Upper Airway Mucociliary Clearance is Impaired in Dyspneic COVID-19 Patients.

Covid-19 is transmitted mainly by respiratory droplets and as the upper airway mucosa is the first innate immune barrier, it is crucial to understand the effects of SARS-CoV-2 on this system. In the current study, we aimed to evaluate the nasal mucociliary clearance in patients with SARS-CoV-2 infection and their symptom development. Observational cross-sectional study. The nasal mucociliary clearance (NMC) time was evaluated by the saccharin test and the results were compared between patients with SARS-CoV-2 infection (group 1) and controls (group 2, asymptomatic patients with a negative polymerase chain reaction test). We also compared the NMC time for each specific symptom suffered by participants in group 1 with the NMC time of the control group as well as with the patients in group 1 who were asymptomatic. There was a significant increase in NMC time in group 1 with dyspnea when compared to the control group (p = 0.032) and also when compared to patients who were infected were not dyspneic (p = 0.04). There were no differences in the clearance times when considering other symptoms. COVID-19 patients with dyspnea present with altered nasal mucociliary clearance.

Cost-effectiveness of an exercise-based cardiovascular rehabilitation program in patients with chronic Chagas cardiomyopathy in Brazil: An analysis from the PEACH study.

OBJECTIVES: The present study aimed to perform a cost-effectiveness analysis of an exercise-based cardiovascular rehabilitation (CR) program in patients with chronic Chagas cardiomyopathy (CCC). METHODS: Cost-effectiveness analysis alongside a randomised clinical trial evaluating the effects of a 6-month exercise-based CR program. The intervention group underwent 3 weekly exercise sessions. The variation of peak oxygen consumption (VO2peak ) was used as a measurement of clinical outcome. Cost information from all healthcare expenses (examinations, healthcare visits, medication and hospitalisation) were obtained from the medical records in Brazilian reais (R$) and transformed into dollars using the purchasing power parity ($PPP). The longitudinal costs variation was evaluated through linear mixed models, represented by ß coefficient, adjusted for the baseline values of the dependent variable. The cost-effectiveness evaluation was determined through an incremental cost-effectiveness ratio using the HEABS package (Stata 15.0). RESULTS: The intervention group presented higher costs with healthcare visits (ß = +3317.3; p < 0.001), hospitalisation (ß = +2810.4; p = 0.02) and total cost (ß = +6407.9; p < 0.001) after 3 months of follow-up. Costs related to healthcare visits (ß = +2455.8; p < 0.001) and total cost (ß = +4711.4; p < 0.001) remained higher in the intervention group after 6 months. The CR program showed an incremental cost-effectiveness ratio (ICER) of $PPP 1874.3 for each increase of 1.0 ml kg-1  min-1 of VO2peak . CONCLUSIONS: The CR program can be considered a cost-effective alternative and should be included as an intervention strategy in the care of patients with CCC.

Rebalancing thoraco-abdominal method does not increase immediate pain assessed by Neonatal Infant Pain Scale: a randomized clinical trial / O método reequilíbrio tóraco-abdominal não aumenta a dor avaliada pela Neonatal Infant Pain Scale: estudo clínico randomizado

Objective: To compare in neonates with transitory tachypnea if chest rebalancing thoraco-abdominal method (RTA) increased immediate pain. Methods: This was a randomized controlled clinical trial. Forty-nine neonates with transitory tachypnea and aged < 72 hours were included to receive either conventional physiotherapy (CP) or RTA method. Participants received usual care and one 15- minute session of chest physiotherapy. Neonatal Infant Pain Scale (NIPS), peripheral oxygen saturation, heart rate, respiratory rate, axillary temperature before and after chest physiotherapy were recorded. Kruskal-Wallis ANOVA and Mc Nemar test were used to compare differences between measures. The relative risk (RR) for pain after interventions was calculated using a Poisson regression model (robust estimation). A significance level of 5% (p < 0.05) was adopted for all analyses. Results: RTA was not associated to pain. After chest physiotherapy, NIPS reduced (2 versus 3, p < 0.001) and number of neonates with pain reduced (10.2% versus 28.6%, p = 0.02). RR for pain after chest physiotherapy in comparison to before was 0.3 (95% CI 0.15-0.41; p = 0.02); respiratory frequency decreased after chest physiotherapy (58 versus 70, p < 0.001) and peripheral oxygen saturation increased (98% versus 96%, p < 0.001). Conclusion: In neonates with transitory tachypnea, in the first 72 hours of life, RTA did not influence pain evaluation, chest physiotherapy was safe and reduced immediate pain. (AU)

Objetivo: Comparar em recém-nascidos com taquipneia transitória se o método reequilíbrio tóraco-abdominal (RTA) aumentou a dor imediatamente após. Métodos: Estudo de ensaio clínico randomizado. Quarenta e nove recémnascidos com diagnóstico de taquipneia transitória com menos de 72 horas de vida, foram incluídos para receber fisioterapia respiratória. Os participantes receberam os cuidados usuais e uma sessão de fisioterapia convencional ou do método reequilíbrio tóraco-abdominal. Foram registradas a escala NIPS (Neonatal Infant Pain Scale), a saturação periférica de oxigênio, a frequência cardíaca, a frequência respiratória e a temperatura axilar antes e depois da fisioterapia. Para as comparações entre as medidas, foram utilizados o teste de ANOVA de Kruskal-Wallis e o teste de McNemar. O risco relativo de dor após os procedimentos foi calculado usando o modelo de regressão de Poisson (estimação robusta). Foi considerado o nível de significância de 5% para todas as análises (p < 0,05). Resultados: O método RTA não foi associado a dor. Após a fisioterapia respiratória, a escala NIPS reduziu (2 versus 3, p < 0,001) e a proporção de recém-nascidos com dor também reduziu (10,2% versus 28,6%, p = 0,02). O risco relativo de dor após a fisioterapia respiratória em comparação a antes, foi de 0,3 (IC 95% 0,15-0,41; p = 0,02), a frequência respiratória diminuiu (58 versus 70, p < 0,001) e a saturação periférica de oxigênio aumentou (98% versus 96%, p < 0,001). Conclusão: Em recém-nascidos com taquipneia transitória nas primeiras 72 horas de vida, o método RTA não influenciou a avaliação da dor, a fisioterapia respiratória foi segura e reduziu a dor imediatamente após. (AU)

Standardization of intralesional meglumine antimoniate treatment for cutaneous leishmaniasis.

INTRODUCTION:: Intralesional treatment for cutaneous leishmaniasis has been applied for over 30 years at the Oswaldo Cruz Foundation, Rio de Janeiro, with good therapeutic results and without relevant systemic toxicity. METHODS: Meglumine antimoniate was injected subcutaneously, using a long medium-caliber needle (for example, 30mm × 0.8mm); patients received 1-3 injections, with 15-day intervals. RESULTS: The technique is described in detail sufficient to enable replication. CONCLUSIONS:: The treatment of cutaneous leishmaniasis with intralesional meglumine antimoniate is a simple, effective, and safe technique, which may be used in basic healthcare settings.

Standardization of intralesional meglumine antimoniate treatment for cutaneous leishmaniasis

Abstract INTRODUCTION: Intralesional treatment for cutaneous leishmaniasis has been applied for over 30 years at the Oswaldo Cruz Foundation, Rio de Janeiro, with good therapeutic results and without relevant systemic toxicity. METHODS Meglumine antimoniate was injected subcutaneously, using a long medium-caliber needle (for example, 30mm × 0.8mm); patients received 1-3 injections, with 15-day intervals. RESULTS The technique is described in detail sufficient to enable replication. CONCLUSIONS: The treatment of cutaneous leishmaniasis with intralesional meglumine antimoniate is a simple, effective, and safe technique, which may be used in basic healthcare settings.

Sporotrichosis in HIV-infected patients: report of 21 cases of endemic sporotrichosis in Rio de Janeiro, Brazil.

Sporotrichosis is endemic in Rio de Janeiro, Brazil, and cases have been reported to be associated with HIV. This article describes the clinical manifestations and evolution of sporotrichosis in HIV-positive patients and constitutes the largest case series reported to date. There were 21 HIV-positive patients with sporotrichosis diagnosed by the recovery of the etiologic agent from 1999-2009. Sixteen patients (76.2%) were men and five (23.8%) were women, with a mean age of 41.2 years. Seven of these individuals were previously unaware of their HIV infection. Mean CD4 count was 346.4 cells/µl. The most frequent clinical presentations of sporotrichosis in these patients were the lymphocutaneous and disseminated form (seven patients each, 33.3%), followed by the widespread cutaneous form in five (23.8%), and fixed form in the remaining two (9.5%). In patients with the disseminated forms, clinical manifestations involved the skin in six, mucosa (nasal, oral, or conjunctival) in four, bone in two, and meninges in two. Eleven (52.4%) patients received itraconazole and eight (38.1%) amphotericin B contributing to an overall cure rate of 81%. Spontaneous cure was observed in one patient. The clinical forms of sporotrichosis varied according to the patients' immune status. The results demonstrate the importance of sporotrichosis as an opportunistic infection associated with AIDS in countries where the mycosis occurs.

American cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis resistant to meglumine antimoniate, but with good response to pentamidine: a case report.

This is a case report of a Brazilian soldier with cutaneous leishmaniasis. The lesion relapsed following two systemic treatments with meglumine antimoniate. The patient was treated with amphotericin B, which was interrupted due to poor tolerance. Following isolation of Leishmania sp., six intralesional infiltrations of meglumine antimoniate resulted in no response. Leishmania sp promastigotes were again isolated. The patient was submitted to intramuscular 4 mg/kg pentamidine. Parasites from the first and second biopsies were identified as Leishmania (Viannia) braziliensis; those isolated from the first biopsy were more sensitive to meglumine antimoniate in vitro than those isolated from the second biopsy. No relapse was observed.

American cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis resistant to meglumine antimoniate, but with good response to pentamidine: a case report / Leishmaniose cutânea americana causada pela Leishmania (Viannia) braziliensis resistente ao antimoniato de meglumina e com boa resposta terapêutica à pentamidina: relato de um caso

Relatamos um caso de um militar brasileiro com leishmaniose cutânea, cuja lesão reativou após dois tratamentos sistêmicos com antimoniato de meglumina. Foi tratado com anfotericina B, mas precisou interromper por intolerância à medicação. Após isolamento de Leishmania sp, seis infiltrações intralesionais de antimoniato de meglumina foram realizadas, sem resposta. Promastigotas de Leishmania sp. foram novamente isoladas. Foi submetido a tratamento intramuscular com pentamidina (4mg/kg). Parasitas da primeira e segunda biópsias foram identificados como Leishmania (Viannia) braziliensis; os da primeira biópsia eram mais sensíveis ao antimoniato de meglumina in vitro do que os da segunda biópsia. A lesão não reativou.

This is a case report of a Brazilian soldier with cutaneous leishmaniasis. The lesion relapsed following two systemic treatments with meglumine antimoniate. The patient was treated with amphotericin B, which was interrupted due to poor tolerance. Following isolation of Leishmania sp., six intralesional infiltrations of meglumine antimoniate resulted in no response. Leishmania sp promastigotes were again isolated. The patient was submitted to intramuscular 4mg/kg pentamidine. Parasites from the first and second biopsies were identified as Leishmania (Viannia) braziliensis; those isolated from the first biopsy were more sensitive to meglumine antimoniate in vitro than those isolated from the second biopsy. No relapse was observed.

[Auditory brainstem responses evaluation of retrocochlear disease in workers from a general hospital exposed to noise]. / Aplicação da audiometria troncoencefálica na detecção de perdas auditivas retrococleares em trabalhadores de manutenção hospitalar expostos a ruído.

The main purpose of this cross-sectional study was to investigate the presence of retrocochlear disease in a group of maintenance workers from a general hospital, who presents a history of noise exposure. Thirty one workers of three engineering sections with age range from 25 to 60 years and continuous noise exposure from 2 and 45 years, were examined. The evaluation included an audiometric occupational selection and auditory brainstem responses (ABR). ABR abnormalities were detected in seven patients (22.6%) and it was found latency increase of waves III (14.3%) and V (28.6%), and interpeak prolongation I-III (71.4%), III-V (28.6%) and I-V (85.7%). Among 35 ears with normal audition - right, left or both -, four (11,4%) ears presented retrocochlear disease. The high retrocochlear disease prevalence in workers exposed to noise lead us to suppose that this disturbance is more frequent than usually found; therefore it is underestimated in workers diagnostic evaluation. The presence of this kind of disturbance, even with the absence of audiometric alterations, suggests that ABR is more sensitive than the tonal audiometry for noise induced hearing loss investigation.

Aplicação da audiometria troncoencefálica na detecção de perdas auditivas retrococleares em trabalhadores de manutenção hospitalar expostos a ruído / Auditory brainstem responses evaluation of retrocochlear disease in workers from a general hospital exposed to noise

O objetivo principal deste estudo seccional foi averiguar a presença de comprometimento auditivo retrococlear num grupo de trabalhadores de manutenção de um hospital de grande porte com histórico de exposição a ruído. Foram avaliados 31 trabalhadores de três setores da divisão de engenharia entre 25 e 60 anos e com exposição contínua a ruído entre 2 e 45 anos. O processo avaliativo contou com triagem audiométrica ocupacional e audiometria troncoencefálica (ATE). Foram detectadas anormalidades na ATE em sete pacientes (22,6 por cento), caracterizadas por aumento de latências de ondas III (14,3 por cento) e V (28,6 por cento); prolongamento dos interpicos I-III (71,4 por cento), III-V (28,6 por cento) e I-V (85,7 por cento). Das 35 orelhas com audição normal (três unilateralmente e 32 bilateralmente), quatro (11,4 por cento) apresentaram comprometimento retrococlear. A alta prevalência de comprometimento retrococlear no grupo induz supor que tal distúrbio seja mais frequente que o encontrado e esteja sendo subestimado na investigação diagnóstica desses trabalhadores. A ocorrência desses resultados sem a presença de alterações audiométricas sugere que a ATE seja mais sensível que a audiometria tonal na investigação de perda auditiva provocada por ruído, por isso sua utilização deva ser incentivada.

The main purpose of this cross-seccional study was to investigate the presence of retrocochlear disease in a group of maintenance workers from a general hospital, who presents a history of noise exposure. Thirty one workers of three engineering sections with age range from 25 to 60 years and continuous noise exposure from 2 and 45 years, were examined. The evaluation included an audiometric occupational selection and auditory brainstem responses (ABR). ABR abnormalities were detected in seven patients (22.6 percent) and it was found latency increase of waves III (14.3 percent) and V (28.6 percent), and interpeak prolongation I-III (71.4 percent), III-V (28.6 percent) and I-V (85.7 percent). Among 35 ears with normal audition right, left or both , four (11,4 percent) ears presented retrocochlear disease. The high retrocochlear disease prevalence in workers exposed to noise lead us to suppose that this disturbance is more frequent than usually found; therefore it is underestimated in workers diagnostic evaluation. The presence of this kind of disturbance, even with the absence of audiometric alterations, suggests that ABR is more sensitive than the tonal audiometry for noise induced hearing loss investigation.