Beyond the Ordinary: An Atypical Guillain-Barré Syndrome Case With Unique Characteristics.

We present a patient with pharyngeal-cervical-brachial Guillain-Barré syndrome (PCB-GBS) that progressed to a severe state followed by a quick recovery after treatment. This unique clinical course has not been documented previously and provides a potentially invaluable description of a novel GBS variant. A 42-year-old man arrived at the emergency department with a 24-hour history of dysphagia, weakness in his right arm, and bilateral shoulder weakness. Nerve conduction velocity testing revealed bilateral sensory and motor polyneuropathy, leading to the diagnosis of GBS with the PCB variant. Timely diagnosis and plasmapheresis treatment contributed to a complete recovery of muscle strength and reflexes. In cases resembling ours, it is imperative to contemplate the existence of rare Guillain-Barré variants. This case underscores the necessity of recognizing and addressing rare Guillain-Barré variants in clinical settings with similar presentations.

Gut microbiota from patients with COVID-19 cause alterations in mice that resemble post-COVID symptoms.

Long-term sequelae of coronavirus disease (COVID)-19 are frequent and of major concern. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection affects the host gut microbiota, which is linked to disease severity in patients with COVID-19. Here, we report that the gut microbiota of post-COVID subjects had a remarkable predominance of Enterobacteriaceae strains with an antibiotic-resistant phenotype compared to healthy controls. Additionally, short-chain fatty acid (SCFA) levels were reduced in feces. Fecal transplantation from post-COVID subjects to germ-free mice led to lung inflammation and worse outcomes during pulmonary infection by multidrug-resistant Klebsiella pneumoniae. transplanted mice also exhibited poor cognitive performance. Overall, we show prolonged impacts of SARS-CoV-2 infection on the gut microbiota that persist after subjects have cleared the virus. Together, these data demonstrate that the gut microbiota can directly contribute to post-COVID sequelae, suggesting that it may be a potential therapeutic target.

Prevalence of reported incidental adrenal findings in chest computerized tomography scans performed during the COVID-19 pandemic in a single center in Northeast Brazil.

Objective: We investigated the prevalence of adrenal incidentalomas (AIs) in a nonselected Brazilian population in chest computed tomography (CT) performed during the COVID-19 pandemic. Materials and methods: This was a retrospective cross-sectional observational study using chest CT reports from a tertiary in- and outpatient radiology clinic from March to September 2020. AIs were defined by changes in the shape, size, or density of the gland initially identified in the released report. Individuals with multiple studies were included, and duplicates were removed. Exams with positive findings were reviewed by a single radiologist. Results: A total of 10,329 chest CTs were reviewed, and after duplicate removal, 8,207 exams were included. The median age was 45 years [IQR 35-59 years], and 4,667 (56.8%) were female. Thirty-eight lesions were identified in 36 patients (prevalence 0.44%). A higher prevalence was observed with age, with 94.4% of the findings in patients aged 40 years and over (RR 9.98 IC 2.39-41.58, p 0.002), but there was no significant difference between the sexes. Seventeen lesions (44.7%) had more than 10 HU, and five lesions (12.1%) were more than 4 cm. Conclusion: The prevalence of AIs in an unselected and unreviewed population in a Brazilian clinic is low. The impact on the health system caused by AIs discovered during the pandemic should be small regarding the need for specialized follow-up.

Prevalence of reported incidental adrenal findings in chest computerized tomography scans performed during the COVID-19 pandemic in a single center in Northeast Brazil

ABSTRACT Objective: We investigated the prevalence of adrenal incidentalomas (AIs) in a nonselected Brazilian population in chest computed tomography (CT) performed during the COVID-19 pandemic. Materials and methods: This was a retrospective cross-sectional observational study using chest CT reports from a tertiary in- and outpatient radiology clinic from March to September 2020. AIs were defined by changes in the shape, size, or density of the gland initially identified in the released report. Individuals with multiple studies were included, and duplicates were removed. Exams with positive findings were reviewed by a single radiologist. Results: A total of 10,329 chest CTs were reviewed, and after duplicate removal, 8,207 exams were included. The median age was 45 years [IQR 35-59 years], and 4,667 (56.8%) were female. Thirty-eight lesions were identified in 36 patients (prevalence 0.44%). A higher prevalence was observed with age, with 94.4% of the findings in patients aged 40 years and over (RR 9.98 IC 2.39-41.58, p 0.002), but there was no significant difference between the sexes. Seventeen lesions (44.7%) had more than 10 HU, and five lesions (12.1%) were more than 4 cm. Conclusions: The prevalence of AIs in an unselected and unreviewed population in a Brazilian clinic is low. The impact on the health system caused by AIs discovered during the pandemic should be small regarding the need for specialized follow-up.

The Therapeutic Effect of Phosphopeptide P140 Attenuates Inflammation Induced by Uric Acid Crystals in Gout Arthritis Mouse Model.

Gout is a painful form of inflammatory arthritis characterized by the deposition of monosodium urate (MSU) crystals in the joints. The aim of this study was to investigate the effect of peptide P140 on the inflammatory responses in crystal-induced mouse models of gout and cell models including MSU-treated human cells. Injection of MSU crystals into the knee joint of mice induced neutrophil influx and inflammatory hypernociception. Injection of MSU crystals subcutaneously into the hind paw induced edema and increased pro-inflammatory cytokines levels. Treatment with P140 effectively reduced hypernociception, the neutrophil influx, and pro-inflammatory cytokine levels in these experimental models. Furthermore, P140 modulated neutrophils chemotaxis in vitro and increased apoptosis pathways through augmented caspase 3 activity and reduced NFκB phosphorylation. Moreover, P140 increased the production of the pro-resolving mediator annexin A1 and decreased the expression of the autophagy-related ATG5-ATG12 complex and HSPA8 chaperone protein. Overall, these findings suggest that P140 exerts a significant beneficial effect in a neutrophilic inflammation observed in the model of gout that can be of special interest in the design of new therapeutic strategies.

Ibogaine Blocks Cue- and Drug-Induced Reinstatement of Conditioned Place Preference to Ethanol in Male Mice.

Ibogaine is a psychedelic extracted from the plant Tabernanthe iboga Baill. (Apocynaceae), natural from Africa, and has been proposed as a potential treatment for substance use disorders. In animal models, ibogaine reduces ethanol self-administration. However, no study to date has investigated the effects of ibogaine on ethanol-induced conditioned place preference (CPP). The present study aimed to investigate the effects of repeated treatment with ibogaine on the reinstatement of CPP to ethanol in male mice. The rewarding effects of ethanol (1.8 g/kg, i. p.) or ibogaine (10 or 30 mg/kg, p. o.) were investigated using the CPP model. Furthermore, we evaluated the effects of repeated treatment with ibogaine (10 or 30 mg/kg, p. o.) on the reinstatement of ethanol-induced CPP. Reinstatement was evaluated under two conditions: 1) during a priming injection re-exposure test in which animals received a priming injection of ethanol and had free access to the CPP apparatus; 2) during a drug-free test conducted 24 h after a context-paired re-exposure, in which subjects received an injection of ethanol and were confined to the compartment previously conditioned to ethanol. Our results show that ethanol, but not ibogaine, induced CPP in mice. Treatment with ibogaine after conditioning with ethanol blocked the reinstatement of ethanol-induced CPP, both during a drug priming reinstatement test and during a drug-free test conducted after re-exposure to ethanol in the ethanol-paired compartment. Our findings add to the literature suggesting that psychedelics, in particular ibogaine, may have therapeutic properties for the treatment of alcohol use disorder at doses that do not have rewarding effects per se.

Sex differences in the development of conditioned place preference induced by intragastric alcohol administration in mice.

BACKGROUND: The present study aimed to identify for the first time sex differences in the development of CPP induced by intragastric alcohol administration in mice. METHODS: Male and female adult Swiss mice were submitted to 16 days of conditioning with alcohol (0.5-3.0 g/kg, N = 8/dose/sex), with 2 post-conditioning tests (after 8 and 16 sessions) during the protocol. RESULTS: 8 days of conditioning (4 alcohol sessions, 4 saline sessions) with intragastric alcohol administration were sufficient to induce CPP in male mice at the doses of 1.0, 1.5 and 2.0 g/kg. However, only higher doses (2.0, 2.5 and 3.0 g/kg) induced CPP in female mice using an 8-day conditioning protocol, while a 16-day conditioning protocol was necessary for the development of intragastric alcohol-induced CPP at the doses of 1.0 and 1.5 g/kg. Regardless of the conditioning protocol, higher doses or alcohol that had rewarding effects in females (2.5 and 3.0 g/kg) did not induce CPP in males, with a significant difference between males and females at those doses. Analysis of the potency (EC50) and efficacy (Emax) of alcohol in inducing CPP when administered intragastrically in male and female mice showed significant sex differences with 8 conditioning sessions. CONCLUSIONS: Our data show a clear protocol (8 vs 16 days) and dose difference between male and female Swiss mice regarding the development of CPP induced by intragastric alcohol administration. Intragastric alcohol administration is closer to human drinking, and our protocol provides a more translational approach to studying the rewarding effects of alcohol in mice.

Conjuntivite e COVID-19 / Conjunctivitis and COVID-19

RESUMO Apresentamos um caso de conjuntivite por SARS-CoV-2 em mulher de 55 anos, com hiperemia e sensação de corpo estranho em ambos os olhos. O exame oftalmológico revelou conjuntivite. A paciente apresentou reação em cadeia da polimerase de SARS-CoV-2 detectável em swab conjuntival e nasal. O tratamento foi realizado com colírio de ciprofloxacina, corticoide e trometamol por 5 dias. Após o sétimo dia de evolução, houve melhora importante da conjuntivite, e foi repetido swab conjuntival, com resultado não detectável.

ABSTRACT We present a case of SARS-CoV-2 conjunctivitis in a 55-year-old female patient, with hyperemia and foreign body sensation in both eyes. The eye examination revealed conjunctivitis. She had detectable SARS-CoV-2 by polymerase chain reaction on conjunctival and nasal swabs. She was treated with ciprofloxacin eye drops, corticosteroids and trometamol for 5 days. After the seventh day of evolution, there was a significant improvement in conjunctivitis, and repeated conjunctival swab was negative.

Preliminary efficacy and tolerability profiles of first versus second-generation Long-Acting Injectable Antipsychotics in schizophrenia: A systematic review and meta-analysis.

We performed a systematic review and meta-analysis of the efficacy and safety of second generation (SG) long-acting antipsychotics (LAIAs) versus first generation (FG) LAIAs in schizophrenia. We conducted a comprehensive search in PubMed, MEDLINE, EMBASE and PsycINFO until May 2019. Inclusion criteria for randomized trials included: (1) patients ≥18 years with schizophrenia, (2) efficacy evaluated through the Positive and Negative Syndrome Scale (PANSS), (3) safety assessment through clinimetry, laboratory analysis, somatometry or adverse events, and (4) treatment duration ≥12 weeks. Data was synthesized using mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes using a random-effect model. Of 1872 citations, 17 trials were included, and direct comparisons of SG vs FG-LAIAs were observed in 3 (n = 459). SG and FG-LAIAs had similar effects on PANSS scores (MD -1.35; 95% CI -8.33-5.64), tardive dyskinesia (RR 0.99; 95% CI, 0.47-2.07), all-cause discontinuation (RR 1.01; 95% CI 0.75-1.36), discontinuation due to inadequate efficacy (RR 1.13; 95% CI 0.81-1.59) or adverse events (RR 1.08; 95% CI 0.55-2.11). SG-LAIAs reduced the risk of using antiparkinsonian drugs (RR 0.54; 95% CI 0.54-0.76) but significantly increased serum prolactin, weight and BMI. For long-term management, depot preparations of paliperidone, haloperidol, risperidone and fluphenazine were equally effective at symptom control and adherence, with significant differences in their safety profiles. These results however are considerably limited due to the small number of included studies and are therefore preliminary, not generalizable. More clinical trials are required to obtain a broader perspective of SG-LAIAs compared to FG-LAIAs.

The Role of ST2 Receptor in the Regulation of Brucella abortus Oral Infection.

The ST2 receptor plays an important role in the gut such as permeability regulation, epithelium regeneration, and promoting intestinal immune modulation. Here, we studied the role of ST2 receptor in a murine model of oral infection with Brucella abortus, its influence on gut homeostasis and control of bacterial replication. Balb/c (wild-type, WT) and ST2 deficient mice (ST2-/-) were infected by oral gavage and the results were obtained at 3 and 14 days post infection (dpi). Our results suggest that ST2-/- are more resistant to B. abortus infection, as a lower bacterial colony-forming unit (CFU) was detected in the livers and spleens of knockout mice, when compared to WT. Additionally, we observed an increase in intestinal permeability in WT-infected mice, compared to ST2-/- animals. Breakage of the intestinal epithelial barrier and bacterial dissemination might be associated with the presence of the ST2 receptor; since, in the knockout mice no change in intestinal permeability was observed after infection. Together with enhanced resistance to infection, ST2-/- produced greater levels of IFN-γ and TNF-α in the small intestine, compared to WT mice. Nevertheless, in the systemic model of infection ST2 plays no role in controlling Brucella replication in vivo. Our results suggest that the ST2 receptor is involved in the invasion process of B. abortus by the mucosa in the oral infection model.

Acetate coordinates neutrophil and ILC3 responses against C. difficile through FFAR2.

Antibiotic-induced dysbiosis is a key predisposing factor for Clostridium difficile infections (CDIs), which cause intestinal disease ranging from mild diarrhea to pseudomembranous colitis. Here, we examined the impact of a microbiota-derived metabolite, short-chain fatty acid acetate, on an acute mouse model of CDI. We found that administration of acetate is remarkably beneficial in ameliorating disease. Mechanistically, we show that acetate enhances innate immune responses by acting on both neutrophils and ILC3s through its cognate receptor free fatty acid receptor 2 (FFAR2). In neutrophils, acetate-FFAR2 signaling accelerates their recruitment to the inflammatory sites, facilitates inflammasome activation, and promotes the release of IL-1ß; in ILC3s, acetate-FFAR2 augments expression of the IL-1 receptor, which boosts IL-22 secretion in response to IL-1ß. We conclude that microbiota-derived acetate promotes host innate responses to C. difficile through coordinate action on neutrophils and ILC3s.

Vivências de violência obstétrica experimentadas por parturientes / Experiences of obstetric violence experienced by parturients

INTRODUÇÃO: A violência apresenta várias faces e, nesse contexto, pode ocorrer no cenário das instituições de saúde a violência obstétrica, que pode ser definida por qualquer ato ou conduta que venha a causar morte, sofrimento seja de ordem sexual, física ou psicológica à mulher, que pode ocorrer em instituições públicas ou privadas. OBJETIVO: Analisar as experiências de trabalho de parto e parto de mulheres que sofreram violência obstétrica. MÉTODO: Estudo descritivo, transversal, com abordagem qualitativa. Desenvolveu-se em Unidades Básicas de Saúde (UBS) do município de Juazeiro do Norte, região Sul do Ceará, Brasil. Foram convidadas a participar do estudo mulheres que sofreram violência obstétrica no referido município e que estivessem cadastradas em UBS desta mesma cidade. Os critérios de inclusão, mulheres que foram mães em um período de até seis meses e sofreram violência obstétrica. Para a coleta de dados, realizou-se uma entrevista semiestruturada, utilizando-se do critério de saturação dos dados. Para a interpretação dos resultados foi utilizada a técnica de análise de conteúdo. RESULTADOS: O estudo evidenciou que as mulheres sentiram medo, insegurança e ficaram de fato assustadas em estar no ambiente da maternidade. Revelou que à assistência precisa ser modificada, com maior clareza, até para os profissionais, sobre a violência obstétrica. Notou-se que as mulheres não souberam identificar ao certo o que é violência obstétrica e de que forma sofreu essa violência. E por fim, percebeu-se que essa violência afeta no vinculo do binômio mãe-filho. CONCLUSÃO: É preciso uma assistência humanizada e qualificada a estas mulheres neste momento tão delicado e importante de suas vidas.

INTRODUCTION: Violence has many faces and, in this context, may occur in the setting of health institutions obstetric violence, act or conduct based on gender, causing death, damage or suffering of a physical, sexual or psychological nature to women, both in the public sphere and in private. OBJECTIVE: To analyze the labor and delivery experiences of women who suffered obstetric violence. METHODS: Descriptive, cross-sectional study with qualitative approach, developed at Primary Health Centers (UBS) of the municipality of Juazeiro do Norte, southern region of Ceará, Brazil. Women registered in UBS of this city who suffered obstetric violence were invited to participate in the study. The inclusion criteria were women who were mothers in a period of up to six months and who suffered obstetric violence. Data collection used a semi-structured interview, using the data saturation criterion. The interpretation of the results used the content analysis technique. RESULTS: The study showed that these women felt fear, insecurity and were actually scared to be in the maternity setting. It revealed the need for care change, and the need for more clarity, even for professionals, on obstetric violence. These women do not know for sure what obstetric violence is and the way they suffered this violence. Finally, the study showed that this violence affects the bond of the mother-child binomial. CONCLUSION: It is necessary to provide humanized and qualified assistance to these women at this very delicate and important time in their lives.

Control of Klebsiella pneumoniae pulmonary infection and immunomodulation by oral treatment with the commensal probiotic Bifidobacterium longum 5(1A).

Klebsiella pneumoniae (Kp) a common cause of pneumonia leads to intense lung injury and mortality that are correlated with infective exacerbations. Probiotics are a class of microorganisms that have immunomodulatory effects to benefit health. We investigated whether the probiotic Bifidobacterium longum 5(1A) induces protection in mice against lung infection induced by Kp and the potential involved mechanisms. Kp infection induced secretion of pro-inflammatory cytokines, neutrophil recruitment, significant bacterial load in the lung and 50% lethality. However, treatment with live B. longum 5(1A) induced faster resolution of inflammation associated with an increased production of IL-10, decreased lung damage with significantly reduction of bacterial burden that contributed to rescue 100% of mice from death. We found that these effects could be attributed, at least in part, to activation of the Toll-like receptor (TLR) adapter protein Mal, since B. longum 5(1A) treatment in Mal-deficient infected mice did not show the protection observed in wild type infected mice. Thus, we propose that live B. longum 5(1A) activates TLR-signaling pathway that results in ROS production and protects the host against pneumonia-induced death by finely tuning the inflammatory response and contributing to faster return to lung homeostasis.

Infertility diagnosis in jaguar (Panthera onca): case report / Diagnóstico de infertilidade em onça pintada (Panthera onca): relato de caso

This work reports one case of infertility in a male jaguar (Panthera onca) aged 21 years and weighing 125 kg. Changes in sperm due to chronic stress, inadequate food handling and reproductive senescence are emphasized.(AU)

O presente trabalho relata um caso de infertilidade em uma onça-pintada (Panthera onca), macho, de 21 anos e 125 kg. São ressaltadas as alterações ocorridas nos espermatozoides, devido a estresse crônico, manejo alimentar inadequado e senescência reprodutiva.(AU)

Comparative study between the free DNA in peripheral blood and TNM staging in patients with colorectal cancer for prognostic evaluation in the university hospital of the State of Alagoas

Colorectal neoplasm is one of the most common cancers in developed countries and its incidence has grown progressively. The currently used attempts to prognostic assessment are limited, since they are restricted to the observation of tumor morphology, such as the TNM staging. The quantification of free DNA in peripheral blood aims to find a way to relate it to the clinical status of patients with cancer. OBJECTIVE: To evaluate the prognosis of patients with colorectal cancer with the quantification of ALU247 fragments in peripheral blood and TNM staging. METHODS: We evaluated 79 patients in the following groups: Operated, and Non-Operated and Control as to the ALU247 fragment dosage and its correlation with tumor staging. RESULTS: The amount of ALU247 fragments revealed very different results when comparing the different groups. The mean quantity in the Non-Operated group was 14.62 pg, while the mean was 0.48 pg for the Control Group and 0.93 pg for the Operated Group. Serum levels of ALU247 were higher in more advanced morphofunctional classes of the TNM staging. CONCLUSIONS: We suggest there is a relation between the advanced TNM stage and high doses of free DNA in peripheral blood with worse prognosis. (AU)

A neoplasia colorretal é uma das formas mais comuns de câncer nos países desenvolvidos e sua incidência tem crescido de maneira contínua. As tentativas de avaliação prognóstica usadas atualmente apresentam a grave limitação de se restringirem à observação da morfologia tumoral, como o estadiamento TNM. A quantificação do DNA livre no sangue periférico busca encontrar uma forma de relacioná-lo com o estado clínico dos portadores de câncer. OBJETIVO: Avaliar o prognóstico dos pacientes portadores do câncer colorretal por meio da quantificação de fragmentos de ALU247 no sangue periférico e do estadiamento TNM. MÉTODOS: Foram avaliados 79 pacientes nos Grupos Operados, Não Operados e Controle quanto à dosagem de fragmento de ALU247 e sua correlação com os estádios dos tumores. RESULTADOS: A quantidade de fragmentos ALU247 revelou resultados bastante distintos quando os diferentes grupos foram comparados. A média da quantificação nos Não Operados foi de 14,62 pg, de 0,48 pg no Grupo Controle e 0,93 pg no Grupo Operados. Os valores séricos do ALU247 encontraram-se mais elevados nas classes morfofuncionais mais avançadas do estadiamento TNM. CONCLUSÕES: Sugere-se uma relação entre o avanço do estádio TNM e a dosagem elevada do DNA livre no sangue periférico com pior prognóstico. (AU)