499 research outputs found

    Spatiotemporal and meteorological relationships in dengue transmission in the Dominican Republic, 2015‚Äď2019

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    Abstract Dengue has broadened its global distribution substantially in the past two decades, and many endemic areas are experiencing increases in incidence. The Dominican Republic recently experienced its two largest outbreaks to date with 16,836 reported cases in 2015 and 20,123 reported cases in 2019. With continued increases in dengue transmission, developing tools to better prepare healthcare systems and mosquito control agencies is of critical importance. Before such tools can be developed, however, we must first better understand potential drivers of dengue transmission. To that end, we focus in this paper on determining relationships between climate variables and dengue transmission with an emphasis on eight provinces and the capital city of the Dominican Republic in the period 2015‚Äď2019. We present summary statistics for dengue cases, temperature, precipitation, and relative humidity in this period, and we conduct an analysis of correlated lags between climate variables and dengue cases as well as correlated lags among dengue cases in each of the nine locations. We find that the southwestern province of Barahona had the largest dengue incidence in both 2015 and 2019. Among all climate variables considered, lags between relative humidity variables and dengue cases were the most frequently correlated. We found that most locations had significant correlations with cases in other locations at lags of zero weeks. These results can be used to improve predictive models of dengue transmission in the country

    Multiplicative mixed-effects modelling of dengue incidence: an analysis of the 2019 outbreak in the Dominican Republic

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    Dengue is a vector-borne disease that is endemic to several countries, including the Dominican Republic, which has experienced dengue outbreaks for over four decades. With outbreaks growing in incidence in recent years, it is becoming increasingly important to develop better tools to understand drivers of dengue transmission. Such tools are critical for providing timely information to assist healthcare authorities in preparing human, material, and medical resources for outbreaks. Here, we investigate associations between meteorological variables and dengue transmission in the Dominican Republic in 2019, the year in which the country‚Äôs largest outbreak to date ocurred. We apply generalized linear mixed modelling with gamma family and log link to model the weekly dengue incidence rate. Because correlations in lags between climate variables and dengue cases exhibited different behaviour among provinces, a backward-type selection method was executed to find a final model with lags in the explanatory variables. We find that in the best models, meteorological conditions such as temperature and rainfall have an impact with a delay of 2‚Äď5 weeks in the development of an outbreak, ensuring breeding conditions for mosquitoes.publishe

    Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.

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    Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

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    Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

    Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis

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    BackgroundHistologically assessed liver fibrosis stage has prognostic significance in patients with non-alcoholic fatty liver disease (NAFLD) and is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD. Our aim was to compare the prognostic performance of non-invasive tests with liver histology in patients with NAFLD.MethodsThis was an individual participant data meta-analysis of the prognostic performance of histologically assessed fibrosis stage (F0‚Äď4), liver stiffness measured by vibration-controlled transient elastography (LSM-VCTE), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) in patients with NAFLD. The literature was searched for a previously published systematic review on the diagnostic accuracy of imaging and simple non-invasive tests and updated to Jan 12, 2022 for this study. Studies were identified through PubMed/MEDLINE, EMBASE, and CENTRAL, and authors were contacted for individual participant data, including outcome data, with a minimum of 12 months of follow-up. The primary outcome was a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, or cirrhosis complications (ie, ascites, variceal bleeding, hepatic encephalopathy, or progression to a MELD score ‚Č•15). We calculated aggregated survival curves for trichotomised groups and compared them using stratified log-rank tests (histology: F0‚Äď2 vs F3 vs F4; LSM: 2¬∑67; NFS: 0¬∑676), calculated areas under the time-dependent receiver operating characteristic curves (tAUC), and performed Cox proportional-hazards regression to adjust for confounding. This study was registered with PROSPERO, CRD42022312226.FindingsOf 65 eligible studies, we included data on 2518 patients with biopsy-proven NAFLD from 25 studies (1126 [44¬∑7%] were female, median age was 54 years [IQR 44‚Äď63), and 1161 [46¬∑1%] had type 2 diabetes). After a median follow-up of 57 months [IQR 33‚Äď91], the composite endpoint was observed in 145 (5¬∑8%) patients. Stratified log-rank tests showed significant differences between the trichotomised patient groups (p<0¬∑0001 for all comparisons). The tAUC at 5 years were 0¬∑72 (95% CI 0¬∑62‚Äď0¬∑81) for histology, 0¬∑76 (0¬∑70‚Äď0¬∑83) for LSM-VCTE, 0¬∑74 (0¬∑64‚Äď0¬∑82) for FIB-4, and 0¬∑70 (0¬∑63‚Äď0¬∑80) for NFS. All index tests were significant predictors of the primary outcome after adjustment for confounders in the Cox regression.InterpretationSimple non-invasive tests performed as well as histologically assessed fibrosis in predicting clinical outcomes in patients with NAFLD and could be considered as alternatives to liver biopsy in some cases

    Integrative toolbox to assess the quality of freshwater sediments contaminated with potentially toxic metals

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    The Guadiana Basin is a transnational basin, presenting historical contamination with potentially toxic metals (PTM), which origin can be both natural and anthropogenic. This study explores the use of a set of observational, chemical and ecotoxicological assays with Heterocypris incongruens, Vibrio fischeri, Pseudokirchneriella subcapitata, Thamnocephalus platyurus, identifying the most sensitive to be included in a toolbox to analyze the quality of freshwater sediments related to this type of contamination. The study included the analysis of a reservoir and streams sediments of Guadiana basin, in two consecutive years with different climate conditions 2017 (dry year) and 2018 (normal year). The results showed high chemical variability along the basin, with greater contami- nation with PTM in the reservoir sediments. The calculated Enrichment Factors (EF) indicated high anthropo- genic contamination by Cd, followed by Pb (EF > 1.5). The geoaccumulation index (Igeo) revealed that the sediments were severely polluted with Cd, and slightly polluted with Pb and Cu, inducing a higher sublethal toxicity to Heterocypris incongruens. Among the parameters evaluated, and after the use of multivariate statistical techniques, the toolbox for assessing sediments quality, in similar climate and geological conditions, should include the analysis of: meteorology, land use/cover in the area, granulometry, organic matter content, PTM concentrations, contamination indices (e.g., Igeo and EF), and sublethal bioassays with H. incongruens (total sediment analysis) and Vibrio fisheri luminescence inhibition (pore water analysis).info:eu-repo/semantics/publishedVersio

    When Kidney Mirrors the Eye: Tubulointerstitial Nephritis and Uveitis Syndrome - Case Report

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    Tubulointerstitial nephritis and uveitis syndrome is an underdiagnosed condition, characterized by the involvement of the kidney and the eye that affects mostly young people. Its pathophysiology remains poorly understood; however, pediatric morbidity is mostly associated with recurrences of uveitis. This article aimed to describe two clinical cases of tubulointerstitial nephritis and uveitis syndrome, with distinct presentations and clinical courses, illustrative of the diversity of this entity. Case1: An 11-year-old male was admitted to the hospital due to a non-oliguric acute kidney injury. A 24-hour urine examination revealed a tubular lesion, and two months later, he was diagnosed with bilateral anterior uveitis. He was started on steroids, with a favorable response. After six weeks, renal function and urine parameters returned to normal. Case 2: A 12-year-old male was admitted to the hospital with complaints of bilateral red eyes. He was diagnosed with bilateral anterior uveitis and treated with topical steroids with transient improvement. At the same time, the clinical investigation detected a tubular lesion. Four months later, due to a uveitis hypertensive flare with macular edema, methotrexate was added to his treatment, which had a favorable response. Six months later, the urinary abnormalities disappeared. The tubulointerstitial nephritis and uveitis syndrome should be actively searched in the presence of tubular renal abnormalities or uveitis in pediatric patients

    Prevalence of undiagnosed rheumatic and musculoskeletal diseases and its association with health-related quality of life and with physical function

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    AIM: To estimate the disease specific prevalence of undiagnosed rheumatic and musculoskeletal diseases (RMDs) in Portugal and determine if people with undiagnosed RMDs have worse quality of life, physical function and higher health resources consumption, than people without RMDs. METHODS: A subgroup analysis of EpiReumaPt was made that included all participants‚Č•18 years evaluated by a rheumatologist. Participants were stratified into three groups: undiagnosed RMDs; previously diagnosed RMDs; non-RMDs. A descriptive analysis of the three groups was performed. To estimate the prevalence of undiagnosed RMDs, weighted proportion were computed considering the sample design. The three groups were compared (Undiagnosed RMDs vs non-RMDs; Previously diagnosed RMDs vs non-RMDs) for health related quality of life (HRQoL) (EQ5D), physical function (HAQ), mental health (HADS) and health resources consumption. The effect of being undiagnosed for these outcomes was assessed in multivariable models adjusted for age, gender, geographical region and years of education (reference: non-RMD). RESULTS: A total of 3877 participants were included. The prevalence of undiagnosed RMDs was 29%. Compared to participants without RMDs, undiagnosed participants had lower HRQoL (EQ-5D: ő≤ (95% CI)=-0.07 (-0.103,-0.043)) and physical function (HAQ: ő≤ (95% CI)=0.10 (0.05, 0.15)), more anxiety (OR (95% CI)=2.3 (1.4, 3.7)) and depression symptoms (OR (95% CI)=1.4 (0.8, 2.4)). Undiagnosed RMDs participants were more likely to visit an orthopedist (OR (95% CI)=2.0 (1.1, 3.5)) and had a higher number of orthopedic appointments (IRR (95% CI)=2.5 (1.3, 4.9)) than participants without RMDs. CONCLUSION: Patients with undiagnosed RMDs are frequent in Portugal, have worse HRQoL, physical function and mental health than people without RMDs. Undiagnosed patients are nonetheless consumers of health resources and tend to seek help from specialties other than rheumatology. Increasing the awareness of RMDs might promote their early identification and treatment leading to both personal and societal benefits.publishersversionepub_ahead_of_prin

    PREVAL√äNCIA DE CLOSTRIDIOIDES DIFFICILE TOXIG√äNICO EM HOSPITAL TERCI√ĀRIO DE PORTO ALEGRE

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    Introdu√ß√£o/Objetivo: Clostridioides Difficile (CDI) √© um bacilo gram-positivo produtor de esporos e toxinas relacionado com desordens do trato gastrointestinal. Diarreia e colite pseudomembranosa s√£o as principais manifesta√ß√Ķes cl√≠nicas que ocorrem pela produ√ß√£o das toxinas A, B e bin√°ria, e das enzimas hialuronidase e colagenase, que danificam o citoesqueleto da c√©lula epitelial, causando a secre√ß√£o de fluido e inflama√ß√£o. CDI √© uma grande amea√ßa √† sa√ļde. Em 2017, foram estimados 223.900 casos em pacientes hospitalizados e 12.800 mortes nos Estados Unidos. O objetivo do estudo foi avaliar a preval√™ncia de CDI produtor de toxina e a preval√™ncia da cepa hipervirulenta, relacionando com o local de interna√ß√£o e idade dos pacientes no Hospital de Cl√≠nicas de Porto Alegre (HCPA). Materiais e m√©todos: Estudo retrospectivo para an√°lise da preval√™ncia de CDI produtor de toxina. Foram utilizados os dados do sistema de inform√°tica laboratorial do per√≠odo de janeiro a 30 de abril de 2023. O diagn√≥stico de CDI foi realizado atrav√©s de uma testagem em duas etapas: primeiramente, as amostras foram submetidas a um imunoensaio fluorescente (ECO F GDH, ECO Diagn√≥stica) para a detec√ß√£o da enzima Glutamato Desidrogenase (GDH). Amostras GDH positivas foram submetidas √† t√©cnica de qPCR (Xpert¬ģ C. difficile BT, Cepheid) para detec√ß√£o dos genes que codificam as toxinas B (tcdB) e bin√°ria (cdt), assim como a dele√ß√£o em tcdC que identifica a cepa hipervirulenta pertencente ao ribotipo 027 e resistente √†s fluoroquinolonas. Resultados: Foram investigadas 473 amostras de fezes de pacientes com diarreia cl√≠nica. Encontrou-se uma preval√™ncia de CDI toxig√™nico em 12,4% (59/473), dos quais 5 pacientes testaram positivo para a cepa hipervirulenta. Apesar de ser relatada a idade avan√ßada como fator de risco, 33% dos pacientes com CDI toxig√™nico estavam na faixa et√°ria de 0 a 10 anos, enquanto que 27% tinham idade acima de 60 anos. 16,9% dos pacientes tinham de 18 a 30 anos e 22% tinham entre 31 e 59 anos. Quanto ao local da solicita√ß√£o, observa-se uma predomin√Ęncia de testes da interna√ß√£o pedi√°trica (23,7%) e interna√ß√£o cl√≠nica (22%). Conclus√£o: A preval√™ncia de CDI toxig√™nico foi de 12,4% nas amostras analisadas. Esses resultados mostram a import√Ęncia da epidemiologia local para melhorar o tratamento e as medidas de controle de infec√ß√£o. CDI √© uma importante infec√ß√£o nosocomial e incorre em tratamentos caros, isolamento do paciente e maior tempo de interna√ß√£o
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