Abstract Background Literature is scarce on echocardiographic characteristics of COVID-19 patients admitted to the intensive care unit (ICU). Objectives To describe echocardiographic characteristics of ICU COVID-19 patients and associate them with clinical signals/symptoms, laboratory findings and outcomes. Methods Patients with RT-PCR-confirmed COVID-19, admitted to the ICU, who underwent echocardiography were included. Clinical characteristics associated with an abnormal echocardiogram (systolic ventricular dysfunction of any degree — left and/or right ventricle — and/or high filling pressures and/or moderate to severe pericardial effusion) were analyzed. Groups were compared using the Student’s t-test, chi-square, and logistic regression. A p < 0.05 was considered statistically significant. Results A total of 140 patients met inclusion criteria, and 74 (52.9%) had an abnormal echocardiogram. A low number of left and right ventricular systolic dysfunction was observed, and 35% of the population had a normal diastolic function. In the univariate analysis, characteristics associated with abnormal echocardiogram were age, chronic kidney disease, elevated troponin, previous heart failure, and simplified acute physiology score 3 (SAPS 3). In the regression model, troponin and SAPS3 score were independent markers of abnormal echocardiogram. An abnormal echocardiogram was associated with a higher prevalence of in-hospital death (RR 2.10; 95% CI 1.04-4.24) and orotracheal intubation (RR 2.3; 95% CI 1.14-4.78). Conclusions COVID-19 has little effect on ventricular function, but it is common to find increased filling pressures. Elevated serum troponin level and SAPS3 score were the independent markers of an abnormal echocardiogram. In addition, the prevalence of in-hospital death and need for mechanical ventilation were higher in patients with abnormal echocardiogram.

Resumo Fundamento Alguns estudos demonstraram uma maior prevalência de óbitos em portadores de fatores de risco cardiovascular (FRC) durante internação por COVID-19. Objetivos Avaliar o impacto do alto risco cardiovascular em pacientes internados em terapia intensiva por COVID-19 Métodos Estudo retrospectivo com pacientes admitidos em terapia intensiva, com diagnóstico confirmado de COVID-19 por RT-PCR e com pelo menos uma dosagem de troponina durante a internação. Os critérios para definição de paciente de alto risco cardiovascular (ARC) foram: histórico de doença cardiovascular estabelecida (infarto, AVC ou doença arterial periférica), diabetes, doença renal crônica com clearance < 60ml/min ou presença de 3 FRC (hipertensão, tabagismo, dislipidemia ou idade > 65 anos). O desfecho primário deste estudo é mortalidade hospitalar por todas as causas. P<0,05 foi considerado significativo. Resultados Foram incluídos 236 pacientes, média de idade= 61,14±16,2 anos, com 63,1% homens, 55,5% hipertensos e 33,1% diabéticos. Um total de 47,4% dos pacientes apresentavam ARC. Observou-se um aumento significativo da mortalidade conforme aumento do número de fatores de risco (0 FRC: 5,9%; 1 FRC: 17,5%; 2 FRC: 32,2% e ≥3 FRC: 41,2%; p=0,001). Na regressão logística ajustada para gravidade (escore SAPS3), o grupo de alto risco cardiovascular e troponina elevada apresentou maior ocorrência de mortalidade hospitalar (OR 40,38; IC95% 11,78-138,39). Pacientes sem alto risco cardiovascular, mas com troponina elevada, também exibiram associação significativa com o desfecho primário (OR 16,7; IC95% 4,45-62,74). Conclusão Em pacientes internados em terapia intensiva por COVID-19, a presença de alto risco cardiovascular afeta a mortalidade hospitalar somente em pacientes que apresentaram elevação de troponina.

Abstract Background Some studies have shown a higher prevalence of deaths in patients with cardiovascular risk factors (CRF) during hospitalization for COVID-19. Objectives To assess the impact of high cardiovascular risk in patients hospitalized in intensive care for COVID-19 Methods Retrospective study with patients admitted to an intensive care unit, with a diagnosis of COVID-19 confirmed by RT-PCR, and with at least one troponin measurement during hospitalization. The criteria for defining high cardiovascular risk (HCR) patients were: history of established cardiovascular disease (myocardial infarction, stroke, or peripheral arterial disease), diabetes, chronic kidney disease with clearance < 60ml/min, or presence of 3 CRFs (hypertension, smoking, dyslipidemia, or age > 65 years). The primary outcome of this study is all-cause in-hospital mortality. P<0.05 was considered significant. Results This study included 236 patients, mean age = 61.14±16.2 years, with 63.1% men, 55.5% hypertensive, and 33.1% diabetic; 47.4% of the patients also presented HCR. A significant increase in mortality was observed as the number of risk factors increased (0 FRC: 5.9%; 1 FRC: 17.5%; 2 FRC: 32.2% and ≥3 FRC: 41.2%; p=0.001). In the logistic regression adjusted for severity (SAPS3 score), the HCR and myocardial injury group had a higher occurrence of in-hospital mortality (OR 40.38; 95% CI 11.78-138.39). Patients without HCR but with myocardial injury also exhibited a significant association with the primary outcome (OR 16.7; 95% CI 4.45-62.74). Conclusion In patients hospitalized in intensive care for COVID-19, HCR impacts in-hospital mortality only in patients with myocardial injury.

Abstract INTRODUCTION: Visceral leishmaniasis has a broad worldwide distribution and constitutes a public health problem in the Northeast of Brazil. Located in this region is the state of Alagoas, where the disease is endemic in humans and where there has been a significant increase in the number of positive dogs. The objective of this study was to describe the temporal and spatial distribution of the cases of human VL in the state of Alagoas with the aim of identifying transmission risk areas in the period from 2007 to 2018. METHODS: The data available in the National Disease Notification System (SINAN-NET) were used. The Bayesian incidence rate and the Moran’s global index were calculated using the Terra View 4.2.2 program, and the maps were created using QGIS2.18.0. RESULTS: From the 102 municipalities, 68.6% (n= 70) had at least one notified case of VL in the years of study. A total of 489 cases were registered, with an average of 40.7 cases per year and an incidence rate of 1.25/100,000 inhabitants. The highest number of confirmed cases (105) occurred in 2018. Male individuals and children between 1-4 years old were the most affected, and 64% of the cases were in rural areas. Spatial dependence was detected in all the intervals except for the first triennium, and clusters were formed in the west of the state. CONCLUSIONS: Alagoas presented an accentuated geographical expansion of VL, and it is necessary to prioritize areas and increase surveillance actions and epidemiological control.

ABSTRACT Background: Thrombotic thrombocytopenic purpura (TTP) is a potentially fatal disease that requires early diagnosis and treatment that can be made possible by applying the PLASMIC score. This study aims to evaluate this score applicability for patients with suspected TTP in a developing country. Methods: This was a retrospective study performed at a tertiary hospital in the northeastern region of Brazil. Patients were analyzed in two groups: ADAMTS13 activity <10% and activity >10%. Patients were stratified according to the PLASMIC score, and the level of agreement between the PLASMIC score and the ADAMTS13 activity was evaluated. Results: Eight patients with thrombotic microangiopathy were included. Four patients had ADAMTS13 activity <10%, all with a PLASMIC score =6. The other four had ADAMTS13 activity >10%, all with a score <6. Based on a score =6 for presumptive diagnosis of TTP, we attained a 100% diagnostic accuracy in our sample. The PLASMIC score was also able to accurately predict response to plasma exchange and the risk of long-term unfavorable outcomes. Conclusions: The reproducibility of the PLASMIC score was quite satisfactory in our sample. It accurately discriminates between patients who had ADAMTS13 deficiency and those with normal enzyme activity, precluding the need for specific laboratory evaluation, which is not always available. This score can be useful for an early diagnosis and indicates which patients will benefit from the treatment in developing countries.

ABSTRACTA revision of the taxonomic status and an identification key for wasp species of the genus Mischocyttarus related to M. punctatus (Ducke, 1904) are presented here. Six new species are proposed (M. tayrona Silveira sp. nov.; M. anchicaya Silveira sp. nov.; M. caxiuana Silveira sp. nov.; M. verissimoi Silveira sp. nov.; M. rodriguesi Silveira sp. nov.; M. ryani Silveira sp. nov.), raising to nine the number of species in the M. punctatus group. The highest diversity of the group concentrates in northern South America, in Andean areas and Amazonia. New information concerning the very peculiar nests of these wasps is also given.

Vespas sociais são importantes nos ecossistemas neotropicais pela abundância e diversidade. A maioria dos inventários recentes não têm dedicado atenção aos atributos espaciais dos espécimes coletados. Dados espaciais são importantes para estudar e mitigar impactos sobre ecossistemas naturais e proteger espécies. Este artigo descreve e analisa em escala local padrões espaciais de registros de coleta, investigando também a variação espacial de descritores de diversidade numa área de 2.500 hectares de floresta amazônica no Brasil. Espécies raras constituíram a maior parte da fauna. Efeitos espaciais de curta distância foram detectados para a maioria das espécies mais comuns, com agregação de registros em distâncias até ca. 800 metros. Hiatos espaciais maiores foram identificados para algumas espécies, constituindo provavelmente autocorrelação exógena e candidatos a explicação por fatores ambientais. Nalguns casos, foram encontradas correlações significativas (ou quase) entre cinco espécies (de Agelaia, Angiopolybia e Mischocyttarus) e três variáveis ambientais estudadas: distância ao riacho mais próximo, altitude topográfica e tipo de copa da floresta. A associação desses fatores com variáveis de biodiversidade foi geralmente baixa. Quando utilizados como preditores de riqueza de Polistinae numa regressão linear múltipla, apenas o coeficiente para tipo de dossel florestal resultou significativo. Alguma predição mostra-se possível sobre variáveis de biodiversidade com base no conhecimento de condições ambientais, especialmente estrutura da vegetação. Estudos devem ser agendados para tratar do assunto em escalas espaciais mais amplas.

Polistine wasps are important in Neotropical ecosystems due to their ubiquity and diversity. Inventories have not adequately considered spatial attributes of collected specimens. Spatial data on biodiversity are important for study and mitigation of anthropogenic impacts over natural ecosystems and for protecting species. We described and analyzed local-scale spatial patterns of collecting records of wasp species, as well as spatial variation of diversity descriptors in a 2500-hectare area of an Amazon forest in Brazil. Rare species comprised the largest fraction of the fauna. Close range spatial effects were detected for most of the more common species, with clustering of presence-data at short distances. Larger spatial lag effects could also be identified in some species, constituting probably cases of exogenous autocorrelation and candidates for explanations based on environmental factors. In a few cases, significant or near significant correlations were found between five species (of Agelaia, Angiopolybia, and Mischocyttarus) and three studied environmental variables: distance to nearest stream, terrain altitude, and the type of forest canopy. However, association between these factors and biodiversity variables were generally low. When used as predictors of polistine richness in a linear multiple regression, only the coefficient for the forest canopy variable resulted significant. Some level of prediction of wasp diversity variables can be attained based on environmental variables, especially vegetation structure. Large-scale landscape and regional studies should be scheduled to address this issue.

Vespas sociais de duas localidades em Cerrado no nordeste do estado do Maranhão, Brasil (Hymenoptera, Vespidae, Polistinae). O presente trabalho consistiu no levantamento da fauna de vespas sociais em duas localidades em região de Cerrado, separadas por 30 km: vila de Bom Jesus (município de Urbano Santos) e vila de Tabocas (município de Barreirinhas), no nordeste do Maranhão, Brasil. Foram encontradas 227 colônias de 31 espécies de 13 gêneros. Polybia rejecta apresentou a maior densidade média de colônias/ha nas duas áreas. A similaridade da fauna (índice de Jaccard) entre Tabocas e Bom Jesus foi de 41,9%. Foram registradas 27 espécies vegetais utilizadas como substrato de nidificação nas duas áreas estudadas. Em Tabocas, Qualea parviflora Mart. (Vochysiaceae) foi a espécie vegetal mais utilizada, abrigando 30,3% das colônias. Em Bom Jesus, a grande maioria das colônias (27,9%) foi localizada em vegetação arbustiva secundária, ou carrasco, considerado indicador de alteração da vegetação original. O número de espécies de vespas sociais registradas no presente trabalho foi semelhante ao alcançado em outros estudos realizados em regiões de Cerrado no Brasil. Nove espécies constituem novos registros para o Maranhão e uma espécie teve sua ocorrência confirmada (Mischocyttarus cerberus), aumentando para 58 o número de espécies conhecidas para o estado.

Social wasps of two Cerrado localities in the northeast of Maranhão state, Brazil (Hymenoptera, Vespidae, Polistinae). Results are presented of a survey of social wasps from two savanna localities 30 km apart from each other in the northeastern part of the Brazilian state of Maranhão, Brazil: village of Bom Jesus (municipality of Urbano Santos) and village of Tabocas (municipality of Barreirinhas). Two hundred and twenty-seven nests of 31 species of 13 genera were found and mapped. Polybia rejecta was the species with the largest average density of colonies/ha in both areas. The similarity (Jaccard's index) between the Tabocas and Bom Jesus faunas was 41.9%. Twenty-seven species of plants were utilized as nesting substrate. In Tabocas, Qualea parviflora Mart. (Vochysiaceae) trees were used as substrate by 30.3% of the wasp colonies. In Bom Jesus, the vast majority of colonies (27.9%) were found in a secondary vegetation type, the so-called carrasco, indicator of vegetation change. The number of social wasp species recorded in this study is similar to others obtained in several areas of Cerrado vegetation in Brazil. Nine species are new to Maranhão, and Mischocyttarus cerberus had its distribution confirmed, increasing to 58 the number of species known to occur in that state.