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5.
PLoS One ; 15(4): e0230692, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32243482

RESUMO

BACKGROUND: Zika virus caused thousands of congenital anomalies during a recent epidemic. Because Zika emerged in areas endemic for dengue and these related flaviviruses elicit cross-reactive antibodies, it is challenging to serologically monitor pregnant women for Zika infection. METHODS: A prospective cohort of 253 pregnant women was established in León, Nicaragua. Women were followed during prenatal care through delivery. Serologic specimens were obtained at each visit, and birth outcome was recorded. Established flavivirus serologic methods were adapted to determine Zika seroprevalence, and a stepwise testing algorithm estimated timing of Zika infection in relation to pregnancy. RESULTS: Zika seroprevalence was approximately 59% among women tested. Neutralization testing was highly concordant with Zika NS1 BOB results. Per study algorithm, 21% (40/187) of women were classified as experiencing Incident ZIKV infection during pregnancy. Importantly, the Incident ZIKV group included mostly women pregnant during the 2016 Zika epidemic peak and the only 3 subjects in the cohort with RT-PCR-confirmed infections. Approximately 17% of births had complications; 1.5% (3/194) manifesting clinical criteria of congenital Zika syndrome, one was RT-PCR-confirmed as a case of congenital Zika syndrome. Adverse birth outcome did not correlate with timing of Zika infection. CONCLUSIONS: By leveraging prenatal care systems, we developed a simple algorithm for identifying women who were likely infected by Zika during pregnancy.


Assuntos
Epidemias , Monitoramento Epidemiológico , Mães , Testes Sorológicos , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/imunologia , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Nicarágua/epidemiologia , Gravidez , Estudos Prospectivos , Fatores de Tempo , Adulto Jovem
6.
Zootaxa ; 4729(2): zootaxa.4729.2.9, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-32229866

RESUMO

A new genus and species of treehopper (Membracidae: Centrotinae) from Nicaragua, Kaikaia gaga, is described and illustrated. Kaikaia is particularly notable in having an assemblage of features more characteristic of the Old World centrotine tribe Beaufortianini than currently recognized New World centrotine tribes. Kaikaia lacks cucullate setae of the mesothoracic femora, which are present in the Boocerini and to some extent, the Platycentrini. The new genus also has an additional m-cu crossvein in the forewing, as well as a frontoclypeal shape and overall appearance similar to Platycentrus Stål. Nevertheless, Kaikaia differs from Platycentrus in its narrow, straight shape of the second valvulae, which bear several prominently raised dorsal teeth and an acute projection along the dorsal margin that resemble those of some members of Nessorhinini.


Assuntos
Hemípteros , Animais , Nicarágua
9.
Int J Infect Dis ; 94: 59-67, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32179138

RESUMO

BACKGROUND: We assessed the cost-effectiveness of Camino Verde, a community-based mobilization strategy to prevent and control dengue and other mosquito-borne diseases. A cluster-randomized controlled trial in Managua, Nicaragua, and in three coastal regions in Guerrero, Mexico (75 intervention and 75 control clusters), Camino Verde used non-governmental community health workers, called brigadistas, to support community mobilization. This donor-funded trial demonstrated reductions of 29.5% (95% confidence interval, CI: 3.8%-55.3%) on dengue infections and 24.7% (CI: 1.8%-51.2%) on self-reported cases. METHODS: We estimated program costs through a micro-costing approach and semi-structured questionnaires. We show results as incremental cost-effectiveness ratios (ICERs) for costs per disability-adjusted life-year (DALYs) averted and conducted probabilistic sensitivity analyses. FINDINGS: The Camino Verde trial spent US$16.72 in Mexico and $7.47 in Nicaragua per person annually. We found an average of 910 (CI: 487-1 353) and 500 (CI: 250-760) dengue cases averted annually per million population in Mexico and Nicaragua, respectively, compared to control communities. The ICER in Mexico was US$29 618 (CI: 13 869-66 898) per DALY averted, or 3.0 times per capita GDP. For Nicaragua, the ICER was US$29 196 (CI: 14294-72181) per DALY averted, or 16.9 times per capita GDP. INTERPRETATION: Camino Verde, as implemented in the research context, was marginally cost-effective in Mexico, and not cost-effective in Nicaragua, from a healthcare sector perspective. Nicaragua's low per capita GDP and the use of grant-funded management personnel weakened the cost-effectiveness results. Achieving efficiencies by incorporating Camino Verde activities into existing public health programs would make Camino Verde cost-effective.


Assuntos
Medicina Comunitária/métodos , Dengue/prevenção & controle , Mosquitos Vetores , Aedes , Animais , Análise por Conglomerados , Análise Custo-Benefício , Dengue/economia , Dengue/epidemiologia , Vírus da Dengue , Humanos , México , Controle de Mosquitos , Nicarágua
10.
Lancet ; 395(10234): 1423-1433, 2020 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-32197105

RESUMO

BACKGROUND: A substantial unmet need remains for safe and effective vaccines against dengue virus disease, particularly for individuals who are dengue-naive and those younger than 9 years. We aimed to assess the efficacy, safety, and immunogenicity of a live attenuated tetravalent dengue vaccine (TAK-003) in healthy children aged 4-16 years. METHODS: We present data up to 18 months post-vaccination from an ongoing phase 3, randomised, double-blind trial of TAK-003 in endemic regions of Asia and Latin America (26 medical and research centres across Brazil, Colombia, Dominican Republic, Nicaragua, Panama, Philippines, Sri Lanka, and Thailand). Healthy children aged 4-16 years were randomly assigned 2:1 (stratified by age and region) to receive two doses of TAK-003 or two doses of placebo, 3 months apart. Investigators, participants and their parents or guardians, and sponsor representatives advising on trial conduct were masked to trial group assignments. Participants presenting with febrile illness were tested for virologically confirmed dengue (VCD) by serotype-specific RT-PCR. In timeframes beginning 30 days post-second dose, the primary endpoint (overall vaccine efficacy) was assessed in the first 11 months, and the secondary endpoints (efficacy by baseline serostatus, serotype, hospitalised dengue, and severe dengue) in the first 17 months. This study is registered with ClinicalTrials.gov, NCT02747927. FINDINGS: 20 099 participants were randomly assigned and vaccinated between Sept 7, 2016, and Aug 18, 2017; 19 021 (94·6%) were included in the per protocol analysis, and 20 071 (99·9%) in the safety set. The primary endpoint was achieved with an overall vaccine efficacy of 80·2% (95% CI 73·3 to 85·3; 61 cases of VCD in the TAK-003 group vs 149 cases of VCD in the placebo group). In the secondary endpoint assessment timeframe, an overall vaccine efficacy of 73·3% (95% CI 66·5 to 78·8) was observed. Analysis of secondary endpoints showed efficacies of 76·1% (95% CI 68·5 to 81·9) in individuals who were seropositive at baseline, 66·2% (49·1 to 77·5) in individuals who were seronegative at baseline, 90·4% (82·6 to 94·7) against hospitalised dengue, and 85·9% (31·9 to 97·1) against dengue haemorrhagic fever. Efficacy varied by individual serotypes (DENV 1, 69·8% [95% CI 54·8 to 79·9]; DENV 2, 95·1% [89·9 to 97·6]; DENV 3, 48·9% [27·2 to 64·1]; DENV 4, 51·0% [-69·4 to 85·8]). Cumulative rates of serious adverse events were similar in TAK-003 (4·0%) and placebo (4·8%) recipients, and were consistent with expected medical disorders in the study population. Infection was the most frequent reason leading to serious adverse events. 20 participants (<0·1% of the safety set) were withdrawn from the trial due to 21 adverse events by the end of part two; 14 of these participants received TAK-003 and six received placebo. INTERPRETATION: TAK-003 was well tolerated and efficacious against symptomatic dengue in children regardless of serostatus before immunisation. Vaccine efficacy varied by serotype, warranting continued follow-up to assess longer-term vaccine performance. FUNDING: Takeda Vaccines.


Assuntos
Vacinas contra Dengue/efeitos adversos , Vírus da Dengue/imunologia , Dengue/prevenção & controle , Vacinação/efeitos adversos , Adolescente , Brasil/epidemiologia , Criança , Pré-Escolar , Colômbia/epidemiologia , Vacinas contra Dengue/uso terapêutico , Vírus da Dengue/genética , República Dominicana/epidemiologia , Método Duplo-Cego , Hospitalização/estatística & dados numéricos , Humanos , Nicarágua/epidemiologia , Panamá/epidemiologia , Filipinas/epidemiologia , Placebos/administração & dosagem , Sorogrupo , Índice de Gravidade de Doença , Sri Lanka/epidemiologia , Tailândia/epidemiologia , Resultado do Tratamento , Vacinação/métodos
11.
Washington, D.C.; OPS; 2020-02-26.
em Espanhol | PAHO-IRIS | ID: phr-51888

RESUMO

El informe Seguridad social en Centroamérica y República Dominicana: situación actual y desafíos ofrece una descripción general de los principales regímenes vigentes en los sistemas y las instituciones de seguridad social de Centroamérica y el Caribe, realiza un análisis comparativo de esos regímenes, y presenta los desafíos regionales en materia de seguridad social, junto con las metas y los indicadores conexos para el decenio 2018-2028. Más allá de la diversidad en cuanto a la madurez y el desarrollo de los arreglos institucionales de seguridad social de la región, es posible distinguir una serie de desafíos comunes que pueden abordarse utilizando como marco de referencia la Estrategia para el acceso universal a la salud y la cobertura universal de salud de la Organización Panamericana de la Salud del 2014. Algunos de ellos se relacionan con temas estructurales que requieren importantes transformaciones en términos de rectoría y gobernanza —como la segmentación de los sistemas y la fragmentación de los servicios, la ampliación del número de contribuyentes y un financiamiento adecuado a las necesidades de la población— y otros con la prestación de los servicios de salud —un aspecto que requiere la transición a una atención integral y el fomento de la articulación de los distintos niveles de atención a través de redes integradas—. Para la elaboración de este documento se han consultado documentos oficiales de las instituciones de seguridad social de los países miembros del CISSCAD, la legislación vigente en los países y normas de cada institución, y se ha recurrido a bases de datos y publicaciones de organismos internacionales. Este informe está dirigido a profesionales, académicos y expertos del sector de la salud y la protección social interesados en la evolución de los sistemas de seguridad social en la Región de las Américas. Brinda información y análisis de datos que representan aportes técnicos útiles para debatir y formular propuestas de mejoras en los institutos de seguridad social de toda la Región.


Assuntos
Financiamento dos Sistemas de Saúde , Financiamento da Assistência à Saúde , Políticas, Planejamento e Administração em Saúde , Planos e Programas de Saúde , Previdência Social , Equidade no Acesso aos Serviços de Saúde , Cobertura Universal de Saúde , Belize , Costa Rica , El Salvador , Guatemala , Honduras , Nicarágua , Panamá , República Dominicana
12.
Am J Trop Med Hyg ; 102(2): 384-387, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31769390

RESUMO

Antimicrobial resistance (AMR) is a global public health crisis. Much of the burden of AMR in resource-limited settings remains unknown. This pilot study characterized clinical isolates of multidrug-resistant Gram-negative rods (MDR-GNRs) from Nicaragua. New Delhi metallo-ß-lactamase (NDM) carbapenemase genes were detected in 60% of isolates. Enterobacteriaceae had the highest rates of NDM detection, with 92% (50/54 isolates) positive by polymerase chain reaction (PCR). Pulsed-field gel electrophoresis (PFGE) analysis revealed patterns of clustering among isolates by two factors: plasmid profiles and year of culture. These findings of very high rates of NDM-carbapenemase genes in MDR-GNRs from hospitals throughout Nicaragua are alarming. Further research is needed to determine clinical and epidemiologic factors associated with multidrug-resistant isolates and to guide interventions to limit further spread.


Assuntos
Antibacterianos/farmacologia , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/genética , beta-Lactamases/genética , Farmacorresistência Bacteriana Múltipla/genética , Regulação Bacteriana da Expressão Gênica , Regulação Enzimológica da Expressão Gênica , Humanos , Nicarágua
13.
Am J Trop Med Hyg ; 102(1): 213-219, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31802728

RESUMO

Rotavirus is the leading cause of childhood deaths due to diarrhea. Although existing oral rotavirus vaccines are highly efficacious in high-income countries, these vaccines have been demonstrated to have decreased efficacy in low- and middle-income countries. A possible explanation for decreased efficacy is the impact of gut microbiota on the enteric immune system's response to vaccination. We analyzed the gut microbiome of 50 children enrolled in a prospective study evaluating response to oral pentavalent rotavirus vaccination (RV5) to assess associations between relative abundance of bacterial taxa and seroconversion following vaccination. Stool samples were taken before the first RV5 dose, and microbiome composition characterized using 16S rRNA amplicon sequencing and Quantitative Insights Into Microbial Ecology software. Relative abundance of bacterial taxa between seroconverters following the first RV5 dose, those with ≥ 4-fold increase in rotavirus-specific IgA titers, and nonseroconverters were compared using the Wilcoxon-Mann-Whitney test. We identified no significant differences in microbiome composition between infants who did and did not respond to vaccination. Infants who responded to vaccination tended to have higher abundance of Proteobacteria and Eggerthella, whereas those who did not respond had higher abundance of Fusobacteria and Enterobacteriaceae; however, these differences were not statistically significant following a multiple comparison correction. This study suggests a limited impact of gut microbial taxa on response to oral rotavirus vaccination among infants; however, additional research is needed to improve our understanding of the impact of gut microbiome on vaccine response, toward a goal of improving vaccine efficacy and rotavirus prevention.


Assuntos
Microbioma Gastrointestinal , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/imunologia , Bactérias/classificação , Fezes/microbiologia , Feminino , Humanos , Lactente , Masculino , Nicarágua/epidemiologia , Soroconversão
14.
Lancet Infect Dis ; 20(3): 371-380, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31870907

RESUMO

BACKGROUND: Paedeatric Zika remains an understudied topic. WHO and the Pan American Health Organization (PAHO) Zika case definitions have not been assessed in children. We aimed to characterise clinical profiles and evaluate the diagnostic performance of the WHO and PAHO case definitions in a large cohort of paediatric Zika cases. METHODS: From January, 2016 to February, 2017, encompassing the major 2016 Zika epidemic, participants in the Pediatric Dengue Cohort Study (PDCS) in Managua, Nicaragua, were encouraged to visit the study health centre at first indication of any illness. PDCS participants were aged 2-14 years, healthy at enrolment, and recruited before the initiation of the present study. Molecular and serological assays were used to test participants exhibiting any of four broad clinical profiles suspected of resulting from a symptomatic Zika virus infection. These clinical profiles were: fever and at least two of headache, retro-orbital pain, myalgia, arthralgia, rash, haemorrhagic manifestations, and leukopenia; fever and at least two of nausea or vomiting, rash, aches and pains, positive tourniquet test, leukopenia, and any dengue warning sign; undifferentiated fever without evident cause, with or without any other clinical finding; and afebrile rash with or without any other clinical finding. We characterised acute clinical findings (signs, symptoms, and complete blood counts) in both Zika cases and non-Zika cases. FINDINGS: We prospectively followed a cohort of about 3700 children, of which 1110 were deemed eligible for inclusion. Four participants with laboratory-confirmed Zika (three co-infections with dengue virus, one missing complete blood count data) and two participants who were non-Zika cases (missing complete blood count data) were excluded from analysis. We analysed 556 laboratory-confirmed Zika and 548 non-Zika cases. The WHO case definition captured 176 confirmed Zika cases, and the PAHO definition 109 confirmed Zika cases, who presented with the most clinical findings and a dengue-like clinical profile. The remaining two thirds of Zika cases, principally characterised by undifferentiated fever or afebrile rash, were missed. Among Zika cases, rash (n=440)-particularly generalised erythematous rash (n=334)-fever (n=333), leukopenia (n=217), and headache (n=203) were most common and peaked within 3 days of illness onset. The most common Zika presentation over the first week of illness was rash only (n=80). The sensitivity of Zika case definitions increased across paediatric age (from 11·3% to 56·1% for the WHO case definition and from 6·0% to 36·6% for the PAHO case definition), as the prevalence of most clinical findings (particularly arthralgia) increased with age, irrespective of previous dengue virus infection. Consequently, Zika manifested differently across paediatric age; older Zika cases presented with a dengue-like clinical profile while younger Zika cases presented with undifferentiated fever or afebrile rash. INTERPRETATION: We provide the most thorough description of paediatric Zika to date. Most paediatric Zika cases go undetected under the WHO and PAHO case definitions, suggesting that current standards for Zika case ascertainment require revision. Zika manifests with mild but differing clinical profiles across paediatric age, presenting major challenges to diagnosis, surveillance, and efforts to control future Zika epidemics. FUNDING: US National Institutes of Health.


Assuntos
Regras de Decisão Clínica , Infecção por Zika virus/patologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Técnicas de Diagnóstico Molecular , Nicarágua , Estudos Prospectivos , Sensibilidade e Especificidade , Testes Sorológicos , Infecção por Zika virus/diagnóstico
15.
Indoor Air ; 30(1): 24-30, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31539172

RESUMO

Household air pollution (HAP) is estimated to be an important risk factor for cardiovascular disease, but little clinical evidence exists and collecting biomarkers of disease risk is difficult in low-resource settings. Among 54 Nicaraguan women with woodburning cookstoves, we evaluated cross-sectional associations between 48-hour measures of HAP (eg, fine particulate matter, PM2.5 ) and C-reactive protein (CRP) via dried blood spots; secondary analyses included seven additional biomarkers of systemic injury and inflammation. We conducted sub-studies to calculate the intraclass correlation coefficient (ICC) in biomarkers collected over four consecutive days in Nicaragua and to assess the validity of measuring biomarkers in dried blood by calculating the correlation with paired venous-drawn samples in Colorado. Measures of HAP were associated with CRP (eg, a 25% increase in indoor PM2.5 was associated with a 7.4% increase in CRP [95% confidence interval: 0.7, 14.5]). Most of the variability in CRP concentrations over the 4-day period was between-person (ICC: 0.88), and CRP concentrations were highly correlated between paired dried blood and venous-drawn serum (Spearman ρ = .96). Results for secondary biomarkers were primarily consistent with null associations, and the sub-study ICCs and correlations were lower. Assessing CRP via dried blood spots provides a feasible approach to elucidate the association between HAP and cardiovascular disease risk.


Assuntos
Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Proteína C-Reativa/metabolismo , Exposição por Inalação/estatística & dados numéricos , Adulto , Poluição do Ar , Biomarcadores/sangue , Colorado , Culinária/métodos , Culinária/estatística & dados numéricos , Feminino , Humanos , Exposição por Inalação/análise , Pessoa de Meia-Idade , Nicarágua
16.
Washington, D.C.; OPS; 2019-12-17.
em Espanhol | PAHO-IRIS | ID: phr-51778

RESUMO

[Introducción]. La sífilis no endémica es una enfermedad de transmisión sexual que se cura fácilmente con penicilina benzatínica, pero que puede acarrear graves complicaciones si no se trata adecuadamente. Las embarazadas con sífilis no tratada pueden transmitir esta infección al feto. Esto se conoce como sífilis congénita y puede provocar abortos, muertes fetales y neonatales, peso bajo al nacer, prematuridad y otras anomalías congénitas. En las Américas, la sífilis en embarazadas y la sífilis congénita siguen en aumento. Además, la sífilis afecta especialmente a grupos de población clave, como los hombres que tienen relaciones sexuales con hombres (HSH), las mujeres trans y las trabajadoras sexuales (MTS). A pesar de la alta carga de sífilis, en las Américas la disponibilidad de datos a nivel nacional es limitada. Esta hoja informativa es un primer intento de aunar la información disponible en un análisis consolidado sobre la sífilis en los países de la Región. Prevalencia de la sífilis en adultos: Nicaragua recoge rutinariamente datos de prevalencia de la sífilis en embarazadas, MTS, y HSH. La figura 1 presenta los datos de prevalencia de 2008 a 2018, incluyendo las tendencias en embarazadas, MTS y HSH (líneas continuas) obtenidas a partir de Spectrum ITS2. Las estimaciones sugieren que la prevalencia de sífilis en los HSH y en las embarazadas ha disminuido ligeramente hasta un 2,72% y un 0,02%, espectivamente. Sin embargo, la prevalencia en MTS se ha incrementado hasta el 3,66%. Es importante destacar que la escasez y dispersion de los datos puede limitar la precisión de las estimaciones...


Assuntos
Sífilis , Sífilis Congênita , Doenças Transmissíveis , Indicadores Básicos de Saúde , Gestantes , Incidência , Dados Demográficos , América , Nicarágua
17.
PLoS Negl Trop Dis ; 13(12): e0007978, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31877200

RESUMO

The 2015-2017 epidemics of Zika virus (ZIKV) in the Americas caused widespread infection, followed by protective immunity. The timing and burden of the next Zika virus outbreak remains unclear. We used an agent-based model to simulate the dynamics of age-specific immunity to ZIKV, and predict the future age-specific risk using data from Managua, Nicaragua. We also investigated the potential impact of a ZIKV vaccine. Assuming lifelong immunity, the risk of a ZIKV outbreak will remain low until 2035 and rise above 50% in 2047. The imbalance in age-specific immunity implies that people in the 15-29 age range will be at highest risk of infection during the next ZIKV outbreak, increasing the expected number of congenital abnormalities. ZIKV vaccine development and licensure are urgent to attain the maximum benefit in reducing the population-level risk of infection and the risk of adverse congenital outcomes. This urgency increases if immunity is not lifelong.


Assuntos
Fatores Etários , Efeitos Psicossociais da Doença , Surtos de Doenças , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/imunologia , Zika virus/imunologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Simulação por Computador , Feminino , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Nicarágua/epidemiologia , Vacinas Virais/administração & dosagem , Vacinas Virais/imunologia , Adulto Jovem , Infecção por Zika virus/prevenção & controle
18.
J Int AIDS Soc ; 22(12): e25429, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31860167

RESUMO

INTRODUCTION: A nationally representative HIV drug resistance (HIVDR) survey in Nicaragua was conducted to estimate the prevalence of pretreatment HIVDR (PDR) among antiretroviral therapy (ART) initiators and acquired HIVDR among people living with HIV (PLHIV) who had received ART for 12 ± 3 months (ADR12) and ≥48 months (ADR48). METHODS: A nationwide cross-sectional survey with a two-stage cluster sampling was conducted from March to November 2016. Nineteen of 45 total ART clinics representing >90% of the national cohort of adults on ART were included. ART initiators were defined as PLHIV initiating or reinitiating first-line ART. HIVDR was assessed for protease, reverse transcriptase and integrase Sanger sequences using the Stanford HIVdb algorithm. Viral load (VL) suppression was defined as <1000 copies/mL. Results were weighted according to the survey design. RESULTS AND DISCUSSION: A total of 638 participants were enrolled (PDR: 171; ADR12: 114; ADR48: 353). The proportion of ART initiators with prior exposure to antiretrovirals (ARVs) was 12.3% (95% CI: 5.8% to 24.3%). PDR prevalence to any drug was 23.4% (95% CI: 14.4% to 35.6%), and 19.3% (95% CI: 12.2% to 29.1%) to non-nucleoside reverse transcriptase inhibitors (NNRTI). NNRTI PDR was higher in ART initiators with previous ARV exposure compared with those with no exposure (76.2% vs. 11.0%, p < 0.001). Protease inhibitors (PI) and integrase strand transfer inhibitors PDR was not observed. VL suppression rate was 77.8% (95% CI: 67.1% to 85.8%) in ADR12 and 70.3% (95% CI: 66.7% to 73.8%) in ADR48. ADR12 prevalence to any drug among PLHIV without VL suppression was 85.1% (95% CI: 66.1% to 94.4%), 82.4% to NNRTI and 70.2% to nucleoside reverse transcriptase inhibitors (NRTI). ADR48 prevalence to any drug among PLHIV without VL suppression was 75.5% (95% CI: 63.5% to 84.5 %), 70.7% to NNRTI, 59.4% to NRTI and 4.6% to PI. CONCLUSIONS: Despite implementation challenges yielding low-precision HIVDR estimates, high rates of NNRTI PDR were observed in Nicaragua, suggesting consideration of non-NNRTI-based first-line regimens for ART initiators. Strengthened HIVDR monitoring, systematic VL testing, and improved ART adherence support are also warranted.


Assuntos
Fármacos Anti-HIV/farmacologia , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , Adulto , Estudos de Coortes , Estudos Transversais , Farmacorresistência Viral , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Nicarágua/epidemiologia , Prevalência , Inquéritos e Questionários , Carga Viral , Adulto Jovem
19.
Zootaxa ; 4638(3): zootaxa.4638.3.2, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31712466

RESUMO

The Hydroscaphidae ("skiff beetles") is a family of minute aquatic beetles within the suborder Myxophaga comprising four genera: Hydroscapha Le Conte, 1874; Scaphydra Reichardt, 1973; Yara Reichardt Hinton, 1976 and Confossa Short et al., 2015. All genera are found within the Neotropical region, with the exception of Hydroscapha, which is widespread. Representatives of this family have been reported for Venezuela, Brazil, Panama (Short et al. 2015) and Nicaragua (Raudez et al. 2019).


Assuntos
Besouros , Animais , Brasil , Nicarágua , Panamá , Peru , Venezuela
20.
Zootaxa ; 4675(1): zootaxa.4675.1.1, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31715982

RESUMO

The Amazon rainforest is the world's most extensive tropical rainforest, holding a considerable ecological and taxonomic diversity. Speciation in this region arises from multiple factors, such as topography, climate fluctuations, oceanic transgression, vegetation and the delimitation of zones circumscribed by sub-basins within the greater Amazon basin. Different scenarios have been proposed to better understand the diversification of Amazonian taxa, whether by Pleistocene refugia or by areas of endemism.                The genus Scaria is distributed mostly in Amazonia, with a single species that ranges from the Tumbes-Chocó-Magdalena ecoregion well into Central America all the way to southern Nicaragua. Eight species are currently recognized, with three additional described here as new: Scaria rafaeli sp. nov., S. jonasi sp. nov. and S. granti sp. nov., and the status of S. laeta stat. resurr. is revalidated. Two new combinations are established: S. verutum comb. nov. (formerly placed in Rehnidium Grant, 1956) and Batrachidea brevis comb. nov. (formerly placed in Scaria). New synonym is proposed: Batrachidea brevis (Hancock, 1909) = Batrachidea inermis Hebard, 1923 syn. nov. Lectotypes and paralectotypes were selected for S. laeta, S. maculata and S. lineata, as well as the neotypes for S. hamata and S. boliviana. An updated key to species of Scaria is also provided.                A cladistic analysis for 15 species was performed (12 in the inner group and 3 in the outer group) with 40 morphological characters, confirming the monophyly of Scaria. A biogeographical analysis of dispersion-vicariance indicates that the origin of the genus was probably in the Inambari endemism center as the only reconstruction of the resulting ancestral distribution, five dispersions and three vicariance events being postulated. These suggest that both types of events are equally important in the current configuration of the distribution in Scaria. Vicariance events arise mostly by isolation of the species because of the uplift of the Andes and the dispersion events comprise four waves originating from the ancestral range into central and east Amazonia.


Assuntos
Ortópteros , Distribuição Animal , Animais , Brasil , América Central , Nicarágua
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