Neurological and neuropsychiatric manifestations of post-COVID-19 condition in South America: a systematic review of the literature.

BACKGROUND: The post-COVID-19 condition is a major modern challenge in medicine and has a high global impact on the health of the population. OBJECTIVE: To determine the main neurological and neuropsychiatric manifestations after acute COVID-19 infection in South American countries. METHODS: This is a systematic review study, registered on the PROSPERO platform following the PRISMA model. 4131 articles were found with the search strategies used. Neurological and neuropsychiatric manifestations were investigated in individuals three months or more after acute COVID-19 infection, and older than 18 years, including studies conducted in South American countries published between 2020 and 2022. RESULTS: Six studies (four from Brazil and two from Ecuador) were analyzed. Regarding the type of study: three were cohorts, two were case reports, and one was cross-sectional. The main outcomes found were new pain (65.5%) and new chronic pain (19.6%), new headache (39.1%), daily chronic headache (13%), paresthesia (62%), in addition to neuropsychiatric diseases, such as generalized anxiety disorder (15.1%), post-traumatic stress syndrome (13.4%), depression and anxiety (13.5%), suicidal ideation (10.1%), and several cognitive disorders. CONCLUSION: Neurological and neuropsychiatric manifestations related to depression and anxiety, and cognition disorders are reported during the post-COVID-19 condition in South America. Symptoms associated with chronic pain appear to be associated with the condition. More studies on post-COVID-19 conditions are needed in the South America region.

ANTECEDENTES: A condição pós-COVID-19 é um grande desafio moderno na medicina e tem alto impacto global na saúde da população. OBJETIVO: Determinar as principais manifestações neurológicas e neuropsiquiátricas após a infecção aguda da COVID-19 nos países da América do Sul. MéTODOS: Trata-se de um estudo de revisão sistemática, registrado na plataforma PROSPERO seguindo o modelo PRISMA. Foram encontrados 4131 artigos com as estratégias de buscas empregadas. Investigaram-se manifestações neurológicas e neuropsiquiátricas em indivíduos com três meses ou mais desde a infecção aguda por COVID-19, maiores de 18 anos, incluindo estudos realizados em países da América do Sul publicados entre 2020 e 2022. RESULTADOS: Foram analisados seis estudos (quatro do Brasil e dois do Equador). Em relação ao tipo de estudo: três eram coortes, dois relatos de casos e um transversal. Os principais desfechos encontrados foram em relação à dor nova (65,5%) e dor crônica nova (19,6%), cefaleia nova (39,1%), cefaleia crônica diária (13%), parestesia (62%), além de doenças neuropsiquiátricas como transtorno de ansiedade generalizada (15,1%), síndrome do estresse pós-traumático (13,4%), depressão e ansiedade (13,5%), ideação suicida (10,1%) e diversos distúrbios cognitivos. CONCLUSãO: Manifestações neurológicas e neuropsiquiátricas relacionadas à depressão e ansiedade e distúrbios de cognição são relatados durante a condição pós-COVID-19 na América do Sul. Os sintomas associados a quadros de dor crônica parecem estar associados à condição. Mais estudos sobre condições pós COVID-19 são necessários na região da América do Sul.

Proteomics of serum-derived extracellular vesicles are associated with the severity and different clinical profiles of patients with COVID-19: An exploratory secondary analysis.

BACKGROUND AIMS: Coronavirus disease 2019 (COVID-19) is characterized by a broad spectrum of clinical manifestations with the potential to progress to multiple organ dysfunction in severe cases. Extracellular vesicles (EVs) carry a range of biological cargoes, which may be used as biomarkers of disease state. METHODS: An exploratory secondary analysis of the SARITA-2 and SARITA-1 datasets (randomized clinical trials on patients with mild and moderate/severe COVID-19) was performed. Serum-derived EVs were used for proteomic analysis to identify enriched biological processes and key proteins, thus providing insights into differences in disease severity. Serum-derived EVs were separated from patients with COVID-19 by size exclusion chromatography and nanoparticle tracking analysis was used to determine particle concentration and diameter. Liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) was performed to identify and quantify protein signatures. Bioinformatics and multivariate statistical analysis were applied to distinguish candidate proteins associated with disease severity (mild versus moderate/severe COVID-19). RESULTS: No differences were observed in terms of the concentration and diameter of enriched EVs between mild (n = 14) and moderate/severe (n = 30) COVID-19. A total of 414 proteins were found to be present in EVs, of which 360 were shared while 48 were uniquely present in severe/moderate compared to mild COVID-19. The main biological signatures in moderate/severe COVID-19 were associated with platelet degranulation, exocytosis, complement activation, immune effector activation, and humoral immune response. Von Willebrand factor, serum amyloid A-2 protein, histone H4 and H2A type 2-C, and fibrinogen ß-chain were the most differentially expressed proteins between severity groups. CONCLUSION: Exploratory proteomic analysis of serum-derived EVs from patients with COVID-19 detected key proteins related to immune response and activation of coagulation and complement pathways, which are associated with disease severity. Our data suggest that EV proteins may be relevant biomarkers of disease state and prognosis.

Neurological and neuropsychiatric manifestations of post-COVID-19 condition in South America: a systematic review of the literature / Manifestações neurológicas e neuropsiquiátricas da condição pós-COVID-19 na América do Sul: revisão sistemática da literatura

Abstract Background The post-COVID-19 condition is a major modern challenge in medicine and has a high global impact on the health of the population. Objective To determine the main neurological and neuropsychiatric manifestations after acute COVID-19 infection in South American countries. Methods This is a systematic review study, registered on the PROSPERO platform following the PRISMA model. 4131 articles were found with the search strategies used. Neurological and neuropsychiatric manifestations were investigated in individuals three months or more after acute COVID-19 infection, and older than 18 years, including studies conducted in South American countries published between 2020 and 2022. Results Six studies (four from Brazil and two from Ecuador) were analyzed. Regarding the type of study: three were cohorts, two were case reports, and one was cross-sectional. The main outcomes found were new pain (65.5%) and new chronic pain (19.6%), new headache (39.1%), daily chronic headache (13%), paresthesia (62%), in addition to neuropsychiatric diseases, such as generalized anxiety disorder (15.1%), post-traumatic stress syndrome (13.4%), depression and anxiety (13.5%), suicidal ideation (10.1%), and several cognitive disorders. Conclusion Neurological and neuropsychiatric manifestations related to depression and anxiety, and cognition disorders are reported during the post-COVID-19 condition in South America. Symptoms associated with chronic pain appear to be associated with the condition. More studies on post-COVID-19 conditions are needed in the South America region.

Resumo Antecedentes A condição pós-COVID-19 é um grande desafio moderno na medicina e tem alto impacto global na saúde da população. Objetivo Determinar as principais manifestações neurológicas e neuropsiquiátricas após a infecção aguda da COVID-19 nos países da América do Sul. Métodos Trata-se de um estudo de revisão sistemática, registrado na plataforma PROSPERO seguindo o modelo PRISMA. Foram encontrados 4131 artigos com as estratégias de buscas empregadas. Investigaram-se manifestações neurológicas e neuropsiquiátricas em indivíduos com três meses ou mais desde a infecção aguda por COVID-19, maiores de 18 anos, incluindo estudos realizados em países da América do Sul publicados entre 2020 e 2022. Resultados Foram analisados seis estudos (quatro do Brasil e dois do Equador). Em relação ao tipo de estudo: três eram coortes, dois relatos de casos e um transversal. Os principais desfechos encontrados foram em relação à dor nova (65,5%) e dor crônica nova (19,6%), cefaleia nova (39,1%), cefaleia crônica diária (13%), parestesia (62%), além de doenças neuropsiquiátricas como transtorno de ansiedade generalizada (15,1%), síndrome do estresse pós-traumático (13,4%), depressão e ansiedade (13,5%), ideação suicida (10,1%) e diversos distúrbios cognitivos. Conclusão Manifestações neurológicas e neuropsiquiátricas relacionadas à depressão e ansiedade e distúrbios de cognição são relatados durante a condição pós-COVID-19 na América do Sul. Os sintomas associados a quadros de dor crônica parecem estar associados à condição. Mais estudos sobre condições pós COVID-19 são necessários na região da América do Sul.

The development of the normal Schirmer tear test results during the dog's first year of life.

OBJECTIVE: To evaluate the relationship between lacrimation and age in a homogeneous group of healthy beagle dogs during the first year of life. MATERIALS AND METHODS: Schirmer tear test I (STT I) was performed at an interval of 12-15 days in both eyes of 16 clinically healthy beagle dogs (eight males and eight females) from 94 to 361 days of age. Three different quadratic polynomial regression equations were estimated for the variation in lacrimation: (1) for the entire period (19 observations), (2) for observations 1-4 (days 94-136), and (3) for observations 5-19 (days 150-361). RESULTS: By fitting quadratic regression equations to different phases of tear production during the dog's first year of life, it was possible to see that with each day of life, lacrimation increased 0.08 times (8%). From days 94 to 136, however, lacrimal production fell 1.1 times with each day of life. From day 150 to 361, production increased by 0.02 (2%) each day of life. In addition, there was a positive significant and moderate linear correlation between body weight and STT I values (p = .01). CONCLUSION: In dogs, during the first year of life, STT I data distribution is parabolic in shape. Age significantly affected tear production. STT I decreased at approximately 108-121 days of age and increased thereafter. Body weight was a significant factor for STT I in young dogs. The establishment of this normal pattern of lacrimation is important for both clinical practitioners and laboratory studies.

Accuracy of Foot Pressure Measurement on Predicting the Development of Foot Ulcer in Patients with Diabetes: A Systematic Review and Meta-Analysis.

OBJECTIVE: Areas of the foot with diabetic ulcers have been observed to have greater plantar pressures compared to non-ulcerated. Pressures play an essential role in the mechanism of lesion, and their reduction is effective in prevention. We conducted a systematic review to evaluate pedobarography as a predictive tool for ulcer development, since there is still no consensus on this aspect. METHODS: We searched PUBMED (MedLine), EMBASE, Scopus, Web of Science, CINAHL and Scielo for cohort studies that measured plantar pressure at baseline and verified ulcer development on follow-up. Pooled effects of accuracy, sensitivity, specificity and relative risk were calculated using the inverse variance method. Risk of bias was assessed using the QUADAS-2 tool. RESULTS: Three studies (n = 2000) had enough information on accuracy to be included into a meta-analysis, and 4 (n = 2651) were analyzed using qualitative methods. Pooled sensitivity and specificity were found to be 0.63 (Confidence Interval (CI) 0.58-0.68) and 0.42 (CI 0.27-0.58), respectively. Pooled relative risk was 1.95 (CI 1.09-3.51). Risk of bias was low to uncertain. CONCLUSIONS: Pedobarography in itself appears to have low accuracy in evaluating risk of ulceration. Several methodological heterogeneities were found, and the most optimal cut-off value is yet to be determined.

Fatores associados à sepse e condições preditoras de óbito para pessoas idosas com doenças respiratórias / Factors associated with sepsis and conditions that predict death for elderly people with respiratory diseases* / Factores asociados a la sepsis y condiciones que predicen la muerte de ancianos con enfermedades respiratorias

Objetivo: analisar os fatores associados à sepse, bem como as condições preditoras do óbito em pessoas idosas, internadas em Unidade de Terapia Intensiva, com diagnóstico inicial de doenças respiratórias agudas não relacionadas à assistência à saúde. Método: estudo epidemiológico de coorte mista, realizado entre setembro de 2019 e setembro de 2020. Os dados foram coletados nos prontuários eletrônicos e verificada associação em análise bivariada e regressão logística. Resultados: das 228 pessoas idosas estudadas, 125 (54,5%) faleceram e observaram-se 204 (89,5%) com sepse. Dispositivos invasivos urinários (RR=1,754; IC 95% 1,360-2,263), presença de sepse segundo o consenso Sepsis-3 (RR=3,55; IC 95% 1,23-10,27) e Covid-19 (RR=1,39; IC 95% 1,08-1,78) foram preditores para o óbito. Conclusão: os fatores associados à sepse entre pacientes de Covid-19 e de outras infecções respiratórias são diferentes. As condições preditoras do óbito para pessoas idosas com infecções respiratórias agudas não relacionadas à assistência à saúde foram: sepse, Covid-19 e dispositivo invasivo urinário.

Objective: to analyze the factors associated with sepsis, as well as the conditions that predict death in elderly people admitted to Intensive Care Units, with an initial diagnosis of acute respiratory diseases not related to health care. Methodology: mixed cohort epidemiological study, carried out between September 2019 and September 2020. Data were collected from electronic medical charts and associations were checked in bivariate analysis and logistic regression. Results: of the studied 228 elderly people, 125 (54.5%) passed away and 204 (89.5%) had sepsis. Urinary invasive devices (RR=1.754; 95% CI 1.360-2.263), presence of sepsis based on the Sepsis-3 consensus (RR=3.55; 95% CI 1.23-10.27) and Covid-19 (RR=1. 39; 95% CI 1.08-1.78) were predictors for death. Conclusion: the factors associated with sepsis among patients with Covid-19 and other respiratory infections are different. The conditions that predict death for elderly people with acute respiratory infections not related to health care were: sepsis, Covid-19 and urinary invasive device.

Objetivo: analizar los factores asociados a la sepsis, así como las condiciones que predicen la muerte de ancianos ingresados​​en una Unidad de Cuidados Intensivos, con diagnóstico inicial de enfermedades respiratorias agudas no relacionadas con la asistencia sanitaria. Metodología: estudio epidemiológico de cohorte mixta, realizado entre septiembre de 2019 y septiembre de 2020. Los datos se recolectaron de historias clínicas electrónicas y se verificaron asociaciones en análisis bivariado y regresión logística. Resultados: de los 228 ancianos estudiados, 125 (54,5%) fallecieron y 204 (89,5%) presentaron sepsis. Dispositivos urinarios invasivos (RR=1,754; IC 95% 1,360-2,263), presencia de sepsis según el consenso Sepsis-3 (RR=3,55; IC 95% 1,23-10,27) y Covid-19 (RR=1,39; 95 %IC 1,08-1,78) fueron predictores de muerte. Conclusión: los factores asociados a la sepsis entre pacientes con Covid-19 y otras infecciones respiratorias son diferentes. Las condiciones que predicen la muerte de ancianos con infecciones respiratorias agudas no relacionadas con la asistencia sanitaria fueron: sepsis, Covid-19 y dispositivo urinario invasivo.

Evaluation of Three Human-Use Glucometers for Blood Glucose Measurement in Dogs.

Background: Glucometers or portable sensors are used to quickly measure blood glucose at low cost. They are used in veterinary practice and by guardians to monitor diseases that require, as in diabetes mellitus. However, not all commercially available glucometers (human and veterinary) are suitable for this purpose. Hypotheses/Objectives. The objective was to evaluate the analytical and clinical precision of three human-use portable glucometers. Animals. This study evaluated 115 samples in three glycemic ranges (hypoglycemia, normoglycemia, and hyperglycemia) from 82 dogs recruited from veterinary services. Methods: The portable glucometers are the FreeStyle Freedom Lite®, FreeStyle Optium Neo®, and On Call Plus® models. Glucometer results were compared with the enzymatic colorimetric glucose oxidase laboratory reference method. Using descriptive and comparative statistical analysis, there were correlations between these devices and the standard method, ISO 15197 : 2003 and ISO 15197 : 2013 standards, and error grid analysis. Results: Only the Freedom Lite® device observed a statistical difference when compared with the reference method. Despite the underestimated glucose concentrations assessed with humane devices, all three tested herein showed a positive coefficient. However, none of these achieved all ISO guidelines. Conclusion and Clinical Importance. Although there was wide use of portable humane devices for dog glucose measurements on routine, the results are generally inferior when compared to the reference method. The FreeStyle Optium Neo® glucometer obtained the best result and is therefore the best option among the glucometers evaluated; however, for the first attendance on veterinary routine, all three glucometers had a satisfactory glucose measurement until the reference method availability.

Relation between Selenium and Female Fertility: A Systematic Review / Relação entre o selênio e a fertilidade feminina: Uma revisão sistemática

Abstract Objective To analyze the influence of selenium in female fertility. Data sourceA search was performed in the following databases: MEDLINE, Web of Science, Scopus, SciELO, LILACS, MDPI, ScienceDirect, and Europe PMC. The descriptors selected were "selenium" AND "female" AND "fertility". The search interval was from 1996 to 2021. Study selectionThe evaluation was performed independently by two reviewers, and a third reviewer confirmed the inclusion of papers in case of divergence between the first two reviewers. Papers were selected after the title and abstract were read, and those that met the eligibility criteria had the full text read. Data collectionThe following data was extracted: author, year of publication, country, type of study, objective, method, sample size, follow-up period, patients' mean age, inclusion and exclusion criteria, and concentration of serum and capillary selenium. The data was organized in chronological order of paper publication. Data synthesisThe number of papers identified totaled 3,800, out of which 7 were included in the systematic review. The studies indicated a positive correlation between serum selenium and antioxidant concentration in the follicular fluid, reduction in antithyroid antibodies, oocyte production and follicle number. Conclusion Selenium supplementation is promising in women with this micronutrient deficiency to promote improvement of the reproductive efficiency and prevent damage to the pregnancy. Further studies on this theme are still required.

Resumo Objetivo Analisar a influência do selênio na fertilidade feminina. Fonte dos dadosUma busca foi realizada nas seguintes bases de dados: MEDLINE, Web of Science, Scopus, SciELO, LILACS, MDPI, ScienceDirect e Europe PMC. Os descritores selecionados foram "selenium" AND "female" AND "fertility". O intervalo de busca foi de 1996 a 2021. Seleção dos estudosA avaliação ocorreu de maneira independente por dois revisores, sendo que um terceiro corroborou a eleição dos artigos em casos de divergência. Os estudos foram selecionados através da leitura do título e resumo, e aqueles que contemplaram os critérios de elegibilidade foram lidos na íntegra. Coleta dos dadosOs seguintes dados foram extraídos: autor, ano de publicação, país, tipo de estudo, objetivo, método, tamanho da amostra, tempo de acompanhamento, média de idade das pacientes, critérios de inclusão e exclusão, concentração de selênio sérico e capilar. Os dados foram organizados em ordem cronológica de publicação do estudo. Síntese dos dadosForam identificados 3.800 artigos e incluídos 7 estudos na revisão sistemática. Os resultados indicaram correlação positiva entre o nível de selênio sérico e a concentração de antioxidantes no fluido folicular; diminuição dos níveis de anticorpos antitireoidianos; produção de oócitos, e número de folículos. Conclusão A suplementação de selênio é promissora em mulheres com deficiência do micronutriente, a fim de promover melhora na eficiência reprodutiva e prevenir danos na gravidez. Salientou-se a necessidade de realização de mais estudos sobre o tema.

Relation between Selenium and Female Fertility: A Systematic Review.

OBJECTIVE: To analyze the influence of selenium in female fertility. DATA SOURCE: A search was performed in the following databases: MEDLINE, Web of Science, Scopus, SciELO, LILACS, MDPI, ScienceDirect, and Europe PMC. The descriptors selected were "selenium" AND "female" AND "fertility". The search interval was from 1996 to 2021. STUDY SELECTION: The evaluation was performed independently by two reviewers, and a third reviewer confirmed the inclusion of papers in case of divergence between the first two reviewers. Papers were selected after the title and abstract were read, and those that met the eligibility criteria had the full text read. DATA COLLECTION: The following data was extracted: author, year of publication, country, type of study, objective, method, sample size, follow-up period, patients' mean age, inclusion and exclusion criteria, and concentration of serum and capillary selenium. The data was organized in chronological order of paper publication. DATA SYNTHESIS: The number of papers identified totaled 3,800, out of which 7 were included in the systematic review. The studies indicated a positive correlation between serum selenium and antioxidant concentration in the follicular fluid, reduction in antithyroid antibodies, oocyte production and follicle number. CONCLUSION: Selenium supplementation is promising in women with this micronutrient deficiency to promote improvement of the reproductive efficiency and prevent damage to the pregnancy. Further studies on this theme are still required.

OBJETIVO: Analisar a influência do selênio na fertilidade feminina. FONTE DOS DADOS: Uma busca foi realizada nas seguintes bases de dados: MEDLINE, Web of Science, Scopus, SciELO, LILACS, MDPI, ScienceDirect e Europe PMC. Os descritores selecionados foram "selenium" AND "female" AND "fertility". O intervalo de busca foi de 1996 a 2021. SELEçãO DOS ESTUDOS: A avaliação ocorreu de maneira independente por dois revisores, sendo que um terceiro corroborou a eleição dos artigos em casos de divergência. Os estudos foram selecionados através da leitura do título e resumo, e aqueles que contemplaram os critérios de elegibilidade foram lidos na íntegra. COLETA DOS DADOS: Os seguintes dados foram extraídos: autor, ano de publicação, país, tipo de estudo, objetivo, método, tamanho da amostra, tempo de acompanhamento, média de idade das pacientes, critérios de inclusão e exclusão, concentração de selênio sérico e capilar. Os dados foram organizados em ordem cronológica de publicação do estudo. SíNTESE DOS DADOS: Foram identificados 3.800 artigos e incluídos 7 estudos na revisão sistemática. Os resultados indicaram correlação positiva entre o nível de selênio sérico e a concentração de antioxidantes no fluido folicular; diminuição dos níveis de anticorpos antitireoidianos; produção de oócitos, e número de folículos. CONCLUSãO: A suplementação de selênio é promissora em mulheres com deficiência do micronutriente, a fim de promover melhora na eficiência reprodutiva e prevenir danos na gravidez. Salientou-se a necessidade de realização de mais estudos sobre o tema.

Nitazoxanide in Patients Hospitalized With COVID-19 Pneumonia: A Multicentre, Randomized, Double-Blind, Placebo-Controlled Trial.

Background: Nitazoxanide exerts antiviral activity in vitro and in vivo and anti-inflammatory effects, but its impact on patients hospitalized with COVID-19 pneumonia is uncertain. Methods: A multicentre, randomized, double-blind, placebo-controlled trial was conducted in 19 hospitals in Brazil. Hospitalized adult patients requiring supplemental oxygen, with COVID-19 symptoms and a chest computed tomography scan suggestive of viral pneumonia or positive RT-PCR test for COVID-19 were enrolled. Patients were randomized 1:1 to receive nitazoxanide (500 mg) or placebo, 3 times daily, for 5 days, and were followed for 14 days. The primary outcome was intensive care unit admission due to the need for invasive mechanical ventilation. Secondary outcomes included clinical improvement, hospital discharge, oxygen requirements, death, and adverse events within 14 days. Results: Of the 498 patients, 405 (202 in the nitazoxanide group and 203 in the placebo group) were included in the analyses. Admission to the intensive care unit did not differ between the groups (hazard ratio [95% confidence interval], 0.68 [0.38-1.20], p = 0.179); death rates also did not differ. Nitazoxanide improved the clinical outcome (2.75 [2.21-3.43], p < 0.0001), time to hospital discharge (1.37 [1.11-1.71], p = 0.005), and reduced oxygen requirements (0.77 [0.64-0.94], p = 0.011). C-reactive protein, D-dimer, and ferritin levels were lower in the nitazoxanide group than the placebo group on day 7. No serious adverse events were observed. Conclusions: Nitazoxanide, compared with placebo, did not prevent admission to the intensive care unit for patients hospitalized with COVID-19 pneumonia. Clinical Trial Registration: Brazilian Registry of Clinical Trials (REBEC) RBR88bs9x; ClinicalTrials.gov, NCT04561219.

Serological survey of anti-Leptospira spp. antibodies in individuals with animal hoarding disorder and their dogs in a major city of Southern Brazil.

BACKGROUND: Individuals with hoarding disorder (HD) presented a persistent difficulty in detaching from objects and/or animals. Unhealthy conditions, frequently found in cases of animal HD (AHD), may favour environmental contamination and the spread of zoonotic pathogens. Despite that, only one study of zoonotic diseases in individuals with AHD and their companion animals has been conducted to date. OBJECTIVES: This study aimed to assess the seroprevalence of anti-Leptospira spp. antibodies in individuals with AHD and their dogs in a major city of Southern Brazil. METHODS: Blood samples were obtained from 264 dogs (21 households) and 19 individuals with AHD (11 households) and tested by microscopic agglutination test. RESULTS: All human samples were seronegative. Seropositivity was found in 16/264 (6.1%; CI 95% 3.3-9.6%) dogs from 11/21 (52.38%) households, with titres ranging from 100 up to 400, and Copenhageni (10/16; 62.5%) was the most frequent serovar. Surprisingly, seropositivity of hoarded dogs found herein was among the lowest reportedly observed in other dog populations of Brazil. Two epidemiological variables were significantly associated with seropositivity in dogs: the presence of cat hoarding (p = 0.004) and the report of flood occurrence in the household (p = 0.031). CONCLUSIONS: No individuals with AHD were seropositive, and besides the lower seroprevalence of dogs, they probably had contact with Leptospira spp. at some point in their life. Since dogs can be considered potential sentinels in leptospirosis, public health programs must become aware of the risk of leptospirosis cases in households of individuals with AHD and nearby communities.

Risk factors associated with ticks and Rickettsia spp. exposure in wild boars (Sus scrofa), hunting dogs, and hunters of Brazil.

BACKGROUND AND AIM: Wild boars have recently been implicated as the maintainers and carriers of Amblyomma spp. ticks, which are essential for Rickettsia spp. transmission. Consequently, wild boar hunting may increase the risk of tick exposure and subsequent human tick-borne infection and disease. Therefore, this study was conducted to evaluate the risk factors for ticks and Rickettsia spp. exposure in wild boars, hunting dogs, and hunters in Brazilian biomes. MATERIALS AND METHODS: The statistical relationship of Rickettsia spp. antibodies were evaluated using the Chi-square test in 80 wild boars, 170 hunting dogs, and 49 hunters. RESULTS: The only statistically significant difference in seropositivity found in this study was between male and female wild boars (p=0.034), probably associated with in-park exposure to Amblyomma brasiliense infected with Rickettsia spp. CONCLUSION: The absence of statistical differences in the associated risk factors for hunting dogs and hunters may indicate a random exposure to Rickettsia spp.

Prevalence of anxiety and depression disorder and associated factors during postpartum in puerperal women / Prevalência do transtorno de ansiedade e de depressão e fatores associados no pós-parto de puérperas

Abstract Objectives: to check the prevalence of anxiety and depression disorder and associated factors during the postpartum period in puerperal women in the city of Ponta Grossa, Paraná. Methods: cross-sectional study conducted in an outpatient clinic for newborn care in the city of Ponta Grossa, Paraná, Brazil, in 2016 and 2017. 250 puerperal women were evaluated with the application of a form to collect anxiety/depression, socioeconomic and gestational data. Descriptive and multiple correspondence analyses were performed. Results: most puerperal women (81.2%) had no depression or a mild depression, 14.4% with mild to moderate depression and 4.4% with moderate to severe depression. In relation to anxiety, 68.4% presented a minimum degree, 21.6% mild anxiety, 7.6% moderate anxiety and 2.4% severe anxiety. Concerning the associated factors with postpartum depression, no sociodemographic variables or those related to childbirth were associated. As for anxiety, yellow/indigenous skin color, lack of paternal support and having interrupted pregnancy were associated with more advanced anxiety conditions. Conclusion: there was no association between demographic and health conditions with postpartum depression; however, regarding anxiety, the yellow/indigenous skin color, the lack of paternal support and the interruption of previous pregnancies were associated with more advanced anxiety conditions.

Resumo Objetivos: verificar a prevalência do transtorno de ansiedade e de depressão e fatores associados no pós-parto de puérperas no município de Ponta Grossa, Paraná. Métodos: estudo transversal, realizado no ambulatório de atendimento de recémnascidos do município de Ponta Grossa, Paraná, nos anos de 2016 e 2017. Foram avaliadas 250 puérperas com aplicação de formulário para levantamento de ansiedade e depressão, dados socioeconômicos, gestacionais. Realizou-se análise descritiva e de correspondência múltipla. Resultados: a maioria das puérperas (81,2%) foi considerada sem depressão ou depressão leve, 14,4% com depressão leve a moderada e 4,4% com depressão moderada a grave. Em relação a ansiedade 68,4% apresentaram grau mínimo, 21,6% ansiedade leve, 7,6% ansiedade moderada e 2,4% ansiedade severa. No que tange aos fatores associados a depressão pós parto, nenhuma variável sociodemográfica e relacionada ao parto apresentouse associada. Já no que se refere à ansiedade, a cor amarela/indígena, a falta de suporte paterna e ter interrompido a gestação apresentaram associação às condições mais avançadas de ansiedade. Conclusão: não houve associação entre condições demográficas e de saúde com a depressão pós-parto, mas, em relação à ansiedade, a cor amarela/indígena, a falta de suporte paterna e a interrupção de gestações anteriores apresentaram associação as condições mais avançadas de ansiedade.

Sepsis mortality and the Human Development Index in Brazilian capitals: 1990-2016 / Mortalidade por sepse e Índice de Desenvolvimento Humano nas capitais brasileiras: 1990-2016 / Mortalidad por sepsis e Índice de Desarrollo Humano en las capitales brasileñas: 1990-2016

Background and Objectives: the Human Development Index is among the determinants associated with access to health services and sepsis assistance. This study aimed to describe the frequency of mortality from sepsis in Brazilian capitals and verify its correlation with the Human Development Index (HDI), in three-year periods that represented from the early 90's to 2016. Methods: a time series ecological epidemiology study, with consultation in secondary database involving Brazilian capital variables, population, deaths from sepsis and HDI. Correlation was assessed with Pearson's/Spearman's correlation coefficient. Results: the three highest mean coefficients of mortality from sepsis were observed in Rio Branco (9082.50), Manaus (6367.25) and Macapá (6085.25). A significant correlation was found between the mean mortality rate and the mean HDI in Aracaju (-0,999; p=0.001), Brasília (-0,991; p=0.009), Campo Grande (-0,977; p=0.023), Cuiabá (-0.983; p=0.017), Florianópolis (0.999; p=0.001), Goiânia (-0.997; p=0.003), Maceió (-0.987; p=0.013), Natal (-0.962; p=0.038), Palmas (-0.982; p=0.018) and Vitória (-0.998; p=0.002). Conclusion: there is a general correlation between the mean mortality coefficients and HDI. As HDI increases, there is a decrease in mortality from sepsis.(AU)

Justificativa e Objetivos: o Índice de Desenvolvimento Humano está entre os determinantes associados ao acesso aos serviços de saúde e assistência à sepse. Este estudo teve como objetivo descrever a frequência de mortalidade por sepse nas capitais brasileiras e verificar sua correlação com o Índice de Desenvolvimento Humano (IDH), em triênios que representaram do início da década de 90 a 2016. Métodos: estudo epidemiológico ecológico de série temporal, com consulta em banco de dados secundário envolvendo variáveis da capital brasileira, população, óbitos por sepse e IDH. A correlação foi avaliada com o coeficiente de correlação de Pearson/Spearman. Resultados: os três maiores coeficientes médios de mortalidade por sepse foram observados em Rio Branco (9.082,50), Manaus (6.367,25) e Macapá (6.085,25). Foi encontrada correlação significativa entre a taxa média de mortalidade e o IDH médio em Aracaju (-0,999; p=0,001), Brasília (-0,991; p=0,009), Campo Grande (-0,977; p=0,023), Cuiabá (-0,983 ; p=0,017), Florianópolis (0,999; p=0,001), Goiânia (-0,997; p=0,003), Maceió (-0,987; p=0,013), Natal (-0,962; p=0,038), Palmas (-0,982; p=0,018) e Vitória (-0,998; p=0,002). Conclusão: existe uma correlação geral entre os coeficientes médios de mortalidade e o IDH. À medida que o IDH aumenta, há uma diminuição na mortalidade por sepse.(AU)

Justificación y Objetivos: el Índice de Desarrollo Humano se encuentra entre los determinantes asociados al acceso a los servicios de salud y asistencia a la sepsis. Este estudio tuvo como objetivo describir la frecuencia de mortalidad por sepsis en las capitales brasileñas y verificar su correlación con el Índice de Desarrollo Humano (IDH), en períodos de tres años que representaron desde principios de la década de 1990 hasta 2016. Métodos: estudio de epidemiología ecológica de serie temporal, con consulta en base de datos secundaria involucrando variables de la capital brasileña, población, muertes por sepsis e IDH. La correlación se evaluó con el coeficiente de correlación de Pearson/Spearman. Resultados: los tres mayores coeficientes medios de mortalidad por sepsis se observaron en Rio Branco (9082,50), Manaus (6367,25) y Macapá (6085,25). Se encontró una correlación significativa entre la tasa de mortalidad media y el IDH medio en Aracaju (-0,999; p=0,001), Brasilia (-0,991; p=0,009), Campo Grande (-0,977; p=0,023), Cuiabá (-0,983 ; p=0,017), Florianópolis (0,999; p=0,001), Goiânia (-0,997; p=0,003), Maceió (-0,987; p=0,013), Natal (-0,962; p=0,038), Palmas (-0,982; p=0,018) y Victoria (-0,998; p=0,002). Conclusión: existe una correlación general entre los coeficientes medios de mortalidad y el IDH. A medida que aumenta el IDH, disminuye la mortalidad por sepsis.(AU)

Spatial Distribution of Bat Shelters and Livestock Rabies in Southern Brazil.

This study focused on the epidemiological characterization and spatial distribution of bat shelters concerning livestock animal rabies in Paraná State, southern Brazil. A spatiotemporal cluster analysis was performed based on rabies-positive cases and the Desmodus rotundus shelters. A total of 1742 suspect rabies cases submitted for diagnosis from 2011 to 2017 were analyzed; 481 (27.61%) were positive, and 1261 (72.39%) were negative by direct immunofluorescence and biological testing in mice. Out of the positive samples, 413/481 (85.8%) was bovine, 44/481 (9.1%) equine, 6/481 (1.2%) sheep, 5/481 (1.0%) bubaline, and 14/481 (2.9%) were bats. From 22 Regional Units of Agricultural Health, the northeast 129 (26.82%) and central 86 (17.88%) units had the highest recurrence rates of positive cases. Paraná State was continuously endemic for livestock rabies, with the highest caseload seen in the southern-central regions, which was associated with the highest number of vampire bat shelters and natural geographical characteristics favoring bat housing. There was a decrease in the number of rabies cases in livestock in 2013 and 2014. Spatiotemporal analyses of point process mapping and control of D. rotundus shelters and suspected livestock rabies cases in the study area were steady and statistically correlated. However, as bats may travel up to 35-40 km to prey on cattle clusters, bat shelter locations may not be the most sensitive measure of exposure. Furthermore, future studies should consider landscape features such as altitude as potential associated risk factors. Rabies vaccination of livestock and bat hematophagous shelters identification combined with bat control is recommended to increase the efficacy of preventive measures, particularly in natural geographic characteristics favoring local bat housing.

Serosurvey of anti-treponema pallidum (syphilis), anti-hepatitis C virus and anti-HIV antibodies in homeless persons of São Paulo city, southeastern Brazil.

Homeless persons have been considered as one of the most susceptible populations to sexually transmitted infections. In Brazil, these population experienced an increase of 140% from 2012 to 2020. Accordingly, the present study aimed to assess the seroprevalence of anti-Treponema pallidum, anti-HCV, anti-HIV antibodies, and the risk factors associated with homeless persons in a daytime attendance shelter of São Paulo city during the syphilis epidemic in Brazil. Blood samples of 116 volunteers and epidemiological data were conveniently collected in the shelter from June through August 2018. Detection of syphilis, HCV, and HIV antibodies was performed by chemiluminescent microparticle immunoassay (CMIA). CMIA-reagent samples for anti-T. pallidum antibodies were confirmed by Venereal Disease Research Laboratory (VDRL) non-treponemal test. VDRL non-reagent samples were confirmed by treponemal rapid immunochromatographic test. A rapid immunoblot assay confirmed seropositivity to HIV. Overall, anti-T. pallidum antibodies were observed in 29/116 (25.0%), anti-HCV antibodies in 4/116 (3.4%), and anti-HIV antibodies in 2/116 (1.7%) individuals, both co-infected with anti-T. pallidum antibodies. Associated risk factors for syphilis in homeless persons were being born or previously living in another city (p = 0.043) and becoming homeless due to family conflicts (p = 0.035). Besides homeless vulnerability, worldwide shortage of benzathine penicillin supply and increasing of syphilis testing access through rapid testing in primary health care services may have also impacted disease spreading at the time. The prevalence of syphilis found herein is the highest worldwide to date in this population.

Eficácia das palmilhas customizadas na melhora da distribuição da pressão plantar em pacientes com neuropatia diabética: Protocolo de um ensaio clínico randomizado e controlado / Efficacy of customized insoles in the improvement of plantar pressure in patients with diabetic neuropathy: Protocol of a randomized and controlled clinical trial

OBJETIVO: Avaliar a influência das palmilhas customizadas na pressão plantar de diabéticos com neuropatia em comparação ao grupo sham. MÉTODOS: O método do estudo, devidamente registrado no Registro Brasileiro de Ensaios Clínicos ­ REBEC (Clinical Trial Brazilian Register) (http://www.ensaiosclinicos.gov.br/) RBR-5NQK4K, incluiu um ensaio clínico randomizado, controlado, prospectivo, duplo-cego, com uma amostra de 46 voluntários que serão randomizados aleatoriamente numa razão de 1: 1 para serem direcionados aos grupos intervenção e controle. O grupo intervenção receberá palmilhas customizadas, com barra retrocapital e placa de etil vinil acetato (EVA) no mesmo formato da barra retrocapital, com a finalidade de reduzir a pressão no antepé. No grupo controle, as palmilhas planas serão confeccionadas sem nenhum objetivo terapêutico. Este projeto foi conduzido de acordo com o padrão de protocolo para ensaios clínicos randomizados (SPIRIT). Junto com a avaliação clínica, serão coletados dados demográficos da amostra para identificar e confirmar a presença de neuropatia periférica, em seguida, será avaliada a podobarografia e, por fim, os pacientes responderão ao questionário FAAM para avaliação da funcionalidade do pé. O desfecho primário será a análise dos pontos de pressão em KiloPascal (kPa) no pé dos pacientes com neuropatia diabética por meio da podobarografia nos pacientes do grupo intervenção e controle. O desfecho secundário será a funcionalidade do pé nas atividades de vida diária através do questionário FAAM (Foot and Ankle Ability Measure), considerando os voluntários na avaliação inicial, 3º e 6º meses. CONSIDERAÇÕES FINAIS: os futuros resultados deste estudo nos mostrarão principalmente se há ou não uma alteração estrutural na análise da pressão plantar decorrente do uso contínuo da palmilha, além de avaliar se o uso da palmilha terapêutica é eficaz na funcionalidade do pé nos mesmos portadores quando comparado à palmilha sham.

| OBJECTIVE: To evaluate the influence of customized insoles in the plantar pressure of diabetes patients with neuropathy in comparison to the sham group. METHODS: The work method, duly registered at the Registro Brasileiro de Ensaios Clínicos ­ REBEC (Clinical Trial Brazilian Register) (http://www.ensaiosclinicos.gov.br/) RBR-5NQK4K, includes a randomized, controlled, prospective, doubleblinded clinical trial, with a sample of 46 volunteers that will be randomly randomized in a 1: 1 ratio to be referred to intervention and control groups. The intervention group will receive customized insoles, with a retrocapital bar and an ethyl vinyl acetate plaque (EVA) in the same shape as the retrocapital bar, in order to reduce the pressure on the forefoot. In the control group, flat insoles will be prepared without any therapeutic objective. This project was developed according to the standard protocol for randomized clinical trials (SPIRIT). Along with the clinical evaluation, demographic data of the sample will be collected to identify and confirm the presence of peripheral neuropathy, next, the pedobarographic will be evaluated, and finally, the patients will answer the FAAM questionnaire to assess foot functionality. The primary outcome will be analyzing pressure points in KiloPascal (kPa) in the patients' feet through pedobarographic of the patients in the intervention and control groups. The secondary outcome will be the foot functionality in activities of daily living through the FAAM (Foot and Ankle Ability Measure), considering the volunteers in the initial evaluation, third and sixth months. FINAL CONSIDERATIONS: Mainly, results of this study will show whether there is a structural alteration in the analysis of the plantar pressure due to the continuous use of insoles and present the evaluation of whether the use of therapeutic insoles improves the foot functionality of the same users when compared to sham insoles.

EXPOSURE OF WILD BOAR (SUS SCROFA) TO THE COMMON VAMPIRE BAT AND LACK OF IMMUNE PROTECTION TO RABIES VIRUS IN BRAZILIAN HUNTERS.

Rabies virus is recognized as one of the most fatal zoonotic agents affecting all mammals. Wild boars (Sus scrofa), classified as a large-size exotic invasive species in Brazil with nationwide hunting permitted, may serve as an extra blood source for the common vampire bat (Desmodus rotundus). Our aim was to document wild boar exposure to vampire bats to determine the seroprevalence of rabies virus antibodies in wild boars and to determine the immune status of hunters in southern and central-western Brazilian regions. Serum samples were collected from 80 wild boars and 49 hunters from natural and degraded areas of the Atlantic Forest biome of southern Brazil and in degraded areas of the Cerrado biome of central-western Brazil. The rabies-modified rapid fluorescent focus inhibition test was performed to detect the presence of rabies virus neutralizing antibodies in wild boars and considered seropositive when ≥0.10 IU/mL. The simplified fluorescence inhibition microtest was used for samples from hunters with a titer of ≥0.50 IU/mL and considered indicative of seroconversion. While 11% (9/80) of wild boars had serum titers for rabies exposure (≥0.10 IU/mL), 88% (43/49) of corresponding hunters lacked immune protective titers (<0.50 IU/mL). Wild boars showed serum titers for rabies likely due to contact with contaminated saliva of vampire bats or from infected carcass consumption. Additionally, Brazilian wild boars can be exposed to rabies and may play an important role in the sylvatic rabies cycle by providing a blood supply for vampire bats, highlighting the possibility of direct transmission of rabies virus to hunting dogs and hunters. These findings suggested hunters are a potential risk group for contracting rabies, and the World Health Organization may consider adding this occupation to their recommendations of who should receive the pre-exposure rabies vaccination.

Serosurvey of anti-Neospora caninum antibodies in wild boars (Sus scrofa), hunting dogs and hunters of Brazil.

The protozoan Neospora caninum is an important cause of abortion in cattle worldwide, with domestic dogs serving as the definitive hosts. Although hunting activities have been indicated as a potential risk factor for N. caninum infection in dogs, no serological evidence has so far been reported in hunting dogs, wild boars (Sus scrofa), and hunters. A total of 98 wild boars, 168 hunting dogs, and 15 hunters from three Brazilian regions were sampled and tested for anti-N. caninum antibodies by indirect immunofluorescence antibody test, resulting in 15/168 (9%) seropositive hunting dogs, and 0/98 wild boars, and 0/15 hunters seropositive. The absence of N. caninum antibodies in wild boars may suggest low exposure to oocysts shed by hunting dogs and wild canids in three different Brazilian regions. Finally, the absence of hunter seropositivity supports the current lack of evidence that N. caninum is a zoonotic parasite.

High herd-level seroprevalence and associated factors for bovine leukemia virus in the semi-arid Paraíba state, Northeast Region of Brazil.

Epidemiological surveys that investigate infectious diseases such as enzootic bovine leukosis (EBL) are important. Furthermore, estimating the prevalence of such infectious diseases and associated factors is key to assess the disease impact and design control programs. In this study, we identified a high herd-level seroprevalence of EBL in cattle from the semi-arid Paraíba state, Northeast Region of Brazil, using a planned cross-sectional survey. Herd-level and animal-level prevalence were estimated using a two-stage random sampling survey. In total, 2067 cows aged ≥24 months from 400 herds were sampled. An enzyme-linked immunosorbent assay was used to detect specific antibodies directed to the bovine leukosis virus gp51 antigen in both individual and pooled sera. The herd-level and animal-level prevalence was 23.4 % (95 % CI = 19.2-28.1 %) and 10.8 % (95 % CI = 7.5 %-15.3 %), respectively. There were no significant clusters of positive herds (within a radius of 2 km). The factors associated with herd-level prevalence were the exclusive use of hand milking (prevalence ratio [PR] = 1.88), herd size (PR = 1.005), artificial insemination (PR = 2.03), purchase of animals in the previous year (PR = 1.87), and peri-urban farms (PR = 2.09). Prevention measures should be applied at the herd-level, particularly for farms located in peri-urban areas, focusing on good hygiene in hand milking, robust practices and standards for artificial insemination, and serological testing of animals prior to purchase.