Multicenter study of the natural history and therapeutic responses of patients with chikungunya, focusing on acute and chronic musculoskeletal manifestations - a study protocol from the clinical and applied research in Chikungunya (REPLICK network).

BACKGROUND: Chikungunya is associated with high morbidity and the natural history of symptomatic infection has been divided into three phases (acute, post-acute, and chronic) according to the duration of musculoskeletal symptoms. Although this classification has been designed to help guide therapeutic decisions, it does not encompass the complexity of the clinical expression of the disease and does not assist in the evaluation of the prognosis of severity nor chronic disease. Thus, the current challenge is to identify and diagnose musculoskeletal disorders and to provide the optimal treatment in order to prevent perpetuation or progression to a potentially destructive disease course. METHODS: The study is the first product of the Clinical and Applied Research Network in Chikungunya (REPLICK). This is a prospective, outpatient department-based, multicenter cohort study in Brazil. Four work packages were defined: i. Clinical research; ii) Translational Science - comprising immunology and virology streams; iii) Epidemiology and Economics; iv) Therapeutic Response and clinical trials design. Scheduled appointments on days 21 (D21) ± 7 after enrollment, D90 ± 15, D120 ± 30, D180 ± 30; D360 ± 30; D720 ± 60, and D1080 ± 60 days. On these visits a panel of blood tests are collected in addition to the clinical report forms to obtain data on socio-demographic, medical history, physical examination and questionnaires devoted to the evaluation of musculoskeletal manifestations and overall health are performed. Participants are asked to consent for their specimens to be maintained in a biobank. Aliquots of blood, serum, saliva, PAXgene, and when clinically indicated to be examined, synovial fluid, are stored at -80° C. The study protocol was submitted and approved to the National IRB and local IRB at each study site. DISCUSSION: Standardized and harmonized patient cohorts are needed to provide better estimates of chronic arthralgia development, the clinical spectra of acute and chronic disease and investigation of associated risk factors. This study is the largest evaluation of the long-term sequelae of individuals infected with CHIKV in the Brazilian population focusing on musculoskeletal manifestations, mental health, quality of life, and chronic pain. This information will both define disease burden and costs associated with CHIKV infection, and better inform therapeutic guidelines.

Serum biomarkers associated with SARS-CoV-2 severity.

Immunity with SARS-CoV-2 infection during the acute phase is not sufficiently well understood to differentiate mild from severe cases and identify prognostic markers. We evaluated the immune response profile using a total of 71 biomarkers in sera from patients with SARS-CoV-2 infection, confirmed by RT-PCR and controls. We correlated biological marker levels with negative control (C) asymptomatic (A), nonhospitalized (mild cases-M), and hospitalized (severe cases-S) groups. Among angiogenesis markers, we identified biomarkers that were more frequently elevated in severe cases when compared to the other groups (C, A, and M). Among cardiovascular diseases, there were biomarkers with differences between the groups, with D-dimer, GDF-15, and sICAM-1 higher in the S group. The levels of the biomarkers Myoglobin and P-Selectin were lower among patients in group M compared to those in groups S and A. Important differences in cytokines and chemokines according to the clinical course were identified. Severe cases presented altered levels when compared to group C. This study helps to characterize biological markers related to angiogenesis, growth factors, heart disease, and cytokine/chemokine production in individuals infected with SARS-CoV-2, offering prognostic signatures and a basis for understanding the biological factors in disease severity.

Knowledge of anaesthesiologists in Recife with respect to potential risks in the operating room-cross-sectional study.

OBJECTIVES: the health care should be a safe act, free of adverse events. However, in daily practice an excessive exposure to factors that endanger the health of the professional is observed. The surgical center stands out as one of the sites where the professional involved is more vulnerable. This environment is the anaesthesiologist's workplace, and this professional must deal with its potential complicators. This study aimed to evaluate the knowledge of anaesthesiologists in Recife on various situations of risk in the workplace. METHOD: a cross-sectional study in which structured questionnaires, completed voluntarily and anonymously by the anesthesiologist itself, were applied to assess the knowledge of the potential risks in the operating room. Data were analyzed using Epi Info version 7. RESULTS: a total of 162 anaesthesiologists responded to the questionnaire, 38.02% of these professionals registered at Cooperative of Anaesthesiologists of Pernambuco. Of these, 3.7% read the manual of the Committee on Hospital Infection Control (Comissão de Controle de Infecção Hospitalar) of their institution and 40.74% chose the correct option, "technical director", as responsible for ensuring proper working conditions. Of the total, 5.56% stated that the anaesthetics' pollution index in the operating theater was monitored. Only 1.85% of the sample was subjected to periodic screening for tuberculosis. By analyzing the hypothetical situation of contamination with a patient with hepatitis C, only 43.83% knew that there is no effective post-exposure prophylaxis. CONCLUSION: educational campaigns should be implemented to improve the knowledge of health professionals and clarify institutions and professionals' rights and duties.

Conhecimento dos anestesiologistas da cidade do Recife com relação aos riscos potenciais no centro cirúrgico - estudo transversal / Knowledge of anaesthesiologists in Recife with respect to potential risks in the operating room-cross-sectional study / Conocimiento de los anestesistas de la ciudad de Recife con relación a los riesgos potenciales en el quirófano - estudio transversal

Objetivos: o cuidado com a saúde deve ser um ato seguro e livre de eventos adversos. Todavia, na prática diária se observa exposição excessiva a fatores que põem em risco a saúde do profissional. O centro cirúrgico sobressai como um dos locais em que o profissional envolvido está mais vulnerável. O anestesiologista faz desse ambiente o seu local de trabalho e convive com seus agravantes potenciais. Este estudo objetivou avaliar o conhecimento dos anestesiologistas da cidade do Recife acerca das diversas situações de risco do seu ambiente de trabalho. Método: estudo tipo corte transversal, no qual foram aplicados questionários estruturados, preenchidos pelo próprio anestesiologista de forma voluntária e anônima, para avaliar o conhecimento acerca dos riscos potenciais no centro cirúrgico. Os dados foram analisados com o programa software Epi Info versão 7. Resultados: responderam ao questionário 162 anestesiologistas, 38,02% dos cadastrados na Cooperativa de Anestesiologistas de Pernambuco. Desses, 3,7% leram o manual da Comissão de Controle de Infecção Hospitalar (CCIH) da sua instituição de trabalho e 40,74% optaram acertadamente pela opção diretor técnico como o responsável por assegurar condições adequadas de trabalho. Do total, 5,56% afirmaram existir monitoração do índice de poluição anestésica nos centros cirúrgicos. Apenas 1,85% da amostra foi submetido à triagem periódica para tuberculose. Ao analisar a situação hipotética de contaminação com paciente portador de hepatite C, apenas 43,83% sabiam não haver profilaxia efetiva após exposição. Conclusão: campanhas educativas devem ser feitas para melhorar o conhecimento dos profissionais de saúde e esclarecer direitos ...

Objectives: the health care should be a safe act, free of adverse events. However, in daily practice an excessive exposure to factors that endanger the health of the professional is observed. The surgical center stands out as one of the sites where the professional involved is more vulnerable. This environment is the anaesthesiologist's workplace, and this professional must deal with its potential complicators. This study aimed to evaluate the knowledge of anaesthesiologists in Recife on various situations of risk in the workplace. Method: a cross-sectional study in which structured questionnaires, completed voluntarily and anonymously by the anesthesiologist itself, were applied to assess the knowledge of the potential risks in the operating room. Data were analyzed using Epi Info version 7. Results: a total of 162 anaesthesiologists responded to the questionnaire, 38.02% of these professionals registered at Cooperative of Anaesthesiologists of Pernambuco. Of these, 3.7% read the manual of the Committee on Hospital Infection Control (Comissão de Controle de Infecção Hospitalar) of their institution and 40.74% chose the correct option, "technical director", as responsible for ensuring proper working conditions. Of the total, 5.56% stated that the anaesthetics' pollution index in the operating theater was monitored. Only 1.85% of the sample was subjected to periodic screening for tuberculosis. By analyzing the hypothetical situation of contamination with a patient with hepatitis C, only 43.83% knew that there is no effective post-exposure prophylaxis. Conclusion: educational campaigns should be implemented to improve the knowledge of health professionals and clarify institutions and professionals' rights and duties. .

Objetivos: El cuidado de la salud debe ser un acto seguro y libre de eventos adversos. Sin embargo, en la práctica diaria, se observa una exposición excesiva a factores que ponen en riesgo la salud del profesional. El centro quirúrgico destaca como uno de los lugares en que el profesional involucrado es más vulnerable. El anestesista convierte ese ambiente en su lugar de trabajo y convive con sus agravantes potenciales. Este estudio quiso evaluar el conocimiento de los anestesistas de la ciudad de Recife sobre las diversas situaciones de riesgo de su ambiente de trabajo. Método: Estudio de tipo corte transversal, en el cual se aplicaron cuestionarios estructurados rellenados por el propio anestesista de forma voluntaria y anónima, para evaluar el conocimiento acerca de los riesgos potenciales en el quirófano. Los datos fueron analizados con el programa software Epi Info versión 7. Resultados: Respondieron al cuestionario 162 anestesistas, el 38,02% de los registrados en la Cooperativa de Anestesistas de Pernambuco. De ellos, un 3,7% leyeron el manual de la Comisión de Control de Infección Hospitalaria (CCIH) de su institución de trabajo y un 40,74% optaron acertadamente por la opción director técnico como el responsable de garantizar las condiciones adecuadas de trabajo. Del total, un 5,56% afirmaron que existía una monitorización del índice de contaminación anestésica en los quirófanos. Solamente un 1,85% de la muestra se sometió a la selección periódica para tuberculosis. Al analizar la situación hipotética de contaminación con el paciente portador de hepatitis C, solamente un 43,83% sabían que no había profilaxis efectiva posterior a la exposición. Conclusión: Se deben realizar campa˜nas educativas para mejorar el conocimiento de los profesionales de salud y clarificar los derechos ...

Effect of simultaneous consumption of milk and coffee on chlorogenic acids' bioavailability in humans.

Different studies have shown that milk may interact with polyphenols and affect their bioavailability in humans. The present study investigated the effect of the simultaneous consumption of coffee and milk on the urinary excretion of chlorogenic acids (CGA) and metabolites. Subjects were submitted to consumption of water, instant coffee (609 mmol of CGA) dissolved in water, and instant coffee dissolved in whole milk. Urine was collected for 24 h after consumption of each treatment for analysis of CGA and metabolites by HPLC/LC-MS. The amount of CGA and metabolites recovered after consumption of combined coffee-milk (40% ± 27%) was consistently lower in all subjects compared to that of coffee alone (68% ± 20%). Concluding, the simultaneous consumption of milk and coffee may impair the bioavailability of coffee CGA in humans.

Lap4, a vacuolar aminopeptidase I, is involved in cadmium-glutathione metabolism.

In Saccharomyces cerevisiae, accumulation of cadmium-glutathione complex in cytoplasm inhibits cadmium absorption, glutathione transferase 2 is required for the formation of the complex and the vacuolar gamma-glutamyl transferase participates of the first step of glutathione degradation. Here, we proposed that Lap4, a vacuolar amino peptidase, is involved in glutathione catabolism under cadmium stress. Saccharomyces cerevisiae cells deficient in Lap4 absorbed almost 3-fold as much cadmium as the wild-type strain (wt), probably due to the lower rate of cadmium-glutathione complex synthesis in the cytoplasm. In wt, but not in lap4 strain, the oxidized/reduced GSH ratio and the Gtt activity increased in response to cadmium, confirming that the mutant is deficient in the synthesis of the complex probably because the degradation of vacuolar glutathione is impaired. Thus, under cadmium stress, Lap4 and gamma-glutamyl transferase seem to work together to assure an efficient glutathione turnover stored in the vacuole.