Epidemiologic surveillance of the rabies virus using the brain immunoflorescence test on a sample of a canine population: probality and analysis with actual cases from Mogi-Guaçu, SP, Brazil, During the 1989-1999 period

The validty of a systematic laboratory exam that consists in examining the nervous system of a canine population sample in a given area was anlyzed, as a proper strategy for epidemiological survilance of the rabies virus presence. The analysis was based on the databank of the County of Mogi-Guaçu, SP, Brazil, referring to the historical period between January 1989 and december 1999. During this period 1,167 animals were examined and an immunofluorescence test applied to rabies showed that 130 animals (11.2%) were positive. The sample size for detecting at least one positive animal was calculated by using the formula n = {1-(1-±)1/d } (N - d/2} + 1. Between 1989 and 1994 the size of sample was calculated based on the real number of recorded cases. Between 1995 and 1999, as there were no new cases of canine rabies, the analysis considered a hypothetical presence of a confirmed case. It was also carried out a simulation of the number of rabies cases that should occur so that the sample effectively used by the Rabies Control Service would be able to reveal the presence of at least one positive animal. Results showed that in the period from 1989 to 1994, in when the annual frequecy of canine rabies cases varied from 5 to 75 cases, the ideal size of sample should be from 12,400 to 12,922. In the period from 1995 to 1999, when no canine rabies cases were recorded, the sample size would be from 13,257 to 14,698 if at least one case occurred. Thus, one can understand that in therms of probability, the proposed strategy is not recommended for the epidemiological survilance of rabies virus presence, since the number of animal to be examined is not feasible in real situation.Foi analisada a validade do exame laboratorial sistemático do sistema nervoso de uma amostra da população canina de uma dada área, como estratégia destinada a vigilância epidemiológica da circulação do vírus da raiva. Foi empregado o banco de dados do município de Mogi-Guacú, SP, Brasil, referente a série histórica compreendida entre janeiro de 1989 a dezembro de 1999. Neste período foram examinados 1167 animais dos quais 130 (11,2%) foram positivos ao teste de imunofluorescência aplicada a raiva. O tamanho da amostra para a detecção de pelo menos um animal positivo foi calculado pela fórmula n = {1-(1-±)1/d} (N - d/2) + 1. No período de 1989 a 1994 o tamanho da amostra foi calculado a partir do número real de casos registrados. Nos anos de 1995 a 1999 como não houve novos casos de raiva canina, a análise considerou hipoteticamente a presença de um caso confirmado. Também foi efetuada a simulação do número de casos de raiva que deveriam ocorrer para que a amostra efetivamente utilizada pelo Serviço de controle da raiva fosse capaz de revelar a presença de pelo menos um animal positivo. Os resultados obtidos demonstraram que no período de 1989 a 1994 em que a freqüência anual de casos de raiva canina variou de 5 a 75 o tamanho das amostras ideal seria de 12.400 a 12.922; já no período de 1995 a 1999, em que não foram diagnosticados casos de raiva canina, se ocorresse pelo menos um registro, o tamanho da amostra seria de 13.257 a 14.698. Do exposto depreende-se que em termos probabilísticos, a estratégia proposta não é indicada para a vigilância epidemiológica da presença do vírus da raiva, quando em situação de controle, pois o número de animais a serem examinados é inviável para situações concretas

Telemedicine-Based Management of Oral Anticoagulation Therapy:Systematic Review and Meta-analysis

BACKGROUND: Oral anticoagulation is the cornerstone treatment of several diseases. Its management is often challenging, and different telemedicine strategies have been implemented to support it. OBJECTIVE: The aim of the study is to systematically review the evidence on the impact of telemedicine-based oral anticoagulation management compared to usual care on thromboembolic and bleeding events. METHODS: Randomized controlled trials were searched in 5 databases from inception to September 2021. Two independent reviewers performed study selection and data extraction. Total thromboembolic events, major bleeding, mortality, and time in therapeutic range were assessed. Results were pooled using random effect models. RESULTS: In total, 25 randomized controlled trials were included (n=25,746 patients) and classified as moderate to high risk of bias by the Cochrane tool. Telemedicine resulted in lower rates of thromboembolic events, though not statistically significant (n=13 studies, relative risk [RR] 0.75, 95% CI 0.53-1.07; I2=42%), comparable rates of major bleeding (n=11 studies, RR 0.94, 95% CI 0.82-1.07; I2=0%) and mortality (n=12 studies, RR 0.96, 95% CI 0.78-1.20; I2=11%), and an improved time in therapeutic range (n=16 studies, mean difference 3.38, 95% CI 1.12-5.65; I2=90%). In the subgroup of the multitasking intervention, telemedicine resulted in an important reduction of thromboembolic events (RR 0.20, 95% CI 0.08-0.48). CONCLUSIONS: Telemedicine-based oral anticoagulation management resulted in similar rates of major bleeding and mortality, a trend for fewer thromboembolic events, and better anticoagulation quality compared to standard care. Given the potential benefits of telemedicine-based care, such as greater access to remote populations or people with ambulatory restrictions, these findings may encourage further implementation of eHealth strategies for anticoagulation management, particularly as part of multifaceted interventions for integrated care of chronic diseases. Meanwhile, researchers should develop higher-quality evidence focusing on hard clinical outcomes, cost-effectiveness, and quality of life. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020159208; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=159208.</p

Aspectos anatomo-clinicos da doença raiva em animais domesticos

Orientador : Konradin MetzeTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: A ocorrência de uma epidemia de raiva animal na região de Mogi Guaçu, estado de São Paulo, proporcionou estudos detalhados da evolução clínica da doença em animais, principalmente cães, possibilitando caracterizar quadros atípicos da doença. Ao longo da evolução da epidemia animal, e durante os anos posteriores em que ações de controle foram aplicadas (de 1989 a 1998), todos os animais de interesse epidemiológico foram observados clinicamente, bem como coletados materiais para estudos histopatológicos, pelas técnicas tradicionais e por imunohistoquímica. Assim sendo, 1152 lâminas de cortes histológicos de diversos órgãos de 112 animais positivos resultantes de 635 amostras de interesse epidemiológico encaminhadas para diagnóstico laboratorial foram confeccionadas e analisadas à microscopia, com correlações posteriores aos históricos dos respectivos animais bem como aos fatos ocorridos durante o período patogênico da doença, fornecendo, tais análises, informações que confirmam fatos já comentados na literatura científica, além de outros até então não descritos. Obtivemos a caracterização da ocorrência de casos atípicos da raiva, com destaque aos casos de morte súbita sem sintomas clínicos anteriores sugestivos da doença, enterite hemorrágica com óbito sem manifestação neurológica associada e manifestações típicas de outras doenças neurológicas. A ocorrência de morte súbita, a enterite hemorrágica e a hemofagocitose nos diversos tecidos, foram alguns dos achados de maior significado no presente estudo. Os casos atípicos com capacidade de eliminação do vírus pela via usual, possibilitam uma reavaliação dos métodos de profilaxia destinados aos comunicantes, já que os animais vítimas de tais manifestações, são importantes fontes de infecção nem sempre consideradas. Portanto, resumimos o presente trabalho como uma análise comparativa entre as evidências clínicas e os resultados da investigação histopatológica, produzindo informações de relevância para estudos epidemiológicosAbstract: The occurrence of an epidemic of rabies in a certain region in the State of São Paulo provided detailed investigations related to the clínical development of the disease in animaIs, particularly in dogs. The event made the identification of the disease atypical pictures possible. During the animal epidemic evolution and the following years, when control actions were applied (ftom 1989 to 1998), alI the animaIs presenting epidemiological interest were clínically observed, and material for histopathological studies was collected both through traditional techniques and immunehistochemistry. This way, 1152 slides of histological cuts ftom different organs of 112 animaIs positive in 635 epidemiologically interesting samples - which were sent for laboratory diagnosis - were prepared and analyzed under microscope. Afterward, comparisons with the history of these animaIs were carried o~ as well as with the facts which occurred during the pathogenic period of the disease. These analyses provided information confirming facts already mentioned in the scientific literature in addition to others which are not yet described. As a result, the occurrence of atypical rabies cases was identified such as sudden death without previous clínical symptoms suggesting the disease, hemorrhage enteritis followed by death without associated neurological manifestation and typical manifestations of other neurological diseases. The occurrence of sudden death, the hemorrhage enteritis, and the hemophagocytosis in several tissues were some ofthe major discoveries in this study. Atypical cases able to eliminate the vírus through usual ways make a re¬evaluation of the prophylaxis methods destined to communicators possible, since the animaIs which are victims of such manifestations are important infection sources and have not always been considered. Therefore we summarized this work as a comparative analysis between clínical evidences and the results of the histopathological investigation, thus producing information relevant to epidemiological studiesDoutoradoAnatomia PatologicaDoutor em Ciências Médica

Do crédito rural oficial ao cooperativismo de crédito rural solidário / From official rural credit for rural credit cooperative solidarity

La política oficial crediticia de Brasil ha sufrido transformaciones desde finales del siglo xx cuando hubo intentos de establecer una política centrada en los mecanismos de financiación. A pesar de las limitaciones presupuestarias y los avances en la implementación de instrumentos menos Intervencio nistas en las políticas agrícolas del Estado, el crédito rural sigue siendo fundamental para la financia ción de la agricultura brasileña. Desde 1995 las políticas de crédito tenían recursos disponibles para un grado cada vez mayor. Agricultura familiar tenia Pronaf en 1996 y el reconocimiento como base para el consumo local de alimentos. En el mismo periodo, las cooperativas de crédito rural se destacan con las funciones más allá de los financieros. Crédito rural juega un papel importante en la promoción de la actividad agrícola (producción y la productividad) y abre las puertas a la aparición de muchas familias y organizaciones rurales. Sin embargo, provoca distorsiones, como el desperdicio de recursos y pérdida de eficacia como herramientas de desarrollo de la producción en consecuencia. Pensando en ello, de la literatura especializada, la investigación "Las cooperativas de crédito rural solidario en la promoción del local", de la Universidade Federal de Viçosa (UFV) y la Universidad Federal de Santa Maria (urs), 2009/2010, tiene como objetivo revisar y analizar la historicidad de las políticas de crédito en Brasil y, en concreto, la experiencia del cooperativismo de crédito la solidaridad como un instrumento eficaz para la democratización del crédito para los agricultores familiares. Palabras clave: cooperativismo de crédito, crédito rural, política agrícola.The Brazilian official credit policies have undergone transformations since late 19th century when there were attempts to establish a policy focused on funding mechanisms. Despite budgetary constraints and advance to implement lesser interventionist instruments in State agricultural policy, the rural credit is still essential to fund Brazilian agriculture. Since 1995 credit policies had resources available to an increasing degree. Family business agriculture had Pronaf in 1996 and recognition as a basis for domestic food consumption. At the same time, rural credit cooperatives stand out performing roles beyond finance tasks. So rural credit plays an important role in agricultural activity promotion (pro- duction and productivity) opening doors to many families and rural organizations. However, it causes alterations, such as wasted resources and consequently loss of effectiveness as a tool developer of pro- duction. Thinking about this issue from specialized literature, the investigation "Solidarity rural credit cooperatives in promoting local development of Universidad Federal de Viçosa (ur) and Universidad Federal de Santa Maria (urs), 2009/2010, aims to review and analyze the historicity of Brazilian credit policies, but specifically the experience of solidarity credit cooperatives as an effective instrument for democratization of credit to family [email protected]@mail.ufsm.brhttps://scholar.google.com.br/citations?user=ClFnr5gAAAAJ&hl=pt-B

Ventilator-associated pneumonia in an adult clinical-surgical intensive care unit of a Brazilian university hospital: incidence, risk factors, etiology, and antibiotic resistance

The objective of this study was to evaluate clinical characteristics, etiology, and resistance to antimicrobial agents, among patients with ventilator-associated pneumonia (VAP). A case study vs. patients control under mechanical ventilation and hospitalized into clinical-surgical adults ICU of HC-UFU was performed from March/2005 to March/2006. Patients under ventilation for over 48 h were included in the study including 84 with diagnosis of VAP, and 191 without VAP (control group). Laboratory diagnosis was carried out through quantitative microbiological evaluation of tracheal aspirate. The identification of pathogens was performed by classical microbiological tests, and the antibiotics sensitivity spectrum was determined through the CLSI technique. VAP incidence rate over 1,000 days of ventilation was 24.59. The mean (± SD) duration of mechanical ventilation prior to VAP diagnosis was 23.2 ± 17.2 days. By multivariate analysis the risk factors predisposing for VAP were: mechanical ventilation time and mechanical ventilation > seven days, tracheostomy and use of > three antibiotics. Mortality rate was high (32.1 %) but lower than that of the control group (46.5%). Major pathogens were identified in most of patients (95.2%) and included: Pseudomonas aeruginosa (29%), Staphylococcus aureus (26%), Enterobacter/Klebsiella/Serratia (19%) and Acinetobacter spp. (18%), with expressive frequencies of P. aeruginosa (52%), S. aureus (65.4%) and Enterobacteriaceae (43.7%) resistant to imipenem, oxacillin and 3/4 generation cephalosporins, respectively. In conclusion, our observation showed VAPs caused by multiresistant microorganisms, the prescription of > three antibiotics, and mortality with unacceptably high rates. The practice of de-escalation therapy appears to be urgently needed in order to improve the situation