Showing papers by "Universidade de Pernambuco published in 2019"

Impact of preexisting dengue immunity on Zika virus emergence in a dengue endemic region

Abstract: The clinical outcomes associated with Zika virus (ZIKV) in the Americas have been well documented, but other aspects of the pandemic, such as attack rates and risk factors, are poorly understood. We prospectively followed a cohort of 1453 urban residents in Salvador, Brazil, and, using an assay that measured immunoglobulin G3 (IgG3) responses against ZIKV NS1 antigen, we estimated that 73% of individuals were infected during the 2015 outbreak. Attack rates were spatially heterogeneous, varying by a factor of 3 within a community spanning 0.17 square kilometers. Preexisting high antibody titers to dengue virus were associated with reduced risk of ZIKV infection and symptoms. The landscape of ZIKV immunity that now exists may affect the risk for future transmission.

Accelerometer-Based Human Fall Detection Using Convolutional Neural Networks

Abstract: Human falls are a global public health issue resulting in over 373 million severe injuries and 646,000 deaths yearly Falls result in direct financial cost to health systems and indirectly to society productivity Unsurprisingly, human fall detection and prevention are a major focus of health research In this article, we consider deep learning for fall detection in an IoT and fog computing environment We propose a Convolutional Neural Network composed of three convolutional layers, two maxpool, and three fully-connected layers as our deep learning model We evaluate its performance using three open data sets and against extant research Our approach for resolving dimensionality and modelling simplicity issues is outlined Accuracy, precision, sensitivity, specificity, and the Matthews Correlation Coefficient are used to evaluate performance The best results are achieved when using data augmentation during the training process The paper concludes with a discussion of challenges and future directions for research in this domain

Clinical performance of bulk-fill and conventional resin composite restorations in posterior teeth: a systematic review and meta-analysis

Abstract: The purpose of this systematic review was to compare the clinical performance of bulk-fill resin composites with conventional resin composites used for direct restorations of posterior teeth. This review followed the PRISMA statement. This review was registered at PROSPERO (registration number CRD42016053436). A search of the scientific literature was performed by two independent reviewers using the PubMed/MEDLINE, Embase, The Cochrane Library, and Web of Science databases from commencement until January 2018. The research question was “Do bulk-fill resin composites have a clinical performance comparable to conventional resin composites in posterior restorations?” Only studies evaluating class I and II direct restorations in permanent teeth with a follow-up period of at least 1 year were included. The RevMan 5 program was used for meta-analysis, calculating the relative risk (RR) and 95% confidence interval (CI) of the dichotomous outcome (restoration failure or success). Ten articles were selected, comprising 941 analyzed restorations. The mean follow-up period was 33.6 months (12–72 months). No statistically significant differences in the failure rate were observed between conventional and base/flowable bulk-fill resin composites (p = 0.31; RR 1.49; 95% CI 0.69–3.25) or full-body/sculptable bulk-fill resin composites (p = 0.12; RR 1.89; 95% CI 0.84–4.24). The present systematic review and meta-analysis indicate similar clinical performances of bulk-fill and conventional resin composites over a follow-up period of 12 to 72 months. Based on the results of this study, the bulk-fill resin composites could be an alternative for direct restorations in posterior teeth. However, clinical trials of longer duration are required.

An intelligent hybridization of ARIMA with machine learning models for time series forecasting

Abstract: The development of accurate forecasting systems can be challenging in real-world applications. The modeling of real-world time series is a particularly difficult task because they are generally composed of linear and nonlinear patterns that are combined in some form. Several hybrid systems that combine linear and nonlinear techniques have obtained relevant results in terms of accuracy in comparison with single models. However, the best combination function of the forecasting of the linear and nonlinear patterns is unknown, which makes this modeling an open question. This work proposes a hybrid system that searches for a suitable function to combine the forecasts of linear and nonlinear models. Thus, the proposed system performs: (i) linear modeling of the time series; (ii) nonlinear modeling of the error series; and (iii) a data-driven combination that searches for: (iii.a) the most suitable function, between linear and nonlinear formalisms, and (iii.b) the number of forecasts of models (i) and (ii) that maximizes the performance of the combination. Two versions of the hybrid system are evaluated. In both versions, the ARIMA model is used in step (i) and two nonlinear intelligent models – Multi-Layer Perceptron (MLP) and Support Vector Regression (SVR) – are used in steps (ii) and (iii), alternately. Experimental simulations with six real-world complex time series that are well-known in the literature are evaluated using a set of popular performance metrics. Our results show that the proposed hybrid system attains superior performance when compared with single and hybrid models in the literature.

Polysaccharide-Based Formulations for Healing of Skin-Related Wound Infections: Lessons from Animal Models and Clinical Trials.

Abstract: Skin injuries constitute a gateway for pathogenic bacteria that can be either part of tissue microbiota or acquired from the environmental. These microorganisms (such as Acinetobacter baumannii, Enterococcus faecalis, Pseudomonas aeruginosa, and Staphylococcus aureus) produce virulence factors that impair tissue integrity and sustain the inflammatory phase leading for establishment of chronic wounds. The high levels of antimicrobial resistance have limited the therapeutic arsenal for combatting skin infections. Thus, the treatment of non-healing chronic wounds is a huge challenge for health services worldwide, imposing great socio-economic damage to the affected individuals. This scenario has encouraged the use of natural polymers, such as polysaccharide, in order to develop new formulations (membranes, nanoparticles, hydrogels, scaffolds) to be applied in the treatment of skin infections. In this non-exhaustive review, we discuss the applications of polysaccharide-based formulations in the healing of infected wounds in animal models and clinical trials. The formulations discussed in this review were prepared using alginate, cellulose, chitosan, and hyaluronic acid. In addition to have healing actions per se, these polysaccharide formulations can act as transdermal drug delivery systems, controlling the release of active ingredients (such as antimicrobial and healing agents). The papers show that these polysaccharides-based formulations are efficient in controlling infection and improve the healing, even in chronic infected wounds. These data should positively impact the design of new dressings to treat skin infections.

Surgical aortic valve replacement and patient-prosthesis mismatch a meta-analysis of 108 182 patients

Abstract: OBJECTIVES This study sought to evaluate the impact of patient-prosthesis mismatch (PPM) on the risk of perioperative, early-, mid- and long-term mortality rates after surgical aortic valve replacement. METHODS Databases were searched for studies published until March 2018. The main outcomes of interest were perioperative mortality, 1-year mortality, 5-year mortality and 10-year mortality. RESULTS The search yielded 3761 studies for inclusion. Of these, 70 articles were analysed, and their data were extracted. The total number of patients included was 108 182 who underwent surgical aortic valve replacement. The incidence of PPM after surgical aortic valve replacement was 53.7% (58 116 with PPM and 50 066 without PPM). Perioperative mortality [odds ratio (OR) 1.491, 95% confidence interval (CI) 1.302-1.707; P < 0.001], 1-year mortality (OR 1.465, 95% CI 1.277-1.681; P < 0.001), 5-year mortality (OR 1.358, 95% CI 1.218-1.515; P < 0.001) and 10-year mortality (OR 1.534, 95% CI 1.290-1.825; P < 0.001) were increased in patients with PPM. Both severe PPM and moderate PPM were associated with increased risk of perioperative mortality, 1-year mortality, 5-year mortality and 10-year mortality when analysed together and separately, although we observed a higher risk in the group with severe PPM. CONCLUSIONS Moderate/severe PPM increases perioperative, early-, mid- and long-term mortality rates proportionally to its severity. The findings of this study support the implementation of surgical strategies to prevent PPM in order to decrease mortality rates.

Access to healthcare for children with Congenital Zika Syndrome in Brazil: perspectives of mothers and health professionals.

Abstract: The Congenital Zika Syndrome (CZS) epidemic took place in Brazil between 2015 and 2017 and led to the emergence of at least 3194 children born with CZS. We explored access to healthcare services and activities in the Unified Health Service (Sistema Unico de Saude: SUS) from the perspective of mothers of children with CZS and professionals in the Public Healthcare Network. We carried out a qualitative, exploratory study, using semi-structured interviews, in two Brazilian states-Pernambuco, which was the epicentre of the epidemic in Brazil, and Rio de Janeiro, where the epidemic was less intense. The mothers and health professionals reported that healthcare provision was insufficient and fragmented and there were problems with follow-up care. There was a lack of co-ordination and an absence of communication between the various specialized services and between different levels of the health system. We also noted a public-private mixture in access to healthcare services, resulting from a segmented system and related to inequality of access. High reported household expenditure is an expression of the phenomenon of underfunding of the public system. The challenges that mothers and health professionals reported exposes contradictions in the health system which, although universal, does not guarantee equitable and comprehensive care. Other gaps were revealed through the outbreak. The epidemic provided visibility regarding difficulties of access for other children with disabilities determined by other causes. It also made explicit the gender inequalities that had an impact on the lives of mothers and other female caregivers, as well as an absence of the provision of care for these groups. In the face of an epidemic, the Brazilian State reproduced old fashioned forms of action-activities related to the transmitting mosquito and to prevention with an emphasis on the individual and no action related to social determinants.

Social-Ecological Theory of Maximization: Basic Concepts and Two Initial Models

Abstract: Efforts have been dedicated to the understanding of social-ecological systems, an important focus in ethnobiological studies. In particular, ethnobiological investigations have found evidence and tested hypotheses over the last 30 years on the interactions between human groups and their environments, generating the need to formulate a theory for such systems. In this article, we propose the social-ecological theory of maximization to explain the construction and functioning of these systems over time, encompassing hypotheses and evidence from previous ethnobiological studies. In proposing the theory, we present definitions and two conceptual models, an environmental maximization model and a redundancy generation model. The first model seeks to address biota selection and its use by human populations. The second emphasizes how the system organizes itself from the elements that were incorporated into it. Furthermore, we provide the theoretical scenario of plant selection and use from an evolutionary perspective, which explicitly integrates the phylogenetic relationships of plants (or other living resources) and human beings.

Majority-vote model for financial markets

Abstract: We use a heterogeneous agent-based two-state sociophysics model to simulate financial markets. Focusing on stock market trader dynamics, we propose a model with two kinds of individual – the contrarian agent and the noise trader – in which the dynamics of buying and selling investors are governed by local and global interactions. We define an antiferromagnetic coupling that relates the option of contrarian agents to global magnetization and a ferromagnetic interaction that connects noise traders to their local neighborhood. Our model presents such stylized facts of real financial markets as clustered volatility, power-law distributed returns, and the long-time correlation of the absolute returns with exponential decay. We also observe that the distribution of logarithmic returns can be fitted by the Student’s t distribution in which its degree of freedom changes with the percentage of contrarian agents in the market.

Ten important questions/issues for ethnobotanical research

Abstract: For at least 30 years researchers have called for a deeper reflection on the paths we desire for ethnobotanical research. Although the discipline of ethnobotany is growing, as measured by the number of publications in the area, there is still work to be done regarding the homogeneity of theoretical and methodological approaches and the implications of ethnobotanical research findings for society as a whole. In this article we present 10 questions/issues that we believe can guide the research and actions of ethnobotanists for the coming years.

The association of depression, anxiety, and stress with caring for a child with Congenital Zika Syndrome in Brazil; Results of a cross-sectional study.

Abstract: BACKGROUND: Zika virus (ZIKV) infection in pregnancy can cause microcephaly and a wide spectrum of severe adverse outcomes, collectively called "Congenital Zika Syndrome" (CZS). Parenting a child with disabilities can have adverse mental health impacts, but these associations have not been fully explored in the context of CZS in Brazil. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study was undertaken in Recife and Rio de Janeiro, including 163 caregivers of a child with CZS (cases) and 324 caregivers with an unaffected child (comparison subjects), identified from existing studies. The primary caregiver, almost always the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, and stress (Depression, Anxiety, and Stress Scale-DASS-21), social support (Medical Outcomes Study Social Support Scale-MOS-SSS), and socio-demographic data. Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. A high proportion of mothers reported experiencing severe or extremely severe levels of depression (18%), anxiety (27%) and stress (36%). Mothers of children with CZS were more likely to experience symptoms of depression, anxiety andstress, compared to mothers of comparison children. These associations were more apparent among mothers living in Rio de Janeiro. These differences were reduced after adjustment for socio-economic status and social support. Among mothers of children with CZS, low social support was linked to higher levels of depression, anxiety and stress, but there was no association with socio-economic status. CONCLUSIONS/SIGNIFICANCE: Depression, anxiety and stress were very common among mothers of young children in Brazil, regardless of whether they were parenting a child with disabilities. Mothers of children with CZS may be particularly vulnerable to poor mental health, and this association may be buffered through better social support.

Perinatal analyses of Zika- and dengue virus-specific neutralizing antibodies: A microcephaly case-control study in an area of high dengue endemicity in Brazil.

Abstract: Laboratory confirmation of Zika virus (ZIKV) infection during pregnancy is challenging due to cross-reactivity with dengue virus (DENV) and limited knowledge about the kinetics of anti-Zika antibody responses during pregnancy. We described ZIKV and DENV serological markers and the maternal-fetal transfer of antibodies among mothers and neonates after the ZIKV microcephaly outbreak in Northeast Brazil (2016). We included 89 microcephaly cases and 173 neonate controls at time of birth and their mothers. Microcephaly cases were defined as newborns with a particular head circumference (2 SD below the mean). Two controls without microcephaly were matched by the expected date of delivery and area of residence. We tested maternal serum for recent (ZIKV genome, IgM and IgG3 anti-NS1) and previous (ZIKV and DENV neutralizing antibodies [NAbs]) markers of infection. Multiple markers of recent or previous ZIKV and DENV infection in mothers were analyzed using principal component analysis (PCA). At delivery, 5.6% of microcephaly case mothers and 1.7% of control mothers were positive for ZIKV IgM. Positivity for ZIKV IgG3 anti-NS1 was 8.0% for case mothers and 3.5% for control mothers. ZIKV NAbs was slightly higher among mothers of cases (69.6%) than that of mothers of controls (57.2%; p = 0.054). DENV exposure was detected in 85.8% of all mothers. PCA discriminated two distinct components related to recent or previous ZIKV infection and DENV exposure. ZIKV NAbs were higher in newborns than in their corresponding mothers (p<0.001). We detected a high frequency of ZIKV exposure among mothers after the first wave of the ZIKV outbreak in Northeast Brazil. However, we found low sensitivity of the serological markers to recent infection (IgM and IgG3 anti-NS1) in perinatal samples of mothers of microcephaly cases. Since the neutralization test cannot precisely determine the time of infection, testing for ZIKV immune status should be performed as early as possible and throughout pregnancy to monitor acute Zika infection in endemic areas.

Prevalence of TMD and level of chronic pain in a group of Brazilian adolescents.

Abstract: Aims To determine the prevalence of temporomandibular disorders and associated factors in an adolescent sample from Recife, Brazil. Materials and methods A cross-sectional study was conducted with 1342 adolescents aged 10–17 years. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used by calibrated examiners to evaluate the presence and levels of chronic pain. To evaluate the socioeconomic conditions, the subjects answered the Brazilian Economic Classification Criteria (CCEB) questionnaire. Data were analyzed by means of binary logistic regression in SPSS. Results The results showed that 33.2% of the subjects had TMD irrespective of age (p = 0.153) or economic class (p = 0.653). Statistically significant associations were found between TMD and female gender (p = 0.017), headache/migraine in the past six months (p<0.001), chronic pain (p<0.001) and chronic pain level (p<0.001). In the final model, logistic regression showed that the level of chronic pain and the headache/migraine in the past six months were related to the presence of TMD. Conclusions The prevalence of TMD was considered high (33.2%) and adolescents with chronic pain and headache in the past six months were more likely to have TMD. Clinical relevance The data contribute to the understanding of TMD among adolescents and to the development of preventive measures and polices to identify the dysfunction promptly.

Understanding the relation between Zika virus infection during pregnancy and adverse fetal, infant and child outcomes: A protocol for a systematic review and individual participant data meta-analysis of longitudinal studies of pregnant women and their infants and children

Abstract: Introduction Zika virus (ZIKV) infection during pregnancy is a known cause of microcephaly and other congenital and developmental anomalies. In the absence of a ZIKV vaccine or prophylactics, principal investigators (PIs) and international leaders in ZIKV research have formed the ZIKV Individual Participant Data (IPD) Consortium to identify, collect and synthesise IPD from longitudinal studies of pregnant women that measure ZIKV infection during pregnancy and fetal, infant or child outcomes. Methods and analysis We will identify eligible studies through the ZIKV IPD Consortium membership and a systematic review and invite study PIs to participate in the IPD meta-analysis (IPD-MA). We will use the combined dataset to estimate the relative and absolute risk of congenital Zika syndrome (CZS), including microcephaly and late symptomatic congenital infections; identify and explore sources of heterogeneity in those estimates and develop and validate a risk prediction model to identify the pregnancies at the highest risk of CZS or adverse developmental outcomes. The variable accuracy of diagnostic assays and differences in exposure and outcome definitions means that included studies will have a higher level of systematic variability, a component of measurement error, than an IPD-MA of studies of an established pathogen. We will use expert testimony, existing internal and external diagnostic accuracy validation studies and laboratory external quality assessments to inform the distribution of measurement error in our models. We will apply both Bayesian and frequentist methods to directly account for these and other sources of uncertainty. Ethics and dissemination The IPD-MA was deemed exempt from ethical review. We will convene a group of patient advocates to evaluate the ethical implications and utility of the risk stratification tool. Findings from these analyses will be shared via national and international conferences and through publication in open access, peer-reviewed journals. Trial registration number PROSPERO International prospective register of systematic reviews (CRD42017068915).

Headaches Attributed to Ischemic Stroke and Transient Ischemic Attack

Abstract: Introduction Although headaches attributed to ischemic strokes and transient ischemic attack occur frequently, they are often overlooked and underdiagnosed as manifestations of cerebrovascular disease. Method This is a narrative review. Results The prevalence of headache attributed to ischemic stroke varies between 7.4% and 34% of cases and of headache attributed to transient ischemic attack, from 26% to 36%. Headache attributed to ischemic stroke is more frequent in younger patients, in migraineurs, in those who have suffered a larger stroke, a posterior circulation infarction, or a cortical infarction, and is less frequent in lacunar infarctions. The most common pattern of headache attributed to ischemic stroke is a mild to moderate bilateral pain, not associated with nausea, vomiting, photophobia, or phonophobia. This headache usually has a concomitant onset with focal neurologic deficit and improves over time. The few studies that have assessed the value of headache for a prognosis of ischemic strokes have demonstrated conflicting results. There are no clinical trials on pain management or prophylactic treatment of persistent headache attributed to ischemic stroke. Conclusion Headache attributed to ischemic stroke is frequent and usually has a tension-type headache pattern. Its frequency varies according to the stroke's etiology. Further studies are required on pain management, prophylactic treatment, and characteristics of this headache.

Functional diversity and composition of Caatinga woody flora are negatively impacted by chronic anthropogenic disturbance

Abstract: Tropical plant assemblages can be taxonomically and phylogenetically impoverished by chronic anthropogenic disturbance (CAD), such as firewood collection and extensive grazing. However, to what extent the functional dimension responds to CAD is still unclear. Such knowledge is urgently required for predicting, preventing or even reversing the impacts of CAD. Chronic anthropogenic disturbance may operate as an ecological filter by selecting functional trait values (e.g. low wood density), thereby altering the functional composition and diversity of plant assemblages. We tested this hypothesis using 29 woody plant assemblages across three ontogenetic stages (seedlings, saplings and adults) in a 220-km 2 landscape of the Caatinga, northeast Brazil. We adopted a CAD index consisting of four indicators (proximity to urban centre and houses and the density of both people and livestock) and tested how well it explained the functional diversity and effect sizes (richness, evenness and dispersion) and composition (community-weighted mean). Chronic anthropogenic disturbance affected several functional metrics across the three ontogenetic stages. However, CAD effects were stronger in adult communities by negatively affecting functional richness, dispersion and their effect sizes. CAD also altered the functional composition of leaf mass per area, woody density and leaf area of adult assemblages. Sapling communities were affected in terms of functional composition (leaf area, leaf dry matter and wood density), with positive and negative effects, while seedling assemblages responded positively to CAD only in terms of functional evenness and its effect size. Some changes in functional metrics were influenced by dominant Euphorbiaceae species across ontogenetic stages, especially in terms of leaf area and woody density. Synthesis. Chronic anthropogenic disturbance is an important driver of plant-community functional organization across ontogenetic stages in the Caatinga. Adult assemblages are particularly sensitive and tend to lose functional niche space and support more acquisitive rather than conservative strategies as chronic anthropogenic disturbance increases. The proliferation of Euphorbiaceae disturbance-adapted species can explain part of the community responses to chronic anthropogenic disturbance. Our findings highlight the ecological effects of chronic anthropogenic disturbance and show that it is a key influence on tropical biotas. Changes in plant functional traits associated with plant resource use are likely to affect ecosystem functioning and services provided by Caatinga.

Anaerobic Digestion Process for the Production of Biogas from Cassava and Sewage Treatment Plant Sludge in Brazil

Abstract: Due to the current need for alternative energy sources associated with the practice of actions to improve the environment, residual biomass has gained ground and importance in the energy sector, because of its high availability and cost-benefit, contributing to sustainable development. This study aimed to evaluate the process of anaerobic digestion using cassava wastewater, a pollutant and toxic residue of cassava processing, and sludge from a sewage treatment plant, to determine the best conditions for the production of biogas and to identify its chemical composition, specifically the levels of methane and carbon dioxide. To accomplish this, six anaerobic digestion media were produced and placed into 100-mL penicillin bottles. The experiments were carried out in triplicate, differentiated by the substrate/inoculum concentration (on a mass basis) and by the type of inoculum used (primary or secondary sludge). The best result was achieved using the following media: 80% cassava wastewater and 20% primary sludge, 4:1, which produced the highest methane content in the biogas over the shortest period of time, reaching 81.41% mol/mol of methane in 48 days of fermentation. In this way, biogas produced by cassava wastewater, both in large starch-producing factories and in smaller flour factories, can be used as a source of renewable energy, reducing production costs and providing an environmentally correct destination for this waste.

Privileged Structures in the Design of Potential Drug Candidates for Neglected Diseases.

Abstract: Background Privileged motifs are recurring in a wide range of biologically active compounds that reach different pharmaceutical targets and pathways and could represent a suitable start point to access potential candidates in the neglected diseases field. The current therapies to treat these diseases are based in drugs that lack of the desired effectiveness, affordable methods of synthesis and allow a way to emergence of resistant strains. Due the lack of financial return, only few pharmaceutical companies have been investing in research for new therapeutics for neglected diseases (ND). Methods Based on the literature search from 2002 to 2016, we discuss how six privileged motifs, focusing phthalimide, isatin, indole, thiosemicarbazone, thiazole, and thiazolidinone are particularly recurrent in compounds active against some of neglected diseases. Results It was observed that attention was paid particularly for Chagas disease, malaria, tuberculosis, schistosomiasis, leishmaniasis, dengue, African sleeping sickness (Human African Trypanosomiasis - HAT) and toxoplasmosis. It was possible to verify that, among the ND, antitrypanosomal and antiplasmodial activities were between the most searched. Besides, thiosemicarbazone moiety seems to be the most versatile and frequently explored scaffold. As well, phthalimide, isatin, thiazole, and thiazolidone nucleus have been also explored in the ND field. Conclusion Some described compounds, appear to be promising drug candidates, while others could represent a valuable inspiration in the research for new lead compounds.

Association of Severe Hydrocephalus With Congenital Zika Syndrome.

Abstract: Importance Hydrocephalus is a treatable but potentially fatal complication that has not been previously described in congenital Zika syndrome (CZS). Objective To describe the clinical features and imaging findings in 24 patients with congenital Zika syndrome (CZS) who developed hydrocephalus. Design, Setting, and Participants This case series included patients with hydrocephalus who were born in October and November 2015 and followed up until mid-2017 in the 2 largest national referral centers for CZS in Brazil. The participants included consecutively enrolled children with a clinical and laboratorial diagnosis of CZS who developed clinical and/or image findings suggestive of hydrocephalus and who were confirmed to experience increased intracranial hypertension during ventriculoperitoneal shunt procedures. Main Outcomes and Measures To retrospectively describe clinical and image findings in these 24 patients. Results This multicenter cohort included 308 patients with CZS; 24 consecutive children were enrolled in this study. These children were aged between 3 to 18 months, and 13 of 24 (54%) were female. All patients presented with at least 1 positive test result for anti-Zika antibodies in cerebrospinal fluid or serum and had classic signs of CZS. At the time of hydrocephalus diagnosis, only 14 of 24 patients (58%) had symptoms and signs suggestive of hydrocephalus (mainly worsening seizures, vomiting, irritability, and/or sudden increase of head circumference percentile). Two of 24 patients (8%) had no symptoms suggestive of hydrocephalus but were found to have reduced brain volume on repeated imaging. Cerebellar or brainstem hypoplasia on baseline imaging were found in 18 of 23 patients (78%). At the second computed tomographic scan, all patients showed a marked increase of ventricular volume, compatible with communicating hydrocephalus, and reduction of brain tissue that was visibly worse than on baseline imaging for the 23 patients with repeated scans. Conclusions and Relevance We present evidence that hydrocephalus is a complication of CZS in at least a proportion of patients. The clinical spectrum of this condition continues to evolve, but given that presenting signs and symptoms of hydrocephalus can be challenging to recognize in CZS, we provisionally recommend that high suspicion and appropriate monitoring for hydrocephalus should be part of the standard care of patients with CZS.

Small IncQ1 and Col-Like Plasmids Harboring bla KPC-2 and Non-Tn 4401 Elements (NTE KPC -IId) in High-Risk Lineages of Klebsiella pneumoniae CG258.

Abstract: A retrospective genomic study led to the identification of two carbapenem-resistant K. pneumoniae isolates (KPN535 and KPC45) carrying bla KPC-2 genes on non-conjugative plasmids.….

Updated Geriatric Cardiology Guidelines of the Brazilian Society of Cardiology - 2019.

Abstract: Atualizacao das Diretrizes em Cardiogeriatria da Sociedade Brasileira de Cardiologia – 2019