Dynamics and Determinants of SARS-CoV-2 RT-PCR Testing on Symptomatic Individuals Attending Healthcare Centers during 2020 in Bahia, Brazil.

RT-PCR testing data provides opportunities to explore regional and individual determinants of test positivity and surveillance infrastructure. Using Generalized Additive Models, we explored 222,515 tests of a random sample of individuals with COVID-19 compatible symptoms in the Brazilian state of Bahia during 2020. We found that age and male gender were the most significant determinants of test positivity. There was evidence of an unequal impact among socio-demographic strata, with higher positivity among those living in areas with low education levels during the first epidemic wave, followed by those living in areas with higher education levels in the second wave. Our estimated probability of testing positive after symptom onset corroborates previous reports that the probability decreases with time, more than halving by about two weeks and converging to zero by three weeks. Test positivity rates generally followed state-level reported cases, and while a single laboratory performed ~90% of tests covering ~99% of the state's area, test turn-around time generally remained below four days. This testing effort is a testimony to the Bahian surveillance capacity during public health emergencies, as previously witnessed during the recent Zika and Yellow Fever outbreaks.

Pulmonary Sporotrichosis Caused by Sporothrix brasiliensis: A 22-Year, Single-Center, Retrospective Cohort Study.

Pulmonary sporotrichosis is a rare condition. It can present as a primary pulmonary disease, resulting from direct Sporothrix species (spp). conidia inhalation, or as part of multifocal sporotrichosis with multiple organ involvement, mainly in immunocompromised patients. This study aimed to describe the sociodemographic and epidemiological characteristics and clinical course of patients with positive cultures for Sporothrix spp. from pulmonary specimens (sputum and/or bronchoalveolar lavage) at a reference center in an area hyperendemic for zoonotic sporotrichosis. The clinical records of these patients were reviewed. Fourteen patients were included, and Sporothrix brasiliensis was identified in all cases. Disseminated sporotrichosis was the clinical presentation in 92.9% of cases, and primary pulmonary sporotrichosis accounted for 7.1%. Comorbidities included human immunodeficiency virus infection (78.6%), alcoholism (71.4%), and chronic obstructive pulmonary disease (14.3%). Treatment with amphotericin B followed by itraconazole was the preferred regimen and was prescribed in 92.9% of cases. Sporotrichosis-related death occurred in 42.9% while 35.7% of patients were cured. In five cases there was a probable contamination from upper airway lesions. Despite the significant increase in sporotrichosis cases, pulmonary sporotrichosis remains rare. The treatment of disseminated sporotrichosis is typically difficult. Prompt diagnosis and identification of all affected organs are crucial for better prognosis.

Detection of SARS-CoV-2 in different human biofluids using the loop-mediated isothermal amplification assay: A prospective diagnostic study in Fortaleza, Brazil.

We adopted the reverse-transcriptase-loop-mediated isothermal amplification (RT-LAMP) to detect severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) in patient samples. Two primer sets for genes N and Orf1ab were designed to detect SARS-CoV-2, and one primer set was designed to detect the human gene Actin. We collected prospective 138 nasopharyngeal swabs, 70 oropharyngeal swabs, 69 salivae, and 68 mouth saline wash samples from patients suspected to have severe acute respiratory syndrome (SARS) caused by SARS-CoV-2 to test the RT-LAMP in comparison with the gold standard technique reverse-transcription quantitative polymerase chain reaction  (RT-qPCR). The accuracy of diagnosis using both primers, N5 and Orf9, was evaluated. Sensitivity and specificity for diagnosis were 96% (95% confidence interval [CI]: 87-99) and 85% (95% CI: 76-91) in 138 samples, respectively. Accurate diagnosis results were obtained only in nasopharyngeal swabs processed via extraction kit. Accurate and rapid diagnosis could aid coronavirus disease 2019 (COVID-19) pandemic management by identifying, isolating, and treating patients rapidly.

A Educação Baseada na Comunidade no Ensino Médico na Uniceplac (2016) e os Desafios para o Futuro / Community-Based Education in Medical Education at UNICEPLAC (2016) and Challenges for the Future

RESUMO Introdução A Educação Baseada na Comunidade (EBC) no contexto da formação de profissionais da saúde não é um conceito novo, pois sua origem data da década de 1970. Porém, ao longo dos anos, o modo como a EBC é aplicada na educação médica vem sofrendo transformações. No Brasil, desde 2001, a EBC foi incorporada às diretrizes curriculares dos cursos de graduação da área da saúde e, mais recentemente, em 2014, na publicação das novas diretrizes dos cursos de graduação em Medicina. Objetivos Os objetivos do estudo foram levantar os sentidos e significados que os professores atribuem à Educação Baseada em Comunidade nas matrizes curriculares em vigência no ensino médico da Uniceplac no ano de 2016 e identificar possibilidades de aprimoramento do ensino na instituição em consonância com as diretrizes nacionais em vigência. Método Estudo de caráter qualitativo, realizado no Centro Universitário do Planalto Central Apparecido dos Santos (Uniceplac). Os dados foram coletados por meio de entrevista reflexiva com 13 docentes que estão ou estiveram diretamente ligados à EBC nessa instituição no ano de 2016. O método de análise de dados foi a Análise de Conteúdo de Bardin, com a utilização do software Atlas-ti 7 para o suporte na análise. Resultados Os resultados demonstram que a maioria dos docentes afirma conhecer o conceito de EBC, mas sua compreensão diverge da literatura. Além disso, os docentes indicaram falhas na carga horária, nas relações dos professores entre si e com a coordenação, no planejamento e na conquista de cenários adequados das disciplinas ligadas à EBC, além de desafios macropolíticos de aplicabilidade da EBC nos cenários do Sistema Único de Saúde (SUS). Estes resultados estavam relacionados à burocratização das parcerias e a uma falta de corresponsabilidade entre professor, instituição de ensino e Estado. Conclusão Como a EBC vem sendo incorporada gradativamente à educação médica, as instituições também têm uma necessidade crescente de transformação e adequação às diretrizes curriculares vigentes. Sugere-se uma capacitação permanente do corpo docente sobre a compreensão e aplicação da EBC, bem como a criação de um órgão, setor ou funcionário destinado apenas à institucionalização, formalização e manutenção dos cenários, destacando-se cenários da atenção básica no SUS. É também essencial instruir os alunos sobre o tema, para que possam compreender a aplicabilidade da EBC, sua importância na formação médica e sua contribuição para a melhoria da qualidade de vida da população.

ABSTRACT Introduction Community-Based Education (CBE) in the context of teaching health professionals is not a new concept, since its origin dates back to the 1970s, but over the years the way in which CBE is applied in medical education has undergone transformations. In Brazil, since 2001, CBE has been incorporated into the curricular guidelines of undergraduate courses in the health area, and more recently in 2014 in the publication of the new guidelines of undergraduate courses in medicine. Objective The purpose of the present research is to ascertain the senses and meanings that teachers attribute to Community-Based Education in the curricular matrices in force in the medical training offered at UNICEPLAC in 2016 and to identify rooms for improvement in the teaching at the institution in line with the national guidelines. Method A qualitative study conducted at the Centro Universitário do Planalto Central Apparecido dos Santos (UNICEPLAC). The data were collected through a reflective interview with 13 teachers who are or were directly connected to CBE promoted at this institution in the year 2016. The method of data analysis was the Bardin Content Analysis, using Atlas-ti 7 software for analysis support. Results The results show that most teachers state that they are familiar with the concept of CBE, but their understanding of the concept often diverges from the literature. They also indicated failures in the workload, teacher-teacher relationships and teachercoordination relationships, in planning and the provision of adequate scenarios for CBE-related subjects, as well as macro-political challenges concerning the applicability of CBE in practical settings of the Unified Health System (SUS). These results were related to the bureaucratization of partnerships and to a lack of accountability shared between teacher, educational institution and State. Conclusion As CBE has gradually been incorporated in medical education, institutions also have an increasing need to transform and adapt to current curricular guidelines. It is suggested that permanent faculty training on the understanding and application of the CBE be implemented, as well as the creation of a sector or appointment of a dedicated role for the institutionalization, formalization and maintenance of the scenarios, highlighting primary care scenarios in the SUS. It is also essential to instruct the students on the subject so they can understand the applicability of CBE, its importance in medical education and its contribution to improving the quality of life of the population.

Impaired Modulation of Corticospinal Excitability in Drug-Free Patients With Major Depressive Disorder: A Theta-Burst Stimulation Study.

Impaired neural plasticity may be an important mechanism in the pathophysiology of major depressive disorder (MDD). Coupled with electromyography (EMG), repetitive transcranial magnetic stimulation (rTMS) is a useful tool to evaluate corticospinal excitability and cortical neuroplasticity in living humans. The goal of this study was to compare rTMS-induced cortical plasticity changes in patients with MDD and in healthy volunteers. In this single-blind controlled study, 11 drug-free patients with MDD and 11 matched healthy controls were analyzed. Cortical excitability, measured by the amplitude of motor evoked potentials (MEPs) evoked by single-pulse TMS, was assessed before and repeatedly after (for 30 min) participants received a single session of intermittent theta-burst stimulation (iTBS) and continuous TBS (cTBS). rTMS was applied over the left motor cortex using a neuronavigation system. Intensity was set at 80% of the active motor threshold (AMT). A large interindividual variability was observed after both iTBS and cTBS in the two groups. At the group level, we observed impaired iTBS-induced neuroplasticity in patients with MDD compared to that in controls. No differences were observed between the groups regarding cTBS-induced neuroplasticity. Our results suggest impaired long-term potentiation (LTP)-like mechanisms in MDD. Clinical Trial Registration: www.Clinicaltrials.gov, identifier #NCT02438163.

Putting the Mess in Order: Aspergillus welwitschiae (and Not A. niger) Is the Etiological Agent of Sisal Bole Rot Disease in Brazil.

Approximately 75% of the worldwide production of hard natural fibers originates from sisal, an industrial crop from arid and semiarid tropical regions. Brazil is the world's largest producer of sisal fiber, accounting for more than 40% of the worldwide production, and sisal bole rot disease has been the main phytosanitary problem of this crop. All previous studies reporting Aspergillus niger as the causal agent of the disease were based on the morphological features of fungal isolates from infected plant tissues in pure cultures. Black aspergilli are one of the most complex and difficult groups to classify and identify. Therefore, we performed an integrative analysis of this disease based on the isolation of black aspergilli from the endospheres and soils in the root zones of symptomatic adult plants, in vivo pathogenicity tests, histopathology of symptomatic plants, and molecular phylogeny and worldwide genetic variability of the causal agent. All sisal isolates were pathogenic and unequivocally produced symptoms of bole rot disease in healthy plants. In all tree-based phylogenetic methods used, a monophyletic group formed by A. welwitschiae along with all sisal isolates was retrieved. Ten A. welwitschiae haplotypes have been identified in the world, and three occur in the largest sisal-producing area. Most of the isolates are from a unique haplotype, present in only the sisal-producing region. A. welwitschiae destroyed parenchymatic and vascular cylinder cells and induced the necrosis of internal stem tissues. Therefore, sisal bole disease is probably the consequence of a saprotrophic fungus that opportunistically invades sisal plants and behaves as a typical necrotrophic pathogen.