A cost-effectiveness analysis of a novel algorithm to sequentially diagnose leprosy based on manufactured tests under the SUS perspective.

Brazil has the second largest number of leprosy cases (a disease with a significant burden) in the world. Despite global and local efforts to eliminate this public health problem, inadequate or late diagnosis contribute to perpetuate its transmission, especially among household contacts. Tests such as the rapid IgM antibody detection (RT) and real-time polymerase chain reaction (RT-PCR) were developed to overcome the challenges of early diagnosis of leprosy. This study aimed to analyze the cost-effectiveness of a new diagnostic algorithm recommended by the Brazilian government to diagnose leprosy in household contacts of confirmed leprosy cases, which includes the RT and RT-PCR tests. A decision tree model was constructed and the perspective of the Brazilian Unified National Health System (SUS) and a 1-year time horizon were adopted. Only direct medical costs related to diagnostic tests were included. Effectiveness was measured as the number of avoided undiagnosed leprosy cases. Different scenarios were analyzed. The sequential use of RT, slit-skin smear (SSS) microscopy, and RT-PCR as recommended by the Brazilian Ministry of Health was compared to a base case (isolated SSS microscopy), yielding an incremental cost-effectiveness ratio of USD 616.46 per avoided undiagnosed leprosy case. Univariate sensitivity analysis showed that the prevalence of leprosy among household contacts was the variable that influenced the model the most. This is the first economic model to analyze a diagnostic algorithm of leprosy. Results may aid managers to define policies and strategies to eradicate leprosy in Brazil.

Cost-Utility Model of Nirmatrelvir/Ritonavir in Brazil: Analysis of a Vaccinated Population.

OBJECTIVES: The aim of this study is to conduct a cost-utility analysis of the use of the antiviral nirmatrelvir/ritonavir, applied to a vaccinated Brazilian population against COVID-19, from the perspective of the Brazilian Public Health System (SUS). METHODS: A microsimulation model was created with individual-level data and daily cycles, with a 1-year time horizon, to compare the current scenario of standard care with a scenario in which nirmatrelvir/ritonavir is offered to the population. Adults of any age group that received ≥2 doses of the COVID-19 vaccine formed the investigated population. Direct medical costs of the outpatients and inpatients admitted to the ward or intensive care unit were included. The effectiveness of the model was measured in quality-adjusted life-years (QALYs). RESULTS: In all simulations, the use of nirmatrelvir/ritonavir resulted in incremental costs per patient of US dollar (USD)245.86 and incremental effectiveness of 0.009 QALY, over a year. The incremental cost-utility ratio was USD27 220.70/QALY. The relative risk of the vaccinated population was the factor that affected the outcome most, according to the univariate sensitivity analysis. The probabilistic sensitivity analysis resulted in 100% of the simulations being more costly and effective, but that only 4% of them were below the established cost-effectiveness threshold of USD24 000.00/QALY. In the scenario considering only the population over 60 years old and immunosuppressed (of any age), the incremental cost-utility ratio was USD7589.37/QALY. CONCLUSIONS: The use of nirmatrelvir/ritonavir in the treatment of COVID-19 in a vaccinated population was cost-effective only for immunosuppressed individuals and people over 60 years of age.

A cost-effectiveness analysis of a novel algorithm to sequentially diagnose leprosy based on manufactured tests under the SUS perspective / Análise de custo-efetividade de um novo algoritmo para exame sequencial de hanseníase baseado em testes fabricados sob a perspectiva do SUS / Análisis de costo-efectividad de un nuevo algoritmo para el examen secuencial de lepra basado en pruebas fabricadas bajo la perspectiva del SUS

Abstract: Brazil has the second largest number of leprosy cases (a disease with a significant burden) in the world. Despite global and local efforts to eliminate this public health problem, inadequate or late diagnosis contribute to perpetuate its transmission, especially among household contacts. Tests such as the rapid IgM antibody detection (RT) and real-time polymerase chain reaction (RT-PCR) were developed to overcome the challenges of early diagnosis of leprosy. This study aimed to analyze the cost-effectiveness of a new diagnostic algorithm recommended by the Brazilian government to diagnose leprosy in household contacts of confirmed leprosy cases, which includes the RT and RT-PCR tests. A decision tree model was constructed and the perspective of the Brazilian Unified National Health System (SUS) and a 1-year time horizon were adopted. Only direct medical costs related to diagnostic tests were included. Effectiveness was measured as the number of avoided undiagnosed leprosy cases. Different scenarios were analyzed. The sequential use of RT, slit-skin smear (SSS) microscopy, and RT-PCR as recommended by the Brazilian Ministry of Health was compared to a base case (isolated SSS microscopy), yielding an incremental cost-effectiveness ratio of USD 616.46 per avoided undiagnosed leprosy case. Univariate sensitivity analysis showed that the prevalence of leprosy among household contacts was the variable that influenced the model the most. This is the first economic model to analyze a diagnostic algorithm of leprosy. Results may aid managers to define policies and strategies to eradicate leprosy in Brazil.

Resumo: O Brasil tem o segundo maior número de casos de hanseníase (doença com carga significativa) do mundo. Apesar dos esforços globais e locais para eliminar esse problema de saúde pública, o diagnóstico inadequado ou tardio contribui para perpetuar sua transmissão, especialmente entre contatos intradomiciliares. Exames como o teste rápido de anticorpos IgM (RT) e a reação em cadeia da polimerase em tempo real (RT-PCR) foram desenvolvidos para superar as barreiras do diagnóstico precoce da hanseníase. Este estudo teve como objetivo analisar a relação custo-efetividade de um novo algoritmo de diagnóstico recomendado pelo governo brasileiro para diagnosticar a hanseníase em contatos domiciliares de casos confirmados de hanseníase, que inclui os testes RT e RT-PCR. Foi construído um modelo de árvore de decisão e adotada a perspectiva do Sistema Único de Saúde (SUS) considerando o período de um ano. Foram incluídos apenas os custos médicos diretos relacionados aos exames diagnósticos. A efetividade foi medida considerando o número de casos evitados de hanseníase. Diferentes cenários foram analisados. O uso sequencial de RT, baciloscopia e RT-PCR, conforme recomendado pelo Ministério da Saúde, foi comparado a um caso base (baciloscopia isolada), obtendo-se uma razão de custo-efetividade incremental de USD 616,46 por caso evitado de hanseníase. A análise de sensibilidade univariada mostrou que a prevalência de hanseníase entre contatos intradomiciliares foi a variável que mais influenciou o modelo. Este é o primeiro modelo econômico a analisar um algoritmo diagnóstico da hanseníase. Os resultados poderão auxiliar os gestores na definição de políticas e estratégias para a erradicação da hanseníase no Brasil.

Resumen: Brasil tiene el segundo mayor número de casos de lepra (enfermedad con carga significativa) del mundo. A pesar de los esfuerzos globales y locales para eliminar ese problema de salud pública, el diagnóstico inadecuado o tardío contribuye a perpetuar su transmisión, sobre todo entre contactos intradomiciliarios. Los exámenes como la prueba rápida de anticuerpos IgM (RT) y la reacción en cadena de la polimerasa en tiempo real (RT-PCR) se desarrollaron para superar las barreras del diagnóstico precoz de la lepra. El objetivo de este estudio fue analizar la relación de costo-efectividad de un nuevo algoritmo de diagnóstico recomendado por el gobierno brasileño para diagnosticar la lepra en contactos domiciliarios de casos confirmados de lepra, que incluye las pruebas RT y RT-PCR. Se construyó un modelo de árbol de decisión y se adoptó la perspectiva del Sistema Único de Salud (SUS) teniendo en cuenta el periodo de un año. Solo se incluyeron los costos médicos directos relacionados con los exámenes diagnósticos. Se midió la efectividad teniendo en cuenta el número de casos de lepra evitados. Se analizaron distintos escenarios. Se comparó el uso secuencial de RT, baciloscopia y RT-PCR, conforme el Ministerio de Salud recomienda, con un caso base (baciloscopia aislada), y se obtuvo un cociente de costo-efectividad incremental de USD 616,46 por cada caso de lepra evitado. El análisis de sensibilidad univariante mostró que la prevalencia de lepra entre contactos intradomiciliarios fue la variable que más influyó el modelo. Este es el primer modelo económico que analiza un algoritmo diagnóstico de lepra. Los resultados podrán ayudar los gestores a definir políticas y estrategias para erradicar la lepra en Brasil.

The ichthyofauna of streams from the Purus-Madeira interfluve: composition, new records, and conservation status for the south of the Amazon / A ictiofauna de igarapés do interflúvio Purus-Madeira: composição, novos registros de ocorrência e estado atual de conservação no sul do Amazonas

Abstract This study presents a survey of small-stream fish species from the Purus-Madeira interfluve, collected in four streams near Humaitá on the highway BR-319. The results reveal a rich and diversified ichthyofauna with 3016 collected individuals distributed in 84 species, six orders, 25 families, and 60 genera. Of all the specimens collected, the Characiformes was the most representative, with eight families, 26 genera, and 42 species, followed Siluriformes, with nine families, 20 genera, and 23 species. In terms of families, Characidae had the highest number of species (25), followed by Loricariidae (9), and Cichlidae (8). Among the 95 captured species,s 11 are the first records for the region, evidencing a high diversity in these environments. Of the 84 species recorded in this study, 15 have not been assessed by the IUCN, while the remaining 62 include 23 listed as Least Concern (LC), three as data deficient (DD), and one as Near Threatened (NT). The southeastern Amazon region still has few fish surveys, especially in the region comprising the Purus-Madeira Interfluve, which highlights the importance of surveys to fill gaps and understand the biodiversity distribution patterns in the region.

Resumo Este estudo apresenta um levantamento das espécies de peixes de pequenos riachos do interflúvio Purus-Madeira, coletadas em quatro riachos perto de Huimaitá na rodovia BR-319. Os resultados revelam uma ictiofauna rica e diversificada com 3016 indivíduos distribuídos em 84 espécies, seis ordens, 25 famílias e 60 gêneros. De todos os espécimes coletados, Characiformes foi a mais representativa, com oito famílias, 26 gêneros e 42 espécies, seguida da Siluriformes, com 9 famílias, 20 gêneros e 23 espécies. Em termos de famílias, Characidae apresentou o maior número de espécies (25), seguida de Loricariidae (9) e Cichlidae (8). Dentre as espécies capturadas, do total de 84 espécies, 11 são o primeiro registro da região, evidenciando uma alta diversidade nesses ambientes. Das 84 espécies registradas neste trabalho, 15 não foram avaliadas pela IUCN, 63 listadas como Menos Preocupante (LC), quatro como Deficientes em Dados (DD) e uma como Quase Ameaçada (NT). A região sudoeste da Amazônia ainda conta com poucos levantamentos de peixes, principalmente na região que compreende o Interflúvio Purus-Madeira, por isso é importante realizar levantamentos para preencher lacunas de coletas e compreender padrões de distribuição da biodiversidade da região.

Lateral exposure of the proximal and distal peroneal artery without bone resection.

Surgical revascularization with distal bypass surgery is associated with good outcomes for chronic limb-threatening ischemia. The peroneal artery, the most-often preserved outflow vessel, is commonly reached through a lateral approach involving resection of the fibula. We present two different techniques for a lateral approach to the peroneal artery: the first by proximal exposure and the second by exposing the distal segment of the peroneal artery. Both techniques are performed without bone resection.

Novel Rodent Arterivirus Detected in the Brazilian Amazon.

As part of a continuous effort to investigate the viral communities associated with wild mammals at the human-animal interface in an Amazonian metropolitan region, this study describes the detection of a novel rodent-borne arterivirus. A sample containing pooled organs of Oecomys paricola was submitted to RNA sequencing, and four sequences taxonomically assigned as related to the Arteriviridae family were recovered, corresponding to an almost complete genome of nearly 13 kb summed. In the phylogenetic analysis with the standard domains used for taxa demarcation in the family, the tentatively named Oecomys arterivirus 1 (OAV-1) was placed within the clade of rodent- and porcine-associated viruses, corresponding to the Variarterivirinae subfamily. The divergence analysis, based on the same amino acid alignment, corroborated the hypothesis that the virus may represent a new genus within the subfamily. These findings contribute to the expansion of the current knowledge about the diversity, host and geographical range of the viral family. Arterivirids are non-human pathogens and are usually species-specific, but the susceptibility of cell lines derived from different organisms should be conducted to confirm these statements for this proposed new genus in an initial attempt to assess its spillover potential.

First Genomic Evidence of a Henipa-like Virus in Brazil.

The viral genus Henipavirus includes two highly virulent zoonotic viruses of serious public health concern. Hendra henipavirus and Nipah henipavirus outbreaks are restricted to Australia and Southeast Asia, respectively. The Henipavirus genus comprises mostly bat-borne viruses, but exceptions have already been described as novel viruses with rodents and shrews as reservoir animals. In the Americas, scarce evidence supports the circulation of these viruses. In this communication, we report a novel henipa-like virus from opossums (Marmosa demerarae) from a forest fragment area in the Peixe-Boi municipality, Brazil, after which the virus was named the Peixe-Boi virus (PBV). The application of next-generation sequencing and metagenomic approach led us to discover the original evidence of a henipa-like virus genome in Brazil and South America and the original description of a henipa-like virus in marsupial species. These findings emphasize the importance of further studies to characterize PBV and clarify its ecology, impact on public health, and its relationship with didelphid marsupials and henipaviruses.

Infecção do trato urinário por leveduras do gênero Candida ­ revisão de literatura / Urinary tract infection by yeast of the genus Candida - literature review / Infección del tracto urinario causada por levaduras del género Candida - revisión de la literatura

A ocorrência das infecções do trato urinário (ITU) causadas por leveduras do gênero Candida estão aumentando consideravelmente nas últimas décadas, sendo a Candida albicans a mais comumente diagnosticada como causadora deste tipo de infecções. Contudo, outras espécies, como exemplo da Candida tropicalis, estão emergindo como preocupantes causadores da doença. Neste sentido, o objetivo do presente trabalho é revisar os aspectos relacionados com as ITU causadas por leveduras do gênero Candida. Foi realizada uma pesquisa na base de dados PubMed, buscando artigos sobre a epidemiologia, patogenia e tratamento das ITU causadas por leveduras do gênero Candida. As espécies de Candida são os fungos patogênicos oportunistas mais relevantes causadores de infecções nosocomiais e podem causar infecção no trato urinário, tanto inferior (ureteres, bexiga e uretra) quanto superior (rins), principalmente em pacientes imunocomprometidos. Existem alguns fatores predisponentes, como gênero feminino, idade avançada, diabetes mellitus, hospitalização prolongada, imunossupressão, gravidez, hipertensão, neutropenia, cálculos renais, infecções nosocomiais, terapia antibiótica e procedimentos, como a cateterização, que atuam como facilitadores das ITU por Candida spp. A doença pode ocorrer de forma assintomática, porém, pode evoluir para casos mais graves com comprometimento sistêmico em situações de candidemia que pode causar a morte do paciente, principalmente se tratando de indivíduos imunocomprometidos. Sendo assim, devido ao risco existente, a doença não pode ser negligenciada e um diagnóstico preciso e um tratamento adequado devem ser estabelecidos.

The occurrence of urinary tract infections (UTI) caused by yeasts of the genus Candida has increased considerably in recent decades, with Candida albicans being the most commonly diagnosed as causing this type of infections. However, other species, such as Candida tropicalis, are emerging as worrisome causes of the disease. In this sense, the objective of the present paper is to review the aspects related to the UTI caused by yeasts of the genus Candida. A search was carried out in the PubMed database, searching for articles on the epidemiology, pathogenesis and treatment of UTI caused by yeasts of the genus Candida. Candida species are the most relevant opportunistic pathogenic fungi that cause nosocomial infections and can cause both lower (ureters, bladder and urethra) and upper (kidneys) urinary tract infections, especially in immunocompromised patients. There are some predisposing factors, such as female gender, advanced age, diabetes mellitus, prolonged hospitalization, immunosuppression, pregnancy, hypertension, neutropenia, kidney stones, nosocomial infections, antibiotic therapy and procedures, such as catheterization, that act as facilitators of UTI by Candida spp. The disease can occur asymptomatically, however, it can progress to more severe cases with systemic involvement in situations of candidemia that can cause the death of the patient, especially in immunocompromised individuals. Therefore, due to the existing risk, the disease cannot be neglected and an accurate diagnosis and adequate treatment must be established.

La aparición de infecciones del tracto urinario (ITU) causadas por levaduras del género Candida ha aumentado considerablemente en las últimas décadas. Candida albicans es la infección por levaduras más comúnmente diagnosticada. Sin embargo, otras especies, como la Candida tropicalis, están surgiendo como causa preocupante de la enfermedad. En este sentido, el objetivo del presente trabajo es revisar los aspectos relacionados con la ITU causada por levaduras del género Candida. Se realizó una búsqueda en la base de datos PubMed, buscando artículos sobre la epidemiología, la patogénesis y el tratamiento de la ITU causada por levaduras del género Candida. Las especies de Candida son los hongos patógenos oportunistas más relevantes que causan infecciones nosocomiales y pueden provocar infecciones del tracto urinario inferior (uréteres, vejiga y uretra) y superior (riñones), especialmente en pacientes inmunodeprimidos. Existen algunos factores predisponentes, como el sexo femenino, la edad avanzada, la diabetes mellitus, la hospitalización prolongada, la inmunosupresión, el embarazo, la hipertensión, la neutropenia, los cálculos renales, las infecciones nosocomiales, la terapia con antibióticos y los procedimientos como el cateterismo, que actúan como facilitadores de la ITU por Candida spp. La enfermedad puede presentarse de forma asintomática, pero puede evolucionar a casos más graves con afectación sistémica en situaciones de candidemia que pueden causar la muerte del paciente, especialmente en individuos inmunodeprimidos. Por lo tanto, debido al riesgo existente, no se puede descuidar la enfermedad y se debe establecer un diagnóstico preciso y un tratamiento adecuado.

Drogas antiagregantes plaquetárias e anticoagulantes em pacientes que se submeterão à cirurgia oral: conduta / Antiagregant platelet and anticoagulant drugs in patients who will submit oral surgery: conduct

Objetivo: Como a frequência de pacientes em uso de anticoagulantes e antiagragantes plaquetários nos consultórios odontológicos é crescente, este trabalho objetivou avaliar através de Revisão de Literatura, qual o melhor manejo desses medicamentos na prática odontológica perioperatória. Metodologia: Trata-se de uma revisão integrativa da literatura, utilizadas as bases de dados Scielo e PubMed. Foram escolhidos os seguintes descritores disponíveis na BVs e PubMed em inglês "Platelet Aggregation Inhibitors", "Oral Surgical Procedures" e "Antigoagulants" no período de 2016 a 2021. Também foram consultados livros e sites de diretrizes do Governo. Foram escolhidos 20 artigos para elaboração da pesquisa. Resultados: doenças cardiovasculares e outras condições clínicas pró-coagulantes tem prevalência crescente e são conhecidos fatores de risco para a ocorrência de fenômenos tromboembólicos graves. A terapia antitrombótica tem papel definido nesses casos. No perioperatorio de cirurgias orais, a decisão por suspender ou manter a terapia deve ser individualizada e pode ser orientada por guidelines. Conclusão: procedimentos orais de baixo risco de sangramento podem ser conduzidos sem a descontinuação da terapia antitrombótica. Cirurgias de moderado a alto risco frequentemente requerem suspensão temporária das medicações para fins de minimizar os riscos de complicações hemorrágicas... (AU)

Objective: As the frequency of patients using anticoagulants and antiplatelet agents in dental offices is increasing, this study aimed to evaluate, through a Literature Review, which is the best management of these medications in dental perioperative practice. Methodology: This is an integrative literature review, being used Scielo and PubMed databases. The following descriptors available in BVs and PubMed "Platelet aggregation inhibitors", "Oral Surgical Procedures" and "Antigoagulants" were used, from 2016 to 2021. In addition, the search was also performed in guideline books and Government websites. Twenty articles were chosen for research elaboration. Results: established cardiovascular disease and other procoagulant clinical conditions have an increasing prevalence, especially among the elderly, and are known risk factors for the occurrence of severe thromboembolic phenomena. Antithrombotic therapy has defined role in these cases. In the perioperative period of oral surgery, the decision to suspend or maintain therapy must be individualized and may be guided by guidelines. Age appears as a clinical criterion in the main ones used. Conclusion: oral procedures with low risk of bleeding can be carried out without discontinuing antithrombotic therapy. Moderate to high-risk surgeries usually require its temporary suspension in order to minimize the risk of bleeding complications... (AU)

The Presence of Mycobacterium leprae in Wild Rodents.

Leprosy is a chronic infection caused by Mycobacterium leprae. There is a lack of data regarding environmental reservoirs, which may represent a serious public health problem in Brazil, especially in the state of Pará, which occupies the fourth position in incidence of cases in the country. Previous studies report evidence of infection occurring among armadillos, mangabei monkeys, and chimpanzees. In the present study, wild animals were captured and tested for the presence of anti-PGL-1 antibodies and M. leprae DNA. Fieldwork was carried out from October to November of 2016 in the cities of Curionópolis and Canaã dos Carajás, southeast of Pará state. Small and medium-sized wild animals were captured using appropriate traps. A total of 15 animals were captured. Sera and viscera fragments were collected and tested by ELISA and PCR methods. The presence of M. leprae DNA was confirmed by sequencing of specific gyrase gene in three animals of two different species, including one Necromys lasiurus (liver sample) and two Proechimys roberti (kidney and liver samples). This unprecedented finding suggests that species other than those previously reported are responsible for maintaining M. leprae in nature.

Retirada de corpo estranho (dispositivo impregnado com progesterona) da cavidade abdominal de novilha da raça Jersey ­ relato de caso / Removal of a foreign body (progesterone impregnated device) from the abdominal cavity of a Jersey heifer ­ a case report / Extracción de cuerpo extraño (dispositivo impregnado con progesterona) de la cavidad abdominal de novilla raza Jersey - reporte de caso

A inseminação artificial em tempo fixo (IATF) é uma biotécnica com inúmeras vantagens para a produção de bovinos. Para a realização da IATF, as fêmeas bovinas devem receber um protocolo farmacológico que induz a ovulação de forma sincronizada. Esse protocolo inicia com a inserção de um dispositivo impregnado com progesterona que deve permanecer no fundo vaginal da fêmea por tempo determinado. O presente relato tem por objetivo descrever a remoção de um implante impregnado com progesterona que foi encontrado na cavidade abdominal de uma novilha. Durante um atendimento reprodutivo de rotina em uma propriedade rural, uma novilha da raça Jersey, recém-adquirida, com histórico de ter sido submetida à IATF, foi avaliada para diagnóstico de gestação. No exame a novilha não estava gestante e apresentava um cisto folicular ovariano. A novilha foi submetida novamente à IATF em que foi inserido e removido um implante, com isso o cisto regrediu e ao inseminar a novilha não foi possível passar a cérvix com o aplicador. Vinte dias após a inseminação a novilha manifestou estro e ao ser avaliada para nova inseminação, foi identificado um implante solto na cavidade abdominal da novilha. Foi realizada uma laparotomia pelo flanco esquerdo e o implante foi removido. Após a recuperação da cirurgia a novilha foi inseminada e novamente e ficou gestante. Os protocolos de IATF devem ser realizados por profissionais capacitados para evitar problemas como a presente situação em que um implante foi encontrado na cavidade abdominal de uma novilha.(AU)

The fixed-time artificial insemination (FTAI) is a biotechnique with numerous advantages for cattle production. In order to perform the FTAI, the cows must receive a pharmacological protocol to induce ovulation in a synchronized way. This protocol begins with the insertion of a device impregnated with progesterone that must remain in the vaginal fundus of the cow for a specific period of time. This report aims at describing the removal of a progesterone impregnated implant that was found in the abdominal cavity of a heifer. During a routine reproductive service in a rural property, a recently acquired Jersey heifer, with history of having been submitted to FTAI, was evaluated for pregnancy diagnosis. At the exam, it was observed that the heifer was not pregnant and presented an ovarian follicular cyst. The heifer was then submitted to FTAI again, where an implant was inserted and removed. This made the cyst to recede, and upon subsequent insemination, the applicator was not able to pass the cervix. Twenty days after insemination, the heifer was in estrus and when it was evaluated for insemination, a loose implant was identified in the abdominal cavity of the heifer. A laparotomy was performed through the left flank and the implant was removed. After recovery from the surgery, the heifer was inseminated again and became pregnant. The FTAI protocols should only be carried out by trained professionals to avoid problems such as the one presented herein, where an implant was found in the abdominal cavity of a heifer.(AU)

La inseminación artificial a tiempo fijo (FTAI) es una biotécnica con numerosas ventajas para la producción de ganado. Para realizar FTAI, las hembras bovinas deben recibir un protocolo farmacológico que induzca la ovulación de forma sincronizada. Este protocolo comienza con la inserción de un dispositivo impregnado con progesterona que debe permanecer en el fondo vaginal de la hembra durante un tiempo específico. Este informe tiene como objetivo describir la extracción de un implante impregnado de progesterona que se encontró en la cavidad abdominal de una novilla. Durante la atención reproductiva de rutina en una propiedad rural, se evaluó el diagnóstico de preñez de una novilla de Jersey recién adquirida con antecedentes de someterse a FTAI. En el examen, la novilla no estaba embarazada y tenía un quiste folicular ovárico. La novilla fue nuevamente sometida a FTAI, en la cual se insertó y removió un implante, con esto el quiste retrocedió y al inseminar a la novilla no fue posible pasar el cérvix con el aplicador. Veinte días después de la inseminación, la vaquilla manifestó estro y cuando se evaluó para una nueva inseminación, se identificó un implante suelto en la cavidad abdominal de la vaquilla. Se realizó una laparotomía a través del flanco izquierdo y se extrajo el implante. Después de recuperarse de la cirugía, la novilla fue inseminada y nuevamente quedó embarazada. Los protocolos FTAI deben ser realizados por profesionales capacitados para evitar problemas como la situación actual donde se encontró un implante en la cavidad abdominal de una novilla.(AU)

Pulmonary COVID-19: Learning Spatiotemporal Features Combining CNN and LSTM Networks for Lung Ultrasound Video Classification.

Deep Learning is a very active and important area for building Computer-Aided Diagnosis (CAD) applications. This work aims to present a hybrid model to classify lung ultrasound (LUS) videos captured by convex transducers to diagnose COVID-19. A Convolutional Neural Network (CNN) performed the extraction of spatial features, and the temporal dependence was learned using a Long Short-Term Memory (LSTM). Different types of convolutional architectures were used for feature extraction. The hybrid model (CNN-LSTM) hyperparameters were optimized using the Optuna framework. The best hybrid model was composed of an Xception pre-trained on ImageNet and an LSTM containing 512 units, configured with a dropout rate of 0.4, two fully connected layers containing 1024 neurons each, and a sequence of 20 frames in the input layer (20×2018). The model presented an average accuracy of 93% and sensitivity of 97% for COVID-19, outperforming models based purely on spatial approaches. Furthermore, feature extraction using transfer learning with models pre-trained on ImageNet provided comparable results to models pre-trained on LUS images. The results corroborate with other studies showing that this model for LUS classification can be an important tool in the fight against COVID-19 and other lung diseases.

Hyperparameter Optimization for COVID-19 Pneumonia Diagnosis Based on Chest CT.

Convolutional Neural Networks (CNNs) have been successfully applied in the medical diagnosis of different types of diseases. However, selecting the architecture and the best set of hyperparameters among the possible combinations can be a significant challenge. The purpose of this work is to investigate the use of the Hyperband optimization algorithm in the process of optimizing a CNN applied to the diagnosis of SARS-Cov2 disease (COVID-19). The test was performed with the Optuna framework, and the optimization process aimed to optimize four hyperparameters: (1) backbone architecture, (2) the number of inception modules, (3) the number of neurons in the fully connected layers, and (4) the learning rate. CNNs were trained on 2175 computed tomography (CT) images. The CNN that was proposed by the optimization process was a VGG16 with five inception modules, 128 neurons in the two fully connected layers, and a learning rate of 0.0027. The proposed method achieved a sensitivity, precision, and accuracy of 97%, 82%, and 88%, outperforming the sensitivity of the Real-Time Polymerase Chain Reaction (RT-PCR) tests (53-88%) and the accuracy of the diagnosis performed by human experts (72%).

Serological evidence of Eastern equine encephalitis circulation in equids in Pará state, Brazil.

Serum samples from 89 equids were analyzed (75 horses, 9 donkeys, and 5 mules) from the municipality of Viseu, Pará state, Brazil. Samples were collected in November 2014 and August 2015. The antibody prevalence against the following alphaviruses was estimated: Eastern equine encephalitis virus, Western equine encephalitis virus, Mucambo virus, and Mayaro virus. Seroprevalence was determined by the hemagglutination inhibition (HI) technique. Sera that exhibited HI antibodies with heterotypic reactions for the analyzed viruses were subjected to the 90% plaque reduction neutralization test (PRNT90). The HI prevalence of monotypic reactions to EEEV was 7.9%, and that of WEEV was 1.1%, as confirmed by PRNT90. Viral isolation attempts were negative for all tested blood samples. Our results suggest the circulation of equine encephalitis complex viruses. Future studies should evaluate the possible involvement of arthropod hosts and residents in the viral transmission in the study area.

Foram analisadas amostras de soros de 89 equídeos (75 equinos, 9 asininos e 5 muares) oriundos do município de Viseu, estado do Pará. As amostras foram coletadas no período de novembro de 2014 e agosto de 2015. Foram estimadas as prevalências de anticorpos contra os seguintes Alfavírus: vírus da Encefalite equina leste (EEEV), vírus da Encefalite equina oeste (WEEV), vírus Mucambo (MUCV), and vírus Mayaro (MAYV). A soroprevalência foi determinada por técnicas de Inibição da Hemaglutinação (IH), porém os soros que apresentaram anticorpos IH com reações heterotípicas para os vírus analisados foram submetidos ao PRNT90. A prevalência de reações monotípicas por IH para EEEV foi de 7, 9% e para WEEV foi de 1,1%, confirmadas por PRNT90. A tentativa de isolamento viral foi negativa em todas as amostras de sangue testadas. Nossos resultados sugerem a circulação de vírus do complexo das encefalites equinas. Estudos futuros devem ser realizados para avaliar possível envolvimento de hospedeiros artrópodes e residentes na área de abrangência do estudo.

Projeto de intervenção: Implantação da comissão de controle de infecção hospitalar na Unidade Mista Maria Eliziaria Paes Alagoinha-PE / Intervention project: Implementation of the control commission of nosocomial infection in the Mixed Unit Maria Eliziaria Paes Alagoinha-PE

Introdução:A infecção hospitalar pode ser definida como toda ou qualquer processo infeccioso adquirido no período de internamento do paciente, período intrahospitalar ou após 72 horas da alta hospitalar. Alguns autores definem a infecçãohospitalar como Infecção Relacionada à Assistência à Saúde (IRAS). No ano de1988 foi criado o programa de controle de infecções hospitalares(PCIH) onde definem a Comissão de Controle de Infecção Hospitalar(CCIH) e os seus respectivos membros e classificam as unidades como pequena, média e alta complexidade de acordo com o número de leitos. A forma mais eficaz de notificar as infecções hospitalares é por meio de planilhas que serão enviadas semanalmentepara o setor de epidemiologia do município. Objetivo geral: Implantar a Comissão de Controle de Infecção Hospitalar na Unidade Mista Maria Eliziária Paes, Alagoinha­PE. Métodos:Será realizado um Projeto deI ntervenção(PI )utilizando cronograma especifico e apoiado na legislação para implantar a CCIH. Viabilidade:Demonstra que a Unidade Hospitalar de Alagoinha pode manter e trabalhar dentro do que preceitua a Lei com uma estrutura adequada de CCIH e será constituída por no mínimo: Médico; Representante do serviço de enfermagem; da Administração/Secretário/Digitador.Resultadosparciais:Elaboração de normas e rotinas referentes à desinfecção de ambientes;Controlede casos de pacientes com suspeita ou não de COVID; Ajustes no protocolo de intubação; Reorganização dos fluxos referentes à dispensação de alimentos etc.(AU)

Introduction: Nosocomial infection can be defined as any or all infectious process acquired during the patient's hospital stay, intra-hospital period or after 72 hours of hospital discharge. Some authors define hospital infection as Healthcare-Related Infection (HAI). In 1988, the hospital infection control program (PCIH) was created, in which the Hospital Infection Control Commission (CCIH) and its respective members were defined and the units were classified as small, medium and high complexity according to the number of beds. . The most effective way of notifying nosocomial infections is through spreadsheets that will be sent weekly to the municipality's epidemiology sector. General objective: Implement the Hospital Infection Control Commission in the Mixed Unit Maria Eliziária Paes, Alagoinha­PE. Methods: An Intervention Project (IP) will be carried out using a specific schedule and supported by legislation to implement the CCIH. Feasibility: Demonstrates that the Hospital Unit of Alagoinha can maintain and work within the provisions of the Law with an adequate structure of CCIH and will be made up of at least: Physician; Representative of the nursing service; Administration/Secretary/Digitator. Partial results:Development of rules and routines regarding the disinfection of environments;Control of cases of patients with or without suspicion of COVID; Adjustments in the intubation protocol; Reorganization of flows related to food dispensing, etc.(AU)

Ichthyofauna of sandy beaches along the Acre river, Brazil / Ictiofauna de praias arenosas ao longo do rio Acre, Brasil

Abstract: Despite increasing efforts in recent years to catalog the fish diversity of Amazonian rivers, many regions are still under-sampled, and sandy beach environments are particularly poorly understood. The present study focused on a 300 km stretch of the Acre river, in the southwestern Amazon basin, where we sampled 30 sandy beaches separated by a mean interval of 10 km. We collected 15,329 fish representing 80 species, 26 families, and nine orders. The Characiformes were the most abundant order, providing 88.24% of the individuals collected, followed by the Siluriformes, with 10.03%, while the Siluriformes had the highest species richness, with 37 species (45.0%), followed by the Characiformes, with 30 (37.5%). The most abundant species were the characiforms Knodus orteguasae and Creagruto barrigai. Reliable data on a region's biota is fundamental for the evaluation of patterns of biodiversity, and the occurrence and management of threatened species. As fish are directly affected by pollutants and the degradation of aquatic environments, further research in areas that are still poorly sampled will be essential for the elaboration of effective conservation strategies.

Resumo: Apesar dos crescentes esforços para catalogar a diversidade de peixes nos rios amazônicos, muitas regiões ainda estão sub-amostradas e os ambientes de praias arenosas são particularmente pouco compreendidos. Este estudo foi realizado ao longo de um trecho de 300 km do Rio Acre, no sudoeste da bacia amazônica, onde foram amostradas 30 praias, separadas por uma distância média de 10 km. Foram coletados 15.329 peixes, representados em 80 espécies, 26 famílias e nove ordens. Characiformes foi a ordem mais abundante, representando 88,24% dos indivíduos coletados, seguidos pelos Siluriformes, com 10,03%, enquanto os Siluriformes apresentaram a maior riqueza, com 37 espécies (45,0%), seguidas pelos Characiformes, com 30 espécies (37,5%). As espécies mais abundantes foram os characiformes Knodus orteguasae e Creagruto barrigai. Dados confiáveis sobre a biota de uma região são fundamentais para a avaliação dos padrões de biodiversidade e conhecimento sobre a ocorrência e manejo de espécies ameaçadas. Como os peixes são diretamente afetados por poluentes e pela degradação dos ambientes aquáticos, mais pesquisas em áreas que ainda são pouco amostradas serão essenciais para a elaboração de estratégias eficazes de conservação.

Does soil color affect fish evolution? Differences in color change rate between lineages of the sailfin tetra

Several organisms match their skin color to the prevalent background color, granting crypsis against predators. The rate at which body color changes occur varies among organisms as a result of physiological constraints and adaptation to variation in contrasts between objects and the environmental background. Faster darkening of body color is favored in environments that show higher amounts of contrast between common objects and the prevailing background. Soil types in Amazon forest streams (igarapés) create distinct environments with respect to the amount of contrast, a result of the amount of sand and clay, which offers different contrasts against dead leaves. Here, we investigated differences in the rates of color change among populations of the sailfin tetra (Crenuchus spilurus) that represent lineages that live in regions of different soil types. Populations inserted into blackwaters (sandy soil) showed higher rates of color darkening in response to exposure to a dark environment composed by dead leaves. We propose that natural selection stemming from predation can favor faster color change rate in environments where there is higher variability of contrasts between leaf litter and soil, which is common in most blackwater streams.(AU)

Diversos organismos combinam sua coloração corporal com a cor de fundo predominante no ambiente, conferindo cripticidade contra predadores. A taxa na qual as mudanças de coloração corpórea ocorrem varia entre os organismos como resultado de restrições fisiológicas e adaptação à variação de contrastes entre objetos e o ambiente. O escurecimento mais rápido da cor do corpo é favorecido em ambientes que mostram maiores quantidades de contraste entre objetos comuns e o fundo predominante. Tipos de solo em igarapés da floresta amazônica criam ambientes distintos em relação à quantidade de contraste, resultado da quantidade de areia e argila, que oferece diferentes contrastes contra folhiço submerso. Nós investigamos as diferenças nas taxas de mudança de cor entre populações do tetra-colibri Crenuchus spilurus que representam linhagens que vivem em regiões de diferentes tipos de solo. Populações inseridas em águas pretas (solo arenoso) apresentaram maiores taxas de escurecimento da cor em resposta à exposição ao ambiente escuro de folhiço submerso. Nós propomos que a seleção natural decorrente da predação pode favorecer uma taxa de mudança de cor mais rápida em ambientes onde há maior variabilidade de contrastes entre o folhiço submerso e o solo, o que é comum na maioria dos igarapés de águas pretas.(AU)

First Complete Genome Sequence of a Feline Alphacoronavirus 1 Strain from Brazil.

We identified a strain of Alphacoronavirus 1, FCoV-SB22, from a pool of fecal samples from domestic cats from a rural settlement in the municipality of Santa Bárbara, Pará, Brazil. The nucleotide identity with feline coronavirus was 91.5%. The present study reports the first complete genome sequence of a feline coronavirus from Brazil.

Relationship between maternal adverse childhood experiences and infant development: A systematic review (protocol).

INTRODUCTION: Twenty years ago, the first study was conducted to access adverse childhood experiences (ACEs) and their relation to outcomes in adulthood. The effects of exposure to childhood trauma can also be transmitted to other generations. There are some studies that suggest the hypothesis that intergenerational transmission may begin during intrauterine life through the change in placental-fetal physiology due to maternal exposure to adverse events in childhood. Those exposures can lead to a variety of conditions such as altered brain architecture, increase in placental corticotrophin hormone (pCRH) at the end of gestation, or emotional and behavioral changes during childhood and adolescence. The systematic review, therefore, is established to determine if there is a reliable association between maternal ACEs in childhood and altered child development. METHOD: We will conduct a systematic review according to the guidelines of the meta-analysis of observational studies in epidemiology (MOOSE) and with the preferred reporting items for systematic review with a focus on health equity (PRISMA-E). A comprehensive search strategy will be conducted in the following databases: MEDLINE, EMBASE, CINAHL, Web of Science, SCOPUS, Lilacs, and SciELO. Following a 2-step screening process, data including the full reference, objectives, target population, description of the exposure (ACEs), outcome measures, study design, length of follow-up period, and the study results will be extracted, synthesized, and reported. Risk of bias and quality of the studies will also be assessed. DISSEMINATION AND ETHICS: The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review has been published, this review does not require ethical approval. DISCUSSION: This systematic review of the last 20 years will summarize and present the evidence for the relationship between maternal ACEs and the development of her child. SYSTEMATIC REVIEW REGISTRATION: PROSPERO #CRD42018111456.

Correction: Rotavirus A in wild and domestic animals from areas with environmental degradation in the Brazilian Amazon.

[This corrects the article DOI: 10.1371/journal.pone.0209005.].