Agreement Between Sars-Cov-2 Pcr Test Results Using Nasopharyngeal and Mid-Turbinate Specimens among asymptomatic Working-Age adults

OBJECTIVE: The aim of this study was to determine whether mid-turbinate specimens reliably detect active infection in asymptomatic adults undergoing regular COVID-19 PCR testing. METHODS: Qualitative agreement between 2481 paired nasopharyngeal and mid-turbinate PCR results was assessed. Mean cycle threshold values for each positive result were evaluated as an indicator of active infection. RESULTS: Overall agreement between nasopharyngeal and mid-turbinate tests was 98.4%. Positive percent agreement was 37.2%, and negative percent agreement was ~100%. Test pairs with lower cycle thresholds (≤30 and ≤25) reached 67% and 100% positive percent agreement, respectively. CONCLUSIONS: SARS-CoV-2 infections with high viral loads were detected regardless of specimen type. Mid-turbinate swabs reduced staff discomfort and may decrease repeated positive test results weeks or months after initial infection. Discordant pairs generally had high cycle threshold values (\u3e30) indicating low viral load and little risk of transmitting COVID-19

PERFIL EPIDEMIOLÓGICO DO ATENDIMENTO ANTIRRÁBICO HUMANO EM UMA ÁREA DE PLANEJAMENTO DO MUNICÍPIO DO RIO DE JANEIRO

RESUMO A raiva é considerada um problema de saúde pública no Brasil e no mundo. O atendimento antirrábico está entre os três agravos de maior notificação no país. Objetivos: descrever e caracterizar o perfil epidemiológico do atendimento antirrábico no município do Rio de Janeiro, na área programática 2.1, no período de 2010 a 2015. Metodologia: estudo descritivo retrospectivo dos registros referentes aos atendimentos antirrábicos humanos inseridos no Sistema de Informação de Agravos de Notificação do município do Rio de Janeiro. Para a seleção dos dados utilizou-se o programa TabWin 32; a organização e análise foram desenvolvidas no Excel©. Resultados: foram encontrados 8.681 registros. Destes, 8.235 (94,9%) foram atendimentos por provável pós-exposição ao vírus rábico. Das 8.235 notificações, 70% eram brancas, 56% do sexo feminino, com destaque para a faixa etária de 20 a 59 anos (54,7%). A principal forma de agressão foi a mordedura (83,1%) em mãos/ pés (41%), e o principal agressor os cães (74,4%), sendo indicadas em 72,3% dos casos observação e vacina. Conclusão: constatou-se que o perfil epidemiológico do atendimento antirrábico na área programática 2.1 ocorreu em pessoas brancas do sexo feminino com o tipo de exposição mordedura em mãos e pés, tendo como animal agressor o cão. Esses dados ajudam a pensar estratégias de prevenção. Torna-se importante a ampliação dos serviços que realizam o atendimento antirrábico, sobretudo vinculado à Estratégia de Saúde da Família. A capilarização desse atendimento é, no mínimo, um redutor de risco para a ocorrência da doença, por permitir os cuidados básicos imediatos

Epidemiological profile of patients with systemic arterial hypertension, registered in the "Casa Saúde da Família Águas Lindas II, Belém – PA"

OBJETIVO: Identificar o perfil epidemiológico dos pacientes com Hipertensão Arterial Sistêmica (HAS) inscritos no Programa Nacional de Atenção à Hipertensão Arterial e Diabetes Mellitus (HIPERDIA) da Casa Saúde da Família Águas Lindas II, Belém – PA, no ano de 2007. MÉTODO: Estudo observacional, transversal e descritivo, realizado em um corte de 33 pacientes hipertensos, de 40 a 80 anos, de ambos os sexos, cadastrados no HIPERDIA da referida unidade de saúde e selecionados aleatoriamente, por meio de sorteio baseado nos números de matrícula. Aplicou-se um questionário acerca de características biossociais e hábitos de vida. Avaliou-se a pressão arterial (esfigmomanômetro aneróide Diasyst® e estetoscópio Littmann-Cardiology II®), o índice de massa corpórea (balança antropométrica com estadiômetro Fillizola®) e a circunferência da cintura (fita métrica inelástica), por meio de uma ficha de avaliação própria. Procedeu-se com análise estatística descritiva através dos programas Bioestat® 4.0 e Microsoft® Excel 2007. RESULTADOS: Observou-se que a maioria (40%) dos pacientes estava na faixa etária de 61 a 70 anos, sendo 82% do sexo feminino; predominaram a raça mulata (46%), renda salarial de 1 a 2 salários mínimos (61%), nível fundamental incompleto (52%), ocupação “do lar” (55%); a maioria era não tabagista (94%), não etilista (85%), sedentária (64%), sem antecedente familiar (52%) nem co-morbidades (61%); todos usavam medicação hipotensora; os níveis pressóricos estavam controlados na maioria (PAS-55%; PAD-67%); elevado percentual de obesidade generalizada e/ou sobrepeso (82%) e central (homens-50%; mulheres-93%). CONCLUSÃO: Houve predominância do sexo feminino; mulatos; baixo nível de escolaridade e de renda salarial; baixa ocorrência de etilismo, tabagismo e prática de exercício físico; baixo índice de co-morbidades e antecedentes familiares; alta ocorrência de sobrepeso e obesidade; além de níveis pressóricos controlados, embora um número significativo tenha apresentado PA descontrolada.OBJECTIVE: Defining the epidemiological profile of the patients with Systemic Arterial Hypertension(SAH) registered in Programa Nacional de Atenção à Hipertensão Arterial e Diabetes Mellitus (HIPERDIA) of Casa Saúde da Família Águas Lindas II, in Belém, Pará, in 2007. METHODS: An observational, descriptive, cross-sectional study in a sample of 33 people aged 40 to 80 years, both genders, who were registered in HIPERDIA of that health center and selected randomly using their registration number. A questionnaire on biosocial characteristics and life habits was applied. The values for Blood Pressure (aneroid sphygmomanometer Diasyst® and stethoscope Littmann-Cardiology II®), Body Mass Index (anthropometric balance with stadiometer Fillizola®) and Waist Circunference (inelastic tape measure) were registered. A descriptive statistical analysis was conducted using the Bioestat® 4.0 and the Microsoft® Excel 2007 programs. RESULTS: It was observed that the majority (40%) of the patients aged 61 to 70 years, 82% were women; race “mulata” (46%); wage income of 1 to 2 minimum wages (61%); incomplete elementary school (52%), occupation “home care”(55%); majority of non-smokers (94%), non-drinkers (85%), sedentary (64%), no familiar antecedent of SAH (52%); no comorbidities (61%); all the patients have used hypotensive medicine; pressure level controlled in the majority of the patients (systolic blood pressure - 55%; diastolic blood pressure – 67%); high percentage of general obesity and/or overweight (82%) and central obesity (men-50%; women -93%). CONCLUSION: The studied sample was characterized predominantly by: women; aged 61 to 70 years; “mulatos”; low schooling level and wage income; low rate of: alcoholism, smoking, practice of physical exercise, comorbidities and familiar antecedents of the disease; high rate of overweight/obesity; pressure level controlled, although a high number of patients had the blood pressure uncontrolled

Towards the elimination of dog-mediated rabies: development and application of an evidence-based management tool

Abstract: Background: International organizations advocate for the elimination of dog-mediated rabies, but there is only limited guidance on interpreting surveillance data for managing elimination programmes. With the regional programme in Latin America approaching elimination of dog-mediated rabies, we aimed to develop a tool to evaluate the programme’s performance and generate locally-tailored rabies control programme management guidance to overcome remaining obstacles. Methods: We developed and validated a robust algorithm to classify progress towards rabies elimination within sub-national administrative units, which we applied to surveillance data from Brazil and Mexico. The method combines criteria that are easy to understand, including logistic regression analysis of case detection time series, assessment of rabies virus variants, and of incursion risk. Subjecting the algorithm to robustness testing, we further employed simulated data sub-sampled at differing levels of case detection to assess the algorithm’s performance and sensitivity to surveillance quality. Results: Our tool demonstrated clear epidemiological transitions in Mexico and Brazil: most states progressed rapidly towards elimination, but a few regressed due to incursions and control lapses. In 2015, dog-mediated rabies continued to circulate in the poorest states, with foci remaining in only 1 of 32 states in Mexico, and 2 of 27 in Brazil, posing incursion risks to the wider region. The classification tool was robust in determining epidemiological status irrespective of most levels of surveillance quality. In endemic settings, surveillance would need to detect less than 2.5% of all circulating cases to result in misclassification, whereas in settings where incursions become the main source of cases the threshold detection level for correct classification should not be less than 5%. Conclusion: Our tool provides guidance on how to progress effectively towards elimination targets and tailor strategies to local epidemiological situations, while revealing insights into rabies dynamics. Post-campaign assessments of dog vaccination coverage in endemic states, and enhanced surveillance to verify and maintain freedom in states threatened by incursions were identified as priorities to catalyze progress towards elimination. Our finding suggests genomic surveillance should become increasingly valuable during the endgame for discriminating circulating variants and pinpointing sources of incursions

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8 \pm 0.7 (stat) \pm 6.7 (sys) MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principle calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.Comment: Replaced with published version. Added journal reference and DOI. Supplemental material in the ancillary file

A SARS-CoV-2 Negative Antigen Rapid Diagnostic in RT-qPCR Positive Samples Correlates With a Low Likelihood of Infectious Viruses in the Nasopharynx

Severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) transmission occurs even among fully vaccinated individuals; thus, prompt identification of infected patients is central to control viral circulation. Antigen rapid diagnostic tests (Ag-RDTs) are highly specific, but sensitivity is variable. Discordant RT-qPCR vs. Ag-RDT results are reported, raising the question of whether negative Ag-RDT in positive RT-qPCR samples could imply the absence of infectious viruses. To study the relationship between negative Ag-RDT results with virological, molecular, and serological parameters, we selected a cross-sectional and a follow-up dataset and analyzed virus culture, subgenomic RNA quantification, and sequencing to determine infectious viruses and mutations. We demonstrated that RT-qPCR positive while SARS-CoV-2 Ag-RDT negative discordant results correlate with the absence of infectious virus in nasopharyngeal samples. A decrease in sgRNA detection together with an expected increase in detectable anti-S and anti-N IgGs was also verified in these samples. The data clearly demonstrate that a negative Ag-RDT sample is less likely to harbor infectious SARS-CoV-2 and, consequently, has a lower transmissible potential