Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients.

BACKGROUND: Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. METHODS: This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). RESULTS: The median age of the model-derivation cohort was 59 (IQR 47-70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918-0.939) and validation (temporal AUROC 0.927, 95% CI 0.911-0.941; geographic AUROC 0.819, 95% CI 0.792-0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ). CONCLUSIONS: The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation.

Extracorporeal membrane oxygenation outcomes in COVID-19 patients: Case series from the Brazilian COVID-19 Registry.

Around 5% of coronavirus disease 2019 (COVID-19) patients develop critical disease, with severe pneumonia and acute respiratory distress syndrome (ARDS). In these cases, extracorporeal membrane oxygenation (ECMO) may be considered when conventional therapy fails. This study aimed to describe the clinical characteristics and in-hospital outcomes of COVID-19 patients with ARDS refractory to lung-protective ventilation and prone positioning on ECMO support, as well as to review the available literature on ECMO use and COVID-19 patients' outcome. Patients from this case series were selected from the Brazilian COVID-19 Registry. From the 7646 patients included in the registry, only eight received ECMO support (0.1%), in four hospitals. The median age of the entire sample was 59 (interquartile range 54.2-64.4) years old and 87.5% were male. Hypertension (50.0%), diabetes mellitus (50.0%) and obesity (37.5%) were the most frequent comorbidities. The indications for ECMO were PaO2 /FiO2 ratio <80 mm Hg for more than 6 h or PaO2 /FiO2 ratio <60 mm Hg for more than 3 h. The mortality rate was 87.5%. In conclusion, in this case series of COVID-19 patients with ARDS refractory to conventional therapy who received ECMO support, a very high mortality was observed. Our findings are not different from previous studies including a small number of patients; however, there is a huge difference from Extracorporeal Life Support Organization results, which encourages us to keep looking for improvement.

Molecular identification and microscopic characterization of poxvirus in a Guiana dolphin and a common bottlenose dolphin, Brazil.

The poxviruses identified in cetaceans are associated with characteristic tattoo or ring skin lesions. However, little is known regarding the prevalence and progression of these lesions and the molecular characterization of cetacean poxviruses in the Southern Hemisphere. This manuscript describes the progression of poxvirus-like skin lesions in 5 free-ranging Guiana dolphins Sotalia guianensis. Additionally, 151 skin samples from 113 free-ranging cetaceans from Brazil, including 4 animals with tattoo skin lesions, were selected for poxvirus testing. Poxviral DNA polymerase gene PCR amplification was used to detect the virus in ß-actin-positive samples (145/151). DNA topoisomerase I gene PCR was then used in Cetaceanpoxvirus (CePV)-positive cases (n = 2), which were further evaluated by histopathology and electron microscopy. Based on photo-identification, adult Guiana dolphins presented regressing or healed poxvirus-like lesions (2/2), while juveniles presented persistent (2/3) or healed and progressive lesions (1/3). CePV DNA was amplified in a common bottlenose dolphin Tursiops truncatus and in a Guiana dolphin. Intracytoplasmic inclusion bodies and viral particles consistent with poxvirus were identified by histology and electron microscopy, respectively. CePV-specific amino acid motifs were identified through phylogenetic analysis. Our findings corroborate previous studies that suggest the placement of poxviruses from cetaceans within the novel CePV genus. This is the first molecular identification of poxvirus in South American odontocetes.

Antimicrobial Effects of Violacein against Planktonic Cells and Biofilms of Staphylococcus aureus.

Violacein is an indole compound, produced by Chromobacterium violaceum, a bacteria present in tropical and subtropical areas. Among its numerous biological activities, its antimicrobial potential stands out. This study aims to determine the antimicrobial activity of VIO on S. aureus in planktonic culture and biofilms. VIO showed excellent antimicrobial activity in inhibiting and killing S. aureus in planktonic cultures and biofilm formation. The minimum bactericidal concentration (5 µg/mL) of VIO caused the death of S. aureus after 3-4 h of exposure and the minimum inhibitory concentration (1.25 µg/mL) of VIO inhibited bacterial growth within the first 8 h of contact. Biofilm formation was also strongly inhibited by VIO (1.25 µg/mL), in contrast to the higher resistance verified for S. aureus in mature biofilm (40 µg/mL). The high bacterial metabolic activity favored VIO activity; however, the good activity observed during phases of reduced metabolism indicates that VIO action involves more than one mechanism. Thus, VIO is a promising molecule for the development of an antimicrobial drug for the eradication of S. aureus infections.

Diagnoses and Treatment of Dental Disorders in a Research Colony of Macaca fascicularis: A Case Series.

During daily routine oral examinations in a research colony of nonhuman primates (NHPs, Macaca fascicularis), a variety of oral-dental lesions were identified. A dental care program was established based on these findings. Based on the presence of dental clinical signs and their severity, 31 animals were triaged to be examined and treated by a veterinarian. Clinical examination consisted of visual inspection using a periodontal probe/explorer and full or partial mouth dental radiographs. Treatment was performed during the same procedure. Some animals had a follow-up examination including radiographs months later. Four common dental diseases were diagnosed: periodontal disease, caries, tooth fracture, and tooth attrition. Less frequent were dental abscess, enamel hypomineralization, gingival hyperplasia, hypercementosis, tooth luxation, tooth dysplasia, root resorption, abrasion. Less severe periodontal disease was treated conservatively. If severely affected, teeth were extracted. Well-circumscribed caries without endodontic involvement were treated by composite restoration. Teeth with extensive caries and pulp involvement were extracted. Teeth with exposed pulp were treated via extraction or orthograde root canal treatment. In this case series, 27 (87%) of 31 NHPs exhibited at least 1 moderate to severe dental lesion that required treatment. The presumable improvement in welfare and weight of oral/dental lesions for the overall health status in research NHPs encourages us to continue this program prospectively.

Cultural Influences on Toddlers' Prosocial Behavior: How Maternal Task Assignment Relates to Helping Others.

This cross-cultural study investigates how maternal task assignment relates to toddlers' requested behavior and helping between 18 and 30 months. One hundred seven mother-child dyads were assessed in three different cultural contexts (rural Brazil, urban Germany, and urban Brazil). Brazilian mothers showed assertive scaffolding (serious and insistent requesting), whereas German mothers employed deliberate scaffolding (asking, pleading, and giving explanations). Assertive scaffolding related to toddlers' requested behavior in all samples. Importantly, assertive scaffolding was associated with toddlers' helping in rural Brazil, whereas mothers' deliberate scaffolding related to toddlers' helping behavior in urban Germany. These findings highlight the role of caregivers' socialization practices for the early ontogeny of helping behavior and suggest culture-specific developmental pathways along the lines of interpersonal responsibility and personal choice.

Non-invasive meat quality assessment: Exploring the potential of ocular infrared thermography to predict ultimate pH in Nellore beef cattle.

This study investigated the use of infrared thermography (IRT) to identify the dark, firm, and dry (DFD) phenomenon in Brazilian beef, which is a significant concern for the industry because of its inferior quality and reduced shelf life. This study examined 113 Nellore bulls and analyzed their minimum and maximum ocular temperatures using IRT. The results highlight the efficacy of thermal images (IRTmax) as a significant predictor, with R2 values ranging from 0.84 to 0.88 for calibration models. The inclusion of parameters such as glucose and lactate further enhanced prediction accuracy. The models also revealed that the combination of features, such as lightness (L*), redness (a*), and yellowness (b*), contributed to the precise prediction of pHu, with an R2 of 0.88. In model validation, RMSEP ranged from 0.104 to 0.158, indicating good generalization capability. The RPD, ranging from 1.7 to 2.6, suggests satisfactory quantitative prediction. The statistical significance of all models, evidenced by P-values <0.001, strengthens the reliability of the results. In conclusion, the models support the use of IRT as a tool for identifying pHu alterations in carcasses. When combined with blood parameters, they may exhibit even greater efficiency in predicting pHu in Nelore cattle carcasses, highlighting the potential applicability of these methods in the beef industry.

Randomized comparison of oblique and perpendicular stabilizers for minimally invasive repair of pectus excavatum.

OBJECTIVES: Bar dislocation is one of the most feared complications of the minimally invasive repair of pectus excavatum. METHODS: Prospective randomized parallel-group clinical trial intending to assess whether oblique stabilizers can reduce bar displacement in comparison with regular stabilizers used in minimally invasive repair of pectus excavatum. Additionally, we evaluated pain, quality of life and other postoperative complications. Participants were randomly assigned to surgery with perpendicular (n = 16) or oblique stabilizers (n = 14) between October 2017 and September 2018 and followed for 3 years. Bar displacements were evaluated with the bar displacement index. Pain scores were evaluated through visual analogue scale and quality of life through the Pectus Excavatum Evaluation Questionnaire. RESULTS: Control group average displacement index was 17.7 (±26.7) and intervention group average displacement index was 8.2 (±10.9). There was 1 reoperation in each group that required correction with 2 bars. Bar displacement was similar among groups (P = 0.12). No other complications were recorded. There was no statistically significant difference on pain score. There was a significant difference between pre- and postoperative composite scores of the participants' body image domain and psycho-social aspects in both groups. The difference between the pre- and postoperative participants' perception of physical difficulties was greater and statistically significant in the intervention group. CONCLUSIONS: There was no statistical difference in the use of perpendicular or oblique stabilizers, but the availability of different models of stabilizers during the study suggested that this can be advantageous. The trial is registered at ClinicalTrials.gov, number NCT03087734.

Enhancing Weaned Piglet Health and Performance: The Role of Autolyzed Yeast (Saccharomyces cerevisiae) and ß-Glucans as a Blood Plasma Alternative in Diets.

The objective of this study was to evaluate the inclusion of the autolyzed yeast (AY) Saccharomyces cerevisiae with or without an immunomodulator (1,3/1,6 ß-glucans) as a total/partial substitute for blood plasma (BP) in the diet of post-weaning piglets; zootechnical performance, intestinal health and microbiota, immune responses and energy metabolism were assessed. A total of 240 castrated male and female piglets, with a mean age of 22 days and mean initial weight of 5.24 ± 0.82 kg, were randomly divided into blocks of four treatments with 12 replicates. The dietary inclusions were blood plasma (BP), autolyzed yeast (AY), autolyzed yeast + immunomodulator (AYI) and 50% BP and 50% AY (BPAY). In pre-initial phase II (29-35 days), piglets fed AY showed better feed conversion (FCR = 1.358) than the piglets in the BP (1.484), AYI (1.379) and BPAY (1.442) groups, i.e., 8.49% (0.126), 1.52% (0.021) and 4.50% (0.084), respectively (p = 0.0293). In the total period (21-42 days), better FCR was observed in the AYI (1.458) group, i.e., 4.64% (0.071), 1.15% (0.017) and 4.58% (0.070), than in the BP (1.529), AY (1.475) and BPAY (1.528) groups, respectively (p = 0.0150). In piglets fed AY (n = 3) and BPAY (n = 2), there was a reduction in the number of medications, i.e., 82.35% (-14n) and 88.23% (-15n), respectively (p = 0.0001), compared with that in the BP group (n = 17). In the AY group (73.83 mg/dL), AYI group (69.92 mg/dL), and BPAY group (69.58 mg/dL), piglets exhibited increases in triglyceride levels of 79.32%, 69.83%, and 69.00%, respectively, in comparison to those in the BP group, which had triglyceride levels of 41.17 mg/dL (p = 0.0400). The beta-hydroxybutyrate concentration in the AY group (79.96 ng/µL) was lower by 31.95%, 22.64%, and 5.89% compared to the BP group (117.50 ng/µL), AYI group (103.36 ng/µL), and BPAY group (84.67 ng/µL), respectively (p = 0.0072). In the AYI group, there was modulation of the microbiota, with an increase in the relative abundance of bacteria of the genera Lactobacillus, Collinsella and Bulleidia. AY, associated or not associated with an immunomodulator, is a potential substitute for BP in diets for piglets in the nursery phase, with positive effects on immune, metabolic, and intestinal microbial performance.

Palliative care and COVID-19: acknowledging past mistakes to forge a better future.

Context: COVID-19 induces complex distress across physical, psychological, and social realms and palliative care (PC) has the potential to mitigate this suffering significantly. Objectives: To describe the clinical characteristics and outcomes of COVID-19 patients with an indication of PC, compared to patients who had no indication, in different pandemic waves. Methods: This retrospective multicenter observational cohort included patients from 40 hospitals, admitted from March 2020 to August 2022. Patients who had an indication of palliative care (PC) described in their medical records were included in the palliative care group (PCG), while those who had no such indication in their medical records were allocated to the non-palliative care group (NPCG). Results: Out of 21,158 patients, only 6.7% had indication for PC registered in their medical records. The PCG was older, had a higher frequency of comorbidities, exhibited higher frailty, and had a higher prevalence of clinical complications and mortality (81.4% vs. 17.7%, p < 0.001), when compared to the NPCG. Regarding artificial life support, the PCG had a higher frequency of dialysis (20.4% vs. 10.1%, p < 0.001), invasive mechanical ventilation (48.2% vs. 26.0%, p < 0.001) and admission to the intensive care unit (53.6% vs. 35.4%, p < 0.001). These differences were consistent across all three waves. Conclusion: A low proportion of patients received PC. Patients in PCG were more fragile, had more clinical complications, and had a higher mortality. On the contrary to our expectations, they received more artificial life support in all three waves. Taken together, these findings suggest that decisions regarding PC indication were made too late, within a context of end-of-life and therapeutic failure.

Euglena gracilis ß-Glucans (1,3): Enriching Colostrum of Sow for Enhanced Piglet Immunity.

The effects of supplementing the diet of sows with ßG-(1,3) derived from Euglena gracilis algae were assessed regarding quality and amount of colostrum as well as performance of piglets. A total of 120 sows (first (nulliparous) to sixth parity (multiparous)) from D85 of gestation until weaning were divided into two groups: the control diet group (n = 60) and the ßG-(1,3) diet group (n = 60). Sows receiving ßG-(1,3) exhibited an average increase of 870 g (24.9%) in colostrum production, leading to a 25.17% higher intake of colostrum by piglets. Furthermore, piglets in the ßG-(1,3) group showed significantly superior weight gain of 34 g (50%) compared to the control group 18 h after birth (p < 0.05). Sows fed with ßG-(1,3) produced colostrum with significantly higher concentrations of IgG (5.914 mg/mL, 16.16%) and IgM (0.378 mg/mL, 16.29%) than the control group (p < 0.05). Similarly, serum concentrations of IgG (13.86 mg/mL, 51.25%), IgA (17.16 mg/mL, 120.19%), and IgM (13.23 mg/mL, 144.78%) were significantly higher in sows fed with ßG-(1,3) than in the control group (p < 0.05). Supplementing sows with ßG-(1,3) derived from the Euglena gracilis algae resulted in increased colostrum production and consumption, along with greater weight gain in piglets during the first 18 h after birth. Additionally, both the colostrum produced by the sows and the blood serum of the piglets exhibited higher concentrations of immunoglobulins.

Capsaicin and 1,25-Dihydroxyvitamin D3 Glycoside: Effects on the Reproductive Performance of Hyper-Prolific Sows.

This study evaluated the effect of a natural source of vitamin D3 [1,25-(OH)2D3] and capsaicin (CAP) in the dietary supplementation of sows in the final phase (85-114 days) of gestation (Gest) and lactation (Lact) on the reproductive performance of the sows and health of piglets through two experiments (Exp I and II). In Exp I, 120 sows were subjected to four treatments: T1-control (without [1,25-(OH)2D3] and supplemental CAP); T2-3.5 µg 1,25-(OH)2D3/Gest/day and 7.0 µg Vit 1,25-(OH)2D3/Lact/day; T3-7.0 µg CAP/Gest/day and 14.0 µg CAP/Lact/day; T4-1.75 µg Vit 1,25-(OH)2D3 + 3.5 µg CAP/Gest/day and 3.5 µg 1,25-(OH)2D3 + 7.0 µg CAP/Lact/day. In Exp II, 200 sows were randomly blocked, factorial 2 × 2 (without or with Vit 1,25-(OH)2D3 and without or with CAP): T1-control (without Vit 1,25-(OH)2D3 and CAP); T2-3.5 µg Vit 1,25-(OH)2D3/Gest/day and 7.0 µg Vit 1,25-(OH)2D3/Lact/day; T3-7.0 µg CAP/Gest/day and 14.0 µg CAP/Lact/day; T4-3.5 µg Vit 1,25-(OH)2D3 + 7 µg CAP/Gest/day; and 7.0 µg Vit 1,25-(OH)2D3 + 14.0 µg CAP/Lact/day. The duration of delivery (3:48 vs. 4:57 h) and the percentage of stillbirths (5.37% vs. 7.61%) were improved (p < 0.05) in the group that received Vit 1,25-(OH)2D3 (Exp II) compared to the control group. Moreover, the dystocia rate decreased (p < 0.05) in Exp II, which received Vit 1,25-(OH)2D3 (4.21 vs. 27.63%), and in Exp I, which received the combination of Vit 1,25-(OH)2D3 + CAP (12 vs. 40%) compared to the respective control groups. Colostrum production was greater (p < 0.05) in sows that received Vit 1,25-(OH)2D3 supplementation compared to the control group, consequently resulting in higher colostrum intake (p < 0.05) of the piglets (330 vs. 258 g/piglet). The additives reduced the incidence of diarrhea (p < 0.05) in piglets (Exp I and II). Thus, the use of additives improved the reproductive performance of sows and contributed to litter growth.

Pharmacological Modulation by Low Molecular Weight Heparin of Purinergic Signaling in Cardiac Cells Prevents Arrhythmia and Lethality Induced by Myocardial Infarction.

BACKGROUND: Although several studies suggest that heparins prevent arrhythmias caused by acute myocardial infarction (AMI), the molecular mechanisms involved remain unclear. To investigate the involvement of pharmacological modulation of adenosine (ADO) signaling in cardiac cells by a low-molecular weight heparin (enoxaparin; ENOX) used in AMI therapy, the effects of ENOX on the incidences of ventricular arrhythmias (VA), atrioventricular block (AVB), and lethality (LET) induced by cardiac ischemia and reperfusion (CIR) were evaluated, with or without ADO signaling blockers. METHODS: To induce CIR, adult male Wistar rats were anesthetized and subjected to CIR. Electrocardiogram (ECG) analysis was used to evaluate CIR-induced VA, AVB, and LET incidence, after treatment with ENOX. ENOX effects were evaluated in the absence or presence of an ADO A1-receptor antagonist (DPCPX) and/or an inhibitor of ABC transporter-mediated cAMP efflux (probenecid, PROB). RESULTS: VA incidence was similar between ENOX-treated (66%) and control rats (83%), but AVB (from 83% to 33%) and LET (from 75% to 25%) incidences were significantly lower in rats treated with ENOX. These cardioprotective effects were blocked by either PROB or DPCPX. CONCLUSION: These results indicate that ENOX was effective in preventing severe and lethal arrhythmias induced by CIR due to pharmacological modulation of ADO signaling in cardiac cells, suggesting that this cardioprotective strategy could be promising in AMI therapy.

Potential and limitations of machine meta-learning (ensemble) methods for predicting COVID-19 mortality in a large inhospital Brazilian dataset.

The majority of early prediction scores and methods to predict COVID-19 mortality are bound by methodological flaws and technological limitations (e.g., the use of a single prediction model). Our aim is to provide a thorough comparative study that tackles those methodological issues, considering multiple techniques to build mortality prediction models, including modern machine learning (neural) algorithms and traditional statistical techniques, as well as meta-learning (ensemble) approaches. This study used a dataset from a multicenter cohort of 10,897 adult Brazilian COVID-19 patients, admitted from March/2020 to November/2021, including patients [median age 60 (interquartile range 48-71), 46% women]. We also proposed new original population-based meta-features that have not been devised in the literature. Stacking has shown to achieve the best results reported in the literature for the death prediction task, improving over previous state-of-the-art by more than 46% in Recall for predicting death, with AUROC 0.826 and MacroF1 of 65.4%. The newly proposed meta-features were highly discriminative of death, but fell short in producing large improvements in final prediction performance, demonstrating that we are possibly on the limits of the prediction capabilities that can be achieved with the current set of ML techniques and (meta-)features. Finally, we investigated how the trained models perform on different hospitals, showing that there are indeed large differences in classifier performance between different hospitals, further making the case that errors are produced by factors that cannot be modeled with the current predictors.

Characteristics of whistles from rough-toothed dolphins (Steno bredanensis) in Rio de Janeiro coast, southeastern Brazil.

There is no information about the whistles of rough-toothed dolphins in the South Atlantic Ocean. This study characterizes the whistle structure of free-ranging rough-toothed dolphins recorded on the Rio de Janeiro coast, southeastern Brazil, and compares it to that of the same species in other regions. A total of 340 whistles were analyzed. Constant (N = 115; 33.8%) and ascending (N = 99; 29.1%) whistles were the most common contours. The whistles recorded had their fundamental frequencies between 2.24 and 13.94 kHz. Whistles without inflection points were frequently emitted (N = 255; 75%). Some signals presented breaks or steps in their contour (N = 97; 28.5%). Whistle duration was short (347 ± 236 ms and 89.7% of the whistles lasted <600 ms). Seventy-eight whistle contour types were found in the total of whistles analyzed, and 27 (7.9%) of these occurred only once. Most of the whistle types were unique to a particular recording session (N = 43). The signals emitted by the rough-toothed dolphins in southeastern Brazil were characterized by low frequency modulation, short duration, low number of inflection points, and breaks. Differences in the mean values of the whistle parameters were found between this and other studies that recorded Steno bredanensis, but as in other localities, whistles above 14 kHz are rare.

Increasing Doses of Bacterial Phytase (Citrobacter braakii) Improves Performance and Carcass Characteristics of Pigs in Growing and Finishing Phases.

The effects of increasing doses of bacterial phytase (Citrobacter braakii) on performance and carcass characteristics of growing-finishing pigs was evaluated. A total of 120 barrows weighing 25.16 ± 2.80 kg and 68 days old were submitted to five treatments: positive control diet (PC) containing inorganic phosphorus (P) and limestone (Ca); negative control (NC) with reductions in P (by 0.13%) and Ca (by 0.11%); and three NC diets supplemented with 1500 (NC15), 3000 (NC30) and 4500 (NC45) units of phytase (FYT)/kg. The daily weight gain (DWG) in growth phase I (68-91 days) was higher in the PC, NC15 and NC30, compared to the NC (1.06, 1.06, 1.06 vs. 0.95, respectively). The DWG in finishing phase II (141-156 days) was higher in the NC15 (1.20 kg) and NC30 (1.14 kg) than in the NC45 (0.94 kg). The final weights (LW156) in the NC15 (122.95 kg LW) were higher than NC (116.47 kg LW) and NC45 (114.43 kg LW). Over the entire period, a quadratic effect (2012 FYT) was observed for the DWG. The increasing levels of phytase in corn and soybean meal-based diets improved the DWG and carcass traits; however, the addition of more than 3000 FYT/kg of feed should be carefully studied to determine enzyme viability.

Quality of life outcomes after minimally invasive repair of pectus excavatum utilizing a new set of metallic bars and stabilizers.

BACKGROUND/PURPOSE: The aim of the study was to evaluate the postoperative quality of life (QoL) of patients who underwent minimally invasive repair of pectus excavatum (MIRPE) with a newly designed bar and bar stabilizers. METHODS: We conducted a prospective randomized study in which patients were operated either with standard perpendicular stabilizers (control group) or with the newly designed oblique stabilizers (intervention group). All patients were evaluated 6 months after the operation with the Pectus Excavatum Evaluation Questionnaire (PEEQ). RESULTS: There were 16 patients in the control group and 14 in the intervention group. Mean age was 17 (SD: 3.3, range 14-27) years. There were no demographic differences between groups. Two patients in the control group and one in the intervention group were repaired with two bars instead of one. There was one reoperation in each group. There was a significant difference between the pre- and postoperative scores, in both groups, in the patient body image domain (control group: 9.5 to 3; p < 0.01; intervention group 10 to 3; p < 0.01), as well as in the psychosocial domain (control group: 13.5 to 24, p < 0.01; intervention group: 15 to 24, p < 0.01). With regards to the patients' perception of physical difficulties before and after MIRPE, the difference between pre- and postoperative scores was greater in the intervention group (8 to 12, p < 0.01) than in the control group (10 to 11, p = 0.04). The mean length of stay was 4.5 and 5 days in the intervention group and the control group, respectively. CONCLUSION: Our study showed that patients who underwent MIRPE with the newly designed bars and stabilizers had non-inferior outcomes than patients reported in the literature who underwent MIRPE with standard bars and stabilizers. We found slightly better outcomes in patients in the intervention group compared to the control group, but larger studies will be needed to confirm if those differences are statistically significant. LEVEL OF EVIDENCE: II.

Chagas disease and SARS-CoV-2 coinfection does not lead to worse in-hospital outcomes.

Chagas disease (CD) continues to be a major public health burden in Latina America. Information on the interplay between COVID-19 and CD is lacking. Our aim was to assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Consecutive patients with confirmed COVID-19 were included from March to September 2020. Genetic matching for sex, age, hypertension, diabetes mellitus and hospital was performed in a 4:1 ratio. Of the 7018 patients who had confirmed COVID-19, 31 patients with CD and 124 matched controls were included (median age 72 (64-80) years-old, 44.5% were male). At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p < 0.05). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). In-hospital management, outcomes and complications were similar between the groups. In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation.

Comparative Immunopathology of Cetacean morbillivirus Infection in Free-Ranging Dolphins From Western Mediterranean, Northeast-Central, and Southwestern Atlantic.

Cetacean morbillivirus (CeMV; Paramyxoviridae) causes epizootic and interepizootic fatalities in odontocetes and mysticetes worldwide. Studies suggest there is different species-specific susceptibility to CeMV infection, with striped dolphins (Stenella coeruleoalba), bottlenose dolphins (Tursiops truncatus), and Guiana dolphins (Sotalia guianensis) ranking among the most susceptible cetacean hosts. The pathogenesis of CeMV infection is not fully resolved. Since no previous studies have evaluated the organ-specific immunopathogenetic features of CeMV infection in tissues from infected dolphins, this study was aimed at characterizing and comparing immunophenotypic profiles of local immune responses in lymphoid organs (lymph nodes, spleen), lung and CNS in CeMV-molecularly (RT-PCR)-positive cetaceans from Western Mediterranean, Northeast-Central, and Southwestern Atlantic. Immunohistochemical (IHC) analyses targeted molecules of immunologic interest: caspase 3, CD3, CD20, CD57, CD68, FoxP3, MHCII, Iba1, IFNγ, IgG, IL4, IL10, lysozyme, TGFß, and PAX5. We detected consistent CeMV-associated inflammatory response patterns. Within CNS, inflammation was dominated by CD3+ (T cells), and CD20+ and PAX5+ (B cells) lymphocytes, accompanied by fewer Iba1+, CD68+, and lysozyme+ histiocytes, mainly in striped dolphins and bottlenose dolphins. Multicentric lymphoid depletion was characterized by reduced numbers of T cells and B cells, more pronounced in Guiana dolphins. Striped dolphins and bottlenose dolphins often had hyperplastic (regenerative) phenomena involving the aforementioned cell populations, particularly chronically infected animals. In the lung, there was mild to moderate increase in T cells, B cells, and histiocytes. Additionally, there was a generalized increased expression of caspase 3 in lymphoid, lung, and CNS tissues. Apoptosis, therefore, is believed to play a major role in generalized lymphoid depletion and likely overt immunosuppression during CeMV infection. No differences were detected regarding cytokine immunoreactivity in lymph nodes, spleen, and lung from infected and non-infected dolphins by semiquantitative analysis; however, there was striking immunoreactivity for IFNγ in the CNS of infected dolphins. These novel results set the basis for tissue-specific immunophenotypic responses during CeMV infection in three highly susceptible delphinid species. They also suggest a complex interplay between viral and host's immune factors, thereby contributing to gain valuable insights into similarities, and differences of CeMV infection's immunopathogenesis in relation to body tissues, CeMV strains, and cetacean hosts.