Machine Learning-Based Routine Laboratory Tests Predict One-Year Cognitive and Functional Decline in a Population Aged 75+ Years.

BACKGROUND: Cognitive and functional decline are common problems in older adults, especially in those 75+ years old. Currently, there is no specific plasma biomarker able to predict this decline in healthy old-age people. Machine learning (ML) is a subarea of artificial intelligence (AI), which can be used to predict outcomes Aim: This study aimed to evaluate routine laboratory variables able to predict cognitive and functional impairment, using ML algorithms, in a cohort aged 75+ years, in a one-year follow-up study. METHOD: One hundred and thirty-two older adults aged 75+ years were selected through a community-health public program or from long-term-care institutions. Their functional and cognitive performances were evaluated at baseline and one year later using a functional activities questionnaire, Mini-Mental State Examination, and the Brief Cognitive Screening Battery. Routine laboratory tests were performed at baseline. ML algorithms-random forest, support vector machine (SVM), and XGBoost-were applied in order to describe the best model able to predict cognitive and functional decline using routine tests as features. RESULTS: The random forest model showed better accuracy than other algorithms and included triglycerides, glucose, hematocrit, red cell distribution width (RDW), albumin, hemoglobin, globulin, high-density lipoprotein cholesterol (HDL-c), thyroid-stimulating hormone (TSH), creatinine, lymphocyte, erythrocyte, platelet/leucocyte (PLR), and neutrophil/leucocyte (NLR) ratios, and alanine transaminase (ALT), leukocyte, low-density lipoprotein cholesterol (LDL-c), cortisol, gamma-glutamyl transferase (GGT), and eosinophil as features to predict cognitive decline (accuracy = 0.79). For functional decline, the most important features were platelet, PLR and NLR, hemoglobin, globulin, cortisol, RDW, glucose, basophil, B12 vitamin, creatinine, GGT, ALT, aspartate transferase (AST), eosinophil, hematocrit, erythrocyte, triglycerides, HDL-c, and monocyte (accuracy = 0.92). CONCLUSIONS: Routine laboratory variables could be applied to predict cognitive and functional decline in oldest-old populations using ML algorithms.

Evaluation of data input in a rabies testing request form for herbivores / Avaliação da entrada de dados em um formulário de requisição de exame de raiva para herbívoros

Bovines and equines are the domestic animals with the highest incidence of rabies in Brazil. This study evaluated the data input in testing request forms for rabies in herbivores accompanying samples sent to a certified laboratory of rabies diagnosis in the state of Rio Grande do Sul, Brazil. Information was obtained systematically from all forms sent to the laboratory in 2013 and 2014 using a collection instrument that listed variables about the kind of form used, municipality of origin, description of the suspected animal, clinical signs, sample collection, and conservation procedure. The 11 most relevant variables (municipality of origin, geographic coordinates, species, gender, breed, age, herd size, clinical signs, persistence of clinical signs, biological material, and sample conservation) were assessed for the quality of the data entered, and percentage data input was calculated per form. In total, 603 forms were sent to the laboratory. The most used form was the FORM SN, (82.0%, 497/603). "Excellent" and "good" data inputs were observed only for one variable describing the location of suspected rabies cases or outbreaks and animals (species, gender, biological material). Quality of data input of variables describing geographic coordinates, age, breed, herd size, clinical signs, persistence of signs, and sample conservation method varied between "average" and "poor". The data input in testing request forms for herbivores are not dully supplied in suspected cases neurological syndromes, pointing to the need to increase awareness and improve training of field staff.(AU)

Bovinos e equinos são os animais domésticos com maior incidência de raiva no Brasil. Este estudo avaliou formulários de solicitação de testes para raiva em herbívoros acompanhando amostras enviadas a um laboratório certificado de diagnóstico de raiva no estado do Rio Grande do Sul, Brasil. As informações foram obtidas sistematicamente de todos os formulários enviados ao laboratório em 2013 e 2014 utilizando um instrumento de coleta que selecionou variáveis sobre o tipo de formulário utilizado, município de origem, descrição do animal suspeito, sinais clínicos, coleta de amostra e procedimento de conservação. As 11 variáveis mais relevantes (município de origem, coordenadas geográficas, espécie, gênero, raça, idade, tamanho do rebanho, sinais clínicos, persistência de sinais clínicos, material biológico e conservação da amostra) foram avaliadas quanto à qualidade dos dados inseridos, e os dados percentuais foram calculados por formulário. No total, 603 formulários foram enviados para o laboratório. O formulário mais utilizado foi o FORM SN, (82,0%, 497/603). Dados classificados como "excelentes" e "bons" foram observados apenas para uma variável que descreve a localização de casos suspeitos de raiva ou surtos e animais (espécie, gênero, material biológico). A qualidade da entrada dos dados das variáveis que descrevem coordenadas geográficas, idade, raça, tamanho do rebanho, sinais clínicos, persistência de sinais e método de conservação da amostra variou entre "regular" e "ruim". A qualidade dos dados dos formulários de solicitação de testes para herbívoros não foi devidamente fornecida em casos suspeitos de síndromes neurológicas, apontando para a necessidade de aumentar a conscientização e melhorar o treinamento do pessoal de campo.(AU)

Perception of Candomble Practitioners About Herbal Medicine and Health Promotion in Ceará, Brazil.

Candomble, a Brazilian religion of African origin that worships Orishas, promotes "healing" assistance during its worship rituals using therapy with plants and beliefs. From its ancestry tradition, the respect and beware with nature are expressed. Therefore, the aim of this study is to investigate the perception of ethnoecology and health promotion among Candomble practitioners from a Candomble temple in the state of Ceará, Brazil. The ethnography was designed to allow greater immersion into the current mystique. This immersion results in the breaking of existing prejudices and admiration for their worldview. Thus, it can be observed that people seek Candomble to get rid of "bad" health difficulties, such as insomnia, depression, eyesight problems among others, which are commonly treated with herbal preparations, baths, and teas, using plants native to the region; however, their indications are not always in accordance with scientific evidence. In parallel with biomedicine, their hospitable and healthcare practices are considered by most as the equivalent to traditional healthcare actions, but greater recognition of biomedicine is necessary. Based on this perspective, the use of native plants in Candomble is examples of memory, hospitality, and humanization for the community wellness.

Vacinação antissarampo / Antiserum vaccination

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Factors of poor prognosis of visceral leishmaniasis among children under 12 years of age. A retrospective monocentric study in Belo Horizonte, State of Minas Gerais, Brazil, 2001-2005.

INTRODUCTION: A major concern with the visceral leishmaniasis (VL) is its high lethality rate, even with proper treatment. Low age, prior malnutrition, disease duration prior to diagnosis, severe anemia, fever for more than 60 days, diarrhea and jaundice are known poor prognostic factors. The goals of this study are to describe the clinical and laboratory characteristics of VL among children under 12 years of age and to identify the factors associated with VL poor outcome. METHODS: Two hundred and fifty children under 12 years of age with confirmed VL admitted to Hospital João Paulo II (FHEMIG), Belo Horizonte, Brazil, between January 2001 and December 2005 were evaluated retrospectively. The primary outcome was the poor clinical evolution: sepsis, and/or pneumonia, and/or urinary tract infection, and/or of bleeding (expect epistaxis), and/or severe neutropenia (neutrophil < 500 cells/mm3). Odds ratio (crude and adjusted) and its 95% confidence interval for each variable were calculated. Values less than 0.05 were considered significant. RESULTS: Average age was 3.3 years (3.6 months-11.6 years), 71.2% were younger than 5 years and 47.2% lived in Metropolitan Area of Belo Horizonte. The mean fatality rate was 3.6%. Sixty-six (26.4%) patients presented poor evolution. After a multivariate analysis, age <18 months, abnormal respiratory physical examination on hospital admission, and platelets <85,000/mm3 remained associated with increased chance of poor evolution. CONCLUSIONS: The results suggest that patients aged between 12 and 18 months, with platelet counts below 85,000/mm3, and respiratory abnormalities at admission should be considered potentially severe.

Factors of poor prognosis of visceral leishmaniasis among children under 12 years of age: A retrospective monocentric study in Belo Horizonte, State of Minas Gerais, Brazil, 2001-2005

INTRODUTION: A major concern with the visceral leishmaniasis (VL) is its high lethality rate, even with proper treatment. Low age, prior malnutrition, disease duration prior to diagnosis, severe anemia, fever for more than 60 days, diarrhea and jaundice are known poor prognostic factors. The goals of this study are to describe the clinical and laboratory characteristics of VL among children under 12 years of age and to identify the factors associated with VL poor outcome. METHODS: Two hundred and fifty children under 12 years of age with confirmed VL admitted to Hospital João Paulo II (FHEMIG), Belo Horizonte, Brazil, between January 2001 and December 2005 were evaluated retrospectively. The primary outcome was the poor clinical evolution: sepsis, and/or pneumonia, and/or urinary tract infection, and/or of bleeding (expect epistaxis), and/or severe neutropenia (neutrophil < 500 cells/mm³). Odds ratio (crude and adjusted) and its 95% confidence interval for each variable were calculated. Values less than 0.05 were considered significant. RESULTS: Average age was 3.3 years (3.6 months-11.6 years), 71.2% were younger than 5 years and 47.2% lived in Metropolitan Area of Belo Horizonte. The mean fatality rate was 3.6%. Sixty-six (26.4%) patients presented poor evolution. After a multivariate analysis, age <18 months, abnormal respiratory physical examination on hospital admission, and platelets <85,000/mm³ remained associated with increased chance of poor evolution. CONCLUSIONS: The results suggest that patients aged between 12 and 18 months, with platelet counts bellow 85,000/mm³, and respiratory abnormalities at admission should be considered potentially severe.

Adams-Oliver syndrome and portal hypertension: fortuitous association or common mechanism?

Adams-Oliver syndrome (AOS) is a rare condition defined by combination of cutis aplasia and transverse limb abnormalities. Some authors have described a possible association between this syndrome and portal hypertension (PH) due to hepatoportal sclerosis (HPS). We present a boy with AOS who developed a progressive splenomegaly and hypersplenism at the age of 2 months, and was admitted for acute gastrointestinal bleeding (GI) at the age of 9 months. Subsequently, we documented an extrahepatic portal vein obstruction and esophageal varices. After several episodes of cataclysmic upper GI bleeding a mesentero-portal shunt (MPS) was performed at 10 months. The shunt thrombosed, and after three failed attempts of thrombectomy, it was removed. One month later a splenorenal shunt was performed, and this closed spontaneously by 3 years. The patient suffered from ischemic stroke after placing the first shunt, and has spastic diplegia, left frontal lobe epilepsy, hyperactivity and attention deficit disorder, and severe psychomotor delay. At 11 years and he presented with chronic liver failure and hyperammonemia and coagulopathy. We hypothesize that there may be an early embryonic vascular abnormality (vascular disruption) that may explain these vascular phenomena.

Multi-centric prospective evaluation of rk39 rapid test and direct agglutination test for the diagnosis of visceral leishmaniasis in Brazil.

The diagnosis of visceral leishmaniasis (VL) is still a major problem in Brazil and several other countries where the disease is endemic. The use of an easy-to-use and interpret, sensitive, and specific method that requires no complex infrastructure or specialized professionals, such as direct agglutination test (DAT) and the rK39-based rapid immunochromatographic test may enhance the diagnosis of disease. This study evaluated the performance of a rapid test (DiaMed- IT-LEISH®) and the DAT for the diagnosis of VL in 213 parasitologically confirmed cases and 119 controls with clinical suspicion of VL and confirmation of another etiology. The sensitivities and specificities of the rapid test were 93% and 97%, respectively and those of the DAT were 90% and 96%, respectively. The positive predictive values of the rapid test and the DAT were 98% and 97%, respectively and the negative predictive values were 89% and 84%, respectively. The Kappa index showed agreement between both methods classified as substantial (0.77). This study showed that the DAT and the rapid test can be used to diagnose VL in Brazil, following a pilot study for implementation of the rapid test in the health services.

Bidirectional mode-locked fiber ring laser using self-regenerative, passively controlled, threshold gating.

We demonstrate a technique to achieve bidirectional mode locking of a fiber ring laser using two amplitude modulators passively driven by a signal regenerated from the oscillation of the laser itself. The new scheme allows generation of two independent-frequency unlocked-countercirculating pulses and active control of their crossing points. The technique minimizes the effects of the dead band associated with crossing at a scattering media. Results show stable bidirectional pulses at a 5MHz repetition rate with no detectable dead band.

Diagnóstico e genotipagem do vírus da pseudoraiva por nested-PCR e análise de restrição enzimática / Diagnosis and genotyping of pseudorabies virus by nested-PCR and restriction enzyme analysis

A pseudoraiva (PR) é uma enfermidade viral responsável por consideráveis perdas econômicas na indústria de suínos. O vírus da pseudoraiva (PrV) apresenta apenas um sorotipo, mas, por análise de restrição enzimática, foi classificado em quatro genótipos denominados I, II, III e IV. Os métodos usados para genotipagem dependem do isolamento do vírus, da purificação do DNA viral, da restrição enzimática do genoma completo e da visualização após eletroforese. O objetivo deste trabalho foi estabelecer um método mais rápido e sensível para detectar e genotipar o PrV por nested-PCR e análise de restrição enzimática. Vinte isolados do PrV das regiões Sul e Sudeste do Brasil e a estirpe padrão Shope foram replicadas em células PK-15 e submetidas à nested-PCR para o gene da glicoproteína E. Além desses vírus previamente isolados, foram avaliadas 75 amostras clínicas de cérebro de suíno em um total de 25 animais positivos para a PR no isolamento e na soroneutralização viral e 50 amostras negativas provenientes de animais negativos na soroneutralização viral e de granjas sem histórico de PR. Todas as amostras clínicas tiveram resultados compatíveis com o isolamento e a soroneutralização, e a totalidade das amostras positivas foi classificada como genótipo II. A sensibilidade analítica da nested-PCR foi de 10-1,3 TCID50 mL-1. A combinação da nested-PCR e da restrição enzimática foi capaz de detectar e genotipar o vírus com resultados em um a dois dias, sendo mais rápida que os métodos convencionais de restrição do genoma completo que podem demorar até sete dias.

Pseudorabies is a disease caused by Suid herpesvirus 1 (PrV) and is responsible for considerable economic losses in the swine industry. The PrV has only one serotype, but based on RFLP (restriction fragment length polymorphism) the virus was divided into four genotypes named I, II, III, IV. The classical methods for PrV genotyping usually require virus isolation, DNA purification enzyme restriction analysis and a long electrophoresis. The aim of this research was to describe a faster and more sensitive method to detect and genotype PrV based on nested-PCR and restriction enzyme analysis. Twenty PrV isolates from south and southeast regions of Brazil, and the standard strain Shope were grown in PK-15 cells and submitted to PCR for glycoprotein E gene amplification. Additionally were tested 75 clinical samples (swine brain), with 25 positives for virus isolation and seroneutralization, and 50 negatives from a flock free PR with negative results in seroneutralization test. There was 100 percent of agreement between results of nested-PCR and virus isolation and seroneutralization and all samples detected were classified as genotype II. The nested-PCR, combined with restriction enzyme analysis, was able to detect and genotype PrV in 1-2 days with a sensitivity of 10-1,3 TCID50 mL-1. It was faster than classical methods described in the literature that require at least 7 days to be completed.

Molecular epidemiology of Brazilian pseudorabies viral isolates.

Pseudorabies is a disease caused by pseudorabies virus (PRV) and is responsible for considerable economic losses in the swine industry. The objective of this work was to use molecular epidemiology as a tool to facilitate the study of PRV outbreaks in Brazil. The standard PRV strain Shope, the vaccine strain Bartha and isolates from the south and the southeast regions of Brazil, were amplified for gE and gC partial genes by PCR. Results indicated that Brazilian PRV isolates are grouped in two clusters, A and B, except for one isolate that grouped with Bartha and Shope. Most Brazilian PRV isolates belonged to cluster B and diverged from virus isolated from other countries.

DASH entre estudantes de curso deodontologia, Belo Horizonte, 2007 / DASH evaluation among dentistry students, Belo Horizonte, 2007

A odontologia é considerada uma profissão derisco ocupacional para os Distúrbios OsteomuscularesRelacionados ao Trabalho. Esses quadros podemser mensurados pelo instrumento denominado DASH(Disabilities Arm, Shoulder and Hand). Entretanto,há pouca informação sobre essas condições entre estudantesde odontologia brasileiros. Assim, o objetivodo presente estudo foi avaliar as incapacidades debraço, ombro e mão entre esses estudantes, bemcomo os fatores associados, no ano de 2007. Questionáriosauto-aplicáveis foram entregues ao universo deestudantes de odontologia, do 1º. e 8º. períodos, deum curso em Belo Horizonte, no segundo semestrede 2007. Para a avaliação das incapacidades, foi utilizadoo instrumento DASH validado no Brasil. Para amensuração das variáveis independentes, foi aplicadoum questionário com questões sobre o período docurso, gênero, trabalho, prática de esportes, sono eatendimento clínico na odontologia. Esta última variávelsó foi avaliada para discentes do 8º. período. Aanálise estatística, realizada no programa SPSS versão11.0, envolveu os testes de Kolmogorov-Smirnov,Mann-Whitney e Kruskal-Wallis, considerandop < 0,05. Do universo de 90 estudantes, 74 (82,2 por cento)preencheram corretamente os questionários. A únicaassociação estatística identificada envolveu maioresincapacidades de braço, ombro e mão entre os indivíduosque nunca praticaram esportes em relaçãoàqueles que praticavam esportes no momento da pesquisa(p = 0,02). Conclui-se que parece não haverimpacto das atividades clínicas desenvolvidas pelosestudantes, bem como das variáveis sócio-demográficase do sono nessas incapacidades. A prática de esportespode ser vista como um fator de proteção parao quadro avaliado entre estudantes de odontologia.

Validação do teste imunocromatográfico rápido IT-LEISH® para o diagnóstico da leishmaniose visceral humana / Validation of the rapid immunochromatographic test IT-LEISH® for the diagnosis of human visceral leishmaniasis

O teste imunocromatográfico rápido IT-LEISH® (DiaMed IT-LEISH®) foi validado para o diagnóstico da leishmaniose visceral (LV) em quatro áreas endêmicas do Brasil. O desempenho do IT-LEISH® foi comparado ao da reação de imunofluorescência indireta; e ao da reação imunoenzimática, usando-se antígeno solúvel de Leishmania chagasi e recombinante K39 (rK39). O estudo incluiu 332 pacientes com quadro clínico sugestivo de LV: 213 casos de LV confirmados parasitologicamente; e 119 não-casos, com confirmação de outra etiologia. O teste IT-LEISH® apresentou sensibilidade de 93 por cento e especificidade de 97 por cento. As técnicas RIFI (imunofluorescência indireta), ELISA L. chagasi e ELISA rK39 apresentaram sensibilidade de 88 por cento, 92 por cento e 97 por cento e especificidades de 81 por cento, 77 por cento e 84 por cento, respectivamente. Os resultados confirmam a validade do teste IT-LEISH® para o diagnóstico da LV no Brasil...

Caracterização antigênica e molecular de oito amostras do vírus da doença de Aujeszky isoladas no estado do Rio Grande do Sul em 2003 / Antigenic and molecular characterization of eight samples of Aujeszky's disease virus isolated in the state of Rio Grande do Sul, Brazil, in 2003

A doença de Aujeszky ou pseudoraiva (DA), causada pelo vírus da pseudoraiva (PRV) é a maior preocupação na produção de suínos. No estado do Rio Grande do Sul, Brasil, a DA foi somente detectada em 1954, em bovino. Em 2003, ocorreram dois surtos de encefalite em granjas na região norte do estado, fronteira com o estado de Santa Catarina. O vírus da doença de Aujeszky (VDA) foi isolado a partir de animais coletados em oito granjas distintas da região e submetido a análises antigênicas e moleculares. As amostras de VDA isoladas foram comparadas com as amostras padrão NIA-3 e NP. A caracterização antigênica dos mesmos foi realizada com testes de imunoperoxidase frente a um painel de anticorpos mono-clonais (Mabs) preparado contra epitopos de glicoproteinas virais (gB, gC, gD e gE). A caracterização genômica foi realizada através da análise restrição enzimática (REA) sobre o genoma total das amostras, com a enzima de restrição (REA) Bam HI. O perfil antigênico das oito amostras isoladas no Rio Grande do Sul, bem como os apresentados pelas amostras padrão NIA-3 e NP, foram similares. A REA revelou que todos as oito amostras do Rio Grande do Sul apresentaram um arranjo genômico do tipo II, genótipo frequentemente encontrado em surtos prévios de DA em outros estados do Brasil. Os resultados aqui obtidos indicam que as oito amostras isoladas no Rio Grande do Sul são similares.

Development and standardization of an indirect ELISA for the serological dianosis of classical swine fever

Um ensaio imunoenzimático do tipo ELISA indireto (ELISA-I) foi desenvolvido e padronizado para o diagnóstico sorológico de peste suína clássica. Na comparaçäo foram utilizadas novecentas e trinta e sete amostras de soros suínos, as quais foram testadas pelo teste de soroneutralizaçäo seguido de revelaçäo por imunoperoxidase (NPLA), tomado como padräo, resultando em 223 amostras positivas e 714 negativas. Em relaçäo ao NPLA, o ELISA-I apresentou sensibilidade de 98,21 por cento, especificidade de 92,86 por cento, valor preditivo positivo de 81,11 por cento, valor preditivo negativo de 99,4 por cento e precisäo de 94,1 por cento. A análise estatística dos resultados revelou uma correlaçäo muito forte (r=0,94) entre os dois testes. Quando comparado com um "kit" de ELISA disponível comercialmente, a performance de ambos em relaçäo ao NPLA foi similar. Concluiu-se que o ELISA-I é um teste apropriado para triagem em larga escala de soros para a detecçäo de anticorpos contra o Vírus da Peste Suína Clássica (VPSC), embora näo seja capaz de diferenciar entre anticorpos induzidos pelo VPSC ou outros pestivírus