Spatio-temporal analysis of leptospirosis in Brazil and its relationship with flooding.

Leptospirosis is a serious public health problem in Brazil, which can be observed after flooding events. Using an exploratory mixed clustering method, this ecological study analyzes whether spatial-temporal clustering patterns of leptospirosis occur in Brazil. Data from the Brazilian Unified Health System (SUS) were used to calculate the prevalence of leptospirosis between 2007 and 2017 in all counties of the country. Clustering techniques, including spatial association indicators, were used for analysis and evaluation of disease yearly spatial distribution. Based on Local Indicators of Spatial Association (LISA) with Empirical Bayesian rates detected spatial patterns of leptospirosis ranging from 0.137 (p = 0.001 in 2009) to 0.293 (p = 0.001 in 2008). Over the whole period, the rate was 0.388 (p = 0.001). The main pattern showed permanence of leptospirosis clusters in the South and emergence and permanence of such clusters in northern Brazil. The municipalities with leptospirosis cases and at least one flood occurrence registered in the Brazilian Integrated Disaster Information System were incorporated into the LISA cluster map with Empirical Bayesian rates. These counties were expected to exhibit clustering, not all did. The results of the cluster analysis suggest allocation of health resources in areas with leptospirosis clustering.

Análise espacial da leptospirose no Brasil / Spatial analysis of leptospirosis in Brazil

RESUMO A leptospirose é um problema de saúde pública mundial. No Brasil, ela é uma doença de notificação compulsória e está relacionada a áreas com precárias condições sanitárias. Foi realizado um estudo ecológico retrospectivo para observar a distribuição espacial e temporal de casos confirmados da leptospirose em escala nacional no período entre 2007 e 2017. A espacialização da leptospirose utilizou técnicas de geoprocessamento por análise de padrões pontuais e por mapas de densidade Kernel. Os resultados revelaram que, no período, foram registrados 42.310 casos confirmados de leptospirose no País, com média anual de 3.846 casos e prevalência de 1,9 a cada 100 mil habitantes. As localidades com mais casos prevalentes foram as regiões Sul e Norte. O Sudeste apresentou taxa de prevalência inferior à taxa nacional em virtude da alta densidade demográfica. O método Kernel se mostrou útil na análise global da situação epidemiológica da leptospirose nas regiões do Brasil.

ABSTRACT Leptospirosis is a worldwide public health problem. In Brazil, leptospirosis is a disease of compulsory notification and is related to areas with precarious sanitary conditions. A retrospective ecological study was conducted to observe the spatial and temporal distribution of confirmed cases of leptospirosis on national scale in the period between 2007 and 2017. The spatialization of leptospirosis used geoprocessing techniques by analysis of point patterns and by Kernel density maps. The results showed that within the analyzed period, 42,310 confirmed cases of Leptospirosis were recorded in the country, with an annual average of 3,846 cases and prevalence of 1.9 per 100,000 inhabitants. The regions with the most prevalent cases are the South and the North. The southeast presented a prevalence rate lower than the national rate due to the high demographic density. The Kernel method proved to be useful in the global analysis of the epidemiological situation of leptospirosis in the regions of Brazil.

Cognitive assessment in patients with Hepatitis C submitted to treatment with Sofosbuvir and Simeprevir or Daclatasvir.

BACKGROUND: Hepatitis C can be defined as an infectious disease that develops an inflammatory activity, which may cause an impairment in the central nervous system, may cause cognitive impairments and symptoms of depression. OBJECTIVE: The objective of this study was to verify the cognitive performance of patients with chronic hepatitis C before and after treatment with simeprevir, sofosbuvir, and daclatasvir. METHODS: A prospective study was carried out in three stages: before, right after treatment, and six months after. Fifty-eight patients under clinical follow-up were evaluated at the Emílio Ribas Infectology Institute, in São Paulo, Brazil. The following instruments were used: sociodemographic questionnaire, Lawton's Scale, Beck's Depression Inventory, and a battery of neuropsychological tests that evaluated: intellectual function, memory, attention, executive function, and motor and processing speed). For statistical analysis, the analyses described (mean, frequency, and standard deviation), chi-square, and ANOVA were used. RESULTS: Most of the participants were male (n=30, 51.7%), with a mean of 58.23±8.79 years, mean schooling of 9.75±4.43 years. Comparing the results of neuropsychological evaluations (before, just after completion of drugs, and six months), a significant improvement was observed in relation to the acquisition of new knowledge (p=0.03), late visual memory (p=0.01), and tendency towards alternate attention (p=0.07). CONCLUSION: The treatment of the hepatitis C virus improved cognitive performance, especially in relation to memory.

Cognitive assessment in patients with Hepatitis C submitted to treatment with Sofosbuvir and Simeprevir or Daclatasvir

BACKGROUND: Hepatitis C can be defined as an infectious disease that develops an inflammatory activity, which may cause an impairment in the central nervous system, may cause cognitive impairments and symptoms of depression. OBJECTIVE: The objective of this study was to verify the cognitive performance of patients with chronic hepatitis C before and after treatment with simeprevir, sofosbuvir, and daclatasvir. METHODS: A prospective study was carried out in three stages: before, right after treatment, and six months after. Fifty-eight patients under clinical follow-up were evaluated at the Emílio Ribas Infectology Institute, in São Paulo, Brazil. The following instruments were used: sociodemographic questionnaire, Lawton's Scale, Beck's Depression Inventory, and a battery of neuropsychological tests that evaluated: intellectual function, memory, attention, executive function, and motor and processing speed). For statistical analysis, the analyses described (mean, frequency, and standard deviation), chi-square, and ANOVA were used. RESULTS: Most of the participants were male (n=30, 51.7%), with a mean of 58.23±8.79 years, mean schooling of 9.75±4.43 years. Comparing the results of neuropsychological evaluations (before, just after completion of drugs, and six months), a significant improvement was observed in relation to the acquisition of new knowledge (p=0.03), late visual memory (p=0.01), and tendency towards alternate attention (p=0.07). CONCLUSION: The treatment of the hepatitis C virus improved cognitive performance, especially in relation to memory

INTRODUÇÃO: A hepatite C pode ser definida como uma doença infecciosa, que se desenvolve por uma atividade inflamatória, que pode gerar um comprometimento no Sistema Nervoso Central, podendo ocasionar prejuízos cognitivos e sintomas de depressão. OBJETIVO: O objetivo deste estudo foi verificar o desempenho cognitivo de pacientes com hepatite C crônica antes e após o tratamento com simeprevir, sofosbuvir e daclatasvir. MÉTODOS: Foi realizado um estudo prospectivo em três etapas: antes, logo após o tratamento e seis meses depois. Foram avaliados 58 pacientes em acompanhamento clínico no Instituto de Infectologia Emílio Ribas, em São Paulo, Brasil. Foram utilizados os seguintes instrumentos: questionário sociodemográfico, Escala de Lawton, Inventário de Depressão de Beck e uma bateria de testes neuropsicológicos que avaliaram: função intelectual, memória, atenção, função executiva e velocidade motora e de processamento). Para análise estatística, foram utilizadas as análises descritas (média, frequência e desvio padrão), qui-quadrado e ANOVA. RESULTADOS: A maioria dos participantes era do sexo masculino (n=30, 51,7%), com média de 58,23±8,79 anos, escolaridade média de 9,75±4,43 anos. Comparando os resultados das avaliações neuropsicológicas (antes, logo após a finalização dos medicamentos e seis meses), observou-se melhora significativa em relação à aquisição de novos conhecimentos (p=0,03), memória visual tardia (p=0,01) e tendência em relação a atenção alternada (p=0,07). CONCLUSÃO: O tratamento do vírus da hepatite C melhorou o desempenho cognitivo, principalmente em relação à memória

Georeferencing of deaths from sepsis in the city of São Paulo

Abstract Objective The aim of the present study was to obtain information about deaths due to sepsis in São Paulo from 2004 to 2009 and their relationship with geographical distribution. Methods Causes of death, both main and secondary, were defined according to the codes of the International Classification of Disease version 10 (ICD-10) contained in the database. Sepsis, septic shock, multiple organ failure, pneumonia, urinary tract infection, peritonitis and other intraabdominal infections, skin and soft tissue infections (including surgical wound infection) and meningitis were considered as immediate cause of death or as the condition leading to the immediate cause of death related or associated to sepsis. Results In the analyzed period, there was a 15.3% increase in the absolute number of deaths from sepsis in São Paulo. The mean number of deaths during this period was 28,472 ± 1566. Most deaths due to sepsis and sepsis-related diseases over the studied period occurred in a hospital or health care facility, showing that most of the patients received medical care during the event that led to death. We observed a significant concentration of deaths in the most populous regions, tending more toward the center of the city. Conclusions Georeferencing data from death certificates or other sources can be a powerful tool to uncover regional epidemiological differences between populations. Our study revealed an even distribution of sepsis all over the inhabited areas of São Paulo.

Georeferencing of deaths from sepsis in the city of São Paulo.

OBJECTIVE: The aim of the present study was to obtain information about deaths due to sepsis in São Paulo from 2004 to 2009 and their relationship with geographical distribution. METHODS: Causes of death, both main and secondary, were defined according to the codes of the International Classification of Disease version 10 (ICD-10) contained in the database. Sepsis, septic shock, multiple organ failure, pneumonia, urinary tract infection, peritonitis and other intraabdominal infections, skin and soft tissue infections (including surgical wound infection) and meningitis were considered as immediate cause of death or as the condition leading to the immediate cause of death related or associated to sepsis. RESULTS: In the analyzed period, there was a 15.3% increase in the absolute number of deaths from sepsis in São Paulo. The mean number of deaths during this period was 28,472±1566. Most deaths due to sepsis and sepsis-related diseases over the studied period occurred in a hospital or health care facility, showing that most of the patients received medical care during the event that led to death. We observed a significant concentration of deaths in the most populous regions, tending more toward the center of the city. CONCLUSIONS: Georeferencing data from death certificates or other sources can be a powerful tool to uncover regional epidemiological differences between populations. Our study revealed an even distribution of sepsis all over the inhabited areas of São Paulo.

Diretrizes para tratamento da sepse grave/choque séptico - abordagem do agente infeccioso - diagnóstico / Guidelines for the treatment of severe sepsis and septic shock - management of the infectious agent - diagnosis

A sepse tem alta incidência, alta letalidade e custos elevados, sendo a principal causa de mortalidade em unidades de terapia intensiva. Está claramente demonstrado que pacientes reconhecidos e tratados precocemente tem melhor prognóstico. Nesse sentido, a abordagem precoce do agente infeccioso, tanto no sentido do diagnóstico como no controle do foco infeccioso são fundamentais para a boa evolução do paciente. A presente diretriz aborda as evidências disponíveis na literatura em relação às principais estratégias para esse diagnóstico.

Sepsis is a common and lethal condition that carries a substantial financial burden and is the primary cause of death in intensive care units. Early diagnosis and treatment of patients has been clearly shown to improve prognosis. Therefore, early diagnosis of infections and control of the primary infection site are fundamental to improving patients' prognosis. This guideline reviews the available evidence concerning the primary strategies for the diagnosis of infection.

Diretrizes para tratamento da sepse grave/choque séptico: abordagem do agente infeccioso - controle do foco infeccioso e tratamento antimicrobiano / Guidelines for the treatment of severe sepsis and septic shock - management of the infectious agent - source control and antimicrobial treatment

A sepse tem alta incidência, alta letalidade e custos elevados, sendo a principal causa de mortalidade em unidades de terapia intensiva. Está claramente demonstrado que pacientes reconhecidos e tratados precocemente tem melhor prognóstico. Nesse sentido, a abordagem precoce do agente infeccioso, tanto no sentido do controle do foco infeccioso como da antibioticoterapia adequada são fundamentais para a boa evolução do paciente. A presente diretriz aborda as evidências disponíveis na literatura em relação às principais estratégias para controle e tratamento.

Sepsis is a common and lethal condition that carries a substantial financial burden. In addition, it is the main cause of death in intensive care units. Early diagnosis and treatment of patients has been clearly shown to improve prognosis. Therefore, early diagnosis of the infecting agent, control of the primary infection site and the use of appropriate antibiotic therapy are fundamental to improving outcomes. This guideline reviews the available evidence in the literature concerning infection control and therapy strategies.

Guidelines for the treatment of severe sepsis and septic shock - management of the infectious agent - diagnosis. / Diretrizes para tratamento da sepse grave/choque séptico - abordagem do agente infeccioso - diagnóstico.

Sepsis is a common and lethal condition that carries a substantial financial burden and is the primary cause of death in intensive care units. Early diagnosis and treatment of patients has been clearly shown to improve prognosis. Therefore, early diagnosis of infections and control of the primary infection site are fundamental to improving patients' prognosis. This guideline reviews the available evidence concerning the primary strategies for the diagnosis of infection.

Guidelines for the treatment of severe sepsis and septic shock - management of the infectious agent - source control and antimicrobial treatment. / Diretrizes para tratamento da sepse grave/choque séptico: abordagem do agente infeccioso - controle do foco infeccioso e tratamento antimicrobiano.

Sepsis is a common and lethal condition that carries a substantial financial burden. In addition, it is the main cause of death in intensive care units. Early diagnosis and treatment of patients has been clearly shown to improve prognosis. Therefore, early diagnosis of the infecting agent, control of the primary infection site and the use of appropriate antibiotic therapy are fundamental to improving outcomes. This guideline reviews the available evidence in the literature concerning infection control and therapy strategies.

Peripheral blood mononuclear cell activation induced by Leptospira interrogans glycolipoprotein.

Leptospira interrogans glycolipoprotein (GLP) has been implicated in pathological and functional derangement seen in leptospirosis. The goal of this study was to evaluate GLP's ability to induce cellular activation, as assessed by cytokine production and expression of surface activation markers. GLP extracted from either pathogenic L. interrogans serovar Copenhageni or nonpathogenic Leptospira biflexa serovar Patoc (GLPp) was used to stimulate peripheral blood mononuclear cell cultures from healthy donors. Supernatant cytokine levels were measured by enzyme-linked immunosorbent assay. Expression of CD69 and HLA-DR on lymphocytes and monocytes, as well as lipopolysaccharide (LPS) binding, were measured by flow cytometry. At 6 h of incubation, GLP induced a significant rise in tumor necrosis factor alpha levels, which dropped progressively until 72 h of incubation. Interleukin-10 peak levels were obtained at between 24 and 48 h, with sustained levels until 72 h of incubation. The response magnitude was proportional to the GLP dose. CD69 expression on T lymphocytes and monocytes increased significantly, as did HLA-DR expression on monocytes. GLPp induced no CD69 or HLA-DR expression. GLP did not block biotinylated LPS binding to monocytes, suggesting that different pathways are used to induce cell activation. In conclusion, GLP induces cellular activation and may play a major role in the pathogenesis of leptospirosis.