Humoral immune response of patients infected by earlier lineages of SARS-CoV-2 neutralizes wild types of the most prevalent variants in Brazil

In the present study, serum samples of 20 hospitalized COVID-19 patients from Brazil who were infected by the earlier SARS-CoV-2 lineages B.1.1.28 and B.1.1.33, and by the variant of concern (VOC) Gamma (P.1) were tested by plaque reduction neutralization test (PRNT90) with wild isolates of a panel of SARS-CoV-2 lineages, including B.1, Zeta, N.10, and the VOCs Gamma, Alpha, and Delta that emerged in different timeframes of the pandemic. The main objectives of the present study were to evaluate if serum of COVID-19 patients infected by earlier lineages of SARS-CoV-2 were capable to neutralize recently emerged VOCs, and if PRNT90 is a reliable serologic method to distinguish infections caused by different SARS-CoV-2 lineages. Overall, sera collected from the day of admittance to the hospital to 21 days after diagnostic of patients infected by the two earlier lineages B.1.1.28 and B.1.1.33 presented neutralizing capacity for all challenged VOCs, including Gamma and Delta, that were the most prevalent VOCs in Brazil. Among all variants tested, Delta and N.10 presented the lowest mean of neutralizing antibody titers, and B.1.1.7, presented the highest titers. Four patients infected with Gamma, that emerged in December 2020, presented neutralizing antibodies for B.1, B.1.1.33 and B.1.1.28, its ancestor lineage. All of them had neutralizing antibodies under the level of detection for the VOC Delta. Interestingly, patients infected by B.1.1.28 presented very similar mean of neutralizing antibody titers for both B.1.1.33 and B.1.1.28. Findings presented here indicate that most patients infected in early stages of COVID-19 pandemic presented neutralizing antibodies up to 21 days after diagnostic capable to neutralize wild types of all recently emerged VOCs in Brazil, and that the PRNT90 it is not a reliable serologic method to distinguish natural infections caused by different SARS-CoV-2 lineages.

Post-acute COVID-19 syndrome after reinfection and vaccine breakthrough by the SARS-CoV-2 Gamma variant in Brazil.

We describe a case of prolonged COVID-19 caused by the SARS-CoV-2 Gamma variant in a fully vaccinated healthcare worker, 387 days after an infection caused by lineage B.1.1.33. Infections were confirmed by whole-genome sequencing and corroborated by the detection of neutralizing antibodies in convalescent serum samples. Considering the permanent exposure of this healthcare worker to SARS-CoV-2, the waning immunity after the first infection, the low efficacy of the inactivated vaccine at preventing COVID-19, the immune escape of the Gamma variant (VOC), and the burden of post-COVID syndrome, this individual would have benefited from an additional dose of a heterologous vaccine.

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.

Use of linkage to analyze completeness and concordance of deaths from congenital syphilis in the Metropolitan Region of São Paulo, Brazil, 2010-2017: a descriptive study. / Uso de linkage para análise de completude e concordância de óbitos por sífilis congênita na Região Metropolitana de São Paulo, 2010-2017: estudo descritivo.

OBJECTIVE: To evaluate the completeness and concordance of infant deaths from congenital syphilis in the Metropolitan Region of Sao Paulo, Brazil, between 2010 and 2017. METHODS: This was a descriptive study based on linkage between the Mortality Information System (SIM) and the Live Birth Information System (SINASC). Deaths with mention of congenital syphilis in multiple causes of death were analyzed. The completeness of 11 SIM variables was analyzed and SINASC was adopted as the reference. The Kappa statistic was used to analyze concordance. RESULTS: There were 134 recorded congenital syphilis deaths, 132 of which were linked. 67 had congenital syphilis as the underlying cause, while 65 involved multiple causes of death, indicating underestimated congenital syphilis mortality. After linkage, the number of variables with excellent completeness increased from two to ten. CONCLUSION: Linking SIM with SINASC data improved completeness. The magnitude of congenital syphilis mortality was found to be underestimated, and the use of multiple causes improved its measurement.

Use of linkage to analyze completeness and agreement of deaths from congenital syphilis in the Metropolitan Region of São Paulo, Brazil, 2010-2017: a descriptive study / Uso de vinculación para análisis de completitud y concordancia de muertes por sífilis congénita en la Región Metropolitana de São Paulo, Brasil, 2010-2017: estudio descriptivo / Uso de linkage para análise de completude e concordância de óbitos por sífilis congênita na região metropolitana de São Paulo, 2010-2017: estudo descritivo

Objective: To evaluate the completeness and agreement of infant deaths from congenital syphilis in the Metropolitan Region of Sao Paulo, Brazil, between 2010 and 2017. Methods: Descriptive study based on linkage between Mortality Information System (SIM) and Information System on Live Births (Sinasc). Deaths with mention of congenital syphilis in multiple causes of death were considered. The completeness of 11 SIM variables was analyzed and Sinasc was adopted as reference. Kappa index was used to analyze the agreement. Results: There were 134 deaths by congenital syphilis of which 132 were linked, being 67 as the underlying cause and 65 considering associated causes, indicating underestimation of mortality. After linkage, it increased from two to 10 variables with excellent filling. Conclusion: Linking SIM with Sinasc data improved the completeness. It was identified an underestimation of the magnitude of mortality from congenital syphilis and the use of multiple causes improved its measurement.

Objetivo: Avaliar a completude e concordância dos óbitos infantis por sífilis congênita na região metropolitana de São Paulo, Brasil, no período 2010-2017. Métodos: Estudo descritivo, baseado na vinculação do Sistema de Informações sobre Mortalidade (SIM) com o Sistema de Informações sobre Nascidos Vivos (Sinasc). Foram considerados os óbitos com menção de sífilis congênita nas causas múltiplas de morte. Analisou-se a completude de 11 variáveis do SIM; adotou-se o Sinasc como referência. Para análise da concordância, utilizou-se o índice Kappa. Resultados: Registraram-se 134 óbitos por sífilis congênita; destes, 132 foram vinculados, sendo 67 como causa básica e 65 ao se considerar causas múltiplas de óbito, indicando subestimação da mortalidade. Após linkage, houve aumento de 2 para 10 variáveis com preenchimento excelente. Conclusão: A vinculação do SIM com dados do Sinasc melhorou sua completude. Identificou-se subestimação da magnitude da mortalidade por sífilis congênita, e o uso das causas múltiplas melhorou sua mensuração.

Investigation of SARS-CoV-2 infection in dogs and cats of humans diagnosed with COVID-19 in Rio de Janeiro, Brazil.

BACKGROUND: Infection by SARS-CoV-2 in domestic animals has been related to close contact with humans diagnosed with COVID-19. Objectives: To assess the exposure, infection, and persistence by SARS-CoV-2 of dogs and cats living in the same households of humans that tested positive for SARS-CoV-2, and to investigate clinical and laboratory alterations associated with animal infection. METHODS: Animals living with COVID-19 patients were longitudinally followed and had nasopharyngeal/oropharyngeal and rectal swabs collected and tested for SARS-CoV-2. Additionally, blood samples were collected for laboratory analysis, and plaque reduction neutralization test (PRNT90) to investigate specific SARS-CoV-2 antibodies. RESULTS: Between May and October 2020, 39 pets (29 dogs and 10 cats) of 21 patients were investigated. Nine dogs (31%) and four cats (40%) from 10 (47.6%) households were infected with or seropositive for SARS-CoV-2. Animals tested positive from 11 to 51 days after the human index COVID-19 case onset of symptoms. Three dogs tested positive twice within 14, 30, and 31 days apart. SARS-CoV-2 neutralizing antibodies were detected in one dog (3.4%) and two cats (20%). In this study, six out of thirteen animals either infected with or seropositive for SARS-CoV-2 have developed mild but reversible signs of the disease. Using logistic regression analysis, neutering, and sharing bed with the ill owner were associated with pet infection. CONCLUSIONS: The presence and persistence of SARS-CoV-2 infection have been identified in dogs and cats from households with human COVID-19 cases in Rio de Janeiro, Brazil. People with COVID-19 should avoid close contact with their pets during the time of their illness.

Severe Acute Respiratory Syndrome Coronavirus 2 P.2 Lineage Associated with Reinfection Case, Brazil, June-October 2020.

A 37-year-old healthcare worker from the northeastern region of Brazil experienced 2 clinical episodes of coronavirus disease. Infection with severe acute respiratory syndrome coronavirus 2 was confirmed by reverse transcription PCR in samples collected 116 days apart. Whole-genome sequencing revealed that the 2 infections were caused by the most prevalent lineage in Brazil, B.1.1.33, and the emerging lineage P.2. The first infection occurred in June 2020; Bayesian analysis suggests reinfection at some point during September 14-October 11, 2020, a few days before the second episode of coronavirus disease. Of note, P.2 corresponds to an emergent viral lineage in Brazil that contains the mutation E484K in the spike protein. The P.2 lineage was initially detected in the state of Rio de Janeiro, and since then it has been found throughout the country. Our findings suggest not only a reinfection case but also geographic dissemination of the emerging Brazil clade P.2.

Uso de linkage para análise de completude e concordância de óbitos por sífilis congênita na Região Metropolitana de São Paulo, 2010-2017: estudo descritivo / Uso de linkage para análisis de completitud y concordancia de muertes por sífilis congénita en la Región Metropolitana de São Paulo, Brasil, 2010-2017: estudio descriptivo / Use of linkage to analyze completeness and concordance of deaths from congenital syphilis in the Metropolitan Region of São Paulo, Brazil, 2010-2017: a descriptive study

Objetivo: Avaliar a completude e concordância dos óbitos infantis por sífilis congênita na Região Metropolitana de São Paulo, Brasil, no período 2010-2017. Métodos: Estudo descritivo, baseado na vinculação do Sistema de Informações sobre Mortalidade (SIM) com o Sistema de Informações sobre Nascidos Vivos (Sinasc). Foram considerados os óbitos com menção de sífilis congênita nas causas múltiplas de morte. Analisou-se a completude de 11 variáveis do SIM; adotou-se o Sinasc como referência. Para análise da concordância, utilizou-se o índice Kappa. Resultados: Registraram-se 134 óbitos por sífilis congênita; destes, 132 foram vinculados, sendo 67 como causa básica e 65 ao se considerar causas múltiplas de óbito, indicando subestimação da mortalidade. Após linkage, houve aumento de 2 para 10 variáveis com preenchimento excelente. Conclusão: A vinculação do SIM com dados do Sinasc melhorou sua completude. Identificou-se subestimação da magnitude da mortalidade por sífilis congênita, e o uso das causas múltiplas melhorou sua mensuração.

Objetivo: Evaluar la completitud y concordancia de muertes infantiles por sífilis congénita en la Región Metropolitana de Sao Paulo, Brasil, entre 2010 y 2017. Métodos: Estudio descriptivo basado en el enlace de datos entre el Sistema de Información de Mortalidad (SIM) y el Sistema de Información sobre Nacidos Vivos (Sinasc). Se consideraron muertes con mención de sífilis congénita en múltiples causas de muerte. Se analizó la completitud de 11 variables del SIM y se adoptó el Sinasc como referencia. Se utilizó el índice Kappa para analizar la concordancia. Resultados: Se registraron 134 muertes por SC, de las cuales 132 fueron vinculadas, siendo 67 como causa básica y 65 al considerar causas asociadas, lo que indica subestimación de la mortalidad. Después del linkage, hubo aumento de 2 para 10 variables con excelente completitud. Conclusión: La vinculación del SIM con el Sinasc mejoró la completitud. Se identificó subestimación de la magnitud de mortalidad por sífilis congénita y el uso de múltiples causas mejoró la medición.

Objective: To evaluate the completeness and concordance of infant deaths from congenital syphilis in the Metropolitan Region of Sao Paulo, Brazil, between 2010 and 2017. Methods: This was a descriptive study based on linkage between the Mortality Information System (SIM) and the Live Birth Information System (SINASC). Deaths with mention of congenital syphilis in multiple causes of death were analyzed. The completeness of 11 SIM variables was analyzed and SINASC was adopted as the reference. The Kappa statistic was used to analyze concordance. Results: There were 134 recorded congenital syphilis deaths, 132 of which were linked. 67 had congenital syphilis as the underlying cause, while 65 involved multiple causes of death, indicating underestimated congenital syphilis mortality. After linkage, the number of variables with excellent completeness increased from two to ten. Conclusion: Linking SIM with SINASC data improved completeness. The magnitude of congenital syphilis mortality was found to be underestimated, and the use of multiple causes improved its measurement.

Mortalidade infantil por sífilis congênita na Região Metropolitana de São Paulo / Infant mortality from congenital syphilis in the Metropolitan Region of Sao Paulo

Introdução - A sífilis congênita (SC) é o resultado da transmissão vertical da bactéria Treponema pallidum da gestante infectada, não tratada ou tratada inadequadamente durante o pré-natal, para seu concepto. É uma importante causa de mortalidade infantil evitável através de adequada atenção à mulher na gestação. Objetivo - Analisar a qualidade da informação dos óbitos menores de um ano com menção de SC (códigos da CID-10 de A50.0 a A50.9) na Declaração de Óbito (DO) e as características das mães e dos óbitos na Região Metropolitana de São Paulo (RMSP), no período 2010-2017. Métodos - Estudo observacional, descritivo, baseado na vinculação de dados do Sistema de Informação sobre Mortalidade (SIM) e Sistema de Informação sobre Nascidos Vivos (SINASC). Foram consideradas todas as DO com menção de SC em qualquer das linhas do atestado, de mães residentes na RMSP, entre 2010-2017. Os óbitos foram vinculados aos nascidos vivos por linkage determinístico. Para avaliar a qualidade dos dados, foi analisada a completude das variáveis e a concordância entre as bases do SIM e do SINASC. Para analisar a evolução foi calculada a taxa de mortalidade infantil com menção de SC por 100.000 nascidos vivos, por ano. As características sociodemográficas das mães, histórico gestacional e dos óbitos foram analisadas por meio de frequências e proporções, a partir das variáveis do SINASC. Resultados - Foram encontrados 134 óbitos, menores de um ano, com menção de SC. Na primeira etapa do linkage foram pareados 96 óbitos (71,6%) e na segunda 36 (26,9%). Dois óbitos (1,5%) foram excluídos. Dos 132 óbitos, 87,1% ocorreram no período neonatal, nos quais 67 a SC foi considerada como causa básica. Os demais tiveram como causa básica códigos dos capítulos Algumas Afecções do Período Perinatal (38,6%) e Malformações Congênitas (6,1%). Ao longo do tempo, a taxa de mortalidade infantil por SC aumentou 16,3% ao ano. A vinculação de dados aumentou a qualidade da informação através do maior preenchimento das variáveis. As mães são predominantemente jovens (60,6%), com 8-11 anos de estudo (64,4%), de cor preta/parda (62,9%), sem companheiro (70,5%). O pré-natal teve início tardio para 28,1% das mães e metade realizaram 0-3 consultas. Predominaram óbitos pré-termos (81,1%) e com baixo peso ao nascer (84,1%). Conclusões: Ao longo dos anos houve aumento na taxa de mortalidade infantil por SC na RMSP. É necessário analisar todas as causas preenchidas na DO, pois nem sempre a SC é selecionada como causa básica de morte. A vinculação do SIM e do SINASC melhorou a qualidade da informação aumentando a completude das variáveis. A SC foi mais frequente em populações mais vulneráveis (jovens, de cor preta/parda e sem companheiro). Muitas gestantes tiveram acesso ao pré-natal, o que indica perda de oportunidade de diagnóstico e tratamento adequado da gestante.

Introduction - Congenital syphilis (CS) is the result of vertical transmission of the bacterium Treponema pallidum from an infected pregnant woman, untreated or improperly treated during prenatal care, to her fetus. It is an important cause of preventable infant mortality through adequate care for women during pregnancy. Objective - To analyze the quality of information on infant deaths with a mention of CS (IDC-10 codes from A50.0 to A50.9) in the Death Certificate (DC) and the characteristics of mothers and deaths in the Metropolitan Region of São Paulo (MRSP), in the period 2010-2017. Methods - Observational, descriptive study, based on linking data from the Mortality Information System (SIM) and the Live Birth Information System (SINASC). All DC with a mention of CS were considered in any of the lines of the certificate, of mothers residing in the MRSP, between 2010-2017. Deaths were linked to live births by deterministic linkage. To assess the quality of the data, the completeness of the variables and the agreement between the SIM and SINASC bases were analyzed. To analyze the evolution, the infant mortality rate with mention of CS per 100,000 live births was calculated per year. The mothers' sociodemographic characteristics, gestational history and deaths were analyzed using frequencies and proportions, based on SINASC variables. Results - Were found 134 deaths, under one year old, with mention of CS. In the first stage of the linkage, 96 deaths (71.6%) were paired and in the second 36 (26.9%). Two deaths (1.5%) were excluded. Of the 132 deaths, 87.1% occurred in the neonatal period, in which 67 SC was considered a underlying cause. The others had a underlying cause codes of the chapters Some Conditions of the Perinatal Period (38.6%) and Congenital Malformations (6.1%). Over time, the infant mortality from CS increased 16.3% per year. Linkage increased the quality of the information through the greater filling of the variables. The mothers are predominantly young (60.6%), with 8-11 years of study (64.4%), black/brown (62.9%), without a partner (70.5%). Prenatal care started late for 28.1% of mothers and half had 0-3 consultations. Pre-term deaths (81.1%) and low birth weight (84.1%) predominated. Conclusion - Over the years there has been an increase in the infant mortality from CS in the MRSP. It is necessary to analyze all the causes filled out in the DC, as CS is not always selected as the underlying cause of death. The linking of SIM and SINASC improved the quality of information, increasing the completeness of the variables. CS was more frequent in more vulnerable populations (young, black/brown and without a partner). Many pregnant women had access to prenatal care, which indicates loss of opportunity for diagnosis and adequate treatment of the pregnant woman.

O uso de probióticos na doença periodontal / Use of probiotics in periodontal disease

Objetivo: analisar, através de uma revisão de literatura, o uso de probióticos na doença periodontal. Materiais e métodos: foram pesquisados artigos científicos publicados nos últimos dez anos e referências clássicas abordando o uso de probióticos na Periodontia através dos bancos de dados Medline-Pubmed e Portal de Periódicos Capes. A busca dos artigos incluiu estudos de revisão de literatura e estudos de relato de casos clínicos. Conclusão: esta revisão de literatura não pôde atestar os efeitos benéficos desses micro-organismos em longo prazo, porém, de uma forma geral, houve uma melhoria nos parâmetros clínicos, microbiológicos e imunológicos periodontais. Pesquisas in vivo mais consistentes, através de estudos controlados abordando os principais parâmetros clínicos periodontais, microbiológicos e imunológicos são necessárias para assegurar a eficácia do uso de probióticos como coadjuvantes ao tratamento periodontal.

Objective: to analyze through a literature review the use of probiotics in periodontal disease. Materials and methods: scientific articles published in the last ten years and classic references dealing with the use of probiotics in periodontics were screened the Medline-Pubmed and Portal de Capes journals databases. The articles search included literature review studies and clinical case report studies. Conclusion: this literature review can't state the benefi cial effects of these microorganisms in the long term, but in general there was an improvement in clinical, microbiological and immunological periodontal parameters. More consistent in vivo controlled studies addressing the major periodontal, microbiological and immunological clinical parameters are needed to ensure the efficacy of probiotics as an adjuvant to periodontal treatment.

Proposta de implantação de um catálogo informativo dos cursos oferecidos no Grupo Hospitalar Conceição

O projeto pretende propor a elaboração de um catálogo direcionado aos funcionários do Grupo Hospitalar Conceição, para a divulgação dos cursos oferecidos pela Instituição.

Diferença: condição básica para a constituição do sujeito / Difference: basic condition of individual'st contitution

Este trabalho é um estudo de caso construído em co-autoria na tentativa de compreender os processos subjetivos para o aprendizado e buscar alternativas para a inclusão de crianças no processo educacional. As autoras acompanharam, em uma escola pública, alunos em processo de alfabetização que apresentavam, segundo o estabelecimento, problemas de aprendizagem. Os encontros foram semanais, por um período de sete meses, havendo apenas interrupções durante férias e festividades. A teoria da subjetividade baseada na Epistemologia Qualitativa foi adotada como eixo teórico-metodológico. Embora tenham ocorrido novas produções de sentido pelas crianças sobre o aprendizado, percebeu-se que o espaço social da escola, caracterizado pelo corpo de educadores, conservava a visão preconceituosa em relação à criança. A ênfase continuava a ser dada à dificuldade e à incapacidade, o que não favorecia a mudança nos processos de aprendizagem. Ao longo do texto, as autoras intercalam suas idéias e ações, em um trabalho conjunto.(AU)

This work is a case study of a child's inclusion in educational process during school first years. It aims to discuss alternative ways of psychological evaluation when children are sent from school to a psychology service for diagnosis. Evaluation process attempted to understand children's subjecvity, according to proposition of the subjectivity theory based on the Epistemology Qualitative. Children were seen at school once a week, during seven months, while teachers and parents have been paralelely seen. In the interviews, the focus was in the subjective sense production for learning. At the end of the evaluation process we had found that prejudice against the children was still present among teachers and coordinators. Otherwise, new senses were produced by the children promoting learning and different forms of dealing with writing and reading. The authors exchange their ideas and actions in research field throughout the study.(AU)

Diferença: condição básica para a constituição do sujeito / Difference: basic condition of individual'st contitution

Este trabalho é um estudo de caso construído em co-autoria na tentativa de compreender os processos subjetivos para o aprendizado e buscar alternativas para a inclusão de crianças no processo educacional. As autoras acompanharam, em uma escola pública, alunos em processo de alfabetização que apresentavam, segundo o estabelecimento, problemas de aprendizagem. Os encontros foram semanais, por um período de sete meses, havendo apenas interrupções durante férias e festividades. A teoria da subjetividade baseada na Epistemologia Qualitativa foi adotada como eixo teórico-metodológico. Embora tenham ocorrido novas produções de sentido pelas crianças sobre o aprendizado, percebeu-se que o espaço social da escola, caracterizado pelo corpo de educadores, conservava a visão preconceituosa em relação à criança. A ênfase continuava a ser dada à dificuldade e à incapacidade, o que não favorecia a mudança nos processos de aprendizagem. Ao longo do texto, as autoras intercalam suas idéias e ações, em um trabalho conjunto.

This work is a case study of a child's inclusion in educational process during school first years. It aims to discuss alternative ways of psychological evaluation when children are sent from school to a psychology service for diagnosis. Evaluation process attempted to understand children's subjecvity, according to proposition of the subjectivity theory based on the Epistemology Qualitative. Children were seen at school once a week, during seven months, while teachers and parents have been paralelely seen. In the interviews, the focus was in the subjective sense production for learning. At the end of the evaluation process we had found that prejudice against the children was still present among teachers and coordinators. Otherwise, new senses were produced by the children promoting learning and different forms of dealing with writing and reading. The authors exchange their ideas and actions in research field throughout the study.