The Thr92Ala polymorphism in the type 2 deiodinase gene is linked to depression in patients with COVID-19 after hospital discharge.

Background: The Thr92Ala-DIO2 polymorphism has been associated with clinical outcomes in hospitalized patients with COVID-19 and neuropsychiatric diseases. This study examines the impact of the Thr92Ala-DIO2 polymorphism on neuropsychological symptoms, particularly depressive symptoms, in patients who have had moderate to severe SARS-CoV-2 infection and were later discharged. Methods: Our prospective cohort study, conducted from June to August 2020, collected data from 273 patients hospitalized with COVID-19. This included thyroid function tests, inflammatory markers, hematologic indices, and genotyping of the Thr92Ala-DIO2 polymorphism. Post-discharge, we followed up with 68 patients over 30 to 45 days, dividing them into depressive (29 patients) and non-depressive (39 patients) groups based on their Beck Depression Inventory scores. Results: We categorized 68 patients into three groups based on their genotypes: Thr/Thr (22 patients), Thr/Ala (41 patients), and Ala/Ala (5 patients). Depressive symptoms were less frequent in the Thr/Ala group (29.3%) compared to the Thr/Thr (59.1%) and Ala/Ala (60%) groups (p = 0.048). The Thr/Ala heterozygous genotype correlated with a lower risk of post-COVID-19 depression, as shown by univariate and multivariate logistic regression analyses. These analyses, adjusted for various factors, indicated a 70% to 81% reduction in risk. Conclusion: Our findings appear to be the first to show that heterozygosity for Thr92Ala-DIO2 in patients with COVID-19 may protect against post-COVID-19 depression symptoms up to 2 months after the illness.

Feline Leishmaniasis: Evidence-based Treatments and Challenges to be Solved.

Leishmaniasis is a neglected tropical disease caused by protozoa parasites from the Leishmania genus. Vertebrate hosts acquire the infection through the bite of a female sandfly, initiating a complex parasite development cycle. Contrary to previous beliefs regarding cats' resistance, these animals have recently been identified as potential reservoirs for leishmaniasis. Clinical symptoms in cats can manifest in diverse forms, including cutaneous, mucocutaneous, and visceral manifestations. The diagnosis of feline leishmaniasis is complicated by nonspecific symptoms and the relatively lower specificity of serological tests. The recommended treatment for feline leishmaniasis involves the administration of medications; however, success varies in each cat. This review aims to present cases of feline leishmaniasis, highlighting clinical symptoms, diagnostic methods, therapy schedules, and outcomes. Among the 24 cases documented in the available literature, 12 achieved successful treatment without relapses, resulting in a reduced parasite load and improved symptoms. Three cases responded well but presented persistent sequelae. Two feline leishmaniasis cases initially had treatment success but later experienced recurrences. Finally, no response was observed in seven cases, leading to the euthanasia of cats due to ineffectiveness or irregularities along the therapy. Conventional treatments, despite potential hepatotoxicity and nephrotoxicity, exhibit a high efficacy in reducing parasitic load, thereby improving clinical symptoms and increasing the life expectancy of affected cats. Nevertheless, consistent adherence is crucial, as interruptions may render the therapy ineffective and contribute to parasite resistance. Therefore, addressing the challenges associated with feline leishmaniasis treatment necessitates the development of new strategies to ensure a more effective and sustained approach.

Is It Possible to Mitigate Fear of Fireworks in Dogs? A Study on the Behavioural and Physiological Effects of a Psychoactive Supplement.

Canine fear of fireworks is a common problem worldwide, with serious implications for the welfare of both dogs and their owners. Therapies for the problem are available, and herbal and nutraceutical agents are increasingly suggested by professionals; nonetheless, studies on their real efficacy in reducing firework fear are lacking. In a randomised, double-blinded, placebo-controlled study, 44 dogs (25 in the "supplement" group and 19 in the "placebo" group) completed a long-term continuous treatment with either a supplement made of tryptophan, valerian, and passiflora or a placebo, including two real exposures to fireworks (on 2020 Christmas and 2021 New Years' Eve, after 42 and 48 days of treatment, respectively). Owners of both groups received the same general environmental management and food/toy offering recommendations for trying with their dogs on those nights. Behavioural (measured by LSSS-Lincoln Sound Sensitivity Scale and PANAS-Positive and Negative Activation scale, as rated by the owners) and stress (measured via salivary cortisol measures) reactions were evaluated. Significantly greater fear decrease (LSSS) was recorded in the "supplement" dogs, as compared to the "placebo" group. Cortisol dosages on New Year's Eve ("noisy" night) were in line with behavioural results; "supplement" dogs showed a smaller increase in the stress response from 22:30 to 00:30 h on New Year's Eve and a greater decrease in their stress response from 02:30 h to 10:30 h on New Year's Day compared to "placebo" dogs. Smaller cortisol levels were also shown by "supplement" dogs than "placebo" dogs on a controlled "quiet night" (27th December). Owners' rates on PANAS remained stable during the whole period of therapy for both groups. The evaluated supplement, a combination of tryptophan, valerian, and passiflora, showed satisfactory results and rare side effects when treating dogs fearful of fireworks.

Glioma of the optic nerve and chiasm: a case report / Glioma óptico-quiasmático: um relato de caso

ABSTRACT This article reports the case of an 11-year-old male patient with a history of proptosis and low progressive visual acuity in the left eye. He presented with a best corrected visual acuity of 20/25 in the right eye and light perception in the left eye. Exotropia and limitation in adduction were observed in the left eye. On automated perimetry, inferiortemporal quadrantopsia was observed in the right eye, while total scotoma was observed in the left eye. On magnetic resonance imaging, there was an expansive lesion in the left optic nerve, extending to the brainstem with chiasmatic involvement. This article aims to report a case of optic pathway glioma, as well as to discuss its clinical findings and their interconnection with the current literature.

RESUMO Este artigo relata o caso de um paciente do sexo masculino, 11 anos de idade, com história de proptose e baixa de acuidade visual progressiva. Ao exame oftalmológico apresentava melhor acuidade visual de 20/25 em olho direito e percepção de luz em olho esquerdo. Existia exotropia e limitação à adução no olho esquerdo. À campimetria automatizada, observou-se quadrantopsia temporal inferior em olho direito e escotoma total em olho esquerdo. À ressonância magnética, evidenciou-se lesão expansiva em trajeto do nervo óptico esquerdo estendendo-se até região do tronco encefálico, com acometimento quiasmático. O objetivo deste artigo é relatar o glioma de vias ópticas, bem como discutir os achados e sua interligação com a literatura atual.

Tungiasis in the Sanumás Amerindians in the Amazon Rainforest, Brazil: Prevalence, Intensity and Morbidity.

BACKGROUND: Tungiasis is a disease associated with extreme poverty. We aimed to evaluate the prevalence of tungiasis in six different settlements of the Sanumás indigenous community in a remote area in the Auaris region, Yanomami territory, Brazil. METHODS: We conducted an observational study to detect clinical and epidemiological factors associated with tungiasis using a cross-sectional strategy and multivariate logistic regression. Soil analysis was performed by visual and microscopic methods. RESULTS: We examined 555 persons, 45 of whom had active tungiasis; 18 cases were classified as mild, 16 as moderate and 11 as severe. The disease was significantly more prevalent in children than in adults (odds ratio (OR) 15.77; 95% confidence interval (CI) = 5.34-67.91; p < 0.001). Soil infestation was significantly related to the occurrence of human tungiasis (OR = 12.29; 95% CI = 3.75-45.88). The sex and GPS location of the houses were not related to the occurrence of tungiasis. CONCLUSIONS: We conclude that tungiasis is an important problem in the Sanumás community, especially for children. We suggest that interruption of the off-host transmission cycle, together with regular treatment [human and animal interventions], must be prioritized to achieve control of tungiasis in indigenous populations.

Heat wave exposure impairs reproductive performance in primiparous sows and gilts in a tropical environment.

We studied the effects of heat waves (HW), defined as three consecutive days with an ambient temperature ≥ 25 °C and a temperature and humidity index (THI) > 74, on the reproductive performance of sows. Meteorological data were obtained from the National Institute of Meteorology and reproductive data from a commercial farm with 51,578 inseminations and 49,103 pregnancies from September 5, 2013, to July 12, 2019. Sows were divided into the following groups according to the parity order: group 1 (sows that did not experience HW on the day of insemination) and group 2 (sows exposed to HW on the day of insemination). The percentage of days that pregnant sows were exposed to HW was calculated as 0 to 25% (1), 26 to 50% (2), 51 to 75% (3), and > 75% (4). Out of a total of 2137 days, there were 160 HW and more than 10 HW per month, except in May, June, and July. Gilts in group 2 showed a decrease in the percentage of gestation (98.21% and 98.78%, respectively, P = 0.0267) and the percentage of births compared with those in group 1 (95.53% and 96.61, respectively, P = 0.0065). Primiparous sows in group 2 had a higher percentage of abortions than gilts in group 1 (3.20% and 2.42%, respectively; P = 0.0334). Sows exposed to more than 50% HW during gestation produced more mummified piglets than sows exposed to less than 50% HW. The number of stillborn piglets was higher in sows exposed to temperatures above 25% HW during gestation. The occurrence of heat waves in gilts and primiparous sows impairs reproductive performance.

Glioma of the optic nerve and chiasm: a case report.

This article reports the case of an 11-year-old male patient with a history of proptosis and low progressive visual acuity in the left eye. He presented with a best corrected visual acuity of 20/25 in the right eye and light perception in the left eye. Exotropia and limitation in adduction were observed in the left eye. On automated perimetry, inferiortemporal quadrantopsia was observed in the right eye, while total scotoma was observed in the left eye. On magnetic resonance imaging, there was an expansive lesion in the left optic nerve, extending to the brainstem with chiasmatic involvement. This article aims to report a case of optic pathway glioma, as well as to discuss its clinical findings and their interconnection with the current literature.

Efeitos simbólicos da implantação da casa de saúde indígena: um estudo histórico / Symbolic effects of the implantation of the indigenous health home: a historical study

Resumo Objetivo: Descrever os efeitos simbólicos da implantação da Casa de Saúde Indígena no campo da saúde no período de 1973 a 1983 em Boa Vista, Roraima, Brasil. Metodologia: Trata-se de um estudo histórico com abordagem da micro história orientado por análises documentais e a teorização dos resultados balizada nos conceitos do sociólogo Pierre Bourdieu. Resultados: Ao todo o corpus documental foi representado por quatro registros imagéticos. As imagens foram analisadas com o intuito de produção de reflexões que versam sobre os efeitos simbólicos de implantação da Casa de Saúde Indígena. Conclusão: A Casa de Saúde Indígena de Boa Vista-RR emerge como pano de fundo no cenário desenvolvimentista da época, como (e representou) moeda de troca simbólica entre os governantes e os indígenas que sofriam com a entrada de doenças em suas comunidades pela ação direta do processo migratório devido ao garimpo em suas terras.

Resumen Objetivo: Describir los efectos simbólicos de la implantación de hogar de salud indígena en el campo de la salud en el período de 1973 a 1983 en Boa Vista, Roraima, Brasil. Metodología: Se trata de un estudio histórico con un enfoque de microhistoria, guiado por el análisis documental. La teorización de los resultados fue guiada por los conceptos del sociólogo Pierre Bourdieu. Resultados: En total, el corpus documental estuvo representado por cuatro registros de imágenes. Las imágenes fueron analizadas con el fin de producir reflexiones sobre los efectos simbólicos de la implantación del hogar de salud indígena. Conclusión: El hogar de salud indígena en Boa Vista-RR surge como telón de fondo en este escenario de desarrollo, asimismo como una moneda simbólica (y representada) de intercambio entre gobernadores y pueblos indígenas, que sufrieron con el ingreso de enfermedades en sus comunidades a través de acción directa del proceso migratorio, debido a la minería en sus tierras.

Abstract Aim: To describe the symbolic effects of the implementation of the indigenous health home in the field of health in the period from 1973 to 1983 in Boa Vista, Roraima, Brazil. Methods: This was a historical study with a microhistory approach guided by a documentary analysis; the theorization of the results was guided by the concepts of the sociologist Pierre Bourdieu. Results: The documentary corpus was represented by four imagery records. The images were analyzed in order to produce reflections on the symbolic effects of the implantation of the indigenous health home. Conclusion: The indigenous health home in Boa Vista-RR emerges as a backdrop in this developmental scenario; it represents a symbolic currency of exchange between the government and the indigenous people who suffered from the entry of diseases in their communities through the direct action of the migratory process and the mining in their lands.

Efeitos simbólicos da implantação da casa de saúde indígena: um estudo histórico

Objetivo: Descrever os efeitos simbólicos da implantação da Casa de Saúde Indígena no campo da saúde no período de 1973 a 1983 em Boa Vista, Roraima, Brasil. Metodologia: Trata-se de um estudo histórico com abordagem da micro história orientado por análises documentais e a teorização dos resultados balizada nos conceitos do sociólogo Pierre Bourdieu. Resultados: Ao todo o corpus documental foi representado por quatro registros imagéticos. As imagens foram analisadas com o intuito de produção de reflexões que versam sobre os efeitos simbólicos de implantação da Casa de Saúde Indígena. Conclusão: A Casa de Saúde Indígena de Boa Vista-RR emerge como pano de fundo no cenário desenvolvimentista da época, como (e representou) moeda de troca simbólica entre os governantes e os indígenas que sofriam com a entrada de doenças em suas comunidades pela ação direta do processo migratório devido ao garimpo em suas terras.

Objetivo: Describir los efectos simbólicos de la implantación de hogar de salud indígena en el campo de la salud en el período de 1973 a 1983 en Boa Vista, Roraima, Brasil. Metodología: Se trata de un estudio histórico con un enfoque de microhistoria, guiado por el análisis documental. La teorización de los resultados fue guiada por los conceptos del sociólogo Pierre Bourdieu. Resultados: En total, el corpus documental estuvo representado por cuatro registros de imágenes. Las imágenes fueron analizadas con el fin de producir reflexiones sobre los efectos simbólicos de la implantación del hogar de salud indígena. Conclusión: El hogar de salud indígena en Boa Vista-RR surge como telón de fondo en este escenario de desarrollo, asimismo como una moneda simbólica (y representada) de intercambio entre gobernadores y pueblos indígenas, que sufrieron con el ingreso de enfermedades en sus comunidades a través de acción directa del proceso migratorio, debido a la minería en sus tierras.

Aim: To describe the symbolic effects of the implementation of the indigenous health home in the field of health in the period from 1973 to 1983 in Boa Vista, Roraima, Brazil. Methods: This was a historical study with a microhistory approach guided by a documentary analysis; the theorization of the results was guided by the concepts of the sociologist Pierre Bourdieu. Results: The documentary corpus was represented by four imagery records. The images were analyzed in order to produce reflections on the symbolic effects of the implantation of the indigenous health home. Conclusion: The indigenous health home in Boa Vista-RR emerges as a backdrop in this developmental scenario; it represents a symbolic currency of exchange between the government and the indigenous people who suffered from the entry of diseases in their communities through the direct action of the migratory process and the mining in their lands.

In vitro evaluation of Sporothrix brasiliensis biotherapic

Sporothrix brasiliensisis one of themost virulent zoonosis which affects animals and humans. This fungus is responsible for subcutaneous infection and its contamination is possible through trauma to the skin. Sporotrichosis is highly prevalent in feline. And Rio de Janeiro appears to have the highest occurrence of cases. Objectives: This study aims to evaluate the in vitroefficacy of Sporothrix brasiliensisbiotherapic, with and without an association to allopathic medicine commonly used in the treatment.Methodology: Conidiumcells of Sporothrix brasiliensiswill be cultured in Potato dextrose agar (PDA) for 5 to 7 days and yeast cells in Brain heart infusion (BHI) for 3 to 5 days. After incubation, the cells will be scraped with a drigalski handle and filtered using cells strainer into a tube and centrifuge for 5 minutes at 3000 RPM. The cells will be resuspended with Phosphate buffered saline (PBS), centrifuge again,and finally resuspended in PBS. After preparing the inocule, the microplates will be prepared. There will be 5groups in vitro. The first one will be the control group, only fungi. The second will be the treatment of fungi with homeopathic medicine (Sporothrix brasiliensis30DH). The third group will be the homeopathic medicine in association with itraconazole. The fourth will be the treatment with itraconazole only. And the last group will be the fungi with dynamized distilled water 30DH. Sporothrix brasiliensis30DHwill be prepared according to Brazilian Homeopathic Pharmacopeia. Results and discussions: The experiments are still in progress and the results will be analyzed through Analysis of variance (ANOVA) to determine statistically significant differences. Previous articles based on biotherapic treatments demonstrated successful results, so our research group is conducting these experiments to evaluate the effect in this model. Conclusion: Experiments will be made to verify the efficacy of biotherapic on sporotrichosis treatments.

Análise de intervenções farmacêuticas utilizando um instrumento de acompanhamento farmacêutico em uma Unidade de Terapia Intensiva Pediátrica / Analysis of pharmaceutical interventions using a pharmaceutical monitoring instrument in a Pediatric Intensive Care Unit

Introdução: A pediatria apresenta um cenário bastante específico devido ao uso de medicamentos off-label e carência de estudos científicos direcionados à utilização de medicamentos por essa população. Assim, o farmacêutico clínico pode contribuir na identificação e prevenção de problemas relacionados a medicamentos.Métodos: Estudo de coorte retrospectivo realizado em uma unidade de terapia intensiva pediátrica de um hospital universitário do Rio Grande do Sul. Foram analisadas as intervenções farmacêuticas realizadas entre março de 2016 a julho de 2018 por farmacêuticos clínicos. Tais intervenções foram reclassificadas conforme os critérios de um instrumento de acompanhamento farmacêutico (bundle) utilizado na rotina. Foi realizada análise estatística descritiva das variáveis estudadas.Resultados: Das 582 intervenções farmacêuticas analisadas, as categorias mais prevalentes foram dose (n = 97; 16,7%), necessidade (n = 92; 15,8%) e forma farmacêutica (n = 56; 9,6%). Após reclassificação das intervenções farmacêuticas utilizando o bundle, os critérios mais prevalentes foram: critério 1 (revisão da farmacoterapia; n = 285; 49%), critério 4 (analgesia; n = 78; 13,4%) e critério 10 (antimicrobianos; n = 65; 11,2%). As classes de medicamentos mais frequentes foram os do sistema nervoso (n = 213; 36,6%) e os anti-infecciosos gerais para uso sistêmico (n = 115; 19,8%). A taxa de adesão das intervenções farmacêuticas pela equipe médica foi de 85,1%.Conclusão: A classificação das intervenções farmacêuticas utilizando o bundle pode contribuir no aperfeiçoamento do instrumento tornando-o mais viável para uso na unidade de terapia intensiva pediátrica e direcionar o trabalho do farmacêutico clínico nas situações que geram mais problemas relacionados a medicamentos.

Introduction: Pharmaceutical interventions in the pediatric setting are highly peculiar due to the use of off-label drugs associated with the lack of scientific studies on the use of drug therapies in this population. Thus, clinical pharmacists may help identify and prevent drug-related problems.Methods: We conducted a retrospective cohort study in the pediatric intensive care unit of a teaching hospital in Rio Grande do Sul, Brazil. Pharmaceutical interventions conducted between March 2016 and July 2018 were analyzed by clinical pharmacists. These interventions were reclassified according to the criteria of a routine pharmaceutical monitoring instrument (care bundle). We conducted a descriptive statistical analysis of study variables.Results: Of 582 pharmaceutical interventions analyzed, the most prevalent categories were dose adjustment (n = 97; 16.7%), need for drug therapy (n = 92; 15.8%), and dosage forms (n = 56; 9.6%). After reclassification of pharmaceutical interventions, the most prevalent criteria were criterion 1 (review of drug therapy; n = 285; 49%), criterion 4 (analgesia; n = 78; 13.4%), and criterion 10 (antimicrobials; n = 65; 11.2%). The most common drug classes were nervous system agents (n = 213; 36.6%) and anti-infectives for systemic use (n = 115; 19.8%). The rate of adherence to pharmaceutical interventions by the medical team was 85.1%.Conclusions: The classification of pharmaceutical interventions according to the pharmaceutical care bundle may help improve the instrument, allowing its use in the pediatric intensive care unit and guiding clinical pharmacists in situations causing drug-related problems.

Percepções de enfermeiros sobre aconselhamento e testagens rápidas para infecções sexualmente transmissíveis / Nurses' perceptions of counseling and rapid testing for sexually transmitted infections

Objetivo: compreender as percepções de enfermeiros da Estratégia Saúde da Família sobre aconselhamento e testa-gem rápida para infecções sexualmente transmissíveis. Mé-todos: estudo qualitativo, com triangulação de dados. Cole-ta de dados realizada mediante entrevista semiestruturada com sete enfermeiros da Estratégia Saúde da Família. Para sistematização e tratamento dos dados, adotou-se a análi-se de conteúdo na modalidade temática. Resultados: após análise, emergiram quatro categorias: Capacitação em teste rápido; Condução do aconselhamento; Facilidades na oferta do teste rápido; e Desafios na oferta de teste rápido. Conclu-são: as percepções de enfermeiros estiveram relacionadas às dificuldades diante do aconselhamento pré e pós-teste, necessitando de aperfeiçoamento, educação permanente e capacitação para preparo profissional, e à logística dos insu-mos e materiais, além de mudanças na estrutura física das unidades. (AU)

The efficacy of topical, oral and surgical interventions for the treatment of tungiasis: A systematic review of the literature.

BACKGROUND: Tungiasis is a neglected disease caused by Tunga penetrans that can be complicated by secondary infections and local tissue destruction. Adequate treatment is important, especially in vulnerable populations; potential treatment options proposed range from surgical extraction to the use of oral and topical medications. We aimed to perform a systematic review to assess the efficacy of topical, oral and surgical interventions for the treatment of tungiasis. METHODOLOGY/PRINCIPAL FINDINGS: The present review is registered in PROSPERO (CRD42021234741). On September 1, 2020, we searched PubMed, EMBASE, Scopus, Web of Science, Science Direct, Scielo and LILACS BVS. We included clinical trials and longitudinal observational studies that evaluated any topical, systemic or mechanical treatment for tungiasis. We used the Revised Cochrane Risk of Bias (RoB) Tool for Randomized Trials for clinical trial analysis. Qualitative and quantitative descriptive syntheses were performed. Our search strategy resulted in 3376 references. Subsequently, 2568 titles/abstracts and 114 full texts were screened. We finally included 19 articles; 9 were classified as clinical trials. Two and 3 articles presented low and some RoB, respectively, according to the tool. Only two articles tested the efficacy of oral medications (niridazole, ivermectin), with discouraging results. Six clinical trials evaluated topical products for the treatment of tungiasis; 2 evaluated dimeticone-based compounds and reported positive results in lesion reduction and cure. None reported significant adverse reactions. Surgical extraction was evaluated only in observational studies. CONCLUSIONS/SIGNIFICANCE: We conclude that, although surgical extraction is the most commonly used treatment, there is sufficient evidence supporting the use of occlusive agents, especially manufactured dimeticone-based products.

Thyroid Hormone Levels During Hospital Admission Inform Disease Severity and Mortality in COVID-19 Patients.

Background: Illness severity in patients infected with COVID-19 is variable. Methods: Here, we conducted an observational, longitudinal, and prospective cohort study to investigate serum thyroid hormone (TH) levels in adult COVID-19 patients, admitted between June and August 2020, and to determine whether they reflect the severity or mortality associated with the disease. Results: Two hundred forty-five patients [median age: 62 (49-75) years] were stratified into non-critical (181) and critically ill (64) groups. Fifty-eight patients (23.6%) were admitted to the intensive care unit, and 41 (16.7%) died. Sixteen (6.5%) exhibited isolated low levels of free triiodothyronine (fT3). fT3 levels were lower in critically ill compared with non-critical patients [fT3: 2.82 (2.46-3.29) pg/mL vs. 3.09 (2.67-3.63) pg/mL, p = 0.007]. Serum reverse triiodothyronine (rT3) was mostly elevated but less so in critically ill compared with non-critical patients [rT3: 0.36 (0.28-0.56) ng/mL vs. 0.51 (0.31-0.67) ng/mL, p = 0.001]. The univariate logistic regression revealed correlation between in-hospital mortality and serum fT3 levels (odds ratio [OR]: 0.47; 95% confidence interval [CI 0.29-0.74]; p = 0.0019), rT3 levels (OR: 0.09; [CI 0.01-0.49]; p = 0.006) and the product fT3 × rT3 (OR: 0.47; [CI 0.28-0.74]; p = 0.0026). Serum thyrotropin, free thyroxine, and fT3/rT3 values were not significantly associated with mortality and severity of the disease. A serum cutoff level of fT3 (≤2.6 pg/mL) and rT3 (≤0.38 ng/mL) was associated with 3.46 and 5.94 OR of mortality, respectively. We found three COVID-19 mortality predictors using the area under the receiver operating characteristic (ROC) curve (AUC score): serum fT3 (AUC = 0.66), rT3 (AUC = 0.64), and the product of serum fT3 × rT3 (AUC = 0.70). Non-thyroidal illness syndrome (fT3 < 2.0 pg/mL) was associated with a 7.05 OR of mortality ([CI 1.78-28.3], p = 0.005) and the product rT3 × fT3 ≤ 1.29 with an 8.08 OR of mortality ([CI 3.14-24.2], p < 0.0001). Conclusions: This prospective study reports data on the largest number of hospitalized moderate-to-severe COVID-19 patients and correlates serum TH levels with illness severity, mortality, and other biomarkers to critical illness. The data revealed the importance of early assessment of thyroid function in hospitalized patients with COVID-19, given the good prognostic value of serum fT3, rT3, and fT3 × rT3 product. Further studies are necessary to confirm these observations.

Supporting Trainees by Addressing Inappropriate Behaviors by Patients.

OBJECTIVES: Physicians in training may be particularly vulnerable to the negative effects of discrimination and inappropriate behaviors by patients. We sought to determine the frequency of inappropriate behaviors by patients toward Internal Medicine (IM) residents, residents' confidence to manage the behaviors, and differences among demographic characteristics, including race, sex, and level of clinical experience. METHODS: We developed a curricular session to equip IM residents and faculty to respond to discrimination or inappropriate behaviors by patients. Before the session, we surveyed residents about their experiences with macroaggressions, microaggressions, and other inappropriate behaviors using a 16-question survey instrument. We used descriptive statistics to summarize the participants' characteristics and the χ2 or Fisher exact test for comparison between groups. RESULTS: Eighty-two percent (27 of 33) of residents who attended the workshop completed the survey. We found that the majority of residents experienced patient macro- and microaggressions. More than 50% had a personal experience or witnessed experience with a macroaggression related to race (56%) or gender (59%). Seventy percent of residents personally experienced a microaggression by a patient. Women and residents of color are more likely to experience these types of encounters, which become more common in residents with higher postgraduate year level. Confidence in how to appropriately respond to such encounters is low. CONCLUSIONS: Our study highlights that macro- and microaggressions by patients toward IM residents are common. Curricula are needed to equip trainees with tools to appropriately respond during such encounters.

Novel platform leveraging electronic medical record (EMR) to triage patients admitted with high-grade immune-related adverse events (irAEs) to the immune-toxicity (ITOX) service.

BACKGROUND: The incidence of high-grade immune-related adverse events (irAEs) due to immune checkpoint inhibitors (ICIs) is increasing due to the rapid expansion of indications for their use. There is an urgent need for a feasible approach of identifying patients with high-grade irAEs to ensure early detection and proper management of this unique set of toxicities. METHODS: We established one of the first inpatient services that are specifically devoted to mitigating irAEs. The service uses a multidisciplinary approach with consulting service from experts in managing irAEs. We are leveraging the electronic medical record (EMR) to triage patients who are admitted to the hospital and have received or are currently receiving ICIs. A list of patients with ICI exposure is generated daily by EMR and then curated manually to identify patients with potential irAEs. RESULTS: A total of 129 patients with high-grade irAEs were admitted between June 2018 and June 2019. The most common irAEs were colitis (32%), pneumonitis (30%), and hepatitis (14%). Eighty five per cent of the patients had grade 3 irAEs and 15% had grade 4-5. About half of the patients had received ICI monotherapy; 30% had received combination of ICIs and non-ICIs; and 19% had received a combination of ICIs. Only 9% of patients had steroid-refractory irAEs requiring other immunosuppressive agents. The average length of stay for irAE-related admission was 11 days with a readmission rate due to recurrent irAEs of 26% within a year. CONCLUSION: We demonstrated the feasibility of using the EMR to accurately triage patients with suspected irAEs to a dedicated immune-toxicity service. Our model is adaptable in major academic centers and could have a major impact on quality of care and future clinical research addressing irAEs.

Classificação dos pacientes na emergência segundo a dependência da enfermagem / Classification of emergency patients according to their dependency on nursing

Objetivo: caracterizar o grau de dependência dos cuidados de enfermagem de usuários internados no setor de emergência. Método: trata-se de estudo quantitativo, transversal, de base secundária e a amostra se constituiu dos usuários internados na área de estabilização no mês de março de 2017. Utilizou-se um instrumento para os dados sociodemográficos e clínicos e o Sistema de Classificação de Pacientes (SCP) de Fugulin, Gaidzinski e Kurcgant. Realizou-se a análise estatística no programa Epi Info. Resultados: verificouse que 62,16% (n=46) da amostra era do sexo masculino, idade média de 55,29 ± 20,76 anos, principal diagnóstico de internação as doenças do aparelho circulatório (39,19%) e média de permanência de 4,29 ± 6,59. O SPC foi aplicado 166 vezes e predominou o cuidado de intensivo (69,28%), seguido por semi-intensivo (13,86%) e de alta dependência (11,45%). Conclusão: constatou-se um elevado número de cuidados intensivos e semi-intensivos, atrelados à longa permanência no setor, o que descaracteriza as unidades de emergência como local de estabilização. Fornece-se com essa caracterização bases científicas e fidedignas para o gerenciamento hospitalar e de pessoal de enfermagem.(AU)

Objective: to characterize the degree of dependency of users hospitalized in the emergency unit with respect to nursing care. Method: this is a quantitative, cross-sectional and secondary-based study. The sample consisted of patients hospitalized in the stabilization unit in March 2017. An instrument was used to obtain sociodemographic and clinical data, and also the Patient Classification System (PCS) proposed by Fugulin, Gaidzinski and Kurcgant. Statistical analysis was performed using the Epi InfoTM software. Results: 62.16% (n=46) of the sample were male, with mean age of 55.29 ± 20.76 years. The main diagnosis of hospitalization was diseases of the circulatory system (39.19%), and the mean permanence was 4.29 ± 6.59. The PCS was applied 166 times and intensive care was prevalent (69.28%), followed by semi-intensive (13.86%) and high dependency (11.45%). Conclusion: There was a high number of intensive care and semi-intensive care provided and linked to prolonged length of stay in the sector, which mischaracterizes emergency units as patient stabilization sectors. This characterization provides scientific and trustworthy bases for hospital management and nursing personnel.(AU)

Objetivo: caracterizar el grado de dependencia de los usuarios internados en el sector de emergencia en relación a los cuidados de enfermería. Método: se trata de un estudio cuantitativo, transversal y de base secundaria. La muestra se compuso de los usuarios internados en la unidad de estabilización durante el mes de marzo de 2017. Se utilizó un instrumento para obtener los datos sociodemográficos y clínicos y el Sistema de Clasificación de Pacientes (SCP) de Fugulin, Gaidzinski y Kurcgant. Se realizó el análisis estadístico en el programa Epi InfoTM . Resultados: se verificó que el 62,16% (n=46) de la muestra era del sexo masculino, con edad media de 55,29 ± 20,76 años. El principal diagnóstico de internación fue las enfermedades del aparato circulatorio (39,19%) y el promedio de permanencia fue de 4,29 ± 6,59. El SCP fue aplicado 166 veces y predominó el cuidado intensivo (69,28%), seguido por el semi-intensivo (13,86%) y el de alta dependencia (11,45%). Conclusión: Se constató un elevado número de cuidados intensivos y semi-intensivos relacionados con la larga permanencia en el sector, lo que descaracteriza las unidades de emergencia como locales de estabilización. Esta caracterización proporciona bases científicas y fidedignas para la gestión hospitalaria y de personal de enfermería.(AU)

Ethanol stress responses of Kluyveromyces marxianus CCT 7735 revealed by proteomic and metabolomic analyses.

Kluyveromyces marxianus CCT 7735 offers advantages to ethanol production over Saccharomyces cerevisiae, including thermotolerance and the ability to convert lactose to ethanol. However, its growth is impaired at high ethanol concentrations. Herein we report on the protein and intracellular metabolite profiles of K. marxianus at 1 and 4 h under ethanol exposure. The concentration of some amino acids, trehalose and ergosterol were also measured. We observed that proteins and metabolites from carbon pathways and translation were less abundant, mainly at 4 h of ethanol stress. Nevertheless, the concentration of some amino acids and trehalose increased at 8 and 12 h under ethanol stress, indicating an adaptive response. Moreover, our results show that the abundance of proteins and metabolites related to the oxidative stresses responses increased. The results obtained in this study provide insights into understanding the physiological changes in K. marxianus under ethanol stress, indicating possible targets for ethanol tolerant strains construction.

Mutation screening of TP53, CHEK2 and BRCA genes in patients at high risk for hereditary breast and ovarian cancer (HBOC) in Brazil.

BACKGROUND: Few studies related to hereditary breast and ovarian cancer syndrome (HBOC) have been conducted in Brazil, and they are restricted to only small areas of the country. Here, we report the mutation profile of BRCA1/2, CHEK2 and TP53 genes in a cohort from Minas Gerais state. METHODS: These genes from 44 patients at high risk for HBOC were screened through high-resolution melting and/or sequencing. The pathogenicity of the alterations was checked using ClinVar database and bioinformatics programs. RESULTS: In BRCA genes we identified 46 variants, 38 without clinical significance and 8 pathogenic mutations including a new pathogenic mutation in BRCA1 gene (c.4688_4694delACCTGGAinsG). The most prevalent pathogenic mutation was c.4829_4830delTG, in the BRCA2 gene. This mutation was not described in the Brazilian population up to now and in this study, it was described with a prevalence of 6.8%. The p.R337H mutation in TP53 gene was found in one patient clinically diagnosed as HBOC and without clinical criteria for Li-Fraumeni syndrome. In CHEK2 gene, the undescribed variant c.485A > G was found and it presents as probably pathogenic through in silico analyses. Pathogenic mutations were found in 29.5% of the patients, 11.3% in BRCA1, 15.9% in BRCA2 and 2.3% in TP53 gene. CONCLUSIONS: Brazilian population is one of the most heterogeneous in the world and the mutational profile knowledge of genes related to HBOC from different regions can contribute to the definition of more cost-effective strategies for the prevention, identification and treatment of cancer.

A Comparison of Different Methodologies for the Measurement of Extracellular Vesicles and Milk-derived Particles in Raw Milk from Cows.

Cow's milk is economically important to the agricultural industry with the nutritive value of milk being routinely measured. This does not give full insight into normal mammary tissue turnover during the course of lactation, which could be important for both an understanding of milk production and animal welfare. We have previously demonstrated that submicron particles, including extracellular vesicles (EVs), can be measured in unprocessed cow's milk by flow cytometry and that they correlate with stage of lactation. A number of different techniques are available to measure EVs and other milk-derived particles. The purpose of this study was to compare two different methodologies and the value of fluorescent staining for the phospholipid phosphatidylserine (PS), which is exposed on the surface of EVs (but not other milk-derived particles). We used two different flow cytometers and nanotracker analysis to detect milk-derived particles in whole and skimmed milk samples. Our findings indicate significant correlation, after staining for PS, suggesting potential for larger multicenter studies in the future.