BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has become a major health concern worldwide.In that context,the understanding of epidemiological and clinical features associated with the disease and its seve...BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has become a major health concern worldwide.In that context,the understanding of epidemiological and clinical features associated with the disease and its severity is crucial for the establishment of strategies aimed at disease control and remedy.AIM To describe epidemiological features,signs,symptoms,and laboratory findings among severely ill COVID-19 patients from an inten-sive care unit in northeastern Brazil as well as to evaluate predictor factors for disease outcomes.METHODS This is a prospective single-center study that evaluated 115 patients admitted to the intensive care unit in a northeastern Brazilian hospital.RESULTS The patients had a median age of 65.60±15.78 years.Dyspnea was the most frequent symptom,affecting 73.9%of the patients,followed by cough(54.7%).Fever was reported in approximately one-third of patients and myalgia in 20.8%of the patients.At least two comorbidities were found in 41.7%of the patients,and hypertension was the most prevalent(57.3%).In addition,having two or more comorbidities was a predictor of mortality,and lower platelet count was positively associated with death.Nausea and vomiting were two symptoms that were predictors of death,and the presence of a cough was a protective factor.CONCLUSION This is the first report of a negative correlation between cough and death in severely ill severe acute respiratory syndrome coronavirus 2-infected individuals.The associations between comorbidities,advanced age,and low platelet count and the outcomes of the infection were similar to the results of previous studies,highlighting the relevance of these features.展开更多
BACKGROUND Helicobacter pylori(H.pylori)infection has been well-established as a significant risk factor for several gastrointestinal disorders.The urea breath test(UBT)has emerged as a leading non-invasive method for...BACKGROUND Helicobacter pylori(H.pylori)infection has been well-established as a significant risk factor for several gastrointestinal disorders.The urea breath test(UBT)has emerged as a leading non-invasive method for detecting H.pylori.Despite numerous studies confirming its substantial accuracy,the reliability of UBT results is often compromised by inherent limitations.These findings underscore the need for a rigorous statistical synthesis to clarify and reconcile the diagnostic accuracy of the UBT for the diagnosis of H.pylori infection.AIM To determine and compare the diagnostic accuracy of 13C-UBT and 14C-UBT for H.pylori infection in adult patients with dyspepsia.METHODS We conducted an independent search of the PubMed/MEDLINE,EMBASE,and Cochrane Central databases until April 2022.Our search included diagnostic accuracy studies that evaluated at least one of the index tests(^(13)C-UBT or ^(14)C-UBT)against a reference standard.We used the QUADAS-2 tool to assess the methodo-logical quality of the studies.We utilized the bivariate random-effects model to calculate sensitivity,specificity,positive and negative test likelihood ratios(LR+and LR-),as well as the diagnostic odds ratio(DOR),and their 95%confidence intervals.We conducted subgroup analyses based on urea dosing,time after urea administration,and assessment technique.To investigate a possible threshold effect,we conducted Spearman correlation analysis,and we generated summary receiver operating characteristic(SROC)curves to assess heterogeneity.Finally,we visually inspected a funnel plot and used Egger’s test to evaluate publication bias.endorsing both as reliable diagnostic tools in clinical practice.CONCLUSION In summary,our study has demonstrated that ^(13)C-UBT has been found to outperform the ^(14)C-UBT,making it the preferred diagnostic approach.Additionally,our results emphasize the significance of carefully considering urea dosage,assessment timing,and measurement techniques for both tests to enhance diagnostic precision.Nevertheless,it is crucial for researchers and clinicians to evaluate the strengths and limitations of our findings before implementing them in practice.展开更多
BACKGROUND Gastric mucosa-associated lymphoid tissue(MALT)lymphoma(GML)is usually a low-grade B-cell neoplasia strongly associated with Helicobacter pylori(H.pylori)-induced chronic gastritis.Clinical practice guideli...BACKGROUND Gastric mucosa-associated lymphoid tissue(MALT)lymphoma(GML)is usually a low-grade B-cell neoplasia strongly associated with Helicobacter pylori(H.pylori)-induced chronic gastritis.Clinical practice guidelines currently recommend H.pylori eradication as the preferred initial treatment for early-stage GML.To determine the practical effect of bacterial eradication as the sole initial therapy for early-stage GML,an updated analysis and review of available evidence is imperative.AIM To perform a meta-analysis to assess the rate of complete remission(CR)of H.pylori-positive early-stage GML following bacterial eradication.METHODS We performed independent,computer-assisted literature searches using the PubMed/MEDLINE,Embase,and Cochrane Central databases through September 2022.Prospective and retrospective observational studies evaluating the CR of early-stage GML following bacterial eradication in H.pylori-positive patients.The risk of bias was assessed using Joanna Briggs Institute(JBI)Critical Appraisal Tools.The pooled estimate of the complete histopathological remission rate and respective confidence intervals(95%CI)were calculated following the random-effects model.Heterogeneity and inconsistency were assessed using Cochran’s Q test and I2 statistic,and heterogeneity was defined as P<0.01 and I²>50%,respectively.Subgroup and meta-regression analyses were conducted to explore potential sources of heterogeneity.RESULTS The titles and abstracts of 1576 studies were screened;96 articles were retrieved and selected for full-text reading.Finally,61 studies were included in the proportional meta-analysis(P-MA).Forty-six were prospective and fifteen were retrospective uncontrolled,single-arm,observational studies.The overall risk of bias was low to moderate in all but a single report,with an average critical appraisal score across all studies of 79.02%.A total of 2936 H.pylori-positive early-stage GML patients,in whom H.pylori was successfully eradicated,were included in the analysis.The pooled CR of H.pylori-positive early-stage GML after bacterial eradication was 75.18%(95%CI:70.45%-79.91%).P-MA indicated the substantial heterogeneity in CR reported across studies(I2=92%;P<0.01).Meta-regression analysis identified statistically significant effect modifiers,including the proportion of patients with t(11;18)(q21;q21)-positive GML and the risk of bias in each study.CONCLUSION Comprehensive synthesis of available evidence suggests that H.pylori eradication is effective as the sole initial therapy for early-stage GML.Although the substantial heterogeneity observed across studies limits the interpretation of the pooled overall CR,the present study is a relevant to informing clinical practice.展开更多
Chronic myeloid leukemia(CML)is a myeloproliferative neoplasm and was the first neoplastic disease associated with a well-defined genotypic anomaly―the presence of the Philadelphia chromosome.The advances in cytogene...Chronic myeloid leukemia(CML)is a myeloproliferative neoplasm and was the first neoplastic disease associated with a well-defined genotypic anomaly―the presence of the Philadelphia chromosome.The advances in cytogenetic and molecular assays are of great importance to the diagnosis,prognosis,treatment,and monitoring of CML.The discovery of the breakpoint cluster region(BCR)-Abelson murine leukemia(ABL)1 fusion oncogene has revolutionized the treatment of CML patients by allowing the development of targeted drugs that inhibit the tyrosine kinase activity of the BCR-ABL oncoprotein.Tyrosine kinase inhibitors(known as TKIs)are the standard therapy for CML and greatly increase the survival rates,despite adverse effects and the odds of residual disease after discontinuation of treatment.As therapeutic alternatives,the subsequent TKIs lead to faster and deeper molecular remissions;however,with the emergence of resistance to these drugs,immunotherapy appears as an alternative,which may have a cure potential in these patients.Against this background,this article aims at providing an overview on CML clinical management and a summary on the main targeted drugs available in that context.展开更多
Helicobacter pylori(H.pylori)is a Gram-negative bacterium that infects about half of the world's population.H.pylori infection prevails by several mechanisms of adaptation of the bacteria and by its virulence fact...Helicobacter pylori(H.pylori)is a Gram-negative bacterium that infects about half of the world's population.H.pylori infection prevails by several mechanisms of adaptation of the bacteria and by its virulence factors including the cytotoxin associated antigen A(CagA).CagA is an oncoprotein that is the protagonist of gastric carcinogenesis associated with prolonged H.pylori infection.In this sense,small regulatory RNAs(sRNAs)are important macromolecules capable of inhibiting and activating gene expression.This function allows sRNAs to act in adjusting to unstable environmental conditions and in responding to cellular stresses in bacterial infections.Recent discoveries have shown that nickelregulated small RNA(NikS)is a post-transcriptional regulator of virulence properties of H.pylori,including the oncoprotein CagA.Notably,high concentrations of nickel cause the reduction of NikS expression and consequently this increases the levels of CagA.In addition,NikS expression appears to be lower in clinical isolates from patients with gastric cancer when compared to patients without.With that in mind,this minireview approaches,in an accessible way,the most important and current aspects about the role of NikS in the control of virulence factors of H.pylori and the potential clinical repercussions of this modulation.展开更多
BACKGROUND Group B Streptococcus(GBS)is a normal component of the gastrointestinal and genital microbiota in humans and can lead to important infections in newborns.AIM To compare GBS isolation and identification meth...BACKGROUND Group B Streptococcus(GBS)is a normal component of the gastrointestinal and genital microbiota in humans and can lead to important infections in newborns.AIM To compare GBS isolation and identification methods as well as to assess the antibiotic susceptibility and to identify resistance genes in GBS strains from pregnant women attended in healthcare services from the city of Vitória da Conquista,in Bahia State,Brazil.METHODS From January 2017 to February 2018,vaginorectal swabs were obtained from 186 participants and the samples were seeded onto chromogenic agar for GBS before and after inoculation in selective broth.Confirmatory identification using 3 CAMP and latex tests was performed in samples with GBS-suggestive colonies.Then,disk diffusion antibiograms were performed in GBS-positive samples,and the detection of the resistance genes ermB,ermTR,mefA,and linB in the clindamycin and/or erythromycin-resistant samples was carried out.RESULTS Thirty-two samples(17.2%)were GBS-positive.The culture in chromogenic agar after sample incubation in selective broth was the most sensitive method(96.9%)for GBS detection.All isolates were susceptible to penicillin,ampicillin,cefotaxime,and vancomycin.Clindamycin resistance was observed in 6 samples(18.8%),while 8 samples(25%)were erythromycin-resistant.All erythromycin and/or clindamycin-resistant GBS strains had negative D-tests.Two strains(25%)presented an M phenotype and 6 isolates(75%)presented a cMLSB phenotype.The ermB gene was identified in 4 samples(44.4%),the mefA gene was also found in 4 samples(44.4%),the ermTR gene was identified in 1 isolate(11.1%),and the linB gene was not found in any isolate.CONCLUSION This study evidenced that the screening for SGB can be performed by means of various methods,including chromogenic media,and that the chemoprophylaxis for pregnant women who cannot use penicillin must be susceptibility-guided.展开更多
Gastric cancer is the fifth most common malignancy and third leading cancerrelated cause of death worldwide.Helicobacter pylori is a Gram-negative bacterium that inhabits the gastric environment of 60.3%of the world’...Gastric cancer is the fifth most common malignancy and third leading cancerrelated cause of death worldwide.Helicobacter pylori is a Gram-negative bacterium that inhabits the gastric environment of 60.3%of the world’s population and represents the main risk factor for the onset of gastric neoplasms.CagA is the most important virulence factor in H.pylori,and is a translocated oncoprotein that induces morphofunctional modifications in gastric epithelial cells and a chronic inflammatory response that increases the risk of developing precancerous lesions.Upon translocation and tyrosine phosphorylation,CagA moves to the cell membrane and acts as a pathological scaffold protein that simultaneously interacts with multiple intracellular signaling pathways,thereby disrupting cell proliferation,differentiation and apoptosis.All these alterations in cell biology increase the risk of damaged cells acquiring pro-oncogenic genetic changes.In this sense,once gastric cancer sets in,its perpetuation is independent of the presence of the oncoprotein,characterizing a“hit-and-run”carcinogenic mechanism.Therefore,this review aims to describe H.pylori-and CagA-related oncogenic mechanisms,to update readers and discuss the novelties and perspectives in this field.展开更多
Gastric cancer(GC)is the result of a multifactorial process whose main components are infection by Helicobacter pylori(H.pylori),bacterial virulence factors,host immune response and environmental factors.The developme...Gastric cancer(GC)is the result of a multifactorial process whose main components are infection by Helicobacter pylori(H.pylori),bacterial virulence factors,host immune response and environmental factors.The development of the neoplastic microenvironment also depends on genetic and epigenetic changes in oncogenes and tumor suppressor genes,which results in deregulation of cell signaling pathways and apoptosis process.This review summarizes the main aspects of the pathogenesis of GC and the immune response involved in chronic inflammation generated by H.pylori.展开更多
BACKGROUNDG roup B Streptococcus agalactiae (GBS) is the main etiologic agent associated withearly-onset neonatal sepsis, and of all newborns of parturients colonized by GBS,approximately 1%-2% develop invasive, early...BACKGROUNDG roup B Streptococcus agalactiae (GBS) is the main etiologic agent associated withearly-onset neonatal sepsis, and of all newborns of parturients colonized by GBS,approximately 1%-2% develop invasive, early-onset disease. The risk of infectionincreases to 15.2% in premature neonates, to 10.7% when the parturient haschorioamnionitis or premature rupture of membranes for more than 24 h and to9.7% if the mother has postpartum bacteremia. In addition to causing perinatal,neonatal and postnatal deaths, neonatal hospital infection is associated with highcosts, as hospitalization is three times longer than in uninfected children. Theidentification of pregnant women colonized by GBS, through universal screening,associated with the adoption of appropriate antibiotics at the time of delivery arethe most successful preventive measures.AIMTo evaluate the sensitivity profile of GBS isolated from pregnant womenattending Vitória da Conquista-BA.METHODS This is a cross-sectional study with a quantitative approach carried out in themunicipality of Vitória da Conquista-Bahia between February 2017 and March2018. The study population was composed of 210 pregnant women, with agestational age of 32 to 40 wk, who were aged 18 years or older living in the urbanarea of the municipality of Vitória da Conquista. After a brief explanation aboutthe research and obtaining a signed an informed consent form, data andvaginorectal swabs were collected from the women for GBS research. Examinationof the samples in order to identify the presence of GBS was by culture on sheep blood agar and chromogenic agar for GBS and then, seeded on plates containingstreptococcal culture medium and incubated for 18 h to 24 h at 35°C. Theantimicrobial sensitivity profile of positive GBS samples was determined by thedisk diffusion technique, according to the Clinical and Laboratory StandardsInstitute manual (2017). The data obtained were stored in a database usingMicrosoft Office Excel spreadsheets and a descriptive analysis was performedwith the aid of the EPI-INFO statistical package (version 3.5.2).RESULTSAmong the 210 pregnant women participating in the study, 38 (18.1%) had apositive GBS culture. All strains isolated from GBS were sensitive to 10 Upenicillin, 10 μg ampicillin, 30 μg cefotaxime and 30 μg vancomycin. Seven strains(18.4%) resistant to clindamycin 2 μg and eight (21.1%) resistant to erythromycin15 μg were found. Of these, six were concomitantly resistant to erythromycin andclindamycin, two resistant only to erythromycin and one resistant only toclindamycin. All nine GBS isolates that showed resistance to erythromycin and/orclindamycin showed negative results on the D-test. Two thirds of the isolatesshowed cMLSB phenotype and resistance only to erythromycin in specimens inthis study (02), refers to strains with phenotype M and resistance to clindamycin(01) only with phenotype L.CONCLUSIONChemoprophylaxis for GBS in pregnant women, especially for those allergic topenicillin, should be guided by an antimicrobial susceptibility test as resistantGBS strains were reported in this study.展开更多
BACKGROUND Abortion is of great importance in public health,as it is among the main causes of maternal morbidity and mortality.In addition to sociodemographic-and lifestylerelated factors,studies have associated infec...BACKGROUND Abortion is of great importance in public health,as it is among the main causes of maternal morbidity and mortality.In addition to sociodemographic-and lifestylerelated factors,studies have associated infections of the genital tract with higher rates of abortion.Therefore,the exacerbated presence and rise of Mollicutes in the genitourinary tract may be related to higher rates of abortion.AIM To perform an epidemiological analysis of women who had spontaneous abortions and placental colonization by Mollicutes in a maternity hospital.METHODS This cross-sectional study involved the collection of data and biological material from women hospitalized due to spontaneous abortion or term delivery.The sample consisted of 89 women who miscarried and 20 women who had full term pregnancy.Data collection was carried out in three stages:(1)Conducting research on the information and clinical data in medical records of patients hospitalized due to abortion;(2)Application of a semi-structured questionnaire to identify the patient's epidemiological profile and(3)Collection of placental tissue.Placental samples were collected after the curettage procedure(abortion)and after placental expulsion(delivery),both performed by an obstetrician.Microbial identification in the fragments was performed by real-time polymerase chain reaction.In this study,the following explanatory variables were considered:(1)Sociodemographic variables;(2)Variables related to access to health services;(3)Variables related to lifestyle;and(4)Variables related to sexual and reproductive health,all of which were used to perform descriptive,univariate and multivariate analyses.RESULTS In the final model,placental colonization by Mollicutes was independently associated with the variables age[odds ratio(OR)=7.55;CI:2.37-24.03]and menarche(OR=3.43;CI:1.03-11.44).In this investigation,the prevalence of Mollicutes colonization by at least one of the following three species:Mycoplasma hominis,Ureaplasma urealyticum,Ureaplasma parvum in women who had spontaneous abortion was 73.0%.When comparing colonization between the two groups of participating women,there was an 8.12-fold risk of placental colonization by at least one Mollicutes species in the women who had an abortion,compared to those who completed pregnancy.The final multivariate analysis model revealed a statistically significant association between placental colonization by Mollicutes in abortion with the following variables:age,as women up to 29 years old had a 7.55-fold risk of spontaneous abortion,compared to those who were older than 29 years;menarche,where women who had menarche up to 13 years old had a 3.43-fold risk of miscarriage compared to those who had menarche over 13 years old;and a change in eating habits,after the discovery of pregnancy,was a protective factor(OR=0.16).CONCLUSION These findings revealed a positive association between spontaneous abortion and placental colonization by Mollicutes.This indicates the need for further investigation of this issue,to guide decision-making for the prevention of abortion.展开更多
BACKGROUND One of the main difficulties faced in the prevention of the vertical transmission of syphilis is the inadequate treatment of pregnant women and their partners.The disease causes serious repercussions in inf...BACKGROUND One of the main difficulties faced in the prevention of the vertical transmission of syphilis is the inadequate treatment of pregnant women and their partners.The disease causes serious repercussions in infected newborns.AIM To evaluate the prevalence and factors associated with the therapeutic adhesion among partners of pregnant women with syphilis in a county in Northeastern Brazil.METHODS This is a descriptive,analytic,quantitative,cross-sectional study that was carried out through interviews with 46 pregnant women diagnosed with syphilis between 2017 and 2018 as well as with their partners.The interviews aimed at collecting data regarding sociodemographic characteristics,obstetric variables and information about syphilis,and partners’related variables.RESULTS Our results showed that 73.91%of the partners did not undergo appropriate treatments,and obtaining negative results in syphilis tests was the main reason for the absence of therapies.The following factors were significantly associated with the lack of treatment among partners:Being a partner that is not the current mate of the pregnant woman,having a level of schooling inferior to 8 years[oddsratio(OR)=10.28],and the pregnant woman undergoing up to two syphilis tests during the prenatal care(OR=8.6).The study found a higher odds of absent treatment among partners if the pregnant woman is not white(OR=13.88)or if the partner has less than 8 years of schooling(OR=21.00)or has a monthly income of less than half the minimum wage(OR=13.93).CONCLUSION The findings of this study show a high prevalence of partners that are not adequately treated for syphilis,a phenomenon that is strongly associated with socioeconomic factors.展开更多
BACKGROUND Human papillomavirus(HPV)is one of the most common sexually transmitted viruses nowadays.AIM To analyze the prevalence of HPV infection in human immunodeficiency virus(HIV)-positive patients and the risk fa...BACKGROUND Human papillomavirus(HPV)is one of the most common sexually transmitted viruses nowadays.AIM To analyze the prevalence of HPV infection in human immunodeficiency virus(HIV)-positive patients and the risk factors associated with this infection through a review of studies published in the period from January 2010 to April 2020.METHODS A total of 384 articles were initially identified in our searches,of which ten were selected according to previously defined eligibility criteria.RESULTS Anal intercourse,absence of condom use,multiple partners,other specific sexual and life habits,and HIV infection are among the risk factors associated with anal HPV infection.CONCLUSION In general,there is a higher prevalence of anal HPV infection among HIV-positive patients,mostly in individuals over 30 years old,those with multiple partners,those who had an early homosexual debut,and cigarette,alcohol,and drug users.展开更多
BACKGROUND Given the high prevalence of cardiovascular and pulmonary abnormalities associated with sickle cell anemia(SCA),the clinical impact caused in addition to compromising the quality of life of patients and the...BACKGROUND Given the high prevalence of cardiovascular and pulmonary abnormalities associated with sickle cell anemia(SCA),the clinical impact caused in addition to compromising the quality of life of patients and the overcharge that it represents to the public health system,this study systematized and evaluated scientific publications on pulmonary complications and cardiovascular diseases in sickle cell patients from 1920 to 2020.This compilation aims to provide knowledge for health professionals and managers in order to draw attention to the importance of chronic diseases in SCA patients and in addition to providing elements that provide improvements in management of useful resources that contribute to improve the quality and increase the life expectancy of these patients.AIM To systematically compile information about cardiopulmonary changes in patients with SCA.METHODS A systematic literature review was performed based on the PRISMA recommendation including scientific articles indexed in the Scientific Electronic Library Online databases of the United States National Library of Medicine and Biblioteca Virtual de Saúde.The search period was delimited between 1990 and 2020 and selected in Portuguese,English and Spanish.Three sets of descriptors were used for each database including research carried out with human beings.After reading the articles,those useful for this review were extracted using a collection instrument designed for this purpose.RESULTS The final selection included 27 studies.The year with the highest number of publications was 2016 with 5 studies(18.51%),followed by 2017 with 4(14.81%).The type of study most carried out in the period was cohort 10(37.03%)followed by cross-sectional and case-control with 8 studies in each(29.62%).Regarding the language of publication,the distribution was as follows:25(92.59%)in English,1(3.70%)in Spanish and 1(3.70%)in Portuguese.CONCLUSION The findings of the present study suggest that cardiopulmonary alterations represent a serious clinical repercussion of SCA.Of the analyzed studies,the high occurrence of pulmonary hypertension,ventricular hypertrophy and diastolic dysfunction stands out as the main cardiopulmonary complications.In view of the increased survival in SCA,there is a need for surveillance and the development of strategies aimed at preserving the cardiopulmonary function and consequently improving the quality of life of these patients.展开更多
Objective:This review aimed to compile scientific data on the distribution and prevalence of group BStreptococcus (GBS) serotypes isolated from pregnant women across 30 countries from 2010 to 2019.Methods:This was a s...Objective:This review aimed to compile scientific data on the distribution and prevalence of group BStreptococcus (GBS) serotypes isolated from pregnant women across 30 countries from 2010 to 2019.Methods:This was a systematic review that addresses the distribution and prevalence of GBS in pregnant women.The search included studies published between January 2010 and December 2019 in PubMed,Virtual Health Library (BVS),ScienceDirect,Scientific Electronic Library Online (SciELO),and LILACS databases.We also surveyed relevant articles published in English,Spanish,and Portuguese between February and April 2020.Original articles,communication,short report,theses,and dissertations were included.The prevalence of GBS colonization,method for capsular serotyping,antimicrobial resistance,distribution and prevalence of serotypes were extracted from each study.Results:In all,795 publications were identified.After applying the eligibility criteria,48 articles were included for the final systematic analysis;most articles were from Asia and were published during the years 2014 to 2017.For the identification of serotypes,most studies used the polymerase chain reaction technique.There were records of all 10 GBS serotypes,namely,Ia,Ib,and II–IX,among the countries analyzed.GBS susceptibility and resistance to antibiotics were addressed in 37.5% of the publications analysed.Conclusion:This review showed that GBS serotypes are distributed differently in the 30 analyzed countries,with serotypes Ia,Ib,and II to V being the most prevalent.Furthermore,our results highlighted the relationship of GBS with maternal colonization,implications for neonates,and antibiotic resistance.展开更多
基金Supported by FAPEMIG Edital 001/2020-Programa Emergencial de Apoio a Ações de Enfrentamento da Pandemia Causada pelo Novo Coronavírus.FUNDAÇÃO DE AMPAROÀPESQUISA DO ESTADO DA BAHIA–FAPESB,PPSUS-Programa Pesquisa para o SUS-Headline 02/2020,Term of Grant nºSUS0025/2021Magalhães Queiroz DM,Freire de Melo F,are research fellows of the Conselho Nacional de Desenvolvimento Científico e Tecnológico(CNPq-)–Brazil.Programa Permanecer da Universidade Federal da Bahia.Programa Institucional de Bolsas de Iniciação Científica da Universidade Federal da Bahia(PIBIC-UFBA).
文摘BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has become a major health concern worldwide.In that context,the understanding of epidemiological and clinical features associated with the disease and its severity is crucial for the establishment of strategies aimed at disease control and remedy.AIM To describe epidemiological features,signs,symptoms,and laboratory findings among severely ill COVID-19 patients from an inten-sive care unit in northeastern Brazil as well as to evaluate predictor factors for disease outcomes.METHODS This is a prospective single-center study that evaluated 115 patients admitted to the intensive care unit in a northeastern Brazilian hospital.RESULTS The patients had a median age of 65.60±15.78 years.Dyspnea was the most frequent symptom,affecting 73.9%of the patients,followed by cough(54.7%).Fever was reported in approximately one-third of patients and myalgia in 20.8%of the patients.At least two comorbidities were found in 41.7%of the patients,and hypertension was the most prevalent(57.3%).In addition,having two or more comorbidities was a predictor of mortality,and lower platelet count was positively associated with death.Nausea and vomiting were two symptoms that were predictors of death,and the presence of a cough was a protective factor.CONCLUSION This is the first report of a negative correlation between cough and death in severely ill severe acute respiratory syndrome coronavirus 2-infected individuals.The associations between comorbidities,advanced age,and low platelet count and the outcomes of the infection were similar to the results of previous studies,highlighting the relevance of these features.
基金Supported by Scientific Initiation Scholarship Programme(PIBIC)of the Bahia State Research Support Foundationthe Doctorate Scholarship Program of the Coordination of Improvement of Higher Education Personnel+1 种基金the Scientific Initiation Scholarship Programme(PIBIC)of the National Council for Scientific and Technological Developmentand the CNPq Research Productivity Fellowship.
文摘BACKGROUND Helicobacter pylori(H.pylori)infection has been well-established as a significant risk factor for several gastrointestinal disorders.The urea breath test(UBT)has emerged as a leading non-invasive method for detecting H.pylori.Despite numerous studies confirming its substantial accuracy,the reliability of UBT results is often compromised by inherent limitations.These findings underscore the need for a rigorous statistical synthesis to clarify and reconcile the diagnostic accuracy of the UBT for the diagnosis of H.pylori infection.AIM To determine and compare the diagnostic accuracy of 13C-UBT and 14C-UBT for H.pylori infection in adult patients with dyspepsia.METHODS We conducted an independent search of the PubMed/MEDLINE,EMBASE,and Cochrane Central databases until April 2022.Our search included diagnostic accuracy studies that evaluated at least one of the index tests(^(13)C-UBT or ^(14)C-UBT)against a reference standard.We used the QUADAS-2 tool to assess the methodo-logical quality of the studies.We utilized the bivariate random-effects model to calculate sensitivity,specificity,positive and negative test likelihood ratios(LR+and LR-),as well as the diagnostic odds ratio(DOR),and their 95%confidence intervals.We conducted subgroup analyses based on urea dosing,time after urea administration,and assessment technique.To investigate a possible threshold effect,we conducted Spearman correlation analysis,and we generated summary receiver operating characteristic(SROC)curves to assess heterogeneity.Finally,we visually inspected a funnel plot and used Egger’s test to evaluate publication bias.endorsing both as reliable diagnostic tools in clinical practice.CONCLUSION In summary,our study has demonstrated that ^(13)C-UBT has been found to outperform the ^(14)C-UBT,making it the preferred diagnostic approach.Additionally,our results emphasize the significance of carefully considering urea dosage,assessment timing,and measurement techniques for both tests to enhance diagnostic precision.Nevertheless,it is crucial for researchers and clinicians to evaluate the strengths and limitations of our findings before implementing them in practice.
基金the Scientific Initiation Scholarship Programme (PIBIC) of the Bahia State Research Support Foundation,FAPESB,Brazilthe Doctorate Scholarship Program of the Coordination of Improvement of Higher Education Personnel,CAPES,Brazil+1 种基金the Scientific Initiation Scholarship Programme (PIBIC) of the National Council for Scientific and Technological Development,CNPq,Brazilthe CNPq Research Productivity Fellowship (PQ)
文摘BACKGROUND Gastric mucosa-associated lymphoid tissue(MALT)lymphoma(GML)is usually a low-grade B-cell neoplasia strongly associated with Helicobacter pylori(H.pylori)-induced chronic gastritis.Clinical practice guidelines currently recommend H.pylori eradication as the preferred initial treatment for early-stage GML.To determine the practical effect of bacterial eradication as the sole initial therapy for early-stage GML,an updated analysis and review of available evidence is imperative.AIM To perform a meta-analysis to assess the rate of complete remission(CR)of H.pylori-positive early-stage GML following bacterial eradication.METHODS We performed independent,computer-assisted literature searches using the PubMed/MEDLINE,Embase,and Cochrane Central databases through September 2022.Prospective and retrospective observational studies evaluating the CR of early-stage GML following bacterial eradication in H.pylori-positive patients.The risk of bias was assessed using Joanna Briggs Institute(JBI)Critical Appraisal Tools.The pooled estimate of the complete histopathological remission rate and respective confidence intervals(95%CI)were calculated following the random-effects model.Heterogeneity and inconsistency were assessed using Cochran’s Q test and I2 statistic,and heterogeneity was defined as P<0.01 and I²>50%,respectively.Subgroup and meta-regression analyses were conducted to explore potential sources of heterogeneity.RESULTS The titles and abstracts of 1576 studies were screened;96 articles were retrieved and selected for full-text reading.Finally,61 studies were included in the proportional meta-analysis(P-MA).Forty-six were prospective and fifteen were retrospective uncontrolled,single-arm,observational studies.The overall risk of bias was low to moderate in all but a single report,with an average critical appraisal score across all studies of 79.02%.A total of 2936 H.pylori-positive early-stage GML patients,in whom H.pylori was successfully eradicated,were included in the analysis.The pooled CR of H.pylori-positive early-stage GML after bacterial eradication was 75.18%(95%CI:70.45%-79.91%).P-MA indicated the substantial heterogeneity in CR reported across studies(I2=92%;P<0.01).Meta-regression analysis identified statistically significant effect modifiers,including the proportion of patients with t(11;18)(q21;q21)-positive GML and the risk of bias in each study.CONCLUSION Comprehensive synthesis of available evidence suggests that H.pylori eradication is effective as the sole initial therapy for early-stage GML.Although the substantial heterogeneity observed across studies limits the interpretation of the pooled overall CR,the present study is a relevant to informing clinical practice.
文摘Chronic myeloid leukemia(CML)is a myeloproliferative neoplasm and was the first neoplastic disease associated with a well-defined genotypic anomaly―the presence of the Philadelphia chromosome.The advances in cytogenetic and molecular assays are of great importance to the diagnosis,prognosis,treatment,and monitoring of CML.The discovery of the breakpoint cluster region(BCR)-Abelson murine leukemia(ABL)1 fusion oncogene has revolutionized the treatment of CML patients by allowing the development of targeted drugs that inhibit the tyrosine kinase activity of the BCR-ABL oncoprotein.Tyrosine kinase inhibitors(known as TKIs)are the standard therapy for CML and greatly increase the survival rates,despite adverse effects and the odds of residual disease after discontinuation of treatment.As therapeutic alternatives,the subsequent TKIs lead to faster and deeper molecular remissions;however,with the emergence of resistance to these drugs,immunotherapy appears as an alternative,which may have a cure potential in these patients.Against this background,this article aims at providing an overview on CML clinical management and a summary on the main targeted drugs available in that context.
基金Supported by CNPq Brazil (National Council for Scientific and Technological Development)-FFM,No. 317005/2021-09
文摘Helicobacter pylori(H.pylori)is a Gram-negative bacterium that infects about half of the world's population.H.pylori infection prevails by several mechanisms of adaptation of the bacteria and by its virulence factors including the cytotoxin associated antigen A(CagA).CagA is an oncoprotein that is the protagonist of gastric carcinogenesis associated with prolonged H.pylori infection.In this sense,small regulatory RNAs(sRNAs)are important macromolecules capable of inhibiting and activating gene expression.This function allows sRNAs to act in adjusting to unstable environmental conditions and in responding to cellular stresses in bacterial infections.Recent discoveries have shown that nickelregulated small RNA(NikS)is a post-transcriptional regulator of virulence properties of H.pylori,including the oncoprotein CagA.Notably,high concentrations of nickel cause the reduction of NikS expression and consequently this increases the levels of CagA.In addition,NikS expression appears to be lower in clinical isolates from patients with gastric cancer when compared to patients without.With that in mind,this minireview approaches,in an accessible way,the most important and current aspects about the role of NikS in the control of virulence factors of H.pylori and the potential clinical repercussions of this modulation.
文摘BACKGROUND Group B Streptococcus(GBS)is a normal component of the gastrointestinal and genital microbiota in humans and can lead to important infections in newborns.AIM To compare GBS isolation and identification methods as well as to assess the antibiotic susceptibility and to identify resistance genes in GBS strains from pregnant women attended in healthcare services from the city of Vitória da Conquista,in Bahia State,Brazil.METHODS From January 2017 to February 2018,vaginorectal swabs were obtained from 186 participants and the samples were seeded onto chromogenic agar for GBS before and after inoculation in selective broth.Confirmatory identification using 3 CAMP and latex tests was performed in samples with GBS-suggestive colonies.Then,disk diffusion antibiograms were performed in GBS-positive samples,and the detection of the resistance genes ermB,ermTR,mefA,and linB in the clindamycin and/or erythromycin-resistant samples was carried out.RESULTS Thirty-two samples(17.2%)were GBS-positive.The culture in chromogenic agar after sample incubation in selective broth was the most sensitive method(96.9%)for GBS detection.All isolates were susceptible to penicillin,ampicillin,cefotaxime,and vancomycin.Clindamycin resistance was observed in 6 samples(18.8%),while 8 samples(25%)were erythromycin-resistant.All erythromycin and/or clindamycin-resistant GBS strains had negative D-tests.Two strains(25%)presented an M phenotype and 6 isolates(75%)presented a cMLSB phenotype.The ermB gene was identified in 4 samples(44.4%),the mefA gene was also found in 4 samples(44.4%),the ermTR gene was identified in 1 isolate(11.1%),and the linB gene was not found in any isolate.CONCLUSION This study evidenced that the screening for SGB can be performed by means of various methods,including chromogenic media,and that the chemoprophylaxis for pregnant women who cannot use penicillin must be susceptibility-guided.
基金Supported by National Council for Scientific and Technological Development,CNPq Brazil.
文摘Gastric cancer is the fifth most common malignancy and third leading cancerrelated cause of death worldwide.Helicobacter pylori is a Gram-negative bacterium that inhabits the gastric environment of 60.3%of the world’s population and represents the main risk factor for the onset of gastric neoplasms.CagA is the most important virulence factor in H.pylori,and is a translocated oncoprotein that induces morphofunctional modifications in gastric epithelial cells and a chronic inflammatory response that increases the risk of developing precancerous lesions.Upon translocation and tyrosine phosphorylation,CagA moves to the cell membrane and acts as a pathological scaffold protein that simultaneously interacts with multiple intracellular signaling pathways,thereby disrupting cell proliferation,differentiation and apoptosis.All these alterations in cell biology increase the risk of damaged cells acquiring pro-oncogenic genetic changes.In this sense,once gastric cancer sets in,its perpetuation is independent of the presence of the oncoprotein,characterizing a“hit-and-run”carcinogenic mechanism.Therefore,this review aims to describe H.pylori-and CagA-related oncogenic mechanisms,to update readers and discuss the novelties and perspectives in this field.
文摘Gastric cancer(GC)is the result of a multifactorial process whose main components are infection by Helicobacter pylori(H.pylori),bacterial virulence factors,host immune response and environmental factors.The development of the neoplastic microenvironment also depends on genetic and epigenetic changes in oncogenes and tumor suppressor genes,which results in deregulation of cell signaling pathways and apoptosis process.This review summarizes the main aspects of the pathogenesis of GC and the immune response involved in chronic inflammation generated by H.pylori.
文摘BACKGROUNDG roup B Streptococcus agalactiae (GBS) is the main etiologic agent associated withearly-onset neonatal sepsis, and of all newborns of parturients colonized by GBS,approximately 1%-2% develop invasive, early-onset disease. The risk of infectionincreases to 15.2% in premature neonates, to 10.7% when the parturient haschorioamnionitis or premature rupture of membranes for more than 24 h and to9.7% if the mother has postpartum bacteremia. In addition to causing perinatal,neonatal and postnatal deaths, neonatal hospital infection is associated with highcosts, as hospitalization is three times longer than in uninfected children. Theidentification of pregnant women colonized by GBS, through universal screening,associated with the adoption of appropriate antibiotics at the time of delivery arethe most successful preventive measures.AIMTo evaluate the sensitivity profile of GBS isolated from pregnant womenattending Vitória da Conquista-BA.METHODS This is a cross-sectional study with a quantitative approach carried out in themunicipality of Vitória da Conquista-Bahia between February 2017 and March2018. The study population was composed of 210 pregnant women, with agestational age of 32 to 40 wk, who were aged 18 years or older living in the urbanarea of the municipality of Vitória da Conquista. After a brief explanation aboutthe research and obtaining a signed an informed consent form, data andvaginorectal swabs were collected from the women for GBS research. Examinationof the samples in order to identify the presence of GBS was by culture on sheep blood agar and chromogenic agar for GBS and then, seeded on plates containingstreptococcal culture medium and incubated for 18 h to 24 h at 35°C. Theantimicrobial sensitivity profile of positive GBS samples was determined by thedisk diffusion technique, according to the Clinical and Laboratory StandardsInstitute manual (2017). The data obtained were stored in a database usingMicrosoft Office Excel spreadsheets and a descriptive analysis was performedwith the aid of the EPI-INFO statistical package (version 3.5.2).RESULTSAmong the 210 pregnant women participating in the study, 38 (18.1%) had apositive GBS culture. All strains isolated from GBS were sensitive to 10 Upenicillin, 10 μg ampicillin, 30 μg cefotaxime and 30 μg vancomycin. Seven strains(18.4%) resistant to clindamycin 2 μg and eight (21.1%) resistant to erythromycin15 μg were found. Of these, six were concomitantly resistant to erythromycin andclindamycin, two resistant only to erythromycin and one resistant only toclindamycin. All nine GBS isolates that showed resistance to erythromycin and/orclindamycin showed negative results on the D-test. Two thirds of the isolatesshowed cMLSB phenotype and resistance only to erythromycin in specimens inthis study (02), refers to strains with phenotype M and resistance to clindamycin(01) only with phenotype L.CONCLUSIONChemoprophylaxis for GBS in pregnant women, especially for those allergic topenicillin, should be guided by an antimicrobial susceptibility test as resistantGBS strains were reported in this study.
文摘BACKGROUND Abortion is of great importance in public health,as it is among the main causes of maternal morbidity and mortality.In addition to sociodemographic-and lifestylerelated factors,studies have associated infections of the genital tract with higher rates of abortion.Therefore,the exacerbated presence and rise of Mollicutes in the genitourinary tract may be related to higher rates of abortion.AIM To perform an epidemiological analysis of women who had spontaneous abortions and placental colonization by Mollicutes in a maternity hospital.METHODS This cross-sectional study involved the collection of data and biological material from women hospitalized due to spontaneous abortion or term delivery.The sample consisted of 89 women who miscarried and 20 women who had full term pregnancy.Data collection was carried out in three stages:(1)Conducting research on the information and clinical data in medical records of patients hospitalized due to abortion;(2)Application of a semi-structured questionnaire to identify the patient's epidemiological profile and(3)Collection of placental tissue.Placental samples were collected after the curettage procedure(abortion)and after placental expulsion(delivery),both performed by an obstetrician.Microbial identification in the fragments was performed by real-time polymerase chain reaction.In this study,the following explanatory variables were considered:(1)Sociodemographic variables;(2)Variables related to access to health services;(3)Variables related to lifestyle;and(4)Variables related to sexual and reproductive health,all of which were used to perform descriptive,univariate and multivariate analyses.RESULTS In the final model,placental colonization by Mollicutes was independently associated with the variables age[odds ratio(OR)=7.55;CI:2.37-24.03]and menarche(OR=3.43;CI:1.03-11.44).In this investigation,the prevalence of Mollicutes colonization by at least one of the following three species:Mycoplasma hominis,Ureaplasma urealyticum,Ureaplasma parvum in women who had spontaneous abortion was 73.0%.When comparing colonization between the two groups of participating women,there was an 8.12-fold risk of placental colonization by at least one Mollicutes species in the women who had an abortion,compared to those who completed pregnancy.The final multivariate analysis model revealed a statistically significant association between placental colonization by Mollicutes in abortion with the following variables:age,as women up to 29 years old had a 7.55-fold risk of spontaneous abortion,compared to those who were older than 29 years;menarche,where women who had menarche up to 13 years old had a 3.43-fold risk of miscarriage compared to those who had menarche over 13 years old;and a change in eating habits,after the discovery of pregnancy,was a protective factor(OR=0.16).CONCLUSION These findings revealed a positive association between spontaneous abortion and placental colonization by Mollicutes.This indicates the need for further investigation of this issue,to guide decision-making for the prevention of abortion.
文摘BACKGROUND One of the main difficulties faced in the prevention of the vertical transmission of syphilis is the inadequate treatment of pregnant women and their partners.The disease causes serious repercussions in infected newborns.AIM To evaluate the prevalence and factors associated with the therapeutic adhesion among partners of pregnant women with syphilis in a county in Northeastern Brazil.METHODS This is a descriptive,analytic,quantitative,cross-sectional study that was carried out through interviews with 46 pregnant women diagnosed with syphilis between 2017 and 2018 as well as with their partners.The interviews aimed at collecting data regarding sociodemographic characteristics,obstetric variables and information about syphilis,and partners’related variables.RESULTS Our results showed that 73.91%of the partners did not undergo appropriate treatments,and obtaining negative results in syphilis tests was the main reason for the absence of therapies.The following factors were significantly associated with the lack of treatment among partners:Being a partner that is not the current mate of the pregnant woman,having a level of schooling inferior to 8 years[oddsratio(OR)=10.28],and the pregnant woman undergoing up to two syphilis tests during the prenatal care(OR=8.6).The study found a higher odds of absent treatment among partners if the pregnant woman is not white(OR=13.88)or if the partner has less than 8 years of schooling(OR=21.00)or has a monthly income of less than half the minimum wage(OR=13.93).CONCLUSION The findings of this study show a high prevalence of partners that are not adequately treated for syphilis,a phenomenon that is strongly associated with socioeconomic factors.
文摘BACKGROUND Human papillomavirus(HPV)is one of the most common sexually transmitted viruses nowadays.AIM To analyze the prevalence of HPV infection in human immunodeficiency virus(HIV)-positive patients and the risk factors associated with this infection through a review of studies published in the period from January 2010 to April 2020.METHODS A total of 384 articles were initially identified in our searches,of which ten were selected according to previously defined eligibility criteria.RESULTS Anal intercourse,absence of condom use,multiple partners,other specific sexual and life habits,and HIV infection are among the risk factors associated with anal HPV infection.CONCLUSION In general,there is a higher prevalence of anal HPV infection among HIV-positive patients,mostly in individuals over 30 years old,those with multiple partners,those who had an early homosexual debut,and cigarette,alcohol,and drug users.
文摘BACKGROUND Given the high prevalence of cardiovascular and pulmonary abnormalities associated with sickle cell anemia(SCA),the clinical impact caused in addition to compromising the quality of life of patients and the overcharge that it represents to the public health system,this study systematized and evaluated scientific publications on pulmonary complications and cardiovascular diseases in sickle cell patients from 1920 to 2020.This compilation aims to provide knowledge for health professionals and managers in order to draw attention to the importance of chronic diseases in SCA patients and in addition to providing elements that provide improvements in management of useful resources that contribute to improve the quality and increase the life expectancy of these patients.AIM To systematically compile information about cardiopulmonary changes in patients with SCA.METHODS A systematic literature review was performed based on the PRISMA recommendation including scientific articles indexed in the Scientific Electronic Library Online databases of the United States National Library of Medicine and Biblioteca Virtual de Saúde.The search period was delimited between 1990 and 2020 and selected in Portuguese,English and Spanish.Three sets of descriptors were used for each database including research carried out with human beings.After reading the articles,those useful for this review were extracted using a collection instrument designed for this purpose.RESULTS The final selection included 27 studies.The year with the highest number of publications was 2016 with 5 studies(18.51%),followed by 2017 with 4(14.81%).The type of study most carried out in the period was cohort 10(37.03%)followed by cross-sectional and case-control with 8 studies in each(29.62%).Regarding the language of publication,the distribution was as follows:25(92.59%)in English,1(3.70%)in Spanish and 1(3.70%)in Portuguese.CONCLUSION The findings of the present study suggest that cardiopulmonary alterations represent a serious clinical repercussion of SCA.Of the analyzed studies,the high occurrence of pulmonary hypertension,ventricular hypertrophy and diastolic dysfunction stands out as the main cardiopulmonary complications.In view of the increased survival in SCA,there is a need for surveillance and the development of strategies aimed at preserving the cardiopulmonary function and consequently improving the quality of life of these patients.
文摘Objective:This review aimed to compile scientific data on the distribution and prevalence of group BStreptococcus (GBS) serotypes isolated from pregnant women across 30 countries from 2010 to 2019.Methods:This was a systematic review that addresses the distribution and prevalence of GBS in pregnant women.The search included studies published between January 2010 and December 2019 in PubMed,Virtual Health Library (BVS),ScienceDirect,Scientific Electronic Library Online (SciELO),and LILACS databases.We also surveyed relevant articles published in English,Spanish,and Portuguese between February and April 2020.Original articles,communication,short report,theses,and dissertations were included.The prevalence of GBS colonization,method for capsular serotyping,antimicrobial resistance,distribution and prevalence of serotypes were extracted from each study.Results:In all,795 publications were identified.After applying the eligibility criteria,48 articles were included for the final systematic analysis;most articles were from Asia and were published during the years 2014 to 2017.For the identification of serotypes,most studies used the polymerase chain reaction technique.There were records of all 10 GBS serotypes,namely,Ia,Ib,and II–IX,among the countries analyzed.GBS susceptibility and resistance to antibiotics were addressed in 37.5% of the publications analysed.Conclusion:This review showed that GBS serotypes are distributed differently in the 30 analyzed countries,with serotypes Ia,Ib,and II to V being the most prevalent.Furthermore,our results highlighted the relationship of GBS with maternal colonization,implications for neonates,and antibiotic resistance.
