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Vanderson S. Sampaio
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Researcher at Fundação de Medicina Tropical Dr. Heitor Vieira Dourado

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Conference paper
Published: 07 June 2021 in Anais Estendidos do XVII Simpósio Brasileiro de Sistemas de Informação (Anais Estendidos do SBSI 2021)
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A malária é uma doença com risco de vida evitável e curável, mas houve mais de 228 milhões de casos de malária e 405.000 mortes por malária em 2018. Enquanto mais de 42 milhões de brasileiros estão sob risco de malária, 99% de todos os casos de malária no Brasil estão localizados dentro ou ao redor da floresta amazônica. Apesar do declínio de casos e mortes, a malária continua sendo um grande problema de saúde pública no Brasil. Em resposta a pedidos de novas pesquisas sobre estratégias de eliminação da malária para atender às condições locais, este artigo propõe modelos de machine learning e deep learning para prever a probabilidade de casos de malária no Estado do Amazonas. Usando um conjunto de dados de aproximadamente 6 milhões de registros, avaliamos os modelos {Random Forest, LSTM e GRU e comparamos desempenho por área geográfica usando a classificação de regionais de saúde do Estado do Amazonas e clusters através do algoritmo k-means. Os resultados sugerem que todos os modelos têm uma precisão satisfatória e forte potencial para prever novos casos de malária na região.

ACS Style

Matheus Félix Xavier Barboza; Vanderson De Souza Sampaio; Patricia Takako Endo. Análise e predição de incidência de casos de malária no tempo e no espaço utilizando modelos deep learning. Anais Estendidos do XVII Simpósio Brasileiro de Sistemas de Informação (Anais Estendidos do SBSI 2021) 2021, 175 -177.

AMA Style

Matheus Félix Xavier Barboza, Vanderson De Souza Sampaio, Patricia Takako Endo. Análise e predição de incidência de casos de malária no tempo e no espaço utilizando modelos deep learning. Anais Estendidos do XVII Simpósio Brasileiro de Sistemas de Informação (Anais Estendidos do SBSI 2021). 2021; ():175-177.

Chicago/Turabian Style

Matheus Félix Xavier Barboza; Vanderson De Souza Sampaio; Patricia Takako Endo. 2021. "Análise e predição de incidência de casos de malária no tempo e no espaço utilizando modelos deep learning." Anais Estendidos do XVII Simpósio Brasileiro de Sistemas de Informação (Anais Estendidos do SBSI 2021) , no. : 175-177.

Article
Published: 25 May 2021 in Nature Medicine
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The northern state of Amazonas is among the regions in Brazil most heavily affected by the COVID-19 epidemic and has experienced two exponentially growing waves, in early and late 2020. Through a genomic epidemiology study based on 250 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes from different Amazonas municipalities sampled between March 2020 and January 2021, we reveal that the first exponential growth phase was driven mostly by the dissemination of lineage B.1.195, which was gradually replaced by lineage B.1.1.28 between May and June 2020. The second wave coincides with the emergence of the variant of concern (VOC) P.1, which evolved from a local B.1.1.28 clade in late November 2020 and replaced the parental lineage in <2 months. Our findings support the conclusion that successive lineage replacements in Amazonas were driven by a complex combination of variable levels of social distancing measures and the emergence of a more transmissible VOC P.1 virus. These data provide insights to understanding the mechanisms underlying the COVID-19 epidemic waves and the risk of dissemination of SARS-CoV-2 VOC P.1 in Brazil and, potentially, worldwide. Analysis of circulating SARS-CoV-2 viruses during the first and second waves of COVID-19 in Amazonas, Brazil, shows successive lineage replacements led to predominance of the variant of concern P.1 and are associated with variable levels of social distancing.

ACS Style

Felipe Gomes Naveca; Valdinete Nascimento; Victor Costa de Souza; André De Lima Corado; Fernanda Nascimento; George Silva; Ágatha Costa; Débora Duarte; Karina Pessoa; Matilde Mejía; Maria Júlia Brandão; Michele Jesus; Luciana Gonçalves; Cristiano Fernandes da Costa; Vanderson Sampaio; Daniel Barros; Marineide Silva; Tirza Mattos; Gemilson Pontes; Ligia Abdalla; João Hugo Santos; Ighor Arantes; Filipe Zimmer Dezordi; Marilda Mendonça Siqueira; Gabriel Luz Wallau; Paola Cristina Resende; Edson Delatorre; Tiago Gräf; Gonzalo Bello. COVID-19 in Amazonas, Brazil, was driven by the persistence of endemic lineages and P.1 emergence. Nature Medicine 2021, 27, 1230 -1238.

AMA Style

Felipe Gomes Naveca, Valdinete Nascimento, Victor Costa de Souza, André De Lima Corado, Fernanda Nascimento, George Silva, Ágatha Costa, Débora Duarte, Karina Pessoa, Matilde Mejía, Maria Júlia Brandão, Michele Jesus, Luciana Gonçalves, Cristiano Fernandes da Costa, Vanderson Sampaio, Daniel Barros, Marineide Silva, Tirza Mattos, Gemilson Pontes, Ligia Abdalla, João Hugo Santos, Ighor Arantes, Filipe Zimmer Dezordi, Marilda Mendonça Siqueira, Gabriel Luz Wallau, Paola Cristina Resende, Edson Delatorre, Tiago Gräf, Gonzalo Bello. COVID-19 in Amazonas, Brazil, was driven by the persistence of endemic lineages and P.1 emergence. Nature Medicine. 2021; 27 (7):1230-1238.

Chicago/Turabian Style

Felipe Gomes Naveca; Valdinete Nascimento; Victor Costa de Souza; André De Lima Corado; Fernanda Nascimento; George Silva; Ágatha Costa; Débora Duarte; Karina Pessoa; Matilde Mejía; Maria Júlia Brandão; Michele Jesus; Luciana Gonçalves; Cristiano Fernandes da Costa; Vanderson Sampaio; Daniel Barros; Marineide Silva; Tirza Mattos; Gemilson Pontes; Ligia Abdalla; João Hugo Santos; Ighor Arantes; Filipe Zimmer Dezordi; Marilda Mendonça Siqueira; Gabriel Luz Wallau; Paola Cristina Resende; Edson Delatorre; Tiago Gräf; Gonzalo Bello. 2021. "COVID-19 in Amazonas, Brazil, was driven by the persistence of endemic lineages and P.1 emergence." Nature Medicine 27, no. 7: 1230-1238.

Pharmacology
Published: 18 May 2021 in PLOS Neglected Tropical Diseases
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Background Glucose-6-phosphate dehydrogenase (G6PD) deficiency greatly hinders Plasmodium vivax malaria radical cure and further elimination due to 8-aminoquinolines-associated hemolysis. Although the deleterious health effects of primaquine in G6PD deficient individuals have been known for over 50 years, G6PD testing is not routinely performed before primaquine treatment in most P. vivax endemic areas. Method/Principal findings The qualitative CareStart G6PD screening test was implemented in 12 malaria treatment units (MTUs) in the municipality of Rio Preto da Eva, Western Brazilian Amazon, a malaria endemic area, between February 2019 and early January 2020. Training materials were developed and validated; evaluations were conducted on the effectiveness of training health care professionals (HCPs) to perform the test, the interpretation and reliability of routine testing performed by HCPs, and perceptions of HCPs and patients. Most HCPs were unaware of G6PD deficiency and primaquine-related adverse effects. Most of 110 HCPs trained (86/110, 78%) were able to correctly perform the G6PD test after a single 4-hour training session. The test performed by HCPs during implementation showed 100.0% (4/4) sensitivity and 68.1% (62/91) specificity in identifying G6PD deficient patients as compared to a point-of-care quantitative test (Standard G6PD). Conclusions/Significance G6PD screening using the qualitative CareStart G6PD test performed by HCPs in MTUs of an endemic area showed high sensitivity and concerning low specificity. The amount of false G6PD deficiency detected led to substantial loss of opportunities for radical cure.

ACS Style

Jose Diego Brito-Sousa; Felipe Murta; Sheila Vitor-Silva; Vanderson S. Sampaio; Maxwell O. Mendes; Marcelo A. M. Brito; Talita S. B. Batista; Alicia P. C. Santos; Leonardo L. G. Marques; Laila R. A. Barbosa; Marly M. Melo; Djane C. Baia-Da-Silva; Alexandre V. Silva-Neto; Thalie C. Santos; Brenda K. A. Souza; Erick F. G. Figueiredo; Emanuelle L. Silva; Sheila Rodovalho; Theresa H. Nakagawa; Ana Ruth Arcanjo; André M. Siqueira; Gisely C. Melo; Judith Recht; Gonzalo J. Domingo; Quique Bassat; Germana Bancone; Wuelton M. Monteiro; Marcus V. G. Lacerda. Real-life implementation of a G6PD deficiency screening qualitative test into routine vivax malaria diagnostic units in the Brazilian Amazon (SAFEPRIM study). PLOS Neglected Tropical Diseases 2021, 15, e0009415 .

AMA Style

Jose Diego Brito-Sousa, Felipe Murta, Sheila Vitor-Silva, Vanderson S. Sampaio, Maxwell O. Mendes, Marcelo A. M. Brito, Talita S. B. Batista, Alicia P. C. Santos, Leonardo L. G. Marques, Laila R. A. Barbosa, Marly M. Melo, Djane C. Baia-Da-Silva, Alexandre V. Silva-Neto, Thalie C. Santos, Brenda K. A. Souza, Erick F. G. Figueiredo, Emanuelle L. Silva, Sheila Rodovalho, Theresa H. Nakagawa, Ana Ruth Arcanjo, André M. Siqueira, Gisely C. Melo, Judith Recht, Gonzalo J. Domingo, Quique Bassat, Germana Bancone, Wuelton M. Monteiro, Marcus V. G. Lacerda. Real-life implementation of a G6PD deficiency screening qualitative test into routine vivax malaria diagnostic units in the Brazilian Amazon (SAFEPRIM study). PLOS Neglected Tropical Diseases. 2021; 15 (5):e0009415.

Chicago/Turabian Style

Jose Diego Brito-Sousa; Felipe Murta; Sheila Vitor-Silva; Vanderson S. Sampaio; Maxwell O. Mendes; Marcelo A. M. Brito; Talita S. B. Batista; Alicia P. C. Santos; Leonardo L. G. Marques; Laila R. A. Barbosa; Marly M. Melo; Djane C. Baia-Da-Silva; Alexandre V. Silva-Neto; Thalie C. Santos; Brenda K. A. Souza; Erick F. G. Figueiredo; Emanuelle L. Silva; Sheila Rodovalho; Theresa H. Nakagawa; Ana Ruth Arcanjo; André M. Siqueira; Gisely C. Melo; Judith Recht; Gonzalo J. Domingo; Quique Bassat; Germana Bancone; Wuelton M. Monteiro; Marcus V. G. Lacerda. 2021. "Real-life implementation of a G6PD deficiency screening qualitative test into routine vivax malaria diagnostic units in the Brazilian Amazon (SAFEPRIM study)." PLOS Neglected Tropical Diseases 15, no. 5: e0009415.

Review
Published: 14 May 2021 in Nature Communications
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ACS Style

Cathrine Axfors; Andreas M. Schmitt; Perrine Janiaud; Janneke Van’T Hooft; Sherief Abd-Elsalam; Ehab F. Abdo; Benjamin S. Abella; Javed Akram; Ravi K. Amaravadi; Derek C. Angus; Yaseen M. Arabi; Shehnoor Azhar; Lindsey R. Baden; Arthur W. Baker; Leila Belkhir; Thomas Benfield; Marvin A. H. Berrevoets; Cheng-Pin Chen; Tsung-Chia Chen; Shu-Hsing Cheng; Chien-Yu Cheng; Wei-Sheng Chung; Yehuda Z. Cohen; Lisa N. Cowan; Olav Dalgard; Fernando F. de Almeida e Val; Marcus V. G. de Lacerda; Gisely C. de Melo; Lennie Derde; Vincent Dubee; Anissa Elfakir; Anthony C. Gordon; Carmen M. Hernandez-Cardenas; Thomas Hills; Andy I. M. Hoepelman; Yi-Wen Huang; Bruno Igau; Ronghua Jin; Felipe Jurado-Camacho; Khalid S. Khan; Peter G. Kremsner; Benno Kreuels; Cheng-Yu Kuo; Thuy Le; Yi-Chun Lin; Wu-Pu Lin; Tse-Hung Lin; Magnus Nakrem Lyngbakken; Colin McArthur; Bryan J. McVerry; Patricia Meza-Meneses; Wuelton M. Monteiro; Susan C. Morpeth; Ahmad Mourad; Mark J. Mulligan; Srinivas Murthy; Susanna Naggie; Shanti Narayanasamy; Alistair Nichol; Lewis A. Novack; Sean M. O’Brien; Nwora Lance Okeke; Léna Perez; Rogelio Perez-Padilla; Laurent Perrin; Arantxa Remigio-Luna; Norma E. Rivera-Martinez; Frank W. Rockhold; Sebastian Rodriguez-Llamazares; Robert Rolfe; Rossana Rosa; Helge Røsjø; Vanderson S. Sampaio; Todd B. Seto; Muhammad Shahzad; Shaimaa Soliman; Jason E. Stout; Ireri Thirion-Romero; Andrea B. Troxel; Ting-Yu Tseng; Nicholas A. Turner; Robert J. Ulrich; Stephen R. Walsh; Steve A. Webb; Jesper M. Weehuizen; Maria Velinova; Hon-Lai Wong; Rebekah Wrenn; Fernando G. Zampieri; Wu Zhong; David Moher; Steven N. Goodman; John P. A. Ioannidis; Lars G. Hemkens. Author Correction: Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials. Nature Communications 2021, 12, 1 -2.

AMA Style

Cathrine Axfors, Andreas M. Schmitt, Perrine Janiaud, Janneke Van’T Hooft, Sherief Abd-Elsalam, Ehab F. Abdo, Benjamin S. Abella, Javed Akram, Ravi K. Amaravadi, Derek C. Angus, Yaseen M. Arabi, Shehnoor Azhar, Lindsey R. Baden, Arthur W. Baker, Leila Belkhir, Thomas Benfield, Marvin A. H. Berrevoets, Cheng-Pin Chen, Tsung-Chia Chen, Shu-Hsing Cheng, Chien-Yu Cheng, Wei-Sheng Chung, Yehuda Z. Cohen, Lisa N. Cowan, Olav Dalgard, Fernando F. de Almeida e Val, Marcus V. G. de Lacerda, Gisely C. de Melo, Lennie Derde, Vincent Dubee, Anissa Elfakir, Anthony C. Gordon, Carmen M. Hernandez-Cardenas, Thomas Hills, Andy I. M. Hoepelman, Yi-Wen Huang, Bruno Igau, Ronghua Jin, Felipe Jurado-Camacho, Khalid S. Khan, Peter G. Kremsner, Benno Kreuels, Cheng-Yu Kuo, Thuy Le, Yi-Chun Lin, Wu-Pu Lin, Tse-Hung Lin, Magnus Nakrem Lyngbakken, Colin McArthur, Bryan J. McVerry, Patricia Meza-Meneses, Wuelton M. Monteiro, Susan C. Morpeth, Ahmad Mourad, Mark J. Mulligan, Srinivas Murthy, Susanna Naggie, Shanti Narayanasamy, Alistair Nichol, Lewis A. Novack, Sean M. O’Brien, Nwora Lance Okeke, Léna Perez, Rogelio Perez-Padilla, Laurent Perrin, Arantxa Remigio-Luna, Norma E. Rivera-Martinez, Frank W. Rockhold, Sebastian Rodriguez-Llamazares, Robert Rolfe, Rossana Rosa, Helge Røsjø, Vanderson S. Sampaio, Todd B. Seto, Muhammad Shahzad, Shaimaa Soliman, Jason E. Stout, Ireri Thirion-Romero, Andrea B. Troxel, Ting-Yu Tseng, Nicholas A. Turner, Robert J. Ulrich, Stephen R. Walsh, Steve A. Webb, Jesper M. Weehuizen, Maria Velinova, Hon-Lai Wong, Rebekah Wrenn, Fernando G. Zampieri, Wu Zhong, David Moher, Steven N. Goodman, John P. A. Ioannidis, Lars G. Hemkens. Author Correction: Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials. Nature Communications. 2021; 12 (1):1-2.

Chicago/Turabian Style

Cathrine Axfors; Andreas M. Schmitt; Perrine Janiaud; Janneke Van’T Hooft; Sherief Abd-Elsalam; Ehab F. Abdo; Benjamin S. Abella; Javed Akram; Ravi K. Amaravadi; Derek C. Angus; Yaseen M. Arabi; Shehnoor Azhar; Lindsey R. Baden; Arthur W. Baker; Leila Belkhir; Thomas Benfield; Marvin A. H. Berrevoets; Cheng-Pin Chen; Tsung-Chia Chen; Shu-Hsing Cheng; Chien-Yu Cheng; Wei-Sheng Chung; Yehuda Z. Cohen; Lisa N. Cowan; Olav Dalgard; Fernando F. de Almeida e Val; Marcus V. G. de Lacerda; Gisely C. de Melo; Lennie Derde; Vincent Dubee; Anissa Elfakir; Anthony C. Gordon; Carmen M. Hernandez-Cardenas; Thomas Hills; Andy I. M. Hoepelman; Yi-Wen Huang; Bruno Igau; Ronghua Jin; Felipe Jurado-Camacho; Khalid S. Khan; Peter G. Kremsner; Benno Kreuels; Cheng-Yu Kuo; Thuy Le; Yi-Chun Lin; Wu-Pu Lin; Tse-Hung Lin; Magnus Nakrem Lyngbakken; Colin McArthur; Bryan J. McVerry; Patricia Meza-Meneses; Wuelton M. Monteiro; Susan C. Morpeth; Ahmad Mourad; Mark J. Mulligan; Srinivas Murthy; Susanna Naggie; Shanti Narayanasamy; Alistair Nichol; Lewis A. Novack; Sean M. O’Brien; Nwora Lance Okeke; Léna Perez; Rogelio Perez-Padilla; Laurent Perrin; Arantxa Remigio-Luna; Norma E. Rivera-Martinez; Frank W. Rockhold; Sebastian Rodriguez-Llamazares; Robert Rolfe; Rossana Rosa; Helge Røsjø; Vanderson S. Sampaio; Todd B. Seto; Muhammad Shahzad; Shaimaa Soliman; Jason E. Stout; Ireri Thirion-Romero; Andrea B. Troxel; Ting-Yu Tseng; Nicholas A. Turner; Robert J. Ulrich; Stephen R. Walsh; Steve A. Webb; Jesper M. Weehuizen; Maria Velinova; Hon-Lai Wong; Rebekah Wrenn; Fernando G. Zampieri; Wu Zhong; David Moher; Steven N. Goodman; John P. A. Ioannidis; Lars G. Hemkens. 2021. "Author Correction: Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials." Nature Communications 12, no. 1: 1-2.

Journal article
Published: 11 May 2021 in International Journal of Environmental Research and Public Health
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In Brazil, malaria caused by Plasmodium vivax presents control challenges due to several reasons, among them the increasing possibility of failure of P. vivax treatment due to chloroquine-resistance (CQR). Despite limited reports of CQR, more extensive studies on the actual magnitude of resistance are still needed. Short-time recurrences of malaria cases were analyzed in different transmission scenarios over three years (2005, 2010, and 2015), selected according to malaria incidence. Multilevel models (binomial) were used to evaluate association of short-time recurrences with variables such as age. The zero-inflated Poisson scan model (scanZIP) was used to detect spatial clusters of recurrences up to 28 days. Recurrences compose less than 5% of overall infection, being more frequent in the age group under four years. Recurrences slightly increased incidence. No fixed clusters were detected throughout the period, although there are clustering sites, spatially varying over the years. This is the most extensive analysis of short-time recurrences worldwide which addresses the occurrence of P. vivax CQR. As an important step forward in malaria elimination, policymakers should focus their efforts on young children, with an eventual shift in the first line of malaria treatment to P. vivax.

ACS Style

Antonio Balieiro; Andre Siqueira; Gisely Melo; Wuelton Monteiro; Vanderson Sampaio; Ivo Mueller; Marcus Lacerda; Daniel Villela. Short-Time Recurrences of Plasmodium vivax Malaria as a Public Health Proxy for Chloroquine-Resistance Surveillance: A Spatio-Temporal Study in the Brazilian Amazon. International Journal of Environmental Research and Public Health 2021, 18, 5061 .

AMA Style

Antonio Balieiro, Andre Siqueira, Gisely Melo, Wuelton Monteiro, Vanderson Sampaio, Ivo Mueller, Marcus Lacerda, Daniel Villela. Short-Time Recurrences of Plasmodium vivax Malaria as a Public Health Proxy for Chloroquine-Resistance Surveillance: A Spatio-Temporal Study in the Brazilian Amazon. International Journal of Environmental Research and Public Health. 2021; 18 (10):5061.

Chicago/Turabian Style

Antonio Balieiro; Andre Siqueira; Gisely Melo; Wuelton Monteiro; Vanderson Sampaio; Ivo Mueller; Marcus Lacerda; Daniel Villela. 2021. "Short-Time Recurrences of Plasmodium vivax Malaria as a Public Health Proxy for Chloroquine-Resistance Surveillance: A Spatio-Temporal Study in the Brazilian Amazon." International Journal of Environmental Research and Public Health 18, no. 10: 5061.

Journal article
Published: 15 April 2021 in Informatics
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Tuberculosis (TB) is an airborne infectious disease caused by organisms in the Mycobacterium tuberculosis (Mtb) complex. In many low and middle-income countries, TB remains a major cause of morbidity and mortality. Once a patient has been diagnosed with TB, it is critical that healthcare workers make the most appropriate treatment decision given the individual conditions of the patient and the likely course of the disease based on medical experience. Depending on the prognosis, delayed or inappropriate treatment can result in unsatisfactory results including the exacerbation of clinical symptoms, poor quality of life, and increased risk of death. This work benchmarks machine learning models to aid TB prognosis using a Brazilian health database of confirmed cases and deaths related to TB in the State of Amazonas. The goal is to predict the probability of death by TB thus aiding the prognosis of TB and associated treatment decision making process. In its original form, the data set comprised 36,228 records and 130 fields but suffered from missing, incomplete, or incorrect data. Following data cleaning and preprocessing, a revised data set was generated comprising 24,015 records and 38 fields, including 22,876 reported cured TB patients and 1139 deaths by TB. To explore how the data imbalance impacts model performance, two controlled experiments were designed using (1) imbalanced and (2) balanced data sets. The best result is achieved by the Gradient Boosting (GB) model using the balanced data set to predict TB-mortality, and the ensemble model composed by the Random Forest (RF), GB and Multi-Layer Perceptron (MLP) models is the best model to predict the cure class.

ACS Style

Maicon Lino Ferreira da Silva Barros; Geovanne Oliveira Alves; Lubnnia Morais Florêncio Souza; Elisson Da Silva Rocha; João Lorenzato de Oliveira; Theo Lynn; Vanderson Sampaio; Patricia Endo. Benchmarking Machine Learning Models to Assist in the Prognosis of Tuberculosis. Informatics 2021, 8, 27 .

AMA Style

Maicon Lino Ferreira da Silva Barros, Geovanne Oliveira Alves, Lubnnia Morais Florêncio Souza, Elisson Da Silva Rocha, João Lorenzato de Oliveira, Theo Lynn, Vanderson Sampaio, Patricia Endo. Benchmarking Machine Learning Models to Assist in the Prognosis of Tuberculosis. Informatics. 2021; 8 (2):27.

Chicago/Turabian Style

Maicon Lino Ferreira da Silva Barros; Geovanne Oliveira Alves; Lubnnia Morais Florêncio Souza; Elisson Da Silva Rocha; João Lorenzato de Oliveira; Theo Lynn; Vanderson Sampaio; Patricia Endo. 2021. "Benchmarking Machine Learning Models to Assist in the Prognosis of Tuberculosis." Informatics 8, no. 2: 27.

Review
Published: 15 April 2021 in Nature Communications
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Substantial COVID-19 research investment has been allocated to randomized clinical trials (RCTs) on hydroxychloroquine/chloroquine, which currently face recruitment challenges or early discontinuation. We aim to estimate the effects of hydroxychloroquine and chloroquine on survival in COVID-19 from all currently available RCT evidence, published and unpublished. We present a rapid meta-analysis of ongoing, completed, or discontinued RCTs on hydroxychloroquine or chloroquine treatment for any COVID-19 patients (protocol: https://osf.io/QESV4/). We systematically identified unpublished RCTs (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Cochrane COVID-registry up to June 11, 2020), and published RCTs (PubMed, medRxiv and bioRxiv up to October 16, 2020). All-cause mortality has been extracted (publications/preprints) or requested from investigators and combined in random-effects meta-analyses, calculating odds ratios (ORs) with 95% confidence intervals (CIs), separately for hydroxychloroquine and chloroquine. Prespecified subgroup analyses include patient setting, diagnostic confirmation, control type, and publication status. Sixty-three trials were potentially eligible. We included 14 unpublished trials (1308 patients) and 14 publications/preprints (9011 patients). Results for hydroxychloroquine are dominated by RECOVERY and WHO SOLIDARITY, two highly pragmatic trials, which employed relatively high doses and included 4716 and 1853 patients, respectively (67% of the total sample size). The combined OR on all-cause mortality for hydroxychloroquine is 1.11 (95% CI: 1.02, 1.20; I² = 0%; 26 trials; 10,012 patients) and for chloroquine 1.77 (95%CI: 0.15, 21.13, I² = 0%; 4 trials; 307 patients). We identified no subgroup effects. We found that treatment with hydroxychloroquine is associated with increased mortality in COVID-19 patients, and there is no benefit of chloroquine. Findings have unclear generalizability to outpatients, children, pregnant women, and people with comorbidities.

ACS Style

Cathrine Axfors; Andreas M. Schmitt; Perrine Janiaud; Janneke Van’T Hooft; Sherief Abd-Elsalam; Ehab F. Abdo; Benjamin S. Abella; Javed Akram; Ravi K. Amaravadi; Derek C. Angus; Yaseen M. Arabi; Shehnoor Azhar; Lindsey R. Baden; Arthur W. Baker; Leila Belkhir; Thomas Benfield; Marvin A. H. Berrevoets; Cheng-Pin Chen; Tsung-Chia Chen; Shu-Hsing Cheng; Chien-Yu Cheng; Wei-Sheng Chung; Yehuda Z. Cohen; Lisa N. Cowan; Olav Dalgard; Fernando F. de Almeida e Val; Marcus V. G. de Lacerda; Gisely C. de Melo; Lennie Derde; Vincent Dubee; Anissa Elfakir; Anthony C. Gordon; Carmen M. Hernandez-Cardenas; Thomas Hills; Andy I. M. Hoepelman; Yi-Wen Huang; Bruno Igau; Ronghua Jin; Felipe Jurado-Camacho; Khalid S. Khan; Peter G. Kremsner; Benno Kreuels; Cheng-Yu Kuo; Thuy Le; Yi-Chun Lin; Wu-Pu Lin; Tse-Hung Lin; Magnus Nakrem Lyngbakken; Colin McArthur; Bryan J. McVerry; Patricia Meza-Meneses; Wuelton M. Monteiro; Susan C. Morpeth; Ahmad Mourad; Mark J. Mulligan; Srinivas Murthy; Susanna Naggie; Shanti Narayanasamy; Alistair Nichol; Lewis A. Novack; Sean M. O’Brien; Nwora Lance Okeke; Léna Perez; Rogelio Perez-Padilla; Laurent Perrin; Arantxa Remigio-Luna; Norma E. Rivera-Martinez; Frank W. Rockhold; Sebastian Rodriguez-Llamazares; Robert Rolfe; Rossana Rosa; Helge Røsjø; Vanderson S. Sampaio; Todd B. Seto; Muhammad Shahzad; Shaimaa Soliman; Jason E. Stout; Ireri Thirion-Romero; Andrea B. Troxel; Ting-Yu Tseng; Nicholas A. Turner; Robert J. Ulrich; Stephen R. Walsh; Steve A. Webb; Jesper M. Weehuizen; Maria Velinova; Hon-Lai Wong; Rebekah Wrenn; Fernando G. Zampieri; Wu Zhong; David Moher; Steven N. Goodman; John P. A. Ioannidis; Lars G. Hemkens. Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials. Nature Communications 2021, 12, 1 -13.

AMA Style

Cathrine Axfors, Andreas M. Schmitt, Perrine Janiaud, Janneke Van’T Hooft, Sherief Abd-Elsalam, Ehab F. Abdo, Benjamin S. Abella, Javed Akram, Ravi K. Amaravadi, Derek C. Angus, Yaseen M. Arabi, Shehnoor Azhar, Lindsey R. Baden, Arthur W. Baker, Leila Belkhir, Thomas Benfield, Marvin A. H. Berrevoets, Cheng-Pin Chen, Tsung-Chia Chen, Shu-Hsing Cheng, Chien-Yu Cheng, Wei-Sheng Chung, Yehuda Z. Cohen, Lisa N. Cowan, Olav Dalgard, Fernando F. de Almeida e Val, Marcus V. G. de Lacerda, Gisely C. de Melo, Lennie Derde, Vincent Dubee, Anissa Elfakir, Anthony C. Gordon, Carmen M. Hernandez-Cardenas, Thomas Hills, Andy I. M. Hoepelman, Yi-Wen Huang, Bruno Igau, Ronghua Jin, Felipe Jurado-Camacho, Khalid S. Khan, Peter G. Kremsner, Benno Kreuels, Cheng-Yu Kuo, Thuy Le, Yi-Chun Lin, Wu-Pu Lin, Tse-Hung Lin, Magnus Nakrem Lyngbakken, Colin McArthur, Bryan J. McVerry, Patricia Meza-Meneses, Wuelton M. Monteiro, Susan C. Morpeth, Ahmad Mourad, Mark J. Mulligan, Srinivas Murthy, Susanna Naggie, Shanti Narayanasamy, Alistair Nichol, Lewis A. Novack, Sean M. O’Brien, Nwora Lance Okeke, Léna Perez, Rogelio Perez-Padilla, Laurent Perrin, Arantxa Remigio-Luna, Norma E. Rivera-Martinez, Frank W. Rockhold, Sebastian Rodriguez-Llamazares, Robert Rolfe, Rossana Rosa, Helge Røsjø, Vanderson S. Sampaio, Todd B. Seto, Muhammad Shahzad, Shaimaa Soliman, Jason E. Stout, Ireri Thirion-Romero, Andrea B. Troxel, Ting-Yu Tseng, Nicholas A. Turner, Robert J. Ulrich, Stephen R. Walsh, Steve A. Webb, Jesper M. Weehuizen, Maria Velinova, Hon-Lai Wong, Rebekah Wrenn, Fernando G. Zampieri, Wu Zhong, David Moher, Steven N. Goodman, John P. A. Ioannidis, Lars G. Hemkens. Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials. Nature Communications. 2021; 12 (1):1-13.

Chicago/Turabian Style

Cathrine Axfors; Andreas M. Schmitt; Perrine Janiaud; Janneke Van’T Hooft; Sherief Abd-Elsalam; Ehab F. Abdo; Benjamin S. Abella; Javed Akram; Ravi K. Amaravadi; Derek C. Angus; Yaseen M. Arabi; Shehnoor Azhar; Lindsey R. Baden; Arthur W. Baker; Leila Belkhir; Thomas Benfield; Marvin A. H. Berrevoets; Cheng-Pin Chen; Tsung-Chia Chen; Shu-Hsing Cheng; Chien-Yu Cheng; Wei-Sheng Chung; Yehuda Z. Cohen; Lisa N. Cowan; Olav Dalgard; Fernando F. de Almeida e Val; Marcus V. G. de Lacerda; Gisely C. de Melo; Lennie Derde; Vincent Dubee; Anissa Elfakir; Anthony C. Gordon; Carmen M. Hernandez-Cardenas; Thomas Hills; Andy I. M. Hoepelman; Yi-Wen Huang; Bruno Igau; Ronghua Jin; Felipe Jurado-Camacho; Khalid S. Khan; Peter G. Kremsner; Benno Kreuels; Cheng-Yu Kuo; Thuy Le; Yi-Chun Lin; Wu-Pu Lin; Tse-Hung Lin; Magnus Nakrem Lyngbakken; Colin McArthur; Bryan J. McVerry; Patricia Meza-Meneses; Wuelton M. Monteiro; Susan C. Morpeth; Ahmad Mourad; Mark J. Mulligan; Srinivas Murthy; Susanna Naggie; Shanti Narayanasamy; Alistair Nichol; Lewis A. Novack; Sean M. O’Brien; Nwora Lance Okeke; Léna Perez; Rogelio Perez-Padilla; Laurent Perrin; Arantxa Remigio-Luna; Norma E. Rivera-Martinez; Frank W. Rockhold; Sebastian Rodriguez-Llamazares; Robert Rolfe; Rossana Rosa; Helge Røsjø; Vanderson S. Sampaio; Todd B. Seto; Muhammad Shahzad; Shaimaa Soliman; Jason E. Stout; Ireri Thirion-Romero; Andrea B. Troxel; Ting-Yu Tseng; Nicholas A. Turner; Robert J. Ulrich; Stephen R. Walsh; Steve A. Webb; Jesper M. Weehuizen; Maria Velinova; Hon-Lai Wong; Rebekah Wrenn; Fernando G. Zampieri; Wu Zhong; David Moher; Steven N. Goodman; John P. A. Ioannidis; Lars G. Hemkens. 2021. "Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials." Nature Communications 12, no. 1: 1-13.

Preprint
Published: 12 April 2021
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Tuberculosis (TB) is an airborne infectious disease caused by organisms in the Mycobacterium tuberculosis (Mtb) complex. In many low and middle-income countries, TB remains a major cause of morbidity and mortality. Once a patient has been diagnosed with TB, it is critical that healthcare workers make the most appropriate treatment decision given the individual conditions of the patient and the likely course of the disease based on medical experience. Depending on the prognosis, delayed or inappropriate treatment can result in unsatisfactory results including the exacerbation of clinical symptoms, poor quality of life, and increased risk of death. This work benchmarks machine learning models to aid TB prognosis using a Brazilian health database of confirmed cases and deaths related to TB in the State of Amazonas. The goal is to predict the probability of death by TB thus aiding the prognosis of TB and associated treatment decision making process. In its original form, the data set comprised 36,228 records and 130 fields but suffered from missing, incomplete, or incorrect data. Following data cleaning and preprocessing, a revised data set was generated comprising 24,015 records and 38 fields, including 22,876 reported cured TB patients and 1,139 deaths by TB. To explore how the data imbalance impacts model performance, two controlled experiments were designed using (1) imbalanced and (2) balanced data sets. The best result is achieved by the Gradient Boosting (GB) model using the balanced data set to predict TB-mortality, and the ensemble model composed by the Random Forest (RF), GB and Multi-layer Perceptron (MLP) models is the best model to predict the cure class.

ACS Style

Maicon Herverton Lino Ferreira Da Silva Barros; Geovanne Oliveira Alves; Lubnnia Morais Florêncio Souza; Élisson Da Silva Rocha; João Fausto Lorenzato de Oliveira; Theo Lynn; Vanderson Sampaio; Patricia Takako Endo. Benchmarking of Machine Learning Models to Assist the Prognosis of Tuberculosis. 2021, 1 .

AMA Style

Maicon Herverton Lino Ferreira Da Silva Barros, Geovanne Oliveira Alves, Lubnnia Morais Florêncio Souza, Élisson Da Silva Rocha, João Fausto Lorenzato de Oliveira, Theo Lynn, Vanderson Sampaio, Patricia Takako Endo. Benchmarking of Machine Learning Models to Assist the Prognosis of Tuberculosis. . 2021; ():1.

Chicago/Turabian Style

Maicon Herverton Lino Ferreira Da Silva Barros; Geovanne Oliveira Alves; Lubnnia Morais Florêncio Souza; Élisson Da Silva Rocha; João Fausto Lorenzato de Oliveira; Theo Lynn; Vanderson Sampaio; Patricia Takako Endo. 2021. "Benchmarking of Machine Learning Models to Assist the Prognosis of Tuberculosis." , no. : 1.

Preprint content
Published: 25 February 2021
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The Northern Brazilian state of Amazonas is one of the most heavily affected country regions by the COVID-19 epidemic and experienced two exponential growing waves in early and late 2020. Through a genomic epidemiology study based on 250 SARS-CoV-2 genomes from different Amazonas municipalities sampled between March 2020 and January 2021 we revealed that the first exponential growth phase was driven mostly by the dissemination of lineage B.1.195 which was gradually replaced by lineage B.1.1.28. The second wave coincides with the emergence of the variant of concern (VOC) P.1 which evolved from a local B.1.1.28 clade in late November and rapidly replaced the parental lineage in less than two months. Our findings support that successive lineage replacements in Amazonas were driven by a complex combination of variable levels of social distancing measures and the emergence of a more transmissible VOC P.1 virus. These data provide unique insights to understanding the mechanisms that underlie the COVID-19 epidemic waves and the risk of disseminating SARS-CoV-2 VOC P.1 in Brazil and potentially worldwide.

ACS Style

Felipe Naveca; Valdinete Nascimento; Victor Souza; André Corado; Fernanda Nascimento; George Silva; Ágatha Costa; Débora Duarte; Karina Pessoa; Matilde Mejía; Maria Brandão; Michele Jesus; Luciana Gonçalves; Cristiano da Costa; Vanderson Sampaio; Daniel Barros; Marineide Silva; Tirza Mattos; Gemilson Pontes; Ligia Abdalla; João Santos; Ighor Arantes; Filipe Dezordi; Marilda Siqueira; Gabriel Wallau; Paola Resende; Edson Delatorre; Tiago Gräff; Gonzalo Bello. COVID-19 epidemic in the Brazilian state of Amazonas was driven by long-term persistence of endemic SARS-CoV-2 lineages and the recent emergence of the new Variant of Concern P.1. 2021, 1 .

AMA Style

Felipe Naveca, Valdinete Nascimento, Victor Souza, André Corado, Fernanda Nascimento, George Silva, Ágatha Costa, Débora Duarte, Karina Pessoa, Matilde Mejía, Maria Brandão, Michele Jesus, Luciana Gonçalves, Cristiano da Costa, Vanderson Sampaio, Daniel Barros, Marineide Silva, Tirza Mattos, Gemilson Pontes, Ligia Abdalla, João Santos, Ighor Arantes, Filipe Dezordi, Marilda Siqueira, Gabriel Wallau, Paola Resende, Edson Delatorre, Tiago Gräff, Gonzalo Bello. COVID-19 epidemic in the Brazilian state of Amazonas was driven by long-term persistence of endemic SARS-CoV-2 lineages and the recent emergence of the new Variant of Concern P.1. . 2021; ():1.

Chicago/Turabian Style

Felipe Naveca; Valdinete Nascimento; Victor Souza; André Corado; Fernanda Nascimento; George Silva; Ágatha Costa; Débora Duarte; Karina Pessoa; Matilde Mejía; Maria Brandão; Michele Jesus; Luciana Gonçalves; Cristiano da Costa; Vanderson Sampaio; Daniel Barros; Marineide Silva; Tirza Mattos; Gemilson Pontes; Ligia Abdalla; João Santos; Ighor Arantes; Filipe Dezordi; Marilda Siqueira; Gabriel Wallau; Paola Resende; Edson Delatorre; Tiago Gräff; Gonzalo Bello. 2021. "COVID-19 epidemic in the Brazilian state of Amazonas was driven by long-term persistence of endemic SARS-CoV-2 lineages and the recent emergence of the new Variant of Concern P.1." , no. : 1.

Review
Published: 05 December 2020 in Toxins
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Snakebites are more frequent in the Brazilian Amazon than in other parts of Brazil, representing a high cost for the health system since antivenoms are only available through medical prescription from central municipal hospitals in most cases. The need for a cold chain and physicians usually restricts access to the only effective treatment of a snakebite, the antivenom. The complex topography of the rivers contributes to delays in treatment, and consequently increases the risk of severe complications, chronic sequelae and death. Thus, decentralization of antivenom treatment to primary healthcare facilities in the interior would increase access by indigenous population groups to proper healthcare. To standardize and evaluate the decentralization to low complexity indigenous healthcare units, we suggest the (i) development and validation of standardized operational procedures, (ii) training of professionals in the validated protocol in a referral health unit, (iii) implementation of the protocol in an indigenous healthcare unit, (iv) assessment of perceptions towards and acceptability of the protocol, and (v) estimation of the impact of the protocol’s implementation. We expect that antivenom decentralization would shorten the time between diagnosis and treatment and, as such, improve the prognosis of snakebites. As health cosmology among indigenous populations has an important role in maintaining their way of life, the introduction of a new therapeutic strategy to their customs must take into account the beliefs of these peoples. Thus, antivenom administration would be inserted as a crucial therapeutic tool in a world of diverse social, natural and supernatural representations. The information presented here also serves as a basis to advocate for support and promotion of health policy initiatives focused on evidence-based care in snakebite management.

ACS Style

Wuelton Marcelo Monteiro; Altair Seabra De Farias; Fernando Val; Alexandre Vilhena Silva Neto; André Sachett; Marcus Lacerda; Vanderson Sampaio; Deugles Cardoso; Luiza Garnelo; João Ricardo Nickenig Vissoci; Jacqueline Sachett; Fan Hui Wen. Providing Antivenom Treatment Access to All Brazilian Amazon Indigenous Areas: ‘Every Life Has Equal Value’. Toxins 2020, 12, 772 .

AMA Style

Wuelton Marcelo Monteiro, Altair Seabra De Farias, Fernando Val, Alexandre Vilhena Silva Neto, André Sachett, Marcus Lacerda, Vanderson Sampaio, Deugles Cardoso, Luiza Garnelo, João Ricardo Nickenig Vissoci, Jacqueline Sachett, Fan Hui Wen. Providing Antivenom Treatment Access to All Brazilian Amazon Indigenous Areas: ‘Every Life Has Equal Value’. Toxins. 2020; 12 (12):772.

Chicago/Turabian Style

Wuelton Marcelo Monteiro; Altair Seabra De Farias; Fernando Val; Alexandre Vilhena Silva Neto; André Sachett; Marcus Lacerda; Vanderson Sampaio; Deugles Cardoso; Luiza Garnelo; João Ricardo Nickenig Vissoci; Jacqueline Sachett; Fan Hui Wen. 2020. "Providing Antivenom Treatment Access to All Brazilian Amazon Indigenous Areas: ‘Every Life Has Equal Value’." Toxins 12, no. 12: 772.

Review
Published: 18 September 2020
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Background Substantial COVID-19 research investment has been allocated to randomized clinical trials (RCTs) on hydroxychloroquine/chloroquine, which currently face recruitment challenges or early discontinuation. We aimed to estimate the effects of hydroxychloroquine and chloroquine on survival in COVID-19 from all currently available RCT evidence, published and unpublished. Methods: Rapid meta-analysis of ongoing, completed, or discontinued RCTs on hydroxychloroquine or chloroquine treatment for any COVID-19 patients (protocol: https://osf.io/QESV4/). We systematically identified published and unpublished RCTs by September 14, 2020 (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, PubMed, Cochrane COVID-19 registry). All-cause mortality was extracted (publications/preprints) or requested from investigators and combined in random-effects meta-analyses, calculating odds ratios (ORs) with 95% confidence intervals (CIs), separately for hydroxychloroquine/chloroquine. Prespecified subgroup analyses included patient setting, diagnostic confirmation, control type, and publication status. Results Sixty-two trials were potentially eligible. We included 16 unpublished trials (1596 patients) and 10 publications/preprints (6317 patients). The combined summary OR on all-cause mortality for hydroxychloroquine was 1.08 (95%CI: 0.99, 1.18; I2=0%; 24 trials; 7659 patients) and for chloroquine 1.77 (95%CI: 0.15, 21.13, I2=0%; 4 trials; 307 patients). We identified no subgroup effects. Conclusions We found no benefit of hydroxychloroquine or chloroquine on the survival of COVID-19 patients. For hydroxychloroquine, the confidence interval is compatible with increased mortality (OR 1.18) or negligibly reduced mortality (OR 0.99). Findings have unclear generalizability to outpatients, children, pregnant women, and people with comorbidities.

ACS Style

Cathrine Axfors; Andreas M Schmitt; Perrine Janiaud; Janneke Van 't Hooft; Sherief Abd-Elsalam; Ehab F Abdo; Benjamin S Abella; Javed Akram; Ravi K Amaravadi; Derek C Angus; Yaseen M Arabi; Shehnoor Azhar; Lindsey R Baden; Arthur W Baker; Leila Belkhir; Thomas Benfield; Marvin A H Berrevoets; Cheng-Pin Chen; Tsung-Chia Chen; Shu-Hsing Cheng; Chien-Yu Cheng; Wei-Sheng Chung; Yehuda Z Cohen; Lisa N Cowan; Olav Dalgard; Fernando F De Almeida E Val; Marcus V G De Lacerda; Gisely C De Melo; Lennie Derde; Vincent Dubee; Anissa Elfakir; Anthony C Gordon; Carmen M Hernandez-Cardenas; Thomas Hills; Andy I M Hoepelman; Yi-Wen Huang; Bruno Igau; Ronghua Jin; Felipe Jurado-Camacho; Khalid S Khan; Peter G Kremsner; Benno Kreuels; Cheng-Yu Kuo; Thuy Le; Yi-Chun Lin; Wu-Pu Lin; Tse-Hung Lin; Magnus Nakrem Lyngbakken; Colin McArthur; Bryan McVerry; Patricia Meza-Meneses; Wuelton M Monteiro; Susan C Morpeth; Ahmad Mourad; Mark J Mulligan; Srinivas Murthy; Susanna Naggie; Shanti Narayanasamy; Alistair Nichol; Lewis A Novack; Sean M O'brien; Nwora Lance Okeke; Lena Perez; Rogelio Perez-Padilla; Laurent Perrin; Arantxa Remigio-Luna; Norma E Rivera-Martinez; Frank W Rockhold; Sebastian Rodriguez-Llamazares; Robert Rolfe; Rossana Rosa; Helge Rosjo; Vanderson S Sampaio; Todd B Seto; Muhammad Shehzad; Shaimaa Soliman; Jason E Stout; Ireri Thirion-Romero; Andrea B Troxel; Ting-Yu Tseng; Nicholas A Turner; Robert J Ulrich; Stephen R Walsh; Steve A Webb; Jesper M Weehuizen; Maria Velinova; Hon-Lai Wong; Rebekah Wrenn; Fernando G Zampieri; Wu Zhong; David Moher; Steven N Goodman; John P A Ioannidis; Lars G Hemkens. Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19: an international collaborative meta-analysis of randomized trials. 2020, 1 .

AMA Style

Cathrine Axfors, Andreas M Schmitt, Perrine Janiaud, Janneke Van 't Hooft, Sherief Abd-Elsalam, Ehab F Abdo, Benjamin S Abella, Javed Akram, Ravi K Amaravadi, Derek C Angus, Yaseen M Arabi, Shehnoor Azhar, Lindsey R Baden, Arthur W Baker, Leila Belkhir, Thomas Benfield, Marvin A H Berrevoets, Cheng-Pin Chen, Tsung-Chia Chen, Shu-Hsing Cheng, Chien-Yu Cheng, Wei-Sheng Chung, Yehuda Z Cohen, Lisa N Cowan, Olav Dalgard, Fernando F De Almeida E Val, Marcus V G De Lacerda, Gisely C De Melo, Lennie Derde, Vincent Dubee, Anissa Elfakir, Anthony C Gordon, Carmen M Hernandez-Cardenas, Thomas Hills, Andy I M Hoepelman, Yi-Wen Huang, Bruno Igau, Ronghua Jin, Felipe Jurado-Camacho, Khalid S Khan, Peter G Kremsner, Benno Kreuels, Cheng-Yu Kuo, Thuy Le, Yi-Chun Lin, Wu-Pu Lin, Tse-Hung Lin, Magnus Nakrem Lyngbakken, Colin McArthur, Bryan McVerry, Patricia Meza-Meneses, Wuelton M Monteiro, Susan C Morpeth, Ahmad Mourad, Mark J Mulligan, Srinivas Murthy, Susanna Naggie, Shanti Narayanasamy, Alistair Nichol, Lewis A Novack, Sean M O'brien, Nwora Lance Okeke, Lena Perez, Rogelio Perez-Padilla, Laurent Perrin, Arantxa Remigio-Luna, Norma E Rivera-Martinez, Frank W Rockhold, Sebastian Rodriguez-Llamazares, Robert Rolfe, Rossana Rosa, Helge Rosjo, Vanderson S Sampaio, Todd B Seto, Muhammad Shehzad, Shaimaa Soliman, Jason E Stout, Ireri Thirion-Romero, Andrea B Troxel, Ting-Yu Tseng, Nicholas A Turner, Robert J Ulrich, Stephen R Walsh, Steve A Webb, Jesper M Weehuizen, Maria Velinova, Hon-Lai Wong, Rebekah Wrenn, Fernando G Zampieri, Wu Zhong, David Moher, Steven N Goodman, John P A Ioannidis, Lars G Hemkens. Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19: an international collaborative meta-analysis of randomized trials. . 2020; ():1.

Chicago/Turabian Style

Cathrine Axfors; Andreas M Schmitt; Perrine Janiaud; Janneke Van 't Hooft; Sherief Abd-Elsalam; Ehab F Abdo; Benjamin S Abella; Javed Akram; Ravi K Amaravadi; Derek C Angus; Yaseen M Arabi; Shehnoor Azhar; Lindsey R Baden; Arthur W Baker; Leila Belkhir; Thomas Benfield; Marvin A H Berrevoets; Cheng-Pin Chen; Tsung-Chia Chen; Shu-Hsing Cheng; Chien-Yu Cheng; Wei-Sheng Chung; Yehuda Z Cohen; Lisa N Cowan; Olav Dalgard; Fernando F De Almeida E Val; Marcus V G De Lacerda; Gisely C De Melo; Lennie Derde; Vincent Dubee; Anissa Elfakir; Anthony C Gordon; Carmen M Hernandez-Cardenas; Thomas Hills; Andy I M Hoepelman; Yi-Wen Huang; Bruno Igau; Ronghua Jin; Felipe Jurado-Camacho; Khalid S Khan; Peter G Kremsner; Benno Kreuels; Cheng-Yu Kuo; Thuy Le; Yi-Chun Lin; Wu-Pu Lin; Tse-Hung Lin; Magnus Nakrem Lyngbakken; Colin McArthur; Bryan McVerry; Patricia Meza-Meneses; Wuelton M Monteiro; Susan C Morpeth; Ahmad Mourad; Mark J Mulligan; Srinivas Murthy; Susanna Naggie; Shanti Narayanasamy; Alistair Nichol; Lewis A Novack; Sean M O'brien; Nwora Lance Okeke; Lena Perez; Rogelio Perez-Padilla; Laurent Perrin; Arantxa Remigio-Luna; Norma E Rivera-Martinez; Frank W Rockhold; Sebastian Rodriguez-Llamazares; Robert Rolfe; Rossana Rosa; Helge Rosjo; Vanderson S Sampaio; Todd B Seto; Muhammad Shehzad; Shaimaa Soliman; Jason E Stout; Ireri Thirion-Romero; Andrea B Troxel; Ting-Yu Tseng; Nicholas A Turner; Robert J Ulrich; Stephen R Walsh; Steve A Webb; Jesper M Weehuizen; Maria Velinova; Hon-Lai Wong; Rebekah Wrenn; Fernando G Zampieri; Wu Zhong; David Moher; Steven N Goodman; John P A Ioannidis; Lars G Hemkens. 2020. "Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19: an international collaborative meta-analysis of randomized trials." , no. : 1.

Journal article
Published: 14 August 2020 in JMIR Research Protocols
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COVID-19, caused by the virus SARS-CoV-2, has brought extensive challenges to the scientific community in recent months. Several studies have been undertaken in an attempt to minimize the impact of the disease worldwide. Although new knowledge has been quickly disseminated, including viral mechanisms, pathophysiology, and clinical findings, there is a lack of information on the effective pharmacological management of this disease. In vitro studies have shown some benefits related to the use of antimalarials (chloroquine and hydroxychloroquine) for inhibiting SARS-CoV-2. However, the data from open clinical trials on COVID-19 patients are controversial. We present the protocol for a research project that compares the potential protective effect of antimalarials in preventing moderate-to-severe forms of COVID-19 in two groups: (1) patients treated chronically with antimalarials for rheumatic diseases and (2) other members of the patients' household who have not been diagnosed with rheumatic diseases and are not taking antimalarials. This is a 24-week, prospective, observational cohort study comprising patients from public and private health services across Brazil, who chronically use antimalarials for the treatment of immune-mediated rheumatic diseases, osteoarthritis, or chikungunya-related arthropathy. A total of six sequential phone interviews were scheduled during the COVID-19 outbreak in five different regions of Brazil. Information regarding social, epidemiological, and demographic data, as well as details about rheumatic diseases, antimalarials, comorbidities, and concomitant medication, is being recorded using a specific online form in the REDCap database. Symptoms suggestive of COVID-19, including fever, cough, dyspnea, anosmia, and dysgeusia, are being self-reported and collected via phone interviews. Our main outcomes are hospitalization, need of intensive care unit, and death. Recruitment began at the end of March 2020, and the inclusion was done during an 8-week period (from March 29 to May 17) with a total of 10,443 individuals enrolled at baseline, 5166 of whom have rheumatic diseases, from 23 tertiary rheumatology centers across 97 Brazilian cities. Data analysis is scheduled to begin after all inclusion data have been collected. This study, which includes a large sample of chronic antimalarial users, will allow us to explore whether SARS-CoV-2 infection may be associated with immune-mediated rheumatic diseases and long-term antimalarial usage. Brazilian Registry of Clinical Trials RBR-9KTWX6; http://www.ensaiosclinicos.gov.br/rg/RBR-9ktwx6/. DERR1-10.2196/23532.

ACS Style

Ana Gomides; Gilda Ferreira; Adriana Kakehasi; Marcus Lacerda; Cláudia Marques; Licia Mota; Eduardo Paiva; Gecilmara Pileggi; José Provenza; Edgard Reis-Neto; Vanderson Sampaio; Ricardo Xavier; Marcelo Pinheiro. IMPACT OF CHRONIC USE OF ANTIMALARIALS ON SARS-CoV-2 INFECTION IN PATIENTS WITH IMMUNE-MEDIATED RHEUMATIC DISEASES: PROTOCOL DESIGN FOR A MULTICENTRIC OBSERVATIONAL COHORT IN BRAZIL (Preprint). JMIR Research Protocols 2020, 9, e23532 .

AMA Style

Ana Gomides, Gilda Ferreira, Adriana Kakehasi, Marcus Lacerda, Cláudia Marques, Licia Mota, Eduardo Paiva, Gecilmara Pileggi, José Provenza, Edgard Reis-Neto, Vanderson Sampaio, Ricardo Xavier, Marcelo Pinheiro. IMPACT OF CHRONIC USE OF ANTIMALARIALS ON SARS-CoV-2 INFECTION IN PATIENTS WITH IMMUNE-MEDIATED RHEUMATIC DISEASES: PROTOCOL DESIGN FOR A MULTICENTRIC OBSERVATIONAL COHORT IN BRAZIL (Preprint). JMIR Research Protocols. 2020; 9 (10):e23532.

Chicago/Turabian Style

Ana Gomides; Gilda Ferreira; Adriana Kakehasi; Marcus Lacerda; Cláudia Marques; Licia Mota; Eduardo Paiva; Gecilmara Pileggi; José Provenza; Edgard Reis-Neto; Vanderson Sampaio; Ricardo Xavier; Marcelo Pinheiro. 2020. "IMPACT OF CHRONIC USE OF ANTIMALARIALS ON SARS-CoV-2 INFECTION IN PATIENTS WITH IMMUNE-MEDIATED RHEUMATIC DISEASES: PROTOCOL DESIGN FOR A MULTICENTRIC OBSERVATIONAL COHORT IN BRAZIL (Preprint)." JMIR Research Protocols 9, no. 10: e23532.

Other
Published: 11 April 2020
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SummaryBackgroundThere is no specific antiviral therapy recommended for the disease caused by SARS-CoV-2 (COVID-19). Recent publications have drawn attention to the possible benefit of chloroquine (CQ). Our study aimed to comprehensively evaluate the safety and efficacy of two different CQ dosages in patients with established severe COVID-19.MethodsWe performed a parallel, double-blinded, randomized, phase IIb clinical trial, aiming to assess safety and efficacy of two different CQ dosages as adjunctive therapy of hospitalized patients with SARS in Manaus, Brazilian Amazon. Eligible participants were allocated to receive orally or via nasogastric tube high dose CQ (600mg CQ twice daily for 10 days or total dose 12g); or low dose CQ (450mg for 5 days, twice daily only on the first day, or total dose 2.7g). In addition, all patients received ceftriaxone and azithromycin. This study was registered with ClinicalTrials.gov, number NCT04323527.FindingsOut of a pre-defined 440 patients sample size, 81 patients were enrolled. The high dosage CQ arm presented more QTc>500ms (18.9%), and a trend toward higher lethality (39%) than the lower dosage. Fatality rate until day 13 was 27% (95%CI=17.9-38.2%), overlapping with the CI of historical data from similar patients not using CQ (95%CI=14.5-19.2%). In 27 patients with paired samples, respiratory secretion at day 4 was negative in only six patients (22%).InterpretationPreliminary findings suggest that the higher CQ dosage (10-day regimen) should not be recommended for COVID-19 treatment because of its potential safety hazards. Such results forced us to prematurely halt patient recruitment to this arm. Given the enormous global push for the use of CQ for COVID-19, results such as the ones found in this trial can provide robust evidence for updated COVID-19 patient management recommendations.FundingThis study was funded by the Government of the Amazonas State, Farmanguinhos (Fiocruz), SUFRAMA, CAPES, FAPEAM, and federal funds granted by a coalition of Brazilian senators.Research in contextEvidence before this studyBefore the CloroCovid-19 trial began, to our knowledge, there were no published reports of robust clinical studies on the safety and/or efficacy of chloroquine (CQ) and/or hydroxychloroquine (HCQ) for the treatment of COVID-19 during the recent 2020 pandemic. We searched PubMed and also MedRxiv.org (pre-print server for health sciences, without peer review), without any language restrictions and including Chinese publications, for studies published between Dec 2019 and April 5, 2020, using the search terms ‘COVID-19, coronavirus, SARS-Cov-2’. We found three non-randomized studies with limited sample sizes in which (1) HCQ use led to a decrease in SARS-Cov-2 detected in respiratory secretions five days after treatment, together with azithromycin (France, 36 patients); (2) HCQ use shortened time to clinical recovery (China, 62 patients); and (3) CQ was superior to control treatment in inhibiting the exacerbation of pneumonia, improving lung imaging findings, and promoting virus-negative conversion and shortening the disease course (China, 100 patients). We found no published studies comparing different dosages of CQ/HCQ and their thorough safety assessment.Added value of this studyIn a larger patient population, we found that a higher dosage of CQ for 10 days presented toxicity red flags, particularly affecting QTc prolongation. The limited sample size recruited so far does not allow to show any benefit regarding treatment efficacy, however the higher fatality associated with the higher dosage by day 13 of follow-up resulted in a premature halting of this arm. This is the first double-blinded, randomized clinical trial addressing different dosages of CQ for the treatment of severe patients with COVID-19 in the absence of a control group using placebo. Due to the impossibility of not using the drug recommended at the national level, we used historical data from the literature to infer comparisons for lethality endpoints. Follow-up until day 28 is ongoing with a larger sample size, in which long-term lethality will be better estimated.Implications of all the available evidenceThe preliminary findings from CloroCovid-19 trial suggest that the higher dosage of CQ (12 g total dose over 10 days) in COVID-19 should not be recommended because of safety concerns regarding QTc prolongation and increased lethality, in the Brazilian population, and more often in older patients in use of drugs such as azithromycin and oseltamivir, which also prolong QTc interval. Among patients randomized to the lower dosage group (5 days of treatment, total dose 2.7 g), given the limited number of patients so far enrolled, it is still not possible to estimate a clear benefit of CQ in patients with severe ARDS. Preliminary data on viral clearance in respiratory secretions in our confirmed cases are also indicative of little effect of the drug at high dosage. More studies initiating CQ prior to the onset of the severe phase of the disease are urgently needed.

ACS Style

Mayla Gabriela Silva Borba; Fernando De Almeida Val; Vanderson Sousa Sampaio; Marcia Almeida Ara&uacutejo Alexandre; Gisely Cardoso Melo; Marcelo Brito; Maria Paula Gomes Mour&atildeo; Jos&eacute Diego Brito Sousa; Djane Clarys Baia-Da-Silva; Marcus Vinitius Farias Guerra; Ludhmila Abrahāo Hajjar; Rosemary Costa Pinto; Antonio Alcirley Silva Balieiro; Felipe Gomes Naveca; Mariana Simāo Xavier; Alexandre Salomão; André Machado Siqueira; Alexandre Schwarzbolt; Júlio Henrique Rosa Croda; Maurício Lacerda Nogueira; Gustavo Adolfo Sierra Romero; Quique Bassat; Cor Jesus Fontes; Bernardino Cláudio Albuquerque; Cláudio Tadeu Daniel-Ribeiro; Wuelton Marcelo Monteiro; Marcus Vinícus Guimarães Lacerda. Chloroquine diphosphate in two different dosages as adjunctive therapy of hospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: Preliminary safety results of a randomized, double-blinded, phase IIb clinical trial (CloroCovid-19 Study). 2020, 1 .

AMA Style

Mayla Gabriela Silva Borba, Fernando De Almeida Val, Vanderson Sousa Sampaio, Marcia Almeida Ara&uacutejo Alexandre, Gisely Cardoso Melo, Marcelo Brito, Maria Paula Gomes Mour&atildeo, Jos&eacute Diego Brito Sousa, Djane Clarys Baia-Da-Silva, Marcus Vinitius Farias Guerra, Ludhmila Abrahāo Hajjar, Rosemary Costa Pinto, Antonio Alcirley Silva Balieiro, Felipe Gomes Naveca, Mariana Simāo Xavier, Alexandre Salomão, André Machado Siqueira, Alexandre Schwarzbolt, Júlio Henrique Rosa Croda, Maurício Lacerda Nogueira, Gustavo Adolfo Sierra Romero, Quique Bassat, Cor Jesus Fontes, Bernardino Cláudio Albuquerque, Cláudio Tadeu Daniel-Ribeiro, Wuelton Marcelo Monteiro, Marcus Vinícus Guimarães Lacerda. Chloroquine diphosphate in two different dosages as adjunctive therapy of hospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: Preliminary safety results of a randomized, double-blinded, phase IIb clinical trial (CloroCovid-19 Study). . 2020; ():1.

Chicago/Turabian Style

Mayla Gabriela Silva Borba; Fernando De Almeida Val; Vanderson Sousa Sampaio; Marcia Almeida Ara&uacutejo Alexandre; Gisely Cardoso Melo; Marcelo Brito; Maria Paula Gomes Mour&atildeo; Jos&eacute Diego Brito Sousa; Djane Clarys Baia-Da-Silva; Marcus Vinitius Farias Guerra; Ludhmila Abrahāo Hajjar; Rosemary Costa Pinto; Antonio Alcirley Silva Balieiro; Felipe Gomes Naveca; Mariana Simāo Xavier; Alexandre Salomão; André Machado Siqueira; Alexandre Schwarzbolt; Júlio Henrique Rosa Croda; Maurício Lacerda Nogueira; Gustavo Adolfo Sierra Romero; Quique Bassat; Cor Jesus Fontes; Bernardino Cláudio Albuquerque; Cláudio Tadeu Daniel-Ribeiro; Wuelton Marcelo Monteiro; Marcus Vinícus Guimarães Lacerda. 2020. "Chloroquine diphosphate in two different dosages as adjunctive therapy of hospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: Preliminary safety results of a randomized, double-blinded, phase IIb clinical trial (CloroCovid-19 Study)." , no. : 1.

Temas livres
Published: 01 January 2020 in Ciência & Saúde Coletiva
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Resumo Objetivou-se investigar fatores associados à mortalidade por causas inespecíficas e mal definidas no estado do Amazonas (AM). Desenvolveu-se um estudo seccional incluindo 90.439 registros de óbitos não fetais, com residência e ocorrência no AM entre 2006 e 2012. Foram estimadas razões de chances de causas inespecíficas e mal definidas por meio de regressão logística multinomial hierárquica. A proporção de causas mal definidas e inespecíficas foi, respectivamente, 16,6% e 9,1%. A ocorrência de causas mal definidas diminuiu ao longo dos anos e a de causas inespecíficas somente no último biênio. As causas inespecíficas associaram-se com residência e ocorrência do óbito fora da capital, via pública, sexo feminino, dos 10 aos 49 anos, cor parda e quando atestadas por legistas. As causas mal definidas associaram-se com residência e ocorrência fora da capital, em domicílios, a partir de 40 anos, cor não branca, não ser solteiro, baixa escolaridade, assistência médica e falta de informação sobre o atestante. A mortalidade por causas mal definidas e inespecíficas no AM declinou entre 2006 e 2012, associando-se às dimensões espacial e temporal, fatores demográficos, socioeconômicos e à assistência médica na ocasião do óbito.

ACS Style

Patrícia Carvalho Da Silva Balieiro; Leila Cristina Ferreira Da Silva; Vanderson De Souza Sampaio; Eyrivania Xavier Do Monte; Edylene Maria Dos Santos Pereira; Lais Araújo Ferreira De Queiroz; Rita Saraiva; Antonio José Leal Costa. Fatores associados à mortalidade por causas inespecíficas e mal definidas no estado do Amazonas, Brasil, de 2006 a 2012. Ciência & Saúde Coletiva 2020, 25, 339 -352.

AMA Style

Patrícia Carvalho Da Silva Balieiro, Leila Cristina Ferreira Da Silva, Vanderson De Souza Sampaio, Eyrivania Xavier Do Monte, Edylene Maria Dos Santos Pereira, Lais Araújo Ferreira De Queiroz, Rita Saraiva, Antonio José Leal Costa. Fatores associados à mortalidade por causas inespecíficas e mal definidas no estado do Amazonas, Brasil, de 2006 a 2012. Ciência & Saúde Coletiva. 2020; 25 (1):339-352.

Chicago/Turabian Style

Patrícia Carvalho Da Silva Balieiro; Leila Cristina Ferreira Da Silva; Vanderson De Souza Sampaio; Eyrivania Xavier Do Monte; Edylene Maria Dos Santos Pereira; Lais Araújo Ferreira De Queiroz; Rita Saraiva; Antonio José Leal Costa. 2020. "Fatores associados à mortalidade por causas inespecíficas e mal definidas no estado do Amazonas, Brasil, de 2006 a 2012." Ciência & Saúde Coletiva 25, no. 1: 339-352.

Original article
Published: 17 June 2019 in Tropical Medicine & International Health
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Objective To assess the spatial distribution of TB and malaria incidence, as well as their spatial association with each other, regardless of environmental and socio‐economic factors commonly reported as determinants of both disease rates among the municipalities of Amazonas State, Brazil between 2012 and 2015. Methods Through an ecological approach considering municipalities of Amazonas, Brazil, as unit of analysis, a negative binomial regression model was used to assess association between malaria and TB rates, in which the dependent variable was the average municipal tuberculosis incidence rate. Results Positive associations of overall malaria (β = 0.100 [CI = 0.032, 0.168], P = 0.004), P. vivax malaria (β = 0.115 [CI = 0.036, 0.195], P = 0.005), and P. falciparum malaria (β = 0.389 [CI = −0.0124, 0.791], P = 0.057) with TB rates were found, regardless of the sociodemographic factors included in the study. Conclusion In the Brazilian Amazon, TB and malaria are spatially associated. Therefore, it is very likely that co‐infections also occur in this region, regardless of the HIV status.

ACS Style

Rahyja Teixeira; Maria Gabriela Almeida Rodrigues; Marcia Danielle Ferreira; Maria Cecília Borges; Izabella Safe; Gisely Cardoso Melo; Renata Spener-Gomes; Marlucia Silva Garrido; Wuelton Marcelo Monteiro; André Machado Siqueira; Marcus Vinícius Guimarães Lacerda; Marcelo Cordeiro-Santos; Vanderson De Souza Sampaio. Tuberculosis and malaria walk side by side in the Brazilian Amazon: an ecological approach. Tropical Medicine & International Health 2019, 24, 1003 -1010.

AMA Style

Rahyja Teixeira, Maria Gabriela Almeida Rodrigues, Marcia Danielle Ferreira, Maria Cecília Borges, Izabella Safe, Gisely Cardoso Melo, Renata Spener-Gomes, Marlucia Silva Garrido, Wuelton Marcelo Monteiro, André Machado Siqueira, Marcus Vinícius Guimarães Lacerda, Marcelo Cordeiro-Santos, Vanderson De Souza Sampaio. Tuberculosis and malaria walk side by side in the Brazilian Amazon: an ecological approach. Tropical Medicine & International Health. 2019; 24 (8):1003-1010.

Chicago/Turabian Style

Rahyja Teixeira; Maria Gabriela Almeida Rodrigues; Marcia Danielle Ferreira; Maria Cecília Borges; Izabella Safe; Gisely Cardoso Melo; Renata Spener-Gomes; Marlucia Silva Garrido; Wuelton Marcelo Monteiro; André Machado Siqueira; Marcus Vinícius Guimarães Lacerda; Marcelo Cordeiro-Santos; Vanderson De Souza Sampaio. 2019. "Tuberculosis and malaria walk side by side in the Brazilian Amazon: an ecological approach." Tropical Medicine & International Health 24, no. 8: 1003-1010.

Preprint content
Published: 03 June 2019
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OBJECTIVES To estimate TB mortality rates, describe multiple causes in death certificates in which TB was reported and identify predictors of TB reporting in death certificates in the State of Amazonas, Brazil, based on a multiple cause of death approach. METHODS Death records of residents in AM within 2006-2014 were classified based on tuberculosis reporting in the death certificate as tuberculosis not reported (TBNoR), reported as the underlying cause of death (TBUC) and as an associate cause of death (TBAC). Age standardized annual mortality rates for TBUC, TBAC and with TB reported (TBUC plus TBAC) were estimated for the State of Amazonas, using the direct standardization method and WHO 2000-2025 standard population. Mortality odds ratios (OR) of reporting TBUC and TBAC were estimated using multinomial logistic regression. RESULTS Age standardized annual TBUC and TBAC mortality rates ranged, between 5.9-7.8/105 and 2.7-4.0/105, respectively. TBUC was associated with residence in the State capital (OR=0.66), female sex (OR=0.87), education level (OR=0.67 and 0.50 for 8 to 11 and 12 or more school years), non-white race/skin colour (OR=1.38) and occurrence of death in the State capital (OR=1.69). TBAC was related to time (OR=1.21 and 1.22 for years 2009-11 and 2012-14), age (OR=36.1 and 16.5 for ages 15-39 and 40-64 years) and when death occurred in the State capital (OR=5.8). CONCLUSION TBUC was predominantly associated with indicators of unfavorable socioeconomic conditions and health care access constraints, whereas TBAC was mainly related to ages typical of high HIV disease incidence. Conflicts of interest None. Funding Fundação de Amparo à Pesquisa do Estado do Amazonas - FAPEAM

ACS Style

Vanderson De Souza Sampaio; Leila Cristina Ferreira da Silva; Daniel Barros de Castro; Patrícia Carvalho Da Silva Balieiro; Ana Alzira Cabrinha; Antonio José Leal Costa. Social, demographic, health care and co-morbidity predictors of tuberculosis mortality in Amazonas, Brazil: a multiple cause of death approach. 2019, 658773 .

AMA Style

Vanderson De Souza Sampaio, Leila Cristina Ferreira da Silva, Daniel Barros de Castro, Patrícia Carvalho Da Silva Balieiro, Ana Alzira Cabrinha, Antonio José Leal Costa. Social, demographic, health care and co-morbidity predictors of tuberculosis mortality in Amazonas, Brazil: a multiple cause of death approach. . 2019; ():658773.

Chicago/Turabian Style

Vanderson De Souza Sampaio; Leila Cristina Ferreira da Silva; Daniel Barros de Castro; Patrícia Carvalho Da Silva Balieiro; Ana Alzira Cabrinha; Antonio José Leal Costa. 2019. "Social, demographic, health care and co-morbidity predictors of tuberculosis mortality in Amazonas, Brazil: a multiple cause of death approach." , no. : 658773.

Observational study
Published: 07 January 2019 in Toxins
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Bothrops snakebites usually present systemic bleeding, and the clinical–epidemiological and laboratorial factors associated with the development of this manifestation are not well established. In this study, we assessed the prevalence of Bothrops snakebites with systemic bleeding reported at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, in Manaus, Amazonas State, Brazil, and the clinical–epidemiological and laboratorial factors associated with systemic bleeding. This is an observational, cross-sectional study carried out between August, 2013 and July, 2016. Patients who developed systemic bleeding on admission or during hospitalization were considered cases, and those with non-systemic bleeding were included in the control group. Systemic bleeding was observed in 63 (15.3%) of the 442 Bothrops snakebites evaluated. Bothrops snakebites mostly occurred in males (78.2%), in rural areas (89.0%) and in the age group of 11 to 30 years old (40.4%). It took most of the patients (59.8%) less than 3 h to receive medical assistance. Unclottable blood (AOR = 3.11 (95% CI = 1.53 to 6.31; p = 0.002)) and thrombocytopenia (AOR = 4.52 (95% CI = 2.03 to 10.09; p < 0.001)) on admission were independently associated with systemic bleeding during hospitalization. These hemostatic disorders on admission increase the chances of systemic bleeding during hospitalization. Prospective studies are needed to clarify the pathophysiology of systemic bleeding in Bothrops snakebites in the Amazon region.

ACS Style

Sâmella S. Oliveira; Eliane C. Alves; Alessandra S. Santos; João Pedro T. Pereira; Lybia Kássia S. Sarraff; Elizandra F. Nascimento; José Diego De-Brito-Sousa; Vanderson S. Sampaio; Marcus V.G. Lacerda; Jacqueline A.G. Sachett; Ida S. Sano-Martins; Wuelton M. Monteiro. Factors Associated with Systemic Bleeding in Bothrops Envenomation in a Tertiary Hospital in the Brazilian Amazon. Toxins 2019, 11, 22 .

AMA Style

Sâmella S. Oliveira, Eliane C. Alves, Alessandra S. Santos, João Pedro T. Pereira, Lybia Kássia S. Sarraff, Elizandra F. Nascimento, José Diego De-Brito-Sousa, Vanderson S. Sampaio, Marcus V.G. Lacerda, Jacqueline A.G. Sachett, Ida S. Sano-Martins, Wuelton M. Monteiro. Factors Associated with Systemic Bleeding in Bothrops Envenomation in a Tertiary Hospital in the Brazilian Amazon. Toxins. 2019; 11 (1):22.

Chicago/Turabian Style

Sâmella S. Oliveira; Eliane C. Alves; Alessandra S. Santos; João Pedro T. Pereira; Lybia Kássia S. Sarraff; Elizandra F. Nascimento; José Diego De-Brito-Sousa; Vanderson S. Sampaio; Marcus V.G. Lacerda; Jacqueline A.G. Sachett; Ida S. Sano-Martins; Wuelton M. Monteiro. 2019. "Factors Associated with Systemic Bleeding in Bothrops Envenomation in a Tertiary Hospital in the Brazilian Amazon." Toxins 11, no. 1: 22.

Original article
Published: 21 December 2018 in Tropical Medicine & International Health
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Objective To analyze the temporal and spatial distribution as well as the environmental and socioeconomic factors associated with cutaneous leishmaniasis incidence in the state of Amazonas, Brazil from 2007 to 2015. Methods Spatial and temporal distribution was evaluated from sequential thematic maps of the mean incidence rates of the disease. A negative binomial regression analysis was performed to evaluate the association of the factors studied with the mean incidence rate of ACL. Results The average proportion of deforestation was negatively associated with the average incidence rate of cutaneous leishmaniasis in municipalities (β=‐2.178; p=0.019; 95%CI ‐3.996, ‐0.361), and the health system performance index (effectiveness) (β=‐0.852; p=0.008; 95%CI ‐1.481, ‐0.225). Conversely, the municipal human development index (MHDI) was a factor positively related to the average incidence among the municipalities (β=7.728; p=0.003; 95%CI 2.716, 12.738). Conclusion Our study shows the important impact of socioeconomic and environmental factors on ACL incidence in the Amazonas State. This article is protected by copyright. All rights reserved.

ACS Style

Maria Gabriela De Almeida Rodrigues; Jose Diego Brito-Sousa; Ádila Liliane Barros Dias; Wuelton Marcelo Monteiro; Vanderson De Souza Sampaio. The role of deforestation on American cutaneous leishmaniasis incidence: spatial‐temporal distribution, environmental and socioeconomic factors associated in the Brazilian Amazon. Tropical Medicine & International Health 2018, 24, 348 -355.

AMA Style

Maria Gabriela De Almeida Rodrigues, Jose Diego Brito-Sousa, Ádila Liliane Barros Dias, Wuelton Marcelo Monteiro, Vanderson De Souza Sampaio. The role of deforestation on American cutaneous leishmaniasis incidence: spatial‐temporal distribution, environmental and socioeconomic factors associated in the Brazilian Amazon. Tropical Medicine & International Health. 2018; 24 (3):348-355.

Chicago/Turabian Style

Maria Gabriela De Almeida Rodrigues; Jose Diego Brito-Sousa; Ádila Liliane Barros Dias; Wuelton Marcelo Monteiro; Vanderson De Souza Sampaio. 2018. "The role of deforestation on American cutaneous leishmaniasis incidence: spatial‐temporal distribution, environmental and socioeconomic factors associated in the Brazilian Amazon." Tropical Medicine & International Health 24, no. 3: 348-355.

Observational study
Published: 17 August 2018 in PLoS ONE
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Acute Kidney Injury (AKI) is the main systemic complication and cause of death in viperid envenomation. Although there are hypotheses for the development of AKI, the mechanisms involved are still not established. The aim of this study was to evaluate the clinical-laboratorial-epidemiological factors associated with AKI in victims of Bothrops sp envenomation. This is an observational study carried out at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado. AKI was defined according to the guidelines of the Acute Kidney Injury Network (AKIN). Among the 186 patients evaluated, AKI was observed in 24 (12.9%) after 48 hours of admission. Stage I was present in 17 (70.8%) patients, II in 3 (12.5%) and III in 4 (16.7%). Epidemiological characterization showed predominance of men, occurrence in rural areas, aged between 16–60 years, feet as the most affected anatomical region, and time to medical assistance less than 3 hours. Hypertension and diabetes were the comorbidities identified. Most of the accidents were classified as moderate, and clinical manifestations included severe pain, mild edema, local bleeding and headache. Laboratory results showed blood uncoagulability, hypofibrinogenemia, leukocytosis, increase of creatine kinase, and high lactate dehydrogenase levels. Multivariate analysis showed an association with high LDH levels [AOR = 1.01 (95% CI = 1.01–1.01, p<0.002)], local bleeding [AOR = 0.13 (95%CI = 0.027–0.59, p<0.009)], and the presence of comorbidities [AOR = 60.96 (95%CI = 9.69–383.30; p<0.000)]. Herein, laboratory markers such as high LDH levels along with local bleeding and comorbidities may aid in the diagnosis of AKI.

ACS Style

Eliane Campos Alves; Jacqueline De Almeida Gonçalves Sachett; Vanderson Sampaio; Jose Diego Brito-Sousa; Sâmella Silva De Oliveira; Elizandra Freitas Do Nascimento; Alessandra Dos Santos Santos; Iran Mendonça Da Silva; Ana Maria Moura-Da-Silva; Fan Hui Wen; Mônica Colombini; Marcus Vinicius Guimarães De Lacerda; Wuelton Marcelo Monteiro; Luiz Carlos De Lima Ferreira. Predicting acute renal failure in Bothrops snakebite patients in a tertiary reference center, Western Brazilian Amazon. PLoS ONE 2018, 13, e0202361 .

AMA Style

Eliane Campos Alves, Jacqueline De Almeida Gonçalves Sachett, Vanderson Sampaio, Jose Diego Brito-Sousa, Sâmella Silva De Oliveira, Elizandra Freitas Do Nascimento, Alessandra Dos Santos Santos, Iran Mendonça Da Silva, Ana Maria Moura-Da-Silva, Fan Hui Wen, Mônica Colombini, Marcus Vinicius Guimarães De Lacerda, Wuelton Marcelo Monteiro, Luiz Carlos De Lima Ferreira. Predicting acute renal failure in Bothrops snakebite patients in a tertiary reference center, Western Brazilian Amazon. PLoS ONE. 2018; 13 (8):e0202361.

Chicago/Turabian Style

Eliane Campos Alves; Jacqueline De Almeida Gonçalves Sachett; Vanderson Sampaio; Jose Diego Brito-Sousa; Sâmella Silva De Oliveira; Elizandra Freitas Do Nascimento; Alessandra Dos Santos Santos; Iran Mendonça Da Silva; Ana Maria Moura-Da-Silva; Fan Hui Wen; Mônica Colombini; Marcus Vinicius Guimarães De Lacerda; Wuelton Marcelo Monteiro; Luiz Carlos De Lima Ferreira. 2018. "Predicting acute renal failure in Bothrops snakebite patients in a tertiary reference center, Western Brazilian Amazon." PLoS ONE 13, no. 8: e0202361.

Preprint
Published: 23 May 2018
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Despite significant and successful efforts in Brazil regarding snakebites in the areas of research, antivenom manufacture and quality control, training of health professionals in the diagnosis and clinical management of bites, little is known about determinants of snakebites incidence in order to further plan interventions to reduce the impact of this medical condition. Understanding the complexity of ecological interactions in a geographical region is important for prediction, prevention and control measures of snakebites. The aim of this investigation is to describe spatial distribution and identify environmental determinants of human- lancehead pit vipers (Bothrops genus) contact resulting in injuries, in the Brazilian Amazon. Aggregated data by municipality was used to analyze the spatial distribution of Bothrops bites cases and its relationship with geographic and environmental factors. Eight geo-environmental factors were included in the analysis as independent variables: (1) tree canopy loss increase; (2) area with vegetation cover; (3) area covered by water bodies; (4) altitude; (5) precipitation; (6) air relative humidity; (7) soil moisture; and (8) air temperature. Human- lancehead pit vipers (Bothrops genus) contact resulting in envenomings in the Amazon region is more incident in lowlands [-0.0006827 (IC95%: −0.0007705; - 0.0005949), pAuthor summaryDespite successful efforts in Brazil regarding snakebites in the areas of research, antivenom manufacture and quality control and training of health professionals, little is known about determinants of snakebites incidence in order to further plan interventions to reduce the impact of this medical condition. Understanding the complexity of ecological interactions in a geographical region is important for prediction, prevention and control measures of snakebites. The aim of this study is to describe spatial distribution and identify environmental determinants of human- lancehead pit vipers (Bothrops genus) contact resulting in injuries, in the Brazilian Amazon. An increase in the forest productivity with a higher availability of some types of prey, such as frogs and amphibians, anurans and lizards, was suggested as a cause for the higher snake abundance in the rainy season. Probably due to the higher forest productivity and abundance of pit vipers in such landscapes, human-lancehead pit vipers contact resulting in envenomings in the Amazon region is more incident in lowlands, with high preserved original vegetation cover, with heaviest rainfall and higher air relative humidity.

ACS Style

João Arthur Alcântara; Paulo Sérgio Bernarde; Jacqueline Sachett; Ageane Mota Da Silva; Samara Freire Valente; Henry Maia Peixoto; Marcus Lacerda; Maria Regina Oliveira; Ivan Saraiva; Vanderson De Souza Sampaio; Wuelton Marcelo Monteiro. Stepping into a dangerous quagmire: environmental determinants of human-lancehead pit vipers (Bothrops genus) contact resulting in injuries, Brazilian Amazon. 2018, 329649 .

AMA Style

João Arthur Alcântara, Paulo Sérgio Bernarde, Jacqueline Sachett, Ageane Mota Da Silva, Samara Freire Valente, Henry Maia Peixoto, Marcus Lacerda, Maria Regina Oliveira, Ivan Saraiva, Vanderson De Souza Sampaio, Wuelton Marcelo Monteiro. Stepping into a dangerous quagmire: environmental determinants of human-lancehead pit vipers (Bothrops genus) contact resulting in injuries, Brazilian Amazon. . 2018; ():329649.

Chicago/Turabian Style

João Arthur Alcântara; Paulo Sérgio Bernarde; Jacqueline Sachett; Ageane Mota Da Silva; Samara Freire Valente; Henry Maia Peixoto; Marcus Lacerda; Maria Regina Oliveira; Ivan Saraiva; Vanderson De Souza Sampaio; Wuelton Marcelo Monteiro. 2018. "Stepping into a dangerous quagmire: environmental determinants of human-lancehead pit vipers (Bothrops genus) contact resulting in injuries, Brazilian Amazon." , no. : 329649.