Human norovirus in Brazil: an update of reports in different settings.

Norovirus is an important etiologic agent of acute gastroenteritis and has become even more relevant in Brazil after the implementation of the monovalent rotavirus vaccine in 2006 through the public health system, now representing a significant portion of the etiology of acute diarrheal diseases. Although diagnosing acute gastroenteritis caused by norovirus is a relatively simple process, and the infection tends to be self-limited, the virus can be considerably harmful to vulnerable populations, such as children, the elderly, and immunocompromised individuals. The spread of norovirus is also particularly favorable among such groups due to its mode of transmission, favored by cluttered environments such as in hospitals and densely populated regions. Additionally, norovirus' ability to spread through water and food creates the need for measures to ensure adequate sanitation and the development of effective measures to prevent outbreaks and severe manifestations of the disease. This review aims to address the main reports of human norovirus detected in Brazil over the years, focusing on clinical-hospital, food-related, and urban conglomerate contexts, including the circulating strains.

Hydrological changes caused by the construction of dams and reservoirs: The CECP analysis.

We investigated the influence of the construction of cascade dams and reservoirs on the predictability and complexity of the streamflow of the São Francisco River, Brazil, by using complexity entropy causality plane (CECP) in its standard and weighted form. We analyzed daily streamflow time series recorded in three fluviometric stations: São Francisco (upstream of cascade dams), Juazeiro (downstream of Sobradinho dam), and Pão de Açúcar station (downstream of Sobradinho and Xingó dams). By comparing the values of CECP information quantifiers (permutation entropy and statistical complexity) for the periods before and after the construction of Sobradinho (1979) and Xingó (1994) dams, we found that the reservoirs' operations changed the temporal variability of streamflow series toward the less predictable regime as indicated by higher entropy (lower complexity) values. Weighted CECP provides some finer details in the predictability of streamflow due to the inclusion of amplitude information in the probability distribution of ordinal patterns. The time evolution of streamflow predictability was analyzed by applying CECP in 2 year sliding windows that revealed the influence of the Paulo Alfonso complex (located between Sobradinho and Xingó dams), construction of which started in the 1950s and was identified through the increased streamflow entropy in the downstream Pão de Açúcar station. The other streamflow alteration unrelated to the construction of the two largest dams was identified in the upstream unimpacted São Francisco station, as an increase in the entropy around 1960s, indicating that some natural factors could also play a role in the decreased predictability of streamflow dynamics.

Epidemiological Characteristics and Risk Factors Related to Drug-resistant Tuberculosis in Luanda, Angola.

Tuberculosis (TB) is a major cause of illness and public health concern, especially in resource-limited countries. This study analyzed the characteristics related to anti-TB drug resistance. Moreover, we examined the evidence-based indications for the treatment of active TB in Angola. This study evaluated the medical records of 176 patients screened for TB from January to September 2016 in Luanda, the capital city of Angola. Approximately 66.5% of the patients were newly diagnosed with active TB. The residence area showed a significant relationship with TB (P = 0.025), whereas age group (P = 0.272), gender (P = 0.853), and HIV status (P = 0.284) did not showed any relationship with TB. Overall, 72.4% of TB patients had resistance to at least one of the anti-TB drugs. The risk of anti-TB drug resistance was higher in males (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 0.42-3.58, P = 0.685] and in TB-HIV coinfected patients [OR: 1.39; (95% CI: 0.26-7.28), P = 0.700], whereas it was lower in patients aged 30 years or older (OR: 0.56; 95% CI: 0.18-1.69) P = 0.303) and in patients living in urbanized areas (OR: 0.74; 95% CI: 0.17-3.25; P = 0.685). Our findings showed that drug-resistant TB is emerging in Angola. Further studies on factors related to anti-TB drug resistance are urgently needed to ascertain the magnitude of the problem and to proffer strategies toward TB control in Angola.

Best-fit probability distribution models for monthly rainfall of Northeastern Brazil.

The analysis of precipitation data is extremely important for strategic planning and decision-making in various natural systems, as well as in planning and preparing for a drought period. The drought is responsible for several impacts on the economy of Northeast Brazil (NEB), mainly in the agricultural and livestock sectors. This study analyzed the fit of 2-parameter distributions gamma (GAM), log-normal (LNORM), Weibull (WEI), generalized Pareto (GP), Gumbel (GUM) and normal (NORM) to monthly precipitation data from 293 rainfall stations across NEB, in the period 1988-2017. The maximum likelihood (ML) method was used to estimate the parameters to fit the models and the selection of the model was based on a modification of the Shapiro-Wilk statistic. The results showed the chosen 2-parameter distributions to be flexible enough to describe the studied monthly precipitation data. The GAM and WEI models showed the overall best fits, but the LNORM and GP models gave the best fits in certain months of the year and regions that differed from the others in terms of their average precipitation.

Ritmo de crescimento de crianças com hiperplasia congênita da supra-renal em tratamento com baixas doses de hidrocortisona / Growth rate of children with congenital adrenal hyperplasia during treatment with low doses of hydrocortisone

O crescimento de 27 crianças com hiperplasia congênita da supra-renal (HCSR) tratadas com baixas doses de hidrocortisona foi avaliado por um período de 6,1 ± 1,8 anos. As crianças receberam acetato de hidrocortisona na dose diária de 10,8 ± 2,0mg/m² e 24 delas utilizaram também acetato de fludrocortisona, 0,1mg/dia. Vinte e três eram do sexo feminino. No início do estudo a idade cronológica (IC) era 6,1 ± 2,9 anos e a idade óssea (IO) 6,9 ± 3,3 (r= 0,66). Cinco crianças apresentavam avanço da IO> 2 anos em relação à IC. Utilizando os dados do NCHS como referência foram calculados os desvios-padrão da média para estatura em relação à IC (DP/E) e à IO (DP/IO). O DP/E inicial era -0,8 ± 1,9 e ao final do estudo -0,17 ± 1,5 (p= 0,02). O DP/IO inicial era -1,5 ± 2,1 e o final -1,34 ± 1,2 (p= 0,51). O grupo de crianças com diferença entre IO e IC > 2 anos apresentou DP/IO inicial -4,55 ± 0,9 e final de -2,48 ± 0,4 (p= 0,003). A IO avançou 1,3 ± 0,3 por ano de IC e o grupo de crianças com IO inicialmente avançada apresentou melhora do DP/IO final em relação ao inicial. As concentrações plasmáticas de 17-OH Progesterona (17OHP) e androstenediona estavam acima dos valores de referência e se elevaram durante o período de avaliação. Concluímos que o crescimento das crianças com HCSR, em uso de doses reduzidas de hidrocortisona, foi adequado no período de avaliação, sem excessivo avanço da maturação óssea, mesmo com supressão incompleta da concentração plasmática da 17-OHP e dos compostos androgênicos.

[Growth rate of children with congenital adrenal hyperplasia during treatment with low doses of hydrocortisone]. / Ritmo de crescimento de crianças com hiperplasia congênita da supra-renal em tratamento com baixas doses de hidrocortisona.

We evaluated linear growth of 27 children with congenital adrenal hyperplasia (CAH) treated with low doses of oral hydrocortisone. They were followed-up during 6.1 +/- 1.8 years with daily hydrocortisone doses of 10.84 +/- 2.0 mg/m2 and 0.1 mg fludrocortisone (24 of them). Twenty-three were female. Mean chronological age (CA) was 6.1 +/- 2.9 years and bone age (BA) 6.9 +/- 3.3 (r = 0.66) at the beginning of the study. Five children showed BA advancement > 2 years relating to CA. It was calculated Height SD for CA (SD/H) and for BA (SD/BA) were calculated using NCHS as reference pattern. At the beginning of the study SD/H was -0.8 +/- 1.9 and corresponding SD/BA was -1.5 +/- 2.1; at the end SD/H was -0.17 +/- 1.5 and SD/BA was -1.34 +/- 1.2 (p = 0.02 and p = 0.51, respectively for the beginning and the end). BA changed 1.3 +/- 0.3 per year during this period. Children with advanced BA showed an improvement of SD/BA, from -4.55 +/- 0.9 at from the beginning, -4.55 +/- 0.9 to -2.48 +/- 0.4 at the end of follow-up, -2.48 +/- 0.4 (p = 0.003). The elevated plasma levels of 17-OH Progesterone (17OHP) and androstenedione showed further increase during follow-up. We conclude that children with CAH receiving low doses of hydrocortisone showed adequate growth during the follow-up, without excessive BA advancement, even though full suppression of plasma levels of 17OHP and androgens wasere not achieved.