2024.1

1 - Food packaging and endocrine disruptors.J Pediatr (Rio J). 2024 Mar-Apr;100 Suppl 1(Suppl 1):S40-S47. doi: 10.1016/j.jped.2023.09.010.

de Paula LCP(1), Alves C(2).

Afiliação:
(1)    Hospital de Clínicas da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Residência de Endocrinologia e Endocrinologia Pediátrica, Porto Alegre, RS, Brazil.
(2)    Universidade Federal da Bahia, Faculdade de Medicina, Hospital Universitário Prof. Edgard Santos, Serviço de Endocrinologia Pediátrica, Salvador, BA, Brazil.

OBJECTIVES:
Narrative review evaluating food contamination by endocrine disruptors present in food packaging. DATA SOURCE: The terms "endocrine disruptors" and "food packaging" were used in combination in the PubMed, MEDLINE and SciELO databases, evaluating studies, in humans, published in Portuguese, English, French and Spanish between 1990 and 2023. DATA SYNTHESIS: Packaging, especially those made from plastic or recycled material, is an important source of food contamination by endocrine disruptors. Bisphenols and phthalates are the endocrine disruptors most frequently associated with food contamination from packaging. However, many unknown substances and even those legally authorized can cause harm to health when exposure is prolonged or when substances with additive effects are mixed. Furthermore, the discarding of packaging can cause contamination to continue into the environment. CONCLUSION: Although packaging materials are essential for the transport and storage of food, many of them are associated with chemical contamination. As it is not possible to exclude them from our routine, it is important to develop research aimed at identifying the endocrine disruptors present in them, including the effects of chronic exposure; and that regulatory agencies and industry come together to reduce or prevent this risk. Additionally, consumers must be instructed on how to purchase products, handle them and prepare them to reduce the migration of chemical substances into food.

 2 - Diagnosis and treatment of eating disorders in children and adolescents. J Pediatr (Rio J). 2024 Mar-Apr;100 Suppl 1(Suppl 1):S88-S96. doi: 10.1016/j.jped.2023.12.001. Epub 2023 Dec 26.

Robatto AP(1), Cunha CM(1), Moreira LAC(2).

Afiliação:
(1)    Universidade Federal da Bahia, Faculdade de Medicina, Departamento de Pediatria, Salvador, BA, Brazil.
(2)    Ambulatório de Transtornos Alimentares do C- HUPES (ATAH), Departamento de Pediatria, Salvador, BA, Brazil.

OBJECTIVES:
To provide a narrative review of the main eating disorders (ED), specifically focusing on children and adolescents. This review also aims to help the pediatrician identify, diagnose, and refer children and adolescents affected by this medical condition and inform them about the multidisciplinary treatment applied to these disorders. DATA SOURCE: The research was conducted in the Scientific Electronic Library Online (SciELO), Medical Literature Analysis and Retrieval System Online (Medline) databases via PubMed and Embase. Consolidated Guidelines and Guidebooks in the area were also included in the review to support the discussion of ED treatment in childhood and adolescence. DATA SYNTHESIS: ED are psychiatric condition that usually begins in adolescence or young adulthood but can occur at any time of life, including in childhood, which has been increasingly frequent. Pediatricians are the first professionals to deal with the problem and, therefore, must be well trained in identifying and managing these disorders, which can be severe, and determine physical complications and quality of life of patients and their families. CONCLUSION: ED has shown an increase in prevalence, as well as a reduction in the age of diagnosed patients, requiring adequate detection and referral by pediatricians. The treatment requires a specialized multidisciplinary team and is generally long-lasting for adequate recovery of affected individuals.

3 - Latin American Trans-ancestry INitiative for OCD genomics (LATINO): Study protocol. Am J Med Genet B Neuropsychiatr Genet. 2024 Jun;195(4):e32962. doi: 10.1002/ajmg.b.32962.

Crowley JJ(1)(2), Cappi C(3)(4), Ochoa-Panaifo ME(5), Frederick RM(6), Kook M(6), Wiese AD(6), Rancourt D(7), Atkinson EG(8), Giusti-Rodriguez P(9), Anderberg JL(6); Latin American Trans‐ancestry INitiative for OCD genomics; Brazilian Obsessive‐Compulsive Spectrum Disorder Working Group; Abramowitz JS(10), Adorno VR(11), Aguirre C(12), Alves GS(13), Alves GS(14)(15), Ancalade N(1), Arellano Espinosa AA(16), Arnold PD(17), Ayton DM(6), et al.

Afiliação:
(1)    Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
(2)    Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
(3)    Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
(4)    Departamento de Psiquiatria, Universidade de São Paulo, São Paulo, São Paulo, Brazil.
(5)    Universidad Privada del Norte, Lima, Lima, Peru.
(6)    Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.
(7)    Department of Psychology, University of South Florida, Tampa, Florida, USA.
(8)    Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.
(9)    Department of Psychiatry, University of Florida College of Medicine, Gainesville, Florida, USA.
(10)Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
(11)Hospital Psiquiátrico de Asunción, Direccion General, Asuncion, Central, Paraguay.
(12)Departamento de Psiquiatría, Hospital Psiquiátrico de Asunción, Asuncion, Central, Paraguay.
(13)Hospital Nina Rodrigues/Universidade Federal do Maranhão (UFMA), Sao Luis do Maranhao, Maranhao, Brazil.
(14)Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia-LANP, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(15)Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Pós-Graduação em Medicina e Saúde, Salvador, Bahia, Brazil.
(16)Talk TOC, Ciudad de Mexico, Mexico.
(17)The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
...

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder. Worldwide, its prevalence is ~2% and its etiology is mostly unknown. Identifying biological factors contributing to OCD will elucidate underlying mechanisms and might contribute to improved treatment outcomes. Genomic studies of OCD are beginning to reveal long-sought risk loci, but >95% of the cases currently in analysis are of homogenous European ancestry. If not addressed, this Eurocentric bias will result in OCD genomic findings being more accurate for individuals of European ancestry than other ancestries, thereby contributing to health disparities in potential future applications of genomics. In this study protocol paper, we describe the Latin American Trans-ancestry INitiative for OCD genomics (LATINO, https://www.latinostudy.org). LATINO is a new network of investigators from across Latin America, the United States, and Canada who have begun to collect DNA and clinical data from 5000 richly phenotyped OCD cases of Latin American ancestry in a culturally sensitive and ethical manner. In this project, we will utilize trans-ancestry genomic analyses to accelerate the identification of OCD risk loci, fine-map putative causal variants, and improve the performance of polygenic risk scores in diverse populations. We will also capitalize on rich clinical data to examine the genetics of treatment response, biologically plausible OCD subtypes, and symptom dimensions. Additionally, LATINO will help elucidate the diversity of the clinical presentations of OCD across cultures through various trainings developed and offered in collaboration with Latin American investigators. We believe this study will advance the important goal of global mental health discovery and equity.

4 - Use of dietary supplements by children and adolescents. J Pediatr (Rio J). 2024 Mar-Apr;100 Suppl 1(Suppl 1):S31-S39. doi: 10.1016/j.jped.2023.09.008.

Barretto JR(1), Gouveia MADC(2), Alves C(3).

Afiliação:
(1)    Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.
(2)    Faculdade de Medicina da Universidade Federal de Pernambuco, Recife, PE, Brazil.
(3)    Universidade Federal da Bahia, Faculdade de Medicina, Serviço de Endocrinologia Pediátrica do Hospital Universitário Prof. Edgard Santos, Salvador, BA, Brazil.

OBJECTIVES: Narrative review evaluating the use of dietary supplements by children and adolescents. DATA SOURCE: The terms "dietary supplements", "children" and "adolescents" were used in combination in the PubMed, MEDLINE, and SciELO databases, between 2000 and 2023, evaluating studies in humans, published in Portuguese, English, French and Spanish. DATA SYNTHESIS: The use of dietary supplements by children and adolescents has increased in recent decades. The most commonly used supplements are vitamins, minerals, trace elements, proteins, amino acids, melatonin, fatty acids, probiotics and energy drinks. CONCLUSION: Despite having specific indications, most of the time they are not prescribed by a healthcare professional. The reasons for use are varied. In children, the main reasons are protection against infections, stimulating growth, and poor food intake, with multivitamins and minerals being the most commonly used supplements. In adolescents, they are used to improve athletic performance and attain the "ideal body", with proteins and amino acids being the most often used nutrients. As they are not regulated by health agencies and are sold without a prescription, their unsupervised use can lead to inadequate doses, with inefficiency or overdose risk. As for compounding formulations, or when available in preparations with multiple nutrients, the chance of errors increases. It is essential that pediatricians advise parents and patients about the indications, risks and benefits, prescribing them when necessary.

5 - Esketamine Augmentation in Treatment-Resistant Obsessive-Compulsive Disorder: A Retrospective Chart Review. Clin Neuropharmacol. 2024 Jan-Feb 01;47(1):17-21. doi: 10.1097/WNF.0000000000000578.

Alves-Pereira R, Fontes M, Cordeiro V, Bandeira ID, Faria-Guimarães D(1), Silva SS(1), Mello RP, Leal GC, Sampaio AS, Quarantini LC.

Afiliação:
(1)    Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia.

OBJECTIVE: Converging evidence supports the role of the glutamate, an excitatory amino acid neurotransmitter, in the pathophysiology of obsessive-compulsive disorder (OCD). Ketamine and esketamine, both noncompetitive N -methyl- d -aspartate antagonists, have emerged as a promising medication for this psychiatric disorder, given its possible efficacy with faster onset and good tolerability. The purpose of this retrospective chart review is to evaluate whether unbiased clinical documentation supports formal clinical trials of esketamine for an OCD indication. METHODS: A retrospective chart review of patients with treatment-resistant OCD receiving a single dose of esketamine (0.5mg/kg) added to standard therapy was conducted. The Yale-Brown Obsessive-Compulsive Scale and the Montgomery-Åsberg Depression Rating Scale were used to evaluate OCD and depressive symptoms respectively at baseline, 24 hours, and 7 days after esketamine administration. Descriptive statistics were used to analyze the data. RESULTS: Eight subjects were identified in this retrospective chart review: esketamine was administered subcutaneously in 7 and intravenously in 1. One week after infusion, 25% of the sample met criteria for treatment response and 50% for partial response. Major depressive disorder was a comorbid diagnosis in 75% of the sample and 2 of these subjects showed a positive antidepressant response. CONCLUSIONS: Our findings provide preliminary evidence that esketamine may reduce obsessive-compulsive symptoms in a subset of treatment-resistant OCD patients.

6 - CKD-Associated Pruritus and Clinical Outcomes in Nondialysis CKD. Kidney Med. 2023 Nov 28;6(1):100754. doi: 10.1016/j.xkme.2023.100754.

Scherer JS(1), Tu C(2), Pisoni RL(2), Speyer E(3), Lopes AA(4), Wen W(5), Menzaghi F(5), Cirulli J(5), Alencar de Pinho N(3), Pecoits-Filho R(2), Karaboyas A(2); CKDopps Investigators.

Afiliação:
(1)    Division of Geriatrics and Palliative Care and Division of Nephrology, NYU Grossman School of Medicine, New York, NY.
(2)    Arbor Research Collaborative for Health, Ann Arbor, MI.
(3)    Centre for Research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France.
(4)    Clinical Epidemiology and Evidence-Based Medicine Unit of the Edgard Santos University Hospital and Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil.
(5)    Cara Therapeutics, Inc, Stamford, CT.

RATIONALE & OBJECTIVE: Itching is a frequent symptom experienced by people with chronic kidney disease (CKD). We investigated the associations of CKD-associated pruritus (CKD-aP) with clinical outcomes. STUDY DESIGN: This was a longitudinal cohort study. SETTING & PARTICIPANTS: Patients from Brazil, France, and the United States enrolled in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) from 2013 to 2021, an international prospective cohort study of adults with nondialysis dependent CKD, and an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2 were included. EXPOSURE: CKD-aP was self-reported by response to the question: "During the past 4 weeks, to what extent were you bothered by itchy skin?" OUTCOMES: The outcomes were as follows: CKD progression, kidney replacement therapy (KRT) initiation, mortality, hospitalization, cardiovascular events, infection events. ANALYTICAL APPROACH: Associations with time-to-event outcomes were investigated using Cox proportional hazards models adjusted for potential confounders. RESULTS: There were 4,410 patients from 91 clinics with a median age of 69 years and a median eGFR at patient questionnaire completion of 29 (21-38) mL/min/1.73 m2. The proportion of patients not at all, somewhat, moderately, very much, and extremely bothered by itchy skin was 49%, 27%, 13%, 7%, and 3%, respectively. Patients with more advanced stages of CKD, older age, and greater comorbidities reported to be more likely bothered by itchy skin. Among patients at least moderately bothered, 23% were prescribed at least 1 pharmacotherapy (35% in the United States, 19% in France, 4% in Brazil), including antihistamine (10%), gabapentin (6%), topical corticosteroids (4%), pregabalin (3%), or sedating antihistamine (3%). The HR (95% CI) for patients extremely (vs not at all) bothered was 1.74 (1.11-2.73) for all-cause mortality, 1.56 (1.11-2.18) for all-cause hospitalization, and 1.84 (1.22-2.75) for cardiovascular events. As CKD-aP severity increased, patients also had higher rates of infection events (P = 0.04); CKD-aP severity was not associated with KRT initiation (P = 0.20) or CKD progression (P = 0.87). LIMITATIONS: The limitations were 25% nonresponse rate, recall bias, and residual confounding factors. CONCLUSIONS: These results demonstrate a strong association between severe itch and clinical outcomes, providing the nephrology community new insights into the possible adverse consequences of CKD-aP in individuals with nondialysis CKD, and warrant further exploration. PLAIN-LANGUAGE SUMMARY: Chronic kidney disease-associated pruritus (CKD-aP) is a common disturbing symptom of chronic kidney disease (CKD). This article analyzes longitudinal data from the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) to describe prevalence of CKD-aP in 4,410 individuals with nondialysis CKD, and its association with clinical outcomes. We found that 51% of the surveyed population were bothered by pruritus. CKD-aP was more prevalent in those with more advanced stages of CKD, older age, and with more comorbid conditions. Compared to those not at all bothered by pruritus, those who were extremely bothered had a higher risk of all-cause mortality, hospitalizations, and cardiovascular events. Severity of CKD-aP was not associated with CKD progression or initiation of kidney replacement therapy.

7 - Infective dermatitis associated with human T-cell lymphotropic virus type-1, an underdiagnosed disease. Int J Infect Dis. 2024 Aug;145:107058. doi: 10.1016/j.ijid.2024.107058.

Bittencourt AL(1), Farre L(2).

Afiliação:
(1)    Department of Pathology, Prof. Edgard Santos Teaching Hospital, Federal University of Bahia, Salvador, Brazil.
(2)    Program Against Cancer Therapeutic Resistance (ProCURE), Catalan Institute of Oncology (ICO), ONCOBELL, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Spain.

Infective dermatitis associated with human T-cell lymphotropic virus type-1 (HTLV-1) (IDH) is a severe form of chronically infected eczema occurring in early childhood, although very rarely cases have been reported in adults. Most of the cases are from Jamaica and Brazil and occur in individuals with low socioeconomic status. IDH is always associated with refractory Staphylococcus aureus or beta-hemolytic Streptococcus infection of the skin and nasal vestibules. Patients with IDH may develop other even more severe HTLV-1-associated diseases, such as HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) of early or late appearance and adult T-cell leukemia/lymphoma. In the context of the Brazilian experience, it has been observed that 54% of IDH patients exhibit the juvenile form of HAM/TSP while the estimated incidence of adult HAM/TSP is 3%. As there are no curative treatments for HTLV-1 infection (or vaccines) or most of its associated diseases, prevention of infection is fundamental, mainly by vertical transmission, as it is responsible for the development of IDH, infantojuvenile HAM/TSP, and ATL. Public measures to reduce this transmission must be implemented urgently. Furthermore, it is recommended, mainly in HTLV-1 endemic areas, to search for HTLV-1 infection in all patients with infected eczema, even in adults.

8 - Anesthesia and perioperative care management in patients with Dengue Fever: considerations and challenges. Braz J Anesthesiol. 2024 Jul-Aug;74(4):844511. doi: 10.1016/j.bjane.2024.844511.

Carvalho LIM(1), Azi LMTA(2), Leal PDC(3), Lorentz MN(4), Diego LADS(5), Schmidt AP(6).

Afiliação:
(1)    Hospital Prontomed, Departamento de Anestesiologia, Teresina, PI, Brazil; Hospital Unimed Primavera, Teresina, PI, Brazil.
(2)    (2)Hospital Universitário Professor Edgard Santos, Departamento de Anestesiologia, Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.
(3)    (3)Hospital São Domingos, Departamento de Anestesiologia, São Luís, MA, Brazil; Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil.
(4)    Hospital Biocor / Rede D'or, Nova Lima, MG, Brazil.
(5)    Universidade Federal Fluminense (UFF), Departamento de Anestesiologia, Rio de Janeiro, RJ, Brazil.
(6)    Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Santa Casa de Porto Alegre, Serviço de Anestesia, Porto Alegre, RS, Brazil; Hospital Nossa Senhora da Conceição, Serviço de Anestesia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Ciências Cirúrgicas, Porto Alegre, RS, Brazil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), Programa de Pós-Graduação em Anestesiologia, Ciências Cirúrgicas e Medicina Perioperatória, São Paulo, SP, Brazil.

Sem Resumo

9 - Editorial: How often can we get the right diagnosis after bone marrow transplant in patients with abnormal liver function tests? Authors' reply. Aliment Pharmacol Ther. 2024 Mar;59(5):707-708. doi: 10.1111/apt.17870.

Dezan MGF(1)(2)(3), Cavalcante LN(1)(2)(3), Silva HRC(4), de Moura Almeida A(4)(5), de Assis LHDS(4), de Freitas TT(4), de Araújo MAS(3)(4)(5), Cotrim HP(2)(3), Lyra AC(1)(2)(3).

Afiliação:
(1)    Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Gastro-Hepatology  ervice, Hospital São Rafael, Salvador, Bahia, Brazil.
(2)    Gastro-Hepatology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil.
(3)    (3)Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil.
(4)    Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Hematology Service, Hospital São Rafael, Salvador, Bahia, Brazil.
(5)    Hematology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil.

Sem Resumo

10 - Characterization of drug-induced liver injury associated with drug reaction with eosinophilia and systemic symptoms in two prospective DILI registries. Arch Toxicol. 2024 Jan;98(1):303-325. doi: 10.1007/s00204-023-03630-0.

Medina-Cáliz I(#)(1), Sanabria-Cabrera J(#)(1)(2)(3), Villanueva-Paz M(#)(1)(2), Aukštikalnė L(4), Stephens C(1)(2), Robles-Díaz M(1)(2), Pinazo-Bandera JM(1)(2), García-Cortes M(1)(2), Conde I(2)(5), Soriano G(2)(6), Bessone F(7), Hernandez N(8), Nunes V(9), Paraná R(9), ..., Alvarez-Alvarez I(#)(1)(2)(3).

Afiliação:
(1)    Servicios de Aparato Digestivo y Farmacología Clínica, Hospital Universitario Virgen de La Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Universidad de Málaga, Málaga, Spain.
(2)    Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
(3)    Plataforma de Investigación Clínica y Ensayos Clínicos, Plataforma ISCIII de Investigación Clínica, UICEC-IBIMA, Madrid, Spain.
(4)    Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
(5)    (5)Unidad de Hepatología, Hospital Universitari I Politècnic La Fe, Servicio de Aparato Digestivo, Valencia, Spain.
(6)    Servicio de Gastroenterología, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
(7)    Hospital Provincial del Centenario, Rosario, Argentina.
(8)    Hospital de Clínicas, Montevideo, Uruguay.
(9)    Hospital Universitário Prof. Edgard Santos-UFBA, Salvador, Brazil.
...

Idiosyncratic drug-induced liver injury (DILI) associated with drug reactions with eosinophilia and systemic symptoms (DRESS) is poorly characterized among patients of Western countries. We aimed to comprehensively assess the clinical characteristics, outcomes, and causative agents in a prospective, well-vetted cohort of DILI patients with DRESS (DILI-DRESS). We identified 53 DILI-DRESS cases from the Spanish DILI Registry and the Latin American DILI Network. For comparison purposes, we defined a group of DILI patients (n = 881). DILI-DRESS cases were younger (47 vs. 53 years, respectively; p = 0.042) and presented more frequently with cholestatic/mixed damage (p = 0.018). Most DILI-DRESS patients showed moderate liver injury, 13% developed severe damage, and only one patient (with hepatocellular injury due to anti-tuberculosis drugs) progressed to acute liver failure and died. DILI-DRESS cases showed a distinctive causative drug pattern compared to DILI cases. The most frequent drugs were carbamazepine (13%), anti-tuberculosis drugs (13%), amoxicillin-clavulanate (11%), and allopurinol and lamotrigine (7.6% each). Among all cases of DILI due to allopurinol and lamotrigine, 67% presented with a DILI-DRESS phenotype, respectively. Higher total bilirubin (TBL) levels at DILI recognition (odds ratio [OR] 1.23; 95% confidence interval [CI] 1.04-1.45) and absence of eosinophilia (OR 8.77; 95% CI 1.11-69.20) increased the risk for developing a severe-fatal injury in DILI-DRESS patients. DILI-DRESS patients have a more frequent cholestasis/mixed pattern of injury at presentation, with antiepileptics as distinctive causative drug class. Most of the lamotrigine and allopurinol cases present with this phenotype. Higher TBL levels and absence of eosinophilia at DILI recognition are markers of poor outcomes.

11 - Classic and Atypical Late Infantile Neuronal Ceroid Lipofuscinosis in Latin America: Clinical and Genetic Aspects, and Treatment Outcome with Cerliponase Alfa. Mol Genet Metab Rep. 2024 Feb 1;38:101060. doi: 10.1016/j.ymgmr.2024.101060.

Guelbert N(1), Espitia Segura OM(2), Amoretti C(3), Arteaga Arteaga A(4), Atanacio NG(5), Bazan Natacha S(6), Carvalho EDF(7)(8), Carvalho de Andrade MDF(7)(8)(9)(10)(11), Denzler IM(12), Durand C(13), Ribeiro E(14), Giugni JC(15), González G(16), González Moron D(17), Guelbert G(18), Hernández Rodriguez ZJ(19), Embiruçu Emilia K(20), Kauffman MA(17), Mancilla NI(21), et al.

Afiliação:
(1)    Clínica Universitaria Reina Fabiola, Córdoba, Argentina.
(2)    Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia.
(3)    Hospital Universitário Professor Edgar Santos, Salvador, Brazil.
(4)    Clínica León XIII, Medellín, Colombia.
(5)    Hospital de Niños Pedro de Elizalde (HNPE), Buenos Aires, Argentina.
(6)    Hospital Italiano Buenos Aires, Buenos Aires, Argentina.
(7)    Christus University Center (UNICHRISTUS), Fortaleza, Brazil.
(8)    General Hospital Dr. Cesar Cals, Fortaleza, Brazil.
(9)    Universidade Estadual do Ceará (UECE), Fortaleza, Brazil.
(10)Hospital Universitário do Ceará, Fortaleza, Brazil.
(11)Faculdadde Paulo Picanço, Fortaleza, Brazil.
(12)Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
(13)Laboratorio de Neuroquímica Dr. N.A. Chamoles, Ciudad Autónoma de Buenos Aires, Argentina.
(14)Hospital Infantil Albert Sabin, Fortaleza, Brazil.
(15)Hospital Dr. Guillermo Rawson, San Juan, Argentina.
(16)Centro Hospitalario Pereira Rossell (CHPR), Montevideo, Uruguay.
(17)Hospital JM Ramos Mejía, Buenos Aires, Argentina.
(18)Hospital de Niños de la Santísima Trinidad, Córdoba, Argentina.
(19)Hospital Central de la Policía Nacional, Bogotá, Colombia.
(20)Hospital Universitario Professor Edgard Santos, Salvador, Brazil.
(21)Universidad Nacional de Colombia, Bogotá, Colombia.

INTRODUCTION: Late infantile neuronal ceroid lipofuscinosis type 2 (CLN2), is a neurodegenerative autosomal recessive disease caused by TPP1 gene variants, with a spectrum of classic and atypical phenotypes. The aim of treatment is to slow functional decline as early as possible in an attempt to improve quality of life and survival. This study describes the clinical characteristics as well as the response to treatment with cerliponase alfa. MATERIALS AND METHODS: A retrospective study was conducted in five Latin-American countries, using clinical records from patients with CLN2. Clinical follow-up and treatment variables are described. A descriptive and bivariate statistical analysis was performed. RESULTS: A total of 36 patients were observed (range of follow-up of 61-110 weeks post-treatment). At presentation, patients with the classic phenotype (n = 16) exhibited regression in language (90%), while seizures were the predominant symptom (87%) in patients with the atypical phenotype (n = 20). Median age of symptom onset and time to first specialized consultation was 3 (classical) and 7 (atypical) years, while the median time interval between onset of symptoms and treatment initiation was 4 years (classical) and 7.5 (atypical). The most frequent variant was c.827 A > T in 17/72 alleles, followed by c.622C > T in 6/72 alleles. All patients were treated with cerliponase alfa, and either remained functionally stable or had a loss of 1 point on the CLN2 scale, or up to 2 points on the Wells Cornel and Hamburg scales, when compared to pretreatment values.DISCUSSION AND CONCLUSION: This study reports the largest number of patients with CLN2 currently on treatment with cerliponase alfa in the world. Data show a higher frequency of patients with atypical phenotypes and a high allelic proportion of intron variants in our region. There was evidence of long intervals until first specialized consultation, diagnosis, and enzyme replacement therapy. Follow-up after the initiation of cerliponase alfa showed slower progression or stabilization of the disease, associated with adequate clinical outcomes and stable functional scores. These improvements were consistent in both clinical phenotypes.

12 - Immunosenescence and Inflammation in Chronic Obstructive Pulmonary Disease: A Systematic Review. J Clin Med. 2024 Jun 13;13(12):3449. doi: 10.3390/jcm13123449.

Ramos Jesus F(1)(2), Correia Passos F(2), Miranda Lopes Falcão M(3), Vincenzo Sarno Filho M(4), Neves da Silva IL(2), Santiago Moraes AC(2), Lima Costa Neves MC(4), Baccan GC(2).

Afiliação:
(1)    Maternidade Climério de Oliveira (MCO/EBSERH), Universidade Federal da Bahia, Salvador 40055-150, Bahia, Brazil.
(2)    Departamento de Bioquímica e Biofísica, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador 40110-110, Bahia, Brazil.
(3)    Departamento de Saúde, Universidade Estadual de Feira de Santana, Avenida Transnordestina, s/n-Novo Horizonte, Feira de Santana 44036-900, Bahia, Brazil.
(4)    Unidade do Sistema Respiratório, Ambulatório Professor Francisco Magalhães Neto-Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador 40110-200, Bahia, Brazil.

Background/Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a disease of premature aging, characterized by airflow limitations in the lungs and systemic chronic inflammation. This systematic review aimed to provide a systematic overview of immunosenescence and inflammation in Chronic Obstructive Pulmonary Disease (COPD). Methods: The PubMed, Science Direct, Scopus, Cochrane Library, and Web of Science databases were searched for studies on markers of immunosenescence. Observational studies comparing patients with COPD to individuals without disease were evaluated, considering the following markers: inflammation and senescence in COPD, naïve, memory, and CD28null T cells, and telomere length in leukocytes. Results: A total of 15 studies were included, eight of which were rated as high quality. IL-6 production, telomere shortening, and the higher frequencies of CD28null T cells were more prominent findings in the COPD studies analyzed. Despite lung function severity being commonly investigated in the included studies, the importance of this clinical marker to immunosenescence remains inconclusive. Conclusions: The findings of this systematic review confirmed the presence of accelerated immunosenescence, in addition to systemic inflammation, in stable COPD patients. Further studies are necessary to more comprehensively evaluate the impact of immunosenescence on lung function in COPD.

13 - Clinical profile of vitiligo patients and relationship with immuno-inflammatory markers. An Bras Dermatol. 2024 Mar-Apr;99(2):196-201. doi: 10.1016/j.abd.2023.03.007.

Mascarenhas MRM(1), Oliveira MC(2), Oliveira LF(2), Magalhães AS(2), Machado PRL(2).

Afiliação:
(1)    Dermatology Service, Hospital Universitário Professor Edgard Santos, Salvador, BA, Brazil.
(2)    Dermatology Service, Hospital Universitário Professor Edgard Santos, Salvador, BA, Brazil.

BACKGROUND: Vitiligo is the most common pigmentary disorder and is considered a chronic, cumulative, multifactorial disease. The crucial role of cytotoxic CD8+ T lymphocytes and the IFNγ/CXCL10 axis has been demonstrated in its pathogenesis. OBJECTIVE: To evaluate the clinical profile and immuno-inflammatory markers in patients with vitiligo in a reference medical center. METHODS: Cross-sectional study in which all patients with vitiligo seen at the medical center the from 2019 to 2022 were evaluated, to outline the clinical profile. Moreover, cardiovascular risk biomarkers (neutrophil/lymphocyte ratio and C-reactive protein levels) were measured, as well as cytokines and chemokines (TNFα, IFNγ, IL10, IL15 and CXCL10) in the serum of a subgroup of 30 patients. RESULTS: There was a predominance of females, with a mean age of 43 years. Most were phototypes IV or V (71.3%), without comorbidities (77.55%), and without a family history of vitiligo (70.41%). Higher levels of neutrophil/lymphocyte ratio, C-reactive protein, and inflammatory cytokines/chemokines were documented in vitiligo patients when compared to the control group (non-significant). As relevant data, the highest values of CXCL10 were detected in patients with vitiligo versus controls, as well as in patients with disease of shorter duration (p<0.05). STUDY LIMITATIONS: The number of assessed patients was small due to recruitment difficulties caused by the COVID-19 pandemic. CONCLUSION: The present data contribute to confirming the relevant role of the IFNγ/CXCL10 axis in the pathogenesis of vitiligo, highlighting CXCL10 as a possible activity marker.

14 - COVID-19 in multiple myeloma patients: frequencies and risk factors for hospitalization, ventilatory support, intensive care admission and mortality -cooperative registry from the Grupo Brasileiro de Mieloma Multiplo (GBRAM). Hematol Transfus Cell Ther. 2024 Apr-Jun;46(2):153-160. doi: 10.1016/j.htct.2023.08.002.

Garnica M(1), Crusoe EQ(2), Ribeiro G(3), Bittencourt R(4), Magalhães RJP(5), Zanella KR(6), Hallack Neto AE(7), Lima JS(8), Solo CB(9), Souza EG(3), Fernandes AM(10), Maiolino A(11), Hungria V(12).

Afiliação:
(1)    Universidade Federal do Rio de Janeiro (UFRJ), Brazil; Tranplant Unit, Complexo Hospitalar de Niterói (DASA - CHN), Brazil.
(2)    Hospital Universitário Professor Edgar Santos (HUPES), Universidade Federal da Bahia, Brazil.
(3)    Universidade Federal de Minas Gerais, Brazil.
(4)    Universidade federal do Rio Grande do Sul, Brazil.
...

INTRODUCTION: This study evaluated outcomes and risk factors for COVID-19 in 91 Brazilian multiple myeloma (MM) patients between April 2020 and January 2022. RESULTS: Of the 91 MM patients diagnosed with COVID-19, 64% had comorbidities and 66% required hospitalization due to COVID-19, with 44% needing ventilatory support and 37% intensive care. Age (OR 2.02; 95%CI 1.02 - 7.7) and hypertension OR 4.5; 95%CI 1.3 - 15.5) were independently associated with hospitalization and certain MM therapies (corticosteroids and monoclonal drugs) were associated with ventilatory support (OR 4.3; 95%CI 1.3 - 14 and OR 5.7; 95%CI 1.8 - 18, respectively), while corticosteroids and immunomodulatory drugs were linked to ICU admission (OR 5.1; 95% CI 1.4 - 18 and OR 3.4; 95%CI 1.1 - 10, respectively). The overall mortality rate was 30%, with the highest rate observed in the ICU (73%). Additionally, the ECOG performance status was linked to increased mortality (OR 11.5; 95%CI 1.9 - 69). The MM treatment was delayed in 63% of patients who recovered from COVID-19. CONCLUSIONS: The findings highlight the need for preventing COVID-19 and prioritizing vaccination among MM patients, as they have high rates of severe outcomes in the event of COVID-19. It is also essential to monitor the potential clinical impacts of COVID-19 on MM patients in the long-term. Given the limited resources available in treating MM patients in Brazil during the COVID-19 pandemic, outcomes might be worse in this population.

15 - Corneal Collagen Crosslinking for Ectasia After Refractive Surgery: A Systematic Review and Meta-Analysis. Clin Ophthalmol. 2024 Mar 19;18:865-879. doi: 10.2147/OPTH.S451232.

Amaral DC(1), Menezes AHG(1), Vilaça Lima LC(1), Faneli AC(2), Neto PFS(3), Canedo ALC(4), Mora-Paez DJ(5), Guedes JAF(5), Louzada RN(1), Fontes BM(6). 

Afiliação:
(1)    Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
(2)    Faculdade de Medicina, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.
(3)    Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brazil.
(4)    Ophthalmology, Hospital Israelita Albert Einstein, Goiânia, GO, Brazil.
(5)    Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA.
(6)    Ophthalmology, Opty Group, Rio de Janeiro, RJ, Brazil.

INTRODUCTION: Corneal ectasia leads to progressive irregular corneal curvature and reduced visual acuity. OBJECTIVE: To assess the safety and effectiveness of corneal collagen cross-linking (CXL) for managing corneal ectasia resulting from refractive laser surgery (RSL). METHODS: A systematic review and meta-analysis were realized according to PRISMA guidelines. We searched PubMed, EMBASE, Cochrane, and Web of Science databases for studies on CXL in patients with ectasia after RLS. The outcomes of interest included visual acuity, refractive outcomes, topographic parameters (Kmax, index surface variance (ISV), index of Vertical Asymmetry (IVA), keratoconus index (KI), central keratoconus index (CKI), index of height asymmetry (IHA), index of height decentration (IHD) and Rmin (minimum sagittal curvature)), central corneal thickness, endothelial cell count, and possible adverse events. Statistical analysis was performed using the R software (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria). RESULTS: 15 studies encompassing 421 patients (512 eyes) were included. The mean age was 32.03 ± 4.4 years. The pooled results showed a stable uncorrected visual acuity post-CXL, with a significant improvement in corrected distance visual acuity (SMD = 0.09; 95% CI: -0.07 to 0.26). The spherical equivalent decreased significantly (SMD = -0.09; 95% CI: -0.35, -0.02). The topographic parameter Kmax decreased significantly (SMD = 0.15; 95% CI:0.01 to 0.28); however, the other parameters, ISV, IVA, KI, CKI, IHA, IHD, and Rmin, did not change significantly. Central corneal thickness decreased significantly (SMD = 0.24; 95% CI:0.07 to 0.41), and the endothelial cell count remained stable The complications were rare. CONCLUSION: CXL is a safe and effective technique for managing corneal ectasia after RLS.

16 - Etiología infecciosa e indicadores de malabsorción o daño intestinal en diarrea infantil. Biomedica. 2024 Mar 31;44(1):80-91. doi: 10.7705/biomedica.6913.

Martins AS(1), Santos SA(1), Lisboa CADS(2), Barros TF(3), Ribeiro TCM(4), Da Costa-Ribeiro H(4), Mattos ÂP(5), Almeida Mendes PS(4), Mendes CMC(6), Souza EL(7), Moreno Amor AL(8), Soares NM(3), Aquino Teixeira MC(3).

Afiliação:
(1)    Programa de Pós-Graduação em Farmácia, Universidade Federal da Bahia, Salvador, Brasil.
(2)    Laboratório de Análises Clínicas do Hospital Geral de Salvador - Hospital do Exército, Salvador, Brasil.
(3)    Programa de Pós-Graduação em Farmácia, Universidade Federal da Bahia, Salvador, Brasil; Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brasil.
(4)    Hospital Universitário Professor Edgard Santos - HUPES, Universidade Federal da Bahia, Salvador, Brasi.
(5)    Hospital Universitário Professor Edgard Santos - HUPES, Universidade Federal da BahiaHospital Universitário Professor Edgard Santos - HUPES, Universidade Federal da Bahia, Salvador, BrasiL.
(6)    Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brasil.
(7)    Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brasil.
(8)    Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia, Santo Antônio de Jesus, Brasil.

INTRODUCTION: The multifactorial etiology of gastroenteritis emphasizes the need for different laboratory methods to identify or exclude infectious agents and evaluate the severity of diarrheal disease. OBJECTIVE: To diagnose the infectious etiology in diarrheic children and to evaluate some fecal markers associated with intestinal integrity. MATERIALS AND METHODS: The study group comprised 45 children with diarrheal disease, tested for enteropathogens and malabsorption markers, and 76 children whose feces were used for fat evaluation by the traditional and acid steatocrit tests. RESULTS: We observed acute diarrhea in 80% of the children and persistent diarrhea in 20%. Of the diarrheic individuals analyzed, 40% were positive for enteropathogens, with rotavirus (13.3%) and Giardia duodenalis (11.1%) the most frequently diagnosed. Among the infected patients, occult blood was more evident in those carrying pathogenic bacteria (40%) and enteroviruses (40%), while steatorrhea was observed in infections by the protozoa G. duodenalis (35.7%). Children with diarrhea excreted significantly more lipids in feces than non-diarrheic children, as determined by the traditional (p<0.0003) and acid steatocrit (p<0.0001) methods. Moreover, the acid steatocrit method detected 16.7% more fecal fat than the traditional method. CONCLUSIONS: Childhood diarrhea can lead to increasingly severe nutrient deficiencies. Steatorrhea is the hallmark of malabsorption, and a stool test, such as the acid steatocrit, can be routinely used as a laboratory tool for the semi-quantitative evaluation of fat malabsorption in diarrheic children.

17 - The effect of antireaction medications on the association between periodontitis and leprosy reactions: An important methodological issue in periodontal medicine. J Periodontol. 2024 Jun 21. doi: 10.1002/JPER.23-0725.

Sacramento IS(1), Gomes-Filho IS(1), Cruz SSD(1)(2), Trindade SC(1), Figueiredo ACMG(3), Machado PRL(4), Vianna MIP(5), Falcão MML(1), Hintz AM(1), de Lacerda JA(5), Matos BC(5), Seymour GJ(6), Scannapieco FA(7), Loomer PM(8), Passos-Soares JS(1)(5).

Afiliação:
(1)    Department of Health, Feira de Santana State University, Feira de Santana, Bahia, Brazil.
(2)    Health Sciences Center, Federal University of Recôncavo of Bahia, Bahia, Brazil.
(3)    Federal District Health State Department, Epidemiology Surveillance, Distrito Federal, Brasília, Brazil.
(4)    Prof. Edgar Santos University Hospital, Federal University of Bahia, Salvador, Brazil.
(5)    Department of Preventive Dentistry, Faculty of Dentistry, Federal University of Bahia, Salvador, Brazil.
(6)    School of Dentistry, The University of Queensland, Queensland, Australia.
(7)    Department of Oral Biology, University at Buffalo, Buffalo, New York, USA.
(8)    School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.

BACKGROUND: The treatment of leprosy reactions (LRs) involves thalidomide, corticosteroids, and other immunomodulatory medications. This study evaluated the effect of these treatments on the association between periodontitis and LRs, as well as factors associated with LRs. METHODS: This case-control study was conducted on 283 individuals followed at a leprosy outpatient clinic in Brazil. The case group was comprised of 158 individuals presenting type 1 or type 2 LRs, and the control group of 125 leprosy individuals without reactions. A complete oral examination was performed to diagnose periodontitis, the independent variable. Antireaction medication used was collected from medical records, and participants were classified according to the use of prednisone and/or thalidomide, time of use, or non-use of medication. Socioeconomic-demographic, clinical, and lifestyle covariables were collected by interview. Unconditional logistic regression analysis by subgroups evaluated the effect of antireaction medication on the association between periodontitis and LRs, estimating the odds ratio with a 95% confidence interval (OR; 95% CI). RESULTS: A relationship between periodontitis and LRs was observed only in the subgroup using the association prednisone and thalidomide: ORadjusted = 0.32; 95% CI = 0.11-0.95. Conversely, more severe periodontal clinical parameters were observed in cases versus controls. Several socioeconomic, health conditions, and  lifestyle factors were associated with the presence of LRs.CONCLUSIONS: Although periodontal disease indicators were worse among the cases, the findings showed a negative relationship between periodontitis and LRs in individuals receiving associated prednisone and thalidomide. These medications appear to influence the inflammatory cascade between diseases, modifying and masking the manifestations of periodontitis.

18 - Immunogenicity and safety of beta variant COVID-19 vaccine AZD2816 and AZD1222 (ChAdOx1 nCoV-19) as primary-series vaccination for previously unvaccinated adults in Brazil, South Africa, Poland, and the UK: a randomised, partly double-blinded, phase 2/3 non-inferiority immunobridging study. Lancet Microbe. 2024 Aug;5(8):100863. doi: 10.1016/S2666-5247(24)00078-8.

Costa Clemens SA(1), Jepson B(2), Bhorat QE(3), Ahmad A(4), Akhund T(4), Aley PK(5), Bansal H(2), Bibi S(5), Kelly EJ(6), Khan M(7), Lambe T(8), Lombaard JJ(9), Matthews S(10), Pipolo Milan E(11), Olsson U(12), Ramasamy MN(13), Moura de Oliveira Paiva MS(14), Seegobin S(10), Shoemaker K(2), Szylak A(15), Villafana T(16), Pollard AJ(5), Green JA(17); AZD2816 Study Group.

Afiliação:
(1)    Department of Paediatrics, University of Oxford, Oxford, UK; Institute for Global Health, Siena University, Siena, Italy.
(2)    Biometrics, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA; Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA.
(3)    Soweto Clinical Trials Centre, Soweto, Gauteng, South Africa.
(4)    Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK.
(5)    Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
(6)    Formerly Translational Medicine, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA.
(7)    Clinical Development, BioPharmaceuticals R&D, AstraZeneca, Mississauga, ON, Canada.
(8)    Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Chinese Academy of Medical Science, Oxford Institute, University of Oxford, Oxford, UK.
(9)    Josha Research, Bloemfontein, Free State, South Africa.
(10)Biometrics, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK.
(11)Centro de Estudos e Pesquisas em Moléstias Infec, Centro de Pesquisas Clínicas de Natal, Natal, Rio Grande do Norte, Brazil.
(12)Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
(13)Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
(14)Instituto Atena de Pesquisa Clínica, Natal, Rio Grande do Norte, Brazil.
(15)Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Mississauga, ON, Canada.
(16)Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA.
(17)Clinical Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK.
(18)Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford, UK.
(19)Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(20)Hospital de Clínicas de Porto Alegre, Porto Alegre/RS, Rio Grande do Sul, Brazil.
...

BACKGROUND: AZD2816 is a variant-adapted COVID-19 vaccine that expresses the full-length SARS-CoV-2 beta variant spike protein but is otherwise similar to AZD1222 (ChAdOx1 nCoV-19). This study aimed to evaluate the safety and immunogenicity of AZD1222 or AZD2816 (or both) primary-series vaccination in a cohort of adult participants who were previously unvaccinated. METHODS: In this phase 2/3, randomised, multinational, active-controlled, non-inferiority, immunobridging study, adult participants previously unvaccinated for COVID-19 were enrolled at 16 study sites in Brazil, South Africa, Poland, and the UK. Participants were stratified by age, sex, and comorbidity and randomly assigned 5:5:5:2 to receive a primary series of AZD1222 (AZD1222 group), AZD2816 (AZD2816 [4-week] group), or AZD1222-AZD2816 (AZD1222-AZD2816 group) at 4-week dosing intervals, or AZD2816 at a 12-week interval (AZD2816 [12-week] group) and evaluated for safety and immunogenicity through 180 days after dose 2. Primary outcomes were safety (rates of solicited adverse events occurring during 7 days and unsolicited adverse events occurring during 28 days after each dose) and immunogenicity (non-inferiority of pseudovirus neutralising antibody geometric mean titre [GMT], GMT ratio margin of 0·67, and seroresponse rate, rate difference margin of -10%, recorded 28 days after dose 2 with AZD2816 [4-week interval] against beta vs AZD1222 against ancestral SARS-CoV-2) in participants who were seronegative at baseline. This trial is registered with ClinicalTrials.gov, NCT04973449, and is completed. FINDINGS: Between July 7 and Nov 12, 2021, 1449 participants were assigned to the AZD1222 group (n=413), the AZD2816 (4-week) group (n=415), the AZD1222-AZD2816 group (n=412), and the AZD2816 (12-week) group (n=209). Ten (2·6%) of 378 participants who were seronegative at baseline in the AZD1222 group, nine (2·4%) of 379 in the AZD2816 (4-week) group, eight (2·1%) of 380 in the AZD1222-AZD2816 group, and 11 (5·8%) of 191 in the AZD2816 (12-week) group had vaccine-related unsolicited adverse events. Serious adverse events were recorded in one (0·3%) participant in the AZD1222 group, one (0·3%) in the AZD2816 (4-week) group, two (0·5%) in the AZD1222-AZD2816 group, and none in the AZD2816 (12-week) group. Co-primary immunogenicity endpoints were met: neutralising antibody GMT (ratio 1·19 [95% CI 1·08-1·32]; lower bound greater than 0·67) and seroresponse rate (difference 1·7% [-3·1 to 6·5]; lower bound greater than -10%) at 28 days after dose 2 were non-inferior in the AZD2816 (4-week) group against beta versus in the AZD1222 group against ancestral SARS-CoV-2. Seroresponse rates were highest with AZD2816 against beta (12-week interval 94·3% [95% CI 89·4-97·3]; 4-week interval 85·7% [81·5-89·2]) and with AZD1222 (84·6% [80·3-88·2]) against ancestral SARS-CoV-2. INTERPRETATION: Primary series of AZD1222 and AZD2816 were well tolerated, with no emergent safety concerns. Both vaccines elicited robust immunogenicity against beta and ancestral SARS-CoV-2 with greater responses demonstrated when testing against SARS-CoV-2 strains that matched those targeted by the respective vaccine. These findings demonstrate the continued importance of ancestral COVID-19 vaccines in protecting against severe COVID-19 and highlight the feasibility of using the ChAdOx1 platform to develop COVID-19 vaccines against future SARS-CoV-2 variants.

19 - Diagnosis of metabolic syndrome in nursing professionals: An accuracy study. PLoS One. 2024 Jun 10;19(6):e0295985. doi: 10.1371/journal.pone.0295985.

Gomes ÉVD(1), Vasconcelos RS(1), Coelho NMF(1), Almeida LC(1), Silva DARD(1), Cerqueira MMBDF(1), Cerqueira JMDF(1), Conceição SDS(2), Soares JSP(3), Magalhães LBNC(4), Lua I(5), Figueredo ACMG(6), Brito VCSG(7), Fernandes SL(7), Viana DA(8), Freitas RPD(8), Requião GM(8), Lima LADS(9), Hayes BK(10), Pinheiro IM(11), Monção MM(11), Souza ACDS(12), Cruz SSD(13), Gomes AMT(14), Pimentel RFW(1)(15), Nardes BO(16), Lopes LC(16), Bastos NSSG(16), D'Oliveira A Júnior(7), Mercês MCD(1)(7)(8), Coelho JMF(1)(8)(17).

Afiliação:
(1)    Department of Life Sciences, University of Bahia State (UNEB), Salvador, Bahia, Brazil.
(2)    School of Health Sciences, University of Brasília (UNB), Brasília, Distrito Federal, Brazil.
(3)    School of Odontology, Federal University of Bahia (UFBA), Salvador, Bahia Brazil.
(4)    Department of Medicine, School of Technology and Sciences (UniFTC), Salvador, Bahia Brazil.
(5)    Department of Health, State University of Feira de Santana (UEFS), Feira de Santana, Bahia, Brazil.
(6)    School of Health Sciences, University of Brasília, Brasília, Distrito Federal, Brazil.
(7)    Department of Health Science, Federal University of Bahia (UFBA), Salvador, Bahia Brazil.
(8)    Department of Medicine, Dom Pedro II University Center (UNIDOMPEDRO), Salvador, Bahia, Brazil.
(9)    Department of Social Science, State University of Bahia, Serrinha, Bahia, Brazil.
(10)Children's Hospital of Los Angeles, Los Angeles, California, United States of America.
(11)Department of Technology and Science, Federal Institute of Education, Science and Technology of Bahia, Salvador, Bahia, Brazil.
(12)Department of Information Technology, Federal Institute of Education, Science and Technology of Bahia. Salvador, Bahia, Brazil. Department of Collective Health, Federal University of Recôncavo of Bahia (UFRB), Santo Antônio de Jesus, Bahia, Brazil.
(13)School of Nursing, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil.
(14)University Hospital Professor Edgard Santos (HUPES), Salvador, Bahia, Brazil.
(15)Institute of Health Science, Federal University of Bahia (UFBA), Salvador, Bahia Brazil.
(16)Department of Teaching, Federal Institute of Education, Science and Technology of Bahia, Lauro de Freitas, Bahia, Brazil.

Metabolic Syndrome (MetS) represents a group of cardiovascular risk factors. This article aims to evaluate the accuracy of the tools of MetS diagnosis in Nursing professionals from Primary Health Care (PHC) in Bahia, Brazil. A cross-sectional study with a random sample selected according to essential health information for the diagnostic of MetS. For MetS diagnostic, we used EGIR, NCEP-ATPIII, AACE, IDF, Barbosa et al. (2006), and IDF/AHA/NHLBI (defined as gold standard) definition. Sensitivity, specificity, predictive values, and likelihood ratio were estimated for each diagnostic tool and compared with the gold standard. Kappa statistic was used to determine the agreement between the diagnostic methods. One thousand one hundred and eleven nursing professionals were included in this study. Sensitivity varied from 15% to 95.1%, and specificity varied between 99.5% and 100%. IDF and Barbosa et al. (2006) definitions were more sensitive (95.1% and 92.8%, respectively), and EGIR, NCEP, ATP III, and IDF showed 100% specificity. IDF and Barbosa et al. (2006) use suitable metabolic syndrome identification and confirmation criteria. The highest agreement was found in the definition of the IDF, Barbosa et al. (2006) and the NCEP ATP III. Defining metabolic syndrome with a higher diagnostic accuracy could contribute to the screening and the early identification of nursing professionals with cardiovascular disease risk factors, which provide opportunities for appropriate prevention and treatment.

20 - Detection of cytokines in cervicovaginal lavage in HIV-infected women and its association with high-risk human papillomavirus. Front Immunol. 2024 Jun 28;15:1416204. doi: 10.3389/fimmu.2024.1416204.

Schindler S(1)(2), Netto E(2), Deminco F(1)(3), Figueiredo CA(4), de Andrade CM(4), Alves R(4), Brites C(1)(2)(3).

Afiliação:
(1)    Programa de Pós-graduação em Medicina e Saúde (PPgMS), Universidade Federal da Bahia, Salvador, Brazil.
(2)    Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.
(3)    Laboratório de Pesquisa em Infectologia (LAPI), Hospital Universitário Prof. Edgard Santos (HUPES), Universidade Federal da Bahia, Salvador, Brazil.
(4)    Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil.

BACKGROUND: Women living with HIV/AIDS (WLHA) have an increased prevalence of high-risk HPV infection (HR-HPV) and cervical intraepithelial neoplasia (CIN) and a greater risk of cervical cancer despite access to a new generation of antiretroviral therapy. The aim of this study is to evaluate the concentrations of different cytokines involved in the local immune response in WLHA, which is fundamental for understanding the pathogenesis of HPV-related cancer in thispopulation. METHODS: IL-1β, IL-2, IL-4, IL-6, IL-10, IFN-γ, TNF-α, IP-10, GM-CSF, and MIP-1α were investigated in the cervicovaginal lavage (CVL) of 106 WLHA attending at Hospital Universitario Professor Edgard Santos in Salvador, Bahia, Brazil, during the period December 2019 to April 2023 by Luminex®. All participants were also tested for Chlamydia trachomatis and Neisseria gonorrhoeae and underwent colposcopy, Pap smear, and Nugent score. HIV plasma viral load (VL) and CD4 cell count were performed for all WLHA. RESULTS: In this study, 22.6% (24/106) of WLHA were infected with HR-HPV. A higher proportion of patients with HR-HPV (66.7%) had detectable levels of IL-10 than those negative ones (40.2%, p = 0.02). More premenopausal women had either IL-6 (51.4%) or IP-10 (58.3%) than those in menopausal status (26.5% for IL-6 and 32.4% for IP-10, p = 0.013 and p = 0.011, respectively). Vaginosis was negatively associated with detection of IP-10 (24.2% vs. 61.4%, p < 0.001) and INF-γ (39.4% vs. 68.6%, p = 0.005). A positive association was detected for IL-1β (66.7 vs. 37.1%, p = 0.005) and IL-10 (63.6% vs. 37.1%, p = 0.01). VL and CD4 were not associated with the studied cytokines. CONCLUSION: We demonstrated a positive association between IL-10 and HPV infection in CVL, suggesting the predominance of the Th2 response in HIV/HPV co-infected patients. However, further studies with longer follow-up will be needed to evaluate the association of IL-10 with HPV infection, CIN, and cervical cancer in WLHA.

21 - MicroRNAs as Diagnostic Biomarkers and Predictors of Antidepressant Response in Major Depressive Disorder: A Systematic Review. Cureus. 2024 Mar 25;16(3):e56910.

Carneiro BA(1), Franco Guerreiro-Costa LN(2), Lins-Silva D(1), Faria Guimaraes
D(1), Souza LS(1), Leal GC(3), Caliman-Fontes AT(3), Beanes G(1), Costa RDS(4), Quarantini LC(5).

Afiliação:
(01)    Medicine, Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BRA.
(02)    Medicine, Universidade Federal da Bahia, Salvador, BRA.
(03)    Medicine, Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BRA.
(04)    Medicine, Laboratório de Imunofarmacologia e Biologia Molecular, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, BRA.
(05)    Psychiatry, Universidade Federal da Bahia, Salvador, BRA.

Despite the hardships of major depressive disorder (MDD), biomarkers for the diagnosis and pharmacological management of this condition are lacking. MicroRNAs are epigenetic mechanisms that could provide promising MDD biomarkers. Our aim was to summarize the findings and provide validation for the selection and use of specific microRNAs as biomarkers in the diagnosis and treatment of MDD. A systematic review was conducted using the PubMed/Medline, Cochrane, PsycINFO, Embase, and LILACS databases from March 2022 to November 2023, with clusters of terms based on "microRNA" and "antidepressant". Studies involving human subjects, animal models, and cell cultures were included, whereas those that evaluated herbal medicines, non-pharmacological therapies, or epigenetic mechanisms other than miRNA were excluded. The review revealed differences in the expression of various microRNAs when considering the time of assessment (before or after antidepressant treatment) and the population studied. However, due to the heterogeneity of the microRNAs investigated, the limited size of the samples, and the wide variety of antidepressants used, few conclusions could be made. Despite the observed heterogeneity, the following microRNAs were determined to be important factors in MDD and the antidepressant response: mir-1202, mir-135, mir-124, and mir-16. The findings indicate the potential for the use of microRNAs as biomarkers for the diagnosis and treatment of MDD; however, more homogeneous studies are needed.

22 - Analysis of Endocrine and Inflammatory Markers in Preserved Ratio Impaired Spirometry. Med Sci (Basel). 2024 Mar 27;12(2):18. doi: 10.3390/medsci12020018.

Jesus FR(1), Moraes ACS(2), da Silva ILN(2), Passos FC(2), Salles C(3), Neves MCLC(3), Baccan GC(2).

Afiliação:
(01)Maternidade Climério de Oliveira (MCO/EBSERH), Universidade Federal da Bahia, Salvador 40055-150, Bahia, Brazil.
(02)Departamento de Bioquímica e Biofísica, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador 40110-110, Bahia, Brazil.
(03)Unidade do Sistema Respiratório, Ambulatório Professor Francisco Magalhães Neto-Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador 40110-200, Bahia, Brazil.

Chronic Obstructive Pulmonary Disease (COPD) is a disease of the lungs characterized by chronic airflow obstruction. Individuals with preserved ratio impaired spirometry (PRISm) may be at risk for developing COPD. This study aimed to characterize PRISm and COPD patients in terms of their immune response and endocrine profile to identify differences extending beyond lung function. The participants performed the clinical assessment, pulmonary function test, and blood collection to determine serum hormone levels and concentrations of cytokine. Differences were observed in the nutritional status, lung function, and comorbidity. There were no differences in IL-6, IL-8, IL-10, IL-12, and TNF levels between PRISm and COPD groups. Both PRISm and COPD patients have lower dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S) levels than controls. Correlation analysis of PRISm and COPD patients revealed positive correlations between serum levels of DHEA-S and DHEA, with forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), which negatively correlated with IL-8 levels. The results indicated that despite differences in lung function parameters, the PRISm and COPD groups exhibited similarities in endocrine profile alterations. This study represents the first attempt to link endocrine with immune markers and lung function in individuals with PRISm.

23 - A new and simple score to predict adequate and deep response to ursodeoxycholic acid in patients with primary biliary cholangitis: the ALP-A score. Eur J Gastroenterol Hepatol. 2024 May 1;36(5):628-635. doi: 10.1097/MEG.0000000000002744.

Cançado GGL(1)(2), Gomes NMF(3), Couto CA(1), Cançado ELR(4), Terrabuio DRB(4), Villela-Nogueira CA(5), Braga MH(4), Nardelli MJ(1), Faria LC(1), Oliveira EMG(6), Rotman V(5), Oliveira MB(7), Cunha SMCFD(8), Mazo DFC(9), Mendes LSC(10), et al.

Afiliação:
(01)Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais.
(02)Hospital da Polícia Militar de Minas Gerais, Belo Horizonte, Minas Gerais.
(03)Disciplina de Gastroenterologia, Universidade Federal de São Paulo.
(04)Departamento de Gastroenterologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo.
(05)Hospital Universitário Clementino Fraga Filho e Departamento de Clínica Médica da Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro.
(06)Centro Universitário Lusíada - UNILUS, Santos.
(07)Ambulatório Municipal de Hepatites Virais de São José dos Campos, São José dos Campos, São Paulo.
(08)Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia.
(09)Divisão de Gastroenterologia (Gastrocentro), Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo.
...

BACKGROUND: Ursodeoxycholic acid (UDCA) is the standard treatment for primary biliary cholangitis (PBC), but a significant proportion of patients do not respond adequately, leading to increased risk of adverse outcomes. This study aims to develop a new and straightforward predictive score to identify PBC patients likely to achieve a complete response to UDCA. METHODS: A logistic regression analysis was conducted using a derivation cohort of PBC patients to identify pre-treatment variables associated with response to UDCA. This analysis led to the development of the ALP-A score, calculated as: Age at diagnosis divided by (alkaline phosphatase at diagnosis/upper limit of normal). ALP-A score accuracy was evaluated using the area under the ROC curve, validated with a large external cohort from Brazil. Additionally, the correlation between the ALP-A score and the previously validated UDCA response score (URS) was assessed. RESULTS: ALP-A score had good predictive power for adequate (AUC 0.794; 95% CI, 0.737-0.852) and deep (0.76; 95% CI, 0.69-0.83) UDCA response at 1 year of treatment. A cutoff score of 17 and 23 points was determined to be the optimal threshold for distinguishing adequate and deep responders, respectively, from non-responders. ALP-A score demonstrated a sensitivity of 73%, specificity of 71%, positive predictive value of 65%, negative predictive value of 78%, and overall accuracy of 72% for biochemical response. The URS displayed similar discriminative ability (AUC 0.798; 95% CI, 0.741-0.855). CONCLUSION: ALP-A score performs comparably to URS but offers the great advantage of simplicity for routine clinical use. It serves as a valuable tool to identify PBC patients less likely to respond to UDCA treatment, facilitating early consideration of alternative therapeutic approaches.

24 - Dual Antiplatelet Therapy vs Alteplase in Adult Patients with Acute Minor Ischemic Stroke: A Systematic Review and Meta-Analysis. J Thromb Thrombolysis. 2024 Aug;57(6):929-935. doi: 10.1007/s11239-024-02994-z.

Viana P(1), Relvas JH(2), Cabral TDD(3), Persson JE(4), Menegaz de Almeida A(5), Persson M(6), Marques MVO(7), Oliveira-Filho J(8).

Afiliação:
(01)Universidade Do Extremo Sul Catarinense, Departamento de Medicina, Criciuma, Santa Catarina, Brazil.
(02)Conjunto Hospitalar Do Mandaqui, Departamento de Clínica Médica, São Paulo, São Paulo, Brazil.
(03)Faculdade de Medicina Souza Marques, Departamento de Medicina, Rio de Janeiro, Rio de Janeiro, Brazil.
(04)Universidade Do Extremo Sul Catarinense, Departamento de Medicina, Criciuma, Santa Catarina, Brazil.
(05)Universidade Federal Do Mato Grosso, Departamento de Medicina, Sinop, Mato Grosso, Brazil.
(06)Universidade Federal de Pelotas, Departamento de Medicina, Pelotas, Rio Grande Do Sul, Brazil.
(07)Faculdade de Medicina da Universidade de São Paulo, Departamento de Medicina, São Paulo, São Paulo, Brazil.
(08)Hospital Universitário Professor Edgar Santos, Departamento de Neurologia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.

The efficacy and safety of dual antiplatelet therapy (DAPT) relative to intravenous (IV) alteplase in patients with acute minor ischemic stroke are insufficiently established. Therefore, we aimed to perform a meta-analysis to compare DAPT with IV alteplase in patients with acute minor stroke. MEDLINE, Embase, and Cochrane were searched for studies comparing DAPT with IV alteplase in patients with minor stroke. Functional and safety outcomes in 90 days were analyzed. Statistical analysis was performed using Rstudio 4.3.1. Subanalyses were performed restricted to non-disabling minor strokes and NIHSS score ≤ 3. PROSPERO (CRD42023440986). We included five studies with a total of 6,340 patients, of whom 4,050 (63.9%) received DAPT. The follow-up period for all included studies was 90 days. There was no significant difference for individual outcomes of mRS 0-1 (OR 1.26; 95% CI 0.85-1.89; p = 0.25), mRS 0-2 (OR 0.99; 95% CI 0.69-1.43; p = 0.97), or all-cause mortality (OR 0.80; 95% CI 0.20-3.13; p = 0.75) between groups. Symptomatic intracranial hemorrhage (sICH) was significantly lower (OR 0.11; 95% CI 0.003-0.36; p < 0.001) in patients treated with DAPT compared with IV alteplase. In terms of mRS 0-1 and mRS 0-2, we found no significant difference in both subgroup analyses. We found no statistically significant difference between DAPT and IV alteplase regarding functional outcome (mRS scores of 0-1 and 0-2) or all-cause mortality at 90 days in patients with minor ischemic stroke. Additionally, DAPT was associated with a significantly lower rate of sICH.

25 - Serum osteoprotegerin and its gene polymorphisms in patients with Takayasu's arteritis: a bicentric cross-sectional study. Adv Rheumatol. 2024 May 28;64(1):43. doi: 10.1186/s42358-024-00384-w.

Cendon Duran CDS(1), de Falco Caparbo V(1), Santiago MB(2), Hounkpe BW(1), Pedreira ALS(2), de Souza Lima IV(2), Giardini HAM(1), Bonoldi VLN(1), Domiciano DS(1), Shinjo SK(3), Pereira RMR(1).

Afiliação:
(01)Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
(02)Division of Rheumatology, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brazil.
(03)Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.

INTRODUCTION: Takayasu's arteritis (TAK) patients are at an elevated risk of metabolic syndrome and cardiovascular diseases (CVD). Currently, there are no well-validated biomarkers to assess this risk in this population. Previous research in different cohorts has linked serum levels of osteoprotegerin (OPG) and its polymorphisms to accelerated atherosclerosis and a marker of poor prognosis in CVD. Thus, we assessed this protein as a potential biomarker of CVD in TAK patients. OBJECTIVES: To evaluate the serum levels of OPG and its SNPs (single nucleotide polymorphisms) in TAK patients and healthy controls, and to associate these parameters with clinical data.METHODS: This bicentric cross-sectional study included TAK patients who were compared with healthy individuals (control group). The serum levels of OPG and the frequency of OPG SNPs [1181G > C (rs2073618), 245 A > C (rs3134069), 163T > C (rs3102735), and 209 C > T (rs3134070)] were compared between the both groups and associated with clinical data. RESULTS: In total, 101 TAK patients and 93 controls were included in the study. The serum levels of OPG (3.8 ± 1.9 vs. 4.3 ± 1.8pmol/L, respectively; P = 0.059), and its four polymorphisms were comparable between both groups. In an additional analysis of only TAK patients, serum OPG levels and its four genes were not associated with any CVD parameters, except for higher OPG levels among patients without dyslipidemia. CONCLUSION: No significant differences were observed in serum OPG levels or in the genotype frequencies of OPG SNPs between the patient and control groups. Similarly, no correlation was found between laboratory parameters and clinical data on CVD risk in TAK patients.

26 - Ten-year outcomes of tips for budd-chiari syndrome: systematic review and meta-analysis. Arq Gastroenterol. 2024 Jun 17;61:e23171. doi: 10.1590/S0004-2803.24612023-171.

Moreno MOA(1), Paz CLDSL(2), Dezan MGF(1)(3)(4), Cavalcante LN(3)(4)(5), Lyra AC(3)(4)(5).

Afiliação:
(01)Escola Bahiana de Medicina e Saúde Pública; Salvador, BA, Brasil.
(02)Universidade Federal da Bahia, Salvador, BA, Brasil.
(03)Hospital São Rafael, Serviço de Gastro-Hepatologia, Salvador, BA, Brasil.
(04)Universidade Federal da Bahia, PPgMs, Salvador, BA, Brasil.
(05)Hospital Universitário Professor Edgard Santos, Serviço de Gastro-Hepatologia, Salvador, BA, Brasil.

BACKGROUND: Budd-Chiari syndrome (BCS) results from the obstruction of the hepatic venous flow, usually at the level of the hepatic vein or inferior vena cava. When left untreated, it can progress with several complications, including liver cirrhosis. Transjugular intrahepatic portosystemic shunt (TIPS) appears to be effective in a subgroup of BCS patients. OBJECTIVE: To perform a systematic review and meta-analysis of TIPS effectiveness in BCS treatment, considering the survival rate, reduction in portosystemic pressure, need for liver transplantation, technical failure, and shunt dysfunction for up to 10 years of follow-up. METHODS: We evaluated 17 studies published in PubMed, Science Direct, Web of Science, and SCOPUS databases, which used TIPS as a treatment for BCS, comprising 618 subjects between 18 and 78 years old. We assessed the bias risk by the NOS, NHI, and JBI scales for cohort stu-dies, before-after studies, and case series, respectively. We conducted the meta-analyses by extracting the number of events and the total patients evaluated to perform the proportion meta-analyses using the R software ("meta" package - version 4.9-6). RESULTS: The pooled results (95%CI) showed a 19% (25.9-12.5%) rate of portosystemic pressure reduction, 6% (1-12%) rate for the need for liver transplants despite the use of TIPS, 2% (1-6%) technical failure rate, 30% (18-46%) shunt dysfunction rate, and 88% (81-93%) for the mean frequency of patients alive between 1 and 10 years after the procedure. We stratified survival rate and found an 86% (74-93%) prevalence of living subjects during less than five years, 92% (83-97%) at five years, and a 77% frequency (68-83%) of patients alive ten years after the TIPS placement. CONCLUSION: TIPS is an effective treatment for BCS, providing a high 10-year frequency of living patients and a significant decrease in portosystemic pressure. The need for liver transplants after TIPS and the technical failure rate is low.

27 - Hepatobiliary disease after bone marrow transplant: A cross-sectional study of 377 patients. Aliment Pharmacol Ther. 2024 Jan;59(1):71-79. doi: 10.1111/apt.17756. 

Dezan MGF(1)(2)(3), Cavalcante LN(1)(2)(3), Silva HRC(4), de Moura Almeida A(4)(5), Dos Santos de Assis LH(4), de Freitas TT(4), de Araújo MAS(3)(4)(5), Cotrim HP(2)(3), Lyra AC(1)(2)(3).

Afiliação:
(01)(1)Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São
(02)Rafael-Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil.
(03)(2)Gastro-Hepatology Service-University Hospital Professor Edgard Santos
(04)(HUPES), Federal University of Bahia, Salvador, Bahia, Brazil.
(05)(3)Postgraduate Program in Medicine and Health, Federal University of Bahia,
(06)Salvador, Bahia, Brazil.
(07)(4)Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Hematology
(08)Service, Hospital São Rafael, Salvador, Bahia, Brazil.
(09)(5)Hematology Service-University Hospital Professor Edgard Santos (HUPES),
(10)Federal University of Bahia, Salvador, Bahia, Brazil.

BACKGROUND: Bone marrow transplantation (BMT) is a standard treatment for several haematologic conditions. Following BMT, patients may develop hepatobiliary complications that impact morbidity and mortality. The differential diagnosis may include drug-induced liver injury (DILI), sepsis-associated liver injury (SALI), sinusoidal obstruction syndrome (SOS), graft-versus-host disease (GVHD), viral hepatitis, ischaemic hepatitis, and fulminant hepatitis. AIMS: To evaluate the frequency, clinical characteristics, and outcomes of patients with hepatobiliary alterations associated with BMT in a tertiary referral centre. METHODS: This was a cross-sectional study with data collected from the medical records of patients undergoing BMT between January 2017 and June 2022. We diagnosed hepatobiliary complications based on established criteria. RESULTS: We included 377 patients; 55.7% had hepatobiliary complications. Female gender, pre-BMT hepatobiliary alteration, and haploidentical allogeneic transplantation were associated with increased risk with odds ratios (OR) of 1.8 (p = 0.005), 1.72 (p = 0.013) and 3.25 (p = 0.003), respectively. Patients with hepatobiliary complications spent longer in the hospital than those without (27.7 × 19.3 days, respectively; p < 0.001). Among 210 patients with hepatobiliary complications, 28 died compared to 5 of 167 without complications (OR 4.98; p = 0.001). CONCLUSIONS: Hepatobiliary complications are frequent in patients undergoing BMT. There is a greater risk of their occurrence in women, people with pre-BMT liver alterations, and in haploidentical transplants. The occurrence of these complications increases the length of stay and is associated with a higher risk of death.

28 - Occupational stressors and mental illness in healthcare work: An intersection between gender, race, and class. Am J Ind Med. 2024 Feb;67(2):143-153. doi: 10.1002/ajim.23558.

de Sousa CC(1), Araújo TM(2), Maturino MM(2).

Afiliação:
(01) University Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil.
(02) State University of Feira de Santana, Feira de Santana, Brazil.

BACKGROUND: Previous studies have supported the relevance of using broad and complex approaches, including multiple explanatory categories, to analyze mental disorders in the working population. This study aimed to assess the direct and indirect effects of gender, race, social class, and occupational stressors on mental health. METHODS: A cross-sectional study used a random sample of 3343 health workers. The effort-reward imbalance (ERI) scale measured occupational stressors. The World Health Organization Self-Reporting Questionnaire (SRQ-20) evaluated common mental disorders (CMDs) as outcomes. The role of gender, race/color, and class determinants (level of schooling and income) in the relationship between occupational stressors and CMD was assessed. Structural equation modeling was used to determine associations and effects. RESULTS: Occupational stressors were directly associated with CMD and mediated the relationship between income and CMD. Gender was directly associated with occupational stressors, income, and domestic overload. Race was associated with education and with CMD through indirect paths mediated by class indicators. Class indicators contributed to increasing exposure to occupational stressors and the occurrence of CMD. CONCLUSION: The results highlight the relevance of gender, race/color, and class in understanding the unequal distribution of work stressors and mental illness in health workers.

29 - Brazilian Thoracic Association recommendations for the management of post-tuberculosis lung disease. J Bras Pneumol. 2024 Jan 5;49(6):e20230269. doi: 10.36416/1806-3756/e20230269. eCollection 2024.

Silva DR(1), Santos AP(2)(3), Visca D(4)(5), Bombarda S(6), Dalcolmo MMP(7), Galvão T(8), Miranda SS(9), et al.

Afiliação:
(01) Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil.
(02) Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil.
(03) Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil.
(04) Dipartimento di Pneumologia Riabilitativa, Istituti Clinici Scientifici Maugeri - IRCCS - Tradate, Italia.
(05) Dipartimento di Medicina e Chirurgia, Malattie Respiratorie, Università Degli Studi Dell'Insubria, Varese-Como, Italia.
(06) Secretaria de Estado da Saúde de São Paulo, Centro de Vigilância Epidemiológica Professor Alexandre Vranjac - CVE-SSP-SP - São Paulo (SP) Brasil.
(07)Centro de Referência Hélio Fraga, Fundação Oswaldo Cruz - Fiocruz - Rio de Janeiro (RJ) Brasil.
(08) Hospital Universitário Professor Edgar Santos. Universidade Federal da Bahia - UFBA - Salvador (BA) Brasil.
(09) Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil.
...

Historically, all efforts against tuberculosis were focused on rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, more and more evidence has been found on the dramatic consequences of the condition defined as post-tuberculosis lung disease (PTLD). Approximately one third of patients surviving pulmonary tuberculosis face considerable ongoing morbidities, including respiratory impairment, psychosocial challenges, and reduced health-related quality of life after treatment completion. Given the important global and local burden of tuberculosis, as well as the estimated burden of PTLD, the development of a consensus document by a Brazilian scientific society-Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)-was considered urgent for the prevention and management of this condition in order to allocate resources to and within tuberculosis services appropriately and serve as a guide for health care professionals. A team of eleven pulmonologists and one methodologist was created by the SBPT to review the current evidence on PTLD and develop recommendations adapted to the Brazilian context. The expert panel selected the topics on the basis of current evidence and international guidelines. During the first phase, three panel members drafted the recommendations, which were divided into three sections: definition and prevalence of PTLD, assessment of PTLD, and management of PTLD. In the second phase, all panel members reviewed, discussed, and revised the recommendations until a consensus was reached. The document was formally approved by the SBPT in a special session organized during the 2023 SBPT Annual Conference.

30 - The Brazilian association of hematology, hemotherapy, and cell therapy (ABHH) and its absolute commitment to ethics and absence of conflicts of interest.  Hematol Transfus Cell Ther. 2024 Jul-Sep;46(3):219-220. doi: 10.1016/j.htct.2024.05.003.

de Souza CA(1), Rego EM(2), Ribeiro GN(3), Magalhães SMM(4), da Silva CAR(5), Passos LNDM(6), Covas DT(7), Tavares RS(8), Hungria VTM(9), Crusoé EQ(10), Marques JFC Jr(11), et al.

Afiliação:
(01) Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
(02) Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
(03) Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
(04) Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Universidade Federal do Ceará (UFC), Fortaleza, CE, Brazil.
(05) Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil.
(06) Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Fundação de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil.
(07) Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Hemocentro de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
(08) Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Hospital das Clínicas da Universidade Federal de Goiás (HC UFG), Goiania, GO, Brazil.
(09) Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
(10) Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.
(11) Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH), São Paulo, SP, Brazil; Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
...

Sem Resumo

31 - Home caregiver strategies for feeding older adults with dysphagia after dehospitalization.  Rev Esc Enferm USP. 2024 May 24;58:e20230318. doi: 10.1590/1980-220X-REEUSP-2023-0318en.

Belmonte MS(1), Pedreira LC(1), Gomes NP(1), Oliveira DV(1), Souza ACFSE(2), Pinto IS(1).

Afiliação:
(01) Universidade Federal da Bahia, Programa de Pós-Graduação em Enfermagem e Saúde. Salvador, BA, Brazil.
(02) Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos. Salvador, BA, Brazil.

OBJECTIVE: To understand caregivers' strategies for offering food to older adults with oropharyngeal dysphagia after dehospitalization. METHOD: Qualitative research carried out with caregivers of older adults with oropharyngeal dysphagia, who were discharged after hospitalization at a university hospital in Bahia. Data collection was carried out between January and February 2023 through a semi-structured interview, whose data were organized  based on content analysis and analyzed with the help of IRaMuTeQ software. RESULTS: Three categories emerged: Caregivers' strategies for safely offering food to older adults with dysphagia; Caregiver strategies for oral hygiene for older adults; Recognition of continuity of speech therapy after dehospitalization. CONCLUSION: Caregivers' strategies for offering food to older adults with oropharyngeal dysphagia were supported by tacit knowledge and effective care in the hospital-home transition.

32 - Ocular complications in adults with psoriasis: a cross-sectional study in a referral center in Brazil. Int Ophthalmol. 2024 May 5;44(1):215. doi: 10.1007/s10792-024-03147-0.

Oliveira RDC(1), Faneli AC(2), Amaral DC(3), Chagas JM(4), Guedes J(5), Follador I(1), de Oliveira MFSP(1), Fernandes BF(6), Correia LCL(7).

Afiliação:
(01) University Hospital Complex Professor Edgard Santos (HUPES) - Federal University of Bahia, Salvador, Brazil.
(02) Bahiana School of Medicine and Public Health, Rua Machado Neto, 129, Pituba, Salvador, Bahia, CEP 41830-510, Brazil.
(03) Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
(04) Faculty of Technology and Sciences FTC, Salvador, Brazil.
(05) Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA.
(06) Argumento Institute, Boucherville, Canada.
(07) Bahiana School of Medicine and Public Health, Rua Machado Neto, 129, Pituba, Salvador, Bahia, CEP 41830-510, Brazil.

PURPOSE: There is limited literature on the ocular manifestations in patients with psoriasis. Therefore, this study aimed to identify the prevalence of and factors associated with ocular manifestations in adults with psoriasis. METHODS: This cross-sectional study included Brazilian adults with psoriasis. The dermatological evaluation included diagnosis, clinical form, Psoriasis Area and Severity Index (PASI) measurement, and location of the lesions. Patients underwent a full ophthalmological examination, including the Schirmer I test, Rose Bengala staining, and tear breakup time tests. The results were analyzed using chi-square and Pearson's linear correlation tests. RESULTS: Of the 130 patients assessed, 118 (90.8%) exhibited ocular abnormalities, with meibomian gland dysfunction (MGD) being the most prevalent (59.2%), followed by dry eye disease (DED) (56.2%). A significant correlation was observed between MGD and PASI (p = 0.05), and between MGD and certain treatment modalities. DED was significantly associated with PASI (p < 0.05). Concurrent use of acitretin was identified as an independent predictor of MGD (odds ratio [OR] = 3.5, p < 0.05), whereas PASI was a protective factor against DED (OR = 0.39, p < 0.01). CONCLUSION: Given the high prevalence of eye disease among individuals with psoriasis, routine ophthalmological assessments are recommended to prevent possible ocular complications.

33- Molecular and Phylogenetic Analysis of HIV-1 Subtype C in Bahia State, Northeastern Brazil. AIDS Res Hum Retroviruses. 2024 Jan;40(1):37-41. doi: 10.1089/AID.2023.0038.

Oliveira RC(1), Souza JSM(1), Alcântara LCJ(2), Guimarães ML(3), Brites C(4), Monteiro-Cunha JP(1).

Afiliação:
(01)Departamento de Bioquímica e Biofísica, Núcleo de Bioinformática, Universidade Federal da Bahia, Salvador, Brasil.
(02)Laboratório de Flavivírus, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil.
(03) Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil.
(04) Laboratório de Pesquisa em Infectologia, Complexo Hospitalar Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brasil.

HIV-1 subtype C is associated with more than half of infections in southern Brazil and has been increasing in other regions of the country. In a previous study carried out in northeastern Brazil, we found a prevalence of 4.1% of subtype C. This work investigates the origin of subtype C in the state of Bahia based on five new viral sequences. The phylogenetic analysis showed that subtype C viruses found in Bahia descend from the main lineage that circulates in other Brazilian regions.

34 - Rechallenge in idiosyncratic drug-induced liver injury: An analysis of cases in two large prospective registries according to existing definitions.  Pharmacol Res. 2024 May;203:107183. doi: 10.1016/j.phrs.2024.107183.

Pinazo-Bandera JM(1), Niu H(2), Alvarez-Alvarez I(3), Medina-Cáliz I(2), Del Campo-Herrera E(3), Ortega-Alonso A(1), Robles-Díaz M(4), Hernández N(5), Paraná R(6), Nunes V(6), Girala M(7), et al.

Afiliação:
(01) Service of Gastroenterology and Hepatology, University Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédico en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
(02) Service of Clinical Farmacology, University Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, Universidad de Málaga, Málaga, Spain.
(03) Service of Gastroenterology and Hepatology, University Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, Universidad de Málaga, Málaga, Spain.
(04) Service of Clinical Farmacology, University Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédico en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
(05) Clínicas Hospital, Montevideo, Uruguay.
(06) University Hospital Prof. Edgard Santos-UFBA, Salvador, Brasil.
(07) Clínicas Hospital, Asunción, Paraguay.
...

INTRODUCTION: Data on positive rechallenge in idiosyncratic drug-induced liver injury (DILI) are scarce. We aim to analyse the clinical presentation, outcome and drugs associated with positive rechallenge in two DILI registries. METHODS: Cases from the Spanish and Latin American DILI registries were included. Demographics, clinical characteristics and outcome of cases with positive rechallenge according to CIOMS/RUCAM and current definitions were analysed.RESULTS: Of 1418 patients with idiosyncratic DILI, 58 cases had positive rechallenge (4.1%). Patients with positive rechallenge had shorter duration of therapy (p=0.001) and latency (p=0.003). In patients with rechallenge, aspartate transaminase levels were increased (p=0.026) and showed a prolonged time to recovery (p=0.020), albeit no differences were seen in terms of fatal outcomes. The main drug implicated in rechallenge was amoxicillin-clavulanate (17%). The majority of re-exposure events were unintentional (71%). Using both existing definitions of positive rechallenge, there were four cases which exclusively fulfilled the current criteria and five which only meet the historical definition. All cases of positive rechallenge, irrespective of the pattern of damage, fulfilled the criteria of either alanine transaminase (ALT) ≥3 times the upper limit of normal (ULN) and/or alkaline phosphatase (ALP) ≥2 times ULN. CONCLUSIONS: Episodes of rechallenge were characterised by shorter duration of therapy and latency, and longer time to resolution, but did not show an increased incidence of fatal outcome. Based on our findings, ALT ≥3 times ULN and/or ALP ≥2 times ULN, regardless of the pattern of damage, is proposed as a new definition of rechallenge in DILI.

35 - Factors associated with hepatitis A susceptibility among men who have sex with men using HIV pre-exposure prophylaxis in Northeastern Brazil: A cross-sectional study. PLoS One. 2024 Mar 28;19(3):e0301397. doi: 10.1371/journal.pone.0301397.

Vechi HT(1)(2), Bay MB(3), Freitas CHS(1), Sant'anna JGFC(1), Brites C(4), Lima KC(5).

Afiliação:
(01)Institute of Tropical Medicine of Rio Grande do Norte, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
(02)Multicampi School of Medical Sciences, Federal University of Rio Grande do Norte, Caicó, Rio Grande do Norte, Brazil.
(03)Department of Infectious Diseases, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
(04)Hospital Universitário Prof. Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil.
(05)Department of Odontology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.

Hepatitis A virus (HAV) infection has disproportionately affected more men who have sex with men (MSM), occurring in outbreaks, despite being vaccine-preventable. We determined the prevalence and factors associated with HAV susceptibility among cisgender MSM on HIV pre-exposure prophylaxis (PrEP) in Northeastern Brazil. From September 30, 2021 to June 19, 2023, 282 cisgender MSM receiving HIV PrEP were enrolled into this cross-sectional study. Sociodemographic and clinical information were collected. Blood samples were collected for screening of sexually transmitted infections (STIs) and serum samples were tested for IgM and total anti-HAV antibodies. Non-reactive results for total anti-HAV antibodies were found in 106 of 282 (37.6%) participants. Factors associated with HAV susceptibility included age <30 years (prevalence ratio [PR]: 2.02; 95% confidence interval [95% CI]: 1.61-2.53), having health insurance (PR: 1.39; 95% CI: 1.19-1.64), sex only with cisgender men (PR: 1.52; 95% CI: 1.23-1.89), non-steady partner (PR: 1.20; 95% CI: 1.01-1.43) and no lifetime history of STIs (PR: 1.25; 95% CI: 1.03-1.53). Identifying clinical correlates of HAV susceptibility in key populations is a fundamental step towards development of public policy focused on prevention, especially following the recent hepatitis A outbreak in Brazil.

36 - Improved Treatment Outcome Following the Use of a Wound Dressings in Cutaneous Leishmaniasis Lesions. Pathogens. 2024 May 16;13(5):416. doi: 10.3390/pathogens13050416.

Borba PB(1), Lago J(2), Lago T(2), Araújo-Pereira M(3)(4), Queiroz ATL(1)(3)(4), Barud HS(5), Carvalho LP(1)(2)(6), Machado PRL(2)(6), Carvalho EM(1)(2)(6), de Oliveira CI(1)(6).

Afiliação:
(01)Instituto Gonçalo Moniz, FIOCRUZ, Salvador 40296-710, BA, Brazil.
(02)Serviço de Imunologia, HUPES-UFBA, Salvador 40110-060, BA, Brazil.
(03)Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER Initiative), Salvador 41720-200, BA, Brazil.
(04)Instituto de Pesquisa Clínica e Translacional (IPCT), UniFTC, Salvador, BA, Brazil.
(05)Laboratório de BioPolímeros e Biomateriais, Uniara, Araraquara, SP, Brazil.
(06)INCT-Instituto de Investigação em Doenças Tropicais, Salvador, BA, Brazil.

Leishmaniasis, caused by Leishmania parasites, is a neglected tropical disease and Cutaneous Leishmaniasis (CL) is the most common form. Despite the associated toxicity and adverse effects, Meglumine antimoniate (MA) remains the first-choice treatment for CL in Brazil, pressing the need for the development of better alternatives. Bacterial NanoCellulose (BNC), a biocompatible nanomaterial, has unique properties regarding wound healing. In a previous study, we showed that use of topical BNC + systemic MA significantly increased the cure rate of CL patients, compared to treatment with MA alone. Herein, we performed a study comparing the combination of a wound dressing (BNC or placebo) plus systemic MA versus systemic MA alone, in CL caused by Leishmania braziliensis. We show that patients treated with the combination treatment (BNC or placebo) + MA showed improved cure rates and decreased need for rescue treatment, although differences compared to controls (systemic MA alone) were not significant. However, the overall time-to-cure was significantly lower in groups treated with the combination treatment (BNC+ systemic MA or placebo + systemic MA) in comparison to controls (MA alone), indicating that the use of a wound dressing improves CL treatment outcome. Assessment of the immune response in peripheral blood showed an overall downmodulation in the inflammatory landscape and a significant decrease in the production of IL-1a (p < 0.05) in patients treated with topical BNC + systemic MA. Our results show that the application of wound dressings to CL lesions can improve chemotherapy outcome in CL caused by L. braziliensis.

37 - Angiolymphoid Hyperplasia With Temporal Artery Eosinophilia: A Case Report. Vasc Endovascular Surg. 2024 Jan;58(1):95-99. doi: 10.1177/15385744231184333.

Carvalho Lujan RA(1), de Melo Mascarenhas DA(1), de Amorim Aquino M(1), Costa Menezes A(1), Pereira de Souza Filho ML(2), Costa Sampaio Silva F(3), Godeiro Fernandez M(4), Silveira Alves CA(1), Aras Júnior R(3).

Afiliação:
(01)Vascular Surgery Division, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Bahia, Brazil.
(02)Pathology Division, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Bahia, Brazil.
(03)Postgraduate Program in Medicine and Health, Faculty of Medicine of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil.
(04)Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.

Angiolymphoid Hyperplasia with Eosinophilia (ALHE) is a benign vascular proliferative disorder with uncertain etiology and pathogenesis. The aim of this paper is to report a case of ALHE in the temporal artery and discuss the general aspects of this pathology. A 29-year-old female black patient sought the Vascular Surgery Outpatient Service, complaining of bulging in the right temporal region, associated with pain and local discomfort. Physical examination revealed pulsatile bulging in the right temporal region measuring approximately 2.5 × 1.5 cm. Nuclear Magnetic Resonance showed an expansive fusiform lesion in the superficial soft parts of the right temporal region, measuring 2.9 cm in the longest longitudinal axis. Surgical excision proved to be the best therapeutic option for the patient in this case. Histopathological sections showed the proliferation of vessels of different sizes, covered by swollen endothelium, prominent inflammatory infiltrate composed of lymphocytes, plasma cells, eosinophils, and scarce histiocytes. Immunohistochemical analysis of the lesion showed positivity for CD31, corroborating the diagnosis of ALHE.

38 - Disease progression in Sanfilippo type B: Case series of Brazilian patients. Genet Mol Biol. 2024 Mar 8;47(1):e20230285. doi: 10.1590/1678-4685-GMB-2023-0285.

Montenegro YHA(1)(2), Kubaski F(1), Trapp FB(2)(3), Riegel-Giugliani M(3), Souza CFM(1)(2)(3), Ribeiro EM(4), Lourenço CM(5), Cardoso-Dos-Santos AC(4), Ribeiro MG(6), Kim CA(7), Castro MAA(7), Embiruçu EK(8), Steiner CE(9), et al.

Afiliação:
(01)Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil.
(02)Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Rede MPS Brasil, Porto Alegre, RS, Brazil.
(03)Casa dos Raros, Porto Alegre, RS, Brazil.
(04)Hospital Infantil Albert Sabin, Serviço de Genética Médica, Fortaleza, CE, Brazil.
(05)Centro Universitário Estácio, Ribeirão Preto, SP, Brazil.
(06)Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagão Gesteira, Serviço de Genética Médica, Rio de Janeiro, RJ, Brazil.
(07)Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, São Paulo, SP, Brazil.
(08)Universidade Federal da Bahia, Complexo Hospitalar Universitário Professor Edgar Santos, Departamento de Ciências da Vida, Salvador, BA, Brazil.
(09)Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Medicina Translacional, São Paulo, SP, Brazil.
...

Mucopolysaccharidosis type IIIB (MPS IIIB) is caused by deficiency of alpha-N-acetylglucosaminidase, leading to storage of heparan sulphate. The disease is characterized by intellectual disability and hyperactivity, among other neurological and somatic features. Here we studied retrospective data from a total of 19 MPS IIIB patients from Brazil, aiming to evaluate disease progression. Mean age at diagnosis was 7.2 years. Speech delay was one of the first symptoms to be identified, around 2-3 years of age. Behavioral alterations include hyperactivity and aggressiveness, starting around age four. By the end of the first decade, patients lost acquired abilities such as speech and ability to walk. Furthermore, as disease progresses, respiratory, cardiovascular and joint abnormalities were found in more than 50% of the patients, along with organomegaly. Most common cause of death was respiratory problems. The disease progression was characterized in multiple systems, and hopefully these data will help the design of appropriate clinical trials and clinical management guidelines.

39 - Self-Reported Fatigue by the Chalder Fatigue Questionnaire and Mortality in Brazilian Hemodialysis Patients: The PROHEMO. Nephron. 2024;148(5):292-299. doi: 10.1159/000533472.

Gutiérrez-Peredo GB(1), Silva Martins MT(2)(3), da Silva FA(2)(4), Lopes MB(2)(5)(6), Lopes GB(2)(6), Norris KC(7), Lopes AA(2)(6)(8).

Afiliação:
(01)Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil.
(02)Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil.
(03)Clinic of Renal Disease and Hypertension (CLINIRIM), Salvador, Brazil.
(04)NEPHRON Clinic, Salvador, Brazil.
(05)Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
(06)Unit of Clinical Epidemiology and Evidence-Based Medicine, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil.
(07)Department of Medicine, University of California, Los Angeles, California, USA.
(08)Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil.

BACKGROUND: The existing data support the Chalder Fatigue Questionnaire (CFQ-11) as a valid instrument to assess fatigue in maintenance hemodialysis (MHD) patients. The objective of this work was to investigate whether self-reported fatigue can serve as an independent prognostic indicator for mortality in MHD patients. METHODS: The data are from 233 adult patients enrolled in the cohort "The Prospective Study of the Prognosis of Chronic Hemodialysis Patients" (PROHEMO) developed in Salvador, BA, Brazil. The Brazilian version of the validated CFQ-11 was used to calculate self-reported fatigue. The CFQ-11 scores may range from 0 to 33; higher scores represent more fatigue. Fatigue categories were created based on proposed cut point: absence or mild degree if CFQ-11 scores &lt;4 and moderate to severe if scores ≥4. Cox models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of associations between fatigue and mortality with adjustments for sociodemographic factors, time on dialysis, education, economic class, hemoglobin concentration, diabetes, heart failure, depression, and other psychiatric disorders. RESULTS: The mean age was 51.5 ± 2.5 years, 58% were male, and 30% were diabetic. Self-reported moderate to severe fatigue was reported by 71% of patients. The mortality rate was 8.6 cases/100 person-years. Patients with moderate to severe fatigue had a more than threefold mortality rate (HR = 3.07, 95% CI: 1.19, 7.93) compared to patients with absent or mild fatigue, after extensive adjustments for covariates. CONCLUSION: The study provides evidence that self-reported fatigue can help identify MHD patients at higher risk of earlier death.

40 - The Working Environment in Primary Healthcare Outpatient Facilities: Assessment of Physical Factors and Health Professionals' Perceptions of Working Environment Conditions. Int J Environ Res Public Health. 2024 Jun 28;21(7):847. doi: 10.3390/ijerph21070847.

Cezar-Vaz MR(1)(2), Bonow CA(2), Vaz JC(3), Nery CHC(4), da Silva MRS(1), Galvão DM(1), Alves AS(1), Sousa FSF(5), Vettorello JS(6), de Souza JL(7), Vaz J(8).}

Afiliação:
(01)School of Nursing, Federal University of Rio Grande, Rio Grande 96203-900, Brazil.
(02)Faculty of Nursing, Federal University of Pelotas, Pelotas 96010-610, Brazil.
(03)Financial Planning Department, Vibra Energia Company, Rio de Janeiro 20211-140, Brazil.
(04)Institute of Human and Information Sciences-ICHI, Federal University of Rio Grande, Santa Vitória do 11 Palmar Campus, Santa Vitória do Palmar 96230-000, Brazil.
(05)University Hospital Professor Edgar Santos, Federal University of Bahia (Hupes-UFBA), Salvador 40110-060, Brazil.
(06)University Hospital Doctor Miguel Riet Corrêa Junior, Federal University of Rio Grande (HU-FURG), Rio Grande 96200-190, Brazil.
(07)Municipal Department of Administrative Management and Bids (SMGAL), Municipal Government, Rio Grande 96200-015, Brazil.
(08)School of Engineering, Federal University of Rio Grande-Carreiros Campus, Rio Grande 96203-900, Brazil.

The objectives of this study were to assess the adequacy of physical parameters/factors (temperature, relative humidity, noise, and illuminance levels) of the work environment in PHC facilities, to evaluate the association between the adequacy of these measured physical parameters and the physical characteristics of the PHC facilities and their surroundings and to assess the association between health professionals' perceptions about exposure to physical risks in the PHC work environment and the adequacy of physical parameters measured in the same facilities. The study monitored 23 PHC facilities in southern Brazil and interviewed 210 health professionals. Data analysis involved Pearson's chi-square, Fisher's exact test, Spearman's correlation, and multivariate linear regression analysis was used to control for confounding factors. The significance level was set at 5% (p ≤ 0.05). The combination of temperature and relative humidity presented thermal comfort levels outside the adopted criteria for adequacy in consultation (outdoor relative humidity, p = 0.013) and procedure rooms (front door open, p = 0.034). Inadequate sound comfort (noise) levels in the morning shift were found in the vaccination (front door open, p = 0.021) and consultation rooms (movement of people, p = 0.016). In PHC facilities where reception rooms had insufficient lighting, internal curtains were opened less frequently (p = 0.047). The analysis of health professionals' perceptions of physical factors demonstrated that physicians more frequently perceive the physical risk of temperature and humidity (p = 0.044). The higher the number of nurses (p = 0.004) and oral health technicians in the PHC facilities (p = 0.031), the greater the general percentage of adequacy of monitored physical parameters. It was also confirmed that the higher the perception of moderate or severe physical risk among health professionals, the lower the general percentage of the adequacy of the physical parameters of the work environment of the PHC facilities evaluated (rs = -0.450, p = 0.031). This study's evidence contributes to a better understanding of physical conditions and future occupational interventions to ensure the comfort, safety, and well-being of PHC workers.

41 - In Situ versus Systemic Immune Response in the Pathogenesis of Cutaneous Leishmaniasis. Pathogens. 2024 Feb 23;13(3):199. doi: 10.3390/pathogens13030199.

Carvalho AM(1)(2)(3), Costa RS(1)(2), Lago A(2), Bacellar O(2)(3), Beiting DP(4), Scott P(4), Carvalho LP(1)(2)(3), Carvalho EM(1)(2)(3).

Afiliação:
(01)Gonçalo Moniz Institute (IGM), Fiocruz, Salvador 40296-710, BA, Brazil.
(02)Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador 40110-160, BA, Brazil.
(03)Instituto Nacional de Ciência e Tecnologia em Doenças Tropicais (INCT-DT), Ministério da Ciência e Tecnologia e Inovação (MCTI), CNPq, Salvador 40110-160, BA, Brazil.
(04)Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104-4539, USA.

The role of the immune response in the pathogenesis of cutaneous leishmaniasis (CL) due to Leishmania (Viannia) braziliensis is predominantly carried out via blood cells. Here, we evaluate whether cytokine production by peripheral blood mononuclear cells (PBMCs) reflects what has been documented at the lesion site. The participants included 22 CL patients diagnosed with a positive PCR. PBMCs were stimulated for 72 h with a soluble leishmania antigen (SLA). Biopsies obtained from the edge of the ulcers were incubated for the same period. Cytokines in supernatants were assessed via ELISA. TNF, IL-1β, IL-6, IL-17, and granzyme B (GzmB) were higher in the supernatants of biopsies than in PBMCs, but IFN-γ was higher in the supernatants of PBMCs than in biopsies. There was a positive correlation between IFN-γ and TNF in PBMCs, and an inverse correlation between TNF and IL-10 in the cells from the lesion site. A strong correlation between IL-1β, IL-17, and GzmB was observed in the biopsies, and a positive correlation was detected between these cytokines and the lesion size. Our results indicate that the immune response in L. braziliensis lesions is different from that observed in peripheral blood, and our data suggest that in addition to IL-1β and GzmB, IL-17 participates in the pathology of CL.

42 - Description of lymphocyte and cytokine profiles in individuals with acute myeloid leukemia associated with FLT3-ITD and NPM1 mutation status. Eur J Cancer Prev. 2024 Jun 21. doi: 10.1097/CEJ.0000000000000905.

Reis R(1)(2), Müller GS(1)(2), Santos MM(1)(2), Santos AS(1)(2), Santos H(1)(3), Santos LS(1), Lopes BA(4), Trindade SC(5), Meyer RJ(1)(2)(5), Freire SM(1)(2)(6).

Afiliação:
(01)Immunology and Molecular Biology Laboratory, Federal University of Bahia.
(02)Postgraduate Program in Immunology, Federal University of Bahia.
(03)Professor Edgard Santos University Hospital, Salvador, BA.
(04)National Cancer Institute, Rio de Janeiro, RJ.
(05)Departament of Health, State University of Feira de Santana, Feira de Santana.
(06)Department of Biointeraction, Federal University of Bahia, Salvador, BA, Brazil.

The pathogenesis of acute myeloid leukemia (AML) involves mutations in genes such as FLT3 and NPM1, which are also associated with the prognosis of the disease. The immune system influences disease progression, but the mechanisms underlying the interaction between the immune system and AML are not clear. In this study, the profiles of lymphocytes and cytokines were described in individuals with AML stratified by molecular changes associated with prognosis. The participants included in this study were newly diagnosed AML patients (n = 43) who were about to undergo chemotherapy. Subtypes of lymphocytes in peripheral blood, including B cells, T cells, and natural killer cells, and serum concentrations of cytokines, including Th1, Th2, and Th17, were studied by flow cytometry assays (BD FACSCanto II). The correlations between lymphocyte subsets, cytokines, and genetic/prognostic risk stratification (based on the FLT3 and NPM1 genes) were analyzed. The differences in B lymphocytes (%), T lymphocytes (%), plasmablasts (%), leukocytes (cells/µl), and tumor necrosis factor (pg/ml) were determined between groups with FLT3-ITD+ and FLT3-ITD- mutations. The presence of mutations in NPM1 and FLT3-ITD and age suggested changes in the lymphocyte and cytokine profile in individuals with AML.

43 - The potential for vaccines to aid the treatment of post-TB lung disease. Int J Tuberc Lung Dis. 2024 Feb 1;28(2):111-112. doi: 10.5588/ijtld.23.0524.

Silva DR(1), Santos AP(2), Visca D(3), Bombarda S(4), Dalcolmo MMP(5), Galvão T(6), de Miranda SS(7), Parente AAAI(8), Rabahi MF(9), de Sales RKB(10), Migliori GB(11), de Queiroz Mello FC(12).

Afiliação:
(01)Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS.
(02)Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
(03)Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy.
(04)Secretaria de Estado da Saúde de São Paulo, Centro de Vigilância Epidemiológica Professor Alexandre Vranjac, São Paulo, SP.
(05)Centro de Referência Hélio Fraga, Oswaldo Cruz Foundation, Rio de Janeiro, RJ.
(06)Hospital Universitário Professor Edgar Santos, Universidade Federal da Bahia, Salvador, BA.
(07)Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG.
(08)(8)Departamento de Pediatria, UFRJ, Rio de Janeiro, RJ.
...

Sem Resumo

44 - Detection of IgG Anti-Giardia duodenalis Antibodies in Sera by Indirect Immunofluorescence and Western Blotting Assays. Acta Parasitol. 2024 Mar;69(1):351-357. doi: 10.1007/s11686-023-00753-3.

Santos SA(1), de Souza JN(2), Pacheco FTF(3), Santos MC(2), Dos Santos Novais D(2), Suzart VN(2), Dos Santos Guedes I(2), Neves MH(2), Gomes MA(4), Soares NM(1)(2), Teixeira MCA(5)(6).

Afiliação:
(01)Programa de Pós-Graduação em Farmácia, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(02)Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(03)Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(04)Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
(05)Programa de Pós-Graduação em Farmácia, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
(06)Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.

INTRODUCTION: Serological assays are alternative laboratory tools for the diagnosis of parasitic infections. The aim of this work was to evaluate the performance of the indirect fluorescent antibody test (IFAT) and Western blotting (WB) for the detection of IgG anti-Giardia antibodies in human sera. METHODOLOGY: Sera from individuals infected with Giardia duodenalis, other parasites or non-parasitized were selected for serological assays. Ninety-seven sera were tested by IFAT at 1:20 and 1:40 dilutions and of these, 40 samples were also analyzed by WB. RESULTS: The sensitivity and specificity of the IFAT was 97% and 46.9% at 1:20 sera dilution, and 39.4% and 59.4% at 1:40 sera dilution. The low molecular weight polypeptides fractions of 25 kDa, 27-31 kDa and 45-55 kDa were the most frequently identified by the sera of individuals infected with G. duodenalis, along with low cross-reactivity, presenting an individual sensitivity of 42.8%, 50.0% and 57.1%, and specificity of 83.3%, 83.3% and 91.7%, respectively. The highest overall sensitivity of WB (85.7%) was based on the immunoreactivity of sera with at least one of those proteins. The concordance between the detection of G. duodenalis in feces by microscopy and the WB results was considered substantial (Kappa = 0.61).CONCLUSION: Constant exposure to Giardia infection throughout a lifetime can maintain high levels of specific antibodies in serum, even without active infection. Moreover, proteins found in intestinal amoebas may hinder the serological diagnosis of giardiasis in endemic areas due to cross-reactivity, which can be partially solved using Giardia low molecular weight proteins.

45 - Ligneous conjunctivitis: Fresh-frozen plasma and heparin use intra-and postoperatively, a report of two cases. Arq Bras Oftalmol. 2024 Mar 22;87(3):e20220288. doi: 10.5935/0004-2749.2022-0288.

Almeida SCGB(1), Marback PMF(1).

Afiliação:
(01)Serviço de Oftalmologia, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brazil.

Ligneous conjunctivitis is a rare chronic form of recurrent membranous inflammation and plasminogen deficiency. Ocular manifestations may be associated with sites other than mucous membranes, such as the oral cavity, internal ear, respiratory, genitals, and kidney. Treatment is extremely difficult because of the lack of topic plasminogen drops, and a high volume is required for systemic supplementation. This report aimed to present two patients with ligneous conjunctivitis treated with membrane excision, topical fresh-frozen plasma, and heparin intra-, and postoperatively. No recurrence was found in the ligneous membrane in the 12-month follow-up. The use of topical fresh-frozen plasma and heparin after membrane excision could be effective to avoid recurrence.

46 - Alpha-lipoic acid does not improve olfactory training results in olfactory loss due to COVID-19: a double-blind randomized trial. Braz J Otorhinolaryngol. 2024 Jan-Feb;90(1):101356. doi: 10.1016/j.bjorl.2023.101356.

Figueiredo LP(1), Paim PVDSL(2), Cerqueira-Silva T(3), Barreto CC(4), Lessa MM(4).

Afiliação:
(01)Universidade Federal da Bahia (UFBA), Programa de Pós-Graduação em Ciências da Saúde, Salvador, BA, Brazil.
(02)Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Salvador, BA, Brazil.
(03)Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil.
(04)Universidade Federal da Bahia (UFBA), Hospital Universitário Professor Edgard Santos (HUPES), Serviço de Otorrinolaringologia, Salvador, BA, Brazil.

OBJECTIVES: Olfactory loss is a recognized long-term dysfunction after Coronavirus Disease 2019 (COVID-19) infection. This investigation aimed to assess the effect of alpha-lipoic acid as an adjuvant treatment of olfactory training on the improvement of smell loss in post-COVID-19 patients. METHODS: This randomized controlled trial included 128 adult outpatients who had persistent smell loss for more than 3-months after COVID-19 infection. The participants were randomly allocated into two groups: the intervention treatment group, which received alpha-lipoic acid associated to olfactory training, and comparison treatment group, which received placebo pills associated to olfactory training. The participants were followed-up for 12-weeks. Olfactory dysfunction was assessed in terms of Visual Analog Scale (VAS), and the Connecticut Chemosensory Clinical Research Center (CCCRC) test for the Brazilian population. RESULTS: A total of 100 participants completed the follow-up period and were analyzed in this study. Both groups have improved CCCRC score (p = 0.000), olfactory threshold (p = 0.000), identification score (p = 0.000) and VAS score (p = 0.000) after 12-weeks follow-up. No significant differences were determined between the intervention and comparison treatment groups in CCCRC score (p = 0.63), olfactory threshold (p = 0.50), identification score (p = 0.96) and VAS score (p = 0.97). In all these criteria, comparison treatment group went slightly worse. At the endpoint of the study, the frequency of anosmia reduced to 2% in the intervention treatment group and to 7.8% in the comparison treatment group. Also, 16.8% of the intervention group' subjects, and 15.7% of comparison treatment group's patients reached normosmia. CONCLUSIONS: Overall, there was a strongly significant difference in olfactory function between baseline and endpoint for both groups. However, based on the lack of significant difference between the intervention treatment and the comparison treatment groups in terms of olfactory changes, our study appoints that the alpha-lipoic acid is not better than olfactory training alone to treat olfactory loss after COVID-19.

47 - Variability in the perception of palliative care and end-of-life care among hematology professionals from the same reference center in Bahia, Brazil: A descriptive cross-sectional study. Sao Paulo Med J. 2024 Feb 23;142(4):e2023225. doi: 10.1590/1516-3180.2023.0255.R1.

Paim Miranda DL(1), Orathes Ponte Silva AM(1), Pereira Ferreira D(2), Teixeira da Silva L(1), Lins-Kusterer L(3), Queiroz Crusoé E(4), Vieira Lima MB(5), Aurélio Salvino M(6).

Afiliação:
(01)Postgraduate Program in Medicine and Health, Professor Edgard Santos University Hospital, Medical School, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
(02)Medicine Student, Medical School, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
(03)Program in Medicine and Health, Department of Preventive and Social Medicine Medical School, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
(04)Hospital Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
(05)Physician, Hospital Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
(06)Associate Professor, Postgraduate Program in Medicine and Health, Professor Edgard Santos University Hospital, Medical School, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.

BACKGROUND: There are several illness-specific cultural and system-based barriers to palliative care (PC) integration and end-of-life (EOL) care in the field of oncohematology.OBJECTIVES: This study aimed to investigate the variability in the perceptions of PC and EOL care.DESIGN AND SETTING: A cross-sectional study was conducted in the Hematology Division of our University Hospital in Salvador, Bahia, Brazil. METHODS: Twenty physicians responded to a sociodemographic questionnaire and an adaptation of clinical questionnaires used in previous studies from October to December 2022. RESULTS: The median age of the participants was 44 years, 80% of the participants identified as female, and 75% were hematologists. Participants faced a hypothetical scenario involving the treatment of a 65-year-old female with a poor prognosis acute myeloid leukemia refractory to first-line treatment. Sixty percent of the participants chose to follow other chemotherapy regimens, whereas 40% opted for PC. Next, participants considered case salvage for the patient who developed septic shock following chemotherapy and were prompted to choose their most probable conduct, and the conduct they thought would be better for the patient. Even though participants were from the same center, we found a divergence from the most probable conduct among 40% of the participants, which was due to personal convictions, legal aspects, and other physicians' reactions. CONCLUSIONS: We found considerable differences in the perception of PC and EOL care among professionals, despite following the same protocols. The study also demonstrated variations between healthcare professionals' beliefs and practices and persistent historical tendencies to prioritize aggressive interventions.

48 - Fatigue by the Chalder Questionnaire and post-hemodialysis recovery in a population of predominantly African descent: The PROHEMO. Int J Artif Organs. 2024 Jun;47(6):373-379. doi: 10.1177/03913988241255501.

Gutiérrez-Peredo GB(1), Silva Martins MT(1)(2), da Silva FA(1)(3), Lopes MB(1)(4)(5), Lopes GB(1)(5), James SA(6), Norris KC(7), Lopes AA(1)(5)(8).

Afiliação:
(01)Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA, Brazil.
(02)Clinic of Renal Disease and Hypertension (CLINIRIM), Salvador, BA, Brazil.
(03)NEPHRON Clinic, Salvador, BA, Brazil.
(04)Arbor Research Collaborative for Health, Ann Arbor, MI, USA.
(05)Unit of Clinical Epidemiology and Evidence Based Medicine, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, BA, Brazil.
(06)Sanford School of Public Policy, Duke University, Durham, NC, USA.
(07)Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA.
(08)Department of Internal Medicine, Federal University of Bahia, Salvador, BA, Brazil.

BACKGROUND/OBJECTIVE: A high prevalence of fatigue and a positive association between fatigue and post-hemodialysis recovery have been reported in predominantly white populations of maintenance hemodialysis (MHD) patients. The present study evaluates associations between self-reported fatigue by the 11-item Chalder Fatigue Questionnaire (CFQ-11) and the need for post-hemodialysis recovery in a predominantly African-descent MHD population. METHODS: A total of 233 patients (94% Black or Mixed-Race) participating in the "Prospective Study of the Prognosis of Patients on Maintenance Hemodialysis" (PROHEMO), Salvador, Brazil were recruited for this cross-sectional study. The CFQ-11 was used to measure fatigue: <4 for absent or mild, ⩾4 for moderate to severe. Patients were also asked if they needed some time to recover after the hemodialysis. Logistic regression was used to estimate odds ratio (OR) of the association with adjustments for age, sex, race, educational level, economic class level, diabetes, hearth failure, and hemoglobin. RESULTS: Mean age was 51.5 ± 12.5 years. Moderate to severe fatigue (⩾4 points) was observed in 70.8% (165/233), and absent or mild fatigue (<4 points) in 29.2% (68/233). Compared to patients with fatigue scores <4 (20.6%), the need for post-hemodialysis recovery was 2.5 times greater in patients with fatigue scores ⩾4 (52.7%). The covariate-adjusted logistic regression OR was 4.60, 95% CI: 2.27, 9.21. CONCLUSION: This study in MHD patients of predominantly African descent supports self-reported fatigue assessed by the CFQ-11 as a relevant predictor of the need for post-hemodialysis recovery. The results offer a rationale for investigating whether interventions to prevent fatigue reduce the need of post-hemodialysis recovery.

49 - CCR5 promotes the migration of pathological CD8+ T cells to the leishmanial lesions.  PLoS Pathog. 2024 May 6;20(5):e1012211. doi: 10.1371/journal.ppat.1012211.

Amorim Sacramento L(1), Farias Amorim C(1), G Lombana C(1), Beiting D(1), Novais F(2), P Carvalho L(3)(4), M Carvalho E(3)(4), Scott P(1).

Afiliação:
(01)Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
(02)Department of Microbial Infection and Immunity, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America.
(03)Laboratório de Pesquisas Clínicas do Instituto de Pesquisas Gonçalo Muniz-Fiocruz, Salvador, Bahia, Brazil.
(04)Immunology Service, Professor Edgard Santos University Hospital Complex, Federal University of Bahia, Salvador, Bahia, Brazil.

Update of
    bioRxiv. 2023 Oct 13:2023.10.10.561700. doi: 10.1101/2023.10.10.561700.

Cytolytic CD8+ T cells mediate immunopathology in cutaneous leishmaniasis without controlling parasites. Here, we identify factors involved in CD8+ T cell migration to the lesion that could be targeted to ameliorate disease severity. CCR5 was the most highly expressed chemokine receptor in patient lesions, and the high expression of CCL3 and CCL4, CCR5 ligands, was associated with delayed healing of lesions. To test the requirement for CCR5, Leishmania-infected Rag1-/- mice were reconstituted with CCR5-/- CD8+ T cells. We found that these mice developed smaller lesions accompanied by a reduction in CD8+ T cell numbers compared to controls. We confirmed these findings by showing that the inhibition of CCR5 with maraviroc, a selective inhibitor of CCR5, reduced lesion development without affecting the parasite burden. Together, these results reveal that CD8+ T cells migrate to leishmanial lesions in a CCR5-dependent manner and that blocking CCR5 prevents CD8+ T cell-mediated pathology.

50 - Adult ocular adnexal xanthogranulomatous disease associated with immunoglobulin G4-related disease: an unusual association. Reumatismo. 2024 Mar 22;76(1). doi: 10.4081/reumatismo.2024.1641.

De Santana AR(1), Castro de Oliveira Figueirôa MDL(2), Souza Pedreira AL(3), Behrens Pinto GL(4), Santiago MB(5).

Afiliação:
(01)Bahiana School of Medicine and Public Health, Salvador.
(02)Bahiana School of Medicine and Public Health, Salvador.
(03)Bahiana School of Medicine and Public Health, Salvador.
(04)Professor Edgard Santos University Hospital Complex, Federal University of Bahia.
(05)Bahiana School of Medicine and Public Health, Salvador; Professor Edgard Santos University Hospital Complex, Federal University of Bahia; Specialized Rheumatology Services, Bahia.

Adult-onset xanthogranuloma (AOX) and immunoglobulin G4-related disease (IgG4-RD) are uncommon fibrosing conditions that may exhibit localized ocular manifestations and occasionally systemic symptoms. These conditions exhibit overlapping clinical and histological features, suggesting a potential correlation between them, although their exact relationship remains unclear. This paper presents the case of a black male patient exhibiting typical histological indications of both AOX and IgG4-RD. The patient responded positively to corticosteroid treatment.

51 - Identifying Genetic Etiology in Patients with Intellectual Disability: An Experience in Public Health Services in Northeastern Brazil. J Pediatr Genet. 2022 Nov 14;13(2):90-98. doi: 10.1055/s-0042-1757888.

de Carvalho AFL(1), Alves ES(1), Pitanga PML(1), Ribeiro EM(2), Doriqui MJR(3), Toralles MBP(4), Topázio BA(1), Dos Santos JF(1), de Lima RLLF(1), Kulikowski LD(5), Acosta AX(4).

Afiliação:
(01)Laboratory of Human Genetics and Mutagenesis, Institute of Biology, Federal University Bahia (UFBA), Salvador, Bahia, Brazil.
(02)Faculty of Medicine Estacio of Juazeiro Norte, Estacio-FMJ, Hospital Infantil Albert Sabin, Fortaleza, Ceará, Brazil.
(03)Association of Parents and Friends of Exceptional Children (APAE), São Luiz, Maranhão, Brazil.
(04)Medical School of Medicine, Medical Genetic Service - Edgard Santos Teaching Hospital/Federal University of Bahia, Salvador, Bahia, Brazil.
(05)Department of Pathology, Cytogenomics Laboratory - LIM 03, University of São Paulo, São Paulo, Brazil.

Intellectual disability (ID) is considered a common neuropsychiatric disorder that affects up to 3% of the population. The etiologic origin of ID may be genetic, environmental, and multifactorial. Chromosomopathies are relatively common among the genetic causes of ID, especially in the most severe cases and those associated with dysmorphic features. Currently, the application of new molecular cytogenetics technologies has increasingly allowed the identification of microdeletions, microduplications, and unbalanced translocations as causes of ID. The objective of this study was to investigate the etiology of ID in patients admitted to a public hospital in Northeastern Brazil. In total, 119 patients with ID who had normal karyotypes and fragile X exams participated in this study. The patients were initially physically examined for microdeletion syndromes and then tested using fluorescence in situ hybridization (FISH), multiplex ligation-dependent probe amplification (MLPA), methylation-sensitive polymerase chain reaction (MS-PCR), and chromosome microarray analysis (CMA), according to clinical suspicion. Patients with no diagnoses after FISH, MLPA, and/or MS-PCR evaluations were subsequently tested by CMA. The rate of etiologic diagnoses of ID in the current study was 28%. FISH diagnosed 25 out of 79 tested (31%), MLPA diagnosed 26 out of 79 tested (32%), MS-PCR diagnosed 7 out of 20 tested (35%), and the single nucleotide polymorphism array diagnosed 6 out of 27 tested (22%). Although the CMA is the most complete and recommended tool for the diagnosis of microdeletions, microduplications, and unbalance translocations in patients with ID, FISH, MLPA, and MS-PCR testing can be used as the first tests for specific syndromes, as long as the patients are first physically screened clinically, especially in the public health networks system in Brazil, where resources are scarce.

52 - Dimensions of the COVID-19 pandemic: prevalence of common mental disorders in "invisible" health workers and their association with occupational stressors. Rev Bras Epidemiol. 2024 Jul 29;27:e240039. doi: 10.1590/1980-549720240039.

Maturino MM(1)(2), Sousa CC(3), Moraes LGDS(1), Souza DS(1), Freitas MYGS(4), Araújo TM(1).

Afiliação:
(01)Universidade Estadual de Feira de Santana, Epidemiology Center - Feira de Santana (BA), Brazil.
(02)Bahia State Secretariat of Health, Eastern Regional Health Center - Salvador (BA), Brazil.
(03)Hospital Universitário Professor Edgar Santos - Salvador (BA), Brazil.
(04)Universidade Estadual de Feira de Santana, Integrated Public Health Research Center, Health Surveillance Research and Extension Center - Feira de Santana, Bahia, Brazil.

OBJECTIVE: To evaluate the association between occupational stressors and common mental disorders (CMD) among "invisible" health workers in the context of the COVID-19 pandemic. METHOD: Cross-sectional study including a probabilistic sample of 1,014 health workers from three municipalities in Bahia. CMDs were assessed using the SRQ-20. The Effort-Reward Imbalance (ERI) scale and the Demand-Control Model assessed occupational stressors. Descriptive, bivariate, and multiple analysis to evaluate the association between the variables of interest. RESULTS: The global prevalence of CMD was 39.9%; it was higher among CHA/EDCA (47.2%), followed by management and surveillance staff (38.6%), technicians (35.4%), and support/maintenance/cleaning staff (29.9%). The association between occupational stressors and CMD varied among occupations: 1. Excessive work commitment (EWC), effort-reward imbalance (ERI), and psychological demand were associated with CMD among support/maintenance/cleaning workers; 2. EWC and ERI were associated with CMD among CHA/EDCA; 3. EWC, ERI, and low control over work were associated with CMD among technicians; 4. Among management and surveillance workers, only ERI remained associated with CMD. CONCLUSIONS: Occupational stressors played a relevant role in mental illness, with variation between occupational strata, demanding attention, monitoring, and control.

53 - Risk of Kidney Failure and Mortality in Patients Under Nephrology Care in NonHigh-Income Settings. Kidney Int Rep. 2023 Dec 1;9(2):486-490. doi: 10.1016/j.ekir.2023.11.023.

Risk of Kidney Failure and Mortality in Patients Under Nephrology Care in NonHigh-Income Settings.

Guedes M(1)(2), Tu C(1), Bieber B(1), Silva VC(3)(4), Lopes A(5)(6), Sesso R(7), De Pinho NA(8), Pecoits-Filho R(1)(2); CKDopps Investigators.

Afiliação:
(01)Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.
(02)Pontificia Universidade Catolica do Parana, Curitiba, Paraná, Brazil.
(03)Pro-Rim Foundation, Joinville, Santa Catarina, Brazil.
(04)School of Medicine, UNIVILLE, Joinville, Santa Catarina, Brazil.
(05)Unit of Clinical Epidemiology and Evidence-Based Medicine, Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador, Bahia, Brazil.
(06)Department of Internal Medicine, Federal University of Bahia, Salvador, Bahia, Brazil.
(07)Division of Nephrology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
(08)Center for Research in Epidemiology and Population Health (CESP), University Paris Saclay, University Versailles Saint-Quentin en Yvelines, National Institute of Health, Clinical Epidemiology Team, Villejuif, France.

Sem Resumo

54 - The contrasting phenotypes of neutrophils during asymptomatic versus symptomatic Leishmania braziliensis infection. J Infect Dis. 2024 Jun 24:jiae317. doi: 10.1093/infdis/jiae317.

Conceiҫão JA(1)(2)(3), Carneiro PP(2), Dórea AS(2), Oliveira WN(2), Muniz AC(2), Carvalho EM(4)(5), Wilson ME(1)(6)(3), Bacellar O(2)(5).

Afiliação:
(01)Department of Internal Medicine, University of Iowa, Iowa City, 52242, USA.
(02)Serviҫo de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, 40110-060, Brazil.
(03)Veterans' Affairs Medical Center, Iowa City, 52246, USA.
(04)Instituto Gonҫalo Moniz (IGM) - Fiocruz Bahia, Salvador, 40296-710, Brazil.
(05)Instituto Nacional de Ciência e Tecnologia de Doenҫas Tropicais - INCT-DT(CNPq/MCT), Salvador, 40110-060, Brazil.
(06)Department of Microbiology & Immunology, University of Iowa, Iowa City, 52242, USA.

BACKGROUND: The mechanisms that mediate immune protection in individuals with subclinical (SC) or asymptomatic infection with L. braziliensis are largely unknown. Neutrophils (PMNs) have been implicated in progressive symptomatic cutaneous leishmaniasis (CL), but their potential participation in maintenance of subclinical infection is unexplored. The aim of this study was to compare the phenotypic and functional profiles of PMNs in individuals with SC infection versus patients with symptomatic CL due to L. braziliensis. METHODS: Subjects were recruited in the endemic region of Corte de Pedra, Bahia, Brazil. Surface markers to define activation status were characterized by flow cytometry. Functional responses of PMNs including phagocytic capacity, production of oxidative species, and oxidative killing of intracellular parasites were studied in vitro. RESULTS: PMNs from individuals with SC infection displayed a more activated phenotype and greater ability to control the infection than PMNs from patients with CL. In contrast, PMNs from patients with CL exhibited higher expression of HLA-DR and higher production of oxidative species than PMNs from subjects with SC infection. CONCLUSION: PMNs from individuals with SC infection can control the infection more efficiently than PMNs from patients with CL, despite the lower production of oxidants. Our observations suggest that L. braziliensis may evade microbicidal mechanisms of PMNs from patients with CL, contributing to parasite dissemination and the establishment of disease.

55 - Palliative care and COVID-19: acknowledging past mistakes to forge a better future. Front Med (Lausanne). 2024 Jul 25;11:1390057. doi: 10.3389/fmed.2024.1390057.

de Andrade CRM(1), Luz FST(2), de Oliveira NR(3), Kopittke L(4)(5), Santa Rosa LMM(6), Gomes AGDR(7), Bartolazzi F(8), Francisco SC(9), da Costa FR(2), Jorge AO(10), Cimini CCR(11), Carneiro M(12), Ruschel KB(13)(14), Schwarzbold AV(15), Ponce D(16), Ferreira MAP(17), Guimarães Júnior MH(18), Silveira DV(19), Aranha FG(20), de Carvalho RLR(21)(22), et al.

Afiliação:
(01)Centro Universitário de Belo Horizonte, UniBH. Av. Professor Mário Werneck, Belo Horizonte, Brazil.
(02)Hospital Metropolitano Odilon Behrens. R. Formiga, Belo Horizonte, Brazil.
(03)Hospital Eduardo de Menezes. R. Dr. Cristiano Rezende, Belo Horizonte, Brazil.
(04)Hospital Nossa Senhora da Conceição. Av. Francisco Trein, Porto Alegre, Brazil.
(05)Hospital Cristo Redentor. R. Domingos Rubbo, Porto Alegre, Brazil.
(06)Faculdade Ciências Médicas de Minas Gerais. Al. Ezequiel Dias, Belo Horizonte, Brazil.
(07)Rede MaterDei de Saúde. Via Expressa, Betim, Brazil.
(08)Hospital Santo Antônio. R. Dr. Márcio de Carvalho Lopes, Curvelo, Brazil.
(09)Hospital Metropolitano Dr. Célio de Castro. R. Dona Luzia, Belo Horizonte, Brazil.
(10)Hospital Risoleta Tolentino Neves. R. das Gabirobas, Belo Horizonte, Brazil.
(11)Hospital Santa Rosália. R. Dr. Onofre, Teófilo Otoni, Brazil.
(12)Hospital Santa Cruz. Universidade de Santa Cruz do Sul. R. Fernando Abott, Santa Cruz do Sul, Brazil.
(13)Hospital Universitário Canoas. Av. Farroupilha, Canoas, Brazil.
(14)Hospital Mãe de Deus. R. José de Alencar, Porto Alegre, Brazil.
(15)Hospital Universitário de Santa Maria. Av. Roraima, Santa Maria, Brazil.
(16)Hospital das Clínicas da Faculdade de Medicina de Botucatu. Rod. Domingos Sartori, Botucatu, Brazil.
(17)Hospital de Clínicas de Porto Alegre. R. Ramiro Barcelos, Porto Alegre, Brazil.
(18)Hospital Márcio Cunha. Av. Eng. Kiyoshi Tsunawaki, Ipatinga, Brazil.
(19)Hospital Unimed-BH. Av. Contorno, Belo Horizonte, Brazil.
(20)Hospital SOS Cárdio. Rod. SC-401, Florianópolis, Brazil.
(21)Hospital Universitário Professor Edgard Santos. R. Augusto Viana, S/N, Salvador, Brazil.
...

CONTEXT: COVID-19 induces complex distress across physical, psychological, and social realms and palliative care (PC) has the potential to mitigate this suffering significantly. OBJECTIVES: To describe the clinical characteristics and outcomes of COVID-19 patients with an indication of PC, compared to patients who had no indication, in different pandemic waves.METHODS: This retrospective multicenter observational cohort included patients from 40 hospitals, admitted from March 2020 to August 2022. Patients who had an indication of palliative care (PC) described in their medical records were included in the palliative care group (PCG), while those who had no such indication in their medical records were allocated to the non-palliative care group (NPCG). RESULTS: Out of 21,158 patients, only 6.7% had indication for PC registered in their medical records. The PCG was older, had a higher frequency of comorbidities, exhibited higher frailty, and had a higher prevalence of clinical complications and mortality (81.4% vs. 17.7%, p < 0.001), when compared to the NPCG. Regarding artificial life support, the PCG had a higher frequency of dialysis (20.4% vs. 10.1%, p < 0.001), invasive mechanical ventilation (48.2% vs. 26.0%, p < 0.001) and admission to the intensive care unit (53.6% vs. 35.4%, p < 0.001). These differences were consistent across all three waves. CONCLUSION: A low proportion of patients received PC. Patients in PCG were more fragile, had more clinical complications, and had a higher mortality. On the contrary to our expectations, they received more artificial life support in all three waves. Taken together, these findings suggest that decisions regarding PC indication were made too late, within a context of end-of-life and therapeutic failure.

56 - Enhancing diagnostic accuracy of multiple myeloma through ML-driven analysis of hematological slides: new dataset and identification model to support hematologists. Sci Rep. 2024 May 15;14(1):11176. doi: 10.1038/s41598-024-61420-9.

Andrade CLB(1), Ferreira MV(2), Alencar BM(2), Junior AMA(2), Lopes TJS(3), Dos Santos AS(1), Dos Santos MM(1), Silva MICS(1), Rosa IMDRP(1), Filho JLSB(2), Guimaraes MA(2), de Carvalho GC(1), Santos HHM(1), Santos MML(4), Meyer R(1), Rios TN(2), Rios RA(5), Freire SM(1).

Afiliação:
(01)Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil.
(02)Institute of Computing, Federal University of Bahia, Salvador, Brazil.
(03)Nezu Life Sciences, 76149, Karlsruhe, Germany.
(04)Hospital Universitario Professor Edgard Santos - HUPES, Federal University of Bahia, Salvador, 40110-902, Brazil.
(05)Institute of Computing, Federal University of Bahia, Salvador, 40170-110, Brazil.

Multiple Myeloma (MM) is a hematological malignancy characterized by the clonal proliferation of plasma cells within the bone marrow. Diagnosing MM presents considerable challenges, involving the identification of plasma cells in cytology examinations on hematological slides. At present, this is still a time-consuming manual task and has high labor costs. These challenges have adverse implications, which rely heavily on medical professionals' expertise and experience. To tackle these challenges, we present an investigation using Artificial Intelligence, specifically a Machine Learning analysis of hematological slides with a Deep Neural Network (DNN), to support specialists during the process of diagnosing MM. In this sense, the contribution of this study is twofold: in addition to the trained model to diagnose MM, we also make available to the community a fully-curated hematological slide dataset with thousands of images of plasma cells. Taken together, the setup we established here is a framework that researchers and hospitals with limited resources can promptly use. Our contributions provide practical results that have been directly applied in the public health system in Brazil. Given the open-source nature of the project, we anticipate it will be used and extended to diagnose other malignancies.

57 - Learning Curve for In-Hospital Mortality of Transcatheter Aortic Valve Replacement: Insights from the Brazilian National Registry. Arq Bras Cardiol. 2024 Jun;121(7):e20230622. doi: 10.36660/abc.20230622.

Bernardi FLM(1), Abizaid AA(1), Brito FS Jr(1)(2), Lemos PA(3), Siqueira DAA(4), Costa RA(2)(4), Leite REGS(5), Mangione FM(6), Thiago LEKS(7), Mangione JA(6), Lima VC(8), Oliveira AD(9), Marino MA(10), Cardoso CJF(11), Caramori PRA(12), Tumelero R(13), Portela ALF(14), Prudente M(15), Henriques LA(16), Souza FS(17)(18), et al.

Afiliação:
(01)Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.
(02)Hospital Sírio-Libanês, São Paulo, SP - Brasil.
(03)Hospital Israelita Albert Einstein, São Paulo, SP - Brasil.
(04)Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil.
(05)Instituto de Cardiologia, Porto Alegre, RS - Brasil.
(06)Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP - Brasil.
(07)Hospital SOS Cárdio, Florianópolis, SC - Brasil.
(08)Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS - Brasil.
(09)Hospital Santa Izabel, Salvador, BA - Brasil.
(10)Hospital Madre Teresa, Belo Horizonte, MG - Brasil.
(11)Hospital Naval Marcilio Dias, Rio de Janeiro, RJ - Brasil.
(12)Hospital São Lucas da PUCRS, Porto Alegre, RS - Brasil.
(13)Universidade de Passo Fundo, Passo Fundo, RS - Brasil.
(14)Associação Piauiense de Combate ao Câncer, Teresina, PI - Brasil.
(15)Hospital Encore, Goiânia, GO - Brasil.
(16)Hospital Albert Sabin, Juiz de Fora, MG - Brasil.
(17)Hospital Universitário Professor Edgard Santos, Salvador, BA - Brasil.
(18)Hospital Cardio-Pulmonar, Salvador, BA - Brasil.
...

BACKGROUND: Robust data on the learning curve (LC) of transcatheter aortic valve replacement (TAVR) are lacking in developing countries. OBJECTIVE: To assess TAVR's LC in Brazil over time. METHODS: We analyzed data from the Brazilian TAVR registry from 2008 to 2023. Patients from each center were numbered chronologically in case sequence numbers (CSNs). LC was performed using restricted cubic splines adjusted for EuroSCORE-II and the use of new-generation prostheses. Also, in-hospital outcomes were compared between groups defined according to the level of experience based on the CSN: 1st to 40th (initial-experience), 41st to 80th (early-experience), 81st to 120th (intermediate-experience), and over 121st (high-experience). Additional analysis was performed grouping hospitals according to the number of cases treated before 2014 (>40 and ≤40 procedures). The level of significance adopted was <0.05. RESULTS: A total of 3,194 patients from 25 centers were included. Mean age and EuroSCORE II were 80.7±8.1 years and 7±7.1, respectively. LC analysis demonstrated a drop in adjusted in-hospital mortality after treating 40 patients. A leveling off of the curve was observed after case #118. In-hospital mortality across the groups was 8.6%, 7.7%, 5.9%, and 3.7% for initial-, early-, intermediate-, and high-experience, respectively (p<0.001). High experience independently predicted lower mortality (OR 0.57, p=0.013 vs. initial experience). Low-volume centers before 2014 showed no significant decrease in the likelihood of death with gained experience, whereas high-volume centers had a continuous improvement after case #10. CONCLUSION: A TAVR LC phenomenon was observed for in-hospital mortality in Brazil. This effect was more pronounced in centers that treated their first 40 cases before 2014 than those that reached this milestone after 2014.

58 - Pentavalent Antimony Associated with G-CSF in the Treatment of Cutaneous Leishmaniasis Caused by Leishmania (Viannia) braziliensis. Pathogens. 2024 Apr 4;13(4):301. doi: 10.3390/pathogens13040301.

Suprien C(1), Guimarães LH(2)(3), de Carvalho LP(1)(2)(4)(5), Machado PRL(1)(2)(4).

Afiliação:
(01)Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Bahia, Salvador 40026-010, Bahia, Brazil
(02)National Institutes of Science and Technology in Tropical Diseases, Ministry of Science and Technology, Salvador, Bahia, Brazil
(03)Medicine School, Federal University of Recôncavo Bahia, Santo Antônio de Jesus
(04)Immunology Service of the Professor Edgard Santos University Hospital, Federal University of Bahia, Salvador 40110-060, Bahia, Brazil
(05)Gonçalo Moniz Institute, Fiocruz, Salvador 40296-710, Bahia, Brazil.

Cutaneous leishmaniasis (CL), caused by Leishmania braziliensis, in recent decades has shown decreasing cure rates after treatment with meglumine antimoniate (MA). Granulocyte colony-stimulating factor (G-CSF) is a cytokine associated with epithelialization and healing processes. METHODS: This study compares the effectiveness of G-CSF associated with MA in the treatment of CL. A total of 32 patients aged between 18 and 50 years with CL confirmed for L. braziliensis were included in this study. G-CSF or placebo (0.9% saline) was applied by intralesional infiltration at four equidistant points on the edges of the largest ulcer on days 0 and 15 of treatment associated with intravenous MA. RESULTS: Males predominated in the G-CSF group (59%), while females predominated in the control group (53%). Injuries to the lower limbs predominated in both study groups. The cure rate in the G-CSF group was 65% and in the control group it was 47%, 90 days after initiation of therapy. CONCLUSIONS: Our data indicate that the association of G-CSF with MA is not superior to MA monotherapy. Although not significant, the potential benefit of this combination deserves further investigation. The use of higher doses or other routes of application of G-CSF in a greater number of patients should contribute to a definitive response.

59 - Efficacy of sodium nitroprusside in the treatment of drug-naive subjects in first episode psychosis - An open label study. Schizophr Res. 2024 Jul;269:114-115. doi: 10.1016/j.schres.2024.05.010.

Adelino MPM(1), Nunes MV(2), Nunes MFQ(2), Quarantini LC(3), Hallak JEC(4), Lacerda ALT(5).

Afiliação:
(01)LiNC - Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil; CNS Unit, BR Trials, São Paulo, Brazil
(02)LiNC - Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil; CNS Unit, BR Trials, São Paulo, Brazil
(03)Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Universidade Federal da Bahia, Brazil; Laboratório de Neuropsicofarmacologia, Universidade Federal da Bahia, Salvador, Brazil; Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Brazil
(04)Department of Neuroscience and Behavior, University of São Paulo, Ribeirão Preto, Brazil; National Institute of Science and Technology in Translational Medicine, CNPq/FAPESP/CAPES, Brazil; PRODAF - Programa de Transtornos Afetivos (Mood Disorders Unit), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
(05)LiNC - Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil; CNS Unit, BR Trials, São Paulo, Brazil; National Institute of Science and Technology in Translational Medicine, CNPq/FAPESP/CAPES, Brazil; PRODAF - Programa de Transtornos Afetivos (Mood Disorders Unit), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.

Sem Resumo

60 - Association between increased Subcutaneous Adipose Tissue Radiodensity and cancer mortality: Automated computation, comparison of cancer types, gender, and scanner bias. Appl Radiat Isot. 2024 Mar;205:111181. doi: 10.1016/j.apradiso.2024.111181.

Machado MAD(1), Moraes TF(2), Anjos BHL(3), Alencar NRG(4), Chang TC(5), Santana BCRF(6), Menezes VO(7), Vieira LO(6), Brandão SCS(4), Salvino MA(8), Netto EM(9).

Afiliação:
(01)Department of Radiology, Complexo Hospitalar Universitário Prof. Edgard Santos/ Ebserh, Universidade Federal da Bahia, Salvador, Bahia, Zip code: 40.110-040, Brazil; Nuclear Medicine Department, São Rafael Hospital/ Rededor, Salvador, Bahia, Zip code: 41.253-190, Brazil; Nuclearis Corporation, Recife, Pernambuco
(02)Northeast Center for Strategic Technologies, Universidade Federal de Pernambuco, Recife, Pernambuco, Zip code: 50.740-545, Brazil
(03)Nuclearis Corporation, Recife, Pernambuco, Zip code: 50.030-200, Brazil.
(04)Radiology and Nuclear Medicine Department, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Zip code: 50.670-901, Brazil
(05)Nuclear Medicine Department, Instituto de Medicina Integrada Fernandes Figueira, Recife, Pernambuco, Zip code: 50.070-902, Brazil.
(06)Nuclear Medicine Department, São Rafael Hospital/ Rededor, Salvador, Bahia, Brazil.
(07)Nuclear Medicine Department, São Rafael Hospital/ Rededor, Salvador, Bahia, Brazil; Nuclearis Corporation, Recife, Pernambuco; Radiology and Nuclear Medicine Department, Hospital das Clínicas, Federal University of Pernambuco/ Ebserh, Recife, Pernambuco
(08)Complexo Hospitalar Universitário Prof. Edgard Santos/ Ebserh, Universidade Federal da Bahia, Salvador, Bahia, Zip code: 40.110-040, Brazil; Hemathology Department, São Rafael Hospital, Salvador, Bahia, Zip code: 41.253-190, Brazil
(09)Infectious Disease Research Laboratory, Complexo Hospitalar Universitário Prof. Edgard Santos/ Ebserh, Universidade Federal da Bahia, Salvador, Bahia, Brazil

PURPOSE: Body composition analysis using computed tomography (CT) is proposed as a predictor of cancer mortality. An association between subcutaneous adipose tissue radiodensity (SATr) and cancer-specific mortality was established, while gender effects and equipment bias were estimated. METHODS: 7,475 CT studies were selected from 17 cohorts containing CT images of untreated cancer patients who underwent follow-up for a period of 2.1-118.8 months. SATr measures were collected from published data (n = 6,718) or calculated according to CT images using a deep-learning network (n = 757). The association between SATr and mortality was ascertained for each cohort and gender using the p-value from either logistic regression or ROC analysis. The Kruskal-Wallis test was used to analyze differences between gender distributions, and automatic segmentation was evaluated using the Dice score and five-point Likert quality scale. Gender effect, scanner bias and changes in the Hounsfield unit (HU) to detect hazards were also estimated. RESULTS: Higher SATr was associated with mortality in eight cancer types (p < 0.05). Automatic segmentation produced a score of 0.949 while the quality scale measurement was good to excellent. The extent of gender effect was 5.2 HU while the scanner bias was 10.3 HU. The minimum proposed HU change to detect a patient at risk of death was between 5.6 and 8.3 HU. CONCLUSIONS: CT imaging provides valuable assessments of body composition as part of the staging process for several cancer types, saving both time and cost. Gender specific scales and scanner bias adjustments should be carried out to successfully implement SATr measures in clinical practice.

61 - ELMO2 biallelic pathogenic variants in a patient with gingival hypertrophy and cherubism phenotype: Case report and molecular review. Am J Med Genet A. 2024 Mar 22:e63602. doi: 10.1002/ajmg.a.63602.

Perrone E(1)(2), Coelho AVC(1), Virmond LDA(1), Espolaor JGA(1)(2), Filho JBO(1), Nascimento ATBD(1), Matta MCD(1), Meira JGC(3), Cardoso-Júnior LM(4), Andrade ACM(3), Chaves RZT(5), Acosta AX(3)(6).

Afiliação:
(01)Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
(02)Departamento de Morfologia e Genética, Universidade Federal de São Paulo, São Paulo, Brazil
(03)Serviço de Genética Médica do Hospital Universitário Professor Edgard Santos (HUPES), Bahia, Brazil
(04)Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil
(05)Disciplina de Cirurgia de Cabeça e Pescoço do Hospital de Clínicas da Universidade de São Paulo, São Paulo, Brazil
(06)Departamento de Pediatria da Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Bahia, Brazil

Ramon syndrome (OMIM #266270) was first described in a patient with cherubism, gingival fibromatosis, epilepsy, intellectual disability, hypertrichosis, and stunted growth. In 2018, Mehawej et al. described a patient with Ramon syndrome in whom a homozygous variant in ELMO2 was identified, suggesting that this gene may be the causative for this syndrome. ELMO2 biallelic pathogenic variants were also described in patients with a primary intraosseous vascular malformation (PIVM; OMIM #606893). These patients presented gingival bleeding and cherubism phenotype. Herein, a patient with gingival hypertrophy, neurodevelopmental delay, and cherubism phenotype with a novel homozygous predicted loss-of-function (LOF) variant in the ELMO2 gene and family recurrence was reported. A surgical approach to treat gingival bleeding and mandible vascular malformation was also described. Furthermore, this study includes a comprehensive literature review of molecular data regarding the ELMO2 gene. All the variants, except one described in the ELMO2, were predicted as LOF, including our patient's variant. There is an overlapping between PIVM, also caused by LOF biallelic variants in the ELMO2 gene, and Ramon syndrome, which can suggest that they are not different entities. However, due to a limited number of cases described with molecular evaluation, it is hard to establish a genotype-phenotype correlation. Our study supports that LOF pathogenic biallelic variants in the ELMO2 gene cause a phenotype that has cherubism and gingival hypertrophy as main characteristics.

62 - Outcomes of severely ill patients with AIDS treated with efavirenz or dolutegravir: a multicenter, observational study. Front Med (Lausanne). 2024 Feb 28;11:1302710. doi: 10.3389/fmed.2024.1302710.

Brites C(1), Lacerda M(2), Sprinz E(3), Bay M(4), Pinto G(5), Azevedo P(1), Luz E(1), Lins-Kusterer L(1), Netto EM(1).

Afiliação:
(01)Laboratório de Pesquisa em Infectologia, Department of Medicine, Hospital Universitário Professor Edgard Santos - EBSERH, Federal University of Bahia, Salvador, Brazil
(02)Fundação de Medicina Tropical de Manaus, Manaus, Brazil
(03)Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
(04)Federal University of Rio Grande do Norte, Natal, Brazil
(05)Federal University of Santa Catarina, Florianópolis, Brazil

BACKGROUND: Currently, integrase inhibitors (INIs)-based ART regimens are the preferred initial therapy for AIDS patients. There is scarce information on the use of dolutegravir (DTG) among late-presenter people living with HIV (PLHIV). OBJECTIVES: To compare the effect of DTG- or efavirenz (EFV)-based regimens on the outcomes of patients with advanced AIDS. METHODS: We compared two cohorts of consecutive symptomatic AIDS patients (WHO stage 4, CD4 count<50 cells/mL) starting therapy with DTG-based (2018-2021, prospective cohort) or EFV-based regimens (2013-2016, retrospective cohort) from five Brazilian cities. The main endpoints were early (all-cause) mortality, viral suppression at 24 and 48 weeks, changes in CD4 count, and changes in initial therapy (for any reason). RESULTS: We included all eligible patients in a consecutive way (in both groups) until we reached 92 individuals per arm. The median baseline CD4 count (20 vs. 21 cells/mL) and the median HIV plasma viral load (5.5 copies/mL log10) were identical across the groups. Viral suppression rates were higher in the DTG group than in the EFV group at 24 (67.4% vs. 42.4%,) and 48 weeks (65.2% vs. 45.7%, p < 0.001 for both comparisons). More patients in the DTG group presented with CD4 > 200 cells/mL compared to the EFV group at 48 weeks (45% vs. 29%, p = 0.03). Treatment changes (ITT, M = F) were significantly more frequent in the EFV group (1% vs. 17%, p < 0.0001). The relative mortality rate was 25% lower in the DTG group, but without statistical significance. CONCLUSION: We detected a higher rate of virological suppression and greater treatment durability in patients with advanced AIDS treated with DTG than in those treated with EFV.