Treponema pallidum PCR with blood and cerebrospinal fluid of newborns exposed and not exposed to syphilis during pregnancy.

INTRODUCTION: Congenital syphilis (CS) has severe adverse outcomes, including abortion and death. Diagnosis of CS in asymptomatic newborns remains difficult. This study aims to evaluate an in-house polymerase chain reaction (PCR) on cerebrospinal fluid (CSF) and blood samples (BS) to identify T. pallidum DNA in newborns. METHODOLOGY: We performed an exploratory cross-sectional study that included newborns exposed to syphilis during pregnancy (SEG) and non-exposed (SNEG) newborns, between 2019 and 2020. In-house conventional PCR for T. pallidum targeting the tpp47 gene was used to analyze CSFS and dried blood spots. RESULTS: BS was obtained from 54 newborns (33 SEG/21 SNEG) and CSF from 55 newborns (33 SEG/22 SNEG). Twenty-five (71.4%) SEG newborns had reactive BS rapid plasmatic reagins (RPR), and all of them had RPR titers less than or equal to the corresponding maternal titers. All RPR CSF tests were negative. PCR for T. pallidum DNA was positive in 19/33 (57.6%) BS, and in 22/33 CSF. The only SEG newborn with clinical signs of early CS had a positive CSF PCR and a negative BS PCR. Conversely, among SNEG newborns, PCR was positive in 2/21 BS and 5/22 (22.7%) CSF. CONCLUSIONS: T. pallidum DNA was identified using our PCR tests. The exposed group did not present abnormalities that would indicate CS. This prevented conclusions regarding sensitivity and specificity. Dried spot permitted bedside collection, easy transportation, and storage. Further research is needed to evaluate and improve the accuracy of CS low-cost PCR tests, especially for limited resource settings.

Maternal syphilis and accomplishing sexual partner treatment: still a huge gap.

Congenital syphilis (CS) is a preventable epidemic disease for which control is hindered by socioeconomic and health system issues. Inadequately treated maternal syphilis (MaS) commonly has serious adverse obstetric outcomes. This study - which is a cross-sectional study in a Brazilian large urban public Mother and Child hospital, making use of secondary data - evaluated the occurrence of treatment of sexual partners (SP) among women with MaS. The results showed that 771 MaS cases were identified from 2007 to 2014. No information on SP treatment was available in 570 (73.9%) cases. Of the 201 cases presenting information, 25 (12.4%) SP were treated. Out of 164 women having six or more prenatal visits, 25 (15.2%) SP received treatment. Data analyzed biennially have shown a growing trend of cases without collected information, ranging from 27.2% in 2007-2008 to 87.5% in 2013-2014. No linear trend in proportions of treated SP (maximum 7.4% SP treated) was found. Thus, in this study, it has been concluded that the proportion of SP adequately treated was consistently low, and the quality of information deteriorated during the studied period. Prenatal care per se, as provided, was not effective in delivering adequate treatment of SP. Creative integrated services with SP active participation are greatly needed if CS is to be controlled.

Behavioral interventions to promote condom use among women living with HIV.

BACKGROUND: High rates of HIV infection among women of reproductive age have dramatic consequences for personal and public health. Prophylaxis during sexual intercourse in the form of condoms has been the most effective way to prevent both STI and HIV transmission among people living with HIV. OBJECTIVES: To investigate the effectiveness of behavioral interventions in promoting condom use among women living with HIV. SEARCH STRATEGY: We conducted a comprehensive literature search in several scientific databases, clinical trials databases, conference proceedings, and conference websites to identify studies produced between 1980 and May 2010 that met our selection criteria. SELECTION CRITERIA: Studies were included in the analysis if they conducted a randomized controlled trial that examined the effects of behavioral interventions on condom use among HIV-positive women; considered at least one HIV-related behavioral outcome (e.g., reported protected anal, vaginal, or oral sex) or biological outcome (e.g., acquisition of STIs); and one follow-up assessment three months or more after the intervention. Studies were assessed irregardless of langauge or publication status. DATA COLLECTION AND ANALYSIS: We used random effects models to summarize odds ratios (ORs) that compared intervention and control groups with respect to a dichotomous outcome (consistent versus inconsistent condom use). We used funnel plots to examine publication bias and a χ(2) statistic to test for heterogeneity. The methodological and evidence quality was evaluated through risk of bias criteria and the GRADE system, respectively. MAIN RESULTS: Five primary studies that collectively researched a total of 725 women living with HIV were analysed. When compared to standard care or minimal HIV support intervention, meta-analysis showed that behavioral interventions had no effect on increasing condom use among HIV-positive women. This finding was consistent at various follow-up meetings (3, 6, and 12-months) as well as over the entire 12-month follow-up period (OR= 0.82; 95% CI 0.65-1.04; p=0.11). Only one study presented adequate data to analyze the relationship between behavioral interventions and STI incidence. Studies included in this analysis demonstrated low risk of bias based on the risk of bias criteria. However, sample size was considered inadequate across all studies. AUTHORS' CONCLUSIONS: Meta-analysis shows that behavioral interventions have little effect on increasing condom use among HIV-positive women. However, these findings should be used with caution since results were based on a few small trials that were targeted specifically towards HIV-positive women. To decrease sexual transmission of HIV among this population, we recommend interventions that combine condom promotion, family planning provision and counselling, and efforts to reduce viral loads among HIV-positive women and their partners (e.g., HAART treatment provision). New research is needed to address the needs of HIV-positive women, including an assessment of the impact of interventions that combine safer sexual behavior and harm reduction approaches.

Ensino à distância: uma proposta de ampliação do estudo em bioética / Distance learning: a proposal for improving bioethical education

O ensino à distância (EAD) vem-se mostrando como uma alternativa interessante de aprendizagem. Novas tecnologias permitem o ensino via internet com alto grau de interatividade entre professores e alunos e bom aproveitamento dos cursos. Considerando a necessidade de ampliação do estudo em Bioética, a modalidade EAD pode se transformar em uma ferramenta útil para atingir um número expressivo de profissionais da saúde. Esse artigo, desta forma, tem como objetivo apresentar um curso à distância de fundamentos de Bioética. Dirigido a estudantes, profissionais e pesquisadores das áreas da saúde, trata-se de um curso de acesso grauito, de execução relativamente rápida, destinado à sensibilização ao estudo da Bioética. Pretende-se que a realização deste curso introdutório seja pré-requisito para outros cursos em saúde. A principal vantagem será prover maior autonomia e auto-genciamento aos alunos. O EAD tem como característica o enfoque nas habilidades de leitura e escrita, gerando um impacto importante na formação de recursos humanos e nas pesquisas nas áreas da saúde.

Publicações científicas em DST, HIV e AIDS: descrição de procedimentos bioéticos nas recomendações para os autores e em artigos selecionados / STD, HIV and AIDS scientific publications: description of bioethical procedures in the instructions for the authors and in selected papers

Introdução: A Bioética tem propiciado reflexões sobre aspectos éticos no âmbito da saúde, principalmente com relação a pesquisas com seres humanos. Entre as áreas de maior produção científica, atualmente, estão os estudos em DST e HIV/AIDS. Objetivo: Investigar artigos científicos selecionados sobre DST e HIV/AIDS em periódicos brasileiros e as normas de publicação destas, analisando a relevância dada aos procedimentos éticos em pesquisa. Métodos: Revisão bibliográfica em banco de dados informatizado (SciELO) com as palavras-chave DST, HIV/AIDS, identificando periódicos com publicações sobre o tema no período de janeiro de 2001 a novembro de 2004. As fontes bibliográficas disponíveis foram revistas e ava-liadas nas seções de instruções para autores e de metodologia de artigos selecionados. Resultados: Foram revisados 33 periódicos. Destes, 67 por cento (22) referiram nas normas de publicação a necessidade de aprovação por Comitê de Ética em Pesquisa e em 39 por cento dos artigos menciona este aspecto. Os aspectos éticos de confidencialidade, privacidade e autonomia foram referidos em 15 por cento dos artigos investigados e em 51 por cento deles foi citado o consentimento dos participantes. Conclusão: A menção de cuidados éticos em pesquisa não tem tido a atenção necessária dos autores de publicações de artigos científicos na área da saúde com enfoque em DST e HIV/AIDS. No momento em que há grandes avanços científico-tecnológicos, faz-se necessário que profissionais tenham igual preocupação aos aspectos éticos em pesquisa, mencionando em seus artigos os procedimentos desenvolvidos.

Estudo populacional de prevalência de chlamydia trachomatis e neisseria gonorrhoeae por PCR em urina de mulheres residentes em Vila Popular atendidas por Serviço de Saúde Comunitária em Porto Alegre, Brasil / Chlamydia trachomatis and neisseria gonorrhoeae prevalence among women living in a low income neighborhood, a populational survey in Porto Alegre, Brazil

Avaliaçäo da ocorrência de C. trachomatis e N. gonorrhoeae e o comportamento de busca de serviços de saúde em mulheres de 15 a 44 anos.

Prevalência de chlamydia trachomatis e neisseria gonorrhoeae pela reaçäo em cadeia por polimerase - PCR em urina de gestantes adolescentes e mulheres atendidas em ambulatórios de ginecologia em Hospital Público em Porto Alegre, Brasil / Prevalence of chlamydia trachomatis e neisseria gonorrhoeae by PCR in urine samples of pregnant adolescents and women sen at outpatient unities in Porto Alegre, Brazil

Objetiva avaliar a ocorrência de C. Trachomatis e N. gonorrhoeae entre gestantes adolescentes e mulheres atendidas por outras causas em ambulatórios e ginecologia de um hospital público em Porto Alegre

SIDA: normatizaçäo para acidentes do trabalho / AIDS: standardization for occupational accidents

Quando um profissional da equipe de saúde é contaminado com líquidos corporais (especialmente sangue) de qualquer paciente, deve ser feita comunicaçäo do fato a Comissäo de Controle de Infecçäo hospitalar. O profissional contaminado, quando o paciente for HIV positivo, deve ser submetidos, imediatamente, a exames anti-HIV, os quais seräo repetidos após 3 e 6 meses. Este profissional deve receber aconselhamento da possível evoluçäo, assim como deve receber acompanhamento médico