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1.
Lancet Reg Health Am ; 34: 100765, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38841150

RESUMO

Background: The state of São Paulo reports the highest number of tuberculosis cases in Brazil. We aimed to analyze the SARS-CoV-2 pandemic's impact on tuberculosis notifications and identify factors associated with reduced notifications and tuberculosis deaths in 2020-2021. Methods: This retrospective cross-sectional study analyzed data from 126,649 patients with tuberculosis notified in São Paulo from 2016 to 2021. Interrupted time series analysis assessed the pandemic's impact on notifications. Descriptive statistics and logistic regressions identified factors associated with decreased tuberculosis notifications and deaths during the pandemic (2020-2021) compared to the pre-pandemic period (2019). Findings: Tuberculosis notifications decreased by 10% and 8% in 2020 and 2021, respectively, with declines 2-3 times higher among individuals with no education or deprived of liberty. Contrastingly, tuberculosis notifications increased 68% among corrections workers in 2021. Diagnostics and contact tracing were compromised. Individuals with HIV, drug addiction, or deprived of liberty had lower odds of notification during the pandemic. Black and Pardo individuals or those with diabetes, treatment interruption history, or treatment changes post-adverse events had higher odds of notification. However, adverse events and tuberculosis-diabetes cases have been increasing since 2016. During the pandemic, tuberculosis-related deaths rose 5.0%-12.7%. Risk factors for mortality remained similar to 2019, with Pardo ethnicity, drug addiction and re-treatment post-adverse events emerging as risk factors in 2020/2021. Interpretation: The pandemic affected tuberculosis notifications and deaths differently among populations, exacerbating inequalities. Treatment interruption, loss of follow-up, and challenges in accessing healthcare led to increased mortality. Funding: FAPESP, CNPq and CAPES, Brazil.

2.
The Lancet Regional Health - Americas ; 34: 1-19, 2024. tab, graf, mapas
Artigo em Inglês | CONASS, Coleciona SUS, Sec. Est. Saúde SP, SESSP-ACVSES, SESSP-CVEPROD, Sec. Est. Saúde SP | ID: biblio-1555507

RESUMO

Background The state of São Paulo reports the highest number of tuberculosis cases in Brazil. We aimed to analyze the SARS-CoV-2 pandemic's impact on tuberculosis notifications and identify factors associated with reduced notifications and tuberculosis deaths in 2020­2021. Methods This retrospective cross-sectional study analyzed data from 126,649 patients with tuberculosis notified in São Paulo from 2016 to 2021. Interrupted time series analysis assessed the pandemic's impact on notifications. Descriptive statistics and logistic regressions identified factors associated with decreased tuberculosis notifications and deaths during the pandemic (2020­2021) compared to the pre-pandemic period (2019). Findings Tuberculosis notifications decreased by 10% and 8% in 2020 and 2021, espectively, with declines 2­3 times higher among individuals with no education or deprived of liberty. Contrastingly, tuberculosis notifications increased 68% among corrections workers in 2021. Diagnostics and contact tracing were compromised. Individuals with HIV, drug addiction, or deprived of liberty had lower odds of notification during the pandemic. Black and Pardo individuals or those with diabetes, treatment interruption history, or treatment changes post-adverse events had higher odds of notification. However, adverse events and tuberculosis-diabetes cases have been increasing since 2016. During the pandemic, tuberculosis-related deaths rose 5.0%­12.7%. Risk factors for mortality remained similar to 2019, with Pardo ethnicity, drug addiction and re-treatment post-adverse events emerging as risk factors in 2020/2021. Interpretation The pandemic affected tuberculosis notifications and deaths differently among populations, exacerbating inequalities. Treatment interruption, loss of follow-up, and challenges in accessing healthcare led to increased mortality. (AU)


Assuntos
Tuberculose , Tuberculose/mortalidade , Brasil , Notificação de Doenças , Pandemias , SARS-CoV-2 , COVID-19
3.
Microorganisms ; 11(5)2023 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-37317323

RESUMO

Influenza A virus (IAV) infection affects the human respiratory tract, causing an acute and highly contagious disease. Individuals with comorbidities and in the extremes of age are classified as risk groups for serious clinical outcomes. However, part of the severe infections and fatalities are observed among young healthy individuals. Noteworthy, influenza infections lack specific prognostic biomarkers that would predict the disease severity. Osteopontin (OPN) has been proposed as a biomarker in a few human malignancies and its differential modulation has been observed during viral infections. However, OPN expression levels in the primary site of IAV infection have not been previously investigated. Therefore, we evaluated the transcriptional expression patterns of total OPN (tOPN) and its splicing isoforms (OPNa, OPNb, OPNc, OPN4, and OPN5) in 176 respiratory secretion samples collected from human influenza A(H1N1)pdm09 cases and a group of 65 IAV-negative controls. IAV samples were differentially classified according to their disease severity. tOPN was more frequently detected in IAV samples (34.1%) when compared with the negative controls (18.5%) (p < 0.05), as well as in fatal (59.1%) versus non-fatal IAV samples (30.5%) (p < 0.01). OPN4 splice variant transcript was more prevalent in IAV cases (78.4%) than in the negative controls (66.1%) (p = 0.05) and in severe cases (85.7%) in relation to the non-severe ones (69.2%) (p < 0.01). OPN4 detection was also associated with severity symptoms such as dyspnea (p < 0.05), respiratory failure (p < 0.05), and oxygen saturation < 95% (p < 0.05). In addition, the OPN4 expression level was increased in the fatal cases of respiratory samples. Our data indicated that tOPN and OPN4 had a more pronounced expression pattern in IAV respiratory samples, pointing to the potential use of these molecules as biomarkers to evaluate disease outcomes.

4.
Viruses ; 14(7)2022 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-35891457

RESUMO

Worldwide, infections by influenza viruses are considered a major public health challenge. In this study, influenza B vaccine mismatches and clinical aspects of Victoria and Yamagata infections in Brazil were assessed. Clinical samples were collected from patients suspected of influenza infection. In addition, sociodemographic, clinical, and epidemiological information were collected by the epidemiological surveillance teams. Influenza B lineages were determined by real-time RT-PCR and/or Sanger sequencing. In addition, putative phylogeny−trait associations were assessed by using the BaTS program after phylogenetic reconstruction by a Bayesian Markov Chain Monte Carlo method (BEAST software package). Over 2010−2020, B/Victoria and B/Yamagata-like lineages co-circulated in almost all seasonal epidemics, with B/Victoria predominance in most years. Vaccine mismatches between circulating viruses and the trivalent vaccine strains occurred in five of the eleven seasons (45.5%). No significant differences were identified in clinical presentation or disease severity caused by both strains, but subjects infected by B/Victoria-like viruses were significantly younger than their B/Yamagata-like counterparts (16.7 vs. 31.4 years, p < 0.001). This study contributes to a better understanding of the circulation patterns and clinical outcomes of B/Victoria- and B/Yamagata-like lineages in Brazil and advocate for the inclusion of a quadrivalent vaccine in the scope of the Brazilian National Immunization Program.


Assuntos
Vacinas contra Influenza , Influenza Humana , Teorema de Bayes , Brasil/epidemiologia , Humanos , Vírus da Influenza B/genética , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Filogenia
5.
Saúde debate ; 46(133): 290-303, jan.-abr. 2022. tab, graf
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1390370

RESUMO

RESUMO O Município do Rio de Janeiro (MRJ) estava entre as cidades com altas taxas de mortalidade ao longo da pandemia de Covid-19. Neste estudo, analisamos as taxas de incidência, de mortalidade e letalidade por Covid-19 nas áreas com predominância de Aglomerados Subnormais (ASN). Foram considerados todos os 36 bairros da Sub-Bacia do Canal do Cunha (SBCC) associadas às características demográficas, socioeconômicas e epidemiológicas, com estatística espacial de Moran. A taxa de incidência nos bairros da SBCC foi de 621,5/10.000 habitantes. Complexo do Alemão, Mangueira, e Maré tiveram maiores proporções de casos e mortes. A menor incidência (33,6/10.000 habitantes) e mortalidade (8,3/10.000 habitantes), mas com maior taxa de letalidade (24,7%) foi registrada no Complexo do Alemão. Foi observado correlação negativa entre a taxa de mortalidade e a proporção de habitantes nos bairros com ASN (rho= -0,433; p=0,023). Na estatística espacial, houve correlação inversa para a incidência da Covid-19 (índice Moran, -0,155863; p=0,02). Conclui-se que incidência e mortalidade nas áreas de ASN estão significativamente relacionadas com as estruturas sociodemográficas, demandando o reforço dos sistemas de vigilância e de controle da Covid-19 em territórios de favelas. As recomendações não farmacológicas e a Atenção Primária à Saúde em favelas desempenham relevante papel na redução da transmissão, mortalidade e iniquidades em saúde.


ABSTRACT Along COVID-19 pandemics, Rio de Janeiro (MRJ) has figured among the Brazilian cities with the highest mortality rates. In this study, we explored COVID-19 incidence and mortality in areas with a predominance of subnormal population clusters (SNC) in MRJ. We analyzed 36 neighborhoods of Canal do Cunha Sub-basin (CCSB) and the associations between demographic, socioeconomic, and epidemiological features, and the cumulative incidence, mortality, and lethality rates, and Moran's spatial statistics were performed. The incidence rate in CCSB neighborhoods was 621.5/10,000 inhabitants. Complexo do Alemão, Mangueira, and Maré had the highest proportions of cases and deaths. And the lowest incidence (33.6/10,000 inhabitants), mortality (8.3/10,000 inhabitants), but with the highest lethality rate (24.7%) was recorded in Complexo do Alemão. There was a negative correlation between mortality and the proportion of inhabitants in neighborhoods with ASN (rho= -0.433; p=0.023). In spatial statistics, there was an inverse correlation for the incidence (Moran index, -0.155863; p=0.02). It is concluded that incidence and mortality in SNC areas are significantly related to their sociodemographic structures, highlighting the need to strengthen the surveillance and control systems of COVID-19 in slums territories. Non-pharmacological recommendations and suitable Primary Health Care in slums areas play a relevant role in reducing viral transmission, mortality, and health inequities.

6.
Saúde debate ; 45(spe2): 82-91, dez. 2021. tab, graf
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1390340

RESUMO

RESUMO O objetivo foi avaliar a relação espacial dos indicadores de saneamento (acesso à água e ao esgoto), considerando a modelagem da concessão da Companhia Estadual de Águas e Esgotos do Rio de Janeiro (Cedae), e a sua possível relação com a incidência da Covid-19, nos bairros com e sem áreas de favelas. Os dados de casos confirmados da Covid-19 analisados foram obtidos no Painel Saúde do Rio de Janeiro. Foi considerado o fracionamento do município em quatro blocos regionais. Nos 163 bairros da cidade, a taxa de incidência média foi de 9,78 casos/1.000 hab. Os bairros com as menores taxa de incidência foram aqueles com predominância de aglomerados subnormais (favelas), baixa renda per capita e cobertura de saneamento, sugerindo maior lacuna de testagem e subnotificação de casos. Reduzir a inequidade e o racismo estrutural deveria ser prioritário. A sindemia da Covid-19 contribuiu fortemente para perdas socioeconômicas e de saúde pública significativas. Em um cenário de reconstrução, é imprescindível retomar o compromisso para com os Objetivos de Desenvolvimento Sustentável da Agenda 2030 das Nações Unidas.


ABSTRACT This assessment aimed to evaluate the putative spatial relationship between sanitation indicators (access to water and sewage) considering the Rio de Janeiro State Water and Sewage Company (CEDAE) parameters and the COVID-19 incidence among districts with and without slum areas. The data of confirmed COVID-19 cases analyzed were obtained from the Rio de Janeiro Health Panel. We considered the division of the municipality into four regional blocks. The mean COVID-19 incidence was 9.78 cases/1,000 inhabitants in the 163 city districts. The lowest COVID-19 incidence rate was most reported in slum regions, with lower per capita income and sanitation coverage, suggesting a significant gap in testing and case underreporting. Reducing inequality and structural racism should be a priority. The COVID-19 syndemic strongly contributed to significant socioeconomic and public health losses. Our commitment to the Sustainable Development Goals of the 2030 agenda of the United Nations is pivotal in a backdrop of reconstruction.

7.
Artigo em Inglês | MEDLINE | ID: mdl-33321987

RESUMO

SARS-CoV-2 is the causative agent of the current COVID-19 pandemic. Disease clinical manifestations range from asymptomatic to severe multiple organ damage. SARS-CoV-2 uses ACE2 as a cellular receptor, which is abundantly expressed in the small intestine, allowing viral replication in the gastrointestinal tract. Viral RNA has been detected in the stool of COVID-19 patients and viable viruses had been isolated in some of these samples. Thus, a putative role of SARS-CoV-2 fecal-oral transmission has been argued. SARS-CoV-2 is shed in human excreta and further disposed in the sewerage or in the environment, in poor basic sanitation settings. Wastewater-based epidemiology (WBE) is a valuable population level approach for monitoring viral pathogens and has been successfully used in different contexts. This review summarizes the current global experience on SARS-CoV-2 WBE in distinct continents and viral detection in polluted surface water. The advantages and concerns of this strategy for SARS-CoV-2 surveillance are discussed. Outcomes suggest that WBE is a valuable early warning alert and a helpful complementary surveillance tool to subside public health response, to tailor containment and mitigation measures and to determine target populations for testing. In poor sanitation settings, contaminated rivers could be alternatively used as a source for environmental surveillance.


Assuntos
COVID-19/epidemiologia , Pandemias , Vigilância Epidemiológica Baseada em Águas Residuárias , Humanos , SARS-CoV-2/isolamento & purificação , Saneamento , Águas Residuárias/virologia
8.
Emerg Microbes Infect ; 9(1): 2536-2546, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33179584

RESUMO

Due to the advanced stage of polio eradication, the possible role of non-polio enteroviruses (NPEVs) associated to acute flaccid paralysis (AFP) cases has been highlighted. In this study, we described epidemiological aspects of NPEVs infections associated to AFP and explore the viral genetic diversity, information still scarce in Brazil. From 2005 to 2017, 6707 stool samples were collected in the scope of the Brazilian Poliomyelitis Surveillance Program. NPEVs were isolated in 359 samples (5.3%) and 341 (94.9%) were genotyped. About 46 different NPEV types were identified with the following detection pattern EV-B > EV-A > EV-C. The major EV-types were CVA2, CV4, EV-A71, CVB3, CVB5, E6, E7, E11, CVA13 and EV-C99, which corresponds to 51.6% of the total. Uncommon types, such as CVA12, EV-90 and CVA11, were also identified. Different E6 genogroups were observed, prevailing the GenIII, despite periods of co-circulation, and replacement of genogroups along time. CVA2 sequences were classified as genotype C and data suggested its dispersion in South-American countries. CVA13 viruses belonged to cluster B and Venezuelan viruses composed a new putative cluster. This study provides extensive information on enterovirus diversity associated with AFP, reinforcing the need of tailoring current surveillance strategies to timely monitor emergence/re-emergence of NPEVs.


Assuntos
Viroses do Sistema Nervoso Central/virologia , Infecções por Enterovirus/epidemiologia , Enterovirus/classificação , Técnicas de Genotipagem/métodos , Mielite/virologia , Doenças Neuromusculares/virologia , Brasil/epidemiologia , Linhagem Celular , Enterovirus/genética , Enterovirus/isolamento & purificação , Fezes/virologia , Variação Genética , Genótipo , Humanos , Filogenia , Filogeografia , Vigilância da População , Venezuela
9.
Int. J. Environ. Res. Public Health ; 17(24): 1-19, Nov. 10, 2020. ilus., tab
Artigo em Inglês | SES-RS, CONASS, Coleciona SUS | ID: biblio-1140629

RESUMO

SARS-COV-2 is the causative agent of the current COVID-19 pandemic. Disease clinical manifestations range from asymptomatic to severe multiple organ damage. SARS-CoV-2 uses ACE2 as a cellular receptor, which is abundantly expressed in the small intestine, allowing viral replication in the gastrointestinal tract. Viral RNA has been detected in the stool of COVID-19 patients and viable viruses had been isolated in some of these samples. Thus, a putative role of SARS-CoV-2 fecal-oral transmission has been argued. SARS-CoV-2 is shed in human excreta and further disposed in the sewerage or in the environment, in poor basic sanitation settings. Wastewater-based epidemiology (WBE) is a valuable population level approach for monitoring viral pathogens and has been successfully used in di_erent contexts. This review summarizes the current global experience on SARS-CoV-2 WBE in distinct continents and viral detection in polluted surface water. The advantages and concerns of this strategy for SARS-CoV-2 surveillance are discussed. Outcomes suggest that WBE is a valuable early warning alert and a helpful complementary surveillance tool to subside public health response, to tailor containment and mitigation measures and to determine target populations for testing. In poor sanitation settings, contaminated rivers could be alternatively used as a source for environmental surveillance.


Assuntos
Humanos , Monitoramento Ambiental/métodos , Infecções por Coronavirus/epidemiologia , Doenças Transmitidas pela Água/epidemiologia , Vigilância Epidemiológica Baseada em Águas Residuárias , Águas Superficiais , Surtos de Doenças , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Águas Residuárias/análise , Águas Residuárias/virologia , Betacoronavirus/patogenicidade , Gastroenteropatias/virologia
10.
Infect Genet Evol ; 67: 55-59, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30389547

RESUMO

BACKGROUND: Influenza is an acute and highly contagious viral respiratory infection that causes significant morbidity and mortality. The identification of host genetic factors associated with susceptibility and severity of influenza virus infection is of paramount importance. Previous studies evaluating the potential involvement of the CCR5Δ32 polymorphism (rs333), a 32 base pair deletion in CC motif chemokine receptor 5 (CCR5) gene, in severity and mortality of influenza A(H1N1)pdm09 infected individuals have been reported, but their results are quite conflicting. OBJECTIVES: The aim of this study was the evaluation of the CCR5Δ32 frequency in individuals with mild, severe and fatal influenza A(H1N1)pdm09 infection and its putative association with clinical and epidemiologic data. PATIENTS/METHODS: A total of 432 individuals were included in this study and classified according to their clinical status, into the following groups: influenza like illness (ILI) (n = 153); severe acute respiratory infection (SARI) (n = 173) and fatal (n = 106) cases. The samples were collected in the post pandemic period, from 2012 to 2018. Individuals were further stratified according to their clinical and epidemiological data. The CCR5Δ32 variant was genotyped by PCR amplification and a subset of samples was further submitted to Sanger sequencing. RESULTS: The different clinical groups (ILI, SARI and fatal) presented similar distribution of wt/wt and wt/Δ32 genotypes and CCR5Δ32 allele frequencies. Genotype Δ32/Δ32 was not detected in our study. Additionally, no association between wt/wt and wt/Δ32 genotypes and dyspnea, a clinical factor for influenza complications was found. Similarly, no significant differences in the distribution of wt/wt and wt/Δ32 genotypes and CCR5Δ32 variant allele frequencies were observed in samples from the different Brazilian geographical regions. CONCLUSIONS: The CCR5Δ32 variant does not influence the susceptibility to influenza A(H1N1)pdm09 severe disease or mortality in individuals from Brazil.


Assuntos
Predisposição Genética para Doença , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Influenza Humana/genética , Polimorfismo Genético , Receptores CCR5/genética , Deleção de Sequência , Adulto , Alelos , Brasil/epidemiologia , Feminino , Frequência do Gene , Genótipo , Humanos , Influenza Humana/mortalidade , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Mortalidade , Vigilância em Saúde Pública , Índice de Gravidade de Doença
11.
Rev Inst Med Trop Sao Paulo ; 60: e31, 2018 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-30043935

RESUMO

The increasing use of illicit drugs imposes a public health challenge worldwide. People who inject drugs (PWID) are more susceptible to health complications due to immunosuppression associated with drug use and non-hygienic self-administration of substances, contaminants, and liquids. PWID are subjected to increased risk of acquiring and transmitting different pathogens (frequently functioning as sentinel cases for (re)emerging pathogens), including those transmitted by arthropods and vertebrate reservoirs in unhealthy environments. A clear association between injection drug use and HIV, HBV, and HCV infections has been described; however, other infectious viral and bacterial agents have been seldomly assessed. In this study, we investigated the seroprevalence of Bartonella spp., Coxiella burnetii, and Hantavirus among 300 randomly selected PWIDs from Rio de Janeiro, as part of a multi-city cross-sectional study carried out in the 1990s. Point seroprevalences and respective 95% CIs are as follows: 9.3% for C. burnetii (95% CI: 6.0%-13.0%), 1.0% for Bartonella spp. (95% CI: 0.0%-3.0%), and 4.0% for Hantavirus (95% CI: 2.0%-7.0%). In addition to the blood-borne pathogens, the results of this study increase our knowledge on other transmissible infectious agents in PWID. The high seroprevalence of C. burnetii and Hantavirus found among PWID is intriguing and suggests the need to carry out prospective studies, including molecular analyses, to confirm these findings and allow a better understanding of the putative relevance of these zoonotic infectious agents among PWID.


Assuntos
Infecções por Bartonella/epidemiologia , Infecções por Hantavirus/epidemiologia , Febre Q/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Bartonella/isolamento & purificação , Bancos de Sangue , Brasil/epidemiologia , Coxiella burnetii/isolamento & purificação , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Orthohantavírus/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estudos Soroepidemiológicos , Distribuição por Sexo , Fatores Socioeconômicos , Abuso de Substâncias por Via Intravenosa/microbiologia , Abuso de Substâncias por Via Intravenosa/virologia , Adulto Jovem
12.
An Acad Bras Cienc ; 90(2): 1279-1284, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29898095
13.
Rev Inst Med Trop Sao Paulo ; 58: 77, 2016 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-27828618

RESUMO

The aim of this retrospective study was to review all the notified cases of multidrug-resistant tuberculosis (MDR-TB) in São Paulo State (Brazil), as well as to describe and discuss the clinical, microbiological and radiologic aspects in a single reference center, within the same state, from 2000 to 2012. There were 1,097 notifications of MDR-TB in São Paulo State over this period, 70% affecting men aged on average 38 years (10-77). There was a significant fall in the MDR-TB mortality rate from 30% to 8% (2000-2003 versus 2009-2012). The same trend was observed in the cases studied at the reference center. The number of notified cases increased and death rate reduced from 37.5% (2000-2005) to 3.4% (2006-2012). Among the 48 drug-resistant TB cases, 17 non-tuberculous Mycobacteria were isolated in the sputum culture of nine patients, without any clinical significance. TB and fungus co-infection was diagnosed in 15% (7/48) of these cases: three with confirmed chronic pulmonary aspergillosis and four with positive serological markers for paracoccidioidomycosis. Overall, the reports show that MDR-TB diagnosis and cure rates have increased, while the mortality rate has decreased significantly in São Paulo State including in the studied reference center.


Assuntos
Notificação de Doenças/estatística & dados numéricos , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
14.
Arq Gastroenterol ; 53(1): 5-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27276097

RESUMO

The Brazilian Gastrointestinal Tumor Group developed guidelines for the surgical and clinical management of patients with billiary cancers. The multidisciplinary panel was composed of experts in the field of radiology, medical oncology, surgical oncology, radiotherapy, endoscopy and pathology. The panel utilized the most recent literature to develop a series of evidence-based recommendations on different treatment and diagnostic strategies for cholangiocarcinomas and gallbladder cancers.


Assuntos
Neoplasias dos Ductos Biliares/terapia , Colangiocarcinoma/terapia , Neoplasias dos Ductos Biliares/patologia , Colangiocarcinoma/patologia , Gerenciamento Clínico , Medicina Baseada em Evidências , Humanos , Estadiamento de Neoplasias , Guias de Prática Clínica como Assunto
15.
Arq. gastroenterol ; Arq. gastroenterol;53(1): 5-9, Jan.-Mar. 2016. graf
Artigo em Inglês | LILACS | ID: lil-777110

RESUMO

ABSTRACT The Brazilian Gastrointestinal Tumor Group developed guidelines for the surgical and clinical management of patients with billiary cancers. The multidisciplinary panel was composed of experts in the field of radiology, medical oncology, surgical oncology, radiotherapy, endoscopy and pathology. The panel utilized the most recent literature to develop a series of evidence-based recommendations on different treatment and diagnostic strategies for cholangiocarcinomas and gallbladder cancers.


RESUMO O Grupo Brasileiro de Tumores Gastrointestinais desenvolveu diretrizes de tratamento cirúrgico e clínico de pacientes com tumores de vias biliares. O painel multidisciplinar foi composto de especialistas nas áreas radiologia, oncologia, cirurgia, radioterapia, endoscopia e anatomia patológica. O painel utilizou literatura atual para desenvolver recomendações baseadas em evidência científica para as diferentes estratégias terapêuticas e diagnósticas dos colangiocarcinomas e tumores de vesícula biliar.


Assuntos
Humanos , Neoplasias dos Ductos Biliares/terapia , Colangiocarcinoma/terapia , Neoplasias dos Ductos Biliares/patologia , Guias de Prática Clínica como Assunto , Colangiocarcinoma/patologia , Medicina Baseada em Evidências , Gerenciamento Clínico , Estadiamento de Neoplasias
16.
Mem Inst Oswaldo Cruz ; 109(7): 912-7, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25410995

RESUMO

After the World Health Organization officially declared the end of the first pandemic of the XXI century in August 2010, the influenza A(H1N1)pdm09 virus has been disseminated in the human population. In spite of its sustained circulation, very little on phylogenetic data or oseltamivir (OST) resistance is available for the virus in equatorial regions of South America. In order to shed more light on this topic, we analysed the haemagglutinin (HA) and neuraminidase (NA) genes of influenza A(H1N1)pdm09 positive samples collected during the pandemic period in the Pernambuco (PE), a northeastern Brazilian state. Complete HA sequences were compared and amino acid changes were related to clinical outcome. In addition, the H275Y substitution in NA, associated with OST resistance, was investigated by pyrosequencing. Samples from PE were grouped in phylogenetic clades 6 and 7, being clustered together with sequences from South and Southeast Brazil. The D222N/G HA gene mutation, associated with severity, was found in one deceased patient that was pregnant. Additionally, the HA mutation K308E, which appeared in Brazil in 2010 and was only detected worldwide the following year, was identified in samples from hospitalised cases. The resistance marker H275Y was not identified in samples tested. However, broader studies are needed to establish the real frequency of resistance in this Brazilian region.


Assuntos
Hemaglutininas/genética , Vírus da Influenza A Subtipo H1N1/genética , Influenza Humana/epidemiologia , Neuraminidase/genética , Pandemias , Antivirais/uso terapêutico , Biomarcadores/análise , Brasil/epidemiologia , Farmacorresistência Viral/fisiologia , Feminino , Frequência do Gene/genética , Humanos , Vírus da Influenza A Subtipo H1N1/classificação , Vírus da Influenza A Subtipo H1N1/patogenicidade , Influenza Humana/virologia , Mutação/genética , Oseltamivir/uso terapêutico , Filogenia , Gravidez , RNA Viral/análise , Análise de Sequência de DNA/métodos , Virulência , Fatores de Virulência/genética
17.
Mem. Inst. Oswaldo Cruz ; 109(7): 912-917, 11/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-728806

RESUMO

After the World Health Organization officially declared the end of the first pandemic of the XXI century in August 2010, the influenza A(H1N1)pdm09 virus has been disseminated in the human population. In spite of its sustained circulation, very little on phylogenetic data or oseltamivir (OST) resistance is available for the virus in equatorial regions of South America. In order to shed more light on this topic, we analysed the haemagglutinin (HA) and neuraminidase (NA) genes of influenza A(H1N1)pdm09 positive samples collected during the pandemic period in the Pernambuco (PE), a northeastern Brazilian state. Complete HA sequences were compared and amino acid changes were related to clinical outcome. In addition, the H275Y substitution in NA, associated with OST resistance, was investigated by pyrosequencing. Samples from PE were grouped in phylogenetic clades 6 and 7, being clustered together with sequences from South and Southeast Brazil. The D222N/G HA gene mutation, associated with severity, was found in one deceased patient that was pregnant. Additionally, the HA mutation K308E, which appeared in Brazil in 2010 and was only detected worldwide the following year, was identified in samples from hospitalised cases. The resistance marker H275Y was not identified in samples tested. However, broader studies are needed to establish the real frequency of resistance in this Brazilian region.


Assuntos
Feminino , Humanos , Gravidez , Hemaglutininas/genética , Vírus da Influenza A Subtipo H1N1/genética , Influenza Humana/epidemiologia , Neuraminidase/genética , Pandemias , Antivirais/uso terapêutico , Biomarcadores/análise , Brasil/epidemiologia , Farmacorresistência Viral/fisiologia , Frequência do Gene/genética , Vírus da Influenza A Subtipo H1N1/classificação , Vírus da Influenza A Subtipo H1N1/patogenicidade , Influenza Humana/virologia , Mutação/genética , Oseltamivir/uso terapêutico , Filogenia , RNA Viral/análise , Análise de Sequência de DNA/métodos , Virulência , Fatores de Virulência/genética
18.
PLoS One ; 9(3): e92789, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24667815

RESUMO

The D222G substitution in the hemagglutinin (HA) gene of the pandemic influenza A(H1N1)pdm09 virus has been identified as a potential virulence marker, because this change allows for virus invasion deeper into the respiratory tract. In this study, we analyzed D, G and N polymorphisms at residue 222 by pyrosequencing (PSQ). We initially analyzed 401 samples from Brazilian patients. These were categorized with respect to clinical conditions due to influenza infection (mild, serious or fatal) and sub-stratified by risky factors. The frequency of mixed population of virus, with more than one polymorphism at residue 222, was significantly higher in serious (10.6%) and fatal (46.7%) influenza cases, whereas those who showed mild influenza infections were all infected by D222 wild-type. Mixtures of quasi-species showed a significant association of mortality, especially for those with risk factors, in special pregnant women. These results not only reinforce the association between D222G substitution and influenza A(H1N1)pdm09-associated morbidity and mortality, but also add the perspective that a worse clinical prognosis is most likely correlated with mixtures of quasi-species at this HA residue. Therefore, quasi-species may have a critical and underestimated role in influenza-related clinical outcomes.


Assuntos
Glicoproteínas de Hemaglutininação de Vírus da Influenza/genética , Vírus da Influenza A Subtipo H1N1/genética , Influenza Humana , Pandemias , Polimorfismo Genético , Complicações Infecciosas na Gravidez , Feminino , Humanos , Influenza Humana/genética , Influenza Humana/mortalidade , Masculino , Gravidez , Complicações Infecciosas na Gravidez/genética , Complicações Infecciosas na Gravidez/mortalidade , Fatores de Risco
19.
Movimento (Porto Alegre) ; 18(3): 281-298, jul.-set. 2012.
Artigo em Português | LILACS | ID: lil-698637

RESUMO

Este ensaio apresenta algumas reflexões e análises acerca das danças descritas no livro Lavoura arcaica, de Raduan Nassar e no filme LavourArcaica, de Luiz Fernando Carvalho, tendo Rudolf Laban como um dos referenciais teóricos. Percebe-se que ao estabelecer um diálogo com Nassar, Carvalho faz em seu hipertexto fílmico uma (re)leituradas danças apresentadas em Lavoura arcaica, porém, em ambos os textos, temos a representação do Dabke, uma dança típica do folclore libanês.


This study presents some reflections and analysis concerning the dances described in Lavoura arcaica, a novel by Raduan Nassar, and LavourArcaica, a movie by Luiz Fernando Carvalho, presenting Rudolf Laban as one of the theoretical references. By establishing a dialog with Nassar, Carvalho does, in his filmic hypertext, a re(reading) of the dances presented in Lavoura arcaica, although we have in both the representation of Dabke, a typical folk dance from Lebanon.


Este estudio presenta algunas reflexiones y análisis sobre las danzas que se describen en El libro Lavoura arcaica, de Raduan Nassar, y em La película LavourArcaica, de Luiz Fernando Carvalho,teniendo Rudolf Laban como uno de los referentes teóricos. Mediante el establecimiento de un diálogo com Nassar, Carvalho hace en su hipertexto unare(lectura) de las danzas presentadas en Lavoura arcaica, aunque en ambos tenemos la representación del Dabke, una danza típica del folclore libanés.


Assuntos
Livros , Dança , Literatura , Folclore
20.
Movimento (Porto Alegre) ; 17(3): 253-267, jul.-set. 2011.
Artigo em Português | LILACS | ID: lil-685096

RESUMO

Este estudo propõe ref letir e analisar a representação das danças de Ana em Lavoura arcaica, obra literária de Raduan Nassar e fílmica de Luiz Fernando Carvalho, tendo como um dos principais referenciais teóricos Rudolf Von Laban. Foi possível concluir que na ausência de expressão verbal, Ana canaliza o seu desejo de comunicação em suas danças. Em sua primeira manifestação dançante exibe marcas da tradição e em sua segunda e última dança, os sinais da ruptura.


The aim of the present study was to analyse and reflect on the representations of Ana's dances in Lavoura arcaica, literary and filmic works of Raduan Nassar e Luiz Fernando de Carvalho, respectively, using as the main theoretical reference Rudolf Von Laban. It was possible to conclude that, in the absense of verbal expression, Ana channels her desire of communication into her dances. In her first dancing manifestation, she shows marks of tradition, and in her second and last dance, the signs of rupture.


Este estudio tiene como objetivo reflexionar y analizar la representación de danzas de Ana en Lavoura arcaica, obra literarias de Raduan Nassar, y cinematográfica de Luiz Fernando Carvalho, teniendo como uno de los principales teóricos Rudolf Von Laban. Se concluyó que, en ausencia de la expresión verbal, Ana canaliza su deseo de comunicarse a través de la danza. En su primera manifestación de baile enseña rasgos de la tradición, ya en la segunda y última danza, presenta los signos de ruptura.


Assuntos
Medicina
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