ACE2 and TMPRSS2 are key players on SARS-CoV-2 entry into host cells. However, it is still unclear whether expression levels of these factors could reflect disease severity. Here, a case–control study was conducted with 213 SARS-CoV-2 positive individuals where cases were defined as COVID-19 patients with respiratory distress requiring oxygen support (N = 38) and controls were those with mild to moderate symptoms of the disease who did not need oxygen therapy along the entire clinical course (N = 175). ACE2 and TMPRSS2 mRNA levels were evaluated in nasopharyngeal swab samples by RT-qPCR and logistic regression analyzes were applied to estimate associations with respiratory outcomes. ACE2 and TMPRSS2 levels positively correlated with age, which was also strongly associated with respiratory distress. Increased nasopharyngeal ACE2 levels showed a protective effect against this outcome (adjOR = 0.30; 95% CI 0.09–0.91), while TMPRSS2/ACE2 ratio was associated with risk (adjOR = 4.28; 95% CI 1.36–13.48). On stepwise regression, TMPRSS2/ACE2 ratio outperformed ACE2 to model COVID-19 severity. When nasopharyngeal swabs were compared to bronchoalveolar lavages in an independent cohort of COVID-19 patients under mechanical ventilation, similar expression levels of these genes were observed. These data suggest nasopharyngeal TMPRSS2/ACE2 as a promising candidate for further prediction models on COVID-19.
OBJECTIVE To estimate HIV incidence in two Brazilian municipalities, Recife and Curitiba, in the year of 2013.METHODS The method for estimating incidence was based on primary information, resulting from the Lag-Avidity laboratory test for detection of recent HIV infections, applied in a sample of the cases diagnosed in the two cities in 2013. For the estimation of the HIV incidence for the total population of the cities, the recent infections detected in the research were annualized and weighted by the inverse of the probability of HIV testing in 2013 among the infected and not diagnosed cases. After estimating HIV incidence for the total population, the incidence rates were estimated by sex, age group, and exposure category.RESULTS In Recife, 902 individuals aged 13 years and older were diagnosed with HIV infection. From these, 528 were included in the study, and the estimated proportion of recent infections was 13.1%. In Curitiba, 1,013 people aged 13 years and older were diagnosed, 497 participated in the study, and the proportion of recent infections was 10.5%. In Recife, the estimated incidence rate was 53.1/100,000 inhabitants of 13 years and older, while in Curitiba, it was 41.1/100,000, with male-to-female ratio of 3.5 and 2.4, respectively. We observed high rates of HIV incidence among men who have sex with men, of 1.47% in Recife and 0.92% in Curitiba.CONCLUSIONS The results obtained in the two cities showed that the group of men who have sex with men are disproportionately subject to a greater risk of new infections, and indicate that strategies to control the spread of the epidemic in this population subgroup are essential and urgent.
Introduction: Respondent-Driven Sampling (RDS) has been used in surveys with key populations at risk of HIV infection, such as female sex workers (FSW). This article describes the application of the RDS method among FSW in 12 Brazilian cities, during a survey carried out in 2016. Methodology: A biological and behavioral surveillance study carried out in 12 Brazilian cities, with a minimum sample of 350 FSW in each city. Tests were performed for HIV, syphilis, and hepatitis B and C infections. A social-behavioral questionnaire was also applied. Results: The sample was comprised of 4,328 FSW. For data analysis, the sample was weighted according to each participant’s network size (due consideration to the implications of RDS complex design and to the effects of homophilia are recommended). Discussion: Although RDS methods for obtaining a statistical sample are based on strong statistical assumptions, allowing for an estimation of statistical parameters, with each new application the method has been rethought. In the analysis of whole-sample data, estimators were robust and compatible with those found in 2009. However, there were significant variations according to each city. Conclusion: The achieved sample size was of great relevance for assessing progress and identifying problems regarding the prevention and treatment of Sexually Transmitted Infections. New RDS studies with more time and operational resources should be envisaged. This could further network development.
The combat simulation exercise is a military activity where combat activities characterized by intense physical activity are simulated. The aim of this study was to describe the behavior of indirect markers of muscle damage during military activities of combat simulation with the realization of strenuous physical efforts. This study was conducted with military recruits/volunteers (n=43; 19-24 age group) from the COMANDOS Army Corporal Training Course. The biomarkers were evaluated at the baseline (T0), 72 hours after the baseline (T1) and 63 hours after the end of the activity (T2). To compare the variables analyzed at different times, an analysis of variance (ANOVA) was applied to repeated measures with post hoc Tukey's test to identify the statistically significant differences. The criteria of significance adopted was the value of p<0,05. On average, the total body mass was significantly greater in T0 when compared to T1 (74,4kg x 69,8Kg; p< 0,05). In relation to the biochemical markers, on average, the serum levels were significantly higher (p<0,001) in T1 when compared to T0: CPK, LDH, CRP, Mb and AGPA. After 63 hours of rest, on average, the serum levels of the biochemical markers were significantly lower than in the moment T1: CPK, LDH, CRP, Mb and AGPA. However, after 63 hours of the end of the activity, all variables evaluated returned to baseline, with the exception of LDH, that on an average remained above the values observed in the moment T0. This study made possible to understand the behavior of indirect markers of muscle damage during the COMANDOS Army Corporal Training Course. However, others studies are necessary, regarding to Training Courses such as: paratrooper, mountain, jungle warfare and others to try establish a possible range of reference values for this markers during military activities.
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