Impacto de la recolección de residuos domésticos de gran tamaño sobre potenciales criaderos de mosquitos transmisores del dengue en Asunción, Paraguay

Introducción: Los brotes recurrentes de dengue subrayan la necesidad de abordajes más efectivos en la prevención y control de vectores. A menudo, las intervenciones se centran en un enfoque biomédico y de promoción de la salud desde un enfoque individual, sin integrar factores socioambientales ni ser evaluados científicamente Objetivo: Evaluar el impacto de la recolección de residuos domésticos de gran tamaño sobre potenciales criaderos de mosquitos transmisores del dengue en Asunción, Paraguay durante los años 2017 a 2021. Material y métodos: Estudio cuasiexperimental, longitudinal, donde se encuestaron 350 hogares, como línea de base durante el 2017 y una línea de cierre en 108 hogares en 2021. Se utilizó el método de Diferencia en Diferencia (DID) para comparar la presencia de criaderos antes y después de la intervención en 43 hogares intervenidos y 65 no intervenidos. Resultados: La recolección diferenciada fue utilizada principalmente por aquellos hogares que tenían una gran cantidad de residuos sólidos de gran tamaño, pero no para deshacerse de todos estos objetos, sino sólo de una parte (DID de -52% en el número total de criaderos y DID de 1% en número de hogares con criaderos). Encontramos una reducción significativa en el número de total de criaderos de gran tamaño, pero no observamos diferencias en el número total de hogares con criaderos. Factores subjetivos, como la creencia de que los objetos en desuso podrían llegar a ser útiles en el futuro explicaban en gran medida su presencia en los hogares, incluso con el servicio disponible. Conclusiones: El enfoque de la gestión municipal en los residuos voluminosos puede contribuir a la prevención del dengue por el hecho de que no constituyen residuos de generación rápida en los hogares, y su eliminación puede tener un impacto relativamente duradero. El factor subjetivo relacionado con la presencia de estos criaderos en los hogares debe ser objeto de mayores estudios.

Introduction: Recurrent dengue outbreaks underscore the need for more effective approaches to vector prevention and control. Often, interventions focus on a biomedical and health promotion approach from an individual approach, without integrating socio-environmental factors or being scientifically evaluated. Objetive: To evaluate the impact of large household waste collection on potential breeding sites of dengue-transmitting mosquitoes in Asuncion, Paraguay during the years 2017 to 2021. Material and methods: Quasi-experimental, longitudinal study, where 350 households were surveyed, as a baseline during 2017 and a closing line in 108 households in 2021. The Difference-in-Difference (DID) method was used to compare the presence of breeding sites before and after the intervention in 43 intervened and 65 non-intervened households. Results: Differentiated collection was mainly used by those households that had a large amount of large solid waste, but not to dispose of all these objects, but only part of them (DID of -52% in the total number of breeding sites and DID of 1% in the number of households with breeding sites). We found a significant reduction in the total number of large breeding sites but did not observe differences in the total number of households with breeding sites. Subjective factors, such as the belief that disused objects could become useful in the future, were largely responsible for the reduction in the number of large breeding sites. Conclusions: The municipal management approach to bulky waste can contribute to dengue prevention because it does not constitute rapidly generated waste in households, and its disposal can have a relatively long-lasting impact. The subjective factors related to the presence of these breeding sites in households warrant further study.

Comparison of Insecticide Sprays in Alternate Rows and in All Rows on Asian Citrus Psyllid Control and Huanglongbing Progress in Sweet Orange Orchards.

One strategy to reduce huanglongbing (HLB) is controlling its insect vector, the Asian citrus psyllid (ACP) Diaphorina citri, by preventive insecticide sprays. The recommendation is to spray insecticide in all rows (conventional spray [CONV]), but some growers empirically spray in alternate rows (ALT) to increase the spray frequency without increasing the operating cost. Therefore, this work compared the effect of ALT with CONV on the ACP population and HLB incidence. The spray deposition (amount of metallic copper per leaf area), coverage (percentage of water-sensitive paper area covered by spray), and efficacy (ACP mortality) of each treatment were also evaluated on both sides of the trees. Two field trials were performed: Trial #1 compared ALT every 7 days (ALT7) with CONV every 14 days (CONV14), and trial #2 compared different spray frequencies of ALT with CONV every 7 days (CONV7). In trial #1, no differences were observed in the ACP population or HLB progress between ALT7 and CONV14 after 5 years. In trial #2, ALT7 presented the highest percentage of ACP and cumulative HLB incidence than CONV7 and ALT every 3 to 4 days, after 2 years. Hence, when the frequency of ALT was half the frequency of CONV, similar results were observed. Spray deposition, coverage, and efficacy were similar between tree sides in CONV, but they were uneven in ALT, resulting in higher values on the tree side that directly received the spray. Insecticide spray should be performed with the frequency enough to keep new shoots protected during their growth.

CRISPRals: A Web Database for Assessing the CRISPR Defense System in the Ralstonia solanacearum Species Complex to Avoid Phage Resistance.

Clustered regularly interspaced short palindromic repeats (CRISPR) has been widely characterized as a defense system against phages and other invading elements in bacteria and archaea. A low percentage of Ralstonia solanacearum species complex (RSSC) strains possess the CRISPR array and the CRISPR-associated proteins (Cas) that would confer immunity against various phages. To provide a wide-range screen of the CRISPR presence in the RSSC, we analyzed 378 genomes of RSSC strains to find the CRISPR locus. We found that 20.1, 14.3, and 54.5% of the R. solanacearum, R. pseudosolanacearum, and R. syzygii strains, respectively, possess the CRISPR locus. In addition, we performed further analysis to identify the respective phages that are restricted by the CRISPR arrays. We found 252 different phages infecting different strains of the RSSC, by means of the identification of similarities between the protospacers in phages and spacers in bacteria. We compiled this information in a database with web access called CRISPRals (https://crisprals.yachaytech.edu.ec/). Additionally, we made available a number of tools to detect and identify CRISPR array and Cas genes in genomic sequences that could be uploaded by users. Finally, a matching tool to relate bacteria spacer with phage protospacer sequences is available. CRISPRals is a valuable resource for the scientific community that contributes to the study of bacteria-phage interaction and a starting point that will help to design efficient phage therapy strategies.

Whole genome sequencing of nine Vibrio parahaemolyticus strains encoding (Pir) toxin-like genes from shrimp cultures in northern Peru using Oxford Nanopore technology.

Nine Peruvian isolates of Vibrio parahaemolyticus were characterized through sequencing, revealing the presence of simple sequence repeat, Pir toxin-like genes, and genes associated with antibiotic resistance, toxic components, and transposable elements. These findings expand our understanding of the genetic diversity, disease resistance, and virulence in cultivated shrimp populations in Peru.

Spatial and temporal trends of dengue infections in Curaçao: A 21-year analysis.

Dengue viruses are a significant global health concern, causing millions of infections annually and putting approximately half of the world's population at risk, as reported by the World Health Organization (WHO). Understanding the spatial and temporal patterns of dengue virus spread is crucial for effective prevention of future outbreaks. By investigating these patterns, targeted dengue surveillance and control measures can be improved, aiding in the management of outbreaks in dengue-affected regions. Curaçao, where dengue is endemic, has experienced frequent outbreaks over the past 25 years. To examine the spatial and temporal trends of dengue outbreaks in Curaçao, this study employs an interdisciplinary and multi-method approach. Data on >6500 cases of dengue infections in Curaçao between the years 1995 and 2016 were used. Temporal and spatial statistics were applied. The Moran's I index identified the presence of spatial autocorrelation for incident locations, allowing us to reject the null hypothesis of spatial randomness. The majority of cases were recorded in highly populated areas and a relationship was observed between population density and dengue cases. Temporal analysis demonstrated that cases mostly occurred from October to January, during the rainy season. Lower average temperatures, higher precipitation and a lower sea surface temperature appear to be related to an increase in dengue cases. This effect has a direct link to La Niña episodes, which is the cooling phase of El Niño Southern Oscillation. The spatial and temporal analyses conducted in this study are fundamental to understanding the timing and locations of outbreaks, and ultimately improving dengue outbreak management.

Caracterização do perfil sociodemográfico dos usuários de profilaxia pré-exposição ao HIV (PrEP) no Ceará / Characterization of the sociodemographic profile of users of hiv pre-exposure prophylaxis (PrEP) in Ceará

Introdução: a PrEP é uma estratégia de prevenção biomédica que consiste no uso de antirretrovirais (ARV) orais com o objetivo de mitigar o risco de adquirir o HIV e, consequentemente, de desenvolver a AIDS. O presente estudo tem como objetivo descrever o perfil sociodemográfico dos usuários com dispensação da PrEP no Ceará, no período de 2018 a 2023. Métodos: trata-se de um estudo transversal descritivo. Os dados foram obtidos por meio do Departamento de HIV/Aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis (DATHI) do Ministério da Saúde por meio do Painel de monitoramento da PrEP. Resultados: observou-se um predomínio de usuários gays e homens que fazem sexo com homens, mas não se consideram gays; autodeclarados como pardos, com alta escolaridade e com faixa etária entre 30 e 39 anos. As dispensações da PrEP apresentaram progressão no período analisado, apesar dos anos de pandemia. Conclusão: embora a PrEP tenha-se mostrado eficaz no controle e declínio no número de infecções pelo HIV, esses dados demonstram que há uma lacuna entre quem se beneficia dela. É um desafio fazer com que a PrEP chegue a quem se pode beneficiar dela e com maior probabilidade de exposição ao HIV indivíduos de baixa escolaridade, pessoas trans, travestis, jovens adultos /adolescentes e não brancos.

Introduction: PrEP is a biomedical prevention strategy that consists of the use of oral antiretrovirals (ARV) to mitigate the risk of acquiring HIV and, consequently, of developing AIDS. The present study aims to describe the sociodemographic profile of users dispensed with PrEP in Ceará from 2018 to 2023. Methods: this is a descriptive cross-sectional study. The data was obtained from the Department of HIV/Aids, Tuberculosis, Viral Hepatitis, and Sexually Transmitted Infections (DATHI) of the Ministry of Health through the PrEP Monitoring Panel. Results: there was a predominance of Gay users and Men who have Sex with Men but do not consider themselves gay; they self-declared as mixed race, highly educated, and aged between 30 and 39 years old. PrEP dispensations showed progression in the period analyzed despite years of pandemic. Conclusion: although PrEP is effective in controlling and declining the number of HIV infections, these data demonstrate that there is a gap between who benefits from it. It is a challenge to make PrEP reach those who can most benefit from it and who are most likely to be exposed to HIV, individuals with low education, trans people, transvestites, young adults/adolescents, and non-whites.

Profile of sexually transmitted infections among attendees of special clinics (Suraksha) at an apex regional sexually transmitted disease centre in North India ­ a five-year study

Introduction: Sexually transmitted infections (STIs) present significant global and national health challenges, particularly in India. Objective: To estimate the prevalence and characteristics of STIs among attendees at the Suraksha Clinic in the Apex Regional STD Centre, Safdarjung Hospital. Methods:Retrospective data from January 2018 to December 2022 were statistically analyzed using Excel and SPSS. The study included the examination for diagnosis of various STIs, such as syphilis, human immunodeficiency virus (HIV), gonorrhoea, chlamydiasis, trichomoniasis, candidiasis, bacterial vaginosis, chancroid, and genital herpes. Gender distribution and syndromic diagnoses, including vaginal/cervical discharge and genital ulcers, were also considered. Referrals to Integrated Counseling and Testing Centres for HIV testing were analyzed. Results: The outcomes reveal a substantial burden of STIs, with 3.06% showing reactivity to syphilis, 1.74% testing positive for HIV, 3.36% for gonorrhoea, 11.78% for chlamydiasis, 1.05% for trichomoniasis, 26.24% for candidiasis, 9.97% for bacterial vaginosis, 7.80% for chancroid, 11.64% for herpes genitalis, and 4.01% for other non-STIs. Attendees' interactions included 34.36% of referrals to Integrated Counseling and Testing Centres for HIV testing. The gender distribution showed 58.92% male and 40.94% female attendees. Conclusion: Syndromic diagnoses, including vaginal/cervical discharge (21.22%) and genital warts (8.00%), highlight prevalent conditions, necessitating routine screening, early detection, and targeted interventions for effective disease control and prevention. These findings underscore the significance of integrated screening, patient education, and proactive strategies to safeguard public health in the face of rising STI rates. (AU)

Introdução: As infecções sexualmente transmissíveis (IST) apresentam desafios de saúde globais e nacionais significativos, particularmente na Índia. Objetivo: Estimar a prevalência e as características das IST entre os pacientes atendidos na Clínica Suraksha do Centro Regional de doenças sexualmente transmissíveis (DST) Apex, Hospital Safdarjung. Métodos: Dados retrospectivos de janeiro de 2018 a dezembro de 2022 foram analisados estatisticamente utilizando Excel e Statistical Package for the Social Sciences (SPSS). O estudo inclui o exame para diagnóstico de diversas IST, como sífilis, HIV, gonorreia, clamídia, tricomoníase, candidíase, vaginose bacteriana, cancroide e herpes genital. A distribuição por gênero e os diagnósticos sindrômicos, incluindo corrimento vaginal/cervical e úlceras genitais, também foram considerados. Foram analisados encaminhamentos para Centros Integrados de Aconselhamento e Testagem para testagem de HIV. Resultados: Os resultados revelam uma carga substancial de IST, com 3,06% apresentando reatividade à sífilis, 1,74% testando positivo para HIV, 3,36% para gonorreia, 11,78% para clamídia, 1,05% para tricomoníase, 26,24% para candidíase, 9,97% para vaginose bacteriana, 7,80% para cancroide, 11,64% para herpes genital e 4,01% para outras infecções não IST. As interações dos participantes incluíram 34,36% de encaminhamentos para Centros Integrados de Aconselhamento e Testagem para testes de HIV. A distribuição por gênero mostrou 58,92% de participantes do sexo masculino e 40,94% do sexo feminino. Conclusão: Os diagnósticos sindrômicos, incluindo corrimento vaginal/cervical (21,22%) e verrugas genitais (8,00%), destacam condições prevalentes, necessitando de exames de rotina, detecção precoce e intervenções direcionadas para controle e prevenção eficazes de doenças. Estas conclusões sublinham a importância do rastreio integrado, da educação dos pacientes e de estratégias proativas para salvaguardar a saúde pública diante do aumento das taxas de IST. (AU)

Evaluation by community health agents of the attributes of primary health care for fighting leprosy: a cross-sectional study

OBJECTIVE: To evaluate whether the attributes of Primary Healthcare are present in leprosy control actions in Londrina from Community Health Workers' (CHW) perspectives. METHOD: Observational and evaluative study. Data collection occurred between January and March 2020 in Londrina, Paraná, using the questionnaire "Primary Care Assessment Tool (PCATool) - Hansen's disease - CHW version" and a population-based census of 246 CHWs from 52 Primary Healthcare Units. The analyses used a cutoff point (≥ 6.6), central tendency, and dispersion measures. One-way ANOVA and Tukey's post hoc tests were used to analyze differences. Results: The general performance towards the primary healthcare attributes were evaluated as strong (mean = 6.95 / SD = 1.08) and the essential score (mean = 7.39 / SD = 1.0). On the other hand, the derived score was evaluated as poor (mean = 6.07 / sd = 1.06). Concerning the Access attribute, the rural zone had a lower score than the urban (mean = 4.47 / SD = 1.63). Conclusion: The study highlights issues that can be improved, such as first contact access, catalog of services offered to leprosy patients, information provided to the community, professional training, and differences in PHC performance between urban and rural regions.

Fungitoxic effect and phytochemical characteristics of Brazilian Cerrado weeds against Rhizoctonia solani and Macrophomina phaseolina fungi / Efeito fungitóxico e características fitoquímicas de plantas daninhas do Cerrado brasileiro frente aos fungos Rhizoctonia solani e Macrophomina phaseolina

The use of natural products obtained from plants, for example, invasive plants, offers a variety of allelochemicals with fungicidal potential. With this in perspective, the objective was to evaluate the fungicidal potential of ethanolic extracts of Cerrado plants on Rhizoctonia solani and Macrophomina phaseolina. The ethanolic hydroalcoholic extract of the 12 plants identified as invaders in the Brazilian Cerrado was prepared (Anacardium humile Saint Hill; Baccharis dracunculifolia DC.; Cenchrus echinatus L; Commelina erecta L.; Erigeron bonariensis L.; Digitaria horizontalis Willd.; Digitaria insularis L.; Porophyllum ruderale Jacq. Cass; Richardia brasiliensis Gomes; Sida rhombifolia L.; Turnera ulmifolia L.; Smilax fluminensis Steud)) and phytochemical screening and determination of total phenols and flavonoids were performed. To evaluate the in vitro antifungal activity, the hydroalcoholic solutions at concentrations of 800, 1200, 1600, 2000, and 2400 µL 100 mL-1 were separately incorporated into BDA agar and poured into Petri dishes, followed by the mycelium disk of the fungus. As a control, two solutions were prepared, one ethanolic solution added to the BDA medium (2400 µg 100 mL-1) and the other with BDA medium only. They were poured into Petri dishes, followed by a 0.5 cm diameter disk of mycelium of the fungus, incubated (23±2 ºC), with a 24-hour photoperiod. Among the constituents found in the plants, 75% are phenolic compounds, 58.3% are cardiotonic heterosides, 50% are steroids, 33.3% are flavonoids, 16.7% are anthraquinones, and 8.3% are alkaloids, saponins, and reducing sugars. Out of the 12 species, only the extracts of C. erecta and R. brasiliensis were active for M. phaseolina and R. solani. Thus, it is concluded that the ethanolic extract of C. erecta has the fungicidal potential to control diseases caused by fungi that are soil inhabitants. Of the other species, A. humille, B. dracuncufolia, D. insulares, C. erecta, D. insulares, P. ruderale, and R. brasiliensis have natural fungitoxic potential because they stand out in the content of polyphenols efficient in reducing the mycelial growth of M. phaseolina and R. solani.

O uso de produtos naturais obtidos de plantas, por exemplo, as plantas invasoras, oferece uma variedade de aleloquímicos com potencial fungicida. Tendo isso em vista, objetivou-se avaliar o potencial fungicida de extratos etanólicos de plantas do Cerrado sobre Rhizoctonia solani e Macrophomina phaseolina. Foi preparado o extrato hidroalcoólicos etanólico das 12 plantas apontadas como invasoras no Cerrado brasileiro (Anacardium humile Saint Hill; Baccharis dracunculifolia DC.; Cenchrus echinatus L; Commelina erecta L.; Erigeron bonariensis L.; Digitaria horizontalis Willd.; Digitaria insularis L.; Porophyllum ruderale Jacq. Cass; Richardia brasiliensis Gomes; Sida rhombifolia L.; Turnera ulmifolia L.; Smilax fluminensis Steud) e foi realizado o screening fitoquímico e a determinação de fenóis e flavonoides totais. Para avaliar a atividade antifúngica in vitro, as soluções hidroalcóolicas nas concentrações de 800, 1200, 1600, 2000 e 2400 µL 100 mL-1 foram incorporadas, separadamente, em ágar BDA, e vertidas em placa de Petri, seguido do disco de micélio do fungo. Como controle, foram preparadas duas soluções, uma solução etanólica adicionada ao meio BDA (2400 µg 100 mL-1), e outra somente com meio BDA, a testemunha. Foram vertidas em placas de Petri, seguido um disco de 0,5 cm de diâmetro de micélio do fungo, incubados (23±2 ºC), com fotoperíodo de 24 horas. Dentre os constituintes encontrados nas plantas, 75% estão os compostos fenólicos, 58,3% estão os heterosídeos cardiotônicos, 50% estão os esteroides, 33,3% estão os flavonoides, 16,7% estão as antraquinonas e 8,3% estão os alcaloides, saponinas e açúcares redutores. Das 12 espécies, apenas os extratos de C. erecta e R. brasiliensis foram ativos para M. phaseolina e R. solani. Desse modo, conclui-se que o extrato etanólico de C. erecta apresenta potencial fungicida para controle de doenças causadas por fungos habitantes do solo. Das demais espécies, a A. humille, B. dracuncufolia, D. insulares, C. erecta, D. insulares, P. ruderale e R. brasiliensis possuem potencial fungitóxicos naturais por destacarem nos teores de polifenóis eficientes na redução do crescimento micelial de M. phaseolina e R. solani.

Percepções da dengue na perspectiva de uma comunidade rural da costa caribenha na Colômbia / Perceptions of dengue fever from the perspective of a rural community on the Caribbean coast in Colombia / Percepciones del dengue desde la perspectiva de una comunidad rural de la costa Caribe en Colombia

O estudo buscou compreender as percepções sobre a dengue em uma comunidade rural de Córdoba, Colômbia, com o objetivo de orientar ações específicas de enfermagem comunitária voltadas para o cuidado e a educação em saúde de pessoas, famílias e comunidades rurais. Foram realizadas 20 entrevistas semiestruturadas com chefes de família (13 homens e 7 mulheres), selecionados com base nos critérios de serem membros da comunidade há mais de 20 anos, se autoidentificarem como camponeses e terem no mínimo 18 anos de idade. O número de participantes foi determinado após alcançar a saturação teórica. As entrevistas foram transcritas e organizadas em uma matriz de análise para codificação, categorização e análise dos dados. Os achados revelaram três categorias analíticas: busca pelo conhecimento sobre a doença, práticas in situ e cuidados do passado e do presente. As famílias entrevistadas possuem conhecimento básico sobre a doença e o vetor causador, mantendo práticas familiares relacionadas ao uso de plantas medicinais para cuidados familiares e automedicação nas fases iniciais, devido à baixa percepção do risco. As famílias camponesas constroem representações socioculturais baseadas em solidariedade, apoio familiar e respeito pelo conhecimento dos idosos. A enfermagem é apresentada como ator essencial na coleta de práticas de cuidado para a elaboração e aplicação de planos de cuidado contextualizados de acordo com as necessidades do território. A pesquisa foi aprovada com o código SI-FCS-02-22, autorizando sua implementação.

The study sought to understand perceptions about dengue fever in a rural community in Córdoba, Colombia, with the aim of guiding specific community nursing actions aimed at health care and education for people, families and rural communities. 20 semi-structured interviews were carried out with heads of families (13 men and 7 women), selected based on the criteria of being members of the community for more than 20 years, self-identifying as peasants and being at least 18 years of age. The number of participants was determined after reaching theoretical saturation. The interviews were transcribed and organized into an analysis matrix for coding, categorization and data analysis. The findings revealed three analytical categories: search for knowledge about the disease, in situ practices and past and present care. The families interviewed have basic knowledge about the disease and the causative vector, maintaining family practices related to the use of medicinal plants for family care and self-medication in the early stages, due to low risk perception. Peasant families build sociocultural representations based on solidarity, family support and respect for the knowledge of the elderly. Nursing is presented as an essential actor in the collection of care practices for the elaboration and application of care plans contextualized according to the needs of the territory. The research was approved with code SI-FCS-02-22, authorizing its implementation.

El estudio buscó comprender las percepciones sobre el dengue en una comunidad rural de Córdoba, Colombia, para orientar acciones específicas de Enfermería comunitaria sobre cuidado y educación en salud para personas, familias y comunidades rurales, mediante la realización de 20 entrevistas semiestructuradas a los jefes de familia (13 hombres y 7 mujeres), seleccionados a partir de los siguientes criterios: miembros de la comunidad con permanencia de más de 20 años, autorreconocerse como campesinos y tener mínimo 18 años. El número de participantes se obtuvo una vez se alcanzó el punto de saturación teórica. Las entrevistas fueron transcritas y organizadas en una matriz de análisis para su codificación, categorización y análisis. Los hallazgos arrojaron tres categorías analíticas: en búsqueda del conocimiento acerca de la enfermedad, las praxis in situ y cuidados del ayer y del hoy. Las familias entrevistadas poseen conocimiento básico sobre la enfermedad y el vector que la causa, conservan prácticas familiares relacionadas con el uso de plantas medicinales para el cuidado familiar y la automedicación en las fases iniciales ante la baja percepción del riesgo. Las familias campesinas construyen representaciones socioculturales a partir de la solidaridad, apoyo familiar y respeto por el conocimiento de los adultos mayores. Se presenta a Enfermería como actor esencial en la recopilación de prácticas de cuidado para la elaboración y aplicación de los planes de cuidado contextualizados y de cara a las necesidades del territorio. La investigación fue aprobada con el código SI-FCS-02-22, a partir del cual se autoriza su implementación.

The Global Leprosy Assessment Index (GLAI): A new approach for measuring the severity of disease in Brazil.

Background: In Brazil, the Ministry of Health (MH) monitors leprosy using 15 indicators, with the aim of implementing and evaluating evidence-based public policies. However, an excessive number of variables can complicate the definition of objectives and verification of epidemiological goals. Methods: In this paper, we develop the Global Leprosy Assessment Index (GLAI), a composite measure that integrates two key dimensions for the control the disease: epidemiological and operational. Using a confirmatory factor analysis model to examine 2020 state-level data, we have standardized GLAI to a range of 0 to 1. Results: Higher values within this range indicate a greater severity of the disease. The mean value of the GLAI was 0.67, with a standard deviation of 0.22. Roraima has the highest value, followed by Paraíba with 0.88 while Tocantins records the lowest value of the indicator, followed by Mato Grosso with 0.14. The epidemiological and operational indicators have a positive but statistically insignificant correlation (r = 0.25; p-value = 0.20). Conclusions: The development of evidence-based public policies depends on the availability of valid and reliable indicators. The GLAI presented in this paper is easily reproducible and can be used to monitor the disease with disaggregated information. Furthermore, the GLAI has the potential to serve as a more robust parameter for evaluating the impact of actions designed to eradicate leprosy in Brazil.

Factors associated with unsuccessful treatment outcome for tuberculosis in previously treated patients in Cali, Colombia, during the period 2015-2019 / Factores asociados al tratamiento no exitoso para tuberculosis en pacientes previamente tratados en Cali, Colombia, en el periodo 2015-2019

Introduction. The success rates in the treatment of tuberculosis are suboptimal. Objective. To identify associated factors with the lack of success of antituberculosis treatment in patients with a tuberculosis treatment history. Materials and methods. We performed a retrospective, analytical, observational, and cohort study of patients reentering the Mycobacterium program in Cali, Colombia. We included patients over 15 years old with pulmonary tuberculosis between 2015 and 2019 and a history of tuberculosis treatment. Patients with drug-resistant tuberculosis were excluded. Results. A total of 605 patients with a treatment history were included, 60% due to unfinished treatment and 40% due to relapse. Compared to patients reentering due to relapse (ORa=2.34, CI=1.62-3.38), the independent variables associated with treatment failure at discharge were homelessness (ORa=2.45, CI=1.54-3.89), substance dependence (ORa=1.95, CI=1.24-3.05), tuberculosis/HIV coinfection (ORa=1.69, CI=1.00-2.86), diabetes (ORa=1.89, CI=1.29-2.77), and unfinished previous tuberculosis treatment due to follow-up loss, abandonment, or other causes. Programmatic variables favoring treatment success were voluntary HIV testing counseling (p<0.001) and HIV testing (p<0.001). Conclusion. Homelessness, substance dependence, tuberculosis/HIV coinfection, diabetes, and incomplete previous treatment due to loss to follow-up, abandonment, or treatment failure hindered the success of antituberculosis. These characteristics should be identified and addressed during the initial care of patients reentering treatment for tuberculosis.

Introducción. Las tasas de éxito del tratamiento de la tuberculosis continúan siendo subóptimas. Objetivo. Identificar los factores asociados al tratamiento no exitoso para tuberculosis en pacientes con antecedentes de tratamiento para la tuberculosis. Materiales y métodos. Se realizó un estudio observacional retrospectivo, analítico, de cohorte de pacientes que reingresaron a un programa de micobacterias en Cali, Colombia. Se incluyeron mayores de 15 años con tuberculosis pulmonar entre el 2015 y el 2019 con antecedentes de tratamiento para la tuberculosis. Se excluyeron los pacientes con tuberculosis resistente. Resultados. Ingresaron 605 pacientes con antecedentes de tratamiento, 60 % por tratamiento inconcluso y 40 % por recaída. En comparación con los pacientes que reingresaron por recaída (ORa= 2,34; IC=1,62-3,38), las variables que explicaron de manera independiente el no tener éxito con el tratamiento para la tuberculosis al egreso fueron: estar en situación de calle (ORa = 2,45; IC = 1,54-3,89), ser farmacodependiente (ORa = 1,95; IC=1,24-3,05), tener coinfección tuberculosis/VIH (ORa = 1,69; IC =1,00-2,86) o diabetes (ORa =1,89; IC=1,29-2,77), y el incumplimiento de un tratamiento previo por pérdida de seguimiento, abandono u otras causas. Las variables programáticas que favorecieron el éxito del tratamiento fueron la asesoría de la prueba voluntaria de VIH (p <0,001) y la realización de la prueba de VIH (p < 0,001). Conclusión. Estar en situación de calle, ser farmacodependiente, tener coinfección de tuberculosis y VIH, o diabetes, así como el incumplimiento del tratamiento previo por pérdida del seguimiento, abandono o fracaso del mismo, dificultaron el éxito del tratamiento antituberculoso. En la primera atención al reingreso de los pacientes con tuberculosis se deben identificar y abordar estas características.

Integrated control of neglected tropical diseases in Brazil: document review of a national campaign in light of WHO recommendations.

Objective: To describe the results of a national campaign aimed at the integrated control of neglected tropical diseases in Brazil in light of the World Health Organization (WHO) official documentation related to the integration of strategies for the prevention, control, and elimination or eradication of neglected tropical diseases. Methods: A document review that included official WHO documents published between 2007 and 2020 and campaign results extracted from the official technical report produced by the Brazilian Ministry of Health. Results: The integrated control of neglected tropical diseases was gradually incorporated in the WHO documentation over time. Preventive chemotherapy through mass drug administration, intensified case management, and integrated vector management were extensively recommended as strategies for integrated control. The Brazilian campaign was carried out in four iterations between 2013 and 2017. Children aged 5 to 14 years enrolled in municipal public schools nationwide were targeted. In summary, a total of 1 074 and 73 522 new cases of leprosy and trachoma, respectively, were detected. Nearly 18 million doses of preventive chemotherapy for soil-transmitted helminthiasis were administered. More than 700 cases of schistosomiasis were diagnosed and treated. Conclusions: The integrated strategies implemented in Brazil throughout the campaign generated results aligned with the WHO recommendations for the control of neglected tropical diseases, especially those regarding mass drug administration, active case detection, and intensified case management. Therefore, the continuity of the campaign with adequate evaluation tools must be encouraged as a constant public health policy in the Brazilian government agenda.

Estrategias de control de la Equinococosis quística en el Uruguay / Strategies for the control of cystic echinococcosis in Uruguay / Estratégias de controle da equinococose cística no Uruguai

La equinococosis quística es una zoonosis de origen parasitario con distribución cosmopolita. En nuestro país continúa siendo una enfermedad endémica, afectando principalmente pequeños centros poblados y áreas rurales pobres relacionadas a la producción ovina. Los planes de control requieren de un abordaje holístico, con la participación de diferentes instituciones, profesionales y en especial de la comunidad. La cooperación regional busca monitorizar el avance de la enfermedad y centrar las medidas de acción sobre cuatro ejes, definidos según los puntos de intervención más comunes para la quiebra del ciclo de transmisión y la consecuente reducción en incidencia y prevalencia de la enfermedad. La presente revisión utilizó literatura obtenida en diferentes bases de datos, bibliotecas virtuales y sitios web regionales y locales con el objetivo describir las principales estrategias de control, vigilancia y prevención aplicadas actualmente en nuestro país.

Cystic echinococcosis is a zoonosis of parasitic origin with cosmopolitan distribution. In our country it continues to be an endemic disease, affecting mainly small population centers and poor rural areas related to sheep production. Control plans require a holistic approach, with the participation of different institutions, professionals and especially the community. Regional cooperation seeks to monitor the progress of the disease and focus action measures on four axes, defined according to the most common points of intervention to break the transmission cycle and consequently reduce the incidence and prevalence of the disease. This review used literature obtained from different databases, virtual libraries and regional and local websites with the aim of describing the main control, surveillance and prevention strategies currently applied in our country.

A equinococose cística é uma zoonose de origem parasitária com distribuição cosmopolita. Em nosso país, continua a ser uma doença endêmica, afetando principalmente pequenos centros populacionais e áreas rurais pobres relacionadas à produção de ovinos. Os planos de controle exigem uma abordagem holística, com a participação de diferentes instituições, profissionais e, principalmente, da comunidade. A cooperação regional busca monitorar o progresso da doença e concentrar as medidas de ação em quatro eixos, definidos de acordo com os pontos de intervenção mais comuns para interromper o ciclo de transmissão e, consequentemente, reduzir a incidência e a prevalência da doença. Esta revisão utilizou a literatura obtida em diferentes bases de dados, bibliotecas virtuais e sites regionais e locais com o objetivo de descrever as principais estratégias de controle, vigilância e prevenção aplicadas atualmente em nosso país.

Factores asociados al tratamiento no exitoso para tuberculosis en pacientes previamente tratados en Cali, Colombia, en el periodo 2015-2019 / Factors associated with unsuccessful treatment outcome for tuberculosis in previously treated patients in Cali, Colombia, during the period 2015-2019

Introducción. Las tasas de éxito del tratamiento de la tuberculosis continúan siendo subóptimas. Objetivo. Identificar los factores asociados al tratamiento no exitoso para tuberculosis en pacientes con antecedentes de tratamiento para la tuberculosis. Materiales y métodos. Se realizó un estudio observacional retrospectivo, analítico, de cohorte de pacientes que reingresaron a un programa de micobacterias en Cali, Colombia. Se incluyeron mayores de 15 años con tuberculosis pulmonar entre el 2015 y el 2019 con antecedentes de tratamiento para la tuberculosis. Se excluyeron los pacientes con tuberculosis resistente. Resultados. Ingresaron 605 pacientes con antecedentes de tratamiento, 60 % por tratamiento inconcluso y 40 % por recaída. En comparación con los pacientes que reingresaron por recaída (ORa= 2,34; IC=1,62-3,38), las variables que explicaron de manera independiente el no tener éxito con el tratamiento para la tuberculosis al egreso fueron: estar en situación de calle (ORa = 2,45; IC = 1,54-3,89), ser farmacodependiente (ORa = 1,95; IC=1,24-3,05), tener coinfección tuberculosis/VIH (ORa = 1,69; IC =1,00- 2,86) o diabetes (ORa =1,89; IC=1,29-2,77), y el incumplimiento de un tratamiento previo por pérdida de seguimiento, abandono u otras causas. Las variables programáticas que favorecieron el éxito del tratamiento fueron la asesoría de la prueba voluntaria de VIH (p < 0,001) y la realización de la prueba de VIH (p < 0,001). Conclusión. Estar en situación de calle, ser farmacodependiente, tener coinfección de tuberculosis y VIH, o diabetes, así como el incumplimiento del tratamiento previo por pérdida del seguimiento, abandono o fracaso del mismo, dificultaron el éxito del tratamiento antituberculoso. En la primera atención al reingreso de los pacientes con tuberculosis se deben identificar y abordar estas características.

Introduction. The success rates in the treatment of tuberculosis are suboptimal. Objective. To identify associated factors with the lack of success of antituberculosis treatment in patients with a tuberculosis treatment history. Materials and methods. We performed a retrospective, analytical, observational, and cohort study of patients reentering the Mycobacterium program in Cali, Colombia. We included patients over 15 years old with pulmonary tuberculosis between 2015 and 2019 and a history of tuberculosis treatment. Patients with drug-resistant tuberculosis were excluded. Results. A total of 605 patients with a treatment history were included, 60% due to unfinished treatment and 40% due to relapse. Compared to patients reentering due to relapse (ORa=2.34, CI=1.62-3.38), the independent variables associated with treatment failure at discharge were homelessness (ORa=2.45, CI=1.54-3.89), substance dependence (ORa=1.95, CI=1.24-3.05), tuberculosis/HIV coinfection (ORa=1.69, CI=1.00-2.86), diabetes (ORa=1.89, CI=1.29-2.77), and unfinished previous tuberculosis treatment due to follow-up loss, abandonment, or other causes. Programmatic variables favoring treatment success were voluntary HIV testing counseling (p<0.001) and HIV testing (p<0.001). Conclusion. Homelessness, substance dependence, tuberculosis/HIV coinfection, diabetes, and incomplete previous treatment due to loss to follow-up, abandonment, or treatment failure hindered the success of antituberculosis. These characteristics should be identified and addressed during the initial care of patients reentering treatment for tuberculosis.

Leprosy and tuberculosis control scenario of the national program for the improvement of access and quality of primary care in Brazil.

BACKGROUND: In Brazil, despite advances in public health policies aimed at eliminating and controlling infectious and parasitic diseases, the incidence of neglected diseases is still high. The epidemiological scenario in Brazil of diseases such as tuberculosis and leprosy evidences a public policy agenda that has not been resolute in terms of control, nor in terms of elimination. OBJECTIVE: To analyze the actions of diagnosis and treatment of leprosy and tuberculosis in the context of primary health care. METHODS: In this ecological study, data from the third cycle of the Program for the Improvement of Access and Quality of Primary Care were extracted from electronic address of the Primary Health Care Secretariat of Brazil in the area of Actions, Programs and Strategies. A total of 37,350 primary health care teams were that answered the questionnaire were eligible, with variables extracted from leprosy and tuberculosis control actions. The municipalities were grouped according to the characteristic of the Brazilian municipality. The partition chi-square and the Residuals Test were used to assess whether there was a difference in the proportion of tuberculosis and leprosy actions between types of municipalities. Statistics were carried out using Minitab 20 and Bioestat 5.3. RESULTS: Regarding the leprosy treatment location, there is a higher proportion of people referred to be treated at the reference in adjacent rural (p = 0.0097) and urban (p < 0.0001) municipalities; monitoring of people with leprosy referred to the service network (p. = 0.0057) in remote rural areas. Lower proportion of teams requesting bacilloscopy in remote rural areas (p = 0.0019). Rural areas have a higher proportion of teams that diagnose new cases (p = 0.0004). Regarding the actions of diagnosis and treatment of tuberculosis. There is a higher proportion of teams that carry out consultations at the unit itself in rural areas when compared to adjacent intermediaries (p = 0.0099) and urban (p < 0.0001); who requested sputum smear microscopy in adjacent intermediaries (p = 0.0021); X-ray in adjacent intermediaries (p < 0.0001) and urban (p < 0.0001); collection of the first sputum sample in urban (p < 0.0001) and adjacent rural areas (p < 0.0001); directly observed treatment (p < 0.0001) in adjacent rural municipalities. CONCLUSION: There are inequalities in the diagnosis and treatment of leprosy and tuberculosis among the types of municipalities.

Evaluating the performance of WHO and CDC case definitions for influenza-like illness in diagnosing influenza during the 2022-2023 flu season in Mexico.

OBJECTIVE: This study aimed to evaluate the performance of the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) case definitions for influenza-like illness (ILI) in diagnosing influenza during the 2022-2023 flu season in Mexico. STUDY DESIGN: We conducted a cross-sectional analysis of national epidemiological surveillance data in Mexico, focusing on respiratory viral pathogens. METHODS: We analyzed data from 6027 non-hospitalized patients between 5 and 65 years old who underwent molecular testing for respiratory viral pathogens. The performance of both case definitions was evaluated in terms of sensitivity, specificity, and the area under the receiver operating characteristic (AUROC) curve. RESULTS: Overall, the diagnostic accuracy of the evaluated ILI definitions in identifying influenza patients was low, particularly among older patients. When compared to the CDC, the WHO definition had a lower sensitivity but a higher specificity, resulting in a higher AUROC (P = 0.031) for the WHO criteria. CONCLUSIONS: Our findings suggest that the WHO and CDC ILI case definitions have limited accuracy for diagnosing influenza in non-hospitalized patients and highlight the need for more specific diagnostic tools to improve the detection of influenza cases during the flu season.

Actitudes del autocuidado de pacientes con tuberculosis en enfermeros peruanos luego de un brote hospitalario

Introducción: La tuberculosis es una de las principales causas de morbimortalidad en todo el mundo. Las medidas de prevención son clave para evitar su propagación y el contagio entre profesionales de salud. Objetivo: Determinar las actitudes del autocuidado sobre la tuberculosis en el personal de enfermería luego de un brote infeccioso hospitalario. Métodos: Estudio transversal, en personal de enfermería (n= 94; personal técnico n= 44; 46,8 %). Se incluyó al personal de enfermería voluntario > 18 años, de ambos sexos, que trabaje en el Departamento de Emergencia. Se usó el cuestionario de 15 ítems de Valle (2017), para estimar los conocimientos y actitudes sobre el autocuidado, 3 dimensiones: prevención, diagnóstico y tratamiento de la tuberculosis. Resultados: El promedio de edad de los participantes fue de 44,7 ± 8,8 años, el 88,3 % mujeres y el tiempo promedio de trabajo fue 11,2 ± 7,8 años. Se hallaron diferencias entre los años de servicio, entre los técnicos (8,55 ± 7,94 años) y profesionales (13,48 ± 6,98 años) (p< 0,001). El 100 % presentaron actitudes de aceptación del autocuidado en todas las dimensiones. El 4,5 % y el 27,3 % de técnicos presentaron actitudes de indiferencia en la dimensión diagnóstico y tratamiento de tuberculosis (p= 0,001). Conclusiones: Existen actitudes favorables en el personal de enfermería sobre autocuidado de la tuberculosis luego de un brote en un hospital de Lima, aunque en técnicos de enfermería se reportan actitudes de indiferencia en el diagnóstico y tratamiento de tuberculosis.

Introduction: Tuberculosis continues to be one of the main causes of morbidity and mortality worldwide. Prevention measures are key to prevent its spread and contagion among health professionals. The objective of the present study was to determine the self-care attitudes about tuberculosis in the nursing staff after a hospital infectious outbreak in Perú. Method: A cross-sectional study was conducted in nursing staff (n= 94; technical staff n= 44, 46.8%). Volunteer nursing staff > 18 years old, of both sexes, and who work in the Emergency Department were included. The 15-item questionnaire from Valle (2017) was used to estimate knowledge and attitudes about self-care in nursing staff in 3 dimensions: prevention, diagnosis and treatment of tuberculosis. Results: The average age of the participants was 44.7±8.8 years, 88.3 % were women, and the average working time was 11.2 ± 7.8 years. Difference was found between the years of service, among technicians (8.55 ± 7.94 years) and nursing professionals (13.48 ± 6.98 years) (p< 0.001). A hundred percent of nurses presented attitudes of acceptance of self-care in all dimensions; 4.5 % and 27.3% of nursing technicians presented attitudes of indifference in the tuberculosis diagnosis and treatment dimension (p= 0.001). Conclusions: There are favorable attitudes in the nursing staff about self-care of tuberculosis after an outbreak in a hospital in Lima, although in nursing technicians we report attitudes of indifference in the diagnosis and treatment of tuberculosis.

Comparison of gefitinib plus chemotherapy versus gefitinib alone for advanced non­small­cell lung cancer: A meta analysis.

This study aimed to perform a meta­analysis comparing the efficacy and safety of gefitinib in combination with chemotherapy versus gefitinib alone in patients with advanced Non­Small Cell Lung Cancer (NSCLC). We searched databases for clinical studies that reported the efficacy or safety of gefitinib plus chemotherapy in comparison with gefitinib alone. Raw data from included studies were extracted and pooled to calculate the Odds Ratio (OR) for Objective Response Rate (ORR) and Disease Control Rate (DCR), the Hazard Ratio (HR) for Progression-Free Survival (PFS) and Overall Survival (OS), and OR for complication ≥ Grade 3. A total of 10 studies containing 1,528 patients with NSCLC were identified and included in the analysis. Gefitinib plus chemotherapy showed significantly better efficacy in improving ORR (OR = 1.54; 95% CI [Confidence Interval], 1.13‒2.1; p = 0.006), DCR (OR = 1.62; 95% CI 1.14‒2.29; p = 0.007), PFS (HR=1.67; 95% CI 1.45‒1.94; p < 0.001) and OS (HR = 1.49; 95% CI 1.2‒1.87; p < 0.001) as compared with gefitinib alone. Consistent results were observed in the sub-population with positive EGFR mutation. The combination of gefitinib with chemotherapy had a significantly higher risk of complication (≥ Grade 3) with an OR of 3.29 (95% CI 2.57‒4.21; p < 0.001). The findings in the present study suggest that the combination of gefitinib with chemotherapy can provide better disease response and survival outcomes for patients with advanced NSCLC.