Artigos e Materiais de Revistas Científicas - LIM/49
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- Data-driven, cross-disciplinary collaboration: lessons learned at the largest academic health center in Latin America during the COVID-19 pandemic(2024) RITTO, Ana Paula; ARAUJO, Adriana Ladeira de; CARVALHO, Carlos Roberto Ribeiro de; SOUZA, Heraldo Possolo De; FAVARETTO, Patricia Manga e Silva; SABOYA, Vivian Renata Boldrim; GARCIA, Michelle Louvaes; KULIKOWSKI, Leslie Domenici; KALLAS, Esper Georges; PEREIRA, Antonio Jose Rodrigues; COBELLO JUNIOR, Vilson; SILVA, Katia Regina; ABDALLA, Eidi Raquel Franco; SEGURADO, Aluisio Augusto Cotrim; SABINO, Ester Cerdeira; RIBEIRO JUNIOR, Ulysses; FRANCISCO, Rossana Pulcineli Vieira; MIETHKE-MORAIS, Anna; LEVIN, Anna Sara Shafferman; SAWAMURA, Marcio Valente Yamada; FERREIRA, Juliana Carvalho; SILVA, Clovis Artur; MAUAD, Thais; GOUVEIA, Nelson da Cruz; LETAIF, Leila Suemi Harima; BEGO, Marco Antonio; BATTISTELLA, Linamara Rizzo; DUARTE, Alberto Jose da Silva; SEELAENDER, Marilia Cerqueira Leite; MARCHINI, Julio; FORLENZA, Orestes Vicente; ROCHA, Vanderson Geraldo; MENDES-CORREA, Maria Cassia; COSTA, Silvia Figueiredo; CERRI, Giovanni Guido; BONFA, Eloisa Silva Dutra de Oliveira; CHAMMAS, Roger; BARROS FILHO, Tarcisio Eloy Pessoa de; BUSATTO FILHO, GeraldoIntroduction The COVID-19 pandemic has prompted global research efforts to reduce infection impact, highlighting the potential of cross-disciplinary collaboration to enhance research quality and efficiency.Methods At the FMUSP-HC academic health system, we implemented innovative flow management routines for collecting, organizing and analyzing demographic data, COVID-related data and biological materials from over 4,500 patients with confirmed SARS-CoV-2 infection hospitalized from 2020 to 2022. This strategy was mainly planned in three areas: organizing a database with data from the hospitalizations; setting-up a multidisciplinary taskforce to conduct follow-up assessments after discharge; and organizing a biobank. Additionally, a COVID-19 curated collection was created within the institutional digital library of academic papers to map the research output.Results Over the course of the experience, the possible benefits and challenges of this type of research support approach were identified and discussed, leading to a set of recommended strategies to enhance collaboration within the research institution. Demographic and clinical data from COVID-19 hospitalizations were compiled in a database including adults and a minority of children and adolescents with laboratory confirmed COVID-19, covering 2020-2022, with approximately 350 fields per patient. To date, this database has been used in 16 published studies. Additionally, we assessed 700 adults 6 to 11 months after hospitalization through comprehensive, multidisciplinary in-person evaluations; this database, comprising around 2000 fields per subject, was used in 15 publications. Furthermore, thousands of blood samples collected during the acute phase and follow-up assessments remain stored for future investigations. To date, more than 3,700 aliquots have been used in ongoing research investigating various aspects of COVID-19. Lastly, the mapping of the overall research output revealed that between 2020 and 2022 our academic system produced 1,394 scientific articles on COVID-19.Discussion Research is a crucial component of an effective epidemic response, and the preparation process should include a well-defined plan for organizing and sharing resources. The initiatives described in the present paper were successful in our aim to foster large-scale research in our institution. Although a single model may not be appropriate for all contexts, cross-disciplinary collaboration and open data sharing should make health research systems more efficient to generate the best evidence.
- Perspectives on research needs in healthcare epidemiology and antimicrobial stewardship: what's on the horizon - Part I(2023) MARSCHALL, J.; SNYDERS, R. E.; SAX, H.; NEWLAND, J. G.; GUIMARãES, T.; KWON, J. H.In this overview, we articulate research needs and opportunities in the field of infection prevention that have been identified from insights gained during operative infection prevention work, our own research in healthcare epidemiology, and from reviewing the literature. The 10 areas of research need are: 1) transmissions and interruptions, 2) personal protective equipment and other safety issues in occupational health, 3) climate change and other crises, 4) device, diagnostic, and antimicrobial stewardship, 5) implementation and de-implementation, 6) health care outside the acute care hospital, 7) low- and middle-income countries, 8) networking with the neighbors, 9) novel research methodologies, and 10) the future state of surveillance. An introduction and chapters 1-5 are presented in part I of the article, and chapters 6-10 and the discussion in part II. There are many barriers to advancing the field, such as finding and motivating the future IP workforce including professionals interested in conducting research, a constant confrontation with challenges and crises, the difficulty of performing studies in a complex environment, the relative lack of adequate incentives and funding streams, and how to disseminate and validate the often very local quality improvement projects. Addressing research gaps now (i.e., in the postpandemic phase) will make healthcare systems more resilient when facing future crises.
- Perspectives on research needs in healthcare epidemiology, infection prevention, and antimicrobial stewardship: What's on the Horizon - Part II(2023) MARSCHALL, J.; SNYDERS, R. E.; SAX, H.; NEWLAND, J. G.; GUIMARãES, T.; KWON, J. H.In this overview, we articulate research needs and opportunities in the field of infection prevention that have been identified from insights gained during operative infection prevention work, our own research in healthcare epidemiology, and from reviewing the literature. The 10 areas of research need are: 1) Transmissions and interruptions, 2) personal protective equipment and other safety issues in occupational health, 3) climate change and other crises, 4) device, diagnostic, and antimicrobial stewardship, 5) implementation and deimplementation, 6) healthcare outside the acute care hospital, 7) low- and middle-income countries, 8) networking with the neighbors, 9) novel research methodologies, and 10) the future state of surveillance. An introduction and chapters 1-5 are presented in part I of the article and chapters 6-10 and the discussion in part II. There are many barriers to advancing the field, such as finding and motivating the future IP workforce including professionals interested in conducting research, a constant confrontation with challenges and crises, the difficulty of performing studies in a complex environment, the relative lack of adequate incentives and funding streams, and how to disseminate and validate the often very local quality improvement projects. Addressing research gaps now (i.e., in the post-pandemic phase) will make healthcare systems more resilient when facing future crises.
- “Benefits of the pedicled osteoplastic flap as a surgical approach of mastoidectomy in cochlear implant surgery”(2022) LOPES, P. T.; BENTO, R. F.; GEBRIM, E. M. Mello Santiago; BECK, R. M. de Oliveira; CARVALLO, R. Mota Memede; SANCHES, S. G. Gandolfi; LESSER, J. C. CisnerosObjective: To evaluate the esthetic and functional results of an osteoplastic flap for mastoid cavity closure in cochlear implant surgery. Study design: Double-blind, prospective, randomized clinical trial. Setting: tertiary referral center. Intervention(s): On hundred and twenty-six patients were randomized in 2 groups for cochlear implant surgery. Cases (n: 63) underwent simple mastoidectomy using an anteriorly pedicled osteoplastic flap for mastoid closure. In controls (n: 63), a traditional periosteal flap was used. Evaluation with the POSAS questionnaire was performed 1 year after surgery to assess surgical wound esthetics. Sixteen patients from each group had postoperative CT-scans and wideband tympanometry to assess mastoid aeration and middle ear absorbance. Gender and time after surgery were correlated. Main outcome measure(s): Evaluation of the quality of the surgical wound with the application of a questionnaire validated in the medical literature and translated into Portuguese language called POSAS, considering the perception of the blinded patient and doctor regarding the surgical technique proceeded. A lower POSAS score suggests better esthetics of the surgical wound. Secondary outcomes are volumetric measurement of aeration inside mastoid cavity using 3D computer tomography exam, which aims to analyze the influence of fibrocicatricial retraction in the surgical wound into the mastoid and the interference of its aeration volume in the absorption of sound in the middle ear, using the wideband tympanometry exam. Results: The POSAS questionnaire in the Case group showed a lower level of local pain and itchiness, a skin color and thickness more similar to the surrounding skin and less irregularity and stiffness, with no influence from time after surgery and gender compared to the Control group. The median tomographic volume was 6.37 cc in the cases and 4.60 cc in controls. Wideband tympanometry showed general smaller sound absorbance in the Case group results, specially, at 1000 Hz frequency. No intraoperative or postoperative complications were observed with the osteoplastic flap. Conclusions: This technique is an effective and safe alternative to alleviate common problems of mastoid surgery for cochlear implantation. In addition to esthetic benefits, it has less interference in middle ear physiology of sound absorbance and less fibrous tissue into the mastoid cavity during the follow-up of more than 1 year.
- Risk of Dysphonia in Legal Professionals: Proposal for a Screening Protocol(2023) GULLINO, M. B. Martini Ramalho; SIMõES-ZENARI, M.; RODRIGUES, D. de Albuquerque; SAID, G. Carvalho; NEMR, K.Introduction. Due to the communicative requirements inherent to the profession, the legal professional benefits from speech therapy monitoring for the proper use of the voice and to avoid the occurrence of vocal disorders. The development of specific instruments will contribute with more relevant data to guide this monitoring. Objective. To verify the applicability of the General Dysphonia Risk Screening Protocol (DRSP-G) and the Specific Dysphonia Risk Screening Protocol for Legal Professionals (DRSP-LP) and to correlate the average scores of both with vocal deviation, sex, age, professional performance time, vocal signs and symp-toms, and vocal self-assessment. Methods. Fifty legal professionals participated. All participants completed the DRSP-G and DRSP-LP and recorded their voices for detection of the presence of altered vocal quality. Results. Most participants presented a high risk of dysphonia, which was higher in men. Altered vocal quality was observed in 34% of the participants. The items with the highest scores in the DRSP-G were talking a lot (76%), excessive daily coffee in-take (70%), contact with smokers (60%), and insufficient hydration and sleep (48%); in the DRSP-LP, alcohol consumption (68%) and exposure to air conditioning (64%). There was no correlation between risk scores and the degree of dysphonia, or with age or length of professional experience. The DRSP-G score correlated with vocal signs and symptoms and vocal self-perception. Conclusions. The joint application of the DRSP-G and the DRSP-LP enabled a quantitative and qualitative analysis of risk factors for dysphonia in legal professionals.
- Characterization of consumption and costs of antimicrobials in intensive care units in a Brazilian tertiary hospital(2023) CASTRO, Tazia Lopes de; CAMBIAIS, Amanda Magalhaes Vilas Boas; SFORSIN, Andrea Cassia Pereira; PINTO, Vanusa Barbosa; FALCAO, Maria Alice PimentelBackground: The consumption of antimicrobials and the growing resistance of infectious agents to these drugs are not related only to health issues, but also to economic parameters.Objectives: The study objective was to evaluate the consumption of antimicrobials in General and Covid-19 Intensive Care Units (ICUs) and the impact on institutional costs in the largest institute of a tertiary public hospital.Methods: This is a quantitative and retrospective study, which analyzed consumption, through the Defined Daily Dose (DDD), and the annual direct cost of antimicrobials in Reais (R$) and Dollars (US$), from January to December 2021. Results: The total annual consumption (DDD/1000 patient-day) of antimicrobials in the ICUs was 14,368.85. beta-Lactams had the highest total annual value, with a DDD/1000 patient-day of 7062.98, being meropenem the antimi-crobial that reached the highest consumption (3107.20), followed by vancomycin (2322.6). Total consumption was higher in Covid-19 ICUs than in General ICUs, and the annual direct cost of antimicrobials in ICUs was US$560,680.79.Conclusions: The study showed high consumption of broad-spectrum antimicrobials, highlighting the importance of structuring programs to manage the use of antimicrobials, both to reduce antimicrobial consumption and hospital costs, consolidating rational use even in pandemic scenarios.
- Acquired immunodeficiency syndrome-related progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome: prevalence, main characteristics, and outcomes in a Brazilian center(2023) SANTANA, Monize Nascimento; FERRARI, Raphaela; MACEDO, Arthur Cassa; MARCUSSO, Rosa Maria Nascimento; FERNANDES, Ruan de Andrade; VIDAL, Jose ErnestoBackground Progressive multifocal leukoencephalopathy (PML) - immune reconstitution inflammatory syndrome (IRIS) in people living with HIV/AIDS (PLWHA) has been rarely described in low- and middle-income countries.Objective To describe the prevalence of PML-IRIS among PLWHA with PML and its main features in a tertiary hospital in Brazil.Methods We performed a retrospective cohort study. We included PLWHA with PML-IRIS patients admitted at Instituto de Infectologia Emilio Ribas , Sao Paulo, Brazil, between 2011 and 2021. We retrieved information on neurological manifestations, neuroimaging findings, treatments, and outcomes.Results We identified 11 (11.8%) PML-IRIS cases among 93 patients with definite PML. Eight (73%) cases were men and had a median (IQR) age of 41 (27-50) years. Seven (63.6%) patients developed unmasking PML-IRIS and 4 (36.4%) had paradoxical PML-IRIS. The median (IQR) time from initiation of combined antiretroviral therapy (cART) to IRIS diagnosis was 49 (30-70) days. Ten (90.9%) patients received corticosteroids. There were 4 (36%) in-hospital deaths and 3 were associated with hospital-acquired pneumonia. Among the 7 (64%) patients who survived, 5 (71.5%) had sequelae at discharge. One year after the PML-IRIS diagnosis, 6 (54.5%) patients were alive.Conclusion The prevalence of PML-IRIS was 11.8%. Most patients had unmasking PML-IRIS. In-hospital mortality and morbidity were high. One-year survival was similar to that described in some high-income countries.
- Beyond HIV prevention: Assessment of the benefits of pre-exposure prophylaxis for sexual quality of life(2024) BERTEVELLO, Daniel A.; VASCONCELOS, Ricardo; CERQUEIRA, Natalia B.; FREITAS, Angela C.; CUNHA, Ana; I, Vivian Avelino-SilvaBackground: Pre-exposure prophylaxis (PrEP) may favor sexual satisfaction by reducing the fear of HIV and promoting less restrictive sexual practices. These benefits may be even higher among PrEP users with mental health issues. Methods: We invited adult PrEP users to answer a questionnaire including demographics, questions on the sexual experience compared to the period before PrEP use, and the Hospital Anxiety and Depression Scale. Factors associated with improvements in the sexual experience were investigated using modified Poisson models. Results: We included 221 participants; most were white males. A large percentage of participants reported improvements in quality of sex after PrEP initiation; the composite outcome ""PrEP-associated improvement in the quality of sex"" was observed in 92 (42%), whereas the outcome ""PrEP-associated improvement in the fear of HIV acquisition"" was observed in 120 participants (54%). Demographics and depression/anxiety were not significantly associated with the outcomes. Conclusion: PrEP has positive effects beyond HIV prevention, improving several aspects of sexual quality of life. These benefits are valid incentives for PrEP use and prescription.
- Rapid profiling of Plasmodium parasites from genome sequences to assist malaria control(2023) PHELAN, Jody E.; TURKIEWICZ, Anna; MANKO, Emilia; THORPE, Joseph; VANHEER, Leen N.; VEGTE-BOLMER, Marga van de; NGOC, Nguyen Thi Hong; BINH, Nguyen Thi Huong; THIEU, Nguyen Quang; GITAKA, Jesse; NOLDER, Debbie; BESHIR, Khalid B.; DOMBROWSKI, Jamille G.; SANTI, Silvia Maria Di; BOUSEMA, Teun; SUTHERLAND, Colin J.; CAMPINO, Susana; CLARK, Taane G.Background Malaria continues to be a major threat to global public health. Whole genome sequencing (WGS) of the underlying Plasmodium parasites has provided insights into the genomic epidemiology of malaria. Genome sequencing is rapidly gaining traction as a diagnostic and surveillance tool for clinical settings, where the profiling of co-infections, identification of imported malaria parasites, and detection of drug resistance are crucial for infection control and disease elimination. To support this informatically, we have developed the Malaria-Profiler tool, which rapidly (within minutes) predicts Plasmodium species, geographical source, and resistance to antimalarial drugs directly from WGS data. Results The online and command line versions of Malaria-Profiler detect similar to 250 markers from genome sequences covering Plasmodium speciation, likely geographical source, and resistance to chloroquine, sulfadoxine-pyrimethamine (SP), and other anti-malarial drugs for P. falciparum, but also providing mutations for orthologous resistance genes in other species. The predictive performance of the mutation library was assessed using 9321 clinical isolates with WGS and geographical data, with most being single-species infections (P. falciparum 7152/7462, P. vivax 1502/1661, P. knowlesi 143/151, P. malariae 18/18, P. ovale ssp. 5/5), but co-infections were identified (456/9321; 4.8%). The accuracy of the predicted geographical profiles was high to both continental (96.1%) and regional levels (94.6%). For P. falciparum, markers were identified for resistance to chloroquine (49.2%; regional range: 24.5% to 100%), sulfadoxine (83.3%; 35.4- 90.5%), pyrimethamine (85.4%; 80.0-100%) and combined SP (77.4%). Markers associated with the partial resistance of artemisinin were found in WGS from isolates sourced from Southeast Asia (30.6%). Conclusions Malaria-Profiler is a user-friendly tool that can rapidly and accurately predict the geographical regional source and anti-malarial drug resistance profiles across large numbers of samples with WGS data. The software is flexible with modifiable bioinformatic pipelines. For example, it is possible to select the sequencing platform, display specific variants, and customise the format of outputs. With the increasing application of next-generation sequencing platforms on Plasmodium DNA, Malaria-Profiler has the potential to be integrated into point-of-care and surveillance settings, thereby assisting malaria control. Malaria-Profiler is available online (bioinformatics.lshtm.ac.uk/malaria-profiler) and as standalone software (https://github.com/jodyphelan/malaria-profiler).
- Finger-Prick Whole Blood Cryptococcal Antigen Lateral Flow Assay for the Diagnosis of Cryptococcosis in HIV-Negative Patients: A Case Series Study in Two Tertiary Centers in São Paulo, Brazil(2023) VIDAL, Jose E.; OLIVEIRA, Fernanda Gurgel; VIEIRA, Marcela; PEREIRA, Luisa; LUCAS JUNIOR, Rodovaldo M.; GUEDES, Bruno Fukelman; MAGRI, Marcello Chaves; BOULWARE, David R.Cryptococcosis in HIV-negative patients can be an opportunistic or endemic disease. There are no published studies on the use of the finger-prick whole blood (point-of-care) cryptococcal antigen lateral flow assay (CrAg LFA) for diagnosing cryptococcosis in HIV-negative patients. We conducted a case series study of HIV-negative patients with cryptococcosis in two centers in S & atilde;o Paulo, Brazil. The objectives were to identify the sensitivity of a finger-prick whole blood CrAg LFA and to describe the main characteristics of this population. We identified 30 HIV-negative patients with cryptococcosis [19 (63%), male; median age, 47 years]. Ten (33%) patients were immunosuppressed, ten (33%) had other comorbidities, and ten (33%) were apparently immunocompetent and without comorbidities. The distribution of the sites of cryptococcosis was as follows: the central nervous system, 90% (n = 27); pulmonary, 43% (n = 13); and other extrapulmonary sites, 40% (n = 12). The sensitivity of the finger-prick whole blood CrAg LFA for the diagnosis of cryptococcosis was 97% (29/30). Among 26 participants with cryptococcal meningitis, the sensitivity of testing cerebrospinal fluid was as follows: CrAg latex agglutination, 77% (20/26); CrAg LFA, 96% (25/26); and culture, 81% (21/26). Culture speciation identified Cryptococcus gattii in 16 (62%) cases, and all had a positive finger-prick whole blood CrAg LFA. This test presented high sensitivity to the diagnosis of cryptococcosis in HIV-negative patients, including those caused by C. gattii.
- Occurrence of Hepatozoon in Some Reptiles from Brazilian Biomes with Molecular and Morphological Characterization of Hepatozoon caimani(2023) CLEMENTE, Gabriella R. C.; GUTIERREZ-LIBERATO, German A.; ANJOS, Carolina C.; SIMOES, Pedro I.; MUDREK, Jessica R.; FECCHIO, Alan; LIMA, Jose H. A.; OLIVEIRA, Patricia M. A.; PINHO, Joao B.; MATHIAS, Bruno S.; GUIMARAES, Lilian O.; KIRCHGATTER, Karin; BELK, Mark C.Amphibians and reptiles represent a considerable proportion of the vertebrate fauna in Brazil. Different blood parasitic infections have been reported in these groups, such as Haemogregarina, Hepatozoon, Trypanosoma and microfilariae. However, insufficient research on interactions between these parasites and their hosts has been carried out in some regions of the country. Samples were collected from populations of wild herpetofauna in different microhabitats throughout Brazil, totaling 111 samples of reptiles from the states of Mato Grosso and Pernambuco. We used an integrative approach, with classical microscopy, morphometry and molecular analysis, in order to identify hemoparasites present in the analyzed fauna. Genomic DNA was extracted for the PCR protocol based on the 18S ribosomal RNA gene for Hepatozoon spp. A total of 53 positives were obtained with molecular screening (47.7%), all confirmed as Hepatozoon spp. using DNA sequencing. Among positive samples, 23 slides were examined, confirming the presence of Hepatozoon spp. in 91.3% of the smears. The phylogenetic analysis performed with sequences from 43 samples resulted in a tree containing several distinct clades. Sequences were generally grouped according to the taxonomic order of the host. Co-infections with microfilariae and Trypanosoma spp. were also found in microscopy analyses. This study describes the presence of Hepatozoon caimani in a new host species (Paleosuchus palpebrosus) that can be a paratenic host in the natural environment. The existence of parasitic co-infections in alligator species underscores the significance of recognizing the impact of infections by various parasitic taxa on the host populations.
- Integrating artificial intelligence and wing geometric morphometry to automate mosquito classification(2024) LIMA, Vinicio Rodrigues de; MORAIS, Mauro Cesar Cafundo de; KIRCHGATTER, KarinMosquitoes (Diptera: Culicidae) comprise over 3500 global species, primarily in tropical regions, where the females act as disease vectors. Thus, identifying medically significant species is vital. In this context, Wing Geometric Morphometry (WGM) emerges as a precise and accessible method, excelling in species differentiation through mathematical approaches. Computational technologies and Artificial Intelligence (AI) promise to overcome WGM challenges, supporting mosquito identification. AI explores computers' thinking capacity, originating in the 1950s. Machine Learning (ML) arose in the 1980s as a subfield of AI, and deep Learning (DL) characterizes ML's subcategory, featuring hierarchical data processing layers. DL relies on data volume and layer adjustments. Over the past decade, AI demonstrated potential in mosquito identification. Various studies employed optical sensors, and Convolutional Neural Networks (CNNs) for mosquito identification, achieving average accuracy rates between 84 % and 93 %. Furthermore, larval Aedes identification reached accuracy rates of 92 % to 94 % using CNNs. DL models such as ResNet50 and VGG16 achieved up to 95 % accuracy in mosquito identification. Applying CNNs to georeference mosquito photos showed promising results. AI algorithms automated landmark detection in various insects' wings with repeatability rates exceeding 90 %. Companies have developed wing landmark detection algorithms, marking significant advancements in the field. In this review, we discuss how AI and WGM are being combined to identify mosquito species, offering benefits in monitoring and controlling mosquito populations.
- Investigation of antimicrobial susceptibility and genetic diversity among Staphylococcus pseudintermedius isolated from dogs in Rio de Janeiro(2023) TEIXEIRA, Izabel Mello; ASSUMPCAO, Yasmim de Moraes; PALETTA, Ana Clara Cabral; AGUIAR, Louise; GUIMARAES, Luciana; SILVA, Isabella Thomaz da; CORTES, Marina F.; BOTELHO, Ana Maria Nunes; JAEGER, Lauren Hubert; FERREIRA, Renata Fernandes; FERREIRA, Eliane de Oliveira; PENNA, BrunoStaphylococcus pseudintermedius is an opportunistic pathogen causing a variety of infections that are difficult to treat, especially because of the development of antimicrobial resistance. It has a clonal distribution around the world. To have a better understanding of the MRSP population, we search the presence of MRSP in colonized or infected dogs. Samples from 99 dogs with infections and 35 from asymptomatic dogs were collected. Isolates were identified by mass spectrometry and Multiplex-PCR. The mecA gene was confirmed by conventional PCR. MRSP strains were analyzed by whole-genome sequencing. 75 S. pseudintermedius were identified, most from infection cases. The species were isolated from 70 out of the 135 dogs. Penicillin and Trimethoprim/Sulfamethoxazole presented higher resistance rates. Forty-seven strains were classified as multi-drug resistant (MDR), and were more isolated from dogs with infection (P < 0.05). Eighteen samples were classified as MRSP, representing 24.0% of the population. Six of 16 MRSP sequenced samples belonged to the world spread clone ST71; others belonged to unknown clones. Most samples carried the SCCmec type IIIA. Twenty-one different genetic resistance determinants were found among MRPS strains. MRSP is circulating among infected and colonized dogs in Rio de Janeiro, Brazil.
- Safeguarding HIV prevention and care services amidst military conflict: experiences from Ukraine(2023) LOPATINA, Yaroslava; ZAKOWICZ, Anna Maria; SHABAROVA, Zoya; FORD, Terri; FONSECA, Fernanda F.; ODOKE, Wilfred; HOMBERGH, Jan van den; I, Vivian Avelino-Silva; BENZAKEN, Adele Schwartz; MILES, Ralph C.Ukraine stands out among European countries concerning HIV epidemiological data. Since February 2022, the military conflict with Russian forces has posed unprecedented challenges to HIV prevention and care. AIDS Healthcare Foundation (AHF), a global non-profit organisation with operations in Ukraine since 2009, implemented a preparedness plan to protect staff members and support local facilities in the continuity of care throughout the war. In this manuscript, we describe the strategies adopted by AHF to anticipate the risk of military conflict, steps to implement a preparedness plan, main challenges faced by local staff members and managers, adaptations needed as the conflict evolved, and indicators of HIV care 1 year before and 1 year after the onset of the conflict. Our experience shows that safeguarding the organisation's human resources has been a prerequisite to sustain services throughout the war.
- Simian malaria: a narrative review on emergence, epidemiology andthreatto global malaria elimination(2023) FORNACE, Kimberly M.; LAPORTA, Gabriel Zorello; VYTHILINGHAM, Indra; CHUA, Trock Hing; CHUA, rock Hing; AHMED, Kamruddin; JEYAPRAKASAM, Nantha K.; DUARTE, Ana Maria Ribeiro de Castro; AMIR, Amirah; PHANG, Wei Kit; DRAKELEY, Chris; SALLUM, Maria Anice M.; LAU, Yee LingSimian malaria from wild non-human primate populations is increasingly recognised as a public health threat and is now the main cause of human malaria in Malaysia and some regions of Brazil. In 2022, WHO changed malaria elimination certification guidelines to require non-negligible risks of simian malaria in people, leaving many countries with no pathway to elimination. We review the global distribution and drivers of simian malaria and identify priorities for diagnosis, treatment, surveillance, and control. Environmental change is driving closer interactions between humans and wildlife, with malaria parasites from non-human primates spilling over into human populations and human malaria parasites spilling back into wild non-human primate populations. These complex transmission cycles require new molecular and epidemiological approaches to track parasite spread. Current methods of malaria control are ineffective, with wildlife reservoirs and primarily outdoor-biting mosquito vectors urgently requiring the development of novel control strategies. Without these, simian malaria has the potential to undermine malaria elimination globally.
- Sensitivity and specificity of a syphilis rapid diagnostic test in blood donors' samples(2023) ARAI, Carolina; LEMOS-MACHADO, Juliano Alves; AUN, Marcelo Vivolo; BONET-BUB, Carolina; SANTOS, Leandro Dinalli; MIRANDA, Angelica Espinosa; AVELINO-SILVA, Vivian I.Rapid Diagnostic Tests (RDT) are useful to identify syphilis cases, particularly for hard-to-reach populations and if laboratory services are scarce. However, RDT performance may be subopti-mal. We aimed to assess the sensitivity and specificity of a syphilis RDT using well-characterized blood donors' samples. We categorized samples from 811 blood donors into five groups: 1 - Sam-ples with reactive Chemiluminescence (QML), FTA-Abs, and VDRL; 2 -Samples with reactive QML and FTA-Abs, and nonreactive VDRL; 3 -Samples with reactive QML, and nonreactive for other markers (false-positives); 4 -Controls with nonreactive QML; and 5 -Samples reactive for HIV, with nonreactive QML. Sensitivity was tested in groups 1 (overall and according to VDRL titers) and 2; specificity was tested in groups 3-5. The RDT had high specificity, even in samples reactive for HIV. The sensitivity was high (91.9%) in samples with reactive VDRL but varied between 75.0%-100% according to VDRL titers. The overall sensitivity was lower (81.3%) in sam-ples with reactive FTA-Abs and nonreactive VDRL. The RDT is a useful tool to detect active syph-ilis but may be more limited for cases with very early or remote infection, or those with prior treatment. When higher sensitivity is needed, additional strategies including recurrent testing or laboratory-based tests may be required.(c) 2023 Sociedade Brasileira de Infectologia.
- Epidemiological profile and genetic resistance of Neisseria gonorrhoeae infection in women in a poor region of Sao Paulo, Brazil(2024) TAVARES, Gabriela Martinez Moura; ALVERGA, Hannar Angelica de Melo; FELIX, Estela Moraes; DICHMAN, Giovana de Oliveira; PINHEIRO, Gabriel Monteiro; JULIANO, Yara; PARUCI, Priscila; FUJITA, Dennis Minoru; NEVES, Lucas Melo; SHIO, Marina Tiemi; NALI, Luiz Henrique da SilvaBackground and aim: Gonorrhea is a bacterial infection in the urogenital tract, transmitted by sexual or perinatal contact, caused by Neisseria gonorrhoeae, a gram-negative diplococcus. The present study evaluates the frequency of N. gonorrhoeae in women treated at Hospital Wladimir Arruda in poor area of Sa similar to o Paulo and also verifies the presence of genetic resistance against three antimicrobials of different classes: Tetracycline, Azithromycin and Ciprofloxacin. Methods: This is an observational and descriptive study with a quantitative approach. Samples were collected at Hospital Escola Wladimir Arruda. The volunteers are women from 16 to 65 years of age. Sociodemographic, gynecological, sexual and health data are collected through a questionnaire, their symptoms/clinical manifestation were requested by the medical records, and then the participant is referred for collection of samples of cervical vaginal smear. The samples were screened for N. gonorrhoeae (dcmH gene) and tested for resistance genes to Tetracycline, Azithromycin and Ciprofloxacin through PCR. Results: In the total of 127 samples analyzed by Real-Time PCR, 23 were positive and correspond to a general prevalence of a gonococcal infection in the studied population of 17% (CI:95%), and the participants were married (43.4%), had active sexual life (56.5%) and did not use any type of condom during sexual intercourse (52.1%). The resistance to the tetM ribosomal gene was found in 14 samples, prevalence of 60% (CI= 95%). Conclusions: We have described a concerning frequency of N. gonorrhoeae infection in females attended in an outcare patient. Also, most of the strains detected presented resistance to one or more antimicrobials.
- Toxoplasma gondii in CD36-/- mice shows lethal infection and poor immunization with probable macrophage immune defects(2023) COSTA, Andrea da; JR, Heitor Franco de AndradeExperimental toxoplasmosis is an excellent model for adaptive immune response. Gamma-irradiated tachyzoites or soluble tachyzoite antigen extracts (STag) induce protection against experimental toxoplasmosis in mice. Scavenger receptors recognize irradiated proteins, promote their entry into cells, and lead to antigen presentation. CD36 is a specific scavenger receptor involved in intracellular transport of free fatty acid (FFA), cellular recycling, and intracellular trafficking in lipid rafts outside the lysosomal pathways. CD36 is also associated with an altered immune response, as CD36(-/-) mice presented some immune defects in the cyst-forming Toxoplasma gondii. We studied T. gondii infection in CD36(-/-) mice, naive or immunized, with irradiated T. gondii STags by investigating protection, antibody production, and primed macrophage transplantation. CD36(-/-) mice presented no resistance against the viable RH tachyzoites, even after immunization with gamma-irradiated STags that protected wild-type mice. The animals presented poor humoral responses to both immunogens despite adequate levels of serum immunoglobulins. CD36(-/-) mice failed to induce protection against virulent T. gondii infection with inadequate antibody production or an innate response. Irradiated antigens failed to induce antibodies in CD36(-/-) mice and only produced adequate levels of immunoglobulin G when transplanted with irradiated STag-primed wild-type macrophages. The CD36 pathway is necessary for humoral response against the irradiated antigen; however, several other pathways are also involved in mounting a humoral response against any antigen. CD36 is a multipurpose molecule for FFA and lipid transport, as well as for the immune response, and gamma radiation mimics the innate response by targeting irradiated antigens of this pathway.
- Dengue and climate changes: Increase of DENV-1 in Sao Paulo/Brazil-2023(2023) FUJITA, Dennis Minoru; SALVADOR, Felipe Scassi; NALI, Luiz Henrique da Silva; ANDRADE JUNIOR, Heitor Franco deDengue is a vector borne disease caused by virus serotypes DENV-1, DENV-2, DENV-3, and DENV-4, representing a significant public health concern in the Region of the Americas (2,997,097 cases in 2023). This study explores the relationship between dengue incidence and climate changes in the city of Sao Paulo-Brazil. During the first semester of 2023, Brazil reported the highest number of dengue cases in Americas' Region. Our data reveals a correlation between the high temperature and rainfall season persistence and the extension of dengue incidence into the winter season. The findings highlight the importance of understanding the relationship between climate change and disease transmission patterns to develop effective strategies for prevention and control.
- Launch of the Sao Paulo Wellcome Trust-funded multidisciplinary research program on optimising antimicrobial use in highly populated urban environments(2023) LEVIN, Anna S.; COSTA, Silvia F.; RAZZOLINI, Maria Tereza P.; PADOVEZE, Maria Clara; NUNES, Fatima L. S.