A case series of SARS-CoV-2 reinfections caused by the variant of concern Gamma in Brazil

The rapid spread of the SARS-CoV-2 Variant of Concern (VOC) Gamma during late 2020 and early 2021 in Brazilian settings with high seroprevalence raised some concern about the potential role of reinfections in driving the epidemic. Very few cases of reinfection associated with the VOC Gamma, however, have been reported. Here we describe 25 cases of SARS-CoV-2 reinfection confirmed by real-time RT-PCR twice within months apart in Brazil. SARS-CoV-2 genomic analysis confirmed that individuals were primo-infected between March and December 2020 with distinct viral lineages, including B.1.1, B.1.1.28, B.1.1.33, B.1.195 and P.2, and then reinfected with the VOC Gamma between 3 to 12 months after primo-infection. The overall mean cycle threshold (Ct) value of the first (25.7) and second (24.5) episodes were roughly similar for the whole group and 14 individuals displayed mean Ct values < 25.0 at reinfection. Sera of 14 patients tested by plaque reduction neutralization test after reinfection displayed detectable neutralizing antibodies against Gamma and other SARS-CoV-2 variants (B.1.33, B.1.1.28 and Delta). All individuals have milder or no symptoms after reinfection and none required hospitalization. The present study demonstrates that the VOC Gamma was associated with reinfections during the second Brazilian epidemic wave in 2021 and raised concern about the potential infectiousness of reinfected subjects. Although individuals here analyzed failed to mount a long-term sterilizing immunity, they developed a high anti-Gamma neutralizing antibody response after reinfection that may provide some protection against severe disease.

Spread of Gamma (P.1) sub-lineages carrying Spike mutations close to the furin cleavage site and deletions in the N-terminal domain drives ongoing transmission of SARS-CoV-2 in Amazonas, Brazil

The Amazonas was one of the most heavily affected Brazilian states by the COVID-19 epidemic. Despite a large number of infected people, particularly during the second wave associated with the spread of the Variant of Concern (VOC) Gamma (lineage P.1), SARS-CoV-2 continues to circulate in the Amazonas. To understand how SARS-CoV-2 persisted in a human population with a high immunity barrier, we generated 1,188 SARS-CoV-2 whole-genome sequences from individuals diagnosed in the Amazonas state from 1st January to 6th July 2021, of which 38 were vaccine breakthrough infections. Our study reveals a sharp increase in the relative prevalence of Gamma plus (P.1+) variants, designated as Pango Lineages P.1.3 to P.1.6, harboring two types of additional Spike changes: deletions in the N-terminal (NTD) domain (particularly{Delta} 144 or{Delta} 141-144) associated with resistance to anti-NTD neutralizing antibodies or mutations at the S1/S2 junction (N679K or P681H) that probably enhance the binding affinity to the furin cleavage site, as suggested by our molecular dynamics simulations. As lineages P.1.4 (S:N679K) and P.1.6 (S:P681H) expanded (Re > 1) from March to July 2021, the lineage P.1 declined (Re < 1) and the median Ct value of SARS-CoV-2 positive cases in Amazonas significantly decreases. Still, we found no overrepresentation of P.1+ variants among breakthrough cases of fully vaccinated patients (71%) in comparison to unvaccinated individuals (93%). This evidence supports that the ongoing endemic transmission of SARS-CoV-2 in the Amazonas is driven by the spread of new local Gamma/P.1 sub-lineages that are more transmissible, although not more efficient to evade vaccine-elicited immunity than the parental VOC. Finally, as SARS-CoV-2 continues to spread in human populations with a declining density of susceptible hosts, the risk of selecting new variants with higher infectivity are expected to increase.

Órteses e próteses de membro superior impressas em 3D: uma revisão integrativa / Upper limbs orthesis and prostheses printed in 3D: an integrative review

Resumo Introdução A impressão tridimensional (3D) é capaz de confeccionar produtos físicos avançados e especializados por meio de tecnologia computadorizada e softwares específicos. Alguns desses produtos são as órteses e próteses, que podem favorecer a funcionalidade do sujeito em seu cotidiano. Objetivo Identificar o tipo, o uso e a aplicabilidade da impressão 3D na confecção de órteses e próteses para membro superior. Método Revisão integrativa realizada nas bases de dados PubMed, LILACS, Web of Science, Scopus e Science Direct, sem delimitação de tempo, na língua portuguesa, inglesa ou espanhola, seguindo os critérios de elegibilidade: estudos do tipo experimental, observacional e relatos de casos, cujo objeto de estudo foram as órteses e próteses impressas em 3D, com pacientes de qualquer idade e qualquer diagnóstico de comprometimento do membro superior. Resultados Foram incluídos nove artigos, sete referentes ao uso da impressão 3D na confecção de prótese e dois referentes à confecção de órteses. Muitos dos estudos foram direcionados ao público infantil e os materiais mais utilizados para confecção foram o PLA e o ABS. A equipe multidisciplinar foi apresentada como fundamental no processo de avaliação, criação e testagem dos dispositivos. Conclusão Apesar dos estudos analisados tangenciarem fases iniciais de desenvolvimento e investigação da aplicabilidade da impressão 3D na criação de órteses e próteses, observou-se que já existem melhorias do custo-benefício gerado pelo uso desta tecnologia, bem como a possibilidade de gerar produtos mais versáteis. Apontando-se como um campo promissor para ampliar a aplicação da impressão 3D como recurso facilitador do processo de reabilitação.

Abstract Introduction Three-dimensional (3D) printing is capable of making advanced and specialized physical products using computerized technologies and specific software. Some of these products are orthosis and prostheses which can support patients' functionality in their daily lives. Objective To identify the type, the usage, and the applicability of 3D printing on the development of upper limbs' orthosis and prostheses. Method Integrative review carried out on the following databases: Pubmed, LILACS, Web of Science, Scopus e Science Direct, with no specific publication period, written in English, Spanish or Portuguese. It also had to fit the following criteria: experimental and observational studies and case reports which had 3D printed orthosis and prosthesis as the object of study with patients of any age or diagnosis of upper limb damage. Results Nine studies were included. Seven referred to the use of 3D printing to make prosthesis and 2 to make orthosis. Many studies were directed to children and the most used materials were PLA and ABS. The multidisciplinary team was fundamental in the process of evaluation, creation, and testing of the devices. Conclusion Despite the analyzed studies mention initial phases of development and investigation of the applicability of 3D printing in the creation of orthosis and prostheses, it was observed that cost-benefit improvements generated by the use of this technology already exist, as well as the possibility of generating more versatile products. It's a promising field to amplify the applicability of 3D printing as a resource facilitating the rehabilitation process.

Aplicabilidade da captura de movimentos na pesquisa interdisciplinar de tecnologia assistiva: um relato de experiência / Applicability of motion capture in interdisciplinary research of assistive technology: a report of experience

Resumo Introdução A Tecnologia Assistiva (TA) é apontada como uma das soluções para proporcionar uma melhor funcionalidade e qualidade de vida às pessoas com doenças reumatológicas. Projetos interdisciplinares com foco em avaliar, indicar e desenvolver TA são importantes para os avanços na pesquisa e assistência clínica. A captura de movimento, por meio da instrumentação tecnológica, apresenta-se como um tema inovador por fornecer dados objetivos sobre o usuário. Mais estudos nessa área são necessários para conhecer as possibilidades de aplicação da instrumentação tecnológica em pesquisas de TA. Objetivo Descrever a aplicabilidade da captura de movimento, por meio de um equipamento de alta tecnologia, numa pesquisa interdisciplinar de TA para pacientes reumatológicos. Método Trata-se de Relato de Experiência, com uma abordagem qualitativa, no qual foi descrito as ações utilizando um equipamento tecnológico específico para captura de movimentos. Resultados Foi utilizada a captura de movimento com três finalidades: apoio educacional; avaliação de usabilidade de recursos de TA desenvolvidos; e suporte a grupos de estudo de terapeutas ocupacionais para análises de atividades. Conclusão Nas diferentes ações, a captura de movimento funcionou como um recurso complementar para as análises de atividades realizadas pelos terapeutas ocupacionais, o que contribuiu para a indicação, desenvolvimento e avaliação dos dispositivos de TA e para facilitar as orientações dadas no manual e nos grupos de orientação sobre Proteção Articular. O trabalho interdisciplinar foi o diferencial para o uso adequado do equipamento.

Abstract Introduction Assistive Technology (AT) is pointed as one of the possible solutions to offer better functionality and quality of life for people with rheumatological diseases. Interdisciplinary projects focused on assessing, indicating, and developing AT are important for advances in research and clinical care. Motion capture, through technological instrumentation, is an innovative theme for providing objective data about the user. Further studies in this area are needed to know the possibilities of applying technological instrumentation in AT research. Objective To describe the applicability of motion capture, using high-tech equipment, in an interdisciplinary AT research for rheumatological patients. Method It is an Experience Report, with a qualitative approach, in which the actions were described using specific technological equipment to motion capture. Results: Motion capture was used for three purposes: educational support; usability evaluation of AT resources developed; and support for study groups of occupational therapists to activity analysis. Conclusion In the different actions, the motion capture was used as a complementary resource for activities' analysis performed by occupational therapists, which contributed to the indication, development, and evaluation of AT devices and to facilitate the instructions provided in manual and in the guidance groups about Joint Protection. Interdisciplinary work was differentiated for the proper use of equipment.

Nonlinear effects of caffeine on the viability, synthesis and gene expression of chondrocytes from the offspring of rats treated during pregnancy.

OBJECTIVE: Evaluate the effects of doses of caffeine administered to pregnant rats on the articular cartilage chondrocytes of their offspring. METHODS: Twenty-four adult Wistar rats were randomly assigned to four groups, with one control group and three groups being treated with caffeine at doses of 25, 50 and 100 mg/kg throughout pregnancy. At birth, three offspring/females were euthanized so that the chondrocytes could be extracted. At 7, 14 and 21 days of culture, the chondrocytes were subjected to the MTT cell viability assay and an evaluation of their alkaline phosphatase activity and collagen synthesis. Chondrocytes were also stained by Hematoxylin-eosin, PAS, Safranin-O and Alcian Blue. The Sox-9, Runx-2, aggrecan, collagen-II and alkaline phosphatase gene transcript levels were also evaluated. Mean comparisons were performed by the Student-Newman-Keuls test. RESULTS: Chondrocyte cultures from the 25 mg/kg group had the lowest results, as chondrocytes from this group had reduced viability, percentage of cells, alkaline phosphatase activity and collagen and chondrogenic matrix synthesis. A reduced expression of Sox-9, alkaline phosphatase and collagen-II was also detected in the 25 mg/kg group. Chondrocyte cultures of the group treated with 50 mg/kg caffeine showed reduced collagen synthesis and Sox-9 expression. The caffeine dose of 100 mg/kg also reduced collagen and Sox-9 and alkaline phosphatase expression. CONCLUSION: Caffeine administered to pregnant rats negatively alters the articular cartilage chondrocytes of their offspring, reducing the synthesis of collagen and Sox-9 expression regardless of the dose. This study also concluded that the effects of caffeine are not linear or dose-dependent.

Analysis of the occupational therapist's activities as a professional adviser in the professional rehabilitation service of the National Institute of Social Security (INSS) / Análise sobre a atuação do terapeuta ocupacional como orientador profissional no serviço de reabilitação profissional do Instituto Nacional do Seguro Social (INSS)

Introduction: The INSS Professional Rehabilitation Service (PR) underwent several changes, especially those that occurred with the creation of the SUS and the withdrawal of any kind of health care from the institute. In 2008, with the revitalization of the service, several occupational therapists joined the institution, but remained a model of action without focusing on health care and without valuing the professional specificity. This form of intervention has been causing discussions about the work of these professionals, implied by the lack of literature that bases their interventions and strengthens the maintenance of their professional identity within this new scenario. Objective: To investigate the relationship between Occupational Therapy and the role played by occupational therapists in the INSS PR service. Method: Qualitative research of the exploratory type, being observed the performance of an occupational therapist of the Executive Management Recife/PE, Responsible for Professional Orientation. Results: It was verified that in the INSS, the occupational therapist employs many specificities of its profession, which are related to: objective (emancipation of the individual and insertion on work activity), object (human doing, occupational performance), instrument (analysis of the labor activity and workstation). In addition, it was noticed that the social security context exerts some limitations in the occupational therapeutic action, within the scope of the institutional norms of management and of conducting the professional doing in the RP. Conclusion: Relationships between Occupational Therapy and function of Responsible for Professional Orientation of INSS were established, indicating ways for a practice based on the theoretical bases of the profession. It is recommended to conduct researches in the area that analyze the performance of this professional and the impact of their interventions in the replacement of INSS policyholders in the labor market.

Introdução: O Serviço de Reabilitação Profissional (RP) do INSS sofreu várias mudanças, destacando-se aquelas que ocorreram com a criação do SUS e a retirada de qualquer tipo de assistência à saúde do instituto. Em 2008, com a revitalização do serviço, vários terapeutas ocupacionais ingressaram na instituição, mas permaneceu um modelo de atuação sem focar a assistência à saúde e sem valorizar a especificidade profissional. Essa forma de intervenção vem causando discussões quanto a atuação desses profissionais, implicadas pela falta de literatura que embase suas intervenções e fortaleça a manutenção de sua identidade profissional dentro desse novo cenário. Objetivo: Investigar a relação existente entre a terapia ocupacional e a função desempenhada pelos terapeutas ocupacionais no serviço de Reabilitação Profissional do INSS. Método: Pesquisa qualitativa, do tipo exploratória, sendo observada a atuação de uma terapeuta ocupacional da Gerência Executiva Recife/PE, Responsável pela Orientação Profissional. Resultados: Verificou-se que, no INSS, o terapeuta ocupacional emprega muitas especificidades de sua profissão, quais sejam relacionadas a: objetivo (emancipação do sujeito e inserção em atividade de trabalho), objeto (fazer humano, desempenho ocupacional), instrumento (análise da atividade laboral e do posto de trabalho). Além disso, percebeu-se que o contexto previdenciário exerce algumas limitações na atuação terapêutica ocupacional, no âmbito das normas institucionais de gestão e de condução do fazer profissional na RP. Conclusão: Foram estabelecidas relações entre a terapia ocupacional e a função de Responsável pela Orientação Profissional do INSS, indicando caminhos para uma prática sustentada nas bases teóricas da profissão. Recomenda-se a realização de pesquisas na área que analisem a atuação desse profissional e o impacto de suas intervenções na recolocação de segurados do INSS no mercado de trabalho.

Glicemia de gatos obesos obtida por meio do teste de tolerância à glicose / Glucose of obese cats obtained through the glucose tolerance test

Esse trabalho avaliou a glicemia de gatos obesos por meio do teste de tolerância à glicose, a fim de identificar a hiperglicemia por resistência à insulina nesses animais. Foram avaliados 16 gatos, sendo oito com condição corpórea ideal (Grupo Controle) e oito com sobrepeso (Grupo Sobrepeso). Após jejum alimentar de 12 horas, os animais receberam glicose, via intravenosa, na dose de 0,5g/kg e amostras de sangue foram coletadas para aferição da glicemia no Tempo zero, após 10 (Tempo 1), 30 (Tempo 2), 60 (Tempo 3), 90 (Tempo 4) e 120 (Tempo 5) minutos. No teste de tolerância à glicose, não houve diferença significativa na comparação da glicemia entre os tempos dos dois grupos. Na comparação entre os tempos de um mesmo grupo pode-se verificar que diferentemente do Grupo Controle, não houve diferença significativa entre os Tempo 1 e Tempo 2 do Grupo Sobrepeso, sugerindo um discreto retardo na redução da concentração de glicose entre esses tempos. No estudo realizado, o teste de tolerância à glicose intravenosa apresentou-se factível, porém o período mínimo de 2 anos de obesidade foi insuficiente para a observação de alterações significativas no metabolismo da glicose em gatos obesos. Entretanto, foi possível observar o retardo na redução da concentração de glicose entre 10 e 30 minutos, o que pode estar relacionado à resistência à insulina.

Factors associated with speech-language disorders in motorcycle accident victims. / Fatores associados às alterações fonoaudiológicas em vítimas de acidentes de motocicletas.

PURPOSE: To investigate factors associated with speech-language disorders in victims of motorcycle accidents. METHODS: This is a cross-sectional study. Victims of motorcycle accidents studied were treated at Hospital da Restauração between June and July 2014. The data were collected by consulting the records and direct interviews with these, at admission and after discharge. For analysis were raised single frequencies, average and chi-square test or Fisher's exact test. The margin of error used in the statistical tests was 5%, and the intervals were obtained with 95% reliability. RESULTS: 99 individuals were studied, 90.9% male, the mean age of 32.7 years. It found a high percentage of 42.3% of drunk drivers and 51.5% were not enabled. The Head Injuries were present in 30.3% of cases. The most affected body area were the lower limbs (71.7%), followed by the head and face region (56.6%). It was also found that 30.3% had complaints of speech pathology after hospital discharge and a statistically significant association between speech therapy complaint and not enabled (p=0.012) and collisions between bikes (p=0.004). CONCLUSION: There was a high percentage of lesions in the head and face resulting from accidents, associated mainly not eligible to drive bike and collisions between motorcycles, suggesting that these factors can aggravate injuries speech therapy.

Fatores associados às alterações fonoaudiológicas em vítimas de acidentes de motocicletas / Factors associated with speech-language disorders in motorcycle accident victims

RESUMO Objetivo Verificar fatores associados às alterações fonoaudiológicas em vítimas de acidentes motociclísticos. Método Trata-se de um estudo de corte transversal. Foram estudadas vítimas de acidentes motociclísticos assistidas no Hospital da Restauração entre junho e julho de 2014. Os dados foram coletados através da consulta dos prontuários e entrevistas direta com esses acidentados, no momento da internação e após a alta hospitalar. Para análise, foram estudadas as frequências simples, média e teste Quiquadrado de Pearson ou o teste Exato de Fisher. A margem de erro utilizada nas decisões dos testes estatísticos foi de 5% e os intervalos de confiança foram obtidos com confiabilidade de 95%. Resultados Foram estudados 99 indivíduos, sendo 90,9% do gênero masculino, com idade média de 32,7 anos. Constatou-se um alto percentual de condutores alcoolizados (42,3%) e não habilitados (51,5%). Os traumatismos cranianos estavam presentes em 30,3% dos casos. As áreas corporais mais afetadas foram os membros inferiores (71,7%), seguidos da região da cabeça e face (56,6%). Depois da alta hospitalar, 30,3% referiram queixa de alterações fonoaudiológicas e essas mostraram uma associação estatisticamente significativa com não habilitados (p=0,012) e colisões entre motos (p=0,004). Conclusão Verificou-se alto percentual de lesões em região de cabeça e face decorrentes dos acidentes, associadas principalmente à não habilitação para conduzir moto e colisões entre motocicletas, sugerindo que tais fatores podem agravar as lesões fonoaudiológicas.

ABSTRACT Purpose To investigate factors associated with speech-language disorders in victims of motorcycle accidents. Methods This is a cross-sectional study. Victims of motorcycle accidents studied were treated at Hospital da Restauração between June and July 2014. The data were collected by consulting the records and direct interviews with these, at admission and after discharge. For analysis were raised single frequencies, average and chi-square test or Fisher's exact test. The margin of error used in the statistical tests was 5%, and the intervals were obtained with 95% reliability. Results 99 individuals were studied, 90.9% male, the mean age of 32.7 years. It found a high percentage of 42.3% of drunk drivers and 51.5% were not enabled. The Head Injuries were present in 30.3% of cases. The most affected body area were the lower limbs (71.7%), followed by the head and face region (56.6%). It was also found that 30.3% had complaints of speech pathology after hospital discharge and a statistically significant association between speech therapy complaint and not enabled (p=0.012) and collisions between bikes (p=0.004). Conclusion There was a high percentage of lesions in the head and face resulting from accidents, associated mainly not eligible to drive bike and collisions between motorcycles, suggesting that these factors can aggravate injuries speech therapy