Use of Envelope Domain III Protein for the Detection of IgG Type Antibodies Specific to Zika Virus by Indirect ELISA.

Zika virus (ZIKV) diagnostics are crucial for proper antenatal and postnatal care and also for surveillance and serosurvey studies. Since the viremia during ZIKV infection is fleeting, serological testing is highly valuable to inform diagnosis. However, current serology tests using whole virus antigens frequently suffer from cross reactivity issues, delays, and technical complexity, especially in low and middle income countries (LMICs) and endemic countries. Here, we describe an indirect ELISA to detect specific IgG antibodies using the ZIKV envelope domain III (EDIII) protein expressed in Drosophila S2 cells as an immunogen. Using a total of 367 clinical samples, we showed that the EDIII-ELISA was able to detect IgG antibodies against ZIKV with high sensitivity of 100.0% and specificity of 94.7% when compared to plaque reduction neutralization tests (PRNTs) as the gold standard and using 0.208 as the cut-off OD value. These results show the usefulness of the recombinant envelope domain III as an alternative to standard whole virus proteins for ZIKV diagnostics as it improves the sensitivity and specificity of IgG ELISA assay when used as an immunogen. This method should, therefore, be extended to serological diagnostic techniques for other members of the flavivirus genus and for use in IgM diagnostic testing.

Using videos in active learning: An experience in veterinary anatomy.

Examination failure rate is high in veterinary anatomy in Brazilian universities. We report here our active learning experience in which students recorded video reports on veterinary anatomical specimens of locomotor apparatus to support classic learning. Eighteen students were divided into 2 groups, case group (V3) and control (E). Case group students individually recorded video reports of prosected specimens weekly. Acceptance and efficacy of the strategy were assessed with a Likert scale anonymous questionnaire and students' scores in theoretical exams. The method was highly accepted and the performance test proved that recording videos is an effective strategy for active learning in anatomy.

Ceftriaxone-induced Acute Cholecystitis.

Ceftriaxone has been increasingly used in pediatric population, due to its bacteriological and pharmacokinetic features. Association between ceftriaxone and biliary sludge/pseudolithiasis formation has been documented in the literature. More rarely, biliary symptoms and cholecystitis during ceftriaxone therapy have been reported. We present a case of acute cholecystitis related to ceftriaxone administration and its management.

Hemophagocytic syndrome and COVID-19.

The case of a woman hospitalized due to COVID-19 is presented. The patient developed a severe macrophage activation syndrome diagnosed by bone marrow biopsy, which did not respond to immunoglobulin therapy.

Effect of Hospital Accreditation Process in Outcomes of Patients with Acute Coronary Syndrome

Abstract Background: Hospital accreditation has as goal the standardization of patient care, aiming quality improvement. On 2015, a cardiology reference hospital was evaluated and got level 3 from ONA in care given to Acute Coronary Syndrome (ACS) patients. Objetive: To compare length of stay (LOS) at Coronary Care Unit (CCU) and the total LOS at the hospital of ACS patients before and after ONA 3 accreditation. Other clinical outcomes were also analyzed. Methods: Systematic and prospective registry of admitted ACS patients at CCU, whose population was divided into pre-accreditation (period 1) and post-accreditation (period 2). Descriptive analysis was performed. For statistical analysis the Mann-Whitney test, chi-squared, Fisher's exact test and Multiple Linear Regression were performed. P value was considered statistically significant when < 0,05. Results: 372 patients were admitted with ACS, 186 in period 1, of which 47 (25,3%) with ST segment Elevation Myocardial Infarction (STEMI), and 186 in period 2, of which 70 (37,6%) with STEMI. The mean age was 65,9 years (± 12,2). About the CCU LOS, there was a reduction from 3 (IQR: 2-4) to 2,5 days (IQR: 2-4; p value = 0,088). Regarding the hospital LOS, there was also a reduction from 8 (IQR: 5-12,25) to 6 days (IQR:4-11; p value = 0,004). Analyzing the type of ACS, there was a significant reduction only at the hospital LOS in non-STEMI patients: 8 to 6 days (p value = 0,001). Other hospitalization length of stay and clinical outcomes did not present a significant reduction in the comparison. Conclusion: After the ONA 3 accreditation, there was a reduction of hospital LOS. There were no significant differences in the other outcomes analyzed.

Pneumomediastinum and subcutaneous emphysema: complication of cocaine use.

Pneumomediastinum is more frequent in young men and usually presents in association with subcutaneous emphysema. It can occur in case of oesophageal or chest trauma, be iatrogenic or develop spontaneously, in case of emesis, coughing or forceful straining. Use of illicit drugs, such as cocaine, has been associated with multiple respiratory complications, including pneumomediastinum and subcutaneous emphysema. The pathogenesis of subcutaneous emphysema and pneumomediastinum after cocaine inhalation is not completely known, but it is thought that the physical manoeuvers used to increase its absorption and effect may lead to alveolar rupture, resulting in air escaping into the mediastinum and fascial planes of the neck and chest. Chest X-ray is usually diagnostic, but CT can be used as complementary study, allowing evaluation of adjacent structures. A case of pneumomediastinum and subcutaneous emphysema after cocaine inhalation in an otherwise healthy man is presented.

Collaborative Brazilian pediatric renal transplant registry (CoBrazPed-RTx): A report from 2004 to 2018.

The Brazilian collaborative registry for pediatric renal transplantation began in 2004 as a multicenter initiative aimed at analyzing, reporting, and disseminating the results of pediatric renal transplantation in Brazil. Data from all pediatric renal transplants performed from January 2004 to May 2018 at the 13 participating centers were analyzed. A total of 2744 pediatric renal transplants were performed in the thirteen participating centers. The median age at transplantation was 12.2 years, with the majority being male recipients (56%). The main underlying diseases were CAKUT (40.5%) and glomerulopathy (28%). 1981 (72%) of the grafts were from deceased donors (DD). Graft survival at one year (censored by death) was 94% in the live donor group (LD) and 91% in the DD group (log-rank test P < 0.01). The patient's survival at one and 5 years was 97% and 95% for the LD group and 96% and 93% for the DD group (log-rank test P = 0.02). The graft loss rate was 19% (n = 517), more frequently caused by vascular thrombosis (n = 102) and chronic graft nephropathy (n = 90). DD recipients had 1.6 (1.0-2.2) times greater chance of death and 1.5 (1.2-1.8) times greater chance of graft loss compared to LD recipients. The mortality rate was 5.4% (n = 148), mainly due to infection (n = 69) and cardiovascular disease (n = 28). The results of this collaborative pediatric renal transplant record are comparable to other international registries, although we still have a high infection rate as a cause of death.

Mesenchymal stem cells in osteotomy repair after tibial tuberosity advancement in dogs with cranial cruciate ligament injury.

BACKGROUND: The cranial cruciate ligament rupture (CCLR) is the most commonly encountered orthopedic condition in dogs. Among the various techniques to treat this condition, tibial tuberosity advancement (TTA) has been used to obtain rapid recovery of the affected knee. The objective of this study was to evaluate the viability of the use of mesenchymal stem cells (MSC) implanted in the osteotomy site obtained by TTA in nine dogs diagnosed with CCLR. METHODS: The MSC were isolated from the adipose tissue of the dogs and cultured for eight days, the animals were divided into two groups. Animals from the treated group (GT) received cell transport medium containing about 1.5 millions MSC, and the animals from the control group (GC) received only the cell transport medium. The study was performed in a double-blind manner using radiographs acquired on days 15, 30, 60 and 120 after the procedure. Evaluations of the density of the trabecular bone were performed using image analysis software. The results were subjected to descriptive statistical analysis, followed by the normality test, Chi-square test, Mann-Whitney test and Tukey's multiple comparison test for p ≤ 0.05. RESULTS: After 30 days of the procedure, the animals of the GT presented an ossification mean 36.45% greater (p ≤ 0.033) than the GC, and there were no statistical differences for the other periods. CONCLUSIONS: Despite the total bone ossification within the expected period, there was no minimization of the estimated recovery time with the application of MSC, and inflammatory factors should be considered for reassessment of the therapeutic intervention time.

Q Fever in Military Firefighters during Cadet Training in Brazil.

We report five cases of Q fever among cadets during a training program for Military Firefighters Academy in the state of Rio de Janeiro, Brazil. This cluster confirms the significance of Coxiella burnetii as an infectious agent in Brazil, where the occurrence of this zoonosis is poorly documented and highlights the potential risk for Q fever transmission in rural areas or farms with infected animals.

Screening of mutations in the additional sex combs like 1, transcriptional regulator, tumor protein p53, and KRAS proto-oncogene, GTPase/NRAS proto-oncogene, GTPase genes of patients with myelodysplastic syndrome.

Myelodysplastic syndrome (MDS) is a heterogeneous group of clonal bone marrow disorders characterized by ineffective hematopoiesis, different degrees of cellular dysplasia, and increased risk of progression to acute myeloid leukemia. International Prognostic Scoring System is the gold standard for MDS classification; however, patients exhibiting different clinical behaviors often coexist in the same group, indicating that the currently available scoring systems are insufficient. The genes that have recently been identified as mutated in MDS, including additional sex combs like 1, transcriptional regulator (ASXL1), tumor protein p53 (TP53), and KRAS proto-oncogene and GTPase (KRAS)/NRAS proto-oncogene, GTPase (NRAS), may contribute to a more comprehensive classification, as well as to the prognosis and progression of the disease. In the present study, the mutations in the ASXL1, TP53 and NRAS/KRAS genes in 50 patients were evaluated by sequencing genomic bone marrow DNA. Nine patients (18%) presented with at least one type of mutation. Mutations in TP53 were the most frequent in six patients (12%), followed by ASXL1 in two patients (4%) and NRAS in one patient (2%). The nine mutations were detected in patients with low- and high-risk MDS. The screening of mutations in MDS cases contributes to the application of personalized medicine.

Antimicrobial photodynamic therapy combined to periodontal treatment: Experimental model.

BACKGROUND: Antimicrobial photodynamic therapy (aPDT) has been used as an adjuvant treatment for periodontitis. It combines a photosensitizer with a light source to induce reactive oxygen species and kill microbial cells. PpNetNI is a protoporphyrin derivative, and it has a chemical binding site at biofilm and great affinity to microbial cells. The aim of this study was to investigate the effects of aPDT as an adjuvant treatment for periodontitis. METHODS: Thirty healthy male rats Wistar (Rattus norvegicus) were used in this study (Approved by UNINOVE Ethical committee AN0029/2015). Periodontitis was induced by placing a cotton ligature around the first mandibular molar in a subgengival position. The contralateral mandibular first molar received neither a ligature nor any treatment, and was used as a control. After 7 days, the ligature was removed and all animals received scaling and root planing (SRP) and were divided according to the following treatments: SRP group (received SRP and irrigation with PpNetNI, 10µM) and aPDT group (PpNetNI 10µM followed by LED irradiation). aPDT was performed with a LED (630nm) with an output power of 400mW (fluence-rate 200mW/cm2; fluence 18J/cm2). Rats were euthanized at 24h, 48h and 7days postoperatively. The area of bone loss in vestibular region of the first molar was evaluated by Optical Coherence Tomography (OCT, THORLABS LTD., Ely, UK). Data were analyzed statistically (ANOVA and Tukey tests, p<0.05). RESULTS: The animals treated by aPDT showed bone gain of approximately 30% compared to the SRP group following 7days from the treatment. CONCLUSION: aPDT promoted bone recovery 7days after periodontal intervention.

Clinical and bacteriological characteristics of invasive pneumococcal disease after pneumococcal 10-valent conjugate vaccine implementation in Salvador, Brazil

Abstract Invasive pneumococcal disease is a relevant public health problem in Brazil, especially among children and the elderly. In July/2010 a 10-valent pneumococcal conjugate vaccine was introduced to the immunization schedule of Brazilian children under two years of age. Between July/2010 and December/2013 we conducted a case-series study on invasive pneumococcal disease in Salvador, Brazil to describe the clinical and bacteriological profile of invasive pneumococcal disease cases during the post-implementation period. Eighty-two cases were eligible. Mean age was 31 years (interquartile range, 3–42); 17.1% and 30.5% were under 2 years and 5 years, respectively. Pneumococcal meningitis (n = 64, 78.1%), bacteraemic pneumococcal pneumonia (n = 12, 14.6%) and bacteraemia (n = 6, 7.3%) were the clinical syndromes identified. Thirty-three different serotypes were found. Of these, serotype 14 (n = 12, 14.6%) was the most common, followed by 23F (n = 10, 12.2%), 12F (n = 8, 9.8%), 18 C (n = 5, 6.1%) and 6B (n = 5, 6.1%). Investigations conducted in Salvador in the pre-vaccine period did not identify serotype 12F as one of the most prevalent serotypes. Increase of serotype 12F was observed in different regions of Brazil, in the post-vaccine period. Among children under two years of age, the target group for 10-valent pneumococcal conjugate vaccine, 11 (78.6%) of the 14 isolated strains of Streptococcus pneumoniae belonged to vaccine serotypes; at least 50% of these children were not vaccinated. The relatively recent implementation of 10-valent pneumococcal conjugate vaccine in Brazil reinforces the need to maintain an active surveillance of invasive pneumococcal disease cases, considering the possible increase of invasive pneumococcal disease cases related to non-vaccine serotypes and the changes on the clinical presentation of the disease.

Clinical and bacteriological characteristics of invasive pneumococcal disease after pneumococcal 10-valent conjugate vaccine implementation in Salvador, Brazil.

Invasive pneumococcal disease is a relevant public health problem in Brazil, especially among children and the elderly. In July/2010 a 10-valent pneumococcal conjugate vaccine was introduced to the immunization schedule of Brazilian children under two years of age. Between July/2010 and December/2013 we conducted a case-series study on invasive pneumococcal disease in Salvador, Brazil to describe the clinical and bacteriological profile of invasive pneumococcal disease cases during the post-implementation period. Eighty-two cases were eligible. Mean age was 31 years (interquartile range, 3-42); 17.1% and 30.5% were under 2 years and 5 years, respectively. Pneumococcal meningitis (n=64, 78.1%), bacteraemic pneumococcal pneumonia (n=12, 14.6%) and bacteraemia (n=6, 7.3%) were the clinical syndromes identified. Thirty-three different serotypes were found. Of these, serotype 14 (n=12, 14.6%) was the most common, followed by 23F (n=10, 12.2%), 12F (n=8, 9.8%), 18C (n=5, 6.1%) and 6B (n=5, 6.1%). Investigations conducted in Salvador in the pre-vaccine period did not identify serotype 12F as one of the most prevalent serotypes. Increase of serotype 12F was observed in different regions of Brazil, in the post-vaccine period. Among children under two years of age, the target group for 10-valent pneumococcal conjugate vaccine, 11 (78.6%) of the 14 isolated strains of Streptococcus pneumoniae belonged to vaccine serotypes; at least 50% of these children were not vaccinated. The relatively recent implementation of 10-valent pneumococcal conjugate vaccine in Brazil reinforces the need to maintain an active surveillance of invasive pneumococcal disease cases, considering the possible increase of invasive pneumococcal disease cases related to non-vaccine serotypes and the changes on the clinical presentation of the disease.