Controle da esquistossomose no Brasil

A extensa área em que há transmissão de esquistossomose (11% do território do país) e o fato de que a distribuição é sempre focal, dependente de condições locais, faz com que o controle seja metodológica e operacionalmente difícil. Desde o ano de 1976, com o Programa Especial de Controle da Esquistossomose (PECE), tem sido cumpridas atividades regulares, desde então sistematizadas em um programa vertical, que assim se manterá até que se alcance taxas de prevalência iguais ou inferiores a 5% em exames coproscópicos, rotineiramente realizados sob a forma de inquéritos que orientam o tratamento humano. A partir daí, os serviços permanentes de saúde deverão assumir as ações de controle. O uso de moluscicidas vem sendo racionalizado, a partir de uma melhor definição dos criadouros de importância epidemiológica. O saneamento e as atividades de educação em áreas localizadas, e nos limites dos recursos disponíveis, são ações complementares algumas vezes, desenvolvidas, em caráter até aqui mais ou menos esporádico. Os resultados colhidos indicam claramente a redução do número de casos de forma grave da doença, e a redução da morbidade, quando examinados os dados a um maior nível de agregação.

Eficiência de alfacipermetrina e cipermetrina no controle de triatomíneos em Camalaú, no sul da Paraíba (Hemiptera: Reduviidae)

We sprayed, in three groups of Domiciliary Units, 10 and 15 g of alphacypermethrin and 31.3 g of cypermethrin per pump of 10 liters, equivaling, if applied on 250 [squared meters), respectiveliy, to 60 and 40 mg of a alphacypermethrin [per squared meter] and 125,2 mg of cypermethrin [per squared meter]. The invasion, colonization and cumulative indices in the houses and the positivity index in shelters near houses were very low and similar in the three groups, in the 15 months of evaluation, indicating that alphacypermethrin can replace cypermethrin. Triatoma infestans predominated in the Domiciliary Units before treatment and T. brasiliensis and T. pseudomaculata predominated after it.

O tratamento específico como arma no controle da esquistossomose

The specific treatment of schistosomiasis has been though to prevent or revert severe forms of the disease, since 1957. Starting in 1977, prospective and controlled studies performed in different endemic areas of Brazil were able to confirm such facts. The new drugs, of high efficacy and well tolerated - Oxamniquine and Praziquantel - can actually prevent and cure the severe forms of some patients, contributing to change the morbidity pattern of the disease, thus being considered as important weapons in its control. Analysis of the Brazilian articles on the subject is presented.

Controle da esquistossomose mansônica em área de baixa transmissao

The schistosomiasis is transmitted by Biomphalaria tenagophila in our study area (Pedro de Toledo, Sao Paulo, Brazil). From 1980 to 1990 epidemiological surveys in a population of 4.000 inhabitants, has shown that: prevalence Kato-Katz (KKT), immunofluorescence (FT) and intradermal (IDT) techniques were 22.8%, 55.5% and 51.8% respectively; intensity of infection was low, 58.5 eggs per gram of faeces (epg); there were no symptomatic cases; prevalences were higher in mates, children and rural zone; index of potential contamination was 57.5% in the age group 5 to 20 years; 2/3 of patients were autochtonous; cases were no-randomly aggregated; transmission was focal and only 0.4% of snails were infected; water contacts through recreation showed the most important odds ratio; knowledge, attitudes and practices were satisfatory. From the epidemiological control findings a control programme was carried out; yearly faeces exams, chemotherapy, molluscocide, health education and sanitation. Thus, the prevalence decreased sharply to 3.3% and intensity of infection to 30.3 epg; the incidence rates ranged between 0.4% and 2.5% annualy; the sanitation became better and the youngsters were the main target in prophylaxis. To improve control, immunodiagnosis has to be conducted and the involvment of the population should be increase. However, we cannot forget that re-infection and the involvment of the population should be increase. However, we cannot forget that re-infection, therapeutic failure, etc, could play a major role in the maintnance this residual prevalence.

Medidas de controle

The control measures preconized by Ministério da Saúde/Fundaçao Nacional de Saúde for 1990/1991, started to have a new focus when significant advances were evidenced in the two last decades and after internal meetings with participation of the cientific community interested in accompanting the actions directed to the control of schistosomiasis in our country. Since then, the priority started to be the suppressing of the occurence of advanced clinical forms, having as an objective, the detection and treatment of all carrier of Schistosoma mansoni. Beyond the control measures, factors that may interfere in the application of those measures were also boarded, the diverse phasis of field operations, the work methodology and results obtained in the first semester of 1991.

Long-Lasting Protection of Activity of Nucleoside Reverse Transcriptase Inhibitors and Protease Inhibitors (PIs) by Boosted PI Containing Regimens.

BACKGROUND: The accumulation of mutations after long-lasting exposure to a failing combination antiretroviral therapy (cART) is problematic and severely reduces the options for further successful treatments. METHODS: We studied patients from the Swiss HIV Cohort Study who failed cART with nucleoside reverse transcriptase inhibitors (NRTIs) and either a ritonavir-boosted PI (PI/r) or a non-nucleoside reverse transcriptase inhibitor (NNRTI). The loss of genotypic activity <3, 3-6, >6 months after virological failure was analyzed with Stanford algorithm. Risk factors associated with early emergence of drug resistance mutations (<6 months after failure) were identified with multivariable logistic regression. RESULTS: Ninety-nine genotypic resistance tests from PI/r-treated and 129 from NNRTI-treated patients were analyzed. The risk of losing the activity of ≥1 NRTIs was lower among PI/r- compared to NNRTI-treated individuals <3, 3-6, and >6 months after failure: 8.8% vs. 38.2% (p = 0.009), 7.1% vs. 46.9% (p<0.001) and 18.9% vs. 60.9% (p<0.001). The percentages of patients who have lost PI/r activity were 2.9%, 3.6% and 5.4% <3, 3-6, >6 months after failure compared to 41.2%, 49.0% and 63.0% of those who have lost NNRTI activity (all p<0.001). The risk to accumulate an early NRTI mutation was strongly associated with NNRTI-containing cART (adjusted odds ratio: 13.3 (95% CI: 4.1-42.8), p<0.001). CONCLUSIONS: The loss of activity of PIs and NRTIs was low among patients treated with PI/r, even after long-lasting exposure to a failing cART. Thus, more options remain for second-line therapy. This finding is potentially of high relevance, in particular for settings with poor or lacking virological monitoring.

Validation interne de la version française du NEO-PI-R et influence de l'âge, du sexe et de la profession

We have examined the internal validity of the French translation of the NEO PI-R personality test which measures the « big five » (Rolland, 1993). The impact of age, gender and professional categories on the NEO PI-R scales was assessed. A large sample (n=731) of subjects of different age, gender and profession and a sample of Swiss students (n=261) responding anonymously were used. Factor analyses confirmed the structure of the instrument (5 domains) and the structures of the domains in terms of facets (six facets within each domain). On the other hand, the age has a significant impact on all the domains of the NEO PI-R; the gender has an impact on the scores on N (neuroticism), O (openness) and A (agreeableness), and the profession has an impact on the domains E (extraversion), O (openness) and A (agreeableness). The scores on several facets are also affected by those three variables. Our study gives the researchers and the practitioner a reference score table according to the studied variables.

The hierarchical structures of the NEO-PI-R and the 16PF5

The present study compares the higher-level dimensions and the hierarchical structures of the fifth edition of the 16 PF with those of the NEO PI-R. Both inventories measure personality according to five higher-level dimensions. These inventories were however constructed according to different methods (bottom-up vs. top-down). 386 participants filled out both questionnaires. Correlations, regressions and canonical correlations made it possible to compare the inventories. As expected they roughly measure the same aspects of personality. There is a coherent association among four of the five dimensions measured in the tests. However Agreeableness, the remaining dimension in the NEO PI-R, is not represented in the 16 PF 5. Our analyses confirmed the hierarchical structures of both instruments, but this confirmation was more complete in the case of the NEO PI-R. Indeed, a parallel analysis indicated that a four-factor solution should be considered in the case of the 16 PF 5. On the other hand, the NEO PI-R's five-factor solution was confirmed. The top-down construction of this instrument seems to make for a more legible structure. Of the two five-dimension constructs, the NEO PI-R thus seems the more reliable. This confirms the relevance of the Five Factor Model of personality.