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To assess the clinical and radiographic characteristics of hip joint deformities in children with congenital Zika syndrome (CZS), and the evolution of hip joint deformities in affected infants for the first three years of life.This prospective observational study evaluated orthopedic clinical examinations performed every 3 months to assess hip flexion and extension, lateral and medial rotation, abduction and adduction, as well as lower limb muscle length and tone. The biannual radiograph comprised anteroposterior panoramic pelvic radiographs with the lower limbs in extension. Percentage of migration was used as a radiographic study tool to measure and evaluate linear hip displacement.From November 2018 to March 2020, we followed 30 children with CZS, of which 15 (50%) had normal pelvic radiographs on admission; five (33.3%) developed hip displacement by the second radiograph exam. During follow up radiographic examinations, 20/30 (66.7%) children were diagnosed with hip displacement and/or dislocation of at least one side, and 10/30 (33.3%) remained normal. Among 30 affected patients, 13 (43.3%) had hip displacement on the right side and 9 (30%) on the left side. Logistic regression analysis revealed that spasticity (p=0.0033; OR=15.9) and ophthalmologic abnormalities (p=0.0163; OR=16.9) were associated with hip dislocation during follow up.Pelvic radiographic follow up for all children with CZS will complement physical examination, diagnosis, and monitoring for hip joint deformities.

Severe cases of coronavirus disease 2019 (COVID-19) have increased risk for acute kidney injury (AKI). The exacerbation of the immune response seems to contribute to AKI development, but the immunopathological process is not completely understood.To analyze levels of circulant immune mediators in COVID-19 patients evolving with or without AKI. We have also investigated possible associations of these mediators with viral load and clinical outcomes.This is a longitudinal study performed with hospitalized patients with moderate to severe COVID-19. Serum levels of 27 immune mediators were measured by a multiplex immunoassay. Data were analyzed at two timepoints during the follow-up: within the first 13 days of the disease onset (early sample) and from the 14th day to death or hospital discharge (follow-up sample).We studied 82 COVID-19 patients (59.5 ± 17.5 years, 54.9% male). Of these, 34 (41.5%) developed AKI. These patients presented higher SARS-CoV-2 viral load (P = 0.03), higher frequency of diabetes (P = 0.01) and death (P = 0.0004). Overall, AKI patients presented significantly higher and sustained levels (P 0.05) of CCL-2, CCL-3, CCL-4, CXCL-8, CXCL-10, IFN-γ, IL-2, IL-6, TNF-α, IL-1Ra, IL-10 and VEGF. Importantly, higher levels of CCL-2, CXCL-10, IL-2, TNF-α, IL-10, FGFb, and VEGF were observed in AKI patients independently of death. ROC curves demonstrated that early alterations in CCL-2, CXCL-8, CXCL-10, IFN-γ, IL-6, IL-1Ra and IL-10 show a good predictive value regarding AKI development. Lastly, immune mediators were significantly associated with each other and with SARS-CoV-2 viral load in AKI patients.COVID-19 associated AKI is accompanied by substantial alterations in circulant levels of immune mediators, which could significantly contribute to the establishment of kidney injury.

Paralelo à pandemia de COVID-19, Brasil continuou a enfrentar doenças tropicais como a Dengue. Mas, segundo os Boletins Epidemiológicos, os casos de Dengue no Brasil em 2020 foram subnotificados. O objetivo deste estudo é identificar a frequência de coinfecções por SARS-CoV-2 e DENV e avaliar a gravidade das coinfecções em relação às monoinfecções. Amostras de plasma de 143 pacientes COVID-19 de 2020, 15 doadores saudáveis e 15 pacientes com infecção por DENV de 2013 foram avaliados. Ensaios imunoenzimáticos utilizando testes comerciais foram realizados: Anti-SARS-CoV-2 IgA e IgG (Euroimmun), proteína NS1 do DENV (Platelia), anti-DENV IgM e IgG (Euroimmun). Dentre os doadores saudáveis foi detectado 75% de IgG anti-DENV; dentre os COVID-19, 75,9% IgA anti SARS-CoV-2, 66,7% IgG anti SARS-CoV-2, 80% IgG anti-DENV e por fim, IgM anti-DENV em 6 (4%) casos; dentre os casos confirmados de Dengue, IgA anti SARS-CoV-2 foi detectado em 1 caso (8,3%), IgG anti-SARS-CoV-2 em nenhum caso, NS1 de DENV em 41,7% e IgM anti-DENV em 33,3%. De acordo com o desfecho clínico, a presença ou não de sinais/sintomas no momento da coleta da amostras, os pacients COVID-19 foram reagrupados em brandos/moderados, graves, óbitos e aqueles já recuperados dos sinais/sintomas. Os 6 casos de COVID-19/Dengue também foram avaliados separadamente. Observamos que idosos são maioria em COVID-19 graves e óbitos; mulheres são maioria dos COVID-19 recuperados; tosse é mais frequente em COVID-19; cefaléia, mialgia/artralgia e vômito são mais frequentes na Dengue; pacientes COVID-19/Dengue foram aqueles com alterações vasculares. As DO IgA anti-SARS-CoV-2 foram mais elevadas nos COVID-19 graves, óbitos e COVID-19/Dengue comparados aos doadores saudáveis e pacientes Dengue; as DO IgG anti-SARS-CoV-2 foram mais elevadas nos COVID-19 comparados aos doadores saudáveis e pacientes Dengue; as DO IgA e IgG anti SARS-CoV-2 foram maiores nos COVID-19 óbitos comparado aos recuperados; COVID-19 recuperados ainda mantém níveis de detecção de IgA e IgG anti-SARS-CoV-2 detectáveis. Há diferenças clínicas, demográficas e de detecção de anticorpos anti-SARS-CoV-2 entre pacientes COVID-19 de acordo com o desfecho clínico e dias da doença. Até o momento, 6% de casos de COVID-19 com sugestiva infecção recente por DENV foram identificados. Os casos de coinfecção SARS-CoV-2/DENV estão sendo confirmados por RT-PCR DENV e esperamos a partir desses resultados, tirar mais conclusões.

Introduction: Human cytomegalovirus is a major cause of morbidity in kidney transplant patients. Objectives: We aimed to study viral replication and serological response in the first months post kidney transplant in patients undergoing universal prophylaxis or preemptive therapy and correlate the findings with the clinical course of Human cytomegalovirus infection. Patients and methods: Independent from the clinical strategy adopted for managing Human cytomegalovirus infection, prophylaxis versus preemptive therapy, the pp65 antigenemia assay and serological response were assessed on the day of transplantation, and then weekly during the first three months of post-transplant. Results: From the 32 transplant recipients, 16 were positive for pp65 antigenemia, with a similar incidence rate in each group. There were no positive results in the first three weeks of monitoring; the positivity rate peaked at week eight. There was a trend for a higher and earlier frequency of positivity in the universal prophylaxis group in which the course of the Human cytomegalovirus infection was also more severe. Despite the differences in clinical picture and in the initial immunosuppressant schedule, the serological response was similar in both groups. Conclusion: Routine monitoring during the first three post-transplant months has a positive impact on the early detection of Human cytomegalovirus viral replication allowing for timely treatment in order to reduce morbidity of the disease. The strategy of universal therapy employing intravenous ganciclovir was associated to a worse clinical course of the Human cytomegalovirus infection suggesting that the use of >10 cells/2 × 105 leukocytes as a cut-off in this setting may be inappropriate. Keywords: Cytomegalovirus, pp65 antigenemia, Kidney transplant, Universal prophylaxis, Preemptive therapy

Introduction Typical symptoms of primary Zika virus infection are not specific and share similarities with other arbovirus infections such as dengue fever and chikungunya. As acute infection can be asymptomatic in up to 73% of cases, infants with microcephaly represent a diagnostic challenge for pediatricians. We describe the frequency of congenital Zika syndrome (CZS) in Brazilian children born to asymptomatic pregnant mothers and its differential diagnosis. Methods This longitudinal, observational study was conducted on children with suspected CZS whose mothers did not report rash during pregnancy, referred to the reference hospital in a metropolitan area of ​ Rio de Janeiro, Brazil. The diagnosis of suspected CZS was based on Brazilian Ministry of Health protocol. Results Forty-three (17%) of 246 referred children were born to mothers without rash history during pregnancy. Thirteen (30%) of 43 children met the Brazilian Ministry of Health criteria for CZS, all with microcephaly (two post-natal). The other children included 11 cases with post-natal microcephaly due to hypoxic-ischemic encephalopathy (6), non-progressive encephalopathy of unknown etiology (2), microcephaly under investigation (2) and congenital toxoplasmosis (1); 17 children were misdiagnosed with microcephaly and progressed with normal head circumference during the follow-up period; one child was included because of epidemiological link and one was loss to follow-up. All children who underwent laboratory investigation for ZIKV infection during neonatal period had negative RT-qPCR tests. Conclusion We emphasize the increasing importance of CZS in differential diagnosis of microcephaly at birth or post-natal period. Detailed clinical investigation assisted by neuroimaging tests may clarify the diagnosis of CZS when laboratory tests are not available during the acute phase of the disease.