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OBJECTIVES: Given the complex pathology of sickle cell anemia (SCA) and low adherence to hydroxyurea (HU) treatment, there is a need to seek parameters that identify recent changes in patient status. The advanced clinical parameters (ACPs) allow an early analysis of hematopoiesis. We aimed to draw the demographic profile of non-adherent SCA patients and to verify the use of ACPs as a measure of HU treatment adherence. METHOD: In a cross-sectional study, we divided 83 SCA subjects treated with HU into Children (<12 years old) and adolescents/adults (≥12 years old). Their hemogram with the ACPs, electronic medical charts and pharmacy claim data were analyzed. RESULTS: Non-adherent ≥12 years old patients had significantly increased WBC, absolute neutrophil, lymphocyte, monocyte, and basophil counts, RBC, RET, RDW, and PLT, and significantly decreased MCV and MCH. Subjects in the adolescent/adult group with IG† ≥0.035 cells/mm3 had the RR for non-adherence increased by 4.6 times (p = .014), and the systemic immune inflammation index (SII) of non-adherent patients was also significantly higher (p = .042). CONCLUSION: IG† presents clinical utility in early identification of non-adherence to HU, especially when combined with other parameters, suggesting the evaluation of ACPs in laboratory routine, as they can be easily implemented.

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Abstract Rhabdomyolysis is defined as the breakdown of skeletal muscle leading to the release of muscle contents into the extracellular fluid. Patients with rhabdomyolysis can be asymptomatic or have myalgia symptoms, weakness, myoglobinuria with dark urine, significant electrolyte imbalance, and acute kidney injury. Here we describe a case on acute kidney injury associated to rhabdomyolysis in a patient with COVID-19.

Resumo A rabdomiólise é definida como a lise da musculatura esquelética levando à liberação do conteúdo muscular para o fluido extracelular. Pacientes com rabdomiólise podem ser assintomáticos ou apresentar sintomas de mialgia, fraqueza, mioglobinúria com urina escura, desequilíbrio eletrolítico significativo e lesão renal aguda. Aqui descrevemos um caso de lesão renal aguda associada à rabdomiólise em um paciente com COVID-19.

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BACKGROUND: P.1 lineage (Gamma) was first described in the State of Amazonas, northern Brazil, in the end of 2020, and has emerged as a very important variant of concern (VOC) of SARS-CoV-2 worldwide. P.1 has been linked to increased infectivity, higher mortality, and immune evasion, leading to reinfections and potentially reduced efficacy of vaccines and neutralizing antibodies. METHODS: The samples of 276 patients from the State of Amazonas were sent to a central referral laboratory for sequencing by gold standard techniques, through Illumina MiSeq platform. Both global and regional phylogenetic analyses of the successfully sequenced genomes were conducted through maximum likelihood method. Multiple alignments were obtained including previously obtained unique human SARS-CoV-2 sequences. The evolutionary histories of spike and non-structural proteins from ORF1a of northern genomes were described and their molecular evolution was analyzed for detection of positive (FUBAR, FEL, and MEME) and negative (FEL and SLAC) selective pressures. To further evaluate the possible pathways of evolution leading to the emergence of P.1, we performed specific analysis for copy-choice recombination events. A global phylogenomic analysis with subsampled P.1 and B.1.1.28 genomes was applied to evaluate the relationship among samples. RESULTS: Forty-four samples from the State of Amazonas were successfully sequenced and confirmed as P.1 (Gamma) lineage. In addition to previously described P.1 characteristic mutations, we find evidence of continuous diversification of SARS-CoV-2, as rare and previously unseen P.1 mutations were detected in spike and non-structural protein from ORF1a. No evidence of recombination was found. Several sites were demonstrated to be under positive and negative selection, with various mutations identified mostly in P.1 lineage. According to the Pango assignment, phylogenomic analyses indicate all samples as belonging to the P.1 lineage. CONCLUSION: P.1 has shown continuous evolution after its emergence. The lack of clear evidence for recombination and the positive selection demonstrated for several sites suggest that this lineage emergence resulted mainly from strong evolutionary forces and progressive accumulation of a favorable signature set of mutations.

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Rhabdomyolysis is defined as the breakdown of skeletal muscle leading to the release of muscle contents into the extracellular fluid. Patients with rhabdomyolysis can be asymptomatic or have myalgia symptoms, weakness, myoglobinuria with dark urine, significant electrolyte imbalance, and acute kidney injury. Here we describe a case on acute kidney injury associated to rhabdomyolysis in a patient with COVID-19.

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Introdução: Considerado um material nobre em laboratório clínico, o líquor (LCR) se assemelha a um ultrafiltrado de plasma e tem como principais funções o fornecimento de nutrientes essenciais ao cérebro e proteção mecânica. Os setores rotineiramente envolvidos na análise laboratorial do LCR são a bioquímica, a microbiologia e a citologia. Objetivo: Avaliar os principais agentes etiológicos associados à ocorrência de meningites e identificar as alterações laboratoriais mais prevalentes nas amostras liquóricas analisadas em laboratório de um hospital da região metropolitana de Porto Alegre. Métodos: Estudo transversal retrospectivo (01/2013 a 12/2017) em banco de dados. Resultados: Foi observada maior ocorrência de meningites bacterianas (35,53%), seguida por infecções virais (26,31%), fúngicas (25%) e parasitárias (13,16%). Os principais agentes infecciosos identificados foram Cryptococcus sp (n=18), Herpes Simples Vírus I e II (n=12), Toxoplasma gondii (n=10) e Streptococcus pneumoniae (n=9), e as principais alterações laboratoriais estiveram associadas à hiperproteinorraquia e à elevação no número de leucócitos. Nas meningites bacterianas, observaram-se hipoglicorraquia, hiperproteinorraquia e importante elevação de lactato desidrogenase (LDH); as fúngicas apresentaram discreta diminuição na glicorraquia e LDH moderadamente elevado, enquanto os agentes virais e parasitários apresentaram maior alteração na dosagem de proteínas (hiperproteinorraquia). Conclusão: Com perfil predominantemente masculino e adulto, a identificação de casos infecciosos na análise laboratorial liquórica representou 8,32% do total das análises, sendo as meningites bacterianas as mais prevalentes, podendo ser laboratorialmente reconhecidas por alterações bioquímicas e celulares. Os achados possibilitam o conhecimento epidemiológico e laboratorial, podendo embasar estudos posteriores.

Introduction: Considered a noble material in the clinical laboratory, CSF is similar to a plasma ultrafiltrate and its main functions are the supply of essential nutrients to the brain and mechanical protection. The sectors routinely involved in the laboratory analysis of CSF are biochemistry, microbiology and cytology. Objective: To evaluate the main etiological agents associated with the occurrence of meningitis and to identify the most prevalent alterations in CSF samples analyzed in the laboratory of a hospital in the metropolitan region of Porto Alegre. Methods: A retrospective cross-sectional study (01/2013 to 12/2017) in a database. Results: A higher occurrence of bacterial meningitis (35.53%) was observed, followed by viral (26.31%), fungal (25%) and parasitic (13.16%) infections. The main infectious agents identified were Cryptococcus sp (n=18), Herpes Simplex Virus I and II (n=12), Toxoplasma gondii (n=10) and Streptococcus pneumoniae (n=9) and the main laboratory alterations were associated with hyperproteinorrhachia and elevation in the number of leukocytes. In bacterial meningitis, hypoglycorrhachia, hyperproteinorrhachia and a significant increase in lactate dehydrogenase (LDH) relawere observed; fungal meningitis showed a slight decrease in glycorrhachia and moderately high LDH, while viral and parasitic agents showed greater change in protein level (hyperproteinorrhachia). Conclusion: With a predominantly male and adult profile, the identification of infectious cases in the CSF laboratory analysis represented 8.32% of the total analyses, with bacterial meningitis being the most prevalent, which can be recognized by biochemical and cellular alterations through laboratory testing. The findings allow for epidemiological and laboratory knowledge, which may support further studies.

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Abstract The Phagocytosis of fungal structures by neutrophils is a well-documented function of these immune cells. However, neutrophil phagocytosis of hyphal structures in the urine sediment is not usually observed during routine sample evaluation. This is a case of hyphal phagocytosis by neutrophils in the urine of a kidney allograft recipient patient.

Resumo A fagocitose de estruturas fúngicas por neutrófilos é uma função bem documentada destas células imunes. No entanto, a fagocitose de hifas por neutrófilos no sedimento urinário não é normalmente observada durante avaliação de rotina de amostras. Este é um caso de fagocitose de hifas por neutrófilos na urina de um paciente receptor de aloenxerto renal.

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Almost a year after the COVID-19 pandemic had begun, new lineages (B.1.1.7, B.1.351, P.1, and B.1.617.2) associated with enhanced transmissibility, immunity evasion, and mortality were identified in the United Kingdom, South Africa, and Brazil. The previous most prevalent lineages in the state of Rio Grande do Sul (RS, Southern Brazil), B.1.1.28 and B.1.1.33, were rapidly replaced by P.1 and P.2, two B.1.1.28-derived lineages harboring the E484K mutation. To perform a genomic characterization from the metropolitan region of Porto Alegre, we sequenced viral samples to: (i) identify the prevalence of SARS-CoV-2 lineages in the region, the state, and bordering countries/regions; (ii) characterize the mutation spectra; (iii) hypothesize viral dispersal routes by using phylogenetic and phylogeographic approaches. We found that 96.4% of the samples belonged to the P.1 lineage and approximately 20% of them were assigned as the novel P.1.2, a P.1-derived sublineage harboring signature substitutions recently described in other Brazilian states and foreign countries. Moreover, sequences from this study were allocated in distinct branches of the P.1 phylogeny, suggesting multiple introductions in RS and placing this state as a potential diffusion core of P.1-derived clades and the emergence of P.1.2. It is uncertain whether the emergence of P.1.2 and other P.1 clades is related to clinical or epidemiological consequences. However, the clear signs of molecular diversity from the recently introduced P.1 warrant further genomic surveillance.

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Population-based prevalence surveys of Covid-19 contribute to establish the burden of infection, the role of asymptomatic and mild infections in transmission, and allow more precise decisions about reopen policies. We performed a systematic review to evaluate qualitative aspects of these studies, assessing their reliability and compiling practices that can influence the methodological quality. We searched MEDLINE, EMBASE, bioRxiv and medRxiv, and included cross-sectional studies using molecular and/or serological tests to estimate the prevalence of Covid-19 in the general population. Survey quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. A correspondence analysis correlated methodological parameters of each study to identify patterns related to higher, intermediate and lower risks of bias. The available data described 37 surveys from 19 countries. The majority were from Europe and America, used antibody testing, and reached highly heterogeneous sample sizes and prevalence estimates. Minority communities were disproportionately affected by Covid-19. Important risk of bias was detected in four domains: sample size, data analysis with sufficient coverage, measurements in standard way and response rate. The correspondence analysis showed few consistent patterns for high risk of bias. Intermediate risk of bias was related to American and European studies, municipal and regional initiatives, blood samples and prevalence >1%. Low risk of bias was related to Asian studies, nationwide initiatives, reverse-transcriptase polymerase chain reaction tests and prevalence <1%. We identified methodological standards applied worldwide in Covid-19 prevalence surveys, which may assist researchers with the planning, execution and reporting of future population-based surveys.

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The Phagocytosis of fungal structures by neutrophils is a well-documented function of these immune cells. However, neutrophil phagocytosis of hyphal structures in the urine sediment is not usually observed during routine sample evaluation. This is a case of hyphal phagocytosis by neutrophils in the urine of a kidney allograft recipient patient.

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