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Introdução: O intenso processo inflamatório desencadeado pela covid-19 tem sido apontado por diversos autores. Objetivo: Avaliar o impacto de marcadores inflamatórios no prognóstico de pacientes com tumores sólidos internados com SARS-CoV-2/covid-19 na primeira onda da pandemia no Brasil. Método: Estudo de coorte com pacientes maiores de 18 anos com câncer, internados em um centro público de referência no tratamento oncológico, com SARS-CoV-2/covid-19, no período de março a setembro de 2020. Os seguintes marcadores inflamatórios foram analisados: razão neutrófilo-linfócito (RNL), derivação da razão neutrófilo-linfócito (dRNL) e razão plaqueta-linfócito (RPL). Foi considerado desfecho deste estudo a ocorrência de óbito durante a internação hospitalar. A associação entre as variáveis independentes e o desfecho foi analisada por meio de regressão logística univariada e múltipla. Resultados: Dos 185 pacientes, a maioria apresentava idade < 65 anos (61,1%), performance status (PS) ≥ 2 (82,4%) e estavam em tratamento oncológico (80,0%). O câncer de mama foi o tumor mais frequente (26,5%). Para a maior parte dos casos, o tempo de internação foi ≥ 5 dias (59,5%) e ocorreu em unidade de tratamento intensivo (84,3%). Durante a internação, 86 (46,5%) pacientes evoluíram para óbito. Na análise ajustada, apenas a RNL elevada (≥ 4,44) esteve associada ao risco de morrer (OR 3,54; IC 95%; 1,68 - 7,46; p = 0,001). Conclusão: A RNL se mostrou um importante marcador prognóstico, e níveis acima do seu valor mediano estiveram relacionados ao aumento do risco de morte durante a internação hospitalar
Introduction: The intense inflammatory process triggered by COVID-19 has been pointed out by several authors. Objective: To evaluate the impact of inflammatory markers on the prognosis of patients with solid tumors hospitalized with SARS-CoV-2/COVID-19 in the first wave of the pandemic in Brazil. Method: A cohort study of patients >18 years old with cancer, hospitalized at a public cancer treatment reference center, with SARS-CoV-2/COVID-19 from March to September 2020. The following inflammatory markers were analyzed: neutrophil-lymphocyte ratio (NLR), derivation of the neutrophil-lymphocyte ratio (dNLR) and platelet-lymphocyte ratio (PLR). The outcome of this study was death during hospitalization. The association between the independent variables and the outcome was analyzed using univariate and multiple logistic regression. Results: Of the 185 patients, most were aged < 65 years (61.1%), had performance status (PS) ≥ 2 (82.4%) and were in cancer treatment (80.0%). Breast cancer was the most frequent tumor (26.5%). For the majority of the cases, the length of hospital stay was ≥ 5 days (59.5%) and occurred in the intensive treatment unit (84.3%). During hospitalization, 86 (46.5%) patients progressed to death. In the adjusted analysis only high NLR (≥ 4.44) was associated with the risk of death (OR 3.54; 95% CI; 1.68 - 7.46; p = 0.001). Conclusion: NLR proved to be an important prognostic marker, and levels above its median value were related to an increased risk of death during hospitalization
Introducción: El papel de la inflamación desencadenada por la COVID-19 ha sido señalado por varios autores. Objetivo: Evaluar el impacto de los marcadores inflamatorios en el pronóstico de pacientes con tumores sólidos hospitalizados por SARS-CoV-2/COVID-19 en la primera ola de la pandemia en el Brasil. Método: Estudio de cohorte con pacientes >18 años con cáncer, ingresados en un centro público de referencia en el tratamiento del cáncer, con SARS-CoV-2/COVID-19 de marzo a septiembre de 2020. Se evaluaron los siguientes marcadores inflamatorios: relación neutrófilos-linfocitos (RNL), derivación de la relación neutrófilos-linfocitos (dRNL) y relación plaquetas-linfocitos (RPL). Se consideró como desenlace de este estudio la ocurrencia de muerte durante la hospitalización. La asociación entre las variables independientes y el desenlace se analizó mediante regresión logística univariada y múltiple. Resultados: De los 185 pacientes hospitalizados, la mayoría tenía una edad < 65 años (61,1%), un performance status (PS) ≥ 2 (82,4%) y estaban en tratamiento oncológico (80,0 %). El cáncer de mama fue el tumor más frecuente (26,5%). Para la mayoría de los casos, el tiempo de hospitalización fue ≥ 5 días (59,5%) y ocurrió en la unidad de tratamiento intensivo (84,3%). Durante la hospitalización, 86 (46,5%) pacientes terminaron falleciendo. En el análisis ajustado, solo una RNL alta (≥ 4,44) se asoció con el riesgo de muerte (OR 3,54; IC 95%; 1,68 - 7,46; p = 0,001). Conclusión: La RNL demostró ser un importante marcador pronóstico, y los niveles por encima de su valor medio se relacionaron con un mayor riesgo de muerte durante la hospitalización
Assuntos
Masculino , Feminino , Biomarcadores , Mortalidade Hospitalar , SARS-CoV-2 , COVID-19 , NeoplasiasRESUMO
ABSTRACT Sporotrichosis is the most frequent subcutaneous mycosis in Latin America. It is caused by species of the genus Sporothrix. Infection in humans occurs through the entry of the fungus into the skin. Zoonotic outbreaks involving cats in the transmission of the disease have been frequently reported. The lymphocutaneous form is the most commonly observed and the upper limbs are the most affected sites. We report a case of a 64-year-old healthy female patient with a lymphocutaneous form with rapid progression of lesions, which was refractory to initial treatment with itraconazole. Treatment with liposomal amphotericin B was performed with a satisfactory resolution, but aesthetic and functional sequelae in the left upper limb were installed.
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BACKGROUND Chikungunya virus (CHIKV) is an arbovirus that can cause chronic and debilitating manifestations. The first autochthonous case in Rio de Janeiro state was diagnosed in 2015, and an outbreak was declared in 2016. OBJECTIVE The aim of this work was to evaluate CHIKV viral load in serum, plasma and urine in cancer patients to determine the best sample for diagnosis, as well as perform molecular characterisation and phylogenetic analysis of circulating strains. METHODS Paired serum, plasma and urine collected from 31 cancer patients were tested by real-time quantitative polymerase chain reaction (qPCR) and a segment of the CHIKV E1 gene was sequenced. FINDINGS We detected 11 CHIKV+ oncological patients. Paired samples analyses of nine patients showed a different pattern of detection. Also, a higher viral load in plasma (6.84 log10) and serum (6.07 log10) vs urine (3.76 log10) was found. Phylogenetic analysis and molecular characterisation revealed East/Central/Southern Africa (ECSA) genotype circulation and three amino acids substitutions (E1-K211T, E1-M269V, E1-T288I) in positive patients. MAIN CONCLUSION The results indicate the bioequivalence of serum and plasma for CHIKV diagnosis, with urine being an important complement. ECSA genotype was circulating among patients in the period of the 2016 outbreak with K211T, M269V and T288I substitution.
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The epidemiology of urinary tract infections (UTI) by Staphylococcus saprophyticus has not been fully characterised and strain typing methods have not been validated for this agent. To evaluate whether epidemiological relationships exist between clusters of pulsed field gel-electrophoresis (PFGE) genotypes of S. saprophyticus from community-acquired UTI, a cross-sectional surveillance study was conducted in the city of Rio de Janeiro, Brazil. In total, 32 (16%) female patients attending two walk-in clinics were culture-positive for S. saprophyticus. Five PFGE clusters were defined and evaluated against epidemiological data. The PFGE clusters were grouped in time, suggesting the existence of community point sources of S. saprophyticus. From these point sources, S. saprophyticus strains may spread among individuals.