Smell loss associated with SARS-CoV-2 is not clinically different from other viruses: a multicenter cohort study.

BACKGROUND: Although the COVID-19 pandemic has increased the prevalence of cases with olfactory loss, other respiratory viruses can also cause this condition. We aimed to compare the prevalence of acute SARS-CoV-2 infection and other respiratory viruses in patients with sudden smell loss, and to assess the impact of SARS-CoV-2 viral load and co-infection on olfactory symptoms. METHODS: Patients with sudden smell loss were recruited in a multicenter prospective cohort study in 15 hospitals in Brazil. Clinical questionnaire, Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test and nasopharyngeal swab to perform a PCR-based respiratory viral panel were collected at first visit (day 0) and 30 and 60 days after recruitment. RESULTS: 188 of 213 patients presented positive test result for SARS-CoV-2, among which 65 were co-infected with other respiratory viruses (e.g., rhinovirus, enterovirus, and parainfluenza). 25 had negative test results for SARS-CoV-2. Patients in both SARSCoV-2 and non-SARS-CoV-2 groups had objective anosmia (less than 2 points according to the psychophysical olfactory CCCRC) at day 0, with no significant difference between them. Both groups had significant smell scores improvement after 30 and 60 days, with no difference between them. Co-infection with other respiratory viruses, and SARS-CoV-2 viral load did not impact olfactory scores. CONCLUSION: Patients with sudden smell loss associated with SARS-CoV-2 and other respiratory viruses had similar presentation, with most participants initiating with anosmia, and total or near total recovery after 60 days. SARS-CoV-2 viral load and co-infections with other respiratory viruses were not associated with poorer olfactory outcomes.

Prevalence of bovines persistently infected with bovine viral diarrhea virus (BVDV) in dairy cattle herds in Paraná State, Brazil

ABSTRACT: This study aimed to establish the prevalence of animals persistently infected (PI) with bovine viral diarrhea virus (BVDV) in dairy farms at Parana State, Brazil. Samples were collected from 6,465 female Holstein Friesian Dairy Cattle, including animals less than two years old, females over two years old who had not given birth at the farm, and mothers of calves diagnosed as persistently infected. The cattle came from 40 dairy herds distributed in 10 municipalities in the State of Paraná. The samples were obtained from May 2015 to August 2018. The diagnosis of PI animals was made with an antigen-capture ELISA test. We detected PI animals in fifteen herds sampled (37.5%), ranging from one to sixteen animals per herd. The prevalence in Parana States municipalities was 1.78%, ranging from 0.3 to 8.9% at positive herds. The analysis of the individual herds shows significant dissemination of the BVDV in Paranas municipalities, including endemic areas. With this, we highlight the need for measures to raise awareness among producers about the existence and importance of bovine viral diarrhea (BVD) in dairy herds, reinforcing the PI animals role in disease epidemiology and the economic impact caused by the maintenance of these farm animals.

RESUMO: Com o intuito de se estabelecer a prevalência de animais persistentemente infectados (PI) com o BVDV em propriedades leiteiras no estado do Paraná. Foram coletadas amostras de 6.465 bovinos, fêmeas, da raça Holandês Preto e Branco (HPB). Amostraram-se animais com idade inferior a dois anos, fêmeas com mais de dois anos que não haviam tido partos na propriedade, e mães de bezerros que foram diagnosticados como persistentemente infectados. Os bovinos foram provenientes de 40 rebanhos leiteiros, distribuídos em 10 municípios no Estado do Paraná. A coleta deu-se no período de maio de 2015 a agosto de 2018. O diagnóstico dos animais PI foi feito por meio do teste de ELISA de captura de antígeno. Animais PI foram detectados em quinze rebanhos amostrais (37,5%), oscilando entre um e dezesseis animais por rebanho. A prevalência nos municípios do estado Paraná foi de 1,78%, oscilando entre 0,3 a 8,9% nos rebanhos positivos. Com a alta prevalência de animais PI observada, quando analisados os rebanhos amostrais individualmente, é possível afirmar que há uma disseminação importante do BVDV em municípios paranaenses, destacando inclusive áreas endêmicas. Com isso, vê-se a necessidade de medidas de conscientização dos produtores sobre a existência e importância da BVD nos rebanhos, destacando o papel dos animais PI na epidemiologia da doença, bem como o impacto econômico causado pela manutenção desses animais nos rebanhos.

Prevalence of bovines persistently infected with bovine viral diarrhea virus (BVDV) in dairy cattle herds in Paraná State, Brazil / Prevalência de bovinos persistentemente infectados com o vírus da diarreia viral bovina (BVDV) em rebanhos leiteiros no estado do Paraná, Brasil

This study aimed to establish the prevalence of animals persistently infected (PI) with bovine viral diarrhea virus (BVDV) in dairy farms at Parana State, Brazil. Samples were collected from 6,465 female Holstein Friesian Dairy Cattle, including animals less than two years old, females over two years old who had not given birth at the farm, and mothers of calves diagnosed as persistently infected. The cattle came from 40 dairy herds distributed in 10 municipalities in the State of Paraná. The samples were obtained from May 2015 to August 2018. The diagnosis of PI animals was made with an antigen-capture ELISA test. We detected PI animals in fifteen herds sampled (37.5%), ranging from one to sixteen animals per herd. The prevalence in Parana State's municipalities was 1.78%, ranging from 0.3 to 8.9% at positive herds. The analysis of the individual herds shows significant dissemination of the BVDV in Parana's municipalities, including endemic areas. With this, we highlight the need for measures to raise awareness among producers about the existence and importance of bovine viral diarrhea (BVD) in dairy herds, reinforcing the PI animals' role in disease epidemiology and the economic impact caused by the maintenance of these farm animals.(AU)

Com o intuito de se estabelecer a prevalência de animais persistentemente infectados (PI) com o BVDV em propriedades leiteiras no estado do Paraná. Foram coletadas amostras de 6.465 bovinos, fêmeas, da raça Holandês Preto e Branco (HPB). Amostraram-se animais com idade inferior a dois anos, fêmeas com mais de dois anos que não haviam tido partos na propriedade, e mães de bezerros que foram diagnosticados como persistentemente infectados. Os bovinos foram provenientes de 40 rebanhos leiteiros, distribuídos em 10 municípios no Estado do Paraná. A coleta deu-se no período de maio de 2015 a agosto de 2018. O diagnóstico dos animais PI foi feito por meio do teste de ELISA de captura de antígeno. Animais PI foram detectados em quinze rebanhos amostrais (37,5%), oscilando entre um e dezesseis animais por rebanho. A prevalência nos municípios do estado Paraná foi de 1,78%, oscilando entre 0,3 a 8,9% nos rebanhos positivos. Com a alta prevalência de animais PI observada, quando analisados os rebanhos amostrais individualmente, é possível afirmar que há uma disseminação importante do BVDV em municípios paranaenses, destacando inclusive áreas endêmicas. Com isso, vê-se a necessidade de medidas de conscientização dos produtores sobre a existência e importância da BVD nos rebanhos, destacando o papel dos animais PI na epidemiologia da doença, bem como o impacto econômico causado pela manutenção desses animais nos rebanhos.(AU)

Determinants of successful tracheostomy decannulation in children: a multicentric cohort study.

BACKGROUND: Determining prognostic factors for the probability of tracheostomy decannulation is key to an adequate therapeutic plan. METHODS: A retrospective cohort study of 160 paediatric patients undergoing tracheostomy was conducted. Associations between different parameters and eventual tracheostomy decannulation were assessed. RESULTS: Mean follow-up duration was 27.8 months (interquartile range = 25.5-30.2 months). Median age at tracheostomy was 6.96 months (interquartile range = 3.37-29.42 months), with median tracheostomy maintenance of 14.5 months (interquartile range = 3.7-21.5 months). The overall tracheostomy decannulation rate was 22.5 per cent. Factors associated with a higher probability of tracheostomy decannulation included age at tracheostomy (hazard ratio = 1.11, 95 per cent confidence interval = 1.03-1.18) and post-intubation laryngitis as an indication for tracheostomy (hazard ratio = 2.25, 95 per cent confidence interval = 1.09-4.62). Neurological (hazard ratio = 0.30, 95 per cent confidence interval = 0.12-0.80) and pulmonary (hazard ratio = 0.41, 95 per cent confidence interval = 0.18-0.91) co-morbidities were negatively associated with tracheostomy decannulation. The probability of tracheostomy decannulation decreased significantly with increasing numbers of co-morbidities (p < 0.001). CONCLUSION: Age, post-intubation laryngitis, and number and type of co-morbidities influence tracheostomy decannulation rate in the paediatric population.

Components of compulsory service program for health professionals in low- and middle-income countries: a scoping review.

AIMS: The global health landscape has been characterized by shortfalls and imbalances in human resources for health (HRH), with more health workers concentrated in urban than rural areas. To address this maldistribution, some countries resorted to the implementation of a compulsory service policy for HRH. However, there is no comprehensive documentation describing the different components of such policies. This scoping review aims to determine the components for compulsory service for selected health professionals in low- and middle-income countries (LMICs). METHODS: A search was conducted in MEDLINE, PLoS, Scopus, and ProQuest Central, using keywords for 'compulsory service', 'return service', 'mandatory service', 'physician', 'dentist', 'nurse', 'midwife', 'physical therapist', 'occupational therapist', and identified LMICs. A total of 6757 records were retrieved and assessed, from which 41 relevant records were included in the study. RESULTS AND CONCLUSIONS: Common elements of a compulsory service program are the following: a comprehensive master plan, clearly articulated program goals, appropriate education and training, transparent recruitment and placement, strong institutional and system support, competitive benefits and incentives, and active management of exit from the program. Results presented in this article can serve to inform LMICs on policy, guide program development and management, and direct future research in the area of HRH to address challenges in maldistribution.

Revealing the needs of children with tracheostomies.

INTRODUCTION: Small children with tracheostomy are at potential risk and have very specific needs. International literature describes the need for tracheostomy in 0.5% to 2% of children following intubation. Reports of children submitted to tracheostomy, their characteristics and needs are limited in developing countries and therefore there is a lack of health programs and government investment directed to medical and non-medical care of these patients. The aim of this study was to describe the characteristics of these children and identify problems related to or caused by the tracheostomy. METHODS: A retrospective cohort study was performed based on a common database applied in four high complexity healthcare facilities to children submitted to tracheostomy from January 2013 to December 2015. Data concerning children's demographics, indication for tracheostomy, early and late complications related to tracheostomy, airway diagnosis, comorbidities and decannulation rates are reported. Patients who did not present a complete database or had a follow-up of less than six months were excluded. RESULTS: A total of 160 children submitted to tracheostomy during the three-year period met the criteria and were enrolled in this study. Median age at tracheostomy was 6.9 months (ranging from 1 month to 16 years, interquartile range of 26 months). Post-intubation laryngitis was the most frequent indication (48.8%). Comorbidities were frequent: neurologic disorders were reported in 40%, pulmonary pathologies in 26.9% and 20% were premature infants. Syndromic children were 23.1% and the most frequent was Down's syndrome. The most common early complication was infection that occurred in 8.1%. Stomal granulomas were the most frequent late complication and occurred in 16.9%. Airway anomalies were frequently diagnosed in follow-up endoscopic evaluations. Subglottic stenosis was the most frequent airway diagnosis and occurred in 29.4% of the cases followed by laryngomalacia, suprastomal collapse and vocal cord paralysis. Decannulation was achieved in 22.5% of the cases in the three-year period. The main cause for persistent tracheostomy was the need for further treatment of airway pathology. Mortality rate was 18.1% during this period but only 1.3% were directly related to the tracheostomy, the other deaths were a consequence of other comorbidities. CONCLUSION: Tracheostomies were performed mostly in very small children and comorbidities were very common. Once a tracheostomy was performed in a child in most cases it was not removed before a year. The most common early complication was stoma infection followed by accidental decannulation. The most frequent late complication was granuloma and suprastomal collapse. Airway abnormalities were very frequent in this population and therefore need to be assessed before attempting decannulation.

Performance of an adipokine pathway-based multilocus genetic risk score for prostate cancer risk prediction.

Few biomarkers are available to predict prostate cancer risk. Single nucleotide polymorphisms (SNPs) tend to have weak individual effects but, in combination, they have stronger predictive value. Adipokine pathways have been implicated in the pathogenesis. We used a candidate pathway approach to investigate 29 functional SNPs in key genes from relevant adipokine pathways in a sample of 1006 men eligible for prostate biopsy. We used stepwise multivariate logistic regression and bootstrapping to develop a multilocus genetic risk score by weighting each risk SNP empirically based on its association with disease. Seven common functional polymorphisms were associated with overall and high-grade prostate cancer (Gleason≥7), whereas three variants were associated with high metastatic-risk prostate cancer (PSA≥20 ng/mL and/or Gleason≥8). The addition of genetic variants to age and PSA improved the predictive accuracy for overall and high-grade prostate cancer, using either the area under the receiver-operating characteristics curves (P<0.02), the net reclassification improvement (P<0.001) and integrated discrimination improvement (P<0.001) measures. These results suggest that functional polymorphisms in adipokine pathways may act individually and cumulatively to affect risk and severity of prostate cancer, supporting the influence of adipokine pathways in the pathogenesis of prostate cancer. Use of such adipokine multilocus genetic risk score can enhance the predictive value of PSA and age in estimating absolute risk, which supports further evaluation of its clinical significance.

Tumor cell-educated periprostatic adipose tissue acquires an aggressive cancer-promoting secretory profile.

BACKGROUND/AIMS: The microenvironment produces important factors that are crucial to prostate cancer (PCa) progression. However, the extent to which the cancer cells stimulate periprostatic adipose tissue (PPAT) to produce these proteins is largely unknown. Our purpose was to determine whether PCa cell-derived factors influence PPAT metabolic activity. METHODS: Primary cultures of human PPAT samples from PCa patients (adipose tissue organotypic explants and primary stromal vascular fraction, SVF) were stimulated with conditioned medium (CM) collected from prostate carcinoma (PC3) cells. Cultures without CM were used as control. We used multiplex analysis and ELISA for protein quantification, qPCR to determine mitochondrial DNA (mtDNA) copy number and zymography for matrix metalloproteinase activity, in order to evaluate the response of adipose tissue explants and SVFs to PC3 CM. RESULTS: Stimulation of PPAT explants with PCa PC3 CM induced adipokines associated with cancer progression (osteopontin, tumoral necrosis factor alpha and interleukin-6) and reduced the expression of the protective adipokine adiponectin. Notably, osteopontin protein expression was 13-fold upregulated. Matrix metalloproteinase 9 activity and mitochondrial DNA copy number were higher after stimulation with cancer CM. Stromovascular cells from PPAT in culture were not influenced by tumor-derived factors. CONCLUSION: The modulation of adipokine expression by tumor CM indicates the pervasive extent to which tumor cells command PPAT to produce factors favorable to their aggressiveness.

Congenital toxoplasmosis: evaluation of serological methods for the detection of anti-Toxoplasma gondii IgM and IgA antibodies.

A study was carried out to evaluate the presence of serological markers for the immunodiagnosis of the vertical transmission of toxoplasmosis. We tested the sensitivity, specificity and predictive values (positive and negative) of different serological methods for the early diagnosis of congenital toxoplasmosis. In a prospective longitudinal study, 50 infants with suspected congenital toxoplasmosis were followed up in the ambulatory care centre of Congenital Infections at University Hospital in Goiânia, Goiás, Brazil, from 1 January 2004-30 September 2005. Microparticle Enzyme Immunoassay (MEIA), Enzyme-Linked Fluorescent Assay (ELFA) and Immune-Fluorescent Antibody Technique (IFAT) were used to detect specific IgM anti-Toxoplasma gondii antibodies and a capture ELISA was used to detect specific IgA antibodies. The results showed that 28/50 infants were infected. During the neonatal period, IgM was detected in 39.3% (11/28) of those infected infants and IgA was detected in 21.4% (6/28). The sensitivity, specificity and predictive values (positive and negative) of each assay were, respectively: MEIA and ELFA: 60.9%, 100%, 100%, 55.0%; IFAT: 59.6%, 91.7%, 93.3%, 53.7%; IgA capture ELISA: 57.1%, 100%, 100%, 51.2%. The presence of specific IgM and IgA antibodies during the neonatal period was not frequent, although it was correlated with the most severe cases of congenital transmission. The results indicate that the absence of congenital disease markers (IgM and IgA) in newborns, even after confirming the absence with several techniques, does not constitute an exclusion criterion for toxoplasmosis.

Congenital toxoplasmosis: evaluation of serological methods for the detection of anti-Toxoplasma gondii IgM and IgA antibodies

A study was carried out to evaluate the presence of serological markers for the immunodiagnosis of the vertical transmission of toxoplasmosis. We tested the sensitivity, specificity and predictive values (positive and negative) of different serological methods for the early diagnosis of congenital toxoplasmosis. In a prospective longitudinal study, 50 infants with suspected congenital toxoplasmosis were followed up in the ambulatory care centre of Congenital Infections at University Hospital in Goiânia, Goiás, Brazil, from 1 January 2004-30 September 2005. Microparticle Enzyme Immunoassay (MEIA), Enzyme-Linked Fluorescent Assay (ELFA) and Immune-Fluorescent Antibody Technique (IFAT) were used to detect specific IgM anti-Toxoplasma gondii antibodies and a capture ELISA was used to detect specific IgA antibodies. The results showed that 28/50 infants were infected. During the neonatal period, IgM was detected in 39.3 percent (11/28) of those infected infants and IgA was detected in 21.4 percent (6/28). The sensitivity, specificity and predictive values (positive and negative) of each assay were, respectively: MEIA and ELFA: 60.9 percent, 100 percent, 100 percent, 55.0 percent; IFAT: 59.6 percent, 91.7 percent, 93.3 percent, 53.7 percent; IgA capture ELISA: 57.1 percent, 100 percent, 100 percent, 51.2 percent. The presence of specific IgM and IgA antibodies during the neonatal period was not frequent, although it was correlated with the most severe cases of congenital transmission. The results indicate that the absence of congenital disease markers (IgM and IgA) in newborns, even after confirming the absence with several techniques, does not constitute an exclusion criterion for toxoplasmosis.

Seroprevalencia del citomegalovirus en gestantes del Hospital Materno Infantil de Goiânia / Seroprevalence of cytomegalovirus in pregnant women of Maternity Hospital of Goiânia (Brazil)

Objetivos: Determinar la seroprevalencia del citomegalovirus en gestantes e identificar a las infectadas agudamente o reactivadas. Material y métodos: Se investigó la seroprevalencia de los anticuerpos IgG e IgM en 323 gestantes del Hospital Materno Infantil de Goiânia, por enzimoinmunoanálisis (ELISA), y de éstas, 77 por la prueba de avidez de la IgG para la fase serológica con IgM ausente, escogidas al azar. Resultados: La media de edad ± DE fue de 24,55 ± 6,80 años, y de 23,09 ± 8,78 semanas de edad gestacional. El 98,76% presentaron IgG y el 0,62% además la IgM. El 31,17% presentó baja avidez y el 68,83%, elevada. Conclusiones: De las gestantes estudiadas, el 98,76% presentó infección crónica y el 0,62%, infección aguda. En las investigadas con la prueba de avidez de la IgG, el 31,17% se encontraba en la fase aguda de infección por citomegalovirus, con lo que son necesarios exámenes más sensibles de detección en esta fase debido a la relación con una mayor afección congénita

Objectives: To determine the seroprevalence of cytomegalovirus in pregnant women and to identify those with acute or reactivated infections. Materials and methods: The seroprevalence of IgG and IgM antibodies in 323 pregnant women in the Maternity Hospital of Goiânia was studied using ELISA. Seventy-seven samples were randomly selected to undergo the IgG avidity test for the serological stage without IgM. Results: The mean ± SD age was 24.55 ± 6.80 years and the mean ± SD gestational age was 23.09 ± 8.78 weeks. IgG antibodies were identified in 98.76% and IgM antibodies in 0.62%. Low avidity was found in 31.17% and high avidity was found in 68.83%.Conclusions: Among the pregnant women studied, 98.76% had chronic infection and 0.62% had acute infection. The results of the IgG avidity test revealed that 31.17% were in the acute stage of cytomegalovirus infection. This finding highlights the need for more sensitive detection methods in the acute phase, due to the greater possibility of congenital infection