41 research outputs found
Two outbreaks of mixed etiology associated with central venous catheters inserted by phlebotomy in critical neonates
Staphylococcus aureus and coagulase-negative staphylococci are the main cause of sepsis in Neonatal Intensive Care Unit (NICU). Central venous catheters (CVCs) are an important part of critical neonates' treatment and are associated with sepsis. The aim of this study was to investigate two outbreaks caused by Staphylococcus aureus and Staphylococcus epidermidis associated with CVC inserted by phlebotomy in critical neonates. The surveillance was performed from January 2001 to December 2005 at the Brazilian NICU. The genotypic analysis of oxacillin susceptible S. aureus (OSSA) and oxacillin resistant S. epidermidis (ORSE) was performed based on pulsed-field gel electrophoresis (PFGE). Staphylococcus was the most frequent pathogen (65.8%) with highest incidence of CoNS (59.9%) followed by S. aureus (40.1%). During the five years of surveillance, there were two outbreaks detected, occurred in January-February/02 and August/02 and confirmed by PFGE analysis. The predisposing factors for infection corresponding to both outbreaks were: age <7 days, hospitalization > 7 days, and use of polyethylene CVC through dissection of vein (phlebotomy). This is the first relate of staphylococcal outbreaks associated with CVC inserted by phlebotomy in NICU. PFGE showed polyclonal spread of OSSA during both epidemic and endemic period, and two monoclonal outbreaks of ORSE in the same epidemic period of OSSA
Association between age at first sexual intercourse and subsequent human papillomavirus infection: results of a Brazilian screening program
Objetivo: descrever a idade de inĂcio da atividade sexual (sexarca) e a sua associação com a idade das mulheres com a infecção por papilomavĂrus humano (HPV) e com as alteraçÔes citolĂłgicas no exame de papanicolaou. MĂ©todos: mulheres da população geral foram recrutadas para participar de um estudo de rastreamento de cĂąncer cervical e lesĂ”es prĂ©-malignas. ApĂłs a aplicação de questionĂĄrio comportamental, foram submetidas ao rastreamento com gia cervical e teste para DNA de HPV de alto risco, por meio de Captura HĂbrida 2. Este projeto faz parte do Latin American Screening Study, que envolve mulheres do Brasil e da Argentina, e os dados aqui apresentados referem-se aos centros brasileiros nas cidades de Porto Alegre, SĂŁo Paulo e Campinas. Resultados: de 8.649 mulheres entrevistadas, 8.641 relataram atividade sexual prĂ©via e foram incluĂdas na anĂĄlise. A mĂ©dia de idade no momento da entrevista foi de 38,1±11,04 anos, com inĂcio da atividade sexual em mĂ©dia aos 18,5±4,0 anos. Identificamos que a idade do inĂcio da atividade sexual aumenta de acordo com o aumento da faixa etĂĄria no momento da entrevista, isto Ă©, mulheres mais novas relataram sexarca mais precoce que mulheres mais velhas (p<0,001). Em relação Ă infecção por HPV de alto risco, do total de mulheres que haviam iniciado as relaçÔes sexuais, 3.463 foram testadas, com 17,3% de positividade para HPV. Notadamente, em todos os centros, as mulheres com idade ao inĂcio da atividade sexual abaixo da mĂ©dia da população entrevistada apresentaram positividade maior para HPV (20,2%) do que as mulheres com sexarca em idade acima da mĂ©dia (12,5%) â Odds Ratio (OR)=1,8 (IC95%=1,5-2,2; p<0,001). Em relação Ă citologia, mulheres com sexarca abaixo da mĂ©dia de idade apresentaram tambĂ©m maior percentual de citologia alterada â„ ASC-US (6,7%) do que mulheres com sexarca em idade maior que a mĂ©dia (4,3%) â OR=1,6 (IC95%=1,3-2,0; p<0,001). ConclusĂ”es: a infecção por HPV e a presença de alteraçÔes citolĂłgicas identificadas no rastreio de lesĂ”es cervicais em uma população assintomĂĄtica estiveram significativamente associadas Ă idade mais precoce no inĂcio das relaçÔes sexuais. Ademais, identificamos tambĂ©m que as mulheres desta amostra apresentaram diminuição da idade ao inĂcio da atividade sexual, nas Ășltimas dĂ©cadas, sugerindo importante causa para o acrĂ©scimo da prevalĂȘncia de HPV e as lesĂ”es decorrentes desta infecção.Purpose: to investigate womenâs age at their first sexual intercourse and its correlation with their present age, human papillomavirus (HPV) infection and cytological abnormalities at Pap smear. Methods: women from the general population were invited to be screened for cervical cancer and pre-malignant lesions. After answering a behavior questionnaire, they were submitted to screening with cervical cytology and high-risk HPV testing with Hybrid Capture 2 (HC2). This report is part of the Latin American Screening (LAMS) study, that comprises centers from Brazil and Argentina, and the data presented herein refer to the Brazilian women evaluated at the cities of Porto Alegre, SĂŁo Paulo and Campinas. Results: from 8,649 women that answered the questionnaire, 8,641 reported previous sexual activity and were included in this analysis. The mean age at the interview was 38.1±11.0 years and the mean age at the first sexual intercourse was 18.5±4.0 years. The age at the first sexual intercourse increased along with the age at the interview, i.e., younger women reported they had begun their sexual life earlier than older women (p<0.001). From the total of women who had already begun having sexual intercourse, 3,643 patients were tested for high-risk HPV infection and 17.3% of them had positive results. In all the centers, it became clear that the women with the first sexual intercourse at ages below the mean age of all the population interviewed presented higher rates of HPV infection (20.2%) than the women with the first sexual intercourse at ages above the mean (12.5%) â Odds Ratio (OR) 1.8 (IC95% 1.5-2.2;p<0,001). According to the cytology, the women with first sexual intercourse at ages under the mean, presented higher percentage of abnormal cytology â„ ASC-US (6.7%) than the women with the first sexual intercourse at ages above the mean (4.3%) â OR 1.6 (IC95% 1.3-2.;p<0.001). ConclusionS: the high-risk HPV infection and cytological abnormalities identified during the asymptomatic population screening were significantly associated to the womenâs age at the first sexual intercourse. Additionally, we have also identified that the womenâs age at the first sexual intercourse has decreased during the last decades, suggesting an important contribution to the increase of HPV infection and the subsequent cervical lesions.ComissĂŁo Europeia - programa INCO-DEV (International Cooperation Development) Contrato #ICA4-2001-10013
Human papillomavirus testing as an optional screening tool in low-resource settings of Latin America: experience from the Latin American Screening study
Hybrid capture II (HC II) test for oncogenic human papillomaviruses (HPV) was carried out in a cohort of 4284 women at their first clinical visit. Overall prevalence of HPV was 17.1%, decreasing with age from 33.9% among women below 20 years to only 11.0% among those older than 41 years. HPV prevalence was significantly higher among current smokers (odds ratio [OR] ÂŒ 1.31; 95% CI 1.1â1.6), in women with two or more lifetime sexual partners (OR ÂŒ 1.9; 95% CI 1.6â2.4), and those women with two or more sexual partners during the past 12 months prior to examination (OR ÂŒ 1.6; 95% CI 1.2â2.2). HPV detection increased in parallel with increasing cytologic abnormality, being highest in women with high-grade squamous intraepithelial lesion (P ÂŒ 0.001). Specificity of the HPV test in detecting histologically confirmed cervical disease was 85% (95% CI 83.9â86.1). Sensitivity of the HPV test in detecting histologic abnormalities increased
in parallel with disease severity, ranging from 51.5% for cervical intraepithelial neoplasia (CIN) 1 to 96.5% for CIN 3 and 100.0% for cancer, with respective decline of positive predictive value. These data suggest
that HPV testing with HC II assay might be a viable screening tool among this population with relatively high prevalence of cervical disease
Evaluation of visual inspection with acetic acid (VIA), Lugolâs iodine (VILI), cervical cytology and HPV testing as cervical screening tools in Latin America
Objectives: To assess the performance indicators of visual inspection with acetic acid (VIA) and visual
inspection with Lugolâs iodine (VILI) in four Latin American centres participating in the ongoing Latin
AMerican Screening (LAMS) study, in settings with moderate incidence of cervical disease and with
poorly to moderately well-organized cervical cancer screening.
Setting: Three Brazilian centres (SĂŁo Paulo, Campinas and Porto Alegre) and one Argentine centre
(Buenos Aires) recruited a total of 11,834 healthy women to undergo VIA, VILI, conventional Pap
smear and Hybrid Capture II (HCII).
Methods: Women who had a positive result from any of these tests were subjected to colposcopy and
biopsies (if necessary), and women with high-grade cervical intraepithelial neoplasia (CIN) were
properly treated. To control for verification bias, 5% of women with normal tests were referred for
colposcopy, as were 20% of HCII-negative women.
Results: Data on VIA (n = 11,834), VILI (n = 2994), conventional Pap smear (n = 10,138) and HCII
(n = 4195) were available for test comparisons, calculating sensitivity, specificity, and positive and
negative predictive values. Overall test positivity was 11.6% for VIA, 23.0% for VILI, 2.2% for Pap
smear (LSIL threshold), 1.1% for Pap smear (HSIL threshold) and 17.1% for HCII. VIA was positive in
61.8% of the women with CIN 1, 57.0% of those with CIN 2, 35.0% of women with CIN 3 and in 21
of 28 (75%) of women with cancer. Approximately 10% of women with no detectable disease had an
abnormal VIA. Regarding VILI, 83.3% of women diagnosed with CIN 1 and 62.5% of those with CIN
3 had an abnormal test. VILI failed to detect one of three cases of cancer. Both the sensitivity, specificity
and positive predictive value of VIA and VILI in detecting CIN 2 or CIN 3 could be significantly
improved depending on the combination with Pap smear or HCII (sensitivity up to 100.0% and
specificity up to 99.8%).
Conclusions: The LAMS study failed to reproduce the performance figures obtained with VIA and VILI
(as stand-alone tests) in some other settings, where the prevalence of cervical disease was higher.
However, a combined use of VIA or VILI with the Pap test or HCII allowed specific detection of cervical
abnormalities.European Union (EU) - INCO-DEV Programme - Contract# ICA4-CT-2001-10013
Genomic analysis of two phlebotomine sand fly vectors of Leishmania from the New and Old World.
Phlebotomine sand flies are of global significance as important vectors of human disease, transmitting bacterial, viral, and protozoan pathogens, including the kinetoplastid parasites of the genus Leishmania, the causative agents of devastating diseases collectively termed leishmaniasis. More than 40 pathogenic Leishmania species are transmitted to humans by approximately 35 sand fly species in 98 countries with hundreds of millions of people at risk around the world. No approved efficacious vaccine exists for leishmaniasis and available therapeutic drugs are either toxic and/or expensive, or the parasites are becoming resistant to the more recently developed drugs. Therefore, sand fly and/or reservoir control are currently the most effective strategies to break transmission. To better understand the biology of sand flies, including the mechanisms involved in their vectorial capacity, insecticide resistance, and population structures we sequenced the genomes of two geographically widespread and important sand fly vector species: Phlebotomus papatasi, a vector of Leishmania parasites that cause cutaneous leishmaniasis, (distributed in Europe, the Middle East and North Africa) and Lutzomyia longipalpis, a vector of Leishmania parasites that cause visceral leishmaniasis (distributed across Central and South America). We categorized and curated genes involved in processes important to their roles as disease vectors, including chemosensation, blood feeding, circadian rhythm, immunity, and detoxification, as well as mobile genetic elements. We also defined gene orthology and observed micro-synteny among the genomes. Finally, we present the genetic diversity and population structure of these species in their respective geographical areas. These genomes will be a foundation on which to base future efforts to prevent vector-borne transmission of Leishmania parasites
2 nd Brazilian Consensus on Chagas Disease, 2015
Abstract Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. It is hoped that this document will strengthen the development of integrated actions against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research
NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics
Xenarthrans â anteaters, sloths, and armadillos â have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with 24 domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, ten anteaters, and six sloths. Our dataset includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data-paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the south of the USA, Mexico, and Caribbean countries at the northern portion of the Neotropics, to its austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n=5,941), and Cyclopes sp. has the fewest (n=240). The armadillo species with the most data is Dasypus novemcinctus (n=11,588), and the least recorded for Calyptophractus retusus (n=33). With regards to sloth species, Bradypus variegatus has the most records (n=962), and Bradypus pygmaeus has the fewest (n=12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other datasets of Neotropical Series which will become available very soon (i.e. Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans dataset
Pervasive gaps in Amazonian ecological research
Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4
While the increasing availability of global databases on ecological communities has advanced our knowledge
of biodiversity sensitivity to environmental changes,5â7 vast areas of the tropics remain understudied.8â11 In
the American tropics, Amazonia stands out as the worldâs most diverse rainforest and the primary source of
Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13â15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazonâs biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus
crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced
environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian
Amazonia, while identifying the regionâs vulnerability to environmental change. 15%â18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by
2050. This means that unless we take immediate action, we will not be able to establish their current status,
much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio