Resumo Introdução: A falta de profissionais especializados pode contribuir para incapacidade de atender à demanda por transplantes renais. Além disto, não existe uma proposta universal para o processo de formação de cirurgiões transplantadores. Nosso objetivo foi explorar características do programa de treinamento e atividades profissionais das equipes de transplante renal no estado de Minas Gerais, Brasil. Métodos: Convidamos os cirurgiões dos 19 centros de transplante renal ativos em Minas Gerais a participarem desse estudo transversal. Comparamos dados demográficos e de formação profissional utilizando modelos de regressão linear e logística. Resultados: A taxa de resposta entre os centros foi elevada (89%); metade dos cirurgiões responderam à pesquisa (39/78). A maioria dos centros eram instituições públicas de ensino, com contrato de remuneração por produção, com média de 6 ± 2,4 cirurgiões/equipe; 94,2% dos centros tinham urologistas. Os cirurgiões eram 95% homens (idade entre 46, 3 ± 9,7 anos) e 59% eram urologistas. A maioria estava envolvida em captação e transplante de órgãos; somente um trabalhava exclusivamente com transplante. O período médio desde a formação foi de 13 ± 9,4 anos, com média de 10 ± 9,7 anos como parte da equipe de transplante. Apenas 25,6% possuíam formação especializada ou formal em transplante, com somente um tendo concluído residência médica formal em transplante renal. A falta de programas de treinamento foi o motivo mais citado. Conclusão: Cirurgiões de transplante renal não são exclusivos e a maioria não concluiu um programa formal de treinamento em transplante pela falta de disponibilidade. Esses dados indicam necessidade de aprimorar programas de treinamento e facilitar a formação de novas equipes de transplante renal. Introdução renais disto transplantadores Brasil Métodos 1 transversal logística Resultados 89% 89 (89%) 39/78. 3978 39/78 . 39 78 (39/78) ensino produção 24 2 4 2, cirurgiões/equipe cirurgiõesequipe 942 94 94,2 urologistas 95 idade 46 97 9 7 9, 59 órgãos 256 25 25,6 citado Conclusão disponibilidade 8 (89% 397 39/7 (39/78 94, 5 25, (89 39/ (39/7 (8 (39/ ( (39 (3

Abstract Introduction: The lack of specialized professionals potentially contributes to the inability to meet the demand for kidney transplantations. Moreover, there is no universal proposal for the training process of transplantation surgeons. We aimed to explore the characteristics of the training program and professional activities of kidney transplantation teams in the state of Minas Gerais, Brazil. Methods: We invited the surgeons of all 19 active kidney transplantation centers in Minas Gerais to participate in this cross-sectional study. Demographic and professional training data were compared using linear and logistic regression models. Results: The response rate among the centers was high (89%); half of the surgeons answered the survey (39/78). Most of the centers were public teaching institutions, under a production-based payment contract, with a mean of 6 ± 2.4 surgeons/team; 94.2% of the centers had urologists. The surgeons were 95% male (age of 46.3 ± 9.7 years) and 59% were urologists. Most were involved in organ procurement and transplantation; only one surgeon worked exclusively with transplantation. The mean period since training was 13 ± 9.4 years, with a mean of 10 ± 9.7 years as part of the transplantation team. Only 25.6% had specialized or formal training in transplantation, with only one completing a formal medical residency for kidney transplantation. The lack of training programs was the most frequently cited reason. Conclusion: Kidney transplantation surgeons are not exclusive and most have not completed a formal fellowship program in transplantation because they are not available. These data indicate the need to improve training programs and facilitate the formation of new kidney transplantation teams. Introduction transplantations Moreover Brazil Methods 1 crosssectional cross sectional study models Results 89% 89 (89%) 39/78. 3978 39/78 . 39 78 (39/78) institutions productionbased production based contract 24 2 4 2. surgeons/team surgeonsteam team 942 94 94.2 urologists 95 age 463 46 3 46. 97 9 7 9. 59 256 25 25.6 reason Conclusion available 8 (89% 397 39/7 (39/78 94. 5 25. (89 39/ (39/7 (8 (39/ ( (39 (3

RESUMO Contexto: Estudos recentes mostram um aumento da doença hepática gordurosa não alcoólica (DHGNA) em populações com maior consumo de carne vermelha, processada e cozida em altas temperaturas. Por outro lado, o polimorfismo rs738409 no gene Patatin-like fosfolipase contendo 3 (PNPLA3) tem sido implicado na suscetibilidade à DHGNA e fibrose hepática. No entanto, o efeito sinérgico entre o consumo de carne vermelha e o polimorfismo no gene PNPLA3 na DHGNA ainda não foi avaliado. Objetivo: Avaliar a associação entre a presença do polimorfismo no gene PNPLA3 e o consumo de macronutrientes, incluindo o consumo de carne e seu modo de cozimento em pacientes com DHGNA. Métodos: Realizamos um estudo transversal com 91 pacientes diagnosticados com DHGNA por biópsia hepática e genotipados para o polimorfismo no gene PNPLA3. O consumo de calorias e macronutrientes foi verificado por meio do questionário de frequência alimentar semi-quantitativo (QFA) e do questionário específico sobre consumo de carnes. O polimorfismo no gene PNPLA3 foi analisado por reação em cadeia da polimerase em tempo real (RT-PCR) e a avaliação antropométrica foi realizada. Resultados: O índice de massa corporal médio foi de 32,38±4,58 kg/m² e a circunferência da cintura foi de 107±10 cm. Na biópsia hepática, 42% dos pacientes apresentavam fibrose significativa (F≥2). O odds ratio de F≥2 foi de 2,12 para o grupo GG e 1,54 para o grupo GC, comparado ao grupo CC. A ingestão calórica média foi de 1.170±463,20 kcal/d. O odds ratio para alto consumo de carne vermelha no grupo CC em comparação ao baixo consumo foi de 1,33. Para a carne branca, este valor foi de 0,8 ao comparar o alto e o baixo consumo, também no grupo CC. Conclusão: A alta ingestão de carne vermelha e o polimorfismo no gene PNPLA3 parecem afetar sinergicamente a DHGNA e a fibrose hepática, necessitando de confirmação em maior número de pacientes e em diferentes populações. Contexto (DHGNA temperaturas lado rs rs73840 Patatinlike Patatin like PNPLA (PNPLA3 entanto avaliado Objetivo Métodos 9 semiquantitativo semi quantitativo QFA (QFA carnes RTPCR RT PCR (RT-PCR realizada Resultados 3238458 32 38 4 58 32,38±4,5 kgm² kgm kg m² m kg/m 10710 107 10 107±1 cm 42 F≥2. F2 F . 2 (F≥2) F≥ 212 12 2,1 154 1 54 1,5 GC 117046320 170 463 20 1.170±463,2 kcald kcal d kcal/d 133 33 1,33 branca 08 0 8 0, Conclusão rs7384 (PNPLA 323845 5 32,38±4, 1071 107± (F≥2 21 2, 15 1, 11704632 17 46 1.170±463, 13 1,3 rs738 32384 32,38±4 (F≥ 1170463 1.170±463 rs73 3238 32,38± (F 117046 1.170±46 rs7 323 32,38 11704 1.170±4 32,3 1170 1.170± 32, 117 1.170 11 1.17 1.1 1.

ABSTRACT Background: Recent studies show an increase in nonalcoholic fatty liver disease (NAFLD) in populations with higher consumption of red meat, processed and cooked at high temperatures. On the other hand, the single nucleotide polymorphism rs738409 in the Patatin-like phospholipase domain containing 3 (PNPLA3) gene has been implicated in susceptibility to NAFLD and liver fibrosis. However, the synergistic effect between red meat consumption and the PNPLA3 gene polymorphism in NAFLD has not yet been evaluated. Objective: To evaluate the association between the presence of the polymorphism in the PNPLA3 gene and the consumption of macronutrients, including meat consumption and its cooking method among NAFLD patients. Methods: This was a cross-sectional study with 91 patients diagnosed with NAFLD by liver biopsy with genotyping for the polymorphism in the PNPLA3 gene were included. The consumption of calories and macronutrients was verified using the semi-quantitative food frequency questionnaire and the specific questionnaire on meat consumption. PNPLA3 gene polymorphism was analyzed by real-time polymerase chain reaction (RT-PCR) and anthropometric evaluation was realized. Results: The mean BMI was 32.38±4.58 kg/m² and the waist circumference was 107±10 cm. On liver biopsy, 42% of patients had significant fibrosis (F≥2). The odds ratio of F≥2 was 2.12 for the GG group and 1.54 for the CG group, compared to the CC group. The mean caloric intake was 1170±463.20 kcal/d. The odds ratio in the CC group concerning high red meat consumption in comparison to low consumption was 1.33. For white meat, the odds ratio was 0.8 when comparing high and low intake, also in the CC group. Conclusion: High red meat intake and PNPLA3 gene polymorphism seem to synergistically affect NAFLD and liver fibrosis, requiring confirmation in a larger number of patients and in different populations. Background (NAFLD temperatures hand rs rs73840 Patatinlike Patatin like PNPLA (PNPLA3 However evaluated Objective Methods crosssectional cross sectional 9 included semiquantitative semi quantitative realtime real time RTPCR RT PCR (RT-PCR realized Results 3238458 32 38 4 58 32.38±4.5 kgm² kgm kg m² m kg/m 10710 107 10 107±1 cm 42 F≥2. F2 F . 2 (F≥2) F≥ 212 12 2.1 154 1 54 1.5 117046320 1170 463 20 1170±463.2 kcald kcal d kcal/d 133 33 1.33 08 0 8 0. Conclusion rs7384 (PNPLA 323845 5 32.38±4. 1071 107± (F≥2 21 2. 15 1. 11704632 117 46 1170±463. 13 1.3 rs738 32384 32.38±4 (F≥ 1170463 11 1170±463 rs73 3238 32.38± (F 117046 1170±46 rs7 323 32.38 11704 1170±4 32.3 1170± 32.

ABSTRACT Children have an increased likelihood of becoming carriers of the chronic hepatitis B virus. A total of 1,381 children and adolescents were assessed in five municipalities of Maranhao State, Brazil, for detection of anti-HBc, HBsAg and anti-HBs serologic markers and sociodemographic and behavioral features. Among those who were HBsAg negative and anti-HBc negative, the proportion of anti-HBs positives was calculated after the individuals had completed the vaccination schedule. The robust variance of the Poisson’s regression model was used in order to have adjusted tables and calculate the prevalence ratio. Multivariate analysis was performed to identify the factors associated with the prevalence of anti-HBc with or without HBsAg and the vaccine response. It was observed that 163 children were anti-HBc positive and nine individuals were HBsAg positive. The factors associated with the infection were: municipality of residence (residing in Morros municipality or Humberto de Campos municipality), residence in a rural area, aged between 13 and 15 years old, and illicit drug use. The percentage of individuals who were anti-HBc negative and received all three doses of the vaccine was 48.5%. Among these, only 276 (38.9%) had antibodies at protective concentrations. In an adjusted analysis, Morros municipality presented an increased positivity of vaccine response (p < 0.001), and the age ranging between 6 and 10 years old presented a reduced frequency of response. This study reveals a high prevalence of current and past HBV infection within the targeted age group which, in addition to the low vaccination coverage and serological responses, raises concerns about the management of prevention measures, especially the quality of vaccination in these locations. virus 1381 1 381 1,38 State Brazil antiHBc, antiHBc anti HBc, HBc antiHBs HBs features schedule Poissons Poisson s ratio 16 residing municipality, , municipality) area use 485 48 5 48.5% 27 38.9% 389 38 9 (38.9% concentrations p 0.001, 0001 0.001 0 001 0.001) which responses measures locations 138 1,3 4 48.5 2 38.9 3 (38.9 000 0.00 00 1, 48. 38. (38. 0.0 (38 0. (3 (

ABSTRACT Objective To describe and compare the clinical characteristics and outcomes of patients admitted to intensive care units during the first and second waves of the COVID-19 pandemic. Methods In this retrospective single-center cohort study, data were retrieved from the Epimed Monitor System; all adult patients admitted to the intensive care unit between March 4, 2020, and October 1, 2021, were included in the study. We compared the clinical characteristics and outcomes of patients admitted to the intensive care unit of a quaternary private hospital in São Paulo, Brazil, during the first (May 1, 2020, to August 31, 2020) and second (March 1, 2021, to June 30, 2021) waves of the COVID-19 pandemic. Results In total, 1,427 patients with COVID-19 were admitted to the intensive care unit during the first (421 patients) and second (1,006 patients) waves. Compared with the first wave group [median (IQR)], the second wave group was younger [57 (46-70) versus 67 (52-80) years; p<0.001], had a lower SAPS 3 Score [45 (42-52) versus 49 (43-57); p<0.001], lower SOFA Score on intensive care unit admission [3 (1-6) versus 4 (2-6); p=0.018], lower Charlson Comorbidity Index [0 (0-1) versus 1 (0-2); p<0.001], and were less frequently frail (10.4% versus 18.1%; p<0.001). The second wave group used more noninvasive ventilation (81.3% versus 53.4%; p<0.001) and high-flow nasal cannula (63.2% versus 23.0%; p<0.001) during their intensive care unit stay. The intensive care unit (11.3% versus 10.5%; p=0.696) and in-hospital mortality (12.3% versus 12.1%; p=0.998) rates did not differ between both waves. Conclusion In the first and second waves, patients with severe COVID-19 exhibited similar mortality rates and need for invasive organ support, despite the second wave group being younger and less severely ill at the time of intensive care unit admission. COVID19 COVID 19 COVID-1 pandemic singlecenter single center study System 2020 2021 Paulo Brazil May 31 30 total 1427 427 1,42 421 (42 1,006 1006 006 (1,00 median IQR, IQR , (IQR)] 57 [5 4670 46 70 (46-70 6 5280 52 80 (52-80 years p<0.001, p0001 p p<0.001 0 001 p<0.001] 45 [4 4252 42 (42-52 4357 43 (43-57) [ 16 (1-6 26 2 (2-6) p=0.018, p0018 p=0.018 018 p=0.018] 01 (0-1 02 (0-2) 10.4% 104 10 (10.4 18.1% 181 18 p<0.001. . 81.3% 813 81 (81.3 53.4% 534 53 highflow high flow 63.2% 632 63 (63.2 23.0% 230 23 stay 11.3% 113 11 (11.3 10.5% 105 5 p=0.696 p0696 696 inhospital 12.3% 123 12 (12.3 12.1% 121 p=0.998 p0998 998 support COVID1 COVID- 202 142 1,4 (4 1,00 100 00 (1,0 (IQR) 467 7 (46-7 528 8 (52-8 p000 p<0.00 425 (42-5 435 (43-57 (1- (2-6 p001 p=0.01 (0- (0-2 10.4 (10. 18.1 81.3 (81. 53.4 63.2 (63. 23.0 11.3 (11. 10.5 p=0.69 p069 69 12.3 (12. 12.1 p=0.99 p099 99 20 14 ( 1,0 (1, (IQR (46- (52- p00 p<0.0 (42- (43-5 (1 (2- p=0.0 (0 10. (10 18. 81. (81 53. 63. (63 23. 11. (11 p=0.6 p06 12. (12 p=0.9 p09 9 (46 (52 p0 p<0. (43- (2 p=0. (8 (6 (5 p<0 (43 p=0 p< p=

ABSTRACT Cycle threshold (Ct) values in COVID-19 reverse-transcription polymerase chain reaction (RT-PCR) tests estimate the viral load in biological samples. Studies have investigated variables associated with SARS-CoV-2 viral load, aiming to identify factors associated with higher transmissibility. Using the results from tests performed between May/2020-July/2022 obtained from the database of a referent hospital in Sao Paulo, Brazil, we investigated associations between Ct values and patient’s age, gender, sample collection setting and pandemic period according to the predominant SARS-CoV-2 variant locally. We also examined variations in Ct values, COVID-19 incidence, mortality, and vaccination coverage over time. The study sample included 42,741 tests. Gender was not significantly associated with Ct values. Age, sample collection setting and the pandemic period were significantly associated with Ct values even after adjustment to the multivariable model. Results showed lower Ct values in older groups, during the Gamma and Delta periods, and in samples collected in emergency units; and higher Ct values in children under 10 years old, home-based tests, during the Omicron period. We found evidence of a linear trend in the association between age and Ct values, with Ct values decreasing as age increases. We found no clear temporal associations between Ct values and local indicators of COVID-19 incidence, mortality, or vaccination between February/2020-November/2022. Our findings suggest that SARS-CoV-2 Ct values, a proxy for viral load and transmissibility, can be influenced by demographic and epidemiological variables. (Ct COVID19 COVID 19 COVID-1 reversetranscription reverse transcription RTPCR RT PCR (RT-PCR SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- transmissibility May/2020July/2022 May2020July2022 MayJuly May/2020 July/2022 May 2020 July 2022 May/2020-July/202 Paulo Brazil patients patient s gender locally incidence mortality time 42741 42 741 42,74 Age model groups periods units 1 old homebased home based increases February/2020November/2022. February2020November2022 FebruaryNovember February/2020 November/2022. February November February/2020-November/2022 COVID1 COVID- SARS-CoV 2020July May/2020July/202 May2020July202 May2020 May/202 July2022 July/202 202 May/2020-July/20 4274 4 74 42,7 2020November February/2020November/2022 February2020November202 February2020 February/202 November2022 November/2022 February/2020-November/202 May/2020July/20 May2020July20 May202 May/20 July202 July/20 20 May/2020-July/2 427 7 42, February/2020November/202 February2020November20 February202 February/20 November202 November/202 February/2020-November/20 May/2020July/2 May2020July2 May20 May/2 July20 July/2 May/2020-July/ February/2020November/20 February2020November2 February20 February/2 November20 November/20 February/2020-November/2 May/2020July/ May2020July May2 May/ July2 July/ May/2020-July February/2020November/2 February2020November February2 February/ November2 November/2 February/2020-November/ May/2020July February/2020November/ November/ February/2020-November February/2020November

Abstract Background Community-Acquired Pneumonia (CAP) is the primary cause of hospitalization in the United States and the third leading cause of death in Brazil. The gold standard for diagnosing the etiology of CAP includes blood culture, Gram-stained sputum, and sputum culture. However, these methods have low sensitivity. No studies investigating the etiology of CAP have been conducted in Brazil in the last 20-years, and the empirical choice of antimicrobials is mainly based on the IDSA guidelines. This is the first national study with this aim, and as a result, there's potential for the Brazilian consensus to be impacted and possibly modify its guidelines rather than adhering strictly to the IDSA's recommendations. Methods The aim of this study is to identify the main microorganisms implicated in CAP by employing a multiplex Polymerase Chain Reaction (mPCR) at the foremost public hospital in Brazil. All patients who were admitted to the emergency department and diagnosed with severe CAP underwent an mPCR panel using nasopharyngeal and oropharyngeal swabs, with the aim of detecting 13 bacterial and 21 viral pathogens. Results A total of 169 patients were enrolled in the study. The mPCR panel identified an etiological agent in 61.5% of patients, with viruses being the most common (42.01%), led by Rhinovirus, followed by Influenza and Coronavirus (non-SARS-CoV-2). Bacterial agents were identified in 34.91% of patients, with S. pneumoniae being the most common, followed by H. influenzae, M. catarrhalis, and S. aureus. Additionally, we found that the prescription for 92.3% of patients could be modified, with most changes involving de-escalation of antibiotics and antiviral therapy. Conclusion Our study revealed different etiological causes of CAP than those suggested by the Brazilian guidelines. Using molecular diagnostic tests, we were able to optimize treatment by using fewer antibiotics. CommunityAcquired Community Acquired (CAP culture Gramstained Gram stained However sensitivity 20years, 20years years 20 years, 20-years result theres there s IDSAs recommendations (mPCR swabs 1 2 pathogens 16 615 61 5 61.5 42.01%, 4201 42.01% , 42 01 (42.01%) Rhinovirus nonSARSCoV2. nonSARSCoV2 nonSARSCoV non SARS CoV . (non-SARS-CoV-2) 3491 34 91 34.91 S H influenzae M catarrhalis aureus Additionally 923 92 3 92.3 modified deescalation de escalation therapy tests 6 61. 420 42.01 4 0 (42.01% (non-SARS-CoV-2 349 9 34.9 92. 42.0 (42.01 (non-SARS-CoV- 34. 42. (42.0 (non-SARS-CoV (42. (42 (4 (

Abstract Objective To develop a low-cost simulator model and a colonoscope with materials that are easily accessible to offer training on colonoscopy skills during undergraduate studies. Since this is the procedure of choice for colorectal cancer screening, the general practitioner must be able to recognize its main indications, preparation, and complications. Methods Using materials such as a mannequin, a vehicle inspection camera, a conduit, polyvinyl chloride (PVC) pipe, acrylic, wood, and red paint, we built a simulator and a 150-cm long and 20-to-25-mm thick colonoscope. The colonoscope’s handle and handhold were made of acrylic, the colonoscope’s mobile end was made with articulated PVC rings, and the up and down movements were performed according to the traction of the steel cables. The camera attached to its distal end enables connection to a smartphone to view the image. In the simulator, the conduit was inserted into the mannequin to simulate the curvatures of the colon. Red spray paint was used to simulate the staining of the colonic mucosa in the inner region of the mannequin and the adventitial layer in the outer region. Results We were able to build a simulator and a colonoscope with a total amount of R $ 182.82 (roughly US$ 36.50). Both were tested and proved to be useful in the acquisition of psychomotor and cognitive skills in colonoscopy. Conclusion The simulator and colonoscope developed by us are cost-effective, useful in the acquisition of psychomotor and cognitive skills in colonoscopy, and can facilitate the structuring of a training program for undergraduate students. lowcost low cost studies screening indications preparation complications (PVC pipe acrylic wood 150cm cm 150 20to25mm tomm 20 25 mm colonoscopes s rings cables image colon 18282 182 82 182.8 roughly US 36.50. 3650 36.50 . 36 50 36.50) costeffective, costeffective effective, effective cost-effective students 15 2 1828 18 8 182. 365 36.5 3 5 1 36.

Abstract Introduction: The loss of muscle mass is becoming a very common problem among critically ill patients and it’s also strongly related to their prognosis and quality of life after lea-ving the intensive care unit. The purpose of this study was to evaluate the loss of muscle mass in the first five days, since the patient is admitted to the intensive care unit, and if there is a relationship between this muscle wasting and the nutritional support provided to patients. Methods: This prospective observational study enrolled adult patients admitted in the intensive care unit between January and March 2020. On the day of admission and on the fifth day of follow-up, an ultrasound evaluation of the thickness of the biceps brachii and quadriceps femoris was performed. During the five-day period we also analyzed the energy and protein support that was provided to the patients. Results: Thirty five patients were enrolled in this study with a mean age of 64±15, mostly male gender (62.9%). There was a loss of 1.77 mm in the thickness of the biceps brachii and 2.19 mm in the quadriceps femoris. We observed that the patients received an estimated daily nutritional support that corresponds to 20.0% of their energy and 24.9% of their protein needs. Conclusion: It is feasible to objectively and non-invasively evaluate the muscle mass in critically ill patients and there was a significant decrease in muscle mass in the first days after admission. The nutritional support provided was significantly lower than recommended.

Resumo Introdução: A perda de massa muscular é um problema cada vez mais prevalente em doentes críticos, estando fortemente relacionada com o seu prognóstico e com a qualidade de vida após a saída da unidade de cuidados intensivos. Pretendeu-se com este estudo avaliar a perda da massa muscular nos primeiros cinco dias de internamento, e se existia uma correlação entre esta e o suporte nutricional fornecido aos doentes. Métodos: Estudo prospetivo observacional entre janeiro e março de 2020 num serviço de cuidados intensivos. No dia de admissão e no quinto dia de internamento procedeu-se à avaliação ecográfica da espessura da massa muscular do bíceps braquial e do quadríceps femoral. Durante o período de cinco dias também se analisou o suporte nutricional energético e proteico. Resultados: Avaliaram-se 35 doentes com idade média de 64±15 anos, maioritariamente do género masculino (62,9%). A espessura da massa muscular foi avaliada com recurso à ecografia, tendo-se obtido uma perda de 1,77 mm na espes-sura do bíceps braquial e 2,19 mm no quadríceps femoral. Os doentes receberam um suporte nutricional correspondente a 20,00% das suas necessidades proteicas e 24,94% das suas necessidades energéticas estimadas. Conclusão: É possível avaliar de forma rápida, objectiva e não invasiva a massa muscular do doente crítico e verificou-se a perda significativa de massa muscular na fase inicial do internamento. O suporte nutricional fornecido foi consideravelmente inferior às recomendações.

ABSTRACT Objective To detect and treat cases of viral hepatitis B, C and D in patients seen at the Native American Outpatient Clinic of Universidade Federal de São Paulo. Methods This sample comprised 81 indigenous recruited between 2018 and 2020. Volunteers were aged 7 months to 70 years (mean age of 28±20 years), belonged to 26 ethnic groups spanning the Brazilian territory and answered a questionnaire, which was attached to their medical records. Peripheral blood samples (20mL) were collected, transported to the Clinical Laboratory of Hospital Israelita Albert Einstein, processed, and tested for markers of viral hepatitis B, C and D. Results In this study, 39 (48.1%) individuals were anti-HBs (+) only, 13 (16.0%) individuals were anti-HBs (+) and anti-HBc (+), and 28 (34.6%) individuals were negative for all markers. No anti-HBc IgM+ samples were found. No cases of hepatitis C and D were found. Conclusion This analysis provided evidence of previous infection by the hepatitis B virus. These findings led to prescription of vaccination against hepatitis B to all participants who were negative for all viral hepatitis B markers, given records of prior hepatitis B vaccination were unreliable.

ABSTRACT The Hepatitis C virus (HCV) infection is a public health problem. The high level of HCV replication and its lack of post-transcriptional correction mechanisms results in the emergence of viral variants and the difficulty in determining polymorphisms and variants that contain the substitutions associated with resistance towards new antivirals. The main focus of this study was to map the NS5A and NS5B polymorphisms and resistance mutations to new antiviral drugs in HCV strains genotype 1 from patients with chronic hepatitis C infection. Serum samples were collected from patients who underwent routine viral load tests at the Instituto Adolfo Lutz, Sao Paulo city, Brazil. A total of 698 and 853 samples were used for the characterization of NS5A and NS5B regions, respectively, which comprise the HCV genotypes 1a and 1b. The prevalence of resistance mutations found in the NS5A region was 6.4%, with Y93H, L31M, Q30R, and Y93N as the main resistance-associated substitutions (RAS). No NS5B-associated RAS was observed for any of the analyzed drugs. These findings support that the RAS test should be offered to individuals with poor response to double combination regimens prior to treatment initiation, thereby assisting strain vigilance and selection of effective treatment or retreatment options using DAA regimens.

ABSTRACT This study aims to assess COVID-19 and other respiratory viruses in pediatric patients. Between April 17 and September 30, 2020, we collected 1,566 respiratory samples from 1,044 symptomatic patients who were younger than 18 years old to assess SARS-CoV-2 infection. Of these, 919 were analyzed for other respiratory pathogens (ORP). Patients with laboratory-confirmed COVID-19 or ORP were included. We evaluated 76 pediatric COVID-19 infections and 157 other respiratory virus infections. Rhinovirus occurred in 132/157 (84%). COVID-19 patients who were significantly older, had more fevers, headaches and pneumonia than those with ORP. The median white blood cell count was lower in patients with SARS-CoV-2 than in those with ORP (6,470 versus 8,170; p=0.02). COVID-19 patients had significantly worse symptoms than those with ORP.

Resumo Fundamentos A incidência de injúria miocárdica (IM) em pacientes com COVID-19 no Brasil é pouco conhecida e o impacto prognóstico da IM, mal elucidado. Objetivos Descrever a incidência de IM em pacientes com COVID-19 em unidade de terapia intensiva (UTI) e identificar variáveis associadas à sua ocorrência. O objetivo secundário foi avaliar a troponina I ultrassensível (US) como preditor de mortalidade intra-hospitalar. Métodos Estudo observacional, retrospectivo, entre março e abril de 2020, com casos confirmados de COVID-19 internados em UTI. Variáveis numéricas foram comparadas com teste t de Student ou U de Mann-Whitney, sendo o teste X2 empregado para as categóricas. Realizou-se análise multivariada com as variáveis associadas à IM e p<0,2 objetivando determinar preditores de IM. Curva ROC foi empregada para determinar o valor da troponina capaz de predizer maior mortalidade intra-hospitalar. Funções de sobrevida foram estimadas pelo método de Kaplan-Meier a partir do ponto de corte apontado pela curva ROC. Resultados Este estudo avaliou 61 pacientes (63,9% do sexo masculino, média de idade de 66,1±15,5 anos). A IM esteve presente em 36% dos casos. Hipertensão arterial sistêmica (HAS) [RC 1,198; IC95%: 2,246-37,665] e índice de massa corporal (IMC) [RC 1,143; IC95%: 1,013-1,289] foram preditores independentes de risco. Troponina I US >48,3 ng/ml, valor determinado pela curva ROC, prediz maior mortalidade intra-hospitalar [AUC 0,786; p<0,05]. A sobrevida no grupo com troponina I US >48,3 ng/ml foi inferior à do grupo com valores ≤48,3 ng/dl [20,3 x 43,5 dias, respectivamente; p<0,05]. Conclusão Observou-se alta incidência de IM na COVID-19 grave com impacto em maior mortalidade intra-hospitalar. HAS e IMC foram preditores independentes de risco de sua ocorrência. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background The incidence of myocardial injury (MI) in patients with COVID-19 in Brazil and the prognostic impact of MI have not been elucidated. Objectives To describe the incidence of MI in patients with COVID-19 in the intensive care unit (ICU) and to identify variables associated with its occurrence. The secondary objective was to assess high-sensitivity troponin I as a predictor of in-hospital mortality. Methods Retrospective, observational study conducted between March and April 2020 with cases of confirmed COVID-19 admitted to the ICU. Numerical variables were compared by using Student t test or Mann-Whitney U test. The chi-square test was used for categorical variables. Multivariate analysis was performed with variables associated with MI and p<0.2 to determine predictors of MI. The ROC curve was used to determine the troponin value capable of predicting higher in-hospital mortality. Survival functions were estimated by use of the Kaplan-Meier method from the cut-off point indicated in the ROC curve. Results This study assessed 61 patients (63.9% of the male sex, mean age of 66.1±15.5 years). Myocardial injury was present in 36% of the patients. Systemic arterial hypertension (HAS) [OR 1.198; 95%CI: 2.246-37.665] and body mass index (BMI) [OR 1.143; 95%CI: 1.013-1.289] were independent risk predictors. High-sensitivity troponin I >48.3 ng/mL, which was determined in the ROC curve, predicts higher in-hospital mortality [AUC 0.786; p<0.05]. Survival in the group with high-sensitivity troponin I >48.3 ng/mL was lower than that in the group with values ≤48.3 ng/dL [20.3 x 43.5 days, respectively; p<0.05]. Conclusion There was a high incidence of MI in severe COVID-19 with impact on higher in-hospital mortality. The independent risk predictors of MI were SAH and BMI. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

OBJECTIVES: To test conjunctival swabs from patients with laboratory-confirmed severe forms of coronavirus disease 2019 (COVID-19) for the presence of SARS-CoV-2 on real-time reverse-transcription polymerase chain reaction (rRT-PCR). METHODS: Fifty conjunctival swabs were collected from 50 in-patients with laboratory-confirmed severe forms of COVID-19 at the largest teaching hospital and referral center in Brazil (HCFMUSP, São Paulo, SP). The samples were tested for SARS-CoV-2 on rRT-PCR with the primers and probes described in the CDC protocol which amplify the region of the nucleocapsid N gene (2019_nCoV_N1 and 2019_nCoV_N2) of SARS-CoV-2 RNA and compared with naso/oropharyngeal swabs collected within 24 hours of the conjunctival swabs. RESULTS: Five conjunctival samples (10%) tested positive (amplification of the N1 and N2 primer/probe sets) while two conjunctival samples (4%) yielded inconclusive results (amplification of the N1 primer/probe set only). The naso/oropharyngeal swabs were positive for SARS-CoV-2 on rRT-PCR in 34 patients (68%), negative in 14 (28%) and inconclusive in 2 (4%). The 5 patients with positive conjunctival swabs had positive (n=2), negative (n=2) or inconclusive (n=1) naso/oropharyngeal swabs on rRT-PCR. Patients with negative or inconclusive naso/oropharyngeal swabs had the diagnosis of COVID-19 confirmed by previous positive rRT-PCR results or by serology. CONCLUSION: This is the first study to present conjunctival swab rRT-PCR results for SARS-CoV-2 in a Brazilian population. In our sample of 50 patients with severe forms of COVID-19, 10% had positive conjunctival swabs, most of which were correlated with positive naso/oropharyngeal rRT-PCR results.

ABSTRACT Hepatitis E Virus (HEV) is an infection known worldwide for its asymptomatic and self-limited course in most cases. Some cases progressing to chronicity have been described in immunosuppressed patients, especially in recipients of solid organ transplants. We evaluated laboratory parameters of HEV infection (HEV RNA, anti-HEV IgM and anti-HEV IgG) through enzyme-linked immunosorbent assay (Elisa), confirmed by immunoblotting, in a cohort of 294 patients who received liver transplants at the HCFMUSP (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo). Laboratory and demographic data were collected from the entirety of the transplanted population. Hepatic biopsies of 122 patients transplanted due liver failure secondary to hepatitis C (HCV), with or without serological or molecular markers of HEV, were analyzed according to METAVIR score. Out of 24 (8.2%) patients tested positive for anti-HEV IgG, six (2%) were positive for anti-HEV IgM and 17 (5.8%) for HEV RNA. Of the patients transplanted because of HCV infection, 95 (77.8%) had received treatment including ribavirin for at least six months before blood sample collection. Among patients transplanted due to HCV cirrhosis who tested positive for anti-HEV IgG, only three (37.5%) showed fibrosis beyond stage 2, while five (41.7%) of the HEV RNA-positive patients had liver fibrosis beyond stage 2. Overall, the prevalence of HEV in the post-hepatic transplant scenario appears to be low, and, at least histologically, seemingly not harmful. We conclude that, although some studies reported a risk of HEV chronification, patients who had their livers transplanted due to HCV and showed serological or molecular markers of HEV did not have higher levels of fibrosis compared to patients who showed no indications of HEV infection at the time of the analysis.