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The prevalence of direct kidney involvement in novel coronavirus disease (COVID-19) is low, but such involvement is a marker of multiple organ dysfunction and severe disease. Here, we explore potential pathways of kidney damage and discuss the rationale for extracorporeal support with various blood purification strategies in patients who are critically ill with COVID-19.

Kidney involvement in patients with coronavirus disease 2019 (COVID-19) is common, and can range from the presence of proteinuria and haematuria to acute kidney injury (AKI) requiring renal replacement therapy (RRT; also known as kidney replacement therapy). COVID-19-associated AKI (COVID-19 AKI) is associated with high mortality and serves as an independent risk factor for all-cause in-hospital death in patients with COVID-19. The pathophysiology and mechanisms of AKI in patients with COVID-19 have not been fully elucidated and seem to be multifactorial, in keeping with the pathophysiology of AKI in other patients who are critically ill. Little is known about the prevention and management of COVID-19 AKI. The emergence of regional ‘surges’ in COVID-19 cases can limit hospital resources, including dialysis availability and supplies; thus, careful daily assessment of available resources is needed. In this Consensus Statement, the Acute Disease Quality Initiative provides recommendations for the diagnosis, prevention and management of COVID-19 AKI based on current literature. We also make recommendations for areas of future research, which are aimed at improving understanding of the underlying processes and improving outcomes for patients with COVID-19 AKI.COVID-19-associated AKI (COVID-19 AKI) is associated with high mortality and is an independent risk factor for all-cause in-hospital death in patients with COVID-19. This Consensus Statement from the Acute Disease Quality Initiative provides recommendations for the diagnosis, prevention and management of COVID-19 AKI and for areas of future research, with the aim of improving understanding of the underlying processes and outcomes for patients with COVID-19 AKI.

Serological assays have been widely used to detect anti-SARS-CoV-2 antibodies, which are generated from previous exposure to the virus or after vaccination. The presence of anti-SARS-CoV-2 Nucleocapsid antibodies was recently reported in patients´ urine using an  in-house urine-based ELISA-platform, allowing a non-invasive way to collect clinical samples and assess immune conversion. In the current study, we evaluated and validated another in-house urine-based ELISA for the detection of anti-SARS-CoV-2 Spike antibodies. Three partial recombinant SARS-CoV-2 Spike proteins comprising the Receptor Binding Domain, expressed in eukaryotic or prokaryotic systems, were tested in an ELISA platform against a panel of over 140 urine and paired serum samples collected from 106 patients confirmed positive for SARS-CoV-2 by qRT-PCR. The key findings from our study were that anti-SARS-CoV-2 Spike antibodies could be detected in urine samples and that the prokaryotic expression of the rSARS-CoV-2 Spike protein was not a barrier to obtain relatively high serology efficiency for the urine-based assay. Thus, use of a urine-based ELISA assay with partial rSARS-CoV-2 Spike proteins, expressed in a prokaryotic system, could be considered as a convenient tool for screening for the presence of anti-SARS-CoV-2 Spike antibodies, and overcome the difficulties arising from sample collection and the need for recombinant proteins produced with eukaryotic expression systems.

Student attrition and academic failure remain pervasive challenges in education, often occurring at substantial rates and posing considerable difficulties for timely identification and intervention. Learning management systems such as Moodle generate extensive datasets reflecting student interactions and enrollment patterns, presenting opportunities for predictive analytics. This study seeks to advance the field of dropout and failure prediction through the application of artificial intelligence with machine learning methodologies. In particular, we employed the CatBoost algorithm, trained on student activity logs from the Moodle platform. To mitigate the challenges posed by a limited and imbalanced dataset, we employed sophisticated data balancing techniques, such as Adaptive Synthetic Sampling, and conducted multi-objective hyperparameter optimization using the Non-dominated Sorting Genetic Algorithm II. We compared models trained on weekly log data against a single model trained on all weeks’ data. The proposed model trained with all weeks’ data demonstrated superior performance, showing significant improvements in F1-scores and recall, particularly for the minority class of at-risk students. For example, the model got an average F1-score across multiple weeks of approximately 0.8 in the holdout test. These findings underscore the potential of targeted machine learning approaches to facilitate early identification of at-risk students, thereby enabling timely interventions and improving educational outcomes.

A post hoc study from the COBI trial compared the impact of continuous hypertonic (NaCl 20%) saline solution on renal outcomes after traumatic brain injury (TBI), specifically, if a high dose of chloride delivered by hypertonic saline solution was associated with an increased incidence of acute kidney injury. Hyperchloremia has been hypothesized to cause renal hypoperfusion and AKI by its renal vascular smooth muscle constrictor effect and other mechanisms [1]. [...]there is a pathophysiological rationale to support its association with AKI. When trying to use more severe stages, as in this case, it is possible to classify some AKI cases as negative endpoints because it only achieved KDIGO 1, being really a true AKI case and not just purely functional and transitory. [...]like the primary study, we believe that the COBI post hoc study should not change our clinical practice by requiring hypertonic solutions in the context of intracranial hypertension.

Sickness behavior is considered part of the specific beneficial adaptive behavioral and neuroimmune changes that occur in individuals in response to infectious/inflammatory processes. However, in dangerous and stressful situations, sickness behavior should be momentarily abrogated to prioritize survival behaviors, such as fight or flight. Taking this assumption into account, we experimentally induced sickness behavior in rats using lipopolysaccharides (LPS), an endotoxin that mimics infection by gram-negative bacteria, and then exposed these rats to a restraint stress challenge. Zinc has been shown to play a regulatory role in the immune and nervous systems. Therefore, the objective of this study was to examine the effects of zinc treatment on the sickness response of stress-challenged rats. We evaluated 22-kHz ultrasonic vocalizations, open-field behavior, tumor necrosis factor α (TNF-α), corticosterone, and brain-derived neurotrophic factor (BDNF) plasma levels. LPS administration induced sickness behavior in rats compared to controls, i.e., decreases in the distance traveled, average velocity, rearing frequency, self-grooming, and number of vocalizations, as well as an increase in the plasma levels of TNF-α, compared with controls after a stressor challenge. LPS also decreased BDNF expression but did not influence anxiety parameters. Zinc treatment was able to prevent sickness behavior in LPS-exposed rats after the stress challenge, restoring exploratory/motor behaviors, communication, and TNF-α levels similar to those of the control group. Thus, zinc treatment appears to be beneficial for sick animals when they are facing risky/stressful situations.

We report the first screening for antioxidant activity (AOX) of three dominant seaweeds from low intertidal reefs of Brazil. Sargassum furcatum, Bryothamnion triquetrum, and Osmundaria obtusiloba were extracted with dichloromethane and methanol (2:1), and AOX was measured by five UV-vis microplate spectrophotometric methods: DPPH (2,2-diphenyl-1-picryhydrazyl) and ABTS (2,2-azinobis (3-ethylbenzthiazoline-6-sulfonic acid)) free radical scavenging, metal chelating capacity, total phenolic compounds using reducing power by Folin-Ciocalteu and FRAP (ferric reducing antioxidant power). All studied species showed high AOX, even at very low extract concentrations. We can attribute these results to the stressful environment in which these seaweeds live, high hydrodynamics, air exposure during low spring tides, intense solar radiation, and other factors that may contribute to oxidative stress, featuring O. obtusiloba as a new source of natural antioxidants.

Background Hemoadsorption has emerged as a promising adjunctive therapy in the management of various inflammatory and toxin-mediated conditions. Its role in context of rhabdomyolysis has generated increasing scientific and clinical interest. In response to the recent consensus statement by an international expert task force—published in BMC Nephrology in July 2024—regarding the use of hemoadsorption in rhabdomyolysis, we aim to contribute further to this evolving discourse. Case presentation We report on a patient with severe rhabdomyolysis secondary to influenza B infection who suffered acute kidney injury (AKI) as a result. Alongside conservative treatment, we successfully implemented a combined regimen of CRRT and hemoadsorption, while using myoglobin levels up- and downstream of the adsorber as a tool for therapy monitoring. The patient subsequently recovered complete renal function and full body mobility. Conclusion The case illustrates the practical implementation of hemoadsorption within a multimodal treatment strategy. In addition to demonstrating concordance with current consensus guidelines, we seek to critically discuss potential refinements in the therapeutic approach—particularly concerning monitoring strategies and the integration of extracorporeal modalities—to facilitate future clinical practice and research.