Urban malaria in the Brazilian Western Amazon Region I: high prevalence of asymptomatic carriers in an urban riverside district is associated with a high level of clinical malaria

Cross sectional studies on malaria prevalence was performed in 2001, 2002, and 2004 in Vila Candelária, an urban riverside area of Porto Velho, Rondônia, in the Brazilian Western Amazon, followed by longitudinal surveys on malaria incidence. Vila Candelária is a working class district, provided with electricity, water supply, and basic sanitation. Previous preliminary surveys indicated high malaria incidence in this community. At the end of year 2000 regular diagnostic and treatment measures for malaria were introduced, with active search of febrile cases among residents. Despite of both rapid treatment of cases and relative good sanitary and housing conditions, the malaria incidence persisted at high levels during the following years with an annual parasite index of 150 to 300/1000 inhabitants. Parasite surveys in 2001, 2002, and 2004 achieved through microscopy and polymerase chain reaction to diagnose malaria showed a constant high prevalence of asymptomatic carriers for both Plasmodium falciparum and P. vivax parasites. It was concluded that asymptomatic carriers represent an important reservoirs of parasites and that the carriers might contribute to maintaining the high level of transmission. Comparing our findings to similar geo-demographic situations found in other important urban communities of the Brazilian Amazon, we propose that asymptomatic carriers could explain malaria's outbreaks like the one recently observed in Manaus.

Occurrence of hybrids and laboratory evidence of fertility among three species of the Phyllosoma complex (Hemiptera: Reduviidae) in Mexico

In seven studied communities of Western Mexico, triatomine specimens were sympatrically collected, some with atypical morphological characteristics in contrast to pure specimens, which were presumed to be hybrids. More than 200 specimens of Meccus pallidipennis and Meccus longipennis with brown-yellow markings on dorsal connexival segments were collected in Ahuacapán and Quitupan. In La Mesa, more than 60 specimens similar to Meccus picturatus in most morphological characteristics (including size) were collected, although they presented a largely yellowish corium like M. pallidipennis. Interfertility was proven between all of the studied wild hybrid specimens, as well as between all the experimental laboratory hybrids. Two different phenotypes (M. picturatus and M. longipennis) were obtained from crosses between M. picturatus x M. picturatus and M. longipennis x M. longipennis from the three studied localities in state of Nayarit as from La Mesita. Results support the hypothesis that the subspecific ranking of those triatomines may, therefore, be more appropriate because reproductive isolation has not been developed and complete interbreeding was recorded.

Bat flies on phyllostomid hosts in the Cerrado region: component community, prevalence and intensity of parasitism

Streblidae flies are specialised parasites of bat hosts, mainly phyllostomids. There is a high richness of streblids in the savannah-like Cerrado region; however, there is little quantitative data available in parasitological indices. Here, we describe the component community, prevalence and intensity of a streblid infestation on a phyllostomid bat assemblage in Serra da Bodoquena, a Cerrado region in Southwest Brazil. We conducted surveys by capturing and inspecting bat hosts during the seven-month period between October 2004-December 2005. All the ectoparasites found on the bats were collected in the field and then counted and identified in the laboratory. We captured 327 bats belonging to 13 species, of which eight species were parasitized by 17 species of streblids. Carollia perspicillata and Glossophaga soricina were infested with seven streblid species, whereas the other bat species were infested with four or fewer streblid species. Megistopoda proxima and Aspidoptera falcata flies were found on Sturnira lilium, and Trichobius joblingi was the most prevalent fly on C. perspicillata. Megistopoda aranea and Aspidoptera phyllostomatis were highly prevalent and had a high intensity of infestation on Artibeus planirostris. Overall comparisons of the available data suggest that the component communities of streblids vary more between the Cerrado and Atlantic Forest phytogeographical regions than between localities within the same phytogeographical region.

Morbidity of Chagas heart disease in the microregion of Rio Negro, Amazonian Brazil: a case-control study

A case-control study on the morbidity of Chagas heart disease was carried out in the municipality of Barcelos in the microregion of the Rio Negro, state of Amazonas. One hundred and six individuals, who were serologically positive for Trypanosoma cruzi infection, as confirmed by at least two techniques with different principles, were matched according to age and sex with an equal number of seronegative individuals. The cases and controls were evaluated using an epidemiological questionnaire and clinical, electrocardiograph and echocardiograph examinations. In the seroepidemiological evaluation, 62% of the interviewees recognised triatomines and most of them confirmed that they had seen these insects in the piassava plantations of the riverside communities of the Negro River tributaries. Of the seropositive patients, 25.8% affirmed that they had been stung by the triatomines and 11.7% denied having been stung. The principal clinical manifestations of the seropositive individuals were palpitations, chest pain and dyspnoea upon effort. Cardiac auscultation revealed extrasystoles, bradycardia and systolic murmurs. The electrocardiographic alterations were ventricular extrasystoles, left and right bundle branch block, atrioventricular block and primary T wave alterations. The echocardiogram was altered in 22.6% of the seropositive individuals and in 8.5% of the seronegative individuals.

Antibody recognition of Plasmodium falciparum infected red blood cells by symptomatic and asymptomatic individuals in the Brazilian Amazon

In the Amazon Region, there is a virtual absence of severe malaria and few fatal cases of naturally occurring Plasmodium falciparum infections; this presents an intriguing and underexplored area of research. In addition to the rapid access of infected persons to effective treatment, one cause of this phenomenon might be the recognition of cytoadherent variant proteins on the infected red blood cell (IRBC) surface, including the var gene encoded P. falciparum erythrocyte membrane protein 1. In order to establish a link between cytoadherence, IRBC surface antibody recognition and the presence or absence of malaria symptoms, we phenotype-selected four Amazonian P. falciparum isolates and the laboratory strain 3D7 for their cytoadherence to CD36 and ICAM1 expressed on CHO cells. We then mapped the dominantly expressed var transcripts and tested whether antibodies from symptomatic or asymptomatic infections showed a differential recognition of the IRBC surface. As controls, the 3D7 lineages expressing severe disease-associated phenotypes were used. We showed that there was no profound difference between the frequency and intensity of antibody recognition of the IRBC-exposed P. falciparum proteins in symptomatic vs. asymptomatic infections. The 3D7 lineages, which expressed severe malaria-associated phenotypes, were strongly recognised by most, but not all plasmas, meaning that the recognition of these phenotypes is frequent in asymptomatic carriers, but is not necessarily a prerequisite to staying free of symptoms.

Updated distribution of Aedes albopictus (Diptera: Culicidae) in Spain: new findings in the mainland Spanish Levante, 2013

In 2004, Aedes (Stegomyia) albopictus (Skuse, 1894) was observed for the first time in Catalonia, northeastern Spain. A decade later, it has spread throughout the eastern Mediterranean region of the country and the Balearic Islands. Framed within a national surveillance project, we present the results of monitoring in 2013 in the autonomous communities of the mainland Levante. The current study reveals a remarkable increase in the spread of the invasive mosquito in relation to results from 2012; the species was present and well-established in 48 municipalities, most of which were along the Mediterranean coastline from the Valencian Community to the Region of Murcia.

Role of complementary therapies in the understanding of primary healthcare professionals: a systematic review

Objective To identify the understanding of the healthcare professionals in relation to the role of complementary therapies in primary health care. Method Systematic review by way of the following information sources: PubMed, CINAHL, PeriEnf, AMED, EMBASE, Web of Science, Psicoinfo and Psicodoc, using the keyword Primary Health Care alone, and associated with the following keywords: Medicinal Plants, Herbal Medicine, Homeopathy, Traditional Chinese Medicine, Acupuncture, Anthroposophical Medicine. Results Twenty-two studies from 1986 to 2011 were included. We identified three styles of practice: conventional medicine, complementary therapies and integrative medicine. Positioning professional practices within these three styles may facilitate discussion of concepts of health care, enhancing the health care provided as a result. Conclusion The work process in primary care presents difficulties for conducting integrative and holistic health care, but this practice has been introduced over time by professionals who integrate conventional medicine and complementary therapies, concerned with the care and well-being of patients.


Empowering a group of seniors in a rural community

OBJECTIVE To describe the stages of the empowerment process of a group of seniors in a rural community. METHOD Convergent care research whose foundation is to use the scope of practice. Conducted with the proposal to change the practice of 21 seniors and nine health professionals, with the aim of health promotion empowerment. Data were collected during 22 meetings, and group interviews at the end of the intervention. RESULTS Showed that despite the initial impact of the change, the group was able to welcome the new change, taking advantage of the space to express anxieties, share joys, and build new knowledge, which led to the incorporation of changes that reflected in the development of healthy habits and improvements in interpersonal relationships. CONCLUSION The convergent care research consisted of strategy that changed the group's lives, empowering them with health promoting actions.

Sex ratios in juveniles and adults of Dichroplus maculipennis (Blanchard) and Borellia bruneri (Rehn) (Orthoptera: Acrididae)

Dichroplus maculipennis and Borellia bruneri are two of the 18 grasshopper species of actual or potential economic relevance as pests in Argentina. The objective of this study was to estimate the sex ratios for adults and older nymphs of D. maculipennis and B. bruneri in the field, and analyze possible temporal variations. The study was conducted during seven seasons (2005-06 to 2011-12) in representative plant communities of the southern Pampas region. A total of 4536 individuals of D. maculipennis, and 6038 individuals of B. bruneri were collected. The sex ratio registered in older nymphs for D. maculipennis and B. bruneri did not deviate from a 1:1 ratio (p > 0.05), suggesting that these species have such a primary sex ratio. However, a significant bias in sex composition in adults of both species was observed (p < 0.05). The sex ratio in adults of D. maculipennis was different in five of the 18 sampling dates carried out. In three sampling dates it was biased toward males, while in the other two it was biased toward females. Taking into account the sex ratio by sampling season, significant differences were recorded in two seasons. In 2007-08 the sex ratio was biased toward males (1 F:2.26 M), while in 2008-09 it was biased toward females (1.35 F:1 M). The sex ratio in adults of B. bruneri was always biased toward males (p < 0.05). We conclude that results obtained in this study indicate that various factors like differential survival, dispersion, predation, among others, could have modified the primary sex ratio in these species.

Faunistic analysis of Carabidae and Staphylinidae (Coleoptera) in five agroecosystems in northeastern São Paulo state, Brazil

The objective of this study was to determined species composition and community structure of Carabidae and Staphylinidae in five areas of forest fragment and soybean/corn crops or orange orchard, from December 2004 to May 2007. Beetles were captured in pitfall traps distributed along two parallel transects of 200 m in length, placed across crop land/forest boundary fragment, with 100 m each. The Shannon-Wiener diversity and evenness indexes and Morisita similarity index were calculated. The carabids Abaris basistriatus Chaudoir, Calosoma granulatum Perty, Megacephala brasiliensis Kirby, Odontochila nodicornis (Dejean) and Selenophorus seriatoporus Putzeys. are dominant and are widely distributed in northeastern São Paulo state, Brazil. Point-scale species diversity was greatest at the transition between forest fragment and cultivated area. The carabid and staphylinid communities of the forest fragment were more similar to the community of orange orchard than that of soybean/corn crops.

Epidemiological survey of the taeniasis/cysticercosis complex in cattle farms in Viçosa County, Minas Gerais, Brazil

Despite the importance of human taeniasis/bovine cysticercosis for public and animal health and the economy, its actual epidemiological status in Brazil is not well-studied. We sought to assess the epidemiological profile of this zoonosis in the rural area of Viçosa County, Minas Gerais, Brazil. The prevalence of bovine cysticercosis was 0.42%, whereas no case of human taeniasis was diagnosed. Factors favoring the persistence of zoonosis were identified. These included the supply of untreated water to animals, animals raised for slaughter without sanitary supervision, poor mechanization of raising techniques, and the use of untreated water for human consumption. Bovine meat for human consumption acquired in the city or from the farm itself was characterized as a risk factor for bovine cysticercosis (Odds Ratio (OR) =16.77; p<0.05). Nevertheless, the families on the investigated farms did apply several appropriate measures to control this disease, such as the virtual lack of open sewers and the consumption of well-cooked meat. The presence of bovine cysticercosis cases, and the factors favoring its persistence, point to the need for constant epidemiological and sanitary surveillance in this county.

Phytoplankton flora of two rivers in Southeast Brazil: Paraibuna and Pomba Rivers, Minas Gerais

This work is a survey of the phytoplankton communities of the Paraibuna and Pomba Rivers. It aims is to contribute to the existing albeit scarce knowledge of the phytoplankton of Minas Gerais and of lotic phytoplankton in general. The results are based on 32 samples collected from Paraibuna and Pomba Rivers, in Minas Gerais State, during the dry (July and August, 2001) and rainy seasons (February 2002). Forty-eight taxa were identified, 20 from Paraibuna River and 28 from Pomba River, thirty-eight of which are new records for Minas Gerais State. The phytoplankton community of Paraibuna River was strongly influenced by a reservoir close to its source, thus the occurrence of lentic species of cyanobacteria and desmids. However, the phytoplankton community of Pomba River was typical of lotic environments, with great number of diatoms and desmids.

Can course format influence the performance of students in an advanced cardiac life support (ACLS) program?

Advanced cardiac life support (ACLS) is a problem-based course that employs simulation techniques to teach the standard management techniques of cardiovascular emergencies. Its structure is periodically revised according to new versions of the American Heart Association guidelines. Since it was introduced in Brazil in 1996, the ACLS has been through two conceptual and structural changes. Detailed documented reports on the effect of these changes on student performance are limited. The objective of the present study was to evaluate the effect of conceptual and structural changes of the course on student ACLS performance at a Brazilian training center. This was a retrospective study of 3266 students divided into two groups according to the teaching model: Model 1 (N = 1181; 1999-2003) and Model 2 (N = 2085; 2003-2007). Model 2 increased practical skill activities to 75% of the total versus 60% in Model 1. Furthermore, the teaching material provided to the students before the course was more objective than that used for Model 1. Scores greater than 85% in the theoretical evaluation and approval in the evaluation of practice by the instructor were considered to be a positive outcome. Multiple logistic regression was used to adjust for potential confounders (specialty, residency, study time, opportunity to enhance practical skills during the course and location where the course was given). Compared to Model 1, Model 2 presented odds ratios (OR) indicating better performance in the theoretical (OR = 1.34; 95%CI = 1.10-1.64), practical (OR = 1.19; 95%CI = 0.90-1.57), and combined (OR = 1.38; 95%CI = 1.13-1.68) outcomes. Increasing the time devoted to practical skills did not improve the performance of ACLS students.

Effect of the implementation of the Hazard Analysis Critical Control Point (HACCP) prerequisite program in an institutional foodservice unit in Southern Brazil

The aims of this study were to investigate the hygienic practices in the food production of an institutional foodservice unit in Southern Brazil and to evaluate the effect of implementing good food handling practices and standard operational procedures using microbiological hygiene indicators. An initial survey of the general operating conditions classified the unit as regular in terms of compliance with State safety guidelines for food service establishments. An action plan that incorporated the correction of noncompliance issues and the training of food handlers in good food handling practices and standard operational procedures were then implemented. The results of the microbiological analysis of utensils, preparation surfaces, food handlers' hands, water, and ambient air were recorded before and after the implementation of the action plan. The results showed that the implementation of this type of practice leads to the production of safer foods.

Room temperature aging to guarantee microbiological safety of Brazilian artisan Canastra cheese

Canastra cheese is one of the oldest and most traditional cheeses made from raw milk in Brazil. However, this type of practice may have severe consequences for human health. According to the current legislation, any cheese made from raw milk must be aged for at least 60 days. Traditionally, Canastra cheese is consumed after different ripening periods, but consumers usually prefer those that are aged less than eight days. This study aimed to evaluate the effects of physicochemical and microbiological parameters, with emphasis on the pathogenic microbiota regulated by law, on cheese aged at room temperature and under refrigeration. Cheese samples were collected from eight different cheese producers located in the Serra da Canastra region twice a year (rainy and dry seasons) and analyzed with 8, 15, 22, 29, 36, and 64 days of ripening. Room temperature aging effectively reduced pathogens, reaching the total count established by law in 22 days, regardless of the season. However, ripening under refrigeration, it was ineffective in reducing the Staphylococcus aureus counts to the legislation limits, even after 64 days. Therefore, Canastra cheese should be ripened for at least 22 days at room temperature in order to fulfill the safety regulatory limits.