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Silva ETT, Furtado FB, da Silveira RA, Tasca KI, Silva CN, Godoy AT, de Moraes LN, Hong MV, Alves CG, Simões RP, Kubo AMS, Fortaleza CMCB, Pereira-Lima MC, Valente GT, Grotto RMT. Saliva as a Biological Fluid in SARS-CoV-2 Detection. Diagnostics (Basel) 2024; 14:922. [PMID: 38732336 PMCID: PMC11083664 DOI: 10.3390/diagnostics14090922] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The polymerase chain reaction of upper respiratory tract swab samples was established as the gold standard procedure for diagnosing SARS-CoV-2 during the COVID pandemic. However, saliva collection has attracted attention as an alternative diagnostic collection method. The goal of this study was to compare the use of saliva and nasopharyngeal swab (NPS) samples for the detection of SARS-CoV-2. METHODS Ninety-nine paired samples were evaluated for the detection of SARS-CoV-2 by saliva and swab for a qualitative diagnosis and quantitative comparison of viral particles. Furthermore, the detection limits for each sample collection technique were determined. The cycle threshold (CT) values of the saliva samples, the vaccination status, and the financial costs associated with each collection technique were compared. RESULTS The results showed qualitative equivalence in diagnosis (96.96%) comparing saliva and swab collection, although there was low quantitative agreement. Furthermore, the detection limit test demonstrated equivalence for both collection methods. We did not observe a statistically significant association between CT values and vaccination status, indicating that the vaccine had no influence on viral load at diagnosis. Finally, we observed that the use of saliva incurs lower financial costs and requires less use of plastic materials, making it more sustainable. CONCLUSIONS These findings support the adoption of saliva collection as a feasible and sustainable alternative to the diagnosis of COVID-19.
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Affiliation(s)
- Emily Thalia Teixeira Silva
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
| | - Fabiana Barcelos Furtado
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
| | - Rosana Antunes da Silveira
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
| | - Karen Ingrid Tasca
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (K.I.T.); (M.V.H.); (C.G.A.); (C.M.C.B.F.)
| | - Cristiane Nonato Silva
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
| | - Amanda Thais Godoy
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
| | - Leonardo Nazario de Moraes
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
- Department of Bioprocess and Biotechnology, School of Agriculture, São Paulo State University (Unesp), Botucatu 18618-689, Brazil;
| | - Michelle Venancio Hong
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (K.I.T.); (M.V.H.); (C.G.A.); (C.M.C.B.F.)
| | - Camila Gonçalves Alves
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (K.I.T.); (M.V.H.); (C.G.A.); (C.M.C.B.F.)
| | - Rafael Plana Simões
- Department of Bioprocess and Biotechnology, School of Agriculture, São Paulo State University (Unesp), Botucatu 18618-689, Brazil;
| | - Agatha Mayume Silva Kubo
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
| | - Carlos Magno Castelo Branco Fortaleza
- Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (K.I.T.); (M.V.H.); (C.G.A.); (C.M.C.B.F.)
| | - Maria Cristina Pereira-Lima
- Department of Neurology, Psychology and Psychiatry, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil;
| | - Guilherme Targino Valente
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
| | - Rejane Maria Tommasini Grotto
- Laboratory of Applied Biotechnology, Medical School, São Paulo State University (Unesp), Botucatu 18618-689, Brazil; (E.T.T.S.); (F.B.F.); (R.A.d.S.); (C.N.S.); (A.T.G.); (L.N.d.M.); (A.M.S.K.)
- Department of Bioprocess and Biotechnology, School of Agriculture, São Paulo State University (Unesp), Botucatu 18618-689, Brazil;
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Cristelli MP, Fortaleza CMCB, Pereira JFCA, Taddeo JB, Viana LA, Requião-Moura LR, Chow CYZ, Nakamura MR, Tedesco-Silva H, Medina-Pestana J. Excess mortality among kidney transplant recipients: Impact of COVID-19-related deaths during the pandemic. Transpl Infect Dis 2024; 26:e14204. [PMID: 38010722 DOI: 10.1111/tid.14204] [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] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Because COVID-19 has been associated with high lethality rates among kidney transplant recipients (KTR), but also with a severe disruption and delays in overall healthcare, this study aims to evaluate the excess mortality in the pandemic era among KTR in a high-volume Brazilian transplant center. METHODS This study used data from a single center that provides follow-up on all its transplant recipients. The population of interest included all the patients who were transplanted between August 31, 1983 and December 31, 2022 and who were live from January 1, 2014. Using the "AutoRegressive Integrated Moving Average" forecasting algorithm, the expected mortality for the pandemic era (2020-2022) was modeled from the pre-pandemic era (2014-2019). RESULTS There were 12 077 KTRs at risk of dying in the entire observation period. In the pre-pandemic era, there were 21 deaths per 1000 patients at risk. In the pandemic era, there were 1429 observed deaths (rate of 47 deaths per 1000 patients at risk) versus the expected 587 deaths, resulting in an absolute number of 842 excess deaths, or an observed-to-expected ratio of 2.4, or an absolute rate of 26 deaths in excess per 1000 patients at risk. The excess deaths exhibited a temporal pattern mirroring that of the surges in new cases and lethality rates of COVID-19. COVID-19-related deaths drove 94% of excess mortality in the pandemic era. CONCLUSION In this large cohort of KTR under centralized follow-up, more than twofold excess mortality was primarily driven by COVID-19-related deaths, highlighting the vulnerability of this population to the most severe presentation of SARS-CoV-2 infection.
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Affiliation(s)
| | | | | | | | | | - Lucio Roberto Requião-Moura
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Charles Yea Zen Chow
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica Rika Nakamura
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Helio Tedesco-Silva
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - José Medina-Pestana
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
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3
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Tasca KI, Alves CG, Grotto RMT, de Moraes LN, Assato PA, Fortaleza CMCB. Dichotomous outcomes vs. survival regression models for identification of predictors of mortality among patients with severe acute respiratory illness during COVID-19 pandemics. Front Public Health 2023; 11:1271177. [PMID: 38125848 PMCID: PMC10732580 DOI: 10.3389/fpubh.2023.1271177] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction As the studies predicting mortality in severe acute respiratory illness (SARI) have inferred associations either from dichotomous outcomes or from time-event models, we identified some clinical-epidemiological characteristics and predictors of mortality by comparing and discussing two multivariate models. Methods To identify factors associated with death among all SARI hospitalizations occurred in Botucatu (Brazil)/regardless of the infectious agent, and among the COVID-19 subgroup, from March 2020 to 2022, we used a multivariate Poisson regression model with binomial outcomes and Cox proportional hazards (time-event). The performance metrics of both models were also analyzed. Results A total of 3,995 hospitalized subjects were included, of whom 1338 (33%) tested positive for SARS-CoV-2. We identified 866 deaths, of which 371 (43%) were due to the COVID-19. In the total number of SARI cases, using both Poisson and Cox models, the predictors of mortality were the presence of neurological diseases, immunosuppression, obesity, older age, and need for invasive ventilation support. However, the Poisson test also revealed that admission to an intensive care unit and the COVID-19 diagnosis were predictors of mortality, with the female gender having a protective effect against death. Likewise, Poisson proved to be more sensitive and specific, and indeed the most suitable model for analyzing risk factors for death in patients with SARI/COVID-19. Conclusion Given these results and the acute course of SARI and COVID-19, to compare the associations and their different meanings is essential and, therefore, models with dichotomous outcomes are more appropriate than time-to-event/survival approaches.
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Affiliation(s)
- Karen Ingrid Tasca
- Department of Infectious Diseases, Botucatu Medical School (FMB), São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
| | - Camila Gonçalves Alves
- Department of Infectious Diseases, Botucatu Medical School (FMB), São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
| | - Rejane Maria Tommasini Grotto
- Department of Biotechnology and Bioprocess, School of Agriculture (FCA), São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
- Clinical Hospital of Botucatu Medical School (HCFMB), Botucatu, Brazil
| | - Leonardo Nazario de Moraes
- Department of Biotechnology and Bioprocess, School of Agriculture (FCA), São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
- Clinical Hospital of Botucatu Medical School (HCFMB), Botucatu, Brazil
| | - Patrícia Akemi Assato
- Department of Biotechnology and Bioprocess, School of Agriculture (FCA), São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
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4
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Bonesso MF, Fortaleza CMCB, Cavalcante RDS, Sobrinho MT, Ronchi CF, Abraão LM, Joo HS, Otto M, Ribeiro de Souza da Cunha MDL. A Study on the Epidemiological-Molecular Role of Staphylococcus aureus Strains in the Development of Ventilator-Associated Pneumonia in a Tertiary Hospital in Brazil. Antibiotics (Basel) 2023; 12:1336. [PMID: 37627756 PMCID: PMC10451267 DOI: 10.3390/antibiotics12081336] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
This study aimed to explore the molecular epidemiology of Staphylococcus aureus isolated from patients on mechanical ventilation and the participation of virulence factors in the development of ventilator-associated pneumonia (VAP). A prospective cohort study was conducted on patients under mechanical ventilation, with periodic visits for the collection of tracheal aspirates and clinical data. The S. aureus isolates were analyzed regarding resistance profile, virulence, expression of protein A and alpha-toxin using Western blot, clonal profile using PFGE, sequence type using MLST, and characterization and quantification of phenol-soluble modulins. Among the 270 patients in the study, 51 S. aureus strains were isolated from 47 patients. The incidence density of S. aureus and MRSA VAP was 2.35/1000 and 1.96/1000 ventilator days, respectively; of these, 45% (n = 5) were resistant to oxacillin, with 100% (n = 5) harboring SCCmec types II and IV. The most frequent among the tested virulence factors were icaA, hla, and hld. The clonal profile showed a predominance of sequence types originating from the community. Risk factors for VAP were the presence of solid tumors and the sea gene. In conclusion, patient-related risk factors, together with microbiological factors, are involved in the development of S. aureus VAP, which is caused by the patient's own strains.
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Affiliation(s)
- Mariana Fávero Bonesso
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Medical School (FMB) of Sao Paulo State University (UNESP), Botucatu 18618-970, Brazil; (C.M.C.B.F.); (R.d.S.C.)
- Department of Chemical and Biological Sciences, Biosciences Institute, UNESP—Universidade Estadual Paulista, Botucatu 18618-691, Brazil
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health, Bethesda, MD 20814, USA; (H.-S.J.); (M.O.)
| | - Carlos Magno Castelo Branco Fortaleza
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Medical School (FMB) of Sao Paulo State University (UNESP), Botucatu 18618-970, Brazil; (C.M.C.B.F.); (R.d.S.C.)
| | - Ricardo de Souza Cavalcante
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Medical School (FMB) of Sao Paulo State University (UNESP), Botucatu 18618-970, Brazil; (C.M.C.B.F.); (R.d.S.C.)
| | - Moises Teixeira Sobrinho
- Hospital das Clínicas, Botucatu Medical School, University of Sao Paulo State, Botucatu 18618-687, Brazil; (M.T.S.); (C.F.R.)
| | - Carlos Fernando Ronchi
- Hospital das Clínicas, Botucatu Medical School, University of Sao Paulo State, Botucatu 18618-687, Brazil; (M.T.S.); (C.F.R.)
| | - Lígia Maria Abraão
- Nursing Research and Care Practices, Hospital Samaritano Higienópolis, São Paulo 01232-010, Brazil;
| | - Hwang-Soo Joo
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health, Bethesda, MD 20814, USA; (H.-S.J.); (M.O.)
| | - Michael Otto
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health, Bethesda, MD 20814, USA; (H.-S.J.); (M.O.)
| | - Maria de Lourdes Ribeiro de Souza da Cunha
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Medical School (FMB) of Sao Paulo State University (UNESP), Botucatu 18618-970, Brazil; (C.M.C.B.F.); (R.d.S.C.)
- Department of Chemical and Biological Sciences, Biosciences Institute, UNESP—Universidade Estadual Paulista, Botucatu 18618-691, Brazil
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5
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Menezes DC, Perico J, Martins BL, Belone ADFF, Fortaleza CMCB, Santana FCDS, Latini ACP, Souza VNBD. Time between symptom and testing in relation to familial transmission of severe acute respiratory syndrome coronavirus 2. Cien Saude Colet 2023; 28:1751-1756. [PMID: 37255151 DOI: 10.1590/1413-81232023286.16112022] [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: 06/06/2022] [Accepted: 11/08/2022] [Indexed: 06/01/2023] Open
Abstract
Brazil has a huge number of cases and deaths due to coronavirus disease 2019 (COVID-19); however, few studies have dealt with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among familial contacts in Brazil. Here, we report our findings on transmission in a family-based study in Bauru, São Paulo, Brazil. The study, conducted from July to November 2020, comprised 974 individuals with 233 index patients and 741 familial contacts. Familial contacts were evaluated using the rapid COVID-19 Ag ECO and reverse transcription-polymerase chain reaction (RT-PCR) tests immediately after the index patient diagnosis. The antigen-based rapid test was validated in 121 individuals using RT-PCR as the gold standard. Additionally, 30 days later, familial contacts were evaluated for IgM and IgG antibodies against SARS-CoV-2. We found 333 cases of COVID-19 among familial contacts (44.9%). A positive correlation was observed between the time elapsed from the onset of symptoms until the index patient's COVID-19 testing and the number of family contacts infected by SARS-CoV-2. Early SARS-CoV-2 testing and familial contact evaluation are relevant strategies to contain transmission.
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Affiliation(s)
- Daiane Cabrera Menezes
- Instituto Lauro de Souza Lima, Secretaria de Estado da Saúde. Rod. Cmte. João Ribeiro de Barros s/n, Distrito Industrial Marcus Vinícius Feliz Machado. 17034-971 Bauru SP Brasil.
- Programa de Pós-Graduação em Doenças Tropicais, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Julio de Mesquita Filho" (Unesp). Botucatu SP Brasil
| | - Jonatas Perico
- Instituto Lauro de Souza Lima, Secretaria de Estado da Saúde. Rod. Cmte. João Ribeiro de Barros s/n, Distrito Industrial Marcus Vinícius Feliz Machado. 17034-971 Bauru SP Brasil.
- Programa de Pós-Graduação em Doenças Tropicais, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Julio de Mesquita Filho" (Unesp). Botucatu SP Brasil
| | - Bruna Letícia Martins
- Instituto Lauro de Souza Lima, Secretaria de Estado da Saúde. Rod. Cmte. João Ribeiro de Barros s/n, Distrito Industrial Marcus Vinícius Feliz Machado. 17034-971 Bauru SP Brasil.
- Programa de Pós-Graduação em Doenças Tropicais, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Julio de Mesquita Filho" (Unesp). Botucatu SP Brasil
| | - Andrea de Faria Fernandes Belone
- Instituto Lauro de Souza Lima, Secretaria de Estado da Saúde. Rod. Cmte. João Ribeiro de Barros s/n, Distrito Industrial Marcus Vinícius Feliz Machado. 17034-971 Bauru SP Brasil.
| | | | - Fabiana Covolo de Souza Santana
- Instituto Lauro de Souza Lima, Secretaria de Estado da Saúde. Rod. Cmte. João Ribeiro de Barros s/n, Distrito Industrial Marcus Vinícius Feliz Machado. 17034-971 Bauru SP Brasil.
| | - Ana Carla Pereira Latini
- Instituto Lauro de Souza Lima, Secretaria de Estado da Saúde. Rod. Cmte. João Ribeiro de Barros s/n, Distrito Industrial Marcus Vinícius Feliz Machado. 17034-971 Bauru SP Brasil.
- Programa de Pós-Graduação em Doenças Tropicais, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Julio de Mesquita Filho" (Unesp). Botucatu SP Brasil
| | - Vania Nieto Brito de Souza
- Instituto Lauro de Souza Lima, Secretaria de Estado da Saúde. Rod. Cmte. João Ribeiro de Barros s/n, Distrito Industrial Marcus Vinícius Feliz Machado. 17034-971 Bauru SP Brasil.
- Programa de Pós-Graduação em Doenças Tropicais, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista "Julio de Mesquita Filho" (Unesp). Botucatu SP Brasil
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6
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Abraão LM, Fortaleza CMCB, Camargo CH, Barbosa TA, Pereira-Franchi EPL, Riboli DFM, Hubinger L, Bonesso MF, Medeiros de Souza R, Ribeiro de Souza da Cunha MDL. Staphylococcus aureus and CA-MRSA Carriage among Brazilian Indians Living in Peri-Urban Areas and Remote Communities. Antibiotics (Basel) 2023; 12:antibiotics12050862. [PMID: 37237765 DOI: 10.3390/antibiotics12050862] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
The emergence of Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections among indigenous populations has been reported. Usually, indigenous communities live in extreme poverty and are at risk of acquiring infections. In Brazil, healthcare inequality is observed in this population. To date, there are no reports of CA-MRSA infections, and no active search for asymptomatic S. aureus carriage has been conducted among Brazilian Indians. The aim of this study was to investigate the prevalence of colonization with S. aureus and CA-MRSA among Brazilian Indians. We screened 400 Indians (from near urban areas and remote hamlets) for S. aureus and CA-MRSA colonization. The isolates were submitted to clonal profiling by pulsed-field gel electrophoresis (PFGE), and selected isolates were submitted to multilocus sequence typing (MLST). Among 931 specimens (nasal and oral) from different indigenous individuals in remote hamlets, S. aureus was cultured in 190 (47.6%). Furthermore, CA-MRSA was found in three isolates (0.7%), all SCCmec type IV. PFGE analysis identified 21 clusters among the S. aureus isolates, and MLST analysis showed a predominance of sequence type 5 among these isolates. Our study revealed a higher prevalence of S. aureus carriage among Shanenawa ethnicity individuals (41.1%). Therefore, ethnicity appears to be associated with the prevalence of S. aureus in these populations.
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Affiliation(s)
- Lígia Maria Abraão
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Medical School (FMB) of Sao Paulo State University (UNESP), Botucatu 18618-970, Brazil
- Nursing Research and Care Practices, Hospital Samaritano Higienopolis, São Paulo 01232-010, Brazil
| | - Carlos Magno Castelo Branco Fortaleza
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Medical School (FMB) of Sao Paulo State University (UNESP), Botucatu 18618-970, Brazil
| | | | - Thaís Alves Barbosa
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Medical School (FMB) of Sao Paulo State University (UNESP), Botucatu 18618-970, Brazil
| | - Eliane Patrícia Lino Pereira-Franchi
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Medical School (FMB) of Sao Paulo State University (UNESP), Botucatu 18618-970, Brazil
| | - Danilo Flávio Moraes Riboli
- Department of Chemical and Biological Sciences, Biosciences Institute, UNESP-Universidade Estadual Paulista, Botucatu 18618-691, Brazil
| | - Luiza Hubinger
- Department of Chemical and Biological Sciences, Biosciences Institute, UNESP-Universidade Estadual Paulista, Botucatu 18618-691, Brazil
| | - Mariana Fávero Bonesso
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Medical School (FMB) of Sao Paulo State University (UNESP), Botucatu 18618-970, Brazil
| | | | - Maria de Lourdes Ribeiro de Souza da Cunha
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Medical School (FMB) of Sao Paulo State University (UNESP), Botucatu 18618-970, Brazil
- Department of Chemical and Biological Sciences, Biosciences Institute, UNESP-Universidade Estadual Paulista, Botucatu 18618-691, Brazil
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7
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Fujimori M, Valencia-Portillo RT, Lindoso JAL, Celeste BJ, de Almeida RP, Costa CHN, da Cruz AM, Druzian AF, Duthie MS, Fortaleza CMCB, de Oliveira ALL, Paniago AMM, Queiroz IT, Reed S, Vallur AC, Goto H, Sanchez MCA. Recombinant protein KR95 as an alternative for serological diagnosis of human visceral leishmaniasis in the Americas. PLoS One 2023; 18:e0282483. [PMID: 36862710 PMCID: PMC9980733 DOI: 10.1371/journal.pone.0282483] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
In the Americas, visceral leishmaniasis (VL) is caused by the protozoan Leishmania infantum, leading to death if not promptly diagnosed and treated. In Brazil, the disease reaches all regions, and in 2020, 1,933 VL cases were reported with 9.5% lethality. Thus, an accurate diagnosis is essential to provide the appropriate treatment. Serological VL diagnosis is based mainly on immunochromatographic tests, but their performance may vary by location, and evaluation of diagnostic alternatives is necessary. In this study, we aimed to evaluate the performance of ELISA with the scantily studied recombinant antigens, K18 and KR95, comparing their performance with the already known rK28 and rK39. Sera from parasitologically confirmed symptomatic VL patients (n = 90) and healthy endemic controls (n = 90) were submitted to ELISA with rK18 and rKR95. Sensitivity (95% CI) was, respectively, 83.3% (74.2-89.7) and 95.6% (88.8-98.6), and specificity (95% CI) was 93.3% (85.9-97.2) and 97.8% (91.8-99.9). For validation of ELISA with the recombinant antigens, we included samples from 122 VL patients and 83 healthy controls collected in three regions in Brazil (Northeast, Southeast, and Midwest). When comparing the results obtained with the VL patients' samples, significantly lower sensitivity was obtained by rK18-ELISA (88.5%, 95% CI: 81.5-93.2) compared with rK28-ELISA (95.9%, 95% CI: 90.5-98.5), but the sensitivity was similar comparing rKR95-ELISA (95.1%, 95% CI: 89.5-98.0), rK28-ELISA (95.9%, 95% CI: 90.5-98.5), and rK39-ELISA (94.3%, 95% CI: 88.4-97.4). Analyzing the specificity, it was lowest with rK18-ELISA (62.7%, 95% CI: 51.9-72.3) with 83 healthy control samples. Conversely, higher and similar specificity was obtained by rKR95-ELISA (96.4%, 95% CI: 89.5-99.2), rK28-ELISA (95.2%, 95% CI: 87.9-98.5), and rK39-ELISA (95.2%, 95% CI: 87.9-98.5). There was no difference in sensitivity and specificity across localities. Cross-reactivity assessment, performed with sera of patients diagnosed with inflammatory disorders and other infectious diseases, was 34.2% with rK18-ELISA and 3.1% with rKR95-ELISA. Based on these data, we suggest using recombinant antigen KR95 in serological assays for VL diagnosis.
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Affiliation(s)
- Mahyumi Fujimori
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - José Angelo Lauletta Lindoso
- Departamento de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Instituto de Infectologia Emílio Ribas, Secretaria de Estado da Saúde, São Paulo, São Paulo, Brazil
| | - Beatriz Julieta Celeste
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Roque Pacheco de Almeida
- Departamento de Medicina Interna e Patologia, Hospital Universitário/EBSERH, Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil
| | | | - Alda Maria da Cruz
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz/FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Angelita Fernandes Druzian
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | | | | | | | | | - Igor Thiago Queiroz
- Hospital Giselda Trigueiro, Secretaria Estadual da Saúde Pública, Natal, Rio Grande do Norte, Brazil
| | - Steve Reed
- HDT Bio, Seattle, Washington, United States of America
| | - Aarthy C. Vallur
- InBios International Inc, Seattle, Washington, United States of America
| | - Hiro Goto
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Maria Carmen Arroyo Sanchez
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Clemens SAC, Fortaleza CMCB, Crowe M, Pollard A, Tasca KI, Grotto RMT, Martins MR, Spadaro AG, Barretti P, Verstraeten T, Clemens R. Safety of the Fiocruz ChAdOx COVID-19 vaccine used in a mass vaccination campaign in Botucatu, Brazil. Vaccine 2022; 40:6722-6729. [PMID: 36055876 PMCID: PMC9393160 DOI: 10.1016/j.vaccine.2022.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/20/2022] [Revised: 07/06/2022] [Accepted: 08/15/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Brazil has been at the core of the COVID-19 pandemic, with the second-highest death toll worldwide. A mass vaccination campaign was initiated on May 16th, 2021, in Botucatu, Brazil, where two doses of ChadOx1-nCoV19 were offered 12 weeks apart to all 18-60- year-olds. This context offers a unique opportunity to study the vaccine safety during a mass campaign. METHODS The first and second doses of the vaccine were administered in May and August 2021, respectively. Emergency room (ER) and hospitalization records were obtained from the Hospital das Clínicas da Faculdade de Medicina de Botucatu for six weeks before and six weeks after the first and second doses, from 4 April to 19 September 2021. Diagnoses with COVID-19-related ICD codes were excluded to distinguish any trends resulting from the COVID-19 pandemic. ER and hospital visits during the two time periods were compared, including an ICD code comparison, to identify any changes in disease distributions. Data were scanned for a defined list of Adverse Events of Special Interest (AESIs), as presented by the Safety Platform for Emergency Vaccines. RESULTS AND DISCUSSION A total of 77,683 and 74,051 subjects received dose 1 and dose 2 of ChadOx1-nCoV19, respectively. Vaccination was well tolerated and not associated with any major safety concerns. Increases in ER visits 1 week following both doses were primarily seen in ICD codes related to non-serious side effects of the vaccine, including vaccination site pain and other local events. The neurological AESIs identified (2 of 3 cases of multiple sclerosis) were relapses of a pre-existing condition. One potentially serious hospitalization event for Bell's palsy had onset before vaccination with dose 1, in a patient who also had a viral infection of the central nervous system. There was no myocarditis, pericarditis cases, or vaccine-related increases in thromboembolic events.
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Affiliation(s)
- Sue Ann Costa Clemens
- Department of Pediatrics, Oxford University, Oxford, United Kingdom; Institute for Global Health, Siena University, Siena, Italy.
| | | | | | - Andrew Pollard
- Department of Pediatrics, Oxford University, Oxford, United Kingdom
| | - Karen Ingrid Tasca
- Department of Infectious Diseases, Botucatu Medical School, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil
| | - Rejane Maria Tommasini Grotto
- Department of Biotechnology, Faculty of Agronomical Sciences, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil
| | - Marcelo Roberto Martins
- Division of Informatics, Botucatu Medical Hospital, Botucatu Medical School, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil
| | | | - Pasqual Barretti
- Department of Clinical Medicine, Botucatu Medical School, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil
| | | | - Ralf Clemens
- International Vaccine Institute (IVI), Seoul, South Korea
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Costa Clemens SA, Fortaleza CMCB, Crowe M, Tasca KI, Spadaro AG, Souza-Neto JA, Grotto RMT, Sider R, Jimeno J, Verstraeten T, Clemens R. Effectiveness of the Fiocruz recombinant ChadOx1-nCoV19 against variants of SARS-CoV-2 in the Municipality of Botucatu-SP. Front Public Health 2022; 10:1016402. [PMID: 36311567 PMCID: PMC9610568 DOI: 10.3389/fpubh.2022.1016402] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/15/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction As the COVID-19 pandemic progresses, rapidly emerging variants of concern raise fears that currently licensed vaccines may have reduced effectiveness against these new strains. In the municipality of Botucatu, São Paulo State, Brazil, a mass vaccination campaign using ChadOx1-nCoV19 was initiated on 16th of May 2021, targeting people 18-60 years old. Two vaccine doses were offered 12 weeks apart, with the second delivered on 8th of August, 2021. This setting offered a unique opportunity to assess the effectiveness of two ChadOx1-nCoV19 doses in a real-life setting. Materials and methods Data on testing, hospitalization, symptoms, demographics, and vaccination were obtained from the Hospital das Clínicas da Faculdade de Medicina de Botucatu. A test-negative study design was employed; whereby the odds of being vaccinated among cases vs controls were calculated to estimate vaccine effectiveness (VE; 1-OR). All individuals aged 18-60 who received a PCR test after the 16th of May and were unvaccinated prior to this date were included in the analysis until the study ended in mid-November 2021. Results 77,683 citizens of Botucatu aged 18-60 received the first dose, and 74,051 received a second ChadOx1-nCoV19 dose 12 weeks later for a vaccination coverage of 84.2 and 80.2%, respectively. Of 7.958 eligible PCR tests, 2.109 were positive and 5.849 negative. The VE against any symptomatic infection was estimated at 39.2%, 21 days after dose 1, and 74.5%, 14 days after dose 2. There were no COVID-19-related hospitalizations or deaths among the 74,051 fully vaccinated individuals. The VE against severe disease was estimated at 70.8 and 100% after doses 1 and 2, respectively. 90.5% of all lineages sequenced between doses 1 and 2 (16th of May-7th of August) were of the Gamma variant, while 83.0% were of the Delta variant during the second period after dose 2 (8th of August-18th of November). Discussion This observational study found the effectiveness of ChadOx1-nCoV19 to be 74.5% against COVID-19 disease of any severity, comparable to the efficacy observed in clinical trials (81.3% after dose 2), despite the dominance of the Gamma and Delta VoCs. No COVID-19-related hospitalizations or deaths in fully vaccinated individuals were reported.
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Affiliation(s)
- Sue Ann Costa Clemens
- Department of Pediatrics, Oxford University, Oxford, United Kingdom,Medical School, Institute for Global Health, Siena University, Siena, Italy
| | - Carlos Magno Castelo Branco Fortaleza
- Department of Infectious Diseases, Botucatu Medical School, São Paulo State University (Universidade Estadual Paulista), Botucatu, São Paulo State, Brazil
| | | | - Karen Ingrid Tasca
- Department of Infectious Diseases, Botucatu Medical School, São Paulo State University (Universidade Estadual Paulista), Botucatu, São Paulo State, Brazil
| | | | - Jayme Augusto Souza-Neto
- Department of Biotechnology, Faculty of Agronomical Sciences, São Paulo State University (Universidade Estadual Paulista), Botucatu, São Paulo State, Brazil
| | - Rejane Maria Tommasini Grotto
- Department of Biotechnology, Faculty of Agronomical Sciences, São Paulo State University (Universidade Estadual Paulista), Botucatu, São Paulo State, Brazil,Department of Clinical Medicine, Botucatu Medical School, São Paulo State University (Universidade Estadual Paulista), Botucatu, São Paulo State, Brazil
| | | | | | | | - Ralf Clemens
- International Vaccine Institute (IVI), Seoul, South Korea,*Correspondence: Ralf Clemens
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Dias VMDCH, Oliveira AF, Marinho AKBB, Santos Ferreira CED, Domingues CEF, Fortaleza CMCB, Vidal CFDL, Carrilho CMDDM, Pinheiro DOBP, de Assis DB, Medeiros EA, Morejón KML, Weissmann L, Michelin L, Carneiro M, Nogueira MDSDP, de Oliveira PRD, Buralli RJ, Stucchi RSB, Lins RS, Costa SF, Chebabo A. COVID-19 and isolation: Risks and implications in the scenario of new variants. Braz J Infect Dis 2022; 26:102703. [PMID: 36100081 PMCID: PMC9444891 DOI: 10.1016/j.bjid.2022.102703] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/01/2022] [Accepted: 08/14/2022] [Indexed: 01/08/2023] Open
Abstract
With the emergence of new variants of SARS-CoV-2, questions about transmissibility, vaccine efficacy, and impact on mortality are important to support decision-making in public health measures. Modifications related to transmissibility combined with the fact that much of the population has already been partially exposed to infection and/or vaccination, have stimulated recommendations to reduce the isolation period for COVID-19. However, these new guidelines have raised questions about their effectiveness in reducing contamination and minimizing impact in work environments. Therefore, a collaborative task force was developed to review the subject in a non-systematic manner, answering questions about SARS-CoV-2 variants, COVID-19 vaccines, isolation/quarantine periods, testing to end the isolation period, and the use of masks as mitigation procedures. Overall, COVID-19 vaccines are effective in preventing severe illness and death but are less effective in preventing infection in the case of the Omicron variant. Any strategy that is adopted to reduce the isolation period should take into consideration the epidemiological situation of the geographical region, individual clinical characteristics, and mask for source control. The use of tests for isolation withdrawal should be evaluated with caution, due to results depending on various conditions and may not be reliable.
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Affiliation(s)
- Viviane Maria de Carvalho Hessel Dias
- Associação Brasileira dos Profissionais em Controle de Infecções e Epidemiologia Hospitalar, São Paulo, SP, Brazil; Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil; Hospital Marcelino Champagnat, Curitiba, PR, Brazil.
| | | | - Ana Karolina Barreto Berselli Marinho
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Serviço de Imunologia Clínica e Alergia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Carlos Eduardo Dos Santos Ferreira
- Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial, São Paulo, SP, Brazil; Laboratório Clínico ‒ Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Laboratório Central ‒ Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | - Claudia Fernanda de Lacerda Vidal
- Associação Brasileira dos Profissionais em Controle de Infecções e Epidemiologia Hospitalar, São Paulo, SP, Brazil; Hospital das Clínicas da Universidade Federal de Pernambuco (HCUFPE), Recife, PE, Brazil
| | | | - Debora Otero Britto Passos Pinheiro
- Associação Brasileira dos Profissionais em Controle de Infecções e Epidemiologia Hospitalar, São Paulo, SP, Brazil; Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil; Hospital Universitário Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Denise Brandão de Assis
- Divisão de Infecção Hospitalar/Centro de Vigilância Epidemiológica Prof. Alexandre Vranjac/Secretaria de Estado da Saúde de São Paulo, São Paulo, SP, Brazil
| | - Eduardo Alexandrino Medeiros
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Karen Mirna Loro Morejón
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Leonardo Weissmann
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Instituto de Infectologia Emilio Ribas, São Paulo, SP, Brazil; Faculdade de Medicina, Universidade de Ribeirão Preto (UNAERP), Guarujá, SP, Brazil
| | - Lessandra Michelin
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade de Caxias do Sul (UCS), Rio Grande do Sul, RS, Brazil
| | - Marcelo Carneiro
- Associação Brasileira dos Profissionais em Controle de Infecções e Epidemiologia Hospitalar, São Paulo, SP, Brazil; Programa de Pós-Graduação Promoção da Saúde, Universidade de Santa Cruz do Sul (UNISC), Hospital Santa Cruz, Santa Cruz do Sul, RS, Brazil
| | | | - Priscila Rosalba Domingos de Oliveira
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rafael Junqueira Buralli
- Coordenação Geral de Saúde do Trabalhador, Departamento de Saúde Ambiental, do Trabalhador e Vigilância das Emergências em Saúde Pública, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF, Brazil
| | - Raquel Silveira Bello Stucchi
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Departamento de Clínica Médica, Área de Infectologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Rodrigo Schrage Lins
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Hospital Naval Marcílio Dias, Rio de Janeiro, RJ, Brazil
| | - Silvia Figueiredo Costa
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alberto Chebabo
- Sociedade Brasileira de Infectologia, São Paulo, SP, Brazil; Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Souza RCD, Almeida ERM, Fortaleza CMCB, Miot HA. Factors associated with COVID-19 mortality in municipalities in the state of São Paulo (Brazil): an ecological study. Rev Soc Bras Med Trop 2022; 55:e04472021. [PMID: 35416872 PMCID: PMC9009881 DOI: 10.1590/0037-8682-0447-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/28/2021] [Accepted: 02/25/2022] [Indexed: 12/23/2022] Open
Abstract
Background: The mortality rate of coronavirus disease (COVID-19) in the state of São Paulo is highly heterogeneous. This study investigated geographic, economic, social, and health-related factors associated with this discrepancy. Methods: An ecological study compared COVID-19 mortality rates according to geographic, economic, social, and health-related variables during initial infection of 2.5% of the population in municipalities with more than 30,000 inhabitants. Results: Mortality was positively associated with demographic density and social inequality (Gini index), and inversely associated with HDI income and longevity of these municipalities, accounting for 33.2% of the variation in mortality. Conclusions: Social determinants influenced COVID-19 outcomes.
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Affiliation(s)
- Rafaela Caroline de Souza
- Faculdade de Medicina de Botucatu, Departamento de Infectologia, Dermatologia, Diagnóstico por Imagem e Radioterapia, Botucatu, SP, Brasil
| | - Ettore Rafael Mai Almeida
- Faculdade de Medicina de Botucatu, Departamento de Infectologia, Dermatologia, Diagnóstico por Imagem e Radioterapia, Botucatu, SP, Brasil
| | | | - Hélio Amante Miot
- Faculdade de Medicina de Botucatu, Departamento de Infectologia, Dermatologia, Diagnóstico por Imagem e Radioterapia, Botucatu, SP, Brasil
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Medina-Pestana J, Covas DT, Viana LA, Dreige YC, Nakamura MR, Lucena EF, Requião-Moura LR, Fortaleza CMCB, Foresto RD, Tedesco-Silva H, Cristelli MP. Inactivated Whole-virus Vaccine Triggers Low Response Against SARS-CoV-2 Infection Among Renal Transplant Patients: Prospective Phase 4 Study Results. Transplantation 2022; 106:853-861. [PMID: 34882589 PMCID: PMC8942595 DOI: 10.1097/tp.0000000000004036] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 09/09/2021] [Revised: 10/18/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anti-severe acute respiratory syndrome coronavirus 2 mRNA vaccines elicit lower humoral responses in solid-organ transplant recipients. This is the first prospective trial investigating the effect of an inactivated whole-virion vaccine in kidney transplant recipients. METHODS Prospective, single-center, phase 4, interventional study. Kidney transplant recipients aged 30-69 y with >30 d of transplantation received two 3 µg intramuscular doses of CoronaVac 28 d apart and are being followed for 6 mo. Primary outcomes: (1) reactogenicity after first dose; (2) antibody responses 28 d after each dose; and (3) incidence/severity of confirmed coronavirus disease 2019 (COVID-19) and 28-d lethality rate. For this analysis, clinical effectiveness was assessed for 3 mo, starting 15 d after the second dose, and compared with 3-mo period before vaccination. RESULTS Of the 3371 individuals who received the first dose, 99% completed vaccination schedule. Mild/local adverse reactions were reported by 33% of the patients. In the immunogenicity cohort (n = 942), the proportion of patients with IgG antibodies to severe acute respiratory syndrome coronavirus 2 increased from 15.2% after first dose to 43% after second dose. Increase in antibody values after second dose was associated with higher proportion of patients with detected neutralizing antibodies. A significant reduction in the incidence of COVID-19 was observed (6.4% versus 4.2%; P < 0.0001), although the 28-d lethality rate remained unchanged (25% versus 22%; P = 0.534). In 45 patients from the immunogenicity cohort who developed COVID-19, all the 6 deaths occurred among those without antibody response (n = 22; 49%). CONCLUSIONS CoronaVac vaccine was associated with low reactogenicity, low immunogenicity but reduced incidence of COVID-19 among kidney transplant recipients. The lack of reduction in lethality rates is perhaps associated with the low percentage of patients developing humoral response after the second dose.
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Affiliation(s)
- José Medina-Pestana
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Dimas Tadeu Covas
- Instituto Butantan, São Paulo, Brazil
- Center for Cell-based Therapy (CTC), Regional Blood Center of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Laila Almeida Viana
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Yasmim Cardoso Dreige
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Monica Rika Nakamura
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Elizabeth França Lucena
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Lucio R. Requião-Moura
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Renato Demarchi Foresto
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Helio Tedesco-Silva
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marina Pontello Cristelli
- Nephrology Division, Hospital do Rim, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Bezerra NP, de Arruda MG, de Moraes LN, Alho MDO, Poli GB, Grotto RMT, Pardini MIDMC, Fortaleza CMCB, de Souza LDR. MULTI PAINEL RESPIRATÓRIO FLOW CHIP NO DIAGNÓSTICO DIFERENCIAL DE SARS-COV-2. Braz J Infect Dis 2022. [PMCID: PMC8829264 DOI: 10.1016/j.bjid.2021.102042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introdução No final do ano de 2019, foi relatado à Organização Mundial da Saúde (OMS), casos de surto de pneumonia de causa desconhecida na cidade de Wuhan, China. Tratava-se de um novo coronavírus, o SARS-COV-2, agente causador de uma doença infecciosa respiratória, a COVID-19. Em fevereiro de 2020, o surto foi elevado à categoria de pandemia pela OMS. A rápida transmissão em conjunto com o aumento no número de óbitos e a sintomatologia semelhante a outras infecções respiratórias virais, tornou necessário o diagnóstico diferencial, rápido, sensível, simples e acessível no enfrentamento da pandemia. Objetivo O trabalho teve como objetivo, a comparação entre a metodologia Multi Painel Respiratório de 24 patógenos (PR24) Flow Chip no diagnóstico diferencial de SARS-COV-2, com a metodologia Multiplex RT-qPCR, considerada padrão-ouro no diagnóstico desse vírus. Métodos A partir de aspirados de naso/orofaringe de 22 indivíduos com sintomas gripais, foi extraído o material genético utilizando o kit BIOPUR de Mini Spin Vírus DNA/RNA 2.0, seguido por transcrição reversa e Reação em Cadeia da Polimerase (RT-PCR) no aparelho Hybrispot 12 PCR Auto, utilizando o kit de detecção XGEN Multi PR24 Flow Chip. Após a amplificação, ocorreu a hibridização reversa em um chip que é composto por uma membrana de nylon (tecnologia Flow Chip) que permite a detecção de até 24 patógenos virais, além do SARS-COV-2 e outros 5 tipos de coronavírus. Resultados De 22 amostras testadas 14 foram detectadas para SARS-COV-2 por RT-qPCR. No Painel Respiratório Viral Flow Chip, apenas duas delas apresentaram resultados contrastantes como positivo incerto e/ou presumível positivo. Porém, na validação dos resultados feita por leitura visual da marcação das sondas na membrana dos chips, ambas amostras se mostraram compatíveis com o resultado da Multiplex RT-qPCR, demonstrando 100% de compatibilidade na detecção do SARS-COV-2. Além disso, foram detectados outros agentes virais (Bocavírus; Corona NL63; Rhinovírus; Corona 229E; Enterovírus e SARS-Like) demonstrando a importância da metodologia molecular no diagnóstico diferencial da COVID-19. Conclusão A metodologia Multi Painel Respiratório Flow Chip, utilizada na detecção e diagnóstico diferencial do SARS-COV-2, demonstrou ser totalmente eficaz, semelhante à Multiplex RT-qPCR. Além de uma importante ferramenta na detecção e rastreamento de outros patógenos causadores de infecções respiratórias virais.
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Proença SVF, Macedo BC, Sawazaki JA, de Almeida GB, Queiroz SM, Filho SPF, Fortaleza CMCB, Cavalcante RDS. TRANSMISSÃO DE COVID-19 INTRA-HOSPITALAR. Braz J Infect Dis 2022. [PMCID: PMC8829266 DOI: 10.1016/j.bjid.2021.102083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introdução O ambiente hospitalar é um cenário de risco para transmissão da covid19, com possibilidade de surtos e comprometimento de pacientes mais suscetíveis a evolução para doença grave. Por isso, medidas como check list de sintomas respiratórios, rastreio com testes laboratoriais, precaução respiratória e de contato para casos suspeitos e confirmados são empregadas para evitar esta transmissão. Objetivo Este estudo buscou avaliar a transmissão da covid19 no ambiente hospitalar onde tais medidas de controle de infecção são utilizadas. Métodos Entre março e agosto de 2021, foi avaliada uma coorte de indivíduos que foram expostos a paciente confirmado com COVID19 durante sua internação. Após contato, os indivíduos expostos foram submetidos à precaução respiratória e contato, e acompanhados por 14 dias. O rastreamento da transmissão envolveu a avaliação diária dos sintomas e, ou, achados típicos em tomografia de tórax. Aqueles identificados com tais alterações foram submetidos a swab nasofaríngeo para RT-PCR. Resultados Foram identificados 73 pacientes confirmados para covid19 durante sua hospitalização, previamente sem este diagnóstico, sendo a maioria em enfermarias (56,2%), seguido do pronto socorro (35,6%) e UTI (8,2%). Foram 197 pacientes expostos a estes casos, dos quais 61 (31%) desenvolveram sintomas sugestivos de síndrome gripal nos 14 dias consecutivos à exposição e 18 (9,1%) confirmaram covid19. Entre estes últimos, 15 (12,2%) foram expostos a caso fonte sintomático respiratório enquanto que 3 (4,0%) decorreu de contato com assintomáticos positivos (p = 0,07). Não foi observada transmissão da covid19 em UTI. Pacientes expostos a casos positivos sintomáticos respiratórios no pronto socorro tiveram maior risco de aquisição de covid19 do que aqueles cujo contato ocorreu em ambiente de enfermaria [OR = 3,78 (1,15 - 12,39), p = 0,02]. Conclusão Embora o hospital adote medidas para evitar a transmissão da covid19 intra hospitalar, tais como check list de sintomas respiratórios e pesquisa por RT-PCR em saliva para todas as admissões, ocorre um escape de casos que podem transmitir a doença para os demais hospitalizados. Esta transmissão foi maior em paciente sintomáticos respiratórios e aqueles acamados no pronto socorro, onde o distanciamento entre leitos é menor.
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Pronunciate M, Fortaleza CMCB. MUDANÇAS EM SÉRIES TEMPORAIS DE INCIDÊNCIA E MORTALIDADE POR COVID-19 NO ESTADO DE SÃO PAULO: UMA ANÁLISE DE “JOINPOINT REGRESSION”. Braz J Infect Dis 2022. [PMCID: PMC8829354 DOI: 10.1016/j.bjid.2021.102041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introdução/Objetivo Métodos Resultados Conclusão
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Giacomini JL, da Costa ÉAPN, Fortaleza CMCB. FARMACOEPIDEMIOLOGIA DE ANTIMICROBIANOS SISTÊMICOS DISPENSADOS EM UNIDADES BÁSICAS DE SAÚDE DE UM MUNICÍPIO DO INTERIOR PAULISTA. Braz J Infect Dis 2022. [DOI: 10.1016/j.bjid.2021.101752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Giacomini JL, Brito NMR, Fortaleza CMCB. ANÁLISE DA EFETIVIDADE DE MEDIDAS DE CONTROLE DA COVID-19 EM UM HOSPITAL PARA USUÁRIOS DE DROGAS PSICOATIVAS. Braz J Infect Dis 2022. [PMCID: PMC8829237 DOI: 10.1016/j.bjid.2021.101777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Introdução/Objetivo Métodos Resultados Conclusão
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Bertanha M, Rodrigues LDS, Mellucci Filho PL, Moroz A, Pardini MIDMC, Sobreira ML, Durigon EL, Machado RRG, Grotto RMT, de Lima MA, Nader HB, de Moraes ML, Barbosa AN, Medolago NB, Cardoso FF, Magro AJ, Carvalho CRG, de Moraes LN, Alvarado RDC, Nunes HC, de Campos GC, Grillo VTRDS, Sertorio ND, Fortaleza CMCB. Nebulized enriched heparin to treat no critical patients with Sars-Cov-2: Triple-blind clinical trial. Medicine (Baltimore) 2021; 100:e28288. [PMID: 34941114 PMCID: PMC8702290 DOI: 10.1097/md.0000000000028288] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a viral respiratory disease that spreads rapidly, reaching pandemic status, causing the collapse of numerous health systems, and a strong economic and social impact. The treatment so far has not been well established and there are several clinical trials testing known drugs that have antiviral activity, due to the urgency that the global situation imposes. Drugs with specific mechanisms of action can take years to be discovered, while vaccines may also take a long time to be widely distributed while new virus variants emerge. Thus, drug repositioning has been shown to be a good strategy for defining new therapeutic approaches. Studies of the effect of enriched heparin in the replication of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) in vitro assays justify the advance for clinical tests. METHODS AND ANALYSIS A phase I/II triple-blind parallel clinical trial will be conducted. Fifty participants with radiological diagnosis of grade IIA pneumonia will be selected, which will be allocated in 2 arms. Participants allocated in Group 1 (placebo) will receive nebulized 0.9% saline. Participants allocated in Group 2 (intervention) will receive nebulized enriched heparin (2.5 mg/mL 0.9% saline). Both groups will receive the respective solutions on a 4/4 hour basis, for 7 days. The main outcomes of interest will be safety (absence of serious adverse events) and efficacy (measured by the viral load).Protocols will be filled on a daily basis, ranging from day 0 (diagnosis) until day 8.
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Affiliation(s)
- Matheus Bertanha
- Department of Surgery and Orthopedics, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
- Applied Biotechnology Laboratory, Research Nucleus of Clinical Hospital, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | - Lenize da Silva Rodrigues
- Department of Surgery and Orthopedics, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | - Pedro Luciano Mellucci Filho
- Department of Surgery and Orthopedics, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | - Andrei Moroz
- Department of Bioprocess and Biotechnology, São Paulo State University – UNESP, School of Pharmaceutical Sciences, Araraquara, SP, Brazil
| | - Maria Inês de Moura Campos Pardini
- Applied Biotechnology Laboratory, Research Nucleus of Clinical Hospital, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
- Internal Medicine Division, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | - Marcone Lima Sobreira
- Department of Surgery and Orthopedics, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | - Edison Luiz Durigon
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo – USP, São Paulo, SP, Brazil
- Scientific Platform Pasteur, University of São Paulo – USP, São Paulo, SP, Brazil
| | | | - Rejane Maria Tommasini Grotto
- Applied Biotechnology Laboratory, Research Nucleus of Clinical Hospital, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
- Bioprocessing and Biotechnology Department, São Paulo State University – UNESP, School of Agriculture, Botucatu, SP, Brazil
| | - Marcelo Andrade de Lima
- Molecular & Structural Biosciences, School of Life Sciences, Keele University, Newcastle-Under-Lyme, Staffordshire, UK
| | - Helena Bonciani Nader
- Department of Biochemistry, Federal University of São Paulo – UNIFESP, São Paulo, SP, Brazil
| | - Marli Leite de Moraes
- Institute of Science and Technology, Federal University of São Paulo – UNIFESP, São José dos Campos, SP, Brazil
| | - Alexandre Naime Barbosa
- Department of Infectious Diseases, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | - Natália Bronzatto Medolago
- Clinical Research Unit, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | | | - Angelo José Magro
- Biosciences Institute, São Paulo State University – UNESP, Botucatu, SP, Brazil
| | | | - Leonardo Nazário de Moraes
- Applied Biotechnology Laboratory, Research Nucleus of Clinical Hospital, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
- Bioprocessing and Biotechnology Department, São Paulo State University – UNESP, School of Agriculture, Botucatu, SP, Brazil
| | - Rita de Cássia Alvarado
- Applied Biotechnology Laboratory, Research Nucleus of Clinical Hospital, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
| | - Helga Caputo Nunes
- Quality control laboratory, Cellavita Scientific Research, Valinhos, SP, Brazil
| | - Gustavo Constantino de Campos
- Department of Orthopedics and Traumatology, University of Campinas – UNICAMP, School of Medical Sciences, Campinas, SP, Brazil
| | | | - Nathalia Dias Sertorio
- Department of Surgery and Orthopedics, São Paulo State University – UNESP, Botucatu Medical School, Botucatu, SP, Brazil
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de Carvalho Hessel Dias VM, Tuon F, de Jesus Capelo P, Telles JP, Fortaleza CMCB, Pellegrino Baena C. Trend analysis of carbapenem-resistant Gram-negative bacteria and antimicrobial consumption in the post-COVID-19 era: an extra challenge for healthcare institutions. J Hosp Infect 2021; 120:43-47. [PMID: 34808311 PMCID: PMC8603865 DOI: 10.1016/j.jhin.2021.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 09/27/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 12/20/2022]
Abstract
The incidence density trend of the carbapenem-resistant Gram-negative bacteria was analysed in device-associated infections and antimicrobial consumption in 99 critical care facilities in a low/middle-income country, between January 2019 and December 2020. Carbapenem-resistant Acinetobacter baumannii (CRAB) per 1000 patient-days increased in 2020 and this finding had a strong positive correlation with the incidence density of COVID-19 by the Spearman test. Polymyxin consumption also increased in 2020 but without significant correlation with CRAB or COVID-19 incidence density, presumably due to empirical and untargeted prescribing as a consequence of concern about CRAB infections. These findings are a warning to infection control programmes and antimicrobial stewardship.
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Affiliation(s)
- V M de Carvalho Hessel Dias
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil; Hospital Marcelino Champagnat, Curitiba, Paraná, Brazil.
| | - F Tuon
- Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | | | - J P Telles
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | | | - C Pellegrino Baena
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil; Hospital Marcelino Champagnat, Curitiba, Paraná, Brazil
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20
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Rodrigues FS, Amat HRA, Fortaleza CMCB. Impact of restriction of over-the-counter sales of antimicrobials on antimicrobial resistance in Escherichia coli from community-onset urinary tract infections in inner São Paulo State, Brazil. PLoS One 2021; 16:e0259632. [PMID: 34758027 PMCID: PMC8580237 DOI: 10.1371/journal.pone.0259632] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022] Open
Abstract
Background Antimicrobial resistance in community-associated infections is an increasing worldwide concern. In low-to-middle income countries, over-the-counter (OTC) sales of antimicrobials without medical prescription have been blamed for increasing consumption and resistance. We studied the impact of restriction of OTC sales of antimicrobials in Brazil (instituted in October 2010) on resistance trends of Escherichia coli from community-onset urinary tract infections. Methods We analyzed monthly resistance trend of Escherichia coli from community-onset urinary tract infections from 2005 through 2018. The data were submitted to interrupted time series analysis in both linear and Poisson regression models. Results We found impact on cefazolin (p<0.001) and amikacin (p<0.001) resistance as immediate impact of the intervention, and no beneficial impact on resistance to ciprofloxacin, ceftriaxone or sulfamethoxazole-trimethoprim. Conclusion At the present study, we found that OTC sales restriction did not generally impact on antimicrobial resistance.
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Affiliation(s)
- Fernanda Saad Rodrigues
- Department of Infectious Diseases, Botucatu School of Medicine, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil
| | - Helena Ribeiro Aiello Amat
- Department of Infectious Diseases, Botucatu School of Medicine, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil
| | - Carlos Magno Castelo Branco Fortaleza
- Department of Infectious Diseases, Botucatu School of Medicine, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil
- * E-mail:
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21
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Fortaleza CR, Vilches TN, Almeida GBD, Ferreira CP, Souza LDRD, Fortaleza CMCB. Impact of nonpharmaceutical strategies on trends of COVID-19 in São Paulo State. Rev Saude Publica 2021; 55:48. [PMID: 34378767 PMCID: PMC8317991 DOI: 10.11606/s1518-8787.2021055003599] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
Interrupted time series analyses were conducted to measure the impact of social distancing policies (instituted on March 22, 2020) and of subsequent mandatory masking in the community (instituted on May 4, 2020) on the incidence and effective reproductive number of COVID-19 in São Paulo State, Brazil. Overall, the impact of social distancing both on incidence and Rt was greater than the incremental effect of mandatory masking. Those findings may reflect either a small impact of face masking or the loosening of social distancing after mandatory use of masks.
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Affiliation(s)
- Cristiane Ravagnani Fortaleza
- Universidade Estadual Paulista. Faculdade de Medicina de Botucatu. Departamento de Infectologia. Botucatu, SP, Brasil
| | - Thomas Nogueira Vilches
- Universidade Estadual Paulista. Departamento de Bioestatística. Instituto de Biociências da Botucatu. Botucatu, SP, Brasil
| | - Gabriel Berg de Almeida
- Universidade Estadual Paulista. Faculdade de Medicina de Botucatu. Departamento de Infectologia. Botucatu, SP, Brasil
| | - Claudia Pio Ferreira
- Universidade Estadual Paulista. Departamento de Bioestatística. Instituto de Biociências da Botucatu. Botucatu, SP, Brasil
| | - Lenice do Rosário de Souza
- Universidade Estadual Paulista. Faculdade de Medicina de Botucatu. Departamento de Infectologia. Botucatu, SP, Brasil
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Nunes da Costa EAP, Victória C, Fortaleza CMCB. Predictors of development of cardiac and digestive disorders among patients with indeterminate chronic Chagas Disease. PLoS Negl Trop Dis 2021; 15:e0009680. [PMID: 34388146 PMCID: PMC8386853 DOI: 10.1371/journal.pntd.0009680] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/25/2021] [Accepted: 07/26/2021] [Indexed: 11/18/2022] Open
Abstract
American trypanosomiasis (Chagas disease, CD) affects circa 7 million persons worldwide. While of those persons present the asymptomatic, indeterminate chronic form (ICF), many will eventually progress to cardiac or digestive disorders. We studied a nonconcurrent (retrospective) cohort of patients attending an outpatient CD clinic in Southeastern Brazil, who were admitted while presenting the ICF in the period from 1998 through 2018 and followed until 2019. The outcomes of interest were the progression to cardiac or digestive CD forms. We were also interested in analyzing the impact of Benznidazole therapy on the progression of the disease. Extensive review of medical charts and laboratory files was conducted, collecting data up to year 2019. Demographics (upon inclusion), body mass index, comorbidities (including the Charlson index) and use of Benznidazole were recorded. The outcomes were defined by abnormalities in those test that could not be attributed to other causes. Statistical analysis included univariate and multivariable Cox regression models. Among 379 subjects included in the study, 87 (22.9%) and 100 (26.4%) progressed to cardiac and digestive forms, respectively. In the final multivariable model, cardiac disorders were positively associated with previous coronary syndrome (Hazzard Ratio [HR], 2.42; 95% Confidence Interval [CI], 1.53-3.81) and negatively associated with Benznidazole therapy (HR, 0.26; 95%CI, 0.11-0.60). On the other hand, female gender was the only independent predictor of progression to digestive forms (HR, 1.56; 95%CI, 1.03-2.38). Our results point to the impact of comorbidities on progression do cardiac CD, with possible benefit of the use of Benznidazole.
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Affiliation(s)
| | - Cassiano Victória
- Department of Zoonosis, Faculty of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), City of Botucatu, Brazil
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Alves AFF, Miranda JRA, Reis F, Oliveira AA, Souza SAS, Fortaleza CMCB, Tanni SE, Castro JTS, Pina DR. Automatic algorithm for quantifying lung involvement in patients with chronic obstructive pulmonary disease, infection with SARS-CoV-2, paracoccidioidomycosis and no lung disease patients. PLoS One 2021; 16:e0251783. [PMID: 34111131 PMCID: PMC8191897 DOI: 10.1371/journal.pone.0251783] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 05/03/2021] [Indexed: 11/19/2022] Open
Abstract
In this work, we aimed to develop an automatic algorithm for the quantification of total volume and lung impairments in four different diseases. The quantification was completely automatic based upon high resolution computed tomography exams. The algorithm was capable of measuring volume and differentiating pulmonary involvement including inflammatory process and fibrosis, emphysema, and ground-glass opacities. The algorithm classifies the percentage of each pulmonary involvement when compared to the entire lung volume. Our algorithm was applied to four different patients groups: no lung disease patients, patients diagnosed with SARS-CoV-2, patients with chronic obstructive pulmonary disease, and patients with paracoccidioidomycosis. The quantification results were compared with a semi-automatic algorithm previously validated. Results confirmed that the automatic approach has a good agreement with the semi-automatic. Bland-Altman (B&A) demonstrated a low dispersion when comparing total lung volume, and also when comparing each lung impairment individually. Linear regression adjustment achieved an R value of 0.81 when comparing total lung volume between both methods. Our approach provides a reliable quantification process for physicians, thus impairments measurements contributes to support prognostic decisions in important lung diseases including the infection of SARS-CoV-2.
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Affiliation(s)
- Allan Felipe Fattori Alves
- Botucatu Medical School, Clinics Hospital, Medical Physics and Radioprotection Nucleus, Botucatu, SP, Brazil
| | | | - Fabiano Reis
- Radiology and Medical Imaging, State University of Campinas, Campinas, SP, Brazil
| | - Abner Alves Oliveira
- Institute of Bioscience, Sao Paulo State University Julio de Mesquita Filho, Botucatu, SP, Brazil
| | | | | | - Suzana Erico Tanni
- Medical School, Sao Paulo State University Julio de Mesquita Filho, Botucatu, SP, Brazil
| | | | - Diana Rodrigues Pina
- Medical School, Sao Paulo State University Julio de Mesquita Filho, Botucatu, SP, Brazil
- * E-mail:
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Almeida GB, Vilches TN, Ferreira CP, Fortaleza CMCB. Addressing the COVID-19 transmission in inner Brazil by a mathematical model. Sci Rep 2021; 11:10760. [PMID: 34031456 PMCID: PMC8144226 DOI: 10.1038/s41598-021-90118-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/06/2021] [Indexed: 11/26/2022] Open
Abstract
In 2020, the world experienced its very first pandemic of the globalized era. A novel coronavirus, SARS-CoV-2, is the causative agent of severe pneumonia and has rapidly spread through many nations, crashing health systems and leading a large number of people to death. In Brazil, the emergence of local epidemics in major metropolitan areas has always been a concern. In a vast and heterogeneous country, with regional disparities and climate diversity, several factors can modulate the dynamics of COVID-19. What should be the scenario for inner Brazil, and what can we do to control infection transmission in each of these locations? Here, a mathematical model is proposed to simulate disease transmission among individuals in several scenarios, differing by abiotic factors, social-economic factors, and effectiveness of mitigation strategies. The disease control relies on keeping all individuals’ social distancing and detecting, followed by isolating, infected ones. The model reinforces social distancing as the most efficient method to control disease transmission. Moreover, it also shows that improving the detection and isolation of infected individuals can loosen this mitigation strategy. Finally, the effectiveness of control may be different across the country, and understanding it can help set up public health strategies.
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Affiliation(s)
- G B Almeida
- Medical School of Botucatu, São Paulo State University, Botucatu, 18618-687, Brazil.
| | - T N Vilches
- Institute of Mathematics, Statistics, and Scientific Computing, University of Campinas, Campinas, 13083-859, Brazil
| | - C P Ferreira
- Institute of Biosciences, São Paulo State University, Botucatu, 18618-689, Brazil
| | - C M C B Fortaleza
- Medical School of Botucatu, São Paulo State University, Botucatu, 18618-687, Brazil
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Teixeira NB, Castelo Branco Fortaleza CM, de Souza MC, Monteiro Pereira TA, de Camargo Colenci BP, Ribeiro de Souza da Cunha MDL. Molecular characterization of methicillin-resistant Staphylococcus aureus among insulin-dependent diabetic individuals in Brazil. Ann Clin Microbiol Antimicrob 2021; 20:12. [PMID: 33568148 PMCID: PMC7876813 DOI: 10.1186/s12941-020-00401-y] [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: 08/27/2020] [Accepted: 11/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background People with diabetes mellitus, especially insulin-dependent diabetic patients, are a risk group for staphylococcal infections. Asymptomatic infection with Staphylococcus aureus is common and favors dissemination of the microorganism, rendering these individuals a source of infection. This study aimed to characterize the resistance profile, clonal profile and sequence type, as well as to analyze the prevalence and risk factors for nasal and oropharyngeal carriage of methicillin-susceptible (MSSA) and methicillin-resistant S. aureus (MRSA) isolated from insulin-dependent diabetic individuals in the city of Botucatu, SP, Brazil. Methods Staphylococcus aureus was collected from the nasopharynx and oropharynx of 312 community-dwelling insulin-dependent diabetic individuals over a period of 3 years (October 2015 to December 2018). The isolates were characterized by susceptibility profiling, detection of the mecA gene, SCCmec typing, and molecular typing by PFGE and MLST. The risk factors associated with S. aureus and MRSA carriage were determined by logistic regression analysis. Results The overall prevalence of colonization with S. aureus and MRSA was 30.4% and 4.8%, respectively. Fifteen of the 112 S. aureus isolates carried the mecA gene; SCCmec type IV was identified in 10 isolates, SCCmec type I in three, and SCCmec type II in two. Among the 15 resistant isolates (MRSA), four were susceptible to oxacillin/cefoxitin by the disc diffusion method and one MSSA isolate was resistant to sulfamethoxazole/trimethoprim. The analysis of risk factors revealed a protective effect of age and lung disease, while lower-extremity ulcers were a risk factor for S. aureus. For MRSA, only male gender was significantly associated as a risk factor in multivariate analysis. Clonal profile analysis demonstrated the formation of clusters among MRSA isolates from different patients, with the identification of ST5-IV, ST5-I, and ST8-IV. Isolates carrying ST398 were identified among MSSA and MRSA (ST398-IV). Conclusion Our findings reinforce the importance of epidemiological studies of S. aureus carriage, especially in populations at high risk of infections such as diabetics. The data suggest widespread dissemination of MRSA in the population of insulin-dependent diabetic patients studied, as well as the emergence of important lineages among these individuals.
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Affiliation(s)
- Nathalia Bibiana Teixeira
- Departamento de Infectologia, Dermatologia, Diagnóstico Por Imagem e Radioterapia, Faculdade de Medicina de Botucatu, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil. .,Departamento de Ciências Químicas e Biológicas, Instituto de Biociências de Botucatu, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil. .,Departamento de Ciências Químicas e Biológicas - Setor Microbiologia e Imunologia, Instituto de Biociências de Botucatu (IBB)-Laboratório de Bacteriologia. Rua Plínio Silva, CEP: 18618-970 - Distrito de Rubião Júnior, Botucatu, SP, Brasil.
| | - Carlos Magno Castelo Branco Fortaleza
- Departamento de Infectologia, Dermatologia, Diagnóstico Por Imagem e Radioterapia, Faculdade de Medicina de Botucatu, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil
| | - Matheus Cristovam de Souza
- Departamento de Ciências Químicas e Biológicas, Instituto de Biociências de Botucatu, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil
| | - Thais Aline Monteiro Pereira
- Departamento de Ciências Químicas e Biológicas, Instituto de Biociências de Botucatu, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil
| | - Bibiana Prada de Camargo Colenci
- Departamento de Clínica Médica - Endocrinologia, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil
| | - Maria de Lourdes Ribeiro de Souza da Cunha
- Departamento de Ciências Químicas e Biológicas, Instituto de Biociências de Botucatu, UNESP - Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brasil
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Fortaleza CMCB, Guimarães RB, Catão RDC, Ferreira CP, Berg de Almeida G, Nogueira Vilches T, Pugliesi E. The use of health geography modeling to understand early dispersion of COVID-19 in São Paulo, Brazil. PLoS One 2021; 16:e0245051. [PMID: 33411768 PMCID: PMC7790416 DOI: 10.1371/journal.pone.0245051] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 04/26/2020] [Accepted: 12/21/2020] [Indexed: 01/31/2023] Open
Abstract
Public health policies to contain the spread of COVID-19 rely mainly on non-pharmacological measures. Those measures, especially social distancing, are a challenge for developing countries, such as Brazil. In São Paulo, the most populous state in Brazil (45 million inhabitants), most COVID-19 cases up to April 18th were reported in the Capital and metropolitan area. However, the inner municipalities, where 20 million people live, are also at risk. As governmental authorities discuss the loosening of measures for restricting population mobility, it is urgent to analyze the routes of dispersion of COVID-19 in São Paulo territory. We hypothesize that urban hierarchy is the main responsible for the disease spreading, and we identify the hotspots and the main routes of virus movement from the metropolis to the inner state. In this ecological study, we use geographic models of population mobility to check for patterns for the spread of SARS-CoV-2 infection. We identify two patterns based on surveillance data: one by contiguous diffusion from the capital metropolitan area, and the other hierarchical with long-distance spread through major highways that connects São Paulo city with cities of regional relevance. This knowledge can provide real-time responses to support public health strategies, optimizing the use of resources in order to minimize disease impact on population and economy.
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Affiliation(s)
| | - Raul Borges Guimarães
- Department of Geography, Faculty of Science and Technology, São Paulo State University (UNESP), Presidente Prudente, São Paulo State, Brazil
| | - Rafael de Castro Catão
- Department of Geography, Federal University of Espírito Santo, Vitória, Espírito Santo State, Brazil
| | - Cláudia Pio Ferreira
- Institute of Biosciences, São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Gabriel Berg de Almeida
- Department of Infectious Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil
| | - Thomas Nogueira Vilches
- Institute of Mathematics, Statistics and Scientific Computation, University of Campinas (UNICAMP), Campinas, São Paulo State, Brazil
| | - Edmur Pugliesi
- Department of Geography, Faculty of Science and Technology, São Paulo State University (UNESP), Presidente Prudente, São Paulo State, Brazil
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Fortaleza CR, de Souza LDR, Rúgolo JM, Fortaleza CMCB. COVID-19: What we talk about when we talk about masks. Rev Soc Bras Med Trop 2020; 53:e20200527. [PMID: 33174963 PMCID: PMC7670747 DOI: 10.1590/0037-8682-0527-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/24/2020] [Indexed: 11/22/2022] Open
Abstract
Even though most current recommendations include the general use of masks to prevent community transmission of SARS-Cov-2, the effectiveness of this measure is still debated. The studies on this policy include physical filtering tests with inanimate microparticles, randomized clinical trials, observational studies, ecological analyses, and even computational modeling of epidemics. Much of the so-called evidence is inferred from studies on different respiratory viruses and epidemiological settings. Heterogeneity is a major factor limiting the generalization of inferences. In this article, we reviewed the empirical and rational bases of mask use and how to understand these recommendations compared to other policies of social distancing, restrictions on non-essential services, and lockdown. We conclude that recent studies suggest a synergistic effect of the use of masks and social distancing rather than opposing effects of the two recommendations. Developing social communication approaches that clarify the need to combine different strategies is a challenge for public health authorities.
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Affiliation(s)
- Cristiane Ravagnani Fortaleza
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Hospital das Clínicas, Botucatu, SP, Brasil
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Programa de Pós-graduação em doenças infecciosas, Botucatu, SP, Brasil
| | - Lenice do Rosário de Souza
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Programa de Pós-graduação em doenças infecciosas, Botucatu, SP, Brasil
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de doenças infecciosas, Botucatu, SP, Brasil
| | - Juliana Machado Rúgolo
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Hospital das Clínicas, Botucatu, SP, Brasil
| | - Carlos Magno Castelo Branco Fortaleza
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Programa de Pós-graduação em doenças infecciosas, Botucatu, SP, Brasil
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de doenças infecciosas, Botucatu, SP, Brasil
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Abstract
Two decades ago, Robert Proctor coined the term agnotology to refer to the study of ignorance that stems from scientific research. Amid the coronavirus disease pandemic, the world is witnessing the greatest natural experiment ever, and countries have adopted different response strategies. An evaluation of the effectiveness of different policies will play a valuable role in preparing for future public health emergencies. However, controversial issues such as the timing and pathways of viral emergence, the effectiveness of social distancing and lockdown strategies, and the use of antimalarial drugs as therapy have still not been fully resolved. This serves as a fertile breeding ground for agnotological strategies, whereby scientific studies are deliberately or unintentionally designed to create distractions or draw conclusions that are not supported by research findings. Researchers, public health authorities, and healthcare workers should be equipped to identify such agnotological strategies, distinguish them from scientific fraud, and avoid drawing misleading inferences based on an irrational adherence to hypotheses and a lack of criticism of implausible results.
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do Lago VC, Cezare TJ, Fortaleza CMCB, Okoshi MP, Baldi BG, Tanni SE. Does COVID-19 Increase the Risk for Spontaneous Pneumothorax? Am J Med Sci 2020; 360:735-737. [PMID: 32819707 PMCID: PMC7365097 DOI: 10.1016/j.amjms.2020.07.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/15/2020] [Indexed: 01/08/2023]
Affiliation(s)
| | - Talita Jacon Cezare
- Pulmonology Division of Botucatu Medical School of UNESP, São Paulo, Brazil.
| | | | - Marina Politi Okoshi
- Internal Medicine Division of Botucatu Medical School of UNESP São Paulo, Brazil
| | - Bruno Guedes Baldi
- Divisão de Pneumologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Instituto do Coração (InCor), Universidade de São Paulo, São Paulo, Brazil
| | - Suzana Erico Tanni
- Pulmonology Division of Botucatu Medical School of UNESP, São Paulo, Brazil
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Sanchez MCA, Celeste BJ, Lindoso JAL, Fujimori M, de Almeida RP, Fortaleza CMCB, Druzian AF, Lemos APF, de Melo VCA, Miranda Paniago AM, Queiroz IT, Goto H. Performance of rK39-based immunochromatographic rapid diagnostic test for serodiagnosis of visceral leishmaniasis using whole blood, serum and oral fluid. PLoS One 2020; 15:e0230610. [PMID: 32240188 PMCID: PMC7117722 DOI: 10.1371/journal.pone.0230610] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 11/19/2022] Open
Abstract
Background The development of rK39-based immunochromatographic rapid diagnostic tests represents an important advance for serodiagnosis of visceral leishmaniasis, being cheap and easy to use at the point of care (POC). Although the use of rK39 have considerably improved the sensitivity and specificity of serological tests compared with total antigens, great variability in sensitivity and specificity was reported. This study aimed at the evaluation of “Kalazar Detect™ Rapid Test, Whole Blood” (Kalazar Detect RDT) for Visceral Leishmaniasis (VL) diagnosis using oral fluid, whole blood and serum specimens collected at different endemic areas of VL of Brazil. Methodology To evaluate Kalazar Detect RDT, oral fluid, whole blood and serum specimens from 128 VL patients, 85 healthy individuals, 22 patients with possible cross-reactivity diseases and 20 VL/aids coinfected patients were collected and assayed at the POC. Principal findings and conclusions The performance of Kalazar Detect RDT in whole blood and serum was similar; however, using oral fluid, the sensitivity was low. Particularly in samples from the city of Natal, Rio Grande do Norte state in Northeastern Brazil, we observed low sensitivity, 80.0% (95% CI: 62.7–90.5), using whole blood and serum, and poor sensitivity, 43.3% (95% CI: 27.4–60.8) with oral fluid. Those values were much lower than in the other regions, where sensitivity ranged from 92.7–96.3% in whole blood and serum, and 80.0–88.9% in oral fluid. Besides, in VL/aids coinfected patients, lower sensitivity was achieved compared with VL patients. In samples from Natal, the sensitivity was 0.0% (95% CI: 0.0–49.0) and 25.0% (95% CI: 4.6–69.9), using oral fluid and serum/whole blood, respectively; in samples from the other regions, the sensitivity ranged from 40.0–63.6% and 80.0–81.8%, respectively. As for specificity, high values were observed across the fluids, 100.0% (95% CI: 96.5–100.0) in whole blood, 96.3% (95% CI: 90.8–98.5) in serum, and 95.3% (95% CI: 89.5–98.0) in oral fluid; across localities, specificity ranged from 85.7–100.0%. Serum samples sent by the collaborating centers to Instituto de Medicina Tropical (n = 250) were tested by Kalazar Detect RDT, Direct Agglutination Test, Indirect immunofluorescence assay, Enzyme-linked immunosorbent assay, and IT-Leish® RDT. The regional difference in the performance of rK39-based RDT and lower sensitivity in Leishmania/HIV coinfected patients raise concern on the routine use of these products for the diagnosis of VL.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Protozoan/blood
- Antibodies, Protozoan/immunology
- Antigens, Protozoan/immunology
- Body Fluids/chemistry
- Brazil/epidemiology
- Child
- Child, Preschool
- Chromatography, Affinity/methods
- Diagnostic Tests, Routine/methods
- Female
- Fluorescent Antibody Technique, Indirect
- Humans
- Infant
- Leishmania/isolation & purification
- Leishmaniasis, Visceral/blood
- Leishmaniasis, Visceral/diagnosis
- Leishmaniasis, Visceral/epidemiology
- Male
- Middle Aged
- Point-of-Care Systems
- Protozoan Proteins/immunology
- Serologic Tests/methods
- Young Adult
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Affiliation(s)
- Maria Carmen Arroyo Sanchez
- Laboratório de Soroepidemiologia e Imunobiologia, Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
- * E-mail:
| | - Beatriz Julieta Celeste
- Laboratório de Soroepidemiologia e Imunobiologia, Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - José Angelo Lauletta Lindoso
- Departamento de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
- Instituto de Infectologia Emílio Ribas, Secretaria de Estado da Saúde, São Paulo, SP, Brazil
| | - Mahyumi Fujimori
- Laboratório de Soroepidemiologia e Imunobiologia, Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Roque Pacheco de Almeida
- Departamento de Medicina Interna e Patologia, Hospital Universitário/EBSERH, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | | | - Angelita Fernandes Druzian
- Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | | | | | - Igor Thiago Queiroz
- Hospital Giselda Trigueiro, Secretaria Estadual da Segurança Pública, Natal, RN, Brazil
| | - Hiro Goto
- Laboratório de Soroepidemiologia e Imunobiologia, Instituto de Medicina Tropical da Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
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Simão JC, Victória C, Fortaleza CMCB. Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil. Int J Infect Dis 2020; 95:44-49. [PMID: 32088340 DOI: 10.1016/j.ijid.2020.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/29/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Visceral leishmaniasis (VL) is a public health threat for several tropical countries, including Brazil. Therapy failures and relapses aggravate VL morbidity and mortality. Our study aimed at identifying predictors of relapse and thus contributes to directing therapeutic options and patient follow-up. METHODS A nonconcurrent cohort of 571 subjects who completed successful therapy for VL in the city of Bauru, São Paulo State, Brazil, was followed for 24 months in order to identify the incidence and predictors of relapse. Extensive review of medical charts and laboratory files was conducted. Univariate and multivariable Cox regression models were used to identify predictors for the outcome of interest. A hierarchical strategy was used for variable selection in multivariable models. RESULTS Relapses occurred in 6.8% of treated subjects, after a median of 6 months (interquartile range, 4-9). In a comprehensive multivariable model, relapse was associated with: HIV-coinfection (hazard ratio [HR], 7.47; 95% confidence interval [CI], 2.58-21.55); the presence of lower limb edema (HR, 6.06; 95%CI, 1.38-26.77) and low platelet count upon admission (HR for platelet count × 1000, 0.99; 95%CI, 0.98-0.99) ; and secondary pneumonia (HR, 5.49; 95%CI, 1.49-20.18). On the other hand, therapy with Liposomal Amphotericin (as opposed to Antimoniate) was not independently associated with relapse (HR, 5.97; 95%CI, 0.63-56.29). CONCLUSION Besides reinforcing the impact of HIV coinfection on the outcome of VL, our study points to clinical and laboratory findings that characterize patients who were more likely to relapse. Those groups should be more closely followed, and possibly could benefit from novel therapeutic options.
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Affiliation(s)
- José Cláudio Simão
- Postgraduate Program in Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Cassiano Victória
- Department of Veterinary Hygiene and Public Health, Veterinary Faculty, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Carlos Magno Castelo Branco Fortaleza
- Postgraduate Program in Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil; Department of Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.
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32
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Limaylla DC, Fortaleza CMCB, Silva MDO. Environmental conditions and health care-associated infections in wards for noncritical patients. Am J Infect Control 2019; 47:599-600. [PMID: 30826124 DOI: 10.1016/j.ajic.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Dayanne Conislla Limaylla
- Postgraduate Program in Collective Health São Paulo State University Botucatu Medical School Botucatu, São Paulo State, Brazil
| | | | - Marina de Oliveira Silva
- Department of Tropical Diseases São Paulo State University Botucatu Medical School Botucatu, São Paulo State, Brazil
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Correa AAF, Fortaleza CMCB. Incidence and predictors of health care-associated infections among patients colonized with carbapenem-resistant Enterobacteriaceae. Am J Infect Control 2019; 47:213-216. [PMID: 30279017 DOI: 10.1016/j.ajic.2018.08.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/03/2018] [Accepted: 08/03/2018] [Indexed: 11/28/2022]
Abstract
Colonization with carbapenem-resistant Enterobacteriaceae (CRE) precedes invasive infections. Neither the actual risk for the latter nor the route between the 2 stages is completely clear. We studied a retrospective cohort of patients hospitalized between 2013-2016 and colonized with CRE. The incidence of CRE health care-associated infections was 13.2%, and predictors were the presence of a urinary catheter and the use of carbapenems. Infection prevention strategies in CRE-colonized patients should focus on invasive devices and antimicrobial stewardship.
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Affiliation(s)
- Adriana Aparecida Feltrin Correa
- Department of Tropical Diseases, Botucatu Medical School, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil; Bauru State Hospital, São Paulo State Health Department. City of Bauru, São Paulo State, Brazil
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34
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Fortaleza CMCB, Silva MDO, Saad Rodrigues F, da Cunha AR. Impact of weather on the risk of surgical site infections in a tropical area. Am J Infect Control 2019; 47:92-94. [PMID: 30262260 DOI: 10.1016/j.ajic.2018.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 05/04/2018] [Revised: 07/15/2018] [Accepted: 07/16/2018] [Indexed: 01/27/2023]
Abstract
We studied the impact of average daily temperature and relative humidity on the risk of surgical site infections in 36,429 surgeries performed in a hospital in inner Brazil. Adjusted Poisson regression models found an association between surgical site infections and temperature (rate ratio [RR], 1.013; 95% confidence interval [CI], 1.001-1.025). The effect was concentrated on clean wound procedures and was greater over the 75th (RR, 1.109; 95% CI, 1.015-1.212) and 90th (RR, 1.196; 95% CI, 1.055-1.355) percentiles of daily temperature.
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Affiliation(s)
| | - Marina de Oliveira Silva
- Department of Tropical Diseases, Botucatu School of Medicine, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil
| | - Fernanda Saad Rodrigues
- Department of Tropical Diseases, Botucatu School of Medicine, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil
| | - Antônio Ribeiro da Cunha
- Faculty of Agronomical Sciences, São Paulo State University (UNESP), City of Botucatu, São Paulo State, Brazil
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35
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Del Masso Pereira MA, Fortaleza CMCB. Factors associated with community-onset multidrug-resistant organisms in inner Brazil. Am J Infect Control 2018; 46:1423-1424. [PMID: 30146109 DOI: 10.1016/j.ajic.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/02/2018] [Indexed: 11/29/2022]
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36
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Vilches TN, Bonesso MF, Guerra HM, Fortaleza CMCB, Park AW, Ferreira CP. The role of intra and inter-hospital patient transfer in the dissemination of heathcare-associated multidrug-resistant pathogens. Epidemics 2018; 26:104-115. [PMID: 30583920 DOI: 10.1016/j.epidem.2018.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 06/20/2018] [Revised: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 11/28/2022] Open
Abstract
Healthcare-associated infections cause significant patient morbidity and mortality, and contribute to growing healthcare costs, whose effects may be felt most strongly in developing countries. Active surveillance systems, hospital staff compliance, including hand hygiene, and a rational use of antimicrobials are among the important measures to mitigate the spread of healthcare-associated infection within and between hospitals. Klebsiella pneumoniae is an important human pathogen that can spread in hospital settings, with some forms exhibiting drug resistance, including resistance to the carbapenem class of antibiotics, the drugs of last resort for such infections. Focusing on the role of patient movement within and between hospitals on the transmission and incidence of enterobacteria producing the K. pneumoniae Carbapenemase (KPC, an enzyme that inactivates several antimicrobials), we developed a metapopulation model where the connections among hospitals are made using a theoretical hospital network based on Brazilian hospital sizes and locations. The pathogen reproductive number, R0 that measures the average number of new infections caused by a single infectious individual, was calculated in different scenarios defined by both the links between hospital environments (regular wards and intensive care units) and between different hospitals (patient transfer). Numerical simulation was used to illustrate the infection dynamics in this set of scenarios. The sensitivity of R0 to model input parameters, such as hospital connectivity and patient-hospital staff contact rates was also established, highlighting the differential importance of factors amenable to change on pathogen transmission and control.
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Affiliation(s)
- T N Vilches
- São Paulo State University (UNESP), Institute of Biosciences, Department of Biostatistics, 18618-689 Botucatu, Brazil
| | - M F Bonesso
- Departamento de Doenças Tropicais, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, Brazil
| | - H M Guerra
- Departamento de Doenças Tropicais, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, Brazil
| | - C M C B Fortaleza
- Departamento de Doenças Tropicais, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, Brazil
| | - A W Park
- Odum School of Ecology & Department of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - C P Ferreira
- São Paulo State University (UNESP), Institute of Biosciences, Department of Biostatistics, 18618-689 Botucatu, Brazil.
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da Silveira M, da Cunha MDLRDS, de Souza CSM, Correa AAF, Fortaleza CMCB. Nasal colonization with methicillin-resistant Staphylococcus aureus among elderly living in nursing homes in Brazil: risk factors and molecular epidemiology. Ann Clin Microbiol Antimicrob 2018; 17:18. [PMID: 29728115 PMCID: PMC5934845 DOI: 10.1186/s12941-018-0271-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 10/24/2017] [Accepted: 04/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus poses a threat to elderly living in nursing homes. Studies focusing on the epidemiology of colonization may help in the design of infection control strategies. OBJECTIVE To identify factors associated with MRSA colonization and the dissemination of clones among nursing home residents. METHODS Nasal swabs were collected from 300 persons from nine nursing homes in the city of Bauru, Brazil. Resistance to methicillin was identified through amplification of the mecA gene. Strain typing (Pulsed-Field Gel Electrophoresis) and characterization of the Staphylococcal Chromosome Cassette (SCC) mec was performed. Univariate and multivariable models were used to identify predictors of overall S. aureus and MRSA carriage. RESULTS Rates of S. aureus and MRSA colonization were 17.7 and 3.7%, respectively. Age and recent admission to a hospital were independently associated with colonization with S. aureus. MRSA colonization was associated with living in small (< 15 residents) and medium-sized (15-49 residents) facilities, as well as with recent hospitalization. Most MRSA strains carried SCCmec types II or IV, and there was evidence of clonal spread within and among different facilities. CONCLUSIONS MRSA may be introduced in nursing homes form hospitals or arise from the community setting. Screening for asymptomatic colonization may identify persons with greater risk for infection, and is advised for residents discharged from acute care hospitals.
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Affiliation(s)
- Monica da Silveira
- Department of Tropical Diseases, Botucatu School of Medicine, University Hospital, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil
| | | | - Camila Sena Martins de Souza
- Department of Microbiology and Immunology, Botucatu Biosciences Institute, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil
| | - Adriana Aparecida Feltrin Correa
- Department of Tropical Diseases, Botucatu School of Medicine, University Hospital, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil
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38
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Giacomini G, Pavan ALM, Altemani JMC, Duarte SB, Fortaleza CMCB, Miranda JRDA, de Pina DR. Computed tomography-based volumetric tool for standardized measurement of the maxillary sinus. PLoS One 2018; 13:e0190770. [PMID: 29304130 PMCID: PMC5755892 DOI: 10.1371/journal.pone.0190770] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 12/09/2016] [Accepted: 11/29/2017] [Indexed: 11/19/2022] Open
Abstract
Volume measurements of maxillary sinus may be useful to identify diseases affecting paranasal sinuses. However, literature shows a lack of consensus in studies measuring the volume. This may be attributable to different computed tomography data acquisition techniques, segmentation methods, focuses of investigation, among other reasons. Furthermore, methods for volumetrically quantifying the maxillary sinus are commonly manual or semiautomated, which require substantial user expertise and are time-consuming. The purpose of the present study was to develop an automated tool for quantifying the total and air-free volume of the maxillary sinus based on computed tomography images. The quantification tool seeks to standardize maxillary sinus volume measurements, thus allowing better comparisons and determinations of factors that influence maxillary sinus size. The automated tool utilized image processing techniques (watershed, threshold, and morphological operators). The maxillary sinus volume was quantified in 30 patients. To evaluate the accuracy of the automated tool, the results were compared with manual segmentation that was performed by an experienced radiologist using a standard procedure. The mean percent differences between the automated and manual methods were 7.19% ± 5.83% and 6.93% ± 4.29% for total and air-free maxillary sinus volume, respectively. Linear regression and Bland-Altman statistics showed good agreement and low dispersion between both methods. The present automated tool for maxillary sinus volume assessment was rapid, reliable, robust, accurate, and reproducible and may be applied in clinical practice. The tool may be used to standardize measurements of maxillary volume. Such standardization is extremely important for allowing comparisons between studies, providing a better understanding of the role of the maxillary sinus, and determining the factors that influence maxillary sinus size under normal and pathological conditions.
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Affiliation(s)
- Guilherme Giacomini
- Instituto de Biociências de Botucatu, Universidade Estadual Paulista (IBB-UNESP), Botucatu, São Paulo, Brazil
| | - Ana Luiza Menegatti Pavan
- Instituto de Biociências de Botucatu, Universidade Estadual Paulista (IBB-UNESP), Botucatu, São Paulo, Brazil
| | | | - Sergio Barbosa Duarte
- Centro Brasileiro de Pesquisas Físicas (CBPF), Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Diana Rodrigues de Pina
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (FMB-UNESP), Botucatu, São Paulo, Brazil
- * E-mail:
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Padoveze MC, Melo S, Bishop S, Poveda VDB, Fortaleza CMCB. Public policies on healthcare-associated infections: a Brazil and UK case study. Rev Saude Publica 2017; 51:119. [PMID: 29236881 PMCID: PMC5718108 DOI: 10.11606/s1518-8787.2017051000315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 10/17/2016] [Accepted: 04/02/2017] [Indexed: 11/21/2022] Open
Abstract
To summarize the historical events and drivers underlying public policy for the prevention and control of healthcare-associated infections in Brazil and in the United Kingdom. In doing so, the article aims to identify lessons and recommendations for future development of public policy. The analysis is based on a historical overview of national healthcare-associated infections programs taken from previously published sources. Findings highlight how the development of healthcare-associated infections prevention and control policies followed similar trajectories in Brazil and the United Kingdom. This can be conceptualized around four sequential phases: Formation, Consolidation, Standardization, and Monitoring and Evaluation. However, while we identified similar phases of development in Brazil and the United Kingdom, it can be seen that the former entered each stage around 20 years after the latter.
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Affiliation(s)
- Maria Clara Padoveze
- Universidade de São Paulo. Escola de Enfermagem. Departamento de Enfermagem em Saúde Coletiva. São Paulo, SP, Brasil
| | - Sara Melo
- Queen's University Belfast. Queen's Management School. Belfast, Northern Ireland, United Kingdom
| | - Simon Bishop
- University of Nottingham. Nottingham University Business School. Nottingham, United Kingdom
| | - Vanessa de Brito Poveda
- Universidade de São Paulo. Escola de Enfermagem. Departamento de Enfermagem Médico Cirúrgica. São Paulo, SP, Brasil
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Pereira-Franchi EPL, Barreira MRN, Costa NDSLMD, Fortaleza CMCB, Cunha MDLRDSD. Prevalence of and risk factors associated with the presence of Staphylococcus aureus in the chronic wounds of patients treated in primary health care settings in Brazil. Rev Soc Bras Med Trop 2017; 50:833-838. [DOI: 10.1590/0037-8682-0205-2017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/24/2017] [Indexed: 11/22/2022] Open
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Armede VCB, Abraão LM, Fortaleza CMCB. Surgical site infections in very small hospitals in inner Brazil: Unveiling a relevant issue for developing countries. Am J Infect Control 2017. [PMID: 28625697 DOI: 10.1016/j.ajic.2017.04.289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moraes EB, Slompo L, Finardi AJ, Silveira HPPD, Ruiz L, Gomes HM, Richini VB, Suffys P, Fortaleza CMCB, Cavalcanti R, Baptista IMFD. Tuberculosis associated factors caused by Mycobacterium tuberculosis of the RDRio genotype. Mem Inst Oswaldo Cruz 2017; 112:182-187. [PMID: 28225901 PMCID: PMC5319367 DOI: 10.1590/0074-02760160347] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 11/07/2016] [Indexed: 11/22/2022] Open
Affiliation(s)
- Eloise Brasil Moraes
- Instituto Lauro de Souza Lima, Brasil; Universidade Estadual Paulista Júlio de Mesquita Filho, Brasil
| | | | - Amanda Juliane Finardi
- Instituto Lauro de Souza Lima, Brasil; Universidade Estadual Paulista Júlio de Mesquita Filho, Brasil
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Monteiro ACM, Fortaleza CMCB, Ferreira AM, Cavalcante RDS, Mondelli AL, Bagagli E, da Cunha MDLRDS. Comparison of methods for the identification of microorganisms isolated from blood cultures. Ann Clin Microbiol Antimicrob 2016; 15:45. [PMID: 27496125 PMCID: PMC4974807 DOI: 10.1186/s12941-016-0158-9] [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] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/14/2016] [Indexed: 11/12/2022] Open
Abstract
Background Bloodstream infections are responsible for thousands of deaths each year. The rapid identification of the microorganisms causing these infections permits correct therapeutic management that will improve the prognosis of the patient. In an attempt to reduce the time spent on this step, microorganism identification devices have been developed, including the VITEK® 2 system, which is currently used in routine clinical microbiology laboratories. Methods This study evaluated the accuracy of the VITEK® 2 system in the identification of 400 microorganisms isolated from blood cultures and compared the results to those obtained with conventional phenotypic and genotypic methods. In parallel to the phenotypic identification methods, the DNA of these microorganisms was extracted directly from the blood culture bottles for genotypic identification by the polymerase chain reaction (PCR) and DNA sequencing. Results The automated VITEK® 2 system correctly identified 94.7 % (379/400) of the isolates. The YST and GN cards resulted in 100 % correct identifications of yeasts (15/15) and Gram-negative bacilli (165/165), respectively. The GP card correctly identified 92.6 % (199/215) of Gram-positive cocci, while the ANC card was unable to correctly identify any Gram-positive bacilli (0/5). Conclusions The performance of the VITEK® 2 system was considered acceptable and statistical analysis showed that the system is a suitable option for routine clinical microbiology laboratories to identify different microorganisms.
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Affiliation(s)
- Aydir Cecília Marinho Monteiro
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, UNESP-Univ. Estadual Paulista, Distrito de Rubião Junior, s/n, Botucatu, SP, CEP: 18618-970, Brazil
| | - Carlos Magno Castelo Branco Fortaleza
- Departamento de Doenças Tropicais, Faculdade de Medicina de Botucatu, UNESP-Univ. Estadual Paulista, Distrito de Rubião Junior, s/n, Botucatu, SP, CEP: 18618-970, Brazil
| | - Adriano Martison Ferreira
- Laboratório de Análises Clínicas do Hospital das Clínicas de Botucatu, Faculdade de Medicina de Botucatu, UNESP-Univ. Estadual Paulista, Distrito de Rubião Junior, s/n, Botucatu, SP, CEP: 18618-970, Brazil
| | - Ricardo de Souza Cavalcante
- Comissão de Controle de Infecção Relacionada à Assistência à Saúde, Hospital das Clínicas, Faculdade de Medicina de Botucatu, UNESP-Univ. Estadual Paulista, Distrito de Rubião Junior, s/n, Botucatu, SP, CEP: 18618-970, Brazil
| | - Alessandro Lia Mondelli
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, UNESP-Univ. Estadual Paulista, Distrito de Rubião Junior, s/n, Botucatu, SP, CEP: 18618-970, Brazil
| | - Eduardo Bagagli
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, UNESP-Univ. Estadual Paulista, Distrito de Rubião Junior, s/n, Botucatu, SP, CEP: 18618-970, Brazil
| | - Maria de Lourdes Ribeiro de Souza da Cunha
- Departamento de Microbiologia e Imunologia, Instituto de Biociências de Botucatu, UNESP-Univ. Estadual Paulista, Distrito de Rubião Junior, s/n, Botucatu, SP, CEP: 18618-970, Brazil. .,Departamento de Doenças Tropicais, Faculdade de Medicina de Botucatu, UNESP-Univ. Estadual Paulista, Distrito de Rubião Junior, s/n, Botucatu, SP, CEP: 18618-970, Brazil.
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de Souza CSM, Fortaleza CMCB, Witzel CL, Silveira M, Bonesso MF, Marques SA, Cunha MDLRDSD. Toxigenic profile of methicillin-sensitive and resistant Staphylococcus aureus isolated from special groups. Ann Clin Microbiol Antimicrob 2016; 15:9. [PMID: 26880287 PMCID: PMC4754922 DOI: 10.1186/s12941-016-0125-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 09/10/2015] [Accepted: 02/03/2016] [Indexed: 11/10/2022] Open
Abstract
Background Staphylococcus aureus is characterized by its pathogenicity and high prevalence, causing disease in both healthy and immunocompromised individuals due to its easy dissemination. This fact is aggravated by the widespread dissemination of S. aureus carrying toxigenic genes.
The objective of this study was to determine the toxigenic profile of methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) in patients with purulent skin and/or soft tissue infections seen at the Dermatology Department of the University Hospital of the Botucatu Medical School, asymptomatic adults older than 60 years living in nursing homes, and prison inmates of the Avaré Detention Center. Methods PCR was used for the detection of the mecA gene, enterotoxin genes (sea, seb, and sec), exfoliative toxins A and B (eta and etb), toxic shock syndrome toxin 1 (tst), panton–valentine leukocidin (lukS-PV and lukF-PV), and alpha- and delta-hemolysins or cytotoxins (hla and hld). Results The results showed a significant prevalence of toxigenic genes among S. aureus isolates from asymptomatic individuals, with the observation of a higher prevalence of cytotoxin genes. However, the panton–valentine leukocidin gene was only detected in MSSA isolated from patients with skin infections and the tst gene was exclusively found in MSSA isolated from prison inmates. Conclusions The present study demonstrated a significant prevalence of toxigenic genes in MSSA and MRSA strains isolated from asymptomatic S. aureus carriers. There was a higher prevalence of cytotoxin genes.
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Affiliation(s)
- Camila Sena Martins de Souza
- Department of Microbiology and Immunology, Botucatu Biosciences Institute, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil. .,Department of Tropical Diseases, Botucatu School of Medicine, University Hospital, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil.
| | | | - Claudia Lima Witzel
- Department of Microbiology and Immunology, Botucatu Biosciences Institute, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil. .,Department of Tropical Diseases, Botucatu School of Medicine, University Hospital, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil.
| | - Mônica Silveira
- Department of Tropical Diseases, Botucatu School of Medicine, University Hospital, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil.
| | - Mariana Fávero Bonesso
- Department of Microbiology and Immunology, Botucatu Biosciences Institute, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil. .,Department of Tropical Diseases, Botucatu School of Medicine, University Hospital, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil.
| | - Silvio Alencar Marques
- Department of Dermatology and Radiology, Botucatu School of Medicine, University Hospital, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil.
| | - Maria de Lourdes Ribeiro de Souza da Cunha
- Department of Microbiology and Immunology, Botucatu Biosciences Institute, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil. .,Department of Tropical Diseases, Botucatu School of Medicine, University Hospital, UNESP-Univ Estadual Paulista, Botucatu, SP, Brazil.
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Fusco SDFB, Massarico NM, Alves MVMFF, Fortaleza CMCB, Pavan ÉCP, Palhares VDC, Melo CED, Avila MAGD, Nitsche MJT. Surgical site infection and its risk factors in colon surgeries. Rev Esc Enferm USP 2016; 50:43-9. [DOI: 10.1590/s0080-623420160000100006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/07/2015] [Indexed: 12/23/2022] Open
Abstract
Abstract OBJECTIVE To identify the occurrence of surgical site infection (SSI) and its risk factors in patients undergoing colon surgery in a tertiary hospital located in the countryside of the state of São Paulo. METHOD Retrospective cohort study, with collection of information contained in the medical records of patients undergoing colon surgery in the period between January 2010 and December 2013. The studied variables were the possible risk factors related to the patient, to demographic characteristics and the surgical procedure. RESULTS In total, were evaluated 155 patients with an overall SSI incidence of 16.7%. A statistically significant association was found both in the univariate as in the multivariate analysis between the SSI and the following variables: male gender, Charlson index and mechanical bowel preparation. CONCLUSION The understanding of health professionals about the factors that influence the incidence of SSI in colon surgery may contribute to the quality of care provided to surgical patients, from effective actions to minimize the risk of infections.
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Padoveze MC, Fortaleza CMCB, Kiffer C, Barth AL, Carneiro ICDRS, Giamberardino HIG, Rodrigues JLN, Santos Filho L, Mello MJGD, Pereira MS, Gontijo Filho P, Rocha M, Medeiros EASD, Pignatari ACC. Structure for prevention of health care-associated infections in Brazilian hospitals: A countrywide study. Am J Infect Control 2016; 44:74-9. [PMID: 26412480 DOI: 10.1016/j.ajic.2015.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 08/01/2015] [Accepted: 08/04/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Minimal structure is required for effective prevention of health care-associated infection (HAI). The objective of this study was to evaluate the structure for prevention of HAI in a sample of Brazilian hospitals. METHODS This was a cross-sectional study from hospitals in 5 Brazilian regions (n = 153; total beds: 13,983) classified according to the number of beds; 11 university hospitals were used as reference for comparison. Trained nurses carried out the evaluation by using structured forms previously validated. The evaluation of conformity index (CI) included elements of structure of the Health Care-Associated Prevention and Control Committee (HAIPCC), hand hygiene, sterilization, and laboratory of microbiology. RESULTS The median CI for the HAIPCC varied from 0.55-0.94 among hospital categories. Hospitals with >200 beds had the worst ratio of beds to sinks (3.9; P < .001). Regarding alcoholic product for handrubbing, the worst ratio of beds to dispensers was found in hospitals with <50 beds (6.4) compared with reference hospitals (3.3; P < .001). The CI for sterilization services showed huge variation ranging from 0.0-1.00. Reference hospitals were more likely to have their own laboratory of microbiology than other hospitals. CONCLUSION This study highlights the need for public health strategies aiming to improve the structure for HAI prevention in Brazilian hospitals.
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Padoveze MC, Fortaleza CMCB. Healthcare-associated infections: challenges to public health in Brazil. Rev Saude Publica 2015; 48:995-1001. [PMID: 26039403 PMCID: PMC4285833 DOI: 10.1590/s0034-8910.2014048004825] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 06/28/2014] [Indexed: 11/22/2022] Open
Abstract
This study presents a critical evaluation of the scientific literature related to this subject, aiming to assess the policies and administrative issues regarding the prevention and magnitude of healthcare-associated infections and discuss the challenges for their prevention in Brazil. The topics discussed included historical and administrative issues, challenges imposed by the characteristics of the healthcare system and the territorial dimension, laboratorial support limitations, costs, institutional culture, professional qualification, and patient engagement. It is urgent to hold a nationwide discussion among government representatives, institutions, and healthcare workers and users to overcome these challenges.
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Affiliation(s)
- Maria Clara Padoveze
- Departamento de Enfermagem em Saúde Coletiva, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brasil
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Correa AAF, Pignatari ACC, da Silveira M, Mingone RCC, de Sales Oliveira VG, Fortaleza CMCB. Small hospitals matter: insights from the emergence and spread of vancomycin-resistant enterococci in 2 public hospitals in inner Brazil. Diagn Microbiol Infect Dis 2015; 82:227-33. [DOI: 10.1016/j.diagmicrobio.2015.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 03/12/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
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Abstract
This exploratory cross-sectional study aims to investigate good practice for preventing and controlling infections in a psychiatric hospital and for limiting potential exposure to biohazards for nursing professionals at this hospital located in the State of São Paulo, Brazil. The researchers directly and systematically observed 830 nursing procedures, 40.6% of which presented a moderate to high risk of biohazard exposure. Results indicate very low adherence to hand hygiene (1.2% before procedures, 2.9% after procedures), inappropriate use of gloves, and other instances of noncompliance to the standards of good practice for preventing and controlling infection, such as a lack of concurrent/terminal cleaning of dirty beds (132 instances) and careless manipulation of sharp devices (34 instances).
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Affiliation(s)
- Thaís Helena Piai-Morais
- a Federal University of São Carlos, Nursing Graduate Program , Rodovia Washington Luís, São Carlos , São Paulo State, Brazil
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Caldeira SM, Cunha ARD, Akazawa RT, Moreira RG, Souza LDRD, Fortaleza CMCB. Weather parameters and nosocomial bloodstream infection: a case-referent study. Rev Saude Publica 2015; 49:19. [PMID: 25830871 PMCID: PMC4390072 DOI: 10.1590/s0034-8910.2015049005438] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 10/20/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate if temperature and humidity influenced the etiology of bloodstream infections in a hospital from 2005 to 2010. METHODS The study had a case-referent design. Individual cases of bloodstream infections caused by specific groups or pathogens were compared with several references. In the first analysis, average temperature and humidity values for the seven days preceding collection of blood cultures were compared with an overall “seven-days moving average” for the study period. The second analysis included only patients with bloodstream infections. Several logistic regression models were used to compare different pathogens and groups with respect to the immediate weather parameters, adjusting for demographics, time, and unit of admission. RESULTS Higher temperatures and humidity were related to the recovery of bacteria as a whole (versus fungi) and of gram-negative bacilli. In the multivariable models, temperature was positively associated with the recovery of gram-negative bacilli (OR = 1.14; 95%CI 1.10;1.19) or Acinetobacter baumannii (OR = 1.26; 95%CI 1.16;1.37), even after adjustment for demographic and admission data. An inverse association was identified for humidity. CONCLUSIONS The study documented the impact of temperature and humidity on the incidence and etiology of bloodstream infections. The results correspond with those from ecological studies, indicating a higher incidence of gram-negative bacilli during warm seasons. These findings should guide policies directed at preventing and controlling healthcare-associated infections.
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