A double-edged sword: Teachers' perceptions of the benefits and challenges of online teaching and learning in higher education.

Due to the impact of the recent pandemic, the teaching and learning experience worldwide was marked by a wave of emergency digitalization. The sudden need to transition to online teaching and learning (OTL) has forced Higher Education actors to adapt quickly without proper planning. This study examines teachers' perceptions of the benefits and challenges posed by OTL during the pandemic in Higher Education. Data were collected from 636 teachers from 54 different countries using an internationally distributed online survey, and responses were coded using thematic analysis. While the main benefits perceived by teachers relate to flexibility (in tasks execution), accessibility, pedagogical innovation, and self-regulation, key challenges emerge in domains such as engagement, interaction, infrastructure/technical support, assessment and pedagogical practice. Our results further suggest a phenomenon that we describe as a "double-edged sword" with elements of OTL being perceived both as a benefit and a challenge. Results and implications for OTL and future blended practices in Higher Education are discussed.

Cell-associated viral burden provides evidence of ongoing viral replication in aviremic HIV-2-infected patients.

Viremia is significantly lower in HIV-2 than in HIV-1 infection, irrespective of disease stage. Nevertheless, the comparable proviral DNA burdens observed for these two infections indicate similar numbers of infected cells. Here we investigated this apparent paradox by assessing cell-associated viral replication. We found that untreated HIV-1-positive (HIV-1(+)) and HIV-2(+) individuals, matched for CD4 T cell depletion, exhibited similar gag mRNA levels, indicating that significant viral transcription is occurring in untreated HIV-2(+) patients, despite the reduced viremia (undetectable to 2.6 × 10(4) RNA copies/ml). However, tat mRNA transcripts were observed at significantly lower levels in HIV-2(+) patients, suggesting that the rate of de novo infection is decreased in these patients. Our data also reveal a direct relationship of gag and tat transcripts with CD4 and CD8 T cell activation, respectively. Antiretroviral therapy (ART)-treated HIV-2(+) patients showed persistent viral replication, irrespective of plasma viremia, possibly contributing to the emergence of drug resistance mutations, persistent hyperimmune activation, and poor CD4 T cell recovery that we observed with these individuals. In conclusion, we provide here evidence of significant ongoing viral replication in HIV-2(+) patients, further emphasizing the dichotomy between amount of plasma virus and cell-associated viral burden and stressing the need for antiretroviral trials and the definition of therapeutic guidelines for HIV-2 infection.

Major CD4 T-Cell Depletion and Immune Senescence in a Patient with Chronic Granulomatous Disease.

Chronic granulomatous disease (CGD) results from primary defects in phagocytic reactive oxygen species (ROS) production. T-cell evaluation is usually neglected during patients' follow-up, although T-cell depletion has been reported in CGD through unknown mechanisms. We describe here a 36-year-old patient with X-linked CGD with severe CD4 T-cell depletion <200 CD4 T-cells/µl, providing insights into the mechanisms that underlie T-cell loss in the context of oxidative burst defects. In addition to the typical infections, the patient featured a progressive T-cell loss associated with persistent lymphocyte activation, expansion of interleukin (IL)-17-producing CD4 T-cells, and impaired thymic activity, leading to a reduced replenishment of the T-cell pool. A relative CD4 depletion was also found at the gut mucosal level, although no bias to IL-17-production was documented. This immunological pattern of exhaustion of immune resources favors prompt, potentially curative, therapeutic interventions in CGD patients, namely, stem-cell transplantation or gene therapy. Moreover, this clinical case raises new research questions on the interplay of ROS production and T-cell homeostasis and immune senescence.

Brachiocephalic vein thrombosis associated with Crohn's disease.

An association between macrovascular thrombosis and idiopathic inflammatory bowel disease has been described, although very few well-documented cases have been published. We report on a 39-year-old woman who presented with right hemifacial and upper limb edema that was shown to be due to an extensive right brachiocephalic vein thrombosis, diagnosed by magnetic resonance angiography. Laboratory findings suggested malabsorption, and a diagnosis of Crohn's disease was established. Moreover, elevation of the plasminogen activator inhibitor system was identified. This represents the first description of a spontaneous thrombosis in a patient with Crohn's disease involving the intrathoracic venous system and raises the possibility of impaired fibrinolysis being involved in the etiopathogenesis of this complication.

Tubulointerstitial Nephritis and Uveitis Syndrome with non caseating granuloma in bone marrow biopsy.

The Tubulointerstitial Nephritis and Uveitis syndrome is a very rare condition, probably under-diagnosed in clinical practice. It is characterized by the combination of an interstitial nephritis and uveitis, and is an exclusion diagnosis. Tissue non caseating granuloma can be rarely present, with only 6 cases reported on bone marrow. We present a case of a 55 year old female with a 3-month history of asthenia and weight loss. Blood tests showed anemia and renal insufficiency. Renal biopsy revealed interstitial nephritis and the bone marrow biopsy showed caseating granuloma. One month later anterior uveitis of the left eye appeared. An extensive exclusion of all possible causes allowed a diagnosis of Tubulointerstitial Nephritis and Uveitis syndrome with caseating granuloma in bone marrow. As ocular and renal manifestations may not occur simultaneously, Tubulointerstitial Nephritis and Uveitis Syndrome should be systematically considered in cases of interstitial nephritis and/or uveitis, and tissue granulomas can be part of this rare syndrome.

A Síndrome nefrite túbulo intersticial e uveíte é uma síndrome rara e provavelmente sub-diagnosticado na prática clinica. É caracterizada pela ocorrência de nefrite intersticial e de uveíte, sendo um diagnóstico de exclusão. Granulomas não caseosos nos vários tecidos são raros, estando descritos apenas seis casos de granulomas não caseosos na medula óssea. Apresentamos um caso de uma mulher de 55 anos, com quadro de três meses de evolução de astenia e emagrecimento. Laboratorialmente apresentava anemia e insuficiência renal. A biopsia renal revelou nefrite intersticial e a biópsia da medula óssea mostrou granulomas não caseosos. Um mês depois surgiu uveíte anterior do olho esquerdo. A exclusão de todas as possíveis etiologias permitiu o diagnóstico final de Síndrome nefrite túbulo intersticial e uveíte com granulomas não caseosos na medula óssea. Considerando que as manifestações oculares e renais podem não ocorrer simultaneamente, a Síndrome nefrite túbulo intersticial e uveíte deve ser sistematicamente equacionada emdoentes com nefrite intersticial e/ou uveíte, podendo os granulomas fazer parte desta rara patologia.

Blood cultures on internal medicine: utilization profile and clinical implications

Introduction: recent literature suggests that excessive use of blood cultures could prolong length of stay and hospital costs. Moreover, low positive rates have been reported and positivity predictive scores have recently been proposed. Methods: we conducted an observational prospective study in an Internal Medicine department of a university reference hospital analysing data from all patients to whom BC was requested. Results: blood cultures were performed in 39.9% of 414 admissions. Patients with blood cultures had higher length of stay and underwent more laboratory and imaging diagnostic tests. Global positivity rate was of 7.5%. Patients fulfilling sepsis criteria had a higher positivity rate (21.7%) and there were no positive blood cultures in patients without sepsis, namely in cases of isolated creactive protein elevation, leucocytosis or fever. In addition, blood cultures results were not a determinant of antibiotic adjust or de-escalation. Conclusions: our data suggest that the use of BC should be done essentially in patients with sepsis criteria, reducing its unnecessary use, although more studies are required to validate such practice (AU)

Introdução: o uso excessivo de hemoculturas tem sido associado a aumento do tempo de internamento e de custos hospitalares. Adicionalmente, a literatura médica reporta taxas de positividade abaixo do esperado, levando à criação de índices de predição de positividade. Métodos: estudo prospectivo observacional conduzido numa enfermaria de Medicina Interna de um hospital terciário, com recolha de dados de todos os doentes a quem foram realizadas hemoculturas. Resultados: em 414 admissões, foram colhidas hemoculturas em 39.9%. Os doentes a quem foram colhidas hemoculturas tiveram maior tempo de internamento e mais exames laboratoriais e imagiológicos pedidos. 7,5% das hemoculturas foram positivas. Nos doentes com critérios de sepsis a taxa de positividade das hemoculturas foi 21,7% e não houve nenhuma hemocultura positiva em doente sem critérios de sépsis, nomeadamente em doentes com elevação isolada de proteína c-reactiva, leucocitose ou febre. O resultado da hemocultura não foi um determinante de de-escalação antibiótica. Conclusões: este estudo sugere que as hemoculturas devem ser colhidas essencialmente em doentes com sepsis, podendo esta prática diminuir o seu sobreuso. (AU)

Low CD4 T-cell counts despite low levels of circulating HIV: insights from the comparison of HIV-1 infected patients with a discordant response to antiretroviral therapy to patients with untreated advanced HIV-2 disease.

A significant proportion of HIV-1+ patients with suppression of viremia under antiretroviral therapy fail to recover CD4(+) T-cell counts (ART-Discordants). Similarly, untreated HIV-2+ patients can also exhibit major CD4 depletion in spite of undetectable viremia. We characterize here the immunological disturbances associated with major CD4-lymphopenia in these two scenarios as compared to untreated viremic HIV-1+ patients with similar CD4-lymphopenia and HIV-1+ patients with successful immunological and virological responses under ART. Low CD4 counts were associated with major naive CD4 and CD8 depletion, irrespective of type of infection or ART-exposure. However, ART-Discordants exhibited lower levels of T-cell activation as compared to both untreated HIV-2 and HIV-1 cohorts, and a less marked increase in circulating IL-7 despite similar CD4 depletion. Nevertheless, ART-Discordants showed a preserved Bcl-2 expression, suggesting increased IL-7 consumption, which in conjunction with the relatively lower T-cell activation may contribute to their CD4 count stability and low rate of opportunistic infections.