Usefulness of the Phalen Test and the Tinel Sign in the Prognosis and the Impact on Quality of Life of Patients with Carpal Tunnel Syndrome Undergoing Classical Open Carpal Tunnel Release.

Objective: To evaluate the usefulness of the Phalen test and the Tinel sign in the prognosis and the impact on quality of life in the clinical course of patients with carpal tunnel syndrome undergoing surgical treatment through the traditional open approach. Methods: The present is a cohort study on prognosis. We included 115 patients with high probability of receiving a clinical diagnosis of carpal tunnel syndrome with indication for surgical treatment. All patients underwent the Phalen test and Tinel sign and answered the Boston Carpal Tunnel Questionnaire before and after the surgical treatment. Results: The estimates for the probability of the time until remission of the Phalen test at 2, 4 and 16 weeks postoperatively were of 3.54% (95% confidence interval [95%CI]: 1.16%-8.17%), 0.88% (95%CI: 0.08%-4.38%) and 0.88% (95%CI: 0.08% to 4.38%) respectively, and, for the Tinel sign, they were of 12.39% (95%CI: 7.13%-19.18% ), 4.42% (95%CI : 1.65%-9.36%) and 2.65% (95%CI : 0.70%-6.94%) respectively. There was a reduction in the postoperative score on the Boston Carpal Tunnel Questionnaire of 1.8 points for symptom severity ( p < 0.001) and of 1.6 points for functional status ( p < 0.001). Conclusion: Phalen test remission was earlier than that of the Tinel sign, but, when performed as of the second postoperative week, they were prognostic factors favorable to the clinical course, with improved quality of life.

Serological screening in a large-scale municipal survey in Cascais, Portugal, during the first waves of the COVID-19 pandemic: lessons for future pandemic preparedness efforts.

Background: Serological surveys for SARS-CoV-2 were used early in the COVID-19 pandemic to assess epidemiological scenarios. In the municipality of Cascais (Portugal), serological testing combined with a comprehensive socio-demographic, clinical and behavioral questionnaire was offered to residents between May 2020 and beginning of 2021. In this study, we analyze the factors associated with adherence to this municipal initiative, as well as the sociodemographic profile and chronic diseases clinical correlates associated to seropositivity. We aim to contribute with relevant information for future pandemic preparedness efforts. Methods: This was a cross-sectional study with non-probabilistic sampling. Citizens residing in Cascais Municipality went voluntarily to blood collection centers to participate in the serological survey. The proportion of participants, stratified by socio-demographic variables, was compared to the census proportions to identify the groups with lower levels of adherence to the survey. Univariate and multivariate logistic regression were used to identify socio-demographic, clinical and behavioral factors associated with seropositivity. Results: From May 2020 to February 2021, 19,608 participants (9.2% of the residents of Cascais) were included in the study. Based on the comparison to census data, groups with lower adherence to this survey were men, the youngest and the oldest age groups, individuals with lower levels of education and unemployed/inactive. Significant predictors of a reactive (positive) serological test were younger age, being employed or a student, and living in larger households. Individuals with chronic diseases generally showed lower seroprevalence. Conclusion: The groups with low adherence to this voluntary study, as well as the socio-economic contexts identified as more at risk of viral transmission, may be targeted in future pandemic situations. We also found that the individuals with chronic diseases, perceiving higher risk of serious illness, adopted protective behaviors that limited infection rates, revealing that health education on preventive measures was effective for these patients.

Applying Next-Generation Sequencing to Track HIV-1 Drug Resistance Mutations Circulating in Portugal.

BACKGROUND: The global scale-up of antiretroviral treatment (ART) offers significant health benefits by suppressing HIV-1 replication and increasing CD4 cell counts. However, incomplete viral suppression poses a potential threat for the emergence of drug resistance mutations (DRMs), limiting ART options, and increasing HIV transmission. OBJECTIVE: We investigated the patterns of transmitted drug resistance (TDR) and acquired drug resistance (ADR) among HIV-1 patients in Portugal. METHODS: Data were obtained from 1050 HIV-1 patient samples submitted for HIV drug resistance (HIVDR) testing from January 2022 to June 2023. Evaluation of DRM affecting viral susceptibility to nucleoside/tide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs) was performed using an NGS technology, the Vela Diagnostics Sentosa SQ HIV-1 Genotyping Assay. RESULTS: About 71% of patients were ART naïve and 29% were experienced. Overall, 20% presented with any DRM. The prevalence of TDR and ADR was 12.6% and 41.1%, respectively. M184V, T215S, and M41L mutations for NRTI, K103N for NNRTI, and M46I/L for PIs were frequent in naïve and treated patients. E138K and R263K mutations against INSTIs were more frequent in naïve than treated patients. TDR and ADR to INSTIs were 0.3% and 7%, respectively. Patients aged 50 or over (OR: 1.81, p = 0.015), originating from Portuguese-speaking African countries (PALOPs) (OR: 1.55, p = 0.050), HIV-1 subtype G (OR: 1.78, p = 0.010), and with CD4 < 200 cells/mm3 (OR: 1.70, p = 0.043) were more likely to present with DRMs, while the males (OR: 0.63, p = 0.003) with a viral load between 4.1 to 5.0 Log10 (OR: 0.55, p = 0.003) or greater than 5.0 Log10 (OR: 0.52, p < 0.001), had lower chances of presenting with DRMs. CONCLUSIONS: We present the first evidence on TDR and ADR to INSTI regimens in followed up patients presenting for healthcare in Portugal. We observed low levels of TDR to INSTIs among ART-naïve and moderate levels in ART-exposed patients. Regimens containing PIs could be an alternative second line in patients with intermediate or high-level drug resistance, especially against second-generation INSTIs (dolutegravir, bictegravir, and cabotegravir).

Dynamics and features of transmission clusters of HIV-1 subtypes in the state of São Paulo, Brazil.

Background: Molecular epidemiology techniques allow us to track the HIV-1 transmission dynamics. Herein, we combined genetic, clinical and epidemiological data collected during routine clinical treatment to evaluate the dynamics and characteristics of transmission clusters of the most prevalent HIV-1 subtypes in the state of São Paulo, Brazil. Methods: This was a cross-sectional study conducted with 2,518 persons living with HIV (PLWH) from 53 cities in São Paulo state between Jan 2004 to Feb 2015. The phylogenetic tree of protease/reverse transcriptase (PR/RT) regions was reconstructed by PhyML and ClusterPicker used to infer the transmission clusters based on Shimodaira-Hasegawa (SH) greater than 90% (phylogenetic support) and genetic distance less than 6%. Results: Of a total of 2,518 sequences, 2,260 were pure subtypes at the PR/RT region, being B (88%), F1 (8.1%), and C (4%). About 21.2% were naïve with a transmitted drug resistance (TDR) rate of 11.8%. A total of 414 (18.3%) of the sequences clustered. These clusters were less evident in subtype B (17.7%) and F1 (15.1%) than in subtype C (40.2%). Clustered sequences were from PLWH at least 5 years younger than non-clustered among subtypes B (p < 0.001) and C (p = 0.037). Men who have sex with men (MSM) predominated the cluster in subtype B (51%), C (85.7%), and F1 (63.6%; p < 0.05). The TDR rate in clustered patients was 15.4, 13.6, and 3.1% for subtypes B, F1, and C, respectively. Most of the infections in subtypes B (80%), C (64%), and F1 (59%) occurred within the state of São Paulo. The metropolitan area of São Paulo presented a high level of endogenous clustering for subtypes B and C. The São Paulo city had 46% endogenous clusters of subtype C. Conclusion: Our findings showed that MSM, antiretroviral therapy in Treatment-Naive (ART-naïve) patients, and HIV1-C, played an important role in the HIV epidemic in the São Paulo state. Further studies in transmission clusters are needed to guide the prevention intervention.

Sociodemographic and clinical features related to hepatitis B virus infection among rejected blood donors in Luanda, Angola.

Background: Hepatitis B virus (HBV) remains a public health concern. Blood donors screened for HBV surface antigen (HBsAg) along with aspartate transaminase (AST)/alanine aminotransferase (ALT) could play a key in providing safe blood products. We investigated the features related to HBV infection among rejected blood donors in Luanda, Angola. Methods: This was a cross-sectional study conducted with 164 rejected donors. Donors were screened for HBsAg from March to May 2022. Overall, 63.4% tested positive for HBV. Results: The mean age of the HBV-positive (29.2 ± 8.02) was lower than the HBV-negative (33.9 ± 10.0) (p < 0.001). Donors between 20 and 40 years (odds ratio [OR]: 2.34, p = 0.045), females (OR: 1.40, p = 0.516), residents in urbanized areas (OR: 1.23, p = 0.530), low educational (OR: 1.54, p = 0.458), unemployed (OR: 1.65, p = 0.271), and unmarried (OR:1.41, p = 0.616) might be likely to contract HBV. AST/ALT ratio was higher in HBV-infected (2.07 ± 1.42) than in HBV-uninfected (1.90 ± 1.14). About 20% of HBV-positive were classified as having acute liver disease, while 80% with chronic liver disease, based on AST/ALT ratio. Age ranged from 20 to 40 years (OR: 1.97, p = 0.305), females (OR: 1.61, p = 0.557), donors from non-urbanized (OR: 1.69, p = 0.557), a low educational (OR: 1.64, p = 0.571), and unemployed donors (OR: 1.81, p = 0.289) were likely to develop chronic liver disease. Conclusions: Our findings indicated the failure of viral hepatitis control measures. Authorities should consider including HBV nucleic acid testing to ensure early identification of HBV in Angola.

HIV-1 diversity and pre-treatment drug resistance in the era of integrase inhibitor among newly diagnosed ART-naïve adult patients in Luanda, Angola.

The surveillance of drug resistance in the HIV-1 naïve population remains critical to optimizing the effectiveness of antiretroviral therapy (ART), mainly in the era of integrase strand transfer inhibitor (INSTI) regimens. Currently, there is no data regarding resistance to INSTI in Angola since Dolutegravir-DTG was included in the first-line ART regimen. Herein, we investigated the HIV-1 genetic diversity and pretreatment drug resistance (PDR) profile against nucleoside/tide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and INSTIs, using a next-generation sequencing (NGS) approach with MinION, established to track and survey DRMs in Angola. This was a cross-sectional study comprising 48 newly HIV-diagnosed patients from Luanda, Angola, screened between March 2022 and May 2023. PR, RT, and IN fragments were sequenced for drug resistance and molecular transmission cluster analysis. A total of 45 out of the 48 plasma samples were successfully sequenced. Of these, 10/45 (22.2%) presented PDR to PIs/NRTIs/NNRTIs. Major mutations for NRTIs (2.2%), NNRTIs (20%), PIs (2.2%), and accessory mutations against INSTIs (13.3%) were detected. No major mutations against INSTIs were detected. M41L (2%) and I85V (2%) mutations were detected for NRTI and PI, respectively. K103N (7%), Y181C (7%), and K101E (7%) mutations were frequently observed in NNRTI. The L74M (9%) accessory mutation was frequently observed in the INSTI class. HIV-1 pure subtypes C (33%), F1 (17%), G (15%), A1 (10%), H (6%), and D (4%), CRF01_AG (4%) were observed, while about 10% were recombinant strains. About 31% of detected HIV-1C sequences were in clusters, suggesting small-scale local transmission chains. No major mutations against integrase inhibitors were detected, supporting the continued use of INSTI in the country. Further studies assessing the HIV-1 epidemiology in the era of INSTI-based ART regimens are needed in Angola.

Sociodemographic, Clinical, and Behavioral Factors Associated with Sexual Transmitted Infection among HIV-1 Positive Migrants in Portugal: Are There Differences between Sexes?

INTRODUCTION: Sexually transmitted infections (STIs) continue to occur at high levels. According to the WHO, each year there are an estimated 374 million new infections with syphilis, gonorrhea, chlamydia, and trichomoniasis. STIs are associated with an increased risk of acquiring HIV infection. Migrants are reportedly highly affected by STIs. OBJECTIVES: This study aims to characterize factors associated with STIs in a population of HIV-positive migrants living in Portugal. METHODOLOGY: This is a cross-sectional observational study of 265 newly diagnosed HIV-1 positive migrants, who were defined as individuals born outside Portugal. This group of people were part of the BESTHOPE study that was developed in 17 Portuguese hospitals between September 2014 and December 2019, and included information collected through sociodemographic and behavioral questionnaires filled in by the migrant patients, clinical questionnaires filled in by the clinicians and HIV-1 genomic sequences generated through resistance testing (Sanger sequencing). A multivariable statistical analysis was used to analyze the association between sociodemographic characteristics, sexual behaviors, HIV testing and sexual infections. RESULTS: Most HIV-1 positive individuals included in the study were men (66.8%) and aged between 25 and 44 years old (59.9%). Men had a higher proportion of STIs when compared to women (40.4% vs. 14.0%) and the majority of men reported homosexual contacts (52.0%). Most men reported having had two or more occasional sexual partners in the previous year (88.8%) and 50.9% reported always using condoms with occasional partners, while 13.2% never used it. For regular partners, only 29.5% of the women reported using condoms, compared to 47.3% of men. Other risk behaviors for acquiring HIV, such as tattooing and performing invasive medical procedures, were more prevalent in men (38.0% and 46.2%, respectively), when compared to women (30.4% and 45.1% respectively) and 4.7% of men reported having already shared injectable materials, with no data for comparison in the case for women. Additionally, 23.9% of women reported having had a blood transfusion while only 10.3% of men reported having had this medical procedure. Meanwhile, 30.9% of the individuals reported having been diagnosed with some type of STI in the last 12 months. In addition, 43.3% of individuals that answered a question about hepatitis reported to be infected with hepatitis B, while 13.0% reported having hepatitis C infection. According to the multivariable analysis, the only transmission route was significantly associated with reports of previous STI infection: men who have sex with men (MSM) were 70% more likely to have been diagnosed with an STI in the past 12 months compared to the heterosexual route. CONCLUSION: HIV-1 infected men were more likely to report previous STIs than women. On the other hand, most migrant women had a regular sexual partner and never or only sometimes used condoms. This somewhat discrepant findings suggest that gender inequalities may make women unable to negotiate safe sexual practices, resulting in increased susceptibility to infection. However, since migrant women report less STIs, we cannot exclude that these STIs may remain undiagnosed. The implementation of safer sex awareness campaigns for condom use and screening for STIs in women is crucial. On the other hand, health education campaigns for STI knowledge need to be implemented for both MSM and women and their partners.

Determinants of HIV late presentation among men who have sex with men in Portugal (2014-2019): who's being left behind?

Introduction: HIV late presentation (LP) remains excessive in Europe. We aimed to analyze the factors associated with late presentation in the MSM population newly diagnosed with HIV in Portugal between 2014 and 2019. Methods: We included 391 newly HIV-1 diagnosed Men who have Sex with Men (MSM), from the BESTHOPE project, in 17 countrywide Portuguese hospitals. The data included clinical and socio-behavioral questionnaires and the viral genomic sequence obtained in the drug resistance test before starting antiretrovirals (ARVs). HIV-1 subtypes and epidemiological surveillance mutations were determined using different bioinformatics tools. Logistic regression was used to estimate the association between predictor variables and late presentation (LP). Results: The median age was 31 years, 51% had a current income between 501-1,000 euros, 28% were migrants. 21% had never been tested for HIV before diagnosis, with 42.3% of MSM presenting LP. 60% were infected with subtype B strains. In the multivariate regression, increased age at diagnosis, higher income, lower frequency of screening, STI ever diagnosed and higher viral load were associated with LP. Conclusion: Our study suggests that specific subgroups of the MSM population, such older MSM, with higher income and lower HIV testing frequency, are not being targeted by community and clinical screening services. Overall, targeted public health measures should be strengthened toward these subgroups, through strengthened primary care testing, expanded access to PrEP, information and promotion of HIV self-testing and more inclusive and accessible health services.

The Role of Late Presenters in HIV-1 Transmission Clusters in Europe.

BACKGROUND: Investigating the role of late presenters (LPs) in HIV-1 transmission is important, as they can contribute to the onward spread of HIV-1 virus before diagnosis, when they are not aware of their HIV status. OBJECTIVE: To characterize individuals living with HIV-1 followed up in Europe infected with subtypes A, B, and G and to compare transmission clusters (TC) in LP vs. non-late presenter (NLP) populations. METHODS: Information from a convenience sample of 2679 individuals living with HIV-1 was collected from the EuResist Integrated Database between 2008 and 2019. Maximum likelihood (ML) phylogenies were constructed using FastTree. Transmission clusters were identified using Cluster Picker. Statistical analyses were performed using R. RESULTS: 2437 (91.0%) sequences were from subtype B, 168 (6.3%) from subtype A, and 74 (2.8%) from subtype G. The median age was 39 y/o (IQR: 31.0-47.0) and 85.2% of individuals were males. The main transmission route was via homosexual (MSM) contact (60.1%) and 85.0% originated from Western Europe. In total, 54.7% of individuals were classified as LPs and 41.7% of individuals were inside TCs. In subtype A, individuals in TCs were more frequently males and natives with a recent infection. For subtype B, individuals in TCs were more frequently individuals with MSM transmission route and with a recent infection. For subtype G, individuals in TCs were those with a recent infection. When analyzing cluster size, we found that LPs more frequently belonged to small clusters (<8 individuals), particularly dual clusters (2 individuals). CONCLUSION: LP individuals are more present either outside or in small clusters, indicating a limited role of late presentation to HIV-1 transmission.

Usefulness of the Phalen Test and the Tinel Sign in the Prognosis and the Impact on Quality of Life of Patients with Carpal Tunnel Syndrome Undergoing Classical Open Carpal Tunnel Release / Utilidade do teste de Phalen e do sinal de Tinel no prognóstico e o impacto na qualidade de vida de pacientes com síndrome do túnel do carpo submetidos a liberação aberta clássica do túnel do carpo

Abstract Objective: To evaluate the usefulness of the Phalen test and the Tinel sign in the prognosis and the impact on quality of life in the clinical course of patients with carpal tunnel syndrome undergoing surgical treatment through the traditional open approach. Methods: The present is a cohort study on prognosis. We included 115 patients with high probability of receiving a clinical diagnosis of carpal tunnel syndrome with indication for surgical treatment. All patients underwent the Phalen test and Tinel sign and answered the Boston Carpal Tunnel Questionnaire before and after the surgical treatment. Results: The estimates for the probability of the time until remission of the Phalen test at 2, 4 and 16 weeks postoperatively were of 3.54% (95% confidence interval [95% CI]: 1.16%-8.17%), 0.88% (95%CI: 0.08%-4.38%) and 0.88% (95%CI: 0.08% to 4.38%) respectively, and, for the Tinel sign, they were of 12.39% (95%CI: 7.13%-19.18%), 4.42% (95%CI : 1.65%-9.36%) and 2.65% (95%CI : 0.70%-6.94%) respectively. There was a reduction in the postoperative score on the Boston Carpal Tunnel Questionnaire of 1.8 points for symptom severity (p < 0.001) and of 1.6 points for functional status (p < 0.001). Conclusion: Phalen test remission was earlier than that of the Tinel sign, but, when performed as of the second postoperative week, they were prognostic factors favorable to the clinical course, with improved quality of life.

Resumo Objetivo: Avaliar a utilidade do teste de Phalen e do sinal de Tinel no prognóstico e o impacto na qualidade de vida no curso clínico de pacientes com síndrome do túnel do carpo submetidos ao tratamento cirúrgico por via aberta clássica. Métodos: Trata-se de um estudo de coorte sobre prognóstico. Foram incluídos 115 pacientes com alta probabilidade de diagnóstico clínico de síndrome do túnel do carpo com indicação de tratamento cirúrgico. Todos os pacientes foram submetidos ao teste de Phalen e ao sinal de Tinel, e responderam ao questionário de Boston antes e depois do tratamento cirúrgico. Resultados: As estimativas de probabilidade do tempo até a remissão do teste de Phalen em 2, 4 e 16 semanas pós-operatórias foram de 3,54% (intervalo de confiança de 95% [IC95%]:1,16%-8,17%), 0,88% (IC95%: 0,08%-4,38%) e 0,88% (IC95%: 0,08%-4,38%), respectivamente, e, do sinal de Tinel, foram de 12,39% (IC95%: 7,13%-19,18%), 4,42% (IC95%: 1,65%-9,36%) e 2,65% (IC95%: 0,70%-6,94%), respectivamente. Na pontuação pós-operatória no Questionário de Boston, houve redução de 1,8 ponto para a gravidade dos sintomas (p < 0,001), e de 1,6 ponto para o estado funcional (p < 0,001). Conclusão: A remissão do teste de Phalen foi mais precoce do que a do sinal de Tinel, mas, realizados a partir da segunda semana de evolução pós-operatória, esses testes foram fatores prognósticos favoráveis ao curso clínico, com melhora da qualidade de vida.

Prevalence of Anatomical Variations in Patients with Carpal Tunnel Syndrome Undergoing Classical Open Carpal Tunnel Release / Prevalência de variações anatômicas encontradas em pacientes com síndrome do túnel do carpo submetidos a liberação cirúrgica por via aberta clássica

Abstract Objective To evaluate the prevalence of anatomical variations encountered in patients with carpal tunnel syndrome who underwent carpal tunnel classical open release. Methods A total of 115 patients with a high probability of clinical diagnosis for carpal tunnel syndrome and indication for surgical treatment were included. These patients underwent electroneuromyography and ultrasound for diagnostic confirmation. They underwent surgical treatment by carpal tunnel classical open release, in which a complete inventory of the surgical wound was performed in the search and visualization of anatomical variations intra- and extra-carpal tunnel. Results The total prevalence of anatomical variations intra- and extra-carpal tunnel found in this study was 63.5% (95% confidence interval [CI]: 54.5-72.4). The prevalence of the carpal transverse muscle was 57.4% (95% CI: 47.8-66.6%), of the bifid median nerve associated with the persistent median artery was 1.7% (95% CI: 0.0-4.2%), and the median bifid nerve associated with the persistent median artery and the transverse carpal muscle was 1.7% (95% CI: 0.0-4.2%). Conclusion The most prevalent extra-carpal tunnel anatomical variation was carpal transverse muscle. The most prevalent intra-carpal tunnel anatomical variation was median bifid nerve associated with the persistent median artery. The surgical finding of an extra-carpal tunnel anatomical variation, such as the transverse carpal muscle, may indicate the presence of other associated carpal intra tunnel anatomical variations, such as the bifid median nerve, persistent median artery, and anatomical variations of the recurrent median nerve branch.

Resumo Objetivo Avaliar a prevalência de variações anatômicas encontradas em pacientes com síndrome do túnel do carpo submetidos a liberação cirúrgica por via aberta clássica. Métodos Foram incluídos um total de 115 pacientes com alta probabilidade de diagnóstico clínico de síndrome do túnel do carpo, com indicação para o tratamento cirúrgico. Estes pacientes realizaram eletroneuromiografia e ultrassonografia para confirmação diagnóstica. Foram submetidos ao tratamento cirúrgico por via aberta clássica, no qual foi realizado um inventário completo da ferida operatória na busca e visualização de variações anatômicas intra e extra túnel do carpo. Resultados A prevalência total das variações anatômicas intra e extra túnel do carpo encontradas neste estudo foi de 63,5% (intervalo de confiança [IC]95%: 54,5-72,4%). A prevalência do músculo transverso do carpo foi de 57,4% (IC95%: 47,8-66,6%), do nervo mediano bífido associado à artéria mediana persistente foi de 1,7% (IC95%: 0,0-4,2%) e do nervo mediano bífido associado à artéria mediana persistente e ao músculo transverso do carpo foi de 1,7% (IC95%: 0,0-4,2%). Conclusão A variação anatômica extra túnel do carpo mais prevalente foi o músculo transverso do carpo e a variação anatômica intra túnel do carpo mais prevalente foi o nervo mediano bífido associado à artéria mediana persistente. O achado cirúrgico de uma variação anatômica extra túnel do carpo, como o músculo transverso do carpo, pode nos indicar a presença de outras variações anatômicas intra túnel do carpo associadas, como nervo mediano bífido, artéria mediana persistente e variações anatômicas do ramo recorrente do nervo mediano.

Biochemical detection of E-ADA on Neospora caninum tachyzoites and the effects of a specific enzymatic inhibitor / Detección bioquímica de E-ADA en taquizoitos de Neospora caninum y los efectos de un inhibidor enzimático específico

Objective. This study aimed to investigate the presence and activity of the ecto adenosine deaminase (E-ADA) enzyme in tachyzoites of Neospora caninum (Nc-1 strain), as well as to assess the activity of a well-known E-ADA inhibitor, the deoxycoformycin. Materials and methods. The parasites were grown in cell culture, being subsequently separated in a pellet of tachyzoites, on which the E-ADA activity was tested using the concentrations 0 (control), 0.2, 0.4 and 0.8 mg mL-1. Results. The E-ADA showed high activity, progressively increasing its activity according to the enhancement of the protein concentration. The test was carried out with different concentrations of deoxycoformycin, showing that it was able to inhibit the E-ADA present on the free form of the parasite. Conclusions. Based on these results we conclude that the E-ADA is present on tachyzoites of N. caninum, and deoxycoformycin is able to inhibit this enzyme. In this sense, knowing the negative impact of N. caninum on reproductive issue in cattle (mainly abortion), might it is an alternative in order to deal with this parasitic infection.

Objetivo. Este estudio tuvo como objetivo investigar la presencia y la actividad de la adenosina deaminasa (E-ADA) en taquizoitos de Neospora caninum (Nc-1 cepa), así como ensayar un conocido inhibidor de estas enzimas. Material y métodos. Los parásitos se multiplicaron en cultivo celular y posteriormente fueron separados en un sedimento de taquizoitos. La actividad de E-ADA fue probada en el parásito, usando concentraciones de 0 (control), 0.2, 0.4 y 0.8 mg mL-1. Resultados. El E-ADA tenía una alta actividad aumentó progresivamente de acuerdo con la concentración de proteínas. La prueba se llevó a cabo con diferentes concentraciones del inhibidor E-ADA (desoxicoformicina) y fue capaz de inhibir la presente E-ADA en el parásito. Conclusiones. Por la observación de los resultados se concluye que la enzima E-ADA está presente en taquizoítos de N. caninum, y desoxicoformicina es capaz de inhibir la acción de la enzima. En este sentido, conocer el impacto negativo del parásito en los problemas productivos y reproductivos en el ganado (principalmente abortos), estos resultados pueden ser una alternativa para evitar esta enfermedad parasitaria.

Fibrocondrogénesis: diagnóstico prenatal en feto de 22 semanas / Fibrocondrogenesis: prenatal diagnosis in a fetus at 22 weeks

Las displasias esqueléticas son patologías que presentan una alteración generalizada del tejido óseo y constituyen una de las causas más frecuentes del retardo severo del crecimiento. Si bien algunas son más comunes que otras, en conjunto presentan una frecuencia de aparición elevada de aproximadamente 1 en 3.000 a 1 en 5.000 recién nacidos. Los criterios usados para la distinción y clasificación de los trastornos genéticos del esqueleto han sido características clínicas como el crecimiento, la edad de comienzo del retardo del crecimiento, la presencia y naturaleza de las alteraciones en las proporciones corporales, y criterios radiológicos...

Analysis of a case series of behavioral variant frontotemporal dementia: emphasis on diagnostic delay / Análise de uma série de casos de variante comportamental da demência frontotemporal: ênfase no atraso diagnóstico

INTRODUCTION: Despite many advances in the characterization of the behavioral variant of frontotemporal dementia (bvFTD), the diagnosis of this syndrome poses a significant challenge, while delays or diagnostic mistakes may impact the proper clinical management of these patients. OBJECTIVE: To describe the clinical profile at first evaluation of a sample of patients with bvFTD from a specialized outpatient neurological unit, with emphasis on the analysis of the delay between the onset of symptoms and diagnosis.METHODS: We selected 31 patients that fulfilled international consensus criteria for possible or probable bvFTD. Patients' medical admission sheets were thoroughly reviewed. RESULTS: Patients' mean age was 67.9±8.2 years; 16 (51.6%) were men. Mean number of years of formal education was 7.7±4.0 years. Mean age at onset was 62.2±7.7 years, indicating a mean of 5.8 years of diagnostic delay. Thirteen patients (41.9%) presented with initial behavioral complaints only, eleven patients (35.5%) had mixed behavioral and memory complaints, five patients (16.1%) presented with memory complaints only, and two patient (6.4%) had behavioral and speech problems. Nine patients (29%) were admitted with alternative diagnoses. Mean and standard deviation scores for the mini-mental state examination, animal category fluency and memory test for drawings (five-minute delayed recall) were 19.3±6.3, 8.3±4.1 and 3.7±2.7, respectively. CONCLUSION: Most patients from this sample were evaluated almost six years after the onset of symptoms and performed poorly on both cognitive screening tests and functional evaluation measures.

INTRODUÇÃO:Apesar dos avanços na caracterização da variante comportamental da demência frontotemporal (vcDFT), o diagnóstico da síndrome apresenta-se desafiador e atrasos ou erros diagnósticos podem prejudicar o tratamento adequado aos pacientes. OBJETIVO: Descrever o perfil clínico à primeira avaliação de pacientes com vcDFT de uma unidade neurológica ambulatorial especializada, com ênfase na análise do atraso entre o início dos sintomas e diagnóstico. MÉTODOS: Selecionamos 31 pacientes que preencheram os critérios internacionais para vcDFT possível ou provável. As fichas de admissão foram minuciosamente revisadas. RESULTADOS: A média de idade dos pacientes foi 67,9±8,2 anos; 16 (51,6%) eram homens. A média de anos de escolaridade foi de 7,7±4,0 anos. A média de idade de início dos sintomas foi 62,2±7,7 anos, indicando um atraso diagnóstico médio de 5,8 anos. Treze pacientes (41,9%) apresentaram-se com apenas queixas comportamentais, onze pacientes (35,5%) tinham queixas amnésticas e comportamentais, cinco pacientes (16,1%) apresentaram-se apenas com queixas de perda de memória, e dois pacientes (6,4%) com problemas de fala e comportamentais. Nove pacientes (29%) foram admitidos com diagnósticos alternativos. A média e desvio-padrão dos escores do mini-exame do estado mental, fluência verbal de animais e teste de memória de figuras (evocação em cinco minutos) foram 19,3±6,3, 8,3±4,1 e 3,7±2,7, respectivamente. CONCLUSÃO: A maioria dos pacientes da amostra foi avaliada após uma média de quase seis anos de início dos sintomas e apresentaram baixo desempenho nos testes cognitivos e nas medidas de avaliação funcional.

SARS-CoV-2 epidemic in Brazil: how variants displacement have driven distinct epidemic waves

Brazil ranks as third in terms of total number of reported SARS-CoV-2 cases globally. The COVID- 19 epidemic in Brazil was characterised by the co-circulation of multiple variants as a consequence of multiple independent introduction events occurring through time. Here, we describe the SARS-CoV-2 variants that are currently circulating and co-circulating in the country, with the aim to highlight which variants have driven the different epidemic waves. For this purpose, we retrieved metadata information of Coronavirus sequences collected in Brazil and available at the GISAID database. SARS-CoV-2 lineages have been identified along with eleven variants, labelled as VOCs (Alpha, Gamma, Beta, Delta and Omicron) VOIs (Lambda and Mu) VUMs (B.1.1.318) and FMVs (Zeta, Eta and B.1.1.519). Here we show that, in the Brazilian context, after 24 months of sustained transmission and evolution of SARS-CoV-2, local variants (among them the B.1.1.28 and B.1.1.33) were displaced by recently introduced VOCs firstly with the Gamma, followed by Delta and more recently Omicron. The rapid spread of some of those VOCs (such as Gamma and Omicron) was also mirror by a large increase in the number of cases and deaths in the country. This in turn reinforces that, due to the emergence of variants that appear to induce a substantial evasion against neutralizing antibody response, it is important to strengthen genomic effort within the country and how vaccination still remains a critical process to protect the vulnerable population, still at risk of infection and death.

Estudo temporal e dinâmica da diversidade do HIV-1 no Rio de Janeiro

Estudos de epidemiologia molecular do Vírus da Imunodeficiência Humana (HIV-1) realizados no Rio de Janeiro permitiram identificar predominantemente a cocirculação dos subtipos B, da variante B" do subtipo B, F1 e formas recombinantes 20 BF1. Sendo assim, o objetivo desse estudo era traçar a dinâmica temporal dos subtipos e formas recombinantes de HIV-1 em diferentes categorias de exposição ao risco: heterossexuais (HET), bissexuais (BIS) e usuário de drogas injetáveis (UDI) em dois distintos períodos [(1990-92) e (2006-2010)] da epidemia de Aids no Rio de Janeiro. A casuística deste trabalho era composta por indivíduos HIV-1 soropositivos de dois distintos períodos da epidemia de HIV/AIDS, sendo o primeiro de amostras coletas entre 1990-92 (n=130) e o segundo composto por amostras de pacientes diagnosticados entre 2006-2010 (n=88). A subtipagem das amostras foi realizada através da filogenia pelo método de NJ com correção K2p (MEGA 4.0) e a recombinação avaliada pelo bootscan (Simplot 3.2), análise de pontos e árvore de fragmentos. Para entendermos a dinâmica das assinaturas moleculares do subtipo B no topo da alça v3 e a sua distribuição nas distintas categorias exposição de risco realizamos a análise Bayesiana (MrBayes). A análise filogenética da região da gp120 foi realizada para o primeiro período e evidenciou uma prevalência do subtipo B (90%) seguida pelo subtipo F1 (8%) e BF1 (2%). No segundo período do estudo identificamos a seguinte prevalência: (84%) do subtipo B, (9%) F1, (3.5%) C, (2.3%) BF1 e (1.2%) subtipo A. Em geral, das amostras 95 de HET e BIS caracterizadas como subtipo B no primeiro período, 40% tinham a assinatura GPG, 43% GWG e 17% GXG. Na segunda coorte, o subtipo B foi detectado em 74 amostras sendo: 62% GPG, 23% GWG e 15% GXG. A distribuição das variantes do subtipo B do HIV-1 nos dois períodos foi respectivamente: HET (GPG) [60%-69%], (GWG) [20%-13%] e (GXG) [20%-19%] e BIS (GPG) [25%-57%], (GWG) [61%-31%], (GXG) [14%-12%]. O estudo das redes de transmissão dos subtipo B realizado com as amostras do primeiro do estudo que nos permitiu detectar uma distribuição não aleatória destas segundo a categoria de exposição ao risco e assinaturas do topo do v3. De um subconjunto de 79 amostras de ambas coortes, que foram caracterizadas na região da polimerase, 8% apresentaram um perfil de recombinação, sendo estas caracterizadas majoritariamente como URFs e apenas uma amostra CRF40_BF-like. Nossos achados indicam uma redução na frequência da variante B" ao longo do tempo, e sugere que a introdução da variante B" no Rio de Janeiro estava relacionado ao grupo dos BIS.

Estudio de motilidad esofágica en síndrome de Sjögren / Esophagic motility in Sjögren's syndrome

Para evaluar la función motora esofágica en pacientes con síndrome de Sjögren (SS) y su relación con el síntoma disfagia, se estudiaron prospectivamente mediante manometría esofágica y en forma ambulatoria, 20 pacientes que reunían los 4 criterios propuestos por Fox et al. para SS (19 mujeres y 1 hombre, con edad media de 59 años). Estos además contestaron un cuestionario acerca de la existencia de sintomatología esofágica, con especial hincapié en la aparición y evolución de la disfagia. Con el objeto de homogeneizar la edad y sexo del grupo a analizar, se utilizaron 20 individuos del grupo control de la Unidad de Motilidad Digestiva (19 mujeres y 1 hombre con edad media de 56 años), ninguno de los cuales refería sintomatología esofágica ni ingería medicamentos que pudiesen influir en la motilidad digestiva. En el estudio de parámetros motores esofágicos se constató un incremento significativo de la presión del EEI y un enlentecimiento de la progresión de las ondas peristálticas tras las degluciones líquidas en pacientes con SS al compararlos con el grupo control. De acuerdo al resultado de la encuesta, 15 pacientes (75 por ciento) presentaba disfagia de mayor o menor intensidad, y al comparar los parámetros de motilidad entre el grupo con y sin disfagia, no se constataron alteraciones ni diferencias significativas entre ellos. En conclusión, podemos señalar que aunque la presencia de disfagia es un hecho común en los pacientes con SS, la motilidad esofágica no parece estar alterada ni siquiera tras la deglución de saliva, cuyo volumen está disminuido en forma real