Norovirus RNA in serum associated with increased fecal viral load in children: Detection, quantification and molecular analysis.

Worldwide, norovirus (NoV) is a major cause of acute gastroenteritis (AGE) responsible for pandemics every ~3 years, and over 200,000 deaths per year, with the majority in children from developing countries. We investigate the incidence of NoV in children hospitalized with AGE from Belém, Pará, Brazil, and also correlated viral RNA levels in their blood and stool with clinical severity. For this purpose, paired stool and serum samples were collected from 445 pediatric patients, ≤9 years between March 2012 and June 2015. Enzyme-linked immunosorbent assay (EIA) was used to detect NoV in stool and reverse transcription quantitative PCR (RT-qPCR) used to quantify NoV RNA levels in sera (RNAemia) and in the positive stool. Positives samples were characterized by the partial ORF1/2 region sequence of viral genome. NoV antigen was detected in 24.3% (108/445) of stool samples, with RNAemia also present in 20.4% (22/108). RNAemia and a high stool viral load (>107 genome copies/gram of faeces) were associated with longer hospitalizations. The prevalent genotypes were GII.4 Sydney_2012 (71.6%-58/81) and New Orleans_2009 (6.2%-5/81) variants. Eight other genotypes belonging to GII were detected and four of them were recombinant strains. All sera were characterized as GII.4 and shared 100% similarity with their stool. The results suggest that the dissemination of NoV to the blood stream is not uncommon and may be related to increased faecal viral loads and disease severity.

Neurophobia in Brazil: Detecting and Preventing a Global Issue / Neurofobia no Brasil: Detectando e Prevenindo um Problema Global

ABSTRACT Neurophobia is a global issue known as a fear of Neurology and Neurosciences by medical students and physicians, and it may contribute to a reduced number of trained neurologists and a global misunderstanding of neurological diseases among physicians. To date, there are no studies that address the issue of Neurophobia in Brazil. The present study aimed to evaluate the perception of Neurology and Neurosciences among Brazilian medical students. Students from four medical schools in the state of Pará, in the second (pre-clinical phase), fourth (clinical phase) and sixth (internship) years of the course, were submitted to a self-administered and written questionnaire divided into two sections: the first section included questions assessing their perceived level of interest, level of knowledge, degree of difficulty, confidence in examining patients, quality of teaching in medical school and likelihood of pursuing the career, concerning different clinical specialties (Cardiology, Endocrinology, Gastroenterology, Nephrology, Neurology, Respiratory Medicine and Rheumatology). In the second section, there were questions about possible reasons why Neurology was perceived as a difficult subject and possible ways to improve neurological education. A total of 486 questionnaires were completed. Neurology was perceived as the most difficult clinical specialty (mean score 4.00; p < 0.001), in which students feel least confident about conducting physical examinations (mean score 2.97; p < 0.001), and with the worst quality of teaching (mean score 3.12; p < 0.001). The main cause of Neurophobia was the need to know neuroanatomy and neurophysiology (very important reason for 39.4% of students), and the most frequently suggested method to improve neurological education was through more and better bedside tutorials (very important factor — 53.3%). Students developing extracurricular activities, women and older students had more unfavorable opinions about Neurology. Neurophobia is also present in Brazil, and new educational approaches must be proposed to improve the misperception of Neurology by medical students. The Medical Education Commission of the Brazilian Academy of Neurology should propose guidelines on Neurology teaching at undergraduate level.

RESUMO A Neurofobia é um problema global conhecido como uma aversão à Neurologia e às Neurociências por parte de estudantes de Medicina e médicos, podendo contribuir para que se forme um número reduzido de neurologistas e que haja um desconhecimento global sobre manejo de doenças neurológicas entre médicos. Até o momento, não existem estudos sobre Neurofobia no Brasil. O objetivo do presente estudo foi avaliar a percepção de Neurologia e Neurociências entre estudantes de Medicina no Brasil. Estudantes de quatro escolas médicas no Estado do Pará, matriculados no segundo ano (fase pré-clínica), quarto ano (fase clínica) e sexto ano (internato), responderam a um questionário autoaplicado, dividido em duas partes: a primeira incluiu perguntas sobre o nível de interesse, nível de conhecimento, grau de dificuldade, confiança ao examinar pacientes, qualidade das aulas no curso médico e probabilidade de seguir carreira, envolvendo diferentes especialidades clínicas (Cardiologia, Endocrinologia, Gastroenterologia, Nefrologia, Neurologia, Pneumologia e Reumatologia). Na segunda parte, foram feitas perguntas sobre possíveis razões para a Neurologia ser vista como uma disciplina difícil e sobre possíveis maneiras de melhorar a educação neurológica. Foram preenchidos 486 questionários. A Neurologia foi percebida como a disciplina mais difícil (pontuação média 4.00; p < 0.001), em que há menos confiança no exame físico (pontuação média 2.97; p < 0.001) e a de pior qualidade de aulas (pontuação média 3.12; p < 0.001). O principal motivo da Neurofobia foi a necessidade de saber Neuroanatomia e Neurofisiologia (razão muito importante para 39,4% dos estudantes), e a sugestão mais importante para melhorar a educação neurológica foi aumentar a quantidade e a qualidade das aulas práticas (fator muito importante — 53,3%). Estudantes envolvidos em atividades extracurriculares, do sexo feminino e mais velhos têm opiniões mais desfavoráveis a respeito da Neurologia. A Neurofobia está também presente no Brasil, e novas abordagens educacionais devem ser propostas para melhora da atual percepção desfavorável da Neurologia por estudantes de Medicina. Sugerimos que a Comissão de Educação Médica da Academia Brasileira de Neurologia proponha diretrizes para o ensino de Neurologia na graduação.