Role of polymorphisms in genes that encode cytokines and Helicobacter pylori virulence factors in gastric carcinogenesis

The Helicobacter pylori(H. pylori) infection is a determinant factor in gastric cancer(GC) development. However, the infection outcomes are variable and depend on both host and bacterial characteristics. Some host cytokines such as interleukin(IL)-1β, IL-1 Ra, IL-8, IL-10 and tumor necrosis factor-α play important roles in the host immune system response to the pathogen, in the development of gastric mucosal lesions and in cell malignant transformation. Therefore, these host factors are crucial in neoplastic processes. Certain polymorphisms in genes that encode these cytokines have been associated with an increased risk of GC. On the other hand, various virulence factors found in distinct H. pylori bacterial strains, including cytotoxinassociated antigen A, vacuolating cytotoxin, duodenal ulcer promoting gene A protein, outer inflammatory protein and blood group antigen binding adhesin, have been associated with the pathogenesis of different gastric diseases. The virulent factors mentioned above allow the successful infection by the bacterium and play crucial roles in gastric mucosa lesions, including malignant transformation. Moreover, the role of host polymorphisms and bacterial virulence factors in gastric carcinogenesis seems to vary among different countries and populations. The identification of host and bacterium factors that are associated with an increased risk of GC development may be useful in determining the prognosis of infection in patients, what could help in clinical decision-making and in providing of an optimized clinical approach.

Chronic myeloid leukemia-from the Philadelphia chromosome to specific target drugs:A literature review

Chronic myeloid leukemia(CML)is a myeloproliferative neoplasm and was the first neoplastic disease associated with a well-defined genotypic anomaly―the presence of the Philadelphia chromosome.The advances in cytogenetic and molecular assays are of great importance to the diagnosis,prognosis,treatment,and monitoring of CML.The discovery of the breakpoint cluster region(BCR)-Abelson murine leukemia(ABL)1 fusion oncogene has revolutionized the treatment of CML patients by allowing the development of targeted drugs that inhibit the tyrosine kinase activity of the BCR-ABL oncoprotein.Tyrosine kinase inhibitors(known as TKIs)are the standard therapy for CML and greatly increase the survival rates,despite adverse effects and the odds of residual disease after discontinuation of treatment.As therapeutic alternatives,the subsequent TKIs lead to faster and deeper molecular remissions;however,with the emergence of resistance to these drugs,immunotherapy appears as an alternative,which may have a cure potential in these patients.Against this background,this article aims at providing an overview on CML clinical management and a summary on the main targeted drugs available in that context.

Streptococcus agalactiae:Identification methods,antimicrobial susceptibility, and resistance genes in pregnant women

BACKGROUND Group B Streptococcus(GBS)is a normal component of the gastrointestinal and genital microbiota in humans and can lead to important infections in newborns.AIM To compare GBS isolation and identification methods as well as to assess the antibiotic susceptibility and to identify resistance genes in GBS strains from pregnant women attended in healthcare services from the city of Vitória da Conquista,in Bahia State,Brazil.METHODS From January 2017 to February 2018,vaginorectal swabs were obtained from 186 participants and the samples were seeded onto chromogenic agar for GBS before and after inoculation in selective broth.Confirmatory identification using 3 CAMP and latex tests was performed in samples with GBS-suggestive colonies.Then,disk diffusion antibiograms were performed in GBS-positive samples,and the detection of the resistance genes ermB,ermTR,mefA,and linB in the clindamycin and/or erythromycin-resistant samples was carried out.RESULTS Thirty-two samples(17.2%)were GBS-positive.The culture in chromogenic agar after sample incubation in selective broth was the most sensitive method(96.9%)for GBS detection.All isolates were susceptible to penicillin,ampicillin,cefotaxime,and vancomycin.Clindamycin resistance was observed in 6 samples(18.8%),while 8 samples(25%)were erythromycin-resistant.All erythromycin and/or clindamycin-resistant GBS strains had negative D-tests.Two strains(25%)presented an M phenotype and 6 isolates(75%)presented a cMLSB phenotype.The ermB gene was identified in 4 samples(44.4%),the mefA gene was also found in 4 samples(44.4%),the ermTR gene was identified in 1 isolate(11.1%),and the linB gene was not found in any isolate.CONCLUSION This study evidenced that the screening for SGB can be performed by means of various methods,including chromogenic media,and that the chemoprophylaxis for pregnant women who cannot use penicillin must be susceptibility-guided.

Non-pharmacological management of pediatric functional abdominal pain disorders:Current evidence and future perspectives

Functional abdominal pain disorders(FAPDs) are an important and prevalent cause of functional gastrointestinal disorders among children, encompassing the diagnoses of functional dyspepsia, irritable bowel syndrome, abdominal migraine, and the one not previously present in Rome Ⅲ, functional abdominal pain not otherwise specified. In the absence of sufficiently effective and safe pharmacological treatments for this public problem, non-pharmacological therapies emerge as a viable means of treating these patients, avoiding not only possible side effects, but also unnecessary prescription, since many of the pharmacological treatments prescribed do not have good efficacy when compared to placebo. Thus, the present study provides a review of current and relevant evidence on non-pharmacological management of FAPDs, covering the most commonly indicated treatments, from cognitive behavioral therapy to meditation, acupuncture, yoga, massage, spinal manipulation, moxibustion, and physical activities. In addition, this article also analyzes the quality of publications in the area, assessing whether it is possible to state if non-pharmacological therapies are viable, safe, and sufficiently well-based for an appropriate and effective prescription of these treatments. Finally, it is possible to observe an increase not only in the number of publications on the non-pharmacological treatments for FAPDs in recent years, but also an increase in the quality of these publications. Finally, the sample selection of satisfactory age groups in these studies enables the formulation of specific guidelines for this age group, thus avoiding the need for adaptation of prescriptions initially made for adults, but for children use.

From Helicobacter pylori infection to gastric cancer:Current evidence on the immune response

Gastric cancer(GC)is the result of a multifactorial process whose main components are infection by Helicobacter pylori(H.pylori),bacterial virulence factors,host immune response and environmental factors.The development of the neoplastic microenvironment also depends on genetic and epigenetic changes in oncogenes and tumor suppressor genes,which results in deregulation of cell signaling pathways and apoptosis process.This review summarizes the main aspects of the pathogenesis of GC and the immune response involved in chronic inflammation generated by H.pylori.

Immune response to Helicobacter pylori infection and gastric cancer development

Gastric adenocarcinoma is a global health concern,and Helicobacter pylori(H.pylori)infection is the main risk factor for its occurrence.Of note,the immune response against the pathogen seems to be a determining factor for gastric oncogenesis,and increasing evidence have emphasized several host and bacterium factors that probably influence in this setting.The development of an inflammatory process against H.pylori involves a wide range of mechanisms such as the activation of pattern recognition receptors and intracellular pathways resulting in the production of proinflammatory cytokines by gastric epithelial cells.This process culminates in the establishment of distinct immune response profiles that result from the cytokine-induced differentiation of T naïve cells into specific T helper cells.Cytokines released from each type of T helper cell orchestrate the immune system and interfere in the development of gastric cancer in idiosyncratic ways.Moreover,variants in genes such as single nucleotide polymorphisms have been associated with variable predispositions for the occurrence of gastric malignancy because they influence both the intensity of gene expression and the affinity of the resultant molecule with its receptor.In addition,various repercussions related to some H.pylori virulence factors seem to substantially influence the host immune response against the infection,and many of them have been associated with gastric tumorigenesis.

Epidemiological and clinical characteristics of COVID-19 in a Brazilian public hospital

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has become a major health concern worldwide.In that context,the understanding of epidemiological and clinical features associated with the disease and its severity is crucial for the establishment of strategies aimed at disease control and remedy.AIM To describe epidemiological features,signs,symptoms,and laboratory findings among severely ill COVID-19 patients from an inten-sive care unit in northeastern Brazil as well as to evaluate predictor factors for disease outcomes.METHODS This is a prospective single-center study that evaluated 115 patients admitted to the intensive care unit in a northeastern Brazilian hospital.RESULTS The patients had a median age of 65.60±15.78 years.Dyspnea was the most frequent symptom,affecting 73.9%of the patients,followed by cough(54.7%).Fever was reported in approximately one-third of patients and myalgia in 20.8%of the patients.At least two comorbidities were found in 41.7%of the patients,and hypertension was the most prevalent(57.3%).In addition,having two or more comorbidities was a predictor of mortality,and lower platelet count was positively associated with death.Nausea and vomiting were two symptoms that were predictors of death,and the presence of a cough was a protective factor.CONCLUSION This is the first report of a negative correlation between cough and death in severely ill severe acute respiratory syndrome coronavirus 2-infected individuals.The associations between comorbidities,advanced age,and low platelet count and the outcomes of the infection were similar to the results of previous studies,highlighting the relevance of these features.

Molecular docking of DS-3032B,a mouse double minute 2 enzyme antagonist with potential for oncology treatment development

BACKGROUND It is known that p53 suppression is an important marker of poor prognosis of cancers,especially in solid tumors of the breast,lung,stomach,and esophagus;liposarcomas,glioblastomas,and leukemias.Because p53 has mouse double minute 2(MDM2)as its primary negative regulator,this molecular docking study seeks to answer the following hypotheses:Is the interaction between DS-3032B and MDM2 stable enough for this drug to be considered as a promising neoplastic inhibitor?AIM To analyze,in silico,the chemical bonds between the antagonist DS-3032B and its binding site in MDM2.METHODS For molecular docking simulations,the file containing structures of MDM2(receptor)and the drug DS-3032B(ligand)were selected.The three-dimensional structure of MDM2 was obtained from Protein Data Bank,and the one for DS-3032B was obtained from PubChem database.The location and dimensions of the Grid box was determined using AutoDock Tools software.In this case,the dimensions of the Grid encompassed the entire receptor.The ligand DS-3032B interacts with the MDM2 receptor in a physiological environment with pH 7.4;thus,to simulate more reliably,its interaction was made with the calculation for the prediction of its protonation state using the MarvinSketch®software.Both ligands,with and without the protonation,were prepared for molecular docking using the AutoDock Tools software.This software detects the torsion points of the drug and calculates the angle of the torsions.Molecular docking simulations were performed using the tools of the AutoDock platform connected to the Vina software.The analyses of the amino acid residues involved in the interactions between the receptor and the ligand as well as the twists of the ligand,atoms involved in the interactions,and type,strength,and length of the interactions were performed using the PyMol software(pymol.org/2)and Discovery Studio from BIOVIA®.RESULTS The global alignment indicated crystal structure 5SWK was more suitable for docking simulations by presenting the p53 binding site.The three-dimensional structure 5SWK for MDM2 was selected from Protein Data Bank and the three-dimensional structure of DS-3032B was selected from PubChem(Compound CID:73297272;Milademetan).After molecular docking simulations,the most stable conformer was selected for both protonated and non-protonated DS-3032B.The interaction between MDM2 and DS-3032B occurs with high affinity;no significant difference was observed in the affinity energies between the MDM2/pronated DS-3032B(-9.9 kcal/mol)and MDM2/non-protonated DS-3032B conformers(-10.0 kcal/mol).Sixteen amino acid residues of MDM2 are involved in chemical bonds with the protonated DS-3032B;these 16 residues of MDM2 belong to the p53 biding site region and provide high affinity to interaction and stability to drugprotein complex.CONCLUSION Molecular docking indicated that DS-3032B antagonist binds to the same region of the p53 binding site in the MDM2 with high affinity and stability,and this suggests therapeutic efficiency.

COVID-19 and dengue coinfection in Brazil

The case we present here is a man who lives in a dengue-endemic area.Initially,the patient was diagnosed with dengue fever by clinical evaluation and laboratorial confirmation.Subsequently,he presented respiratory symptoms,and a concomitant severe acute respiratory syndrome coronavirus 2 infection was confirmed.He was hospitalized for 17 d and had a satisfactory recovery.

Influence of the COVID-19 pandemic in the gastrointestinal oncology setting:An overview

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection has been impacting healthcare in various ways worldwide and cancer patients are greatly affected by the coronavirus disease 2019(COVID-19)pandemic.The reorganization of the health facilities in order to supply the high demand resulting from the aforementioned infection as well as the social isolation measures led to impairments for the diagnosis and follow-up of patients with gastrointestinal cancers,which has had an impact on the prognosis of the oncologic patients.In that context,health authorities and organizations have elaborated new guidelines with specific recommendations for the management of individuals with gastrointestinal neoplasms during the pandemic.Of note,oncologic populations seem to be more susceptible to unfavorable outcomes when exposed to SARS-CoV-2 infection and some interactions involving virus,tumor,host immune system and anticancer therapies are probably related to the poorer prognosis observed in those COVID-19 patients.Moreover,vaccination stands out as the main prevention method against severe SARS-CoV-2 infection and some particularities have been observed regarding the seroconversion of vaccinated oncologic patients including those with gastrointestinal malignancies.In this minireview,we gather updated information regarding the influence of the pandemic in the diagnosis of gastrointestinal neoplasms,new recommendations for the management of gastrointestinal cancer patients,the occurrence of SARSCoV-2 infection in those individuals and the scenario of the vaccination against the virus in that population.

Identification and characterization of resistance and pathogenicity of Enterococcus spp.in samples of donor breast milk

BACKGROUND Breast milk is the primary source of nutrition for newborns.Hospitalized babies frequently need nutritional support from Human Milk Banks.As bacterial species of the genus Enterococcus are part of the microbiota of healthy donors,they may contaminate samples of pumped breast milk.AIM To identify and characterize the bacterial virulence and resistance in samples isolated from the nipple-areolar region,hands,and breast milk aliquots from donors at the Human Milk Bank of Municipal Hospital EsauMatos in the city of Vitória da Conquista,Bahia State,Brazil.METHODS The personal hygiene and sanitation of donors were analyzed with the aim of identifying possible reasons for contamination of pumped milk.Cutaneous samples as well as aliquots of unpasteurized and pasteurized milk from 30 participants were obtained.Each Enterococcus spp.isolate underwent a disk diffusion susceptibility test and molecular biology techniques to determine resistance and virulence genes.RESULTS Enterococcus spp.were identified in 30%of donors(n=9),and 11 specimens were isolated.Resistance to tetracycline was highly prevalent,being detectable in 63%of the isolates(n=7)and followed by intermediate sensitivity to ciprofloxacin,observed in 27%of the specimens(n=3).The efaA gene was found in 63%(n=7)of the isolates,while the ace gene was detected in 27%(n=3).CONCLUSION This study illustrates the importance of microbiological monitoring by Human Milk Banks and the need for alternatives to prevent the presence of Enterococcus spp.in hospital settings.

Pathogenesis and clinical management of Helicobacter pylori gastric infection

Helicobacter pylori(H.pylori)is a gram-negative bacterium that infects approximately 4.4 billion individuals worldwide.However,its prevalence varies among different geographic areas,and is influenced by several factors.The infection can be acquired by means of oral-oral or fecal-oral transmission,and the pathogen possesses various mechanisms that improve its capacity of mobility,adherence and manipulation of the gastric microenvironment,making possible the colonization of an organ with a highly acidic lumen.In addition,H.pylori presents a large variety of virulence factors that improve its pathogenicity,of which we highlight cytotoxin associated antigen A,vacuolating cytotoxin,duodenal ulcer promoting gene A protein,outer inflammatory protein and gamma-glutamyl transpeptidase.The host immune system,mainly by means of a Th1-polarized response,also plays a crucial role in the infection course.Although most H.pylori-positive individuals remain asymptomatic,the infection predisposes the development of various clinical conditions as peptic ulcers,gastric adenocarcinomas and mucosa-associated lymphoid tissue lymphomas.Invasive and non-invasive diagnostic methods,each of them with their related advantages and limitations,have been applied in H.pylori detection.Moreover,bacterial resistance to antimicrobial therapy is a major challenge in the treatment of this infection,and new therapy alternatives are being tested to improve H.pylori eradication.Last but not least,the development of effective vaccines against H.pylori infection have been the aim of several research studies.

Helicobacter pylori infection: Beyond gastric manifestations

Helicobacter pylori(H.pylori)is a bacterium that infects more than a half of world’s population.Although it is mainly related to the development of gastroduodenal diseases,several studies have shown that such infection may also influence the development and severity of various extragastric diseases.According to the current evidence,whereas this bacterium is a risk factor for some of these manifestations,it might play a protective role in other pathological conditions.In that context,when considered the gastrointestinal tract,H.pylori positivity have been related to Inflammatory Bowel Disease,Gastroesophageal Reflux Disease,Non-Alcoholic Fatty Liver Disease,Hepatic Carcinoma,Cholelithiasis,and Cholecystitis.Moreover,lower serum levels of iron and vitamin B12 have been found in patients with H.pylori infection,leading to the emergence of anemias in a portion of them.With regards to neurological manifestations,a growing number of studies have associated that bacterium with multiple sclerosis,Alzheimer’s disease,Parkinson’s disease,and Guillain-Barrésyndrome.Interestingly,the risk of developing cardiovascular disorders,such as atherosclerosis,is also influenced by the infection.Besides that,the H.pylori-associated inflammation may also lead to increased insulin resistance,leading to a higher risk of diabetes mellitus among infected individuals.Finally,the occurrence of dermatological and ophthalmic disorders have also been related to that microorganism.In this sense,this minireview aims to gather the main studies associating H.pylori infection with extragastric conditions,and also to explore the main mechanisms that may explain the role of H.pylori in those diseases.

Relationship between Th17 immune response and cancer

Cancer is the second leading cause of death worldwide and epidemiological projections predict growing cancer mortality rates in the next decades.Cancer has a close relationship with the immune system and,although Th17 cells are known to play roles in the immune response against microorganisms and in autoimmunity,studies have emphasized their roles in cancer pathogenesis.The Th17 immune response profile is involved in several types of cancer including urogenital,respiratory,gastrointestinal,and skin cancers.This type of immune response exerts pro and antitumor functions through several mechanisms,depending on the context of each tumor,including the protumor angiogenesis and exhaustion of T cells and the antitumor recruitment of T cells and neutrophils to the tumor microenvironment.Among other factors,the paradoxical behavior of Th17 cells in this setting has been attributed to its plasticity potential,which makes possible their conversion into other types of T cells such as Th17/Treg and Th17/Th1 cells.Interleukin(IL)-17 stands out among Th17-related cytokines since it modulates pathways and interacts with other cell profiles in the tumor microenvironment,which allow Th17 cells to prevail in tumors.Moreover,the IL-17 is able to mediate pro and antitumor processes that influence the development and progression of various cancers,being associated with variable clinical outcomes.The understanding of the relationship between the Th17 immune response and cancer as well as the singularities of carcinogenic processes in each type of tumor is crucial for the identification of new therapeutic targets.

Nephrotoxicity in cancer treatment:An overview

Anticancer drug nephrotoxicity is an important and increasing adverse drug event that limits the efficacy of cancer treatment.The kidney is an important elimination pathway for many antineoplastic drugs and their metabolites,which occurs by glomerular filtration and tubular secretion.Chemotherapeutic agents,both conventional cytotoxic agents and molecularly targeted agents,can affect any segment of the nephron including its microvasculature,leading to many clinical manifestations such as proteinuria,hypertension,electrolyte disturbances,glomerulopathy,acute and chronic interstitial nephritis,acute kidney injury and at times chronic kidney disease.The clinician should be alert to recognize several factors that may maximize renal dysfunction and contribute to the increased incidence of nephrotoxicity associated with these drugs,such as intravascular volume depletion,the associated use of nonchemotherapeutic nephrotoxic drugs(analgesics,antibiotics,proton pump inhibitors,and bonetargeted therapies),radiographic ionic contrast media or radiation therapy,urinary tract obstruction,and intrinsic renal disease.Identification of patients at higher risk for nephrotoxicity may allow the prevention or at least reduction in the development and severity of this adverse effect.Therefore,the aim of this brief review is to provide currently available evidences on oncologic drug-related nephrotoxicity.

Immunotherapy – new perspective in lung cancer

Lung carcinoma is associated with a high mortality worldwide,being the leading cause of cancer death.It is mainly classified into squamous non-small cell lung cancer(NSCLC),non-squamous NSCLC,and small cell lung cancer.However,such malignancy has been increasingly subdivided into histological and molecular subtypes to guide treatment.Therapies can be used in adjuvant and palliative settings.Regarding immunotherapy,it has been widely tested in both first or subsequent palliative lines.In this sense,drugs such as pembrolizumab,nivolumab,atezolizumab,ipilimumab,avelumab,and durvalumab have been assessed in large studies.Some of these trials have also studied these medicines in adjuvant and in maintenance therapy.In recent years,advances in immunotherapy have raised the hope that the unfavorable prognosis observed in several affected individuals can be changed.Immunotherapy has increased the overall survival in squamous NSCLC,non-squamous NSCLC,and small cell lung cancer.However,it has added to the oncology practice some side effects that are unusual in standard chemotherapy and require special clinical support.In order to show how immunotherapy is being applied in the treatment of lung carcinoma,we reviewed the main studies in adjuvant and palliative scenarios.What is the better scheme?What is the better combination?What is the better dose?When should we use immunotherapy?Does programmed cell death ligand 1 expression significantly interfere in immunotherapy efficiency?Some of these questions have already been answered,while others require more investigations.

Tertiary peritonitis: A disease that should not be ignored

Intra-abdominal infections can be classified into uncomplicated or complicated(peritonitis). Peritonitis is divided into primary, secondary, and tertiary. Tertiaryperitonitis is the less common but the most severe among peritonitisstratifications, being defined as a recurrent intra-abdominal infection that occurs48 h after a well-succeeded control of a secondary peritonitis. This disease has acomplex pathogenesis that is closely related to the capacity of the peritonealcavity to activate immunological processes. Patients who progress to persistentperitonitis are at an increased risk of developing several infectious complicationssuch as sepsis and multiple organ failure syndrome. Moreover, tertiary peritonitisremains an important cause of hospital death mainly among patients withassociated risk factors. The microbiological profile of organisms causing tertiaryperitonitis is often different from that observed in other types of peritonitis. Inaddition, there is a high prevalence of multidrug-resistant pathogens causing thiscondition, and an appropriate and successful clinical management depends on anearly diagnosis, which can be made easier with the use of clinical scorespresenting a good prediction value during the intensive care unit admission.Complementarily, immediate therapy should be performed to control theinfectious focus and to prevent new recurrences. In this sense, the treatment isbased on initial antimicrobial therapy and well-performed peritoneal drainage.

Treatment of Helicobacter pylori infection in children:A systematic review

BACKGROUND Helicobacter pylori(H.pylori)infection is predominantly acquired in childhood.When indicated,the most accepted treatment for H.pylori eradication in this age group is first-line triple therapy.However,the increasing resistance to clarithromycin and nitroimidazoles has been associated with treatment failure,and thus,alternative treatment regimens have been proposed.AIM To perform a systematic review of randomized controlled trials on treatment regimens for H.pylori infection in children.METHODS We surveyed relevant articles published in English from 2010 to April 2020 in the PubMed and MEDLINE databases.Keywords included“Helicobacter pylori“/”children or childhood“/”treatment or eradication.”The risk of bias was evaluated according to the Cochrane Handbook of Systematic Reviews for Interventions.RESULTS Among the 1144 records identified through the database,20 articles were selected.Four studies compared the eradication rates of H.pylori infection between standard triple therapies,changing only the main antibiotic used.Seven studies evaluated the effectiveness of standard triple therapy with the addition of probiotics.One study investigated the relationship between the effectiveness in the eradication rates of standard triple therapy and vitamin E levels.Six studies analyzed the eradication rates of sequential therapy.CONCLUSION The findings suggest that although standard triple therapy is the most recommended regimen for children by the current guidelines,other therapeutic schemes have shown promising results and may also be recommended for clinical practice in the future.

Transmission of severe acute respiratory syndrome coronavirus 2 via fecal-oral:Current knowledge

The pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has resulted in more than 93 million cases and 2 million deaths in the world.SARS-CoV-2 respiratory tract infection and its main clinical manifestations such as cough and shortness of breath are well known to the scientific community.However,a growing number of studies have reported SARS-CoV-2-related gastrointestinal involvement based on clinical manifestations,such as diarrhea,nausea,vomiting,and abdominal pain as well as on the pathophysiological mechanisms associated with coronavirus disease 2019.Furthermore,current evidence suggests SARS-CoV-2 transmission via the fecal-oral route and aerosol dissemination.Moreover,studies have shown a high risk of contamination through hospital surfaces and personal fomites.Indeed,viable SARS-CoV-2 specimens can be obtained from aerosols,which raises the possibility of transmission through aerosolized viral particles from feces.Therefore,the infection by SARS-CoV-2 via fecal-oral route or aerosolized particles should beconsidered.In addition,a possible viral spread to sources of drinking water,sewage,and rivers as well as the possible risk of viral transmission in shared toilets become a major public health concern,especially in the least developed countries.Since authors have emphasized the presence of viral RNA and even viable SARS-CoV-2 in human feces,studies on the possible fecal-oral coronavirus disease 2019 transmission become essential to understand better the dynamics of its transmission and,then,to reinforce preventive measures against this infection,leading to a more satisfactory control of the incidence of the infection.

Highlighting COVID-19:What the imaging exams show about the disease

Coronavirus disease 2019(COVID-19),a global emergency,is caused by severe acute respiratory syndrome coronavirus 2.The gold standard for its diagnosis is the reverse transcription polymerase chain reaction,but considering the high number of infected people,the low availability of this diagnostic tool in some contexts,and the limitations of the test,other tools that aid in the identification of the disease are necessary.In this scenario,imaging exams such as chest X-ray(CXR)and computed tomography(CT)have played important roles.CXR is useful for assessing disease progression because it allows the detection of extensive consolidations,besides being a fast and cheap method.On the other hand,CT is more sensitive for detecting lung changes in the early stages of the disease and is also useful for assessing disease progression.Of note,ground-glass opacities are the main COVID-19-related CT findings.Positron emission tomography combined with CT can be used to evaluate chronic and substantial damage to the lungs and other organs;however,it is an expensive test.Lung ultrasound(LUS)has been shown to be a promising technique in that context as well,being useful in the screening and monitoring of patients,disease classification,and management related to mechanical ventilation.Moreover,LUS is an inexpensive alternative available at the bedside.Finally,magnetic resonance imaging,although not usually requested,allows the detection of pulmonary,cardiovascular,and neurological abnormalities associated with COVID-19.Furthermore,it is important to consider the challenges faced in the radiology field in the adoption of control measures to prevent infection and in the follow-up of post-COVID-19 patients.