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Background In Brazil, some local city government’s adopted several measures, which probably had a positive impact on COVID-19 control. Objective To report the distribution of COVID-19 cases in Brazil, Rio de Janeiro state and Niterói city. In parallel, we aimed to demonstrate the preventive strategies adopted by Niterói city. Method Data provided by the Brazilian Ministry of Health and Municipal Health Foundation of Niterói were used to report COVID-19 cases and deaths. For some analysis, data were grouped by week and normalized for 100,000 inhabitants. Results By July 18th, 2020, Brazil reported 2,074,860 cases and 78,772 deaths and Rio de Janeiro state registered 135,230 cases and 11,919 deaths; both still presenting ascendant curves for COVID-19 deaths. In contrast, the rate of new deaths per 100,000 inhabitants is consistently lower in Niterói city. Importantly, we estimated that 712 deaths were prevented by the measures adopted by Niterói city, in comparison to which was observed in Rio de Janeiro. Conclusion The early preventive measures adopted in Niterói city were effective in reducing both the viral spread and rate of deaths. In this regard, this discussion could be relevant for making future decisions during the COVID-19 outbreak in Brazil.

Human herpesvirus‐6 (HHV‐6) may cause serious diseases in immunocompromised individuals. SARS‐CoV‐2/HHV‐6 coinfection has been emphasized in previous works, mostly case reports, small series, or epidemiological studies, but few are known about its real clinical outcomes. Here we present a real‐world pilot study aiming to understand the frequency and the clinical impact of HHV‐6 coinfection in moderate to critically ill patients hospitalized due to COVID‐19. SARS‐CoV‐2 and HHV‐6 were evaluated in nasopharyngeal samples at the hospital admission of suspected COVID‐19 patients. From 173 consecutive cases, 60 were SARS‐CoV‐2 positive and 13/60 (21.7%) were HHV‐6 positive after identified as the HHV‐6B species by a Sanger sequencing. The SARS‐CoV‐2+/HHV‐6+ group was younger but not significant for cardiovascular diseases, diabetes, obesity, and cancer, but significant among therapeutic immunosuppressed patients (as systemic lupus erythematosus and kidney transplant patients). In the medical records, only sparse data on cutaneous or neurological manifestations were found. Biochemical and hematological data showed only a trend towards hyperferritinemic status and lymphopenia. In conclusion, despite the impressive high frequency of HHV‐6 coinfection in SARS‐CoV‐2 positive cases, it did not impact general mortality. We suggest larger future prospective studies to better elucidate the influence of HHV‐6 reactivation in cases of COVID‐19, designed to specific assessment of clinical outcomes and viral reactivation mechanisms.

Considering the importance of the evaluation of quality and performance attributes of herbal medicines, this work evaluated a gynecological gel containing aroeira (Schinus terebinthifolius Raddi), which was previously registered in 2001, and is still marketed in Brazil. Using the updated guides and legislation as a basis, the product was evaluated by checking the pH, spreadability, rheological behavior, in vitro release test, ex vivo permeation and retention study using porcine vaginal mucosa in Franz diffusion cells, and histological evaluation of the porcine vaginal mucosa before and after application of the product. After the permeation study, it was verified that gallic acid (chemical marker quantified) does not cross the mucosa, therefore, it is safe for local use. In addition, the pH of the formulation is within the range considered normal for use in healthy women. Finally, the histological evaluation of the mucosa showed changes compatible with the application of tannins (major compounds of the plant), and without changes indicative of loss of tissue integrity.

Context: Polycystic Ovarian Syndrome (PCOS) is a common multisystem disease that causes reproductive, metabolic and psychological changes. Lately, the use of medicinal plants has grown considerably in the hope of reducing the side effects of synthetic drugs and in an attempt to reduce harm and costs. Objective: Analyze the use of medicinal plants that are used in PCOS from an integrative literature review, in order to verify the pharmacological effects caused by their use in PCOS. Methodology: An integrative literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines through searches in PubMed, Scielo and Scopus databases to select ethnobotanical, ethnopharmacological, preclinical and clinical studies, published in full in the last 10 years (2012 – 2022), in English, Portuguese and Spanish using health descriptors. Results: The ten publications analyzed showed ten families and 11 plant species, which, in general, showed antiandrogenic activities. Conclusions: With the exception of Foeniculum vulgare, all other medicinal plants analyzed in this study have anti-androgenic effects on PCOS. However, these species need better clinical and toxicological evaluations regarding their use in order to provide a safe and effective therapy. Contexto: El síndrome de ovario poliquístico (SOP) es una enfermedad multisistémica común que causa cambios reproductivos, metabólicos y psicológicos. Últimamente, el uso de plantas medicinales ha crecido considerablemente con la esperanza de reducir los efectos secundarios de las drogas sintéticas y en un intento por reducir daños y costos. Objetivo: Analizar el uso de las plantas medicinales que se utilizan en el SOP a partir de una revisión integrativa de la literatura, con el fin de verificar los efectos farmacológicos provocados por su uso en el SOP. Metodología: Se realizó una revisión integrativa de la literatura utilizando las guías Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) a través de búsquedas en las bases de datos PubMed, Scielo y Scopus para seleccionar estudios etnobotánicos, etnofarmacológicos, preclínicos y clínicos, publicados íntegramente en el últimos 10 años (2012 – 2022), en inglés, portugués y español utilizando descriptores de salud. Resultados: Las diez publicaciones analizadas mostraron diez familias y 11 especies de plantas, las cuales, en general, mostraron actividades antiandrogénicas. Conclusiones: Con la excepción de Foeniculum vulgare, todas las demás plantas medicinales analizadas en este estudio tienen efectos antiandrogénicos sobre el SOP. Sin embargo, estas especies necesitan mejores evaluaciones clínicas y toxicológicas con respecto a su uso para brindar una terapia segura y efectiva. Contexto: A Síndrome do Ovário Policístico (SOP) é uma doença multissistêmica comum, que causa alterações reprodutivas, metabólicas e psicológicas. Ultimamente, o uso de plantas medicinais vêm crescendo consideravelmente na esperança de reduzir os efeitos colaterais das drogas sintéticas e na tentativa de redução dos danos e custos. Objetivo: Analisar o uso de plantas medicinais que são utilizadas na SOP a partir de uma revisão integrativa da literatura, com a finalidade de verificar os efeitos farmacológicos ocasionados a partir do uso na SOP. Metodologia: Foi realizada uma revisão integrativa da literatura utilizando as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) através de pesquisas nas bases de dados PubMed, Scielo e Scopus para seleção de estudos etnobotânicos, etnofarmacológicos, pré-clínico e clínico, publicados na íntegra nos últimos 10 anos (2012 – 2022), nos idiomas Inglês, Português e Espanhol a partir de descritores em saúde. Resultados: As dez publicações analisadas evidenciaram dez famílias e 11 espécies de plantas, que, de modo geral, apresentaram atividades antiandrogênicas. Conclusões: Com exceção de Foeniculum vulgare, todas as demais plantas medicinais analisadas neste estudo possuem efeitos anti androgênicos na SOP. Porém, essas espécies necessitam de melhores avaliações clínicas e toxicológicas quanto ao seu uso para que seja possível proporcionar uma terapia segura e eficaz.

In 2019, a new coronavirus (SARS-CoV-2) was identified in China and had rapidly spread across the world. Its associated disease, coronavirus disease 2019 (COVID-19), has led to millions of deaths in 2020-2021. Studies have been demonstrating that SARS-CoV-2 induces a systemic hyperinflammatory state, which is associated with a decreased cytotoxic capacity and impaired Type I interferon (IFN) response. Moreover, iron dysfunction/hyperferritinemia in association with hyperinflammation leads to oxidative stress and apoptosis. Altogether, these cellular events contribute to COVID-19 severity. In viral infections, systemic and cellular alterations can promote mitochondrial dysfunction. In this regard, dysfunctional mitochondria can trigger the immune response, leading to the release of mitochondrial damage-associated molecular patterns, including mitochondrial DNA (mtDNA) and reactive oxygen species (mtROS). mtDNA is known to promote a beneficial antiviral response; however, sustained nocive stimuli, such as SARS-CoV-2, could turn this response into oxidative stress and exacerbated inflammation leading to tissue injury. In addition, mtDNA can be released into the extracellular space and induce a proinflammatory state in neighboring cells. Here, we highlight the potential role of mtDNA as an important marker of hyperinflammation in the progress of COVID-19. Furthermore, we briefly discuss the role of mtROS and its interactions with the mitochondrial antiviral signaling (MAVS), which can also contribute to COVID-19 immunopathogenesis.

Introduction After DAA treatment for chronic hepatitis C infection, peripheral monocyte subsets from patients who achieved sustained virological response (SVR) reduced compared to healthy control. Improvement in inflammatory parameters and liver stiffness has been observed. However, little is known about the long-term impact of DAA treatment on peripheral monocyte subsets and immune mediators levels. Objectives We aimed to examine peripheral monocyte subsets and immune mediators levels in Brazilian chronic HCV patients after long-term successful IFN-free SOF-based treatment. Material and methods We analyzed CD14++CD16-, CD14++CD16+ and CD14+CD16++ monocytes and 27 immune mediators by flow cytometry and analysis of multiple secreted proteins assay, respectively, in monoinfected chronic HCV patients receiving IFN-free sofosbuvir-based regimens followed before treatment, at SVR and one year after the end of treatment (1y). Results Twenty-one biomarkers decreased significantly at 1y and 55–80 % of patients this reduction at 1y. Experimented patients presented a greater modulation of immune mediators at 1y. HLA-DR expression significantly decreased on CD14++CD16- and CD14++CD16+ monocytes at 1y when compared to SVR. Conclusions Successful DAA therapy did not modify monocyte subsets frequency but reduced monocyte activation at 1y and sustained the downregulation and restoration of circulating immune mediators, indicating that long-term reversal of inflammation status could occur after HCV eradication.

Since distinguishing pulmonary (PTB) from latent tuberculosis (LTBI) in pediatric patients remains a challenge, we aimed to investigate the efficacy of immune mediators in diagnosing PTB and LTBI in this population. In this cross-sectional study performed with children and adolescents, serum levels of 20 biomarkers were assessed and data were analyzed according to age groups. We included 65 participants (PTB, n = 28 and LTBI, n = 37). Overall, levels of TNF-α, IL-1Ra, IL-6, IL-17A, VEGF, MMP-1, and procalcitonin were significantly higher (P 0.05) in adolescents and children10 years-old with PTB. Also, principal component analysis (PCA) showed that immune mediators were able to distinguish PTB from LTBI. VEGF and IL-1Ra presented the highest area under the curve (AUC) values, both separately (AUC 0.890 and 0.785) and combined (AUC 0.99). Taken together, we showed that VEGF and IL-1Ra are promising biomarkers to distinguish PTB from LTBI in pediatric patients, especially in children5 years-old.

Aims Interleukin-9 (IL-9) attenuates podocyte injury in experimental kidney disease, but its role in diabetic nephropathy is unknown. We sought to relate urinary IL-9 levels to the release of podocyte-derived extracellular vesicles (EVs) in youth with type 1 diabetes. We related urinary IL-9 levels to clinical variables and studied interactions between urinary IL-9, vascular endothelial growth factor (VEGF), tumor necrosis factor alpha (TNFα) and interleukin-6 (IL-6) on urinary albumin/creatinine ratio (ACR) a functional measure of podocyte injury. Methods We performed an analysis of urine samples and clinical data from a cohort of youth with type 1 diabetes (n = 53). Cytokines were measured using a Luminex platform (Eve Technologies), and nanoscale flow cytometry was employed to quantify urinary podocyte-derived EVs. All urinary measures were normalized to urinary creatinine. Results Mean age was 14.7 ± 1.6 years, and the mean time from diagnosis was 6.7 ± 2.9 years. Mean HbA1c was 70.3 ± 13.9 mmol/mol, mean ACR was 1.3 ± 1.9 mg/mmol, and mean eGFR was 140.3 ± 32.6 ml/min/1.73 m2. IL-9 was inversely related to podocyte EVs (r = − 0.56, p = 0.003). IL-9 was also inversely related to blood glucose, HbA1C and eGFR (r = − 0.44, p = 0.002; r = − 0.41, p = 0.003; r = − 0.49, p r = 0.30, p = 0.04). There was a significant interaction between IL-9, EVs and ACR (p = 0.0143), and the relationship between IL-9 and ACR depended on VEGF (p = 0.0083), TNFα (p = 0.0231) and IL-6 levels (p = 0.0178). Conclusions IL-9 is associated with podocyte injury in early type 1 diabetes, and there are complex interactions between urinary IL-9, inflammatory cytokines and ACR.

Contexto: A Síndrome do Ovário Policístico (SOP) é uma doença multissistêmica comum, que causa alterações reprodutivas, metabólicas e psicológicas. Ultimamente, o uso de plantas medicinais vêm crescendo consideravelmente na esperança de reduzir os efeitos colaterais das drogas sintéticas e na tentativa de redução dos danos e custos. Objetivo: Analisar o uso de plantas medicinais que são utilizadas na SOP a partir de uma revisão integrativa da literatura, com a finalidade de verificar os efeitos farmacológicos ocasionados a partir do uso na SOP. Metodologia: Foi realizada uma revisão integrativa da literatura utilizando as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) através de pesquisas nas bases de dados PubMed, Scielo e Scopus para seleção de estudos etnobotânicos, etnofarmacológicos, pré-clínico e clínico, publicados na íntegra nos últimos 10 anos (2012 – 2022), nos idiomas Inglês, Português e Espanhol a partir de descritores em saúde. Resultados: As dez publicações analisadas evidenciaram dez famílias e 11 espécies de plantas, que, de modo geral, apresentaram atividades antiandrogênicas. Conclusões: Com exceção de Foeniculum vulgare, todas as demais plantas medicinais analisadas neste estudo possuem efeitos anti androgênicos na SOP. Porém, essas espécies necessitam de melhores avaliações clínicas e toxicológicas quanto ao seu uso para que seja possível proporcionar uma terapia segura e eficaz.

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.

Introduction: Some COVID-19 patients have higher mortality and the responsible factors for this unfavorable outcome is still not well understood. Objective: To study the association between ferritin levels at admission, representing an inflammatory state, and hospital mortality in COVID-19 patients. Methods: From May through July 2020, SARS-CoV-2 positive patients with moderate to severe clinical symptoms were evaluated at admission, regarding clinical and laboratory data on renal and hepatic function, hematologic parameters, cytomegalovirus co-infection, and acute phase proteins. Results: A total of 97 patients were included; mean age = 59.9 ± 16.3 years, 58.8% male, 57.7% non-white, in-hospital mortality = 45.4%. Age, ferritin, C-reactive protein, serum albumin and creatinine were significantly associated with mortality. Ferritin showed area under the curve (AUC) of 0.79 (p < 0.001) for the cut-off of 1873.0 ng/mL, sensitivity of 68.4% and specificity of 79.3% in predicting in-hospital mortality. Age ≥60 years had an odds ratio (OR) of 10.5 (95% CI = 1.8–59.5; p = 0.008) and ferritin ≥1873.0 ng/mL had an OR of 6.0 (95% CI = 1.4–26.2; p = 0.016), both independently associated with mortality based on logistic regression analysis. Conclusion: The magnitude of inflammation present at admission of COVID-19 patients, represented by high ferritin levels, is independently predictive of in-hospital mortality.

Profissionais de saúde tem prescrito cada vez mais vitamina D, visto que sua deficiência representa um problema de saúde coletiva mundial. Adicionalmente, indivíduos têm utilizado esta substância para outros fins além daqueles ligados ao metabolismo mineral, apesar da escassez de dados científicos sobre seu papel na prevenção de outras doenças. Este trabalho analisou a prescrição, manipulação e uso do colecalciferol em apresentações magistrais e comerciais nacionais. Farmácias magistrais de Recife, PE informaram as formas farmacêuticas manipuladas contendo colecalciferol para administração oral; consultas eletrônicas ao site da Anvisa e ao software INTUITIVE®, utilizado pela Farmácia Escola Carlos Drummond de Andrade (FECDA), permitiram que as apresentações comerciais/manipuladas, no período do estudo, fossem elencadas e analisadas. Foram realizadas consultas a bases de dados visando estabelecer uma análise crítica e atual diante dos achados. Foi verificada uma ampla preocupação no estabelecimento dos níveis sanguíneos adequados desta vitamina na população por parte dos profissionais de saúde habilitados, visto que 29 diferentes especialistas prescreveram colecalciferol manipulado. Também foi constatada uma maior quantidade de dosagens e formas farmacêuticas magistrais quando comparadas com as apresentações comerciais do mercado nacional. No mais, garantir que estas prescrições estejam embasadas nas necessidades de cada paciente, requer exames sanguíneos e utilização de guias reconhecidos, o que, associado ao acompanhamento farmacoterapêutico, poderá contribuir para o sucesso terapêutico.

Background Hepatitis C virus is known to be highly dependent of lipid metabolism to infect new cells and replicate. Aims To investigate lipid and apolipoprotein profile in chronic HCV patients according to treatment response. Methods Patients recruited from the Hepatitis Treatment Center at Niteroi (Brazil) who received interferon (IFN)-based therapies were separated into two groups, those who achieved sustained virological response (SVR) or not (non-SVR). Another group of patients treated with IFN-free direct-acting antiviral (DAA) therapies was followed from before starting the treatment until one year after therapy. Triglycerides, total cholesterol and fractions were determined by colorimetric and/or electrophoresis techniques. Lecithin cholesterol acyltransferase (LCAT) activity and serum levels of apolipoproteins A1, A2, B, C2, C3 and E were assessed by enzymatic and multiplex assays, respectively. Results We studied 114 patients, and SVR was reached in 28 (39.4%) patients treated with IFN-therapy and in all (100%) patients who received DAA. Non-SVR patients (n = 43) presented altered liver parameters post-treatment. Levels of total cholesterol, LDL-C, VLDL-C and triglycerides were significant higher in SVR group. In contrast, LCAT activity and HDL-C levels were elevated in non-SVR patients. Only apolipoproteins B, C2 and C3 levels were increased in SVR group. The follow-up of SVR-DAA patients (n = 43) revealed a significant and progressive increase in serum levels of total cholesterol, LDL-C, VLDL-C and triglycerides. Conclusions After a successful treatment, chronic hepatitis C patients experienced a reestablishment of lipid metabolism. Our results suggest that the monitoring of serum lipids could be a practical and routine laboratory tool to be applied during the treatment follow-up.

Disturbances in matrix metalloproteinases (MMPs) and corresponding tissue inhibitors (TIMPs) contribute to hepatitis C virus (HCV)-induced fibrosis. This study aimed to determine MMP-9/TIMP-1 levels in addition to MMP-2 and -9 activities; correlating with the improvement of liver fibrosis in patients under direct-acting antiviral (DAA) therapy.Clinical and laboratory follow-up were performed before treatment and after 12 weeks post-treatment, referred as sustained viral response (SVR). We evaluated liver function including non-invasive fibrosis measurements; MMP activity by zymography; and MMP-9/TIMP-1 complex, inflammatory and pro-fibrogenic mediators by immunoenzymatic assays.Cohort included 33 patients (59.5 ± 9.3 years, 60.6% females) whose reached SVR and 11 control-paired subjects (42.5 ± 15 years, 54.5% females). Before treatment, HCV patients presented higher MMP-9/TIMP-1 levels (P 0.05) when compared to controls, and the highest values were observed in patients with fibrosis (P 0.05). In addition, MMP-9/TIMP-1 levels were significantly reduced after DAA therapy (P 0.0001) and were associated with profibrogenic biomarkers. No differences were observed for MMP-2 and -9 activities; however, these biomarkers were significantly associated with inflammatory mediators.Our data suggest that MMP-9/TIMP-1 complex can be a promising biomarker of active fibrogenesis, being able to identify the interruption of fibrosis progression after HCV eradication.

Extracellular vesicles (EVs) are important mediators of intercellular communication. Since EVs are also released during pathological conditions, there has been considerable interest in their potential as sensitive biomarkers of cellular stress and/or injury. In the context of kidney disease, urinary EVs are promising indicators of glomerular and tubular damage. In the present review we discuss the role of urinary EVs in kidney health and disease. Our focus is to explore urinary large EVs (lEVs, often referred to as microparticles or microvesicles) as direct and noninvasive early biomarkers of renal injury. In this regard, studies have been demonstrating altered levels of urinary lEVs, especially podocyte-derived lEVs, preceding the decrease of renal function assessed by classical markers. In addition, we discuss the role of small EVs (sEVs, often referred to as exosomes) and their contents in kidney pathophysiology. Even though results concerning the production of sEVs during diseased conditions are varied, there has been a consensus on the importance of urinary sEV content assessment in kidney disease. These mediators, including EV-released miRNAs and mRNAs, are responsible for EV-mediated signaling in the regulation of renal cellular homeostasis, pathogenesis and regeneration. Finally, steps necessary for the validation of EVs as reliable markers will be discussed.

PBI-4050 (3-pentylbenzenacetic acid sodium salt), a novel first-in-class orally active compound that has completed clinical Phases Ib and II in subjects with chronic kidney disease (CKD) and metabolic syndrome respectively, exerts antifibrotic effects in several organs via a novel mechanism of action, partly through activation of the G protein receptor 40 (GPR40) receptor. Here we evaluate the effects of PBI-4050 in both WT and Gpr40−/− mice on adenine-induced tubulointerstitial injury, anemia and activation of the unfolded protein response (UPR) pathway. Adenine-induced CKD was achieved in 8-week-old C57BL/6 mice fed a diet supplemented with 0.25% adenine. After 1 week, PBI-4050 or vehicle was administered daily by oral-gavage for 3 weeks. Gpr40−/− mice were also subjected to adenine-feeding, with or without PBI-4050 treatment. PBI-4050 improved renal function and urine concentrating ability. Anemia was present in adenine-fed mice, while PBI-4050 blunted these effects and led to significantly higher plasma erythropoietin (EPO) levels. Adenine-induced renal fibrosis, endoplasmic reticulum (ER) stress and apoptosis were significantly decreased by PBI-4050. In parallel, Gpr40−/− mice were more susceptible to adenine-induced fibrosis, renal function impairment, anemia and ER stress compared with WT mice. Importantly, PBI-4050 treatment in Gpr40−/− mice failed to reduce renal injury in this model. Taken together, PBI-4050 prevented adenine-induced renal injury while these beneficial effects were lost upon Gpr40 deletion. These data reinforce PBI-4050’s use as a renoprotective therapy and identify GPR40 as a crucial mediator of its beneficial effects.

Background Arboviruses (Zika, dengue and chikungunya) represent a major risk for pregnant women, especially because their vertical transmission can lead to neurological damage in newborns. Early diagnosis can be difficult due to similar clinical presentation with other congenital infections that are associated with congenital abnormalities. Objectives To investigate the circulation of arboviruses and other pathogens responsible for congenital infections, reporting clinical aspects and geographic distribution of maternal rash in a metropolitan region of Rio de Janeiro (Brazil). Methods Cross-sectional study with pregnant women presenting rash attended at the Exanthematic Diseases Unit (Niteroi, Rio de Janeiro) from 2015 to 2018. Diagnosis of arboviruses was performed by real-time PCR (RT-qPCR) and laboratorial screening for syphilis, toxoplasmosis, rubella, cytomegalovirus and HIV was assessed. Demographic data was used for georeferencing analysis. Findings We included 121 pregnant women, of whom Zika virus was detected in 45 cases (37.2%), chikungunya in 33 (27.3%) and dengue in one (0.8%). Five patients presented syphilis, and we observed one case each of listeria, cytomegalovirus, and a syphilis-toxoplasmosis case. Similarity of clinical symptoms was observed in all groups; however, 84.8% of patients with chikungunya presented arthralgia. Following the decline of Zika cases, chikungunya infection was mostly observed during 2017–2018. Considering pregnant women infected with arboviruses and other infections, 41% resided in urban slums, mostly in Niteroi. Main conclusions Simultaneous circulation of arboviruses and other agents responsible for congenital infections were observed; however, we did not identify co-infections between arboviruses. In this scenario, we emphasize the importance of adequate prenatal care to provide an accurate diagnosis of maternal rash.

WHAT IS KNOWN AND OBJECTIVE Sofosbuvir(SOF)-based regimens have been administrated with excellent efficacy in chronic hepatitis C. Few uncontrolled ("real-life") studies consider the assessment of renal function when evaluating their post-treatment outcomes. This study aims to evaluate renal biomarkers in a "real-life" experience with chronic hepatitis C patients treated with SOF therapy in a long-term follow-up. METHODS Serum and urinary biomarkers were analysed before, at the end of therapy (EoT), after 12 weeks (sustained virological response-SVR) and one year (1y) post-treatment. Patients were categorized according to baseline glomerular filtration rate (GFR-cut-off 45 mL/min/1.73 m2 ). RESULTS Ninety-four patients with a mean age of 59.9 ± 8.5 years were included; 98.9% of patients reached SVR. Significant improvement in renal biomarkers was observed in patients with GFR ≥45 mL/min/1.73 m2 , as indicated by a progressive increase in mean GFR values until 1y. No evidence of tubular dysfunction was identified. Patients with baseline GFR

This study aimed at analyzing circulating levels of inflammatory and profibrogenic cytokines in patients with hepatitis C virus (HCV) chronic infection undergoing therapy with direct-acting antiviral agents (DAA) and correlating these immune biomarkers with liver disease status. We studied 88 Brazilian monoinfected chronic hepatitis C patients receiving interferon- (IFN-) free sofosbuvir-based regimens for 12 or 24 weeks, followed-up before therapy initiation and three months after the end of treatment. Liver disease was determined by transient elastography, in addition to APRI and FIB-4 indexes. Analysis of 30 immune mediators was carried out by multiplex or enzymatic immunoassays. Sustained virological response rate was 98.9%. Serum levels of cytokines were increased in HCV-infected patients when compared to control group. CCL-2, CCL-3, CCL-4, CXCL-8, CXCL-10, IL-1β, IL-15, IFN-γ, IL-4, IL-10, TGF-β, FGFb, and PAI-1 decreased significantly after antiviral therapy, reaching values similar to noninfected controls. TGF-βand suPAR levels were associated with fibrosis/cirrhosis. Also, we observed amelioration in hepatic parameters after DAA treatment. Together, our results suggest that viral control induced by IFN-free DAA therapy restores inflammatory mediators in association with improvement in liver function.