COVID-19 mortality in an area of northeast Brazil: epidemiological characteristics and prospective spatiotemporal modelling.

This study aimed to analyse the spatial-temporal distribution of COVID-19 mortality in Sergipe, Northeast, Brazil. It was an ecological study utilising spatiotemporal analysis techniques that included all deaths confirmed by COVID-19 in Sergipe, from 2 April to 14 June 2020. Mortality rates were calculated per 100 000 inhabitants and the temporal trends were analysed using a segmented log-linear model. For spatial analysis, the Kernel estimator was used and the crude mortality rates were smoothed by the empirical Bayesian method. The space-time prospective scan statistics applied the Poisson's probability distribution model. There were 391 COVID-19 registered deaths, with the majority among ⩾60 years old (62%) and males (53%). The most prevalent comorbidities were hypertension (40%), diabetes (31%) and cardiovascular disease (15%). An increasing mortality trend across the state was observed, with a higher increase in the countryside. An active spatiotemporal cluster of mortality comprising the metropolitan area and neighbouring cities was identified. The trend of COVID-19 mortality in Sergipe was increasing and the spatial distribution of deaths was heterogeneous with progression towards the countryside. Therefore, the use of spatial analysis techniques may contribute to surveillance and control of COVID-19 pandemic.

Risk clusters of COVID-19 transmission in northeastern Brazil: prospective space-time modelling.

This study aimed to analyse the trend and spatial-temporal clusters of risk of transmission of COVID-19 in northeastern Brazil. We conducted an ecological study using spatial and temporal trend analysis. All confirmed cases of COVID-19 in the Northeast region of Brazil were included, from 7 March to 22 May 2020. We used the segmented log-linear regression model to assess time trends, and the local empirical Bayesian estimator, the global and local Moran indexes for spatial analysis. The prospective space-time scan statistic was performed using the Poisson probability distribution model. There were 113 951 confirmed cases of COVID-19. The average incidence rate was 199.73 cases/100 000 inhabitants. We observed an increasing trend in the incidence rate in all states. Spatial autocorrelation was reported in metropolitan areas, and 178 municipalities were considered a priority, especially in the states of Ceará and Maranhão. We identified 11 spatiotemporal clusters of COVID-19 cases; the primary cluster included 70 municipalities from Ceará state. COVID-19 epidemic is increasing rapidly throughout the Northeast region of Brazil, with dispersion towards countryside. It was identified high risk clusters for COVID-19, especially in the coastal side.

Gods associated with male fertility and virility.

BACKGROUND: Human fertility has always been a topic of curiosity and devotion. Many cultures consider fertility to be a necessity for the survival and perpetuation of mankind and since early times, myths were created to explain this fabulous process. Fertility gods were ubiquitous in numerous ancient human cultures and were used both to understand fertility and to cope with infertility by means of rituals and offerings. OBJECTIVES: This manuscript aims to catalog and describe the deities associated with male fertility and virility. MATERIAL AND METHODS: We conducted a comprehensive search for the terms "male fertility god" and "male virility god" on the internet using web-based search engines. Based on the information retrieved, we selected those deities directed related to male fertility and/or virility and further deepened the search using Pubmed and Medline databases for peer-reviewed articles as well as books and articles about ancient mythology. RESULTS: We identified several gods linked to male fertility and virility in various cultures from Egypt, Greece, Rome, India, Southwestern United States, France, Colombia and Buthan.. DISCUSSION: Most of these deities were depicted with an erect phallus and with other fertility symbols like snakes. Some deities were also associated with plants and/or animal fertility and their festivals were often held during the harvest period. CONCLUSION: Gods of male fertility and virility played important roles in many ancient cultures. Offerings and rituals to these gods were the only available options to deal with problems of reproduction and demonstrate the lengths to which ancient people would go seeking cures for infertility.

How to perform enterocystoplasty without opening the intestine.

OBJECTIVES: To introduce a new technique for intestinal anastomosis when performing demucosalized enterocystoplasty. METHODS: In 8 dogs, a vascularized seromuscular patch of sigmoid colon was harvested without opening the bowel lumen. The bowel mucosa was invaginated into the intestinal lumen and the sigmoid musculature was reapproximated. Twelve patients underwent a nonsecretory sigmoid cystoplasty following the same principle. RESULTS: No complications occurred in the experimental animals. The animals were fed normally starting on the first postoperative day. Prolapse of the excess mucosa occurred in 3 cases and disappeared spontaneously. In the clinical group, the postoperative course was normal. Oral intake was resumed on the first day after the operation. The hospital stay was shorter than that of patients in whom the bowel lumen was opened. CONCLUSIONS: The use of demucosalized intestinal patches without opening the intestinal lumen appears to be feasible and is expected to reduce perioperative morbidity. Extensive bowel preparation can be reduced, as can the prophylactic use of antibiotics.

Serogroup identification, phenotypic detection of hemolysis and extended spectrum beta-lactamases of Escherichia coli isolated from psittacine of illegal wildlife trade in Fortaleza, Brazil / Identificação de sorogrupo e detecção fenotípica de betalactamase de espectro estendido e produção de hemolisina em Escherichia coli isoladas de psitacídeos do tráfico de animais silvestres em Fortaleza-CE

This study aimed to identify serogroups of Escherichia coli important for human health in isolates from psittacine of illegal wildlife trade in Ceará State. In addition, hemolysis and production of Extended Spectrum Beta-Lactamases (ESBL) was assessed in the isolates. A total of 78 E. coli strains isolated from different Psittaciformes species from a wildlife rehabilitation center in Fortaleza, Brazil. The isolates used in this study were previously identified and stored. Serogroup identification was performed using polyvalent sera for EPEC (O55, O111, O119, O114, O125, O86, O126, O127, O128), EIEC (O136, O124) and EHEC (O157). ESBL detection was performed with double disk synergy method. For hemolysis detection, isolates were inoculated in blood agar base enriched with ovine blood. Only 31 (39.7%) isolates were seropositive and the most frequent were O127, O114, O128 and O111. There was no agglutination for serogroups O55, O124, O136 or O157. Considering both seropositive and seronegative isolates, 9 (11.5%) and 35 (44.9%) presented hemolysis and ESBL production, respectively. In conclusion, the investigated psittacine from illegal wildlife trade hosted ESBL-producing E. coli strains and some belong to important serogroups often linked to severe human infections.(AU)

Este trabalho teve como objetivo identificar sorogrupos de E. coli importantes para a saúde humana, oriundos de psitacídeos provenientes do tráfico no estado do Ceará, assim como detectar atividade hemolítica e produção de betalactamase de espectro estendido (ESBL). Foram testadas 78 cepas de Escherichia coli provenientes de psitaciformes do Centro de Triagem de Animais Silvestres, Fortaleza, CE. Para a identificação dos sorogrupos, utilizaram-se soros polivalentes EPEC (O55, O111, O119, O114, O125, O86, O126, O127, O128), EIEC (O136, O124) e EHEC (O157). Para detecção de ESBL, as cepas foram submetidas ao método de aproximação de disco e, para a detecção de hemolisina, foram plaqueadas em ágar sangue base enriquecido com sangue de carneiro. No geral, 31 (39,7%) das amostras foram soropositivas. Os sorogrupos mais frequentemente detectados foram O127, O114, O128 e O111. Não houve positividade para os sorogrupos O55, O124, O136 e O157. Considerando-se as amostras sororreagentes e não sororreagentes, observou-se que nove (11,5%) e 35 (44,9%) cepas de E. coli apresentaram produção de hemolisinas e de ESBL, respectivamente. Em conclusão, constatou-se que psitacídeos provenientes do tráfico de animais silvestres albergam cepas de E. coli produtoras de ESBL e providas de importantes sorogrupos implicados em graves infecções humanas.(AU)

Detecção e avaliação do perfil de sensibilidade antimicrobiana de enterobactérias isoladas de periquitos cara-suja (Pyrrhura griseipectus) em cativeiro / Detection and evaluation of the antimicrobial sensibility profile of enterobacteria isolated from captive Grey-breasted parakeet (Pyrrhura griseipectus)

This study was conducted to detect enterobacteria in captive Grey-breasted parakeet from a commercial breeding located in the state of Ceara. 25 individual cloacal swabs were collected and this material was subjected to microbiological processing to obtain the bacterial isolation, identification, and evaluation of the sensitivity profile to antimicrobials. The bacterial isolation in ten samples was determined, belonging to the genera Enterobacter, Hafnia, Serratia, Escherichia, Pantoea and Klebsiella, in which these last three corresponded to the bacteria most isolated, with respective percentages of 28.6%, 21.4%, and 21.4%. As for the sensitivity profile, antibiotics to which the bacteria showed more resistance were trimethoprim-sulfamethoxazole (57%), tetracycline (21%), and azithromycin (43%). Thus, it was shown that the parakeets were carriers of Enterobacteriaceae with resistance characteristics.(AU)

Isolation of Salmonella enterica subsp. enterica (O: 4, 5: i) and Salmonella enterica subsp. Typhimurium from free-living domestic pigeons (Columba livia) / Detecção de Salmonella enterica subsp enterica (O: 4, 5: i) e Salmonella enterica subsp. Typhimurium em pombo doméstico de vida livre (Columba livia)

The present study reports the isolation of Salmonella enterica in organs of free-living domestic pigeons. In the clinic examination, the presence of feces in the peri-cloacal and abdominal regions were observed, as well as symptoms such as cachexy, incoordination and opisthotonos. Before any therapeutic protocol was applied the bird died and a necropsy was then performed for the removal of spleen, liver, kidney and intestine for bacteriological examination and antibiotic sensitivity test. Salmonella enterica subsp.enterica (O:4,5:i-) and Salmonella enterica subsp. enterica serovar Typhimurium were isolated from the liver and intestine and the sensitivity test demonstrated that these strains are sensitive to several antibiotics...

O presente trabalho relata o isolamento de Salmonella enterica em órgãos de um pombo doméstico de vida livre. No exame clínico foi observada a presença de fezes pericloacal na região ventral, caquexia, incoordenação motora e opistótono. Antes de iniciar um protocolo terapêutico, a ave foi a óbito, e, em seguida, foi realizada uma necropsia para remoção do baço, fígado, rim e intestino para exame bacteriológico e teste de sensibilidade a antibióticos. Foi isolado Salmonella enterica subsp. enterica (O:4,5:i-) e Salmonella enterica subsp. enterica sorovar Typhimurium do fígado e intestino, e o teste de sensibilidade demonstrou que essas cepas são sensíveis a vários antimicrobianos...

Isolation of Salmonella spp. in captive Psittaciformes from zoos and a commercial establishment of Fortaleza, Brazil / Isolamento de Salmonella spp. em Psittaciformes de zoológicos e estabelecimento comercial de Fortaleza, Brasil

This study showed a low prevalence of Salmonella spp. in captive psittacines from zoos and a commercial establishment of Fortaleza. None of the isolated serotypes (S. Lexington, S. Saintpaul and S. Newport) have yet been reported in Amazona aestiva, Ara chloroptera or Melopsittacus undulatus. However, the fact that most birds presented negative for Salmonella spp. may not imply the absence of this pathogen in these birds, since the intermittent excretion is a well-known characteristic of this microorganism...

A manutenção de aves em cativeiro reúne condições que favorecem a disseminação de doenças infecciosas, sendo a Salmonella uma dessas doenças infecciosas que acomete os psitacídeos. Portanto o objetivo do presente estudo foi isolar e identificar Salmonella spp. em Psittaciformes mantidos em criatórios comerciais e conservacionistas da Região Metropolitana de Fortaleza. Para o estudo, foram coletados swabs cloacais de 182 psitacídeos clinicamente sadios. Os resultados mostraram que três psitacídeos avaliados (1,65%) foram positivos: Amazona aestiva (Salmonella Lexington), Ara chloroptera (Salmonella Saintpaul) e Melopsittacus undulatus (Salmonella Newport). De acordo com a literatura científica, não há registro desses sorotipos em psitacídeos. Esta pesquisa evidenciou uma baixa prevalência de Salmonella spp. em Psittaciformes mantidos em criatórios comerciais e conservacionistas da Região Metropolitana de Fortaleza...

Further experience with the periurethral expander: a new type of artificial sphincter.

OBJECTIVE: To determine the long-term effects of the periurethral expander, a new device for the treatment of urinary incontinence in children. PATIENTS AND METHODS: Twenty-five patients (mean age 11.2 years, range 3-22) had a periurethral expander implanted around the bladder neck within the last 41 months. Twelve of these patients had neurogenic bladders as a result of myelomeningocele, 12 had undergone unsuccessful exstrophy reconstructions and one had megalourethra. Bladder augmentations were carried out in 23 of the patients. The mean follow-up was 23 months. RESULTS: Ten patients had the device removed due to erosion and/or infection; patients with exstrophy were more susceptible to complications. Patients with neurogenic bladders use clean intermittent catheterization and the remainder void spontaneously. The mean pressure in the cuff was 58.7 cmH2O. CONCLUSION: The periurethral expander seems to be a valid option in the treatment of selected cases of urinary incontinence in children and young adults. There were more complications in patients with exstrophy/epispadias and such patients must be considered unsuitable for this treatment.

Experience with demucosalized ileum for bladder augmentation.

OBJECTIVE: To assess the use of demucosalized ileum for bladder augmentation, following the same principles previously used with the sigmoid colon. PATIENTS AND METHODS: Eleven patients with bladder exstrophy or a neurogenic bladder had their bladders augmented with demucosalized ileum instead of the sigmoid colon, but following the same technique. The use of a Foley catheter with an inflated balloon greatly facilitated the dissection of the mucosa from the muscle. A silicone model, inserted in the bladder, was used to avoid shrinkage of the patch. An animal model was also used for total bladder replacement following the same principle. RESULTS: The mean (range) follow-up was 15.4 (2-25) months. There was a significant increase in bladder compliance in all patients. A bladder of good shape and compliance was obtained in the animal model, with epithelial growth detected in all cases. CONCLUSIONS: Demucosalized ileum can be used safely for bladder augmentation in the same way as with the sigmoid colon. The distension of the isolated patch greatly facilitates dissection between the mucosa and muscle. The animal model supported this method of bladder replacement.

Bladder exstrophy. Primary reconstruction with human dura mater.

A new surgical technique for primary reconstruction of bladder exstrophy is described. Human cranial dura mater is used as an alloplastic free graft to replace the missing anterior bladder wall. The technique has been successfully applied to 8 patients and the early achievement of good bladder capacity seems to improve urinary continence.

Nonsecretory sigmoid cystoplasty: experimental and clinical results.

We report the results of experimental and clinical studies in which a de-epithelialized segment of sigmoid colon was used to cover the bladder dome where the mucosa was exposed (auto-augmentation) to increase bladder capacity. Experimentally, the technique was performed in 10 healthy female mongrel dogs and the intestinal segments established continuity perfectly over the exposed bladder mucosa. Histology 30 and 60 days postoperatively showed transitional epithelium lining the intestinal segment at the site of implantation. One island of intestinal mucosa was found. The technique was performed in 10 patients, including 9 with neurogenic bladder secondary to myelomeningocele and 1 with posterior urethral valves. Bladder capacity improved in all cases and intravesical pressure was reduced. Followup ranged from 6 to 43 months. The technique is proposed as a valuable alternative to traditional full-thickness patches of the digestive tract and auto-augmentation.

Combined use of enterocystoplasty and a new type of artificial sphincter in the treatment of urinary incontinence.

PURPOSE: We report the results of the combination of enterocystoplasty and a periurethral expander, a simplified type of artificial sphincter, in the treatment of urinary incontinence. MATERIALS AND METHODS: The new 1-piece device has an adjustable cuff connected to a port positioned at the subcutaneous space in the abdomen. The cuff is adjusted to the bladder neck and the pins are fixed according to the diameter of the urethra. The port is punctured percutaneously and saline is injected until continence is achieved. Eight boys and 3 girls underwent nonsecretory sigmoid cystoplasty and placement of the device at a single operation. Nine patients had neurogenic bladder and in 2 exstrophy reconstruction had failed. Followup ranged from 4 to 26 months. RESULTS: All patients were continent with improved bladder compliance 6 to 8 weeks after the operation, when the device was activated. In 1 case the device was extracted after 2 months due to frequent episodes of hematuria and edema at the port site. Two patients had erosion of the skin at the port site. Urodynamics were repeated at the time of activation. Maximal urethral closing pressure increased from 16.27 to 157.44%. Two patients needed a second injection to achieve continence. The patients with exstrophy void spontaneously and those with neurogenic bladder are on clean intermittent catheterization. CONCLUSIONS: Although more followup is needed, the combination of these procedures seems to offer a new option for the treatment of urinary incontinence in children.