Seroprevalence of SARS-CoV-2 on health professionals via Bayesian estimation: a Brazilian case study before and after vaccines.

The increasing number of COVID-19 infections brought by the current pandemic has encouraged the scientific community to analyze the seroprevalence in populations to support health policies. In this context, accurate estimations of SARS-CoV-2 antibodies based on antibody tests metrics (e.g., specificity and sensitivity) and the study of population characteristics are essential. Here, we propose a Bayesian analysis using IgA and IgG antibody levels through multiple scenarios regarding data availability from different information sources to estimate the seroprevalence of health professionals in a Northeastern Brazilian city: no data available, data only related to the test performance, data from other regions. The study population comprises 432 subjects with more than 620 collections analyzed via IgA/IgG ELISA tests. We conducted the study in pre- and post-vaccination campaigns started in Brazil. We discuss the importance of aggregating available data from various sources to create informative prior knowledge. Considering prior information from the USA and Europe, the pre-vaccine seroprevalence means are 8.04% and 10.09% for IgG and 7.40% and 9.11% for IgA. For the post-vaccination campaign and considering local informative prior, the median is 84.83% for IgG, which confirms a sharp increase in the seroprevalence after vaccination. Additionally, stratification considering differences in sex, age (younger than 30 years, between 30 and 49 years, and older than 49 years), and presence of comorbidities are provided for all scenarios.

Effects of protein source and lipid supplementation on conservation and feed value of total mixed ration silages for finishing beef cattle.

The objective of this study was to examine the conservation process and feed value of total mixed ration (TMR) silages. In exp. 1, we evaluated the fermentation pattern and aerobic stability of TMR silages containing different protein and lipid supplementations. In exp. 2, we compared the performance of finishing beef heifers fed those TMR silages. In both experiments, treatments were as follows: ensiled TMR with urea (U); ensiled TMR without a protein supplement at ensiling, but soybean meal supplemented at feeding to balance diet crude protein (CP) in exp. 2 (SMnf; where the acronym nf indicates nonfermented); ensiled TMR with soybean meal (SM); and ensiled TMR with rolled soybean grain (SG). Thirty-two Nellore heifers (313 ± 8.8 kg shrunk body weight [SBW]) were blocked by initial SBW, housed in individual pens, and enrolled in exp. 2 for 82 d. In exp. 1, treatment without a protein supplement (SMnf) had a lower content of CP, soluble CP, NH3-N, pH, and Clostridium count compared with U (P ≤ 0.03). Lactic acid concentrations tended to be reduced for SMnf compared with U (P = 0.09). Ethanol concentration was reduced in SG compared with SM (P < 0.01). 1,2-Propanediol concentration was increased in SMnf compared with U (P < 0.01), reduced in SM compared with SMnf (P = 0.02), and increased in SG compared with SM (P = 0.02). Dry matter (DM) loss during fermentation was low and similar among treatments (~3.7%). All silages remained stable during 10 d of aerobic exposure after feed out. Considering fermentation traits, such as pH (≤4.72), NH3-N (<10% of N, except for U treatment), butyric acid (<0.05 % DM), and DM losses (<3.70% DM), all silages can be considered well conserved. In exp. 2, diets were isonitrogenous because soybean meal was added to SMnf before feeding. Compared with SM, cattle fed SG made more meals per day (P = 0.04) and tended to have a decreased intermeal interval (P = 0.09). DM intake, average daily gain, final SBW, hot carcass weight, Biceps femoris fat thickness, and serum levels of triglycerides and cholesterol were increased for SG compared with SM (P ≤ 0.05). In brief, TMR silages exhibited an adequate fermentation pattern and high aerobic stability. The supplementation of true protein did not improve animal performance, whereas the addition of soybean grain as a lipid source improved the performance of finishing cattle fed TMR silages.

Effects of processing, moisture, and storage length on the fermentation profile, particle size, and ruminal disappearance of reconstituted corn grain.

Our objective was to examine the effects of processing, moisture, and anaerobic storage length of reconstituted corn grain (RCG) on the fermentation profile, geometric mean particle size (GMPS), and ruminal dry matter disappearance (DMD). Dry corn kernels were ground (hammer mill, 5-mm screen) or rolled, then rehydrated to 30%, 35%, or 40% moisture, and stored for 0, 14, 30, 60, 90, 120, or 180 d in laboratory silos. Rolled corn had an increased GMPS compared with ground corn (2.24 and 1.13 mm, respectively, at ensiling). However, there was a trend for an interaction between processing and moisture concentration to affect particle size, with GMPS increasing with increased moisture concentration, especially in ground corn. Longer storage periods also slightly increased GMPS. Processing, moisture, and storage length interacted to affect the fermentation pattern (two- or three-way interactions). Overall, pH decreased, whereas lactic acid, acetic acid, ethanol, and NH3-N increased with storage length. RCG with 30% moisture had less lactic acid than corn with 35% and 40% moisture, indicating that fermentation might have been curtailed and also due to the clostridial fermentation that converts lactic acid to butyric acid. Ensiling reconstituted ground corn with 30% of moisture led to greater concentrations of ethanol and butyric acid, resulting in greater DM loss than grain rehydrated to 35% or 40% of moisture. Ammonia-N and in situ ruminal DMD were highest for reconstituted ground corn with 35% or 40% of moisture, mainly after 60 d of storage. Therefore, longer storage periods and greater moisture contents did not offset the negative effect of greater particle size on the in situ ruminal DMD of rolled RCG. Nonetheless, RCG should be ensiled with more than 30% moisture and stored for at least 2 mo to improve the ruminal DMD and reduce the formation of ethanol and butyric acid.

Breaking Bad News: A Study on Formal Training in a High-Risk Obstetrics Setting.

Background: Breaking bad news is a frequent task in high-risk obstetrics clinics. Few studies have examined the role of training in improving such a difficult medical task. Aim: To evaluate the influence of a training program on the participants' perceptions of bad news communication at a high-risk obstetrics center. Design: This prospective study was conducted at the Department of Obstetrics/Gynecology, Hospital das Clinicas, from March 2016 to May 2017. Setting/Participants: Maternal-fetal health specialists were invited to complete an institutional questionnaire based on the SPIKES protocol for communicating bad news before and after training. The training consisted of theoretical lectures and small group practice using role play. The questionnaire responses were compared using nonparametric tests to evaluate the differences in physicians' perceptions at the two timepoints. The questionnaire items were evaluated individually and in groups following the communication steps of the SPIKES protocol. Results: In total, 110 physicians were invited to participate. Ninety completed the pretraining questionnaire and 40 answered the post-training questionnaire. After training, there were significant improvements in knowing how to prepare the environment before delivering bad news (p = 0.010), feeling able to transmit bad news (p < 0.001), and to discuss the prognosis (p = 0.026), feeling capable of discussing ending the pregnancy (p = 0.003), and end-of-life issues (p = 0.007) and feeling confident about answering difficult questions (p = 0.004). The comparison of the grouped responses following the steps of the SPIKES protocol showed significant differences for "knowledge" (p < 0.001), "emotions," (p = 0.004) and "strategy and summary" (p = 0.002). Conclusion: The implementation of institutional training in breaking bad news changed the perception of the physicians in the communication setting.

The digestive tube of Piaractus brachypomus: gross morphology, histology/histochemistry of the mucosal layer and the effects of parasitism by Neoechinorhynchus sp.

The objective of the present study was to describe the histology and histochemistry of the mucosal layer of the digestive tube of Piaractus brachypomus, and the histopathology associated with parasitism by Neoechinorhynchus sp. The digestive tube of P. brachypomus consists of three macroscopically distinct portions: short, rectilinear and elastic-walled ooesophagus, J-shaped siphon stomach and a long intestine with rectilinear and curved portions, defined by patterns of villi as foregut, midgut, and hindgut. Histological and histochemical differences were observed in the mucosal layers of the different digestive tube regions, such as intense production of neutral and acidic mucous substances in the pseudostratified mucosal epithelium of the oesophagus; positive periodic acid Schiff reagent (PAS)reactions at the apex of the columnar epithelial cells of the stomach and increased intensity of histochemical reactions in the hindgut region. Neoechinorhynchus sp. was present in 85.7% of specimens examined, with a mean intensity of 7.4 ± 6.2 (±) and abundance of 6.33. Good health of the fish indicated by high relative condition factor values ( Kn ) and occurrence of only mild to moderate alteration in the mucosal layer indicated that Neoechinorhynchus sp. exhibits low pathogenicity towards P. brachypomus hosts in farming environments, with low levels of infection.

Identification and genetic characterization of classical swine fever virus isolates in Brazil: a new subgenotype.

The classical swine fever (CSF) is a highly contagious viral disease of pigs and wild boar. The CSF causes great economic losses for pork production and the occurrence of the disease is notifiable to the OIE. The objective of this work was to identify and characterize CSF virus isolates from Brazil. Seven viral isolates were obtained and the full-length E2 sequences were analyzed. Phylogenetic analysis revealed a different segregation pattern between Brazilian isolates and members of subgenotype 1.1, forming a separate group within genotype 1. Genetic distance analysis suggested the existence of two new subgenotypes, designated subgenotypes 1.5 and 1.6.

Early molecular markers predictive of dengue hemorrhagic fever

The management of acute dengue patients during outbreaks is a challenging problem. Most of the dengue fever cases are benign, but some cases develop into a severe and possibly lethal vasculopathy, known as dengue hemorrhagic fever. Early symptoms of dengue and hemorrhagic fever are very similar. An early differential diagnosis is needed to predict which of these two clinical presentations is crucial to proper patient care and public health management. This study evaluates the predictive potential of specific mRNA expression markers of dengue hemorrhagic fever using quantitative real-time PCR assays. Six candidate "dengue hemorrhagic fever specific signature genes" were evaluated and all showed good correlation among their transcription levels at early days of infection and the later development of severe vasculopathy. The markers selected were able to indicate, at early stages of infection, the evolution of a dengue-infected patient to the severe form of the illness. Despite the fact that these results grant further validation studies, the panel of candidate prognostic markers obtained demonstrated the potential to be useful for clinical use in the form of a fast assay based in blood samples.

O manejo de pacientes infectados pelo dengue ainda é um problema desafiador. A maioria dos casos de dengue é benigna mas parte desses casos pode evoluir para o desenvolvimento de vasculopatia severa conhecida como dengue hemorrágica, que pode ser letal. Os sintomas iniciais da dengue e sua forma hemorrágica são bastante similares. O desenvolvimento de um teste diagnóstico que seja rápido e capaz de diferenciar as duas formas clínicas da dengue é crucial para o cuidado adequado de pacientes. O presente estudo avalia, através da PCR quantitativa em tempo real, o potencial preditivo dos níveis de expressão de RNAm candidatos a marcadores da dengue hemorrágica, previamente identificados por estudos genômicos funcionais. Um conjunto de seis marcadores moleculares para a dengue hemorrágica foi avaliado e apresentou correlação entre seus níveis de transcrição e o posterior desenvolvimento da vasculopatia severa. Os marcadores selecionados foram capazes de indicar, nos momentos iniciais dos sintomas, a evolução de um paciente infectado pelo dengue para a forma severa da doença. O painel de candidatos a marcadores de prognóstico obtido demonstrou um bom potencial para uso clínico na forma de um ensaios rápido baseado em amostras de sangue.

Gene expression profiling during early acute febrile stage of dengue infection can predict the disease outcome.

BACKGROUND: We report the detailed development of biomarkers to predict the clinical outcome under dengue infection. Transcriptional signatures from purified peripheral blood mononuclear cells were derived from whole-genome gene-expression microarray data, validated by quantitative PCR and tested in independent samples. METHODOLOGY/PRINCIPAL FINDINGS: The study was performed on patients of a well-characterized dengue cohort from Recife, Brazil. The samples analyzed were collected prospectively from acute febrile dengue patients who evolved with different degrees of disease severity: classic dengue fever or dengue hemorrhagic fever (DHF) samples were compared with similar samples from other non-dengue febrile illnesses. The DHF samples were collected 2-3 days before the presentation of the plasma leakage symptoms. Differentially-expressed genes were selected by univariate statistical tests as well as multivariate classification techniques. The results showed that at early stages of dengue infection, the genes involved in effector mechanisms of innate immune response presented a weaker activation on patients who later developed hemorrhagic fever, whereas the genes involved in apoptosis were expressed in higher levels. CONCLUSIONS/SIGNIFICANCE: Some of the gene expression signatures displayed estimated accuracy rates of more than 95%, indicating that expression profiling with these signatures may provide a useful means of DHF prognosis at early stages of infection.

Early molecular markers predictive of dengue hemorrhagic fever.

The management of acute dengue patients during outbreaks is a challenging problem. Most of the dengue fever cases are benign, but some cases develop into a severe and possibly lethal vasculopathy, known as dengue hemorrhagic fever. Early symptoms of dengue and hemorrhagic fever are very similar. An early differential diagnosis is needed to predict which of these two clinical presentations is crucial to proper patient care and public health management. This study evaluates the predictive potential of specific mRNA expression markers of dengue hemorrhagic fever using quantitative real-time PCR assays. Six candidate 'dengue hemorrhagic fever specific signature genes' were evaluated and all showed good correlation among their transcription levels at early days of infection and the later development of severe vasculopathy. The markers selected were able to indicate, at early stages of infection, the evolution of a dengue-infected patient to the severe form of the illness. Despite the fact that these results grant further validation studies, the panel of candidate prognostic markers obtained demonstrated the potential to be useful for clinical use in the form of a fast assay based in blood samples.