Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines

ABSTRACT Background: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. Methods: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others Results: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly.

Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines

Background: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. Methods: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others RESULTS: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly. Keywords: Antimicrobial resistance; Chronic diseases; Comorbidity; Invasive pneumococcal diseases; Pneumococcal conjugate vaccine; Pneumococcal serotypes; Pneumococcal vaccine.

Clinical, laboratory, and radiographic aspects of patients with pulmonary tuberculosis and dysglycemia and tuberculosis treatment outcomes / Aspectos clínicos, laboratoriais e radiográficos de pacientes com tuberculose pulmonar e disglicemia e desfechos do tratamento da tuberculose

ABSTRACT Objective: To analyze the association of dysglycemia with clinical, laboratory, and radiographic characteristics of patients with pulmonary tuberculosis (PTB), as well as with their tuberculosis treatment outcomes. Methods: This was a longitudinal study involving 140 patients diagnosed with PTB (positive cultures for Mycobacterium tuberculosis or positive Xpert MTB/RIF results from sputum samples). Patients were evaluated at diagnosis (M0), after completing the second month of treatment (M2), and at the end of treatment (MEND). At M0, the patients were classified into three groups: normoglycemia+PTB (NGTB); pre-diabetes mellitus+PTB (PDMTB), and diabetes mellitus+PTB (DMTB), in accordance with glycated hemoglobin levels (< 5.7%, 5.7%-6.4%, and ≥ 6.5%, respectively). Treatment outcomes were classified as favorable (cure or treatment completion) and unfavorable (death, loss to follow-up, or treatment failure). Results: In our sample, 76 patients (61.4%) had dysglycemia, 20 of whom (14.3%) had DM at M0. The patients with dysglycemia, in comparison with those in the NGTB group, more frequently presented with positive sputum smear microscopy (94.2% vs. 75.9%; p = 0.003); cavities (80.2% vs. 63.0%; p = 0.03); bilateral lesions (67.4% vs. 46.0%; p = 0.02); and higher median of affected thirds of the lungs (3.0 vs. 2.0; p = 0.03) on chest radiography. No significant differences regarding outcomes were found among the groups, but tuberculosis lethality was higher in the DMTB group than in the PDMTB and NGTB groups (20% vs. 2.2%). Conclusions: PTB patients with dysglycemia had laboratory and radiographic manifestations indicative of more advanced disease, and the risk of death was higher in the DMTB group. These findings reinforce the recommendation for early screening for DM in patients with newly diagnosed tuberculosis in order to reduce the risk of death during treatment.

RESUMO Objetivo: Analisar a associação de disglicemia e características clínicas, laboratoriais e radiográficas em pacientes com tuberculose pulmonar (TBP), bem como a associação de disglicemia e desfechos do tratamento da tuberculose. Métodos: Estudo longitudinal com 140 pacientes com diagnóstico de TBP (culturas de escarro positivas para Mycobacterium tuberculosis ou resultados positivos do teste Xpert MTB/RIF em amostras de escarro). Os pacientes foram avaliados no momento do diagnóstico (M0), após dois meses de tratamento (M2) e no fim do tratamento (MFIM). Em M0, os pacientes foram divididos em três grupos: normoglicemia+TBP (NGTB); pré-diabetes mellitus+TBP (PDMTB) e diabetes mellitus+TBP (DMTB), de acordo com os níveis de hemoglobina glicada (< 5,7%, 5,7%-6,4% e ≥ 6,5%, respectivamente). Os desfechos do tratamento foram classificados em favoráveis (cura ou conclusão do tratamento) e desfavoráveis (óbito, perda de seguimento ou falência do tratamento). Resultados: Em nossa amostra, 76 pacientes (61,4%) apresentavam disglicemia, 20 (14,3%) dos quais apresentavam DM em M0. Os pacientes com disglicemia, em comparação com os do grupo NGTB, apresentaram mais frequentemente baciloscopia de escarro positiva (94,2% vs. 75,9%; p = 0,003); cavidades (80,2% vs. 63,0%; p = 0,03); lesões bilaterais (67,4% vs. 46,0%; p = 0,02) e maior mediana de terços pulmonares acometidos (3,0 vs. 2,0; p = 0,03) na radiografia de tórax. Não foram observadas diferenças significativas entre os grupos quanto aos desfechos, mas a letalidade da tuberculose foi maior no grupo DMTB do que nos grupos PDMTB e NGTB (20% vs. 2,2%). Conclusões: Pacientes com TBP e disglicemia apresentaram manifestações laboratoriais e radiográficas indicativas de doença mais avançada, e o risco de óbito foi maior no grupo DMTB. Esses achados reforçam a recomendação de detecção precoce de DM em pacientes com tuberculose recém-diagnosticada, a fim de reduzir o risco de óbito durante o tratamento.

Spatiotemporal parameters of gait in Filipino adults using the 3-D motion capture system

@#<p style="text-align: justify;"><strong>Background and Purpose:</strong> Gait is one of the outcome measures used in evaluation in the field of rehabilitation and there is a need for reference data of gait parameters primarily to understand the physiological significance of these parameters, describe their changes in pathologic gait for better understanding of pathophysiology and be able to provide the appropriate therapeutic approach. The purpose of this study was: 1) To derive a reference data of spatiotemporal parameters of gait among Filipinos, which include step time, stride time, stance time, swing time, single limb support time, double limb support time, cadence, speed, step length, stride length, and step width; 2) To determine correlation of age, gender, and anthropometric measures with spatiotemporal parameters, and 3) To determine<br />gait symmetry.</p><p style="text-align: justify;"><strong>Materials and Methods:</strong> In this cross-sectional study, 374 participants aged 20-69 years (males = 181, females = 193) were included. They were asked to walk in their comfortable speed. Spatiotemporal parameters were obtained using the Vicon motion capture system.</p><p style="text-align: justify;"><strong>Results:</strong> The walking speed, step length, stride length, and step width declined with age. Filipino men demonstrated higher values in all parameters except cadence which is higher in Filipino women. Height and leg length both have positive correlation with all parameters except for cadence. Weight has a positive correlation with all spatiotemporal parameters except for cadence, swing time, single limb support time, and speed. Cadence and stride length were symmetrical between right and left lower extremities.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Spatiotemporal parameters among healthy Filipinos 20-69 years old were presented including their correlations with age, gender, and anthropometric measures. This can serve as a reference for future studies in gait where Filipinos are the participants.</p>

Maternal and fetal outcomes of patients referred from primary health-care facilities to a tertiary hospital: A cross-sectional study / Philippine Journal of Obstetrics and Gynecology

Introduction@#There is insufficient local data on the maternal and fetal morbidity and mortality of cases seen initially at the primary health-care facility (PHCF) and subsequently referred to a tertiary hospital for acute management. This study aimed to determine the maternal and fetal outcomes of such patients using the World Health Organization maternal near miss, mortality, and neonatal mortality rates. @*Materials and Methods@#A cross-sectional study was done that involved obstetric patients beyond 20-week gestation and in the immediate postpartum who were initially managed at the PHCF then referred to a tertiary hospital for management. @*Results@#There were 485 deliveries (85.5%) with a primary cesarean section rate of 16.6%. One patient underwent exploratory laparotomy for uterine rupture with extraction of a stillborn baby and hysterectomy. Eighteen cases (3.2%) necessitated other forms of surgical interventions including hysterectomy (6), transverse compression suture (3) with bilateral uterine or hypogastric artery ligation, uterine repositioning (1), evacuation of vaginal hematoma (4), balloon pack insertion (2), postpartum curettage (1), and removal of retained suture needle (1). The maternal near-miss rate is 46.7/1000 live births (46.7%). There were three intensive care unit admissions and 5 cases required ventilatory support. The maternal mortality rate is 10.6 maternal deaths per 1000 live births (1.06%). Majority of the babies had good APGAR scores at birth. Twenty-two babies (4.5%) required intensive neonatal management. The neonatal mortality rate is 0.42% or 4.2/1000 live births.@*Conclusion@#Almost 40% of referred cases were primigravidas and have preexisting medical problems that should not have been seen at the primary care level but directed to secondary or tertiary center at the outset. It cannot be understated that education of the populace, more training, and monitoring the performance of base health facility workers should be done to prevent maternal and fetal catastrophes.

Association between circulating exhausted CD4+ T cells with poor meningococcal C conjugate vaccine antibody response in HIV-infected children and adolescents

OBJECTIVES: To investigate the expression levels of surface markers of activation (CD38 and HLA-DR), inhibition (PD-1, TIGIT and CD57) and co-stimulation (CD28 and CD127) on CD4+ T cells of children/adolescents with vertical HIV infection (HI patients) and HIV-uninfected (HU) controls vaccinated with the meningococcal C conjugate vaccine (MCC). METHODS: HI patients (n=12), aged 8-17 years, were immunized with two MCC injections, while HU controls (n=9), aged 5.3-10.7 years, received a single MCC dose (as per national recommendation at the time of this study, a single MCC vaccine dose should be given for healthy children and youth aged 1-18 years). The HI patients were categorized according to the combined antiretroviral therapy (cART) treatment. Blood samples were obtained before vaccination, after priming, and after the administration of a booster dose of vaccine to determine the serum bactericidal antibody (SBA) titers and the expression levels of surface markers on CD4+ T cells by flow cytometry. The levels of serum cytokines, IL-4 and CXCL-13 were also measured using Luminex kits. RESULTS: The co-expression of the TIGIT-HLA-DR-CD38 molecules increased in the CD4+ T cells of HI patients/no-cART who also showed a lower frequency of CD127+CD28+ CD4+ T cells than HI patients/cART and HU group subjects. There were significant negative correlations between the frequency of exhausted CD4+ T cells and the SBA response. IL-4 levels were higher in HI patients/cART and positively correlated with SBA titers but negatively associated with the expression of exhaustion markers. Moreover, the CXCL-13 levels were positively correlated with the exhausted CD4+ T cells. CONCLUSION: The results of our study suggest that the co-expression of exhaustion markers and/or loss of co-stimulatory molecules influence the SBA response in HI patients.

Adenoid cystic carcinoma: immunohistochemistry and differential diagnosis, a case report / Carcinoma adenoide cístico: imuno-histoquímica e diagnóstico diferencial, um relato de caso

ABSTRACT A 52-year-old male patient complained of loss of sensitivity and pain in the maxilla. After examination, root canal treatment of tooth 12 was requested. Subsequently, there was a purplish increased volume of softened consistency in the area of vestibular attached gingiva of tooth 12. The anterior upper dental segment presented mobility. Incisional biopsy revealed malignant neoplasm of glandular epithelial origin, suggestive of solid adenoid cystic carcinoma (ACC). An immunohistochemical panel was performed, which confirmed the histopathological suspicion. Solid ACC may lead to diagnostic difficulties, since this lesion exhibits morphological features similar to other malignancies.

RESUMEN Paciente masculino, 52 años de edad, quejase de pérdida de sensibilidad y dolor en la maxila. Después de la consulta, se indicó el tratamiento endodóntico del elemento dental 12. Luego, se observó aumento de volumen amoratado y consistencia ablandada en la superficie vestibular de la encía insertada del elemento 12. El segmento dental superior anterior presentaba movilidad. La biopsia incisional demostró neoplasia maligna sugestiva de carcinoma adenoide quístico (CAQ) sólido. Se realizó un panel de pruebas inmunohistoquímico que confirmó la sospecha histopatológica. El CAQ sólido puede causar dificultades de diagnóstico, pues esa lesión muestra aspectos morfológicos semejantes a otras neoplasias malignas.

RESUMO Paciente do sexo masculino, 52 anos de idade, queixou-se de perda de sensibilidade e dor na maxila. Após investigação, foi solicitado o tratamento endodôntico do elemento dentário 12. Posteriormente, observou-se aumento de volume arroxeado e consistência amolecida na porção vestibular da gengiva inserida do elemento 12. O segmento dentário superior anterior apresentava mobilidade. A biópsia incisional evidenciou neoplasia maligna de origem epitelial glandular, sugestiva de carcinoma adenoide cístico (CAC) sólido. Um painel imuno-histoquímico foi realizado, o qual confirmou a suspeita histopatológica. O CAC sólido pode gerar dificuldades de diagnóstico, pois essa lesão exibe aspectos morfológicos similares aos de outras neoplasias malignas.

Congenital granular cell epulis: case report and differential diagnosis / Epúlide de células granulares congênita: relato de caso e diagnóstico diferencial

ABSTRACT A 16-days-old female patient exhibiting an exophytic nodular lesion located at anterior maxilla on the alveolar ridge since birth. The clinical hypothesis of congenital granular cell epulis (CGCE) was established, and the patient underwent excisional biopsy. Microscopically, a sheet-like proliferation of eosinophilic cells with granular cytoplasm was observed in a stroma of vascularized fibrous connective tissue. The immunohistochemical analysis for S100 evidenced the absence of immunostaining. The CGCE hypothesis was confirmed and, after six months, the patient showed no signs of recurrence of the lesion.

RESUMEN Niña de 16 días de edad, presentaba una lesión exofítica de aspecto nodular ubicada en la región de la cresta alveolar maxilar anterior desde su nacimiento. Se estableció la hipótesis clínica de épulis congénito de células granulares, y la paciente se sometió a una biopsia por escisión. Microscópicamente se ha observado una proliferación laminar de células eosinofílicas con citoplasma granular en medio de un estroma de tejido conectivo fibroso vascularizado. El análisis inmunohistoquímica para S100 reveló ausencia de inmunomarcación. La hipótesis de épulis congénito ha sido confirmada, y, después de seis meses, la paciente no mostró señales de recidiva de la lesión.

RESUMO Paciente do sexo feminino, 16 dias de idade, exibiu lesão exofítica de aspecto nodular localizada em região anterior do rebordo alveolar maxilar desde o nascimento. A hipótese clínica de epúlide de células granulares congênita (ECGC) foi estabelecida, e a paciente foi submetida à biópsia excisional. Microscopicamente, observou-se a proliferação em lençol de células eosinofílicas com citoplasma granular em meio a um estroma de tecido conjuntivo fibroso vascularizado. A análise imuno-histoquímica para S100 evidenciou ausência de imunomarcação. A hipótese de ECGC foi confirmada e, após seis meses, a paciente não apresentou sinais de recidiva da lesão.

Peripheral odontogenic fibroma in the mandibular gingiva: case report / Fibroma odontogênico periférico em gengiva mandibular: relato de caso

ABSTRACT Peripheral odontogenic fibroma (POF) is a rare benign neoplasm of odontogenic mesenchymal origin that accounts for approximately 4.7% of all odontogenic tumors. This article reports the case of a 29-year-old woman who presented with a painless, reddish mass in the right vestibular mandibular gingiva between the second premolar and the first molar. Radiographic examination revealed small crestal bone loss in the region. Microscopic analysis revealed a tumor composed of cellular fibroblastic connective tissue intermingled with conspicuous islands and strands of apparently inactive odontogenic epithelium. The final diagnosis was POF. No clinical signs of recurrence were observed 22 months after surgical excision. POF may be clinically mistaken for other common gingival lesions, such as pyogenic granuloma, peripheral giant cell lesion, and peripheral ossifying fibroma. Conservative local excision has been suggested as the treatment of choice for POF. However, in view of the paucity of information on the biological behavior and recurrence rate of this tumor, long-term follow-up of patients is mandatory.

RESUMEN El fibroma odontogénico periférico (FOP) es una neoplasia benigna rara de origen mesenquimatosa dental, que representa aproximadamente el 4,7% de todos los tumores odontogénicos. Este reporte describe el caso de una mujer de 29 años de edad que se presentó con un nódulo rojizo indoloro en la encía mandibular vestibular derecha, entre el segundo premolar y el primer molar. El examen radiográfico reveló una pequeña pérdida de tejido óseo en la región de la cresta alveolar. El análisis microscópico mostró un tumor compuesto de tejido conjuntivo fibroso celular entremezclado con visibles islotes y filamentos de epitelio odontógeno aparentemente inactivo. El diagnóstico final fue FOP. No se observó recurrencia de la lesión después de 22 meses de la cirugía. El FOP puede ser clínicamente confundido con otras lesiones gingivales comunes, como granuloma piogénico, lesión periférica de células gigantes y fibroma osificante periférico. Escisión local conservadora ha sido recomendada como tratamiento de elección para FOP. Sin embargo, teniendo en cuenta la escasez de informaciones sobre el comportamiento biológico y la tasa de recidiva de este tumor, el seguimiento a largo plazo de los pacientes es fundamental.

RESUMO Fibroma odontogênico periférico (FOP) é uma neoplasia benigna rara, de origem mesenquimal odontogênica, representando aproximadamente 4,7% de todos os tumores odontogênicos. Este artigo relata o caso de uma mulher de 29 anos de idade que se apresentou com um nódulo avermelhado, indolor, na gengiva mandibular vestibular direita, entre o segundo pré-molar e o primeiro molar. O exame radiográfico revelou uma pequena perda óssea na região da crista alveolar. A análise microscópica evidenciou um tumor composto de tecido conjuntivo fibroso celularizado, entremeado por conspícuas ilhas e cordões de epitélio odontogênico aparentemente inativo. O diagnóstico final foi de FOP. Nenhum sinal clínico de recorrência foi observado 22 meses após a excisão cirúrgica. O FOP pode ser clinicamente confundido com outras lesões gengivais comuns, como granuloma piogênico, lesão periférica de células gigantes e fibroma ossificante periférico. A excisão local conservadora tem sido sugerida como tratamento de escolha para o FOP. No entanto, tendo em vista a escassez de informações sobre o comportamento biológico e a taxa de recorrência desse tumor, o acompanhamento dos pacientes a longo prazo é mandatório.

Polymorphisms in the IL17A gene are not involved in the development of preeclampsia in the Brazilian population / Polimorfismos no gene IL17A não estão envolvidos no desenvolvimento de pré-eclâmpsia na população brasileira

ABSTRACT Introduction: Preeclampsia is defined by the development of hypertension associated with proteinuria after the 20th week of gestation in previously normotensive women. IL17A is a potent inducer of tissue inflammation and polymorphisms in the IL17A gene can modulate gene expression and affect the functioning of Th17 cells, strengthening susceptibility to preeclampsia. Objective: To investigate the polymorphisms rs4711998 A>G, rs8193036 C>T and rs2275913 A>G in the IL17A gene in women with preeclampsia. Methods: This is a control case study, composed of 263 women, 89 with preeclampsia and 174 of the control group. The polymorphisms investigated by real time polymerase chain reaction (PCR) allele discrimination technique. The risk of IL17A polymorphisms contributing to preeclampsia was assessed by the inheritance model through logistic regression. Statistical power presented 99.5% for association detection. Statistical significance was defined as p < 0.05. Results: Genotype frequencies as well as multiple logistic regression analysis were not statistically significant for the rs4711998 A>G, rs8193036 C>T and rs2275913 A>G polymorphisms of the IL17A gene. No association was found between any haplotypes of the polymorphisms investigated and the risk of developing PE. Conclusion: There is no association between the allele frequencies, genotype, inheritance models and haplotypes of the rs4711998 A>G, rs8193036 C>T and rs2275913 A>G polymorphisms of the IL17A gene and PE.

RESUMEN Introducción: La preeclampsia (PE) se define como hipertensión arterial asociada a proteinuria después de la semana 20 de gestación en mujeres anteriormente normotensas. La interleucina 17ª (IL17A) es un inductor potente de inflamación tisular y polimorfismos del gen IL17A pueden modular la expresión génica y afectar las funciones de las células Th17, aumentando la susceptibilidad a la PE. Objetivo: Investigar los polimorfismos rs4711998 A>G, rs8193036 C>T y rs2275913 A>G del gen IL17A en pacientes con PE. Métodos: Se realizó un estudio de casos y controles, compuesto por 263 mujeres: 89 diagnosticadas con PE y 174 del grupo de control. Se evaluaron los polimorfismos investigados a partir del ácido desoxirribonucleico (ADN) genómico aislado de la sangre periférica por reacción en cadena de la polimerasa (PCR) en tiempo real para discriminación alélica. El riesgo de los polimorfismos del gen IL17A para la PE fue evaluado según el modelo de herencia empleando regresión logística. El poder estadístico presentó 99,5% para la detección de asociación. Resultados: Las frecuencias genotípicas, así como el análisis de regresión logística múltiple, no fueron estadísticamente significativas para los polimorfismos rs3761549 C>T, rs3761548 A>C y rs2232365 A>G del gen IL17A. Ningún haplotipo de los polimorfismos investigados mostró asociación con el riesgo de desarrollo de PE. Conclusión: No hay asociación entre las frecuencias alélicas y genotípicas, los modelos de herencia y los haplotipos de los polimorfismos rs4711998 A>G, rs8193036 C>T y rs2275913 A>G del gen IL17A y la PE.

RESUMO Introdução: A pré-eclâmpsia (PE) é definida pelo desenvolvimento de hipertensão arterial associada à proteinúria após a semana de gestação em mulheres previamente normotensas. A interleucina 17A (IL17A) é um potente indutor de inflamação tecidual, e polimorfismos no gene IL17A podem modular a expressão gênica e afetar o funcionamento das células Th17, contribuindo para a suscetibilidade à PE. Objetivo: Investigar os polimorfismos rs4711998 A>G, rs8193036 C>T e rs2275913 A>G no gene IL17A em mulheres com PE. Métodos: Trata-se de um estudo do tipo caso-controle, composto por 263 mulheres, sendo 89 diagnosticadas com PE e 174 do grupo-controle. Os polimorfismos investigados foram avaliados a partir do ácido desoxirribonucleico (DNA) genômico extraído do sangue periférico pela técnica de discriminação alélica por reação em cadeia da polimerase (PCR) em tempo real. O risco de os polimorfismos do gene IL17A contribuírem com a PE foi avaliado pelo modelo de herança através da regressão logística. O poder estatístico apresentou 99,5% para a detecção de associação. A significância estatística foi definida como p < 0,05. Resultados: As frequências genotípicas, assim como a análise de regressão logística múltipla, não foram estatisticamente significativas para os polimorfismos rs3761549 C>T, rs3761548 A>C e rs2232365 A>G do gene IL17A. Não foi observada associação entre nenhum dos haplótipos dos polimorfismos investigados e o risco de desenvolvimento de PE. Conclusão: Não há associação entre as frequências alélicas e genotípicas, os modelos de herança e os haplótipos dos polimorfismos rs4711998 A>G, rs8193036 C>T e rs2275913 A>G do gene IL17A e a PE.

Pediatric rehabilitation: social support and stress in cases of cerebral palsy / Reabilitação pediátrica: suporte social e estresse em casos de paralisia cerebral / Rehabilitación pediátrica: apoyo social y estrés en casos de parálisis cerebral

In pediatric rehabilitation, cerebral palsy constitutes one of the most diagnosed clinical conditions, however, further research is still necessary to improve care quality in the Brazilian context. Therefore, the present study aimed to: characterize, evaluate, and correlate social support and stress in family caregivers; and compare two care modalities (individual and group) of a rehabilitation program. In Study 1, 22 family members received individual and group care. In Study 2, 29 family members received only individual care. The instruments used were Sociodemographic Questionnaire, Social Support Perception Scale, Parental Stress Scale, Question about the Source of Social Support, and Case Reports. Researchers found no differences between the participants in Studies 1 and 2. The analysis of the entire sample revealed low-stress levels. Limited sources of support were observed, with family support being predominant. It was possible to identify a negative correlation between social support and stress.

Em reabilitação pediátrica, a paralisia cerebral é uma das condições clínicas mais diagnosticadas, mas ainda são necessárias pesquisas para aprimorar a qualidade assistencial no contexto brasileiro. Diante disso, a presente investigação teve como objetivos: caracterizar, avaliar e correlacionar suporte social e estresse de familiares cuidadores; e comparar duas modalidades de atendimento (individual e grupal) em um programa de reabilitação. No Estudo 1, 22 familiares receberam atendimentos individuais e grupais. No Estudo 2, 29 familiares frequentaram somente atendimentos individuais. Adotaram-se como instrumentos: o Questionário Sociodemográfico, a Escala de Percepção do Suporte Social, a Escala de Stress Parental, a Questão sobre Fonte de Suporte e os Registros de Casos. Não se constatou diferença entre participantes do Estudo 1 e do Estudo 2. A análise da totalidade amostral revelou baixo nível de estresse. Notou-se limitação das fontes de suporte, havendo predomínio do suporte familiar. Foi possível identificar correlação negativa entre suporte social e estresse

En rehabilitación pediátrica, la parálisis cerebral constituye una de las condiciones clínicas más diagnosticadas, pero se requiere pesquisas para mejorar la calidad asistencial brasileña. Por eso, la presente investigación tuvo como objetivos: caracterizar, evaluar y correlacionar apoyo social y estrés de familiares cuidadores; y comparar dos modalidades asistenciales (individual y grupal) en un programa de rehabilitación. En el Estudio 1, 22 familiares recibieron atenciones individuales y grupales. En el Estudio 2, 29 familiares frecuentaron solamente atenciones individuales. Se adoptaron como instrumentos: Cuestionario Sociodemográfico, Escala de Percepción del Apoyo Social, Escala de Estrés Parental, Cuestión sobre Fuente de Apoyo y Registros de Casos. No se constató diferencia entre participantes del Estudio 1 y del Estudio 2. El análisis del total de muestras reveló bajo nivel de estrés. Se percató limitación de las fuentes de apoyo, habiendo predominio del apoyo familiar. Fue posible identificar correlación negativa entre apoyo social y estrés.

Acanthamoeba in Southeast Asia – Overview and Challenges

Acanthamoeba, one of free-living amoebae (FLA), remains a high risk of direct contact with this protozoan parasite which is ubiquitous in nature and man-made environment. This pathogenic FLA can cause sight-threatening amoebic keratitis (AK) and fatal granulomatous amoebic encephalitis (GAE) though these cases may not commonly be reported in our clinical settings. Acanthamoeba has been detected from different environmental sources namely; soil, water, hot-spring, swimming pool, air-conditioner, or contact lens storage cases. The identification of Acanthamoeba is based on morphological appearance and molecular techniques using PCR and DNA sequencing for clinico-epidemiological purposes. Recent treatments have long been ineffective against Acanthamoeba cyst, novel anti-Acanthamoeba agents have therefore been extensively investigated. There are efforts to utilize synthetic chemicals, lead compounds from medicinal plant extracts, and animal products to combat Acanthamoeba infection. Applied nanotechnology, an advanced technology, has shown to enhance the anti-Acanthamoeba activity in the encapsulated nanoparticles leading to new therapeutic options. This review attempts to provide an overview of the available data and studies on the occurrence of pathogenic Acanthamoeba among the Association of Southeast Asian Nations (ASEAN) members with the aim of identifying some potential contributing factors such as distribution, demographic profile of the patients, possible source of the parasite, mode of transmission and treatment. Further, this review attempts to provide future direction for prevention and control of the Acanthamoeba infection.

Recém-nascidos com risco de toxoplasmose congênita, revisão de 16 anos / Newborns at risk for congenital toxoplasmosis, review of 16 years

OBJETIVOS: Analisar os dados de gestações com risco de toxoplasmose congênita e investigar a evolução dos recém-nascidos, em um hospital de nível II em Portugal. MÉTODOS: Um estudo transversal retrospetivo incluiu recém-nascidos com risco de toxoplasmose congênita e suas mães, cujo parto ocorreu entre janeiro de 2000 e dezembro de 2015. Os critérios de inclusão foram mãe com soroconversão para toxoplasmose durante a gestação ou primeira amostra sérica com IgM e IgG específicas positivas. O diagnóstico de toxoplasmose congênita foi definido por IgM específica positiva ao nascimento e/ou reação em cadeia da polimerase positiva no líquido amniótico e/ou persistência de IgG específica até os 12 meses de vida. A toxoplasmose congênita foi definida como sintomática quando os achados clínicos foram atribuídos à doença. Os testes Qui-quadrado ou Exato de Fisher foram usados para testar associações entre variáveis, assumindo-se significado estatístico quando p<0,05. RESULTADOS: Ocorreram 39.585 nascimentos vivos no período em estudo e foram identificados 98 casos com risco de toxoplasmose congênita, dos quais 89 completaram o seguimento. A prevalência de IgG para T. gondii nas gestantes foi de 26% (intervalo de confiança [IC] 95% 24-27%). Foram confirmados 22 casos de toxoplasmose congênita (5,6 por 10.000 nascidos vivos, IC95% 3,5-8,5 por 10.000). Dos 22 recém-nascidos, 18 (82%, IC95% 61-93%) eram sintomáticos. Os achados clínicos mais frequentes foram calcificação intracraniana (64%), hepatomegalia e/ou elevação das transaminases (32%) e retinocoroidite (14%). As lesões cerebrais foram mais frequentes quando a infeção materna foi documentada no primeiro e segundo trimestres em comparação com o terceiro (p=0,018). Em 31 casos (35%), as gestantes foram tratadas desde o momento do diagnóstico até o parto com espiramicina, não se tendo encontrado diferenças relativamente à taxa de transmissão vertical ou ao aparecimento de manifestações clínicas entre os recém-nascidos de mães tratadas e não tratadas. CONCLUSÕES: A prevalência de toxoplasmose congênita foi superior à reportada em outros países da Europa. A prevalência de calcificações intracranianas foi maior do que a descrita na literatura, enquanto que a de retinocoroidite e estrabismo foi menor. As alterações cerebrais nos recém-nascidos foram mais frequentes nas infecções de primeiro e segundo trimestre. Não houve diferença na taxa de transmissão vertical e na ocorrência de manifestações clínicas entre os recém-nascidos cujas mães receberam espiramicina na gestação ou não receberam tratamento.

AIMS: To analyze the data on pregnancies with risk of congenital toxoplasmosis and to investigate the newborns' outcome, in a level II hospital in Portugal. METHODS: A cross-sectional retrospective study included newborns at risk for congenital toxoplasmosis and their mothers, whose delivery occurred between January 2000 and December 2015. The inclusion criteria were mother with seroconversion to toxoplasmosis during pregnancy or first serum sample with positive specific IgM and IgG. The diagnosis of congenital toxoplasmosis was defined by positive specific IgM at birth and/or polymerase chain reaction positive in amniotic fluid and/or persistence of specific IgG up to 12 months of life. Congenital toxoplasmosis was defined as symptomatic when clinical findings were attributed to the disease. Chi-square or Fisher's exact tests were used to test associations between variables, assuming statistical significance when p<0.05. RESULTS: There were 39,585 live births in the study period and 98 cases with risk of congenital toxoplasmosis were identified, of which 89 completed the follow-up. The prevalence of anti-T. gondii IgG in the pregnant women was 26% (95% confidence interval [CI] 24-27%). Twenty-two cases of congenital toxoplasmosis (5.6 per 10,000 live births, 95%CI 3.5-8.5 per 10,000) were confirmed. Of the 22 newborns, 18 (82%, 95%CI 61-93%) were symptomatic. The most frequent clinical findings were intracranial calcification (64%), hepatomegaly and / or elevation of transaminases (32%) and retinochoroiditis (14%). Cerebral lesions were more frequent when maternal infection was documented in the first and second trimester compared to the third trimester (p=0.018). In 31 cases (35%), the pregnant women were treated from the time of diagnosis until delivery with spiramycin, and no differences were found regarding the rate of vertical transmission or the appearance of clinical manifestations among the newborns of treated and non-treated mothers treated. CONCLUSIONS: The prevalence of congenital toxoplasmosis was higher than that reported in other European countries. The prevalence of intracranial calcifications was higher than that described in the literature, whereas retinochoroiditis and strabismus occurrence was lower. Brain lesions in newborns were more frequent in first- and second-trimester infections. There was no difference in the rate of vertical transmission and in the occurrence of clinical manifestations among newborns whose mothers received spiramycin during gestation and those whose mothers did not receive treatment.

The role of the Xpert MTB/RIF assay among adolescents suspected of pulmonary tuberculosis in Rio de Janeiro, Brazil

Abstract INTRODUCTION The teste rápido molecular para tuberculose (TRM-TB) was introduced in 2014 in Brazil for tuberculosis screening. However, its role in adolescents in Brazil has not been studied. METHODS A descriptive study of adolescents with suspected tuberculosis using National Laboratory software. RESULTS Of 852 (15.4%) suspected cases, 131 were positive by TRM-TB and 2% were resistant to rifampicin. Among TRM-TB-positive cases, 105 (91.4%) were culture-positive. Sixty-four of 96 samples were sensitive to rifampicin by TRM-TB; 11 were resistant to other drugs by drug sensitivity test (DST). CONCLUSIONS Among suspected cases, 16% were diagnosed by TRM-TB, of which 17% were drug-resistant by DST.

Analysis of 18 bp Ins/Del at -2549 polymorphism of the vascular endothelial growth factor gene in patients with systemic lupus erythematosus / Análise do polimorfismo -2549 18 pb Ins/Del do gene do fator de crescimento vascular endotelial em indivíduos com lúpus eritematoso sistêmico

ABSTRACT Systemic lupus erythematosus (SLE) is considered an autoimmune disease characterized by the action of autoantibodies, which cause chronic inflammation in various tissues of the body. Considering the vascular endothelial growth factor (VEGF) participation in the development of inflammation, this study aimed to evaluate the frequency of the polymorphism at the -2549 position (Ins/Del 18pb, rs35569394) in patients with SLE and in healthy individuals. No statistical differences were found when comparing the allele and genotype frequencies between patients and controls, suggesting that there is no association between the studied polymorphism and the development of SLE.

RESUMO O lúpus eritematoso sistêmico (LES) é considerado uma doença autoimune devido à atuação de autoanticorpos, que ocasionam inflamações crônicas em diversos tecidos corporais. Considerando o envolvimento do fator de crescimento vascular endotelial (VEGF) no desenvolvimento da inflamação, este trabalho objetivou avaliar a frequência do polimorfismo na posição -2549 (Ins/Del 18pb, rs35569394) em pacientes com LES, comparando-os com indivíduos saudáveis. Não foram encontradas diferenças estatísticas ao comparar as frequências alélicas e genotípicas entre pacientes e controles, sugerindo que não há associação entre o desenvolvimento de LES e o polimorfismo estudado.

Unusual presentation of oral actinomycosis in the tongue: case report / Apresentação incomum de actinomicose em língua: relato de caso

ABSTRACT Actinomycosis is a rare infection caused by bacteria of Actinomyces genus that can affect both soft and bone tissues; it may be associated with trauma or previous infections. This paper aims to report a clinical case of actinomycosis on the lateral border of the tongue originating from a previous trauma with the use of sclerosing substance for treatment of vascular malformation. The patient underwent debridement of necrotic tissue in the region, and the material was sent for histopathological analysis, which confirmed the diagnosis of actinomycosis. After two years of follow-up, no recurrence was detected.

RESUMO A actinomicose é uma infecção rara causada pela bactéria do gênero Actinomyces, que pode acometer tanto tecidos moles como ósseo; pode estar associada a traumas ou infecções prévias. O presente trabalho tem o objetivo de relatar um caso clínico de actinomicose na borda lateral de língua originária de um trauma prévio com o uso de substância esclerosante para tratamento de malformação vascular. A paciente foi submetida ao debridamento de tecido necrótico na região, e o material, encaminhado para análise histopatológica, confirmando o diagnóstico de actinomicose. Após dois anos de acompanhamento, não se detectou recidiva.

Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that? / Uso de corticosteroides orais nas exacerbações da asma pode estar associado à supressão adrenal: os médicos estão alertas?

Summary Introduction: Oral corticosteroids (OCS) are a mainstay of treatment for asthma exacerbations, and short-term OCS courses were generally considered to be safe. Nevertheless, frequent short-term OCS courses could lead to hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Our study aimed at investigating the integrity of the HPA axis in children with persistent asthma or recurrent wheezing at the beginning of an inhaled corticosteroids (ICS) trial. Method: Morning basal cortisol was assessed just before the beginning of ICS, and 30, 60, and 90 days later, using Immulite® Siemens Medical Solutions Diagnostic chemiluminescent enzyme immunoassay (Los Angeles, USA; 2006). Results: In all, 140 children (0.3-15 years old) with persistent asthma or recurrent wheezing have been evaluated and 40% of them reported short-term OCS courses for up to 30 days before evaluation. Out of these, 12.5% had biochemical adrenal suppression but showed adrenal recovery during a three-month ICS trial treatment. No significant differences were observed among children with or without adrenal suppression, neither in the number of days free of OCS treatment before cortisol evaluation (p=0.29) nor in the last OCS course duration (p=0.20). The number of short-term OCS courses reported in the year preceding the cortisol evaluation was also not different (p=0.89). Conclusion: Short-term systemic courses of corticosteroids at conventional doses can put children at risk of HPA axis dysfunction. ICS treatment does not impair adrenal recovery from occurring. Health practitioners should be aware of the risk of a blunted cortisol response upon exposure to stress during the follow-up of patients with persistent asthma or recurrent wheezing.

Resumo Introdução: A corticoterapia oral (CO) é um dos pilares do tratamento na exacerbação da asma, e cursos de curta duração são geralmente considerados seguros. No entanto, crianças submetidas a repetidos cursos estão sujeitas a disfunção do eixo hipotálamo-hipófise-adrenal (HHA). Objetivo: Investigar a integridade do eixo HHA em crianças com asma persistente ou sibilância recorrente com indicação para corticoterapia inalatória (CI). Método: Avaliação do cortisol sérico basal antes da introdução da CI e 30, 60 e 90 dias após iniciado o tratamento, utilizando-se o imunoensaio ImmuliteÒ Siemens Medical Solutions Diagnostic chemiluminescent (Los Angeles, EUA; 2006). Resultados: Das 140 crianças avaliadas (0,3 a 15 anos de idade) com asma persistente ou sibilância recorrente, 40% relataram ter recebido CO no último mês antes da avaliação. Cerca de 12,5% delas apresentaram supressão adrenal bioquímica e evoluíram com recuperação do eixo HHA durante os primeiros três meses em CI. O número de dias livres de CO e a duração do último curso antes da avaliação do cortisol não foram significativamente diferentes entre as crianças com ou sem supressão adrenal (p=0,29 e p=0,20, respectivamente). O número de cursos de curta duração relatados no ano anterior à avaliação também não esteve associado à supressão adrenal (p=0,89). Conclusão: A utilização dos corticosteroides nas doses convencionais, em cursos de curta duração, pode colocar as crianças em risco de disfunção do eixo HHA. A recuperação desse eixo é possível durante a CI. Profissionais de saúde devem estar atentos para a possibilidade de resposta inadequada ao estresse durante o acompanhamento de crianças com asma persistente ou sibilância recorrente.

CYP2B6 516 G>T polymorphism and side effects of the central nervous system in HIV-positive individuals under Efavirenz treatment: Study of a sample from southern Brazil

ABSTRACT This study aimed to identify the 516 G>T polymorphism of the CYP2B6 gene and evaluate its influence on central nervous system (CNS) side effect development in HIV-positive individuals undergoing Efavirenz (EFV) treatment in a population from southern Brazil. Additionally, we performed a survey on the clinical and epidemiological characteristics of our sample. In addition to medical records evaluation, whole blood of 89 individuals was analyzed for viral load, T lymphocyte count (CD4+ and CD8+), and the polymorphism. Considering the side effects of the CNS reported by individuals but without considering the genetic variables, no statistically significant association was noted between the adverse effects and the antiretroviral treatment (including or not EFV). In addition, no statistically significant difference was noted for the influence of genotype on the viral load or the number of T lymphocytes (CD4+ and CD8+) among individuals undergoing EFV treatment. This is the first study that investigated the impact of the 516 G>T polymorphism of the CYP2B6 gene among HIV-positive individuals from southern Brazil. Its clinical significance indicates the need for prospective studies in this population.

Assessment and nutrition education in patients with amyotrophic lateral sclerosis / Avaliação e educação nutricional em pacientes com esclerose lateral amiotrófica

ABSTRACT Neurological patients with amyotrophic lateral sclerosis (ALS)often deteriorate to a worsening nutritional status. The aim of this study was to compare the nutritional status and food intake after nutrition education in patients with ALS. Clinical, anthropometric and functional variables were analyzed. Fifty-three patients were monitored at an early stage of the disease. The average score on the functionality scale was 33 points. Initially only 3.8% were classified as low body weight. After three months, 50% showed significant variation in anthropometric measures related to muscle mass and body fat reserves without association with clinical variables. After nutritional guidance, there was an increase in the intake of all food groups, especially the dairy group (p <0.05).The change of the nutritional status occurs early in patients with amyotrophic lateral sclerosis, even in those previously eutrophic or over weight. There was an increase in food intake after nutritional guidance according to the food guide adapted to the Brazilian population.

RESUMO Pacientes neurológicos com esclerose lateral amiotrófica frequentemente evoluem com piora do estado nutricional. O objetivo desse estudo foi comparar o estado nutricional e a ingestão alimentar depois da orientação nutricional em pacientes com ELA. Variáveis clínicas,antropométricas e funcionais foram analisadas. 53 pacientes foram avaliados na fase inicial da doença. A pontuação média da escala de funcionalidade foi de 33 pontos. Inicialmente apenas 3,8% foram classificados como baixo peso. Após três meses, 50% apresentaram variação significativa nas medidas antropométricas relacionadas com reservas de massa muscular e gordura corporal, sem associação com variáveis clínicas. Após orientação nutricional, houve um aumento na ingestão de alimentos de todos os grupos com relevância para o grupo de lacticínios (p <0,05). A mudança do estado nutricional ocorre precocemente em pacientes com ELA, mesmo naqueles anteriormente eutróficos ou sobrepeso. Houve um aumento na ingestão de alimentos após orientação nutricional de acordo com o guia alimentar adaptado da população brasileira.

Exposure to fine particulate matter and hospital admissions due to pneumonia: Effects on the number of hospital admissions and its costs / Exposição ao material particulado fino e internações por pneumonias. Efeitos no número de internações e em seus custos

Summary Objective: Given that respiratory diseases are a major cause of hospitalization in children, the objectives of this study are to estimate the role of exposure to fine particulate matter in hospitalizations due to pneumonia and a possible reduction in the number of these hospitalizations and costs. Method: An ecological time-series study was developed with data on hospitalization for pneumonia among children under 10 years of age living in São José do Rio Preto, state of São Paulo, using PM2.5 concentrations estimated using a mathematical model. We used Poisson regression with a dependent variable (hospitalization) associated with PM2.5 concentrations and adjusted for effective temperature, seasonality and day of the week, with estimates of reductions in the number of hospitalizations and costs. Results: 1,161 children were admitted to hospital between October 1st, 2011, and September 30th, 2013; the average concentration of PM2.5 was 18.7 µg/m3 (≈32 µg/m3 of PM10) and exposure to this pollutant was associated with hospitalization four and five days after exposure. Conclusion: A 10 µg/m3 decrease in concentration would imply 256 less hospital admissions and savings of approximately R$ 220,000 in a medium-sized city.

Resumo Objetivo: como as doenças do aparelho respiratório são importantes causas de internação em crianças, os objetivos deste estudo são estimar o papel da exposição ao particulado fino nas internações por pneumonias e a possível redução do número dessas internações e de seus custos. Método: um estudo ecológico de séries temporais foi desenvolvido com dados de internação por pneumonias em crianças de até 10 anos de idade, residentes em São José do Rio Preto, SP, utilizando concentrações de PM2,5 estimadas por modelo matemático. Foi utilizada a regressão de Poisson com a variável dependente – internação, sendo associada às concentrações de PM2,5, ajustada por temperatura efetiva, sazonalidade e dia da semana e foram estimadas reduções no número de internações e em seus custos. Resultados: foram internadas 1161 crianças entre 01.10.2011 e 30.09.2013. A concentração média de PM2,5 foi de 18,7 µg/m3 (≈ 32 µg/m3 de PM10) e a exposição a esse poluente foi associada à internação 4 e 5 dias após a exposição. Conclusão: redução em 10 µg/m3 em sua concentração implicaria redução de 256 internações e de aproximados R$ 220 mil em uma cidade de porte médio.