Epidemiology and molecular detection of human adenovirus and non-polio enterovirus in fecal samples of children with acute gastroenteritis: A five-year surveillance in northern Brazil.

Acute gastroenteritis (AGE) is a common pediatric infection that remains a significant cause of childhood morbidity and mortality worldwide, especially in low-income regions. Thus, the objective of this study was to detect human adenovirus (HAdV) and non-polio enterovirus (NPEV) in fecal samples from the Gastroenteritis Surveillance Network, and to identify circulating strains by nucleotide sequencing. A total of 801 fecal samples were tested using qPCR/RT-qPCR, and 657 (82.0%) were inoculated into HEp-2C and RD cell lines. The HAdV and NPEV positivity rates obtained using qPCR/RT-qPCR were 31.7% (254/801) and 10.5% (84/801), respectively, with 5.4% (43/801) co-detection. Cytopathic effect was observed in 9.6% (63/657) of patients, 2.7% (18/657) associated with HAdV, and 6.2% (41/657) associated with NPEV after testing by ICC-PCR. A comparison of the two methodologies demonstrated an agreement of 93.5% for EVNP and 64.4% for HAdV. These two viruses were detected throughout the study period, with HAdV positivity rates ranging from 41% in Amapá to 18% in Pará. The NEPV varied from 18% in Pará/Rondônia to 3% in Acre. The most affected age group was over 60 months for both HAdV and NPEV. Samples previously positive for rotavirus and norovirus, which did not show a major difference in the presence or absence of diarrhea, fever, and vomiting, were excluded from the clinical analyses of these two viruses. These viruses circulated over five years, with a few months of absence, mainly during the months corresponding to the waves of SARS-CoV-2 infection in Brazil. Five HAdV species were identified (A, B, C, D, and F), with a greater predominance of HAdV-F41 (56.5%) followed by HAdV-C (15.2%). Three NPEV species (A, B, and C) were detected, with serotypes E14 (19.3%) and CVA-24 (16.1%) being the most prevalent. The present study revealed a high diversity of NPEV and HAdV types circulating in children with AGE symptoms in the northern region of Brazil.

Nearly Complete Genome Sequences of Two Canine Mamastrovirus 5 Strains from Latin America.

We report the nearly complete genome sequences of CAstV-PK01 and CAstV-PK03, two canine astrovirus strains belonging to the species Mamastrovirus 5, which were detected in fecal swab samples collected from puppies with diarrhea from two different kennels in the Brazilian Amazon.

Cuidados paliativos e a importância da comunicação entre o enfermeiro e paciente, familiar e cuidador / Palliative care and the importance of communication between nurse and patient, family and caregiver / Cuidados paliativos y la importancia de la comunicación entre el enfermero y del paciente, familiar y cuidador

Objective: The study's goal has been to both assess and understand the scientific production over the period from 2005 to 2016 with regards to palliative care and the importance of communication related to the palliative care strategy. Methods: It is a descriptive-exploratory research with a quantitative approach, which was performed by the integrative review method. Results: After reading all the 14 articles, it was possible to group them by observing the theme studied and, in turn, the following categorization was obtained: Palliative care and the interpersonal relationship between nurse and patient; Communication as a strategy to strengthen the link between nurses and the user of palliative care; The importance of communication between nurse and family/caregiver. Conclusion: The nurse plays a fundamental role towards the promotion of palliative care. They are able to perform the acceptance of diagnosis and help patients living with their diseases, then providing integral assistance to the user and all involved with the patient

Objetivo: Conhecer e analisar a produção científica no período de 2005 à 2016 em relação cuidados paliativos e a importância da comunicação na estratégia dos cuidados paliativos. Método: Esta pesquisa possui características descritivas, exploratórias com abordagem quantitativa, realizado pelo método da revisão integrativa. Resultados: A partir da leitura dos 14 artigos, os artigos foram agrupados observando-se a temática em questão e, assim obteve-se a seguinte categorização: Cuidados Paliativos e a Relação interpessoal do enfermeiro e do paciente; Comunicação como estratégia para fortalecimento do vinculo entre enfermeiro e o usuário dos Cuidados Paliativos; A importância da comunicação do enfermeiro e o familiar/cuidador. Conclusão: O enfermeiro tem um papel fundamental para a promoção do CP, como na aceitação do diagnostico e auxilio para conviver com a doença, prestando assistência integral ao usuário e a todos envolvidos com o doente

Objetivo: Conocer y analizar la producción científica en el período de 2005 a 2016 en relación con los cuidados paliativos y la importancia de la comunicación en la estrategia de los cuidados paliativos. Método: Esta investigación posee características descriptivas, exploratorias con abordaje cuantitativo, realizado por el método de la revisión integrativa. Resultados: A partir de la lectura de los 14 artículos, los artículos fueron agrupados observándose la temática en cuestión y, así se obtuvo la siguiente categorización: Cuidados Paliativos y la Relación interpersonal del enfermero y del paciente; Comunicación como estrategia para fortalecer el vínculo entre enfermero y el usuario de los cuidados paliativos; La importancia de la comunicación del enfermero y el familiar / cuidador. Conclusión: El enfermero tiene un papel fundamental para la promoción del CP, como en la aceptación del diagnóstico y auxilio para convivir con la enfermedad, prestando asistencia integral al usuario ya todos involucrados con el enfermo

Percepção das famílias sobre o acolhimento no contexto neonatal durante um processo de intervenção / Perception of families on reception in the neonatal context during an intervention process / Percepción de las familias sobre e la cogida en el contexto neonatal durante un procedimiento de intervención

Objetivo: Compreender a percepção familiar sobre o acolhimento no contexto da assistência em enfermagem neonatal, antes e após a implementação de um protocolo de acolhimento. Método:Estudo de intervenção, caráter descritivo, realizado numa Unidade de Terapia Intensiva Neonatal, de abril a setembro de 2014, antes e após a implementação de uma rotina de acolhimento da unidade, junto a 24 pais. Os dados foram coletados com instrumento semiestruturado e foram analisados conforme referencial metodológico da Análise de Conteúdo, da qual emergiram cinco categorias temáticas. Resultados: Transversalidade do cuidado de enfermagem; contato inicial ao contexto de cuidado neonatal; compartilhamento de informações e saberes profissional; corresponsabilização do cuidado a partir do papel parental; protagonismo familiar para alta hospitalar. Conclusão: A compreensão das potencialidades e fragilidades no processo de acolhimento, a partir da perspectiva familiar possibilita a transformação da realidade, propiciando uma assistência pautada nas reais necessidades da família e, portanto, mais humanizada e qualificada

Objective: To understand the familiar perception about the host in the context of the assistance in neonatal nursing, before and after the implementation of a host protocol. Method: Interventional study, descriptive, performed in a Neonatal Intensive Care Unit, from April to September 2014, before and after the implementation of a routine of receiving the unit, together with 24 parents. The data were collected with a semi-structured instrument and were analyzed according to the methodological framework of Content Analysis, and five thematic categories emerged. Results: Transversality of nursing care; Initial contact with the context of neonatal care; Sharing of information and professional knowledge; Responsible care copying from parental paper; Family role for hospital discharge. Conclusion: The understanding of the potentialities and fragilities in the reception process, from the family perspective allows the transformation of reality, providing assistance based on the real needs of the family and therefore more humanized and qualified

Objetivo: Comprender la percepción familiar sobre La acogida em el contexto de La asistencia em enfermería neonatal, antes y después de la implementación de un protocolo de acogida. Método: Estudio de intervención, carácter descriptivo, realizado en una Unidad de Terapia Intensiva Neonatal, de abril a septiembre de 2014, antes y después de la implementación de una rutina de acogida de la unidad, junto a 24 padres. Los datos fueron recolectados com un instrumento semiestructurado y se analizaron como referencia metodológica Del Análisis de Contenido, y surgieron cinco categorías temáticas. Resultados: Transversalidad del cuidado de enfermería; Contacto inicial al contexto de cuidado neonatal; Compartir información y conocimientos profesionales; Corresponsabilidad del cuidado a partir del papel parental; Protagonismo familiar para el alta hospitalaria. Conclusión: La comprensión de las potencialidades y fragilidades em el proceso de acogida, a partir de la perspectiva familiar, posibilita la transformación de la realidad, propiciando una asistencia pautada en las reales necesidades de la familia y por lo tanto, más humanizada y calificada

High prevalence of norovirus in children with sporadic acute gastroenteritis in Manaus, Amazon Region, northern Brazil.

BACKGROUND: Norovirus (NoV) is a major cause of acute gastroenteritis (AGE) worldwide, especially in children under five years. Studies involving the detection and molecular characterisation of NoV have been performed in Brazil, demonstrating its importance as an etiological agent of AGE. OBJECTIVES: The objectives of this study were to investigate the frequency of human NoV and to genotype the strains isolated from 0-14-year-old patients of AGE in Manaus, Brazil, over a period of two years. METHODS: A total of 426 faecal samples were collected between January 2010 and December 2011. All samples were tested for the presence of NoV antigens using a commercial enzyme immunoassay kit. RNA was extracted from all faecal suspensions and reverse transcription-polymerase chain reaction (RT-PCR) for the NoV-polymerase partial region was performed as a trial test. Positive samples were then subjected to PCR with specific primers for partial capsid genes, which were then sequenced. FINDINGS: NoV was detected in 150 (35.2%) faecal samples, for at least one of the two techniques used. NoV was detected in children from all age groups, with the highest positivity observed among the group of 1-2 years old. Clinically, fever was verified in 43% of the positive cases and 46.3% of the negative cases, and vomiting was observed in 75.8% and 70.8% cases in these groups, respectively. Monthly distribution showed that the highest positivity was observed in January 2010 (81.2%), followed by February and April 2010 and March 2011, when the positivity rate reached almost 50%. Phylogenetic analyses performed with 65 positive strains demonstrated that 58 (89.2%) cases of NoV belonged to genotype GII.4, five (7.7%) to GII.6, and one (1.5%) each to GII.7 and GII.3. MAIN CONCLUSIONS: This research revealed a high circulation of NoV GII.4 in Manaus and contributed to the understanding of the importance of this virus in the aetiology of AGE cases, especially in a region with such few studies available.

High prevalence of norovirus in children with sporadic acute gastroenteritis in Manaus, Amazon Region, northern Brazil

BACKGROUND Norovirus (NoV) is a major cause of acute gastroenteritis (AGE) worldwide, especially in children under five years. Studies involving the detection and molecular characterisation of NoV have been performed in Brazil, demonstrating its importance as an etiological agent of AGE. OBJECTIVES The objectives of this study were to investigate the frequency of human NoV and to genotype the strains isolated from 0-14-year-old patients of AGE in Manaus, Brazil, over a period of two years. METHODS A total of 426 faecal samples were collected between January 2010 and December 2011. All samples were tested for the presence of NoV antigens using a commercial enzyme immunoassay kit. RNA was extracted from all faecal suspensions and reverse transcription-polymerase chain reaction (RT-PCR) for the NoV-polymerase partial region was performed as a trial test. Positive samples were then subjected to PCR with specific primers for partial capsid genes, which were then sequenced. FINDINGS NoV was detected in 150 (35.2%) faecal samples, for at least one of the two techniques used. NoV was detected in children from all age groups, with the highest positivity observed among the group of 1-2 years old. Clinically, fever was verified in 43% of the positive cases and 46.3% of the negative cases, and vomiting was observed in 75.8% and 70.8% cases in these groups, respectively. Monthly distribution showed that the highest positivity was observed in January 2010 (81.2%), followed by February and April 2010 and March 2011, when the positivity rate reached almost 50%. Phylogenetic analyses performed with 65 positive strains demonstrated that 58 (89.2%) cases of NoV belonged to genotype GII.4, five (7.7%) to GII.6, and one (1.5%) each to GII.7 and GII.3. MAIN CONCLUSIONS This research revealed a high circulation of NoV GII.4 in Manaus and contributed to the understanding of the importance of this virus in the aetiology of AGE cases, especially in a region with such few studies available.

SAPOVIRUSES IN CHILDREN WITH ACUTE GASTROENTERITIS FROM MANAUS , AMAZON REGION, BRAZIL, 2010-2011.

Sapoviruses (SaVs) are responsible for acute gastroenteritis in humans, especially children and the elderly. In Brazil, data on SaVs infections are very limited, especially in Northern Brazil. Here, we investigated the occurrence of SaVs in samples from hospitalized children under ten years old that presented acute gastroenteritis. Positive samples were genotyped and phylogenetic analysis was performed using prototype strains sequences obtained from GenBank database. In total, 156 fecal samples were screened by RT-PCR for SaVs. A positivity rate of 3.8% (6/156) was found in children under three years of age. Four genotypes were detected: GI.I, GI.2 and GII.2?-GII.4?/GII.4, suggesting a possible inter-genotypes recombination. Most infections (83.3%) occurred between August and September. The positivity was similar to that found in other countries and genotyping demonstrated the presence of distinct genotypes. To our knowledge, this is the first study reporting the circulation of SaVs in Manaus, state of Amazonas, Amazon region, Brazil.

Analysis of uncommon norovirus recombinants from Manaus, Amazon region, Brazil: GII.P22/GII.5, GII.P7/GII.6 and GII.Pg/GII.1.

Norovirus (NoV) is responsible for outbreaks and sporadic cases of nonbacterial acute gastroenteritis in humans worldwide. The virus consists of small round particles containing a single-stranded RNA genome that is divided into three Open Reading Frames. NoV evolves via mechanisms of antigenic drift and recombination, which lead to the emergence of new strains that are capable of causing global epidemics. Recombination usually occurs in the ORF1/ORF2 overlapping region and generates strains with different genotypes in the polymerase and capsid region. The primary objective of this study was to analyze recombination in positive-NoV samples. Specimens were collected during 2011, 2012 and 2014, from children under two years of age presenting gastrointestinal symptoms such as vomiting and diarrhea. The partial polymerase (B region), capsid (D region) genes and the ORF1-ORF2 overlap regions were sequenced in each sample. The recombinant analyses were performed in the Simplot software v.3.5.1 and RDP4 Beta v. 4.6 program. These analyses showed that GII.Pg/GII.1, GII.P7/GII.6, and GII.P22/GII.5 were recombinant strains. To our knowledge, this is the first time that the GII.P22/GII.5 and GII.Pg/GII.1 strains were described in South America and the GII.P7/GII.6 was detected in Northern of Brazil.

Phylogenetic analysis of human group C rotavirus in hospitalized children with gastroenteritis in Belém, Brazil.

Group C rotavirus (RVC) is potentially an important pathogen associated with acute gastroenteritis (AG), especially in outbreaks. This study aims to detect and molecularly characterize RVC in hospitalized children with AG in Belém, Brazil. From May 2008 to April 2011, 279 stools were subjected to reverse-transcription polymerase chain reaction targeting VP7, VP6, VP4, and NSP4 genes. RVC positivity rate was 2.1% (6/279) and phylogenetic analysis of positive samples yields genotype G4-P[2]-I2-E2. No evidence of zoonotic transmission and VP7 gene demonstrated close relationship with Asian strains. RVC surveillance is worth to expand information on evolutionary and epidemiological features of this virus.

Norovirus diversity in diarrheic children from an African-descendant settlement in Belém, Northern Brazil.

Norovirus (NoV), sapovirus (SaV) and human astrovirus (HAstV) are viral pathogens that are associated with outbreaks and sporadic cases of gastroenteritis. However, little is known about the occurrence of these pathogens in relatively isolated communities, such as the remnants of African-descendant villages ("Quilombola"). The objective of this study was the frequency determination of these viruses in children under 10 years, with and without gastroenteritis, from a "Quilombola" Community, Northern Brazil. A total of 159 stool samples were obtained from April/2008 to July/2010 and tested by an enzyme immunoassay (EIA) and reverse transcription-polymerase chain reaction (RT-PCR) to detect NoV, SaV and HAstV, and further molecular characterization was performed. These viruses were detected only in the diarrheic group. NoV was the most frequent viral agent detected (19.7%-16/81), followed by SaV (2.5%-2/81) and HAstV (1.2%-1/81). Of the 16 NoV-positive samples, 14 were sequenced with primers targeting the B region of the polymerase (ORF1) and the D region of the capsid (ORF2). The results showed a broad genetic diversity of NoV, with 12 strains being classified as GII-4 (5-41.7%), GII-6 (3-25%), GII-7 (2-16.7%), GII-17 (1-8.3%) and GI-2 (1-8.3%), as based on the polymerase region; 12 samples were classified, based on the capsid region, as GII-4 (6-50%, being 3-2006b variant and 3-2010 variant), GII-6 (3-25%), GII-17 (2-16.7%) and GII-20 (1-8.3%). One NoV-strain showed dual genotype specificity, based on the polymerase and capsid region (GII-7/GII-20). This study provides, for the first time, epidemiological and molecular information on the circulation of NoV, SaV and HAstV in African-descendant communities in Northern Brazil and identifies NoV genotypes that were different from those detected previously in studies conducted in the urban area of Belém. It remains to be determined why a broader NoV diversity was observed in such a semi-isolated community.

Phylogenetic analysis of probable non-human genes of group A rotaviruses isolated from children with acute gastroenteritis in Belém, Brazil.

Rotaviruses (RVs) are the main cause of acute viral gastroenteritis in both humans and young animals of various species such as calves, horses, pigs, dogs, cats, and birds. The genetic diversity of RVs is related to a variety of evolutionary mechanisms, including point mutation, and genome reassortment. The objective of this study was to characterize molecularly genes that encode structural and nonstructural proteins in unusual RV strains. The clinical specimens selected for this study were obtained from children and newborn with RV gastroenteritis, who participated in research projects on viral gastroenteritis conducted at the Evandro Chagas Institute. Structural (VP1-VP4, VP6, and VP7) and nonstructural (NSP1-NSP6) genes were amplified from stool samples by the polymerase chain reaction and subsequently sequenced. Eight unusual RV strains isolated from children and newborn with gastroenteritis were studied. Reassortment between genes of animal origin were observed in 5/8 (62.5%) strains analyzed. These results demonstrate that, although rare, interspecies (animal-human) transmission of RVs occurs in nature, as observed in the present study in strains NB150, HSP034, HSP180, HST327, and RV10109. This study is the first to be conducted in the Amazon region and supports previous data showing a close relationship between genes of human and animal origin, representing a challenge to the large-scale introduction of RV vaccines in national immunization programs.

Identification of lineage III of G12 rotavirus strains in diarrheic children in the Northern Region of Brazil between 2008 and 2010.

This study reports on the surveillance for rotavirus genotypes and the identification of G12 human rotavirus in the Northern Region of Brazil. Rotavirus-positive samples were collected from children <5 years of age with acute diarrhea from January 2008 to October 2010. G2P[4] was the most prevalent genotype, accounting for 45.6% (126/303) of cases. Five rotavirus strains bearing G12P[6] genotype specificity were detected. Phylogenetic analysis of the VP7 gene showed that G12 strains clustered into lineage III. This is the first detection of G12 strains from lineage III in Latin America, broadening the current evidence for the worldwide emergence of this genotype.

Evaluation of third-generation RIDASCREEN enzyme immunoassay for the detection of norovirus antigens in stool samples of hospitalized children in Belém, Pará, Brazil.

Noroviruses (NoVs) are major agents of gastroenteritis outbreaks and hospitalization worldwide. This study evaluated the sensitivity and specificity of the commercially available third-generation RIDASCREEN® Norovirus Enzyme Immunoassay (EIA) kit in comparison to the reverse transcription-polymerase chain reaction (RT-PCR) to detect NoVs in hospitalized children with gastroenteritis. An agreement of 88% (81/92) was observed when comparing EIA with RT-PCR. A sensitivity of 92% and a specificity of 83.3% were demonstrated. Eleven samples were positive by 1 method only (4 RT-PCR/7 EIA). Fourteen samples were sequenced and all classified as NoV genogroup GII-4. The 7 positive only by EIA were also evaluated by electron microscopy, and in 3 (42.9%) samples viral particles with a suggestive morphology of NoVs were visualized. These same samples were tested by seminested-RT-PCR with a positivity of 85.7%. The results obtained in this study demonstrated a significant improvement in the sensitivity and specificity of this updated assay.

Molecular characterization of G1 human rotaviruses detected in children from Belém, Pará, Brazil / Caracterização molecular de rotavírus humanos do tipo G1 detectados em crianças de Belém, Pará, Brasil

Rotavirus is responsible for 40 percent of gastroenteritis infections worldwide, resulting in 611 thousand deaths annually among infants and young children. The aim of the present study was to perform molecular characterization of strains of the most common circulating rotavirus genotype (G1), which was obtained from children participating in studies previously conducted in Belém, northern Brazil over a 21-year period (1982 to 2003). G1 type rotavirus was detected by polyacrylamide gel electrophoresis, enzyme immunoassay and by reverse transcription polymerase chain reaction for the VP7 and VP4 genes. Of 798 specimens that were found to be positive for rotavirus, 330 (41 percent) had G1-specificity by EIA using monoclonal antibodies. A total of 148 G1 strains were analyzed by reverse transcription polymerase chain reaction. Electropherotypes and P genotypes characterization of G1 rotavirus occurred at frequencies of 78 percent and 88 percent, respectively. Three long electropherotype varieties were identified, with the L1 variety the most frequently found (79 percent). The G1P[8] combination was the most frequent, responsible for 64 percent of cases. Mixed infections of G1P[6]+P[8], G1P[4]+P[8], G1P[4]+P[6] and G1P[4]+P[6]+P[8] were found in 11 (7 percent), 11 (7 percent), 3 (2 percent) and 1 (0.6 percent) samples, respectively. One sample displaying a mixed G1+G4 infection was found. To our knowledge, this is the first study to focus on G1 rotavirus molecular characterization in Brazil. Our findings provide information that will allow a better understanding of the molecular diversity of G1 rotavirus infections in our region.

Os rotavírus são responsáveis por 40 por cento das ocorrências de gastroenterites infantil no mundo, resultando em 611 mil mortes anualmente, e o rotavírus do tipo G1 representa o seu genótipo circulante mais comum. O objetivo do presente artigo foi realizar a caracterização molecular das amostras de rotavírus do tipo G1 obtidas de crianças que participaram de estudos anteriormente conduzidos na Cidade de Belém, norte do Brasil, por um período de 21 anos (1982 a 2003). O rotavírus do tipo G1 foi detectado por meio de eletroforese em gel de poliacrilamida, ensaio imunoenzimático (EIA) e reação em cadeia da polimerase precedida da transcrição reversa para os genes VP7 e VP4. Dos 798 espécimes positivos para rotavírus, 330 (41 por cento) apresentavam especificidade G1 por EIA, usando anticorpos monoclonais. Um total de 148 amostras do tipo G1 foram analisadas por meio da reação em cadeia da polimerase precedida da transcrição reversa. A caracterização dos eletroferotipos e genótipos P dos rotavírus do tipo G1 ocorreu em frequências de 78 por cento e 88 por cento, respectivamente. Três variedades de eletroferotipos longos foram identificados, sendo L1 a predominante (79 por cento). A combinação G1P[8] foi a mais frequente, responsável por 64 por cento dos casos. As infecções mistas G1P[6]+P[8], G1P[4]+P[8], G1P[4]+P[6] e G1P[4]+P[6]+P[8] foram encontradas em 11 (7 por cento ), 11 (7 por cent), 3 (2 percent) e 1 (0,6 por cento) amostras, respectivamente. Uma amostra apresentando infecção mista G1+G4 foi identificada. Ressalte-se que este é o primeiro estudo a abordar a caracterização molecular de rotavírus do tipo G1 no Brasil. Nossos achados permitirão melhor compreensão a respeito da diversidade molecular associada às infecções por rotavírus do tipo G1 em nossa região.