Visceral leishmaniasis is an opportunistic disease in HIV-1 infected individuals, unrecognized as a determining factor for AIDS diagnosis. The growing geographical overlap of HIV-1 and
infections is ...an emerging challenge worldwide, as co-infection increases morbidity and mortality for both infections. Here, we determined the prevalence of people living with HIV (PWH) with a previous or ongoing infection by
and investigated the virological and immunological factors associated with co-infection. We adopted a two-stage cross-sectional cohort (CSC) design (CSC-I,
= 5,346 and CSC-II,
= 317) of treatment-
HIV-1-infected individuals in Bahia, Brazil. In CSC-I, samples collected between 1998 and 2013 were used for serological screening for leishmaniasis by an in-house Enzyme-Linked Immunosorbent Assay (ELISA) with SLA (Soluble
Antigen), resulting in a prevalence of previous or ongoing infection of 16.27%. Next, 317 PWH were prospectively recruited from July 2014 to December 2015 with the collection of sociodemographic and clinical data. Serological validation by two different immunoassays confirmed a prevalence of 15.46 and 8.20% by anti-SLA, and anti-HSP70 serology, respectively, whereas 4.73% were double-positive (DP). Stratification of these 317 individuals in DP and double-negative (DN) revealed a significant reduction of CD4
counts and CD4
/CD8
ratios and a tendency of increased viral load in the DP group, as compared to DN. No statistical differences in HIV-1 subtype distribution were observed between the two groups. However, we found a significant increase of CXCL10 (
= 0.0076) and a tendency of increased CXCL9 (
= 0.061) in individuals with DP serology, demonstrating intensified immune activation in this group. These findings were corroborated at the transcriptome level in independent Leishmania- and HIV-1-infected cohorts (Swiss HIV Cohort and Piaui Northeast Brazil Cohort), indicating that CXCL10 transcripts are shared by the IFN-dominated immune activation gene signatures of both pathogens and positively correlated to viral load in untreated PWH. This study demonstrated a high prevalence of PWH with
seropositivity in Bahia, Brazil, linked to IFN-mediated immune activation and a significant decrease in CD4
levels. Our results highlight the urgent need to increase awareness and define public health strategies for the management and prevention of HIV-1 and
co-infection.
Rationale
Both typical and atypical antipsychotic drugs are D2 receptor antagonists but yet appear to have markedly different effects upon the induction of dopamine sensitization.
Objective
This ...study aims to compare the effects of subchronic regimens of low-dose olanzapine and haloperidol administered to rats previously sensitized to apomorphine.
Methods
Initially, rats received apomorphine (2.0 mg/kg) or vehicle treatments for five consecutive days followed by a conditioning test and an apomorphine challenge test. Next, there was an antipsychotic exposure phase in which three vehicle groups and three apomorphine groups received 10 daily injections of either vehicle, haloperidol (0.03 mg/kg) or olanzapine (0.01 mg/kg). In the final phase, all groups were given a second conditioning test and apomorphine challenge test.
Results
Apomorphine induced sensitization and conditioning effects. Following haloperidol exposure, apomorphine conditioned and sensitization effects were potentiated but, in contrast, olanzapine exposure eliminated apomorphine sensitization effects. In addition, the sensitization induced by apomorphine transformed the low-dose haloperidol treatment into a potent locomotor stimulant treatment. In the vehicle groups, haloperidol and olanzapine exposure effects were equivalent and not different from vehicle treatment.
Conclusions
The profound differences observed between typical and atypical antipsychotic exposure in animals with an upregulated dopamine system are consistent with clinical evidence for lower risk of psychomotor disturbances with chronic treatment with atypical antipsychotic. Importantly, the finding that a very low dose of olanzapine reversed sensitization effects suggests that low-dose olanzapine may have clinical utility in a variety of disorders linked to sensitization of the dopamine system.
Morphine has substantial pro-dopamine effects and in rodents, this is expressed in behavior as increased locomotor activation. Here we administered post-trial 3 dose levels of morphine (3.0, 5.0 and ...10.0 mg/kg) or vehicle either immediately or after a 15 min delay to different groups of rats following a brief (5 min) exposure to a novel test environment. Three post-trial injections were administered on three successive days. One day after the first post-trial morphine injections, the non-drug activity levels in the immediate post-trial morphine treatment groups were selectively increased compared to vehicle groups. The activity effects were potentiated with repeated immediate post-trial morphine treatments but the same morphine treatments given after a 15 min post-trial delay did not increase activity in any tests and did not differ from vehicle. Subsequently, all groups were given 5 daily non-drug test sessions as an extinction protocol. The increased activity levels in the 5.0 and 10.0 mg/kg immediate post-trial morphine groups were sustained over the five extinction sessions. Two days later all groups were given a 30 min non-drug test and the 5.0 and 10.0 immediate post-trial groups continued to exhibit a heightened level of activity relative to vehicle restricted to the initial 10 min of the test session. There were no other group differences. The findings that the locomotor stimulant effects in the immediate post-test morphine groups occurred on non-drug tests and that the same morphine treatments given 15 min post-test were without effect are consistent with a conditioned morphine effect. In that acquisition of familiarization with a new environment is a basic learning process that engages consolidation mechanisms, it is possible that the immediate post-trial morphine effects that occur concurrently with consolidation can become incorporated into this consolidation process and subsequently be expressed as a conditioned drug effect.
•Immediate post-trial morphine can induce conditioning in one trial.•Morphine post-trial after a delay does not induce conditioning.•Immediate post-trial Morphine conditioning is highly resistant to extinction.
The system of Related Diagnostic Groups (DRG) allows to evaluate the institutional performance regarding the services of the health team. Acquired conditions (AC) are associated with complications of ...the actions of this team. The objective of the study was to analyze strategies to identify hospital CAs using DRG system records.
We have adopted the Centers for Medicare & Medicaid Service (CMS) Hospital Acquired Conditions (HACs) list. HACs were compared to the CAs identified in the database (DB) of the institutional DRG system, applying Relative Risk (RR) and 95% confidence interval. The concordance between observations (HACs and CAs) was analyzed using Kappa statistics. Randomly selected DRG system records were classified as to the probability for HAC. We recorded 550 CAs among 31,472 participants (1.7%) and 1,594 HACs (5.0%), with 123 events (7.7%) common in both. RR of HACs compared to CAs was 5.4 95% CI: 4.5-6.6, p value
O sistema de Grupos Diagnósticos Relacionados (DRG) permite avaliar o desempenho institucional quanto aos serviços da equipe de saúde. Condições adquiridas (CA) associam-se a complicações das ações dessa equipe. O objetivo do estudo foi analisar estratégias para identificar CAs hospitalares mediante registros do sistema DRG.
Adotamos a lista de Hospital Acquired Conditions (HACs) do Centers of Medicare & Medicaid Service (CMS). Comparou-se HACs às CAs identificadas no banco de dados (BD) do sistema DRG institucional, aplicando-se Risco Relativo (RR) e intervalo de confiança de 95%. A concordância entre observações (HACs e CAs) foi analisada através da estatística Kappa. Registros do sistema DRG selecionados aleatoriamente foram classificados quanto à probabilidade para HAC. Registraram-se 550 CAs entre 31.472 participantes (1,7%) e 1.594 HACs (5,0%), sendo 123 eventos (7,7%) comuns em ambas. RR de HACs em comparação às CAs foi 5,4 IC 95%: 4,5-6,6, valor p < 0,01. A concordância foi pobre (kappa 0,09, IC 95% 0,07-0,1 e valor p < 0,01). Analisando-se subgrupos de HAC 5 (Diagnóstico secundário de quedas e traumas) e 6 (Diagnóstico secundário de infecção do trato urinário associado a cateter) em 91 internações, classificamos 33 como baixo risco para HAC, 34 como alto risco e 24 como risco indeterminado. Concluímos que a análise do BD Institucional subestima a incidência de CAs, embora o método HACs possa incluir falso-positivos. Recomendamos estudos comparativos com outros modelos de identificação de HACs.
IntroductionThe aim of this study was to evaluate the clinical, epidemiological and laboratory aspects of SARS-CoV-2 infection during pregnancy and postpartum in 16 maternity hospitals.Methods and ...analysisA prospective multicentre study, with five axes. First, the prevalence of SARS-CoV-2 infection among women admitted for childbirth will be described in a cross-sectional study. Second, maternal and perinatal outcomes will be assessed in a prospective cohort study including pregnant or postpartum women with suspected COVID-19. Third, a cohort of positive COVID-19 cases with sampling of a variety of biological material. Histopathological and viral analysis of biological maternal and neonatal samples will be performed, and the assessment of nutritional variables to evaluate the association between vitamin D and severity of infection. Fourth, a monitoring and evaluation committee to collect relevant healthcare information and plan actions in centres facing the pandemic. Furthermore, qualitative studies will be performed to study pregnant women, their families and health professionals. Fifth, an ecological study will monitor the number of live births, stillbirths and other outcomes to explore any trend among the periods before, during and after the pandemic. Data will systematically be collected in an electronic platform following standardised operational procedures. For quantitative study components, an appropriate statistical approach will be used for each analysis. For qualitative data, in-depth interviews recorded in audio will be transcribed, checking the text obtained with the recording. Subsequently, thematic analysis with the aid of the NVivo programme will be performed.Ethics and disseminationEthical approval was obtained (letters of approval numbers 4.047.168, 4.179.679 and 4.083.988). All women will be fully informed to sign the consent form before enrolment in the study. Findings will be disseminated through peer-reviewed journals and scientific conferences.
O impacto da pandemia desencadeou uma escalada de morte de gestantes e puérperas com grandes desafios para a vigilância e atenção à saúde. O estudo tem como objetivo discutir a formação de ...profissionais da saúde em vigilância do óbito materno, infantil e fetal no contexto da pandemia de covid-19. Aborda os desafios do trabalho de equipe multidisciplinar na identificação, atualização e produção. São apresentadas as etapas de desenvolvimento do curso desde a sua concepção e implementação, atualização do material didático, o processo de acompanhamento pedagógico por meio de uma rede formativa docente e as contribuições para a formação dos profissionais de saúde. O cenário epidemiológico demandou o uso intensificado de tecnologias digitais de informação e comunicação, formação e apoio aos tutores-docentes e maior acolhimento a docentes e estudantes para a criação de uma ambiência que favorecesse as atividades de ensino-aprendizagem. A qualificação das ações da vigilância e do trabalho dos comitês de mortalidade tornou-se ainda mais relevante e necessária para o enfrentamento da pandemia. O comprometimento com o desenvolvimento contínuo do curso constitui uma forma de ligação dos saberes teóricos e práticos com as necessidades sociais e institucionais e, sobretudo, dos trabalhadores envolvidos no processo.
PALABRAS-CHAVE: Mortalidade Materna. Mortalidade Infantil. Mortalidade Fetal. Vigilância Epidemiológica. Capacitação de Recursos Humanos em Saúde.
The system of Related Diagnostic Groups (DRG) allows to evaluate the institutional performance regarding the services of the health team. Acquired conditions (AC) are associated with complications of ...the actions of this team. The objective of the study was to analyze strategies to identify hospital CAs using DRG system records. We have adopted the Centers for Medicare & Medicaid Service (CMS) Hospital Acquired Conditions (HACs) list. HACs were compared to the CAs identified in the database (DB) of the institutional DRG system, applying Relative Risk (RR) and 95% confidence interval. The concordance between observations (HACs and CAs) was analyzed using Kappa statistics. Randomly selected DRG system records were classified as to the probability for HAC. We recorded 550 CAs among 31,472 participants (1.7%) and 1,594 HACs (5.0%), with 123 events (7.7%) common in both. RR of HACs compared to CAs was 5.4 95% CI: 4.5-6.6, p value <0.01. The agreement was poor (0.09 kappa, 95% CI 0.07-0.1 and p value <0.01). Analyzing subgroups of HAC 5 (Secondary diagnosis of falls and traumas) and 6 (Secondary diagnosis of catheter-associated urinary tract infection) in 91 hospitalizations, we classified 33 as low risk for HAC, 34 as high risk and 24 as undetermined risk. We conclude that the analysis of Institutional BD underestimates the incidence of CAs, although the HACs method may include false positives. We recommend comparative studies with other HAC identification models. Key Words: Iatrogenic Disease. Related Diagnostic Groups. Patient Safety. Quality of Health Care. Conditions Acquired in Hospital. O sistema de Grupos Diagnosticos Relacionados (DRG) permite avaliar o desempenho institucional quanto aos servicos da equipe de saude. CondicOes adquiridas (CA) associam-se a complicacOes das acOes dessa equipe. O objetivo do estudo foi analisar estrategias para identificar CAs hospitalares mediante registros do sistema DRG. Adotamos a lista de Hospital Acquired Conditions (HACs) do Centers of Medicare & Medicaid Service (CMS). Comparou-se HACs as CAs identificadas no banco de dados (BD) do sistema DRG institucional, aplicando-se Risco Relativo (RR) e intervalo de confianca de 95%. A concordancia entre observacOes (HACs e CAs) foi analisada atraves da estatistica Kappa. Registros do sistema DRG selecionados aleatoriamente foram classificados quanto a probabilidade para HAC. Registraram-se 550 CAs entre 31.472 participantes (1,7%) e 1.594 HACs (5,0%), sendo 123 eventos (7,7%) comuns em ambas. RR de HACs em comparacao as CAs foi 5,4 IC 95%: 4,56,6, valor p < 0,01. A concordancia foi pobre (kappa 0,09, IC 95% 0,07-0,1 e valor p < 0,01). Analisando-se subgrupos de HAC 5 (Diagnostico secundario de quedas e traumas) e 6 (Diagnostico secundario de infeccao do trato urinario associado a cateter) em 91 internacOes, classificamos 33 como baixo risco para HAC, 34 como alto risco e 24 como risco indeterminado. Concluimos que a analise do BD Institucional subestima a incidencia de CAs, embora o metodo HACs possa incluir falso-positivos. Recomendamos estudos comparativos com outros modelos de identificacao de HACs. Palavras-Chave: Doenca iatrogenica. Grupos Diagnosticos Relacionados. Seguranca do paciente. Qualidade da Assistencia a Saude. CondicOes adquiridas em Hospital.
ABSTRACT Objective To validate the Brazilian National Health System Hospital Information System (SIH/SUS) for maternal morbidity surveillance. Methods This was a cross-sectional study conducted in ...2021/2022, taking as its reference a national study on maternal morbidity (MMG) conducted in 50 public and 28 private hospitals; we compared SIH/SUS and MMG data for hospitalization frequency, reason and type of discharge and calculated sensitivity, specificity, positive and negative likelihood ratios for seven diagnoses and four procedures. Results Hospitalizations identified on SIH/SUS (32,212) corresponded to 95.1% of hospitalizations assessed by MMG (33,867), with lower recording on SIH/SUS (85.5%) for private hospitals 10,036 (SIH/SUS); 11,742 (MMG); compared to MMG, SIH/SUS had a lower proportion of hospitalizations due to “complications during pregnancy” (9.7% versus 16.5%) as well as under-recording of all diagnoses and procedures assessed, except “ectopic pregnancy”. Conclusion Better recording of diagnoses and procedures on SIH/SUS is essential for its use in maternal morbidity surveillance.
RESUMEN Objetivo Validar el Sistema de Información Hospitalaria del Sistema Único de Salud (SIH/SUS) para vigilancia de la morbilidad materna. Métodos Estudio transversal, 2021/2022, utilizando como referencia datos de estudio nacional de morbilidad materna (MMG) realizado en 50 hospitales públicos y 28 privados; comparando: frecuencia, motivo y tipo de alta de internaciones en SIH/SUS y MMG y calculando sensibilidad, especificidad y razones de probabilidad positivos y negativos para siete diagnósticos y cuatro procedimientos. Resultados Las internaciones identificadas en SIH/SUS (32.212) correspondieron al 95,1% de internaciones evaluadas en MMG (33.867), observándose menor registro en SIH/SUS (85,5%) en hospitales privados 10.036 (SIH/SUS); 11.742 (MMG); comparado con MMG, SIH/SUS tuvo menor proporción de internaciones por “complicaciones durante el embarazo” (9,7% vs 16,5%), así como subregistro de todos los diagnósticos y procedimientos evaluados, excepto “embarazo ectópico”. Conclusión Mejor registro de diagnósticos y procedimientos en SIH/SUS es fundamental para su uso en la vigilancia de la morbilidad materna.
RESUMO Objetivo Validar o Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS) para vigilância da morbidade materna. Métodos Estudo transversal, de 2021-2022, utilizando-se como referência dados de estudo nacional sobre morbidade materna (MMG) realizado em 50 hospitais públicos e 28 privados; foram comparados frequência, motivo e tipo de saída das internações, segundo SIH/SUS e MMG, e calculadas sensibilidade, especificidade, razão de verossimilhança positiva e negativa para sete diagnósticos e quatro procedimentos. Resultados Internações identificadas no SIH/SUS (32.212) corresponderam a 95,1% das internações avaliadas no MMG (33.867), tendo-se observado menor registro no SIH/SUS (85,5%) em hospitais privados 10.036 (SIH/SUS); 11.742 (MMG); comparado ao MMG, o SIH/SUS apresentou menor proporção de internações por “intercorrências na gestação” (9,7% versus 16,5%), bem como sub-registro de todos os diagnósticos e procedimentos avaliados, exceto “gestação ectópica”. Conclusão Melhor registro de diagnósticos e procedimentos no SIH/SUS é essencial para sua utilização na vigilância da morbidade materna.
O sistema de Grupos Diagnósticos Relacionados (DRG) permite avaliar o desempenho institucional quanto aos serviços da equipe de saúde. Condiçöes adquiridas (CA) associam-se a complicates das açöes ...dessa equipe. O objetivo do estudo foi analisar estrategias para identificar CAs hospitalares mediante registros do sistema DRG. Adotamos a lista de Hospital Acquired Conditions (HACs) do Centers of Medicare & Medicaid Service (CMS). Comparou-se HACs as CAs identificadas no banco de dados (BD) do sistema DRG institucional, aplicando-se Risco Relativo (RR) e intervalo de confiança de 95%. A concordancia entre observaçöes (HACs e CAs) foi analisada através da estatística Kappa. Registros do sistema DRG selecionados aleatoriamente foram classificados quanto a probabilidade para HAC. Registraram-se 550 CAs entre 31.472 participantes (1,7%) e 1.594 HACs (5,0%), sendo 123 eventos (7,7%) comuns em ambas. RR de HACs em comparaçâo as CAs foi 5,4 IC 95%: 4,56,6, valor p < 0,01. A concordancia foi pobre (kappa 0,09, IC 95% 0,07-0,1 e valor p < 0,01). Analisando-se subgrupos de HAC 5 (Diagnóstico secundario de quedas e traumas) e 6 (Diagnóstico secundario de infecçâo do trato urinario associado a cateter) em 91 internaçöes, classificamos 33 como baixo risco para HAC, 34 como alto risco e 24 como risco indeterminado. Concluimos que a análise do BD Institucional subestima a incidencia de CAs, embora o método HACs possa incluir falso-positivos. Recomendamos estudos comparativos com outros modelos de identificaçâo de HACs.
The system of Related Diagnostic Groups (DRG) allows to evaluate the institutional performance regarding the services of the health team. Acquired conditions (AC) are associated with complications of ...the actions of this team. The objective of the study was to analyze strategies to identify hospital CAs using DRG system records. We have adopted the Centers for Medicare & Medicaid Service (CMS) Hospital Acquired Conditions (HACs) list. HACs were compared to the CAs identified in the database (DB) of the institutional DRG system, applying Relative Risk (RR) and 95% confidence interval. The concordance between observations (HACs and CAs) was analyzed using Kappa statistics. Randomly selected DRG system records were classified as to the probability for HAC. We recorded 550 CAs among 31,472 participants (1.7%) and 1,594 HACs (5.0%), with 123 events (7.7%) common in both. RR of HACs compared to CAs was 5.4 95% CI: 4.5-6.6, p value <0.01. The agreement was poor (0.09 kappa, 95% CI 0.07-0.1 and p value <0.01). Analyzing subgroups of HAC 5 (Secondary diagnosis of falls and traumas) and 6 (Secondary diagnosis of catheter-associated urinary tract infection) in 91 hospitalizations, we classified 33 as low risk for HAC, 34 as high risk and 24 as undetermined risk. We conclude that the analysis of Institutional BD underestimates the incidence of CAs, although the HACs method may include false positives. We recommend comparative studies with other HAC identification models.
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