Thinking out of the box: revisiting health surveillance based on medical records.

Despite the considerable advances in the last years, the health information systems for health surveillance still need to overcome some critical issues so that epidemic detection can be performed in real time. For instance, despite the efforts of the Brazilian Ministry of Health (MoH) to make COVID-19 data available during the pandemic, delays due to data entry and data availability posed an additional threat to disease monitoring. Here, we propose a complementary approach by using electronic medical records (EMRs) data collected in real time to generate a system to enable insights from the local health surveillance system personnel. As a proof of concept, we assessed data from São Caetano do Sul City (SCS), São Paulo, Brazil. We used the "fever" term as a sentinel event. Regular expression techniques were applied to detect febrile diseases. Other specific terms such as "malaria," "dengue," "Zika," or any infectious disease were included in the dictionary and mapped to "fever." Additionally, after "tokenizing," we assessed the frequencies of most mentioned terms when fever was also mentioned in the patient complaint. The findings allowed us to detect the overlapping outbreaks of both COVID-19 Omicron BA.1 subvariant and Influenza A virus, which were confirmed by our team by analyzing data from private laboratories and another COVID-19 public monitoring system. Timely information generated from EMRs will be a very important tool to the decision-making process as well as research in epidemiology. Quality and security on the data produced is of paramount importance to allow the use by health surveillance systems.

Risk factors for long coronavirus disease 2019 (long COVID) among healthcare personnel, Brazil, 2020-2022.

OBJECTIVE: To determine risk factors for the development of long coronavirus disease 2019 (COVID-19) in healthcare personnel (HCP). METHODS: We conducted a case-control study among HCP who had confirmed symptomatic COVID-19 working in a Brazilian healthcare system between March 1, 2020, and July 15, 2022. Cases were defined as those having long COVID according to the Centers for Disease Control and Prevention definition. Controls were defined as HCP who had documented COVID-19 but did not develop long COVID. Multiple logistic regression was used to assess the association between exposure variables and long COVID during 180 days of follow-up. RESULTS: Of 7,051 HCP diagnosed with COVID-19, 1,933 (27.4%) who developed long COVID were compared to 5,118 (72.6%) who did not. The majority of those with long COVID (51.8%) had 3 or more symptoms. Factors associated with the development of long COVID were female sex (OR, 1.21; 95% CI, 1.05-1.39), age (OR, 1.01; 95% CI, 1.00-1.02), and 2 or more SARS-CoV-2 infections (OR, 1.27; 95% CI, 1.07-1.50). Those infected with the SARS-CoV-2 δ (delta) variant (OR, 0.30; 95% CI, 0.17-0.50) or the SARS-CoV-2 o (omicron) variant (OR, 0.49; 95% CI, 0.30-0.78), and those receiving 4 COVID-19 vaccine doses prior to infection (OR, 0.05; 95% CI, 0.01-0.19) were significantly less likely to develop long COVID. CONCLUSIONS: Long COVID can be prevalent among HCP. Acquiring >1 SARS-CoV-2 infection was a major risk factor for long COVID, while maintenance of immunity via vaccination was highly protective.

Combined liver transplantation with sleeve gastrectomy: a pioneer case series from Brazil.

The association of a bariatric operation during liver transplantation may benefit patients with liver failure and obesity and sleeve gastrectomy emerges as the procedure of choice. The aim of this study is to present our experience with combined liver transplantation and sleeve gastrectomy. During an 18-month period, seven patients were submitted to simultaneous liver transplant and sleeve gastrectomy (LTSG). There were four male and three female, and the mean recipient age was 60.5 years, mean BMI was 38.2 kg/m2, and mean MELD score was 25 points. The indication for liver transplantation was nonalcoholic steatohepatitis (NASH) with hepatocellular carcinoma (HCC) in four cases, hepatitis C with HCC in one case, pure NASH in one case and alcoholic cirrhosis with HCC in one case. Six patients are alive with normal allograft function. There were no biliary complications.

Liver transplantation in gastroenteropancreatic neuroendocrine tumors.

Neuroendocrine tumors are part of a heterogeneous group of tumors located in organs such as the gastrointestinal tract (GIT), lungs, thymus, thyroid, and adrenal glands. The most prevalent sites are the small intestine, cecal appendix, and pancreas. More than 50% of these tumors are associated with metastases at the time of diagnosis. Neuroendocrine tumors are classified according to the degree of cell differentiation and the histopathological proliferation index of the lesion. Neuroendocrine tumors can be well differentiated or poorly differentiated. G3 tumors are characterized by Ki-67 expression greater than 20% and can be either well differentiated (G3 NET) or poorly differentiated (G3 NEC). Neuroendocrine carcinoma (NEC G3) is subdivided into small-cell and large-cell types. When neuroendocrine tumors present clinical and compressive symptoms, carcinoid syndrome is evident. Carcinoid syndrome occurs when the tumor produces neuroendocrine mediators that cannot be metabolized by the liver due to either the size of the tumor or their secretion by the liver itself. Several therapeutic strategies have been described for the treatment of metastatic neuroendocrine tumors, including curative or palliative surgical approaches, peptide receptor radionuclide therapy, percutaneous therapy, systemic chemotherapy, and radiotherapy. Liver surgery is the only approach that can offer a cure for metastatic patients. Liver metastases must be completely resected, and in this context, orthotopic liver transplantation has gained prominence for yielding very promising outcomes in selected cases. The aim of this study is to review the literature on OLT as a form of treatment with curative intent for patients with gastroenteropancreatic neuroendocrine tumors with liver metastasis.

Lying in wait: the resurgence of dengue virus after the Zika epidemic in Brazil.

After the Zika virus (ZIKV) epidemic in the Americas in 2016, both Zika and dengue incidence declined to record lows in many countries in 2017-2018, but in 2019 dengue resurged in Brazil, causing ~2.1 million cases. In this study we use epidemiological, climatological and genomic data to investigate dengue dynamics in recent years in Brazil. First, we estimate dengue virus force of infection (FOI) and model mosquito-borne transmission suitability since the early 2000s. Our estimates reveal that DENV transmission was low in 2017-2018, despite conditions being suitable for viral spread. Our study also shows a marked decline in dengue susceptibility between 2002 and 2019, which could explain the synchronous decline of dengue in the country, partially as a result of protective immunity from prior ZIKV and/or DENV infections. Furthermore, we performed phylogeographic analyses using 69 newly sequenced genomes of dengue virus serotype 1 and 2 from Brazil, and found that the outbreaks in 2018-2019 were caused by local DENV lineages that persisted for 5-10 years, circulating cryptically before and after the Zika epidemic. We hypothesize that DENV lineages may circulate at low transmission levels for many years, until local conditions are suitable for higher transmission, when they cause major outbreaks.

Sensing soluble uric acid by Naip1-Nlrp3 platform.

Uric acid (UA), a product of purine nucleotide degradation able to initiate an immune response, represents a breakpoint in the evolutionary history of humans, when uricase, the enzyme required for UA cleavage, was lost. Despite being inert in human cells, UA in its soluble form (sUA) can increase the level of interleukin-1ß (IL-1ß) in murine macrophages. We, therefore, hypothesized that the recognition of sUA is achieved by the Naip1-Nlrp3 inflammasome platform. Through structural modelling predictions and transcriptome and functional analyses, we found that murine Naip1 expression in human macrophages induces IL-1ß expression, fatty acid production and an inflammation-related response upon sUA stimulation, a process reversed by the pharmacological and genetic inhibition of Nlrp3. Moreover, molecular interaction experiments showed that Naip1 directly recognizes sUA. Accordingly, Naip may be the sUA receptor lost through the human evolutionary process, and a better understanding of its recognition may lead to novel anti-hyperuricaemia therapies.

Fatores Associados à satisfação com a vida de idosos usuários de unidades básicas de saúde / Associated factors in satisfaction with the life of elderly users of basic health units / Fatores asociados a la satisfacción con la vida de los ancianos usuarios de unidades básicas de salud

Este estudo investigou os fatores associados à satisfação com a vida de 654 idosos usuários de Unidades Básicas de Saúde de Maringá, Paraná. Foi utilizado um questionário sociodemográfico, o International Physical Activity Questionnaire (IPAQ) e a Escala de Satisfação com a Vida. A análise dos dados foi realizada por meio dos testes de Kruskal-Wallis, Mann-Whitney e correlação de Spearman (p < 0,05). Verificou-se que os idosos com menor poder aquisitivo que se perceberam com saúde ruim e tomam medicamentos regularmente são menos satisfeitos com a vida do que seus pares. Os idosos fisicamente ativos se mostraram mais satisfeitos com a vida do que os sedentários/irregularmente ativos. A satisfação com a vida se associou com os dias de caminhada por semana (r = 0,15). Conclui-se que a renda familiar, a percepção de saúde, o uso de medicamentos e a atividade física são fatores intervenientes na satisfação com a vida.

This study investigated the associated factors involved in life satisfaction of 654 elderly users of Basic Health Units of Maringá, Paraná. A sociodemographic questionnaire was used, the International Physical Activity Questionnaire (IPAQ) and the Life Satisfaction Scale. Data analysis was performed using the Kruskal-Wallis, Mann-Whitney, and Spearman correlation tests (p < 0.05). Older people with lower purchasing power who were perceived with poor health and who take medications regularly are less satisfied with life than their peers (p < 0.05). The physically active elderly were more satisfied with life than the sedentary/irregularly active (p = 0.004). Satisfaction with life correlated with walking days per week (r = 0.15). It is concluded that family income, health perception, medication use, and physical activity are factors that intervene in life satisfaction.

Este estudio investigó los factores asociados con la satisfacción con la vida de 654 ancianos usuarios de Unidades Básicas de Salud de Maringá, Paraná. Se utilizó un cuestionario sociodemográfico, el International Physical Activity Questionnaire (IPAQ) y la Escala de Satisfacción con la vida. El análisis de los datos fue realizado por medio de las pruebas de Kruskal-Wallis, Mann-Whitney y correlación de Spearman (p < 0,05). Se verificó que los ancianos con menor poder adquisitivo que se percibieron con mala salud y que toman medicamentos regularmente son menos satisfechos con la vida que sus pares. Los ancianos físicamente activos se mostraron más satisfechos con la vida que los sedentarios/irregularmente activos. La satisfacción con la vida se asoció con los días de caminata por semana (r = 0,15). Se concluye que la renta familiar, la percepción de salud, el uso de medicamentos y la actividad física son factores intervinientes en la satisfacción con la vida.

Denervação articular aberta em cadela / Open articular denervation in bitch

A displasia coxofemoral (DCF) é uma afecção de cães e gatos definida como uma doença hereditária biomecânica ou adquirida, representada pela disparidade entre a massa muscular primária e o rápido crescimento ósseo, que pode levar à doença articular degenerativa (DAD). Com a evolução do quadro, os animais apresentarão perda da cartilagem, evoluindo para um desgaste, deformação da cabeça do fêmur e do acetábulo, levando a um quadro de dor e dificuldade de locomoção. O objetivo do presente trabalho foi relatar uma abordagem cirúrgica como tratamento de DCF e DAD de uma cadela da raça labrador. O diagnóstico foi obtido através do histórico, exame físico e exame radiológico. Na radiografia verificouse diminuição de espaço articular em ambos os membros posteriores, artrose do quadril e sub-luxação. O tratamento definitivo instituído para a correção da DCF foi a intervenção cirúrgica usando a técnica de denervação coxofemoral com abordagem aberta, com principal objetivo de amenizar a dor, prevenir a progressão da enfermidade articular degenerativa e restaurar a função normal da articulação. O tratamento se mostrou eficiente, garantindo conforto ao paciente e retorno da função articular e dos membros.

Hip dysplasia (DCF) is a condition of dogs and cats defined as a hereditary biomechanical or acquired disease, represented by the disparity between primary muscle mass and rapid bone growth, which can lead to degenerative joint disease (DAD). With the development of the condition, these animals will present loss of cartilage, evolving to a wear and tear, and deformation of the head of the femur and acetabulum, leading to a picture of pain and difficulty in locomotion. The aim of the present study was to report a surgical approach as treatment of DCF and DAD of a Labrador bitch. The diagnosis is obtained through history, physical examination and radiological examination. Radiography revealed decreased joint space in both hind limbs, hip arthrosis and sub-dislocation. The definitive treatment instituted for the correction of FDD was surgical intervention using the hip denervation technique with open approach, with the main objective of alleviating pain, preventing the progression of degenerative joint disease and restoring normal joint function. The treatment proved to be efficient, ensuring patient comfort and return of joint and limb function.

Denervação articular aberta em cadela / Open articular denervation in bitch

A displasia coxofemoral (DCF) é uma afecção de cães e gatos definida como uma doença hereditária biomecânica ou adquirida, representada pela disparidade entre a massa muscular primária e o rápido crescimento ósseo, que pode levar à doença articular degenerativa (DAD). Com a evolução do quadro, os animais apresentarão perda da cartilagem, evoluindo para um desgaste, deformação da cabeça do fêmur e do acetábulo, levando a um quadro de dor e dificuldade de locomoção. O objetivo do presente trabalho foi relatar uma abordagem cirúrgica como tratamento de DCF e DAD de uma cadela da raça labrador. O diagnóstico foi obtido através do histórico, exame físico e exame radiológico. Na radiografia verificouse diminuição de espaço articular em ambos os membros posteriores, artrose do quadril e sub-luxação. O tratamento definitivo instituído para a correção da DCF foi a intervenção cirúrgica usando a técnica de denervação coxofemoral com abordagem aberta, com principal objetivo de amenizar a dor, prevenir a progressão da enfermidade articular degenerativa e restaurar a função normal da articulação. O tratamento se mostrou eficiente, garantindo conforto ao paciente e retorno da função articular e dos membros.(AU)

Hip dysplasia (DCF) is a condition of dogs and cats defined as a hereditary biomechanical or acquired disease, represented by the disparity between primary muscle mass and rapid bone growth, which can lead to degenerative joint disease (DAD). With the development of the condition, these animals will present loss of cartilage, evolving to a wear and tear, and deformation of the head of the femur and acetabulum, leading to a picture of pain and difficulty in locomotion. The aim of the present study was to report a surgical approach as treatment of DCF and DAD of a Labrador bitch. The diagnosis is obtained through history, physical examination and radiological examination. Radiography revealed decreased joint space in both hind limbs, hip arthrosis and sub-dislocation. The definitive treatment instituted for the correction of FDD was surgical intervention using the hip denervation technique with open approach, with the main objective of alleviating pain, preventing the progression of degenerative joint disease and restoring normal joint function. The treatment proved to be efficient, ensuring patient comfort and return of joint and limb function.(AU)

Effect of Different Circuit Training on Cardiovascular Responses in Cirrhotic Patients.

The purpose of this study was to analyze and compare heart rate (HR), heart rate variability (HRV), and blood pressure (BP) responses during and after circuit resistance training with 1 min. (CIR1) vs. 2 min. (CIR2) rest intervals between exercises in liver cirrhosis patients. 10 patients (7 women, 3 men) participated in 2 experimental sessions (CIR1 and CIR2) in random order. Each experimental session consisted of 6 exercises performed for 3 sets of 10 repetitions with 70% of the 10-RM load. The only difference between experimental sessions was taking either 1 min. (CIR1) or 2 min. (CIR2) of rest between exercises. Prior and during each session, BP, HR and HRV (beat-to-beat intervals) were assessed. Training efficiency were significant higher for CIR1 when compared to CIR2, since same total training volume was performed in less time. Both protocols elicited significant changes in HR, SBP, and SampEn. Based on the ∆HR and ∆IRR between protocols, higher cardiovascular stress was observed for CIR1 vs. CIR2. However, the patients presented a similar recovery pattern between experimental sessions, and did not present significant alterations in the HRV at 60 min post-workout. In summary, the fast adjustment of autonomic modulation in HRV and BP suggests that circuit resistance training with 1-min or 2-min rest intervals between exercises elicits typical cardiovascular responses in liver cirrhosis patients.

The Pangenome of the Anticarsia gemmatalis Multiple Nucleopolyhedrovirus (AgMNPV).

The alphabaculovirus Anticarsia gemmatalis multiple nucleopolyhedrovirus (AgMNPV) is the world's most successful viral bioinsecticide. Through the 1980s and 1990s, this virus was extensively used for biological control of populations of Anticarsia gemmatalis (Velvetbean caterpillar) in soybean crops. During this period, genetic studies identified several variable loci in the AgMNPV; however, most of them were not characterized at the sequence level. In this study we report a full genome comparison among 17 wild-type isolates of AgMNPV. We found the pangenome of this virus to contain at least 167 hypothetical genes, 151 of which are shared by all genomes. The gene bro-a that might be involved in host specificity and carrying transporter is absent in some genomes, and new hypothetical genes were observed. Among these genes there is a unique rnf12-like gene, probably implicated in ubiquitination. Events of gene fission and fusion are common, as four genes have been observed as single or split open reading frames. Gains and losses of genomic fragments (from 20 to 900 bp) are observed within tandem repeats, such as in eight direct repeats and four homologous regions. Most AgMNPV genes present low nucleotide diversity, and variable genes are mainly located in a locus known to evolve through homologous recombination. The evolution of AgMNPV is mainly driven by small indels, substitutions, gain and loss of nucleotide stretches or entire coding sequences. These variations may cause relevant phenotypic alterations, which probably affect the infectivity of AgMNPV. This work provides novel information on genomic evolution of the AgMNPV in particular and of baculoviruses in general.

Modularity and evolutionary constraints in a baculovirus gene regulatory network.

BACKGROUND: The structure of regulatory networks remains an open question in our understanding of complex biological systems. Interactions during complete viral life cycles present unique opportunities to understand how host-parasite network take shape and behave. The Anticarsia gemmatalis multiple nucleopolyhedrovirus (AgMNPV) is a large double-stranded DNA virus, whose genome may encode for 152 open reading frames (ORFs). Here we present the analysis of the ordered cascade of the AgMNPV gene expression. RESULTS: We observed an earlier onset of the expression than previously reported for other baculoviruses, especially for genes involved in DNA replication. Most ORFs were expressed at higher levels in a more permissive host cell line. Genes with more than one copy in the genome had distinct expression profiles, which could indicate the acquisition of new functionalities. The transcription gene regulatory network (GRN) for 149 ORFs had a modular topology comprising five communities of highly interconnected nodes that separated key genes that are functionally related on different communities, possibly maximizing redundancy and GRN robustness by compartmentalization of important functions. Core conserved functions showed expression synchronicity, distinct GRN features and significantly less genetic diversity, consistent with evolutionary constraints imposed in key elements of biological systems. This reduced genetic diversity also had a positive correlation with the importance of the gene in our estimated GRN, supporting a relationship between phylogenetic data of baculovirus genes and network features inferred from expression data. We also observed that gene arrangement in overlapping transcripts was conserved among related baculoviruses, suggesting a principle of genome organization. CONCLUSIONS: Albeit with a reduced number of nodes (149), the AgMNPV GRN had a topology and key characteristics similar to those observed in complex cellular organisms, which indicates that modularity may be a general feature of biological gene regulatory networks.

Genomic mosaicism in two strains of Dengue virus type 3.

Recombination is a significant factor driving genomic evolution, but it is not well understood in Dengue virus. We used phylogenetic methods to search for recombination in 636 Dengue virus type 3 (DENV-3) genomes and unveiled complex recombination patterns in two strains, which appear to be the outcome of recombination between genotype II and genotype I parental DENV-3 lineages. Our findings of genomic mosaic structures suggest that strand switching during RNA synthesis may be involved in the generation of genetic diversity in dengue viruses.

Meeting the needs of adolescent post-abortion care patients in the Dominican Republic.

Counselling on contraception and contraceptive method provision are key components of post-abortion care (PAC). Some studies have suggested that adolescent PAC patients receive worse care than older women seeking these services. This study aimed to evaluate an intervention whose goal was to improve the counselling and contraceptive uptake of PAC patients, with special attention given to the needs of adolescent patients, in the four public hospitals in the Dominican Republic where PAC services were not being routinely offered. The counselling intervention effort included provider training and the development of adolescent-friendly information, education and communication (IEC) materials. Eighty-eight providers were interviewed at baseline and 6 months after the intervention was implemented. Six months after providers were trained, 140 adolescent PAC patients (< or = 19 years of age) and 134 older PAC patients (20-35 years) were interviewed about the contraceptive counselling messages and contraceptive methods they received before they were discharged from hospital. The adolescent and older PAC patients were matched on study hospital and time of arrival. Significant improvements were noted in provider knowledge and attitudes. No changes were noted in provider-reported PAC counselling behaviours, with close to 70% of providers reporting they routinely assess patients' fertility intentions, discuss contraception, assess STI/HIV risk and discuss post-abortion complications. Adolescent and older PAC patients reported receiving PAC counselling messages at similar rates. Forty per cent of adolescent PAC patients and 45% of older PAC patients who wanted to delay pregnancy were discharged with a contraceptive method. Adolescents were more likely to receive an injectable contraceptive method whereas older women were discharged with a variety of methods. The PAC counselling intervention increased provider knowledge and improved their attitudes and benefited both adolescent and older patients.

Quality of care in institutionalized deliveries: the paradox of the Dominican Republic.

OBJECTIVES: To better understand the paradox in the Dominican Republic of a relatively high maternal mortality ratio despite nearly universal institutionalized deliveries with trained attendants, a rapid assessment using an adaptation of the strategic assessment method was conducted. METHODS: A multi-disciplinary team reviewed national statistics and hospital records, inventoried facilities, and observed peripartum client-provider interactions at 14 facilities. RESULTS: The major referral hospitals, where more than 40% of births in the country occur, were overcrowded and understaffed, with inexperienced residents overseeing care provided by medical students, interns and nurses. Uncomplicated labor and deliveries were overmedicalized, while complicated ones were not managed appropriately; emergencies were not dealt with in a timely fashion. In the peripheral hospitals physicians were seldom present and clients were either turned away or delivered by unprepared nursing staff. Providers in the busiest facilities suffered from compassion fatigue, and were demoralized and overworked. In all facilities, quality of care was lacking and the delivery and birthing process was dehumanized. CONCLUSIONS: Access and availability of institutional delivery alone is not enough to decrease MMR, it is also the quality of emergency obstetric care that saves lives.