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The aims of this study were to carry out a serological survey of canine leishmaniasis and identify the phlebotomine fauna in the urban area of Bonito, Mato Grosso do Sul. The serological survey was conducted on a sample of 303 dogs, by means of the indirect immunofluorescence test. Phlebotomines were captured using automated light traps. The serological survey found that 30% of the dogs were seropositive, both from the center and from all districts of the town. A total of 2,772 specimens of phlebotomines were caught and the species most found was Lutzomyia longipalpis (90.4%), which corroborated its role as the vector of for canine visceral leishmaniasis in the region. Phlebotomines of the species Bichromomyia flaviscutellata (the main vector for Leishmania (Leishmania) amazonensis) and Nyssomyia whitmani (the vector for Leishmania (Viannia) brasiliensis) were also caught. The findings indicate the need for continuous epidemiological surveillance, with attention towards diminishing the vector breeding sites and the transmission of these diseases in that region.

BackgroundMato Grosso do Sul has been undergoing a process of urbanization which results in loss of native vegetation. This withdrawal makes vectors of man and domestic animals closer, causing changes in the epidemiology of diseases such as American Visceral Leishmaniasis. The aim of the study was to evaluate the phlebotomine fauna and environmental issues related to the transmission of AVL in Ponta Porã, Mato Grosso do Sul, between 2009 and 2010.MethodsVegetation of the urban area was evaluated by Normalized Difference Vegetation Index (NDVI), Normalized Difference Water Index (NDWI) and Soil Adjusted Vegetation Index (SAVI).ResultsThe results showed that the phlebotomine fauna of the city consists of five species, especially Lutzomyia longipalpis (Lutz and Neiva, 1912), the vector of Leishmania (Leishmania) infantum. Predominance of males was observed. The insects were captured in greater quantity in the intradomicile. Lu. longipalpis was the most frequent and abundant species, present throughout the year, with a peak population after the rainy season. Vectors can be found in high amounts in forest and disturbed environments.ConclusionsThe finding of Lu. longipalpis in regions with little vegetation and humidity suggests that the species is adapted to different sorts of environmental conditions, demonstrating its close association with man and the environment it inhabits. The tourist feature of Ponta Porã reinforces its epidemiological importance as a vulnerable city. The geographical location, bordering Paraguay through dry border, makes possible the existence of a corridor of vectors and infected dogs between the two countries.

Background and aims Capsule endoscopy is a central element in the management of patients with suspected or known Crohn’s disease. In 2017, PillCam™ Crohn’s Capsule was introduced and demonstrated greater accuracy in the evaluation of extension of disease in these patients. Artificial Intelligence is expected to enhance the diagnostic accuracy of capsule endoscopy. This study aims to develop an AI algorithm for the automatic detection of ulcers and erosions of the small intestine and colon in PillCam™ Crohn’s Capsule images. Methods A total of 8085 PillCam™ Crohn’s Capsule images were extracted between 2017-2020, constituted by 2855 images of ulcers and 1975 erosions; the remaining images showed normal enteric and colonic mucosa. This pool of images was subsequently split into training and validation datasets. The performance of the network was subsequently assessed in an independent test set. Results The model had an overall sensitivity and specificity of 90.0% and 96.0%, respectively. The precision and accuracy of this model were 97.1% and 92.4%, respectively. Particularly, the algorithm detected ulcers with a sensitivity of 83% and specificity of 98%, and erosions with sensitivity and specificity of 91% and 93%, respectively. Conclusion A deep learning model capable of automatically detecting ulcers and erosions in PillCam™ Crohn’s Capsule images was developed for the first time. These findings pave the way for the development of automatic systems for detection of clinically significant lesions, optimizing diagnostic performance and efficiency of monitoring Crohn’s disease activity.

ObjectiveCapsule endoscopy (CE) is pivotal for evaluation of small bowel disease. Obscure gastrointestinal bleeding most often originates from the small bowel. CE frequently identifies a wide range of lesions with different bleeding potentials in these patients. However, reading CE examinations is a time-consuming task. Convolutional neural networks (CNNs) are highly efficient artificial intelligence tools for image analysis. This study aims to develop a CNN-based model for identification and differentiation of multiple small bowel lesions with distinct haemorrhagic potential using CE images.DesignWe developed, trained, and validated a denary CNN based on CE images. Each frame was labelled according to the type of lesion (lymphangiectasia, xanthomas, ulcers, erosions, vascular lesions, protruding lesions, and blood). The haemorrhagic potential was assessed by Saurin’s classification. The entire dataset was divided into training and validation sets. The performance of the CNN was measured by the area under the receiving operating characteristic curve, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).ResultsA total of 53 555 CE images were included. The model had an overall accuracy of 99%, a sensitivity of 88%, a specificity of 99%, a PPV of 87%, and an NPV of 99% for detection of multiple small bowel abnormalities and respective classification of bleeding potential.ConclusionWe developed and tested a CNN-based model for automatic detection of multiple types of small bowel lesions and classification of the respective bleeding potential. This system may improve the diagnostic yield of CE for these lesions and overall CE efficiency.

RESUMO: Este estudo de caráter descritivo objetivou identificar os fatores envolvidos nas reinternações dos portadores de esquizofrenia de um hospital psiquiátrico em uma capital brasileira. Os sujeitos da pesquisa foram portadores de esquizofrenia com histórico de três ou mais internações na instituição, no período de um ano. Dados secundários foram coletados com pesquisa documental e os dados primários com entrevistas com os responsáveis pelos pacientes. Como fatores relacionados às reinternações estão a não-continuidade do cuidado ao portador de esquizofrenia na rede de atenção substitutiva, após a alta hospitalar, a baixa condição socioeconômica dos pacientes e familiares, as dificuldade dos familiares em lidar e conviver com os adoecidos, a não-adesão ao tratamento medicamentoso, e a gravidade da doença. Conclui-se que são necessárias estratégias para a corresponsabilização da família no acompanhamento ao paciente, assim como melhor assistência das instituições complementares ao tratamento hospitalar, possibilitando redução nas reinternações. PALAVRAS-CHAVE: Esquizofrenia; Serviços de saúde mental; Readmissão do paciente. FACTORS RELATED WITH READMISSIONS OF SCHIZOPHRENIC PATIENTSABSTRACT: This descriptive study aimed to identify factors involved in readmissions of schizophrenic patients in a psychiatric hospital in a Brazilian capital. The research subjects were schizophrenic patients with a history of three or more admissions in the institution within one year. Secondary data were collected through documentary research and primary data through interviews with parents or caregivers. As readmissions-related factors are: the discontinuance of care for patients with schizophrenia in the care network replacement after hospital discharge, low socioeconomic status of patients and families, the difficulty of families to cope and live with the ill, non-compliance to drug therapy and disease severity. It was concluded that strategies are needed for the joint responsibility of the family in monitoring the patient, as well as a better care performed by the complementary institutions after hospital treatment, enabling a reduction in readmissions. KEYWORDS: Schizophrenia; Mental health services; Patient readmission. FACTORES RELACIONADOS CON LAS REINTERNACIONES DE PORTADORES DE ESQUIZOFRENIARESUMEN: Este estudio de carácter descriptivo objetivó identificar los factores envueltos en las reinternaciones de los portadores de esquizofrenia de un hospital psiquiátrico en una capital brasileira. Los sujetos de la investigación fueron portadores de esquizofrenia con histórico de tres o más internaciones en la institución, en el período de un año. Datos secundarios fueron recogidos con investigación documental y los datos primarios con entrevistas con los responsables por los pacientes. Como factores relacionados a las reinternaciones están la no-continuidad del cuidado al portador de esquizofrenia en la red de atención substitutiva, después del alta hospitalario, la baja condición socioeconómica de los pacientes y familiares,...

Background: Endoscopic submucosal dissection (ESD) is usually associated with hospital admission. Objectives: To evaluate, prospectively, the feasibility, safety and efficacy of outpatient gastrointestinal ESD. Methods: Patients with suitable lesions were invited to participate. Those that dwelt more than 1 hour from the hospital, lived alone, had severe co-morbidities, were <18 years old, had duodenal lesions, or that had ESD-related complications were admitted. The remaining patients were discharged if no complications were detected. A patients' inquiry was performed.Results: Of the 164 ESD patients, 122 were outpatient-based, corresponding to 115 patients, 47% male and mean age 63 AE 12 years-old. Outpatients tended to be younger, female, to have gastric lesions, less advanced lesions, and shorter and less complicated ESDs (all p < 0.05). Outpatients' mean tumour size was 38 mm, en bloc and R0 resection rates were 88 and 78%, respectively. Seven ESD outpatients (5.7%) had complications: delayed bleeding (n ¼ 4), pneumonitis (n ¼ 2) or emphysema (n ¼ 1), all managed conservatively. Colorectal location of the lesions was predictive of hospital admission (p ¼ 0.03). In total, 97% of patients were satisfied with the outpatient strategy. Conclusion: Risks of ambulatory ESD are low and complications can be successfully managed. This strategy has high patient satisfaction. More studies are needed to evaluate its implications on costs and patients' management.

No final de 2019, em Wuhan, na China, foi identificado o surgimento de um novo vírus, denominado coronavírus de síndrome respiratória aguda grave 2 (SARS-CoV-2, do inglês Severe acute respiratory syndrome-associated coronavirus 2), causador da COVID-19, uma doença infectocontagiosa. As caraterísticas clínicas dos pacientes com essa doença são bastante variáveis, podendo apresentar-se de forma leve, grave e até mesmo fatal. Ainda que não haja grandes incidências na pediatria, uma nova apresentação, responsável por acometer crianças e adolescentes e que pode ter uma associação causal ao SARS-CoV-2, foi denominada como síndrome inflamatória multissistêmica pediátrica (SIM-P). Tal condição remete a um acometimento grave de crianças e que necessitam de intervenção hospitalar devido a quadro inflamatório intenso, associado à febre persistente, que pode levar à choque e falência de múltiplos órgãos. Tem-se como objetivo identificar a associação entre SIM-P e COVID-19 e suas principais manifestações clinicas, através de uma revisão sistemática de literatura em diferentes regiões brasileiras, de forma a colaborar na abordagem médica e no conhecimento científico a respeito da SIM-P, auxiliando na otimização do seu diagnóstico e tratamento, uma vez que, os dados sobre a temática ainda são escassos. Este trabalho consiste em uma revisão sistemática de literatura, de caráter quantitativo e descritivo, na qual foram utilizados como bases de dados a Scientific Electronic Library Online (SciELO), U.S. National Library of Medicine (PubMed) e Biblioteca Virtual em Saúde (BVS), usando palavras-chave presentes nos Descritores em Ciências da Saúde (DeCS).