Clinical-laboratory characteristics predictive of COVID-19 severity: a prospective hospital cohort, in Pernambuco, Northeast Brazil.

OBJECTIVE: To describe the clinical-laboratory profile and analyze the factors associated with the severity of COVID-19. METHODS: A prospective cohort study involving patients with COVID-19 admitted to a tertiary hospital in Recife, Brazil. All cases were confirmed by RT-PCR and classified according to severity criteria. A descriptive statistical analysis of the population's characteristics was conducted. Risk factors associated with the outcome of the case according to severity were analyzed by calculating the odds ratio (OR) using the general equation estimation (GEE) model. RESULTS: Among the 75 cases included, 64% were female, and 62.7% were aged 65 years or older. The median length of stay was 9 days (6 - 14). Hypertension (65.3%) and Diabetes Mellitus (36%) were the most frequent comorbidities. Severe forms of COVID-19 constituted 41.3% of the sample. The factors associated with severity were a history of asthma (OR=4.58, 95%CI:1.13 - 18.7), report of anorexia (OR=1, 12, 95%CI:1.01-1.24), and laboratory changes that included elevated platelets (OR=1.00, 95% CI:1.00-1.01), elevated D'Dimer (OR=1, 26, 95% CI:1.04-1.52), elevated aspartate aminotransferase (OR=1.00, 95% CI:1.00-1.01), and gamma-glutamyl transferase (OR=1.22, IC95 %:0.98-1.51), hypernatremia (OR=1.31, 95%CI:1.12-1.52), and hyperkalemia (OR=1.21, 95% CI:1.04-1.41). CONCLUSION: Multisystemic involvement with a tendency for thrombophilia, electrolyte disturbances, and hepatic aggression, reflected by laboratory changes, were factors associated with the severity of COVID-19.

Spread of Gamma (P.1) sub-lineages carrying Spike mutations close to the furin cleavage site and deletions in the N-terminal domain drives ongoing transmission of SARS-CoV-2 in Amazonas, Brazil

The Amazonas was one of the most heavily affected Brazilian states by the COVID-19 epidemic. Despite a large number of infected people, particularly during the second wave associated with the spread of the Variant of Concern (VOC) Gamma (lineage P.1), SARS-CoV-2 continues to circulate in the Amazonas. To understand how SARS-CoV-2 persisted in a human population with a high immunity barrier, we generated 1,188 SARS-CoV-2 whole-genome sequences from individuals diagnosed in the Amazonas state from 1st January to 6th July 2021, of which 38 were vaccine breakthrough infections. Our study reveals a sharp increase in the relative prevalence of Gamma plus (P.1+) variants, designated as Pango Lineages P.1.3 to P.1.6, harboring two types of additional Spike changes: deletions in the N-terminal (NTD) domain (particularly{Delta} 144 or{Delta} 141-144) associated with resistance to anti-NTD neutralizing antibodies or mutations at the S1/S2 junction (N679K or P681H) that probably enhance the binding affinity to the furin cleavage site, as suggested by our molecular dynamics simulations. As lineages P.1.4 (S:N679K) and P.1.6 (S:P681H) expanded (Re > 1) from March to July 2021, the lineage P.1 declined (Re < 1) and the median Ct value of SARS-CoV-2 positive cases in Amazonas significantly decreases. Still, we found no overrepresentation of P.1+ variants among breakthrough cases of fully vaccinated patients (71%) in comparison to unvaccinated individuals (93%). This evidence supports that the ongoing endemic transmission of SARS-CoV-2 in the Amazonas is driven by the spread of new local Gamma/P.1 sub-lineages that are more transmissible, although not more efficient to evade vaccine-elicited immunity than the parental VOC. Finally, as SARS-CoV-2 continues to spread in human populations with a declining density of susceptible hosts, the risk of selecting new variants with higher infectivity are expected to increase.

Clinical evaluation, biochemistry and genetic polymorphism analysis for the diagnosis of lactose intolerance in a population from northeastern Brazil.

OBJECTIVE: This work aimed to evaluate and correlate symptoms, biochemical blood test results and single nucleotide polymorphisms for lactose intolerance diagnosis. METHOD: A cross-sectional study was conducted in Fortaleza, Ceará, Brazil, with a total of 119 patients, 54 of whom were lactose intolerant. Clinical evaluation and biochemical blood tests were conducted after lactose ingestion and blood samples were collected for genotyping evaluation. In particular, the single nucleotide polymorphisms C>T-13910 and G>A-22018 were analyzed by restriction fragment length polymorphism/polymerase chain reaction and validated by DNA sequencing. RESULTS: Lactose-intolerant patients presented with more symptoms of flatulence (81.4%), bloating (68.5%), borborygmus (59.3%) and diarrhea (46.3%) compared with non-lactose-intolerant patients (p<0.05). We observed a significant association between the presence of the alleles T-13910 and A-22018 and the lactose-tolerant phenotype (p<0.05). After evaluation of the biochemical blood test results for lactose, we found that the most effective cutoff for glucose levels obtained for lactose malabsorbers was <15 mg/dL, presenting an area under the receiver operating characteristic curve greater than 80.3%, with satisfactory values for sensitivity and specificity. CONCLUSIONS: These data corroborate the association of these single nucleotide polymorphisms (C>T-13910 and G>A-22018) with lactose tolerance in this population and suggest clinical management for patients with lactose intolerance that considers single nucleotide polymorphism detection and a change in the biochemical blood test cutoff from <25 mg/dL to <15 mg/dL.

Clinical evaluation, biochemistry and genetic polymorphism analysis for the diagnosis of lactose intolerance in a population from northeastern Brazil

OBJECTIVE: This work aimed to evaluate and correlate symptoms, biochemical blood test results and single nucleotide polymorphisms for lactose intolerance diagnosis. METHOD: A cross-sectional study was conducted in Fortaleza, Ceará, Brazil, with a total of 119 patients, 54 of whom were lactose intolerant. Clinical evaluation and biochemical blood tests were conducted after lactose ingestion and blood samples were collected for genotyping evaluation. In particular, the single nucleotide polymorphisms C>T-13910 and G>A-22018 were analyzed by restriction fragment length polymorphism/polymerase chain reaction and validated by DNA sequencing. RESULTS: Lactose-intolerant patients presented with more symptoms of flatulence (81.4%), bloating (68.5%), borborygmus (59.3%) and diarrhea (46.3%) compared with non-lactose-intolerant patients (p<0.05). We observed a significant association between the presence of the alleles T-13910 and A-22018 and the lactose-tolerant phenotype (p<0.05). After evaluation of the biochemical blood test results for lactose, we found that the most effective cutoff for glucose levels obtained for lactose malabsorbers was <15 mg/dL, presenting an area under the receiver operating characteristic curve greater than 80.3%, with satisfactory values for sensitivity and specificity. CONCLUSIONS: These data corroborate the association of these single nucleotide polymorphisms (C>T-13910 and G>A-22018) with lactose tolerance in this population and suggest clinical management for patients with lactose intolerance that considers single nucleotide polymorphism detection and a change in the biochemical blood test cutoff from <25 mg/dL to <15 mg/dL.

[Identification of bacterial contamination in liquid soap for hospital use]. / Identificação de contaminação bacteriana no sabão líquido de uso hospitalar.

This study performed a bacteriological analysis of the liquid soap in dispensers that health professionals use for hand washing. This exploratory, cross-sectional study was developed at the hospitalization units of a medium-sized hospital in Fortaleza, Ceará, Brazil. Data were collected between May and July 2007. Fifty-nine liquid soap dispensers were analyzed, of which 33 contained the following microorganisms: Burkholderia cepacia (14), Pseudomonas putidas (9), Pseudomonas aeruginosa (3), Klebsiella pneumoniae (3), Enterobacter clocae (2), and Pseudomonas luteola (2). The units with the largest number of contaminated samples were the surgical (n=7) and the dermatological clinics (n=4). Contamination was also found in an original flask of the same lot of liquid soap used to fill up the dispensers. In conclusion, there is a need to regulate and control the quality of these products in the production lines as well as during use in hospital services, mainly because they are used to prevent hospital infection.

Identificação de contaminação bacteriana no sabão líquido de uso hospitalar / Identification of bacterial contamination in liquid soap for hospital use / Identificación de contaminación bacteriana en el jabón líquido de uso hospitalario

O estudo realizou a análise bacteriológica de sabões líquidos utilizados para lavagem das mãos dos profissionais de saúde. Trata-se de estudo exploratório transversal, desenvolvido nas unidades de internação de hospital de médio porte em Fortaleza/CE. Os dados foram colhidos no período de maio a julho de 2007. Do total de 59 frascos com sabão líquido, 33 continham os seguintes microorganismos: Burkholderia cepacia (n=14), Pseudomonas putidas (9), Pseudomonas aeruginosa (3), Klebsiella pneumoniae (3), Enterobacter cloacae (2), Pseudomonas luteola (2). As unidades com maior número de amostras contaminadas foram a clínica cirúrgica (n=7) e a clínica dermatológica (n=4). A contaminação também foi verificada em frasco original do mesmo lote de sabão líquido usado para abastecer as saboneteiras. Podemos concluir ser necessário disciplinar e controlar a qualidade desses produtos nas linhas de produção tanto quanto nas fases de uso nos serviços de saúde, sobretudo porque sua utilidade se presta à prevenção de infecção hospitalar.

This study performed a bacteriological analysis of the liquid soap in dispensers that health professionals use for hand washing. This exploratory, cross-sectional study was developed at the hospitalization units of a medium-sized hospital in Fortaleza, Ceará, Brazil. Data were collected between May and July 2007. Fifty-nine liquid soap dispensers were analyzed, of which 33 contained the following microorganisms: Burkholderia cepacia (14), Pseudomonas putidas (9), Pseudomonas aeruginosa (3), Klebsiella pneumoniae (3), Enterobacter clocae (2), and Pseudomonas luteola (2). The units with the largest number of contaminated samples were the surgical (n=7) and the dermatological clinics (n=4). Contamination was also found in an original flask of the same lot of liquid soap used to fill up the dispensers. In conclusion, there is a need to regulate and control the quality of these products in the production lines as well as during use in hospital services, mainly because they are used to prevent hospital infection.

El estudio realizó el análisis bacteriológico de jabones líquidos utilizados para lavado de manos de los profesionales de salud. Se trata de un estudio exploratorio transversal, desarrollado en las unidades de internación de hospital mediano en Fortaleza, Ceará, Brasil. Los datos fueron recolectados en el período de mayo a julio de 2007. Del total de 59 frascos con jabón líquido, 33 contenían los siguientes microorganismos: Burkholderia cepacia (n=14), Pseudomonas putidas (9), Pseudomonas aeruginosa (3), Klebsiella pneumoniae (3), Enterobacter cloacae (2), Pseudomonas luteola (2). Las unidades con mayor número de muestras contaminadas fueron la de clínica quirúrgica (n=7) y la clínica dermatológica (n=4). Se verificó también contaminación en frasco original del mismo lote de jabón líquido usado para abastecer las jaboneras. Podemos concluir en que es necesario disciplinar y controlar la calidad de estos productos en las líneas de producción, tanto como en las fases de uso en los servicios de salud, sobre todo porque su utilidad apunta a la prevención de infecciones hospitalarias.