Lipid Metabolism Modulation during SARS-CoV-2 Infection: A Spotlight on Extracellular Vesicles and Therapeutic Prospects.

Extracellular vesicles (EVs) have a significant impact on the pathophysiological processes associated with various diseases such as tumors, inflammation, and infection. They exhibit molecular, biochemical, and entry control characteristics similar to viral infections. Viruses, on the other hand, depend on host metabolic machineries to fulfill their biosynthetic requirements. Due to potential advantages such as biocompatibility, biodegradation, and efficient immune activation, EVs have emerged as potential therapeutic targets against the SARS-CoV-2 infection. Studies on COVID-19 patients have shown that they frequently have dysregulated lipid profiles, which are associated with an increased risk of severe repercussions. Lipid droplets (LDs) serve as organelles with significant roles in lipid metabolism and energy homeostasis as well as having a wide range of functions in infections. The down-modulation of lipids, such as sphingolipid ceramide and eicosanoids, or of the transcriptional factors involved in lipogenesis seem to inhibit the viral multiplication, suggesting their involvement in the virus replication and pathogenesis as well as highlighting their potential as targets for drug development. Hence, this review focuses on the role of modulation of lipid metabolism and EVs in the mechanism of immune system evasion during SARS-CoV-2 infection and explores the therapeutic potential of EVs as well as application for delivering therapeutic substances to mitigate viral infections.

Molecular epidemiology of SARS-CoV-2 variants in circulation in the state of Maranhão, Brazil.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a coronavirus belonging to the beta CoV genus, responsible for SARS in humans, which became known as COVID-19. The emergence of variants of this virus is related to the presence of cases of reinfection, reduced vaccine effectiveness and greater transmission of the virus. Objective: In this study, we evaluated the molecular epidemiology of SARS-CoV-2 lineages circulating in the state of Maranhão. This is a cross-sectional and retrospective epidemiological study of genomic surveillance of SARS-CoV-2. The study comprised of 338 genomes sequenced by the Next Generation Sequencing technique on Illumina's Miseq equipment, submitted to Global Initiative on Sharing Avian Influenza Data, 190 (56.2%) are from samples of female and 148 (43.8%) from male patients. Sequencing performed covered samples of patients aged between 1 and 108 years, with emphasis on the age groups from 30 to 39 years with 15.0% of sequenced genomes and 20 to 29 years with 12.4%. As for the distribution of sequenced genomes by health macro-regions, 285 (84.3%) are from cities in the northern macro-region. We evidenced the circulation of 29 lineages and sub-lineages, four of which belonging to the Delta variant (AY.43, AY.99.1, AY.99.2 and AY.101 responsible for 4.5% of the genomes) and the others belonging to the Omicron variant, with emphasis on: BA.1 and sub-lineages (42.8%); BA.4, BA.5 and sub-lineages (5.3% and 41.1%); the sub-lineages DL.1 and BQ.1 (5% and 2%). A strong genomic surveillance system allows the study of the natural history of the disease, when there is a resurgence of SARS-CoV-2 cases.

Antimicrobial effect of quercetin against Streptococcus pneumoniae.

Streptococcus pneumoniae is a bacterium that causes serious infections, including pneumonia. The limited range of available vaccines and the rise of antibiotic-resistant bacteria mean that new treatments are needed. This study looked at the potential of quercetin as an antimicrobial agent against S. pneumoniae in both isolation and in biofilms. The researchers used microdilution tests, checkerboard assays, and death curve assays, as well as in silico and in vitro cytotoxicity evaluations. They found that quercetin at a concentration of 125.0 µg/mL had both inhibitory and bactericidal effects against S. pneumoniae, and these effects were increased when quercetin was combined with ampicillin. Quercetin also reduced the growth of pneumococcal biofilms. In addition, quercetin (absence or in combination with ampicillin) reduced the death time of Tenebrio molitor larvae compared to the infection control. The study also demonstrated that quercetin had low toxicity in both in silico and in vivo assays, suggesting that it could be a promising treatment for infections caused by S. pneumoniae.

Thiols as a marker of inflammatory bowel disease activity: a systematic review.

BACKGROUND: Evidence indicates that inflammation in Inflammatory Bowel Disease (IBD) is associated with increased systemic levels of reactive oxygen species. Systemic oxidative stress has been associated with reduced levels of plasma thiols. Less invasive tests capable of reflecting and predicting IBD activity are increasingly sought after. We sought to systematically review the evidence inherent in serum thiol levels as a marker of Crohn's Disease and Ulcerative Colitis activity (PROSPERO: CRD42021255521). METHODS: The highest quality documents for systematic reviews standards were used as reference. Articles were searched on Medline via PubMed, VHL, LILACS, WOS, EMBASE, SCOPUS, COCHRANE, CINAHL, OVID, CTGOV, WHO/ICTRP, OPENGREY, BDTD and CAPES, between August, 03 and September, 03 on 2021. Descriptors were defined according to the Medical Subject Heading. Of the 11 articles selected for full reading, 8 were included in the review. It was not possible to perform a pooled analysis of the studies, as there were no combinable studies between subjects with active IBD and controls/inactive disease. RESULTS: Findings from the individual studies included in this review suggest an association between disease activity and systemic oxidation, as measured by serum thiol levels, however, there are limitations that preclude weighting the study results in a meta-analysis. CONCLUSIONS: We recommend conducting better-designed and controlled studies, that include individuals of both phenotypes and at different stages of IBD, involving a larger number of participants, using the standardization of the technique for measuring serum thiols, to confirm whether thiols can be a good parameter for monitoring the clinical course of these intestinal diseases and the degree of clinical applicability.

Sensory and muscular functions of the pelvic floor in women with endometriosis - cross-sectional study.

PURPOSE: The aim of this study was to analyze the sensory and muscle functions of the pelvic floor in women with endometriosis, trying to improve overall knowledge/findings regarding pelvic floor muscle functions in patients with endometriosis. METHODS: Sample size calculated as 92 patients with endometriosis, aged between 18 and 45 years, not virgin, without other causes of pain and could not be pregnant. Patients underwent the Pelvic Floor Sensorial and Muscle Function Exam (EFSMAP). Descriptive data were recorded with mean and standard deviation, median (range), and absolute and relative frequency. The Kolmogorov-Smirnov test was used to observe the normality of quantitative variables. The significance level adopted for this study was 5%. RESULTS: Of 92 women assessed, 93.3% had pain and 75% had increased tone in the levator ani muscle; 50.4% had impaired pelvic floor relaxation with median strength of 3 by the Oxford scale and endurance of 2 s. CONCLUSIONS: The patients had a high prevalence of pain and dysfunction of the pelvic floor muscles, such as low muscle endurance and difficulty to relax. It shows that these patients should be referred to a pelvic floor physiotherapist, as soon as they have the diagnosis of endometriosis, to be assessed to prevent and/or treat pelvic floor impairments.

Antioxidant and in vitro cytogenotoxic properties of Amburana cearensis (Allemão) A.C.Sm. leaf extract.

Amburana cearensis leaves have been used in folk medicine to treat respiratory diseases and inflammations. This study aimed to evaluate the biological potential of A. cearensis leaves by antioxidant and in vitro cytogenotoxic analyses of ethanolic crude extract (EE) and its fractions in healthy human cells. The EE was obtained by percolation, followed by fractionation using dichloromethane, cyclohexane, ethyl acetate (EtOAc), and methanol (MeOH) as organic solvents. Extract and all fractions were evaluated for their antioxidant potential by DPPH and reducing power tests. In vitro cytotoxic activity was determined in human peripheral blood mononuclear cells by MTT assay for the extract, EtOAc and MeOH fractions. In turn, the genotoxic activity was determined in human lymphocytes by the Cytokinesis Block Micronucleus assay only for the EtOAc fraction. Only EtOAc fraction was analyzed via gas chromatography coupled to mass spectrometry due to its higher biological activity. Considering the antioxidant potential, the EtOAc fraction was most effective in DPPH (EC50 43.37 µg/mL) and reducing power (EC50 89.80 µg/mL) assays. GC-MS analysis of the EtOAc fraction led to the identification of guaiacol, 2,3-dihydro-benzofuran, 2-methoxy-4-vinylphenol, isovanillic acid methyl ester, 4-hydroxybenzaldehyde, and 4-(ethoxymethyl)-phenol. The EE (400-1000 µg/mL), EtOAc (≤150 µg/mL) and MeOH (50 and 150-600 µg/mL) fractions were not cytotoxic by MTT test. Additionally, the EtOAc fraction (100-400 µg/mL) did not induce significant genotoxic damage. Concentrations of the EtOAc fraction with antioxidant activity showed no cytotoxicity, nor genotoxicity potential, indicating them as a nontoxic natural antioxidant source.

Does the use of a diving mask adapted for non-invasive ventilation in hypoxemic acute respiratory failure in individuals with and without COVID-19 increase the ratio of arterial oxygen partial pressure to fractional inspired oxygen? A randomized clinical trial.

Non-invasive ventilation (NIV) can be used in acute hypoxemic respiratory failure (AHRF); however, verifying the best interface for its use needs to be evaluated in the COVID-19 pandemic scenario. The objective of this study was to evaluate the behavior of the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2 ratio) in patients with AHRF with and without COVID-19 undergoing NIV with the conventional orofacial mask and the adapted diving mask. This is a randomized clinical trial in which patients were allocated into four groups: i) group 1: COVID-19 + adapted mask (n=12); ii) group 2: COVID-19 + conventional orofacial mask (n=12); iii) group 3: non-COVID-19 + adapted mask (n=2); iv) group 4: non-COVID-19 + conventional orofacial mask (n=12). The PaO2/FiO2 ratio was obtained 1, 24, and 48 hours after starting NIV, and the success of NIV was evaluated. This study followed the norms of the Consolidated Standards of Reporting Trials statement and was registered in the Brazilian Registry of Clinical Trials under registration RBR-7xmbgsz. Both the adapted diving mask and the conventional orofacial mask increased the PaO2/FiO2 ratio. The interfaces differed in terms of the PaO2/FiO2 ratio in the first hour [309.66 (11.48) and 275.71 (11.48), respectively] (p=0.042) and 48 hours [365.81 (16.85) and 308.79 (18.86), respectively] (p=0.021). NIV success was 91.7% in groups 1, 2, and 3, and 83.3% in group 4. No adverse effects related to interfaces or NIV were observed. NIV through the conventional orofacial mask interfaces and the adapted diving mask was effective in improving the PaO2/FiO2 ratio; however, the adapted mask presented a better PaO2/FiO2 ratio during use. There was no significant difference between interfaces regarding NIV failure.

Electromyographic analysis of pelvic floor muscles during the execution of pelvic patterns of proprioceptive neuromuscular facilitation-concept: An observational study.

OBJECTIVE: To assess the effect of pelvic patterns of proprioceptive neuromuscular facilitation (PNF-concept) on pelvic floor muscles (PFM) recruitment, as well as the electromyographic activity of muscles synergic to the pelvic floor in healthy women. METHODS: Observational study conducted with 31 women aged between 18 and 35 years, with mean age of 23.3 ± 3.2 (22.1-24.4). PFM activity was monitored by surface electromyography during the combination of isotonics technique of four pelvic patterns of PNF-concept (i.e., anterior elevation, posterior depression, anterior depression, and posterior elevation). The electromyographic signal was analyzed using root mean square amplitude. Two-way repeated measures analysis of variance was performed to analyze differences in PFM activity between types of contraction (i.e., concentric, isometric, and eccentric) and the four pelvic patterns. RESULTS: PFM activity did not differ among the four pelvic pattens. However, PFM activity was significantly different between the combination of isotonics technique and baseline, F(1.6, 48.2) = 71.5; p < 0.000, with a large effect size (partial ƞ² = 0.705). Concentric (22.4 µV ± 1.1), isometric (17.3 µV ± 0.6), and eccentric (15 µV ± 0.5) contractions of combination of isotonics technique increased PFM activity compared with baseline (10.8 µV ± 0.4) in all pelvic patterns. By analyzing the electromyographic activity of the muscles synergistic to the pelvic floor, there is effect of the interaction of the type of contraction, the pelvic pattern of the PNF concept, and the synergistic muscles on the myoelectric activity of the external anal sphincter, F(3.2, 96.5) = 5.6; p < 0.000, with a large magnitude of effect (partial ƞ² = 0.15). In the anterior elevation pattern, the muscles synergistic to the pelvic floor present synergy in phase with the PFM, and in the posterior patterns there was a decrease in the activity level of all synergistic muscles, without changing the activity level of the PFM. CONCLUSION: PFM activity did not differ among the four pelvic patterns of PNF-concept. Nonetheless, the combination of isotonics technique showed a significant effect on PFM compared with baseline, with greater PFM activity during concentric contraction. Pelvic patterns of PNF-concept may be used to increase PFM recruitment in young healthy women.

Proprioceptive Training on Dynamic Neuromuscular Control in Fencers: A Clinical Trial.

CONTEXT: Fencing is a sport of agility, with a higher incidence of lower-limb injuries, of which the ankle sprain is the most prevalent. Injury prevention is very important to improve performance and decrease the withdrawal time of athletes. Proprioceptive training programs can be added to the training of athletes, since, in addition to easy application and low cost, proprioception has the function of stabilizing the ankle joint to prevent injuries. OBJECTIVE: To verify the influence of a 12-week proprioceptive training program on dynamic neuromuscular control in fencing athletes. DESIGN: The study was a clinical trial, and the athletes were allocated, for convenience, in the intervention group or in the control group. SETTING: The study was developed in 4 stages (preintervention, intervention, postintervention, and follow-up of 3). The neuromuscular control during the star excursion balance test was evaluated. PARTICIPANTS: The participants were 19 fencing athletes (intervention group: 10, and control group: 9), aged 14-35 years, from a multisport club. INTERVENTIONS: The athletes performed the proprioceptive training during 12 weeks, 3 times a week, with a duration of 30 minutes. MAIN OUTCOME MEASURES: Dynamic neuromuscular control. RESULTS: The data and SE were considered for statistical analysis, submitted to the generalized estimates equations test with Bonferroni post hoc. The level of significance was .05. The distance reached in the star excursion balance test increased significantly in all 8 directions evaluated in the 2 legs of the intervention group. CONCLUSIONS: The proprioceptive training program was able to improve dynamic neuromuscular control in fencing athletes.

Daily life of women with alcoholic companions and the provided care.

The study aimed to know the daily life of women with alcoholic companions and the provided care. This is a comprehensive-interpretative, qualitative study, guided by the thematic Oral History method. Data collection occurred by semistructured interview. The empirical material was subjected to content analysis under the light of the King's Theory of Goal Attainment. Women are frustrated and frightened by the alcoholic companion's behavior and lifestyle, and still feel judged by society. Many abandon their life projects and self-care due to the overload caused by the companion's absence in the care of home and children. The family care they develop focuses on maintaining the family and protecting from further damage. The study revealed that these women are sick due to the companion's dependence and, even supporting a type of family care, they cannot control the effects of the alcohol in the family. This reinforces the need for health professionals' greater bond and involvement, establishing therapeutic projects in which women feel involved and, at the same time, supported.

Saline extract from Malpighia emarginata DC leaves showed higher polyphenol presence, antioxidant and antifungal activity and promoted cell proliferation in mice splenocytes.

Currently, the research of new natural compounds with biological potential demonstrates great ethnopharmacological importance. In this study, we evaluated the biological properties promoted by saline extract from Malpighia emarginata DC leaves, whose objective is to evaluate the antioxidant, antimicrobial and cytotoxicity potential. Phytochemical characterization was performed by UPLC-MS chromatography to identify the chemical compounds. For the antioxidant potential, DPPH, ATT and FRAP methods were used. The antibacterial and antifungal tests were performed evaluating the MIC50, MIC90, CMB and CMF parameters. Moreover, antibiofilm action was evaluated. Cytotoxicity and proliferation were performed using splenocytes from Balb/c mice and were evaluated by cytometry. We found a list of phenolic compounds among other bioactive compounds in the M. emarginata saline extract. In addition, higher antioxidant profile and antifungal activity against different strains of Candida spp. was promoted by the saline extract. Splenocytes showed greater cell viability (more than 90%) and showed higher proliferate index in 24 and 48 hours of incubation with the extract. Saline extract from Malpighia emarginata DC has potential action like antioxidant and antifungal agent without promote animal cell damage.

Effects of proprioceptive training on the incidence of ankle sprain in athletes: systematic review and meta-analysis.

OBJECTIVE:: To investigate how dynamic neuromuscular control, postural sway, joint position sense, and incidence of ankle sprain are influenced by balance training in athletes compared with the control group in randomized clinical trials. DATA SOURCES:: The search strategy included MEDLINE, Physical Therapy Evidence Database, Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Center on Health Sciences Information. Randomized controlled trials (RCTs) were published by June of 2018. METHODS:: RCTs that evaluate the effectiveness of proprioception in these outcomes: dynamic neuromuscular control, postural sway, joint position, and the incidence of ankle sprains in athletes aged between 18 and 35 years. Two reviewers independently screened the searched records, extracted the data, and assessed risk of bias. The treatment effect sizes were pooled in a meta-analysis using the RevMan 5.2 software. Internal validity was assessed through topics suggested by Cochrane Collaborations. RESULTS:: Of the 12 articles included ( n = 1817), eight were in the meta-analysis ( n = 1722). The balance training reduced the incidence of ankle sprains in 38% compared with the control group ( RR: 0.62; 95% CI: 0.43-0.90). In relation to the dynamic neuromuscular control, the training showed increase in the distance of reach in the anterior (0.62 cm, 95% CI: 0.13-1.11), posterolateral (4.22 cm, 95% CI: 1.76-6.68), and posteromedial (3.65 cm, 95% CI: 1.03-6.26) through the Star Excursion Balance test. Furthermore, training seems to improve postural sway and joint position sense. CONCLUSION:: Balance training reduces the incidence of ankle sprains and increases dynamic neuromuscular control, postural sway, and the joint position sense in athletes.

Evaluation of embryotoxic and embryostatic effects of the aqueous extract of Rhizophora mangle and tannic acid on eggs and larvae of Aedes aegypti.

Rhizophora mangle is an abundant plant in mangroves and tannic acid is a polyphenol produced by the secondary metabolism of plants. The aim of the study was to evaluate the embryotoxic and embriostatic effects of the aqueous extract of R. mangle and synthetic tannic acid on eggs and larvae of Aedes aegypti. A. aegypti eggs were exposed in duplicate at concentrations of 250, 500, 750 and 1000 µg/mL of extract and tannic acid for a period of 14 days. Mineral water was used as a negative control. The eggs were observed and counted in a stereomicroscope (1.2x). In all extract concentrations there was stimulation in hatching in relation to the control, but only in concentration of 750 mg/mL it was statistically significant. In tannic acid (250µg/ml) there was significant stimulus in hatching, but in 500, 750 and 1000 µg/mL there was significant inhibition. All concentrations of aqueous extract and tannic acid on larvae showed embryotoxic and embryostatic effects when compared to the control. The aqueous extract of R. mangle showed effect on hatching of A. aegypti eggs and synthetic tannic acid showed embryotoxic and embryostatic effects. On larvae, both the aqueous extract as tannic acid showed embryotoxic and embryostatic effects.

Acute Toxicity and Cytotoxicity Effect of Ethanolic Extract of Spondias tuberosa Arruda Bark: Hematological, Biochemical and Histopathological Evaluation.

Spondias tuberosa Arruda, popularly named as umbu, is native from savanna-like vegetation and widely used for medicinal purposes, however, the toxicological profile is not available yet. This study evaluated the phytochemical profile and acute toxicity and citoxicity of Ethanolic Extract of Spondias tuberosa Arruda Bark (EEStb) in hematological, biochemical and histopathological parameters. Female Wistar rats were divided into: control (C) and animal treated single doses of 300mg/Kg (EEStb300) or 2.000mg/kg body weight (ESStb2.000) of the EEStb. After 24 hours and 14 days from gavage, the behavior, hematological, biochemical and histopathological parameters were assayed. Cytotoxicity effect was evaluated on HEp-2 cell lines. Neither EEStb300 nor EEStb2.000 produced mortality nor changes in body weight during the 14-days of observation, but EEStb2.000 reduced quietly the food and water intake as well as locomotor activity at first day. There were no changes in macroscopic, histopathological, biochemical and hematological parameters. EEStb in concentrations of 6.25- 50µg ml-1 on HEp-2 cell did not produce cytotoxic effect. These results suggest that EEStb did not cause acute toxicity and cytotoxic, suggesting a good safety rate for Spondias tuberosa Arruda.

Biological activity and photostability of biflorin micellar nanostructures.

Capraria biflora L. is a shrub from the Scrophulariaceae family which produces in its roots a compound named biflorin, an o-naphthoquinone that shows activity against Gram-positive bacteria and fungi and also presents antitumor and antimetastatic activities. However, biflorin is hydrophobic and photosensitive. These properties make its application difficult. In this work we prepared biflorin micellar nanostructures looking for a more effective vehiculation and better preservation of the biological activity. Biflorin was obtained, purified and characterized by UV-Vis, infrared (IR) and 1H- and 13C-NMR. Micellar nanostructures of biflorin were then assembled with Tween 80®, Tween 20® and saline (0.9%) and characterized by UV-Vis spectroscopy and dynamic light scattering (DLS). The results showed that the micellar nanostructures were stable and presented an average size of 8.3 nm. Biflorin micellar nanostructures' photodegradation was evaluated in comparison with biflorin in ethanol. Results showed that the biflorin in micellar nanostructures was better protected from light than biflorin dissolved in ethanol, and also indicated that biflorin in micelles were efficient against Gram-positive bacteria and yeast species. In conclusion, the results showed that the micellar nanostructures could ensure the maintenance of the biological activity of biflorin, conferring photoprotection. Moreover, biflorin vehiculation in aqueous media was improved, favoring its applicability in biological systems.

Five new species of Apobaetis Day (Ephemeroptera: Baetidae) and updated key to nymphs.

This study focuses on the Baetidae family of Ephemeroptera, particularly the Pan-American genus Apobaetis Day, 1955, in Brazil. Baetidae is the second richest family in this order, with over 1100 species globally. Although extensively studied in Brazil, there is still a considerable Linnean deficit, emphasizing the need for further exploration and identification. This research reveals that in-depth studies of specific groups often lead to the discovery of new species and corrections to existing records, enhancing the accuracy of identification. We conducted a detailed study of Apobaetis resulting in the identification of five new species: A. dalcolmoae sp. nov., A. danielae sp. nov., A. nisiae sp. nov., A. sabinoae sp. nov., and A. trivellae sp. nov., each described here from nymphs and distinguished by specific morphological features. The study provides detailed comparisons with existing species, emphasizing characteristics such as maxillary palp, paraproct, glossa shape, and setae presence. We also propose an updated identification key to aid in the recognition of all Apobaetis species known in the nymphal stage. We also address the distribution of certain species in Brazil, pointing out potential misidentifications and the need for further revision. In conclusion, the research expands the known species within Apobaetis to 22. The findings underscore the importance of continuous taxonomic studies for accurate species identification and pave the way for future evolutionary research within this genus.

Effects of Kinesio tape on vascularity, pliability and height of the hypertrophic scar in burns patients: a randomized pilot clinical trial.

Deep burns damage the reticular dermis and may lead to the formation of hypertrophic scars. Compression therapy reduces local vascularity and realigns collagen fibers, resulting in esthetic and functional improvements. This study evaluated the effect of Kinesio tape compression with maximum mechanical tension on vascularity, pliability and the height of hypertrophic scars following deep burns. A single blind, randomized pilot clinical trial was carried out. The elastic compression of Kinesio tape was applied at maximum stretch in the intervention group (n=11) and no stretch in the sham group (n=11). Vascularity, pliability and height (the primary outcomes) were evaluated at 0, 45 and 90 days using the Vancouver Scar Scale (VSS). The association between the VSS scores, the intervention and the evaluation moment were analyzed using linear mixed-effects regression models, while comparisons of means between the groups were performed using the t Student test was. Significance was set at 5%. The mean VSS scores were similar between the groups. Significant improvement occurred in both groups when post-treatment and baseline scores were compared. No further improvement was found in the vascularity, pliability or height of hypertrophic scars resulting from deep burns when an elastic compression of Kinesio tape was used at maximum tension compared to lesser mechanical tension.

Clinical and Epidemiological Assessment of Children and Adolescents Hospitalized with SARS-CoV-2 in the Pre-Amazon Region.

INTRODUCTION: SARS-CoV-2 infection usually presents similarly to other respiratory viral pathogens. Children and adolescents do not present as a group that is highly affected by the disease, having low infection rates. However, limited publications are associated with the findings of pneumonia in pediatric patients with COVID-19. OBJECTIVE: To analyze the clinical and epidemiological aspects of children and adolescents hospitalized with SARS-CoV-2 in a pre-Amazon region. METHODS: A retrospective study, carried out in four public hospitals in São Luís, Brazil where medical records of children and adolescents aged from 0 to 13 years, of both sexes, with clinical diagnosis of community-acquired pneumonia were evaluated from March 2020 to March 2021. RESULTS: Almost 40.0% of children were aged between 1 year and 5 years. Of the 128 children who had SARS-CoV-2, 3 are of indigenous ethnicity. Additionally, 78.6% of the children had fever and there was no significant difference between COVID-19 patients and those of other respiratory viruses. Eighteen patients had chronic neurological disease, which is the most common comorbidity observed in patients with coronavirus infection. Ground glass opacity attenuation was observed in 24.8% of children and adolescents with COVID-19. Anemia and increased inflammatory response markers were related to SARS-CoV-2 infection. More than 90.0% of patients admitted to hospital, regardless of etiology, were treated with antibiotics. Eighteen patients died. Pediatric multisystem inflammatory syndrome (PMIS) was diagnosed in 17 patients. CONCLUSIONS: SARS-CoV-2 in children and adolescents is mild, but the condition of patients with PMIS is more serious, with an increase in inflammatory biomarkers which can lead to death. Therefore, rapid diagnosis and differentiation of agents causing respiratory diseases are necessary for better therapeutic decision making, since the results of this study make us question the excessive use of antibiotics without meeting well-defined clinical-epidemiological criteria.

International Consensus on Standard Outcome Measures for Neurodevelopmental Disorders: A Consensus Statement.

Importance: The use of evidence-based standardized outcome measures is increasingly recognized as key to guiding clinical decision-making in mental health. Implementation of these measures into clinical practice has been hampered by lack of clarity on what to measure and how to do this in a reliable and standardized way. Objective: To develop a core set of outcome measures for specific neurodevelopmental disorders (NDDs), such as attention-deficit/hyperactivity disorder (ADHD), communication disorders, specific learning disorders, and motor disorders, that may be used across a range of geographic and cultural settings. Evidence Review: An international working group composed of clinical and research experts and service users (n = 27) was convened to develop a standard core set of accessible, valid, and reliable outcome measures for children and adolescents with NDDs. The working group participated in 9 video conference calls and 8 surveys between March 1, 2021, and June 30, 2022. A modified Delphi approach defined the scope, outcomes, included measures, case-mix variables, and measurement time points. After development, the NDD set was distributed to professionals and service users for open review, feedback, and external validation. Findings: The final set recommends measuring 12 outcomes across 3 key domains: (1) core symptoms related to the diagnosis; (2) impact, functioning, and quality of life; and (3) common coexisting problems. The following 14 measures should be administered at least every 6 months to monitor these outcomes: ADHD Rating Scale 5, Vanderbilt ADHD Diagnostic Rating Scale, or Swanson, Nolan, and Pelham Rating Scale IV; Affective Reactivity Index; Children's Communication Checklist 2; Colorado Learning Disabilities Questionnaire; Children's Sleep Habits Questionnaire; Developmental-Disability Children's Global Assessment Scale; Developmental Coordination Disorder Questionnaire; Family Strain Index; Intelligibility in Context Scale; Vineland Adaptive Behavior Scale or Repetitive Behavior Scale-Revised and Social Responsiveness Scale; Revised Child Anxiety and Depression Scales; and Yale Global Tic Severity Scale. The external review survey was completed by 32 professionals and 40 service users. The NDD set items were endorsed by more than 70% of professionals and service users in the open review survey. Conclusions and Relevance: The NDD set covers outcomes of most concern to patients and caregivers. Use of the NDD set has the potential to improve clinical practice and research.

Clinical Reasoning: A 24-Year-Old Pregnant Woman With Headache and Behavioral Change Progressing to Coma.

The broad differential diagnosis associated with progressive subacute encephalopathy can be intimidating, especially in a young, pregnant woman. In this case, a 24-year-old woman at 21 weeks of gestation presented with persistent, drug-resistant fronto-parietal headache, with subsequent progressive development of psychomotor lentification and inappropriate behavior. Physical examination was normal, as were routine laboratory parameters and CT findings, and these symptoms were initially interpreted in the context of chronic depression. Later, the patient developed generalized dystonia and fever, with rapid clinical deterioration, depression of consciousness and, eventually, progression to coma. This case emphasizes the complexity and challenges involved in the diagnostic approach to a patient with progressive subacute encephalopathy framed by worsening CNS symptoms. It highlights the clinical considerations and complementary investigation of various etiologies, in a step-by-step approach, ultimately leading to the final diagnosis. Early recognition and appropriate treatment of these conditions can lead to more favorable outcomes, particularly in gestating patients, where prompt intervention is crucial, and where critical decisions may have to be made regarding pregnancy and the safety of treatment options.