Sexual transmission of hepatitis C virus

In order to contribute to a better understanding of the forms of acquisition of hepatitis C virus (HCV) in Brazil, with special emphasis on sexual transmission, we determined the presence of HCV infection in regular partners and in non-sexual home communicants of blood donors seen at Fundação Pró-Sangue Hemocentro de São Paulo from January 1992 to July 1996. Of 154 blood donors with HCV infection (index cases), 111 had had regular partners for at least 6 months. Sixty-eight of 111 partners were evaluated for HCV infection. Of these, 8 (11.76%) were considered to have current or previous HCV infection; a history of sexually transmissible diseases and index cases with a positive HCV-RNA test were more prevalent among partners with HCV infection. Of the 68 index cases whose partners were studied, 56 had non-sexual home communicants. Of the total of 81 home communicants, 66 accepted to be evaluated for HCV infection. None of them was HCV-positive, suggesting that the high prevalence of HCV infection among partners may be attributed at least partially to sexual transmission.

Susceptibility of peritoneal macrophage from different species of neotropical primates to Ex vivo Leishmania (L.) infantum chagasi-infection

This study examined the susceptibility of peritoneal macrophage (PM) from the Neotropical primates: Callithrix jacchus, Callithrix penicillata, Saimiri sciureus, Aotus azarae infulatus and Callimico goeldii to ex vivo Leishmania (L.) infantum chagasi-infection, the etiological agent of American visceral leishmaniasis (AVL), as a screening assay for evaluating the potential of these non-human primates as experimental models for studying AVL. The PM-susceptibility to infection was accessed by the PM-infection index (PMI) at 24, 72 h and by the mean of these rates (FPMI), as well as by the TNF-α, IL-12 (Capture ELISA) and Nitric oxide (NO) responses (Griess method). At 24h, the PMI of A. azarae infulatus (128) was higher than those of C. penicillata (83), C. goeldii (78), S. sciureus (77) and C. jacchus (55). At 72h, there was a significant PMI decrease in four monkeys: A. azarae infulatus (128/37), C. penicillata (83/38), S. sciureus (77/38) and C. jacchus (55/12), with exception of C. goeldii (78/54). The FPMI of A. azarae infulatus (82.5) and C. goeldii (66) were higher than C. jacchus (33.5), but not higher than those of C. penicillata (60.5) and S. sciureus (57.5). The TNF-a response was more regular in those four primates which decreased their PMI at 24/72 h: C. jacchus (145/122 pg/mL), C. penicillata (154/130 pg/mL), S. sciureus (164/104 pg/mL) and A. azarae infulatus (154/104 pg/mL), with exception of C. goeldii (38/83 pg/mL). The IL-12 response was mainly prominent in A. infulatus and C. goeldii which presented the highest FPMI and, the NO response was higher in C. goeldii, mainly at 72 h. These findings strongly suggest that these New World primates have developed a resistant innate immune response mechanism capable of controlling the macrophage intracellular growth of L. (L.) i. chagasi-infection, which do not encourage their use as animal model for studying AVL.

PREVALENCE OF CHAGAS DISEASE IN A RURAL AREA IN THE STATE OF CEARA, BRAZIL

SUMMARY Chagas disease is caused by Trypanosoma cruzi and affects about two to three million people in Brazil, still figuring as an important public health problem. A study was conducted in a rural area of the municipality of Limoeiro do Norte - CE, northeastern Brazil, aiming to determine the prevalence of T. cruzi infection. Of the inhabitants, 52% were examined, among whom 2.6% (4/154) were seropositive in at least two serological tests. All seropositive individuals were older than 50 years, farmers, with a low education and a family income of less than three minimum wages. Active surveillance may be an alternative for early detection of this disease.

Resultado parcial do xenodiagnóstico realizado em um grupo de pacientes serològicamente positivos para a doença de Chagas e internados no hospital São Pedro (de alienados), em Pôrto Alegre, Rio Grande do Sul, Brasil

Exames sorológicos de Imunofluorescència, Fixação do Complemento e Hemoaglutinação para a Doença de Chagas foram rezalidos em 1609 pacientes. Em 154 casos, as provas foram positivas, com um índice percentual de 9,57%. Posteriormente, 50 casos sorològicamente positivos foram submetidos ao xenodiagnústico. Os xeno-positivos revelaram um índice de 5,35% sobre o total de casos examinados e de 56% sôbre os sorològicamente positivos. Chama-se a atenção para a alta incidência de chagásicos no Hospital São Pedro, ao lado de outras considerações.

Prevalência sorológica da doença de Chagas e correlação sorológica-eletrocardiográfica em populações não selecionadas, do município de São Lourenço do Sul-RS

De um total de 545 amostras de sangue, colhidas ao acaso entre a população rural do município de São Lourenço do Sul (RS) e submetidas a reação de fixação de complemento, 21 reagiram positivamente para a Doença de Chagas (3,85%). Não houve diferença significativa com relação ao sexo, cor ou etnia, dos examinados. Os índices de prevalência mostraram-se mais elevados nas zonas periféricas do município, contíguas as áreas endêmicas dos municípios vizinhos. A análise dos eletrocardiogramas revelou 57,4% de alterações nos positivos contra 26,72% nos negativos com diferença estatisticamente significativa a favor dos positivos. A medida de tensão arterial mostrou que entre 442 pessoas acima dos 18 anos, 154 (34,84%) apresentaram valores tensionais aumentados, sem diferença significativa entre os sexos ou os grupos étnicos.

Valor do interrogatório no rastreamento de infecção chagásica

Esse trabalho apresenta análise sobre a associação entre interrogatório de picada do barbeiro e resultados da reação de fixação de complemento. O propósito foi estimar, nas condições usuais de funcionamento de um serviço de saúde, o valor diagnóstico do interrogatório sobre picada do barbeiro em infecção chagásica. Só foram incluídos aqueles indivíduos cujos exames laboratoriais estavam confirmados, positivos ou negativos. Foram retirados da análise 259 pessoas com reações divergentes. Na anamnese, ao mesmo tempo que a pergunta sobre antecedentes de picada de inseto era feita, eram mostrados 5 insetos adultos. Os resultados foram os seguintes em 2.154 pessoas: prevalência da infecção pelo exame laboratorial (14,5%) e de história positiva de contato com o barbeiro (11,5%). A coincidência de exame e história positivos ocorreu em 2,5% e de ambos negativos em 76,5%, perfazendo um total de concordância de 79% (eficiência do interrogatório). A sensibilidade do interrogatório foi baixa (17,3%) e a especificidade alta (89,5%). O valor preditivo de uma história positiva de picada de barbeiro foi de apenas 21,5% e a de história negativa, 86,5%. Esses dados apontam para a pouca utilidade de interrogatórios em rastreamento de infecção chagásica, epoderiam mesmo não serem realizados em bancos de sangue, ao menos que esforços sejam feitos para que a sua precisão seja aumentada.

Tentativa de avaliação do programa especial de controle da esquistossomose (PECE) no Estado da Paraíba, Brasil

Foi feita uma tentativa de avaliação do Programa Especial de Controle da Esquistossomose (PECE) do Ministério da Saúde do Brasil, desenvolvido pela SUCAM no Estado da Paraíba, a partir de 1976. Foram tomadas como base as 5 primeiras avaliações do Programa de 1978 a 1983 e posteriormente em 1984/85 realizados exames quantitativos de fezes em uma amostra de 9.155 indivíduos e exame clínico em 1.036 positivos, em 3 municípios selecionados nas principais regiões hidrográficas, onde o programa vem sendo realizado. As 5 primeiras avaliações realizadas pela SUCAM de 1978 a 1983 nos 47 municípios trabalhados, 23 na região do Mamanguape, 18 na região do Paraíba, 5 na região Litoral Sul e um na região do Curimataú, demonstraram uma queda da prevalência média inicial da esquistossomose de 28% para 4,9% na região do Mamanguape, de 20,9% para 5,9% na região do Paraíba, de 40,2%para 18,9% na região Litoral Sul e de 4,9para 1,4% na região do Curimataú. Em nível de localidade, entretanto, permaneciam com prevalência igual ou superiora 20%, 36(10,9%) das 329 avaliadas na região do Mamanguape, 40(13,6%) das 293 na região do Paraíba e 43 (47,2%) das 91 da região Litoral Sul. Nos municípios tomados como amostra para exame clínico e quantitativo de fezes no ano de 1985 verificou-se que em Cuitegi, na região do Mamanguape, dos 3.494 examinados 154 (4,4%) eliminavam em média 123 ovos de S. mansoni por grama de fezes, nenhum tinha a forma hepatoesplênica e 20(12,9%) tinham fígado palpável. Em Mari, na região do Paraíba, dos 3.735 examinados 410 (10,9%) estavam positivos eliminando em média 165,9 ovos de S. mansoni por grama de fezes; apenas um (0,24%) tinha a forma hepatoesplênica e 48 (11,7%) tinham fígado palpável. Em Alhandra, na região Litoral Sul, dos 1.926 examinados 472 (24,5%) eliminavam em média 115,4 ovos de S. mansoni por grama de fezes, 3,6% eram hepatoesplênicos e 81 (17,1%) tinham fígado palpável. Em estudo anterior realizado na sede desse município em 1979, 24,2% da população era positiva, eliminando em média 211 ovos de S. mansoni por grama de fezes, 2,4% tinham a forma hepatoesplênica e apenas 3% tinham fígado palpável.

Estudo sobre triatomíneos e reservatórios silvestres de Trypanosoma cruzi no estado do Paraná, Sul do Brasil. Resultados preliminares

Em localidades da zona rural de cinco municípios da região noroeste do Paraná adultos e ninfas de Triatoma sordida foram capturados em 21 (41,2%) de 51 unidades domiciliares pesquisadas. Foram capturados 154 exemplares de T. sordida e 2 Panstrongylus megistus. De 135 exemplares examinados 58 (43,0%) apresentavam o Trypanosoma tipo cruzi. Constatou-se também a infecção em 57,1% (4/7) dos gambás (Didelphis sp) examinados. O peridomicílio apresentou-se mais infestado que o intradomicílio, sendo a casa de madeira abandonada a construção mais freqüente (34,7% do total investigado) e com maior taxa de infestação (53,9%). Os dados mostram um elevado índice de infestação da zona rural por espécies secundárias de triatomíneos com altas taxas de infecção por flagelados do tipo T. cruzi, em uma área endêmica para a doença de Chagas já em fase de vigilância epidemiológica.

Estudo clínico durante 13 anos de 190 chagásicos crônicos de Mambaí, Goiás, Brasil

Foram estudados prospectivamente 190 chagásicos, do ponto de vista clínico, eletrocardiográfico e abreugráfico do esôfago, no período médio de 13 anos, sendo encontrados 108 (56,8%) com a forma clínica inalterada, 72 (37,9%) com doença progressiva e 10 (5,3%) nos quais houve normalização do eletrocardiograma. Nos 72, em que a doença progrediu, 39 desenvolveram cardiopatia ou agravaram a já existente, 32 evoluíram para, ou pioraram o megaesôfago prévio e, 12 evoluíram para colopatia ou agravaram a já existente. Dentre os 72, 11 tinham formas clínicas associadas. A evolução da cardiopatia foi maior no sexo masculino 29,6% (21/71) que no feminino 15,1% (18/119), p = 0,015. Houve 19 casos novos de cardiopatia e 20 agravaram a cardiopatia prévia. A incidência de megaesôfago foi 14,9% (23/154) e nove agravaram o megaesôfago já existente. A evolução da colopatia foi maior no sexo feminino 9,2% (11/119), que no masculino 1,4% (1/71), p =0,026.

Sorovares de Listeria monocytogenes e espécies relacionadas, isoladas de material clínico humano

A análise fenotípica de 255 amostras do gênero Listeria isoladas de material clínico humano, tanto de indivíduos doentes (220-86,3%), como de aparentemente normais (35-13,7%) de várias regiões do país e colecionadas no período de 1969 a 2000, permitiu caracterizar a distribuição de sorovares de Listeria monocytogenes. Nas faixas etárias de 0 a 10 e de 41 a 60 anos, predominaram os isolamentos de líquido cefalorraquidiano sobre os de sangue, incluindo dos transplantados renais. Somente dos hemocultivos foi possível detectar os sete sorovares de Listeria monocytogenes. No cômputo geral, o sorovar 4b foi o mais incidente (154-60,3%) secundado por ¹/2 a (74-29%) nos três decênios considerados, além de ocorrerem em quase todas as regiões do país. Os dados deste estudo evidenciaram a circulação de L. monocytogenes na espécie humana, provocando quadros graves de meningite e septicemia, bem como, revelando a figura do portador assintomático, razão pela qual são recomendadas novas investigações bacteriológicas, subsidiadas por análises clínico-patológicas e epidemiológicas.

Evolution of coauthorship networks: worldwide scientific production on leishmaniasis

Introduction Collaboration is one of the defining features of contemporary scientific research, and it is particularly important with regard to neglected diseases that primarily affect developing countries. Methods The present study has identified publications on leishmaniasis in the Medline database from 1945 to 2010, analyzing them according to bibliometric indicators and statistics from social network analysis. Examining aspects such as scientific production, diachronic evolution, and collaboration and configuration of the research groups in the field, we have considered the different types of Leishmania studied and the institutional affiliation and nationality of the authors. Results Seven-hundred and thirty-five authors participate in 154 prominent research clusters or groups. Although the most predominant and consolidated collaborations are characterized by members from the same country studying the same type of Leishmania, there are also notable links between authors from different countries or who study different clinical strains of the disease. Brazil took the lead in this research, with numerous Brazilian researchers heading different clusters in the center of the collaboration network. Investigators from the USA, India, and European countries, such as France, Spain, the United Kingdom, and Italy, also stand out within the network. Conclusions Research should be fostered in countries such as Bangladesh, Nepal, Sudan, and Ethiopia, where there is a high prevalence of different forms of the disease but limited research development with reference authors integrated into the collaboration networks.

Spatial analysis of visceral leishmaniasis in the municipality of Rondonópolis, in the Brazilian State of Mato Grosso, from 2003 to 2012: human, canine and vector distribution in areas of disease transmission

INTRODUCTION: Visceral leishmaniasis (VL) is a zoonosis of great importance to public health and is considered a neglected disease by the World Health Organization. The disease has expanded and become more prevalent in urban areas in Brazil. METHODS: Geospatial analyses were performed and thematic maps of the triad of the disease were produced for the study period (2003-2012) in the urban area of the municipality of Rondonópolis in the midwestern State of Mato Grosso (MT), Brazil, TerraView 4.2.2 software was used for the analyses. RESULTS: A total of 87.9% of the 186 confirmed human cases of VL were cured. Children between the ages of 1 and 4 were the most affected. Registered deaths were predominant among adults aged 60 years or older. The urban area of the municipality consists of eight strata and 12 census districts include 237 neighborhoods. All sectors had confirmed cases of VL. During the study period, human cases of the disease were recorded in 90 neighborhoods. The 23 deaths from the disease were distributed in 21 neighborhoods. Sandflies carrying the parasite were captured in 192 out of 200 neighborhoods evaluated for the presence of the VL vector. The presence of dogs carrying the parasite was confirmed in, 140 out of 154 surveyed neighborhoods. CONCLUSIONS: The data demonstrated the endemic nature of VL, with a high percentage of infected children, a high distribution of canine infection, and a wide adaptation and dispersal of the vectors in the urban environment. These results, illustrate the process of urbanization of VL in the municipality of Rondonópolis, MT, Brazil.

Gastric and colorectal cancer mortality in an urban and industrialized area of Brazil

PURPOSE: To study the gastric and colorectal cancer mortalities and their relation to the urban-industrialization in Baixada Santista, located in the southeastern region of Brazil. METHODS: Selected from the registries of the State System of Data Analysis Foundation (SEADE) were 1105 deaths due to gastric cancer (ICD 153--154) and 690 due to colorectal cancer (ICD 151) that occurred from 1980 to 1993 in males, above 10 years of age, residing in Baixada Santista. For each of these types of cancer, the standardized mortality rates, age-adjusted by world population in the 1960s, for 4 industrialized and 4 non-industrialized urban communities in that region were calculated. The ratios among those rates were calculated in order to compare the mortality in the periods 1980--93, 1980--1986, and 1987--1993. RESULTS: Standardized mortality rates for colorectal cancer were significantly higher in industrialized area, with ratios of 1.6 [95% CI 1.22 -- 2.29], 1.6 [95% CI 1.2 -- 2.0], and 1.6 [95% CI 1.3 -- 2.0] in the periods 1980--86, 1987--1993 and 1980--93, respectively. Gastric cancer did not show any statistical difference between the industrialized and non-industrialized areas, but there was a significant decrease in BS from the period 1980--1986 to 1987--1993. CONCLUSIONS: The significant elevation of colorectal cancer mortality in the industrialized area could be related to exposure to numerous carcinogens such as aromatic hydrocarbon, organic-chloride, metals, and industrial-port dust present in the region. Alternatively, the non-significant difference in gastric cancer between industrialized and non-industrialized areas and significant decrease in the last few years could be predominately reflecting the advances in the quality of life in urban areas. These results require further case-control studies that could help with the analysis of the associations among cancer and environmental factors (occupational, urban-industrial, habit, and life condition) and genetic susceptibility.

Comorbidities of mental and behavioral disorders in chemically dependent patients in different periods of abstinence

OBJECTIVE: To assess the frequency of comorbidities of mental and behavioral disorders (CMBD) in psychoactive substance (PAS)-dependent patients with different periods of abstinence cared for at Alcohol and Other Drug Psychosocial Care Centers (CAPS-ad). METHOD: All patients under treatment in the two CAPS-ad of the city of Uberlândia-MG, between April and September 2010, were consecutively assessed. The ICD-10 symptom checklist was used to diagnose CMBD; additional information was obtained from interviews and medical records. The patients were divided according to duration of abstinence: < 1 week (Group 1); 1-4 weeks (Group 2); and > 4 weeks (Group 3). RESULTS: Of all patients assessed, 62.8% were diagnosed with CMBD, which were more frequent (p < 0.05) in Group 1 (72%) than Group 3 (54.2%), and both groups were similar to Group 2 (61%). Depressive and anxiety disorders were more frequent among patients of Group 1. Mood disorders were more frequent (p < 0.05) in women [22/34 (65%) vs. 54/154 (35.1%)], whereas psychotic disorders were more frequent (p = 0.05) in men [16/154 (10.4%) vs. 0]. The presence of CMBD was associated with more severe clinical conditions. CONCLUSIONS: The higher frequency of diagnosis of CMBD in patients of Group 1 may have resulted from the difficulties in distinguishing mental disorders that are due to PAS intoxication or withdrawal from those that are not. However, to make the diagnosis of CMBD, even during detoxification, can increase the likelihood of better response to treatment.

Quantitative study of myocardial microcirculation in arterial hypertension due to progressive inhibition of NO synthesis

OBJECTIVE: To study the quantitative changes in intramyocardial blood vessels in rats in whom nitric oxide synthesis was inhibited. METHODS: Four groups of 10 rats were studied: control (C25 and C40) and L-NAME (L25 and L40). The animals L25 and L40 received L-NAME in the dosage of 50mg/kg/day for 25 and 40 days, respectively. On days 26 and 41 the animals in groups 25 and 40 were sacrificed. Analysis of the myocardium was performed using light microscopy and stereology. RESULTS: Arterial blood pressure and heart weight increased 74.5 and 57.8% after 25 days and 90.2 and 34.6% after 40 days, respectively. Comparing the L-NAME rats with the respective controls revealed that vessel volume density decreased 31.3% after 40 days, and the vessel length-density decreased 53.5% after 25 days and 25.7% after 40 days. The mean cross-sectional area of the vessels showed an important reduction of 154.6% after 25 days. The intramyocardial vessels decreased significantly in length- density in the L-NAME animals. The mean cross-sectional area of the vessels, which normally increases during heart growth between 25 and 40 days, showed a precocious increase by the 25th day in the L-NAME rats. This suggests an increase of the size of the heart, including blood vessels. CONCLUSION: The inhibition of the NO synthesis provokes rarefaction in the intramyocardial vessels that progresses with the time of administration of L-NAME.