Cannabidiol for COVID-19 Patients with Mild to Moderate Symptoms (CANDIDATE Study): A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Importance: Owing to its anti-inflammatory properties and antiviral "in vitro" effect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), cannabidiol (CBD) has been proposed as a potential treatment for coronavirus disease 2019 (COVID-19). Objective: To investigate the safety and efficacy of CBD for treating patients with mild to moderate COVID-19. Design: Randomized, parallel-group, double-blind, placebo-controlled clinical trial conducted between July 7 and October 16, 2020, in two sites in Brazil. Setting: Patients were recruited in an emergency room. Participants: Block randomized patients (1:1 allocation ratio-by a researcher not directly involved in data collection) with mild and moderate COVID-19 living in Ribeirão Preto, Brazil, seeking medical consultation, and those who voluntarily agreed to participate in the study. Interventions: Patients received 300 mg of CBD or placebo added to standard symptomatic care during 14 days. Main Outcome and Measure: The primary outcome was reduction or prevention of the deterioration in clinical status from mild/moderate to severe/critical measured with the COVID-19 Scale or the natural course of the resolution of typical clinical symptoms. Primary study outcome was assessed on days 14, 21, and 28 after enrollment. Results: A total of 321 patients were recruited and assessed for eligibility, and 105 were randomly allocated either in CBD (n=49) or in placebo (n=42) group. Ninety-one participants were included in the analysis of efficacy. There were no baseline between-group differences regarding disease severity (χ2=0.025, p=0.988) and median time to symptom resolution (12 days [95% confidence interval, CI, 6.5-17.5] in the CBD group, 9 days [95% CI, 4.8-13.2] in the placebo group [χ2=1.6, p=0.205 by log-rank test]). By day 28, 83.3% in the CBD group and 90.2% in the placebo group had resolved symptoms. There were no between-group differences on secondary measures. CBD was well tolerated, producing mostly mild and transient side effects (e.g., somnolence, fatigue, changes in appetite, lethargy, nausea, diarrhea, and fever), with no significant differences between CBD and placebo treatment groups. Conclusions and Relevance: Daily administration of 300 mg CBD for 14 days failed to alter the clinical evolution of COVID-19. Further trials should explore the therapeutic effect of CBD in patients with severe COVID-19, possibly trying higher doses than the used in our study. Trial Registration: ClinicalTrials.gov identifier NCT04467918 (date of registration: July 13, 2020).

Feasibility of very short-term forecast models for COVID-19 hospital-based surveillance.

INTRODUCTION: We evaluated the performance of Bayesian vector autoregressive (BVAR) and Holt's models to forecast the weekly COVID-19 reported cases in six units of a large hospital. METHODS: Cases reported from epidemiologic weeks (EW) 12-37 were selected as the training period, and from EW 38-41 as the test period. RESULTS: The models performed well in forecasting cases within one or two weeks following the end of the time-series, but forecasts for a more distant period were inaccurate. CONCLUSIONS: Both models offered reasonable performance in very short-term forecasts for confirmed cases of COVID-19.

Frequency and visual outcomes of ocular toxoplasmosis in an adult Brazilian population.

Although ocular toxoplasmosis is a leading cause of posterior uveitis worldwide, there is scarce information about the real-life frequency of ocular lesions, visual outcomes, and risk factors for poor prognosis. We conducted a community-based cross-sectional study with 721 adults living in Cássia dos Coqueiros, Southeast Brazil, consisted of visual acuity measurement, dilated ocular examination, a risk-factor questionnaire, and peripheral blood collection for anti-T. gondii serology. Presumed toxoplasmic lesions were recorded on video and analyzed by experienced and masked ophthalmologists. Ocular toxoplasmosis was determined if at least one suspected lesion was appointed by two graders in the presence of positive anti-T. gondii serology. Forty-eight eyes (n = 42 participants; 6.7% among those with positive anti-T. gondii serology) with ocular toxoplasmosis were found. Most lesions were single (n = 28; 58.3%), peripheral (n = 34; 77.1%) and unilateral (85.7% of participants); no active lesions were found. Older age was associated with lesions larger than one-disc diameter (p = 0.047), and lower social stratum (OR: 2.89; CI 1.2-6.97; p = 0.018) was associated with the presence of toxoplasmic lesions. Although there were no differences in visual acuity between participants and eyes with or without ocular lesions (p > 0.05), unilateral blindness associated with ocular toxoplasmosis was identified in a reduced number of individuals.

Prevalence of virological and serological markers of SARS-CoV-2 infection in the population of Ribeirão Preto, Southeast Brazil: an epidemiological survey.

INTRODUCTION: This epidemiological household survey aimed to estimate the prevalence of the current and past SARS-CoV-2 infections in Ribeirão Preto, a municipality of southeast Brazil. METHODS: The survey was conducted in two phases using a clustered sampling scheme. The first phase spanned May 1-3 and involved 709 participants. The second phase spanned June 11-14, 2020, and involved 646 participants. RESULTS: During the first phase, RT-PCR performed on nasopharyngeal swabs was positive at 0.14%. The serological tests were positive in 1.27% of the patients during the first phase and 2.79% during the second phase. People living in households with more than five members had a prevalence of 10.83% (95%CI: 1.58-74.27) higher than those living alone or with someone other. Considering the proportion of the positive serological test results with sex and age adjustments, approximately 2.37% (95%CI: 1.32-3.42) of the population had been cumulatively infected by mid-June 2020, which is equivalent to 16,670 people (95%CI: 9,267-24,074). Considering that 68 deaths from the disease in the residents of the city had been confirmed as at the date of the second phase of the survey, the infection fatality rate was estimated to be 0.41% (95%CI: 0.28-0.73). Our results suggest that approximately 88% of the cases of SARS-CoV-2 infection at the time of the survey were not reported to the local epidemiological surveillance service. CONCLUSIONS: The findings of this study provide in-depth knowledge of the COVID-19 pandemic in Brazil and are helpful for the preventive and decision-making policies of public managers.

Declining prevalence of hepatitis A and silent circulation of hepatitis E virus infection in southeastern Brazil.

OBJECTIVES: Hepatitis A virus (HAV) infection is considered highly endemic in Brazil, especially in low-income areas. In contrast, only a few human cases of hepatitis E have been reported. This study aimed to estimate the prevalence and potential risk factors of HAV and hepatitis E virus (HEV) infections in an adult population from a rural township of southeastern Brazil. METHODS: We conducted a cross-sectional survey using serum samples from urban and rural residents of Cássia dos Coqueiros, São Paulo state. A total of 990 samples were tested for anti-HAV IgG by chemiluminescent microparticle immunoassay, and a subset of 248 samples tested for anti-HEV IgG, using two commercial ELISA. Variables associated with anti-HAV and anti-HEV positivity were assessed by a multivariate analysis using a binomial logistic regression model. RESULTS: Seroprevalence of HAV and HEV was 89.1% and 20.7%, respectively. Age was significantly associated with HAV infection. Wantai and Mikrogen ELISA yielded comparable HEV seroprevalence results. CONCLUSIONS: Anti-HAV seroprevalence has declined and correlates with age, whereas anti-HEV was significantly higher than that found in previous population-based studies. These results indicate a need for further investigations of the magnitude of HEV infection in Brazil using the currently available, more sensitive diagnostic methods.

Are SARS-CoV-2 reinfection and Covid-19 recurrence possible? a case report from Brazil.

With the large number of individuals infected and recovered from Covid-19, there is intense discussion about the quality and duration of the immunity elicited by SARS-CoV-2 infection, including the possibility of disease recurrence. Here we report a case with strong clinical, epidemiological and laboratorial evidence of, not only reinfection by SARS-CoV-2, but also clinical recurrence of Covid-19.

Tuberculosis among health care workers in a Brazilian tertiary hospital emergency unit.

The Brazilian emergency system is being reorganized as a hierarchy in the region of Ribeirão Preto, state of São Paulo. We found increased occupational risk for tuberculosis in this region tertiary reference center--a nurse technician (Incidence rate [IR] 526.3/100,000 inhabitants) had a risk of tuberculosis 12.6 (95% confidence interval [CI], 2.57-37.23) greater than the city population (41.8/100,000 inhabitants). The system reorganization will have to make the centers adequate to deal with this problem.

Hepatitis C among former athletes: association with the use of injectable stimulants in the past.

This study was performed with the purpose of testing the hypothesis that the high prevalence of hepatitis C among former athletes is associated with their past use of injectable stimulants. The study involved the participation of 208 former professional and amateur soccer and basketball players from the region of Ribeirão Preto, Brazil, who answered a questionnaire regarding their exposure to risk factors, including the use of injectable stimulants in the time they were engaged in sporting activities. ELISA tests were used to detect infection by the hepatitis C virus, and confirmed with PCR and genotyping for the positive cases. It was observed that the former use of injectable stimulants was a practice disseminated among the participants (24.5%), reaching 50.8% in the professionals. The overall prevalence for hepatitis C was 7.2%, with values of 11% among professionals and 5.5% among amateurs. In both categories, the presence of infection was markedly higher among those who admitted past use of injectable stimulants when compared to those who denied such practice (36% and 0.8% among amateurs; 21.9% and 0% among professionals, respectively). Multivariate analysis showed that the use of those substances was the only variable associated with the risk of hepatitis C. This confirms previous observations, performed with reduced sample sizes and without comparison groups, which indicated that the use of injectable vitamins was a risk factor of hepatitis C among former athletes.

Prevalence and risk factors of toxoplasmosis among adults in a small Brazilian city.

INTRODUCTION: The prevalence of Toxoplasma gondii infection varies markedly among different populations, especially depending on factors related to socioeconomic development and eating habits. Cássia dos Coqueiros is a small city in Brazil with rural characteristics and increased risk factors traditionally associated with T. gondii infection. METHODS: We carried out a cross-sectional study involving 970 inhabitants aged 18 years or more, selected from patients of the local health unit and home visits in urban and rural areas. Each participant completed a survey with questions regarding demographic, socioeconomic, and risk factors for toxoplasmosis. Blood samples from participants were tested for presence of IgG and IgM antibodies against T. gondii using a chemiluminescent microparticle immunoassay. RESULTS: The prevalence of IgG and IgM antibodies was 62.3% and 2.5%, respectively. Variables that proved to be independent predictors of infection were age, low levels of education, and previous diagnosis of toxoplasmosis. CONCLUSIONS: The high prevalence of toxoplasmosis serological markers in this adult population highlights the need to promote preventive practices, especially those directed toward women of childbearing age, in this part of Brazil.

HIV prevalence and risk factors in a Brazilian penitentiary.

HIV infection among prison inmates shows one of the highest prevalence rates for specific population subgroups, reaching as high as 17% in Brazil and elsewhere in the world. The present study aimed to estimate HIV antibody prevalence and risk factors for infection in male inmates at the Ribeirão Preto Penitentiary, São Paulo State, Brazil, from May to August 2003. Using simple random sampling, 333 participants were selected, answered a standardized questionnaire, and had blood samples collected. Enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence were used for HIV serological diagnosis. Overall HIV prevalence among inmates was 5.7% (95%CI: 3.2-8.2). All variables associated with HIV antibodies in the univariate analysis were submitted to unconditional multivariate logistic regression. Independent predictors of HIV infection were: total prison sentence less than five years and sharing needles and syringes.

[Compliance to drug therapy in inflammatory bowel diseases outpatients from a university hospital]. / Adesão ao tratamento medicamentoso de pacientes com doenças inflamatórias intestinais acompanhados no ambulatório de um hospital universitário.

BACKGROUND: Compliance to drug therapy is important for a successful treatment. Although many studies have assessed compliance to treatment in patients with chronic diseases, few investigations have been carried out in inflammatory bowel diseases. AIM: To assess compliance to drug therapy in patients with inflammatory bowel diseases, Crohn's disease and ulcerative colitis, followed at a university hospital, who had prescribed medication supplied by the Brazilian National Health System. METHODS: In a cross sectional study, a structured interview was applied to assess the compliance of 26 Crohn's disease patients, 26 ulcerative colitis patients and 4 cases with undetermined colitis. Patients were characterized as presenting higher or lower degree of compliance, based on the comparison of the information provided by the patient in the interview and data in the medical records. The Morisky test was also used to assess the behavioral pattern of the patient regarding the daily use of the medication. RESULTS: The interview showed that 15.4% of patients with Crohn's disease and 13.3% of those with ulcerative colitis could be regarded as less compliant. However, the Morisky test revealed lower compliance in 50% of patients with Crohn's disease and 63.3% of those with ulcerative colitis. Univariate analysis showed an association between low compliance and long disease duration, married status and colon involvement in Crohn's disease, and between low compliance and increased disease activity and greater number of medications in ulcerative colitis. However, multivariate analysis did not confirm any association between low compliance and any demographic or clinical factor. CONCLUSIONS: A high degree of noncompliance to treatment, linked to habitual behavior and hard to predict from demographic or clinical factor, was detected in inflammatory bowel disease patients, which suggests the need for investment in patient education regarding medication use.

Chronic liver disease prevention strategies and liver transplantation.

Chronic liver disease is a considerable burden on society, being one of the three main causes of death in certain regions of Africa and Asia. Liver transplant is the only treatment option for cirrhosis, which is the end stage of many chronic liver diseases. This article reviews the preventable causes of cirrhosis and the preventive strategies which could be implemented in order to avoid the catastrophic consequences of cirrhosis. With small variations around the world, 70 to 80% of the end stage liver diseases are caused by excessive alcohol consumption and by viral hepatitis, both of which are potentially preventable. Excessive alcohol consumption has important public health consequences because of its involvement not only with cirrhosis, but also with motor vehicle accidents, unemployment, domestic violence etc. Among the viral causes, Hepatitis Virus B and C have the greatest impact on public health. Effective vaccine is available for Hepatitis Virus B and must be put in use. While a vaccine for Hepatitis Virus C is awaited, effective preventive strategies should be undertaken to avoid the preventable cases of end stage liver disease.

[Characteristics of the notification of violence against children in the municipality of Ribeirão Preto, São Paulo, Brazil]. / Caracterização das notificações de violência em crianças no município de Ribeirão Preto, São Paulo, no período 2006-2008.

OBJECTIVE: to describe the cases of violence against children reported in Ribeirão Preto-SP, Brazil. METHODS: this was a descriptive study using data provided by the Violence and Accidents Surveillance System (VIVA), of the Municipal Health Department of Ribeirão Preto-SP, Brazil, from 2006 to 2008. RESULTS: a total of 498 cases of violence against children (0-9 years old) were reported in the period, with an increase in the number of notifications, from 112 in 2006 to 197 in 2008; 79.3% of the notifications came from the Health area; and most children were female (56.4%), aged between two and five years old (over 60%); most aggressors were male (53.6%) and the father figure stood out (22.7%); physical aggressions were the most frequent (59.2%) and the most frequent place of the occurrence was the family household (75.5%). CONCLUSION: most victims were female, abused by men, mostly fathers and other family members, at the family household.

Incidence and causes of lower-limb amputations in the city of Ribeirão Preto from 1985 to 2008: evaluation of the medical records from 3,274 cases.

OBJECTIVE: It was to identify trends of traumatic and non-traumatic causes of lower limb amputations, as well as the role played by population aging, traffic violence increase, public health policy of diabetes control program and drivers anti-alcohol laws on these amputations. METHOD: Hospitalization data recorded in the discharge forms of 32 hospitals located in the region of Ribeirão Preto, Brazil, from 1985 to 2008 were analyzed. RESULT: A total of 3,274 lower-limb amputations were analyzed, of which 95.2% were related to non-traumatic causes, mainly infectious and ischemic complications of diabetes mellitus. Cancer (2.8%) and congenital (1.3%) causes were included in this group. Only 4.8% were related to traumatic causes. Traumatic amputation average rate was 1.5 amputations in 100,000 habitants with a slight tendency of increase in the last 5 years. Non-traumatic causes showed an average rate of 30.0 amputations for 100,000 habitants and remained relatively constant during the whole period. Non-traumatic were much more predominant in patients older than 60 years and traumatic amputations occurred more frequently in patients younger than 39 years. CONCLUSION: The overall rates of amputation and the rates of traumatic and non-traumatic amputations remained nearly constant during the study period. The impact of diabetes control policies and the introduction of traffic safety laws could not be identified on the amputation rates.

Knowledge and practices related to dengue and its vector: a community-based study from Southeast Brazil.

INTRODUCTION: This study investigated the knowledge of users of primary healthcare services living in Ribeirão Preto, Brazil, about dengue and its vector. METHODS: A cross-sectional survey of 605 people was conducted following a major dengue outbreak in 2013. RESULTS: Participants with higher levels of education were more likely to identify correctly the vector of the disease. CONCLUSIONS: The results emphasize the relevance of health education programs, the continuous promotion of educational campaigns in the media, the role of the television as a source of information, and the importance of motivating the population to control the vector.

Clinical Features, Psychiatric Assessment, and Longitudinal Outcome of Suicide Attempters Admitted to a Tertiary Emergency Hospital.

The objective of this study was to characterize admissions to an emergency hospital due to suicide attempts and verify outcomes in 2 years. Data were collected from medical records and were analyzed using descriptive statistics and logistic regression. The sample consisted of 412 patients (58.7% women; mean age = 32.6 years old, SD = 14.3). Self-poisoning was the most frequent method (84.0%), and they were diagnosed mainly as depressive (40.3%) and borderline personality disorders (19.1%). Previous suicide attempts and current psychiatric treatment were reported by, respectively, 32.0% and 28.4%. Fifteen patients (3.6%, 9 males) died during hospitalization. At discharge, 79.3% were referred to community-based psychiatric services. Being male (OR = 2.11; 95% CI = 1.25-3.55), using violent methods (i.e., hanging, firearms, and knives) (OR = 1.96; 95% CI = 1.02-3.75) and psychiatric treatment history (OR = 2.58; 95% CI = 1.53-4.36) were predictors for psychiatric hospitalization. Of 258 patients followed for 2 years, 10 (3.9%) died (3 suicide), and 24 (9.3%) undertook new suicide attempts. Patients with a history of psychiatric treatment had higher risks of new suicide attempts (OR = 2.46, 95% CI = 1.07-5.65). Suicide attempters admitted to emergency hospitals exhibit severe psychiatric disorders, and despite interventions, they continue to present high risks for suicide attempts and death.

Feasibility of very short-term forecast models for COVID-19 hospital-based surveillance

Abstract INTRODUCTION: We evaluated the performance of Bayesian vector autoregressive (BVAR) and Holt's models to forecast the weekly COVID-19 reported cases in six units of a large hospital. METHODS: Cases reported from epidemiologic weeks (EW) 12-37 were selected as the training period, and from EW 38-41 as the test period. RESULTS: The models performed well in forecasting cases within one or two weeks following the end of the time-series, but forecasts for a more distant period were inaccurate. CONCLUSIONS: Both models offered reasonable performance in very short-term forecasts for confirmed cases of COVID-19.

[Hepatitis B and C serologic markers in blood donors of the Ribeirão Preto Blood Center]. / Marcadores sorológicos das hepatites B e C em doadores de sangue do Hemocentro de Ribeirão Preto, SP.

The investigation involved 25,891 blood donors who attended for the first time the Blood Center of Ribeirão Preto, Brazil, between Jun 23, 1996 and Jun 22, 2001. The objective was to study the proportion of positive serological markers for hepatitis B and C at the initial screening tests and to estimate the prevalence of such infections through the analysis of confirmatory tests, carried out at the University Hospital as a part of the patients evaluation. Data from the donors and laboratory results were obtained from the records of both the Blood Bank and the Hospital. The population of donors was mainly composed by males (83.6%) and by individuals between 26 and 45 (64%) years of age. The proportions of positive results in screening tests were 0.6% (CI95%: 0.54-0.72) for HBsAg and 1.2% (CI95%: 1.02-1.28) for anti-HCV. Confirmatory testes showed values of prevalence of 0.2% (CI95%: 0.16-0.28) for hepatitis B and 0.3% (IC95%: 0.24-0.38) for hepatitis C.

Hepatitis B and C in a Brazilian deaf community.

INTRODUCTION: Although deaf people are exposed to hepatitis B and C risk factors, epidemiological studies regarding these diseases in deaf people are lacking. METHODS: After watching an explanatory digital versatile disc (DVD) in Brazilian Sign Language, 88 deaf people were interviewed and tested for hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), hepatitis B core antibody (anti-HBc), and hepatitis C virus antibody (anti-HCV). RESULTS: The prevalence of hepatitis B markers was 8%; they were associated with incarceration and being born outside the State of São Paulo. No cases of hepatitis C were identified. CONCLUSIONS: Participants showed a substantial lack of knowledge regarding viral hepatitis, indicating a need for public policies that consider linguistic and cultural profiles.

Epidemiological study of hepatitis B and C in a municipality with rural characteristics: Cássia dos Coqueiros, State of São Paulo, Brazil.

INTRODUCTION: Hepatitis B and C viral infections remain an important cause of global morbidity and mortality. Studies have been conducted in population groups of large cities, leaving gaps in the knowledge regarding the situation in small municipalities. We aimed to measure the prevalence of hepatitis B and C markers and presence of infection-associated factors. METHODS: All inhabitants of Cássia dos Coqueiros aged ≥18 years who agreed to participate in the research were included. We collected blood as well as information via a questionnaire between March 2011 and December 2013. Univariate and multivariate analyses were conducted. RESULTS: Among the 1,001 participants, 41 (4.1%) participants had a serological profile of hepatitis B viral exposure, and only one (0.1%) participant was considered a virus carrier. The frequency of isolated antibody to hepatitis B virus surface antigen (anti-HBs) markers was 17.8% for the overall population. In the multivariate analysis, hepatitis B virus (HBV) infection was associated with age, birth outside the State of São Paulo, history of hepatitis, ≥2 sexual partners in the last 6 months, and tattoos. Four (0.4%) participants had a serological profile of hepatitis C viral exposure. However, after confirmation using viral ribonucleic acid (RNA) evaluation, only one (0.1%) individual remained positive. CONCLUSIONS: The positivity rates for hepatitis B and C were low, despite greater sexual freedom and the recent emergence of illicit drugs, as observed by the health personnel working in Cássia dos Coqueiros.