Rapid Genome Sequencing Shows Diagnostic Utility In Infants With Congenital Heart Defects.

Congenital heart disease (CHD) is the most common birth defect and a leading cause of infant mortality. CHD often has a genetic etiology and recent studies demonstrate utility in genetic testing. In clinical practice, decisions around genetic testing choices continue to evolve, and the incorporation of rapid genome sequencing (rGS) in CHD has not been well studied. Though smaller studies demonstrate the value of rGS, they also highlight the burden of results interpretation. We analyze genetic testing in CHD at two time-points, in 2018 and 2022-2023, across a change in clinical testing guidelines from chromosome microarray (CMA) to rGS. Analysis of 421 hospitalized infants with CHD demonstrated consistent genetic testing across time. Overall, after incorporation of rGS in 2022-2023, the diagnostic yield was 6.8% higher compared to 2018, and this pattern was consistent across all patient subtypes analyzed. In 2018, CMA was the most common test performed, with diagnostic results for CHD in 14.3%, while in 2022-2023, rGS was the most frequent test performed, with results diagnostic for CHD in 16.9%. Additionally, rGS identified 44% more unique genetic diagnoses than CMA. This is the largest study to highlight the value of rGS in CHD and has important implications for management.

Antibody response and soluble mediator profile in the first six months following acute SARS-CoV-2 infection.

The COVID-19 pandemic has caused a severe global health and economic crisis, with significant consequences for human mortality and morbidity. Therefore, there is an urgent need for more studies on the immune response to SARS-CoV-2 infection, both to enhance its effectiveness and prevent its deleterious effects. This study presents the chronology of antibodies during six months after infection in hospitalized patients and the kinetics of serum soluble mediators of the cellular response triggered by SARS-CoV-2. Samples and clinical data from 330 patients hospitalized at the Hospital da Baleia in Belo Horizonte, Brazil, who were suspected of having COVID-19, were collected at the time of hospitalization and during 6 months after infection. The immune response was analyzed by enzyme-linked immunosorbent assay (ELISA) and flow cytometry. There was a significant difference in IgM specific antibody titers from the 7th to 60th days after infection between COVID-19 negative and positive patients. Soon after 60 days after infection, antibody levels started to reduce, becoming similar to the antibody levels of the COVID-19 negative patients. IgG specific antibodies started to be detectable after 9 days of infection and antibody levels were comparatively higher in positive patients as soon as after 7 days. Furthermore, IgG levels remained higher in these patients during the complete period of 180 days after infection. The study observed similar antibody profiles between different patient groups. The soluble systemic biomarkers evaluated showed a decrease during the six months after hospitalization, except for CCL11, CXCL8, CCL3, CCL4, CCL5, IL-6, IFN-g, IL-17, IL-5, FGF-basic, PDGF, VEGF, G-CSF, and GM-CSF. The results indicate that IgM antibodies are more prominent in the early stages of infection, while IgG antibodies persist for a longer period. Additionally, the study identified that patients with COVID-19 have elevated levels of biomarkers after symptom onset, which decrease over time.

Genetic Testing Guidelines Impact Care in Newborns with Congenital Heart Defects.

OBJECTIVE: To evaluate genetic evaluation practices in newborns with the most common birth defect, congenital heart defects (CHD), we determined the prevalence and the yield of genetic evaluation across time and across patient subtypes, before and after implementation of institutional genetic testing guidelines. STUDY DESIGN: This was a retrospective, cross-sectional study of 664 hospitalized newborns with CHD using multivariate analyses of genetic evaluation practices across time and patient subtypes. RESULTS: Genetic testing guidelines for hospitalized newborns with CHD were implemented in 2014, and subsequently genetic testing increased (40% in 2013 and 75% in 2018, OR 5.02, 95% CI 2.84-8.88, P < .001) as did medical geneticists' involvement (24% in 2013 and 64% in 2018, P < .001). In 2018, there was an increased use of chromosomal microarray (P < .001), gene panels (P = .016), and exome sequencing (P = .001). The testing yield was high (42%) and consistent across years and patient subtypes analyzed. Increased testing prevalence (P < .001) concomitant with consistent testing yield (P = .139) added an estimated 10 additional genetic diagnoses per year, reflecting a 29% increase. CONCLUSIONS: In patients with CHD, yield of genetic testing was high. After implementing guidelines, genetic testing increased significantly and shifted to newer sequence-based methods. Increased use of genetic testing identified more patients with clinically important results with potential to impact patient care.

High levels of pro-inflammatory SARS-CoV-2-specific biomarkers revealed by in vitro whole blood cytokine release assay (CRA) in recovered and long-COVID-19 patients.

BACKGROUND: Cytokines induced by SARS-CoV-2 infection play a crucial role in the pathophysiology of COVID-19 and hyperinflammatory responses have been associated with poor clinical outcomes, with progression to severe conditions or long-term subacute complications named as long-COVID-19. METHODS: In this cross-sectional study, we aimed to evaluate a set of antigen-specific inflammatory cytokines in blood from recovered COVID-19 individuals or who suffered a post-acute phase of SARS-CoV-2 infection compared to healthy individuals with no history of COVID-19 exposition or infection. Interferon-gamma (IFN-γ), IFN-γ-induced protein 10 (IP-10), tumor necrosis factor (TNF), IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, and IL-17A were quantified by multiplex cytometric bead assay and enzyme-linked immunosorbent assay after stimulation of whole blood with recombinant Spike protein from SARS-CoV-2. Additionally, all participants have evaluated for anti-(S) protein-specific IgG antibodies. Clinical specimens were collected within two months of COVID-19 diagnosis. RESULTS: A total of 47 individuals were enrolled in the study, a median age of 43 years (IQR = 14.5), grouped into healthy individuals with no history of infection or exposure to SARS-CoV-2 (unexposed group; N = 21); and patients from the Health Complex of the Rio de Janeiro State University (UERJ), Brazil, who were SARS-CoV-2 positive by RT-PCR (COVID-19 group)-categorized as recovered COVID-19 (N = 11) or long-COVID-19 (N = 15). All COVID-19 patients presented at least one signal or symptom during the first two weeks of infection. Six patients were hospitalized and required invasive mechanical ventilation. Our results showed that COVID-19 patients had significantly higher levels of IFN-γ, TNF, IL-1ß, IL-2, IL-6, IL-8, and IP-10 than the unexposed group. The long-COVID-19 group has presented significantly high levels of IL-1ß and IL-6 compared to unexposed individuals, but not from recovered COVID-19. A principal-component analysis demonstrated 84.3% of the total variance of inflammatory-SARS-CoV-2 response in the first two components, and it was possible to stratify IL-6, TNF, IL-1ß, IL-10, and IL-2 as the top-five cytokines which are candidates to discriminate COVID-19 group (including long-COVID-19 subgroup) and healthy unexposed individuals. CONCLUSION: We revealed important S protein-specific differential biomarkers in individuals affected by COVID-19, bringing new insights into the inflammatory status or SARS-CoV-2 exposition determination.

Conformational stability of SARS-CoV-2 glycoprotein spike variants.

The severe acute respiratory syndrome spread worldwide, causing a pandemic. SARS-CoV-2 mutations have arisen in the spike, a glycoprotein at the viral envelope and an antigenic candidate for vaccines against COVID-19. Here, we present comparative data of the glycosylated full-length ancestral and D614G spike together with three other transmissible strains classified by the World Health Organization as variants of concern: beta, gamma, and delta. By showing that D614G has less hydrophobic surface exposure and trimer persistence, we place D614G with features that support a model of temporary fitness advantage for virus spillover. Furthermore, during the SARS-CoV-2 adaptation, the spike accumulates alterations leading to less structural stability for some variants. The decreased trimer stability of the ancestral and gamma and the presence of D614G uncoupled conformations mean higher ACE-2 affinities compared to the beta and delta strains. Mapping the energetics and flexibility of variants is necessary to improve vaccine development.

Using intrinsic properties of quantum dots to provide additional security when uniquely identifying devices.

Unique identification of optical devices is important for anti-counterfeiting. Physical unclonable functions (PUFs), which use random physical characteristics for authentication, are advantageous over existing optical solutions, such as holograms, due to the inherent asymmetry in their fabrication and reproduction complexity. However, whilst unique, PUFs are potentially vulnerable to replication and simulation. Here we introduce an additional benefit of a small modification to an established model of nanoparticle PUFs by using a second measurement parameter to verify their authenticity. A randomly deposited array of quantum dots is encapsulated in a transparent polymer, forming a tag. Photoluminescence is measured as a function of excitation power to assess uniqueness as well as the intrinsic nonlinear response of the quantum material. This captures a fingerprint, which is non-trivial to clone or simulate. To demonstrate this concept practically, we show that these tags can be read using an unmodified smartphone, with its built-in flash for excitation. This development over constellation-style optical PUFs paves the way for more secure, facile authentication of devices without requiring complex fabrication or characterisation techniques.

Intradermal Immunization of SARS-CoV-2 Original Strain Trimeric Spike Protein Associated to CpG and AddaS03 Adjuvants, but Not MPL, Provide Strong Humoral and Cellular Response in Mice.

Despite the intramuscular route being the most used vaccination strategy against SARS-CoV-2, the intradermal route has been studied around the globe as a strong candidate for immunization against SARS-CoV-2. Adjuvants have shown to be essential vaccine components that are capable of driving robust immune responses and increasing the vaccination efficacy. In this work, our group aimed to develop a vaccination strategy for SARS-CoV-2 using a trimeric spike protein, by testing the best route with formulations containing the adjuvants AddaS03, CpG, MPL, Alum, or a combination of two of them. Our results showed that formulations that were made with AddaS03 or CpG alone or AddaS03 combined with CpG were able to induce high levels of IgG, IgG1, and IgG2a; high titers of neutralizing antibodies against SARS-CoV-2 original strain; and also induced high hypersensitivity during the challenge with Spike protein and a high level of IFN-γ producing CD4+ T-cells in mice. Altogether, those data indicate that AddaS03, CpG, or both combined may be used as adjuvants in vaccines for COVID-19.

From a recombinant key antigen to an accurate, affordable serological test: Lessons learnt from COVID-19 for future pandemics.

Serological tests detect antibodies generated by infection or vaccination, and are indispensable tools along different phases of a pandemic, from early monitoring of pathogen spread up to seroepidemiological studies supporting immunization policies. This work discusses the development of an accurate and affordable COVID-19 antibody test, from production of a recombinant protein antigen up to test validation and economic analysis. We first developed a cost-effective, scalable technology to produce SARS-COV-2 spike protein and then used this antigen to develop an enzyme-linked immunosorbent assay (ELISA). A receiver operator characteristic (ROC) analysis allowed optimizing the cut-off and confirmed the high accuracy of the test: 98.6% specificity and 95% sensitivity for 11+ days after symptoms onset. We further showed that dried blood spots collected by finger pricking on simple test strips could replace conventional plasma/serum samples. A cost estimate was performed and revealed a final retail price in the range of one US dollar, reflecting the low cost of the ELISA test platform and the elimination of the need for venous blood sampling and refrigerated sample handling in clinical laboratories. The presented workflow can be completed in 4 months from first antigen expression to final test validation. It can be applied to other pathogens and in future pandemics, facilitating reliable and affordable seroepidemiological surveillance also in remote areas and in low-income countries.

Immunogenicity of SARS-CoV-2 Trimeric Spike Protein Associated to Poly(I:C) Plus Alum.

The SARS-CoV-2 pandemic has had a social and economic impact worldwide, and vaccination is an efficient strategy for diminishing those damages. New adjuvant formulations are required for the high vaccine demands, especially adjuvant formulations that induce a Th1 phenotype. Herein we assess a vaccination strategy using a combination of Alum and polyinosinic:polycytidylic acid [Poly(I:C)] adjuvants plus the SARS-CoV-2 spike protein in a prefusion trimeric conformation by an intradermal (ID) route. We found high levels of IgG anti-spike antibodies in the serum by enzyme linked immunosorbent assay (ELISA) and high neutralizing titers against SARS-CoV-2 in vitro by neutralization assay, after two or three immunizations. By evaluating the production of IgG subtypes, as expected, we found that formulations containing Poly(I:C) induced IgG2a whereas Alum did not. The combination of these two adjuvants induced high levels of both IgG1 and IgG2a. In addition, cellular immune responses of CD4+ and CD8+ T cells producing interferon-gamma were equivalent, demonstrating that the Alum + Poly(I:C) combination supported a Th1 profile. Based on the high neutralizing titers, we evaluated B cells in the germinal centers, which are specific for receptor-binding domain (RBD) and spike, and observed that more positive B cells were induced upon the Alum + Poly(I:C) combination. Moreover, these B cells produced antibodies against both RBD and non-RBD sites. We also studied the impact of this vaccination preparation [spike protein with Alum + Poly(I:C)] in the lungs of mice challenged with inactivated SARS-CoV-2 virus. We found a production of IgG, but not IgA, and a reduction in neutrophil recruitment in the bronchoalveolar lavage fluid (BALF) of mice, suggesting that our immunization scheme reduced lung inflammation. Altogether, our data suggest that Alum and Poly(I:C) together is a possible adjuvant combination for vaccines against SARS-CoV-2 by the intradermal route.

Immunogenicity, Effectiveness, and Safety of Inactivated Virus (CoronaVac) Vaccine in a Two-Dose Primary Protocol and BNT162b2 Heterologous Booster in Brazil (Immunita-001): A One Year Period Follow Up Phase 4 Study.

Background: Effective and safe vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are critical to controlling the COVID-19 pandemic and will remain the most important tool in limiting the spread of the virus long after the pandemic is over. Methods: We bring pioneering contributions on the maintenance of the immune response over a year on a real-life basis study in 1,587 individuals (18-90 yrs, median 39 yrs; 1,208 female/379 male) who underwent vaccination with two doses of CoronaVac and BNT162b2 booster after 6-months of primary protocol. Findings: Elevated levels of anti-spike IgG antibodies were detected after CoronaVac vaccination, which significantly decreased after 80 days and remained stable until the introduction of the booster dose. Heterologous booster restored antibody titers up to-1·7-fold, changing overall seropositivity to 96%. Titers of neutralising antibodies to the Omicron variant were lower in all timepoints than those against Delta variant. Individuals presenting neutralising antibodies against Omicron also presented the highest titers against Delta and anti-Spike IgG. Cellular immune response measurement pointed out a mixed immune profile with a robust release of chemokines, cytokines, and growth factors on the first month after CoronaVac vaccination followed by a gradual reduction over time and no increase after the booster dose. A stronger interaction between those mediators was noted over time. Prior exposure to the virus leaded to a more robust cellular immune response and a rise in antibody levels 60 days post CoronaVac than in individuals with no previous COVID-19. Both vaccines were safe and well tolerated among individuals. Interpretation: Our data approach the effectiveness of CoronaVac association with BNT162b2 from the clinical and biological perspectives, aspects that have important implications for informing decisions about vaccine boosters. Funding: Fiocruz, Brazil.

From the Approach to the Concept: One Health in Latin America-Experiences and Perspectives in Brazil, Chile, and Colombia.

Professionals throughout the world have been working to assess the interdisciplinary interaction and interdependence between health and wellbeing in a constantly changing environment. The One Health concept was developed to encourage sustainable collaborative partnerships and to promote optimal health for people, animals, plants, the environment, and the whole planet. The dissemination of scientific discoveries and policies, by working directly with diverse communities, has been one of the main goals for Global One Health. The One Health concept has also been referred or related to as "One Medicine, One Medicine-One Health, One World-One Health, EcoHealth," and Planetary Health," depending on each fundamental view and approach. In Latin America, despite the concept still being discussed among health professionals and educators, several One Health initiatives have been used daily for more than decades. One Health action has been applied especially in rural and underserved urban areas where low socioeconomic status, lack of health professionals, and scarcity of medical resources may require professionals to work together. Local communities from diverse social and economic statuses, including indigenous populations have been working with institutions and social organizations for many years, accomplishing results through grassroots movements. These "bottom-up" socio-community approaches have also been tools for the prevention and control of diseases, such practice has preceded the One Health concepts in Latin American countries. It is strongly believed that collaborative, multidisciplinary, political, and economic initiatives with prosocial focus may become investments toward obtaining significant results in the face of global, economic and health challenges; working for a healthier world with inclusivity, equity, and equality. In this study, it is briefly presented how the One Health approach has been initiated and developed in Latin America, highlighting the events and actions taken in Brazil, Chile, and Colombia.

Detection of Rickettsia sp. strain Itinguçú in Ornithodoros faccinii (Acari: Argasidae) parasitizing the toad Rhinella ornata (Anura: Bufonidae) in Brazil.

The pivotal role of amphibians in food webs and their value as indicators of disequilibrium in ecosystem health have long been recognized by wildlife biologists. However, massive pathogen-induced declines in global amphibian populations reported during the last 30 years served to alert the scientific community that knowledge of amphibian disease ecology, including parasitic and vector-borne conditions, was and remains incipient. Herein, we report the detection of a Rickettsia bacterium infecting larvae of the argasid tick Ornithodoros faccinii, collected from the toad Rhinella ornata, in Southeastern Brazil. Fragments of the genes 16S rDNA, gltA, htrA, sca1, sca4, and ompB were amplified by polymerase chain reaction (PCR), but the sequence encoding the ompA antigen was not detected. Nucleotide sequencing and multi-locus (gltA, htrA, sca1, and sca4) phylogenetic analyses characterized the bacterium, designated Rickettsia sp. strain Itinguçú, as a novel member of the spotted fever group (SFG) of the Rickettsia, closely related to the Rickettsia massiliae and to a lesser extent the Rickettsia helvetica subgroups. The apparent absence of the ompA protein together with limited levels of nucleotide (90.5 %) and amino acid (82-83 %) sequence identity, relative to the ompB gene of other species in the R. massiliae subgroup, were unusual features that may reflect adaptation to selective pressures exerted by the tick and/or amphibian immune systems. The ompB sequence was exploited to develop a low-cost method for differential identification of Rickettsia sp. strain Itinguçú, based on restriction fragment length polymorphism analysis of amplicons (PCR-RFLP). The characterization of this novel bacterium provided an unprecedented record of infection by an SFG Rickettsia in a member of the family Argasidae infesting a cold-blooded animal and raised the number of tick-associated Rickettsia reported in Brazil to sixteen. Moreover, it highlighted the value of and the requirement for continued and extended surveillance of wildlife as potential sources of emerging tick-borne pathogens.

Improve Pasture or Feed Grain? Greenhouse Gas Emissions, Profitability, and Resource Use for Nelore Beef Cattle in Brazil's Cerrado and Amazon Biomes.

Economic development, international food and feed demand, and government policies have converted Brazil's natural ecosystems into agricultural land. The Integrated Farm System Model (IFSM) was evaluated using production, economic, and weather data collected on two cooperating farms in the Legal Amazon and Cerrado biomes in the Midwest state of Mato Grosso, Brazil. Three sustainable agricultural intensification strategies, namely grain supplementation, pasture re-seeding, and pasture fertilization were simulated in IFSM with double the beef cattle stocking density compared to extensive grazing. Livestock dry matter consumption simulated in IFSM was similar for pasture grazing estimates and actual feed consumed by beef cattle on the two collaborating farms. Grain supplementation best balanced beef production and profitability with lower carbon footprint compared to extensive grazing, followed by pasture fertilization and pasture re-seeding. However, pasture re-seeding and fertilization had greater use of water and energy and more nitrogen losses. Human edible livestock feed use was greatest for grain supplementation compared to other modeled systems. While grain supplementation appears more favorable economically and environmentally, greater use of human edible livestock feed may compete with future human food needs. Pasture intensification had greater human edible feed conversion efficiency, but its greater natural resource use may be challenging.

Two for the price of one: Co-infection with Rickettsia bellii and spotted fever group Rickettsia in Amblyomma (Acari: Ixodidae) ticks recovered from wild birds in Brazil.

The bacterium Rickettsia bellii has been detected in 25 species of ticks in the American continents, but its pathogenic potential is considered as undetermined. A possible role for this species in the phenomenon of transovarial exclusion of pathogenic members of the spotted fever group (SFG) of Rickettsia has been suggested and co-infections with pathogenic species have been reported infrequently in both North and South America. Traditional methods for the molecular detection of rickettsial agents in ticks focus largely on the identification of sequences found in SFG Rickettsia, an approach that may overlook the presence of co-infections with R. bellii. Two novel, species-specific polymerase chain reaction (PCR) assays, targeting the genes encoding the surface cell antigen (Sca), autotransporter proteins sca9 and sca14, were developed and validated for the detection of R. bellii using 150 Amblyomma ticks collected from wild birds in Brazil. Co-infection of R. bellii infected ticks was evaluated using a novel PCR assay targeting the ompA sequence characteristic of SFG Rickettsia. Preliminary species-level identification was achieved by restriction fragment length polymorphism (RFLP) analysis and subsequently confirmed by sequencing of amplicons. Nine out of seventy-three Amblyomma longirostre and one of two Amblyomma calcaratum ticks were shown to be co-infected with R. bellii and Rickettsia amblyommatis, while two out of sixty-seven Amblyomma sp. haplotype Nazaré ticks were recorded as co-infected with R. bellii and the Rickettsia parkeri-like bacterium, strain ApPR. Interestingly, our data represent the first records of R. bellii in association with A. calcaratum and Amblyomma sp. haplotype Nazaré. The novel PCR-RFLP systems reported herein, provide an alternative, rapid and cost-efficient (relative to strategies based on sequencing or real-time PCR), approach to evaluate rickettsial co-infection of ticks, a potentially significant phenomenon that has most likely been underestimated to date.

Unveiling atopic dermatitis burden in Brazil: a report from clinical assistance perspective / Revelando a dermatite atópica no Brasil: um relato da perspectiva da assistência clínica

Objective: Atopic dermatitis (AD) or atopic eczema is a chronic skin inflammatory disease that involves the interaction between immune, genetic and environmental triggers. AD affects 15%-20% of infants and 1%-4% of adults worldwide although prevalence varies per country. The main objective is to raise the awareness of AD impact on patients' quality of life (QoL) in Brazil. Methods: Interviews were carried out with key Therapeutic Area Experts (TAEs) throughout the country to gain information about disease management, treatment efficacy and patient's QoL. For disease cost estimation, private health costs from public sources was used. Results: AD prevalence in adults was estimated at 7% in Brazil, of which 35% was moderate and 30% severe AD. Overall, 41% of patients have undergone 5 or more different treatments. However, 17% and 29% of patients with moderate and severe AD, respectively, fail to control their disease. Emollients and topical steroids are the main first-line (1L) treatments for all AD patients, although in the case of moderate and severe AD, a rapid 2-week treatment transition from 1L to 2L has been reported. In terms of economic burden, for severe and moderate AD patients, direct medical costs (medical appointments, treatments, hospitalizations and others) are between 94% and 93%. Regarding indirect costs, absenteeism was estimated to be responsible for 6% and 7% of total cost in moderate and severe AD patients, respectively. Conclusion: There is a need for AD treatments that can be used in the long term without severe side effects and with a positive impact on QoL.

Objetivo: A dermatite atópica (DA) ou eczema atópico é uma doença inflamatória que envolve a interação entre fatores imunológicos, genéticos e ambientais. A DA afeta 15% a 20% das crianças e 1% a 4% dos adultos. O objetivo é conscientizar sobre o impacto da DA na qualidade de vida (QdV) dos pacientes no Brasil. Métodos: Entrevistas foram conduzidas com Especialistas dessa Área Terapêutica (EATs) em todo o país para obter informações sobre o manejo da doença, eficácia do tratamento e QdV dos pacientes. Para estimativa dos custos da doença, utilizamos custos da saúde privada de fontes públicas. Resultados: A prevalência de DA em adultos foi estimada em 7% no Brasil, dos quais 35% possuem DA moderada e 30%, severa. No geral, 41% dos pacientes foram submetidos a cinco ou mais tratamentos diferentes. No entanto, 17% e 29% dos pacientes com DA moderada/grave, respectivamente, não conseguem controlar sua doença. Emolientes e esteroides tópicos são os principais tratamentos de primeira linha (1L) para todos os pacientes. No caso de DA moderada/grave, a transição rápida do tratamento de 1L para 2L em duas semanas é relatada. Em termos de carga econômica, para pacientes com DA grave e moderada, entre 94% e 93% são custos médicos diretos (consultas médicas, tratamentos, hospitalizações e outros). Considerando custos indiretos, o absenteísmo é responsável por 6% e 7% do custo total em pacientes com DA moderada e grave, respectivamente. Conclusão: Em conclusão, há necessidade de tratamentos de DA que possam ser usados a longo prazo sem efeitos colaterais graves e com impacto positivo na qualidade de vida.

Presentación de un paciente con adenocarcinoma neuroendocrino de próstata / Presentation of a Patient with Prostate Neuroendocrine Adenocarcinoma

El cáncer de próstata comúnmente afecta al hombre después de sus 50 años, la evolución es lenta, con variedad histológica de adenocarcinoma presente en aproximadamente el 95%. No es frecuente encontrar diferenciaciones histológicas de tipo neuroendocrina. Se presentó un hombre de 29 años de edad, procedente de Banes, que por dolores perineales y molestias en el acto sexual asiste a Consulta de Urología del Hospital Lenin de Holguín, donde es tratado como proceso inflamatorio prostático y se utilizan fármacos antimicrobianos y antinflamatorios. Al no obtener mejoría se realizan otros estudios y el antígeno prostático específico informó valores elevados; al tacto rectal se detectaron cambios de consistencia, se sugirió una biopsia de próstata que al realizarla arrojó tumor adenocarcinoma neuroendocrino de próstata. Al consultar la bibliografía se encontró la no disponibilidad de protocolos terapéuticos específicos para estos casos, pero de forma general se utiliza etopósido y cisplatino. La evolución fue tórpida y pronta la aparición de metástasis óseas, hepáticas, mediastínicas, ascitis y dificultad respiratoria hasta el agobio y muerte del paciente a los 19 meses de definido el diagnóstico.

Prostate cancer commonly affects men after age 50; the evolution is slow, with histological variety of adenocarcinoma present in approximately 95%. It is not frequent to find histological differentiations of neuroendocrine type. A 29-year-old man from Banes was presented with perineal pain and discomfort during the sexual intercourse. The patient was assisted at Urology Consultation of the Lenin Hospital in Holguín where he was treated as a prostatic inflammatory process and antimicrobial and anti-inflammatory drugs were used. Other studies were not obtained and the prostate specific antigen reported high values; rectal examination revealed changes in consistency, a prostate biopsy was suggested, revealing a neuroendocrine adenocarcinoma of the prostate. When consulting the literature, specific therapeutic protocols were not available for these cases, but generally etoposide and cisplatin were used. The evolutions was torpid and rapid the appearance of bone, hepatic, mediastinal and ascites metastases as well as respiratory distress until the patient´s death, at 19 months the diagnosis was defined.

Presentación de un paciente con adenocarcinoma neuroendocrino de próstata / Presentation of a Patient with Prostate Neuroendocrine Adenocarcinoma

El cáncer de próstata comúnmente afecta al hombre después de sus 50 años, la evolución es lenta, con variedad histológica de adenocarcinoma presente en aproximadamente el 95 por ciento. No es frecuente encontrar diferenciaciones histológicas de tipo neuroendocrina. Se presentó un hombre de 29 años de edad, procedente de Banes, que por dolores perineales y molestias en el acto sexual asiste a Consulta de Urología del Hospital Lenin de Holguín, donde es tratado como proceso inflamatorio prostático y se utilizan fármacos antimicrobianos y antinflamatorios. Al no obtener mejoría se realizan otros estudios y el antígeno prostático específico informó valores elevados; al tacto rectal se detectaron cambios de consistencia, se sugirió una biopsia de próstata que al realizarla arrojó tumor adenocarcinoma neuroendocrino de próstata. Al consultar la bibliografía se encontró la no disponibilidad de protocolos terapéuticos específicos para estos casos, pero de forma general se utiliza etopósido y cisplatino. La evolución fue tórpida y pronta la aparición de metástasis óseas, hepáticas, mediastínicas, ascitis y dificultad respiratoria hasta el agobio y muerte del paciente a los 19 meses de definido el diagnóstico(AU)

Prostate cancer commonly affects men after age 50; the evolution is slow, with histological variety of adenocarcinoma present in approximately 95 percent. It is not frequent to find histological differentiations of neuroendocrine type. A 29-year-old man from Banes was presented with perineal pain and discomfort during the sexual intercourse. The patient was assisted at Urology Consultation of the Lenin Hospital in Holguín where he was treated as a prostatic inflammatory process and antimicrobial and anti-inflammatory drugs were used. Other studies were not obtained and the prostate specific antigen reported high values; rectal examination revealed changes in consistency, a prostate biopsy was suggested, revealing a neuroendocrine adenocarcinoma of the prostate. When consulting the literature, specific therapeutic protocols were not available for these cases, but generally etoposide and cisplatin were used. The evolutions was torpid and rapid the appearance of bone, hepatic, mediastinal and ascites metastases as well as respiratory distress until the patient´s death, at 19 months the diagnosis was defined(AU)

Intestinal Lesion in a Dog Due to Cryptococcus gattii Type VGII and Review of Published Cases of Canine Gastrointestinal Cryptococcosis.

Cryptococcosis is a mycosis caused by yeasts of genus Cryptococcus, mainly the species C. neoformans and C. gattii that can affect humans and animals. These yeasts are widely distributed in the environment and are typically associated with avian droppings and decaying wood. Most infections are related to the respiratory tract, but the central nervous system and cutaneous lesions are also reported in the literature. The present report is a case of cryptococcosis in an 18-month-old unspayed female English Bulldog with the main complaint of weight loss and diarrhea. The presence of two large masses observed in an ultrasound examination leads us to perform an exploratory laparotomy. Considering the size of the lesion and the impossibility of owner to provide intensive care, the consent for euthanasia was requested. The postmortem diagnosis of cryptococcosis was revealed by cytological evaluation, and the involvement of C. gattii VGII was confirmed by isolation and identification tests as well as by the detection of the URA5 gene restriction fragment length polymorphism PCR analysis. Reports in the literature of the involvement of Cryptococcus in gastrointestinal lesions are rare in both human and veterinary medicine. Data about different forms of cryptococcosis are important to provide more knowledge of uncommon clinical presentations of this yeast and therefore improve the diagnoses and decisions for the best therapy.

Fotoeducación: información básica / Photoeducation: basic information

En las últimas décadas, a nivel mundial y en Cuba particularmente, ha aumentado de la incidencia de cáncer de piel, debido en gran medida a los cambios ambientales, sumado a nuevos patrones de belleza y a la desinformación existente en relación con el tema. El objetivo de este trabajo es aportar información elemental al médico no especialista en dermatología, y al personal de la salud en general, sobre la prevención del cáncer cutáneo(AU)

In the last few decades, there has been an increase of skin cancer incidence worldwide and particularly in Cuba largely due to environmental changes in addition to new beauty patterns and lack of information about this topic. This article is a literature review that intends to provide the physician, who is not a specialist in dermatology questions, and the general health staff with the necessary information about the prevention of skin cancer(AU)

Effectiveness of glycyrrhizinic Acid (glizigen) and an immunostimulant (viusid) to treat anogenital warts.

Genital warts are benign proliferations of skin and mucosa caused by the human papillomavirus infection (hereinafter referred to as HPV). It is one of the most common sexually transmitted diseases in the world, whose incidence rate has increased in the last three decades. Current treatment involves the physical destruction of the infected cells. The fact that there are many different types of treatment goes to show that none of them are uniformly effective or directly antiviral. Objective. Demonstrate the efficacy of Glizigen in the III-phase clinical trial combined with a food supplement (VIUSID) formulated to boost the immune system when treating external anogenital warts. Design. 100 patients clinically diagnosed with anogenital lesions were included in the trial and assigned to two groups of 50 individuals. Those from one group where treated with Glizigen and Viusid and those from the other group with 25% podophyllin in alcohol, the results from each were then compared. Results. The combined Glizigen-Viusid treatment was seen to have an 87.5% efficacy rate, which was slightly more than that of the treatment with podophyllin, and there were hardly any adverse reactions reported during the treatment. Conclusions. the combined Glizigen-Viusid treatment was effective in treating genital warts.