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2.
Neonatology ; 117(6): 742-749, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33429398

RESUMO

INTRODUCTION: Apgar scoring in modern practice has extended beyond the original described remit by Virginia Apgar, including prognostication. Prognostic value of Apgar scoring in preterm populations is unsupported by robust evidence. OBJECTIVES: We aimed to identify the association between mortality or a composite mortality/major morbidity outcome in preterm infants with 1-min, 5-min, and sum 1 + 5-min Apgar scores. METHODS: Seven-year retrospective data was analysed on neonates born <32 weeks gestation in a regional neonatal centre. Co-primary outcomes were mortality and composite mortality/major morbidity. Adjusted odds ratios (aOR) were estimated using multivariable logistic regression analysis. RESULTS: 394 infants were included in the analysis. In neonates born <28 weeks gestation, no significant association was found between Apgar scores and the co-primary outcomes. In neonates born ≥28 weeks, low 1-min (aOR 10.452 [1.273, 85.835] for scores 4-6, 22.173 [2.666, 184.438] for scores 0-3), 5-min (4.724 [1.616, 13.806] for scores 4-6, 11.178 [1.803, 69.299] for scores 0-3), and sum 1 + 5-min Apgar scores (12.447 [2.674, 57.941] for scores 4-6, 55.960 [8.333, 375.804] for scores 0-3) were associated with significantly increased aOR of mortality. Increased aOR of composite mortality/major morbidity were also seen in neonates with moderately low (4-6) Apgar scores (aOR 3.104 [1.522, 6.328] for 1 min, 2.804 [1.406, 5.594] for 5 min, and 3.232 [1.769, 5.905] for 1 + 5 min). CONCLUSIONS: Apgar scoring at 1 and 5 min has limited prognostic accuracy for extremely preterm infants but is prognostic in older infants. Sum Apgar scores, a measure of initial condition and response to resuscitation, may be a better predictor of mortality than individual scores.


Assuntos
Mortalidade Infantil , Lactente Extremamente Prematuro , Idoso , Índice de Apgar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Morbidade , Estudos Retrospectivos
3.
Proc Natl Acad Sci U S A ; 115(50): E11790-E11797, 2018 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-30478041

RESUMO

Over the last few years, genomic studies on Yersinia pestis, the causative agent of all known plague epidemics, have considerably increased in numbers, spanning a period of about 5,000 y. Nonetheless, questions concerning historical reservoirs and routes of transmission remain open. Here, we present and describe five genomes from the second half of the 14th century and reconstruct the evolutionary history of Y. pestis by reanalyzing previously published genomes and by building a comprehensive phylogeny focused on strains attributed to the Second Plague Pandemic (14th to 18th century). Corroborated by historical and ecological evidence, the presented phylogeny, which includes our Y. pestis genomes, could support the hypothesis of an entry of plague into Western European ports through distinct waves of introduction during the Medieval Period, possibly by means of fur trade routes, as well as the recirculation of plague within the human population via trade routes and human movement.


Assuntos
Pandemias/história , Peste/história , Yersinia pestis/genética , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Europa (Continente)/epidemiologia , Evolução Molecular , Fósseis/microbiologia , Genoma Bacteriano , História Medieval , Humanos , Filogenia , Peste/epidemiologia , Peste/microbiologia , Polimorfismo de Nucleotídeo Único , Fatores de Tempo , Yersinia pestis/classificação
4.
Proc Natl Acad Sci U S A ; 115(41): 10422-10427, 2018 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-30249639

RESUMO

Louse-borne relapsing fever (LBRF) is known to have killed millions of people over the course of European history and remains a major cause of mortality in parts of the world. Its pathogen, Borrelia recurrentis, shares a common vector with global killers such as typhus and plague and is known for its involvement in devastating historical epidemics such as the Irish potato famine. Here, we describe a European and historical genome of Brecurrentis, recovered from a 15th century skeleton from Oslo. Our distinct European lineage has a discrete genomic makeup, displaying an ancestral oppA-1 gene and gene loss in antigenic variation sites. Our results illustrate the potential of ancient DNA research to elucidate dynamics of reductive evolution in a specialized human pathogen and to uncover aspects of human health usually invisible to the archaeological record.


Assuntos
Proteínas de Bactérias/genética , Borrelia/genética , Genoma Bacteriano , Metagenômica , Febre Recorrente/genética , Adulto , Animais , Borrelia/classificação , Borrelia/patogenicidade , Criança , Feminino , História do Século XV , Humanos , Filogenia , Febre Recorrente/história , Febre Recorrente/microbiologia , Países Escandinavos e Nórdicos
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