Biological, biochemical and molecular features of Trypanosoma cruzi strains isolated from patients infected through oral transmission during a 2005 outbreak in the state of Santa Catarina, Brazil: its correspondence with the new T. cruzi Taxonomy Consensus (2009)

We examined strains of Trypanosoma cruzi isolated from patients with acute Chagas disease that had been acquired by oral transmission in the state of Santa Catarina, Brazil (2005) and two isolates that had been obtained from a marsupial (Didelphis aurita) and a vector (Triatoma tibiamaculata). These strains were characterised through their biological behaviour and isoenzymic profiles and genotyped according to the new Taxonomy Consensus (2009) based on the discrete typing unities, that is, T. cruzi genotypes I-VI. All strains exhibited the biological behaviour of biodeme type II. In six isolates, late peaks of parasitaemia, beyond the 20th day, suggested a double infection with biodemes II + III. Isoenzymes revealed Z2 or mixed Z1 and Z2 profiles. Genotyping was performed using three polymorphic genes (cytochrome oxidase II, spliced leader intergenic region and 24Sα rRNA) and the restriction fragment length polymorphism of the kDNA minicircles. Based on these markers, all but four isolates were characterised as T. cruzi II genotypes. Four mixed populations were identified: SC90, SC93 and SC97 (T. cruzi I + T. cruzi II) and SC95 (T. cruzi I + T. cruzi VI). Comparison of the results obtained by different methods was essential for the correct identification of the mixed populations and major lineages involved indicating that characterisation by different methods can provide new insights into the relationship between phenotypic and genotypic aspects of parasite behaviour.

VaxcineTM: an oil-based adjuvant for influenza vaccines

Vaccination is the method of choice for the prevention of influenza infection. However, the quantity of the antigen available, especially in the case of pandemics, often fails to meet the global demand. However, improved adjuvants can overcome this problem. Preliminary results obtained in this study revealed that one year after a single subcutaneous immunisation with influenza A H3N2 virus in an oil-based carrier, VaxcineTM, outbreed mice produced a high immunoglobulin G response that lasted for up to one year and exhibited less variation in titre compared with the response of the control group treated with alum. The haemagglutination-inhibition titres induced by VaxcineTM were also higher than those generated by alum. These data indicate that VaxcineTM is a good adjuvant candidate for seasonal influenza vaccines.

Oral live attenuated human rotavirus vaccine (RotarixTM) offers sustained high protection against severe G9P[8] rotavirus gastroenteritis during the first two years of life in Brazilian children

In a large Phase III trial conducted in 10 Latin American countries, the safety and efficacy of the live attenuated monovalent rotavirus vaccine RIX4414 was evaluated in 15,183 healthy infants followed up during the first two years of life. Belém was the only site in Brazil included in this multicentre trial. The study in Belém included a subset of 653 infants who were followed up until 24 months of age for protection against severe rotavirus gastroenteritis. These subjects were randomly assigned in a 1:1 ratio to receive two doses of vaccine (n = 328) or two doses of placebo (n = 325) at approximately two and four months of age. Of the 653 enrolled infants, 23 dropped out during the study period. For the combined two-year period, the efficacy of RIX4414 was 72.3% [95% confidence interval (CI) 37.5-89.1%] against severe rotavirus-related gastroenteritis, reaching a protection rate of 81.8% (95% CI 36.4-96.6%) against circulating wild-type G9 rotavirus strains. It is concluded that two doses of RIX4414 are highly efficacious against severe rotavirus gastroenteritis in Belém during the first two years of life and provide high protection against the worldwide emergence and spread of G9P[8] strains.

Comparison of adverse events following immunization with pandemic influenza A (H1N1)pdm09 vaccine with or without adjuvant among health professionals in Rio de Janeiro, Brazil

A vaccination campaign against pandemic influenza A (H1N1)pdm09 was held in Brazil in March 2010, using two types of monovalent split virus vaccines: an AS03-adjuvanted vaccine and a non-adjuvanted vaccine. We compared the reactogenicity of the vaccines in health professionals from a Clinical Research Institute in Rio de Janeiro, Brazil and there were no serious adverse events following immunization (AEFI) among the 494 subjects evaluated. The prevalence of any AEFI was higher in the AS03-adjuvanted vaccine at 2 h and 24 h post-vaccination [preva-lence ratio (PR): 2.05, confidence interval (CI) 95%: 1.55-2.71, PR: 3.42, CI 95%: 2.62-4.48, respectively]; however, there was no difference between the vaccines in the assessments conducted at seven and 21 days post-vaccination. The group receiving the AS03 post-adjuvanted vaccine had a higher frequency of local reactions at 2 h (PR: 3.01, CI 95%: 2.12-4.29), 24 h (PR: 4.57, CI 95%: 3.29-6.37) and seven days (PR: 6.05, CI 95%: 2.98-12.28) post-vaccination. We concluded that the two types of vaccines caused no serious AEFI in the studied population and the adjuvanted vaccine was more reactogenic, particularly in the 24 h following vaccination. This behaviour must be confirmed and better characterised by longitudinal studies in the general population.

Ionic imbalance and lack of effect of adjuvant treatment with methylene blue in the hamster model of leptospirosis

Leptospirosis in humans usually involves hypokalaemia and hypomagnesaemia and the putative mechanism underlying such ionic imbalances may be related to nitric oxide (NO) production. We previously demonstrated the correlation between serum levels of NO and the severity of renal disease in patients with severe leptospirosis. Methylene blue inhibits soluble guanylyl cyclase (downstream of the action of any NO synthase isoforms) and was recently reported to have beneficial effects on clinical and experimental sepsis. We investigated the occurrence of serum ionic changes in experimental leptospirosis at various time points (4, 8, 16 and 28 days) in a hamster model. We also determined the effect of methylene blue treatment when administered as an adjuvant therapy, combined with late initiation of standard antibiotic (ampicillin) treatment. Hypokalaemia was not reproduced in this model: all of the groups developed increased levels of serum potassium (K). Furthermore, hypermagnesaemia, rather than magnesium (Mg) depletion, was observed in this hamster model of acute infection. These findings may be associated with an accelerated progression to acute renal failure. Adjuvant treatment with methylene blue had no effect on survival or serum Mg and K levels during acute-phase leptospirosis in hamsters.

Detection of Mycobacterium leprae in saliva and the evaluation of oral sensitivity in patients with leprosy

The aim of this study was to investigate sensitivity disorders in the oral cavity related to the presence of Mycobacterium leprae in the saliva of treatment-naïve patients with leprosy in the state of Amazonas, Brazil. A cross-sectional study was conducted involving 45 subjects with leprosy. The subjects were interviewed to evaluate the sensitivity of the oral cavity. For the detection of M. leprae, saliva and slit-skin smear samples were collected. The samples were analysed using a bacteriological index (BI) protocol and the real-time quantitative polymerase chain reaction (qPCR). The results indicated that 15 of the 45 (33.3%) subjects with leprosy showed decreased oral sensitivity, which confirmed the importance of the oral cavity sensitivity evaluation. There was not a direct relationship between the presence of M. leprae in saliva and changes in oral sensitivity. Positive saliva qPCR results from six (31.6%) of 19 paucibacillary (PB) patients suggested the possibility of a new site for sample collection. Positive results using these diagnostic techniques (BI, slit-skin smear and saliva qPCR) increased to 55.5%, thus opening the possibility of combining these different techniques to increase the rate of positive diagnoses, especially in PB patients.

Vascular dysfunction as a target for adjuvant therapy in cerebral malaria

Cerebral malaria (CM) is a life-threatening complication of Plasmodium falciparum malaria that continues to be a major global health problem. Brain vascular dysfunction is a main factor underlying the pathogenesis of CM and can be a target for the development of adjuvant therapies for the disease. Vascular occlusion by parasitised red blood cells and vasoconstriction/vascular dysfunction results in impaired cerebral blood flow, ischaemia, hypoxia, acidosis and death. In this review, we discuss the mechanisms of vascular dysfunction in CM and the roles of low nitric oxide bioavailability, high levels of endothelin-1 and dysfunction of the angiopoietin-Tie2 axis. We also discuss the usefulness and relevance of the murine experimental model of CM by Plasmodium berghei ANKA to identify mechanisms of disease and to screen potential therapeutic interventions.

Oral bacillus Calmette-Guérin vaccine against tuberculosis: why not?

The bacillus Calmette-Guérin (BCG) vaccine is the only licensed vaccine for human use against tuberculosis (TB). Although controversy exists about its efficacy, the BCG vaccine is able to protect newborns and children against disseminated forms of TB, but fails to protect adults against active forms of TB. In the last few years, interest in the mucosal delivery route for the vaccine has been increasing owing to its increased capacity to induce protective immune responses both in the mucosal and the systemic immune compartments. Here, we show the importance of this route of vaccination in newly developed vaccines, especially for vaccines against TB.

The main sceneries of Chagas disease transmission. The vectors, blood and oral transmissions - A comprehensive review

This review deals with transmission ofTrypanosoma cruziby the most important domestic vectors, blood transfusion and oral intake. Among the vectors,Triatoma infestans,Panstrongylus megistus, Rhodnius prolixus,Triatoma dimidiata, Triatoma brasiliensis,Triatoma pseudomaculata, Triatoma sordida,Triatoma maculata, Panstrongylus geniculatus,Rhodnius ecuadoriensis and Rhodnius pallescens can be highlighted. Transmission of Chagas infection, which has been brought under control in some countries in South and Central America, remains a great challenge, particularly considering that many endemic countries do not have control over blood donors. Even more concerning is the case of non-endemic countries that receive thousands of migrants from endemic areas that carry Chagas disease, such as the United States of America, in North America, Spain, in Europe, Japan, in Asia, and Australia, in Oceania. In the Brazilian Amazon Region, since Shaw et al. (1969) described the first acute cases of the disease caused by oral transmission, hundreds of acute cases of the disease due to oral transmission have been described in that region, which is today considered to be endemic for oral transmission. Several other outbreaks of acute Chagas disease by oral transmission have been described in different states of Brazil and in other South American countries.

Update on oral Chagas disease outbreaks in Venezuela: epidemiological, clinical and diagnostic approaches

Orally transmitted Chagas disease has become a matter of concern due to outbreaks reported in four Latin American countries. Although several mechanisms for orally transmitted Chagas disease transmission have been proposed, food and beverages contaminated with whole infected triatomines or their faeces, which contain metacyclic trypomastigotes of Trypanosoma cruzi, seems to be the primary vehicle. In 2007, the first recognised outbreak of orally transmitted Chagas disease occurred in Venezuela and largest recorded outbreak at that time. Since then, 10 outbreaks (four in Caracas) with 249 cases (73.5% children) and 4% mortality have occurred. The absence of contact with the vector and of traditional cutaneous and Romana’s signs, together with a florid spectrum of clinical manifestations during the acute phase, confuse the diagnosis of orally transmitted Chagas disease with other infectious diseases. The simultaneous detection of IgG and IgM by ELISA and the search for parasites in all individuals at risk have been valuable diagnostic tools for detecting acute cases. Follow-up studies regarding the microepidemics primarily affecting children has resulted in 70% infection persistence six years after anti-parasitic treatment. Panstrongylus geniculatushas been the incriminating vector in most cases. As a food-borne disease, this entity requires epidemiological, clinical, diagnostic and therapeutic approaches that differ from those approaches used for traditional direct or cutaneous vector transmission.

Comunicação oral com pacientes hematológicos: comportamentos facilitadores e bloqueadores

Neste estudo descritivo, adotamos o modelo de FORREST (1983) para categorização das emissões orais dos elementos da equipe de enfermagem ao prestarem assistência a pacientes hematológicos com alterações oncológicas. Buscando identificar a freqüência das categorias facilitadoras(F) e bloqueadoras(B) da comunicação, bem como de suas subcategorias, observamos, com o registro em vídeo, as interações entre 8 pacientes e 14 membros da equipe de Enfermagem de um Hospital Escola da cidade de Ribeirão Preto-SP. Registramos 8822 categorias sendo 56,9% facilitadoras(F). Dentre estas as mais freqüentes foram: dando informações (50,3%) clarificando (28,0%) e reconhecendo presença (11,2%). Das bloqueadoras(B), as mais frequentes foram: questões fechadas (64,6%), aconselhamento (13,9%) e aprovando ou concordando (10%). As demais subcategorias (F e B) obtiveram freqüências inferiores a 4,5%. Sugerimos maior emprego das outras categorias facilitadoras e, em situações especiais, o uso de questões fechadas. Acreditamos ser fundamental para o aprofundamento da relação equipe de enfermagem-pacientes a redução da subcategoria aconselhamento e aprovações da forma como vêm sendo empregados.

A pesquisa em saúde infantil: a técnica do relato oral e o depoimento de mães

Os coeficientes de morbimortalidade infantil apontam alguns fatores aos quais determinados grupos considerados de risco estão expostos, mas não revelam as reais condições de sua qualidade de vida. O presente estudo tem por objetivo descrever os passos percorridos pelas autoras na construção de uma pesquisa qualitativa sobre o modo de vida materno, discutindo aspectos metodológicos referentes ao recorte do objeto e à coleta de dados, em particular, à utilização da técnica de relato oral e as vantagens e dificuldades que esta apresenta. A narrativa das mães possibilita conhecer as necessidades, preocupações e estratégias que elas utilizam para cuidar da saúde dos filhos, bem como, determinações sociais mais amplas de suas condições de existência. Desta forma, o conhecimento gerado é importante para a organização das políticas e práticas sociais desenvolvidas pelo setor saúde.

História oral de vida: buscando o significado da hemodiálise para o paciente renal crônico

Este artigo tem como objetivo mostrar a utilização da história oral de vida como referencial metodológico para obtenção de dados qualitativos, buscando compreender o significado da hemodiálise e o impacto desta modalidade terapêutica na vida de pacientes do serviço de Hemodiálise do Hospital Universitário da Universidade de São Paulo.

Variabilidade circadiana da temperatura oral, timpânica e axilar em adultos hospitalizados

Este estudo teve como objetivo verificar a variabilidade circadiana da temperatura timpânica, oral e axilar, considerando o ângulo de medida. Realizou-se em um hospital de ensino HC-Unicamp, na cidade de Campinas-SP. Os dados foram coletados a cada duas horas, por dois dias consecutivos, a partir do horário de vigília até as 22 horas, nas enfermarias de Cardiologia, Geral de Adultos e Gastroclínica. Os resultados mostraram que as medidas dos períodos matutino e vespertino, comparadas com as do período noturno, pela análise de variância, houve diferença significativa com p-value = 0,0001. O teste de Tukey confirmou a diferença no que se refere ao nível de significância µ =0,05. Identificou-se que as medidas do termômetro timpânico mostraram temperaturas mais elevadas em relação aos outros termômetros, confirmando os dados das literaturas internacionais e também demonstrando que a curva de ritmicidade circadiana foi similar à obtida pelas medidas do termômetro oral durante o período de vigília.

Evaluación del razonamiento científico y comunicación oral y escrita en el licenciado en enfermería

Estudio descriptivo, transversal, realizado en Santiago de Chile. Tuvo como objetivo evaluar el razonamiento científico y comunicación oral y escrita en el licenciado en enfermería. Muestra constituida por 37 estudiantes licenciados en la carrera de enfermería. La investigación fue diseñada en tres etapas: I) creación y validación del instrumento; II) capacitación del equipo de docentes participantes para la aplicación uniforme del instrumento; III) aplicación del instrumento y análisis de datos. Los principales resultados muestran porcentajes diferentes de competencia obtenidos por los licenciados en enfermería, prevaleciendo el logro del razonamiento científico (83,16%); seguido de la comunicación oral y escrita (78,37%). Esta investigación muestra la utilidad para las Escuelas de Enfermería de implementar un sistema para evaluar el perfil de egresados del grado de licenciado en enfermería que garantice la calidad de la formación.