Smartphone-based evaluation of static balance and mobility in long-lasting COVID-19 patients

BackgroundSARS-CoV-2 infection can lead to a variety of persistent sequelae, collectively known as long COVID-19. Deficits in postural balance have been reported in patients several months after COVID-19 infection. The purpose of this study was to evaluate the static balance and balance of individuals with long COVID-19 using inertial sensors in smartphones.MethodsA total of 73 participants were included in this study, of which 41 had long COVID-19 and 32 served as controls. All participants in the long COVID-19 group reported physical complaints for at least 7 months after SARS-CoV-2 infection. Participants were evaluated using a built-in inertial sensor of a smartphone attached to the low back, which recorded inertial signals during a static balance and mobility task (timed up and go test). The parameters of static balance and mobility obtained from both groups were compared.ResultsThe groups were matched for age and BMI. Of the 41 participants in the long COVID-19 group, 22 reported balance impairment and 33 had impaired balance in the Sharpened Romberg test. Static balance assessment revealed that the long COVID-19 group had greater postural instability with both eyes open and closed than the control group. In the TUG test, the long COVID-19 group showed greater acceleration during the sit-to-stand transition compared to the control group.ConclusionThe smartphone was feasible to identify losses in the balance motor control and mobility of patients with long-lasting symptomatic COVID-19 even after several months or years. Attention to the balance impairment experienced by these patients could help prevent falls and improve their quality of life, and the use of the smartphone can expand this monitoring for a broader population

Polymorphisms in the MBL2 gene are associated with the plasma levels of MBL and the cytokines IL-6 and TNF-α in severe COVID-19

IntroductionMannose-binding lectin (MBL) promotes opsonization, favoring phagocytosis and activation of the complement system in response to different microorganisms, and may influence the synthesis of inflammatory cytokines. This study investigated the association of MBL2 gene polymorphisms with the plasma levels of MBL and inflammatory cytokines in COVID-19.MethodsBlood samples from 385 individuals (208 with acute COVID-19 and 117 post-COVID-19) were subjected to real-time PCR genotyping. Plasma measurements of MBL and cytokines were performed by enzyme-linked immunosorbent assay and flow cytometry, respectively.ResultsThe frequencies of the polymorphic MBL2 genotype (OO) and allele (O) were higher in patients with severe COVID-19 (p< 0.05). The polymorphic genotypes (AO and OO) were associated with lower MBL levels (p< 0.05). IL-6 and TNF-α were higher in patients with low MBL and severe COVID-19 (p< 0.05). No association of polymorphisms, MBL levels, or cytokine levels with long COVID was observed.DiscussionThe results suggest that, besides MBL2 polymorphisms promoting a reduction in MBL levels and therefore in its function, they may also contribute to the development of a more intense inflammatory process responsible for the severity of COVID-19

Inquérito sorológico da infecção pelo vírus linfotrópico humano de células T (HTLV) em comunidades amazônicas localizadasnas margens do Lago da Usina Hidrelétrica de Tucurui/PA

The aim of this study was to evaluate seroprevalence lymphotropic virus human T cells (HTLV) in individuals living in communities of Alcobaça e Ararão, located on the shores of lake Hydroelectric Plant Tucuruí / PA. Serum samples from 657 individuals were analyzed by immunoenzymatic assays the type of ELISA (Symbioys ®). There was a significant prevalence of HTLVI / II (4.7%) in the study population and the demographic characteristics reflects most of them are older than 40 years (p = 0.0239), unmarried (p = 0.035), resident for over 10 years in the catchment area of the study (p = 0.0027) and educational level was equal to or less than 4 years (p = 0.0308). There was no statistically significant difference when analyzing variables such as sex, birth, blood transfusion and previous surgery. The prevalence for HTLV is considered high according to current literature, justifying the screening for this virus at the study sites in order that we can better understand the epidemiology of HTLV transmission in the population.Este trabalho objetivou avaliar a soroprevalência do vírus linfotrópico humano de células T (HTLV) em pessoas residentes nas comunidades de Alcobaça e Ararão, localizadas às margens do lago da Usina Hidrelétrica de Tucuruí/PA. Amostras de soro de 657 indivíduos foram analisadas por meio do teste sorológico imunoenzimático do tipo ELISA (Symbioys®). Observou-se uma importante prevalência do HTLVI/II (4,7%) na população estudada e as características demográficas do grupo de pessoas analisadas reflete que a maioria possui idade superior a 40 anos (p=0,0239), estado civil solteiro (p=0,035), residem há mais de 10 anos na área de abrangência do estudo (p = 0.0027) e escolaridade igual ou inferior a 4 anos (p=0,0308). Não houve diferença estatisticamente significante quando se analisou variáveis como o sexo, naturalidade, prática de hemotransfusão e cirurgia prévia. A prevalência encontrada para o HTLV é considerada alta segundo a literatura vigente, justificando-se o rastreamento para esse vírus nos locais do estudo afim de que se possa entender melhor a epidemiologia de transmissão do HTLV na população

Alterações no sistema pulmonar de pacientes com paraparesia espástica tropical ou mielopatia associada ao HTLV-1 ( Pet/Mah)

Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Resumo: Associação entre HTLV e alterações no sistema pulmonar tem sido cada vez mais descrita na literatura como parte de processo inflamatório desencadeado pelo vírus resultando em infiltração linfocítica e liberação de citocinas e quimiocinas lesivas ao tecido pulmonar. Assim, o objetivo desta pesquisa foi comparar achados de tomografia computadorizada (TC) de tórax e função pulmonar entre grupos de pacientes infectados pelo Vírus T-linfotrópico humano (HTLV). Trata-se de um estudo observacional transversal realizado entre janeiro de 2013 e abril de 2016 incluindo pacientes com paraparesia espástica tropical ou mielopatia associada ao HTLV-1 (PET/MAH) do tipo definitivo (n=19), PET/MAH provável (n=11) e sem PET/MAH (n=18), os quais realizaram exames de TC de tórax e espirometria e os achados foram comparados entre os grupos cujo nível α adotado foi de 0.05. Ao final do estudo pôde ser observado maior número de pacientes com PET/MAH definitivo que apresentaram achados anormais de TC quando comparado a pacientes sem PET/MAH (p=0.00), sendo mais frequentes bronquiectasias (p=0.00), cicatriz fibrosa (p=0.00), espessamento de septo interlobular (p=0.04), espessamento pleural (p=0.01) e cicatrizes pulmonares (p=0.00). Além disso, 18,75% (9/48) dos pacientes apresentaram distúrbio ventilatório obstrutivo ou restritivo, sendo 31,5% (6/19) PET/MAH definitivo, 27% (3/11) PET/MAH provável e nenhum (0/18) sem PET/MAH (p=0.01 e p=0.04, respectivamente). Adicionalmente, 23% (11/48) dos pacientes com HTLV-1 apresentaram diâmetro da artéria pulmonar principal igual ou superior a 29mm (µ=31.5±4.0mm). Em resumo, alterações pulmonares foram observadas principalmente nos pacientes com PET/MAH o que pode estar relacionado à resposta inflamatória desencadeada pelo vírus

A protocol of hepatic volume measurement using magnetic resonance imaging in individuals from the Eastern Brazilian Amazon population.

Determination of hepatic volume is an important preoperative procedure and is done through imaging exams or standard liver volume (SLV) formulas developed based on the biotype of each population. In the absence of a specific SLV formula for the Brazilian Eastern Amazon population, the measurement of liver volume is made with reference values from other populations. The aim of study was to compare the hepatic volume in healthy residents from the Brazilian Eastern Amazon population obtained with magnetic resonance imaging (MRI) and recommended SLV formulas validated to other populations. This was a Observational, cross-sectional study. Anthropometric data of 42 healthy individuals aged 18-60 years of both sexes was collected to measure the liver volume through SLV formulas calculations and MRI. MRI shows similarity with the Western European SLV liver volume values and significant differences with the Japan SLV formula, mainly for women, with a moderate-to-weak correlation with the MRI measurements. There was a strong correlation between weight and body surface area in male patients analysed with measurements of the liver volume by the MRI and SLV formulas. The SLV formula based on the Western European population could be used in the absence of a specific formula for individuals living in the Amazon region. The results suggest that liver measurement formulas should take into consideration the sex of individuals, as well as the development of a specific SLV formula for the Eastern Amazon population and the conduction of similar studies in other Brazilian regions

Doppler ultrasonography: A non‐invasive method used to diagnose and follow up patients with chronic hepatitis C

National Health and Medical Research Council (61856616.1.3001.5172)Universidade Federal do Pará. Núcleo de Medicina Tropical. Belém, PA, Brazil.Universidade Federal do Pará. Núcleo de Medicina Tropical. Belém, PA, Brazil / Santa Casa de Misericórdia. Belém, PA, Brazil.Universidade Federal do Pará. Núcleo de Medicina Tropical. Belém, PA, Brazil / Universidade do Estado do Pará. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Santa Casa de Misericórdia. Belém, PA, BrazilUniversidade Federal do Pará. Núcleo de Medicina Tropical. Belém, PA, Brazil / Universidade do Estado do Pará. Belém, PA, Brazil / Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Background and Aim: This study aimed to investigate the association between the findings of Doppler ultrasonography and transient elastography using FibroScan and to determine the cut-off points, sensitivity, and specificity of resistance indices, and pulsatility of the hepatic vessels to predict significant hepatic fibrosis. Methods: This is a transversal, observational, and analytical study that includes 30 patients with chronic hepatitis C who were admitted at a public referral hospital. Transient elastography and ultrasonographic data were collected, and the linear association between these methods was evaluated using the Pearson test. Various Doppler velocimetric indices were compared according to the presence/absence of significant (≥ F2) fibrosis. Results: There was a moderate-strong linear association between the FibroScan data and the Doppler velocimetric indices and splenic index in the hepatic vessels; the mean values of the indices differed between groups with absent/mild (F0/F1) and significant (≥ F2) hepatic fibrosis. There was an association between the monophasic and biphasic wave pattern of the suprahepatic veins and the stratification of hepatic fibrosis estimated by the values of kilopascal in FibroScan. Conclusion: Doppler ultrasonography is a non-invasive method used to evaluate liver fibrosis, and it presents acceptable sensitivity/specificity for the prediction of fibrosis ≥ F2 in patients with chronic hepatitis C

Mechanisms of human cytomegalovirus infection with a focus on epidermal growth factor receptor interactions

Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Divisão de Doenças Infecciosas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Virologia e Biologia Molecular. Ananindeua, PA, Brasil.Federal University of Pará. School of Dentistry. Department of Oral and Maxillofacial Pathology. Belém, PA, Brazil / University of São Paulo. Institute of Biomedical Sciences. Department of Cell and Developmental Biology. São Paulo, SP, Brazil.Pará State University. Center for Biological Sciences and Health. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Divisão de Doenças Infecciosas. Ananindeua, PA, Brasil / Pará State University. Center for Biological Sciences and Health. Belém, PA, Brazil / Federal University of Pará. Tropical Medicine Center. Division of Infectious Diseases. Belém, PA, Brazil.Human cytomegalovirus (HCMV) is a widespread opportunistic herpesvirus that causes severe diseases in immunocompromised individuals. It has a high prevalence worldwide that is linked with socioeconomic factors. Similar to other herpesviruses, HCMV has the ability to establish lifelong persistence and latent infection following primary exposure. HCMV infects a broad range of cell types. This broad tropism suggests that it may use multiple receptors for host cell entry. The identification of receptors used by HCMV is essential for understanding viral pathogenesis, because these receptors mediate the early events necessary for infection. Many cell surface components have been identified as virus receptors, such as epidermal growth factor receptor (EGFR), which is characterized by tyrosine kinase activity and plays a crucial role in the control of key cellular transduction pathways. EGFR is essential for HCMV binding, signaling, and host cell entry. This review focuses on HCMV infection via EGFR on different cell types and its implications for the cellular environment, viral persistence, and infection

Nerve Growth Factor and Pathogenesis of Leprosy: Review and Update

Neurotrophins are a family of proteins that regulate different aspects of biological development and neural function and are of great importance in neuroplasticity. This group of proteins has multiple functions in neuronal cells, as well as in other cellular populations. Nerve growth factor (NGF) is a neurotrophin that is endogenously produced during development and maturation by multiple cell types, including neurons, Schwann cells, oligodendrocytes, lymphocytes, mast cells, macrophages, keratinocytes, and fibroblasts. These cells produce proNGF, which is transformed by proteolytic cleavage into the biologically active NGF in the endoplasmic reticulum. The present review describes the role of NGF in the pathogenesis of leprosy and its correlations with different clinical forms of the disease and with the phenomena of regeneration and neural injury observed during infection. We discuss the involvement of NGF in the induction of neural damage and the pathophysiology of pain associated with peripheral neuropathy in leprosy. We also discuss the roles of immune factors in the evolution of this pathological process. Finally, we highlight avenues of investigation for future research to broaden our understanding of the role of NGF in the pathogenesis of leprosy. Our analysis of the literature indicates that NGF plays an important role in the evolution and outcome of Mycobacterium leprae infection. The findings described here highlight an important area of investigation, as leprosy is one of the main causes of infection in the peripheral nervous system

The complexity of respiratory disease associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: from immunopathogenesis to respiratory therapy

Amazon FoundationState University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.Federal University of Pará. Center for Tropical Medicine. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil / Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Covid-19, a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, may present with polymorphic symptomatology and subclinical, neurological, gastrointestinal, dermatological, renal and severe acute respiratory manifestations. The diffuse alveolar damage caused by the disease presents with fibrin deposition, oedema, lymphocytic inflammatory infiltrate, destruction of epithelial cells, hyaline membrane formation and occasional angiogenesis formation of microthrombi. A common radiological finding is bilateral ground glass opacity, present even in mild cases. Severe cases occur mainly among the elderly and individuals with underlying comorbidities. Here, we provide an overview of the pathophysiology of the disease associated with SARS-CoV-2 infection, interaction of the virus with the immune system, and subsequent dysfunctional immune response, essential for progression of Covid-19. We also discuss the role of the nervous system as a possible aggravating agent of the respiratory condition and propose a protocol for airway management based on the pathophysiological and immunological characteristics of the disease. Finally, we highlight the implications of such approaches for future therapeutic intervention

HTLV-I induces lesions in the pulmonary system: a systematic review

Federal University of Pará. Center for Tropical Medicine. Belém, PA, Brazil / State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.Federal University of Pará. Center for Tropical Medicine. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.Federal University of Pará. Center for Tropical Medicine. Belém, PA, Brazil / Santa Casa de Misericórdia Foundation. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.Federal University of Pará. Center for Tropical Medicine. Belém, PA, Brazil.State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil.Federal University of Pará. Center for Tropical Medicine. Belém, PA, Brazil / State University of Pará. Center for Biological and Health Sciences. Belém, PA, Brazil / Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.This study analyzed the relationship between infection by human T-cell lymphotropic virus type 1 (HTLV-1) and changes in the pulmonary system. Cohort and case-control study models that analyzed a causal association between HTLV-1 and changes in the pulmonary system were considered. There were no restrictions on language and publication period. The study was registered in the PROSPERO systematic analysis database (Protocol No. CRD42017078236) and was prepared according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The following databases were used: PubMed, BVS Regional Portal, Embase, CINAHL and Web of Science. We utilized the Newcastle-Ottawa Scale to assess the methodological quality of published studies and the Kappa coefficient to assess the agreement level between two reviewers. Of the total 1156 studies retrieved by the search strategy, 28 were considered potentially eligible (Kappa test = 0.928). Of the 28 studies, three fully met the inclusion criteria. These indicated that pulmonary lesions, such as bronchiectasis and bronchitis/bronchiolitis, were observed in patients with HTLV-1, with high-resolution computed tomography of the chest being the main method of diagnostic investigation. The analyzed cohort and case-control studies indicated an etiological relationship between HTLV-1 infection and the presence of lung lesions, with emphasis on bronchiectasis in the presence of high viral loads, as well as a higher mortality in these individuals compared with the general population