The duration and severity of COVID-19 are related to age, comorbidities, and cytokine synthesis. This study evaluated the impact of these factors on patients with clinical presentations of COVID-19 in a Brazilian cohort. A total of 317 patients diagnosed with COVID-19 were included; cases were distributed according to clinical status as severe (n=91), moderate (n=56) and mild (n=170). Of these patients, 92 had acute COVID-19 at sample collection, 90 had already recovered from COVID-19 without sequelae, and 135 had sequelae (long COVID syndrome). In the acute COVID-19 group, patients with the severe form had higher IL-6 levels (p=0.0260). In the post-COVID-19 group, there was no significant difference in cytokine levels between groups with different clinical conditions. In the acute COVID-19 group, younger patients had higher levels of TNF-α, and patients without comorbidities had higher levels of TNF-α, IL-4 and IL-2 (p<0.05). In contrast, patients over age 60 with comorbidities had higher levels of IL-6. In the post-COVID-19 group, subjects with long COVID-19 had higher levels of IL-17 and IL-2 (p<0.05), and subjects without sequelae had higher levels of IL-10, IL-6 and IL- 4 (p<0.05). Our results suggest that advanced age, comorbidities and elevated serum IL-6 levels are associated with severe COVID-19 and are good markers to differentiate severe from mild cases. Furthermore, high serum levels of IL-17 and IL-2 and low levels of IL-4 and IL-10 appear to constitute a cytokine profile of long COVID-19, and these markers are potential targets for COVID-19 treatment and prevention strategies.

RESUMOINTRODUÇÃO: A tuberculose (TB), no Brasil, concentra-se nas regiões metropolitanas e é associada à situação socioeconômica da população. Em 2011, Belém, capital do estado do Pará, apresentou uma das maiores baixas de incidência da doença. OBJETIVOS: Avaliar a distribuição espacial da infecção pelo Mycobacterium tuberculosis em Belém entre 2006 e 2010, e associar a incidência da infecção com as condições de vida da população. MATERIAIS E MÉTODOS: Informações de morbidade e mortalidade foram obtidas de bancos de dados nacionais (SINAN, SIM e IBGE). Os índices de Moran global (IMG) e Moran local identificaram dependência espacial. RESULTADOS: A taxa de incidência da TB alcançou 93 casos/100.000 habitantes e a de mortalidade 4 casos/100.000 habitantes. O IMG mostrou dependência espacial negativa quanto à incidência e à dependência espacial positiva nas taxas de mortalidade entre bairros. A incidência de casos de TB cresceu com o aumento do número de áreas carentes nos bairros. O método bayesiano foi eficiente para analisar a incidência da doença em bairros com populações pequenas. A incidência se distribuiu espacialmente de forma aleatória e associada às condições socioeconômicas da população. A baixa taxa de mortalidade evidenciou uma boa avaliação dos serviços de tratamento e acompanhamento dos doentes. CONCLUSÃO: A aplicação da análise espacial e métodos estatísticos, que aprimoram a qualidade da informação, são importantes para melhor avaliar ações futuras de prevenção contra agentes infecciosos. É necessário dar continuidade a campanhas de prevenção da TB e ao acompanhamento de doentes, a fim de aumentar a adesão ao tratamento e diminuir a mortalidade entre a população com maior dificuldade de acesso aos serviços de saúde.Palavras-chave: Tuberculose; Análise Espacial; Método Bayesiano. ARTIGO ORIGINAL | ORIGINAL ARTICLEABSTRACT INTRODUCTION: Tuberculosis (TB) in Brazil is mainly located in major urban centers and is associated with the social and economical patterns. In 2011, Belém, the capital of Pará State, showed one of the highest incidence. OBJECTIVES: To investigate the spatial distribution of Mycobacterium tuberculosis in Belém between 2006 and 2010, and to associate the incidence of infection with the life quality of the population. MATERIALS AND METHODS: Morbidity and mortality information were obtained from national public information sources (SINAN, SIM and IBGE). Global Moran's index (GMI) and local Moran's index were used to identify spatial associations. RESULTS: Incidence rate of TB was 93 cases/100,000 inhabitants and mortality reached 4 cases/100,000. GMI showed negative space dependence with regard to incidence and positive space dependence in mortality rates among districts. Incidence of TB showed an increase according to the poorest quality of life areas of the city. The Bayesian method was successful to analyze the incidence of TB in low population density areas. The incidence was spatially distributed randomly and associated with the socioeconomic conditions of population. The low mo...

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BackgroundA rare phenotype of clinical non-progressors to AIDS is not well understood and the new protocol for universal treatment, may block the understanding of viral control thus it is crucial to define this controversial group.MethodsA cohort of 30 persons followed a criteria for viremia control groups 1 (VC1; n = 2) and 2 (VC2; n = 7) and non-viral controllers (NC; n = 21) including number of years of diagnosis, LTCD4+, LTCD8+ counts, plasma viral load and the absence of ART; 241 uninfected control persons were matched to age and sex. Infected persons were regularly examined and submitted to two or three annual laboratory measurements. Polymorphisms and allele frequencies of CCR5Δ32 and SDF1–3’A were detected in the genomic DNA. Plasma levels of cytokines (IL-2, IL-4, IL-5, IL-9, IL-10, IL-13, IL-17 and IFN-y) were measured.ResultsThe group investigated is originated from a miscigenetic population and demographic and social characteristics were not significantly relevant. LTCD4+ median values were higher among VC than NC, but significantly lower than uninfected controls. Evolution of LTCD4+ and LTCD8+ counts, showed a slight increase of LTCD4+ among VC, but a significant decrease in the NC. The percentage of annual change in LTCD4+ was also significantly different between the groups. LTCD4+/LTCD8+ ratio was inverted but not significant among the VC, thus the ratio may be a useful biomarker for the VC. A clear signature indicated a change from Th1 to Th2 cytokine profiles from VC to NC, respectively.ConclusionsThe knowledge of viral controllers characteristics in different population groups is important to define a strict universal definition for the sake of learning about the pathogenesis of HIV-1. Data on LTCD4+ seems to be stable and repetitive from published data, but the LTCD8+ response and the significance of LTCD4+/LTCD8+ ratio values are in need to further exploration as biomarkers. The change from Th1 to Th2 cytokine profile may help to design and adjust specific treatment protocols for the group.

Introduction: Leprosy often results in sensory and physical limitations. This study aimed to evaluate these limitations using a quantitative approach in leprosy patients in Belém (Pará, Brazil). Methods: This epidemiological, cross-sectional study measured the sensory impairment of smell and taste through the use of a questionnaire and evaluated activity limitations of daily life imposed by leprosy through the Screening of Activity Limitation and Safety Awareness (SALSA) Scale. Data were collected from 84 patients and associations between the degree of disability and clinical and epidemiological characteristics were assessed. Results: The majority of patients were men (64.3%), married (52.4%), age 31-40 years old (26.2%), had primary education (50%), and were independent laborers (36.9%). The multibacillary operational classification (81%), borderline clinical form (57.1%), and 0 degrees of physical disability (41.7%) were predominant. SALSA scores ranged from 17 to 59 points, and being without limitations was predominant (53.6%). The risk awareness score ranged from 0 to 8, with a score of 0 (no awareness of risk) being the most common (56%). Evaluation of smell and taste sensory sensitivities revealed that 70.2% did not experience these sensory changes. Patients with leprosy reactions were 7 times more likely to develop activity limitations, and those who had physical disabilities were approximately four times more likely to develop a clinical picture of activity limitations. Conclusions: Most patients showed no sensory changes, but patients with leprosy reactions were significantly more likely to develop activity limitations. Finally, further studies should be performed, assessing a higher number of patients to confirm the present results.

Although the study indicates a low HIV-1 prevalence in Marajó Island, some factors may increase the risk for HIV-1 and these include early sexual initiation, unprotected sexual intercourse and the use of illicit drugs.

The CYP2B6 G516T polymorphism seems to affect the response to efavirenz treatment by reducing CD4 T-cell counts in patients with a high degree of miscegenation who use this antiretroviral agent.

Pro- and anti-inflammatory markers (tumor necrosis factor [TNF]-α, TNF-β, interferon [IFN]-γ, interleukin [IL]-6, IL-8, IL-10, and C-reactive protein [CRP]) were investigated in 80 patients infected with dengue viruses, 100 patients presenting with febrile illness but negative for dengue, and 99 healthy subjects. Immunoenzyme methods were used for quantitative assays in the plasma. Polymorphisms of TNF-α, TNF-β, IL-6, IL-8, and IL-10 genes were assessed by polymerase chain reaction (PCR)-restriction fragment length polymorphism and allele-specific oligonucleotide (ASO)-PCR for the IFN-γ. The highest mean serum levels of TNF-α, IFN-γ, IL-8, and CRP were observed in dengue-positive individuals. TNF-β, IL-6, and IL-10 levels were significantly higher in the dengue-negative individuals. No cytokine expression pattern was evidenced according to virus serotype. Genotypic frequency distributions were statistically significant for the polymorphisms of TNF-α and IFN-γ among positive, negative, and control dengue groups and IFN-γ among groups DENV-1, DENV-2, DENV-3, and controls. Modulation of cytokine expression and polymorphisms is a complex matter and needs further explanation considering the ethnic origins of the Brazilian population.