Visceral leishmaniasis in Brazil: revisiting paradigms of epidemiology and control

In the last 20 years, despite the known underestimation of cases, Brazil registered a marked increase in the incidence of visceral leishmaniasis. The main goal of this review is to reflect on some aspects of this zoonosis in Brazil and also to encourage the discussion in order to find more viable, effective and affordable strategies to be implemented by the Brazilian Leishmaniasis Control Program. The current situation of visceral leishmaniasis in Brazil might be seen as a paradox: the most important aspects of the disease are known, but so far the control of this disease has not yet been achieved. The current control strategies have not been able to prevent the geographical expansion, and even a rise in the incidence and lethality of visceral leishmaniasis. There is a need not only for a better definition of priority areas, but also for the implementation of a fieldwork monitoring system to the disease surveillance that could permit a further evaluation of the control program in areas where visceral leishmaniasis is endemic.

Health problems of nursing workers in a public educational institution

Objective: To identify the issues occurred with nursing workers through a Health Monitoring System for Nursing Workers (SIMOSTE) and to describe the consequences of those problems. Method: This is a quantitative, exploratory and descriptive study realized in a teaching hospital in the west region of the city of São Paulo. Results: From the SIMOSTE, 1.847 occurrences were registered in a six month period. Within the main occurrences, medical licenses, work related accidents with and without removals; psychiatric consultations and psychotherapy were highlighted. Conclusion: The data points out to the need for the development of new health vigilance actions to notify accidents and illness related to work, besides the prevention of issues. 


Workloads and strain process in Community Health Agents

ABSTRACT OBJECTIVE To identify the workloads present in the work activities of community health agents (CHAs) and the resulting strain processes. METHOD A descriptive, exploratory, cross-sectional and quantitative study conducted with 137 CHAs. Data were collected through a questionnaire and interview guided by the health surveillance software called SIMOSTE (Health Monitoring System of Nursing Workers), following the ethical codes of the current law. RESULTS In total, were identified 140 workloads involved in 122 strain processes, represented by the occurrence of health problems of the CHAs. The mechanical (55.00%) and biological (16.43%) loads stood out. The most common strain processes were the external causes of morbidity and mortality (62.31%) and diseases of the musculoskeletal system and connective tissue (10.66%). CONCLUSION From the identified overloads, it became evident that all workloads are present in the work process of CHAs, highlighting the mechanical load, represented mainly by external causes of morbidity and mortality that are related to occupational accidents.

Water percolation estimated with time domain reflectometry (TDR) in drainage lysimeters

Due to the difficulty of estimating water percolation in unsaturated soils, the purpose of this study was to estimate water percolation based on time-domain reflectometry (TDR). In two drainage lysimeters with different soil textures TDR probes were installed, forming a water monitoring system consisting of different numbers of probes. The soils were saturated and covered with plastic to prevent evaporation. Tests of internal drainage were carried out using a TDR 100 unit with constant dielectric readings (every 15 min). To test the consistency of TDR-estimated percolation levels in comparison with the observed leachate levels in the drainage lysimeters, the combined null hypothesis was tested at 5 % probability. A higher number of probes in the water monitoring system resulted in an approximation of the percolation levels estimated from TDR - based moisture data to the levels measured by lysimeters. The definition of the number of probes required for water monitoring to estimate water percolation by TDR depends on the soil physical properties. For sandy clay soils, three batteries with four probes installed at depths of 0.20, 0.40, 0.60, and 0.80 m, at a distance of 0.20, 0.40 and 0.6 m from the center of lysimeters were sufficient to estimate percolation levels equivalent to the observed. In the sandy loam soils, the observed and predicted percolation levels were not equivalent even when using four batteries with four probes each, at depths of 0.20, 0.40, 0.60, and 0.80 m.

Start-up of anaerobic reactors for slaughterhouse wastewater treatment

This study aimed to evaluate the start-up of a horizontal anaerobic fixed bed reactor (HAFBR) followed by an upflow anaerobic sludge blanket (UASB) for the slaughterhouse wastewater treatment. HAFBR was filled with bamboo rings and had 1.2 m in length, 0.10 m in diameter and volume of 7.5 L. The UASB had the volume of 15 L. The HAFBR and UASB operated at organic loading rate and hydraulic retention time average of 8.46 and 3.77 kg m-3 d-1 of COD and 0.53 and 0.98 days, respectively. During 150 days of monitoring system it was found pH 6.8, relatively high values of bicarbonate alkalinity (> 1000 mg L-1) and reduced values of volatile acids (70 to 150 mg L-1), which afforded average removal efficiencies of COD total and total suspended solids of the order of 31 and 23% in HAFBR and 79% and 63% in UASB. It can be concluded that the generation and consumption of bicarbonate alkalinity and total volatile acids, thereby maintaining the pH during the study indicated stable operation of the reactors. The COD removal in the reactors was satisfactory especially when it considers that the assessment was conducted in a period of adaptation of organisms to the effluent and also the high organic load applied during this period.

HPV vaccines: a controversial issue?

Controversy still exists over whether the benefits of the available HPV vaccines outweigh the risks and this has suppressed uptake of the HPV vaccines in comparison to other vaccines. Concerns about HPV vaccine safety have led some physicians, healthcare officials and parents to withhold the recommended vaccination from the target population. The most common reason for not administering the prophylactic HPV vaccines are concerns over adverse effects. The aim of this review is the assessment of peer-reviewed scientific data related to measurable outcomes from the use of HPV vaccines throughout the world with focused attention on the potential adverse effects. We found that the majority of studies continue to suggest a positive risk-benefit from vaccination against HPV, with minimal documented adverse effects, which is consistent with other vaccines. However, much of the published scientific data regarding the safety of HPV vaccines appears to originate from within the financially competitive HPV vaccine market. We advocate a more independent monitoring system for vaccine immunogenicity and adverse effects to address potential conflicts of interest with regular systematic literature reviews by qualified individuals to vigilantly assess and communicate adverse effects associated with HPV vaccination. Finally, our evaluation suggests that an expanded use of HPV vaccine into more diverse populations, particularly those living in low-resource settings, would provide numerous health and social benefits.

Biological drugs for the treatment of psoriasis in a public health system

OBJECTIVE To analyze the access and utilization profile of biological medications for psoriasis provided by the judicial system in Brazil.METHODSThis is a cross-sectional study. We interviewed a total of 203 patients with psoriasis who were on biological medications obtained by the judicial system of the State of Sao Paulo, from 2004 to 2010. Sociodemographics, medical, and political-administrative characteristics were complemented with data obtained from dispensation orders that included biological medications to treat psoriasis and the legal actions involved. The data was analyzed using an electronic data base and shown as simple variable frequencies. The prescriptions contained in the lawsuits were analyzed according to legal provisions.RESULTS A total of 190 lawsuits requesting several biological drugs (adalimumab, efalizumab, etanercept, and infliximab) were analyzed. Patients obtained these medications as a result of injunctions (59.5%) or without having ever demanded biological medication from any health institution (86.2%), i.e., public or private health services. They used the prerogative of free legal aid (72.6%), even though they were represented by private lawyers (91.1%) and treated in private facilities (69.5%). Most of the patients used a biological medication for more than 13 months (66.0%), and some patients were undergoing treatment with this medication when interviewed (44.9%). Approximately one third of the patients discontinued treatment due to worsening of their illness (26.6%), adverse drug reactions (20.5%), lack of efficacy, or because the doctor discontinued this medication (13.8%). None of the analyzed medical prescriptions matched the legal prescribing requirements. Clinical monitoring results showed that 70.3% of the patients had not undergone laboratory examinations (blood work, liver and kidney function tests) for treatment control purposes.CONCLUSIONS The plaintiffs resorted to legal action to get access to biological medications because they were either unaware or had difficulty in accessing them through institutional public health system procedures. Access by means of legal action facilitated long-term use of this type of medication through irregular prescriptions and led to a high rate of adverse drug reactions as well as inappropriate clinical monitoring.

Microbiological contamination of a hemodialysis center water distribution system

The microbiological monitoring of the water used for hemodialysis is extremely important, especially because of the debilitated immune system of patients suffering from chronic renal insufficiency. To investigate the occurrence and species diversity of bacteria in waters, water samples were collected monthly from a hemodialysis center in upstate São Paulo and tap water samples at the terminal sites of the distribution system was sampled repeatedly (22 times) at each of five points in the distribution system; a further 36 samples were taken from cannulae in 19 hemodialysis machines that were ready for the next patient, four samples from the reuse system and 13 from the water storage system. To identify bacteria, samples were filtered through 0.22 µm-pore membranes; for mycobacteria, 0.45 µm pores were used. Conventional microbiological and molecular methods were used in the analysis. Bacteria were isolated from the distribution system (128 isolates), kidney machine water (43) and reuse system (3). Among these isolates, 32 were Gram-positive rods, 120 Gram-negative rods, 20 Gram-positive cocci and 11 mycobacteria. We propose the continual monitoring of the water supplies in hemodialysis centers and the adoption of effective prophylactic measures that minimize the exposure of these immunodeficient patients to contaminated sources of water.

Phlebotominae sand flies (Diptera: Psychodidae): potential vectors of American cutaneous leishmaniasis agents in the area associated with the Santo Antônio Hydroelectric System in Western Amazonian Brazil

INTRODUCTION: An entomological study was conducted as part of a vector-monitoring program in the area associated with the Santo Antônio hydroelectric system in State of Rondônia, Western Amazonian Brazil. METHODS: Fourteen sampling sites were surveyed to obtain data on the potential vectors of Leishmania spp. in the area. Sand flies were collected from 2011 to 2014 during the months of January/February (rainy season), May/June (dry season), and September/October (intermediary season) using light traps arranged in three vertical strata (0.5, 1, and 20m). RESULTS : A total of 7,575 individuals belonging to 62 species/subspecies were collected. The five most frequently collected sand flies were Psychodopygus davisi (Root) (36.67%), Trichophoromyia ubiquitalis (Mangabeira) (8.51%), Nyssomyia umbratilis (Ward & Fraiha) (6.14%), Bichromomyia flaviscutellata (Mangabeira) (5.74%), and Psychodopygus complexus (Mangabeira) (5.25%). These species have been implicated in the transmission of American cutaneous leishmaniasis agents in the Brazilian Amazon region and described as potential vectors of this disease in the study area. CONCLUSIONS: Additional surveillance is needed, especially in areas where these five species of sand fly are found.

Renin-Angiotensin System Blockade Associated with Statin Improves Endothelial Function in Diabetics

Abstract Background: Studies suggest that statins have pleiotropic effects, such as reduction in blood pressure, and improvement in endothelial function and vascular stiffness. Objective: To analyze if prior statin use influences the effect of renin-angiotensin-aldosterone system inhibitors on blood pressure, endothelial function, and vascular stiffness. Methods: Patients with diabetes and hypertension with office systolic blood pressure ≥ 130 mmHg and/or diastolic blood pressure ≥ 80 mmHg had their antihypertensive medications replaced by amlodipine during 6 weeks. They were then randomized to either benazepril or losartan for 12 additional weeks while continuing on amlodipine. Blood pressure (assessed with ambulatory blood pressure monitoring), endothelial function (brachial artery flow-mediated dilation), and vascular stiffness (pulse wave velocity) were evaluated before and after the combined treatment. In this study, a post hoc analysis was performed to compare patients who were or were not on statins (SU and NSU groups, respectively). Results: The SU group presented a greater reduction in the 24-hour systolic blood pressure (from 134 to 122 mmHg, p = 0.007), and in the brachial artery flow-mediated dilation (from 6.5 to 10.9%, p = 0.003) when compared with the NSU group (from 137 to 128 mmHg, p = 0.362, and from 7.5 to 8.3%, p = 0.820). There was no statistically significant difference in pulse wave velocity (SU group: from 9.95 to 9.90 m/s, p = 0.650; NSU group: from 10.65 to 11.05 m/s, p = 0.586). Conclusion: Combined use of statins, amlodipine, and renin-angiotensin-aldosterone system inhibitors improves the antihypertensive response and endothelial function in patients with hypertension and diabetes.

Assessing the performance of macroinvertebrate metrics in the Challhuaco-Ñireco System (Northern Patagonia, Argentina)

ABSTRACT Seven sites were examined in the Challhuaco-Ñireco system, located in the reserve of the Nahuel Huapi National Park, however part of the catchment is urbanized, being San Carlos de Bariloche (150,000 inhabitants) placed in the lower part of the basin. Physico-chemical variables were measured and benthic macroinvertebrates were collected during three consecutive years at seven sites from the headwater to the river outlet. Sites near the source of the river were characterised by Plecoptera, Ephemeroptera, Trichoptera and Diptera, whereas sites close to the river mouth were dominated by Diptera, Oligochaeta and Mollusca. Regarding functional feeding groups, collector-gatherers were dominant at all sites and this pattern was consistent among years. Ordination Analysis (RDA) revealed that species assemblages distribution responded to the climatic and topographic gradient (temperature and elevation), but also were associated with variables related to human impact (conductivity, nitrate and phosphate contents). Species assemblages at headwaters were mostly represented by sensitive insects, whereas tolerant taxa such as Tubificidae, Lumbriculidae, Chironomidae and crustacean Aegla sp. were dominant at urbanised sites. Regarding macroinvertebrate metrics employed, total richness, EPT taxa, Shannon diversity index and Biotic Monitoring Patagonian Stream index resulted fairly consistent and evidenced different levels of disturbances at the stream, meaning that this measures are suitable for evaluation of the status of Patagonian mountain streams.

Household-based malaria control in a highly endemic area of Africa (Tanzania): determinants of transmission and disease and indicators for monitoring - Kilombero Malaria Project

The Kilombero Malaria Project (KMP) attemps to define opperationally useful indicators of levels of transmission and disease and health system relevant monitoring indicators to evaluate the impact of disease control at the community or health facility level. The KMP is longitudinal community based study (N = 1024) in rural Southern Tanzania, investigating risk factors for malarial morbidity and developing household based malaria control strategies. Biweekly morbidity and bimonthly serological, parasitological and drug consumption surveys are carried out in all study households. Mosquito densities are measured biweekly in 50 sentinel houses by timed light traps. Determinants of transmission and indicators of exposure were not strongly aggregated within households. Subjective morbidity (recalled fever), objective morbidity (elevated body temperature and high parasitaemia) and chloroquine consumption were strongly aggregated within a few households. Nested analysis of anti-NANP40 antibody suggest that only approximately 30% of the titer variance can explained by household clustering and that the largest proportion of antibody titer variability must be explained by non-measured behavioral determinants relating to an individual's level of exposure within a household. Indicators for evaluation and monitoring and outcome measures are described within the context of health service management to describe control measure output in terms of community effectiveness.

Microbial biomass and soil fauna during the decomposition of cover crops in no-tillage system

The decomposition of plant residues is a biological process mediated by soil fauna, but few studies have been done evaluating its dynamics in time during the process of disappearance of straw. This study was carried out in Chapecó, in southern Brazil, with the objective of monitoring modifications in soil fauna populations and the C content in the soil microbial biomass (C SMB) during the decomposition of winter cover crop residues in a no-till system. The following treatments were tested: 1) Black oat straw (Avena strigosa Schreb.); 2) Rye straw (Secale cereale L.); 3) Common vetch straw (Vicia sativa L.). The cover crops were grown until full flowering and then cut mechanically with a rolling stalk chopper. The soil fauna and C content in soil microbial biomass (C SMB) were assessed during the period of straw decomposition, from October 2006 to February 2007. To evaluate C SMB by the irradiation-extraction method, soil samples from the 0-10 cm layer were used, collected on eight dates, from before until 100 days after residue chopping. The soil fauna was collected with pitfall traps on seven dates up to 85 days after residue chopping. The phytomass decomposition of common vetch was faster than of black oat and rye residues. The C SMB decreased during the process of straw decomposition, fastest in the treatment with common vetch. In the common vetch treatment, the diversity of the soil fauna was reduced at the end of the decomposition process.

Water treatment by multistage filtration system with natural coagulant from Moringa oleifera seeds

This study presents an evaluation of a pilot multistage filtration system (MSF) with different dosages, 131 mg L-1 and 106 mg L-1, of the natural coagulant extracted from Moringa oleifera seeds in pre-filtration and slow filtration stages, respectively. The system was comprised by a dynamic pre-filter unit, two upflow filters in parallel and four slow filters in parallel, and in one of the four filters had the filter media altered. The performance of the system was evaluated by monitoring some water quality parameters such as: turbidity, apparent color and slow filter load loss. The stages that have received the coagulant solution had better treatment efficiency compared with the steps without it. However, the direct application of the coagulant solution in the slow filter caused rapid clogging of the non-woven blanket and shorter career length.

Energetic efficiency of a deep bed swine production system

The aim of this work was to evaluate the energy flows of a commercial production system of swine deep bed in its finishing phase, located in Juiz de Fora, in the State of Minas Gerais, Brazil. Thus, an energy efficiency study was carried out by monitoring a lot of animals, during a 94-day period. The energy rate of each compound involved in the production process was quantified and the matrixes of energy consumption were determined in the form of animal feeding, electrical energy, piglets, material used as deep bed, human labor, equipment, swine buildings, production of alive swine for slaughter, organic fertilizer production (swine deep bed or swine deep litter). From the direct input energy, 80.57% correspond to animal feeding, 11.90% to pigs for slaughter and 6.76% to piglets, while from the energy output 53.45% correspond to the terminating swine and 46.55% to organic fertilizer (swine deep bed). By the results obtained, we can conclude that such production system has corresponded to an industrial and highly specialized agro ecosystem, importing a great part of the energy consumed in the production process, with 41% of energy efficiency.