&E) Department to interpret electrocardiographs (ECGs) and tested the value of a single seminar and guidelines on interpretation. We prospectively audited ECG interpretation taken from notes over a two-month period and ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.71.833.132
更新日期:1995-03-01 00:00:00
abstract::Colonic strictures are very common and are a frequent finding on double contrast barium examination; they very often reflect the presence of malignancy, diverticular disease, ischaemia, inflammatory bowel disease, and rarely mycobacterial disease. A case of mycobacterial disease mimicking malignancy is presented; this...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:
更新日期:2003-12-01 00:00:00
abstract:OBJECTIVE:To investigate the characteristics and outcomes of older patients with pelvic fracture admitted to medical and geriatric wards. METHODS:All patients admitted to medical and geriatric wards with a pelvic fracture over a four year period were identified using the hospital clinical coding database. Data were co...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pmj.76.900.646
更新日期:2000-10-01 00:00:00
abstract::Several cardiorespiratory diseases can complicate human immunodeficiency virus infection. Primary pulmonary hypertension is a rare clinical disorder which carries a bad prognosis. More than 90 cases of HIV-associated primary pulmonary hypertension have been reported to date. Although its pathogenesis remains unknown, ...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/pgmj.74.873.400
更新日期:1998-07-01 00:00:00
abstract::The healthcare industry has seen an increase in the adoption of team training, such as crew resource management (CRM), to improve teamwork and coordination within acute care medical teams. A meta-analysis was carried out in order to quantify the effects of CRM training on reactions, learning, behaviour and clinical ca...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,meta分析
doi:10.1136/postgradmedj-2014-132800
更新日期:2014-12-01 00:00:00
abstract:BACKGROUND:Randomised controlled trials (RCTs) have shown that endoscopic haemostasis is beneficial for patients with a bleeding peptic ulcer. The relevance of such data to management outside of RCTs is unclear. Therefore we examined management of patients with a bleeding peptic ulcer in a UK teaching hospital. METHOD...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pmj.78.920.347
更新日期:2002-06-01 00:00:00
abstract::A female patient demonstrating a previously not reported constellation of polyglandular autoimmune syndrome type III (including autoimmune thyroiditis, Graves' ophthalmopathy, insulin-dependent diabetes mellitus and vitiligo), coeliac disease and sarcoidosis is described. This may be a random association but might als...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.69.807.72
更新日期:1993-01-01 00:00:00
abstract::In 91 patients with bronchiectasis seen over 6 years, a positive mycobacterial culture was obtained in 12 cases (13%). The organisms isolated were Mycobacterium tuberculosis in nine cases, Mycobacterium avium in two cases and Mycobacterium tuberculosis and chelonei were obtained on separate occasions in one case. Comp...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/pgmj.68.805.896
更新日期:1992-11-01 00:00:00
abstract::Twenty-four hour intragastric acidity was measured in nine volunteer subjects in a single-blind placebo-controlled cross-over study comparing the effects of famotidine with ranitidine. The volunteer subjects received famotidine (40 mg at night), famotidine (20 mg at night), ranitidine (300 mg at night) or placebo in a...
journal_title:Postgraduate medical journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1986-01-01 00:00:00
abstract::The literature of the outbreaks of 'epidemic neuromyasthenia' (ENM) from 1934 to 1955 has been selected to show that the disease affects other people besides young adult females in hospitals and nursing homes. There have been district epidemics, in which the male: female ratio was almost even and several male outbreak...
journal_title:Postgraduate medical journal
pub_type: 杂志文章,评审
doi:10.1136/pgmj.54.637.711
更新日期:1978-11-01 00:00:00
abstract:BACKGROUND:Repetitive laboratory testing in stable patients is low-value care. Electronic health record (EHR)-based interventions are easy to disseminate but can be restrictive. OBJECTIVE:To evaluate the effect of a minimally restrictive EHR-based intervention on utilisation. SETTING:One year before and after interve...
journal_title:Postgraduate medical journal
pub_type: 杂志文章
doi:10.1136/postgradmedj-2019-136992
更新日期:2021-02-01 00:00:00