Wells syndrome following vaccination: A pediatric case with positive patch test to gelatin.

We report a 12-month-old boy with a skin eruption that developed 15 days after receiving the measles, mumps, rubella (MMR), pneumococcal, and meningococcal vaccines, consistent with the diagnosis of Wells syndrome. Patch testing showed a positive reaction to gelatin, which is used as a stabilizer for both live and inactivated vaccines. Gelatin was only present in the MMR vaccine.

In vivo mutagenic effects and oxidative stress parameters evaluation of cypermethrin and benzoate of emamectin and their mixtures in female mice.

We evaluated the biological effects of ingestion by gavage, for 28 days, of the pesticides cypermethrin (CP) and emamectin benzoate (EB) and their mixtures in female Swiss mice. The groups were Control (water); CP; EB and three distinct concentrations of CP and EB mixture expressed in mg/kg/day. The biological effects were analyzed in the complete blood count and plasma (alkaline phosphatase (ALP), alanine aminotransferase (ALT) and creatinine); the biochemical parameters of oxidative stress (substances reactive to thiobarbituric acid (TBARS); reduced glutathione (GSH); catalase (CAT), superoxide dismutase (SOD) and glutathione-S-transferase (GST)), and bone marrow cells obtained from the femur for the micronucleus (MN) test. In the heart, there was a reduction in GSH in the groups (0.5 + 0.67 and 2.5 + 3.37), although in the brain this effect appeared for the other groups, except EB. Brain TBARS increased in CP and in the group (2.5 + 3.37) and platelets increased in the group (12.5 + 16.87). Genotoxic/mutagenic effects, showing a consistent increase dose-dependent effect on micronucleus counting for in the female mice. After 28 days of treatment, we can observe that the pesticide mixtures promoted genotoxic damage and oxidative brain damage in female mice, which can damage the health of these animals and possibly their future offspring.

Trichomonas vaginalis as a risk factor for human papillomavirus: a study with women undergoing cervical cancer screening in a northeast region of Brazil.

BACKGROUND: Human papillomavirus (HPV) and Trichomonas vaginalis (TV) infections are the most common sexually transmitted infections (STIs) globally. The latter has contributed to a variety of adverse outcomes for both sexes. Moreover, in Brazil, epidemiological studies on patients with STIs are limited. Therefore, this study aimed to determine the prevalence of TV and its association with HPV in women undergoing cervical cancer screening. METHODS: Women with a normal cervix were recruited from a community-based cervical cancer screening program. Gynecological examinations were conducted, and questionnaires were provided. Vaginal canal and uterine cervix samples were collected for cytological examinations (reported using the 2001 Bethesda System) and tested for the presence of TV and HPV DNA. RESULTS: In total, 562 women who attended public primary healthcare were included in the study. The T. vaginalis was present in 19.0% (107) and HPV DNA was present in 46.8% (263) of women. Among the women of TV 73.8% (79) had a co-infection with HPV (p = 0.001). CONCLUSIONS: We concluded that a TV infection is associated with an HPV infection of the cervix as well as with the cervical cytological abnormalities. Further studies could reveal the mechanisms by which these two organisms interact at the cellular level, with control for shared behavioral risk factors.

Physiotherapy in nursing homes. A qualitative study of physiotherapists' views and experiences.

BACKGROUND: There are distinct differences in the implementation of physiotherapeutic care in nursing homes. Both nationally and internationally staffing levels of physiotherapy differ significantly between and within nursing homes. Since legislation or guidelines that specify the parameters of physiotherapy required in nursing homes are lacking, it is unknown how physiotherapists currently estimate the usefulness and necessity of physiotherapy in individual situations in long-term care. The purpose of this study was to describe how physiotherapists actually work, and how they want to work, in daily practice in Dutch nursing homes. METHODS: We performed a qualitative study with an online questionnaire. We asked 72 physiotherapists working in Dutch nursing homes to describe as accurately as possible usual care in nine different cases in long-term care. Furthermore we asked them to describe their role in the prevention and treatment of a number of indicators that measure the quality of care in nursing homes. Two reviewers thematically analysed the answers to the questionnaires. RESULTS: Forty-six physiotherapists returned the questionnaire. Physiotherapy services include active exercise therapy aimed to improve mobility and movement dysfunctions, advising on prevention and management of falls, pressure ulcers, incontinence, malnutrition and sarcopenia, overweight, physical restraints, intertrigo, chronic wounds, behavioural and psychological symptoms in dementia, and physical inactivity, and ergonomic and behavioural training. The way and extent in which physiotherapists are involved in the various care- and functional problems differs and depends on organisational and personal factors such as, organisation's policy, type of ward, time pressure, staffing level, collaboration with other members of the multidisciplinary team, or lack of knowledge. CONCLUSION: Physiotherapists in nursing homes are involved in the prevention and management of different care situations and functional problems. The way in which they are involved differs between physiotherapist. Aiming for more uniformity seems necessary. A shared vision can help physiotherapists to work more consistently and will strengthen their position in nursing homes.

Role of HPV 16 variants among cervical carcinoma samples from Northeastern Brazil.

BACKGROUND: Cervical cancer is the fourth most common type of cancer affecting women globally. In Brazil, it is the third most frequent type of cancer in women and HPV is present in approximately 90% of cases. Evidence suggests that variants of HPV 16 can interfere biologically and etiologically during the development of cervical cancer. METHODS: Cervix tumor fragments were collected, their DNA was extracted, and nested PCR was used to detect HPV. Positive samples were sequenced to determine the viral genotype. To characterize the HPV 16 strains, positive samples PCR was used to amplify the LCR and E6 regions of the HPV 16 virus. RESULTS: Data from 120 patients with cervical cancer were analyzed. Most women were between 41 and 54 years of age, had schooling until primary school, a family income between 1 and 2 times the minimum wage and were married/in a consensual union. There was no statistically significant association between HPV or socio-demographic variables and risk factors for cervical cancer (P <  0.05). HPV was present in 88 women (73%). The most prevalent types were HPV 16 (53.4%), HPV 18 (13.8%), HPV 35 (6.9%) and HPV 45 (5.7%). Of the 47 HPV 16 positive cases, variant A (49%) was present in 23 samples, followed by variant D in 20 cases (43%), and variants B and C in 2 cases each (4%). The most prevalent histological type of HPV 16 tumors was squamous cell carcinoma, followed by adenocarcinoma. There was a statistically significant association between HPV 16 variants and the tumors' histological types (P <  0.001). CONCLUSIONS: Knowledge of HPV 16 variants will provide data on their influence on the pathological and oncogenic aspects of cervical lesions.

Drought monitoring in the Brazilian Semiarid region.

Drought is a natural and recurrent phenomenon. It is considered 'a natural disaster' whenever it occurs in an intensive manner in highly populated regions, resulting in significant damage (material and human) and loss (socioeconomic). This paper presents the efforts developed to monitor the impact of drought in the semiarid region of Northeast Brazil. In this scope, information from different sources is compiled to support the evaluation and identification of impacted municipalities, with the main objective of supporting emergency actions to mitigate their impact. In the semiarid region of Brazil there are frequent occurrences of dry periods during the rainy season, which, depending on the intensity and duration, can cause significant damage to family-farmed crops, with a farming system characterized by low productivity indices. However, rain-fed agriculture has great economic expression and high social importance due to the region is densely occupied, and contributes to the establishment of communities in the countryside. Specifically, in the present study, the methodology adopted to monitor the impact of agricultural droughts, including an analysis of the hydrological year 2015-2016, is presented, considering different water stress indicators for the identification of the affected municipalities and assessment of the methods and tools developed.

Climatic characteristics of the 2010-2016 drought in the semiarid Northeast Brazil region.

This study discusses the climatological aspects of the most severe drought ever recorded in the semiarid region Northeast Brazil. Droughts are recurrent in the region and while El Nino has driven some of these events others are more dependent on the tropical North Atlantic sea surface temperature fields. The drought affecting this region during the last 5 years shows an intensity and impact not seen in several decades in the regional economy and society. The analysis of this event using drought indicators as well as meteorological fields shows that since the middle 1990s to 2016, 16 out of 25 years experienced rainfall below normal. This suggests that the recent drought may have in fact started in the middle-late 1990s, with the intense droughts of 1993 and 1998, and then the sequence of dry years (interrupted by relatively wet years in 2007, 2008, 2009 and 2011) after that may have affected the levels of reservoirs in the region, leading to a real water crisis that was magnified by the negative rainfall anomalies since 2010.

Dynamic of CSF and serum biomarkers in HIV-1 subtype C encephalitis with CNS genetic compartmentalization-case study.

Despite the effective suppression of viremia with antiretroviral therapy, HIV can still replicate in the central nervous system (CNS). This was a longitudinal study of the cerebrospinal fluid (CSF) and serum dynamics of several biomarkers related to inflammation, the blood-brain barrier, neuronal injury, and IgG intrathecal synthesis in serial samples of CSF and serum from a patient infected with HIV-1 subtype C with CNS compartmentalization.The phylogenetic analyses of plasma and CSF samples in an acute phase using next-generation sequencing and F-statistics analysis of C2-V3 haplotypes revealed distinct compartmentalized CSF viruses in paired CSF and peripheral blood mononuclear cell samples. The CSF biomarker analysis in this patient showed that symptomatic CSF escape is accompanied by CNS inflammation, high levels of cell and humoral immune biomarkers, CNS barrier dysfunction, and an increase in neuronal injury biomarkers with demyelization. Independent and isolated HIV replication can occur in the CNS, even in HIV-1 subtype C, leading to compartmentalization and development of quasispecies distinct from the peripheral plasma. These immunological aspects of the HIV CNS escape have not been described previously. To our knowledge, this is the first report of CNS HIV escape and compartmentalization in HIV-1 subtype C.

Multi-criteria decision analysis and spatial statistic: an approach to determining human vulnerability to vector transmission of Trypanosoma cruzi.

BACKGROUND: Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, is a neglected human disease. It is endemic to the Americas and is estimated to have an economic impact, including lost productivity and disability, of 7 billion dollars per year on average. OBJECTIVES: To assess vulnerability to vector-borne transmission of T. cruzi in domiciliary environments within an area undergoing domiciliary vector interruption of T. cruzi in Colombia. METHODS: Multi-criteria decision analysis [preference ranking method for enrichment evaluation (PROMETHEE) and geometrical analysis for interactive assistance (GAIA) methods] and spatial statistics were performed on data from a socio-environmental questionnaire and an entomological survey. In the construction of multi-criteria descriptors, decision-making processes and indicators of five determinants of the CD vector pathway were summarily defined, including: (1) house indicator (HI); (2) triatominae indicator (TI); (3) host/reservoir indicator (Ho/RoI); (4) ecotope indicator (EI); and (5) socio-cultural indicator (S-CI). FINDINGS: Determination of vulnerability to CD is mostly influenced by TI, with 44.96% of the total weight in the model, while the lowest contribution was from S-CI, with 7.15%. The five indicators comprise 17 indices, and include 78 of the original 104 priority criteria and variables. The PROMETHEE and GAIA methods proved very efficient for prioritisation and quantitative categorisation of socio-environmental determinants and for better determining which criteria should be considered for interrupting the man-T. cruzi-vector relationship in endemic areas of the Americas. Through the analysis of spatial autocorrelation it is clear that there is a spatial dependence in establishing categories of vulnerability, therefore, the effect of neighbors' setting (border areas) on local values should be incorporated into disease management for establishing programs of surveillance and control of CD via vector. CONCLUSIONS: The study model proposed here is flexible and can be adapted to various eco-epidemiological profiles and is suitable for focusing anti-T. cruzi serological surveillance programs in vulnerable human populations.

Assessment of trends, variability and impacts of droughts across Brazil over the period 1980-2019.

Drought indices are a numerical representation of drought conditions aimed to provide quantitative assessments of the magnitude, spatial extent, timing, and duration of drought events. Since the adverse effects of droughts vary according to the characteristics of the event, the socioeconomic vulnerabilities, exposed communities or environments, there is a profusion of drought indicators to assess drought impacts in different sectors. In this study, we evaluated the performance of two drought indices, the Standardized Precipitation Index-SPI and Standardized Precipitation Evapotranspiration Index-SPEI over Brazil derived from gridded meteorological information over the period 1980-2019. Firstly, we compared the gridded derived indices against the same indices derived from weather station data and available from a global dataset for time scales of 3, 6, 12, 24 months. Then we analyzed the spatio-temporal trends in SPI and SPEI time-series, which revealed statistically significant trends toward drier conditions across central Brazil for all time scales, though with more intensity for time scales of 12 months and larger. Trends were more significant in magnitude for SPEI than SPI, indicating an important role in the increase in evaporation, driven by increasingly higher temperatures. Finally, we demonstrated that climate signals are already having a disruptive effect on the country's energy security. Supplementary Information: The online version contains supplementary material available at 10.1007/s11069-022-05759-0.

Nickel Allergy After a Negative Test Result Following Nuss Procedure for Pectus Excavatum: a Case Report.

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HPV 18 variants in women with cervical cancer in Northeast Brazil.

BACKGROUND: Human Papillomavirus (HPV) is the main etiological factor for the development of cervical cancer. HPV 18 is the second most frequent type, accounting for up to 65% of all cases. HPV intratypic variation may influence the potential for progression to invasive cancer. The aim of this study was to evaluate the prevalence of human papillomavirus 18 intratypic variants in cervical cancer samples from women in the state of Maranhão, Brazil. METHODS: The study included 118 women over 18 years of age with a diagnosis of cervical cancer. Tumor fragments were collected and subjected to DNA extraction and Polymerase Chain Reaction (PCR) for HPV detection using the PGMY09/11 and GP+5/6 primers. Positive samples were submitted to automated sequencing for viral genotyping. To determine the HPV 18 lineages, positive samples were submitted to PCR, using specific primers to amplify the LCR and E6 regions of HPV 18 virus. RESULTS: HPV was present in 88 women (73.3%). Of those, 48 (54%) were HPV 16, the most prevalent, followed by 12 (13.6%) HPV 18. Histologically, squamous cell carcinoma was predominant (79.1%). Among the HPV 18 variants identified, 10 (80%) belonged to lineage A, and sublineages A1, A2, A3, and A4. Two (29%) HPV 18 B variant was also detected, with the sublineages B1 and B2. In this study, the C variant was not found. There was no statistically significant association between the HPV 18 lineages found and sociodemographic and lifestyle variables (p > 0.05). CONCLUSIONS: A higher frequency of HPV 16 and 18 were found in women with cervical cancer in the state of Maranhão, Brazil, with a high prevalence of the lineage A among women with HPV 18.

Acute generalized exanthematous pustulosis to amoxicillin associated with parvovirus B19 reactivation.

We report the case of a 22-year-old male patient with 2 episodes, 4 months apart, of acute generalized exanthematous pustulosis (AGEP) associated with oral intake of amoxicillin and simultaneous reactivation of parvovirus B19 infection proven by positive polymerase chain reaction test in the skin fragment and blood sample and elevation of the IgG antibodies titer. To our knowledge, this is the first report of AGEP resulting from the interaction between drug hypersensitivity and the reactivation of parvovirus B19. A combination of an immunological reaction to the drug and virus infection could be responsible for the clinical picture.

Erythema multiforme-like lesions revealing allergic contact dermatitis to exotic woods.

We report a 45-year old man who developed maculopapular exanthema on the inferior cervical folder, axillae and umbilicus, as well as erythema multiforme-like lesions on the wrists after the introduction in his work of pao ferro (Machaerium scleroxylon). Patch tests were positive to pao ferro and ebony. This case highlights the importance of patch tests for the confirmation of the culprit agent in occupational dermatoses and also to identify other occupational allergens that the patient should avoid. Tropical woods contain quinones that could explain the possible cross-reactions between woods belonging to different families.

Analysis of trend in mortality due to HIV/AIDS-defining and non-HIV/AIDS defining illnesses according to sociodemographic characteristics, by Federative Unit and Brazil, 2000-2018. / Análise da tendência da mortalidade por doenças definidoras e não definidoras de HIV/aids segundo características sociodemográficas, por Unidade da Federação e Brasil, 2000-2018.

OBJECTIVE: To analyze the temporal trend of mortality rate due to HIV/AIDS defining and non-HIV/AIDS defining illnesses in Brazil between 2000 and 2018. METHODS: This was an ecological time series study, using data from the Mortality Information System, in Brazil and the Federative Units. Trend analysis was performed by means of Prais-Winsten regression model, according to overall mortality rate, sex, age group, marital status and race/skin color. RESULTS: A total of 237,435 deaths were recorded in the period. In the country, defining illnesses showed higher rates (7.4 to 4.4 deaths/100,000 inhabitants in the period) than those observed among non-defining diseases (0.4 to 0.8 death/100,000 inhabitants in the period). It could be seen a decrease in overall mortality due to defining diseases (-6.3%; 95%CI -8.8;-3.8); while it increased due to non-defining diseases (11.0%; 95%CI 6.5;15.7). CONCLUSION: There was a change in HIV/AIDS mortality profile over the years, with a decrease in deaths due to HIV/AIDS-defining diseases.

Analysis of the trend of mortality from HIV/AIDS according to sociodemographic characteristics in Brazil, 2000 to 2018. / Análise da tendência da mortalidade por HIV/AIDS segundo características sociodemográficas no Brasil, 2000 a 2018.

This investigation analyzed the trend of HIV/AIDS mortality by sociodemographic characteristics in the Brazilian states from 2000 to 2018. This is an ecological study of time-series of standardized rates of mortality from AIDS overall, by gender, age group, marital status, and ethnicity/skin color, employing the Prais-Winsten generalized linear model. The results showed that the states with the highest rates were Rio Grande do Sul, Rio de Janeiro, São Paulo, and Santa Catarina. The trend was increasing in the North and Northeast. Men had higher rates than women and the general population. The most advanced age groups showed a growing trend. The analysis by marital status showed higher and growing rates among the unmarried. Blacks had higher rates, except for Paraná, with a mainly increasing trend. Mortality due to HIV/AIDS had different trends by sociodemographic characteristics, with a need for preventive and care actions for men, adults, older adults, unmarried, and black people due to the change in the mortality profile.

A investigação analisou a tendência da mortalidade por HIV/Aids segundo características sociodemográficas nos estados brasileiros entre 2000 e 2018. Estudo ecológico de série temporal das taxas padronizadas de mortalidade por Aids geral, por sexo, faixa etária, estado civil e raça/cor. Foi utilizado o modelo linear generalizado de Prais-Winsten. Os resultados do estudo evidenciaram que os estados com as maiores taxas foram Rio Grande do Sul, Rio de Janeiro, São Paulo e Santa Catarina. A tendência foi crescente nas regiões Norte e Nordeste. Os homens tiveram taxas mais elevadas quando comparados às mulheres e à população geral. Quanto às faixas etárias, as mais avançadas mostraram tendência a crescimento. A análise de acordo com o estado civil evidenciou taxas mais elevadas entre os não casados e tendência a crescimento concentrada nesta população. De acordo com raça/cor, identificou-se que os negros apresentaram maiores taxas, exceto no Paraná, e a tendência foi majoritariamente crescente. A mortalidade por HIV/Aids apresenta tendências distintas segundo as características sociodemográficas, verificando-se necessidade de ações de prevenção e cuidado aos homens, adultos, idosos, não casados e negros em vista de mudança no perfil da mortalidade.

Increased climate pressure on the agricultural frontier in the Eastern Amazonia-Cerrado transition zone.

Several large-scale drivers of both anthropogenic and natural environmental changes are interacting nonlinearly in the transition zone between eastern Amazonia and the adjacent Cerrado, considered to be another Brazilian agricultural frontier. Land-use change for agrobusiness expansion together with climate change in the transition zone between eastern Amazonia and the adjacent Cerrado may have induced a worsening of severe drought conditions over the last decade. Here we show that the largest warming and drying trends over tropical South America during the last four decades are observed to be precisely in the eastern Amazonia-Cerrado transition region, where they induce delayed wet-season and worsen severe drought conditions over the last decade. Our results evidence an increase in temperature, vapor pressure deficit, subsidence, dry-day frequency, and a decrease in precipitation, humidity, and evaporation, plus a delay in the onset of the wet season, inducing a higher risk of fire during the dry-to-wet transition season. These findings provide observational evidence of the increasing climatic pressure in this area, which is sensitive for global food security, and the need to reconcile agricultural expansion and protection of natural tropical biomes.

Etoricoxib-induced fixed drug eruption with positive lesional patch tests.

Fixed drug eruption (FDE) is most commonly associated with antibiotics, anticonvulsants, and nonnarcotic analgens, including nonsteroidal anti-inflammatory drugs (NSAIDs). However, the newer cyclooxygenase 2 (COX-2) inhibitors have been rarely reported to cause FDE. We report the case of a 52-year-old Caucasian woman with erythematous pruritic plaques on the neck, left forearm, and second finger of the right hand, healing with hyperpigmentation and recurring in the same locations. The patient was sporadically taking oral etoricoxib 90 mg for her back pain and noticed the relation between administration of the drug and skin lesions, the time interval decreasing progressively from 1 week to 30 minutes. No other signs, symptoms, or drug intake was mentioned. The patch tests with etoricoxib 1% and 5% in petrolatum were positive at the location of the lesions and negative on the back (nonlesional skin). Standard European and NSAID series were negative. Patch tests of 10 healthy controls with etoricoxib 1% and 5% in petrolatum were negative. After the avoidance of the drug, no relapse was mentioned. The patch test was reliable for the diagnosis of FDE, avoiding the need for subsequent oral provocation testing and therefore preventing the possible adverse effects. Despite being regarded as a safe drug, the occurrence of cutaneous adverse reactions to etoricoxib should be considered, especially in the setting of its increasing use in pain control.

Systemic allergic contact dermatitis to fiberglass in a factory worker of wind turbine blades.

Fiberglass is extensively used due to its properties of thermal, acoustic and electrical insulation, and also to reinforce other materials such as plastics. Irritant contact dermatitis to fiberglass is a well established occupational dermatose and is due to penetration of small fragments in the cornified layer of the skin. On the other hand, allergic contact dermatitis (ACD) is rare and is more often triggered by sensitivity to the additives and resins used in the manufacture of fiberglass products. We report a case of ACD to fiberglass in a factory worker of fiberglass reinforced products.

Severe onychodystrophy caused by allergic contact dermatitis to acrylates in artificial nails.

Acrylic resin monomers, especially acrylates and methacrylates, are well-known sensitizers responsible for allergic contact dermatitis mainly in the occupational setting. The most frequently affected professionals are dentists, orthopedic surgeons, manicurists, painting industry and fiberglass workers. The authors report the case of a 39-year-old healthy woman, a secretary, who developed severe onychodystrophy of all fingers, 1 week after the application of sculptured acrylic nails.