Early Hyperglycemia in Very Preterm Infants Is Associated with Reduced White Matter Volume and Worse Cognitive and Motor Outcomes at 2.5 Years.

INTRODUCTION: Hyperglycemia in very preterm infants is associated with increased morbidity and mortality. We aimed to investigate potential associations between early hyperglycemia, neonatal cerebral magnetic resonance imaging (MRI), and neurodevelopment at 2.5 years. METHODS: The study population included 69 infants with gestational age (GA) 22.3-31.9 weeks (n = 29 with GA <28 weeks), born 2011-2014. Plasma glucose concentrations during the first week were checked according to clinical routines. Hyperglycemia was defined as glucose concentrations above 8.3 mmol/L (150 mg/dL) and above 10 mmol/L (180 mg/dL), respectively, categorized as the highest glucose days 0-2, number of days above 8.3 and 10 mmol/L, and prolonged (yes/no) 2 days or more above 8.3 and 10 mmol/L. The MRI analysis included morphological assessment, regional brain volumes, and assessment of apparent diffusion coefficient (ADC). Neurodevelopmental impairment (NDI) developed in 13 of 67 infants with available outcomes, of which 57 were assessed with the Bayley-III. Univariate and multiple linear and logistic regressions were performed with adjustments for GA, birth weight z-scores, and illness severity expressed as days on mechanical ventilation. RESULTS: Hyperglycemia above 8.3 mmol/L and 10 mmol/L was present in 47.8% and 31.9% of the infants. Hyperglycemia correlated independently with lower white matter volume, but not with other regional brain volumes, and was also associated with lower ADC values in white matter. Hyperglycemia also correlated with lower Bayley-III cognitive and motor scores in infants with GA <28 weeks, but there was no significant effect on NDI. CONCLUSION: Early hyperglycemia is associated with white matter injury and poorer neurodevelopment in very preterm infants.

Automatic stratification of priority areas for Dengue control using the QGIS Model Builder in multicriteria analysis. / Estratificação automática de áreas prioritárias para controle da dengue utilizando o Model Builder do QGIS em uma análise multicritério.

OBJECTIVE: to present a methodological sequence resulting from multicriteria analysis indicating areas with different Aedes aegypti intervention priorities. METHODS: a Female Aedes Displacement Index (IDFAedes) was created, consolidated according to urban blocks, representing interaction between population densities, Aedes aegypti oviposition sites and dengue case notifications; a graphical model (Model Builder) was developed with QGIS software using the Kernel mapping algorithm and IDFAedes as the weighting factor. RESULTS: stratification for the evaluated example - Anápolis, GO, Brazil - indicated intervention priority levels for urban blocks - 17.5%, very low priority; 37.3%, low; 33.6%, medium; 10.2%, high; 1.4%, very high -; blocks with medium, high, and very high priority accounted for 22.53,% of the territory in the area. CONCLUSION: the spatial block method proposed in this article can be included in health surveillance programs for intensified targeting and planning of control actions.

Índice estegômico modificado crítico: novo critério de decisão para ações de monitoramento e controle vetorial de Aedes aegypti / Modified estegomia index critical: new decision criterion for the monitoring and vector control actions of Aedes aegypti

Objetivo: Desenvolver, em ambiente de Sistemas de Informações Geográficas ­ SIG e a luz da estatística espacial, um novo índice de adulto de Aedes aegypti vinculado a patamares epidemiológicos intramunicipais, para monitoramento e direcionamento modular das ações de controle desse vetor. Métodos: Efetuou-se monitoramento entomológico, de fêmeas de Aedes aegypti, utilizando-se armadilhas Adultrap® semanalmente, em 287 áreas preestabelecidas em Morrinhos-GO. Calculou-se o Índice Estegômico Modificado para Adultos, ISA. Utilizou-se a regressão espacial temporal para relacionar ISA e Notificações de Casos de Dengue. Resultados: Houve dependência espacial das ocorrências de dengue avaliado pelo Índice Global de Moran. O ISAc variou nas 287 áreas entre 4,8 fêmeas/1000 hab. e 43,9 fêmeas/1000 hab.. Conclusão: Foi proposto um novo indicador, o Índice Estegômico Modificado Crítico - ISAc. Sua adoção prevê diferentes gatilhos para ações decontrole. Esse modelo é posto como alternativa aos programas vigentes, representando patamares operacionais, com significância epidemiológica e simplicidade operacional para as ações de vigilância e controle ambiental dos vetores do complexo Aedes.

High prevalence of human papillomavirus infection in HIV-infected women living in French Antilles and French Guiana.

An association between HIV infection and cervical cancer, a major public health issue worldwide, has been reported. The aim of this study was to estimate the prevalence of human papillomavirus (HPV) infection and the distribution of HPV genotypes in HIV-infected women living in French Antilles and Guiana and to determine HIV-related characteristics associated with HPV infection. This cross-sectional study included 439 HIV-infected women who were followed between January 2011 and May 2014. Variables related to HIV infections were collected, and cervical samples were analysed to determine HPV genotypes. The median age of the population was 46 years. Estimated prevalence of HPV and high-risk (HR)-HPV infection were 50.1% IC95 [45.4-54.7] and 42% IC95 [37.3-46.6], respectively. HR-HPV 16, 52, 53 or intermediate risk-HPV-68 were found in 25% to 30% of the HPV-infected patients. Gynaecological screening revealed abnormal cervical smear in 24% and 42% of HR-HPV-negative and HPV-positive women, respectively (p = 0.003). Approximately 90% of women were on antiretroviral therapy (ART). Demographic characteristics associated with a higher prevalence of HPV infection included alcohol consumption. Regarding HIV-related characteristics, current therapy on ART, its duration, and undetectable plasma concentrations of RNA-HIV1 were associated with a lower risk of HPV infection. Infection rate with HR-HPV was higher than what is commonly reported in HIV-negative women worldwide and was more likely in women with incomplete HIV suppression. These results highlight the need for supporting adherence to ART, cervical cytology, HPV testing and HPV vaccination.

Pregnancy in Sickle Cell Disease Is a Very High-Risk Situation: An Observational Study.

Sickle cell disease is a serious genetic disorder affecting 1/235 births in French Guiana. This study aimed to describe the follow-up of pregnancies among sickle cell disease patients in Cayenne Hospital, in order to highlight the most reported complications. 62 records of pregnancies were analyzed among 44 females with sickle cell disease, between 2007 and 2013. Our results were compared to those of studies conducted in Brazil and Guadeloupe. There were 61 monofetal pregnancies and 2 twin pregnancies, 27 pregnancies among women with SS phenotype, 30 SC pregnancies, and five S-beta pregnancies. The study showed that the follow-up of patients was variable, but no maternal death was found. We also noted that the main maternofetal complications of pregnancies were anemia (36.5%), infection (31.7%), vasoocclusive crisis (20.6%), preeclampsia (17.5%), premature birth (11.1%), intrauterine growth retardation (15.9%), abnormal fetal heart rate (14.3%), and intrauterine fetal death (4.8%). Pregnancies were more at risk among women with SS phenotype. Pregnancy in sickle cell disease patients requires a supported multidisciplinary team including the primary care physician, the obstetrician, and the Integrated Center for Sickle Cell Disease.

Genetic modulators of sickle cell disease in French Guiana: Markers of the slave trade.

OBJECTIVES: Sickle cell disease (SCD) is the leading genetic disease in French Guiana, reflecting the predominantly African ancestry of the Guianese population. Our purpose was to characterize the genetic modulators of SCD in order to retrace the origin of the population in light of the slave trade. METHODS: We have studied the sickle cell genotype, the ßS haplotypes, the alpha and beta thalassemia and the UGT1A1 promoter polymorphisms in 224 Guianese patients with SCD. RESULTS: The genotypes of SCD were HbSS 65.6%, HbSC 24.5%, and HbS-beta thalassemia 9.4%. The most frequent ßS haplotypes were the Benin haplotype (65.9% of the chromosomes) and the Bantu (20.5%). Alpha thalassemic deletions were present in 37% of the patients and homozygosity for the (TA)7 allele of the UGT1A1 promoter in 21.4%. When the patients' origins were considered, 3 groups, Noir Marron, Haitians and Creoles, displayed distinctive characteristics. The HbSC genotype, the Benin haplotype, and the homozygous UGT1A1 genotype TA7/TA7 were significantly more frequent in Noir Marron. The Haitian patients were characterized by the occurrence of alpha-thalassemia and beta-thalassemia and by a higher prevalence of the Bantu haplotype. In the group of Creole patients, the genotype HbSS was predominant but the other modulators of SCD were associated with intermediate risk. CONCLUSIONS: The results highlight the genetic diversity of the Guianese population and are concordant with historical data on the slave trade showing a West African origin for Noir Marron and a Central African origin for Haitians, while Guianese Creoles are highly admixed. Am. J. Hum. Biol. 28:811-816, 2016. © 2016Wiley Periodicals, Inc.

OC20 - Skin-to-skin contact in the first hour of life.

UNLABELLED: Theme: Child protection and managing risk. BACKGROUND: Skin-to-skin contact in the first hour of life has benefits for the mother and the newborn, as well as a major role in establishing breastfeeding. OBJECTIVES: Determine the prevalence of skin-to-skin contact and breastfeeding within the first hour of life. METHOD: A systematic review of literature followed by a quantitative and simple descriptive cross-sectional study, according to a non-probability analyzing of 382 clinic records of postpartum mothers. RESULTS: Evidence that early skin-to-skin contact immediately after birth is a potential sensory stimulus, which covers the newborn warming, tactile and active stimulation, respiratory rates and level of blood glucose, reduces baby crying and promotes breastfeeding. In the sample, about 92.6% of the mothers put the baby to the breast in the first hour of life, but only 26.6% made skin-to-skin contact with the baby. CONCLUSION: Despite the scientific evidence of the benefits of skin-to-skin contact immediately after birth, this practice is still not widely used as, according to the study results, and is only applied to one in every four newborns.

Nuclear medicine technologist education and training in Europe: literature and web-based findings.

PURPOSE: The education and training of a nuclear medicine technologist (NMT) is not homogeneous among European countries, which leads to different scope of practices and, therefore, different technical skills are assigned. The goal of this research was to characterize the education and training of NMT in Europe. MATERIALS AND METHODS: This study was based on a literature research to characterize the education and training of NMT and support the historical evolution of this profession. It was divided into two different phases: the first phase included analysis of scientific articles and the second phase included research of curricula that allow health professionals to work as NMT in Europe. RESULTS: The majority of the countries [N=31 (89%)] offer the NMT curriculum integrated into the high education system and only in four (11%) countries the education is provided by professional schools. The duration in each education system is not equal, varying in professional schools (2-3 years) and high education level system (2-4 years), which means that different European Credit Transfer and Accumulation System, such as 240, 230, 222, 210 or 180 European Credit Transfer and Accumulation System, are attributed to the graduates. The professional title and scope of the practice of NMT are different in different countries in Europe. In most countries of Europe, nuclear medicine training is not specific and curriculum does not demonstrate the Nuclear Medicine competencies performed in clinical practice. CONCLUSION: The heterogeneity in education and training for NMT is an issue prevalent among European countries. For NMT professional development, there is a huge need to formalize and unify educational and training programmes in Europe.

Molecular characterization and clonal relationships among Escherichia coli strains isolated from broiler chickens with colisepticemia.

This study characterized 52 Escherichia coli isolates from distinct diseased organs of 29 broiler chickens with clinical symptoms of colibacillosis in the Southern Brazilian state of Rio Grande do Sul. Thirty-eight isolates were highly virulent and 14 were virtually avirulent in 1-day-old chicks, yet all isolates harbored virulence factors characteristic of avian pathogenic E. coli (APEC), including those related to adhesion, iron acquisition, and serum resistance. E. coli reference collection phylogenetic typing showed that isolates belonged mostly to group D (39%), followed by group A (29%), group B1 (17%), and group B2 (15%). Phylogenetic analyses using the Amplified Ribosomal DNA Restriction Analysis and pulse-field gel electrophoresis methods were used to discriminate among isolates displaying the same serotype, revealing that five birds were infected with two distinct APEC strains. Among the 52 avian isolates, 2 were members of the pandemic E. coli O25:H4-B2-ST131 clone.

Serodiagnosis as adjunct assay for pertussis infection in São Paulo, Brazil.

Pertussis remains an important public health problem in many countries despite extensive immunization. Cultures and real-time PCR (RT-PCR) assays are the recommended pertussis diagnostic tests, but they lack sensitivity at the later stage of the disease. This study introduces the IgG anti-pertussis toxin enzyme-linked immunosorbent assay (PT ELISA) in our routine diagnosis to improve disease burden estimation. Serum samples and nasopharyngeal swabs (n = 503) were collected at the same time from patients presenting with cough illness suspected of being pertussis and tested by the PT ELISA and culture and/or RT-PCR, respectively. Patients were separated into three age groups: group 1, <1 year (n = 260; mean age, 3 months), group 2, 1 to 6 years (n = 81; mean age, 3 years), and group 3, ≥7 years (n = 162; mean age, 26 years). The times (means) from cough onset to specimen collection were 16, 24, and 26 days, respectively. In group 1, 83 (82.2%) of 101 positive cases were positive for pertussis by culture/RT-PCR, while 40 (39.6%) tested positive by PT ELISA. In group 2, 6 (19.4%) of 31 positive cases were culture/RT-PCR positive, and 29 (93.6%) were seropositive. In group 3, 13 (13.8%) of 94 positive cases were positive by culture/RT-PCR and 91 (96.8%) were positive by serology. Culture/RT-PCR detected more cases of pertussis in infants (P < 0.0001), whereas the PT ELISA detected more cases in adolescents and adults (P < 0.0001). The timing between cough onset and specimen collection or recent vaccination may have partially affected our results. Serology is a suitable, cost-effective, and complementary pertussis diagnostic tool, especially among older children, adolescents, and adults during the later disease phase.

Presence of Shiga toxin 2e-producing Escherichia coli and atypical enteropathogenic E. coli in an asymptomatic child.

INTRODUCTION: Escherichia coli causes gastroenteritis in humans and animals. CASE PRESENTATION: In this study, both Shiga toxin-producing E. coli (STEC) and atypical enteropathogenic E. coli (EPEC) strains were identified in a stool sample from a healthy child, and they were serotyped as Shiga toxin-producing E. coli (STEC) ONT : H19 and atypical enteropathogenic E. coli (EPEC) O37 : H45. CONCLUSION: This is the first report, to our knowledge, of a concomitant presence of diarrhoeagenic E. coli (DEC) strains in an asymptomatic child. None of the microorganisms was able to produce diarrhoea, maybe because they were transient bacteria or because of the good immune status of the child. Attention should be paid to this result and it could be of interest in vaccine prospects.

Different assay conditions for detecting the production and release of heat-labile and heat-stable toxins in enterotoxigenic Escherichia coli isolates.

Enterotoxigenic Escherichia coli (ETEC) produce heat-labile (LT) and/or heat-stable enterotoxins (ST). Despite that, the mechanism of action of both toxins are well known, there is great controversy in the literature concerning the in vitro production and release of LT and, for ST, no major concerns have been discussed. Furthermore, the majority of published papers describe the use of only one or a few ETEC isolates to define the production and release of these toxins, which hinders the detection of ETEC by phenotypic approaches. Thus, the present study was undertaken to obtain a better understanding of ST and LT toxin production and release under laboratory conditions. Accordingly, a collection of 90 LT-, ST-, and ST/LT-producing ETEC isolates was used to determine a protocol for toxin production and release aimed at ETEC detection. For this, we used previously raised anti-LT antibodies and the anti-ST monoclonal and polyclonal antibodies described herein. The presence of bile salts and the use of certain antibiotics improved ETEC toxin production/release. Triton X-100, as chemical treatment, proved to be an alternative method for toxin release. Consequently, a common protocol that can increase the production and release of LT and ST toxins could facilitate and enhance the sensitivity of diagnostic tests for ETEC using the raised and described antibodies in the present work.

Sorotipos e perfis genéticos de cepas de Bordetella pertussis isoladas na cidade de São Paulo, 2006-2008 / Serotypes and genetic profiles of Bordetella pertussis strains isolated in the city of São Paulo, 2006-2008

OBJETIVO: O conhecimento de Bordetella pertussis circulante na América Latina é limitado. Portanto, o objetivo deste estudo foi usar a técnica da eletroforese em campo pulsado e a sorotipagem para caracterizar cepas de B. pertussis isoladas na cidade de São Paulo (SP). MÉTODOS: Este estudo, conduzido entre 2006 e 2008, analisou 652 swabs de nasofaringe coletados de casos suspeitos e comunicantes de coqueluche, provenientes de 37 hospitais sentinela de São Paulo. Foram realizadas as técnicas da eletroforese em campo pulsado e sorotipagem em 91 (70%) cepas de B. pertussis, escolhidas aleatoriamente. RESULTADOS: Noventa e sete por cento das cepas de São Paulo foram sorotipadas como Fim3. Foram identificados 14 perfis genéticos pela eletroforese em campo pulsado; o mais prevalente (57%) também é o mais prevalente nos EUA. CONCLUSÕES: Esses dados, em conjunto com ações da vigilância, podem ter um impacto nas estratégias de prevenção e controle de coqueluche na região, oferecendo informações úteis para a introdução de estratégias novas de vacinação e redução do risco de transmissão para bebês menores de 6 meses de idade.

OBJECTIVE: Knowledge of Bordetella pertussis circulating in Latin America is limited. Therefore, the goal of this study was to use pulsed-field gel electrophoresis and serotyping to characterize B. pertussis strains isolated in the city of São Paulo, Brazil. METHODS: This study, conducted between 2006 and 2008, analyzed 652 nasopharyngeal swabs from suspected pertussis cases and contacts, collected from 37 sentinel hospitals in São Paulo. Randomized samples of 91 (70%) strains of B. pertussis were subtyped by pulsed-field gel electrophoresis and serotyping. RESULTS: Ninety-seven percent of strains from São Paulo were serotyped as Fim3. Fourteen pulsed-field gel electrophoresis profiles were identified; the most prevalent (57%) is also the most prevalent in the USA. CONCLUSIONS: These data, in conjunction with surveillance activities, may impact strategies regarding prevention and control of pertussis in the region, providing useful information for introduction of new vaccination strategies and reduction of risk of transmission to infants less than 6 months of age.

Serotypes and genetic profiles of Bordetella pertussis strains isolated in the city of São Paulo, 2006-2008.

OBJECTIVE: Knowledge of Bordetella pertussis circulating in Latin America is limited. Therefore, the goal of this study was to use pulsed-field gel electrophoresis and serotyping to characterize B. pertussis strains isolated in the city of São Paulo, Brazil. METHODS: This study, conducted between 2006 and 2008, analyzed 652 nasopharyngeal swabs from suspected pertussis cases and contacts, collected from 37 sentinel hospitals in São Paulo. Randomized samples of 91 (70%) strains of B. pertussis were subtyped by pulsed-field gel electrophoresis and serotyping. RESULTS: Ninety-seven percent of strains from São Paulo were serotyped as Fim3. Fourteen pulsed-field gel electrophoresis profiles were identified; the most prevalent (57%) is also the most prevalent in the USA. CONCLUSIONS: These data, in conjunction with surveillance activities, may impact strategies regarding prevention and control of pertussis in the region, providing useful information for introduction of new vaccination strategies and reduction of risk of transmission to infants less than 6 months of age.

Standardization and international multicenter validation of a PulseNet pulsed-field gel electrophoresis protocol for subtyping Shigella flexneri isolates.

Shigella flexneri is one of the agents most frequently linked to diarrheal illness in developing countries and often causes outbreaks in settings with poor hygiene or sanitary conditions. Travel is one of the means by which S. flexneri can be imported into developed countries, where this pathogen is not commonly seen. A robust and discriminatory subtyping method is needed for the surveillance of S. flexneri locally and regionally, and to aid in the detection and investigation of outbreaks. The PulseNet International network utilizes standardized pulsed-field gel electrophoresis (PFGE) protocols to carry out laboratory-based surveillance of foodborne pathogens in combination with epidemiologic data. A multicenter validation was carried out in nine PulseNet laboratories located in North and South America, Europe, and Asia, and it demonstrated that a new protocol is highly robust and reproducible for subtyping of S. flexneri. This protocol, already approved for PulseNet laboratories, applies NotI and XbaI as primary and secondary restriction enzymes, respectively, under electrophoresis conditions of initial switch time of 5 s to final switch time of 35 s, at 6 volts/cm.

Adhesin-encoding genes from shiga toxin-producing Escherichia coli are more prevalent in atypical than in typical enteropathogenic E. coli.

Four of six adhesin-encoding genes (lpfA, paa, iha, and toxB) from Shiga toxin-producing Escherichia coli strains were detected in typical and atypical enteropathogenic E. coli (EPEC) strains of various serotypes. Although the most prevalent gene was lpfA in both groups, paa was the only potential diarrhea-associated gene in atypical EPEC.

High prevalence of HBsAg during pregnancy in Asian communities at Cayenne Hospital, French Guiana.

We described hepatitis B surface antigen (HBsAg) prevalence among 2,347 pregnant women having delivered at the Cayenne hospital in 2007 according to ethnicity. With 11.0% HBsAg prevalence, Asian women (Hmong and Chinese) were the group with the highest risk of hepatitis B virus (HBV) perinatal transmission compared with other ethnic groups.

Predictive factors and incidence of anxiety and depression in a cohort of HIV-positive patients in French Guiana.

A retrospective cohort study was conducted to determine the predictive factors and the incidence of anxiety and depression in a cohort of patients followed in French Guiana. A total of 2315 patients were followed for a total of 9116 years of follow-up. The incidence rate of first observed depression was 1.89 per 100 person years. The incidence rate of first observed generalized anxiety was 1.27 per 100 person years. A single failure Cox proportional hazards model showed that patients diagnosed <1 year (Hazard ratio (HR)=4.15; 95% CI=1.15-14.9; P=0.029), patients treated

Set of virulence genes and genetic relatedness of O113 : H21 Escherichia coli strains isolated from the animal reservoir and human infections in Brazil.

Escherichia coli strains of serotype O113 : H21 are commonly described as belonging to a Shiga toxin (Stx)-producing E. coli (STEC) pathotype worldwide. Albeit this STEC serotype is frequently identified among cattle and other domestic animals, to the best of our knowledge no human infections associated with STEC O113:H21 have been registered in Brazil to date. Here, we report the virulence profile and genetic relatedness of a collection of O113:H21 E. coli strains mainly isolated from the animal reservoir aimed at determining their potential as human pathogens. The strains from the animal reservoir (n=34) were all classified as STEC, whereas the few isolates recovered so far from human diarrhoea (n=3) lacked stx genes. Among the STEC, the stx2d-activatable gene was identified in 85% of the strains that also carried lpfAO113, iha, saa, ehxA, subAB, astA, cdt-V, espP, espI and epeA; the human strains harboured only lpfAO113, iha and astA. All the strains except one, isolated from cattle, were genetically classified as phylogenetic group B1. High mass plasmids were observed in 25 isolates, but only in the STEC group were these plasmids confirmed as the STEC O113 megaplasmid (pO113). Many closely related subgroups (more than 80% similarity) were identified by PFGE, with human isolates clustering in a subgroup separate from most of the animal isolates. In conclusion, potentially pathogenic O113:H21 STEC isolates carrying virulence markers in common with O113:H21 clones associated with haemolytic uraemic syndrome cases in other regions were demonstrated to occur in the natural reservoir in our settings, and therefore the risk represented by them to public health should be carefully monitored.