Clinical, epidemiological, and care profile of hospitalized patients with retinoblastoma in Brazil

ABSTRACT Purpose: To describe the epidemiological and clinical profile of hospitalized patients with retinoblastoma in Brazil. Methods: Using data from the Hospital Cancer Registry of the Instituto Nacional de Câncer, patients with the morphological codes of retinoblastoma who were diagnosed between 2000 to 2018, aged 0-19 years, and followed up in registered hospitals (analytical cases) were selected. The relative and absolute frequencies of demographic, clinical, diagnostic, therapeutic, and outcome variables were described. Hospital performance indicators were calculated and compared between hospitals qualified and not qualified to treat pediatric oncology cases and between hospitals with different case volumes (<20, 20-75, >75 cases). Results: Of the 2,269 identified analytical cases from 86 institutions, 48% were from the Southeast, 54% were male, and 66% were aged <4 years. The proportion of missing data (NA) was too high for several variables. Approximately 84% of the patients were from the public health system, 40% had a positive family history, and 88% had unilateral involvement. The first treatment included surgery in 58.3% of the patients (NA=2), Approximately 36.6% of these patients achieved complete remission, 10.8% achieved partial remission, and 12.7% died (NA=59%). Hospital performance indicators were within the target in >90% of the patients. The median time between the first appointment and diagnosis (6 days, interquartile range [IQR] 1-14) was significantly lower and the median time to death was longer (343 days, IQR, 212-539) in high-volume hospitals (>75 cases) than in medium- and low-volume hospitals. Conclusions: Despite the high proportion of missing data, we found that the delay in diagnosis is due to prehospital factors. Additionally, there is a need for educational programs for healthcare professionals and families that emphasize early identification and referral to specialized centers. Future studies should focus on the impact of Hospital Cancer Registry data completeness on outcomes, causes of delay in diagnosis, regional inequalities, and barriers to accessing specialized services.

Factors Associated with Stigma and Beliefs About Psychotropics Among the Japanese Ancestry Population Diagnosed with Depression in Brazil.

To analyze stigma related to depression, beliefs about psychotropics, and associated factors in a population of Japanese ancestry in Brazil. This cross-sectional study was conducted between March and June, 2022. Beliefs about psychotropics (BMQ-specific) and depression-related stigma (The Stigma Scale) were collected through an online questionnaire. Multiple linear regression analysis was performed to identify the factors associated with these dependent variables. Ninety-three respondents of Japanese ancestry completed the questionnaire. Participants were more focused on the necessity of the prescribed psychotropics than on possible adverse effects. Married individuals (ß=-4.68 [95%CI -8.74, -0.63]; p = 0.024) were less concerned with their psychotropics than single individuals, while those undergoing treatment for longer years (ß = 6.23 [95%CI 1.35, 11.11]; p = 0.013) perceive a greater necessity for treatment than those who started it recently. In addition, older individuals perceived less necessity for treatment (ß=-5.83 [95%CI -10.76, -0.90]; p = 0.021) than younger individuals. Unemployed people (ß = 12.09 [95%CI 0.47, 23.70]; p = 0.042) perceived more depression-related stigma than those employed. Aspects of Japanese cultural heritage related to depression and its treatment are still prevalent among people of Japanese ancestry in Brazil. Factors such as age, treatment duration, and marital status affects the perception of beliefs about psychotropics, whereas occupation affects the perception of stigma.

Two names, one species: redescription and phylogenetic position of Schrankiana formosula Freitas, 1959 provides new insights into the evolutionary history of the Cosmocercidae.

Schrankiana are gastrointestinal parasites of anurans, distributed throughout Central and South America. Schrankiana formosula and Schrankiana inconspicata are some of the most commonly reported species parasitising anurans from Brazil, and the morphological differences between them are unclear. In the present study, we redescribed S. formosula based on a re-examination of type series and newly collected material from the frog Leptodactylus pentadactylus in the state of Amapá, Brazil. Additionally, we re-examined the type series of S. inconspicata, and propose it as a junior synonym of S. formosula. We provide detailed morphological and morphometric data with intraspecific variation analyses and new molecular data for S. formosula. In the present phylogeny, S. formosula formed a well-supported clade with Raillietnema sp. and Labeonema synodontisi. Based on molecular phylogenetic analyses and some morphological similarities, our findings support the hypothesis that Schrankiana is a member of the family Cosmocercidae, not Atractidae. Additionally, we provide the first ultrastructural descriptions of S. formosula, and establish the species' phylogenetic position from the Cosmocercidae.

Evaluation of statistical process control charts for infant mortality monitoring in Brazilian cities with different population sizes.

OBJECTIVES: The control chart is a classic statistical technique in epidemiology for identifying trends, patterns, or alerts. One meaningful use is monitoring and tracking Infant Mortality Rates, which is a priority both domestically and for the World Health Organization, as it reflects the effectiveness of public policies and the progress of nations. This study aims to evaluate the applicability and performance of this technique in Brazilian cities with different population sizes using infant mortality data. RESULTS: In this article, we evaluate the effectiveness of the statistical process control chart in the context of Brazilian cities. We present three categories of city groups, divided based on population size and classified according to the quality of the analyses when subjected to the control method: consistent, interpretable, and inconsistent. In cities with a large population, the data in these contexts show a lower noise level and reliable results. However, in intermediate and small-sized cities, the technique becomes limited in detecting deviations from expected behaviors, resulting in reduced reliability of the generated patterns and alerts.

Ambient air pollution and low birth weight in Brazil: A nationwide study of more than 10 million births between 2001 and 2018.

Low birth weight (LBW) is a global health concern. While it is commonly associated with maternal health and behavior, exposure to ambient air pollution, can also play a role in contributing to LBW. In Brazil, where diverse environmental conditions and regional disparities exist, assessing the impact of ambient air pollution on LBW becomes particularly pertinent. To our knowledge, there is a gap in the existing literature, as no previous study has specifically investigated the relationship between ambient air pollution and LBW nationwide in Brazil. This study aims to fill this gap by examining the association between ambient air pollution and LBW in each trimester of pregnancy across the Brazilian states. In this work, birth data from January 1, 2001, to December 31, 2018 has been used. We utilized logistic regression models to estimate the odds ratio (OR) for low birth weight (LBW) associated with ambient air pollution (PM2.5, NO2, and O3) during each trimester of pregnancy (1st to 3rd trimester) across all 27 Brazilian states in our nationwide case-control study. We adjusted our model for several variables, including ambient temperature, relative humidity, and socioeconomic status (SES) variables at the individual level. We also conducted effect modification analyses by infant sex, mother's age, and the number of prenatal visits. Our study comprises over 10,213,144 birth records nationwide. Of these, 479,204 (4.92%) infants were included as cases of LBW. Our results indicate positive associations between PM2.5 and LBW, mainly in the Southern region. For example, in the state of Santa Catarina (South region), ORs were 1.003 (95% CI: 1.002, 1.004), 1.003 (95% CI: 1.002, 1.004), and 1.005 (95% CI: 1.003, 1.007) for the 1st, 2nd, and 3rd trimesters of exposure, respectively. NO2 had a robust association with LBW in the Northern and Northeastern states, including the state of Amapá (North region, where the Amazon Forest is located) with ORs of 1.377 (95% CI: 1.010, 1.878), 1.390 (95% CI: 1.020, 1.894), and 1.747 (95% CI: 1.297, 2.352) for the 1st, 2nd, and 3rd trimesters of exposure, respectively. Similarly, O3 had a robust association in the North and Midwest states, as observed in the state of Amapá with ORs of 1.033 (95% CI: 1.012, 1.054), and 1.033 (95% CI: 1.013, 1.053) for the 2nd, and 3rd trimesters, respectively. In the stratified analysis, boys were more vulnerable than girls, and the lower number of prenatal visits was associated with higher OR. Our findings are essential to the development of guidelines to prevent maternal exposure and protection of newborns in Brazil. This study provides valuable insights for region-specific strategies to improve maternal and neonatal health.

Filling the gaps on parasites of Osteocephalus: Helminth community structure of Osteocephalus cabrerai (Anura: Hylidae) from the Brazilian Amazon.

Osteocephalus cabrerai is an arboreal anuran widely distributed in South America. However, there are no parasitological studies conducted on the species, resulting in a parasite fauna completely unknown. Thus, this study aims to characterize the parasitic community structure of O. cabrerai in the municipality of Pedra Branca do Amapari, Amapá state, Amazon region, Brazil. We collected and necropsied 84 specimens of O. cabrerai to search for helminths. Parasite community structure was analyzed using helminth parasite richness, diversity, and abundance. The helminth component community of O. cabrerai comprises six nematode species: Cosmocerca parva, Cosmocerca podicipinus, Oxyascaris oxyascaris, Oswaldocruzia chabaudi, and Physaloptera sp. (larvae). Most helminth species represent the first record for the genus Osteocephalus, except Physaloptera sp. The helminth infections in the host showed a typical aggregated distribution pattern for parasites. We only found a positive correlation between the host weight and total intensity. Our bibliography revision reinforces the need for further studies on the helminth fauna of Osteocephalus spp.

Prevalence of syphilis and associated factors among pregnant women in Brazil: systematic review and meta-analysis.

Objective: This systematic review accompanied by a meta-analysis aimed to estimate the prevalence of syphilis in pregnant women in Brazil and describe its associated factors. Methods: Following the establishment the search strategies and the registration of the review protocol in PROSPERO, we conducted a search for relevant articles in the Pubmed, LILACS, Science Direct, SciELO and Web of Science databases. Our inclusion criteria were cross-sectional studies published between 2005 and 2023, with no language restrictions. The combined prevalence of syphilis infection was estimated using the random effects model in the R Software with a 95% confidence interval (95% CI) and p < 0.01 as statistically significant. Results: A total of 24 articles were recruited, which together investigated 221,884 women. The combined prevalence of syphilis in pregnant women in Brazil was 1.79% (95% CI: 1.24-2.57%), and the main factors associated with its occurrence were black and brown skin color, low education and factors related to the partner. Conclusion: There was a high prevalence of syphilis in pregnancy in Brazil, mainly associated with socioeconomic factors.

Towards an update on the antimicrobial use in Adult Care Units in Brazil: insights from multi-hospital prevalence study.

Introduction. Efforts to understand the burden of antibiotic use in low- and middle-income countries such as Brazil are essential for developing strategies that are effective and appropriate in the context of endemic multidrug-resistant organisms.Aim. This study aims to determine antimicrobial-prescribing practices among patients hospitalized in intensive care units (ICUs) for adults in Brazil.Methodology. A 1-day point prevalence multicentre survey was conducted in 58 adult ICUs across the five regions of Brazil. The institutions were categorized according to their type and size. Detailed antimicrobial prescription data were prospectively provided to all patients hospitalized on the day of data collection.Results. A total of 620 patients were included in the study, of whom 63.9% were receiving at least one antimicrobial. Of these, 34.6% were treated for an infection, but only 39.9% of the cases were based on microbiological criteria. Empirical treatment was applied to 72.3% of the patients. Significant differences in antibiotic usage were observed across the different hospitals included in the study. Overall, treatment was most commonly directed towards pneumonia (51.8%) and bloodstream infections (29.6%). Glycopeptides (19.4%) and carbapenems (18.5%) were the most prescribed in teaching hospitals, while in non-teaching hospitals, carbapenems (17.8%) and broad-spectrum cephalosporins (16.8%) were most frequently used.Conclusion. Our study reveals alarming data on antibiotic use in adult ICUs in Brazil, with high frequencies of severe healthcare-associated infections acquired in these units, where patients are frequently subjected to empirical treatment.

To What Extent are Food, Culture, Economics and the Natural Environment Reflected in the Language of the Australian and Brazilian Food-based Dietary Guidelines?

PURPOSE OF THE REVIEW: Our aim was to review literature describing language use in dietary guidelines and explore the extent to which food, culture, economics and the natural environment are reflected in the language of the Australian, compared to the Brazilian food-based dietary guidelines (FBDGs). RECENT FINDINGS: Australia's FBDGs are based on the best available scientific evidence and claim to "form a bridge between research and evidence-based advice to address the major health challenge of improving Australians' eating patterns". Brazil's FBDGs recognise reasons beyond health for people's food choices. Not a lot of attention has been paid to language use in dietary guidelines. The reviewed studies suggest that language in dietary guidelines should be unambiguous for consumers and evolve with national nutrition priorities. A notable difference between Australian and Brazilian FBDGs was that Australia centralised individuals and individual food groups, whereas Brazil placed people in an ecosystem. Inclusion of words that speak to how food is prepared and eaten, to expressions of culture and community, and to strategies people use for enhancing and protecting livelihoods and planetary health may enhance the relevance of future dietary guidelines.

Prevalence analysis of Chagas disease by age group in an endemic region of Brazil: possible scenario of active vectorial transmission.

Objectives: Chagas disease (CD) is an infectious disease that predominantly affects poor and vulnerable populations. The last estimate conducted by the World Health Organization in Latin America regarding the prevalence of CD occurred more than 10 years ago. However, there is a scarcity of data assessing the magnitude of CD in populations residing in considered high-risk regions. Therefore, this study aimed to assess the seroprevalence of CD in an endemic region in Northern Minas Gerais through serologic screening. Methods: This is a prevalence study conducted in the municipalities of Catuti, Mato Verde, Mirabela, Montes Azul, and São Francisco, Minas Gerais, Brazil. Data collection occurred between December 2021 and December 2022, involving a questionnaire with closed-ended questions. The variables analyzed included serologic test results, stratified age groups, health indicators, and housing conditions. Results: Of the 2978 participants, 272 individuals (9.1%) tested positive for CD serology. In the age group of 4 to 14 years, 15 to 49 years, and 50 years or older, the prevalence of positive serology was 0.8% (95% confidence interval [CI] 0.16-1.43), 5.5% (95% CI 4.20-6.83), and 18.8% (95% CI 16.48-21.11), respectively. Among the participating municipalities, Mato Verde had the highest prevalence of positive serology for CD (17%). For participants aged 4 to 14 years with positive serology for CD, first-degree relatives were invited to undergo serologic testing. It was possible to collect samples from relatives of all participants in this age group. However, none of the relatives tested positive. Conclusion: This study identified a 9.1% prevalence of individuals affected by CD who were unaware of their condition. In addition, having infected children in the 4 to 14 age group with mothers with negative serology would rule out congenital transmission of the disease.

Monitoring financial healthcare protection in Brazil: evolution, inequalities, and associated factors.

OBJECTIVES: Although catastrophic health spending is the main measure for assessing financial healthcare protection, it varies considerably in methodological and empirical terms, which hinders comparison between studies. The aim of this study was to measure the prevalence of catastrophic health spending in Brazil in 2003, 2009, and 2018, its associated factors, and disparities in prevalence distribution according to socioeconomic status. STUDY DESIGN: This was a time series study. METHODS: Data from the Household Budget Surveys were used. Prevalence of catastrophic health spending was measured as a percentage of the budget and ability to pay, considering thresholds of 10, 25, and 40%. It was determined whether household, family, and household head characteristics influence the likelihood of incurring catastrophic health spending. Households were stratified by income deciles, consumption, and wealth score. RESULTS: There was an increase in prevalence of catastrophic health spending between 2003 and 2009 in Brazil and a slight reduction in 2018. The wealth score showed more pronounced distributional effects between the poor and the rich, with the former being the most affected by catastrophic health spending. Consumption showed greater percentage variations in the prevalence of catastrophic health spending. The prevalence of catastrophic health spending was positively associated with the presence of older adults, age and female household head, rural area, receipt of government benefits, and some degree of food insecurity. CONCLUSIONS: The poorest families are most affected by catastrophic health spending in Brazil, requiring more effective and equitable policies to mitigate financial risk.

Molecular identification of Chrysomya albiceps (Diptera: Calliphoridae) in a case of primary cutaneous myiasis in sheep at southern Brazil.

Sheep farming has been growing in Brazil, driven by an expanding consumer market due to greater acceptance of its meat and derivatives. There are several factors that limit sheep production, and one of them is infestation by ectoparasites, which cause stress in animals, weight loss, poor development, low productivity, low quality wool and reduced fertility. Chrysomya albiceps is a species of blowfly belonging to the Calliphoridae family that occurs in neotropical regions, where it causes secondary myiasis. We identified here a rare case of cutaneous myiasis with the presence of tissue lesions caused by C. albiceps in sheep in southern Brazil. We highlight the need to carry out more in-depth studies regarding the biology of these insects, with the aim of proving this atypical behavior for Brazil.

A new southern Atlantic cryptic marine shrimp species of Acetes (Decapoda, Sergestidae).

A recently published molecular phylogenetic analysis, focusing on selected Western Atlantic subspecies of Acetesamericanus Ortmann, 1893 and allies, was inconclusive about relationships among these members. This previous study found three groups that split into two distinct lineages: Acetesamericanus (Brazil 1) (= A.americanus sensu stricto) and Acetesamericanus (Brazil 2) + A.americanus (USA). Combined morphometry and molecular analyses applied to members of the group Acetesamericanus (Brazil 2) revealed a new unidentified species genetically related to the A.americanus representatives. However, at that time, no conclusive morphological characters were found to identify it. In the present study, following an in-depth morphological analysis of specimens from the three groups, including data on the type series and consideration of the subtle distinctions of members of each lineage, morphological features of the reproductive structures (petasma and genital sternite) were found to characterize the new species, which is formally described and named herein.

Validation of the HIV/AIDS-Targeted Quality of Life (HAT-QOL) for Evaluation of Health-related Quality of Life in People Living with HIV/AIDS in Brazil.

HIV/AIDS-Targeted Quality of Life (HAT-QOL) is an instrument for evaluating health-related quality of life (HRQOL) in people living with HIV (PLWHIV). This has been adapted into Brazilian Portuguese, but its dimensional structure has not been analyzed. This study evaluated the psychometric properties of the Brazilian Portuguese version of the HAT-QOL, using a sample of 319 PLWHIV in Salvador, Brazil. The study performed Exploratory Factor Analysis (EFA) to assess the HAT-QOL dimensional structure. The analysis used a polychoric correlation matrix, Robust Diagonally Weighted Least Squares (RDWLS) as an extraction method, Parallel Analysis for factor retention, robust promin as oblique rotation, and Generalized H-index (G-H) for construct replicability of each factor. Model adequacy was assessed using the Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), and Tucker-Lewis Index (TLI). Concurrent validity was evaluated with the 36-item Short Form Health Survey, version 2 (SF-36v2). EFA identified a HAT-QOL six-factor solution: Financial Worries, Sexual Function, Medication Concerns, Life Satisfaction, Health Worries, and Overall Function. This solution showed high G-H indexes, concurrent validity, and satisfactory adequacy indexes (X2 = 231.345, df = 291, p < 0,001; RMSEA = 0.001, CFI = 0.999, TLI = 1.028). HIV Mastery, Disclosure Worries, and Provider Trust domains were not retained in EFA and did not have evidence of concurrent validity. This study proposed a HAT-QOL six-factor model for measuring HRQOL in the Brazilian PLWHIV. Future research could help identify another latent construct from not-included domains.

RESUMEN: El HIV/AIDS-Targeted Quality of Life (HAT-QOL) es un instrumento que evalúa calidad de vida relacionada con la salud (CVRS) en personas que viven con VIH (PVVIH). Éste ha sido adaptado al portugués brasilero, pero su estructura dimensional no ha sido analizada. Se evaluaron las propiedades psicométricas de la versión en portugués brasilero del HAT-QOL, en una muestra de 319 PVVIH en Salvador, Brasil. Se empleó un Análisis Factorial Exploratorio (AFE) para evaluar la estructura dimensional del HAT-QOL. El análisis utilizó una matriz de correlación policórica, mínimos cuadrados ponderados robustos diagonalmente (RDWLS) para extraer factores, análisis paralelo para retener factores, promin robusto como rotación oblicua y el índice H generalizado (G-H) para la replicabilidad de constructo de cada factor. La adecuación del modelo fue evaluado con el error cuadrático medio de aproximación (RMSEA) y los índices de ajuste comparativo (CFI) y Tucker-Lewis (TLI). Se evaluó la validez concurrente con el cuestionario 36-item Short Form Health, versión 2 (SF-36v2). El AFE identificó una solución de seis factores para el HAT-QOL: Preocupaciones Financieras, Función Sexual, Preocupaciones por la medicación, Satisfacción con la vida, Preocupaciones por la salud y Función general. Esta solución mostró altos índices G-H, validez concurrente e índices de adecuación satisfactorios (X2 = 231.345, df = 291, p < 0,001; RMSEA = 0.001, CFI = 0.999, TLI = 1.028). Los dominios Aceptación del VIH, Preocupaciones por el sigilo y Confianza en el profesional no fueron retenidos en el AFE y no evidenciaron validez concurrente. Se propone un modelo de seis factores del HAT-QOL para evaluar CVRS en PVVIH brasileras. Futuras investigaciones ayudarían a identificar otros constructos latentes a partir de los dominios no incluidos en la estructura.

[Evidence for Health Promotion in Brazil: report on a rapid response serviceEvidencia para la promoción de la salud en Brasil: informe sobre un servicio de respuesta rápida]. / Evidências para a Promoção da Saúde no Brasil: relato de um serviço de resposta rápida.

Objective: Present the experience of a rapid response service to support decision-making in health systems. Methodology: Description of the processes and results of a service that produces rapid reviews and evidence maps to support decision-making under the National Health Promotion Policy, as well as the authors' perception of the work process. Results: The rapid response service started in 2020. By December 2023, 54 rapid reviews and five evidence maps had been produced, covering nine health promotion topics. These products were developed in 14 stages by a team made up of a coordinator, supervisors, proofreaders, and a librarian. The development of rapid responses involved a knowledge translation process, with continuous interactions between the requesting teams and production teams. Establishing effective communication was a critical factor in delivering products on time and in line with the needs of decision-makers and their supporters. Conclusion: Rapid response services can help improve the use of evidence for decision-making in health policies and health systems.

Objetivo: Presentación de la experiencia de un servicio de respuesta rápida para brindar apoyo a la toma de decisiones en materia de salud. Método: Se describen los procesos y resultados de un servicio de elaboración de revisiones rápidas y mapas de evidencia para brindar apoyo a la toma de decisiones en el marco de la Política Nacional de Promoción de la Salud, así como la percepción de los autores sobre el proceso de trabajo. Resultados: El servicio de respuesta rápida se inició en el 2020. Hasta diciembre del 2023, se habían elaborado 54 revisiones rápidas y cinco mapas de evidencia, que abarcaban nueve temas de promoción de la salud. Estos productos fueron elaborados en 14 etapas por un equipo formado por un coordinador, varios supervisores y revisores y un bibliotecario. La elaboración de respuestas rápidas fue un proceso de traducción del conocimiento e implicó una interacción continua entre los equipos solicitantes y el equipo de elaboración. El establecimiento de una comunicación eficaz fue un factor decisivo para entregar los productos a tiempo y en consonancia con las necesidades de los responsables de la toma de decisiones y su personal de apoyo. Conclusión: Los servicios de respuesta rápida pueden ayudar a mejorar el uso de evidencia en la toma de decisiones relacionadas con las políticas y los sistemas de salud.

Induced abortion incidence and associated factors in a cohort of women living with HIV in Rio De Janeiro, Brazil, 1996-2016.

BACKGROUND: Abortion is a public health problem in Latin America and is more common among women living with HIV. OBJECTIVE: to verify the incidence and factors associated with induced abortion in a cohort of women living with HIV assisted in a reference service for care for individuals with HIV/AIDS in Rio de Janeiro/Brazil. METHODS: Prospective cohort during the period 1996-2016. We estimated the incidence of induced abortions during follow-up in the cohort by calculating person-time incidence rates [per 100 persons-years (PY)] and investigated the factors associated with the outcome "induced abortion" using a generalized linear mixed model. RESULTS: 753 women and 210 pregnancies were included in the present analysis. We estimated an induced abortion incidence rate of 0.68/100 persons-years (95% confidence interval [CI]: 0.47; 0.94) in the study period, with a significant reduction after 2006. The main factors associated with an induced abortion were currently living with a partner (adjusted OR [AdjOR] 0.32 95% CI: 0.10-0.98), number of children (2 children AdjOR 0.12, 95% CI: 0.02-0.95) and the type of antiretroviral treatment used (regimen without Efavirenz: AdjOR: 0.11, 95% CI 0.02-0.70). CONCLUSIONS: We showed a significant reduction in the incidence of induced abortions in a cohort of women living with HIV in Rio de Janeiro, Brazil, probably due to a decrease in the incidence of pregnancies observed in the same period. The factors associated with a lower occurrence of induced abortion suggest a good integration between the clinical and reproductive assistance offered to those women.

Immunologic mediators profile in COVID-19 convalescence.

SARS-CoV-2 caused the pandemic situation experienced since the beginning of 2020, and many countries faced the rapid spread and severe form of the disease. Mechanisms of interaction between the virus and the host were observed during acute phase, but few data are available when related to immunity dynamics in convalescents. We conducted a longitudinal study, with 51 healthy donors and 62 COVID-19 convalescent patients, which these had a 2-month follow-up after symptoms recovery. Venous blood sample was obtained from all participants to measure blood count, subpopulations of monocytes, lymphocytes, natural killer cells and dendritic cells. Serum was used to measure cytokines, chemokines, growth factors, anti-N IgG and anti-S IgG/IgM antibodies. Statistic was performed by Kruskal-Wallis test, and linear regression with days post symptoms and antibody titers. All analysis had confidence interval of 95%. Less than 35% of convalescents were anti-S IgM+, while more than 80% were IgG+ in D30. Anti-N IgG decreased along time, with loss of seroreactivity of 13%. Eosinophil count played a distinct role on both antibodies during all study, and the convalescence was orchestrated by higher neutrophil-to-lymphocyte ratio and IL-15, but initial stages were marked by increase in myeloid DCs, B1 lymphocytes, inflammatory and patrolling monocytes, G-CSF and IL-2. Later convalescence seemed to change to cytotoxicity mediated by T lymphocytes, plasmacytoid DCs, VEGF, IL-9 and CXCL10. Anti-S IgG antibodies showed the longest perseverance and may be a better option for diagnosis. The inflammatory pattern is yet present on initial stage of convalescence, but quickly shifts to a reparative dynamic. Meanwhile eosinophils seem to play a role on anti-N levels in convalescence, although may not be the major causative agent. We must highlight the importance of immunological markers on acute clinical outcomes, but their comprehension to potentialize adaptive system must be explored to improve immunizations and further preventive policies.

Effect of spirulina on risk of hospitalization among patients with COVID-19: the TOGETHER randomized trial.

BACKGROUND: Algae-derived nutraceuticals, such as spirulina, have been reported to have biological activities that may minimize clinical consequences to COVID-19 infections. OBJECTIVES: This study aimed to determine whether spirulina is an effective treatment for high-risk patients with early COVID-19 in an outpatient setting. METHODS: The TOGETHER trial is a placebo-controlled, randomized, platform trial conducted in Brazil. Eligible participants were symptomatic adults with a positive rapid test for SARS-CoV-2 older than 50 y or with a known risk factor for disease severity. Patients were randomly assigned to receive placebo or spirulina (1 g twice daily for 14 d). The primary end point was hospitalization defined as either retention in a COVID-19 emergency setting for >6 h or transfer to tertiary hospital owing to COVID-19 at 28 d. Secondary outcomes included time-to-hospitalization, mortality, and adverse drug reactions. We used a Bayesian framework to compare spirulina with placebo. RESULTS: We recruited 1126 participants, 569 randomly assigned to spirulina and 557 to placebo. The median age was 49.0 y, and 65.3% were female. The primary outcome occurred in 11.2% in the spirulina group and 8.1% in the placebo group (odds ratio [OR]: 1.24; 95% credible interval: 0.84, 1.86). There were no differences in emergency department visit (OR: 1.21; 95% credible interval: 0.81, 1.83), nor time to symptom relief (hazard ratio: 0.90; 95% credible interval: 0.79, 1.03). Spirulina also not demonstrate important treatment effects in the prespecified subgroups defined by age, sex, BMI, days since symptom onset, or vaccination status. CONCLUSIONS: Spirulina has no any clinical benefits as an outpatient therapy for COVID-19 compared with placebo with respect to reducing the retention in an emergency setting or COVID-19-related hospitalization. There are no differences between spirulina and placebo for other secondary outcomes. This trial was registered at clinicaltrials.gov as NCT04727424.

Fatal Oropouche Virus Infections in Nonendemic Region, Brazil, 2024.

We report acute Oropouche virus infections in 2 previously healthy women from a nonendemic region of Brazil outside the Amazon Basin. Infections rapidly progressed to hemorrhagic manifestations and fatal outcomes in 4-5 days. These cases highlight the critical need for enhanced surveillance to clarify epidemiology of this neglected disease.

Expanding the knowledge of the bat fauna of the Brazilian Caatinga: new geographical records of molossid bats (Chiroptera, Molossidae) for the Chapada Diamantina region, with taxonomic notes.

The Caatinga, an exclusive biome in Brazil, is the largest tropical dry forest area in the Americas. It is characterized by a semi-arid climate and various soils that harbor a great diversity of flora and fauna. Novel records of aerial insectivorous bat species in the family Molossidae in the Chapada Diamantina, northeastern Brazil are presented. The study is based on field sampling of 115 molossid bat specimens from six genera and 12 taxonomically confirmed species, along with four taxa requiring further evaluation for definitive species identification. All specimens were obtained using mist nets around a small freshwater lagoon surrounded by semideciduous dry forest. The verified genera were Cynomops, Eumops, Molossops, Molossus, Neoplatymops, and Nyctinomops. Our findings enhance the understanding of bat diversity in the Brazilian Caatinga, with the first records of Eumopsdelticus, E.bonariensis, and Molossuscurrentium. The most abundant species were Molossusrufus, Eumopsglaucinus, Cynomopsplanirostris, Nyctinomopslaticaudatus, and Molossusmolossus. Previously unreported morphological and morphometric variations for these Caatinga taxa were examined. Additionally, information on sexual dimorphism in craniodental characteristics of Molossopstemminckii and variations in the presence of the sagittal crest in Neoplatymopsmattogrossensis are provided. Based on the voucher specimens from this study, the recognized number of species of Molossidae known from the Caatinga has increased to 21. Our results offer new insights into the taxonomy and biogeography of Neotropical molossids, highlighting their importance as members of bat communities in dry forest ecosystems from northeastern South America.