OBJECTIVES: We designed a cohort study to describe characteristics and outcomes of patients with coronavirus disease (COVID-19) admitted to the intensive care unit (ICU) in the largest public hospital in Sao Paulo, Brazil, as Latin America becomes the epicenter of the pandemic. METHODS: This is the protocol for a study being conducted at an academic hospital in Brazil with 300 adult ICU beds dedicated to COVID-19 patients. We will include adult patients admitted to the ICU with suspected or confirmed COVID-19 during the study period. The main outcome is ICU survival at 28 days. Data will be collected prospectively and retrospectively by trained investigators from the hospital’s electronic medical records, using an electronic data capture tool. We will collect data on demographics, comorbidities, severity of disease, and laboratorial test results at admission. Information on the need for advanced life support and ventilator parameters will be collected during ICU stay. Patients will be followed up for 28 days in the ICU and 60 days in the hospital. We will plot Kaplan-Meier curves to estimate ICU and hospital survival and perform survival analysis using the Cox proportional hazards model to identify the main risk factors for mortality. ClinicalTrials.gov: NCT04378582. RESULTS: We expect to include a large sample of patients with COVID-19 admitted to the ICU and to be able to provide data on admission characteristics, use of advanced life support, ICU survival at 28 days, and hospital survival at 60 days. CONCLUSIONS: This study will provide epidemiological data about critically ill patients with COVID-19 in Brazil, which could inform health policy and resource allocation in low- and middle-income countries.
ABSTRACT Introduction Latent tuberculosis infection diagnosis based on the release of interferon-gamma in cultures of peripheral blood cells stimulated with Mycobacterium tuberculosis antigens has replaced the tuberculin skin test in many countries with low tuberculosis prevalence. The IFN-γ production can be influenced by genetic polymorphisms, of which the IFNG + 874 (rs62559044) locus is the most studied. We investigated the possible influence of the IFNG + 874 A/T polymorphism on interferon-gamma test performance. Methods Patients diagnosed with pulmonary tuberculosis (75), volunteers with positive tuberculin skin test (70) and healthy volunteers with negative tuberculin skin test and no history of contact with tuberculosis (57) were evaluated regarding the IFNG + 874 genotype and the IFN-γ levels in whole blood cultures performed using an interferon-gamma commercial kit (QuantiFERON-TB® Gold In-Tube). Results IFN-γ production was not influenced by the IFNG + 874 genotype, regardless of antigen or mitogen-based stimulation, which suggests that other genes may influence IFN-γ production in response to mycobacteria. The IFNG + 874 polymorphism was found to exert no influence over QFT-IT test sensitivity in our study. Conclusions The IFNG + 874 polymorphism was not shown to influence QuantiFERON-TB® Gold In-Tube test performance in an admixed population from northeastern Brazil.
Abstract Background: Despite the development of new therapies for leishmaniasis, among the 200 countries or territories reporting to the WHO, 87 were identified as endemic for Tegumentary Leishmaniasis and 75 as endemic for Visceral Leishmaniasis. The identification of antileishmanial drug candidates is essential to fill the drug discovery pipeline for leishmaniasis. In the hit molecule LQB-118 selected, the first generation of pterocarpanquinones was effective and safe against experimental visceral and cutaneous leishmaniasis via oral delivery. In this paper, we report the synthesis and antileishmanial activity of the second generation of pterocarpanoquinones. Methods: The second generation of pterocarpanquinones 2a-f was prepared through a palladium-catalyzed oxyarylation of dihydronaphtalen and chromens with iodolawsone, easily prepared by iodination of lawsone. The spectrum of antileishmanial activity was evaluated in promastigotes and intracellular amastigotes of L. amazonensis, L. braziliensis, and L. infantum. Toxicity was assessed in peritoneal macrophages and selective index calculated by CC50/IC50. Oxidative stress was measured by intracellular ROS levels and mitochondrial membrane potential in treated cells. Results: In this work, we answered two pertinent questions about the structure of the first-generation pterocarpanquinones: the configuration and positions of rings B (pyran) and C (furan) and the presence of oxygen in the B ring. When rings B and C are exchanged, we noted an improvement of the activity against promastigotes and amastigotes of L. amazonensis and promastigotes of L. infantum. As to the oxygen in ring B of the new generation, we observed that the oxygenated compound 2b is approximately twice as active against L. braziliensis promastigotes than its deoxy derivative 2a. Another modification that improved the activity was the addition of the methylenedioxy group. A variation in the susceptibility among species was evident in the clinically relevant form of the parasite, the intracellular amastigote. L. amazonensis was the species most susceptible to novel derivatives, whilst L. infantum was resistant to most of them. The pterocarpanoquinones (2b and 2c) that possess the oxygen atom in ring B showed induction of increased ROS production. Conclusions: The data presented indicate that the pterocarpanoquinones are promising compounds for the development of new leishmanicidal agents.
An experiment was conducted under controlled conditions during 90 days to study the fortnightly response of two Eucalyptus hybrids (Eucalyptus grandis x Eucalyptus camaldulensis and Eucalyptus grandis x Eucalyptus tereticornis), subject to the effect of 3 water levels A: 1) normal watering; 2) cycles of 30 days of waterlogging followed by 15 days of normal irrigation; and 3) water table. At the same time, A2 and A3 treatments were combined with salinity levels (EC): <4 (control), 6 and 12 dS m-1. Biweekly total plant height and neck diameter were measured and mortality was recorded. After 90 days, leaf, branch and stem dry matter was determined along with foliar macronutrient concentration and soil fertility characterization in the pots. Plant growth and biomass significantly decreased with increasing salinity associated to flooding and high salty water table. Na foliar concentration increased whereas K decreased in treatments with moderate to high salinity. The effect on growth and biomass was less adverse when the solution was not saline. Saline solution added to the soil displaced exchangeable bases (Ca + Mg) and increased Na and PSI, but soil EC did not exceed 4 dS m-1. The hybrid E. grandis x E. camaldulensis showed higher growth, foliar concentration and biomass compared with E. grandis x E. tereticornis. This lower tolerance was also evidenced by earlier mortality.
Se realizó un experimento en condiciones controladas durante 90 días para estudiar la respuesta de dos combinaciones híbridas de Eucalyptus (Eucalyptus grandis x Eucalyptus camaldulensis y Eucalyptus grandis x Eucalyptus tereticornis), sometidos al efecto de 3 niveles de agua (A): 1) riego normal; 2) ciclos de 30 días de anegamiento seguido de 15 días de riego normal y 3) napa de agua permanente. A su vez, los tratamientos A2 y A3 se combinaron con 3 niveles de salinidad (CE): < 4 (control), 6 y 12 dS m-1. Quincenalmente se midió la altura y el diámetro del cuello de las plantas y se registró la mortalidad. A los 83 días se determinó materia seca en hojas, ramas y tallos, la concentración de macronutrientes foliares y se caracterizó la fertilidad del suelo de las macetas. El crecimiento de las plantas y la materia seca disminuyó significativamente con el aumento de la salinidad asociada a la inundación y la napa salina alta. La concentración foliar de Na aumentó y descendió la de K en los tratamientos con salinidad (moderada y alta). El efecto sobre el crecimiento y la biomasa fue menos adverso cuando la solución no fue salina. La solución salina agregada al suelo desplazó las bases intercambiables (Ca+Mg) y aumentó el Na y el PSI, pero la CE del suelo no superó los 4 dS m-1. El híbrido E. grandis x E. camaldulensis mostró mayores crecimientos, concentraciones foliares y biomasa en comparación con E. grandis x E. tereticornis. La menor tolerancia de este híbrido también se evidenció por la mortalidad más temprana.
Intervalo de referências para leucócitos e linfócitos atualmente utilizados pela maioria dos laboratórios clínicos, apresentam limitações e são primariamente derivados de indivíduos Norte-americanos e europeus. O objetivo deste trabalho foi determinar os valores de referências para linfócitos B e subpopulações de linfócitos T (CD4+, CD8+, naive, memória, regulatórias, TCRαβ and TCRγδ) e células Natural Killers em doadores de sangue em Salvador-Bahia, Brasil. Resultados: A proporção de homens incluídos foi de 73.7% e média de idade em homens (34) e mulheres (35) foram similares. Para os linfócitos totais foram encontrados em ambos os gêneros, valores absolutos na ordem de 1.956 (1.060-4.186) células e 34% para média relativa. Para linfócitos T CD4+ e T CD8+, os valores relativos foram de 51% (20-62) e 24% (9-28), respectivamente. Os mais altos índices de significância estatística encontrados foram alto percentuais de linfócitos B (p=0,03) em mulheres. Os resultados encontrados para outras populações celulares foram consistentes em relação a muitas populações de diferentes áreas geográficas.
The reference intervals for leukocytes and lymphocytes currently used by most clinical laboratories present limitations as they are primarily derived from individuals of North American and European origin. The objective this study was to determine reference values for peripheral blood B lymphocytes, T lymphocyte subsets (CD4+, CD8+, naïve, memory, regulatory, TCRαβ and TCRγδ+) and NK cells from blood donors in Salvador-Bahia, Brazil. Results: The proportion of included male subjects was 73.7% and the median ages of males (34) and females (35) were found to be similar. Absolute counts total lymphocytes subsets to both gender was 1,956 (1,060-4,186) cells and relative values 34%. The T CD4+ and T CD8+ lymphocytes relative values was 51% (20-62) and 24% (9-28), respectively. The most statistically significant finding observed was a higher percentage of B lymphocytes (p=0.03) in females. Commonly cited subset reference intervals were found to be consistent with values in several populations from different geographic areas.
BACKGROUND: The human retroviruses HIV-1 and HTLV-1 share the routes of infection with hepatitis viruses B and C. Co-infection by these agents are a common event, but we have scarce knowledge on co-infection by two or more of these agents. OBJECTIVE: To evaluate the characteristics and risk factors for co-infections by HBV and HCV in patients infected by HIV-1 or/and HTLV-1, in Salvador, Brazil. METHODS: In a case-control study we evaluated patients followed in the AIDS and HTLV clinics of Federal University of Bahia Hospital. Clinical and epidemiological characteristics were reviewed, and patients were tested for the presence of serological markers of HBV and HCV infections. HCV-infected patients were tested by PCR to evaluate the presence of viremia. RESULTS: A total of 200 HIV-1, 213 HTLV-1-infected, and 38 HIV-HTLV-co-infected individuals were included. HIV-infected patients were more likely to have had more sexual partners in the lifetime than other patients' groups. HIV-HTLV-co-infected subjects were predominantly male. Patients infected by HTLV or co-infected had a significantly higher frequency of previous syphilis or gonorrhea, while HIV infection was mainly associated with HPV infection. Co-infection was significantly associated to intravenous drug use (IVDU). HBV and/or HCV markers were more frequently found among co-infected patients. HBV markers were more frequently detected among HIV-infected patients, while HCV was clearly associated with IVDU across all groups. AgHBs was strongly associated with co-infection by HIV-HTLV (OR = 22.03, 95% CI: 2.69-469.7), as well as confirmed HCV infection (p = 0.001). Concomitant HCV and HBV infection was also associated with retroviral co-infection. Patients infected by HTLV-1 had a lower chance of detectable HCV viremia (OR = 0.04, 95% CI: 0.002-0.85). CONCLUSIONS: Infection by HCV and/or HBV is frequent among patients presenting retroviral infection, but risk factors and prevalence for each infection are distinct for each agent. Retroviral co-infection increases the risk of a positive AgHBs, but HTLV-1 infection seems to increase the likelihood of HCV spontaneous clearance.
BACKGROUND: The occurrence of syphilis and HIV-1 infections during pregnancy are major risks to the fetus due to mother-to-child transmission (MTCT). OBJECTIVES: To determine peripartum seroprevalence and risk factors of syphilis and HIV-1 infection among pregnant women in Salvador, Brazil, and the rate of HIV-1 MTCT. METHODS:Cross-sectional study of pregnant women who were admitted for delivery in a reference maternity hospital between May 2008 and March 2009 was conducted. Women were screened for HIV-1 infection and syphilis, and interviewed regarding demographic, behavioral and obstetric data. Newborns to HIV-infected mothers were tested by b-DNA and DNA-PCR to detect HIV-1. RESULTS: A total 3300/8516 women were evaluated. Mean age was 25.8 ± 7.3 years. HIV-1 and syphilis seroprevalence rates were 0.84% (28/3300) and 0.51% (17/3300), respectively. HIV-1 infection was associated with: low education (p = 0.04), having a partner with known HIV infection (p < 0.0001) or with previous sexually transmitted infection (p < 0.0001), blood transfusion (p = 0.003), or accidental exposure to blood (p = 0.003). Syphilis was associated with being Caucasian (p = 0.02), having no steady partner (p = 0.02), being a housewife (p = 0.01), having an intravenous drug user (IVDU) sexual partner (p = 0.04) or a sexual partner with previous STI (p < 0.001). Higher education (p = 0.04) was protective against HIV-infection. Attending a prenatal care program was protective against syphilis (p = 0.008) and HIV-1 (p = 0.02). No case of HIV-1 MTCT was detected, but 25% of children born to HIV-infected mothers were lost to follow up. CONCLUSIONS: In Salvador, peripartum prevalence of syphilis and HIV-1 infection among pregnant women were low, and associated with classic risk factors for both infections. The great proportion of very late diagnosis of HIV infection, and the high rate of loss of follow-up among positive mothers and their infants are of high concern.
Para modelar o fluxo de água e o transporte de soluto em solos são necessários parâmetros hidrodinâmicos e hidrodispersivos como dados de entrada nos modelos numéricos. O experimento de infiltração axissimétrica utilizando um infiltrômetro de anel simples com um traçador conservativo (KCl) é um método simples e eficiente para determinar esses parâmetros no campo. O objetivo deste trabalho consistiu na caracterização hidrodinâmica e hidrodispersiva de um Latossolo Amarelo situado na microrregião do brejo paraibano, no município de Areia, PB, em nível de campo, por meio da infiltrometria de anel simples. Os experimentos foram realizados em uma área cultivada com feijão em uma malha de 50 x 50 m. A condutividade hidráulica saturada, Ks, e a sorvidade, S, foram estimadas pelas análises de infiltração tridimensional axissimétrica para tempos curto e longo. O soluto inerte (Cl-) foi utilizado para o cálculo da fração de água móvel, Φ, por meio da medição da concentração de soluto na camada do solo (0-15 cm) ao final do experimento de infiltração. Um modelo numérico de transferência de soluto com base no conceito de convecção-dispersão (CD) foi utilizado para definir os parâmetros (D e R) de transporte. A infiltrometria de anel simples demonstrou ser um método simples e eficiente para obtenção dos parâmetros hidrodinâmicos e hidrodispersivos. Observou-se boa concordância entre os valores medidos e calculados (v, D e R) com o modelo CD observado pelos coeficientes de determinação (r²).
To model the water flow and solute transport in soils, hydrodynamic and hydrodispersive parameters are required as input data in the mathematical models. The axisymmetric infiltration experiment using a single-ring infiltrometer with a conservative tracer (KCl) is a simple and efficient method for the determination of these parameters in the field. The objective of this study was to characterize hydrodynamic and hydrodispersive parameters of some soils in a marshy region, in Areia-PB, in the field, based on single-ring infiltration tests. The experiments were conducted in an area with common bean, in a 50 x 50 m grid. Saturated hydraulic conductivity (Ks) and sorptivity (S) were estimated by analysis of three- dimensional axisymmetric infiltration for short and long periods. The inert solute (Cl-) was used to calculate the mobile water fraction Φ, by measuring solute concentration in the 0-15 cm layer at the end of the infiltration experiment. A numerical model of solute transfer based on the concept of convection-dispersion (CD) was used to determine the transport parameters (D and R). Single-ring infiltrometry proved to be a simple and efficient method to obtain the hydrodynamic and hydrodispersive parameters. A good agreement was observed between measured and calculated values (v, D and R) with the model CD, based on the coefficients of determination (r²).
This study aimed to evaluate the prevalence of sexually transmitted infections (STIs) and associated risk factors in HIV-infected pregnant women followed for prenatal care in Salvador, Bahia. This was a cross-sectional study of 63 women seeking prenatal care at a reference center. Participants were interviewed regarding socio-epidemiological and clinical history, and were tested for HBsAg, anti-HCV, anti HTLV I/II, VDRL, Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma hominis, Ureaplasma urealyticum, CD4 count, and HIV plasma viral load. The main outcome variable was the presence of any STI. The mean age of patients was 28.2 years (16-40 years). 23 (36.5%) were diagnosed with at least one STI. The frequency of diagnoses was: HBV, 3.2%; HCV, 8.1%; HTLV I/II, 3.4%; syphilis, 9.5%; Chlamydia trachomatis, 11.1%; HPV, 15.0%; Mycoplasma hominis, 2.1%, and Ureaplasma urealyticum, 2.1%. No case of Neisseria gonorrhoeae was identified. No association was found between socio-epidemiological variables and the presence of an STI. CD4 T lymphocyte < 500 cells/µl (p = 0.047) and plasma viral load >1,000 copies (p = 0.027) were associated with the presence of sti. stis are frequent in pregnant women infected with hiv, and all hiv-infected pregnant women should be screened to decrease transmission of these pathogens and to protect their own health.
Estudos ambientais em bacias hidrográficas são fundamentais para o entendimento do uso dos recursos naturais e dos problemas relacionados à ocupação do espaço. Em Sergipe, há necessidade de se obter informações para fins de planejamento e gestão futura de suas bacias hidrográficas, uma vez que gradualmente observa-se uma redução do volume produzido nos cursos d'água e da qualidade de suas águas, que são imprescindíveis para o abastecimento humano, a utilização na agricultura e na indústria. Devido ao acelerado processo de supressão da vegetação na sub-bacia hidrográfica do rio Poxim, formada pelos rios Poxim-mirim, Poxim-açu, e Pitanga e seus pequenos tributários, foi realizado um diagnóstico para se verificar o estado de conservação das suas principais nascentes, a situação quanto ao fluxo de água, as formas de uso e ocupação do solo no entorno destas e os tipos fisionômicos de vegetação remanescentes. As informações obtidas serão úteis para a realização de projetos de restauração ambiental, a promoção de melhorias no ambiente e nas comunidades rurais e resgate da diversidade da flora e fauna nestas áreas. Observou-se que as 20 principais nascentes dos rios e tributários que compõem a sub-bacia hidrográfica do rio Poxim, apresentam alterações decorrentes da acelerada antropização (90%), a maioria delas (65%) com elevada degradação (sem raio mínimo de 50m de vegetação) e ocupadas por agricultura (50%) e pastagens (35%). Somente duas nascentes encontram-se preservadas. Quanto à composição florística, as espécies identificadas (43) podem ser utilizadas em projetos futuros para restauração das nascentes e dos cursos d'água nesta sub-bacia hidrográfica.
Environmental studies on river basins are fundamental to understanding the natural resources use and the problems related to the space occupation. In Sergipe, it is necessary to obtain information for planning purposes and future management of their watersheds, once the watercourses volume and its quality are reducing gradually, which are essential for human supply and use in agriculture and industry. Due to the accelerated removal of vegetation in the river Poxim sub-basin, formed by the Poxim-Mirim, Poxim-Açu, Pitanga rivers, and its small tributaries, a diagnosis was carried out to verify the conservation status of their main sources, the situation on the water flow, the different uses, and land use around these sources and the remaining vegetation physiognomic types. The information is useful for carrying out environmental restoration projects, promoting improvements in the environment and in the rural communities and for the flora and fauna diversity rescue in these areas. It was observed that the 20 rivers sources top and tributaries that compose the river Poxim sub-basin showed changes from accelerated human anthropization (90%), most (65%) with high degradation (no vegetation in the minimum radius of 50 m), being occupied by agriculture (50%) and pastures (35%). Only two sources were preserved. The floristic composition, the identified species (43) can be used in future projects for sources and watercourses restoration in this sub-basin.
O hemograma é muito útil no diagnóstico quando o intervalo de referência é adequadamente estabelecido para população. Com o objetivo de verificar os valores hematológicos em população heterogênea foi analisado o hemograma e frequências alélica de marcadores informativos de ancestralidade de brasileiros. Foi observada associação positiva entre sexo e os valores de neutrófilos, monócitos, eosinófilos, eritrócitos, hemoglobina, hematócrito, MCV, MCHC e plaquetas (IC 95%; P<0,05). E não houve diferenças entre idade, consumo de álcool, nível educacional, etnia, tabagismo e os valores do hemograma (IC 95%; P>0,05). Os homens apresentaram valores maiores no eritrograma, enquanto no leucograma e plaquetograma foram as mulheres. Foi observado também que a população é altamente heterogênea e as médias proporcionais (±DP) de ancestralidade Africana, Europeia e Ameríndia estimada foram: 49,0 ± 3,0 %, 44,0 ± 9,0% e 7,0 ± 9,0%, respectivamente. A contribuição ancestral ameríndia se demonstrou pequena, mas a estimativa de proporções ancestrais foi estatisticamente significante (r = 0,9838; P<0,001). Os valores hematológicos aqui descritos são parecidos com os descritos em negros americanos, outra população heterogênea.
A complete blood count is very useful in clinical diagnoses when reference ranges are well established for the population. Complete blood counts and allele frequencies of Ancestry Informative Markers (AIMs) were analyzed in Brazilians with the aim of characterizing the hematological values of an admixed population. Positive associations were observed between gender and neutrophils, monocytes, eosinophils, erythrocytes, hemoglobin, hematocrit, MCV, MCHC and platelet counts. No significant differences were found for age, alcohol consumption, educational status, ethnicity, smoking in respect to the complete blood count values. In general, men had higher red blood cell values, while women had higher values for white blood cells and platelets. The study of the population was highly heterogeneous with mean proportions (± SE) of African, European and Amerindian ancestry being 49.0 ± 3.0%, 44.0 ± 9.0% and 7.0 ± 9.0%, respectively. Amerindian ancestry showed limited contribution to the makeup of the population, but estimated ancestral proportions were statistically significant (r = 0.9838; P<0.001). These hematologic values are similar to Afro-Americans, another admixed population.
O conhecimento das curvas de retenção e da condutividade hidráulica da água do solo é indispensável para a modelagem do transporte de água e de poluentes em sistemas agrícolas. Essas propriedades são afetadas por numerosas fontes de variabilidade, geralmente associadas a fatores espacial e temporal, e relacionadas com o manejo agrícola. O objetivo desse trabalho foi analisar a variabilidade espacial dos parâmetros das curvas de retenção da água (van Genuchten) e da condutividade hidráulica (Brooks & Corey) da água do solo, obtidos com o método "Beerkan", que se baseia em ensaios de infiltração simplificados e nas informações texturais do solo. Esses parâmetros são de forma ou texturais (parâmetros de ajuste que dão forma às curvas) e de normalização ou estruturais (umidade volumétrica saturada, condutividade hidráulica saturada do solo e potencial de entrada de ar). Os ensaios de campo foram conduzidos em uma malha regular de 25 x 25 m num Neossolo Flúvico e num Latossolo Amarelo cultivados com feijão (Vigna unguiculata (L.) Walp.). Para ambos os solos, os valores dos parâmetros de forma, da umidade volumétrica saturada, dos logaritmos da condutividade hidráulica saturada e do potencial de entrada de ar apresentaram dependência espacial. Os valores da umidade volumétrica saturada e dos logaritmos do potencial de entrada de ar foram mais sensíveis à variação a pouca distância no Neossolo Flúvico do que do Latossolo Amarelo, com semivariogramas apresentando estruturas de variação com fraca dependência espacial.
Knowledge on soil hydraulic properties such as water retention and hydraulic conductivity curves is indispensable for water and pollutant transport modeling of agricultural systems. This soil hydraulic properties are affected by numerous sources of variability, mostly associated with spatial, temporal, and management-related factors. The objective of this study was to analyze the spatial variability of parameters of water retention (van Genuchten) and hydraulic conductivity (Brooks & Corey) curves obtained with the "Beerkan" method based on simple infiltration experiments and soil texture data. These parameters are related to shape or texture (fitting parameters that shape the curves) and normalization or structure (saturated water content, saturated hydraulic conductivity and air entry potential). The field tests were carried out in a 25 x 25 m grid in a Fluvent soil and in an Oxisoil planted with beans (Vigna Unguiculata (L.) Walp.). For both soils, spatial dependence was verified in the values of parameters of shape, saturated water content, logarithms of the saturated hydraulic conductivity and air entry potential. The values of saturated water content and air entry potential were more sensitive to variation at short distances in the Fluvent than in the Oxisoil. The spatial dependence in the variograms was weak.