Inflammasome genes polymorphisms are associated with progression to mechanical ventilation and death in a cohort of hospitalized COVID-19 patients in a reference hospital in Rio de Janeiro, Brazil.

COVID-19 has a broad spectrum of clinical manifestations. We assessed the impact of single nucleotide polymorphisms (SNPs) of inflammasome genesas risk factors for progression toCOVID-19 critical outcomes, such as mechanical ventilation support (MVS) or death.The study included 451 hospitalized individuals followed up at the INI/FIOCRUZ, Rio de Janeiro, Brazil, from 06/2020 to 03/2021. SNPs genotyping was determined by Real-Time PCR. We analyzed risk factors for progression to MVS (n = 174[38.6 %]) or death (n = 175[38.8 %])as a result of COVID-19 by Cox proportional hazardmodels.Slower progression toMVSwas associated with allele G (aHR = 0.66;P = 0.005) or the genotype G/G (aHR = 0.391;P = 0.006) in the NLRP3 rs10754558 or the allele G (aHR = 0.309;P = 0.004) in the IL1ßrs1143634, while C allele in the NLRP3 rs4612666 (aHR = 2.342;P = 0.006) or in the rs10754558 (aHR = 2.957;P = 0.005) were associated with faster progression to death. Slower progression to death was associated to allele G (aHR = 0.563;P = 0.006) or the genotype A/G (aHR = 0.537;P = 0.005) in the CARD8 rs6509365; the genotype A/C in the IFI16 rs1101996 (aHR = 0.569;P = 0.011); the genotype T/T (aHR = 0.394;P = 0.004) or allele T (aHR = 0.68;P = 0.006) in the NLRP3 rs4612666, and the genotype G/G (aHR = 0.326;P = 0.005) or allele G (aHR = 0,68;P = 0.014) in the NLRP3 rs10754558. Our results suggest that inflammasome genetic variations might influence the critical clinical course of COVID-19.

The first case of acute HIV and monkeypox coinfection in Latin America

ABSTRACT Monkeypox (MPX) transmission outside non-endemic countries has been reported since May 2022, rapidly evolving into a multi-country outbreak. A potential role of sexual contact in transmission dynamics, as well as a predominance of anogenitallesions, are remarkable features of current cases. Screening for sexually transmitted infections (STIs) plays an important role in the evaluation of patients with suspected MPX infection. Herein we report the first case of a patient diagnosed with both MPX and acute HIV infection in Latin America. He had no major complications during his clinical course, and antiretroviral therapy was promptly initiated. Diagnosis of acute HIV requires a high level of suspicion and appropriate laboratory investigation. Health practitioners need to consider this diagnosis while evaluating patients with suspected MPX with a recent unprotected sexual contact.

Inflammasome Genetic Variants Are Associated with Protection to Clinical Severity of COVID-19 among Patients from Rio de Janeiro, Brazil.

COVID-19 has a broad spectrum of clinical manifestations, from asymptomatic or mild/moderate symptoms to severe symptoms and death. The mechanisms underlying its clinical evolution are still unclear. Upon SARS-CoV-2 infection, host factors, such as the inflammasome system, are activated by the presence of the virus inside host cells. The search for COVID-19 risk factors is of relevance for clinical management. In this study, we investigated the impact of inflammasome single-nucleotide polymorphisms (SNPs) in SARS-CoV-2-infected individuals with distinct severity profiles at clinical presentation. Patients were divided into two groups according to disease severity at clinical presentation based on the WHO Clinical Progression Scale. Group 1 included patients with mild/moderate disease (WHO < 6; n = 76), and group 2 included patients with severe/critical COVID-19 (WHO ≥ 6; n = 357). Inpatients with moderate to severe/critical profiles were recruited and followed-up at Hospital Center for COVID-19 Pandemic - National Institute of Infectology (INI)/FIOCRUZ, RJ, Brazil, from June 2020 to March 2021. Patients with mild disease were recruited at Oswaldo Cruz Institute (IOC)/FIOCRUZ, RJ, Brazil, in August 2020. Genotyping of 11 inflammasome SNPs was determined by real-time PCR. Protection and risk estimation were performed using unconditional logistic regression models. Significant differences in NLRP3 rs1539019 and CARD8 rs2043211 were observed between the two groups. Protection against disease severity was associated with the A/A genotype (ORadj = 0.36; P = 0.032), allele A (ORadj = 0.93; P = 0.010), or carrier-A (ORadj = 0.45; P = 0.027) in the NLRP3 rs1539019 polymorphism; A/T genotype (ORadj = 0.5; P = 0.045), allele T (ORadj = 0.93; P = 0.018), or carrier-T (ORadj = 0.48; P = 0.029) in the CARD8 rs2043211 polymorphism; and the A-C-G-C-C (ORadj = 0.11; P = 0.018), A-C-G-C-G (ORadj = 0.23; P = 0.003), C-C-G-C-C (ORadj = 0.37; P = 0.021), and C-T-G-A-C (ORadj = 0.04; P = 0.0473) in NLRP3 genetic haplotype variants. No significant associations were observed for the other polymorphisms. To the best of our knowledge, this is the first study demonstrating an association between CARD8 and NLRP3 inflammasome genetic variants and protection against COVID-19 severity, contributing to the discussion of the impact of inflammasomes on COVID-19 outcomes.

Epidemiologia de Infecções Fúngicas Invasivas em Receptores de Transplante de Células Tronco Hematopoéticas e em Pacientes com Leucemia Mielóide Aguda ou Mielodisplasia - Resultado de um Estudo Multicêntrico Brasileiro

Introdução: As infecções fúngicas invasivas (IFI) representam um problema importante nos pacientes submetidos a transplantes de células tronco hematopoéticas (TCTH) e em pacientes com leucemia mielóide aguda (LMA) e mielodisplasia (MDS). Há pouca informação sobre a epidemiologia de IFI nessa população de pacientes no Brasil. O objetivo desse estudo foi avaliar a incidência de IFI em receptores de TCTH e em pacientes com LMA ou MDS. Pacientes e Métodos: Esta coorte multicêntrica prospectiva foi conduzida em 8 centros de hematologia e/ou TCTH no Brasil, conduzido entre maio de 2007 e julho de 2009. Resultados: Um total de 937 pacientes foi acompanhado (700 TCTHs e 237 pacientes com LMA/MDS). A incidência global de IFI foi de 11,4%, sendo 21% na coorte LMA/MDS e 8% na coorte TCTH (entre TCTH alogênico a incidência foi de 13,8% e entre TCTH autólogo foi de 1,9%). Aspergilose invasiva foi a IFI mais frequente, com uma incidência global de 6,3%, seguido de fusariose (2,1%) e candidíase invasiva (1,5%). A incidência acumulada de IFI em 1 ano na coorte de 937 pacientes foi 11,5%, significativamente diferente em TCTH autólogo (2,3%), TCTH alogênico (18,6%) e LMA/MDS (34,9%, p<0,001). A incidência acumulada de as pergilose invasiva foi significativamente maior na coorte de LMA/MDS (29,5%), seguida de 8,5% no TCTH alogênico e 0,3% nos receptores de TCTH autólogo (p<0,001).A sobrevida global em 1 ano foi significativamente menor nos pacientesque desenvolveram IFI (28% x 74% para pacientes sem IFI, p<0,001). Conclusões: Observamos uma elevada incidência de IFI, maior no grupo de pacientes com LMA/MDS quando comparados a TCTH. Entre o grupo receptor de TCTH, os pacientes alogênicos tiveram incidência global de IFI maior do que os autólogos. Aspergilose é a infecção mais comum, seguida de fusariose

Background: Invasive fungal infections (IFI) are a major problem among hematopoietic stem cell transplant (HSCT) recipients and in patients with acute myeloid leukemia (AML) or myelodyspla sia (MDS). Data on the epidemiology of IFI in Brazil are lacking. The purpose of this study was to evaluate the incidence of IFI in HSCT recipients and in patients with AML or MDS. Methods: This prospective cohort was conducted in 8 hematologic centers in Brazil, from May 2007 to July 2009. Results: A total of 937 patients were followed (700 HSCT e 237 AML/MDS). The incidence of IFI was 11.4%, being 21% in AML/MDS and 8% in HSCT (13.8% in allogeneic and 1.9% in autologous HSCT). Invasive aspergillosis was the most frequent IFI, with a global incidence of 6.3%, followed by fusariosis (2.1%) and invasive candidiasis (1.5%). The overall 1-year cumulative incidence of IFI was 11.5%, significantly different between autologous HSCT (2.3%), allogeneic HSCT (18.6%) and AML/MDS (34.9%, p<0.001). The cumulative incidence of invasive aspergillosis was significantly higher in the AML/MDS cohort (29.5%), followed by allogeneic HSCT (8.5%) and autologous HSCT (0.3%, p<0,001). The 1-year overall survival was significantly lower in patients with IFI (28% x 74% for patients without IFI, p<0.001). Conclusion: We observed a high burden of IFI in HSCT recipients and in patients with AML/MDS, with different incidence rates among allogeneic and autologous HSCT, and in AML/MDS. Invasive aspergillosis was the leading IFI, followed by fusariosis

O aprendizado de Semiologia em um currículo tradicional / Learning basic clinical skills ins a traditional medical school curriculum

Realizou-se um estudo etnográfico entre estudantes de Medicina no primeiro momento de seu primeiro contato com pacientes numa escola pública do Rio de Janeiro ao longo de seu aprendizado de Semiologia. Este artigo apresenta reultados parciais, obtidos em entrevistas em que os estudantes responderam questões sobre a relação médico-paciente e suas impressões sobre a Semiologia. Não houve recusas, e os estudantes responderam às questões escrevendo suas opiniões e impressões. Os resultados mostraram algumas diferenças de gênero. Estudantes do sexo feminino freqüentemente expressaram seus sentimentos sobre professores e pacientes, e os do sexo masculino comentaram principalmente sobre o nível científico e questões pedagógicas concernentes aos conteúdos da disciplina. Ambos os grupos referiram a presença de fortes laços relacionais com o professor. Bons relacionamentos foram apresentados como fonte importante de motivação para estudo e esforço de desenvolver habilidades junto ao paciente. O professor é encarado como um "pai". Por outro lado, relações conflituosas são relatadas como fonte de depressão e desestímulo tanto para estudar como para estabelecer boas relações com pacientes. Algumas respostas apontaram procedimentos desrespeitosos para com o paciente da parte dos alunos e professores, deplorando estes eventos como um antiexemplo para a formação médica. O pouco tempo destinado ao retorno de pacientes já examinados foi criticado, por cerca de 50 por cento dos estudantes, como negativo para o aprendizado de como seguir pacientes e se relacionar com eles de modo mais humanizado. Concluiu-se que, embora 50 por cento dos estudantes não se apresentam problemas com o ambiente de relações no hospital, é necessário estar atento às críticas do corpo discente a fim de incrementar o conteúdo ético do aprendizado clínico.