Geospatial analysis and prevalence of Schistosoma mansoni and soil-transmitted helminth infections in an endemic area in Eastern Brazilian Amazon.

OBJECTIVES: This study evaluated the occurrence of Schistosoma mansoni and soil-transmitted helminths in an endemic area in the Eastern Brazilian Amazon, analysing prevalence and spatial distribution. METHODS: The study was conducted in four localities of Primavera Municipality, in Pará state. Data was obtained from the Decit 40/2012 project and the participants were divided into five age range categories for evaluation: children, adolescents, young adults, adults and elderly individuals. For the diagnostic tests, Kato-Katz slides were prepared to detect S. mansoni and soil-transmitted helminths eggs. The spatial distribution map and the Kernel Density Estimation were performed to assess the presence and location of infections. RESULTS: Stool samples revealed the presence of hookworms, S. mansoni, Ascaris lumbricoides and Trichuris trichiura eggs. Mono-, bi- and poly-parasitic infections were observed, with a significant prevalence of hookworm monoparasitism. CONCLUSIONS: The high frequency of children infected with soil-transmitted helminths confirms their significance as an ongoing public health problem in the poorest municipalities of Brazil. The Geographic Information System plays a crucial role in environmental surveillance and in the control of epidemics and endemic diseases, enabling accurate assessment and informed decision-making for their control.

The Role of GeneXpert® for Tuberculosis Diagnostics in Brazil: An Examination from a Historical and Epidemiological Perspective.

The rapid molecular test (RMT) performed on the GeneXpert® system is widely used as a control strategy and surveillance technique for tuberculosis (TB). In the region of the Americas, TB incidence is slowly increasing owing to an upward trend in Brazil, which is among the high TB-burden countries (HBCs), ranking in the 19th position. In this context, we aimed to (i) describe the implementation and history of RMT-TB (Xpert® MTB/RIF and Xpert® MTB/RIF Ultra) in Brazil; (ii) to evaluate the national RMT laboratory distribution, TB, and resistance to RIF detection by RMT; and (iii) to correlate these data with Brazilian TB incidence. The quantitative data of Xpert® MTB/RIF and Xpert® MTB/RIF Ultra assays performed in the pulmonary TB investigation from 2014 to 2020 were provided by the Brazilian Ministry of Health. A spatial visualization using ArcGIS software was performed. The Southeast region constituted about half of the RMT laboratories-from 39.4% to 45.9% of the total value over the five regions. Regarding the federal units, the São Paulo state alone represented from 20.2% to 34.1% (5.0 to 8.5 times the value) of RMT laboratories over the years observed. There were significant differences (p < 0.0001) in the frequency of RMT laboratories between all years of the historical series. There was an unequal distribution of RMT laboratories between Brazilian regions and federal units. This alerts us for the surveillance of rapid molecular detection of TB in different parts of the country, with the possibility of improving the distribution of tests in areas of higher incidence in order to achieve the level of disease control recommended by national and worldwide authorities.

Analysis of Epidemiological Factors and SNP rs3804100 of TLR2 for COVID-19 in a Cohort of Professionals Who Worked in the First Pandemic Wave in Belém-PA, Brazil.

COVID-19 is an infectious disease caused by coronavirus 2 of the severe acute syndrome (SARS-CoV-2). Single nucleotide polymorphisms (SNPs) in genes, such as TLR2, responsible for an effective human immune response, can change the course of infection. The objective of this article was to verify associations between epidemiological factors and TLR2 SNP rs3804100 (Thymine [T] > Cytosine [C]) in professionals from Health Institutions (HI) who worked during the first pandemic wave and COVID-19. A case-control study was conducted with Belém-PA HI workers (Northern Brazil), divided into symptomatology groups (Asymptomatic-AS; n = 91; and Symptomatic-SI; n = 123); and severity groups classified by Chest Computerized Tomography data (symptomatic with pulmonary involvement-SCP; n = 35; symptomatic without pulmonary involvement-SSP; n = 8). Genotyping was performed by Sanger sequencing, and Statistical Analysis was conducted through the SPSS program. Bioinformatics servers predicted the biological functions of the TLR2 SNP. There were associations between the presence of comorbidities and poor prognosis of COVID-19 (especially between symptomatology and severity of COVID-19 and overweight and obesity) and between the sickness in family members and kinship (related to blood relatives). The homozygous recessive (C/C) genotype was not found, and the frequency of the mutant allele (C) was less than 10% in the cohort. No significant associations were found for this SNP in this cohort. The presence of SNP was indicated to be benign and causes a decrease in the stability of the TLR2 protein. These data can help the scientific community and medicine find new forms of COVID-19 containment.

The Association between CCL5/RANTES SNPs and Susceptibility to HIV-1 Infection: A Meta-Analysis.

Genetic polymorphisms in genes that encode natural ligands of CCR5 (the main human HIV coreceptor), such as CCL5/RANTES, can alter the levels of secretion of these peptides. This article sought to review the relationship between single nucleotide polymorphisms (SNPs) of CCL5/RANTES and HIV-1 disease susceptibility. A meta-analysis was conducted through 17 articles found from January 1999 to December 2022 in the PUBMED, Science Direct, Medline, and SciELO databases. A total of three SNPs were identified and investigated under their dominant genotypic model and through a fixed-effects model. In terms of the SNP rs2107538 (G > A), in Africa and Asia, it has a protective role (OR = 0.56; 95% CI = 0.41-0.76; p = 0.0002, and OR = 0.88; 95% CI = 0.76-1.02; p = 0.08, respectively). In terms of the SNP rs2280788 (C > G), in Europe and America, it shows a higher risk role (OR = 1.92; 95% CI = 1.06-3.47; p = 0.03, and OR = 0.94; 95% CI = 0.94-1.11; p = 0.04, respectively), but in the population of Asia, with its mutant allele, it has a protective role (OR = 0.76; 95% CI = 0.63-0.93; p = 0.007). In terms of the SNP rs2280789 (T > C), no significant associations were found. Both SNPs rs2107538 and rs2280788 have a positive transcriptional effect on the RANTES/CCL5 gene, while SNP rs2280789 causes a decrease in gene expression levels. This study suggests that there is an association between the increased expression of CCL5/RANTES and a lower risk of AIDS. Therefore, further studies are needed to arrive at a definitive conclusion, and these results may help establish scientific bases for effective HIV/AIDS control strategies.

The Prevalence of Metallo-Beta-Lactamese-(MßL)-Producing Pseudomonas aeruginosa Isolates in Brazil: A Systematic Review and Meta-Analysis.

The purpose of the current study is to describe the prevalence of Pseudomonas aeruginosa (PA)-producing MßL among Brazilian isolates and the frequency of blaSPM-1 in MßL-PA-producing isolates. From January 2009 to August 2023, we carried out an investigation on this subject in the internet databases SciELO, PubMed, Science Direct, and LILACS. A total of 20 papers that met the eligibility requirements were chosen by comprehensive meta-analysis software v2.2 for data retrieval and analysis by one meta-analysis using a fixed-effects model for the two investigations. The prevalence of MßL-producing P. aeruginosa was 35.8% or 0.358 (95% CI = 0.324-0.393). The studies' differences were significantly different from one another (x2 = 243.15; p < 0.001; I2 = 92.18%), so they were divided into subgroups based on Brazilian regions. There was indication of asymmetry in the meta-analyses' publishing bias funnel plot; so, a meta-regression was conducted by the study's publication year. According to the findings of Begg's test, no discernible publishing bias was found. blaSPM-1 prevalence was estimated at 66.9% or 0.669 in MßL-PA isolates (95% CI = 0.593-0.738). The analysis of this one showed an average heterogeneity (x2 = 90.93; p < 0.001; I2 = 80.20%). According to the results of Begg's test and a funnel plot, no discernible publishing bias was found. The research showed that MßL-P. aeruginosa and SPM-1 isolates were relatively common among individuals in Brazil. P. aeruginosa and other opportunistic bacteria are spreading quickly and causing severe infections, so efforts are needed to pinpoint risk factors, reservoirs, transmission pathways, and the origin of infection.

Spatial Analysis of Tuberculosis Patient Flow in a Neglected Region of Northern Brazil.

Tuberculosis (TB) is still considered a priority due to its high incidence rate in Brazil. In this context, we aimed to evaluate the flow of care between the municipalities of patients diagnosed with TB through notification forms of the Information System for Diseases and Notifications (SINAN) in a neglected region of Northern Brazil, Ilha do Marajó, state of Para. For this, we performed a descriptive, retrospective study on data obtained from the National Register of Health Establishments and SINAN from 2013 to 2018. We used Pearson's Chi-square and G Test with p-value < 0.05 for descriptive statistics and spatial analysis technique on flow network analysis. Of the 749 cases, 16.5% were notified in another municipality that was not the patient's residence. Regarding diagnostic methods, a positive bacterioscopy was adopted for 56% of the patients; culture was not performed for 82% of cases. Histopathological examination was not performed in 90% of the individuals. Rapid molecular test (RMT) was performed in only six (5%) cases. The region needs greater attention focused on diagnostic tests, suggesting that the introduction of RMT and culture by Ogawa-Kudoh could improve the region's health network to minimise patient displacement and thus avoid the increase in the transmission chain of TB.

Endemic High-Risk Clone ST277 Is Related to the Spread of SPM-1-Producing Pseudomonas aeruginosa during the COVID-19 Pandemic Period in Northern Brazil.

Pseudomonas aeruginosa is a high-priority bacterial agent that causes healthcare-acquired infections (HAIs), which often leads to serious infections and poor prognosis in vulnerable patients. Its increasing resistance to antimicrobials, associated with SPM production, is a case of public health concern. Therefore, this study aims to determine the antimicrobial resistance, virulence, and genotyping features of P. aeruginosa strains producing SPM-1 in the Northern region of Brazil. To determine the presence of virulence and resistance genes, the PCR technique was used. For the susceptibility profile of antimicrobials, the Kirby-Bauer disk diffusion method was performed on Mueller-Hinton agar. The MLST technique was used to define the ST of the isolates. The exoS+/exoU- virulotype was standard for all strains, with the aprA, lasA, toxA, exoS, exoT, and exoY genes as the most prevalent. All the isolates showed an MDR or XDR profile against the six classes of antimicrobials tested. HRC ST277 played a major role in spreading the SPM-1-producing P. aeruginosa strains.

The Relationship between TLR3 rs3775291 Polymorphism and Infectious Diseases: A Meta-Analysis of Case-Control Studies.

As the host's first line of defense against pathogens, Toll-like receptors (TLRs), such as the TLR3, are genes encoding transmembrane receptors of the same name. Depending on their expression, TLRs cause a pro- or anti-inflammatory response. The purpose of the article was to determine whether there is an association between the Toll-like receptor 3 (TLR3) rs3775291 Single Nucleotide Polymorphism-SNP and susceptibility to infections. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and was registered in PROSPERO under the code CRD42023429533. A systematic search for relevant studies was performed using PubMed, Scopus, SciELO, Google Scholar, and Science Direct by the MeSH descriptors and the Boolean Operator "AND": "Infections"; "TLR3"; "SNP", between January 2005 and July 2022. Summary odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated for genotypic comparison assuming a dominant genetic model (CT + TT vs. CC). A meta-analysis of 18 studies consisting of 3118 cases and 4368 controls found a significant association for risk between the presence of the TLR3 SNP rs3775291 and infections as part of the general analysis (OR = 1.16, 95% CI = 1.04-1.28, p = 0.004). In the subgroups of continents, the SNP had a protective role in Europe for 1044 cases and 1471 controls (OR = 0.83, 95% CI = 0.70-0.99, p = 0.04); however, the Asian (for 1588 patients and 2306 controls) and American (for 486 patients and 591 controls) continents had an increase in infectious risk (OR = 1.37, 95% CI = 1.19-1.58, p < 0.001; OR = 1.42, 95% CI = 1.08-1.86, and p = 0.01, respectively). Heterogeneity between studies was detected (I2 = 58%) but was explained in meta-regression by the subgroup of continents itself and publication bias was not evident. The results of the meta-analysis suggest a significant association between the TLR3 rs3775291 polymorphism and susceptibility to infections. Thus, when analyzing subgroups, the Asian and American continents showed that this SNP confers a higher risk against infections in a dominant genotypic model. Therefore, more studies are necessary to fully elucidate the role of TLR3 rs3775291 in infections.

Social Experiences, Discrimination, and Violence among Men Who Have Sex with Men in a Northern Brazilian Capital.

Men who have sex with men who suffer stigmatization and discrimination become more fragile in facing life's problems, such as the search for treatment in health services. In the present study, the social aspects related to discrimination and violence among men who have sex with men in Belém, Pará, are evaluated. Data were obtained by applying the respondent-driven sampling method to recruit 349 participants aged 18 years or older and who reported having had at least one sexual relationship with a man in the last 12 months. Data were collected from June to December 2016 in a semi-structured interview. Five seeds were initially recruited who applied RDS. The vast majority were between 18 and 35 years old, had completed elementary school but not high school, and were of mixed race. Almost a third lived in peripheral neighborhoods and were employed/self-employed. Additionally, most participants reported having suffered aggression/discrimination, more often in religious contexts, with family or in health services. The findings reported here may contribute to the development of public policies aimed at this population and indicate the need for new strategies to combat sexually transmitted infections, stigma, and discrimination suffered by this population.

Clinical Characteristics and Outcomes among Vaccinated and Unvaccinated Patients with Cardiovascular Disease Who Were Hospitalized for COVID-19 in Brazil: Retrospective Cohort.

INTRODUCTION: COVID-19 in Brazil has already caused, and it still causes, several impacts on health, economy, and education. The risk factors for death involved those with cardiovascular diseases (CVD), which were prioritized for the vaccination of COVID-19. OBJECTIVE: To investigate the clinical characteristics and outcomes between vaccinated and unvaccinated patients with cardiovascular diseases hospitalized for COVID-19 in Brazil in the year 2022. METHODS: A retrospective cohort was analyzed from the year 2022, with cases being hospitalized by COVID-19 being drawn from SIVEP-GRIPE surveillance. We compared clinical characteristics, comorbidities, and outcomes between CVD carriers and non-carriers, and we also compared vaccinated with two doses vs. those that are unvaccinated in CVD carriers. We performed chi-square, odds ratio, logistic regression, and survival analysis. RESULTS: We included, in the cohort, 112,459 hospital inpatients. An amount of 71,661 (63.72%) of the hospitalized patients had CVD. Regarding deaths, 37,888 (33.69%) died. Regarding vaccination against COVID-19, 20,855 (18.54%) people were not vaccinated with any dose among those with CVD. Death p- < 0.001 (OR 1.307-CI 1.235-1.383) and fever p- < 0.001 (OR 1.156-CI 1.098-1.218) were associated with the unvaccinated CVD carriers, and diarrhea p-0.015 (OR 1.116-CI 1.022-1.218), dyspnea p-0.022 (OR 1.074-CI 1.011-1.142), and respiratory distress p-0.021 (OR 1.070-CI 1.011-1.134) were also recorded. Those patients who possessed predictors of death, including invasive ventilation (p- < 0.001 (OR 8.816-CI 8.313-9.350)), were admitted to the ICU p- < 0.001 (OR 1.754-CI 1.684-1.827), and some had respiratory distress p- < 0.001 (OR 1.367-CI 1.312-1.423), dyspnea p < 0.001 (OR 1.341-CI 1.284-1.400), O2 saturation < 95% p- < 0. 001 (OR 1.307-CI 1.254-1.363), they were unvaccinated against COVID-19 p- < 0.001 (OR 1.258-CI 1.200-1.319), they were of male sex p- < 0.001 (OR 1.179-CI 1.138-1.221), they had diarrhea p-0.018 (OR 1.081-CI 1.013-1.154), and they may have been old p < 0.001 (OR 1.034-CI 1.033-1.035). Survival was shorter for the unvaccinated p-0.003, and p- <0.001. CONCLUSIONS: We highlight the predictors of death for those unvaccinated against COVID-19 in this research, and we evidenced the benefits of the COVID-19 vaccine in reducing deaths in hospitalized CVD patients.

Reports from the frontline: health workers describe COVID-19 risks and fears in five cities in Brazil.

BACKGROUND: Health providers are under unprecedented pressures to perform in the COVID-19 health crisis and under unprecedented risks. We initiated a large mixed-method survey of health professionals in five large metropolitan areas in Brazil to document the risks and needs of health professionals. To initiate the study, we conducted formative research. METHODS: We conducted 77 open-ended semi-structured interviews online in a convenience sample of physicians, nurses, nurse technicians, and physiotherapists in Belem, Fortaleza, Porto Alegre, Recife, and São Paulo, Brazil. Design, data collection, and analysis were informed by Rapid Ethnographic Analysis (REA). RESULTS: Responses are organized into three themes that emerged in the interviews: the lack of preparation - both locally and nationally-for the pandemic and its effects on staffing and training; the overlap of personal, family, and professional risk and consequences; and inadequately addressed anxiety and suffering among health staff. CONCLUSIONS: Our respondents were unprepared for the epidemic, especially the institutional sequelae and psychological cost. These consequences were exacerbated by both lack of leadership and sweeping changes undercutting the Brazilian health system noted by almost all participants.

Factors Associated with Tuberculosis Outcome in a Hyperendemic City in the North of Brazil.

Ananindeua city, State of Pará, North of Brazil, is a hyperendemic area for tuberculosis (TB), with a cure rate below the recommendation by the Brazilian Ministry of Health. We aimed to describe: (I) the TB incidence coefficient of Ananindeua municipality comparatively against Brazilian data; (II) TB treatment outcomes; (III) to compare the socioeconomic and epidemiological characteristics of abandonment versus cure outcome; and (IV) to evaluate the risk factors associated with TB treatment abandonment in Ananindeua city, from 2017 to 2021. This is a retrospective, descriptive, and cross-sectional epidemiological study which used secondary TB entries. Data were analyzed by linear regression, descriptive statistics, and associations were made using the Chi-square test and G-test, followed by univariate and multivariate logistic regression analyses. Cure rates ranged from 28.7% to 70.1%, abandonment between 7.3% and 11.8%, deaths from the disease ranged from 0% to 1.6%, and drug-resistant tuberculosis (TB-DR) rates had frequencies from 0% to 0.9%. Patient transfer rates to other municipalities were between 4.9% and 12.5%. The multivariate analysis showed that alcohol is almost 2 times more likely to lead an individual to abandon treatment and use of illicit drugs was almost 3 times more likely. Individuals between 20 and 59 years of age were also more likely to abandon treatment almost twice as often. Finally, data obtained in the present report is of great relevance to strengthen epidemiological surveillance and minimize possible discrepancies between the information systems and the reality of public health in high endemicity areas.

Hyperinflammatory Response in COVID-19: A Systematic Review.

COVID-19 is a multisystemic disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The immunopathogenic conditions of the hyperinflammatory response that cause systemic inflammation are extremely linked to its severity. This research sought to review the immunopathological elements that contribute to its progression. This is a systematic review using the PUBMED, LILACS, MEDLINE, and SCIELO databases using articles between May 2020 and July 2022 with the following search terms in conjunction with "AND": "SARS-CoV-2"; "COVID-19"; "ARDS" and "Cytokine Storm". The quality appraisal and risk of bias were assessed by the JBI checklists and the Cochrane Collaboration's RoB 2.0 and ROBINS-I tools, respectively, and the risk of bias for in vitro studies by a pre-defined standard in the literature. The search resulted in 39 articles. The main actors in this response denote SARS-CoV-2 Spike proteins, cellular proteases, leukocytes, cytokines, and proteolytic cascades. The "cytokine storm" itself brings several complications to the host through cytokines such as IL-6 and chemokines (such as CCL2), which influence tissue inflammation through apoptosis and pyroptosis. The hyperinflammatory response causes several unfavorable outcomes in patients, and systemic inflammation caused largely by the dysregulation of the immune response should be controlled for their recovery.

Genomic Diversity of the Rarely Observed Genotype of the Mycobacterium tuberculosis Central Asian (CAS) Lineage 3 from North Brazil.

Mycobacterium tuberculosis (Mtb) Central Asian Strain (CAS) Lineage 3 (L3) genotype is predominantly found in East-Africa, Central-Asia, Western-Asia, and South-Asia; however, a new spoligotyping CAS/SIT2545 was found in northern regions of Brazil. We aimed to characterize and describe the genetic diversity and perform a phylogenetic assessment of this novel genotype. We performed 24-MIRU-VNTR loci and Whole-genome sequencing (WGS) of six Brazilian isolates previously spoligotyped. The libraries were prepared using a Nextera-XT kit and sequenced in a NextSeq 550 Illumina instrument. We performed lineage assignment and genomic characterization. From publicly available genomes of Mtb L3 and other lineages, we created a robust dataset to run the MTBSeq pipeline and perform a phylogenetic analysis. MIRU-VNTR and WGS confirmed CAS/SIT2545 belongs to L3. Out of 1691 genomes, 1350 (79.83%) passed in quality control (genomic coverage > 95%). Strain 431 differed in 52 single nucleotide variants (SNV), confirming it does not belong to the same transmission chain. The eight genomes from a global dataset clustered closer to Brazilian strains differed in >52 SNVs. We hypothesized L3 and L1 were introduced in Brazilian Northern in the same historical event; however, there is a need for additional studies exploring the genetic diversity of Mtb Brazilian Northern.

Analysis of associations between the TLR3 SNPs rs3775291 and rs3775290 and COVID-19 in a cohort of professionals of Belém-PA, Brazil.

The objective of this article was to verify associations between the SNPs rs3775291 (Cytosine [C]>Thymine [T]) and rs3775290 (C>T) of TLR3 in professionals from Health Institutions (HI) who worked during the first pandemic wave and COVID-19. A case-control study was carried out with workers from HI in Belém-PA, Brazil, divided into symptomatology groups (Asymptomatic-AS, n=91; and Symptomatic-SI, n=121), and severity groups, classified by Chest CT scan (symptomatic with lung involvement - SCP, n=34; symptomatic without lung involvement - SSP, n=8). Genotyping was performed by Sanger sequencing and statistical analysis was performed using the SPSS program. In the analysis of SNP rs3775291, the homozygous recessive genotype (T/T) was not found and the frequency of the mutant allele (T) was less than 2% in the cohort. For the rs3775290 SNP, the frequency of the mutant allele (T) was greater than 42% in the cohort. No significant associations were found for these SNPs in this cohort (N= 212 individuals). The scientific community and physicians can use these facts to find new methods of managing COVID-19.

Physical structure and supplies for hand hygiene in the CCU of a public hospital / Estrutura física e insumos destinados à higienização das mãos no CTI de um hospital público / Estructura física e insumos destinados a la higienización de manos en la UCI de un hospital público

Background and Objectives: healthcare-associated infections (HAIs) are a serious public health problem worldwide. They occur mainly in Critical Care Units (CCUs), where physical structure and supplies do not favor hand hygiene (HH) compliance among health professionals. Thus, the present study aimed to describe and assess the physical structure and supplies for HH practice in a CCU of a public cancer hospital in the North region, Pará, Brazil. Methods: this is a descriptive, observational and cross-sectional study with a quantitative approach. Data were collected through a questionnaire based on the Guide to the Implementation of the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. Results: the study identified that there were 17 functioning beds and 6 interdicted, in addition to 11 sinks on site, but only 5 had liquid soap and paper towels, all with water. Ten alcohol dispensers were identified, but only 7 were functioning and replenished. None of the professionals found had a pocket alcoholic bottle. Conclusion: the study concluded that the physical structure and supplies found in the investigated CCU are partially adequate for carrying out hand disinfection. However, improvements in these structures must be implemented as well as periodic audits and permanent health education activities, aiming to remind professionals about HH practice correctly.(AU)

Justificativas e objetivos: as infecções relacionadas à assistência a saúde (IRAS) são um grave problema de saúde pública mundial. Ocorrem principalmente nos Centros de Terapia Intensiva (CTI), onde a estrutura física e insumos não favorecem a adesão da higienização das mãos (HM) entre os profissionais de saúde. Dessa forma, o presente estudo teve como objetivo descrever e avaliar a estrutura física e de insumos destinados à prática de HM em um CTI de um hospital público oncológico da região Norte, Pará, Brasil. Métodos: trata-se de um estudo descritivo, observacional e transversal com abordagem quantitativa. Os dados foram coletados através de um questionário baseado no Guia para a Implementação da Estratégia Multimodal da Organização Mundial da Saúde (OMS) para a Melhoria da Higiene das Mãos. Resultados: o estudo identificou que existiam 17 leitos funcionantes e 6 interditados, além de 11 pias no local, porém apenas 5 possuíam sabão líquido e papel toalha, todas com água. Foram identificados 10 dispensadores de álcool, porém apenas 7 estavam funcionantes e reabastecidos. Nenhum dos profissionais encontrados possuíam frasco alcoólico de bolso. Conclusão: o estudo concluiu que a estrutura física e os insumos encontrados no CTI investigado estão parcialmente adequados para a realização da prática de desinfecção das mãos. Contudo, devem ser implementadas melhorias nessas estruturas, bem como auditorias periódicas e atividades de educação permanente em saúde, visando relembrar os profissionais sobre a prática de HM de forma correta.(AU)

Justificación y objetivos: las infecciones asociadas a la atención de la salud (IAAS) son un grave problema de salud pública a nivel mundial. Ocurren principalmente en Unidades de Cuidados Intensivos (UCI), donde la estructura física y los suministros no favorecen la adherencia a la higiene de manos (HM) entre los profesionales de la salud. Así, el presente estudio tuvo como objetivo describir y evaluar la estructura física y los insumos para la práctica de la HM en una UCI de un hospital oncológico público de la región Norte de Pará, Brasil. Métodos: se trata de un estudio descriptivo, observacional, transversal con enfoque cuantitativo. Los datos fueron recolectados a través de un cuestionario basado en la Guía para la Implementación de la Estrategia Multimodal para la Mejora de la Higiene de Manos de la Organización Mundial de la Salud (OMS). Resultados: el estudio identificó que había 17 camas en funcionamiento y 6 intervenidas, además de 11 lavabos en el lugar, pero solo 5 tenían jabón líquido y toallas de papel, todas con agua. Se identificaron 10 dispensadores de alcohol, pero solo 7 funcionaban y se reponían. Ninguno de los profesionales encontrados tenía una botella de alcohol de bolsillo. Conclusión: el estudio concluyó que la estructura física y los insumos encontrados en la UCI investigada son parcialmente adecuados para la realización de la práctica de desinfección de manos. Sin embargo, se deben implementar mejoras en estas estructuras, así como auditorías periódicas y actividades de educación continua en salud, con el objetivo de recordar a los profesionales sobre la práctica correcta de HM.(AU)

Characteristics and outcomes of severe COVID-19 in hospitalized patients with cardiovascular diseases in the Amazonian region of Brazil: a retrospective cohort.

The northern region of Brazil is already vulnerable to other infectious diseases and it was no different in COVID-19. However, cardiovascular diseases still lead the causes of death. Thus, the objective of this study is to identify the clinical predictors and outcome of severe COVID-19 in hospitalized patients with and without CVD in this region of the Amazon. A retrospective cohort, referring to the notifications from January 1 to December 31, 2020, including cases confirmed by molecular testing. The study consisted of 9223 confirmed cases for COVID-19. Of these, 6011 (65.17%) did not have cardiovascular disease and 3212 (34.83%) had some cardiovascular disease. The significance of deaths was in the age group of < 1 to 59 CVD carriers (< 0.001). Predictor of mortality were invasive ventilation for patients with CVD, (OR 23,688 CI 18,180-30,866), followed by chronic kidney disease (OR 2442 CI 1568-3740), dyspnea (OR 2312 CI 1817-3941), respiratory distress (OR 1523 CI 1210-2919), cough (OR 1268 CI 1005-1599), Lower oxygen saturation 95% (OR 1281 CI 1039-1579), diabetes mellitus (OR 1267 CI 1050-1528) and age (OR 1051 CI 1044-1058). Carriers of CVD had a lower survival rate (< 0.0001). The order of the predictors of death differed among the non-carriers, as well as the high odds ratio in the predictors of CVD, only cough was an independent predictor. The age group under 59 years was associated with deaths. We also show the shorter survival in CVD carriers, as well as the higher cardiovascular morbidity rate than other studies in the literature.

Adaptive immunity to SARS-CoV-2 infection: A systematic review.

Background: There is evidence that the adaptive or acquired immune system is one of the crucial variables in differentiating the course of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This work aimed to analyze the immunopathological aspects of adaptive immunity that are involved in the progression of this disease. Methods: This is a systematic review based on articles that included experimental evidence from in vitro assays, cohort studies, reviews, cross-sectional and case-control studies from PubMed, SciELO, MEDLINE, and Lilacs databases in English, Portuguese, or Spanish between January 2020 and July 2022. Results: Fifty-six articles were finalized for this review. CD4+ T cells were the most resolutive in the health-disease process compared with B cells and CD8+ T lymphocytes. The predominant subpopulations of T helper lymphocytes (Th) in critically ill patients are Th1, Th2, Th17 (without their main characteristics) and regulatory T cells (Treg), while in mild cases there is an influx of Th1, Th2, Th17 and follicular T helper cells (Tfh). These cells are responsible for the secretion of cytokines, including interleukin (IL) - 6, IL-4, IL-10, IL-7, IL-22, IL-21, IL-15, IL-1α, IL-23, IL-5, IL-13, IL-2, IL-17, tumor necrosis factor alpha (TNF-α), CXC motivating ligand (CXCL) 8, CXCL9 and tumor growth factor beta (TGF-ß), with the abovementioned first 8 inflammatory mediators related to clinical benefits, while the others to a poor prognosis. Some CD8+ T lymphocyte markers are associated with the severity of the disease, such as human leukocyte antigen (HLA-DR) and programmed cell death protein 1 (PD-1). Among the antibodies produced by SARS-CoV-2, Immunoglobulin (Ig) A stood out due to its potent release associated with a more severe clinical form. Conclusions: It is concluded that through this study it is possible to have a brief overview of the main immunological biomarkers and their function during SARS-CoV-2 infection in particular cell types. In critically ill individuals, adaptive immunity is varied, aberrantly compromised, and late. In particular, the T-cell response is also an essential and necessary component in immunological memory and therefore should be addressed in vaccine formulation strategies.

Surveillance Quality Indicators Highlight the Need for Improving Tuberculosis Diagnostics and Monitoring in a Hyperendemic Area of the Brazilian Amazon Region.

The city of Ananindeua, State of Pará, Brazil, is a hyperendemic area for tuberculosis (TB). The present study describes the population characteristics and epidemiological indicators of TB cases from Ananindeua, from 2018 to 2020. The TB cases were screened from the Municipal Health Department of Ananindeua database, and the secondary data were obtained from the Brazilian Notifiable Diseases Information System (SINAN). A high percentage of cases did not undergo a rapid molecular test (74.9%) or culture (84.8%) for diagnosis of TB; a chest X-ray examination for diagnosis of TB was performed in 74.47% of new cases. The SINAN form data was incomplete on susceptibility test results (<0.01−92.7). Sputum smear microscopy for monitoring treatment was recorded in the follow-up form in 34.3% and after the 6th month in 61.1% of cases. The cure rate (60.31%) was below the recommendation by the Brazilian Ministry of Health. The quality indicators showed many weaknesses: (I) lack of availability of smear microscopy as a diagnostic test in a hyper-endemic area; (II) low availability of specific exams such as culture and rapid molecular test (RMT); (III) low adherence to smear microscopy to monitor the evolution of cases during treatment; (IV) absence of drug susceptibility test data; (V) failure to fill in essential variables for TB surveillance.

Laboratory-based study of drug resistance and genotypic profile of multidrug-resistant tuberculosis isolates in Salvador, Bahia, Brazil.

BACKGROUND: Surveillance of multidrug resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB) is essential to guide disease dissemination control measures. Brazil contributes to a significant fraction of tuberculosis (TB) cases worldwide, but only few reports addressed MDR/XDR-TB in the country. METHODS: This cross-sectional, laboratory-based study describes the phenotypic resistance profiles of isolates obtained between January 2008 and December 2011 in Bahia, Brazil, and sociodemographic, epidemiological, and clinical characteristics (obtained from mandatory national registries) of the corresponding 204 MDR/XDR-TB patients. We analyzed the mycobacterial spoligotyping and variable number of tandem repeats of mycobacterial interspersed repetitive units in 12-loci profiles obtained from Salvador. RESULTS: MDR/XDR-TB patients were predominantly male, had a median age of 43 years, belonged to black ethnicity, and failed treatment before MDR-TB diagnosis. Nearly one-third of the isolates had phenotypic resistance (evaluated by mycobacteria growth indicator tube assay) to second-line anti-TB drugs (64/204, 31%), of which 22% cases (14/64) were diagnosed as XDR-TB. Death was a frequent outcome among these individuals and was associated with resistance to second-line anti-TB drugs. Most isolates successfully genotyped belonged to the Latin-American Mediterranean (LAM) Family, with an unprecedented high proportion of LAM10-Cameroon subfamily bacilli. More than half of these isolates were assigned to a unique cluster by the genotyping methods performed. Large clusters of identical genotypes were also observed among LAM SIT42 and SIT376 strains. CONCLUSIONS: We highlight the need for strengthening local and national efforts to perform early detection of TB drug resistance and to prevent treatment discontinuation to limit the emergence of drug-resistant strains.