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Mpox is a zoonotic disease historically reported in Africa. Since 2003, limited outbreaks have occurred outside Africa. In 2022, the global spread of cases with sustained interhuman transmission and unusual disease features raised public health concerns. We explore the mpox outbreak in Rio de Janeiro (RJ) state, Brazil, in an observational study of mpox‐suspected cases from June to December 2022. Data collection relied on a public healthcare notification form. Diagnosis was determined by MPXV‐PCR. In 46 confirmed cases, anti‐OPXV IgG was determined by ELISA, and seven MPXV genomes were sequenced. A total of 3095 cases were included, 816 (26.3%) with positive MPXV‐PCR results. Most positive cases were men in their 30 s and MSM. A total of 285 (34.9%) MPXV‐PCR+ patients live with HIV. Eight were coinfected with varicella‐zoster virus. Anogenital lesions and adenomegaly were associated with the diagnosis of mpox. Females and individuals under 18 represented 9.4% and 5.4% of all confirmed cases, respectively, showing higher PCR cycle threshold (Ct) values and fewer anogenital lesions compared to adult men. Anti‐OPXV IgG was detected in 29/46 (63.0%) patients. All analyzed sequences belonged to clade IIb. In RJ state, mpox presented a diverse clinical picture, represented mainly by mild cases with low complication rates and prominent genital involvement. The incidence in females and children was higher than usually reported. The observation of a bimodal distribution of Ct values, with few positive results, may suggest the need to review the diagnostic criteria in these groups. [ABSTRACT FROM AUTHOR]

Paper aims: This paper analyzes Command and Control (C2) Systems and identifies the level of knowledge on the subject by actors involved in disaster response operations in Brazil, besides assessing the evolution in this area since the disaster of the Serrana Region of Rio de Janeiro in 2011. Originality: The concept of C2 is still little explored academically, especially in disaster management systems. This study contributes to the understanding of the dynamics of different C2 Systems operated in Brazil, as well as identifying the level of knowledge on the subject and its evolution since 2011. Research method: This is an exploratory survey in which data was analyzed using descriptive statistics techniques. Main findings: We conclude that the actors involved in real disaster situations have little formal training in C2. The findings indicate that the performance of a simulated exercise helps in disaster preparedness, but the participants observed deficiencies concerning C2 training besides the lack of local community involvement in the simulated exercise. Implications for theory and practice: This study contributes to the disaster management literature, showing empirical evidence that the results obtained in a simulated exercise can boost the specialization of professionals in C2 systems in the area of disasters. [ABSTRACT FROM AUTHOR]

Background: The emergence and spread of antimicrobial resistance and infectious agents have challenged hospitals in recent decades. Our aim was to investigate the circulation of target infectious agents using Geographic Information System (GIS) and spatial–temporal statistics to improve surveillance and control of healthcare-associated infection and of antimicrobial resistance (AMR), using Klebsiella pneumoniae complex as a model. Methods: A retrospective study carried out in a 450-bed federal, tertiary hospital, located in Rio de Janeiro. All isolates of K. pneumoniae complex from clinical and surveillance cultures of hospitalized patients between 2014 and 2016, identified by the use of Vitek-2 system (BioMérieux), were extracted from the hospital's microbiology laboratory database. A basic scaled map of the hospital's physical structure was created in AutoCAD and converted to QGis software (version 2.18). Thereafter, bacteria according to resistance profiles and patients with carbapenem-resistant K. pneumoniae (CRKp) complex were georeferenced by intensive and nonintensive care wards. Space–time permutation probability scan tests were used for cluster signals detection. Results: Of the total 759 studied isolates, a significant increase in the resistance profile of K. pneumoniae complex was detected during the studied years. We also identified two space–time clusters affecting adult and paediatric patients harbouring CRKp complex on different floors, unnoticed by regular antimicrobial resistance surveillance. Conclusions: In-hospital GIS with space–time statistical analysis can be applied in hospitals. This spatial methodology has the potential to expand and facilitate early detection of hospital outbreaks and may become a new tool in combating AMR or hospital-acquired infection. [ABSTRACT FROM AUTHOR]

Objectives: To test if the use of an inspiratory muscle training program with an electronic resistive loading device is associated with benefits as to muscle strength, weaning, and survival in the ICU.Design: Prospective randomized controlled trial.Settings: Study conducted at the ICU of a Navy's hospital, Rio de Janeiro, Brazil, from January 2016 to September 2018.Patients: Tracheostomized patients (18-86 yr) on prolonged weaning.Interventions: Participants were assigned to inspiratory muscle training (intervention group) or a traditional T-piece protocol (control group). In the inspiratory muscle training group, participants underwent training with an electronic inspiratory training device (POWERbreathe K-5; Technologies Ltd, Birmingham, United Kingdom).Measurements and Main Results: Changes in respiratory muscle strength and rates of ICU survival and weaning success were compared between groups. Forty-eight participants in the inspiratory muscle training group and 53 ones in the control group were included in the final analysis. The inspiratory muscle training was associated with a substantially higher gain on muscle strength as assessed by the maximal inspiratory pressure (70.5 [51.0-82.5] vs -48.0 cm H2O [36.0-72.0 cm H2O]; p = 0.003) and the timed inspiratory effort index (1.56 [1.25-2.08] vs 0.99 cm H2O/s [0.65-1.71 cm H2O/s]; p = 0.001). Outcomes at the 60th day of ICU were significantly better in the intervention group regarding both survival (71.1% vs 48.9%; p = 0.030) and weaning success (74.8% vs 44.5%; p = 0.001).Conclusions: The use of an inspiratory muscle training program with an electronic resistive loading device was associated with substantial muscle strength gain and positive impacts in two very relevant clinical outcomes: the rates of ICU survival and successful weaning. [ABSTRACT FROM AUTHOR]

Introduction The influence of sociodemographics and clinical factors on the quality of life (qol) of an individual with schizophrenia is being widely studied, particularly in developed countries. The de-institutionalization process that is taking course in Brazil, to a less symptoms-focused approach, makes necessary the assessment of the qol of these patients living in the community. Objectives To evaluate factors related to the qol in patients diagnosed with schizophrenia or schizo-affective disorder, and who are users of one of the two municipal community mental health services of a Rio de Janeiro district, Brazil. Material and methods A cross-sectional study was carried out. Selected patients were interviewed with Brazilian versions of Lancashire Quality of Life Profile, Brief Psychiatric Rating Scale and Calgary Depression Scale for Schizophrenia. Results A total of 136 patients participated in the study. Most of them were single and lived with their relatives, had low educational level, were unemployed and had low income. A great number of the interviewed did not have any social contact outside the family and leisure activity, except watching television and/or listening to the radio. Finances and work situation had the lowest satisfaction level. Educational level, presence of positive and depressive symptoms, hospital admissions were negatively associated with qol. For those receiving state benefit, perceived qol increased with age. These predictors explained more than 42% of the total subjective qol score variance. [ABSTRACT FROM AUTHOR]