Effectiveness of highly active antiretroviral therapy using non-brand name drugs in Brazil

In Brazil, HIV-infected individuals receive drugs (including non-brand name drugs which comprise locally produced generics and drugs that have not been tested in bioequivalence trials) free of charge from the government. The objective of the present study was to evaluate the effectiveness of highly active antiretroviral therapy (HAART) in Rio de Janeiro, Brazil, where non-brand drugs are widely used. For this purpose, we estimated the proportion of subjects with virologic failure (plasma HIV viral load greater than 400 copies/mL at 6 months after initiation of treatment). This was a retrospective cohort study of drug-naive HIV-infected subjects who initiated HAART. Subjects were included in the analysis if they were 18 years of age or older, were treatment naive, started HAART with a minimum of 3 drugs, and had available information on blood plasma HIV-1 viral load after 6 months on therapy. All subjects used antiretrovirals in dosing regimens recommended by the Brazilian National Advisory Committee for Antiretroviral Therapy. Chart reviews were conducted in three settings: at two public health outpatient units, at one clinical trial unit and at one private office. No comparisons of the effectiveness of non-brand name with the effectiveness of brand name drugs were made. We present results for 485 patients; of these, 354 (73%), 55 (11%), and 76 (16%) were seen at the public health outpatient units, private office, and clinical trial unit, respectively. Virologic failure was observed in 119 (25%) of the subjects. This study demonstrates the effectiveness of HAART in a setting where non-brand name drugs are widely used.

Feeding non-preference by Spodoptera frugiperda and Spodoptera eridania on tomato genotypes

Larvae of the genus Spodoptera spp. are highly polyphagous and can cause economical losses in several agricultural crops. Given their growing importance in the tomato crop, especially for industry, this work aimed to evaluate the feeding non-preference by larvae of Spodoptera frugiperda (J. E. Smith, 1797) and Spodoptera eridania (Cramer, 1782) on tomato genotypes and classify them by the levels of resistance. The commercial cultivar Santa Clara was set as the susceptible standard and line PI 134417 as the resistant standard to evaluate the lines PI 134418, PI 126931, LA 462 and LA 716. Feeding non-preference tests were performed under non-choice and free-choice conditions to evaluate the genotype attractiveness to larvae at predetermined times after their release, as well as the leaf area consumed. Overall, the genotypes LA 716 and PI 126931 were the least attractive to S. frugiperda, whereas Santa Clara was the most attractive and consumed. For S. eridania, the genotypes PI 126931, LA 462, LA 716 and PI 134418 were the least preferred for feeding, and Santa Clara and PI 134417 were the most attractive and consumed. The genotypes LA 716 and PI 126931 are moderately resistant to S. frugiperda and S. eridania; PI 134418 and LA 462 are moderately resistant to S. eridania; PI 134417 is susceptible to S. frugiperda and S. eridania; and Santa Clara is highly susceptible to both S. frugiperda and S. eridania.

Antibodies against Bovine herpesvirus 1 in dairy herds in the state of Espirito Santo, Brasil

Bovine herpesvirus 1 (BoHV-1) causes major losses in worldwide livestock, affecting the respiratory and reproductive tracts of bovine. In the past decades, the number of cases in Brazil has been gradually increasing. Therefore, it is important to assess the distribution of infection in different regions of the country. In the state of Espírito Santo (ES) the BoHV 1 infection rate in dairy cattle herds is unknown. Thus, the aim of this study was to detect neutralizing antibodies against BoHV-1 in serum samples from 1,161 non-vaccinated cows from 59 dairy cattle herds in 23 municipalities of the Metropolitan, North, Northwest and South macro-regions. The identification of seropositive cows was evaluated by the virus neutralization test. The results showed that of all serum samples evaluated 775 (66.75%) had neutralizing antibodies against BoHV-1. Moreover, all herds were found positive; however, the percentage of positive cows varied among regions; 49.06%, 62.15%, 67.21% and 80.04% for the Metropolitan, South, North and Northwest macro-regions, respectively. In this study, the results clearly indicate the dissemination of the viral agent in dairy cattle in the ES state, requiring the monitoring and control of diseases related to BoHV-1 infection.

Etiologia viral e bacteriana de casos de gastroenterite infantil: uma caracterização clínica

Numa pesquisa sobre gastroenterites infantis, feita em crianças internadas no Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brasil, foram identificados rotavírus em 35,2% dos pacientes e bactérias patogênicas em 37,0%; em 38,9% não foi possível identificar rotavírus ou bactérias patogênicas; foram identificados rotavírus em associação com bactérias patogênicas em 11,1% dos casos. Esta pesquisa compreendeu, além do estudo etiológico, outros aspectos, como distribuição etária, estado nutricional, tipo e grau de desidratação e duração média da diarréia.

Avaliação de três cepas de vírus rábico, antigenicamente distintas, em camundongos: II - Estudo da disseminação viral por diferentes órgãos

Estudou-se, comparativamente, o grau de disseminação de três cepas de vírus rábico, duas de origem de cão, Jales e Nigéria, e uma de origem de morcego, DR 19, com perfis antigênicos do nucleocapside distintos. Estas cepas foram inoculadas por via intramuscular, na face interna da coxa, em dois grupos de camundongos, com 21 e 28 dias de idade. Os animais foram mantidos em observação por um período total de 30 dias, e dos animais vitimados pela infecção, foram coletados diferentes órgãos, músculo lingual, coração, pulmão, rim e fígado, além do cérebro e da medula espinal, para avaliar-se o grau de disseminação de cada cepa viral, através da prova de imunofluorescência direta (IFD). Os resultados obtidos evidenciaram que os decalques de cérebro e de medula espinal apresentaram total concordância na prova de IFD, constatando-se as maiores diferenças com as cepas Jales e Nigéria, situando-se a cepa DR 19, intermediariamente, a estas duas. O músculo lingual foi o órgão que apresentou maior freqüência de positividade para ambos os grupos etários e para as três cepas virais.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment: 3- Survey of adult stages at the rice irrigation system and the emergence of Anopheles albitarsis in South-Eastern, Brazil

A study of adult Culicidae ecology was carried out from January 1992 through January 1993 at the rice irrigation system of the Ribeira Valley Experimental Station. The adaptation of Anopheles albitarsis to the anthropic environment became evident through the adult collections made at its various habitats represented by the irrigation system and the edge of the residual pond, as well as at those made within the local patchy residual woods. Other potential disease vectors were prevalent in the irrigated system too. There were Aedes scapularis, Culex nigripalpus and Cx. ribeirensis that were collected at various habitats. Remarkable differences among their prevalences were obtained such as between the natural forest and anthropic environments. In the former An. albitarsis was practically non-existent, thus suggesting that it might be considered as eusynathropic. As the populations of other species seemed to increase in the anthropic environment, they may be regarded as hemisynanthropes. Observations suggest the hypothesis that the development of irrigated land may be a factor in the emergence of An. albitarsis, and some other species, as well as the possibility of an increase in the transmission of mosquito-borne diseases such as malaria.

Mortality among patients with non-affective functional psychoses in a metropolitan area of South-Eastern Brazil

High mortality rates among those suffering from schizophrenia and related psychoses have been consistently described in developed societies. However, to date there is a lack of data on this matter in Brazil. In order to examine this issue, a prospective 2-year follow-up study was carried out in S. Paulo. The sample consisted of 120 consecutive admissions to psychiatric hospitals in a defined catchment area, aged 18 to 44 years old, with clinical diagnoses of non-affective functional psychoses according to the ICD-9. After 2 years, 116 (96.7%) subjects were traced. During the study period there were 7 deaths (6.0% of those traced), 5 (4.3%) due to suicide. All but one of the suicides occurred in the first year after discharge from hospital. Age and sex Standardised Mortality Ratios (relative to rates for the population of the city of Sao Paulo) were 8.4 for overall mortality (95% confidence interval: 4.0-15.9) and 317.9 for deaths due to suicide (95% confidence interval: 125.2-668.3). These results are in agreement with previous studies, and show that in Brazil non-affective functional psychoses are life-threatening illnesses, which need adequate care, particularly when patients go back to live in the community after hospital discharge.

Malaria transmission model for different levels of acquired immunity and temperature-dependent parameters (vector)

OBJECTIVE: Describe the overall transmission of malaria through a compartmental model, considering the human host and mosquito vector. METHODS: A mathematical model was developed based on the following parameters: human host immunity, assuming the existence of acquired immunity and immunological memory, which boosts the protective response upon reinfection; mosquito vector, taking into account that the average period of development from egg to adult mosquito and the extrinsic incubation period of parasites (transformation of infected but non-infectious mosquitoes into infectious mosquitoes) are dependent on the ambient temperature. RESULTS: The steady state equilibrium values obtained with the model allowed the calculation of the basic reproduction ratio in terms of the model's parameters. CONCLUSIONS: The model allowed the calculation of the basic reproduction ratio, one of the most important epidemiological variables.

Predicting the revolving door phenomenon among patients with schizophrenic, affective disorders and non-organic psychoses

OBJECTIVE: The aim of the study was to identify the variables that predict the revolving door phenomenon in psychiatric hospital at the moment of a second admission. METHODS: The sample consisted of 3,093 patients who have been followed during 5 to 24 years after their first hospital admission due to schizophrenia, and affective or psychotic disorders. Those who had had four or more admissions during the study period were considered as revolving door patients. Logistic regression analyses were used to assess the impact of gender, age, marital status, urban conditions, diagnosis, mean period of stay on the first admission, interval between the first and second admissions on the patterns of hospitalization. RESULTS: The variables with the highest predictive power for readmission were the interval between first and second admissions, and the length of stay in the first admission. CONCLUSIONS: These data may help public health planners in providing optimal care to a small group of patients with more effective utilization of the available services.

Quality of life, life satisfaction and happiness in shift- and non-shiftworkers

OBJECTIVE: To investigate the quality of life, life satisfaction, happiness and demands of work in workers with different work schedules. METHODS: The survey was carried out on professional workers in social care. Some were shiftworkers whose schedule included night shifts (N=311), some were shiftworkers without night shifts (N=207) and some were non-shiftworkers (N=1,210). Surveys were mailed and the response rate was 86%. For the purpose of this study several variables were selected from the Survey: The Quality of Life Profile, which measures importance, satisfaction, control and opportunities in nine domains of life plus measures of happiness, life satisfaction and demands of work. RESULTS: While both groups of shiftworkers, compared to non-shiftworkers, reported needing more physical effort to complete their work, and reported 'being' more physically tired, no differences were found in reports of overall happiness, life satisfaction or total quality of life. However, night-shiftworkers reported greater percentage of time unhappy than the other two groups of workers. In analyses of the quality of life, night-shiftworkers were less satisfied with domains of spiritual 'being' and physical and community 'belonging' than day-shiftworkers and non-shiftworkers. They also reported having fewer opportunities to improve their physical 'being', leisure, and personal growth than the other two groups. CONCLUSIONS: Quality of life in specific domains in night-shiftworkers was rated worse than in other groups of workers. Domain-based quality of life assessment gives more information regarding the particular needs of workers than overall or global measures of well-being.

Phlebotomine fauna in a rural area of the Brazilian Pantanal

The aim of the study was to identify among the phlebotomine fauna potential leishmaniasis vectors. The study was carried out in Corumbá county, State of Mato Grosso do Sul, Mid-West Brazil (18º59'S, 56º39'W). Sand fly captures were undertaken fortnightly with automatic light traps at 11 sites in forested environments and anthropic areas from April 2001 to July 2003. A total of only 41 specimens were captured. Thirty-one percent of the specimens were captured in forests and 68.3% in anthropic areas. The predominance of non-anthropophilic groups and the low density of N. whitmani, a known cutaneous leishmaniasis vector, does not seem to indicate any actual risk of the transmission of this disease in the study area.

Yellow fever in Brazil: thoughts and hypotheses on the emergence in previously free areas

This article describes and discusses factors associated to the reemergence of yellow fever and its transmission dynamics in the states of São Paulo (Southeastern Brazil) and Rio Grande do Sul (Southern) during 2008 and 2009. The following factors have played a pivotal role for the reemergence of yellow fever in these areas: large susceptible human population; high prevalence of vectors and primary hosts (non-human primates); favorable climate conditions, especially increased rainfall; emergence of a new genetic lineage; and circulation of people and/or monkeys infected by virus. There is a need for an effective surveillance program to prevent the reemergence of yellow fever in other Brazilian states.