Smell loss associated with SARS-CoV-2 is not clinically different from other viruses: a multicenter cohort study.

BACKGROUND: Although the COVID-19 pandemic has increased the prevalence of cases with olfactory loss, other respiratory viruses can also cause this condition. We aimed to compare the prevalence of acute SARS-CoV-2 infection and other respiratory viruses in patients with sudden smell loss, and to assess the impact of SARS-CoV-2 viral load and co-infection on olfactory symptoms. METHODS: Patients with sudden smell loss were recruited in a multicenter prospective cohort study in 15 hospitals in Brazil. Clinical questionnaire, Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test and nasopharyngeal swab to perform a PCR-based respiratory viral panel were collected at first visit (day 0) and 30 and 60 days after recruitment. RESULTS: 188 of 213 patients presented positive test result for SARS-CoV-2, among which 65 were co-infected with other respiratory viruses (e.g., rhinovirus, enterovirus, and parainfluenza). 25 had negative test results for SARS-CoV-2. Patients in both SARSCoV-2 and non-SARS-CoV-2 groups had objective anosmia (less than 2 points according to the psychophysical olfactory CCCRC) at day 0, with no significant difference between them. Both groups had significant smell scores improvement after 30 and 60 days, with no difference between them. Co-infection with other respiratory viruses, and SARS-CoV-2 viral load did not impact olfactory scores. CONCLUSION: Patients with sudden smell loss associated with SARS-CoV-2 and other respiratory viruses had similar presentation, with most participants initiating with anosmia, and total or near total recovery after 60 days. SARS-CoV-2 viral load and co-infections with other respiratory viruses were not associated with poorer olfactory outcomes.

Role of Recombinant Parvalbumin Gad c 1 in the Diagnosis and Prognosis of Fish Allergy.

BACKGROUND AND OBJECTIVES: The prevalence of fish allergy has increased in recent years. The parvalbumin Gad c 1 is a major cod allergen that is used as a follow-up marker in patients with fish allergy. Objectives: To determine the clinical and laboratory characteristics of a population of patients with fish allergy. To analyze the role of the specific IgE (sIgE) of recombinant Gad c 1 (rGad c 1) and skin prick tests (SPTs) in confirming the acquisition of tolerance to fish. METHODS: We performed a retrospective study of patients with fish allergy from July 1, 2005 to December 31, 2016. The population was characterized according to demographic data, species of fish associated with allergic reactions, and symptoms. The SPT wheal diameter and sIgE for fish and rGad c 1 were evaluated before acquisition of tolerance (T0) and afterwards (T1). RESULTS: The study population comprised 81 patients (68% male). Most reactions were triggered by hake (51%), mackerel (30%), and cod (26%). The most frequent manifestations were urticaria/angioedema (72%), gastrointestinal symptoms (35%), and eczema (33%); 42% of patients experienced anaphylaxis. At T0, the average sIgE values were as follows: cod, 32.2 kUA/L; sardine, 18.4 kUA/L; hake, 17.5 kUA/L; salmon, 13.9 kUA/L; tuna, 4.5 kUA/L; and rGad c 1, 22.9 kUA/L. In patients who acquired tolerance to at least 1 fish species (n=60; 74%), the mean value of rGad c 1 at T1 (5.1 kUA/L) was significantly lower than at T0 (16.8 kUA/L) (P=.001). Significant values were also recorded for the average diameter of the SPT wheal and the evaluations at T0 and T1 for hake (9.42 mm/3.79 mm) and salmon (7.8 mm/2.8 mm) (P=.002 and P=.026, respectively). CONCLUSION: The decrease in sIgE to rGad c 1 and the mean wheal diameter of SPT for hake and salmon can be used as markers of prognosis in the acquisition of tolerance by fish-allergic patients.

Long-term persistence of anti-ß2 glycoprotein I in treated leprosy patients.

ß2 glycoprotein I (ß2GPI) is a phospholipid binding protein that plays an important role in endothelial stability, blood coagulation, clearance of apoptotic debris and other physiologic processes. Anti-ß2GPI antibodies occur in normal individuals and transiently during the course of infections, but are also associated with thrombotic events in autoimmune disease: the antiphospholipid syndrome (APS). A total of 31 out of 37 treated leprosy patients previously found to present high titers of IgM anti-ß2GPI and/or anticardiolipin antibodies (aCL) remained positive for IgM antiphospholipid antibodies (aPL), and exhibited high titers of anti-ß2GPI. The 37 patients were part of the 77 aPL-positive patients from a previous study that evaluated 158 leprosy patients. The median time elapsed between the first and second sample was 66 months. None of the 37 patients had any thrombotic event and 24 had a reactional state and were still requiring the use of prednisone, thalidomide or both. None of them fulfilled World Health Organization criteria for leprosy recurrence.

Decreased serum T3 after an exercise session is independent of glucocorticoid peak.

Physical exercise increases serum glucocorticoids, which is believed to be involved in the fall of T3 after high intensity exercise. The objective was to evaluate whether a physical exercise session alters the thyroid economy and adrenal axis in humans, and the possible role of corticosteroids in thyroid function disturbance. Active but not athlete subjects were enrolled in an open field competition and cortisol, TSH, T3, and T4 were measured before and after the race. To give new insights into the mechanisms underlying the changes in thyroid economy after exercise, we used a rat model to evaluate the impact of blocking corticosterone synthesis during treadmill exercise by metyrapone administration. Cortisol levels increased 1.5-fold (from 28.2±3.8 to 42.2±2.2 µg/dl; p<0.05), while serum T3 decreased by 13% (from 115±5 to 99±5 µg/dl; p<0.05) 6 h after the race in humans. Also, in rats, glucocorticoid increased by 2-fold while T3 decreased 15% after exercise session (p<0.05). However, the complete blockage of corticosterone peak did not impair serum T3 decrease observed in rats submitted to exercise. Interestingly, the lack of corticosterone peak led not only to lower serum T3, but also to decreased serum T4, indicating that corticosterone might be fundamental for the maintenance of serum thyroid hormone levels after high intensity exercise. Although cortisol increases and T3 decreases after high intensity exercise in both humans and rats, it does not seem to be a cause-effect response since pharmacological blockage of corticosterone peak does not modulate T3 response.

Glycogen stores are impaired in hypothalamic nuclei of rats malnourished during early life.

Perinatal nutrition has persistent influences on neural development and cognition. In humans and other animals, protein malnutrition during the perinatal period causes permanent changes, inducing to adulthood metabolic syndrome. Feeding is mainly modulated by neural and hormonal inputs to the hypothalamus. Hypothalamic glycogen stores are a source of glucose in high energetic demands, as during development of neural circuits. As some hypothalamic circuits are formed during lactation, we studied the effects of malnutrition, during the first 10 days of lactation, on glycogen stores in hypothalamic nuclei involved in the control of energy metabolism. Female pregnant rats were fed ad libitum with a normal protein diet (22% protein). After delivery, each dam was kept with 6 male pups. During the first 10 days of lactation, dams from the experimental group received a protein-free diet and the control group a normoprotein diet. By post-natal day 10 (P10), glycogen stores were very high in the arcuate nucleus and median eminence of control group. Glycogen stores decreased during development. In P20 control animals, glycogen stores were lower when compared to P10 control animals. Animals submitted to malnutrition presented a staining even lower than control ones. After P45, it was difficult to determine differences between control and diet groups because glycogen stores were reduced. We also showed that tanycytes were the cells presenting glycogen stores. Our data reinforce the concept that maternal nutritional state during lactation may be critical for neurodevelopment since it resulted in a low hypothalamic glycogen store, which may be critical for establishment of neuronal circuitry.

Parathyroid hormone administration may modulate periodontal tissue levels of interleukin-6, matrix metalloproteinase-2 and matrix metalloproteinase-9 in experimental periodontitis.

BACKGROUND AND OBJECTIVE: Intermittent administration of the parathyroid hormone (1-34) has an anabolic effect on bone and it has been shown to reduce alveolar bone loss in experimental periodontitis models. The aim of the present study was to investigate the effect of parathyroid hormone on tissue degradation-related factors in an experimental periodontitis model in rats. MATERIAL AND METHODS: Periodontitis was induced in seventy-six male Wistar rats using ligature around the lower right first molars. The animals were then treated with parathyroid hormone (1-34) (T-group) or vehicle (C-group), three times a week for 15 d (C15, T15) or 30 d (C30, T30). At each experimental time-point, the 19 rats were killed in each group and the gingival tissue around the first lower molar was removed and prepared for the following analyses: mRNA expression of interleukin-1 beta, interleukin-6, matrix metalloproteinase (MMP)-2 and MMP-9, and gelatinolytic activity of MMP-2 and MMP-9. Hemimandibles were decalcified, and serial sections were processed and analyzed for interleukin-6 immohistochemistry. Samples were also histochemically stained by tartrate-resistant acid phosphatase (TRAP) to evaluate the number of osteoclasts present. RESULTS: Parathyroid hormone-treated samples showed decreased of levels of mRNA for interleukin-6 in the T30 group (p < 0.01) and of MMP-2 in the T15 and T30 groups (p < 0.05). Zymography assays demonstrated that treatment with parathyroid hormone led to a decrease in MMP-9 activity (p < 0.01). TRAP staining of alveolar bone revealed that osteoclasts were present in higher numbers (p < 0.05) in the groups not treated with parathyroid hormone. CONCLUSION: These data suggest that intermittent administration of parathyroid hormone can down-regulate the expression of biomarkers responsible for connective tissue breakdown and bone resorption, and potentially affect alveolar bone resorption activity.

Ophthalmic artery Doppler as a measure of severe pre-eclampsia.

OBJECTIVE: To identify differences in orbital flow behavior in mild and severe pre-eclamptic women compared with healthy pregnant women, demonstrated by ophthalmic artery Doppler indexes. METHODS: Ophthalmic artery Doppler indexes of 20 mild and 20 severe pre-eclamptic women were compared with 51 healthy pregnant women. Right and left eye Doppler index means were evaluated and the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), end diastolic velocity (EDV), and peak ratio (PR) were calculated. RESULTS: Statistically significant differences were observed between PR, PSV, and EDV (P=0.0009, P=0.0020, P=0.0001) ophthalmic artery Doppler in a comparison of women with mild and severe pre-eclampsia. Statistically significant differences were seen between all Doppler indexes of the study group and healthy pregnant women. Ophthalmic PR, PSV, and EDV were significantly higher in severe pre-eclamptic cases but other index parameters did not show any difference. An elevation of diastolic and systolic flow occurred when pre-eclampsia became severe. CONCLUSION: Orbital vascular impedance reduction with orbital hyperperfusion was present in severe pre-eclamptic women compared with mild pre-eclamptic and healthy pregnant women. Ophthalmic Doppler is a novel parameter that may be useful in the diagnosis of severe pre-eclampsia.

Pro-inflammatory activities in elapid snake venoms.

1. Snake venoms from the genera Micrurus (M. ibiboboca and M. spixii) and Naja (N. naja, N. melanoleuca and N. nigricollis) were analysed, using biological and immunochemical methods, to detect pro-inflammatory activities, cobra venom factor (COF), proteolytic enzymes, thrombin-like substances, haemorrhagic and oedema-producing substances. 2. The venoms of the five snake species activate the complement system (C) in normal human serum (NHS) in a dose-related fashion, at concentrations ranging from 5 micrograms to 200 micrograms ml-1 serum. Electrophoretic conversion of C3 was observed with all venoms in NHS containing normal concentrations of Ca2+ and Mg2+, but only by venoms from N. naja and N. melanoleuca when Ca2+ was chelated by adding Mg(2+)-EGTA. 3. Purified human C3 was electrophoretically converted, in the absence of other C components, by the venoms from N. naja, N. nigricollis and M. ibiboboca. However, only the venoms from N. naja and N. melanoleuca contained a 144 kDa protein revealed in Western blot with sera against COF or human C3. 4. All venoms, at minimum concentrations of 30 ng ml-1, were capable of lysing sheep red blood cells, also in a dose-related fashion, when incubated with these cells in presence of egg yolk as a source of lecithin. Although the venoms from M. spixii and N. nigricollis showed detectable thrombin-like activity, these and the other venoms were free of proteolytic activity when fibrin, gelatin and casein, were used as substrates. 5. When tested on mice skin, all five venoms were capable of inducing an increase in vascular permeability and oedema, but were devoid of haemorrhagic producing substances (haemorrhagins). 6. These data provide evidence indicating that Elapidae venoms contain various pro-inflammatory factors which may be important in the spreading of neurotoxins throughout the tissues of the prey or human victim.

Biotransformation of the diperpenoid, isosteviol, by Aspergillus niger, Penicillium chrysogenum and Rhizopus arrhizus.

The biotransformation of isosteviol (ent-16-ketobeyeran-19-oic acid) by three fungi is described. Aspergillus niger produced the 7 beta-OH derivative, ent-7 alpha-hydroxy-16-ketobeyeran-19-oic, and the 1 alpha, 7 beta-diOH derivative, ent-1 beta, 7 alpha-dihydroxy-16-ketobeyeran-19-oic acid. The 17-OH compound, ent-17-hydroxy-16-ketobeyeran-19-oic acid, was obtained with Penicillium chrysogenum. Rhizopus arrhizus produced the 7 beta-OH derivative, ent-7 alpha-hydroxy-16-ketobeyeran-19-oic acid. The isolated metabolites were characterised by IR, NMR and MS.

Phospholipase A2 injection in mice induces immunity against the lethal effects of Crotalus durissus terrificus venom.

Phospholipase A2, purified from crotoxin obtained from C. d. terrificus venom, alone or incorporated in Freund's complete adjuvant (FCA) or in Al(OH)3 was used as an antigen to immunize mice against the lethal effects of C. d. terrificus venom. The animals were intracutaneously (i.c.) or subcutaneously (s.c.) injected with 60 micrograms of phospholipase A2, divided into three equal doses and injected every 7 days. Samples of blood were collected just before each injection and the sera used to determine the antibodies against whole venom by the ELISA method. The animals were s.c. challenged with 8 LD50 or with 16 LD50 28 or 95 days after immunization. The animals that received two s.c. doses of antigen followed by a third i.c. dose were partially resistant to 8 LD50 (58% protection). This resistance increased when the first two injections consisted of phospholipase A2, the third of whole venom, all i.c., all in Al(OH)3 (67% of protection). The maximal protection (90%) was attained when the animals were i.c. injected with phospholipase A2 in Al(OH)3 in all three immunizing doses. Antibodies against whole venom were detected 15 days after immunization, reaching a plateau on the twenty-eighth day and remaining unchanged at least until the ninety-fifth day after immunization.

[Characterization of the biological activities of the 'yellow' and 'white' venoms from Crotalus durissus ruruima compared with the Crotalus durissus terrificus venom. Neutralizing activity of Crotalus durissus ruruima antivenins]. / Caracterizacion de las actividades biologicas de los venenos 'amarillo' y 'blanco' de Crotalus durissus ruruima comparados con el veneno de Crotalus durissus terrificus. Poder neutralizante de los antivenenos frente a los venenos de Crotalus durissus ruruima.

The biological activities of 'yellow' and 'white' venom of a rattlesnake Crotalus durissus ruruima Hoge, 1965, found in the savanna-like vegetation (cerrado) of northern Brazil (Roraima) and Venezuela have been studied, and compared to the reference Crotalus durissus terrificus venom. The lethal activity of venoms depended on the inoculation route. The most toxic venom was the white one. The venoms of C. d. terrificus and the yellow of C. d. ruruima had similar lethalities. The yellow venom of C. d. ruruima showed a caseinolytic activity three times higher than that obtained with either the venom of C. d. terrificus or the white one of the C. d. ruruima. Hemorrhagic and necrotic activities were found only in the yellow venom. White and yellow venoms from C. d. ruruima showed a similar action on fibrinogen; this thrombin-like action was greater with C. d. terrificus venom. On histopathological sections local and pulmonary hemorrhage was found only with the yellow venom, but myonecrotic activity was observed with both venoms of C. d. ruruima. Among all antivenoms studied, the anti-bothropic-crotalic was the best at neutralizing hemorrhagic and hemolytic activities. These results suggest that antivenom bothropic-crotalic should be used in the treatment of patients with snakebite by C. d. ruruima: besides its neutralization on lethal activity, it also neutralizes the hemorrhagic activity present in some venoms.

Local effects induced by venoms from five species of genus Micrurus sp. (coral snakes).

Venoms from five species of Micrurus (coral snakes) from Brazil (Amazonas State) were tested for the following effects: edematogenic, myotoxic, coagulant, hemorrhagic and phospholipase A2 (PLA2) detection. None of the venoms tested presented coagulant activity. The presence of PLA2 was detected by ELISA in the venoms of M. spixii, M. averyi and M. lemniscatus. The myotoxicity was estimated by the increase in the serum creatine kinase level and by histological analysis. All venoms, except that from M. surinamensis, induced intense edematogenic and myotoxic effects. The venom of M. averyi showed hemorrhagic activity which was confirmed by histopathological analysis. This is the first evidence of such an effect by coral snake venom.

Biochemical and pharmacological similarities between the venoms of newborn Crotalus durissus durissus and adult Crotalus durissus terrificus rattlesnakes.

A comparative study was performed with the venoms of newborn Crotalus durissus durissus, adult Crotalus durissus terrificus and adult Crotalus durissus durissus snakes. Venom of newborn specimens of C.d. durissus is very similar to that of adult specimens of C.d. terrificus, since they have strong lethal and myotoxic activities, and weak proteolytic, hemorrhagic and edema-forming effects, in contrast to venom of adult specimens of C.d. durissus. In addition, the two former venoms have high amounts of the neurotoxic complex crotoxin, whereas venom from adult C.d. durissus has a low concentration of crotoxin. Electrophoretic analysis corroborates the strong similarities between the former two venoms. It is concluded that venom of newborn C.d. durissus contains high concentrations of crotoxin and low amounts of hemorrhagic and proteolytic components, and that a drastic ontogenetic change takes place in the venom composition of this subspecies.

Purification of F(ab')2 anti-snake venom by caprylic acid: a fast method for obtaining IgG fragments with high neutralization activity, purity and yield.

Pooled horse plasma containing antibodies against Crotalus durissus terrificus whole venom were digested with pepsin at an enzyme-substrate ratio of 8:1, pH 3.1, for 40 min and the F(ab')2M fragments purified by adding 8.7% caprylic acid (pH 5.0). For comparison, F(ab')2B purified by precipitation with ammonium sulphate and uncleaved IgG purified with caprylic acid were also prepared. Fab' fragments were obtained by reduction and alkylation of F(ab')2B. The anti-whole C.d. terrificus venom titers, determined by Dot-Blot were 12,800 (IgG), 6400 [F(ab')2B], 4800 [F(ab')2M] and 3200 (Fab'B). Immunochemical analysis of these fragments by SDS gel electrophoresis, Western blot and by double immunodiffusion revealed that the solution containing F(ab')2M was free of IgG and of other plasma proteins, whereas that containing F(ab')2B was not. One milligram of either F(ab')2B, F(ab')2M or Fab'B was able to neutralize respectively 20.7 micrograms, 20.2 micrograms and 13.8 micrograms of C.d. terrificus venom.

Snake antivenoms from hyperimmunized horses: comparison of the antivenom activity and biological properties of their whole IgG and F(ab')2 fragments.

IgG and F(ab')2 fragments were prepared from horse plasma rich in specific antibodies against Brazilian Bothrops or Crotalus venoms. Both preparations, free of gross contamination with non-immunoglobulin proteins, were able to combine in vitro with their respective antigens, forming immune complexes at antigen excess, equivalence or antibody excess, and activating the C system, through either the classical or the alternative pathways. The IgG preparation was more effective in neutralizing the lethal factors in Bothrops or Crotalus venoms, compared with the F(ab')2 fragments. In contrast, IgG and F(ab')2 anti-Bothrops venom were almost equipotent in neutralizing the haemorrhagic and defibrinating activities in the venom. The method used to purify IgG, precipitation of most non-immunoglobulin plasma proteins with caprylic acid, produced antivenoms richer in specific antibodies, with higher specific activity, recovery and yield, compared with the method commonly used to prepare antivenoms containing F(ab')2.

Susceptibility of different strains of mice to South American rattlesnake (Crotalus durissus terrificus) venom: correlation between lethal effect and creatine kinase release.

In the present work we report that susceptibility to Crotalus durissus terrificus venom: varies according to the strain of inbred mouse used. The s.c. LD50 for Balb/c and C57BI/6 mice were 193 micrograms/kg and 171 micrograms/kg, whereas for A/J and DBA/J they were 78 micrograms/kg and 74 micrograms/kg, respectively. In addition, a direct correlation between susceptibility to C. d. terrificus venom and creatine kinase serum levels (CK) was observed.

Antigenic cross-reactivity among the venoms from several species of Brazilian scorpions.

The venoms of seven species of scorpions living in different regions of Brazil were analysed with regard to their lethality, antigenic cross-reactivity and ability to induce antibody production. In mice, the tested scorpion venoms can be grouped as: (a) highly toxic: Tityus stigmurus Thorell (LD50 = 0.773 mg/kg), Tityus bahiensis (Perty) (LD50 = 1.062 mg/kg), Tityus serrulatus Lutz and Mello (LD50 = 1.160 mg/kg), and Tityus costatus (Karsch) (LD50 = 1.590 mg/kg); (b) moderately toxic: Tityus cambridgei Pocock (LD50 = 12.136 mg/kg); and (c) practically nontoxic: Rhopalurus agamemnon (Koch) (LD50 = 36.363 mg/kg), and Brotheas amazonicus Lourenço (LD50 = 90.909 mg/kg). On electrophoresis the venoms showed many protein bands displayed along the chromatogram, most of them cross-reacting in immunoelectrophoresis and immunoblotting using horse anti-T. serrulatus, anti-T. bahiensis or anti-T. serrulatus+T. bahiensis sera as probes. The antibodies present in these antivenoms combine with venom components as measured in vitro by the ELISA assay, and neutralize their lethal effects in vivo. These results indicate that horse anti-venoms against a mixture of T. serrulatus and T. bahiensis venoms or only against T. serrulatus venom yield an antibody population able to neutralize the toxic effects found in all venoms studied.

Antigenic cross-reactivity of venoms obtained from snakes of genus Bothrops.

Antigenic cross-reactivity was studied among the components of venoms from nine species of the genus Bothrops using species-specific antivenoms. Sera titration by DOT-ELISA detected similar levels of antibody when either homologous or heterologous antigens were used. Transblotted antigens, after SDS-PAGE fractionation, were also revealed by homologous and heterologous antivenoms. Antigens with mol. wt greater than 30,000 seemed to be the most cross-reactive. Antigens of about 24,000 mol. wt were poorly immunogenic. Antigens between 14-18,000 mol. wt cross-reacted only with B. moojeni, B. jararacussu, B. neuwiedi and B. pradoi venoms. Neutralization of the lethality of B. jararaca venom was observed by homologous and heterologous antivenoms.

Immunization of equines with phospholipase A2 protects against the lethal effects of Crotalus durissus terrificus venom.

Equines (2 horses and 2 donkeys) immunized with whole Crotalus durissus terrificus venom or its phospholipase A2 component either presented an increased survival time determined 3 days after challenge or were totally resistant to a challenging lethal dose of 200 mg crude venom 270 days after the initial immunization or 90 days after the last booster injection. The resistance was demonstrable on the basis of a good correlation with antibody titers determined by the ELISA method but not with the flocculation and neutralization assays. Since phospholipase A2 is essentially nontoxic, it can be used as a substitute for whole venom for the production of commercial antisera and as an immunizing agent in prophylactic programs.