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BACKGROUND: Queiroz et al. showed that the application of cluster methodology for classifying gastric cancer is suitable and efficient within a Brazilian cohort, which is known for its population heterogeneity. The study highlighted the potential utilization of this method within public health services due to its low-cost, presenting a viable means to improve the diagnosis and prognosis of gastric cancer. BACKGROUND: Our Brazilian cohort with gastric cancer has a distinct distribution between mutated and normal p53. BACKGROUND: New genetic marker-based classifications improve gastric cancer diagnosis accuracy. BACKGROUND: Machine learning integration enhances predictive value in gastric cancer diagnosis. BACKGROUND: Molecular biomarkers complement clinical decisions, advancing personalized medicine. OBJECTIVE: Gastric adenocarcinoma remains an aggressive disease with a poor prognosis, as evidenced by a 5-year survival rate of approximately 31%. The histological classifications already proposed do not accurately reflect the high biological heterogeneity of this neoplasm, particularly in diverse populations, and new classification systems using genetic markers have recently been proposed. Following these newly proposed models, we aimed to assess the cluster distribution in a Brazilian cohort. Furthermore, we evaluated whether the inclusion of other clinical and histological parameters could enhance the predictive value. METHODS: We used a previously described four-immunohistochemistry/EBER-ISH marker to classify a cohort of 30 Brazilian patients with gastric adenocarcinoma into five different clusters and compared the distribution with other genetically diverse populations. Furthermore, we used artificial intelligence methods to evaluate whether other clinical and pathological parameters could improve the results of the methodology. RESULTS: Disclosing the genetic variability between populations, we observed a more balanced distribution of the aberrant/normal p53 ratio (0.6) between patients negative for the other markers tested, unlike previous studies with Asian and North American populations. In addition, decision tree analysis reinforced the efficiency of these new classifications, as the stratification accuracy was not altered with or without additional data. CONCLUSION: Our study underscores the importance of local research in characterizing diverse populations and highlights the complementary role of molecular biomarkers in personalized medicine for gastric adenocarcinoma, enhancing diagnostic accuracy and potentially improving survival rates.
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Adenocarcinoma , Biomarcadores de Tumor , Neoplasias Gástricas , Proteína p53 Supresora de Tumor , Neoplasias Gástricas/genética , Neoplasias Gástricas/clasificación , Neoplasias Gástricas/patología , Humanos , Brasil , Proteína p53 Supresora de Tumor/genética , Proteína p53 Supresora de Tumor/análisis , Masculino , Femenino , Adenocarcinoma/genética , Adenocarcinoma/clasificación , Adenocarcinoma/patología , Persona de Mediana Edad , Biomarcadores de Tumor/genética , Biomarcadores de Tumor/análisis , Estudios de Cohortes , Anciano , Análisis por Conglomerados , Mutación , Inmunohistoquímica , Adulto , Pronóstico , Anciano de 80 o más AñosRESUMEN
This article aims to analyze spatial and temporal patterns of maternal mortality in Brazil during the period 2010-2020 and identify related socioeconomic indicators. We conducted an ecological study of the maternal mortality ratio (MMR) in Brazil's municipalities using secondary data. Temporal analysis was performed using the joinpoint method. Bayesian statistics, spatial autocorrelation, the Getis Ord Gi* technique and the scan statistic were used to identify spatial clusters, and multiple non-spatial and spatial regression models were used to assess the association between factors and the MMR. There was an increase in the MMR in 2020 and an increase in deaths in the North and Southeast. Clusters were found in Amazonas, Tocantins, Piauí, Maranhão, Bahia and Mato Grosso do Sul. The following indicators were negatively associated with the MMR: cesarean section rate, Municipal Human Development Index, and per capita household income of people who are vulnerable to poverty. The MMR was stable up to 2019, followed by a sharp rise in 2020 coinciding with the onset of the Covid-19 pandemic in the country. It is essential that efforts to reduce maternal mortality in Brazil extend beyond the promotion of improvements in antenatal, childbirth and postpartum care to address the social determinants of the problem.
O objetivo do artigo é analisar o padrão espacial e temporal e identificar indicadores socioeconômicos relacionados à razão de mortalidade materna (RMM) no Brasil de 2010 a 2020. Estudo ecológico que analisou a RMM nos municípios do Brasil, utilizando dados secundários. Para análise temporal, utilizou-se o método joinpoint. Para a identificação de aglomerados espaciais, utilizou-se estatística bayesiana, autocorrelação espacial, a técnica Getis Ord Gi* e a varredura scan. Para a identificação dos fatores associados à RMM, foram adotados modelos múltiplos de regressão não espacial e espacial. Observou-se aumento da RMM de 2019 para 2020. Houve crescimento de óbitos nas regiões Norte e Sudeste. Os clusters foram encontrados no Amazonas, Tocantins, Piauí, Maranhão, Bahia e Mato Grosso do Sul. Estão negativamente relacionados à RMM os seguintes indicadores: taxa de parto cesáreo, índice de desenvolvimento humano municipal e renda domiciliar per capita dos vulneráveis à pobreza. Embora a tendência temporal tenha se mostrado constante até 2019, a RMM apresentou crescimento no ano de início da pandemia de COVID-19 no país. A redução da MM no Brasil vai além da promoção de melhorias na assistência gravídico-puerperal, sendo fundamental focar também nos determinantes sociais do problema.
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Mortalidad Materna , Factores Socioeconómicos , Análisis Espacio-Temporal , Brasil/epidemiología , Humanos , Femenino , Mortalidad Materna/tendencias , Embarazo , Teorema de Bayes , COVID-19/mortalidad , COVID-19/epidemiología , Cesárea/estadística & datos numéricos , Cesárea/mortalidad , Análisis por Conglomerados , Análisis Espacial , Pobreza/estadística & datos numéricosRESUMEN
Patients with orofacial clefts are more likely to develop oral fungal diseases due to anatomo-physiological changes and surgical rehabilitation treatment. This case-series study evaluated the genetic diversity and dynamics of oral colonization and spread of C. albicans and C. tropicalis in four patients with orofacial clefts, from the time of hospital admission, perioperative and outpatient follow-up, with specialized physician. Candida biotypes previously identified by CHROMagar Candida and PCR methods were studied by MALDI-TOF MS assays and clustering analyses. Possible correlations with pathogenicity characteristics were observed, including production of hydrolytic exoenzymes and the antifungal sensitivity profiles. Amphotericin B-sensitive and fluconazole-resistant (low frequency) C. tropicalis and C. albicans, including clinically compatible MIC of nystatin, were found in the oral cavity of these patients. Clusters of isolates revealed phenomena of (i) elimination in the operative phase, (ii) maintenance or (iii) acquisition of oral C. tropicalis in the perioperative period and specialized outpatient and medical follow-up. For C. albicans, these phenomena included (i) elimination in the operative phase, (ii) acquisition in the operative phase and propagation from the hospital environment, and (iii) maintenance during hospitalization and operative phase. Amphotericin B and nystatin were shown to be effective in cases of clinical treatment and/or prophylaxis, especially considering the pre-existence of fluconazole-resistant strains. This study confirmed the phenomena of septic maintenance, septic neocolonization and septic elimination involving the opportunistic pathogens. MALDI-TOF MS associated with clustering analysis may assist the monitoring of clinical isolates or groups of epidemiologically important microbial strains in the hospital setting.
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Anfotericina B , Antifúngicos , Candida albicans , Candida tropicalis , Farmacorresistencia Fúngica , Genotipo , Pruebas de Sensibilidad Microbiana , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Humanos , Candida tropicalis/efectos de los fármacos , Candida tropicalis/aislamiento & purificación , Candida tropicalis/genética , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Candida albicans/genética , Candida albicans/efectos de los fármacos , Candida albicans/aislamiento & purificación , Anfotericina B/farmacología , Anfotericina B/uso terapéutico , Masculino , Femenino , Boca/microbiología , Niño , Fluconazol/farmacología , Fluconazol/uso terapéutico , Candidiasis Bucal/microbiología , Nistatina/farmacología , Nistatina/uso terapéutico , Técnicas de Tipificación Micológica , Fisura del Paladar/cirugía , Labio Leporino/cirugía , Adolescente , Análisis por Conglomerados , PreescolarRESUMEN
SUMMARY: This study aims to examine the hand morphometry of healthy young individuals from different countries and investigate the differences between countries in typing of hand based on the morphometric values obtained. In the study, 16 different parameters, including two surface areas and 14 lengths, were measured from the right hand of 579 volunteers (250 females, 329 males) from 7 different countries (Turkey, Chad, Morocco, Gabon, Kazakhstan, Senegal and Syria). Factor analysis was performed on the parameters, cluster analysis was performed according to the factor score obtained, and the hand types in the study were determined. As a result of the study, four different hand types were defined, and the distribution of these types according to countries was analyzed. All parameters showed significant differences between countries in both genders (p<0.05). According to the results of the study, there was a difference between male and female hand types between countries. In females, the type 1 hand type was found only in Gabon, the type 2 hand type was found only in Senegal, the type 3 hand type was found in Turkey, Morocco and Kazakhstan, while the type 4 hand type was significantly distributed in Senegal and Gabon (X2 =104.62; df=18, p<0.05). In males, type 1 hand type was found in Turkey, type 2 hand type in Senegal and Gabon, type 3 hand type in Turkey, while type 4 hand type was significantly distributed in Morocco and Kazakhstan (X2 =76.964; df=18, p<0.05).
Este estudio tuvo como objetivo examinar la morfometría de la mano de individuos jóvenes sanos de diferentes países e investigar las diferencias en la mecanografía de la mano entre países en función de los valores morfométricos obtenidos. En el estudio, se midieron 16 parámetros diferentes, incluidas dos superficies y 14 longitudes, de la mano derecha de 579 voluntarios (250 mujeres, 329 hombres) de 7 países diferentes (Turquía, Chad, Marruecos, Gabón, Kazajstán, Senegal y Siria). Se realizó un análisis factorial de los parámetros, un análisis de conglomerados según la puntuación factorial obtenida y se determinaron los tipos de manos en el estudio. Como resultado, se definieron cuatro tipos diferentes de manos y se analizó la distribución de estos tipos según países. Todos los parámetros mostraron diferencias significativas entre países en ambos sexos (p<0,05). Según los resultados del estudio, hubo una diferencia entre los tipos de manos de los hombres y de las mujeres entre países. En las mujeres, el tipo de mano tipo 1 se encontró solo en Gabón, el tipo de mano tipo 2 se encontró solo en Senegal, el tipo de mano tipo 3 se encontró en Turquía, Marruecos y Kazajstán, mientras que la mano tipo 4 se distribuyó significativamente en Senegal y Gabón (X2=104,62; gl=18, p<0,05). En los hombres, el tipo de mano tipo 1 se encontró en Turquía, el tipo de mano tipo 2 en Senegal y Gabón, el tipo de mano tipo 3 en Turquía, mientras que la mano tipo 4 se distribuyó significativamente en Marruecos y Kazajstán (X2=76,964; gl=18, p <0,05).
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Humanos , Masculino , Femenino , Adolescente , Adulto , Adulto Joven , Mano/anatomía & histología , Análisis por Conglomerados , Análisis de Varianza , Análisis Factorial , Caracteres Sexuales , AntropologíaRESUMEN
OBJECTIVES: To determine the inflammatory profile of CRSwNP in Brazil and characterize the subgroups of CRSwNP patients in this population through cluster analysis. STUDY DESIGN: Multicenter cross-sectional study involving 15 centers representing different regions of Brazil. SUBJECTS AND METHODS: Clinical data of 166 patients and 80 controls, aged 18 to 70 years old, number of surgeries for CRS, history of asthma and aspirin sensitivity, and Lund-Mackay scores on CT scans. During nasal endoscopy, we obtained the Lund-Kennedy scores and collected 2 samples of nasal polyps: one for eosinophil and neutrophil tissue counts and one to quantify different cytokines. RESULTS: 79.6% of our patients had 10 or more eosinophils/HPF. CRSwNP groups exhibited significantly lower concentrations of TNF-alpha and significantly higher concentrations of IFN-gamma, CCL11/Eotaxin, CCL24/Eotaxin-2/MPIF-2, and CCL26/Eotaxin-3 versus the control group (Kruskal-Wallis test). Comparison between CRSwNP groups (≥10 vs <10 eosinophils/HPF) showed no difference in cytokine concentration (Mann-Whitney test). Hierarchical clustering and PCA according to cytokine concentrations revealed 2 main Clusters, with a significantly higher concentration of all cytokines in Cluster 1 (n = 35) than in Cluster 2 (n = 121), except IL-6 and IL-33 (Mann-Whitney test). According to ROC curve analysis the best cut-off to differentiate the 2 clusters was 43 eosinophils/HPF. The group with ≥43 presented a higher prevalence of men and a higher Lund-Mackay score (Mann-Whitney test). CONCLUSIONS: CRSwNP patients in Brazil present mixed inflammation, with 2 distinct groups (high and low inflammatory pattern) that can be distinguished by tissue eosinophilia of ≥43 eosinophils/HPF cut-off in nasal polyps.
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Pólipos Nasales , Rinitis , Sinusitis , Humanos , Pólipos Nasales/complicaciones , Sinusitis/complicaciones , Adulto , Persona de Mediana Edad , Masculino , Estudios Transversales , Brasil/epidemiología , Femenino , Rinitis/complicaciones , Enfermedad Crónica , Anciano , Adolescente , Citocinas , Adulto Joven , Eosinófilos , Análisis por Conglomerados , RinosinusitisRESUMEN
The Oomycetes fungus Phytophthora spp. which causes Abnormal leaf fall (ALF) disease poses a significant threat as one of the most devastating diseases affecting rubber trees in India. A total of 30 Phytophthora isolates were obtained from ALF-affected samples collected during the Southwest monsoon season of Kerala. The colony morphology of Phytophthora isolates revealed eight different types of growth patterns, with stellate, stellate striated, and petaloid patterns growing rapidly, whereas chrysanthemum pattern grew slowly. Sporangia were papillate to non-papillate in various shapes, and sporangiophores exhibited simple, simple sympodial, or irregularly branching patterns. Highly virulent isolates exhibited petaloid morphology and rapid growth rates. Regardless of their virulence, all isolates showed susceptibility to the fungicide metalaxyl. Under in vitro conditions, the highly virulent isolate (R17) from rubber caused severe infections in chili, brinjal, and tomato with brown water-soaked lesions. Sequence analysis and multi-locus phylogeny of Internal transcribed spacer (ITS), cCytochrome c oxidase 1 (COX 1), Heat shock protein 90 (HSP 90), and Ribosomal protein L10 (RPL 10) confirmed the pathogen as Phytophthora meadii. A comprehensive understanding of both morphological and molecular traits of P. meadii is crucial for precise identification and future genetic variability studies.
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Hevea , Filogenia , Phytophthora , Enfermedades de las Plantas , India , Phytophthora/genética , Phytophthora/clasificación , Enfermedades de las Plantas/microbiología , Enfermedades de las Plantas/parasitología , Hevea/microbiología , Hevea/parasitología , Tipificación de Secuencias Multilocus , Hojas de la Planta/microbiología , Hojas de la Planta/parasitología , Análisis de Secuencia de ADN , Virulencia , ADN Espaciador Ribosómico/genética , Prevalencia , Análisis por Conglomerados , Fungicidas Industriales/farmacología , Alanina/análogos & derivadosRESUMEN
This study examined the spatial distribution and social inequalities in COVID-19 vaccine coverage among children aged 5-11 in Brazil. First and second dose vaccine coverage was calculated for all Brazilian municipalities and analyzed by geographic region and deciles based on human development index (HDI-M) and expected years of schooling at 18 years of age. Multilevel models were used to determine the variance partition coefficient, and bivariate local Moran's I statistic was used to assess spatial association. Results showed significant differences in vaccine coverage rates among Brazilian municipalities, with lower coverage in the North and Midwest regions. Municipalities with lower HDI and expected years of schooling had consistently lower vaccine coverage rates. Bivariate clustering analysis identified extensive concentrations of municipalities in the Northern and Northeastern regions with low vaccine coverage and low human development, while some clusters of municipalities in the Southeast and South regions with low coverage were located in areas with high HDI-M. These findings highlight the persistent municipal-level inequalities in vaccine coverage among children in Brazil and the need for targeted interventions to improve vaccine access and coverage in underserved areas.
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Vacunas contra la COVID-19 , COVID-19 , Factores Socioeconómicos , Cobertura de Vacunación , Humanos , Brasil , Niño , Vacunas contra la COVID-19/administración & dosificación , Preescolar , Cobertura de Vacunación/estadística & datos numéricos , COVID-19/prevención & control , COVID-19/epidemiología , Análisis por Conglomerados , Disparidades en Atención de Salud/estadística & datos numéricos , Análisis EspacialRESUMEN
Brain damage triggers diverse cellular and molecular events, with astrocytes playing a crucial role in activating local neuroprotective and reparative signaling within damaged neuronal circuits. Here, we investigated reactive astrocytes using a multidimensional approach to categorize their responses into different subtypes based on morphology. This approach utilized the StarTrack lineage tracer, single-cell imaging reconstruction and multivariate data analysis. Our findings identified three profiles of reactive astrocyte responses, categorized by their effects on cell size- and shape- related morphological parameters: "moderate", "strong," and "very strong". We also examined the heterogeneity of astrocyte reactivity, focusing on spatial and clonal distribution. Our research revealed a notable enrichment of protoplasmic and fibrous astrocytes within the "strong" and "very strong" response subtypes. Overall, our study contributes to a better understanding of astrocyte heterogeneity in response to an injury. By characterizing the diverse reactive responses among astrocyte subpopulations, we provide insights that could guide future research aimed at identifying novel therapeutic targets to mitigate brain damage and promote neural repair.
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Astrocitos , Astrocitos/fisiología , Animales , Ratones , Linaje de la Célula/fisiología , Análisis por Conglomerados , Análisis de la Célula IndividualRESUMEN
OBJECTIVES: To identify distinct phenotypes of critically ill leptospirosis patients upon ICU admission and their potential associations with outcome. DESIGN: Retrospective observational study including all patients with biologically confirmed leptospirosis admitted to the ICU between January 2014 and December 2022. Subgroups of patients with similar clinical profiles were identified by unsupervised clustering (factor analysis for mixed data and hierarchical clustering on principal components). SETTING: All patients admitted to the ICU of the University Hospital of Guadeloupe on the study period. PATIENTS: One hundred thirty critically ill patients with confirmed leptospirosis were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: At ICU admission, 34% of the patients had acute respiratory failure, and 26% required invasive mechanical ventilation. Shock was observed in 52% of patients, myocarditis in 41%, and neurological involvement in 20%. Unsupervised clustering identified three clusters-"Weil's Disease" (48%), "neurological leptospirosis" (20%), and "multiple organ failure" (32%)-with different ICU courses and outcomes. Myocarditis and neurological involvement were key components for cluster identification and were significantly associated with death in ICU. Other factors associated with mortality included shock, acute respiratory failure, and requiring renal replacement therapy. CONCLUSIONS AND RELEVANCE: Unsupervised analysis of critically ill patients with leptospirosis revealed three patient clusters with distinct phenotypic characteristics and clinical outcomes. These patients should be carefully screened for neurological involvement and myocarditis at ICU admission.
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Enfermedad Crítica , Unidades de Cuidados Intensivos , Leptospirosis , Humanos , Masculino , Leptospirosis/mortalidad , Leptospirosis/epidemiología , Femenino , Enfermedad Crítica/mortalidad , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Insuficiencia Multiorgánica/mortalidad , Guadalupe/epidemiología , Anciano , Análisis por ConglomeradosRESUMEN
Here, we report on a Cordyceps species entering into a multi-trophic, multi-kingdom association. Cordyceps cateniannulata, isolated from the stem of wild Coffea arabica in Ethiopia, is shown to function as an endophyte, a mycoparasite and an entomopathogen. A detailed polyphasic taxonomic study, including a multilocus phylogenetic analysis, confirmed its identity. An emended description of C. cateniannulata is provided herein. Previously, this species was known as a pathogen of various insect hosts in both the Old and New World. The endophytic status of C. cateniannulata was confirmed by re-isolating it from inoculated coffee plants. Inoculation studies have further shown that C. cateniannulata is a mycoparasite of Hemileia vastatrix, as well as an entomopathogen of major coffee pests; infecting and killing Hypothenemus hampei and Leucoptera coffeella. This is the first record of C. cateniannulata from Africa, as well as an endophyte and a mycoparasite. The implications for its use as a biocontrol agent are discussed.
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Coffea , Cordyceps , Endófitos , Filogenia , Endófitos/clasificación , Endófitos/aislamiento & purificación , Endófitos/genética , Endófitos/fisiología , Cordyceps/genética , Cordyceps/clasificación , Coffea/microbiología , Coffea/parasitología , Animales , Enfermedades de las Plantas/microbiología , Enfermedades de las Plantas/parasitología , Etiopía , ADN de Hongos/genética , ADN de Hongos/química , ADN Espaciador Ribosómico/genética , ADN Espaciador Ribosómico/química , Tallos de la Planta/microbiología , Tallos de la Planta/parasitología , Análisis de Secuencia de ADN , Análisis por ConglomeradosRESUMEN
PURPOSE: The aim of the current study was to examine the association between dietary patterns and health-related quality of life (HRQoL) among Spanish children and adolescents. METHODS: A modified version of the parental version of 10 items of the Screening for and Promotion of Health-Related Quality of Life in Children and Adolescents-a European Public Health perspective (KIDSCREEN-10) was used to assess children's HRQoL in three areas: subjective physical, mental, and social status. To evaluate dietary habits, a food frequency questionnaire was employed. To identify different feeding patterns in the sample of children and adolescents examined, cluster analyses were carried out. In addition, a generalized linear model with a Gaussian distribution was applied to test the associations between the determined clusters and HRQoL. RESULTS: The lowest HRQoL was identified in participants located in the unhealthiest cluster (Cluster 1) (mean [M] = 85.2; 95% confidence interval [CI] 83.7 to 86.7). In comparison with the unhealthiest cluster (Cluster 1), a greater estimated marginal mean of HRQoL was identified for participants in the moderately healthy cluster (Cluster 1) (p = 0.020) and in the healthiest cluster (Cluster 2) (p = 0.044). CONCLUSIONS: Based on our findings, dietary habits based on the low consumption of bread, cereals, and dairy products (mainly), together with low intake of fruits and vegetables, are related to lower HRQoL in children and adolescents. These results underscore the importance of promoting balanced and nutrient-rich diets among young populations. Public health initiatives should focus on educating parents, caregivers, and children about the benefits of a varied diet that includes adequate portions of fruits, vegetables, whole grains, and dairy products.
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Dieta , Conducta Alimentaria , Calidad de Vida , Humanos , Adolescente , Femenino , Niño , Masculino , España , Conducta Alimentaria/psicología , Análisis por Conglomerados , Dieta/estadística & datos numéricos , Encuestas y Cuestionarios , Estudios Transversales , Encuestas sobre Dietas , Patrones DietéticosRESUMEN
Long COVID presents with diverse symptoms after COVID-19. Different clusters of symptoms have been reported; however, their persistence beyond 2 years after COVID-19 remains unclear. In this cohort study, we prospectively evaluated individuals with previous severe COVID-19 presenting with long COVID at a two-year follow-up. We characterized the included patients and performed a cluster analysis of symptoms through multiple correspondence analysis and hierarchical clustering. A total of 199 patients with long COVID were included. The median age was 58 years (48-69), 56% were male, and the median follow-up time since the COVID-19 diagnosis was 26 months (IQR: 25, 27). Three symptom clusters were identified: Cluster 1 is characterized by fatigue, myalgia/arthralgia, a low prevalence of symptoms, and a lack of specific symptoms; Cluster 2 is defined by a high prevalence of fatigue, myalgia/arthralgia, and cardiorespiratory symptoms, including palpitations, shortness of breath, cough, and chest pain; and Cluster 3 is demonstrated a high prevalence of ageusia, anosmia, fatigue, and cardiorespiratory symptoms. Our study reinforces the concept of symptom clustering in long COVID, providing evidence that these clusters may persist beyond two years after a COVID-19 diagnosis. This highlights the chronic and debilitating nature of long COVID and the importance of developing strategies to mitigate symptoms in these patients.
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Artralgia , COVID-19 , Fatiga , Mialgia , Síndrome Post Agudo de COVID-19 , Sistema de Registros , SARS-CoV-2 , Humanos , COVID-19/epidemiología , COVID-19/complicaciones , Masculino , Persona de Mediana Edad , Femenino , Anciano , Fatiga/etiología , Mialgia/etiología , Mialgia/fisiopatología , Artralgia/virología , Artralgia/etiología , Estudios Prospectivos , Prevalencia , Análisis por Conglomerados , Ageusia/epidemiología , Ageusia/etiología , Ageusia/virología , Anosmia/epidemiología , Anosmia/etiología , Disnea/fisiopatología , Disnea/virología , Disnea/etiología , Estudios de Seguimiento , Tos , Factores de Tiempo , Estudios de CohortesRESUMEN
In dengue-endemic areas, transmission control is limited by the difficulty of achieving sufficient coverage and sustainability of interventions. To maximize the effectiveness of interventions, areas with higher transmission could be identified and prioritized. The aim was to identify burden clusters of Dengue virus (DENV) infection and evaluate their association with microclimatic factors in two endemic towns from southern Mexico. Information from a prospective population cohort study (2·5 years of follow-up) was used, microclimatic variables were calculated from satellite information, and a cross-sectional design was conducted to evaluate the relationship between the outcome and microclimatic variables in the five surveys. Spatial clustering was observed in specific geographic areas at different periods. Both, land surface temperature (aPR 0·945; IC95% 0·895-0·996) and soil humidity (aPR 3·018; IC95% 1·013-8·994), were independently associated with DENV burden clusters. These findings can help health authorities design focused dengue surveillance and control activities in dengue endemic areas.
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Virus del Dengue , Dengue , Microclima , Humanos , Dengue/epidemiología , Dengue/transmisión , México/epidemiología , Femenino , Masculino , Estudios Transversales , Adulto , Adolescente , Estudios Prospectivos , Niño , Enfermedades Endémicas , Adulto Joven , Persona de Mediana Edad , Preescolar , Humedad , Análisis por Conglomerados , TemperaturaRESUMEN
OBJECTIVE: To examine spatiotemporal variability and identify clustering patterns of hospitalization rates for diarrhea in children younger than five years in Mato Grosso, Brazil, from 2011 to 2020. METHODS: An ecological study was conducted using hospitalization records associated with diarrhea from the Brazilian Hospital Information System/Unified Health System. The relative risk of hospitalization for diarrhea in each municipality was calculated using SaTScan software considering a statistical significance level of 5% and 999 Monte Carlo replications. RESULTS: A total of 13,315 diarrhea-associated hospitalizations for 5-year-old children were recorded. From 2011 to 2020, the annual rates for hospitalizations related to diarrhea decreased from 8.50 to 3.45/1,000 live births among children younger than one year and from 4.99 to 1.57 for children aged 1-4 years. Clusters of municipalities with high relative risk for hospitalizations due to diarrhea, statistically significant, predominated in the North, Northeast, and Southwest health administrative macro-regions of Mato Grosso for both age groups until 2016. From 2016 to 2020, clusters of the lowest relative risk were identified in the North and Center South health administrative macro-regions for children younger than five years. CONCLUSION: Results showed that hospitalization rates for diarrhea in children younger than five years reduced with the presence of low-risk clusters in Mato Grosso in the final years of the study. Public health surveillance should incorporate spatial analysis to investigate the diarrhea-related morbidity.
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Diarrea , Hospitalización , Análisis Espacio-Temporal , Humanos , Brasil/epidemiología , Hospitalización/estadística & datos numéricos , Hospitalización/tendencias , Preescolar , Lactante , Diarrea/epidemiología , Masculino , Femenino , Factores de Tiempo , Recién Nacido , Análisis por Conglomerados , Distribución por EdadRESUMEN
Statement of Problem: Progressive urbanization has reduced human interactions with nature, raising concerns about its impact on mental well-being. Previous research has often focused on specific aspects of nature contact, neglecting its multifaceted dimensions and their effects on mental health, particularly in developing countries. Research Gap: There is a scarcity of studies exploring the comprehensive dimensions of nature contact, such as frequency, duration, intensity, and space naturalness, and their correlation with mental well-being in developing countries' urban settings. Purpose: This study aims to identify patterns of nature contact related to mental well-being in metropolitan areas of Brazil using exploratory cluster analysis, bridging the existing knowledge gap and informing targeted interventions to enhance mental health through nature contact. Method: An online survey collected data from 2136 participants in Brazil's metropolitan areas, focusing on their nature interaction patterns and mental health status using the Depression Anxiety and Stress Scale (DASS-21), hierarchical clustering with p-values via multiscale bootstrap resampling, and analysis of variance. Results and Conclusions: Three distinct groups were identified, showing varied patterns of nature contact and demographic profiles. Greater and more frequent nature contact was associated with lower levels of depression, anxiety, and stress. These findings suggest a beneficial relationship between nature contact and mental well-being. Practical Implications: The results underline the importance of urban planning and public health policies that facilitate access to natural spaces, highlighting socioeconomic factors as significant barriers to this access. Future Directions: Further research should explore causal relationships and consider the specific realities and challenges faced by residents of developing nations.
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Salud Mental , Humanos , Brasil , Análisis por Conglomerados , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Depresión/epidemiología , Depresión/psicología , Adolescente , Ansiedad , Naturaleza , Encuestas y Cuestionarios , Estrés Psicológico , AncianoRESUMEN
Background: Molecular epidemiology techniques allow us to track the HIV-1 transmission dynamics. Herein, we combined genetic, clinical and epidemiological data collected during routine clinical treatment to evaluate the dynamics and characteristics of transmission clusters of the most prevalent HIV-1 subtypes in the state of São Paulo, Brazil. Methods: This was a cross-sectional study conducted with 2,518 persons living with HIV (PLWH) from 53 cities in São Paulo state between Jan 2004 to Feb 2015. The phylogenetic tree of protease/reverse transcriptase (PR/RT) regions was reconstructed by PhyML and ClusterPicker used to infer the transmission clusters based on Shimodaira-Hasegawa (SH) greater than 90% (phylogenetic support) and genetic distance less than 6%. Results: Of a total of 2,518 sequences, 2,260 were pure subtypes at the PR/RT region, being B (88%), F1 (8.1%), and C (4%). About 21.2% were naïve with a transmitted drug resistance (TDR) rate of 11.8%. A total of 414 (18.3%) of the sequences clustered. These clusters were less evident in subtype B (17.7%) and F1 (15.1%) than in subtype C (40.2%). Clustered sequences were from PLWH at least 5 years younger than non-clustered among subtypes B (p < 0.001) and C (p = 0.037). Men who have sex with men (MSM) predominated the cluster in subtype B (51%), C (85.7%), and F1 (63.6%; p < 0.05). The TDR rate in clustered patients was 15.4, 13.6, and 3.1% for subtypes B, F1, and C, respectively. Most of the infections in subtypes B (80%), C (64%), and F1 (59%) occurred within the state of São Paulo. The metropolitan area of São Paulo presented a high level of endogenous clustering for subtypes B and C. The São Paulo city had 46% endogenous clusters of subtype C. Conclusion: Our findings showed that MSM, antiretroviral therapy in Treatment-Naive (ART-naïve) patients, and HIV1-C, played an important role in the HIV epidemic in the São Paulo state. Further studies in transmission clusters are needed to guide the prevention intervention.
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Infecciones por VIH , VIH-1 , Filogenia , Humanos , Brasil/epidemiología , VIH-1/genética , VIH-1/clasificación , Masculino , Estudios Transversales , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Adulto , Femenino , Persona de Mediana Edad , Epidemiología Molecular , Análisis por Conglomerados , Adulto Joven , Adolescente , Farmacorresistencia Viral/genéticaRESUMEN
Introduction: Polyarticular juvenile idiopathic arthritis (pJIA) is a childhood-onset autoimmune disease. Immune cells contribute to persistent inflammation observed in pJIA. Despite the crucial role of monocytes in arthritis, the precise involvement of classical monocytes in the pathogenesis of pJIA remains uncertain. Here, we aimed to uncover the transcriptomic patterns of classical monocytes in pJIA, focusing on their involvement in disease mechanism and heterogeneity. Methods: A total of 17 healthy subjects and 18 premenopausal women with pJIA according to ILAR criteria were included. Classical monocytes were isolated, and RNA sequencing was performed. Differential expression analysis was used to compare pJIA patients and healthy control group. Differentially expressed genes (DEGs) were identified, and gene set enrichment analysis (GSEA) was performed. Using unsupervised learning approach, patients were clustered in two groups based on their similarities at transcriptomic level. Subsequently, these clusters underwent a comparative analysis to reveal differences at the transcriptomic level. Results: We identified 440 DEGs in pJIA patients of which 360 were upregulated and 80 downregulated. GSEA highlighted TNF-α and IFN-γ response. Importantly, this analysis not only detected genes targeted by pJIA therapy but also identified new modulators of immuno-inflammation. PLAUR, IL1B, IL6, CDKN1A, PIM1, and ICAM1 were pointed as drivers of chronic hyperinflammation. Unsupervised learning approach revealed two clusters within pJIA, each exhibiting varying inflammation levels. Conclusion: These findings indicate the pivotal role of immuno-inflammation driven by classical monocytes in pJIA and reveals the existence of two subclusters within pJIA, regardless the positivity of rheumatoid factor and anti-CCP, paving the way to precision medicine.
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Artritis Juvenil , Perfilación de la Expresión Génica , Inflamación , Monocitos , Transcriptoma , Adulto , Niño , Femenino , Humanos , Anticuerpos Antiproteína Citrulinada , Artritis Juvenil/clasificación , Artritis Juvenil/genética , Artritis Juvenil/inmunología , Artritis Juvenil/patología , Estudios de Casos y Controles , Enfermedad Crónica , Análisis por Conglomerados , Inflamación/genética , Inflamación/inmunología , Inflamación/patología , Mediadores de Inflamación/inmunología , Interferón gamma/inmunología , Monocitos/inmunología , Monocitos/metabolismo , Fenotipo , Medicina de Precisión , Premenopausia , Unión Proteica , Mapas de Interacción de Proteínas , Factor Reumatoide , Análisis de Secuencia de ARN , Transcriptoma/genética , Factor de Necrosis Tumoral alfa/inmunología , Aprendizaje Automático no SupervisadoRESUMEN
BACKGROUND: We aimed to identify clusters of health behaviors and study their associations with cardiometabolic risk factors in adults at high risk for type 2 diabetes in India. METHODS: Baseline data from the Kerala Diabetes Prevention Program (n = 1000; age 30-60 years) were used for this study. Information on physical activity (PA), sedentary behavior, fruit and vegetable intake, sleep, and alcohol and tobacco use was collected using questionnaires. Blood pressure, waist circumference, 2-h plasma glucose, high-density lipoprotein and low-density lipoprotein cholesterol, and triglycerides were measured using standardized protocols. Latent class analysis was used to identify clusters of health behaviors, and multilevel mixed-effects linear regression was employed to examine their associations with cardiometabolic risk factors. RESULTS: Two classes were identified, with 87.4% of participants in class 1 and 12.6% in class 2. Participants in both classes had a high probability of not engaging in leisure-time PA (0.80 for class 1; 0.73 for class 2) and consuming <5 servings of fruit and vegetables per day (0.70 for class 1; 0.63 for class 2). However, participants in class 1 had a lower probability of sitting for >=3 h per day (0.26 vs 0.42), tobacco use (0.10 vs 0.75), and alcohol use (0.08 vs 1.00) compared to those in class 2. Class 1 had a significantly lower mean systolic blood pressure (ß = -3.70 mm Hg, 95% confidence interval [CI] -7.05, -0.36), diastolic blood pressure (ß = -2.45 mm Hg, 95% CI -4.74, -0.16), and triglycerides (ß = -0.81 mg/dL, 95% CI -0.75, -0.89). CONCLUSION: Implementing intervention strategies, tailored to cluster-specific health behaviors, is required for the effective prevention of cardiometabolic disorders among high-risk adults for type 2 diabetes.
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Factores de Riesgo Cardiometabólico , Diabetes Mellitus Tipo 2 , Conductas Relacionadas con la Salud , Análisis de Clases Latentes , Humanos , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/prevención & control , Masculino , Femenino , India/epidemiología , Persona de Mediana Edad , Adulto , Ejercicio Físico , Conducta Sedentaria , Factores de Riesgo , Análisis por Conglomerados , Presión Sanguínea , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/etiologíaRESUMEN
Introduction: Obesity and gender play a critical role in shaping the outcomes of COVID-19 disease. These two factors have a dynamic relationship with each other, as well as other risk factors, which hinders interpretation of how they influence severity and disease progression. This work aimed to study differences in COVID-19 disease outcomes through analysis of risk profiles stratified by gender and obesity status. Methods: This study employed an unsupervised clustering analysis, using Mexico's national COVID-19 hospitalization dataset, which contains demographic information and health outcomes of patients hospitalized due to COVID-19. Patients were segmented into four groups by obesity and gender, with participants' attributes and clinical outcome data described for each. Then, Consensus and PAM clustering methods were used to identify distinct risk profiles based on underlying patient characteristics. Risk profile discovery was completed on 70% of records, with the remaining 30% available for validation. Results: Data from 88,536 hospitalized patients were analyzed. Obesity, regardless of gender, was linked with higher odds of hypertension, diabetes, cardiovascular diseases, pneumonia, and Intensive Care Unit (ICU) admissions. Men tended to have higher frequencies of ICU admissions and pneumonia and higher mortality rates than women. Within each of the four analysis groups (divided based on gender and obesity status), clustering analyses identified four to five distinct risk profiles. For example, among women with obesity, there were four profiles; those with a hypertensive profile were more likely to have pneumonia, and those with a diabetic profile were most likely to be admitted to the ICU. Conclusion: Our analysis emphasizes the complex interplay between obesity, gender, and health outcomes in COVID-19 hospitalizations. The identified risk profiles highlight the need for personalized treatment strategies for COVID-19 patients and can assist in planning for patterns of deterioration in future waves of SARS-CoV-2 virus transmission. This research underscores the importance of tackling obesity as a major public health concern, given its interplay with many other health conditions, including infectious diseases such as COVID-19.
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COVID-19 , Hospitalización , Obesidad , Aprendizaje Automático no Supervisado , Humanos , COVID-19/epidemiología , COVID-19/mortalidad , Masculino , Femenino , Obesidad/epidemiología , México/epidemiología , Persona de Mediana Edad , Hospitalización/estadística & datos numéricos , Factores de Riesgo , Adulto , Factores Sexuales , Anciano , SARS-CoV-2 , Análisis por ConglomeradosRESUMEN
Glioblastoma Multiforme is a brain tumor distinguished by its aggressiveness. We suggested that this aggressiveness leads single-cell RNA-sequence data (scRNA-seq) to span a representative portion of the cancer attractors domain. This conjecture allowed us to interpret the scRNA-seq heterogeneity as reflecting a representative trajectory within the attractor's domain. We considered factors such as genomic instability to characterize the cancer dynamics through stochastic fixed points. The fixed points were derived from centroids obtained through various clustering methods to verify our method sensitivity. This methodological foundation is based upon sample and time average equivalence, assigning an interpretative value to the data cluster centroids and supporting parameters estimation. We used stochastic simulations to reproduce the dynamics, and our results showed an alignment between experimental and simulated dataset centroids. We also computed the Waddington landscape, which provided a visual framework for validating the centroids and standard deviations as characterizations of cancer attractors. Additionally, we examined the stability and transitions between attractors and revealed a potential interplay between subtypes. These transitions might be related to cancer recurrence and progression, connecting the molecular mechanisms of cancer heterogeneity with statistical properties of gene expression dynamics. Our work advances the modeling of gene expression dynamics and paves the way for personalized therapeutic interventions.