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Hiporexia e características celulares e bioquímicas do líquido pleural como variáveis preditivas em um modelo para diagnóstico de tuberculose pleural
No full textObjetivo
o diagnóstico da tuberculose pleural (TBpl) é um desafio devido à sua natureza paucibacilar e à necessidade de procedimentos invasivos. Este estudo visou identificar variáveis facilmente disponíveis, bem como construir um modelo preditivo para o diagnóstico da TBpl que possa permitir a utilização de uma estratégia alternativa precoce e acessível em unidades de cuidados básicos de saúde.
Métodos
um estudo transversal observacional comparou pacientes com TB e não TB seguidos em um hospital terciário brasileiro entre 2010 e 2018. Foi realizada uma análise de regressão logística incondicional que foi validado e aplicado em um modelo de classificação de árvore de decisão (CAD) em pacientes com diagnóstico empírico de TB. Foram calculados precisão (Prec), sensibilidade (Se), especificidade (Esp), assim como os valores preditivos positivos e negativos.
Resultados
de 1.135 pacientes com diagnóstico de TB, 160 foram considerados para análise (111 com TBpl confirmada e 49 com TBpl não confirmada. 58 pacientes não TB foram considerados como controles. Hiporexia [odds ratio ajustado (ORa) 27,39 (95% IC 6,26-119,89)] e características celulares/bioquímicas do líquido pleural (LP) (polimorfonuclear em duas categorias: 3%-14% ORa 26,22, 95% IC 7,11-96,68; e < 3% ORa 28,67, 95% IC 5,51-149,25; e proteína ≥ 5g/dL ORa 7,24, 95% IC 3,07-17,11) foram associadas a um risco mais elevado de tuberculose. O diagnóstico de CAD construído ao empregar essas variáveis mostrou valores de Prec = 87,6%, Se = 89,2%, Esp = 84,5% para o diagnóstico de TB e foi aplicado com sucesso em doentes com TB não confirmada.
Conclusão
o modelo CAD mostrou um excelente desempenho para o diagnóstico de TB e pode ser considerado como estratégia alternativa de diagnóstico, utilizando padrões clínicos em associação com características celulares/bioquímicas do LP, que são acessíveis e facilmente realizados em unidades de cuidados básicos de saúde.Objectives: Pleural tuberculosis (PlTB) diagnosis is a challenge due to its paucibacillary nature and to the need of invasive procedures. This study aimed to identify easily available variables and build a predictive model for PlTB diagnosis which may allow earlier and affordable alternative strategy to be used in basic health care units.
Methods: An observational cross-sectional study compared PlTB and non-TB patients followed at a tertiary Brazilian hospital between 2010 and 2018. Unconditional logistic regression analysis was performed and a Decision Tree Classifier (DTC) model was validated and applied in additional PlTB patients with empiric diagnosis. The accuracy (Acc), sensitivity (Se), specificity (Sp), positive and negative predictive values were calculated.
Results: From 1,135 TB patients, 160 were considered for analysis (111 confirmed PlTB and 49 unconfirmed PlTB). Indeed, 58 non-TB patients were enrolled as controls. Hyporexia [adjusted odds ratio (aOR) 27.39 (95% CI 6.26 - 119.89)] and cellular/biochemical characteristics on pleural fluid (PF) (polimorphonuclear in two categories: 3-14% aOR 26.22, 95% CI 7.11 - 96.68 and < 3% aOR 28.67, 95% CI 5.51 - 149.25; and protein ≥ 5g/dL aOR 7.24, 95% CI 3.07 - 17.11) were associated with higher risk for TB. The DTC constructed using these variables showed Acc=87.6%, Se=89.2%, Sp=84.5% for PlTB diagnosis and was successfully applied in unconfirmed PlTB patients.
Conclusion: The DTC model showed an excellent performance for PlTB diagnosis and can be considered as an alternative diagnostic strategy by using clinical patterns in association with PF cellular/biochemical characteristics, which were affordable and easily performed in basic health care units
Cytokine profle during occult hepatitis B virus infection in chronic hepatitis C patients
No full textBackground: The hepatitis B virus (HBV) is one of the leading causes of acute, chronic and occult hepatitis (OBI)
representing a serious public health threat. Cytokines are known to be important chemical mediators that regulate
the diferentiation, proliferation and function of immune cells. Accumulating evidence indicate that the inadequate
immune responses are responsible for HBV persistency. The aim of this study were to investigate the cytokines IFN-γ,
TNF-α, IL-2, IL-4, IL-6, IL-10 and IL-17A in patients with OBI and verify if there is an association between the levels of
these cytokines with the determination of clinical courses during HBV occult infection.
Methods: 114 patients with chronic hepatitis C were investigated through serological and molecular tests, the
OBI coinfected patients were subjected to the test for cytokines using the commercial human CBA kit. As controls,
ten healthy donors with no history of liver disease and 10 chronic HBV monoinfected patients of similar age to OBI
patients were selected.
Results: Among 114 HCV patients investigated, 11 individuals had occult hepatitis B. The levels of cytokines were
heterogeneous between the groups, most of the cytokines showed higher levels of production detection among
OBI/HCV individuals when compared to control group and HBV monoinfected pacients. We found a high level of IL 17A in the HBV monoinfected group, high levels of TNF-α, IL-10, IL-6, IL-4 and IL-2 in OBI/HCV patients.
Conclusion: These cytokines could be involved in the persistence of HBV DNA in hepatocytes triggers a constant
immune response, inducing continuous liver infammation, which can accelerate liver damage and favor the develop ment of liver cirrhosis in other chronic liver diseases
Large-Scale Deployment and Establishment of Wolbachia Into the Aedes aegypti Population in Rio de Janeiro, Brazil
No full textTraditional methods of vector control have proven insufficient to reduce the alarming incidence of dengue, Zika, and chikungunya in endemic countries. The bacterium symbiont Wolbachia has emerged as an efficient pathogen-blocking and self-dispersing agent that reduces the vectorial potential of Aedes aegypti populations and potentially impairs arboviral disease transmission. In this work, we report the results of a large-scale Wolbachia intervention in Ilha do Governador, Rio de Janeiro, Brazil. wMel-infected adults were released across residential areas between August 2017 and March 2020. Over 131 weeks, including release and post-release phases, we monitored the wMel prevalence in field specimens and analyzed introgression profiles of two assigned intervention areas, RJ1 and RJ2. Our results revealed that wMel successfully invaded both areas, reaching overall infection rates of 50-70% in RJ1 and 30-60% in RJ2 by the end of the monitoring period. At the neighborhood-level, wMel introgression was heterogeneous in both RJ1 and RJ2, with some profiles sustaining a consistent increase in infection rates and others failing to elicit the same. Correlation analysis revealed a weak overall association between RJ1 and RJ2 (r = 0.2849, p = 0.0236), and an association at a higher degree when comparing different deployment strategies, vehicle or backpack-assisted, within RJ1 (r = 0.4676, p < 0.0001) or RJ2 (r = 0.6263, p < 0.0001). The frequency knockdown resistance (kdr) alleles in wMel-infected specimens from both areas were consistently high over this study. Altogether, these findings corroborate that wMel can be successfully deployed at large-scale as part of vector control intervention strategies and provide the basis for imminent disease impact studies in Southeastern Brazil
Infodemic, disinformation and vaccines: the circulation of content on social networks before and after COVID-19
No full textA pandemia da COVID-19 está sendo acompanhada pela circulação de um grande volume de informações, em parte enganosas ou falsas, fenômeno conhecido como “infodemia”. A superabundância informativa dificulta a identificação de fontes confiáveis e pode afetar a adesão a medidas de contenção, como as vacinas. Neste artigo, investigamos os cem links sobre “vacina” que geraram mais engajamento nas redes sociais em 2020 e os comparamos com os de mais engajamento em 2018-2019, antes da pandemia. O objetivo é compreender os modos como a infodemia afeta o debate público sobre vacinação, como a desinformação aparece nessas conversações e quais são os posicionamentos, emissores e temas privilegiados. Identificamos que o engajamento médio aumentou 8,6 vezes e que a predominância de informações verificadas se manteve antes e durante a pandemia. Contudo, o engajamento da desinformação cresceu de maneira expressiva e seu perfil mudou: se em 2018-2019 predominavam os conteúdos totalmente falsos e emitidos por veículos não profissionais, em 2020 se destacam as informações distorcidas por manchetes sensacionalistas emitidas por veículos profissionais. Além disso, a instrumentalização política do debate sobre vacinação, presente nos dois contextos, chama a atenção para a relação entre desinformação e disputas narrativas. Esses resultados apontam a complexificação da infodemia e a necessidade de estratégias de combate à desinformação que levem em consideração os contextos econômicos e sociopolíticos da circulação de informações nas redes.The COVID-19 pandemic is being accompanied by the circulation of a large volume of information, partly misleading or false, a phenomenon known as “infodemic”. The profusion of information makes it difficult to identify reliable sources and can affect adherence to containment measures, such as vaccines. In this article, we investigated the 100 links about vaccines that generated the highest engagement on social media in 2020 and compared them with those with the highest engagement in 2018-2019, before the pandemic. The objective is to understand how infodemic affects the public debate on vaccination, how disinformation appears in these conversations, and what are the positions, emitters, and privileged themes. We found that the average engagement increased by 8.6 times and that the predominance of verified information remained before and during the pandemic. However, the engagement of disinformation has grown significantly and its profile has changed: if the false content, emitted by non-professional vehicles, predominated in 2018-2019, the information distorted by sensationalized headlines emitted by professional vehicles stands out in 2020. Besides, the political instrumentalization of the debate on vaccination, present in both contexts, draws attention to the relationship between disinformation and narrative disputes. These results point to the infodemic complexity and the need for strategies to combat disinformation that take into account the economic and socio-political contexts of the informative circulation on the networks
Cadernos CRIS - Fiocruz: Saúde Global e Diplomacia da Saúde - Informe 15 - Agosto - 2021
No full textInforme 15 produzido pelo CRIS-Fiocruz, sobre a semana de 10 a 23 de agosto de 2021
Quantifying convergence on health-related indicators of the 2030 agenda for sustainable development
No full textThe extended scope and complexity of the United Nations 2030 agenda entail important challenges for the operationalization of the health-related sustainable development goal (SDG) indicators. Divergences in concepts, agendas and implementation strategies among institutions have fostered the parallel development of alternative and concurrent indicators. We aim to determine the convergences and divergences between five key institutions: the Global Burden of Disease Study (GBD), the Pan American Health Organization, the Sustainable Development Solutions Network, the World Bank and the World Health Organization (WHO). Of the 104 health-related indicators listed by these five institutions, 60 are consistent with official Inter-agency and Expert Group SDG indicators. Our analysis considers the indicators included, and the themes these indicators cover, in each institution list and each institution online platform. We quantified convergence in indicators between the institutions themselves, but also between the institutions and the official Inter-agency and Expert Group. Our results indicate important divergences; only 22 of the 60 indicators are included in the lists of all five institutions. The level of adoption of the official metrics varies from 40.5% (15/(47-10)) for the GBD to 86.2% (25/(29-0)) for the World Bank. WHO, the official curator of the Inter-agency and Expert Group SDG indicators, is only convergent with the official metrics by 72.1% (31/(45-2)). Our analysis, and the resulting awareness of the differences, potentialities and limitations of indicators and platforms, provides important contributions to enable the achievement of the health-related SDGs and deliver the promise of the 2030 agenda
Use of Environmental Enrichment as a Clinical Methodology During Acute Experimental Infection by Trypanosoma Cruzi
No full textOne critial point in the Laboratory Animal Science (CAL) is the non-invasive evaluation of Animal Welfare (BEA). The detection (predictive or
diagnostic) of the presence of suffering in mice when used for scientific purposes is a gap. The manuscrip aim to create a technical-scientific form
to preditive presence of suffering in mice lab, based on the principle of Refinement of the 3Rs and BEA monitoring. Our methodology was based in
usual environmental enrichment the objects, the trapeze. From these observations, our study hypothesis emerged, which was, the creation of the
#1 Trap prototype and the measurement through the daily counting of the number of trapeze use during 15 minutes. Experimental acute infection
by Trypanosoma cruzi was experimental model in Swiss Webster mice. Our results described that, after division into four groups: [N] without
infection and [Inf] mice infected and without treatment. The predictive statistical difference was observed on the 11th day post infection (dpi) when
compared ([N]: 72±18.5 Events number/15min) and ([Inf]: 32±13.1 Events number/15min) (p ≤ 0.05). The 21st dpi was the most severe time point
([N]: 75±17.3 and [Inf]: 11±5.1 Events number/15min, respectively) (p ≤ 0.05). So, our results suggest the #1 Trap prototype has predictive and
monitoring capacity for experimental disease course. It makes it possible to prevent suffering and preservation of mice welfare during acute T. cruzi
experimental model
“Kit-covid” y el Programa de Farmacia Popular en Brasil
No full textA infecção pelo SARS-CoV-2 vem desafiando os países e seus sistemas de saúde, sendo a maior emergência de saúde pública de importância internacional já declarada. O grande número de perdas de vidas se soma às dificuldades relacionadas ao manejo da doença, ainda sem tratamento eficaz disponível. Desde o início da pandemia, muitos medicamentos já utilizados em outras doenças foram propostos como possibilidades terapêuticas contra COVID-19 - os chamados medicamentos “reposicionados”, entre eles a cloroquina e seu derivado, a hidroxicloroquina, a ivermectina, a nitazoxanida, o remdesivir e a azitromicina. Entretanto, quase um ano após o início da pandemia, não há evidências científicas que respaldem o uso dessas substâncias na prevenção ou tratamento da COVID-19
Calcium phosphate-based bioceramics in the treatment of osteosarcoma: drug delivery composites and magnetic hyperthermia agents
No full textThe use of biomaterials in medicine is not recent, and in the last few decades, the research and development of biocompatible materials had emerged. Hydroxyapatite (HAp), a calcium phosphate that constitutes a large part of the inorganic composition of human bones and teeth, has been used as an interesting bioceramic material. Among its applications, HAp has been used to carry antitumor drugs, such as doxorubicin, cisplatin, and gemcitabine. Such HAp-based composites have an essential role in anticancer drug delivery systems, including the treatment of osteosarcoma. In addition, the association of this bioceramic with magnetic nanoparticles (MNPs) has also been used as an effective agent of local magnetic hyperthermia. Further, the combined approach of the aforementioned techniques (HAp scaffolds combined with anti-tumor drugs and MNPs) is also an attractive therapeutical alternative. Considering the promising role of the use of bioceramics in modern medicine, we proposed this review, presenting an updated perspective on the use of HAp in the treatment of cancer, especially osteosarcoma. Finally, after giving the current progress in this field, we highlight the urgent need for efforts to provide a better understanding of their potential applications
Saúde Amanhã: Textos para Discussão 68: Formação de recursos humanos no século 21
No full textPublicação cujo objetivo é divulgar resultados de estudos desenvolvidos no âmbito do Projeto Saúde Amanhã, disseminando informações sobre a prospecção estratégica em saúde, em um horizonte móvel de 20 anos. Busca, ainda, estabelecer um espaço para discussões e debates entre os profissionais especializados e instituições do setor. As opiniões emitidas nesta publicação são de exclusiva e de inteira responsabilidade do autor, não exprimindo, necessariamente, o ponto de vista da Fiocruz/MS. O projeto Saúde Amanhã é conduzido pela Fundação Oswaldo Cruz (Fiocruz) no contexto da “Estratégia Fiocruz para a Agenda 2030”/Fiocruz. É permitida a reprodução deste texto e dos dados nele contidos, desde que citada a fonte. Reproduções para fins comerciais são proibidas