New cases of the novel coronavirus disease 2019 (COVID-19), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continue to rise worldwide following the declaration of a pandemic by the World Health Organization (WHO). The current pandemic has completely altered the workflow of health services worldwide. However, even during this critical period, patients with other diseases, like cancer, need to be properly treated. A few reports have shown that mortality due to SARS-CoV-2 is higher in elderly patients and those with other active comorbidities, including cancer. Patients with lung cancer are at risk of pulmonary complications from COVID-19, and as such, the risk/benefit ratio of local and systemic anticancer treatment has to be considered. For each patient, several factors, including age, comorbidities, and immunosuppression, as well as the number of hospital visits for treatment, can influence this risk. The number of cases is rising exponentially in Brazil, and it is important to consider the local characteristics when approaching the pandemic. In this regard, the Brazilian Thoracic Oncology Group has developed recommendations to guide decisions in lung cancer treatment during the SARS-CoV-2 pandemic. Due to the scarcity of relevant data, discussions based on disease stage, evaluation of surgical treatment, radiotherapy techniques, systemic therapy, follow-up, and supportive care were carried out, and specific suggestions issued. All recommendations seek to reduce contagion risk by decreasing the number of medical visits and hospitalization, and in the case of immunosuppression, by adapting treatment schemes when possible. This statement should be adjusted according to the reality of each service, and can be revised as new data become available.

Resumo Introdução: Na obesidade, verifica-se um acúmulo de tecido adiposo, o que favorece a ocorrência de estresse oxidativo. A fim de diminuir a produção das espécies reativas que levam a danos teciduais, buscam-se alternativas que contribuam para a redução do peso corporal. Este estudo avaliou se os marcadores oxidantes e antioxidantes de obesas antes e após cirurgia bariátrica reduziram o dano oxidativo. Método: Foram avaliadas 16 mulheres obesas mórbidas cinco dias antes e 180 dias após o procedimento cirúrgico. O grupo controle constituiu-se de 16 mulheres não obesas. Os níveis das substâncias reativas ao ácido tiobarbitúrico, das proteínas carboniladas, da glutationa reduzida e do ácido ascórbico foram avaliados no plasma dessas pacientes. Resultados: Os níveis de lipoperoxidação e da carbonilação de proteínas nas obesas pré-cirúrgicas eram mais elevados quando comparados ao controle e às obesas pós-cirúrgicas; os níveis de glutationa reduzida eram maiores nas obesas pré-cirúrgicas em comparação ao controle e diminuíram após a cirurgia; os níveis de ácido ascórbico eram menores nas obesas pré-cirúrgicas em relação ao controle e às obesas pós-cirúrgicas. Conclusão: Observou-se que a massa corporal influenciou na produção das espécies reativas. A cirurgia bariátrica, somada à perda de peso e à suplementação vitamínica, diminui a oxidação celular e, com isso, reduz os danos teciduais.

Summary Introduction: Obesity refers to the accumulation of fatty tissues and it favors the occurrence of oxidative stress. Alternatives that can contribute to body weight reduction have been investigated in order to reduce the production of reactive oxygen species responsible for tissue damage. The aim of the current study was to assess whether the oxidant and antioxidant markers of obese women before and after bariatric surgery were able to reduce oxidative damage. Method: We have assessed 16 morbidly obese women five days before and 180 days after the surgery. The control group comprised 16 non-obese women. Levels of thiobarbituric acid-reactive substances, carbonylated proteins, reduced glutathione and ascorbic acid were assessed in the patients' plasma. Results: Levels of lipid peroxidation and protein carbonylation in the pre-surgical obese women were higher than those of the controls and post-surgical obese women. Levels of reduced glutathione in the pre-surgical obese women were high compared to the controls, and declined after surgery. Levels of ascorbic acid fell in the pre--surgical obese women compared to the control and post-surgical obese women. Conclusion: Body weight influences the production of reactive oxygen species. Bariatric surgery, combined with weight loss and vitamin supplementation, reduces cellular oxidation, thus reducing tissue damage.

BACKGROUND:One of the most stigmatizing physical sequelaeof leprosy in cured patients is the development of chronic lower extremity ulcers. The bacterial diversity present in ulcers is considered one of the factors that can delay the healing process, as well as serve as a focus for severe secondary infections.OBJECTIVE:To identify the microbiota and antimicrobial resistance profile of bacteria isolated from skin ulcers in patients cured of leprosy.METHODS:After obtaining informed consent, material was collected from ulcers of 16 patients treated at the Outpatient Public Health Dermatology Clinic of Rio Grande do Sul and Hospital Colônia Itapuã. Sampleswere collected during dressing, and the material sent to the Microbiology Laboratory of the Federal University of Health Sciences of Porto Alegre for microbiological culture. Methicillin-resistant Staphylococcus aureus(MRSA) was characterized by two molecular methods, including detection of the mecA gene by PCR and SCCmecgene typing.RESULTS:Cultures revealed microorganisms in all ulcers: Gram-negative bacilli in 80%, Gram-positive cocci in 63%, and mixed microflora in 36%. Staphylococcus aureusand Pseudomonas aeruginosa were the most prevalent bacteria. Assessment of the antimicrobial resistance profile was notable for the presence of MRSA. Molecular analysis of this isolate revealed presence of the mecA gene contained in a type IV staphylococcal cassette chromosome mec (SCCmec).CONCLUSIONS:In patients with leprosy, laboratory culture of skin ulcers is essential for correct antibiotic selection and to control emerging pathogens, such as MRSA carrying SCCmec type IV.

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen commonly associated with nosocomial infections. However, it has also been associated with community-acquired skin and soft tissue infections (CA-MRSA). There are few data on the identification and prevalence of CA-MRSA infections in Brazil. METHODS: This is a cross-sectional study of 104 patients with community-acquired skin infections attending two health care centers in Porto Alegre, southern Brazil. MRSA isolates were characterized by molecular methods, including detection of the mecA gene by PCR, gene SCCmec typing, Panton-Valentine leukocidin (PVL) detection, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). RESULTS: From the 104 samples, 58 Staphylococcus aureus isolates were obtained, of which five (8.6%) had a CA-MRSA-resistant profile. All five isolates had the mecA gene and amplified to SCCmec type IV. Analysis of chromosomal DNA by PFGE revealed the presence of two clusters related to international clones (OSPC and USA 300), with a Dice similarity coefficient >80%. The study was complemented by MLST, which detected three different strains: ST30, ST8, and ST45, the latter not presenting any relation with the clones compared in PFGE. CONCLUSIONS: The presence of CA-MRSA reveals an important change in the epidemiology of this pathogen and adds new elements to the knowledge of the molecular biology of infections by MRSA with SCCmec type IV in southern Brazil.

Staphylococcus aureus é uma bactéria responsável por uma ampla variedade de enfermidades infecciosas. A grande preocupação está relacionada, principalmente, com os isolados resistentes à meticilina (MRSA), que, tradicionalmente, estavam limitados aos hospitais. Nos últimos anos, infecções causadas por MRSA associadas ou adquiridas na comunidade (CA-MRSA) têm sido relatadas com frequência crescente em todo o mundo. Algumas características fenotípicas e genéticas são distintas entre a forma de infecção hospitalar e a comunitária. Atualmente, verifica-se um perfil de sensibilidade reduzido para diferentes antimicrobianos; sendo assim faz-se necessário um alerta aos profissionais da saúde, particularmente aos dermatologistas, para a importância da distinção entre as formas de infecções, evitando uma terapia empírica incorreta e sem sucesso.

Staphylococcus aureus is responsible for a broad variety of infectious diseases. The main concern is about methicillin-resistant isolates (MRSA), which are usually limited to hospitals. In recent years, community associated or acquired MRSA infections (CA-MRSA) have been frequently reported and emerged in the world. Some phenotypic and genotypic characteristics are distinct between hospital and community infection. Currently, there is reduced sensibility profile to different antimicrobials, reason why it is necessary to issue an alert to healthcare professionals, dermatologists in particular, about the importance of knowing the differences between the infections, preventing wrong and unsuccessful empirical therapy.

Staphylococcus aureus resistente à meticilina foi inicialmente descrito como um típico microrganismo adquirido em infecções nosocomiais. No entanto, nos últimos anos Staphylococcus aureus resistente à meticilina adquirido na comunidade é causa de infecções de pele e tecidos moles, mas infecções graves como pneumonia e sepse podem ocorrer. Este relato descreve um caso de sepse em criança, complicado com pneumonia secundária a lesão em partes moles por Staphylococcus aureus resistente à meticilina adquirido na comunidade no Sul do Brasil. O paciente foi atendido em Unidade de Emergência com história de ferimento provocado por trauma em membro inferior que evoluiu para celulite, pneumonia e sepse.

Methicillin-resistant Staphylococcus aureus was initially described as a typical microorganism acquired in nosocomial infections. However, over recent years, community-acquired methicillin-resistant Staphylococcus aureus has been a cause of skin and soft-tissue infections. Serious infections such as pneumonia and sepsis can also occur. This report describes a case of sepsis in a child that was complicated by pneumonia secondary to soft tissue lesions that were due to community-acquired methicillin-resistant Staphylococcus aureus in southern Brazil. The patient was attended at the Emergency Unit with a history of injury caused by lower-limb trauma that evolved to cellulitis, pneumonia and sepsis.