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Background: The aim was to analyze changes in normal functional parameters of gait analysis by aging, sex, and body mass index (BMI). Methods: A cross-sectional study with a consecutive sample of asymptomatic subjects was performed between 2014 and 2020. Primary outcomes were time and force parameters (contact time and center of force [CoF] time), in the heel, midfoot, and metatarsal areas, measured using an in-office force platform. Results: A total of 156 subjects (312 feet) were included, including 67% of women with a mean age of 47 years. The mean of total contact time was similar in males and females (P = .695) and across BMI (P = .413). Contact time did not show differences by region (P = .648 heel, P = .286 midfoot, and P = .690 metatarsal). CoF time in the heel and metatarsal areas did not change between males and females (P = .288 and P = .879, respectively); meanwhile, it was different in midfoot (P = .002). Maximum force showed a reduction between sexes in the heel (P = .039) but did not in the midfoot and metatarsal areas. By age, differences were detected in the heel and metatarsal areas in females (P = .002 and P = .001) and the metatarsal area in males (P = .001). According to the age groups, total contact time increased in females (P = .001) but not in males (P = .018), and no differences were detected between foot areas. In females, CoF time did not change either foot areas or age groups. In males, CoF time values increased in the midfoot area in the older group (P = .001). Conclusion: Time variables did not change by foot region, independent of age, sex, and BMI. Heel maximum force decreased in females, probably linked to adaptive phenomena by aging. The midfoot remains stable, and acts as an undamaged "bridge." These parameters could be interpreted as normal in asymptomatic subjects. Level of Evidence: Level III, diagnostic and prognostic.

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Following the discovery of COVID-19 disease caused by the SARS-CoV-2 coronavirus, different studies have been carried out to recognize the stages of the disease and the methods of achieving correct diagnosis. Investigations of cases and their contacts have revealed different degrees in the symptomatology of the disease, with asymptomatic patients gaining relevance because of the controversy regarding their role in the spread of the disease. Recognition and assessment of asymptomatic patients is essential to carry out containment actions such as public health measures for affected patients and contacts. In this review, we assess the diagnostic aspects of asymptomatic patients according to the available evidence of people with COVID-19.

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Introducción: La COVID-19 es una enfermedad emergente de categoría pandémica. Las formas clínicas son variables y existe una elevada frecuencia de la forma asintomática. Objetivo: Describir las características clínicas y epidemiológicas en los pacientes de la COVID-19 asintomáticos. Métodos: Se realizó un estudio descriptivo, con todos los pacientes asintomáticos al ingreso, con diagnóstico confirmado, por la prueba de reacción en cadena de la polimerasa-transcriptasa inversa en tiempo real, para el SARS-CoV-2 en el Hospital Militar Dr. Fermín Valdés Domínguez, desde marzo hasta julio de 2020. Fueron estudiadas las variables expresividad clínica, proporción de asintomáticos, edad, sexo, antecedentes epidemiológicos y clínicos. Se utilizaron medidas de frecuencias. Resultados: El 41,8 por ciento de los pacientes permanecieron asintomáticos, predominó el grupo etario entre 20 y 39 años (33,3 por ciento) y el sexo femenino (55,6 por ciento). La fuente de infección más frecuente fue el contacto con caso confirmado (88,9 por ciento) y los municipios de mayor frecuencia fueron Holguín, Gibara y Banes. Los factores de riesgo clínico preponderante fueron: la condición de adulto mayor (20 por ciento) y la hipertensión arterial (17,8 por ciento). El 57, 8 por ciento de los pacientes no tenían comorbilidades. Conclusiones: Predominaron los adultos jóvenes, del sexo femenino, pertenecientes a los municipios Holguín, Gibara y Banes, con antecedentes epidemiológicos de ser contactos de casos confirmados. La condición adulto mayor y la hipertensión arterial fueron los factores de riesgo más frecuentes y la mayoría de los casos no presentaron comorbilidades(AU)

Introduction: COVID-19 is an emerging disease of pandemic category. The clinical forms are variable and the asymptomatic form has high frequency. Objective: To describe the clinical and epidemiological characteristics of COVID-19 positive and asymptomatic patients. Methods: A descriptive study was carried out, including all asymptomatic patients on admission, whit a confirmed diagnosis, by the real-time reverse transcriptase-polymerase chain reaction test for SARS-CoV-2 infection at Military Hospital Dr. Fermín Valdés Domínguez from March to July 2020. The variables age, sex, clinical expressiveness, clinical and epidemiological history were studied. Frequencies and percentage were used. Results: The 41,8 percent of the patients remained asymptomatic, the age group between 20 and 39 years (33,3 percent) and female sex predominated (55,6 percent). The most frequent source of infection was contact with confirmed case (88,9 percent) and the most frequent municipalities were Holguín, Gibara and Banes. Older adults and hypertension were most frequent clinical risk factors (20,0 and 57,8 percent respectively) and 57,8 percent of the patients had no comorbidities. Conclusions: Young adults predominated, female sex, from Holguín, Gibara and Banes municipalities with a history of being a contact confirmed case. Elderly condition and hypertension were the most frequent risk factors and most of the cases did not have comorbidities(AU)

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OBJECTIVE: The increasing use of computed tomography (CT) angiography has led to more frequent diagnoses of celiac artery compression (CAC) by the median arcuate ligament (MAL). The signs of CAC by the MAL have been described as stenosis and a hook or J appearance on sagittal views. The importance of the "hook signal," however, has not been documented by studies of the normal anatomy of the celiac axis. METHODS: CT angiography images of 344 completely asymptomatic, live kidney donors (without history of chronic abdominal pain or weight loss) were reviewed. The angle of emergence (AE) of the celiac axis from the aorta and the angle of upward or downward shifting of the celiac axis before its first branch (fold angle [FA]) were measured. Weight, height, and body mass index were obtained from our electronic database, and correlations with the angles measured were tested. The occurrence of stenosis >50% at the origins of the celiac axis was also determined in the sample. RESULTS: Measurements were possible in 321 cases. The celiac axis was found to leave the aorta at an angle of <90 degrees in all patients (AE range, 7-83 degrees) and <45 degrees in 292 (90%) patients. The FA ranged from 66 to 208 degrees. Before the first branch, the celiac trunk shifted upward in 306 (95%) patients, remained straight in just one of them, and shifted downward in 14 (4%). The AE was positively correlated with weight in women. The FA was negatively correlated with weight in men and women. Body mass index was positively correlated with AE and negatively correlated with FA in both men and women. In 11 cases (3.4%), stenosis >50% was found at the origin of the celiac axis. In only two patients, the celiac axis had an upward slope after the stenosis, which could be interpreted as a hook shape. CONCLUSIONS: The normal anatomy of the celiac axis, when seen on CT angiography images, demonstrates that it exits the aorta downward and then shifts upward. This hook or J shape should not be interpreted as resulting from external compression. CAC by the MAL occurs in 3.42% of the normal asymptomatic population; a hook or J shape is not visible in most cases in that subgroup.

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Dengue is the most prevalent arthropod-borne viral illness in humans worldwide. Single-nucleotide polymorphisms (SNPs) in genes involved in the immune response, such as dendritic cell-specific intercellular adhesion molecule-3-grabbing non-integrin (DC-SIGN), IgG Fc receptor II-A (FcγRIIa), vitamin D receptor (VDR), and tumor necrosis factor alpha (TNF-α), were previously reported to be associated with susceptibility to dengue disease in different human populations. Therefore, due to the relevant association of host immune and genetic status with disease susceptibility/severity of dengue, this work aims to verify the frequency of anti-dengue virus antibodies and some dengue-associated risk SNPs in a population in Minas Gerais State, Southeast Brazil. A total of 1560 individuals were genotyped for polymorphisms in DC-SIGN (rs4804803), FcγRIIa (rs1801274), VDR (rs7975232), and TNF-α (rs1800629). The presence of anti-dengue antibodies (IgM and/or IgG) in these samples was also assayed. Anti-dengue antibodies were detected at an overall frequency of 16.86%, indicating a virus infection in asymptomatic individuals. The genotypic frequencies of all SNPs studied did not differ between the asymptomatic and control groups. Regarding the allelic frequencies of the four SNPs analyzed, a higher frequency was detected of the G allele of FcγRIIa/rs1801274 in the asymptomatic individuals when compared to that in the control group (p = 0.03). Therefore, the results showed a high prevalence of asymptomatic individuals in Minas Gerais State, with a potential association between the presence of the G allele of FcγRIIa/rs1801274 and protection against symptomatic disease.

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X-linked adrenoleukodystrophy (X-ALD) is an inherited disease characterized by progressive inflammatory demyelization in the brain, adrenal insufficiency, and an abnormal accumulation of very long chain fatty acids (VLCFA) in tissue and body fluids. Considering that inflammation might be involved in pathophysiology of X-ALD, we aimed to investigate pro- and anti-inflammatory cytokines in plasma from three different male phenotypes (CCER, AMN, and asymptomatic individuals). Our results showed that asymptomatic patients presented increased levels of pro-inflammatory cytokines IL-1ß, IL-2, IL-8, and TNF-α and the last one was also higher in AMN phenotype. Besides, asymptomatic patients presented higher levels of anti-inflammatory cytokines IL-4 and IL-10. AMN patients presented higher levels of IL-2, IL-5, and IL-4. We might hypothesize that inflammation in X-ALD is related to plasmatic VLCFA concentration, since there were positive correlations between C26:0 plasmatic levels and pro-inflammatory cytokines in asymptomatic and AMN patients and negative correlation between anti-inflammatory cytokine and C24:0/C22:0 ratio in AMN patients. The present work yields experimental evidence that there is an inflammatory imbalance associated Th1, (IL-2, IL-6, and IFN-γ), Th2 (IL-4 and IL-10), and macrophages response (TNF-α and IL-1ß) in the periphery of asymptomatic and AMN patients, and there is correlation between VLCFA plasmatic levels and inflammatory mediators in X-ALD. Furthermore, we might also speculate that the increase of plasmatic cytokines in asymptomatic patients could be considered an early biomarker of brain damage and maybe also a predictor of disease progression.

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Recent findings from the START Trial provided evidence that early initiation of antiretroviral treatment should be implemented as the global standard of care. However, a large proportion of patients are still being diagnosed in late stages. Our objective was to evaluate the temporal trend in the CD4+ cell count at diagnosis during a 13 year period and the factors associated with late HIV diagnosis in asymptomatic individuals tested in the Centre for Prevention, Counselling and Diagnosis of our hospital. It was a retrospective study including all asymptomatic patients with new diagnosis of HIV infection. Very late presenters (VLP) were defined as those with CD4+ counts < 200 and late presenters (LP) with CD4+ < 350 cell/mm3. We also evaluated the proportion of patients diagnosed with CD4+ cell counts below 500 cell/mm3. Between January 2002 and December 2014, 20 263 patients were tested for HIV, 1104 with a positive result of whom 995 asymptomatic individuals were included. Overall, median CD4+ count was 372 cells/mm3 and HIV-RNA 31 145 copies/ml. There was no evidence that the CD4+ count at diagnosis progressively increased over time, nor that the proportion of VLP and LP decreased. In a multivariate model older age, heterosexual transmission and intravenous drug use remained as independent factors associated with LP. In conclusion, late diagnosis of HIV infection remains prevalent among asymptomatic patients, highlighting the need to continue implementing strategies towards early diagnosis.

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Recent findings from the START Trial provided evidence that early initiation of antiretroviral treatment should be implemented as the global standard of care. However, a large proportion of patients are still being diagnosed in late stages. Our objective was to evaluate the temporal trend in the CD4+ cell count at diagnosis during a 13 year period and the factors associated with late HIV diagnosis in asymptomatic individuals tested in the Centre for Prevention, Counselling and Diagnosis of our hospital. It was a retrospective study including all asymptomatic patients with new diagnosis of HIV infection. Very late presenters (VLP) were defined as those with CD4+ counts < 200 and late presenters (LP) with CD4+ < 350 cell/mm³. We also evaluated the proportion of patients diagnosed with CD4+ cell counts below 500 cell/mm3. Between January 2002 and December 2014, 20 263 patients were tested for HIV, 1104 with a positive result of whom 995 asymptomatic individuals were included. Overall, median CD4+ count was 372 cells/mm3 and HIV-RNA 31 145 copies/ml. There was no evidence that the CD4+ count at diagnosis progressively increased over time, nor that the proportion of VLP and LP decreased. In a multivariate model older age, heterosexual transmission and intravenous drug use remained as independent factors associated with LP. In conclusion, late diagnosis of HIV infection remains prevalent among asymptomatic patients, highlighting the need to continue implementing strategies towards early diagnosis.

Los resultados del estudio START han evidenciado que la iniciación temprana del tratamiento antirretroviral debe ser un estándar global. No obstante, una gran proporción de pacientes aún se diagnostican en etapas tardías. Nuestro objetivo fue evaluar la tendencia en el recuento de CD4+ al diagnóstico de infección por HIV, la proporción de presentadores tardíos entre 2002 y 2014, y los factores asociados con el diagnóstico tardío en pacientes asintomáticos en el Centro de Prevención, Asesoramiento y Diagnóstico de nuestro hospital. Se incluyeron en un estudio retrospectivo todos los sujetos asintomáticos con un diagnóstico de HIV. Se consideraron presentadores muy tardíos (PMT) a aquellos pacientes con CD4+ < 200 y presentadores tardíos (PT) con cifras de CD4+ < 350 células/mm³. Adicionalmente evaluamos la proporción de pacientes diagnosticados con recuentos de CD4+ inferiores a 500 células/mm³. Desde enero 2002 a diciembre de 2014 se testearon para HIV 20 263 pacientes, 1104 con resultado positivo, de los cuales 995 eran asintomáticos. Globalmente, la mediana de CD4+ fue 372 células/mm3 y la de HIV-ARN de 31 145 copias/ml. No hubo evidencia de que el recuento de CD4+ al diagnóstico haya aumentado en el tiempo, ni de disminución de la proporción de PT o PMT. En un modelo multivariado, la mayor edad, la transmisión heterosexual y el uso de drogas intravenosas se asociaron independientemente con PT. En conclusión, el diagnóstico tardío de infección por HIV se mantiene prevalente en pacientes asintomáticos, resaltando la necesidad de continuar implementando estrategias orientadas a favorecer el diagnóstico temprano.

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