Papers by Aluisio Segurado
Clinical Infectious Diseases, Jul 1, 2023
Background. Overcrowded emergency departments (EDs) may increase the risk of carbapenem-resistant... more Background. Overcrowded emergency departments (EDs) may increase the risk of carbapenem-resistant Enterobacterales (CRE) transmission. Methods. We conducted a quasi-experimental study divided into 2 phases (baseline and intervention) to investigate the impact of an intervention on the acquisition rate and identify risk factors for CRE colonization in an ED of a tertiary academic hospital in Brazil. In both phases, we did universal screening with rapid molecular test (bla KPC , bla NDM , bla OXA48 , bla OXA23 , and bla IMP) and culture. At baseline, both screening test results were not reported, and patients were put under contact precautions (CP) based on previous colonization or infection by multidrug-resistant organisms. During the intervention, all patients hospitalized in the ED were placed in empiric CP and the result of CRE screening was reported; if negative, patients were released from CP. Patients were rescreened if they stayed >7 days in the ED or were transferred to an intensive care unit. Results. A total of 845 patients were included: 342 in baseline and 503 in intervention. Colonization at admission was 3.4% by culture and molecular test. Acquisition rates during ED stay dropped from 4.6% (11/241) to 1% (5/416) during intervention (P = .06). The aggregated antimicrobial use in the ED decreased from phase 1 to phase 2 (804 defined daily doses [DDD]/1000 patients to 394 DDD/1000 patients, respectively). Length of stay >2 days in the ED was a risk factor for CRE acquisition (adjusted odds ratio, 4.58 [95% confidence interval, 1.44-14.58]; P = .01). Conclusions. Early empiric CP and rapid identification of CRE-colonized patients reduce cross-transmission in ED. Nevertheless, staying >2 days in ED compromised efforts.
The Journal of Sexual Medicine, May 1, 2017
pothesized to compromise neurodevelopment and immune function, leading to an increased risk of va... more pothesized to compromise neurodevelopment and immune function, leading to an increased risk of various illnesses. Traumatic childhood experiences are also associated with a range of high risk behaviors including excessive use of alcohol, tobacco use, criminal activity, early and unprotected sex. Present Study: The purpose of the present study was twofold: 1) Armenian translation and cross-cultural validation of the Adverse Childhood Experience (ACE) questionnaire, and 2) explore the prevalence of adverse childhood experience in psychiatric patients and control volunteers from the general population. Method: Using structured interviews and self-report measures data were collected from 237 adult psychiatric patients and 41 control volunteers. Patients were recruited from four inpatient psychiatric facilities, whereas controls were recruited from the general population using snowball sampling. Adverse childhood was assessed using the Armenian translated version of the ACE questionnaire (Felitti et al., 1998). ACE questionnaire is a 10-item retrospective self-report that assesses three primary domains: abuse, neglect, and family dysfunction. Results: More than three-fourth of the sample reported experiencing at least one adverse childhood experience, and nearly 25% of the patient group and 15% of the control volunteers reported experiencing at least four adverse childhood experiences. In both groups, women reported experiencing more adverse childhood experiences than men. Sexual abuse was more common in control volunteers than the patient group, 20% in comparison to 15%, respectively. Conclusion: To the best of our knowledge, this is the first study to examine the prevalence and characteristics of adverse childhood experiences in the Republic of Armenia. Preliminary findings suggest that adverse childhood experiences are more common among people with serious mental illness than the general population. Theoretical and policy implications are discussed.
Sexual Medicine, Jul 21, 2022
Introduction: Sexuality plays an essential role in the psychosocial well-being of people living w... more Introduction: Sexuality plays an essential role in the psychosocial well-being of people living with HIV (PLHIV) but it is still less assessed by healthcare professionals during treatment. Aim: To investigate the frequency of those screening positive for sexual dysfunction (SD) and associated factors according to gender/sexual orientation in PLHIV under long-term treatment with antiretroviral therapy (ART). Methods: Between September 2013 and October 2016, 234 PLHIV adults in treatment in São Paulo were included. Participants were sexually active, did not present sexual orientation disorder or body dysmorphic disorder, and did not use sexual hormones. We performed clinical interviews and measured levels of depression, anxiety, and levels of sexual hormones. SD was assessed using a self-report questionnaire. Main Outcome Measures: Proportion of participants screening positive for SD in the International Index of Erectile Function, the Index of Premature Ejaculation, and the Female Sexual Function Index. In the regression analyses, the outcome SD considered any SD presented with disregard to gender. Results: 70% of participants reported consistent adherence to ART and 96% had an undetectable viral load. The median (Md) duration of ART was 198 months (inter quartil range, IQR 111.6−230.4) and the median CD4 was 655 cells/mm 3 (IQR 443−871). Screening positive for erectile dysfunction was 49.7%, premature ejaculation 16.9%, female sexual dysfunction 27.4% and hypoactive desire 45.1%. Lower testosterone and prolactin levels were associated with erectile dysfunction in heterosexual men (n = 58); lower levels of oestradiol and higher levels of follicle stimulating hormone were associated with female sexual dysfunction and hypoactive desire in female participants (n = 63). The multivariable model used included comorbidities and hormonal abnormality and found that age (odds ratio, OR = 1.04, 95% confidence interval, 95%CI 1.00−1.08, P = .026) and the presence of depression/anxiety (OR = 2.96; 95%CI 1.52−5.77; P = .001) were associated with SD. Also, men reporting engaging in sex with other men were associated with screening positive for SD (OR 2.66; 95%CI 1.52−5.77, P = .013). During treatment of PLHIV, it is important to evaluate sexual health and symptoms of depression and anxiety specifically.
Journal of Negative Results in Biomedicine, Jan 10, 2013
Background: An estimated 10-20 million individuals are infected with the retrovirus human T-cell ... more Background: An estimated 10-20 million individuals are infected with the retrovirus human T-cell leukemia virus type 1 (HTLV-1). While the majority of these individuals remain asymptomatic, 0.3-4% develop a neurodegenerative inflammatory disease, termed HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). HAM/TSP results in the progressive demyelination of the central nervous system and is a differential diagnosis of multiple sclerosis (MS). The etiology of HAM/TSP is unclear, but evidence points to a role for CNS-inflitrating T-cells in pathogenesis. Recently, the HTLV-1-Tax protein has been shown to induce transcription of the human endogenous retrovirus (HERV) families W, H and K. Intriguingly, numerous studies have implicated these same HERV families in MS, though this association remains controversial. Results: Here, we explore the hypothesis that HTLV-1-infection results in the induction of HERV antigen expression and the elicitation of HERV-specific T-cells responses which, in turn, may be reactive against neurons and other tissues. PBMC from 15 HTLV-1-infected subjects, 5 of whom presented with HAM/TSP, were comprehensively screened for T-cell responses to overlapping peptides spanning HERV-K(HML-2) Gag and Env. In addition, we screened for responses to peptides derived from diverse HERV families, selected based on predicted binding to predicted optimal epitopes. We observed a lack of responses to each of these peptide sets. Conclusions: Thus, although the limited scope of our screening prevents us from conclusively disproving our hypothesis, the current study does not provide data supporting a role for HERV-specific T-cell responses in HTLV-1 associated immunopathology.
The Journal of Sexual Medicine, Sep 1, 2020
Results: The average age was 36.69 years +/-9.62 (19 to 55). The intraprostatic calcifications ar... more Results: The average age was 36.69 years +/-9.62 (19 to 55). The intraprostatic calcifications are associated with the severity of global symptoms of CP/CPPS (p ¼ 0.022). The level in serum C-Reactive protein(CRP) was associated with increased severity of global symptoms of CP/CPPS (p ¼ 0.029). The calcifications of the prostate are associated with the severity of pain in CP/CPPS (p ¼ 0.042). The structural changes of the prostate are associated with the severity of pain in CP/CPPS (p ¼ 0.043). Calcifications of the prostate are associated with urinary symptoms in chronic prostatitis / chronic pelvic pain (p ¼ 0.05). The practice of anal sex is a characteristic in 67% of the population studied. Conclusions: Intraprostatic calcifications and CPR are associated with higher severity of global symptoms of CP/CPPS, as well intraprostatic calcifications and structural prostate changes, have been associated with severity of pain in patients with CP/CPPS.
Frontiers in Microbiology, May 22, 2018
Virus Reviews & Research, 2006
American Journal of Infection Control, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
The Brazilian Journal of Infectious Diseases, 2019
Background: HIV-infected children surviving until adulthood have been transitioning to adult outp... more Background: HIV-infected children surviving until adulthood have been transitioning to adult outpatient health care service in Brazil since the late 2000's. Deterioration of clinical condition is expected during this period, as reported among youths with non-communicable chronic diseases. Despite their young age, they are long-term hosts of the virus, have prolonged exposure to antiretroviral therapy and have suffered from the social determinants and stigma of HIV infection since early childhood. Objectives: This study aimed to (1) describe demographic and clinical characteristics at the first appointment at adult care service following pediatric care of a cohort of Brazilian youths living with HIV since childhood; and (2) retrospectively address adherence and clinical variables in the last two years of pediatric follow-up. Methods: Descriptive study. Results: 41 consecutive patients referred to adult outpatient care from a pediatric HIV unit were enrolled, median age 19 years, and median lifetime CD4+ nadir 117 cell/mm 3 ; 89% reported previous AIDS-defining conditions. At first laboratory assessment in adult care, only 46% had undetectable (<400 copies/ml) HIV viral load and the median CD4+ count was 250 cell/mm 3. Conclusion: Youths living with HIV at the transition from pediatric to adult care had poor treatment adherence, low lifetime CD4+ cell nadir, low CD4 cell count and detectable HIV viral load. Health care providers should closely monitor these adolescents in a youth friendly environment, prepared for open communication about all aspects of their health.
Chlamydia trachomatis infection is the most common bacterial sexually transmitted disease (STD) i... more Chlamydia trachomatis infection is the most common bacterial sexually transmitted disease (STD) in the world. Multi-locus sequence typing (MLST) is a nucleotide sequence based approach for unambiguously characterising isolates of bacteria and other organisms via the internet, and has been used to monitor the molecular epidemiology of pathogenic bacteria and also to help understand their evolution and population biology. To enrich genetic background information on C. trachomatis in the MLST database and to deepen the current knowledge of the molecular characteristics of C. trachomatis strains circulating in China. Methods Ninty-nine C. trachomatis-infected patients and 16 follow-up patients were recruited from selected STD clinics in Jiangsu Province and Guangxi Zhuang Autonomous Region, from whom cervical swabs and demographic data were collected. C. trachomatis type was determined by MLST analysis. Chlamydia sequence types from different areas were compared by using Bio-Numerics 7 to generate a minimum spanning tree. Results Six out of the 16 follow-up samples tested positive for C. Trachomatis DNA. Of 105 Chlamydia-positive samples, 90 (85.71%) were available for MLST analysis, by which seven ompA genovars and 26 MLST types were determined. Significant differences in genovar distribution were not observed between C. trachomatis strains from Jiangsu and Guangxi, but noted between Chinese and Italian strains. Among the six Chlamydia-positive follow-up samples, three were identified as Chlamydia re-infections, while the other three failed to yield an MLST result. Conclusion The prevalent STs of C. trachomatis in China were different from those in Italy. Half of Chlamydia-positive follow-up samples (3/6) were identified as re-infections; hence, follow-up Chlamydial infected patients deserve more attention of clinicians.
Revista Da Sociedade Brasileira De Medicina Tropical, 1999
Revista Da Sociedade Brasileira De Medicina Tropical, 1986
... 52 Otras limitaciones para la ampliación del uso de tera-pia antirretroviral con fines de PTM... more ... 52 Otras limitaciones para la ampliación del uso de tera-pia antirretroviral con fines de PTMH pueden incluir la falta de disponibilidad de medicamentos dentro del AC Segurado, V Paiva/Reproductive Health Matters 2007; 15 (29 Supplement): 2745 Page 105. ...
Journal of Clinical Virology, Oct 1, 2020
Since January 2020 Elsevier has created a COVID-19 resource centre with free information in Engli... more Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre -including this research content -immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Journal of Virology, Jul 1, 2001
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Papers by Aluisio Segurado