Body fat predicts urinary tract infection in kidney transplant recipients: a prospective cohort study.

BACKGROUND: The association between obesity and infectious diseases is increasingly reported in the literature. There are scarce studies on the association between obesity and urinary tract infection after kidney transplantation (KTx). These studies defined obesity based on body mass index, and their results were conflicting. The present study aimed to evaluate this association using bioelectrical impedance analysis for body composition evaluation, and obesity definition. METHODS: A single-center cohort study was conducted. Demographic, clinical, anthropometric, and laboratory data were collected at KTx admission, and bioelectrical impedance analysis was performed to measure the visceral fat area, waist circumference, and total fat mass. The occurrence of urinary tract infection (symptomatic bacteriuria and/or histological evidence of pyelonephritis) was evaluated within three months after KTx. RESULTS: Seventy-seven patients were included in the cohort, and 67 were included in the final analysis. Urinary tract infection was diagnosed in 23.9% of the transplanted patients. Waist circumference (HR: 1.053; 95% CI 1.005-1.104; p = 0.032), visceral fat area (HR: 1.015; 95% CI 1.003-1.027; p = 0.014), and total fat mass (HR: 1.075; 95% CI 1.008-1.146; p = 0.028) were associated with urinary tract infection occurrence after KTx, using Cox regression models. Patients with high waist circumference (above 102 cm for men and above 88 cm for women) had a 4.7 times higher risk of a urinary tract infection than those with normal waist circumference (HR: 4.726; 95% CI 1.267-17.630; p = 0.021). Kaplan-Meier curves showed that patients with high waist circumference, high visceral fat area, and high total fat mass had more urinary tract infections (Log-rank test p = 0.014, p = 0.020, and p = 0.018, respectively). Body mass index was not able to predict urinary tract infection in the study sample. CONCLUSIONS: Waist circumference, visceral fat area, and total fat mass, assessed by bioelectrical impedance analysis, were predictors of urinary tract infection risk within the first three months after KTx.

Dynamic transmission modeling of COVID-19 to support decision-making in Brazil: A scoping review in the pre-vaccine era.

Brazil was one of the countries most affected during the first year of the COVID-19 pandemic, in a pre-vaccine era, and mathematical and statistical models were used in decision-making and public policies to mitigate and suppress SARS-CoV-2 dispersion. In this article, we intend to overview the modeling for COVID-19 in Brazil, focusing on the first 18 months of the pandemic. We conducted a scoping review and searched for studies on infectious disease modeling methods in peer-reviewed journals and gray literature, published between January 01, 2020, and June 2, 2021, reporting real-world or scenario-based COVID-19 modeling for Brazil. We included 81 studies, most corresponding to published articles produced in Brazilian institutions. The models were dynamic and deterministic in the majority. The predominant model type was compartmental, but other models were also found. The main modeling objectives were to analyze epidemiological scenarios (testing interventions' effectiveness) and to project short and long-term predictions, while few articles performed economic impact analysis. Estimations of the R0 and transmission rates or projections regarding the course of the epidemic figured as major, especially at the beginning of the crisis. However, several other outputs were forecasted, such as the isolation/quarantine effect on transmission, hospital facilities required, secondary cases caused by infected children, and the economic effects of the pandemic. This study reveals numerous articles with shared objectives and similar methods and data sources. We observed a deficiency in addressing social inequities in the Brazilian context within the utilized models, which may also be expected in several low- and middle-income countries with significant social disparities. We conclude that the models were of great relevance in the pandemic scenario of COVID-19. Nevertheless, efforts could be better planned and executed with improved institutional organization, dialogue among research groups, increased interaction between modelers and epidemiologists, and establishment of a sustainable cooperation network.

Modeling the impact of child vaccination (5-11 y) on overall COVID-19 related hospitalizations and mortality in a context of omicron variant predominance and different vaccination coverage paces in Brazil.

Background: Developing countries have experienced significant COVID-19 disease burden. With the emergence of new variants, particularly omicron, the disease burden in children has increased. When the first COVID-19 vaccine was approved for use in children aged 5-11 years of age, very few countries recommended vaccination due to limited risk-benefit evidence for vaccination of this population. In Brazil, ranking second in the global COVID-19 death toll, the childhood COVID-19 disease burden increased significantly in early 2022. This prompted a risk-benefit assessment of the introduction and scaling-up of COVID-19 vaccination of children. Methods: To estimate the potential impact of vaccinating children aged 5-11 years with mRNA-based COVID-19 vaccine in the context of omicron dominance, we developed a discrete-time SEIR-like model stratified in age groups, considering a three-month time horizon. We considered three scenarios: No vaccination, slow, and maximum vaccination paces. In each scenario, we estimated the potential reduction in total COVID-19 cases, hospitalizations, deaths, hospitalization costs, and potential years of life lost, considering the absence of vaccination as the base-case scenario. Findings: We estimated that vaccinating at a maximum pace could prevent, between mid-January and April 2022, about 26,000 COVID-19 hospitalizations, and 4200 deaths in all age groups; of which 5400 hospitalizations and 410 deaths in children aged 5-11 years. Continuing vaccination at a slow/current pace would prevent 1450 deaths and 9700 COVID-19 hospitalizations in all age groups in this same time period; of which 180 deaths and 2390 hospitalizations in children only. Interpretation: Maximum vaccination of children results in a significant reduction of COVID-19 hospitalizations and deaths and should be enforced in developing countries with significant disease incidence in children. Funding: This manuscript was funded by the Brazilian Council for Scientific and Technology Development (CNPq - Process # 402834/2020-8).

Transitions in frailty state 12 months after kidney transplantation: a prospective cohort study.

BACKGROUND: Frailty is associated with several unfavorable outcomes after kidney transplantation (KTx). However, limited information is available regarding the transitions in frailty state and its components after KTx. This study aimed to evaluate the transitions in physical frailty phenotype and its components over a period of 12 months after KTx. METHODS: In this prospective single-center cohort study, we measured physical frailty phenotype (PFP) and its components at the time of admission for KTx and 12 months after KTx. The evaluation includes five components: weakness (grip strength analysed by sex and body mass index quartiles), physical activity (kcals/week based on the Minnesota Leisure Time Physical Activity questionnaire), exhaustion (self-report using the Center for Epidemiological Studies Depression Scale), gait speed (time taken to walk 15 feet based on sex and height-specific cutoff), and unintentional weight loss (self-report of unintentional weight loss > 10 lbs in the last year). The exhaustion and physical activity components are validated in the Brazilian population. Each component is scored as 0 or 1 according to its presence or absence, and a PFP score of 3-5 defines frailty, 2 is intermediate, and 0-1 is rated as non-frail. We used the McNemar and Wilcoxon test to compare physical frailty phenotype and its components between the two periods. RESULTS: Among 87 patients included in the study, 16.1% were classified as frail, 20.7% as intermediately frail, and 63.2% as non-frail. Sixty-four patients were included in the analysis to evaluate transitions in frailty. At the time of admission for KTx, 15.6% of patients were defined as frail compared to 4.7% of patients at 12 months after KTx (p = 0.023). Among the physical frailty phenotype components, the proportion of patients who scored in the weight loss category 12 months after KTx was significantly lower than that at the time of KTx (6.3% vs 34.4%, p < 0.001). CONCLUSIONS: There was a 69.9% reduction in the prevalence of frail patients at the end of the 12-month follow-up after KTx. Among the components of frailty, weight loss showed a significant improvement.

Modelling optimal vaccination strategies against Covid-19 in a context of Gamma variant predominance in Brazil

Brazil experienced moments of collapse in its health system throughout 2021, driven by a timid initial vaccination strategy against Covid-19, combined with the emergence of variants of interest (VOC). Mathematical modelling has been used to subsidize decision-makers in public health planning. Considering the vaccine products available, effectiveness estimates, the emergence of Gamma as the predominant VOC circulating in 2021, and national estimated doses available for the next several months, we developed a Markov-chain mathematical modelling approach to evaluate optimal strategies for Covid-19 vaccination in Brazil in terms of Covid deaths averted. Our main findings are that in order to reach higher vaccination impact in Brazil, Covid-19 immunization strategies should include recovering vaccination coverage rates in high-risk groups reaching higher coverage; expanding vaccination to younger age groups should be considered only after ensuring at least 80% coverage in older age groups; reducing the interval between doses of AZD1222 from 12 to 8 weeks. We also demonstrate that the latter is only feasible if accompanied by an increase in vaccine supply of at least 50% in the next six month period.

Impact of nonpharmaceutical strategies on trends of COVID-19 in São Paulo State.

Interrupted time series analyses were conducted to measure the impact of social distancing policies (instituted on March 22, 2020) and of subsequent mandatory masking in the community (instituted on May 4, 2020) on the incidence and effective reproductive number of COVID-19 in São Paulo State, Brazil. Overall, the impact of social distancing both on incidence and Rt was greater than the incremental effect of mandatory masking. Those findings may reflect either a small impact of face masking or the loosening of social distancing after mandatory use of masks.

Vaccination efforts in Brazil: scenarios and perspectives under a mathematical modeling approach

An agent-based model is proposed to access the impact of vaccination strategies to halt the COVID-19 spread. The model is parameterized using data from Sao Paulo State, Brazil. It was considered the two vaccines that are already approved for emergency use in Brazil, the CoronaVac vaccine developed by the Chinese bio-pharmaceutical company Sinovac and the Oxford-AstraZeneca vaccine (ChadOx1) developed by Oxford University and the British laboratory AstraZeneca. Both of them are two-dose schemes, but the efficacy and the interval between doses are different. We found that even in the worst scenario, in which the vaccine does not prevent infection either severe symptoms, the number of deaths decreases from 122 to 99 for CoronaVac application and to 80 for ChadOx1 administration. The same patterns have been seen in hospitalizations. Nevertheless, we show that when a low risk perception occurs, the reduction values decrease between 2% to 4%. Moreover, the increase of disease prevalence also jeopardizes immunization, showing the importance of the mitigation measures maintenance. On the other hand, doubling the vaccination rate would be able to significantly decrease the disease outcomes, reducing deaths by up to 74.4%. In conclusion, vaccination, along with non-pharmaceutical measures, is key to the control of COVID-19 in Brazil.

The use of health geography modeling to understand early dispersion of COVID-19 in São Paulo, Brazil.

Public health policies to contain the spread of COVID-19 rely mainly on non-pharmacological measures. Those measures, especially social distancing, are a challenge for developing countries, such as Brazil. In São Paulo, the most populous state in Brazil (45 million inhabitants), most COVID-19 cases up to April 18th were reported in the Capital and metropolitan area. However, the inner municipalities, where 20 million people live, are also at risk. As governmental authorities discuss the loosening of measures for restricting population mobility, it is urgent to analyze the routes of dispersion of COVID-19 in São Paulo territory. We hypothesize that urban hierarchy is the main responsible for the disease spreading, and we identify the hotspots and the main routes of virus movement from the metropolis to the inner state. In this ecological study, we use geographic models of population mobility to check for patterns for the spread of SARS-CoV-2 infection. We identify two patterns based on surveillance data: one by contiguous diffusion from the capital metropolitan area, and the other hierarchical with long-distance spread through major highways that connects São Paulo city with cities of regional relevance. This knowledge can provide real-time responses to support public health strategies, optimizing the use of resources in order to minimize disease impact on population and economy.

Impact of nonpharmaceutical strategies on trends of COVID-19 in São Paulo State

ABSTRACT Interrupted time series analyses were conducted to measure the impact of social distancing policies (instituted on March 22, 2020) and of subsequent mandatory masking in the community (instituted on May 4, 2020) on the incidence and effective reproductive number of COVID-19 in São Paulo State, Brazil. Overall, the impact of social distancing both on incidence and Rt was greater than the incremental effect of mandatory masking. Those findings may reflect either a small impact of face masking or the loosening of social distancing after mandatory use of masks.

Impact of nonpharmaceutical governmental strategies for prevention and control of COVID-19 in Sao Paulo State, Brazil.

Interrupted time series analyses (ITSA) were performed to measure the impact of social distancing policies (instituted 22/03/2020) and subsequent mandatory masking in the community (instituted 04/05/2020) on the incidence and effective reproductive number (Rt) of COVID-19 in Sao Paulo State, Brazil. Overall, the impact of social distancing both on incidence and Rt was greater than the incremental effect of mandatory masking. Those findings may reflect either a small impact of face masking or the loosening of social distancing after mandatory use of masks.

Elementary spatial structures and dispersion of COVID-19: health geography directing responses to public health emergency in Sao Paulo State, Brazil

Public health policies to contain the spread of COVID-19 rely mainly on non-pharmacological measures. Those measures, especially social distancing, are a challenge for developing countries, such as Brazil. In Sao Paulo, the most populous state in Brazil (45 million inhabitants), most COVID-19 cases up to April 18th were reported in the Capital and metropolitan area. However, the inner municipalities, where 20 million people live, are also at risk. As governmental authorities discuss the loosening of measures for restricting population mobility, it is urgent to analyze the routes of dispersion of COVID-19 in those municipalities. In this ecological study, we use geographical models of population mobility as patterns for spread of SARS-Cov-2 infection. Based on surveillance data, we identify two patterns: one by contiguous diffusion from the capital metropolitan area and other that is hierarchical, with long-distance spread through major highways to cities of regional relevance. We also modelled the impact of social distancing strategies in the most relevant cities, and estimated a beneficial effect in each and every setting studied. This acknowledgement can provide real-time responses to support public health strategies.

Several countries in one: a mathematical modeling analysis for COVID-19 in inner Brazil

Early 2020 and the world experiences its very first pandemic of globalized era. A novel coronavirus, SARS-Cov-2, is the causative agent of severe pneumonia and rapidly spread through many nations, crashing health systems. In Brazil, the emergence of local epidemics in major metropolitan areas is a concern. In a huge and heterogeneous country, with regional disparities and climate diversity, several factors can modulate the dynamics of COVID-19. What should be the scenario for an inner Brazil and what can we do to control infection transmission in each one of these locations? In this paper, a mathematical model was developed to simulate disease transmission among individuals in several scenarios, differing by the intensity and type of control measures. Mitigation strategies rely on social distancing of all individuals, and detection and isolation of infected ones. The model shows that control effort varies among cities. The social distancing is the most efficient method to control disease transmission but improving detection and isolation of infected individuals can help loosening this mitigation strategy.

Risco cardiovascular pelo escore de Framingham em serviços de cardiologia de uma cidade de médio porte de Minas Gerais / Cardiovascular risk by the Framingham score in cardiology services of a medium-sized city of Minas Gerais

Objetivo. Estratificar os pacientes de serviços ambulatoriais de cardiologia através do escore de Framingham, para subsidiar o planejamento de futuras intervenções. Métodos. Trata-se de um corte transversal realizado em serviços de cardiologia de centro público ambulatorial e consultório particular de cidade de médio porte de Minas Gerais. A amostragem foi aleatória, com 329 prontuários, de pacientes acima de 30 anos, com dados suficientes. Os dados foram utilizados para cálculo do risco cardiovascular dos pacientes a partir da aplicação do escore, com posterior processamento de dados em softwares estatísticos. Resultados. A idade dos participantes variou de 30 a 74 anos, 54,7% eram do sexo feminino e 74,8% foram atendidos no serviço público de saúde. Dentre os pacientes, 48% tinham valores de HDL inferiores a 45mg/ dL e 36,5% apresentaram LDL inferior a 100mg/dL. 22,5% dos pacientes eram tabagistas e 37,1% diabéticos. 46,2% dos pacientes tiveram valores sistólicos acima de 139mmHg e 61,7% tinham valores diastólicos abaixo de 85mmHg. Em 43,8% dos prontuários analisados o risco encontrado era baixo, em 36,5% era moderado, em 19,8% era alto. O risco médio da população foi de 13,4%. Conclusão. Na população estudada, a respeito dos fatores de risco cardiovascular que compõem o Escore de Framingham, destacam-se o DM, HAS, LDL-c e tabagismo como principais contribuintes da definição do risco. Os resultados encontrados a partir do estudo são importantes para o planejamento de futuras intervenções, principalmente na atenção primária a fim de prevenir o surgimento e implementar o controle de tais fatores. (AU)

Objectives. Stratify outpatient cardiology services patients through the Framingham score to assist the planning of future interventions. Methods. This is a cross-sectional study performed in cardiology services from an outpatient public center and a private clinic of a medium-sized city of Minas Gerais. The sampling was random, with 329 medical records, of patients over the age of 30 years, with sufficient data. The data were used to calculate the cardiovascular risk of patients through the application of the score, with subsequent data processing in statistical software. Results. The age of the participants ranged from 30 to 74 years, 54.7% were female and 74.8% were treated in the public health service. Among the patients, 48% had HDL-c values lower than 45mg/dL and 36.5% had LDL-c below 100mg/dL. 22.5% of the patients were smokers and 37.1% diabetics. 46.2% of the patients had systolic values greater or equal to 139mmHg and 61.7% had diastolic values less or equal to 85mmHg. In 43.8% of the analyzed medical records, the risk was found low, in 36.5% it was moderate, in 19.8% it was high. The average risk of the population was 13.4%. Conclusion. In the studied population, regarding the cardiovascular risk factors that compose the Framingham Score, DM, systemic arterial hypertension, LDL-c and smoking stand out as the main contributors to risk definition. The results found in the study are important for the planning of future interventions, especially in primary care in order to prevent the appearance and implement the control of such factors. (AU)

Ipsilesional upper limb performance in stroke individuals: relationship among outcomes of different tests used to assess hand function / Relação entre o desempenho em diferentes testes de função manual de indivíduos pós acidente vascular encefálico: avaliação do membro ipsilesional

Abstract Introduction: Stroke individuals have sensorimotor repercussions on their ipsilesional upper limb. Therefore, it is important to use tests that allow an adequate assessment and follow-up of such deficits. Physical and occupational therapists commonly use maximal grip strength tests to assess the functional condition of stroke individuals. However, one could ask whether a single test is able to characterize the hand function in this population. Objective: The aim of this study was to investigate the relationship among outcomes of different tests frequently used to describe the function of the hand in the ipsilesional upper limb of stroke individuals. Methods: Twenty-two stroke individuals performed four hand function tests: maximal handgrip strength (HGSMax), maximal pinch grip strength (PGSMax), Jebsen-Taylor Hand Function Test (JTHFT) and Nine Hole Peg Test (9-HPT). All tests were performed with the ipsilesional hand. Pearson's correlation analyses were performed. Results: the results indicated a moderate and positive relationship between HGSMax and JTHFT (r = 0.50) and between JTHFT and 9-HPT (r = 0.55). Conclusion: We conclude that the existence of only moderate relationships between test outcomes demonstrates the need to use at least two instruments to better describe the ipsilesional hand function of stroke individuals.

Resumo Introdução: Indivíduos que sofreram um acidente vascular encefálico (AVE) apresentam repercussões sensoriomotoras em membro superior ipsilesional, se tornando importante a utilização de testes que possibilitem a avaliação e o acompanhamento adequado de tais déficits. Profissionais da reabilitação, como fisioterapeutas e terapeutas ocupacionais, comumente utilizam testes de força de preensão máxima para avaliar as condições funcionais de indivíduos após um AVE. Porém, será que apenas um teste é capaz de caracterizar a funcionalidade das mãos? Objetivo: O objetivo desse estudo foi examinar a relação do desempenho entre testes comumente utilizados para descrever a função manual do membro ipsilesional de indivíduos que sofreram um AVE. Métodos: Vinte e dois indivíduos pós AVE realizaram quatro testes: força de preensão palmar máxima (FPPMax), força de preensão digital máxima (FPDMax), teste de função manual Jebsen-Taylor (TFMJT) e teste dos nove pinos nos buracos (9-PnB). Todos os testes foram realizados com a mão ipsilesional. Foram realizados testes de correlação de Pearson entre os resultados obtidos em cada teste. Resultados: Os resultados indicaram uma relação positiva e moderada apenas entre TFMJT e FPPMax (r = 0,50) e entre o desempenho no TFMJT e no teste dos 9-PnB (r = 0,55). Conclusão: Conclui-se que a existência de relações de fraca a moderada demonstra a necessidade de utilização de pelo menos dois instrumentos, para que se possa descrever melhor a funcionalidade das mãos de indivíduos pós AVE.

What Makes a Bacterial Species Pathogenic?: Comparative Genomic Analysis of the Genus Leptospira

Leptospirosis, caused by spirochetes of the genus Leptospira, is a globally widespread, neglected and emerging zoonotic disease. While whole genome analysis of individual pathogenic, intermediately pathogenic and saprophytic Leptospira species has been reported, comprehensive cross-species genomic comparison of all known species of infectious and non-infectious Leptospira, with the goal of identifying genes related to pathogenesis and mammalian host adaptation, remains a key gap in the field. Infectious Leptospira, comprised of pathogenic and intermediately pathogenic Leptospira, evolutionarily diverged from non-infectious, saprophytic Leptospira, as demonstrated by the following computational biology analyses: 1) the definitive taxonomy and evolutionary relatedness among all known Leptospira species; 2) genomically-predicted metabolic reconstructions that indicate novel adaptation of infectious Leptospira to mammals, including sialic acid biosynthesis, pathogen-specific porphyrin metabolism and the first-time demonstration of cobalamin (B12) autotrophy as a bacterial virulence factor; 3) CRISPR/Cas systems demonstrated only to be present in pathogenic Leptospira, suggesting a potential mechanism for this clade's refractoriness to gene targeting; 4) finding Leptospira pathogen-specific specialized protein secretion systems; 5) novel virulence-related genes/gene families such as the Virulence Modifying (VM) (PF07598 paralogs) proteins and pathogen-specific adhesins; 6) discovery of novel, pathogen-specific protein modification and secretion mechanisms including unique lipoprotein signal peptide motifs, Sec-independent twin arginine protein secretion motifs, and the absence of certain canonical signal recognition particle proteins from all Leptospira; and 7) and demonstration of infectious Leptospira-specific signal-responsive gene expression, motility and chemotaxis systems. By identifying large scale changes in infectious (pathogenic and intermediately pathogenic) vs. non-infectious Leptospira, this work provides new insights into the evolution of a genus of bacterial pathogens. This work will be a comprehensive roadmap for understanding leptospirosis pathogenesis. More generally, it provides new insights into mechanisms by which bacterial pathogens adapt to mammalian hosts

Clinical, molecular, and prognostic significance of WHO type inv(3)(q21q26.2)/t(3;3)(q21;q26.2) and various other 3q abnormalities in acute myeloid leukemia.

PURPOSE: Acute myeloid leukemia (AML) with inv(3)(q21q26.2)/t(3;3)(q21;q26.2) [inv(3)/t(3;3)] is recognized as a distinctive entity in the WHO classification. Risk assignment and clinical and genetic characterization of AML with chromosome 3q abnormalities other than inv(3)/t(3;3) remain largely unresolved. PATIENTS AND METHODS: Cytogenetics, molecular genetics, therapy response, and outcome analysis were performed in 6,515 newly diagnosed adult AML patients. Patients were treated on Dutch-Belgian Hemato-Oncology Cooperative Group/Swiss Group for Clinical Cancer Research (HOVON/SAKK; n = 3,501) and German-Austrian Acute Myeloid Leukemia Study Group (AMLSG; n = 3,014) protocols. EVI1 and MDS1/EVI1 expression was determined by real-time quantitative polymerase chain reaction. RESULTS: 3q abnormalities were detected in 4.4% of AML patients (288 of 6,515). Four distinct groups were defined: A: inv(3)/t(3;3), 32%; B: balanced t(3q26), 18%; C: balanced t(3q21), 7%; and D: other 3q abnormalities, 43%. Monosomy 7 was the most common additional aberration in groups (A), 66%; (B), 31%; and (D), 37%. N-RAS mutations and dissociate EVI1 versus MDS1/EVI1 overexpression were associated with inv(3)/t(3;3). Patients with inv(3)/t(3;3) and balanced t(3q21) at diagnosis presented with higher WBC and platelet counts. In multivariable analysis, only inv(3)/t(3;3), but not t(3q26) and t(3q21), predicted reduced relapse-free survival (hazard ratio [HR], 1.99; P < .001) and overall survival (HR, 1.4; P = .006). This adverse prognostic impact of inv(3)/t(3;3) was enhanced by additional monosomy 7. Group D 3q aberrant AML also had a poor outcome related to the coexistence of complex and/or monosomal karyotypes and cryptic inv(3)/t(3;3). CONCLUSION: Various categories of 3q abnormalities in AML can be distinguished according to their clinical, hematologic, and genetic features. AML with inv(3)/t(3;3) represents a distinctive subgroup with unfavorable prognosis.