An overview on the current available treatment for COVID-19 and the impact of antibiotic administration during the pandemic

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has caused several problems in healthcare systems around the world, as to date, there is no effective and specific treatment against all forms of COVID-19. Currently, drugs with therapeutic potential are being tested, including antiviral, anti-inflammatory, anti-malarial, immunotherapy, and antibiotics. Although antibiotics have no direct effect on viral infections, they are often used against secondary bacterial infections, or even as empiric treatment to reduce viral load, infection, and replication of coronaviruses. However, there are many concerns about this therapeutic approach as it may accelerate and/or increase the long-term rates of antimicrobial resistance (AMR). We focused this overview on exploring candidate drugs for COVID-19 therapy, including antibiotics, considering the lack of specific treatment and that it is unclear whether the widespread use of antibiotics in the treatment of COVID-19 has implications for the emergence and transmission of multidrug-resistant bacteria.

Coinfection by HTLV-I/II is associated with an increased risk of strongyloidiasis and delay in starting antiretroviral therapy for AIDS patients

OBJECTIVE: To compare the clinical characteristics and outcomes of HIV-1-HTLV-1 coinfected patients, in Bahia, Brazil. METHODS: Retrospective, comparative study. RESULTS: Among a total of 123 consecutive HIV infected patients, 20 men (20.6 percent) and 6 women (23.1 percent) had detectable antibodies against HTLV-I/II. The major risk factor associated with coinfection by HTLV was intravenous drug use (57.7 percent of coinfected patient versus 9.2 percent of HTLV seronegative patients, p < 0.0001). Coinfected patients had higher absolute lymphocyte counts (1,921 + 762 versus 1,587 + 951, p = 0.03). Both groups of patients had similar means of CD4+ and CD8+ cell counts. However, among patients with AIDS CD4+ cell counts were significantly higher among those coinfected with HTLV-I/II (292 ± 92 cells/mm³, versus 140 ± 177cells/mm³, p = 0.36). The frequency and type of opportunistic infections were similar for both groups, but strongyloidiasis and encephalopathy were more frequently diagnosed in coinfected patients (p < 0.05). On the other hand, patients coinfected with HTLV-I/II received significantly less antiretroviral therapy than singly infected by HIV-1. CONCLUSION: Coinfection by HTLV-I/II is associated with an increased risk of strongyloidiasis for HIV patients. Higher CD4 count may lead to underestimation of immunodeficiency, and delay to initiate antiretroviral therapy.

Uso de probiótico e óleo de soja sobre o desempenho de frangos de corte / Use of probiotic and soybean oil on the growing broiler chickens / Uso del probiótico y del aceite de soja en el desempeñode los pollos de corte

O objetivo do experimento foi avaliar o desempenho de frangos de corte recebendo dietas com probiótico Biobac , contendo ingredientes ativos de Saccaromyces cerevisae, Lactobacillus acidophylus e Enterococcus faecium, em uso isolado ou associado com 3% de óleo de soja nas fases inicial, engorda e final; respectivamente 1 a 21; 22 a 42 e 43 a 47 dias de idade. Foram utilizadas 3.200 aves de corte de 1 dia de idade de ambos os sexos, distribuídos em um delineamento em blocos casualisados em oito tratamentos com quatro repetições, sendo: T1 - controle, T2 - probiótico em todas as fases, T3 - óleo de soja na fase final, T4 - (T2+T3), T5 - óleo de soja nas fases de engorda e final, T6-(T2+T5), T7 - óleo de soja em todas as fases, T8 - (T2 + T7). As rações continham 22; 20 e 18% de proteína bruta, com níveis de energia metabolizável entre 2.881 a 3.033 kcal/kg conforme a inclusão ou não de óleo de soja. Foram avaliados os ganhos de peso, consumo de ração e conversão alimentar. Somente os períodos de engorda e final cujos tratamentos foram adicionados concomitantemente probiótico e óleo de soja apresentaram os melhores resultados em ganho de peso e conversão alimentar.

The goal of this experiment was to assess broiler chickens performance receveing diet with probiotic Biobac®, contained actives ingredients of Saccaromycescerevisae, Lactobacillus acidophylus and Enterococcus faecium,in isolated use or associated with 3% soybean oil at initial, growing and fi nal phases, respectively 1-21; 22-42 and 43-47 day of age. A gross one 3.200 broilers chicken of both gender were used, distributed in a randomized blocks desing in eight treatments with four repetitions, being: T1- control, T2- probiotic all phases, T3-soybean oil at fi nal phase, T4- (T2 + T3), T5- soybean oil at growing and fi nal phases, T6- (T2 + T5), T7- soybean oil all phases, T8- (T2 + T7). The diets contained 22, 20 and 18% crude protein, with levels of metabolizable energy between 2.881 to 3.033 kcal/kg according to the inclusion or not of soybean oil. Weight gain, feed intake and feed:gain ratio were assessed. Only growing and fi nal phases whose treatments were additioned at the same time probiotic and soybean oil, showed the best results in weight gain and feed intake.

El objetivo del experimento fue avaluar el desempeño de los pollos de corte recibiendo dietas con probiótico Biobac®, conteniendo ingredientes activos del Saccaromyces cerevisae, Lactobacillus acidophylus y Enterococcus faecium, en el uso aislado o asociado con 3% de aceite de soja en las fases inicial, engorda y fi nal; respectivamente 1 al 21; 22 al 42 y del 43 al 47 días de edad. Fueran utilizadas 3.200 aves del corte de ambos los sexos con un día de edad, distribuidos en un diseño en bloques aleatorizados en ocho tratamientos con cuatro repeticiones sendo: T1- control, T2- probiótico en todas las fases, T3- aceite de soja en la fase fi nal, T4- (T2 + T3), T5- aceite de soja en las fases del engorda y fi nal, T6- ( T2 + T5), T7- aceite de soja en todas las fases, T8- (T2 + T7). Las raciones contenían 22; 20 e 18% de proteína bruta, con niveles de energía metabolizável entre 2.881 a 3.033 kcal/kg según la inclusión o no del aceite de soja. Fueron evaluados la ganancia del peso, consumo de ración y conversión alimentar. Solamente los periodos de engorda y fi nal cuyos tratamientos fueran adicionados conjuntamente probiótico y aceite de soja presentaran los mejores resultados en aumento de peso y conversión alimentar.

Endocardite bacteriana como complicaçäo de sepse neonatal: relato de caso / Bacterial endocarditis as a complication of neonatal sepsis: a case report

Os autores relatam um paciente com 11 dias de vida, internado em Unidade de Terapia Intensiva Neonatal devido a múltiplas malformações congênitas, apresentando sepse e endocardite bacteriana. Entre os fatores de risco para endocardite foram destacados o cateterismo venoso central, hemocultura com crescimento de Staphylococcus aureus e ventilação mecânica. O diagnóstico foi realizado no 61§ dia de internação devido a presença de febre persistente e aparecimento de sopro cardíaco sistólico. O ecocardiograma mostrou trombo em átrio direito, medindo 1,9 x 0,7mm sendo realizada antibioticoterapia e ressecção cirúrgica, com melhora clínica. No 125§ dia de internação ocorreu óbito devido à sepse e abscesso cerebral. Na necrópsia não foram observados malformações cardíacas. Os autores concluem ser de grande importância o conhecimento das complicações potenciais das técnicas invasivas utilizadas em recém-nascidos criticamente doentes. A suspeita clínica de endocardite deve ser realizada em todos os neonatos com sepse, internados em Unidade de Terapia Intensiva Neonatal por tempo prolongado.

Safety and efficacy of reduced doses of ritonavir (RTV) plus saquinavir (SQV) in the treatment of AIDS patients in Brazil

The use of reduced doses of Ritonavir (RIT) and Saquinavir (SQV) is considered a potent alternative in treating patients infected by HIV-1. We tested a combination of 300mg of RIT plus 600mg of SQV, twice daily, in association with two reverse transcriptase inhibitors to treat AIDS patients for a period of 6 monts. Evaluation of HIV-1 RNA plasma levels, CD4+/CD8+ cell count and biochemical/hematological parameters (liver enzymes, serum electrolytes, creatinin, blood glucose, uric acid, white blood cell count, platelet count, and hemoglobin level) were performed after 30, 90 and 180 days of therapy. Clinical failure and adverse reactions were also recorded in order to assess safety and efficacy of the treatment. A total of 30 AIDS patients (25 male; 5 female) were enrolled in the study. Eight patients discontinuede the therapy due to intolerance, 2 patients presented clinical failure (onset of AIDS defining events during the study period), 2 patients were excluded due to protocol violation. Five patients tolerated only a lower dose of RIT (400mg/day). Patients who completed 6 months of therapy had a drop in viral load from 4.8ñ.7log10median4.9log) to 3.4ñ1.0log10(median 2.6log), and an increase in CD4+ count from 109ñ86 cells/ml(median 84 cells/ml) to 249ñ114 cells/ml(median 265cells/ml), compared to baseline values. However, patients who used a lower dose of RIT (400mg/day) had a less impressive drop in viral load values(mean0.6log10RNA copies/ml) when compared with those using the 600mg/day of the drug(mean 2.4log10). The percentage of patients presenting undetectable levels of HIV-1 RNA in plasma was quite different for the 2 groups: 92 percent of patients with a viral load <400 RNA copies/ml were using 600mg of RIT. The combination of reduced doses of RIT and SQV reduced viral load >1.0log10 after 6 months in 83 percent of study patients. The dose of 600mg/day of RIT was more effective in reducing viral load than 400mg/day, but was less well-tolerated. CD4+ cell counts increased in all patients regardless of the RIT dose used.

Anemia hemolitica apos correcao cirurgica de complexo de Fallot. Relato de um caso. / Hemolytic anemia after surgical correction of tetralogy of Fallot.Report of a case

Os autores relatam o caso de uma crianca de 8 anos de idade, de sexo masculino, portadora de complexo de Fallot, submetida a correcao cirurgica e que, no periodo pos-operatorio imediato, apresentou anemia hemolitica de etiologia mecanica - traumatica. Na reoperacao, com a retirada de uma porcao saliente e nao endotelizada da placa de teflon que fechava a CIV e a abertura do anel da valva pulmonar que apresentava estenose residual, nao mais se evidenciaram os sinais de hemolise