Osteology of an exceptionally well-preserved tapejarid skeleton from Brazil: Revealing the anatomy of a curious pterodactyloid clade.

A remarkably well-preserved, almost complete and articulated new specimen (GP/2E 9266) of Tupandactylus navigans is here described for the Early Cretaceous Crato Formation of Brazil. The new specimen comprises an almost complete skeleton, preserving both the skull and post-cranium, associated with remarkable preservation of soft tissues, which makes it the most complete tapejarid known thus far. CT-Scanning was performed to allow the assessment of bones still covered by sediment. The specimen can be assigned to Tupa. navigans due to its vertical supra-premaxillary bony process and short and rounded parietal crest. It also bears the largest dentary crest among tapejarine pterosaurs and a notarium, which is absent in other representatives of the clade. The new specimen is here regarded as an adult individual. This is the first time that postcranial remains of Tupa. navigans are described, being also an unprecedented record of an articulated tapejarid skeleton from the Araripe Basin.

Zika detection: comparison of methodologies.

Many countries in the Americas have detected local transmission of multiple arboviruses that cause febrile illnesses. Therefore, laboratory testing has become an important tool for confirming the etiology of these diseases. The present study aimed to compare the sensitivity and specificity of three different Zika virus detection assays. One hundred serum samples from patients presenting with acute febrile symptoms were tested using a previously reported TaqMan® RT-qPCR assay. We used a SYBR® Green RT-qPCR and a conventional PCR methodologies to compare the results. Of the samples that were determined to be negative by the TaqMan® RT-qPCR assay, 100% (Kappa=0.670) were also found to be negative by SYBR® Green RT-qPCR based on Tm comparison; however, 14% (Kappa=0.035) were found to be positive by conventional PCR followed by agarose gel electrophoresis. The differences between the ZIKV strains circulating worldwide and the low viremia period can compromise diagnostic accuracy and thereby the accuracy of outbreak data. Therefore, improved assays are required to improve the diagnosis and surveillance of arbovirus.

Clinical, laboratory and virological data from suspected ZIKV patients in an endemic arbovirus area.

BACKGROUND: The emergence of Zika virus (ZIKV) presents new challenges to both clinicians and public health authorities. Overlapping clinical features between the diseases caused by ZIKV, dengue (DENV) and chikungunya (CHIKV) and the lack of validated serological assays for ZIKV make accurate diagnosis difficult. Brazilian authorities largely rely on clinical and epidemiological data for the epidemiological and clinical classifications of most ZIKV cases. OBJECTIVE: To report the laboratory and clinical profiles of patients diagnosed with Zika fever based only on clinical and epidemiological data. STUDY DESIGN: We analyzed 433 suspected cases of ZIKV identified by the attending physician based on proposed clinical criteria. The samples were also screened for ZIKV, DENV and CHIKV using PCR. RESULTS: Of the 433 patients analyzed, 168 (38.8%) were laboratory-confirmed for arboviruses: 96 were positive for ZIKV, 67 were positive for DENV (56 for DENV-2, 9 for DENV-1, and 2 for DENV-4), four were positive for co-infection with ZIKV/DENV-2, and one was positive for CHIKV. The most common signs or symptoms in the patients with laboratory-confirmed ZIKV were rash (100%), arthralgia (77.1%), fever (74.0%), myalgia (74.0%) and non-purulent conjunctivitis (69.8%). In patients with laboratory-confirmed DENV infections, the most frequently observed symptoms were rash (100%), fever (79.1%), myalgia (74.6%), headache (73.1%) and arthralgia (70.1%). The measure of association between clinical manifestations and laboratory manifestations among patients with ZIKV and DENV detected a statistically significant difference only in abdominal pain (p=0.04), leukopenia (p=0.003), and thrombocytopenia (p=0.01). CONCLUSION: Our data suggests that clinical and epidemiological criteria alone are not a good tool for ZIKV and DENV differentiation, and that laboratory diagnosis should be mandatory.

Dengue virus surveillance: Detection of DENV-4 in the city of São José do Rio Preto, SP, Brazil.

Dengue viruses are the most common arbovirus infection worldwide and are caused by four distinct serotypes of the dengue virus (DENV). In the present study, we assessed DENV transmission in São José do Rio Preto (SJRP) from 2010 to 2014. We analyzed blood samples from febrile patients who were attended at health care centers in SJRP. DENV detection was performed using multiplex RT-PCR, using flavivirus generic primers, based on the genes of the non-structural protein (NS5), followed by nested-PCR assay with species-specific primers. We analyzed 1549 samples, of which 1389 were positive for NS1 by rapid test. One thousand and eight-seven samples (78%) were confirmed as positive by multiplex RT-PCR: DENV-4, 48.5% (528/1087); DENV-1, 41.5% (449/1087); DENV-2, 9.5% (104/1087); and co-infection (5 DENV-1/DENV-4, 1 DENV-1/DENV-2), 0.5% (6/1087). Phylogenetic analysis of the DENV-4 grouped the isolates identified in this study with the American genotype and the showed a relationship between isolates from SJRP and isolates from the northern region of South America. Taken together, our data shows the detection and emergence of new dengue genotype in a new region and reiterate the importance of surveillance programs to detect and trace the evolution of DENV.

Zika detection: comparison of methodologies

ABSTRACT Many countries in the Americas have detected local transmission of multiple arboviruses that cause febrile illnesses. Therefore, laboratory testing has become an important tool for confirming the etiology of these diseases. The present study aimed to compare the sensitivity and specificity of three different Zika virus detection assays. One hundred serum samples from patients presenting with acute febrile symptoms were tested using a previously reported TaqMan® RT-qPCR assay. We used a SYBR® Green RT-qPCR and a conventional PCR methodologies to compare the results. Of the samples that were determined to be negative by the TaqMan® RT-qPCR assay, 100% (Kappa = 0.670) were also found to be negative by SYBR® Green RT-qPCR based on Tm comparison; however, 14% (Kappa = 0.035) were found to be positive by conventional PCR followed by agarose gel electrophoresis. The differences between the ZIKV strains circulating worldwide and the low viremia period can compromise diagnostic accuracy and thereby the accuracy of outbreak data. Therefore, improved assays are required to improve the diagnosis and surveillance of arbovirus.

Dengue-4 false negative results by Panbio® Dengue Early ELISA assay in Brazil.

BACKGROUND: Dengue is a serious public health problem in numerous countries. The ability to rapidly diagnosis dengue is important for patient triage and management. Detection of dengue viral protein, NS1, represents a new approach to dengue diagnosis. OBJECTIVE: The present study aims to evaluate if there are false negative results using the NS1 Ag rapid assay (Panbio(®) Dengue Early ELISA) in two different epidemiological situations (epidemic and non-epidemic). STUDY DESIGN: 220 serum samples from patients with clinical symptoms of classical dengue fever were tested by NS1 antigen capture ELISA and Multiplex-Nested-PCR. RESULTS: In samples collected in a non-epidemic period we found a 100% agreement of ELISA and RT-PCR in dengue negative samples and 85% agreement of ELISA and RT-PCR in dengue positive samples. But when we tested samples during an epidemic period (large DENV-4 outbreak) we found 15% false negative results (p<0.05) in dengue negative samples. CONCLUSIONS: Due to false negative results for DENV-4, the sole use of the Panbio(®) Dengue Early ELISA assay as a screening method for monitoring circulating dengue serotypes must be reevaluated.

A percepção do acompanhante sobre o atendimento humanizado em unidade de terapia intensiva pediátrica / La percepción de el compañero sobre el cuidado humanizado en una unidad de cuidados intensivos pediátricos / The perception of the companion of the humanized care in a pediatric intensive care unit

Objective: to understand the perception of the companion of the hospitalized child about humanized carein the context of pediatric intensive care unit. Methods: A descriptive, exploratory study with a qualitative approach, developed in the pediatric intensive care unit of a pediatric hospital in Salvador to interview the caregivers of hospitalized children. The interviews were analyzed using content analysis technique. Results: Perceptions of family associate the meaning of humanized care to a greater affection and attention; values the guidance provided by the health team and emphasizes the importance of their presence throughout assistance. Concerns about the “lack of care” are from the suffering inherent in the child’s situation. Conclusion: The perception of companions on the concept of humanization involves attention, care, concern and sometimes even an emotional involvement with the patient and to understand their perception means to bei alert to the real needs of the patient.

Objetivo: comprender la percepción del compañero del niño hospitalizado acerca del cuidado humanizado en el contexto de la unidad de cuidados intensivos pediátricos. Métodos: Estudio descriptivo, exploratorio con abordaje cualitativo, desarrollado en la unidad de cuidados intensivos pediátricos de un hospital pediátrico en Salvador para entrevistar a los cuidadores de los niños hospitalizados. Las entrevistas fueron analizadas utilizando la técnica de análisis de contenido. Resultados: La percepción de la familia asocia el significado del cuidado humanizado en mayor afecto y atención; valorar la orientación proporcionada por el equipo de salud y hacer hincapié en la importancia de su presencia en la asistencia. La preocupación por la “falta de cuidado” es por el sufrimiento inherente a la situación del niño. Conclusión: La percepción de los compañeros en el concepto de humanización implica atención, cuidado, preocupación y, a veces incluso una implicación emocional con el paciente, y entender supercepción significa estar alerta a sus necesidades reales.

Objetivo: compreender a percepção do acompanhante da criança hospitalizada acerca do atendimento humanizado no contexto da unidade de terapia intensiva pediátrica. Métodos: Estudo descritivo e exploratório com abordagem qualitativa, desenvolvido na unidade de terapia intensiva pediátrica de um Hospital Pediátrico em Salvador, onde foram entrevistados os acompanhantes das crianças hospitalizadas. Os depoimentos foram analisados através da Técnica de Análise de Conteúdo. Resultados: As percepções dos familiares associam o significado de cuidado humanizado a um carinho e atenção maiores; valorizam as orientações dadas pela equipe de saúde e enfatizam a importância da sua presença durante toda assistência. As inquietações acerca do “nãocuidado” são oriundas do sofrimento inerente à própria situação da criança. Conclusão: A percepção dos acompanhantes sobre o conceito de humanização envolve atenção, zelo, preocupação e muitas vezes até um envolvimento afetivo com o paciente e compreender a percepção deste, significa estar alerta às reais necessidades do indivíduo.