Advancing TB research using digitized programmatic data

The use of real-world data from national TB care programs has great potential to answer key research questions in TB control and is now opportune due to increasing digital data collection and storage. We summarize an expert stakeholder workshop conducted on this topic in October 2019, with perspectives from academics, national TB program officers, and data managers. We discuss challenges and opportunities in the use of TB programmatic data for research and describe digital data availability in two large, high TB burden countries, Brazil and South Africa. From this, we posit that with a standardized data collection set, improved data management, and greater collaboration, more TB programmatic data can be used for research with measurable public health impact.

Medium and large-sized mammals of a private protected wetland in the Cerrado-Amazon biological corridor, Brazil

Brazil is the world's richest country in biodiversity, including mammal species. In the Brazilian Cerrado biome, mammalian diversity is vast, with about 251 species, 32 of them are endemic and 22 listed as threatened species. In this work, we investigated species diversity of medium- and large-sized mammals in the private protected area RPPN Pontal do Jaburu (RPPN-PJ) and its surroundings, which is a flooded area located in an important biological corridor in the Cerrado-Amazon ecotone zone, a priority area for biodiversity conservation in Brazil. We used camera-trapping, active search (night and day), and track survey during dry season (Apr - Aug 2016). We recorded 29 mammal species, being the Carnivora order the most representative with 11 species. Regarding threat status, 35.7% of the recorded species were listed as threatened in Brazil and 32.1% worldwide. We highlight the high relative frequency of threatened species records such as Tapirus terrestris, Panthera onca, Blastocerus dichotomus, Pteronura brasiliensis, Priodontes maximus, and other, as well as the presence of the newly described aquatic mammal species Inia araguaiaensis. We stress the importance of RPPN-PJ and its surroundings for mammal conservation, which include complex habitats (wetlands) located in an important ecotone zone.

Ethics and human rights considerations regarding involuntary isolation of people with TB

Involuntary isolation of people with tuberculosis is rarely medically required, ethically permitted or justified on the ground of human rights law. The rare circumstances that do call for involuntary isolation must only occur once a number of conditions are met. These include just procedural protections and ensuring that all other options have been exhausted before resorting to involuntary isolation. This article is intended to outline for healthcare workers, policy makers and advocates the ethical reasoning behind isolation and involuntary isolation, as well as describing the requisite human rights laws that impinge on the topic. Finally, we present a list of conditions that must be met to justify involuntary isolation on the grounds of both ethics and human rights.

Regional support in the health regions of Rio de Janeiro state: a strategy for strengthening SUS

Brazil is one of the few countries in the world with more than 200 million inhabitants that has a universal public health system. In its 30 years of existence, the Unified Health System (SUS) has brought many advances to the Brazilian society. However, it still faces challenges to ensure health services in quantity and quality to the entire population. Federal, state and municipal government levels share the responsibility for its management and financing. In this governance scheme, it is the Municipal Health Secretariats (MHS) of the 5,596 Brazilian municipalities that are primarily responsible for providing and managing health services. Given the importance of this responsibility, Councils of Municipal Health Departments (COSEMS) and the National Council of Municipal Health Departments (CONASEMS) were created in 1986. Their role is to promote the articulation and negotiation of their interests with the federal and state levels. In Rio de Janeiro, a team of specialized professionals has been providing support for COSEMS-RJ since 2012. The team carries out activities in the nine regions of the state, which has 92 municipalities and more than 16 million inhabitants, the 3rd largest population in Brazil. Its activities are maintained by CONASEMS, the Ministry of Health and the State University of Rio de Janeiro (UERJ). The objetive of this report is to present the experience of the expert team of COSEMS RJ as a strategy for strengthening regional governance and intergovernmental relations. Providing specialized technical support for MHS has improved local management of SUS and has allowed for the establishment of regionalized health care networks in Rio de Janeiro.

Key messages

The project improves the participation of municipal managers and teams in regional spaces. It strengthens their capacity for intergovernamental decision-making and regionalization of the health system. The project qualifies the municipal management for fundraising, knowledge building, policy implementing and monitoring, as well as participatory planning.

Provider perspectives on liberty and harm in the treatment of persons with tuberculosis and mental illness

<sec id="st1"> <title>OBJECTIVES</title> To examine how frontline health care workers (HCWs) and decision-makers working in tuberculosis (TB) care and mental health care conceptualise liberty, harm and the harm principle-which are often invoked in health care legislation to justify liberty restrictions-in the treatment and care of persons with TB and severe and persistent mental illness (SPMI). </sec> <sec id="st2"> <title>DESIGN</title> Qualitative study of 20 semi-structured interviews with HCWs and decision-makers working in public or mental health from three public health units and two psychiatric hospitals in the Greater Toronto Area in Ontario, Canada. Interviews were evaluated using thematic analysis. </sec> <sec id="st3"> <title>RESULTS</title> Three themes were identified: 1) the contextual nature of liberty restrictions; 2) the concept of liberty as a matter of degree; and 3) the challenges of balancing the treatment and care goals of TB and mental health for persons with both TB and SPMI. </sec> <sec id="st4"> <title>CONCLUSION</title> Harm is understood by HCWs caring for persons with TB and/or SPMI in a context-dependent manner. This is compounded in the case of persons with both TB and SPMI. Liberty restrictions to advance public health goals entail reciprocal obligations from society, including social protections and additional resources, to ease the effects and range of liberty restrictions. Attention is required to ensure that treatment and care for SPMI does not impede that of TB and vice versa. </sec>.

Respiratory Condition of Family Farmers Exposed to Pesticides in the State of Rio de Janeiro, Brazil

Pesticide exposure is a growing public health concern. Although Brazil is the world’s largest consumer of pesticides, only a few studies have addressed the health effects among farmers. This study aimed to evaluate whether pesticide exposure is associated with respiratory outcomes among rural workers and relatives in Brazil during the crop and off-seasons. Family farmers (82) were interviewed about occupational history and respiratory symptoms, and cholinesterase tests were conducted in the crop-season. Spirometry was performed during the crop and off-season. Respiratory outcomes were compared between seasons and multiple regressions analysis were conducted to search for associations with exposure indicators. Participants were occupationally and environmentally exposed to multiple pesticides from an early age. During the crop and off-season, respectively, they presented a prevalence of 40% and 30.7% for cough, 30.7% and 24% for nasal allergies, and 24% and 17.3% for chest tightness. Significant associations between spirometry impairments and exposure indicators were found both during the crop and off-season. These findings provide complementary evidence about the association of pesticide exposure with adverse respiratory effects among family farmers in Brazil. This situation requires special attention as it may increase the risk of pulmonary dysfunctions, and the morbidity and mortality burden associated with these diseases.

Sensing the Plant Surface Prior to Feeding and Oviposition: Differences in External Ultrastructure and Function Among Tarsi of Heliconius erato

Adult foretarsi of Heliconius erato Linnaeus (Lepidoptera, Nymphalidae) are reduced in size and are not used for walking. Foretarsi of the female have specialized sensilla that are presumably used to identify the host plant, by drumming. The mid- and hind tarsi also bear sensilla in both sexes, but these have not been described in detail, nor has their chemosensory function been determined. We described and compared the tarsi of H. erato under light and scanning electron microscopy. Behavioral experiments showed that differences in the shape, number, and size of sensilla were related to feeding and oviposition behaviors. Two types of sensillum (chaeticum and trichodeum) were found in similar numbers and size on the mid- and hind tarsi of both sexes. Sensilla on the female foretarsi act in host-plant site selection, strongly affecting oviposition rates when isolated. Male foretarsi lack sensilla, which may have been selected against due to the absence of function and thus lost. Sensilla on the mid- and hind tarsi are involved in sugar detection in both sexes, responding to an effective dose of sucrose (ED₅₀) near 0.01 M, and therefore might be used to identify food resources when the butterflies settle on flowers.

Endothelial analysis in patients having corneal intrastromal surgery with Cornealring for correction of Keratoconus

PURPOSE

Evaluate corneal endothelium by means of specular microscopy exam in patients with Keratoconus, before and after Cornealring® corneal intrastromal ring surgery.

METHODS

One hundred and two eyes of 67 patients, aged between 12 and 45, with the average age of 27.31 ± 8.15 years, 30 females and 37 males, were selected to be submitted to the implant of Cornealring® corneal ring segments in pre- and post-surgery (six months after the procedure) in the External Diseases and Cornea Ward of the Instituto Panamericano da Visão.

RESULTS

Of the 102 eyes treated, only those that received two rings of equal thickness up to 250 µ showed statistical significance between the initial and final mean number of endothelial cells (P = 0.008), a decrease of 10.1% in the mean coefficient of variation (P = 0.003), and a 9.75% decrease in initial and final hexagonal cell counts. The other eyes receiving rings of other thicknesses showed no statistically significant differences between the mean initial and final SM examinations.

CONCLUSION

A longer segment is necessary for the confirmation or not of the alterations found in this study, particularly regarding the thickness of the ring used, because with the new technologies and the improvement in the result of deep lamellar transplantation, the decrease in the cell count might represent a problem in the indication of this procedure following thick corneal ring implants.

Gymnotus capanema, a new species of electric knife fish (Gymnotiformes, Gymnotidae) from eastern Amazonia, with comments on an unusual karyotype

Gymnotus capanema n. sp. is described on the basis of cytogenetic, morphometric, meristic and osteological data from nine specimens (one male and eight females) from the municipality of Capanema, Pará, in the eastern Amazon of Brazil. Later, three additional specimens were found in museums and regarded as nontypes (not cytogenetically analysed). Gymnotus capanema, which occurs in sympatry with Gymnotus cf. carapo cytotype 2n = 42 (30m/sm + 12st/a) exhibits a novel karyotype for the genus, with 2n = 34 (20m/sm + 14st/a). Gymnotus capanema can be unambiguously diagnosed from all congeners on the basis of a combination of characters from external anatomy, pigmentation and osteology. The constitutive heterochromatin, rich in adenine-thymine (A-T) base pairs [4',6 diamidino-2-phenylindole dihydrochloride (DAPI) positive], occurs in the centromeric region of all of the chromosomes, and in the pericentromeric and the entire short arm of some chromosomes. The nucleolar organizing region (NOR), stained by silver nitrate, chromomycin A(3) (CMA(3)) and 18S ribosomal (r)DNA fluorescence in situ hybridization (FISH), occurs in the short arm of pair 15. FISH, with telomeric probes did not show interstitial telomeric sequences (ITS), despite the reduced 2n in comparison to the karyotypes of other species of Gymnotus. The karyotype of G. capanema, with a reduced 2n, is strikingly different from all other previously studied congeners.

Clinical ethicists' perspectives on organisational ethics in healthcare organisations

BACKGROUND

Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature.

OBJECTIVE

To describe clinical ethicists' perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues.

DESIGN AND SETTING

Qualitative case study involving semi-structured interviews with 18 clinical ethicists across 13 health organisations in Toronto, Canada.

RESULTS

From the clinical ethicists' perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation's moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support.

CONCLUSION

Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education.

EFFECT OF THE PROCESSING ON SOME CHEMICAL COMPONENTS OF PINEAPPLE TROPICAL JUICE

The chemical and physicochemical changes during the tropical pineapple juiceprocessing were evaluated. It was verified that all the chemical and physicochemicalparameters evaluated showed a statistical difference at a level of 5% of probability bythe Tukey test, exception for carotenoid content. Total titratable acidity, reducing sugarand carotenoid content increased during the processing. The pH, total soluble solids(Brix), total sugars and anthocyanins content did not differed statistically amongformulation/homogenation and after thermal treatment phases. The results suggestedthat processing phases such as extraction, formulation/homogenation and thermaltreatment had a significant effect on the chemical and physicochemical characteristicsof the tropical pineapple juice.

Histochemically-reactive zinc in amyloid plaques, angiopathy, and degenerating neurons of Alzheimer's diseased brains

Excess brain zinc has been implicated in Alzheimer's neuropathology. Here we evaluated that hypothesis by searching the brains of Alzheimer's patients for abnormal zinc deposits. Using histochemical methods, we found vivid Zn2+ staining in the amyloid deposits of dense-core (senile) plaques, in the amyloid angiopathy surrounding diseased blood vessels, and in the somata and dendrites of neurons showing the characteristic neurofibrillary tangles (NFT) of Alzheimer's. In contrast, brains from age-matched, non-demented subjects showed only occasional staining for Zn2+ in scattered neurons and possible plaques. A role of abnormal zinc metabolism in Alzheimer's neuropathology is suggested.

Protective efficacy of doramectin and ivermectin against Cochliomyia hominivorax

Two studies were conducted in Brazil using induced infestations of the New World screwworm, Cochliomyia hominivorax, to investigate: a) the comparative prophylactic efficacy of doramectin and ivermectin at their recommended use levels (200 micrograms kg-1 s.c.), and b) the duration of protection of a single injection of doramectin. In the comparative efficacy study, two groups of six animals each were treated with ivermectin or doramectin. Two hours after treatment, four incisions were made. Each incision was infested with 30 first instar C. hominivorax larvae and their status evaluated daily for 7 days post-treatment (p.t.). Doramectin treatment was 100% effective in prevention of C. hominivorax infestations whereas ivermectin efficacy was incomplete. First instar larvae were eliminated in doramectin-treated calves by 48 h p.t., while in the ivermectin group, C. hominivorax developed in over 29% of the incisions. Healing began in wounds of doramectin-treated animals at 24 h p.t. and was in progress in 100% of all wounds at 2 days p.t., while 50% of ivermectin-treated calves showed incisions with active lesions. In the duration of protection study, 24 calves were allocated to six groups (T1-T6) of four animals each. Three groups (T1, T3 and T5) were treated with saline and three groups (T2, T4 and T6) with doramectin. Animals were infested as described previously according to the following schedule: T1 and T2 at day 14, T3 and T4 at day 21, and T5 and T6 at day 28 p.t. Incisions were evaluated daily for 8 days post-infestation. Screwworm infestations and viable third-instar larvae developed of all incisions of saline-treated calves, while doramectin was 100% effective preventing development of C. hominivorax for 21 days p.t. and showed partial activity at 28 days p.t.