Prevalence and clinical consequences of Hepatitis C virus infection in patients undergoing hematopoietic stem cell transplantation.

Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality among hematopoietic stem cell transplant (HCT) recipients. In Brazil, its occurrence in HCT recipients remains undetermined. We now report on HCV prevalence in HCT recipients and its clinical consequences. The medical records of all HCT recipients seen at Hospital das Clinicas, Sao Paulo University Medical School, from January 2010 to January 2020 were reviewed to determine HCV serostatus. A retrospective analysis of medical charts was undertaken on all seropositive cases to determine HCV genotype, presence of liver fibrosis, co-infections with other viruses, previous treatments, and clinical evolution of liver pathology after HCT. Of the 1,293 HCT recipients included in the study, seven (0.54%) were HCV antibody-positive and five (0.39%) were also viremic for HCV-RNA. Four of these individuals had moderate to severe liver fibrosis (METAVIR F2/F3) and one was cirrhotic. Two of the viremic patients developed acute liver dysfunction following transplantation. All patients had their acute episode of liver dysfunction resolved with no further complications. Four of the viremic patients were treated for HCV infection with direct acting agents (DAA). Information regarding HCV treatment was lacking for one of the viremic HCV patients due to loss of follow up. Sustained anti-virologic responses were observed in three cases after the use of DAA. The detection of HCV in hematological adults undergoing HCT and its successful treatment with DAA highlight the necessity of testing for HCV both prior to and following transplantation.

Prevalence and clinical consequences of Hepatitis C virus infection in patients undergoing hematopoietic stem cell transplantation

ABSTRACT Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality among hematopoietic stem cell transplant (HCT) recipients. In Brazil, its occurrence in HCT recipients remains undetermined. We now report on HCV prevalence in HCT recipients and its clinical consequences. The medical records of all HCT recipients seen at Hospital das Clinicas, Sao Paulo University Medical School, from January 2010 to January 2020 were reviewed to determine HCV serostatus. A retrospective analysis of medical charts was undertaken on all seropositive cases to determine HCV genotype, presence of liver fibrosis, co-infections with other viruses, previous treatments, and clinical evolution of liver pathology after HCT. Of the 1,293 HCT recipients included in the study, seven (0.54%) were HCV antibody-positive and five (0.39%) were also viremic for HCV-RNA. Four of these individuals had moderate to severe liver fibrosis (METAVIR F2/F3) and one was cirrhotic. Two of the viremic patients developed acute liver dysfunction following transplantation. All patients had their acute episode of liver dysfunction resolved with no further complications. Four of the viremic patients were treated for HCV infection with direct acting agents (DAA). Information regarding HCV treatment was lacking for one of the viremic HCV patients due to loss of follow up. Sustained anti-virologic responses were observed in three cases after the use of DAA. The detection of HCV in hematological adults undergoing HCT and its successful treatment with DAA highlight the necessity of testing for HCV both prior to and following transplantation.

Acute disseminated encephalomyelitis in a COVID-19 pediatric patient.

The authors present a case of acute disseminated encephalomyelitis in a COVID-19 pediatric patient with positive SARS-CoV2 markers from a nasopharyngeal swab. A previously healthy 12-year-old-girl presented with a skin rash, headache, and fever. Five days after that, she had an acute, progressive, bilateral, and symmetrical motor weakness. She evolved to respiratory failure. Magnetic resonance imaging (MRI) of the brain and cervical spine showed extensive bilateral and symmetric restricted diffusion involving the subcortical and deep white matter, a focal hyperintense T2/FLAIR lesion in the splenium of the corpus callosum with restricted diffusion, and extensive cervical myelopathy involving both white and gray matter. Follow-up examinations of the brain and spine were performed 30 days after the first MRI examination. The images of the brain demonstrated mild dilatation of the lateral ventricles and widespread widening of the cerebral sulci, complete resolution of the extensive white matter restricted diffusion, and complete resolution of the restricted diffusion in the lesion of the splenium of the corpus callosum, leaving behind a small gliotic focus. The follow-up examination of the spine demonstrated nearly complete resolution of the extensive signal changes in the spinal cord, leaving behind scattered signal changes in keeping with gliosis. She evolved with partial clinical and neurological improvement and was subsequently discharged.

Guidelines for accurate genotyping of SARS-CoV-2 using amplicon-based sequencing of clinical samples

BackgroundSARS-CoV-2 genotyping has been instrumental to monitor virus evolution and transmission during the pandemic. The reliability of the information extracted from the genotyping efforts depends on a number of aspects, including the quality of the input material, applied technology and potential laboratory-specific biases. These variables must be monitored to ensure genotype reliability. The current lack of guidelines for SARS-CoV-2 genotyping leads to inclusion of error-containing genome sequences in studies of viral spread and evolution. ResultsWe used clinical samples and synthetic viral genomes to evaluate the impact of experimental factors, including viral load and sequencing depth, on correct sequence determination using an amplicon-based approach. We found that at least 1000 viral genomes are necessary to confidently detect variants in the genome at frequencies of 10% or higher. The broad applicability of our recommendations was validated in >200 clinical samples from six independent laboratories. The genotypes of clinical isolates with viral load above the recommended threshold cluster by sampling location and period. Our analysis also supports the rise in frequency of 20A.EU1 and 20A.EU2, two recently reported European strains whose dissemination was favoured by travelling during the summer 2020. ConclusionsWe present much-needed recommendations for reliable determination of SARS-CoV-2 genome sequence and demonstrate their broad applicability in a large cohort of clinical samples.

Diaphragmatic paralysis: Evaluation in infants with congenital Zika syndrome.

BACKGROUND: Paralysis of the diaphragm in newborn infants can lead to recurrent infections and life-threatening respiratory insufficiency. The clinical diagnosis of unilateral diaphragmatic paralysis has been reported in infants with laboratory evidence of congenital Zika virus infection and/or the congenital Zika syndrome (CZS) phenotype but no evaluation of phrenic nerve function has been described. All reported infants have had accompanying arthrogryposis. High infant mortality is reported. METHODS: The causal mechanism of congenital diaphragmatic paralysis was evaluated in three infants with arthrogryposis as a manifestation of CZS (two of the three infants had laboratory evidence of ZIKV infection shortly after birth; the remaining infant had negative serology for ZIKV when first tested at 7 months of age). Electromyography and phrenic nerve compound muscle action potential (CMAP) were performed in all infants with diaphragmatic paralysis demonstrated on imaging studies. RESULTS: All infants had evidence of moderate chronic involvement of peripheral motor neurons. Phrenic nerve CMAP was reduced on the side of the diaphragmatic paralysis in two infants and reduced bilaterally in the remaining infant who had primarily anterior involvement of the diaphragm. All three infants had multiple medical complications and one infant died at 18 months of age. CONCLUSION: Evaluation of three infants with CZS and diaphragmatic paralysis demonstrated phrenic nerve dysfunction. In these and other affected infants, arthrogryposis appears to be a constant co-occurring condition and health problems are significant; both conditions are likely due to involvement of the peripheral nervous system in some infants with CZS.

Perfil de cirurgiões-dentistas e demandas de qualificação em UNACON e CACON no estado Rio de Janeiro / Profile of dentists and qualification demands in Unacon and CACON in Rio de Janeiro state

Objetivo: Analisar o perfil dos cirurgiões-dentistas que atuam nos hospitais habilitados em oncologia no âmbito do estado do Rio de Janeiro e identificar demandas de qualificação nessa área. Métodos: Trata-se de estudo exploratório descritivo do tipo survey destinado a gestores e profissionais dos hospitais habilitados em oncologia do estado do Rio de Janeiro. A análise dos dados foi realizada por meio de estatística descritiva. Resultados: Responderam aos formulários 14 gestores e 85 cirurgiões dentistas. Apesar do número de profissionais atuando nas unidades participantes, poucos são os profissionais que prestam o cuidado direto ao paciente oncológico. Os profissionais possuem, comparando com a média nacional, faixa etária mais elevada (47 anos), maior tempo de experiência profissional (24 anos) e de vínculo com a instituição (14 anos). Além disso, a maioria dos profissionais são especialistas (91,8%) e alguns fizeram mestrado (30,6%) e doutorado (3,5%). Apesar dos profissionais atuarem em unidades habilitadas para o cuidado oncológico, somente sete (8,2%) declararam terem feito cursos em oncologia. Diante da estrutura das instituições, a utilização da estratégia de ensino a distância pode otimizar os esforços e superar as dificuldades, porém, é necessário planejamento pedagógico coerente com o perfil dos profissionais. Conclusão: Os dados apontam para a necessidade de ampliação e qualificação da rede de cuidado odontológico aos pacientes oncológicos.(AU)

Aim: To analyze the profile of dentists who work in cancer hospitals in the state of Rio de Janeiro, Brazil, and identify skill requirements in this area. Methods: This is a descriptive-exploratory, surveylike study geared toward managers and professionals in cancer hospitals in the state of Rio de Janeiro. Data analysis was performed using descriptive statistics. Results: Fourteen managers and 85 dentists answered the questionnaire. Despite the adequate number of professionals working in the participating units, few professionals actually provide direct care to cancer patients. Compared to the national average, the professionals are of an older age (47 years), and have a longer professional experience (24 years) and a longer time working at the institution (14 years). In addition, most professionals are experts (91.8%), while some have completed their Masters (30.6%) and Ph.D. (3.5%). Although the professionals work in cancer care units, only seven (8.2%) reported having taken courses in oncology. Given the structure of the institutions, the use of a distance learning strategy could optimize efforts and overcome difficulties; however, pedagogical planning that is consistent with the profile of the professionals is necessary. Conclusion: The data point out the need for the expansion and qualification of the dental care network for cancer patients.(AU)

Estudo das características antropométricas e das respostas das variáveis cardiovasculares à manobra postural passiva em pacientes com suspeita clínica de síncope neurocardiogênica

A síncope neurocardiogênica (SNC), também conhecida como síncope vasovagal, é uma síndrome que se caracteriza por redução global e aguda do fluxo cerebral, com perda transitória da consciência e do controle postural, quando recorrente, causa grande comprometimento da qualidade de vida dos pacientes. Apesar de a SNC ser de natureza reflexa, ainda existem grandes discordâncias na literatura, a respeito dos mecanismos aferentes (de “gatilho”) que a desencadeiam. Os mecanismos eferentes envolvidos na SNC são mais conhecidos (vasodilatação das arteríolas periféricas, causada pela diminuição do tônus simpático basal e/ou bradicardia, por aumento do tônus vagal). Entretanto, ainda existem divergências, no que diz respeito às respostas das variáveis cardiorrespiratórias que antecedem à síncope, durante a realização da manobra postural passiva (MPP), que se constitui no principal teste para o diagnóstico desta síndrome. Por outro lado, a influência da idade e das características antropométricas dos pacientes, como peso, altura e índice de massa corporal, na gênese e no tempo do aparecimento da síncope, após a mudança postural da MPP, é pouco estudada, e os resultados existentes na literatura são discordantes. Dentro desse contexto, é que se insere o presente estudo, que teve por objetivo, usando critérios rígidos de inclusão e exclusão dos pacientes existentes no Banco de Dados da Divisão de Cardiologia, HCFMRP-USP, selecionar, naqueles com história clínica altamente sugestiva de síncope SNC, um grupo com resposta positiva e outro negativa, no que se refere à indução de síncope durante teste da MPP convencional. O presente estudo comparou entre os grupos selecionados: 1- as respostas de frequência cardíaca e da pressão arterial sistêmica na posição horizontal e no 5º minuto na posição vertical, em 70º, durante o teste da MPP; 2- as porcentagens de sexo e idade dos pacientes em cada grupo; 3- as características antropométricas (peso, altura...

[Occurrence de Leishmania spp. in domestic cats from Araçatuba, SP]. / Ocorrência de Leishmania spp. em felinos do município de Araçatuba, SP.

This study had the purpose to compare the occurrence of Leishmania spp. in felines through two methods (cytological and serological), as well as to associate the occurrence of this protozoan with the sex, age and breed variables. Serum samples from 283 domestic felines were processed by means of Indirect Immunofluorescence Reaction (IIR), and the direct parasitological test for linfonodes was also carried out in order to verify positivity for Leishmania spp. Occurrence of 0.7% (2/283) was observed in the tested felines by means of linfonode imprinting and no animal showed title of antibodies for Leishmania spp. The two positive females were mongrel, a young female and an adult female feline. From the obtained results, no statistically significant difference was observed as regards the sex, breed and age variables in this research (p > 0.05). Occurrence of Leishmania spp. in the cats of this study was low. Such low incidence suggests that these hosts has no epidemiological relevance in the study area.

Ocorrência de Leishmania spp. em felinos do município de Araçatuba, SP / Occurrence de Leishmania spp. in domestic cats from Araçatuba, SP

Este trabalho teve como objetivo comparar a ocorrência de Leishmania spp. em gatos por dois métodos (citológico e sorológico), bem como associar a ocorrência deste protozoário com as variáveis sexo, idade e raça. Amostras séricas de 283 felinos domésticos foram testadas pela Reação de Imunofluorescência Indireta (RIFI), e o exame parasitológico direto de linfonodos também foi realizado para a verificação da positividade para Leishmania spp. Ocorrência de 0,7 por cento (2/283) foi observada nos felinos examinados, por meio de imprint de linfonodos e nenhum animal apresentou títulos de anticorpos para Leishmania spp. As duas fêmeas positivas eram sem raça definida, sendo uma jovem e outra adulta. Por meio dos resultados obtidos, não foi constatada diferença estatisticamente significante em relação às variáveis sexo, raça e idade nos gatos desta pesquisa (p > 0,05). Ocorrência de Leishmania spp. nos gatos deste estudo foi baixa. Devido a esta baixa incidência sugere-se que estes não assumem importância epidemiológica na área do estudo.

This study had the purpose to compare the occurrence of Leishmania spp. in felines through two methods (cytological and serological), as well as to associate the occurrence of this protozoan with the sex, age and breed variables. Serum samples from 283 domestic felines were processed by means of Indirect Immunofluorescence Reaction (IIR), and the direct parasitological test for linfonodes was also carried out in order to verify positivity for Leishmania spp. Occurrence of 0.7 percent (2/283) was observed in the tested felines by means of linfonode imprinting and no animal showed title of antibodies for Leishmania spp. The two positive females were mongrel, a young female and an adult female feline. From the obtained results, no statistically significant difference was observed as regards the sex, breed and age variables in this research (p > 0.05). Occurrence of Leishmania spp. in the cats of this study was low. Such low incidence suggests that these hosts has no epidemiological relevance in the study area.

Ocorrência de leishmania spp. em felinos do município de Araçatuba, SP / Occurrence de Leishmania spp. in domestic cats from Araçatuba, SP

Este trabalho teve como objetivo comparar a ocorrência de Leishmania spp. em gatos por dois métodos (citológico e sorológico), bem como associar a ocorrência deste protozoário com as variáveis sexo, idade e raça. Amostras séricas de 283 felinos domésticos foram testadas pela Reação de Imunofluorescência Indireta (RIFI), e o exame parasitológico direto de linfonodos também foi realizado para a verificação da positividade para Leishmania spp. Ocorrência de 0,7% (2/283) foi observada nos felinos examinados, por meio de imprint de linfonodos e nenhum animal apresentou títulos de anticorpos para Leishmania spp. As duas fêmeas positivas eram sem raça definida, sendo uma jovem e outra adulta. Por meio dos resultados obtidos, não foi constatada diferença estatisticamente significante em relação às variáveis sexo, raça e idade nos gatos desta pesquisa (p > 0,05). Ocorrência de Leishmania spp. nos gatos deste estudo foi baixa. Devido a esta baixa incidência sugere-se que estes não assumem importância epidemiológica na área do estudo.