Genomic diversity of the human pathogen Paracoccidioides across the South American continent

Paracoccidioidomycosis (PCM) is a life-threatening systemic mycosis widely reported in the Gran Chaco ecosystem. The disease is caused by different species from the genus Paracoccidioides, which are all endemic to South and Central America. Here, we sequenced and analyzed 31 isolates of Paracoccidioides across South America, with particular focus on isolates from Argentina and Paraguay. The de novo sequenced isolates were compared with publicly available genomes. Phylogenetics and population genomics revealed that PCM in Argentina and Paraguay is caused by three distinct Paracoccidioides genotypes, P. brasiliensis (S1a and S1b) and P. restrepiensis (PS3). P. brasiliensis S1a isolates from Argentina are frequently associated with chronic forms of the disease. Our results suggest the existence of extensive molecular polymorphism among Paracoccidioides species, and provide a framework to begin to dissect the connection between genotypic differences in the pathogen and the clinical outcomes of the disease.Fil: Teixeira, Marcus de Melo. Universidade do Brasília; BrasilFil: Cattana, Maria Emilia. Universidad Nacional del Nordeste. Instituto de Medicina Regional; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; ArgentinaFil: Matute, Daniel R.. University of North Carolina; Estados UnidosFil: Muñoz, José F.. Broad Institute Of Mit And Harvard; Estados UnidosFil: Arechavala, Alicia. Hospital Francisco J Muñiz; ArgentinaFil: Isbell, Kristin. University of North Carolina; Estados UnidosFil: Schipper, Rafael. Universidade do Brasília; BrasilFil: Santiso, Gabriela Maria. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Tracogna, Fernanda. Gobierno de la Provincia de Chaco. Hospital Julio Cecilio Perrando.; ArgentinaFil: Sosa, María de los Ángeles. Universidad Nacional del Nordeste. Instituto de Medicina Regional; ArgentinaFil: Cech, Norma. Hospital 4 de Junio; ArgentinaFil: Alvarado, Primavera. Instituto de Biomedicina Dr. Jacinto Convit; VenezuelaFil: Barreto, Laura. Instituto Superior de Formación Docente Salome Ureña; República DominicanaFil: Chacón, Yone. Provincia de Salta. Ministerio de Salud Pública. Hospital del Milagro; ArgentinaFil: Ortellado, Juana. Universidad Nacional de Asunción; ParaguayFil: Lima, Cleoni Mendes de. Universidade Federal de Rondonia; BrasilFil: Chang, Marilene Rodrigues. Universidade Federal do Mato Grosso do Sul; BrasilFil: Niño Vega, Gustavo. Universidad de Guanajuato; MéxicoFil: Yasuda, Maria Aparecida Shikanai. Universidade de Sao Paulo; BrasilFil: Felipe, Maria Sueli Soares. Universidade Catolica de Brasilia; BrasilFil: Negroni, Ricardo. Gobierno de la Ciudad de Buenos Aires. Hospital de Infecciosas "Dr. Francisco Javier Muñiz"; ArgentinaFil: Cuomo, Christina A.. Broad Institute of MIT And Harvard; Estados UnidosFil: Barker, Bridget. Tgen Northern Arizona University; Estados UnidosFil: Giusiano, Gustavo Emilio. Universidad Nacional del Nordeste. Instituto de Medicina Regional; Argentina. Universidad Nacional del Nordeste. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; Argentin

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Características clínico-epidemiológicas de pacientes hipertensos en un Consultorio Médico de Santa Clara

High blood pressure is a chronic non-transmittable disease, which is also a risk factor for the development of other clinical conditions. The incidence of arterial hypertension in the Cuban population is high.Aim: to characterize the evolution of arterial hypertension in a Family Doctor's Office.Methods: an observational, descriptive and cross-sectional study was carried out at the Family Doctor's Office 17-19 in the municipality of Santa Clara. The study covered the months of January to March 2020. Of the 256 hypertensive patients, a sample of 52 was selected by a simple random method.Results: Males predominated (53.84 %), together with the age group between 40 and 49 years (28.84 %). A total of 63.46 % of the patients were white-skinned. 51.61% presented risk factors. The risk factors with the highest incidence were smoking, followed by obesity and sedentary lifestyle.Conclusions: the most affected hypertensive patients are male. Most patients have a family history of high blood pressure. Smoking is a high incidence risk factor in the hypertensive population.Introducción: la hipertensión arterial es una enfermedad crónica no transmisible, que a la vez constituye un factor de riesgo para el desarrollo de otras enfermedades. La incidencia de la hipertensión arterial en la población de Cuba es alta.Objetivo: caracterizar el comportamiento de la hipertensión arterial en un Consultorio Médico de Familia.Métodos: se realizó un estudio observacional, descriptivo y transversal en el Consultorio Médico de Familia 17-19 del municipio Santa Clara. El período de estudio comprendió los meses de enero a marzo del 2020. La población fue de 256 hipertensos y se escogió una muestra de 52 hipertensos por muestreo aleatorio simple.Resultados: predominó el sexo masculino (53,84 %), y el grupo de edad entre 40 y 49 años (28,84 %). El 63,46 % de los pacientes fueron de color de la piel blanca. El 51,61 % presentaron factores de riesgo. Los factores de riesgo de mayor incidencia fueron el tabaquismo, seguido por la obesidad y el sedentarismo.Conclusiones: los pacientes hipertensos más afectados son los del sexo masculino. La mayor parte de los pacientes tienen antecedentes familiares de hipertensión arterial. El tabaquismo es un factor de riesgo de alta incidencia en la población hipertensa

¿Son los niños considerados personas?: conocimientos, actitudes y prácticas acerca del niño hospitalizado

Introducción: A pesar del nuevo Código de la Niñez y la Adolescencia (Ley 1680/01) vigente en nuestro país, los niños con frecuencia son poco considerados como personas.Objetivos: Determinar el conocimiento que tienen los familiares acerca de la enfermedad del niño/a, describir la percepción del trato recibido, y constatar la atención que reciben los pacientes de parte del adulto, durante su internación.Materiales y métodos: Se aplicó un cuestionario al acompañante del niño internado durante los meses de marzo-julio/02 en la Cátedra de Pediatría del Hospital de Clínicas, en 4 salas de internación. Se excluyeron las salas de Terapia Intensiva y Oncohematología. A través de la observación durante las recorridas, el investigador registró la forma de interacción del adulto con el niño/a internado.Resultados: Fueron evaluados 68 niños con sus acompañantes. 73% (49/68) de los acompañantes recibió explicación de la enfermedad que tuvo el niño/a, pero 62% (42/68) no entendió bien acerca de la enfermedad (p<00002). No recibió explicación sobre la causa de la enfermedad 72% (49/68) y el tiempo estimativo que quedaría internado 85%(58/68). 23% (16/68) refirió que recibió un trato muy bueno, 62% (42/68) recibió un trato bueno y 15% (10/68) recibió un trato regular. El médico no le explicó al niño acerca de las diferentes intervenciones que se le habían practicado en 85% (55/68) y el familiar tampoco explicó al niño los motivos de su internación al 72% (49/68).Durante las recorridas se observó que el residente o interno llamó al niño por su nombre al 84% (57/68) pero no le explicó el procedimiento que se le realizaría al 85% (58/68); el jefe de sala llamó por su nombre al 24% (16/68) y explicó a los familiares la situación de salud del niño al 47% (32/68).Conclusión: Un alto porcentaje los padres no comprende la enfermedad del niño, ni conoce el tiempo estimativo que quedaría internado. En la gran mayoría los niños no son tratados como personas por sus cuidadores y el personal de salud

Qualidade dos e-servi?os oferecidos pelos portais de munic?pios do oeste do Paran?

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS ([email protected]) on 2015-06-23T12:02:48Z No. of bitstreams: 1 470953 Texto Completo.pdf: 2723001 bytes, checksum: efb79c0a6a34ed5279796fee9e4ea67f (MD5)Made available in DSpace on 2015-06-23T12:02:48Z (GMT). No. of bitstreams: 1 470953 Texto Completo.pdf: 2723001 bytes, checksum: efb79c0a6a34ed5279796fee9e4ea67f (MD5) Previous issue date: 2015-02-27The use of Information and Communication Technologies (ICT) has been instrumental in the ongoing development of organizations, particularly governments. The use of ICT has hallenged governments to adapt to this new feature, in which different levels of government and society as a whole are connected. The use of these technologies allows governments to act efficiently, effectively and transparently. In Brazil, the adoption and implementation of e-government is still new and so the offer of services in government portals is something that has been put in place in recent years. For the government is aligned with the interests of the population is the constant monitoring and evaluation of these services is necessary. Thus, this work is to answer the following question: What is the level of quality perceived by e-Service users offered by portals of the West of Paran? municipalities? To answer it a literature review was performed identifying the existing quality assessment approaches in government. We adopted the Service Quality Model in Electronic Government (e-GovQual) developed by Papadomichelaki and Mentzas (2012). We used a quantitative approach to research, through an exploratory survey applied in western Parana municipalities. The results contributed to the development of e-government theme, especially in western Paran?. It also identified the profile of users and noted that the adoption of e-government services in these municipalities, is under implementation and the evaluation of services offered not to the satisfaction occurs.A utiliza??o das Tecnologias de Informa??o e Comunica??o (TIC) tem sido fundamentais para o constante desenvolvimento das organiza??es, sobretudo dos governos. O uso das TIC tem desafiado os governos a se adaptarem a esta nova caracter?stica, na qual diferentes n?veis da administra??o e da sociedade como um todo est?o conectados.A utiliza??o destas tecnologias permite que os governos atuem de forma eficiente, eficaz e transparente.No Brasil, a ado??o e implementa??o do governo eletr?nico ainda ? recente e por isso a oferta de servi?os nos portais governamentais ? algo que vem sendo colocado em pr?tica nos ?ltimos anos. Para que o governo esteja alinhado com os interesses da popula??o se faz necess?rio o acompanhamento e avalia??o constantes destes servi?os. Neste sentido, este trabalho vem responder a seguinte quest?o:Qual o n?vel de qualidade percebido pelos usu?rios de e-Servi?os oferecidos pelos portais de munic?pios do Oeste do Paran?? Para respond?-la uma revis?o de literatura foi realizada identificando-se as abordagens de avalia??o de qualidade existentes em governo. Adotou-se o modelo de Qualidade de Servi?os no Governo Eletr?nico(e-GovQual), desenvolvido por Papadomichelaki e Mentzas (2012). Utilizou-se uma abordagem quantitativa de pesquisa, por meio de uma survey explorat?ria aplicada em munic?pios do oeste do Paran?. Os resultados obtidos contribu?ram para o desenvolvimento do tema governo eletr?nico, sobretudo na regi?o Oeste do Paran?.Al?m disso, identificou-se o perfil dos usu?rios e observou-se que a ado??o dos servi?os no governo eletr?nico nesses munic?pios,encontra-se em fase de implanta??o e que a avalia??o dos servi?os oferecidos n?o ocorre a contento

Sobrevida após recidiva intratável do carcinoma epidermóide de cabeça e pescoço

OBJETIVO: Avaliar a sobrevida em pacientes com câncer de cabeça e pescoço recidivado e sem possibilidade de tratamento curativo. MÉTODO: Foram revisados os prontuários dos pacientes com carcinoma epidermóide de boca, orofaringe, hipofaringe e laringe tratados cirurgicamente (tumor primário e esvaziamento cervical) entre 1978 e 2001, e selecionados 140 com recidiva da doença acompanhados até o óbito pelo câncer. Após 1999, 30 pacientes receberam cuidados paliativos de uma equipe multidisciplinar. Foi avaliado o intervalo de tempo entre a recidiva não resgatável e o óbito, considerando o sítio primário, estadiamento inicial, sobrevida livre de doença e cuidados paliativos. Os resultados foram expressos em medianas e médias, com os respectivos quartis e percentis. RESULTADOS: A sobrevida livre de doença apresentou média de 30 semanas. A sobrevida média após a recidiva foi de 17 semanas (Q25-75% = 8 a 34 semanas). Dezessete pacientes (12%) sobreviveram por mais de 12 meses após a recidiva. O sítio primário, estadiamento inicial, local da recidiva, sobrevida livre de doença e os cuidados paliativos não influenciaram a sobrevida após a recidiva. CONCLUSÃO: A sobrevida após uma recidiva não resgatável é similar ao relatado para os pacientes não tratados. Os cuidados paliativos não aumentaram a sobrevida destes pacientes