What else in times of COVID-19? The role of minimally invasive autopsy for the differential diagnosis of acute respiratory failure in a case of kala-azar.

Visceral leishmaniasis (VL) is a chronic vector-borne zoonotic disease caused by trypanosomatids, considered endemic in 98 countries, mainly associated with poverty. About 50,000-90,000 cases of VL occur annually worldwide, and Brazil has the second largest number of cases in the world. The clinical picture of VL is fever, hepatosplenomegaly, and pancytopenia, progressing to death in 90% of cases due to secondary infections and multi-organ failure, if left untreated. We describe the case of a 25-year-old female who lived in the metropolitan area of Sao Paulo, who had recently taken touristic trips to several rural areas in Southeastern Brazil and was diagnosed post-mortem. During the hospitalization in a hospital reference for the treatment of COVID-19, the patient developed acute respiratory failure, with chest radiographic changes, and died due to refractory shock. The ultrasound-guided minimally invasive autopsy diagnosed VL (macrophages containing amastigote forms of Leishmania in the spleen, liver and bone marrow), as well as pneumonia and bloodstream infection by gram-negative bacilli.

Neisseria gonorrhoeae arthritis in a patient with systemic lupus: resistance and virulence profiles.

In this study, we describe a case report of gonococcal arthritis in a Systemic Lupus Erythematosus patient. Although several mechanisms favor disseminated gonococcal infection (DGI) in patients immunosuppressed by SLE, this association is rarely reported in literature. We performed whole genome sequencing (WGS) of the etiologic agent involved and molecular analysis using a global collection of Neisseria gonorrhoeae strains. Ours is the only sample derived from synovial fluid identified in this collection, the others being from the usual anatomical sites. Antimicrobial susceptibility was determined by disk diffusion and Etest, and WGS was conducted to determine multilocus sequence typing profiles, group isolates based on core genome single nucleotide polymorphisms (SNP), and identify virulence genes and antimicrobial resistance determinants. The N. gonorrhoeae samples in the global collection were highly heterogeneous. The SNP tree had a total 19,532 SNPs in 320 samples. Our sample displayed resistance to ciprofloxacin (MIC = 2 µg/mL) and tetracycline (zone diameter = 0 mm) belonged to ST 1588 and was not closely related to any isolate in the global collection of N. gonorrhoeae strains. The isolate had genetic features related to beta-lactam, tetracycline and quinolone resistance. Seventy-one virulence genes were identified in our sample, belonging to the following classes: adherence, efflux pump, immune modulator, invasion, iron uptake, protease and stress adaptation. Moreover, no virulence genes for immune evasion and toxin were identified.

What else in times of COVID-19? The role of minimally invasive autopsy for the differential diagnosis of acute respiratory failure in a case of kala-azar

ABSTRACT Visceral leishmaniasis (VL) is a chronic vector-borne zoonotic disease caused by trypanosomatids, considered endemic in 98 countries, mainly associated with poverty. About 50,000-90,000 cases of VL occur annually worldwide, and Brazil has the second largest number of cases in the world. The clinical picture of VL is fever, hepatosplenomegaly, and pancytopenia, progressing to death in 90% of cases due to secondary infections and multi-organ failure, if left untreated. We describe the case of a 25-year-old female who lived in the metropolitan area of Sao Paulo, who had recently taken touristic trips to several rural areas in Southeastern Brazil and was diagnosed post-mortem. During the hospitalization in a hospital reference for the treatment of COVID-19, the patient developed acute respiratory failure, with chest radiographic changes, and died due to refractory shock. The ultrasound-guided minimally invasive autopsy diagnosed VL (macrophages containing amastigote forms of Leishmania in the spleen, liver and bone marrow), as well as pneumonia and bloodstream infection by gram-negative bacilli.

Virulomic Analysis of Multidrug-Resistant Klebsiella pneumoniae Isolates and Experimental Virulence Model Using Danio rerio (Zebrafish).

This study evaluates a possible correlation between multidrug-resistant Klebsiella pneumoniae strains and virulence markers in a Danio rerio (zebrafish) model. Whole-genome sequencing (WGS) was performed on 46 strains from three Brazilian hospitals. All of the isolates were colistin-resistant and harbored blaKPC-2. Ten different sequence types (STs) were found; 63% belonged to CC258, 22% to ST340, and 11% to ST16. The virulence factors most frequently found were type 3 fimbriae, siderophores, capsule regulators, and RND efflux-pumps. Six strains were selected for a time-kill experiment in zebrafish embryos: infection by ST16 was associated with a significantly higher mortality rate when compared to non-ST16 strains (52% vs. 29%, p = 0.002). Among the STs, the distribution of virulence factors did not differ significantly except for ST23, which harbored a greater variety of factors than other STs but was not related to a higher mortality rate in zebrafish. Although several virulence factors are described in K. pneumoniae, our study found ST16 to be the only significant predictor of a virulent phenotype in an animal model. Further research is needed to fully understand the correlation between virulence and sequence types.

Carbapenem-resistant Klebsiella pneumoniae colonization and infection is associated with lower overall survival in a cohort of haematopoietic stem-cell transplantation patients: mechanism of resistance and virulence by whole-genome sequencing.

Carbapenem-resistant Klebsiella pneumoniae (CRK) infections are a growing concern in immunocompromised patients. The aim of the present study was to evaluate the impact of CRK colonization and infection in overall mortality for haematopoietic stem-cell transplant (HSCT) patients. We also aimed to investigate resistance and virulence profiles of CRK isolates and assess their epidemiological and genetic relatedness. Patients in the HSCT unit were screened for colonization with CRK with weekly rectal swab or stool cultures and placed under contact precautions. We defined CRK colonization as positive culture from a swab or stool sample grown in MacConkey agar with meropenem at 1 µg ml-1. Demographic and clinical data were retrieved from the patients' charts and electronic records. According to resistance mechanisms and pulsed field gel electrophoresis profile, isolates were selected based on whole-genome sequencing (WGS) using MiSeq Illumina. Outcomes were defined as overall mortality (death up to D+100), and infection-related death (within 14 days of infection). We report a retrospective cohort of 569 haematopoietic stem-cell transplant patients with 105 (18.4 %) CRK colonizations and 30 (5.3 %) infections. blaKPC was the most frequent carbapenemase in our cohort with three isolates co-harbouring blaKPC and blaNDM. We found no difference in virulence profiles from the CRK isolates. There were also no significant differences in virulence profiles among colonization and infection isolates regarding genes encoding for type 1 and 3 fimbriae, siderophores, lipopolysaccharide and colibactin. In clonality analysis by PFGE and WGS, isolates were polyclonal and ST340 was the most prevalent. Overall survival at D+100 was 75.4 % in in CRK-colonized (P=0.02) and 35.7 % in infected patients and significantly lower than non-colonized patients (85.8 %; P<0.001). We found a higher overall mortality associated with colonization and infection; KPC was the main resistance mechanism for carbapenems. The polyclonal distribution of isolates and findings of CRK infection in patients not previously colonized suggest the need to reinforce antibiotic stewardship.

Severity and disability related to epilepsy from the perspective of patients and physicians: A cross-cultural adaptation of the GASE and GAD scales.

PURPOSE: To perform a cross-cultural adaptation of the Global Assessment of Severity of Epilepsy (GASE) and Global Assessment of Disability (GAD) scales to Brazilian Portuguese and compare patients' self-rated scores with their attending physicians' ratings. METHODS: We conducted an observational, multicentre, cross-sectional study. Patients followed up in five epilepsy centres in Brazil responded to GASE and GAD questionnaires and to the Hospital Anxiety and Depression Scale and the Adverse Events Profile, both previously validated in Brazil. GASE and GAD scales were also completed by 20 attending physicians providing care to these patients. RESULTS: A total of 138 patients were interviewed, with a mean age of 39.9 ± 13.81 years and a median of 11 (interquartile range, IQR = 7.5-12) years of education. Eighty-five (61.6%) patients were female. Most patients were diagnosed with focal epilepsy (82.6%). Only 5.8% and 3.6% of respondents reported having difficulty understanding the GASE and GAD, respectively. The patients scored a median of 3 (IQR = 2-5) on the self-perceived GASE and 4 (IQR = 2-6) on the GAD. Physician ratings were moderately to highly correlated with patients' self-perceived scores on the GASE and GAD. Linear regression analysis demonstrated that physicians' GASE and GAD scores predicted 37% and 20% of the patients' self-reported GASE and GAD variation, respectively. CONCLUSION: Brazilian Portuguese cross-cultural adaptation of the GASE and GAD was successful. These scales were found to be easy to use by patients and health professionals, and revealed the burden of epilepsy on patients' lives.

Female sex is strongly associated with cognitive impairment in HIV infection.

BACKGROUND: Neurocognitive disorders remain frequent despite highly active antiretroviral treatment (HAART). The CNS is known as the sanctuary of HIV infection, where persistent neuroinflammation occurs regardless of viral suppression. Moreover, opportunistic infections, neurovascular damage and HAART neurotoxicity contribute to neurocognitive impairment. Therefore, detailed epidemiological studies might help to elucidate those complex mechanisms. OBJECTIVE: To investigate the prevalence of cognitive impairment and the associated sociodemographic, clinical and neuropsychological variables among HIV-infected patients admitted to a tertiary centre, in southern Brazil. METHODS: An observational, cross-sectional and analytic study was conducted between February 2019 and March 2020, in Hospital Nereu Ramos (HNR), with148 HIV-infected patients. They were interviewed, submitted to the International HIV Dementia Scale (IHDS) and had their medical data analysed. RESULTS: The prevalence of cognitive impairment was 69.6%. It was higher among women (OR = 3.5; 95% CI 1.5-8; p < 0.01), independently of depression, educational status and age. Full years of schooling were strongly associated with IHDS scores (p < 0.01). Patient Health Questionnaire-9 (PHQ-9) scores for depression (p = 0.8), time since HIV diagnosis (p = 0.2), CD4+ cell counts (p = 0.8) and viral load (p = 0.8) were not associated with IHDS scale. CONCLUSION: A high prevalence of cognitive impairment in HIV-infected patients was identified, independently associated with the female sex and fewer years of schooling. Further studies are needed to clarify the differences in the pathophysiology between sexes and the role of cognitive reserve in prevention of cognitive impairment in HIV infection.

Qualidade fisiológica de sementes de Dyckia goehringii Gross & Rauh (Bromeliaceae) em função do estádio de maturação dos frutos / Physiological seed properties of Dyckia Goehringii Gross & Rauh (Bromeliaceae) influenced by fruit ripening

Este trabalho objetivou acompanhar as alterações físico-fisiológicas das sementes de Dyckia goehringii, uma bromélia nativa do Cerrado, em função do estádio de maturação dos frutos. Flores foram marcadas em seu local de origem, acompanhando-se o desenvolvimento dos frutos até a fase de dispersão das sementes, quando então foi realizada a coleta de escapos florais contendo frutos de várias idades, os quais foram destacados e separados em cinco estádios segundo a sua coloração e integridade. Foram tomadas as medidas relativas ao comprimento, largura e espessura das sementes, expressando-se os dados em valores médios. Utilizaram-se quatro repetições de 100 sementes para avaliação do teor de água, da massa da matéria seca, da porcentagem de germinação e do índice de velocidade de germinação em cada estádio de maturação. Os testes de germinação foram realizados sobre papel umedecido, em câmara de germinação à temperatura de 30 °C. A largura e o comprimento das sementes foram mais elevados no estádio 4 de maturação, reduzindo posteriormente com sua desidratação. As maiores dimensões obtidas nesse estádio foram coincidentes com o maior acúmulo de matéria seca, alta porcentagem de germinação e maior índice de velocidade de germinação (IVG), indicando a ocorrência da maturidade fisiológica das sementes. A largura, o comprimento, o teor de água e a massa de matéria seca das sementes, correlacionaram-se significativamente, afetando a germinação e o vigor. As características visuais dos frutos de D. goehringii, podem ser indicadoras da maturidade fisiológica das sementes, recomendando-se a coleta de frutos de coloração marrom-enegrecida e brilhante, antes da deiscência.

This investigation aimed to follow the physical and physiological changes in the seeds during fruit ripening of D. goehringii, a bromeliad native in the Cerrado savannah. Flowers were marked and fruits development was followed until seed scattering. Then floral seed stalks containing fruits of different ages were collected. These fruits were detached and classified into five grades according to their colour and integrity. Length, width and thickness of the seeds were measured. Four samples of one hundred seeds each were used for measuring water content, dry mass, germination rate and germination speed (GS) in each ripening grade. Germination tests were carried out on wettish paper in a seed germinator at 30 °C. Seeds of ripening grade 4 showed the highest values of length and width, decreasing later by dehydration. The major dimensions found in this grad were coincident with the highest dry mass content, high germination rate and higher GS, proving physiological seed maturity. There was significant correlation among length, width, water and dry mass content of seeds, showing a narrow relation between germination rate and vigour. The visual traits of D. goehringii fruits like shining, dark brown colour and integrity of the pericarp indicate physiological maturity and harvesting point.

Adapted physical education for mentally disabled adults: a way to understand social role

Avaliar como a educaçäo física adaptada poderia contribuir para o desenvolvimento de adultos com deficiência mental em programas de residência. Este foi um estudo qualitativo desenvolvido em uma residência localizada no município de Vinhedo, Estado de Säo Paulo, Brasil, onde um grupo de adultos residentes com deficiência mental foi acompanhado desde 1992 até 1996. Os 13 adultos com deficiência mental vivendo neste programa de residência foram divididos em dois grupos, um com seis adultos com retardo mental severo e outro com sete residentes com retardo mental moderado. Procedeu-se à observaçäo sistemática dos 13 residentes quatro vezes por semana durante as atividades de educaçäo física em um período de quatro anos. Observou-se o cumprimento de regras bem como suas performances nas capacidades motoras e sociais através destas atividades. Ao final do período de quatro anos houve uma significativa melhoria de todos os 13 residentes com relaçäo à sua habilidade em seguir as regras aprendidas através dos esportes em situaçöes sociais. Os indivíduos do grupo 1 foram capazes de incorporar com êxito as regras às suas vidas cotidianas e também as estenderam às suas atividades sociais. O grupo 2 alcançou as mesmas metas e ainda foi capaz de ajudar o grupo um em suas atividades. A prática de esportes, recreaçäo e lazer mostrou ser importante para melhorar as capacidades motoras e sociais de adultos com deficiência mental em um programa de residência, expandindo estas capacidades para outras situaçöes sociais fora da residência. O programa de educaçäo física proporcionou ferramentas à equipe para lidar com os residentes de uma maneira sistemática que organizou seu trabalho cotidiano.