Analysis of spatial and demographic factors associated with chikungunya in Espírito Santo state, Brazil.

BACKGROUND: Chikungunya (CHIK) emerged in Brazil in 2014 and since then several epidemics have been observed. This study aims to describe the spatial, social and demographic characteristics of individuals affected by CHIK in Espírito Santo state. METHODS: A cross-sectional study was performed using data from individuals with a confirmed diagnosis of CHIK in Espírito Santo state, Brazil, from 2018 to 2020. Monthly incidence was calculated and annual spatial distribution maps were constructed. Statistical analysis using the χ2 test identified associations between disease occurrence and sociodemographic variables. RESULTS: In the period and area analysed, a CHIK epidemic occurred in 2020, with an incidence of 219.8 cases per 100 000 inhabitants. The southern and central regions of Espirito Santo state harboured a risk five times greater than the others in the epidemic region. Females (odds ratio [OR] 1.65 [95% confidence interval {CI} 1.58 to 1.72]), black people (OR 1.22 [95% CI 1.13 to 1.33]), individuals with ≤11 y of education (OR 1.48 [95% CI 1.37 to 1.61]) and the elderly (OR 7.49 [95% CI 6.53 to 8.59]) had a greater risk for the disease. CONCLUSIONS: CHIK stands as an emerging public health problem in Brazil since its introduction in 2014. Espírito Santo suffered a substantial epidemic in 2020, possibly due to outbreaks in neighbouring states. The population at risk should be prioritized in healthcare, considering the morbidity potential of the disease.

Diagnostic criteria and case definitions for abdominal angiostrongyliasis: a systematic review from the Brazilian experience.

Although rare, Angiostrongylus costaricensis infection may be a more prevalent etiology of inflammatory bowel disease than ulcerative colitis and Chron's disease in endemic areas in Central and South America. The present study reviewed the occurrence of A. costaricensis in Brazil, its clinical presentation and pathology; and proposed diagnostic criteria and case definitions for abdominal angiostrongyliasis (AA). Southern and southeastern Brazilian regions are the main endemic areas, and AA affects both genders and all age groups. A review of all 23 published reports of 51 Brazilian patients highlighted the following features that were subsequently classified as minor diagnostic criteria: abdominal pain, palpable mass in the right lower abdominal quadrant, history of exposure, ileocecal tumor, and intestinal perforation with wall thickening. Proposed major criteria include right lower quadrant abdominal pain, blood eosinophilia, positive serology (antibody detection), intense eosinophilic infiltration that involves all strata of the intestinal wall, eosinophilic granulomatous reaction, and eosinophilic vasculitis. In addition to the definitions of suspected and possible cases according to increasing strength of evidence of this infection, demonstration of worms/eggs/larvae in tissues or Angiostrongylus DNA in tissues or serum are required for a confirmed diagnosis. The application of the proposed criteria and definitions may improve patient management, epidemiologic surveillance, and identification of new endemic areas.

Factors associated with hospitalization in the acute phase of Chikungunya.

OBJECTIVE: Determine characteristics associated with hospitalization in the acute phase of Chikungunya. METHODS: Cross-sectional study including data on Chikungunya cases reported in Vitória, Espírito Santo state, Brazil, between March 2016 and December 2021. RESULTS: Hospitalizations accounted for 1.42% (n = 41) of the 2,868 cases included. There were statistically significant differences between hospitalized and non-hospitalized regarding age (P 0.001), which was lower among hospitalized patients, and pregnancy, which was more frequent in the hospitalized group (P 0.010). Patients younger than two years old and older than 65 years corresponded to 31.7% of hospitalizations. Back pain (OR = 0.134; 95% CI = 0.044-0.409) and arthralgia (OR = 0.226; 95% CI = 0.083-0.613) were protective factors for hospitalization. CONCLUSION: Groups at risk of severe Chikungunya, including those under two and over 65 years of age, may require more hospitalization, even with milder manifestations.

Prognostic Factors and Markers in Non-Small Cell Lung Cancer: Recent Progress and Future Challenges.

Lung cancer is a highly aggressive neoplasm and, despite the development of recent therapies, tumor progression and recurrence following the initial response remains unsolved. Several questions remain unanswered about non-small cell lung cancer (NSCLC): (1) Which patients will actually benefit from therapy? (2) What are the predictive factors of response to MAbs and TKIs? (3) What are the best combination strategies with conventional treatments or new antineoplastic drugs? To answer these questions, an integrative literature review was carried out, searching articles in PUBMED, NCBI-PMC, Google Academic, and others. Here, we will examine the molecular genetics of lung cancer, emphasizing NSCLC, and delineate the primary categories of inhibitors based on their molecular targets, alongside the main treatment alternatives depending on the type of acquired resistance. We highlighted new therapies based on epigenetic information and a single-cell approach as a potential source of new biomarkers. The current and future of NSCLC management hinges upon genotyping correct prognostic markers, as well as on the evolution of precision medicine, which guarantees a tailored drug combination with precise targeting.

The impact of COVID-19 on maternal death and fetal death, a cohort study in Brazil.

OBJECTIVE: The study aimed to evaluate the risk of maternal death and fetal death among pregnant women infected with SARS-CoV-2. METHODS: This is a retrospective cohort study among pregnant women with secondary data from the National Live Births System (Sistema Nacional de Nascidos Vivos), National Mortality System (Sistema Nacional de Mortalidade), and e-SUS Health Surveillance System (Sistema e-SUS Vigilância em Saúde). Pregnant women confirmed for COVID-19 had positive RT-PCR between March 2020 and May 2021, pregnant women without COVID-19 were those without notification for disease. Maternal death, fetal death, and stillbirth were assessed as primary outcomes. RESULTS: We included 68,673 pregnant women not notified as suspected of COVID-19 and 1,386 with a confirmed diagnosis of COVID-19. Among pregnant women with COVID-19, 1013 (73.0%) were aged 20 to 34 years, 655 (47.2%) were brown, 907 (65.4%) had ≥ 8 years of education, in the third trimester of pregnancy (41.5%), undergoing cesarean section (64.5%). In adjusted analyses, COVID-19 in pregnancy had a higher risk of maternal death (relative risk [RR] 18.73-95% confidence interval [95%CI] 11.07-31.69), fetal death/stillbirth (RR 1.96-95%CI 1.18-3.25), preterm birth [RR 1.18-95%CI 1.01-1.39], cesarean delivery (RR 1.07-95%CI 1.02-1.11), and cesarean delivery occurring before the onset of labor (RR 1.33-95%CI 1.23-1.44). CONCLUSION: COVID-19 may contribute to unfavorable pregnancy outcomes. Results showed that pregnant women infected with SARS-CoV-2 had a higher risk of maternal death, fetal death/stillbirth, preterm birth, cesarean delivery, and cesarean section occurring before the onset of labor.

Translational Bioinformatics Applied to the Study of Complex Diseases.

Translational Bioinformatics (TBI) is defined as the union of translational medicine and bioinformatics. It emerges as a major advance in science and technology by covering everything, from the most basic database discoveries, to the development of algorithms for molecular and cellular analysis, as well as their clinical applications. This technology makes it possible to access the knowledge of scientific evidence and apply it to clinical practice. This manuscript aims to highlight the role of TBI in the study of complex diseases, as well as its application to the understanding and treatment of cancer. An integrative literature review was carried out, obtaining articles through several websites, among them: PUBMED, Science Direct, NCBI-PMC, Scientific Electronic Library Online (SciELO), and Google Academic, published in English, Spanish, and Portuguese, indexed in the referred databases and answering the following guiding question: "How does TBI provide a scientific understanding of complex diseases?" An additional effort is aimed at the dissemination, inclusion, and perpetuation of TBI knowledge from the academic environment to society, helping the study, understanding, and elucidating of complex disease mechanics and their treatment.

Achieving herd immunity in South America.

South America, once an epicenter of COVID-19, has stayed on the road of continued management of the pandemic. The region initially struggled to cope with the pandemic as it experienced spiraling numbers of infections and overwhelmed public health systems. South America has risen in its pandemic response to be the region with the highest global vaccination rate. The region posed a strong vaccination drive, with over 76% of its population fully vaccinated with the initial protocol. South America leveraged its deeply rooted vaccination culture and public health confidence among its population. Herd immunity is an integral concept in population infectious disease management. Attaining herd immunity is presently not feasible with available vaccines, but the high vaccination rate in the region depicts the acceptance of vaccination as a strategy for population protection. The availability of effective transmission-blocking vaccines, the continuous implementation of strategies that will enable the undisrupted supply of the vaccines, equity in access to the vaccines, improved vaccine acceptance, and trust in the vaccination and public health systems will help shepherd the region towards herd immunity. Local vaccine production backed with investment in infrastructure and international collaboration for research and knowledge development will also drive population safety.

Back to Where It Was First Described: Vectors of Sylvatic Yellow Fever Transmission in the 2017 Outbreak in Espírito Santo, Brazil.

Evidence of sylvatic yellow fever was first reported in Atlantic Forest areas in Espírito Santo, Brazil, during a yellow fever virus (YFV) outbreak in 1931. An entomological survey was conducted in six forest sites during and after an outbreak reported ~80 years after the last case in the area. Among 10,658 mosquitoes of 78 species, Haemagogus leucocelaenus, and Hg. janthinomys/capricornii were considered the main vectors as they had a relatively high abundance, co-occurred in essentially all areas, and showed high YFV infection rates. Sabethes chloropterus, Sa. soperi, Sa. identicus, Aedes aureolineatus, and Shannoniana fluviatilis may have a secondary role in transmission. This is the first report of Sa. identicus, Ae. aureolineatus, and Sh. fluviatilis infected with YFV. Our study emphasizes the importance of entomological monitoring and maintenance of high vaccination coverage in receptive areas to YFV transmission.

The Joint Initiative for Teaching and Learning on Global Health Challenges and One Health experience on implementing an online collaborative course.

The "Joint Initiative for Teaching and Learning on Global Health Challenges and One Health" piloted the online course "Global Health Challenges and One Health in 2021. The present work documents this experience, lessons learned, and the future outlook of the course. A descriptive study was conducted based on the evaluations performed with the enrolled students and course coordinators. Of 30 enrolled students from graduate programs of six institutions from Brazil, Germany, Mozambique, and Kosovo, two unenrolled, and nine failed for not completing the activities. Therefore, 19 (63%) students completed the course. Some challenges identified were language and technology access barriers, difficulty scheduling group meetings due to different time zones, and high workload per credit in some institutions. Activities in groups conducted synchronously, such as debates, journal clubs, and case studies, were highlighted as those with higher impact in the learning process, having more participation of students when carried in small groups. Some students reported the establishment of research and work partnerships with other participants from partner institutions. The experience reinforces the importance of international exchange to improve collaboration between institutions and the impact of working in small interprofessional groups to develop technical, intercultural, and interdisciplinarity competencies necessary to human resources working with the One Health approach. The success of such international educational initiatives depends on overcoming barriers to implementation, which can be detected in institutional and course levels. Therefore, continuing evaluation of the course and improvements must be performed and involve all participants.

From the Approach to the Concept: One Health in Latin America-Experiences and Perspectives in Brazil, Chile, and Colombia.

Professionals throughout the world have been working to assess the interdisciplinary interaction and interdependence between health and wellbeing in a constantly changing environment. The One Health concept was developed to encourage sustainable collaborative partnerships and to promote optimal health for people, animals, plants, the environment, and the whole planet. The dissemination of scientific discoveries and policies, by working directly with diverse communities, has been one of the main goals for Global One Health. The One Health concept has also been referred or related to as "One Medicine, One Medicine-One Health, One World-One Health, EcoHealth," and Planetary Health," depending on each fundamental view and approach. In Latin America, despite the concept still being discussed among health professionals and educators, several One Health initiatives have been used daily for more than decades. One Health action has been applied especially in rural and underserved urban areas where low socioeconomic status, lack of health professionals, and scarcity of medical resources may require professionals to work together. Local communities from diverse social and economic statuses, including indigenous populations have been working with institutions and social organizations for many years, accomplishing results through grassroots movements. These "bottom-up" socio-community approaches have also been tools for the prevention and control of diseases, such practice has preceded the One Health concepts in Latin American countries. It is strongly believed that collaborative, multidisciplinary, political, and economic initiatives with prosocial focus may become investments toward obtaining significant results in the face of global, economic and health challenges; working for a healthier world with inclusivity, equity, and equality. In this study, it is briefly presented how the One Health approach has been initiated and developed in Latin America, highlighting the events and actions taken in Brazil, Chile, and Colombia.

Creating a platform to enable collaborative learning in One Health: The Joint Initiative for Teaching and Learning on Global Health Challenges and One Health experience.

The "Joint Initiative for Teaching and Learning on Global Health Challenges and One Health" targets education and training in Global Health Challenges and One Health, focusing on surpassing issues that affect One Health training programs. The present work describes the planning, implementation, and challenges to develop an international educational initiative among six partner institutions from four different countries, to build a collaborative teaching and learning environment. The course applies collaborative online international learning principles and is addressed to graduate students of universities from Brazil, Germany, Mozambique, and Kosovo. A pilot curriculum was developed with modules on intercultural competence, interprofessional and collaborative practice in One Health; One Health; healthcare, surveillance, and One Health; bioethics in One Health and careers in Global Health. The course combines synchronous and asynchronous activities developed in groups by mixing students from different institutions and countries. Forty-four experts from 22 institutions of the Americas, Africa, Europe, and Asia collaborated with the course content. Some challenges to implementing the course were the different criteria to assign credits across institutions, the lack of bibliographic material across all partners, limited overlap hours and periods for synchronous activities, and short semester overlap across institutions. Despite the challenges for implementation, the entire process of planning and delivering the course involves intense international collaboration, contributing to the curriculum internationalization, benefiting all institutions involved, promoting exchange even in the challenging scenario of the pandemic of coronavirus disease 2019 (COVID-19).

Impact of concurrent epidemics of dengue, chikungunya, zika, and COVID-19.

INTRODUCTION: This study evaluated the epidemiological implications of arbovirus infections and coronavirus disease (COVID-19) co-occurrences in Espírito Santo, Brazil. METHODS: This ecological study of dengue, chikungunya, zika, and COVID-19 was performed from January 1 to July 31, 2020. RESULTS: Espírito Santo registered 44,614, 8,092, 3,138, and 91,483 cases of dengue, chikungunya, zika, and COVID-19, respectively (January-July, 2020). In the 27 and four municipalities with a high incidence of dengue and chikungunya, respectively, the incidence of COVID-19 was 647.0-3,721.7 and 1,787.2-3,403.0 cases per 100,000 inhabitants, respectively. CONCLUSIONS: Espírito Santo experienced an overlap of epidemics, especially in urban areas.

Atlantic Forest Malaria: A Review of More than 20 Years of Epidemiological Investigation.

In the south and southeast regions of Brazil, cases of malaria occur outside the endemic Amazon region near the Atlantic Forest in some coastal states, where Plasmodium vivax is the recognized parasite. Characteristics of cases and vectors, especially Anopheles (Kerteszia) cruzii, raise the hypothesis of a zoonosis with simians as reservoirs. The present review aims to report on investigations of the disease over a 23-year period. Two main sources have provided epidemiological data: the behavior of Anopheles vectors and the genetic and immunological aspects of Plasmodium spp. obtained from humans, Alouatta simians, and Anopheles spp. mosquitoes. Anopheles (K.) cruzii is the most captured species in the forest canopy and is the recognized vector. The similarity between P. vivax and Plasmodium simium and that between Plasmodium malariae and Plasmodium brasilianum shared between simian and human hosts and the involvement of the same vector in the transmission to both hosts suggest interspecies transfer of the parasites. Finally, recent evidence points to the presence of Plasmodium falciparum in a silent cycle, detected only by molecular methods in asymptomatic individuals and An. (K.) cruzii. In the context of malaria elimination, it is paramount to assemble data about transmission in such non-endemic low-incidence areas.

Impact of concurrent epidemics of dengue, chikungunya, zika, and COVID-19

Abstract INTRODUCTION: This study evaluated the epidemiological implications of arbovirus infections and coronavirus disease (COVID-19) co-occurrences in Espírito Santo, Brazil. METHODS: This ecological study of dengue, chikungunya, zika, and COVID-19 was performed from January 1 to July 31, 2020. RESULTS: Espírito Santo registered 44,614, 8,092, 3,138, and 91,483 cases of dengue, chikungunya, zika, and COVID-19, respectively (January-July, 2020). In the 27 and four municipalities with a high incidence of dengue and chikungunya, respectively, the incidence of COVID-19 was 647.0-3,721.7 and 1,787.2-3,403.0 cases per 100,000 inhabitants, respectively. CONCLUSIONS: Espírito Santo experienced an overlap of epidemics, especially in urban areas.

First report of Aedes albopictus infected by Dengue and Zika virus in a rural outbreak in Brazil.

In Brazil, Dengue (DENV) and Zika (ZIKV) viruses are reported as being transmitted exclusively by Aedes aegypti in urban settings. This study established the vectors and viruses involved in an arbovirus outbreak that occurred in 2019 in a rural area of Espírito Santo state, Brazil. Mosquitoes collected were morphologically identified, sorted in samples, and submitted to molecular analysis for arboviruses detection. Phylogenetic reconstruction was performed for the viral sequence obtained. All 393 mosquitoes were identified as Aedes albopictus. DENV-1 genotype V was present in one sample and another sample was positive for ZIKV. The DENV-1 clustered with viruses that have circulated in previous years in large urban centers of different regions in Brazil. This is the first report of A. albopictus infected by DENV and ZIKV during an outbreak in a rural area in Brazil, indicating its involvement in arboviral transmission. The DENV-1 strain found in the A. albopictus was not new in Brazil, being involved previously in epidemics related to A. aegypti, suggesting the potential to A. albopictus in transmitting viruses already circulating in the Brazilian population. This finding also indicates the possibility of these viruses to disperse across urban and rural settings, imposing additional challenges for the control of the diseases.

Horta terapêutica e saúde bucal: desafios na utilização de plantas medicinais na promoção da saúde / Therapeutic gardens and oral health: challenges in the use of medicinal plants in health promotion

Resumo A inserção de hortas terapêuticas no SUS fomenta o cuidado compartilhado e incentiva promissoras abordagens terapêuticas para saúde bucal, pois transporta para o centro as práticas populares em saúde. Isso implica reorganizar os serviços adotando como eixo a Clínica Ampliada. Estudos nessa esfera justificam-se pela necessidade de conhecer experiências desenvolvidas nos territórios. Relata-se o trabalho desenvolvido de março a agosto de 2017 numa Unidade Básica de Saúde do município de Vitória-ES. As experiências e efeitos dos processos de trabalho foram cartografados com a equipe de saúde bucal e usuários, a partir da construção de uma horta na Estratégia da Saúde da Família. Adotaram-se como eixos metodológicos: produção de diário de campo e realização de entrevistas semiestruturadas. A investigação produziu dispositivos de análise coletiva dos processos de trabalho e das práticas de formação, que expressam ainda incompatibilidades entre o perfil profissional demandado para estruturação da Clínica Ampliada e os reais processos de trabalho em Odontologia. Assim, compreender a construção da horta como dispositivo de criação de redes de cuidado implica delinear práticas ricas em interlocuções interdisciplinares e elaborar novas concepções de atuação em saúde bucal e possibilidades para a Atenção Primária.

Abstract The insertion of therapeutic gardens in SUS fosters shared care and encourages promising therapeutic approaches to oral health, as it transports popular health practices to the center. This implies reorganizing the services using the Extended Clinic as an axis. Studies in this sphere are justified by the need to know experiences developed in the territories. The work carried out from March to August 2017 in a Basic Health Unit in Vitória-ES is reported. The experiences and effects of the work processes were mapped with the oral health team and users, from the construction of a vegetable garden in the Family Health Strategy. The methodological axes were adopted: production of field diaries and conducting semi-structured interviews. The investigation produced devices for collective analysis of work processes and training practices, which also express incompatibilities between the professional profile required for structuring the Amplified Clinic and the real work processes in Dentistry. Thus, understanding the construction of the garden as a device for creating care networks implies outlining practices rich in interdisciplinary dialogue and developing new concepts of performance in oral health and possibilities for Primary Care.