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1.
Arq Bras Cardiol ; 121(5): e20230650, 2024.
Article in Portuguese, English | MEDLINE | ID: mdl-38747748

ABSTRACT

BACKGROUND: Early reperfusion therapy is acknowledged as the most effective approach for reducing case fatality rates in patients with ST-segment elevation myocardial infarction (STEMI). OBJECTIVE: Estimate the clinical and economic consequences of delaying reperfusion in patients with STEMI. METHODS: This retrospective cohort study evaluated mortality rates and the total expenses incurred by delaying reperfusion therapy among 2622 individuals with STEMI. Costs of in-hospital care and lost productivity due to death or disability were estimated from the perspective of the Brazilian Unified Health System indexed in international dollars (Int$) adjusted by purchase power parity. A p < 0.05 was considered statistically significant. RESULTS: Each additional hour of delay in reperfusion therapy was associated with a 6.2% increase (95% CI: 0.3% to 11.8%, p = 0.032) in the risk of in-hospital mortality. The overall expenses were 45% higher among individuals who received treatment after 9 hours compared to those who were treated within the first 3 hours, primarily driven by in-hospital costs (p = 0.005). A multivariate linear regression model indicated that for every 3-hour delay in thrombolysis, there was an increase in in-hospital costs of Int$497 ± 286 (p = 0.003). CONCLUSIONS: The findings of our study offer further evidence that emphasizes the crucial role of prompt reperfusion therapy in saving lives and preserving public health resources. These results underscore the urgent need for implementing a network to manage STEMI cases.


FUNDAMENTO: A terapia de reperfusão precoce é reconhecida como a abordagem mais eficaz para reduzir as taxas de letalidade de casos em pacientes com infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST). OBJETIVO: Estimar as consequências clínicas e econômicas do atraso da reperfusão em pacientes com IAMCSST. MÉTODOS: O presente estudo de coorte retrospectivo avaliou as taxas de mortalidade e as despesas totais decorrentes do atraso na terapia de reperfusão em 2.622 indivíduos com IAMCSST. Os custos de cuidados hospitalares e perda de produtividade por morte ou incapacidade foram estimados sob a perspectiva do Sistema Único de Saúde indexado em dólares internacionais (Int$) ajustados pela paridade do poder de compra. Foi considerado estatisticamente significativo p < 0,05. RESULTADOS: Cada hora adicional de atraso na terapia de reperfusão foi associada a um aumento de 6,2% (intervalo de confiança de 95%: 0,3% a 11,8%, p = 0,032) no risco de mortalidade hospitalar. As despesas gerais foram 45% maiores entre os indivíduos que receberam tratamento após 9 horas em comparação com aqueles que foram tratados nas primeiras 3 horas, impulsionados principalmente pelos custos hospitalares (p = 0,005). Um modelo de regressão linear multivariada indicou que para cada 3 horas de atraso na trombólise, houve um aumento nos custos hospitalares de Int$ 497 ± 286 (p = 0,003). CONCLUSÕES: Os achados do nosso estudo oferecem mais evidências que enfatizam o papel crucial da terapia de reperfusão imediata no salvamento de vidas e na preservação dos recursos de saúde pública. Estes resultados enfatizam a necessidade urgente de implementação de uma rede para gerir casos de IAMCSST.


Subject(s)
Hospital Mortality , Myocardial Reperfusion , ST Elevation Myocardial Infarction , Time-to-Treatment , Humans , Female , Male , Retrospective Studies , ST Elevation Myocardial Infarction/economics , ST Elevation Myocardial Infarction/therapy , ST Elevation Myocardial Infarction/mortality , Middle Aged , Time Factors , Brazil , Aged , Time-to-Treatment/economics , Myocardial Reperfusion/economics , Treatment Outcome , Hospital Costs/statistics & numerical data , Thrombolytic Therapy/economics
2.
Arq. bras. cardiol ; 121(5): e20230650, 2024. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1557055

ABSTRACT

Resumo Fundamento: A terapia de reperfusão precoce é reconhecida como a abordagem mais eficaz para reduzir as taxas de letalidade de casos em pacientes com infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST). Objetivo: Estimar as consequências clínicas e econômicas do atraso da reperfusão em pacientes com IAMCSST. Métodos: O presente estudo de coorte retrospectivo avaliou as taxas de mortalidade e as despesas totais decorrentes do atraso na terapia de reperfusão em 2.622 indivíduos com IAMCSST. Os custos de cuidados hospitalares e perda de produtividade por morte ou incapacidade foram estimados sob a perspectiva do Sistema Único de Saúde indexado em dólares internacionais (Int$) ajustados pela paridade do poder de compra. Foi considerado estatisticamente significativo p < 0,05. Resultados: Cada hora adicional de atraso na terapia de reperfusão foi associada a um aumento de 6,2% (intervalo de confiança de 95%: 0,3% a 11,8%, p = 0,032) no risco de mortalidade hospitalar. As despesas gerais foram 45% maiores entre os indivíduos que receberam tratamento após 9 horas em comparação com aqueles que foram tratados nas primeiras 3 horas, impulsionados principalmente pelos custos hospitalares (p = 0,005). Um modelo de regressão linear multivariada indicou que para cada 3 horas de atraso na trombólise, houve um aumento nos custos hospitalares de Int$ 497 ± 286 (p = 0,003). Conclusões: Os achados do nosso estudo oferecem mais evidências que enfatizam o papel crucial da terapia de reperfusão imediata no salvamento de vidas e na preservação dos recursos de saúde pública. Estes resultados enfatizam a necessidade urgente de implementação de uma rede para gerir casos de IAMCSST.


Abstract Background: Early reperfusion therapy is acknowledged as the most effective approach for reducing case fatality rates in patients with ST-segment elevation myocardial infarction (STEMI). Objective: Estimate the clinical and economic consequences of delaying reperfusion in patients with STEMI. Methods: This retrospective cohort study evaluated mortality rates and the total expenses incurred by delaying reperfusion therapy among 2622 individuals with STEMI. Costs of in-hospital care and lost productivity due to death or disability were estimated from the perspective of the Brazilian Unified Health System indexed in international dollars (Int$) adjusted by purchase power parity. A p < 0.05 was considered statistically significant. Results: Each additional hour of delay in reperfusion therapy was associated with a 6.2% increase (95% CI: 0.3% to 11.8%, p = 0.032) in the risk of in-hospital mortality. The overall expenses were 45% higher among individuals who received treatment after 9 hours compared to those who were treated within the first 3 hours, primarily driven by in-hospital costs (p = 0.005). A multivariate linear regression model indicated that for every 3-hour delay in thrombolysis, there was an increase in in-hospital costs of Int$497 ± 286 (p = 0.003). Conclusions: The findings of our study offer further evidence that emphasizes the crucial role of prompt reperfusion therapy in saving lives and preserving public health resources. These results underscore the urgent need for implementing a network to manage STEMI cases.

3.
Rev. bras. cir. plást ; 38(2): 1-4, abr.jun.2023. ilus
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1443596

ABSTRACT

Introduction: The columella is an important subunit of the nose, essential for nasal architecture and facial aesthetics. The total reconstruction of the nasal columella becomes a great challenge after repairing trauma, carcinomas, and necrosis in this region. There are descriptions in the literature of numerous reconstruction techniques using different flaps, such as a frontal region flap, an infraclavicular region flap, and a unilateral and bilateral nasolabial flap. Case Report: A total reconstruction of the nasal columella after resection of basal cell carcinoma (BCC) using a bilateral nasolabial flap is reported. Conclusion: The technique proved effective for correcting the complex defect after BCC resection, with technical ease for resolution and good aesthetic and functional results.


Introdução: A columela é uma importante subunidade do nariz, sendo essencial para a arquitetura nasal e estética facial. A reconstrução total da columela nasal torna-se, portanto, um grande desafio após reparação de traumas, carcinomas e necroses nesta região. Há na literatura a descrição de inúmeras técnicas de reconstrução com uso de diferentes retalhos, como retalho da região frontal, retalho da região infraclavicular, retalho nasolabial unilateral e bilateral. Relato de Caso: Reporta-se uma reconstrução total da columela nasal pós-ressecção de carcinoma basocelular (CBC) utilizando retalho nasolabial bilateral. Conclusão: A técnica utilizada mostrou-se eficaz para correção do defeito complexo pós-ressecção de CBC, apresentando facilidade técnica para resolução e bom resultado estético-funcional.

4.
Fundam Clin Pharmacol ; 37(4): 824-832, 2023 Aug.
Article in English | MEDLINE | ID: mdl-36869661

ABSTRACT

The rising of diseases caused by multidrug-resistant bacteria has encouraged researchers to explore more antimicrobial substances, as well as chemicals capable of potentiating the action of existing ones against multidrug-resistant bacteria. Anacardium occidentale produces a fruit known as cashew nut, filled with a dark, almost black, caustic, and flammable liquid called cashew nutshell liquid (CNSL). The goal of the study was to evaluate the intrinsic antimicrobial activity of the major compounds present in CNSL, called anacardic acids (AA), as well as their possible modulatory action as an adjuvant of Norfloxacin against a Staphylococcus aureus strain overproducing the NorA efflux pump (SA1199B). Microdilution assays were performed to determine the minimum inhibitory concentration (MIC) of AA against different microbial species. Norfloxacin and Ethidium Bromide (EtBr) resistance modulation assays were performed in the presence or absence of AA against SA1199-B. AA showed antimicrobial activity against Gram-positive bacterial strains tested but no activity against Gram-negative bacteria or yeast strains. At subinhibitory concentration, AA reduced the MIC values for Norfloxacin and EtBr against the SA1199-B strain. Furthermore, AA increased the intracellular accumulation of EtBr in this NorA overproducer strain, indicating that AA are NorA inhibitors. Docking analysis showed that AA probably modulates Norfloxacin efflux by spatial impediment at the same binding site of NorA.


Subject(s)
Anacardium , Staphylococcal Infections , Norfloxacin/pharmacology , Anti-Bacterial Agents/pharmacology , Staphylococcus aureus , Anacardium/metabolism , Anacardic Acids/pharmacology , Anacardic Acids/metabolism , Multidrug Resistance-Associated Proteins , Staphylococcal Infections/microbiology , Ethidium/metabolism , Ethidium/pharmacology , Microbial Sensitivity Tests
5.
Psychiatry Res ; 312: 114581, 2022 06.
Article in English | MEDLINE | ID: mdl-35509132

ABSTRACT

Acute episodes of Schizophrenia and Schizoaffective Disorder often require hospitalizations and/or psychiatry emergency room (PER) visits, with significant economic burden. Long-acting injectables (LAI), such as the once-monthly Palmitate Paliperidone LAI (1MPP) are effective in suppressing symptoms and raise treatment adherence. This study is the first aimed at evaluating long-term efficacy of initiation of 1MPP. This was a mirror-image study with a total 10 year observational length. Sample was divided into five different groups according to time span of observation: 2,4,6,8, and 10 years. Number of participants per group was 162, 129, 95, 77 and 35, respectively. Main outcomes were number and length of hospitalizations and number of PER visit. Significant reductions in these outcomes after initiation of 1MPP were found in all groups. Subgroups consisting only of patients with full adherence were evaluated, and these had better outcomes. A cost evaluation was also performed, which demonstrated decreases every year, for all main outcomes. Sensitivity analysis in the 2-year group showed results in this time-frame are independent of gender, diagnosis, previous LAI or 1MPP initiation setting. Initiation of 1MPP reduces number and length of hospitalizations up to 5 years, decreasing associated costs. This study increases evidence supporting use of 1MPP in patients with Schizophrenia or Schizoaffective disorder.


Subject(s)
Antipsychotic Agents , Psychotic Disorders , Schizophrenia , Antipsychotic Agents/therapeutic use , Delayed-Action Preparations/therapeutic use , Hospitalization , Humans , Paliperidone Palmitate/therapeutic use , Psychotic Disorders/drug therapy , Schizophrenia/drug therapy
6.
Sci Rep ; 11(1): 1421, 2021 01 14.
Article in English | MEDLINE | ID: mdl-33446825

ABSTRACT

Gut microbiota composition can modulate neuroendocrine function, inflammation, and cellular and immunological responses against different pathogens, including viruses. Zika virus (ZIKV) can infect adult immunocompetent individuals and trigger brain damage and antiviral responses. However, it is not known whether ZIKV infection could impact the gut microbiome from adult immunocompetent mice. Here, we investigated modifications induced by ZIKV infection in the gut microbiome of immunocompetent C57BL/6J mice. Adult C57BL/6J mice were infected with ZIKV and the gut microbiota composition was analyzed by next-generation sequencing of the V4 hypervariable region present in the bacterial 16S rDNA gene. Our data showed that ZIKV infection triggered a significant decrease in the bacteria belonging to Actinobacteria and Firmicutes phyla, and increased Deferribacteres and Spirochaetes phyla components compared to uninfected mice. Interestingly, ZIKV infection triggered a significant increase in the abundance of bacteria from the Spirochaetaceae family in the gut microbiota. Lastly, we demonstrated that modulation of microbiota induced by ZIKV infection may lead to intestinal epithelium damage and intense leukocyte recruitment to the intestinal mucosa. Taken together, our data demonstrate that ZIKV infection can impact the gut microbiota composition and colon tissue homeostasis in adult immunocompetent mice.


Subject(s)
Firmicutes , Gastrointestinal Microbiome , Intestinal Mucosa , Spirochaetaceae , Zika Virus Infection , Zika Virus/metabolism , Animals , Firmicutes/classification , Firmicutes/growth & development , Intestinal Mucosa/metabolism , Intestinal Mucosa/microbiology , Intestinal Mucosa/virology , Mice , Spirochaetaceae/classification , Spirochaetaceae/growth & development , Zika Virus Infection/metabolism , Zika Virus Infection/microbiology
7.
Preprint in English | medRxiv | ID: ppmedrxiv-20115824

ABSTRACT

IntroductionDeterminants of hospitalization, intensive care unit (ICU) admission and death are still unclear for Covid-19 and only a few studies have adjusted for confounding for different clinical outcomes including all reported cases in a country. We used routine surveillance data from Portugal to identify risk factors for COVID-19 outcomes, in order to support risk stratification, clinical and public health interventions, and scenarios to plan health care resources. MethodsWe conducted a retrospective cohort study including 20,293 laboratory confirmed cases of COVID-19 in Portugal extracted in April 28 2020, electronically through the National Epidemic Surveillance System of the Directorate-General of Health(DGS). We calculated absolute risks, relative risks (RR) and adjusted relative risks (aRR) to identify demographic and clinical factors associated with hospitalization, admission to ICU and death using Poisson regressions. ResultsIncreasing age after 60 years was the greatest determinant for all outcomes. Assuming 0-50 years as reference, being aged 80-89 years was the strongest determinant of hospital admission (aRR-5.7), 70-79 years for ICU(aRR-10.4) and > 90 years for death(aRR-226.8) with an aRR of 112.7 in those 70-79. Among comorbidities, Immunodeficiency, cardiac disease, kidney disease, and neurologic disease were independent risk factors for hospitalization (aRR 1.83,1.79,1.56, 1.82), for ICU these were cardiac, Immunodeficiency, kidney and lung disease (aRR 4.33, 2.76, 2.43, 2.04), and for death they were kidney, cardiac and chronic neurological disease (aRR: 2.9, 2.6, 2.0) Male gender was a risk factor for all outcomes. There were small statistically significant differences for the 3 outcomes between regions. Discussion and ConclusionsOlder age stands out as the strongest risk factor for all outcomes specially for death as absolute is risk was small for those younger than 50. These findings have implications in terms of risk stratified public health measures that should prioritize protecting older people although preventive behavior is needed in all ages. Epidemiologic scenarios and clinical guidelines may consider these estimated risks, even though under-ascertainment of mild and asymptomatic cases should be considered.

8.
Trauma Case Rep ; 26: 100291, 2020 Apr.
Article in English | MEDLINE | ID: mdl-32123719

ABSTRACT

BACKGROUND: Prosthetic titanium plates are frequently used in the stabilization of rib fractures and are typically contoured to the patient's anatomy at the time of implant in the operating room. Smith et al. [17] described the use of a 3D prototype biomodel of his patient's skeletal anatomy for preoperative customization of standard titanium plates for rib fractures. This process facilitated the preoperative planning and provided implants appropriate for a patient's unique anatomy. Further, the approach facilitated repair of complex fractures and may decrease operating time. Besides that, it provides idealized conditions for plate shaping and may facilitate implantation. METHODS: We performed rib fixation combined with 3D biomodels for surgical planning for the first time in Brazil, achieving reduced operating time with a good outcome for our patient. RESULTS: Surgical planning was conducted one day before the surgery using a 3D printer to make a patient-specific model. The printing time of the model was 16 h. The 3D biomodel was used for simulating the surgical procedure, pre-molding the titanium plates, and measuring the screw sizes that would be used in the procedure. All five fractures were fixed on the 3D biomodel and the total simulation time was 58 min. We used four pre-contoured titanium plates of 1.5 mm thickness and one straight 1.5 mm thickness titanium plate. We used the printed model to measure screw size, as we would do in the surgery. After planning, the material was processed and sterilized according to the hospital standards to be implanted in the patient the following day. CONCLUSION: This is the second reported case of surgical stabilization of rib fractures using a 3D model. Both cases demonstrated the advantages of this approach. More studies are needed to validate the safety and benefits for the patient, as well as the impact on cost savings.

9.
Sci Rep ; 9(1): 20119, 2019 12 27.
Article in English | MEDLINE | ID: mdl-31882804

ABSTRACT

Zika virus (ZIKV) has a strong tropism for the nervous system and has been related to post-infection neurological syndromes. Once neuronal cells are infected, the virus is capable of modulating cell metabolism, leading to neurotoxicity and cellular death. The negative effect of ZIKV in neuron cells has been characterized. However, the description of molecules capable of reversing these cytotoxic effects is still under investigation. In this context, it has been largely demonstrated that docosahexaenoic acid (DHA), an omega-3 polyunsaturated fatty acid, is highly neuroprotective. Here, we hypothesized that DHA's neuroprotective proprieties could have an influence on ZIKV-induced neurotoxicity in SH-SY5Y cells. Our data showed that pre-treatment of SH-SY5Y cells with DHA increased the cell viability and proliferation in ZIKV-infected cells. Moreover, DHA triggered an anti-inflammatory response in those infected cells. Besides, DHA was capable of restoring mitochondria function and number in ZIKV-infected SH-SY5Y cells. In addition, cells pre-treated with DHA prior to ZIKV infection presented a lower viral load at different times of infection. Taking together, these results demonstrated that DHA has a potential anti-inflammatory and neuroprotective effect against ZIKV infection in these neuron-like cells and could be a useful tool in the treatment against this virus.


Subject(s)
Anti-Inflammatory Agents/pharmacology , Fatty Acids, Omega-3/pharmacology , Neuroprotective Agents/pharmacology , Zika Virus/drug effects , Zika Virus/physiology , Cell Line, Tumor , Cell Survival/drug effects , Cytopathogenic Effect, Viral/drug effects , Humans , Mitochondria/drug effects , Mitochondria/metabolism , Virus Replication/drug effects , Zika Virus Infection/virology
10.
Rev. Soc. Bras. Clín. Méd ; 17(2): 66-70, abr.-jun. 2019. graf.
Article in Portuguese | LILACS | ID: biblio-1026500

ABSTRACT

Objetivo: Trazer um panorama atualizado acerca dos índices de internações e mortalidade por amebíase nos últimos 5 anos pelo sistema de saúde público brasileiro. Métodos: As informações analisadas foram pesquisadas no banco de dados do Departamento de Informática do Sistema Único de Saúde, considerandose as seguintes variáveis: amebíase; internações e mortalidade; sexo; faixa etária; e período de 2012 a 2016. Resultados: De 14.268 internações por amebíase em todo o Brasil, 4.252 foram em 2012, 3.248 em 2013, 2.552 em 2014, 2.033 em 2015 e 2.183 em 2016. Na Região Norte, encontraram-se os dois Estados com maior e menor número de internações da região e do país: o Pará, com 4.379 casos, e Roraima, com 5. Na Região Nordeste, o Maranhão foi o Estado com mais notificações (4.114) e o segundo maior do Brasil. Na Região Sudeste, Minas Gerais apresentou maior número de registros (793); no Sul, foi o Paraná (325) e, no Centro-Oeste, Goiás (731). Dos Estados com registro de mortalidade, na Região Norte, o Amazonas obteve maior valor (1,02); no Nordeste, foi o Sergipe (5,26); no Sudeste, o Rio de Janeiro (7,81); no Sul, o Rio Grande do Sul (5,26); e, no Centro-Oeste, o Mato Grosso (1,22). Conclusão: Apesar de uma redução no número de internações, as estatísticas para a amebíase ainda continuam altas, principalmente, considerando- se que se trata de uma patologia que poderia ser evitada. É necessário investir em mais medidas educativas, que ensinem a população a evitar a contaminação pelo Entamoeba spp., bem como que seja promovidas ações de saneamento básico e abastecimento de água potável adequados para todas as regiões do Brasil. (AU)


Objective: To provide an updated picture of the hospitalization rates, and mortality due to amebiasis in the last 5 years in the Brazilian public health system. Methods: The information analyzed was searched in the Informatics Department of the Unified Health System database, considering the following variables: amebiasis; hospitalizations and mortality; gender; age group; and period from 2012-2016. Results: Of 14,268 hospitalizations for amebiasis throughout Brazil, 4,252 were in 2012, 3,248 in 2013, 2,552 in 2014, 2,033 in 2015, and 2,183 in 2016. In the North Region, there were the two states with the highest and lowest number of hospitalizations in the region and in the country: the state of Pará, with 4,379 cases, and of Roraima with 5. In the Northeast region, the state of Maranhão was the one with more notifications (4,114), and the second largest one in Brazil. In the Southeast region, the stat of Minas Gerais presented the highest number of records (793); in the South region, it was the state of Paraná (325); and in Center-West, Goiás (731). Of the states with mortality records, in the North region Amazonas reached the highest value (1.02); in the Northeast, Sergipe (5,26); in the Southeast, Rio de Janeiro (7.81); in the South, Rio Grande do Sul (5.26); and in the Center-West region, Mato Grosso (1,22). Conclusion: Despite a reduction in the number of hospitalizations, the statistics for amebiasis are still high, mainly considering that it is a pathology that could be avoided. It is necessary to invest in more educational measures, which teach the population how to avoid contamination by Entamoeba spp., as well as to promote basic sanitation actions, and drinking water supply suitable for all regions of Brazil. (AU)


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Amebiasis/epidemiology , Socioeconomic Factors , Health Profile , Brazil/epidemiology , Demography/statistics & numerical data , Indicators of Morbidity and Mortality , Cross-Sectional Studies , Sex Distribution , Age Distribution , Emergencies , Amebiasis/mortality , Hospitalization
11.
Mem Inst Oswaldo Cruz ; 113(8): e170433, 2018 Jun 25.
Article in English | MEDLINE | ID: mdl-29947711

ABSTRACT

BACKGROUND: The diagnosis of dengue is complex. Until recently, only specialised laboratories were able to confirm dengue infection. However, this has changed with the newly available immunochromatographic rapid tests. Early diagnosis is of great interest, and point-of-care rapid tests have been increasingly used in Brazil. Most of those tests have not undergone validation in the Brazilian population. In this context, we decided to evaluate a rapid test introduced in the Federal District (FD). OBJECTIVES: To estimate the accuracy and reliability of the SD Bioeasy Dengue Duo rapid test and its components to detect dengue infections in a consecutive sample of symptomatic residents in the FD, Brazil. METHODS: In total, 1353 venous blood samples were collected between 2013 and 2014. Two hundred and six positive samples (cases) and 246 negative samples (non cases) were required for sensitivity and specificity estimation, respectively; for agreement evaluation, we used 401 samples. The reference standard used was a composite of MAC-ELISA, virus isolation and real-time polymerase chain reaction (RT-qPCR). The evaluation was conducted prospectively under field conditions in the public health units of the FD. FINDINGS: The results for the overall accuracy of the rapid test (NS1/IgM combined) showed 76% sensitivity and 98% specificity. The sensitivity for the NS1 component (67%) was better than that for the IgM component (35%). The positive likelihood ratio was 46, and the negative likelihood ratio was 0.24. The reliability of the test (NS1/IgM combined) demonstrated crude agreement of 98% (Kappa index 0.94). MAIN CONCLUSIONS: The present phase III, large-scale validation study demonstrates that the rapid test SD Bioeasy Dengue Duo has moderate sensitivity (NS1/IgM combined) and high specificity. Therefore, the test is useful in confirming the diagnosis of dengue, but not enough to rule out the diagnosis. Our results also suggest that Dengue virus (DENV) viral load estimated through the RT-qPCR and antibody level measured through the MAC-ELISA could have had a direct influence on the accuracy of the rapid test.


Subject(s)
Dengue Virus/isolation & purification , Dengue/diagnosis , Diagnostic Tests, Routine/methods , Early Diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Antibodies, Viral/blood , Brazil , Child , Child, Preschool , Dengue/virology , Female , Humans , Immunoglobulin M/blood , Infant , Male , Middle Aged , Predictive Value of Tests , Real-Time Polymerase Chain Reaction , Reproducibility of Results , Sensitivity and Specificity , Young Adult
12.
Mem. Inst. Oswaldo Cruz ; 113(8): e170433, 2018. tab, graf
Article in English | LILACS | ID: biblio-955113

ABSTRACT

BACKGROUND The diagnosis of dengue is complex. Until recently, only specialised laboratories were able to confirm dengue infection. However, this has changed with the newly available immunochromatographic rapid tests. Early diagnosis is of great interest, and point-of-care rapid tests have been increasingly used in Brazil. Most of those tests have not undergone validation in the Brazilian population. In this context, we decided to evaluate a rapid test introduced in the Federal District (FD). OBJECTIVES To estimate the accuracy and reliability of the SD Bioeasy Dengue Duo rapid test and its components to detect dengue infections in a consecutive sample of symptomatic residents in the FD, Brazil. METHODS In total, 1353 venous blood samples were collected between 2013 and 2014. Two hundred and six positive samples (cases) and 246 negative samples (non cases) were required for sensitivity and specificity estimation, respectively; for agreement evaluation, we used 401 samples. The reference standard used was a composite of MAC-ELISA, virus isolation and real-time polymerase chain reaction (RT-qPCR). The evaluation was conducted prospectively under field conditions in the public health units of the FD. FINDINGS The results for the overall accuracy of the rapid test (NS1/IgM combined) showed 76% sensitivity and 98% specificity. The sensitivity for the NS1 component (67%) was better than that for the IgM component (35%). The positive likelihood ratio was 46, and the negative likelihood ratio was 0.24. The reliability of the test (NS1/IgM combined) demonstrated crude agreement of 98% (Kappa index 0.94). MAIN CONCLUSIONS The present phase III, large-scale validation study demonstrates that the rapid test SD Bioeasy Dengue Duo has moderate sensitivity (NS1/IgM combined) and high specificity. Therefore, the test is useful in confirming the diagnosis of dengue, but not enough to rule out the diagnosis. Our results also suggest that Dengue virus (DENV) viral load estimated through the RT-qPCR and antibody level measured through the MAC-ELISA could have had a direct influence on the accuracy of the rapid test.


Subject(s)
Humans , Immunoglobulin M/analysis , Dengue/diagnosis , Early Diagnosis , Brazil/epidemiology , Chile/epidemiology , Real-Time Polymerase Chain Reaction , Antibodies, Viral/blood
13.
PLoS One ; 11(8): e0160404, 2016.
Article in English | MEDLINE | ID: mdl-27494028

ABSTRACT

Over the last decade, ocean sunfish movements have been monitored worldwide using various satellite tracking methods. This study reports the near-real time monitoring of fine-scale (< 10 m) behaviour of sunfish. The study was conducted in southern Portugal in May 2014 and involved satellite tags and underwater and surface robotic vehicles to measure both the movements and the contextual environment of the fish. A total of four individuals were tracked using custom-made GPS satellite tags providing geolocation estimates of fine-scale resolution. These accurate positions further informed sunfish areas of restricted search (ARS), which were directly correlated to steep thermal frontal zones. Simultaneously, and for two different occasions, an Autonomous Underwater Vehicle (AUV) video-recorded the path of the tracked fish and detected buoyant particles in the water column. Importantly, the densities of these particles were also directly correlated to steep thermal gradients. Thus, both sunfish foraging behaviour (ARS) and possibly prey densities, were found to be influenced by analogous environmental conditions. In addition, the dynamic structure of the water transited by the tracked individuals was described by a Lagrangian modelling approach. The model informed the distribution of zooplankton in the region, both horizontally and in the water column, and the resultant simulated densities positively correlated with sunfish ARS behaviour estimator (rs = 0.184, p<0.001). The model also revealed that tracked fish opportunistically displace with respect to subsurface current flow. Thus, we show how physical forcing and current structure provide a rationale for a predator's fine-scale behaviour observed over a two weeks in May 2014.


Subject(s)
Marine Biology/methods , Remote Sensing Technology/methods , Tetraodontiformes , Animals , Behavior, Animal , Environmental Monitoring/methods , Geographic Information Systems , Portugal , Robotics/instrumentation , Robotics/methods , Satellite Communications , Zooplankton
14.
Ecotoxicol Environ Saf ; 119: 90-7, 2015 Sep.
Article in English | MEDLINE | ID: mdl-25985252

ABSTRACT

Mining activity is an important economic activity in several North Atlantic Treaty Organization (NATO) and North African countries. Within their territory derelict or active mining explorations represent risks to surrounding ecosystems, but engineered-based remediation processes are usually too expensive to be an option for the reclamation of these areas. A project funded by NATO was performed, with the aim of finding a more eco-friendly solution for reclamation of these areas. As part of an overall risk assessment, the risk of contaminated soils to selected soil organisms was evaluated. The main question addressed was: Does the metal-contaminated soils from a former iron mine located at Ait Amar (Morocco),which was abandoned in the mid-Sixties, affect the reproduction of enchytraeids (Enchytraeus bigeminus) and predatory mites (Hypoaspis aculeifer)? Soil samples were taken at 20 plots along four transects covering the mine area and at a reference site about 15km away from the mine. The soils were characterized pedologically and chemically, which showed a heterogeneous pattern of metal contamination (mainly cadmium, copper, and chromium, sometimes at concentrations higher than European soil trigger values). The reproduction of enchytraeids (Enchytraeus bigeminus) and predatory mites (Hypoaspis aculeifer) was studied using standard laboratory tests according to OECD guidelines 220 (2004) and 226 (2008). The number of juveniles of E. bigeminus was reduced at several plots with high concentrations of Cd or Cu (the latter in combination with low pH values). There was nearly no effect of the metal contaminated soils on the reproduction of H. aculeifer. The overall lack of toxicity at the majority of the studied plots is probably caused by the low availability of the metals in these soils unless soil pH was very low. Different exposure pathways are likely responsible for the different reaction of mites and enchytraeids (hard-bodied versus soft-bodied organisms). The results of this study can be used not only for assessing the risk of contaminated soils but also could play a role for the identification of soil remediation programs.


Subject(s)
Environmental Pollution/adverse effects , Metals, Heavy/toxicity , Mites/drug effects , Oligochaeta/drug effects , Soil Pollutants/toxicity , Soil/chemistry , Animals , Ecosystem , Environmental Monitoring , Iron/toxicity , Mining , Morocco , Reproduction/drug effects , Risk Assessment
15.
Rev Soc Bras Med Trop ; 46(5): 566-74, 2013.
Article in English | MEDLINE | ID: mdl-24142367

ABSTRACT

INTRODUCTION: We analyzed the vertical and monthly distributions of culicid species in the gallery forest of Brasília National Park, with an emphasis on the potential vectors of yellow fever (YF). METHODS: Between September 2010 and August 2011, mosquitoes were captured on the ground and in the canopy of the forest for five consecutive days per month, from nine to 15 hours. The mosquitoes were examined to verify natural infection with flaviviruses by isolation in Aedes albopictus Skuse, 1864 cells followed by indirect immunofluorescence. RESULTS: We identified 2,677 culicids distributed in 29 species. Most of the mosquitoes were captured at ground level (69%) during the rainy season (86%). The most abundant species were Sabethes (Sabethes) albiprivus Theobald, 1903; Limatus durhamii Theobald, 1901; Haemagogus (Conopostegus) leucocelaenus Dyar & Shannon, 1924; Haemagogus (Haemagogus) janthinomys Dyar, 1921; Aedes (Ochlerotatus) scapularis Rondani, 1848; Psorophora (Janthinosoma) ferox Von Humboldt, 1819; and Aedes (Ochlerotatus) serratus Theobald, 1901. Limatus durhamii, Limatus durhamii, Psorophora ferox, Aedes scapularis and Aedes serratus showed significant differences (p<0.05) in their habitat use. Limatus durhamii was found more often in the canopy, unlike the other species. During the rainy season, the most abundant species were Sa. albiprivus, Haemagogus leucocelaenus and Limatus durhamii. During the dry season, the potential YF vectors exhibited a very low frequency and abundance, except Aedes scapularis and Aedes serratus. No flavivirus was detected in the 2,677 examined mosquitoes. CONCLUSIONS: We recommend continued and systematic entomological monitoring in areas vulnerable to the transmission of YF in the Federal District of Brazil.


Subject(s)
Culicidae/classification , Insect Vectors/classification , Yellow Fever , Animals , Brazil , Culicidae/virology , Ecosystem , Flavivirus/isolation & purification , Fluorescent Antibody Technique, Indirect , Insect Vectors/virology , Population Density , Population Dynamics , Seasons , Trees , Yellow Fever/transmission
16.
Rev. Soc. Bras. Med. Trop ; 46(5): 566-574, Sept-Oct/2013.
Article in English | LILACS | ID: lil-691431

ABSTRACT

Introduction We analyzed the vertical and monthly distributions of culicid species in the gallery forest of Brasília National Park, with an emphasis on the potential vectors of yellow fever (YF). Methods Between September 2010 and August 2011, mosquitoes were captured on the ground and in the canopy of the forest for five consecutive days per month, from nine to 15 hours. The mosquitoes were examined to verify natural infection with flaviviruses by isolation in Aedes albopictus Skuse, 1864 cells followed by indirect immunofluorescence. Results We identified 2,677 culicids distributed in 29 species. Most of the mosquitoes were captured at ground level (69%) during the rainy season (86%). The most abundant species were Sabethes (Sabethes) albiprivus Theobald, 1903; Limatus durhamii Theobald, 1901; Haemagogus (Conopostegus) leucocelaenus Dyar & Shannon, 1924; Haemagogus (Haemagogus) janthinomys Dyar, 1921; Aedes (Ochlerotatus) scapularis Rondani, 1848; Psorophora (Janthinosoma) ferox Von Humboldt, 1819; and Aedes (Ochlerotatus) serratus Theobald, 1901. Limatus durhamii, Limatus durhamii, Psorophora ferox, Aedes scapularis and Aedes serratus showed significant differences (p<0.05) in their habitat use. Limatus durhamii was found more often in the canopy, unlike the other species. During the rainy season, the most abundant species were Sa. albiprivus, Haemagogus leucocelaenus and Limatus durhamii. During the dry season, the potential YF vectors exhibited a very low frequency and abundance, except Aedes scapularis and Aedes serratus. No flavivirus was detected in the 2,677 examined mosquitoes. Conclusions We recommend continued and systematic entomological monitoring in areas vulnerable to the transmission of YF in the Federal District of Brazil. .


Subject(s)
Animals , Culicidae/classification , Insect Vectors/classification , Yellow Fever , Brazil , Culicidae/virology , Ecosystem , Fluorescent Antibody Technique, Indirect , Flavivirus/isolation & purification , Insect Vectors/virology , Population Density , Population Dynamics , Seasons , Trees , Yellow Fever/transmission
17.
Chemosphere ; 85(6): 1040-7, 2011 Oct.
Article in English | MEDLINE | ID: mdl-21840031

ABSTRACT

The sole routine testing of the standard earthworm Eisenia fetida for the terrestrial risk assessment of pesticides has been under much debate since other soil invertebrates may be more sensitive than this standard test species. However, the very low availability of laboratory toxicity data for taxa other than E. fetida has greatly hampered sensitivity comparisons. In the present study, the relative tolerance (T(rel)) approach was used to enable comparing toxicity thresholds obtained from the US-EPA ECOTOX database, for main terrestrial taxonomic groups and pesticidal types of action (insecticides, fungicides, herbicides, and other) separately. Analyses confirmed previously reported lower and higher sensitivity of collembolans to fungicides and insecticides, respectively. However, various other discrepancies in susceptibility relative to E. fetida were encountered as indicated by species sensitivity distributions and/or calculated 95% confidence intervals of T(rel) values. Arachnids and isopods were found to be more sensitive to insecticides, and nematodes to fungicides, as compared to E. fetida. Implications of study findings for the terrestrial risk assessment of pesticides are discussed.


Subject(s)
Ecotoxicology/methods , Oligochaeta/drug effects , Pesticide Residues/toxicity , Soil , Animals , Risk Assessment , Species Specificity
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