Diagramas de Voronoi para a definição de áreas de abrangência de hospitais públicos no Município do Rio de Janeiro Defining catchment areas for public hospitals in the Municipality of Rio de Janeiro through Weighted Voronoi Diagrams

No planejamento de recursos em saúde é importante o conhecimento da área de abrangência de uma unidade. Os Diagramas de Voronoi constituem uma técnica para tal; são polígonos construídos de tal forma que as bordas de polígonos adjacentes encontram-se eqüidistantes de seus respectivos pontos geradores. Uma modificação nas áreas de abrangência assim definidas é sua ponderação (Diagramas de Voronoi ponderados), representando a capacidade da unidade de forma mais real. No presente trabalho foram utilizados, como pontos geradores, 21 hospitais gerais públicos no Rio de Janeiro, RJ. Inicialmente foram criados os Diagramas de Voronoi sem ponderação, e, a partir destes, os diagramas ponderados, empregando-se como variável de ponderação as estimativas de internação anual para cada unidade. Na divisão clássica, áreas de abrangência similares foram atribuídas a hospitais com características diferenciadas, problema esse contornado no método ponderado. O método é de simples implementação e visualização, utiliza dados de fácil acesso e independe de parâmetros arbitrários ou geopolíticos. Portanto, esses diagramas podem fornecer, a gerentes de saúde, uma visão mais realista para o planejamento da demanda de suas unidades.<br>One of the most important pieces of information for health resources planning is the definition of catchment areas for health units. Voronoi Diagrams are a potential technique for this purpose. They are polygons with the property whereby adjacent polygons have their borders located within the same distance of the respective generator points. One possible adjustment to the catchment areas thus defined is the use of weighted Voronoi Diagrams, which result in an improved representation of a health unit's actual capacity. In this study, the 21 public general hospitals in the city of Rio de Janeiro, Brazil, were used as generator points for Voronoi Diagrams. Non-weighted Voronoi Diagrams were initially implemented and then used as the basis for obtaining weighted Voronoi Diagrams, using as weights the annual admission rates estimated for each unit. In the classic Voronoi Diagram case, some catchment areas had similar sizes, although their respective health units had different characteristics. In the weighted case the areas were modified in a way that appeared closer to the actual functioning of the units. The method appeared simple to implement, used easy-to-access data, and did not rely on geopolitical considerations such as existing administrative areas. It thus provided a more realistic picture of a unit's capacity to support basic health programs

A framework to identify gene expression profiles in a model of inflammation induced by lipopolysaccharide after treatment with thalidomide

<p>Abstract</p> <p>Background</p> <p>Thalidomide is an anti-inflammatory and anti-angiogenic drug currently used for the treatment of several diseases, including erythema nodosum leprosum, which occurs in patients with lepromatous leprosy. In this research, we use DNA microarray analysis to identify the impact of thalidomide on gene expression responses in human cells after lipopolysaccharide (LPS) stimulation. We employed a two-stage framework. Initially, we identified 1584 altered genes in response to LPS. Modulation of this set of genes was then analyzed in the LPS stimulated cells treated with thalidomide.</p> <p>Results</p> <p>We identified 64 genes with altered expression induced by thalidomide using the rank product method. In addition, the lists of up-regulated and down-regulated genes were investigated by means of bioinformatics functional analysis, which allowed for the identification of biological processes affected by thalidomide. Confirmatory analysis was done in five of the identified genes using real time PCR.</p> <p>Conclusions</p> <p>The results showed some genes that can further our understanding of the biological mechanisms in the action of thalidomide. Of the five genes evaluated with real time PCR, three were down regulated and two were up regulated confirming the initial results of the microarray analysis.</p

Análise dos padrões de difusão espacial dos casos de AIDS por estados brasileiros Analysis of spatial diffusion patterns for AIDS cases in some Brazilian States

Ações preventivas ainda são essenciais ao controle da epidemia de AIDS; contudo, programas de prevenção eficazes dependem da distribuição correta e eficiente dos recursos de saúde. Assim, informações acerca de onde, quando, com que intensidade e como se difundirá a epidemia são valiosos. Este estudo visou obter melhor compreensão do processo de difusão espacial dos casos de AIDS em quatro Estados brasileiros. Tais padrões foram avaliados qualitativamente - estudo de mapas seqüenciais - e quantitativamente - análise de correlogramas espaciais - ao longo de dez anos, agrupados em três períodos: 1987-1989, 1990-1992 e 1993-1996. O processo de difusão foi estudado para o total de casos de AIDS e para os do sexo feminino e masculino. De modo geral, houve difusão significativa dos casos de AIDS nos períodos, mas o processo exibiu características específicas a cada Estado. As informações obtidas - em especial, os resultados da análise de correlogramas - permitem entender melhor os padrões de difusão espacial da epidemia em diferentes partes do País e podem ser empregadas para fixar parâmetros a outros modelos epidemiológicos da AIDS.<br>Despite new improvements in AIDS treatment, preventive measures are still essential to control the epidemic. Effective programs almost always depend on correct and efficient allocation of scarce health resources. Detailed information on the epidemic, such as where, when, and how the epidemic will spread are of great value. This study was conducted to obtain a better understanding of the dissemination of AIDS cases in four important Brazilian States. Spatial diffusion patterns were evaluated qualitatively by studying sequential maps and quantitatively by analyzing spatial correlograms. Ten years were analyzed, grouped in three periods (1987-1989, 1990-1992, and 1993-1996). The diffusion process was studied for both total AIDS cases and male and female cases. Diffusion of AIDS cases presented specific characteristics for each of the four States. Information derived from the study, especially the results of the correlogram analysis, improve our understanding of the epidemic's spatial diffusion in different parts of the country and can also be used to determine parameters for other AIDS epidemiological models

B-Cell Epitopes-Based Chimeric Protein from SARS-CoV-2 N and S Proteins Is Recognized by Specific Antibodies in Serum and Urine Samples from Patients

The impact of the COVID-19 pandemic caused by the SARS-CoV-2 virus underscored the crucial role of laboratorial tests as a strategy to control the disease, mainly to indicate the presence of specific antibodies in human samples from infected patients. Therefore, suitable recombinant antigens are relevant for the development of reliable tests, and so far, single recombinant proteins have been used. In this context, B-cell epitopes-based chimeric proteins can be an alternative to obtain tests with high accuracy through easier and cheaper production. The present study used bioinformatics tools to select specific B-cell epitopes from the spike (S) and the nucleocapsid (N) proteins from the SARS-CoV-2 virus, aiming to produce a novel recombinant chimeric antigen (N4S11-SC2). Eleven S and four N-derived B-cell epitopes were predicted and used to construct the N4S11-SC2 protein, which was analyzed in a recombinant format against serum and urine samples, by means of an in house-ELISA. Specific antibodies were detected in the serum and urine samples of COVID-19 patients, which were previously confirmed by qRT-PCR. Results showed that N4S11-SC2 presented 83.7% sensitivity and 100% specificity when using sera samples, and 91.1% sensitivity and 100% specificity using urine samples. Comparable findings were achieved with paired urine samples when compared to N and S recombinant proteins expressed in prokaryotic systems. However, better results were reached for N4S11-SC2 in comparison to the S recombinant protein when using paired serum samples. Anti-N4S11-SC2 antibodies were not clearly identified in Janssen Ad26.COV2.S COVID-19-vaccinated subjects, using serum or paired urine samples. In conclusion, this study presents a new chimeric recombinant antigen expressed in a prokaryotic system that could be considered as an alternative diagnostic marker for the SARS-CoV-2 infection, with the potential benefits to be used on serum or urine from infected patients

Doctors' awareness concerning primary immunodeficiencies in Brazil

Background: PIDs are a heterogeneous group of genetic illnesses, and delay in their diagnosis is thought to be caused by a lack of awareness among physicians concerning PIDs. the latter is what we aimed to evaluate in Brazil.Methods: Physicians working at general hospitals all over the country were asked to complete a 14-item questionnaire. One of the questions described 25 clinical situations that could be associated with PIDs and a score was created based on percentages of appropriate answers.Results: A total of 4026 physicians participated in the study: 1628 paediatricians (40.4%), 1436 clinicians (35.7%), and 962 surgeons (23.9%). About 67% of the physicians had learned about PIDs in medical school or residency training, 84.6% evaluated patients who frequently took antibiotics, but only 40.3% of them participated in the immunological evaluation of these patients. Seventy-seven percent of the participating physicians were not familiar with the warning signs for PIDs. the mean score of correct answers for the 25 clinical situations was 48.08% (+/- 16.06). Only 18.3% of the paediatricians, 7.4% of the clinicians, and 5.8% of the surgeons answered at least 2/3 of these situations appropriately.Conclusions: There is a lack of medical awareness concerning PIDs, even among paediatricians, who have been targeted with PID educational programmes in recent years in Brazil. An increase in awareness with regard to these disorders within the medical community is an important step towards improving recognition and treatment of PIDs. (C) 2014 SEICAP. Published by Elsevier Espana, S.L.U. All rights reserved.Jeffrey Modell FoundationBrazilian Jeffrey Modell CentreUniversidade Federal de São Paulo, São Paulo, BrazilUniv Fed Pernambuco, Recife, PE, BrazilUniv Hosp, Brasilia, DF, BrazilChildrens Hosp, Brasilia, DF, BrazilAlbert Sabin Childrens Hosp, Fortaleza, Ceara, BrazilUniv Estadual Montes Claros, Montes Claros, BrazilUniv Fed Parana, BR-80060000 Curitiba, Parana, BrazilUniv São Paulo, Fac Med Ribeirao Preto, BR-14049 Ribeirao Preto, BrazilFac Med Sao Jose Rio Preto, Sao Jose Do Rio Preto, BrazilUniv Hosp Sao Vicente Paulo, Passo Fundo, BrazilJoana Gusmao Childrens Hosp, Florianopolis, SC, BrazilUniv Hosp Muller, Fac Med, Cuiaba, BrazilUniv Fed Mato Grosso, Cuiaba, BrazilNipo Brasileiro Hosp, São Paulo, BrazilHosp lsraelita Albert Einstein, São Paulo, BrazilUniv Fed Rio Grande do Norte, Natal, RN, BrazilUniv Fed Uberlandia, BR-38400 Uberlandia, MG, BrazilUniv Fed Bahia, Complexo Hosp Univ Prof Edgar Santos, Salvador, BA, BrazilUniv Estadual Piaui, Teresina, BrazilABC, Fac Med, Santo Andre, BrazilUniv Fed Minas Gerais, Belo Horizonte, MG, BrazilUniv Ctr Para, Belem, Para, BrazilMed Course Lusiada Univ Ctr UNILUS, Dept Pediat, Santos, BrazilUniv Fed Sergipe, Aracaju, BrazilHosp Servidor Publ Municipal, São Paulo, BrazilUniv São Paulo, Inst Biomed Sci, BR-05508 São Paulo, BrazilUniv Estadual Campinas, Sch Med, Dept Pediat, Campinas, BrazilPrivate Off, Macapa, BrazilHosp Ministro Costa Cavalcanti, Foz Do Iguacu, BrazilChildrens Hosp Cosme & Damitio, Rondonia, BrazilUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Effect of lung recruitment and titrated Positive End-Expiratory Pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome - A randomized clinical trial

IMPORTANCE: The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. OBJECTIVE: To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. INTERVENTIONS: An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501; experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stay; ventilator-free days through day 28; pneumothorax requiring drainage within 7 days; barotrauma within 7 days; and ICU, in-hospital, and 6-month mortality. RESULTS: A total of 1010 patients (37.5% female; mean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.20; 95% CI, 1.01 to 1.42; P = .041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%; HR, 1.18; 95% CI, 1.01 to 1.38; P = .04), decreased the number of mean ventilator-free days (5.3 vs 6.4; difference, −1.1; 95% CI, −2.1 to −0.1; P = .03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%; difference, 2.0%; 95% CI, 0.0% to 4.0%; P = .03), and the risk of barotrauma (5.6% vs 1.6%; difference, 4.0%; 95% CI, 1.5% to 6.5%; P = .001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. CONCLUSIONS AND RELEVANCE: In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01374022