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[PMID]:28453841
[Au] Autor:Requena-Méndez A; Goñi P; Rubio E; Pou D; Fumadó V; Lóbez S; Aldasoro E; Cabezos J; Valls ME; Treviño B; Martínez Montseny AF; Clavel A; Gascon J; Muñoz J
[Ad] Endereço:Barcelona Institute for Global Health, ISGlobal-CRESIB, Universitat de Barcelona, Barcelona , Spain.
[Ti] Título:The Use of Quinacrine in Nitroimidazole-resistant Giardia Duodenalis: An Old Drug for an Emerging Problem.
[So] Source:J Infect Dis;215(6):946-953, 2017 03 15.
[Is] ISSN:1537-6613
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background: There is little evidence regarding the management of refractory giardiasis after treatment with nitroimidazoles. This study estimates the proportion of persistent giardiasis in 3 hospitals in Barcelona, describes associated risk factors and genotype, and evaluates the efficacy rate of quinacrine in those with persistent giardiasis. Methods: A clinical, prospective, observational study was conducted in patients with giardiasis treated with nitroimidazoles. Those with persistent giardiasis were provided quinacrine. Molecular characterization of Giardia isolates was performed by polymerase chain reaction amplification of a fragment of tpi and bg genes. Results: Seventy-seven patients were recruited and treated with nitroimidazoles, and in 14 of 71 (20%) of patients followed up, Giardia persisted. Refractory giardiasis was associated with malaise (P = .007) and anorexia (P = .02), with previous giardiasis (P = .03), and with previous antibiotic (P = .02) or antiparasitic(P = .04) use. Quinacrine had an effectiveness rate of 100% in refractory giardiasis (n = 13; 95% confidence interval = 75-100). Molecular characterization showed that 17 (25%) Giardia isolates belonged to assemblage A, and 31 (43%) belonged to assemblage B. In refractory giardiasis, assemblage A and B were found responsible in 4 and 6 cases, respectively. Conclusions: Almost 20% of patients presented persistent giardiasis, belonging to both assemblages A and B, after nitroimidazole. Short course of quinacrine was effective in treating refractory cases. Further controlled studies should evaluate its efficacy and safety.
[Mh] Termos MeSH primário: Giardia lamblia/genética
Giardíase/tratamento farmacológico
Nitroimidazóis/uso terapêutico
Quinacrina/uso terapêutico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Criança
Pré-Escolar
DNA de Protozoário/genética
Resistência a Medicamentos
Fezes/parasitologia
Feminino
Genótipo
Giardia lamblia/efeitos dos fármacos
Giardia lamblia/isolamento & purificação
Seres Humanos
Lactente
Recém-Nascido
Modelos Logísticos
Masculino
Análise Multivariada
Nitroimidazóis/efeitos adversos
Filogenia
Estudos Prospectivos
Quinacrina/efeitos adversos
Espanha
Viagem
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (DNA, Protozoan); 0 (Nitroimidazoles); H0C805XYDE (Quinacrine)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/infdis/jix066


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[PMID]:28749337
[Au] Autor:Dorigatti I; Hamlet A; Aguas R; Cattarino L; Cori A; Donnelly CA; Garske T; Imai N; Ferguson NM
[Ad] Endereço:MRC Centre for Outbreak analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
[Ti] Título:International risk of yellow fever spread from the ongoing outbreak in Brazil, December 2016 to May 2017.
[So] Source:Euro Surveill;22(28), 2017 Jul 13.
[Is] ISSN:1560-7917
[Cp] País de publicação:Sweden
[La] Idioma:eng
[Ab] Resumo:States in south-eastern Brazil were recently affected by the largest Yellow Fever (YF) outbreak seen in a decade in Latin America. Here we provide a quantitative assessment of the risk of travel-related international spread of YF indicating that the United States, Argentina, Uruguay, Spain, Italy and Germany may have received at least one travel-related YF case capable of seeding local transmission. Mitigating the risk of imported YF cases seeding local transmission requires heightened surveillance globally.
[Mh] Termos MeSH primário: Surtos de Doenças/prevenção & controle
Modelos Teóricos
Risco
Viagem
Febre Amarela/prevenção & controle
Febre Amarela/transmissão
Vírus da Febre Amarela/isolamento & purificação
Vírus da Febre Amarela/patogenicidade
[Mh] Termos MeSH secundário: Animais
Argentina
Brasil/epidemiologia
Alemanha
Saúde Global
Seres Humanos
Insetos Vetores
Itália
Fatores de Risco
Espanha
Estados Unidos
Uruguai
Febre Amarela/epidemiologia
Vacina contra Febre Amarela/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Yellow Fever Vaccine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE


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[PMID]:29385373
[Au] Autor:Bann M; Kaul DR; Haider MZ; Saint S; Goldberger ZD
[Ad] Endereço:From the Department of Medicine (M.B., M.Z.H., Z.D.G.) and the Divisions of General Internal Medicine (M.B., M.Z.H.) and Cardiology (Z.D.G.), University of Washington School of Medicine, Harborview Medical Center, Seattle; and the Department of Internal Medicine (D.R.K., S.S.) and Division of Infect
[Ti] Título:Home Sweet Home.
[So] Source:N Engl J Med;378(5):461-466, 2018 Feb 01.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Salmonella typhi/isolamento & purificação
Viagem
Febre Tifoide/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Diagnóstico Diferencial
Feminino
Febre/etiologia
Bactérias Gram-Negativas/isolamento & purificação
Seres Humanos
Mialgia/etiologia
Sudorese
Febre Tifoide/complicações
[Pt] Tipo de publicação:CASE REPORTS; CLINICAL CONFERENCE; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMcps1704731


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[PMID]:29293686
[Au] Autor:Tang J; Heinimann HR
[Ad] Endereço:ETH Zurich, Future Resilient Systems, Singapore-ETH Centre, Singapore, Singapore.
[Ti] Título:A resilience-oriented approach for quantitatively assessing recurrent spatial-temporal congestion on urban roads.
[So] Source:PLoS One;13(1):e0190616, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Traffic congestion brings not only delay and inconvenience, but other associated national concerns, such as greenhouse gases, air pollutants, road safety issues and risks. Identification, measurement, tracking, and control of urban recurrent congestion are vital for building a livable and smart community. A considerable amount of works has made contributions to tackle the problem. Several methods, such as time-based approaches and level of service, can be effective for characterizing congestion on urban streets. However, studies with systemic perspectives have been minor in congestion quantification. Resilience, on the other hand, is an emerging concept that focuses on comprehensive systemic performance and characterizes the ability of a system to cope with disturbance and to recover its functionality. In this paper, we symbolized recurrent congestion as internal disturbance and proposed a modified metric inspired by the well-applied "R4" resilience-triangle framework. We constructed the metric with generic dimensions from both resilience engineering and transport science to quantify recurrent congestion based on spatial-temporal traffic patterns and made the comparison with other two approaches in freeway and signal-controlled arterial cases. Results showed that the metric can effectively capture congestion patterns in the study area and provides a quantitative benchmark for comparison. Also, it suggested not only a good comparative performance in measuring strength of proposed metric, but also its capability of considering the discharging process in congestion. The sensitivity tests showed that proposed metric possesses robustness against parameter perturbation in Robustness Range (RR), but the number of identified congestion patterns can be influenced by the existence of ϵ. In addition, the Elasticity Threshold (ET) and the spatial dimension of cell-based platform differ the congestion results significantly on both the detected number and intensity. By tackling this conventional problem with emerging concept, our metric provides a systemic alternative approach and enriches the toolbox for congestion assessment. Future work will be conducted on a larger scale with multiplex scenarios in various traffic conditions.
[Mh] Termos MeSH primário: Transportes
Urbanização
[Mh] Termos MeSH secundário: Poluentes Atmosféricos
Monitoramento Ambiental/métodos
Modelos Teóricos
Fatores de Tempo
Viagem
Emissões de Veículos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Air Pollutants); 0 (Vehicle Emissions)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180103
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190616


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[PMID]:28467570
[Au] Autor:Azman F; Erkilinç B; Çabalar M; Çagirici S; Yayla V
[Ti] Título:[A rarely known headache: Airplane travel headache].
[Ti] Título:Az taninan bir basagrisi: Uçak yolculugu basagrisi..
[So] Source:Agri;29(1):47-48, 2017 Jan.
[Is] ISSN:1300-0012
[Cp] País de publicação:Turkey
[La] Idioma:tur
[Ab] Resumo:Recently, headache associated with airplane travel has gained importance with case reports and took its place in the classification of headache in 2013. This rare condition has different spesific characteristic from the primary headaches and its pathophysiology is not clear yet. In this case report, a 27-years-old female patient was diagnosed with the headache associated with airplane travel by history, examination and imaging findings. The possible pathophysiology and treatment were discussed.
[Mh] Termos MeSH primário: Aeronaves
Cefaleia/diagnóstico
Viagem
[Mh] Termos MeSH secundário: Adulto
Diagnóstico Diferencial
Feminino
Cefaleia/etiologia
Cefaleia/fisiopatologia
Seres Humanos
Medição da Dor
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.5505/agri.2015.79037


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[PMID]:29419678
[Au] Autor:Hsu SH; Huang HL; Lu CW; Cheng SY; Lee LT; Chiu TY; Huang KC
[Ad] Endereço:Department of Family Medicine, National Taiwan University Hospital.
[Ti] Título:Tour leaders with detailed knowledge of travel-related diseases play a key role in disease prevention.
[So] Source:Medicine (Baltimore);97(6):e9806, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In Taiwan, group tours are a popular mode of international travel; hence, group tour leaders must ensure traveler safety and health. This study identified factors influencing tour leaders' willingness to recommend pretravel medical consultation and vaccination.A cross-sectional questionnaire survey was administered to tour leaders from January 2011 to December 2012. Multivariate logistic regression analyses were performed to estimate the odds ratios of having a positive attitude and willingness based on different knowledge scores of the tour leaders after adjustments for age, sex, education level, and seniority.Tour leaders with a more detailed knowledge of both travel-related infectious and noninfectious diseases demonstrated a higher willingness to receive vaccination. They believed that consultation at travel clinics before travel can improve travelers' health (P < .05).This study supports the importance and effectiveness on educating tour leaders' knowledge about travel-related diseases to improve health care for travelers.
[Mh] Termos MeSH primário: Educação em Saúde/métodos
Doença Relacionada a Viagens
Viagem
[Mh] Termos MeSH secundário: Adulto
Estudos Transversais
Feminino
Promoção da Saúde/organização & administração
Seres Humanos
Masculino
Meia-Idade
Cultura Organizacional
Papel Profissional
Gestão da Segurança/métodos
Inquéritos e Questionários
Taiwan
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180209
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009806


  7 / 22186 MEDLINE  
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[PMID]:29296142
[Au] Autor:Mwamba GN; Yoloyolo N; Masembe Y; Nsambu MN; Nzuzi C; Tshekoya P; Dah B; Kaya G
[Ad] Endereço:Ministry of Health, Kinshasa, Democratic Republic of Congo.
[Ti] Título:Vaccination coverage and factors influencing routine vaccination status in 12 high risk health zones in the Province of Kinshasa City, Democratic Republic of Congo (DRC), 2015.
[So] Source:Pan Afr Med J;27(Suppl 3):7, 2017.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:eng
[Ab] Resumo:Introduction: Vaccination coverage of the first dose of diphtheria-tetanus-pertussis-hepatitis B- type b (pentavalent) vaccine for the City-Province of Kinshasain the years 2012 - 2014 wasbelow the national objective of 92%, with coverage less than 80% reported in 12 of the 35 health zones (HZ). The purpose of this study was to discern potential contributing factors to low vaccination coverage in Kinshasa. Methods: We conducted a multi-stage cluster household study of children 6 - 11 months in households residing in their current neighborhood for at least 3 months in the 12 high risk HZ in Kinshasa. Additional information on vaccination status of the children was collected at the health facility. Results: Of the 1,513 households with a child 6-11 months old, 81% were eligible and participated. Among the 1224 children surveyed, 96% had received the first dose of pentavalent vaccine; 84% had received the third dose; and 71% had received all recommended vaccines for their age. Longer travel time to get to health facility (p=0.04) and shorter length of residence in the neighborhood (p=0.04) showed significant differences in relation to incomplete vaccination. Forty percent of children received their most recent vaccination in a facility outside of their HZ of residence. Conclusion: This survey found vaccination coverage in 12 HZs in Kinshasa was higher than estimates derived from administrative reports. The large percentage of children vaccinated outside of their HZ of residence demonstrates the challenge to use of the Reaching Every District strategy in urban areas.
[Mh] Termos MeSH primário: Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem
Vacinas Anti-Haemophilus/administração & dosagem
Vacinas contra Hepatite B/administração & dosagem
Cobertura Vacinal/estatística & dados numéricos
Vacinação/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Estudos Transversais
República Democrática do Congo
Feminino
Seres Humanos
Esquemas de Imunização
Lactente
Masculino
Distribuição Espacial da População/estatística & dados numéricos
Fatores de Tempo
Viagem
População Urbana
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Diphtheria-Tetanus-Pertussis Vaccine); 0 (Haemophilus Vaccines); 0 (Hepatitis B Vaccines); 0 (diphtheria-tetanus-acellular pertussis-Hib-hepatitis B vaccine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180104
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.supp.2017.27.3.11930


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[PMID]:29391118
[Au] Autor:Juo YY; Woods A; Ou R; Ramos G; Shemin R; Benharash P
[Ad] Endereço:Center for Advanced Surgical and Interventional Technologies (CASIT), University of California, Los Angeles, California, USA.
[Ti] Título:Does Travel Distance Affect Readmission Rates after Cardiac Surgery?
[So] Source:Am Surg;83(10):1170-1173, 2017 Oct 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:With emphasis on value-based health care, empiric models are used to estimate expected readmission rates for individual institutions. The aim of this study was to determine the relationship between distance traveled to seek surgical care and likelihood of readmission in adult patients undergoing cardiac operations at a single medical center. All adults undergoing major cardiac surgeries from 2008 to 2015 were included. Patients were stratified by travel distance into regional and distant travel groups. Multivariable logistic regression models were developed to assess the impact of distance traveled on odds of readmission. Of the 4232 patients analyzed, 29 per cent were in the regional group and 71 per cent in the distant. Baseline characteristics between the two groups were comparable except mean age (62 vs 61 years, P < 0.01) and Caucasian race (59 vs 73%, P < 0.01). Distant travel was associated with a significantly longer hospital length of stay (11.8 vs 10.5 days, P < 0.01) and lower risk of readmission (9.5 vs 13.4%, P < 0.01). Odds of readmission was inversely associated with logarithm of distance traveled (odds ratio 0.75). Travel distance in patients undergoing major cardiac surgeries was inversely associated with odds of readmission.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Cardíacos
Acesso aos Serviços de Saúde/estatística & dados numéricos
Readmissão do Paciente/estatística & dados numéricos
Viagem/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Idoso
California
Feminino
Seguimentos
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Estudos Retrospectivos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE


  9 / 22186 MEDLINE  
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[PMID]:29253373
[Au] Autor:Bearak JM; Burke KL; Jones RK
[Ad] Endereço:Guttmacher Institute, New York, NY, USA. Electronic address: jbearak@guttmacher.org.
[Ti] Título:Disparities and change over time in distance women would need to travel to have an abortion in the USA: a spatial analysis.
[So] Source:Lancet Public Health;2(11):e493-e500, 2017 Nov.
[Is] ISSN:2468-2667
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Abortion can help women to control their fertility and is an important component of health care for women. Although women in the USA who live further from an abortion clinic are less likely to obtain an abortion than women who live closer to an abortion clinic, no national study has examined inequality in access to abortion and whether inequality has increased as the number of abortion clinics has declined. METHODS: For this analysis, we obtained data on abortion clinics for 2000, 2011, and 2014 from the Guttmacher Institute's Abortion Provider Census. Block groups and the percentage of women aged 15-44 years by census tract were obtained from the US Census Bureau. Distance to the nearest clinic was calculated for the population-weighted centroid of every block group. We calculated the median distance to an abortion clinic for women in each county and the median and 80th percentile distances for each state by weighting block groups by the number of women of reproductive age (15-44 years). FINDINGS: In 2014, women in the USA would have had to travel a median distance of 10·79 miles (17·36 km) to reach the nearest abortion clinic, although 20% of women would have had to travel 42·54 miles (68·46 km) or more. We found substantially greater variation within than between states because, even in mostly rural states, women and clinics were concentrated in urban areas. We identified spatial disparities in abortion access, which were broadly unchanged, at least as far back as 2000. INTERPRETATION: We showed substantial and persistent spatial disparities in access to abortion in the USA. These results contribute to an emerging literature documenting similar disparities in other high-income countries. FUNDING: An anonymous grant to the Guttmacher Institute.
[Mh] Termos MeSH primário: Aborto Induzido
Instituições de Assistência Ambulatorial/estatística & dados numéricos
Acesso aos Serviços de Saúde/tendências
Viagem/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Seres Humanos
Gravidez
Análise Espacial
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE


  10 / 22186 MEDLINE  
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[PMID]:29337997
[Au] Autor:Muraduzzaman AKM; Khan MH; Parveen R; Sultana S; Alam AN; Akram A; Rahman M; Shirin T
[Ad] Endereço:Deparment of Virology, Institute of Epidemiology, Disease Control & Research (IEDCR), Dhaka, Bangladesh.
[Ti] Título:Event based surveillance of Middle East Respiratory Syndrome Coronavirus (MERS- CoV) in Bangladesh among pilgrims and travelers from the Middle East: An update for the period 2013-2016.
[So] Source:PLoS One;13(1):e0189914, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Every year around 150,000 pilgrims from Bangladesh perform Umrah and Hajj. Emergence and continuous reporting of MERS-CoV infection in Saudi Arabia emphasize the need for surveillance of MERS-CoV in returning pilgrims or travelers from the Middle East and capacity building of health care providers for disease containment. The Institute of Epidemiology, Disease Control & Research (IEDCR) under the Bangladesh Ministry of Health and Family welfare (MoHFW), is responsible for MERS-CoV screening of pilgrims/ travelers returning from the Middle East with respiratory illness as part of its outbreak investigation and surveillance activities. METHODS: Bangladeshi travelers/pilgrims who returned from the Middle East and presented with fever and respiratory symptoms were studied over the period from October 2013 to June 2016. Patients with respiratory symptoms that fulfilled the WHO MERS-CoV case algorithm were tested for MERS-CoV and other respiratory tract viruses. Beside surveillance, case recognition training was conducted at multiple levels of health care facilities across the country in support of early detection and containment of the disease. RESULTS: Eighty one suspected cases tested by real time PCR resulted in zero detection of MERS-CoV infection. Viral etiology detected in 29.6% of the cases was predominantly influenza A (H1N1 and H3N2), and influenza B infection (22%). Peak testing occurred mostly following the annual Hajj season. CONCLUSIONS: Respiratory tract infections in travelers/pilgrims returning to Bangladesh from the Middle East are mainly due to influenza A and influenza B. Though MERS-CoV was not detected in the 81 patients tested, continuous screening and surveillance are essential for early detection of MERS-CoV infection and other respiratory pathogens to prevent transmissions in hospital settings and within communities. Awareness building among healthcare providers will help identify suspected cases.
[Mh] Termos MeSH primário: Infecções por Coronavirus/epidemiologia
Viagem
[Mh] Termos MeSH secundário: Bangladesh/epidemiologia
Seres Humanos
Oriente Médio/epidemiologia
Coronavírus da Síndrome Respiratória do Oriente Médio/genética
Coronavírus da Síndrome Respiratória do Oriente Médio/isolamento & purificação
Reação em Cadeia da Polimerase
Vigilância da População
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180210
[Lr] Data última revisão:
180210
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180117
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189914



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