Artigos e Materiais de Revistas Científicas - COVID-19
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- How Can COVID-19 Influence the Evolution of Patients with Acute Coronary Syndromes?(2024) SOEIRO, Alexandre de Matos
- The Use of the Oxygenation Stretch Index to Predict Outcomes in Mechanically Ventilated PatientsWith COVID-19 ARDS(2023) ROLDAN, Rollin; BARRIGA, Fernando; VILLAMONTE, Renan; ROMANI, Franco; TUCCI, Mauro; GONZALES, Arturo; WONG, Paolo; ZAGACETA, Jorge; BROCHARD, LaurentBACKGROUND: In ARDS caused by COVID-19 pneumonia, appropriate adjustment of physiologic parameters based on lung stretch or oxygenation may optimize the ventilatory strategy. This study aims to describe the prognostic performance on 60-d mortality of single and composite respiratory variables in subjects with COVID- 19 ARDS who are on mechanical ventilation with a lung-protective strategy, including the oxygenation stretch index combining oxygenation and driving pressure (Delta P). METHODS: This single-center observational cohort study enrolled 166 subjects on mechanical ventilation and diagnosed with COVID-19 ARDS. We evaluated their clinical and physiologic characteristics. The primary study outcome was 60-d mortality. Prognostic factors were evaluated through receiver operating characteristic analysis, Cox proportional hazards regression model, and Kaplan-Meier survival curves. RESULTS: Mortality at day 60 was 18.1%, and hospital mortality was 22.9%. Oxygenation, DP, and composite variables were tested: oxygenation stretch index (P-aO2 /F-IO2 divided by Delta P) and Delta P 3 4 + breathing frequency (f) (Delta P 3 4 + f). At both day 1 and day 2 after inclusion, the oxygenation stretch index had the best area under the receiver operating characteristic curve (oxygenation stretch index on day 1 0.76 (95% CI 0.67-0.84) and on day 2 0.83 (95% CI 0.76-0.91) to predict 60-d mortality, although without significant difference from other indexes. In multivariable Cox regression, Delta P, PaO2 /FIO2, Delta P 3 4 + f, and oxygenation stretch index were all associated with 60-d mortality. When dichotomizing the variables, Delta P >= 14, P-aO2 / F-IO2 >= 152 mm Hg, Delta P x 4 + f >= 80, and oxygenation stretch index < 7.7 showed lower 60-d survival probability. At day 2, after optimization of ventilatory settings, the subjects who persisted with the worse cutoff values for the oxygenation stretch index showed a lower probability of survival at 60 d compared with day 1; this was not the case for other parameters. CONCLUSIONS: The oxygenation stretch index, which combines P-aO2 /F-IO2 and DP, is associated with mortality and may be useful to predict clinical outcomes in COVID-19 ARDS.
- Cold Atmospheric Helium Plasma in the Post-COVID-19 Era: A Promising Tool for the Disinfection of Silicone Endotracheal Prostheses(2024) SILVA, Diego Morais da; NASCIMENTO, Fellype Do; MILHAN, Noala Vicensoto Moreira; OLIVEIRA, Maria Alcioneia Carvalho de; CARDOSO, Paulo Francisco Guerreiro; LEGENDRE, Daniel; AOKI, Fabio Gava; KOSTOV, Konstantin Georgiev; KOGA-ITO, Cristiane YumiDespite the excellent properties of silicone endotracheal prostheses, their main limitation is the formation of a polymicrobial biofilm on their surfaces. It can cause local inflammation, interfering with the local healing process and leading to further complications in the clinical scenario. The present study evaluated the inhibitory effect of cold atmospheric plasma (CAP) on multispecies biofilms grown on the silicone protheses' surfaces. In addition to silicone characterization before and after CAP exposure, CAP cytotoxicity on immortalized human bronchial epithelium cell line (BEAS-2B) was evaluated. The aging time test reported that CAP could temporarily change the silicone surface wetting characteristics from hydrophilic (80.5 degrees) to highly hydrophilic (<5 degrees). ATR-FTIR showed no significant alterations in the silicone surficial chemical composition after CAP exposure for 5 min. A significant log reduction in viable cells in monospecies biofilms (log CFU/mL) of C. albicans, S. aureus, and P. aeruginosa (0.636, 0.738, and 1.445, respectively) was detected after CAP exposure. Multispecies biofilms exposed to CAP showed significant viability reduction for C. albicans and S. aureus (1.385 and 0.831, respectively). The protocol was not cytotoxic to BEAS-2B. CAP can be a simple and effective method to delay multispecies biofilm formation inside the endotracheal prosthesis.
- Cardiovascular Safety of Azithromycin in Patients Hospitalized With COVID-19: A Prespecified Pooled Analysis of the COALITION I and COALITION II Randomized Clinical Trials(2024) FURTADO, Remo H. M.; SILVA, Pedro G. M. Barros e; FONSECA, Henrique A. R.; SERPA-NETO, Ary; CORREA, Thiago D.; GUIMARAES, Helio P.; PEREIRA, Adriano J.; OLIVATO, Guilherme B.; ZAMPIERI, Fernando G.; LISBOA, Thiago; JUNQUEIRA, Debora L. M.; LAPA, Maura G.; MONFARDINI, Frederico; DAMIANI, Lucas P.; ECHENIQUE, Leandro S.; GEBARA, Otavio E.; HOFFMAN FILHO, Conrado R.; POLANCZYK, Carisi A.; ROHDE, Luis E.; AMAZONAS, Roberto; MACHADO, Flavia R.; AVEZUM, Alvaro; AZEVEDO, Luciano C. P.; VEIGA, Viviane C.; ROSA, Regis G.; LOPES, Renato D.; CAVALCANTI, Alexandre B.; BERWANGER, OtavioThe cardiovascular safety from azithromycin in the treatment of several infectious diseases has been challenged. In this prespecified pooled analysis of 2 multicenter randomized clinical trials, we aimed to assess whether the use of azithromycin might lead to corrected QT (QTc) interval prolongation or clinically relevant ventricular arrhythmias. In the COALITION COVID Brazil I trial, 667 patients admitted with moderate COVID-19 were randomly allocated to hydroxychloroquine, hydroxychloroquine plus azithromycin, or standard of care. In the COALITION COVID Brazil II trial, 447 patients with severe COVID-19 were randomly allocated to hydroxychloroquine alone versus hydroxychloroquine plus azithromycin. The principal end point for the present analysis was the composite of death, resuscitated cardiac arrest, or ventricular arrhythmias. The addition of azithromycin to hydroxychloroquine did not result in any prolongation of the QTc interval (425.8 +/- 3.6 ms vs 427.9 +/- 3.9 ms, respectively, mean difference -2.1 ms, 95% confidence interval -12.5 to 8.4 ms, p = 0.70). The combination of azithromycin plus hydroxychloroquine compared with hydroxychloroquine alone did not result in increased risk of the primary end point (proportion of patients with events at 15 days 17.2% vs 16.0%, respectively, hazard ratio 1.08, 95% confidence interval 0.78 to 1.49, p = 0.65). In conclusion, in patients hospitalized with COVID-19 already receiving standardof-care management (including hydroxychloroquine), the addition of azithromycin did not result in the prolongation of the QTc interval or increase in cardiovascular adverse events. Because azithromycin is among the most commonly prescribed antimicrobial agents, our results may inform clinical practice. Clinical Trial Registration: NCT04322123, NCT04321278.
- You knew you had to be there, it had to be done: Experiences of health professionals who faced the COVID-19 pandemic in one public hospital in Spain(2023) RODRIGUEZ-MADRID, Maria Nieves; PASTOR-MORENO, Guadalupe; ALBERT-LOPEZ, Enrique; PASTOR-VALERO, MariaIntroductionThe COVID-19 pandemic highlighted the lack of a government contingency plan for an effective response to an unexpected health crisis. This study uses a phenomenological approach to explore the experience of healthcare professionals during the first three waves of the COVID-19 pandemic in a public health hospital in the Valencia region, Spain. It assesses the impact on their health, coping strategies, institutional support, organizational changes, quality of care, and lessons learned. MethodsWe carried out a qualitative study with semi-structured interviews with doctors and nurses from the Preventive Medicine, Emergency, and Internal Medicine Services and the Intensive Care Unit, using the Colaizzi's 7-step data analysis method. ResultsDuring the first wave, lack of information and leadership led to feelings of uncertainty, fear of infection, and transmission to family members. Continuous organizational changes and lack of material and human resources brought limited results. The lack of space to accommodate patients, along with insufficient training in treating critical patients, and the frequent moving around of healthcare workers, reduced the quality of care. Despite the high levels of emotional stress reported, no sick leave was taken; the high levels of commitment and professional vocation helped in adapting to the intense work rhythms. Healthcare professionals in the medical services and support units reported higher levels of stress, and a greater sense of neglect by their institution than their colleagues in managerial roles. Family, social support, and camaraderie at work were effective coping strategies. Health professionals showed a strong collective spirit and sense of solidarity. This helped them cope with the additional stress and workload that accompanied the pandemic. ConclusionIn the wake of this experience, they highlight the need for a contingency plan adapted to each organizational context. Such a plan should include psychological counseling and continuous training in critical patient care. Above all, it needs to take advantage of the hard-won knowledge born of the COVID-19 pandemic.
- A novel insight on SARS-CoV-2 S-derived fragments in the control of the host immunity (vol 13, 8060, 2023)(2023) BASTOS, Thais Sibioni Berti; PAULA, Andre Guilherme Portela de; LUZ, Rebeca Bosso dos Santos; GARNIQUE, Anali M. B.; BELO, Marco A. A.; ETO, Silas Fernandes; FERNANDES, Dayanne Carla; FERRARIS, Fausto Klabund; PONTES, Leticia Gomes de; FRANCA, Tabata Takahashi; BARCELLOS, Leonardo Jose Gil; VERAS, Flavio P. P.; BERMEJO, Pamela; GUIDELLI, Giovanna; MANEIRA, Carla; MELLO, Fellipe da Silveira Bezerra de; TEIXEIRA, Gleidson; PEREIRA, Goncalo Amarante Guimaraes; FERNANDES, Bianca H. Ventura; SANCHES, Paulo R. S.; BRAZ, Helyson Lucas Bezerra; JORGE, Roberta Jeane Bezerra; MALAFAIA, Guilherme; CILLI, Eduardo M. M.; OLIVIER, Danilo da Silva; AMARAL, Marcos Serrou do; MEDEIROS, Renata J. J.; CONDINO-NETO, Antonio; CARVALHO, Luciani R. R.; MACHADO-SANTELLI, Glaucia M. M.; CHARLIE-SILVA, Ives; GALINDO-VILLEGAS, Jorge; BRAGA, Tarcio Teodoro
- Endovascular treatment of cerebral sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia(2024) WELLER, Johannes; KRZYWICKA, Katarzyna; MUNCKHOF, Anita van de; DORN, Franziska; ALTHAUS, Katharina; BODE, Felix J.; POGGIO, Monica Bandettini di; BUCK, Brian; KLEINIG, Timothy; CORDONNIER, Charlotte; DIZONNO, Vanessa; DUAN, Jiangang; ELKADY, Ahmed; CHEW, Beng Lim Alvin; GARCIA-ESPERON, Carlos; FIELD, Thalia S.; LEGAULT, Catherine; MARTIN, Mar Morin; MICHALSKI, Dominik; PELZ, Johann; SCHOENENBERGER, Silvia; NAGEL, Simon; PETRUZZELLIS, Marco; RAPOSO, Nicolas; SKJELLAND, Mona; ZIMATORE, Domenico Sergio; AARON, Sanjith; KAMMEN, Mayte Sanchez van; SOUSA, Diana Aguiar de; LINDGREN, Erik; JOOD, Katarina; SCUTELNIC, Adrian; HELDNER, Mirjam R.; POLI, Sven; ARAUZ, Antonio; CONFORTO, Adriana B.; PUTAALA, Jukka; TATLISUMAK, Turgut; ARNOLD, Marcel; COUTINHO, Jonathan M.; GUENTHER, Albrecht; ZIMMERMANN, Julian; FERRO, Jose M.Introduction: There is little data on the role of endovascular treatment (EVT) of cerebral venous sinus thrombosis (CVST) due to vaccine-induced immune thrombotic thrombocytopenia (VITT). Here, we describe clinical characteristics and outcomes of CVST-VITT patients who were treated with EVT. Patients and methods: We report data from an international registry of patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 6 March 2023. VITT was defined according to the Pavord criteria. Results: EVT was performed in 18/136 (13%) patients with CVST-VITT (92% aspiration and/or stent retrieval, 8% local thrombolysis). Most common indications were extensive thrombosis and clinical or radiological deterioration. Compared to non-EVT patients, those receiving EVT had a higher median thrombus load (4.5 vs 3). Following EVT, local blood flow was improved in 83% (10/12, 95% confidence interval [CI] 54-96). One (6%) asymptomatic sinus perforation occurred. Eight (44%) patients treated with EVT also underwent decompressive surgery. Mortality was 50% (9/18, 95% CI 29-71) and 88% (8/9, 95% CI 25-66) of surviving EVT patients achieved functional independence with a modified Rankin Scale score of 0-2 at follow-up. In multivariable analysis, EVT was not associated with increased mortality (adjusted odds ratio, 0.66, 95% CI 0.16-2.58). Discussion and conclusion: We describe the largest cohort of CVST-VITT patients receiving EVT. Half of the patients receiving EVT died during hospital admission, but most survivors achieved functional independence.
- Health equity, care access and quality in headache - part 1(2024) TANA, Claudio; RAFFAELLI, Bianca; SOUZA, Marcio Nattan Portes; TORRE, Elena Ruiz de la; MASSI, Daniel Gams; KISANI, Najib; GARCIA-AZORIN, David; WALISZEWSKA-PROSOL, MartaCurrent definitions of migraine that are based mainly on clinical characteristics do not account for other patient's features such as those related to an impaired quality of life, due to loss of social life and productivity, and the differences related to the geographical distribution of the disease and cultural misconceptions which tend to underestimate migraine as a psychosocial rather than neurobiological disorder. Global differences definition, care access, and health equity for headache disorders, especially migraine are reported in this paper from a collaborative group of the editorial board members of the Journal of Headache and Pain. Other components that affect patients with migraine, in addition to the impact promoted by the migraine symptoms such as stigma and social determinants, are also reported.
- Sex differences in cerebral venous sinus thrombosis after adenoviral vaccination against COVID-19(2023) SCUTELNIC, Adrian; MUNCKHOF, Anita van de; KRZYWICKA, Katarzyna; KAMMEN, Mayte Sanchez van; LINDGREN, Erik; CORDONNIER, Charlotte; KLEINIG, Timothy J.; FIELD, Thalia S.; POLI, Sven; LEMMENS, Robin; MIDDELDORP, Saskia; AARON, Sanjith; BORHANI-HAGHIGHI, Afshin; ARAUZ, Antonio; HOVINGA, Johanna A. Kremer; GUENTHER, Albrecht; PUTAALA, Jukka; WASAY, Mohammad; CONFORTO, Adriana Bastos; SOUSA, Diana Aguiar de; JOOD, Katarina; TATLISUMAK, Turgut; FERRO, Jose M.; COUTINHO, Jonathan M.; ARNOLD, Marcel; HELDNER, Mirjam R.Introduction: Cerebral venous sinus thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is a severe disease with high mortality. There are few data on sex differences in CVST-VITT. The aim of our study was to investigate the differences in presentation, treatment, clinical course, complications, and outcome of CVST-VITT between women and men. Patients and methods: We used data from an ongoing international registry on CVST-VITT. VITT was diagnosed according to the Pavord criteria. We compared the characteristics of CVST-VITT in women and men. Results: Of 133 patients with possible, probable, or definite CVST-VITT, 102 (77%) were women. Women were slightly younger [median age 42 (IQR 28-54) vs 45 (28-56)], presented more often with coma (26% vs 10%) and had a lower platelet count at presentation [median (IQR) 50x10(9)/L (28-79) vs 68 (30-125)] than men. The nadir platelet count was lower in women [median (IQR) 34 (19-62) vs 53 (20-92)]. More women received endovascular treatment than men (15% vs 6%). Rates of treatment with intravenous immunoglobulins were similar (63% vs 66%), as were new venous thromboembolic events (14% vs 14%) and major bleeding complications (30% vs 20%). Rates of good functional outcome (modified Rankin Scale 0-2, 42% vs 45%) and in-hospital death (39% vs 41%) did not differ. Discussion and conclusions: Three quarters of CVST-VITT patients in this study were women. Women were more severely affected at presentation, but clinical course and outcome did not differ between women and men. VITT-specific treatments were overall similar, but more women received endovascular treatment.
- The Hierarchy of Communication Needs: A Novel Communication Strategy for High Mistrust Settings Developed in a Brazilian COVID-ICU(2024) FORTE, Daniel Neves; STOLTENBERG, Mark; RIBEIRO, Sabrina Correa da Costa; ALMEIDA, Ingrid Maria (Mia) Olsen de; JACKSON, Vicki; DAUBMAN, Bethany-RoseContext: The COVID-19 pandemic presented unique challenges for health care systems. Overcrowded units, extreme illness severity, uncertain prognoses, and mistrust in providers resulted in a ""pressure cooker"" where traditional communication strategies were often insufficient.Objectives: Building on well-studied traditional communication interventions, neurobiology principles were used to create a novel communication strategy designed in the COVID-ICU to respond to the unique communication needs of patients within the context of a high mistrust setting.Methods: The hierarchy of communication needs recognizes three specific levels of communication that are essential within high-emotion and low-trust settings. The first level is to establish trust. The second level is to resonate with patients' emotions, helping to reduce arousal and improve empathy. The third level includes the more traditional content of disclosing prognostic information and shared decision-making. When facing communication challenges, clinicians are taught to move back a level and reattune to emotions and/or reestablish trust.Discussion: The COVID pandemic revealed the shortcomings of a primarily cognitive communication style. The hierarchy of communication needs emphasizes trust building, and emotional resonance as prerequisites of effective cognitive discussions, resulting in more effective clinician-patient communication that more fully incorporates cultural humility and better meets the needs of diverse patient populations. Additional research is needed to further develop this strategy and evaluate its impact on patient experience and outcomes.
- Immune Evasion of SARS-CoV-2 Omicron Subvariants XBB.1.5, XBB.1.16 and EG.5.1 in a Cohort of Older Adults after ChAdOx1-S Vaccination and BA.4/5 Bivalent Booster(2024) MACHADO, Rafael Rahal Guaragna; CANDIDO, erika Donizetti; AGUIAR, Andressa Simoes; CHALUP, Vanessa Nascimento; SANCHES, Patricia Romao; DORLASS, Erick Gustavo; AMGARTEN, Deyvid Emanuel; PINHO, Joao Renato Rebello; DURIGON, Edison Luiz; OLIVEIRA, Danielle Bruna LealThe recently emerged SARS-CoV-2 Omicron sublineages, including the BA.2-derived XBB.1.5 (Kraken), XBB.1.16 (Arcturus), and EG.5.1 (Eris), have accumulated several spike mutations that may increase immune escape, affecting vaccine effectiveness. Older adults are an understudied group at significantly increased risk of severe COVID-19. Here we report the neutralizing activities of 177 sera samples from 59 older adults, aged 62-97 years, 1 and 4 months after vaccination with a 4th dose of ChAdOx1-S (Oxford/AstraZeneca) and 3 months after a 5th dose of Comirnaty Bivalent Original/Omicron BA.4/BA.5 vaccine (Pfizer-BioNTech). The ChAdOx1-S vaccination-induced antibodies neutralized efficiently the ancestral D614G and BA.4/5 variants, but to a much lesser extent the XBB.1.5, XBB.1.16, and EG.5.1 variants. The results showed similar neutralization titers between XBB.1.16 and EG.5.1 and were lower compared to XBB.1.5. Sera from the same individuals boosted with the bivalent mRNA vaccine contained higher neutralizing antibody titers, providing a better cross-protection against Omicron XBB.1.5, XBB.1.16 and EG.5.1 variants. Previous history of infection during the epidemiological waves of BA.1/BA.2 and BA.4/BA.5, poorly enhanced neutralization activity of serum samples against XBBs and EG.5.1 variants. Our data highlight the continued immune evasion of recent Omicron subvariants and support the booster administration of BA.4/5 bivalent vaccine, as a continuous strategy of updating future vaccine booster doses to match newly emerged SARS-CoV-2 variants.
- Participating as a research team during the COVID-19 pandemic benefits mental health of undergraduate medical students in Brazil(2023) CALDERARO, Debora Cerqueira; TEODORO, Maycoln Leoni Martins; BASUALTO, Samuel; BORGES, Aline Rizzo; LOPES, Joao Vitor Ziroldo; ARAUJO, Nafice Costa; MARIZ, Henrique de Ataide; VALADARES, Lilian David de Azevedo; RIBEIRO, Sandra Lucia Euzebio; KAHLOW, Barbara Stadler; GOMES, Kirla Wagner Poti; MUNHOZ, Gabriela Araujo; FERREIRA, Gilda Aparecida; KAKEHASI, Adriana Maria; PILEGGI, Gecilmara Salviato; BICA, Blanca; BRITO, Danielle Christinne Soares Egypto; GOMIDES, Ana Paula Monteiro; KLUMB, Evandro Mendes; PAIVA, Eduardo Dos Santos; PROVENZA, Jose Roberto; REIS-NETO, Edgard; SOUZA, Viviane Angelina de; VALIM, Valeria; PINHEIRO, Marcelo de MedeirosDuring the COVID-19 pandemic, undergraduate medical students (UMS) exposed to isolation, social distancing and complete or partial face-to-face educational activities interruption may present increased stress, depression and anxiety. This study was undertaken to evaluate if, during isolation, UMS involved in online group activities as investigators of a research project (volunteer group) would present better mental health than their colleagues, not involved in that research (control group). A Web-based survey, via the Google Forms platform, including details on demographic data, life habits, previous health conditions, worries with the COVID-19 pandemic, sleep pattern modifications and depression, anxiety and mental stress, using the DASS-21 (Depression, Anxiety and Stress Scale) was implemented from 20 July to 31 August 2020. Statistical analysis was performed using the SPSS version 20.0. A p-value <0.05 was significant. A total of 684 UMS were included, 228 as a volunteer group and 456 as a control group. Mean age was 23.15 (3.16) years. The groups were paired for age, gender, ethnicity, life habits and previous health conditions. Older age, male gender, participation in the research project, unchanged sleep pattern during the pandemic, lack of fear from getting the COVID-19 and lack of previous health conditions were associated with lower DASS21 scores (better mental health). Participating as investigators of a research project foreseeing frequent interaction with patients, colleagues and professors (other investigators) lead to better mental health during the COVID-19 quarantine in Brazil.
- Challenges and potential solutions for physician suicide risk factors in the COVID-19 era: psychiatric comorbidities, judicialization of medicine, and burnout(2023) DUARTE, Dante; EL-HAGRASSY, Mirret M.; COUTO, Tiago; GURGEL, Wagner; MINUZZI, Luciano; SAPERSON, Karen; CORREA, HumbertoIntroduction: Suicide among physicians constitutes a public health problem that deserves more consideration. A recently performed meta-analysis and systematic review evaluated suicide mortality in physicians by gender and investigated several related risk factors. It showed that the post-1980 suicide mortality was 46% higher in female physicians than among women in the general population, while the risk in male physicians was 33% lower than among men in general, despite an overall contraction in physician mortality rates in both genders.Methods: This narrative review was conducted by searching and analyzing articles/databases that were relevant to addressing questions raised by a prior meta-analysis and how they might be affected by COVID-19. This process included unstructured searches on Pubmed for physician suicide, burnout, judicialization of medicine, healthcare organizations, and COVID-19, and Google searches for relevant databases and medical society, expert, and media commentaries on these topics. We focus on three factors critical to addressing physician suicides: epidemiological data limitations, psychiatric comorbidities, and professional overload. Results: We found relevant articles on suicide reporting, physician mental health, the effects of healthcare judicialization, and organizational involvement on physician and patient health, and how COVID-19 may impact such factors. This review addresses information sources, underreporting/misreporting of physician suicide rates, inadequate diagnosis and management of psychiatric comorbidities and the chronic effects on physicians' work capacity, and, finally, judicialization of medicine and organizational failures increasing physician burnout. We discuss these factors in general and in relation to the COVID-19 pandemic.Conclusions: We present an overview of the above factors, discuss possible solutions, and specifically address how COVID-19 may impact such factors.
- High prevalence of olfactory impairment among leprosy patients: A cross-sectional study(2023) KONDO, Rogerio Nabor; ARAUJO, Milene Cripa Pizatto de; RAMOS, Paulo Muller; MIOT, Helio Amante; FORNAZIERI, Marco AurelioBackgroundThe effect of leprosy on the sense of smell is not yet fully established. Studies that have relied only on patients' perceptions may have under- or over-estimated the change in smell perception. A validated and psychophysical method is necessary to avoid these errors in assessment. ObjectivesThis study aimed to validate the existence of olfactory involvement in leprosy patients. MethodsA cross-sectional, controlled study was conducted, in which individuals with leprosy (exposed individuals) and individuals without leprosy (control patients) were recruited. For each exposed individual, we selected two control patients. A total of 108 patients (72 control patients and 36 exposed individuals) with no history of infection with the new coronavirus (COVID-19) took the University of Pennsylvania Smell Identification Test (UPSIT). ResultsMost exposed individuals had olfactory dysfunction [n = 33, 91.7% (CI 95%: 77.5%-98.3%)] when compared with the control patients [n = 28, 38.9% (CI 95%: 27.6%-51.1%)], but only two (5.6%) had olfactory complaints. The olfactory function was significantly worse among exposed individuals [UPSIT leprosy = 25.2 (CI 95%: 23.1-27.3) when compared with the UPSIT control patients = 34.1 (CI 95%: 33.0-35.3); p<0.001]. The risk of olfactory loss was higher among the exposed individuals [OR: 19.5 (CI 95%: 5.18-105.70; p < 0.001)]. ConclusionsOlfactory dysfunction was highly prevalent among exposed individuals, although they had little or no self-knowledge of the disorder. The results show that it is important to assess the sense of smell in exposed individuals. Author summaryLeprosy is one of the oldest neurocutaneous diseases in the world. However, it has been neglected by the general population, doctors, and scientists. Transmitted by Mycobacterium leprae and Mycobacterium lepromatosis, leprosy is met with stigma and prejudice. Some patients with leprosy (exposed individuals) keep their diagnosis a secret, fearing a negative impact on their social lives. The disease is characterized by white or red skin lesions associated with local numbness. Few studies have evaluated smell among exposed individuals, but they have not used the University of Pennsylvania Smell Identification Test (UPSIT), which is a validated psychophysical method. The present study found a high prevalence of olfactory impairment (91.7%) among exposed individuals, accompanied by low self-knowledge of the disorder (5.6%). It is thus important to assess the sense of smell in infected individuals, as this sensorineural assessment has not been performed as a routine for patients.
- Cardiovascular autonomic dysfunction in ""Long COVID"": pathophysiology, heart rate variability, and inflammatory markers(2023) MARQUES, Karina Carvalho; QUARESMA, Juarez Antonio Simoes; FALCAO, Luiz Fabio MagnoLong COVID is characterized by persistent signs and symptoms that continue or develop for more than 4 weeks after acute COVID-19 infection. Patients with Long COVID experience a cardiovascular autonomic imbalance known as dysautonomia. However, the underlying autonomic pathophysiological mechanisms behind this remain unclear. Current hypotheses include neurotropism, cytokine storms, and inflammatory persistence. Certain immunological factors indicate autoimmune dysfunction, which can be used to identify patients at a higher risk of Long COVID. Heart rate variability can indicate autonomic imbalances in individuals suffering from Long COVID, and measurement is a non-invasive and low-cost method for assessing cardiovascular autonomic modulation. Additionally, biochemical inflammatory markers are used for diagnosing and monitoring Long COVID. These inflammatory markers can be used to improve the understanding of the mechanisms driving the inflammatory response and its effects on the sympathetic and parasympathetic pathways of the autonomic nervous system. Autonomic imbalances in patients with Long COVID may result in lower heart rate variability, impaired vagal activity, and substantial sympathovagal imbalance. New research on this subject must be encouraged to enhance the understanding of the long-term risks that cardiovascular autonomic imbalances can cause in individuals with Long COVID.
- Implementing a provisional overarching intervention for COVID-19 monitoring and control in the Brazil-Colombia-Peru frontier(2024) CONTRERAS, Matilde; NAVECA, Felipe Gomes; CARVAJAL-CORTES, Jose Joaquin; FAVIERO, Guilherme F.; SAAVEDRA, Jorge; SANTOS, Eduardo Ruback dos; NASCIMENTO, Valdinete Alves do; SOUZA, Victor Costa de; NASCIMENTO, Fernanda Oliveira do; SILVA, Dejane Silva e; LUZ, Sergio Luiz Bessa; VESGA, Kelly Natalia Romero; NIETO, Juan Camilo Grisales; AVELINO-SILVA, Vivian I.; BENZAKEN, Adele SchwartzIntroduction: he challenge was to provide comprehensive health resources to a remote and underserved population living in the Brazil-Colombia-Peru border, amid the most disruptive global crisis of the century. Methods: In August 2021, Funda & ccedil;& atilde;o Oswaldo Cruz Amazonia (FIOCRUZ Amaz & ocirc;nia) and partner collaborators implemented an overarching provisional program for SARS-CoV-2 detection and lineages characterization, training of laboratory personnel and healthcare providers, donation of diagnostic supplies and personal protective equipment, and COVID-19 vaccination. The expedition was conducted at the Port of Tabatinga, a busy terminal with an intense flux of people arriving and departing in boats of all sizes, located in the Amazon River basin. Local government, non-profit organizations, private companies, and other stakeholders supported the intervention. Results: The expedition was accomplished in a convergence point, where migrant workers, traders, army personnel, people living in urban areas, and people from small villages living in riversides and indigenous territories are in close and frequent contact, with widespread cross-border movement. Using a boat as a provisional lab and storage facility, the intervention provided clinical and laboratory monitoring for 891 participants; vaccination for 536 individuals; personal protective equipment for 200 healthcare providers; diagnostic supplies for 1,000 COVID-19 rapid tests; training for 42 community health agents on personal protection, rapid test execution, and pulse oximeter management; and hands-on training for four lab technicians on molecular diagnosis. Discussion: Our experience demonstrates that multilateral initiatives can counterweigh the scarcity of health resources in underserved regions. Moreover, provisional programs can have a long-lasting effect if investments are also provided for local capacity building.
- Tip Lesion Most Frequent FSGS Variant Related to COVID-19 Vaccine: Two Case Reports and Literature Review(2024) ARAUJO, Emmy Marjorie Carvalho de; CAMPOS, Marcos Adriano Garcia; SODRE, Andressa Monteiro; HOLANDA, Maria Izabel de; HAGEMANN, Rodrigo; TEIXEIRA JUNIOR, Antonio Augusto Lima; SALGADO FILHO, Natalino; NEVES, Precil Diego Miranda de Menezes; SILVA, Gyl Eanes BarrosLarge-scale COVID-19 vaccination has been one of the most effective strategies to control the spread of the SARS-CoV-2 virus. However, several cases of glomerular injury related to the COVID-19 vaccine have been described in the literature. We report two cases of a tip lesion variant of focal segmental glomerulosclerosis (FSGS), which presented with significant proteinuria and improved after immunosuppression. In our literature review, the tip lesion variant of FSGS is currently the most frequent variant associated with vaccination against COVID-19. Prognosis is favorable and without significant alterations in the tubulointerstitial or vascular compartments. Adverse effects of vaccines need to be recognized early and will help us to understand the immune and pathological mechanisms of kidney damage.
- Effectiveness of the BNT162b2 mRNA COVID-19 vaccine in children under 5 years(2023) STRUMANN, Christoph; RANZANI, Otavio; MOOR, Jeanne; BERNER, Reinhard; TOEPFNER, Nicole; CHAO, Cho-Ming; MOOR, Matthias B.
- Metagenomic of Liver Tissue Identified at Least Two Genera of Totivirus-like Viruses in Molossus molossus Bats(2024) COUTO, Roseane da Silva; RAMOS, Endrya do Socorro Foro; ABREU, Wandercleyson Uchoa; RODRIGUES, Luis Reginaldo Ribeiro; MARINHO, Luis Fernando; MORAIS, Vanessa dos Santos; VILLANOVA, Fabiola; PANDEY, Ramendra Pati; DENG, Xutao; DELWART, Eric; COSTA, Antonio Charlys da; LEAL, ElcioThe Totiviridae family of viruses has a unique genome consisting of double-stranded RNA with two open reading frames that encode the capsid protein (Cap) and the RNA-dependent RNA polymerase (RdRpol). Most virions in this family are isometric in shape, approximately 40 nm in diameter, and lack an envelope. There are five genera within this family, including Totivirus, Victorivirus, Giardiavirus, Leishmaniavirus, and Trichomonasvirus. While Totivirus and Victorivirus primarily infect fungi, Giardiavirus, Leishmaniavirus, and Trichomonasvirus infect diverse hosts, including protists, insects, and vertebrates. Recently, new totivirus-like species have been discovered in fish and plant hosts, and through metagenomic analysis, a novel totivirus-like virus (named Tianjin totivirus) has been isolated from bat guano. Interestingly, Tianjin totivirus causes cytopathic effects in insect cells but cannot grow in mammalian cells, suggesting that it infects insects consumed by insectivorous bats. In this study, we used next-generation sequencing and identified totivirus-like viruses in liver tissue from Molossus molossus bats in the Amazon region of Brazil. Comparative phylogenetic analysis based on the RNA-dependent RNA polymerase region revealed that the viruses identified in Molossus bats belong to two distinct phylogenetic clades, possibly comprising different genera within the Totiviridae family. Notably, the mean similarity between the Tianjin totivirus and the totiviruses identified in Molossus bats is less than 18%. These findings suggest that the diversity of totiviruses in bats is more extensive than previously recognized and highlight the potential for bats to serve as reservoirs for novel toti-like viruses.
- Human Rabies during the COVID-19 Pandemic: Insights into Rabies Worldwide and Brazil(2024) FARIAS, Luis Arthur Brasil Gadelha; CAMINHA, Iusta; NETO, Lauro Vieira Perdigao; CAVALCANTI, Luciano Pamplona de GoesHuman Rabies (HR) is a fatal zoonotic disease caused by lyssaviruses, with the rabies virus (RABV) identified as the causative agent. While the incidence of HR transmitted by dogs has decreased in Latin America, there has been a corresponding rise in transmission via wild animals. Given the lack of effective treatments and specific therapies, the management of HR relies on the availability of post-exposure prophylaxis and animal control measures. This review examines the dynamics and spread of HR during the global pandemic.