Chagas disease in the State of Pernambuco, Brazil: analysis of admissions and mortality time series

INTRODUCTION: A time series study of admissions, deaths and acute cases was conducted in order to evaluate the context of Chagas disease in Pernambuco. METHODS: Data reported to the Information Technology Department of the Brazilian National Health Service between 1980 and 2008 was collected for regions and Federal Units of Brazil; and microregions and municipalities of Pernambuco. Rates (per 100,000 inhabitants) of hospitalization, mortality and acute cases were calculated using a national hospital database (SIH), a national mortality database (SIM) and the national Information System for Notifiable Diseases (SINAN), respectively. RESULTS: The national average for Chagas disease admissions was 0.99 from 1995 to 2008. Pernambuco obtained a mean of 0.39 in the same period, with the highest rates being concentrated in the interior of the state. The state obtained a mean mortality rate of 1.56 between 1980 and 2007, which was lower than the national average (3.66). The mortality rate has tended to decline nationally, while it has remained relatively unchanged in Pernambuco. Interpolating national rates of admissions and deaths, mortality rates were higher than hospitalization rates between 1995 and 2007. The same occurred in Pernambuco, except for 2003. Between 2001 and 2006, rates for acute cases were 0.56 and 0.21 for Brazil and Pernambuco, respectively. CONCLUSIONS: Although a decrease in Chagas mortality has occurred in Brazil, the disease remains a serious public health problem, especially in the Northeast region. It is thus essential that medical care, prevention and control regarding Chagas disease be maintained and improved.

Comparison of digestion methods to determine heavy metals in fertilizers

The lack of a standard method to regulate heavy metal determination in Brazilian fertilizers and the subsequent use of several digestion methods have produced variations in the results, hampering interpretation. Thus, the aim of this study was to compare the effectiveness of three digestion methods for determination of metals such as Cd, Ni, Pb, and Cr in fertilizers. Samples of 45 fertilizers marketed in northeastern Brazil were used. A fertilizer sample with heavy metal contents certified by the US National Institute of Standards and Technology (NIST) was used as control. The following fertilizers were tested: rock phosphate; organo-mineral fertilizer with rock phosphate; single superphosphate; triple superphosphate; mixed N-P-K fertilizer; and fertilizer with micronutrients. The substances were digested according to the method recommended by the Ministry for Agriculture, Livestock and Supply of Brazil (MAPA) and by the two methods 3051A and 3052 of the United States Environmental Protection Agency (USEPA). By the USEPA method 3052, higher portions of the less soluble metals such as Ni and Pb were recovered, indicating that the conventional digestion methods for fertilizers underestimate the total amount of these elements. The results of the USEPA method 3051A were very similar to those of the method currently used in Brazil (Brasil, 2006). The latter is preferable, in view of the lower cost requirement for acids, a shorter digestion period and greater reproducibility.

Decomposição de amostras de solos assistida por radiação microondas: estratégia para evitar a formação de fluoretos insolúveis

A decomposição de amostras que contêm elevados teores de Si, utilizando mistura com os ácidos nítrico e fluorídrico, pode provocar a precipitação de fluoretos de Al(III), Ca(II), Fe(III) e Mg(II) durante a digestão, impedindo a recuperação total desses elementos. Visando minimizar esse problema, foram testados quatro procedimentos aplicados a diferentes amostras de solos. O procedimento mais eficiente envolveu a decomposição assistida por radiação microondas, seguida pela separação do material sólido residual com elevado teor de Si do sobrenadante ácido. A fração residual foi solubilizada usando HF concentrado e, após complexação com ácido bórico, essa solução foi misturada à fase líquida do digerido. Os teores de metais nos digeridos foram determinados por espectrometria de emissão óptica em plasma induzido (ICP OES) e a exatidão foi demonstrada aplicando o procedimento proposto em amostras provenientes do programa colaborativo International Soil-Analytical Exchange (ISE, Wegening Agricultural University, Holanda) e em amostra certificada de solo proveniente do National Institute of Standard and Technology (NIST, SRM 2709), que apresentou respectivamente, os seguintes percentuais de recuperação: 100,0 ± 2,6; 99,5 ± 1,9; 108,5 ± 2,7; 94,6 ± 8,9; 92,2 ± 9,7; 95,7 ± 1,8; 96,7 ± 2,7; 95,2 ± 0,6; 103,6 ± 2,6 e 96,1 ± 1,6 para, Al, Ba, Ca, Cr, Cu, Fe, Mg, Mn, V e Zn.

Organic sulfur oxidation to sulfate in soil samples for total sulfur determination by turbidimetry

Sulfur in the soil occurs in two basic forms, organic and inorganic S. The organic form accounts for 95 % of S in most soils. The effectiveness of organic S to oxidate to sulfate was evaluated for total S determination in soil samples by wet (acid) and dry-ash (alkaline) oxidation methods. To evaluate the wet method and the possible use as a reference when evaluating the dry method proposed here, a reference standard from the US National Institute of Standards and Technology (NIST) was used (Montana Soil - NIST 2710). The dry-ash oxidation process with alkaline oxidizing agents is one of the simplest oxidation methods of organic S to the sulfate form and was compared with the wet process. The objective of the study was to develop a dry method that would be easy to apply and allow the complete conversion of organic S to sulfate in soil samples and later detection by turbidimetry. The effectiveness of organic S oxidation to sulfate was evaluated by means of three alkaline oxidation mixtures: NaHCO3 + Ag2O, Eschka mixture (17 % Na2CO3, 66 % MgO, and 17 % K2CO3), and NaHCO3 + CuO. The procedure to quantify the sulfate concentration was based on the reaction with barium chloride and turbidimetric detection. Sulfur quantification in the standard sample by the wet method proved adequate, precise and accurate. It should also be pointed out that no significant differences were found (95 % reliability) between the wet and dry processes (NaHCO3 and Ag2O oxidation mixture) in six different Brazilian soils. The proposed dry method can therefore be used in the preparation of soil samples for total S determination.

Potencial de fertilizantes e corretivos no aporte de micronutrientes ao solo

Fertilizantes e corretivos, ao serem aplicados nos solos, fornecem micronutrientes como impurezas residuais da sua fabricação, os quais podem ser importantes fontes para as culturas. Em decorrência disso, o objetivo deste trabalho foi quantificar os teores dos micronutrientes Zn, Cu, Fe, Mn e Ni em fertilizantes e corretivos comercializados no Nordeste brasileiro, visando avaliar o potencial desses insumos no fornecimento indireto de micronutrientes às culturas agrícolas. Os insumos analisados neste estudo (24 amostras de fertilizantes e 26 de corretivos) foram coletados nos Estados da Bahia e Pernambuco pelo Ministério da Agricultura, Pecuária e Abastecimento (MAPA) e digeridos pelo método 3051A (USEPA, 1998). As determinações dos micronutrientes foram feitas por espectrofotometria de absorção atômica. Amostras de fertilizante SRM 695 (National Institute of Standards and Technology - NIST) e spikes foram adicionadas para controle de qualidade das análises. Os fertilizantes fosfatados, em geral, apresentaram maiores teores de micronutrientes do que os demais produtos testados. Os fertilizantes e corretivos avaliados representam uma fonte de micronutrientes ao solo que não pode ser desprezada. No entanto, a real disponibilidade desses elementos aportados ao solo necessita ser avaliada em estudos com plantas, pois fatores como solubilidade dos insumos, absorção pelas culturas, reações com o solo e perdas por precipitação e lixiviação devem ser considerados.

Geração eletroquímica do hidreto de selênio em sistema de injeção em fluxo com detecção por espectrometria de absorção atômica com chama Ar-Glp

This paper presents a system for electrochemical hydride generation using flow-injection and atomic absorption spectrometry to determine selenium in biological materials. The electrolytic cell was constructed by assembling two reservoirs, one for the sample and the other for the electrolytic solution separated by a Nafion membrane. Each compartment had a Pt electrode. The sample and electrolyte flow-rates, acidic media, and applied current were adjusted to attain the best analytical performance and ensure the membrane lifetime. The atomisation system used a T quartz tube in an air-LPG flame. The composition of the flame, the observation height, and the argon flow rate used to carry the hydrides were critically investigated. The system allowed to perform thirty determinations per hour with a detection limit of 10 mug L-1 of Se. Relative standard deviations were in general lower than 1.5% for a solution containing 20.0 and 34.0 mug L-1 of Se in a typical sample digest. Accuracy was assessed analysing the certified materials: rice flour (NIST-1568) from National Institute of Standard and Technology and dried fish (MA-A-2), whole animal blood (A-2/1974) from the International Atomic Energy Agency.

Oceanografia e Química: unindo conhecimentos em prol dos oceanos e da sociedade

The marine environment is certainly one of the most complex systems to study, not only because of the challenges posed by the nature of the waters, but especially due to the interactions of physical, chemical and biological processes that control the cycles of the elements. Together with analytical chemists, oceanographers have been making a great effort in the advancement of knowledge of the distribution patterns of trace elements and processes that determine their biogeochemical cycles and influences on the climate of the planet. The international academic community is now in prime position to perform the first study on a global scale for observation of trace elements and their isotopes in the marine environment (GEOTRACES) and to evaluate the effects of major global changes associated with the influences of megacities distributed around the globe. This action can only be performed due to the development of highly sensitive detection methods and the use of clean sampling and handling techniques, together with a joint international program working toward the clear objective of expanding the frontiers of the biogeochemistry of the oceans and related topics, including climate change issues and ocean acidification associated with alterations in the carbon cycle. It is expected that the oceanographic data produced this coming decade will allow a better understanding of biogeochemical cycles, and especially the assessment of changes in trace elements and contaminants in the oceans due to anthropogenic influences, as well as its effects on ecosystems and climate. Computational models are to be constructed to simulate the conditions and processes of the modern oceans and to allow predictions. The environmental changes arising from human activity since the 18th century (also called the Anthropocene) have made the Earth System even more complex. Anthropogenic activities have altered both terrestrial and marine ecosystems, and the legacy of these impacts in the oceans include: a) pollution of the marine environment by solid waste, including plastics; b) pollution by chemical and medical (including those for veterinary use) substances such as hormones, antibiotics, legal and illegal drugs, leading to possible endocrine disruption of marine organisms; and c) ocean acidification, the collateral effect of anthropogenic emissions of CO2 into the atmosphere, irreversible in the human life time scale. Unfortunately, the anthropogenic alteration of the hydrosphere due to inputs of plastics, metal, hydrocarbons, contaminants of emerging concern and even with formerly "exotic" trace elements, such us rare earth elements is likely to accelerate in the near future. These emerging contaminants would likely soon present difficulties for studies in pristine environments. All this knowledge brings with it a great responsibility: helping to envisage viable adaptation and mitigation solutions to the problems identified. The greatest challenge faced by Brazil is currently to create a framework project to develop education, science and technology applied to oceanography and related areas. This framework would strengthen the present working groups and enhance capacity building, allowing a broader Brazilian participation in joint international actions and scientific programs. Recently, the establishment of the National Institutes of Science and Technology (INCTs) for marine science, and the creation of the National Institute of Oceanographic and Hydrological Research represent an exemplary start. However, the participation of the Brazilian academic community in the latest assaults on the frontier of chemical oceanography is extremely limited, largely due to: i. absence of physical infrastructure for the preparation and processing of field samples at ultra-trace level; ii. limited access to oceanographic cruises, due to the small number of Brazilian vessels and/or absence of "clean" laboratories on board; iii. restricted international cooperation; iv. limited analytical capacity of Brazilian institutions for the analysis of trace elements in seawater; v. high cost of ultrapure reagents associated with processing a large number of samples, and vi. lack of qualified technical staff. Advances in knowledge, analytic capabilities and the increasing availability of analytical resources available today offer favorable conditions for chemical oceanography to grow. The Brazilian academic community is maturing and willing to play a role in strengthening the marine science research programs by connecting them with educational and technological initiatives in order to preserve the oceans and to promote the development of society.

Entomological and ecological aspects of six sylvatic species of triatomines (Hemiptera, Reduviidae) from the collection of the National Biodiversity Institute of Costa Rica, Central America

A total of 797 specimens of wild adult triatomines, belonging to six species from the entomological collections of the Costa Rican National Biodiversity Institute, was studied from the standpoint of their relative abundance, as reflected by light traps, distribution in the country, seasonal variations and climatic and altitudinal preferences. Triatoma dimidiata was the most abundant species (32.9% of the total specimens), with a very extensive distribution in different ecological zones, being more common between 100 to 400 m above sea level mainly at the end of the dry season. T. dispar was the third in frequency (21.5%), with narrower distribution, more abundant between 600 to 800 m and scarce during the dry season. Panstrongylus geniculatus and P. rufotuberculatus, second and fourth in frequency (22.1% and 15.1%, respectively), were widely distributed on both the Pacific and Caribbean basins, the former being more common between 80 to 270 m all year round and the latter below 800 m mainly during the first semester. Eratyrus cuspidatus which represented only 4.9% of the insects, was also present on both basins mainly below 200 m with a tendency to be scarce during certain months of the year, and was found in all types of ecological zones. Finally, Rhodnius pallescens, the least abundant species (3.6%) was restricted to very humid areas below 20 m, on the north side and Caribbean basin. With the exception of R. pallescens, males were more commonly found than females. Some epidemiological implications related to the six species are discussed.

Use of neuron-specific enolase for assessing the severity and outcome of neurological disorders in patients

Neuron-specific enolase (NSE) is a glycolytic enzyme present almost exclusively in neurons and neuroendocrine cells. NSE levels in cerebrospinal fluid (CSF) are assumed to be useful to estimate neuronal injury and clinical outcome of patients with serious clinical manifestations such as those observed in stroke, head injury, anoxic encephalopathy, encephalitis, brain metastasis, and status epilepticus. We compared levels of NSE in serum (sNSE) and in CSF (cNSE) among four groups: patients with meningitis (N = 11), patients with encephalic injuries associated with impairment of consciousness (ENC, N = 7), patients with neurocysticercosis (N = 25), and normal subjects (N = 8). Albumin was determined in serum and CSF samples, and the albumin quotient was used to estimate blood-brain barrier permeability. The Glasgow Coma Scale score was calculated at the time of lumbar puncture and the Glasgow Outcome Scale (GOS) score was calculated at the time of patient discharge or death. The ENC group had significantly higher cNSE (P = 0.01) and albumin quotient (P = 0.005), but not sNSE (P = 0.14), levels than the other groups (Kruskal-Wallis test). Patients with lower GOS scores had higher cNSE levels (P = 0.035) than patients with favorable outcomes. Our findings indicate that sNSE is not sensitive enough to detect neuronal damage, but cNSE seems to be reliable for assessing patients with considerable neurological insult and cases with adverse outcome. However, one should be cautious about estimating the severity of neurological status as well as outcome based exclusively on cNSE in a single patient.

Detection of enteroviruses in cases of neurological disorders in the State of Pará, Brazil

Eighty-one cerebrospinal fluid (CSF) samples mainly from cases of aseptic meningitis and motor deficiency syndrome were sent to the Virology Section of Evandro Chagas Institute, Belém Pará, in the period of January 1995 to January 1996 in order to isolate viruses. All samples were inoculated onto HEp-2 cell culture and newborn mice, with negative results. The probability of isolating viruses by these methods is reduced because of the low concentration of viral particles in these specimens. In order to obtain more information about the etiology of these cases, a group of 23 samples were selected to be tested by a more sensitive technique than the virus isolation - the reverse transcription polymerase chain reaction (RT-PCR). Specific primers directed to conserved regions in the enterovirus genome were used, considering that this group of viruses is frequently associated with these neurological disorder. The age of the patients ranged from 1 to 55 years and nearly all of them lived in Belém, State of Pará, North of Brazil. Of 15 samples analyzed by RT PCR nine (60%) were positive; of these, 6 (66.6%) had motor deficiency and 3 (33.3%) developed aseptic meningitis. These results show that it is important to investigate enterovirus as cause of these syndromes.

Smoking, consumption of alcohol and sedentary life style in population grouping and their relationships with lipemic disorders

The study, part of the project "Atherosclerotic cardiovascular diseases, lipemic disorders, hypertension, obesity and diabetis mellitus in a population of the metropolitan area of the southeastern region of Brazil", had the following objectives: a) the characterization and distribution among typical human socio-economic groupings, of the prevalence of some particular habits which constitute aspects of life-style-the use of tobacco, the use of alcohol and sedentary activity; b) the establishment of the interrelation between the above-mentioned habits and some lipemic disorders. The prevalence of the habits cited behaved in the following manner: the use of tobacco predominated among men, distributed uniformly throughout the social strata; among the women the average percentage of smokers was 18,9%, a significant difference occurring among the highest socio-economic class, where the average was of 40.2%. The sedentary style of life presented high prevalence, among both men and women with exception of the women of the highest socio-economic level and of the skilled working class. The use of alcohol, as one would expect, is a habit basically practised by the men, without any statistically significant differences between classes. For the purpose of establishing associations between these risk fictors and lipemic conditions four situations were chosen, of the following characteristics: 1- total cholesterol > or = 220 mg/dl and triglycerides > or = 150 mg/dl; 2- HDL cholesterol <35 mg/dl for men and <45 mg/dl for women and triglycerides levels > or = 150 mg/dl; 3- HDL cholesterol <35 mg/dl for men and <45 mg/dl for women and triglycerides levels <150 mg/dl; 4- total cholesterol 220 mg/dl with triglycerides levels <150 mg/dl. Six models of multiple (backward) regression were established, with seven independent variables- age, sex, use of tobacco, consumption of alcohol, light physical activity, hypertension and obesity. Significant associations (P<0,05) were revealed with hypercholesterolemia, accompanied by triglyceride levels > or = 150 mg/dl, and the following independent variables: age, use of tobacco and the interactions between obesity and smoking, age and sedentary lifestyle, sex and obesity (R2=22%); the standardized B coefficient showed that the variables with the greatest weight in the forecasting of the variation in the levels of cholesterol were smoking and the interaction between obesity and smoking. The hypercholesterolemia accompanied by triglycerides levels <150 mg/dl showed a positive association between total cholesterol and sex and the interactions obesity/smoking and sex/obesity. As regards HDL cholesterol accompanied by triglyceride/ levels > or = 150 mg/dl was inversely associated with obesity and the interaction smoking/ age and directly with age (R=31%). The standardized B coeffients, indicated that the variables obesity and the interactions smoking/age possessed a weight three times greater than age alone in accounting for the variation in the serum levels of HDL cholesterol. When accompanied by triglycerides <150 mg/dl there was no association between and the independent variables and the set of them presented R equal to 22%. The sum of top, in the population stutied in this project, the component habits of life-style (smoking, alcohol consumption and sedentary activity) which constitute risk factors which determine morbidity from atherosclerotic cardiovascular diseases are be found distributed through all the typical social groupings of this particular form of social organization. On the other hand, the seven independent variables used in the multiple regression models for the explanation of the lipemic conditions considered presented multiple determination coefficients which varied, approximately, between 20% and 30%. Thus it is important that in the genetic epidemiology the study of the morbidities in question be emphasized.

Clinical and functional aspects of work-related musculoskeletal disorders among active workers

OBJECTIVE: To evaluate musculoskeletal disorders among active industrial workers. METHODS: The study was carried out in São Carlos, Southeastern Brazil, in 2005. One hundred and thirty-four female workers were physically evaluated and answered questions about their physical symptoms, filled out a pain scale and gave responses in the Oswestry Disability Questionnaire, and the Work Ability Index questionnaire. The data were analyzed descriptively, and in correlation tests and through applying logistic regression. The outcome was evaluated in relation to the perceptions of pain, symptoms, physical assessment, ability to work and disability. RESULTS: Clinical evaluations and sick leave presented positive correlations with the subjective variables. The Work Ability Index presented a negative correlation with the physical disability index (r=-0.69). Symptoms reported at the time of the assessment presented a good correlation with the results from the pain scale and the clinical findings. Previous sick leave showed an association with disability (OR=1.13; 95% CI:1.08;1.18). CONCLUSION: Symptom reports and pain scales may be useful for assessing current conditions at the time of evaluating individuals with work-related musculoskeletal disorders, as they are easier to apply. In more severe cases of such injuries, clinical and functional evaluations and questionnaires such as those relating to ability to work and disability are preferable. Precise and specific evaluations of these disorders may contribute towards fairer legal and administrative decisions.

Edentulism and shortened dental arch in Brazilian elderly from the National Survey of Oral Health 2003

OBJECTIVE: To describe the distribution of edentulism and estimate the prevalence of functional dentition and shortened dental arch among elderly population. METHODS: A population-based epidemiological study was carried out with a sample of 5,349 respondents aged 65 to 74 years obtained from the 2002 and 2003 Brazilian Ministry of Health/Division of Oral Health survey database. The following variables were studied: gender; macroregion of residence; missing teeth; percentage that met the World Health Organization goal for oral health in the age group 65 to 74 years (50% having at least 20 natural teeth); presence of shortened dental arch; number of posterior occluding pairs of teeth. The Chi-square test assessed the association between categorical variables. The Kruskal-Wallis and Mann-Whitney tests were used to assess differences of mean between number of posterior occluding pairs teeth, macro-region and gender. RESULTS: The elderly population had an average of 5.49 teeth (SD: 7.93) with a median of 0. The proportion of completely edentulous respondents was 54.7%. Complete edentulism was 18.2% in the upper arch and 1.9% in the lower arch. The World Health Organization goal was achieved in 10% of all respondents studied. However, only 2.7% had acceptable masticatory function and aesthetics (having at least shortened dental arch) and a mean number of posterior occluding pairs of 6.94 (SD=2.97). There were significant differences of the percentage of respondents that met the World Health Organization goal and presence of shortened dental arch between men and women. There were differences in shortened dental arch between macroregions. CONCLUSIONS: The Brazilian epidemiological oral health survey showed high rate of edentulism and low rate of shortened dental arch in the elderly population studied, thus suggesting significant functional and aesthetic impairment in all Brazilian macroregions especially among women.

Lack of access and continuity of adult health care: a national population-based survey

OBJECTIVE To describe the lack of access and continuity of health care in adults.METHODS A cross-sectional population-based study was performed on a sample of 12,402 adults aged 20 to 59 years in urban areas of 100 municipalities of 23 states in the five Brazilian geopolitical regions. Barriers to the access and continuity of health care and were investigated based on receiving, needing and seeking health care (hospitalization and accident/emergency care in the last 12 months; care provided by a doctor, by other health professional or home care in the last three months). Based on the results obtained by the description of the sample, a projection is provided for adults living in Brazilian urban areas.RESULTS The highest prevalence of lack of access to health services and to provision of care by health professionals was for hospitalization (3.0%), whilst the lowest prevalence was for care provided by a doctor (1.1%). The lack of access to care provided by other health professionals was 2.0%; to accident and emergency services, 2.1%; and to home care, 2.9%. As for prevalences, the greatest absolute lack of access occurred in emergency care (more than 360,000 adults). The main reasons were structural and organizational problems, such as unavailability of hospital beds, of health professionals, of appointments for the type of care needed and charges made for care.CONCLUSIONS The universal right to health care in Brazil has not yet been achieved. These projections can help health care management in scaling the efforts needed to overcome this problem, such as expanding the infrastructure of health services and the workforce.