Vulnerabilidade à transmissão da leishmaniose visceral humana em área urbana brasileira

OBJECTIVE To analyze the determinants for the occurrence of human visceral leishmaniasis linked to the conditions of vulnerability. METHODS This is an ecological study, whose spatial analysis unit was the Territorial Analysis Unit in Araguaína, State of Tocantins, Brazil, from 2007 to 2012. We have carried out an analysis of the sociodemographic and urban infrastructure situation of the municipality. Normalized primary indicators were calculated and used to construct the indicators of vulnerability of the social structure, household structure, and urban infrastructure. From them, we have composed a vulnerability index. Kernel density estimation was used to evaluate the density of cases of human visceral leishmaniasis, based on the coordinates of the cases. Bivariate global Moran’s I was used to verify the existence of spatial autocorrelation between the incidence of human visceral leishmaniasis and the indicators and index of vulnerability. Bivariate local Moran’s I was used to identify spatial clusters. RESULTS We have observed a pattern of centrifugal spread of human visceral leishmaniasis in the municipality, where outbreaks of the disease have progressively reached central and peri-urban areas. There has been no correlation between higher incidences of human visceral leishmaniasis and worse living conditions. Statistically significant clusters have been observed between the incidences of human visceral leishmaniasis in both periods analyzed (2007 to 2009 and 2010 to 2012) and the indicators and index of vulnerability. CONCLUSIONS The environment in circumscribed areas helps as protection factor or increases the local vulnerability to the occurrence of human visceral leishmaniasis. The use of methodology that analyzes the conditions of life of the population and the spatial distribution of human visceral leishmaniasis is essential to identify the most vulnerable areas to the spread/maintenance of the disease.OBJETIVO Analisar determinantes para a ocorrência da leishmaniose visceral humana vinculados às condições de vulnerabilidade. MÉTODOS Estudo ecológico, cuja unidade de análise espacial foi a Unidade de Análise Territorial em Araguaína, TO, de 2007 a 2012. Foi realizada análise da situação sociodemográfica e de infraestrutura urbana no município. Indicadores primários normalizados foram calculados e utilizados na construção de indicadores de vulnerabilidade de estrutura social, de estrutura domiciliar e de infraestrutura urbana. A partir deles, foi composto um índice de vulnerabilidade. A estimativa de Kernel foi utilizada para avaliar a densidade de casos de leishmaniose visceral humana, com base nas coordenadas dos casos. O I-Moran Global Bivariado foi empregado para verificar a existência de autocorrelação espacial entre a incidência de leishmaniose visceral humana e os indicadores e índice de vulnerabilidade. I-Moran Local Bivariado foi utilizado para identificar clusters espaciais. RESULTADOS Foi observado um padrão de disseminação centrífuga da leishmaniose visceral humana no município, em que surtos da doença atingiram progressivamente áreas centrais e periurbanas. Houve correlação entre maiores incidências de leishmaniose visceral humana e piores condições de vida. Foram observados clusters estatisticamente significativos entre as incidências de leishmaniose visceral humana nos dois períodos analisados (2007 a 2009 e 2010 a 2012) e os indicadores e índice de vulnerabilidade. CONCLUSÕES O ambiente em áreas circunscritas contribui como fator de proteção ou aumenta a vulnerabilidade local à ocorrência de leishmaniose visceral humana. O uso de metodologia que analisa as condições de vida da população e distribuição espacial da leishmaniose visceral humana é essencial na identificação de áreas mais vulneráveis à disseminação/manutenção da doença

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Données palynologiques d'un milieu végétal dégradé dans la vallée moyenne du Rio Paraiba do Sul - Brésil [ Palynological data from a degraded landscape in the middle valley of the Paraiba do sul river in Brazil ]

Due to current and past environmental changes, i.e. the deforestation and coffee-implantation that occurred on an historical scale (the last 200 years) in the region of Vale do Rio Paraiba do Sul (Brazil), a colluvial layer of 20 to 50 cm thick, was formed. At Bananal (22°38'42"S ; 44°19'17"W, 650 m elev.) the sediments have been collected in four sections: Resgate, Sâo Joaquim, Bom Retiro and Bela Vista. This paper emphasizes the significance of the Palynology as a basis for environmental studies at Bananal. The high quantity of organic matter and the high level of preservation of the pollen content give, through pollen analysis, reliable evidence to clarify the possible changes that occurred during this time. The result shows a landscape and vegetation change such as the forest replaced by an open vegetation and coffee plantations.Les changements environnementaux passés et actuels, la déforestation et la mise en place de plantations de café, survenus à une échelle historique (les derniers 200 ans) dans la Vallée du Rio Paraiba do Sul (Brésil), ont été enregistrés dans un dépôt colluvial de 20 à 50 cm. À Bananal (22°38'42"S - 44°19'17"W, 650 m alt), nos prélèvements ont été effectués dans quatre sections: Resgate, Sâo Joaquim, Bom Retiro et Bela Vista. Cet article met en évidence l'apport que la Palynologie peut offrir aux études portant sur l'environnement dans cette région. La forte quantité de matière organique, ainsi que la bonne préservation du contenu pollinique obtenu à partir de l'analyse, ont permis de révéler les probables changements survenus tout au long de cette période. Nos résultats démontrent un changement de la dynamique de la végétation et du paysage: la forêt est substituée, d'une part par des espaces présentant une végétation ouverte et, d'autre part, par les plantations à café.De Miranda Chaves Sergio Augusto. Données palynologiques d'un milieu végétal dégradé dans la vallée moyenne du Rio Paraiba do Sul - Brésil [ Palynological data from a degraded landscape in the middle valley of the Paraiba do sul river in Brazil ]. In: Quaternaire, vol. 8, n°1, 1997. pp. 49-54

Caracterização da espécie Leishmania infantum em cães de área urbana de Cuiabá, Estado do Mato Grosso

Submitted by Sandra Infurna ([email protected]) on 2018-04-19T17:11:56Z No. of bitstreams: 1 renato_porrozzi_etal_IOC_2011.pdf: 707205 bytes, checksum: b50d5085224e77f0d48be47607687153 (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2018-04-19T17:21:17Z (GMT) No. of bitstreams: 1 renato_porrozzi_etal_IOC_2011.pdf: 707205 bytes, checksum: b50d5085224e77f0d48be47607687153 (MD5)Made available in DSpace on 2018-04-19T17:21:17Z (GMT). No. of bitstreams: 1 renato_porrozzi_etal_IOC_2011.pdf: 707205 bytes, checksum: b50d5085224e77f0d48be47607687153 (MD5) Previous issue date: 2010Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Laboratório de Zoonoses. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Laboratório de Zoonoses. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Referência Nacional de Tipagem de Leishmania. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Referência Nacional de Tipagem de Leishmania. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Referência Nacional de Tipagem de Leishmania. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Referência Nacional de Tipagem de Leishmania. Rio de Janeiro, RJ. Brasil.Instituto Federal de Educação, Ciência e Tecnologia de Mato Grosso. São Vicente, MT, Brasil.Secretaria Municipal de Saúde de Cuiabá. Centro de Controle de Zoonoses. Cuiabá, MT, BrasilFundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Laboratório de Ecologia. Rio de Janeiro, RJ, Brasil.Introdução: A leishmaniose visceral apresenta comportamento urbano em algumas cidades brasileiras, sendo os cães domésticos as principais fontes de infecção. Em Cuiabá-MT, a leishmaniose visceral canina foi diagnosticada e caracterizada, como recomendação do Ministério da Saúde. Métodos: Amostras biológicas de cães suspeitos foram analisadas por eletroforese de isoenzimas. Foram utilizadas a enzima 6PGDH e a cepa de referência IOC/ L0566 (MHOM/BR/1975/M2903) de Leishmania (Leishmania) infantum, como um dos controles. Resultados: A análise eletroforética revelou que os isolados pertenciam à espécie L. (L.) infantum. Conclusões: Os autores ressaltam a importância da caracterização.Introdução: A leishmaniose visceral apresenta comportamento urbano em algumas cidades brasileiras, sendo os cães domésticos as principais fontes de infecção. Em Cuiabá-MT, a leishmaniose visceral canina foi diagnosticada e caracterizada, como recomendação do Ministério da Saúde. Métodos: Amostras biológicas de cães suspeitos foram analisadas por eletroforese de isoenzimas. Foram utilizadas a enzima 6PGDH e a cepa de referência IOC/ L0566 (MHOM/BR/1975/M2903) de Leishmania (Leishmania) infantum, como um dos controles. Resultados: A análise eletroforética revelou que os isolados pertenciam à espécie L. (L.) infantum. Conclusões: Os autores ressaltam a importância da caracterizaçãIntrodução: A leishmaniose visceral apresenta comportamento urbano em algumas cidades brasileiras, sendo os cães domésticos as principais fontes de infecção. Em Cuiabá-MT, a leishmaniose visceral canina foi diagnosticada e caracterizada, como recomendação do Ministério da Saúde. Métodos: Amostras biológicas de cães suspeitos foram analisadas por eletroforese de isoenzimas. Foram utilizadas a enzima 6PGDH e a cepa de referência IOC/ L0566 (MHOM/BR/1975/M2903) de Leishmania (Leishmania) infantum, como um dos controles. Resultados: A análise eletroforética revelou que os isolados pertenciam à espécie L. (L.) infantum. Conclusões: Os autores ressaltam a importância da caracterização da espécie, principalmente em cidades com infecção mista, como Cuiabá.Introduction: Visceral leishmaniasis presents urban behavior in some Brazilian cities, with domestic dogs as the main infection source. In Cuiabá, MT, canine visceral leishmaniasis was diagnosed and characterized as recommended by the Ministry of Health. Methods: Biological samples from suspected canine carriers were analyzed by the isoenzyme electrophoresis technique. The 6PGDH enzyme and reference strain IOC/L0566 (MHOM/ BR/1975/M2903) of Leishmania (Leishmania) infantum was used as one of the controls. Results: Electrophoresis analysis revealed that the canine isolates belonged to the species L. (L.) infantum. Conclusions: The authors emphasize the importance of species characterization, particularly in areas of mixed infection like Cuiabá

Characterization of Leishmania infantum species in dogs from the urban area of Cuiabá, State of Mato Grosso, Brazil

INTRODUCTION: Visceral leishmaniasis presents urban behavior in some Brazilian cities, with domestic dogs as the main infection source. In Cuiabá, MT, canine visceral leishmaniasis was diagnosed and characterized as recommended by the Ministry of Health. METHODS: Biological samples from suspected canine carriers were analyzed by the isoenzyme electrophoresis technique. The 6PGDH enzyme and reference strain IOC/L0566 (MHOM/BR/1975/M2903) of Leishmania (Leishmania) infantum was used as one of the controls. RESULTS: Electrophoresis analysis revealed that the canine isolates belonged to the species L. (L.) infantum. CONCLUSIONS: The authors emphasize the importance of species characterization, particularly in areas of mixed infection like Cuiabá

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt