O novo Regulamento Sanitário Internacional

A mais recente revisão do Regulamento Sanitário Internacional (RSI), publicada em 2005, trouxe inovações com o intuito de transpor as limitações enfrentadas pelo regulamento de 1969, que se tornaram cada vez mais aparentes com o ressurgimento de antigas doenças e o aparecimento de novas, nas décadas de 1970 e 1980. Por meio da revisão da literatura, dos regulamentos sanitários internacionais (1951, 1969, 2005) e de sítios eletrônicos de entidades de saúde, foi feito um estudo essencialmente bibliográfico e documental, com o objetivo de identificar e apresentar as ferramentas trazidas pelo novo RSI. Apesar de esse instrumento se mostrar promissor para auxiliar na resposta mundial a um surto, há outros fatores envolvidos, como as diferenças econômicas, políticas, culturais e religiosas entre os Estados-Membros da OMS; é preciso considerar que alguns países não contam com o mínimo de infraestrutura básica para atender satisfatoriamente situações menos complexas que a  transnacionalização dos riscos, e possivelmente jamais conseguirão atender às capacidades nacionais básicas para detectar, avaliar, notifi car e informar uma Emergência de Saúde Pública de Importância Internacional (ESPII) sem ajuda técnica e financeira, não prevista expressamente pelo novo instrumento regulatório. Além disso, a visão de que se podem controlar totalmente a ocorrência e o alastramento de eventos em saúde é demasiadamente otimista. Sempre que possível, o intuito do regulamento é evitar a ocorrência de eventos em saúde; porém, quando isso não acontece, o objetivo torna-se minimizar o alastramento e diminuir a gravidade das consequências

Severe COVID-19 recovery is associated with timely acquisition of a myeloid cell immune-regulatory phenotype

Copyright © 2021 Trombetta, Farias, Gomes, Godinho-Santos, Rosmaninho, Conceição, Laia, Santos, Almeida, Mota, Gomes, Serrano, Veldhoen, Sousa and Fernandes. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.After more than one year since the COVID-19 outbreak, patients with severe disease still constitute the bottleneck of the pandemic management. Aberrant inflammatory responses, ranging from cytokine storm to immune-suppression, were described in COVID-19 and no treatment was demonstrated to change the prognosis significantly. Therefore, there is an urgent need for understanding the underlying pathogenic mechanisms to guide therapeutic interventions. This study was designed to assess myeloid cell activation and phenotype leading to recovery in patients surviving severe COVID-19. We evaluated longitudinally patients with COVID-19 related respiratory insufficiency, stratified according to the need of intensive care unit admission (ICU, n = 11, and No-ICU, n = 9), and age and sex matched healthy controls (HCs, n = 11), by flow cytometry and a wide array of serum inflammatory/immune-regulatory mediators. All patients featured systemic immune-regulatory myeloid cell phenotype as assessed by both unsupervised and supervised analysis of circulating monocyte and dendritic cell subsets. Specifically, we observed a reduction of CD14lowCD16+ monocytes, and reduced expression of CD80, CD86, and Slan. Moreover, mDCs, pDCs, and basophils were significantly reduced, in comparison to healthy subjects. Contemporaneously, both monocytes and DCs showed increased expression of CD163, CD204, CD206, and PD-L1 immune-regulatory markers. The expansion of M2-like monocytes was significantly higher at admission in patients featuring detectable SARS-CoV-2 plasma viral load and it was positively correlated with the levels of specific antibodies. In No-ICU patients, we observed a peak of the alterations at admission and a progressive regression to a phenotype similar to HCs at discharge. Interestingly, in ICU patients, the expression of immuno-suppressive markers progressively increased until discharge. Notably, an increase of M2-like HLA-DRhighPD-L1+ cells in CD14++CD16- monocytes and in dendritic cell subsets was observed at ICU discharge. Furthermore, IFN-γ and IL-12p40 showed a decline over time in ICU patients, while high values of IL1RA and IL-10 were maintained. In conclusion, these results support that timely acquisition of a myeloid cell immune-regulatory phenotype might contribute to recovery in severe systemic SARS-CoV-2 infection and suggest that therapeutic agents favoring an innate immune system regulatory shift may represent the best strategy to be implemented at this stage.The Research was funded by Fundação para a Ciência e Tecnologia (FCT), “APOIO ESPECIAL RESEARCH 4COVID-19” projects 803, 125, 231_596873172, and 729. AMCG and GF received fellowships funded by FCT (DOCTORATES4COVID-19, 2020.10202.BD), and JANSSEN- CILAG FARMACÊUTICA, respectively. The funder was not involved in the study design, collection, analysis, interpretation of data, writing of the article or decision to submit it for publication. MV was supported by the European Union H2020 ERA project (No 667824 – EXCELLtoINNOV). This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 667824.info:eu-repo/semantics/publishedVersio

The contribution of meteorological parameters and the COVID-19 partial lockdown on air quality in Rio de Janeiro, Brazil

This study evaluated the pollutant levels (NO2, SO2, CO, and O3), air quality index (AQI) and the influence of meteorological variables and coronavirus disease (COVID-19) pandemic on the air quality in Rio de Janeiro. The data set used comprises periods before (March-April, 2019) and during pandemic (March-April, 2020). According to the AQI results, on most days, the air quality was ranked as “good”. Brazilian air quality standards for SO2, O3, and NO2 were not exceeded in any of the monitoring stations during partial lockdown, while CO exceeded in all periods in one site due to industrial emission. Comparing both periods, descriptive statistics for the meteorological parameters presented no differences, which suggests similar conditions. However, when evaluated week by week in 2020, weather conditions presented some differences that probably affected pollutant concentrations. The correlations between O3 and NO2 and some meteorological parameters indicate that variations in both favored ozone formation, since it is a photochemical process favored by temperature and solar radiation and that, in Rio de Janeiro, low NO2 concentrations lead to increased O3. The improvements on air quality during the partial lockdown may be attributed mainly to a reduction on emission sources rather than weather conditions.Campus Lima Centr

SAMARAS OF AUSTROPLENCKIA POPULNEA (CELASTRACEAE): NEW CONSTITUENTS AND EFFECT OF EXTRACTS AND FRIEDELIN ON GERMINATION OF BIDENS PILOSA (ASTERACEAE)

Objective: Evaluation of the impact of extracts and constituents from samaras of Austroplenckia populnea on percentage of seed germination (%SG), germination speed index (GSI), length of rootlets (LR), seedling length (SL), and on dry mass (DM) of Bidens pilosa L weed.Methods: The  powder  of  samaras  was  extracted  with  organic  solvents  providing  the  hexane  (SAPEH),  chloroform  (SAPEC),  ethyl  acetate  (SAPEAE) and ethanol  (SAPEE)  extracts. The terpene 1 was isolated from SAPEH by means of column and thin layer chromatography and identified through NMR spectroscopy. Each extract and 1 were subjected to growth inhibition assays evaluating the following parameters: %SG, GSI, LR, SL and DM, with five repetitions.Results: The compounds Friedelin (1), 7-hydroxy-clerodan-3-en-16,15:18,20-diolide (2), 3,5,7,4'-tetrahydroxy-6-methoxy-8-prenylflavanone (3), tetradecanamide (4), and 4-hydroxy-1,6,15-acetyloxy-8,9-benzoyloxy-agarofurane (5) were isolated from hexane extract of samaras of A. populnea and identified by spectroscopic data. The compounds 2, 3 and 5 were not previously described as being chemical constituents from Celastraceae family. In addition, the novel compounds 3 and 5 were described here for the first time. Substantial effect on the germination of B. pilosa L. (picão-preto) was observed after treatment of seeds with nonpolar extracts from Samaras of A. populnea. Friedelin inhibited the seed germination in the tested concentrations showing toxic properties against picão-preto.Conclusion: The germination inhibition of seeds was higher using nonpolar extracts than polar extract. Friedelin inhibited the seed germination in the tested concentrations showing toxic properties against B. pilosa.Â

Acute HIV-1 and SARS-CoV-2 infections Share Slan+ Monocyte Depletion - evidence from an hyperacute HIV-1 case report

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).Monocytes are key modulators in acute viral infections, determining both inflammation and development of specific B- and T-cell responses. Recently, these cells were shown to be associated to different SARS-CoV-2 infection outcome. However, their role in acute HIV-1 infection remains unclear. We had the opportunity to evaluate the mononuclear cell compartment in an early hyper-acute HIV-1 patient in comparison with an untreated chronic HIV-1 and a cohort of SARS-CoV-2 infected patients, by high dimensional flow cytometry using an unsupervised approach. A distinct polarization of the monocyte phenotype was observed in the two viral infections, with maintenance of pro-inflammatory M1-like profile in HIV-1, in contrast to the M2-like immunosuppressive shift in SARS-CoV-2. Noticeably, both acute infections had reduced CD14low/-CD16+ non-classical monocytes, with depletion of the population expressing Slan (6-sulfo LacNac), which is thought to contribute to immune surveillance through pro-inflammatory properties. This depletion indicates a potential role of these cells in acute viral infection, which has not previously been explored. The inflammatory state accompanied by the depletion of Slan+ monocytes may provide new insights on the critical events that determine the rate of viral set-point in acute HIV-1 infection and subsequent impact on transmission and reservoir establishment.This work was funded by the following grants from Fundação para a Ciência e a Tecnologia (FCT), Portugal, through “Apoio Especial Research4COVID-19”, project numbers 125 to S.M.F. and 803 to A.C.T. Fellowships funded by FCT (Doctorates4COVID-19, 2020.10202.BD), and Janssen-Cilag Farmacêutica were received by A.M.C.G. and G.B.F., respectively.info:eu-repo/semantics/publishedVersio

SARS‐CoV2 pneumonia recovery is linked to expansion of innate lymphoid cells type 2 expressing CCR10

© 2021 The Authors. European Journal of Immunology published by Wiley-VCH GmbH. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Accelerate lung repair in SARS-CoV-2 pneumonia is essential for pandemic handling. Innate lymphoid cells (ILCs) are likely players, given their role in mucosal protection and tissue homeostasis. We studied ILC subpopulations at two time points in a cohort of patients admitted in the hospital due to SARS-CoV-2 infection. COVID-19 patients with moderate/severe respiratory failure featured profound depletion of circulating ILCs at hospital admission, in agreement with overall lymphocyte depletion. However, ILCs recovered in direct correlation with lung function improvement as measured by oxygenation index and in negative association with inflammatory and lung/endothelial damage markers like RAGE. While both ILC1 and ILC2 expanded, ILC2 showed the most striking phenotype changes, with CCR10 upregulation in strong correlation with these parameters. Overall, CCR10+ ILC2 emerge as relevant contributors to SARS-CoV-2 pneumonia recovery.This work was funded by the following grants from Fundação para a Ciência e a Tecnologia (FCT), Portugal, through “APOIO ESPECIAL RESEARCH4COVID-19,” project numbers 125 to SMF and 803 to ACT. AMCG and GBF received fellowships funded by FCT (DOCTORATES4COVID-19, 2020.10202.BD) and JANSSEN- CILAG FARMACÊUTICA, respectively.info:eu-repo/semantics/publishedVersio

A busca ativa de tuberculose pulmonar em Teresópolis, RJ, Brasil: a procura de sintomáticos respiratórios na emergência do Hospital das Clínicas de Teresópolis Costantino Ottaviano, Fundação Educacional Serra dos Órgãos

The aim of the present study was to investigate the detection percentage of tuberculosis among patients that are respiratory symptomatic (TB suspects). In this work, we present the preliminary results of research carried out at "Hospital das Clínicas de Teresópolis Costantino Ottaviano da Fundação Educacional Serra dos Órgãos (FESO)" from November 2003 to April 2004. Among the 40 respiratory symptomatic individuals identified and referred to the Tuberculosis Control Program in Teresópolis, two (5.0%) were characterized as smear-positive. These results confirm reports in the literature and underscore the need for and importance of this strategy.Investigar o percentual de detecção de tuberculose entre sintomáticos respiratórios é o objetivo do presente estudo. Nesta nota prévia, apresentam-se os resultados preliminares da pesquisa desenvolvida no Hospital das Clinicas de Teresópolis Costantino Ottaviano da Fundação Educacional Serra dos Órgãos (FESO), de novembro de 2003 a abril de 2004. Dos 40 sintomáticos respiratórios identificados e encaminhados ao Programa de Controle da Tuberculose do município de Teresópolis, dois (5.0%) foram caracterizados como bacilíferos. Esses resultados corroboram com os relatos da literatura e confirmam a necessidade e importância desta estratégia

Tuberculosis in Brazil and cash transfer programs: A longitudinal database study of the effect of cash transfer on cure rates.

INTRODUCTION: Tuberculosis incidence is disproportionately high among people in poverty. Cash transfer programs have become an important strategy in Brazil fight inequalities as part of comprehensive poverty alleviation policies. This study was aimed at assessing the effect of being a beneficiary of a governmental cash transfer program on tuberculosis (TB) treatment cure rates. METHODS: We conducted a longitudinal database study including people ≥18 years old with confirmed incident TB in Brazil in 2015. We treated missing data with multiple imputation. Poisson regression models with robust variance were carried out to assess the effect of TB determinants on cure rates. The average effect of being beneficiary of cash transfer was estimated by propensity-score matching. RESULTS: In 2015, 25,084 women and men diagnosed as new tuberculosis case, of whom 1,714 (6.8%) were beneficiaries of a national cash transfer. Among the total population with pulmonary tuberculosis several determinants were associated with cure rates. However, among the cash transfer group, this association was vanished in males, blacks, region of residence, and people not deprived of their freedom and who smoke tobacco. The average treatment effect of cash transfers on TB cure rates, based on propensity score matching, found that being beneficiary of cash transfer improved TB cure rates by 8% [Coefficient 0.08 (95% confidence interval 0.06-0.11) in subjects with pulmonary TB]. CONCLUSION: Our study suggests that, in Brazil, the effect of cash transfer on the outcome of TB treatment may be achieved by the indirect effect of other determinants. Also, these results suggest the direct effect of being beneficiary of cash transfer on improving TB cure rates