Zika virus infection among symptomatic patients from two healthcare centers in Sao Paulo State, Brazil: prevalence, clinical characteristics, viral detection in body fluids and serodynamics.

Zika virus (ZIKV) clinical presentation and frequency/duration of shedding need further clarification. Symptomatic ZIKV-infected individuals identified in two hospitals in Sao Paulo State, Brazil, were investigated regarding clinical characteristics, shedding in body fluids, and serodynamics. Ninety-four of 235 symptomatic patients (Site A: 58%; Site B: 16%) had Real-Time PCR-confirmed ZIKV infection; fever, headache and gastrointestinal symptoms were less frequent, and rash was more frequent compared to ZIKV-negative patients. Real-Time PCR in serum had worse performance compared to plasma, while urine had the highest sensitivity. Shedding in genital fluids and saliva was rare. IgM positivity was the highest 28 days (24%); IgG positivity increased >14 days (96%) remaining positive in 94% of patients >28 days. ZIKV prevalence varied importantly in two neighboring cities during the same transmission season. Urine Real-Time PCR can improve diagnostic sensitivity; serum testing is less useful. Accurate serological tests are needed to improve diagnosis and surveillance

Zika virus infection among symptomatic patients from two healthcare centers in Sao Paulo State, Brazil: prevalence, clinical characteristics, viral detection in body fluids and serodynamics

Zika virus (ZIKV) clinical presentation and frequency/duration of shedding need further clarification. Symptomatic ZIKV-infected individuals identified in two hospitals in Sao Paulo State, Brazil, were investigated regarding clinical characteristics, shedding in body fluids, and serodynamics. Ninety-four of 235 symptomatic patients (Site A: 58%; Site B: 16%) had Real-Time PCR-confirmed ZIKV infection; fever, headache and gastrointestinal symptoms were less frequent, and rash was more frequent compared to ZIKV-negative patients. Real-Time PCR in serum had worse performance compared to plasma, while urine had the highest sensitivity. Shedding in genital fluids and saliva was rare. IgM positivity was the highest <14 days after the symptoms onset (86%), decreasing >28 days (24%); IgG positivity increased >14 days (96%) remaining positive in 94% of patients >28 days. ZIKV prevalence varied importantly in two neighboring cities during the same transmission season. Urine Real-Time PCR can improve diagnostic sensitivity; serum testing is less useful. Accurate serological tests are needed to improve diagnosis and surveillance

Recurrent Implantation Failure: The Role of Anatomical Causes

Recurrent implantation failure (RIF) is one of the great challenges of current reproductive medicine. The term refers to the failure of repeated transfers of embryos of good morphological quality. Embryo implantation is a crucial moment in in vitro fertilization (IVF) treatments. A successful pregnancy depends on a synchronized interaction between a good quality embryo and a receptive endometrium. Its failure may be a consequence of embryo quality, anatomical or immunological factors. The anatomic causes constitute an important factor for RIF, although they are usually manageable. Fibroids, polyps and adhesions that develop after a surgical procedure or infection can hamper the embryo - endometrium attachment process. In addition, Mullerian abnormalities and hydrosalpinx can cause a negative impact on implantation rates and should also be taken into account in patients with RIF. In this chapter, we will address the main anatomical causes that may impact the implantation rates of patients undergoing IVF, as well as recommendations on management and its treatment

Identification of novel consensus CD4 T-cell epitopes from clade B HIV-1 whole genome that are frequently recognized by HIV-1 infected patients

Objective: To identify promiscuous and potentially protective human CD4 T-cell epitopes in most conserved regions within the protein-coding genome of HIV-1 clade B consensus sequence.Design: We used the TEPITOPE algorithm to screen the most conserved regions of the whole genome of the HIV-1 subtype B consensus sequence to identify promiscuous human CD4 T-cell epitopes in HIV-1. the actual promiscuity of HLA binding of the 18 selected peptides was assessed by binding assays to nine prevalent HLA-DR molecules. Synthetic peptides were tested with interferon-gamma ELISPOT assays on peripheral blood mononuclear cells (PBMC) from 38 HIV-1 infected patients and eight uninfected controls.Results: Most peptides bound to multiple HLA-DR molecules. PBMC from 91% of chronically HIV-1 infected patients recognized at least one of the promiscuous peptides, while none of the healthy controls recognized peptides. All 18 peptides were recognized, and each peptide was recognized by at least 18% of patients; 44% of the patients recognized five or more peptides. This response was not associated to particular HLA-DR alleles. Similar responses were obtained in CD8 T-cell-depleted PBMC.Conclusion: in silico prediction of promiscuous epitopes led to the identification of naturally immunodominant CD4 T-cell epitopes recognized by PBMC from a significant proportion of a genetically heterogeneous patient population exposed to HIV-1. This combination of CD4 T-cell epitopes-11 of them not described before-may have the potential for inclusion in a vaccine against HIV-1, allowing the immunization of genetically distinct populations. (c) 2006 Lippincott Williams & Wilkins.Univ São Paulo, Sch Med, Heart Inst Incor, Immunol Lab, BR-05403000 São Paulo, BrazilUniv São Paulo, Sch Med, Div Clin Immunol & Allergy, Dept Med, BR-05403000 São Paulo, BrazilUniv São Paulo, Sch Med, Dept Infect Dis, BR-05403000 São Paulo, BrazilUniv São Paulo, Inst Trop Med, BR-05403000 São Paulo, BrazilHoffmann La Roche Inc, Dept Genom & Informat Sci, Nutley, NJ 07110 USAUniversidade Federal de São Paulo, Div Infect & Parasit Dis, São Paulo, BrazilLa Jolla Inst Allergy & Immunol, San Diego, CA USAUniversidade Federal de São Paulo, Div Infect & Parasit Dis, São Paulo, BrazilWeb of Scienc

Osteotomia em Chevron modificada: análise preliminar do comportamento baropodométrico Modified Chevron osteotomy: preliminary analysis of baropodometric behavior

OBJETIVO: Avaliar as características clínicas e baropodométricas da marcha de indivíduos com Hálux Valgo após a osteotomia em Chevron modificada, isolada ou em associação com a osteotomia de Weil. MÉTODOS: FORAM avaliados, antes e três meses após a cirurgia, 27 pés com deformidade leve e moderada. A avaliação clínica incluiu a pontuação da AOFAS e medidas radiográficas. A avaliação baropodométrica foi realizada através da Plataforma Emed-at. As variáveis Pico de Pressão, Integral Pressão-Tempo e Carga Relativa foram calculadas em 10 regiões: calcanhar, mediopé, 1-5º metatársicos, hálux, 2º, 3-5º dedos. RESULTADOS: Após a cirurgia houve aumento na pontuação da AOFAS e redução dos parâmetros radiográficos. A avaliação baropodométrica, após osteotomia em Chevron isolada, demonstrou redução da pressão e da força sob o 1º metatársico e hálux, assim como, aumento dessas variáveis nos metatársicos centrais e laterais. Após a osteotomia em Chevron/Weil ocorreram alterações significativas apenas na região do hálux e dos dedos. CONCLUSÃO: Em curto prazo, a técnica em Chevron modificada promoveu melhora das condições clínicas e dos parâmetros radiográficos. Em relação a avaliação baropodométrica constatou-se uma transferência de cargas da região medial para lateral do antepé, possivelmente pelo curto período de pós-operatório.<br>OBJECTIVE: To evaluate the clinical and baropodometric characteristics of the gaits of individuals with a hallux valgus deformity after modified Chevron osteotomy, in isolation or in association with the Weil osteotomy. METHODS: Foot evaluation happened before and three months after surgery analyzing 27 mildly and moderately deformed feet. The clinical evaluation included the AOFAS score and radiographic measurements. The baropodometric evaluation was done with the Emed-at platform. Peak of Pressure, Pressure-Time Integral and Relative Load were calculated in 10 different regions of the feet: calcaneous, midfoot, first to fifth metatarsal regions, hallux, second and third to fifth toes. RESULTS: After the surgical procedure, an increase in AOFAS scores and a decrease of radiographic parameters were seen. The baropodometric evaluation, after isolated Chevron osteotomy, showed a reduction in pressure and strength under the first metatarsal and hallux, as well as an increase in the same variables on central and lateral metatarsals. After Chevron/Weil osteotomy significant alterations had only occurred in the region of the hallux and toes. CONCLUSION: In the short-term, the modified Chevron technique promoted improvements in clinical conditions and radiographic parameters. The baropodometric evaluation evidenced a load transference from medial to lateral regions of the forefoot, possibly due to the short postoperative period