The influence of growth time on the identification of Bartonella henselae strains by MALDI-TOF mass spectrometry

ABSTRACT Bartonella spp. are bacteria responsible for neglected diseases worldwide. Bartonella henselae is the species most associated with human infections. It is associated with a large spectrum of clinical manifestations and is potentially fatal. The identification of Bartonella spp. is considered a challenge in clinical routine. These bacteria are fastidious, and the time required to isolate them varies from one to six weeks. MALDI-TOF mass spectrometry has emerged as an application for research on Bartonella spp. , and has still been little explored. We investigated whether three different B. henselae strains with different growth times—14 and 28 days—could be correctly identified by MALDI-TOF mass spectra fingerprint comparison and matching. We found that the spectra from strains with different growth times do not match each other, leading to misidentification. We suggest creating database entries with multiple spectra from strains with different growth times to increase the chances of accurate identification of Bartonella spp. by MALD-TOF MS.

Transmissão vertical do HIV na rede de saúde: reflexões bioéticas sobre gênero e cuidado a partir de um caso emblemático / Vertical transmission of HIV in the health network: bioethics reflections on gender and care based on an emblematic case

Resumo Num cenário epidêmico ainda preocupante, a prevenção da Transmissão Vertical (TV) do HIV impõe problemas complexos, devido as vulnerabilidades individual, social e moral das mulheres vivendo com o vírus, somadas às fragilidades da rede de saúde. A partir de um caso emblemático, este estudo buscou compreender os desafios bioéticos do cuidado para a prevenção da TV do HIV no âmbito do Comitê de Porto Alegre/RS. Os eixos analíticos desenvolvidos refletem sobre como a produção do cuidado se articula, por um lado, com discursos e práticas relacionais pautadas no gênero e interseccionadas por raça e classe social e, por outro, com vulnerabilidades programáticas das políticas de saúde. Vislumbrou-se um processo de extrema estigmatização, em que as poucas ofertas para as mulheres cisgênero se dirigiam à regulação reprodutiva e perpetuavam dinâmicas de violência estrutural. Discute-se caminhos para a construção de um cuidado que incorpore a perspectiva decolonial e busque produzir equidade e justiça social ao reconhecer as trajetórias das mulheres.

Abstract In a still worrying epidemic scenario, the prevention of Vertical Transmission (VT) of HIV poses complex problems, due to the individual, social, and moral vulnerabilities of women living with the virus, in addition to the weaknesses of the health network. Based on an emblematic case, this study sought to understand the bioethical challenges of HIV VT prevention in the scope of the Porto Alegre/RS Committee. The analytical categories developed reflect on how the production of care is articulated, on the one hand, with relational discourses and practices based on gender and intersected by race and social class and, on the other, with programmatic vulnerabilities of health policies. A process of extreme stigmatization was revealed, in which the few offers for cisgender women were aimed toward reproductive regulation and perpetuated dynamics of structural violence. We discuss ways of building care that incorporates a decolonial perspective and seeks to produce equity and social justice by recognizing women's trajectories.

Aborto infectocontagioso em éguas: uma revisão bibliográfica / Infectious-contagious abortion in mares: a literature review / Aborto infecto-contagioso en yeguas: una revisión de la literatura

O aborto infectocontagioso em éguas é um tema de grande relevância e interesse para os médicos veterinários e criadores de equinos. Além dos impactos econômicos decorrentes de perdas e redução das taxas reprodutivas, os surtos de abortos causados por doenças infectocontagiosas representam uma ameaça significativa para a saúde equina. Neste trabalho, realizamos uma revisão bibliográfica abrangente sobre as principais doenças que causam abortos infecciosos em éguas. Nosso objetivo é fornecer uma visão geral das patologias mais relevantes nesse contexto, abordando suas características clínicas, epidemiologia, diagnóstico e medidas de controle. Para isso, realizamos uma busca em bancos de dados renomados, como o PubMed e o Scopus, por artigos científicos relevantes publicados nos últimos dez anos. As informações selecionadas foram cuidadosamente analisadas, comparadas e sintetizadas, com o intuito de identificar as principais doenças e suas implicações na saúde reprodutiva das éguas. Esta revisão pretende auxiliar veterinários, pesquisadores e profissionais da área a compreenderem melhor essas doenças e desenvolverem estratégias eficazes de prevenção e controle.(AU)

El aborto infeccioso en yeguas es un tema de gran relevancia e interés para veterinarios y criadores de equinos. Además de las repercusiones económicas derivadas de las pérdidas y la reducción de las tasas reproductivas, los brotes de aborto causados por enfermedades infecciosas representan una importante amenaza para la salud equina. En este artículo, realizamos una revisión exhaustiva de la literatura sobre las principales enfermedades que causan abortos infecciosos en yeguas. Nuestro objetivo es ofrecer una visión general de las patologías más relevantes en este contexto, abordando sus características clínicas, epidemiología, diagnóstico y medidas de control. Para ello, buscamos en bases de datos de renombre como PubMed y Scopus artículos científicos relevantes publicados en los últimos diez años. La información seleccionada fue cuidadosamente analizada, comparada y sintetizada con el fin de identificar las principales enfermedades y sus implicaciones en la salud reproductiva de las yeguas. El objetivo de esta revisión es ayudar a veterinarios, investigadores y profesionales del sector a comprender mejor estas enfermedades y desarrollar estrategias eficaces de prevención y control.(AU)

Infectious abortion in mares is a topic of great relevance and interest for veterinarians and equine breeders. In addition to economic impacts from losses and reduced reproductive rates, abortion outbreaks caused by infectious diseases represent a significant threat to equine health. In this paper, we conduct a comprehensive literature review on the major diseases that cause infectious abortions in mares. Our goal is to provide an overview of the most relevant pathologies in this context, addressing their clinical features, epidemiology, diagnosis, and control measures. To this end, we searched renowned databases such as PubMed and Scopus for relevant scientific articles published in the last ten years. The selected information was carefully analyzed, compared and synthesized in order to identify the main diseases and their implications in the reproductive health of mares. This review aims to assist veterinarians, researchers, and professionals in the field to better understand these diseases and develop effective prevention and control strategies.(AU)

Infectious human diseases: Regions, habitats, threats, and mitigation strategies: The issues—Part II

Globally, vaccines against 47 infectious etiologic agents are approved by at least one regulatory authority as of December 2022. The numbers of viral diseases, infections caused by mycoplasma, bacterial and protozoal diseases, mycoses, diseases caused by parasitic worms, and other infectious diseases of unknown etiology run into thousands. Therefore, more vaccines are required to be developed to keep more populations disease free. Climate change and global increase in temperature may promote sea level rises and an increase in the intensity of rains, causing an upsurge in certain infectious diseases in regions of the human population and even causing movement of habitats. In societies where the expenditure on health as a percentage of gross domestic product is higher, people are more capacitated to tackle the treatment and spread of infectious diseases. As several of such conditions are zoonotic, well-planned strategies for controlling the spread would go a long way in the proper direction. Poverty and contagious diseases are infallibly linked. Major infectious diseases of poverty include tuberculosis, human immunodeficiency virus (HIV)/ acquired immuno deficiency syndrome (AIDS), malaria, measles, pneumonia, diarrheal diseases, and several neglected tropical diseases. The world is not yet unified in action to jointly work to contain the global problem of infectious diseases in every human habitat. There was a visible divide between and among the rich countries versus the developing countries regarding accessibility and deployment of vaccines against COVID-19 flu. To contain the spread of infectious diseases in the future, the whole world would have to work together, raising funds, strengthening epidemiological surveys, inventing effective vaccines, and vaccinating the eligible population, as also treating the infected with therapy in time, besides resorting to other preventive measures for overall human progress. The developmental efforts are to be pursued jointly and together to benefit all people, respecting the world as one.

Clinical study of common inflammatory indicators in children with infectious diseases / 中国小儿急救医学

Objective:To evaluate the clinical significance of commonly used clinical inflammatory indicators in children with infectious diseases.Methods:A total of 354 children diagnosed with infectious diseases in our hospital from December 2018 to October 2020 were selected and divided into viral infection group(83 cases), sepsis group (65 cases), atypical pathogen infection group(23 cases), fungal infection group (11 cases), and bacterial infection group(172 cases). The data of serum amyloid A(SAA), procalcitonin(PCT), C-reactive protein(CRP), SAA/CRP, and interleukin (IL) in each group were collected.The fever peak, duration of fever, and fever subsidence time after admission were recorded.The receiver operating characteristic (ROC) curve was plotted, and the area under the curve(AUC), cut-off value, sensitivity and specificity were recorded.The correlation between fever and inflammatory indicators was analyzed.Results:The duration of fever in the atypical pathogen infection group was significantly higher than that in the other groups.Compared with the sepsis group, the differences regarding the levels of SAA, CRP, PCT, and IL-6 were statistically significant compared with those in the bacterial infection group, the atypical pathogen infection group, and the viral infection group (all P<0.05). SAA/CRP was the highest in the viral infection group, and its mean value was nearly twice compared with that in the sepsis group ( P<0.05). IL-10 was significantly different between bacterial infection group and viral infection group( P<0.05). Compared with the fungal infection group, the difference of interferon-γ was statistically significant compared with that in the bacterial infection group, viral infection group and sepsis group (all P<0.05). The ROC curves suggested that the AUC of SAA/CRP and IL-10 was the largest and the same in the viral infection group.The AUC of PCT in the sepsis group was the largest of 0.877, and the specificity was the highest at 91.7% when the PCT was 1.055 ng/mL.Correlation analysis found that SAA and CRP detected for the first time at admission were positively correlated with the time to heat remission. Conclusion:SAA/CRP has significant significance in differentiating sepsis and virus infection, and significantly increased PCT is an important sign of sepsis.

Construction of the index system of nurses′ability to cope with new infectious diseases based on ability-based education theory / 中国实用护理杂志

Objective:To construct a scientific and feasible index system for nurses′ ability to cope with new infectious diseases based on ability-based education theory, so as to provide reference for the training of nurses′ ability to cope with new infectious diseases.Methods:After consulting domestic and foreign literaturesuch as China National Knowledge Internet, Wanfang, VIP, PubMed, Web of Science, etc. from the establishment of the database to October 2020, based on the theory of "ability-based education", taking the action framework of the theory of "life cycle of emergency" and "sudden infectious disease events proposed" by WHO as the structural framework, the index items were preliminarily constructed, and the Delphi expert consultation method was used to conduct two rounds of expert consultation for 15 experts, so as to finally establish the index system of nurses′ ability to cope with new infectious diseases.Results:The effective recovery rate of the two rounds of expert consultation questionnaires was 100.00%, and the authority coefficient was 0.930. Kendall′s concordance coefficients of two rounds of consultation experts in the tertiary indicators were 0.363, 0.304 and 0.269, respectively, with statistically significant differences (all P<0.01), and the coefficient of variation of each index was 0.000-0.167. The index system of nurses′ ability to cope with new infectious diseases included 3 primary indicators, 12 secondary indicators and 44 tertiary indicators. Conclusions:The index system of nurses′ ability to cope with new infectious diseases based on ability-based education theory is scientific, reliable and practical, which can provide reference for the training and assessment of new infectious diseases coping ability of nurses.

The application and effect of "Trinity" emergency chain in the management of patients with epidemic respiratory tract infection under the coordination of multi-branches / 中华急诊医学杂志

Objective:To summarize the application and effect of "Trinity" emergency chain in the management of patients with epidemic respiratory tract infection under the cooperation of multiple hospitals and districts, and to provide a reference for medical institutions to improve the risk response ability.Methods:Based on the collaborative management of multi-branches, the "Trinity" emergency chain of pre-hospital-emergency-critical care, identification-triage-treatment, expansion-training-dispatch was implemented to optimize and integrate medical resources.Results:During the two months, 43,000 patients were admitted to the fever clinic, with an increase of 36.08%. The average waiting time for treatment was 19.83 min, and the average admission time to ICU was 25.35 min.Conclusions:The "Trinity" emergency chain treatment scheme under the coordination of multi-branches can effectively deal with the public health events of respiratory tract infectious diseases, improve the efficiency of rescue and treatment, and enhance the risk response ability of medical institutions.

Development progress and application of monoclonal antibody drugs against respiratory virus / 中国生物制品学杂志

@#Abstract：In recent years，the outbreak and prevalence of respiratory infectious diseases in the world seriously endanger human health，among which the respiratory infectious diseases caused by viral infection account for a large proportion. The use of vaccines and common antiviral drugs is an effective way to fight viral infection，but there are also problems such as lag and drug resistance. Monoclonal antibodies against respiratory viral infections provide a new strategy for clinical treatment. This paper reviews the development of monoclonal antibody against respiratory virus and its application in respiratory viral infectious diseases. Keywords：Respiratory viral infectious diseases；Respiratory syncytial virus（RSV）；Influenza virus（IFV）；Coronavirus （CoV）；Monoclonal antibody

Main Infection Control Measures for Respiratory Infectious Diseases in Medical Institutions and Public Places in China / 中国医学科学院学报

Respiratory infectious diseases (RID) are the major public health problems threatening the people's lives and health.Infection control (IC) is one of the effective tools to contain the occurrence and spread of RID.We collected the articles and data on IC published since January 1,2018 and summarized the achievements,problems,and challenges of IC from administrative control,management control,environment and engineering control,and personal protection in the medical institutions and public places in China.The efforts for IC vary in different regions and medical institutions of different levels.There are still links to be improved for IC from administrative control,management control,environment and engineering control,and personal protection,especially in community-level medical institutions and public areas.It is urgent to strengthen the implementation of IC policies and conduct IC precisely according to local situations.We proposed the following suggestions.First,the existing IC products and tools should be applied to precisely implement the IC measures;second,modern high technology should be employed to develop efficient and convenient IC products and tools;finally,a digital or intelligent IC platform should be built for monitoring infections,so as to contain the occurrence and spread of RID.

Recent progress in application of nanovaccines for enhancing mucosal immune responses

Mucosal vaccines that stimulate both mucosal and systemic immune responses are desirable, as they could prevent the invading pathogens at their initial infection sites in a convenient and user-friendly way. Nanovaccines are receiving increasing attention for mucosal vaccination due to their merits in overcoming mucosal immune barriers and in enhancing immunogenicity of the encapsulated antigens. Herein, we summarized several nanovaccine strategies that have been reported for enhancing mucosal immune responses, including designing nanovaccines that have superior mucoadhesion and mucus penetration capacity, designing nanovaccines with better targeting efficiency to M cells or antigen-presenting cells, and co-delivering adjuvants by using nanovaccines. The reported applications of mucosal nanovaccines were also briefly discussed, including prevention of infectious diseases, and treatment of tumors and autoimmune diseases. Future research progresses in mucosal nanovaccines may promote the clinical translation and application of mucosal vaccines.

Description of the dermatoscopic features observed in sporotrichosis and American cutaneous leishmaniasis in a reference center in Rio de Janeiro, Brazil

Abstract Background The evaluation of American cutaneous leishmaniasis (CL) and sporotrichosis (SP) with dermoscopy may improve the diagnosis accuracy and clinical monitoring. Objectives To describe the dermoscopic findings and patterns of skin lesions of patients with CL and SP followed up at the Laboratory of Clinical Research and Surveillance in Leishmaniasis (LaPClinVigiLeish), Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. Methods The authors included patients with a diagnosis of CL or SP, who attended at INI/ Fiocruz, between 2019‒2021. All patients had 3 dermoscopic examinations (DermLite DL4): before treatment (T0), during treatment (T1), and after healing (T2). Up to three lesions per patient were evaluated. Results The authors studied 47 patients with CL (74 lesions), and 19 patients with SP (24 lesions). The authors described dermoscopic structures such as rosettes, white lines, white dots, brown focal structureless areas, brown lines and dots, white perilesional circles, perilesional hyperchromic circles, microulcerations and the rainbow patterns. The authors created specific patterns; in CL: CL-T0 "central yellow scales with a white perilesional circle pattern", CL-T1 "diffuse structureless white area pattern" and CL-T2 "white and brown focal structureless areas pattern". In SP: SP-T0 the "pustule with erythema pattern"; SP-T1 the "focal structureless white areas with erythema pattern" and SP-T2 the "white linear pattern". Study limitations This study does not correlate dermoscopic findings with time of disease evolution at the first medical examination. Conclusions The recognition of CL and SP dermoscopy patterns may be helpful tool for the differential diagnosis and monitoring of disease evolution.

Influence of sex on the exposure to isoniazid in patients with pulmonary tuberculosis

ABSTRACT Isoniazid is a key component of tuberculosis treatment. Adequate exposure is a determinant for therapeutic success; however, considerable inter- and intraindividual variations in drug plasma levels can lead to unfavorable outcomes. While some predictors of isoniazid levels are well-known, others, such as sex, yield controversial results, requiring further investigation to optimize exposure. This study investigates whether the sex of patients influences the dose administered and the concentrations of isoniazid in plasma. Levels of isoniazid were associated with the N-acetyltransferase 2 phenotypes. A total of 76 male and 58 female patients were included. Isoniazid was measured by high-performance liquid chromatography, and N-acetyltransferase 2 phenotypes were assessed using molecular techniques. The results show that the dose administered, expressed in mg/kg, was higher in females, but the plasma levels were similar between both sexes. Among patients, 46.2%, 38.8%, and 15% were slow, intermediate, and fast acetylators, respectively. As expected, isoniazid levels were associated with the acetylation phenotypes, with higher concentrations in the slow acetylators. Thus, sex-related difference in isoniazid levels is due to the body weight of patients, and the optimized dose regimen based on patient weight and acetylator phenotypes can improve the treatment outcomes.

Toxoplasma gondii infection in pig intended for human consumption: seroprevalence, risk factors and influence of biosecurity measures / Infecção por Toxoplasma gondii em suínos destinados ao consumo humano: soroprevalência, fatores de risco e influência de medidas de biosseguridade

Abstract A serologic and epidemiologic study was carried out in order to determinate herd and animal seroprevalence and associated factors for Toxoplasma gondii in commercial pigs from Espírito Santo state, Brazil. Blood samples were collected from 416 pigs from 55 producer farms in 27 municipalities. An indirect immunofluorescent assay (IFA) was performed to estimate the seroprevalence of T. gondii and identify the associated risk factors using a questionnaire. The T. gondii antibody prevalence rate in commercial swine herds was 15.4% (64/416) using a cutoff of 1:64. The seropositivity for T. gondii was related to the presence of cats, water origin and age of swine in the increase of seroprevalence, and the existence of internal isolation fences and use of composting chambers as protective factors. To the best of our knowledge, this is the first study to report anti- T. gondii antibodies in the serum of pigs in the state of Espírito Santo, Brazil. This finding is important to public health because seropositive pigs can harbor tissue cysts in their meat, thereby representing a zoonotic risk for consumers of raw or undercooked porcine meat or its products.

Resumo Um estudo sorológico e epidemiológico foi realizado com o objetivo de determinar a soroprevalência nas granjas e animais e também em fatores associados para Toxoplasma gondii em suínos comerciais do estado do Espírito Santo, Brasil. Foram coletadas amostras de sangue de 416 suínos de 55 granjas produtoras de 27 municípios. A reação de imunofluorescência indireta (RIFI) foi realizada com o uso de questionário, para estimar a soroprevalência do T. gondii e identificar os fatores de risco associados. A taxa de prevalência de anticorpos contra T. gondii, nos rebanhos comerciais de suínos, foi de 15,4% (64/416) com ponto de corte de 1:64. A soropositividade para T. gondii foi relacionada à presença de gatos, origem da água, a idade dos suínos no aumento da soroprevalência, a existência de cercas de isolamento interno e uso de câmaras de compostagem como fatores de proteção. De acordo com este estudo, ele é o primeiro a relatar anticorpos anti-T. gondii no soro de suínos no estado do Espírito Santo, Brasil. Este achado é importante para a saúde pública, pois suínos soropositivos podem abrigar cistos teciduais em suas carnes, representando um risco zoonótico para os consumidores de carne suína crua ou mal cozida ou seus produtos.

Presencia de Oligoryzomys microtis (Rodentia) en hábitats silvestres en Bolivia / Presence of Oligoryzomys microtis (Rodentia) in wild habitats in Bolivia

Rodents are very important organisms within ecosystems; however, some species are considered pests because they consume and damage crops and because they are vectors, hosts, or reservoirs in the transmission of emerging infectious diseases. Rodents in Bolivia are represented by 148 species, Oligoryzomys microtis (Allen, 1916) being a species of public health importance because it is considered a potential natural reservoir of the Chapare virus, which causes Chapare Hemorrhagic Fever, and it is a deadly disease for humans. Its impact on public health is still unknown. The present study consisted of recording the presence of the species O. microtis through the use of Sherman-type live capture traps for small mammals arranged in linear transects in the wild and intervened habitats of the Samuzabety community, where the Chapare virus was detected for the first time, this community is located in the Chapare Province of the department of Cochabamba, Bolivia. The species recorded were the rodents Oligoryzomys microtis (morphotype matogrossae), Proechimys brevicauda, Neacomys vargasllosai, Hylaeamys perenensis, and the marsupial Metachiurus nudicaudatus. The presence of the species O. microtis (morphotype matogrossae) in the community of Samuzabety is confirmed. This species is associated with forest habitats with nearby and surrounding crops. The species O. microtis has epidemiological relevance as it is the natural reservoir of the Río Mamoré Hantavirus and is currently considered a potential reservoir of the Chapare virus and other Arenaviruses.

Los roedores son organismos muy importantes dentro de los ecosistemas; sin embargo, algunas especies son consideradas como plagas porque consumen y dañan cultivos y porque son vectores, hospederos o reservorios en la trasmisión de enfermedades infecciosas emergentes. Los roedores en Bolivia están representados por 148 especies, entre las cuales Oligoryzomys microtis (Allen, 1916) es una especie de importancia en salud pública, debido a que es considerada como potencial reservorio natural del virus Chapare, el cual produce la fiebre hemorrágica Chapare, enfermedad mortal para el ser humano y con un impacto en la salud pública aún desconocido. En este estudio se registró la presencia de la especie O. microtis?/i>, mediante el uso de trampas de captura viva tipo Sherman para pequeños mamíferos dispuestas en transectos lineales, en los hábitats silvestres e intervenidos de la comunidad de Samuzabety, sitio en el que se detectó por primera vez el virus Chapare. Esta comunidad se encuentra ubicada en la Provincia Chapare del departamento de Cochabamba, Bolivia. Las especies registradas fueron los roedores Oligoryzomys microtis (morfotipo matogrossae), Proechimys brevicauda, Neacomys vargasllosai, Hylaeamys perenensis y el marsupial Metachiurus nudicaudatus. Se confirma la presencia de la especie O. microtis (morfotipo matogrossae) en la comunidad de Samuzabety, la cual se encuentra asociada con hábitats de bosques, con cultivos cercanos y a su alrededor. La especie O. microtis tiene relevancia epidemiológica al ser el reservorio natural del hantavirus Río Mamoré y al ser considerado actualmente como potencial reservorio del virus Chapare y de otros arenavirus.

Excess of deaths during COVID-19 pandemic in Mato Grosso, Brazil / Excesso de mortes durante a pandemia de COVID-19 em Mato Grosso, Brasil

Abstract This article aims to estimate the excess of deaths in the years 2020 and 2021 in Mato Grosso state, in the state capital and in the countryside, according to gender and age group. Data was extracted from DATASUS/Ministry of Health website for the period from 2015 to 2020 and from the website of the State Department of Health - Data Warehouse System (DW) for 2021. Non-fetal deaths by natural causes of residents in Mato Grosso were analyzed and the analyses were broken down into countryside and state capital (Cuiabá). The variables selected were age group, gender, month of occurrence, and underlying cause of death. Excess mortality was calculated using generalized additive quasi-Poisson model adjustments with correction for overdispersion. A 30% excess of deaths was identified in 2020, with the state capital recording the highest estimate, in older age groups, and between the months of July and September. In 2021, the expected number of deaths was 57% higher, with the double in the younger age groups in the countryside. The study showed different demographic profiles of excess deaths in the years 2020 and 2021 during COVID-19 pandemic and distinct patterns between countryside and state capital, suggesting inequalities that may have caused impact on different risks.

Resumo O objetivo deste artigo é estimar o excesso de óbitos nos anos de 2020 e 2021 no estado de Mato Grosso, na capital do estado e no interior, segundo sexo e faixa etária. Os dados foram extraídos do site do DATASUS/Ministério da Saúde para o período de 2015 a 2020 e do site da Secretaria de Estado da Saúde - Sistema Data Warehouse (DW) para 2021. Óbitos não fetais por causas naturais de residentes no Mato Grosso foram analisados ​​e as análises foram divididas em interior e capital do estado (Cuiabá). As variáveis ​​selecionadas foram: faixa etária, sexo, mês de ocorrência e causa básica do óbito. O excesso de mortalidade foi calculado usando ajustes generalizados do modelo aditivo quase-Poisson com correção para superdispersão. Identificou-se um excesso de 30% de óbitos em 2020, com a capital do estado registrando a maior estimativa, nas faixas etárias mais avançadas, e entre os meses de julho e setembro. Em 2021, o número esperado de óbitos foi de 57% superior, sendo o dobro nas faixas etárias mais jovens do interior do estado. O estudo mostrou diferentes perfis demográficos de excesso de óbitos nos anos de 2020 e 2021 durante a pandemia de COVID-19 e padrões distintos entre interior e capital do estado, sugerindo desigualdades que podem ter impactado em diferentes riscos.

Construction and validation of an algorithm for disinfection of ambulances transporting patients with contagious infectious diseases / Construcción y validación de algoritmo para desinfección de ambulancia para transporte de pacientes con enfermedades transmisibles / Construção e validação de algoritmo para desinfecção de ambulância para transporte de pacientes com doenças infectocontagiosas

ABSTRACT Objectives: to develop and validate an algorithm to guide professionals in cleaning and disinfecting ambulances after transferring patients with contagious infectious diseases. Methods: the study was conducted between September and November 2021. The developed algorithm was validated by 104 judges, including nurses, physical therapists, and physicians who care for patients with contagious infectious diseases. It used the Delphi technique and content validity index. Results: in the first evaluation, the judges considered the algorithm "unsuitable" and "fully suitable". The algorithm reviewed according to the judges' suggestions was rated between "suitable" and "fully suitable" in the second evaluation. The overall content validity index was 0.960 and 0.998 in the first and second evaluations. Conclusions: the algorithm to guide the cleaning and disinfection of ambulances after transferring patients with contagious infectious diseases was developed and validated by specialists in the field, with consensus among the judges in the second evaluation.

RESUMEN Objetivos: desarrollar y validar algoritmo para orientar profesionales en la limpieza y desinfección de ambulancia tras transferencia de paciente con enfermedades transmisibles. Métodos: estudio realizado entre septiembre y noviembre de 2021. El algoritmo desarrollado fue validado por 104 jueces, incluyendo enfermeros, fisioterapeutas y médicos que asisten a pacientes con enfermedades transmisibles. Utilizada técnica Delphi e índice de validez de contenido. Resultados: en la primera evaluación, los jueces consideraron el algoritmo entre "inadecuado" y "totalmente adecuado". El algoritmo revisado conforme sugestiones de los jueces fue clasificado entre "adecuado" y "totalmente adecuado" en la segunda evaluación. El índice de validez de contenido general fue de 0,960 y 0,998 en la primera y segunda evaluación, respectivamente. Conclusiones: el algoritmo para orientar en la limpieza y desinfección de ambulancia tras transferencia de paciente con enfermedades transmisibles fue construido y validado por especialistas en el área, habiendo consenso entre los jueces en la segunda evaluación.

RESUMO Objetivos: desenvolver e validar um algoritmo para orientar profissionais na limpeza e desinfecção de ambulância após transferência de paciente com doenças infectocontagiosas. Métodos: estudo realizado entre setembro e novembro de 2021. O algoritmo desenvolvido foi validado por 104 juízes, incluindo enfermeiros, fisioterapeutas e médicos que prestam assistência aos pacientes com doenças infectocontagiosas. Utilizaram-se a técnica Delphi e o índice de validade de conteúdo. Resultados: na primeira avaliação, o algoritmo foi considerado pelos juízes entre "inadequado" e "totalmente adequado". O algoritmo revisado segundo as sugestões dos juízes foi classificado entre "adequado" e "totalmente adequado" na segunda avaliação. O índice de validade de conteúdo geral foi de 0,960 e 0,998 na primeira e segunda avaliação, respectivamente. Conclusões: o algoritmo para orientar na limpeza e desinfecção de ambulância após transferência de paciente com doenças infectocontagiosas foi construído e validado por especialistas na área, havendo consenso entre os juízes na segunda avaliação.

Profile of pregnant women and children accompanied due to T. gondii exposure at a referred healthcare center: What has changed in 10 years? / Perfil de gestantes e crianças acompanhadas por exposição ao Toxoplasma gondii num centro de referência: O que mudou 10 anos depois?

Abstract Objectives: to characterize the profile of pregnant women and newborns accompanied at a reference center for infectious-parasitic diseases, after the exposure of T. gondii, establishing comparisons with a previous study, in the same location, ten years ago. Methods: this is a retrospective cohort study, with a follow-up of four years (2016 to 2019), using the previous study carried out from 2002 to 2010 as a comparative for the variables assessed. Mothers who presented tests suggestive of seroconversion for the disease during prenatal care and their respective concepts, followed up over a year, were included. The chi-square test was used, assuming a significance level of 5% for the comparison of the groups in the two periods. Results: during the period from 2016 to 2019, 79 binomials were studied, whereas 58 binomials were accompanied in the previous period. Comparing both periods, the findings showed lower proportions of adolescents (p<0.001), with low schooling (p<0.001), with low serological testing (p<0.001) and with late or postnatal diagnosis (p<0.001). As to the children, the findings showed fewer changes in fundoscopy (p<0.001), strabismus (p=0.002), hepatomegaly (p=0.026) and any sequelae (p<0.001). Conclusion: a positive advance was observed regarding the care provided for the mother-child binomial affected by T. gondii, with a reduction in negative outcomes for the child. However, there are still challenges concerning the diagnosis and proper management of the disease.

Resumo Objetivos: caracterizar o perfil de gestantes e neonatos acompanhadas em um centro de referência em doenças infecto-parasitárias, após exposição ao Toxoplasma gondii, estabelecendo comparações em relação a estudo prévio, no mesmo local, há dez anos. Métodos: trata-se de estudo de coorte retrospectivo, com seguimento de quatro anos (2016 a 2019), servindo o estudo prévio realizado de 2002 a 2010 como comparativo para as variáveis estudadas. Foram incluídas mães que apresentaram durante o pré-natal exames sugestivos soroconversão para a doença e seus respectivos conceptos, acompanhados ao longo de um ano. Utilizou-se o teste qui-quadrado, assumindo-se nível de significância de 5% para a comparação dos grupos nos dois períodos. Resultados: durante o período de 2016 a 2019, foram estudados 79 binômios, enquanto no período anterior foram acompanhados 58 binômios. Comparando-se os dois períodos, em relação às mães, registraram-se menores proporções de adolescentes (p<0,001), de baixa escolaridade (p<0,001), baixa realização de testes sorológicos (p<0,001) e com diagnóstico tardio ou pós-natal (p<0,001). Em relação às crianças, verificaram-se menores proporções de alterações de fundoscopia (p<0,001), estrabismo (p=0,002), hepatomegalia (p=0,026) e qualquer sequela (p<0,001). Conclusão: observou-se um avanço em relação aos cuidados para o binômio mãe-filho acometido pelo T. gondii, com redução de desfechos negativos sobre a criança. Todavia, ainda existem desafios para o diagnóstico e adequado manejo da doença.

Changes in access to water and incidence of waterborne diseases after the Vale dam collapse in Brumadinho (MG), Brazil / Alterações no acesso à água e na incidência de doenças de veiculação hídrica após o rompimento da barragem da Vale em Brumadinho (MG)

ABSTRACT Objective: To describe, within the Human Rights to Water and Sanitation (HRWS) framework, the access to water supply services and the incidence of waterborne diseases in the communities affected by the dam disaster in Brumadinho (MG), Brazil. Methods: A quantitative and qualitative methodology was used, having as variables information on access to water supply services and waterborne diseases. The primary data were extracted from the "Brumadinho Health Project", using a sample stratum with 981 people interviewed, totaling 92.5% of the eligible population in the affected communities of Córrego do Feijão and Parque da Cachoeira. The secondary data from Brumadinho was extracted from the project "Sanitation conditions and the River Basin of the B1 River Basin of Mineradora Vale between 2017 and 2020", available in public databases between 2017 and 2020, and qualitative data was collected in 2022 through individual interviews with health professional also live in the communities. Results: With regard to access to water supply services, the results of this combined data analysis indicate that the HRWS is being neglected, especially with regard to availability, accessibility, acceptability and quality of water. The study also shows a significant increase in the incidence of waterborne diseases in the region after the disaster. Conclusion: It is necessary to use the HRWS as the basis to the implementation of public policies aiming to reduce vulnerability in access to water supply services.

RESUMO Objetivo: Descrever, na ótica dos direitos humanos à água e ao esgotamento sanitário (DHAES), o acesso à água e a incidência de doenças de veiculação hídrica na região atingida pelo rompimento da barragem da Mina B1 em Brumadinho (MG). Métodos: Utilizou-se a metodologia quantitativa e qualitativa, tendo como variáveis, em ambos os métodos, informações sobre o acesso à água e as doenças de veiculação hídrica. Os dados primários foram extraídos do Projeto de Saúde Brumadinho, sendo aqui utilizado um estrato amostral com 981 pessoas entrevistadas, totalizando 92,5% da população elegível das comunidades atingidas de Córrego do Feijão e Parque da Cachoeira. Os dados secundários de Brumadinho foram coletados pelo Projeto Condições de Saneamento e Saúde da População da Bacia do Rio Paraopeba, a Jusante da Barragem B1 da Mineradora Vale, entre 2017 e 2020, em banco de dados públicos entre 2017 e 2020, e os dados qualitativos foram coletados em 2022 por meio de entrevistas individuais com profissionais de saúde residentes nas comunidades atingidas. Resultados: No tocante ao acesso à água, a análise combinada dos dados apontou que os DHAES estão sendo negligenciados na região, de maneira especial no que se refere à disponibilidade, acessibilidade física, aceitabilidade e qualidade da água. Observou-se também que houve aumento significativo na incidência das doenças de veiculação hídrica na região após o desastre. Conclusão: É necessária utilização dos DHAES como marco referencial na implementação de políticas públicas voltadas para reduzir as situações de vulnerabilidade relacionadas ao acesso à água.

Vertical transmission of HIV to neonates in a reference hospital in Northeastern Brazil from 2013 to 2017

ABSTRACT The aim of this study was to estimate the rate of Mother-to-child Transmission (MTCT) of HIV to neonates in a reference university hospital in Sao Luis city, the capital of Maranhao State (MA), evaluating MTCT-associated factors. A retrospective cohort study based on data from the Notifiable Diseases Data System (SINAN) was carried out and included all HIV-exposed neonates notified from 2013 to 2017 by the university hospital. The study population comprised 725 HIV-exposed neonates, of whom 672 neonates were exposed and uninfected, and 53 were exposed and infected. The estimated rate of MTCT in the period of 2013 to 2017 was 7.3%. Most pregnant women were ≥ 20 years old (86.9%), reported ≥ 8 years of schooling (53.2%), reported full-time or independent paid work (46.9%) and were residents in other cities of the state (61.7%). Regarding healthcare, 86.3% received prenatal care, 74.6% received Antiretroviral Therapy (ART) as prophylaxis during pregnancy, 81.8% received ART prophylaxis during childbirth and 78.1% underwent cesarean section. Among the neonates, 92.8% received ART prophylaxis and 94.3% were not breastfed. Despite these variables, the 7.3% MTCT rate found in this study makes it clear that the interventions recommended by the Ministry of Health were not fully adopted.

The COVID-19 pandemic in sub-Saharan Africa: The significance of presumed immune sufficiency

A novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in China in 2019 and later ignited a global pandemic. Contrary to expectations, the effect of the pandemic was not as devastating to Africa and its young population compared to the rest of the world. To provide insight into the possible reasons for the presumed immune sufficiency to coronavirus disease 2019 (COVID-19) in Africa, this review critically examines literature published from 2020 onwards on the dynamics of COVID-19 infection and immunity and how other prevalent infectious diseases in Africa might have influenced the outcome of COVID-19. Studies characterising the immune response in patients with COVID-19 show that the correlates of protection in infected individuals are T-cell responses against the SARSCoV-2 spike protein and neutralising titres of immunoglobin G and immunoglobin A antibodies. In some other studies, substantial pre-existing T-cell reactivity to SARS-CoV-2 was detected in many people from diverse geographical locations without a history of exposure. Certain studies also suggest that innate immune memory, which offers protection against reinfection with the same or another pathogen, might influence the severity of COVID-19. In addition, an initial analysis of epidemiological data showed that COVID-19 cases were not severe in some countries that implemented universal Bacillus Calmette­Guerin (BCG) vaccination policies, thus supporting the potential of BCG vaccination to boost innate immunity. The high burden of infectious diseases and the extensive vaccination campaigns previously conducted in Africa could have induced specific and non-specific protective immunity to infectious pathogens in Africans.