Prevalência de brucelose bovina no Estado da Paraíba

A serosurvey was conducted to estimate the prevalence of bovine brucellosis in the State of Paraíba, Brazil. A random sample of six municipalities was selected from each of three ecoregions of the State: the Agreste/Litoral region (1), the Cariri/Curimatau region (2) and the Sertão region (3). These 18 municipalities were divided in quadrants and one herd was selected at random from each quadrant. The sampling scheme included herds with more than 50 bovines, which excludes small-holder subsistence livestock production. At least 32 animals were sampled within each herd, stratified in four age categories, as follows: (1) at least 8 animals under 6 months of age, (2) at least 8 animals of 7 to 18 months of age, (3) at least 8 animals of 19 to 30 months of age and (4) at least 8 animals over 30 months of age. Antibodies to Brucella abortus were observed in 8 out of 18 municipalities (44.44%),in 8 out of 72 herds included in this study (11.11%) and in 8 animals out of 2343 samples collected (0.34%). The prevalence of test positive cattle by ecoregion/cattle production regions in the state showed no significant differences of risk among them. Likewise, there was no significant difference of risk among the different age categories studied. It was observed that brucellosis is widely spread across the state albeit with low animal prevalence. These results may be used in the design of a strategy for controlling bovine brucellosis in the State of Paraíba.Foi realizado um estudo para a determinação da prevalência sorológica de brucelose bovina no Estado da Paraíba. Seis municípios foram selecionados aleatoriamente em cada uma das três ecorregiões do Estado: a região do Agreste/Litoral (1), a região do Cariri/Curimatau (2) e a região do Sertão (3). Estes 18 municípios foram divididos em quadrantes e uma propriedade foi selecionada em cada quadrante. Foram amostradas propriedades com mais de 50 animais, o que exclui as pequenas propriedades de subsistência. Pelo menos 32 animais foram amostrados de cada rebanho, estratificados nas quatro faixas etárias seguintes: (1) no mínimo 8 animais até 6 meses de idade, (2) no mínimo 8 animais com 7 a 18 meses de idade, (3) no mínimo 8 animais com 19 a 30 meses de idade e (4) no mínimo 8 animais com mais de 30 meses de idade. Anticorpos anti-B. abortus foram observados em 8 de 18 municípios (44,44%), em 8 de 72 rebanhos (11,11%) e em 8 animais dos 2343 amostrados (0,34%). A análise dos resultados de prevalência por ecorregião do Estado não revelou diferença significativa de risco entre elas. A análise dos resultados por categorias de faixa etária também não evidenciaram diferença significativa de risco entre as mesmas. Foi observado que a brucelose está amplamente disseminada no estado embora com uma baixa prevalência animal. Estes resultados podem ser úteis no delineamento de estratégias de controle da brucelose bovina no estado da Paraíba

Prevalência de Brucelose bovina no Estado da Paraíba

Foi realizado um estudo para a determinação da prevalência sorológica de brucelose bovina no Estado da Paraíba. Seis municípios foram selecionados aleatoriamente em cada uma das três ecorregiões do Estado: a região do Agreste/Litoral (1), a região do Cariri/Curimatau (2) e a região do Sertão (3). Estes 18 municípios foram divididos em quadrantes e uma propriedade foi selecionada em cada quadrante. Foram amostradas propriedades com mais de 50 animais, o que exclui as pequenas propriedades de subsistência. Pelo menos 32 animais foram amostrados de cada rebanho, estratificados nas quatro faixas etárias seguintes: (1) no mínimo 8 animais até 6 meses de idade, (2) no mínimo 8 animais com 7 a 18 meses de idade, (3) no mínimo 8 animais com 19 a 30 meses de idade e (4) no mínimo 8 animais com mais de 30 meses de idade. Anticorpos anti-B. abortus foram observados em 8 de 18 municípios (44,44%), em 8 de 72 rebanhos (11,11%) e em 8 animais dos 2343 amostrados (0,34%). A análise dos resultados de prevalência por ecorregião do Estado não revelou diferença significativa de risco entre elas. A análise dos resultados por categorias de faixa etária também não evidenciaram diferença significativa de risco entre as mesmas. Foi observado que a brucelose está amplamente disseminada no estado embora com uma baixa prevalência animal. Estes resultados podem ser úteis no delineamento de estratégias de controle da brucelose bovina no estado da Paraíba.A serosurvey was conducted to estimate the prevalence of bovine brucellosis in the State of Paraíba, Brazil. A random sample of six municipalities was selected from each of three ecoregions of the State: the Agreste/Litoral region (1), the Cariri/Curimatau region (2) and the Sertão region (3). These 18 municipalities were divided in quadrants and one herd was selected at random from each quadrant. The sampling scheme included herds with more than 50 bovines, which excludes small-holder subsistence livestock production. At least 32 animals were sampled within each herd, stratified in four age categories, as follows: (1) at least 8 animals under 6 months of age, (2) at least 8 animals of 7 to 18 months of age, (3) at least 8 animals of 19 to 30 months of age and (4) at least 8 animals over 30 months of age. Antibodies to Brucella abortus were observed in 8 out of 18 municipalities (44.44%),in 8 out of 72 herds included in this study (11.11%) and in 8 animals out of 2343 samples collected (0.34%). The prevalence of test positive cattle by ecoregion/cattle production regions in the state showed no significant differences of risk among them. Likewise, there was no significant difference of risk among the different age categories studied. It was observed that brucellosis is widely spread across the state albeit with low animal prevalence. These results may be used in the design of a strategy for controlling bovine brucellosis in the State of Paraíba

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt