ABSTRACT In Brazil, the COVID-19 burden was substantial, and risk factors associated with higher in-hospital mortality rates have been extensively studied. However, information on short-term all-cause mortality and the factors associated with death in patients who survived the hospitalization period of acute SARS-CoV-2 infection is limited. We analyzed the six-month post-hospitalization mortality rate and possible risk factors of COVID-19 patients in a single center in Brazil. This is a retrospective cohort study focused on a six-month follow-up. The exclusion criteria were death during hospitalization, transference to another hospital, and age under 18. We collected data from the charts of all hospitalized patients from March 2020 to December 2020 with a positive RT-PCR test for SARS-CoV-2, resulting in a sample size of 106 patients. The main outcome was death after hospitalization, whereas comorbidities and demographics were evaluated as risk factors. The crude post-hospitalization death rate was 16%. The first 30 days of follow-up had the highest mortality rate. In a Cox regression model for post-hospitalization mortality, previous chronic kidney disease (HR, 4.06, 95%CI 1.46 – 11.30) and longer hospital stay (HR 1.01, 95%CI 1.00 – 1.02) were the only factors statistically associated with death. In conclusion, a high six-month all-cause mortality was observed. Within the six-month follow-up, a higher risk of death was observed for patients who had prior CKD and longer hospital stay. These findings highlight the importance of more intensive medical surveillance during this period.

Abstract Food processing allows a wide variation in the final quality of the product, which directly depends on the quality of the raw material used, the processing conditions, storage and commercialization. Salting, for example, is one of the oldest methods used to preserve meat. In the meat industry, the incorporation of salts into products is commonly used to improve dietary functionality and ensure food safety. Thus, the objective of this review was to understand that the discarded matrix meat can be used to make jerky meat, adding value to the final product. The processing of jerked beef is based on the osmotic dehydration process in counter flow, promoted by the penetration of salt with consequent exit of water from the inter and extra fibrillar compartments to the surface, with subsequent drying. At the same time, myosin denaturation occurs as a result of high temperatures, as well as myoglobin oxidation, promoted by salt, increasing the susceptibility to protein oxidation. The use of discarded animal meat to make jerky adds value to the by-product, improving sensory quality.

Abstract This study aimed to evaluate the hematological and coagulation parameters according to the clinical outcomes of coronavirus disease (COVID-19). We analyzed the hematological and coagulation parameters of hospitalized patients with COVID-19 at admission, and two and three weeks during hospitalization. To assess the performance of these parameters in predicting poor outcomes, receiver operating characteristic (ROC) curves were created. We studied 128 patients with COVID-19 (59.2±17.7 years, 56% male). Non-survivors (n=54, 42%) presented significant alterations in hematological and coagulation parameters at admission, such as increased in white blood cells (WBC), neutrophil, and band cell counts, as well as elevated prothrombin time (PT), activated partial thromboplastin time, and D-dimer levels. During follow-up, the same group presented a gradual increase in D-dimer and PT levels, accompanied by a reduction in PT activity, hemoglobin, and red blood cell count (RBC). ROC curves showed that WBC, neutrophil, and band cell counts presented the best area under the curve (AUC) values with sensitivity and specificity of >70%; however, a logistic regression model combining all the parameters, except for RBC, presented an AUC of 0.89, sensitivity of 84.84%, and specificity of 77.41%. Our study shows that significant alterations in hematological and coagulation tests at admission could be useful predictors of disease severity and mortality in COVID-19.

Resumen El objetivo principal de esta revisión fue obtener datos de aplicación de la inteligencia artificial en el Ecuador dentro del sector de la educación superior. Se examinaron los trabajos de integración curricular desarrollados en tres centros de educación superior estatales del Ecuador. Se extrajo de cada trabajo información sobre: campo detallado de conocimiento de la carrera que realizó el trabajo, campo detallado de conocimiento del área de aplicación de la inteligencia artificial, técnica aplicada y software utilizado. Se concluyó lo siguiente: los campos de conocimientos con mayores publicaciones son los relacionadas a la electrónica, mecatrónica y tecnologías de software, el campo de aplicación de la inteligencia artificial es muy variado sin mostrar alguna tendencia específica, las técnicas más utilizadas son machine learning y redes neuronales, finalmente el uso de software libre y de pago es balanceado sin que predomine alguno de ellos.

Abstract This review was conducted to obtain data on the application of artificial intelligence in the Ecuadorian higher education system. The curricular integration projects, developed in three state higher education centers in Ecuador, were examined to extract information about the following topics: the detailed field of knowledge of the job that was performed; the detailed field of knowledge of the area of application of artificial intelligence; the applied technique; and the software used. It was concluded that: the fields of knowledge with the greatest publications are those related to electronics, mechatronics, and software technologies; the artificial intelligence field is very wide and does not show any specific trend; the most used techniques are machine learning and neural networks; and finally, the use of free and paid software is balanced without any of them predominating.

Abstract Introduction: Members of the Herpesviridae family have been described in patients with systemic lupus erythematous (SLE), but the clinical impact on renal function is not well known. Methods: HSV1, HSV2, VZV, EBV, CMV, HHV-6, HHV-7, and HHV-8 were evaluated by molecular biology on admission in blood samples from 40 consecutive SLE patients hospitalized for lupus activity. Results: Patients were 90.0% female, 77.5% non-white, with average age of 32.7 ± 13.6 years. We found positivity for EBV (65.0%), CMV (30.0%), HSV-1 (30.0%), HHV-6 (12.5%), and HHV-7 (7.5%). For all viruses, age, SLEDAI, hematological tests, ferritin, LDH, C-reactive protein, and erythrocyte sedimentation rate (ESR) were not significant. However, EBV positivity was a significant factor for higher serum creatinine (3.0 ± 2.8 vs. 0.9 ± 0.8; P = 0.001) and urea (86 ± 51 vs. 50 ± 46; P = 0.03). Moreover, positive cases for EBV only or with combined co-infections (66.7%-CMV; 58.3%-HSV-1) or negative for EBV only were evaluated by Kruskal-Wallis test again showed statistical significance for serum creatinine and urea (both P ≤ 0.01), with posttest also showing statistical differences for renal dysfunction and EBV presence (alone or in combined co-infections). The presence of EBV viral load was also significant for nephrotic-range proteinuria, renal flare, and the need for hemodialysis. Conclusion: Members of the Herpeviridae family (mainly EBV, HSV-1 and CMV) are common on hospital admission of SLE patients, reaching 65% for EBV, which seems to be associated with renal dysfunction and could reflect a previous association or overlapping disease, which is not well understood.

Resumo Introdução: Membros da família Herpesviridae tem sido descritos em pacientes com lúpus eritematoso sistêmico (LES), mas o impacto clínico na função renal não é bem conhecido. Métodos: Avaliou-se HSV1, HSV2, VZV, EBV, CMV, HHV-6, HHV-7, HHV-8 por biologia molecular na admissão em amostras sanguíneas de 40 pacientes com LES consecutivos hospitalizados por atividade lúpica. Resultados: Pacientes 90,0% mulheres, 77,5% não brancos, idade média 32,7 ± 13,6 anos. Encontramos positividade para EBV (65,0%), CMV (30,0%), HSV-1 (30,0%), HHV-6 (12,5%), HHV-7 (7,5%). Para todos os vírus, idade, SLEDAI, exames hematológicos, ferritina, LDH, proteína C reativa, velocidade de hemossedimentação não foram significativos. Entretanto, positividade para EBV foi estatisticamente significativo para creatinina (3,0 ± 2,8 vs. 0,9 ± 0,8; P = 0,001) e ureia (86 ± 51 vs. 50 ± 46; P = 0,03) séricas mais elevadas. Ademais, casos positivos para EBV isolado ou com coinfecções combinadas (66,7%-CMV; 58,3%-HSV-1) ou negativos apenas para EBV foram avaliados pelo teste Kruskal-Wallis e novamente mostraram significância estatística para creatinina e ureia séricas (ambas P ≤ 0,01), com pós-teste mostrando também diferenças estatísticas para disfunção renal e presença de EBV (sozinho ou em coinfecções combinadas). A presença de carga viral do EBV também foi significativa para proteinúria de faixa nefrótica, inflamação aguda, necessidade de hemodiálise. Conclusão: Membros da família Herpeviridae (principalmente EBV, HSV-1, CMV) são comuns na admissão de pacientes com LES, chegando a 65% para EBV, que parece associar-se à disfunção renal podendo refletir associação prévia ou doença sobreposta, o que não é bem compreendido.

Resumo Introdução No Brasil, algumas cidades adotaram várias medidas que provavelmente tiveram um impacto positivo no controle da Covid-19. Objetivo Relatar a distribuição dos casos de Covid-19 no Brasil, no estado do Rio de Janeiro e na cidade de Niterói. Paralelamente, buscamos demonstrar as estratégias preventivas adotadas pela cidade de Niterói para o controle da Covid-19. Método Dados fornecidos pelo Ministério da Saúde e Fundação Municipal de Saúde de Niterói foram usados para relatar o número de casos e óbitos causados pela Covid-19. Para algumas análises, os dados foram agrupados por semana e normalizados para 100.000 habitantes. Resultados Até 18 de julho de 2020, o Brasil registrou 2.074.860 casos e 78.772 mortes e o estado do Rio de Janeiro registrou 135.230 casos e 11.919 mortes; ambos ainda apresentando curvas ascendentes para mortes por Covid-19. Em contrapartida, a taxa de novos óbitos/100.000 habitantes é consistentemente menor na cidade de Niterói. Estimamos que 712 mortes foram evitadas pelas medidas adotadas pela cidade de Niterói, em comparação com o que foi observado no Rio de Janeiro. Conclusão As medidas preventivas adotadas pela cidade de Niterói foram eficazes na redução tanto da disseminação do vírus quanto da taxa de óbitos. Portanto, esta discussão se mostra relevante para a tomada de decisões futuras durante o surto de Covid-19 no Brasil.

Abstract Background In Brazil, some local city government’s adopted several measures, which probably had a positive impact on COVID-19 control. Objective To report the distribution of COVID-19 cases in Brazil, Rio de Janeiro state and Niterói city. In parallel, we aimed to demonstrate the preventive strategies adopted by Niterói city. Method Data provided by the Brazilian Ministry of Health and Municipal Health Foundation of Niterói were used to report COVID-19 cases and deaths. For some analysis, data were grouped by week and normalized for 100,000 inhabitants. Results By July 18th, 2020, Brazil reported 2,074,860 cases and 78,772 deaths and Rio de Janeiro state registered 135,230 cases and 11,919 deaths; both still presenting ascendant curves for COVID-19 deaths. In contrast, the rate of new deaths per 100,000 inhabitants is consistently lower in Niterói city. Importantly, we estimated that 712 deaths were prevented by the measures adopted by Niterói city, in comparison to which was observed in Rio de Janeiro. Conclusion The early preventive measures adopted in Niterói city were effective in reducing both the viral spread and rate of deaths. In this regard, this discussion could be relevant for making future decisions during the COVID-19 outbreak in Brazil.

Resumo A perceção do risco muda ao longo da vida. Estudos anteriores mostraram que os jovens adultos são mais propensos a comportamentos de risco do que os adultos mais velhos. Será que estas diferenças relacionadas com a idade influenciam a perceção de risco durante uma crise pandémica? Aqui, investigámos como a idade influenciou o risco previsto durante o estado de emergência da COVID-19 em Portugal. Demonstramos que as estimativas de tempo projetadas (e.g., avaliações baseadas em agora vs. "daqui a duas semanas", ou "daqui a quatro semanas") tanto do comportamento de risco como da importância da prevenção da transmissão diminuem ao longo do tempo. É importante notar que o risco projetado diminuiu mais acentuadamente para os jovens adultos do que para os adultos mais velhos. Os nossos resultados sugerem que os jovens adultos têm uma perceção do risco relacionado com epidemias diferente do que os adultos mais velhos e parecem corroborar a perspetiva de que a elaboração de políticas de saúde pública durante epidemias deve visar de forma diferente os jovens adultos.

Abstract Perception of risk is known to change throughout the lifespan. Previous studies showed that younger adults are more prone to risk behaviours than older adults. Do these age-related differences influence risk perception during a pandemic crisis? Here, we investigated how age influenced predicted risk during the COVID-19 emergency state in Portugal. We show that time-projected estimations (e.g., appraisals based on ‘now’ vs. ‘in two weeks’ time’, or ‘in four weeks’ time’) of both risk behaviour and importance of transmission prevention decrease over time. Importantly, projected risk decreased more steeply for younger than older adults. Our findings suggest that younger adults have a different perception of epidemic-related risk than older adults. This seems to support the view that public health policy making during epidemics should differentially target younger adults.

Abstract This work aims to evaluate the application of ultrasound and marinate with extract of acerola (Malpighia emarginata) residue on the tenderness and lipid oxidation of the meat pork. Samples of loin (Longissimus dorsi) containing approximately 90 g, 10 cm long, 5 cm wide, and 2 cm high were extracted from the pig carcass. The samples were coded and randomly allocated under a factorial scheme 2 (with and without antioxidant extract) x 3 (ultrasonic bath times 0, 5, and 10 minutes); each treatment had four replicates. The final extract volume was adjusted with distilled water, ensuring 200 mg of gallic acid equivalents per kilo of meat. Then, the samples were placed in the ultrasonic bath at a fixed frequency of 170 W, 35 kHz. During the ultrasound application, the bath temperature was maintained at 10 °C with ice/ice water addition when necessary. The acerola´s extract showed a significant effect (P < 0.05) on the meat Cohesiveness and to a lesser extent before rupture. With the modification of the microstructure in the meat, there was a decrease in elasticity. The application of ultrasound to meat (170 W, 35 kHz) in times (5 and 10 minutes) combined with the marinating in a natural antioxidant acerolas residue extract improves the meat's quality characteristics, decreasing the hardness and chewiness.

Resumo Os manguezais se configuram em um dos ecossistemas mais produtivos do planeta, entretanto eles vêm sofrendo progressivas alterações ambientais, devido às pressões antrópicas. Informações sobre o comportamento fenológico podem ser utilizadas como instrumento na construção de projetos de conservação de recursos naturais. O presente estudo foi realizado em quatro áreas estuarinas em Acaraú, Ceará, objetivando analisar o comportamento fenológico dos componentes reprodutivos de três espécies de mangue em diferentes áreas sujeitas a diferentes tipos de impactos ambientais (resíduos sólidos, desmatamento e efluentes da carcinicultura) e uma área de baixo impacto no período de um ano. A fim de se caracterizar os padrões fenológicos foi realizada observação direta, registrando-se a presença e a intensidade da floração e frutificação. Dois métodos de análise foram aplicados para entender os padrões de floração e frutificação: percentual de intensidade de Fournier e o índice de atividade. As florações de Avicennia spp. e Rhizophora mangle L, em condições naturais, ocorrem o ano todo, e nas áreas impactadas mostraram padrões irregulares. Quanto à frutificação, Laguncularia racemosa (L.) C. F. Gaertn foi a espécie que apresentou os mais altos percentuais para os dois índices fenológicos analisados. A pluviosidade e a salinidade parecem exercer maior força seletiva quando as espécies estão sujeitas a algum tipo de impacto antrópico. A análise comparativa dos diferentes métodos de avaliação fenológicos realizados neste estudo indicou que estes fornecem dados distintos e complementares sobre o comportamento reprodutivo vegetal e de como os impactos a que estes ambientes estão sujeitos pode estar interferindo negativamente sobre a flora deste ecossistema.

Abstract Mangroves are one of the most productive ecosystems on the planet however they have undergone progressive environmental changes due to anthropic pressures. Information on phenological behavior can be used as an instrument in the construction of conservation projects of natural resources. The present study was carried out in four estuarine areas in Acaraú, Ceará, Brazil, with the aim of analyzing of phenological behavior regarding reproductive components of three mangrove species in different areas subject to different environmental impacts (solid waste, deforestation and shrimp farm effluent) and a low impacted area, during a period of one year. patterns of flowering and fruiting: Fournier Index (percentage of intensity) and the index of activity. The flowering of Avicennia spp. and Rhizophora mangle, under natural conditions, occurred all year round, and it showed irregular patterns. Regarding fruiting, Laguncularia racemosa was the species that presented the highest values for the two phenological indices analyzed. Rainfall and salinity seemed to exert a more selective force when species were subjected to an anthropic impact. The comparative analysis of the different phenological evaluation methods carried out in this study indicated that they provide different and complementary data about the reproductive behavior of the plant and how the impacts to which these environments are subjected may be negatively interfering with the flora of this ecosystem.

Abstract This paper presents a general methodology based on the description of the inductive channel as virtual magnetic transmission-lines (VMGTLs). In comparison with other existing methods, VMGTL approach presents a better physical insight of the channel behavior since the model correctly preserves the energy flow between the transmitting and receiving coils. Besides that, it facilitates the integration into the analysis of highly nonlinear and dispersive structures such as metamaterial (MTM) lenses. Particularly, the virtual-TL analogy clarifies that the enhancement of the transmission gain between any two coils assisted by MTM is not due to an enhanced coupling between the drivers, as usually claimed, but to the emergence of propagating near-field modes supported by the MTM. This approach, by means of a parametric study, also indicates, for the first time, that MTMs could be employed not only for the increasing of power but also of data transfer due to the emergence of a sub-resonant region of minimum distortion. Nonetheless, since both effects are mutually exclusive, no passive MTM structure could simultaneously improve power and data transmission.

Resumo: A síndrome do intestino curto (SIC) é caracterizada por um estado de malabsorção de macro e micronutrientes que habitualmente se desenvolve após resseção de intestino delgado. Parece faltar uma correlação entre a quantidade de intestino ressecado e os sintomas desenvolvidos com a adaptação da estrutura e função intestinal. Reportamos o caso de um homem de 59 anos, submetido a resseção de 100 cm de intestino delgado tendo posteriormente desenvolvido síndrome de má absorção. Dos 95 dias de internamento hospitalar, várias complicações associadas à SIC ocorreram e de difícil gestão. Apesar de ser expectável um mau prognóstico, o doente apresentou melhoria significativa do estado nutricional após nutrição entérica e parentérica. À data de alta, apresentava um ganho ponderal de 9 kg. A SIC é uma patologia pouco reportada na literatura dado tratar-se de uma entidade complexa. Pretendemos com este caso reportar todo o processo de recuperação do doente e rever a fisiopatologia desta entidade.

Abstract: Short bowel syndrome (SBS) is characterized by a state of macro and micronutrient malabsorption which usually develops after small bowel resection. There is a weakly correlation between the amount of resected intestine and the clinical symptoms with the adaptation of bowel structure and function. We report a case of a 59-year-old man, who underwent a 100 cm small bowel resection developing malabsorption syndrome afterwards. Throughout the 95 days spent in hospital many complications of SBS with complex management arose. Although the patient was expected to have a poor prognosis, his nutritional status improved significantly through continuous parenteral and enteral nutrition. At discharge he had recovered carrying a 9 kg weight gain. SBS is a non-common disease reported in the literature as being a complex entity. The aim of this case is to report the process of the patient´s recovery and to provide a review of the physiopathology of this entity.

RESUMO Foram realizados dois ensaios experimentais para avaliar a inclusão de biofermentado a base de plantas do semiárido na dieta de leitões na fase inicial. No ensaio I foi avaliado o valor nutricional e a digestibilidade dos nutrientes e os valores de energia digestível e metabolizável do biofermentado. Para tanto, foram utilizados oito leitões com peso médio inicial de 15,2 ± 2,7 kg, alojados em gaiolas de metabolismo, utilizou-se o método de coleta total de fezes e urina. O biofermentado apresentou 80,40% e 68,18% como coeficientes de digestibilidade para a matéria seca e fibra bruta, respectivamente; 10,08% de proteína bruta e 2.865 kcal/kg de energia metabolizável. No segundo ensaio foi avaliada a inclusão de 0; 3; 6 e 9% de biofermentado sobre o desempenho, incidência de diarreia, componentes plasmáticos, peso e comprimento de órgãos digestivos de leitões na fase inicial. Para tanto, foram utilizados 40 leitões com peso médio inicial de 12,6±3,5 kg, distribuídos em delineamento em blocos casualizados com quatro tratamentos, cinco repetições e dois animais por unidade experimental. A inclusão dos diferentes níveis de biofermentado não afetou (P>0,05) o desempenho, o peso e comprimento dos órgãos digestivos e parâmetros séricos. No entanto, a inclusão do biofermentado reduziu (P<0,01) a incidência de diarreia. Conclui-se que o biofermentado a base de plantas adaptadas ao semiárido apresenta potencial de ser utilizado em dietas para suínos na fase inicial.

ABSTRACT Two experimental tests were carried out to evaluate the inclusion of a biofermented semi-arid plant mix in diets of piglets in the initial weaning phase. In the first trial, the nutritional value and digestibility of nutrients and the digestible and metabolizable energy values of the bio-fermented plants mix were evaluated. To do so, eight piglets with an initial average weight of 15.2 ± 2.7 kg were used, housed in metabolic cages, and using the total collection of feces and urine. The bio-fermented plant mix diet presented 80.40% and 68.18% as digestibility coefficients for dry matter and crude fiber, respectively; 10.08% crude protein and 2,865 kcal/kg of metabolizable energy. In the second trial, the inclusion of 0, 3, 6 and 9% of bio-fermented plant mix was evaluated on performance, diarrhea incidence, plasma components, weight, and length of digestive organs of piglets in the initial weaning phase. To do so, 40 piglets with an initial average weight of 12.6 ± 3.5 kg were used, distributed in a randomized block design with four treatments, five replicates, and two animals per experimental unit. The inclusion of different levels of bio-fermented plant mix did not affect (P>0.05) the performance, weight, and length of digestive organs or serum parameters. However, the inclusion of bio-fermented plant reduced (P<0.01) the diarrhea incidence. It is concluded that bio-fermented plants adapted to the semi-arid region has the potential to be used in diets for pigs in the initial weaning phase.

ABSTRACT Introduction: Some COVID-19 patients have higher mortality and the responsible factors for this unfavorable outcome is still not well understood. Objective: To study the association between ferritin levels at admission, representing an inflammatory state, and hospital mortality in COVID-19 patients. Methods: From May through July 2020, SARS-CoV-2 positive patients with moderate to severe clinical symptoms were evaluated at admission, regarding clinical and laboratory data on renal and hepatic function, hematologic parameters, cytomegalovirus co-infection, and acute phase proteins. Results: A total of 97 patients were included; mean age = 59.9 ± 16.3 years, 58.8% male, 57.7% non-white, in-hospital mortality = 45.4%. Age, ferritin, C-reactive protein, serum albumin and creatinine were significantly associated with mortality. Ferritin showed area under the curve (AUC) of 0.79 (p < 0.001) for the cut-off of 1873.0 ng/mL, sensitivity of 68.4% and specificity of 79.3% in predicting in-hospital mortality. Age ≥60 years had an odds ratio (OR) of 10.5 (95% CI = 1.8–59.5; p = 0.008) and ferritin ≥1873.0 ng/mL had an OR of 6.0 (95% CI = 1.4–26.2; p = 0.016), both independently associated with mortality based on logistic regression analysis. Conclusion: The magnitude of inflammation present at admission of COVID-19 patients, represented by high ferritin levels, is independently predictive of in-hospital mortality.

RESUMO Introdução: Estudos sugerem a associação entre a produção de anticorpos e a gravidade da coronavirus disease 2019 (Covid-19). Objetivos: Avaliar as concentrações de imunoglobulinas da classe A (IgA) e da classe G (IgG) durante a internação de pacientes com Covid-19 de acordo com o desfecho (sobrevida vs óbito). Materiais e métodos: Pacientes com infecção pela síndrome respiratória aguda grave do coronavírus 2 (Sars-CoV-2) confirmada por reação da transcriptase reversa seguida de reação em cadeia da polimerase (RT-PCR) foram incluídos neste estudo prospectivo. As amostras foram obtidas semanalmente durante o acompanhamento dos indivíduos, considerando o início dos sintomas. Os títulos de IgA e IgG anti-Sars-CoV-2 foram mensurados por meio de um imunoensaio comercial. Correlações entre IgA/IgG e valores de limiar de detecção [cycle thresholds (Ct)] para os genes alvos N1 e N2 também foram avaliadas. Resultados: Estudamos 55 pacientes com Covid-19 (59,7 ± 6,2 anos; 63,6% do sexo masculino); destes, 28 (50,9%) morreram. Observamos positividade para IgA e IgG (IgA+/IgG+) em 90,9% e 80% dos pacientes, respectivamente. A maior frequência de IgA+ foi verificada nas semanas 2 e 3, e a maior frequência de IgG+, nas semanas 3 e 4. É importante observar que os pacientes que morreram apresentaram títulos de IgA mais baixos nas primeiras duas semanas (p < 0,05); no entanto, um aumento significativo na concentração de IgA foi observado nas semanas subsequentes. Por fim, identificamos correlações significativas entre os valores de Ct e imunoglobulinas; tanto IgA quanto IgG foram correlacionadas com Ct N2 em pacientes que morreram. Conclusão: Nossos resultados sugerem que títulos mais baixos de IgA no início da Covid-19 - que estão associados a valores mais baixos de Ct - podem indicar pacientes com risco elevado de evoluir para óbito.

ABSTRACT Introduction: Studies suggest the association between antibody production and the severity of coronavirus disease 2019 (Covid-19). Objectives: To evaluate the concentrations of immunoglobulins class A (IgA) and class G (IgG) during the hospitalization period of Covid-19 patients according to the outcome (survival vs death). Materials and methods: Patients with severe acute respiratory syndrome of coronavirus 2 (Sars-CoV-2) infection confirmed by reverse transcriptase reaction followed by polymerase chain reaction (RT-PCR) were included in this prospective study. Samples were obtained weekly during the follow-up of individuals, considering symptom onset. Titers of anti-Sars-CoV-2 IgA and IgG were measured using a commercial immunoassay. Correlations between IgA/IgG and cycle threshold (Ct) values for N1 and N2 target genes were also assessed. Results: We studied 55 Covid-19 patients (59.7±16.2 years, 63.6% male), of which 28 (50.9%) died. We observed IgA and IgG positivity (IgA+ and IgG+) in 90.9% and 80% of patients, respectively. The highest IgA+ frequency was observed at weeks 2 and 3 and the highest IgG+ at weeks 3 and 4. It is important to note that patients who died presented lower IgA titers in the first two weeks (p < 0.05); however, a significant increase in IgA levels was observed in the subsequent weeks. Lastly, we identified that significant correlations between Ct values and immunoglobulins levels, both IgA and IgG were correlated with Ct N2 in patients who died. Conclusion: Our results suggest that lower IgA titers in early Covid-19, which is associated with lower Ct values, may indicate patients at higher risk for death.

RESUMEN Introducción: Los estudios sugieren una asociación entre la producción de anticuerpos y la gravedad de la enfermedad por coronavirus 2019 (Covid-19). Objetivos: Evaluar las concentraciones de inmunoglobulinas clase A (IgA) y clase G (IgG) durante la hospitalización de pacientes con Covid-19 según el desenlace (supervivencia vs muerte). Materiales y métodos: Se incluyeron en este estudio prospectivo pacientes con síndrome respiratorio agudo severo de infección por coronavirus 2 (Sars-CoV-2) confirmado por la reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR). Las muestras se obtuvieron semanalmente durante el seguimiento de los individuos, considerando la aparición de los síntomas. Los títulos de IgA e IgG anti-Sars-CoV-2 se midieron usando un inmunoensayo comercial. También se evaluaron las correlaciones entre IgA/IgG y los valores de los umbrales de ciclo [cycle threshold (Ct)] para los genes N1 y N2. Resultados: Se estudiaron 55 pacientes Covid-19 (59,7 ± 16,2 años, 63,6% varones), de los cuales 28 (50,9%) fallecieron. Observamos positividad de IgA e IgG (IgA+ e IgG+) en el 90,9% y el 80% de los pacientes, respectivamente. La frecuencia más alta de IgA+ se observó en las semanas dos y tres y la IgG + más alta en las semanas tres y cuatro. Es importante señalar que los pacientes que fallecieron presentaron títulos de IgA más bajos en las dos primeras semanas (p < 0,05); sin embargo, se observó un aumento significativo en los niveles de IgA en las semanas siguientes. Conclusión: Identificamos correlaciones significativas entre los valores de Ct y los niveles de Ig, tanto IgA como IgG se correlacionaron con Ct N2 en los pacientes que fallecieron. Nuestros resultados sugieren que los títulos de IgA más bajos en Covid-19 temprano, que se asocia con valores de Ct más bajos, pueden indicar que los pacientes tienen un mayor riesgo de muerte.

Gastrinomas são tumores neuroendócrinos caracterizados por hipersecreção de gastrina - 80% são esporádicos e 20% associados a neoplasia endócrina múltipla tipo 1 (MEN1). Apresenta-se o caso de um homem, de 75 anos, tratado cirurgicamente aos 50 anos por gastrinoma, seguido em consulta de Medicina Interna por diarreia crónica não-sanguinolenta, internado no nosso hospital por dor abdominal, diarreia aquosa e vómitos não biliares. À admissão, apresentava-se hipotenso e pouco responsivo a fluidoterapia. As hemoculturas foram positivas para Salmonella e foi feito o diagnóstico de choque séptico por Salmonella. O doente melhorou, mas a história prévia de diarreia crónica não estava esclarecida. Para investigar a diarreia crónica, foi colocada como hipótese recidiva de gastrinoma. A medição de gastrina sérica foi cinco vezes superior ao limite superior do normal (536 pg/mL). A cintigrafia com receptores de somatostatina foi diagnóstica para tumor neuroendócrino. Foram excluídas metástases. O doente foi proposto para cirurgia curativa e foi feito o diagnóstico de tumor neuroendócrino bem diferenciado.

Gastrinomas are neuroendocrine tumors characterized by gastrin overexpression - 80% are sporadic and 20% are associated with multiple endocrine neoplasia type 1. A 75-year-old male patient, surgically treated at the age of 50 years for gastrinoma, followed on an outpatient basis because of chronic non-bloody diarrhea, was admitted to our hospital because of abdominal pain, watery diarrhea, and nonbiliary vomits. He was hypotensive and showed no response to fluids. Blood cultures were positive for Salmonella, and a diagnosis of septic shock due to Salmonella infection was made. The patient’s condition improved, but the history of chronic diarrhea was still not explained. To investigate chronic diarrhea, gastrinoma recurrence was considered. Serum gastrin measurement was five times higher than the upper limit of the normal range (536 pg/mL). A positive somatostatin receptor scintigraphy was diagnostic for neuroendocrine tumor. Metastases were excluded. The patient was proposed to curative surgery, and a diagnosis of a well-differentiated neuroendocrine tumor was made.