IL-10 predicts incident neuroinflammatory disease and proviral load dynamics in a large Brazilian cohort of people living with human T-lymphotropic virus type 1.

Human T-Lymphotropic Virus type-1 (HTLV-1) is a unique retrovirus associated with both leukemogenesis and a specific neuroinflammatory condition known as HTLV-1-Associated Myelopathy (HAM). Currently, most proposed HAM biomarkers require invasive CSF sampling, which is not suitable for large cohorts or repeated prospective screening. To identify non-invasive biomarkers for incident HAM in a large Brazilian cohort of PLwHTLV-1 (n=615 with 6,673 person-years of clinical follow-up), we selected all plasma samples available at the time of entry in the cohort (between 1997-2019), in which up to 43 cytokines/chemokines and immune mediators were measured. Thus, we selected 110 People Living with HTLV-1 (PLwHTLV-1), of which 68 were neurologically asymptomatic (AS) at baseline and 42 HAM patients. Nine incident HAM cases were identified among 68 AS during follow-up. Using multivariate logistic regression, we found that lower IL-10, IL-4 and female sex were independent predictors of clinical progression to definite HAM (AUROC 0.91), and outperformed previously suggested biomarkers age, sex and proviral load (AUROC 0.77). Moreover, baseline IL-10 significantly predicted proviral load dynamics at follow-up in all PLwHTLV-1. In an exploratory analysis, we identified additional plasma biomarkers which were able to discriminate iHAM from either AS (IL6Rα, IL-27) or HAM (IL-29/IFN-λ1, Osteopontin, and TNFR2). In conclusion, female sex and low anti-inflammatory IL-10 and IL-4 are independent risk factors for incident HAM in PLwHTLV-1,while proviral load is not, in agreement with IL-10 being upstream of proviral load dynamics. Additional candidate biomarkers IL-29/IL-6R/TNFR2 represent plausible therapeutic targets for future clinical trials in HAM patients.

Phenyl dialkynylcarbinols, a Bioinspired Series of Synthetic Antitumor Acetylenic Lipids.

A series of 25 chiral anti-cancer lipidic alkynylcarbinols (LACs) were devised by introducing an (hetero)aromatic ring between the aliphatic chain and the dialkynylcarbinol warhead. The resulting phenyl-dialkynylcarbinols (PACs) exhibit enhanced stability, while retaining cytotoxicity against HCT116 and U2OS cell lines with IC50 down to 40 nM for resolved eutomers. A clickable probe was used to confirm the PAC prodrug behavior: upon enantiospecific bio-oxidation of the carbinol by the HSD17B11 short-chain dehydrogenase/reductase (SDR), the resulting ynones covalently modify cellular proteins, leading to endoplasmic reticulum stress, ubiquitin-proteasome system inhibition, and apoptosis. Insights into the design of LAC prodrugs specifically bioactivated by HSD17B11 vs its paralogue HSD17B13 were obtained. The HSD17B11/HSD17B13-dependent cytotoxicity of PACs was exploited to develop a cellular assay to identify specific inhibitors of these enzymes. A docking study was performed with the HSD17B11 AlphaFold model, providing a molecular basis of the SDR substrates mimicry by PACs. The safety profile of a representative PAC was established in mice.

Discovery of new diaryl ether inhibitors against Mycobacterium tuberculosis targeting the minor portal of InhA.

Tuberculosis (TB) caused by Mycobacterium tuberculosis (Mtb) affects 10 million people each year and the emergence of resistant TB augurs for a growing incidence. In the last 60 years, only three new drugs were approved for TB treatment, for which resistances are already emerging. Therefore, there is a crucial need for new chemotherapeutic agents capable of eradicating TB. Enzymes belonging to the type II fatty acid synthase system (FAS-II) are involved in the biosynthesis of mycolic acids, cell envelope components essential for mycobacterial survival. Among them, InhA is the primary target of isoniazid (INH), one of the most effective compounds to treat TB. INH acts as a prodrug requiring activation by the catalase-peroxidase KatG, whose mutations are the major cause for INH resistance. Herein, a new series of direct InhA inhibitors were designed based on a molecular hybridization approach. They exhibit potent inhibitory activities of InhA and, for some of them, good antitubercular activities. Moreover, they display a low toxicity on human cells. A study of the mechanism of action of the most effective molecules shows that they inhibit the biosynthesis of mycolic acids. The X-ray structures of two InhA/NAD+/inhibitor complexes have been obtained showing a binding mode of a part of the molecule in the minor portal, rarely seen in the InhA structures reported so far.

Effects of red and infrared laser on post extraction socket repair in rats subjected to alendronate therapy

Abstract This study evaluated the effect of photobiomodulation therapy (PBMT) with a red or infrared laser on the repair of post extraction sockets in rats administered alendronate (ALN). Forty male rats were randomly allocated into four groups: Control Group (CTR): subcutaneous administration of saline solution throughout the experimental period; Alendronate Group (ALN): subcutaneous administration of alendronate during the entire experimental period; Alendronate/Red Laser Group (ALN/RL): administration of ALN and irradiation with a GaAlAs laser (λ 660 nm); and Alendronate/Infrared Laser Group (ALN/IRL): administration of ALN and irradiation with a GaAlAs laser (λ 830 nm). The first lower molars were extracted 60 days after the beginning of the administration of the drugs. The PBMT was applied after tooth extraction (7 sessions with intervals of 48 hours between sessions). Thirty days after tooth extraction, the animals were euthanized. Micro-CT and histometric analysis were performed to assess the bone healing and soft tissue repair of the tooth socket. The ALN group presented with more bone than the CTR; however, most of this bone was necrotic. ALN does not affect the bone microarchitecture. On the other hand, PBMT with IRL enhances the bone density due to the increase in the number and reduction in the spacing of the trabeculae. The amount of vital bone and connective tissue matrix was higher in the ALN/RL and ALN/IRL groups than in the ALN and CTR groups. PBMT enhanced the healing of the post extraction sockets in rats subjected to ALN administration. Furthermore, IRL improved the new bone microarchitecture.

Systemic cytokines and GlycA discriminate disease status and predict corticosteroid response in HTLV-1-associated neuroinflammation.

BACKGROUND: HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) is an incapacitating neuroinflammatory disorder for which no disease-modifying therapy is available, but corticosteroids provide some clinical benefit. Although HAM/TSP pathogenesis is not fully elucidated, older age, female sex and higher proviral load are established risk factors. We investigated systemic cytokines and a novel chronic inflammatory marker, GlycA, as possible biomarkers of immunopathogenesis and therapeutic response in HAM/TSP, and examined their interaction with established risk factors. PATIENTS AND METHODS: We recruited 110 People living with HTLV-1 (PLHTLV-1, 67 asymptomatic individuals and 43 HAM/TSP patients) with a total of 946 person-years of clinical follow-up. Plasma cytokine levels (IL-2, IL-4, IL-6, IL-10, IL-17A, IFN-γ, TNF) and GlycA were quantified by Cytometric Bead Array and 1NMR, respectively. Cytokine signaling and prednisolone response were validated in an independent cohort by nCounter digital transcriptomics. We used multivariable regression, machine learning algorithms and Bayesian network learning for biomarker identification. RESULTS: We found that systemic IL-6 was positively correlated with both age (r = 0.50, p < 0.001) and GlycA (r = 0.45, p = 0.00049) in asymptomatics, revealing an 'inflammaging" signature which was absent in HAM/TSP. GlycA levels were higher in women (p = 0.0069), but cytokine levels did not differ between the sexes. IFN-γ (p = 0.007) and IL-17A (p = 0.0001) levels were increased in untreated HAM/TSP Multivariable logistic regression identified IL-17A and proviral load as independent determinants of clinical status, resulting in modest accuracy of predicting HAM/TSP status (64.1%), while a machine learning-derived decision tree classified HAM/TSP patients with 90.7% accuracy. Pre-treatment GlycA and TNF levels significantly predicted clinical worsening (measured by Osame Motor Disability Scale), independent of proviral load. In addition, a poor prednisolone response was significantly correlated with higher post-treatment IFN-γ levels. Likewise, a transcriptomic IFN signaling score, significantly correlated with previously proposed HAM/TSP biomarkers (CASP5/CXCL10/FCGR1A/STAT1), was efficiently blunted by in vitro prednisolone treatment of PBMC from PLHTLV-1 and incident HAM/TSP. CONCLUSIONS: An age-related increase in systemic IL-6/GlycA levels reveals inflammaging in PLHTLV-1, in the absence of neurological disease. IFN-γ and IL-17A are biomarkers of untreated HAM/TSP, while pre-treatment GlycA and TNF predict therapeutic response to prednisolone pulse therapy, paving the way for a precision medicine approach in HAM/TSP.

Validação do instrumento de cuidado do enfermeiro ao paciente crítico com cateter venoso central / Validation of the nurse's care instrument for the critical patient with a central venous catheter / Validación de un instrumento para la atención de enfermería a pacientes críticos con catéteres venosos centrales

Objetivo: Validar o conteúdo do instrumento de cuidado do enfermeiro ao paciente com cateter venoso central, internado na unidade de terapia intensiva. Métodos: Estudo quantitativo, conduzido em duas etapas: análise teórica por sete enfermeiros especialistas, dos itens do instrumento construído anteriormente e análise estatística a partir do Índice de Validade de Conteúdo e o coeficiente Alpha de Cronbach. Resultados: Após avaliação dos especialistas, o instrumento compôs- se por 36 itens e quatro domínios. Todos os itens apresentaram índice de validade de conteúdo superior a 0,78, com concordância de 0,85 a 1,00 nas avaliações. O índice de validade de conteúdo médio dos domínios e do instrumento foi maior que 0,90. Os itens dos domínios apresentaram consistência interna satisfatória. Conclusão: O instrumento de cuidado do enfermeiro apresentou conteúdo validado e confiável, sendo, portanto, seguro e de qualidade para cuidados com o paciente crítico com cateter venoso central.

Objective: To validate the content of the nurse's care instrument for patient with a central venous catheter in the intensive care unit. Methods: Quantitative study, conducted in two stages: theoretical analysis by seven specialist nurses of the instrument items previously developed and statistical analysis based on the Content Validity Index and Cronbach's Alpha coefficient. Results: After expert evaluation, the instrument consisted of 36 items and four domains. All items had a content validity index greater than 0.78, with an agreement between 0.85 and 1.00 in the evaluations. The mean content validity index of the domains and the instrument was greater than 0.90. The domain items showed satisfactory internal consistency. Conclusion: The nurse's care instrument presented validated and reliable content, being, therefore, safe and of quality for the care of critically ill patients with central venous catheters.

Objetivo: Validar el contenido del instrumento de atención de la enfermera al paciente con catéter venoso central, ingresado en la unidad de cuidados intensivos. Métodos: Estudio cuantitativo, conducido en dos etapas: análisis teórico por parte de siete enfermeros especialistas, de los ítems del instrumento construido anteriormente y análisis estadístico a partir del Índice de Validez de Conteúdo y el coeficiente Alpha de Cronbach. Resultados: Tras la evaluación de los expertos, el instrumento quedó compuesto por 36 ítems y cuatro dominios. Todos los ítems tuvieron un índice de validez de contenido superior a 0,78, con un acuerdo entre 0,85 y 1,00 en las evaluaciones. El índice medio de validez de contenido de los dominios y del instrumento fue superior a 0,90. Los ítems de los dominios mostraron una consistencia interna satisfactoria. Conclusión: El instrumento de cuidado del enfermero presentó un contenido validado y fiable, siendo, además, seguro y de calidad para el cuidado del paciente crítico con catéter venoso central.

The copy number variation of GSTM1 as a promising prognostic factor of oral squamous cell carcinoma.

OBJECTIVE: The aim of this study was to investigate whether the copy number variation (CNV) of GSTM1 and GSTT1 is related to the occurrence of oral squamous cell carcinoma (OSCC) relapses, along the overall and progression-free survival of patients. STUDY DESIGN: A total of 234 OSCC patients were recruited from the Heliópolis hospital and they were distributed among 4 groups according to the occurrence of OSCC relapses. Fisher exact test, odds ratio (OR), and 95% CI were determined to investigate the chances of OSCC progression. The overall and progression-free survival were analyzed by the Kaplan-Meier and Cox regression methods. RESULTS: The CNV of GSTM1 analysis showed that one copy of the gene was associated with reduced chances of OSCC recurrences (OR 0.45; 95% CI 0.25-0.81) and decreased the risk of tumor progression (HR 0.50; 95% CI 0.33-0.75). Furthermore, one copy of GSTM1 was related to a better overall survival rate (HR 0.63; 95% CI 0.0.44-0.91). Regarding the CNV of GSTT1, no copies were associated with the chances of OSCC relapses, the overall survival, or the progression-free survival. CONCLUSIONS: The CNV of GSTM1 may be applied to predict OSCC relapses and aid the treatment management, which might improve the survival rates of patients.

Many hands make light work: CNV of GSTM1 effect on the oral carcinoma risk.

BACKGROUND: Genetic alterations of oral squamous cell carcinoma (OSCC) allow the understanding of the oral carcinogenesis and the identification of molecular biomarkers that aid the early diagnosis of the disease. The copy number variation (CNV) of GSTM1 and GSTT1 are promising targets because these two genes codify enzymes that perform the inactivation of tobacco carcinogens, which are the main risk factor of OSCC. However, the different levels of - detoxification mechanism in relation to each copy of the genes are unknown. Therefore, this study aimed to investigate the possible association of the CNV of GSTM1 and GSTT1 with the risk of development of OSCC. METHODS: A total of 234 OSCC patients and 422 patients without any cancer diagnoses were recruited from Heliópolis Hospital from 2000 to 2011. The CNV was determined by TaqMan real-time PCR and the CopyCaller software. Odds ratio (OR) and 95% confidence interval (95% CI) values were calculated by Multiple Logistic Regression. RESULTS: Most OSCC patients reported they continued smoking high amounts of cigarettes despite the tumor diagnosis. The CNV of GSTM1 varied from zero to two copies and the analysis revealed that two copies of GSTM1 decreased by 53% the OSCC risk (OR 0.47; 95% CI 0.24-0.92) and the risk of the tumor was modified according to the interaction of the CNV of GSTM1 and the cigarette smoking consumption, which for the amount of 40 packs-year of cigarettes the OSCC risk diminished progressively according to the increase of copies of GSTM1. Although the GSTT1 gene varied from zero to three copies, none of them were associated with the tumor risk. CONCLUSION: The findings suggest that the CNV of GSTM1 might be applied as a tool for the surveillance of patients and the early detection of OSCC.

Vincristine sulfate treatment influence on kidney function of female dogs with transmissible venereal tumor / Influência do tratamento com sulfato de vincristina na função renal de cadela com tumor transmissível venéreo

Chemotherapy agents have some undesirable and non-selective cytostatic effects. Considering that kidneys are vulnerable to drug-induced toxicity, this study evaluated renal injury caused by vincristine sulfate (VS) in 12 female dogs diagnosed with transmissible venereal tumor (TVT). The animals were treated with VS (0.025 mg/kg IV) every 7 days for 4 weeks. During treatment, the animals were subjected to clinical examination, blood count, serum measurement of symmetric dimethylarginine (SDMA), blood urea nitrogen (BUN), creatinine, alanine aminotransferase, and alkaline phosphatase. In addition, urinalysis and urinary gamma-glutamyl transferase (GGT) measurements were performed. All parameters were determined three times: before beginning the treatment (T0), after 14 days (T1), and after 28 days (T2). During the study period, there were no changes in serum urea or creatinine levels, urine specific gravity, or persistent proteinuria. Furthermore, urinary GGT measurement did not indicate tubular lesions, and consistent elevation of SDMA was found in only one patient above the reference range. The results showed that weekly therapy with VS as a single agent for 28 days does not induce renal injury in most cases.(AU)

Os agentes quimioterápicos possuem efeitos citostáticos indesejáveis e não seletivos. Considerando a vulnerabilidade renal à toxicidade induzida por drogas, este estudo avaliou a lesão renal causada pelo sulfato de vincristina (VS) em 12 cadelas com diagnóstico de tumor venéreo transmissível (TVT). Os animais foram tratados com VS (0,025 mg / kg IV) a cada sete dias, durante quatro semanas. No transcurso do tratamento, os animais foram submetidos a exame clínico, hemograma, dosagem sérica de dimetilarginina simétrica (SDMA), nitrogênio ureico sanguíneo (BUN), creatinina, alanina aminotransferase e fosfatase alcalina. Além disso, foram realizadas análises de urina e medições de gama-glutamil transferase (GGT) urinária. Todos os parâmetros foram mensurados em três tempos, antes do início do tratamento (T0), aos 14 dias (T1) e aos 28 dias (T2). Durante o período do estudo, não houve alterações nas concentrações de ureia ou creatinina séricas, na gravidade específica da urina ou proteinúria persistente. Além disso, a medição de GGT urinária não indicou lesões tubulares, e elevação consistente de SDMA foi encontrada em apenas um paciente acima do intervalo de referência. Os resultados mostraram que a terapia semanal com VS como agente único por 28 dias não induz lesão renal na maioria dos casos.(AU)

Linfoma cutâneo difuso de grandes células B, tipo perna: sobre um caso típico / Cutaneous diffuse large B-cell lymphoma, leg type - a typical case

O linfoma cutâneo difuso de grandes células B, tipo perna, compreende uma neoplasia rara, agressiva e de mau prognóstico. Corresponde a 10-20% dos linfomas cutâneos de células B e afeta principalmente membros inferiores de mulheres idosas. Relatamos o caso de mulher de 81 anos, com nódulos e tumorações dolorosos, de crescimento rápido na perna esquerda. Os achados histopatológicos e a imuno-histoquímica, associados à ausência de comprometimento extracutâneo no estadiamento, concluíram o diagnóstico de linfoma cutâneo difuso de grandes células B, tipo perna. A raridade, a clínica e a epidemiologia típicas e a excelente resposta ao tratamento motivaram este relato

Cutaneous diffuse large B-cell lymphoma, leg type, is a rare, aggressive, and poorly prognostic neoplasm. It corresponds to 10-20% of cutaneous B-cell lymphomas and mainly affects the lower limbs of older women. We report the case of an 81-year-old woman with painful, fast-growing nodules and tumors in her left leg. Histopathological and immunohistochemical findings, associated with the absence of extra-cutaneous involvement during staging, concluded the diagnosis of cutaneous diffuse large B-cell lymphoma, leg type. The rarity of this limphoma, its typical clinic and epidemiology, and the excellent response to treatment motivated this report

Construção de instrumento de cuidado do enfermeiro ao paciente com cateter venoso centra / Construction of a nursing care instrument for patients with central venous catheters

Objetivo: construir um instrumento de cuidados do en-fermeiro ao paciente com cateter venoso central de curta permanência em Unidade de Terapia Intensiva. Métodos: estudo multimétodo em três etapas:estruturação do instru-mento; pré-teste do instrumento; análises de concordância entre os enfermeiros e composição final do instrumento. Resultados: o instrumento, em sua primeira versão, apre-sentou três domínios relacionados ao momento de inserção (cinco itens), manutenção (15 itens) e remoção do cateter (dez itens). A maioria dos 30 itens foi avaliada como rele-vante (23/77%) e apresentou satisfatório Índice de Vali-dade de Conteúdo (28/93%). Reformularam-se dez itens, incluíram-se 32 novos e excluíram-se três itens. Conclusão: foi construído o instrumento, que apresentou validade de resposta para os cuidados do enfermeiro ao paciente com cateter venoso central em Unidade de Terapia Intensiva, compondo-se de três domínios e 59 itens avaliados por en-fermeiros e considerados adequados para os momentos de inserção, manutenção e remoção do cateter. (AU)

Violência contra a população negra na região sudeste do Brasil: uma análise epidemiológica / Violence against black people of southeast Brazil: an epidemiological analysis / Violencia contra la población negra en la región sureste de Brasil: un análisis epidemiológico

RESUMOObjetivo: conhecer o perfil epidemiológico dos casos de violência contra a população negra no Sudeste brasileiro. Método: estudo epidemiológico descritivo, de caráter quantitativo e comparativo, com dados dos casos de violência contra a população negra no Sudeste brasileiro de janeiro de 2009 a dezembro de 2018 do sistema de informação de agravos de notificação. Resultados: houve 386.373 notificações, e o número anual de casos cresceu no período. A violência contra mulheres foi72,48% dos casos. A idade mais acometida foi de 20 a 29 anos (22,98%). O local com o maior número de notificações de violência foi a residência das vítimas (61,46%), e os principais responsáveis pela violência foram o cônjuge (17,90%), própria pessoa (15,79%) e amigos/conhecidos (12,93%). Os tipos de violência mais comuns foram física (37,82%), de repetição (19,29%) e psico moral (14,90%).Conclusão: o perfil epidemiológico da violência contra a população negra revela um aumento anual no número de notificações nesse período, dados que refletem a opressão e a violência contra essa população, em especial às mulheres negras. Assim, são necessárias políticas públicas que atendam esses indivíduos buscando reduzir preconceitos e desigualdades estruturais.

ABSTRACTObjective: to meet the epidemiological profile of the cases of violence against the black population of brazillian Southeast. Method:descriptive epidemiological study, of quantitative and comparative character, with data from cases of violence against the black population in southeastern Brazil from January 2009 to December 2018 of the notifiable diseases information system. Results:there were 386.373 notifications, and the annual number of cases increased in the period. Violence against women was 72.48% of the cases. The most affected age was 20 to 29 years (22.98%). The place with the highest number of notifications of violence was the victims' residence (61.46%), and the main responsible for the violence were the spouse (17.90%), the person himself (15.79%) and friends / acquaintances (12.93%). The most common types of violence were physical (37.82%), repetitive (19.29%) and psycho-moral (14.90%). Conclusion:the epidemiological profile of violence against the black population reveals an annual increase in the number of notifications in this period, data that reflect oppression and violence against this population, especially for black women. Thus, public policies are needed to assist these individuals seeking to reduce prejudices and structural inequalities.

RESUMENObjetivo: conocer el perfil epidemiológico de los casos de violencia contra la población negra en el sureste de Brasil. Método: estudio epidemiológico descriptivo, de carácter cuantitativo y comparativo, con datos de casos de violencia contra la población negra en el sudeste de Brasil de enero de 2009 a diciembre de 2018 del sistema de información de enfermedades de declaración obligatoria. Resultados:hubo 386,373 notificaciones y el número anual de casos aumentó en el período. La violencia contra la mujer fue del 72,48% de los casos. La edad más afectada fue de 20 a 29 años (22,98%). El lugar con más notificaciones de violencia fue el domicilio (61,46%), y los principales responsables fueron el cónyuge (17,90%), la propia persona (15,79%) y los amigos/conocidos (12,93%). Los tipos de violencia más comunes fueron física (37,82%), repetitiva (19,29%) y psico-moral (14,90%). Conclusión: el perfil epidemiológico de la violencia contra la población negra revela un incremento anual en el número de notificaciones en este período, datos que reflejan la opresión y violenciacontra esta población, especialmente para las mujeres negras. Por lo tanto, se necesitan políticas públicas para reducir los prejuicios y las desigualdades estructurales a estas personas.

Prognosis Markers for Monitoring HTLV-1 Neurologic Disease.

BACKGROUND: Human T-cell lymphotropic virus type 1 (HTLV-1) infection is associated not only with some severe manifestations, such as HTLV-1-associated myelopathy (HAM) and ATLL, but also with other, less severe conditions. Some studies have reported neurologic manifestations that did not meet all the criteria for the diagnosis of HAM in individuals infected with HTLV-1; these conditions may later progress to HAM or constitute an intermediate clinical form, between asymptomatic HTLV-1 carriers and those with full myelopathy. This study evaluated the prognostic value and looked for a possible association of those parameters with the intermediate syndrome (IS) status and HAM status. METHODS: Proviral load (PVL), spontaneous lymphoproliferation, interferon (IFN)-γ spontaneous production was quantified in samples of asymptomatic and HAM patients, as well as patients with IS. RESULTS: The critical age range was 50-60 years for IS outcome and more of 60 years for HAM outcome, with an increased risk of 2.5-fold for IS and 6.8-fold for HAM. IFN-γ was increased in patients with IS compared with asymptomatic carriers (ACs) (p = 0.007) and in patients with HAM compared with ACs (p = 0.03). Lymphoproliferation was increased in patients with HAM vs ACs (p = 0.0001) and patients with IS (p = 0.0001). PVL was similar between groups. CONCLUSION: IFN-γ has high specificity of prediction of subject remain asymptomatic compared with PVL and lymphoproliferation assay tests. IFN-γ has been shown to be a biomarker of progression to intermediate stage and to HAM. The association of other markers with manifestations associated with HTLV-1 infection that does not meet the HAM criteria should be verified.

Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.

Case for diagnosis. Phagedenic ulcer on the thorax

Abstract Paget's disease is a rare disorder of the nipple and/or the areola that is characterized by an erythematosquamous lesion and is often associated with in situ or invasive breast carcinoma. The authors present an atypical, exuberant case that had evolved over eight years, emphasizing the importance of early diagnosis.

Nursing diagnosis/outcomes and interventions for critically ill patients affected by covid-19 and sepsis / Diagnósticos/resultados e intervenciones de enfermería para pacientes graves afectados por covid-19 y por sepsis / Diagnósticos/resultados e intervenções de enfermagem para pacientes graves acometidos por covid-19 e sepse

ABSTRACT Objective: to relate nursing diagnoses/outcomes and interventions for critically ill patients affected by COVID-19 and sepsis in the Intensive Care Unit, according to the International Classification for Nursing Practice (ICNP®). Method: a documentary study conducted in March and April 2020 from the ICNP® terminology subset for adult patients with sepsis. The documentary corpus was composed of the list of nursing diagnoses/outcomes and interventions based on Horta's Theory of Basic Human Needs; on the 7-Axis Model of the International Classification for Nursing Practice, version 2017; on the Pathophysiological model of sepsis; as well as relying on the authors' expertise in direct care for suspected or confirmed critically ill patients affected by COVID-19. Outcomes: a total of 58 nursing diagnoses/outcomes were identified that belong to the psychobiological needs of oxygenation (13-22.4%), vascular regulation (12-20.7%), neurological regulation (10-17.2%), hydration (08-13.8%), elimination (08-13.8%), immunological regulation (04-6.9%) and thermal regulation (03-5.2%), evidencing a total of 172 nursing interventions with a mean of 03 for each nursing diagnosis/outcome. Conclusion: data analysis provided greater knowledge about the disease and the nursing process in the ICU setting, serving as a guide for the professional practice for critically ill patients hospitalized with COVID-19 and sepsis.

RESUMEN Objetivo: relacionar diagnósticos/resultados e intervenciones de enfermería para pacientes graves afectados por COVID-19 y por sepsis en la Unidad de Cuidados Intensivos, de acuerdo con la Clasificación Internacional para la Práctica de Enfermería (CIPE®). Método: estudio documental realizado en los meses de marzo y abril de 2020 a partir del subconjunto terminológico de la CIPE® para pacientes adultos con sepsis. El corpus documental estuvo compuesto por la lista de diagnósticos/resultados e intervenciones de enfermería sobre la base de la Teoría de las Necesidades Humanas Básicas de Horta; del Modelo de 7 ejes de la Clasificación Internacional para la Práctica de Enfermería, versión 2017; y del Modelo fisiopatológico de la sepsis; al igual que contó con los profundos conocimientos de los autores en el cuidado directo a pacientes graves con sospecha o confirmación de COVID-19. Resultados: se identificaron 58 diagnósticos/resultados de enfermería que pertenecen a las necesidades psicobiológicas de oxigenación (13-22,4%), regulación vascular (12-20,7%), regulación neurológica (10-17,2%), hidratación (08-13,8%), eliminación (08-13,8%), regulación inmunológica (04-6,9%) y regulación térmica (03-5,2%), evidenciando un total de 172 intervenciones de enfermería con una media de 03 para cada diagnóstico/resultado de enfermería. Conclusión: el análisis de los datos amplió el conocimiento sobre la enfermedad y el proceso de enfermería en el ámbito de la UCI, sirviendo así como guía para la práctica profesional ofrecida al paciente grave internado con COVID-19 y sepsis.

RESUMO Objetivo: relacionar diagnósticos/resultados e intervenções de enfermagem para pacientes graves acometidos por COVID-19 e sepse na Unidade de Terapia Intensiva, segundo a Classificação Internacional para a Prática de Enfermagem (CIPE®). Método: estudo documental realizado nos meses de março e abril de 2020 a partir do subconjunto terminológico da CIPE® para pacientes adultos com sepse. O corpus documental foi composto pela lista de diagnósticos/resultados e intervenções de enfermagem com base na Teoria das Necessidades Humanas Básicas de Horta; no Modelo de 7-Eixos da Classificação Internacional para a Prática de Enfermagem, versão 2017; no Modelo fisiopatológico da sepse; bem como contou com a expertise dos autores no cuidado direto a pacientes graves suspeitos ou confirmados de COVID-19. Resultados: foram identificados 58 diagnósticos/resultados de enfermagem que pertencem às necessidades psicobiológicas de oxigenação (13-22,4%), regulação vascular (12-20,7%), regulação neurológica (10-17,2%), hidratação (08-13,8%), eliminação (08-13,8%), regulação imunológica (04-6,9%) e regulação térmica (03-5,2%), evidenciando um total de 172 intervenções de enfermagem com uma média de 03 para cada diagnóstico/resultado de enfermagem. Conclusão: a análise dos dados oportunizou maior conhecimento sobre a doença e o processo de enfermagem no âmbito da UTI, servindo como um guia para a prática profissional ao paciente grave internado com COVID-19 e sepse.

Early resynchronization protocols for goats: Progestogens can be used prior to an early pregnancy diagnosis without affecting corpus luteum functionality.

This study aimed to evaluate the exogenous progesterone (P4) effect on the luteal function from Day 16 to Day 21 of the oestrous cycle in inseminated goats with unknown pregnancy status. A total of 54 does passed through a short progestin-based synchronization protocol and, on Day 16 of the following oestrous cycle, 27 does received a new P4 device which was retained until Day 21. Blood samples were collected daily from all does during this period, as well as on Day 24. Pregnancy diagnoses were performed on Day 30. Serum P4 values from 26 animals (GNPSP : Group of non-pregnant does with second sponge: n = 8; GNPNSP : Group of non-pregnant does without second sponge: n = 6; GPSP : Group of pregnant does with second sponge: n = 5; GPNSP : Group of pregnant does without second sponge: n = 7) were determined by radioimmunoassay commercial kits. No P4 differences were found between groups (GNPSP : 3.1 ± 2.8; 1.7 ± 1.8; 0.4 ± 1.0; and 0.0 ± 0.0 vs. GNPNSP : 4.4 ± 1.8; 3.0 ± 2.2; 0.8 ± 0.8; and 0.0 ± 0.0 or GPSP : 4.2 ± 1.0; 3.4 ± 0.6; 3.3 ± 1.6; 3.2 ± 0.9; 3.6 ± 1.2; 3.5 ± 1.3; 2.7 ± 1.3 vs. GPNSP : 4.4 ± 1.6; 3.6 ± 1.5; 3.7 ± 1.5; 3.8 ± 1.4; 3.2 ± 1.2; 3.1 ± 1.2; 3.6 ± 1.1; D16, D17, D18, D19, D20, D21, D24, respectively) or for the interaction of group and time. In conclusion, a second progestogen device had no effect on luteolysis or early pregnancy in the following oestrous cycle.

Case for diagnosis. Phagedenic ulcer on the thorax.

Paget's disease is a rare disorder of the nipple and/or the areola that is characterized by an erythematosquamous lesion and is often associated with in situ or invasive breast carcinoma. The authors present an atypical, exuberant case that had evolved over eight years, emphasizing the importance of early diagnosis.

Correlação entre dois testes e a pontuação do Child Health Assessment Questionnaire em crianças com cardiopatia reumática / Correlation between two tests and Children Health Assessment Questionnaire in child with rheumatic cardiopathy

As crianças que evoluem para cardiopatia reumática passam a conviver com limitações, tornam-se comumente restritas no desempenho de atividade do cotidiano. OBJETIVO: Verificar a existência de correlação entre o desempenho no teste de caminhada de seis minutos (TC6M) e do degrau de três minutos (TD3) e a pontuação do child health assessment questionnaire (CHAQ) em criança com febre reumática. MÉTODOS: Estudo seccional sem grupo de comparação, descritivo e exploratório, realizado com 15 crianças. Foram avaliadas através dos testes submáximos, o TC6M e o TD3 e a avaliação da capacidade física sob a percepção do cuidador foi realizada por meio da aplicação do CHAQ. RESULTADOS: A média de idade 13,7 anos, desvio padrão 1,9 anos. A maioria dos acompanhantes eram mães, 66,7%, e uma parcela considerável dos cuidadores apresentou baixo nível socioeconômico e de escolaridade. O valor obtido na distância percorrida através do TC6M demonstrou um baixo desempenho, mediana (intervalo interquartil) 420 (101) metros que também foi observado no teste do degrau de três minutos, mediana (intervalo interquartil) 68 (6,5) degraus. Em relação ao questionário CHAQ foi observado ausência de comprometimento da capacidade física diante da percepção dos responsáveis com escore final do questionário de 0,1. A correlação entre o questionário e o teste de caminhada de seis minutos (correlação de Sperman = - 0,21) e, entre o questionário e o teste do degrau de três minutos, (correlação de Sperman = - 0,39). CONCLUSÃO: Não foi encontrada correlação dos testes submáximos, em relação à capacidade física obtida através da percepção dos responsáveis avaliada através do questionário. Esse resultado chama a atenção para a importância do fisioterapeuta inserir na sua prática clínica, nesse perfil de pacientes os testes submáximos.

Children who develop rheumatic heart disease live with limitations, they become commonly restricted in the performance of everyday activities. OBJECTIVE: To verify the correlation between performance between two submaximal exercise tests and the questionnaire score in children with chronic rheumatic disease. METHODS: A cross-sectional, descriptive and exploratory study with 15 children. They were evaluated through the submaximal tests, the 6MWT and TD3 and the physical capacity assessment under the caregiver's perception was performed through the application of the questionnaire of CHAQ. RESULTS: Mean age 13.7 years, standard deviation 1.9 years. Most of the companions were mothers, 66.7%, and a considerable portion of the caregivers had low socioeconomic and educational levels. The value obtained in the distance covered by the 6MWT demonstrated a low performance, median (interquartile range) 420 (101) meters, which was also observed in the three-minute step test, median (interquartile range) 68 (6.5) steps. Regarding the CHAQ questionnaire, there was an absence of impairment of physical capacity in view of the perception of those responsible with a final score of 0.1. The correlation between the questionnaire and the six-minute walk test (Sperman correlation = -0.21) and between the questionnaire and the three-minute step test (Sperman's correlation = -0.39). CONCLUSION: No correlation was found between submaximal tests, in relation to the physical capacity obtained through the perception of those responsible, assessed through the questionnaire. This result draws attention to the importance of the physiotherapist inserting submaximal tests in his clinical practice.