Resumo em Inglês:

Abstract The present study aimed to evaluate the effectiveness of two doses of CoronaVac in preventing SARS-CoV-2 symptomatic disease with virological confirmation, as well as in the prevention of COVID-19 moderate and severe cases. A test-negative unmatched case-control design was used, in which cases were patients with suspected COVID-19 (presenting at least two of the following symptoms: fever, chills, sore throat, headache, cough, runny nose, olfactory or taste disorders) with virological confirmation, and controls were those whose SARS-CoV-2 test was negative. As for exposure, participants were classified as unvaccinated, or vaccinated with a complete schedule. Suspected COVID-19 cases were identified from March to November 2021, in two cities located in the State of São Paulo, Brazil. All participants signed the Informed Consent Form before enrollment. RT-PCR results and vaccination data were obtained from the local surveillance systems. Up to two phone calls were made to obtain information on the outcome of the cases. A total of 2981 potential participants were screened for eligibility, of which 2163 were included, being 493 cases and 1670 controls. Vaccination, age, the reported contact with a COVID-19 suspected or confirmed case in the 14 days before symptoms onset, and the educational level were the variables independently associated with the outcome. The adjusted vaccine effectiveness for symptomatic COVID-19 (AVE) was 39.0 % (95 % CI 6.0-60.0 %). The AVE in the prevention of moderate and severe disease was 91.0 % (95 % CI 76.0-97.0 %). Our results were influenced by the waning of the Gamma variant, in the second trimester of 2021, followed by the increase in vaccination coverage, and a drop in the number of cases in the second half of the year. The study demonstrated the high effectiveness of CoronaVac in preventing moderate/severe COVID-19 cases.

Resumo em Inglês:

Abstract Vancomycin is a glycopeptide antibiotic mainly excreted by glomerular filtration. Therefore, patients undergoing hemodialysis tend to accumulate its crystalline degradation product, which has been associated with cross-reaction in commercial immunoassays. The aim of this study was to assess the performance of two commercial immunoassays for measuring vancomycin levels in patients undergoing hemodialysis. This method-comparison study enrolled patients undergoing hemodialysis at two hospitals in Porto Alegre, Brazil. Vancomycin serum concentrations measured by Chemiluminescent Microparticle Assay (CMIA) and measured by Kinetic Interaction of Microparticles in Solution (KIMS) were compared with Liquid Chromatography coupled with Tandem Mass Spectrometry (LC-MS/MS). A total of 64 samples from 42 patients and 54 samples from 23 patients were included in CMIA and KIMS groups. Both measurements were highly correlated with LC-MS/MS, with Spearman rank correlation coefficient r = 0.840 (p < 0.001) and r = 0.926 (p < 0.001), respectively. No deviation of linearity was observed (p = 0.81 and p = 0.49, respectively). The mean difference between CMIA and LC-MS/MS was -1.19 μg/mL and between KIMS and LC-MS/MS was -2.28 μg/mL. LC-MS/MS measured levels were, on average, 2.64 % higher than CMIA and 8.81 % higher than KIMS. CMIA and KIMS revealed accurate commercial methods to measure vancomycin serum concentrations in patients undergoing hemodialysis.

Resumo em Inglês:

Abstract Infective Endocarditis (IE) is a complex, life-threatening disease. The aim of the present study was to evaluate the impact of the Endocarditis-Team on management of IE. This observational study conducted at a university hospital (2015‒22), included adult patients with IE. The study period was divided in two periods: before (pre-Endocarditis-Team; pre-ET) and after the establishment of the Endocarditis-Team (post-Endocarditis-Team; post-ET) on January 2018. Among 505 IE episodes (187 in pre-Endocarditis-Team, 318 in post-ET period), 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography was more commonly used in post-ET period (14 % vs. 28 %; p < 0.001). Overall, thirty-day and one-year mortality were 14 % and 27 %, respectively; no difference was observed between the two periods. In post-ET period, the administration of 4-weeks, rather than 6-weeks, of intravenous antimicrobial treatment was higher than in the post-ET period (15 % vs. 45 %; p < 0.001). Indication for surgery was present in 115 (61 %) patients in pre-ET and in 153 (48 %) in the post-ET period. In post-ET period, among patients with indication, valve surgery was more frequently performed (66 % vs. 78 %; p = 0.038). Such difference was due to a higher acceptance of operative indication by the cardiac surgeon (69 % vs. 94 %; p = 0.013). The observed increase in number of patients benefiting from cardiac surgery in the post-ET period led to a decrease of subsequent embolic events, since among patients with operative indication (n = 268), new embolic events after the establishment of the indication were more common in the pre-ET period compared to post-ET (23 % vs. 12 %; p = 0.033). After the implementation of the multidisciplinary Endocarditis-Team we observed several improvements in the general management of IE patients.

Resumo em Inglês:

Abstract Sporotrichosis is a fungal anthropozoonosis that has become a major public health problem in tropical countries. With that in mind, this study analyzed the relationship between this disease and demographic, socioeconomic and public health issues in Belém, State of Pará, Brazil, from 2020 to 2022. This ecological and cross-sectional study used data from the Belém Zoonosis Control Center, the Brazilian Institute of Geography and Statistics and the Health Ministry. Descriptive and spatial analyses were performed employing significance statistical, kernel, buffer and Moran techniques. One hundred sporotrichosis cases in cats and 49 in humans were analyzed. The results showed that the individuals most affected were women (61.22 %), adults (87.76 %), with the cutaneous form (95.92 %), diagnosed histopathologically (38.78 %), still undergoing treatment (46.94 %) and that the form of contagion was through cat scratches or bites (73.47 %). The profile also showed quantitative significance of ignored data related to treatment (65.31 %) and cat presence at home (63.27 %). The disease had a non-homogeneous distribution with very high densities in Campina de Icoaraci, Águas Negras and Parque Guajará. Those neighborhoods presented a very low Living Conditions Index and precarious services and health centers. The spatial dependence between the environmental and socioeconomic studied variables evidenced the establishment of an active transmission circuit for sporotrichosis in peripheral areas of the city, related to health inequalities with an underlying possible epidemiological silence, suggesting the need for expanding One Health public policies, aiming the sustainable development.

Resumo em Inglês:

Abstract Bartonelloses represent a group of potentially fatal diseases associated with various clinical manifestations including endocarditis. Caused by bacteria belonging to the genus Bartonella, these microorganisms have a remarkable ability to infect mammals, and their transmission is commonly associated with hematophagous vectors such as fleas, lice, mosquitoes, and ticks. The aim of this study was to evaluate the occurrence of Bartonella sp. DNA in 81 triatomines of the species Triatoma sordida collected in the field in peri‑domiciliary areas of the Brazilian city of Seabra, located in the state of Bahia. Nested PCR was conducted targeting the ftsZ gene and real-time PCR targeting the gltA gene, both representing specific reactions for Bartonella henselae. Additionally, conventional PCR targeting kDNA was employed to evaluate the presence of Trypanosoma cruzi. Of the samples tested, 23/81 (28.39 %) bugs showed positive PCR for B. henselae. No sample showed positive PCR for T. cruzi. The high prevalence of triatomines with a positive PCR for B. henselae emphasizes the close relationship between these insects and the bacteria, indicating the need for further studies to investigate the vectorial potential of these kissing bugs.

Resumo em Inglês:

Abstract Human Immunodeficiency Virus (HIV) infection is among the most challenging issues in the healthcare system, presenting significant financial and hygiene problems with a wide range of clinical manifestations. Despite the hopeful outcomes of Antiretroviral Therapies (ARTs), the current strategies for the treatment of patients with HIV infection have not shown clinical significance for all subjects, which is mainly due to the complexity of the disease. Therefore, the need for collaborative and interdisciplinary research focused on deciphering the multifaceted cellular, and molecular immunopathogenesis of HIV remains essential in the development of innovative and more efficacious therapeutic approaches. T-regulatory (Treg) cells function as suppressors of effector T-cell responses contributing to the inhibition of autoimmune disorders and the limitation of chronic inflammatory diseases. Notably, these cells can play substantial roles in regulating immune responses, immunopathogenesis, viral persistence and disease progression, and affect therapeutic responses in HIV patients. In this review, we aim elucidating the role of T-regulatory cells (Tregs) in the immunopathogenesis of HIV, including immunological fatigue and seroconversion. In particular, the focus of the current study is exploration of novel immunotherapeutic approaches to target HIV or related co-infections.

Resumo em Inglês:

Abstract Itraconazole (ITZ) is widely prescribed for the treatment of mycosis such as Paracoccidioidomycosis (PCM). However, it's related to toxicity and serious adverse events, such as Congestive Heart Failure (CHF). The objective is to describe a patient with PCM and CHF secondary to ITZ. Male, 50-years old, was diagnosed with chronic adult PCM and started ITZ 200 mg 12/12 h. After 2-months, acute CHF began without previous-heart disease. The electrocardiogram showed changes in ventricular repolarization and left anterior superior divisional block. Echocardiogram: slight reduction in left ventricular systolic function and ejection fraction of 51%. ITZ was replaced by trimethoprim-sulfamethoxazole. After a week, there was remission of symptoms. Despite thousands of patients around the world received ITZ, few cases of CHF were reported. It's dose dependent and improves when the drug is discontinuing. ITZ has negative inotropic effect and probably causes mitochondrial dysfunction. However, the intrinsic mechanisms are not yet completely understood.

Resumo em Inglês:

Abstract Leprosy is a chronic infectious disease caused by the bacilli Mycobacterium leprae and Mycobacterium lepromatosis. In addition to humans, animals such as nine-banded armadillos and red squirrels are species naturally infected. The objective of this study was to investigate the presence of M. leprae and M. lepromatosis in non-volant small mammals of the order Didelphimorphia and Rodentia through Polymerase Chain Reaction (PCR) assay. During 2015 and 2018, field expeditions were carried out in three municipalities, covering biotic elements of the Amazon and Cerrado biomes, in the Mato Grosso State, Midwest of Brazil. A specific primer for repetitive sequences of the genomic DNA of M. leprae and M. lepromatosis targeting the RLEP and RLPM gene, respectively, was used to screen for these agents. The molecular detection of M. leprae DNA in the samples was 13.8%. M. lepromatosis was not detected. The present study reports a description of M. leprae in small non-volant mammals in Brazil.