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au:ROCHA, JAIME L.

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Effects of the presence of litter on the composition of stream tadpoles' assemblages in an Atlantic Forest remnant of southeastern Brazil
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Bertoluci, Jaime

; Famelli, Shirley

; Rocha, Pedro L. B.

; Rodrigues, Miguel T.

Biota Neotropica

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2021, Volumen 21 Nº 4 elocation e20201147

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo: Uma variedade de espécies de anuros tropicais usa riachos da floresta para depositar seus ovos, mas o uso e a seleção de recursos por girinos em florestas tropicais são pouco conhecidos. Na presente pesquisa, nossa hipótese era a de que a presença de serapilheira e a profundidade das poça dos riachos influenciam a presença de girinos devido à seleção de habitats de ovipostura pelos adultos e/ou seleção de micro-habitats pelos girinos. O trabalho de campo foi realizado na Estação Biológica de Boracéia, uma reserva de Mata Atlântica no estado de São Paulo, sudeste do Brasil. Amostramos girinos durante um ano usando 40 armadilhas-de-funil de dupla entrada distribuídas ao longo de quatro riachos na floresta. Apenas os efeitos da presença de serapilheira foram significativos Nós discutimos as relações entre a estrutura do habitat e características morfológicas, ecológicas e adaptações para procura de alimento e para evitar competição no interior da comunidade de girinos.

Abstract: Many tropical anurans use forest streams to deposit their eggs, but resource use and selection by tadpoles in tropical forests are poorly known. In the present research, we hypothesized that leaf litter and water depth affect tadpole assemblages due to adult habitat selection for oviposition and/or microhabitat selection by tadpoles. Fieldwork was carried out in the Estação Biológica de Boracéia, an Atlantic Rainforest reserve in São Paulo state, southeastern Brazil. We sampled tadpoles during a year using 40 double-entry funnel-traps distributed along four streams in the forest. Only leaf litter effects are species dependent. We discussed that habitat structure significance depends on the morphological and ecological adaptation to forage and avoid competition within the tadpole community.

https://doi.org/10.1590/1676-0611-bn-2020-1147 247 descargas

Medidas de distanciamento social no controle da pandemia de COVID-19: potenciais impactos e desafios no Brasil
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Aquino, Estela M. L.

; Silveira, Ismael Henrique

; Pescarini, Julia Moreira

; Aquino, Rosana

; Souza-Filho, Jaime Almeida de

; Rocha, Aline dos Santos

; Ferreira, Andrea

; Victor, Audêncio

; Teixeira, Camila

; Machado, Daiane Borges

; Paixão, Enny

; Alves, Flávia Jôse Oliveira

; Pilecco, Flávia

; Menezes, Greice

; Gabrielli, Ligia

; Leite, Luciana

; Almeida, Maria da Conceição Chagas de

; Ortelan, Naiá

; Fernandes, Qeren Hapuk R. Ferreira

; Ortiz, Renzo Joel Flores

; Palmeira, Raquel Nunes

; Pinto Junior, Elzo Pereira

; Aragão, Erika

; Souza, Luis Eugenio Portela Fernandes de

; Barral Netto, Manoel

; Teixeira, Maria Glória

; Barreto, Mauricio Lima

; Ichihara, Maria Yury

; Lima, Raíza Tourinho dos Reis Silva

Ciência & Saúde Coletiva

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Jun 2020, Volumen 25 Supl. 1 Paginas 2423 - 2446

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo A pandemia de COVID-19 tem desafiado pesquisadores e gestores a encontrar medidas de saúde pública que evitem o colapso dos sistemas de saúde e reduzam os óbitos. Esta revisão narrativa buscou sistematizar as evidências sobre o impacto das medidas de distanciamento social na epidemia de COVID-19 e discutir sua implementação no Brasil. Foram triados artigos sobre o efeito do distanciamento social na COVID-19 no PubMed, medRXiv e bioRvix, e analisados atos do poder público nos níveis federal e estadual para sumarizar as estratégias implementadas no Brasil. Os achados sugerem que o distanciamento social adotado por população é efetivo, especialmente quando combinado ao isolamento de casos e à quarentena dos contatos. Recomenda-se a implementação de medidas de distanciamento social e de políticas de proteção social para garantir a sustentabilidade dessas medidas. Para o controle da COVID-19 no Brasil, é imprescindível que essas medidas estejam aliadas ao fortalecimento do sistema de vigilância nos três níveis do SUS, que inclui a avaliação e uso de indicadores adicionais para monitorar a evolução da pandemia e o efeito das medidas de controle, a ampliação da capacidade de testagem, e divulgação ampla e transparente das notificações e de testagem desagregadas.

Abstract The COVID-19 pandemic has challenged researchers and policy makers to identify public safety measures forpreventing the collapse of healthcare systems and reducingdeaths. This narrative review summarizes the available evidence on the impact of social distancing measures on the epidemic and discusses the implementation of these measures in Brazil. Articles on the effect of social distancing on COVID-19 were selected from the PubMed, medRXiv and bioRvix databases. Federal and state legislation was analyzed to summarize the strategies implemented in Brazil. Social distancing measures adopted by the population appear effective, particularly when implemented in conjunction with the isolation of cases and quarantining of contacts. Therefore, social distancing measures, and social protection policies to guarantee the sustainability of these measures, should be implemented. To control COVID-19 in Brazil, it is also crucial that epidemiological monitoring is strengthened at all three levels of the Brazilian National Health System (SUS). This includes evaluating and usingsupplementary indicators to monitor the progression of the pandemic and the effect of the control measures, increasing testing capacity, and making disaggregated notificationsand testing resultstransparentand broadly available.

https://doi.org/10.1590/1413-81232020256.1.10502020 73073 descargas

Medidas de distanciamento social no controle da pandemia de COVID-19: potenciais impactos e desafios no Brasil
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Aquino, Estela M. L.

; Silveira, Ismael Henrique

; Pescarini, Julia Moreira

; Aquino, Rosana

; Souza-Filho, Jaime Almeida de

; Rocha, Aline dos Santos

; Ferreira, Andrea

; Victor, Audêncio

; Teixeira, Camila

; Machado, Daiane Borges

; Paixão, Enny

; Alves, Flávia Jôse Oliveira

; Pilecco, Flávia

; Menezes, Greice

; Gabrielli, Ligia

; Leite, Luciana

; Almeida, Maria da Conceição Chagas de

; Ortelan, Naiá

; Fernandes, Qeren Hapuk R. Ferreira

; Ortiz, Renzo Joel Flores

; Palmeira, Raquel Nunes

; Pinto Junior, Elzo Pereira

; Aragão, Erika

; Souza, Luis Eugenio Portela Fernandes de

; Barral Netto, Manoel

; Teixeira, Maria Glória

; Barreto, Mauricio Lima

; Ichihara, Maria Yury

; Lima, Raíza Tourinho dos Reis Silva

Ciência & Saúde Coletiva

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2020, Volumen 25 Supl. 1 Paginas 2423 - 2446

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1413-81232020256.1.10502020

Risk factors for mortality in patients with ventilator-associated pneumonia caused by carbapenem-resistant Enterobacteriaceae
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Tuon, Felipe F.

; Graf, Maria Esther

; Merlini, Alexandre

; Rocha, Jaime L.

; Stallbaum, Suellen

; Arend, Lavinia N.

; Pecoit-Filho, Roberto

Brazilian Journal of Infectious Diseases

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Feb 2017, Volumen 21 Nº 1 Paginas 1 - 6

Resumen: En | Texto: En | PDF: En

Abstract Background: The ideal therapeutic option for ventilator associated pneumonia caused by carbapenem-resistant Enterobacteriaceae is not defined. The aim of this study was to assess mortality-associated risk factors in patients with VAP by CRE and determine the outcome of several treatment options. Methods: This was a retrospective study performed in two tertiary hospitals involving patients with VAP caused by CRE between January 2010 and August 2014. The outcomes were mortality within 30 days of VAP diagnosis and overall mortality during hospital admission. Risk factors for mortality were assessed by comparing variables of survivors and non-survivors. Results: One hundred and twelve patients with CRE-VAP were included, 73 (65%) male, median age 56 years. The 30-day mortality was 57.1% and the overall hospital mortality was 67%. In the binary logistic regression analysis, only age >50 years was independently associated to increased mortality. Polymyxin was the most used drug (47.5%), followed by tigecycline (29.2%) and aminoglycosides (2.4%). Combined therapy with two active drugs was used by 17 patients (20.8%). No therapeutic option was independently associated to survival. However, combined therapy with two active drugs was superior to the therapy with a single active drug when inappropriate therapy was the comparator (p = 0.044). The addition of carbapenem was not associated with increased survival. Conclusion: The best therapeutic option for VAP by CRE is still not completely defined, but the therapy with at least two active drugs was superior in this study.

https://doi.org/10.1016/j.bjid.2016.09.008 1253 descargas

KPC-producing Enterobacter aerogenes infection
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Tuon, Felipe F.

; Scharf, Camila

; Rocha, Jaime L.

; Cieslinsk, Juliette

; Becker, Guilherme Nardi

; Arend, Lavinia N.

Brazilian Journal of Infectious Diseases

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Jun 2015, Volumen 19 Nº 3 Paginas 324 - 327

Resumen: En | Texto: En | PDF: En

Background: Enterobacteris a common nosocomial microorganism and its carbapenem's resistance has increased. The management of these cases is unclear.Objective: We evaluated 16 patients with KPC-producing Enterobacter aerogenesinfections, detailing the site of infection, therapy, clinical and epidemiological data.Methods: A retrospective and descriptive study. Clinical data were revised and KPC-2 detection was by molecular methods. Risk factors associated with mortality were compared using appropriate tests according to variable type with a significance level of 0.05.Results: The 30-day mortality rate was 37.5% with no association with inadequate treatment. Age (p= 0.004) and Charlson score of comorbidities (p= 0.048) were independent risk factors associated with death in the multivariate analysis. The odds ratio for age >43 years was 3.00 (95% CI: 1.02-9.32) and for Charlson score >3 was 2.00 (95% CI: 1.08-3.71). Five strains were pan-resistant based on automated susceptibility tests. All patients were treated with monotherapy.Conclusion: The clinician should be alert to carbapenem-resistant Enterobacteriaceaeinfection in older patients with comorbidities. The mortality is high and we believe that prompt and adequate therapy must be employed.

https://doi.org/10.1016/j.bjid.2015.01.003 1688 descargas

A simple mathematical model to determine the ideal empirical antibiotic therapy for bacteremic patients
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Tuon, Felipe F.

; Rocha, Jaime L.

; Leite, Talita M.

; Dias, Camila

Brazilian Journal of Infectious Diseases

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Ago 2014, Volumen 18 Nº 4 Paginas 360 - 363

Resumen: En | Texto: En | PDF: En

BACKGROUND: Local epidemiological data are always helpful when choosing the best antibiotic regimen, but it is more complex than it seems as it may require the analysis of multiple combinations. The aim of this study was to demonstrate a simplified mathematical calculation to determine the most appropriate antibiotic combination in a scenario where monotherapy is doomed to failure. METHODS: The susceptibility pattern of 11 antibiotics from 216 positive blood cultures from January 2012 to January 2013 was analyzed based on local policy. The length of hospitalization before bacteremia and the unit (ward or intensive care unit) were the analyzed variables. Bacteremia was classified as early, intermediate or late. The antibiotics were combined according to the combination model presented herein. RESULTS: A total of 55 possible mathematical associations were found combining 2 by 2, 165 associations with 3 by 3 and 330 combinations with 4 by 4. In the intensive care unit, monotherapy never reached 80% of susceptibility. In the ward, only carbapenems covered more than 90% of early bacteremia. Only three drugs combined reached a susceptibility rate higher than 90% anywhere in the hospital. Several regimens using four drugs combined reached 100% of susceptibility. CONCLUSIONS: Association of three drugs is necessary for adequate coverage of empirical treatment of bacteremia in both the intensive care unit and the ward.

https://doi.org/10.1016/j.bjid.2013.11.006 1025 descargas

Is nosocomial Escherichia coli bacteremia a predictive risk factor for mortality?
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Tuon, Felipe F.

; Rocha, Jaime L.

; Guadagnin, Fernanda A.

; Alves, Márcia S.

Brazilian Journal of Infectious Diseases

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Ene 2014, Volumen 18 Nº 1 Paginas 92 - 94

Resumen: En | Texto: En | PDF: En

The objective of this study was to determine risk factors associated with mortality in patients with nosocomial Escherichia coli bacteremia from January 2009 to January 2011. In a retrospective study the medical records of 88 patients over 18 years with nosocomial bacteremia caused by E. coli were analyzed. In univariate analysis several risk factors, including chronic renal failure, altered mental status, leukocytosis, and higher Charlson index of comorbidities were associated with mortality. In multivariate analysis only altered mental status remained independently associated with mortality. Mental confusion can be a risk factor for mortality in patients with E. coli bacteremia.

https://doi.org/10.1016/j.bjid.2013.05.005 933 descargas

Risk factors for KPC-producing Klebsiella pneumoniae bacteremia
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Tuon, Felipe F.

; Rocha, Jaime L.

; Toledo, Paula

; Arend, Lavinia N.

; Dias, Camila H.

; Leite, Talita M.

; Penteado-Filho, Sergio R.

; Pilonetto, Marcelo

; Zavascki, Alexandre P.

Brazilian Journal of Infectious Diseases

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Oct 2012, Volumen 16 Nº 5 Paginas 416 - 419

Resumen: En | Texto: En | PDF: En

The molecular epidemiology of carbapenemase-producing Klebsiella pneumoniae (KPC) has been largely investigated, but limited clinical information is available. A case-control study was performed to evaluate the risk factors for KPC bacteremia in hospitalized patients. Cases were patients with KPC bacteremia and controls were patients with non-KPC bacteremia. A total of 85 patients were included, 18 (21.2%) were KPC, and 67 (78.8%) were non-KPC (40 [59.7%] of them were extended-spectrum beta-lactamase producers). All KPC isolates were type 2 producers. These isolates belong to five distinct clones. Multivariate analysis showed that age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02 - 1.11; p = 0.004), presence of mechanical ventilation (OR, 11.1; 95% CI, 1.92 - 63.3; p = 0.007) and fluoroquinolone exposure during hospitalization (OR, 28.9; 95% CI, 1.85 - 454.6; p = 0.02) were independent risk factors for KPC in patients with K. pneumoniae bacteremia. Factors associated with severity of illness, such as age and mechanical ventilation, seem to be the main risks factors for KPC. Fluoroquinolones use might be a risk factor for KPC bacteremia. Further investigations on risk factors for KPC are warranted.

https://doi.org/10.1016/j.bjid.2012.08.006 4698 descargas

Risk factors for pan-resistant Pseudomonas aeruginosa bacteremia and the adequacy of antibiotic therapy
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Tuon, Felipe F.

; Gortz, Lucas W.

; Rocha, Jaime L.

Brazilian Journal of Infectious Diseases

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Ago 2012, Volumen 16 Nº 4 Paginas 351 - 356

Resumen: En | Texto: En | PDF: En

INTRODUCTION: The aim of this study was to determine risk factors for acquiring carbapenemresistant Pseudomonas aeruginosa bacteremia (CR-PA) and factors associated with in-hospital mortality. METHODS: Seventy-seven cases of bacteremia caused by P. aeruginosa were evaluated in a hospital with high incidence of CR-PA. Clinical and laboratorial factors, and previous use of antibiotics were also evaluated. In one analysis, CR-PA and carbapenem-susceptible P. aeruginosa (CS-PA) bacteremia were compared. A second analysis compared patients who died with survivors. RESULTS: Among 77 P. aeruginosa bacteremia, 29 were caused by CR-PA. Admission to the intensive care unit, higher number of total leukocytes, and previous use of carbapenem were statistically associated with CR-PA. In the multivariate analysis, only previous use of carbapenem (including ertapenem) turned out to be a risk factor for CR-PA (p = 0.014). The 30-day mortality of patients with P. aeruginosa bloodstream infection was 44.8% for CS-PA and 54.2% for patients with CR-PA (p = 0.288). Chronic renal failure, admission to the intensive care unit, mechanical ventilation, and central venous catheter were risk factors for mortality. Incorrect treatment increased mortality of patients with bacteremia caused by CS-PA, but not for CR-SA. The odd ratio of mortality associated with incorrect therapy in patients with CS-PA was 3.30 (1.01-10.82; p = 0.043). The mortality of patients with bacteremia caused by CR-PA was unexpectedly similar regardless of antimicrobial treatment adequacy. CONCLUSION: Appropriate treatment for CS-PA bacteremia initiated within the first 24 hours was associated with lower mortality, but this cannot be extrapolated for CR-PA.

https://doi.org/10.1016/j.bjid.2012.06.009 3399 descargas

10.

Sex, drugs, bugs, and age: rational selection of empirical therapy for outpatient urinary tract infection in an era of extensive antimicrobial resistance
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Rocha, Jaime L.

; Tuon, Felipe Francisco

; Johnson, James R.

Brazilian Journal of Infectious Diseases

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Abr 2012, Volumen 16 Nº 2 Paginas 115 - 121

Resumen: En | Texto: En | PDF: En

BACKGROUND: Optimal empirical therapy of urinary tract infection requires accurate knowledge of local susceptibility patterns, which may vary with organism and patient characteristics. METHODS: Among 9,798 consecutive, non-duplicate, community-source urine isolates from ambulatory patients > 13 years old, from clinical laboratory and an academic medical center in Curitiba, Brazil (May 1st to December 1st, 2009), susceptibility data for ampicillin, nitrofurantoin, trimethoprim-sulfamethoxazole, gentamicin, fluoroquinolones, and ceftriaxone/cefotaxime were compared with organism and patient gender and age. RESULTS: The female-to-male ratio decreased with age, from 28.1 (among 20-29 year-olds) to 3.3 (among > 80 year-olds). Overall, susceptibility prevalence varied widely by drug class, from unacceptably low levels (53.5% and 61.1%: ampicillin and trimethoprimsulfamethoxazole) to acceptable but suboptimal levels (81.2% to 91.7%: fluoroquinolones, ceftriaxone, nitrofurantoin, and gentamicin). E. coli isolates exhibited higher susceptibility rates than other isolates, from 3-4% higher (fluoroquinolones, gentamicin) to > 30% (nitrofurantoin, ceftriaxone). Males exhibited lower susceptibility rates than females. Within each gender, susceptibility declined with increasing age. For females, only nitrofurantoin and gentamicin were suitable for empirical therapy (> 80% susceptibility) across all age cohorts; fluoroquinolones were suitable only through age 60, and ceftriaxone only through age 80. For males, only gentamicin yielded > 80% susceptibility in any age cohort. CONCLUSION: Few suitable empirical treatment options for community-source urinary tract infection were identified for women aged over 60 years or males of any age. Empirical therapy recommendations must consider the patient's demographic characteristics. Site-specific, age and gender-stratified susceptibility surveillance involving all uropathogens is needed.

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