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The spread of Chikungunya virus is a major public health concern in the Americas. There were >120,000 cases and 51 deaths in 2023, of which 46 occurred in Paraguay. Using a suite of genomic, phylodynamic, and epidemiologic techniques, we characterized the ongoing large chikungunya epidemic in Paraguay.
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Febre de Chikungunya , Vírus Chikungunya , Epidemias , Humanos , Vírus Chikungunya/genética , Paraguai/epidemiologia , África do Sul , Febre de Chikungunya/epidemiologia , Filogenia , GenótipoRESUMO
Despite the great diversity, economic and environmental importance of limnic mollusks, the group is still little investigated in the Brazilian semiarid region, especially in the state of Piauí. Thus, this work aims to gather information on the diversity of limnic mollusks in the Brazilian Northeast and the semiarid region, including new records for the state of Piauí, northeastern Brazil. For this, collections in the urban perimeter of the Itaim and Guaribas Rivers, municipalities of Itainópolis, and Picos, respectively, between October 2017 and September 2019. Besides, a literature review was conducted on studies of malacofauna in the Northeast and the Brazilian semiarid region. A total of 11 species from the classes Gastropoda and Bivalvia were collected on the rivers of Piauí, being the first record of Uncancylus concentricus for the Northeast region. For lotic environments in the state of Piauí, Drepanotrema schubarti, Pomacea canaliculata, Pisidium dorbignyi and Stenophysa marmorata were registered for the first time. Then, it was possible to verify that the Northeast of Brazil has 71 species registered, of which 34 occur in the semiarid. The diversity of species surveyed and the first record of the occurrence of several of them for the semiarid region demonstrate the importance of expanding studies involving this group to other areas. The present study is the first to gather and increase the information available on the fauna of limnic mollusks for the Northeast and Brazilian semiarid regions. The information gathered here may contribute to future research and to the species conservation and the environments they occupy, especially considering the presence of non- native and vector species.
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Bivalves , Rios , Animais , Brasil , CidadesRESUMO
Uruguay experienced its first Chikungunya virus outbreak in 2023, resulting in a significant burden to its healthcare system. We conducted analysis based on real-time genomic surveillance (30 novel whole genomes) to offer timely insights into recent local transmission dynamics and eco-epidemiological factors behind its emergence and spread in the country.
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Vírus Chikungunya , Vírus Chikungunya/genética , Uruguai/epidemiologia , América/epidemiologia , Surtos de Doenças , GenômicaRESUMO
[This corrects the article DOI: 10.3389/fpubh.2023.1195779.].
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The potential role of obstructive sleep apnea (OSA) in hypertension-mediated organ damage (HMOD) may be influenced by the presence of resistant hypertension (RH). Herein, we enrolled patients with hypertension from a tertiary center for clinical evaluation and performed a sleep study to identify OSA (apnea-hypopnea index ≥15 events/h) and a blinded analysis of four standard HMOD parameters (left ventricular hypertrophy [LVH], increased arterial stiffness [≥10 m/s], presence of retinopathy, and nephropathy). RH was diagnosed based on uncontrolled blood pressure (BP) (≥140/90 mmHg) despite concurrent use of at least three antihypertensive drug classes or controlled BP with concurrent use of ≥4 antihypertensive drug classes at optimal doses. To avoid the white-coat effect, ambulatory BP monitoring was performed to confirm RH diagnosis. One-hundred patients were included in the analysis (mean age: 54 ± 8 years, 65% females, body mass index: 30.4 ± 4.5 kg/m²). OSA was detected in 52% of patients. Among patients with non-RH (n = 53), the presence of OSA (52.8%) was not associated with an increased frequency of HMOD. Conversely, among patients with RH, OSA (51.1%) was associated with a higher incidence of LVH (RH-OSA,61%; RH + OSA,87%; p = 0.049). Logistic regression analysis using the total sample revealed that RH (OR:7.89; 95% CI:2.18-28.52; p = 0.002), systolic BP (OR:1.04; 95% CI:1.00-1.07; p = 0.042) and OSA (OR:4.31; 95% CI:1.14-16.34; p = 0.032) were independently associated with LVH. No significant association was observed between OSA and arterial stiffness, retinopathy, or nephropathy. In conclusion, OSA is independently associated with LVH in RH, suggesting a potential role of OSA in RH prognosis.
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Hipertensão , Apneia Obstrutiva do Sono , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/fisiologia , Hipertensão/complicações , Polissonografia , Apneia Obstrutiva do Sono/complicaçõesRESUMO
We report the first whole-genome sequences of Dengue Virus type I genotypes I and V from Uruguay, including the first cases ever reported in the country. Through timely genomic analysis, identification of these genotypes was possible, aiding in timely public health responses and intervention strategies to mitigate the impact of dengue outbreaks.
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Uruguay experienced its first Chikungunya virus outbreak in 2023, resulting in a significant burden to its healthcare system. We conducted analysis based on real-time genomic surveillance (30 novel whole genomes) to offer timely insights into recent local transmission dynamics and eco-epidemiological factors behind its emergence and spread in the country.
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Background: The COVID-19 pandemic had a major impact on indigenous populations. Understanding the viral dynamics within this population is essential to create targeted protection measures. Methods: A total of 204 SARS-CoV-2 positive samples collected between May 2020 and November 2021 from an indigenous area in Mato Grosso do Sul (MS), Midwestern Brazil, were screened. Samples were submitted to whole genome sequencing using the Nanopore sequencing platform. Clinical, demographic, and phylogenetic data were analyzed. Results: We found the co-circulation of six main SARS-CoV-2 lineages in the indigenous population, with the Zeta lineage being the most prevalent (27.66%), followed by B.1.1 (an ancestral strain) (20.21%), Gamma (14.36%) and Delta (13.83%). Other lineages represent 45.74% of the total. Our phylogenetic reconstruction indicates that multiple introduction events of different SARS-CoV-2 lineages occurred in the indigenous villages in MS. The estimated indigenous population mortality rate was 1.47%. Regarding the ethnicity of our cohort, 64.82% belong to the Guarani ethnicity, while 33.16% belong to the Terena ethnicity, with a slightly higher prevalence of males (53.43%) among females. Other ethnicities represent 2.01%. We also observed that almost all patients (89.55%) presented signs and symptoms related to COVID-19, being the most prevalent cough, fever, sore throat, and headache. Discussion: Our results revealed that multiple independent SARS-CoV-2 introduction events had occurred through time, probably due to indigenous mobility, since the villages studied here are close to urban areas in MS. The mortality rate was slightly below of the estimation for the state in the period studied, which we believe could be related to the small number of samples evaluated, the underreporting of cases and deaths among this population, and the inconsistency of secondary data available for this study. Conclusion: In this study, we showed the circulation of multiple SARS-CoV-2 variants in this population, which should be isolated and protected as they belong to the most fragile group due to their socioeconomic and cultural disparities. We reinforce the need for constant genomic surveillance to monitor and prevent the spread of new emerging viruses and to better understand the viral dynamics in these populations, making it possible to direct specific actions.
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COVID-19 , SARS-CoV-2 , Masculino , Feminino , Humanos , SARS-CoV-2/genética , COVID-19/epidemiologia , Brasil/epidemiologia , Pandemias , Filogenia , GenômicaRESUMO
Dengue virus (DENV) has been a major public health concern in Paraguay, with frequent outbreaks occurring since early 1988. Although control measures have been implemented, dengue remains a significant health threat in the country, and continued efforts are required for prevention and control. In response to that, in collaboration with the Central Public Health Laboratory in Asunción, we conducted a portable whole-genome sequencing and phylodynamic analysis to investigate DENV viral strains circulating in Paraguay over the past epidemics. Our genomic surveillance activities revealed the co-circulation of multiple DENV serotypes: DENV-1 genotype V, the emerging DENV-2 genotype III, BR4-L2 clade, and DENV-4 genotype II. Results additionally highlight the possible role of Brazil as a source for the international dispersion of different viral strains to other countries in the Americas emphasizing the need for increased surveillance across the borders, for the early detection and response to outbreaks. This, in turn, emphasizes the critical role of genomic surveillance in monitoring and understanding arbovirus transmission and persistence locally and over long distances.
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Vírus da Dengue , Dengue , Humanos , Vírus da Dengue/genética , Dengue/epidemiologia , Paraguai/epidemiologia , Estudos Retrospectivos , Filogenia , Sorogrupo , GenótipoRESUMO
The emergence and reemergence of mosquito-borne diseases in Brazil such as Yellow Fever, Zika, Chikungunya, and Dengue have had serious impacts on public health. Concerns have been raised due to the rapid dissemination of the chikungunya virus (CHIKV) across the country since its first detection in 2014 in Northeast Brazil. Faced with this scenario, on-site training activities in genomic surveillance carried out in partnership with the National Network of Public Health Laboratories have led to the generation of 422 CHIKV genomes from 12 Brazilian states over the past two years (2021-2022), a period that has seen more than 312 thousand chikungunya fever cases reported in the country. These new genomes increased the amount of available data and allowed a more comprehensive characterization of the dispersion dynamics of the CHIKV East-Central-South-African (ECSA) lineage in Brazil. Tree branching patterns revealed the emergence and expansion of two distinct subclades. Phylogeographic analysis indicated that the northeast region has been the leading hub of virus spread towards other regions. Increased frequency of C>T transitions among the new genomes suggested that host restriction factors from the immune system such as ADAR and AID/APOBEC deaminases might be driving CHIKV ECSA lineage genetic diversity in Brazil.
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The emergence and reemergence of mosquito-borne diseases in Brazil such as yellow fever, zika, chikungunya, and dengue have had serious impacts on public health. Concerns have been raised due to the rapid dissemination of the chikungunya virus across the country since its first detection in 2014 in Northeast Brazil. In this work, we carried out on-site training activities in genomic surveillance in partnership with the National Network of Public Health Laboratories that have led to the generation of 422 chikungunya virus genomes from 12 Brazilian states over the past two years (2021-2022), a period that has seen more than 312 thousand chikungunya fever cases reported in the country. These genomes increased the amount of available data and allowed a more comprehensive characterization of the dispersal dynamics of the chikungunya virus East-Central-South-African lineage in Brazil. Tree branching patterns revealed the emergence and expansion of two distinct subclades. Phylogeographic analysis indicated that the northeast region has been the leading hub of virus spread towards other regions. Increased frequency of C > T transitions among the new genomes suggested that host restriction factors from the immune system such as ADAR and AID/APOBEC deaminases might be driving the genetic diversity of the chikungunya virus in Brazil.
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Febre de Chikungunya , Vírus Chikungunya , Febre Amarela , Infecção por Zika virus , Zika virus , Animais , Humanos , Vírus Chikungunya/genética , Brasil/epidemiologia , Febre de Chikungunya/epidemiologia , NucleotídeosRESUMO
The spread of vector-borne viruses, such as CHIKV, is a significant public health concern in the Americas, with over 120,000 cases and 51 deaths in 2023, of which 46 occurred in Paraguay. Using a suite of genomic, phylodynamic, and epidemiological techniques, we characterized the ongoing large CHIKV epidemic in Paraguay. Article Summary Line: Genomic and epidemiological characterization of the ongoing Chikungunya virus epidemic in Paraguay.
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The emergence and continued geographic expansion of arboviruses and the growing number of infected people have highlighted the need to develop and improve multiplex methods for rapid and specific detection of pathogens. Sequencing technologies are promising tools that can help in the laboratory diagnosis of conditions that share common symptoms, such as pathologies caused by emerging arboviruses. In this study, we integrated nanopore sequencing and the advantages of reverse transcription polymerase chain reaction (RT-PCR) to develop a multiplex RT-PCR protocol for the detection of Chikungunya virus (CHIKV) and several orthoflaviviruses (such as dengue (Orthoflavivirus dengue), Zika (Orthoflavivirus zikaense), yellow fever (Orthoflavivirus flavi), and West Nile (Orthoflavivirus nilense) viruses) in a single reaction, which provides data for sequence-based differentiation of arbovirus lineages.
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Arbovírus , Vírus Chikungunya , Dengue , Sequenciamento por Nanoporos , Infecção por Zika virus , Zika virus , Humanos , Arbovírus/genética , Vírus Chikungunya/genética , Reação em Cadeia da Polimerase Multiplex , Zika virus/genéticaRESUMO
INTRODUCTION: Orbital compartment syndrome (OCS) is a rare condition characterized by increased intraorbital pressure and hypoperfusion of critical neural structures. It is usually associated with external ophthalmoplegia. We report a case of postoperative OCS following a frontotemporal craniotomy and review pertinent literature. CASE DESCRIPTION: A 3-year-old female patient presented with a 3-year history of refractory epilepsy and diagnosis of right frontobasal cortical dysplasia. She underwent an elective frontotemporal craniotomy to allow resection of dysplastic cortex. The intraoperative period was uneventful. Postoperatively, following removal of operating fields, we noticed proptosis and right periorbital swelling. A diagnosis of orbital compartment syndrome was made. At the pediatric intensive care unit, the patient underwent an emergency right lateral canthotomy with wide inferior and superior cantholysis. Nowadays she is in the fourth month of postoperative follow-up. There is still slight and almost indistinguishable exophthalmos, but her extrinsic eye movement ranges and reaction to light are normal. DISCUSSION: OCS is a rare ophthalmologic emergency characterized by an acute rise in orbital pressure and may result in complete irreversible blindness if not rapidly treated. The frontotemporal or "pterional" craniotomy exposure requires a myocutaneous flap to be retracted anteriorly and inferiorly near the orbit. There may be orbital compression due to this flap leading to potential harmful complications. Attention to factors such as direct ocular pressure from skin flaps, congestion from head positioning, and adequate intraoperative eye protection may reduce the risk or allow faster management.
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Síndromes Compartimentais/etiologia , Craniotomia/efeitos adversos , Descompressão Cirúrgica/efeitos adversos , Pré-Escolar , Síndromes Compartimentais/cirurgia , Epilepsia/cirurgia , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgiaRESUMO
Abstract: The pronounced dry season determines the characteristics of the semiarid region of Brazil. Numerous small reservoirs are built to overcome this condition, accumulating multiple uses and causing important changes in the landscape and the local biota. Considering the limited amount of information about the malacofauna of reservoirs, mainly in the Northeast region of the country, this inventory provides a list of mollusks from three important reservoirs located in the city of São Julião, state of Piauí. The collections were carried out monthly between May/2017 and April/2018, sampling a total of 11,149 mollusks, corresponding to the species Melanoides tuberculata (Müller, 1774) (n = 9,724), Biomphalaria straminea (Dunker, 1848) (n = 1,361) and Pomacea lineata (Spix, 1827) (n = 64). The richness of mollusks from the three reservoirs was low, similar to those described in studies conducted in other regions of Northeast Brazil. There was a significant difference in the abundance of M. tuberculata and B. straminea among the studied reservoirs. These environments are not connected and are installed in urban and rural areas, presenting different ecological conditions. The relationship between the human population and the reservoirs, associated with the lack of sanitation, increases the risks of spreading waterborne diseases besides the development of environmental imbalance by the introduction of exotic species.
Resumo: O período de seca pronunciado marca a região semiárida brasileira. Para superação dessa condição inúmeros reservatórios de pequeno porte são construídos, acumulando múltiplos usos e causando alterações importantes na paisagem e na biota local. Considerando as poucas informações sobre a malacofauna de reservatórios, principalmente na região nordeste do país, este trabalho apresenta o inventário das espécies de moluscos provenientes de três importantes reservatórios localizados no município de São Julião, estado do Piauí. As coletas foram realizadas mensalmente entre os meses de maio/2017 e abril/2018. Foi amostrado um total de 11.149 moluscos, correspondentes as espécies Melanoides tuberculata (Müller, 1774) (n=9,724), Biomphalaria straminea (Dunker, 1848) (n=1,361) e Pomacea lineata (Spix, 1827) (n=64). A riqueza de moluscos amostrados nos três reservatórios foi baixa, não diferindo daquelas descritas em estudos realizados em outras regiões do Nordeste do Brasil. Houve diferença significativa na abundância de M. tuberculata e B. straminea entre os reservatórios estudados os quais não são conectados e encontram-se instalados em áreas urbana e rurais, com condições ambientais distintas. A relação entre a população humana da região e os reservatórios, juntamente com a falta de saneamento representam riscos à propagação de doenças transmitidas pela água e desequilíbrio ambiental pela introdução de espécies exóticas.
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PURPOSE: To evaluate macular edema after uncomplicated phacoemulsification with implantation of intraocular lens by spectral domain optical coherence tomography (OCT). METHODS: Prospective study was conducted in 62 eyes of patients underwent phacoemulsification with implantation of intraocular lens. Patients were evaluated before surgery and after surgery at day 1, week 1, week 2 and week 4. Visual acuity (VA), anterior chamber cells and 200 x 200 macular cube optical coherence tomography were measured. RESULTS: After phacoemulsification there was an improvement in visual acuity, decreasing inflammation, and increased macular thickness and macular volume. There was one case of cystoid macular edema. There was a weak inverse correlation between visual acuity and central macular thickness, and between visual acuity and macular volume. We observed a week direct correlation between inflammation and macular volume. CONCLUSION: Subclinical macular edema develops even after uncomplicated cataract surgery in patients not predisposed. The spectral domain optical coherence tomography was able to detect small increases in macular thickness in the study period.
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Implante de Lente Intraocular/métodos , Edema Macular/patologia , Facoemulsificação/métodos , Tomografia de Coerência Óptica/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Lentes Intraoculares , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Valores de Referência , Retina/patologia , Fatores de Tempo , Resultado do Tratamento , Acuidade VisualRESUMO
Abstract Objetive: To evaluate the association between sympathetic nervous system activity and blood pressure variability with central serous chorioretinopathy (CSC). Methods: We performed an individual, observational, and cross-sectional study involving 11 patients with CSC and 16 healthy individuals in similar age range. Participants underwent spectral power analysis of heart rate variability (HRV) at the Hypertension Department of Heart Institute at the University of São Paulo. Results: We demonstrated sympathetic activity predominance in CSC group and found that the LF (low frequency) of heart rate variability was significantly higher in this group (p = 0.04). when compared to control group. The CSC group's mean LF / HF (high frequency) ratio was higher than the control group but was not statistically significant (p = 0.2). Blood pressure variability was higher in CSC patients than in normal patients (p = 0.055), whereas heart rate variability was lower in these patients when compared to normal patients, although no statistical significance was found (p = 0.2). Spontaneous baroreflex function was significantly reduced in patients with CSC when compared to healthy individuals (p = 0.04). Conclusion: Autonomic dysfunction and a predominance of sympathetic modulation were observed in CSC patients.
Resumo Objetivo: Avaliar a associação entre a atividade do sistema nervoso simpático e a variabilidade da pressão arterial com a coriorretinopatia serosa central (CSC). Métodos: Estudo individuado, observacional e transversal envolvendo 11 pacientes com CSC e 16 indivíduos saudáveis de idade semelhante. Os participantes foram submetidos à análise de poder espectral da variabilidade da freqüência cardíaca no Departamento de Hipertensão do Instituto do Coração da Universidade de São Paulo. Resultados: Observamos o predomínio da atividade simpática no grupo com CSC, evidenciado pelo LF da variabilidade da freqüência cardíaca significativamente maior neste grupo (P = 0.04) quando comparado ao grupo controle. A média da relação LF / HF e a variabilidade da pressão arterial foram maiores nos pacientes com CSC do que nos pacientes normais (P = 0,2 e P = 0,055, respectivamente), enquanto a variabilidade da freqüência cardíaca foi menor nesses pacientes quando comparados aos pacientes normais (P = 0,2), embora não tenha sido encontrada significância estatística. A função barorreflexa espontânea também foi significativamente reduzida nos pacientes com CSC quando comparados aos indivíduos saudáveis (P= 0,04). Conclusão: Concluímos que há sinais de disfunção autonômica e predomínio da modulação simpática nos pacientes com CSC.