Background Although infection with Trypanosoma cruzi is thought to be lifelong, less than half of those infected develop cardiomyopathy, suggesting greater parasite control or even clearance. Antibody levels appear to correlate with T. cruzi (antigen) load. We test the association between a downwards antibody trajectory, PCR positivity and ECG alterations in untreated individuals with Chagas disease. Methodology/Principal findings This is a retrospective cohort of T. cruzi seropositive blood donors. Paired blood samples (index donation and follow-up) were tested using the VITROS Immunodiagnostic Products Anti-T.cruzi (Chagas) assay (Ortho Clinical Diagnostics, Raritan NJ) and PCR performed on the follow-up sample. A 12-lead resting ECG was performed. Significant antibody decline was defined as a reduction of > 1 signal-to-cutoff (S/CO) unit on the VITROS assay. Follow-up S/CO of < 4 was defined as borderline/low. 276 untreated seropositive blood donors were included. The median (IQR) follow-up was 12.7 years (8.5–16.9). 56 (22.1%) subjects had a significant antibody decline and 35 (12.7%) had a low/borderline follow-up result. PCR positivity was lower in the falling (26.8% vs 52.8%, p = 0.001) and low/borderline (17.1% vs 51.9%, p < 0.001) antibody groups, as was the rate of ECG abnormalities. Falling and low/borderline antibody groups were predominantly composed of individuals with negative PCR and normal ECG findings: 64% and 71%, respectively. Conclusions/Significance Low and falling antibody levels define a phenotype of possible spontaneous parasite clearance.
Previous phylogenetic analyses indicated that the ZIKV epidemic was caused by the introduction of a single Asian genotype lineage into the Americas around late 2013, at least one year before its detection there 4 . An estimated 100 million people in the Americas are predicted to be at risk of acquiring ZIKV once the epidemic has reached its full extent 5 . However, little is known about the genetic diversity and transmission history of the virus in different regions in Brazil 6 . Reconstructing ZIKV spread from case reports alone is challenging because symptoms (typically fever, headache, joint pain, rashes, and conjunctivitis) overlap with those caused by co-circulating arthropod-borne viruses 7 and due to a lack of nationwide ZIKV-specific surveillance in Brazil before 2016. [Figure 1 around here]To address this we undertook a collaborative investigation of ZIKV molecular epidemiology in Brazil, including results from a mobile genomics laboratory that travelled through NE Brazil during June 2016 (the ZiBRA project; http://www.zibraproject.org). Of five regions of Brazil (Fig. 1a), the Northeast region (NE Brazil) has the most notified ZIKV cases (40% of Brazilian cases) and the most confirmed microcephaly cases (76% of Brazilian cases, to 31 Dec 2016 2 ), raising questions about why the region has been so severely affected 8 . Further, NE Brazil is the most populous region of Brazil with the potential for year-round ZIKV transmission 9 . With the support of the Brazilian Ministry of Health and other institutions (Acknowledgements), the ZiBRA lab screened 1330 samples (almost exclusively serum or blood) from patients residing in 82 municipalities across five federal states in NE Brazil ( Fig. 1 On average, ZIKV viremia persists for 10 days after infection; symptoms develop ~6 days after infection and can last 1-2 weeks 10 . In line with previous observations in Colombia 11 , we found that the RT-qPCR+ samples in NE Brazil were, on average, collected only two days after onset of symptoms. The median RT-qPCR cycle threshold (Ct) value of positive samples was correspondingly high, at 36 (Extended Data Fig. 1). For NE Brazil, the time series of RT-qPCR+ cases was positively correlated with the number of weekly-notified cases (Pearson's ρ=0.62; Fig. 1b).The ability of the mosquito vector Aedes aegypti to transmit ZIKV is determined by ecological factors that affect adult survival, viral replication, and infective periods 12 .To investigate the receptivity of each Brazilian region to ZIKV transmission, we used a measure of vector climatic suitability derived from monthly temperature, relative humidity, and precipitation data 9 . Using linear regression we find that, for each Brazilian region, there is a strong association between estimated climatic suitability and weekly notified cases (Figs. 1b,1c; adjusted R 2 >0.84, P<0.001; Extended Data Table 2). Similar to previous findings obtained for dengue virus outbreaks 13,14 , notified ZIKV cases lag climatic suitability by ~4 to 6 weeks in all regions, except NE Brazil,...
Mobile phones (MPs) have become an important work tool around the world including in hospitals. We evaluated whether SARS-CoV-2 can remain on the surface of MPs of first-line healthcare workers (HCW) and also the knowledge of HCWs about SARS-CoV-2 cross-transmission and conceptions on the virus survival on the MPs of HCWs. A cross-sectional study was conducted in the COVID-19 Intensive Care Unit of a teaching hospital. An educational campaign was carried out on cross-transmission of SARS-CoV-2, and its permanence in fomites, in addition to the proper use and disinfection of MPs. Herewith an electronic questionnaire was applied including queried conceptions about hand hygiene and care with MP before and after the pandemic. The MPs were swabbed with a nylon FLOQ Swab ™ , in an attempt to increase the recovery of SARS-CoV-2. All MP swab samples were subjected to SARS-CoV-2 RT-PCR; RT-PCR positive samples were subjected to viral culture in Vero cells (ATCC ® CCL-81™). Fifty-one MPs were swabbed and a questionnaire on hand hygiene and the use and disinfection of MP was applied after an educational campaign. Most HCWs increased adherence to hand hygiene and MP disinfection during the pandemic. Fifty-one MP swabs were collected and two were positive by RT-PCR (4%), with Cycle threshold (C t ) values of 34-36, however, the cultures of these samples were negative. Although most HCWs believed in the importance of cross-transmission and increased adherence to hand hygiene and disinfection of MP during the pandemic, SARS-CoV-2 RNA was detected in MPs. Our results suggest the need for a universal policy in infection control guidelines on how to care for electronic devices in hospital settings.
SARS-CoV-2 cross-transmission has become an concern in hospitals. We investigate healthcare workers(HCWs) knowledge about SARS-CoV-2 cross-transmission and conceptions whether the virus can remain on HCWs mobile phones(MPs) and be part of the chain of transmission. A cross-sectional study was conducted at a COVID-19 Intensive Care Unit of a teaching-hospital. Fifty-one MPs were swabbed and a questionnaire about hand hygiene and MP use and disinfection was applied after an educational campaign. Although most of HCWs believed on the importance of cross-transmission and increased hand hygiene adhesion and MP disinfection during the pandemic, SARS-CoV-2 RNA was detected in two MPs(culture of the samples was negative). Implementation of official hospital policies to guide HCWs regarding disinfection and care of personal MP are needed.
Background TUI (Targeted Ultrasound Initiative) and TURA (Targeted Ultrasound Rheumatoid Arthritis), have been proposed as additional tools for managing and improving outcomes in rheumatoid arthritis (RA) (1), with the main objectives: education, research and training (2) Objectives To evaluate the role of Targeted Ultrasound Initiative in the management of RA in Peru. Methods With TUI TURA format has been developed in a training to 5 rheumatologists, with practices in 16 sessions, after 30 consecutive patients with a diagnosis of RA (ACR / EULAR, 2010), 12 with undifferentiated polyarthritis and 20 controls, all three regions of the country, who agreed to participate in the study, TUI TURA was applied for a period of six months (June to December 2012). The examinations were performed in 8 regions (shoulders, elbows, wrists, hands, knees, ankles and feet), performed with ultrasound Esaote, My Lab 25 Gold, with 10-18 MHz linear transducer, grayscale and power Doppler. Correlated with the DAS 28, HAQ, FR / AACP, clinical evaluation and radiographic study. With the results, the treatment decision was taken in each case and were followed quarterly AR in 15 cases. Results 4 rheumatologists, after a period of four months, managed learning and optimal capacity for directed ultrasound leaf verified by the tutor and teacher evaluation to external (ultrasound group PANLAR/ EULAR). Average characteristics (intervals) of RA patients were age (years) 48 (18-61), disease duration (years): 3.5 (0.5 -14), DAS28 3.8 (1.2 - 5.8)) and HAQ: 2.6 (0.9 to 5.6). Of these, 68% had FR and 71% Positive AACP. In 25 of 30 patients with RA synovitis was observed in the study areas. 8 of 12 patients with undifferentiated polyarthritis were finally classified as AR, all early stage. In 6 of the 20 controls showed mild synovitis in the wrists, no clinical translation. In 78% of cases RA synovitis was observed (90%), tendinitis (33%) and / or bone erosion (56%), and 83% had Doppler signal power in at least one joint. In 60% of cases of RA, demonstrates aggressive and joint deterioration despite treatment with MTX, low doses of steroids and NSAIDs. In 18 patients was modified or added another DMARDS and 7 were selected to scale to biological therapy. Of the 15 patients, follow-up, 7 achieved partial remission and 8 are active. Conclusions Following the proposal of TUI TURA can musculoskeletal ultrasound and joints, helps to clarify the diagnosis, especially in early stage disease, inflammation of the joints and tendons document, evaluate the aggressiveness and / or forecast illness, injury documentation damage (erosions and tendon rupture), directed by therapeutic decisions and monitor remission or failure to obtain the objectives, which can be filtered to a reasonable increase biologic therapy options. Multicenter longitudinal studies are needed to evaluate validity and use in daily practice. References Wakefield RJ, D’Agostino MA, Naredo E, et al. After treat-to-target: can a targeted ultrasound initiative improve RA outcomes? Ann Rheum Di...
Background Background:Rheumatoid arthritis (RA) cause sarcopenia (SCP). The European Working Group on Sarcopenia in Older People (EWGSOP)1,2 defined primary and secondary SCP cut-off values. Studies have reported prevalence (PV) of SCP in RA whit the previous criteria, it was between 21.4% and 33.3%. The SCP is considered a disability cause in patients with RA Objectives Objective: To estimate prevalence of secondary SCP in patients with RA using new EWGSOP criteria; associate joint function, quality of life and physical activity with the presence of SCP. Methods Methods: An observational, cross-sectional study. Inclusion criteria: Patients with RA that fulfilling ACR criteria/EULAR 2010, 18-59 years. Exclusion Criteria: Patients with previous arthroplasty, unstable chronic illness, stroke with motor deficits. Demographics, clinimetric (DAS28, CDAI, HAQ-DI and EuroQol) were collected. The measurement of body composition was performed by multifrequency bioimpedance (InBody 720®), physical performance (walking speed), muscle strength (Handgrip strength). Descriptive and inferential statistical analysis was used according to the variable type and distribution using Stata12®. Results Results: 46 patients were studied, 86.9% female, mean age 44.9±10.6 years; family history of RA in 45.6%; duration of RA 9.9±6.8 years, time of diagnosis of RA 7.8±6.5 years, comorbidities found: diabetes 4.8%, hypertension 10.8%, history of non prosthetic orthopedic surgery 17.4% and 19.6% previous fracture. We found a DAS28 3.64 (1.74-6.38), CDAI 7.5 (0-32). Anthropometric measures: weight 67±10.2 kg, height 1.56±0.007 m, BMI 27.4±3.6, body fat mass 25.7±8.3 kg (reference population 11.4-18.2 kg), percent body fat 37.9±8.5 (reference 18-28%), waist hip ratio 0.96±0.07 (reference 0.75-0.85), muscle mass (MM) in women median 8.88 (6.8-10.4) kg/m2 (reference >6.76kg/m2), men MM median 10.2 (6.7-12.5) kg/m2 (reference >10.76 kg/m2), handgrip strength in women of 14.9 kg (2.6-27 kg) (reference >20 kg) in men and 25.7 kg (18-38) (reference >30 kg), walking speed 0.96±0.23 m/s (reference >1 m/s). We found prevalence of 6.5% pre-SCP, SCP 2.1% and did not find patient with severe SCP. Comparing the quality of life, joint function between groups with and without SCP, we found no statistically significant differences. Conclusions Conclusions: We found less PV of SCP with respect to previously published, although our population probably does not represent all patients with RA. Our population had more overweight and percent body fat. We found no difference between these groups in quality of life, joint function and activity. Applying new EWGSOP criteria we obtain accurate data for diagnosed secondary SCP in RA patients. References Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39(4):412–23. Janssen I, Baumgartner R, Ross R et al. Skeletal muscle cutpoints associated with elevated physical disabi...
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