Serodiagnosis of paucibacillary and multibacillary leprosy using a recombinant chimeric protein composed of specific B-cell epitopes derived from Mycobacterium leprae proteins

Leprosy diagnosis is difficult due to the clinical similarity with other infectious diseases, and laboratory tests presents problems related to sensitivity and/or specificity. In this study, we used bioinformatics to assess Mycobacterium leprae proteins and formulated a chimeric protein that was tested as a diagnostic marker for the disease. The amino acid sequences from ML0008, ML0126, ML0308, ML1057, ML2028, ML2038, ML2498 proteins were evaluated, and the B-cell epitopes QASVAYPATSYADFRAHNHWWNGP, SLQRSISPNSYNTARVDP and QLLGQTADVAGAAKSGPVQPMGDRGSVSPVGQ were considered M. leprae-specific and used to construct the gene encoding the recombinant antigen. The gene was constructed, the recombinant protein was expressed, purified and tested in ELISA using 252 sera, which contained samples from multibacillary (MB) or paucibacillary (PB) leprosy patients, from their household contacts and healthy individuals, as well as from patients with Chagas disease, visceral and tegumentary leishmaniases (VL/TL), malaria, tuberculosis, and HIV. Sensitivity (Se) and specificity (Sp) for MB and PB samples compared to sera from both healthy subjects and individuals with cross-reactive diseases were 100%. The Se value for MB and PB samples compared to sera from household contacts was 100%, but Sp was 64%. In conclusion, data suggest that this protein could be considered in future studies for leprosy diagnosis.

Sertraline associated with gold nanoparticles reduce cellular toxicity and induce sex-specific responses in behavior and neuroinflammation biomarkers in a mouse model of anxiety

This study aimed to evaluate the effects of sertraline associated with gold nanoparticles (AuNPs) in vitro cell viability and in vivo behavior and inflammatory biomarkers in a mouse model of anxiety. Sertraline associated with AuNPs were synthesized and characterized. For the in vitro study, NIH3T3 and HT-22 cells were treated with different doses of sertraline, AuNPs, and sertraline + AuNPs and their viability was evaluated using the MTT assay. For the in vivo study, pregnant Swiss mice were administered a single dose of lipopolysaccharide (LPS) on the ninth day of gestation. The female and male offspring were divided into five treatment groups on PND 60 and administered chronic treatment for 28 days. The animals were subjected to behavioral testing and were subsequently euthanized. Their brains were collected and analyzed for inflammatory biomarkers. Sertraline associated with AuNPs exhibited significant changes in surface characteristics and increased diameters. Different doses of sertraline + AuNPs showed higher cell viability in NIH3T3 and HT-22 cells compared with sertraline alone. The offspring of LPS-treated dams exhibited anxiety-like behavior and neuroinflammatory biomarker changes during adulthood, which were ameliorated via sertraline + AuNPs treatment. The treatment response was sex-dependent and brain region-specific. These results suggest that AuNPs, which demonstrate potential to bind to other molecules, low toxicity, and reduced inflammation, can be synergistically used with sertraline to improve drug efficacy and safety by decreasing neuroinflammation and sertraline toxicity.

B-Cell Epitopes-Based Chimeric Protein from SARS-CoV-2 N and S Proteins Is Recognized by Specific Antibodies in Serum and Urine Samples from Patients

The impact of the COVID-19 pandemic caused by the SARS-CoV-2 virus underscored the crucial role of laboratorial tests as a strategy to control the disease, mainly to indicate the presence of specific antibodies in human samples from infected patients. Therefore, suitable recombinant antigens are relevant for the development of reliable tests, and so far, single recombinant proteins have been used. In this context, B-cell epitopes-based chimeric proteins can be an alternative to obtain tests with high accuracy through easier and cheaper production. The present study used bioinformatics tools to select specific B-cell epitopes from the spike (S) and the nucleocapsid (N) proteins from the SARS-CoV-2 virus, aiming to produce a novel recombinant chimeric antigen (N4S11-SC2). Eleven S and four N-derived B-cell epitopes were predicted and used to construct the N4S11-SC2 protein, which was analyzed in a recombinant format against serum and urine samples, by means of an in house-ELISA. Specific antibodies were detected in the serum and urine samples of COVID-19 patients, which were previously confirmed by qRT-PCR. Results showed that N4S11-SC2 presented 83.7% sensitivity and 100% specificity when using sera samples, and 91.1% sensitivity and 100% specificity using urine samples. Comparable findings were achieved with paired urine samples when compared to N and S recombinant proteins expressed in prokaryotic systems. However, better results were reached for N4S11-SC2 in comparison to the S recombinant protein when using paired serum samples. Anti-N4S11-SC2 antibodies were not clearly identified in Janssen Ad26.COV2.S COVID-19-vaccinated subjects, using serum or paired urine samples. In conclusion, this study presents a new chimeric recombinant antigen expressed in a prokaryotic system that could be considered as an alternative diagnostic marker for the SARS-CoV-2 infection, with the potential benefits to be used on serum or urine from infected patients.

[Utility of gas chromatography for the identification of mycobacterial species]

The human immunodeficiency virus (HIV) epidemic has altered the epidemiological profile of tuberculosis in both industrialized and developing countries. Serious diseases caused by mycobacteria other than Mycobacterium tuberculosis, mostly belonging to the M. avium-intracellulare complex (MAC), have become very common in association with severe immunosuppression. The increase in mycobacterial disease complexity has stimulated the development of more rapid and efficient methods for diagnosis. In the present study, we investigated and assessed the suitability of a gas-liquid chromatography technique for diagnosis of clinically important mycobacteria in Argentina. An identification scheme was developed from the results obtained in a previous study where we characterized the cellular fatty acids and the mycolic acid cleavage products from most frequent species in Argentina. Of 183 isolates tested, 69% were correctly identified to species level and 5% were incorrectly classified. If we only take into account the isolates that could be identified, 93% were correctly identified. Although all of the isolates of M. tuberculosis were correctly identified, four isolates of MAC incorrectly matched by M. tuberculosis. Gas chromatography provides a rapid technique of highly predictive value for mycobacteria identification; it could be used in reference laboratories as a rapid presumptive identification until the biochemical tests are completed.

[Anna Justina Ferreira Nery: framework in the history of Brazilian nursing]

The object of this study is Anna Neri (1814-1880), an anonymous woman who participated in the Paraguay War (1865-1870). This is a social-historical biographical study guided by the principles of the New History. The objective of this research is to characterize and raise relevant aspects of Anna Neri's life. It is known that this woman left her domestic life to play an important role in the public space. Her motivation was genuinely affectionate, and she didn't expect to be called a nurse. Anna Neri met the requirements that would raise the social and moral status of the XXth century nursing workers, and became a symbol of Brazilian nursing.

Portable devices used to detect endotracheal intubation during emergency situations: a review

OBJECTIVES

To review the operational characteristics of commercial devices used to detect endotracheal intubation; and to identify an ideal device for detecting endotracheal intubation in emergency situations, especially in the prehospital setting during cardiac arrest.

DATA SOURCES

Relevant articles from the medical literature are referenced.

STUDY SELECTION

The authors identified the need for understanding the basic operation principles of portable devices used to detect endotracheal intubation and to correctly use them in unpredictable clinical situations.

DATA EXTRACTION

Data from published literature.

DATA SYNTHESIS

Recently, a number of new portable devices have been marketed for detecting endotracheal intubation, each having advantages and disadvantages, especially when used during emergency situations. The devices are classified based on their principle of operation. Some rely on CO2 detection (STATCAP, Easy Cap, and Pedi-Cap), others utilize the transmission of light (Trachlight, SURCH-LITE), one operates based on reflection of sound energy (SCOTI), and some depend on aspiration of air (TubeChek and TubeChek-B). A brief description of each device and its operational characteristics are reviewed. A comparative analysis among the devices is made based on size, portability, cost, ease of operation, need for calibration or regular maintenance, reliability for patients with and without cardiac arrest, and the possibility of use for adult and pediatric patients. False-negative and false-positive results for each device are also discussed. False-negative results mean that although the endotracheal tube is in the trachea, the device indicates it is not. False-positive results mean that although the endotracheal tube is in the esophagus, the device indicates it is in the trachea.

CONCLUSIONS

Although no clinical comparative study of commercial devices to detect endotracheal intubation exists, the syringe device (TubeChek) has most of the characteristics necessary for a device to be considered ideal in emergency situations in the prehospital setting. It is simple, inexpensive, easy to handle and operate, disposable, does not require maintenance, gives reliable results for patients with and without cardiac arrest, and can be used for almost all age groups. The device may yield false-negative results, most commonly in the presence of copious secretions and in cases of accidental endobronchial intubation. Regardless of the device used, clinical judgment and direct visualization of the endotracheal tube in the trachea are required to unequivocally confirm proper endotracheal tube placement.

Small doses of intrathecal morphine combined with systemic diclofenac for postoperative pain control after cesarean delivery

Postoperative pain control after cesarean delivery under spinal anesthesia is effectively obtained with morphine 0.1-0.3 mg intrathecally, although there may be dose-dependent side effects. We evaluated the quality of analgesia and the incidence of side effects with smaller doses of intrathecal morphine combined with intramuscular (i.m.) diclofenac. One hundred-twenty pregnant patients were allocated into six groups, which received the following treatments: Groups 1, 3, and 5 received 0.1, 0.05, and 0.025 mg of intrathecal morphine, respectively, plus 75 mg of i.m. diclofenac every 8 h; Groups 2, 4, and 6 received 0.1, 0.05, and 0.025 mg of intrathecal morphine, respectively, plus i.m. diclofenac on demand. Spinal anesthesia was performed with 15 mg of 0.5% hyperbaric bupivacaine. Pain scores and side effects were evaluated hourly for the first 24 h. Groups 1 and 2 had lower pain scores than Groups 3, 4, 5, and 6. However, only patients in Groups 2, 4, and 6 requested additional analgesics. Severe pruritus was more frequent in Groups 1 and 2. No patient experienced respiratory depression. We conclude that there is no advantage in using doses larger than 0.025 mg of intrathecal morphine if they are combined with systemic diclofenac.

IMPLICATIONS

A multimodal approach to pain control may provide good quality analgesia while reducing drug-related side effects. In this study, a very small dose of intrathecal morphine, in association with intramuscular diclofenac, proved effective for controlling pain after cesarean delivery, with a low incidence of morphine-induced pruritus.

Epidural pressures and spread of 2% lidocaine in the epidural space: influence of volume and speed of injection of the local anesthetic solution

BACKGROUND AND OBJECTIVES

The impact of epidural pressures on the spread of epidural block is controversial. This study examined the effect of volume and speed of injection of local anesthetics on epidural pressures and the spread of anesthesia.

METHODS

Twenty women undergoing epidural anesthesia received a test dose of 3 mL of 2% lidocaine with epinephrine 1:200,000 over 6 seconds and subsequently the main dose of 15 mL of the solution over 30 seconds (group I) or 3 minutes (group II). Variables studied included epidural pressures and the extent and duration of thermal and sensory block.

RESULTS

Peak epidural pressure following the main dose was significantly higher in group I as compared to group II. All other epidural pressures and the extent and duration of sensory and thermal block were similar in both groups. The peak epidural pressure in group II and the pressures obtained at 3 minutes after the main dose in both groups were inversely correlated with the extent of the thermal block and directly correlated with its regression time.

CONCLUSIONS

The peak epidural pressures correlated with the speed of injection of the lidocaine solution and not with its volume, whereas the remaining epidural pressures correlated with its volume and not with the speed of injection. The extent and duration of the thermal block exhibited a more consistent correlation (inverse and direct, respectively) with the epidural pressures than those of the sensory block.