Objective:Tuberculosis (TB) transmission in healthcare facilities is still a concern in low-income countries, where airborne isolation rooms are scarce due to high costs. We evaluated the use of single GeneXpert MTB/RIF, the molecular Mycobacterium tuberculosis (MTB) DNA and resistance to rifampicin (RIF) test, as an accurate and faster alternative to the current criteria of 3 negative acid-fast bacilli (AFB) smears to remove patients from airborne isolation.Methods:In this real-world investigation, we evaluated the impact of a single GeneXpert MTB/RIF on the decision making for discharging patients from respiratory isolation. We enrolled patients with suspected pulmonary TB in a public hospital that provides care for high-complexity patients in Brazil. We studied the performance, costs, and time saved comparing the GeneXpert MTB/RIF with AFB smears.Results:We enrolled 644 patients in 3 groups based on the number of AFB smears performed (1, 2, and 3, respectively) on respiratory specimens. GeneXpert MTB/RIF demonstrated good performance compared to AFB smear to rule out TB in all groups. The negative predictive value for AFB smear was 94% (95% confidence interval [CI], 0.90–0.97) and 98% (95% CIs, 0.94–0.99) for GeneXpert MTB/RIF in G3. The isolation discharge based on 3 AFB smears took 84 hours compared to 24 hours with GeneXpert MTB/RIF, which represents 560 patient-days saved in the isolation rooms.Conclusion:A single GeneXpert MTB/RIF is a fast and strong predictor for TB absence in a high-complexity hospital, which is quite similar to results obtained in recent studies in low-burden settings. This molecular test may also increase patient rotation through isolation rooms, with a positive impact in the emergency room and infectious diseases wards.
Agradeço primeiramente a Deus, por ter me concedido esta chance de crescer, trabalhar e melhorar sempre, e por me dar forças em todos os momentos de dificuldade. Aos meus pais, Telmo e Maria Cristina, por todo o cuidado, estímulo e apoio desde sempre. À minha esposa Mônica, pelo companheirismo, compreensão, carinho e amor em todos os momentos. Ao meu orientador, Prof. Dr. Valdes Roberto Bollela, pela disponibilidade, competência e pela paciência ao longo desses anos. À minha amiga Cinara, pelo importante auxílio ao longo do projeto, pelas ideias e pelas cobranças. Aos meus amigos da Vigilância Epidemiológica e da Comissão de Controle de Infecção Hospitalar, por todo auxílio em diferentes momentos. Ao Diego Moroço, pela ajuda fundamental na extração dos dados que permitiram esta pesquisa. A todos que trabalham e trabalharam no Laboratório de Microbiologia do HCRP, sem os quais eu não poderia realizar este projeto. A todos os amigos que torceram por mim e que ajudaram de alguma maneira na realização deste trabalho. "Temos que continuar aprendendo. Temos que estar abertos. E temos que estar prontos para espalhar nosso conhecimento a fim de chegar a uma compreensão mais elevada da realidade." (Thich Nhat Hanh) Resumo CAMPOS, MR. "Avaliação do perfil de resistência de bactérias isoladas de hemoculturas em um hospital terciário no período de 2009 a 2018". 2022. 80 f.
Background: The pathogenesis of adrenocortical tumors (ACTs) in the pediatric population is partially known, and few prognostic factors have been identified in this age group. Recently, ATRX and DAXX have been implicated in the pathogenesis and prognosis of a variety of cancers. Their altered function has been shown to affect telomere length through a telomerase-independent mechanism. Objective: To investigate ATRX and DAXX gene expression, ATRX and DAXX protein expression, and telomere length, as well as their clinical significance, in ACT samples from pediatric patients. Methods: The records of 110 pediatric patients with available ACT samples were reviewed. ATRX, DAXX, TERT and TERC gene expression was assessed by qPCR (n = 100 ACTs; n = 12 normal adrenals). ATRX and DAXX protein expression was assessed by IHC (n = 45 ACTs). Telomere length was assessed by qPCR (n = 64 ACTs). For survival analysis, Kaplan-Meier curves were obtained. For association analysis, simple linear regression models were adjusted. Results: Most patients were female (70.9%) and harbored germline TP53 mutations (90.2%). Median age at diagnosis was 21.1 months (2.1 – 199). Younger patients (< 3 years) had better survival (p < 0.01), while those with metastasis at diagnosis and carcinomas (classified by the Wieneke score) had worse survival (p < 0.01). ATRX gene expression was decreased (p < 0.01), while DAXX gene expression was increased (p < 0.01) in ACTs, compared to normal adrenals. ATRX gene expression was even lower in the context of the germline TP53 (R337H) mutation (p < 0.01). TERT expression was not detected in ACTs or normal adrenals, and TERC expression was not altered (p = 0.69). ATRX protein expression was lost in the majority of ACTs (95.6%), while DAXX was lost in a minority (21.1%). There was no association between gene or protein expression and disease-free or overall survival. There was a significant association between decreased ATRX and DAXX gene expression and increased telomere length (p < 0.01 and p = 0.03, respectively). Conclusion: In pediatric ACTs, decreased ATRX and DAXX gene expression was associated with increased telomere length, independently of TERT or TERC expression. In these tumors, ATRX gene expression was decreased and ATRX protein expression was overall lost, while DAXX gene expression was increased and DAXX protein expression was overall retained. No significant association between these alterations and prognosis was found in this cohort. These findings suggest that ATRX and DAXX altered function may be more involved in the pathogenesis of pediatric ACTs than in the prognosis of the affected patients.
This work aimed to study the role of different SARS-CoV-2 lineages in the epidemiology of multiple waves of the COVID-19 pandemic in Ribeirão Preto (São Paulo state), with comparison within Brazil and globally. Viral genomic sequencing was combined with clinical and sociodemographic information of 2,379 subjects at a large Brazilian hospital. On the whole 2,395 complete SARS-CoV-2 genomes were obtained from April 2020 to January 2022. We report variants of concern (VOC) and interest (VOI) dynamics and the role of Brazilian lineages. We identified three World Health Organization VOCs (Gamma, Delta, Omicron) and one VOI (Zeta), which caused distinct waves in this cohort. We also identified 47 distinct Pango lineages. Consistent with the high prevalence of Gamma in Brazil, Pango lineage P.1 dominated infections in this cohort for half of 2021. Each wave of infection largely consisted of a single variant group, with each new group quickly and completely rising to dominance. Despite increasing vaccination in Brazil starting in 2021, this pattern was observed throughout the study and is consistent with the hypothesis that herd immunity tends to be SARS-CoV-2 variant-specific and does not broadly protect against COVID-19.
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