Hábitos alimentares, infecção natural e distribuição de triatomíneos domiciliados na região central do Brasil

Apresentam-se as informações obtidas no inquérito triatomíneo levado a efeito na região central do Brasil. As características biogeográficas incluem a existência de áreas abertas dos cerrados e amplas faixas transicionais com outras feições paisagísticas. Dentre estas destacam-se a floresta tropical atlântica e a presença de extensas inclusões florestadas (florestas, galerias e capões de matas de diferentes ordens de grandeza). No período de 1975/1980 foram examinados 3.160 triatomíneos coletados no ambiente domiciliar, objetivando detectar a presença de sangue ingerido e de infecção natural por Trypanosoma tipo cruzi. Por ordem de freqüência, as espécies encontradas foram Triatoma infestans (43,5%), Triatoma sordida (33,0%) e Panstrongylus megistus (23,5%) e algumas outras menos freqüentes. A presença de sangue foi detectada em 35,9% e a infecção em 2,2% desse total de espécimens examinados. Na mobilidade alimentar obteve-se coeficientes gerais de 54,0% para ave e 30,0% para homem. De maneira específica, revelaram-se apreciáveis níveis de antropofilia para T. infestans e de ornitofilia para T. sordida. Quanto a P. megistus, se bem que encontrado frequentemente com sangue de mamíferos, apresentou também boa presença de sangue de ave. A presença de sangue humano em exemplares coletados no peridomicílio evidenciou a ocorrência de mobilidade espacial, em especial modo por parte de P. megistus e T. sordida. A distribuição geográfica mostrou o caráter autóctone de T. sordida em relação ao domínio de cerrado, com poder invasivo para o das áreas florestadas. O inverso verificou-se com relação a P. megistus, enquanto que T. infestans revelou seu aspecto invasivo para ambas as regiões, sob influência da atividade humana. Os resultados permitem concluir que, na transmissão regional epidemiologicamente signicante da tripanossomíase americana, desempenha papel relevante o T. infestans em primeiro lugar, e o P. megistus, em segundo. Este poderá vir a ter maior atuação, na dependência de fatores vários, como a sua capacidade de invasão domiciliar. Quanto a T. sordida, na atualidade, representa risco potencial de infestação ou reinfestação das habitações. O controle rotineiro, mediante a desinsetização domiciliar deverá fornecer bons resultados, com a eliminação da transmissão nesse ambiente. Todavia, continuará o risco de reinfestação, pelo menos no peridomicílio face aos focos extradomiciliares de P. megistus e T. sordida. Isso implicará, necessariamente, vigilância cuja eficiência estará na dependência da continuidade das pesquisas.

Planejamento de banco de leite humano e central de informações sobre aleitamento materno

Apresenta-se o planejamento das atividades e da área física do Banco de Leite Humano e Central de Informações sobre Aleitamento Materno da Maternidade Carmela Dutra, da Fundação Hospitalar de Santa Catarina. Com a implantação deste serviço, procura-se atender as necessidades dos bebês internados em Unidades de Tratamento Intensivo das Maternidades e Hospitais Infantis desta Fundação. Além de coletar, analisar, armazenar e processar adequadamente o leite doado por nutrizes voluntárias, são realizadas atividades educativas e de incentivo ao aleitamento materno junto a comunidade e aos profissionais de saúde.

Neonatal mortality in intensive care units of Central Brazil

OBJECTIVE: To identify potential prognostic factors for neonatal mortality among newborns referred to intensive care units. METHODS: A live-birth cohort study was carried out in Goiânia, Central Brazil, from November 1999 to October 2000. Linked birth and infant death certificates were used to ascertain the cohort of live born infants. An additional active surveillance system of neonatal-based mortality was implemented. Exposure variables were collected from birth and death certificates. The outcome was survivors (n=713) and deaths (n=162) in all intensive care units in the study period. Cox's proportional hazards model was applied and a Receiver Operating Characteristic curve was used to compare the performance of statistically significant variables in the multivariable model. Adjusted mortality rates by birth weight and 5-min Apgar score were calculated for each intensive care unit. RESULTS: Low birth weight and 5-min Apgar score remained independently associated to death. Birth weight equal to 2,500g had 0.71 accuracy (95% CI: 0.65-0.77) for predicting neonatal death (sensitivity =72.2%). A wide variation in the mortality rates was found among intensive care units (9.5-48.1%) and two of them remained with significant high mortality rates even after adjusting for birth weight and 5-min Apgar score. CONCLUSIONS: This study corroborates birth weight as a sensitive screening variable in surveillance programs for neonatal death and also to target intensive care units with high mortality rates for implementing preventive actions and interventions during the delivery period.

Central obesity and dietary intake in HIV/AIDS patients

OBJECTIVE: To assess the association between dietary intake and central obesity among people living with HIV/AIDS and receiving highly active antiretroviral therapy. METHODS: A cross-sectional study was conducted involving 223 adult individuals in the city of São Paulo city in 2002. The study population was classified according to central obesity, defined as waist-to-hip ratio >0.95 for men and >0.85 for women. The dietary variables studied were energy consumption (in calories and calories/kilo of body weight), macronutrients (in grams and % of energy intake), total fiber (grams) and fruit and vegetables intake (grams). The potential confounders examined were sex, skin color, age, schooling, income, body mass index, physical activity, smoking habits, peripheral CD4+ T lymphocyte count and length of protease inhibitor use. The multiple logistic regression model was performed in order to evaluate the association between central obesity and dietary intake. RESULTS: The prevalence of central obesity was 45.7% and it was associated with greater consumption of lipids: for every increase of 10g of lipid intake the odds of central obesity increased 1.28 times. Carbohydrate consumption showed negative association (OR=0.93) with central obesity after adjustment for control variables. CONCLUSIONS: The results suggest that the amount of carbohydrates and lipids in the diet, regardless of total energy intake, may modify the chance of developing central obesity in the studied population. Nutritional interventions may be beneficial for preventing central obesity among HIV/AIDS patients.

Access to medicines for acute illness in middle income countries in Central America

OBJECTIVE : To analyze the main predictors of access to medicines for persons who experienced acute health conditions. METHODS : This was a cross-sectional analytic study, based on data from household surveys. We examined the predictors of: (1) seeking care for acute illness in the formal health care system and (2) obtaining all medicines sought for the acute condition. RESULTS : The significant predictors of seeking health care for acute illnesses were urban geographic location, head of household with secondary school education or above, age under 15, severity of illness perceived by the respondent, and having health insurance. The most important predictor of obtaining full access to medicines was seeking care in the formal health care system. People who sought care in the formal system were three times more likely to receive all the medicines sought (OR 3.0, 95%CI 2.3;4.0). For those who sought care in the formal health system, the strongest predictors of full access to medicines were seeking care in the private sector, having secondary school education or above, and positive perceptions of quality of health care and medicines in public sector health facilities. For patients who did not seek care in the formal health system, full access to medicines was more likely in Honduras or Nicaragua than in Guatemala. Urban geographic location, higher economic status, and male gender were also significant predictors. CONCLUSIONS : A substantial part of the population in these three countries sought and obtained medicines outside of the formal health care system, which may compromise quality of care and pose a risk to patients. Determinants of full access to medicines inside and outside the formal health care system differ, and thus may require different strategies to improve access to medicines. 

Logística de coleta e transporte de material biológico e organização do laboratório central no ELSA-Brasil

O Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) é um estudo de coorte multicêntrico com o objetivo de identificar os fatores de risco associados ao diabetes tipo 2 e à doença cardiovascular na população brasileira. O artigo descreve as estratégias de coleta, processamento, transporte e de controle de qualidade dos exames de sangue e urina no ELSA. O estudo optou pela centralização dos exames em um único laboratório. O processamento das amostras foi realizado nos laboratórios locais, reduzindo o peso do material a ser transportado e diminuindo os custos do transporte para o laboratório central no Hospital da Universidade de São Paulo. O estudo incluiu exames para avaliação de diabetes, resistência à insulina, dislipidemias, alterações eletrolíticas, hormônios tireoidianos, ácido úrico, alterações de enzimas hepáticas, inflamação e hemograma completo. Além desses exames, foram estocados DNA de leucócitos, amostras de urina, plasma e soro. O laboratório central realizou aproximadamente 375.000 exames.

Epidemiological role of humans, dogs and cats in the transmission of Trypanosoma cruzi in a central area of Argentina

Trypanosoma cruzi prevalence rates of human, dog and cat populations from 47 households of 3 rural localities of the phytogeographical Chaqueña area of Argentina were determined both by serological and xenodiagnostic procedures. Human prevalence rates were uniform and ranged from 49.6 to 58.7%. Overall prevalence rate in dogs (75.0%) was significantly higher than in humans (51.0%). The overall proportion of parasitemic individuals assessed by xenodiagnosis was significantly higher in either dog (64.2%) or cat (63.6%) populations than among humans (12.5%). Although both the average number of resident as well as infected individuals per household was higher for people than for dogs (6.5 vs. 3.3, and 3.4 vs. 2.4, respectively), the reverse was recorded when parasitemic individuals were considered (1.0 vs. 2.1). Results are discussed in relation to dog between dogs and people, and dogs and bugs. In the light of present data, dogs must be considered as the major donors of parasites to vector bugs and thus, principal contributors to transmission in this region of Argentina.

Natural Trypanosoma cruzi infection in dogs of endemic areas of the Argentine Republic

The population dynamics and the prevalence of chagasic infection of 352 dogs living in 108 rural houses infested by triatomines were studied. The region was divided into three sections according to increasing distances to an urban area. Each animal was identified by means of its particular characteristics and built, and its owners gave information about its habits. By means of xenodiagnosis, serology and ECG studies, prevalences of infection, parasitological-serological correlation, percentage of altered electrocardiographic outlines and percentage of houses with parasitemic dogs, were determined. The rural area showed a characteristic T. cruzi infection pattern and differences in the canine population parameters with respect to the other areas were observed: a higher proportion of puppies than adult dogs, a more sedentary population, higher prevalences of infection, as measured by xenodiagnosis, in dogs, and the highest proportion of bedroom insects infected with T. cruzi. It is assumed that the sedentary characteristics of the human population in that rural area impinge in the blood offer to the triatomine population, and the high percentage of parasitemic dogs of the area, contribute to the rise of "kissing ougs" infected with T. cruzi found in bedrooms.

Sero-epidemiologia de la toxoplasmosis en dos comunidades de Rwanda (Africa Central)

Se ha estudiado la prevalência de anticuerpos antitoxoplasma en dos comunidades rurales rwandesas, utilizando sangre total desecada en papel de filtro que se procesó por la técnica de Aglutinación Directa. En ambas comunidades están afectados el 50% de los adultos. La adquisición de los anticuerpos se hace tardiamente en NGD (a los 14 años sólo un 12% de la problación muestra anticuerpos antitoxoplasma) y más pronto en NVU (31% de la población estudiada tiene anticuerpos antitoxoplasma a los 14 años). Se destaca el posible papel que juega esta enfermedad en la patología materno-fetal, y la necesidad de nuevos studios que aumenten el conocimiento de la epidemiología de la toxoplasmosis y sus mecanismos de transmisión en Rwanda.

Ocorrência de Taenia sp. na população atendida no laboratório central do Instituto Adolfo Lutz, São Paulo, SP, Brasil (1960/1989)

Foram examinados retrospectivamente os relatórios mensais e anuais da Seção de Enteroparasitoses do Laboratório Central do Instituto Adolfo Lutz, São Paulo, SP, do período de 1960 a 1989, perfazendo uma série histórica de 30 anos, com 1.519.730 exames protoparasitológicos e 355 identificações de proglotes de Taenia. Pelo método da sedimentação espontânea foram diagnosticados 7.663 (0,5%) casos de presença de ovos de Taenia sp. nas fezes. Das 355 proglotes enviadas para identificação, 311 (87,60%) estavam em condições de serem especificadas, e dessas, 273 (87,80%) eram proglotes de Taenia saginata e 38 (12,22%) de T. solium.

Associantion between leprosy and hepatitis B infecion: a survey in Goiânia, Central Brazil

This investigation presents the results of Hepatitis B virus screening among leprosy patients conducted in Central Brazil as a preliminary information for a HBV vaccination programme. The main objectives were to assess the seroprevalence of HBV serum markers among lepromatous patients and to analyse institutionalization as risk factor for HBV infection in this population. Two groups of lepromatous patients were studied, 83 outpatients and 171 institutionalized ones. Screening for HBV serum markers included the detection of HBsAg, anti-HBc by radioimmune assay (RIA). The prevalence of carrier state (HBsAg) was 4.8% and 8.8% among outpatients and institutionalized, respectively, (p>0.05). Seroprevalence of exposure (all markers) was statistically significant different between outpatients (16.9%) and institutionalized ones (50.3%). Institutionalized patients had an almost four fold risk of HBV infection when compared to the outpatients, and the highest risks were among patients with more than 21 years of residence in the colony, after adjusting for age and sex.

Central nervous system involvement in Chagas' disease: an updating

A review was made of the available literature on central nervous system (CNS) involvement in Chagas' disease. Thirty-one works concerning the acute nervous form and 17 others dealing with the chronic nervous form, all presenting neuropathologic studies, were critically analysed. Based on this analysis, an attempt was made to establish the possible natural history of CNS involvement in Chagas' disease. Among others, the following facts stand out: 1) the initial, acute phase of Trypanosoma cruzi infection is usually asymptomatic and subclinical; 2) only a small percentage of cases develop encephalitis in the acute phase of Chagas' disease; 3) the symptomatic acute forms accompanied by chagasic encephalitis are grave, with death ensuing in virtually all cases as a result of the brain lesions per se or of acute chagasic myocarditis, this being usually intense and always present; 4) individuals with the asymptomatic acute form and with the mild symptomatic acute form probably have no CNS infection or, in some cases, they may have discrete encephalitis in sparse foci. In the latter case, regression of the lesions may be total, or residual inflammatory nodules of relative insignificance may persist. Thus, no anatomical basis exists that might characterize the existence of a chronic nervous form of Chagas' disease; 5) reactivation of the CNS infection in the chronic form of Chagas' disease is uncommon and occurs only in immunosuppressed patients.

African histoplasmosis: report of the first case in Brazil and treatment with itraconazole

We report the first case of African histoplasmosis diagnosed in Brazil. The patient was an immigrant from Angola who had come to Brazil six months after the appearance of the skin lesion. The skin of the right retroauricular area was the only site of involvement. The diagnosis was established by direct mycologic examination, culture and by histopathologic examination of the lesion. The patient was successfully treated with Itraconazole 100mg a day for 52 days. No recurrent skin lesions were observed during the ten month follow-up period.

Anti-HCV related to HCV PCR and risk factors analysis in a blood donor population of Central Brazil

Data concerning HCV infection in Central Brazil are rare. Upon testing 2,350 voluntary blood donors from this region, we found anti-HCV prevalence rates of 2.2% by a second generation ELISA and 1.4% after confirmation by a line immunoassay. Antibodies against core, NS4, and NS5 antigens of HCV were detected in 81.8%, 72.7%, and 57.5%, respectively, of the positive samples in the line immunoassay. HCV viremia was present in 76.6% of the anti-HCV-positive blood donors. A relation was observed between PCR positivity and serum reactivity in recognizing different HCV antigens in the line immunoassay. The majority of the positive donors had history of previous parenteral exposure. While the combination of ALT>50 IU/l and anti-HBc positivity do not appear to be good surrogate markers for HCV infection, the use of both ALT anti-HCV tests is indicated in the screening of Brazilian blood donors.