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Editorial on the Research TopicVenoms and Toxins: At the Crossroads of Basic, Applied and Clinical Immunology Animal venoms are a rich source of biologically active molecules, and represent an important field in toxinology given its medical importance and bioprospecting potential of novel drugs. The studies explore a wide range of areas of knowledge, from animal biology to biomedical and chemical aspects of venom toxins and their biological effects including biochemistry, pathology, molecular biology, pharmacology, and others. In particular, immunology represents an essential field in toxinology, in which basic and clinical research covers four main pillars: pathophysiology, diagnosis, treatment, and drug discovery. In this Research Topic, authors from all over the world present new data or reviews regarding the effects triggered by toxins from a variety of venoms in the immune system, besides presenting new approaches for antivenom development and diagnosis. It is well established that immunological bases of envenomation pathophysiology are possibly one of the most studied topics in toxinology. Ryan et al. presented a review article on the major immunopathological aspects induced by animal venoms. The work consists of a detailed review of the latest efforts in the literature, covering innate and adaptative responses to envenomation as well as the toxin-induced effects on tissue cellular components and leukocyte populations. Among the topics, the authors approached mechanistic aspects of toxins recognition directly or indirectly (via tissue-damaged products) by the immune system and the pathological and protective responses towards venom compounds in order to neutralize the aggressor and symptom resolution. The inflammatory response corresponds to a major issue considering its relevance to local and systemic damage caused by animal venoms, which the investigation of the mechanisms involved corresponds an essential aspect to better understand pathophysiological aspects of envenomation. Caterpillar envenoming is responsible for cutaneous reactions, and among its manifestations, the development of osteochondritis is associated with severe cases of envenoming. In order to better understand the inflammatory mechanism on joints, Villas-Boas et al. evaluated the Premolis semirufa (found in the Amazon forest region) hair extract on human chondrocytes culture. The authors demonstrated that venom extracts were capable of increasing the production of inflammatory mediators such as cytokines, chemokines, eicosanoids, and complement components, as well as matrix metalloproteinases and HMGB1, and reduced the expression of cartilage components aggrecan and type II collagen. Moreover, using transcriptome analysis, the study identified pathways associated with the inflammatory process of joint diseases, such as the inflammatory response, chemotaxis of immune cells, and extracellular matrix remodeling, evidencing an osteoarthritis-like signature. Scorpion stings are responsible for the most cases of envenoming by venomous animals worldwide. Among the main pathological aspects, pain represents an important clinical manifestation in scorpion envenoming, which is associated with the direct action of neurotoxins on ion channels as well as by the inflammatory process induced by the venom. Abreu et al. carried out a pioneering study with the venom of Rhopalurus crassicauda, an endemic species that inhabits exclusively the northernmost state of Brazil. The authors demonstrated that the venom and its isolated β-neurotoxin, Rc1, were capable to modulate the production of inflammatory cytokines and NFκ-B activation by macrophages, besides inducing a nociceptive behavior in mice. Rc1 was also shown to activate the voltage-dependent ion channels Nav1.4, Nav1.6, and BgNav1. The authors also demonstrated that scorpion antivenom used in Brazilian health units were unable to recognize Rhopalurus crassicauda venom and Rc1, indicating the need for different approaches for the treatment of envenomings regarding Rhopalurus crassicauda accidents. Complement activation induced by snake venoms has been widely reported. Silva-de-França et al. investigated the effects of Naja annulifera venom on the complement system and explored its contribution to envenomation pathological aspects. Using in vitro and in vivo assays, the authors found that the venom was capable to induce an inflammatory response, characterized by local and systemic reactions (leukocyte influx, oedema, acute lung injury, and production of inflammatory mediators) in a complement-dependent manner. The research group also indicated the C5a-C5aR1 axis as a possible therapeutical target for Naja annulifera snakebite treatment. The evaluation of circulatory inflammatory mediators in patients has brought important information on the inflammatory behavior of envenomation, guiding the search for novel biomarkers. Gerardo et al. introduce a novel prognostic model by associating inflammatory mediators (obtained pre and post antivenom therapy) and clinical features to functional recovery up to 28 days of patients from Crotalinae snakebite in the United States. The authors discovered biomarkers networks, as well as clinical variables, to predict patient recovery and increase patient prognosis as a strategy to be applied in the clinical management of snakebite. During animal envenomation, much is discussed around the direct effects of inflammation and its association to local tissue damage. However, the inflammatory response is also responsible for interfering in other physiological systems, such as hemostasis known as the inflammation-coagulation crosstalk. The study performed by Wellmann et al. investigated the correlation of circulating inflammatory cytokines and chemokines to fibrinogen levels observed in victims of the lancehead Bothrops atrox snakebite in North Brazil. The authors have found distinguished cytokines/chemokines profile...
Manuela B. Pucca; Bryan G. Fry; Marco A. Sartim; Steve Peigneur; Wuelton M. Monteiro. Editorial: Venoms and Toxins: At the Crossroads of Basic, Applied and Clinical Immunology. Frontiers in Immunology 2021, 12, 1 .
AMA StyleManuela B. Pucca, Bryan G. Fry, Marco A. Sartim, Steve Peigneur, Wuelton M. Monteiro. Editorial: Venoms and Toxins: At the Crossroads of Basic, Applied and Clinical Immunology. Frontiers in Immunology. 2021; 12 ():1.
Chicago/Turabian StyleManuela B. Pucca; Bryan G. Fry; Marco A. Sartim; Steve Peigneur; Wuelton M. Monteiro. 2021. "Editorial: Venoms and Toxins: At the Crossroads of Basic, Applied and Clinical Immunology." Frontiers in Immunology 12, no. : 1.
Background Relapses in vivax malaria have posed great challenges for malaria control, and they also account for a great proportion of reported cases. Knowing the real effectiveness of a 7-day primaquine (PQ) scheme is crucial in order to evaluate not only the cost-effectiveness of implementing new anti-hypnozoite drugs, but also how health education strategies can guarantee better compliance and be reinforced. This study aimed to evaluate the effect of daily treatment with chloroquine and PQ supervised by health workers versus prescription without supervision. Methods The outcome was the passive detection of new positive thick blood smears up to 180 days, based on the official data records from the National Malaria Control Programme. The recurrences seen in the real life were, therefore, used as a surrogate for true relapses. Results Patients under supervised treatment had a lower risk of recurrence up to day 180 when compared to the unsupervised treatment (17.9% vs. 36.1%; p = 0.027). Conclusions The lack of supervision in the non-supervised group (which followed standard of care in the real life) enabled proper comparison, as consent itself would have lead to greater compliance in this group. Future studies should scale such an analysis to different settings in the Brazilian Amazon.
Kelry Mazurega Oliveira Dinelly; Sheila Vitor-Silva; Jose Diego Brito-Sousa; Vanderson Souza Sampaio; Milena Gabriela Oliveira Silva; André Machado Siqueira; Cássio Peterka; Sheila Rodovalho; Aretha Gomes Omena; Wuelton Marcelo Monteiro; Marcus Vinícius Guimarães Lacerda; Gisely Cardoso Melo. Evaluation of the effect of supervised anti-malarial treatment on recurrences of Plasmodium vivax malaria. Malaria Journal 2021, 20, 1 -6.
AMA StyleKelry Mazurega Oliveira Dinelly, Sheila Vitor-Silva, Jose Diego Brito-Sousa, Vanderson Souza Sampaio, Milena Gabriela Oliveira Silva, André Machado Siqueira, Cássio Peterka, Sheila Rodovalho, Aretha Gomes Omena, Wuelton Marcelo Monteiro, Marcus Vinícius Guimarães Lacerda, Gisely Cardoso Melo. Evaluation of the effect of supervised anti-malarial treatment on recurrences of Plasmodium vivax malaria. Malaria Journal. 2021; 20 (1):1-6.
Chicago/Turabian StyleKelry Mazurega Oliveira Dinelly; Sheila Vitor-Silva; Jose Diego Brito-Sousa; Vanderson Souza Sampaio; Milena Gabriela Oliveira Silva; André Machado Siqueira; Cássio Peterka; Sheila Rodovalho; Aretha Gomes Omena; Wuelton Marcelo Monteiro; Marcus Vinícius Guimarães Lacerda; Gisely Cardoso Melo. 2021. "Evaluation of the effect of supervised anti-malarial treatment on recurrences of Plasmodium vivax malaria." Malaria Journal 20, no. 1: 1-6.
Crotalus durissus ruruima is a rattlesnake subspecies mainly found in Roraima, the northernmost state of Brazil. Envenomings caused by this subspecies lead to severe clinical manifestations (e.g. respiratory muscle paralysis, rhabdomyolysis, and acute renal failure) that can lead to the victim’s death. In this review, we comprehensively describe C. d. ruruima biology and the challenges this subspecies poses for human health, including morphology, distribution, epidemiology, venom cocktail, clinical envenoming, and the current and future specific treatment of envenomings by this snake. Moreover, this review presents maps of the distribution of the snake subspecies and evidence that this species is responsible for some of the most severe envenomings in the country and causes the highest lethality rates. Finally, we also discuss the efficacy of the Brazilian horse-derived antivenoms to treat C. d. ruruima envenomings in Roraima state.
Manuela B. Pucca; Paulo Sérgio Bernarde; Anderson Maciel Rocha; Patrik F. Viana; Raimundo Erasmo Souza Farias; Felipe A. Cerni; Isadora S. Oliveira; Isabela G. Ferreira; Eliseu A. Sandri; Jacqueline Sachett; Fan Hui Wen; Vanderson Sampaio; Andreas H. Laustsen; Marco A. Sartim; Wuelton M. Monteiro. Crotalus Durissus Ruruima: Current Knowledge on Natural History, Medical Importance, and Clinical Toxinology. Frontiers in Immunology 2021, 12, 1 .
AMA StyleManuela B. Pucca, Paulo Sérgio Bernarde, Anderson Maciel Rocha, Patrik F. Viana, Raimundo Erasmo Souza Farias, Felipe A. Cerni, Isadora S. Oliveira, Isabela G. Ferreira, Eliseu A. Sandri, Jacqueline Sachett, Fan Hui Wen, Vanderson Sampaio, Andreas H. Laustsen, Marco A. Sartim, Wuelton M. Monteiro. Crotalus Durissus Ruruima: Current Knowledge on Natural History, Medical Importance, and Clinical Toxinology. Frontiers in Immunology. 2021; 12 ():1.
Chicago/Turabian StyleManuela B. Pucca; Paulo Sérgio Bernarde; Anderson Maciel Rocha; Patrik F. Viana; Raimundo Erasmo Souza Farias; Felipe A. Cerni; Isadora S. Oliveira; Isabela G. Ferreira; Eliseu A. Sandri; Jacqueline Sachett; Fan Hui Wen; Vanderson Sampaio; Andreas H. Laustsen; Marco A. Sartim; Wuelton M. Monteiro. 2021. "Crotalus Durissus Ruruima: Current Knowledge on Natural History, Medical Importance, and Clinical Toxinology." Frontiers in Immunology 12, no. : 1.
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.
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 StyleAntonio 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 StyleAntonio 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.
Background Despite recent intensification of control measures, Plasmodium vivax poses a major challenge for malaria elimination efforts. Liver-stage hypnozoite parasites that cause relapsing infections can be cleared with primaquine; however, poor treatment adherence undermines drug effectiveness. Tafenoquine, a new single-dose treatment, offers an alternative option for preventing relapses and reducing transmission. In 2018, over 237,000 cases of malaria were reported to the Brazilian health system, of which 91.5% were due to P. vivax. Methods and findings We evaluated the impact of introducing tafenoquine into case management practices on population-level transmission dynamics using a mathematical model of P. vivax transmission. The model was calibrated to reflect the transmission dynamics of P. vivax endemic settings in Brazil in 2018, informed by nationwide malaria case reporting data. Parameters for treatment pathways with chloroquine, primaquine, and tafenoquine with glucose-6-phosphate dehydrogenase deficiency (G6PDd) testing were informed by clinical trial data and the literature. We assumed 71.3% efficacy for primaquine and tafenoquine, a 66.7% adherence rate to the 7-day primaquine regimen, a mean 5.5% G6PDd prevalence, and 8.1% low metaboliser prevalence. The introduction of tafenoquine is predicted to improve effective hypnozoite clearance among P. vivax cases and reduce population-level transmission over time, with heterogeneous levels of impact across different transmission settings. According to the model, while achieving elimination in only few settings in Brazil, tafenoquine rollout in 2021 is estimated to improve the mean effective radical cure rate from 42% (95% uncertainty interval [UI] 41%–44%) to 62% (95% UI 54%–68%) among clinical cases, leading to a predicted 38% (95% UI 7%–99%) reduction in transmission and over 214,000 cumulative averted cases between 2021 and 2025. Higher impact is predicted in settings with low transmission, low pre-existing primaquine adherence, and a high proportion of cases in working-aged males. High-transmission settings with a high proportion of cases in children would benefit from a safe high-efficacy tafenoquine dose for children. Our methodological limitations include not accounting for the role of imported cases from outside the transmission setting, relying on reported clinical cases as a measurement of community-level transmission, and implementing treatment efficacy as a binary condition. Conclusions In our modelling study, we predicted that, provided there is concurrent rollout of G6PDd diagnostics, tafenoquine has the potential to reduce P. vivax transmission by improving effective radical cure through increased adherence and increased protection from new infections. While tafenoquine alone may not be sufficient for P. vivax elimination, its introduction will improve case management, prevent a substantial number of cases, and bring countries closer to achieving malaria elimination goals.
Narimane Nekkab; Raquel Lana; Marcus Lacerda; Thomas Obadia; André Siqueira; Wuelton Monteiro; Daniel Villela; Ivo Mueller; Michael White. Estimated impact of tafenoquine for Plasmodium vivax control and elimination in Brazil: A modelling study. PLOS Medicine 2021, 18, e1003535 .
AMA StyleNarimane Nekkab, Raquel Lana, Marcus Lacerda, Thomas Obadia, André Siqueira, Wuelton Monteiro, Daniel Villela, Ivo Mueller, Michael White. Estimated impact of tafenoquine for Plasmodium vivax control and elimination in Brazil: A modelling study. PLOS Medicine. 2021; 18 (4):e1003535.
Chicago/Turabian StyleNarimane Nekkab; Raquel Lana; Marcus Lacerda; Thomas Obadia; André Siqueira; Wuelton Monteiro; Daniel Villela; Ivo Mueller; Michael White. 2021. "Estimated impact of tafenoquine for Plasmodium vivax control and elimination in Brazil: A modelling study." PLOS Medicine 18, no. 4: e1003535.
Background Vivax malaria diagnosis remains a challenge in malaria elimination, with current point of care rapid diagnostic tests (RDT) missing many clinically significant infections because of usually lower peripheral parasitaemia. Haemozoin-detecting assays have been suggested as an alternative to immunoassay platforms but to date have not reached successful field deployment. Haemozoin is a paramagnetic crystal by-product of haemoglobin digestion by malaria parasites and is present in the food vacuole of malaria parasite-infected erythrocytes. This study aimed to compare the diagnostic capability of a new haemozoin-detecting platform, the Gazelle™ device with optical microscopy, RDT and PCR in a vivax malaria-endemic region. Methods A comparative, double-blind study evaluating symptomatic malaria patients seeking medical care was conducted at an infectious diseases reference hospital in the western Brazilian Amazon. Optical microscopy, PCR, RDT, and Gazelle™ were used to analyse blood samples. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Kappa values were calculated. Results Out of 300 patients, 24 test results were excluded from the final analysis due to protocol violation (6) and inconclusive and/or irretrievable results (18). Gazelle™ sensitivity was 96.1 % (91.3–98.3) and 72.1 % (65.0–78.3) when compared to optical microscopy and PCR, respectively whereas it was 83.9 % and 62.8 % for RDTs. The platform presented specificity of 100 % (97.4–100), and 99.0 % (94.8–99.9) when compared to optical microscopy, and PCR, respectively, which was the same for RDTs. Its correct classification rate was 98.2 % when compared to optical microscopy and 82.3 % for PCR; the test’s accuracy when compared to optical microscopy was 98.1 % (96.4–99.7), when compared to RDT was 95.2 % (93.0–97.5), and when compared to PCR was 85.6 % (82.1–89.1). Kappa (95 % CI) values for Gazelle™ were 96.4 (93.2–99.5), 88.2 (82.6–93.8) and 65.3 (57.0–73.6) for optical microscopy, RDT and PCR, respectively. Conclusions The Gazelle™ device was shown to have faster, easier, good sensitivity, specificity, and accuracy when compared to microscopy and was superior to RDT, demonstrating to be an alternative for vivax malaria screening particularly in areas where malaria is concomitant with other febrile infections (including dengue fever, zika, chikungunya, Chagas, yellow fever, babesiosis).
Gisely Cardoso de Melo; Rebeca Linhares Abreu Netto; Victor Irungu Mwangi; Yanka Evellyn Alves Rodrigues Salazar; Vanderson De Souza Sampaio; Wuelton Marcelo Monteiro; Fernando Fonseca De Almeida E Val; Anne Rocheleau; Priyaleela Thota; Marcus Vinícius Guimarães Lacerda. Performance of a sensitive haemozoin‐based malaria diagnostic test validated for vivax malaria diagnosis in Brazilian Amazon. Malaria Journal 2021, 20, 1 -10.
AMA StyleGisely Cardoso de Melo, Rebeca Linhares Abreu Netto, Victor Irungu Mwangi, Yanka Evellyn Alves Rodrigues Salazar, Vanderson De Souza Sampaio, Wuelton Marcelo Monteiro, Fernando Fonseca De Almeida E Val, Anne Rocheleau, Priyaleela Thota, Marcus Vinícius Guimarães Lacerda. Performance of a sensitive haemozoin‐based malaria diagnostic test validated for vivax malaria diagnosis in Brazilian Amazon. Malaria Journal. 2021; 20 (1):1-10.
Chicago/Turabian StyleGisely Cardoso de Melo; Rebeca Linhares Abreu Netto; Victor Irungu Mwangi; Yanka Evellyn Alves Rodrigues Salazar; Vanderson De Souza Sampaio; Wuelton Marcelo Monteiro; Fernando Fonseca De Almeida E Val; Anne Rocheleau; Priyaleela Thota; Marcus Vinícius Guimarães Lacerda. 2021. "Performance of a sensitive haemozoin‐based malaria diagnostic test validated for vivax malaria diagnosis in Brazilian Amazon." Malaria Journal 20, no. 1: 1-10.
Access to antivenoms is not guarranteed for vulnerable populations that inhabit remote areas in the Amazon. The study of therapeutic itineraries (TI) for treatment of snakebites would support strategies to provide timely access to users. A TI is the set of processes by which individuals adhere to certain forms of treatment, and includes the path traveled in the search for healthcare, and practices to solve their health problems. This study aims to describe TIs of snakebite patients in the Brazilian Amazon. This study was carried out at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, state of Amazonas, Brazil. The itinerary from the moment of the bite to the patient’s admission to the reference unit was analyzed. Sample size was defined by saturation. After an exploratory survey to collect epidemiological variables, in-depth interviews were conducted following a semi-structured guide. Patients originated from rural areas of 11 different municipalities, including ones located >500 kilometers from Manaus. A great fragmentation was observed in the itineraries, marked by several changes of means of transport along the route. Four themes emerged from the analysis: exposure to snakebite during day-to-day activities, use of traditional therapeutic practices, and personal perception of the severity, as well as the route taken and its contingencies. Access to healthcare requires considerable effort on the part of snakebite patients. Major barriers were identified, such as the low number of hospitals that offer antivenom treatment, poor access to healthcare due to long distances and geographic barriers, low acceptability of healthcare offered in countryside, lack of use of personal protective equipment, common use of ineffective or deleterious self-care practices, late recognition of serious clinical signs and resistance to seeking medical assistance. Health education, promotion of immediate transport to health centers and decentralization of antivenom from reference hospitals to community healthcare centers in the Brazilian Amazon are more effective strategies that would to maximize access to antivenom treatment.
Joseir Saturnino Cristino; Guilherme Maciel Salazar; Vinícius Azevedo Machado; Eduardo Honorato; Altair Seabra Farias; João Ricardo Nickenig Vissoci; Alexandre Vilhena Silva Neto; Marcus Lacerda; Fan Hui Wen; Wuelton Marcelo Monteiro; Jacqueline Almeida Gonçalves Sachett. A painful journey to antivenom: The therapeutic itinerary of snakebite patients in the Brazilian Amazon (The QUALISnake Study). PLOS Neglected Tropical Diseases 2021, 15, e0009245 .
AMA StyleJoseir Saturnino Cristino, Guilherme Maciel Salazar, Vinícius Azevedo Machado, Eduardo Honorato, Altair Seabra Farias, João Ricardo Nickenig Vissoci, Alexandre Vilhena Silva Neto, Marcus Lacerda, Fan Hui Wen, Wuelton Marcelo Monteiro, Jacqueline Almeida Gonçalves Sachett. A painful journey to antivenom: The therapeutic itinerary of snakebite patients in the Brazilian Amazon (The QUALISnake Study). PLOS Neglected Tropical Diseases. 2021; 15 (3):e0009245.
Chicago/Turabian StyleJoseir Saturnino Cristino; Guilherme Maciel Salazar; Vinícius Azevedo Machado; Eduardo Honorato; Altair Seabra Farias; João Ricardo Nickenig Vissoci; Alexandre Vilhena Silva Neto; Marcus Lacerda; Fan Hui Wen; Wuelton Marcelo Monteiro; Jacqueline Almeida Gonçalves Sachett. 2021. "A painful journey to antivenom: The therapeutic itinerary of snakebite patients in the Brazilian Amazon (The QUALISnake Study)." PLOS Neglected Tropical Diseases 15, no. 3: e0009245.
BackgroundRelapses in vivax malaria have posed great challenges to malaria control, accounting for a great proportion of reported cases. Knowing the real effectiveness of 7 day primaquine (PQ) scheme is crucial to understand not only the cost-effectiveness of implementing new anti-hypnozoite drugs but how health education strategies can guarantee better compliance and be reinforced. This study aimed the evaluation of the daily supervised treatment effect with chloroquine and PQ (in consented patients) versus prescription without supervision (non-consented patients), and the outcome was the passive detection of new positive thick blood smears until 180 days, based on the official data records from the National Malaria Control Program. The recurrences seen in the real life were therefore used as a surrogate for true relapses. Patients under supervised treatment had a lower risk of recurrence until day 180 when compared to the unsupervised treatment (17.9% vs 36.1%; p=0.027). The lack of consent in the non-supervised group (which followed standard of care in the real life) enabled proper comparison, as consent itself could lead to better compliance in this group. Future studies should scale such analysis to different settings in the Brazilian Amazon.
Kelry Mazurega Oliveira Dinelly; Sheila Vitor-Silva; Jose Diego Brito-Sousa; Vanderson Souza Sampaio; Milena Gabriela Oliveira Silva; André Machado Siqueira; Cássio Peterka; Sheila Rodovalho; Aretha Gomes Omena; Wuelton Marcelo Monteiro; Marcus Vinicius Guimaraes De Lacerda; Gisely Melo. Evaluation of the Effect of Supervised Antimalarial Treatment on P. Vivax Malaria Recurrences. 2021, 1 .
AMA StyleKelry Mazurega Oliveira Dinelly, Sheila Vitor-Silva, Jose Diego Brito-Sousa, Vanderson Souza Sampaio, Milena Gabriela Oliveira Silva, André Machado Siqueira, Cássio Peterka, Sheila Rodovalho, Aretha Gomes Omena, Wuelton Marcelo Monteiro, Marcus Vinicius Guimaraes De Lacerda, Gisely Melo. Evaluation of the Effect of Supervised Antimalarial Treatment on P. Vivax Malaria Recurrences. . 2021; ():1.
Chicago/Turabian StyleKelry Mazurega Oliveira Dinelly; Sheila Vitor-Silva; Jose Diego Brito-Sousa; Vanderson Souza Sampaio; Milena Gabriela Oliveira Silva; André Machado Siqueira; Cássio Peterka; Sheila Rodovalho; Aretha Gomes Omena; Wuelton Marcelo Monteiro; Marcus Vinicius Guimaraes De Lacerda; Gisely Melo. 2021. "Evaluation of the Effect of Supervised Antimalarial Treatment on P. Vivax Malaria Recurrences." , no. : 1.
The efficacy of 20-minute whole blood clotting (WBCT20) and the Lee-White clotting time (LWCT) tests in diagnosing coagulation alterations from snakebites were compared. We evaluated 89 snakebite cases treated at the Hospital Regional do Juruá em Cruzeiro do Sul, Acre, Brazil. WBCT20 results were normal in 33.7% and unclottable in 66.3% of cases, while LWCT results were normal in 23.6% and altered (prolonged or unclottable) in 76.4% of cases, with no significant differences. The WBCT20 is important for rapidly diagnosing coagulation alterations from snakebites. Furthermore, it is efficient, inexpensive, and can be deployed in isolated hospitals.
Tamires Nascimento da Costa; Ageane Mota da Silva; Rodrigo Medeiros de Souza; Wuelton Marcelo Monteiro; Paulo Sérgio Bernarde. Efficacy of the 20-minute whole blood clotting test (WBCT20) in the diagnosis of coagulation alteration related to snakebites in a Western Brazilian Amazon hospital. Revista da Sociedade Brasileira de Medicina Tropical 2021, 54, e00912021 .
AMA StyleTamires Nascimento da Costa, Ageane Mota da Silva, Rodrigo Medeiros de Souza, Wuelton Marcelo Monteiro, Paulo Sérgio Bernarde. Efficacy of the 20-minute whole blood clotting test (WBCT20) in the diagnosis of coagulation alteration related to snakebites in a Western Brazilian Amazon hospital. Revista da Sociedade Brasileira de Medicina Tropical. 2021; 54 ():e00912021.
Chicago/Turabian StyleTamires Nascimento da Costa; Ageane Mota da Silva; Rodrigo Medeiros de Souza; Wuelton Marcelo Monteiro; Paulo Sérgio Bernarde. 2021. "Efficacy of the 20-minute whole blood clotting test (WBCT20) in the diagnosis of coagulation alteration related to snakebites in a Western Brazilian Amazon hospital." Revista da Sociedade Brasileira de Medicina Tropical 54, no. : e00912021.
Bee venom is a natural toxin composed of several peptides. Massive envenoming causes severe local and systemic reactions. We report two cases of severe bee envenomation, of which one was fatal. We also describe clinical characteristics and immune markers. Both victims suffered from respiratory distress, renal failure, rhabdomyolysis, and shock. They required invasive mechanical ventilation, vasoactive drugs, and renal replacement therapy. Moreover, serum levels of chemokines, cytokines, and cell-free circulating nucleic acids demonstrated an intense inflammatory process. Massive envenoming produced systemic injury in the victims, with an uncontrolled inflammatory response, and a more significant chemotactic response in the fatal case.
Iran Mendonça-Da-Silva; Wuelton Marcelo Monteiro; Jacqueline Almeida Gonçalves Sachett; Endila Souza Barbosa; Marcelo Cordeiro-Dos-Santos; Marcus Vinícius Guimarães Lacerda; Gisely Cardoso Melo; Allyson Guimarães Costa; Fernando Fonseca Almeida Val. Bee sting envenomation severe cases in Manaus, Brazilian Amazon: clinical characteristics and immune markers of case reports. Revista da Sociedade Brasileira de Medicina Tropical 2021, 54, e20200319 .
AMA StyleIran Mendonça-Da-Silva, Wuelton Marcelo Monteiro, Jacqueline Almeida Gonçalves Sachett, Endila Souza Barbosa, Marcelo Cordeiro-Dos-Santos, Marcus Vinícius Guimarães Lacerda, Gisely Cardoso Melo, Allyson Guimarães Costa, Fernando Fonseca Almeida Val. Bee sting envenomation severe cases in Manaus, Brazilian Amazon: clinical characteristics and immune markers of case reports. Revista da Sociedade Brasileira de Medicina Tropical. 2021; 54 ():e20200319.
Chicago/Turabian StyleIran Mendonça-Da-Silva; Wuelton Marcelo Monteiro; Jacqueline Almeida Gonçalves Sachett; Endila Souza Barbosa; Marcelo Cordeiro-Dos-Santos; Marcus Vinícius Guimarães Lacerda; Gisely Cardoso Melo; Allyson Guimarães Costa; Fernando Fonseca Almeida Val. 2021. "Bee sting envenomation severe cases in Manaus, Brazilian Amazon: clinical characteristics and immune markers of case reports." Revista da Sociedade Brasileira de Medicina Tropical 54, no. : e20200319.
Electron microscopy (EM) is a rapid and effective tool that can be used to create images of a whole spectrum of virus-host interactions and, as such, has long been used in the discovery and description of viral mechanisms. Electron microscopy was used to evaluate the pulmonary pathologies of postmortem lung sections from three patients who died from infection with SARS-associated coronavirus 2 (SARS-CoV-2), a new member of the Coronaviridae family. Diffuse alveolar damage (DAD) was predominant in all three patients. The early exudative stage was characterized principally by edema and extravasation of red blood cells into the alveolar space with injury to the alveolar epithelial cells; this was followed by detachment, apoptosis, and necrosis of type I and II pneumocytes. The capillaries exhibited congestion, exposure of the basement membrane from denuded endothelial cells, platelet adhesion, fibrin thrombi, and rupture of the capillary walls. The proliferative stage was characterized by pronounced proliferation of type II alveolar pneumocytes and multinucleated giant cells. The cytopathic effect of SARS-CoV-2 was observed both in degenerated type II pneumocytes and freely circulating in the alveoli, with components from virions, macrophages, lymphocytes, and cellular debris. Viral particles consistent with the characteristics of SARS-CoV-2 were observed mainly in degenerated pneumocytes, in the endothelium, or freely circulating in the alveoli. In the final stage of illness, the alveolar spaces were replaced by fibrosis.
Monique Freire Santana; Rebecca Augusta de Araújo Pinto; Bruna Hilzendeger Marcon; Lia Carolina Almeida Soares de Medeiros; Thiago Barros Do Nascimento de Morais; Lucas Castanhola Dias; Lorenna Pereira de Souza; Gisely Cardoso de Melo; Wuelton Marcelo Monteiro; Marcus Vinicius Guimarães Lacerda; Fernando Almeida Val; Pritesh Jaychand Lalwani; Luiz Carlos De Lima Ferreira. Pathological findings and morphologic correlation of the lungs of autopsied patients with SARS-CoV-2 infection in the Brazilian Amazon using transmission electron microscopy. Revista da Sociedade Brasileira de Medicina Tropical 2021, 54, e0850 .
AMA StyleMonique Freire Santana, Rebecca Augusta de Araújo Pinto, Bruna Hilzendeger Marcon, Lia Carolina Almeida Soares de Medeiros, Thiago Barros Do Nascimento de Morais, Lucas Castanhola Dias, Lorenna Pereira de Souza, Gisely Cardoso de Melo, Wuelton Marcelo Monteiro, Marcus Vinicius Guimarães Lacerda, Fernando Almeida Val, Pritesh Jaychand Lalwani, Luiz Carlos De Lima Ferreira. Pathological findings and morphologic correlation of the lungs of autopsied patients with SARS-CoV-2 infection in the Brazilian Amazon using transmission electron microscopy. Revista da Sociedade Brasileira de Medicina Tropical. 2021; 54 ():e0850.
Chicago/Turabian StyleMonique Freire Santana; Rebecca Augusta de Araújo Pinto; Bruna Hilzendeger Marcon; Lia Carolina Almeida Soares de Medeiros; Thiago Barros Do Nascimento de Morais; Lucas Castanhola Dias; Lorenna Pereira de Souza; Gisely Cardoso de Melo; Wuelton Marcelo Monteiro; Marcus Vinicius Guimarães Lacerda; Fernando Almeida Val; Pritesh Jaychand Lalwani; Luiz Carlos De Lima Ferreira. 2021. "Pathological findings and morphologic correlation of the lungs of autopsied patients with SARS-CoV-2 infection in the Brazilian Amazon using transmission electron microscopy." Revista da Sociedade Brasileira de Medicina Tropical 54, no. : e0850.
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.
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 StyleWuelton 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 StyleWuelton 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.
CrypticPlasmodiumniches outside the liver possibly represent a major source of hypnozoite-unrelated recrudescences in malaria. Maurizio Ascoli, an Italian physician and scientist, suggested that infection was maintained as a result of the persistence of endoerythrocytic parasites in the circulatory bed of some internal organs, mainly the spleen. This would explain a proportion of the recurrences in patients, regardless of thePlasmodiumspecies. Ascoli proposed a method that included the co-administration of adrenaline, in order to induce splenic contraction, and quinine to clear expelled forms in major vessels. Driven by controversy regarding safety and effectiveness, along with the introduction of new drugs, the Ascoli method was abandoned and mostly forgotten by the malaria research community. To date, however, the existence of cryptic parasites outside the liver is gaining supportive data. This work is a historical retrospective of cryptic malaria infections and the Ascoli method, highlighting key knowledge gaps regarding these possible parasite reservoirs.
Wuelton Monteiro; José Diego Brito-Sousa; Aleix Elizalde-Torrent; Camila Bôtto-Menezes; Gisely Cardoso Melo; Carmen Fernandez-Becerra; Marcus Lacerda; Hernando A. Del Portillo. Cryptic Plasmodium chronic infections: was Maurizio Ascoli right? Malaria Journal 2020, 19, 1 -9.
AMA StyleWuelton Monteiro, José Diego Brito-Sousa, Aleix Elizalde-Torrent, Camila Bôtto-Menezes, Gisely Cardoso Melo, Carmen Fernandez-Becerra, Marcus Lacerda, Hernando A. Del Portillo. Cryptic Plasmodium chronic infections: was Maurizio Ascoli right? Malaria Journal. 2020; 19 (1):1-9.
Chicago/Turabian StyleWuelton Monteiro; José Diego Brito-Sousa; Aleix Elizalde-Torrent; Camila Bôtto-Menezes; Gisely Cardoso Melo; Carmen Fernandez-Becerra; Marcus Lacerda; Hernando A. Del Portillo. 2020. "Cryptic Plasmodium chronic infections: was Maurizio Ascoli right?" Malaria Journal 19, no. 1: 1-9.
Snake ‘dry bites’ are characterized by the absence of venom being injected into the victim during a snakebite incident. The dry bite mechanism and diagnosis are quite complex, and the lack of envenoming symptoms in these cases may be misinterpreted as a miraculous treatment or as proof that the bite from the perpetrating snake species is rather harmless. The circumstances of dry bites and their clinical diagnosis are not well-explored in the literature, which may lead to ambiguity amongst treating personnel about whether antivenom is indicated or not. Here, the epidemiology and recorded history of dry bites are reviewed, and the clinical knowledge on the dry bite phenomenon is presented and discussed. Finally, this review proposes a diagnostic and therapeutic protocol to assist medical care after snake dry bites, aiming to improve patient outcomes.
Manuela B. Pucca; Cecilie Knudsen; Isadora S. Oliveira; Charlotte Rimbault; Felipe A. Cerni; Fan Hui Wen; Jacqueline Sachett; Marco A. Sartim; Andreas H. Laustsen; Wuelton M. Monteiro. Current Knowledge on Snake Dry Bites. Toxins 2020, 12, 668 .
AMA StyleManuela B. Pucca, Cecilie Knudsen, Isadora S. Oliveira, Charlotte Rimbault, Felipe A. Cerni, Fan Hui Wen, Jacqueline Sachett, Marco A. Sartim, Andreas H. Laustsen, Wuelton M. Monteiro. Current Knowledge on Snake Dry Bites. Toxins. 2020; 12 (11):668.
Chicago/Turabian StyleManuela B. Pucca; Cecilie Knudsen; Isadora S. Oliveira; Charlotte Rimbault; Felipe A. Cerni; Fan Hui Wen; Jacqueline Sachett; Marco A. Sartim; Andreas H. Laustsen; Wuelton M. Monteiro. 2020. "Current Knowledge on Snake Dry Bites." Toxins 12, no. 11: 668.
BackgroundIn 2017, the World Health Organization declared the snakebite envenomation as a neglected tropical disease. Annually, snakebite envenomation causes approximately 400,000 permanent disabilities and 95,000 deaths worldwide. People with the greatest risk of envenomation lack access to adequate health care, including treatment with antivenom. We developed an analysis of accessibility to antivenom in Brazil in order to verify the impacts on mortality.Methods and FindingsInformation about number of accidents, deaths, antivenom, medical assistance, and species, were retrieved from the Brazilian Health Informatics Department (DATASUS) from 2010 to 2015 and analyzed using geostatistics to evaluate the association between snakebite accidents and mortality. An Spatial analysis using Global Moran’s I was performed in order to verify the presence of spatiality as an independent variable to the distribution of the accidents. In addition, we also tested three different analysis of regression using Ordinary Least Square (OLS), Spatial Error, and Geographically Weighed Regression (GWR), together with the information obtained from the DATASUS and sociodemographic indicators, to verify the spatial-temporal distribution of envenomation cases and time to reach the healthcare centers. The regression presenting the lowest Akaike Criterion Information (AIC), highest adjusted R2, and variables with p < 0.05 was selected to represent our model. Lastly, the accessibility index was performed using 2-step floating catchment area based on the amount of hospital beds and inhabitants. This study revealed 141,039 cases of snakebites, 598 deaths, and mortality rate of 3.13 per 1,000,000 inhabitants. Moreover, GWR presented the best fit (AIC = 55477.56; adjusted R2 = 0.55) and showed that illiteracy, income, percentage of urban population, percentage of antivenom, accessibility index for hospital beds with antivenom, proportion of cases with more than 3 hours to reach healthcare are correlated with the mortality rate by snakebite (p < 0.05).ConclusionThis study identified regions affected by snakebite and how the accessibility to antivenom treatment plays an important role in the mortality in Brazil. Public interventions can located to those most vulnerable regions in order to improve the accident outcome.
Jinny Jing Ye; João Felipe Hermann Costa Scheidt; Luciano De Andrade; Thiago Augusto Hernandes Rocha; Hui Wen Fan; Wuelton Monteiro; Ricardo Palacios; Catherine Ann Staton; João Ricardo Nickenig Vissoci; Charles John Gerardo. Antivenom accessibility impacts mortality and severity of Brazilian snake envenomation: a geospatial information systems analysis. 2020, 1 .
AMA StyleJinny Jing Ye, João Felipe Hermann Costa Scheidt, Luciano De Andrade, Thiago Augusto Hernandes Rocha, Hui Wen Fan, Wuelton Monteiro, Ricardo Palacios, Catherine Ann Staton, João Ricardo Nickenig Vissoci, Charles John Gerardo. Antivenom accessibility impacts mortality and severity of Brazilian snake envenomation: a geospatial information systems analysis. . 2020; ():1.
Chicago/Turabian StyleJinny Jing Ye; João Felipe Hermann Costa Scheidt; Luciano De Andrade; Thiago Augusto Hernandes Rocha; Hui Wen Fan; Wuelton Monteiro; Ricardo Palacios; Catherine Ann Staton; João Ricardo Nickenig Vissoci; Charles John Gerardo. 2020. "Antivenom accessibility impacts mortality and severity of Brazilian snake envenomation: a geospatial information systems analysis." , no. : 1.
Although high mortality has been reported in many COVID-19 studies, very limited postmortem information from complete autopsies is available. We report the findings in the adrenal glands in 28 autopsies with confirmed SARS-CoV-2 infection. Microscopic lesions were identified in the adrenal glands in 12/28 patients (46%). Seven cases showed necrosis, generally ischemic; four showed cortical lipid degeneration; two showed hemorrhage; and one unspecific focal adrenalitis. Vascular thrombosis in one patient and focal inflammation in association with other findings in three patients were observed. No case presented adrenal insufficiency. In conclusion, adrenal lesions are frequent in patients with severe COVID-19. The lesions are mild but could contribute to the lethal outcome.
Monique Freire Santana; Mayla Gabriela Silva Borba; Djane Clarys Baía-Da-Silva; Fernando Val; Márcia Almeida Araújo Alexandre; Jose Diego Brito-Sousa; Gisely Cardoso Melo; Marcos Vinícius Oliveira Queiroga; Maria Eduarda Leão Farias; Cecília Cunha Camilo; Felipe Gomes Naveca; Mariana Simão Xavier; Wuelton Marcelo Monteiro; Guilherme Augusto Pivoto João; Ludhmila Abrahão Hajjar; Jaume Ordi; Marcus Vinícius Guimarães Lacerda; Luiz Carlos Lima Ferreira. Case Report: Adrenal Pathology Findings in Severe COVID-19: An Autopsy Study. The American Journal of Tropical Medicine and Hygiene 2020, 103, 1604 -1607.
AMA StyleMonique Freire Santana, Mayla Gabriela Silva Borba, Djane Clarys Baía-Da-Silva, Fernando Val, Márcia Almeida Araújo Alexandre, Jose Diego Brito-Sousa, Gisely Cardoso Melo, Marcos Vinícius Oliveira Queiroga, Maria Eduarda Leão Farias, Cecília Cunha Camilo, Felipe Gomes Naveca, Mariana Simão Xavier, Wuelton Marcelo Monteiro, Guilherme Augusto Pivoto João, Ludhmila Abrahão Hajjar, Jaume Ordi, Marcus Vinícius Guimarães Lacerda, Luiz Carlos Lima Ferreira. Case Report: Adrenal Pathology Findings in Severe COVID-19: An Autopsy Study. The American Journal of Tropical Medicine and Hygiene. 2020; 103 (4):1604-1607.
Chicago/Turabian StyleMonique Freire Santana; Mayla Gabriela Silva Borba; Djane Clarys Baía-Da-Silva; Fernando Val; Márcia Almeida Araújo Alexandre; Jose Diego Brito-Sousa; Gisely Cardoso Melo; Marcos Vinícius Oliveira Queiroga; Maria Eduarda Leão Farias; Cecília Cunha Camilo; Felipe Gomes Naveca; Mariana Simão Xavier; Wuelton Marcelo Monteiro; Guilherme Augusto Pivoto João; Ludhmila Abrahão Hajjar; Jaume Ordi; Marcus Vinícius Guimarães Lacerda; Luiz Carlos Lima Ferreira. 2020. "Case Report: Adrenal Pathology Findings in Severe COVID-19: An Autopsy Study." The American Journal of Tropical Medicine and Hygiene 103, no. 4: 1604-1607.
Scorpion envenomations are a major public health problem in Brazil, and most medically important cases are attributable to the Tityus genus. The objective of this study is to describe the clinical and epidemiological aspects of a series of 151 cases of confirmed scorpion stings, which were treated at the hospitals of two cities in the Western Brazilian Amazon, between June 2014 and December 2019. This study shows that the genus Tityus was the most prevalent. Tityus (Atreus) metuendus (Pocock, 1897) was responsible for the greatest number of cases (68.2%), followed by Tityus (Archaeotityus) silvestris (Pocock, 1897) (14.6%). Most of the envenomations involved males (53.6%), and analysis showed a slight predominance in the group from 40 to 49 years (22.5%). The most affected body regions were feet (49.0%) and hands (31.8%). The time elapsed between the accident and medical care was ≤6 h in 92.1% of cases. Regarding clinical severity, classes I (80.8%) and II (15.9%) predominated. However, there were five (3.3%) class III cases; four for T. metuendus and one for T. silvestris. The most frequent local and systemic manifestations were, respectively, pain (84.1%), paresthesia (34.4%) and mild edema (25.8%), and nausea (9.3%) and myoclonia (8.6%). The clinical manifestations were similar among the patients stung by the different species of scorpions. There were no differences between the manifestations of envenomation caused by T. metuendus, T. silvestris and T. raquelae. For victims of T. apiacas, a higher frequency of piloerection and myoclonia was observed, and was described by the affected patients as a ‘sensation of receiving an electric shock’ throughout the body. No deaths were registered. The species of greatest epidemiological importance in Manaus is T. metuendus, a species that leads to clinical pictures that do not differ substantially from those observed in other Brazilian regions. T. apiacas causes neurological manifestations that differed from other Tityus species. Our findings suggest that the available antivenoms have little effectiveness when used in the treatment of envenomations by some Amazonian scorpions.
Jacimara Vasques Gomes; Nelson Ferreira Fé; Hildegard Loren Rebouças Santos; Bruna Jung; Pedro Ferreira Bisneto; André Sachett; Valéria Mourão de Moura; Iran Mendonça da Silva; Gisely Cardoso de Melo; Pedro Pereira De Oliveira Pardal; Marcus Lacerda; Vanderson Sampaio; Fan Hui Wen; Jacqueline De Almeida Gonçalves Sachett; Wuelton M. Monteiro. Clinical profile of confirmed scorpion stings in a referral center in Manaus, Western Brazilian Amazon. Toxicon 2020, 187, 245 -254.
AMA StyleJacimara Vasques Gomes, Nelson Ferreira Fé, Hildegard Loren Rebouças Santos, Bruna Jung, Pedro Ferreira Bisneto, André Sachett, Valéria Mourão de Moura, Iran Mendonça da Silva, Gisely Cardoso de Melo, Pedro Pereira De Oliveira Pardal, Marcus Lacerda, Vanderson Sampaio, Fan Hui Wen, Jacqueline De Almeida Gonçalves Sachett, Wuelton M. Monteiro. Clinical profile of confirmed scorpion stings in a referral center in Manaus, Western Brazilian Amazon. Toxicon. 2020; 187 ():245-254.
Chicago/Turabian StyleJacimara Vasques Gomes; Nelson Ferreira Fé; Hildegard Loren Rebouças Santos; Bruna Jung; Pedro Ferreira Bisneto; André Sachett; Valéria Mourão de Moura; Iran Mendonça da Silva; Gisely Cardoso de Melo; Pedro Pereira De Oliveira Pardal; Marcus Lacerda; Vanderson Sampaio; Fan Hui Wen; Jacqueline De Almeida Gonçalves Sachett; Wuelton M. Monteiro. 2020. "Clinical profile of confirmed scorpion stings in a referral center in Manaus, Western Brazilian Amazon." Toxicon 187, no. : 245-254.
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.
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 StyleCathrine 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 StyleCathrine 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.
Bleeding is a common hemostatic disorder that occurs in Bothrops envenomations. We evaluated the changes in coagulation, fibrinolysis components, and platelets in Bothrops atrox envenomations with bleeding. This is an observational study with B. atrox snakebite patients (n = 100) treated in Manaus, Brazilian Amazon. Bleeding was recorded on admission and during hospitalization. We found that the platelet count in our patients presented a weak correlation to tissue factor, factor II, and plasminogen. Tissue factor presented weak correlation to factor V, II, D-dimer, plasminogen, alpha 2-antiplasmin, and moderate correlation to fibrinogen and fibrin/fibrinogen degradation product (FDP). Patients with systemic bleeding (n = 20) presented low levels of factor V, II, fibrinogen, plasminogen, and alpha 2-antiplasmin, and high levels of tissue factor and FDP compared to those without bleeding. Patients with only local bleeding (n = 41) and without bleeding showed similar levels of hemostatic factors. Thrombocytopenia was observed mainly in patients with systemic bleeding and increased levels of serum venom. No association was found between venom levels and systemic bleeding, or between venom levels and clinical severity of envenomation. This is the first report that shows the participation of the extrinsic coagulation pathway in the consumption coagulopathy of B. atrox envenomations with systemic bleeding due to tissue factor release.
Sâmella S. Oliveira; Eliane C. Alves; Alessandra S. Santos; Elizandra F. Nascimento; João T. Pereira; Iran M. Silva; Jacqueline A. G. Sachett; Lybia S. Sarraff; Luciana Freitas-De-Sousa; Mônica Colombini; Hedylamar O. Marques; Marcus V. G. Lacerda; Marco Sartim; Ana Moura-Da-Silva; Luiz L. Ferreira; Ida S. Sano-Martins; Wuelton M. Monteiro. Bleeding Disorders in Bothrops atrox Envenomations in the Brazilian Amazon: Participation of Hemostatic Factors and the Impact of Tissue Factor. Toxins 2020, 12, 554 .
AMA StyleSâmella S. Oliveira, Eliane C. Alves, Alessandra S. Santos, Elizandra F. Nascimento, João T. Pereira, Iran M. Silva, Jacqueline A. G. Sachett, Lybia S. Sarraff, Luciana Freitas-De-Sousa, Mônica Colombini, Hedylamar O. Marques, Marcus V. G. Lacerda, Marco Sartim, Ana Moura-Da-Silva, Luiz L. Ferreira, Ida S. Sano-Martins, Wuelton M. Monteiro. Bleeding Disorders in Bothrops atrox Envenomations in the Brazilian Amazon: Participation of Hemostatic Factors and the Impact of Tissue Factor. Toxins. 2020; 12 (9):554.
Chicago/Turabian StyleSâmella S. Oliveira; Eliane C. Alves; Alessandra S. Santos; Elizandra F. Nascimento; João T. Pereira; Iran M. Silva; Jacqueline A. G. Sachett; Lybia S. Sarraff; Luciana Freitas-De-Sousa; Mônica Colombini; Hedylamar O. Marques; Marcus V. G. Lacerda; Marco Sartim; Ana Moura-Da-Silva; Luiz L. Ferreira; Ida S. Sano-Martins; Wuelton M. Monteiro. 2020. "Bleeding Disorders in Bothrops atrox Envenomations in the Brazilian Amazon: Participation of Hemostatic Factors and the Impact of Tissue Factor." Toxins 12, no. 9: 554.
To achieve malaria elimination, new tools are required to explicitly target Plasmodium vivax. Recently, a novel panel of P. vivax proteins were identified and validated as serological markers for detecting recent exposure to P. vivax within the last 9 months. In order to improve the sensitivity and specificity of these markers, IgM in addition to IgG antibody responses were assessed to a down-selected panel of 20 P. vivax proteins. IgM was tested using archival plasma samples from observational cohort studies conducted in malaria-endemic regions of Thailand and Brazil. IgM responses to these proteins generally had poorer classification performance than IgG.
Rhea J Longley; Michael T White; Jessica Brewster; Zoe Sj Liu; Caitlin Bourke; Eizo Takashima; Matthias Harbers; Wai-Hong Tham; Julie Healer; Chetan E Chitnis; Wuelton Monteiro; Marcus Lacerda; Jetsumon Sattabongkot; Takafumi Tsuboi; Ivo Mueller. IgG antibody responses are preferential compared to IgM for use as serological markers for detecting recent exposure to Plasmodium vivax infection. 2020, 1 .
AMA StyleRhea J Longley, Michael T White, Jessica Brewster, Zoe Sj Liu, Caitlin Bourke, Eizo Takashima, Matthias Harbers, Wai-Hong Tham, Julie Healer, Chetan E Chitnis, Wuelton Monteiro, Marcus Lacerda, Jetsumon Sattabongkot, Takafumi Tsuboi, Ivo Mueller. IgG antibody responses are preferential compared to IgM for use as serological markers for detecting recent exposure to Plasmodium vivax infection. . 2020; ():1.
Chicago/Turabian StyleRhea J Longley; Michael T White; Jessica Brewster; Zoe Sj Liu; Caitlin Bourke; Eizo Takashima; Matthias Harbers; Wai-Hong Tham; Julie Healer; Chetan E Chitnis; Wuelton Monteiro; Marcus Lacerda; Jetsumon Sattabongkot; Takafumi Tsuboi; Ivo Mueller. 2020. "IgG antibody responses are preferential compared to IgM for use as serological markers for detecting recent exposure to Plasmodium vivax infection." , no. : 1.