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Oliveira DMDS, de Barros Miranda-Filho D, de Alencar Ximenes RA, Montarroyos UR, Brickley EB, Pinto MHT, Martelli CMT, Ramos RC, de Araújo TVB, Eickmann SH, da Silva PFS, Carvalho MDCG, de Sousa Martins OS, Dos Santos ACO. Feeding characteristics and growth among children with prenatal exposure to Zika virus with and without microcephaly in the microcephaly epidemic research group pediatric cohort. BMC Pediatr 2024; 24:286. [PMID: 38685089 PMCID: PMC11057065 DOI: 10.1186/s12887-024-04728-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE To describe the feeding characteristics and growth of children with prenatal exposure to Zika virus (ZIKV) from birth to 48 months. DESIGN Using data from the prospective Microcephaly Epidemic Research Group Pediatric Cohort (MERG-PC), children without microcephaly born to mothers with evidence of ZIKV infection during pregnancy (ZIKV-exposed children without microcephaly) and children with Zika-related microcephaly were compared using repeated cross-sectional analyses within the following age strata: birth; 1 to 12; 13 to 24; 25 to 36; and 37 to 48 months. The groups were compared in relation to prematurity, birth weight, breastfeeding, alternative feeding routes, dysphagia and anthropometric profiles based on the World Health Organization Anthro z-scores (weight-length/height, weight-age, length/height-age and BMI-age). RESULTS The first assessment included 248 children, 77 (31.05%) with microcephaly and 171 (68.95%) without microcephaly. The final assessment was performed on 86 children. Prematurity was 2.35 times higher and low birth weight was 3.49 times higher in children with microcephaly. The frequency of breastfeeding was high (> 80%) in both groups. On discharge from the maternity hospital, the frequency of children requiring alternative feeding route in both groups was less than 5%. After 12 months of age, children with microcephaly required alternative feeding route more often than children without microcephaly. In children with microcephaly, the z-score of all growth indicators was lower than in children without microcephaly. CONCLUSIONS Children with Zika-related microcephaly were more frequently premature and low birth weight and remained with nutritional parameters, i.e., weight-for-age, weight-for-length/height and length/height-for-age below those of the children without microcephaly.
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Affiliation(s)
- Danielle Maria da Silva Oliveira
- Speech Terapist and Epidemiologist Universidade de Pernambuco Santo Amaro- Recife- Pernambuco, Street Arnóbio Marques, Recife, 31050100-130, Brazil.
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Leite KME, Lima KO, Ximenes RADA, de Albuquerque MDFM, Miranda-Filho DDB, Godoi ETAM, Montarroyos UR, Lacerda HR. Survival and mortality profile among people living with HIV in a cohort in the Northeastern region of Brazil. Rev Inst Med Trop Sao Paulo 2024; 66:e23. [PMID: 38656039 PMCID: PMC11027485 DOI: 10.1590/s1678-9946202466023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/29/2024] [Indexed: 04/26/2024] Open
Abstract
Conditions related to the acquired immune deficiency syndrome (AIDS) are still a significant cause of morbidity and mortality among people living with HIV (PLHIV). Longer survival in this population were reported to increase the risk of developing noncommunicable chronic diseases (NCDs). This study aimed to estimate the survival and causes of death according to age group and sex among PLHIV monitored at two referral centers in the Northeastern Brazil. This is a prospective, retrospective cohort with death records from 2007 to 2018, based on a database that registers causes of death using the International Classification of Disease (ICD-10), which were subsequently coded following the Coding Causes of Death in HIV (CoDe). A total of 2,359 PLHIV participated in the study, with 63.2% being men, with a follow-up period of 13.9 years. Annual mortality rate was 1.46 deaths per 100 PLHIV (95% CI: 1.33 - 1.60) with a frequency of 20.9%. Risk of death for men increased by 49% when compared to women, and the risk of death in PLHIV increased by 51% among those aged 50 years and over at the time of diagnosis. It was observed that 73.5% accounted for AIDS-related deaths, 6.9% for non-AIDS defining cancer, 6.3% for external causes, and 3.2% for cardiovascular diseases. Among the youngest, 97.2% presented an AIDS-related cause of death. Highest frequency of deaths from neoplasms was among women and from external causes among men. There is a need for health services to implement strategies ensuring greater adherence to treatment, especially among men and young people. Moreover, screening for chronic diseases and cancer is essential, including the establishment of easily accessible multidisciplinary care centers that can identify and address habits such as illicit drug use and alcoholism, which are associated with violent deaths.
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Affiliation(s)
| | - Kledoaldo Oliveira Lima
- Universidade Federal de Pernambuco, Hospital das Clínicas, Recife, Pernambuco, Brazil
- European Virus Bioinformatics Center, Jena, Germany
- Instituto de Medicina Integral Prof. Fernando Figueira, Faculdade Pernambucana de Saúde, Recife, Pernambuco, Brazil
| | - Ricardo Arraes de Alencar Ximenes
- Universidade Federal de Pernambuco, Pós-Graduação em Medicina Tropical, Recife, Pernambuco, Brazil
- Universidade de Pernambuco, Pós-Graduação em Ciências da Saúde, Recife, Pernambuco, Brazil
| | | | | | | | | | - Heloísa Ramos Lacerda
- Universidade Federal de Pernambuco, Pós-Graduação em Medicina Tropical, Recife, Pernambuco, Brazil
- Universidade de Pernambuco, Pós-Graduação em Ciências da Saúde, Recife, Pernambuco, Brazil
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Brandão Marquis V, de Oliveira Melo A, Pradella-Hallinan M, de Vasconcelos Ataíde G, Ramos Amorim MM, de Barros Miranda-Filho D, Arraes de Alencar Ximenes R. Sleep in children from northeastern Brazil with congenital Zika syndrome: assessment using polysomnography. J Clin Sleep Med 2023; 19:1759-1767. [PMID: 37259896 PMCID: PMC10545994 DOI: 10.5664/jcsm.10674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/02/2023]
Abstract
STUDY OBJECTIVES We performed this study to describe the characteristics of sleep in children with congenital Zika syndrome through polysomnographic assessment. METHODS Polysomnography with neurological setup and capnography was performed. Respiratory events were scored according to American Academy of Sleep Medicine criteria. Children were classified based on neuroclinical examination as having corticospinal plus neuromuscular abnormalities or exclusively corticospinal abnormalities. Neuroradiological classification was based on imaging exams, with children classed as having supratentorial plus infratentorial abnormalities or exclusively supratentorial abnormalities. RESULTS Of 65 children diagnosed with congenital Zika syndrome, sleep apnea was present in 23 children (35.4%), desaturation in 26 (40%), and snoring in 13 (20%). The most prevalent apnea type was central in 15 children (65.2%), followed by obstructive apnea in 5 (21.7%) and mixed type in 3 (13%). The average of the lowest saturation recorded was slightly below normal (89.1 ± 4.9%) and the mean partial pressure of end-tidal carbon dioxide value was normal. Periodic leg movements were present in 48 of 65 children. Lower ferritin levels were observed in 84.6% of children. Palatine and pharyngeal tonsils (adenoids) were small in most children and not associated with the presence of obstructive apnea. Ventriculomegaly and subcortical and nucleus calcification were the most frequent neuroimaging findings. Supratentorial and infratentorial anomalies were present in 26.7% (16 of 60) and exclusively supratentorial changes in 73.3% (44 of 60). In the neuroclinical classification, isolated corticospinal changes were more frequent and the mean peak in capnography was lower in this group. There was no difference regarding the presence of apnea for children in the neuroclinical and neuroradiological classification groups. CONCLUSIONS Sleep disorders were frequent in children with congenital Zika syndrome, with central sleep apnea being the main finding. CITATION Brandão Marquis V, de Oliveira Melo A, Pradella-Hallinan M, et al. Sleep in children from northeastern Brazil with congenital Zika syndrome: assessment using polysomnography. J Clin Sleep Med. 2023;19(10):1759-1767.
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Affiliation(s)
- Valéria Brandão Marquis
- Federal University of Campina Grande, Campina Grande, Paraíba, Brazil
- Professor Joaquim Amorim Neto Research Institute, Campina Grande, Paraíba, Brazil
| | - Adriana de Oliveira Melo
- Federal University of Campina Grande, Campina Grande, Paraíba, Brazil
- Professor Joaquim Amorim Neto Research Institute, Campina Grande, Paraíba, Brazil
| | | | | | - Melânia Maria Ramos Amorim
- Federal University of Campina Grande, Campina Grande, Paraíba, Brazil
- Professor Joaquim Amorim Neto Research Institute, Campina Grande, Paraíba, Brazil
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de Melo Araujo AC, da Silva Aragão J, de Souza WV, Rodrigues LC, de Barros Miranda-Filho D. The impact of implementing the 10-valent pneumococcal conjugate vaccine on hospitalizations for pneumonia among children. Vaccine 2023:S0264-410X(23)00724-7. [PMID: 37353456 DOI: 10.1016/j.vaccine.2023.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/19/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023]
Abstract
Pneumonia is a major cause of morbidity and mortality in children, with pneumococcus as the main etiologic agent. In Brazil, the 10-valent pneumococcal conjugate vaccine (PCV-10) was introduced into the childhood immunization schedule in 2010. The aim of this study was to assess the impact caused by implementing PCV-10 on the hospitalizations of children with pneumonia, between 2005 and 2015, in the state of Pernambuco, Brazil. An ecological time series study and a forecasting analysis were conducted. A comparison was made between the hospitalizations of children aged between seven months and four years due to pneumonia in the Brazilian Unified Health System, in the 5 years before (2005-2009) and after (2011-2015) implementation of PCV-10. Descriptive analysis included absolute and relative values, means and rates of hospitalization. The chi-square test was used to compare the annual incidence of hospitalizations and the t-Student test to compare the five-year mean values. For the temporal modeling of hospitalizations, an autoregressive integrated moving average was used, adjusted with seasonal-SARIMA (Box-Jenkins methodology), with a prediction of the monthly number of hospitalizations for 2011-2015. The predicted and observed values for 2011-2015 were then compared. The number of hospitalizations after implementing PCV-10 was reduced by 24.5 %. The monthly average of hospitalizations dropped from 681 (2005-2009) to 514 (2011-2015). The hospitalization rate dropped from 56.1 per thousand live births in the five-year period prior to PCV-10 to 43.4 in the following five-year period (a 22.7% reduction). Comparing the values predicted by the SARIMA model for a scenario without PCV-10 in the second five-year period, with those reported after implementing PCV-10, the estimated number of prevented hospitalizations was 8,682 in the five years following the introduction of the vaccine. In conclusion, in the five years following implementation of PCV-10, hospitalizations of children with pneumonia in Pernambuco decrease by 22%.
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Affiliation(s)
- Ana Catarina de Melo Araujo
- Programa Associado de Pós-Graduação em Enfermagem UPE/UEPB, Universidade de Pernambuco (UPE), Av. Agamenon Magalhães, s/n, Santo Amaro, Recife, PE 50100-010, Brazil.
| | - Jamilly da Silva Aragão
- Programa Associado de Pós-Graduação em Enfermagem UPE/UEPB, Universidade de Pernambuco (UPE), Av. Agamenon Magalhães, s/n, Santo Amaro, Recife, PE 50100-010, Brazil
| | - Wayner Vieira de Souza
- Programa de Pós-Graduação em Saúde Pública, Instituto Aggeu Magalhães, Fiocruz Pernambuco, Av. Professor Moraes Rego, s/n, Cidade Universitária, Recife, PE 50740-465, Brazil
| | - Laura Cunha Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
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Ximenes RADA, Miranda-Filho DDB, Martinez-Espinoza FE, Brasil P. Still on the Brazilian Response to the Microcephaly Epidemic: A Meta-analysis of 1,548 Pregnant Women from 13 Cohorts to Evaluate the Risk of Adverse Outcomes. Rev Bras Ginecol Obstet 2023; 45:169-170. [PMID: 37224837 PMCID: PMC10208725 DOI: 10.1055/s-0043-1769107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Arraes de Alencar Ximenes R, de Barros Miranda-Filho D, Brickley EB, Barreto de Araújo TV, Montarroyos UR, Abtibol-Bernardino MR, Mussi-Pinhata MM, Duarte G, Coutinho CM, Biason de Moura Negrini SF, Alecrim MDGC, Albuquerque de Almeida Peixoto LDF, Lopes Moreira ME, Zin A, Pereira Júnior JP, Nielsen-Saines K, Turchi Martelli CM, Rodrigues LC, Vieira de Souza W, Ventura LO, Silva de Oliveira C, de Matos H, Furtado Serra EM, Souza Gomes LT, Nogueira ML, Estofolete C, Vaz-Oliani DC, Passos SD, Moron A, Duarte Rodrigues MM, Pereira Sarmento SG, Turchi MD, Pela Rosado LE, de Sene Amâncio Zara AL, Franco Gomes MB, Schuler-Faccini L, Herrero-Silva J, Amorim MM, Melo AO, Ledo Alves da Cunha AJ, Prata-Barbosa A, Amim J, Rezende-Filho J, Calcagno JI, Júnior Alcântara LC, Lima de Almeida B, Hofer CB, Machado ES, de Siqueira IC, Martinez-Espinosa FE, Brasil P. Risk of adverse outcomes in offspring with RT-PCR confirmed prenatal Zika virus exposure: An individual participant data meta-analysis of 13 cohorts in the Zika Brazilian Cohorts Consortium. Lancet Reg Health Am 2023; 17:100395. [PMID: 36714276 PMCID: PMC9880800 DOI: 10.1016/j.lana.2022.100395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Knowledge regarding the risks associated with Zika virus (ZIKV) infections in pregnancy has relied on individual studies with relatively small sample sizes and variable risk estimates of adverse outcomes, or on surveillance or routinely collected data. Using data from the Zika Brazilian Cohorts Consortium, this study aims, to estimate the risk of adverse outcomes among offspring of women with RT-PCR-confirmed ZIKV infection during pregnancy and to explore heterogeneity between studies. Methods We performed an individual participant data meta-analysis of the offspring of 1548 pregnant women from 13 studies, using one and two-stage meta-analyses to estimate the absolute risks. Findings Of the 1548 ZIKV-exposed pregnancies, the risk of miscarriage was 0.9%, while the risk of stillbirth was 0.3%. Among the pregnancies with liveborn children, the risk of prematurity was 10,5%, the risk of low birth weight was 7.7, and the risk of small for gestational age (SGA) was 16.2%. For other abnormalities, the absolute risks were: 2.6% for microcephaly at birth or first evaluation, 4.0% for microcephaly at any time during follow-up, 7.9% for neuroimaging abnormalities, 18.7% for functional neurological abnormalities, 4.0% for ophthalmic abnormalities, 6.4% for auditory abnormalities, 0.6% for arthrogryposis, and 1.5% for dysphagia. This risk was similar in all sites studied and in different socioeconomic conditions, indicating that there are not likely to be other factors modifying this association. Interpretation This study based on prospectively collected data generates the most robust evidence to date on the risks of congenital ZIKV infections over the early life course. Overall, approximately one-third of liveborn children with prenatal ZIKV exposure presented with at least one abnormality compatible with congenital infection, while the risk to present with at least two abnormalities in combination was less than 1.0%.
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Affiliation(s)
- Ricardo Arraes de Alencar Ximenes
- Postgraduate Program in Tropical Medicine, Federal University of Pernambuco, Recife, PE, Brazil,Post-Graduation in Health Sciences, University of Pernambuco, Recife, PE, Brazil,Corresponding author. Professional address: Postgraduate Program in Tropical Medicine, Federal University of Pernambuco, Av. Prof. Moraes Rego, s/n., Cidade Universitária, Recife, PE 50670-901, Brazil; University of Pernambuco, Rua Arnóbio Marques, n. 310, Santo Amaro, Recife, PE 50100-130, Brazil.
| | | | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Marília Rosa Abtibol-Bernardino
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus, AM, Brazil,Postgraduate Program in Tropical Medicine, Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | | | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, Ribeirão Preto, SP, Brazil
| | - Conrado Milani Coutinho
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, Ribeirão Preto, SP, Brazil
| | | | - Maria das Graças Costa Alecrim
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus, AM, Brazil,Postgraduate Program in Tropical Medicine, Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Lucíola de Fátima Albuquerque de Almeida Peixoto
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus, AM, Brazil,Postgraduate Program in Tropical Medicine, Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | | | - Andrea Zin
- Clinical Research Unit, Instituto Fernandes Figueira, Oswaldo Cruz Foundation, Fiocruz, Rio de Janeiro, RJ, Brazil
| | | | - Karin Nielsen-Saines
- Department of Pediatrics, David Geffen University of California at Los Angeles School of Medicine, LA, United States
| | | | - Laura Cunha Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Liana O. Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, PE, Brazil,Pernambuco Eyes Hospital, Recife, PE, Brazil
| | | | - Haroldo de Matos
- Department of Epidemiology, Evandro Chagas Institute, Ananindeua, PA, Brazil
| | | | - Luna Thais Souza Gomes
- Department of Arbovirology and Hemorrhagic Fever, Evandro Chagas Institute, Ananindeua, PA, Brazil
| | - Maurício L. Nogueira
- Department of Infectious Disease, Medicine School of São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Cassia Estofolete
- Department of Infectious Disease, Medicine School of São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Denise Cristina Vaz-Oliani
- Department of Gynecology and Obstetrics, Medicine School of São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Saulo Duarte Passos
- Infectious Pediatric Laboratory, Medicine School of Jundiaí, Jundiaí, SP, Brazil
| | - Antonio Moron
- Department of Fetal Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Marília Dalva Turchi
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, GO, Brazil
| | | | | | | | - Lavínia Schuler-Faccini
- Departamento de Genética, Hospital das Clinicas de Porto Alegre, Universidade Federal do Rio Grandedo Sul, Porto Alegre, RS, Brazil
| | - Juliana Herrero-Silva
- City Hall of Tangará da Serra, Municipal Health Department, Tangará da Serra, MT, Brazil
| | - Melania M. Amorim
- Medical Academic Unit, Federal University of Campina Grande, Campina Grande, PB, Brazil
| | - Adriana Oliveira Melo
- Medical Academic Unit, Federal University of Campina Grande, Campina Grande, PB, Brazil
| | | | - Arnaldo Prata-Barbosa
- Department of Pediatrics, D’Or Institute for Research & Education, Rio de Janeiro, RJ, Brazil
| | - Joffre Amim
- Department of Obstectrics, Federal University of Rio de Janeiro Maternity School, Rio de Janeiro, RJ, Brazil
| | - Jorge Rezende-Filho
- Department of Obstectrics, Federal University of Rio de Janeiro Maternity School, Rio de Janeiro, RJ, Brazil
| | - Juan Ignacio Calcagno
- Reference Maternity Prof. José Maria de Magalhães Netto, Bahia Health Department, Salvador, BA, Brazil
| | | | | | - Cristina Barroso Hofer
- Department of Infecitous Diseases, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Elizabeth S. Machado
- Department of Infecitous Diseases, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Flor Ernestina Martinez-Espinosa
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus, AM, Brazil,Postgraduate Program in Tropical Medicine, Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil,Leonidas and Maria Deane Institute, Fiocruz, Manaus, AM, Brazil
| | - Patrícia Brasil
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation, Fiocruz, Rio de Janeiro, Brazil
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de Vasconcelos RAL, Ximenes RADA, Calado AA, Martelli CMT, Veras Gonçalves A, Brickley EB, de Araújo TVB, Wanderley Rocha MA, Miranda-Filho DDB. Zika-Related Microcephaly and Its Repercussions for the Urinary Tract: Clinical, Urodynamic, Scintigraphic and Radiological Aspects. Viruses 2022; 14:v14071512. [PMID: 35891492 PMCID: PMC9320115 DOI: 10.3390/v14071512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 02/04/2023] Open
Abstract
Aims: Describing the urodynamic parameters of children aged 3 to 5 years with microcephaly related to congenital Zika syndrome and verifying the association with clinical, imaging and neurological characteristics. Methods: From October 2018 to March 2020, children with Zika-related microcephaly underwent urological, ultrasonographic and urodynamic evaluation. In selected cases, complementary exams such as urethrocystography and scintigraphy were performed. The children also underwent a complete neurological evaluation. To compare frequency between groups, we used Pearson’s chi-squared test or Fisher’s exact test. Results: This study evaluated 40 children, of whom 85% were 4 years old, and all had abnormalities on the urodynamic study, with low bladder capacity (92.5%) and detrusor overactivity (77.5%) as the most frequent findings. Only three children had ultrasound abnormalities, but no child had cystographic or scintigraphic abnormalities, and the postvoid residual volume was normal in 80% of cases. In spite of a frequency of 67.5% of intestinal constipation, there was no record of febrile urinary tract infection after the first year of life. All children presented severe microcephaly and at least one neurological abnormality in addition to microcephaly. The homogeneity of the children in relation to microcephaly severity and neurological abnormalities limited the study of the association with the urodynamic parameters. Conclusions: Urodynamic abnormalities in children aged 3 to 5 years with Zika-related microcephaly do not seem to characterize a neurogenic bladder with immediate risks for the upper urinary tract. The satisfactory bladder emptying suggests that the voiding pattern is reflex.
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Affiliation(s)
- Rômulo Augusto Lucena de Vasconcelos
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
- Correspondence: (R.A.L.d.V.); (D.d.B.M.-F.); Tel./Fax: +558131833510 (R.A.L.d.V. & D.d.B.M.-F.)
| | - Ricardo Arraes de Alencar Ximenes
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
- Departamento de Medicina Social, Universidade Federal de Pernambuco, Recife 50670-901, Brazil;
| | - Adriano Almeida Calado
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
| | | | - Andreia Veras Gonçalves
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
- Departamento de Medicina Social, Universidade Federal de Pernambuco, Recife 50670-901, Brazil;
| | - Elizabeth Bailey Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | | | - Maria Angela Wanderley Rocha
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
| | - Demócrito de Barros Miranda-Filho
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Rua Arnóbio Marques, 310, Santo Amaro, Recife 50100-130, Brazil; (R.A.d.A.X.); (A.A.C.); (A.V.G.); (M.A.W.R.)
- Correspondence: (R.A.L.d.V.); (D.d.B.M.-F.); Tel./Fax: +558131833510 (R.A.L.d.V. & D.d.B.M.-F.)
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Albuquerque MDFPMD, Souza WVD, Montarroyos UR, Pereira CR, Braga C, Araújo TVBD, Ximenes RADA, Miranda-Filho DDB, Szwarcwald CL, Souza-Junior PRBD, Xavier MN, Morais CNLD, Albuquerque GDMD, Bresani-Salvi C, Mariz CA, Siqueira-Filha NTD, Galindo JM, França-Neto CL, Barbosa JMV, Veras MASM, Lima LNGC, Cruz LN, Kendall C, Kerr LRFS, Martelli CMT. Risk of SARS-CoV-2 infection among front-line healthcare workers in Northeast Brazil: a respondent-driven sampling approach. BMJ Open 2022; 12:e058369. [PMID: 35667719 PMCID: PMC9170795 DOI: 10.1136/bmjopen-2021-058369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES We assessed the prevalence of SARS-CoV-2 infection, personal protective equipment (PPE) shortages and occurrence of biological accidents among front-line healthcare workers (HCW). DESIGN, SETTING AND PARTICIPANTS Using respondent-driven sampling, the study recruited distinct categories of HCW attending suspected or confirmed patients with COVID-19 from May 2020 to February 2021, in the Recife metropolitan area, Northeast Brazil. OUTCOME MEASURES The criterion to assess SARS-CoV-2 infection among HCW was a positive self-reported PCR test. RESULTS We analysed 1525 HCW: 527 physicians, 471 registered nurses, 263 nursing assistants and 264 physical therapists. Women predominated in all categories (81.1%; 95% CI: 77.8% to 84.1%). Nurses were older with more comorbidities (hypertension and overweight/obesity) than the other staff. The overall prevalence of SARS-CoV-2 infection was 61.8% (95% CI: 55.7% to 67.5%) after adjustment for the cluster random effect, weighted by network, and the reference population size. Risk factors for a positive RT-PCR test were being a nursing assistant (OR adjusted: 2.56; 95% CI: 1.42 to 4.61), not always using all recommended PPE while assisting patients with COVID-19 (OR adj: 2.15; 95% CI: 1.02 to 4.53) and reporting a splash of biological fluid/respiratory secretion in the eyes (OR adj: 3.37; 95% CI: 1.10 to 10.34). CONCLUSIONS This study shows the high frequency of SARS-CoV2 infection among HCW presumably due to workplace exposures. In our setting, nursing assistant comprised the most vulnerable category. Our findings highlight the need for improving healthcare facility environments, specific training and supervision to cope with public health emergencies.
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Affiliation(s)
| | - Wayner Vieira de Souza
- Department of Collective Health, Institute Aggeu Magalhaes, FIOCRUZ-PE, Recife, Pernambuco, Brazil
| | | | | | - Cynthia Braga
- Department of Parasitology, Institute Aggeu Magalhaes, FIOCRUZ-PE, Recife, Pernambuco, Brazil
| | | | | | | | - Celia Landmann Szwarcwald
- Institute of Scientific Communication and Information and Technological (ICIT), FIOCRUZ-RJ, Rio de Janeiro, Brazil
| | | | - Morgana Nascimento Xavier
- Department of Collective Health, Institute Aggeu Magalhaes, FIOCRUZ-PE, Recife, Pernambuco, Brazil
- Department of Biology, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | | | | | - Carolline Araújo Mariz
- Department of Collective Health, Institute Aggeu Magalhaes, FIOCRUZ-PE, Recife, Pernambuco, Brazil
- Olinda Medical School, Olinda, Pernambuco, Brazil
| | | | - Jadson Mendonça Galindo
- Department of Collective Health, Institute Aggeu Magalhaes, FIOCRUZ-PE, Recife, Pernambuco, Brazil
| | | | | | | | | | | | - Carl Kendall
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Community Health, Federal University of Ceara, Fortaleza, Ceara, Brazil
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9
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Lobkowicz L, Miranda-Filho DDB, Montarroyos UR, Martelli CMT, de Araújo TVB, De Souza WV, Bezerra LCA, Dhalia R, Marques ETA, Sanchez Clemente N, Webster J, Vaughan A, Webb EL, Brickley EB, Ximenes RADA. Co-circulation of Chikungunya Virus during the 2015-2017 Zika Virus Outbreak in Pernambuco, Brazil: An Analysis of the Microcephaly Epidemic Research Group Pregnancy Cohort. Am J Trop Med Hyg 2022; 106:tpmd210449. [PMID: 35405646 PMCID: PMC9209936 DOI: 10.4269/ajtmh.21-0449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 01/20/2022] [Indexed: 12/05/2022] Open
Abstract
Co-circulation of arthropod-borne viruses, particularly those with shared mosquito vectors like Zika (ZIKV) and Chikungunya (CHIKV), is increasingly reported. An accurate differential diagnosis between ZIKV and CHIKV is of high clinical importance, especially in the context of pregnancy, but remains challenging due to limitations in the availability of specialized laboratory testing facilities. Using data collected from the prospective pregnancy cohort study of the Microcephaly Epidemic Research Group, which followed up pregnant persons with rash during the peak and decline of the 2015-2017 ZIKV epidemic in Recife, Pernambuco, Brazil, this study aims to describe the geographic and temporal distribution of ZIKV and CHIKV infections and to investigate the extent to which ZIKV and CHIKV infections may be clinically differentiable. Between December 2015 and June 2017, we observed evidence of co-circulation with laboratory confirmation of 213 ZIKV mono-infections, 55 CHIKV mono-infections, and 58 sequential ZIKV/CHIKV infections (i.e., cases with evidence of acute ZIKV infection with concomitant serological evidence of recent CHIKV infection). In logistic regressions with adjustment for maternal age, ZIKV mono-infected cases had lower odds than CHIKV mono-infected cases of presenting with arthralgia (aOR, 99% CI: 0.33, 0.15-0.74), arthritis (0.35, 0.14-0.85), fatigue (0.40, 0.17-0.96), and headache (0.44, 0.19-1.90). However, sequential ZIKV/CHIKV infections complicated discrimination, as they did not significantly differ in clinical presentation from CHIKV mono-infections. These findings suggest clinical symptoms alone may be insufficient for differentiating between ZIKV and CHIKV infections during pregnancy and therefore laboratory diagnostics continue to be a valuable tool for tailoring care in the event of arboviral co-circulation.
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Affiliation(s)
- Ludmila Lobkowicz
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | | | | | | | - Rafael Dhalia
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brasil
| | - Ernesto T. A. Marques
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brasil
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nuria Sanchez Clemente
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jayne Webster
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aisling Vaughan
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emily L. Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Elizabeth B. Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Interna, Universidade de Pernambuco, Recife, Brasil
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, Brasil
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10
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Fonseca Lima RA, Miranda-Filho DDB, Montarroyos UR, Cavalcanti ATDAE, Ximenes RADA. Adherence to antiretroviral therapy and factors associated with non-adherence: a cohort study at two referral services in Brazil. AIDS Care 2022; 35:961-969. [PMID: 35100884 DOI: 10.1080/09540121.2022.2029814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This cohort study evaluated non-adherence to antiretrovirals at referral services in Pernambuco, Brazil, 2016/2017, through self-report. A generalized mixed-effects model for binary outcomewas used. We assessed 542 participants with an adherence rate of 85.50%. A greater chance of non-adherence was associated with:a low/moderate level of nicotine dependence (OR = 2.79, p = 0.00, IC = 1.44-5.41); ≥7 tablets/day (OR = 6.14, p = 0.00, IC = 3.42-11.02); LPV/r (OR = 1.49, p = 0.6, IC = 0.98-2.26), ddI (OR = 3.34, p = 0.03, IC = 1.12-9.97), ABC (OR = 4.02, p = 0.05, IC = 1.01-16.03), RAL (OR = 2.49, p = 0.01, IC = 1.32-4.70) and DTG (OR = 4.65, p = 0.01, IC = 1.42-15.16); 6-10 year seropositive diagnosis (OR = 2.17, p = 0.01, IC = 1.20-3.92) and symptoms of depression (OR = 1.55, p = 0.03, IC = 1.03-2.33). Protective factors for non-adherence weres: ≥50 years (OR = 0.67, p = 0.06, IC = 0.45-1.01), secondary/higher education (OR = 0.48, p = 0.00, IC = 0.34-0.70), embarrassment at health service (OR = 0.49, p = 0.04, IC = 0.24-0.97), good understanding of antiretrovirals (OR = 0.62, p = 0.03, IC = 0.40-0.96), adverse event (OR = 0.74, p = 0,06, IC = 0.54-1.01), use of TDF (OR = 0.62, p = 0.01, IC = 0.43-0.90), NVP (OR = 0.41, p = 0.05, IC = 0.71-1.00) and EFZ (OR = 0.48, p = 0.01, IC = 0.29-0.80) and good knowledge of HIV/AIDS/ART. (OR = 0.67, p = 0.07, IC = 0.43-1.04). Variables with stronger association were those linked to ART. Systematic use of self-report adherence is recommended for priority groups.
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Affiliation(s)
- Rosário Antunes Fonseca Lima
- Faculdade Enfermagem Nossa Senhora das Graças, Universidade de Pernambuco, Recife, Brazil
- Programa de Pós-graduação de Ciências da Saúde, Universidade de Pernambuco, Recife, Brazil
| | - Demócrito de Barros Miranda-Filho
- Programa de Pós-graduação de Ciências da Saúde, Universidade de Pernambuco, Recife, Brazil
- Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife, Brazil
| | - Ulísses Ramos Montarroyos
- Programa de Pós-graduação de Ciências da Saúde, Universidade de Pernambuco, Recife, Brazil
- Instituto de Ciências Biológicas, Universidade de Pernambuco, Recife, Brazil
| | - Aracele Tenório de Almeida e Cavalcanti
- Programa de Pós-graduação de Ciências da Saúde, Universidade de Pernambuco, Recife, Brazil
- Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
| | - Ricardo Arraes de Alencar Ximenes
- Programa de Pós-graduação de Ciências da Saúde, Universidade de Pernambuco, Recife, Brazil
- Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife, Brazil
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, Brazil
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11
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Takahasi EHM, Alves MTSSDBE, Ribeiro MRC, Santos AMD, Campos MAG, Simões VMF, Amaral GA, Sousa PDS, Miranda-Filho DDB, Silva AAMD. Decline in head circumference growth and associated factors in congenital Zika syndrome. CAD SAUDE PUBLICA 2022; 38:e00296021. [DOI: 10.1590/0102-311xen296021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/16/2022] [Indexed: 12/23/2022] Open
Abstract
Little is known about the evolution of head circumference (HC) in children with congenital Zika syndrome (CZS). This study aims to evaluate HC growth in children with CZS in the first three years of life and identify associated factors. HC data obtained at birth and in neuropediatric consultations from 74 children with CZS were collected from the Child’s Health Handbook, parents’ reports, and medical records. Predictors of HC z-score were investigated using different mixed-effects models; Akaike’s information criterion was used for model selection. The HC z-score decreased from -2.7 ± 1.6 at birth to -5.5 ± 2.2 at 3 months of age, remaining relatively stable thereafter. In the selected adjusted model, the presence of severe brain parenchymal atrophy and maternal symptoms of infection in the first trimester of pregnancy were associated with a more pronounced reduction in the HC z-score in the first three years of life. The decrease of HC z-score in CZS children over the first three months demonstrated a reduced potential for growth and development of the central nervous system of these children. The prognosis of head growth in the first 3 years of life is worse when maternal infection occurs in the first gestational trimester and in children who have severe brain parenchymal atrophy.
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12
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Lobkowicz L, Power GM, De Souza WV, Montarroyos UR, Martelli CMT, de Araùjo TVB, Bezerra LCA, Dhalia R, Marques ETA, Miranda-Filho DDB, Brickley EB, Ximenes RADA. Neighbourhood-level income and Zika virus infection during pregnancy in Recife, Pernambuco, Brazil: an ecological perspective, 2015-2017. BMJ Glob Health 2021; 6:bmjgh-2021-006811. [PMID: 34857522 PMCID: PMC8640636 DOI: 10.1136/bmjgh-2021-006811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/28/2021] [Indexed: 11/24/2022] Open
Abstract
Zika virus (ZIKV) infections during pregnancy can lead to adverse neurodevelopmental and clinical outcomes in congenitally infected offspring. As the city of Recife in Pernambuco State, Brazil—the epicentre of the Brazilian microcephaly epidemic—has considerable disparities in living conditions, this study used an ecological approach to investigate the association between income at the neighbourhood level and the risk of ZIKV infections in pregnant individuals between December 2015 and April 2017. The spatial distribution of pregnant individuals with ZIKV infection was plotted on a map of Recife stratified into four categories based on mean monthly income of household heads. Additionally, a Poisson regression model with robust variance was fitted to compare proportions of ZIKV infections among pregnant individuals in relation to the mean monthly income of household heads, based on the 2010 census data, across 94 neighbourhoods in Recife. The results provide evidence that the risk of ZIKV infection to pregnant individuals was higher among those residing in lower-income neighbourhoods: relative to neighbourhoods that had a mean monthly income of ≥5 times minimum wage, neighbourhoods with <1 and 1 to <2 times minimum wage had more than four times the risk (incidence rate ratio, 95% CI 4.08, 1.88 to 8.85 and 4.30, 2.00 to 9.20, respectively). This study provides evidence of a strong association between neighbourhood-level income and ZIKV infection risks in the pregnant population of Recife. In settings prone to arboviral outbreaks, locally targeted interventions to improve living conditions, sanitation, and mosquito control should be a key focus of governmental interventions to reduce risks associated with ZIKV infections during pregnancy.
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Affiliation(s)
- Ludmila Lobkowicz
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Grace M Power
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.,MRC Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, Bristol, UK
| | | | | | | | | | | | - Rafael Dhalia
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Ernesto T A Marques
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil.,Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Interna, Universidade de Pernambuco, Recife, PE, Brasil.,Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, PE, Brasil
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13
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Gonçalves FCLDSP, Lima MDC, Ximenes RADA, Miranda-Filho DDB, Martelli CMT, Rodrigues LC, Souza WVD, Lira PICD, Eickmann SH, Araújo TVB. A new insight into the definition of microcephaly in Zika congenital syndrome era. CAD SAUDE PUBLICA 2021; 37:e00228520. [PMID: 34852159 DOI: 10.1590/0102-311x00228520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/26/2021] [Indexed: 11/22/2022] Open
Abstract
This study aimed to compare the anthropometric measurements and body proportionalities of neonates born before the Zika virus epidemic with those born during this period. We compared 958 neonates born during the pre-Zika epidemic with 264 neonates born during the epidemic period. The newborns had their head circumference, weight, and length classified according to the Fenton & Kim growth chart. We considered disproportionate those individuals that presented microcephaly and adequate weight or length for sex and gestational age, and those whose head circumferences were lower than the ratio ((length / 2) + 9.5) - 2.5cm. We estimated the frequencies of Zika positivity and brain imaging findings among neonates with microcephaly born during the epidemic period, concerning the anthropometric and body proportionality parameters. Low weight and proportionate microcephaly were similar among newborns from both periods. However, the frequencies of newborns with microcephaly with a very low length and disproportionate microcephaly were higher among the neonates of the epidemic period with brain abnormalities and positive for Zika virus. We conclude that, at birth, the disproportion between head circumference and length can be an indicator of the severity of microcephaly caused by congenital Zika.
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14
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Wilder-Smith A, Brickley EB, Ximenes RADA, Miranda-Filho DDB, Turchi Martelli CM, Solomon T, Jacobs BC, Pardo CA, Osorio L, Parra B, Lant S, Willison HJ, Leonhard S, Turtle L, Ferreira MLB, de Oliveira Franca RF, Lambrechts L, Neyts J, Kaptein S, Peeling R, Boeras D, Logan J, Dolk H, Orioli IM, Neumayr A, Lang T, Baker B, Massad E, Preet R. The legacy of ZikaPLAN: a transnational research consortium addressing Zika. Glob Health Action 2021; 14:2008139. [PMID: 35377284 PMCID: PMC8986226 DOI: 10.1080/16549716.2021.2008139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Global health research partnerships with institutions from high-income countries and low- and middle-income countries are one of the European Commission's flagship programmes. Here, we report on the ZikaPLAN research consortium funded by the European Commission with the primary goal of addressing the urgent knowledge gaps related to the Zika epidemic and the secondary goal of building up research capacity and establishing a Latin American-European research network for emerging vector-borne diseases. Five years of collaborative research effort have led to a better understanding of the full clinical spectrum of congenital Zika syndrome in children and the neurological complications of Zika virus infections in adults and helped explore the origins and trajectory of Zika virus transmission. Individual-level data from ZikaPLAN`s cohort studies were shared for joint analyses as part of the Zika Brazilian Cohorts Consortium, the European Commission-funded Zika Cohorts Vertical Transmission Study Group, and the World Health Organization-led Zika Virus Individual Participant Data Consortium. Furthermore, the legacy of ZikaPLAN includes new tools for birth defect surveillance and a Latin American birth defect surveillance network, an enhanced Guillain-Barre Syndrome research collaboration, a de-centralized evaluation platform for diagnostic assays, a global vector control hub, and the REDe network with freely available training resources to enhance global research capacity in vector-borne diseases.
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Affiliation(s)
- Annelies Wilder-Smith
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Tom Solomon
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | - Bart C Jacobs
- Departments of Neurology and Immunology, Erasmus Universitair Medisch Centrum Rotterdam, The Netherlands
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | | - Suzannah Lant
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | - Hugh J Willison
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Sonja Leonhard
- Departments of Neurology and Immunology, Erasmus Universitair Medisch Centrum Rotterdam, The Netherlands
| | - Lance Turtle
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | | | | | - Louis Lambrechts
- Insect-Virus Interactions Unit, Institut Pasteur, UMR2000, CNRS, 75015 Paris, France
| | - Johan Neyts
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Suzanne Kaptein
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Rosanna Peeling
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - James Logan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, Institute for Nursing and Health Research, Ulster University, Ulster, United Kingdom
| | - Ieda M Orioli
- RELAMC and ECLAMC at Genetics Department, Federal University of Rio de Janeiro, Brazil
| | - Andreas Neumayr
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Trudie Lang
- The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Bonny Baker
- The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Eduardo Massad
- School of Medicine, University of Sao Paulo and Fundacao Getulio Vargas, Sao Paulo, Brazil
| | - Raman Preet
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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15
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Qiao L, Martelli CMT, Raja AI, Sanchez Clemente N, de Araùjo TVB, Ximenes RADA, Miranda-Filho DDB, Ramond A, Brickley EB. Epidemic preparedness: Prenatal Zika virus screening during the next epidemic. BMJ Glob Health 2021; 6:bmjgh-2021-005332. [PMID: 34117012 PMCID: PMC8202108 DOI: 10.1136/bmjgh-2021-005332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/10/2021] [Indexed: 12/29/2022] Open
Abstract
Zika virus (ZIKV) is a vectorborne infectious agent of global public health significance due to its potential to cause severe teratogenic outcomes. The question of whether health systems should consider adopting screening programmes for ZIKV infections during pregnancy warrants consideration. In this analysis, we apply the Wilson-Jungner framework to appraise the potential utility of a prenatal ZIKV screening programme, outline potential screening strategies within the case-finding pathway, and consider other epidemiological factors that may influence the planning of such a screening programme. Our evaluation of a potential prenatal ZIKV screening programme highlights factors affirming its usefulness, including the importance of Congenital Zika Syndrome as a public health problem and the existence of analogous congenital prenatal screening programmes for STORCH agents (syphilis, toxoplasmosis, others (eg, human immunodeficiency virus, varicella-zoster virus, parvovirus B19), rubella, cytomegalovirus, and herpes simplex virus). However, our assessment also reveals key barriers to implementation, such as the need for more accurate diagnostic tests, effective antiviral treatments, increased social service capacity, and surveillance. Given that the reemergence of ZIKV is likely, we provide a guiding framework for policymakers and public health leaders that can be further elaborated and adapted to different contexts in order to reduce the burden of adverse ZIKV-related birth outcomes during future outbreaks.
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Affiliation(s)
- Luxi Qiao
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,School of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | | | - Amber I Raja
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Nuria Sanchez Clemente
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, Pernambuco, Brasil.,Departamento de Medicina Interna, Universidade de Pernambuco, Recife, Pernambuco, Brasil
| | | | - Anna Ramond
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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16
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Silva ASD, Cavalcanti MDSDM, Belmont TFDM, Ximenes RADA, Silva AVD, Nóbrega DND, Souza RDS, Farias ICC, do Ó KP, Vasconcelos LRS, Diniz GTN, Miranda-Filho DDB. The 1G/1G+1G/2G Genotypes of MMP1 rs1799750 Are Associated with Higher Levels of MMP-1 and Are Both Associated with Lipodystrophy in People Living with HIV on Antiretroviral Therapy. AIDS Res Hum Retroviruses 2021; 37:399-406. [PMID: 33587019 DOI: 10.1089/aid.2020.0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In HIV-infected patients, antiretroviral therapy (ART) is associated to adipose tissue redistribution known as lipodystrophy (LD). This study aimed at verifying the association between the polymorphism of the MMP1 gene (rs1799750) (1G/2G) and the serum levels of matrix metalloproteinase 1 (MMP-1) with LD and its subtypes in people living with HIV on ART. This is a cross-secional study. LD was self-reported. The determination of the MMP1 rs1799750 gene polymorphism was performed by real-time PCR, and the serum concentrations of MMP-1 were quantified by the enzyme-linked immunosorbent assay (ELISA) method. Of 404 participants, 204 (51%) were diagnosed with LD, of whom 89 (43%) had mixed lipodystrophy (ML), 72 (35%) had lipohypertrophy (LH), and 43 (22%) had lipoatrophy (LA). There was an association between the genotypes 1G/1G+1G/2G and higher serum levels of MMP-1 (p = .025). There was no association of MMP1 (1G/2G) with LD. Other factors associated with LD were current CD4 ≤ 350 [odds ratio (OR) = 4.85, confidence interval (CI) = 1.78-47.99, p = .0033] and serum MMP-1 levels >6.81 (OR = 2.67, CI = 1.21-6.08, p = .0165). Factors associated with ML: current CD4 ≤ 350 (OR = 5.59, CI = 1.69-20.39, p = .006); with LH: number of antiretroviral regimens used: 2 (OR = 2.06, CI = 1.01-4.20, p = .0460) and 3+ (OR = 2.09, CI = 1.00-4.35, p = .0477), and current CD4 ≤ 350 (OR = 2.08, CI = 1.00-4.24, p = .0461); and with LA: current viral load >40 (OR = 2.52, CI = 1.03-5.91, p = .0372) and current use of zidovudine (OR = 2.97, CI = 1.32-6.54, p = .0074). Higher levels of MMP-1 were associated with genotypes 1G/2G+1G/1G and with LD. Other individual risk factors were independently associated with LD, and its subtypes, suggesting that the pathogenesis itself is differently manifested for each type of LD.
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Alecrim MDGC, de Amorim MMR, de Araújo TVB, Brasil P, Brickley EB, Castilho MDC, Coelho BP, da Cunha AJLA, Duarte G, Estofolete CF, Gurgel RQ, Herrero-Silva J, Hofer CB, Lopes ASA, Martelli CMT, Melo ASDO, Miranda-Filho DDB, Montarroyos UR, Moreira ME, Mussi-Pinhata MM, de Oliveira CS, Passos SD, Prata-Barbosa A, dos Santos DN, Schuler-Faccini L, da Silva AAM, de Siqueira IC, Sousa PDS, Turchi MD, Ximenes RADA, Zara ALDSA. Zika Brazilian Cohorts (ZBC) Consortium: Protocol for an Individual Participant Data Meta-Analysis of Congenital Zika Syndrome after Maternal Exposure during Pregnancy. Viruses 2021; 13:v13040687. [PMID: 33923434 PMCID: PMC8072625 DOI: 10.3390/v13040687] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/31/2022] Open
Abstract
Despite great advances in our knowledge of the consequences of Zika virus to human health, many questions remain unanswered, and results are often inconsistent. The small sample size of individual studies has limited inference about the spectrum of congenital Zika manifestations and the prognosis of affected children. The Brazilian Zika Cohorts Consortium addresses these limitations by bringing together and harmonizing epidemiological data from a series of prospective cohort studies of pregnant women with rash and of children with microcephaly and/or other manifestations of congenital Zika. The objective is to estimate the absolute risk of congenital Zika manifestations and to characterize the full spectrum and natural history of the manifestations of congenital Zika in children with and without microcephaly. This protocol describes the assembly of the Consortium and protocol for the Individual Participant Data Meta-analyses (IPD Meta-analyses). The findings will address knowledge gaps and inform public policies related to Zika virus. The large harmonized dataset and joint analyses will facilitate more precise estimates of the absolute risk of congenital Zika manifestations among Zika virus-infected pregnancies and more complete descriptions of its full spectrum, including rare manifestations. It will enable sensitivity analyses using different definitions of exposure and outcomes, and the investigation of the sources of heterogeneity between studies and regions.
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Affiliation(s)
| | - Melania Maria Ramos de Amorim
- Universidade Federal de Campina Grande, Campina Grande 58428-830, Brazil; (M.M.R.d.A.); (A.S.d.O.M.)
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife 50070-902, Brazil
| | | | - Patrícia Brasil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Brazil;
| | | | - Marcia da Costa Castilho
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil; (M.d.G.C.A.); (M.d.C.C.)
| | - Bernadete Perez Coelho
- Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife 50670-901, Brazil;
| | | | - Geraldo Duarte
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14049-900, Brazil; (G.D.); (M.M.M.-P.)
| | | | | | | | - Cristina Barroso Hofer
- Departamento de Pediatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-971, Brazil; (A.J.L.A.d.C.); (C.B.H.)
| | | | | | - Adriana Suely de Oliveira Melo
- Universidade Federal de Campina Grande, Campina Grande 58428-830, Brazil; (M.M.R.d.A.); (A.S.d.O.M.)
- Instituto Paraibano de Diagnóstico (EMBRION), Campina Grande 58400-506, Brazil
| | | | | | | | - Marisa Marcia Mussi-Pinhata
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14049-900, Brazil; (G.D.); (M.M.M.-P.)
| | | | | | | | | | | | | | | | - Patrícia da Silva Sousa
- Centro de Referência em Neurodesenvolvimento, Assistência e Reabilitação de Crianças, Secretaria de Saúde do Estado do Maranhão, São Luís 65076-820, Brazil;
| | - Marília Dalva Turchi
- Departamento de Saude Coletiva, Universidade Federal de Goiás, Goiânia 74605-050, Brazil; (M.D.T.); (A.L.d.S.A.Z.)
| | - Ricardo Arraes de Alencar Ximenes
- Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife 50100-130, Brazil;
- Departamento de Medicina Tropical da Universidade Federal de Pernambuco, Recife 50670-901, Brazil
- Correspondence:
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de Barros Miranda-Filho D, Brickley EB, Ramond A, Martelli CMT, Sanchez Clemente N, Velho Barreto de Araújo T, Rodrigues LC, Montarroyos UR, de Souza WV, de Albuquerque MDFPM, Ventura LO, Marques ETA, Leal MC, Eickmann SH, Wanderley Rocha MA, Sobral da Silva PF, Gomes Carvalho MDC, Ramos RCF, da Silva Oliveira DM, Xavier MDN, Vasconcelos RAL, Veras Gonçalves A, Brainer AM, Tenório Cordeiro M, Arraes de Alencar Ximenes R. The Microcephaly Epidemic Research Group Paediatric Cohort (MERG-PC): A Cohort Profile. Viruses 2021; 13:v13040602. [PMID: 33916084 PMCID: PMC8067191 DOI: 10.3390/v13040602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 12/21/2022] Open
Abstract
This cohort profile aims to describe the ongoing follow-up of children in the Microcephaly Epidemic Research Group Paediatric Cohort (MERG–PC). The profile details the context and aims of the study, study population, methodology including assessments, and key results and publications to date. The children that make up MERG–PC were born in Recife or within 120 km of the city, in Pernambuco/Brazil, the epicentre of the microcephaly epidemic. MERG–PC includes children from four groups recruited at different stages of the ZIKV microcephaly epidemic in Pernambuco, i.e., the Outpatient Group (OG/n = 195), the Microcephaly Case–Control Study (MCCS/n = 80), the MERG Pregnant Women Cohort (MERG-PWC/n = 336), and the Control Group (CG/n = 100). We developed a comprehensive array of clinical, laboratory, and imaging assessments that were undertaken by a ‘task force’ of clinical specialists in a single day at 3, 6, 12, 18 months of age, and annually from 24 months. Children from MCCS and CG had their baseline assessment at birth and children from the other groups, at the first evaluation by the task force. The baseline cohort includes 711 children born between February 2015 and February 2019. Children’s characteristics at baseline, excluding CG, were as follows: 32.6% (184/565) had microcephaly, 47% (263/559) had at least one physical abnormality, 29.5% (160/543) had at least one neurological abnormality, and 46.2% (257/556) had at least one ophthalmological abnormality. This ongoing cohort has contributed to the understanding of the congenital Zika syndrome (CZS) spectrum. The cohort has provided descriptions of paediatric neurodevelopment and early epilepsy, including EEG patterns and treatment response, and information on the frequency and characteristics of oropharyngeal dysphagia; cryptorchidism and its surgical findings; endocrine dysfunction; and adenoid hypertrophy in children with Zika-related microcephaly. The study protocols and questionnaires were shared across Brazilian states to enable harmonization across the different studies investigating microcephaly and CZS, providing the opportunity for the Zika Brazilian Cohorts Consortium to be formed, uniting all the ZIKV clinical cohorts in Brazil.
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Affiliation(s)
- Demócrito de Barros Miranda-Filho
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Correspondence:
| | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (E.B.B.); (A.R.); (N.S.C.); (L.C.R.)
| | - Anna Ramond
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (E.B.B.); (A.R.); (N.S.C.); (L.C.R.)
| | - Celina Maria Turchi Martelli
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Nuria Sanchez Clemente
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (E.B.B.); (A.R.); (N.S.C.); (L.C.R.)
| | | | - Laura Cunha Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (E.B.B.); (A.R.); (N.S.C.); (L.C.R.)
| | - Ulisses Ramos Montarroyos
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
| | - Wayner Vieira de Souza
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Maria de Fátima P. M. de Albuquerque
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Liana O. Ventura
- Departamento de Oftalmologia, Fundação Altino Ventura, Recife 52171-011, Brazil;
| | - Ernesto T. A. Marques
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Mariana C. Leal
- Departamento de Cirurgia, Universidade Federal de Pernambuco, Recife 50670-420, Brazil;
| | - Sophie H. Eickmann
- Departamento Materno-Infantil, Universidade Federal de Pernambuco, Recife 50670-420, Brazil;
| | | | - Paula Fabiana Sobral da Silva
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
| | - Maria Durce Costa Gomes Carvalho
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
| | - Regina Coeli F. Ramos
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
- Pós-Graduação em Medicina Tropical, Universidade Federal de Pernambuco, Recife 50670-901, Brazil
| | - Danielle Maria da Silva Oliveira
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
| | - Morgana do Nascimento Xavier
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Rômulo A. L. Vasconcelos
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
| | - Andreia Veras Gonçalves
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
- Pós-Graduação em Medicina Tropical, Universidade Federal de Pernambuco, Recife 50670-901, Brazil
| | - Alessandra Mertens Brainer
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
| | - Marli Tenório Cordeiro
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Ricardo Arraes de Alencar Ximenes
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Pós-Graduação em Medicina Tropical, Universidade Federal de Pernambuco, Recife 50670-901, Brazil
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Souza WVD, Martelli CMT, Silva APDSC, Maia LTDS, Braga MC, Bezerra LCA, Dimech GS, Montarroyos UR, Araújo TVBD, Barros Miranda-Filho DD, Ximenes RADA, Albuquerque MDFPMD. The first hundred days of COVID-19 in Pernambuco State, Brazil: epidemiology in historical context. CAD SAUDE PUBLICA 2020; 36:e00228220. [PMID: 33331595 DOI: 10.1590/0102-311x00228220] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/20/2020] [Indexed: 12/20/2022] Open
Abstract
The timeline of the COVID-19 pandemic began on December 31, 2019, in China, with SARS-CoV-2 identified as the etiological agent. This article aims to describe the COVID-19 epidemic's spatial and temporal dynamics in the first hundred days in the State of Pernambuco, Brazil. We present the evolution in cases and deaths according to epidemiological weeks. We analyzed the series of accumulated daily confirmed COVID-19 cases, with projections for the subsequent 15 days, using the JoinPoint app. This software allows identifying turning points, testing their statistical significance. We also analyze the trend in the spread of COVID-19 to the interior of the state, considering the percent distribution of cases in the state capital, Recife, municipalities in Greater Metropolitan Recife, and the state's interior, by sets of three weeks, constructing thematic maps. The first hundred days of the COVID-19 epidemic resulted in 52,213 cases and 4,235 deaths from March 12, or epidemiological week 11, until June 20, 2020 (epidemiological week 25). The peak in the epidemic curve occurred in epidemiological week 21 (May 23), followed by deceleration in the number of cases. We initially detected the spread of cases from the city center to the periphery of the state capital and Metropolitan Area, followed by rapid spread to the state's interior. There was a decrease in the mean daily growth starting in April, but with an average threshold of more than 6,000 weekly cases of COVID-19. At the end of the period, the state's case series indicates the persistence of SARS-CoV-2 circulation and community transmission. Finally, paraphrasing Gabriel Garcia Marques in One Hundred Years of Solitude, we ask whether we are facing "a pause in the storm or a sign of redoubled rain".
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Ades AE, Brickley EB, Alexander N, Brown D, Jaenisch T, Miranda-Filho DDB, Pohl M, Rosenberger KD, Soriano-Arandes A, Thorne C, Ximenes RADA, de Araújo TVB, Avelino-Silva VI, Bethencourt Castillo SE, Borja Aburto VH, Brasil P, Christie CDC, de Souza WV, Gotuzzo H JE, Hoen B, Koopmans M, Martelli CMT, Martins Teixeira M, Marques ETA, Miranda MC, Montarroyos UR, Moreira ME, Morris JG, Rockx B, Saba Villarroel PM, Soria Segarra C, Tami A, Turchi MD, Giaquinto C, de Lamballerie X, Wilder-Smith A. Zika virus infection in pregnancy: a protocol for the joint analysis of the prospective cohort studies of the ZIKAlliance, ZikaPLAN and ZIKAction consortia. BMJ Open 2020; 10:e035307. [PMID: 33323426 PMCID: PMC7745317 DOI: 10.1136/bmjopen-2019-035307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Zika virus (ZIKV) infection in pregnancy has been associated with microcephaly and severe neurological damage to the fetus. Our aim is to document the risks of adverse pregnancy and birth outcomes and the prevalence of laboratory markers of congenital infection in deliveries to women experiencing ZIKV infection during pregnancy, using data from European Commission-funded prospective cohort studies in 20 centres in 11 countries across Latin America and the Caribbean. METHODS AND ANALYSIS We will carry out a centre-by-centre analysis of the risks of adverse pregnancy and birth outcomes, comparing women with confirmed and suspected ZIKV infection in pregnancy to those with no evidence of infection in pregnancy. We will document the proportion of deliveries in which laboratory markers of congenital infection were present. Finally, we will investigate the associations of trimester of maternal infection in pregnancy, presence or absence of maternal symptoms of acute ZIKV infection and previous flavivirus infections with adverse outcomes and with markers of congenital infection. Centre-specific estimates will be pooled using a two-stage approach. ETHICS AND DISSEMINATION Ethical approval was obtained at each centre. Findings will be presented at international conferences and published in peer-reviewed open access journals and discussed with local public health officials and representatives of the national Ministries of Health, Pan American Health Organization and WHO involved with ZIKV prevention and control activities.
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Affiliation(s)
- A E Ades
- Department of Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Neal Alexander
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - David Brown
- Flavivirus Reference Laboratory, Fundacão Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Thomas Jaenisch
- Department of Infectious Diseases, Section Clinical Tropical Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | | | - Moritz Pohl
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Kerstin D Rosenberger
- Department of Infectious Diseases, Section Clinical Tropical Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Claire Thorne
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | | | - Vivian I Avelino-Silva
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
| | | | | | - Patrícia Brasil
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Celia D C Christie
- Department of Child and Adolescent Health, University of the West Indies at Mona, Kingston, Jamaica
| | | | - Jose Eduardo Gotuzzo H
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Bruno Hoen
- INSERM Centre d'Investigation Clinique 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Guadeloupe, France
- Faculté de Médecine Hyacinthe Bastaraud, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe, France
| | - Marion Koopmans
- Department of Viroscience, Erasmus Universiteit Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | | | | | - Ernesto T A Marques
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | - Maria Elisabeth Moreira
- Figueira National Institute for Women's, Children's and Adolescents Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - J Glenn Morris
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Barry Rockx
- Department of Viroscience, Erasmus Universiteit Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | | | - Carmen Soria Segarra
- Universidad Católica de Santiago de Guayaquil, Guayaquil, Guayas, Ecuador
- SOSECALI C., Ltda, Guayaquil, Ecuador
| | - Adriana Tami
- Facultad de Ciencias de la Salud, Universidad de Carabobo, Valencia, Venezuela
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
| | - Marília Dalva Turchi
- Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, Brazil
| | - Carlo Giaquinto
- Department of Woman's and Child's Health, Università degli Studi di Padova, Padova, Italy
| | - Xavier de Lamballerie
- Aix-Marseille Université Institut Universitaire de Technologie d'Aix-en-Provence, Aix-en-Provence, Provence-Alpes-Côte d'Azur, France
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Sobral da Silva PF, Eickmann SH, Arraes de Alencar Ximenes R, Ramos Montarroyos U, de Carvalho Lima M, Turchi Martelli CM, Velho Barreto de Araújo T, Brickley EB, Cunha Rodrigues L, Lima da Silva Pastich Gonçalves FC, Costa Gomes Carvalho MD, Vieira de Souza W, de Barros Miranda-Filho D. Pediatric neurodevelopment by prenatal Zika virus exposure: a cross-sectional study of the Microcephaly Epidemic Research Group Cohort. BMC Pediatr 2020; 20:472. [PMID: 33038931 PMCID: PMC7547521 DOI: 10.1186/s12887-020-02331-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/07/2020] [Indexed: 01/29/2023] Open
Abstract
Background The implications of congenital Zika Virus (ZIKV) infections for pediatric neurodevelopment and behavior remain inadequately studied. The aim of this study is to investigate patterns of neurodevelopment and behavior in groups of children with differening severities of ZIKV-related microcephaly and children with prenatal ZIKV exposure in the absence of microcephaly. Methods We conducted a cross-sectional study, nested in a cohort, of 274 children (aged 10–45 months) who were born during the peak and decline of the microcephaly epidemic in Northeast Brazil. Participants were evaluated between February 2017 and August 2019 at two tertiary care hospitals in Recife, Pernambuco, Brazil. We analyzed the children in four groups assigned based on clinical and laboratory criteria: Group 1 had severe microcephaly; Group 2 had moderate microcephaly; Group 3 had prenatal ZIKVexposure confirmed by maternal RT-PCR testing but no microcephaly; and Group 4 was a neurotypical control group. Groups were evaluated clinically for neurological abnormalities and compared using the Survey of Wellbeing of Young Children (SWYC), a neurodevelopment and behavior screening instrument validated for use in Brazil. Children with severe delays underwent further evaluation with an adapted version of the SWYC. Results Based on the SWYC screening, we observed differences between the groups for developmental milestones but not behavior. Among the 114 children with severe microcephaly of whom 98.2% presented with neurological abnormalities, 99.1% were ‘at risk of development delay’ according to the SWYC instrument. Among the 20 children with moderate microcephaly of whom 60% presented with neurological abnormalities, 65% were ‘at risk of development delay’. For children without microcephaly, the percentages found to be ‘at risk of developmental delay’ were markedly lower and did not differ by prenatal ZIKV exposure status: Group 3 (N = 94), 13.8%; Group 4 (N = 46), 21.7%. Conclusions Among children with prenatal ZIKV exposure, we found a gradient of risk of development delay according to head circumference. Children with severe microcephaly were at highest risk for delays, while normocephalic ZIKV-exposed children had similar risks to unexposed control children. We propose that ZIKV-exposed children should undergo first-line screening for neurodevelopment and behavior using the SWYC instrument. Early assessment and follow-up will enable at-risk children to be referred to a more comprehensive developmental evaluation and to multidisciplinary care management.
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Cavalcanti ATDAE, de Alencar Ximenes RA, Montarroyos UR, d’Albuquerque PM, Fonseca RA, de Barros Miranda-Filho D. Effectiveness of four antiretroviral regimens for treating people living with HIV. PLoS One 2020; 15:e0239527. [PMID: 32986730 PMCID: PMC7521729 DOI: 10.1371/journal.pone.0239527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 09/08/2020] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to compare 4 different ARV regimens in a clinical cohort in Brazil, with regard to the virologic and immunologic responses, clinical failure and reasons for changing. To compare the virologic response and clinical failure between groups we used the Cox and Kaplan Meier proportional hazard models. To analyze the immunologic outcome, we used multilevel GLLAMM and mixed effect linear regression models. To compare regimen change outcomes we used the Pearson's chi-square test. We included 840 participants distributed across the groups according to the initial ART regimen. The mean follow-up period was 27.8 months. Almost half the sample initiated ART with AIDS-related signs/symptoms. Virologic response was effective in 79.6% of participants within 12 months. The tenofovir/lamivudine/efavirenz group presented a higher proportion of virologic response (VL<50 at 6 months) when compared to the zidovudine/lamivudine/efavirenz group. There was no difference between the regimens regarding the immunologic response. A total of 17.3% of individuals changed regimen because of failure and 46.5% due to adverse events. Changes due to adverse events were more frequent in the group using zidovudine/lamivudine/efavirenz. The proportion of hospitalizations at 1 year was higher in the zidovudine/lamivudine/efavirenz group when compared to the tenofovir/lamivudine/efavirenz group. The effectiveness outcomes between the regimens were similar. Some differences may be due to the individual characteristics of patients, toxicity and acceptability of drugs. Studies are needed that compare similarly effective regimens and their respective treatment costs and financial impacts on SUS (Integrated Healthcare System).
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Affiliation(s)
| | - Ricardo Arraes de Alencar Ximenes
- Postgraduate Program in Health Sciences, University of Pernambuco, Recife, Brazil
- Tropical Medicine, Federal University of Pernambuco, Recife, Brazil
| | | | | | | | - Demócrito de Barros Miranda-Filho
- Postgraduate Program in Health Sciences, University of Pernambuco, Recife, Brazil
- Internal Medicine, University of Pernambuco, Recife, Brazil
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23
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Oliveira DMDS, Miranda-Filho DDB, Ximenes RADA, Montarroyos UR, Martelli CMT, Brickley EB, Gouveia MDCL, Ramos RC, Rocha MÂW, Araujo TVBD, Eickmann SH, Rodrigues LC, Bernardes JPDOS, Pinto MHT, Soares KPND, Araújo CMTD, Militão-Albuquerque MDFP, Santos ACOD. Comparison of Oropharyngeal Dysphagia in Brazilian Children with Prenatal Exposure to Zika Virus, With and Without Microcephaly. Dysphagia 2020; 36:583-594. [PMID: 32886254 PMCID: PMC8289769 DOI: 10.1007/s00455-020-10173-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/24/2020] [Indexed: 01/12/2023]
Abstract
Severe brain damage associated with Zika-related microcephaly (ZRM) have been reported to result in oropharyngeal dysphagia (OPD); however, it is unknown if OPD presents in children with prenatal Zika virus (ZIKV) exposure but only mild or undetectable abnormalities. The aims of this study were: to compare the frequency and characteristics of OPD in children with ZRM and in children without microcephaly born to mothers who tested polymerase chain reaction positive (PCR+) for ZIKV during pregnancy; and to investigate the concordance of caregiver reports of OPD with the diagnosis from the clinical swallowing assessment (CSA). Between Mar/2017 and May/2018, we evaluated 116 children (n = 58 with microcephaly, n = 58 children without microcephaly born to ZIKV PCR + mothers) participating in the Microcephaly Epidemic Research Group (MERG) cohort of children born during the 2015–2016 ZIKV epidemic in Pernambuco, Brazil. To assess OPD we used: a CSA; a clinical assessment of the stomatognathic system; and a questionnaire administered to caregivers. The frequency of OPD was markedly higher in children with ZRM (79.3%) than in the exposed but normocephalic group (8.6%). The children with microcephaly also presented more frequently with anatomic and functional abnormalities in the stomatognathic system. There was a high degree of agreement between the caregiver reports of OPD and the CSA (κ = 0.92). In conclusion, our findings confirm that OPD is a feature of Congenital Zika Syndrome that primarily occurs in children with microcephaly and provide support for policies in which children are referred for rehabilitation with an OPD diagnosis based on caregiver report.
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Affiliation(s)
- Danielle Maria da Silva Oliveira
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil.
| | - Demócrito de Barros Miranda-Filho
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil
| | - Ricardo Arraes de Alencar Ximenes
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil.,Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife, Pernambuco, Brazil
| | - Ulisses Ramos Montarroyos
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil
| | - Celina Maria Turchi Martelli
- Instituto Aggeu Magalhães, Campus da UFPE - Av. Prof. Moraes Rego, S/N - Cidade Universitária, Recife, Pernambuco, Brazil
| | - Elizabeth B Brickley
- London School of Hygiene and Tropical Medicine, London, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | | | - Regina Coeli Ramos
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil
| | - Maria Ângela Wanderley Rocha
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil
| | | | - Sophie Helena Eickmann
- Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife, Pernambuco, Brazil
| | - Laura Cunha Rodrigues
- London School of Hygiene and Tropical Medicine, London, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Jeyse Polliane de Oliveira Soares Bernardes
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil
| | - Maria Helena Teixeira Pinto
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil
| | | | | | | | - Ana Célia Oliveira Dos Santos
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE, CEP 50100-130, Brazil
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24
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Lobkowicz L, Ramond A, Sanchez Clemente N, Ximenes RADA, Miranda-Filho DDB, Montarroyos UR, Martelli CMT, de Araújo TVB, Brickley EB. The frequency and clinical presentation of Zika virus coinfections: a systematic review. BMJ Glob Health 2020; 5:e002350. [PMID: 32381652 PMCID: PMC7228501 DOI: 10.1136/bmjgh-2020-002350] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/24/2020] [Accepted: 04/07/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is limited knowledge on the influence of concurrent coinfections on the clinical presentation of Zika virus (ZIKV) disease. METHODS To better understand the types, frequencies and clinical manifestations of ZIKV coinfections, we did a systematic review of four databases (PubMed, Embase, Web of Science, LILACS) without restrictions for studies on ZIKV coinfections confirmed by nucleic acid (quantitative real-time-PCR) testing of ZIKV and coinfecting pathogens. The review aimed to identify cohort, cross-sectional, case series and case report studies that described frequencies and/or clinical signs and symptoms of ZIKV coinfections. Conference abstracts, reviews, commentaries and studies with imprecise pathogen diagnoses and/or no clinical evaluations were excluded. RESULTS The search identified 34 articles from 10 countries, comprising 2 cohort, 10 cross-sectional, 8 case series and 14 case report studies. Coinfections were most frequently reported to have occurred with other arthropod-borne viruses (arboviruses); out of the 213 coinfections described, ZIKV infections co-occurred with chikungunya in 115 cases, with dengue in 68 cases and with both viruses in 19 cases. Other coinfecting agents included human immunodeficiency, Epstein-Barr, human herpes and Mayaro viruses, Leptospira spp, Toxoplasma gondii and Schistosoma mansoni. ZIKV-coinfected cases primarily presented with mild clinical features, typical of ZIKV monoinfection; however, 9% of cases in cohort and cross-sectional studies were reported to experience complications. CONCLUSION Based on the evidence collated in this review, coinfections do not appear to strongly influence the clinical manifestations of uncomplicated ZIKV infections. Further research is needed to confirm whether risk of severe complications is altered when ZIKV infection co-occurs with other infections. PROSPERO REGISTRATION NUMBER CRD42018111023.
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Affiliation(s)
- Ludmila Lobkowicz
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Ramond
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nuria Sanchez Clemente
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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25
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da Silva AS, Carvalho TL, do Ó KP, da Nóbrega DN, Dos Santos Souza R, da Silva Lima VF, Farias ICC, de Mendonça Belmont TF, de Mendonça Cavalcanti MDS, de Barros Miranda-Filho D. Association of the polymorphisms of the genes APOC3 (rs2854116), ESR2 (rs3020450), HFE (rs1799945), MMP1 (rs1799750) and PPARG (rs1801282) with lipodystrophy in people living with HIV on antiretroviral therapy: a systematic review. Mol Biol Rep 2020; 47:4779-4787. [PMID: 32323264 DOI: 10.1007/s11033-020-05441-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/06/2020] [Indexed: 12/30/2022]
Abstract
The aim of this study was to perform a systematic review to identify data reported in the literature concerning the association of APOC3 (rs2854116), ESR2 (rs3020450), HFE (rs1799945), MMP1 (rs1799750) and PPARG (rs1801282) polymorphisms with lipodystrophy in people living with HIV (PLWHIV) on antirretroviral therapy. The research was conducted in six databases and the studies were selected in two steps. First, a search was undertaken in the following electronic databases: PubMed, Science Direct, Medline, World Wide Science, Directory of Open Access Journals, Scielo, Lilacs and Medcarib. The titles and abstracts of 24,859 articles were read to select those that match the elegibilty criteria. Five papers that addressed the association of HAART, lipodystrophy and polymorphisms were selected for the review. There was no association between the polymorphisms of the genes APOC3 and PPARG and lipodystrophy. Another study described an association between the variant allele (G) of HFE and protection concerning the development of lipoatrophy (0.02) when compared with the reference allele (C). On the other hand, the variant allele (T) of the ESR2 gene was associated with the development of lipoatrophy (p = 0.007) when compared with the reference allele (C). In addition, the genotype and the variant allele of the gene MMP1 (2G) were associated with lipodystrophy in PLWHIV on HAART (p = 0.0002 and p = 0.0008, respectively). Therefore, further studies with other populations, involving PLWHIV on HAART are necessary to better understand the role of genetic markers, which may be involved in a predisposition to lipodystrophy.
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Affiliation(s)
| | - Tatiana Lins Carvalho
- Hospital Universitário Oswaldo Cruz (HUOC), Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Kleyton Palmeira do Ó
- Instituto de Pesquisa Aggeu Magalhães (CPqAM), Fundação Oswaldo Cruz (FIOCRUZ), Recife, PE, Brazil
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26
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Wilder-Smith A, Preet R, Brickley EB, Ximenes RADA, Miranda-Filho DDB, Turchi Martelli CM, Araújo TVBD, Montarroyos UR, Moreira ME, Turchi MD, Solomon T, Jacobs BC, Villamizar CP, Osorio L, de Filipps AMB, Neyts J, Kaptein S, Huits R, Ariën KK, Willison HJ, Edgar JM, Barnett SC, Peeling R, Boeras D, Guzman MG, de Silva AM, Falconar AK, Romero-Vivas C, Gaunt MW, Sette A, Weiskopf D, Lambrechts L, Dolk H, Morris JK, Orioli IM, O'Reilly KM, Yakob L, Rocklöv J, Soares C, Ferreira MLB, Franca RFDO, Precioso AR, Logan J, Lang T, Jamieson N, Massad E. ZikaPLAN: addressing the knowledge gaps and working towards a research preparedness network in the Americas. Glob Health Action 2020; 12:1666566. [PMID: 31640505 PMCID: PMC6818126 DOI: 10.1080/16549716.2019.1666566] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Zika Preparedness Latin American Network (ZikaPLAN) is a research consortium funded by the European Commission to address the research gaps in combating Zika and to establish a sustainable network with research capacity building in the Americas. Here we present a report on ZikaPLAN`s mid-term achievements since its initiation in October 2016 to June 2019, illustrating the research objectives of the 15 work packages ranging from virology, diagnostics, entomology and vector control, modelling to clinical cohort studies in pregnant women and neonates, as well as studies on the neurological complications of Zika infections in adolescents and adults. For example, the Neuroviruses Emerging in the Americas Study (NEAS) has set up more than 10 clinical sites in Colombia. Through the Butantan Phase 3 dengue vaccine trial, we have access to samples of 17,000 subjects in 14 different geographic locations in Brazil. To address the lack of access to clinical samples for diagnostic evaluation, ZikaPLAN set up a network of quality sites with access to well-characterized clinical specimens and capacity for independent evaluations. The International Committee for Congenital Anomaly Surveillance Tools was formed with global representation from regional networks conducting birth defects surveillance. We have collated a comprehensive inventory of resources and tools for birth defects surveillance, and developed an App for low resource regions facilitating the coding and description of all major externally visible congenital anomalies including congenital Zika syndrome. Research Capacity Network (REDe) is a shared and open resource centre where researchers and health workers can access tools, resources and support, enabling better and more research in the region. Addressing the gap in research capacity in LMICs is pivotal in ensuring broad-based systems to be prepared for the next outbreak. Our shared and open research space through REDe will be used to maximize the transfer of research into practice by summarizing the research output and by hosting the tools, resources, guidance and recommendations generated by these studies. Leveraging on the research from this consortium, we are working towards a research preparedness network.
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Affiliation(s)
| | - Raman Preet
- Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | | | - Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco , Recife , Brasil.,Departamento de Medicina Interna, Universidade de Pernambuco , Recife , Brasil
| | | | | | | | | | | | - Marília Dalva Turchi
- Instituto de Patologia Tropical e Saúde Publica, Universidade Federal de Goiás , Goiânia , Brasil
| | - Tom Solomon
- Institute of Infection and Global Health, The University of Liverpool , Liverpool , UK
| | - Bart C Jacobs
- Departments of Neurology and Immunology, Erasmus Universitair Medisch Centrum Rotterdam , The Netherlands
| | | | | | | | - Johan Neyts
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute of Medical Research , Leuven , Belgium
| | - Suzanne Kaptein
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute of Medical Research , Leuven , Belgium
| | - Ralph Huits
- Institute of Tropical Medicine , Antwerp , Belgium
| | | | - Hugh J Willison
- Institute of Infection, Immunity & Inflammation, University of Glasgow , Glasgow , UK
| | - Julia M Edgar
- Institute of Infection, Immunity & Inflammation, University of Glasgow , Glasgow , UK
| | - Susan C Barnett
- Institute of Infection, Immunity & Inflammation, University of Glasgow , Glasgow , UK
| | | | - Debi Boeras
- London School of Hygiene & Tropical Medicine , London , UK
| | | | - Aravinda M de Silva
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill , NC , USA
| | - Andrew K Falconar
- London School of Hygiene & Tropical Medicine , London , UK.,Departmento del Medicina, Fundacion Universidad del Norte , Barranquilla , Colombia
| | - Claudia Romero-Vivas
- Departmento del Medicina, Fundacion Universidad del Norte , Barranquilla , Colombia
| | | | - Alessandro Sette
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology , La Jolla , CA , USA.,Department of Medicine, University of California San Diego , La Jolla , CA , USA
| | - Daniela Weiskopf
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology , La Jolla , CA , USA
| | - Louis Lambrechts
- Insect-Virus Interactions Unit, Institut Pasteur, UMR2000, CNRS , Paris , France
| | - Helen Dolk
- Maternal Fetal and Infant Research Centre, Institute of Nursing and Health Research, Ulster University , Newtownabbey , UK
| | - Joan K Morris
- Population Health Research Institute, St George's, University of London , London , UK
| | - Ieda M Orioli
- Associação Técnico-Científica Estudo Colaborativo Latino Americano de Malformações Congênitas (ECLAMC) no Departmento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | | | - Laith Yakob
- London School of Hygiene & Tropical Medicine , London , UK
| | - Joacim Rocklöv
- Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | - Cristiane Soares
- Hospital Federal dos Servidores do Estado , Rio de Janeiro , Brazil
| | | | | | - Alexander R Precioso
- Instituto Butantan , Brazil.,Pediatrics Department, Medical School of University of Sao Paulo , Sao Paulo , Brazil
| | - James Logan
- London School of Hygiene & Tropical Medicine , London , UK
| | - Trudie Lang
- The Global Health Network, Masters and Scholars of the University of Oxford , Oxford , UK
| | - Nina Jamieson
- The Global Health Network, Masters and Scholars of the University of Oxford , Oxford , UK
| | - Eduardo Massad
- Fundacao de Apoio a Universidade de Sao Paulo , Sao Paulo , Brazil.,School of Applied Mathematics, Fundacao Getulio Vargas , Rio de Janeiro , Brazil
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27
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Azevedo LN, Ximenes RADA, Monteiro P, Montarroyos UR, Miranda-Filho DDB. Factors associated to modification of first-line antiretroviral therapy due to adverse events in people living with HIV/AIDS. Braz J Infect Dis 2019; 24:65-72. [PMID: 31835018 PMCID: PMC9392020 DOI: 10.1016/j.bjid.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/10/2019] [Accepted: 11/24/2019] [Indexed: 12/02/2022] Open
Abstract
Antiretroviral therapy (ART) has modified the outcome of patients with HIV infection, providing virological control and reducing mortality. However, there are several reasons as to why patients may discontinue their antiretroviral therapy, with adverse events being one of the main reasons reported in the literature. This is a case-control nested in a cohort of people living with HIV/AIDS, conducted to identify the incidence of ART modification due to adverse events and the associated factors, in two referral services in Recife, Brazil, between 2011 and 2014. Of the modifications occurred in the first year of ART, 25.7% were driven by adverse events. The median time elapsed between initiating ART and the first modification due to adverse events was 70.5 days (95% CI: 26-161 days). The main adverse events were dermatological, neuropsychiatric and gastrointestinal. Dermatological events were the earliest to appear after initiating ART. Efavirenz was the most prescribed and most modified drug during the study period. The group of participants who used zidovudine, lamivudine, and efavirenz had a 2-fold greater chance (adjusted OR: 2.16 95% CI: 1.28-3.65) of switching ART due to adverse events when compared to the group that used tenofovir with lamivudine and efavirenz.
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Affiliation(s)
| | | | - Polyana Monteiro
- Universidade de Pernambuco, Faculdade de Ciências Médicas, Serviço de Doenças Infecciosas, Recife, PE, Brazil
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28
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Ximenes RADA, Miranda-Filho DDB, Brickley EB, Montarroyos UR, Martelli CMT, de Araújo TVB, Rodrigues LC, de Albuquerque MDFPM, de Souza WV, Castanha PMDS, França RFO, Dhália R, Marques ETA. Zika virus infection in pregnancy: Establishing a case definition for clinical research on pregnant women with rash in an active transmission setting. PLoS Negl Trop Dis 2019; 13:e0007763. [PMID: 31589611 PMCID: PMC6797234 DOI: 10.1371/journal.pntd.0007763] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 10/17/2019] [Accepted: 09/08/2019] [Indexed: 12/26/2022] Open
Abstract
Defining cases of Zika virus (ZIKV) infection is a critical challenge for epidemiological research. Due to ZIKV’s overlapping clinical features and potential immunologic cross-reactivity with other flaviviruses and the current lack of an optimal ZIKV-specific diagnostic assay, varying approaches for identifying ZIKV infections have been employed to date. This paper presents the laboratory results and diagnostic criteria developed by the Microcephaly Epidemic Research Group for defining cases of maternal ZIKV infection in a cohort of pregnant women with rash (N = 694) recruited during the declining 2015–2017 epidemic in northeast Brazil. For this investigation, we tested maternal sera for ZIKV by quantitative reverse transcription polymerase chain reaction (qRT-PCR), Immunoglobulin (Ig) M and IgG3 enzyme-linked immunosorbent assays (ELISAs), and Plaque Reduction Neutralization Test (PRNT50). Overall, 23.8% of participants tested positive by qRT-PCR during pregnancy (range of detection: 0–72 days after rash onset). However, the inter-assay concordance was lower than expected. Among women with qRT-PCR-confirmed ZIKV and further testing, only 10.1% had positive IgM tests within 90 days of rash, and only 48.5% had ZIKV-specific PRNT50 titers ≥20 within 1 year of rash. Given the complexity of these data, we convened a panel of experts to propose an algorithm for identifying ZIKV infections in pregnancy based on all available lines of evidence. When the diagnostic algorithm was applied to the cohort, 26.9% of participants were classified as having robust evidence of a ZIKV infection during pregnancy, 4.0% as having moderate evidence, 13.3% as having limited evidence of a ZIKV infection but with uncertain timing, and 19.5% as having evidence of an unspecified flavivirus infection before or during pregnancy. Our findings suggest that integrating longitudinal data from nucleic acid and serologic testing may enhance diagnostic sensitivity and underscore the need for an on-going dialogue regarding the optimization of strategies for defining cases of ZIKV in research. On February 1, 2016, the World Health Organization declared a Public Health Emergency of International Concern following a “cluster of microcephaly cases and other neurological disorders in Brazil” and highlighted the “urgent need” for coordinated international efforts to investigate the relationship between maternal Zika virus (ZIKV) infections and microcephaly. Due to the lack of a standard algorithm, resultant epidemiological investigations have utilized different strategies for defining cases of ZIKV infections in pregnancy. Here, we report the experience of the Microcephaly Epidemic Research Group in Pernambuco, Brazil, in evaluating 694 pregnant women presenting with rash (i.e., a common sign of ZIKV infection) during the 2015–2017 Latin American outbreak. Integrating time-sensitive data from both nucleic acid amplification testing and serologic assays, a panel of experts developed an evidence-graded set of criteria for identifying cases of maternal infection. When applied to the cohort, nearly one-third of the participants were categorized as having robust or moderate evidence of being infected with ZIKV in pregnancy. The classifications described in this investigation will enable scientists to investigate maternal ZIKV infection and estimate the absolute and relative risks of adverse pregnancy outcomes. The results also underscore the importance of on-going efforts to develop robust diagnostic assays for ZIKV.
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Affiliation(s)
- Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, PE, Brasil
- Departamento de Medicina Interna, Universidade de Pernambuco, Recife, PE, Brasil
- * E-mail:
| | | | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | - Laura C. Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Priscila Mayrelle da Silva Castanha
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife, PE, Brasil
| | | | - Rafael Dhália
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Ernesto T. A. Marques
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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Wilder-Smith A, Wei Y, de Araújo TVB, VanKerkhove M, Turchi Martelli CM, Turchi MD, Teixeira M, Tami A, Souza J, Sousa P, Soriano-Arandes A, Soria-Segarra C, Sanchez Clemente N, Rosenberger KD, Reveiz L, Prata-Barbosa A, Pomar L, Pelá Rosado LE, Perez F, Passos SD, Nogueira M, Noel TP, Moura da Silva A, Moreira ME, Morales I, Miranda Montoya MC, Miranda-Filho DDB, Maxwell L, Macpherson CNL, Low N, Lan Z, LaBeaud AD, Koopmans M, Kim C, João E, Jaenisch T, Hofer CB, Gustafson P, Gérardin P, Ganz JS, Dias ACF, Elias V, Duarte G, Debray TPA, Cafferata ML, Buekens P, Broutet N, Brickley EB, Brasil P, Brant F, Bethencourt S, Benedetti A, Avelino-Silva VL, Ximenes RADA, Alves da Cunha A, Alger J. Understanding the relation between Zika virus infection during pregnancy and adverse fetal, infant and child outcomes: a protocol for a systematic review and individual participant data meta-analysis of longitudinal studies of pregnant women and their infants and children. BMJ Open 2019; 9:e026092. [PMID: 31217315 PMCID: PMC6588966 DOI: 10.1136/bmjopen-2018-026092] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Zika virus (ZIKV) infection during pregnancy is a known cause of microcephaly and other congenital and developmental anomalies. In the absence of a ZIKV vaccine or prophylactics, principal investigators (PIs) and international leaders in ZIKV research have formed the ZIKV Individual Participant Data (IPD) Consortium to identify, collect and synthesise IPD from longitudinal studies of pregnant women that measure ZIKV infection during pregnancy and fetal, infant or child outcomes. METHODS AND ANALYSIS We will identify eligible studies through the ZIKV IPD Consortium membership and a systematic review and invite study PIs to participate in the IPD meta-analysis (IPD-MA). We will use the combined dataset to estimate the relative and absolute risk of congenital Zika syndrome (CZS), including microcephaly and late symptomatic congenital infections; identify and explore sources of heterogeneity in those estimates and develop and validate a risk prediction model to identify the pregnancies at the highest risk of CZS or adverse developmental outcomes. The variable accuracy of diagnostic assays and differences in exposure and outcome definitions means that included studies will have a higher level of systematic variability, a component of measurement error, than an IPD-MA of studies of an established pathogen. We will use expert testimony, existing internal and external diagnostic accuracy validation studies and laboratory external quality assessments to inform the distribution of measurement error in our models. We will apply both Bayesian and frequentist methods to directly account for these and other sources of uncertainty. ETHICS AND DISSEMINATION The IPD-MA was deemed exempt from ethical review. We will convene a group of patient advocates to evaluate the ethical implications and utility of the risk stratification tool. Findings from these analyses will be shared via national and international conferences and through publication in open access, peer-reviewed journals. TRIAL REGISTRATION NUMBER PROSPERO International prospective register of systematic reviews (CRD42017068915).
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Affiliation(s)
- Annelies Wilder-Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Yinghui Wei
- Centre for Mathematical Sciences, University of Plymouth, Plymouth, UK
| | | | - Maria VanKerkhove
- Health Emergencies Programme, Organisation mondiale de la Sante, Geneve, Switzerland
| | | | - Marília Dalva Turchi
- Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, Brazil
| | - Mauro Teixeira
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Adriana Tami
- Department of Medical Microbiology, University Medical Center Groningen, Groningen, The Netherlands
| | - João Souza
- Department of Social Medicine, University of São Paulo, São Paulo, Brazil
| | - Patricia Sousa
- Reference Center for Neurodevelopment, Assistance, and Rehabilitation of Children, State Department of Health of Maranhão, Sao Luís, Brazil
| | | | | | | | - Kerstin Daniela Rosenberger
- Department of Infectious Diseases, Section Clinical Tropical Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Ludovic Reveiz
- Evidence and Intelligence for Action in Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Arnaldo Prata-Barbosa
- Department of Pediatrics, D’Or Institute for Research & Education, Rio de Janeiro, Brazil
| | - Léo Pomar
- Department of Obstetrics and Gynecology, Centre Hospitalier de l’Ouest Guyanais, Saint-Laurent du Maroni, French Guiana
| | | | - Freddy Perez
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington, District of Columbia, USA
| | | | - Mauricio Nogueira
- Faculdade de Medicina de Sao Jose do Rio Preto, Department of Dermatologic Diseases, São José do Rio Preto, Brazil
| | - Trevor P. Noel
- Windward Islands Research and Education Foundation, St. George’s University, True Blue Point, Grenada
| | - Antônio Moura da Silva
- Department of Public Health, Universidade Federal do Maranhão – São Luís, São Luís, Brazil
| | | | - Ivonne Morales
- Department of Infectious Diseases, Section Clinical Tropical Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | | | | | - Lauren Maxwell
- Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
| | - Calum N. L. Macpherson
- Windward Islands Research and Education Foundation, St. George’s University, True Blue Point, Grenada
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Zhiyi Lan
- McGill University Health Centre, McGill University, Montréal, Canada
| | | | - Marion Koopmans
- Department of Virology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Caron Kim
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Esaú João
- Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Thomas Jaenisch
- Department of Infectious Diseases, Section Clinical Tropical Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Cristina Barroso Hofer
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paul Gustafson
- Statistics, University of British Columbia, British Columbia, Vancouver, Canada
| | - Patrick Gérardin
- INSERM CIC1410 Clinical Epidemiology, CHU La Réunion, Saint Pierre, Réunion
- UM 134 PIMIT (CNRS 9192, INSERM U1187, IRD 249, Université de la Réunion), Universite de la Reunion, Sainte Clotilde, Réunion
| | | | - Ana Carolina Fialho Dias
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Vanessa Elias
- Sustainable Development and Environmental Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Geraldo Duarte
- Department of Gynecology and Obstetrics, University of São Paulo, São Paulo, Brazil
| | - Thomas Paul Alfons Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - María Luisa Cafferata
- Mother and Children Health Research Department, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | - Pierre Buekens
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Patrícia Brasil
- Instituto de pesquisa Clínica Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Fátima Brant
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sarah Bethencourt
- Facultad de Ciencias de la Salud, Universidad de Carabobo, Valencia, Carabobo, Bolivarian Republic of Venezuela
| | - Andrea Benedetti
- Departments of Medicine and of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Vivian Lida Avelino-Silva
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | | | | | - Jackeline Alger
- Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
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Guedes DL, Medeiros Z, Dionísio da Silva E, Martins de Vasconcelos AV, Santana da Silva M, Lopes da Silva MA, Ramos de Araújo PS, Miranda-Filho DDB. Visceral Leishmaniasis in Hospitalized HIV-Infected Patients in Pernambuco, Brazil. Am J Trop Med Hyg 2018; 99:1541-1546. [PMID: 30328408 PMCID: PMC6283492 DOI: 10.4269/ajtmh.17-0787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 08/14/2018] [Indexed: 12/25/2022] Open
Abstract
Common in four continents, visceral leishmaniasis (VL) is an important but neglected disease. Human immunodeficiency virus (HIV) infection increases the risk of developing VL in people from leishmaniasis-endemic areas, with worse prognosis when there is coinfection. We conducted a cross-sectional study to determine the prevalence of HIV/VL coinfection in patients admitted in three referral hospitals for HIV/acquired immunodeficiency syndrome (AIDS) in Pernambuco, Brazil, and to compare epidemiological, clinical, and laboratory characteristics among HIV/VL coinfected and HIV mono-infected individuals. The sample consisted of HIV patients aged 18 years or more, in a period of data collection of 6 months. We performed four Leishmania tests-polymerase chain reaction (PCR), direct agglutination test, rK39, and latex agglutination test-and individuals with at least one positive test were considered coinfected. The HIV/VL coinfection prevalence we found was 16.9%. We observed large variation in prevalence according to the Leishmania test used, with low coincidence of positive tests. The most frequent symptoms found were weight loss (75.6%), fever (67.6%), and cough (55.3%). When we compared HIV/VL coinfected and HIV mono-infected groups we did not observe statistically significant differences. Low educational level (P = 0.004) and pallor (P = 0.009) were more frequent in the coinfected group. Serum albumin level was higher in coinfected individuals (P = 0.009). It is important to follow-up these individuals to understand the dynamics of VL in people living with HIV. New tests are necessary, ideally differentiating active from latent infection. Testing for VL in people with HIV is important and should be considered as part of the initial investigation in these individuals.
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Affiliation(s)
- Diego Lins Guedes
- Curso de Medicina, Núcleo de Ciências da Vida, Universidade Federal de Pernambuco, Caruaru, Brazil
- Departamento de Parasitologia, Centro de Pesquisa Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil
| | - Zulma Medeiros
- Departamento de Parasitologia, Centro de Pesquisa Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil
- Instituto de Ciências Biológicas, Universidade de Pernambuco, Recife, Brazil
| | - Elis Dionísio da Silva
- Departamento de Parasitologia, Centro de Pesquisa Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil
| | | | - Mariana Santana da Silva
- Departamento de Parasitologia, Centro de Pesquisa Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil
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Souza WVD, Albuquerque MDFPMD, Vazquez E, Bezerra LCA, Mendes ADCG, Lyra TM, Araujo TVBD, Oliveira ALSD, Braga MC, Ximenes RADA, Miranda-Filho DDB, Cabral Silva APDS, Rodrigues L, Martelli CMT. Microcephaly epidemic related to the Zika virus and living conditions in Recife, Northeast Brazil. BMC Public Health 2018; 18:130. [PMID: 29329574 PMCID: PMC5767029 DOI: 10.1186/s12889-018-5039-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 01/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Starting in August 2015, there was an increase in the number of cases of neonatal microcephaly in Northeast Brazil. These findings were identified as being an epidemic of microcephaly related to Zika virus (ZIKV) infection. The present study aims to analyse the spatial distribution of microcephaly cases in Recife (2015–2016), which is in Northeast Brazil, and its association with the living conditions in this city. Methods This was an ecological study that used data from reported cases of microcephaly from the State Health Department of Pernambuco (August 2015 to July 2016). The basic spatial unit of analysis was the 94 districts of Recife. The case definition of microcephaly was: neonates with a head circumference of less than the cut-off point of −2 standard deviations below the mean value from the established Fenton growth curve. As an indicator of the living conditions of the 94 districts, the percentage of heads of households with an income of less than twice the minimum wage was calculated. The districts were classified into four homogeneous strata using the K-means clustering algorithm. We plotted the locations of each microcephaly case over a layer of living conditions. Results During the study period, 347 microcephaly cases were reported, of which 142 (40.9%) fulfilled the definition of a microcephaly case. Stratification of the 94 districts resulted in the identification of four strata. The highest stratum in relation to the living conditions presented the lowest prevalence rate of microcephaly, and the overall difference between this rate and the rates of the other strata was statistically significant. The results of the Kruskal-Wallis test demonstrated that there was a strong association between a higher prevalence of microcephaly and poor living conditions. After the first 6 months of the study period, there were no microcephaly cases recorded within the population living in the richest socio-economic strata. Conclusion This study showed that those residing in areas with precarious living conditions had a higher prevalence of microcephaly compared with populations with better living conditions.
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Affiliation(s)
- Wayner Vieira de Souza
- The Aggeu Magalhães Research Center -FIOCRUZ/PE, Av. Professor Moraes Rego, s/n Cidade Universitária, Recife, Pernambuco, CEP 50.740-465, Brazil.
| | | | - Enrique Vazquez
- Pan American Health Organization, Setor de Embaixadas Norte, Lote 19, Brasília, CEP 70800-400, Brazil
| | | | - Antonio da Cruz Gouveia Mendes
- The Aggeu Magalhães Research Center -FIOCRUZ/PE, Av. Professor Moraes Rego, s/n Cidade Universitária, Recife, Pernambuco, CEP 50.740-465, Brazil
| | - Tereza Maciel Lyra
- The Aggeu Magalhães Research Center -FIOCRUZ/PE, Av. Professor Moraes Rego, s/n Cidade Universitária, Recife, Pernambuco, CEP 50.740-465, Brazil
| | - Thalia Velho Barreto de Araujo
- Universidade Federal de Pernambuco, Av. Prof. Moares Rego, 1235, Cidade Universitáia, Recife, Pernambuco, CEP 50670-901, Brazil
| | - André Luiz Sá de Oliveira
- The Aggeu Magalhães Research Center -FIOCRUZ/PE, Av. Professor Moraes Rego, s/n Cidade Universitária, Recife, Pernambuco, CEP 50.740-465, Brazil
| | - Maria Cynthia Braga
- The Aggeu Magalhães Research Center -FIOCRUZ/PE, Av. Professor Moraes Rego, s/n Cidade Universitária, Recife, Pernambuco, CEP 50.740-465, Brazil
| | - Ricardo Arraes de Alencar Ximenes
- Universidade Federal de Pernambuco, Av. Prof. Moares Rego, 1235, Cidade Universitáia, Recife, Pernambuco, CEP 50670-901, Brazil.,Universidade de Pernambuco, Avenida Agamenon Magalhães, S/N, Santo Amaro, Recife, Pernambuco, CEP 501100-010, Brazil
| | | | | | - Laura Rodrigues
- London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Celina Maria Turchi Martelli
- The Aggeu Magalhães Research Center -FIOCRUZ/PE, Av. Professor Moraes Rego, s/n Cidade Universitária, Recife, Pernambuco, CEP 50.740-465, Brazil.,Universidade Federal de Goiás, Avenida Esperança, S/N, Campus Samambaia, Goiânia, Goiás, CEP 74690-900, Brazil
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Alves DN, Bresani-Salvi CC, Batista JDL, Ximenes RADA, Miranda-Filho DDB, Melo HRLD, Albuquerque MDFPMD. Use of the Coding Causes of Death in HIV in the classification of deaths in Northeastern Brazil. Rev Saude Publica 2017; 51:88. [PMID: 28954163 PMCID: PMC5602274 DOI: 10.11606/s1518-8787.2017051000124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/18/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Describe the coding process of death causes for people living with HIV/AIDS, and classify deaths as related or unrelated to immunodeficiency by applying the Coding Causes of Death in HIV (CoDe) system. METHODS A cross-sectional study that codifies and classifies the causes of deaths occurring in a cohort of 2,372 people living with HIV/AIDS, monitored between 2007 and 2012, in two specialized HIV care services in Pernambuco. The causes of death already codified according to the International Classification of Diseases were recoded and classified as deaths related and unrelated to immunodeficiency by the CoDe system. We calculated the frequencies of the CoDe codes for the causes of death in each classification category. RESULTS There were 315 (13%) deaths during the study period; 93 (30%) were caused by an AIDS-defining illness on the Centers for Disease Control and Prevention list. A total of 232 deaths (74%) were related to immunodeficiency after application of the CoDe. Infections were the most common cause, both related (76%) and unrelated (47%) to immunodeficiency, followed by malignancies (5%) in the first group and external causes (16%), malignancies (12 %) and cardiovascular diseases (11%) in the second group. Tuberculosis comprised 70% of the immunodeficiency-defining infections. CONCLUSIONS Opportunistic infections and aging diseases were the most frequent causes of death, adding multiple disease burdens on health services. The CoDe system increases the probability of classifying deaths more accurately in people living with HIV/AIDS. OBJETIVO Descrever o processo de codificação das causas de morte em pessoas vivendo com HIV/Aids, e classificar os óbitos como relacionados ou não relacionados à imunodeficiência aplicando o sistema Coding Causes of Death in HIV (CoDe). MÉTODOS Estudo transversal, que codifica e classifica as causas dos óbitos ocorridos em uma coorte de 2.372 pessoas vivendo com HIV/Aids acompanhadas entre 2007 e 2012 em dois serviços de atendimento especializado em HIV em Pernambuco. As causas de óbito já codificadas a partir da Classificação Internacional de Doenças foram recodificadas e classificadas como óbitos relacionados e não relacionados à imunodeficiência pelo sistema CoDe. Foram calculadas as frequências dos códigos CoDe das causas do óbito em cada categoria de classificação. RESULTADOS Ocorreram 315 (13%) óbitos no período do estudo; 93 (30%) tinham como causa uma doença definidora de Aids da lista do Centers for Disease Control and Prevention. No total 232 óbitos (74%) foram relacionados à imunodeficiência após aplicar o CoDe. As infecções foram as causas mais comuns, tanto nos óbitos relacionados (76%) como não relacionados (47%) à imunodeficiência, seguindo-se de malignidades (5%) no primeiro grupo e de causas externas (16%), malignidades (12%) e doenças cardiovasculares (11%) no segundo. A tuberculose compreendeu 70% das infecções definidoras de imunodeficiência. CONCLUSÕES Infecções oportunistas e doenças do envelhecimento foram as causas mais frequentes de óbito, imprimindo carga múltipla de doenças aos serviços de saúde. O sistema CoDe aumenta a probabilidade de classificar os óbitos com maior precisão em pessoas vivendo com HIV/Aids.
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Affiliation(s)
- Diana Neves Alves
- Programa de Pós-Graduação em Saúde Pública. Centro de Pesquisas Aggeu Magalhães. Fundação Oswaldo Cruz. Recife, PE, Brasil
| | | | | | - Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Tropical. Universidade Federal de Pernambuco. Recife, PE, Brasil.,Faculdade de Ciências Médicas. Universidade de Pernambuco. Recife, PE, Brasil
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Melo MCVD, Ximenes RADA, Falcão IV, Miranda-Filho DDB. Does rapid HIV testing result in an early diagnosis and reduce the waiting time for patients to receive medical care? AIDS Care 2017; 30:40-46. [PMID: 28764562 DOI: 10.1080/09540121.2017.1360996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The implementation of rapid HIV testing in Brazil began in 2006 for specific groups, and from 2009 was extended to the Counseling and Testing Centers (CTC) in certain Brazilian capitals. The aim of this study was to compare two groups of individuals: those diagnosed with HIV infection by conventional testing and those diagnosed with rapid testing, with respect to: the waiting time before receiving medical care, the time of the first laboratory tests and the virological, immune and clinical status. This is a cross-sectional study to compare a group with individuals diagnosed by conventional testing (2006-2008) and another with those diagnosed by rapid testing (2010-2011).The median time between blood collection and diagnosis of HIV in the conventional test group was 76 days, while in the rapid test group 94.2% of the subjects received their results on the same day of blood collection (p < 0.001). In the conventional test group, the median period of time before the first consultation with an infectious disease specialist was 99 days, and for the rapid test group the time was 14 days (p < 0.001). The median time between the first blood sample and the first results of the CD4 count and viral load was approximately 2.5 times lower in the rapid test group (p < 0.001 for both). The median CD4 count in the rapid test group (472) was higher than in the conventional test group (397) (p = 0.01). The introduction of rapid HIV testing as a diagnostic strategy has reduced the waiting times for medical care and laboratory tests and also allowed earlier diagnosis of HIV infection than with the conventional test.
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Affiliation(s)
| | - Ricardo Arraes de Alencar Ximenes
- a Post-graduation Program in Health Sciences , Universidade de Pernambuco , Recife , Brazil.,b Centro de Ciências da Saúde , Universidade Federal de Pernambuco , Recife , Brazil
| | - Ilka Veras Falcão
- a Post-graduation Program in Health Sciences , Universidade de Pernambuco , Recife , Brazil.,b Centro de Ciências da Saúde , Universidade Federal de Pernambuco , Recife , Brazil
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Carvalho MDCG, Miranda-Filho DDB, van der Linden V, Sobral PF, Ramos RCF, Rocha MÂW, Cordeiro MT, de Alencar SP, Nunes ML. Sleep EEG patterns in infants with congenital Zika virus syndrome. Clin Neurophysiol 2016; 128:204-214. [PMID: 27923187 DOI: 10.1016/j.clinph.2016.11.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 11/01/2016] [Accepted: 11/04/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe sleep EEG patterns of neonates, and infants with microcephaly due to congenital Zika virus (ZikV) syndrome. METHODS A descriptive case series of EEGs performed in a cohort of neonates with microcephaly monitored from October 2015 to February 2016 at a University Hospital in Northeast Brazil. Infants were investigated following an established protocol that includes EEG, neuroimaging studies, PCR and specific antibodies for ZikV detection. RESULTS EEGs (n=37) from 37 infants were reviewed. Age at investigation varied from 1 to 5months (mean=2.6). Diffuse low voltage (n=7), background asymmetry (n=6) and modified hypsarrhythmia with or without burst-suppression (n=11), were the main background abnormalities identified. Interictal EEG abnormalities were identified in 23 recordings (62%) and localized as focal frontal (n=8) or occipital (n=2) spikes/sharp, multifocal spikes/sharp waves (n=13). Electrographic seizures without clinical manifestation were identified in 4 recordings and characterized as focal pseudo rhythmic pattern. Further findings were focal high amplitude slow waves that were registered in the frontal (n=3) or occipital (n=1) regions. CONCLUSIONS Different types of EEG abnormalities were encountered with a predominance of interictal epileptogenic activity and hypsarrhythmia. SIGNIFICANCE Sleep EEGs in congenital Zika virus syndrome are consistently abnormal even in infants who have not yet developed epilepsy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Magda Lahorgue Nunes
- School of Medicine - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) and Brain Institute of Rio Grande do Sul (BraIns), Porto Alegre, Brazil.
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Miranda-Filho DDB, Martelli CMT, Ximenes RADA, Araújo TVB, Rocha MAW, Ramos RCF, Dhalia R, França RFDO, Marques Júnior ETDA, Rodrigues LC. Initial Description of the Presumed Congenital Zika Syndrome. Am J Public Health 2016; 106:598-600. [PMID: 26959258 DOI: 10.2105/ajph.2016.303115] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To provide an initial description of the congenital syndrome presumably associated with infection by Zika virus compared with other syndromes including congenital infections of established etiologies. METHODS We provide an overview of a published case series of 35 cases, a clinical series of 104 cases, and published and unpublished reports of clinical and laboratory findings describing cases diagnosed since the beginning of the epidemic of microcephaly in Brazil. RESULTS About 60% to 70% of mothers report rash during pregnancy; mainly in the first trimester. Principal features are microcephaly, facial disproportionality, cutis girata, hypertonia/spasticity, hyperreflexia, and irritability; abnormal neuroimages include calcifications, ventriculomegaly, and lissencephaly. Hearing and visual abnormalities may be present. CONCLUSIONS Preliminary data suggest that severe congenital abnormalities are linked to Zika virus infection. Cases have severe abnormalities, and although sharing many characteristics with congenital abnormalities associated with other viral infections, abnormalities presumably linked to the Zika virus may have distinguishing characteristics. These severe neurologic abnormalities may result in marked mental retardation and motor disabilities for many surviving offspring. POLICY IMPLICATIONS Affected nations need to prepare to provide complex and costly multidisciplinary care that children diagnosed with this new congenital syndrome will require.
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Affiliation(s)
- Demócrito de Barros Miranda-Filho
- Demócrito de Barros Miranda-Filho, Ricardo Arraes de Alencar Ximenes, Maria Angela Wanderley Rocha, and Regina Coeli Ferreira Ramos are with the University of Pernambuco, Recife, Brazil. Celina Maria Turchi Martelli, Rafael Dhalia, Rafael Freitas de Oliveira França, and Ernesto T. A. Marques Júnior are with The Research Center Aggeu Magalhães (CPqAM)/Oswaldo Cruz Foundation (Fiocruz), Recife. Thalia Velho Barreto Araújo and Ricardo Arraes de Alencar Ximenes are with the Federal University of Pernambuco, Recife. Laura Cunha Rodrigues is with the London School of Hygiene and Tropical Medicine, London, UK
| | - Celina Maria Turchi Martelli
- Demócrito de Barros Miranda-Filho, Ricardo Arraes de Alencar Ximenes, Maria Angela Wanderley Rocha, and Regina Coeli Ferreira Ramos are with the University of Pernambuco, Recife, Brazil. Celina Maria Turchi Martelli, Rafael Dhalia, Rafael Freitas de Oliveira França, and Ernesto T. A. Marques Júnior are with The Research Center Aggeu Magalhães (CPqAM)/Oswaldo Cruz Foundation (Fiocruz), Recife. Thalia Velho Barreto Araújo and Ricardo Arraes de Alencar Ximenes are with the Federal University of Pernambuco, Recife. Laura Cunha Rodrigues is with the London School of Hygiene and Tropical Medicine, London, UK
| | - Ricardo Arraes de Alencar Ximenes
- Demócrito de Barros Miranda-Filho, Ricardo Arraes de Alencar Ximenes, Maria Angela Wanderley Rocha, and Regina Coeli Ferreira Ramos are with the University of Pernambuco, Recife, Brazil. Celina Maria Turchi Martelli, Rafael Dhalia, Rafael Freitas de Oliveira França, and Ernesto T. A. Marques Júnior are with The Research Center Aggeu Magalhães (CPqAM)/Oswaldo Cruz Foundation (Fiocruz), Recife. Thalia Velho Barreto Araújo and Ricardo Arraes de Alencar Ximenes are with the Federal University of Pernambuco, Recife. Laura Cunha Rodrigues is with the London School of Hygiene and Tropical Medicine, London, UK
| | - Thalia Velho Barreto Araújo
- Demócrito de Barros Miranda-Filho, Ricardo Arraes de Alencar Ximenes, Maria Angela Wanderley Rocha, and Regina Coeli Ferreira Ramos are with the University of Pernambuco, Recife, Brazil. Celina Maria Turchi Martelli, Rafael Dhalia, Rafael Freitas de Oliveira França, and Ernesto T. A. Marques Júnior are with The Research Center Aggeu Magalhães (CPqAM)/Oswaldo Cruz Foundation (Fiocruz), Recife. Thalia Velho Barreto Araújo and Ricardo Arraes de Alencar Ximenes are with the Federal University of Pernambuco, Recife. Laura Cunha Rodrigues is with the London School of Hygiene and Tropical Medicine, London, UK
| | - Maria Angela Wanderley Rocha
- Demócrito de Barros Miranda-Filho, Ricardo Arraes de Alencar Ximenes, Maria Angela Wanderley Rocha, and Regina Coeli Ferreira Ramos are with the University of Pernambuco, Recife, Brazil. Celina Maria Turchi Martelli, Rafael Dhalia, Rafael Freitas de Oliveira França, and Ernesto T. A. Marques Júnior are with The Research Center Aggeu Magalhães (CPqAM)/Oswaldo Cruz Foundation (Fiocruz), Recife. Thalia Velho Barreto Araújo and Ricardo Arraes de Alencar Ximenes are with the Federal University of Pernambuco, Recife. Laura Cunha Rodrigues is with the London School of Hygiene and Tropical Medicine, London, UK
| | - Regina Coeli Ferreira Ramos
- Demócrito de Barros Miranda-Filho, Ricardo Arraes de Alencar Ximenes, Maria Angela Wanderley Rocha, and Regina Coeli Ferreira Ramos are with the University of Pernambuco, Recife, Brazil. Celina Maria Turchi Martelli, Rafael Dhalia, Rafael Freitas de Oliveira França, and Ernesto T. A. Marques Júnior are with The Research Center Aggeu Magalhães (CPqAM)/Oswaldo Cruz Foundation (Fiocruz), Recife. Thalia Velho Barreto Araújo and Ricardo Arraes de Alencar Ximenes are with the Federal University of Pernambuco, Recife. Laura Cunha Rodrigues is with the London School of Hygiene and Tropical Medicine, London, UK
| | - Rafael Dhalia
- Demócrito de Barros Miranda-Filho, Ricardo Arraes de Alencar Ximenes, Maria Angela Wanderley Rocha, and Regina Coeli Ferreira Ramos are with the University of Pernambuco, Recife, Brazil. Celina Maria Turchi Martelli, Rafael Dhalia, Rafael Freitas de Oliveira França, and Ernesto T. A. Marques Júnior are with The Research Center Aggeu Magalhães (CPqAM)/Oswaldo Cruz Foundation (Fiocruz), Recife. Thalia Velho Barreto Araújo and Ricardo Arraes de Alencar Ximenes are with the Federal University of Pernambuco, Recife. Laura Cunha Rodrigues is with the London School of Hygiene and Tropical Medicine, London, UK
| | - Rafael Freitas de Oliveira França
- Demócrito de Barros Miranda-Filho, Ricardo Arraes de Alencar Ximenes, Maria Angela Wanderley Rocha, and Regina Coeli Ferreira Ramos are with the University of Pernambuco, Recife, Brazil. Celina Maria Turchi Martelli, Rafael Dhalia, Rafael Freitas de Oliveira França, and Ernesto T. A. Marques Júnior are with The Research Center Aggeu Magalhães (CPqAM)/Oswaldo Cruz Foundation (Fiocruz), Recife. Thalia Velho Barreto Araújo and Ricardo Arraes de Alencar Ximenes are with the Federal University of Pernambuco, Recife. Laura Cunha Rodrigues is with the London School of Hygiene and Tropical Medicine, London, UK
| | - Ernesto Torres de Azevedo Marques Júnior
- Demócrito de Barros Miranda-Filho, Ricardo Arraes de Alencar Ximenes, Maria Angela Wanderley Rocha, and Regina Coeli Ferreira Ramos are with the University of Pernambuco, Recife, Brazil. Celina Maria Turchi Martelli, Rafael Dhalia, Rafael Freitas de Oliveira França, and Ernesto T. A. Marques Júnior are with The Research Center Aggeu Magalhães (CPqAM)/Oswaldo Cruz Foundation (Fiocruz), Recife. Thalia Velho Barreto Araújo and Ricardo Arraes de Alencar Ximenes are with the Federal University of Pernambuco, Recife. Laura Cunha Rodrigues is with the London School of Hygiene and Tropical Medicine, London, UK
| | - Laura Cunha Rodrigues
- Demócrito de Barros Miranda-Filho, Ricardo Arraes de Alencar Ximenes, Maria Angela Wanderley Rocha, and Regina Coeli Ferreira Ramos are with the University of Pernambuco, Recife, Brazil. Celina Maria Turchi Martelli, Rafael Dhalia, Rafael Freitas de Oliveira França, and Ernesto T. A. Marques Júnior are with The Research Center Aggeu Magalhães (CPqAM)/Oswaldo Cruz Foundation (Fiocruz), Recife. Thalia Velho Barreto Araújo and Ricardo Arraes de Alencar Ximenes are with the Federal University of Pernambuco, Recife. Laura Cunha Rodrigues is with the London School of Hygiene and Tropical Medicine, London, UK
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Hazin AN, Poretti A, Di Cavalcanti Souza Cruz D, Tenorio M, van der Linden A, Pena LJ, Brito C, Gil LHV, de Barros Miranda-Filho D, Marques ETDA, Turchi Martelli CM, Alves JGB, Huisman TA. Computed Tomographic Findings in Microcephaly Associated with Zika Virus. N Engl J Med 2016; 374:2193-5. [PMID: 27050112 DOI: 10.1056/nejmc1603617] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Adriano N Hazin
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | - Andrea Poretti
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Ana van der Linden
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
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Souza WVD, Araújo TVBD, Albuquerque MDFPM, Braga MC, Ximenes RADA, Miranda-Filho DDB, Bezerra LCA, Dimech GS, Carvalho PID, Assunção RSD, Santos RH, Oliveira WKD, Rodrigues LC, Martelli CMT. Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases. CAD SAUDE PUBLICA 2016; 32:e00017216. [PMID: 27143306 DOI: 10.1590/0102-311x00017216] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/29/2016] [Indexed: 11/22/2022] Open
Abstract
The increase in the number of reported cases of microcephaly in Pernambuco State, and Northeast Brazil, characterized an epidemic that led the Brazilian Ministry of Health to declare a national public health emergency. The Brazilian Ministry of Health initially defined suspected cases as newborns with gestational age (GA) ≥ 37 weeks and head circumference (HC) ≤ 33cm, but in December 2015 this cutoff was lowered to 32cm. The current study aimed to estimate the accuracy, sensitivity, and specificity of different cutoff points for HC, using ROC curves, with the Fenton and Intergrowth (2014) curves as the gold standard. The study described cases reported in Pernambuco from August 8 to November 28, 2015, according to sex and GA categories. The Fenton and Intergrowth methods provide HC growth curves according to GA and sex, and microcephaly is defined as a newborn with HC below the 3rd percentile in these distributions. Of the 684 reported cases, 599 were term or post-term neonates. For these, the analyses with ROC curves show that according to the Fenton criterion the cutoff point with the largest area under the ROC curve, with sensitivity greater than specificity, is 32cm for both sexes. Using the Intergrowth method and following the same criteria, the cutoff points are 32cm and 31.5cm for males and females, respectively. The cutoff point identified by the Fenton method (32cm) coincided with the Brazilian Ministry of Health recommendation. Adopting Intergrowth as the standard, the choice would be 32cm for males and 31.5cm for females. The study identified the need to conduct critical and on-going analyses to evaluate cutoff points, including other characteristics for microcephaly case definition.
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Affiliation(s)
| | | | | | | | | | | | | | - George Santiago Dimech
- Secretaria Executiva de Vigilância em Saúde, Secretaria Estadual de Saúde de Pernambuco, Recife, Brasil
| | | | | | - Roselene Hans Santos
- Secretaria Executiva de Vigilância em Saúde, Secretaria Estadual de Saúde de Pernambuco, Recife, Brasil
| | | | - Laura Cunha Rodrigues
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
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Corrêa-Lima ARM, de Barros Miranda-Filho D, Valença MM, Andrade-Valença L. Risk Factors for Acute Symptomatic Seizure in Bacterial Meningitis in Children. J Child Neurol 2015; 30:1182-5. [PMID: 25387548 DOI: 10.1177/0883073814555907] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/11/2014] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate the association between clinical and laboratory parameters at admission and the occurrence of in-hospital symptomatic seizures in children with acute bacterial meningitis in Brazil. A retrospective case-control study in 270 children with confirmed bacterial meningitis, aged from 1 month to 14 years, was conducted between January 2004 and December 2008. Associations with the occurrence of in-hospital epileptic seizures were adjusted using stepwise multiple logistic regression analysis. Sixty-seven children suffered at least one in-hospital epileptic seizure. After multivariate analysis, the independent predictors considered for in-hospital epileptic seizures were as follows: age less than 2 years (odds ratio = 0.97; 95% confidence interval 0.97-0.98), pneumococcal etiology (odds ratio = 4.55; 95% confidence interval 1.88-11.0); altered mental status (odds ratio = 3.47; 95% confidence interval 1.66-7.26) and cerebrospinal fluid leukocyte count below 1000 cells (odds ratio = 2.14; 95% confidence interval 0.99-4.60). Mortality was higher in patients with intrahospital epileptic seizures compared to those without (25/67 [37.3%] vs 9/203 [4.43%], P < .001].
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Affiliation(s)
| | | | | | - Luciana Andrade-Valença
- Department of Neurology, University of Pernambuco, Recife, Brazil Department of Neurosurgery and Neurology, Federal University of Pernambuco, Brazil
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Batista JDL, Militão de Albuquerque MDFP, Ximenes RADA, Miranda-Filho DDB, Lacerda de Melo HR, Maruza M, Moura LV, Pinto da Costa Ferraz EJS, Rodrigues LC. Prevalence and socioeconomic factors associated with smoking in people living with HIV by sex, in Recife, Brazil. Rev Bras Epidemiol 2014; 16:432-43. [PMID: 24142014 DOI: 10.1590/s1415-790x2013000200018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 05/23/2012] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Smoking is the leading cause of preventable death in the world. The prevalence of smoking is higher in people infected with HIV than in the general population. Although it is biologically plausible that smoking increases the morbidity and mortality of people living with HIV/AIDS, few studies in developing countries have analyzed the determinants and consequences of smoking in HIV infected people. OBJECTIVE To estimate the prevalence of smoking and identify the socioeconomic factors associated with smoking and smoking cessation in patients with HIV by sex. METHODS A cross-sectional study was conducted with baseline data, obtained from an ongoing prospective cohort study of patients with HIV attending two referral centers in Recife, Northeast Region of Brazil, between July 2007 and October 2009. RESULTS The prevalence of current smoking was 28.9%. For both sexes, smoking was independently associated with heavy alcohol drinking and marijuana use. Among women, smoking was associated with living alone, not being married and illiteracy; and among men, being 40 years or older, low income and using crack. Compared with ex-smokers, current smokers were younger and more likely to be unmarried, heavy drinkers and marijuana users. CONCLUSIONS It is important to incorporate smoking cessation interventions for the treatment of heavy alcohol drinkers and marijuana users with HIV/AIDS, which may increase life expectancy and quality of life, as smoking is related to risk of death, relapse of tuberculosis, and non communicable diseases.
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Batista JDL, Albuquerque MDFPMD, Santos ML, Miranda-Filho DDB, Lacerda HR, Maruza M, Moura LV, Coimbra I, Ximenes RADA. Association between smoking, crack cocaine abuse and the discontinuation of combination antiretroviral therapy in Recife, Pernambuco, Brazil. Rev Inst Med Trop Sao Paulo 2014; 56:127-32. [PMID: 24626414 PMCID: PMC4085845 DOI: 10.1590/s0036-46652014000200007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 08/05/2013] [Indexed: 11/22/2022] Open
Abstract
Despite the effectiveness of combination antiretroviral therapy in the
treatment of people living with HIV/AIDS (PLWHA), nonadherence to medication has
become a major threat to its effectiveness. This study aimed to estimate the
prevalence of self-reported irregular use of antiretroviral therapy and the factors
associated with such an irregularity in PLWHA. A cross-sectional study of PLWHA who
attended two referral centers in the city of Recife, in Northeastern Brazil, between
June 2007 and October 2009 was carried out. The study analyzed socioeconomic factors,
social service support and personal habits associated with nonadherence to
antiretroviral therapy, adjusted by multivariable logistic regression analysis. The
prevalence of PLWHA who reported irregular use of combination antiretroviral therapy
(cART) was 25.7%. In the final multivariate model, the irregular use of cART was
associated with the following variables: being aged less than 40 years (OR =
1.66, 95%-CI: 1.29-2.13), current smokers (OR = 1.76, 95%-CI: 1.31-2.37) or
former smokers (OR = 1.43, 95%-CI: 1.05-1.95), and crack cocaine users (OR
= 2.79, 95%-CI: 1.24-6.32). Special measures should be directed towards each
of the following groups: individuals aged less than 40 years, smokers, former smokers
and crack cocaine users. Measures for giving up smoking and crack cocaine should be
incorporated into HIV-control programs in order to promote greater adherence to
antiretroviral drugs and thus improve the quality of life and prolong life
expectancy.
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Affiliation(s)
- Joanna d'Arc Lyra Batista
- Universidade Federal de Pernambuco, RecifePernambuco, Brazil, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Marcela Lopes Santos
- Centro de Pesquisas Aggeu Magalhães/FIOCRUZ, RecifePernambuco, Brazil, Centro de Pesquisas Aggeu Magalhães/FIOCRUZ, Recife, Pernambuco, Brazil
| | | | - Heloísa Ramos Lacerda
- Universidade Federal de Pernambuco, RecifePernambuco, Brazil, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Magda Maruza
- Hospital Correia Picanço, Secretaria de Saúde, RecifePernambuco, Brazil, Hospital Correia Picanço, Secretaria de Saúde, Recife, Pernambuco, Brazil
| | - Libia Vilela Moura
- Universidade Federal de Pernambuco, RecifePernambuco, Brazil, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Isabella Coimbra
- Universidade de Pernambuco, RecifePernambuco, Brazil, Universidade de Pernambuco, Recife, Pernambuco, Brazil
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Lacerda HR, Falcão MDCC, de Albuquerque VMG, Zírpoli JC, Miranda-Filho DDB, de Albuquerque MDFPM, Montarroyos U, Ximenes RADA. Association of inflammatory cytokines and endothelial adhesion molecules with immunological, virological, and cardiometabolic disease in HIV-infected individuals. J Interferon Cytokine Res 2013; 34:385-93. [PMID: 24359573 DOI: 10.1089/jir.2013.0029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Elevated levels of inflammatory and endothelial biomarkers are related to chronic diseases, cancers, and cardiovascular disease. This study aimed at evaluating the association of inflammatory cytokines and endothelial adhesion molecules with immunological, virological, and cardiometabolic disease in HIV-infected individuals. A cross-sectional study was initiated to evaluate the association of CD4 lymphocyte count, viral load, antiretroviral therapy, and metabolic and cardiovascular disease with inflammatory cytokines [interleukin (IL)-1β, IL-6, and tumor necrosis factor α (TNF-α)], adhesion molecules [soluble intercellular Adhesion Molecule 1 (sICAM) and soluble Vascular Adhesion Molecule 1 (sVCAM)], and highsensitive C-reactive protein (hs-CRP) levels in 125 HIV-infected patients. The associations between independent variables and biomarkers were analyzed by means of multivariate logistic regression. A viral load ≥100,000 copies/mL had a stronger association with high levels of sVCAM-1 (P=0.026; OR=2.54; CI=1.12-5.78) and TNF-α (P=0.048; OR=2.42; CI=1.01-5.85) than the current viral load using a multivariate analysis. Antiretroviral treatment was associated with lower levels of sVCAM-1 (P=0.20; OR=0.20; CI=0.05-0.78), TNF-α (P=0.060; OR=0.22; CI=0.05-1.07), and hs-CRP (P=0.093; OR=0.44; CI=0.17-1.15). CD4 counts <200 cells/mm(3) were associated with high IL-6 levels (P=0.013; OR=3.17; CI=1.27-7.91); however, antiretroviral treatment was not associated with IL-6 levels. Metabolic syndrome was associated with high hs-CRP levels, systolic hypertension was associated with IL-6 levels, and family history of coronary disease was associated with TNF-α levels. High biomarker levels were associated not only with viral and immunological characteristics but also with cardiometabolic factors. The maximum viral load attained was an important risk factor for high levels of TNF-α and sVCAM-1. Treatment protected patients from high biomarker levels, except IL-6.
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Affiliation(s)
- Heloísa Ramos Lacerda
- 1 Postgraduate Program on Tropical Medicine, Federal University of Pernambuco , Recife, Brazil
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de Fátima Magalhães Acioly Mendizabal M, Bezerra PC, Guedes DL, Cabral DBC, de Barros Miranda-Filho D. Prognostic indicators in bacterial meningitis: a case–control study. Braz J Infect Dis 2013; 17:538-44. [PMID: 23835007 PMCID: PMC9425123 DOI: 10.1016/j.bjid.2013.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/07/2013] [Accepted: 01/08/2013] [Indexed: 12/02/2022] Open
Abstract
This was a case–control study to identify prognostic indicators of bacterial meningitis in a reference hospital in Pernambuco/Brazil. The data were collected from charts of 294 patients with bacterial meningitis between January 2000 and December 2004. Variables were grouped in biological, clinical, laboratory and etiologic agent/treatment. Variables selected in each step were grouped and adjusted for age. Two models were created: one containing clinical variables (clinical model) and other containing laboratory variables (laboratory model). In the clinical model the variables associated with death due to bacterial meningitis were dyspnea (p = 0.006), evidence of shock (p = 0.051), evidence of altered mental state (p = 0.000), absence of headache (p = 0.008), absence of vomiting (p = 0.052), and age ≥40 years old (p = 0.013). In the laboratory model, the variables associated with death due to bacterial meningitis were positive blood cultures (p = 0.073) and thrombocytopenia (p = 0.019). Identification of prognostic indicators soon after admission may allow early specific measures, like admission of patients with higher risk of death to Intensive Care Units.
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Affiliation(s)
| | | | | | | | - Demócrito de Barros Miranda-Filho
- Faculdade de Ciências Médicas, UPE, Recife, PE, Brazil
- Corresponding author at: Rua Santo Elias, 175, 1001, Espinheiro, Recife, PE, 52020-090, Brazil.
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Albuquerque VMG, Zírpoli JC, de Barros Miranda-Filho D, Albuquerque MDFPM, Montarroyos UR, de Alencar Ximenes RA, Lacerda HR. Risk factors for subclinical atherosclerosis in HIV-infected patients under and over 40 years: a case-control study. BMC Infect Dis 2013; 13:274. [PMID: 23773229 PMCID: PMC3686657 DOI: 10.1186/1471-2334-13-274] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 06/14/2013] [Indexed: 01/29/2023] Open
Abstract
Background Cardiovascular diseases (CVD) are a major cause of death in people with AIDS. Factors contributing to atherosclerosis include traditional risk factors, antiretrovirals and inflammatory factors related to HIV infection. This study set out to compare risk factors associated with subclinical atherosclerosis in individuals under and over 40 years of age. Methods Case–control study with 697 HIV/AIDS individuals without HAART or who remain on their first antiretroviral regimen. Of the total, 351 individuals under 40 years and 346 over 40 years were analyzed separately. Subclinical atherosclerosis was assessed by carotid intima-media thickness, using B-mode ultrasound. Multivariate logistic regression was performed to find predictors of subclinical atherosclerosis in the entire group. Subsequent analysis excluded patients with major risk factors for CVD. Magnitudes of associations were expressed by odds ratio (OR) statistical significance, using a 95% confidence interval and p-value <0.05. Results In the <40 years group subclinical atherosclerosis was associated with male gender (OR: 2.77, 95% CI: 1.43–5.34), nonwhite race (OR: 3.01, 95% CI: 1.23-6.53), obesity (OR: 5.13, 95% CI: 1.79–14.7) and metabolic syndrome (OR: 3.30, 95% CI: 1.44–7.58). In the group ≥40 years predictors of subclinical atherosclerosis were overweight and obesity (OR = 2.53, 95% CI, 0.85–7.54), current CD4 ≥350 cells/mL (OR: 2.81, 95% CI: 1.22–6.47) and NNRTI use ≥ 5 years (OR: 2.65, 95% CI: 1.10-6.37) or PI use >5 years (OR: 1.81, 95% CI: 0.38-8.59). In the multivariate model excluding patients with major risk factors for CVD, age, male sex and nonwhite race were associated with subclinical atherosclerosis in the <40 y group, while in the ≥40 y group, age, HIV viral load >10,000 copies and the use of NNRTI (OR: 7.60, 95% CI: 1.61-35.8) or PI ≥5 years (OR: 3.62, 95% CI: 0.48-26.8) were associated with subclinical atherosclerosis. Conclusions In young people the fight against obesity and metabolic syndrome is the main aim in the prevention of CVD. In individuals aged ≥40 y, the prevention of obesity is also of great importance. Moreover, the effects of uncontrolled viremia and the prolonged use of HAART appear to be more harmful in the older group.
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Batista JDL, de Albuquerque MDFPM, Maruza M, Ximenes RADA, Santos ML, Montarroyos UR, de Barros Miranda-Filho D, Lacerda HR, Rodrigues LC. Incidence and risk factors for tuberculosis in people living with HIV: cohort from HIV referral health centers in Recife, Brazil. PLoS One 2013; 8:e63916. [PMID: 23675515 PMCID: PMC3651200 DOI: 10.1371/journal.pone.0063916] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 04/08/2013] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To identify the incidence of and risk factors for tuberculosis in people living with HIV (PLHIV). DESIGN Observational, prospective cohort study. METHODS A total of 2069 HIV-infected patients was observed between July 2007 and December 2010. The Kaplan-Meier method was used to estimate the probability of survival free of tuberculosis, and Cox regression analysis to identify risk factors associated with the development of tuberculosis. RESULTS Survival free of tuberculosis (TB) was 91%. The incidence rate of tuberculosis was 2.8 per 100 persons/years. Incidence of tuberculosis was higher when subjects had CD4 cell count <200 cells/mm(3); were not on antiretroviral therapy; in those who had, a body mass index <18.5 kg/m(2), anemia (or were not tested for it), were illiterate or referred previous tuberculosis treatment at entry into the cohort. Those not treated for latent TB infection had a much higher risk (HR = 7.9) of tuberculosis than those with a negative tuberculin skin test (TST). Having a TST≥5 mm but not being treated for latent TB infection increased the risk of incident tuberculosis even in those with a history of previous tuberculosis. CONCLUSIONS Preventive actions to reduce the risk of TB in people living with HIV should include an appropriate HAART and treatment for latent TB infection in those with TST≥5 mm. The actions towards enabling rigorous implementation of treatment of latent TB infection and targeting of PLHIV drug users both at the individual and in public health level can reduce substantially the incidence of TB in PLHIV.
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Falcão MDCBDA, Zírpoli JC, Albuquerque VMD, Markman Filho B, Araújo NAMD, Falcão CA, Miranda-Filho DDB, Ximenes RADA, Albuquerque MDFMD, Lacerda HR. Association of biomarkers with atherosclerosis and risk for coronary artery disease in patients with HIV. Arq Bras Cardiol 2012; 99:971-8. [PMID: 23080223 DOI: 10.1590/s0066-782x2012005000093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 05/30/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The massive use of Highly-Active Antiretroviral Therapy (HAART) in individuals with human immunodeficiency virus (HIV) coincided with an increase in cardiovascular disease, a major cause of morbidity and mortality in this group. OBJECTIVE To determine the frequency of carotid atherosclerosis and the association between biomarker levels and carotid intimal-medial thickening in HIV-positive individuals treated for HIV at referral centers in Pernambuco. METHODS This was a cross-sectional study of 122 HIV-positive patients. Subclinical carotid atherosclerosis was considered with the presence of increased intimal-medial thickness of the common carotid artery > 0.8 mm or plaques in the carotid ultrasound. The following inflammatory biomarkers were analyzed: IL6, IL1-β, TNF-α, high-sensitivity CRP, sVCAM-1 and sICAM-1. RESULTS Of the 122 patients analyzed, most were men (60.7%) aged > 40 years (57.4%) receiving HAART (81.1%). The prevalence of atherosclerosis was 42.6% (52 cases). Patients older than 40 years and intermediate or high Framingham score were more likely to develop atherosclerosis at the univariate analysis. Age older than 40 years (OR = 6.57, 95%CI: 2.66 to 16.2, p = 0.000), male gender (OR = 2.76, 95%CI: 1.12 to 6.79, p = 0.027) and presence of syndrome metabolic (OR = 2.27, 95%CI: 0.94 to 5.50, p = 0.070) were associated with atherosclerosis at the multivariate analysis. Elevated levels of inflammatory cytokines and adhesion molecules were not associated with the presence of atherosclerosis. CONCLUSION There was no association between inflammatory biomarkers, adhesion molecules and presence of carotid atherosclerosis. However, a higher chance of subclinical atherosclerosis was observed in men, those older than 40 years, with intermediate / high Framingham score or metabolic syndrome.
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Cavalcanti ATDAE, Medeiros Z, Lopes F, Andrade LDD, Ferreira VDM, Magalhães V, Miranda-Filho DDB. Diagnosing visceral leishmaniasis and HIV/AIDS co-infection: a case series study in Pernambuco, Brazil. Rev Inst Med Trop Sao Paulo 2012; 54:43-7. [PMID: 22370753 DOI: 10.1590/s0036-46652012000100008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Accepted: 12/14/2011] [Indexed: 11/21/2022] Open
Abstract
HIV/AIDS-associated visceral leishmaniasis may display the characteristics of an aggressive disease or without specific symptoms at all, thus making diagnosis difficult. The present study describes the results of diagnostic tests applied to a series of suspected VL cases in HIV-infected/AIDS patients admitted in referral hospitals in Pernambuco, Brazil. From a total of 14 eligible patients with cytopenias and/or fever of an unknown etiology, and indication of bone marrow aspirate, 10 patients were selected for inclusion in the study. Diagnosis was confirmed by the following examinations: Leishmania detection in bone marrow aspirate, direct agglutination test, indirect immunofluorescence, rK39 dipstick test, polymerase chain reaction and latex agglutination test. Five out of the ten patients were diagnosed with co-infection. A positive direct agglutination test was recorded for all five co-infected patients, the Leishmania detection and latex agglutination tests were positive in four patients, the rK39 dipstick test in three, the indirect immunofluorescence in two and a positive polymerase chain reaction was recorded for one patient. This series of cases was the first to be conducted in Brazil using this set of tests in order to detect co-infection. However, no consensus has thus far been reached regarding the most appropriate examination for the screening and monitoring of this group of patients.
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Coimbra I, Maruza M, Militão-Albuquerque MDFP, Moura LV, Diniz GTN, Miranda-Filho DDB, Lacerda HR, Rodrigues LC, Ximenes RADA. Associated factors for treatment delay in pulmonary tuberculosis in HIV-infected individuals: a nested case-control study. BMC Infect Dis 2012; 12:208. [PMID: 22958583 PMCID: PMC3490888 DOI: 10.1186/1471-2334-12-208] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 08/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The delay in initiating treatment for tuberculosis (TB) in HIV-infected individuals may lead to the development of a more severe form of the disease, with higher rates of morbidity, mortality and transmissibility. The aim of the present study was to estimate the time interval between the onset of symptoms and initiating treatment for TB in HIV-infected individuals, and to identify the factors associated to this delay. METHODS A nested case-control study was undertaken within a cohort of HIV-infected individuals, attended at two HIV referral centers, in the state of Pernambuco, Brazil. Delay in initiating treatment for TB was defined as the period of time, in days, which was greater than the median value between the onset of cough and initiating treatment for TB. The study analyzed biological, clinical, socioeconomic, and lifestyle factors as well as those related to HIV and TB infection, potentially associated to delay. The odds ratios were estimated with the respective confidence intervals and p-values. RESULTS From a cohort of 2365 HIV-infected adults, 274 presented pulmonary TB and of these, 242 participated in the study. Patients were already attending 2 health services at the time they developed a cough (period range: 1 - 552 days), with a median value of 41 days. Factors associated to delay were: systemic symptoms asthenia, chest pain, use of illicit drugs and sputum smear-negative. CONCLUSION The present study indirectly showed the difficulty of diagnosing TB in HIV-infected individuals and indicated the need for a better assessment of asthenia and chest pain as factors that may be present in co-infected patients. It is also necessary to discuss the role played by negative sputum smear results in diagnosing TB/HIV co-infection as well as the need to assess the best approach for drug users with TB/HIV.
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Affiliation(s)
- Isabella Coimbra
- Universidade Federal de Pernambuco, Rua Antonio Rabelo 245, Madalena, Recife, PE, Brazil.
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Conrado T, Miranda-Filho DDB, Ximenes RADA, Albuquerque MDF, Lacerda HR, Ramos RCF, Araújo PSRD, Montarroyos U, Bandeira F. Vitamin D Deficiency in HIV-Infected Women on Antiretroviral Therapy Living in the Tropics. ACTA ACUST UNITED AC 2011; 10:239-45. [PMID: 21521809 DOI: 10.1177/1545109711399657] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The effects of HIV/AIDS and antiretroviral drugs on vitamin D metabolism are still mostly unknown. This was a cross-sectional study to estimate the prevalence of vitamin D deficiency and identify its association with the clinical and metabolic parameters among 214 HIV-positive female patients on antiretroviral therapy (ART) in Brazil. The prevalence of vitamin D deficiency (< 30 ng/ml) was 40.65% (87/214). Hypercholesterolemia, high LDL-c, duration of use of current antiretroviral regimen, hypertriglyceridemia, body mass index, age, hypertension, time with AIDS ≥ 10 years and hyperglycemia were selected for multivariate analysis (p < 0.20). After this analysis, hypercholesterolemia and use of current antiretroviral regimen ≥ 3 years remained independently associated with vitamin D deficiency. There was an inverse statistically significant correlation between total cholesterol and serum 25(OH)D levels. High prevalence of vitamin D deficiency was found among HIV-positive women on ART and was independently associated with its prolonged use and with hypercholesterolemia.
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Affiliation(s)
- Tereza Conrado
- 1Department of Mother and Child Health, University of Pernambuco, School of Medical Sciences, Recife, Pernambuco, Brazil
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Wilheim AB, Miranda-Filho DDB, Nogueira RA, Rêgo RSDM, Lima KDM, Pereira LMMB. The resistance to fluconazole in patients with esophageal candidiasis. Arq Gastroenterol 2009; 46:32-7. [PMID: 19466307 DOI: 10.1590/s0004-28032009000100011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 12/22/2008] [Indexed: 11/22/2022]
Abstract
CONTEXT Esophageal candidiasis is often observed in patients with risk factors for its development and fluconazole is the therapeutic choice for the treatment of this disease. OBJECTIVES To determine its frequency, by performing upper digestive endoscopy; to determine Candida species involved in its pathogenesis and verify their distribution according with the predisposing factors and to determine susceptibility to fluconazole in the samples. METHODS From March 2006 to April 2007, all patients submitted to esophagogastroduodenoscopy at the Digestive Endoscopy Unit in the Oswaldo Cruz University Hospital, Recife, PE, Brazil, were eligible for the study. Samples were collected from patients who presented lesions consistent with esophageal candidiasis in order to identify Candida species and verify their susceptibility to fluconazole. The predisposing factors for the occurrence of esophageal candidiasis were described. RESULTS Of 2,672 patients referred to upper endoscopy at the Digestive Endoscopy Unit, 40 (1.5%) had endoscopic findings compatible with esophageal candidiasis. The average age was 49.1 years. Twenty one patients (52.5%) were less than 50 years old, of which 82.6% were infected with HIV. Most of them (52.5%) were males and 65.0% were inpatients. Diseases were identified in 90% of the patients and 21 (52.5%) were HIV positive. Concerning endoscopic findings, severe forms of esophagitis were found in 50% of the patients with CD4 count <200. Non-albicans Candida species were isolated in 22.7% of HIV positive and in 45% HIV negative patients. A total of 6 (14.28%) samples were resistant to fluconazole, while 2 (4.76%) samples had dose depending susceptibility to this drug. CONCLUSIONS Esophageal candidiasis prevalence was low, although within the results described by other authors. Male and inpatients were the most affected. The species isolated varied according to the characteristics of each group studied. Both, resistance and dose-depending susceptibility to fluconazole were considered high.
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Affiliation(s)
- Ana Botler Wilheim
- Department of Internal Medicine, School of Medical Sciences, University of Pernambuco, Recife, PE, Brazil.
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Miranda-Filho DDB, Ximenes RADA, Barone AA, Vaz VL, Vieira AG, Albuquerque VMG. Randomised controlled trial of tetanus treatment with antitetanus immunoglobulin by the intrathecal or intramuscular route. BMJ 2004; 328:615. [PMID: 15003976 PMCID: PMC381133 DOI: 10.1136/bmj.38027.560347.7c] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the effect of intrathecal therapy with human antitetanus immunoglobulin on clinical progression of and mortality from tetanus. DESIGN Randomised controlled trial. SETTING Intensive care unit of a university hospital, Pernambuco, Brazil. PARTICIPANTS 120 patients with tetanus allocated to antitetanus immunoglobulin by either the intrathecal and intramuscular route (n = 58) or the intramuscular route (n = 62; control group). MAIN OUTCOME MEASURES Clinical progression of disease, duration of hospital stay, duration of occurrence of spasms, complications, respiratory infection, respiratory failure or mechanical ventilation, duration of respiratory assistance, and mortality. RESULTS Patients in the treatment group showed a better clinical progression than those in the control group (chi2 for trend 7.752, P = 0.005; difference in proportion of patients with improvement 20%, 95% confidence interval 4% to 35%). The duration of occurrence of spasms, hospital stay, and respiratory assistance were all shorter in patients the treatment group: respectively, 14.96, 0.0001 (difference in proportion of patients with spasms lasting < or = 10 days 36%, 18% to 55%); 4.56, 0.03; and 6.56, 0.01 (proportion of patients who needed assistance for < or = 10 days 69.2% in the treatment group and 30.8% in the control group (difference 38%, 12% to 65%)). CONCLUSION Patients treated with antitetanus immunoglobulin by the intrathecal route show better clinical progression than those treated by the intramuscular route.
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Affiliation(s)
- Demócrito de Barros Miranda-Filho
- Department of Clinical Medicine, Faculty of Medical Sciences, University of Pernambuco, Santo Amaro, 50100.130, Recife, Pernambuco, Brazil
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