Subjective sleep pattern in hospitalized patients

Objective: To evaluate the subjective sleep pattern in hospitalized patients. Methods: This is a cross-sectional design developed with 230 patients in a university hospital in northeastern Brazil from September 2017 to March 2018. We included patients 18 years old or older, hospitalized for a minimum of 48 hours and a maximum of five days, with stable clinical conditions and preserved guidance. For data collection, a structured questionnaire was used and the subjective sleep pattern was assessed using Visual Analog Sleep Scales. Univariate and bivariate statistics were calculated using IBM® SPSS® software, version 23.0. Results: In the hospitalization, the Disorder, Effectiveness, and Supplementation scales reached scores of 208.7 points, 353.8 points, and 62.9 points, respectively. The clinical characteristics that interfered with sleep were the practice of regular physical activity (p = 0.024) and a higher body mass index (p = 0.033). We also observed statistically significant differences between VAS scores and factors influencing sleep. Conclusion: There was a certain level of sleep disturbance during the hospitalization period, and consequently the need for sleep supplementation during the day. We also observed that some factors negatively influenced the quality of hospital sleep

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

REAÇÃO CRUZADA DO TESTE DE ANTÍGENO GALACTOMANANA DO HISTOPLASMA EM PACIENTE IMUNOSSUPRIMIDO TRANSPLANTADO RENAL COM PARACOCCIDIOIDOMICOSE

Introdução: Paracoccidioidomicose (PCM) e histoplasmose são micoses endêmicas na América do Sul. Ambas podem apresentar semelhanças, como adenopatias, lesões pulmonares escavadas e lesões cutâneas. O isolamento fúngico e a histopatologia ainda são os métodos padrão-ouro, porém podem causar atraso no diagnóstico, contribuindo para a morbi-mortalidade, especialmente em pacientes imunodeprimidos. Um grande avanço na investigação da histoplasmose é a detecção de antígeno urinário de Histoplasma, que permite o rápido diagnóstico com alta sensibilidade e especificidade nos casos de infecção disseminada. Reportamos aqui um paciente imunossuprimido cuja investigação inicial com antígeno urinário de Histoplasma sugeriu diagnóstico de histoplasmose disseminada, porém o diagnóstico definitivo foi PCM. Relato de caso: Um homem de 42 anos, transplantado renal em 2016 em uso de tacrolimus, micofenolato de sódio e prednisona, abriu um quadro em 2021 de lesões de pele ulceradas e evoluiu com perda ponderal, febre, linfadenopatia generalizada e rouquidão. Internado em setembro de 2022 com anemia, alteração da função renal, infiltrado pulmonar bilateral, cavitação em lobo superior esquerdo e linfonodomegalia disseminada. Nos quatro primeiros dias foram coletadas hemoculturas para fungos e micobactérias, escarro para fungos e micobactérias, biópsias de pele e linfonodo, antígeno criptocócico sérico e antígeno de Histoplasma urinário. Os primeiros resultados, disponíveis em 3 dias, foram o antígeno criptocócico sérico negativo e o antígeno de Histoplasma urinário positivo, sendo prontamente iniciado anfotericina B complexo lipídico. Após 7 dias os histopatológicos de pele e linfonodo revelaram Paracoccidioides sp., e após 42 dias as culturas de pele, linfonodo e escarro foram positivas para P brasiliensis. Houve melhora do quadro clínico e paciente recebeu alta em uso de itraconazol para acompanhamento ambulatorial. Comentários: Reação cruzada do antígeno urinário para Histoplasma com outros fungos é pouco reportada, limitada a estudos de validação do método e alguns estudos transversais. Apesar do resultado falso-positivo, o antígeno urinário para Histoplasma não deixou de ser uma importante ferramenta no caso acima reportado, pois permitiu o início rápido de anfotericina B, que trata a grande maioria dos fungos. Dessa forma, esse exame tem grande valia para pacientes com suspeita de infecção fúngica e merece ser estudado em outras micoses endêmicas

Desafío diagnóstico: PCR anidada y en tiempo real frente a un sistema de puntuación en individuos con gran riesgo de neumonía por Pneumocystis jirovecii

Introduction. Pneumocystis jirovecii is an opportunistic fungus that affects mainly people living with HIV (CD4 cell count lower than 200 cells/ml) and other immunosuppressed patients. Since P. jirovecii does not grow on routine mycological media, diagnosis of P. jirovecii pneumonia relies on indirect evidence of its presence in respiratory samples.Objectives. To associate the results of direct immunofluorescence and two molecular methods with a score to predict P. jirovecii pneumonia in patients with AIDS.Materials and methods. A prospective study was conducted with 40 patients. A respiratory sample collected before treatment was subjected to direct immunofluorescence using the Merifluor kit, to nested PCR targeting the mitochondrial large subunit ribosomal RNA, and to the VIASURE real-time PCR kit.Results. These three techniques revealed P. jirovecii in 6, 12, and 15 samples, respectively. All positive samples by direct immunofluorescence were positive by nested PCR, and all positive samples by nested PCR amplified by real-time PCR. There was a statistically significant association between the P. jirovecii pneumonia score and the molecular methods. Two patients were early diagnosed and responded well to treatment.Conclusion. Molecular methods, especially real-time PCR, are recommended for early diagnosis of P. jirovecii pneumonia in AIDS patients.Introducción. Pneumocystis jirovecii es un hongo oportunista que afecta principalmente a personas con HIV (recuento de CD4 menor de 200 células/ml) y a otros pacientes inmunosuprimidos. Como P. jirovecii no crece en los medios micológicos de rutina, el diagnóstico de neumonía por P. jirovecii se basa en la evidencia presente en muestra respiratorias.Objetivos. Asociar los resultados de la inmunofluorescencia directa y los de dos métodos moleculares con un puntaje para predecir la neumonía causada por P. jirovecii en pacientes con sida.Materiales y métodos. Se realizó un estudio prospectivo de 40 pacientes. Se recolectó una muestra respiratoria antes del inicio de tratamiento y se sometió a una prueba de inmunofluorescencia directa con el kit Merifluor, una PCR anidada para la amplificación de la subunidad larga del ribosoma mitocondrial y una PCR en tiempo real usando el kit VIASURE.Resultados. Estas tres técnicas evidenciaron la presencia de P. jirovecii en 6, 12 y 15 muestras, respectivamente. Todas las muestras positivas por inmunofluorescencia directa fueron positivas en la PCR anidada y todas las muestras positivas en la PCR anidada amplificaron por PCR en tiempo real. Se encontró una asociación estadística entre los valores de la neumonía causada por P. jirovecii y los métodos moleculares. Dos pacientes con diagnóstico temprano respondieron satisfactoriamente al tratamiento.Conclusión. Se recomiendan los métodos moleculares, especialmente la PCR en tiempo real, para el diagnóstico temprano de neumonía causada por P. jirovecii en pacientes con sida

Genomic Diversity Analysis Reveals a Strong Population Structure in Histoplasma capsulatum LAmA (Histoplasma suramericanum)

Histoplasmosis is a severe mycotic disease affecting thousands of immunocompetent and immunocompromised individuals with high incidence in Latin America, where the disease agents are Histoplasma capsulatum and Histoplasma suramericanum. In this work, we used whole-genome sequencing to infer the species diversity and the population structure of H. suramericanum in South America. We find evidence for strong population structure and little admixture within the species. Genome-level phylogenetic trees indicate the existence of at least three different discrete populations. We recovered the existence of a previously identified population, LAmB, and confirm that it is highly differentiated along the whole genome. We also find that H. suramericanum is composed of two populations, one in Northern South America, and another in the southern portion of the continent. Moreover, one of the lineages from the southern population is endemic to Rio de Janeiro and there was no association with clinical data and species isolated from patients with histoplasmosis. Our results point out the need to characterize the symptomatology of histoplasmosis caused by different species and lineages of Histoplasma spp