Effectiveness of ivermectin and atazanavir on time to resolution from COVID-19 symptoms: a prospective cohort

Objective: to evaluate the effectiveness of Ivermectin and Atazanavir compared to placebo in the time to resolution of symptoms and duration of illness due to COVID-19. Method: observational, prospective, longitudinal, descriptive and analytical cohort study with symptomatic outpatients, followed for 06 months in two Basic Health Units for COVID-19 care in Teresina-Piaui, Brazil, from November to April 2021 identified by 1:1:1 random sampling. Reverse transcription polymerase chain reaction (RT-PCR) tests were performed for laboratory confirmation of suspected infection with the new coronavirus and sociodemographic and clinical evaluation. Results: of the 87 randomized patients, 62.1% (n=54) were male, with a mean age of 35.1 years, had a partner (53.9%), low income (50.6%), eutrophic (40.7%) and without health comorbidities (78.2%). There was no difference between the median time to resolution of symptoms, which was 21 days (IQR, 8-30) in the atazanavir group, 30 days (IQR, 5-90) in the ivermectin group compared with 14 days (IQR, 9-21) in the control group. At day 180, there was resolution of symptoms in 100% in the placebo group, 93.9% in the atazanavir group, and 95% in the ivermectin group. The median duration of illness was 8 days in all study arms. Conclusion: Treatment with atazanavir (6 days) and ivermectin (3 days) did not reduce the time to symptom resolution or the duration of illness among outpatients with mild COVID-19 compared to the placebo group. The results do not support the use of ivermectin and atazanavir for the treatment of mild to moderate COVID-19.

Effect of Early Treatment with Pegylated Interferon Lambda for Covid-19

Background: We assessed the efficacy of a single dose of peginterferon lambda in preventing clinical events among acutely symptomatic COVID-19 outpatients. Method(s): We conducted a placebo-controlled, randomized, adaptive platform trial among predominantly vaccinated SARS-CoV-2-positive adults in Brazil and Canada receiving either one subcutaneous injection of peginterferon lambda or placebo. The primary composite endpoint was medical admission to hospital, defined as either observation in a COVID-19 emergency setting for > 6 hours, or transfer to a tertiary hospital due to symptomatic COVID-19 within 28 days post-randomization. Result(s): For this evaluation, 931 patients received peginterferon lambda and 1018 received placebo. 84% of the population were vaccinated and the trial occurred across multiple COVID-19 variants. In the primary analysis of patients, the primary outcome was reduced by 51% in the peginterferon lambda vs. placebo groups (relative risk 0.49 [25/916 vs 57/1003], 95% Bayesian credible interval 0.30-0.76, posterior probability >99.9%). This effect was maintained in subgroup analyses including COVID-19-related hospitalization alone (relative risk 0.57, 95% Bayesian credible intervals 0.33-0.95, ) and COVID-19-related hospitalization or death (Hazard ratio 0.59, 95% Bayesian credible interval 0.35- 0.97). The effects were consistent across dominant variants and vaccination status. Among individuals with a high viral level at baseline, peginterferon lambda resulted in lower viral loads by Day 7, compared to placebo. The incidence of adverse events was similar in the two groups. Conclusion(s): Among predominantly vaccinated outpatients with COVID-19, single-dose of peginterferon lambda resulted in significantly decreased clinical events.

Customized Luminescent Multiplexed Quick-Response Codes as Reliable Temperature Mobile Optical Sensors for eHealth and Internet of Things

The need to sense and track in real time through sustainable and multifunctional labels is exacerbated by the COVID-19 pandemic, where the simultaneous measurement of body temperature and the fast tracking of people is required. One of the big challenges is to develop effective low-cost systems that can promote healthcare provision everywhere and for that, smarter and personalized Internet of things (IoT) devices are a pathway in large exploration, toward cost reduction and sustainability. Using the concept of color-multiplexed quick response (QR) codes, customized smart labels formed by two independent layers and smart location patterns provide simultaneous tracking and multiple synchronous temperature reading with maximum sensitivity values of 8.5% K-1 in the physiological temperature range, overwhelming the state-of-the-art optical sensor for healthcare services provided electronically via the internet (eHealth) and mobile sensors (mHealth).

Dynamics and Heterogeneity of the Lung Immunopathology in Severe COVID-19

Background: The key impact of SARS-CoV-2 is its ability to cause a life-threatening infection in the lung. Aim(s): Using spatially resolved multiplex imaging the present study decodes the immunopathological complexity of severe COVID-19. Method(s): Autopsy lung tissue from 18 COVID-19 patients was used to map immune and structural cells in acute/exudative, intermediate and advanced diffuse alveolar damage (DAD) through multiplex immunohistochemistry and spatial statistical analyses. Cytokine profiling, viral, bacteria and fungi detection and transcriptome analyses were also performed. Result(s): All cases displayed concomitant patterns of DAD. The spatially resolved multiplex data revealed intricate patchworks of mm -size microenvironments representing distinct immunological niches. In-depth analysis of DAD areas revealed that the temporal/spatial DAD progression is associated with expansion of adaptive immune cells, macrophages, CD8 T cells, fibroblasts, angiogenesis and lymphangiogenesis. Viral load correlated positively with acute DAD and negatively with disease/hospital length. Cytokines correlated mainly with macrophages and CD8 T cells. Pro-coagulation and acute repair markers were enriched in acute DAD whereas intermediate/advanced DAD had a molecular profile of elevated humoral and innate immune responses and extracellular matrix production. Conclusion(s): Our unraveling of the spatio-temporal immunopathology in COVID-19 cases exposes the heterogeneous dynamics of acute viral infection and subsequent responses that occur side-by-side in the lungs. This complex disease feature has important implications for disease management and development of novel immunemodulatory treatments.

Differentially expressed genes in Diffuse Alveolar Damage (DAD) patterns of COVID-19

Severe COVID-19 induces DAD, a condition with temporal-spatial heterogeneity. We determined the differentially expressed genes (DEGs) in the histological patterns of DAD. Twelve fatal COVID-19 cases were classified in acute DAD (n=5) and intermediate/advanced (IA) DAD (n=7). Autopsy lung RNA was extracted from COVID-19 and 4 control cases. RNA sequencing was performed on the Illumina NovaSeq 6000. Enrichment analysis was performed with clusterProfiler using Genome-wide annotation for Human R package. GO terms and KEGG pathways were considered enriched if adjusted p<=0.05. Principal component analysis showed that IA-DAD samples were grouped, while acute DAD samples were scattered. The differential expression analysis between these two groups and the control cases revealed: 261 DEGs in the acute DAD (143 Up- and 53 Down-regulated), 244 DEGs in the IA- DAD tissues (67 Up- and 116 Down-regulated), and 61 DEGs were shared between them (45 Up- and 16 Downregulated). Patients with acute DAD had up-regulated genes related to oxidative phosphorylation, blood coagulation, megakaryocytes differentiation/regulation, and platelet degranulation/activation. Patients with IA-DAD had DEGs related to immunoglobulins and extracellular matrix. The shared up-regulated DEGs between both patterns are involved in innate and adaptive immune responses. We selected 3 DEGs in each DAD pattern for validation by realtime PCR. There were no differences in acute DAD DEGs, but DEGs overexpressed in intermediate DAD (COL3A1, IGLV3-19, IGHV1-58) were significantly higher. Genes related to thrombotic events occur at the acute stage of DAD, whereas immunoglobulin production and remodeling occur at later stages of DAD.

Correlation between lung inflammatory cells, viral load and cytokines in fatal COVID-19

SARS-CoV2 infection induces a complex interaction between virus and host immune system, activating multiple inflammatory pathways and leading to hyperinflammation, diffuse alveolar damage (DAD), ARDS, and multiorgan failure. We aimed to correlate the quantification of viral load, inflammatory cells and cytokines in lung tissue of fatal COVID-19. We assessed inflammatory cells by multiplex immunohistochemistry, cytokines by Luminex xMAP Assay and viral load by real time PCR in autopsy lung tissue of 18 COVID-19 patients. Correlations were considered statistically significant if p<0.05. Macrophages correlated with IL-1beta (r=0.54), IL-10 (r=0.5), IFN-alpha2 (r=0.72), IFN-gamma (r=0.6), CCL20 (r=0.5), TGF-beta1 (r=0.6), TGF-beta2 (r=0.6). CD4+T cells correlated with CCL20 (r=0.6), MDC/CCL2 (r=0.53), CCL17 (r=0.5), IP-10 (r=0.6), CXCL9 (r=0.6). CD8+T cells correlated with IL-1beta (r=0.54), IL-4 (r=0.63), IL-6 (r=0.7), IL-8 (r=0.63), IL-10 (r=0.6), TNF-alpha (r=0.6), IFN-gamma (r=0.74), CCL20 (r=0.7), TGF-beta1 (r=0.7), TGF-beta2 (r=0.56), TGF-beta3 (r=0.54), MDC/CCL2 (r=0.7), CCL17 (r=0.64). Langerin dendritic cells (DC) correlated with symptom onset to death interval (r=0.6), hospitalization length (r=0.65), mechanical ventilation (MV) length (r=0.6), ICU stay (r=0.6), exudative DAD (r=-0.5), viral load (r=-0.6). Myeloid DC correlated with symptom onset to death interval (r=0.8), hospitalization length (r=0.8), MV length (r=0.8), ICU stay (r=0.8), exudative DAD (r=-0.5), viral load (r=-0.7). Viral load correlated with symptom onset to death interval (r=-0.7), hospitalization length (r=-0.8), MV length (r=-0.7), ICU stay (r=-0.8), exudative DAD (r=0.6). There is a complex temporal inflammatory modulation in severe COVID-19.

Regional and sectorial impacts of the COVID-19 pandemic in Sergipe, Brazil

This paper aims at estimating the regional and sectoral impacts of the Covid-19 pandemic in the state of Sergipe, Brazil in 2020. We use an input-output model with partial hypothetical extraction. The main results suggest a significant reduction in economic activity in the state, particularly in the Transport and Industry sectors. On the other hand, the Real estate and Food and Accommodation sectors have a greater capacity for recovery with the introduction of an emergency aid program. The municipalities with the largest absolute impact on gross domestic product are Aracaju, Canindé de São Francisco and Nossa Senhora do Socorro, two of them located in the metropolitan area of Aracaju. © 2023 Wiley Periodicals LLC.

Influence of biosafety protocols adopted for the prevention of SARS-CoV-2 in slaughterhouses and a positive effect on the reduction of Staphylococcus aureus presence in beef cuts

Staphylococcus aureus is a food quality indicator microorganism commonly found in human mucous membranes. With the emergence of the virus related to SARS-CoV-2, several prevention protocols were established. Therefore, this study assessed whether the adoption of SARS-CoV-2 protocols influenced the presence of S. aureus in beef samples. We analyzed the S. aureus results of 3654 beef samples between April and September 2019 and 2020. Mean percentages of the population of S. aureus were different between years (2.63%-2019;1.13%-2020), revealing that after the adoption of the SARS-CoV-2 protocols there was a decrease in the presence of S. aureus. Concomitantly, a significant difference was also presented in the annual means of S. aureus load counts (2.30 log of CFU/g in 2019, and 1.60 log of CFU/g in 2020), of the sets of beef samples analyzed. Therefore, we suggest that the measures used to prevent SARS-CoV-2 can continue to be applied even after the pandemic, especially in the stages that involve beef handling in slaughterhouses.

Effect of the absence of the crowd in the two main divisions of Brazilian championship

Effect of the absence of the crowd in the two main divisions of Brazilian championship The aim of this study was to compare these markers during gamis in the two divisions of the Brazilian Championship before and during the pandemic. Retropective study Where the technical performance data of the 2019 and 2020 season rounds of the Brazilian Champioship first and second division. The technical data analyzed were number of draws, number of victories, number of goals, yellow cards, red cards, shots, shots on goal, penalties, fouls, percentage of correct passes, percentage of ball possession and number of games in which all substitutions were used. The statistics were performed using the independent t-Test, adopting the value of p < 0.05 as the statistical difference. In the first division, the principals teams reduced the number of shots, shots on goal, tackles and substitutions made and the number of fouls and for the visitors the number of fouls increased and the number of substitutions decreased. In Serie B, the principals team increased the number of sending offs, shots and substitutions and the visitors decreased the number of yellow cards, substitutions and the number of correct passes increased.

[Pre-clinical validation of a turbine-based ventilator for invasive ventilation-The ACUTE-19 ventilator]. / Validación preclínica de un respirador de turbina para la ventilación invasiva: el respirador ACUTE-19.

Background: The severe acute respiratory syndrome-coronavirus 2 pandemic pressure on healthcare systems can exhaust ventilator resources, especially where resources are restricted. Our objective was a rapid preclinical evaluation of a newly developed turbine-based ventilator, named the ACUTE-19, for invasive ventilation. Methods: Validation consisted of (a) testing tidal volume delivery in 11 simulated models, with various resistances and compliances; (b) comparison with a commercial ventilator (VIVO-50) adapting the United Kingdom Medicines and Healthcare products Regulatory Agency-recommendations for rapidly manufactured ventilators; and (c) in vivo testing in a sheep before and after inducing acute respiratory distress syndrome by saline lavage. Results: Differences in tidal volume in the simulated models were marginally different (largest difference 33 ml [95% CI 31 to 36]; P < .001). Plateau pressure was not different (-0.3 cmH2O [95% CI -0.9 to 0.3]; P = .409), and positive end-expiratory pressure was marginally different (0.3 cmH2O [95% CI 0.2 to 0.3]; P < .001) between the ACUTE-19 and the commercial ventilator. Bland-Altman analyses showed good agreement (mean bias -0.29 [limits of agreement 0.82 to -1.42], and mean bias 0.56 [limits of agreement 1.94 to -0.81], at a plateau pressure of 15 and 30 cmH2O, respectively). The ACUTE-19 achieved optimal oxygenation and ventilation before and after acute respiratory distress syndrome induction. Conclusions: The ACUTE-19 performed accurately in simulated and animal models yielding a comparable performance with a VIVO-50 commercial device. The ACUTE-19 can provide the basis for the development of a future affordable commercial ventilator.

Validación preclínica de un respirador de turbina para la ventilación invasiva: el respirador ACUTE-19 Pre-clinical validation of a turbine-based ventilator for invasive ventilation–The ACUTE-19 ventilator

Graphical Antecedentes La pandemia producida por el síndrome respiratorio agudo severo por coronavirus 2 puede agotar los recursos sanitarios, especialmente de respiradores, en situaciones de escasez de recursos sanitarios. Nuestro objetivo fue realizar una evaluación preclínica rápida de un prototipo de respirador de turbina para la ventilación invasiva denominado ACUTE-19. Métodos La validación consistió en: a) evaluación de la administración de un volumen corriente en 11 modelos pulmonares simulados, con diversas resistencias y compliancias;b) comparación con un ventilador comercial (VIVO-50) adaptando las recomendaciones de la Agencia Reguladora de Medicamentos y Productos Sanitarios del Reino Unido para ventiladores de fabricación rápida, y c) realización de pruebas in vivo en una oveja antes y después de inducir el síndrome de distrés respiratorio agudo mediante lavado salino. Resultados Las diferencias de volumen corriente en los modelos simulados fueron mínimamente diferentes (la mayor diferencia fue de 33 ml [IC 95%: 31 a 36];p < 0,001). La presión de meseta no fue diferente (−0,3 cmH2O [IC 95%: −0,9 a 0,3];p = 0,409), y la presión positiva al final de la espiración fue levemente diferente (0,3 cmH2O [IC 95%: 0,2 a 0,3];p < 0,001) comparando el ACUTE-19 y el ventilador comercial. El análisis de Bland-Altman mostró una buena concordancia (sesgo medio −0,29 [límites de concordancia 0,82 a −1,42], y sesgo medio 0,56 [límites de concordancia 1,94 a −0,81], a una presión de meseta de 15 y 30 cmH2O, respectivamente). El ACUTE-19 consiguió una oxigenación y ventilación óptimas antes y después de la inducción del síndrome de distrés respiratorio agudo en el modelo animal. Conclusiones El ACUTE-19 se comportó con precisión en los modelos simulados y animales, con un rendimiento comparable al del dispositivo comercial VIVO-50. El ACUTE-19 puede servir de base para el desarrollo de un futuro ventilador comercial asequible.

Pre-clinical validation of a turbine-based ventilator for invasive ventilation-The ACUTE-19 ventilator.

BACKGROUND: The Severe Acute Respiratory Syndrome (SARS)-Coronavirus 2 (CoV-2) pandemic pressure on healthcare systems can exhaust ventilator resources, especially where resources are restricted. Our objective was a rapid preclinical evaluation of a newly developed turbine-based ventilator, named the ACUTE-19, for invasive ventilation. METHODS: Validation consisted of (a) testing tidal volume (V_T) delivery in 11 simulated models, with various resistances and compliances; (b) comparison with a commercial ventilator (VIVO-50) adapting the United Kingdom Medicines and Healthcare products Regulatory Agency-recommendations for rapidly manufactured ventilators; and (c) in vivo testing in a sheep before and after inducing acute respiratory distress syndrome (ARDS) by saline lavage. RESULTS: Differences in V_T in the simulated models were marginally different (largest difference 33ml [95%-confidence interval (CI) 31-36]; P<.001ml). Plateau pressure (P_plat) was not different (-0.3cmH₂O [95%-CI -0.9 to 0.3]; P=.409), and positive end-expiratory pressure (PEEP) was marginally different (0.3 cmH₂O [95%-CI 0.2 to 0.3]; P<.001) between the ACUTE-19 and the commercial ventilator. Bland-Altman analyses showed good agreement (mean bias, -0.29, [limits of agreement, 0.82 to -1.42], and mean bias 0.56 [limits of agreement, 1.94 to -0.81], at a P_plat of 15 and 30cmH₂O, respectively). The ACUTE-19 achieved optimal oxygenation and ventilation before and after ARDS induction. CONCLUSIONS: The ACUTE-19 performed accurately in simulated and animal models yielding a comparable performance with a VIVO-50 commercial device. The acute 19 can provide the basis for the development of a future affordable commercial ventilator.

Hyperoxemia in invasively ventilated COVID-19 patients-Insights from the PRoVENT-COVID study.

OBJECTIVE: We determined the prevalences of hyperoxemia and excessive oxygen use, and the epidemiology, ventilation characteristics and outcomes associated with hyperoxemia in invasively ventilated patients with coronavirus disease 2019 (COVID-19). METHODS: Post hoc analysis of a national, multicentre, observational study in 22 ICUs. Patients were classified in the first two days of invasive ventilation as 'hyperoxemic' or 'normoxemic'. The co-primary endpoints were prevalence of hyperoxemia (PaO2 > 90 mmHg) and prevalence of excessive oxygen use (FiO2 ≥ 60% while PaO2 > 90 mmHg or SpO2 > 92%). Secondary endpoints included ventilator settings and ventilation parameters, duration of ventilation, length of stay (LOS) in ICU and hospital, and mortality in ICU, hospital, and at day 28 and 90. We used propensity matching to control for observed confounding factors that may influence endpoints. RESULTS: Of 851 COVID-19 patients, 225 (26.4%) were classified as hyperoxemic. Excessive oxygen use occurred in 385 (45.2%) patients. Acute respiratory distress syndrome (ARDS) severity was lowest in hyperoxemic patients. Hyperoxemic patients were ventilated with higher positive end-expiratory pressure (PEEP), while rescue therapies for hypoxemia were applied more often in normoxemic patients. Neither in the unmatched nor in the matched analysis were there differences between hyperoxemic and normoxemic patients with regard to any of the clinical outcomes. CONCLUSION: In this cohort of invasively ventilated COVID-19 patients, hyperoxemia occurred often and so did excessive oxygen use. The main differences between hyperoxemic and normoxemic patients were ARDS severity and use of PEEP. Clinical outcomes were not different between hyperoxemic and normoxemic patients.

IN THE TECHNOLOGICAL ERA, ON THE WAY TO OBLIVION: A STUDY OF THE CURRENT EDUCATIONAL SITUATION OF STUDENTS FROM SOME PUBLIC SCHOOLS IN THE INTERIOR OF BAHIA, IN THE PERIOD OF THE COVID-19 PANDEMIC

This writing is an approach to the vision of some elementary school students and high school students from public schools in the interior of Bahia, about how they think about their current educational situations in the midst of the pandemic caused by Covid-19, which is why classes attendance was suspended. Regarding the (im)possibilities of access to ICTs by students, we observe the expansion of their educational autonomies;the opening of their critical and reflexive postures, triggering the undertaking of their own school learning. We seek to externalize learning difficulties in pandemic times;the digital exclusions, whose discrepancies became more evident through the pandemic reality. A qualitative approach combined with the activity of listening to the participating subjects in their places and contexts. We use online interviews, we seek to dialogue with authors such as (Lemos, 2015);(Silva, 2011);(Freire, 2006);(Amiel, 2018) and with students, young people and adolescents, tracing an image of the tangent reality under their vision

Intensive care admissions following rapid response team reviews in patients with COVID-19 in Australia

Objectives: To evaluate the epidemiology of rapid response team (RRT) reviews that led to intensive care unit (ICU) admissions, and to evaluate the frequency of in-hospital cardiac arrests (IHCAs) among ICU patients with confirmed coronavirus disease 2019 (COVID-19) in Australia. Design: Multicentre, retrospective cohort study. Setting: 48 public and private ICUs in Australia. Participants: All adults (aged ≥ 16 years) with confirmed COVID-19 admitted to participating ICUs between 25 January and 31 October 2020, as part of SPRINT-SARI (Short PeRiod IncideNce sTudy of Severe Acute Respiratory Infection) Australia, which were linked with ICUs contributing to the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS APD). Main outcome measures and results: Of the 413 critically ill patients with COVID-19 who were analysed, 48.2% (199/413) were admitted from the ward and 30.5% (126/413) were admitted to the ICU following an RRT review. Patients admitted following an RRT review had higher Acute Physiology and Chronic Health Evaluation (APACHE) scores, fewer days from symptom onset to hospitalisation (median, 5.4 [interquartile range (IQR), 3.2–7.6] v 7.1 days [IQR, 4.1–9.8];P < 0.001) and longer hospitalisations (median, 18 [IQR, 11–33] v 13 days [IQR, 7–24];P < 0.001) compared with those not admitted via an RRT review. Admissions following RRT review comprised 60.3% (120/199) of all ward-based admissions. Overall, IHCA occurred in 1.9% (8/413) of ICU patients with COVID-19, and most IHCAs (6/8, 75%) occurred during ICU admission. There were no differences in IHCA rates or in ICU or hospital mortality rates based on whether a patient had a prior RRT review or not. Conclusions: This study found that RRT reviews were a common way for deteriorating ward patients with COVID-19 to be admitted to the ICU, and that IHCA was rare among ICU patients with COVID-19. © 2022, College of Intensive Care Medicine. All rights reserved.

Symptoms of COVID-19 in children.

The aim of this study was to review the symptomatic manifestations of COVID-19 in children in the scientific literature. An integrative review of studies published between December 2019 and September 5, 2021, from the Medical Literature Analysis and Retrieval System Online, Web of Science, Scopus, Literatura Latino-Americana em Ciência de Saúde, and Base de Dados de Enfermagem databases, was carried out to answer the following research question: What symptomatic manifestations does COVID-19 cause in children?". Twenty articles were included. The main symptoms described were fever, cough, diarrhea, vomiting, sore throat, dyspnea, headache, abdominal pain, malaise, and weakness or tiredness. The findings of this review can contribute to the diagnosis and clinical decision-making of the health team by providing information that facilitates the identification of COVID-19 in the target population, favoring early identification, better care, and consequently a better prognosis.

INTRACELLULAR SARS-COV-2 FOUNDIN THE SPERMATOZOA OF CONVALESCENT MEN WITH NEGATIVE PCR SEMEN SAMPLES REVEALED BY ELECTRON MICROSCOPY

INTRODUCTION AND OBJECTIVE: SARS-CoV-2 can invade different testicular cell types, such as spermatogonia, spermatids, Sertoli, and Leydig cells. We investigated the viral presence inside the sperm of negative PCR infected men up to 3 months after discharge from the hospital. METHODS: This cross-sectional study included 13 of a 26 moderate-to-severe SARS-CoV-2 infected men cohort (mean 34.3 ± 6.5 years;range: 21-50 years old). Patients were enrolled 30 to 90 days after the diagnosis. Semen samples were obtained by masturbation and processed within one hour according to WHO guidelines. All patients were PCR negative for the virus in the ejaculate. Samples were liquefied for 30 min at room temperature in 0.1M phosphate buffer before centrifuging at 500 g for 10 min. The supernatant was removed, and pellets were fixed in 2,5% v/v glutaraldehyde in 0.1M phosphate buffer for 2h at 4°C, post-fixed in 1% OsO4 for 1h at 4°C, stained overnight in 1% aqueous uranyl acetate. Then, the pellets were dehydrated sequentially in 30%, 70%, and 100% ethanol and embedded in epoxy resin. Ultrathin sections (70nm) were obtained in an ultramicrotome, collected on nickel grids, and double-stained by uranyl acetate and lead citrate. Micrographs were obtained with a Jeol JEM 1010 electron microscope (Tokyo, Japan, 80 kV). RESULTS: We identified viruses inside spermatozoa in 9/13 patients up to 90 days after discharge from the hospital. Moreover, in all 13 men, a type of DNA-based extracellular traps, probably in a cfDNAdependent manner, like described in the COVID-19 systemic inflammatory response. FIGURE: High magnification electron micrograph of a spermatozoon with the nucleus (nu) displaying the typical condensed chromatin. The remained cytoplasm contains several viral particles (ranging in diameter from 90 to 110 nm). The inset corresponds to a higher magnification of the boxed area containing two virions, showing the SARS-CoV-2 characteristics: viral envelope (white arrowhead), nucleocapsids (black arrowhead), and spike-like projections (white arrow). CONCLUSIONS: Although SARS-CoV-2 is not found in the infected men's semen, it was intracellularly present in the spermatozoa. The potential implications for assisted conception should be addressed. (Figure Presented).

ELEVATED ROS LEVELS AND DNA FRAGMENTATION IN SPERM FROM CONVALESCENT MEN IN SARS-COV-2 INFECTION

INTRODUCTION AND OBJECTIVE: Current evidence has proven the systemic nature of COVID19, including its involvement in the male reproductive tract. We aimed to investigate seminal parameters of moderate-to-severe COVID-19 men during the convalescence phase. METHODS: This cross-sectional study included 18 to 50-yearold men with confirmed moderate-to-severe COVID-19. Patients were enrolled 15 to 45 days after the diagnosis. After a urologist's initial clinical evaluation, semen samples were obtained by masturbation and processed within one hour. Semen analysis was performed using the World Health Organization (WHO) manual (6th edition). Sperm function tests were conducted in an andrology laboratory, including Reactive oxygen species (ROS), DNA fragmentation, lipid peroxidation, and Creatine Kinase (CK) analysis. An essential endocrine evaluation was performed. Patients with a history of disorders that could impair testicular function were excluded. A group of pre-vasectomy baseline samples was used as a control group. Statistical analysis was performed using R version 4.0.5. One-tailed and paired T-tests were used for comparisons between groups. RESULTS: The sample size was 26 men (mean 34.3±6.5 years;range: 21-50 years). Sperm concentration (mean 38.74±32, P <0.01) and total motile count (mean 55.3±66.8, P <0.01) were significantly reduced in the COVID-19 group. The DNA fragmentation (mean 41.1±29.2) and ROS (mean 4.84±8.7) were significantly higher in post-infection patients. Other parameters such as WHO/ Kruger morphology and progressive motility were also reduced in the disease group, albeit not statistically significant. Total testosterone (mean 409.2±201.2) was lower in the convalescent men. All semen samples were negative for SARS-CoV-2 using the PCR analysis. CONCLUSIONS: Our findings indicate that male reproductive injury can be a relevant component of SARS-CoV-2 systemic infection. High DNA fragmentation and ROS, hallmarks of tissue injury, might signal a direct testicular involvement. The morphological and functional damage could represent significant impairment of the male reproductive health if persistent after convalescence.

RELATO DE CASO: TROMBOCITOPENIA IMUNE PÓS VACINAÇÃO COVID

Introdução: A Trombocitopenia Imune (TI) pós vacina é um fenômeno já relatado com outros imunizantes já introduzidos no calendário vacinal. Com a atual pandemia da infecção pelo coronavírus (COVID-19) houve também uma corrida para desenvolvimento de agentes capazes de imunizar e dessa forma proteger a população da infecção. O mecanismo pelo qual ocorre a TI pós vacina é imunológico, com desenvolvimento de anticorpos contra plaquetas. O tempo médio para desenvolvimento da TI na infecção por COVID foi de 13 dias, na reação pós vacinal variou em uma série de casos de 1-23 dias. Nosso estudo vem relatar um quadro de TI após 9 dias da vacinação com AstraZeneca. Relato: Trata-se de paciente adulto, sexo masculino,53 anos, previamente hígido, intercorrendo 9 dias após vacinação, imunizante AstraZeneca, com petéquias em MMII, tronco e purpura úmida, o que o levou a procurar atendimento médico. Sendo internado no dia 04 de julho com plaquetopenia isolada. Exames: Hb:14,30 Htc:41,50 VCM:92 HCM:31,80 GB:14210 (Seg:11652—Linf:1421) Plaquetas: 3000. Investigadas infecções latentes que poderiam ser a etiologia do processo, contudo negativas. Iniciado corticoterapia em dose 1 mg/Kg/dia, sem resposta adequada. Prescrito Imunoglobulina venosa (IGV), no 4°dia de internação, na dose 1 g/kg/dia por 2 dias, sem resposta. Mantido prednisona 1 mg/kg/dia e repetido no 25°dia, a IGV, com resposta clínica. Durante o período o paciente foi investigado para fenômenos trombogênicos, associado a Trombocitopenia Trombótica induzida por Vacina (TTIV) não pontuando para síndrome (Fibrinogênio não consumido, VHS e PCR dentro do valor normal de referência, LDH normal, D-dímero: normal, anticorpo anti fator 4 plaquetário ainda pendente). Discussão: No caso da COVID-19 foi descrita TI com diversos mecanismos: destruição imunológica;destruição direta pela infecção, redução da produção da trombopoetina. O mecanismo pós vacina é imunomediada. A TTIV ocorre de 4 a 28 dias após a vacinação contudo haveria fenômeno trombótico associado, o que não ocorreu com nosso paciente. A demora a resposta terapêutica é similar a TI pós Covid-19.