Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid-19

COVID-19 is a new disease caused by the Sars-CoV-2 virus and the vast majority of patients have symptoms similar to a flu-like syndrome. A small portion of those infected ends up being hospitalized and may develop with the most severe presentation of the disease. Data from Chinese series report that hypertension appears to be a condition that imposes a greater risk of unfavorable evolution of patients. Some studies have reported that Sars-CoV-2 uses the angiotensin-converting enzyme to access its target cells. There are theories that differ about the protective or harmful role that drugs that act in the renin angiotensin aldosterone system in these patients. A British study suggests that patients using angiotensin-converting enzyme inhibitors had a lower incidence of severe forms of the disease. Another study carried out a retrospective and multicenter analysis showing that mortality was lower in the group that had used the drugs when compared to the other group (3,7 vs. 9,8%; p=0,01). The various hypotheses raised through pathophysiology are not yet able to really predict the best course of action for patients using drugs that act on the renin angiotensin system. Thus, a randomized study becomes important to try to answer definitively and with a high degree of reliability to this question

Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid-19

COVID-19 is a new disease caused by the Sars-CoV-2 virus and the vast majority of patients have symptoms similar to a flu-like syndrome. A small portion of those infected ends up being hospitalized and may develop with the most severe presentation of the disease. Data from Chinese series report that hypertension appears to be a condition that imposes a greater risk of unfavorable evolution of patients. Some studies have reported that Sars-CoV-2 uses the angiotensin-converting enzyme to access its target cells. There are theories that differ about the protective or harmful role that drugs that act in the renin angiotensin aldosterone system in these patients. A British study suggests that patients using angiotensin-converting enzyme inhibitors had a lower incidence of severe forms of the disease. Another study carried out a retrospective and multicenter analysis showing that mortality was lower in the group that had used the drugs when compared to the other group (3,7 vs. 9,8%; p=0,01). The various hypotheses raised through pathophysiology are not yet able to really predict the best course of action for patients using drugs that act on the renin angiotensin system. Thus, a randomized study becomes important to try to answer definitively and with a high degree of reliability to this question

ABANDONO DO TRATAMENTO DA TUBERCULOSE: UMA ANÁLISE EPIDEMIOLÓGICA DOS SEUS FATORES DE RISCO

O abandono do tratamento, no atual panorama da luta contra a Tuberculose, se constitui em um dos principais desafios para o sistema de saúde brasileiro e é caracterizado pelo não comparecimento do doente ao serviço de saúde por mais de trinta dias consecutivos, após a data aprazada para o retorno. Objetivou-se caracterizar o perfil epidemiológico e os fatores de risco associados ao abandono do tratamento por pacientes portadores de tuberculose do município do Iguatu – Ceará. Estudo de caráter descritivo, exploratório, com abordagem quantitativa realizado no município de Iguatu-CE, desenvolvida com 06 pacientes de tuberculose que abandonaram o tratamento e/ou que interromperam-no antes da alta por cura, registrados no Sistema de Informação de Agravos de Notificação no período compreendido pelos anos de 2009 e 2013. A análise estatística se deu através do Software Excel for Windows na sua versão 2010 e analisadas à luz da literatura pertinente. De acordo com os resultados foi constatado que 66,64% eram do sexo masculino, em sua maioria de cor negra 83,30%, com faixa etária entre 20 a 50 anos. Quanto ao nível de escolaridade, percebeu-se que do total de pacientes estudados, 49,98% tinham entre quatro e sete anos de estudos, principal agravo encontrado no estudo foi o etilismo, 66,64% dos seis participantes apresentaram o etilismo como agravo associado ao seu tratamento, 49,98% não tinham a ocupação informada, ao tipo de entrada do paciente ao tratamento da tuberculose, quatro 66,64% foram por caso novo, sendo dois 33,32% por reingresso após abandono, todos os participantes do estudo são provindos da zona urbana e todos foram indicados ao Tratamento Diretamente Observado. Verificou-se então que, o abandono de tratamento está relacionado a vários fatores condicionantes, sobretudo os socioeconômicos, e ocorre principalmente na população com menor escolaridade, da raça negra e relaciona-se também ao consumo de álcool.(http://dx.doi.org/10.14295/cad.cult.cienc.v13i2.855)

The Genome of the Zoonotic Malaria Parasite Plasmodium simium Reveals Adaptions to Host-switching

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The genome of the zoonotic malaria parasite Plasmodium simium reveals adaptations to host switching

BACKGROUND: Plasmodium simium, a malaria parasite of non-human primates (NHP), was recently shown to cause zoonotic infections in humans in Brazil. We sequenced the P. simium genome to investigate its evolutionary history and to identify any genetic adaptions that may underlie the ability of this parasite to switch between host species. RESULTS: Phylogenetic analyses based on whole genome sequences of P. simium from humans and NHPs reveals that P. simium is monophyletic within the broader diversity of South American Plasmodium vivax, suggesting P. simium first infected NHPs as a result of a host switch of P. vivax from humans. The P. simium isolates show the closest relationship to Mexican P. vivax isolates. Analysis of erythrocyte invasion genes reveals differences between P. vivax and P. simium, including large deletions in the Duffy-binding protein 1 (DBP1) and reticulocyte-binding protein 2a genes of P. simium. Analysis of P. simium isolated from NHPs and humans revealed a deletion of 38 amino acids in DBP1 present in all human-derived isolates, whereas NHP isolates were multi-allelic. CONCLUSIONS: Analysis of the P. simium genome confirmed a close phylogenetic relationship between P. simium and P. vivax, and suggests a very recent American origin for P. simium. The presence of the DBP1 deletion in all human-derived isolates tested suggests that this deletion, in combination with other genetic changes in P. simium, may facilitate the invasion of human red blood cells and may explain, at least in part, the basis of the recent zoonotic infections

Native diversity buffers against severity of non-native tree invasions

Determining the drivers of non-native plant invasions is critical for managing native ecosystems and limiting the spread of invasive species$^{1,2}$. Tree invasions in particular have been relatively overlooked, even though they have the potential to transform ecosystems and economies$^{3,4}$. Here, leveraging global tree databases$^{5,6,7}$, we explore how the phylogenetic and functional diversity of native tree communities, human pressure and the environment influence the establishment of non-native tree species and the subsequent invasion severity. We find that anthropogenic factors are key to predicting whether a location is invaded, but that invasion severity is underpinned by native diversity, with higher diversity predicting lower invasion severity. Temperature and precipitation emerge as strong predictors of invasion strategy, with non-native species invading successfully when they are similar to the native community in cold or dry extremes. Yet, despite the influence of these ecological forces in determining invasion strategy, we find evidence that these patterns can be obscured by human activity, with lower ecological signal in areas with higher proximity to shipping ports. Our global perspective of non-native tree invasion highlights that human drivers influence non-native tree presence, and that native phylogenetic and functional diversity have a critical role in the establishment and spread of subsequent invasions

Evenness mediates the global relationship between forest productivity and richness

1. Biodiversity is an important component of natural ecosystems, with higher species richness often correlating with an increase in ecosystem productivity. Yet, this relationship varies substantially across environments, typically becoming less pronounced at high levels of species richness. However, species richness alone cannot reflect all important properties of a community, including community evenness, which may mediate the relationship between biodiversity and productivity. If the evenness of a community correlates negatively with richness across forests globally, then a greater number of species may not always increase overall diversity and productivity of the system. Theoretical work and local empirical studies have shown that the effect of evenness on ecosystem functioning may be especially strong at high richness levels, yet the consistency of this remains untested at a global scale. 2. Here, we used a dataset of forests from across the globe, which includes composition, biomass accumulation and net primary productivity, to explore whether productivity correlates with community evenness and richness in a way that evenness appears to buffer the effect of richness. Specifically, we evaluated whether low levels of evenness in speciose communities correlate with the attenuation of the richness–productivity relationship. 3. We found that tree species richness and evenness are negatively correlated across forests globally, with highly speciose forests typically comprising a few dominant and many rare species. Furthermore, we found that the correlation between diversity and productivity changes with evenness: at low richness, uneven communities are more productive, while at high richness, even communities are more productive. 4. Synthesis. Collectively, these results demonstrate that evenness is an integral component of the relationship between biodiversity and productivity, and that the attenuating effect of richness on forest productivity might be partly explained by low evenness in speciose communities. Productivity generally increases with species richness, until reduced evenness limits the overall increases in community diversity. Our research suggests that evenness is a fundamental component of biodiversity–ecosystem function relationships, and is of critical importance for guiding conservation and sustainable ecosystem management decisions