Interrupção do acompanhamento clínico ambulatorial de pacientes infectados pelo HIV

OBJECTIVE: To determine factors associated with the interruption of outpatient care of HIV-positive patients. METHODS: Non-concurrent prospective study carried out in a public AIDS referral center in Belo Horizonte, Brazil. Medical records were reviewed in order to assess factors associated with the interruption of clinical care of HIV patients admitted between 1993 and 1995. Patients should have attended at least one follow-up visit within a period of 7 months. Statistical analysis was carried out using Chi-square and relative hazard (RH) with 95% confidence interval (CI) estimated by Cox Regression Model. RESULTS: Cumulative incidence of interruption was 54% among 517 patients included in the study (mean follow-up=24.6 months; 26.5/100 person-years). Multivariate analysis indicated that those individuals who had fewer (OBJETIVO: Determinar os fatores associados à interrupção do acompanhamento clínico ambulatorial de pacientes com infecção pelo HIV. MÉTODOS: Foi realizado um estudo do tipo prospectivo não-concorrente (coorte histórica) no município de Belo Horizonte, MG, em um ambulatório público de referência para atendimento de pacientes com infecção pelo HIV/Aids. Foram revisados registros médicos para se avaliar os fatores associados à interrupção do acompanhamento clínico por pacientes soropositivos para o HIV admitidos no serviço entre 1993 e 1995. Os pacientes deveriam ter comparecido a pelo menos uma consulta de retorno no prazo de sete meses. A análise estatística incluiu chi2 e Relative Hazard - RH com intervalo de 95% de confiança (IC) estimado pelo Modelo de Regressão de Cox. RESULTADOS: A incidência acumulada da interrupção do acompanhamento clínico foi de 54,3% entre os 517 pacientes incluídos no estudo (tempo médio de acompanhamento =24,6 meses; incidência pessoa tempo =26,5/100 pessoas-ano). A análise multivariada mostrou que realizar menos que duas contagens de linfócitos T CD4+ (RH =1.94; IC 95% =1.32-2.84) não realizar medida de carga viral (RH =14.94; IC 95% =5.44-41.04), comparecer a seis retornos ou menos (RH =2.80; IC 95% =1.89-4.14), não mudar de categoria clínica (RH =1.40; IC 95% =1.00-1.93) e não usar anti-retroviral, (RH =1.43; IC 95% =1.06-1.93) estava associado a um maior risco de interromper o acompanhamento clínico no serviço estudado. CONCLUSÕES: Foi alta a taxa de interrupção do acompanhamento clínico aos pacientes estudados, sugerindo que a interrupção do acompanhamento pode ser uma função que vise a priorizar os pacientes com pior situação clínica, podendo ser um marcador de futura aderência ao uso de anti-retroviral

Molecular epidemiology and antimicrobial susceptibility of enterococci recovered from Brazilian intensive care units

ABSTRACT: We studied the antimicrobial resistance and the molecular epidemiology of 99 enterococcal surveillance isolates from two hospitals of Brasília, Brazil. Conventional biochemical tests were used to identify the enterococcal species and the disk diffusion method was used to determine their resistance profiles. Enterococcus faecalis (76%) and E. faecium (9%) were the most prevalent species. No enterococci showed the vanA or vanB vancomycin resistance phenotypes or genotypes. Only the intrinsically resistant species E. gallinarum (n=2) and E. casseliflavus (n=3) harbored the vancomycin-resistance genes vanC1 and vanC2/3, respectively. We found E. faecalis isolates with high-level resistance to gentamicin (22%) and streptomycin (8%) and both E. faecalis and E. faecium isolates with resistance to more than two antimicrobials (84% and 67%, respectively). Nine E. faecalis isolates (12%) were resistant to ampicillin; the minimal inhibitory concentration (MIC) values were 16µg/mL (n=6) and 32µg/mL (n=3). Among these ampicillin-resistant E. faecalis, seven were also resistant to gentamicin, ciprofloxacin, rifampin, penicillin, chloramphenicol, tetracycline and erythromycin. Pulsed-field gel electrophoresis classified those isolates in three different genotypes, suggesting dissemination of genetically related ampicillin-resistant E. faecalis strains among different patients

Positividade para sífilis em puérperas: ainda um desafio para o Brasil Syphilis positivity in puerperal women: still a challenge in Brazil

OBJETIVO: Estudar os fatores associados à sorologia positiva para sífilis em puérperas atendidas em 24 centros cadastrados pelo Programa Nacional de Doenças Sexualmente Transmissíveis/ AIDS. MÉTODOS: Estudo transversal com amostra aleatória probabilística de 3 047 puérperas, tendo como critério de elegibilidade as gestantes admitidas para parto ou curetagem nos centros selecionados. Após a entrevista foi coletada alíquota de sangue para realização de teste do Venereal Disease Research Laboratory (VDRL). No caso de VDRL positivo, foi realizado o teste fluorescent treponemal antibody-absorption (FTA-abs). O evento considerado para análise foi a positividade para VDRL confirmada pelo FTA-abs. Na análise estatística foi estimada a razão de chances (OR) com intervalo de confiança de 95%. A adequação do modelo foi feita pelo teste de Hosmer-Lemeshow. RESULTADOS: A prevalência de sífilis na amostra estudada foi de 1,7%. A análise multivariada mostrou que o maior risco de positividade para VDRL estava associado a renda familiar menor do que 1 salário mínimo, idade < 17 anos na primeira relação sexual, idade < 14 anos na primeira gravidez, história de sífilis e história de doença sexualmente transmissível anteriores a esta gravidez, tratamento para sífilis nesta gravidez, realização de exame de sífilis no parceiro, exame anti-HIV positivo ou não realizado, parto pré-termo anterior e feto natimorto como resultado da gravidez. Apenas 43% das puérperas realizaram seis ou mais consultas de pré-natal e apenas 3% realizaram um VDRL no 1&deg; e outro no 3&deg; trimestres de gestação, conforme recomenda o Ministério da Saúde. CONCLUSÕES: O estudo mostra que o problema da sífilis congênita ainda está longe de ser equacionado no Brasil. São necessárias ações de orientação sexual e de planejamento familiar para adolescentes. Também é preciso melhorar o acompanhamento pré-natal e investigar a história pregressa de doenças sexualmente transmissíveis na gestante e em seu parceiro sexual.<br>OBJECTIVE: To investigate the factors associated with positive syphilis serology results in puerperal women who were receiving care at 24 health centers accredited by Brazil's National Program on Sexually Transmitted Diseases and AIDS. METHODS: This cross-sectional study included a probabilistic random sample of 3 047 puerperal women. The eligibility criterion was being admitted for delivery or curettage in the selected centers. After an interview to collect demographic and clinical information, a blood sample was taken and then examined with the Venereal Disease Research Laboratory (VDRL) slide test. With positive VDRL results, the fluorescent treponemal antibody-absorption test (FTA-Abs) was used for confirmation. The event considered for analysis was positivity on the VDRL test, with confirmation by the FTA-Abs. For the statistical analysis, odds ratios and 95% confidence intervals were calculated. The model fit was assessed using the Hosmer-Lemeshow test. RESULTS: The prevalence of syphilis among the women studied was 1.7%. Multivariate analysis showed that increased risk for positive VDRL and FTA-Abs results was associated with the following characteristics: family income below one minimum wage, age < 17 years at first sexual intercourse, age < 14 years at first pregnancy, history of syphilis or of other sexually transmitted diseases prior to the current pregnancy, treatment for syphilis during the current pregnancy, partner having been tested for syphilis, having a positive HIV test result or having no HIV test result on record, previous preterm delivery, and stillbirth as an outcome of pregnancy. Only 43% of the women had had six or more prenatal visits, and only 3% had had one VDRL test during the first trimester of pregnancy and another VDRL test during the third trimester, as is recommended by Brazil's national Ministry of Health. CONCLUSIONS: This study shows that the problem of congenital syphilis is far from being solved in Brazil. It is necessary to provide adolescents with family planning services as well as guidance on sexual issues, to improve prenatal follow-up, and to research the history of sexually transmitted diseases in both the pregnant woman and her sexual partner

Mimicking the halo-galaxy connection using machine learning

Elucidating the connection between the properties of galaxies and the properties of their hosting haloes is a key element in galaxy formation. When the spatial distribution of objects is also taken under consideration, it becomes very relevant for cosmological measurements. In this paper, we use machine learning techniques to analyse these intricate relations in the IllustrisTNG300 magnetohydrodynamical simulation, predicting baryonic properties from halo properties. We employ four different algorithms: extremely randomized trees, K-nearest neighbours, light gradient boosting machine, and neural networks, along with a unique and powerful combination of the results from all four approaches. Overall, the different algorithms produce consistent results in terms of predicting galaxy properties from a set of input halo properties that include halo mass, concentration, spin, and halo overdensity. For stellar mass, the Pearson correlation coefficient is 0.98, dropping down to 0.7-0.8 for specific star formation rate (sSFR), colour, and size. In addition, we apply, for the first time in this context, an existing data augmentation method, synthetic minority over-sampling technique for regression with Gaussian noise (SMOGN), designed to alleviate the problem of imbalanced data sets, showing that it improves the overall shape of the predicted distributions and the scatter in the halo-galaxy relations. We also demonstrate that our predictions are good enough to reproduce the power spectra of multiple galaxy populations, defined in terms of stellar mass, sSFR, colour, and size with high accuracy. Our results align with previous reports suggesting that certain galaxy properties cannot be reproduced using halo features alone.Comment: Matches published version; very minor changes wrt V