Diabetes as risk factor to severity of dengue in naïve patients.

Background: Dengue cases can progress to severe ant life-threating forms particularly in subsequent heterologous infections. However, recent studies had explored additional risk factors, including underlying health conditions, even in individuals without prior exposure to dengue, notably, in patients with endothelial dysfunction and chronic inflammation. This study examines the link between diabetes and the development of severe dengue disease in dengue-naive patients during the 2019 dengue outbreak in São Jose do Rio Preto, Brazil. Methodology: We enrolled 529 laboratory-confirmed dengue cases, identified through DENV RT-PCR or NS1 antigen assays in a hospital cohort of acute febrile illness. Subsequently, we investigated the presence of anti-dengue and anti-Zika IgG antibodies. Samples testing positive for Zika were excluded from the analyses. Two groups were analyzed: naïve (DV-), and dengue history (DV+). Results: Initially, presence of diabetes and kidney disease, as well as being dengue-naive, were associated with a higher frequency of severe and potentially severe clinical outcomes. Multivariate analysis identified diabetes as a risk factor, while the presence of anti-dengue antibodies was considered protective. Analysis of dengue naïve samples, highlighted diabetes as an independent risk factor to severe forms of dengue disease. In DV+ patients, no condition was highlighted as a risk factor by univariate analysis or multivariate analysis. Conclusions: We investigated and confirmed diabetes as a risk factor for severe dengue disease in individuals without prior dengue or Zika exposure. Our conclusions raise significant concerns given diabetes' ever increasing global prevalence and its potential impact on patients with or previous dengue exposure.

Influence of previous Zika virus infection on acute dengue episode.

BACKGROUND: The co-circulation of flaviviruses in tropical regions has led to the hypothesis that immunity generated by a previous dengue infection could promote severe disease outcomes in subsequent infections by heterologous serotypes. This study investigated the influence of antibodies generated by previous Zika infection on the clinical outcomes of dengue infection. METHODOLOGY/PRINCIPAL FINDINGS: We enrolled 1,043 laboratory confirmed dengue patients and investigated their prior infection to Zika or dengue. Severe forms of dengue disease were more frequent in patients with previous Zika infection, but not in those previously exposed to dengue. CONCLUSIONS/SIGNIFICANCE: Our findings suggest that previous Zika infection may represent a risk factor for subsequent severe dengue disease, but we did not find evidence of antibody-dependent enhancement (higher viral titer or pro-inflammatory cytokine overexpression) contributing to exacerbation of the subsequent dengue infection.

Arboviral Infections in Neurological Disorders in Hospitalized Patients in São José do Rio Preto, São Paulo, Brazil.

Arbovirus infections are increasingly important causes of disease, whose spectrum of neurological manifestations are not fully known. This study sought to retrospectively assess the incidence of arboviruses in cerebrospinal fluid samples of patients with neurological symptoms to inform diagnosis of central and peripheral nervous system disorders. A total of 255 cerebrospinal fluid (CSF) samples collected from January 2016 to December 2017 were tested for dengue virus (DENV 1-4), Zika virus (ZIKV), and Chikungunya virus (CHIKV) in addition to other neurotropic arboviruses of interest, using genetic and serologic assays. Of the 255 CSF samples analyzed, 3.53% (09/255) were positive for arboviruses presenting mainly as meningitis, encephalitis, and cerebrovascular events, of which ZIKV was detected in 2.74% (7/255), DENV in 0.78% (2/255), in addition to an identified ILHV infection that was described previously. All the cases were detected in adults aged 18 to 74 years old. Our findings highlight the scientific and clinical importance of neurological syndromes associated with arboviruses and demonstrate the relevance of specific laboratory methods to achieve accurate diagnoses as well as highlight the true dimension of these diseases to ultimately improve public health planning and medical case management.

Efeitos da mobilização precoce em crianças com pneumonia associada à ventilação mecânica: efeitos sobre variáveis não lineares da variabilidade da frequência cardíaca / Effects of early mobilization in children with pneumonia associated with mechanical ventilation: effects on non-linear variables of variability of heart rate

A pesquisa teve como objetivo verificar os efeitos da mobilização precoce em crianças com pneumonia associada à ventilação mecânica (PAV) sobre variáveis não lineares da variabilidade da frequência cardíaca. Foi realizado um ensaio clínico, prospectivo, de caráter quantitativo realizado em 13 pacientes de ambos os gêneros, com idade média de 5±1,3 anos, com diagnóstico de PAV. O estudo foi aprovado pelo Comitê de Ética e Pesquisa da Fundação Santa Casa de Misericórdia do Pará, parecer 2.084.580 e registo no Clinical Trials NCT03343717. Os voluntários foram submetidos ao protocolo convencional do hospital que consistia em exercícios respiratórios que incluíam técnicas de manobras de higiene brônquica, técnicas de reexpansão pulmonar e técnicas de mobilização passiva acrescida do protocolo de mobilização precoce proposto pelos autores. Os pacientes receberam atendimento uma vez ao dia, durante 4 dias consecutivos a partir do quarto dia após internação. A análise da recorrência, assim como a DFA α1, não obtiveram resultados relevantes para o estudo, com p=0,812 e p=0,09, respectivamente. A variável determinismo apresentou resultado com nível de significância <0,05 quando comparadas as médias, sendo que os valores dos pós protocolo foram inferiores ao do pré protocolo, indicando uma melhora da modulação autonômica da frequência cardíaca. A DFA α2 quando analisada a curto prazo, de 4 a 11 intervalos, não apresentou alteração pelo exercício, entretanto, na análise a longo prazo apontou diferença significante entre o pré e o pós protocolo. Os valores do pré-protocolo foram maiores indicando uma melhora da modulação autonômica após o protocolo de MP. A obilização precoce quando aplicada a pacientes pediátricos, levou a melhora da modulação autonômica da frequência cardíaca, além de ser um recurso da fisioterapia seguro e aplicável nas UTIs....(AU)

The aim of the research was to verify the effects of early mobilization in children with pneumonia associated with mechanical ventilation (PAV) on the nonlinear variables of the Heart Rate Variability. A prospective, quantitative clinical trial was conducted in 13 patients of both genders, with a mean age of 3 ± 2.3 years, with a diagnosis of PAV. The study was approved by the Ethics and Research Committee of the FSCMP, assent 2,084,580 and registered in Clinical Trials NCT03343717. The volunteers were submitted to the conventional protocol of the hospital consisting of breathing exercises that included techniques of bronchial hygiene maneuvers, pulmonary reexpansion techniques and passive mobilization techniques plus the protocol of early mobilization proposed by the authors. Patients received care once a day for 4 consecutive days from the fourth day after admission. The recurrence analysis, as well as the DFA α1, did not obtain relevant results for the study, with p = 0.812 and p = 0.09, respectively. The deterministic variable presented a result with significance level <0.05 when compared to the means, and the values of the post protocol were lower than the pre-protocol, indicating an improvement in theautonomic heart rate modulation. The DFA α2 when analyzed in the short term, from 4 to 11 intervals, did not present alteration by the exercise, however, in the long term analysis it pointed out a significant difference between the pre and post protocol. The pre-protocol values were higher indicating an improvement of the autonomic modulation after the MP protocol. Early mobilization when applied to pediatric patients led to an improvement in autonomic heart rate modulation, as well as being a safe physiotherapy resource in the ICUs....(AU)

A influência de um programa de reabilitação pulmonar na descontinuidade da matriz extracelular, no estado de saúde e na resposta ao exercício em pacientes com DPOC / The influence of a pulmonary rehabilitation program in oxidative stress, in health status and response to exercise in patients with COPD

A Doença Pulmonar Obstrutiva Crônica (DPOC) altera a ventilação pulmonar com redução da capacidade de extração de oxigênio, com consequente declínio da tolerância ao exercício físico e qualidade de vida. O objetivo do estudo é comparar os efeitos da reabilitação pulmonar com exercício físico aeróbico no estado de saúde, na tolerância ao exercício e na descontinuidade da matriz extracelular.Estudo experimental, de caráter quantitativo, com amostragem de 18 indivíduos com DPOC moderado a grave. Todos foram submetidos a 3 etapas do estudo, constituindo-se de três avaliações antes do programa, após dez semanas de reabilitação pulmonar, e após vinte semanas, onde foram realizadas: Avaliação geral; Análise do estresse oxidativo (EOx); Aplicação do questionário de vias aéreas 20 (AQ20); Teste de caminhada de 6 minutos, tendo como acompanhamento a escala de Borg modificada. Na análise estatística foi utilizado o teste de D´Agostino para análise de normalidade das variáveis, o Wilcoxon Sign Rank Test para os valores do AQ20, após a constatação de normalidade aplicamos o Teste T para amostras pareadas ou o Wilcoxon Sign Rank Test (distribuição normal e não paramétrica respectivamente) e Teste Kruskall-wallis, destinado a comparar proporções de mesma variável mensurada no EOx. A significância estatística p<0,05 foi adotada. O AQ20 revelou não significância quando aplicado no pré (10±1,5) e pós-reabilitação pulmonar pelo período de 10 (10±1,2) e 20 semanas (8±2). O TC6 não apresentou significância quando comparado pré (410±30m) e pós 10 (415±45m) e 20 semanas (450±40m) o programa de reabilitação. Após a constatação de normalidade, foi obtida significância nos parâmetros do Eox, com p=valor < 0,0001. Pode-se concluir que o protocolo de reabilitação pulmonar com exercício físico reduziu a descontinuidade da matriz extracelular, demonstrando menor estresse oxidativo, sem influencia no estado de saúde e tolerância ao exercício...(AU)

Chronic Obstructive Pulmonary Disease (COPD) alters pulmonary ventilation with reduced oxygen extraction capacity, with a consequent decline in tolerance to physical exercise and quality of life. The objective of the study is to compare the effects of pulmonary rehabilitation with aerobic physical exercise on health status, exercise tolerance and extracellular matrix discontinuity. Experimental study, with quantitative character, with sampling of 18 individuals with moderate to severe COPD. All were submitted 3 stages of the study, constituting three evaluations before the program, after ten weeks of pulmonary rehabilitation, and after twenty weeks, where they were performed: Overall evaluation; Analysis of oxidative stress (EOx); Application of the airway questionnaire 20 (AQ20); A 6-minute walk test, followed by the modified Borg scale. In the statistical analysis, the D'Agostino test was used to analyze the variables normality, the Wilcoxon Sign Rank Test for the AQ20 values, after the normality test we applied the T-Test for paired samples or the Wilcoxon Sign Rank Test and non-parametric, respectively) and Kruskall-wallis test, to compare proportions of the same variable measured in the EOx. Statistical significance was set at p <0.05. The AQ20 revealed no significance when applied in the pre (10 ± 1,5) and post pulmonary rehabilitation for the period of 10 (10 ± 1.2) and 20 weeks (8 ± 2). The 6MWT did not present significance when compared to the rehabilitation program (410 ± 30m) and post 10 (415 ± 45m) and 20 weeks (450 ± 40m). After the normality was verified, the significance was obtained in the Eox parameters, with p = value <0.0001. It can be concluded that the pulmonary rehabilitation protocol with physical exercise reduced the discontinuity of the extracellular matrix, demonstrating lower oxidative stress...(AU)

Early Endoscopic Retrograde Cholangiopancreatography Versus Conservative Treatment in Patients With Acute Biliary Pancreatitis: Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVES: The aim of the study was to evaluate the role of early endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of acute biliary pancreatitis, in comparison with conservative treatment. METHODS: Systematic review via databases (MEDLINE [PubMed], Latin-American and Caribbean Health Sciences Literature database, Embase, Cochrane Central, and the [Brazilian] Regional Library of Medicine) is conducted. We analyzed 10 randomized controlled trials (1091 patients). Outcomes were the following: local and systemic adverse events; acute cholangitis; death; length of hospital stay; cost; abdominal pain; and time to a reduction in body temperature. For the meta-analysis, we used risk difference (RD) and mean with standard deviation as measures of variability. RESULTS: There was a statistically significant difference between the patients submitted to ERCP in terms of the following: local adverse events (RD, 0.74; 95% confidence interval [CI], 0.55-0.99), time to pain relief and time to a reduction in axillary temperature (RD, -5.01; 95% CI, -6.98 to -3.04, and RD, -1.70; 95 CI%, -2.33 to -1.08, respectively). Patients undergoing ERCP spent less time in hospital (RD, -11.04; 95% CI, -15.15 to -6.93). Cost was lower in the group treated with ERCP. CONCLUSIONS: Early ERCP decreases local adverse events, shortening the time to pain relief, to a reduction in axillary temperature, hospital stays, and cost in patients with acute biliary pancreatitis.

Estudo clínico da fadiga na cirrose alcoólica e não-alcoólica / A clinical study on fatigue in alcoholic and non-alcoholic cirrhotic patients

A fadiga é um sintoma frequente nas hepatopatias crônicas, que interfere na qualidade de vida, cujas causas são discutíveis e o mecanismo de ação indeterminado. O álcool é um fator importante na fadiga, porém esse sintoma não tem sido estudado na cirrose alcoólica. Objetivos: estudar a prevalência da fadiga na cirrose alcoólica e não-alcoólica e verificar se fatores bioquímicos, ascite, além do álcool, podem contribuir para o conhecimento dos agentes desencadeantes do sintoma. Casuística e método: foram estudados retrospectivamente os protocolos de 794 cirróticos divididos em alcoólicos (CA=464) e não-alcoólicos (NA=330), comparando-se os valores dos níveis de sódio, potássio, creatinina, albumina, além da ascite. Na CA não havia portadores de vírus B ou C; o grupo NA constitui-se apenas de portadores de vírus B ou C. Outras etiologias de cirrose não foram incluídas. Resultados: a fadiga foi encontrada em 258/794 pacientes (32%), 18% na CA e 14% no grupo NA. Nenhuma das variáveis estudadas foi considerada como um possível fator desencadeante ou específico da fadiga. Conclusão: a fadiga na cirrose alcoólica ou viral deve ser um sintoma multifatorial, independentemente do estado funcional ou concentrações de proteínas e elementos eletrolíticos. O fator álcool não interferiu na prevalência da fadiga.

Background/aim: health-related quality of life is impaired by fatigue in chronic liver disease, mainly in cirrhosis. We investigated the prevalence of fatigue in alcoholic and nonalcoholic cirrhotics in relation to the serum levels of sodium, potassium, creatinin, albumin and ascites. Method: we conducted a retrospective study in 794 cirrhotics (464 alcohol related (AC) but not viral associated and 330 virus B or C (NA) cirrhotics; other etiologies of cirrhosis were not considered. Results: fatigue was found in 258 (32%) patients, but this prevalence was not related with alcohol effect (18% in AC vs 14% in NA). The compensation status of cirrhosis and biochemical variables were not significant between the two groups in relation to the prevalence of the fatigue. Conclusion: our study suggests that fatigue is a multifatorial symptom not related with the etiology of cirrhosis.

Lesões bucais manifestadas em pacientes aidéticos e tuberculose, relacionadas com a contagem celular cd4+/cd8+ / Oral lesions in patients with AIDS and tuberculosis and the relation to the CD4+/CD8+ cells counting

Este trabalho relata manifestações bucais que ocorrem em pacientes infectados pelo vírus da imunodeficiência humana (HIV), assim como descreve sua etiopatogenia. Apresenta como pesquisa de campo quantitativa o estudo da prevalência das manifestações bucais da AIDS, em 42 pacientes portadores do HIV e com tuberculose, internados no Hospital Sanatório Partenon. Relacionou-se a lesões encontradas clinicamente com o estado de imunodepressão mapeado através de contagem celular de linfócitos CD4+ e relação celular CD4+/CD8+. Verificou-se que a lesão mais prevalente é a candidíase nas suas diversas formas de manifestação clínica, independente de contagem linfocitária, com números variando de depressões imunológicas severas às brandas, evidenciando seu caráter oportunista. Com relação a Leucoplasia Pilosa, este estudo mostra a sua especificidade com relação ao estado avançado de imunodepressão do paciente infectado pelo HIV; a Doença Periodontal apresenta-se como uma manifestação clínica de prevalência moderada, estando relacionada sua etiologia ao controle de placa do paciente, mostrando-se um padrão mais agressivo em áreas localizadas