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Sewage surveillance can be used as an effective complementary tool for detecting pathogens in local communities, providing insights into emerging threats and aiding in the monitoring of outbreaks. In this study using qPCR and whole genomic sewage surveillance, we detected the Mpox virus along with other viruses, in municipal and hospital wastewaters in Belo Horizonte, Brazil over a 9-month period (from July 2022 until March 2023). MPXV DNA detection rates varied in our study, with 19.6% (11 out of 56 samples) detected through the hybrid capture method of whole-genome sequencing and 20% (12 out of 60 samples) through qPCR. In hospital wastewaters, the detection rate was higher, at 40% (12 out of 30 samples) compared to 13.3% (4 out of 30 samples) in municipal wastewaters. This variation could be attributed to the relatively low number of MPXV cases reported in the city, which ranged from 106 to 341 cases during the study period, and the dilution effects, given that each of the two wastewater treatment plants (WWTP) investigated serves approximately 1.1 million inhabitants. Additionally, nine other virus families were identified in both hospitals and municipal wastewaters, including Adenoviridade, Astroviridae, Caliciviridae, Picornaviridade, Polyomaviridae, Coronaviridae (which includes SARS-CoV-2), Herspesviridae, Papillomaviridae and Flaviviridae (notably including Dengue). These findings underscore the potential of genomic sewage surveillance as a robust public health tool for monitoring a wide range of viruses circulating in both community and hospitals environments, including MPXV.
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This study addresses the State's capacity to combat the COVID-19 pandemic and contributes to the literature on crisis management in health care. We analyzed whether the capacity level impacted the State response to COVID-19 in Brazilian healthcare regions in 2020 using a set of statistical analysis techniques and public health impact analysis, including propensity score matching (PSM). Results revealed that a low COVID-19 mortality was associated with participation in municipal health consortia, schooling level of municipal health managers and the resources allocated by the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ). Conversely, the number of intensive care units (ICU) and life-sustaining equipment available were associated with higher mortality, as locations with a larger population concentrated operational capacity to treat the most severe cases. In conclusion, the different levels of State capacity in health regions led to different outcomes in combating the pandemic. This reinforces the importance of discussing State capacity and crisis management, since the COVID-19 confrontation in Brazil related to the level of existing resources concerning health system capacity, bureaucratic capacity and participation in consortia for sharing inputs and ensuring the provision of health services to the population.
Assuntos
COVID-19 , Pandemias , COVID-19/mortalidade , Humanos , Brasil/epidemiologia , SARS-CoV-2 , Acessibilidade aos Serviços de Saúde , Atenção à Saúde , Programas Nacionais de Saúde , Pontuação de Propensão , Unidades de Terapia Intensiva/estatística & dados numéricosRESUMO
Indoor house dust is considered an important human exposure route to polybrominated diphenyl ethers (PBDEs), which has raised concern about their environmental persistence and toxicity properties. In this study, eight PBDEs (BDE-28, -47, -99, -100, -153, -154, -183, and -209) were determined in house dust from two cities with different socio-demographic characteristics from Brazil, examining possible relationships with factors that potentially influence contamination (population density, economic activities, presence of electronic equipment, and so on) and also estimating the risk of human exposure through oral ingestion and dermal contact. The Σ8PBDE concentration in Sorocaba city ranged between 380 and 4269 ng/g dw, while in Itapetininga city ranged from 106 to 1000 ng/g dw. In both regions, BDE-209 was the most abundantly found congener, followed by BDE-99. House dust from Sorocaba presented significantly greater concentrations of BDE-183 and BDE-209 than Itapetininga. Regarding risk exposure assessment, the estimated daily intake (EDI) of PBDEs was much lower than their respective reference doses (RfDs) in all pathways estimated (non-dietary ingestion and dermal contact). This study provided valuable data to improve the knowledge about the presence and exposure to PBDEs in Brazilian house dust in comparison to other developing countries and the need to control environmental pollution and protect human health.
Assuntos
Poluição do Ar em Ambientes Fechados , Poeira , Exposição Ambiental , Éteres Difenil Halogenados , Brasil , Éteres Difenil Halogenados/análise , Humanos , Poeira/análise , Poluição do Ar em Ambientes Fechados/análise , Monitoramento AmbientalRESUMO
BACKGROUND: Curative treatment for gastric cancer involves tumor resection, followed by transit reconstruction, with Roux-en-Y being the main technique employed. To permit food transit to the duodenum, which is absent in Roux-en-Y, double transit reconstruction has been used, whose theoretical advantages seem to surpass the previous technique. AIMS: To compare the clinical evolution of gastric cancer patients who underwent total gastrectomy with Roux-en-Y and double tract reconstruction. METHODS: A systematic review was carried out on Web of Science, Scopus, EmbasE, SciELO, Virtual Health Library, PubMed, Cochrane, and Google Scholar databases. Data were collected until June 11, 2022. Observational studies or clinical trials evaluating patients submitted to double tract (DT) and Roux-en-Y (RY) reconstructions were included. There was no temporal or language restriction. Review articles, case reports, case series, and incomplete texts were excluded. The risk of bias was calculated using the Cochrane tool designed for randomized clinical trials. RESULTS: Four studies of good methodological quality were included, encompassing 209 participants. In the RY group, there was a greater reduction in food intake. In the DT group, the decrease in body mass index was less pronounced compared to preoperative values. CONCLUSIONS: The double tract reconstruction had better outcomes concerning body mass index and the time until starting a light diet; however, it did not present any advantages in relation to nutritional deficits, quality of life, and post-surgical complications.
Assuntos
Anastomose em-Y de Roux , Gastrectomia , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirurgia , Gastrectomia/métodos , Anastomose em-Y de Roux/métodos , Trânsito Gastrointestinal/fisiologia , Procedimentos de Cirurgia Plástica/métodosRESUMO
Fungal infections are a public health problem that mainly affects immunosuppressed people, Candida spp. have been responsible for most sources of contamination and invasive fungal infections described around the world. The need arises to find new therapeutic approaches to combat growing infections. Plants and natural products have been considered a valuable source for discovering new molecules with active ingredients. Diosgenin is a sapogenin found in the families of Leguminosae and Dioscoreaceae, it is obtained mainly from the dioscin saponin through the hydrolysis method, it is a phytochemical that has been highlighted in the treatment of various diseases, as well as in combating microbial resistance. The present study aimed to evaluate the susceptibility of fungal strains to diosgenin, as well as verify the association with the reference drug and evaluate the inhibition of the virulence factor through morphological changes in the yeast state to the filamentous form of hyphae and pseudohyphae in strains of Candida albicans, Candida tropicalis and Candida krusei using the broth microdilution method and microculture technique. Antifungal assays revealed that diosgenin was not able to inhibit the growth of the tested strains. However, it was able to inhibit the fungal dimorphism of the strains evaluated, however further studies are recommended to verify its effectiveness against other virulence factors.
Assuntos
Antifúngicos , Candida , Diosgenina , Testes de Sensibilidade Microbiana , Diosgenina/farmacologia , Diosgenina/química , Diosgenina/análogos & derivados , Antifúngicos/farmacologia , Antifúngicos/química , Candida/efeitos dos fármacos , Virulência/efeitos dos fármacos , Candida albicans/efeitos dos fármacos , Candida albicans/patogenicidadeRESUMO
The combination of sewage anaerobic treatment and partial nitritation/anammox process (PN/A) can make wastewater treatment plants energetically self-sufficient. However, PN/A application has been a challenge in low-nitrogen wastewaters and it is little explored in anaerobically pretreated domestic sewage, as well as aeration strategies and the PN/A feasibility at ambient temperature. This study investigated PN/A in a sequential batch reactor (SBR) treating real anaerobically pretreated domestic sewage. After the startup, SBR was fed with real wastewater and operated at 35°C and at ambient temperature (20-31°C) without total nitrogen (TN) removal decrease (71 ± 8 and 75 ± 6%, respectively). The median ammonium and TN removals were 68 ± 21 and 59 ± 9%, respectively with 7 min on/14 min off strategy, which represents 12.3 ± 4.2â mgâ L-1 N-NH4+ effluent, which is lower than Brazilian discharge limits. The qPCR results showed anammox abundance in the range of 108-109 n° copiesâ gVSS-1. Thus, results were very promising and showed the feasibility of the PN/A process for treating real anaerobically pretreated domestic sewage at ambient temperature.
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Abstract: This study addresses the State's capacity to combat the COVID-19 pandemic and contributes to the literature on crisis management in health care. We analyzed whether the capacity level impacted the State response to COVID-19 in Brazilian healthcare regions in 2020 using a set of statistical analysis techniques and public health impact analysis, including propensity score matching (PSM). Results revealed that a low COVID-19 mortality was associated with participation in municipal health consortia, schooling level of municipal health managers and the resources allocated by the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ). Conversely, the number of intensive care units (ICU) and life-sustaining equipment available were associated with higher mortality, as locations with a larger population concentrated operational capacity to treat the most severe cases. In conclusion, the different levels of State capacity in health regions led to different outcomes in combating the pandemic. This reinforces the importance of discussing State capacity and crisis management, since the COVID-19 confrontation in Brazil related to the level of existing resources concerning health system capacity, bureaucratic capacity and participation in consortia for sharing inputs and ensuring the provision of health services to the population.
Resumo: Este estudo aborda a capacidade do Estado em lidar com a pandemia da COVID-19, bem como contribuir com a literatura sobre gestão de crises no setor da saúde. Analisamos se o nível de capacidade do Estado teve impacto na resposta à COVID-19 nas regiões de saúde brasileiras em 2020. O estudo utiliza um conjunto de técnicas de análise estatística e análise de impacto na saúde pública, incluindo o método de pareamento por escore de propensão (PSM). Os achados revelaram que o menor número de óbitos por COVID-19 esteve associado à participação em consórcios intermunicipais de saúde, ao nível de escolaridade dos gestores municipais de saúde e aos recursos repassados por meio do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ). Por outro lado, o número de unidades de terapia intensiva (UTI) e de equipamentos para manutenção da vida associou-se a um maior número de óbitos, uma vez que locais populacionais maiores concentraram capacidade operacional para atender os casos mais graves. Conclui-se, portanto, que os diferentes níveis de capacitação implementados pelo Estado nas regiões de saúde brasileiras levaram a resultados distintos no enfrentamento da pandemia. Isso reforça a importância da discussão sobre a capacitação implementada pelo Estado e a gestão de crises, destacando que o resultado do enfrentamento da COVID-19 no Brasil esteve relacionado ao nível de recursos existentes, principalmente em termos de capacidade do sistema de saúde, capacidade burocrática e associação em consórcios para compartilhar insumos e garantir a prestação de serviços de saúde à população.
Resumen: Este estudio aborda la capacidad del Estado para hacer frente a la pandemia del COVID-19 y busca contribuir a la literatura sobre gestión de crisis en el sector salud. Se analizó si el nivel de capacidad del Estado tuvo un impacto en la respuesta al COVID-19 en las regiones sanitarias brasileñas en 2020. Este estudio utilizó un conjunto de técnicas de análisis estadísticos y análisis de impacto en la salud pública, incluido el método de pareamiento por puntaje de propensión (PSM). Los hallazgos muestran que el menor número de muertes por el COVID-19 se asoció con la participación en consorcios intermunicipales de salud, el nivel de educación de los gestores municipales de salud y los recursos transferidos por el Programa Nacional de Mejoría y Acceso de la Calidad de la Atención Básica (PMAQ). Por otro lado, la cantidad de unidades de cuidados intensivos (UCI) y de equipos de soporte vital estuvo asociada a un mayor número de muertes, ya que los lugares con mayor población concentraron la capacidad operativa para tratar los casos más graves. Se concluye que los diferentes niveles de capacitación implementados por el Estado en las regiones sanitarias brasileñas llevaron a diferentes resultados para hacer frente a la pandemia. Esto refuerza la importancia de la discusión sobre la capacitación implementada por el Estado y la gestión de crisis, destacando que la respuesta al COVID-19 en Brasil estuvo relacionada con el nivel de recursos existentes, especialmente con relación a la capacidad del sistema de salud, la capacidad burocrática y la asociación en consorcios para compartir insumos y garantizar la prestación de servicios sanitarios a la población.
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ABSTRACT BACKGROUND: Curative treatment for gastric cancer involves tumor resection, followed by transit reconstruction, with Roux-en-Y being the main technique employed. To permit food transit to the duodenum, which is absent in Roux-en-Y, double transit reconstruction has been used, whose theoretical advantages seem to surpass the previous technique. AIMS: To compare the clinical evolution of gastric cancer patients who underwent total gastrectomy with Roux-en-Y and double tract reconstruction. METHODS: A systematic review was carried out on Web of Science, Scopus, EmbasE, SciELO, Virtual Health Library, PubMed, Cochrane, and Google Scholar databases. Data were collected until June 11, 2022. Observational studies or clinical trials evaluating patients submitted to double tract (DT) and Roux-en-Y (RY) reconstructions were included. There was no temporal or language restriction. Review articles, case reports, case series, and incomplete texts were excluded. The risk of bias was calculated using the Cochrane tool designed for randomized clinical trials. RESULTS: Four studies of good methodological quality were included, encompassing 209 participants. In the RY group, there was a greater reduction in food intake. In the DT group, the decrease in body mass index was less pronounced compared to preoperative values. CONCLUSIONS: The double tract reconstruction had better outcomes concerning body mass index and the time until starting a light diet; however, it did not present any advantages in relation to nutritional deficits, quality of life, and post-surgical complications.
RESUMO RACIONAL: O tratamento curativo do câncer gástrico envolve a ressecção do tumor, seguida de reconstrução do trânsito, sendo o Y-de-Roux a principal técnica empregada. Para permitir o trânsito alimentar para o duodeno, ausente em Y-de-Roux, tem-se utilizado a reconstrução de duplo trânsito, cujas vantagens teóricas parecem superar a técnica anterior. OBJETIVOS: Comparar a evolução clínica de pacientes com câncer gástrico submetidos à gastrectomia total com Y-de-Roux e reconstrução de duplo trânsito. MÉTODOS: Foi realizada uma revisão sistemática nas bases de dados: Web of Science, Scopus, Embase, Scielo, Biblioteca Virtual em Saúde, PubMed e Cochrane. Os dados foram coletados até 11 de junho de 2022. Foram incluídos estudos observacionais ou ensaios clínicos avaliando pacientes que utilizaram reconstruções de duplo trânsito (DT) e Y-de-Roux (RY). Não houve restrição temporal ou de idioma. Foram excluídos artigos de revisão, relatos de casos, séries de casos e aqueles com texto incompleto. O risco de viés foi calculado utilizando a ferramenta Cochrane desenvolvida para ensaios clínicos randomizados. RESULTADOS: Foram incluídos quatro estudos de boa qualidade metodológica, abrangendo 209 participantes. No grupo RY houve maior redução na ingestão alimentar. No grupo DT, a diminuição do índice de massa corporal (IMC) foi menos pronunciada em comparação aos valores pré-operatórios. CONCLUSÕES: A reconstrução de duplo trânsito apresentou melhores resultados em relação ao índice de massa corporal e ao tempo para início de dieta leve, porém não apresentou vantagens em relação aos déficits nutricionais, qualidade de vida e complicações pós-cirúrgicas.
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RESUMO Objetivo: Descrever e explorar, sob a perspectiva de gestores e profissionais de saúde, o cuidado ofertado ao adolescente com obesidade no âmbito da Atenção Primária à Saúde. Método: Estudo de caso, realizado em município do estado do Ceará-Brasil. A coleta de dados ocorreu em 2022, por meio de entrevistas semiestruturadas. Os dados foram examinados através da Análise de conteúdo de Bardin. Resultados: O cuidado ao adolescente com obesidade é fragmentado, cada profissional atua conforme decisão própria, pois o município não utiliza protocolos que subsidiem a prática assistencial. Foram elencadas potencialidades para o cuidado, sendo a principal a equipe multiprofissional. Quanto às dificuldades, destacou-se a procura do serviço de saúde pelo adolescente. Conclusão: Faz-se necessária uma (re)organização do modelo de atenção ao adolescente com obesidade no município. Além disso, o estudo ressalta a necessidade de maior atenção a obesidade na adolescência e provoca reflexões acerca do cuidado dispensado a este adolescente.
ABSTRACT Objective: Describe and explore, from the perspective of managers and health professionals, the care offered to adolescents with obesity in the context of Primary Health Care. Method: A case study conducted in a municipality in the state of Ceará-Brazil. Data collection took place in 2022 through semi-structured interviews. The data were examined using Bardin Content Analysis. Results: The care of obese adolescents is fragmented, and each professional acts according to their own decision, as the municipality does not use protocols that subsidize the practice of care. Potentials for care were listed, the main one being the multidisciplinary team. Regarding the difficulties, the adolescent's demand for health services was highlighted. Conclusion: It is necessary to (re) organize the care model for obese adolescents in the municipality. In addition, the study highlights the need for greater attention to adolescent obesity and causes reflections on the care provided to this adolescent.
RESUMEN Objetivo: Describir y explorar, desde la perspectiva de los gestores y profesionales sanitarios, la atención ofrecida a los adolescentes con obesidad en el ámbito de la Atención Primaria de Salud. Método: Estudio de caso, realizado en un municipio del estado de Ceará-Brasil. Los datos se recogieron en 2022 mediante entrevistas semiestructuradas. Los datos se analizaron mediante el análisis de contenido de Bardin. Resultados: La atención a los adolescentes con obesidad está fragmentada, y cada profesional actúa según su propia decisión, ya que el municipio no utiliza protocolos para subvencionar la práctica asistencial. Se enumeraron las potencialidades asistenciales, siendo la principal el equipo multiprofesional. En cuanto a las dificultades, se destaca la búsqueda del servicio sanitario por parte del adolescente. Conclusión: Es necesario (re)organizar el modelo de atención a los adolescentes con obesidad en el municipio. Además, el estudio pone de manifiesto la necesidad de prestar más atención a la obesidad en la adolescencia y suscita reflexiones sobre la atención prestada a este adolescente.
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As a result of human activities and natural dispersal, exotic species can be brought to new areas, where they become established and spread, becoming invaders. These species are responsible for the loss of biodiversity and cause ecosystemic harm throughout the world. In this paper, we report the rapid, broad geographic expansion of the invasive fly Drosophila nasuta in Brazil. An 84% increase was found in its area of occupation in the country compared to previous studies. The present data reveal its arrival to the Pantanal wetlands in a location more than one thousand kilometers from the closest previous record in the Cerrado biome. We present the first record of D. nasuta in the Atlantic Forest in the states of Paraíba and Bahia. We report its introduction in the Amazon Forest in the state of Amazonas approximately 700 kilometers from previous records. The relative abundance of D. nasuta in this biome increased fivefold in comparison to a previous study. In the first decade of invasion in Brazil, D. nasuta has already colonized more than half of the country. The present data reveal its invasive potential and underscore the importance of following up the possible negative effects of this biological invasion.