Epidemiological and Clinical Aspects of Cutaneous and Mucosal Leishmaniases in Portugal: Retrospective Analysis of Cases Diagnosed in Public Hospitals and Reported in the Literature between 2010 and 2020

Leishmania infantum, a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM® SPSS® Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond.

Assessment of Cardiovascular Risk and Arterial Stiffness in Patients With Human Immunodeficiency Virus

BACKGROUND

Several studies suggest that patients infected with the human immunodeficiency virus (HIV) under highly active antiretroviral therapy (HAART) have a higher cardiovascular risk than the general population. Arterial stiffness is an independent predictor of cardiovascular events and can be measured through carotid-femoral pulse wave velocity (PWV). The objectives of this study were to characterize a sample of HIV-infected patients under HAART regarding cardiovascular risk, compare PWV values of this group with those of uninfected controls, and investigate predictors of PWV in the HIV-infected group.

METHODS

PWV was measured, and data was collected from a sample of 125 HIV-infected patients under HAART. PWV measurements in the study group were compared with those in a control group of 250 subjects similar in sex, age, prevalence of hypertension, and type 2 diabetes mellitus (DM). A linear regression model was constructed to identify predictors of PWV in the HIV-infected group.

RESULTS

In the HIV-infected group, composed mostly of men, the mean age and respective standard deviation were 48.6 ± 11.6 years. In this group, 112 individuals (89.6%) presented moderate to very high cardiovascular risk. Significant differences were found in median PWV between HIV-infected and control groups (8.56 vs. 8.00 m/s, p = .002). Age, peripheral systolic blood pressure, presence of DM, amount of alcohol consumed, and current CD4+ T cell count were independent predictors of PWV in the HIV-infected group.  Conclusions: The HIV-infected group showed higher cardiovascular risk and arterial stiffness measurements than the general population. PWV may be an important predictor of subclinical cardiovascular disease in HIV-infected patients.

Increased Gal-3BP plasma levels in hospitalized patients infected with SARS-CoV-2

Coronavirus disease 2019 (COVID-19) has quickly turned into a health, financial and societal problem globally. The complex pathogenesis of severe acute respiratory syndrome coronavirus centers on the unpredictable clinical progression of the disease, which may evolve abruptly and results in critical and life-threatening clinical complications. Effective laboratory biomarkers that can classify patients according to risk of progression to severe disease are essential for ensuring timely treatment. Gal-3BP is a human secreted protein with innate immune functions, which is upregulated in viral infections, promotes inflammation and has been shown to induce IL-6 expression. In this study, Gal-3BP plasma levels were measured retrospectively in a cohort of 84 hospitalized COVID-19 patients. These were classified as having either "non-severe" or "severe" disease. Compared to healthy controls, Gal-3BP plasma levels were markedly increased in COVID-19 patients (P < 0.0001). Moreover, the levels were higher in severe than in non-severe patients (P < 0.05). As expected, patients with severe disease had plasma levels of IL-6 higher than patients with non-severe disease (P < 0.01). In non-severe disease patients, Gal-3BP levels collected at a late stage (13.3 + 5.7 days after the first positive PCR result) were significantly lower than those collected at an early stage (4.2 + 2.9 days form the first positive PCR result). Larger prospective analyses are needed to strength our understanding of the prognostic utility of Gal-3BP in COVID-19 patients.

Clostridium difficile Severity and Outcome at a North of Portugal Healthcare Facility

INTRODUCTION

Clostridium difficile infection has been increasingly reported, with a significant healthcare burden and important morbimortality. This study aimed to characterize and describe the severity and outcomes of this event at a Portuguese hospital.

MATERIAL AND METHODS

We conducted a retrospective analysis, by clinical record review, of all confirmed cases diagnosed in a hospital in the North of Portugal, between January 2013 and December 2018. We included those who were non-pregnant and at least 18 years old.

RESULTS

Fifty-seven cases occurred, mostly in females and aged patients; 33.3% were healthcare facility-outset, while 31.6% were community-associated. Regarding severity, 43.9% had non-severe, while 29.8% severe and 21.0% fulminant presentations, the latter with the need of admission. Exposure to antibiotics occurred in 68.4%, while to proton-pump inhibitors in 57.9%. Risk factors for severe disease were female gender, chronic renal disease, and high neutrophil-lymphocyte ratio. Moreover, renal disease and a higher ratio were associated with fulminant disease. Thirty-day all-cause mortality was found in 15.8% while 90-day in 28.1%. Risk factors for 30-day mortality were renal disease, higher Charlson score, and higher neutrophil-lymphocyte ratio. Risk factors for 90-day mortality were advanced age, previous antibiotic exposure, higher Charlson score, and higher neutrophil-lymphocyte ratio.

CONCLUSION

Data concerning Clostridium difficile infection severity and prognosis in Portugal is scarce, and future studies should focus on this important topic.

Performance assessment of 11 commercial serological tests for SARS-CoV-2 on hospitalised COVID-19 patients

BACKGROUND

Commercial availability of serological tests to evaluate immunoglobulins (Ig) targeting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has grown exponentially since the start of the coronavirus disease 2019 (COVID-19) outbreak. Thorough validation of these tests is important before use as epidemiological tools to infer seroprevalence in specific populations and as diagnostic tools to complement molecular approaches (e.g., quantitative reverse transcription-polymerase chain reaction).

METHODS

Commercial serological tests from 11 suppliers were assayed side-by-side using 126 samples from SARS-CoV-2-infected inpatients and 36 from healthy and HIV-infected individuals.

RESULTS

The majority of the tests assayed have >95% specificity. For the sensitivity calculation, samples were stratified by days since symptoms onset; sensitivity peaks at 16-21 days for IgM and IgA (maximum 91.2%, Euroimmun) and, dependant on the test, at 16-21 or >21 days for IgG (maximum 94.1%, Snibe). Data from semiquantitative tests show that patients with a severe clinical presentation have lower levels of Ig targeting SARS-CoV-2 at <10 days since symptoms onset and higher levels at >21 days, compared to patients with a non-severe presentation.

CONCLUSIONS

This study highlights the heterogeneity of sensitivity and generally high specificity of the serological tests and establishes a basis for their usefulness to complement diagnostic techniques and population seroprevalence studies.

Disseminated Tuberculosis: A Case of Multiple Spread Mass

Disseminated tuberculosis is associated with significant morbidity and mortality. It results from a lymphohematogenous dissemination of mycobacterium tuberculosis (MT) and its atypical clinical presentation often delays the diagnosis. Diagnosis is established by identifying MT obtained from a biopsy sample in culture or acid-fast smear. Evidence suggests an initial two-month phase of four-drug therapy followed by a two-drug phase for six to nine months. A 61-year-old man presented with back lumbar pain. He presented two masses, a left parasternal and a left axillary masses with approximately 6 cm each. He referred a 21% weight loss, anorexia and asthenia. His computed tomography revealed recent lumbar fractures and a left paravertebral space-occupying lesion; hilum and upper lobe masses; inflammatory/infectious micronodules; mediastinal adenomegaly, hypodense lesions in the spleen, sternum and left scapula. Magnetic resonance imaging revealed lumbar vertebral fractures, an anterior epidural collection, left iliac psoas muscle liquid collection. A mass puncture and biopsy were performed, resulting in a positive detection of MT in nucleic acid amplification (NAA). The patient started on quaternary antibacillary therapy with isoniazid, rifampin, pyrazinamide and ethambutol. Bronchofibroscopy revealed an hypervascularized and infiltrated submucosa. Later, histopathology was compatible with chronic granulomatous inflammatory process and bronchial lavage molecular test was positive for MT. At the moment, he is under two-drug antibacillary therapy with isoniazid and rifampin and masses are regressing.

Athletes' perceptions of coaching competency and team conflict in sport teams: A multilevel analysis

The purpose of this study was to examine the relationship between coaching competency and team conflict, at individual and team levels, over the season. The participants were professional female and male soccer players, who participated in the First and Second Division. A longitudinal study was performed. At Time 1, the sample of participants consisted of 581 soccer players aged between 15 and 39 years. At Time 2, 549 players were recruited from the original sample aged between 15 and 37 years. Finally, at Time 3, the sample comprised 576 players aged between 15 and 37 years. All participants completed a multi-section questionnaire assessing coaching competency (motivation, game strategy, technique competency, and character-building competency) and team conflict (task conflict and relationship conflict). Results showed that both task and relationship conflict increased significantly over time. Multilevel modelling analysis showed that game strategy and character-building competencies negatively predicted both task and relationship conflicts at the individual level, whereas motivation competency was also added as a significant predictor of task conflict at the team level. Moreover, technique competency positively predicted task conflict at the team level. The current study suggests the importance of coaching competency in group dynamics in sport.

A snapshot on prokaryotic diversity of the Solimões River basin (Amazon, Brazil)

The Amazon region has the largest hydrographic basin on the planet and 
is well known for its huge biodiversity of plants and animals. However, 
there is a lack of studies on aquatic microbial biodiversity in the 
Solimões River, one of its main water courses. To investigate the 
microbial biodiversity of this region, we performed 16S rRNA gene clone 
libraries from Solimões River and adjacent rivers and lakes. Our question was which microorganisms inhabit the different types of aquatic 
environments in this part of the basin, and how diversity varies among 
these environments (rivers and lakes). The microbial 
diversity generating 13 clone libraries of the bacterial 16S rRNA gene 
and 5 libraries of the archaeal 16S rRNA gene was assessed. Diversity measured by several alpha diversity indices (ACE, Chao, Shannon and Simpson) revealed significant differences in diversity indices between lake and river samples. The site with higher microbial diversity was in the Solimões River (4S), downstream the confluence with Purus River. The most common bacterial taxon was the cosmopolitan Polynucleobacter genus, widely observed in all samples. The phylum Thaumarchaeota was the prevailing archaeal taxon. Our results provide the first insight into the microbial diversity of the world's largest river basin.

Primary production in a tropical large lake: the role of phytoplankton composition

Phytoplankton biomass and primary production in tropical large lakes vary at different time scales, from seasons to centuries. We provide a dataset made of 7 consecutive years of phytoplankton biomass and production in Lake Kivu (Eastern Africa). From 2002 to 2008, bi-weekly samplings were performed in a pelagic site in order to quantify phytoplankton composition and biomass, using marker pigments determined by HPLC. Primary production rates were estimated by 96 in situ (14)C incubations. A principal component analysis showed that the main environmental gradient was linked to a seasonal variation of the phytoplankton assemblage, with a clear separation between diatoms during the dry season and cyanobacteria during the rainy season. A rather wide range of the maximum specific photosynthetic rate (PBm) was found, ranging between 1.15 and 7.21 g carbong(-1)chlorophyll ah(-1), and was best predicted by a regression model using phytoplankton composition as an explanatory variable. The irradiance at the onset of light saturation (Ik) ranged between 91 and 752 μE m(-2)s(-1) and was linearly correlated with the mean irradiance in the mixed layer. The inter-annual variability of phytoplankton biomass and production was high, ranging from 53 to 100 mg chlorophyll am(-2) (annual mean) and from 143 to 278 g carbon m(-2)y(-1), respectively. The degree of seasonal mixing determined annual production, demonstrating the sensitivity of tropical lakes to climate variability. A review of primary production of other African great lakes allows situating Lake Kivu productivity in the same range as that of lakes Tanganyika and Malawi, even if mean phytoplankton biomass was higher in Lake Kivu.

Wireless data communications using DECT air interface

DECT is an approved ETSI standard for cordless communications, defined as a general radio access technology that can be used as the air interface to any network. In addition to the well-established voice service, it supports data communications. DECT currently addresses low bit rates, but additional modulation options have recently been included for high-speed, up to 2Mbps. In this paper, we describe the hardware and software design of an entire wireless communications system to be used in SOHO applications. While putting the emphasis on data communication, we demonstrate the feasibility of maintaining the compatibility with existent voice terminals. We developed generic hardware and software components, which revealed a very flexible approach. We easily created a wireless LANs, extended an Ethernet LAN and provided access to ISDN 1.