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Fowlkes AL, Nogareda F, Regan A, Loayza S, Mancio JM, Duca LM, Couto P, Leite J, Rodriguez A, Salas D, Azziz-Baumgartner E. Interim Effectiveness Estimates of 2023 Southern Hemisphere Influenza Vaccines in Preventing Influenza-Associated Hospitalizations - REVELAC-i Network, March-July 2023. MMWR Morb Mortal Wkly Rep 2023; 72:1010-1015. [PMID: 37708084 PMCID: PMC10511266 DOI: 10.15585/mmwr.mm7237e1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - REVELAC–i Network
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC; Pan American Health Organization, Washington, DC; School of Nursing and Health Professions, University of San Francisco, San Francisco, California; Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
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Giovanetti M, Vazquez C, Lima M, Castro E, Rojas A, Gomez de la Fuente A, Aquino C, Cantero C, Fleitas F, Torales J, Barrios J, Ortega MJ, Gamarra ML, Villalba S, Alfonzo T, Xavier J, Adelino T, Fritsch H, Iani FC, Pereira GC, de Oliveira C, Schuab G, Rodrigues ES, Kashima S, Leite J, Gresh L, Franco L, Tegally H, Van Voorhis WC, Lessels R, de Filippis AMB, Ojeda A, Sequera G, Montoya R, Holmes EC, de Oliveira T, Rico JM, Lourenço J, Fonseca V, Alcantara LC. Rapid Epidemic Expansion of Chikungunya Virus East/Central/South African Lineage, Paraguay. Emerg Infect Dis 2023; 29:1859-1863. [PMID: 37488810 PMCID: PMC10461647 DOI: 10.3201/eid2909.230523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
The spread of Chikungunya virus is a major public health concern in the Americas. There were >120,000 cases and 51 deaths in 2023, of which 46 occurred in Paraguay. Using a suite of genomic, phylodynamic, and epidemiologic techniques, we characterized the ongoing large chikungunya epidemic in Paraguay.
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Affiliation(s)
| | | | | | | | - Analia Rojas
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Andrea Gomez de la Fuente
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Carolina Aquino
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Cesar Cantero
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Fatima Fleitas
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Juan Torales
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Julio Barrios
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Maria J. Ortega
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Maria L. Gamarra
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Shirley Villalba
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Tania Alfonzo
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Joilson Xavier
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Talita Adelino
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Hegger Fritsch
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Felipe C.M. Iani
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Glauco C. Pereira
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Carla de Oliveira
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Gabriel Schuab
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Evandra S. Rodrigues
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Simone Kashima
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Juliana Leite
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Lionel Gresh
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Leticia Franco
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Houriiyah Tegally
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Wesley C. Van Voorhis
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Richard Lessels
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Ana Maria Bispo de Filippis
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Andrea Ojeda
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Guillermo Sequera
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Romeo Montoya
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Edward C. Holmes
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Tulio de Oliveira
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Jairo M. Rico
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - José Lourenço
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Vagner Fonseca
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
| | - Luiz C.J. Alcantara
- Università Campus Bio-Medico di Roma, Italy (M. Giovanetti)
- Instituto Oswaldo Cruz, Belo Horizonte, Brazil (M. Giovanetti, M. Lima, E. Castro, J. Xavier, H. Fritsch, L.C.J. Alcantara)
- Laboratorio Central de Salud Pública, Asunción, Paraguay (C. Vazquez, A. Rojas, A. Gomez de la Fuente, C. Aquino, C. Cantero, F. Fleitas, J. Torales, J. Barrios, M.J. Ortega, M.L. Gamarra, S. Villalba, T. Alfonzo)
- Central de Saúde Pública do Estado de Minas Gerais, Ezequiel Dias, Brazil (M. Lima, E. Castro, T. Adelino, F.C.M. Iani, G.C. Pereira)
- Universidade Federal de Minas Gerais, Belo Horizonte (J. Xavier, H. Fritsch)
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil (C. de Oliveira, G. Schuab, A.M.B. de Filippis)
- University of São Paulo, São Paulo, Brazil (E.S. Rodrigues, S. Kashima)
- Pan American Health Organization/World Health Organization, Washington, DC, USA (J. Leite, L. Gresh, L. Franco, J.M. Rico)
- Stellenbosch University, Stellenbosch, South Africa (H. Tegally, T. de Oliveira)
- University of KwaZulu-Natal, Durban, South Africa (H. Tegally, R. Lessels, T. de Oliveira)
- National Institutes of Health, Bethesda, Maryland, USA (W.C. Van Voorhis)
- Dirección General de Vigilancia de la Salud, Asunción (A. Ojeda, G. Sequera)
- Organización Panamericana de la Salud/Organización Mundial de la Salud Asuncion (R. Montoya)
- University of Sydney, Sydney, New South Wales, Australia (E.C. Holmes)
- University of Lisbon, Lisbon, Portugal (J. Lourenço)
- Organização Pan-Americana da Saúde/Organização/Mundial da Saúde, Brasilia, Brazil. (V. Fonseca)
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3
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Akande OW, Carter LL, Abubakar A, Achilla R, Barakat A, Gumede N, Guseinova A, Inbanathan FY, Kato M, Koua E, Leite J, Marklewitz M, Mendez-Rico J, Monamele C, Musul B, Nahapetyan K, Naidoo D, Ochola R, Ozel M, Raftery P, Vicari A, Wijesinghe PR, Zwetyenga J, Safreed-Harmon K, Barnadas C, Mulders M, Pereyaslov DI, Sacks JA, Warren T, Cognat S, Briand S, Samaan G. Strengthening pathogen genomic surveillance for health emergencies: insights from the World Health Organization's regional initiatives. Front Public Health 2023; 11:1146730. [PMID: 37361158 PMCID: PMC10289157 DOI: 10.3389/fpubh.2023.1146730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023] Open
Abstract
The onset of the COVID-19 pandemic triggered a rapid scale-up in the use of genomic surveillance as a pandemic preparedness and response tool. As a result, the number of countries with in-country SARS-CoV-2 genomic sequencing capability increased by 40% from February 2021 to July 2022. The Global Genomic Surveillance Strategy for Pathogens with Pandemic and Epidemic Potential 2022-2032 was launched by the World Health Organization (WHO) in March 2022 to bring greater coherence to ongoing work to strengthen genomic surveillance. This paper describes how WHO's tailored regional approaches contribute to expanding and further institutionalizing the use of genomic surveillance to guide pandemic preparedness and response measures as part of a harmonized global undertaking. Challenges to achieving this vision include difficulties obtaining sequencing equipment and supplies, shortages of skilled staff, and obstacles to maximizing the utility of genomic data to inform risk assessment and public health action. WHO is helping to overcome these challenges in collaboration with partners. Through its global headquarters, six regional offices, and 153 country offices, WHO is providing support for country-driven efforts to strengthen genomic surveillance in its 194 Member States, with activities reflecting regional specificities. WHO's regional offices serve as platforms for those countries in their respective regions to share resources and knowledge, engage stakeholders in ways that reflect national and regional priorities, and develop regionally aligned approaches to implementing and sustaining genomic surveillance within public health systems.
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Affiliation(s)
| | - Lisa L. Carter
- Country Readiness Strengthening, World Health Organization Lyon Office, Lyon, France
| | - Abdinasir Abubakar
- Infectious Hazard Prevention and Preparedness, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Rachel Achilla
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Democratic Republic of Congo
| | - Amal Barakat
- Infectious Hazard Prevention and Preparedness, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Nicksy Gumede
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Democratic Republic of Congo
| | - Alina Guseinova
- Infectious Hazard Management, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | - Masaya Kato
- WHO Health Emergencies, Regional Office for South-East Asia, New Delhi, India
| | - Etien Koua
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Democratic Republic of Congo
| | - Juliana Leite
- PAHO Health Emergencies, Pan American Health Organization, Washington DC, United States
| | - Marco Marklewitz
- Infectious Hazard Management, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Jairo Mendez-Rico
- PAHO Health Emergencies, Pan American Health Organization, Washington DC, United States
| | - Chavely Monamele
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Democratic Republic of Congo
| | - Biran Musul
- WHO Health Emergencies Programme, World Health Organization Country Office, Ankara, Türkiye
| | - Karen Nahapetyan
- Infectious Hazard Management, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Dhamari Naidoo
- WHO Health Emergencies, Regional Office for South-East Asia, New Delhi, India
| | - Rachel Ochola
- Infectious Hazard Prevention and Preparedness, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Mehmet Ozel
- Infectious Hazard Prevention and Preparedness, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Philomena Raftery
- WHO Health Emergencies Programme, World Health Organization Country Office, Ankara, Türkiye
| | - Andrea Vicari
- PAHO Health Emergencies, Pan American Health Organization, Washington DC, United States
| | | | - Joanna Zwetyenga
- Infectious Hazard Management, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | - Céline Barnadas
- Country Readiness Strengthening, World Health Organization Lyon Office, Lyon, France
| | - Mick Mulders
- Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Dmitriy I. Pereyaslov
- Epidemic and Pandemic Preparedness and Prevention, World Health Organization, Geneva, Switzerland
| | - Jilian A. Sacks
- Epidemic and Pandemic Preparedness and Prevention, World Health Organization, Geneva, Switzerland
| | - Taylor Warren
- Disaster Risk Management and Resilience, World Health Organization, Geneva, Switzerland
| | - Sébastien Cognat
- Country Readiness Strengthening, World Health Organization Lyon Office, Lyon, France
| | - Sylvie Briand
- Epidemic and Pandemic Preparedness and Prevention, World Health Organization, Geneva, Switzerland
| | - Gina Samaan
- Epidemic and Pandemic Preparedness and Prevention, World Health Organization, Geneva, Switzerland
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4
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Vazquez C, Alcantara LCJ, Fonseca V, Lima M, Xavier J, Adelino T, Fritsch H, Castro E, de Oliveira C, Schuab G, Lima ARJ, Villalba S, Gomez de la Fuente A, Rojas A, Cantero C, Fleitas F, Aquino C, Ojeda A, Sequera G, Torales J, Barrios J, Elias MC, Iani FCM, Ortega MJ, Gamarra ML, Montoya R, Rodrigues ES, Kashima S, Sampaio SC, Coluchi N, Leite J, Gresh L, Franco L, Lourenço J, Rico JM, Bispo de Filippis AM, Giovanetti M. Retrospective Spatio-Temporal Dynamics of Dengue Virus 1, 2 and 4 in Paraguay. Viruses 2023; 15:1275. [PMID: 37376575 DOI: 10.3390/v15061275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 06/29/2023] Open
Abstract
Dengue virus (DENV) has been a major public health concern in Paraguay, with frequent outbreaks occurring since early 1988. Although control measures have been implemented, dengue remains a significant health threat in the country, and continued efforts are required for prevention and control. In response to that, in collaboration with the Central Public Health Laboratory in Asunción, we conducted a portable whole-genome sequencing and phylodynamic analysis to investigate DENV viral strains circulating in Paraguay over the past epidemics. Our genomic surveillance activities revealed the co-circulation of multiple DENV serotypes: DENV-1 genotype V, the emerging DENV-2 genotype III, BR4-L2 clade, and DENV-4 genotype II. Results additionally highlight the possible role of Brazil as a source for the international dispersion of different viral strains to other countries in the Americas emphasizing the need for increased surveillance across the borders, for the early detection and response to outbreaks. This, in turn, emphasizes the critical role of genomic surveillance in monitoring and understanding arbovirus transmission and persistence locally and over long distances.
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Affiliation(s)
- Cynthia Vazquez
- Laboratorio Central de Salud Pública, Asunción 001535, Paraguay
| | | | - Vagner Fonseca
- Organização Pan-Americana da Saúde, Organização Mundial da Saúde, Brasília 70-800400, SP, Brazil
| | - Mauricio Lima
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Belo Horizonte 30190-002, MG, Brazil
- Laboratorio Central de Saúde Pública do Estado de Minas Gerais, Fundação Ezequiel Dias, Belo Horizonte 30510-010, MG, Brazil
| | - Joilson Xavier
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Belo Horizonte 30190-002, MG, Brazil
- Laboratorio Central de Saúde Pública do Estado de Minas Gerais, Fundação Ezequiel Dias, Belo Horizonte 30510-010, MG, Brazil
| | - Talita Adelino
- Laboratorio Central de Saúde Pública do Estado de Minas Gerais, Fundação Ezequiel Dias, Belo Horizonte 30510-010, MG, Brazil
| | - Hegger Fritsch
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Belo Horizonte 30190-002, MG, Brazil
- Laboratorio Central de Saúde Pública do Estado de Minas Gerais, Fundação Ezequiel Dias, Belo Horizonte 30510-010, MG, Brazil
| | - Emerson Castro
- Laboratorio Central de Saúde Pública do Estado de Minas Gerais, Fundação Ezequiel Dias, Belo Horizonte 30510-010, MG, Brazil
| | - Carla de Oliveira
- Laboratório de Arbovírus e Vírus Hemorrágicos (LARBOH), Instituto Osawldo Cruz, Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil
| | - Gabriel Schuab
- Laboratório de Arbovírus e Vírus Hemorrágicos (LARBOH), Instituto Osawldo Cruz, Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil
| | - Alex Ranieri Jerônimo Lima
- Butantan Institute, Center for Viral Surveillance and Serological Assessment (CeVIVAS), Sao Paulo 05507-000, SP, Brazil
| | | | | | - Analia Rojas
- Laboratorio Central de Salud Pública, Asunción 001535, Paraguay
| | - Cesar Cantero
- Laboratorio Central de Salud Pública, Asunción 001535, Paraguay
| | - Fatima Fleitas
- Laboratorio Central de Salud Pública, Asunción 001535, Paraguay
| | - Carolina Aquino
- Laboratorio Central de Salud Pública, Asunción 001535, Paraguay
| | - Andrea Ojeda
- Dirección General de Vigilancia de la Salud, Asunción 40556, Paraguay
| | - Guillermo Sequera
- Dirección General de Vigilancia de la Salud, Asunción 40556, Paraguay
| | - Juan Torales
- Laboratorio Central de Salud Pública, Asunción 001535, Paraguay
| | - Julio Barrios
- Laboratorio Central de Salud Pública, Asunción 001535, Paraguay
| | - Maria Carolina Elias
- Butantan Institute, Center for Viral Surveillance and Serological Assessment (CeVIVAS), Sao Paulo 05507-000, SP, Brazil
| | - Felipe C M Iani
- Laboratorio Central de Saúde Pública do Estado de Minas Gerais, Fundação Ezequiel Dias, Belo Horizonte 30510-010, MG, Brazil
| | | | | | - Romeo Montoya
- Enfermedades Trasmisibles y Determinantes Ambientales de la Salud CDE/HA/PHE, OPS/OMS, Asuncion 40126, Paraguay
| | - Evandra Strazza Rodrigues
- Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14051-140, SP, Brazil
| | - Simone Kashima
- Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14051-140, SP, Brazil
| | - Sandra Coccuzzo Sampaio
- Butantan Institute, Center for Viral Surveillance and Serological Assessment (CeVIVAS), Sao Paulo 05507-000, SP, Brazil
| | - Norma Coluchi
- Laboratorio Central de Salud Pública, Asunción 001535, Paraguay
| | - Juliana Leite
- Emergency Department, Infectious Hazards Management, Pan American Health Organization, Washington, DC 20037, USA
| | - Lionel Gresh
- Emergency Department, Infectious Hazards Management, Pan American Health Organization, Washington, DC 20037, USA
| | - Leticia Franco
- Emergency Department, Infectious Hazards Management, Pan American Health Organization, Washington, DC 20037, USA
| | - José Lourenço
- Biosystems and Integrative Sciences Institute, Faculty of Sciences, University of Lisbon, 1749-016 Lisbon, Portugal
| | - Jairo Mendez Rico
- Emergency Department, Infectious Hazards Management, Pan American Health Organization, Washington, DC 20037, USA
| | - Ana Maria Bispo de Filippis
- Laboratório de Arbovírus e Vírus Hemorrágicos (LARBOH), Instituto Osawldo Cruz, Fiocruz, Rio de Janeiro 21040-900, RJ, Brazil
| | - Marta Giovanetti
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Belo Horizonte 30190-002, MG, Brazil
- Sciences and Technologies for Sustainable Development and One Health, University of Campus Bio-Medico, 00128 Rome, Italy
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Giovanetti M, Vazquez C, Lima M, Castro E, Rojas A, de la Fuente AG, Aquino C, Cantero C, Fleitas F, Torales J, Barrios J, Ortega MJ, Gamarra ML, Villalba S, Alfonzo T, Xavier J, Adelino T, Fritsch H, Iani FCM, Pereira GC, de Oliveira C, Schuab G, Rodrigues ES, Kashima S, Leite J, Gresh L, Franco L, Tegally H, Van Voorhis WC, Lessels R, de Filippis AMB, Ojeda A, Sequera G, Montoya R, Holmes EC, de Oliveira T, Rico JM, Lourenço J, Fonseca V, Alcantara LCJ. Rapid epidemic expansion of chikungunya virus-ECSA lineage in Paraguay. medRxiv 2023:2023.04.16.23288635. [PMID: 37131602 PMCID: PMC10153315 DOI: 10.1101/2023.04.16.23288635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The spread of vector-borne viruses, such as CHIKV, is a significant public health concern in the Americas, with over 120,000 cases and 51 deaths in 2023, of which 46 occurred in Paraguay. Using a suite of genomic, phylodynamic, and epidemiological techniques, we characterized the ongoing large CHIKV epidemic in Paraguay. Article Summary Line Genomic and epidemiological characterization of the ongoing Chikungunya virus epidemic in Paraguay.
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Affiliation(s)
- Marta Giovanetti
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Minas Gerais, Brazil
- Sciences and Technologies for Sustainable Development and One Health, University of Campus Bio-Medico,Rome, Italy
| | | | - Mauricio Lima
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Minas Gerais, Brazil
- Laboratorio Central de Saúde Pública do Estado de Minas Gerais, Fundação Ezequiel Dias, Brazil
| | - Emerson Castro
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Minas Gerais, Brazil
- Laboratorio Central de Saúde Pública do Estado de Minas Gerais, Fundação Ezequiel Dias, Brazil
| | - Analia Rojas
- Laboratorio Central de Salud Pública, Asunción, Paraguay
| | | | | | - Cesar Cantero
- Laboratorio Central de Salud Pública, Asunción, Paraguay
| | - Fatima Fleitas
- Laboratorio Central de Salud Pública, Asunción, Paraguay
| | - Juan Torales
- Laboratorio Central de Salud Pública, Asunción, Paraguay
| | - Julio Barrios
- Laboratorio Central de Salud Pública, Asunción, Paraguay
| | | | | | | | - Tania Alfonzo
- Laboratorio Central de Salud Pública, Asunción, Paraguay
| | - Joilson Xavier
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Minas Gerais, Brazil
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Brazil
| | - Talita Adelino
- Laboratorio Central de Saúde Pública do Estado de Minas Gerais, Fundação Ezequiel Dias, Brazil
| | - Hegger Fritsch
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Minas Gerais, Brazil
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Brazil
| | - Felipe C. M. Iani
- Laboratorio Central de Saúde Pública do Estado de Minas Gerais, Fundação Ezequiel Dias, Brazil
| | - Glauco Carvalho Pereira
- Laboratorio Central de Saúde Pública do Estado de Minas Gerais, Fundação Ezequiel Dias, Brazil
| | - Carla de Oliveira
- Laboratório de Arbovírus e Vírus Hemorrágicos (LARBOH), Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Gabriel Schuab
- Laboratório de Arbovírus e Vírus Hemorrágicos (LARBOH), Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Evandra Strazza Rodrigues
- University of São Paulo, Ribeirão Preto Medical School, Blood Center of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Simone Kashima
- University of São Paulo, Ribeirão Preto Medical School, Blood Center of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Juliana Leite
- Infectious Hazards Management, Health Emergencies Department (PHE), Pan American Health Organization / World Health Organization (PAHO/WHO), Washington DC, USA
| | - Lionel Gresh
- Infectious Hazards Management, Health Emergencies Department (PHE), Pan American Health Organization / World Health Organization (PAHO/WHO), Washington DC, USA
| | - Leticia Franco
- Infectious Hazards Management, Health Emergencies Department (PHE), Pan American Health Organization / World Health Organization (PAHO/WHO), Washington DC, USA
| | - Houriiyah Tegally
- Centre for Epidemic Response and Innovation (CERI), School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch 7600, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Wesley C. Van Voorhis
- Center for Emerging and Re-emerging Infectious Diseases, University of Washington, USA
| | - Richard Lessels
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Ana Maria Bispo de Filippis
- Laboratório de Arbovírus e Vírus Hemorrágicos (LARBOH), Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Andrea Ojeda
- Dirección General de Vigilancia de la Salud, Asunción, Paraguay
| | | | - Romeo Montoya
- Enfermedades Trasmisibles y Determinantes Ambientales de la Salud CDE/HA/PHE, Organización Panamericana de la Salud / Organización Mundial de la Salud (OPS/OMS), Asuncion, Paraguay
| | - Edward C. Holmes
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life and Environmental Sciences and School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Tulio de Oliveira
- Centre for Epidemic Response and Innovation (CERI), School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch 7600, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Jairo Mendez Rico
- Infectious Hazards Management, Health Emergencies Department (PHE), Pan American Health Organization / World Health Organization (PAHO/WHO), Washington DC, USA
| | - José Lourenço
- Biosystems and Integrative Sciences Institute, Faculty of Sciences, University of Lisbon, Lisbon, 1749-016, Portugal
| | - Vagner Fonseca
- Coordenação de Vigilância, Preparação e Resposta à Emergências e Desastres (PHE), Organização Pan-Americana da Saúde / Organização Mundial da Saúde (OPAS/OMS), Brasilia DF, Brazil
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Kamarajah S, Evans R, Nepogodiev D, Hodson J, Bundred J, Gockel I, Gossage J, Isik A, Kidane B, Mahendran H, Negoi I, Okonta K, Sayyed R, van Hillegersberg R, Vohra R, Wijnhoven B, Singh P, Griffiths E, Kamarajah S, Hodson J, Griffiths E, Alderson D, Bundred J, Evans R, Gossage J, Griffiths E, Jefferies B, Kamarajah S, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno J, Takeda F, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra J, Mahendran H, Mejía-Fernández L, Wijnhoven B, El Kafsi J, Sayyed R, Sousa M, Sampaio A, Negoi I, Blanco R, Wallner B, Schneider P, Hsu P, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii M, Jacobs R, Andreollo N, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts J, Dikinis S, Kjaer D, Larsen M, Achiam M, Saarnio J, Theodorou D, Liakakos T, Korkolis D, Robb W, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White R, Alghunaim E, Elhadi M, Leon-Takahashi A, Medina-Franco H, Lau P, Okonta K, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak J, Pal K, Qureshi A, Naqi S, Syed A, Barbosa J, Vicente C, Leite J, Freire J, Casaca R, Costa R, Scurtu R, Mogoanta S, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So J, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera M, Vallve-Bernal M, Cítores Pascual M, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz M, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath Y, Turner P, Dexter S, Boddy A, Allum W, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Al-Bahrani A, Bryce G, Thomas M, Arndt A, Palazzo F, Meguid R, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira M, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher O, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum R, da Rocha J, Lopes L, Tercioti V, Coelho J, Ferrer J, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García T, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen P, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort A, Stilling N, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila J, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis D, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin C, Hennessy M, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Sartarelli L, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual C, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed H, Shebani A, Elhadi A, Elnagar F, Elnagar H, Makkai-Popa S, Wong L, Tan Y, Thannimalai S, Ho C, Pang W, Tan J, Basave H, Cortés-González R, Lagarde S, van Lanschot J, Cords C, Jansen W, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda J, van der Sluis P, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Young M, Smith B, Ekwunife C, Memon A, Shaikh K, Wajid A, Khalil N, Haris M, Mirza Z, Qudus S, Sarwar M, Shehzadi A, Raza A, Jhanzaib M, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, MA N, Ahmed H, Naeem A, Pinho A, da Silva R, Bernardes A, Campos J, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes M, Martins P, Correia A, Videira J, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu A, Obleaga C, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla R, Predescu D, Hoara P, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin T, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón J, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles J, Rodicio Miravalles J, Pais S, Turienzo S, Alvarez L, Campos P, Rendo A, García S, Santos E, Martínez E, Fernández Díaz M, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez L, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez D, Ahmed M, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki B, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins T, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan L, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Willem J, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly J, Singh P, van Boxel Gijs, Akbari K, Zanotti D, Sgromo B, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar M, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey I, Karush M, Seder C, Liptay M, Chmielewski G, Rosato E, Berger A, Zheng R, Okolo E, Singh A, Scott C, Weyant M, Mitchell J. The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit. J Thorac Cardiovasc Surg 2022; 164:674-684.e5. [PMID: 35249756 DOI: 10.1016/j.jtcvs.2022.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/22/2021] [Accepted: 01/18/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort. METHODS This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders. RESULTS Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses. CONCLUSIONS Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.
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Lewis HC, Marcato AJ, Meagher N, Valenciano M, Villanueva‐Cabezas J, Spirkoska V, Fielding JE, Karahalios A, Subissi L, Nardone A, Cheng B, Rajatonirina S, Okeibunor J, Aly EA, Barakat A, Jorgensen P, Azim T, Wijesinghe PR, Le L, Rodriguez A, Vicari A, Van Kerkhove MD, McVernon J, Pebody R, Price DJ, Bergeri I, Alemu MA, Alvi Y, Bukusi EA, Chung PS, Dambadarjaa D, Das AK, Dub T, Dulacha D, Ebrahim F, González‐Duarte MA, Guruge D, Heraud J, Heredia‐Melo DC, Herman‐Roloff A, Herring BL, Inbanathan FY, Islam F, Jeewandara KC, Kant S, Khan W, Lako R, Leite J, Malavige GN, Mandakh U, Mariam W, Mend T, Mize VA, Musa S, Nohynek H, Olu OO, Osorio‐Merchán MB, Pereyaslov D, Randremanana RV, de Dieu Randria MJ, Ransom J, Saxena S, Sharma P, Sreedevi A, Satheesh M, Subhashini KJ, Tippet‐Barr BA, Usha A, Wamala JF, Watare SH, Yadav K. Transmission of SARS-CoV-2 in standardised first few X cases and household transmission investigations: A systematic review and meta-analysis. Influenza Other Respir Viruses 2022; 16:803-819. [PMID: 36825117 PMCID: PMC9343340 DOI: 10.1111/irv.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
We aimed to estimate the household secondary infection attack rate (hSAR) of SARS-CoV-2 in investigations aligned with the WHO Unity Studies Household Transmission Investigations (HHTI) protocol. We conducted a systematic review and meta-analysis according to PRISMA 2020 guidelines. We searched Medline, Embase, Web of Science, Scopus and medRxiv/bioRxiv for "Unity-aligned" First Few X cases (FFX) and HHTIs published 1 December 2019 to 26 July 2021. Standardised early results were shared by WHO Unity Studies collaborators (to 1 October 2021). We used a bespoke tool to assess investigation methodological quality. Values for hSAR and 95% confidence intervals (CIs) were extracted or calculated from crude data. Heterogeneity was assessed by visually inspecting overlap of CIs on forest plots and quantified in meta-analyses. Of 9988 records retrieved, 80 articles (64 from databases; 16 provided by Unity Studies collaborators) were retained in the systematic review; 62 were included in the primary meta-analysis. hSAR point estimates ranged from 2% to 90% (95% prediction interval: 3%-71%; I 2 = 99.7%); I 2 values remained >99% in subgroup analyses, indicating high, unexplained heterogeneity and leading to a decision not to report pooled hSAR estimates. FFX and HHTI remain critical epidemiological tools for early and ongoing characterisation of novel infectious pathogens. The large, unexplained variance in hSAR estimates emphasises the need to further support standardisation in planning, conduct and analysis, and for clear and comprehensive reporting of FFX and HHTIs in time and place, to guide evidence-based pandemic preparedness and response efforts for SARS-CoV-2, influenza and future novel respiratory viruses.
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Affiliation(s)
- Hannah C. Lewis
- World Health OrganizationGenevaSwitzerland,World Health Organization, Regional Office for AfricaBrazzavilleRepublic of Congo
| | - Adrian J. Marcato
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - Niamh Meagher
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | - Marta Valenciano
- World Health OrganizationGenevaSwitzerland,EpiconceptParisFrance
| | - Juan‐Pablo Villanueva‐Cabezas
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,The Nossal Institute for Global HealthThe University of MelbourneMelbourneAustralia
| | - Violeta Spirkoska
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Victorian Infectious Diseases Reference LaboratoryRoyal Melbourne Hospital, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - James E. Fielding
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia,Victorian Infectious Diseases Reference LaboratoryRoyal Melbourne Hospital, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | | | - Anthony Nardone
- World Health OrganizationGenevaSwitzerland,EpiconceptParisFrance
| | - Brianna Cheng
- World Health OrganizationGenevaSwitzerland,School of Population and Global HealthMcGill UniversityMontrealQuebecCanada
| | | | - Joseph Okeibunor
- World Health Organization, Regional Office for AfricaBrazzavilleRepublic of Congo
| | - Eman A. Aly
- World Health Organization, Regional Office for the Eastern MediterraneanCairoEgypt
| | - Amal Barakat
- World Health Organization, Regional Office for the Eastern MediterraneanCairoEgypt
| | | | - Tasnim Azim
- World Health Organization, Regional Office for South‐East AsiaNew DelhiIndia
| | | | - Linh‐Vi Le
- World Health Organization, Regional Office for the Western PacificManilaPhilippines
| | - Angel Rodriguez
- World Health Organization, Regional Office for the Americas (Pan American Health Organization)WashingtonDCUSA
| | - Andrea Vicari
- World Health Organization, Regional Office for the Americas (Pan American Health Organization)WashingtonDCUSA
| | | | - Jodie McVernon
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia,Murdoch Children's Research InstituteMelbourneAustralia
| | - Richard Pebody
- World Health Organization Regional Office for EuropeCopenhagenDenmark
| | - David J. Price
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | | | | | | | - Yasir Alvi
- Department of Community Medicine Hamdard Institute of Medical Sciences and Research New Delhi India
| | | | - Pui Shan Chung
- World Health Organization, Regional Office for the Western Pacific Manila Philippines
| | - Davaalkham Dambadarjaa
- School of Public Health Mongolian National University of Medical Sciences Ulaanbaatar Mongolia
| | - Ayan K. Das
- Department of Microbiology Hamdard Institute of Medical Science and Research New Delhi India
- Hakeem Abdul Hameed Centenary Hospital New Delhi India
| | - Timothée Dub
- Department of Health Security Finnish Institute for Health and Welfare Helsinki Finland
| | | | - Faiqa Ebrahim
- World Health Organization Country Office Addis Ababa Ethiopia
| | | | | | | | | | | | - Belinda L. Herring
- World Health Organization, Regional Office for Africa Brazzaville Republic of Congo
| | | | - Farzana Islam
- Hamdard Institute of Medical Sciences and Research (HIMSR) New Delhi India
| | - Kamal Chandima Jeewandara
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura Nugegoda Sri Lanka
| | - Shashi Kant
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi India
| | - Wasiq Khan
- World Health Organization, Regional Office for the Eastern Mediterranean Cairo Egypt
| | | | - Juliana Leite
- World Health Organization, Regional Office for the Americas (Pan American Health Organization) Washington DC USA
| | | | - Undram Mandakh
- Mongolian National University of Medical Sciences Ulaanbaatar Mongolia
| | - Warisha Mariam
- Department of Community Medicine Maulana Azad Medical College New Delhi India
| | - Tsogt Mend
- National Center for Communicable Diseases Ulaanbaatar Mongolia
| | | | - Sanjin Musa
- Institute for Public Health of the Federation of Bosnia and Herzegovina Sarajevo Bosnia and Herzegovina
- Sarajevo School of Science and Technology Sarajevo Bosnia and Herzegovina
| | - Hanna Nohynek
- Department of Health Security Finnish Institute for Health and Welfare Helsinki Finland
| | | | | | | | | | | | - James Ransom
- Centers for Disease Control and Prevention Juba South Sudan
| | - Sonal Saxena
- Department of Microbiology Maulana Azad Medical College New Delhi India
| | - Pragya Sharma
- Department of Community Medicine Maulana Azad Medical College New Delhi India
| | - Aswathy Sreedevi
- Department of Community Medicine Amrita Institute of Medical Sciences Kochi Kerala India
| | - Mini Satheesh
- Kerala University of Health Sciences Kerala India
- Government Medical College Thiruvananthapuram Kerala India
| | - K. J. Subhashini
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi India
| | - Beth A. Tippet‐Barr
- U.S. Centers for Disease Control and Prevention Nairobi Kenya
- Nyanja Health Research Institute Salima Malawi
| | - Anuja Usha
- Regional Prevention of Epidemic and Infectious Disease Cell Government of Kerala Kerala India
| | | | | | - Kapil Yadav
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi India
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8
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Kamarajah SK, Evans RPT, Nepogodiev D, Hodson J, Bundred JR, Gockel I, Gossage JA, Isik A, Kidane B, Mahendran HA, Negoi I, Okonta KE, Sayyed R, van Hillegersberg R, Vohra RS, Wijnhoven BPL, Singh P, Griffiths EA, Kamarajah SK, Hodson J, Griffiths EA, Alderson D, Bundred J, Evans RPT, Gossage J, Griffiths EA, Jefferies B, Kamarajah SK, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno JI, Takeda FR, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra JS, Mahendran HA, Mejía-Fernández L, Wijnhoven BPL, El Kafsi J, Sayyed RH, Sousa M M, Sampaio AS, Negoi I, Blanco R, Wallner B, Schneider PM, Hsu PK, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii MW, Jacobs R, Andreollo NA, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts JH, Dikinis S, Kjaer DW, Larsen MH, Achiam MP, Saarnio J, Theodorou D, Liakakos T, Korkolis DP, Robb WB, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White RE, Alghunaim E, Elhadi M, Leon-Takahashi AM, Medina-Franco H, Lau PC, Okonta KE, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak JI, Pal KMI, Qureshi AU, Naqi SA, Syed AA, Barbosa J, Vicente CS, Leite J, Freire J, Casaca R, Costa RCT, Scurtu RR, Mogoanta SS, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So JBY, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera MS, Vallve-Bernal M, Cítores Pascual MA, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz MB, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath YKS, Turner P, Dexter S, Boddy A, Allum WH, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Bryce G, Thomas M, Arndt AT, Palazzo F, Meguid RA, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira MP, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher OM, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum RAA, da Rocha JRM, Lopes LR, Tercioti Jr V, Coelho JDS, Ferrer JAP, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García TC, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen PB, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort AP, Stilling NM, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila JH, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis DK, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin CB, Hennessy MM, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual CA, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed HA, Shebani AO, Elhadi A, Elnagar FA, Elnagar HF, Makkai-Popa ST, Wong LF, Tan YR, Thannimalai S, Ho CA, Pang WS, Tan JH, Basave HNL, Cortés-González R, Lagarde SM, van Lanschot JJB, Cords C, Jansen WA, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda JP, van der Sluis PC, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Smith B, Ekwunife C, Memon AH, Shaikh K, Wajid A, Khalil N, Haris M, Mirza ZU, Qudus SBA, Sarwar MZ, Shehzadi A, Raza A, Jhanzaib MH, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor MA, Ahmed HH, Naeem A, Pinho AC, da Silva R, Bernardes A, Campos JC, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes MP, Martins PC, Correia AM, Videira JF, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu AE, Obleaga CV, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla RD, Predescu D, Hoara PA, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin TS, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón JM, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles JA, Rodicio Miravalles JL, Pais SA, Turienzo SA, Alvarez LS, Campos PV, Rendo AG, García SS, Santos EPG, Martínez ET, Fernández Díaz MJ, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez LE, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez DP, Ahmed ME, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki BE, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins TH, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan LC, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly JJ, Singh P, van Boxel G, Akbari K, Zanotti D, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar MMA, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey IA, Karush MK, Seder CW, Liptay MJ, Chmielewski G, Rosato EL, Berger AC, Zheng R, Okolo E, Singh A, Scott CD, Weyant MJ, Mitchell JD. Textbook outcome following oesophagectomy for cancer: international cohort study. Br J Surg 2022. [DOI: https://doi.org/10.1093/bjs/znac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.
Methods
Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).
Results
Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.
Conclusion
Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.
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Kamarajah SK, Evans RPT, Nepogodiev D, Hodson J, Bundred JR, Gockel I, Gossage JA, Isik A, Kidane B, Mahendran HA, Negoi I, Okonta KE, Sayyed R, van Hillegersberg R, Vohra RS, Wijnhoven BPL, Singh P, Griffiths EA, Kamarajah SK, Hodson J, Griffiths EA, Alderson D, Bundred J, Evans RPT, Gossage J, Griffiths EA, Jefferies B, Kamarajah SK, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno JI, Takeda FR, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra JS, Mahendran HA, Mejía-Fernández L, Wijnhoven BPL, El Kafsi J, Sayyed RH, Sousa M M, Sampaio AS, Negoi I, Blanco R, Wallner B, Schneider PM, Hsu PK, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii MW, Jacobs R, Andreollo NA, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts JH, Dikinis S, Kjaer DW, Larsen MH, Achiam MP, Saarnio J, Theodorou D, Liakakos T, Korkolis DP, Robb WB, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White RE, Alghunaim E, Elhadi M, Leon-Takahashi AM, Medina-Franco H, Lau PC, Okonta KE, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak JI, Pal KMI, Qureshi AU, Naqi SA, Syed AA, Barbosa J, Vicente CS, Leite J, Freire J, Casaca R, Costa RCT, Scurtu RR, Mogoanta SS, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So JBY, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera MS, Vallve-Bernal M, Cítores Pascual MA, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz MB, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath YKS, Turner P, Dexter S, Boddy A, Allum WH, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Bryce G, Thomas M, Arndt AT, Palazzo F, Meguid RA, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira MP, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher OM, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum RAA, da Rocha JRM, Lopes LR, Tercioti Jr V, Coelho JDS, Ferrer JAP, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García TC, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen PB, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort AP, Stilling NM, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila JH, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis DK, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin CB, Hennessy MM, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual CA, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed HA, Shebani AO, Elhadi A, Elnagar FA, Elnagar HF, Makkai-Popa ST, Wong LF, Tan YR, Thannimalai S, Ho CA, Pang WS, Tan JH, Basave HNL, Cortés-González R, Lagarde SM, van Lanschot JJB, Cords C, Jansen WA, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda JP, van der Sluis PC, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Smith B, Ekwunife C, Memon AH, Shaikh K, Wajid A, Khalil N, Haris M, Mirza ZU, Qudus SBA, Sarwar MZ, Shehzadi A, Raza A, Jhanzaib MH, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor MA, Ahmed HH, Naeem A, Pinho AC, da Silva R, Bernardes A, Campos JC, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes MP, Martins PC, Correia AM, Videira JF, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu AE, Obleaga CV, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla RD, Predescu D, Hoara PA, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin TS, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón JM, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles JA, Rodicio Miravalles JL, Pais SA, Turienzo SA, Alvarez LS, Campos PV, Rendo AG, García SS, Santos EPG, Martínez ET, Fernández Díaz MJ, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez LE, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez DP, Ahmed ME, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki BE, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins TH, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan LC, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly JJ, Singh P, van Boxel G, Akbari K, Zanotti D, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar MMA, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey IA, Karush MK, Seder CW, Liptay MJ, Chmielewski G, Rosato EL, Berger AC, Zheng R, Okolo E, Singh A, Scott CD, Weyant MJ, Mitchell JD. Textbook outcome following oesophagectomy for cancer: international cohort study. Br J Surg 2022; 109:439-449. [PMID: 35194634 DOI: 10.1093/bjs/znac016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/08/2021] [Accepted: 01/04/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting. METHODS Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.). RESULTS Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome. CONCLUSION Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.
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Evans RPT, Kamarajah SK, Bundred J, Nepogodiev D, Hodson J, van Hillegersberg R, Gossage J, Vohra R, Griffiths EA, Singh P, Evans RPT, Hodson J, Kamarajah SK, Griffiths EA, Singh P, Alderson D, Bundred J, Evans RPT, Gossage J, Griffiths EA, Jefferies B, Kamarajah SK, McKay S, Mohamed I, Nepogodiev D, Siaw- Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno JI, Takeda FR, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra JS, Mahendran HA, Mejía-Fernández L, Wijnhoven BPL, El Kafsi J, Sayyed RH, Sousa M, Sampaio AS, Negoi I, Blanco R, Wallner B, Schneider PM, Hsu PK, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii MW, Jacobs R, Andreollo NA, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts JH, Dikinis S, Kjaer DW, Larsen MH, Achiam MP, Saarnio J, Theodorou D, Liakakos T, Korkolis DP, Robb WB, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White RE, Alghunaim E, Elhadi M, Leon-Takahashi AM, Medina-Franco H, Lau PC, Okonta KE, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak JI, Pal KMI, Qureshi AU, Naqi SA, Syed AA, Barbosa J, Vicente CS, Leite J, Freire J, Casaca R, Costa RCT, Scurtu RR, Mogoanta SS, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So JBY, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera MS, Vallve-Bernal M, Cítores Pascual MA, Elmahi S, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz TB, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath YKS, Turner P, Dexter S, Boddy A, Allum WH, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Al-Bahrani A, Bryce G, Thomas M, Arndt AT, Palazzo F, Meguid RA, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira MP, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher OM, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum RAA, da Rocha JRM, Lopes LR, Tercioti V, Coelho JDS, Ferrer JAP, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García TC, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen PB, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort AP, Stilling NM, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila JS, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Baili E, Mpoura M, Charalabopoulos A, Manatakis DK, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Súilleabháin CBÓ, Hennessy MM, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Sartarelli L, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual CA, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed HA, Shebani AO, Elhadi A, Elnagar FA, Elnagar HF, Makkai-Popa ST, Wong LF, Yunrong T, Thanninalai S, Aik HC, Soon PW, Huei TJ, Basave HNL, Cortés-González R, Lagarde SM, van Lanschot JJB, Cords C, Jansen WA, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda JP, van der Veen A, van den Berg JW, Evenett N, Johnston P, Patel R, MacCormick A, Young M, Smith B, Ekwunife C, Memon AH, Shaikh K, Wajid A, Khalil N, Haris M, Mirza ZU, Qudus SBA, Sarwar MZ, Shehzadi A, Raza A, Jhanzaib MH, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor MA, Ahmed HH, Naeem A, Pinho AC, da Silva R, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes MP, Martins PC, Correia AM, Videira JF, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu AE, Obleaga CV, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla RD, Predescu D, Hoara PA, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin TS, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Díez del Val I, Leturio S, Ramón JM, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles JA, Rodicio Miravalles JL, Pais SA, Turienzo SA, Alvarez LS, Campos PV, Rendo AG, García SS, Santos EPG, Martínez ET, Fernández Díaz MJ, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez LE, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez DP, Ahmed ME, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki BE, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins TH, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan LC, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Willem J, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly JJ, Singh P, van Boxel G, Akbari K, Zanotti D, Sgromo B, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar MMA, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, McCormack K, Makey IA, Karush MK, Seder CW, Liptay MJ, Chmielewski G, Rosato EL, Berger AC, Zheng R, Okolo E, Singh A, Scott CD, Weyant MJ, Mitchell JD. Postoperative outcomes in oesophagectomy with trainee involvement. BJS Open 2021; 5:zrab132. [PMID: 35038327 PMCID: PMC8763367 DOI: 10.1093/bjsopen/zrab132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.
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Bianchi L, Ceci F, Droghetti M, Castellucci P, Artigas C, Leite J, Corona P, Farolfi A, Shagera Q, Moreira R, Gonzales C, Queiroz M, Barbosa F, Schiavina R, Brunocilla E, Deandreis D, Fanti S. External validation of a nomogram for predicting 68GA-PSMA PET/CT detection rate in patients with prostate cancer recurrence: a clinical tool to guide physicians before suggesting 68GA-PSMA PET/CT. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00968-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Konings F, Perkins MD, Kuhn JH, Pallen MJ, Alm EJ, Archer BN, Barakat A, Bedford T, Bhiman JN, Caly L, Carter LL, Cullinane A, de Oliveira T, Druce J, El Masry I, Evans R, Gao GF, Gorbalenya AE, Hamblion E, Herring BL, Hodcroft E, Holmes EC, Kakkar M, Khare S, Koopmans MPG, Korber B, Leite J, MacCannell D, Marklewitz M, Maurer-Stroh S, Rico JAM, Munster VJ, Neher R, Munnink BO, Pavlin BI, Peiris M, Poon L, Pybus O, Rambaut A, Resende P, Subissi L, Thiel V, Tong S, van der Werf S, von Gottberg A, Ziebuhr J, Van Kerkhove MD. SARS-CoV-2 Variants of Interest and Concern naming scheme conducive for global discourse. Nat Microbiol 2021; 6:821-823. [PMID: 34108654 DOI: 10.1038/s41564-021-00932-w] [Citation(s) in RCA: 154] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD, USA
| | - Mark J Pallen
- Quadram Institute Bioscience, University of East Anglia, Norwich, UK
| | - Erik J Alm
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | | | - Trevor Bedford
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jinal N Bhiman
- National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Leon Caly
- Victorian Infectious Diseases Reference Laboratory (VIDRL), Melbourne, Victoria, Australia
| | | | - Anne Cullinane
- Faculty of Science and Engineering, University of Limerick, Limerick, Ireland
| | | | - Julian Druce
- Victorian Infectious Diseases Reference Laboratory (VIDRL), Melbourne, Victoria, Australia
| | - Ihab El Masry
- Emergency Centre for Transboundary Animal Disease, Food and Agriculture Organization of the United Nations (FAO), Cairo, Egypt
| | - Roger Evans
- World Health Organization, Geneva, Switzerland
| | - George F Gao
- Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Alexander E Gorbalenya
- Leiden University Medical Center, Leiden, The Netherlands.,Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, Moscow, Russia
| | | | | | | | - Edward C Holmes
- The University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | - Bette Korber
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM, USA
| | | | - Duncan MacCannell
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Sebastian Maurer-Stroh
- The Global Initiative on Sharing All Influenza Data (GISAID), Munich, Germany.,Bioinformatics Institute, Agency for Science, Technology and Research, Singapore, Singapore
| | | | - Vincent J Munster
- Virus Ecology Unit, National Institute of Allergy and Infectious Diseases, Rockville, MA, USA
| | - Richard Neher
- Biozentrum, University of Basel, Switzerland Swiss Institute of Bioinformatics, Basel, Switzerland
| | | | | | | | - Leo Poon
- The University of Hong Kong, Hong Kong, China
| | | | - Andrew Rambaut
- Institute for Evolutionary Biology, Ashworth Laboratories, University of Edinburgh, Edinburgh, UK
| | - Paola Resende
- Laboratory of Respiratory Viruses and Measles (LVRS), Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | | | - Volker Thiel
- University of Bern, Bern, Switzerland.,Institute of Virology and Immunology, Mittelhäusern, Switzerland
| | - Suxiang Tong
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Anne von Gottberg
- National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - John Ziebuhr
- Institute of Medical Virology, Justus Liebig University Giessen, Giessen, Germany
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Kamarajah S, Nepogodiev D, Bekele A, Cecconello I, Evans R, Guner A, Gossage J, Harustiak T, Hodson J, Isik A, Kidane B, Leon-Takahashi A, Mahendran H, Negoi I, Okonta K, Rosero G, Sayyed R, Singh P, Takeda F, van Hillegersberg R, Vohra R, White R, Griffiths E, Alderson D, Bundred J, Evans R, Gossage J, Griffiths E, Jefferies B, Kamarajah S, McKay S, Mohamed I, Nepogodiev D, Siaw- Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno J, Takeda F, Kidane B, Guevara CR, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra J, Mahendran H, Mejía-Fernández L, Wijnhoven B, El Kafsi J, Sayyed R, Sousa M, Sampaio A, Negoi I, Blanco R, Wallner B, Schneider P, Hsu P, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii M, Jacobs R, Andreollo N, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias- Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts J, Dikinis S, Kjaer D, Larsen M, Achiam M, Saarnio J, Theodorou D, Liakakos T, Korkolis D, Robb W, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White R, Alghunaim E, Elhadi M, Leon-Takahashi A, Medina-Franco H, Lau P, Okonta K, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak J, Pal K, Qureshi A, Naqi S, Syed A, Barbosa J, Vicente C, Leite J, Freire J, Casaca R, Costa R, Scurtu R, Mogoanta S, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So J, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno GM, Martín Fernández J, Trugeda Carrera M, Vallve-Bernal M, Cítores Pascual M, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz M, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath Y, Turner P, Dexter S, Boddy A, Allum W, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Al-Bahrani A, Bryce G, Thomas M, Arndt A, Palazzo F, Meguid R, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira M, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher O, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum R, da Rocha J, Lopes L, Tercioti V, Coelho J, Ferrer J, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García T, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen P, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort A, Stilling N, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila J, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Mpali E, Mpoura M, Charalabopoulos A, Manatakis D, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin C, Hennessy M, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Sartarelli L, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual C, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed H, Shebani A, Elhadi A, Elnagar F, Elnagar H, Makkai-Popa S, Wong L, Tan Y, Thannimalai S, Ho C, Pang W, Tan J, Basave H, Cortés-González R, Lagarde S, van Lanschot J, Cords C, Jansen W, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda J, van der Sluis P, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Young M, Smith B, Ekwunife C, Memon A, Shaikh K, Wajid A, Khalil N, Haris M, Mirza Z, Qudus S, Sarwar M, Shehzadi A, Raza A, Jhanzaib M, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor M, Ahmed H, Naeem A, Pinho A, da Silva R, Bernardes A, Campos J, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes M, Martins P, Correia A, Videira J, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu A, Obleaga C, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla R, Predescu D, Hoara P, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin T, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón J, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles J, Rodicio Miravalles J, Pais S, Turienzo S, Alvarez L, Campos P, Rendo A, García S, Santos E, Martínez E, Fernández DMJ, Magadán ÁC, Concepción MV, Díaz LC, Rosat RA, Pérez SLE, Bailón CM, Tinoco CC, Choolani Bhojwani E, Sánchez D, Ahmed M, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki B, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins T, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan L, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue LH, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Willem J, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly J, Singh P, van Boxel G, Akbari K, Zanotti D, Sgromo B, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar M, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey I, Karush M, Seder C, Liptay M, Chmielewski G, Rosato E, Berger A, Zheng R, Okolo E, Singh A, Scott C, Weyant M, Mitchell J. Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study. Eur J Surg Oncol 2021; 47:1481-1488. [PMID: 33451919 DOI: 10.1016/j.ejso.2020.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer. METHOD This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III - V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%). RESULTS Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC. CONCLUSION Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer.
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Souza J, Araújo B, Leite J, Vasconcelos A, Santos C, Aguiar M, Catai A, Brandão D, De Andrade AD. IS THERE AN ASSOCIATION BETWEEN THE PRESENCE OF ENDOTHELIAL DYSFUNCTION AND EXERCISE TOLERANCE IN CARDIAC TRANSPLANT RECIPIENTS? Chest 2020. [DOI: 10.1016/j.chest.2020.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Araújo B, Leite J, Henriques D, Souza J, Figueiredo T, Santos C, Aguiar M, Brandão D, De Andrade AD. INFLUENCE OF AUTONOMIC DYSFUNCTION ON THE FUNCTIONAL CAPACITY OF INDIVIDUALS WITH HEART FAILURE. Chest 2020. [DOI: 10.1016/j.chest.2020.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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16
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Reis de Matos M, Santos-Bezerra DP, Dias Cavalcante CDG, Xavier de Carvalho J, Leite J, Neves JAJ, Admoni SN, Passarelli M, Parisi MC, Correa-Giannella ML. Distal Symmetric and Cardiovascular Autonomic Neuropathies in Brazilian Individuals with Type 2 Diabetes Followed in a Primary Health Care Unit: A Cross-Sectional Study. Int J Environ Res Public Health 2020; 17:ijerph17093232. [PMID: 32384735 PMCID: PMC7246466 DOI: 10.3390/ijerph17093232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 01/27/2023]
Abstract
The paucity of epidemiological data regarding diabetes complications in Brazil motivated us to evaluate the prevalence rates of distal symmetric polyneuropathy (DSP) and of cardiovascular autonomic neuropathy (CAN) in individuals with type 2 diabetes (T2D) followed in a primary care unit. A total of 551 individuals (59.3% women, 65 years old; diabetes duration of 10 years; HbA1c of 7.2%, medians) were included in this cross-sectional study. DSP was diagnosed by sum of the Neuropathy Symptoms Score (NSS) and Modified Neuropathy Disability Score (NDS) and by the Semmes-Weinstein monofilament. CAN was diagnosed by cardiovascular autonomic reflex tests combined with spectral analysis of heart rate variability. The prevalence rates of DSP were 6.3% and 14.3%, as evaluated by the sum of NSS and NDS and by the Semmes-Weinstein monofilament, respectively. Those with DSP diagnosed by monofilament presented longer diabetes duration, worse glycemic control and a higher stature. The prevalence rates of incipient and definitive CAN were 12.5% and 10%, respectively. Individuals with definitive CAN presented a higher frequency of hypercholesterolemia and of arterial hypertension. The higher prevalence rate of DSP with the use of the monofilament suggests that it may be a more appropriate tool to diagnose DSP in the primary care setting in Brazil.
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Affiliation(s)
- Mozania Reis de Matos
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo 01504-001, Brazil; (M.R.d.M.); (J.L.); (J.A.J.N.); (M.P.)
- Unidade Basica de Saude Dra. Ilza Weltman Hutzler. Rua Coronel Walfrido de Carvalho, Sao Paulo 02472-180, Brazil; (C.d.G.D.C.); (J.X.d.C.)
| | - Daniele Pereira Santos-Bezerra
- Laboratorio de Carboidratos e Radioimunoensaio (LIM-18), Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo. Avenida Dr. Arnaldo, 455, Sala 3321, Sao Paulo 01246-903, Brazil; (D.P.S.-B.); (S.N.A.)
| | | | - Jacira Xavier de Carvalho
- Unidade Basica de Saude Dra. Ilza Weltman Hutzler. Rua Coronel Walfrido de Carvalho, Sao Paulo 02472-180, Brazil; (C.d.G.D.C.); (J.X.d.C.)
| | - Juliana Leite
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo 01504-001, Brazil; (M.R.d.M.); (J.L.); (J.A.J.N.); (M.P.)
| | - Jose Antonio Januario Neves
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo 01504-001, Brazil; (M.R.d.M.); (J.L.); (J.A.J.N.); (M.P.)
| | - Sharon Nina Admoni
- Laboratorio de Carboidratos e Radioimunoensaio (LIM-18), Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo. Avenida Dr. Arnaldo, 455, Sala 3321, Sao Paulo 01246-903, Brazil; (D.P.S.-B.); (S.N.A.)
| | - Marisa Passarelli
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo 01504-001, Brazil; (M.R.d.M.); (J.L.); (J.A.J.N.); (M.P.)
- Laboratorio de Lipides (LIM-10), Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Avenida Dr. Arnaldo, 455, Sala 3305, Sao Paulo 01246-903, Brazil
| | - Maria Candida Parisi
- Divisao de Endocrinologia, Departamento de Clinica Medica, Faculdade de Medicina da Universidade Estadual de Campinas (UNICAMP), Rua Tessalia Vieira de Camargo, 126 – Cidade Universitaria, Campinas 13083-887, Brazil;
| | - Maria Lucia Correa-Giannella
- Programa de Pos-Graduaçao em Medicina, Universidade Nove de Julho (UNINOVE), Rua Vergueiro 235, 2° subsolo, Pos-graduação, Sao Paulo 01504-001, Brazil; (M.R.d.M.); (J.L.); (J.A.J.N.); (M.P.)
- Laboratorio de Carboidratos e Radioimunoensaio (LIM-18), Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo. Avenida Dr. Arnaldo, 455, Sala 3321, Sao Paulo 01246-903, Brazil; (D.P.S.-B.); (S.N.A.)
- Correspondence:
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Campos I, Batista B, Matos AC, Dutra F, Gomes G, Pinna A, Leite J, Ferreira A. Pregnancy loss due to amnionitis in anglo-arabian mare-Case report. Reprod Domest Anim 2020; 55:438-441. [PMID: 31916285 DOI: 10.1111/rda.13625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/03/2020] [Indexed: 11/29/2022]
Abstract
The amnion is a layer of the foetal membrane that has mechanical protection function and allows expansion and growth. The diseases that affect amnion have rarely been reported in horses. Amnionitis and funiculitis have been implicated as components of abortions as observed in abortions caused by the mare reproductive loss syndrome. Here, we report an abortion at 240-day gestation of a 7-year-old Anglo-Arabian mare with a history of previous stillbirth. Blood samples from both mare and foetus were collected for serological testing. Fragments from the placenta were taken for macroscopic and histopathological examinations. The results of these tests ruled out leptospirosis and concluded that the cause of the abortion was non-infectious chronic amnionitis. Moreover, the decreased vascularization in the placenta was consistent with placental insufficiency. This case highlights the importance of monthly ultrasound monitoring in equine pregnancy in order to diagnose placental insufficiency. The study also confirmed the efficiency of the histopathological examination for the definitive diagnosis of placental inflammation and for the study of foetal vascularization to rule out placental insufficiency in equine reproduction.
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Affiliation(s)
- Isabela Campos
- Department of Pathology and Veterinary Clinic, Federal Fluminense Universit, Niteroi, Brazil
| | - Barbara Batista
- Department of Pathology and Veterinary Clinic, Federal Fluminense Universit, Niteroi, Brazil
| | - Ana Carina Matos
- Department of Pathology and Veterinary Clinic, Federal Fluminense Universit, Niteroi, Brazil
| | | | - Gustavo Gomes
- Diagnostic Veterinary Medicine, University of Vassouras, Vassouras, Brazil
| | - Aline Pinna
- Department of Pathology and Veterinary Clinic, Federal Fluminense Universit, Niteroi, Brazil
| | - Juliana Leite
- Department of Pathology and Veterinary Clinic, Federal Fluminense Universit, Niteroi, Brazil
| | - Ana Ferreira
- Department of Pathology and Veterinary Clinic, Federal Fluminense Universit, Niteroi, Brazil
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Victor M, Leite J, Ramos G, David J, Cardoso K. UTILIZAÇÃO DE BIOMASSA EM AULAS DE GRADUAÇÃO DE QUÍMICA ORGÂNICA EXPERIMENTAL: EXTRAÇÃO DE FLAVONOIDES A PARTIR DE RESÍDUOS DE CASCAS DE FRUTAS CÍTRICAS. QUIM NOVA 2020. [DOI: 10.21577/0100-4042.20170609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Rosete M, Amaro A, Manso A, Leite J. Laparoscopic right hemicolectomy - stepwise approach for the trainee. Colorectal Dis 2019; 21:1222-1223. [PMID: 31314160 DOI: 10.1111/codi.14780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/01/2019] [Indexed: 02/08/2023]
Affiliation(s)
- M Rosete
- Serviço de Cirurgia Geral, Unidade de Cirurgia Colo-Rectal, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - A Amaro
- Serviço de Cirurgia Geral, Unidade de Cirurgia Colo-Rectal, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Manso
- Serviço de Cirurgia Geral, Unidade de Cirurgia Colo-Rectal, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - J Leite
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
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Ghodratitoostani I, Vazirikangolya Z, Nascimento D, Colacique M, Louzada F, Delbem A, Barros C, Oliveira A, Hyppolito M, Leite J. Anodal HD- tDCS of left dlPFC together with Positive Emotion Induction Can Modulate Tinnitus Loudness. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Leite J, Magalhães A, Valente A, Silva CM. Measurement and modelling of tracer diffusivities of gallic acid in liquid ethanol and in supercritical CO 2 modified with ethanol. J Supercrit Fluids 2018. [DOI: 10.1016/j.supflu.2017.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cunha S, Corgozinho K, Justen H, Silva K, Leite J, Ferreira AM. Survival and Disease-free Interval of Cats with Mammary Carcinoma Treated with Chain Mastectomy. ACTA SCI VET 2016. [DOI: 10.22456/1679-9216.80900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Mammary tumors are extremely common in cats and have high metastatic rates with poor prognosis. The main objective of the present study was to evaluate the disease free interval and survival in cats undergoing radical mastectomy as sole therapy.Materials, Methods & Results: Twenty cats with mammary tumors and no evidence of distant metastasis were studied. General health and concomitant diseases were assessed by clinical and hematological examination. Thoracic radiographs and abdominal ultrasonography were performed to evaluate thoracic and abdominal metastases. All cats underwent chain mastectomy, which was unilateral when tumor was present in one mammary chain, and bilateral in steps if tumors were present in both mammary chains. Intact cats were spayed. An elliptical incision was made around the mammary chain with a three centimeter margin around tumor. Regional lymph node was removed. Mean age was ten years, and 14 cats were mixed breed, three were Persian and two were Siamese. Fifteen cats were spayed at tumor diagnosis, but only three had been spayed before one year old. The inguinal mammary glands were the most affected, followed by abdominal and thoracic glands. Histopathology diagnosed well-differentiated adenocarcinoma in eight cases, moderately differentiated adenocarcinoma in nine cases, poorly differentiated adenocarcinoma in two cases and carcinoma in situ in one case. Most tumors were grade II, and regional lymph node metastasis was present in two cases. Disease free interval ranged from 120 to 1800 days, with an average of 678 days. Four cats had tumor local recurrence and six developed lung metastasis. The survival time ranged from seven to 1800 days, with an average of 768 days. Twelve cats are still alive with no tumor recurrence.Discussion: The average age of onset of mammary carcinomas in cats was ten years old, similar to previous studies. Siamese cats have more risk of developing this disease, but mixed breed cats were frequent in this study. Intact or late spayed cats are predisposed to mammary tumors because of hormonal stimulation, the same was observed in this study. Inguinal and abdominal glands were most affected, similar to other reports. The histopathologic diagnosis was adenocarcinoma in most cases of this study, mostly grade II tumors, which was also observed in previous papers. Regional lymph nodes (axillary or inguinal) should always be removed during mastectomy in cats, as regional metastasis at diagnosis is common, even when not clinically palpable, as was observed in two cases. Distant metastasis occurs most often to the lungs, leading to severe dyspnea. In this study, four cats had local tumor recurrence and six developed lung metastasis. Aggressive and early surgical intervention is the treatment of choice for feline mammary tumors. Unlike dogs (where conservative mammary resections are appropriate in some cases), radical chain mastectomy is recommended for feline mammary tumors, as significantly reduces the risk of local recurrence. In this study, all animals underwent radical mastectomy, without previous cytology or biopsy. Survival is variable between studies, ranging from 220 to 1408 days. Several factors may be involved in disease free intervals and survival times, as tumor size, tumor histological grade, presence of metastasis at diagnosis, type of surgery performed, presence of concomitant diseases and adjuvant chemotherapy. In this study, mean survival time was 768 days and 12 cats are still alive and in follow-up, which may increase this number. This study supports that, if treated early and agressively, cats with malignant mammary tumors can have long survival after chain mastectomy.
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Fregni F, Nitsche MA, Loo CK, Brunoni AR, Marangolo P, Leite J, Carvalho S, Bolognini N, Caumo W, Paik NJ, Simis M, Ueda K, Ekhitari H, Luu P, Tucker DM, Tyler WJ, Brunelin J, Datta A, Juan CH, Venkatasubramanian G, Boggio PS, Bikson M. Regulatory Considerations for the Clinical and Research Use of Transcranial Direct Current Stimulation (tDCS): review and recommendations from an expert panel. ACTA ACUST UNITED AC 2014; 32:22-35. [PMID: 25983531 DOI: 10.3109/10601333.2015.980944] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The field of transcranial electrical stimulation (tES) has experienced significant growth in the past 15 years. One of the tES techniques leading this increased interest is transcranial direct current stimulation (tDCS). Significant research efforts have been devoted to determining the clinical potential of tDCS in humans. Despite the promising results obtained with tDCS in basic and clinical neuroscience, further progress has been impeded by a lack of clarity on international regulatory pathways. We therefore convened a group of research and clinician experts on tDCS to review the research and clinical use of tDCS. In this report, we review the regulatory status of tDCS, and we summarize the results according to research, off-label and compassionate use of tDCS in the following countries: Australia, Brazil, France, Germany, India, Iran, Italy, Portugal, South Korea, Taiwan and United States. Research use, off label treatment and compassionate use of tDCS are employed in most of the countries reviewed in this study. It is critical that a global or local effort is organized to pursue definite evidence to either approve and regulate or restrict the use of tDCS in clinical practice on the basis of adequate randomized controlled treatment trials.
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Affiliation(s)
- F Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - M A Nitsche
- Department of Clinical Neurophysiology, Georg-August-University, Göttingen, Germany
| | - C K Loo
- School of Psychiatry & The Black Dog Institute, University of New South Wales, Sydney, Australia
| | - A R Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil and Division of Neurology, Santa Casa Medicak School, Sao Paulo, Brazil
| | - P Marangolo
- Department of Experimental and Clinical Medicine, University Politecnica delle Marche, Ancona, and IRCCS Fondazione Santa Lucia, Roma, Italy
| | - J Leite
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA ; Neuropsychophysiology Laboratory, CIPsi, School of Psychology (EPsi), University of Minho, Campus de Gualtar, Braga, Portugal
| | - S Carvalho
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA ; Neuropsychophysiology Laboratory, CIPsi, School of Psychology (EPsi), University of Minho, Campus de Gualtar, Braga, Portugal
| | - N Bolognini
- Department of Psychology, University of Milano Bicocca, and Laboratory of Neuropsychology, IRCC Instituto Auxologico Italiano, Milano, Italy
| | - W Caumo
- Laboratory of Pain & Neuromodulation at Hospital de Clínicas de Porto Alegre at UFRGS
| | - N J Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - M Simis
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil and Division of Neurology, Santa Casa Medicak School, Sao Paulo, Brazil
| | - K Ueda
- National Cardiovascular Center, Osaka, Japan
| | - H Ekhitari
- Translational Neuroscience Program, Institute for Cognitive Science Studies, Tehran, Iran ; Neurocognitive Laboratory, Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - P Luu
- Electrical Geodesics, Inc., and University of Oregon, Eugene, Oregon, USA
| | - D M Tucker
- Electrical Geodesics, Inc., and University of Oregon, Eugene, Oregon, USA
| | - W J Tyler
- Virginia Tech Carilion Research Institute, Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, and School of Biomedical Engineering and Sciences, Virginia Tech, Roanoke, VA USA
| | - J Brunelin
- EA 4615, Centre Hospitalier le Vinatier, Université de Lyon, F-69003, Université Claude Bernard Lyon I, Bron, France
| | - A Datta
- Department of Biomedical Engineering, Neural Engineering Laboratory, The City College of the City University of New York New York, NY, USA
| | - C H Juan
- Institute of Cognitive Neuroscience, National Central University, Taiwan
| | - G Venkatasubramanian
- Translational Psychiatry Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - P S Boggio
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Healthy and Biological Sciences, Mackenzie Presbyterian University, Sao Paulo, Brazil
| | - M Bikson
- Department of Biomedical Engineering, Neural Engineering Laboratory, The City College of the City University of New York New York, NY, USA
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Asht LDS, Rêgo TDS, Pessoa LR, Leite J, Ferreira AM, dos Santos ADS, Feijó MBDS, dos Anjos JS, Correia-Santos AM, da Costa CAS, Boaventura GT. The effects of Yam (Dioscorea bulbifera) intake on small intestine morphology in streptozotocin-induced diabetic rats. Int J Food Sci Technol 2014. [DOI: 10.1111/ijfs.12598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Louise da S. Asht
- Experimental Nutrition Laboratory; College of Nutrition; Federal Fluminense University; Rua Mário Santos Braga, 30 Niterói RJ 24020-140 Brazil
| | - Thaís de S. Rêgo
- Experimental Nutrition Laboratory; College of Nutrition; Federal Fluminense University; Rua Mário Santos Braga, 30 Niterói RJ 24020-140 Brazil
| | - Letícia R. Pessoa
- Experimental Nutrition Laboratory; College of Nutrition; Federal Fluminense University; Rua Mário Santos Braga, 30 Niterói RJ 24020-140 Brazil
| | - Juliana Leite
- Department of Pathology and Veterinary Clinics; Veterinary Faculty; Federal Fluminense University; Rua Vital Brazil, 64, Vital Brazil Niterói RJ 24230-340 Brazil
| | - Ana M. Ferreira
- Department of Pathology and Veterinary Clinics; Veterinary Faculty; Federal Fluminense University; Rua Vital Brazil, 64, Vital Brazil Niterói RJ 24230-340 Brazil
| | - Aline de S. dos Santos
- Physiological Sciences Department; Institute of Biology Roberto Alcantara Gomes; State University of Rio de Janeiro; Av. 28 de Setembro, 87 Vila Isabel Rio de Janeiro RJ 20551-030 Brazil
| | - Márcia B. da S. Feijó
- Bromatology Laboratory; College of Pharmacy; Federal Fluminense University; Rua Dr. Mário Viana, 523 Niterói RJ 24241- 001 Brazil
| | - Juliana S. dos Anjos
- Experimental Nutrition Laboratory; College of Nutrition; Federal Fluminense University; Rua Mário Santos Braga, 30 Niterói RJ 24020-140 Brazil
| | - André M. Correia-Santos
- Experimental Nutrition Laboratory; College of Nutrition; Federal Fluminense University; Rua Mário Santos Braga, 30 Niterói RJ 24020-140 Brazil
| | - Carlos A. S. da Costa
- Experimental Nutrition Laboratory; College of Nutrition; Federal Fluminense University; Rua Mário Santos Braga, 30 Niterói RJ 24020-140 Brazil
| | - Gilson T. Boaventura
- Experimental Nutrition Laboratory; College of Nutrition; Federal Fluminense University; Rua Mário Santos Braga, 30 Niterói RJ 24020-140 Brazil
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Rêgo TDS, Ash LDS, Pessoa L, Feijó MBDS, Leite J, dos Santos ADS, da Costa CAS, Boaventura GT. The intake of yam (Dioscorea bulbifera Linn) attenuated the hyperglycemia and the bone fragility in female diabetic rats. NUTR HOSP 2014; 29:370-5. [PMID: 24528355 DOI: 10.3305/nh.2014.29.2.7046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Diabetic patients have a higher risk to osteoporotic fractures. Foods, such as yam, to oppose hyperglycemia, has been used to treatment of diabetes. OBJECTIVE The goal was assess the role of Brazilian yam (Dioscorea bulbifera) on glycemia and bone parameters of female diabetic rats. METHODS Female Wistar rats with 3 months age were allocated in three groups. Control group (C, n = 6), treated with normal fat diet. Diabetic rats treated with high-fat diet without (DM, n = 8) and with (DMY, n = 8) liofilized yam flour. After 5 weeks of the experiment, serum glucose and insulin, pancreas mass, number and area of pancreas islets were quantified. And femur parameters were analyzed by dual-energy X-ray absorptiometry (DXA) and computed tomography (CT). RESULTS Differences were considered significant if P<0.05. Diabetic groups showed lower (P < 0.05): femur and pancreas mass, area of the pancreatic islets and insulin. However, DMY showed lower (-10%, P < 0.05) concentrations of glucose to DM group. Femur, by DXA, showed lower bone mineral density, content and area in the DM group. While the DMY group showed greater (+27%, P < 0.05) radiodensity of femoral head when compared to DM group. DISCUSSION Brazilian yam flour supplement did not fix a defect, but alleviated the consequences of the experimental diabetic disease. It showed results to control the rise in blood glucose levels in diabetic rats, suggesting protection in oxidative agents and postpone harm in the bone. CONCLUSION Considering all the findings of the present study, our results suggest that yam flour does act producing benefits in the experimental diabetes.
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Affiliation(s)
- Thaís de Salgado Rêgo
- Experimental Nutrition Laboratory. College of Nutrition. Federal Fluminense University. Brazil..
| | - Louise da Silva Ash
- Experimental Nutrition Laboratory. College of Nutrition. Federal Fluminense University. Brazil..
| | - Letícia Pessoa
- Experimental Nutrition Laboratory. College of Nutrition. Federal Fluminense University. Brazil..
| | | | - Juliana Leite
- Department of Pathology and Veterinary Clinics. Veterinary Faculty. Federal Fluminense University. Brazil..
| | - Aline de Sousa dos Santos
- Physiological Sciences Department. Institute of Biology Roberto Alcantara Gomes. State University of Rio de Janeiro. Brazil.
| | | | - Gilson Teles Boaventura
- Experimental Nutrition Laboratory. College of Nutrition. Federal Fluminense University. Brazil..
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Costa FM, Schiavo JA, Brasil MS, Leite J, Xavier GR, Fernandes PI. Phenotypic and molecular fingerprinting of fast growing rhizobia of field-grown pigeonpea from the eastern edge of the Brazilian Pantanal. Genet Mol Res 2014; 13:469-82. [PMID: 24535875 DOI: 10.4238/2014.january.21.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The aim of this study was to evaluate the diversity of rhizobial isolates obtained from root nodules of pigeonpea plants grown at the eastern edge of the Brazilian Pantanal. The bacterial isolates were isolated from root nodules from field-growing pigeonpea grown in two rural settlements of the Aquidauana municipality. The bacterial isolates were characterized phenotypically by means of cultural characterization, intrinsic antibiotic resistance (IAR), salt and high incubation temperature tolerance, and amylolytic and cellulolytic activities. The molecular characterization of the bacterial isolates was carried out using amplified ribosomal DNA restriction analysis (ARDRA) and Box-polymerase chain reaction (PCR) techniques. In addition, the symbiotic performance of selected rhizobial isolates was evaluated in a greenhouse experiment using sterile substrate. The phenotypic characterization revealed that the bacterial strains obtained from pigeonpea root nodules presented characteristics that are uncommon among rhizobial isolates, indicating the presence of new species nodulating the pigeonpea plants in the Brazilian Pantanal. The molecular fingerprinting of these bacterial isolates also showed a highly diverse collection, with both techniques revealing less than 25% similarity among bacterial isolates. The evaluation of symbiotic performance also indicated the presence of microorganisms with high potential to increase the growth and nitrogen content at the shoots of pigeonpea plants. The results obtained in this study indicate the presence of a highly diversified rhizobial community nodulating the pigeonpea at the eastern edge of the Brazilian Pantanal.
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Affiliation(s)
- F M Costa
- Laboratório de Matéria Orgânica e Microbiologia do Solo, Departamento de Solos, Universidade Estadual do Mato Grosso do Sul, Aquidauana, MS, Brasil
| | - J A Schiavo
- Laboratório de Matéria Orgânica e Microbiologia do Solo, Departamento de Solos, Universidade Estadual do Mato Grosso do Sul, Aquidauana, MS, Brasil
| | - M S Brasil
- Laboratório de Biologia Molecular e de Micro-Organismos, Departamento de Ciências do Ambiente, Universidade Federal do Mato Grosso do Sul, Corumbá, MS, Brasil
| | - J Leite
- Curso de Pós-Graduação em Agronomia-Ciência do Solo, Departamento de Solos, Instituto de Agronomia, Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ, Brasil
| | - G R Xavier
- Laboratório de Ecologia Microbiana, Embrapa Agrobiologia, Seropédica, RJ, Brasil
| | - P I Fernandes
- Laboratório de Microbiologia do Solo, Embrapa Semiárido, Petrolina, PE, Brasil
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Abstract
The content of total lipids and the fatty acid (FA) profile were determined for eight macroalgae (Cystoseira abies-marina, Fucus spiralis, Chaetomorpha pachynema, Codium elisabethae, Porphyra sp., Osmundea pinnatifida, Pterocladiella capillacea and Sphaeroccoccus coronopifolius). Total lipids were extracted using a solvent mixture of methanol/chloroform (2/1, v/v) and further derivatised to FA methyl esters (FAME). The analyses of FAME samples were performed by gas chromatography coupled to a flame ionisation detector. The total lipid content ranged from 0.06 to 3.54 g (per 100 g). The most abundant saturated FA were palmitic (C16:0) and myristic (C14:0), while oleic (C18:1 n-9) was the dominant monounsaturated acid. All seaweeds contained linoleic FA (C18:2 n-6). The α-linolenic (C18:3 n-3) and eicosapentaenoic (20:5 n-3) acids were present only in Porphyra sp. (3.34% ± 0.13) and C. pachynema (0.47% ± 0.12), respectively. The n-6/n-3 and h/H ratios were low, suggesting a high nutritional value of the algae studied.
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Affiliation(s)
- R F Patarra
- Departamento Biologia, Universidade dos Açores, Ponta Delgada, Portugal.
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Medeiros LS, Marassi CD, Figueiredo EE, Leite J, Ferreira AMR, Lilenbaum W. Assessing the histopathology to depict the different stages of bovine tuberculosis infection in a naturally infected herd. Pesq Vet Bras 2012. [DOI: 10.1590/s0100-736x2012000200008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The standard method for detection of bovine tuberculosis (TB) is the single intradermal tuberculin test (SITT). Nevertheless, current studies suggest that a single test is not enough to detect all cattle infected by TB, particularly when animals present different stages of infection. A dairy herd comprised of 270 cows was studied and 15 were reactive to SITT plus nine inconclusive animals. Blood samples (for IFN and ELISA) were collected from these 24 cows. At 30 days after injection of PPD, all the cows that were reactive to any of the employed tests were slaughtered, and tissues were processed by Bacteriology, Histopathology (HP) and PCR. According to HP 33.4% of the animals were positive, 45.8% inconclusive and 20.8% were negative. The inconclusive samples came from IFN positive animals, signalizing recent infection. Regarding the animals that were negative to HP, all of them were identified by IFN while ELISA was negative. Immune responses are different in recent and advanced infections, what supports the identification between chronically or recently infected animals. This multidisciplinary approach is mandatory for the interpretation of the various tools that are frequently employed for the diagnosis of TB and mainly to identify all infected animals.
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Teixeira LS, Leite J, Castro Viegas MJB, Faria MML, Pires MC, Teixeira HC, Teixeira RC, Pettersen H. Non-influence of fetal gender on ductus venosus Doppler flow in the first trimester. Ultrasound Obstet Gynecol 2008; 32:12-14. [PMID: 18504786 DOI: 10.1002/uog.5330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Recent findings have suggested that ductus venosus blood flow may be influenced by fetal gender. The aim of this study was to investigate further the influence of fetal gender on ductus venosus Doppler flow in the first trimester. METHODS This was a cross-sectional and retrospective study performed between January 1998 and January 2003. A total of 932 fetuses at between 10 and 14 weeks' gestation were included. The following inclusion criteria were used: singleton gestation; crown-rump length between 39 and 84 mm; and absence of fetal anomalies. The following variables of the ductus venosus were evaluated: peak velocity during ventricular systole (S-wave) and diastole (D-wave); nadir during atrial contraction in late diastole (A-wave); pulsatility index for veins (PIV); peak velocity index for veins (PVIV); and time-averaged maximum velocity (TAMXV). RESULTS Four hundred and forty-eight (48.1%) female and 484 (51.9%) male fetuses were included in the study. Comparing males and females at between 10 and 14 weeks' gestation, there was no statistically significant difference in S-wave, D-wave, A-wave, PIV, PVIV or TAMXV. CONCLUSIONS Our study suggests that fetal gender does not influence ductus venosus blood flow in the first trimester.
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Affiliation(s)
- L S Teixeira
- Serviço de Medicina Fetal-Eccos-Clinica da Imagem, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
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Teixeira LS, Leite J, Viegas MJBC, Faria MML, Chaves AS, Teixeira RC, Pires MC, Pettersen H. Ductus venosus Doppler velocimetry in the first trimester: a new finding. Ultrasound Obstet Gynecol 2008; 31:261-265. [PMID: 18275091 DOI: 10.1002/uog.5245] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To establish reference curves for ductus venosus blood flow velocities during the first trimester and compare them with previously published curves. METHODS This was a cross-sectional and retrospective study performed between January 1998 and January 2003. The following inclusion criteria were used: singleton pregnancy, velocity measurements taken when the crown-rump length (CRL) was between 34 and 84 mm, absence of fetal anomalies, full-term pregnancy and newborn birth weight appropriate for gestational age. The following variables of the ductus venosus were measured: peak velocity during ventricular systole (S-wave) and diastole (D-wave), nadir during atrial contraction in late diastole (A-wave), time-averaged maximum velocity (TAMXV) and pulsatility index for veins (PIV). RESULTS A total of 843 fetuses were included. The mean CRL was 62 (range, 34-84) mm. The S-wave, D-wave, TAMXV and PIV were normally distributed, and logarithmic transformation was performed to achieve a normal distribution for the A-wave. S-wave, D-wave and A-wave and TAMXV increased with CRL. PIV increased up to a CRL of 63 mm and decreased thereafter. Regression analysis revealed a significant quadratic relationship between PIV and CRL. CONCLUSIONS S-wave, D-wave, A-wave velocities and TAMXV in the ductus venosus increase with CRL between 34 and 84 mm. The reference range for PIV has a biphasic pattern, with an initial non-significant increase up to a CRL of 63 mm and a fall thereafter.
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Affiliation(s)
- L S Teixeira
- Pós-Graduação em Saúde da Mulher, Faculdade de Medicina, Belo Horizonte, Minas Gerais, Brazil
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Benoit B, Murta MM, Leite J, Jeanty P. Intrathoracic fluid may be a normal finding at around 8 gestational weeks. Ultrasound Obstet Gynecol 2007; 30:188-91. [PMID: 17582229 DOI: 10.1002/uog.3976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To describe the observation of embryonic thoracic fluid at around 8 weeks' gestation and to discuss the likely etiology. METHODS This was a retrospective study of patients referred between August 2005 and May 2006 to our units in France and in the USA for a dating scan between 6 and 10 weeks. Included in our series were all embryos presenting with an ultrasound finding suggestive of an early pericardial fluid collection, i.e. a large anechoic fluid collection surrounding the heart. The gestational age, fetal heart rate and maternal age at this first scan were recorded, along with nuchal translucency thickness as measured at the 12-week scan and the second-trimester anomaly scan results. RESULTS Five cases were included in this study. In all five patients, the anechoic fluid collection was visualized at 8 weeks, and by the time of the nuchal scan it had disappeared completely. The nuchal translucency thickness was normal in all cases and all five embryos had normal cardiac examinations during the second trimester and were normal at birth. CONCLUSIONS The observation on ultrasound at 8 weeks' gestation of a large anechoic fluid collection surrounding the heart that disappears by week 12 is suggestive of a transient pericardial collection.
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Affiliation(s)
- B Benoit
- Obstetrics and Gynecology, Princess Grace Hospital, Monaco, France
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Teixeira L, Castro M, Leite J, Teixeira H, Teixeira R, Pettersen H, Julio C. Mesenteric cystic lymphangioma: a prenatal diagnostic challenge. Prenat Diagn 2007; 27:479-80. [PMID: 17471606 DOI: 10.1002/pd.1680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
OBJECTIVE The aim of this study was to evaluate the outcome of pregnancies complicated by very large hematomas in the first trimester. METHODS Between January 2001 and January 2006, 8085 patients between 5 and 14 weeks' gestation underwent routine first-trimester ultrasonographic examinations at our practice. Of these, 30 patients had a "very large" (> 50% of the gestational sac) intrauterine hematoma. These 30 patients were further classified according to pregnancy outcome (normal or adverse), maternal age, vaginal bleeding, crown-rump length, gestational age at diagnosis of the hematoma, and position and location of the hematoma. P < .05 was considered statistically significant. RESULTS Six patients were excluded (4 were still pregnant, and 2 were lost to follow-up), leaving 24 patients eligible for analysis, of which 11 (46%) had adverse outcomes and 13 (54%) had normal outcomes. The group with adverse outcomes had a significantly lower gestational age at diagnosis than the second group (7 weeks [range, 5.7-8.4 weeks] versus 8.4 weeks [range, 6.2-14 weeks]; P = .0227), but crown-rump length, vaginal bleeding, and position and location of the hematoma were similar. CONCLUSIONS Very large hematomas were associated with adverse outcome in 46% of the pregnancies. Vaginal bleeding was not associated with a poor prognosis. Neither position nor location of the placental hematoma was related to the outcome; however, when the hematoma was diagnosed at an early gestational age, the outcomes were worse.
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Affiliation(s)
- Juliana Leite
- Inner Vision Women's Ultrasound, Nashville, TN 37203-1926 USA.
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Silveira AC, Peñaranda-Carrillo R, Lorosa ES, Leite J, Vinhaes MC, Castro C, Prata A, Macêdo V. Evaluation of the impact of chemical control measures and entomological surveillance on Chagas' disease in the counties of Mambaí and Buritinópolis, Goiás State, Brazil. Rev Soc Bras Med Trop 2001; 34:549-57. [PMID: 11813062 DOI: 10.1590/s0037-86822001000600009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Epidemiological surveillance activities were implemented in 1980 in Mambaí and Buritinópolis counties, Goiás State. Twenty years later the authors evaluated the impact of these vector control measures on Chagas' disease transmission, based on entomological indicators. Entomological investigation was conducted using the man-hour technique and covering all domiciles. In order to study vector food sources the stomach contents of triatomines were analyzed using the modified precipitins technique. Triatomines were shown to be present in 48 (71.6%) of the 67 locations. Peridomiciliary infestation rates in Mambaí and Buritinópolis were 8.7% and 12.1%, respectively, while intradomiciliary rates were 0.7% and 1.2%. Triatoma sordida was the species identified in 97.3% of all captured specimens. It was also the only species found to be naturally infected with Trypanosoma cruzi. Birds were the most frequent food source (45%) for Triatoma sordida. The most significant result was the complete absence of Triatoma infestans in the two counties.
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Affiliation(s)
- A C Silveira
- Núcleo de Medicina Tropical, Universidade de Brasília, Brasília, DF
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Yamagishi T, Leite J, Ueda S, Yamaguchi F, Suwa Y. Simultaneous removal of phenol and ammonia by an activated sludge process with cross-flow filtration. Water Res 2001; 35:3089-3096. [PMID: 11487105 DOI: 10.1016/s0043-1354(01)00032-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Attempts were made for removing ammonia from synthetic wastewater under the presence of phenol, which is inhibitory to nitrification, by using a single-stage activated sludge process with cross-flow filtration. Activated sludge biomass which had been acclimated with phenol for over 15 years was used for the inoculum, and synthetic wastewater was continuously supplied to the process retaining biomass at 8000 mg VSS l(-1). Phenol was completely removed, and ammonia was simultaneously nitrified to nitrate; nitrification rate reached 200 mg N l(-1) d(-1) when phenol was removed at a rate up to 300 mg l(-1) d(-1). It was observed that 0-13% of the ammonia was removed via denitrification. Intermittent aeration enhanced the denitrification rate to 160 mg N l(-1) d(-1) by utilizing phenol. and approximately 24% of the denitrified nitrogen was recovered as nitrous oxide. Methanol, which is the most commonly used electron donor in conventional nitrogen removal processes, did not enhance the denitrification rate of the phenol-acclimated activated sludge used in this study, however phenol did. The results suggest that this process potentially works as a space- and energy-saving nitrogen removal process by utilizing substances inhibitory to nitrifiers as electron donors for denitrification.
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Affiliation(s)
- T Yamagishi
- Department of Ecological Chemistry and Microbiology, National Institute for Resources and Environment, AIST, MITI, Tsukuba, Ibaraki, Japan.
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Norton R, Leite J, Vieira E, Bambirra E, Moura C, Penna G, Penna F. Use of nucleotides in weanling rats with diarrhea induced by a lactose overload: effect on the evolution of diarrhea and weight and on the histopathology of intestine, liver and spleen. Braz J Med Biol Res 2001; 34:195-202. [PMID: 11175494 DOI: 10.1590/s0100-879x2001000200006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Until recently, dietary sources of nucleotides were thought not to be essential for good nutrition. Certain states with higher metabolic demands may require larger amounts that cannot be provided by endogenous production. The objective of the present study was to determine the action of nucleotides on the recovery from lactose-induced diarrhea in weaned rats. Thirty-six weanling Fisher rats were divided into two groups. Group 1 received a standard diet and group 2 received a diet containing lactose in place of starch. On the 10th day, six animals per group were sacrificed for histopathological evaluation. The remaining animals were divided into two other subgroups, each with 6 animals, receiving a control diet, a control diet with nucleotides (0.05% adenosine monophosphate, 0.05% guanosine monophosphate, 0.05% cytidine monophosphate, 0.05% uridine monophosphate and 0.05% inosine monophosphate), a diet with lactose, and a diet with lactose and nucleotides. On the 32nd day of the experiment all animals were sacrificed. Animals with diarrhea weighed less than animals without diarrhea. The introduction of nucleotides did not lead to weight gain. Mean diet consumption was lower in the group that continued to ingest lactose, with the group receiving lactose plus nucleotides showing a lower mean consumption. Animals receiving lactose had inflammatory reaction and deposits of periodic acid-Schiff-positive material in intestinal, hepatic and splenic tissues. The introduction of nucleotides led to an improvement of the intestinal inflammatory reaction. In lactose-induced diarrhea, when the stimulus is maintained--lactose overload--the nucleotides have a limited action on the weight gain and on recovery of intestinal morphology, although they have a protective effect on hepatic injury and improve the inflammatory response.
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Affiliation(s)
- R Norton
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
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Rosa A, Sequeira C, Maç as F, Nunes A, Gregório C, Leite J, Castro e Sousa F, Leitão M, Freitas D. Histoacryl in the endoscopic treatment of severe arterial tumor bleeding. Endoscopy 2000; 32:S69. [PMID: 11147954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- A Rosa
- Dept. of Gastroenterology, Coimbra University Hospital, Portugal
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Isidro G, Matos P, Almeida S, Claudino S, Marshall B, Soares J, Leite J, Regateiro F, Brito MJ, Giria J, Castro C, Ramos J, Novais L, Morna H, Medeira A, Castedo S, Boavida MG. Eleven novel APC mutations identified in Portuguese FAP families. Hum Mutat 2000; 16:178. [PMID: 10923044 DOI: 10.1002/1098-1004(200008)16:2<178::aid-humu15>3.0.co;2-#] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Germline mutations of the adenomatous polyposis coli (APC) gene are responsible for familial adenomatous polyposis (FAP), an autosomal dominant predisposition to colorectal cancer. In the present study we screened all of the exons of the APC gene in individuals belonging to 85 Portuguese FAP families. We here report eleven novel mutations which are predominantly frameshifts or single base substitutions, resulting in premature stop codons. Hum Mutat 16:178, 2000.
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Affiliation(s)
- G Isidro
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa.
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40
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Isidro G, Veiga I, Matos P, Almeida S, Bizarro S, Marshall B, Baptista M, Leite J, Regateiro F, Soares J, Castedo S, Boavida MG. Four novel MSH2 / MLH1 gene mutations in portuguese HNPCC families. Hum Mutat 2000; 15:116. [PMID: 10612836 DOI: 10.1002/(sici)1098-1004(200001)15:1<116::aid-humu24>3.0.co;2-q] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hereditary non-polyposis colorectal cancer (HNPCC) is considered to be determined by germline mutations in the mismatch repair (MMR) genes, especially MSH2 and MLH1. While screening for mutations in these two genes in HNPCC portuguese families, 3 previously unreported MSH2 and 1 MLH1 mutations have been identified in families meeting strict Amsterdam criteria. Hum Mutat 15:116, 2000.
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Affiliation(s)
- G Isidro
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal.
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Garcia JL, Navarro IT, Ogawa L, de Oliveira RC, de Faria Garcia SM, Leite J. [Seroepidemiology of toxoplasmosis and ocular evaluation by Amsler grid in patients from the rural area treated at the Jaguapitã county health center, Paraná State, Brazil]. Rev Soc Bras Med Trop 1999; 32:671-6. [PMID: 10881104 DOI: 10.1590/s0037-86821999000600009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this study, we collected serum from 82 randomly selected patients from a rural area in Jaguapitã county, Paraná State. All sera were subjected to indirect immunofluorescence assay (IFA) to detect IgG antibodies against T. gondii. Serum titers >/=+ 16 were considered positive. Of the 82 evaluated sera, 68 (82.9%) were positive to toxoplasmosis and 14 (17.1%) were non-reactive. The most common titers found were 64 (23/33.8%) and 256 (16/23.5%), the highest titer being 4096 (8/11.8%). The 82 patients were also evaluated by the Amsler Grid test, with 22 (26.8%) patients presenting at least one alteration in this test. Masculinity was found to be a protection factor in the Amsler grid test (OR = 0.21 0.04 < OR < 0. 86 chi2 = 4,98 p = 0,02). There were no significant statistical differences related to the epidemiological investigation. We concluded that T. gondii has a wide distribution in the population studied.
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Affiliation(s)
- J L Garcia
- Departamento de Medicina Veterinária Preventiva e de Serviço Social, Universidade Estadual de Londrina, PR, Brasil
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Caseiro-Alves F, Gonçalo M, Cruz L, Ilharco J, Leite J, Agostinho A, Castro e Sousa F, Vilaça-Ramos H. Water enema computed tomography (WE-CT) in the local staging of low colorectal neoplasms: comparison with transrectal ultrasound. Abdom Imaging 1998; 23:370-4. [PMID: 9663271 DOI: 10.1007/s002619900363] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND To determine the accuracy of computed tomography performed with a water enema application (WE-CT) in the local staging of low colorectal neoplasms and to compare the results with those of transrectal ultrasonography (TRUS). METHODS Forty patients with low colorectal tumors were evaluated prospectively by CT with the simultaneous administration of a lukewarm rectal enema (0.5-1.5 L). Thin slices (5 mm) and intravenous application of iodinated contrast media were routinely used. TRUS was performed in 18 patients. Tumor size, location, and staging according to the TNM classification of the UICC were registered. Tumors were classified as < T3 (T1 or T2) or as T3 or T4. For staging peritumoral lymph node metastases on WE-CT, two criteria of positivity were tested: N+ if at least one peritumoral node > or 5 mm in diameter was seen (reading A); N+ if at least one peritumoral node > or = 5 mm or three peritumoral nodes < 5 mm were identified (reading B). RESULTS For the tumor staging, WE-CT showed a sensitivity of 90%, a specificity of 73%, a positive predictive value (PPV) of 90%, a negative predictive value (NPV) of 73%, and an accuracy of 85%. For TRUS, the results were sensitivity of 73%, specificity of 29%, PPV of 62%, NPV of 40%, and an accuracy of 39%. Concerning nodal staging with WE-CT, results were superior when reading A was used: sensitivity = 84%, specificity = 83%, PPV = 73%, NPV = 91%, and accuracy = 84%. TRUS showed a sensitivity of 29%, specificity of 100%, PPV of 100%, NPV of 67%, and an accuracy of 71%. CONCLUSION WE-CT is a reliable technique for the local staging of low colorectal tumors that can be superior to TRUS. For diagnosis of peritumoral metastatic lymph nodes on WE-CT, the 5-mm diameter cutoff value is the most appropriate size criterion.
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Affiliation(s)
- F Caseiro-Alves
- Serviço de Radiologia, Hospital Universidade de Coimbra, Portugal
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Costa RM, Leite J. [Rapid recovery after treatment with granulocyte-macrophage colony-stimulating factor (GM-CSF) for neutropenia caused by indomethacin]. Sangre (Barc) 1993; 38:502-3. [PMID: 8171389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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