Cytokines, chemokines, and cells growth factors in patients with mild to moderate SARS-CoV-2 infection: A case-control study.

Several biomarkers have been evaluated as predictors of severity or in directing the treatment of COVID-19, however there are no conclusive results. In this study, we evaluated serum levels of cytokines, chemokines, and cell growth factors in association with the pathobiology of mild to moderate SARS-CoV-2 infection. Serum levels of SARS-CoV-2 infected patients (n = 113) and flu symptoms individuals negative for SARS-CoV-2 (n = 58), tested by the RT-qPCR test-nasal swab were compared to healthy controls (n = 53). Results showed that the proinflammatory cytokines IL-1ß, MCP-3, TNF-α, and G-CSF were increased in symptomatic patients and the cytokines IL-6 and IL-10 were associated with patients positive for SARS-CoV-2 when compared to healthy controls. Symptoms associated with COVID-19 were fever, anosmia, ageusia, and myalgia. For patients without SARS-CoV-2 infection, their major symptom was sore throat. The pathobiology of mild to moderate SARS-CoV-2 infection was associated with increasing proinflammatory cytokines and a pleiotropic IL-6 and anti-inflammatory IL-10 cytokines compared to healthy controls. Thus, knowledge about the pathophysiology and the involvement of biomarkers in the mild to moderate profile of the disease should be evaluated. Monitoring these biomarkers in patients with mild to moderate disease can help establish adequate treatment and prevention strategies for long-term COVID-19.

Monitoring Renal Function in HIV Patients Without Kidney Disease Using Endothelial Biomarkers: A Prospective Pilot Study.

This study aimed to investigate the association between novel biomarkers and renal injury in people with HIV (PWH). A cohort study was carried out with PWH under chronic use of antiretroviral therapy (ART), followed at a public outpatient service. Clinical and laboratory parameters of the patients were evaluated year by year, from 2015 [at baseline (year 1, Y1)] to 2019 [year 5 (Y5)]. At baseline, biomarkers of renal damage (e.g., neutrophil gelatinase-associated lipocalin-NGAL, monocyte chemoattractant protein-1-MCP-1, and kidney injury molecule-1-KIM-1) and endothelial activation or glycocalyx damage [e.g., intercellular adhesion molecule 1 (ICAM-1), E-selectin, and syndecan-1] were quantified using enzyme-linked immunosorbent assays and their levels were used to classify patients into different groups. However, only syndecan-1 showed a significant correlation with serum creatinine (p < .001) and glomerular filtration rate (GFR) (p = .003) over the years. Moreover, both serum creatinine and GFR in almost 5 years were significantly associated with serum levels of syndecan-1 at baseline. The multivariate linear regression with confounders showed a significant and independent association between GFR and levels of syndecan-1 and CD4 cell count in the beginning of the study, as well as age in Y5. The data reinforce the screening for kidney diseases with novel biomarkers, especially syndecan-1, as an important strategy for a timely diagnostic and therapeutic approach.

Epidemiology of human rabies in the state of Ceará, Brazil, 1970-2019 / Epidemiología de la rabia humana en el estado de Ceará, Brasil, 1970-2019 / Epidemiologia da raiva humana no estado do Ceará, 1970-2019

Objective: To describe the epidemiology of cases of human rabies in Ceará State, Brazil, 1970-2019. Methods: We analyzed secondary data from the State Department of Health and the reference hospital. Results: Of 171 cases, 75.7% occurred in males, 60.0% in <19 year-olds, and 56.0% in urban areas. Rabies was transmitted by dogs in 74.0%, marmosets in 16.7% and bats in 7.3%. Between 1970 and 1978, there was an increase of cases (by Joinpoint Regression Program, annual percentage change [APC] = 13.7 ­ 95%CI 4.6;41.5), and 1978-2019 a decrease (APC = -6.7 ­ 95%CI -8.8;-5.9). There was a reduction of transmission by dogs (71 cases, last case in 2010) and an increase by sylvatic animals (5 cases since 2005). Conclusion: This study demonstrates changes of transmission dynamics of rabies during the last years, with reduction of transmission by dogs and relative increase of transmission by sylvatic animals.

Objetivo: Descrever os casos de raiva humana no estado do Ceará, Brasil, no período 1970-2019. Métodos: Estudo descritivo, sobre dados secundários da Secretaria da Saúde e do hospital de referência do Ceará. Resultados: Dos 171 casos, 75,7% ocorreram em homens, 60,0% nas idades até 19 anos e 56,0% em áreas urbanas. O cão foi agente transmissor em 74,0% dos casos, sagui em 16,7% e morcego em 7,3%. Entre 1970 e 1978, houve crescimento do número de casos (pelo Joinpoint Regression Program, percentual da mudança anual [APC] = 13,7 ­ IC95% 4,6;41,5); e entre 1978 e 2019, redução (APC = -6,7 ­ IC95% -8,8;-5,9). Houve redução da transmissão por cães (71 casos; último caso em 2010) e aumento relativo por mamíferos silvestres (5 casos a partir de 2005). Conclusão: O estudo evidencia mudança na dinâmica da transmissão da raiva no período observado, com redução da transmissão por cão e incremento de casos por animais silvestres.

Endothelial Glycocalyx Damage and Renal Dysfunction in HIV Patients Receiving Combined Antiretroviral Therapy.

Widespread use of combined antiretroviral therapy (cART) increased HIV patients' life expectancy, however, favored the development of kidney and cardiovascular diseases. The aim of this study was to investigate endothelial glycocalyx (eGC) damage and its association with renal function in HIV patients receiving cART. This is a cross-sectional study with HIV-infected patients with no renal and cardiovascular disease, recruited in public health centers in Brazil. Clinical and laboratory parameters of HIV patients were compared according to cART use and with a healthy control group. Blood ICAM-1 and syndecan-1 levels were quantified by ELISA kit. Estimated glomerular filtration rate (eGFR) was evaluated. A total of 69 HIV patients were included, with mean age of 33.4 ± 8.9 years, and 77.3% were male. Serum urea, creatinine, and eGFR were similar in all groups. No HIV patient had decreased GFR <60 ml/min. All HIV patients had higher systemic syndecan-1 compared with healthy controls (71.8 ± 25.4 ng/ml vs. 36.5 ± 14.3 ng/ml, p < .001). Syndecan-1 showed a significant positive correlation with serum creatinine (r = 0.437, p = .001), serum urea levels (r = 0.352, p = .006), and a negative correlation with eGFR (r = -0.315, p = .015) in HIV patients. Syndecan-1 remained independently associated with serum creatinine and reduced GFR even after we forced variables related with HIV infection status, tenofovir use, treatment time, dyslipidemia, and others in a multivariate analysis. HIV patients using cART with no clinical renal and cardiovascular disease presented eGC damage and it is associated with clinical markers of kidney dysfunction. Syndecan-1 may be a useful early biomarker to monitoring renal dysfunction in HIV patients in chronic use of cART. Further research is needed to evaluate this applicability.

HIV or human papillomavirus co-infection among Brazilian individuals infected with hepatitis B and/or hepatitis C.

OBJECTIVE: To investigate the incidence of co-infection with HIV and human papillomavirus (HPV) among Brazilian individuals with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. METHODS: A prospective study was conducted that enrolled 103 individuals from the Ceará region of Brazil between January 4, 2010, and August 9, 2012. Eligible participants were men (n=45) or women (n=58) infected with HBV and/or HCV. Pap smears were collected from female patients. Material from male (urethra) and female (cervix) patients was then collected via DNA-HPV test and visual inspection with acetic acid. RESULTS: In all, 48 participants tested positive for HBV and 55 tested positive for HCV; 2 had dual infection with HBV and HCV. Co-infection with HIV was detected among 15 participants, whereas 20 participants were found to be co-infected with HPV. CONCLUSION: A high prevalence of co-infection with HIV and HPV was detected among Brazilian individuals with HBV and/or HCV.

Microepidemia de doença de Chagas aguda por transmissão oral no Ceará. / Microepidemics of acute Chagas' disease by oral transmission in Ceará.

No Brasil, em virtude das ações de controle, a transmissão vetorial da doença de Chagas foi reduzida. Por outro lado, vêm se destacando casos de transmissão por via oral. Esse trabalho relata a investigação de um surto de doença de Chagas aguda ocorrido no interior do Ceará no ano de 2006, cuja transmissão se deu provavelmente por via oral. O estudo foi realizado através de revisão de prontuários; entrevistas com pacientes, familiares e profissionais de saúde; achados laboratoriais e da investigação ambiental e entomológica. A microepidemia acometeu 8 integrantes de uma família que estiveram juntos nas férias do mês de janeiro de 2006. Duas mulheres e seis crianças, com idade variando entre 2 e 35 anos. Todos apresentaram quadro inicial de febre, cefaleia, náuseas, vômitos, mialgia e diarreia. Três semanas após o início dos sintomas apresentaram quadro de edema de membros inferiores e de face. Ao exame físico, além de edema, todos apresentaram hepatoesplenomegalia e linfoadenomegalia. O diagnóstico foi confirmado através da demonstração direta de amastigota em linfonodo, tecido muscular e medula. Anticorpos IgM contra Trypanosoma cruzi foram detectados em soro pelo método de hemaglutinação indireta. Todas as culturas para Trypanosoma cruzi foram positivas. A possível fonte de contaminação foi uma sopa à qual tinham sido adicionados coentro e cebolinha liquidificados, provenientes de uma horta domiciliar.

In Brazil, due to control actions, vectorial transmission of Chagas? disease has been largely reduced. On the other hand, oral transmission cases are showing up. This work reports the investigation of an outbreak of acute Chagas? disease in the inland of Ceará state in the year 2006 in which transmission occurred probably by oral route. This research was done through analysis of medical records, interviews with patients, their relatives and health professionals, laboratory data and environmental and entomological investigation. The microepidemics hit eight members of a family that were together on vacations in January 2006: two women and six children, ages ranging from 2 to 35 years. All of them shown initial clinical manifestations of headache, nausea, vomit, myalgia and diarrhea. Three weeks after these initial symptoms they shown edema of the lower limbs and face. Under clinical examination, besides edema, all of them shown hepatosplenomegaly and lymphadenomegaly. Diagnostic was confirmed by direct visualization of amastigota forms in lymph nodes, muscular tissue and bone marrow. IgM antibodies against Trypanosoma cruzi were detected on the serum by indirect hemagglutination assay. All cultures for Trypanosoma cruzi were positive. The probable contamination source was a stew into which liquid coriander and scallion from an orchard were added.