Pooling of sputum samples to increase tuberculosis diagnostic capacity in Brazil during the COVID-19 pandemic

Objectives We assessed whether combining (pooling) four individual's samples and testing with Xpert Ultra has the same accuracy as testing samples individually, as a more efficient testing method. Methods We conducted a cross-sectional study of individuals with presumptive TB attending primary health care or general hospital facilities in Alagoas, Brazil. Sputum samples of four consecutive individuals were pooled and the pool and individual samples were tested with Xpert Ultra. The agreement of the tests was compared using kappa statistics. We estimated the sensitivity and specificity of pooling using the individual test as the reference standard and potential cartridge savings. Results Three hundred and ninety-six participants were tested. Ninety-five (24.0%) individual samples were MTB-positive, 300 (75.8%) MTB-not detected, including 20 MTB-trace, and one reported an error. Ninety-nine pools of four samples were tested, of which 62 (62.6%) had MTB-detected and 37 (37.4%) MTB-not detected, including six (6.1%) with MTB-trace. The agreement of individual and pooled testing was 96.0%. Pooling had sensitivity of 95.0% (95%CI 86.9%–99%), specificity of 97.1% (95%CI 85.1%–99.9%) and Kappa of 0.913. The method saved 12.4% of cartridge costs. Conclusion The pooled testing of specimens had a high level of agreement with individual testing. Pooling of samples for testing improves the efficiency of testing, potentially enabling the screening and testing of larger numbers of people more cost-effectively

Síndrome de Stevens-Johnson: uma doença dermatológica ou uma farmacodermia? / Stevens-Johnson Syndrome: a dermatological disease or a pharmacodermia?

INTRODUÇÃO: A síndrome de Stevens-Johnson refere-se à uma reação mucocutânea aguda caracterizada por necrose e descolamento extenso da epiderme. É uma síndrome rara e com etiologia desconhecida, relacionada sensibilidade a medicações ou a infecções por vírus como herpes simples e micoplasma. O quadro clínico se inicia com um exantema prodrômico morbiliforme disseminado com acometimento centrífugo envolvendo mucosas e evolui com necrose epidérmica e eritema e erupções dolorosas em mucosas. O diagnóstico é clínico e o tratamento é controverso, envolvendo corticosteroides, clorexidina oral e imunomoduladores. OBJETIVO: Entender a Síndrome de Steve Johnson relacionado com seus sintomas dermatológicos e suas etiologias farmacológicas. METODOLOGIA: trata-se de uma revisão de literatura integrativa com dados coletados nas bases Scielo e Pubmed com 13 artigos coletados. DISCUSSÃO E RESULTADOS:. Foram descritos diversos fatores de risco que estão relacionados com a gravidade da apresentação da doença bem como a extensão da superfície corporal acometida. É importante ressaltar ainda as limitações das opções terapêuticas e a importância da assertividade das indicações para que não haja uma piora do quadro. CONCLUSÃO: a Síndrome de Steven Johnson é uma afecção rara, com potencial letalidade e apresenta como sintomas principais a descamação dérmica além de ulceração na mucos. Pode ser desencadeada principalmente pelo uso de medicações e em pessoas com fatores de risco. Poucos estudos foram realizados a respeito da síndrome e seu tratamento.

Os impactos do iam para o sistema único de saúde e para o Brasil / The impacts of iam for the unique health system and for Brazil

A partir da década de 1960 vem ocorrendo diminuição das doenças infecto-parasitárias (DIP) e aumento das Doenças Crônicas Não Transmissíveis (DCNT). O Infarto Agudo do Miocárdio (IAM) é a principal causa das Doenças Cardiovasculares (DCV). Dados do Departamento de Informática do Sistema Único de Saúde (DATASUS) de 2013 revelavam que o IAM foi a principal causa de morte por doença cardíaca no Brasil e os especialistas projetam que assim seja nos próximos anos caso medidas não sejam instituídas visando inverter essa curva. Dessa forma, é de importância obter atendimento pré-hospitalar rápido e eficiente reduzindo o tempo entre o início do evento isquêmico e necrose até o tratamento. Por isso, o objetivo deste trabalho é interpretar a prevalência do IAM em relação a regiões, sexo e idade no Brasil e o possível impacto disso nos custos pro sistema único de saúde (SUS). A metodologia utilizada foi uma revisão sistemática da literatura, usando como base de dados Pubmed, Scielo e Google Acadêmico a partir das seguintes palavras-chaves: “IAM”. “incidência” e “prevalência”.

Emergências hiperglicêmicas e seus impactos na sala de emergência: uma revisão de literatura / Hyperglycemic emergencies and their impacts in the emergency room: a literature review

Introdução: Hiperglicemia é uma causa muito comum nas emergências médicas, sendo uma alteração de descompensação do metabolismo. Os estados hiperglicêmicos agudos compreendem a cetoacidose diabética e o coma hiperosmolar hiperglicêmico não cetótico. Objetivo: Analisar as duas principais condições hiperglicêmicas, que representam um desafio para o clínico e o médico generalista em salas de emergências. Métodos: Trata-se de uma revisão integrativa da literatura que incluiu estudos, com dados de pacientes em situação de emergência hiperglicêmica, publicados entre 2010 e 2020, disponíveis na íntegra em inglês, em espanhol ou em português, na base de dados LILACS, SciELO, PubMed, com os termos: “Hiperglicemia”, “Emergência”, “Departamento/Sala de emergência”, “Crise hiperglicêmica” e “Impactos”. Atenderam aos critérios de inclusão 19 artigos, os quais, após a leitura na íntegra, tiveram as informações sintetizadas, agrupadas por semelhanças ao tema e analisadas de forma descritiva. Resultados e discussão:  Crises hiperglicêmicas podem ocorrer em pacientes portadores de diabetes mellitus tipo 1 ou tipo 2, assim, requer manejo rápido e tratamento da causa base, visando evitar a mortalidade.

AI is a viable alternative to high throughput screening: a 318-target study

: High throughput screening (HTS) is routinely used to identify bioactive small molecules. This requires physical compounds, which limits coverage of accessible chemical space. Computational approaches combined with vast on-demand chemical libraries can access far greater chemical space, provided that the predictive accuracy is sufficient to identify useful molecules. Through the largest and most diverse virtual HTS campaign reported to date, comprising 318 individual projects, we demonstrate that our AtomNet® convolutional neural network successfully finds novel hits across every major therapeutic area and protein class. We address historical limitations of computational screening by demonstrating success for target proteins without known binders, high-quality X-ray crystal structures, or manual cherry-picking of compounds. We show that the molecules selected by the AtomNet® model are novel drug-like scaffolds rather than minor modifications to known bioactive compounds. Our empirical results suggest that computational methods can substantially replace HTS as the first step of small-molecule drug discovery

Pooling of sputum samples to increase tuberculosis diagnostic capacity in Brazil during the COVID-19 pandemic

Objectives: We assessed whether combining (pooling) four individual's samples and testing with Xpert Ultra has the same accuracy as testing samples individually as a more efficient testing method. Methods: We conducted a cross-sectional study of individuals with presumptive tuberculosis attending primary health care or general hospital facilities in Alagoas, Brazil. The sputum samples of four consecutive individuals were pooled and the pool and individual samples were tested with Xpert Ultra. The agreement of the tests was compared using kappa statistics. We estimated the sensitivity and specificity of pooling using the individual test as the reference standard and potential cartridge savings. Results: A total of 396 participants were tested. A total of 95 (24.0%) individual samples were Mycobacterium tuberculosis (MTB)-positive, 300 (75.8%) “MTB not detected”, including 20 “MTB trace”, and one reported an error. A total of 99 pools of four samples were tested, of which 62 (62.6%) had MTB detected and 37 (37.4%) MTB not detected, including six (6.1%) with MTB trace. The agreement between individual and pooled testing was 96.0%. Pooling had a sensitivity of 95.0% (95% confidence interval 86.9-99%), specificity of 97.1% (95% confidence interval 85.1-99.9%), and kappa of 0.913. The method saved 12.4% of cartridge costs. Conclusion: The pooled testing of specimens had a high level of agreement with individual testing. The pooling of samples for testing improves the efficiency of testing, potentially enabling the screening and testing of larger numbers of individuals more cost-effectively

Do despotismo da gentalha à democracia da gravata lavada: história do conceito de democracia no Brasil (1770-1870)

The voting rate in Brazil only reached 40% (considered consistent with a modern democracy) in the 1980s. However, the bibliography always refers to the 1986, 1945, and 1933 elections as moments of "re-democratization", when explicitly or implicitly the original "democracy" could only have existed during the fraudulent and oligarchic First Republic (1889-1930). This article focuses on the process by which the 19th century Brazilian elites slowly forged this purely liberal-institutional concept of democracy, with extensive repercussions during the following century. The concept found its symbol in the "starched collar democracy" to which Teófilo Ottoni referred in his campaign in 1860, limited to the educated and moneyed stratum of the population, and reclaimed by the UDN party in the 1945 presidential campaign

Neotropical freshwater fisheries : A dataset of occurrence and abundance of freshwater fishes in the Neotropics

The Neotropical region hosts 4225 freshwater fish species, ranking first among the world's most diverse regions for freshwater fishes. Our NEOTROPICAL FRESHWATER FISHES data set is the first to produce a large-scale Neotropical freshwater fish inventory, covering the entire Neotropical region from Mexico and the Caribbean in the north to the southern limits in Argentina, Paraguay, Chile, and Uruguay. We compiled 185,787 distribution records, with unique georeferenced coordinates, for the 4225 species, represented by occurrence and abundance data. The number of species for the most numerous orders are as follows: Characiformes (1289), Siluriformes (1384), Cichliformes (354), Cyprinodontiformes (245), and Gymnotiformes (135). The most recorded species was the characid Astyanax fasciatus (4696 records). We registered 116,802 distribution records for native species, compared to 1802 distribution records for nonnative species. The main aim of the NEOTROPICAL FRESHWATER FISHES data set was to make these occurrence and abundance data accessible for international researchers to develop ecological and macroecological studies, from local to regional scales, with focal fish species, families, or orders. We anticipate that the NEOTROPICAL FRESHWATER FISHES data set will be valuable for studies on a wide range of ecological processes, such as trophic cascades, fishery pressure, the effects of habitat loss and fragmentation, and the impacts of species invasion and climate change. There are no copyright restrictions on the data, and please cite this data paper when using the data in publications

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data