ABSTRACT Interstitial keratitis is an inflammation of the corneal stroma without epithelium or endothelium involvement. The underlying causes are mostly infectious or immune mediated. Brazil has one of the highest incidence rates of tuberculosis in the world. Tuberculosis is considered one of the causes of interstitial keratitis. Malnutrition and anemia are risk factors of the disseminated disease. This is a case report of a 10-year-old child who presented with decreased visual acuity and a clinical diagnosis of bilateral interstitial keratitis and sclero-uveitis. The patient had been treated with topical steroids with partial improvement. Examinations revealed severe iron deficiency anemia, negative serologies for human immunodeficiency virus and syphilis, positivity for cytomegalovirus- and herpes simplex-specific IgG, and purified protein derivative of 17 mm. During the follow-up, the patient presented with tonic-clonic seizures, and magnetic resonance imaging findings suggested a central nervous system tuberculoma. Interstitial keratitis improvement was observed after specific tuberculosis treatment. This is the first case report describing the association of interstitial keratitis and central nervous system tuberculoma.

RESUMO A ceratite intersticial é uma inflamação do estroma corneano sem envolvimento epitelial ou endotelial causada principalmente por doenças infecciosas e imunomediadas. O Brasil tem altas taxas de tuberculose que deve ser lembrada como causa de ceratite intersticial. Desnutrição e anemia são fatores de risco da forma disseminada da tuberculose. Este é um relato de uma criança de 10 anos com redução de acuidade visual e diagnóstico clínico de ceratite intersticial bilateral e esclerouveíte. O paciente obteve melhora parcial da ceratite com corticoide tópico. Exames laboratoriais mostraram anemia ferropriva grave, sorologias negativas para HIV e sífilis; IgM negativo e IgG positivo para citomegalovírus e herpes simplex e PPD positivo (17 mm). Ele evoluiu com crises tônico-clônicas e a ressonância nuclear magnética revelou tuberculoma do sistema nervoso central. A melhora da ceratite intersticial foi observada após tratamento para tuberculose. Este é o primeiro caso que descreve a associação de ceratite intersticial e tuberculoma do sistema nervoso central.

BACKGROUND The prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) has changed unevenly over time around the world. Although whole genome sequencing is the gold standard for virus characterisation, the discovery of alpha VOC causing spike gene target failure (SGTF) result, when tested using an reverse transcription real-time polymerase chain reaction (RT-qPCR) assay, has provided a simple tool for tracking the frequencies of variants. OBJECTIVES The aim of this study was to investigate if a multiplex RT-qPCR assay (BioM 4Plex VOC) could be used to detect SARS-CoV-2 and to perform a VOC screening test in a single reaction tube. Here, we present the multicentre study evaluating this assay. METHODS Twelve laboratories have participated in the multicentre study. The BioM 4Plex VOC was distributed to them with detailed instructions of how to perform the test. They were asked to test the BioM 4Plex VOC in parallel with their routine Commercial SARS-CoV-2 diagnostic assay. Additionally, they were requested to select SARS-CoV-2-positive samples with genome sequenced and lineage definition according to PANGO lineage classification. FINDINGS The BioM 4Plex VOC and commercial RT-PCR assay are equally effective in detecting SARS-CoV-2. Results revealed a specificity of 96.5-100% [95% confidence interval (CI)], a sensitivity of 99.8-100% (95% CI), and an accuracy of 99.8-100% (95% CI). A 99% concordance rate was found between results from the BioM 4Plex VOC and that from available genome sequencing data. MAIN CONCLUSIONS The BioM 4Plex VOC provides an effective solution to detect SARS-CoV-2 infections and screening for VOCs in a single reaction. It is a straightforward method to help us monitor the frequency and distribution of VOCs and develop strategies to better cope with the pandemics.

Abstract Objective: To analyze aspects of sexual life and fertility desire among 46, XY DSD people, including those who changed their gender. Methods: It is a cross-sectional study including 127 adults (> 16 years of age) with 46, XY DSD (83 females; 44 males) from a Single Brazilian Tertiary-Care Medical Center. Results: Sexual fantasies and masturbation were more frequent in 46, XY DSD males, whereas orgasm and sexual life satisfaction were similar in both genders. More 46, XY DSD men than women had a long-term romantic relationship. 46, XY DSD women with prenatal androgen exposure reported more fear of being romantically rejected. External genitalia appearance at birth did not impact the sexuality of 46, XY DSD women after surgical genital treatment had been completed. Overall, the sexual life was similar between 46, XY men assigned as males and those who changed to the male gender. Regarding sexual orientation, most self-reported as heterosexual (91% and 92% of women and men, respectively). The desire for fertility had a similar prevalence in both genders, but more women than men considered infertility a barrier to a long-term romantic relationship. Twelve individuals (7 males) had children; 10 out of 12 have adopted children. Conclusion: Fertility desire was shared among 46, XY DSD people, regardless of gender. Prenatal androgen exposure reduced the desire for motherhood in 46, XY women. 46, XY DSD people who changed from female to male gender presented similar sexual parameters as those assigned as males. Among females, virilized genitalia at birth did not affect sexuality once the surgical treatment is completed.

Abstract: This study describes a qualitative study on the theme of parasitic diseases in the thirty books of the ten didactic series recommended by the triennial National Textbook Program 2018 - 2020 for ordinary high schools. In terms of methodology, an adapted form of Mohr's evaluative criteria used. The results point to the predominance of sanitarianism as a guiding principle in health education, erroneous information, and content being limited only to the description of etiological agents, the cycle of zoonoses, and the symptoms of diseases, thus neglecting the exploration of content about the processes and conditioning factors involved in the context of infection-disease.

Resumo O presente artigo desenvolve um estudo qualitativo sobre a temática das doenças parasitárias nos trinta livros das dez coleções didáticas preconizadas pelo triênio do Programa Nacional do Livro Didático 2018-2020 para o ensino médio regular. Para o processo metodológico foram utilizados os critérios avaliativos de Mohr em uma ficha adaptada. Os resultados apontam para a predominância do sanitarismo, como vertente orientadora na educação em saúde, informações errôneas e mantendo seu conteúdo unicamente em informações a respeito da descrição de agentes etiológicos, no ciclo das zoonoses e na sintomatologia das doenças, ignorando o desenvolvimento de conteúdos sobre os processos e fatores condicionantes envolvidos no contexto infecção-doença.

Resumo Samambaias são pouco relatadas como hospedeiras de galhas, e suas interações e relações multitroficas são comumente desconhecidas pela ciência. Atualmente, nos concentramos em Niphidium crassifolium (Polypodiaceae) que abriga galhas globoides nas folhas. As galhas em N. crassifolium são relatadas apenas nas regiões sul e sudeste do Brasil, onde também há uma discussão sobre a identidade do indutor da galha: seria um Cecidomyiidae-Diptera ou um Coccidae-Hemiptera? Esses dois grupos de insetos possuem características distintas e, consequentemente, suas galhas devem apresentar características anatômicas e histoquímicas distintas. Tais características podem ser utilizadas como ferramentas funcionais para corroborar a identificação dos táxons do galhador associado e avaliar sua distribuição geográfica. Nosso estudo teve como objetivo ampliar a distribuição conhecida de N. crassifolium e suas interações com base em inventário de artigos científicos e dados de herbário, e também testar a utilidade de características anatômicas e histoquímicas para propor a identidade galhador. A distribuição geográfica das galhas de N. crassifolium foi ampliada para cinco países da América do Sul: Bolívia, Guiana Francesa, Guiana, Peru e Brasil. O desenvolvimento de um compartimento tecidual externo com camadas de células ricas em fenólicos e um tecido nutritivo interno nos leva a supor que o indutor pertence a família Cecidomyiidae. ciência Atualmente Polypodiaceae (Polypodiaceae folhas N Brasil galha CecidomyiidaeDiptera Cecidomyiidae Diptera CoccidaeHemiptera Coccidae Hemiptera Coccidae-Hemiptera consequentemente herbário Sul Bolívia Francesa

Abstract Ferns have been poorly reported as hosts of gall inducers, and their multitrophic interactions and relationships are practically unknown to science. We focused on Niphidium crassifolium (Polypodiaceae) that hosts globoid leaf galls. The galls on N. crassifolium have only reported for the South and Southeast regions of Brazil, with a discussion regarding the identity of the gall inducer: is it a Cecidomyiidae-Diptera or to Coccidae-Hemiptera? These two insect groups have distinct characteristics and consequently their galls must have distinct anatomical and histochemical traits. Such traits may work out as functional tools to be used to confirm the taxa of the associated galling herbivore and to evaluate their geographic distribution. Our study aimed to expand the known distribution of N. crassifolium and its interactions based on an inventory of scientific articles and on herbarium data, and also to test the usefulness of anatomical and histochemical traits for proposing the identity of the gall inducer. The geographic distribution of N. crassifolium galls involves five South American countries, i.e., Bolivia, French Guiana, Guyana, Peru, and Brazil. The development of an outer tissue compartment with phenolic-rich cell layers and an inner nutritive tissue leads us to infer that the inducer belongs to the Cecidomyiidae family. inducers science Polypodiaceae (Polypodiaceae N Brazil CecidomyiidaeDiptera Diptera CoccidaeHemiptera Coccidae Hemiptera Coccidae-Hemiptera data countries ie i e i.e. Bolivia Guiana Guyana Peru phenolicrich phenolic rich family i.e

ABSTRACT Introduction: Flow cytometry has become an increasingly important tool in the clinical laboratory for the diagnosis and monitoring of many hematopoietic neoplasms. This method is ideal for immunophenotypic identification of cellular subpopulations in complex samples, such as bone marrow and peripheral blood. In general, 4-color panels appear to be adequate, depending on the assay. In acute leukemias (ALs), it is necessary identify and characterize the population of abnormal cells in order to recognize the compromised lineage and classify leukemia according to the WHO criteria. Although the use of eightto ten-color immunophenotyping panels is wellestablished, many laboratories do not have access to this technology. Objective and Method: In 2015, the Brazilian Group of Flow Cytometry (Grupo Brasileiro de Citometria de Fluxo, GBCFLUX) proposed antibody panels designed to allow the precise diagnosis and characterization of AL within available resources. As many Brazilian flow cytometry laboratories use four-color immunophenotyping, the GBCFLUX has updated that document, according to current leukemia knowledge and after a forum of discussion and validation of antibody panels. Results: Recommendations for morphological analysis of bone marrow smears and performing screening panel for lineage (s) identification of AL were maintained from the previous publication. The lineage-oriented proposed panels for B and T cell acute lymphoblastic leukemia (ALL) and for acute myeloid leukemia (AML) were constructed for an appropriate leukemia classification. Conclusion: Three levels of recommendations (i.e., mandatory, recommended, and optional) were established to enable an accurate diagnosis with some flexibility, considering local laboratory resources and patient-specific needs.

Abstract Introduction: The minimal residual disease (MRD) status plays a crucial role in the treatment of acute lymphoblastic leukemia (ALL) and is currently used in most therapeutic protocols to guide the appropriate therapeutic decision. Therefore, it is imperative that laboratories offer accurate and reliable results through well standardized technical processes by establishing rigorous operating procedures. Method: Our goal is to propose a monoclonal antibody (MoAb) panel for MRD detection in ALL and provide recommendations intended for flow cytometry laboratories that work on 4-color flow cytometry platforms. Results and conclusion: The document includes pre-analytical and analytical procedures, quality control assurance, technical procedures, as well as the information that needs to be included in the reports for clinicians.

Abstract This study inventoried and characterized the richness of galling insects based on gall morphotypes and their host plants in two Cerrado sensu stricto areas of Caetité municipality in Bahia State, Brazil, to aid the identification of galling insects and their host plants, as well as to contribute to the knowledge and conservation of local biodiversity. The survey was conducted in the Moita dos Porcos archaeological site and João Barroca Farm site, adopting the random walking methodology for sampling, during 12 months. We recorded 98 gall morphotypes on 42 plant species belonging to 36 genera and 22 families. Leguminosae, Malpighiaceae and Myrtaceae demonstrated the greatest richness of galls, and the Copaifera langsdorffii was the super-host species, with 16 gall morphotypes. Most galls occur on leaves, and may be globoid, glabrous, grouped, and are usually unilocular, and brown. The galling insects identified belonged to Coleoptera, Diptera, Lepidoptera, and Thysanoptera. Eight plant host species and eight gall morphotypes were recorded for the first time in Cerrado areas in Brazil. The areas surveyed demonstrated high richness of gall morphotypes and host plants, evidencing the importance of studying and preserving different areas of the same biome.

ABSTRACT In response to the Zika epidemics in Brazil, the ZDC molecular assay (Bio-Manguinhos) was developed and registered at the Brazilian Regulatory Agency of Health Surveillance - ANVISA. The circulation of Zika (ZIKV) Dengue (DENV) and Chikungunya (CHIKV) viruses and their clinical similarities are challenges to correctly diagnose these viruses. The simultaneous detection of ZIKV, DENV and CHIKV is an important tool for diagnosis and surveillance. Here, we present the analytical and clinical performance evaluation of ZDC molecular assay (Bio-Manguinhos) at the public health laboratories three years after its registration at ANVISA. The clinical performance demonstrates the ZDC molecular assay (Bio-Manguinhos) has 100% sensitivity and 100% specificity to detect and discriminate ZIKV, CHIKV, and DENV from clinical plasma samples. The ZDC molecular assay (Bio-Manguinhos) results were highly reproducible and no cross-reactivity was seen during testing with a panel of other infectious agents. In conclusion, the ZDC molecular assay (Bio-Manguinhos) is an accurate and reliable tool to monitor Zika, dengue and chikungunya infections in countries like Brazil with simultaneous circulation of the three viruses.

ABSTRACT Objective Discrimination and bullying are common conditions among LGBT people. During schooling, these practices compromising education. The aim of this study is to evaluate educational attainment among Brazilian transgender women (TW) and how their education level affects the risk of HIV infection. Study design a cross-sectional population-based study. Subjects and methods 95 adult TW were selected. Information concerning verbal and physical aggression, school dropout, school years (SY), and educational level were assessed. HIV status was screened using a fourth-generation immunoassay followed by western blot testing. Results The mean of SY was 9.1 ± 3.8 ys. The mean age at school dropout was 16.3 ± 3.4 ys old. Verbal aggression was reported by 83%, physical by 48%, and 18% of the TW dropped out school immediately after being physically assaulted. Participants who suffered physical aggression attended school for almost 4 years less than those participants who did not suffer this abuse (OR = -3.96, p < 0.0001). A similar result was found for verbal aggression (OR = -4.35; p < 0.0001). HIV/AIDS prevalence was 18% (n = 17). The mean of SY among HIV/AIDS positive and negative individuals were 6.8 ± 43 versus 9.7 ± 3, respectively (p = 0.004). Lower education was associated with higher frequency of HIV/AIDS among TW and this relationship was sustained after adjustment for injectable drug use and sex work (OR = 0.79, p = 0.04). Conclusion Among Brazilian TW, lower education level was a risk factor associated with HIV. The reasons for low schooling among TW are multifactorial, but verbal and physical harassment strongly contribute for it.

Abstract Hepatitis C virus (HCV) infection is a worldwide health problem. Nowadays, direct-acting antiviral agents (DAAs) are the main treatment for HCV; however, the high level of virus variability leads to the development of resistance-associated variants (RAVs). Thus, assessing RAVs in infected patients is important for monitoring treatment efficacy. The aim of our study was to investigate the presence of naturally occurring resistance mutations in HCV NS3 and NS5 regions in treatment-naïve patients. Ninety-six anti-HCV positive serum samples from blood donors at the Center of Hematology and Hemotherapy of Santa Catarina State (HEMOSC) were collected retrospectively in 2013 and evaluated in this study. HCV 1a (37.9%), 1b (25.3%), and 3a (36.8%) subtypes were found. The frequency of patients with RAVs in our study was 6.9%. The HCV NS5b sequencing reveled 1 sample with L320F mutation and 4 samples with the C316N/R polymorphism. The analysis of the NS3 region revealed the D168A/G/T (3.45%), S122G (1.15%), and V55A (2.3%) mutations. All samples from genotype 3a (36.8%) presented the V170 I/V non-synonymous mutation. In conclusion, we have shown that mutations in NS3 and NS5b genes are present in Brazilian isolates from therapy-naïve HCV patients.

Resumo Objetivos: Avaliar o perfil epidemiológico e o prognóstico visual de pacientes com trauma ocular mecânico. Métodos: Estudo observacional transversal descritivo de pacientes consecutivos atendidos durante o período de um ano em um centro de referência público em São Luís, Maranhão. O Ocular Trauma Score foi aplicado a fim de estimar a acuidade visual final. As variáveis foram analisadas por meio do teste de Qui-quadrado com nível de significância de 5%. Resultados: Encontrou-se 154 pacientes tratados, a média de idade foi 30,1 anos, 27,92% menores que 16 anos, homens (81,8%) e do interior do Estado (55,2%). A maioria eram dependentes (34%), dos trabalhadores ocorreu o predomínio do trabalhador rural (19%). Quanto ao prognóstico, 33,77% dos pacientes apresentavam-se na categoria 5 e 31,16% na 1 ou 2, de pior prognóstico. Os melhores prognósticos foram inversamente proporcionais a idade e ao tempo até o atendimento (p<0,001). Conclusão: O trauma ocular se mantém como importante causa de morbidade ocular na infância e no trabalho informal. A supervisão de adultos e medidas socioeducativas são fundamentais para mudar esse cenário.

Abstract Objectives: To evaluate the epidemiological profile and prognosis of patients with mechanical ocular trauma. Methods: Descriptive cross-sectional observational study of consecutive patients evaluated during a one-year period at a public referral center in São Luis, Maranhão, Brazil. The Ocular Trauma Score (OTS) was used to estimate final visual acuity. The variables were analyzed using the chi-square test with a significance level of 5%. Results: Out of a total of 154 patients (mean age of 30.1 years), 27.92% were younger than 16 years, and 81.8% were men, with most coming from the state's countryside (55.2%). Most of the patients were dependents (34%) or rural workers (19%). Regarding the OTS prognosis, 33.77% of the patients were category 5 and 31.16% category 1 or 2, indicating worse prognosis. The best prognoses (visual outcomes) were inversely proportional to age and time to treatment (p<0.001). Conclusion: Ocular trauma remains an important cause of ocular morbidity in childhood and in informal work. Adult supervision and socio-educational measures are mandatory to change this scenario.

Abstract: Several microbiological indicators of soil quality present high sensitivity, but little is known about the influence of topographic factors on them. This work aimed to evaluate variability of biological indicators of soil quality across a hillslope under native forest and the influence of topographic factors on them. Four positions on a hillslope were evaluated. Activity of the enzymes β-glucosidase, acid phosphatase, urease and fluorescein diacetate (FDA) hydrolysis were determined, as well as basal and substrate-induced respiration, and density of microorganisms: total bacteria, total fungi, actinobacteria, phosphate solubilizers, ammonifiers, native rhizobia, free-living N2-fixing bacteria, spores of arbuscular mycorrhizal fungi and percentage of root colonization by arbuscular mycorrhizal fungi. Activity and density of microorganisms were correlated with topographic factors. The relation of these factors to the variations of the evaluated indicators was determined using the random forest algorithm. Microbiological indicators varied according to the hillslope positions. The indicators urease, basal respiration, spore density, mycorrhizal colonization, total bacteria and fungi, phosphate solubilizers, and free-living N2-fixing bacteria detected in JNFB and FAM culture medium did not vary with terrain attributes and were therefore more indicated in cases of topographic variations. This and future studies can help to select the best microbiological indicators for different conditions.

ABSTRACT Intensive growth of aquatic macrophytes interferes with water quality and ecosystem dynamics worldwide. Although mechanically removing macrophytes is the most commonly used method for their eradication, it can also cause undesirable disturbances in aquatic reservoir communities. We performed laboratory incubations of phytoplankton sampled before and after macrophytes were mechanically removed from the Piraquara II reservoir, South Brazil. We analyzed changes in growth and composition of the main phytoplankton groups with respect to nutrient shifting. Prior to removing the macrophytes, the phytoplankton community was dominated by low cell abundances of diatoms and flagellates. In contrast, growth rates of cyanobacteria (mainly Cylindrospermopsis raciborskii, Pseudanabaena sp., and Geitlerinema sp.) and of colonial chlorophytes were favored after macrophyte removal, while the abundances of diatoms and flagellates decreased. Our results suggest that removing macrophytes causes dramatic changes in phytoplankton composition and biomass and selects for toxigenic species of cyanobacteria. These changes were probably associated with the disturbance caused by removing the macrophytes, which immediately created new environmental conditions prone to species competition. These findings indicate that the use of mechanical techniques to manage macrophytes should be carefully considered, along with monitoring of harmful species and changes of limnological parameters.