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Racismo Institucional: uma experiência vivida na Saúde da Família
No full textO objetivo desse trabalho é apresentar fatores identificados durante a residência em saúde da família que se enquadram como racismo institucional
Early and Late Mortality Following Discharge From the ICU: A Multicenter Prospective Cohort Study
No full textQuality of Life After ICU Study Group Investigators and the BRICNet.The present study was funded by the Brazilian Ministry of Health through the Brazilian Unified Health System Institutional Development Program. Drs. Rosa’s, Falavigna’s, Robinson’s, Sanchez’s, Kochhann’s, Schneider’s, Sganzerla’s, Dietrich’s, Barbosa’s, de Souza’s, Rech’s, and dos Santos’s institutions received funding from Brazilian Ministry of Health through the Brazilian Unified Health System Institutional Development Program. Dr Falavigna is manager partner of HTAnalyze, a consulting and training firm in health technology assessment topics. The remaining authors have disclosed that they do not have any potential conflicts of interest.Objectives: To identify the frequency, causes, and risk factors of early and late mortality among general adult patients discharged from ICUs. Design: Multicenter, prospective cohort study. Setting: ICUs of 10 tertiary hospitals in Brazil. Patients: One-thousand five-hundred fifty-four adult ICU survivors with an ICU stay greater than 72 hours for medical and emergency surgical admissions or greater than 120 hours for elective surgical admissions. Interventions: None. Measurements and main results: The main outcomes were early (30 d) and late (31 to 365 d) mortality. Causes of death were extracted from death certificates and medical records. Twelve-month cumulative mortality was 28.2% (439 deaths). The frequency of early mortality was 7.9% (123 deaths), and the frequency of late mortality was 22.3% (316 deaths). Infections were the leading cause of death in both early (47.2%) and late (36.4%) periods. Multivariable analysis identified age greater than or equal to 65 years (hazard ratio, 1.65; p = 0.01), pre-ICU high comorbidity (hazard ratio, 1.59; p = 0.02), pre-ICU physical dependence (hazard ratio, 2.29; p < 0.001), risk of death at ICU admission (hazard ratio per 1% increase, 1.008; p = 0.03), ICU-acquired infections (hazard ratio, 2.25; p < 0.001), and ICU readmission (hazard ratio, 3.76; p < 0.001) as risk factors for early mortality. Age greater than or equal to 65 years (hazard ratio, 1.30; p = 0.03), pre-ICU high comorbidity (hazard ratio, 2.28; p < 0.001), pre-ICU physical dependence (hazard ratio, 2.00; p < 0.001), risk of death at ICU admission (hazard ratio per 1% increase, 1.010; p < 0.001), and ICU readmission (hazard ratios, 4.10, 4.17, and 1.82 for death between 31 and 60 days, 61 and 90 days, and greater than 90 days after ICU discharge, respectively; p < 0.001 for all comparisons) were associated with late mortality. Conclusions: Infections are the main cause of death after ICU discharge. Older age, pre-ICU comorbidities, pre-ICU physical dependence, severity of illness at ICU admission, and ICU readmission are associated with increased risk of early and late mortality, while ICU-acquired infections are associated with increased risk of early mortality.2030-12-3
Longitudinal Profiling of the Vaccination Coverage in Brazil Reveals a Recent Change in the Patterns Hallmarked by Differential Reduction Across Regions
No full textIntramural Research Program of the
Fundação Oswaldo Cruz (Inova FIOCRUZ, grant number: VPPIS-001-FIO18 to A.T.L.Q.).
K.F.F. received a research fellowship from the Programa Nacional de Pós-Doutorado
(PNPD), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES; finance
code: 97 001). B.B.A. is a sênior fellow of the Conselho Nacional de Desenvolvimento
Científico e Tecnológico (CNPq; bolsista de produtividade).Vaccination coverage is decreasing worldwide, favoring potential reemergence of vaccine-preventable disease. Here, we performed a longitudinal characterization of the vaccination coverage in Brazil and compared the profiles between the distinct regions in the country to test whether there has been a substantial change over the last five years
(In)Seguridad alimentaria en el contexto de la pandemia por SARS-CoV-2
No full textDevido a pandemia mundial do COVID-19, o artigo da revista foi liberado em acesso aberto durante o ano de 2020, visando divulgação e disseminação.O avanço do novo coronavírus, denominado SARS-CoV-2, sobre os países tem gerado a interrupção das atividades cotidianas da população, devido à necessidade de isolamento social para frear o avanço da doença, que em menos de 4 meses já expandiu para 190 países, incluindo o Brasil 1. Os principais sinais e sintomas provocados pelo vírus incluem febre, tosse e dificuldade para respirar 2. Sintomas gastrointestinais, como diarreia, vômitos e dor abdominal também foram relatados para a COVID-19, assim como nas infecções por outros coronavírus 3. A transmissão da doença costuma ocorrer pelo ar ou pelo contato direto das pessoas e se dá por meio de gotículas de saliva, espirro, tosse e secreções que podem contaminar mãos e superfícies 2. Como tentativa de frear a propagação do vírus, a Organização Mundial da Saúde (OMS) e as principais autarquias de saúde no Brasil divulgaram como cuidados: higienizar as mãos, cobrir a boca com o antebraço ou lenço descartável ao tossir e espirrar, evitar aglomerações e manter-se em isolamento domiciliar, por até 14 dias, em caso de sintomas da doença 4. Também é incentivada a manutenção das pessoas em ambientes bem ventilados 5 e que as empresas e instituições públicas considerem a realização de trabalho remoto (home office), reuniões virtuais e cancelamento de viagens. No Brasil, os esforços neste estágio inicial da epidemia estão voltados para o enfrentamento do SARS-CoV-2, especialmente no sentido de evitar sua propagação 6 e, ao mesmo tempo, possibilitar o atendimento em saúde dos casos graves. Entretanto, outra face que se apresenta é a da segurança alimentar. Itália, Espanha e Portugal, já em quarentena, desenvolveram iniciativas para evitar aglomerações que impactaram a cadeia de alimentos. Nesses países, muitos estabelecimentos comerciais de refeições estão fechados e os supermercados passaram a implantar regras para acesso e aquisição de produtos, a fim de evitar o desabastecimento.PDJ Inova Fiocru
Evaluation of two commercially available chikungunya virus IgM enzyme-linked immunoassays (ELISA) in a setting of concomitant transmission of chikungunya, dengue and Zika viruses
No full textBrazilian National Council for
Scientific and Technological Development (grants 400830/2013-2
and 440891/2016-7 to GSR; and scholarships to UK, MGR, and
GSR); the Bahia Foundation for Research Support (grants PET0026/
2013, APP0044/2016, and PET0022/2016 to GSR); the Coordination
for the Improvement of Higher Education Personnel, Brazilian
Ministry of Education (grant 88887.130746/2016-00 to GSR and
scholarship to MK); the Oswaldo Cruz Foundation; the Federal
University of Bahia; and the Department of Science and
Technology, Secretariat of Science, Technology and Strategic
Inputs, Brazilian Ministry of Health.To evaluate the diagnostic performance of the Inbios (Seattle, US) and Euroimmun (Luebeck, Germany) chikungunya virus (CHIKV) IgM enzyme-linked immunoassays (ELISAs). Methods: We evaluated the tests’ accuracy on sera from 372 patients enrolled in an acute febrile illness
surveillance study performed in Salvador, Brazil from Sept/2014 to Jul/2016, a period of simultaneous
CHIKV, dengue (DENV), and Zika (ZIKV) virus transmission. We assessed the sensitivity on acute and
paired convalescent sera from RT-PCR-confirmed CHIKV cases (collected at median one and 19 days postonset
of symptoms, respectively), and the specificity on sera of RT-PCR-confirmed DENV and ZIKV cases,
and on negative patients.
Results: The Inbios and Euroimmun tests’ sensitivities for acute samples were 4.0% and 10.3%, while for
convalescent samples they were 92.4% and 96.9%, respectively. Overall, Inbios IgM ELISA specificities for
acute and convalescent samples were 97.7% and 90.5%, respectively, and Euroimmun specificities were
88.5% and 83.9%, respectively.
Conclusions: Both tests presented high sensitivity for convalescent samples. However, the Euroimmun
test returned more equivocal results and presented a slightly lower specificity, which might result in a
higher rate of false positives if the test is used in scenarios of low CHIKV transmission, when the chance of
CHIKV infection is lower
Avaliação e reabilitação fonoaudiológica das alterações vocais em pacientes com leishmaniose tegumentar americana, tuberculose e paracoccidioidomicose
No full textNas doenças infecciosas granulomatosas (DIG), as estruturas responsáveis pela manutenção da fisiologia da produção vocal podem estar afetadas devido ao processo cicatricial fibrótico. Estudos recentes demonstraram que em diferentes doenças infecciosas, como a leishmaniose tegumentar americana (LTA), tuberculose (TB), e a paracoccidioidomicose (PCM), a alteração da qualidade vocal permanece após a cura clínica. A terapia vocal exige uma abordagem interdisciplinar, com estratégias terapêuticas individualizadas. Até o momento, nenhum estudo propôs a comparação da reabilitação vocal nestas três doenças. Esta tese é composta por três artigos científicos e um protocolo operacional padrão (POP) para avaliação e reabilitação vocal em pacientes com DIG das vias aéreas e digestivas superiores (VADS), e teve como objetivo descrever a avaliação e reabilitação fonoaudiológica das alterações vocais em pacientes com LTA, TB e PCM. No primeiro artigo, foi realizado um estudo de ensaio clínico com controle histórico de terapia fonoaudiológica, em pacientes diagnosticados com tuberculose laríngea (TBL). O grupo de intervenção (n=17) foi composto por pacientes que receberam terapia fonoaudiológica simultânea ao tratamento para a TBL e o grupo controle (n=13), pacientes que terminaram o tratamento para TBL, sem terapia fonoaudiológica. Foi observado que a melhora da qualidade vocal é possível simultaneamente ao tratamento para TBL, restaurando a função vocal de maneira precoce e reduzindo os impactos sociais decorrentes desta doença. No segundo artigo, o objetivo foi comparar o efeito da terapia fonoaudiológica entre pacientes com lesão ativa ou residual de PCM nas VADS. Foi realizada uma série de 12 casos de PCM com alterações vocais atendidos de 2012 a 2015. Oito pacientes tinha lesões residuais (RES) e quatro, lesões ativas (ATIV). Os pacientes do grupo ATIV restabeleceram a qualidade vocal mais precocemente. O terceiro artigo, em desenvolvimento, teve como objetivo descrever os efeitos da terapia fonoaudiológica após o tratamento para leishmaniose mucosa. Todos os parâmetros vocais avaliados melhoraram após a terapia vocal. O POP para avaliação e reabilitação vocal em pacientes com DIG das VADS, foi elaborado e validado por fonoaudiólogos e otorrinolaringologistas especialistas em doenças infecciosas, para ser utilizado na assistência do Instituto Nacional de Infectologia Evandro Chagas/FIOCRUZ, por fonoaudiólogos treinados, com o objetivo de um atendimento assertivo, e que leve à melhoria de seus resultados terapêuticos. Concluímos que a terapia vocal realizada simultaneamente ao tratamento da doença, facilitaria a adesão, uma vez que o paciente clinicamente curado tem mais dificuldade para retornar exclusivamente para o tratamento das sequelas vocais, além de reestabelecer as funções vocais mais precocemente.In granulomatous infectious diseases (GID), the structures responsible for maintaining the physiology of vocal production may be affected due to the fibrotic healing process. Recent studies have shown that different infectious diseases, such as American cutaneous leishmaniasis (ACL), tuberculosis (TB) and paracoccidioidomycosis (PCM), are affected by the vocal quality suffered after clinical cure. Voice therapy requires an interdisciplinary approach, with individualised therapeutic strategies. To date, no study has proposed a comparison of vocal rehabilitation in these three diseases. This thesis consists of three scientific articles and a standard operational protocol (SOP) for assessment and vocal rehabilitation in patients with GID of the upper airways and digestive tract (UADT), and aimed to describe the assessment and speech rehabilitation of vocal changes in patients with ACL, TB and PCM. In the first article, a clinical trial study was conducted with a historical control of speech therapy, in patients diagnosed with laryngeal tuberculosis (TBL). The intervention group (n=17) was composed of patients who received speech therapy simultaneously with treatment for TBL and the control group (n=13), patients who finished treatment for TBL, without speech therapy. It was observed that improving vocal quality is possible for the treatment of TBL, restoring vocal function early and allowing the social effects caused by the disease. In the second article, the objective was to compare the effect of speech therapy between patients with active or residual PCM of UADT. A series of 12 PCM cases with voice changes from 2012 to 2015 was performed. Eight patients had residual lesions (RES) and four, active lesions (ACTIV). Patients in the ACTIV group restored vocal quality earlier. The third article, under development, aimed to describe the effects of speech therapy after the treatment of the mucosal leishmaniasis. All recommended vocal parameters improved after vocal therapy. The SOP for assessment and vocal rehabilitation in patients with GID of UADT, was developed and validated by speech therapists and otorhinolaryngologists specialised in infectious diseases, to be used in the assistance of the Evandro Chagas National Institute of Infectious Diseases/FIOCRUZ, by trained speech therapists, with the objective of assertive care, leading to the improvement of its therapeutic results. We concluded that vocal therapy performed during the treatment of the disease, facilitated adherence, since the clinically cured patient has more difficulty to return to the treatment of vocal sequelae, in addition to reestablishing vocal functions earlier
Zika virus targets the human thymic epithelium
No full textPrevious work showed that the thymus can be infected by RNA viruses as HIV and HTLV-1. We thus hypothesized that the thymus might also be infected by the Zika virus (ZIKV). Herein we provide compelling evidence that ZIKV targets human thymic epithelial cells (TEC) in vivo and in vitro. ZIKV-infection enhances keratinization of TEC, with a decrease in proliferation and increase in cell death. Moreover, ZIKV modulates a high amount of coding RNAs with upregulation of genes related to cell adhesion and migration, as well as non-coding genes including miRNAs, circRNAs and lncRNAs. Moreover, we observed enhanced attachment of lymphoblastic T-cells to infected TEC, as well as virus transfer to those cells. Lastly, alterations in thymuses from babies congenitally infected were seen, with the presence of viral envelope protein in TEC. Taken together, our data reveals that the thymus, particularly the thymic epithelium, is a target for the ZIKV with changes in the expression of molecules that are relevant for interactions with developing thymocytes
Covid-19: Como reduzir o risco de infecção
No full textA Fiocruz tem produzido uma série de materiais informativos sobre a pandemia da doença pelo SARS-CoV-2 (Covid-19). A reprodução do material é livre e gratuita. Baixe e compartilhe informação correta e de qualidade
Sickle Cell Anemia Patients Display an Intricate Cellular and Serum Biomarker Network Highlighted by TCD4+CD69+ Lymphocytes, IL-17/MIP-1β, IL-12/VEGF, and IL-10/IP-10 Axis
No full textBackground. Sickle cell anemia (SCA) is associated with a chronic proinflammatory state characterized by elevated leukocyte count, mortality from severe recurrent infections, and subsequent vasoocclusive complications with leukocyte adhesion to the endothelium and increased plasma levels of inflammatory cytokines. The immune system has a close connection with morbidity in SCA, but further studies are needed to uncover the involvement of innate and adaptive immunities in modulating the SCA physiopathology. We performed measurements of the frequency of innate and adaptive immunity cells, cytokines, chemokines, and growth factors and immunophenotyping of Toll-like receptor and adhesion molecule expression in the blood of SCA patients and healthy donors to evaluate the different profiles of these biomarkers, the relationship among them, and their correlation to laboratory records and death risk. Material and Methods. Immunophenotyping of cells, Toll-like receptors, and adhesion molecules were performed from peripheral blood samples of SCA patients and healthy donors by flow cytometry and cytokine/chemokine/growth factor measurement by the Luminex technique performed from the serum of the same subjects. Results. Cells of adaptive immunity such as IL-12, IL-17, and IL-10 cytokines; IL-8, IP-10, MIP-1α, MIP-1β, and RANTES chemokines; and VEGF, FGF-basic, and GM-CSF growth factors were higher in SCA patients than healthy donors regardless of any laboratorial and clinical condition. However, high death risk appears to have relevant biomarkers. Conclusion. In the SCA pathophysiology at steady state, there is a broad immunological biomarker crosstalk highlighted by TCD4+CD69+ lymphocytes, IL-12 and IL-17 inflammatory and IL-10 regulatory cytokines, MIP-1α, MIP-1β, and IP-10 chemokines, and VEGF growth factor. High expression of TLR2 in monocytes and VLA-4 in TCD8+ lymphocytes and high levels of MIP-1β and RANTES appear to be relevant in high death risk conditions. The high reticulocytosis and high death risk conditions present common correlations, and there seems to be a balance by the Th2 profile.2035-01-0
Mutações relacionadas com resistência a inseticidas e diversidade de Wolbachia pipientis Hertig e Wobach,1924 em populações de Culex quinquefasciatus Say, 1823 do Brasil
No full textCulex quinquefasciatus Say, 1823 (Diptera: Culicidae), vulgarmente conhecido como pernilongo, é um mosquito amplamente distribuído em todo o território brasileiro. Esta espécie antropofílica e naturalmente infectada por Wolbachia é principal vetora de patógenos responsáveis pelo desenvolvimento de doenças como a filariose linfática e a febre do Nilo Ocidental. O manejo ambiental e o uso de inseticidas são as estratégias mais empregadas para diminuir a densidade das populações naturais desse vetor. No entanto, o uso exacerbado desses compostos tem selecionado populações resistentes em todo o mundo, diminuindo a efetividade do controle químico. Embora exista no Brasil um programa governamental bem estruturado de vigilância e monitoramento da resistência a inseticidas em Ae. aegypti, são raros os estudos envolvendo Cx. quinquefasciatus neste sentido, ainda que o controle químico exerça pressão seletiva semelhante sobre estas espécies essencialmente urbanas. O objetivo deste estudo foi avaliar a presença de mutações nos principais genes relacionados com resistência a inseticidas e a diversidade de Wolbachia pipientis em populações brasileiras de Cx. quinquefasciatus. Adicionamente, foi determinado o perfil de suscetibilidade a inseticidas em linhagens de laboratório de Cx. quinquefasciatus por meio de bioensaios padronizados pela OMS. Foi extraído o DNA de Cx. quinquefasciatus de duas linhagens de laboratório e de treze localidades brasileiras, cobrindo as cinco regiões do país, totalizando 744 amostras. A presença de mutações relacionadas à resistência a piretroides, organofosforados e ao biolarvicida Lysinibacillus sphaericus foi investigada por sequenciamento e diferentes métodos de genotipagem baseados em PCR, nos genes do canal de sódio regulado por voltagem (NaV), acetilcolinesterase (ace-1) e Culex quinquefasciatus maltase 1 (cqm-1). Adicionalmente, determinou-se o grupo genético de Wolbachia pipientis naquelas mesmas amostras, baseado em amplificação por PCR dos genes bacterianos wsp e ftsZ. As duas linhagens de laboratórios foram consideradas suscetíveis aos inseticidas temefós e malathion. Foram identificados 14 haplótipos para o gene NaV e 42 para o gene ace-1. A clássica mutação kdr L1014F do NaV foi observada nas populações de Boa Vista (2,2%), Manaus (1,6%), Cáceres (1,9%) e na linhagem JPA (1%). O alelo mutante ace-1 R foi observado na população de Foz do Iguaçu (3,5%). Nenhum dos alelos mutantes cqm1REC e cqm1REC-2 foram observados no gene cqm1. Todas as amostras apresentaram Wolbachia do supergrupo B, exceto alguns indivíduos (0.5%) de Caseara-TO que não estavam infectados pela bactéria. Alguns indivíduos de Recife (14,8%) e Campina Grande (45%) indicam a possibilidade de superinfeção pelos supergrupos A e B. A presença de alelos classicamente relacionados à resistência em populações de Cx. quinquefasciatus de diferentes regiões do país indica fortemente a necessidade de se implementar um programa de monitoramento de resistência a inseticidas para esse vetor. A existência de W. pipientis do supergrupo A em Cx. quinquefasciatus do Brasil surpreende e indica necessidade de maiores estudos neste sentido.Culex quinquefasciatus Say, 1823 (Diptera: Culicidae), commonly known as the southern house mosquito, is widely distributed throughout the Brazilian territory. This anthropophilic species and naturally infected with Wolbachia is the main vector of pathogens responsible for the development of diseases such as lymphatic filariasis and West Nile fever. Environmental management and use of insecticides are the most employed strategies aiming at to decrease the density of natural populations of this vector. However, the exaggerated use of such compounds has selected resistant populations worldwide, decreasing the effectiveness of chemical control. Although there is a well-structured governmental program in Brazil for surveillance and monitoring of insecticide resistance in Ae. aegypti, studies involving Cx. quinquefasciatus in this sense are rare, even though chemical control exerts similar selective pressure over these essentially urban species. The aim of this study was to evaluate the presence of mutations in the main insecticide resistance related genes and the diversity of Wolbachia pipientis in Cx. quinquefasciatus Brazilian populations. In addition, the profile of susceptibility to insecticides in laboratory strains of Cx. quinquefasciatus was determined using WHO-standardized bioassays. The DNA of the insects was extracted from two laboratory strains and from thirteen Brazilian populations, covering the five regions of the country, totaling 744 samples. The presence of mutations related to resistance to pyrethroids, organophosphates and the biolarvicide Lysinibacillus sphaericus was investigated by sequencing and through different PCR-based genotyping methods, in their respective target genes: voltage-regulated sodium channel (NaV), acetylcholinesterase (ace-1) and Culex quinquefasciatus maltase 1 (cqm-1). Additionally, the genetic supergroup of Wolbachia pipientis was determined in those same samples, based on PCR amplification of the bacterial genes wsp and ftsZ. Both laboratory strains were considered susceptible to the insecticides temephos and malathion. The total of 14 haplotypes were identified in the NaV gene and 42 in the ace-1 gene. The classic L1014F kdr mutation was observed in the populations of Boa Vista (2.2%), Manaus (1.6%), Cáceres (1.9%) and in the JPA strain (1%). The ace-1 R mutant allele was observed in the population of Foz do Iguaçu (3.5%). Neither of cqm1REC and cqm1REC-2 mutant alleles were observed in the cqm1 gene. All samples harbored supergroup B Wolbachia, except few individuals (0.5%) from Caseara-TO, which were not infected. Some samples from Recife (14.8%) and Campina Grande (45%) indicated the superinfection, containging both supergroups A and B. The presence of alleles classically related to insecticide resistance in Cx. quinquefasciatus natural populations from different regions strongly indicates the needs of implementing an insecticide resistance monitoring program for this vector. The occurence of supergroup A W. pipientis in Brazilian Cx. quinquefasciatus is surprising and indicates the necessity of further studies in this regard