RESUMO
Plasmodium falciparum entered into the Peruvian Amazon in 1994, sparking an epidemic between 1995 and 1998. Since 2000, there has been sustained low P. falciparum transmission. The Malaria Immunology and Genetics in the Amazon project has longitudinally followed members of the community of Zungarococha (N = 1,945, 4 villages) with active household and health center-based visits each year since 2003. We examined parasite population structure and traced the parasite genetic diversity temporally and spatially. We genotyped infections over 5 years (2003-2007) using 14 microsatellite (MS) markers scattered across ten different chromosomes. Despite low transmission, there was considerable genetic diversity, which we compared with other geographic regions. We detected 182 different haplotypes from 302 parasites in 217 infections. Structure v2.2 identified five clusters (subpopulations) of phylogenetically related clones. To consider genetic diversity on a more detailed level, we defined haplotype families (hapfams) by grouping haplotypes with three or less loci differences. We identified 34 different hapfams identified. The F(st) statistic and heterozygosity analysis showed the five clusters were maintained in each village throughout this time. A minimum spanning network (MSN), stratified by the year of detection, showed that haplotypes within hapfams had allele differences and haplotypes within a cluster definition were more separated in the later years (2006-2007). We modeled hapfam detection and loss, accounting for sample size and stochastic fluctuations in frequencies overtime. Principle component analysis of genetic variation revealed patterns of genetic structure with time rather than village. The population structure, genetic diversity, appearance/disappearance of the different haplotypes from 2003 to 2007 provides a genome-wide "real-time" perspective of P. falciparum parasites in a low transmission region.
Assuntos
Variação Genética , Malária Falciparum/parasitologia , Plasmodium falciparum/genética , Teorema de Bayes , Doenças Endêmicas , Haplótipos , Humanos , Estudos Longitudinais , Malária Falciparum/epidemiologia , Malária Falciparum/transmissão , Repetições de Microssatélites , Peru/epidemiologia , Filogenia , Reação em Cadeia da Polimerase , Análise de Componente Principal , Estatísticas não ParamétricasRESUMO
OBJECTIVE: To test the hypothesis that exposure to preeclampsia is associated with an increased risk of bronchopulmonary dysplasia (BPD). STUDY DESIGN: A prospective cohort study of 107 babies born between 23 and 32 weeks gestation, collecting maternal, neonatal, and placental data. RESULTS: Of the 107 infants studied, 27 (25%) developed BPD. The bivariate odds ratio (OR) for the relationship between pre-eclampsia and BPD was 2.96 (95% confidence interval [CI] = 1.17 to 7.51; P = .01). When controlling for gestational age, birth weight z-score, chorioamnionitis, and other clinical confounders, the OR of developing BPD was 18.7 (95% CI = 2.44 to 144.76). Including the occurrence of preeclampsia, clinical chorioamnionitis, male sex, and maternal tobacco use in addition to gestational age and birth weight z-score accounted for 54% of the variability of the odds of developing BPD. CONCLUSIONS: BPD is increased for infants exposed to preeclampsia. This has possible implications for the prevention of BPD with proangiogenic agents, such as vascular endothelial growth factor.
Assuntos
Displasia Broncopulmonar/etiologia , Exposição Materna/efeitos adversos , Pré-Eclâmpsia , Efeitos Tardios da Exposição Pré-Natal/etiologia , Adulto , Peso ao Nascer , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/epidemiologia , Feminino , Seguimentos , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Masculino , Massachusetts/epidemiologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Estudos ProspectivosRESUMO
This article, the third of the series called pharmacovigilance, deals with international experience with adverse drug reactions. It highlights the countries with the greatest cumulative number of reports and how their position changes with the use of the country-adjusted number of reports by million of inhabitants/year. It includes, in decreasing order, the number of reports of twenty therapeutic drug classes. Included in each one are the most plausible explanations for their frequency and, finally, the cumulative number of reports for clinical manifestations of adverse drug reactions.