Prognostic factors and impact of CMV reactivation on acute myeloid leukemia patients after HLA-matched myeloablative allogeneic stem cell transplantation in a high CMV prevalence country

ABSTRACT Introduction: Relapse of acute myeloid leukemia (AML) after allogeneic stem cell transplantation (allo-SCT) leads to dismal outcomes. This study aimed to identify high-risk patients and explore the effects of cytomegalovirus (CMV) reactivation in a high CMV-seropositive population. Methods: The study involved a single-center retrospective cohort in Thailand, analyzing clinical risk factors and CMV-mediated immune responses, correlated with transplant outcomes in AML patients. Results: Eighty-five patients with AML in complete remission (CR) undergoing HLA-matched myeloablative allo-SCT between 2011 and February 2021 were enrolled. The relapse rate was 27.1% with the median time of 7 months after transplantation. The 3-year relapse-free-survival (RFS) and overall-survival (OS) were 72.2% and 80.8%, respectively. The disease status (>CR1) and absence of chronic graft-versus-host disease (cGVHD) were independently significant adverse prognostic factors of RFS and OS. Ninety-two percent of recipient-donor pairs were both CMV seropositive. The CMV reactivation occurred in 54.1% of the patients. The clinically significant CMV infection rate was 49.4%. No CMV syndrome/disease or CMV-related mortality occurred. One-year cumulative incidence of relapse among CMV-reactivation and non-reactivation groups were 14.3% and 25.6%, respectively, without a statistically significant difference. Transplantation-related mortality was 11.1%. Conclusions: The transplantation beyond CR1 and absence of cGVHD are powerful prognostic factors associated with inferior RFS and OS. In a high CMV prevalence country, there appears to be no impact of CMV reactivation on relapse in AML patients undergoing an allo-SCT.

Comparative Analysis of Primary and Reactivated EB Virus Infection Associated Hemophagocytic Lymphohistiocytosis / 中国实验血液学杂志

OBJECTIVE@#To compare the clinical characteristics of children with hemophagocytic lymphocytosis (HLH) associated with primary Epstein-Barr virus (EBV) infection and EBV reactivation, and explore the effects of different EBV infection status on the clinical indexes and prognosis of HLH.@*METHODS@#The clinical data of 51 children with EBV associated HLH treated in Henan Children's Hospital from June 2016 to June 2021 were collected. According to the detection results of plasma EBV antibody spectrum, they were divided into EBV primary infection-associated HLH group (18 cases) and EBV reactivation-associated HLH group (33 cases). The clinical features, laboratory indexes and prognosis of the two groups were analyzed and compared.@*RESULTS@#There were no significant differences in age, gender, hepatomegaly, splenomegaly, lymphadenopathy, neutrophil count in peripheral blood, hemoglobin content, platelet count, plasma EBV-DNA load, lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase, albumin, fibrinogen, triglyceride, ferritin, hemophagocytosis in bone marrow, NK cell activity and sCD25 between the two groups(P>0.05). The central nervous system involvement and CD4/CD8 in EBV reactivation-associated HLH group were significantly higher than those in primary infection-associated HLH group, but the total bilirubin was significantly lower than that in primary infection-associated HLH group (P<0.05). After treatment according to HLH-2004 protocol, the remission rate, 5-year OS rate and 5-year EFS rate of patients in EBV reactivation-associated HLH group were significantly lower than those in EBV primary infection-associated HLH group (P<0.05).@*CONCLUSION@#EBV reactivation-associated HLH is more likely to cause central nervous system involvement and the prognosis is worser than EBV primary infection-associated HLH, which requires intensive treatment.

Clinical analysis and curative effect of reactivation of retinopathy of prematurity after intravitreous injection of ranibizumab / 中华眼底病杂志

Objective:To observe the clinical characteristics and therapeutic effect of reactivation of retinopathy of prematurity (ROP) patients after intravitreal injection of ranibizumab (IVR).Methods:A retrospective case series study. Eleven children with ROP (21 eyes) who were reactivated after IVR in Shenzhen Eye Hospital from January 2019 to October 2021 were included in the study. Among them, there were 6 males (11 eyes) and 5 females (10 eyes), with the gestational age of (27.6±2.2) weeks and birth weight of (1 034.6±306.5) g. At the first IVR treatment, 14 eyes (63.7%, 14/22) had acute ROP (AROP), 8 eyes (36.3%, 8/22) had threshold lesions. Post-reactivation treatments include IVR, retinal laser photocoagulation (LP), or minimally invasive vitrectomy (MIVS). The follow-up time after treatment was 12 to 18 months. Birth gestational age, birth weight, treatment method, corrected gestational age at treatment, lesion stage before and after treatment, lesion reactivation and regression time were recorded. The clinical characteristics and efficacy were observed and analyzed.Results:The time from initial IVR treatment to reactivation was (8.2±3.5) weeks. The corrected gestational age of the child was (43.62±4.08) weeks. In 21 eyes, AROP, threshold lesion, prethreshold lesion, and stage 4 lesion were in 2, 4, 12, and 3 eyes, respectively. The patients were treated with IVR, LP, IVR+LP, IVR+MIVS in 2, 13, 4 and 2 eyes, respectively. After the first reactivation treatment, the time of regression and stability was (8.4±4.9) weeks after treatment. There were 5 eyes with secondary reactivation of the lesion, and the lesion stages were stage 3, stage 4a and stage 5 in 2, 1 and 2 eyes, respectively. The mean reactivation time was (19.3±6.0) weeks after the last treatment. The patients in stage 3, stage 4a and stage 5 were treated with LP, LP+MIVS and IVR, respecitively, and the lesions subsided steadily during follow-up. At the last follow-up, 19 out of 21 eyes showed complete regression of the lesions, stable photocoagulation, regression of crista-like lesions, no additional lesions, and retinal leveling. All retinal detachment was "funnel-shaped" in 2 eyes.Conclusions:The lesion reactivation of AROP after IVR treatment is more common. The early reactivation rate is higher after treatment. There is a possibility of reactivation twice after re-treatment.

Delayed-onset unilateral facial paralysis after mastoidectomy: A case report

Objective@#To discuss the case of a 36-year-old man who presented with left unilateral facial paralysis 11 days after mastoidectomy.@*Methods@#Design: Case Report Setting: Tertiary Government Training Hospital Patient: One@*Results@#A 36-year-old man with recurrent left ear discharge of 30 years duration underwent left canal wall-down mastoidectomy and was discharged well after 3 days. On follow up after 8 more days, he was noted to have House Brackmann IV left facial paralysis. Following 5 days methylprednisolone, neurologic evaluation and physical therapy rehabilitation, facial paralysis improved in the ensuing weeks until House-Brackmann I was achieved at week 12.@*Conclusion@#Delayed-onset Facial Palsy (DFP) following tympanomastoid surgery may be approached conservatively, including steroids, acyclovir, and, if with a history of herpes or varicella infection, immunization can be given. Prognosis for DFP is good especially when the facial nerve is identified intraoperatively during otologic surgeries

Implant-supported canine retraction using different reactivation intervals of elastomeric chains: A CBCT-based split-mouth randomized controlled trial

ABSTRACT Introduction: Orthodontists attempt to maximize treatment efficiency regarding time, tooth position and adverse effects. A new approach, not yet explored, is the activation frequency. Objective: The aim of this split-mouth randomized controlled trial was to evaluate the effect of reactivation intervals on the efficiency of tooth movement. Methods: Thirty eight patients having a Class I malocclusion with bimaxillary dentoalveolar protrusion or severe crowding, Class II with mandibular deficiency or Class III, requiring first premolar extraction and canine retraction were recruited. Elastomeric chains producing 150g were replaced every two, four, six or eight weeks. There were 36, 37, 36, and 36 quadrants randomly allocated to these groups, respectively. The canine retraction rate was the primary outcome. Canine tipping, rotation, and root resorption and pain were the secondary outcomes. Only the outcome assessors were blinded to group assignment. Results: The average total movement for the 6 months was 5.14, 5.31, 2.79 and 3.85 mm for the two-week, four-week, six-week and eight-week reactivation intervals, respectively. Root resorption was significantly higher in the two-week and four-week groups. No adverse events were observed. Conclusion: The canine retraction rate, tipping, rotation and pain were similar in 2, 4, 6 and 8-week activation intervals groups. Longer reactivation intervals show less root resorption. The trial protocol was not pre-registered. The study was self-funded.

RESUMO Introdução: Os ortodontistas buscam otimizar a eficiência do tratamento quanto ao tempo de duração, à posição dos dentes e aos efeitos adversos. Um aspecto ainda não avaliado são os diferentes intervalos entre as ativações. Objetivo: O objetivo desse estudo controlado e randomizado de boca dividida foi avaliar a influência de diferentes intervalos de reativação na eficiência da movimentação dentária. Métodos: Foram recrutados 38 pacientes com má oclusão de Classe I com biprotrusão dentoalveolar ou apinhamento severo, Classe II com deficiência mandibular ou Classe III, que necessitavam de extração do primeiro pré-molar e retração do canino. As cadeias elastoméricas gerando 150 g foram substituídas a cada duas, quatro, seis ou oito semanas, constando 36, 37, 36 e 36 quadrantes alocados aleatoriamente nesses grupos, respectivamente. O desfecho primário foi a taxa de retração do canino. Os desfechos secundários foram a inclinação, a rotação e a reabsorção radicular do canino, e a dor. Somente os avaliadores dos resultados não tinham conhecimento da alocação nos grupos. Resultados: O movimento total médio para os seis meses foi de 5,14; 5,31; 2,79 e 3,85 mm para os intervalos de reativação de duas semanas, quatro semanas, seis semanas e oito semanas, respectivamente. A reabsorção radicular foi significativamente maior nos grupos de duas e quatro semanas. Não foram observados eventos adversos. Conclusão: A taxa de retração, a inclinação e a rotação do canino e a dor foram semelhantes nos grupos com intervalos de ativação de duas, quatro, seis e oito semanas. Intervalos de reativação mais longos mostram menos reabsorção radicular. O protocolo do estudo não foi pré-registrado. O estudo foi autofinanciado.

Reactivation of latent human cytomegaloviral infection in critically ill patients

Background & objectives: Human cytomegalovirus (HCMV) is a frequent participant in the infectious process in critically ill patients. This study aimed to determine the incidence of HCMV reactivation in critically ill patients and estimate the clinical effect of reactivation on the course of the pathological process. Methods: To determine the incidence of HCMV reactivation, plasma and sputum samples were collected from 82 critically ill patients. HCMV reactivation was determined by quantitative PCR together with the presence of circulating HCMV IgG in the plasma. The statistical analysis of clinical data employed methods of descriptive (median with 95% confidence interval; minimum and maximum values, interquartile range) and nonparametric statistics [Mann-Whitney U test, odds ratio (OR), Kaplan–Meier survival analysis]. Results: HCMV reactivation was found in 36.6 per cent of cases. An association between the presence of sepsis and the development of HCMV reactivation (P<0.001), as well as higher HCMV viral loads in septic patients, was found. There was also an association between the presence of HCMV DNA and the subsequent development of sepsis (OR=1.504). The involvement of HCMV in the emerging immunological shifts manifested by a decrease in CD8+ T-lymphocytes (P=0.01) and an increase in the immunoregulatory index (P=0.03) was found. Interpretation & conclusions: HCMV reactivation can influence the course of bacterial pathology with a deteriorating effect on such groups of patients. Monitoring the viral load of latent HCMV can be helpful in the assessment of the host immune status, the course of the pathological process, and its clinical prognosis.

Stromal and endothelial herpes simplex virus keratitis reactivation in the convalescent period of COVID-19 � A case report

A 73?year?old lady presented with a white spot and redness in the left eye for 1 month and had been treated elsewhere as a case of fungal keratitis. She had severe acute respiratory syndrome coronavirus 2 (SARS?CoV?2) viral infection 2 months before. Her past ocular history and examination gave a probable diagnosis of herpetic stromal and endothelial keratitis. She responded to oral acyclovir and topical steroid, leading to resolution of stromal edema and inflammation. Anterior chamber fluid polymerase chain reaction (PCR) confirmed pathogen herpes simplex virus (HSV)?1. HSV ocular reactivation after coronavirus disease 2019 (COVID?19) has been reported currently. The present report will add knowledge about this potential opportunistic ophthalmic infection during the recovery phase of COVID?19 disease

Herpes Zoster Following Vaccination with ChAdOx1 nCoV-19 Coronavirus Vaccine (Recombinant)

Ever since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS?CoV?2) pandemic, science has unraveled much knowledge on SARS?CoV?2 which has led to extraordinary and unprecedented progress in developing COVID?19 vaccines. Several adverse cutaneous reactions, ranging from more common local injection site reaction, neutrophilic and pustular drug reactions to flare?up of preexisting dermatoses, have been reported with currently available vaccines. We report a case series of 7 patients who developed herpes zoster (HZ) following the first dose of ChAdOx1 nCoV?19 coronavirus vaccine (recombinant). HZ following vaccination is a rare entity. The occurrence of HZ in the patients presented in this series within the time window 1–21 days after vaccination defined for increased risk and postulated dysregulation of T?cell?mediated immunity, suggests that the ChAdOx1 nCoV?19 coronavirus vaccine (recombinant) could probably be a trigger for reactivation of varicella zoster virus to cause HZ in them.

Trasplante cardíaco en miocardiopatía chagásica: 23 años de experiencia en un centro de referencia / Heart Transplantation in Chagas Cardiomyopathy: 23-Year Follow-Up in a Referral Center

RESUMEN Introducción: La enfermedad de Chagas afecta aproximadamente a 6 millones de personas en América Latina. El 25 a 35% evoluciona hacia la Miocardiopatía Chagásica (MCh). Una opción terapéutica en sus estadios avanzados es el trasplante cardíaco (TxC). Objetivos: Comparar la supervivencia de pacientes con TxC por MCh frente a otras etiologías. Analizar la incidencia de la reactivación (Ra) de enfermedad de Chagas y su impacto en la supervivencia en este subgrupo de pacientes. Material y métodos: Se evaluaron retrospectivamente pacientes con TxC entre agosto 1998 y marzo 2021. Se analizó la supervivencia mediante curvas de Kaplan-Meier y log rank test. El diagnóstico de Ra se realizó mediante métodos moleculares, prueba de Strout en sangre periférica, tejido miocárdico y/o cutáneo. Resultados: De 606 pacientes con TxC, 39 (6,4%) presentaban MCh. Seguimiento medio 4,4 años (Rango Intercuartilo 1,2-8,6). Edad subgrupo MCh 51 años (RIC 45-60). Hombres 28 (72%). Se documentó Ra en el 38,5% de los pacientes. Supervivencia a 1, 5 y 10 años en TxC por MCh con Ra versus no Ra: 85%, 76% y 61% versus 72%, 55% y 44% (p = 0,3). Supervivencia a 1, 5 y 10 años en TxC por MCh versus TxC por otras causas: 79%, 65% y 50% versus 79%, 62% y 47% (p = 0,5). Conclusión: En nuestra serie no se encontró diferencia estadísticamente significativa en la supervivencia de los pacientes trasplantados cardíacos por MCh en comparación con aquellos trasplantados por otras causas; así como tampoco entre los pacientes que reactivaron la enfermedad de Chagas y los que no lo hicieron.

ABSTRACT Background: Chagas disease affects about 6 million people in Latin America, and 25 to 35% progress to Chagas cardiomyopathy (ChCM). Heart transplantation (HTx) is a therapeutic option in advanced stages. Objectives: The aim of this study is to compare survival of patients with HTx due to ChCM versus those transplanted for other etiologies and to analyze the incidence of Chagas disease reactivation (Ra) and its impact on survival in this group of patients. Methods: Patients undergoing HTx between August 1998 and March 2021 were retrospectively evaluated. Survival was analyzed using Kaplan-Meier curves and the log-rank test. The diagnosis of Ra was performed by molecular methods, Strout's test in peripheral blood, myocardial tissue or skin tissue. Results: Of 606 patients with Htx, 39(6,4%) presented ChCM. Median follow up was 4.4 years (interquartile range 1.2-8.6). Median age of the subgroup with ChCM was 51 years (IQR 45-60) and 28 were men (72%). Reactivation was documented in 38.5% of the patients. Survival at 1, 5 and 10 years in HTx recipients due to ChCM and Ra versus no Ra was 85%, 76% and 61% versus 72%, 55% and 44%, respectively (p = 0.3). Survival at 1, 5 and 10 years in HTx recipients due to ChCM versus HTx for other causes was 79%, 65% and 50% versus 79%, 62% and 47%, respectively (p = 0.5). Conclusion: In our series we did not find statistically significant differences in survival of heart transplant recipients due to ChCM versus those transplanted due to other reasons. Survival in patients with Chagas disease reactivation and those without reactivation was also similar.

Qingre Xiaoyanning inhibits emotional stress-induced reactivation of latent herpes simplex virus type 1 in mice / 药学学报

In this study, according to TCM theory of "liver qi stagnation forming fire", emotional stress mice model was employed to evaluate the protective effects of Qingre Xiaoyanning on herpes simplex virus type 1 (HSV-1) induced reactivation. The animal experimental protocol has been reviewed and approved by Laboratory Animal Ethics Committee of Jinan University, in compliance with the Institutional Animal Care Guidelines. BALB/c mice were divided into six groups, including mock group, HSV-1 latency group, HSV-1 reactivation group (HSV-1 latency + stress), low (0.658 g·kg-1·day-1) and high dose (1.316 g·kg-1·day-1) of Qingre Xiaoyanning groups and positive control group (acyclovir, 0.206 g·kg-1·day-1). Except for the normal group and HSV-1 latency group, all mice in other groups received a daily 12-h restraint stress for 4 days. After 7-day treatment of drugs, body weight and recurrent eye infections of mice were recorded. Brain tissues were harvested to monitor HSV-1 antigen distribution by immunohistochemical staining and detect virus titer by plaque assay. In the meantime, the mRNA and protein levels of infected cell polypeptide (ICP27) and glycoprotein B (gB) in the brain tissues were detected by RT-PCR and Western blot, respectively. The level of 4-hydroxynonenal (4-HNE) and expressions of ferroptosis-related proteins were measured by Western blot. The evaluation of malondialdehyde (MDA) content in the brain tissues was conducted by MDA assay commercial kit. The results showed that Qingre Xiaoyanning significantly retarded the decline of body weight of mice induced by HSV-1 reactivation, reduced the activation rate of HSV-1 and recurrent eye infections, declined virus titer of HSV-1, down-regulated gene and protein expressions of ICP27 and gB, and hindered the distribution of HSV-1 antigen in the brain of mice. Meanwhile, Qingre Xiaoyanning also decreased the protein expression of ferroptosis-related proteins, including DMT1, TFR1 and ALOX15 in the brain tissue of HSV-1 reactivated mice. The levels of lipid peroxidation products, 4-HNE and MDA, were also reduced by Qingre Xiaoyanning treatment. All the above results indicate that Qingre Xiaoyanning significantly inhibited HSV-1 reactivation by restraint stress, which might be related to the regulation of ferroptosis. Our findings provide a theoretical basis for the application of "clearing liver-fire" TCM on treatmenting HSV-1 reactivation-related symptoms.

Drugs and hepatitis B virus reactivation / 生物医学工程学杂志

Drugs may induce hepatitis B virus (HBV) reactivation (HBV-R). Here we have reviewed the definition and harm of HBV-R, the risk drugs and their underlying mechanism, the influence factors, as well as the early intervention measures. It is shown that multiple drugs, including chemotherapy drugs, immunotherapy drugs, directly acting antivirals, cell therapy, etc., can induce HBV-R by affecting host immunity or directly activating HBV transcription factors. HBV-R could cause severe liver damage, even interruption of treatment of original diseases, affecting the prognosis of patients. Through precisely identifying risk drugs, monitoring the influence factors, and prescribing preventive anti-HBV regimen if necessary, the incidence of HBV-R can be significantly reduced. It is also suggested that clinical physicians should not only pay attention to the early identification and intervention of HBV-R, but also further study the mechanism of HBV-R in depth, especially the underlying mechanism between host, HBV and risk factors. This will help to promote the discovery of more valuable markers for risk prediction and targets for early intervention, and to further reduce the risk of HBV-R and improve the prognosis of patients.

Major molecular events of reactivation of human cytomegalovirus after allogeneic hematopoietic stem cell transplantation / 器官移植

Immune deficiency of the host caused by allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the initial factor of reactivation of latent human cytomegalovirus (HCMV). The risk factors of reactivation of HCMV in allo-HSCT recipients consist of the serological status of HCMV in donors and recipients, the matching degree of human leukocyte antigen (HLA) and pretreatment patterns, etc. The reactivation of HCMV is associated with the expression of a series of viral cleavage and proliferation proteins induced by the overexpression of major immediate early promoter/enhancer (MIEP) in the viral genome. In this article, the risk factors of reactivation of HCMV after allo-HSCT, the molecular changes related to maintaining latent infection of HCMV, the key role of MIEP overexpression in reactivation of HCMV, and the molecular pathways involved in reactivation of HCMV after allo-HSCT were reviewed and the major molecular events of reactivation of HCMV after allo-HSCT were elucidated, aiming to provide reference for the prevention and treatment of cytomegaloviral disease (CMVD) after allo-HSCT.

COVID-19 monetary transfer in El Salvador: determining factors / Transferência de renda em El Salvador diante da COVID-19: fatores determinantes / Transferencia monetaria en El Salvador ante la COVID-19: factores determinantes

Abstract Given the lack of governmental guidelines, this paper identifies and analyzes the statistical determinants associated with receiving the onetime monetary transfer in El Salvador ($300 dollars) as an economic measure to face the COVID-19 pandemic. A logistic regression was implemented (whether received the transfer or not) based on a probabilistic sample (n=1222) of surveyed people throughout the country. Independent variables were selected drawing upon key characteristics employed internationally in monetary transfers: age, gender, rural area, employment, family income, and education. The text identifies a statistically significant and negative relation between receiving the monetary transfer and two variables: family income and educational level. The need to increase coverage of the program is addressed as well as the importance of considering age, gender, rural areas, and employment as criteria for selecting the beneficiaries in such economic measures.

Resumo Dada a ausência de diretrizes governamentais, o texto apresenta uma análise exploratória e identifica quais são os fatores estatísticos determinantes que explicam a transferência única de renda ($300 dólares) como medida econômica para enfrentar a pandemia gerada pela COVID-19 em El Salvador. Para tal fim, utiliza-se uma análise estatística de regressão logística (receber ou não a ajuda) com base em uma amostra probabilística de respondentes em todo o país (n=1222). Como variáveis independentes emprega-se caraterísticas importantes utilizadas em programas de transferência de renda em todo o mundo: Idade, gênero, zona de procedência, emprego e renda familiar e nível educacional. O presente texto identifica que existe uma relação inversa e estatisticamente significativa entre essa ajuda pública com a renda familiar e o nível educacional. Finalmente, discute-se a necessidade de ampliação do programa econômico e a importância de considerar características como idade, gênero, zona de procedência e emprego nesse tipo de políticas econômicas.

Resumen Ante la falta de lineamientos gubernamentales, el presente texto muestra un análisis exploratorio e identifica cuáles han sido los determinantes estadísticos asociados a la recepción de la transferencia monetaria única ($300 dólares) como medida económica para enfrentar la pandemia de COVID-19 en El Salvador. Para tal efecto, se utiliza un análisis estadístico de regresión logística (recibir la ayuda o no) con base en una muestra probabilística de encuestados en todo el país (n=1222). Como variables independientes se emplean características cruciales utilizadas en programas de transferencias monetarias a nivel internacional: Edad, género, lugar de origen, empleo, ingresos familiares y nivel educacional. El presente texto identifica que existe una relación inversa y estadísticamente significativa entre la asignación de esa ayuda pública, los ingresos familiares y el nivel educacional. Finalmente, se discute la necesidad de ampliación del programa y la importancia de considerar aspectos como edad, género, lugar de origen y empleo en ese tipo de políticas económicas.

Case report of Chagas disease reactivation: new diagnosis tool by direct microscopic observation of biopsy specimen and its preservation fluid

Abstract Chagas Disease is caused by Trypanosoma cruzi. This infection is endemic in the Americas region. Neurological Chagas reactivation is diagnosed through the visualization of the parasite in the cerebrospinal fluid, blood, or tissue samples. Herein, we report the visualization of trypomastigotes by direct microscopic observation of a brain biopsy specimen and its preservation fluid (PF) in a paitient infected with VIH and T. cruzi. This easy and simple diagnostic method coupled with quantitative polymerase chain reaction can be used in all tissue biopsies and PF of T. cruzi seropositive patients, suspected of Chagas disease reactivation.

Lobular panniculitis of the thigh as the only cutaneous manifestation of reactivation of Chagas disease in a renal transplant patient: a case report

Abstract Reactivation of chronic Trypanosoma cruzi infection in solid organ transplant recipients (SOTRs) has been reported. The patient presented with a 2-week history of two painful erythematous, infiltrated plaques with central ulceration and necrotic crust on the left thigh. She had a history of chronic indeterminate Chagas disease (CD) and had received a kidney transplant before 2 months. Skin biopsies revealed lobular panniculitis with intracellular amastigote forms of T. cruzi. The patient was diagnosed with CD reactivation. Treatment with benznidazole significantly improved her condition. CD reactivation should be suspected in SOTRs living in endemic areas with clinical polymorphism of skin lesions.

Role of Long Non-coding RNAs in Reprogramming to Induced Pluripotency / 基因组蛋白质组与生物信息学报·英文版

The generation of induced pluripotent stem cells through somatic cell reprogramming requires a global reorganization of cellular functions. This reorganization occurs in a multi-phased manner and involves a gradual revision of both the epigenome and transcriptome. Recent studies have shown that the large-scale transcriptional changes observed during reprogramming also apply to long non-coding RNAs (lncRNAs), a type of traditionally neglected RNA species that are increasingly viewed as critical regulators of cellular function. Deeper understanding of lncRNAs in reprogramming may not only help to improve this process but also have implications for studying cell plasticity in other contexts, such as development, aging, and cancer. In this review, we summarize the current progress made in profiling and analyzing the role of lncRNAs in various phases of somatic cell reprogramming, with emphasis on the re-establishment of the pluripotency gene network and X chromosome reactivation.

Does the number of sets in a resistance exercise session affect the fast and slow phases of post-exercise cardiac autonomic recovery?

Abstract Aims: The purpose of this study was to evaluate the acute effects of different resistance exercise (RE) volumes on postexercise cardiac autonomic modulation in men. Methods: Ten young men (25.5 ± 4.9 years, 24.8 ± 2.1 kg/m2) performed 3 trials of RE with 1, 2 or 3 sets (48-72 h between each trial) of 10-12 repetitions (70% of the one-maximum repetition) of bench press, leg press, and barbell row. Heart rate variability (HRV) was assessed at the 1st and 5th minutes of recovery (fast phase) and 3 consecutive 5-minute intervals from the 5th to 20th minute of recovery (slow phase). Parasympathetic and global modulations were assessed using the SD1 and SD2 indices of HRV, respectively. The comparison of the interventions was performed using the Friedman and Wilcoxon tests (p<0.05). Results: Lower parasympathetic modulation was identified after 2 and 3 sets compared to 1 set in both the fast and slow recovery phases (p= 0.004-0.05). Lower global modulation was identified after 3 sets compared to 1 set in both fast and slow recovery phases (p= 0.005-0.01). No differences in post-exercise parasympathetic and global modulation were observed between 2 and 3 sets. Conclusion: We concluded that 2 and 3 sets of RE compared to 1 set promoted higher autonomic reduction on the post-exercise phase, which should be considered by coaches when prescribing an RE program for untrained participants or intend to manipulate the postexercise organic recovery.

Uveitis and deficient lens capsules: Effect of glued intraocular lens on the visual outcome and the reactivation of inflammation

Purpose: To evaluate the visual outcome and complication profile after glued intraocular lens (IOL) in post uveitic eyes. Methods: Patients with history of uveitis who had glued IOL with 3 months antecedent quiet anterior chamber (AC) were included in this prospective observational case series. Visual acuity, slit-lamp examination, fundus evaluation, optical coherence tomography, intraocular pressure, specular count and AC inflammation were analyzed before and after glued IOL procedure. Glued IOL eyes were also compared with their fellow normal capsular bag IOL. Results: Overall 17 eyes (50.7 ± 16.1 years) were analyzed. It included 41.8%, 23.5%, and 35.29% anterior, posterior, and pan uveitis, respectively. The etiologies were tuberculosis (23.53%), toxoplasmosis (11.77%), Fuch's heterochromic cyclitis (5.88%), HLA B27 (11.77%), psoriatic arthritis (5.88%), Rheumatoid arthritis (5.8%), sarcoidosis (11.77%), herpetic kerato-uveitis (5.88%), and idiopathic (17.65%). Cataractous subluxated lens (35.3%), aphakia (23.5%), decentered IOL (23.5%) and intraoperative capsular rupture (17.6%) were the surgical indications. A significant improvement in the mean uncorrected and best corrected visual acuity (P < 0.001) was recorded. The complications were IOL pigment dispersion (47%), macular edema (41%), and epiretinal membrane (24%). There was significant rise in AC reaction on day 1 (P < 0.001) and normal AC was attained by 88.2% eyes at 6 months. AC inflammation reactivation was noted in 11.7% of eyes. Though inflammatory reactivation was similar to the normal IOL, macular edema was higher in glued IOL. Conclusion: Glued IOL can cause inflammation in uveitis eyes which can be managed medically with minimal complications.

Hospitalizaciones por Herpes zoster en niños

El herpes zoster (HZ) en niños es una patología infrecuente. Objetivo: Describir las hospitalizaciones por HZ en niños. Métodos: Prospectivamente se seleccionaron los menores de 12 años hospitalizados con HZ en Pediatría-Infecciosa-HUC, entre el 2000 y 2015. Se recolectaron datos clínico-epidemiológicos, serologías virales y subpoblación de linfocitos. Completado los años de estudio, se evaluó la recurrencia de HZ y la adquisición de condiciones inmunosupresoras. Resultados: De 8 758 niños hospitalizados, 28 fueron seleccionados, ocho presentaron alguna condición inmunosupresora. La edad promedio fue 6,99 años e ingresaron a los 3,92 días de enfermedad. Ninguno tuvo inmunización contra varicela. Consultaron previo al ingreso 12/28 niños con diagnósticos errados 6/12. El antecedente de varicela in útero o antes del año de edad fue más frecuente en los niños sanos (P=0,04). El dermatoma más afectado fue el del trigémino (36 %). La media de hospitalización fue 7,6 días con complicaciones inherentes al virus en 7/28 niños sin diferencias entre sanos e inmucocomprometidos. Los CD4 fueron reportados en 15/28 niños con valores disminuidos en 2/12 inmunocompetentes y 2/3 inmunocomprometidos (P=0,08). Los inmunocomprometidos con CD4 bajos tuvieron un RR=4 de complicarse. Las serologías para el virus de la inmunodeficiencia humana resultaron negativas. No hubo recurrencias HZ ni la adquisición de inmunosupresión en el seguimiento realizado a 9 pacientes. Conclusiones: HZ es una causa rara de hospitalización en pediatría pudiendo afectar inmunocompetentes e inmunocomprometidos, cursando con complicaciones frecuentes con mayor riesgo en niños inmunocomprometidos con CD4 bajos. El antecedente de varicela antes del año de edad fue el factor predisponente detectado.

Herpes zoster (HZ) in children is an uncommon condition. Objective: To describe children's herpes zoster hospitalization. Methods: children under 12 years of age hospitalized with HZ in Pediatrics-Infectious-HUC between 2000 and 2015 were selected. Clinical and epidemiological data, viral serology and lymphocyte subpopulation were collected. After completing the years of study, viral recurrence and the acquisition of immunosuppressive conditions were evaluated. Results: Of 8 758 hospitalized children, 28 were selected, eight with immunosuppressive status. The mean age was 6.99 years and they were hospitalized at 3.92 days from the onset of the illness. Twelve patients were consulted prior to their admittance and 6 were misdiagnosed. The history of varicella in utero or before the first year was more frequent in healthy children (P=0.04). The most affected dermatome was the trigeminal (36 %). An average hospitalization duration was 7.6 days with complications inherent to virus in 7/28 children with no difference between healthy and immunocompromised ones. None was immunized against varicella. CD4 was reported in fifteen children with low count in 2/12 immunocompetent and 2/3 immunocompromised (P=0.08). Immunocompromised patients with complicated HZ and low CD4 had a RR = 4.1. Serologies for the human immunodeficiency virus came out negative. There were no HZ recurrences nor the acquisition of immunosuppression in the follow-up of nine patients. Conclusions: HZ is a rare cause of hospitalization that may affect immunocompetent children well as immunocompromised ones and frequently presents complications with a greater risk to the immunocompromised group with low CD4. The antecedent of varicella before the first year of age was the predisposing factor detected.

Sympatho-Vagal Imbalance is Associated with Sarcopenia in Male Patients with Heart Failure / Desequilíbrio Simpático-Vagal está Associado com Sarcopenia em Pacientes do Sexo Masculino com Insuficiência Cardíaca

Abstract Background: Resting sympathetic hyperactivity and impaired parasympathetic reactivation after exercise have been described in patients with heart failure (HF). However, the association of these autonomic changes in patients with HF and sarcopenia is unknown. Objective: The aim of this study was to evaluate the impact of autonomic modulation on sarcopenia in male patients with HF. Methods: We enrolled 116 male patients with HF and left ventricular ejection fraction < 40%. All patients underwent a maximal cardiopulmonary exercise testing. Maximal heart rate was recorded and delta heart rate recovery (∆HRR) was assessed at 1st and 2nd minutes after exercise. Muscle sympathetic nerve activity (MSNA) was recorded by microneurography. Dual-energy X-ray absorptiometry was used to measure body composition and sarcopenia was defined by the sum of appendicular lean muscle mass (ALM) divided by height in meters squared and handgrip strength. Results: Sarcopenia was identified in 33 patients (28%). Patients with sarcopenia had higher MSNA than those without (47 [41-52] vs. 40 [34-48] bursts/min, p = 0.028). Sarcopenic patients showed lower ∆HRR at 1st (15 [10-21] vs. 22 [16-30] beats/min, p < 0.001) and 2nd min (25 [19-39] vs. 35 [24-48] beats/min, p = 0.017) than non-sarcopenic. There was a positive correlation between ALM and ∆HRR at 1st (r = 0.26, p = 0.008) and 2nd min (r = 0.25, p = 0.012). We observed a negative correlation between ALM and MSNA (r = -0.29, p = 0.003). Conclusion: Sympatho-vagal imbalance seems to be associated with sarcopenia in male patients with HF. These results highlight the importance of a therapeutic approach in patients with muscle wasting and increased peripheral sympathetic outflow.

Resumo Fundamento: Hiperatividade simpática de repouso e uma reativação parassimpática diminuída pós-exercício têm sido descritas em pacientes com insuficiência cardíaca (IC). No entanto, a associação dessas alterações autonômicas em pacientes com IC sarcopênicos ainda não são conhecidas. Objetivo: O objetivo deste estudo foi avaliar o impacto da modulação autonômica sobre sarcopenia em pacientes com IC do sexo masculino. Métodos: Foram estudados 116 pacientes com IC e fração de ejeção ventricular esquerda inferior a 40%. Todos os pacientes foram submetidos ao teste de exercício cardiopulmonar máximo. A frequência cardíaca máxima foi registrada, e o delta de recuperação da frequência cardíaca (∆RFC) foi avaliado no primeiro e no segundo minuto após o exercício. A atividade nervosa simpática muscular (ANSM) foi registrada por microneurografia. A Absorciometria Radiológica de Dupla Energia foi usada para medir composição cpororal, e a sarcopenia definida como a soma da massa muscular apendicular (MMA) dividida pela altura em metros ao quadrado e força da mão. Resultados: A sarcopenia foi identificada em 33 pacientes (28%). Os pacientes com sarcopenia apresentaram maior ANSM que aqueles sem sarcopenia - 47 (41-52) vs. 40 (34-48) impulsos (bursts)/min, p = 0,028). Pacientes sarcopênicos apresentaram ∆RFC mais baixo no primeiro [15 (10-21) vs. 22 (16-30) batimentos/min, p < 0,001) e no segundo [25 (19-39) vs. 35 (24-48) batimentos/min, p = 0,017) minuto que pacientes não sarcopênicos. Observou-se uma correlação positiva entre a MMA e a ANSM (r = -0,29; p = 0,003). Conclusão: Um desequilíbrio simpático-vagal parece estar associado com sarcopenia em pacientes com IC do sexo masculino. Esses resultados destacam a importância de uma abordagem terapêutica em pacientes com perda muscular e fluxo simpático periférico aumentado.