Impact of the COVID-19 pandemic on testing services for HIV, viral hepatitis and sexually transmitted infections in the WHO European Region, March to August 2020.

We present preliminary results of a coronavirus disease (COVID-19) impact assessment on testing for HIV, viral hepatitis and sexually transmitted infections in the WHO European Region. We analyse 98 responses from secondary care (n = 36), community testing sites (n = 52) and national level (n = 10). Compared to pre-COVID-19, 95% of respondents report decreased testing volumes during March-May and 58% during June-August 2020. Reasons for decreases and mitigation measures were analysed.

Infestação pelo mosquito Aedes albopictus em um Município da Região Oeste de Santa Catarina / Aedes albopictus mosquito infestation in a Municipality in the Western Region of the state of Santa Catarina

O mosquito Aedes albopictus possui ampla distribuição em regiões tropicais, bem como nos países de clima temperado e tem sido apontado pela literatura científica como importante para a saúde pública. Observa-se a carência de estudos acerca da infestação, dispersão e a associação da espécie com o grau de urbanização, criadouros, tipos de imóveis e sazonalidade. Este estudo teve como objetivos, dentre outros, analisar a evolução da infestação por A. albopictus ao longo de um gradiente de urbanização. O estudo teve como referência geográfica o município de Chapecó (SC). Para avaliar a dispersão e a flutuação populacional foi criado um gradiente de urbanização. Para avaliar a tendência da infestação em cada região no período, foram utilizadas análises de regressão linear. A infestação pelo mosquito foi maior nas regiões periurbanas e rurais e menor nas regiões mais urbanizadas. Os resultados encontrados são relevantes no planejamento e na implantação de ações de prevenção das arboviroses transmitidas.

Aedes albopictus mosquito is widely distributed in tropical regions, as well as in temperate countries, and has been identified by the scientific literature as important to public health. There is a lack of studies on infestation, dispersion and the species association with the level of urbanization, breeding sites, types of property and seasonality. This study aimed to analyze the evolution of A. albopictus infestation along an urbanization gradient. The geographical reference of this study was the municipality of Chapecó, State of Santa Catariana. To assess dispersion and population fluctuation an urbanization gradient was created. Linear regression analysis was applied to evaluate the trend of infestation in each region in the study period. Mosquito infestation was higher in peri-urban and rural regions, and lower in more urbanized regions. The results are relevant for planning and implementing prevention actions for transmitted arbovirus diseases.

Are Opportunities Being Missed? Burden of HIV, STI and TB, and Unawareness of HIV among African Migrants.

Sub-Saharan African migrants (SSAMs) have been disproportionately affected by infectious disease burden. We aimed to identify correlates of HIV, past sexually transmitted infection (STI) and past Tuberculosis infection (TB), as well as examine HIV seropositivity unawareness and testing history among SSAMs. A venue-based sample of 790 SSAMs completed a cross-sectional biobehavioral survey on sexual practices, HIV testing and self-reported infectious diseases; an HIV rapid test was offered. Overall, 5.4% of participants were HIV-positive and 16.7% reported a past STI. Odds of being HIV positive or having a past STI were higher among participants with low socioeconomic status and who experienced violence from a partner. Increased odds of having a past STI were also found among long-term migrants and those who reported sexual risk behaviors. In total, 4.1% of participants had TB in the past; these were more likely male and HIV positive. Unawareness of HIV-positive status was notably high (35%). Half of the participants had never been tested for HIV before, including over a third of those who had STI or TB in the past. Efforts are needed to reduce missed opportunities for HIV/STIs prevention and uptake of HIV testing among SSAMs through more integrated care, while addressing social determinants of infectious diseases.

Adaptação cardiovascular no Teste de Caminhada dos Seis Minutos em pacientes com DPOC: estudo transversal / Cardiovascular adaptation in the six-minute walk test in COPD patients: transversal study

OBJETIVO: Avaliar o comportamento da adaptação cardiovascular e da saturação periférica de oxigênio em indivíduos com DPOC submetidos no teste de caminhada dos seis minutos (TC6). MATERIAL E MÉTODOS: Trata-se de um estudo de corte transversal, que foram incluídas pessoas com diagnóstico de DPOC, confirmado pela espirometria e de ambos os sexos. A magnitude de sintomas foi avaliada pela escala de dispneia Medical Research Council (MRC) e questionário COPD Assessment Test (CAT). Aplicou-se o TC6 para avaliar a tolerância ao esforço. Para mensurar a frequência cardíaca máxima (FC máx) prevista para a idade foram utilizadas equações específicas para população brasileira. RESULTADOS: Avaliou-se 34 indivíduos com DPOC, 20 (58,8%) homens; relação VEF1/CVF foi 56,7%± 10,2% pós broncodilatador (BD). Quatorze 14 (41,2%) indivíduos apresentaram impacto clínico moderado; 16 (47,2%) dos avaliados apresentou grau 2 na escala do MRC. As médias das distâncias percorridas no primeiro e segundo TC6 foram 383,5 ± 13,6; 408,6 ± 85,7 metros, correspondendo a 70, 75%; 75,10% em relação ao valor previsto (p=0,001). As médias da FC máx ao final do primeiro e segundo TC6, foram 94,1 ± 21,9; 92,3 ± 17,9 bpm e a FC pós percentual da FC máx prevista pré e pós TC6 foram 61,1% ± 17,7%; 59,7% ± 21,5% e 14 (41,2%) pacientes apresentaram dessaturação de O2 no primeiro TC6; 9 (26,5%) no segundo teste. CONCLUSÕES: Pacientes com DPOC, apresentam aumento da FC identificado pelo esforço submáximo, por meio do percentual da FC max. Indivíduos com maior comprometimento da função pulmonar apresentaram dessaturação de O2. .

OBJECTIVE: To evaluate the behavior of cardiovascular adaptation and peripheral oxygen saturation in individuals with COPD submitted to the six-minute walk test (6MWT). MATERIAL AND METHODS: It was performed a descriptive study with person with a diagnosis of COPD confirmed by spirometry of both sexes. The Medical Research Council (MRC) dyspnea scale and the COPD Assessment Test (CAT) questionnaire were used to assess the magnitude of symptoms. The 6MWT was used to assess effort tolerance. To measure the maximum heart rate (HRmax) predicted for age, specific equations were used for the Brazilian population. RESULTS: 34 individuals with COPD were evaluated, 20 (58.8%) men; FEV1 / FVC ratio was 56.7% ± 10.2% after BD. Fourteen (41.2%) were classified as grade 2 and were classified as grade 2 (MRC scale). The means of the distances covered in the first and second TC6 were 383.5 ± 13.6; 408.6 ± 85.7 meters, corresponding to 70.7%; 75.1% in relation to the predicted value (p = 0.001). The mean maximum heart rate at the end of the first and second 6MWT were 94.1 ± 21.9; 92.3 ± 17.9 bpm and the heart rate post-percentage of the predicted maximum heart rate before and after the 6MWT were 61.1% ± 17.7%; 59.7% ± 21.5% and 14 (41.2%) patients presented O2 desaturation on the 6MWT; 9 (26.5%) in the second test. CONCLUSIONS: Patients with COPD throughout the 6MWT show increased heart rate and O2 desaturation in exercise activity.

Environmental factors associated to dengue fever occurrence in the Chapecó municipality, Santa Catarina State / Fatores ambientais associados à ocorrência de dengue no município de Chapecó, Estado de Santa Catarina

This study aimed to evaluate the influence of environmental factors on the occurrence of dengue and the spatial distribution of the cases in the municipality of Chapecó, Santa Catarina State. Dengue cases were obtained from the Epidemiological Surveillance Department of Santa Catarina and Epidemiological Surveillance of Chapecó. The data of positive containers for Aedes aegypti were obtained from the Environmental Health Surveillance of the municipality. In 2015 and 2016, Chapecó registered 819 autochthonous cases of dengue. It showed a significant relationship between the number of foci of the vector and the minimum and maximum temperatures, as well as the cases of dengue and the population size of the neighborhoods evaluated. This study indicated a multifactorial influence on mosquito proliferation and the occurrence of viral transmission of dengue in the municipality of Chapecó. It reinforces the need of an interdisciplinary approach to prevent and control this endemic disease (AU)

Epidemiológica de Chapecó. Os dados de recipientes positivos para Aedes aegypti na Vigilância em Saúde Ambiental do município. Em 2015 e 2016 Chapecó registrou 819 casos autóctones de dengue. Apresentou relação significativa entre o número de focos do vetor e as temperaturas mínimas e máximas, assim como os casos de dengue com o tamanho populacional dos bairros avaliados. Este estudo indicou influência multifatorial sobre a proliferação do mosquito e a ocorrência da transmissão viral de dengue no município de Chapecó. Reforça a necessidade de uma abordagem interdisciplinar de ações de prevenção e controle desta endemia (AU)

Do container size and predator presence affect Culex (Diptera: Culicidae) oviposition preferences?

ABSTRACT Organisms with complex life cycles typically do not exhibit parental care. Hence, the ability of adult females to choose quality oviposition sites is critical for offspring success. Gravid females of many insect taxa have the capability to detect environmental conditions in water-holding containers (e.g., resource level, presence of competitors or predators) and to choose the sites that are most suitable for offspring growth and development. Mosquitoes may also detect physical container characteristics related to water permanence such as surface area, volume, or container size, and some species such as those in the genus Culex have been shown to prefer larger containers. However, predators may also preferentially colonize larger containers; thus, ovipositing females may face decisions based on cues of site quality that balance the costs and benefits for offspring. We used a field experiment to evaluate the oviposition preferences of two Culex species in response to experimental container size and predator abundances within the containers. We found that both species avoided ovipositing in the largest containers, which have high abundances of Chaoborus sp. and dragonfly larvae (predators). However, the container size most commonly chosen for oviposition (15-L buckets) also had high mean abundance per liter of dragonfly larvae. These results suggest either prey naiveté or reduced vulnerability of these species to dragonflies compared to Chaoborus sp. Other potential mechanisms for the observed patterns are discussed.

LOCAL PERIARTICULAR ANALGESIA IN TOTAL KNEE ARTHROPLASTY / ANALGESIA LOCAL PERIARTICULAR NA ARTROPLASTIA TOTAL DE JOELHO

ABSTRACT Objective: To evaluate the use of infiltration of periarticular analgesic agents intraoperatively in total knee arthroplasty (TKA), with regard to benefits, reduction of pain, opioid consumption, improvement of range of motion and early ambulation. Methods: To analyze the benefits of periarticular drug infiltration, the patients submitted to TKA were evaluated, being separated into two groups. One group received the local periarticular infiltration protocol containing 0.5% bupivacaine (400mg/20ml), 1/1000 epinephrine (0.3ml), triamcinolone hexacetonide (20mg/1ml), clonidine (150mcg/1ml) and 20 ml of saline (0.9% SS) and, the other group underwent conventional intravenous analgesia. The results were compared and the variables analyzed were age, sex, BMI, comorbidities, postoperative complications, pain, functional capacity, range of motion, transfusion and rescue opioids for analgesia. Results: The mean age of the patients was 68 years and most were female and presented involvement of the left knee. Postoperatively, patients who had received periarticular infiltration showed improvement of pain as well as functional capacity. Conclusion: The analysis of data obtained demonstrated that the periarticular infiltration of analgesic agents is significantly effective for pain control and functional recovery. Level of Evidence II, Prospective Comparative Study.

RESUMO Objetivo: Avaliar a realização da infiltração de solução de agentes analgésicos periarticulares no intraoperatório da artroplastia total do joelho (ATJ), no que tange aos seus benefícios, redução da dor, consumo de opioides, melhora do arco de movimento e deambulação precoce. Métodos: Para avaliar os benefícios da infiltração de agentes periarticulares, foram analisados pacientes submetidos à ATJ, sendo separados em dois grupos. Um grupo recebeu o protocolo de infiltração periarticular local, contendo solução de bupivacaína a 0,5% (400 mg /20 ml), epinefrina 1/1000 (0,3 ml), hexacetonido de triancinolona (20 mg/1 ml), clonidina (150 mcg/1 ml) e 20 ml de solução salina (SF a 0,9%) e outro grupo recebeu analgesia endovenosa convencional. Os resultados foram comparados e as variáveis analisadas foram idade, sexo, IMC, comorbidades, complicações pós-cirúrgicas, dor, capacidade funcional, amplitude de movimento, transfusão e resgate de opioides para analgesia. Resultados: Dos pacientes analisados a média de idade foi de 68 anos e a maioria era do sexo feminino e com acometimento do joelho esquerdo. No pós-operatório os pacientes que haviam recebido infiltração periarticular apresentaram melhora da dor, bem como da capacidade funcional. Conclusão: A análise dos dados obtidos demonstrou que a infiltração periarticular de agentes analgésicos é significativamente eficaz para o controle da dor e recuperação funcional. Nível de Evidência II, Estudo Prospectivo Comparativo.

Omega-3 supplementation improves pancreatic islet redox status: in vivo and in vitro studies.

OBJECTIVES: The aim of the study was to evaluate the potential changes induced by fish oil (FO) supplementation on the redox status of pancreatic islets from healthy rats. To test whether these effects were due to eicosapentaenoic acid and docosahexaenoic acid (ω-3), in vitro experiments were performed. METHODS: Rats were supplemented with FO, and pancreatic islets were obtained. Islets were also treated in vitro with palmitate (P) or eicosapentaenoic acid + docosahexaenoic acid (ω-3). Insulin secretion (GSIS), glucose oxidation, protein expression, and superoxide content were analyzed. RESULTS: The FO group showed a reduction in superoxide content. Moreover, FO reduced the expression of NAD(P)H oxidase subunits and increased superoxide dismutase, without altering ß-cell function. Palmitate increased ß-cell reactive oxygen species (ROS) production, apoptosis, and impaired GSIS. Under these conditions, ω-3 triggered a parallel reduction in ROS production and ß-cell apoptosis induced by P and protected against the impairment in GSIS. There was no difference in mitochondrial ROS production. CONCLUSIONS: Our results show that ω-3 protect pancreatic islets from alterations induced by P. In vivo FO supplementation modulates the redox state of pancreatic ß-cell. Considering that in vitro effects do not involve mitochondrial superoxide production, we can speculate that this protection might involve NAD(P)H oxidase activity.

Remifentanil versus Sufentanil em infusão contínua em intervenções cirúrgicas videolaparoscópicas: estudo comparativo / Continuous infusion of remifentanil versus sufentanil in videolaparoscopic surgeries: a comparative study

JUSTIFICATIVA E OBJETIVOS: A infusão contínua (IC) de remifentanil na técnica de anestesia venosa total é prática comum. Já o sufentanil em IC para cirurgias de curta/média duração tem sido pouco utilizado. O objetivo desse estudo foi comparar duas técnicas de anestesia venosa total, utilizando remifentanil ou sufentanil em IC, quanto ao comportamento anestésico no intra-operatório e às características da recuperação anestésica em pacientes submetidos à videolaparoscopia. MÉTODO: Participaram desse estudo 60 pacientes divididos em 2 grupos iguais (GR e GS). O GR foi induzido com remifentanil IC e o GS com sufentanil em bolus associado à IC. A IC de remifentanil era desligada ao fim da cirurgia, enquanto a IC de sufentanil, 20 minutos antes. Os pacientes receberam no intra-operatório cetoprofeno e dipirona. Como analgésico de resgate na sala de recuperação pós-anestésica (SRPA) foi utilizado tramadol. Foram analisados as variações da pressão arterial média (PAM) e freqüência cardíaca (FC), o tempo de despertar, o consumo de propofol, as intercorrências na SRPA e o tempo de permanência na SRPA. RESULTADOS: A média da PAM foi maior no GS em relação ao GR (91,9 × 77,6, p < 0,0001). A incidência de dor foi significativamente maior no GR em relação ao GS (22 × 1 paciente, p < 0,0001). A incidência de NVPO foi maior no GR em relação ao GS (10 × 2 pacientes, p = 0,0098). A média do tempo de permanência na SRPA foi maior no GR em relação ao GS (76 × 49 min, p < 0,0001). CONCLUSÕES: O controle hemodinâmico foi satisfatório nos grupos. A IC de sufentanil promoveu melhor controle da dor no pós-operatório com menor consumo de analgésico de resgate; conseqüentemente, houve menor incidência de NVPO e menor tempo de permanência na SRPA.

BACKGROUND AND OBJECTIVES: Continuous infusion (CI) of remifentanil is common in total intravenous anesthesia. On the other hand, CI of sufentanil for short/medium-term surgeries has not been widely used. The objective of this study was to compare two techniques of total intravenous anesthesia, using CI of remifentanil or sufentanil, regarding their intraoperative behavior and characteristics of recovery of patients undergoing videolaparoscopic surgeries. METHODS: Sixty patients, equally divided in 2 groups (RG and SG), participated in this study. Continuous infusion of remifentanil was used for anesthetic induction in RG, while a bolus of sufentanil associated with CI of this drug was used in SG. The CI of remifentanil was discontinued at the end of the surgery, while the CI of sufentanil was discontinued 20 minutes before the end of the surgery. Patients received ketoprofen and dypirone intraoperatively. Tramadol was used for rescue analgesia in the recovery room. Variations of mean arterial pressure (MAP) and hard reate (HR), time for awakening, propofol consumption, intercurrences in the recovery room, and time of stay in the recovery room were analyzed. RESULTS: Mean MAP was greater in SG than in RG (91.9 × 77.6, p < 0.0001). The incidence of pain was significantly greater in RG than on SG (22 × 1 patient, p < 0.0001). The incidence of postoperative nausea and vomiting (PONV) was greater in RG than in SG (10 × 2 patients, p < 0.0098). The mean time of stay in the recovery room was greater in RG than in SG (76 × 49 min, p < 0.0001). CONCLUSIONS: Hemodynamic control was satisfactory in both groups. Continuous infusion of sufentanil promoted better postoperative pain control with decreased consumption of rescue analgesic and, consequently, reduced incidence of PONV and reduced time of stay in the recovery room.

JUSTIFICATIVA Y OBJETIVOS: La infusión continua (IC) de remifentanil en la técnica de anestesia venosa total es una práctica común. Ya el sufentanil en IC para cirugías de corta/media duración ha sido poco utilizado. El objetivo de este estudio fue el de comparar dos técnicas de anestesia venosa total, utilizando remifentanil o sufentanil en IC, en cuanto al comportamiento anestésico en el intraoperatorio y en cuanto a las características de la recuperación anestésica en pacientes sometidos a la videolaparoscopía. MÉTODO: Participaron en el estudio 60 pacientes divididos en 2 grupos iguales (GR y GS). El GR fue inducido con remifentanil IC y el GS con sufentanil en bolus asociado a IC. La IC de remifentanil se desconectaba al final de la cirugía, mientras que la IC de sufentanil 20 minutos antes. Los pacientes recibieron en el intraoperatorio cetoprofeno y dipirona. Como analgésico de rescate en la sala de recuperación pos anestésica (SRPA) se usó el tramadol. Fueron analizadas las variaciones de la PAM y FC, tiempo de despertar, consumo de propofol, intercurrencias en la SRPA y tiempo de permanencia en la SRPA. RESULTADOS: El promedio de la PAM fue mayor en el GS con relación al GR (91,9 × 77,6, p < 0,0001). La incidencia de dolor fue significativamente mayor en el GR con relación al GS (22 × 1 paciente, p < 0,0001). La incidencia de NVPO fue mayor en el GR con relación al GS (10 × 2 pacientes, p = 0,0098). El promedio del tiempo de permanencia en la SRPA fue mayor en el GR en con relación al GS (76 × 49 min, p < 0,0001). CONCLUSIONES: El control hemodinámico fue satisfactorio en los grupos. La IC de sufentanil generó un mejor control del dolor en el pos operatorio con menor consumo de analgésico de rescate, por lo tanto, se registró una menos incidencia de NVPO y un menor tiempo de permanencia en la SRPA.

Continuous infusion of remifentanil versus sufentanil in videolaparoscopic surgeries. A comparative study.

BACKGROUND AND OBJECTIVES: Continuous infusion (CI) of remifentanil is common in total intravenous anesthesia. On the other hand, CI of sufentanil for short/medium-term surgeries has not been widely used. The objective of this study was to compare two techniques of total intravenous anesthesia, using CI of remifentanil or sufentanil, regarding their intraoperative behavior and characteristics of recovery of patients undergoing videolaparoscopic surgeries. METHODS: Sixty patients, equally divided in 2 groups (RG, and SG), participated in this study. Continuous infusion of remifentanil was used for anesthetic induction in RG, while a bolus of sufentanil associated with CI of this drug was used in SG. The CI of remifentanil was discontinued at the end of the surgery, while the CI of sufentanil was discontinued 20 minutes before the end of the surgery. Patients received ketoprofen and dypirone intraoperatively. Tramadol was used for rescue analgesia in the recovery room. Variations of mean arterial pressure (MAP) and hard reate (HR), time for awakening, propofol consumption, intercurrences in the recovery room, and time of stay in the recovery room were analyzed. RESULTS: Mean MAP was greater in SG than in RG (91.9 x 77.6, p < 0.0001). The incidence of pain was significantly greater in RG than on SG (22 x 1 patient, p < 0.0001). The incidence of postoperative nausea and vomiting (PONV) was greater in RG than in SG (10 x 2 patients, p < 0.0098). The mean time of stay in the recovery room was greater in RG than in SG (76 x 49 min, p < 0.0001). CONCLUSIONS: Hemodynamic control was satisfactory in both groups. Continuous infusion of sufentanil promoted better postoperative pain control with decreased consumption of rescue analgesic and, consequently, reduced incidence of PONV and reduced time of stay in the recovery room.