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1.
Environ Monit Assess ; 192(11): 678, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33025274

RESUMO

Detecting the probable impact of climate change responses on hydrological components is most important for understanding such changes on water resources. The impact of climate change on virtual parameters of water was assessed through hydrological modeling of the Wunna, Mahanadi (Middle), and Bharathpuzha watersheds. In this article, future hydrological component responses under two Representative Concentration Pathway (RCP) 4.5 and 8.5 scenarios were considered for investigating the runoff, sediment, and water storage components. RegCM4 CSIRO-Mk3.6.0 CORDEX South Asia of RCM model was used which is specially downscaled for the Asian region by IITM-India. Delta change method was adopted to remove bias correction in RCM data. Hydrological simulation for current and future periods was performed by GIS interfaced Soil Water and Assessment Tool (SWAT) model. The surface runoff of Wunna and Bharathpuzha watersheds and the yield of sediment are expected to increase further under RCP8.5 than RCP4.5 and in contrast to Mahanadi watershed. Both blue water storage (BW) and green water storage (GWS) of Wunna watershed are expected to decline under RCP4.5, and rise under RCP8.5 scenario. Both BW and GWS of Bharathpuzha are expected to increase in the future except in western region under RCP4.5 scenario. BW of Mahanadi is expected to increase in the future. However, GWS will decrease in some of the sub-basins. The model-generated results will be helpful for future water resources planning and development.


Assuntos
Mudança Climática , Hidrologia , Ásia , Monitoramento Ambiental , Índia , Modelos Teóricos
2.
JAMA Netw Open ; 3(10): e2024191, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33026453

RESUMO

Importance: In late December 2019, an outbreak of a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China. Data on the routes of transmission to Los Angeles, California, the US West Coast epicenter for coronavirus disease 2019 (COVID-19), and subsequent community spread are limited. Objective: To determine the transmission routes of SARS-CoV-2 to Southern California and elucidate local community spread within the Los Angeles metropolitan area. Design, Setting, and Participants: This case series included 192 consecutive patients with reverse transcription-polymerase chain reaction (RT-PCR) test results positive for SARS-CoV-2 who were evaluated at Cedars-Sinai Medical Center in Los Angeles, California, from March 22 to April 15, 2020. Data analysis was performed from April to May 2020. Main Outcomes and Measures: SARS-CoV-2 viral genomes were sequenced. Los Angeles isolates were compared with genomes from global subsampling and from New York, New York; Washington state; and China to determine potential sources of viral dissemination. Demographic data and outcomes were collected. Results: The cohort included 192 patients (median [interquartile range] age, 59.5 [43-75] years; 110 [57.3%] men). The genetic characterization of SARS-CoV-2 isolates in the Los Angeles population pinpointed community transmission of 13 patients within a 3.81 km2 radius. Variation landscapes of this case series also revealed a cluster of 10 patients that contained 5 residents at a skilled nursing facility, 1 resident of a nearby skilled nursing facility, 3 health care workers, and a family member of a resident of one of the skilled nursing facilities. Person-to-person transmission was detected in a cluster of 5 patients who shared the same single-nucleotide variation in their SARS-CoV-2 genomes. High viral genomic diversity was identified: 20 Los Angeles isolates (15.0%) resembled SARS-CoV-2 genomes from Asia, while 109 Los Angeles isolates (82.0%) were similar to isolates originating from Europe. Analysis of other common respiratory viral pathogens did not reveal coinfection in the cohort. Conclusions and Relevance: These findings highlight the precision of detecting person-to-person transmission and accurate contact tracing directly through SARS-CoV-2 genome isolation and sequencing. Development and application of phylogenetic analyses from the Los Angeles population established connections between COVID-19 clusters locally and throughout the US.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/transmissão , Genoma Viral/genética , Pneumonia Viral/transmissão , Adulto , Idoso , Ásia , California/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Europa (Continente) , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Pandemias , Filogenia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Análise de Sequência de RNA , Proteínas não Estruturais Virais/genética , Washington
3.
Glob Health Sci Pract ; 8(3): 396-412, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33008854

RESUMO

This article assesses the CORE Group Polio Project (CGPP) experience over a 20-year period in 5 countries. It examines how a program designed to provide social mobilization to eradicate one disease, and which did so effectively, functioned within the general framework of community health workers (CHWs). Vertical health programs often have limited impact on broader community health. CGPP has a 20-year history of social mobilization and effective program interventions. This history provided an opportunity to assess how CGPP community mobilizers (CMs) functioned in polio and maternal and child health. The Updated Program Functionality Matrix for Optimizing Community Health Programs tool of the CHW Assessment and Improvement Matrix (AIM) was used to examine CGPP CM roles across different contexts. The analysis determined that CGPP CMs met the basic level of functioning (level 3) for 6 of the 10 components of the AIM tool. This cross-country descriptive analysis of the CGPP demonstrates the importance of embracing the full range of CHW AIM components, even in a vertical program. Use of data, community involvement, local adaptation, and linkage with the health system are especially critical for success. This general lesson could be applied to other community mobilization and disease/epidemic control initiatives, especially as we face the issues of the COVID-19 pandemic.


Assuntos
Agentes Comunitários de Saúde , Erradicação de Doenças/métodos , Poliomielite/prevenção & controle , Avaliação de Programas e Projetos de Saúde/métodos , Serviços de Saúde Rural , África , Ásia , Humanos , População Rural
4.
Orphanet J Rare Dis ; 15(1): 265, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32977826

RESUMO

South Asia is the hotspot of beta-thalassemia, with an estimated 200,000 patients whose lives depend on regular blood transfusion. Due to COVID-19 pandemic, many countries have adopted unprecedented lockdown to minimize the spread of transmission. Restriction of nationwide human mobility and fear of COVID-19 infection has put thalassemia patients in a life-threatening situation because of an acute shortage of blood supply. As a public health preparedness strategy during a crisis like COVID-19 pandemic, the plights of thalassemia patients should be considered. Government-sponsored community blood-banks needs to be established or coverage expanded as a safety net for the thalassemia patients in lower- and middle-income countries.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Talassemia , Ásia , Bangladesh , Betacoronavirus , Estudos Transversais , Humanos , Estudantes
5.
Clin Imaging ; 67: 219-225, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32871426

RESUMO

Since first report of a novel coronavirus in December of 2019, the Coronavirus Disease 2019 (COVID-19) pandemic has crippled healthcare systems around the world. While many initial screening protocols centered around laboratory detection of the virus, early testing assays were thought to be poorly sensitive in comparison to chest computed tomography, especially in asymptomatic disease. Coupled with shortages of reverse transcription polymerase chain reaction (RT-PCR) testing kits in many parts of the world, these regions instead turned to the use of advanced imaging as a first-line screening modality. However, in contrast to previous Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome coronavirus epidemics, chest X-ray has not demonstrated optimal sensitivity to be of much utility in first-line screening protocols. Though current national and international guidelines recommend for the use of RT-PCR as the primary screening tool for suspected cases of COVID-19, institutional and regional protocols must consider local availability of resources when issuing universal recommendations. Successful containment and social mitigation strategies worldwide have been thus far predicated on unified governmental responses, though the underlying ideologies of these practices may not be widely applicable in many Western nations. As the strain on the radiology workforce continues to mount, early results indicate a promising role for the use of machine-learning algorithms as risk stratification schema in the months to come.


Assuntos
Técnicas de Laboratório Clínico/métodos , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/diagnóstico , Saúde Global , Programas de Rastreamento/métodos , Pandemias , Pneumonia Viral/diagnóstico , Ásia , Betacoronavirus , Coronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Europa (Continente) , Humanos , América do Norte , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
6.
Chemosphere ; 254: 126876, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32957286

RESUMO

Chromium is a controversial element, since it has been classified as essential trace element, to chemically and biologically inert compound, to potent intoxicator. Concerns have been risen for chromium effects on human and aquatic life because chromium has been accused for genotoxicity and carcinogenesis. Metals and their ions or complexes (and thus chromium substances) are included in the indicative list of main pollutants (Annex VIII of the Water Framework Directive (2000/60/EC)). Biological effects of chromium are strongly depended on chromium speciation. No universal CrIII or CrVI discharge limits to the aquatic environment have been suggested by the EU. International bodies within the EU, such as the Helsinki Commission and the Oslo-Paris Convention, have issued recommendations on chromium discharge levels. National CrVI and CrIII discharge limits vary in each EU Member State with respect to the receiving water body (marine water, lake, river, sewer system). The maximum discharge limit to the aquatic environment in EU is 1 and 5 mg L-1 for CrVI and Crtotal, respectively. The present work summarizes EU legislation, with respect to the discharge limits to the aquatic environment for CrVI and CrIII. EU national limits that are currently effective are presented and compared to the limits in other parts of the world, such as Australia, Asia, USA, Latin America and South Africa. It is wise that future perspective of chromium policy should differentiate between CrIII and CrVI discharge limits to the aquatic environment, as analytical techniques become more sensitive and chromium speciation specific, and environmental awareness rises.


Assuntos
Cromo/análise , Monitoramento Ambiental , Poluentes Químicos da Água/análise , Ásia , Austrália , Europa (Continente) , Íons , Rios , África do Sul , Oligoelementos
7.
Am J Bot ; 107(9): 1283-1295, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32930404

RESUMO

PREMISE: The Sphagnum recurvum complex comprises a group of closely related peat mosses that are dominant components of many northern wetland ecosystems. Taxonomic hypotheses for the group range from interpreting the whole complex as one polymorphic species to distinguishing 6-10 species. The complex occurs throughout the Northern Hemisphere, and some of the putative species have intercontinental ranges. Our goals were to delimit the complex and assess its phylogenetic structure in relation to morphologically defined species and intercontinental geography. METHODS: RADseq analyses were applied to a sample of 384 collections from Europe, North America, and Asia. The data were subjected to maximum likelihood phylogenetic analyses and analyses of genetic structure using the software STRUCTURE and multivariate ordination approaches. RESULTS: The S. recurvum complex includes S. angustifolium, S. fallax, S. flexuosum, S. pacificum, and S. recurvum as clades with little evidence of admixture. We also resolved an unnamed clade that is referred to here as S. "pseudopacificum." We confirm that S. balticum and S. obtusum are nested within the complex. Species with bluntly acute to obtuse stem leaf apices are sister to those with acute to apiculate leaves. Most of the species exhibit some differentiation between intraspecific population systems disjunct on different continents. CONCLUSIONS: We recognize seven species in the amended S. recurvum complex, including S. balticum and S. obtusum, in addition to the informal clade S. "pseudopacificum." Although we detected some geographically correlated phylogenetic structure within widespread morphospecies, our RADseq data support the interpretation that these species have intercontinental geographic ranges.


Assuntos
Briófitas , Sphagnopsida , Ásia , Ecossistema , Europa (Continente) , Geografia , América do Norte , Filogenia
8.
J Int Med Res ; 48(8): 300060520938943, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32865095

RESUMO

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) began in December 2019 and continues to spread worldwide. Rapid and accurate identification of suspected cases is critical in slowing spread of the virus that causes the disease. We aimed to highlight discrepancies in the various criteria used by international agencies and highly impacted individual countries around the world. METHODS: We reviewed the criteria for identifying a suspected case of COVID-19 used by two international public health agencies and 10 countries across Asia, Europe, and North America. The criteria included information on the clinical causes of illness and epidemiological risk factors. Non-English language guidelines were translated into English by a co-author who is fluent in that particular language. RESULTS: Although most criteria are modifications of World Health Organization recommendations, the specific clinical features and epidemiological risks for triggering evaluation of patients with suspected COVID-19 differed widely among countries. The rationale for these differences may be related to each country's resources, politics, experience with previous outbreaks or pandemics, health insurance system, COVID-19 outbreak severity, and other undetermined factors. CONCLUSION: We found no consensus regarding the best diagnostic criteria for identifying a suspected case of COVID-19.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Regulamento Sanitário Internacional , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Saúde Pública/legislação & jurisprudência , Ásia/epidemiologia , Betacoronavirus , Centers for Disease Control and Prevention, U.S. , Europa (Continente)/epidemiologia , Humanos , Cooperação Internacional , América do Norte/epidemiologia , Pandemias , Estados Unidos , Organização Mundial da Saúde
9.
J Environ Manage ; 275: 111295, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-32891008

RESUMO

Following the "Belt and Road" (B&R) initiative, China has significantly increased its outward direct investment (ODI). Although these investments help to boost these countries' productivity, their impacts on the environment are still controversial and deserve careful investigation. This study for the first time examines whether China's ODI has improved the green total factor productivity (GTFP), a comprehensive index for environmental quality and productivity. Moreover, a new data set composed of ICRG, World Bank WDI, Heritage Foundation, and Wind databases is used to match the panel data of 46 B&R countries for the period of 2003-2016. A newly developed dynamic threshold panel model with GMM characteristics is utilized to explore the possible nonlinear relationship with full consideration of heterogeneity. The empirical results indicate that there is no pollution shelter effect on China's ODI. With the increase in China's ODI, the GTFP of the B&R countries has been significantly improved. Additionally, China's ODI has a greater role in promoting GTFP in B&R countries with higher institutional quality. The positive effects of China's ODI on the GTFP of B&R countries depend on the institutional qualities of the countries, and the enhancement effect becomes greater when the countries have better institutions. There is also evidence that China's ODI significantly promoted the GTFP of countries in the East Asia and Pacific region, South Asia, Central Asia and Europe, while China's ODI did not significantly promote the GTFP of countries in the Middle East and North Africa.


Assuntos
África do Norte , Ásia , China , Europa (Continente) , Oriente Médio
10.
Lancet ; 396(10254): 830-838, 2020 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-32877651

RESUMO

BACKGROUND: Angina might persist or reoccur despite successful revascularisation with percutaneous coronary intervention (PCI) and antianginal therapy. Additionally, PCI in stable patients has not been shown to improve survival compared with optimal medical therapy. Trimetazidine is an antianginal agent that improves energy metabolism of the ischaemic myocardium and might improve outcomes and symptoms of patients who recently had a PCI. In this study, we aimed to assess the long-term potential benefits and safety of trimetazidine added to standard evidence-based medical treatment in patients who had a recent successful PCI. METHODS: We did a randomised, double-blind, placebo-controlled, event-driven trial of trimetazidine added to standard background therapy in patients who had undergone successful PCI at 365 centres in 27 countries across Europe, South America, Asia, and north Africa. Eligible patients were aged 21-85 years and had had either elective PCI for stable angina or urgent PCI for unstable angina or non-ST segment elevation myocardial infarction less than 30 days before randomisation. Patients were randomly assigned by an interactive web response system to oral trimetazidine 35 mg modified-release twice daily or matching placebo. Participants, study investigators, and all study staff were masked to treatment allocation. The primary efficacy endpoint was a composite of cardiac death; hospital admission for a cardiac event; recurrence or persistence of angina requiring an addition, switch, or increase of the dose of at least one antianginal drug; or recurrence or persistence of angina requiring a coronary angiography. Efficacy analyses were done according to the intention-to-treat principle. Safety was assessed in all patients who had at least one dose of study drug. This study is registered with the EU Clinical Trials Register (EudraCT 2010-022134-89). FINDINGS: From Sept 17, 2014, to June 15, 2016, 6007 patients were enrolled and randomly assigned to receive either trimetazidine (n=2998) or placebo (n=3009). After a median follow-up of 47·5 months (IQR 42·3-53·3), incidence of primary endpoint events was not significantly different between the trimetazidine group (700 [23·3%] patients) and the placebo group (714 [23·7%]; hazard ratio 0·98 [95% CI 0·88-1·09], p=0·73). When analysed individually, there were no significant differences in the incidence of the components of the primary endpoint between the treatment groups. Similar results were obtained when patients were categorised according to whether they had an elective or urgent PCI. 1219 (40·9%) of 2983 patients in the trimetazidine group and 1230 (41·1%) of 2990 patients in the placebo group had serious treatment-emergent adverse events. Frequencies of adverse events of interest were similar between the groups. INTERPRETATION: Our results show that the routine use of oral trimetazidine 35 mg twice daily over several years in patients receiving optimal medical therapy, after successful PCI, does not influence the recurrence of angina or the outcome; these findings should be taken into account when considering the place of trimetazidine in clinical practice. However, the long-term prescription of this treatment does not appear to be associated with any statistically significant safety concerns in the population studied. FUNDING: Servier.


Assuntos
Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Intervenção Coronária Percutânea/métodos , Trimetazidina/efeitos adversos , Vasodilatadores/efeitos adversos , Administração Oral , África do Norte/epidemiologia , Idoso , Angina Estável/terapia , Angina Instável/terapia , Ásia/epidemiologia , Estudos de Casos e Controles , Angiografia Coronária/métodos , Angiografia Coronária/estatística & dados numéricos , Morte , Europa (Continente)/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/tendências , Placebos/administração & dosagem , Recidiva , Segurança , América do Sul/epidemiologia , Resultado do Tratamento , Trimetazidina/administração & dosagem , Trimetazidina/uso terapêutico , Vasodilatadores/administração & dosagem , Vasodilatadores/uso terapêutico
11.
BMC Public Health ; 20(1): 1466, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993570

RESUMO

BACKGROUND: Lung cancer is the most diagnosed cancer worldwide. In low- and middle-income countries (LMICs), lung cancer is often diagnosed at a late stage due to poor knowledge and awareness of its signs and symptoms. Increasing lung cancer awareness is likely to reduce the diagnosis and treatment delays. The implementation of early palliative care has also been reported to improve a patient's quality of life, and even survival. The aim of this scoping review was to map evidence on lung cancer awareness and palliative care interventions implemented in sub-Saharan Africa (SSA) and other LMICs. METHODS: This scoping review was guided by Arksey and O'Malley's framework. Databases such as the EBSCOhost, PubMed, Science Direct, Google Scholar, World Health Organization (WHO) library and grey literature were used to perform systematic searches of relevant articles. The methodological quality assessment of included primary studies was assessed using the Mixed Method Appraisal Tool (MMAT). NVivo version 10 software was used to perform the thematic content analysis of the included studies. RESULTS: A total number of screened articles was 2886, with 236 meeting the eligibility criteria and 167 further excluded following abstract screening. Sixty-nine (69) articles qualified for full-article screening and 9 were selected for detailed data extraction and methodological quality assessment. Of the included nine studies, eight described at least one lung cancer warning signs and symptoms, while one described the effectiveness of palliative care for lung cancer. Eight articles recognized the level of lung cancer knowledge, risk factors awareness of warning signs and symptoms in LMICs, mostly Africa and Asia. CONCLUSIONS: Most of the participants were aware of tobacco use as the major risk factor for lung cancer but lacked knowledge on the other pre-disposing risk factors. Evidence on palliative care is scarce, therefore, awareness interventions packaged with evidence on the value of timely access to palliative care services in improving the quality of life of the lung cancer patients and their families, are required.


Assuntos
Países em Desenvolvimento , Disparidades em Assistência à Saúde/estatística & dados numéricos , Neoplasias Pulmonares/terapia , Cuidados Paliativos/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Adulto , África ao Sul do Saara , Ásia , Feminino , Humanos , Neoplasias Pulmonares/economia , Qualidade de Vida , Fatores de Risco
12.
BMC Public Health ; 20(1): 1467, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993596

RESUMO

BACKGROUND: Breast cancer is one of the leading public health problem globally, especially in low-resource countries (LRCs). Breast cancer screening (BCS) services are an effective strategy for early determining of breast cancer. Hence, it is imperative to understand the utilisation of BCS services and their correlated predictors in LRCs. This study aims to determine the distribution of predictors that significantly influence the utilisation of BCS services among women in LRCs. METHODS: The present study used data on 140,974 women aged 40 years or over from 14 LRCs. The data came from country Demographic and Health Surveys (DHS) between 2008 and 2016. Multivariate logistic regression analysis was employed to investigate the significant predictors that influence the use of BCS services. RESULTS: The utilisation of BCS services was 15.41%, varying from 81.10% (95% CI: 76.85-84.73%) in one European country, to 18.61% (95% CI: 18.16 to 19.06%) in Asian countries, 14.30% (95% CI: 13.67-14.96%) in American countries, and 14.29% (95% CI: 13.87-14.74%). Factors that were significantly associated to increase the use of BCS services include a higher level of education (OR = 2.48), advanced age at first birth (> 25 years) (OR = 1.65), female-headed households (OR = 1.65), access to mass media communication (OR = 1.84), health insurance coverage (OR = 1.09), urban residence (OR = 1.20) and highest socio-economic status (OR = 2.01). However, obese women shown a significantly 11% (OR = 0.89) lower use of BSC services compared to health weight women. CONCLUSION: The utilisation of BCS services is low in many LRCs. The findings of this study will assist policymakers in identifying the factors that influence the use of BCS services. To increase the national BCS rate, more attention should be essential to under-represented clusters; in particular women who have a poor socioeconomic clusters, live in a rural community, have limited access to mass media communication, and are have a low level educational background. These factors highlight the necessity for a new country-specific emphasis of promotional campaigns, health education, and policy targeting these underrepresented groups in LRCs.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde da Mulher/estatística & dados numéricos , Saúde da Mulher/estatística & dados numéricos , Adulto , Idoso , Ásia , Neoplasias da Mama/epidemiologia , Europa (Continente) , Feminino , Educação em Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Estados Unidos
13.
BMC Infect Dis ; 20(1): 717, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993529

RESUMO

BACKGROUND: Fungal peritonitis (FP) is a rare complication of peritoneal dialysis. We herein describe the second case in Asia of Histoplasma capsulatum peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). CASE PRESENTATION: An 85-year-old woman with end-stage renal disease (ESRD) who had been on CAPD for 3 years and who had a history of 3 prior episodes of peritonitis presented with intermittent abdominal pain for 2 weeks and high-grade fever for 3 days. Elevated white blood cell (WBC) count and rare small oval budding yeasts were found in her peritoneal dialysis (PD) fluid. From this fluid, a white mold colony was observed macroscopically after 7 days of incubation, and numerous large, round with rough-walled tuberculate macroconidia along with small smooth-walled microconidia were observed microscopically upon tease slide preparation, which is consistent with H. capsulatum. The peritoneal dialysis (PD) catheter was then removed, and it also grew H. capsulatum after 20 days of incubation. The patient was switched from CAPD to hemodialysis. The patient was successfully treated with intravenous amphotericin B deoxycholate (AmBD) for 2 weeks, followed by oral itraconazole for 6 months with satisfactory result. The patient remains on hemodialysis and continues to be clinically stable. CONCLUSION: H. capsulatum peritonitis is an extremely rare condition that is associated with high morbidity and mortality. Demonstration of small yeasts upon staining of PD fluid, and isolation of slow growing mold in the culture of clinical specimen should provide important clues for diagnosis of H. capsulatum peritonitis. Prompt removal of the PD catheter and empirical treatment with amphotericin B or itraconazole is recommended until the culture results are known.


Assuntos
Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Histoplasmose/etiologia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Peritonite/diagnóstico , Peritonite/etiologia , Administração Intravenosa , Administração Oral , Idoso de 80 Anos ou mais , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Ásia , Ácido Desoxicólico/administração & dosagem , Ácido Desoxicólico/uso terapêutico , Combinação de Medicamentos , Feminino , Histoplasmose/tratamento farmacológico , Histoplasmose/microbiologia , Humanos , Itraconazol/administração & dosagem , Itraconazol/uso terapêutico , Falência Renal Crônica/terapia , Peritonite/tratamento farmacológico , Peritonite/microbiologia , Resultado do Tratamento
14.
Curr Hypertens Rep ; 22(11): 90, 2020 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-32910274

RESUMO

PURPOSE OF REVIEW: While the COVID-19 pandemic is constantly evolving, it remains unclear whether the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) affects the clinical course of SARS-CoV-2 infection. For this meta-analysis, PubMed, CENTRAL, and grey literature were searched from their inception to 19 May 2020 for randomized, controlled trials or observational studies that evaluate the association between the use of either ACE inhibitors or ARBs and the risk for major clinical endpoints (infection, hospitalization, admission to ICU, death) in adult patients during the COVID-19 pandemic. In addition, a subgroup geographical analysis of outcomes was performed. Studies including less than 100 subjects were excluded from our analysis. RECENT FINDINGS: In total, 25 observational studies were included. ACE inhibitors and ARBs were not associated with increased odds for SARS-CoV-2 infection, admission to hospital, severe or critical illness, admission to ICU, and SARS-CoV-2-related death. In Asian countries, the use of ACE inhibitors/ARBs decreased the odds for severe or critical illness and death (OR = 0.37, 95% CI 0.16-0.89, I2 = 83%, and OR = 0.62, 95% CI 0.39-0.99, I2 = 0%, respectively), whereas they increased the odds for ICU admission in North America and death in Europe (OR = 1.75, 95% CI 1.37-2.23, I2 = 0%, and OR = 1.68, 95% CI 1.05-2.70, I2 = 82%, respectively). ACE inhibitors might be marginally protective regarding SARS-CoV-2-related death compared with ARBs (OR = 0.86, 95% CI 0.74-1.00, I2 = 0%). Randomized controlled trials are needed to confirm the aforementioned associations between ACE inhibitors, ARBs, and SARS-CoV-2.


Assuntos
Antagonistas de Receptores de Angiotensina/efeitos adversos , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/mortalidade , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/mortalidade , Adulto , Ásia , Betacoronavirus , Europa (Continente) , Humanos , América do Norte , Pandemias , Sistema Renina-Angiotensina
15.
PLoS One ; 15(9): e0238255, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936832

RESUMO

It was shown that the human Angiotensin-converting enzyme 2 (ACE2) is the receptor of recent coronavirus SARS-CoV-2, and variation in this gene may affect the susceptibility of a population. Therefore, we have analysed the sequence data of ACE2 among 393 samples worldwide, focusing on South Asia. Genetically, South Asians are more related to West Eurasian populations rather than to East Eurasians. In the present analyses of ACE2, we observed that the majority of South Asian haplotypes are closer to East Eurasians rather than to West Eurasians. The phylogenetic analysis suggested that the South Asian haplotypes shared with East Eurasians involved two unique event polymorphisms (rs4646120 and rs2285666). In contrast with the European/American populations, both of the SNPs have largely similar frequencies for East Eurasians and South Asians, Therefore, it is likely that among the South Asians, host susceptibility to the novel coronavirus SARS-CoV-2 will be more similar to that of East Eurasians rather than to that of Europeans.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Infecções por Coronavirus/genética , Peptidil Dipeptidase A/genética , Pneumonia Viral/genética , Polimorfismo de Nucleotídeo Único , Receptores Virais/genética , Ásia/epidemiologia , Betacoronavirus/fisiologia , Infecções por Coronavirus/etnologia , Grupo com Ancestrais do Continente Europeu/genética , Haplótipos/genética , Migração Humana , Humanos , Desequilíbrio de Ligação , Pandemias , Filogenia , Pneumonia Viral/etnologia
16.
PLoS One ; 15(9): e0238678, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941467

RESUMO

BACKGROUND: The COVID-19 virus pandemic has caused a significant number of deaths worldwide. If the prevalence of the infection continues to grow, this could impact life expectancy. This paper provides first estimates of the potential direct impact of the COVID-19 pandemic on period life expectancy. METHODS: From the estimates of bias-adjusted age-specific infection fatality rates in Hubei (China) and a range of six prevalence rate assumptions ranging from 1% to 70%, we built a discrete-time microsimulation model that simulates the number of people infected by COVID-19, the number dying from it, and the number of deaths from all causes week by week for a period of one year. We applied our simulation to four broad regions: North America and Europe; Latin America and the Caribbean; Southeastern Asia; and sub-Saharan African. For each region, 100,000 individuals per each 5-year age group are simulated. RESULTS: At a 10% COVID-19 prevalence rate, the loss in life expectancy at birth is likely above 1 year in North America and Europe and in Latin America and the Caribbean. In Southeastern Asia and sub-Saharan Africa, one year lost in life expectancy corresponds to an infection prevalence of about 15% and 25%, respectively. Given the uncertainty in fatality rates, with a 50% prevalence of COVID-19 infections under 95% prediction intervals, life expectancy would drop by 3 to 9 years in North America and Europe, by 3 to 8 years in Latin America and the Caribbean, by 2 to 7 years in Southeastern Asia, and by 1 to 4 years in sub-Saharan Africa. In all prevalence scenarios, as long as the COVID-19 infection prevalence rate remains below 1 or 2%, COVID-19 would not affect life expectancy in a substantial manner. INTERPRETATION: In regions with relatively high life expectancy, if the infection prevalence threshold exceeds 1 or 2%, the COVID-19 pandemic will break the secular trend of increasing life expectancy, resulting in a decline in period life expectancy. With life expectancy being a key indicator of human development, mortality increase, especially among the vulnerable subgroups of populations, would set a country back on its path of human development.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Expectativa de Vida , Pandemias , Pneumonia Viral/mortalidade , Adulto , África ao Sul do Saara/epidemiologia , Distribuição por Idade , Idoso , América/epidemiologia , Ásia/epidemiologia , Simulação por Computador , Países em Desenvolvimento , Europa (Continente)/epidemiologia , Feminino , Saúde Global , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Prevalência
17.
PLoS One ; 15(9): e0239175, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941485

RESUMO

The COVID-19 outbreak has forced most of the global population to lock-down and has put in check the health services all over the world. Current predictive models are complex, region-dependent, and might not be generalized to other countries. However, a 150-year old epidemics law promulgated by William Farr might be useful as a simple arithmetical model (percent increase [R1] and acceleration [R2] of new cases and deaths) to provide a first sight of the epidemic behavior and to detect regions with high predicted dynamics. Thus, this study tested Farr's Law assumptions by modeling COVID-19 data of new cases and deaths. COVID-19 data until April 10, 2020, was extracted from available countries, including income, urban index, and population characteristics. Farr's law first (R1) and second ratio (R2) were calculated. We constructed epidemic curves and predictive models for the available countries and performed ecological correlation analysis between R1 and R2 with demographic data. We extracted data from 210 countries, and it was possible to estimate the ratios of 170 of them. Around 42·94% of the countries were in an initial acceleration phase, while 23·5% already crossed the peak. We predicted a reduction close to zero with wide confidence intervals for 56 countries until June 10 (high-income countries from Asia and Oceania, with strict political actions). There was a significant association between high R1 of deaths and high urban index. Farr's law seems to be a useful model to give an overview of COVID-19 pandemic dynamics. The countries with high dynamics are from Africa and Latin America. Thus, this is a call to urgently prioritize actions in those countries to intensify surveillance, to re-allocate resources, and to build healthcare capacities based on multi-nation collaboration to limit onward transmission and to reduce the future impact on these regions in an eventual second wave.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Modelos Biológicos , Pandemias/legislação & jurisprudência , Pneumonia Viral/prevenção & controle , África/epidemiologia , Ásia/epidemiologia , Infecções por Coronavirus/epidemiologia , Previsões , Geografia Médica , Humanos , Incidência , América Latina/epidemiologia , Morbidade/tendências , Mortalidade/tendências , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Dinâmica Populacional , Saúde da População Urbana
18.
J Oral Sci ; 62(4): 449-451, 2020 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-32893198

RESUMO

The aim of the present study was to gather information to clarify the scope of oral health services in Asia, focusing particularly on the role of dental hygienists, anticipating that international exchange of data on oral health would benefit the establishment of such systems in other countries. Data on oral health providers were obtained from reliable sources, cited reports and professional websites, or from embassies of Asian countries located in Japan. The embassies were contacted by email, telephone, post, or interview. The survey was conducted from February 1, 2015, until June 18, 2019. Twenty-eight countries in Asia were selected according to their classification by the United Nations. Among them, 14 countries were found to recognize the professional status of dental hygienists. Nine of the 28 countries had no working dental hygienists, and their role was taken by other oral hygiene providers. It was unclear whether oral hygiene providers were operating in 5 of those countries. Many countries were found to lack formal oral health systems, and some had limited systems in rural areas. Dental hygienists work to prevent oral diseases in order to protect teeth and gums, as is the case in Japan. However, other oral health providers offer other dental services in other Asian countries, probably depending on individual national circumstances.


Assuntos
Higienistas Dentários , Saúde Bucal , Ásia , Humanos , Japão , Âmbito da Prática
19.
J Assoc Physicians India ; 68(10): 60-65, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32978928

RESUMO

Rheumatic heart disease (RHD) disables millions in Asia and Africa. Epidemiological data and clinical studies in India have reported a significant decline in its prevalence in last century. Global Burden of Disease (GBD) study estimated that RHD in India led to 395/100000 disability adjusted life years (DALYs) and 9.2/100000 deaths in 1990. This declined to 270/100000 and 7.9/100000, respectively, in 2017. School-based epidemiological studies in India have reported decline in clinically diagnosed RHD. On the other hand, GBD study has reported that in terms of absolute numbers, India contributes to one-third of global RHD burden. RHD in 1990 led to 3.44 million DALYs and 80,470 deaths which has increased to 3.73 million DALYs and 108,460 deaths in 2017. India Disease Burden Initiative has reported high RHD burden in many less developed states of the country, e.g., Bihar, Odisha, Assam, Chhattisgarh, Uttar Pradesh, etc. Echocardiographic epidemiology studies have reported high burden of subclinical RHD. Significant proportions of patients in hospital-based echocardiographic clinics have RHD and it contributes to 25-45% of cardiac surgeries in government hospitals. The continuing burden of RHD needs proper public health and clinical response.


Assuntos
Cardiopatia Reumática/epidemiologia , África , Ásia , Carga Global da Doença , Humanos , Índia/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida
20.
Epidemiol Prev ; 44(4): 304-307, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32921037

RESUMO

It has been hypothesized that bacille Calmette-Guerin (BCG), the anti-tuberculosis vaccine, can be protective against Covid-19. Using data of performed swabs and RT-PCR results for SARS-CoV-2 in the Reggio Emilia province (Emilia-Romagna Region, Northern Italy) from March 6th to March 26th, 2020, we computed age, gender, and place of birth (Italy or abroad) specific risk of being tested, prevalence of positive tests, and probability of testing positive given that a swab has been taken during the epidemic peak. We report that immigrants resident in Reggio Emilia province, mostly coming from Countries with high BCG vaccination coverage, and Italians had a similar prevalence of infection (odds ratio - OR 0.99; 95%CI 0.82-1.20) and similar probability of being tested (OR 0.93; 95%CI 0.81-1.10). Our data do not support the hypothesis that immigrants from Countries where BCG vaccination is recommended have a lower risk of Covid-19 infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Emigrantes e Imigrantes/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Adulto , África/etnologia , Idoso , Ásia/etnologia , Vacina BCG , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Nasofaringe/virologia , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/etnologia , Pneumonia Viral/prevenção & controle , Polônia/etnologia , Prevalência , Utilização de Procedimentos e Técnicas , Cobertura Vacinal
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