Influenza A infections: predictors of disease severity.

Influenza affects approximately 10% of the world's population annually. It is associated with high morbidity and mortality rates due to its propensity to progress to severe acute respiratory infection, leading to 10-40% of hospitalized patients needing intensive care. Characterizing the multifactorial predictors of poor prognosis is essential for developing strategies against this disease. This study aimed to identify predictors of disease severity in influenza A-infected (IFA-infected) patients and to propose a prognostic score. A retrospective cross-sectional study was conducted with 142 IFA-infected out- and inpatients treated at a tertiary hospital between 2010 and 2018. The viral subtypes, hemagglutinin mutations, viral load, IL-28B SNPs, and clinical risk factors were evaluated according to the patient's ICU admission. Multivariate analysis identified the following risk factors for disease severity: neuromuscular diseases (OR = 7.02; 95% CI = 1.18-41.75; p = 0.032), cardiovascular diseases (OR = 5.47; 95% CI = 1.96-15.27; p = 0.001), subtype (H1N1) pdm09 infection (OR = 2.29; 95% CI = 1.02-5.15; p = 0.046), and viral load (OR = 1.43; 95% CI = 1.09-1.88; p = 0.009). The prognosis score for ICU admission is based on these predictors of severity presented and ROC curve AUC = 0.812 (p < 0.0001). Our results identified viral and host predictors of disease severity in IFA-infected patients, yielding a prognostic score that had a high performance in predicting the IFA patients' ICU admission and better results than a viral load value alone. However, its implementation in health services needs to be validated in a broader population.

Recovery of rare earth elements (Nd3+ and Dy3+) by using carbon-based adsorbents from spent tire rubber.

Two samples of spent tire rubber (rubber A and rubber B) were submitted to thermochemical conversion by pyrolysis process. A450, B450 and A900, B900 chars were obtained from rubber A and rubber B at 450 °C and 900 °C, respectively. The chars were then applied as recovery agents of Nd3+ and Dy3+ from aqueous solutions in mono and bicomponent solutions, and their performance was benchmarked with a commercial activated carbon. The chars obtained at 900 °C were the most efficient adsorbents for both elements with uptake capacities around 30 mg g-1. The chars obtained at 450 °C presented uptake capacities similar to the commercial carbon (≈ 11 mg g-1). A900 and B900 chars presented a higher availability of Zn ions that favored the ion exchange mechanism. It was found that Nd3+ and Dy3+ were adsorbed as oxides after Zn was released from silicate structures (Zn2SiO4). A900 char was further selected to be tested with Nd/Dy binary mixtures and it was found a trend to adsorb a slightly higher amount of Dy3+ due to its smaller ionic radius. The uptake capacity in bicomponent solutions was generally higher than for single component solutions due to the higher driving force triggered by the higher concentration gradient.

Impacts of an urban flood control infrastructure on the limnology and ichthyofauna of a basaltic Cuesta stream (southeast Brazil).

Strategies for flood control associated to extreme precipitation events in urban areas are urgent, in order to prevent not only material damages but also to avoid human losses. The construction of flood contention reservoirs ("piscinões") has become a common engineering intervention in urban and peri-urban areas. However, there is a lack of studies focused on the evaluation of environmental impacts of this type of construction. This study intended to verify the ecological effects of a retention reservoir built directly on the course of the Cascata stream, Botucatu (SP). Three sampling sites were selected, located upstream the reservoir, in the reservoir and downstream. Samplings were carried out in July (winter - dry) and November (late spring - rainy) 2020. In situ measurements were obtained through a multiparameter probe (temperature, pH, electrical conductivity, dissolved oxygen, total dissolved solids, and oxidation-reduction potential) and water samples were collected for laboratory determinations (nitrogen, total phosphorus, thermotolerant coliforms, and chlorophyll-a). For fish sampling, manual trawls, sieves and hand nets were used, with a sampling effort of 10 throws per artefact and site. Despite the small distance between the sampling points (~1,300 m) considerable changes in the limnological conditions and fish community structure were observed. The studied environment is originally a small river surrounded by riparian forest, but this characteristic was abruptly changed in the reservoir stretch, with the direct exposition of a much larger water surface to intense solar radiation and atmosphere exchanges. Consequently, as evidenced by the PCA analysis, there was a considerable (stream-reservoir increase) of temperature, dissolved oxygen and chlorophyll. However, this spatial trend was partially disturbed by an accidental sewage-pipe rupture (posteriorly fixed) adjacent to the first sampling point, due to a previous event of extreme precipitation, which resulted in increased values of nutrients, chlorophyll, conductivity and thermotolerant coliforms. Eleven fish species were collected (two non-native), belonging to seven families and five orders. The upstream reference point (despite not be pristine), was characterized by the predominance of native species, while the reservoir condition favored the development of large populations of the non-native species. Despite the urgency of effective actions to prevent floods in urban areas, construction of contention reservoirs directly on stream courses should be avoided, due to their negative ecological impacts.

Backbone NMR resonance assignments for the C terminal domain of the Streptococcus mutans adhesin P1.

Adhesin P1 (aka AgI/II) plays a pivotal role in mediating Streptococcus mutans attachment in the oral cavity, as well as in regulating biofilm development and maturation. P1's naturally occurring truncation product, Antigen II (AgII), adopts both soluble, monomeric and insoluble, amyloidogenic forms within the bacterial life cycle. Monomers are involved in important quaternary interactions that promote cell adhesion and the functional amyloid form promotes detachment of mature biofilms. The heterologous, 51-kD C123 construct comprises most of AgII and was previously characterized by X-ray crystallography. C123 contains three structurally homologous domains, C1, C2, and C3. NMR samples made using the original C123 construct, or its C3 domain, yielded moderately resolved NMR spectra. Using Alphafold, we re-analyzed the P1 sequence to better identify domain boundaries for C123, and in particular the C3 domain. We then generated a more tractable construct for NMR studies of the monomeric form, including quaternary interactions with other proteins. The addition of seven amino acids at the C-terminus greatly improved the spectral dispersion for C3 relative to the prior construct. Here we report the backbone NMR resonance assignments for the new construct and characterize some of its quaternary interactions. These data are in good agreement with the structure predicted by Alphafold, which contains additional ß-sheet secondary structure compared to the C3 domain in the C123 crystal structure for a construct lacking the seven C-terminal amino acids. Its quaternary interactions with known protein partners are in good agreement with prior competitive binding assays. This construct can be used for further NMR studies, including protein-protein interaction studies and assessing the impact of environmental conditions on C3 structure and dynamics within C123 as it transitions from monomer to amyloid form.

Applicability of 'Toolkit for Safety Assessment' tool to interventional radiology using probabilistic risk assessment techniques.

Interventional radiology brings extensive benefits to patients. Nevertheless, certain procedures may result in high doses of radiation, leading to health risks to occupationally exposed individuals (OEIs). Therefore, a more comprehensive risk analysis is essential to ensuring safety and minimising radiation exposures for all OEIs. The Toolkit for Safety Assessment (TOKSA) tool performs risk assessments based on the concepts described in 'General Safety Requirements' Part 3 (Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards) and Part 4 (Safety Assessment for Facilities and Activities). This tool was developed based on the 'Ibero-American Forum of Radiological and Nuclear Regulatory Agencies' risk models and can promote the use of the risk assessment processes by OEIs. The aim of this study was to experimentally analyse the applicability of the TOKSA tool in interventional radiology with the use/support of probabilistic risk assessment techniques. The results were used to reduce the risks associated with a hemodynamics room in a hospital in Belo Horizonte, Brazil.

Cancer risk in healthy patients who underwent chest tomography comparing three different technologies.

This research aimed to estimate the risk of cancer associated with patients without previous disease undergoing chest tomography. Siemens CT scanners have 6, 64, and 128 detectors. The Biologic Effects of Ionizing Radiation Reports - BEIR VII methodology was used. The study presented a sample of 64 patients aged between 18 and 80 years, in the city of Belo Horizonte, Minas Gerais - Brazil. The IMPACT CT software and CalDose X CT Online were used to calculate the absorbed and equivalent dose from the Volumetric Computed Tomography Dose Index - CTDIvol (mGy) and Dose Length Product - DLP values provided by the equipment. CT-Expo Software was also used to estimate Specific Dose Estimates (SSDEs) values. The CTDvol results for the MG1, MG,2 and MG3 Diagnostic Centers in mGy were respectively 4.369 ± 1.352, 6.99 4 ± 1.53,3 and 9.984 ± 2.282 and the SSDE values were 3.800, 6.40,0 and 9,.500. The values for the equivalent dose, at the MG2 Diagnostic Center, by IMPACT CT, in (mSv) for the breasts, esophagus, heart, thyroid, lung and thymus were respectively 3.9, 5.7, 4.7, 1.0, 4.8 and 5.7. The CalDose Software, for the same equipment and the same organs, in mSv, estimated the values 7.4, 9.4, 11.1, 5.3, 10.8 and 11.3 for women and 7.1, 9.3, 11.0, 5.3, 10.2 and 10.9 for men. The estimated risk of cancer decreased according to the patient's age, but with a higher incidence for females. The use of each software must be carefully analyzed to avoid undue values due to the particularities of each one. The results also showed that the risk of developing cancer due to radiation decreases with patient age and is higher in females.

HLA-G expression in Merkel cell carcinoma and the correlation with Merkel cell polyomavirus infection.

Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine cutaneous carcinoma with a high mortality rate. The MCC etiology is not fully understood. Merkel cell-associated polyomavirus (MCPyV) was found in MCC patients, indicating a risk factor for the tumor. Caucasian, elderly, and immunocompromised individuals are more likely to develop this tumor. HLA-G consists of a non-classical class I (Ib) HLA molecule with an immunoregulatory function and was associated with tumor escape in different types of tumors, nonetheless, never been studied in MCC. The purpose of this study was to evaluate the HLA-G expression and also to detect the MCPyV in MCC patients and correlate it with the clinical course of the disease. Forty-five MCC patients were included in a retrospective study. Formalin-fixed paraffin-embedded cutaneous skin biopsies were used by immunohistochemistry and RT-PCR to verify the HLA-G expression and MCPyV infection. HLA-G expression was found in 7 (15.6%), while the presence of MCPyV was detected in 28 (62.2%) of the studied patients. No significant association was found between HLA-G expression and MCPyV infection (p = 0.250). The presence of MCPyV was associated with areas of low sunlight exposure (p = 0.042) and the HLA-G expression with progression to death (p = 0.038). HLA-G expression was detected in MCC patients, as well as the MCPyV presence was confirmed. These markers could represent factors with a possible impact on patient survival; however, further studies with a greater number of patients are needed, to better elucidate the possible role in disease progression.

DIAGNOSTIC REFERENCE LEVELS BASED ON PATIENT BODY MASS INDEX FOR SELECT INTERVENTIONAL PROCEDURES IN MINAS GERAIS/BRAZIL.

This work establishes local diagnostic reference levels (DRLs) in interventional radiology based on adult patient body mass index (BMI). The monitoring was carried out from 23 institutions and patient data from 3015 procedures were collected, being 907 Catheterism (CAT), 921 Percutaneous transluminal coronary angioplasty (PTCA) and 1187 CAT/PTCA and 6 BMI ranges were taken, going from under 18 up to 40 kg·m-2. It is presented that 18 initial DRL values to be used in the county of Minas Gerais. The overall 75th kerma-area product (KAP), commonly considered DRL, in Gy·cm2, is 94.6(SD 119)-CAT, 88.6(SD 121)-PTCA and 33.0(SD 47.6)-CAT/PTCA. In considering KAP-BMI individual values, one obtain the min-max ranges, in Gy·cm2, 3.2-BMI A to 101-BMI B for CAT, 65-BMI A to 102-BMI F for PTCA and 10.4-BMI A to 59.2-BMI E for CAT/PTCA. The KAP-BMI approach has shown to be feasible as a DRL optimization process.

Defining Endocytic Pathways of Fucoidan-Coated PIBCA Nanoparticles from the Design of their Surface Architecture.

PURPOSE: This work investigated the endocytic pathways taken by poly(isobutylcyanoacrylate) (PIBCA) nanoparticles differing in their surface composition and architecture, assuming that this might determine their efficiency of intracellular drug delivery. METHODS: Nanoparticles (A0, A25, A100, R0, R25 ) were prepared by anionic or redox radical emulsion polymerization using mixtures of dextran and fucoidan (0, 25, 100 % in fucoidan). Cell uptake was evaluated by incubating J774A.1 macrophages with nanoparticles. Endocytic pathways were studied by incubating cells with endocytic pathway inhibitors (chlorpromazine, genistein, cytochalasin D, methyl-ß-cyclodextrin and nocodazole) and nanoparticle uptake was evaluated by flow cytometry and confocal microscopy. RESULTS: The fucoidan-coated PIBCA nanoparticles A25 were internalized 3-fold more efficiently than R25 due to the different architecture of the fucoidan chains presented on the surface. Different fucoidan density and architecture led to different internalization pathway preferred by the cells. Large A100 nanoparticles with surface was covered with fucoidan chains in a loop and train configuration were internalized the most efficiently, 47-fold compared with A0, and 3-fold compared with R0 and R25 through non-endocytic energy-independent pathways and reached the cell cytoplasm. CONCLUSION: Internalization pathways of PIBCA nanoparticles by J774A.1 macrophages could be determined by nanoparticle fucoidan surface composition and architecture. In turn, this influenced the extent of internalization and localization of accumulated nanoparticles within cells. The results are of interest for rationalizing the design of nanoparticles for potential cytoplamic drug delivery by controlling the nature of the nanoparticle surface.

Síndrome PURA en una niña con retraso grave del desarrollo: un diagnóstico desafiante / PURA syndrome in a child with severe developmental delay: a challenging diagnosis

Introducción: El síndrome PURA es una condición autosómica dominante poco común causada por variantes patogénicas de novo en el gen PURA y que se caracteriza por un fenotipo multisistémico que incluye retraso del neurodesarrollo global, hipotonía temprana, ausencia de habla, dificultades para alimentarse, hipersomnolencia, epilepsia y trastornos del movimiento. Caso clínico: Presentamos una niña de 9 años con hipotonía y dificultades para alimentarse con retraso del crecimiento desde el período neonatal. A la edad de 3 años era evidente el retraso motor e intelectual, tenía una marcha de base amplia, no hablaba y una respuesta de sobresalto acústico exagerada. Desarrolló estereotipias de mano-boca y epilepsia a los 6 años. La monitorización electroencefalográfica continua de 24 horas reveló una actividad lenta global y una actividad epileptiforme frecuente en las áreas temporal izquierda y centrotemporal. La resonancia magnética del cerebro reveló un retraso en la mielinización. A los 6 años, la secuenciación clínica del exoma identificó una variante patógena heterocigótica en el gen PURA, c.153delA p. (Leu54CysfsTer24). Conclusión: El síndrome PURA tiene características clínicas similares a otros trastornos neurológicos, pero la asociación con algunas características clínicas, no tan comunes en otras entidades neurológicas, como no poder hablar, pero poder seguir órdenes simples, y una respuesta de sobresalto acústico exagerado, deben ser factores de sospecha de síndrome PURA y servir para realizar un análisis genético para confirmar el diagnóstico y proporcionar una intervención multidisciplinar precoz.(AU)

Introduction: PURA syndrome is a rare autosomal dominant condition caused by de novo pathogenic variants in PURA gene and characterized by a multisystemic phenotype that includes global neurodevelopmental delay, early hypotonia, absence of speech, feeding difficulties, hypersomnolence, epilepsy and movement disorders. Case report: We report a 9-year-old girl with hypotonia and feeding difficulties with failure to thrive since the neonatal period. At the age of 3 years motor and intellectual delay were evident, she had a wide-based gait, no speech and an exaggerated acoustic startle response. She developed hand-mouthing stereotypies and epilepsy at 6 years old. The 24 hours continuous electroencephalogram monitoring revealed global slow activity and frequent epileptiform activity in left temporal and centrotemporal areas. The brain MRI revealed delayed myelination. At 6 years old the clinical exome sequencing identified a heterozygous pathogenic variant in the PURA gene, c.153delA p.(Leu54CysfsTer24). Conclusion: PURA syndrome has clinical features similar to other neurological disorders but the association with some clinical features, not as common in other neurological entities, like never being able to speak but being able to follow simple orders and exaggerated acoustic startle response, should raise the suspicion of PURA syndrome and genetic analysis must be performed to confirm the diagnosis and provide early multidisciplinary intervention.(AU)

PURA syndrome in a child with severe developmental delay: a challenging diagnosis. / Síndrome PURA en una niña con retraso grave del desarrollo: un diagnóstico desafiante.

INTRODUCTION: PURA syndrome is a rare autosomal dominant condition caused by de novo pathogenic variants in PURA gene and characterized by a multisystemic phenotype that includes global neurodevelopmental delay, early hypotonia, absence of speech, feeding difficulties, hypersomnolence, epilepsy and movement disorders. CASE REPORT: We report a 9-year-old girl with hypotonia and feeding difficulties with failure to thrive since the neonatal period. At the age of 3 years motor and intellectual delay were evident, she had a wide-based gait, no speech and an exaggerated acoustic startle response. She developed hand-mouthing stereotypies and epilepsy at 6 years old. The 24 hours continuous electroencephalogram monitoring revealed global slow activity and frequent epileptiform activity in left temporal and centrotemporal areas. The brain MRI revealed delayed myelination. At 6 years old the clinical exome sequencing identified a heterozygous pathogenic variant in the PURA gene, c.153delA p.(Leu54CysfsTer24). CONCLUSION: PURA syndrome has clinical features similar to other neurological disorders but the association with some clinical features, not as common in other neurological entities, like never being able to speak but being able to follow simple orders and exaggerated acoustic startle response, should raise the suspicion of PURA syndrome and genetic analysis must be performed to confirm the diagnosis and provide early multidisciplinary intervention.

TITLE: Síndrome PURA en una niña con retraso grave del desarrollo: un diagnóstico desafiante.Introducción. El síndrome PURA es una condición autosómica dominante poco común causada por variantes patogénicas de novo en el gen PURA y que se caracteriza por un fenotipo multisistémico que incluye retraso del neurodesarrollo global, hipotonía temprana, ausencia de habla, dificultades para alimentarse, hipersomnolencia, epilepsia y trastornos del movimiento. Caso clínico. Presentamos una niña de 9 años con hipotonía y dificultades para alimentarse con retraso del crecimiento desde el período neonatal. A la edad de 3 años era evidente el retraso motor e intelectual, tenía una marcha de base amplia, no hablaba y una respuesta de sobresalto acústico exagerada. Desarrolló estereotipias de mano-boca y epilepsia a los 6 años. La monitorización electroencefalográfica continua de 24 horas reveló una actividad lenta global y una actividad epileptiforme frecuente en las áreas temporal izquierda y centrotemporal. La resonancia magnética del cerebro reveló un retraso en la mielinización. A los 6 años, la secuenciación clínica del exoma identificó una variante patógena heterocigótica en el gen PURA, c.153delA p. (Leu54CysfsTer24). Conclusión. El síndrome PURA tiene características clínicas similares a otros trastornos neurológicos, pero la asociación con algunas características clínicas, no tan comunes en otras entidades neurológicas, como no poder hablar, pero poder seguir órdenes simples, y una respuesta de sobresalto acústico exagerado, deben ser factores de sospecha de síndrome PURA y servir para realizar un análisis genético para confirmar el diagnóstico y proporcionar una intervención multidisciplinar precoz.

Nationwide surveillance system to evaluate hospital-acquired COVID-19 in Brazilian hospitals.

BACKGROUND: Although the risk of SARS-CoV-2 transmission within hospitals has been well recognized, there is a paucity of data on its occurrence. Our aim was to report the incidence of hospital-acquired (HA) COVID-19 at Brazilian hospitals. METHODS: We investigated the incidence of HA COVID-19 in Brazilian hospitals using data from a national surveillance system, from August 2020 through September 2021. Definitions of HA COVID-19 were: (1) symptom onset >14 days after hospital admission plus a positive SARS-CoV-2 RNA or antigen test; (2) symptom onset on days 8-14 after admission, plus a positive SARS-CoV-2 RNA or antigen test positive, plus documented high-risk exposure. We performed descriptive analyses and reported HA COVID-19 rates using pooled mean and percentile distribution. RESULTS: A total of 48,634 cases of HA COVID-19 were reported from 1428 hospitals. Incidence ranged from 0.16/1000 patient-days at neonatal intensive care units (ICUs) to 5.8/1000 patient-days at adult ICUs. The highest incidence of HA COVID-19 was during the months March to July 2021, similar to that which was observed for community-acquired COVID-19. CONCLUSIONS: This report provides a national view of the burden of HA COVID-19. The highest incidence of HA COVID-19 similar that which was observed for community-acquired COVID-19. We believe that this reflects the difficulty of implementing preventive measures. Further studies evaluating risk factors for the hospital transmission of SARS-Cov-2 should clarify strategies to minimize the risk of HA COVID-19 and may be applicable to other respiratory diseases. Furthermore, the implementation of a national system to evaluate HA COVID-19 has the potential to shine a light on this problem and lead to interventions in each hospital.

Dupilumab for atopic dermatitis: a real-world Portuguese multicenter retrospective study.

INTRODUCTION: Atopic dermatitis (AD) is a difficult-to-treat inflammatory skin disease with a high impact on patients' quality of life. Dupilumab, an IL-4 and IL-13 inhibitor, was the first monoclonal antibody approved for the treatment of moderate-to-severe AD and is currently approved in patients aged 6 or older. METHODS: This is a nationwide, multicenter, retrospective, 48-week study designed by the Portuguese Group of AD to assess real-world efficacy and safety of dupilumab for the treatment of AD. RESULTS: A total of 169 patients were enrolled, with a mean disease duration of 22.75 (±11.98) years. The percentage of patients achieving an improvement of at least 75% in Eczema Area and Severity Index (EASI) compared to baseline (EASI75 response) at weeks 12 and 48 was 67.6% and 74.1%, respectively. In the same timepoints, 25.0% and 44.1% achieved an EASI90 response. Patient-reported outcome measures also improved throughout the study period. Regarding safety, 32.0% of the patients developed adverse events, with conjunctivitis (26.6%), persistent facial erythema (4.7%), and arthritis/arthralgia (3.6%) as the more frequently reported. CONCLUSION: Data from real-world populations are crucial to guide clinicians in their daily decisions. This study provides data demonstrating that dupilumab is an effective and safe therapeutic option for AD.

Standardization of a high-performance RT-qPCR for viral load absolute quantification of influenza A.

Influenza is an acute viral infectious respiratory disease worldwide, presenting in different clinical forms, from influenza-like illness (ILI) to severe acute respiratory infection (SARI). Although real-time quantitative polymerase chain reaction (qPCR) is already an important tool for both diagnosis and treatment monitoring of several viral infections, the correlation between the clinical aspects and the viral load of influenza is still unclear. This lack of clarity is primarily due to the low accuracy and reproducibility of the methodologies developed to quantify the influenza virus. Thus, this study aimed to develop and standardize a universal absolute quantification for influenza A by reverse transcription-quantitative PCR (RT-qPCR), using a plasmid DNA. The assay showed efficiency (Eff%) 98.6, determination coefficient (R2) 0.998, linear range 10^1 to 10^10, limit of detection (LOD) 6.77, limit of quantification (LOQ) 20.52 copies/reaction. No inter and intra assay variability was shown, and neither was the matrix effect observed. Serial measurements of clinical samples collected at a 72h interval showed no change in viral load. By contrast, immunocompetent patients have a significantly lower viral load than immunosuppressed ones. Absolute quantification in clinical samples showed some predictors associated with increased viral load: (H1N1)pdm09 (0.045); women (p = 0.049) and asthmatics (p = 0.035). The high efficiency, precision, and previous performance in clinical samples suggest the assay can be used as an accurate universal viral load quantification of influenza A. Its applicability in predicting severity and response to antivirals needs to be evaluated.

HLA-G expression in Merkel cell carcinoma and the correlation with Merkel cell polyomavirus infection

Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine cutaneous carcinoma with a high mortality rate. The MCC etiology is not fully understood. Merkel cell-associated polyomavirus (MCPyV) was found in MCC patients, indicating a risk factor for the tumor. Caucasian, elderly, and immunocompromised individuals are more likely to develop this tumor. HLA-G consists of a non-classical class I (Ib) HLA molecule with an immunoregulatory function and was associated with tumor escape in different types of tumors, nonetheless, never been studied in MCC. The purpose of this study was to evaluate the HLA-G expression and also to detect the MCPyV in MCC patients and correlate it with the clinical course of the disease. Forty-five MCC patients were included in a retrospective study. Formalin-fixed paraffin-embedded cutaneous skin biopsies were used by immunohistochemistry and RT-PCR to verify the HLA-G expression and MCPyV infection. HLA-G expression was found in 7 (15.6%), while the presence of MCPyV was detected in 28 (62.2%) of the studied patients. No significant association was found between HLA-G expression and MCPyV infection (p = 0.250). The presence of MCPyV was associated with areas of low sunlight exposure (p = 0.042) and the HLA-G expression with progression to death (p = 0.038). HLA-G expression was detected in MCC patients, as well as the MCPyV presence was confirmed. These markers could represent factors with a possible impact on patient survival; however, further studies with a greater number of patients are needed, to better elucidate the possible role in disease progression.

Cardiomiopatia hipertrófica apical x infarto apical: strain longitudinal ou ressonância magnética? / Apical hypertrophic cardiomyopathy vs. apical infarction: longitudinal strain or MRI?

INTRODUÇÃO: A cardiomiopatia hipertrófica apical (CMHA) ou síndrome de Yamaguchi é uma condição relativamente rara, que apresenta acometimento predominante da região apical do ventrículo esquerdo (VE). O Ecocardiograma com strain nesta condição apresenta uma redução no ápice bem semelhante à imagem obtida no Infarto Apical. Descrevemos um caso onde as duas condições estavam presentes. (Figuras 1 -4) RELATO DE CASO: Masculino, de 78 anos, previamente hipertenso, procurou o pronto socorro por dor precordial teve o diagnóstico de infarto sem supra do segmento ST. Seu eletrocardiograma evidenciava ondas T profundas na parede anterior e lateral. Submetido à estratificação invasiva, sendo evidenciada coronária direita (CD) ocluída no terço proximal (CD), com circulação colateral presente e lesão grave em terço proximal de artéria circunflexa (Cx). Foi submetido à angioplastia com stent farmacológico na CX. Um mês após o evento coronariano agudo, o paciente retorna ao serviço referindo persistência de dor precordial, semelhante ao quadro anterior. Mantinha-se em uso de dupla antiagregação plaquetária, de modo que foi optado por nova estratificação invasiva, que revelou as mesmas lesões previamente citadas, com stent farmacológico em Cx apresentando fluxo TIMI 3. Ao ECO com strain, evidenciou-se aumento isolado da espessura da região apical do VE, medindo 15mm, com contratilidade miocárdica preservada nesta região, redução do strain global de 11.2% e área de redução muito acentuada sugerindo fibrose nessa mesma região poupando as demais paredes. Neste momento, não foi possível a determinação da causa da redução do strain apical, se IAM, Takotsubo ou CMH. A ressonância magnética cardíaca (RMC) com estresse com dipiridamol observou hipertrofia miocárdica assimétrica apical com carga fibrótica de 16% e presença de isquemia miocárdica em segmentos inferosseptal e inferior medioapical, além de realce tardio de padrão não coronariano acometendo a porção apical do VE, com fração de ejeção de 66%. CONCLUSÃO: A identificação da etiologia da fibrose apical só foi possível com a ressonância magnética, que deixou claro ser decorrente da CMHA, já que o padrão de realce era não coronariano. Ao estresse com Dipiridamol, evidenciou isquemia na parede inferior e inferosseptal medioapical determinando que a dor precordial tinha como causa a circulação colateral insuficiente da CD. Concluímos pela necessidade do diagnóstico ser multimodalidades de imagem, com resultados mais conclusivos com RMC.