Specialized care for people with AIDS in the state of Ceara, Brazil

OBJECTIVE To analyze if the distribution of specialized care services for HIV/AIDS is associated with AIDS rates. METHODS Ecological study, for which the distribution of 10 specialized care services in the Ceara state, Northeastern Brazil, was obtained, and the mean rates of the disease were estimated per mesoregion. We evaluated 7,896 individuals who had been diagnosed with AIDS, were aged 13 years or older, lived in Ceara, and had been informed of their condition between 2001 and 2011. Maps were constructed to verify the relationship between the distribution of AIDS cases and institutionalized support networks in the 2001-2006 and 2007-2011 periods. BoxMap and LisaMap were used for data analysis. The Voronoi diagram was applied for the distribution of the studied services. RESULTS Specialized care services concentrated in AIDS clusters in the metropolitan area. The Noroeste Cearense and west of the Sertoes Cearenses had high AIDS rates, but a low number of specialized care services over time. Two of these services were implemented where clusters of the disease exist in the second period. The application of the Voronoi diagram showed that the specialized care services located outside the metropolitan area covered a large territory. We identified one polygon that had no services. CONCLUSIONS The scenario of AIDS cases spread away from major urban areas demands the creation of social support services in areas other than the capital and the metropolitan area of the state; this can reduce access barriers to these institutions. It is necessary to create specialized care services for HIV/AIDS in the Noroeste Cearense and north of Jaguaribe.

Difficulties in access and estimates of public beds in intensive care units in the state of Rio de Janeiro

ABSTRACT OBJECTIVE To estimate the required number of public beds for adults in intensive care units in the state of Rio de Janeiro to meet the existing demand and compare results with recommendations by the Brazilian Ministry of Health. METHODS The study uses a hybrid model combining time series and queuing theory to predict the demand and estimate the number of required beds. Four patient flow scenarios were considered according to bed requests, percentage of abandonments and average length of stay in intensive care unit beds. The results were plotted against Ministry of Health parameters. Data were obtained from the State Regulation Center from 2010 to 2011. RESULTS There were 33,101 medical requests for 268 regulated intensive care unit beds in Rio de Janeiro. With an average length of stay in regulated ICUs of 11.3 days, there would be a need for 595 active beds to ensure system stability and 628 beds to ensure a maximum waiting time of six hours. Deducting current abandonment rates due to clinical improvement (25.8%), these figures fall to 441 and 417. With an average length of stay of 6.5 days, the number of required beds would be 342 and 366, respectively; deducting abandonment rates, 254 and 275. The Brazilian Ministry of Health establishes a parameter of 118 to 353 beds. Although the number of regulated beds is within the recommended range, an increase in beds of 122.0% is required to guarantee system stability and of 134.0% for a maximum waiting time of six hours. CONCLUSIONS Adequate bed estimation must consider reasons for limited timely access and patient flow management in a scenario that associates prioritization of requests with the lowest average length of stay.

Surto de larva migrans cutnea em uma creche de belo horizonte, minas gerais (Brasil)

O presente trabalho relata a ocorrência de um surto de Larva migrans cutânea, em 17 crianças de uma creche em Belo Horizonte, MG. As crianças adquiriram esta dermatose quando brincavam em uma caixa de areia contaminada com larvas infectantes de ancilostomídeos de cão.

Morbidade da esquistossomose e sua relação com a contagem de ovos de Schistosoma mansoni em uma zona hiperendêmica do Estado de Minas Gerais

Um estudo seccional da esquistossomose foi desenvolvido em Comercinho, cidade de 1474 habitantes situada em Minas Gerais. Foram feitos exame de fezes pelo método de KATO-KATZ e exame clínico em, respectivamente, 90 e 80% da população da cidade. Foram estudados os sinais e sintomas apresentados pelos pacientes com diferentes contagens de ovos de S. mansoni, verificando-se que as alterações do tamanho e da consistência do fígado estavam relacionadas à maior eliminação de ovos (> 1000/gr fezes) nos pacientes com 2-14 anos de idade, mas não nos pacientes mais velhos. Os seguintes sinais clínicos foram mais freqüentes nos pacientes que eliminavam ovos de S. mansoni nas fezes, quando comparados ao grupo controle (sem ovos do parasita nas fezes, sem história de tratamento e com reação intradérmica negativa): a) nos pacientes com 2-14 anos, sangue nas fezes, fígado palpável, aumento da consistência e aumento do tamanho dos lobos direito e esquerdo do fígado; b) nos maiores de 15 anos, presença de fígado palpável; c) em ambos os grupos etários, as esplenomegalias estiveram exclusivamente relacionadas à infecção pelo S. mansoni.

Estudo de moluscos do gênero biomphalaria de Minas Gerais, com relação a adaptação parasito hospedeiro e importância na epidemiologia da esquistossomose

Caramujos do gênero Biomphalaria das espécies B. tenagophila e B. straminea, descendentes de exemplares coletados em oito municípios mineiros, foram infectados com Schistosoma, mansoni das cepas LE e SJ. As taxas de infecção experimenta] variaram de 0 a 28% para B. tenagophila e de 0 a 21% para B. straminea. Esses resultados foram confrontados com os obtidos anteriormente por vários autores, mostrando que mais de 70% dentre 32 populações (doze de B. tenagophila e vinte de B. straminea) de Minas Gerais, foram suscetíveis experimentalmente a S. mansoni. Os dados experimentais, aliados a relatos de encontro de B. tenagophila e B. straminea com infecção natural por S. mansoni em quatro localidades a partir de 1982, parecem indicar que nessas regiões existem condições favoráveis de pré-adaptação ao parasitismo, a exemplo do que ocorreu no nordeste brasileiro e em São Paulo, pois, anteriormente moluscos dessas espécies não foram encontrados com infecção natural pelo trematúdeo em Minas Gerais. Estes dados são importantes para o controle da disseminação da esquistossomose em áreas indenes, tendo em vista a vasta distribuição das duas espécies no Brasil.

Rabies in the state of São Paulo: the rodents question

The authors looked over the epidemiological data on the aggression by rodents in the period 1976-1985 in the records of the Instituto Pasteur in the State of São Paulo (Brazil). They observed that out of 367 379 people attacked, 22 250 were victims of rodents. Mainly responsible for these accidents were urban rodents, whose capture, however, was a limiting factor for the sending of samples to the laboratory. Laboratory diagnosis carried out in 1 083 samples of rodents did not show any positive case in the period, in spite of the presence of rabies in other animals species. It is conclude that, as rabies is rare among rodents, tests are necessary for the identification of the virus whenever suspicion of a positive case occurs; in addition, in the absence of reported cases of human death caused by rabies related to rodents, possibility exists for a reduction of antirabies treatments following exposure to these animals.

Botulismo: considerações acerca de oito casos ocorridos no Triângulo Mineiro, Minas Gerais, Brasil

O botulismo constitui uma forma rara de intoxicação alimentar, particularmente em nosso meio. A única epidemia comprovada desta doença no Brasil ocorreu na década de 1950, no Rio Grande do Sul, onde nove pessoas a adquiriram, após a ingestão de conserva caseira de peixe. O presente estudo relata um surto de Botulismo tipo A ocorrido em uma família de 8 membros, dos quais 7 contraíram esta toxinfecção após a ingestão de carne suína conservada sob a forma de enlatado caseiro. Duas pessoas evoluíram para o óbito, e os restantes recuperaram-se após variável tempo de evolução. Onze meses após, diagnosticou-se novo caso desta doença, cuja fonte da intoxicação não pôde ser detectada Os autores pretendem com esta publicação, divulgar a segunda epidemia comprovada de Botulismo no Brasil, e chamar atenção para seu quadro clínico, diagnóstico e tratamento, praticamente desconhecidos em nosso meio.

Freqüência de anticorpos neutralizantes contra o vesiculovirus Piry, em doadores de sangue de Uberaba , Minas Gerais, Brasil

Na cidade de Uberaba, Estado de Minas Gerais, dos 162 doadores de sangue, 13 (8,0%) apresentaram anticorpos neutralizantes contra o vesiculovirus Piry. Nos indivíduos positivos foi estatisticamente mais freqüente o relato de residência anterior em área rural (p < 0,0001) e em cidades do Estado de São Paulo (p < 0,05).

Drug susceptibility of Plasmodium falciparum in the western Amazon region, state of Acre, Brazil

Field studies in the western Amazon region (state of Acre, Brazil) indicate that the 4-aminoquinolines, as well as the combined regimen with sulfadoxine-pyrimethamine, can no longer be recomended for the treatment and prophylaxis of P. falciparum infections in this region. Quinine remains an effective drug when used correctly. However, compliance problems arise due to the often occurring side-effects during a ten day regimen. Prospects of overcoming these constraints by combining a short course of quinine with other drugs are limited, because of the lack of suitable partner compounds. For this reason quinine/clindamycin appears to be a more practical therapy of P. falciparum malaria. In vitro data from this study suggest that mefloquine is another effective alternative for the treatment of falciparum malaria in this Amazon region.

Biological and morphological characteristics of Schistosoma mansoni from Ribeira Valley, State of São Paulo, Brazil: I - susceptibility of Biomphalaria tenagophila snail to sympatric S. mansoni strain

In the São Paulo State, Brazil, where the Biomphalaria tenagophila is the intermediate host, the Ribeira Valley is an important endemic schistosomiasis mansoni area. During last eleven years there has been intense control measures focusing on schistosomiasis. The efforts have been concentrated in the municipalities of Pedro de Toledo and Itariri. We determined the susceptibility of B. tenagophila to sympatric strain of S. mansoni, both recently isolated from Itariri field. In 1988, this strain was isolated and maintained in the experimental model: Swiss mice - sympatric B. tenagophila. The second generation of the worm was evaluated. The snail were divided in the three groups of 60 snails each. One group was exposed to 1 miracidium and other to 10. The third group was the control. The mortality and the shedding of cercariae were checked during 78 days. After that, the positive snails were observed until they ceased to shed cercariae. The exposed molluscs showed mortality rates of 23% and 31% and infection indexes were of 8% and 60% to 1 and 10 miracidia respectively. The mortality was of 22% in the control group. The periods of shedding cercariae in the two groups were 82 and 104 days. We can conclude that B. tenagophila is an effective intermediate host to the sympatric strain of S. mansoni sympatric strain

Dengue epidemic in the state of Rio de Janeiro, Brazil: virological and epidemiological aspects

Laboratorial studies were carried out on 3178 patients with signs and symptoms suggestive of dengue infection from April 1986 to December 1987 in the State of Rio de Janeiro, Brazil. The epidemic had two peaks following the first virus isolation and affected the inhabitants of 17 counties. Both sex and all age groups were affected. Dengue virus type 1 was isolated from 1039 sera and the number of confirmed cases was increased to 1874 (59%) by MAC-ELISA. Isolation rate confirmed cases reached 80% in the specimens obtained until the 4th day after the onset of disease and viraemia ranged from 10 3.0 to 10(8.5) TCID50/ml.

Presença de ovos de Toxocara spp em praças públicas da cidade de Uberlândia, Minas Gerais, Brasil

O objetivo deste trabalho foi verificar a presença de ovos de Toxocara spp nos solos de praças públicas da cidade de Uberlândia, região do Triângulo Mineiro, no período de outubro de 1991 a janeiro de 1992. A cidade possui 89 praças distribuídas em 39 bairros. Para que se tivesse um perfil da ocorrência do parasita, foram colhidas amostras de terra e areia (quando existente) de uma praça, determinada por sorteio, por bairro. As amostras de solo homogeneizadas de 5 pontos distintos das 39 praças foram colhidas em frascos plásticos e analisadas empregando-se os métodos de flutuação em solução saturada de cloreto de sódio e de solução saturada de sulfato de magnésio contendo 5% de iodeto de potássio. Para cada amostra foram realizados os dois métodos em duplicata. Os resultados mostraram estarem contaminados os solos de 9 praças (23,07%), das quais 6 localizavam-se próximas ao centro da cidade. A realização de mais de um método laboratorial permitiu a identificação do agente em maior porcentagem de locais.

Seasonal variation of anti-resa/Pf155 Plasmodium falciparum antibodies in three localities from the state of Amapá, Brazil

Anti-RESA/Pf155 antibodies were assayed in sera of individuals from three localities (Laranjal do Jari, Vila Padaria and Vila Paraíso) in the State of Amapá, Brazil, during the long-rains and short-rains seasons. All of these had negative blood smears for malaria. Most of the sera collected were positive in Indirect Fluorescent Antibody (IFA) with P. falciparum parasites, with no seasonal variation. A high percentage of these sera (62% to 100%) was RESA positive by Modified Indirect Fluorescent Antibody (MIFA), with a significant (p < 0.05) increase of geometric mean titers during the short-rains season, when the transmission of the disease is highest. ELISA with three repetitive RESA peptides (EENV)3 (4x3), (EENVEHDA)2 (8x2) and (DDEHVEEPTVA)2(11x2) did not reveal statistically significant seasonal variations, although a small enhancement of positivity was observed in V. Padaria (15.3 to 38.8%) in the short-rains season with the 8x2 peptides, and with 4x3 and 8x2 peptides in V. Paraíso, with a decrease in 11x2. MIFA titers appeared to be correlated mainly to the peptide 4x3 and it was the immunodominant in the three localities.