Prioritizing COVID-19 tests based on participatory surveillance and spatial scanning.

OBJECTIVES: This study aimed to identify, describe and analyze priority areas for COVID-19 testing combining participatory surveillance and traditional surveillance. DESIGN: It was carried out a descriptive transversal study in the city of Caruaru, Pernambuco state, Brazil, within the period of 20/02/2020 to 05/05/2020. Data included all official reports for influenza-like illness notified by the municipality health department and the self-reports collected through the participatory surveillance platform Brasil Sem Corona. METHODS: We used linear regression and loess regression to verify a correlation between Participatory Surveillance (PS) and Traditional Surveillance (TS). Also a spatial scanning approach was deployed in order to identify risk clusters for COVID-19. RESULTS: In Caruaru, the PS had 861 active users, presenting an average of 1.2 reports per user per week. The platform Brasil Sem Corona started on March 20th and since then, has been officially used by the Caruaru health authority to improve the quality of information from the traditional surveillance system. Regarding the respiratory syndrome cases from TS, 1588 individuals were positive for this clinical outcome. The spatial scanning analysis detected 18 clusters and 6 of them presented statistical significance (p-value < 0.1). Clusters 3 and 4 presented an overlapping area that was chosen by the local authority to deploy the COVID-19 serology, where 50 individuals were tested. From there, 32 % (n = 16) presented reagent results for antibodies related to COVID-19. CONCLUSION: Participatory surveillance is an effective epidemiological method to complement the traditional surveillance system in response to the COVID-19 pandemic by adding real-time spatial data to detect priority areas for COVID-19 testing.

Correlation of Y-chromosome multiple segmental deletions and chromosomal anomalies in non-obstructive azoospermic males from northeastern China.

We investigated the frequency and types of Y-chromosome microdeletions and chromosomal anomalies in non-obstructive azoospermic and severely oligozoospermic infertile males in northeastern China. The sample consisted of 519 infertile males (456 azoospermic, 63 severely oligozoospermic). PCR assays for Y-chromosome microdeletions and chromosome analysis were performed on all patients and controls. Array-comparative genomic hybridization was performed for three patients with chromosomal anomalies. Fifty-nine of 519 patients (11.37%) had Y-chromosome microdeletions. Microdeletions were found in 11.18% (51/456) of the non-obstructive azoospermic patients and in 12.7% (8/63) of the severely oligozoospermic patients. Eleven of 51 non-obstructive azoospermic patients with Y-chromosome microdeletions had multiple segmental deletions in the AZFb+c regions; four of these patients had chromosomal anomalies. Our sample from northeastern China had a higher frequency of microdeletions among severely oligozoospermic than among non-obstructive azoospermic males.

O papel da biópsia renal percutânea no transplante renal / The value of percutaneous renal biopsy in kidney transplantation

A biópsia renal percutânea (BRP) vem sendo utilizada como padräo-ouro para o diagnóstico das disfunçöes renais pós-transplante renal. OBJETIVO. Avaliar o papel atual da BRP como modificadora do diagnóstico e conduta nas disfunçöes renais agudas (DRA) pós-transplante renal. MÉTODOS. Foram estudados 67 pacientes tranplantados renais como disfunçöes renais agudas submetidos a 95 biópsias válidas feitas à beira do leito, sem complicaçöes maiores. RESULTADOS. Foi observado discordância entre o diagnóstico clínico e o patológico em 28 ocasiöes (29,5 por cento). Em 36 situaçöes (37,9 por cento) os resultados dos exames histopatológicos levaram a mudanças no manejo dos pacientes. Entre essas modificaçöes destacam-se: suspensäo do pulso de esteróides (oito casos); nefrectomia do enxerto renal (oito casos); suspensäo ou diminuiçäo da dosagem de ciclosporina (seis casos); início de pulso de esteróides (cinco casos) e início de antibioticoterapia por pielonefrite aguda em quatro casos. O uso de rins de doadores cadavéricos esteve significativamente associado a uma freqüência aumentada de biópsia renais (p < 0,05). CONCLUSAO. Esses resultados demonstram que, apesar da existência de métodos menos invasivos, a BRP permanece sendo um método indispensável no manejo do paciente transplantado renal com DRA

Amplitude regulation of episodic release, in vitro biological to immunological ratio, and median charge of human chorionic gonadotropin in pregnancy.

In the present study, we examined the regulation of 24-h serum immunoreactive levels, in vitro biological to immunological (B/I) ratio, and median charge of circulating CG at the end of the first, second, and third trimesters of human gestation. Seven pregnant women were prospectively studied at 12-15, 23-26, and 35-38 weeks of gestation. Blood was sampled every 20 min over a 24-h period, and serum CG concentrations were determined by RIA. Pulse detection and analysis of the 24-h rhythm of serum immunoreactive CG concentrations were carried out by the program Cluster and cosine curve fitting, respectively. The in vitro biological activity of circulating CG was determined by the mouse Leydig cell-testosterone production bioassay, and the median charge of its isoforms was determined by zone electrophoresis in agarose suspension. The immunoreactive levels of CG present at the end of each trimester of gestation fluctuated over a 24-h period; such variability exceeded that of the within-assay coefficient of variation of the CG RIA and could be resolved into a series of CG peaks and valleys. Although no trend in the number of peaks or valleys was systematically found in relation to gestational age, comparisons between the amplitude and area of the CG peaks revealed that these pulse parameters were significantly higher at 12-15 weeks than at 23-26 and 35-38 weeks of gestation. Cosine fits for 24-h rhythms revealed the existence of significant nyctohemeral profiles of serum CG levels in all women studied at 12-15 weeks, in four subjects at 23-26 weeks, and in six women at 35-38 weeks gestation. The time of acrophase was highly homogeneous only between 12-15 weeks of gestation, occurring between 1057-1452 h in six of the women. The in vitro B/I ratio of CG contained in serum pools from 12-15 weeks was significantly (P < 0.05) higher than that exhibited by CG during later gestational periods (B/I ratio at the end of first trimester, 1.14 +/- 0.14; second trimester, 0.87 +/- 0.22; third trimester, 0.79 +/- 0.12). hCG isoforms at 12-15 weeks were more negatively charged than those circulating at 23-26 and 35-38 weeks of gestation. There were no significant differences between the B/I ratio and the median charge of CG molecules from the second and third trimesters. We conclude that serial serum concentrations of CG throughout pregnancy show significant amplitude-modulated pulsatile release and nyctohemeral variations.(ABSTRACT TRUNCATED AT 400 WORDS)

[The role of percutaneous renal biopsy in kidney transplant]. / O papel da biópsia renal percutânea no transplante renal.

Percutaneous renal biopsy (PRB) is an useful tool for diagnostic and therapeutic orientation in renal transplantation. PURPOSE--To evaluate the current role of PRB in post-transplant acute renal dysfunction (ARD) of renal allografts. METHODS--Sixty-five renal transplant patients were submitted to 95 valid renal biopsies with no major complications. RESULTS--There was disagreement between the clinical and the pathological diagnosis in 28 occasions (29.5%). In 36 cases (37.9%) the results of the pathological examination led to a modification in patient's management. These modifications were most commonly the avoidance or witholding of a steroid pulse (8 cases); nephrectomy of the renal allograft (8 cases); witholding or decrease of cyclosporine dosage (6 cases); giving a steroid pulse (5 cases) and giving antibiotics to treat acute pyelonephritis in 4 cases. The use of kidneys from cadaveric donors was significantly associated with an increased number of biopsies (p < 0.05). CONCLUSION--These results demonstrate that even though several less invasive procedures are currently employed, renal biopsy is still an indispensable method to the management of ARD in renal transplant patients.

Hemostatic abnormalities associated with monoclonal gammopathies.

To confirm and expand previous observations about the association of monoclonal gammopathies with hemostatic defects, a prospective evaluation was made in 42 patients with lymphoplasmacytic disorders. The incidence of bleeding complications was low, despite the diversity of abnormal hemostatic tests observed in these patients. Patients with myeloma frequently had abnormal coagulation tests, including thrombin time (64%), fibrin degradation products (32%), platelet aggregation tests with different agonist (30% to 55%), and bleeding time (22%). The lack of platelet response to ristocetin and normal ristocetin cofactor activity in four patients with myeloma may suggest a Bernard-Soulier-type defect. Serum viscosity was negatively correlated with platelet aggregation with collagen, ristocetin, and adenosine diphosphate. In patients with immunoglobulin myeloma, there was a positive correlation between an increased viscosity and a prolonged thrombin time. This study demonstrates the wide variety of coagulation abnormalities in lymphoplasmacytic disorders, usually without significant clinical implications.

Solitary spindle cell tumor with myoid differentiation of the lymph node.

Spindle cell tumors arising in the lymph nodes are very rare. We report the light microscopic, histochemical, immunohistochemical, and ultrastructural findings of an unusual solitary spindle cell tumor in a peripheral lymph node of a 45-year-old woman. Microscopically, the tumor was characterized by interlacing fascicles of uniform spindle cells with nuclear palisading and formation of Verocay bodies. Numerous erythrocytes were found interstitially. There were no mitotic figures or significant nuclear atypia. The ultrastructural findings of abundant myofilaments with dense bodies indicated myoid differentiation. The clinical and pathologic findings favored this being a benign tumor and could represent a unique example of "intranodal myofibroblastoma." The differential diagnosis includes neurilemoma, leiomyoma, and, more importantly, leiomyosarcoma, Kaposi's sarcoma, and other metastatic spindle cell tumors.

Blood pressure in a high school population. II. Clinical profile of the juvenile hypertensive.

One-hundred-fourteen hypertensive high school students were evaluated to determine whether a distinctive clinical profile could be identified; 71 normotensive students served as controls. Selected blood chemistry determinations, urinalysis, and chest roentgenograms were done to help rule out secondary causes of hypertension. Left ventricular function was assessed by echocardiography and systolic time intervals. The hemodynamic response to exercise was also evaluated. A significant number of the subjects 14 to 18 years of age with persistent systolic and/or diastolic pressure 1.65 SD above the mean for age and sex showed the following: obesity; elevated serum triglyceride concentration; basilar hypertrophy by electrocardiogram/vectorcardiogram; electromechanical systole and pre-ejection period shorter, and the ratio of the pre-ejection period over the left ventricular ejection time lower, than mean for age and sex as determined by systolic time intervals; volume indices depressed and cardiac contractile functions elevated as determined by echocardiography; higher blood pressure at start of exercise stress test and higher peak systolic and diastolic pressures during test, and a slower return of heart rate to base line level after the test. The above findings should be useful in following the course of a young individual with essential hypertension and may provide a means of evaluating therapeutic intervention.