Liver test abnormalities are frequently observed in COVID-19 patients and are associated with worse prognosis. However, information is limited about pathological changes in the liver in this infection, so the mechanism of liver injury is unclear. Here we describe liver histopathology and clinical correlates of 27 patients who died of COVID-19 in Manaus, Brazil. There was a high prevalence of liver injury (elevated ALT and AST in 44% and 48% of patients, respectively) in these patients. Histological analysis showed sinusoidal congestion and ischemic necrosis in more than 85% of the cases, but these appeared to be secondary to systemic rather than intrahepatic thrombotic events, as only 14% and 22% of samples were positive for CD61 (marker of platelet activation) and C4d (activated complement factor), respectively. Furthermore, the extent of these vascular findings did not correlate with the extent of transaminase elevations. Steatosis was present in 63% of patients, and portal inflammation was present in 52%. In most cases hepatocytes expressed angiotensin converting enzyme 2 (ACE2), which is responsible for binding and entry of SARS-CoV-2, even though this ectoenzyme was minimally expressed on hepatocytes in normal controls. However, SARS-CoV-2 staining was not observed. Most hepatocytes also expressed ITPR3, a calcium channel that becomes expressed in acute liver injury. Conclusion: The hepatocellular injury that commonly occurs in patients with severe COVID-19 is not due to the vascular events that contribute to pulmonary or cardiac damage. However, new expression of ACE2 and ITPR3 with concomitant inflammation and steatosis suggests that liver injury may result from inflammation, metabolic abnormalities and perhaps direct viral injury.

Background The collapsing variant of focal segmental glomerulosclerosis (FSGS) is the most aggressive form of FSGS and is characterized by at least one glomerulus with segmental or global collapse and overlying podocyte hypertrophy and hyperplasia. Viruses can act as aetiological agents of secondary FSGS. This study aims to establish an aetiological link between dengue virus (DENV) infection and the collapsing variant of FSGS and to analyse possible influences of the apolipoprotein 1 (APOL1) gene risk alleles on the disease. Methods Biopsies and medical records were gathered from 700 patients of the Instituto de Nefropatologia, Belo Horizonte, Brazil. Screening for the collapsing variant of FSGS was performed and serological, immunohistochemical, tissue polymerase chain reaction (PCR) and genetic analysis were conducted. Results Eight patients were identified with positive DENV serology and negative serological and/or tissue markers for hepatitis B virus, hepatitis C virus, Epstein–Barr virus, human immunodeficiency virus, cytomegalovirus and parvovirus B19. In PCR analysis, six patients had positive markers for DENV strain genetic material, one patient had positive markers for co-infection of Zika virus (ZIKV) and DENV and one patient had positive markers only for ZIKV infection. Six of the eight patients did not show risk alleles of the APOL1 gene. One patient had only one risk allele (G1) and the sample from another did not contain enough DNA for genetic analysis to be performed. Conclusions This study provided strong evidence that DENV can infect renal tissue and possibly functions as a second hit to the development of the collapsing variant of FSGS. Nonetheless, this study also highlights the possible implication of ZIKV infection in FSGS and supports the argument that risk alleles of the APOL1 gene may not be implicated in the susceptibility to FSGS in these patients.

As ligas acadêmicas estão presentes no Brasil desde 1920 (Liga de Combate à Sífilis e outras Doenças Sexualmente Transmissíveis). As atividades são estruturadas a partir da tríade: ensino, pesquisa e extensão. A Liga Acadêmica de Oftalmologia (OFTALMOLIGA) da Faculdade Ciências Médicas de Minas Gerais (FCMMG), fundada em 2012, proporciona aos alunos um maior contato com a oftalmologia, que é negligenciada na maioria dos currículos obrigatórios de cursos de graduação. Objetiva-se, com este trabalho, descrever as atividades vivenciadas durante a gestão de uma liga acadêmica de oftalmologia entre os anos de 2017-2019. A OFTALMOLIGA é uma agremiação de alunos bastante ativa do ponto de vista teórico-prático-científico. Ao longo do período descrito, uma quantidade expressiva de textos científicos (Artigos) e trabalhos para eventos médicos foram produzidas. Ser membro integrante da OFTALMOLIGA é algo almejado por muitos acadêmicos da FCMMG e de outras instituições de ensino da Região Metropolitana de Belo Horizonte. Nós acreditamos que o contato dos acadêmicos nas ligas de diferentes especialidades pode ajudá-los na escolha do caminho a ser seguido em direção à especialização médica.

Objective: To assess the number of cases and the profile of hospitalizations from varicella after the introduction of the measles, mumps, rubella and varicella combination vaccine in the public health system. Methods: Retrospective study in an infectious diseases pediatric hospital of reference in Southeast Brazil. The cases with a clinical diagnosis of varicella, from January 2011 to June 2016, were assessed from pediatricians’ medical records. The hospitalizations were classified into a pre-vaccine group and post-vaccine group, based on the date the vaccine was introduced (September 2013). Both groups were compared by age, sex, time of hospitalization, reason for hospitalization, hospital complications, duration of intensive care, and clinical outcome. Results: A total of 830 hospitalizations were recorded; 543 in the pre-vaccine period and 287 in the post-vaccine period, a reduction of 47.1% (p<0.001). In both periods, a similar profile in the hospitalizations was noticed: majority male; aged between one to five years old; most complications due to secondary causes (mainly skin infections); main outcome was clinical improvement and discharge from the hospital. In the pre-vaccine period, six deaths were recorded and two were recorded in the post-vaccine period. Conclusions: The profile of the hospitalizations was expected to stay the same since this study did not compare vaccinated with unvaccinated children, but hospitalizations before and after the vaccine was introduced. In accordance with the medical literature, we found a significant fall in the number of hospitalizations from varicella.