Clinical Manifestations and Complications of Children With COVID-19 Compared to Other Respiratory Viral Infections: A Cohort Inpatient Study From Rio de Janeiro, Brazil.

Introduction: The coronavirus disease-2019 (COVID-19) clinical manifestations in children and adolescents are diverse, despite the respiratory condition being the main presentation. Factors such as comorbidities and other respiratory infections may play a role in the initial presentation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aims to describe the epidemiological aspects, clinical, and laboratory manifestations of pediatric patients admitted to a tertiary pediatric hospital in Rio de Janeiro, diagnosed with COVID-19, and compare these with other viral conditions during the first year of the SARS-CoV-2 pandemic. Methods: All patients under 18 years of age that were admitted with upper airway infection were enrolled and followed up for 30 days. The main dependent variable was the laboratorial diagnosis of SARS-CoV-2, and independent variables were studied through logistic regression. Results: A total of 533 patients were recruited, and 105 had confirmed SARS-CoV-2 infection. Detection of other viruses occurred in 34% of 264 tested participants. Six patients died (two in SARS-CoV-2 infected group). The variables independently associated with COVID-19 were older age (OR = 1.1, 95% CI = 1.0-1.1), lower leukocytes count at entry (OR = 0.9, 95% CI = 0.8-0.9), and contact with suspected case (OR = 1.6, 95% CI = 1.0-2.6). Patients with COVID-19 presented higher odds to be admitted in an intensive care unit (OR = 1.99, 95% CI = 1.08-3.66). Conclusions: Even during the SARS-CoV-2 pandemic, several other respiratory viruses were present in admitted pediatric patients. Variables associated with COVID-19 infection were older age, lower leukocytes count at entry, and a domiciliary suspect contact. Although patients with COVID-19 were more frequently admitted to ICU, we did not observe higher mortality in this group.

Tumor Necrosis Factor Receptor-1 (p55) Deficiency Attenuates Tumor Growth and Intratumoral Angiogenesis and Stimulates CD8+ T Cell Function in Melanoma.

The role of tumor necrosis factor-α (TNF-α) in shaping the tumor microenvironment is ambiguous. Consistent with its uncertain role in melanoma, TNF-α plays a dual role, either acting as a cytotoxic cytokine or favoring a tumorigenic inflammatory microenvironment. TNF-α signals via two cognate receptors, namely TNFR1 (p55) and TNFR2 (p75), which mediate divergent biological activities. Here, we analyzed the impact of TNFR1 deficiency in tumor progression in the B16.F1 melanoma model. Tumors developed in mice lacking TNFR1 (TNFR1 knock-out; KO) were smaller and displayed lower proliferation compared to their wild type (WT) counterpart. Moreover, TNFR1 KO mice showed reduced tumor angiogenesis. Although no evidence of spontaneous metastases was observed, conditioned media obtained from TNFR1 KO tumors increased tumor cell migration. Whereas the analysis of tumor-associated immune cell infiltrates showed similar frequency of total and M2-polarized tumor-associated macrophages (TAMs), the percentage of CD8+ T cells was augmented in TNFR1 KO tumors. Indeed, functional ex vivo assays demonstrated that CD8+ T cells obtained from TNFR1KO mice displayed an increased cytotoxic function. Thus, lack of TNFR1 attenuates melanoma growth by modulating tumor cell proliferation, migration, angiogenesis and CD8+ T cell accumulation and activation, suggesting that interruption of TNF-TNFR1 signaling may contribute to control tumor burden.

Hydroxynaphthalenecarboxamides and substituted piperazinylpropandiols, two new series of BRAF inhibitors. A theoretical and experimental study.

The oncogenic mutated kinase BRAFV600E is an attractive molecular target because it is expressed in several human cancers, including melanoma. To present, only three BRAF small inhibitors are approved by the FDA for the treatment of patients with metastatic melanoma: Vemurafenib, Dabrafenib and Encorafenib. Although many protocol treatments have been probed in clinical trials, BRAF inhibition has a limited effectiveness because patients invariably develop resistance and secondary toxic effects associated with the therapy. These limitations highlight the importance of designing new and better inhibitors with different structures that could establish different interactions in the active site of the enzyme and therefore decrease resistance progress. Considering the data from our previous report, here we studied two series of derivatives of structural scaffolds as potential BRAF inhibitors: hydroxynaphthalenecarboxamides and substituted piperazinylpropandiols. Our results indicate that structural analogues of substituted piperazinylpropandiols do not show significantly better activities to that previously reported. In contrast, the hydroxynaphthalenecarboxamides derivatives significantly inhibited cell viability and ERK phosphorylation, a measure of BRAF activity, in Lu1205 BRAFV600E melanoma cells. In order to better understand these experimental results, we carried out a molecular modeling study using different combined techniques: docking, MD simulations and quantum theory of atoms in molecules (QTAIM) calculations. Thus, by using this approach we determined that the molecular interactions that stabilize the different molecular complexes are closely related to Vemurafenib, a well-documented BRAF inhibitor. Furthermore, we found that bi-substituted compounds may interact more strongly respect to the mono-substituted analogues, by establishing additional interactions with the DFG-loop at the BRAF-active site. On the bases of these results we synthesized and tested a new series of hydroxynaphthalenecarboxamides bi-substituted. Remarkably, all these compounds displayed significant inhibitory effects on the bioassays performed. Thus, the structural information reported here is important for the design of new BRAFV600E inhibitors possessing this type of structural scaffold.

Searching new structural scaffolds for BRAF inhibitors. An integrative study using theoretical and experimental techniques.

The identification of the V600E activating mutation in the protein kinase BRAF in around 50% of melanoma patients has driven the development of highly potent small inhibitors (BRAFi) of the mutated protein. To date, Dabrafenib and Vemurafenib, two specific BRAFi, have been clinically approved for the treatment of metastatic melanoma. Unfortunately, after the initial response, tumors become resistant and patients develop a progressive and lethal disease, making imperative the development of new therapeutic options. The main objective of this work was to find new BRAF inhibitors with different structural scaffolds than those of the known inhibitors. Our study was carried out in different stages; in the first step we performed a virtual screening that allowed us to identify potential new inhibitors. In the second step, we synthesized and tested the inhibitory activity of the novel compounds founded. Finally, we conducted a molecular modelling study that allowed us to understand interactions at the molecular level that stabilize the formation of the different molecular complexes. Our theoretical and experimental study allowed the identification of four new structural scaffolds, which could be used as starting structures for the design and development of new inhibitors of BRAF. Our experimental data indicate that the most active compounds reduced significantly ERK½ phosphorylation, a measure of BRAF inhibition, and cell viability. Thus, from our theoretical and experimental results, we propose new substituted hydroxynaphthalenecarboxamides, N-(hetero)aryl-piperazinylhydroxyalkylphenylcarbamates, substituted piperazinylethanols and substituted piperazinylpropandiols as initial structures for the development of new inhibitors for BRAF. Moreover, by performing QTAIM analysis, we are able to describe in detail the molecular interactions that stabilize the different Ligand-Receptor complexes. Such analysis indicates which portion of the different molecules must be changed in order to obtain an increase in the binding affinity of these new ligands.

In Vitro Methods to Study the Modulation of Migration and Invasion by Sphingosine-1-Phosphate.

Sphingosine-1-phosphate (S1P) is a bioactive lipid that modulates migratory behavior of cells during embryonic development. In addition, S1P might promote tumor progression by enhancing migratory ability and invasiveness of tumor cells. Migration is a complex process that implies cytoskeletal reorganization and formation of structures that enable cell movement. Besides having similar requirements than migration, invasion also involves proteolytic degradation of extracellular matrix (ECM). Matrix metalloproteases (MMPs) have been identified to break down components of the ECM, allowing cancer cells to spread out of the primary tumor. In this chapter, we will describe different techniques to study migration and invasion induced by S1P. To this end, we include detailed protocols of end-point assays to study migration/invasion, and zymography assay to analyze MMP-2 and MMP-9 activity that were standardized in our laboratory in human melanoma cell lines.

Sphingosine-1 Phosphate: A New Modulator of Immune Plasticity in the Tumor Microenvironment.

In the last 15 years, increasing evidences demonstrate a strong link between sphingosine-1-phosphate (S1P) and both normal physiology and progression of different diseases, including cancer and inflammation. Indeed, numerous studies show that tissue levels of this sphingolipid metabolite are augmented in many cancers, affecting survival, proliferation, angiogenesis, and metastatic spread. Recent insights into the possible role of S1P as a therapeutic target has attracted enormous attention and opened new opportunities in this evolving field. In this review, we will focus on the role of S1P in cancer, with particular emphasis in new developments that highlight the many functions of this sphingolipid in the tumor microenvironment. We will discuss how S1P modulates phenotypic plasticity of macrophages and mast cells, tumor-induced immune evasion, differentiation and survival of immune cells in the tumor milieu, interaction between cancer and stromal cells, and hypoxic response.

Filamin A Expression Negatively Regulates Sphingosine-1-Phosphate-Induced NF-κB Activation in Melanoma Cells by Inhibition of Akt Signaling.

Sphingosine-1-phosphate (S1P) is a bioactive lipid mediator that regulates many processes in inflammation and cancer. S1P is a ligand for five G-protein-coupled receptors, S1PR1 to -5, and also has important intracellular actions. Previously, we showed that intracellular S1P is involved in tumor necrosis factor alpha (TNF)-induced NF-κB activation in melanoma cell lines that express filamin A (FLNA). Here, we show that extracellular S1P activates NF-κB only in melanoma cells that lack FLNA. In these cells, S1P, but not TNF, promotes IκB kinase (IKK) and p65 phosphorylation, IκBα degradation, p65 nuclear translocation, and NF-κB reporter activity. NF-κB activation induced by S1P was mediated via S1PR1 and S1PR2. Exogenous S1P enhanced the phosphorylation of protein kinase Cδ (PKCδ), and its downregulation reduced S1P-induced the phosphorylation of IKK and p65. In addition, silencing of Bcl10 also inhibited S1P-induced IKK phosphorylation. Surprisingly, S1P reduced Akt activation in melanoma cells that express FLNA, whereas in the absence of FLNA, high phosphorylation levels of Akt were maintained, enabling S1P-mediated NF-κB signaling. In accord, inhibition of Akt suppressed S1P-mediated IKK and p65 phosphorylation and degradation of IκBα. Hence, these results support a negative role of FLNA in S1P-mediated NF-κB activation in melanoma cells through modulation of Akt.

Efeitos dos tratamentos fisioterapêutico e odontológico em pacientes com disfunção temporomandibular / Effects of treatments in dental physiotherapists and patients with temporomandibular disorders

OBJETIVOS: Verificar os efeitos dos tratamentos odontológico e fisioterapêutico na redução da dor em pacientes com disfunção temporomandibular (DTM). MATERIAIS E MÉTODOS: A amostra foi composta por dez pacientes (idade média de 34,3 anos) com DTM. Foram utilizados como instrumentos de coleta de dados o índice clínico de severidade para DTM, a escala visual analógica de dor (EVA) e a versão brasileira do Questionário McGill de Dor (Br-MPQ). Cinco pacientes realizaram o tratamento fisioterapêutico, com dez sessões (três semanas) de aplicações de estimulação elétrica nervosa transcutânea (Tens), ultrassom, massoterapia e alongamento; e cinco pacientes realizaram o tratamento odontológico com procedimentos farmacológicos e a confecção de uma placa miorrelaxante, usada por três semanas. RESULTADOS:Comparando-se as médias dos resultados diários pré e pós-tratamento fisioterapêutico, houve redução significativa (p < 0,05) do quadro álgico em 69,3%. Analisando-se a dor inicial e final, observou-se redução de 96,5% no tratamento fisioterapêutico (p < 0,05) e de 30,9% no tratamento odontológico (p > 0,05). No Br-MPQ a média de redução no tratamento fisioterapêutico, por categorias, foi de 92,5% na categoria sensorial, 80% na afetiva, 80% na avaliação subjetiva e 92% na mista; e no tratamento odontológico foi de 40,1% na categoria sensorial, 51,9% na afetiva, 34% na avaliação subjetiva e 55,9% na mista. Quanto à intensidade, no tratamento fisioterapêutico houve diminuição de 83,6% (p < 0,05) e no odontológico foi de 43,75 (p > 0,05). CONCLUSÕES:Ambos os tratamentos demonstraram ser positivos para o alívio da sintomatologia dolorosa em pacientes com DTM, sendo a fisioterapia, neste caso, um tratamento indicado, com melhora significativa da dor a curto prazo.

OBJECTIVES: To investigate the effects of dental treatments and physical therapy in reducing pain in patients with temporomandibular disorder (TMD). MATERIALS AND METHODS: The sample consisted of ten patients (mean age 34.3 years) with TMD. Used as instruments for data collection index clinical severity for TMD, visual analog scale for pain (VAS) and the Brazilian version of the McGill Pain Questionnaire (Br-MPQ). Five patients underwent physical therapy, with 10 sessions (three weeks) application of transcutaneous electrical nerve stimulation (Tens), ultrasound, massage and stretching, and five patients underwent dental treatment with pharmacological procedures and the making of a plate miorelaxante, used for three weeks. RESULTS: Comparing the mean daily results before and after physical therapy, decreased significantly (p < 0.05) of pain in 69.3%. Analyzing the initial and final pain, there was a decrease of 96.5% in physical therapy (p < 0.05) and 30.9% in dental treatment (p > 0.05). In the Br-MPQ the mean reduction in physical therapy, by category, was 92.5% in the sensory category, 80% in affective, 80% in the subjective evaluation and 92% in mixed and dental treatment was 40.1% in the sensory category, 51.9% in the affective, 34% in the subjective evaluation and 55.9% in mixed. As for intensity, physical therapy decreased from 83.6% (p < 0.05) and in dentistry was 43.75 (p > 0.05). CONCLUSIONS: Both treatments proved to be positive for the relief of painful symptoms in patients with TMD physiotherapy in this case a recommended treatment, with significant improvement in short-term pain.

Ethnicity and young age influence the frequency of diabetic ketoacidosis at the onset of type 1 diabetes.

Diabetic ketoacidosis (DKA) may be present at the onset of type 1 diabetes (T1D), increasing both its morbidity and mortality. The aim of this study was to describe the frequency of this complication at the clinical presentation of T1D, as well as possible interfering factors in a multi-ethnic population from Brazil. We have reviewed the medical charts of 545 individuals with T1D diagnosed between 1968 and 2006 from two major local diabetes treatment centers. DKA occurred in 179 patients (32.8%) at the onset of T1D. The frequency of DKA was higher in non-white than white individuals (p<0.0001) and in the younger age groups (

[Growth hormone deficiency, hypothyroidism and ring chromosome 18: case report]. / Deficiência de hormônio do crescimento, hipotireoidismo e cromossomo 18 em anel: relato de caso.

INTRODUCTION: The association of 18-ring chromosome syndrome and growth hormone deficiency (GHD) is extremely rare, with only two reports in the literature. CASE REPORT: A one year-old, non-white female was referred due to hypoglycemic seizures. She had developmental delay and poor nutrition. Her physical examination was significant for a weight Z score of -6.95, height Z score of -5,05, cleft palate, epicanthic folds and generalized hypotony. Karyotype was 46XX r(18) (p11,2- q.23)--18 ring chromosome syndrome, the MRI showed an ectopic neurohypophysis. The diagnosis GHD was made due to low GH levels during spontaneous severe hypoglycemia at the age of 16 months. She was started on hGH 0.1 U/kg/day. Three months later, TSH deficiency was diagnosed and L-thyroxin therapy was started. During hGH replacement the hypoglycemic events stopped but after 3 years of hGH therapy, she did not improve growth velocity. DISCUSSION: We were unable to find any report of GHD and hypothyroidism associated with the 18-ring chromosome syndrome. Children with 18-ring chromosome should undergo investigation of GHD. In our child with 18-ring syndrome the hGH therapy did not improve growth velocity.

Deficiência de hormônio do crescimento, hipotireoidismo e cromossomo 18 em anel: relato de caso / Growth hormone deficiency, hypothyroidism and ring chromosome 18: case report / Growth hormone deficiency, hypothyroidism and ring chromosome 18: case report

INTRODUÇÃO: A associação de síndrome do cromossomo 18 em anel com deficiência de hormônio de crescimento (DGH) é muito rara, com apenas dois relatos na literatura. RELATO DO CASO: Paciente feminina, negra, 1 ano de idade, encaminhada para investigação de crises de hipoglicemia desde os 6 meses, acompanhadas de crise convulsiva. Apresentava atraso do desenvolvimento neuropsicomotor e erro alimentar. Ao exame físico, criança desnutrida (escores z peso/idade de -6,95 e estatura/idade de -5,05), fenda palatina, prega epicântica e hipotonia generalizada. O diagnóstico de DGH foi feito em vigência de hipoglicemia e iniciado o tratamento com somatropina 0,1 U/kg aos 16 meses de idade. A RM do crânio evidenciou neuro-hipófise ectópica. O hipotireoidismo foi diagnosticado com 1 ano e 7 meses, sendo adicionada levotiroxina ao tratamento. O cariótipo 46XX r(18) (p11,2 ­ q.23), estabeleceu o diagnóstico de síndrome do cromossomo 18 em anel. Está em uso de GH há 3 anos, os episódios de hipoglicemia com crise convulsiva desapareceram mas não houve melhora da velocidade de crescimento. DISCUSSÃO: Não foram encontrados na literatura relatos da associação de DGH, hipotireoidismo e cromossomo 18 em anel. Crianças com cromossomo 18 em anel merecem investigação para DGH. A reposição com GH não melhorou o crescimento da nossa paciente.

INTRODUCTION: The association of 18-ring chromosome syndrome and growth hormone deficiency (GHD) is extremely rare, with only two reports in the literature. CASE REPORT: A one year-old, non-white female was referred due to hypoglycemic seizures. She had developmental delay and poor nutrition. Her physical examination was significant for a weight Z score of -6.95, height Z score of -5,05, cleft palate, epicanthic folds and generalized hypotony. Karyotype was 46XX r(18) (p11,2 ­ q.23) - 18 ring chromosome syndrome, the MRI showed an ectopic neurohypophysis. The diagnosis GHD was made due to low GH levels during spontaneous severe hypoglycemia at the age of 16 months. She was started on hGH 0.1 U/kg/day. Three months later, TSH deficiency was diagnosed and L-thyroxin therapy was started. During hGH replacement the hypoglycemic events stopped but after 3 years of hGH therapy, she did not improve growth velocity. DISCUSSION: We were unable to find any report of GHD and hypothyroidism associated with the 18-ring chromosome syndrome. Children with 18-ring chromosome should undergo investigation of GHD. In our child with 18-ring syndrome the hGH therapy did not improve growth velocity.