A Decade Of Malaria During Pregnancy In Brazil: What Has Been Done Concerning Prevention And Management.

In Brazil, malaria remains a disease of major epidemiological importance because of the high number of cases in the Amazonian Region. Plasmodium spp infections during pregnancy are a significant public health problem with substantial risks for the pregnant woman, the foetus and the newborn child. In Brazil, the control of malaria during pregnancy is primarily achieved by prompt and effective treatment of the acute episodes. Thus, to assure rapid diagnosis and treatment for pregnant women with malaria, one of the recommended strategy for low transmission areas by World Health Organization and as part of a strategy by the Ministry of Health, the National Malaria Control Program has focused on integrative measures with woman and reproductive health. Here, we discuss the approach for the prevention and management of malaria during pregnancy in Brazil over the last 10 years (2003-2012) using morbidity data from Malaria Health Information System. Improving the efficiency and quality of healthcare and education and the consolidation of prevention programmes will be challenges in the control of malaria during pregnancy in the next decade.

Myocardial Extracellular Volume Expansion And The Risk Of Recurrent Atrial Fibrillation After Pulmonary Vein Isolation.

This study tested whether myocardial extracellular volume (ECV) is increased in patients with hypertension and atrial fibrillation (AF) undergoing pulmonary vein isolation and whether there is an association between ECV and post-procedural recurrence of AF. Hypertension is associated with myocardial fibrosis, an increase in ECV, and AF. Data linking these findings are limited. T1 measurements pre-contrast and post-contrast in a cardiac magnetic resonance (CMR) study provide a method for quantification of ECV. Consecutive patients with hypertension and recurrent AF referred for pulmonary vein isolation underwent a contrast CMR study with measurement of ECV and were followed up prospectively for a median of 18 months. The endpoint of interest was late recurrence of AF. Patients had elevated left ventricular (LV) volumes, LV mass, left atrial volumes, and increased ECV (patients with AF, 0.34 �� 0.03; healthy control patients, 0.29 �� 0.03; p < 0.001). There were positive associations between ECV and left atrial volume (r��= 0.46, p < 0.01) and LV mass and a negative association between ECV and diastolic function (early mitral annular relaxation [E'], r��=��-0.55, p��<��0.001). In the best overall multivariable model, ECV was the strongest predictor of the��primary outcome of recurrent AF (hazard ratio: 1.29; 95% confidence interval: 1.15 to 1.44; p��<��0.0001) and the secondary composite outcome of recurrent AF, heart failure admission, and death (hazard ratio: 1.35; 95% confidence interval: 1.21 to 1.51; p < 0.0001). Each 10% increase in ECV was associated with a 29% increased risk of recurrent AF. In patients with AF and hypertension, expansion of ECV is associated with diastolic��function and left atrial remodeling and is a strong independent predictor of recurrent AF post-pulmonary vein isolation.

Enhanced Endothelium-dependent Relaxation Of Rat Pulmonary Artery Following ��-adrenergic Overstimulation: Involvement Of The No/cgmp/vasp Pathway.

The aim of this study was to investigate whether ��-adrenoceptor (��-AR) overstimulation induced by in vivo treatment with isoproterenol (ISO) alters vascular reactivity and nitric oxide (NO) production and signaling in pulmonary arteries. Vehicle or ISO (0.3mgkg(-1)day(-1)) was administered daily to male Wistar rats. After 7days, the jugular vein was cannulated to assess right ventricular (RV) systolic pressure (SP) and end diastolic pressure (EDP). The extralobar pulmonary arteries were isolated to evaluate the relaxation responses, protein expression (Western blot), NO production (diaminofluorescein-2 fluorescence), and cyclic guanosine 3',5'-monophosphate (cGMP) levels (enzyme immunoassay kit). ISO treatment induced RV hypertrophy; however, no differences in RV-SP and EDP were observed. The pulmonary arteries from the ISO-treated group showed enhanced relaxation to acetylcholine that was abolished by the NO synthase (NOS) inhibitor N(��)-nitro-l-arginine methyl ester (l-NAME); whereas relaxation elicited by sodium nitroprusside, ISO, metaproterenol, mirabegron, or KCl was not affected by ISO treatment. ISO-treated rats displayed enhanced endothelial NOS (eNOS) and vasodilator-stimulated phosphoprotein (VASP) expression in the pulmonary arteries, while phosphodiesterase-5 protein expression decreased. ISO treatment increased NO and cGMP levels and did not induce eNOS uncoupling. The present data indicate that ��-AR overactivation enhances the endothelium-dependent relaxation of pulmonary arteries. This effect was linked to an increase in eNOS-derived NO production, cGMP formation and VASP content and to a decrease in phosphodiesterase-5 expression. Therefore, elevated NO bioactivity through cGMP/VASP signaling could represent a protective mechanism of ��-AR overactivation on pulmonary circulation.

Intrapupal temperature variation during Er,Cr: YSGG enamel irradiation on carries prevention

Studies have shown the cariostatic effect of Er,Cr:YSGG (2.78 mm) laser irradiation on human enamel and have suggested its use on caries prevention. However there are still no reports on the intrapulpal temperature increase during enamel irradiation using parameters for caries prevention. The aim of this in vitro study was to evaluate the temperature variation in the pulp chamber during human enamel irradiation with Er,Cr:YSGG laser at different energy densities. Fifteen enamel blocks obtained from third molars (3 x 3 x 3 mm) were randomly assigned to 3 groups (n=5): G1 - Er,Cr:YSGG laser 0.25 W, 20 Hz, 2.84 J/cm��, G2 - Er,Cr:YSGG laser 0.50 W, 20 Hz, 5.68 J/cm��, G3 - Er,Cr:YSGG laser 0.75 W, 20 Hz, 8.52 J/cm��. During enamel irradiation, two thermocouples were fixed in the inner surface of the specimens and a thermal conducting paste was used. One-way ANOVA did not show statistically significant difference among the experimental groups (a=0.05). There was intrapulpal temperature variation <0.1��C for all irradiation parameters. In conclusion, under the tested conditions, the use of Er,Cr:YSGG laser with parameters set for caries prevention lead to an acceptable temperature increase in the pulp chamber.

Acupuncture for the prevention of radiation-induced xerostomia in patients with head and neck cancer

The aim of this study was to evaluate the effectiveness of acupuncture in minimizing the severity of radiation-induced xerostomia in patients with head and neck cancer. A total of 24 consecutive patients receiving &gt; 5000 cGy radiotherapy (RT) involving the major salivary glands bilaterally were assigned to either the preventive acupuncture group (PA, n = 12), treated with acupuncture before and during RT, or the control group (CT, n = 12), treated with RT and not receiving acupuncture. After RT completion, clinical response was assessed in all patients by syalometry, measuring the resting (RSFR) and stimulated (SSFR) salivary flow rates, and by the visual analogue scale (VAS) regarding dry mouth-related symptoms. Statistical analyses were performed with repeated-measures using a mixed-effect modeling procedure and analysis of variance. An alpha level of 0.05 was accepted for statistical significance. Although all patients exhibited some degree of impairment in salivary gland functioning after RT, significant differences were found between the groups. Patients in the PA group showed improved salivary flow rates (RSFR, SSFR; p < 0.001) and decreased xerostomia-related symptoms (VAS, p < 0.05) compared with patients in the CT group. Although PA treatment did not prevent the oral sequelae of RT completely, it significantly minimized the severity of radiation-induced xerostomia. The results suggest that acupuncture focused in a preventive approach can be a useful therapy in the management of patients with head and neck cancer undergoing RT.

Self-disclosure of HIV diagnosis to sexual partners by heterosexual and bisexual men: a challenge for HIV/AIDS care and prevention

This study investigated the disclosure of HIV-positive serostatus to sexual partners by heterosexual and bisexual men, selected in centers for HIV/AIDS care. In 250 interviews, we investigated disclosure of serostatus to partners, correlating disclosure to characteristics of relationships. The focus group further explored barriers to maintenance/establishment of partnerships and their association with disclosure and condom use. Fear of rejection led to isolation and distress, thus hindering disclosure to current and new partners. Disclosure requires trust and was more frequent to steady partners, to partners who were HIV-positive themselves, to female partners, and by heterosexuals, occurring less frequently with commercial sex workers. Most interviewees reported consistent condom use. Unprotected sex was more frequent with seropositive partners. Suggestions to enhance comprehensive care for HIV-positive men included stigma management, group activities, and human rights-based approaches involving professional education in care for sexual health, disclosure, and care of "persons living with HIV".

High prevalence of drug-resistant tuberculosis and other mycobacteria among HIV-infected patients in Brazil: a systematic review

There is a little-noticed trend involving human immunodeficiency virus (HIV)-infected patients suspected of having tuberculosis: the triple-treatment regimen recommended in Brazil for years has been potentially ineffective in over 30% of the cases. This proportion may be attributable to drug resistance (to at least 1 drug) and/or to infection with non-tuberculous mycobacteria. This evidence was not disclosed in official statistics, but arose from a systematic review of a few regional studies in which the diagnosis was reliably confirmed by mycobacterial culture. This paper clarifies that there has long been ample evidence for the potential benefits of a four-drug regimen for co-infected patients in Brazil and it reinforces the need for determining the species and drug susceptibility in all positive cultures from HIV-positive patients.

A situa����o epidemiol��gica da tuberculose na Rep��blica da Guin��-Bissau, 2000 - 2005

INTRODU����O: A tuberculose na Rep��blica da Guin��-Bissau n��o apresenta bons indicadores de sa��de, assim como na maioria dos pa��ses em vias de desenvolvimento. OBJETIVO: Estudar na Rep��blica da Guin��-Bissau e nas suas Prov��ncias, a situa����o epidemiol��gica da doen��a no per��odo de 2000 a 2005. M��TODO: Realizou-se levantamento de dados secund��rios junto ao Programa Nacional de Luta Contra Lepra e Tuberculose, no per��odo de 2000 a 2005, e an��lise de relat��rios anuais da Capital e das Prov��ncias da Guin��-Bissau, para o c��lculo de coeficientes e taxas dos indicadores. RESULTADOS: O n��mero de casos de tuberculose manteve-se est��vel no per��odo de 2000 (1.959 casos) a 2005 (1.888 casos). O percentual de casos pulmonares variou de 96,0 a 98,8%, dos quais 55% eram bacil��feros. Em 2005 o coeficiente de preval��ncia foi de 142,4/100.000, o de incid��ncia 131,3/100.000 e o de mortalidade, 16,8/100.000 habitantes. A maior concentra����o de casos ocorreu na regi��o da Capital. A taxa de cura variou entre 46,5% em 2000 e 69,6% em 2005, e a de abandono de tratamento de 29,8% em 2000 para 12,1% em 2005. CONCLUS��O: Os indicadores do Plano Estrat��gico Nacional devem ser melhorados, sobretudo no que diz respeito �� busca ativa de casos, �� descentraliza����o do atendimento aos doentes, �� implanta����o da estrat��gia DOTS e �� necessidade de um sistema de informa����o e notifica����o eficientes.

��reas de vulnerabilidade para co-infec����o HIV-aids/TB em Ribeir��o Preto, SP

OBJETIVO: Identificar ��reas de vulnerabilidade para os casos novos de co-infec����o HIV/tuberculose (TB). M��TODOS: Estudo descritivo ecol��gico realizado por meio do georreferenciamento dos casos novos de HIV/TB notificados em Ribeir��o Preto, SP, em 2006. Os dados foram obtidos do sistema de informa����o estadual paulista de notifica����o de TB. Os casos novos de co-infec����o HIV/TB foram analisados conforme caracter��sticas sociodemogr��ficas e cl��nicas e, posteriormente, georreferenciados na base cartogr��fica do munic��pio segundo endere��o residencial. Os setores do munic��pio foram categorizados em tr��s n��veis socioecon��micos: inferior, intermedi��rio e superior, com base na an��lise de componentes principais das vari��veis do censo demogr��fico de 2000 (renda, instru����o e percentagem de domic��lios com cinco ou mais moradores). Foi calculada a incid��ncia da co-infec����o HIV/TB para cada n��vel socioecon��mico. RESULTADOS: A co-infec����o HIV/TB acometeu mais adultos do sexo masculino em idade economicamente ativa e a forma pulmonar da TB foi a mais comum. A distribui����o espacial mostrou que as incid��ncias nas ��reas com n��veis socioecon��micos intermedi��rios e inferiores (8,3 e 11,5 casos por 100 mil habitantes, respectivamente) foram superiores ��quela (4,8 casos por 100 mil habitantes) de n��vel socioecon��mico superior. CONCLUS��ES: A taxa de incid��ncia de co-infec����o HIV/TB analisada por n��veis socioecon��micos mostrou padra��o espacial de distribui��a��o n��o homog��neo e apresentou valores mais altos em ��reas de maior vulnerabilidade social. O estudo diagnosticou a��reas geogra��ficas priorita��rias para o controle da co-infec����o e a tecnologia do sistema de informa����o geogr��fica pode ser empregada no planejamento das a����es em sa��de pelos gestores municipais.

Nutritional aspects of the prevention and treatment of osteoporosis

Osteoporosis is a global health problem characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture. Nutrition plays a critical role in reducing the risk of osteoporosis through its effect on all of these fragility factors, especially on the development and maintenance of bone mass. An adequate calcium, vitamin D and protein intake resulted in reduced bone remodeling, better calcium retention, reduced age-related bone loss, and reduced fracture risk. Recent evidence indicates that a healthy dietary pattern including dairy products (mainly fat free), fruit and vegetables and adequate amounts of meat, fish and poultry is positively related to bone health. Furthermore, mineral and vitamin supplementation should be closely monitored by health professionals since it could have adverse effects and be insufficient to ensure optimal protection of bone health.

Influence of food components on lipid metabolism: scenarios and perspective on the control and prevention of dyslipidemias

Cardiovascular diseases (CVD) are the main causes of death in the Western world. Among the risk factors that are modifiable by diet, for reducing cardiovascular disease risks, the total plasma concentrations of cholesterol, triglycerides, LDL-C, and HDL-C are the most important. Dietary measures can balance these components of the lipid profile thus reducing the risk of cardiovascular diseases. The main food components that affect the lipid profile and can be modified by diet are the saturated and trans fats, unsaturated fats, cholesterol, phytosterols, plant protein, and soluble fiber. A wealth of evidence suggests that saturated and trans fats and cholesterol in the diet raise the total plasma cholesterol and LDL-C. Trans fats also reduce HDL-C, an important lipoprotein for mediating the reverse cholesterol transport. On the other hand, phytosterols, plant proteins, isoflavones, and soluble fiber are protective diet factors against cardiovascular diseases by modulating plasma lipoprotein levels. These food components at certain concentrations are able to reduce the total cholesterol, TG, and LDL-C and raise the plasma levels of HDL-C. Therefore, diet is an important tool for the prevention and control of cardiovascular diseases, and should be taken into account as a whole, i.e., not only the food components that modulate plasma concentrations of lipoproteins, but also the diet content of macro nutrients and micronutrients should be considered.

Pharmacist professionals in the prevention of drug abuse: updating roles, and opportunities

The objective of this paper was to prepare and provide resources to pharmacists and other healthcare professionals, enabling them to carry out a critical analysis on drug abuse, acquiring knowledge in several areas that effectively contribute to their personal development in this professional field. Professionals play a crucial role in the reduction and prevention of substances abuse, since they are able to advise patient about illicit drugs, psychotropic medicines and alcohol abuse. There is an urgent need to specialize pharmacists to act in the national public health service and contribute to actions aimed at the surrounding community.

Tuberculosis determined by Mycobacterium bovis in captive waterbucks (Kobus ellipsiprymnus) in S��o Paulo, Brazil

Two waterbucks from S��o Paulo Zoo Foundation exhibited respiratory symptoms in July 2004. After euthanasia, granulommas in lungs and mediastinic lymph nodes were observed. Acid-fast bacilli isolated were identified as Mycobacterium bovis spoligotype SB0121 by PRA and spoligotyping. They were born and kept in the same enclosure with the same group, without any contact to other species housed in the zoo. This is the first detailed description of M. bovis infection in Kobus ellipsiprymnus.

Evaluation of the efficacy of hydrated sodium aluminosilicate in the prevention of aflatoxin-induced hepatic cancer in rainbow trout

The use of aluminum silicates for decontaminating animal feed containing aflatoxins has yielded encouraging results in chicken and turkey poults. In contrast, very few studies have tested these substances in aquaculture. In this work, we investigated the efficacy of a trout diet containing 0.5% hydrated sodium aluminosilicate (HSAS) in protecting against contamination with aflatoxin B1. Trout were reared on these diets for one year and the experimental groups were examined monthly for hepatic presumptive preneoplastic and neoplastic lesions. Regardless of the presence of HSAS, all of the fish that received aflatoxin in their diet have shown hepatic lesions indicative of a carcinogenic process, presenting also the development of cancer in some fish. The concentration of HSAS used in this study was ineffective in preventing the onset of hepatic lesions induced by aflatoxin B1 in rainbow trout.

Perfil de pacientes que evoluem para ��bito por tuberculose no munic��pio de S��o Paulo, 2002

OBJETIVO: Descrever o perfil de pacientes adultos residentes no munic��pio de S��o Paulo que evolu��ram para ��bito associado �� tuberculose, segundo fatores biol��gicos, ambientais e institucionais. M��TODOS: Estudo descritivo, abrangendo todos os ��bitos por tuberculose (N=416) ocorridos em 2002, entre maiores de 15 anos. Os dados analisados foram obtidos do Sistema Municipal de Informa����es de Mortalidade, prontu��rios hospitalares, Servi��o de Verifica����o de ��bitos e Sistema de Vigil��ncia de Tuberculose. Os c��lculos dos riscos relativos e intervalos de confian��a de 95 por cento (IC 95 por cento) tiveram como refer��ncia o sexo feminino, grupo de 15 a 29 anos, e os naturais do Estado de S��o Paulo. A an��lise comparativa usou o teste do qui-quadrado de Pearson e o exato de Fisher para vari��veis categ��ricas e o teste Kruskal-Wallis para vari��veis cont��nuas. RESULTADOS: Do total de ��bitos, 78 por cento apresentavam a forma pulmonar; o diagn��stico foi efetuado ap��s a morte em 30 por cento e em unidades de atendimento prim��rio em 14 por cento dos casos; 44 por cento n��o iniciaram tratamento; 49 por cento n��o foram notificados; 76 por cento eram homens e a mediana da idade foi de 51 anos; 52 por cento tinham at�� quatro anos de estudo, 4 por cento eram prov��veis moradores de rua. As taxas de mortalidade aumentavam com a idade, sendo de 5,0/100.000 no munic��pio, variando de zero a 35, conforme o distrito. Para 82 de 232 pacientes com registro de tratamento, havia refer��ncia de tratamento anterior, e desses, 41 o haviam abandonado. Constatou-se presen��a de diabetes (16 por cento), doen��a pulmonar obstrutiva cr��nica (19 por cento), HIV (11 por cento), tabagismo (71 por cento) e alcoolismo (64 por cento) nos pacientes. CONCLUS��ES: Homens acima de 50 anos, migrantes e residentes em distritos com baixo ��ndice de Desenvolvimento Humano apresentam maiores riscos de ��bito. )A pouca escolaridade e apresentar co-morbidades s��o caracter��sticas importante Observou-se baixa participa����o das unidades b��sicas de sa��de no diagn��stico e a elevada sub-notifica����o