Papers by Anna Cristina C. Carvalho
Background Neutrophils have been associated with lung tissue damage in many diseases, including t... more Background Neutrophils have been associated with lung tissue damage in many diseases, including tuberculosis (TB). Whether neutrophil count can serve as a predictor of adverse treatment outcomes is unknown. Methods We prospectively assessed 936 patients (172 HIV-seropositive) with culture-confirmed pulmonary TB, enrolled in a multicenter prospective cohort study from different regions in Brazil, from June 2015 to June 2019, and were followed up to two years. TB patients had a baseline visit before treatment (month 0) and visits at month 2 and 6 (or at the end of TB treatment). Smear microscopy, and culture for Mycobacterium tuberculosis (MTB) were performed at TB diagnosis and during follow-up. Complete blood counts were measured at baseline. Treatment outcome was defined as either unfavorable (death, treatment failure or TB recurrence) or favorable (cure or treatment completion). We performed multivariable logistic regression, with propensity score regression adjustment, to estimat...
Advances in Bioinformatics and Computational Biology
BMC public health, Jan 29, 2016
We carried out a study to evaluate the prevalence of Chlamydia trachomatis and Neisseria gonorrho... more We carried out a study to evaluate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae genital infections in school-based adolescents in Northern Italy. Systematic screening for C. trachomatis and N. gonorrhoeae genital infection was performed in 13th grade students in the province of Brescia, an industrialized area in Northern Italy. Student filled in a questionnaire on sexual behaviour and provided a urine sample for microbiological testing. A total of 2,718 students (mean age: 18.4 years; 59.1 % females) provided complete data (62.2 % of those eligible). Overall 2,059 students (75.8 %) were sexually active (i.e. had had at least one partner), and the mean age at sexual debut was 16.1 years (SD: 1.4). Only 27.5 % of the sexually active students reported regular condom use during the previous 6 months, with higher frequency in males than in females (33.8 % vs 24.2 %). No case of N. gonorrhoeae infection was detected, while C. trachomatis was found in 36 adolescents, w...
Antibiotics
Tuberculosis (TB) does not respect borders, and migration confounds global TB control and elimina... more Tuberculosis (TB) does not respect borders, and migration confounds global TB control and elimination. Systematic screening of immigrants from TB high burden settings and—to a lesser degree TB infection (TBI)—is recommended in most countries with a low incidence of TB. The aim of the study was to evaluate the views of a diverse group of international health professionals on TB management among migrants. Participants expressed their level of agreement using a six-point Likert scale with different statements in an online survey available in English, French, Mandarin, Spanish, Portuguese and Russian. The survey consisted of eight sections, covering TB and TBI screening and treatment in migrants. A total of 1055 respondents from 80 countries and territories participated between November 2019 and April 2020. The largest professional groups were pulmonologists (16.8%), other clinicians (30.4%), and nurses (11.8%). Participants generally supported infection control and TB surveillance esta...
This study was performed to investigate the role of dysglycemia on the genetic diversity ofMycoba... more This study was performed to investigate the role of dysglycemia on the genetic diversity ofMycobacterium tuberculosis(MTB) among pulmonary tuberculosis (TB) patients to build scientific evidence about the possible mechanisms of TB transmission. MTB isolates obtained of patients affected by pulmonary tuberculosis from health care facilities of North Lima - Peru, were analyzed using whole genome sequencing and 24-locus mycobacterial interspersed repetitive-unit-variable-number tandem repeats (MIRU-VNTR). Subsequently, clinical and epidemiological characteristics were associated with clustering, lineages and comorbid conditions. The analysis carried out 112 pulmonary TB patients from various health centers in North Lima, 17 (15%) had diabetes mellitus (DM) and 33 (29%) had pre-diabetes (PDM). Latin American-Mediterranean, Haarlem and Beijing were the most frequent MTB lineages found in those patients. Previous TB (adjusted odds ratio [aOR]=3.65; 95%CI: 1.32-17.81), age (aOR=1.12; 95%CI...
Pathogens
Over the past 15 years, and despite many difficulties, significant progress has been made to adva... more Over the past 15 years, and despite many difficulties, significant progress has been made to advance child and adolescent tuberculosis (TB) care. Despite increasing availability of safe and effective treatment and prevention options, TB remains a global health priority as a major cause of child and adolescent morbidity and mortality—over one and a half million children and adolescents develop TB each year. A history of the global public health perspective on child and adolescent TB is followed by 12 narratives detailing challenges and progress in 19 TB endemic low and middle-income countries. Overarching challenges include: under-detection and under-reporting of child and adolescent TB; poor implementation and reporting of contact investigation and TB preventive treatment services; the need for health systems strengthening to deliver effective, decentralized services; and lack of integration between TB programs and child health services. The COVID-19 pandemic has had a significant n...
Ensino, Saude e Ambiente
A alimentação é reconhecida como um direito humano fundamental pela Constituição Federal Brasilei... more A alimentação é reconhecida como um direito humano fundamental pela Constituição Federal Brasileira de 1988. Atualmente, hábitos alimentares pouco saudáveis e redução na prática de atividades físicas podem estar diretamente relacionados com o aumento da prevalência de casos de obesidade e doenças crônicas na população brasileira. Uma das principais medidas para promover a saúde e a qualidade de vida é a educação alimentar e nutricional, e o cinema com suas representações da realidade repletas de imagens e sons pode favorecer o debate e a criticidade nas salas de aula. Nesse sentido, analisamos o documentário “Muito Além do Peso”, quanto ao seu potencial pedagógico para a discussão da educação alimentar e nutricional. Inicialmente, realizamos uma pré-análise para identificar cenas relevantes sobre problemas relacionados à alimentação, e posteriormente esse conteúdo foi analisado quanto a veracidade científica no que tange a saúde e seu potencial como material educacional. O documentá...
Revista da Sociedade Brasileira de Medicina Tropical
Introduction: In March 2020, the rapid increase in COVID-19 cases overburdened the Italian health... more Introduction: In March 2020, the rapid increase in COVID-19 cases overburdened the Italian health system, with the country becoming the pandemic's epicenter. Methods: We present a narrative review based on manuscripts, official documents, and newspaper articles regarding COVID-19 in Italy. Results: Characteristics of the epidemic, possible causes for its worsening, and the measures adopted across Italian regions are presented. Conclusions: In the early stages of an epidemic, effective decision-making is essential to contain the number of cases. Medical support for patients and social isolation measures are the most appropriate strategies currently available to reduce the spread and lethality of COVID-19.
International Journal of Infectious Diseases
The Lancet
Background Tens of millions of children are exposed to Mycobacterium tuberculosis globally every ... more Background Tens of millions of children are exposed to Mycobacterium tuberculosis globally every year; however, there are no contemporary estimates of the risk of developing tuberculosis in exposed children. The effectiveness of contact investigations and preventive therapy remains poorly understood. Methods In this systematic review and meta-analysis, we investigated the development of tuberculosis in children closely exposed to a tuberculosis case and followed for incident disease. We restricted our search to cohort studies published between Jan 1, 1998, and April 6, 2018, in MEDLINE, Web of Science, BIOSIS, and Embase electronic databases. Individual-participant data and a pre-specified list of variables were requested from authors of all eligible studies. These included characteristics of the exposed child, the index case, and environmental characteristics. To be eligible for inclusion in the final analysis, a dataset needed to include: (1) individuals below 19 years of age; (2) followup for tuberculosis for a minimum of 6 months; (3) individuals with household or close exposure to an individual with tuberculosis; (4) information on the age and sex of the child; and (4) start and end follow-up dates. Studies assessing incident tuberculosis but without dates or time of follow-up were excluded. Our analysis had two primary aims: (1) estimating the risk of developing tuberculosis by time-period of follow-up, demographics (age, region), and clinical attributes (HIV, tuberculosis infection status, previous tuberculosis); and (2) estimating the effectiveness of preventive therapy and BCG vaccination on the risk of developing tuberculosis. We estimated the odds of prevalent tuberculosis with mixed-effects logistic models and estimated adjusted hazard ratios (HRs) for incident tuberculosis with mixedeffects Poisson regression models. The effectiveness of preventive therapy against incident tuberculosis was estimated through propensity score matching. The study protocol is registered with PROSPERO (CRD42018087022). Findings In total, study groups from 46 cohort studies in 34 countries-29 (63%) prospective studies and 17 (37%) retrospective-agreed to share their data and were included in the final analysis. 137 647 exposed children were evaluated at baseline and 130 512 children were followed for 429 538 child-years, during which 1299 prevalent and 999 incident tuberculosis cases were diagnosed. [A: OK as edited?] Children not receiving preventive therapy with a positive result for tuberculosis infection had significantly higher 2-year cumulative tuberculosis incidence than children with a negative result for tuberculosis infection, and this incidence was greatest among children below 5 years of age (19•0% [95% CI 8•4-37•4]). The effectiveness of preventive therapy was 63% (adjusted HR 0•37 [95% CI 0•30-0•47]) among all exposed children, and 85% (adjusted HR 0•15 [95% CI 0•11-0•20]) among those with a positive result for tuberculosis infection. [A: Would you like to add results of your first primary aim (estimating the risk of developing tuberculosis by time-period of follow-up, demographics, and clinical attributes)?] Among all children <5 years of age who developed tuberculosis, 83% were diagnosed within 90 days of the baseline visit. Interpretation The risk of developing tuberculosis among exposed infants and young children is very high. Most cases occurred within weeks of contact investigation initiation and might not be preventable through prophylaxis. This suggests that alternative strategies for prevention are needed, such as earlier initiation of preventive therapy through earlier diagnosis of adult cases, or community-wide screening approaches.
Revista Ciências & Ideias ISSN: 2176-1477
A Fundação Oswaldo Cruz estruturou o Programa “Fiocruz para um Brasil sem Miséria”, para geraçã... more A Fundação Oswaldo Cruz estruturou o Programa “Fiocruz para um Brasil sem Miséria”, para geração de conhecimentos nos componentes de saúde, educação, ciência, cultura e ambiente, e enfrentamento das doenças perpetuadoras da pobreza. A fim de contribuir com o programa, o Instituto Oswaldo Cruz, unidade integrante da Fiocruz, desenvolveu o projeto “Expedições Fiocruz para um Brasil sem miséria”. As expedições ocorrem em cidades brasileiras com baixo Índice de Desenvolvimento Humano, com atividades para docentes, discentes, profissionais de saúde e da assistência social, dependendo da necessidade local, a população também pode se inscrever nas oficinas. A quarta expedição, ocorreu em 2015, no município de Miracema, no estado do Rio de Janeiro. Nessa expedição foi ministrado um minicurso de ciência e arte e oficinas dialógicas, como construção de materiais educacionais, contação de histórias, literatura de cordel, fotografia, “ecoarte”, “biodiversidarte”, e música no ensino em biociên...
Revista Ciências & Ideias ISSN: 2176-1477
Atividade educativa sobre a tuberculose (TB) foi desenvolvida em aulas de Ciências com alunos do ... more Atividade educativa sobre a tuberculose (TB) foi desenvolvida em aulas de Ciências com alunos do Programa de Educação de Jovens e Adultos da cidade do Rio de Janeiro (RJ). A TB é uma doença infectocontagiosa causada pelo bacilo Mycobacterium tuberculosis. O RJ tem uma das mais altas incidências de TB no Brasil e ocupa o primeiro lugar em relação à taxa de mortalidade. O objetivo foi promover e trocar conhecimentos sobre a TB. Para isso adotou-se a abordagem qualitativa e o uso de questionários, cuja análise indicou um conhecimento limitado sobre a doença por parte dos alunos. A metodologia Freireana e o Arco de Maguerez foram os referenciais teóricos usados. A estratégia didática baseou-se na formulação de textos, em rodas de conversa e em consultas na internet sobre TB. Os alunos participaram ativamente do processo, discutindo a doença e refletindo sobre as situações e hábitos de saúde adotados. O estudo culminou com a apresentação de uma peça teatral e a distribuição de folhetos s...
Jornal Brasileiro de Pneumologia
Tuberculosis continues to be a public health priority in many countries. In 2015, tuberculosis ki... more Tuberculosis continues to be a public health priority in many countries. In 2015, tuberculosis killed 1.4 million people, including 210,000 children. Despite the recent progress made in the control of tuberculosis in Brazil, it is still one of the countries with the highest tuberculosis burdens. In 2015, there were 69,000 reported cases of tuberculosis in Brazil and tuberculosis was the cause of 4,500 deaths in the country. In 2014, the World Health Organization approved the End TB Strategy, which set a target date of 2035 for meeting its goals of reducing the tuberculosis incidence by 90% and reducing the number of tuberculosis deaths by 95%. However, to achieve those goals in Brazil, there is a need for collaboration among the various sectors involved in tuberculosis control and for the prioritization of activities, including control measures targeting the most vulnerable populations. Children are highly vulnerable to tuberculosis, and there are particularities specific to pediatr...
Em Aberto
Com o objetivo de identificar o potencial transdisciplinar das representações artísticas presente... more Com o objetivo de identificar o potencial transdisciplinar das representações artísticas presentes nas coleções de livros didáticos da educação básica aprovadas pelo PNLD 2018, docentes da rede estadual de ensino do Rio de Janeiro classificaram os livros de acordo com uma escala de preferência, justificando sua escolha. As justificativas foram analisadas pelo método do Discurso do Sujeito Coletivo (DSC), constatando-se que, na escolha do livro, prevalecem as categorias conteúdo e exercício. Em seguida, 12 representações artísticas, selecionadas desses livros, foram apresentadas aos docentes para que indicassem quais conteúdos do seu componente curricular poderiam ser relacionados às imagens. As respostas foram categorizadas em forma de nuvens de palavras, revelando que a maioria dos docentes relacionou conteúdos de seu componente curricular para todas as imagens. Conclui-se que as representações artísticas permitem não apenas uma abordagem interdisciplinar, mas também transdisciplinar.
European respiratory review : an official journal of the European Respiratory Society, Jan 30, 2018
Tuberculosis (TB) still represents a major public health issue in spite of the significant impact... more Tuberculosis (TB) still represents a major public health issue in spite of the significant impact of the efforts made by the World Health Organization (WHO) and partners to improve its control. In 2014 WHO launched a new global strategy (End TB) with a vision of a world free of TB, and a 2035 goal of TB elimination (defined as less than one incident case per million). The aim of this article is to summarise the theoretical bases of the End TB Strategy and to analyse progresses and persistent obstacles on the way to TB elimination.The evolution of the WHO recommended strategies of TB control (Directly Observed Therapy, Short Course (DOTS), Stop TB and End TB) are described and the concept of TB elimination is discussed. Furthermore, the eight core activities recently proposed by WHO as the milestones to achieve TB elimination are discussed in detail. Finally, the recently published experiences of Cyprus and Oman on their way towards TB elimination are described, together with the reg...
Presse medicale (Paris, France : 1983), Jan 27, 2017
The tuberculosis (TB) and HIV syndemic continues to rage and are a major public health concern wo... more The tuberculosis (TB) and HIV syndemic continues to rage and are a major public health concern worldwide. This deadly association raises complexity and represent a significant barrier towards TB elimination. TB continues to be the leading cause of death amongst HIV-infected people. This paper reports the challenges that lay ahead and outlines some of the current and future strategies that may be able to address this co-epidemic efficiently. Improved diagnostics, cheaper and more effective drugs, shorter treatment regimens for both drug-sensitive and drug-resistant TB are discussed. Also, special topics on drug interactions, TB-IRIS and TB relapse are also described. Notwithstanding the defeats and meagre investments, diagnosis and management of the two diseases have seen significant and unexpected improvements of late. On the HIV side, expansion of ART coverage, development of new updated guidelines aimed at the universal treatment of those infected, and the increasing availability ...
Bollettino Aib, Sep 28, 2012
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Papers by Anna Cristina C. Carvalho