Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 29
Filtrar
Mais filtros

Base de dados
Tipo de documento
Intervalo de ano de publicação
1.
Proc Natl Acad Sci U S A ; 120(23): e2217398120, 2023 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-37252955

RESUMO

We investigate the underlying distribution of orbital eccentricities for planets around early-to-mid M dwarf host stars. We employ a sample of 163 planets around early- to mid-M dwarfs across 101 systems detected by NASA's Kepler Mission. We constrain the orbital eccentricity for each planet by leveraging the Kepler lightcurve together with a stellar density prior, constructed using metallicity from spectroscopy, Ks magnitude from 2MASS, and stellar parallax from Gaia. Within a Bayesian hierarchical framework, we extract the underlying eccentricity distribution, assuming alternately Rayleigh, half-Gaussian, and Beta functions for both single- and multi-transit systems. We described the eccentricity distribution for apparently single-transiting planetary systems with a Rayleigh distribution with [Formula: see text], and for multitransit systems with [Formula: see text]. The data suggest the possibility of distinct dynamically warmer and cooler subpopulations within the single-transit distribution: The single-transit data prefer a mixture model composed of two distinct Rayleigh distributions with [Formula: see text] and [Formula: see text] over a single Rayleigh distribution, with 7:1 odds. We contextualize our findings within a planet formation framework, by comparing them to analogous results in the literature for planets orbiting FGK stars. By combining our derived eccentricity distribution with other M dwarf demographic constraints, we estimate the underlying eccentricity distribution for the population of early- to mid-M dwarf planets in the local neighborhood.

2.
N Engl J Med ; 386(13): 1244-1253, 2022 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-35353962

RESUMO

BACKGROUND: In most of the Americas, the recommended treatment to prevent relapse of Plasmodium vivax malaria is primaquine at a total dose of 3.5 mg per kilogram of body weight, despite evidence of only moderate efficacy. METHODS: In this trial conducted in Brazil, we evaluated three primaquine regimens to prevent relapse of P. vivax malaria in children at least 5 years of age and in adults with microscopy-confirmed P. vivax monoinfection. All the patients received directly observed chloroquine for 3 days (total dose, 25 mg per kilogram). Group 1 received a total primaquine dose of 3.5 mg per kilogram (0.5 mg per kilogram per day) over 7 days with unobserved administration; group 2 received the same regimen as group 1 but with observed administration; and group 3 received a total primaquine dose of 7.0 mg per kilogram over 14 days (also 0.5 mg per kilogram per day) with observed administration. We monitored the patients for 168 days. RESULTS: We enrolled 63 patients in group 1, 96 in group 2, and 95 in group 3. The median age of the patients was 22.4 years (range, 5.4 to 79.8). By day 28, three P. vivax recurrences were observed: 2 in group 1 and 1 in group 2. By day 168, a total of 70 recurrences had occurred: 24 in group 1, 34 in group 2, and 12 in group 3. No serious adverse events were noted. On day 168, the percentage of patients without recurrence was 58% (95% confidence interval [CI], 44 to 70) in group 1, 59% (95% CI, 47 to 69) in group 2, and 86% (95% CI, 76 to 92) in group 3. Survival analysis showed a difference in the day 168 recurrence-free percentage of 27 percentage points (97.5% CI, 10 to 44; P<0.001) between group 1 and group 3 and a difference of 27 percentage points (97.5% CI, 12 to 42; P<0.001) between group 2 and group 3. CONCLUSIONS: The administration of primaquine at a total dose of 7.0 mg per kilogram had higher efficacy in preventing relapse of P. vivax malaria than a total dose of 3.5 mg per kilogram through day 168. (Supported by the U.S. Agency for International Development; ClinicalTrials.gov number, NCT03610399.).


Assuntos
Antimaláricos , Cloroquina , Malária Vivax , Primaquina , Adolescente , Adulto , Idoso , Antimaláricos/administração & dosagem , Antimaláricos/efeitos adversos , Antimaláricos/uso terapêutico , Brasil , Criança , Pré-Escolar , Cloroquina/administração & dosagem , Cloroquina/efeitos adversos , Cloroquina/uso terapêutico , Terapia Diretamente Observada , Relação Dose-Resposta a Droga , Esquema de Medicação , Humanos , Malária Vivax/tratamento farmacológico , Malária Vivax/prevenção & controle , Pessoa de Meia-Idade , Primaquina/administração & dosagem , Primaquina/efeitos adversos , Primaquina/uso terapêutico , Recidiva , Prevenção Secundária , Adulto Jovem
3.
Emerg Infect Dis ; 26(9): 2196-2200, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32818406

RESUMO

We evaluated the performance of X-bar chart, exponentially weighted moving average, and C3 cumulative sums aberration detection algorithms for acute diarrheal disease syndromic surveillance at naval sites in Peru during 2007-2011. The 3 algorithms' detection sensitivity was 100%, specificity was 97%-99%, and positive predictive value was 27%-46%.


Assuntos
Vigilância da População , Vigilância de Evento Sentinela , Algoritmos , Surtos de Doenças , Eletrônica , Peru/epidemiologia , Sensibilidade e Especificidade
4.
J Infect Dis ; 219(8): 1234-1242, 2019 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-30517651

RESUMO

BACKGROUND: Norovirus is a leading cause of acute gastroenteritis worldwide. Routine norovirus diagnosis requires stool collection. The goal of this study was to develop and validate a noninvasive method to diagnose norovirus to complement stool diagnostics and to facilitate studies on transmission. METHODS: A multiplex immunoassay to measure salivary immunoglobulin G (IgG) responses to 5 common norovirus genotypes (GI.1, GII.2, GII.4, GII.6, and GII.17) was developed. The assay was validated using acute and convalescent saliva samples collected from Peruvian children <5 years of age with polymerase chain reaction (PCR)-diagnosed norovirus infections (n = 175) and controls (n = 32). The assay sensitivity and specificity were calculated to determine infection status based on fold rise of salivary norovirus genotype-specific IgG using norovirus genotype from stool as reference. RESULTS: The salivary assay detected recent norovirus infections and correctly assigned the infecting genotype. Sensitivity was 71% and specificity was 96% across the evaluated genotypes compared to PCR-diagnosed norovirus infection. CONCLUSIONS: This saliva-based assay will be a useful tool to monitor norovirus transmission in high-risk settings such as daycare centers or hospitals. Cross-reactivity is limited between the tested genotypes, which represent the most commonly circulating genotypes.


Assuntos
Infecções por Caliciviridae/diagnóstico , Saliva/virologia , Anticorpos Antivirais/imunologia , Infecções por Caliciviridae/epidemiologia , Infecções por Caliciviridae/virologia , Estudos de Casos e Controles , Pré-Escolar , Fezes/virologia , Humanos , Imunoglobulina G/imunologia , Norovirus/genética , Norovirus/imunologia , Peru/epidemiologia , Curva ROC , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Saliva/imunologia , Sensibilidade e Especificidade
5.
Clin Infect Dis ; 66(12): 1858-1863, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29309577

RESUMO

Background: Sapovirus is one of the primary viral causes of acute gastroenteritis (AGE), especially where rotavirus vaccination has been implemented. The characteristics and impact of natural infection at the community level, however, have not been well documented. Methods: Stool samples were analyzed from 100 children randomly selected from a community-based birth cohort study in Peru. All diarrheal and 1 nondiarrheal stools collected trimonthly from children up to age 2 years (n = 1669) were tested for sapovirus detection. Viral shedding duration was determined by testing additional weekly samples (n = 440) collected before and after a sapovirus-positive sample. Results: The incidence of sapovirus infection in the first and second years of life was 4.3 and 11.1 per 100 child-months, respectively. By age 2 years, 82% of children had at least 1 sapovirus infection, and 64% had at least 1 sapovirus-associated diarrhea episode. The median shedding period was 18.5 days. In 112 of 175 infections, 14 genotypes from 4 genogroups (GI, GII, GIV, and GV) were determined. Among genogroups, GI were more frequently found in symptomatic infections than in asymptomatic infections (odds ratio, 3.1; 95% confidence interval, 1.3-7.4). Fifty-nine children had serial sapovirus infections, but only 3 had repeated infection of the same genotype. Conclusions: Sapovirus was frequently detected in children with AGE at the community level during the first 2 years of life. Serial sapovirus infections by multiple genotypes in a child suggest genotype-specific immunity from each infection, which needs to be taken into account for vaccine development.


Assuntos
Infecções por Caliciviridae/epidemiologia , Diarreia/virologia , Gastroenterite/epidemiologia , Gastroenterite/virologia , Sapovirus/isolamento & purificação , Estudos de Coortes , Diarreia/epidemiologia , Fezes/virologia , Feminino , Genótipo , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Peru/epidemiologia , Filogenia , Saúde Pública , Eliminação de Partículas Virais
6.
MMWR Morb Mortal Wkly Rep ; 67(14): 424-431, 2018 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-29649190

RESUMO

Malaria infection during pregnancy is associated with an increased risk for maternal and fetal complications. In the United States, treatment options for uncomplicated, chloroquine-resistant Plasmodium falciparum and P. vivax malaria in pregnant women are limited to mefloquine or quinine plus clindamycin (1). However, limited availability of quinine and increasing resistance to mefloquine restrict these options. Strong evidence now demonstrates that artemether-lumefantrine (AL) (Coartem) is effective and safe in the treatment of malaria in pregnancy. The World Health Organization (WHO) has endorsed artemisinin-based combination therapies (ACTs), such as AL, for treatment of uncomplicated malaria during the second and third trimesters of pregnancy and is currently considering whether to add ACTs, including AL, as an option for malaria treatment during the first trimester (2,3). This policy note reviews the evidence and updates CDC recommendations to include AL as a treatment option for uncomplicated malaria during the second and third trimesters of pregnancy and during the first trimester of pregnancy when other treatment options are unavailable. These updated recommendations reflect current evidence and are consistent with WHO treatment guidelines.


Assuntos
Antimaláricos/uso terapêutico , Artemisininas/uso terapêutico , Etanolaminas/uso terapêutico , Fluorenos/uso terapêutico , Malária/tratamento farmacológico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Combinação Arteméter e Lumefantrina , Centers for Disease Control and Prevention, U.S. , Combinação de Medicamentos , Feminino , Humanos , Gravidez , Estados Unidos
7.
Pediatr Rev ; 44(3): 182-184, 2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-36854827
8.
Nature ; 482(7384): 195-8, 2011 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-22186831

RESUMO

Since the discovery of the first extrasolar giant planets around Sun-like stars, evolving observational capabilities have brought us closer to the detection of true Earth analogues. The size of an exoplanet can be determined when it periodically passes in front of (transits) its parent star, causing a decrease in starlight proportional to its radius. The smallest exoplanet hitherto discovered has a radius 1.42 times that of the Earth's radius (R(⊕)), and hence has 2.9 times its volume. Here we report the discovery of two planets, one Earth-sized (1.03R(⊕)) and the other smaller than the Earth (0.87R(⊕)), orbiting the star Kepler-20, which is already known to host three other, larger, transiting planets. The gravitational pull of the new planets on the parent star is too small to measure with current instrumentation. We apply a statistical method to show that the likelihood of the planetary interpretation of the transit signals is more than three orders of magnitude larger than that of the alternative hypothesis that the signals result from an eclipsing binary star. Theoretical considerations imply that these planets are rocky, with a composition of iron and silicate. The outer planet could have developed a thick water vapour atmosphere.

9.
J Clin Microbiol ; 54(6): 1598-1604, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27076657

RESUMO

Human sapovirus has been shown to be one of the most important etiologies in pediatric patients with acute diarrhea. However, very limited data are available about the causative roles and epidemiology of sapovirus in community settings. A nested matched case-control study within a birth cohort study of acute diarrhea in a peri-urban community in Peru from 2007 to 2010 was conducted to investigate the attributable fraction (AF) and genetic diversity of sapovirus. By quantitative reverse transcription-real-time PCR (qPCR) sapovirus was detected in 12.4% (37/299) of diarrheal and 5.7% (17/300) of nondiarrheal stools (P = 0.004). The sapovirus AF (7.1%) was higher in the second year (13.2%) than in the first year (1.4%) of life of children. Ten known genotypes and one novel cluster (n = 5) within four genogroups (GI, GII, GIV, and GV) were identified by phylogenetic analysis of a partial VP1 gene. Further sequence analysis of the full VP1 gene revealed a possible novel genotype, tentatively named GII.8. Notably, symptomatic reinfections with different genotypes within the same (n = 3) or different (n = 5) genogroups were observed in eight children. Sapovirus exhibited a high attributable burden for acute gastroenteritis, especially in the second year of life, of children in a Peruvian community. Further large-scale studies are needed to understand better the global burden, genetic diversity, and repeated infections of sapovirus.


Assuntos
Infecções por Caliciviridae/epidemiologia , Infecções por Caliciviridae/virologia , Gastroenterite/epidemiologia , Gastroenterite/virologia , Sapovirus/isolamento & purificação , Estudos de Casos e Controles , Estudos de Coortes , Diarreia/epidemiologia , Diarreia/virologia , Feminino , Genótipo , Humanos , Lactente , Recém-Nascido , Masculino , Peru/epidemiologia , Filogenia , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Recidiva , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sapovirus/classificação , Sapovirus/genética , Análise de Sequência de DNA , População Suburbana
10.
J Pept Sci ; 22(10): 622-627, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27501347

RESUMO

Orthogonal protection of amino acid side chains in solid phase peptide synthesis allows for selective deprotection of side chains and the formation of cyclic peptides on resin. Cyclizations are useful as they may improve the activity of the peptide or improve the metabolic stability of peptides in vivo. One cyclization method often used is the formation of a lactam bridge between an amine and a carboxylic acid. It is desirable to perform the cyclization on resin as opposed to in solution to avoid unwanted side reactions; therefore, a common strategy is to use -Alloc and -OAllyl protecting groups as they are compatible with Fmoc solid phase peptide synthesis conditions. Alloc and -OAllyl may be removed using Pd(PPh3 )4 and phenylsilane in DMF. This method can be problematic as the reaction is most often performed at room temperature under argon gas. It is not usually done at higher temperatures because of the fear of poisoning the palladium catalyst. As a result, the reaction is long and reagent-intensive. Herein, we report the development of a method in which the -Alloc/-OAllyl groups are removed using a microwave synthesizer under atmospheric conditions. The reaction is much faster, allowing for the removal of the protecting groups before the catalyst is oxidized, as well as being less reagent-intensive. This method of deprotection was tested using a variety of amino acid sequences and side chain protecting groups, and it was found that after two 5-min deprotections at 38°C, all -Alloc and -OAllyl groups were removed with >98% purity. Copyright © 2016 European Peptide Society and John Wiley & Sons, Ltd.


Assuntos
Fluorenos/química , Peptídeos Cíclicos/síntese química , Técnicas de Síntese em Fase Sólida/métodos , Sequência de Aminoácidos , Ácidos Carboxílicos/química , Catálise , Ciclização , Ésteres , Lactamas/química , Micro-Ondas , Paládio/química , Peptídeos Cíclicos/isolamento & purificação , Silanos/química
11.
Curr Opin Infect Dis ; 28(5): 408-16, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26237546

RESUMO

PURPOSE OF REVIEW: We highlight recent advances relevant to understanding norovirus infections in the tropics, both in populations living in developing settings and travelers to these regions. RECENT FINDINGS: Because of the decrease in diarrheal disease associated with the global rollout of vaccines against rotavirus, norovirus is emerging as the predominant cause of diarrhea morbidity among children in the tropics, and evidence suggests that it contributes to adult disease in endemic populations and travelers. In addition to identifying potential target populations for preventive measures, we provide an update on norovirus vaccine development and concepts related to their implementation in low-income and middle-income countries. SUMMARY: These current concepts related to norovirus-attributable disease burden, clinical significance, and economic impact can potentially be applied to tailoring efforts to prevent and mitigate the effects of this important enteropathogen.


Assuntos
Infecções por Caliciviridae , Gastroenterite , Norovirus , Viagem , Diarreia , Humanos , Vacinas Virais
12.
Transp Res Rec ; 2471: 1-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-27773963

RESUMO

This study provides new public health data about U.S. civil air shows. Risk factors for fatalities in civil air show crashes were analyzed. The value of the FIA score in predicting fatal outcomes was evaluated. With the use of the FAA's General Aviation and Air Taxi Survey and the National Transportation Safety Board's data, the incidence of civil air show crashes from 1993 to 2013 was calculated. Fatality risk factors for crashes were analyzed by means of regression methods. The FIA index was validated to predict fatal outcomes by using the factors of fire, instrument conditions, and away-from-airport location, and was evaluated through receiver operating characteristic (ROC) curves. The civil air show crash rate was 31 crashes per 1,000 civil air events. Of the 174 civil air show crashes that occurred during the study period, 91 (52%) involved at least one fatality; on average, 1.1 people died per fatal crash. Fatalities were associated with four major risk factors: fire [adjusted odds ratio (AOR) = 7.1, 95% confidence interval (CI) = 2.4 to 20.6, P < .001], pilot error (AOR = 5.2, 95% CI = 1.8 to 14.5, P = .002), aerobatic flight (AOR = 3.6, 95% CI = 1.6 to 8.2, P = .002), and off-airport location (AOR = 3.4, 95% CI = 1.5 to 7.5, P = .003). The area under the FIA score's ROC curve was 0.71 (95% CI = 0.64 to 0.78). Civil air show crashes were marked by a high risk of fatal outcomes to pilots in aerobatic performances but rare mass casualties. The FIA score was not a valid measurement of fatal risk in civil air show crashes.

13.
Aviat Space Environ Med ; 85(2): 160-6, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24597160

RESUMO

The U.S. Title 14 Code of Federal Regulations defines commercial air tours as "flight[s] conducted for compensation or hire in an airplane or helicopter where a purpose of the flight is sightseeing." The incidence of air tour crashes in the United States is disproportionately high relative to similar commercial aviation operations, and air tours operating under Part 91 governance crash significantly more than those governed by Part 135. This paper reviews the government and industry response to four specific areas of air tour safety concern: surveillance of flight operations, pilot factors, regulatory standardization, and maintenance quality assurance. It concludes that the government and industry have successfully addressed many of these tenet issues, most notably by: advancing the operations surveillance infrastructure through implementation of en route, ground-based, and technological surveillance methods; developing Aeronautical Decision Making and cue-based training programs for air tour pilots; consolidating federal air tour regulations under Part 136; and developing public-private partnerships for raising maintenance operating standards and improving quality assurance programs. However, opportunities remain to improve air tour safety by: increasing the number and efficiency of flight surveillance programs; addressing pilot fatigue with more restrictive flight hour limitations for air tour pilots; ensuring widespread uptake of maintenance quality assurance programs, especially among high-risk operators not currently affiliated with private air tour safety programs; and eliminating the 25-mile exception allowing Part 91 operators to conduct commercial air tours without the safety oversight required of Part 135 operators.


Assuntos
Acidentes Aeronáuticos/prevenção & controle , Aviação , Segurança/normas , Aviação/legislação & jurisprudência , Humanos , Manutenção/normas , Parcerias Público-Privadas , Controle de Qualidade , Segurança/legislação & jurisprudência , Gestão da Segurança , Estados Unidos
14.
Aviat Space Environ Med ; 84(11): 1172-7, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24279231

RESUMO

INTRODUCTION: Hot-air balloon tours are FAR Part 91-governed balloon rides conducted for compensation or hire. Part 91, General Aviation, in general involves the least strict federal regulations and accounts for the majority of aviation crashes and fatalities. METHODS: National Transportation Safety Board reports of hot-air balloon tour crashes in the United States from 2000 through 2011 were read and analyzed. RESULTS: During the 12-yr period, 78 hot-air balloon tours crashed, involving 518 occupants. There were 91 serious injuries and 5 fatalities; 83% of crashes resulted in one or more serious or fatal outcomes. Of the serious injuries characterized, 56% were lower extremity fractures. Most crashes (81%) occurred during landing; 65% involved hard landings. Fixed object collisions contributed to 50% of serious injuries and all 5 fatalities. During landing sequences, gondola dragging, tipping, bouncing, and occupant ejection were associated with poor outcomes. Of the crashes resulting in serious or fatal outcomes, 20% of balloons were significantly damaged or destroyed. DISCUSSION: The incidence of morbidity and mortality is high among hot-air balloon tour crashes, and the proportion of balloon crashes attributed to paid rides appears to have increased over time. In addition to examining the role of restraint systems, personal protective equipment, and power line emergency procedures in ballooning, injury prevention efforts should target factors such hard landings, object strikes, gondola instability, and occupant ejections, which are associated with balloon injuries and deaths. Crash outcomes may also improve with vehicle engineering that enables balloons themselves to absorb impact forces.


Assuntos
Acidentes Aeronáuticos/estatística & dados numéricos , Atividades de Lazer , Dispositivos de Proteção da Cabeça , Humanos , Estados Unidos
15.
Pediatrics ; 149(1)2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34918158

RESUMO

OBJECTIVES: To inform next steps in pediatric diarrhea burden reduction by understanding the shifting enteropathogen landscape after rotavirus vaccine implementation. METHODS: We conducted a case-control study of 1788 medically attended children younger than 5 years, with and without gastroenteritis, after universal rotavirus vaccine implementation in Peru. We tested case and control stools for 5 viruses, 19 bacteria, and parasites; calculated coinfection-adjusted attributable fractions (AFs) to determine pathogen-specific burdens; and evaluated pathogen-specific gastroenteritis severity using Clark and Vesikari scales. RESULTS: Six pathogens were independently positively associated with gastroenteritis: norovirus genogroup II (GII) (AF 29.1, 95% confidence interval [CI]: 28.0-32.3), rotavirus (AF 8.9, 95% CI: 6.8-9.7), sapovirus (AF 6.3, 95% CI: 4.3-7.4), astrovirus (AF 2.8, 95% CI: 0.0-4.0); enterotoxigenic Escherichia coli heat stable and/or heat labile and heat stable (AF 2.4, 95% CI: 0.6-3.1), and Shigella spp. (AF 2.0, 95% CI: 0.4-2.2). Among typeable rotavirus cases, we most frequently identified partially heterotypic strain G12P[8] (54 of 81, 67%). Mean severity was significantly higher for norovirus GII-positive cases relative to norovirus GII-negative cases (Vesikari [12.7 vs 11.8; P < .001] and Clark [11.7 vs 11.4; P = .016]), and cases in the 6- to 12-month age range relative to cases in other age groups (Vesikari [12.7 vs 12.0; P = .0002] and Clark [12.0 vs 11.4; P = .0016]). CONCLUSIONS: Norovirus is well recognized as the leading cause of pediatric gastroenteritis in settings with universal rotavirus vaccination. However, sapovirus is often overlooked. Both norovirus and sapovirus contribute significantly to the severe pediatric disease burden in this setting. Decision-makers should consider multivalent vaccine acquisition strategies to target multiple caliciviruses in similar countries after successful rotavirus vaccine implementation.


Assuntos
Gastroenterite/microbiologia , Gastroenterite/prevenção & controle , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus , Estudos de Casos e Controles , Pré-Escolar , Diarreia/microbiologia , Diarreia/prevenção & controle , Diarreia/virologia , Fezes/microbiologia , Fezes/virologia , Gastroenterite/parasitologia , Gastroenterite/virologia , Genótipo , Humanos , Norovirus/genética , Peru , Estudos Prospectivos , Rotavirus/genética , Sapovirus/genética , Índice de Gravidade de Doença
16.
Pract Midwife ; 14(1): 37-41, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21323088

RESUMO

Nausea and vomiting in pregnancy (NVP) is commonplace, with many midwives frequently counselling women in their care. But how do midwives know when NVP becomes pathological? Although hyperemesis gravidarum (HEG) is less common, midwives must be able to recognise and differentiate between these two conditions, especially as HEG has the potential to have a detrimental effect on maternal and fetal wellbeing. The physiological impact of HEG is well documented but what often goes unacknowledged is the psychological, social, occupational and familial impact it also has on a woman's life. Knowledge about the aetiology of HEG and treatment options available is essential but a timely initial diagnosis is paramount. For this to occur the midwife must be skilled in history taking, clinical examination and utilisation of serum blood tests--specifically electrolytes and urea. An understanding of how electrolyte levels can cause pathology is vital if the midwife wishes to interpret blood tests for women with this condition.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Hiperêmese Gravídica/sangue , Hiperêmese Gravídica/enfermagem , Tocologia/métodos , Papel do Profissional de Enfermagem , Relações Enfermeiro-Paciente , Feminino , Humanos , Hiperêmese Gravídica/diagnóstico , Hiperêmese Gravídica/prevenção & controle , Capacitação em Serviço/métodos , Tocologia/educação , Diagnóstico de Enfermagem/métodos , Pesquisa em Educação em Enfermagem , Gravidez , Cuidado Pré-Natal/métodos
17.
J Neurosci Methods ; 343: 108857, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32652184

RESUMO

Animal models have significantly contributed to the understanding of reward-related behaviors, such as in Substance Use Disorder research. One of the most heavily utilized paradigms to date is conditioned place preference (CPP). However, CPP is limited by non-contingent exposure. Our new method advances this classic method by utilizing its benefits and simultaneously diminishing its limitations. We used a traditional 3-compartment CPP apparatus, where each chamber differs by both visual and tactile contexts. We restructured the apparatus allowing for insertion of bottles so that mice could orally self-administer sucrose or morphine-containing solutions in a specific context. Our results show that mice who self-administer sucrose or morphine show a place preference for the sucrose- or morphine-paired chamber. This place preference lasts for 21 d in sucrose-treated, but not morphine-treated mice. Additionally, we found that that mice will drink more water in the morphine-paired context during extinction tests. This model combines the distinct contextual cues associated with conditioned place preference and combines them with voluntary self-administration, thus enabling researchers to measure behavior using a model that incorporates spatial memory involved in affective states, while also providing a quantifiable readout of context/environment-specific drug seeking. In conclusion, we combined CPP and voluntary intake to establish a novel technique to assess not only preference for a context associated with rewarding stimuli (natural or drug), but also seeking, retention, and locomotor activity. This model can be further utilized to examine other drugs of abuse, extinction training, other learning models, or to allow for the assessment of neurobiological manipulations.


Assuntos
Comportamento de Procura de Droga , Recompensa , Animais , Condicionamento Clássico , Sinais (Psicologia) , Camundongos , Morfina/farmacologia
18.
Vaccine ; 38(10): 2292-2297, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-32019702

RESUMO

Vaccine implementation planning in low- and middle-income countries (LMIC) often focuses on children without considering special adult populations. We adapted an economic model developed by the United States Department of Defense (DoD) to evaluate the cost-effectiveness of vaccine acquisition strategies for Campylobacter-, ETEC-, Shigella-, and norovirus-associated gastroenteritis. We compared implementation costs with current medical management in the Peruvian armed forces, a special population of low- and middle-income (LMIC) adults with a high incidence of infectious gastroenteritis. Pathogen-specific vaccine implementation resulted in calculated cost-effectiveness ratio (CER) per duty day lost averted (CERDDL) of $13,741; $1,272; $301; and $803, and a CER per diarrhea day averted of $2,130; $215; $51; and $199 for Campylobacter, ETEC, Shigella, and norovirus, respectively. These estimates compare favorably to CERDDL estimates from high-income military population and suggest that implementing vaccines gastroenteritis may be cost-effective in the Peruvian military population.


Assuntos
Análise Custo-Benefício , Gastroenterite/prevenção & controle , Militares , Vacinas/economia , Adulto , Países em Desenvolvimento , Gastroenterite/economia , Humanos , Modelos Econômicos , Peru
19.
Am J Trop Med Hyg ; 99(2): 331-337, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29869605

RESUMO

Cutaneous leishmaniasis is endemic to South America where diagnosis is most commonly conducted via microscopy. Patients with suspected leishmaniasis were referred for enrollment by the Ministry of Health (MoH) in Lima, Iquitos, Puerto Maldonado, and several rural areas of Peru. A 43-question survey requesting age, gender, occupation, characterization of the lesion(s), history of leishmaniasis, and insect-deterrent behaviors was administered. Polymerase chain reaction (PCR) was conducted on lesion materials at the Naval Medical Research Unit No. 6 in Lima, and the results were compared with those obtained by the MoH using microscopy. Factors associated with negative microscopy and positive PCR results were identified using χ2 test, t-test, and multivariate logistic regression analyses. Negative microscopy with positive PCR occurred in 31% (123/403) of the 403 cases. After adjusting for confounders, binary multivariate logistic regression analyses revealed that negative microscopy with positive PCR was associated with patients who were male (adjusted odds ration [OR] = 1.93 [1.06-3.53], P = 0.032), had previous leishmaniasis (adjusted OR = 2.93 [1.65-5.22], P < 0.0001), had larger lesions (adjusted OR = 1.02 [1.003-1.03], P = 0.016), and/or had a longer duration between lesion appearance and PCR testing (adjusted OR = 1.12 [1.02-1.22], P = 0.017). Future research should focus on further exploration of these underlying variables, discovery of other factors that may be associated with negative microscopy diagnosis, and the development and implementation of improved testing in endemic regions.


Assuntos
Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/epidemiologia , Microscopia/normas , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , DNA de Protozoário/genética , Feminino , Humanos , Lactente , Recém-Nascido , Leishmania/genética , Leishmania/isolamento & purificação , Masculino , Microscopia/métodos , Pessoa de Meia-Idade , Peru/epidemiologia , Reação em Cadeia da Polimerase , Prevalência , Vigilância de Evento Sentinela , Inquéritos e Questionários , Adulto Jovem
20.
Am J Trop Med Hyg ; 99(3): 723-728, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30014825

RESUMO

In the Americas, 8 million people are infected with Chagas disease, and an additional 90 million people are at risk for infection. Little is known about the role bats play in the sylvatic transmission cycle of Trypanosoma cruzi, the parasite causing Chagas disease. Here, we captured bats in the villages of Palmiche, Pachacutec, Nuevo San Martin, and Mayuriaga located in the Datem del Marañon Province in Loreto, Peru. Venous blood samples were collected by cardiac puncture or from the upper extremities, and trypanosomatids were identified by microscopy and molecularly. We collected blood samples from 121 bats on filter paper for molecular studies and 111 slides for microscopic examination of thin and thick blood smears from 16 different bat species. The prevalence of trypanosomatids in all bats species was 34.7% (42/121) and the prevalence of T. cruzi was 4.1% (5/121). In hematophagous bat species, the prevalence of trypanosomatids and T. cruzi was 36.9% (27/73) and 2.7% (2/73), respectively. In non-hematophagous bats, the prevalences of trypanosomatids and T. cruzi were 31.2% (15/48) and 6.2% (3/48), respectively. Also, we confirm the presence of T. cruzi in salivary glands of hematophagous bats Diaemus youngi. These results suggest a sylvatic cycle of trypanosomatid transmission in which bats may harbor infectious T. cruzi parasites that could be transmitted to humans via hematophagous bat bites or salivary contamination by non-hematophagous bats of vegetables consumed by humans.


Assuntos
Quirópteros/parasitologia , Glândulas Salivares/parasitologia , Trypanosoma cruzi/isolamento & purificação , Animais , Quirópteros/classificação , Feminino , Masculino , Peru
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA