Clinical and Virological Study of Dengue Cases and the Members of Their Households: The Multinational DENFRAME Project

Dengue is the most important mosquito-borne viral disease in humans. This disease is now endemic in more than 100 countries and threatens more than 2.5 billion people living in tropical countries. It currently affects about 50 to 100 million people each year. It causes a wide range of symptoms, from an inapparent to mild dengue fever, to severe forms, including dengue hemorrhagic fever. Currently no specific vaccine or antiviral drugs are available. We carried out a prospective clinical study in South-East Asia and Latin America, of virologically confirmed dengue-infected patients attending the hospital, and members of their households. Among 215 febrile dengue subjects, 177 agreed to household investigation. Based on our data, we estimated the proportion of dengue-infected household members to be about 45%. At the time of the home visit, almost three quarters of (29/39) presented an inapparent dengue infection. The proportion of inapparent dengue infection was higher in South-East Asia than in Latin America. These findings confirm the complexity of dengue disease in humans and the need to strengthen multidisciplinary research efforts to improve our understanding of virus transmission and host responses to dengue virus in various human populations

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

A natação minimiza o retardo no crescimento somático e ósseo de ratos? Does swimming minimize somatic and bone growth delay in rats?

A formação óssea é regulada por fatores hormonais e modificada por estímulos extrínsecos, como a prática de exercícios. Avaliou-se o efeito da natação sobre o crescimento somático e ósseo de ratas submetidas a dois modelos experimentais a fim de reproduzir déficit hormonal. Utilizou-se 28 ratas Wistar neonatas fêmeas separadas em: grupo Glutamato Monossódico (GluM, n = 14; solução de GM 4.0mg/g, dias alternados, primeiros 14 dias de vida) e grupo Salina (Sal, n = 14; solução salina). Peso corpóreo e mensurações murinométricas (eixos laterolateral, anteroposterior do crânio - LLC/APC - e comprimento da cauda - CC) foram avaliados do primeiro ao 30º dia de vida. Aos 60 dias, o Grupo GluM foi ovariectomizado (GluMO) e o sal apenas passou pelo estresse cirúrgico. Então, metade dos animais de cada grupo iniciou o programa de natação (12 semanas, cinco dias/semanas, 60 min/sessão) resultando nos seguintes grupos experimentais: Salina Sedentário (Salsed, n = 7), Salina Natação (Salnat, n = 7), Glutamato Ovariectomia Sedentário (GluMOsed, n = 7) e Glutamato Ovariectomia Natação (GluMOnat, n = 7). Ao final do experimento o fêmur direito foi pesado e seu comprimento avaliado. Nos 30 dias iniciais, GluM reduziu o peso corpóreo e os eixos LLC, APC e CC comparado ao grupo SAL. Aos 60 dias, o peso corpóreo do GLuM permaneceu menor comparado ao SAL e ao final foi similar entre os grupos SALsed e SALnat e, GLuMOsed e GluMOnat. Porém, houve redução no peso do GlutMOsed comparado ao SALsed. A natação favoreceu o peso do fêmur no SAL e não o alterou entre os GluMOsed e GluMOnat, entretanto, houve aumento no grupo SALsed comparado ao GluMOsed. No comprimento, o SALnat foi similar ao SALsed e o mesmo ocorreu entre GluMOnat e GluMOsed. Porém, SALsed apresentou comprimento maior que GluMOsed. A natação não foi capaz de reverter, em animais adultos jovens, os efeitos provocados por situações de desequilíbrio corpóreo induzidas precocemente no tecido ósseo.<br>The bone formation is regulated by hormonal factors and modified by extrinsic stimuli, such as practice of exercises. The effect of swimming on the somatic and bone growth of female rats subjected to two experimental models to reproduce hormone deficiency was assessed.Twenty-eight Wistar, neonate female rats separated in two groups: Monosodium glutamate (MGlu, n = 14; solution of monosodium glutamate 4.0mg/g, alternate days, first 14 days of life) and Saline Group (SAL, n = 14; saline solution. Body weight and measurements of somatic development (latero-lateral axis of the skull, anterior-posterior axis of the skull - LLS / APS - and length of the tail - LT) were evaluated from the 1st to the 30th day of life. At 60 days of life, the MGlu group was ovariectomized and SAL just went though surgical stress. Subsequently, half of the animals in each group started the swimming training (12 weeks, 5 days/week, 60 min/session), resulting in the following experimental groups: Sedentary saline (Sedsal, n = 7), Swimming saline (Swisal, n = 7), Sedentary glutamate ovariectomy (SedMGluO, n = 7) and Swimming glutamate ovariectomy (SwiMGluO, n = 7).At the end of the experiment, the right femur was weighed and its length assessed. At the 30 initial days, the MGlu group reduced its body weight and the LLS, APC and LT compared to SAL. At day 60, body weight of MGlu group remained lower and at the end of the experiment it was similar between Swisal and Sedsal groups; SedMGLuO and SwiMGluO groups. However, weight reduction was observed in SedMGlutO compared to SedSAL. Swimming helped the weight of the femur in the SAL and did not alter it between SedMGluO and SwiMGluO, but it increased in Sedsal compared to SedMGluO group. In length, the SwiSal was similar to Sedsal and the same situation occurred between SwiMGluO and SedMGluO. However, Sedsal group presented greater length than SedMGluO. Swimming was not able to reverse the effects caused by situations of body imbalance early induced in the bone tissue in young adult animals