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Cytomegalovirus (CMV) can cause a broad range of diseases, with severity depending on immune status, comorbidities, and age. Initial CMV infection usually occurs in childhood and is typically asymptomatic, leading to lifelong latency. In immunocompromised patients, CMV can affect multiple organs, but salivary gland infections are rare. This study presents a case of a 66-year-old woman with B-cell acute lymphoblastic leukemia who developed swelling and pain in the right preauricular region during pre-transplant consolidation therapy. Despite a recent bone marrow biopsy indicating morphological remission and a flow cytometry analysis detecting only 0.04 % B lymphoblasts, she exhibited these symptoms. A CT scan revealed enlargement, hyperdensity, and enhancement of the right parotid glands, with accompanying subcutaneous edema. A biopsy of the right parotid gland showed a dense interstitial lymphoplasmacytic infiltrate with numerous Cowdry bodies and smaller granular cytoplasmic inclusions, all testing positive for CMV immunohistochemistry. The findings confirm the diagnosis of CMV sialadenitis in an immunocompromised patient. This case underscores the importance of considering CMV infections in similar clinical scenarios, particularly in patients with compromised immune systems.

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Introdução: Em instituições de longa permanência para idosos a comunicação é um elemento fundamental para o relacionamento interpessoal entre os profissionais e moradores, a fim de proporcionar adequada compreensão do planoterapêutico e melhor desenvolvimento das relações de confiança e satisfação. Objetivo: Avaliar a comunicação interpessoal de profissionais de saúde em instituição de longa permanência para idosos. Materiais e Métodos: Trata-sede uma pesquisa transversal, descritiva, analítica com abordagem quantitativa, realizada em uma entidade filantrópicasem fins lucrativos de assistência e moradia à pessoa idosa - Lar São Vicente de Paulo, em um município no interior doestado de São Paulo. A coleta de dados ocorreu entre junho e julho de 2023. Utilizaram-se dois questionários, sendo um instrumento para dados sociodemográficos e a Escala de Competência em Comunicação Interpessoal para avaliar a comunicação dos profissionais de saúde. Foram realizadas análises descritivas e inferenciais. Resultados: Participaram 23 profissionais de saúde, 95,7% do sexo feminino, com média de idade de 45,2 anos, 91,3%, com renda mensal menor que três salários-mínimos e o mesmo percentual de profissionais que não possui outro trabalho. A pontuação mediana do escore total da Escala de Competência em Comunicação Interpessoal foi 64,8 pontos, com consistência interna média (Alpha de Cronbach= 0,58). Conclusões: Houve boa habilidade de comunicação interpessoal entre os profissionais de saúde, com diagnóstico situacional da comunicação interpessoal, além de conhecimento e possibilidade de aprimoramento dos processos de comunicação da equipe multidisciplinar, para maior qualidade e segurança no cuidado à pessoa idosa

Introduction: In long-term care institutions for elderly, communication is a fundamental element for the interpersonal relationship between professionals and residents, in order to provide adequate understanding of the therapeutic plan and better development of relationships of trust and satisfaction. Objective: To evaluate the interpersonal communication of health professionals in a long-term care institution for elderly. Materials and Methods: This is a cross-sectional, descriptive, analytical research with a quantitative approach, carried out in a non-profit philanthropic entity providing assistance and housing to elderly people - Lar São Vicente de Paulo, in a municipality of the State of São Paulo. Data collection occurred between June and July 2023. Two questionnaires were used, one instrument for sociodemographic data and the Interpersonal Communication Competence Scale to evaluate the communication of health professionals. Descriptive and inferential analyzes were carried out. Results: 23 health professionals participated, 95.7% female, with an average age of 45.2 years, 91.3% with a monthly income of less than three minimum wages, and the same percentage of professionals who did not have another job. The median score of the Interpersonal Communication Competence Scale total score was 64.8 points, with average internal consistency (Cronbach's Alpha= 0.58). Conclusions: There was good interpersonal communication skills among health professionals, with situational diagnosis of interpersonal communication, in addition to knowledge and the possibility of improving the communication processes of the multidisciplinary team, for greater quality and safety in the care of elderly people

Introduction: In long-term care institutions for elderly, communication is a fundamental element for the interpersonal relationship between professionals and residents, in order to provide adequate understanding of the therapeutic plan and better development of relationships of trust and satisfaction. Objective: To evaluate the interpersonal communication of health professionals in a long-term care institution for elderly. Materials and Methods: This is a cross-sectional, descriptive, analytical research with a quantitative approach, carried out in a non-profit philanthropic entity providing assistance and housing to elderly people - Lar São Vicente de Paulo, in a municipality of the State of São Paulo. Data collection occurred between June and July 2023. Two questionnaires were used, one instrument for sociodemographic data and the Interpersonal Communication Competence Scale to evaluate the communication of health professionals. Descriptive and inferential analyzes were carried out. Results: 23 health professionals participated, 95.7% female, with an average age of 45.2 years, 91.3% with a monthly income of less than three minimum wages, and the same percentage of professionals who did not have another job. The median score of the Interpersonal Communication Competence Scale total score was 64.8 points, with average internal consistency (Cronbach's Alpha= 0.58). Conclusions: There was good interpersonal communication skills among health professionals, with situational diagnosis of interpersonal communication, in addition to knowledge and the possibility of improving the communication processes of the multidisciplinary team, for greater quality and safety in the care of elderly people en un municipio del Estado de São Paulo. La recolección de datos se realizó entre junio y julio de 2023. Se utilizaron dos cuestionarios, un instrumento para datos sociodemográficos y la Escala de Competencia en Comunicación Interpersonal para evaluar la comunicación de los profesionales de la salud. Se realizaron análisis descriptivos e inferenciales. Resultados: Participaron 23 profesionales de la salud, 95,7% del sexo femenino, con edad promedio de 45,2 años, 91,3% con ingresos mensuales inferiores a tres salarios mínimos, e igual porcentaje de profesionales que no tenían otro trabajo. La mediana de la puntuación total en la Escala de Competencia en Comunicación Interpersonal fue de 64,8 puntos, con consistencia interna media (Alfa de Cronbach= 0,58). Conclusiones: Hubo buenas habilidades de comunicación interpersonal entre los profesionales de la salud, con diagnóstico situacional de la comunicación interpersonal, además de conocimiento y posibilidad de mejorar los procesos de comunicación del equipo multidisciplinario, para mayor calidad y seguridad en la atención a las personas mayores

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Resumen: Introducción: la persistencia de la vena cava superior izquierda (PVCSI) tiene una prevalencia de 0.21% en la población general. Presentación del caso: masculino de 67 años de edad diagnosticado con bloqueo auriculoventricular (AV) de tercer grado y que requirió colocación de marcapasos; sin embargo, debido a la ausencia de la vena cava superior derecha, corroborado por angiotomografía, se colocó marcapasos definitivo a través de la vena cava superior izquierda persistente. Conclusión: la persistencia de la vena cava superior izquierda (PVCSI) es la anomalía venosa torácica más común. Puede causar una serie de síntomas clínicamente significativos, incluso en un corazón con anatomía normal. La colocación de marcapasos dificulta la fijación del electrodo debido al recorrido tortuoso que genera.

Abstract: Introduction: the persistence of the left superior vena cava (PLSVC) has a prevalence of 0.21% in the general population. Case presentation: 67-year-old male diagnosed with third-degree AV block, requiring pacemaker placement. However, due to the absence of a right superior vena cava, corroborated by CT angiography, a definitive pacemaker was placed through a persistent left superior vena cava. Conclusion: the persistence of the left superior vena cava (PLSVC) is the most common thoracic venous anomaly. It can cause a number of clinically significant symptoms, even in a heart with normal anatomy. Pacemaker placement makes electrode fixation difficult due to tortuous travel.

Resumo: Introdução: a persistência da veia cava superior esquerda (PVCSI) tem uma prevalência de 0.21% na população geral. Apresentação do caso: Homem de 67 anos com diagnóstico de bloqueio AV de terceiro grau, necessitando de colocação de marcapasso. No entanto, devido à ausência da veia cava superior direita, corroborada pela angiotomografia, colocou-se marcapasso definitivo através da veia cava superior esquerda persistente. Conclusão: a persistência da veia cava superior esquerda (PVCSI) é a anomalia venosa torácica mais comum. Pode causar uma série de sintomas clinicamente significativos, mesmo em um coração com anatomia normal. A colocação do marcapasso dificulta a fixação do eletrodo devido ao trajeto tortuoso.

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Introducción: Las medidas para el control de la epidemia de COVID-19 probablemente permiten el control de otras enfermedades de transmisión respiratorias. Objetivo: Determinar el efecto de las medidas aplicadas para la prevención y control de la COVID-19 en la incidencia de algunas enfermedades de transmisión respiratoria. Métodos: Se realizó un estudio ecológico de series temporales. Las unidades de análisis fueron las series temporales de la incidencia semanal de casos atendidos por algunas enfermedades infecciosas (infecciones respiratorias agudas, varicela, escarlatina y meningitis virales) en el periodo 2013-2020 en la provincia Santiago de Cuba. Con estas se construyeron los canales endémicos se empleó el método de inframáximo y supramínimo con las series de las 52 semanas en el periodo del 2013 al 2019, las cuales sirvieron de base para el análisis de la serie de 2020. Resultados: El alza de algunas enfermedades respiratorias en el 2020 coincidió con el alza de la epidemia de COVID-19 en el territorio y a partir de la semana 15 se apreció una disminución de la incidencia, lo cual concuerda con la fecha en que se aplican las medidas de control de la COVID-19 (restricción de movimientos, uso de nasobucos, lavado y desinfección de manos, distanciamiento social, etc.). Conclusiones: Las medidas para el control de la COVID-19 han ejercido un efecto positivo sobre la incidencia de las enfermedades seleccionadas, las que exhibieron una reducción por debajo de lo esperado para el 2020, en Santiago de Cuba(AU)

Introduction: Measures to control COVID-19 epidemic are likely to enable the control of other respiratory transmitted diseases. Objective: To determine the effect of the measures applied for the prevention and control of COVID-19 on the incidence of other respiratory transmitted diseases. Methods: An ecological time series study was carried out. The units of analysis were the time series of the weekly incidence of the cases treated for some infectious diseases (acute respiratory infections, chickenpox, scarlet fever, and viral meningitis) from 2013 to 2020 in Santiago de Cuba. These units were used to create the endemic channels by the infra-maximal and supra-minimal method with series from the 52 weeks between 2013 and 2019, which served as the starting point for the analysis of the 2020 series. Results: The increase of some respiratory diseases in 2020 coincided with the increase of COVID-19 epidemic in the territory, and from week 15 onwards, it was evidenced a decrease in the incidence which is consistent with the date on which COVID-19 control measures were established (movement restriction, mask wearing, hand washing and disinfection, social distancing, etc.). Conclusions: Control measures for COVID-19 have exerted a positive impact on the incidence of the selected diseases, which exhibited a reduction below what was expected for 2020 in Santiago de Cuba(AU)

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BACKGROUND: Malnutrition status, body composition indicators, and bioelectrical impedance analysis (BIA) parameters have been associated with increased risk of death in several pathologies. The aim of this study was to describe the associations between phase angle (PhA) indicators obtained by BIA with length of hospital stay, days on mechanical ventilation, and 60-day mortality in critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: This is a prospective cohort of mechanically ventilated patients with coronavirus disease 2019 (COVID-19). We assessed nutrition risk and body composition with BIA within 48 h from intensive care unit admission. Logistic and linear regression models were used to analyze the association between variables and clinical outcomes. Survival analysis by PhA value was performed using Kaplan-Meier curves. RESULTS: Sixty-seven patients were included. PhA (odds ratio [OR], 0.36; P = .002), standardized PhA (SPA) (OR, 0.45; P = .001), and extracellular water/total body water ratio (OR, 3.25; P = .002) were significant predictors of 60-day mortality. PhA <3.85° in females and <5.25° in males showed good and fair discrimination, respectively, for mortality prediction. Using cutoff values, low PhA was associated with a significantly increased risk of 60-day mortality (hazard ratio, 3.08; 95% CI, 1.12-8.41; P = .02). No association was detected for SPA. CONCLUSION: Low PhA values could be a predictor of 60-day mortality in critically ill patients with COVID-19. This biological marker could be incorporated as part of nutrition and mortality risk assessment in this population.

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OBJECTIVES: Normal weight obesity (NWO) is defined as a condition of normal body weight, but with high body fat percentage. Clinical and immunologic implications of NWO in persons living with HIV (PLHIV) remain unknown. The aim of this study was to examine NWO prevalence and its associations with metabolic and immunologic measurements in a cohort of PLHIV on antiretroviral treatment (ART). METHODS: We enrolled 73 adult PLHIV on ART. Body composition was assessed by dual-energy x-ray absorptiometry. NWO was defined as body mass index 18.5 to 24.9 kg/m2 and body fat ≥25%. We determined triacylglycerols, total cholesterol, high-density lipoprotein, low-density lipoprotein, blood glucose, blood pressure, bone mineral density, inflammatory cytokines (interleukin [IL]-1ß, tumor necrosis factor-α and IL-6) and CD4+ and CD8+ T-cell activation. RESULTS: The prevalence of NWO was 49% (36 of 73). Participants with NWO showed lower CD4+ T-cell percentage (25 versus 27%, P = 0.03), lower CD4/CD8 ratio (0.62 versus 0.82, P = 0.02), lower muscle mass (6.84 versus 7.11 kg/m2, P = 0.01) and higher prevalence of hypercholesterolemia (26% versus 6%, P = 0.03) than individuals with normal body composition. No differences in inflammation/activation markers were observed between groups (P > 0.05 in all cases). CONCLUSION: NWO was frequent in a cohort of Mexican PLHIV on ART and was associated with lower muscle mass, hypercholesterolemia, lower CD4+ T-cell percentage, and lower CD4/CD8 ratio. The incorporation of body fat measurements in the regular physical examination of PLHIV could contribute to early identification of the NWO condition and lead to better management of possible long-term morbidity.

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BACKGROUND: Phase angle (PhA), measured by bioelectrical impedance analysis (BIA) has been studied as an indicator of survival in people living with HIV (PLWH). However, it remains unclear whether PhA is associated with malnutrition or low CD4+ T-cell counts. OBJECTIVE: In this study, we assessed the discriminative capacity of PhA for malnutrition detection using Global Leadership Initiative on Malnutrition (GLIM) criteria in PLWH, aiming to propose cutoff points for this population. METHODS: This retrospective observational study included 427 adult PLWH (13% female). Participants were classified according to malnutrition status by using GLIM criteria. Body composition was assessed by using BIA. CD4+ T-cell counts were determined by flow cytometry. RESULTS: According to GLIM criteria, 30% of the participants were malnourished. Multivariate regression analysis showed that PhA (adjusted odds ratio [OR], 0.10; 95% CI, 0.05-0.18; P < 0.001), fat-mass percentage (adjusted OR, 0.86; 95% CI, 0.82-0.90; P < 0.001), and male sex (adjusted OR, 0.26; 95% CI, 0.09-0.76; P = 0.013) were independently associated with malnutrition. A PhA cutoff of 5.45° in men and 4.95° in women may predict malnutrition with sensitivity and specificity >70%. CONCLUSION: PhA could be a valid, useful, and simple predictor of malnutrition in PLWH.

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Abstract We present the case of a 56-year-old patient with progressive kidney function deterioration whose kidney biopsy reported granulomatous interstitial nephritis. The medical chart was reviewed, and it was noted that the deterioration coincided with the initiation of the medication adalimumab. It was discontinued and steroid plus cytostatic treatment was begun, with improvement. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2050).

Resumen Se presenta el caso de una paciente de 56 años, quien presenta deterioro progresivo en la función renal, y en quien la biopsia renal reportó nefritis intersticial granulomatosa. Se revisó historia clínica, y se detectó que el deterioro coincidía con el inicio del medicamento adalimumab. Se suspendió, inicio terapia de esteroide más citostático con mejoría. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2050).

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Background: nutritional risk has been associated with worse outcomes at the critical care unit. The aim of this study was to describe the association between nutritional risk and length of stay, days on mechanical ventilation, and in-hospital mortality in patients infected with SARS-CoV-2. Methods: a retrospective cohort of ventilated, critically ill patients. We assessed nutrition risk at baseline using NUTRIC-score. Logistic and linear regression models were used to analyze the association between NUTRIC-score and clinical outcomes (days on mechanical ventilation, hospital length of stay, and in-hospital mortality). A survival analysis was performed using Kaplan-Meier curves. Results: a total of 112 patients were included, 39.3 % were overweight and 47.3 % were obese. Based on NUTRIC-Score, 66 % and 34 % of patients were at high and low nutritional risk, respectively. High nutritional risk was associated with increased mortality risk (OR: 2.4, 95 % CI, 1.06-5.47, p = 0.036) and higher 28-day mortality (HR: 2.05, 95 % CI, 1.01-4.23, p = 0.04) in comparison with low risk. Conclusion: high nutritional risk is related to mortality in SARS-CoV-2 critically ill patients. Overweight and obesity are common in this sample. More studies are needed to elucidate the impact of nutritional therapy on infection course and outcomes. (AU)

Introducción: el riesgo nutricional se asocia a peores desenlaces en los pacientes en estado crítico. El objetivo de este estudio es describir la asociación entre el riesgo nutricional y los días de estancia hospitalaria, los días de ventilación mecánica y la mortalidad en pacientes infectados por el SARS-CoV-2. Métodos: cohorte retrospectiva de pacientes en estado crítico bajo ventilación mecánica invasiva. Se evaluó el riesgo nutricional utilizando la herramienta NUTRIC-Score. Se utilizaron regresiones lineares y logísticas para evaluar la asociación entre el riesgo nutricional y los desenlaces clínicos (días de ventilación mecánica, días de estancia hospitalaria y mortalidad hospitalaria). Se utilizaron curvas de Kaplan-Meier para analizar la sobrevivencia. Resultados: se incluyeron 112 pacientes, el 39,3 % con diagnóstico de sobrepeso y el 47,3 % con obesidad de acuerdo con el IMC. Utilizando la herramienta NUTRIC-Score, el 66 % tenían riesgo nutricional alto y el 34 % riesgo nutricional bajo. El riesgo nutricional alto se asoció a un mayor riesgo de mortalidad (OR: 2,4; IC 95 %: 1,06-5,47; p = 0,036) y mayor mortalidad a 28 días (HR: 2,05; IC 95 %: 1,01-4,23; p = 0,04) en comparación con los individuos con riesgo nutricional bajo. Conclusión: el riesgo nutricional alto se asocia con mortalidad en los pacientes con infección por SARS-CoV-2 en estado crítico. El sobrepeso y la obesidad son comunes en este grupo de pacientes. Se necesitan más estudios que evalúen el impacto de la terapia nutricional sobre el curso de la infección y los desenlaces clínicos. (AU)

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BACKGROUND: There is a lack of evidence about the tolerance of enteral nutrition (EN) in COVID-19 critically ill patients. However, several gastrointestinal manifestations related to COVID-19 have been described. The aims of this study were to analyze the incidence of gastrointestinal intolerance (GI) associated to EN (diarrhea, vomiting, gastroparesis and constipation) and to describe energy/protein provision along with biochemical alterations during the first week of EN. METHODS: A retrospective cohort of COVID-19 critically ill patients under mechanical ventilation. We reported daily enteral nutrition infusion and gastrointestinal manifestations within the first week of intubation and enteral nutrition initiation. RESULTS: Fifty-two patients were included; 40.3% were overweight and 46.2% were obese. During the first 7 days of EN, manifestations of GI intolerance such as vomiting, diarrhea and gastroparesis were present in 18 patients (32.4%). Hypernatremia (39%) was the most frequent electrolyte abnormality. Only Acute Kidney Injury (AKI) diagnosis was associated with a higher energy deficit on day 7. No associations between drug prescription and GI intolerance were observed. On day 4, 94.5% of patients were receiving more than 80% of energy requirements and 94.2% of protein requirements. Accumulated energy and protein deficits at day 3 were 2171.2 ± 945 kcal and 114.9 ± 49.2 g, respectively; and 2586.4 ± 1151 kcal, 133.3 ± 60.4 g at day 7. CONCLUSION: Enteral nutrition is feasible and well-tolerated in COVID-19 patients with mechanical ventilation within the first week of enteral nutrition initiation. More studies are needed to elucidate the impact of nutritional therapy on infection course and outcomes.

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INTRODUCTION: Background: nutritional risk has been associated with worse outcomes at the critical care unit. The aim of this study was to describe the association between nutritional risk and length of stay, days on mechanical ventilation, and in-hospital mortality in patients infected with SARS-CoV-2. Methods: a retrospective cohort of ventilated, critically ill patients. We assessed nutrition risk at baseline using NUTRIC-score. Logistic and linear regression models were used to analyze the association between NUTRIC-score and clinical outcomes (days on mechanical ventilation, hospital length of stay, and in-hospital mortality). A survival analysis was performed using Kaplan-Meier curves. Results: a total of 112 patients were included, 39.3 % were overweight and 47.3 % were obese. Based on NUTRIC-Score, 66 % and 34 % of patients were at high and low nutritional risk, respectively. High nutritional risk was associated with increased mortality risk (OR: 2.4, 95 % CI, 1.06-5.47, p = 0.036) and higher 28-day mortality (HR: 2.05, 95 % CI, 1.01-4.23, p = 0.04) in comparison with low risk. Conclusion: high nutritional risk is related to mortality in SARS-CoV-2 critically ill patients. Overweight and obesity are common in this sample. More studies are needed to elucidate the impact of nutritional therapy on infection course and outcomes.

INTRODUCCIÓN: Introducción: el riesgo nutricional se asocia a peores desenlaces en los pacientes en estado crítico. El objetivo de este estudio es describir la asociación entre el riesgo nutricional y los días de estancia hospitalaria, los días de ventilación mecánica y la mortalidad en pacientes infectados por el SARS-CoV-2. Métodos: cohorte retrospectiva de pacientes en estado crítico bajo ventilación mecánica invasiva. Se evaluó el riesgo nutricional utilizando la herramienta NUTRIC-Score. Se utilizaron regresiones lineares y logísticas para evaluar la asociación entre el riesgo nutricional y los desenlaces clínicos (días de ventilación mecánica, días de estancia hospitalaria y mortalidad hospitalaria). Se utilizaron curvas de Kaplan-Meier para analizar la sobrevivencia. Resultados: se incluyeron 112 pacientes, el 39,3 % con diagnóstico de sobrepeso y el 47,3 % con obesidad de acuerdo con el IMC. Utilizando la herramienta NUTRIC-Score, el 66 % tenían riesgo nutricional alto y el 34 % riesgo nutricional bajo. El riesgo nutricional alto se asoció a un mayor riesgo de mortalidad (OR: 2,4; IC 95 %: 1,06-5,47; p = 0,036) y mayor mortalidad a 28 días (HR: 2,05; IC 95 %: 1,01-4,23; p = 0,04) en comparación con los individuos con riesgo nutricional bajo. Conclusión: el riesgo nutricional alto se asocia con mortalidad en los pacientes con infección por SARS-CoV-2 en estado crítico. El sobrepeso y la obesidad son comunes en este grupo de pacientes. Se necesitan más estudios que evalúen el impacto de la terapia nutricional sobre el curso de la infección y los desenlaces clínicos.

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The KARS gene encodes the aminoacyl-tRNA synthetase (aaRS), which activates and joins the lysin with its corresponding transfer RNA (tRNA) through the ATP-dependent aminoacylation of the amino acid. KARS gene mutations have been linked to diverse neurologic phenotypes, such as neurosensorial hearing loss, leukodystrophy, microcephaly, developmental delay or regression, peripheral neuropathy, cardiomyopathy, the impairment of the mitochondrial respiratory chain, and hyperlactatemia, among others. This article presents the case of a Colombian pediatric patient with two pathological missense variants in a compound heterozygous state in the KARS gene and, in addition to the case report, the paper reviews the literature for other cases of KARS1-associated leukodystrophy.

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BACKGROUND: Accurate measurements of resting energy expenditure (REE) are important for determining nutritional needs in HIV patients. Indirect calorimetry (IC) is a noninvasive method that reflects REE but can be costly and is frequently calculated with predictive equations. Research suggests that REE obtained by predictive equations in people living with HIV/AIDS (PLWH) is inaccurate. The aim of the study is to develop and validate a new predictive equation of REE based on a population of PLWH. METHODS: Cross-sectional study including 164 PLWH (82 to develop and 82 to validate the equation). Multiple linear regression was used to determine the relationship between variables and to develop the new predictive equation. Intraclass correlation coefficient (ICC) and Bland-Altman methods were used to evaluate agreement between the new predictive equation and indirect calorimetry. RESULTS: A new predictive equation with an accuracy of 67% when compared with IC was developed. This equation included as covariates: fat free mass, antiretroviral therapy status and age. CONCLUSION: A new equation to predict energy expenditure in PLWH was developed and validated. This formula can be used to estimate REE if IC is not available.

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RESUMEN Existe una relación compleja, dinámica y bidireccional entre la autoinmunidad y el cáncer. Si bien los mecanismos carcinogénicos y fisiopatológicos de las enfermedades autoinmunes no están claramente dilucidados, existe una base inmunológica común relacionada con la expresión de autoantígenos por parte de las células tumorales que desencadenan una respuesta antitumoral, facilitando el desarrollo de síndromes paraneoplásicos reumáticos y enfermedades autoinmunes reumáticas en población genéticamente susceptible. Se presenta un caso de un hombre que debutó con un síndrome pulmón riñón y se diagnosticó cáncer de pulmón y lupus eritematoso sistémico de forma simultánea.

A B S T R A C T There is a complex, dynamic, and bidirectional connection between autoimmunity and cancer. The underlying mechanisms of carcinogenesis and physiopathological aspects of autoimmune diseases are not fully understood. However, there is a common immunological base related to expression of autoantigens by tumour cells that cause an anti-cancer immune response, thereby, triggering the development of paraneoplastic rheumatic syndromes and autoimmune rheumatic diseases in a genetically predisposed population. The case is reported of a 57 year-old man presenting with pulmonary renal syndrome, and who was diagnosed lung cancer and systemic lupus erythematosus at the same time.

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Anticarsia gemmatalis Hübner, 1818 (Lepidoptera) is a major pest of soybean in the Brazil. It is known that the reduction of proteolytic activity by the ingestion of protease inhibitors reduces digestion and larval development of the insects. Control via inhibition of the digestive enzymes necessitates deeper knowledge of the enzyme kinetics and the characterization of the inhibition kinetics of these proteases, for better understanding of the active centers and action mechanisms of this enzyme. Trypsin-like proteases found in the gut of Anticarsia gemmatalis were purified in a p-aminobenzamidine agarose column. Kinetic characterization showed KM 0.503 mM for the L-BApNA substrate; Vmax= 46.650 nM s-1; Vmax/[E]= 9.256 nM s-1 mg L-1 and Vmax/[E]/KM= 18.402 nM s-1 mg L-1 mM. The Ki values for the inhibitors benzamidine, berenil, SKTI and SBBI were 11.2 µM, 32.4 µM, 0.25 nM and 1.4 nM, respectively, and all revealed linear competitive inhibition. The SKTI showed the greatest inhibition, which makes it a promising subject for future research to manufacture peptide mimetic inhibitors.

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BACKGROUND: Protein-protein interactions (PPIs) are fundamental in many biological processes and understanding these interactions is key for a myriad of applications including drug development, peptide design and identification of drug targets. The biological data deluge demands efficient and scalable methods to characterize and understand protein-protein interfaces. In this paper, we present ppiGReMLIN, a graph based strategy to infer interaction patterns in a set of protein-protein complexes. Our method combines an unsupervised learning strategy with frequent subgraph mining in order to detect conserved structural arrangements (patterns) based on the physicochemical properties of atoms on protein interfaces. To assess the ability of ppiGReMLIN to point out relevant conserved substructures on protein-protein interfaces, we compared our results to experimentally determined patterns that are key for protein-protein interactions in 2 datasets of complexes, Serine-protease and BCL-2. RESULTS: ppiGReMLIN was able to detect, in an automatic fashion, conserved structural arrangements that represent highly conserved interactions at the specificity binding pocket of trypsin and trypsin-like proteins from Serine-protease dataset. Also, for the BCL-2 dataset, our method pointed out conserved arrangements that include critical residue interactions within the conserved motif LXXXXD, pivotal to the binding specificity of BH3 domains of pro-apoptotic BCL-2 proteins towards apoptotic suppressors. Quantitatively, ppiGReMLIN was able to find all of the most relevant residues described in literature for our datasets, showing precision of at least 69% up to 100% and recall of 100%. CONCLUSIONS: ppiGReMLIN was able to find highly conserved structures on the interfaces of protein-protein complexes, with minimum support value of 60%, in datasets of similar proteins. We showed that the patterns automatically detected on protein interfaces by our method are in agreement with interaction patterns described in the literature.

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BACKGROUND: Interactions between proteins and non-proteic small molecule ligands play important roles in the biological processes of living systems. Thus, the development of computational methods to support our understanding of the ligand-receptor recognition process is of fundamental importance since these methods are a major step towards ligand prediction, target identification, lead discovery, and more. This article presents visGReMLIN, a web server that couples a graph mining-based strategy to detect motifs at the protein-ligand interface with an interactive platform to visually explore and interpret these motifs in the context of protein-ligand interfaces. RESULTS: To illustrate the potential of visGReMLIN, we conducted two cases in which our strategy was compared with previous experimentally and computationally determined results. visGReMLIN allowed us to detect patterns previously documented in the literature in a totally visual manner. In addition, we found some motifs that we believe are relevant to protein-ligand interactions in the analyzed datasets. CONCLUSIONS: We aimed to build a visual analytics-oriented web server to detect and visualize common motifs at the protein-ligand interface. visGReMLIN motifs can support users in gaining insights on the key atoms/residues responsible for protein-ligand interactions in a dataset of complexes.

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OBJECTIVE: This study aimed to analyze the trend in cervical cancer (ICD C53) mortality in Brazilian regions in women who are who are screened and not screened from 1996 to 2015. METHODS: An epidemiological study, of time series of mortality from cervical cancer performed in 90,856 women under 24 years old (343 women), between 25 and 64 years old (32,703 women), and over 65 years old (10,909 women). The data from this research were collected from the DATASUS, from the SIM Health Surveillance Secretariat files, captured through TABNET selecting the resident population by gender and age group and ICD 10 C53 from 1996 to 2015. RESULTS: Among women, 43.8% were white, and 76% had less than eight years of formal education. Polynomial regression showed an increasing trend in cervical cancer mortality in Brazil for women aged 15 - 24 years (p=0.01). Between 25 - 64 and 65 years or older it remained constant, but high (p=0.07; 0.99). The Northeast region pointed a growing trend in women aged 15 to 24 (p=0.01), 25 to 64 years (p=0.01) and 65 or older (p=0.001). The Northeast presented the highest average growth per year. In the Southeast, South and Midwest regions, decreasing trends were observed despite the high rates. The Joinpoint regression showed a 95% confidence interval, and that mortality from cervical cancer in the North region increased throughout the period analyzed. an increasing trend was observed from 1996 to 1998, whereas in the Midwest region, the trend remained stable throughout the period analyzed. The Federal District presented an upward trend from 1996 to 2015. In Brazil, an upward trend was observed throughout the whole period analyzed. CONCLUSIONS: Cervical cancer mortality in younger women is becoming more predominant, in addition to the high rate observed for women aged 65 or older. 
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Cadmium (Cd) occurs naturally; however, its concentration can increase with anthropogenic activities. Excess Cd increases reactive oxygen species (ROS) production and oxidative damage, which can lead to pathological conditions. Marine mammals accumulate Cd in the liver and the kidney; yet, there are no reports of Cd-associated tissue damage in whales, seals or dolphins. Response to Cd exposure (0-5.0 µM CdCl2 for 1-12 h) was analyzed and compared in primary skeletal muscle cells isolated from northern elephant seals (Mirounga angustirostris) and humans (Homo sapiens). Antioxidant enzyme activities (glutathione S-transferase, glutathione reductase, glutathione peroxidase), glutathione concentration, and protein carbonyl levels (an indicator of oxidative damage) were quantified. Glutathione levels were higher in northern elephant seal than in human cells. Protein carbonyl content in cells exposed to Cd was lower and had a smaller variability range in elephant seals than in humans. Generalized linear models (GLIM) identified Cd exposure and antioxidant defenses as significant contributors to protein carbonyl variability in human but not in elephant seal cells. These results suggest that the previously observed differences in circulating and tissue glutathione levels between marine and terrestrial mammals are maintained under cell culture conditions and that northern elephant seal and human muscle cells respond differently to Cd exposure. The results also suggest that the observed differences could potentially be associated with the protective mechanisms that allow northern elephant seals to tolerate extreme conditions that result in increased ROS generation (e.g. diving, sleep apnea, fasting) with no oxidative damage.

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OBJECTIVES: Micronutrient deficiencies are common among people living with HIV (PLWHIV). The clinical and immunologic consequences of micronutrient deficiencies have been poorly explored in the context of human immunodeficiency virus (HIV) infection. The aim of this study was to determine the prevalence of zinc and selenium deficiency (dietary intake and serum concentrations) and analyze their associations with absolute CD4+ T-cell counts, inflammation markers, and metabolic disorders in a cohort of antiretroviral-experienced HIV-infected individuals. METHODS: The zinc and selenium intakes of 124 HIV-infected men were estimated using 3-d food records. In a subcohort of 45 individuals, serum zinc and selenium concentrations and proinflammatory cytokines were determined. Body composition, bone mineral density (BMD), CD4+ T-cell counts, lipid profile, glucose, and blood pressure were determined and were associated with zinc and selenium dietary intake and serum concentrations. RESULTS: Of the PLWHIV studied, 58% had suboptimal intake of zinc and 8% demonstrated suboptimal intake of selenium. Serum deficiencies for zinc and selenium were 23.9% and 65.9%, respectively. Zinc and selenium intake were correlated with increased muscle mass. Selenium intake was associated with increased BMD of the lumbar region. An inverse correlation between serum selenium concentration and several proinflammatory cytokines (interleukin-1ß, interleukin-6, and tumor necrosis factor-α) was found. CONCLUSION: Suboptimal zinc and selenium intake and serum concentration deficiencies are highly prevalent in treated HIV-positive individuals and are associated with body composition, BMD, and inflammation. Clinical trials should be designed to explore the effect of zinc and selenium supplementation on metabolic, inflammatory, and immunologic parameters on the HIV-positive population.

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