EPICOVID19 protocol: repeated serological surveys on SARS-CoV-2 antibodies in Brazil / Protocolo EPICOVID19: pesquisas sorológicas repetidas de anticorpos SARS-CoV-2 no Brasil

Abstract The first case of COVID-19 was reported in China in December 2019, and, as the virus has spread worldwide, the World Health Organization declared it a pandemic. Estimates on the number of COVID-19 cases do not reflect it real magnitude as testing is limited. Population based data on the proportion of the population with antibodies is relevant for planning public health policies. We aim to assess the prevalence of SARS-CoV-2 antibodies, presence of signs and symptoms of COVID-19, and adherence to isolation measures. A random sample comprising 133 sentinel cities from all states of the country will be selected. Three serological surveys, three weeks apart, will be conducted. The most populous municipality in each intermediate region of the country, defined by the Brazilian Institute of Geography and Statistics, was chosen as sentinel city. In each city, 25 census tracts will be selected, and 10 households will be systematically sampled in each tract, totaling 33,250 participants. In each household, one inhabitant will be randomly selected to be interviewed and tested for antibodies against SARS-CoV-2, using WONDFO SARS-CoV-2 Antibody Test. By evaluating a representative sample of Brazilian sentinel sites, this study will provide essential information for the design of health policies.

Resumo O COVID-19 é causado pelo vírus SARS-CoV-2, sendo o primeiro caso relatado na China em dezembro de 2019. O vírus se espalhou pelo mundo, levando a Organização Mundial da Saúde a declarar uma pandemia. As estimativas do número de casos de COVID-19 não refletem sua magnitude real, pois os testes são limitados em muitos países. Dados populacionais sobre a proporção da população com anticorpos são relevantes para o planejamento de políticas públicas de saúde. Nosso objetivo é avaliar a prevalência de anticorpos SARS-CoV-2, a presença de sinais e de sintomas de COVID-19 e a adesão a medidas de isolamento. Uma amostra aleatória composta por 133 cidades sentinelas de todos os estados do país será selecionada. Serão realizados três levantamentos sorológicos, com três semanas de intervalo. Em cada cidade, serão selecionados 25 setores censitários e 10 famílias serão amostradas aleatoriamente em cada setor. Em cada domicílio, um habitante será selecionado aleatoriamente para ser entrevistado e testado para anticorpos contra SARS-CoV-2, usando o Teste de Anticorpo WONDFO SARS-CoV-2, que foi validado antes do trabalho de campo. Ao avaliar uma amostra representativa dos locais sentinela ao longo do tempo, este estudo fornecerá informações essenciais para o desenho de políticas de saúde.

Social distancing patterns in nine municipalities of Rio Grande do Sul, Brazil: the Epicovid19/RS study / Padrões de distanciamento social em nove cidades gaúchas: estudo Epicovid19/RS

ABSTRACT OBJECTIVE To describe social distancing practices in nine municipalities of the state of Rio Grande do Sul, Brazil, stratified by gender, age, and educational attainment. METHODS Two sequential cross-sectional studies were conducted in the municipalities of Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria, and Uruguaiana to estimate the population prevalence of COVID-19. The study was designed to be representative of the urban population of these municipalities. A questionnaire including three questions about social distancing was also administered to the participants. Here, we present descriptive analyses of social distancing practices by subgroups and use chi-square tests for comparisons. RESULTS In terms of degree of social distancing, 25.8% of the interviewees reported being essentially isolated and 41.1% reported being quite isolated. 20.1% of respondents reported staying at home all the time, while 44.5% left only for essential activities. More than half of households reported receiving no visits from non-residents. Adults aged 20 to 59 reported the least social distancing, while more than 80% of participants aged 60 years or older reported being essentially isolated or quite isolated. Women reported more stringent distancing than men. Groups with higher educational attainment reported going out for daily activities more frequently. CONCLUSIONS The extremes of age are more protected by social distancing, but some groups remain highly exposed. This can be an important limiting factor in controlling progression of the COVID-19 pandemic.

RESUMO OBJETIVO Descrever práticas de distanciamento social em nove municípios do Rio Grande do Sul por sexo, idade, escolaridade e cidade. MÉTODOS Foram realizados dois estudos transversais sequenciais representativos da população urbana nos municípios de Canoas, Caxias do Sul, Ijuí, Passo Fundo, Pelotas, Porto Alegre, Santa Cruz do Sul, Santa Maria e Uruguaiana com o intuito de estimar a prevalência populacional de Covid-19. Foi aplicado questionário contendo três perguntas sobre distanciamento social, cujas práticas foram submetidas a análises descritivas por subgrupos. Os dados foram comparados por testes qui-quadrado. RESULTADOS Em termos de grau de distanciamento social, 25,8% dos entrevistados relataram estar praticamente isolados e 41,1% indicam praticar bastante distanciamento. Relataram ficar em casa o tempo todo 20,1% dos entrevistados, e 44,5% informam que saem apenas para atividades essenciais. Mais da metade dos domicílios não recebe visitas de não moradores. O grupo que relatou menos distanciamento social foi o de adultos entre 20 e 59 anos, enquanto mais de 80% dos entrevistados com 60 anos ou mais relataram estar praticamente isolados ou fazendo bastante distanciamento. As mulheres relataram fazer mais distanciamento que os homens, e os grupos de maior escolaridade foram os que relataram sair diariamente para atividades regulares com mais frequência. CONCLUSÕES Os grupos mais jovens e mais idosos estão mais protegidos pelo distanciamento social, mas há grupos bastante expostos, o que pode ser um limitador importante no controle da progressão da epidemia de Covid-19.

Evolução da prevalência de infecção por COVID-19 no Rio Grande do Sul, Brasil: inquéritos sorológicos seriados / Trends in the prevalence of COVID-19 infection in Rio Grande do Sul, Brazil: repeated serological surveys

Resumo A COVID-19 é uma doença produzida pelo vírus SARS-CoV-2. Esse vírus se espalhou rapidamente pelo mundo, o que levou a Organização Mundial da Saúde a classificar a COVID-19 como uma emergência de saúde internacional e, posteriormente, a declará-la uma pandemia. O número de casos confirmados, no dia 11 de abril de 2020, já passa de 1.700.000, porém esses dados não refletem a real prevalência de COVID-19 na população, visto que, em muitos países, os testes são quase que exclusivamente realizados em pessoas com sintomas, especialmente os mais graves. Para definir políticas de enfrentamento, é essencial dispor de dados sobre a prevalência real de infecção na população. Este estudo tem por objetivos avaliar a proporção de indivíduos já infectados pelo SARS-CoV-2 no Rio Grande do Sul, Brasil, analisar a velocidade de expansão da infecção e estimar o percentual de infectados com e sem sintomas. Serão realizados quatro inquéritos sorológicos repetidos a cada 15 dias, com amostragem probabilística de nove cidades sentinela, em todas as sub-regiões do Estado. As entrevistas e testes ocorrerão no âmbito domiciliar. Serão utilizados testes rápidos para detecção de anticorpos, validados previamente ao início da coleta de dados.

Abstract COVID-19, the disease produced by the virus SARS-CoV-2, has spread quickly throughout the world, leading the World Health Organization to first classify it as an international health emergency and, subsequently, declaring it pandemic. The number of confirmed cases, as April 11, surpassed 1,700,000, but this figure does not reflect the prevalence of COVID-19 in the population as, in many countries, tests are almost exclusively performed in people with symptoms, particularly severe cases. To properly assess the magnitude of the problem and to contribute to the design of evidence-based policies for fighting COVID-19, one must accurately estimate the population prevalence of infection. Our study is aimed at estimating the prevalence of infected individuals in the state of Rio Grande do Sul, Brazil, to document how fast the infection spreads, and to estimate the proportion of infected persons who present or presented symptoms, as well as the proportion of asymptomatic infections. Four repeated serological surveys will be conducted in probability samples of nine sentinel cities every two weeks. Tests will be performed in 4,500 participants in each survey, totaling18,000 interviews. Interviews and tests will be conducted at the participants' household. A rapid test for the detection of antibodies will be used; the test was validated prior to the beginning of the fieldwork.

Age and regional differences in clinical presentation and risk of hospitalization for dengue in Brazil, 2000-2014

OBJECTIVES: Dengue cases range from asymptomatic to severe, eventually leading to hospitalization and death. Timely and appropriate management is critical to reduce morbidity. Since 1980, dengue has spread throughout Brazil, affecting an increasing number of individuals. This paper describes age and regional differences in dengue’s clinical presentation and associated risk of hospitalization based on more than 5 million cases reported to the Brazilian Ministry of Health from 2000-2014. METHODS: We performed a retrospective analysis of ∼5,450,000 dengue cases, relating clinical manifestations and the risk of hospitalization to age, gender, previous infection by dengue, dengue virus serotype, years of formal education, delay to first attendance and the occurrence of dengue during outbreaks and in different Brazilian regions. RESULTS: Complicated forms of dengue occurred more frequently among those younger than 10 years (3.12% vs 1.92%) and those with dengue virus 2 infection (7.65% vs 2.42%), with a delay to first attendance >2 days (3.18% vs 0.82%) and with ≤4 years of formal education (2.02% vs 1.46%). The risk of hospitalization was higher among those aged 6-10 years old (OR 4.57; 95% CI 1.43-29.96) and those who were infected by dengue virus 2 (OR 6.36; 95% CI 2.52-16.06), who lived in the Northeast region (OR 1.38; 95% CI 1.11-2.10) and who delayed first attendance by >5 days (composite OR 3.15; 95% CI 1.33-8.9). CONCLUSIONS: In Brazil, the occurrence of severe dengue and related hospitalization is associated with being younger than 10 years old, being infected by dengue virus 2 or 3, living in the Northeast region (the poorest and the second most populated) and delaying first attendance for more than 2 days.

Serological, parasitological and molecular tests for canine visceral leishmaniosis diagnosis in a longitudinal study / Testes sorológicos, parasitológicos e moleculares para o diagnóstico da leishmaniose visceral canina em estudo longitudinal

Abstract One of the measures to control visceral leishmaniosis (VL) in Brazil is the identification and culling of the canine reservoir. There is much controversy concerning this strategy, including the proper identification of positive dogs and the fact that the host-parasite relationship changes over time make it more challenging. A dynamic cohort of 62 dogs was followed every three months using serological and parasitological examinations and PCR. Positivity by PCR was higher than by serology and by parasitological examinations and showed a tendency to decrease over time, while serology tended to increase after six months. Concomitant positivity in all tests was observed in 10.4% of the samples, and negativity in 29.1%. Overall sensitivity ranged from 43.6 to 64.1%, and was not uniform over time. The proportion of dogs with or without clinical signs was not different by cytology or PCR but PCR was able to identify a larger number of asymptomatic dogs compared to ELISA and immunochromatography. PCR can be useful for surveillance of areas where cases of canine VL have not yet been detected and in which control strategies can be implemented to limit the spread of the disease. Despite the advance in diagnostic tools CVL diagnosis remains a challenge.

Resumo Uma das medidas de controle da leishmaniose visceral (LV) no Brasil se baseia na identificação e eliminação do reservatório canino. Existe considerável controvérsia relativa a esta estratégia incluindo a correta identificação dos cães positivos e a variação temporal da relação hospedeiro-parasita, o que torna esta medida ainda mais desafiadora. Uma coorte dinâmica de 62 cães foi acompanhada trimestralmente utilizando-se métodos sorológicos, parasitológicos e a PCR. A taxa de positividade por PCR foi maior em comparação à dos métodos sorológicos e parasitológicos, e mostrou tendência à diminuição com o passar do tempo, enquanto que a positividade sorológica apresentou tendência a aumento, após seis meses. Observou-se positividade concomitante em todos os testes em 10,4% das amostras e, negatividade concomitante, em 29,1%. A sensibilidade geral variou de 43,6% a 64,1%, não sendo uniforme ao longo do estudo. A proporção de cães com e sem sinais clínicos que foram positivos ao exame parasitológico ou à PCR não foi estatisticamente diferente. Contudo, foi possível identificar como positivos um maior número de animais assintomáticos por meio da técnica de PCR, em comparação aos testes ELISA e imunocromatográfico. A PCR pode ser bastante útil para a vigilância epidemiológica de áreas onde casos de LV canina ainda não tenham sido descritos e onde estratégias de controle podem ser implantadas para limitar a disseminação da doença. Não obstante o avanço nas ferramentas diagnósticas, diagnosticar a LVC continua um desafio.

A public health risk assessment for yellow fever vaccination: a model exemplified by an outbreak in the state of São Paulo, Brazil

We propose a method to analyse the 2009 outbreak in the region of Botucatu in the state of São Paulo (SP), Brazil, when 28 yellow fever (YF) cases were confirmed, including 11 deaths. At the time of the outbreak, the Secretary of Health of the State of São Paulo vaccinated one million people, causing the death of five individuals, an unprecedented number of YF vaccine-induced fatalities. We apply a mathematical model described previously to optimise the proportion of people who should be vaccinated to minimise the total number of deaths. The model was used to calculate the optimum proportion that should be vaccinated in the remaining, vaccine-free regions of SP, considering the risk of vaccine-induced fatalities and the risk of YF outbreaks in these regions.

Risk of symptomatic dengue for foreign visitors to the 2014 FIFA World Cup in Brazil

Brazil will host the FIFA World Cup™, the biggest single-event competition in the world, from June 12-July 13 2014 in 12 cities. This event will draw an estimated 600,000 international visitors. Brazil is endemic for dengue. Hence, attendees of the 2014 event are theoretically at risk for dengue. We calculated the risk of dengue acquisition to non-immune international travellers to Brazil, depending on the football match schedules, considering locations and dates of such matches for June and July 2014. We estimated the average per-capita risk and expected number of dengue cases for each host-city and each game schedule chosen based on reported dengue cases to the Brazilian Ministry of Health for the period between 2010-2013. On the average, the expected number of cases among the 600,000 foreigner tourists during the World Cup is 33, varying from 3-59. Such risk estimates will not only benefit individual travellers for adequate pre-travel preparations, but also provide valuable information for public health professionals and policy makers worldwide. Furthermore, estimates of dengue cases in international travellers during the World Cup can help to anticipate the theoretical risk for exportation of dengue into currently non-infected areas.

Pandemic H1N1 illness prognosis: evidence from clinical and epidemiological data from the first pandemic wave in São Paulo, Brazil

OBJECTIVES: The pandemic of 2009 H1N1 influenza A emerged in February 2009, with high morbidity and mortality, and rapidly spread globally. São Paulo was among the most affected areas in Brazil. This study compares the clinical and epidemiological characteristics of influenza-like illness between outpatients and hospitalized patients and evaluates the impact of oseltamivir therapy on the outcome of 2009 H1N1 influenza A patients. METHODS: This is a case series study comparing the clinical and epidemiological characteristics of influenza-like illness between outpatients attended at Hospital São Paulo in August 2009 (the peak of the first pandemic wave) and those patients hospitalized between May and September 2009 (the entire first pandemic wave). RESULTS: The 1651 patients evaluated were predominantly female (927×686, p<0.001) and aged 31.71±16.42 years, with 148 reporting chronic pulmonary disease. Dyspnea was presented by 381 (23.4%) patients and was more frequent among those aged 30 years or more (p<0.001). Hospitalization occurred at 3.73±2.85 days, and antiviral treatment started 2.27±2.97 days after the onset of first symptoms. A delay of more than 5 days in starting oseltamivir therapy was independently associated with hospitalization (p<0.001), a stay in the ICU (p<0.001) and a higher risk of dying (OR = 28.1, 95% CI 2.81-280.2, p = 0.007). CONCLUSION: The 2009 pandemic of H1N1 influenza A affected young adults, presented a significant disease burden and produced severe cases with a significant fatality rate. However, promptly starting specific therapy improved the outcome. .

Effect of progressive resistance exercise on strength evolution of elderly patients living with HIV compared to healthy controls

OBJECTIVES: Human Immunodeficiency Virus (HIV) infection worsens the frailty of elderly people, compromising their quality of life. In this study we prospectively evaluated eleven patients living with HIV and 21 controls older than 60 years and without prior regular physical activity, who engaged in a one-year progressive resistance exercise program to compare its effects on muscular strength, physical fitness and body composition. METHODS: Exercises for major muscular groups were performed 2 times/week, under professional supervision. Strength increase was evaluated bimonthly, while body composition, lipid and glycaemic profiles (only of those living with HIV) and physical fitness were evaluated before and after the one-year training. RESULTS: The participants living with HIV were lighter, had smaller Body Mass Index and were initially much weaker than controls. However, their strength increased more (1.52-2.33 times the baseline values for those living with HIV x 1.21-1.48 times for controls, p<0.01), nullifying the differences initially seen. These effects were seen independently of gender, age or baseline physical activity. In addition, those living with HIV improved their fasting glucose levels and showed a tendency to improve their lipids after the one year training program. These effects were slightly more pronounced among those not using protease inhibitors, although not significantly. CONCLUSIONS: Resistance exercise safely increased the strength of older patients living with HIV adults, allowing them to achieve performance levels observed among otherwise healthy controls. These findings favor the recommendation of resistance exercise for elderly adults living with HIV adults.

Candidemia epidemiology and susceptibility profile in the largest Brazilian teaching hospital complex

INTRODUCTION: Although the spectrum of fungi causing bloodstream fungal infections continues to expand, Candida spp. remains responsible for the majority of these cases. OBJECTIVE: The purpose of this study was to characterize the candidemia epidemiology, species distribution and antifungal susceptibility patterns at a Brazilian tertiary teaching public hospital with 2,500 beds. METHODS: Records from the microbiology laboratory were used to identify patients with positive blood cultures during 2006. The in vitro activity of amphotericin B, caspofungin, itraconazole, fluconazole, voricanozole, and posaconazole were determined using the Etest method. RESULTS: One hundred and thirty-six cases of candidemia were identified and 100 strains were available for antifungal susceptibility testing. The overall incidence of candidemia was 1.87 cases/1.000 admissions and 0.27 cases/1.000 patient-days. Among the patients, 58.1 percent were male, and the median age was 40 years old. C. albicans was the most common species (52.2 percent), followed by C. parapsilosis (22.1 percent), C. tropicalis (14.8 percent), and C. glabrata (6.6 percent). All strains were susceptible to amphotericin B with a MIC90 of 0.5 µg/mL. Overall susceptibility for voriconozole, fluconazole, and caspofungin was > 97 percent with a MIC90 of 0.064, 4.0 and 1.0 µg/mL, respectively. For itraconazole the susceptibility rate was 81 percent with a MIC90 of 0.5 µg/mL. Posaconazole also demonstrated good in vitro activity with a MIC90 of 0.25 µg/mL. CONCLUSION: This is the first antifungal susceptibility report in our institution.

Evaluation of Helicobacter pylory colonization by serologic test (IgG) and dyspepsia in volunteers from the countryside of Monte Negro, in the Brazilian western Amazon region / Avaliação da colonização por Helicobacter pylori através de teste sorológico (IgG) e de dispepsia em voluntários da população rural de Monte Negro (RO), região da Amazônia ocidental

The present study intended to analyze the seroprevalence of Helicobacter pylori, IgG, and its relation to dyspepsia in a population from the western Amazon region. During the "Projeto Bandeira Científica", a University of São Paulo Medical School program, in Monte Negro's rural areas, state of Rondônia, 266 blood samples were collected from volunteers. The material was tested for IgG antibodies anti-Helicobacter pylori by ELISA method and the participants were also interviewed on dyspepsia, hygiene and social aspects. Participants aged between five and 81 years old (34 years on average), 149 (56 percent) were female and 117 (44 percent) male. We found 210 (78.9 percent) positive, 50 (18.8 percent) negative and six (2.3 percent) undetermined samples. Dyspeptic complaints were found in 226 cases (85.2 percent). There was no statistical association between dyspepsia and positive serology for H. pylori. We concluded that the seroprevalence in all age categories is similar to results found in other studies conducted in developing countries, including those from Brazil. On the other hand, the seroprevalence found in Monte Negro was higher than that reported in developed countries. As expected, there was a progressive increase in the positivity for H. pylori in older age groups.

Este trabalho tem por objetivo analisar a soroprevalência do Helicobacter pylori, IgG, em população rural da Amazônia, e sua correlação com queixa dispéptica. No Projeto Bandeira Científica da FMUSP, em Monte Negro - RO, foram coletadas 266 amostras sangüíneas nos assentamentos rurais do município. Foram pesquisados anticorpos da classe IgG dirigidos contra Helicobacter pylori pelo método ELISA e aplicados questionários sobre dispepsia, aspectos sociais e epidemiológicos. Os pacientes tinham idades entre cinco e 81 anos (média de 34 anos); 149 (56 por cento) do sexo feminino e 117 (44 por cento) do sexo masculino. Foram encontradas 210 (78.9 por cento) amostras positivas, 50 negativas (18.8 por cento) e seis indeterminadas (2.3 por cento). A queixa de dispepsia foi encontrada em 226 casos (85.2 por cento). Não houve associação significativa entre os sintomas dispépticos e a soro positividade para H. pylori. Concluímos que a soro prevalência para todas as faixas etárias é comparável com os resultados de outros estudos realizados em países em desenvolvimento, e maior que aquela encontrada nos países desenvolvidos. Houve aumento progressivo da positividade com a idade, como citado na literatura.

The risk of acquiring the new influenza A(H1N1) for Brazilian travelers to Chile, Argentina and the USA

We estimate the risk of acquiring the new influenza A(H1N1) for Brazilian travelers to Chile, Argentina and the USA. This is done by a mathematical model that quantifies the intensity of transmission of the new virus in those countries and the probability that one individual has of acquiring the influenza depending on the date of arrival and time spent in the area. The maximum estimated risk reached 7.5 cases per 10,000 visitors to Chile, 17 cases per 10,000 travelers to Argentina and 23 cases per 10,000 travelers to the USA. The estimated number of imported cases until 27 July is 57 ± 9 from Chile, 136 ± 27 from the USA and 301 ± 21 from Argentina, which are in accord with the official figures. Estimating the number of imported cases was particularly important for the moment of the disease introduction into this country, but it will certainly be important again as a tool to calculate the number of future imported cases from northern countries in our next inter-epidemic season, were imported cases can constitute again the majority of the new influenza burden to the Brazilian health services.

Metallo-beta-lactamases among imipenem-resistant Pseudomonas aeruginosa in a Brazilian university hospital

INTRODUCTION: Imipenem-resistant Pseudomonas aeruginosa resulting from metallo-β-lactamases has been reported to be an important cause of nosocomial infection and is a critical therapeutic problem worldwide, especially in the case of bacteremia. OBJECTIVES: To determine the frequency of metallo-β-lactamases among imipenem-resistant Pseudomonas aeruginosa isolates and to compare methods of phenotypic and molecular detection. METHODS: During 2006, 69 imipenem-resistant Pseudomonas aeruginosa samples were isolated from blood and tested for metallo-β-lactamase production using both phenotypic methods. Minimal Inhibitory Concentratrions (MIC) (μg/mL) was determined with commercial microdilution panels. Pulsed Field Gel Electrophoresis (PFGE) was performed among metallo-β-lactamase producers. RESULTS: Of all the blood isolates, 34.5 percent were found to be imipenem-resistant Pseudomonas aeruginosa. Positive phenotypic tests for metallo-β-lactamases ranged from 28 percent-77 percent, and Polymerase Chain Reaction (PCR) were positive in 30 percent (of note, 81 percent of those samples were blaSPM-1 and 19 percent were blaVIM-2). Ethylenediamine tetracetic acid (EDTA) combinations for the detected enzymes had low kappa values; thus, care should be taken when use it as a phenotypic indicator of MBL. Despite a very resistant antibiogram, four isolates demonstrated the worrisome finding of a colistin MIC in the resistant range. PFGE showed a clonal pattern. CONCLUSION: Metallo-β-lactamases among imipenem-resistant Pseudomonas aeruginosa were detected in 30.4 percent of imipenem-resistant Pseudomonas aeruginosa isolates. This number might have been higher if other genes were included. SPM-1 was the predominant enzyme found. Phenotypic tests with low kappa values could be misleading when testing for metallo-β-lactamases. Polymerase Chain Reaction detection remains the gold standard.

Analysis of antimicrobials' consumption profile in a University Hospital of Western Paraná, Brazil / Análise do perfil de antimicrobianos "consumo em um Hospital Universitário do Oeste do Paraná, Brasil

The objective of this study was to analyze the variation in antimicrobials' consumption and the costs related to their use at a University Hospital between 1999 and 2004. The annual consumption of nine antimicrobials, expressed in DDD/100 patients-day, and the direct costs with their acquisition were evaluated. Analysis of variance and regression techniques were used to compare data, considering a significance level of 5 percent. The most consumed antimicrobials were amikacin and ceftriaxone. In general, antimicrobials consumption, expressed in DDD/100 patients-day, increased from 9.21 in 1999 to 25.08 in 2004 (p<0.0001). When analyzing antimicrobial consumption as related to specific hospital units, the ICU showed the highest consumption followed by Chemotherapy and Medical Clinical units, respectively. In addition, the number of patients-day increased from 2671/month in 1999 to 3502/month in 2004, p<0.0001. As a consequence, total expenditure with antimicrobials increased from R$ 98.89 per 100 patients-day in 1999 to R$ 731.26 in 2004, p<0.0001. Between 1999 and 2004 significant increases in both consumption and financial expenditure with antimicrobials were observed.

O trabalho teve por objetivo analisar a variação do consumo e gastos financeiros com antimicrobianos em Hospital Universitário entre 1999 e 2004. Analisou-se 9 antimicrobianos, sendo o consumo expresso em DDDs/100 pacientes-dia e o preço médio de compra obtido do relatório da farmácia hospitalar. As variações anuais no consumo, o consumo por tipo de unidades de internação e gastos com cada antimicrobiano foram estudadas por análise de variância. Adotou-se 5 por cento como limiar de significância. Os antimicrobianos mais consumidos no período foram amicacina e ceftriaxona. Observou-se aumento no consumo dos antimicrobianos selecionados de 9,21 DDDs/100 pacientes-dia em 1999 para 25,08 em 2004 (p<0,0001). Entre as unidades de internação, a UTI apresentou o maior consumo médio, seguindo-se as unidades de Quimioterapia e Clínica Médica. A média mensal de pacientes-dia atendidos aumentou de 2671 em 1999 para 3502 em 2004 (p<0,0001). Observou-se aumento significativo nos gastos totais com antimicrobianos no período (R$ 98,89 x R$ 731,26 por 100 pacientes-dia entre 1999 e 2004, p<0,0001). Observou-se aumento significativo tanto na utilização quanto no gasto financeiro por 100 pacientes-dia diretamente relacionado à aquisição dos antimicrobianos estudados.

HIV infection and related risk behaviors in a community of recyclable waste collectors of Santos, Brazil / Infecção por HIV e comportamentos de risco relacionados em coletores de lixo de Santos, Brasil / Infección por HIV y comportamiento de riesgo relacionados con colectores de basura de Santos, Brasil

OBJECTIVE: To estimate the seroprevalence of HIV, hepatitis B and C and syphilis and to describe risk behaviors associated to their transmission among recyclable waste collectors. METHODS: A seroepidemiological survey was carried out in the city of Santos, Southeastern Brazil, in 2005. A total of 315 individuals were enrolled in the survey, of which 253 subjects underwent serological testing HIV, hepatitis B and C and syphilis. Statistical analysis consisted of univariate and bivariate analyses (cross-tabulation and odds ratio) and multivariate analysis (by logistic regression), relating HIV infection with established risk behaviors and seropositivity. RESULTS: Overall seroprevalences were: HIV, 8.9 percent; hepatitis B, 34.4 percent; hepatitis C, 12.4 percent; and syphilis, 18.4 percent. Subjects were characterized by a predominance of males with low educational and economic levels, subjected to parenteral and sexual exposures to HIV and other sexually transmitted infections. Multivariate analysis results indicated that risk factors for both sexually and parenterally related exposure were significantly associated with HIV in this community. CONCLUSIONS: Seroprevalences found in the study were approximately 10 to 12 times higher than the national average. These communities are socially marginalized and generally not recognized by national programs as potentially endangered populations.

OBJETIVO: Estimar a soroprevalência de HIV, Hepatites B e C e sífilis e descrever os comportamentos de risco associados à sua transmissão entre coletores autônomos de lixo. MÉTODOS: Um inquérito soroepidemiológico foi conduzido na cidade de Santos (SP), em 2005. Um total de 315 indivíduos foi incluído no estudo, dos quais 253 submeteram-se a testes sorológicos para HIV, Hepatites B e C e sífilis. A análise estatística consistiu de análises uni e bivariadas (tabulação cruzada e odds ratio) e análise multivariada (por regressão logística), relacionando a infecção por HIV com os fatores de risco estabelecidos e soropositividade. RESULTADOS: As soroprevalências totais foram: HIV, 8,9 por cento; Hepatite B, 34,4 por cento; Hepatite C, 12,4 por cento; e sífilis, 18,4 por cento. A amostra foi caracterizada por predominância de indivíduos do sexo masculino, com baixos níveis econômicos e educacionais e sujeitos a exposição parenteral e sexual ao HIV e outras doenças sexualmente transmissíveis. Os resultados da análise multivariada indicaram que fatores de risco ligados tanto à exposição sexual quanto à parenteral estão significativamente associados ao HIV nesta comunidade. CONCLUSÕES: As soroprevalências encontradas no estudo foram aproximadamente 10 a 12 vezes maiores que a média nacional. Estas comunidades são socialmente marginalizadas e geralmente não reconhecidas pelos programas nacionais como populações de risco potencial.

OBJETIVO: Estimar la seroprevalencia de HIV, Hepatitis B y C y sífilis y describir los comportamientos de riesgo asociados a la transmisión entre colectores autónomos de basura. MÉTODOS: Se realizó una investigación seroepidemiológica en la ciudad de Santos (Sudeste de Brasil), en 2005. Se realizaron análisis serológicas para HIV, Hepatitis B y C y sífilis a 253 individuos, de un total de 315 incluidos en el estudio. Los análisis estadísticos consistieron de pruebas uni y bivariadas (tabulación cruzada y odds ratio) y análisis multivariada (por regresión logística), relacionando la infección por HIV con los factores de riesgo establecidos y la seropositividad. RESULTADOS: Las seroprevalencias totales fueron: HIV, 8,9 por ciento; Hepatitis B, 34,4 por ciento; Hepatitis C, 12,4 por ciento; y sífilis, 18,4 por ciento. La muestra estuvo caracterizada por la predominancia de individuos del sexo masculino, con bajos niveles económicos y educacionales y sujetos a exposición parenteral y sexual al HIV y otras enfermedades transmisibles sexualmente. Los resultados del análisis multivariado indicaron que factores de riesgo unidos tanto a la exposición sexual como a la parenteral están significativamente asociados al HIV en esta comunidad. CONCLUSIONES: Las seroprevalencias encontradas en el estudio fueron aproximadamente 10 a 12 veces mayores que el promedio nacional. Estas comunidades son socialmente marginalizadas y generalmente no reconocidas por los programas nacionales como poblaciones de riesgo potencial.

Dynamics of the 2006/2007 dengue outbreak in Brazil

We analyzed dengue incidence in the period between October 2006-July 2007 of 146 cities around the country were Larval Index Rapid Assay (LIRA) surveillance was carried out in October 2006. Of these, we chosen 61 cities that had 500 or more cases reported during this period. We calculated the incidence coefficient, the force of infection (¼) and the basic reproduction number (R0) of dengue in those 61 cities and correlated those variables with the LIRA. We concluded that ¼ and R0 are more associated with the number of cases than LIRA. In addition, the average R0 for the 2006/2007 dengue season was almost as high as that calculated for the 2001/2002 season, the worst in Brazilian history.

Monitoração terapêutica da azatioprina: uma revisão: [revisão] / Therapeutic drug monitoring of azathioprine: a review: [review]

Os nucleotídeos de tioguanina (6-TGN), metabólitos ativos da azatioprina (AZA) e da 6-mercaptopurina (6-MP), atuam como antagonistas das purinas, inibindo as sínteses de DNA, RNA e a protéica, e induzindo à citotoxicidade/imunossupressão. A enzima geneticamente determinada, tiopurina metiltransferase (TPMT), está envolvida no metabolismo desses agentes e, hipoteticamente, determina a resposta clínica às tiopurinas. A baixa atividade dessa enzima diminui a metilação das tiopurinas, resultando em potencial sobredose, enquanto altos níveis de TPMT levam à superprodução do metabólito tóxico 6-metilmercaptopurina (6-MMP) e à não-efetividade terapêutica da AZA e da 6-MP. Várias mutações no gene da TPMT têm sido identificadas e correlacionadas com fenótipos de baixa atividade. Neste artigo, também se discute a monitoração terapêutica desses fármacos por meio da medida dos níveis de 6-TGN intra-eritrocitários, os quais se correlacionam com imunossupressão e mielotoxicidade. Já a 6-MMP está diretamente relacionada com hepatotoxicidade. Esses ensaios estão associados ao uso de doses adequadas dessa droga, resultando num melhor controle da doença e menor uso de corticosteróides.

Thioguanine nucleotides (6-TGN), active metabolites of azathioprine (AZA) and 6-mercaptopurine (6-MP), act as purine antagonists, inhibiting DNA, RNA, and protein synthesis and inducing cytotoxicity and immunosuppression. The genetically determined thiopurine methyltransferase enzyme (TPMT) is involved in the metabolism of these agents and, theoretically, determines the clinical response to thiopurines. Low activity of this enzyme decreases the methylation of thiopurines, what results in potential overdosing, whereas high TPMT status leads to overproduction of toxic metabolite 6-methilmercaptopurine (6-MMP) and ineffectiveness of AZA and 6-MP. Several mutations in the TPMT gene have been identified and correlated with low activity phenotypes. In this study, we also discuss the therapeutic monitoring of these drugs by means of red blood cell 6-TGN levels, which correlate with immunosuppression and mielotoxicity. 6-MMP is directly connected with hepatotoxicity. These metabolites assays are associated with the use of appropriate doses of this drug, what results in a better control of the disease and a decreased use of corticosteroids.

Progressive resistance training in elderly hiv-positive patients: does it work?

BACKGROUND: Elderly people present alterations in body composition and physical fitness, compromising their quality of life. Chronic diseases, including HIV/AIDS, worsen this situation. Resistance exercises are prescribed to improve fitness and promote healthier and independent aging. Recovery of strength and physical fitness is the goal of exercise in AIDS wasting syndrome. OBJECTIVE: This study describes a case series of HIV-positive elderly patients who participated in a progressive resistance training program and evaluates their body composition, muscular strength, physical fitness and the evolution of CD4+ and CD8+ cell counts. METHODS: Subjects were prospectively recruited for nine months. The training program consisted of three sets of 8-12 repetitions of leg press, seated row, lumbar extension and chest press, performed with free weight machines hts, twice/week for one year. Infectious disease physicians followed patients and reported all relevant clinical data. Body composition was assessed by anthropometric measures and dual-energy x-ray absorptiometry before and after the training program. RESULTS: Fourteen patients, aged 62-71 years old, of both genders, without regular physical activity who had an average of nine years of HIV/AIDS history were enrolled. The strengths of major muscle groups increased (74 percent-122 percent, p=0.003-0.021) with a corresponding improvement in sit-standing and walking 2.4 m tests (p=0.003). There were no changes in clinical conditions and body composition measures, but triceps and thigh skinfolds were significantly reduced (p=0.037). In addition, there were significant increases in the CD4+ counts (N=151 cells; p=0.008) and the CD4+/CD8+ ratio (0.63 to 0.81, p=0.009). CONCLUSION: Resistance training increased strength, improved physical fitness, reduced upper and lower limb skinfolds, and were associated with an improvement in the CD4+ and CD4+/CD8+ counts in HIV positive elderly patients without ...

Validação de metodologia para dosagem de porfirinas urinárias por cromatografia líquida de alta eficiência / Validation of a high performance liquid chromatography method for quantification of urinary porphyrins

Porfirinas são produtos originados da biossíntese do heme. As enzimas envolvidas neste processo podem ter sua atividade inibida por fatores genéticos, adquiridos ou uma combinação de ambos, acarretando um aumento sérico do substrato correspondente que será eliminado pela urina. Considerando-se a importância do diagnóstico precoce nas alterações da biossíntese do heme, o objetivo deste trabalho foi desenvolver um método de cromatografia líquida de alta eficiência (CLAE) com detecção por fluorescência, sensível o suficiente para identificar cinco frações de porfirinas urinárias: uroporfirina (8-carboxil porfirina), heptaporfirina (7-carboxil porfirina), hexaporfirina (6-carboxil porfirina), pentaporfirina (5-carboxil porfirina) e coproporfirina I e III (4- carboxil porfirinas). Métodos de extração por detecção espectrofotométrica não são sensíveis para este propósito. O cromatógrafo utilizado, da marca Shimadzu, é composto de duas bombas, injetor automático e detector de fluorescência (RF-535) com excitação de 400 nm e emissão de 620 nm. Foi utilizada uma coluna de fase reversa com um programa de gradiente linear. O método desenvolvido apresentou linearidade de 8,0 a 120,0 µg/L para as frações de interesse, demonstrando ser adequado na identificação e quantificação das porfirinas com diferentes grupos carboxílicos, importantes para o diagnóstico precoce e acompanhamento de porfirias.

Porphyrins are products that originate from the heme biosyntetic pathway. Enzymes that take part in this route can have their activity inhibited due to inherited/acquired or both factors resulting in increased serum heme precursor that will be eliminated in urine. Considering the importance of early detection of heme biosynthesis alterations, the purpose of this study was to establish a high pressure liquid chromatographic (HPLC) method with fluorescence detection, to detect five fractions of porphyrins: uroporphyrin (8-carboxyporphyrin), heptaporphyrin (7-carboxyporphyrin), hexaporphyrin (6-carboxyporphyrin), pentaporphyrin (5-carboxyporphyrin) and coproporphyrin I and III (4- carboxyporphyrin). Extraction methods with spectrophotometric detection are not sensitive enough for this purpose. The HPLC (Shimadzu Co., Kioto, Japan) was composed of two high-pressure pumps, auto-sampler and fluorescence detector (RF-535) with excitation at 400 nm and emission at 620 nm. The sample was eluted from a reversed-phase column with a linear gradient. The linearity of the method was from 8.0 to 120 µg/L for all fractions, proving its ablility to identify and quantify porphyrins with differents carboxylic groups for early diagnosis and follow-up of porphyrias.