Venous Thromboembolism as an Initial Manifestation of COVID-19 in a Heart Transplant Patient

Introduction

The disease caused by the coronavirus 2019 (COVID-19) is mainly characterized by symptoms related to the upper respiratory tract associated with fever and constitutional symptoms, progressing in the most severe cases to pneumonia and severe acute respiratory syndrome (SARS). However, due to the increasing number of cases, atypical presentations have been found. Among them, thromboembolic manifestations stand out, since the virus itself seems to predispose to changes in the coagulation system.

Case Report

A 62-year-old male patient who underwent cardiac transplantation 6 months ago, secondary to chagasic cardiomyopathy, had pain and edema in his left foot for 1 week. Upon admission, he was eupneic, afebrile, heart rate of 96bpm, blood pressure of 120 × 70mmhg, with edema and erythema on his left foot. Chagas reactivation, cellulite or deep vein thrombosis were the diagnostic hypotheses suggested. Soft tissue ultrasound and venous doppler of the left lower limb were compatible with deep venous thrombosis and superficial thrombophlebitis. Skin lesion biopsy confirmed Chagas reactivation. Antibiotic therapy with cefazolin, full anticoagulation with enoxaparin and treatment with benzonidazole were introduced. In the second day of hospitalization, patient presented myalgia and dry cough, in addition to an increased C-reactive protein and multiple ground-glass opacities on computed tomography of the chest, suggestive of COVID-19. This finding was corroborated by a positive result of RT-PCR for SARS-COV2. The patient evolved with SARS, requiring progressive use of vasoactive drugs, mechanical ventilation and pronation.

Summary

It is currently known that COVID-19 increases the risk of thromboembolic events, especially in hospitalized patients, reaching an incidence of 25%, even in the presence of effective prophylaxis. Several mechanisms have been proposed for this association, but not with robust evidence. Despite these increased cases, there are no reports in the literature of initial presentation with a thromboembolic event in a heart transplant patient, emphasizing the importance of clinical suspicion and appropriate investigation.

The Prevalence of Adenoid Hypertrophy among Children with Zika Related Microcephaly

Upper respiratory obstruction is a common sequela in children with Zika-related microcephaly (ZRM). As a cross-sectional analysis nested in a cohort study, this study aims to investigate the prevalence of adenoid hypertrophy (AH) in children with ZRM and symptoms of respiratory obstruction. The data were collected in the first three years of life from children with ZRM who were followed in two reference centers for otorhinolaryngological care of patients with congenital Zika syndrome. Out of 92 children with confirmed ZRM, 57 were evaluated by nasopharyngoscopy after presenting with upper respiratory obstruction symptoms. In this study, 31 of the 57 (54%) children with ZRM who were evaluated had obstructive AH. Thirteen children with obstructive AH were submitted to surgery, which resulted in the complete resolution of symptoms for 11, partial resolution in 1, and no improvement in 1. No evidence of direct involvement by Zika virus (ZIKV) infection in the adenoid tissues was demonstrated by histology or immunohistochemistry. Our results suggest that there is a high prevalence and early presentation of AH in children with ZRM, with consequent upper airway obstruction causing upper airway obstructive disorder, secretory otitis media, and dysphagia.

Detection of Approximal Caries Lesions in Adults: A Cross-sectional Study

Detection and management of posterior approximal caries lesions are still problematic. Inspection of approximal surfaces is challenging, and bitewing radiographs are used when direct vision is not possible. Unfortunately, there is no definite radiographic appearance to identify lesion cavitation with absolute certainty. Many lesions detected radiographically within the outer half of dentin are not cavitated, often resulting in unnecessary restorative treatment. Our study compared radiographic depth of approximal caries lesions with presence of cavitation in adults using visual inspection following temporary tooth separation (TTS). We conducted this observational descriptive cross-sectional study at two dental schools in two cities in Chile. Clinicians were unaware of radiographic depths of lesions and examined 147 participants (57.3% female and 42.7% male) following TTS. Using the common classification system that consists of E0 (no lesion), E1 (lesion within the outer half of enamel), E2 (lesion within the inner half of enamel), D1 (lesion within the outer third of dentin), D2 (lesion within the middle third of dentin), and D3 (lesion within the inner third of dentin), a trained dentist evaluated all the processed films. Cavitation was detected in only three sites (0.22%) within the E0 category, seven sites (3.41%) in E1, five sites (14.8%) in E2, four sites (14.8%) in D1, six sites (50%) in D2, and eight sites (61.5%) in D3. Considering that restorative treatment should be indicated strictly for cavitated lesions, our findings support indication for restorative treatment for D3 lesions and the rationale for TTS for D1-D2 caries lesions to allow direct visual inspection to determine whether there is surface cavitation.

Demographic, Social and Health-Related Variables that Predict Normal-Weight Preschool Children Having Overweight or Obesity When Entering Primary Education in Chile

We determined which variables are predictive of normal-weight (N) Chilean 4-year-olds developing overweight/obesity when entering primary school. This study used national data of preschoolers (PK, age 4) in 2011 through 2015, and the same children in the first grade (1st G, age 6) in 2013 through 2017. We formed longitudinal cohorts considering PK as the baseline and 1st G as the follow-up and included anthropometric, socio-demographic, and health variables in PK and anthropometry in the 1st G. We report the percentage N who remained N at follow-up (N-N) or gained excessive weight (N-OW) and (N-OB), by sex. We ran univariate logistic regressions to determine for each variable, its association with gaining excessive weight (N-OW + OB), incorporating significant variables (p < 0.001) in multivariate logistic regression. A total of 483,509 (251,150 girls) of PK had anthropometry in the 1st G. In PK, 22% of the children were obese; in the 1st G (24.8% and 19.7% in boys and girls, respectively). Of normal-weight children, 30% developed OW + OB. The predictive variables were: Being born macrosomic, attending a very vulnerable school, being indigenous, the mother’s low schooling, and the child being cared for by the grandmother after school. In this study, the factors predicting that normal-weight preschoolers gain excessive weight gain in a short period of time are mostly related to poverty. Prevention should focus on this population.

[Socioeconomic vulnerability and obesity in Chilean schoolchildren attending first grade: comparison between 2009 and 2013]

INTRODUCTION

Although obesity is related to socioeconomic level, studies are inconclusive.

OBJECTIVES

To determine obesity risk according to socioeconomic vulnerability among Chilean children (1st grade) in 2009 and 2013 and assess its change during that period, by sex and geographical area.

PATIENTS AND METHOD

Cross-sectional study (N = 175,462 in 2009) and (N = 189,055 in 2013) which included: weight, height, rural / urban, gender and vulnerability obtained from JUNAEB's survey. BMI Z, % obesity and 3 categories of vulnerability (very vulnerable, moderate, non-vulnerable) were determined. For the descriptive analyses, we used t tests and for predictor variables (2 categories of vulnerability) and outcome (obesity) by sex and area, we used %2. Logistic regression models determined OR to develop obesity by.

RESULTS

% obesity was 19.6% and 24.1% in 2009 and 2013, higher in boys. In urban and rural areas respectively, OR to develop obesity were: 0.85 (0.82-0.88) and 0.70 (0.64-0.75) in the most vulnerable students and 0.94 (0.91-0.97) and 0.81 (0.74-0.88) in those with moderate vulnerability in 2009 and 0.96 (0.93-0.98) and 0.89 (0.82-0.96) in the most vulnerable students and 0.99 (0.96-1.02) and 0.94 (0.86-1.02) in students with moderate vulnerability in 2013. The highest increase in obesity was observed among the most vulnerable group from rural areas (16, 6 to 24.3%). vulnerability.

CONCLUSION

The non-vulnerable group had the highest % obesity. Although the most vulnerable students in rural areas had the lowest obesity risk in both years, the highest increase in obesity during the period, occurred in that group.

Development of secondary mutations in wild-type and mutant EZH2 alleles cooperates to confer resistance to EZH2 inhibitors

The histone methyltransferase Enhancer of Zeste Homolog 2 (EZH2) is frequently dysregulated in cancers, and gain-of-function (GOF) EZH2 mutations have been identified in non-Hodgkin lymphomas. Small-molecule inhibitors against EZH2 demonstrated anti-tumor activity in EZH2-mutated lymphomas and entered clinical trials. Here, we developed models of acquired resistance to EZH2 inhibitor EI1 with EZH2-mutated lymphoma cells. Resistance was generated by secondary mutations in both wild-type (WT) and GOF Y641N EZH2 alleles. These EZH2 mutants retained the substrate specificity of their predecessor complexes but became refractory to biochemical inhibition by EZH2 inhibitors. Resistant cells were able to maintain a high level of H3K27Me3 in the presence of inhibitors. Interestingly, mutation of EZH2 WT alone generated an intermediate resistance phenotype, which is consistent with a previously proposed model of cooperation between EZH2 WT and Y641N mutants to promote tumorigenesis. In addition, the findings presented here have implications for the clinical translation of EZH2 inhibitors and underscore the need to develop novel EZH2 inhibitors to target potential resistance emerging in clinical settings.

Caracterização morfológica e química de mimosa Caesalpiniifolia submetida à adubação com p

Foram avaliados os componentes morfológicas e composição química de plantas de Mimosa caesalpiniifolia Benth submetidas a adubação fosfatada e em diferentes épocas do ano. O experimento foi conduzido na Estação Experimental de Itambé do Instituto Agronômico de Pernambuco. Foi utilizado delineamento em blocos ao acaso em parcelas subdivididas, sendo os níveis de fósforo (0, 100 e 200 kg de P2O5/ha) como parcelas e época de avaliação (seca e chuvosa) como subparcelas. A área experimental foi um bosque de sabiá com aproximadamente 13 anos e área de 0,3 ha com espaçamento 3,0 x 3,0 m, constituído de 210 plantas. Cada parcela experimental foi representada por uma planta circundada por oito plantas competitivas, que não receberam os tratamentos. As avaliações morfológicas foram realizadas em seis períodos com intervalos de 60 dias, quando foram realizadas coletas de folhas e ramos com diâmetro de até 5 mm. Observou-se efeito da adubação fosfatada apenas para comprimento dos ramos, sendo de 202,1; 193,6 e 173,5 cm para 0, 100 e 200 kg P2O5/ha, respectivamente. Para as demais variáveis, observou-se efeito somente do período de avaliação, tendo valores médios de 195,3 cm; 24,6; 8,8 mm e 3,8 para altura, número de brotações, espessura de ramos e número de acúleos, respectivamente. Observou-se interação entre período de avaliação e adubação fosfatada apenas para a FDN dos ramos e efeito tanto do período quanto da adubação fosfatada sobre o teor de tanino nos ramos. A adubação fosfatada não influenciou a maioria dos componentes morfológicas e a composição química das plantas de sabiá.

The effect of lens wear on refractive index of conventional hydrogel and silicone-hydrogel contact lenses: a comparative study

PURPOSE

The purpose of this work was to evaluate the ability of four silicone-hydrogel contact lenses (galyfilcon A, balafilcon A, lotrafilcon A and lotrafilcon B) to retain their equilibrium water content before and after wear, through measurements of refractive index and compare with that of a conventional disposable hydrogel contact lens (etafilcon A).

METHODS

The refractive indices of 115 contact lenses were measured using an automated refractometer (CLR 12-70, Index Instruments, Cambridge, U.K.) before and after a schedule of daily wear by 58 patients for 30 days in the case of silicone-hydrogel lenses and 15 days for the conventional contact lenses.

RESULTS

In the silicone-hydrogel contact lenses the changes on the refractive indices were not statistically significant, however after being worn the refractive index of the conventional etalfilcon A hydrogel contact lens increased significantly (p<0.001).

CONCLUSION

The results presented here show that after being worn the silicone-hydrogel contact lens, show more capacity to retain or to reach their initial equilibrium water content than conventional hydrogel contact lenses. This suggests that the silicone-hydrogel contact lenses are less susceptible to spoilation over time maintaining its biocompatibility and contributing to the clinical success of lens performance.

Diagnostic value of combining immunostaining for CD3 and nuclear morphometry in mycosis fungoides

BACKGROUND

Mycosis fungoides (MF) is the most common skin lymphoid neoplasm. In initial stages, differential diagnosis of MF from other benign dermal lymphoid infiltrates (BDLI) may be impossible on morphological basis alone. In previous studies, only deletion of CD7 in MF proved to be of diagnostic help, but not the ratio between immunoexpression of CD4 and CD8.

METHODS

30 cases of MF and 11 cases of BDLI were analysed, in order to compare morphometric parameters, which could be of diagnostic aid. As CD7 is frequently deleted in MF, immunohistochemical detection of T-cells was made using an antibody to CD3. Images of 100 CD3-positive cells per case in both groups were captured and analysed using a simple computer program for nuclear perimeter, area, diameter and nuclear contour index.

RESULTS

All parameters showed statistically significant higher values for MF. Area was the variable with the strongest discriminating power between the two groups of patients. Thus even if morphological evaluation is not accurate to distinguish benign versus malignant dermal lymphoid infiltrates, due to the variability of size and shape of these cells, a more sensitive method promptly shows this difference.

CONCLUSION

Results suggest that morphometry of CD3-positive lymphoid cells may add valuable information in the differential diagnosis of MF and benign dermatoses.

Sugar absorption by the biliary ductular epithelium of the rat: evidence for two transport systems

Sugar absorption by the biliary ductular epithelium under steady-state conditions was examined using isolated perfused rat liver. The test sugar and mannitol (as a putative marker of paracellular entry) were added to the glucose-free recirculating perfusate each at a concentration of 5 mmol/L, and apparent active biliary ductular absorption equated with the change in concentration of the test sugar relative to that of mannitol. A metabolizable hexose (D-glucose), pentose (D-xylose), and three nonmetabolizable hexoses (alpha-methyl-glucoside, 3-o-methyl-glucose, and L-glucose) were used. All five monosaccharides were well absorbed at constant rates for 2 hours with apparent rates of absorption (mumol.kg body weight-1.min-1, mean +/- SE) of D-glucose, 0.24 +/- 0.01; L-glucose, 0.20 +/- 0.02; 3-o-methyl-glucose, 0.19 +/- 0.02; alpha-methyl-glucoside, 0.16 +/- 0.03; and D-xylose, 0.10 +/- 0.04. The addition of phloridzin to the perfusate inhibited D-glucose absorption in part but did not inhibit L-glucose absorption. When perfusate Na+ was replaced by N-methylglucamine, the bile-plasma ratio of mannitol remained unchanged, as did the apparent absorption rate of D-glucose and 3-o-methyl-glucose. In contrast, absorption of L-glucose and alpha-methyl-D-glucoside gradually ceased. The addition of 15 mmol/L glucose to the perfusate caused decreased bile flow and increased taurocholate concentration in bile, suggesting that glucose absorption by the biliary ductules induced water reabsorption. It is concluded that sugars are absorbed by the biliary ductular system by Na(+)-dependent and Na(+)-independent transport systems, the substrate affinities of which differ from those reported for apical membrane hexose transport systems in renal tubular and intestinal epithelia. Ductular absorption of solutes such as glucose that enter bile passively may have biological use, because ductular absorption decreases the concentration of substrates for bacterial growth in gallbladder bile. On the other hand, ductular absorption of solutes induces reabsorption of biliary water, resulting in decreased bile flow; this might contribute to cholestasis during prolonged hyperalimentation with solutions containing glucose.