Molecular interaction between tissue repair via SDF-1/CXCR4 signaling and the inflammatory response in acute myocardial infarction with ST-segment elevation

The inflammatory response/ischemic damage relationship is a prerequisite for the initiation of the process of adaptation of the post-infarction cardiac tissue, in which the SDF-1/CXCR4 signaling plays a central role in tissue repair. This study aimed to investigate the modulation exerted by the SDF-1/CXCR4 axis on the inflammatory response after ST-segment elevation acute myocardial infarction (STEMI). Therefore, we developed Bayesian Networks from microarray (GEO) data and evaluated the expression of transcripts of interest in patients with STEMI by qPCR. In the chronic and anti-inflammatory scenario, we verified a relationship between proteins involved in tissue remodeling and the blockade of apoptotic pathways. The expression levels of the transcripts evaluated were increased in the initial moments after the infarction. In conclusion, the effects promoted by the SDF-1/CXCR4 interaction can be modulated according to the immunological profile, directly influencing its adaptive and cardioprotective effects. Therefore, we believe that students can contribute to the awareness of family and friends about COVID-19 and fake news. © 2023 Multidisciplinary Science Journal. All rights reserved.

Renal replacement therapy by the popliteal vein in a critical patient with COVID-19 in the prone position

This patient was a 73-year-old man who initially came to our service with acute respiratory failure secondary to COVID-19. Soon after hospitalization, he was submitted to orotracheal intubation and placed in the prone position to improve hypoxia, due to severe acute respiratory syndrome (SARS). On the third day of hospitalization, he developed acute oliguric kidney injury and volume overload. The nephrology service was activated to obtain deep venous access for renal replacement therapy (RRT). The patient could not be placed in the supine position due to significant hypoxemia. A 50-cm Permcath (MAHURKARTM, Covidien, Massachusetts, USA) was inserted through the left popliteal vein. This case report describes a possible challenging scenario that the interventional nephrologist may encounter when dealing with patients with COVID-19 with respiratory impairment in the prone position.

COVID-19 pandemic and immunoglobulin shortages in Brazil

Background: Immunoglobulin replacement has been revolutionized the treatment of inborn errors of immunity (IEI), ensuring greater survival and quality of life for these patients. Most IEI patients need to receive continuous and regular immunoglobulin replacement. In Brazil, unfortunately, there is no production of this biological or policies for plasma reuse and its importation becomes necessary. Immunoglobulin is distributed monthly by the Brazilian Public Health System (SUS), free of charge. Apart from the difficulty in importing, we had to face the worldwide decrease in blood donations related to COVID-19 pandemic. The aim of this study was to report the rate of lack of immunoglobulins and complications related to this event. Method: This is a cross-sectional, retrospective study, based on the analysis of patient's medical charts at an IEI reference center in Brazil, from January to December 2020. Results: During this period, 124 patients received intravenous immunoglobulin (IVIG) replacement, 62 patients are female (50%), 70 adults (18 to 84 years, median age: 38y) and 54 children (0 to 17 years, median 11y). The most prevalent diagnostic were Common Variable Immunodeficiency-CVID (28.2%), Hypogammaglobulinemia (19.3%), Specific Antibody Deficiency-SAD (11.2%), Ataxia-Telangiectasia (8.8%) and other diagnostics (32,5%: SCIDS, leaky SCID, XLP2, XHIGM, VEO-IBD). Indeed, 70 patients (56.4%) were affected by the lack of distribution of IVIG (56.4%) related to COVID-19 pandemic, remaining without IVIG from one to 12 months, 2.9 months on average. Of these, 48 patients (68.5%) had at least one infection (total 125), all of whom needed to use antibiotics for the treatment of infections and 12 patients required hospitalization. Conclusion: In 2020, 70 (56.4%) patients were affected by the lack of distribution of IVIG. It was possible to identify shortage of immunoglobulin replacement in Brazil due to COVID-19 pandemic led to more infections and increase of antibiotics use.

The epicenter of COVID-19 outbreak and quality of life (QoL) of patients with inborn errors of immunity (IEI): A sad reality

Background: The world is facing one of the worst pandemics in history. Its social, economic and psychological consequences will leave profound marks on society. This study evaluated the QoL of patients with IEI at an immunology referral centre, during the SARS-CoV-2 pandemic. Method: A prospective, single-center study with an adapted questionnaire was applied in two moments of the pandemic: from April to June 2020, and again in March 2021. IEI patients over 18 years old and the caregivers of children under this age answered it online. This questionnaire was adapted from the Portuguese version of the shortened WHO QoL-brief QoL assessment instrument (questions 1,2,4,5 e 26) and the 10-item version of the Perceived Stress Scale (questions 1,2 e 3), taking into account the past four weeks. Results: In the first three months analyzed (April to June/2020), 123/160 questionnaires were answered: 44.7% by caregivers and 55.3% by patients themselves. The children were 12-18 years old and adults were 18-45 years old. 91.1% of the patients have been receiving intravenous immunoglobulin replacement. 84.5% of the patients have already been hospitalized, and 38.2% of them in the intensive care unit at least once. All participants have heard of SARS-CoV-2 and 91% were afraid of being infected with the new virus. 81 patients (66%) reported good QoL prior to the pandemic and, after its onset, this percentage dropped to 27%. In March 2021, with the exponential increase in cases and deaths in Brazil, the questionnaire was reapplied, and 99/160 were answered, 52.4% by patients. The majority (72.6%) are between 18-45 years old, and only 8% of the responders reported good QoL. Everyone fears the coronavirus. Conclusion: Currently, Brazil is the epicenter of COVID-19 outbreak on the planet. In recent weeks, the number of new cases and deaths has grown wildly. Furthermore, IEI patients in Brazil had to deal with the lack of immunoglobulin supply throughout 2020, and until now. In the face of so much adversity, there is an urgent need to think about strategies to improve the QoL of these patients. This is one of the alerts of World primary immunodeficiencies (PI) Week 2021.

In COVID-19 times, can remote rapid drug desensitization (RDD) be possible?

Background: Since 2019, we have experienced a terrible pandemic, COVID-19. Emerging countries, like Brazil, with logistical difficulties and lack of public policies, face a generalized collapse in health system. Rare Diseases Reference Centers are located distant from patients' houses. Thus, patients with lysosomal diseases, unable to travel and need to receive their recombinant enzyme replacement therapy (ERT) close to their homes. Infusion-related reactions (IRR) are uncommon;however, they can impair the treatment. Therefore, due to the impossibility of locomotion and unavailability of teams of allergists, RDD protocol were accomplished. The study aimed to describe remote points of training and protocols execution. Method: After appointments from treating lysosomal centers (TLC) diseases about adverse reactions, the following strategy was adopted: three online meetings between metabolic team and allergists to present the clinical case;lectures about adverse reactions to medications and RDD: video demonstrations off how to perform skin tests and nursing training for the use of. Two meetings were held with the families, terms of consent were applied, and a communication group was created on WhatsApp® with team leaders. Afterwards, the RDD was formulated and applied remotely, by Google Meet®. Finally, three infusions were followed up under the supervision of our center. Results:: Six patients presented immediate IRR to different recombinant enzymes: three patients with Fabry disease, one with MPS I, one with MPS II and one with MPS IV. The Allergy Center located in São Paulo, was composed of a team of allergology and health professionals with expertise in inborn errors of metabolism. The (TLC) were in the interior of São Paulo, Bahia, Pernambuco and Piauí, 300 to 1,800 miles apart. The protocols were carried out respecting the Standard 12-16 steps according to risk stratification. One of the patients, developed urticaria on the 11th step, despite the addition of premedication. Conclusion: The new Coronavirus' pandemic imposed a new reality, which include much more telecommunication. Barriers have been overcome, such as offering remote alternatives to the treatment of incurable diseases in countries with continental dimensions.

PASC, reinfections and variants: COVID-19 in patients with inborn errors of immunity in São paulo-Brazil

Background: Inborn Errors of Immunity (IEI) are a heterogeneous group of diseases which immune defect may be related to a complications by COVID 19. Although there are few studies on the evolution and the real clinical impact of infection by SARS-CoV 2 in this group of patients. The aim of the study was to describe the clinical evolution of COVID-19 in patients with different IEI, in a reference center in Brazil. Method: Retrospective and longitudinal study, with analysis of electronic medical charts of patients with IEI and diagnosis of suspected/ confirmed COVID-19 from March 2020 until now. Results: Eighteen patients (61% male), with a median age of 26.6 years (range 12,3-53,4 y), were included in the study. Four X-linked agammaglobulinemia (XLA), 7 common variable immunodeficiency (CVID), 1 specific antibody deficiency, one Good Syndrome-GS, 2 STAT1-GOF, 2 MSMD and one AT. Ten patients (55,5%) had mild flu syndrome and only one patient was asymptomatic. Hospitalization was necessary for 7 patients (38,8%) due to respiratory complications and 3 (16.6%) deceased (2 XLA and 1 GS). Two patients were reinfected (STAT1-GOF and MSMD), with no need for hospitalizations or long-term complications. One of the XLA patients remains hospitalized, with fever for more than 90 days. Five patients experience coughing and tiredness after more than three months of the disease, one also persists with anosmia. Conclusion: Almost 40% of our sample required hospitalization and 16% died. This rate is worrying and reveals how much immunological competence is required by SARS-CoV-2 as well as the fact that Brazil has increasing death rates from COVID-19. Post-acute COVID-19 syndrome (PASC) has presented in more than 25% of IEI patients infected with SARS-CoV-2.

Detection of SARS-CoV-2 in Saliva by RT-LAMP During a Screening of Workers in Brazil, Including Pre-Symptomatic Carriers

The coronavirus pandemic has been causing damage to many nations, as public and private health systems deteriorate by the increasing demand. Some infected patients have culturable severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) even though not presenting any symptoms, and therefore, are probably able to transmit it. Correctly diagnosing and isolating infected patients is an important step towards preventing new infections. Current diagnostic methods rely mainly on reverse transcription quantitative polymerase chain reaction (RT-qPCR). Methods such as reverse transcription loop-mediated isothermal amplification (RT-LAMP) have risen as viable alternatives, as they are cheaper and require less infrastructure, they have the potential to be applied in low-resource scenarios and even at point-of-care. Here we report a colorimetric RT-LAMP assay capable of detecting SARS-CoV-2 in ribonucleic acid (RNA) from saliva. In some cases, the test was able to detect viral RNA before symptom onset and even in a self-reported asymptomatic carrier. It had a limit of detection of 300 copies per reaction and showed a sensitivity of 80%, a specificity of 100%, a general accuracy of 99.59%, and a Cohen's kappa of 0.887. The possibility of detecting positive cases even before the clinical manifestation shows great potential and can contribute to controlling the pandemic.

Increasing impact of COVID-19 on young adults: evidence from hospitalisations in Brazil.

OBJECTIVES: Concerns about the increasing impact of severe COVID-19 in younger individuals in Brazil came after a recent synchronised country-wide wave of cases in Brazil. This communication analyses how hospitalisations due to COVID-19 changed in the age groups 18-49 years and ≥70 years. STUDY DESIGN: Longitudinal study based on secondary data. METHODS: Data from SIVEP-Gripe, a public and open-access database of Severe Acute Respiratory Illness records (including COVID-19 notifications), were used in this study. Statistical control charts examined changes in the magnitude and variation of younger (18-49 years) and older (≥70 years) adults who were hospitalised between 15th March 2020 and 19th June 2021. RESULTS: During the few first weeks of the pandemic in Brazil, the number of COVID-19 hospitalisations increased in older adults but decreased in younger adults. Subsequently, hospitalisations reached statistical control zones in epidemiological weeks (EW) 19-48 of 2020 (EW 19-48/2020) and EW 03-05/2021 (18-49 y, mean = 26.1%; ≥70 y, mean = 32.8%). Between EW 49/2020 and EW 02/2021, the number of hospitalisations of younger adults dropped to levels below the lower control limit. In contrast, the number of hospitalisations of older adults surpassed the upper limit of the corresponding statistical control zones. However, from EW 06/2021, numbers of hospitalisations changed from statistical control zones, with hospitalisations of younger adults increasing and reaching 44.9% in EW 24/2021 and hospitalisations of older adults decreasing until EW 19/2021 (14.1%) and reaching 17.3% in EW 24/2021. CONCLUSIONS: An increasing number of COVID-19 hospitalisations were observed in younger adults from EW 06/2021. This could be a result of the successful vaccination programme in older adults, who were initially prioritised, and possibly an increased exposure to highly transmissible variants of COVID-19 in younger adults who had to go to work in the absence of social protection (i.e. government financial support). Potential consequences of COVID-19 hospitalisations in younger adults could include a reduced life expectancy of the population and an increased number of people unable to perform daily activities due to post-COVID-19 conditions.

Design and Development of a Wearable Device for Monitoring Social Distance using Received Signal Strength Indicator

This paper presents the prototype of a compact and low-cost wearable electronic device that, based on the reading of the Wi-Fi signal strength emitted by other wearable devices of the same type, estimates the proximity between users and issues a notification (an audible and visual alarm) when the distance between them is less than a reference value. Our preliminary results suggest that the proposed solution may be a viable alternative to ensure social distancing as a practice to face the pandemic caused by COVID-19. © 2020 ACM.

Taking the inner route: spatial and demographic factors affecting vulnerability to COVID-19 among 604 cities from inner São Paulo State, Brazil.

Even though the impact of COVID-19 in metropolitan areas has been extensively studied, the geographic spread to smaller cities is also of great concern. We conducted an ecological study aimed at identifying predictors of early introduction, incidence rates of COVID-19 and mortality (up to 8 May 2020) among 604 municipalities in inner São Paulo State, Brazil. Socio-demographic indexes, road distance to the state capital and a classification of regional relevance were included in predictive models for time to COVID-19 introduction (Cox regression), incidence and mortality rates (zero-inflated binomial negative regression). In multivariable analyses, greater demographic density and higher classification of regional relevance were associated with both early introduction and increased rates of COVID-19 incidence and mortality. Other predictive factors varied, but distance from the State Capital (São Paulo City) was negatively associated with time-to-introduction and with incidence rates of COVID-19. Our results reinforce the hypothesis of two patterns of geographical spread of SARS-Cov-2 infection: one that is spatial (from the metropolitan area into the inner state) and another which is hierarchical (from urban centres of regional relevance to smaller and less connected municipalities). Those findings may apply to other settings, especially in developing and highly heterogeneous countries, and point to a potential benefit from strengthening non-pharmaceutical control strategies in areas of greater risk.

Vaccines: From Public Health to Big Business

The text presents and discusses the main aspects related to the current dynamics of the vaccine industry in the world and in Brazil, focusing on the demand created by the pandemic of COVID-19. At the global level, it briefly exposes the place currently occupied by Brazil within the scope of the BRICS and sets out and analyzes the options - identities and differences - of industrial policy in Brazil, China and India in the field of vaccines. Next, it analyzes the displacement of the vaccine industry, from a situation of exclusive production of immunizers to a majority control by the large pharmaceutical industry. Further on, it recovers recent fundamental aspects of the vaccine industry in Brazil, with an emphasis on Biomanguinhos / Fiocruz and the Butantan Institute. Finally, it discusses the successes and limitations of the technology transfer mechanism used by the two institutions, as well as the relevance of their historically assumed commitment to public health policies.

Covid-19 pandemic: A geopolitical analysis

From a critical re-elaboration of the Gramsci’s analytical categories of war of position and war of movement, in an inter-scale perspective, the different power structures and how they position themselves in the face of the global health crisis in search of hegemony are analyzed. Such perspectives point to the covid-19 pandemic as a geopolitical issue and highlight how the strategies of supra-state bodies (WTO, WHO, ILO), States and sectoral economic groups materialize as territorial determinations developed over a fragmented civil society, particularly in the most vulnerable strata (indigenous peoples, peasants and black communities). These territorial determinations express a set of power relations for the realization of the form of value. © 2021, UNIV SAOPAULO. All rights reserved.

Space-time analysis of the first year of COVID-19 pandemic in the city of Rio de Janeiro, Brazil

OBJECTIVE: To describe the space-time evolution of cases and deaths due to COVID-19 in the Rio de Janeiro municipality, Brazil, during the first year of the pandemic. METHODS: An ecological study was carried out. The units of analysis were the neighborhoods of the city of Rio de Janeiro. Incidence and mortality rates, excess risk, Global Moran's Index (Moran's I), local indicator for spatial association, standardized incidence ratio, and standardized mortality ratio were estimated for neighborhoods in the municipality of Rio de Janeiro. RESULTS: Over the first year of the pandemic, registries in the city of Rio de Janeiro included 204,888 cases and 19,017 deaths due to COVID-19. During the first three months of the pandemic, higher incidence rates were verified in the municipality compared with the state of Rio de Janeiro and Brazil, in addition to higher mortality rates compared with the state of Rio de Janeiro and Brazil from May 2020 to February 2021. Bonsucesso was the neighborhood with the highest incidence and mortality rates, and throughout the neighborhoods and months, there is no synchrony between the worst moments of the COVID-19 pandemic. CONCLUSION: The authors emphasize the need for implementing more rigid control and prevention measures, increasing case detection, and accelerating the COVID-19 immunization campaign.

The butantan institute and the brazilian anticovid vaccine

The text explores the theme of Brazilian sufficiency in vaccines. It presents the ways prac-ticed in the two most important Brazilian institu-tions in the development and production of vaccines-the Butantan Institute and the Institute of Technology in Immunobiologicals (Bio-Mangui-nhos). These paths are the pure and simple pur-chase, the purchase of the product with technology transfer commitment, partnerships that include the fulfillment of phase 3 trials by the buyer, the new path announced by Instituto Butantan in which the partnership includes for the realization of trials in phases 1 and 2 and, finally, the inven-tion, development and local vaccine production. The latter is only mentioned as a possibility cur-rently not achieved. Finally, the text presents data on the chances of success in vaccine development.

Age transition of cases, admissions, and deaths by COVID-19 in the municipality of Rio de Janeiro

Objective: To describe the evolution of cases, hospitalizations, and deaths from COVID-19 in the city of Rio de Janeiro by age group between March 2020 and April 2021. Methods: The relative frequencies of COVID-19 cases and deaths were calculated for ten-year age groups in the epidemiological week (EW) 13 from 2020 to 21 of 2021 and expected value ranges by age group and EW. Results: The higher burden of cases was concentrated in the 20-29 and 30-39 age groups. Hospitalizations and deaths were concentrated in the age groups 60-69 years, 70-79 years and 80 years or more, with a marked tendency to rejuvenate the burden of deaths from EW 10 of 2021. Conclusions: There is an age transition in the pandemic in Rio de Janeiro, possibly due to the progress of vaccination. This is, therefore, a successful measure. We insist on the need to accelerate the population immunization process for the control and prevention of COVID-19. © 2022, Associacao Brasileira de Estudos Populacionais. All rights reserved.