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While costs of norovirus acute gastroenteritis (AGE) to healthcare systems have been estimated, out-of-pocket and indirect costs incurred by households are not well documented in community settings, particularly in developing countries. We conducted active surveillance for AGE in two communities in Peru: Puerto Maldonado (October 2012-August 2015) and San Jeronimo (April 2015-April 2019). Norovirus AGE events with PCR-positive stool specimens were included. Data collected in follow-up interviews included event-related medical resource utilization, associated out-of-pocket costs, and indirect costs. There were 330 norovirus-associated AGE events among 3,438 participants from 685 households. Approximately 49% of norovirus events occurred among children <5 years of age and total cost to the household per episode was highest in this age group. Norovirus events cost a median of US $2.95 (IQR $1.04-7.85) in out-of-pocket costs and $12.58 (IQR $6.39-25.16) in indirect costs. Medication expenses accounted for 53% of out-of-pocket costs, and productivity losses accounted for 59% of the total financial burden on households. The frequency and associated costs of norovirus events to households in Peruvian communities support the need for prevention strategies including vaccines. Norovirus interventions targeting children <5 years of age and their households may have the greatest economic benefit.
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ABSTRACT: In patients with severe heart disease, the implantation of a ventricular assist device (VAD) may be necessary, especially in patients with an indication for heart transplantation. For this, the Institute Dante Pazzanese of Cardiology (IDPC) has developed an implantable centrifugal blood pump that will be able to help a diseased human heart to maintain physiological blood flow and pressure. This device will be used as a totally or partially implantable VAD. Therefore, performance assurance and correct specification of the VAD are important factors in achieving a safe interaction between the device and the patient's behavior or condition. Even with reliable devices, some failures may occur if the pumping control does not keep up with changes in the patient's behavior or condition. If the VAD control system has no fault tolerance and no system dynamic adaptation that occurs according to changes in the patient's cardiovascular system, a number of limitations can be observed in the results and effectiveness of these devices, especially in patients with acute comorbidities. This work proposes the application of a mechatronic approach to this class of devices based on advanced control, instrumentation, and automation techniques to define a method to develop a hierarchical supervisory control system capable of dynamically, automatically, and safely VAD control. For this methodology, concepts based on Bayesian networks (BN) were used to diagnose the patient's cardiovascular system conditions, Petri nets (PN) to generate the VAD control algorithm, and safety instrumented systems to ensure the safety of the VAD system.
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Materiais Biocompatíveis , Coração Auxiliar , Pressão Sanguínea , Tomada de Decisões Assistida por ComputadorRESUMO
BACKGROUND: Diarrhea is a major cause of morbidity and mortality, yet incidence and etiology data are limited. We conducted laboratory-based diarrhea surveillance in Guatemala. METHODS: A diarrhea case was defined as ≥3 loose stools in a 24-h period in a person presenting to the surveillance facilities. Epidemiologic data and stool specimens were collected. Specimens were tested for bacterial, parasitic, and viral pathogens. Yearly incidence was adjusted for healthcare seeking behaviors determined from a household survey conducted in the surveillance catchment area. RESULTS: From November 2008 to December 2012, the surveillance system captured 5331 diarrhea cases; among these 1381 (26%) had specimens tested for all enteric pathogens of interest. The adjusted incidence averaged 659 diarrhea cases per 10,000 persons per year, and was highest among children aged < 5 years, averaging 1584 cases per 10,000 children per year. Among 1381 (26%) specimens tested for all the pathogens of interest, 235 (17%) had a viral etiology, 275 (20%) had a bacterial, 50 (4%) had parasites, and 86 (6%) had co-infections. Among 827 (60%) specimens from children aged < 5 years, a virus was identified in 196 (23%) patients; 165 (20%) had norovirus and 99 (12%) rotavirus, including co-infections. Among 554 patients aged ≥5 years, 103 (19%) had a bacterial etiology, including diarrheagenic Escherichia coli in 94 (17%) cases, Shigella spp. in 31 (6%), Campylobacter spp. in 5 (1%), and Salmonella spp. in 4 (1%) cases. Detection of Giardia and Cryptosporidium was infrequent (73 cases; 5%). CONCLUSIONS: There was a substantial burden of viral and bacterial diarrheal diseases in Guatemala, highlighting the importance of strengthening laboratory capacity for rapid detection and control and for evaluation of public health interventions.
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Disenteria/epidemiologia , Disenteria/etiologia , Vigilância em Saúde Pública/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Fezes/microbiologia , Fezes/parasitologia , Fezes/virologia , Feminino , Guatemala/epidemiologia , Humanos , Incidência , Lactente , Laboratórios , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Fibrous scaffolds have become popular in tissue engineering (TE) due to their morphological resemblance to extracellular matrix components. While electrospinning is the most common technique in the ï¬eld, solution blow spinning is an emerging technique with great potential. One of its many advantages is that it can produce aligned ï¬bers with a very simple experimental setup. This work aimed to fabricate poly (ε-caprolactone) mats with aligned ï¬bers and compare them to nonaligned ones. For that, samples were produced using three rotational speeds of a cylindrical collector and characterized in terms of ï¬ber alignment and diameter, mechanical properties, wettability, and biological response. Results showed that with a static collector, ï¬bers were randomly deposited and nonaligned. As the speed was increased, the ï¬bers began to align (as proven by image analysis), resulting in a change in mechanical behavior, but no differences in ï¬ber diameter. Cells cultured on aligned samples were more elongated, and a higher alignment degree seemed to favor cellular growth. The results conï¬rmed the potential of this up-and-coming technique to produce aligned ï¬bers for TE. (AU)
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Humanos , Materiais Biocompatíveis , Engenharia Tecidual/métodosRESUMO
As molecular tools for assessing trophic interactions become common, research is increasingly focused on the construction of interaction networks. Here, we demonstrate three key methods for incorporating DNA data into network ecology and discuss analytical considerations using a model consisting of plants, insects, bats and their parasites from the Costa Rica dry forest. The simplest method involves the use of Sanger sequencing to acquire long sequences to validate or refine field identifications, for example of bats and their parasites, where one specimen yields one sequence and one identification. This method can be fully quantified and resolved and these data resemble traditional ecological networks. For more complex taxonomic identifications, we target multiple DNA loci, for example from a seed or fruit pulp sample in faeces. These networks are also well resolved but gene targets vary in resolution and quantification is difficult. Finally, for mixed templates such as faecal contents of insectivorous bats, we use DNA metabarcoding targeting two sequence lengths (157 and 407 bp) of one gene region and a MOTU, BLAST and BIN association approach to resolve nodes. This network type is complex to generate and analyse, and we discuss the implications of this type of resolution on network analysis. Using these data, we construct the first molecular-based network of networks containing 3,304 interactions between 762 nodes of eight trophic functions and involving parasitic, mutualistic and predatory interactions. We provide a comparison of the relative strengths and weaknesses of these data types in network ecology.
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Código de Barras de DNA Taxonômico , Ecologia , Insetos/genética , Plantas/genética , Animais , Costa Rica , Cadeia Alimentar , Insetos/fisiologia , Simbiose/genéticaRESUMO
Fibrous scaffolds have become popular in tissue engineering (TE) due to their morphological resemblance to extracellular matrix components. While electrospinning is the most common technique in the field, solution blow spinning is an emerging technique with great potential. One of its many advantages is that it can produce aligned fibers with a very simple experimental setup. This work aimed to fabricate poly(ε-caprolactone) mats with aligned fibers and compare them to nonaligned ones. For that, samples were produced using three rotational speeds of a cylindrical collector and characterized in terms of fiber alignment and diameter, mechanical properties, wettability, and biological response. Results showed that with a static collector, fibers were randomly deposited and nonaligned. As the speed was increased, the fibers began to align (as proven by image analysis), resulting in a change in mechanical behavior, but no differences in fiber diameter. Cells cultured on aligned samples were more elongated, and a higher alignment degree seemed to favor cellular growth. The results confirmed the potential of this up-and-coming technique to produce aligned fibers for TE. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1462-1470, 2019.
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Teste de Materiais , Poliésteres/química , Alicerces Teciduais/química , Animais , Chlorocebus aethiops , Células VeroRESUMO
Background: Acute gastroenteritis (AGE) is a leading infectious cause of morbidity worldwide, particularly among children in developing countries. With the decline of rotavirus disease rates following introduction of rotavirus vaccines, the relative importance of norovirus will likely increase. Our objectives in this study were to determine the incidence and clinical profile of norovirus disease in Guatemala. Methods: We analyzed data from a population-based surveillance study conducted in Guatemala from 2008 through 2013. Demographic information, clinical data, and stool samples were collected from patients who presented with AGE (≥3 liquid stools within 24 hours that initiated 7 days before presentation). Estimated incidence of hospitalized, outpatient, and total community norovirus disease was calculated using surveillance data and household surveys of healthcare use. Results: We included 999 AGE hospitalizations and 3189 AGE outpatient visits at facilities, of which 164 (16%) and 370 (12%), respectively, were positive for norovirus. Severity of norovirus was milder than of rotavirus. Community incidence of norovirus ranged from 2068 to 4954 per 100000 person-years (py) in children aged<5 years. Children aged <5 years also had higher incidence of norovirus-associated hospitalization (51-105 per 100000 py) compared with patients aged ≥5 years (0-1.6 per 100000 py and 49-80 per 100000 py, respectively). Conclusions: This study highlights the burden of norovirus disease in Guatemala, especially among young children. These data can help prioritize development of control strategies, including the potential use of vaccines, and provide a baseline to evaluate the impact of such interventions.
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Infecções por Caliciviridae/epidemiologia , Diarreia/epidemiologia , Gastroenterite/epidemiologia , Norovirus/isolamento & purificação , Doença Aguda/epidemiologia , Adolescente , Adulto , Infecções por Caliciviridae/complicações , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Diarreia/virologia , Feminino , Gastroenterite/virologia , Guatemala/epidemiologia , Hospitalização , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Vigilância da População , Adulto JovemRESUMO
BACKGROUND: During 8-20 April 2012, an outbreak of gastrointestinal illness occurred among guests and employees of a resort hotel in St. Thomas, US Virgin Islands. We describe outbreak characteristics, and estimate indirect (non-medical) costs to travellers. METHODS: Employees who met the case definition were interviewed and provided stool samples. Samples were tested for norovirus by real-time reverse-transcription polymerase chain reaction. Guests were asked to complete a survey aimed to identify and characterize cases, and to estimate quality adjusted vacation days (QAVD) lost. RESULTS: Overall, 66 persons (20 employees and 46 guests) met the probable case definition. The first reported illness onset occurred in a hotel employee on 8 April, while the first reported onset in a guest occurred on 13 April. An employee suffered a public diarrhoea incident on 13 April in the central kitchen, followed by illness onset in the next day among employees that assisted with the clean-up. On 15 April, after 10 guests reported ill, the hotel implemented an outbreak response protocol instructing ill employees to take a 3-day leave, and obtain medical clearance prior to resuming work. Ill guests were advised to self-isolate, and rapid cleaning of public areas and guest rooms where suspected contamination occurred was implemented. We estimated that 65 QAVDs were lost by 43 guests (1.5 days/guest). Using an approximate cost of $450 per vacation day, we estimated indirect illness cost at $675 per guest case. Seven (64%) of 11 cases' stool specimens were positive for norovirus genotype GII.4 Den Haag. CONCLUSIONS: A norovirus outbreak in a resort hotel resulted in substantial indirect costs and loss of vacation days to ill travellers. We recommend outbreak control measures including exclusion of ill employees, until ≥48-72 h after resolution of symptoms, self-isolation of ill guests and appropriate cleaning in hotel-associated norovirus outbreaks.
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Infecções por Caliciviridae/epidemiologia , Diarreia/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Gastroenterite/epidemiologia , Viagem , Infecções por Caliciviridae/diagnóstico , Diarreia/diagnóstico , Feminino , Gastroenterite/diagnóstico , Humanos , Norovirus/isolamento & purificação , Ilhas Virgens AmericanasRESUMO
The Apico Aortic Blood Pump (AABP) is a centrifugal continuous flow left ventricular assist device (LVAD) with ceramic bearings. The device is in the initial development phase and is being designed to be attached directly to the left ventricular apex by introducing an inlet cannula. This paper reports results from in vitro experiments. In order to evaluate implantation procedures and device dimensioning, in vitro experiments included an anatomic positioning study for the analysis of surgical implantation procedure and device dimensions and positioning that was performed using the body of a pig. The results revealed no damage caused by the device, and the surgical implantation procedure was considered feasible. Hydrodynamic performance curves were obtained to verify the applicability of the device as an LVAD, showing adequate performance. Mechanical blood trauma was analyzed through 6-h hemolysis tests, with total pressure head of 100 mm Hg and flow of 5 L/min. Mean normalized index of hemolysis was 0.009 g/100 L (±0.002 g/100 L). Studies using a hybrid cardiovascular simulator were conducted for three types of circulatory conditions: normal healthy conditions, concentric hypertrophic heart failure (CHHF), and CHHF with AABP assistance. Analysis of cardiovascular parameters under those three conditions demonstrated that when the AABP was assisting the system, parameters under CHHF conditions went back to normal healthy values, indicating the AABP's effectiveness as CHHF therapy. Our preliminary results indicate that it is feasible to use the AABP as a LVAD. The next steps include long-term in vivo experiments.
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Ventrículos do Coração/cirurgia , Coração Auxiliar , Animais , Cerâmica/química , Coração Auxiliar/efeitos adversos , Hemólise , Humanos , Hidrodinâmica , Modelos Cardiovasculares , Desenho de Prótese , SuínosRESUMO
BACKGROUND: In January of 2008, during the peak of the rotavirus season in Guatemala, a gastroenteritis outbreak with high mortality among infants was reported in Guatemala. Despite extensive efforts, the investigation was limited by the lack of bulk stool specimens collected, particularly from the more severely dehydrated or deceased children. OBJECTIVES: We evaluated the diagnostic performance of rectal swab specimens compared with bulk stool for the detection of rotavirus and norovirus. STUDY DESIGN: Patients with diarrhea (≥3 loose stools in 24 h) were enrolled through an ongoing surveillance system in Guatemala. From January through March 2009, we attempted to enroll 100 patients <5 years old captured by the diarrhea surveillance, and collected paired bulk stool and rectal swabs specimens from them. Specimens were tested for norovirus using real-time reverse transcription-polymerase chain reaction and for rotavirus via enzyme immunoassay. RESULTS: We enrolled 102 patients with paired specimens; 91% of 100 paired specimens tested for rotavirus yielded concordant results positive for rotavirus with a negativity rate of 83%. Among 100 paired specimens tested for norovirus, 86% were concordant norovirus detection and the negativity rate was 85%. The diagnostic performance for rotavirus and norovirus detection did not differ significantly between the two specimen types. CONCLUSIONS: Testing of properly collected fecal specimens using rectal swabs may be a viable alternative to bulk stool for detection of rotavirus and norovirus, particularly during outbreaks where collection of bulk stool may be difficult.
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Infecções por Caliciviridae/diagnóstico , Surtos de Doenças , Gastroenterite/diagnóstico , Norovirus/isolamento & purificação , Infecções por Rotavirus/diagnóstico , Rotavirus/isolamento & purificação , Infecções por Caliciviridae/epidemiologia , Infecções por Caliciviridae/virologia , Pré-Escolar , Estudos de Coortes , Fezes/virologia , Feminino , Gastroenterite/epidemiologia , Gastroenterite/virologia , Guatemala/epidemiologia , Humanos , Lactente , Masculino , Reto/virologia , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/virologiaRESUMO
Noroviruses (NoVs) are a leading cause of acute gastroenteritis outbreaks and sporadic cases of diarrhea in industrialized countries. To study the prevalence and genetic diversity of NoVs in Guatemala, stool specimens were collected from hospitalized and ambulatory patients presenting with diarrhea (≥3 loose or liquid stools in a 24-hr period) who were enrolled in a prospective surveillance system in the Departments of Santa Rosa (October 2007 to August 2010) and Quetzaltenango (August 2009 to August 2010), Guatemala. Specimens were tested for rotavirus, enteric bacteria, and parasites by routine methods and for genogroups I and II NoV by real-time reverse transcription-PCR. A total of 2,403 stool specimens were collected from hospitalized (n = 528) and ambulatory patients (n = 1,875). Overall, 341 (14%) samples tested positive for NoVs including 114 (22%) hospitalized and 227 (12%) ambulatory patients. NoVs disease peaked during the winter (November-January) months. Among the 341 NoVs-positive patients, 32 (9%) were also positive for rotavirus, 32 (9%) for bacteria, and 9 (3%) for protozoa. Nucleotide sequences were obtained from 84 samples collected from hospitalized children aged <5 years of age, which could be grouped into nine GII and three GI genotypes with GII.4 (74%) and GI.8 (10%) being the most common. This is the first study on the prevalence of NoVs among hospitalized and ambulatory patients with diarrhea in Guatemala. The findings highlight the need to implement laboratory diagnostics for NoVs to improve appropriate clinical management of diarrheal diseases and guide vaccine development.
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Infecções por Caliciviridae/epidemiologia , Diarreia/epidemiologia , Variação Genética , Norovirus/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Caliciviridae/virologia , Criança , Pré-Escolar , Coinfecção/epidemiologia , Coinfecção/microbiologia , Coinfecção/parasitologia , Coinfecção/virologia , Diarreia/virologia , Fezes/virologia , Feminino , Genótipo , Guatemala/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Norovirus/classificação , Norovirus/genética , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Estações do Ano , Adulto JovemAssuntos
Infecções por Caliciviridae/epidemiologia , Surtos de Doenças , Gastroenterite/epidemiologia , RNA Viral/genética , Sapovirus/genética , Infecções por Caliciviridae/patologia , Infecções por Caliciviridae/virologia , Pré-Escolar , Feminino , Gastroenterite/patologia , Gastroenterite/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia , RNA Viral/isolamento & purificação , Reação em Cadeia da Polimerase em Tempo Real , Sapovirus/isolamento & purificação , Sapovirus/patogenicidadeRESUMO
Abstract: The Apico Aortic Blood Pump (AABP) is acentrifugal continuous flow left ventricular assist device(LVAD) with ceramic bearings. The device is in the initialdevelopment phase and is being designed to be attacheddirectly to the left ventricular apex by introducing an inletcannula. This paper reports results from in vitro experiments.In order to evaluate implantation procedures anddevice dimensioning, in vitro experiments included an anatomicpositioning study for the analysis of surgical implantationprocedure and device dimensions and positioningthat was performed using the body of a pig. The resultsrevealed no damage caused by the device, and the surgicalimplantation procedure was considered feasible. Hydrodynamicperformance curves were obtained to verify theapplicability of the device as an LVAD, showing adequateperformance. Mechanical blood trauma was analyzedthrough 6-h hemolysis tests, with total pressure head of100 mm Hg and flow of 5 L/min. Mean normalized index ofhemolysis was 0.009 g/100 L (±0.002 g/100 L).Studies usinga hybrid cardiovascular simulator were conducted for threetypes of circulatory conditions: normal healthy conditions,concentric hypertrophic heart failure (CHHF), and CHHFwith AABP assistance. Analysis of cardiovascular parametersunder those three conditions demonstrated that whenthe AABP was assisting the system, parameters underCHHF conditions went back to normal healthy values, indicatingthe AABPs effectiveness as CHHF therapy. Ourpreliminary results indicate that it is feasible to use theAABP as a LVAD. The next steps include long-term invivo experiments.
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Hemólise , HidrodinâmicaRESUMO
BACKGROUND: In February 2009, a group of Guatemalan school children developed acute gastroenteritis (AGE) after participating in a school excursion. OBJECTIVES: We conducted a retrospective cohort investigation to characterize the outbreak and guide control measures. STUDY DESIGN: A case was defined as an illness with onset of diarrhea or vomiting during February 25-March 5, 2009. Participants were interviewed using a standardized questionnaire, and stool specimens were collected. We inspected the excursion site and tested water samples for total coliforms and Escherichia coli. RESULTS: We identified 119 excursion participants, of which 92 (77%) had been ill. Fifty-six (62%) patients sought care for their illness, and three (3%) were hospitalized. Eighteen (90%) of the 20 specimens from ill children tested positive for norovirus. Among these, 16 (89%) were of the genogroup I (GI.7) and two (11%) were genogroup II (GII.12 and GII.17). One (8%) of the 12 food handlers had norovirus (GI.7). Drinking water samples had 146 most probable numbers (MPN)/100ml of total coliforms and five MPN/100ml of E. coli. CONCLUSION: We describe the first laboratory-confirmed norovirus outbreak in Guatemala. The high illness attack rate, detection of multiple norovirus strains in sick persons, and presence of fecal contamination of drinking water indicate likely waterborne transmission.
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Infecções por Caliciviridae/epidemiologia , Surtos de Doenças , Água Potável/microbiologia , Gastroenterite/epidemiologia , Norovirus/isolamento & purificação , Adulto , Infecções por Caliciviridae/virologia , Criança , Feminino , Manipulação de Alimentos , Gastroenterite/virologia , Guatemala/epidemiologia , Estâncias para Tratamento de Saúde , Humanos , Masculino , Norovirus/genética , Estudos RetrospectivosRESUMO
In previous studies, we presented main strategies for suspending the rotor of a mixed-flow type (centrifugal and axial) ventricular assist device (VAD), originally presented by the Institute Dante Pazzanese of Cardiology (IDPC), Brazil. Magnetic suspension is achieved by the use of a magnetic bearing architecture in which the active control is executed in only one degree of freedom, in the axial direction of the rotor. Remaining degrees of freedom, excepting the rotation, are restricted only by the attraction force between pairs of permanent magnets. This study is part of a joint project in development by IDPC and Escola Politecnica of São Paulo University, Brazil. This article shows advances in that project, presenting two promising solutions for magnetic bearings. One solution uses hybrid cores as electromagnetic actuators, that is, cores that combine iron and permanent magnets. The other solution uses actuators, also of hybrid type, but with the magnetic circuit closed by an iron core. After preliminary analysis, a pump prototype has been developed for each solution and has been tested. For each prototype, a brushless DC motor has been developed as the rotor driver. Each solution was evaluated by in vitro experiments and guidelines are extracted for future improvements. Tests have shown good results and demonstrated that one solution is not isolated from the other. One complements the other for the development of a single-axis-controlled, hybrid-type magnetic bearing for a mixed-flow type VAD.
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Coração Auxiliar , Magnetismo , Função Ventricular Esquerda , Brasil , Hemorreologia , Teste de Materiais , Desenho de Prótese , RotaçãoRESUMO
Familial dysautonomia is an autosomal recessive congenital neuropathy that occurs almost exclusively in the Ashkenazi Jewish population and has rarely been diagnosed in the neonatal period in unaffected families. This report describes a patient who, during the neonatal period, had episodes of marked decrease in the level of consciousness with durations of 4-15 hours. Other signs and symptoms included the absence of fungiform papillae of the tongue, areflexia, and failure to thrive. The diagnosis was confirmed by the demonstration of mutations in the IkappaB kinase complex-associated protein gene with the identification of IVS20 (+6T --> C) which is responsible for more than 99.5% of known Ashkenazi Jewish patients with familial dysautonomia. The prognosis of this disease and the possibility of genetic counseling are clearly related with an early definitive diagnosis, and this patient illustrates the importance of episodes of somnolence as a possible sign of familial dysautonomia.