What do asthmatic patients think about telemedicine visits?

Summary: Introduction. Due to the Coronavirus disease 2019 (COVID-19) outbreak and the national emergency state, virtual visits were implemented as an alternative to in-person visits. With this study we aimed to establish asthma patients' general satisfaction with the quality of health care provided by virtual visits (phone or video calls). Materials and methods. A questionnaire (9 questions) was published on the Facebook page of the Portuguese Association of Asthmatics. It was available online for general self-reported asthmatic patients to answer during one month, starting on 11st May 2020. The survey only allowed one answer per registered user. Results. Fifty-five responses were obtained. Patients were satisfied with communication with providers (> 88%); nevertheless, one-half evaluated the virtual visit as inferior when compared to in-person visits. About one third attributed a classification of 6 or less (0-10 scale, 0 being the worst and 10 the best consultation possible), but still most of the patients would either recommend it or use this kind of medical visits in the future, even outside the actual pandemic context. Patients also referred some important limitations, as lack of physical examination and the fact that the medical visit was more impersonal. Only 27% had technical issues accessing virtual visits. Positive aspects were also named, such as virtual visits being practical and avoiding the need to move to the hospital. Discussion and conclusions. Our survey revealed that small changes could further increase patients' satisfaction, adherence and confidence in telemedicine. Although presenting some limitations, virtual visits seem to be generally well accepted by asthmatic patients and it might be a good alternative for in-person visits, at leastin such difficult times when social distancing is recommended.

Variations in maternal adenylate cyclase genes are associated with congenital Zika syndrome in a cohort from Northeast, Brazil.

BACKGROUND: Vertical transmission of Zika virus (ZIKV) is associated with congenital malformations but the mechanism of pathogenesis remains unclear. Although host genetics appear to play a role, no genetic association study has yet been performed to evaluate this question. In order to investigate if maternal genetic variation is associated with Congenital Zika Syndrome (CZS), we conducted a case-control study in a cohort of Brazilian women infected with ZIKV during pregnancy. METHODS: A total of 100 women who reported symptoms of zika during pregnancy were enrolled and tested for ZIKV. Among 52 women positive for ZIKV infection, 28 were classified as cases and 24 as controls based on the presence or absence of CZS in their infants. Variations in the coding region of 205 candidate genes involved in cAMP signaling or immune response were assessed by high throughput sequencing and tested for association with development of CZS. RESULTS: From the 817 single nucleotide variations (SNVs) included in association analyses, 22 SNVs in 17 genes were associated with CZS under an additive model (alpha = 0.05). Variations c.319T>C (rs11676272) and c.1297G>A, located at ADCY3 and ADCY7 genes showed the most prominent effect. The association of ADCY3 and ADCY7 genes was confirmed using a Sequence Kernel Association Test to assess the joint effect of common and rare variations, and results were statistically significant after adjustment for multiple comparisons (P < 0.002). CONCLUSION: These results suggest that maternal ADCY genes contribute to ZIKV pathogenicity and influence the outcome of CZS, being promising candidates for further replication studies and functional analysis.

Acute kidney injury in kidney transplant patients.

Managing kidney transplant patients in an acute medical unit can be challenging, as patients have a single functioning kidney, underlying chronic kidney disease, and are immunosuppressed. Transplant patients develop AKI for all usual reasons but the differential diagnosis is wider and includes specific problems, such as obstruction of a single functioning kidney, vascular thrombosis, rejection, drug toxicity and drug-induced thrombotic microangiopathy. Septic AKI is common but again, the differential diagnosis of sepsis is wider. Transplant patients are at higher risk of developing both community and opportunistic infections, especially in the first year after the transplant or after any increase in immunosuppressive medication. In addition, there is always a risk of rejection, especially in case of reduction of immunosuppressive medications. Therefore, any change in the immunosuppressive therapy should to be discussed with the transplant team to achieve an appropriate balance between avoiding rejection and preventing opportunistic infections.

Pediatric eosinophilic esophagitis in Portugal.

SUMMARY: Eosinophilic esophagitis (EoE) is an increasingly frequent diagnosis in our clinical practice, mainly in pediatric age. Allergic responses to food and aeroallergens have been increasingly implicated in the etiology of this disease. We describe a retrospective data analysis of pediatric EoE patients followed in our Immunoallergology Department. Of the 25 children (22 male, average 10.8 years), 88% had prior history of rhinoconjunctivitis, 76% asthma, 48% eczema and 36% food allergy. After evaluation, we identified in 76% and 92% of patients food and aeroallergen sensitization, respectively; 68% had simultaneously food and inhalant sensitization and 96% had at least one positive test to aeroallergens or food allergens. The first (44%) and the most frequent (56%) symptom was dysphagia. The time between symptoms onset and the EoE diagnosis averaged 18.6 ± 29.4 months. A multidisciplinary approach is needed for a correct evaluation, intervention and follow-up of these patients.

High-intensity Interval Training in the Boundaries of the Severe Domain: Effects on Sprint and Endurance Performance.

In order to compare the effects of two 4-week interval training programs performed at the lower (Critical Power, CP) or at the higher (The highest intensity at which V˙O2max is attained, IHIGH) intensities of the severe exercise domain on sprint and endurance cycling performance, 21 recreationally trained cyclists performed the Wingate Anaerobic Test (WAnT) and a 250-kJ time trial. Accumulated oxygen deficit (AOD), surface electromyography (RMS), and blood lactate kinetics were measured during the WAnT. Subjects were assigned to 105% CP or IHIGH groups. During the WAnT, significantly greater improvements in peak (Mean ±95%CI) (5.7±2.3% vs. 0.2±2.2%), mean power output (MPO) (3.7±2.0% vs. 0.5±1.8%), and RMS (17.8±7.4% vs. -15.7±7.9%) were observed in the IHIGH group (P<0.05). Higher and lower AOD, respectively, at the start and during the second half of the WAnT were observed after IHIGH training. The changes in RMS and MPO induced by the training were significantly correlated (r=0.584). The 2 interventions induced improvements in the 250-kJ time trial. In conclusion, although the improvements in endurance performance were similar, training at IHIGH led to higher gains in WAnT performance than training at 105%CP.

miRQuest: integration of tools on a Web server for microRNA research.

This report describes the miRQuest - a novel middleware available in a Web server that allows the end user to do the miRNA research in a user-friendly way. It is known that there are many prediction tools for microRNA (miRNA) identification that use different programming languages and methods to realize this task. It is difficult to understand each tool and apply it to diverse datasets and organisms available for miRNA analysis. miRQuest can easily be used by biologists and researchers with limited experience with bioinformatics. We built it using the middleware architecture on a Web platform for miRNA research that performs two main functions: i) integration of different miRNA prediction tools for miRNA identification in a user-friendly environment; and ii) comparison of these prediction tools. In both cases, the user provides sequences (in FASTA format) as an input set for the analysis and comparisons. All the tools were selected on the basis of a survey of the literature on the available tools for miRNA prediction. As results, three different cases of use of the tools are also described, where one is the miRNA identification analysis in 30 different species. Finally, miRQuest seems to be a novel and useful tool; and it is freely available for both benchmarking and miRNA identification at http://mirquest.integrativebioinformatics.me/.

First Report of Leaf Spot Caused by Cladosporium perangustum on Syagrus oleracea in Brazil.

Syagrus oleracea (Mart.) Becc. (bitter coconut), a palm tree species that is native to central Brazil, has been increasingly cultivated in this country for heart-of-palm production. Epidemics of a necrotic leaf spot of unknown etiology have been recorded on bitter coconut plants in transplant nurseries and plantation since 2008. The first symptoms appear as small, yellow, hydrotic flecks on young or mature leaves that evolve to necrotic brown streaks that run parallel to the leaf veins. Usually, yellow halos occur around the lesions and hydrosis is common during lesion expansion. Necrotic lesions can reach up to 40 mm in length and 10 mm in width, and the lesions often coalesce, causing extensive tissue damage. During a survey in a 3-year-old bitter coconut plantation in Maringá County (coordinates: 23°23'51.25″ S, 51°57'02.09″ W; elevation: 507 m) in the state of Parana, a dozen symptomatic leaves were collected with the aim of elucidating the etiology of this disease. Conidia and conidiophores typical of Cladosporium were frequently observed on the diseased leaf tissue under natural field conditions as well on the surfaces of disinfected leaf tissues kept in a humid chamber for 48 h at 25 ± 2°C with a 12-h photoperiod. Five monoconidial cultures growing on potato dextrose agar (PDA) medium were obtained from different leaves showing leaf spot symptoms. The cultures were grown on PDA to induce sporulation. At 7 days after incubation at 25 ± 2°C and a 12-h photoperiod, gray to gray-olive colonies were observed. The conidiophores were macronematous, erect, oblong, branched, 1 to 5 septate, and 75.0 to 120.0 × 1.90 to 3.20 µm. The ramoconidia were cylindrical or oblong, 0 to 2 septate, and 28.0 to 40.0 × 2.8 to 3.6 µm, with a truncate base of 1.9 to 2.2 µm; secondary ramoconidia were cylindrical or oblong, 0 to 2 septate, 8.0 to 31.0 × 2.2 to 3.1 µm, with 3 to 5 distal conidial hila; intercalary 1-septate conidia were 5.5 to 17.0 × 2.1 to 3.4 µm, with 1 to 3 distal conidial hila; terminal 1-septate conidia were catenulate and 2.2 to 4.2 × 1.8 to 3.1 µm. Species identification was performed based on morphology and DNA sequence data (1). Portions of the elongation factor 1α (551 bp; TEF) and actin (213 bp; ACT) genes were amplified by PCR. A BLAST search of the GenBank database revealed that the TEF (KC484658 to KC484662) and ACT (KC484663 to KC484667) sequence fragments from isolates Gua1, Gua2, Gua3, Gua4, and Gua5 had 100% identity with the accessions HM148616 and HM148371 of Cladosporium perangustum (1). Isolates were tested for pathogenicity against bitter coconut. Ten potted plants with 4 to 6 fully expanded leaves were inoculated with each isolate by spraying a suspension of conidia (105 spores per ml) onto leaves until runoff using a handheld spray bottle. Non-inoculated controls (10 plants) were sprayed with distilled water. The plants were kept in a humid plastic chamber at 20 to 26°C. All examined isolates were pathogenic to bitter coconut, causing symptoms identical to those described above 12 days after inoculation. All inoculated tissues were plated onto PDA to confirm the presence of the pathogen. Live cultures are being maintained at the Micoteca/URM/UFPE ( www.ufpe.br/micoteca ), Brazil. To our knowledge, this is the first report of a disease caused by C. perangustum on S. oleracea worldwide, and the study provides valuable plant disease diagnostic information for the palm hearth industry in Latin America. Reference: (1) K. Bensch et al. Stud Mycol. 67:1, 2010.

Myogenin, MyoD and IGF-I regulate muscle mass but not fiber-type conversion during resistance training in rats.

The purpose of this study was to test the hypothesis that skeletal muscle adaptations induced by long-term resistance training (RT) are associated with increased myogenic regulatory factors (MRF) and insulin-like growth factor-I (IGF-I) mRNA expression in rats skeletal muscle. Male Wistar rats were divided into 4 groups: 8-week control (C8), 8-week trained (T8), 12-week control (C12) and 12-week trained (T12). Trained rats were submitted to a progressive RT program (4 sets of 10-12 repetitions at 65-75% of the 1RM, 3 day/week), using a squat-training apparatus with electric stimulation. Muscle hypertrophy was determined by measurement of muscle fiber cross-sectional area (CSA) of the muscle fibers, and myogenin, MyoD and IGF-I mRNA expression were measured by RT-qPCR. A hypertrophic stabilization occurred between 8 and 12 weeks of RT (control-relative % area increase, T8: 29% vs. T12: 35%; p>0.05) and was accompanied by the stabilization of myogenin (control-relative % increase, T8: 44.8% vs. T12: 37.7%, p>0.05) and MyoD (control-relative % increase, T8: 22.9% vs. T12: 22.3%, p>0.05) mRNA expression and the return of IGF-I mRNA levels to the baseline (control-relative % increase, T8: 30.1% vs. T12: 1.5%, p<0.05). Moreover, there were significant positive correlations between the muscle fiber CSA and mRNA expression for MyoD (r=0.85, p=0.0001), myogenin (r=0.87, p=0.0001), and IGF-I (r=0.88, p=0.0001). The significant (p<0.05) increase in myogenin, MyoD and IGF-I mRNA expression after 8 weeks was not associated with changes in the fiber-type frequency. In addition, there was a type IIX/D-to-IIA fiber conversion at 12 weeks, even with the stabilization of MyoD and myogenin expression and the return of IGF-I levels to baseline. These results indicate a possible interaction between MRFs and IGF-I in the control of muscle hypertrophy during long-term RT and suggest that these factors are involved more in the regulation of muscle mass than in fiber-type conversion.

50 years of the water-flow variance in Tucuruí reservoir related with Brazilian energy consumption.

Dammed rivers lose its natural characteristics of the flow cycle and becomes controlled by the energy demands of the hydroelectric plants. With the connection of the energy-producing plants to a central station in Brazil the situation is aggravated since demands in different regions of the country affect the water flow. Using downstream flow data from the Tucuruí dam over a 50-year period, we tested whether the variation in water flow has changed. We observed an increase of the annual variation of the water flow and the extreme events of flooding at downstream of the dam, indicating the operation of the dam intensified the control of water passage. The study reveals an increase in the variation of water flow in the dam's downstream section following the interconnection of the Tucurui dam with the Central System in 1997. Management strategies for the dam should be considered integrated with the national electricity demand, since distant demands may affect the local environment in question.

VO2 responses to running speeds above intermittent critical speed.

The aim of this study was to examine whether intermittent critical speed (ICS) is the threshold velocity above which intermittent exercise leads to the attainment of VO(2max). After an incremental test, 7 active male subjects (49.7 ± 3.74 mL.min (- 1).kg (- 1)) performed 3 intermittent exercises until exhaustion at 100%, 110%, 120% of the velocity associated with VO(2max) to determine ICS. On 4 occasions, the subjects performed intermittent exercise tests until exhaustion at the velocity corresponding to 105% (IE(105)) and 110% (IE(110)) of ICS, and at a speed that was initially set at 125%ICS but which then decreased to 105%ICS (IE(125-105)) in one instance and to 110%ICS (IE(125-110)) in another. The intermittent exercises consisted of repeated 30-s runs alternated with 15-s passive rest intervals. At IE(125)-105, peak VO(2) was not different from VO(2max) but decreased significantly after the change of speed to 105%ICS. During IE(110), peak VO(2) value reached VO(2max) and also during the higher speed at IE(125-110), but did not change when the speed was lowered. These results demonstrated that during intermittent exercise just above ICS (105%) VO(2max) was not elicited, suggesting that ICS might not be the threshold speed above which VO(2max) can be reached.

Criteria for progressive fibrotic hypersensitivity pneumonitis in a Portuguese patient cohort.

Background: Hypersensitivity pneumonitis (HP) is a syndrome caused by sensitisation to inhaled antigens that leads to an abnormal immune response in the airways and lung parenchyma. Some patients previously diagnosed with certain types of fibrotic interstitial lung diseases (f-ILDs), including fibrotic HP (f-HP), are susceptible to develop a progressive fibrosing phenotype (PF-ILD), despite initial state-of-the-art management. Objectives: To characterise a cohort of patients with a multidisciplinary diagnosis (MTD) of chronic f-HP, who were followed up in an ILD outpatient clinic of a hospital in Portugal, and to assess the prevalence of PF-ILD criteria in these patients. Methods: Data were collected from all patients with a definite or provisional diagnosis of f-HP after a multidisciplinary team discussion. Patients were followed up between December 2014 and July 2019. Data included clinical characteristics, high-resolution chest tomography (HRCT) disease patterns, lung function tests, bronchoalveolar lavage and further immunological work-up, biopsy reports (conventional transbronchial lung biopsy, transbronchial lung cryobiopsy or surgical video-assisted thoracoscopic lung biopsy), all ILD multidisciplinary team records and diagnostic confidence levels. Patients were assessed according to PF-ILD criteria as defined in the INBUILD trial. Results: We identified 83 patients with an MTD of HP, who had been followed up for at least 12 months. Of these, 63 (75.9%) were diagnosed with f-HP. Of the 63 f-HP patients, 33.3% (n=21) fulfilled the predefined criteria for PF-HP: 66.7% had a relative decline of ≥10% forced vital capacity (FVC); 5% a relative decline of 5 - 9% FVC, with worsening symptoms or increased fibrosis on HRCT; and 23.8% had worsening respiratory symptoms with radiological progression. Conclusion: This single-centre cohort study demonstrated that a third of f-HP patients presented with PF-ILD, as determined by progression during initial standard-of-care treatment. A usual interstitial pneumonia (UIP)/UIP-like pattern was present in >70% of patients with f-HP, and two-thirds of these patients had an FVC decline of ≥10%. PF-HP patients were also more exacerbation prone. According to recent trial data, this segment of patients can be considered possible candidates for antifibrotic treatment, with a reasonable prospect of effectiveness. Further efforts should focus on refining knowledge of longitudinal behaviour of large multicentric cohorts of f-HP patients, establishing a consensual and uniform definition of progression for use in clinical practice, as well as developing prognostic prediction tools to better (and early) inform the disease course.

Factors associated with non-completion of latent tuberculosis infection treatment in Rio de Janeiro, Brazil: A non-matched case control study.

INTRODUCTION: There are scarce data on the routine latent tuberculosis infection treatment (LTBIT) and factors associated with a non-completion in high tuberculosis burden countries. Therefore, in this study we aimed to evaluate the factors associated with non-completion of LTBIT. MATERIALS AND METHODS: This was a non-matched case control study conducted at a University Hospital in Rio de Janeiro, Brazil. A total of 114 cases and 404 controls were enrolled between January/1999 and December/2009. Cases were close contacts who did not complete the LTBIT and controls were the contacts that completed it. Multivariate analysis was used to investigate risk factors associated with non-completion of LTBIT among contacts in two different periods of recruitment. RESULTS: Factors associated with non-completion LTBIT included: drug use (OR 23.33, 95% CI 1.83-296.1), TB treatment default by the index case (OR 16.97, 95% CI 3.63-79.24) and drug intolerance. TB disease rates after two years of follow up varied from 0.4% to 1.9%. The number necessary to treat to prevent one TB case among contacts was 116. CONCLUSIONS: Non-completion treatment by the index case and illicit drug use were associated with not completing latent tuberculosis infection treatment and no tuberculosis disease was identified among those who completed latent tuberculosis infection treatment.

Entomopathogenic Viruses in the Neotropics: Current Status and Recently Discovered Species.

The market for biological control of insect pests in the world and in Brazil has grown in recent years due to the unwanted ecological and human health impacts of chemical insecticides. Therefore, research on biological control agents for pest management has also increased. For instance, insect viruses have been used to protect crops and forests around the world for decades. Among insect viruses, the baculoviruses are the most studied and used viral biocontrol agent. More than 700 species of insects have been found to be naturally infected by baculoviruses, with 90% isolated from lepidopteran insects. In this review, some basic aspects of baculovirus infection in vivo and in vitro infection, gene content, viral replication will be discussed. Furthermore, we provide examples of the use of insect viruses for biological pest control and recently characterized baculoviruses in Brazil.

Congenital Zika syndrome is associated with maternal protein malnutrition.

Zika virus (ZIKV) infection during pregnancy is associated with a spectrum of developmental impairments known as congenital Zika syndrome (CZS). The prevalence of this syndrome varies across ZIKV endemic regions, suggesting that its occurrence could depend on cofactors. Here, we evaluate the relevance of protein malnutrition for the emergence of CZS. Epidemiological data from the ZIKV outbreak in the Americas suggest a relationship between undernutrition and cases of microcephaly. To experimentally examine this relationship, we use immunocompetent pregnant mice, which were subjected to protein malnutrition and infected with a Brazilian ZIKV strain. We found that the combination of protein restriction and ZIKV infection leads to severe alterations of placental structure and embryonic body growth, with offspring displaying a reduction in neurogenesis and postnatal brain size. RNA-seq analysis reveals gene expression deregulation required for brain development in infected low-protein progeny. These results suggest that maternal protein malnutrition increases susceptibility to CZS.

Identification of Zika virus in immature phases of Aedes aegypti and Aedes albopictus: a surveillance strategy for outbreak anticipation.

A progressive increase in the circulation of arboviruses in tropical countries has been observed, accounting for 700,000 yearly deaths in the world. The main objective of this article was to identify the presence of Zika (ZIKV), dengue (DENV), and Chikungunya (CHIKV) viruses in immature stages of Aedes aegypti and Ae. albopictus. Household collections of immature phases of the vectors were carried out in the years 2015 and 2016. A total of 2902 dwellings were visited and the rate of infestation with larvae and pupae of Aedes mosquitoes was 283/1462 (19.4%) in March 2015 and 55/1440 (3.8%) in June 2015. In March 2015, 907 larvae/pupae were collected (583 or 64.3% of Ae. aegypti and 324 or 35.7% of Ae. albopictus) while in June 2015 there was a reduction in the number of immature forms found: 197 larvae/pupae (121 or 61.4% of Ae. aegypti and 76 or 38.6% of Ae. albopictus). This reduction was accompanied by a decrease in suspected human ZIKV cases from March to June 2015. The RT-qPCR performed in 18 pools identified that three (two of Ae. aegypti and one of Ae. albopictus) were positive for ZIKV, and none were positive for DENV or CHIKV. Our findings demonstrated that ZIKV was present in immature stages of insect vectors in the study region at least five months prior to the peak of ZIKV associated cases. Xenomonitoring of immature phases of the vectors may prove useful for predicting outbreaks.

Recombinant Cry1Ia protein is highly toxic to cotton boll weevil (Anthonomus grandis Boheman) and fall armyworm (Spodoptera frugiperda).

AIMS: To evaluate the activity of cry1Ia gene against cotton pests, Spodoptera frugiperda and Anthonomus grandis. METHODS AND RESULTS: Had isolated and characterized a toxin gene from the Bacillus thuringiensis S1451 strain which have been previously shown to be toxic to S. frugiperda and A. grandis. The toxin gene (cry1Ia) was amplified by PCR, sequenced, and cloned into the genome of a baculovirus. The Cry1Ia protein was expressed in baculovirus infected insect cells, producing protein inclusions in infected cells. The Cry1Ia protein has used in bioassays against to S. frugiperda and A. grandis. CONCLUSIONS: Bioassays using the purified recombinant protein showed high toxicity to S. frugiperda and A. grandis larvae. Molecular modelling of the Cry1Ia protein translated from the DNA sequence obtained in this work, showed that this protein possibly posses a similar structure to the Cry3A protein. Ultrastructural analysis of midgut cells from A. grandis incubated with the Cry1Ia toxin, showed loss of microvilli integrity. SIGNIFICANCE AND IMPACT OF THE STUDY: The results indicate that the cry1Ia is a good candidate for the construction of transgenic plants resistant to these important cotton pests.

Genomic and epidemiological monitoring of yellow fever virus transmission potential.

The yellow fever virus (YFV) epidemic in Brazil is the largest in decades. The recent discovery of YFV in Brazilian Aedes species mosquitos highlights a need to monitor the risk of reestablishment of urban YFV transmission in the Americas. We use a suite of epidemiological, spatial, and genomic approaches to characterize YFV transmission. We show that the age and sex distribution of human cases is characteristic of sylvatic transmission. Analysis of YFV cases combined with genomes generated locally reveals an early phase of sylvatic YFV transmission and spatial expansion toward previously YFV-free areas, followed by a rise in viral spillover to humans in late 2016. Our results establish a framework for monitoring YFV transmission in real time that will contribute to a global strategy to eliminate future YFV epidemics.