Clinical outcomes of intravitreal treatment for ocular toxoplasmosis: systematic review and meta-analysis

ABSTRACT Background: Ocular toxoplasmosis is the leading cause of infectious posterior uveitis worldwide, accounting for 30-50% of all cases in immunocompetent patients. Conventional treatment is associated with adverse effects and does not prevent recurrence. Intravitreal drug administration can improve disease outcomes and reduce side effects. Herein, we conducted a systematic review and meta-analysis on the efficacy of intravitreal injections for treating ocular toxoplasmosis. Methods: The systematic search was conducted using PubMed, SciELO, and Google Scholar with the descriptors "ocular toxoplasmosis" AND "intravitreal". We analyzed studies that met the inclusion criteria, i.e., experimental cases in patients treated intravitreally for ocular toxoplasmosis. Considering the systematic review, we focused on the number of intravitreal injections, the therapeutic drug class, and the presence of preexisting conditions. To assess the efficacy of intravitreal injections, a meta-analysis was performed using visual acuity, side effects, disease recurrence, and inflammatory responses as variables. Results: Intravitreal injection-induced side effects were rarely observed (0.49% [0.00, 1.51%] ). The use of antiparasitic and anti-inflammatory drugs afforded improved visual acuity (99.81% [98.60, 100.00%]) and marked effectiveness in treating ocular toxoplasmosis. Conclusions: Intravitreal injections may facilitate the successful treatment of ocular toxoplasmosis. However, clinicians should carefully evaluate the presence of preexisting conditions for ocular toxoplasmosis or previous diseases, as these can impact the decision to administer intravitreal injections.

Hepatitis B prevalence in Brazilian waste pickers: a systematic review with meta-analysis

ABSTRACT OBJECTIVE: To describe the hepatitis B prevalence in Brazilian waste pickers. METHODS: We performed a literature search in the SciELO, Biblioteca Virtual em Saúde (BVS), PubMed and Web of Science databases using the descriptors: "hepatitis B" AND ("informal recycling" OR "waste picker" OR "recyclable waste collectors" OR "solid waste segregator") AND ("recyclable waste" OR "solid waste") AND Brazil. Epidemiological studies on HBV in Brazilian waste pickers published prior to February 2020 were included and evaluated for quality and bias using a funnel plot. RESULTS: This meta-analysis consisted of five articles. Prevalence of HBV surface antigen seropositivity was 14% (95%CI: 6%-22%) in Brazilian waste pickers. CONCLUSION: HBV prevalence in Brazilian waste pickers remains high. There should be more campaigns showing the importance of vaccination and personal protective equipment use.

Correlação estatística entre parâmetros microscópicos e microbiológicos em pimenta-do-reino moída (Piper nigrum L) comercializada em Minas Gerais / Statistical correlation between microscopic and microbiological parameters in ground black pepper ( Pipper nigrum L) sold in Minas Gerais

A ausência de Boas Práticas de Fabricação durante a colheita, processamento e manuseio da pimenta-do-reino pode acarretar a contaminação do produto com sujidades microscópicas e microrganismos. Foram analisadas 227 amostras de pimenta-do-reino, comercializadas em Minas Gerais, coletadas entre 2008 e 2018, quanto à presença de fragmentos de pelo de roedor e de insetos, coliformes a 45°C ou Escherichia coli e Salmonella spp. Para verificar se havia correlação entre os contaminantes, foi empregado método estatístico de regressão linear múltipla. As análises microscópicas evidenciaram presença de fragmentos de pelo de roedor e de insetos em 26,0% e 30,5% das amostras, respectivamente, em valores superiores ao limite tolerado pela RDC 14/2014. Quanto às análises microbiológicas, 10% das amostras apresentaram coliformes a 45°C ou E. coli acima dos limites tolerados pela RDC 12/2001 e em 8,8% das amostras foi detectada presença de Salmonella spp. A avaliação estatística mostrou que houve correlação entre presença de fragmentos de insetos e de pelos de roedor e a contaminação por Salmonella spp. em pimenta-do-reino. Os resultados demonstraram a importância das análises microscópica e microbiológica simultaneamente para detecção dos contaminantes presentes bem como das possíveis relações existentes entre eles e a melhor compreensão dos fatores que favorecem as contaminações. (AU)

The absence of Good Manufacturing Practices during harvesting, processing and handling of black pepper can lead to contamination of the product with microscopic dirt and microrganisms. Two hundred and twenty seven black pepper samples, commercialized in Minas Gerais, collected between 2008 and 2018, were analyzed for the presence of rodent and insect fragments, coliforms at 45°C or Escherichia coli and Salmonella spp. To verify whether there was a correlation between the contaminants, a statistical method of multiple linear regression was used. Microscopic analysis showed the presence of rodent and insect fragments in 26.0% and 30.5% of the samples, respectively, in values above the limit tolerated by RDC14/2014. As for the microbiological analysis, 10% of the samples presented coliforms at 45°C or E.coli above the limits tolerated by the RDC 12/2001 and in 8.8% of the samples Salmonella spp. were detected. The statistical evaluation showed that there was a relationship between the presence of insect fragments and rodent hair and contamination by Salmonella spp. in black pepper. The results demonstrated the importance of simultaneous microscopic and microbiological analysis to detect the contaminants present, as well as the possible relationships between them and better understanding of the factors that favor contamination. (AU)

Correlação estatística entre parâmetros microscópicos e microbiológicos em pimenta-do-reino moída (Piper nigrum L) comercializada em Minas Gerais / Statistical correlation between microscopic and microbiological parameters in ground black pepper (Pipper nigrum L) sold in Minas Gerais

A ausência de Boas Práticas de Fabricação durante a colheita, processamento e manuseio da pimenta-do-reino pode acarretar a contaminação do produto com sujidades microscópicas e microrganismos. Foram analisadas 227 amostras de pimenta-do-reino, comercializadas em Minas Gerais, coletadas entre 2008 e 2018, quanto à presença de fragmentos de pelo de roedor e de insetos, coliformes a 45°C ou Escherichia coli e Salmonella spp. Para verificar se havia correlação entre os contaminantes, foi empregado método estatístico de regressão linear múltipla. As análises microscópicas evidenciaram presença de fragmentos de pelo de roedor e de insetos em 26,0% e 30,5% das amostras, respectivamente, em valores superiores ao limite tolerado pela RDC 14/2014. Quanto às análises microbiológicas, 10% das amostras apresentaram coliformes a 45°C ou E. coli acima dos limites tolerados pela RDC 12/2001 e em 8,8% das amostras foi detectada presença de Salmonella spp. A avaliação estatística mostrou que houve correlação entre presença de fragmentos de insetos e de pelos de roedor e a contaminação por Salmonella spp. em pimenta-do-reino. Os resultados demonstraram a importância das análises microscópica e microbiológica simultaneamente para detecção dos contaminantes presentes bem como das possíveis relações existentes entre eles e a melhor compreensão dos fatores que favorecem as contaminações.

The absence of Good Manufacturing Practices during harvesting, processing and handling of black pepper can lead to contamination of the product with microscopic dirt and microrganisms. Two hundred and twenty seven black pepper samples, commercialized in Minas Gerais, collected between 2008 and 2018, were analyzed for the presence of rodent and insect fragments, coliforms at 45°C or Escherichia coli and Salmonella spp. To verify whether there was a correlation between the contaminants, a statistical method of multiple linear regression was used. Microscopic analysis showed the presence of rodent and insect fragments in 26.0% and 30.5% of the samples, respectively, in values above the limit tolerated by RDC14/2014. As for the microbiological analysis, 10% of the samples presented coliforms at 45°C or E.coli above the limits tolerated by the RDC 12/2001 and in 8.8% of the samples Salmonella spp. were detected. The statistical evaluation showed that there was a relationship between the presence of insect fragments and rodent hair and contamination by Salmonella spp. in black pepper. The results demonstrated the importance of simultaneous microscopic and microbiological analysis to detect the contaminants present, as well as the possible relationships between them and better understanding of the factors that favor contamination.

Gestão adequada de resíduos sólidos como fator de proteção na ocorrência da dengue / Adequate solid waste management as a protection factor against dengue cases / Gestión adecuada de los residuos sólidos como factor de protección contra los casos de dengue

RESUMO Objetivo. Verificar a existência de associação de indicadores de gestão de resíduos sólidos e socioeconômicos municipais com índices de incidência de dengue, Zika e Chikungunya nos municípios do estado brasileiro de Minas Gerais. Métodos. Este estudo de caráter exploratório, quantitativo e transversal abrangeu os 853 municípios do estado de Minas Gerais. Todos os dados utilizados foram secundários, coletados e agrupados por regionais de planejamento. Como variáveis independentes, foram consideradas a cobertura de coleta de resíduos sólidos urbanos, cobertura de coleta seletiva e massa de resíduos sólidos urbanos, além de um indicador da qualidade da destinação final de resídulos, índices de desenvolvimento humano municipal e de Gini, renda mensal per capita e porcentagem de vulneráveis à pobreza. Os fatores potencialmente associados aos desfechos - incidências municipais de dengue, Chikungunya e Zika - foram selecionados inicialmente através de análises univariadas. Posteriormente, os modelos de regressão linear para as incidências de dengue, Chikungunya ou Zika foram gerados considerando os preditores selecionados pela análise univariada. Resultados. Não foi observada associação entre gestão de resíduos sólidos e incidência de Chikungunya e Zika. Por sua vez, a incidência de dengue associou-se à gestão de resíduos sólidos e apresentou relação inversa significativa com o percentual de vulneráveis à pobreza. Houve também associação direta o índice de Gini, sugerindo que quanto maiores os registros de incidência de dengue de 2007 a 2016, maiores os valores de Gini dos municípios - ou seja, maior a desigualdade social. A cobertura da coleta seletiva apresentou relação inversa e significativa com os casos de dengue, sugerindo que quanto menor a cobertura da coleta de seletiva, maiores foram os casos registrados de dengue. Conclusões. A gestão de resíduos sólidos pode influenciar os casos de dengue e, por isso, deve ser considerada nas ações de saúde pública.(AU)

ABSTRACT Objective. To investigate whether solid waste management and municipal socioeconomic indicators are associated with incidence rates of dengue, Zika, and Chikungunya in municipalities located in the state of Minas Gerais, Brazil. Methods. This exploratory, quantitative, cross-sectional study included all the 853 municipalities of Minas Gerais. Only secondary data were used, collected and grouped according to planning regions. Independent variables included regular urban solid waste collection, separated waste collection, and urban solid waste mass, in addition to a quality indicator of final waste disposal, municipal human development and Gini indices, monthly per capita income, and percentage of population vulnerable to poverty. The factors potentially associated with outcomes - municipal incidence of dengue, Chikungunya, and Zika - were initially selected by univariate analysis, followed by linear regression analysis for the incidence of dengue, Chikungunya, or Zika using the predictors selected through univariate analysis. Results. Solid waste management was not associated with incidence of Zika or Chikungunya. In turn, the incidence of dengue was associated with solid waste management and had a significant inverse association with percent population vulnerable to poverty. A direct association was also observed with Gini index, suggesting that the higher the incidence of dengue from 2007 to 2016, the higher the municipal Gini coefficient and thus social inequality. Selective waste collection was inversely and significantly correlated with dengue cases, suggesting that the lower the coverage by regular separated waste collection, the higher the number of dengue cases. Conclusions. Solid waste management may influence the occurrence of dengue cases, and therefore should be considered in the planning of public health actions.(AU)

RESUMEN Objetivo. Investigar si el manejo de los residuos sólidos y los indicadores socioeconómicos municipales están asociados con las tasas de incidencia de dengue, zika y chikunguña en los municipios del estado de Minas Gerais, Brasil. Métodos. Estudio exploratorio, cuantitativo y transversal que incluyó los 853 municipios de Minas Gerais. Sólo se utilizaron datos secundarios, recopilados y agrupados según las regiones de planificación. Las variables independientes incluyeron la recolección urbana regular de residuos sólidos, la recolección separada de residuos y la masa de residuos sólidos urbanos, además de un indicador de calidad de la eliminación final de desechos, el desarrollo humano municipal y los índices de Gini, el ingreso mensual per cápita y el porcentaje de población vulnerable a la pobreza. Los factores potencialmente asociados con los resultados -incidencia municipal de dengue, zika y chikunguña- se seleccionaron inicialmente mediante un análisis univariado, seguido de un análisis de regresión lineal para la incidencia del dengue, zika o chikunguña utilizando los predictores seleccionados mediante el análisis univariado. Resultados. El manejo de residuos sólidos no se asoció con la incidencia de zika o chikungunya. A su vez, la incidencia del dengue se asoció con un manejo sólido y tuvo una asociación inversa significativa con el porcentaje de población vulnerable a la pobreza. También se observó una asociación directa con el índice de Gini, lo que sugiere que cuanto mayor sea la incidencia del dengue entre 2007 y 2016, mayor será el coeficiente de Gini municipal y, por lo tanto, la desigualdad social. La recolección selectiva de residuos se correlacionó de manera significativa e inversa con los casos de dengue, lo que sugiere que cuanto menor sea la cobertura de la recolección regular selectiva de residuos, mayor será el número de casos de dengue. Conclusiones. La gestión de los residuos sólidos puede influir en la aparición de casos de dengue y, por lo tanto, debe considerarse en la planificación de las medidas de salud pública.(AU)

Hepatitis delta prevalence in South America: a systematic review and meta-analysis

Abstract Hepatitis delta virus (HDV) has been associated with acute or chronic hepatitis in Latin America, but there is no prevalence study covering South American countries. This meta-analysis aimed to estimate anti-HDV prevalence through a systematic review of published articles in English, Portuguese and Spanish until December 2017. Searches were conducted in Health Virtual Library, Capes, Lilacs, PubMed, and SciELO, according to defined criteria regarding participant selection and geographical setting. Study quality was assessed using the GRADE guidelines. Pooled anti-HDV prevalence was calculated using the DerSimonian-Laird random-effects model with Freeman-Tukey double arcsine transformation. Out of the 405 identified articles, only 31 met the eligibility criteria for inclusion in the meta-analysis. In South America, pooled anti-HDV prevalence among hepatitis B virus carriers was 22.37% (95% confidence interval: 13.72-32.26), though it appeared less frequently in some countries and populations, according to the data collection date. The findings indicated significant successive reductions in anti-HDV prevalence over thirty years. However, there was a scarcity of HDV epidemiological studies outside the Amazon Basin, notably in the Southwest continent and absence of target population standardization. There was a high HDV prevalence in South American countries, despite differences in methodological characteristics and outcomes, highlighting a drastic decline in the last decades. Future studies should identify HDV prevalence estimates in other regions of the continent and identify risk factors.

Is waste collection associated with hepatitis B infection? A meta-analysis

Abstract This meta-analysis, which is based on a previously published systematic review, aims to contribute to the scientific discussion on hepatitis B virus (HBV) infection in workers who are exposed to domestic and healthcare wastes. Publications were sought which had been made available on the data used by December 2013 and updated to December 2016. The quality of the included studies was assessed according to the guidelines of Loney et al. for the critical appraisal of studies on the prevalence or incidence of a health problem. To verify the presence of heterogeneity between the papers, we used the Chi-squared test based on a Q statistic. A funnel plot was used to test for publication bias. All included studies had across-sectional study design. The association between exposure to waste and positive serology for the HBV surface antigen (HBsAg) showed a significant association [odds ratio (OR) 1.89, 95% confidence interval (CI) 1.27-2.86; p = 0.0019]. The prevalence rates of HBsAg and anti-HBc seropositivity was 0.04 (95% CI 0.03-0.05) and 0.21 (95% CI 0.14-0.28), respectively (p <0.0001). We found no evidence of publication bias. The results of this meta-analysis indicate a statistically significant association between exposure to solid waste, whether healthcare or domestic, and positive HBV infection markers. Therefore, the working conditions of waste collectors should be analyzed more closely. Immunization against HBV is recommended as the chief preventive measure for all solid waste workers.

Destinação de resíduos de serviços de saúde do subgrupo A4: política baseada em evidência ou em intuição? / Disposal of medical wastes (A4 subgroup): evidence-based or intuitive policy?

RESUMO A destinação dos resíduos de serviços de saúde (RSS) representa uma discussão ampla e polêmica, e o momento de revisão da resolução da diretoria colegiada n.º 306/2004, da Agência Nacional de Vigilância Sanitária (ANVISA), é oportuno para ampliar esse debate. Nesse contexto, este artigo buscou, por meio da revisão de publicações científicas, subsidiar escolhas que favoreçam a sustentabilidade ambiental e a proteção da saúde humana na destinação dos RSS. Foram realizadas pesquisa bibliográfica, em âmbitos nacional e internacional, e a revisão de instrumentos legais que regulam a destinação dos RSS no Brasil. As resoluções da ANVISA (n.º 306/2004) e do Conselho Nacional do Meio Ambiente (n.º 358/2005) mostram que a disposição final dos RSS do subgrupo A4 pode ser feita em local licenciado para receber RSS, sem tratamento prévio. Diversas publicações científicas apontam para a falta de evidências quanto à existência de riscos aumentados para o ambiente e à saúde humana dos RSS se comparados aos resíduos sólidos domiciliares e explicam que ambos poderiam ter destinação final com base nos mesmos requisitos. A segregação dos RSS de acordo com os riscos reais de cada grupo e no momento da geração, assim como o acondicionamento como barreira de proteção, é o procedimento mais seguro de gerenciamento de risco contra contaminações e acidentes, sobrepondo-se aos requisitos para a destinação final. A exigência de tratar previamente os resíduos do subgrupo A4 antes de serem aterrados, conforme defendem alguns, poderia resultar em desnecessária elevação dos custos do processo sem evidência de redução dos riscos envolvidos.

ABSTRACT The disposal of healthcare waste (HCW) is a controversial and wide discussion, and the review of the Collegiate Directorate Resolution no. 306/2004, from the National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária - ANVISA), a Brazilian regulation, is appropriate to increase this debate. In this context, through the review of scientific publications, this paper supports choices that promote environmental sustainability and the protection of human health during the HCW disposal process. A bibliographical research including national and international levels and a review of legal instruments about HCW management in Brazil were done. The rules of ANVISA (no. 306/2004) and National Environment Council (no. 358/2005) point out that the final disposal of HCW, specially the subgroup A4, could be done in certified place to disposal HCW, without prior treatment. Several scientific papers mention the lack of evidences about increased risks of some kinds of HCW when compared to domestic waste, and these wastes may have final disposal based on the same criteria. Segregation of the HCW according to the real risks of each group at the moment of the generation of waste, as well as the packaging as a protective barrier, configures a safer risk management procedures against contamination and accidents. The requirement to treat the A4 subgroup before landfill disposal, as argue by some researchers, could represent an increase of unnecessary economical costs without evidences of risk reduction.