Multiple myeloma and Chagas disease: qPCR as a marker for preemptive antiparasitic therapy: a case reports series and review.

Multiple myeloma (MM) associated with Chagas disease is rarely described. This disease and its therapy suppress T cell and macrophage functions and increase regulatory T cell function, allowing the increase of parasitemia and the risk of Chagas Disease Reactivation (CDR). We aimed to analyze the role of conventional (cPCR) and quantitative Polymerase Chain Reaction (qPCR) for prospective monitoring of T. cruzi parasitemia, searching for markers of preemptive antiparasitic therapy in MM patients with Chagas disease. Moreover, we investigated the incidence and management of hematological diseases and CDR both inside and outside the transplant setting in the MEDLINE database. We found 293 studies and included 31 of them. Around 1.9-2.0% of patients with Chagas disease were reported in patients undergoing Stem Cell Transplantation. One case of CDR was described in eight cases of MM and Chagas disease. We monitored nine MM and Chagas disease patients, seven under Autologous Stem Cell Transplantation (ASCT), during 44.56±32.10 months (mean±SD) using parasitological methods, cPCR, and qPCR. From these patients, three had parasitemia. In the first, up to 256 par Eq/mL were detected, starting from 28 months after ASCT. The second patient dropped out and died soon after the detection of 161.0 par Eq/mL. The third patient had a positive blood culture. Benznidazole induced fast negativity in two cases; followed by notably lower levels in one of them. Increased T. cruzi parasitemia was related to the severity of the underlying disease. We recommend parasitemia monitoring by qPCR for early introduction of preemptive antiparasitic therapy to avoid CDR.

Quantitative PCR as a marker for preemptive therapy and its role in therapeutic control in Trypanosoma cruzi/HIV coinfection.

BACKGROUND: Trypanosoma cruzi and HIV coinfection can evolve with depression of cellular immunity and increased parasitemia. We applied quantitative PCR (qPCR) as a marker for preemptive antiparasitic treatment to avoid fatal Chagas disease reactivation and analyzed the outcome of treated cases. METHODOLOGY: This mixed cross-sectional and longitudinal study included 171 Chagas disease patients, 60 coinfected with HIV. Of these 60 patients, ten showed Chagas disease reactivation, confirmed by parasites identified in the blood, cerebrospinal fluid, or tissues, 12 exhibited high parasitemia without reactivation, and 38 had low parasitemia and no reactivation. RESULTS: We showed, for the first time, the success of the timely introduction of benznidazole in the non-reactivated group with high levels of parasitemia detected by qPCR and the absence of parasites in reactivated cases with at least 58 days of benznidazole. All HIV+ patients with or without reactivation had a 4.0-5.1 higher chance of having parasitemia than HIV seronegative cases. A positive correlation was found between parasites and viral loads. Remarkably, treated T. cruzi/HIV-coinfected patients had 77.3% conversion from positive to negative parasitemia compared to 19.1% of untreated patients. Additionally, untreated patients showed ~13.6 times higher Odds Ratio of having positive parasitemia in the follow-up period compared with treated patients. Treated and untreated patients showed no differences regarding the evolution of Chagas disease. The main factors associated with all-cause mortality were higher parasitemia, lower CD4 counts/µL, higher viral load, and absence of antiretroviral therapy. CONCLUSION: We recommend qPCR prospective monitoring of T. cruzi parasitemia in HIV+ coinfected patients and point out the value of pre-emptive therapy for those with high parasitemia. In parallel, early antiretroviral therapy introduction is advisable, aiming at viral load control, immune response restoration, and increasing survival. We also suggest an early antiparasitic treatment for all coinfected patients, followed by effectiveness analysis alongside antiretroviral therapy.

Multiple myeloma and Chagas disease: qPCR as a marker for preemptive antiparasitic therapy: a case reports series and review

ABSTRACT Multiple myeloma (MM) associated with Chagas disease is rarely described. This disease and its therapy suppress T cell and macrophage functions and increase regulatory T cell function, allowing the increase of parasitemia and the risk of Chagas Disease Reactivation (CDR). We aimed to analyze the role of conventional (cPCR) and quantitative Polymerase Chain Reaction (qPCR) for prospective monitoring of T. cruzi parasitemia, searching for markers of preemptive antiparasitic therapy in MM patients with Chagas disease. Moreover, we investigated the incidence and management of hematological diseases and CDR both inside and outside the transplant setting in the MEDLINE database. We found 293 studies and included 31 of them. Around 1.9-2.0% of patients with Chagas disease were reported in patients undergoing Stem Cell Transplantation. One case of CDR was described in eight cases of MM and Chagas disease. We monitored nine MM and Chagas disease patients, seven under Autologous Stem Cell Transplantation (ASCT), during 44.56±32.10 months (mean±SD) using parasitological methods, cPCR, and qPCR. From these patients, three had parasitemia. In the first, up to 256 par Eq/mL were detected, starting from 28 months after ASCT. The second patient dropped out and died soon after the detection of 161.0 par Eq/mL. The third patient had a positive blood culture. Benznidazole induced fast negativity in two cases; followed by notably lower levels in one of them. Increased T. cruzi parasitemia was related to the severity of the underlying disease. We recommend parasitemia monitoring by qPCR for early introduction of preemptive antiparasitic therapy to avoid CDR.

Risco de Desenvolvimento de Lesão em Decorrência de Posicionamento Cirúrgico: Estudo Observacional / Risk of Injury Development Due to Surgical Positioning: an Observational Study / Riesgo de Desarrollo de Lesiones Debido al Posicionamiento Quirúrgico: Estudio Observacional

Objetivo:Classificar o risco de desenvolvimento de lesão por posicionamento cirúrgico. Método: Estudo observacional, longitudinal, prospectivo, de abordagem quantitativa realizado em hospital público, com 135 pacientes submetidos à cirurgia eletiva. Utilizaram-se instrumentos contendo caracterização sociodemográfica, clínica e cirúrgica e escala de avaliação de risco para desenvolvimento de lesões decorrentes do posicionamento cirúrgico. Empregaram-se análise descritiva, teste exato de Fisher ou teste χ2 e a medida de associação odds ratio, conforme apropriado. Resultados: A maioria dos participantes era do sexo masculino (51,11%), adulta (52,59%) e foi classificada como maior risco para o desenvolvimento de lesões por posicionamento cirúrgico (51,85%). Ser idoso, hipertensão, diabetes mellitus e cirurgias urológicas foram estatisticamente significativos (p < 0,05) para maior risco de desenvolvimento de lesões. A incidência de lesão por pressão foi de 0,74%, com observação apenas na região sacra. Conclusão: Verificou-se maior risco para desenvolvimento de lesão em decorrência do posicionamento cirúrgico e baixa incidência de lesão por pressão. A enfermagem perioperatória deve incorporar à prática assistencial ferramentas validadas de mensuração de risco para um cuidado seguro, individualizado e de qualidade aos pacientes cirúrgicos.

Objective:To classify the risk of developing injury due to surgical positioning. Method: Observational, longitudinal, prospective study with a quantitative approach carried out in a public hospital, with 135 patients undergoing elective surgery. Instruments containing sociodemographic, clinical, and surgical characteristics and a risk assessment scale for the development of injuries due to surgical positioning were used. Descriptive analysis, Fisher's exact test or χ2 test and odds ratio association measure were used as appropriate. Results: Most participants were male (51.11%), adults (52.59%) and were classified as having a higher risk for developing injuries due to surgical positioning (51.85%). Elderly, hypertension, diabetes mellitus and urological surgeries were statistically significant (p < 0.05) for a higher risk of developing lesions. The incidence of pressure injuries was 0.74%, with observation only in the sacral region. Conclusion: There was a greater risk of developing lesions due to surgical positioning and low incidence of pressure injury. Perioperative nursing should incorporate validated risk measurement tools into care practice for safe, individualized and quality care for surgical patients,

Objetivo:Clasificar el riesgo de desarrollar lesión por posicionamiento quirúrgico. Método: Estudio observacional, longitudinal, prospectivo, con abordaje cuantitativo, realizado en un hospital público, con 135 pacientes sometidos a cirugía electiva. Se utilizaron instrumentos que contenían características sociodemográficas, clínicas y quirúrgicas y una Escala de Evaluación de Riesgo para el Desarrollo de Lesiones por Posicionamiento Quirúrgico. Se utilizó el análisis descriptivo, la prueba exacta de Fisher, o chi-cuadrado y la medida de asociación odds ratio, según corresponda. Resultados: La mayoría de los participantes eran hombres (51,11 %), adultos (52,59 %) y se clasificaron con mayor riesgo de desarrollar lesiones debido al posicionamiento quirúrgico (51,85 %). Ancianos, hipertensión, diabetes mellitus y cirugías urológicas fueron estadísticamente significativos (p ˂ 0,05) para mayor riesgo de desarrollar lesiones. La incidencia de lesiones por presión fue del 0,74%, observándose solo en la región sacra. Conclusión: Hubo un mayor riesgo de desarrollar lesiones debido al posicionamiento quirúrgico y una baja incidencia de lesión presión. La enfermería perioperatoria debe incorporar herramientas validadas de medición del riesgo en la práctica asistencial para una atención segura, individualizada y de calidad a los pacientes quirúrgicos.

Assessment of biomarkers and clinical parameters as predictors of survival in patients with chagasic heart failure.

BACKGROUND: Chagas disease, endemic in Latin America and spreading globally due to emigration, has a significant health burden, particularly in relation to chagasic heart failure (HF). Chagasic cardiomyopathy (CCM) is characterized by chronic inflammatory myocardial disease. This study aimed to identify inflammatory parameters and biomarkers that could aid in the management of patients with chagasic HF. METHODS AND FINDINGS: A cohort study was conducted at a tertiary cardiology single-center over a mean follow-up period of 2.4 years. The study included patients with HF secondary to CCM enrolled between October 2013 and July 2017. Various clinical parameters, echocardiography findings, parasitemia status, brain natriuretic peptide (BNP) and troponin T (TnT) levels, and inflammatory biomarkers (IL-6, IL-10, IL-12p70, IL-17A, adiponectin, and IFN-γ) were assessed. The study encompassed a cohort of 103 patients, with a median age of 53 years and 70% being male. The left ventricular ejection fraction (LVEF) was 28%, with 40% of patients classified as NYHA II functional class. The median BNP level was 291 pg/ml. The observed mortality rate during the study period was 38.8%. Predictors of lower survival were identified as elevated levels of BNP, TnT, reduced LVEF, and increased adiponectin (thresholds: BNP > 309 pg/ml, TnT > 27.5 ng/ml, LVEF < 25.5%, adiponectin > 38 µg/mL). Notably, there was no evidence indicating a relationship between parasitemia and the inflammatory parameters with lower survival in these patients, including INF-γ, IL-6, IL-10, IL12-(p70), and IL17a. CONCLUSION: Despite the presence of a chronic inflammatory process, the evaluated inflammatory biomarkers in this cohort were not predictive of survival in patients with chagasic HF with reduced ejection fraction (HFrEF). However, reduced LVEF, elevated BNP, adiponectin levels, and troponin T were identified as predictors of lower survival in these patients.

Seasonality of sporotrichosis in Brazil: A modelled analysis of the epidemic in São Paulo, 2011-2020.

BACKGROUND: Sporotrichosis is an endemic subcutaneous mycosis classically caused by the Sporothrix schenckii species complex. Recently, sporotrichosis has emerged in Brazil as a cat-transmitted epidemic caused by a new species, Sporothrix brasiliensis. OBJECTIVES: To survey the clinical-epidemiological profile of all sporotrichosis cases diagnosed between 2011 and 2020 at a reference hospital in São Paulo metropolitan area and evaluate the annual distribution of cases in relation to seasonality. METHODS: Patients' demographic and clinical-epidemiological data were surveyed. A generalized linear model was fitted to relate the quarterly number of sporotrichosis cases detected between 2015 and 2019 with precipitation and temperature series. Prediction of the number of cases from 2011 to 2014 was attempted based on the fitted model without the trend component that appears from 2015. RESULTS: Among 271 suspected cases admitted during 2011-2020, 254 were confirmed by fungal isolation and/or clinical-epidemiological criteria. We observed that 2015 onwards the number of cases regularly increased during Autumn and Winter, the driest and coldest stations of the year. We verified that temperature series affected the number of cases (p = .005) because an increase of 1°C in the temperature series was associated with a 14.24% decrease in the average cases number, with the average number of cases increasing by 10.96% (p < .0001) every quarter, corresponding to an annual increase of 52%. Between 2011 and 2014, the predicted number of sporotrichosis cases averaged 10-12 per year, with 33%-38% occurring in the winter. CONCLUSION: We hypothesize that sporotrichosis seasonality is associated with the felines' oestrus cycle, which may provide alternative, cat-directed approaches to the sporotrichosis epidemic control.

Factors interfering with the production of Histoplasma capsulatum antigens / Fatores que interferem na produção de antígenos de Histoplasma capsulatum

Histoplasma capsulatum causes systemic mycosis that depends on host susceptibility, fungal virulence, and factors associated with the infectious process. We evaluated the possible interference of the phenotype of 12 samples of H. capsulatum isolated from HIV-positive and negative patients in obtaining antigens, aiming at the serological diagnosis through the gender-specific recognition of the H and M fractions. The antigens were evaluated by double immunodiffusion against H. capsulatum anti-antigen polyclonal antibody and serum samples from patients with histoplasmosis.The phenotypic evaluation revealed differences in the identification of the fungal agent and in the expression of H and M antigens, considered serological markers of the disease, associated with pigmentation and the production of conidia. It was found that antigenic preparations obtained from H. capsulatum isolated from HIV-positive patients may have satisfactory antigenic capacity. The patient's immune status does not seem to interfere with the expression of antigenic proteins secreted by H. capsulatum. However, we suggest that prolonged use of antiretrovirals drugs or steroids can cause important phenotypic alterations. We showed that some fungal samples from patients with a long history of immunosuppressive drugs produced atypical cellular elements and low reactivity against the H and M fractions. (AU)

Histoplasma capsulatum causa micose sistêmica endêmica que depende da suscetibilidade do hospedeiro, da virulência fúngica e de fatores associados ao processo infeccioso. Avaliamos a possível interferência do fenótipo de 12 amostras de H. capsulatumisolados de pacientes HIV positivos e negativos na obtenção de antígenos, visando o diagnóstico sorológico por meio do reconhecimento gênero-específico das frações H e M. Os antígenos foram avaliados por imunodifusão dupla, frente a anticorpo policlonal anti-antígeno de H. capsulatum e frente a amostras de soro de pacientes com histoplasmose. A avaliação fenotípica revelou diferenças, não só na identificação do agente fúngico, mas também na expressão dos antígenos H e M, considerados marcadores sorológicos da doença, associados à pigmentação e produção de conídios. Verificou-se que preparações antigênicas obtidas de H. capsulatum isoladas de pacientes HIV positivos podem ter capacidade antigênica satisfatória. O estado imunológico do paciente parece não interferir na expressão de proteínas antigênicas secretadas por H. capsulatum. No entanto, sugerimos que o uso prolongado de antirretrovirais e/ou esteróides pode causar alterações fenotípicas importantes. Verificou-se que algumas amostras fúngicas isoladas de pacientes com longo histórico de uso de imunossupressores produziram elementos celulares atípicos e baixa reatividade sorológica contra as frações H e M de H. capsulatum. (AU)

Comparative analysis of diagnostic methods for the detection of Cryptococcus neoformans meningitis.

BACKGROUND: Cryptococcosis is a devastating opportunistic infection in immunocompromised individuals, primarily in people living with HIV/AIDS. This study evaluated a protocol for the early diagnosis of meningitis due to C. neoformans, utilizing established molecular techniques from serum and CSF samples. METHODS: The 18S and 5.8S (rDNA-ITS) sequence-specific nested PCR assays were compared with direct India ink staining and the latex agglutination test for detection of C. neoformans in serum and cerebrospinal fluid (CSF) from 49 Brazilian suspected meningitis patients. Results were validated with samples obtained from 10 patients negative for cryptococcosis and HIV, and by analysis of standard C. neoformans strains. PRINCIPAL FINDINGS: The 5.8S DNA-ITS PCR was more sensitive (89-100%) and specific (100%) than the 18S rDNA PCR and conventional tests (India ink staining and latex agglutination) for identification of C. neoformans. While the 18S PCR exhibited a sensitivity (72%) similar to that of the latex agglutination assay in serum samples, it was superior to the latex agglutination assay when testing CSF, with a sensitivity of 84%. However, the latex agglutination was superior to the 18SrDNA PCR in specificity in CSF (92%). The 5.8S DNA-ITS PCR yielded the highest levels of accuracy (96-100%) of any test for detection (serological and mycological) of C. neoformans in both serum and CSF. CONCLUSION: Use of the nested 5.8S PCR was superior to other techniques for the diagnosis of cryptococcosis. The possibility of using serum, a non-invasively collected material, in a targeted 5.8S PCR analysis to identify Cryptococcus spp. is recommended, especially in immunosuppressed patients. Our results indicate that nested 5.8S PCR can increase the diagnostic capability of cryptococcosis, and we suggest its use to monitor patients in the future.

Detection of Trypanosoma cruzi DTUs TcI and TcIV in two outbreaks of orally-transmitted Chagas disease in the Northern region of Brazil.

This study describes the laboratory investigation of two acute Chagas disease outbreaks that occurred in the riverside communities of Marimarituba and Cachoeira do Arua, in the Santarem municipality, Para State, located in the Northern region of Brazil, and occurred in March 2016 and August 2017, respectively. The generation of data regarding the diversity of Trypanosoma cruzi parasites circulating in the Amazon region is key for understanding the emergence and expansion of Chagas disease. This study aimed to identify T. cruzi Discrete Typing Units (DTUs) involved in two outbreaks of acute Chagas disease (ACD) directly from the patient's biological sample. Nested and multiplex PCR targeting the 24Sα (rRNA) and mini-exon genes, respectively, were used to identify T. cruzi DTU in blood samples from patients diagnosed with ACD. The samples with positive cPCR were submitted for analysis for T. cruzi DTUs, which included 13 samples from the patients with ACD by oral transmission and two samples collected from two newborns of two women with ACD, from Marimarituba and Cachoeira do Arua. The samples were classified as T. cruzi TcIV, from Marimarituba's outbreak, and T. cruzi TcI, from Cachoeira do Arua's outbreak. The molecular identification of T. cruzi may increase understanding of the role of this parasite in Chagas disease's emergence within the Amazon region, contributing to the improvement of the management of this important, but also neglected, disease.

Detection of Trypanosoma cruzi DTUs TcI and TcIV in two outbreaks of orally-transmitted Chagas disease in the Northern region of Brazil

ABSTRACT This study describes the laboratory investigation of two acute Chagas disease outbreaks that occurred in the riverside communities of Marimarituba and Cachoeira do Arua, in the Santarem municipality, Para State, located in the Northern region of Brazil, and occurred in March 2016 and August 2017, respectively. The generation of data regarding the diversity of Trypanosoma cruzi parasites circulating in the Amazon region is key for understanding the emergence and expansion of Chagas disease. This study aimed to identify T. cruzi Discrete Typing Units (DTUs) involved in two outbreaks of acute Chagas disease (ACD) directly from the patient's biological sample. Nested and multiplex PCR targeting the 24Sα (rRNA) and mini-exon genes, respectively, were used to identify T. cruzi DTU in blood samples from patients diagnosed with ACD. The samples with positive cPCR were submitted for analysis for T. cruzi DTUs, which included 13 samples from the patients with ACD by oral transmission and two samples collected from two newborns of two women with ACD, from Marimarituba and Cachoeira do Arua. The samples were classified as T. cruzi TcIV, from Marimarituba's outbreak, and T. cruzi TcI, from Cachoeira do Arua's outbreak. The molecular identification of T. cruzi may increase understanding of the role of this parasite in Chagas disease's emergence within the Amazon region, contributing to the improvement of the management of this important, but also neglected, disease.

Oral administration of buparvaquone nanostructured lipid carrier enables in vivo activity against Leishmania infantum.

Leishmaniasis, a neglected tropical disease, is prevalent in 98 countries with the occurrence of 1.3 million new cases annually. The conventional therapy for visceral leishmaniasis requires hospitalization due to the severe adverse effects of the drugs, which are administered parenterally. Buparvaquone (BPQ) showed in vitro activity against leishmania parasites; nevertheless, it has failed in vivo tests due to its low aqueous solubility. Though, lipid nanoparticles can overcome this holdback. In this study we tested the hypothesis whether BPQ-NLC shows in vivo activity against L. infantum. Two optimized formulations were prepared (V1: 173.9 ± 1.6 nm, 0.5 mg of BPQ/mL; V2: 232.4 ± 1.6 nm, 1.3 mg of BPQ/mL), both showed increased solubility up to 73.00-fold, and dissolution up to 83.29%, while for the free drug it was only 2.89%. Cytotoxicity test showed their biocompatibility (CC50 >554.4 µM). Besides, the V1 dose of 0.3 mg/kg/day for 10 days reduced the parasite burden in 83.4% ±18.2% (p <0.05) in the liver. BPQ-NLC showed similar leishmanicidal activity compared to miltefosine. Therefore, BPQ-NLC is a promising addition to the limited therapeutic arsenal suitable for leishmaniasis oral administration treatment.

Atuação da enfermagem no controle de infecção da corrente sanguínea relacionada aos cateteres venosos periféricos / Nursing performance without control of blood current infection related to peripheral venous catheters / Desempeño de enfermería sin control de la infección de corriente sanguínea relacionada con catéteres venosos periféricos

Objetivo:identificar o controle da infecção da corrente sanguínea por meio da inspeção dos cateteres venosos periféricos dos pacientes internados na Clínica Médica de um hospital federal do município do Rio de Janeiro.Método:trata-se de um estudo de natureza descritiva documental, retrospectivo, com abordagem quantitativa. Coletaram-se os dados por meio de uma análise documental de um bundle, dispondo-os em uma planilha tipo Excel® para, posteriormente, submetê-los à análise estatística descritiva simples. Resultados: sugere-se, pelos dados obtidos no estudo, que os profissionais de Enfermagem devem ser capacitados para alinhamentos no controle e na manutenção dos acessos venosos periféricos visando à prevenção da infecção da corrente sanguínea. Conclusão: tornam-se, desse modo, as atividades regulares desenvolvidas pela Educação Permanente em serviço primordiais na capacitação dos profissionais de saúde, proporcionando uma reflexão sobre os conhecimentos e as práticas assistenciais. Contribui-se, além disso, por meio da ênfase à criação de protocolos institucionais, para a relevância das medidas de boas práticas voltadas ao uso do acesso venoso periférico.(AU)

Objective:identify the control of bloodstream infection through the inspection of peripheral venous catheters of patients admitted to the Internal Medicine Clinic of a federal hospital in the city of Rio de Janeiro. Method: this is a retrospective descriptive documental study with a quantitative approach. The data were collected by means of a documental analysis of a bundle, arranged in an Excel® spreadsheet and later submitted to simple descriptive statistical analysis. Results: it is suggested, by the data obtained in the study, that Nursing professionals should be trained for alignments in the control and maintenance of peripheral venous accesses aiming at the prevention of bloodstream infection. Conclusion: thus become the regular activities developed by the Permanent Education in service primordial in the training of health professionals, providing a reflection on the knowledge and care practices. It also contributes, through the emphasis on the creation of institutional protocols, to the relevance of good practice measures aimed at the use of peripheral venous access.(AU)

Objetivo: identificar el control de la infección de la corriente sanguínea mediante la inspección de catéteres venosos periféricos en pacientes ingresados en la Clínica Médica de un hospitalfederal de la ciudad de Río de Janeiro. Método: se trata de un estudio naturaleza descriptiva, documental, retrospectiva con enfoque cuantitativo. Los datos fueron recolectados a través de un análisis documental de bundle, colocándolos en una hoja de cálculo tipo Excel® para luego someterlos a un análisis estadístico descriptivo simple. Resultados: se sugiere, con base en los datos obtenidos en el estudio, que los profesionales de Enfermería sean capacitados en alineaciones en el control y mantenimiento del acceso venoso periférico, con el objetivo de prevenirla infección de la corriente sanguínea. Conclusión: de esta manera, las actividades regulares desarrolladas por la Educación Continuada en servicio se vuelven primordiales en la formación de los profesionales de la salud, aportando una reflexión sobre los conocimientos y las prácticas asistenciales. Además, a través del énfasis en la creación de protocolos institucionales, contribuye a la relevancia de las medidas de buenas prácticas dirigidas al uso del acceso venoso periférico.(AU)

Suspected vertical transmission of Chagas disease caused by DTU TcIV in an infection probably transmitted orally, during anoutbreak in the Brazilian Amazon.

This study describes difficulties in the monitoring of a child born during an oral outbreak of Chagas disease, in which there are several indications that the transmission occurred through the congenital route: 1. the mother was in the third trimester of pregnancy when she was infected; 2. She presented high parasitemia at the time of delivery; 3. In both, the mother and her daughter, T. cruzi was classified as DTU TcIV. The parasites were not found in the blood at birth and the infection was detected only three months later in an asymptomatic infant. As the mother and her child live in a highly endemic area, vector transmission could not be excluded during this period.

Acupuntura no controle de náuseas e vômitos em pacientes oncológicos / Acupuncture in the control of nausea and vomiting in oncology patients / Acupuntura en el control de náuseas y vómitos en pacientes oncológicos

Objetivo: verificar o efeito da acupuntura no controle de náuseas e vômitos em pacientes submetidos à quimioterapia. Método: trata-se de um estudo bibliográfico, descritivo, tipo revisão integrativa da literatura, entre 2008 a 2018, na BVS (Biblioteca Virtual de Saúde) e na MEDLINE via PUBMED. Analisaram-se os artigos pela leitura reflexiva e criteriosa acerca das principais informações e elementos que compõem a temática nos estudos. Resultados: resultaram-se 15 artigos em inglês, espanhol e português. Percebeu-se que o efeito da acupuntura no controle de náuseas e vômitos induzidos pela quimioterapia foi satisfatório em 13 dos 15 estudos que compuseram esta revisão, mostrando uma diminuição desses sintomas durante e após o tratamento. Destacaram-se, entre os métodos evidenciados nos estudos, a acupuntura clássica e a eletroacupuntura. Conclusão: avalia-se que a acupuntura é uma prática integrativa e complementar aos tratamentos convencionais na oncologia, pois melhora a qualidade de vida dos pacientes em tratamento quimioterápico.(AU)

Objective: to verify the effect of acupuncture on the control of nausea and vomiting in patients undergoing chemotherapy. Method: this is a bibliographic, descriptive, integrative literature review type study, between 2008 and 2018, at the VHL (Virtual Health Library) and at MEDLINE via PUBMED. The articles were analyzed by a reflexive and careful reading about the main information and elements that make up the theme in the studies. Results: the result was 15 articles in English, Spanish and Portuguese. It was noticed that the effect of acupuncture in the control of nausea and vomiting induced by chemotherapy was satisfactory in 13 of the 15 studies that composed this review, showing a decrease in these symptoms during and after treatment. Among the methods evidenced in the studies, classical acupuncture and electroacupuncture were highlighted. Conclusion: acupuncture is considered an integrative practice and complementary to conventional treatments in oncology, because it improves the quality of life of patients in chemotherapy treatment.

Objetivo: verificar el efecto de la acupuntura en el control de náuseas y vómitos en pacientes sometidos a quimioterapia. Método: se trata de una revisión bibliográfica, descriptiva, integradora de la literatura, entre 2008 y 2018, en la BVS (Virtual Health Library) y MEDLINE vía PUBMED. Los artículos fueron analizados mediante una lectura reflexiva y atenta sobre las principales informaciones y elementos que componen el tema de los estudios. Resultados: se publicaron 15 artículos en inglés, español y portugués, se notó que el efecto de la acupuntura en el control de náuseas y vómitos inducidos por quimioterapia fue satisfactorio en 13 de los 15 estudios que componen esta revisión, mostrando una disminución de estos síntomas durante y después del tratamiento. Entre los métodos evidenciados en los estudios se destacaron la acupuntura clásica y la electroacupuntura. Conclusión: se evalúa que la acupuntura es una práctica integradora y complementaria a los tratamientos convencionales en oncología, ya que mejora la calidad de vida de los pacientes sometidos a quimioterapia.(AU)

Enfermagem e higienização no gerenciamento dos resíduos sólidos de saúde / Nursing and hygienization in the management of solid health waste / Enfermería e higienización en la gestión de residuos sólidos sanitarios

Objetivo: analisar o conhecimento dos profissionais da equipe de Enfermagem e de higienização sobre o manejo dos resíduos sólidos dos serviços de saúde. Método: trata-se de um estudo quantitativo, descritivo, exploratório. Utilizaram-se para a coleta de dados dois questionários, um para a equipe de Enfermagem com 53 integrantes e outro para a equipe de limpeza com 21 integrantes, abordando questões pertinentes a cada categoria profissional. Calcularam-se as frequências relativas e absolutas das respostas para fins de mensuração e comparação. Resultados: observou-se, um nível de acertos alto de ambos os grupos entrevistados, que pode estar associado ao fato de a instituição manter, no seu Plano de Gerenciamento de Resíduos de Saúde, um programa de educação continuada, independentemente do tipo de vínculo empregatício dos trabalhadores. Conclusão: conclui-se que o conhecimento dos profissionais envolvidos sobre a prática correta do gerenciamento de resíduos de saúde demonstrou-se satisfatório e aqui destacamse os profissionais de limpeza, por vezes, negligenciados. Pontua-se que não se pode negar o impacto desse trabalho conjunto nos custos da instituição, na saúde dos trabalhadores e na preservação do meio ambiente.(AU)

Objective: to analyze the knowledge of the Nursing and Cleaning team professionals on the management of solid waste from health services. Method: It is a quantitative, descriptive, exploratory study. Two questionnaires were used for data collection, one for the 53-member nursing team and the other for the 21-member cleaning team, addressing issues relevant to each professional category. The relative and absolute frequencies of the answers were calculated for measurement and comparison purposes. Results: It was observed a high level of success of both groups interviewed, which may be associated to the fact that the institution maintains, in its Health Waste Management Plan, a program of continuous education, regardless of the type of employment relationship of the workers. Conclusion: The conclusion is that the knowledge of the professionals involved about the correct practice of health waste management has proved to be satisfactory and here cleaning professionals are sometimes neglected. It is pointed out that one cannot deny the impact of this joint work on the institution's costs, on the workers' health and on the environment's preservation.(AU)

Objetivo: analizar el conocimiento de los profesionales del equipo de Enfermería e higienización sobre el manejo de residuos sólidos de los servicios de salud. Método: se trata de un estudio cuantitativo, descriptivo, exploratorio. Para la recolección de datos se utilizaron dos cuestionarios, uno para el equipo de Enfermería con 53 integrantes y otro para el equipo de limpieza con 21 integrantes, abordando temas relevantes para cada categoría profesional. Se calcularon las frecuencias relativas y absolutas de las respuestas con fines de medición y comparación. Resultados: hubo un alto nivel de aciertos de ambos grupos entrevistados, lo que puede estar asociado a que la institución mantiene, en su Plan de Manejo de Residuos Sanitarios, un programa de educación continua, independientemente del tipo de relación laboral de los trabajadores. Conclusión: se concluye que el conocimiento de los profesionales involucrados sobre la correcta práctica de la gestión de residuos sanitarios resultó ser satisfactorio y aquí destacan los profesionales de la limpieza, en ocasiones desatendidos. Se señala que no se puede negar el impacto de este trabajo conjunto sobre los costos de la institución, la salud de los trabajadores y la preservación del medio ambiente.(AU)

A Specific IL6 Polymorphic Genotype Modulates the Risk of Trypanosoma cruzi Parasitemia While IL18, IL17A, and IL1B Variant Profiles and HIV Infection Protect Against Cardiomyopathy in Chagas Disease.

Background: Chagas disease caused by Trypanosoma cruzi (T. cruzi) affects approximately six million individuals worldwide. Clinical manifestations are expected to occur due to the parasite persistence and host immune response. Herein we investigated potential associations between IL1B, IL6, IL17A, or IL18 polymorphism profiles and cardiomyopathy or T. cruzi parasitemia, as well as the impact of HIV infection on cardiopathy. Methods: Two hundred twenty-six patients and 90 control individuals were analyzed. IL1B rs1143627 T>C, IL6 rs1800795 C>G, IL17A rs2275913 G>A, IL18 rs187238 C>G, and IL18 rs1946518 C>A SNVs were analyzed by real-time PCR and T. cruzi parasitemia by PCR. Results: Our data revealed association between a cytokine gene polymorphism and parasitemia never previously reported. The IL6 rs1800795 CG genotype lowered the risk of positive parasitemia (OR = 0.45, 95% CI 0.24-0.86, P = 0.015). Original findings included associations between IL17A rs2275913 AA and IL18 s1946518 AA genotypes with decreased risk of developing cardiomyopathy (OR = 0.27, 95% CI 0.07-0.97, P = 0.044; and OR = 0.35, 95% CI 0.14-0.87, P = 0.023, respectively). IL18 rs1946518 AA and IL1B rs1143627 TC were associated with reduced risk for cardiomyopathy severity, including NYHA (New York Heart Association) class ≥ 2 (OR = 0.21, 95% CI 0.06-0.68, P = 0.009; and OR = 0.48, 95% CI 0.24-0.95, P = 0.036, respectively) and LVEF (left ventricular ejection fraction) <45% for IL18 rs1946518 AA (OR = 0.22, 95% CI 0.05-0.89, P = 0.034). A novel, unexpected protective effect of HIV infection against development/progression of cardiomyopathy was identified, based on a lower risk of developing cardiopathy (OR = 0.48, 95% CI 0.23-0.96, P = 0.039), NYHA class ≥ 2 (OR = 0.15, 95% CI 0.06-0.39, P < 0.001), and LVEF < 45% (OR = 0.03, 95% CI 0.00-0.25, P = 0.001). Digestive involvement was negatively associated with NYHA ≥ 2 and LVEF < 45% (OR = 0.20, 95% CI 0.09-0.47, P < 0.001; and OR = 0.24, 95% CI 0.09-0.62, P = 0.004, respectively). Conclusions: Our data support a protective role of IL17A AA, IL18 AA, and IL1B TC genotypes against development/progression of cardiomyopathy and a modulatory effect of the IL6 CG genotype on the risk of parasitemia in Chagas disease. Notably, HIV infection was shown to protect against development/progression of cardiopathy, potentially associated with a synergistic effect of HIV and highly active antiretroviral therapy (HAART), attenuating a Th1-mediated response in the myocardium. This proposed hypothesis requires confirmation, however, in larger and more comprehensive future studies.

A Real Time PCR strategy for the detection and quantification of Candida albicans in human blood.

Candidemia is a significant cause of bloodstream infections (BSI) in nosocomial settings. The identification of species can potentially improve the quality of care and decrease human mortality. Quantitative PCR (qPCR) was evaluated for Candida albicans detection using culture suspensions containing C. albicans , spiked human blood, the cloned qPCR target fragment (ITS2 region) and the results of these assays were compared. The assays showed a good detection limit: C. albicans DNA extracted from yeast (sensitivity 0.2 CFU/µL), spiked human blood (sensitivity 10 CFU/mL), and cloned fragment of ITS2 region (sensitivity 20 target copies/µL). The efficiency of ITS2 fragment-qPCR ranged from 89.67 to 97.07, and the linearity (R2) of the standard curve ranged from 0.992 to 0.999. The results showed that this ITS2-qPCR has a great potential as a molecular prototype model for the development of a test to be applied in clinical practice, greatly reducing the time of candidemia diagnosis, which is extremely important in this clinical setting.

Evaluación del transporte crítico de pacientes: una revisión sistemática / Avaliação do transporte crítico de pacientes: uma revisão sistemática / Evaluation of critical transportation of patients: a systematic review

OBJETIVO: Evaluar, según la literatura, cuáles son los principales factores considerados facilitadores y/o agravantes en la realización del transporte de pacientes en estado crítico. MÉTODO: Este estudio se trata de una revisión sistemática realizada con el método PICO. RESULTADO: Los periódicos seleccionados comprendían un espacio temporal en los últimos diez años, donde 6 periódicos fueron elegibles, basado en los criterios establecidos. Los resultados relatan que los temas encontrados en esta revisión demuestran una alineación entre la práctica asistencial y la literatura, pero para que el transporte sea realizado sin eventos adversos, es necesario que haya unión entre la gestión y los profesionales involucrados. CONCLUSIÓN: Aunque los hallazgos demuestren una gran preocupación en relación a la calidad en la asistencia y en la preparación del equipo, los autores creen que más estudios deben ser fomentados una vez que el trabajo en equipo, a pesar de ser complejo, es la clave para la realización de los procedimientos con efectividad

OBJETIVO: Avaliar segundo a literatura quais são os principais fatores que são considerados facilitadores e/ou agravantes na realização do transporte de pacientes em estado crítico. MÉTODO: Este estudo trata-se de uma revisão sistemática realizada com método PICO. RESULTADO: Os periódicos selecionados compreendiam um espaço temporal nos últimos dez anos, onde 6 periódicos foram elegíveis, baseado nos critérios estabelecidos. Os resultados relatam que os temas encontrados nesta revisão demonstram um alinhamento entre a prática assistencial e a literatura, porém para que o transporte seja realizado sem eventos adversos, é necessário que haja união entre a gestão e os profissionais envolvidos. CONCLUSÃO: Embora os achados demonstrem uma grande preocupação em relação à qualidade na assistência e no preparo da equipe, os autores acreditam que mais estudos devem ser fomentados uma vez que o trabalho em equipe apesar de ser complexo, é a chave para a realização dos procedimentos com efetividade

OBJECTIVE: To evaluate, according to the literature, the main factors considered facilitators and/or aggravating in the transportation of patients in critical condition. METHOD: This study is a systematic review performed using the PICO method. RESULTS: The selected journals comprised a time space in the last 10 years, with six journals eligible, based on the established criteria. The results report that the themes found in this review demonstrate an alignment between care practice and literature, but, for a transportation without adverse events, there must be a union between the management and the professionals involved. CONCLUSION: Although the findings demonstrate a great concern regarding the quality of care and team preparation, the authors believe that more studies should be encouraged since teamwork, despite being complex, is the key to performing the procedures with effectiveness

Enfermagem e clientes hospitalizados: a comunicação em uma unidade militar / Nursing and users hospitalized: communication in a military unit

Objetivo: analisar o processo de comunicação entre a equipe de enfermagem e o cliente hospitalizado. Método: tratase de um estudo qualitativo, descritivo, com 21 profissionais de enfermagem e 20 clientes hospitalizados em uma clínica médica e cirúrgica de um hospital militar. Obtiveram-se os dados por meio de entrevistas semiestruturada, analisando-as pela técnica de Análise de Conteúdo na modalidade Análise de Conteúdo Temática. Resultados: evidencia-se, apesar de alguns ruídos encontrados no processo de comunicação, que existe, por parte da equipe de enfermagem, a tentativa de compreender e de responder às necessidades quando surgem, assim tornando-se empática para com os clientes e familiares. Conclusão: torna--se claro que o processo de comunicação não é tarefa fácil, pelo contrário, exige bastante esforço entre os envolvidos. Precisa-se a comunicação, visando à qualidade em saúde e às metas de segurança do paciente, ser clara, eficiente e concisa para que não falte nenhuma informação ou que para que não sejam passadas informações equivocadas, dessa forma, evitando erros que podem levar a eventos adversos e, consequentemente, diminuir a qualidade do serviço.(AU)

Objective: to analyze the communication process between the nursing team and the user hospitalized. Method: this is a qualitative, descriptive study, with 21 nursing professionals and 20 users hospitalized in a medical and surgical clinic of a military hospital. Data was obtained through semi-structured interviews, analyzing them using the Content Analysis technique in the Thematic Content Analysis modality. Results: it is evident, despite some noises found in the communication process, that there is, on the part of the nursing team, an attempt to understand and respond to needs when they arise, thus becoming empathetic towards users and family members. Conclusion: it becomes clear that the communication process is not an easy task; on the contrary, it requires a lot of effort among those involved. Communication, with a view to quality in health and patient safety goals, needs to be clear, efficient and concise so that no information is missing or that incorrect information is not passed on, thus avoiding errors that can lead to adverse events and, consequently, decrease the quality of service.(AU)

Objetivo: analizar el proceso de comunicación entre el equipo de enfermería y el cliente hospitalizado. Método: este es un estudio cualitativo, descriptivo, con 21 profesionales de enfermería y 20 clientes hospitalizados en una clínica médica y quirúrgica de un hospital militar. Los datos se obtuvieron a través de entrevistas semiestructuradas, analizándolas a través de la técnica de Análisis de Contenido en la modalidad de Análisis de Contenido Temático. Resultados: es evidente, a pesar de algunos ruidos encontrados en el proceso de comunicación, que existe, por parte del equipo de enfermería, un intento de comprender y responder a las necesidades cuando surgen, lo que genera empatía hacia los clientes y los miembros de la familia. Conclusión: queda claro que el proceso de comunicación no es una tarea fácil, por el contrario, requiere mucho esfuerzo entre los involucrados. La comunicación es necesaria, apuntando a la calidad de la salud y a los objetivos de seguridad del paciente, debe ser clara, eficiente y concisa para que no falte información o que no se transmita información incorrecta, evitando así errores que puedan conducir a eventos adversos y, en consecuencia, disminuyen la calidad del servicio.(AU)

Fatal evolution of acute Chagas disease in a child from Northern Brazil: factors that determine poor prognosis.

Trypanosoma cruzi is the causative agent of Chagas disease. Nowadays, the transmission in Brazil occurs mainly by oral ingestion of contaminated food that has been associated with more severe clinical manifestations. We report a case of Acute Chagas disease caused by oral transmission in a child from Northern Brazil. In the hospital admission, physical examination showed tachycardia, hepatomegaly, bipalpebral edema and anasarca. Trypanosoma cruzi trypomastigotes were found in microscopy during blood cell count. Twenty-three days before hospitalization, the child had ingested the "bacaba palm fruit's wine". Even with the appropriate diagnosis and starting of treatment, she did not survive. Quantitative analysis of Trypanosoma cruzi DNA in a blood sample resulted in 54,053.42 parasite equivalents/mL and the DTU TcIV was identified. The outcome may have been determined by several factors, including the delay to seek a medical service beyond the high parasitemia, detected by qPCR. DTU TcIV could also have influenced the natural history of the disease.