•Soluble mediators are valuable tools in COVID-19 diagnosis and prognosis.•sTREM-1 has been described as a predictor of inflammation severity.•sTREM-1 concentrations were markedly higher in MIS-C vs ...non-MIS-C acute patients.•High sTREM-1 concentrations had a significant association with MIS-C development.•IL-6, IL-8, and IL-10 concentrations were higher in the acute phase compared with the convalescent phase, regardless of whether the patient developed MIS-C.•sTREM-1 in pediatric patients has good predictive accuracy as an early screening biomarker to identify MIS-C cases.
The exacerbation of the inflammatory response caused by SARS-CoV-2 in adults promotes the production of soluble mediators that could act as diagnostic and prognostic biomarkers for COVID-19. Among the potential biomarkers, the soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) has been described as a predictor of inflammation severity. The aim was to evaluate sTREM-1 and cytokine serum concentrations in pediatric patients during the acute and convalescent phases of COVID-19. This was a prospective study that included 53 children/adolescents with acute COVID-19 (Acute-CoV group); 54 who recovered from COVID-19 (Post-CoV group) and 54 controls (Control group). Preexisting chronic conditions were present in the three groups, which were defined as follows: immunological diseases, neurological disorders, and renal and hepatic failures. The three groups were matched by age, sex, and similar preexisting chronic conditions. No differences in sTREM-1 levels were detected among the groups or when the groups were separately analyzed by preexisting chronic conditions. However, sTREM-1 analysis in the seven multisystemic inflammatory syndrome children (MIS-C) within the Acute-Cov group showed that sTREM-1 concentrations were higher in MIS-C vs non-MIS-C acute patients. Then, the receiver operating curve analysis (ROC) performed with MIS-C acute patients revealed a significant AUC of 0.870, and the sTREM-1 cutoff value of > 5781 pg/mL yielded a sensitivity of 71.4 % and a specificity of 91.3 % for disease severity, and patients with sTREM-1 levels above this cutoff presented an elevated risk for MIS-C development in 22.85-fold (OR = 22.85 95 % CI 1.64–317.5, p = 0.02). The cytokine analyses in the acute phase revealed that IL-6, IL-8, and IL-10 concentrations were elevated regardless of whether the patient developed MIS-C, and those levels decreased in the convalescent phase, even when compared with controls. Spearman correlation analysis generated positive indexes between sTREM-1 and IL-12 and TNF-α concentrations, only within the Acute-CoV group. Our findings revealed that sTREM-1 in pediatric patients has good predictive accuracy as an early screening tool for surveillance of MIS-C cases, even in patients with chronic underlying conditions.
The Standard Precautions (SP) are measures to reduce the risk of transmission of bloodborne and other pathogens, and should be used by health professionals in the care of all patients regardless of ...their condition of infection. However, suboptimal compliance with SP has been consistently reported in the nursing literature. This study evaluated the differences of compliance with SP among nurses from Brazil and Hong Kong. This cross-sectional study was conducted in 2 countries—Hong Kong and Brazil—with nurses working in hospitals who responded to a self-administered questionnaire with demographic data and responses to a 20-item Compliance with Standard Precautions Scale. The compliance rate of 560 nurses was 69.4% for the Brazilian sample and 57.4% for the Hong Kong sample. The additional clinical experience of the Brazilian nurses versus those in Hong Kong may be related to differences in compliance with SP between nurses.
Abstract Background Spinocerebellar ataxia type 2 (SCA2) is due to a CAG expansion (CAGexp) at ATXN2 . SCA2 presents great clinical variability, alongside characteristic ataxia with saccadic ...slowness. Aims To study parkinsonism, dementia, dystonia, and amyotrophy as subphenotypes of SCA2, and to explore the effect of CAG repeats at different loci and of mitochondrial polymorphism A10398G as modifiers of phenotype. Methods Symptomatic subjects were classified by presence/absence of neurological signs mentioned above; SARA and NESSCA scores were obtained. CAG repeats at ATXN1, ATXN2, ATXN3, CACNA1A, ATXN7 and RAI1 , and polymorphism A10398G at mtDNA were established. Group characteristics were compared, with a p < 0.05. Results Forty-eight SCA2 individuals were included. Age at onset, CAGexp, and disease duration explained 53% and 43% of SARA and NESSCA variations, respectively. CAGexp of subjects with and without parkinsonism were different (medians of 42 and 39 repeats) as well as of subjects with and without dystonia (44 and 40 repeats). Amyotrophy was not significantly related to any variable under study. Concerning polymorphism A10398G, 83% of subjects with and 34% of those without cognitive decline carried 10398G at (p = 0.003). Discussion Treating the four phenotypic subgroups as outcomes was a valid strategy to identify modifiers of disease. Among correlations found, some confirmed previous reports, such as that between dystonia and CAGexp. Of note was the association between cognitive decline and the variant G at mitochondrial polymorphism A10398G, a variant formerly related to earlier ages at onset in SCA2.
Background/aimWe evaluated the association between leisure time physical activity (PA) and quality of life (QoL) in medical students. Our hypothesis was that there was a positive association between ...volume of PA and various domains of perception of QoL.MethodsData were evaluated from a random sample of 1350 medical students from 22 Brazilian medical schools. Information from participants included the WHO Quality of Life questionnaire-short form (WHOQOL-BREF), a questionnaire specifically designed to evaluate QoL in medical students (VERAS-Q) and questions for both global QoL self-assessment and leisure time PA. According to the amount of metabolic equivalents (METs) spend during PA, volunteers were divided into four groups, according to the volume of PA: (a) no PA; (b) low PA, ≤540 MET min/week; (c) moderate PA, from 541 to 1260 MET min/week and (d) high PA, > 1261 MET min/week.ResultsForty per cent of the medical students reported no leisure time PA (46.0% of females and 32.3% of males). In contrast, 27.2% were classified in the group of high PA (21.0% of females and 34.2% of males). We found significant associations between moderate and high levels of PA and better QoL for all measurements. For low levels of PA, this association was also significant for most QoL measurements, with the exceptions of WHOQOL physical health (p=0.08) and social relationships (p=0.26) domains.ConclusionWe observed a strong dose-effect relationship between the volume of leisure time PA and QoL in both male and female medical students.
To prospectively assess health-related quality of life (HRQoL), global functionality, and disability in primary caregivers of surviving children and adolescents after COVID-19.
A longitudinal ...observational study was carried out on primary caregivers of surviving pediatric post-COVID-19 patients (
= 51) and subjects without COVID-19 (
= 60). EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and 12-question WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) were answered for both groups. The univariate regression analysis was carried out using SPSS (v 20) and significance was established at 5%.
The median duration between COVID-19 diagnosis in children and adolescents and longitudinal follow-up visits was 4.4 months (0.8-10.7). The median age of children and adolescents caregivers with laboratory-confirmed COVID-19 was similar to primary caregivers of subjects without laboratory-confirmed COVID-19 43.2 (31.6-60.9) vs. 41.5 (21.6-54.8) years,
= 0.08, as well as similar female sex (
= 1.00), level of schooling (
= 0.11), social assistance program (
= 0.28), family income/month U$ (
= 0.25) and the number of household's members in the residence (
= 0.68). The frequency of slight to extreme problems (level ≥ 2) of the pain/discomfort domain according to EQ-5D-5L score was significantly higher in the former group 74% vs. 52.5%,
= 0.03, OR = 2.57 (1.14-5.96). The frequency of disability according to WHODAS 2.0 total score was similar to those without disability and unknown (
= 0.79); however, with a very high disability in both groups (72.5% and 78.3%). Further analysis of primary caregivers of children and adolescents with post-COVID-19 condition (PCC)
= 12/51 (23%) compared to those without PCC
= 39/51(77%) revealed no differences between demographic data, EQ-5D-5L and WHODAS 2.0 scores in both groups (
> 0.05).
We longitudinally demonstrated that pain/discomfort were predominantly reported in approximately 75% of primary caregiver of COVID-19 patients, with high disability in approximately three-quarters of both caregiver groups. These data emphasized the prospective and systematic caregiver burden evaluation relevance of pediatric COVID-19.
Summary
Objective To evaluate retrospectively the microbiological profile of Mycobacterium species isolated from HIV‐infected patients attending the HIV/TB reference health care units in São José do ...Rio Preto, Brazil.
Method Retrospective evaluation of all HIV‐1 positive patients whose IAL‐SJRP laboratorial analysis was positive for Mycobacterium sp. after diagnosis of HIV Infection, from January 2000 to December 2006.
Results Of 198 patients, acid‐fast staining detected mycobacteria early in 41%. Culture revealed 52.5% to be infected with Mycobacterium tuberculosis (MT). 42.4% had non‐tuberculous mycobacteria (NTM) and 5.1% had MT/NTM positive cultures. Eleven per cent of MT strains were resistant to at least one of the antimycobacterial drugs and 3.1% were multidrug resistant. 39.4% of isolated mycobacteria were NTM species.
Conclusion Our data may serve as a starting point for further comparisons with other Brazilian regions and other developing countries. The data may provide important clues to the future understanding, prevention and control of such co‐infections around the world.
Objectif: Evaluer rétrospectivement le profil microbiologique des espèces de Mycobacterium isolées de patients infectés par le VIH fréquentant des unités de soins de santé de référence pour la tuberculose/VIH à São José do Rio Preto, au Brésil.
Méthode: Evaluation rétrospective de tous les patients VIH‐1 positifs dont l’analyse IAL‐SJRP de laboratoire était positive pour Mycobacterium sp, de janvier 2000 à décembre 2006.
Résultats: Sur 198 patients, la coloration acido‐résistante a permis de détecter des mycobactéries chez 41% d’eux. La culture a révélé 52,5% infectés par Mycobacterium tuberculosis (MT). 42,4% avaient des mycobactéries non‐tuberculeuses (NTM) et 5,1% avaient des cultures positives pour MT et NTM. 11% des souches MT étaient résistantes à au moins un des médicaments antituberculeux, 3,1%étaient multirésistantes. 39,4% des mycobactéries isolées étaient des espèces NTM.
Conclusion: Nos données pourraient servir de point de départ pour des comparaisons avec d’autres régions du Brésil et d’autres pays en développement. Les données pourraient fournir d’importants indices à la compréhension, prévention et au contrôle de telles coinfections à travers le monde.
Objetivo: Evaluar de forma retrospectiva el perfil microbiológico de las especies de Mycobacterium aisladas de pacientes infectados con VIH atendidos en los centros sanitarios de referencia para VIH/TB en São José do Rio Preto, Brasil.
Método: Evaluación retrospectiva de todos los pacientes VIH‐1 positivos cuyos análisis realizados en el laboratorio IAL‐SJRP eran positivos para Mycobacterium sp. tras habérseles diagnosticado la infección por VIH entre Enero 2000 y Diciembre 2006.
Resultados: Las micobacterias se detectaron mediante tinción ácido‐resistente en 41% de 198 pacientes. Los cultivos revelaron que un 52.5% estaban infectados con Mycobacterium tuberculosis (MT). 42.4% tenían una micobacteria no tuberculosa (MNT), 5.1% tenía cultivos MT/MNT positivos. Un 11% de las cepas de MT eran resistentes a al menos uno de los medicamentos antimicobacterianos. Un 39.4% de las micobacterias aisladas eran especies MNT.
Conclusiones: Nuestros datos podrían servir como punto de partida para futuras comparaciones con otras regiones del Brasil y de otros países en vías de desarrollo. Los datos podrían proveer claves importantes para la comprensión futura, prevención y control de este tipo de coinfecciones alrededor del mundo.
The present study protocol is designed to assess the relationship between outdoor air pollution and low birth weight and preterm births outcomes performing a semi-ecological analysis. Semi-ecological ...design studies are widely used to assess effects of air pollution in humans. In this type of analysis, health outcomes and covariates are measured in individuals and exposure assignments are usually based on air quality monitor stations. Therefore, estimating individual exposures are one of the major challenges when investigating these relationships with a semi-ecologic design.
Semi-ecologic study consisting of a retrospective cohort study with ecologic assignment of exposure is applied. Health outcomes and covariates are collected at Primary Health Care Center. Data from pregnant registry, clinical record and specific questionnaire administered orally to the mothers of children born in period 2007-2010 in Portuguese Alentejo Litoral region, are collected by the research team. Outdoor air pollution data are collected with a lichen diversity biomonitoring program, and individual pregnancy exposures are assessed with spatial geostatistical simulation, which provides the basis for uncertainty analysis of individual exposures. Awareness of outdoor air pollution uncertainty will improve validity of individual exposures assignments for further statistical analysis with multivariate regression models.
Exposure misclassification is an issue of concern in semi-ecological design. In this study, personal exposures are assigned to each pregnant using geocoded addresses data. A stochastic simulation method is applied to lichen diversity values index measured at biomonitoring survey locations, in order to assess spatial uncertainty of lichen diversity value index at each geocoded address. These methods assume a model for spatial autocorrelation of exposure and provide a distribution of exposures in each study location. We believe that variability of simulated exposure values at geocoded addresses will improve knowledge on variability of exposures, improving therefore validity of individual exposures to input in posterior statistical analysis.
To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19)
This was a ...longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed.
The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 0-100 versus 81 34-100, p=0.012), and school score (60 15-100 versus 70 15-95, p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls.
Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.
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