The Bernhard Nocht Institute: 100 years of tropical medicine in Hamburg

The Bernhard Nocht Institute (BNI) is a four months younger and much smaller sibling of the Instituto Oswaldo Cruz. It was founded on 1 October 1900 as an Institut für Schiffs- und Tropenkrankheiten (Institute for Maritime and Tropical Diseases) and was later named after its founder and first director Bernhard Nocht. Today it is the Germany's largest institution for research in tropical medicine. It is a government institution affiliated to the Federal Ministry of Health of Germany and the Department of Health of the State of Hamburg. As the center for research in tropical medicine in Germany the BNI is dedicated to research, training and patient care in the area of human infectious diseases, which are of particular relevance in the tropics. It is the primary mission of the BNI to develop means to the control of these diseases. Secondary missions are to provide expertise for regional and national authorities and to directly and indirectly improve the health care for national and regional citizens in regard to diseases of the tropics.

Altered Response of Strain of Schistosoma mansoni to Oxamniquine and Praziquantel

The susceptibility of a fourth generation Ouh strain (Paranapanema Valley, São Paulo, Brazil) of Schistosoma mansoni to oxamniquine (OXA) and praziquantel (PZQ) was studied. Ten groups of 13 female albino mice each were infected with 70 cercariae per animal. These mice were medicated orally on the 50th day after infection. Five groups were given OXA doses of 0, 100, 200, 300 and 400 mg/kg (single doses) and the rest were treated with PZQ doses of 0, 100, 200, and 250 mg/kg/5 days. Each group was sub-divided: 8 animals underwent perfusion after 15 days treatment, 5 mice followed up for oviposition and their feces were tested every 15 days for miracidia hatching. The efficacy of the OXA doses of 100 and 200 mg/kg was 66% and 91.4%, respectively and for the 100 mg/kg PZQ dose it was 90.1%. The follow-up groups with 100 and 200 mg/kg of OXA and PZQ, 100 and 150 mg/kg, showed that they re-established the oviposition after a period of 60 to 75 days of treatment. The ED50 was 69.6mg/kg OXA and 39.4 mg/kg PZQ. The results show the tolerance of the Ouh strain to a dose of 100 mg with both drugs and they appoint the need for a dose review during the follow up of the oviposition and in monitoring phenomena in the field.

Preliminary assays indicate that Antonia ovata (Loganiaceae) and Derris amazonica (Papilionaceae), ichthyotoxic plants used for fishing in Roraima, Brazil, have an insecticide effect on Lutzomyia longipalpis (Diptera: Psychodidae: Phlebotominae)

Laboratory-reared Lutzomyia longipalpis (Lutz and Neiva 1912) was tested with extracts of two ichthyotoxic plants, known as timbós, used as fishing poison in the Amazon. Phlebotomines, L. longipalpis, and plants, Antonia ovata and Derris amazonica, were collected in the Raposa-Serra do Sol Indian Reserve, a focus of visceral leishmaniasis in the State of Roraima, Brazil. Extracts were prepared from dried leaves of A. ovata and roots of D. amazonica that were percolated in water, filtered and dried out at 50°C. The solid extract obtained was diluted in water at 150, 200 and 250 mg/ml. The solution was blotted in filter paper placed at the bottom of cylindric glass tubes containing sand flies. For each plant extract and dilution, two series of triplicates with 5 male and 5 female specimens of L. longipalpis were used. Mortality was recorded every 2 h during 72 h of exposure. At 72 h the mortality was as high as 80% for extracts of A. ovata (LD50 = 233 mg/ ml), and 100% for D. amazonica (LD50 = 212 mg/ ml) whereas in the control groups maximum mortality never surpassed 13%. Preliminary assays indicated that A. ovata and D. amazonica displayed significant insecticide effect against L. longipalpis.

Prevalence and risk factors of hepatitis C virus infection in hemodialysis patients from one center in Recife, Brazil

A hemodialysis population from a dialysis unit in the city of Recife, Northeastern Brazil, was screened to assess the prevalence of hepatitis C virus (HCV) infection and to investigate the associated risk factors. Hemodialysis patients (n = 250) were interviewed and serum samples tested for anti-HCV antibodies by enzyme-linked immunosorbent assay (ELISA). All samples were also tested for HCV RNA by reverse transcriptase nested polymerase chain reaction (RT-nested-PCR). Out of 250 patients, 21 (8.4%) were found to be seropositive by ELISA, and 19 (7.6%) patients were HCV RNA positive. HCV viraemia was present in 90.5% of the anti-HCV positive patients. The predominant genotype was HCV 1a (8/19), followed by 3a (7/19), and 1b (4/19). None of the anti-HCV negative patients were shown to be viraemic by the PCR. Univariate analysis of risk factors showed that time spent on hemodialysis, the number of blood transfusions and a blood transfusion before November 1993 were associated with HCV positivity. However, multivariate analysis revealed that blood transfusions before November 1993 were significantly associated with HCV infection in this population. Low prevalence levels were encountered in this center, however prospective studies are necessary to confirm these findings.

Evaluation of HA negatively charged membranes in the recovery of human adenoviruses and hepatitis A virus in different water matrices

Human adenoviruses (HAdV) and hepatitis A virus (HAV) are shed in the faeces and consequently may be present in environmental waters, resulting in an increase in pathogen concentration that can affect water quality and human health. The aim of this study was to evaluate an adsorption-elution method which utilizes negatively charged membrane HA to determine the efficient recovery of HAdV and HAV from different water matrices and to combine this procedure with a qualitative molecular method (nested RT-PCR and nested PCR). The best efficiency recovery was achieved in distilled water and treated wastewater effluent (100%) for both viruses and in recreational lagoon water for HAV (100%). The efficiency recovery was 10% for HAdV and HAV in seawater and 10% for HAdV in lagoon water. The viral detection limit by nested PCR for HAV in water samples ranged between 20-0.2 FFU/mL and 250 and 25 TCID50/mL for HAdV. In conclusion, these results suggest that the HA negatively charged membranes vary their efficiency for recovery of viral concentration depending upon the types of both enteric viruses and water matrices.

Dispersal and survival of Nyssomyia intermedia and Nyssomyia neivai (Diptera: Psychodidae: Phlebotominae) in a cutaneous leishmaniasis endemic area of the speleological province of the Ribeira Valley, state of São Paulo, Brazil

The dispersal and survival of the phlebotomines Nyssomyia intermedia and Nyssomyia neivai (both implicated as vectors of the cutaneous leishmaniasis agent) in an endemic area was investigated using a capture-mark-release technique in five experiments from August-December 2003 in municipality of Iporanga, state of São Paulo, Brazil. A total of 1,749 males and 1,262 females of Ny. intermedia and 915 males and 411 females of Ny. neivai were marked and released during the five experiments. Recapture attempts were made using automatic light traps, aspiration in natural resting places and domestic animal shelters and Shannon traps. A total of 153 specimens (3.48%) were recaptured: 2.59% (78/3,011) for Ny. intermedia and 5.35% (71/1,326) for Ny. neivai. Both species were recaptured up to 144 h post-release, with the larger part of them recaptured within 48 h. The median dispersion distances for Ny. intermedia and Ny. neivai, respectively, were 109 m and 100 m. The greatest dispersal range of Ny. intermedia was 180 m, while for Ny. neivai one female was recaptured in a pasture at 250 m and another in a pigsty at 520 m, showing a tendency to disperse to more open areas. The daily survival rates calculated based on regressions of the numbers of marked insects recaptured on the six successive days after release were 0.746 for males and 0.575 for females of Ny. intermedia and 0.649 for both sexes of Ny. neivai. The size of the populations in the five months ranged from 8,332-725,085 for Ny. intermedia males, 2,193-104,490 for Ny. intermedia females, 1,687-350,122 for Ny. neivai males and 254-49,705 for Ny. neivai females.

Epidemiology, control and surveillance of Chagas disease: 100 years after its discovery

Chagas disease originated millions of years ago as an enzootic infection of wild animals and began to be transmitted to humans as an anthropozoonosis when man invaded wild ecotopes. While evidence of human infection has been found in mummies up to 9,000 years old, endemic Chagas disease became established as a zoonosis only in the last 200-300 years, as triatomines adapted to domestic environments. It is estimated that 15-16 million people are infected with Trypanosoma cruzi in Latin America, and 75-90 million are exposed to infection. Control of Chagas disease must be undertaken by interrupting its transmission by vectors and blood transfusions, improving housing and areas surrounding dwellings, providing sanitation education for exposed populations and treating acute and recently infected chronic cases. These measures should be complemented by surveillance and primary, secondary and tertiary care.

Using a single tablet daily to treat latent tuberculosis infection in Brazil: bioequivalence of two different isoniazid formulations (300 mg and 100 mg) demonstrated by a sensitive and rapid high-performance liquid chromatography-tandem mass spectrometry method in a randomised, crossover study

The recommended treatment for latent tuberculosis (TB) infection in adults is a daily dose of isoniazid (INH) 300 mg for six months. In Brazil, INH was formulated as 100 mg tablets. The treatment duration and the high pill burden compromised patient adherence to the treatment. The Brazilian National Programme for Tuberculosis requested a new 300 mg INH formulation. The aim of our study was to compare the bioavailability of the new INH 300 mg formulation and three 100 mg tablets of the reference formulation. We conducted a randomised, single dose, open label, two-phase crossover bioequivalence study in 28 healthy human volunteers. The 90% confidence interval for the INH maximum concentration of drug observed in plasma and area under the plasma concentration vs. time curve from time zero to the last measurable concentration “time t” was 89.61-115.92 and 94.82-119.44, respectively. The main limitation of our study was that neither adherence nor the safety profile of multiple doses was evaluated. To determine the level of INH in human plasma, we developed and validated a sensitive, simple and rapid high-performance liquid chromatography-tandem mass spectrometry method. Our results showed that the new formulation was bioequivalent to the 100 mg reference product. This finding supports the use of a single 300 mg tablet daily strategy to treat latent TB. This new formulation may increase patients’ adherence to the treatment and quality of life.

Padronização das atividades em centro cirúrgico oncológico segundo a Classificação das Intervenções de Enfermagem

Este estudo teve como objetivos identificar em um centro cirúrgico especializado em oncologia, as atividades de enfermagem realizadas no período transoperatório, classificar e validar as atividades em intervenções, segundo a Classificação das Intervenções de Enfermagem (NIC). O levantamento das atividades foi realizado por meio dos registros e da observação direta da assistência de enfermagem, nos quatro turnos de trabalho. As atividades foram classificadas em intervenções de enfermagem da NIC utilizando-se a técnica mapeamento cruzado. O elenco de intervenções foi validado por profissionais de enfermagem, em oficinas de trabalho. Identificaram-se 49 intervenções: 34 de cuidados diretos e 15 de cuidados indiretos. O reconhecimento das intervenções de enfermagem permite medir o tempo despendido na sua execução, variável fundamental para quantificar e qualificar a carga de trabalho dos profissionais de enfermagem.

Comunicação nas práticas de coordenação de grupos socioeducativos na saúde da família

Este estudo objetivou desvelar a forma da comunicação do coordenador de grupos socioeducativos na Saúde da Família. Pesquisa qualitativa, descritiva e exploratória desenvolvida com 25 coordenadores de grupos distribuídos em oito unidades básicas de saúde de Belo Horizonte, Brasil. Para coleta de dados, utilizou-se a observação não participante e a entrevista semiestruturada com os coordenadores. O estudo teve como marco teórico as concepções de Bakhtin e referenciais sobre comunicação e saúde. As informações coletadas mostram que a tríade corpo, saúde e doença é comunicada nos grupos por diferentes canais e em níveis diversificados de discurso. Conclui-se que há necessidade do coordenador valer-se de uma abordagem que valoriza a expressão do participante, não estritamente da saúde em sua dimensão física, mas da vida de cada um, buscando diferentes formas de comunicação para efetivar a ação educativa dialógica e os espaços de interação nos grupos.

Concepção de enfermeiros de uma rede pública de saúde sobre Educação para a Saúde

Estudo qualitativo que objetivou conhecer as concepções de 12 enfermeiros assistenciais, que compõem a rede pública de saúde de um município do interior paulista, sobre Educação para a Saúde, e propor ação educativa. Utilizou-se da metodologia da pesquisa-ação. A coleta dos dados ocorreu no segundo semestre de 2009, nas unidades públicas de saúde desse município. Foram usadas as técnicas de observação participante e entrevistas individuais. A análise e interpretação dos dados foi feita por categorização, fundamentada na teoria de Paulo Freire. Como resultados, revelou-se o reducionismo da Educação para a Saúde na abordagem pedagógica que envolvia a transmissão de conhecimentos, contemplando uma tendência biologicista da formação acadêmica. Porém, nos círculos de discussão, presumiu-se o despertar de uma consciência política relacionada à temática e à promoção da saúde. Concluindo, apreendeu-se a necessidade de mudanças na formação, e de viabilizar novos modos de produção de ciência, na busca pela transformação social.

Fatores terapêuticos identificados em um grupo de Promoção da Saúde de Idosos

O objetivo do estudo foi identificar fatores terapêuticos presentes em grupo de promoção da saúde de idosos. Estudo descritivo exploratório com abordagem qualitativa, cujos dados foram coletados por meio de grupos focais realizados com participantes do grupo e suas coordenadoras, entre dezembro de 2010 e abril de 2011. Os dados foram submetidos a análise de conteúdo, modalidade temática. Os achados mostraram convergência de respostas entre os participantes da pesquisa, indicando ressonância e complementaridade na identificação dos fatores terapêuticos coesão, instilação de esperança, socialização, compartilhamento de informações, fatores existenciais, altruísmo, aprendizagem interpessoal e universalidade. A identificação desses vários fatores no grupo estudado comprova seu potencial terapêutico, especialmente por atender as necessidades dos idosos, mantê-los saudáveis, fortalecer o sentimento de amor pela vida e pertença a um grupo social.

Tabela de vida de fertilidade de Lysiphlebus testaceipes (Cresson) (Hymenoptera, Braconidae, Aphidiinae) em Rhopalosiphum maidis (Fitch) e Aphis gossypii Glover (Hemiptera, Aphididae)

Avaliar o potencial de crescimento de Lysiphlebus testaceipes (Cresson) é importante para seu uso em programas de controle biológico de pulgões. Este trabalho teve como objetivo determinar a tabela de vida de fertilidade de L. testaceipes em Rhopalosiphum maidis (Fitch) e Aphis gossypii Glover. Na avaliação da mortalidade de imaturos, do desenvolvimento e da razão sexual foram utilizadas 12 fêmeas do parasitóide e 480 ninfas de cada pulgão testado. Na avaliação da longevidade e da fertilidade foram utilizadas 15 fêmeas do parasitóide e uma colônia por dia de cada pulgão, até a morte da fêmea do parasitóide, sendo 300 (1º dia); 250 (2º dia); 200 (3º dia); 150 (4º dia); 100 (5º dia) e 50 ninfas nos demais dias. L. testaceipes apresentou taxas de mortalidade de imaturos de 5,6% em R. maidis e de 9,2% em A. gossypii, desenvolvimento de 10,2 e 10,1 dias e razão sexual de 0,71 e 0,66, respectivamente. L. testaceipes apresentou fecundidade de 498,2 ovos em R. maidis e de 327,8 ovos em A. gossypii. Os parâmetros de crescimento de L. testaceipes em R. maidis e A. gossypii foram, respectivamente, R O= 205,38 e 164,08 fêmeas; r m= 0,449 e 0,431 fêmeas/fêmeas/dia; lambda = 1,57 e 1,54 fêmeas/dia; T= 11,86 e 11,83 dias e TD= 10,78 e 11,27 dias. L. testaceipes apresenta alto potencial de crescimento em R. maidis e A. gossypii. R. maidis mostrou ser hospedeiro adequado aos propósitos de criação massal e utilização em sistema de criação aberta para L. testaceipes.

Functional response of Telenomus remus Nixon(Hymenoptera, Scelionidae) to Spodoptera frugiperda (J. E. Smith) (Lepidoptera, Noctuidae) eggs: effect of female age

Functional response of Telenomus remus Nixon (Hymenoptera, Scelionidae) to Spodoptera frugiperda (J. E. Smith) (Lepidoptera, Noctuidae) eggs: effect of female age. Functional response of 24-h and 48-h-old Telenomus remus adults was studied on Spodoptera frugiperda eggs. The study was carried out in climatic chamber regulated at 25 ± 1°C, 70 ± 10% RH and 12:12h (L: D). Females of T. remus were honey fed and individualized in glass vials along with 25, 50, 75, 100, 150, 200, 250 or 300 eggs of S. frugiperda for 24 h. Complete randomized design with ten replications was adopted. The parameters evaluated to construct the functional response curve were daily average parasitism, searching rate and oviposition time. It was observed that the higher the egg density, the higher the parasitism for 24-h and 48-h-old females although there was a tendency of parasitism stabilization at 150-egg density. The results showed a type II functional response curve for both 24-h and 48-h-old female.