Flavivirus cross‐reactivity in serological tests and Guillain‐Barré syndrome in a hematopoietic stem cell transplant patient: A case report

Serological diagnosis of flavivirus infection is a challenge, particularly in the context of a disease associated with immune response enhancement in a transplant patient, where aspects such as previous flavivirus infections may be involved with the outcome. We report a case of a pediatric patient who developed Guillain‐Barré syndrome (GBS) after matched‐unrelated hematopoietic stem cell transplantation (HSCT). The patient lives in a Brazilian region that is experiencing an epidemic of Zika virus (ZIKV) and dengue virus (DENV). Because an increasing number of cases of GBS, likely triggered by ZIKV infection, are being reported in Brazil, samples from the patient were tested for both ZIKV and DENV infection. Serological assays strongly suggested a recent ZIKV infection, although infection by DENV or co‐infection with both viruses cannot be ruled out. The presence of anti‐DENV immunoglobulin‐G in donor serum led to the hypothesis that antibodies from the donor could have enhanced the severity of the ZIKV infection. This hypothesis is in agreement with the recent findings that DENV sero‐cross‐reactivity drives antibody‐dependent enhancement of ZIKV infection. These findings highlight the need for discussion of the indication to perform previous flavivirus tests in HSCT donors, especially in areas where ZIKV and other flaviviruses co‐circulate.     

Comparative study of sickle cell anemia and hemoglobin SC disease: clinical characterization,laboratory biomarkers and genetic profiles

Background

In this study, we evaluate the association of different clinical profiles, laboratory and genetic biomarkers in patients with sickle cell anemia (SCA) and hemoglobin SC disease (HbSC) in attempt to characterize the sickle cell disease (SCD) genotypes.

Methods

We conducted a cross-sectional study from 2013 to 2014 in 200 SCD individuals (141 with SCA; 59 with HbSC) and analyzed demographic data to characterize the study population. In addition, we determined the association of hematological, biochemical and genetic markers including the β^S-globin gene haplotypes and the 3.7 Kb deletion of α-thalassemia (?α^3.7Kb-thal), as well as the occurrence of clinical events in both SCD genotypes.

Results

Laboratory parameters showed a hemolytic profile associated with endothelial dysfunction in SCA individuals; however, the HbSC genotype was more associated with increased blood viscosity and inflammatory conditions. The BEN haplotype was the most frequently observed and was associated with elevated fetal hemoglobin (HbF) and low S hemoglobin (HbS). The -α^3.7Kb-thal prevalence was 0.09 (9%), and it was associated with elevated hemoglobin and hematocrit concentrations. Clinical events were more frequent in SCA patients.

Conclusions

Our data emphasize the differences between SCA and HbSC patients based on laboratory parameters and the clinical and genetic profile of both genotypes.

     

Therapeutic ultrasound after sciatic nerve compression of Wistar rats

Objectives: The present study analyzed the effect of therapy with therapeutic ultrasound on the sciatic nerve after compression injury, comparing two similar doses of SATA.

Methods: In total, 32 Wistar rats were used, divided into the following groups: CG — control; IG — compression injury of the sciatic nerve; IGCU — injury and continuous ultrasound; and IGPU — injury and 20% pulsed ultrasound. The treatment with ultrasound started on the 3rd postoperative day, with a frequency of 1 MHz, 0.4 W/cm² (SATA) for IGCU. IGPU received 2.0 W/cm² (SATP), with 20% of the active cycle, for 3 minutes. The treatment was performed on a daily basis, totaling 15 days of therapy. Evaluations were performed for functional, histological, and morphometric forms.

Results: Both the Sciatic Functional Index and the withdrawal threshold and grip strength failed to show an advantage of using therapeutic ultrasound. For the morphometric evaluations of nerve fiber diameter and axons, myelin sheath thickness, and G quotient and nerve fiber estimates, IGPU values were estimated to be significantly lower. The morphological analysis revealed intense inflammatory response and neovascularization, as well as degeneration of axons and the myelin sheath, for the injury group and IGCU; however, IGPU showed greater tissue disorganization.

Conclusion: There were no significant differences, showing functional or nocicepitive recovery of the treated groups, including with characteristics pointing to the pulsed group with worse results.     

Comparative results of Doppler sonography after TIPS using covered and bare stents

OBJECTIVE: Our purpose was to evaluate the role of sonography in the early follow-up of patients with a covered transjugular intrahepatic portosystemic shunt (TIPS). CONCLUSION: Routine baseline Doppler sonography should occur 7-14 days after shunt placement unless malfunction or procedural complications are suspected.     

Pyoderma gangrenosum – a review of 24 cases observed over 10 years

Background and objectives Pyoderma gangrenosum (PG) is a disorder, included in the spectrum of neutrophilic and auto‐inflammatory dermatoses, whose clinical aspects and outcome we intend to characterize. Materials and methods In a retrospective study based on files of patients diagnosed during a 10‐year period (2000–2009), we evaluated demographic data, anatomic locations, number of lesions, clinical variants, associated diseases, treatment regimens, healing time, and recurrence. Results A total of 24 patients were included, 19 women and five men (F/M = 3.8/1), aged between 17 and 89 years (mean 58.3 ± 24.6 years) with a diagnosis of PG. Lesions, single in 15 patients (62.5%) and multiple in nine (37.5%), were localized in the lower limbs in 19 patients (79.2%), upper limbs (4), abdomen (4), face (2) and genital area (1). Clinical variants observed were ulcerative (17 patients), pustular (4), bullous (2) and superficial granulomatous (1). Associated systemic diseases were observed in 18 patients (75%), gastrointestinal in seven patients (29.2%), hematological in seven (25%), autoimmune inflammatory in three (12%), and solid tumors in two (8.3%). Systemic steroids were used in the treatment, either alone in 10 patients (41.7%) or combined with cyclosporine in eight (33.3%). Complete healing was achieved in 20 patients, on average five months after diagnosis, but lesions recurred one or more times in four patients (16.7%). Conclusions As reported in the literature, PG is a rare disorder, more common in females, frequently associated with systemic disease, which compromises the prognosis.     

青少年和年轻成人先天性心脏病的心理社会远期转归

目的：先天性心脏病（CHD）是一种在全球范围内高发的慢性疾病,通常在出生时或出生前确诊。由于诊断以及早期药物和手术治疗的条件较好,患者的生存率达到90%,并且生存时间不断延长,面临着生活中的各种挑战。该研究探讨了不同人口统计学、临床和心理社会变量对CHD青少年和年轻成人患者的生活质量（QOL）感知、心理社会适应和精神障碍患病率的影响,评估CHD青少年和年轻成人患者的生活质量、心理社会适应和精神障碍发病率,确定哪些变量（人口统计学、临床和心理社会变量）对缓解压力、促进恢复起到积极作用,哪些变量起到不良作用。方法：该研究入组了150名CHD患者（男87例,女63例）,年龄12~26岁（平均年龄：17.45±3.373岁）。对参与者进行了关于社会支持、家庭教育方式、自我形象、人口统计信息和生理限制等方面的访谈。他们对标准化精神病学访谈（SADS-L）中的问题进行了回答,并填写了自我报告问卷,以进行生活质量（WHOQOL-BREF）和心理社会适应（YSR/ASR）的评估。结果：所有参与者精神障碍的终身患病率为18.7%（女性25.4%,男性13.8%）。57.1%的参与者有过留级（平均1.53±0.804年）。与整体葡萄牙人相比,CHD患者的生活质量感知在社会关系、环境、身体和总体方面较好。而女性、学习成绩差、较少的社会支持、复杂性CHD、紫绀型CHD、中重度残留病灶、接受过手术和有生理限制患者生活质量感知较差。除了紫绀,所有这些变量也会引起较差的心理社会适应。结论：女性CHD患者及学习成绩差且获得社会支持少的CHD患者的心理社会适应和生活质量较差。     

Eating behaviors are risk factors for the development of overweight

This research aimed to characterize eating behavior in a sample of Chilean adults according to their gender and body mass index and to analyze the possible links between these variables and abnormal eating behaviors. We hypothesized that there would be significant differences in the eating behavior of normal-weight and overweight people, and also between men and women. Further, we hypothesized that overweight participants would show more abnormal eating behaviors than their normal-weight counterparts. Two hundred ninety-two participants (205 women and 87 men, age range 18-64 years) were evaluated with a battery of self-administered questionnaires. Mean body mass index was 26.58 kg/m² (women 26.22 kg/m², men 27.41 kg/m²), that is, within the overweight range. Participants with overweight (BMI ≥25 kg/m²) tended to eat faster and in greater quantities, selected more hyper-calorie foods, and engaged in a greater number of abnormal eating behaviors of various kinds. The results suggest that, in addition to what people eat, the question of how people eat may also contribute to the rapid increase in the levels of overweight and obesity in the Chilean population.