Susceptibility of Triatoma sordida Stal, 1859 (Hemiptera: Reduviidae) to alpha-cypermethrin under natural climatic conditions

Abstract:INTRODUCTION:Despite the recommendations by interpretation of resistance ratios obtained in laboratory bioassays, little is known about the actual impact of these results in the effectiveness of vector control activities in the field. In this context, our objective was to determine the mean value of different resistance ratios obtained by laboratory bioassays performed as part of the chemical control strategies of Triatoma sordida in the field.METHODS:Field bioassays were developed in Monte Azul and Coração de Jesus (Southeast, Brazil). In each location, samples were formed with three domestic units treated with alpha-cypermethrin 20.0% (Alfatek (r) 200 SC). One day after spraying, 10 fifth-instar nymphs remained in contact with the surfaces treated (adobe with plaster, adobe without plaster, or wood) with insecticide in plastic cones for 72h. Three cones were exposed inside the intradomicile and the peridomicile. The insects in the control group were exposed to an insecticide-free piece of cardboard. Mortality was measured 72h after removal of the insects from the treated surfaces. The tests were realized in triplicate.RESULTS:Mortality was 100.0% in all locations, except for Monte Azul; Landinho (96.6%) and Coração de Jesus; Barriguda (96.6%).CONCLUSIONS:Although the resistant populations in laboratory tests proved to be susceptible in the field, this observation is not sufficient to suggest that the cut-off points used to justify the resistance ratio should be changed. In this sense, we recommend that laboratory and field bioassays are carried out with a greater number of Triatominae populations to allow more in-depth consideration of the subject.

Malaria in the State of Amazonas: a typical Brazilian tropical disease influenced by waves of economic development

In Brazil, more than 99% of malaria cases are reported in the Amazon, and the State of Amazonas accounts for 40% of this total. However, the accumulated experience and challenges in controlling malaria in this region in recent decades have not been reported. Throughout the first economic cycle during the rubber boom (1879 to 1912), malaria was recorded in the entire state, with the highest incidence in the villages near the Madeira River in the Southern part of the State of Amazonas. In the 1970s, during the second economic development cycle, the economy turned to the industrial sector and demanded a large labor force, resulting in a large migratory influx to the capital Manaus. Over time, a gradual increase in malaria transmission was observed in peri-urban areas. In the 1990s, the stimulation of agroforestry, particularly fish farming, led to the formation of permanent Anopheline breeding sites and increased malaria in settlements. The estimation of environmental impacts and the planning of measures to mitigate them, as seen in the construction of the Coari-Manaus gas pipeline, proved effective. Considering the changes occurred since the Amsterdam Conference in 1992, disease control has been based on early diagnosis and treatment, but the development of parasites that are resistant to major antimalarial drugs in Brazilian Amazon has posed a new challenge. Despite the decreased lethality and the gradual decrease in the number of malaria cases, disease elimination, which should be associated with government programs for economic development in the region, continues to be a challenge.

Epidemiology of infectious meningitis in the State of Amazonas, Brazil

INTRODUCTION: In the State of Amazonas, particularly in the capital Manaus, meningitis has affected populations of different cultures and social strata over the years. Bacterial meningitis is caused by several different species and represents a major issue of public health importance. The present study reports the meningitis case numbers with different etiologies in Amazonas from January 1976 to December 2012. METHODS: Since the 1970s, the (currently named) Tropical Medicine Foundation of Doutor Heitor Vieira Dourado [Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD)] has remained a reference center in Amazonas for the treatment of meningitis through the diagnosis and notification of cases and the confirmation of such cases using specific laboratory tests. RESULTS: The foundation has achieved coverage of over 90% of the state medical records for many years. Between 1990 and 2012, meningitis cases caused by Haemophilus influenzae decreased with the introduction of the H. influenzae vaccine. Meningococcal disease previously had a higher frequency of serogroup B disease, but starting in 2008, the detection of serogroup C increased gradually and has outpaced the detection of serogroup B. Recently, surveillance has improved the etiological definition of viral meningitis at FMT-HVD, with enteroviruses, Epstein-Barr virus (EBV) and varicella zoster virus (VZV) prevailing in this group of pathogens. With the advent of acquired immunodeficiency syndrome (AIDS), cryptococcal meningitis has become an important disease in Amazonas. Additionally, infectious meningitis is an important burden in the State of Amazonas. CONCLUSIONS: Changes in the epidemiological profile for the different etiology-defined cases are the result of continuous epidemiological surveillance and laboratory capacity improvements and control measures, such as Haemophilus influenzae vaccination.

Vivências do Quotidiano do Hospital Real de Todos-os-Santos (Lisboa) : os contextos do poço SE do claustro NE

As intervenções arqueológicas concretizadas entre 1999-2001 permitiram o reconhecimento de contextos referentes ao Hospital Real de Todos-os-Santos, nomeadamente o claustro NE, bem como uma estrutura hidráulica no seu perímetro interno. A identificação do espólio cerâmico e vítreo aqui descartado permite, numa primeira fase, a aferição cronológica e tipológica destes e, consequentemente, do perfil funcional (utilitário, de cozinha e medicinal), numa tentativa de padronização do conjunto arte factual no edifício hospitalar e na cidade de Lisboa. Num segundo estágio, pretendese obter uma leitura concreta no que concerne ao período de utilização desta estrutura, indo de encontro às distintas áreas a vigorar no espaço claustral.

Redes sociais, capital social e governança ambiental no Território Portal da Amazônia

O artigo trata de um estudo empírico em que a análise de redes sociais é utilizada para mapear o capital social de atores envolvidos em processos de governança ambiental na Amazônia brasileira. Por meio de entrevistas, foi mapeada a rede de relações de diálogo sobre questões socioambientais de um conjunto de 505 atores no Território Portal da Amazônia. Foram identificadas 3384 relações de diálogo, com uma média de 6,7 parceiros de diálogo por ator. A análise dos aspectos estruturais da rede de diálogo foi utilizada para construir indicadores de capital social de ligação, com mapeamento da organização interna dos atores de um mesmo município, e de conexão, com a caracterização das relações entre atores de municípios diferentes. Em nível municipal, a distribuição das duas formas de capital social permitiu caracterizar os grupos de atores de acordo com as suas atuações diferenciadas na governança ambiental do Território. Em nível territorial, o padrão de conectividade entre os 16 municípios mostra um equilíbrio entre as duas formas de capital social e revela o potencial de comunicação e organização dos atores, como demonstrado no exemplo dos projetos de Agendas 21 locais. Estes resultados demonstram como a análise de redes sociais pode contribuir na definição (ou redefinição) das fronteiras dos territórios de modo a incluir um conjunto de municípios cujos atores mantêm relações sociais efetivas. Ações de governança no Portal da Amazônia são propostas com potencial para fortalecer os processos de diálogo, diminuir os conflitos e promover o uso sustentável dos recursos naturais na Amazônia.

Social entrepreneurship: does institutional environment make a difference?

The purpose of this paper is to contribute to a better understanding of the link between social entrepreneurs and institutional environment in Portugal. A quantitative approach is used in the study, and primary data were collected through an online survey. A questionnaire was emailed to, both, Portuguese Non-Governmental organizations and projects available on the Portuguese social stock exchange. In the analysis of the data were used descriptive statistics, factorial analysis and t-student tests to validate (or not) the research hypotheses. The results show that a favorable institutional environment has a low importance in the decision to develop social initiatives. This conclusion supports the idea that many social entrepreneurs can emerge even in developing regions where the institutional environment is weak. Therefore, social entrepreneurship could be an instrument of regional development and contribute to attenuate the social and economic differences among Portuguese regions.

Arquitetura distribuída para análises multimodais de conectividade cerebral

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Informática Médica)

Characteristics and identification of sites of chagasic ventricular tachycardia by endocardial mapping

OBJECTIVE: To study electrophysiological characteristics that enable the identification and ablation of sites of chagasic tachycardia. METHODS: Thirty-one patients with chronic Chagas' heart disease and sustained ventricular tachycardia (SVT) underwent electrophysiological study to map and ablate that arrhythmia. Fifteen patients had hemodinamically stable SVT reproducible by programmed ventricular stimulation, 9 men and 6 women with ages ranging from 37 to 67 years and ejection fraction varying from 0.17 to 0.64. Endocardial mapping was performed during SVT in all patients. Radiofrequency (RF) current was applied to sites of presystolic activity of at least 30 ms. Entrainment was used to identify reentrant circuits. In both successful and unsuccessful sites of RF current application, electrogram and entrainment were analyzed. RESULTS: Entrainment was obtained during all mapped SVT. In 70.5% of the sites we observed concealed entrainment and ventricular tachycardia termination in the first 15 seconds of RF current application. In the unsuccessful sites, significantly earlier electrical activity was seen than in the successful ones. Concealed entrainment was significantly associated with ventricular tachycardia termination. Bystander areas were not observed. CONCLUSION: The reentrant mechanism was responsible for the genesis of all tachycardias. In 70.5% of the studied sites, the endocardial participation of the slow conducting zone of reentrant circuits was shown. Concealed entrainment was the main electrophysiological parameter associated with successful RF current application. There was no electrophysiological evidence of bystander regions in the mapped circuits of SVT.

Predictive value of clinical and electrophysiological variables in patients with chronic chagasic cardiomyopathy and nonsustained ventricular tachycardia

OBJECTIVE: Risk stratification of patients with nonsustained ventricular tachycardia (NSVT) and chronic chagasic cardiomyopathy (CCC). METHODS: Seventy eight patients with CCC and NSVT were consecutively and prospectively studied. All patients underwent to 24-hour Holter monitoring, radioisotopic ventriculography, left ventricular angiography, and electrophysiologic study. With programmed ventricular stimulation. RESULTS: Sustained monomorphic ventricular tachycardia (SMVT) was induced in 25 patients (32%), NSVT in 20 (25.6%) and ventricular fibrillation in 4 (5.1%). In 29 patients (37.2%) no arrhythmia was inducible. During a 55.7-month-follow-up, 22 (28.2%) patients died, 16 due to sudden death, 2 due to nonsudden cardiac death and 4 due to noncardiac death. Logistic regression analysis showed that induction was the independent and main variable that predicted the occurrence of subsequent events and cardiac death (probability of 2.56 and 2.17, respectively). The Mantel-Haenszel chi-square test showed that survival probability was significantly lower in the inducible group than in the noninductible group. The percentage of patients free of events was significantly higher in the noninducible group. CONCLUSION: Induction of SMVT during programmed ventricular stimulation was a predictor of arrhythmia occurrence cardiac death and general mortality in patients with CCC and NSVT.

Useful clinical features for the selection of ideal patients with strial fibrillation for mapping and catheter ablation

OBJECTIVE: To identify useful clinical characteristics for selecting patients eligible for mapping and ablation of atrial fibrillation. METHODS: We studied 9 patients with atrial fibrillation, without structural heart disease, associated with: 1) antiarrhythmic drugs, 2) symptoms of low cardiac output, and 3) intention to treat. Seven patients had paroxysmal atrial fibrillation and 2 had recurrent atrial fibrillation. RESULTS: In the 6 patients who underwent mapping (all had paroxysmal atrial fibrillation), catheter ablation was successfully carried out in superior pulmonary veins in 5 patients (the first 3 in the left superior pulmonary vein and the last 2 in the right superior pulmonary vein). One patient experienced a recurrence of atrial fibrillation after 10 days. We observed that patients who had short episodes of atrial fibrillation on 24-hour Holter monitoring before the procedure were those in whom mapping the focus of tachycardia was possible. Tachycardia was successfully suppressed in 4 of 6 patients. The cause of failure was due to the impossibility of maintaining sinus rhythm long enough for efficient mapping. CONCLUSION: Patients experiencing short episodes of atrial fibrillation during 24-hour Holter monitoring were the most eligible for mapping and ablation, with a final success rate of 66%, versus the global success rate of 44%. Patients with persistent atrial fibrillation were not good candidates for focal ablation.

Comparação da coronariografia de mulheres diabéticas e não-diabéticas com síndrome coronariana aguda sem supradesnivelamento de ST

OBJETIVO: Comparar o padrão hemodinâmico, angiográfico e a morfologia da lesão aterosclerótica em diabéticas e não-diabéticas com angina instável ou infarto agudo do miocárdio sem supradesnivelamento do segmento ST (AI/IAMSS). MÉTODOS: Dois hemodinamicistas determinaram a presença de lesão aterosclerótica grave, definida como > 70%, a morfologia da placa, de acordo com a classificação da American Heart Association, a presença de circulação colateral e as pressões ventriculares e aórticas. A fração de ejeção foi calculada pela angiografia ou pelo ecocardiograma. RESULTADOS: Em oito anos e meio, foram realizados 645 coronariografias em mulheres com AI/IAMSS. Foram analisadas 593 pacientes (215 diabéticas - 36%). Este grupo diferiu das não-diabéticas nos seguintes aspectos: idade mais alta (61 ± 10,6 x 58,1 ± 11,4), prevalência maior de mulheres pós-menopausa e menor prevalência de tabagismo. Lesão grave em três vasos foi significativamente mais freqüente nas pacientes diabéticas (28% x 10%), assim como vasos totalmente ocluídos: 51 (23%) x 54 (14.3%), p < 0.005.Fração de ejeção < 50% foi mais comum nas diabéticas. CONCLUSÃO: Estes achados confirmam o acometimento difuso da doença aterosclerótica em pacientes diabéticas, assim como maior deterioração da função ventricular, que pode estar relacionada ao pior prognóstico dessa população em curto e em longo prazo.

Forame oval patente e acidente vascular cerebral isquêmico em jovens: associação causal ou estatística?

OBJETIVOS: Determinar se há evidências de uma relação causal entre forame oval patente (FOP) e acidente vascular cerebral isquêmico (AVCI) criptogênico em jovens. Analisar essa relação à luz dos critérios de causalidade. MÉTODOS: Avaliaram-se, retrospectivamente, 168 pacientes jovens com AVCI, divididos em dois grupos: criptogênico e de causa definida. Como parte da rotina, os pacientes foram submetidos a pesquisa de FOP por ecocardiograma transesofágico e/ou Doppler transcraniano, ambos associados ao teste de bolhas. Demonstrada a associação estatística univariada entre FOP e AVCI, procedeu-se a análise multivariada. RESULTADOS: Após análise multivariada, a associação FOP e AVCI criptogênico mostrou-se ainda estatisticamente significante, com razão de chance (RCajustada de 3,3 (IC95% 1,5-7,4). O número total de lesões no encéfalo também apresentou associação significativa com o AVCI criptogênico (RCajustada= 0,4 IC95% 0,2-0,9). A associação FOP e AVCI criptogênico satisfez todos os critérios de causalidade. CONCLUSÃO: A relação causal entre o FOP e o AVCI criptogênico em jovens é altamente provável. Esse fato deve ser considerado na decisão terapêutica.

Aneurismas múltiplos de pontes aorto-coronárias de veia safena com ruptura fatal

Aneurismas de pontes aorto-coronárias de veia safena são eventos raros, usualmente assintomáticos e detectados de forma incidental. Rupturas espontâneas de pontes de safena são raras, havendo poucos dados radiológicos disponíveis na literatura. Relatamos o caso de um senhor de 39 anos internado com hematêmese dez anos depois de ter sido submetido a cirurgia de revascularização miocárdica. Imagens tomográficas mostraram três aneurismas nas pontes de safena, mas o exame não detectou ruptura. O paciente veio a falecer e a necropsia revelou que a causa do óbito havia sido ruptura de aneurisma de pontes de safena. Esse caso ilustra a necessidade de tratamento agressivo de aneurismas sintomáticos de pontes coronarianas.

Fração de ejeção e volumes do ventrículo esquerdo medidos com eco 3D e com tomografia ultra-rápida

FUNDAMENTO: O ecocardiograma tridimensional em tempo real (ECO 3D) e a tomografia computadorizada ultra-rápida (CT) são dois novos métodos de análise da fração de ejeção e dos volumes do VE. OBJETIVO: Comparar as medidas da FEVE e dos volumes do VE aferidos pelo ECO 3D e pela CT ultra-rápida. MÉTODOS: Foram estudados pelo ECO 3D e pela CT ultra-rápida de 64 cortes, 39 pacientes consecutivos (27 homens, média etária de 57±12 anos). Foram analisados: FEVE e volumes do VE. Análise estatística: coeficiente de correlação (r: Pearson), teste de Bland & Altman, teste de regressão linear, 95 % IC, p<0,05. RESULTADOS: Medidas do ECO 3D: a FEVE variou de 56,1 a 78,6 (65,5±5,58)%; volume diastólico final variou de 49,6 a 178,2 (87±27,8)ml; volume sistólico final variou de 11,4 a 78 (33,1±13,6)ml. Medidas da CT: a FEVE variou de 53 a 86 (67,8±7,78)%; volume diastólico final variou de 51 a 186 (106,5±30,3) ml; volume sistólico final variou de 7 a 72 (35,5±13,4)ml. As correlações entre ECO 3D e CT foram: FEVE (r: 0,7888, p<0,0001, 95% IC 0,6301 a 0,8843); volume diastólico final (r: 0,7695, p<0,0001, 95% IC 0,5995 a 0,8730); volume sistólico final (r: 0,8119, p<0,0001, 95% IC 0,6673 a 0,8975). CONCLUSÃO: Nesta série, foi observada boa correlação entre as medidas da FEVE e entre os volumes ventriculares aferidos pelo ECO3D e pela CT ultra-rápida de 64 cortes.

Análise comparativa entre tipos de alimentação de Micrurus corallinus (Serpentes, Elapidae) em cativeiro

Micrurus corallinus (Merrem, 1820) kept in laboratory animal rooms swallow voluntarily various colubrid species. The most accepted species belong to the genera Sibynomorphus Fitzinger, 1843, Oxyrhopus Wagler, 1830 and Liophis Wagler, 1830. The voluntary feeding guaranteed resistance against pathogenic agents. The forced feeding was unsatisfactory due to stress resulting from handling, feeding frequency (30 days), susceptibility to pathogenic agents and high occurrence of pathologies.