In patients with severe forms of COVID-19, thromboelastometry has been reported to display a hypercoagulant pattern. However, an algorithm to differentiate severe COVID-19 patients from nonsevere patients and healthy controls based on thromboelastometry parameters has not been developed. Forty-one patients over 18 years of age with positive qRT-PCR for SARS-CoV-2 were classified according to the severity of the disease: nonsevere (NS, n = 20) or severe (S, n = 21). A healthy control (HC, n = 9) group was also examined. Blood samples from all participants were tested by extrinsic (EXTEM), intrinsic (INTEM), non-activated (NATEM) and functional assessment of fibrinogen (FIBTEM) assays of thromboelastometry. The thrombodynamic potential index (TPI) was also calculated. Severe COVID-19 patients exhibited a thromboelastometry profile with clear hypercoagulability, which was significantly different from the NS and HC groups. Nonsevere COVID-19 cases showed a trend to thrombotic pole. The NATEM test suggested that nonsevere and severe COVID-19 patients presented endogenous coagulation activation (reduced clotting time and clot formation time). TPI data were significantly different between the NS and S groups. The maximum clot firmness profile obtained by FIBTEM showed moderate/elevated accuracy to differentiate severe patients from NS and HC. A decision tree algorithm based on the FIBTEM-MCF profile was proposed to differentiate S from HC and NS. Thromboelastometric parameters are a useful tool to differentiate the coagulation profile of nonsevere and severe COVID-19 patients for therapeutic intervention purposes.

: Experts have called attention to the possible negative impact of the coronavirus disease 2019 (COVID-19)–related cytokine storm syndrome on the progression of leprosy-related disabilities. We assessed the frequency of reactional states in patients co-infected with Mycobacterium leprae and severe acute respiratory syndrome (SARS) coronavirus (CoV) 2 (SARS-CoV-2). We consecutively included patients during the first peak of the COVID-19 epidemic in Brazil and analyzed the expressions of genes encoding interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12A, IL-12B, and tumor necrosis factor-α in peripheral blood mononuclear cells. We included 64 leprosy patients and 50 controls. Twelve of the leprosy patients and 14 of the controls had been diagnosed with COVID-19. Co-infection was associated with increased IL-6 (P = 0.043) and IL-12B (P = 0.017) expression. The median disability grades were higher for leprosy/COVID-19 patients; however, the difference was not significant (P = 0.194). Patients co-infected with M. leprae and SARS-CoV-2 may experience a higher-grade proinflammatory state.

O câncer do colo do útero tem se apresentado como um problema grave de saúde pública no Brasil, pois se trata de uma doença de evolução lenta com elevado impacto nas taxas de prevalência e letalidade, sobretudo em mulheres com condição social e econômica mais baixa e que se encontram no período produtivo de suas vidas. Pode ser desencadeado por infecção persistente por subtipos oncogênicos do Papilomavírus Humano, principalmente o 16 e o 18. Portanto, o objetivo deste estudo foi analisar a segurança e efetividade da vacina contra o HPV. Trata-se de uma revisão compreensiva da literatura, com síntese narrativa abrangente das evidências científicas. Esse tipo metodológico permite uma visão ampliada de um determinado assunto. A partir deste estudo, foi possível identificar que a vacina contra o HPV é considerada a medida mais eficaz para a prevenção do câncer do colo do útero, uma vez que é segura, imunogênica e bastante efetiva. Sugerem-se mais estudos futuros para aprimorar o entendimento, assim como a difusão das informações para a promoção da saúde.

Aim: The aim of the present study was to analyze a panel of immune-related miRNAs found in the respiratory tract among patients with symptomatic COVID-19. Method: This is a cross-sectional analysis on the total levels of selected miRNAs assessed from peripheral blood mononuclear cells of 33 male and female patients split according to a mild/moderate (n = 9) or a severe/critical phenotype (n = 24). Low molecular weight RNA was obtained the 10 miRNAs (miR-1-2, miR-10a, miR-92a, miR-100, miR-145, miR-146a, miR-155, miR-181a, miR-200a, miR-221) were quantified using specific TaqMan® RT-qPCR assays. Results: The main results indicate a negative correlation for miR-92a expression levels with oxygen saturation scores. In a direct comparison, there was a significant difference in concentrations of log-transformed levels of miR-92a (p=0.046) between groups, with higher values shown by the mild/moderate group. Conclusions: These findings revealed that the severity of COVID-19 is associated with differences in the expression of miR-92a, possibly due to an anti-inflammatory regimen that, despite being clinically useful, may yield this adverse outcome of oxygen deprivation.

The present study intended to characterize the profile of serum immune mediators in healthcare professionals at the pandemic onset, aiming to identify baseline immunological patterns associated with prospective COVID-19 diagnosis. A total of 386 participants with negative COVID-19 diagnosis were enrolled in a 19-month follow-up observational study. Quantitative analysis of immune mediators (chemokines, pro-inflammatory & regulatory cytokines and growth factors) was carried out by high-throughput multiplex array. All participants were SARS-CoV-2-negative at baseline, and immune mediators were measured prior to any documented COVID-19 diagnosis. Participants were categorized according to prospective diagnosis of COVID-19 [COVID-19 (-) and COVID-19 (+)]; time elapsed prior COVID-19 (+) diagnosis, disease outcome and age ranges. Data demonstrated that participants with prospective COVID-19 (+) diagnosis presented higher levels of immune mediators as compared to COVID-19 (-). The higher the baseline levels of immune mediators, the shorter the elapsed time prior COVID-19 (+) diagnosis. GM-CSF, IL-5, VEGF, IL-13, CCL11 and IL-10 presented higher increment magnitude in COVID-19 (+) over the COVID (-) counterpart. Signatures profiles further confirmed these findings. Symptomatic or severe disease outcomes, as well as persistent symptom duration were associated with distinct profiles of immune mediators. Networks with higher correlation numbers were observed in COVID-19 (+), particularly in short-time prior prospective diagnosis, symptomatic mild disease and with short symptom duration. Multivariate and decision tree analysis demonstrated that GM-CSF, CCL11, CXCL10 and TNF-α effectively distinguished COVID-19 (+) individuals and pointed out that G-CSF was consistently associated with severe disease and prolonged symptom duration. These findings demonstrate that baseline serum immune mediator profiles are associated with prospective COVID-19 diagnosis and clinical outcomes, as identified through non-linear modeling.

A síndrome HELLP é uma condição grave e complexa, decorrente de distúrbios hipertensivos da gravidez. Por não se tratar de uma condição com características definidoras comuns à gestação, muitos profissionais não são capazes de identificar as suas manifestações clínicas de forma oportuna, o que muitas vezes, retarda a intervenção e negligencia o quadro clínico-obstétrico. Embora a fisiopatologia seja incerta, acredita-se que há uma rejeição imune em relação ao concepto. Desse modo, o objetivo deste estudo foi analisar as principais evidências disponíveis sobre a síndrome HELLP. Trata-se de uma revisão compreensiva da literatura a partir da síntese narrativa das evidências científicas. A partir deste estudo, foi possível identificar que a síndrome HELLP é uma emergência obstétrica ainda negligenciada, que por vezes, apresenta desfechos desfavoráveis. Diante dessa realidade, urge a necessidade de implementar ações efetivas e em tempo hábil com vistas a uma assistência integral e segura, livre de agravos e incidentes.