Resumen Los coronavirus (CoV) causan enfermedades respiratorias y entéricas leves, graves o críticas, pudiendo ocasionar la muerte del paciente. Debido a la alta conectividad entre naciones y a la transmisión, actualmente la COVID-19 representa un verdadero problema de salud pública en todo el mundo. El CoV-2 causante del síndrome respiratorio agudo grave (SARS-CoV-2) apareció a finales de diciembre de 2019 en Wuhan, China, y en marzo de 2020 la COVID-19 fue declarada pandemia. En esta revisión se describen las características del genoma y de la proteína espiga del SARS-CoV-2, su papel en la inmunopatogénesis de la COVID-19, la tormenta de citocinas, la actividad citotóxica inducida por células T y la producción de anticuerpos contra el SARS-CoV-2 mediada por células B, así como la eficacia de algunas vacunas, tomando en cuenta las mutaciones presentes en la proteína espiga.

Abstract Coronavirus (CoV) infections cause respiratory and enteric diseases with clinical manifestations ranging from faint to severe, even lead to death of patients. High connectivity between nations and infectivity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), represent a global health problem as the coronavirus disease 19 (COVID-19). This CoV-2 that cause SARS, which appeared in Wuhan, China, in December 2019 originated COVID-19 and declared as pandemic a few months posterior its appearance. In this review, the genomic and spike protein characteristics of SARS-CoV-2, the role of SARS-CoV-2 in the COVID-19 pathogenesis, cytokine storm, the role of cytotoxic T and B cells against SARS-CoV-2, as well as the vaccines efficacy (taking into account mutations in the spike protein) are described.

Resumo Objetivo Verificar se há correlação entre o índice de massa corporal e os sintomas do climatério em mulheres na pós-menopausa. Métodos Participaram do estudo 109 mulheres na pós-menopausa, com idade média de 57± 8 anos, índice de massa corporal (IMC) médio de 30± 6kg/m2 e 8± 8 anos após a menopausa. Para a avaliação dos sintomas climatéricos, foram utilizados os questionários específicos para essa população: Índice de Kupperman-Blatt (IKB), Menopause Rating Scale (MRS), e Escala de Cervantes (EC). A análise dos dados foi realizada por meio do teste do chi-quadrado, análise de variância (analysis of variance, ANOVA, em inglês) com o teste post hoc de Bonferroni e regressão linear múltipla. O nível de significância adotado foi p<0,05. Todas as análises estatísticas foram realizadas no programa Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, Estados Unidos), versão 26.0. Resultados A regressão linear múltipla mostrou associação positiva (p < 0,01) entre os valores do IMC e os sintomas do climatério quando ajustados pela idade e pelo tempo após a menopausa nos 3 questionários utilizados (IKB: B = 0,432; CE: B = 304; e MRS: B = 302). Quanto às pontuações dos sintomas, as mulheres com obesidade apresentaram médias maiores (p < 0,05) quando comparadas às mulheres eutróficas (IKB = 28 ± 10 e 20 ± 10; e MRS = 20± 10 e 13 ±7). Na análise pelo chi-quadrado 28% das mulheres obesas apresentaram sintomas graves, e 46%, moderados, ao passo que apenas 1% e 46% das eutrópicas apresentavam esses mesmos sintomas. Conclusão Há uma associação entre IMC e sintomas climatéricos, e mulheres com sobrepeso ou obesidade apresentam sintomas mais intensos e moderados do que mulheres eutróficas.

Abstract Objective To determine if there is a correlation between body mass index (BMI) and climacteric symptoms in postmenopausal women. Methods The study sample was composed of 109 postmenopausal women with a mean age of 57 ± 8 years, mean body mass index (BMI) of 30 ± 6 kg/m2, and 8 ± 8 years after menopause. For the assessment of the climacteric symptoms, the Blatt-Kupperman Index (BKI), the Menopause Rating Scale (MRS), and the Cervantes Scale (CS) were used. Data analysis was performed through the Chi-squared test, analysis of variance (ANOVA) with the Bonferroni post hoc test, and multiple linear regression. The level of significance adopted was of p < 0.05. The statistical analyses were performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, United States) software, version 26.0. Results The multiple linear regression showed a positive association (p<0.01) between BMI values and menopause symptoms when adjusted for age and time after menopause in the 3 questionnaires used (BKI: B = 0.432; CS: B = 304; and MRS: B = 302). Regarding symptom scores, the obese women had higher mean scores (p<0.05) when compared to eutrophic women (BKI = 28 ± 10 and 20 ± 10; and MRS = 20 ± 10 and 13±7, respectively). In the Chi-squared analysis, 28% of obese women had severe symptoms and 46% had moderate symptoms, while only 1% and 46% of eutrophic women had these same symptoms. Conclusion There is an association between BMI and climacteric symptoms, and overweight or obese women have more intense and moderate symptoms than eutrophic women.

ABSTRACT Enteric diseases affect poultry and cause important economic losses in many countries worldwide. Avian parvovirus has been linked to enteric conditions, such as malabsorption and runting-stunting syndrome (RSS), characterized by diarrhoea, and reduced weight gain and growth retardation. In 2013 and 2016, 79 samples were collected from different organs of chickens in Ecuador that exhibited signs of diarrhea and stunting syndrome, and analysed for the presence of chicken parvovirus (ChPV). The detection method of ChPV applied was Polymerase Chain Reaction (PCR), using primers designed from the conserved region of the viral genome that encodes the non-structural protein NS1. Out of the 79 samples, 50.6% (40/79) were positive for ChPV, and their nucleotide and amino acid sequences were analysed to determine their phylogenetic relationship with the sequences reported in the United States, Canada, China, South Korea, Croatia, Poland, Hungary, and Brazil. Strong similarity of nucleotide and amino acid sequences among all analyzed sequences and between the analysed and reference sequences was demonstrated, and the phylogenetic analysis clustered all the sequences within the same group, demonstrating a strong relation between the studied strains and the reference chicken parvovirus strains.

Abstract INTRODUCTION: The prevalence of hepatitis B and hepatitis C and risk behaviors among 402 female sex workers in Central Brazil were investigated by respondent-driven sampling. METHODS: Blood samples were tested for hepatitis B and C markers by enzyme-linked immunosorbent assay. Two hepatitis B vaccination schedules were performed. RESULTS: The prevalence of hepatitis B and C infections were 9.3% and 0.5%, respectively. Susceptibility to hepatitis B infection was observed in 61.5% of subjects. There was no significant difference in adherence index (p=0.52) between vaccination schedules and all participants had protective antibody titers. CONCLUSIONS: This hard-to-reach population requires hepatitis B and C surveillance.

Background: Intensified treatment of Philadelphia chromosome negative acute lymphoblastic leukemia (Ph(-)ALL) in adolescents by pediatric teams, with fve years disease free survival (DFS) rate of 65%, encouraged the use of intensified protocols in patients between 15 and 30 years, improving the DFS from 45% to 60-80%. The protocol LLA 15-30 for patients between 15 and 30 years with Ph(-)ALL, based on the Children’s Oncology Group (COG) protocol AALL0232 resulting in a five years DFS of 78%, was started in 2007 by the PANDA national program. Aim: To report the results of the prospective cohort study evaluating the results of this protocol four years after its implementation. Patients and Methods: Between January 2007 and December 2010, 68 Ph(-) ALL patients, aged between 15-30 years (75% males) were incorporated. Survival was evaluated using Kaplan-Meier and log-rank tests. Results: Fifty percent of patients were of high risk. A complete response was achieved in 91%, early death occurred in 6% and induction failure in 3%. Median follow-up was 23 months. Overall survival, disease free survival and relapse rates at 35 months were 61.8, 67.5% and 31% respectively. Conclusions: LLA 15-30 protocol significantly improved three-year overall survival from 31 to 62%. The 20% difference observed with AALL0232 protocol is explained by the high rate of relapse. Improving provider and patient compliance with protocols may eliminate this gap.

Background The aim of the present study was to estimate hepatitis B virus seroprevalence among first-time blood donors in the city of Campo Grande, Mato Grosso do Sul State, in the central-western region of Brazil. Findings A retrospective analysis of first-time voluntary blood donor records, from January 2010 to December 2010, was conducted at the Hematology Center of Mato Grosso do Sul. The prevalence of the HBsAg and anti-HBc serological markers and their respective 95% confidence intervals were calculated. Chi-square analysis was performed between the seroprevalence previously found in 2001 and the one determined by the current study. Results were considered statistically significant if p < 0.05. Among 8,840 subjects, 269 (3.04%, 95% CI: 2.7-3.4) were positive for HBV markers. The prevalence rate of HBsAg was 0.19% (95% CI: 0.1-0.3) and anti-HBc alone was 2.85% (95% CI: 2.5-3.2). Conclusions There was no statistically significant difference regarding gender. However, an important association was observed between HBV infection and older age ( p < 0.01). The seroprevalence of HBV infection in first-time blood donors diminished from 2001 to 2010 ( p < 0.01). Such decrease suggests an improvement in the recruitment of safe donors, the positive impact of vaccination programs and the decreasing of HBV infection prevalence in the general population.

Introduction: Information is available regarding the prevalence and incidence of positive microbiological serology results both in the general population and in patients on haemodialysis in Spain. Nevertheless, little information is known regarding patients with diabetes attended in external nephrology consultations. Objective: To evaluate the percentage of patients with positive serology results for hepatitis B and C, Human Immunodeficiency Virus (HIV), and syphilis in the initial assessment of patients referred to diabetic nephropathy external consultations. Patients and method: Retrospective study of 500 patients assessed over the course of 5 years with the diagnosis of diabetic nephropathy originating in external consultations and for which hepatitis B, C, HIV, and syphilis serology had been requested. Results: With regard to hepatitis B virus, 0.4% of patients had chronic hepatitis B, 10.2% had overcome the hepatitis and were in recovery, and 4.2% had received the hepatitis B vaccine. As for hepatitis C, 2.4% of the patients studied had antibodies against hepatitis C. With regard to syphilis, 0.8% of patients had positive serological results. No patients had positive HIV serology results. Conclusions: Despite major methodological limitations, this would be the first study to evaluate the microbiological serology of diabetic nephropathy patients treated in external consultations.

Antecedentes: En España hay datos sobre prevalencia e incidencia de serologías microbiológicas positivas tanto en la población general como en pacientes en hemodiálisis. Sin embargo, se conocen pocos datos sobre los pacientes con diabetes atendidos en consulta externa de Nefrología. Objetivo: Valorar el porcentaje de pacientes con serologías positivas para hepatitis B y C, virus de inmunodeficiencia humana (VIH) y sífilis en la valoración inicial de los pacientes remitidos para estudio a la consulta externa de nefropatía diabética. Pacientes y métodos: Estudio retrospectivo de las serologías solicitadas con el diagnóstico de nefropatía diabética con origen en consultas externas de 500 pacientes valorados durante 5 años a los que se les había solicitado serologías de la hepatitis B, C, VIH y sífilis. Resultados: Respecto al virus de la hepatitis B, el 0,4 % de los pacientes tenían hepatitis B crónica, el 10,2 % había pasado la hepatitis y estaban curados y el 4,2 % había recibido la vacuna de la hepatitis B. En cuanto a la hepatitis C, el 2,4 % de los pacientes estudiados tenían anticuerpos frente hepatitis C. Respecto a la sífilis, el 0,8 % de los pacientes tenían serologías positivas. Ningún paciente presentó serologías positivas para VIH. Conclusiones: Si bien con grandes limitaciones metodológicas, este sería el primer estudio donde se revisan las serologías microbiológicas de pacientes con nefropatía diabética atendidos en consulta externa.

Background: Hematopoietic stem cell transplantation (HSCT) is an effective therapy for hematological diseases such as lymphoma and multiple myeloma. In 2004, the Cancer Unit of the Ministry of Health incorporated the HSCT to the National Cancer Program in Adults. Until 2008 we purchased services to private institutions while implementing the national center for HSCT of adults in the Hospital del Salvador. Aim: To report the first ten HSCT conducted in this center. Material and Methods: All cases were approved by a national commission for adult HSCT. The entire process was carried out based on evidence-based protocols. Results: Six patients with Hodgkin lymphoma, three with multiple myeloma and one with a diffuse large B cell lymphoma were transplanted. Age range was 19 to 48 years and five patients were male. An average of 2.2 aphereses per patient was required. The CD 34 stem cell collection was 5.06 x 10(6) x Kg. The conditioning regimes were BEAM (carmus-tine, etoposide, cytosine arabinoside, melphalan) and melphalan 200 according to the underlying disease. Seventy percent of the patients developed mild to moderate mucositis and 50% had febrile neutropenia, with good response to treatment. In two cases there was an association with influenza. The engraftment of neutrophils and platelets was achieved on day +10 and +11 respectively. At follow-up until day +100, there was no morbidity or mortality. Conclusions: These results confirm the quality standard that this intervention has achieved in our institution. The Chilean National Center for HSCT on Adults should be established as a public core care, teaching and research facility.

Antimicrobial chemotherapy in human and veterinary medicine is one of the most important therapeutic tool against pathogenic agents causing infectious diseases; nevertheless, the development of multiple resistant strains during the last years has been reported. Some of the measures adopted to control this problem have been the veterinary prescription of antimicrobials for animal use, the permanent rotation of drugs, and the implementation of continuous monitoring programs for bacterial resistance. In the present paper the sensitivity of pathogenic bacteria isolated from dairy cows suffering mastitis in different regions of Chile against antimicrobials most frequently used in dairy herds is reported. The Plate Dilution Method and the Minimum Inhibitory Concentration (MIC) were used to evaluate the bacterial resistance of each isolated strain. A total of 449 bacterial strains were isolated from 963 aseptically collected milk samples in the 5th and Metropolitan Regions of Chile, E. coli being the most frequent mastitis pathogen recovered. In the 10th Region, however, S. aureus was the main pathogen among 1012 bacterial strains isolated from 2000 milk samples. S. aureus, Streptococcus spp and coagulase-negative Staphilococcus (CNS) were shown to be highly resistant to amoxicilin, ampicillin, penicillin, streptomycin and lincomicyn. Resistance to cloxacilin of S. aureus strains isolated in the 5th-Metropolitan and 10th Regions were 6.2% and 3.7% respectively. On the other hand, a high rate of sensitivity was observed in E. coli with resistance values below 25%. According to these results it is possible to conclude that the mastitis pathogens present in the geographical regions under study are resistant to more than one antimicrobial drug and, therefore, usage of these drugs under medical prescription and implementation of permanent monitoring programs for bacterial resistance are strongly recommended

La quimioterapia antimicrobiana en medicina humana y veterinaria es la principal herramienta terapéutica frente a los microorganismos patógenos causantes de enfermedades infecciosas; sin embargo, con el transcurrir de los años se ha observado la aparición de cepas multiresistentes. Dentro de las medidas utilizadas a nivel mundial para enfrentar este riesgo, están el uso de antimicrobianos bajo receta veterinaria, la rotación en el uso de estos fármacos y la instauración de programas permanentes de monitoreo de la resistencia bacteriana. Este trabajo forma parte de un proyecto de fármacovigilancia de resistencia bacteriana en el ganado lechero, cuyo objetivo fue determinar la sensibilidad en bacterias patógenas aisladas de mastitis en vacas lecheras de la V Región, Región Metropolitana (VR,RM) y X Región (XR), frente a los antimicrobianos utilizados con mayor frecuencia en lecherías del país. Para evaluar la resistencia bacteriana, se utilizó el Método de Dilución en Placa con el fin de determinar la Concentración Mínima Inhibitoria (MIC) de cada cepa bacteriana. En la VR,RM a partir de 963 muestras de leche, se lograron aislar 449 cepas bacterianas, observándose un fuerte predominio de E. coli (40.76%). En la XR, de 2.000 muestras se aislaron 1.012 cepas, observándose un claro predominio de S. aureus (55.53%). Las bacterias grampositivas (Staphylococcus aureus, Streptococcus spp y Staphylococcus coagulasa negativo) presentaron altos porcentajes de resistencia ( 25%), frente a amoxicilina, ampicilina, penicilina, estreptomicina y lincomicina. Para S. aureus, un 6.15% y 3.74% de las cepas aisladas de la VR,RM y XR respectivamente, mostraron resistencia a cloxacilina. Las cepas de E. coli presentaron una mayor sensibilidad, no observándose resistencias superiores al 25%. De los resultados se puede concluir también que las bacterias causantes de mastitis en las regiones en estudio presentan resistencia a más de un antimicrobiano, siendo recomendable que la adquisición de estos fármacos se realice a través de receta veterinaria, instaurando además programas permanentes de monitoreo de resistencia bacteriana en nuestro país

Sixty-seven patients with acute myocardial infarction were studied, who had been applied a streptokinase-based thrombolytic treatment in the Emergency service of “Dr Luis Díaz Soto” Higher Institute of Military Medicine. The sample was divided into 2 groups: those who receive thrombolytics within 6 hours of the onset of symptoms (group A) and those who received them after 6 hours (group B). This variable was called door-drug interval. The objective was to define how the door-drug interval influences on the course and complication of the acute myocardial infarction. The group A patients had less mechanical complications and heart failure, more supraventricular arrhythmias and the difference of ST segment regression was higher, but their progression was more favorable than that of the group B patients. It is concluded that the use of thrombolytic therapy in the acute myocardial infarction should begin as soon as possible to reduce risks of future complications.

Se estudiaron 67 pacientes afectados de infarto agudo del miocardio, a los cuales se les aplicó tratamiento trombolítico con estreptoquinasa, en el Servicio de Urgencias del Instituto Superior de Medicina Militar “Dr. Luis Díaz Soto”. La muestra se dividió en 2 grupos: los que recibieron el trombolítico antes de las 6 h del inicio de los síntomas (grupo A) y los que lo recibieron pasadas las 6 h (grupo B). A esta variable se le llamó puerta-droga. El objetivo del estudio era definir cómo determinar el intervalo puerta-droga en la evolución y complicaciones del infarto agudo del miocardio. Se obtuvo que los enfermos que pertenecieron al grupo A desarrollaron menos complicaciones mecánicas y menos insuficiencia cardíaca, así como más arritmias del tipo supraventriculares y la diferencia de regresión del segmento ST fue mayor. La evolución de estos enfermos fue más favorable con respecto al grupo B. Se concluye que el uso de la trombólisis en el infarto agudo del miocardio debe comenzarse lo más pronto posible para disminuir el riesgo de futuras complicaciones.

Meningoencephalitis caused by gram-negative bacilli has increased since the 1970s, with a higher incidence in little children , although there is a a trend to rise in the elderly. Within this group of micororganisms, the meningoencephalitis caused by Salmonella sp is rare, since it is not very common. The case of an 80-year-old female patient with a clinical picture of meningoencephalitis is reported. Salmonella typhimurium serogroup B was isolated from the cerebrospinal fluid. The patient died 5 days after being admitted in the hospital. The meningoencephalitis caused by Salmonella sp should be taken into consideration in children under 2 and in the elederly because of the severity of the clinical picture and the elevated mortality.

La meningoencefalitis por bacilos gramnegativos ha ido incrementándose desde la década de los 70, con una mayor incidencia en niños pequeños, aunque existe una tendencia a aumentar en pacientes de la 3ra. edad. Dentro de este grupo de microorganismos, la causada por Salmonella sp, por su poca frecuencia, resulta una rareza. En este caso se presenta a una paciente de 80 años de edad con cuadro clínico de meningoencefalitis, que en el estudio del líquido cefalorraquídeo se aisló Salmonella grupo B serotipo typhimurium; la paciente fallece a los 5 días de su ingreso. La meningoencefalitis por Salmonella sp debe tenerse en cuenta en pacientes menores de 2 años de edad y ancianos, por la severidad del cuadro clínico y elevada mortalidad.

As lipofuscinoses ceroides neuronais (LCN) constituem um grupo de desordens neurodegenerativas, progressivas e de origem genética. O início dos sintomas varia desde a infancia até a vida adulta. Três principais formas infantis são estabelecidas com base na idade de início, evolução clínica e morfologia celular, através de microscopia eletrônica: infantil (LCNI), infantil tardia (LCNIT) e juvenil (LCNJ). Vários subtipos têm sido descritos. Investigação genética e bioquímica vem possibilitando melhor entendimento, diagnóstico e classificação destas desordens. Relatamos achados clínicos, neurofisiológicos, neurorradiológicos e morfológicos de 17 pacientes com diferentes formas de LCN (infantil, infantil tardia e juvenil), avaliados no Hospital de Clínicas de Porto Alegre, durante 6 anos (1992-1997). Tivemos 7 diagnósticos de LCNI, 5 de LCNIT, e 5 casos de LCNJ. Proporção entre gêneros foi 11:6 (masculino:feminino). Convulsões (6 pacientes) e retardo psicomotor (1 paciente) foram os sintomas iniciais no grupo LCNI. Todos os casos de LCNIT tiveram achados usuais. Os pacientes com LCNJ apresentaram diferentes sintomas iniciais, embora tendendo a similaridade em casos familiais. Não há dados epidemiológicos sobre LCN no Brasil. Esperamos que esta serie de casos contribua para maior investigação deste grupo de desordens em nossa população.

The neuronal ceroid lipofuscinoses (NCL) are a group of inherited progressive neurodegenerative disorders with presentation from infancy to adulthood. Three main childhood forms can be established on the basis of age of onset, clinical course, and ultrastructural morphology: infantile (INCL), late infantile (LINCL), and juvenile (JNCL). Several variant subtypes have been described. Genetic and biochemical analysis are helping to better understand, diagnose and classify these disorders. We report on clinical, neurophysiological, neuroradiological, and morphological data from 17 patients with different forms (infantile, late infantile, and juvenile ) of neuronal ceroid lipofuscinoses (NCL) evaluated at Hospital de Clínicas de Porto Alegre, Southern Brazil, during 6 years (1992-1997). Seven cases were infantile; 5 were late infantile; and 5 were juvenile NCL. Gender ratio was male:female, 11:6. Age at presentation varied from 2-24 months for INCL; 2,5 to 5 years for LINCL ; and 4-10 years for the JNCL cases. Seizures (6 patients) and psychomotor retardation (1 patient) were the initial symptoms in the INCL group. All the patients in the group of LINCL had the usual findings. JNCL patients manifested different initial symptoms, although tending to follow a similar clinical picture within familial cases. Epidemiological data on the prevalence of NCLs in Brazil are not available, we expect this series of cases to contribute to further research in our population.