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Abstract Background The arthropod-borne Mayaro virus (MAYV) causes ‘Mayaro fever’, a disease of medical significance, primarily affecting individuals in permanent contact with forested areas in tropical South America. Recently, MAYV has attracted attention due to its likely urbanization. Currently, there are no licensed drugs against most mosquito-transmitted viruses. Here, we investigated the in vitro anti-MAYV activity of the flavonoids quercetin and its derivatives from the Brazilian shrub Bauhinia longifolia (Bong.) Steud. Methods Flavonoids were purified by chromatographic fractionation from leaf extracts of B. longifolia and chemically identified as quercetin and quercetin glycosides using spectroscopic techniques. Cytotoxicity of purified flavonoids and of EtOAc- and n-BuOH-containing flavonoid mixtures was measured by the dye-uptake assay while their antiviral activity was evaluated by a virus yield inhibition assay. Results The following flavonoids were purified from B. longifolia leaves: non-glycosylated quercetin and its glycosides guaijaverin, quercitrin, isoquercitrin, and hyperin. EtOAc and n-BuOH fractions containing these flavonoids demonstrated the highest antiviral activity of all tested substances, while quercetin had the highest antiviral activity amongst purified flavonoids. Quercetin, EtOAc, or n-BuOH fractions inhibited MAYV production by more than 90% at 25 μg/mL, displaying a stronger antiviral effect than the licensed antiviral ribavirin. A mixture of the isomers isoquercitrin and hyperin had a modest antiviral effect (IC90 = 104.9), while guaijaverin and quercitrin did not show significant antiviral activity. Conclusions B. longifolia is a good source of flavonoids with anti-Mayaro virus activity. This is the first report of the activity of quercetin and its derivatives against an alphavirus.

Introduction: Mumps virus infection is a public health concern mainly in low- and middleincome countries and has been associated with complications such as spontaneous abortion and post-pubertal orchitis that may result in testicular atrophy and, consequently, infertility. Mumps vaccination is not currently implemented in Tanzania, and the data regarding its magnitude is limited, with no data among women with spontaneous abortions. Objective: This study aimed to determine seropositivity and factors associated with specific mumps virus IgG antibodies among women with spontaneous abortion in Mwanza, Tanzania. Methodology: From July to August 2022, a laboratory-based analytical cross-sectional study involving 212 sera collected between 2015 and 2019 from women with spontaneous abortions in Mwanza was conducted. Mumps IgG antibodies were detected by an indirect Enzyme-Linked Immunosorbent Assay. Descriptive data analysis was done using Stata version 15. Results: The median age of enrolled participants was 27 [IQR: 24-32] years. The overall seroprevalence of mumps virus IgG antibodies was 117/212(55.19%) [95% CI: 48.39-61.80]. Being an urban resident (OR: 3.23, 95% CI 1.83-5.96, P= 0.000) and an increase in the number of household members (OR: 1.18, 95% CI: 1.01-1.38, P=0.040) predicted seropositivity of mumps IgG antibodies among women with spontaneous abortion in Mwanza, Tanzania. Conclusion: More than half of the women with spontaneous abortion live in the urban settings in the city of Mwanza, Tanzania, and those living in houses with a high number of household members are Mumps virus IgG seropositive. More studies on the causal effect relationship between women with spontaneous abortion and mumps virus are warranted. [ABSTRACT FROM AUTHOR]

In the operation of coal-fired power plants (CFPPs), the generation of particulate matter (PM) is monitored using a continuous emission monitoring system (CEMS); this data is useful for emission dispersion, planning, and reduction. However, due to local variability in the coal used, control technologies, and policies, emission factors need to be established. Notably, no PM emission factor has been derived or can be applied to CFPPs owned by the National Electricity Company of Indonesia/PT PLN (Persero) and other CFPPs. This study considered 52 CEMS-equipped CFPP units with emission factor values differing according to the boiler type, installed capacity, and air pollution control device (APCD). The PM concentration, volumetric flow rate, coal consumption, and electricity production data were assessed to determine PM emission factors for these units. A correlation test was also conducted to determine the effect of various parameters (based on the boiler type, installed capacity, and APCD type) on the PM emission factor by categorizing the CFPP units into two or three similar subcategories.Furthermore, using calorific values and carbon contents, dynamic emission factors were developed – expressed in terms of a simple or multiple linear regression equation – and their accuracy was determined. The different configurations of the 52 investigated CFPP units led to variations in the obtained emission factor values. The precision of the PM emission factors was enhanced by grouping the CFPP units based on similarities in the boiler type, installed capacity, or APCD type. The boiler type (represented by the superficial gas velocity) has the largest influence on the emission factor (in g PM/kg coal), with a moderate positive correlation, followed by the type of APCD installed (represented by the theoretical PM removal efficiency) and the installed capacity (represented by the heat rate or specific coal consumption). The dynamic PM emission factor is expressed by the equation y = 0.763 + (−0.016x), where only the fixed carbon content (from the proximate analysis results) – the independent variable on the x-axis – has a significant correlation with it.

Recurrent outbreaks of oral infection and isolated cases characterize the new epidemiological scenario of Chagas disease (CD) in the Brazilian Amazon. Acute Chagas disease (ACD) is common in Pará and Amazonas, Northeastern and Northwestern Brazilian Amazonia. In the present study, we describe the first molecularly characterized autochthonous case of ACD in Rondônia, Southwestern Amazonia. The patient, a 39-year-old male resident in the small city of Cujubim, presented typical ACD symptoms: fever, asthenia, myalgia, progressive dyspnea, swelling of the legs, and tiredness at minimal efforts, all compatible with ACD and indicative of cardiac involvement. A thick blood drop test revealed trypomastigote forms of Trypanosoma cruzi genotyped as TcIV. An epidemiological investigation ruled out oral infection, and support for vectorial transmission included the finding of Panstrongylus geniculatus positive for T. cruzi (TcIII and TcIV) inside the tent used by the patient when harvesting forest timber, and a circular cutaneous lesion resembling a chagoma of inoculation. Treatment with benznidazole led to blood parasite clearance as confirmed by molecular tests. Altogether, our findings fitted well into the ecological scenario where deforestation and colonization of forested areas represent an important risk factor to the adaptation of P. geniculatus to human habitats, favoring vectorial transmission of CD in the Amazonian region. [ABSTRACT FROM AUTHOR]

Objective: To determine self-care in patients with chemotherapy in a pre-post educational intervention test performed by nurses from a specialized oncology institute. Methodology: Quantitative, quasi-experimental, longitudinal. Population of 90 patients with chemotherapy treatment, who were given 3 educational sessions with a pre and post test evaluation; in addition, a questionnaire with 4 dimensions was applied: nutrition, hygiene, infection prevention and avoidance of complications, with 20 items, a Likert scale validated by experts and a reliability of 0.8. Results: In the pre-test, self-care levels were 60% low, 22.2% high and 17.8% medium. In the post-test, self-care levels were 96.7% high and 3.3% medium. In relation to the dimensions of self-care in the pre-test, levels were found to be in Food: 52.2% low and 26.7% high; Hygiene: 42.2% low and 17.8% high; Infection prevention: 36% high and 30% low; and avoidance of complications: 55.6% low and 8.9% high. Finally, in the post-test, levels of: Feeding 94.4% high and 5.6% medium; Prevention of infections: 91.1% high and 8.9% medium. Dimensions: Hygiene and avoidance of complications, obtained 100% high level. Conclusion: It was demonstrated that nurses who promote education on self-care and incorporate the delivery of educational materials, increase knowledge and practices of self-care in their daily lives, which favor the welfare and ensure a quality of life in the patient.

• El “techo de cristal” se ha hecho notar con más claridad, considerado un vestigio más del lamentable machismo de antaño, vislumbrando una desigualdad meramente marcada por el género. • Los presentes autores han creado una escala, titulada como “Escala de Evaluación de Artículos con Metodologías Heterogéneas para Revisiones Integrativas” (EAMH). • Un elemento interesante de destacar es la exposición de la problemática cuantificada a través del “Índice Techo de Cristal (ITC)”. • Las mujeres enfermeras tienen más dificultades, barreras o limitantes que los hombres para acceder a cargos directivos, con una aparente etiología marcada meramente por el género. Introducción: El fenómeno “techo de cristal”, es un término denominado de esta forma por un movimiento feminista de los años ochenta en los Estados Unidos, el cual hace referencia a la barrera “invisible” que impide el progreso de las mujeres en su carrera laboral. Objetivo: Analizar en el estado del arte disponible, la presencia del fenómeno techo de cristal en enfermería. Materiales y métodos: Se realizó una revisión integrativa basada en las cinco etapas de Crossetti, utilizando descriptores (enfermería, consejo directivo, supervisión de enfermería, liderazgo, inequidad de género y sexismo) validados en el tesauro DeCS y unidas con el booleano AND, en las bases de datos WOS, PUBMED, SCOPUS, SCIELO y BVS. Resultados: Tras la aplicación de los descriptores y estrategias de búsqueda se localizaron 133 artículos, posterior a la aplicación de filtros se seleccionan 43 artículos, tras aplicar criterios de inclusión y exclusión se obtuvieron 6 artículos, luego se complementó con una búsqueda manual localizando 2 artículos, conformándose una muestra de 8 documentos, se aplicó una propuesta de escala que asegura la calidad de la muestra, quedando 7 artículos. Discusión: Todos los artículos seleccionados expresaban una escasa representatividad femenina de enfermería en puestos directivos, se destaca que los hombres son mejor recompensados en términos de remuneración, avance profesional, ocupación de puestos mejores y más prestigiosos. Conclusiones: Los artículos analizados muestran la presencia del fenómeno techo de cristal, donde las mujeres enfermeras presentan más dificultades que los hombres para acceder a cargos directivos, con una aparente etiología marcada meramente por el género. Como citar este artículo: Valencia-Contrera Miguel Andrez, Orellana-Yañez Alda Ester. Fenómeno techo de cristal en enfermería: revisión integrativa. Revista Cuidarte. 2022;13(1):e2261. http://dx.doi.org/10.15649/cuidarte.2261

Background. Stillbirth adversely affects pregnancy outcomes in low- and middle-income countries (LMICs). Viral infections have been implicated as one of the causes of stillbirths. Despite high rates of stillbirths and high viral prevalence in LMICs, there is limited information regarding their association. This study investigated the magnitude of herpes simplex 2 virus (HSV-2) and human cytomegalovirus (HCMV) among women with macerated stillbirth. Methods. A cross-sectional hospital-based study was conducted involving 279 women with macerated stillbirth between July and August 2018 at different health facilities in Mwanza, Tanzania. Detection of HSV-2 was done by immunochromatographic test while that of HCMV was done using enzyme-linked immunosorbent assay (ELISA). Descriptive data analysis was done using STATA version 13. Results. A total of 28 (10.04%, 95% CI: 6.8-13.9) tested positive for HSV-2 IgG antibodies with only 4 (1.43%, 95% CL: 0.3-2.8) testing positive for HSV-2 IgM antibodies. HCMV IgG antibodies were detected in 131 (77.98%, 95% CI: 71-84) of 168 women tested. By multivariate logistic regulation analysis, advanced age (OR: 0.93, 95% CI: 0.87-0.99, p=0.025) was significantly associated with negative HSV-2 IgG antibodies. By log multinomial regression analysis, only urban residence (RRR.4.43: 95% CI 1.53-12.80, p=0.006) independently predicted HCMV IgG seropositivity among women with stillbirth. Twenty-one (30.9%) of women with positive HCMV IgG antibodies had low avidity index (

Background: The arthropod-borne Mayaro virus (MAYV) causes ‘Mayaro fever’, a disease of medical significance, primarily affecting individuals in permanent contact with forested areas in tropical South America. Recently, MAYV has attracted attention due to its likely urbanization. Currently, there are no licensed drugs against most mosquito-transmitted viruses. Here, we investigated the in vitro anti-MAYV activity of the flavonoids quercetin and its derivatives from the Brazilian shrub Bauhinia longifolia (Bong.) Steud. Methods: Flavonoids were purified by chromatographic fractionation from leaf extracts of B. longifolia and chemically identified as quercetin and quercetin glycosides using spectroscopic techniques. Cytotoxicity of purified flavonoids and of EtOAc- and n-BuOH-containing flavonoid mixtures was measured by the dye-uptake assay while their antiviral activity was evaluated by a virus yield inhibition assay. Results: The following flavonoids were purified from B. longifolia leaves: non-glycosylated quercetin and its glycosides guaijaverin, quercitrin, isoquercitrin, and hyperin. EtOAc and n-BuOH fractions containing these flavonoids demonstrated the highest antiviral activity of all tested substances, while quercetin had the highest antiviral activity amongst purified flavonoids. Quercetin, EtOAc, or n-BuOH fractions inhibited MAYV production by more than 90% at 25 μg/mL, displaying a stronger antiviral effect than the licensed antiviral ribavirin. A mixture of the isomers isoquercitrin and hyperin had a modest antiviral effect (IC90 = 104.9), while guaijaverin and quercitrin did not show significant antiviral activity. Conclusions: B. longifolia is a good source of flavonoids with anti-Mayaro virus activity. This is the first report of the activity of quercetin and its derivatives against an alphavirus. [ABSTRACT FROM AUTHOR]

Recurrent outbreaks of oral infection and isolated cases characterize the new epidemiological scenario of Chagas disease (CD) in the Brazilian Amazon. Acute Chagas disease (ACD) is common in Pará and Amazonas, Northeastern and Northwestern Brazilian Amazonia. In the present study, we describe the first molecularly characterized autochthonous case of ACD in Rondônia, Southwestern Amazonia. The patient, a 39-year-old male resident in the small city of Cujubim, presented typical ACD symptoms: fever, asthenia, myalgia, progressive dyspnea, swelling of the legs, and tiredness at minimal efforts, all compatible with ACD and indicative of cardiac involvement. A thick blood drop test revealed trypomastigote forms of Trypanosoma cruzi genotyped as TcIV. An epidemiological investigation ruled out oral infection, and support for vectorial transmission included the finding of Panstrongylus geniculatus positive for T. cruzi (TcIII and TcIV) inside the tent used by the patient when harvesting forest timber, and a circular cutaneous lesion resembling a chagoma of inoculation. Treatment with benznidazole led to blood parasite clearance as confirmed by molecular tests. Altogether, our findings fitted well into the ecological scenario where deforestation and colonization of forested areas represent an important risk factor to the adaptation of P. geniculatus to human habitats, favoring vectorial transmission of CD in the Amazonian region.

Competing Interests: None

Introduction: The ROP Argentina Group was created in 2003 and is responsible for the National Program for the Prevention of Blindness in Childhood by Retinopathy of Prematurity (ROP) in Argentina., Objetives: To describe the program implementation and results achieved in relation to ROP care in terms of effectiveness, access, and quality (2004-2016)., Population and Methods: Descriptive, retrospective study with a dynamic cohort carried out in facilities that are part of the registry. Eligible population: All preterm newborn infants with risk factors for ROP., Results: Participating health care services increased from 14 to 98 and covered the 23 provinces and the Autonomous City of Buenos Aires. A total of 956 infants were born with < 1500 g in 2004 and 2739, in 2016. Of these, 22.7 % had some degree of ROP and 7.8 % required treatment (severe ROP). Vision screening exceeded 90 %, and treatments at the place of origin increased (57 %-92 %). The incidence of unusual cases is still high (17.3 % of treated cases), and missed opportunities are still recorded. The use of anti-angiogenic drugs trebled since 2011, when they started to be used., Conclusions: Significant achievements were observed in terms of program representativeness, scope, and adherence, and also in relation to screening access and treatment at the place of origin; however, the incidence of ROP is still high. The persistence of unusual cases and missed opportunities evidences deficiencies in the quality of health care and outpatient followup and underlines the need to strengthen the program actions in relation to services., (Sociedad Argentina de Pediatría.)

Background: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach (IMA) on ventilator-associated pneumonia (VAP) rates in 11 hospitals within 5 cities of Argentina from January 2014-April 2017., Methods: A multicenter, prospective, before-after surveillance study was conducted through the use of International Nosocomial Infection Control Consortium Surveillance Online System. During baseline, we performed outcome surveillance of VAP applying the definitions of the Centers for Disease Control andPrevention's National Healthcare Safety Network. During intervention, we implemented the IMA, which included a bundle of infection prevention practice interventions, education, outcome surveillance, process surveillance, feedback on VAP rates and consequences, and performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention., Results: We recorded 3,940 patients admitted to 14 intensive care units. At baseline, there were 19.9 VAPs per 1,000 mechanical ventilator (MV)-days-with 2,920 MV-days and 58 VAPs, which was reduced during intervention to 9.4 VAPs per 1,000 MV-days-with 9,261 MV-days and 103 VAPs. This accounted for a 52% rate reduction (incidence density rate, 0.48; 95% confidence interval, 0.3-0.7; P .001)., Conclusions: Implementing the IMA was associated with significant reductions in VAP rates in intensive care units within Argentina., (Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Retinopathy of prematurity (ROP) is a largely avoidable cause of blindness in children worldwide, requiring high-quality neonatal care, early detection and treatment. In middle-income countries throughout Latin America, Eastern Europe and South Asia, there has been a rise in ROP blindness due to a combination of increased survival of preterm infants, resource-scarce medical environments and lack of policies, training and human resources. However, Argentina is an example of country where rates of ROP blindness have declined and ROP programmes have been successfully and effectively embedded within the health and legal system. The purpose of this study is to describe the activities and stakeholders, including Ministry of Health (MoH) and UNICEF, involved in the process, from recognition of an epidemic of ROP blindness to the development of national guidelines, policies and legislation for control. Using a retrospective mixed methods case study design, data on rates of severe ROP was collected from 13 neonatal intensive care units from 1999 to 2012, and on the proportion of children blind from ROP in nine blind schools in seven provinces. Legislative document review, focus group discussions and key informant interviews were conducted with neonatologists, ophthalmologists, neonatal nurses, parents, MoH officials, clinical societies, legislators and UNICEF officials in seven provinces. Results are presented combining the stages heuristic policy framework and Shiffman including: agenda setting, policy formulation, implementation and evaluation. By 2012, ROP had declined as a cause of blindness in children in schools for the blind as had rates of severe ROP needing treatment in the NICUs visited. Multiple factors played a role in reducing blindness from ROP in Argentina and successfully coordinating its control including national advocacy, leadership, legislation and international collaboration. Lessons learned in Argentina can potentially be scaled to other LMICs in Latin America and beyond with further context-specific research.

OBJECTIVE To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and the INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in 14 intensive care units (ICUs) in Argentina from January 2014 to April 2017. DESIGN This prospective, pre-post surveillance study of 3,940 ICU patients was conducted in 11 hospitals in 5 cities in Argentina. During our baseline evaluation, we performed outcome and process surveillance of CLABSI applying Centers for Disease Control and Prevention/National Health Safety Network (CDC/NHSN) definitions. During the intervention, we implemented the IMA through ISOS: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on CLABSI rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the CLABSI rate. RESULTS During the baseline period, 5,118 CL days and 49 CLABSIs were recorded, for a rate of 9.6 CLABSIs per 1,000 central-line (CL) days. During the intervention, 15,659 CL days and 68 CLABSIs were recorded, for a rate of 4.1 CLABSIs per 1,000 CL days. The CLABSI rate was reduced by 57% (incidence density rate: 0.43; 95% confidence interval, 0.34-0.6; P<.001). CONCLUSIONS Implementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in ICUs in Argentina. Infect Control Hosp Epidemiol 2018;39:445-451.