Outcomes of critically ill patients with acute kidney injury in COVID-19 infection: an observational study.

BACKGROUND: Early reports indicate that AKI is common during COVID-19 infection. Different mortality rates of AKI due to SARS-CoV-2 have been reported, based on the degree of organic dysfunction and varying from public to private hospitals. However, there is a lack of data about AKI among critically ill patients with COVID-19. METHODS: We conducted a multicenter cohort study of 424 critically ill adults with severe acute respiratory syndrome (SARS) and AKI, both associated with SARS-CoV-2, admitted to six public ICUs in Brazil. We used multivariable logistic regression to identify risk factors for AKI severity and in-hospital mortality. RESULTS: The average age was 66.42 ± 13.79 years, 90.3% were on mechanical ventilation (MV), 76.6% were at KDIGO stage 3, and 79% underwent hemodialysis. The overall mortality was 90.1%. We found a higher frequency of dialysis (82.7% versus 45.2%), MV (95% versus 47.6%), vasopressors (81.2% versus 35.7%) (p < 0.001) and severe AKI (79.3% versus 52.4%; p = 0.002) in nonsurvivors. MV, vasopressors, dialysis, sepsis-associated AKI, and death (p < 0.001) were more frequent in KDIGO 3. Logistic regression for death demonstrated an association with MV (OR = 8.44; CI 3.43-20.74) and vasopressors (OR = 2.93; CI 1.28-6.71; p < 0.001). Severe AKI and dialysis need were not independent risk factors for death. MV (OR = 2.60; CI 1.23-5.45) and vasopressors (OR = 1.95; CI 1.12-3.99) were also independent risk factors for KDIGO 3 (p < 0.001). CONCLUSION: Critically ill patients with SARS and AKI due to COVID-19 had high mortality in this cohort. Mortality was largely determined by the need for mechanical ventilation and vasopressors rather than AKI severity.

Assessment of the foot-and-mouth disease surveillance system in Brazil.

In 2021, the 88th General Session of the World Assembly of National Delegates to the World Organisation for Animal Health (OIE) recognized the estates of Acre, Paraná, the Rio Grande do Sul, and Rondônia as being free of foot-and-mouth disease (FMD) without vaccination. The certification was also extended to some cities in Amazonas and Mato Grosso. The new national strategic plan for 2026, which focuses on creating and maintaining sustainable conditions to expand FMD-free zones without vaccination, imposes new challenges and requires continuous evaluation of the FMD surveillance system. The objective of this research was to evaluate the FMD surveillance system in Brazil using quantitative models through Bayesian network approaches. The research was conducted using the Continental Surveillance and Information System (SivCont) database for Official Veterinary Services in Brazil, which refers to notified vesicular syndromes. The data on states, reported diseases, source of notification, disease confirmation, and timeliness (TL in days) of the delay by owners in notifying (TL.1) after a suspected case of the disease, and the response of Brazilian Veterinary Services after being notified (TL.2), were analysed. The collected data were analysed using Bayesian networks. It was observed that diseases with symptoms identical to FMD are the most notified events. TL.1 was long (mean of 18.96, CI: 18.33-19.59), and a low number of notifications was observed throughout the study period, which increases the chances of disseminating FMD in the population. Meanwhile, TL.2 suggests appropriate effectiveness of the Veterinary Services responding to suspected cases of FMD with interventions in less than 24 h (mean of 1, CI: 0.68-1.31). This study evaluated the performance of Brazilian Veterinary Services facing the report of vesicular diseases in the period 2004-2018. The results can help the states improve the surveillance system and the transition to the vaccination stop. Furthermore, the analytical method presented in the paper could serve as a model for other countries to evaluate the effectiveness of FMD surveillance systems.

Infections by trypanosomatid (Kinetoplastida: Trypanosomatidae) in triatomines (Hemiptera: Triatominae): A spatiotemporal assessment in an endemic area for Chagas disease.

This research analysed the spatiotemporal distribution of triatomines infected by trypanosomatid parasites in an endemic region for Chagas disease, in the state of Pernambuco, Northeastern Brazil. The database included the total number of triatomines captured from intradomicile and peridomicile areas, as well as the infection rate (IR) by trypanosomatid. The Gi∗ by Getis-Ord method was used to statistically identify significant concentration clusters and the IR of triatomines by trypanosomatids. A generalized linear regression model with a binomial distribution was used to evaluate the probability of finding an IR by trypanosomatids. Overall, of 4,800 triatomines examined, trypanosomatid forms similar to Trypanosoma cruzi were detected in 10.29% of them, and the majority of positive specimens (98.17%) were collected at intradomicile. The geospatial analyses identified triatomines clusters in intradomicile and peridomicile environments. According to the logistic regression data for species (Panstrongylus lutzi, P. megistus, Triatoma brasiliensis and T. pseudomaculata), the probability of detection of T. cruzi infection remains constant in up to 50 specimens examined or more. The findings of this research revealed a scenario never studied in this area through this type of spatiotemporal analysis, which is essential to identify areas of vulnerability for the occurrence of these vectors and consequently for Chagas disease.

Epidemiology and spatial distribution of Echinococcus granulosus in sheep and goats slaughtered in a hyperendemic European Mediterranean area.

BACKGROUND: Cystic echinococcosis (CE) is a worldwide parasitic zoonosis caused by the larval stage of Echinococcus granulosus sensu lato affecting livestock, particularly sheep and goats. However, often this parasitosis is underestimated. For this reason, this study aimed to evaluate the epidemiological features and spatial distribution of CE in sheep and goats slaughtered in a hyperendemic Mediterranean area. METHODS: A survey was conducted in the Basilicata region (southern Italy) from 2014 to 2019. A total of 1454 animals (1265 sheep and 189 goats) from 824 farms were examined for hydatid cyst detection by visual inspection, palpation and incision of target organs. All the CE cysts were counted and classified into five morphostructural types (unilocular, multiseptate, calcified, caseous and hyperlaminated). Molecular analysis was performed on 353 cysts. For spatial analysis, a kriging interpolation method was used to create risk maps, while clustering was assessed by Moran's I test. RESULTS: CE prevalence of 72.2% (595/824) and 58.4% (849/1454) was observed at the farm and animal levels, respectively, with higher values in sheep (62.9%) than goats (28.0%). The liver and lungs were the most frequently infected organs in both sheep and goats. Most of recovered cysts were of the calcified and multiseptate morphotypes. All the isolates were identified as E. granulosus sensu stricto (genotypes G1-G3). Spatial distribution showed a moderate clustering of positive animals. CONCLUSION: The findings of this study can be used to better understand the eco-epidemiology of echinococcosis and to improve CE surveillance and prevention programs in regions highly endemic for CE.

Timeliness of vesicular disease notification system in Brazilian foot-and-mouth disease surveillance programme.

Animal health surveillance programmes should be reliable and informative to ensure their effective implementation. As such, the regular assessment of those aiming to demonstrate the absence of disease, as well as the ability to detect outbreaks on time, is of vital importance. Several criteria make it possible to assess the performance of surveillance systems, including timeliness, which represents the speed between steps in a surveillance system. Therefore, the objective of this study was to evaluate the variability in the timeliness, within and between states, of the surveillance programme of the Brazilian Veterinary Services (BVS) for foot-and-mouth disease (FMD), for the notification of vesicular disease. A total of 14 years (2004-2017) of data relating to vesicular syndromes from the Brazilian Continental Information and Surveillance System (SivCont) were included. A categorical variable was created with four classes to group the notified vesicular processes in the SivCont, according to two criteria, the similarity of the symptoms of the diseases reported with FMD and aetiology (viral, bacterial, fungal and non-infectious). The three timeliness values (TL-1, TL-2 and TL-3) related to different portions of the FMD surveillance system were analysed as a response in a generalized linear model in which the states of Brazil were the explanatory variables. The analyses were performed separately for each notification class (FMD, vesicular stomatitis, similar symptoms and similar non-infectious symptoms) and included comparisons within and between states. The study results provide an understanding and evaluation of the timeliness of the Brazilian FMD surveillance system, thereby providing a base of knowledge from which involved agents and decision-makers can evaluate BVS and reinforce surveillance measures in the states with poorer timeliness than permitted.

Classical Swine Fever in a Cuban Zone Intended for Eradication: Spatiotemporal Clustering and Risk Factors.

Classical Swine Fever (CSF) is an endemic disease in Cuba, and an eradication strategy by zones is planned by the Official Veterinary Service. The aim of this study was to identify high-risk areas of CSF and the risk factors associated with the disease occurrence in the Pinar del Río province, one of the prioritized areas in the eradication strategy. The outbreak occurrence at district level was analyzed through a 7-year period (2009 to 2015). A high-risk cluster (RR = 5.13, 95% CI 3.49-7.56) was detected during the last 2 years of the study period in the eastern half of the province, with 38 out of 97 districts included. The rate of CSF-affected holdings had a significant increase during 2014-2015 and seems to have occurred mainly in the high-risk cluster area. Swine population density by district (heads/km2) and road length (km) by district were associated with the disease outbreak occurrence. These results provide new insights into the knowledge of the epidemiology of the disease in Cuban endemic conditions and can contribute to improving the control and the eradication strategy in this situation.