Clinical and epidemiological characterization of dengue hemorrhagic fever cases in northeastern, Brazil

INTRODUCTION: The dengue hemorrhagic dengue (DHF) remains an important public health problem in Brazil. The objective of this study was to analyze the epidemiological characteristics of DHF cases during the 2003 epidemic in Ceará. METHODS: Suspected DHF cases with onset of symptoms between January and December 2003 were investigated. RESULTS: 37,964 classic dengue cases and 291 DHF cases were reported. Among the cases discarded, 75.5% were serologically positive but did not meet the criteria recommended by the World Health Organization (WHO). The DHF patients' median age was 30 years (2 - 88). Among the hemorrhagic manifestations, petechiae were the most (32.6%) frequent. Cases of gastrointestinal bleeding, ascites, pericardial pleural effusion, hepatomegaly, hypotension and shock showed higher risk of progression to death (p <0.05). CONCLUSIONS: The introduction of a new serotype (DENV-3) in Ceará, which encountered a susceptible population and high vector density, may have been the primary agent responsible for the magnitude of the epidemic. Timely and appropriate medical care, along with an organized care structure are essential for reducing its lethality.

Bits, Atoms, and Information Sharing: new opportunities for participation

The particular characteristics and affordances of technologies play a significant role in human experience by defining the realm of possibilities available to individuals and societies. Some technological configurations, such as the Internet, facilitate peer-to-peer communication and participatory behaviors. Others, like television broadcasting, tend to encourage centralization of creative processes and unidirectional communication. In other instances still, the affordances of technologies can be further constrained by social practices. That is the case, for example, of radio which, although technically allowing peer-to-peer communication, has effectively been converted into a broadcast medium through the legislation of the airwaves. How technologies acquire particular properties, meanings and uses, and who is involved in those decisions are the broader questions explored here. Although a long line of thought maintains that technologies evolve according to the logic of scientific rationality, recent studies demonstrated that technologies are, in fact, primarily shaped by social forces in specific historical contexts. In this view, adopted here, there is no one best way to design a technological artifact or system; the selection between alternative designs—which determine the affordances of each technology—is made by social actors according to their particular values, assumptions and goals. Thus, the arrangement of technical elements in any technological artifact is configured to conform to the views and interests of those involved in its development. Understanding how technologies assume particular shapes, who is involved in these decisions and how, in turn, they propitiate particular behaviors and modes of organization but not others, requires understanding the contexts in which they are developed. It is argued here that, throughout the last century, two distinct approaches to the development and dissemination of technologies have coexisted. In each of these models, based on fundamentally different ethoi, technologies are developed through different processes and by different participants—and therefore tend to assume different shapes and offer different possibilities. In the first of these approaches, the dominant model in Western societies, technologies are typically developed by firms, manufactured in large factories, and subsequently disseminated to the rest of the population for consumption. In this centralized model, the role of users is limited to selecting from the alternatives presented by professional producers. Thus, according to this approach, the technologies that are now so deeply woven into human experience, are primarily shaped by a relatively small number of producers. In recent years, however, a group of three interconnected interest groups—the makers, hackerspaces, and open source hardware communities—have increasingly challenged this dominant model by enacting an alternative approach in which technologies are both individually transformed and collectively shaped. Through a in-depth analysis of these phenomena, their practices and ethos, it is argued here that the distributed approach practiced by these communities offers a practical path towards a democratization of the technosphere by: 1) demystifying technologies, 2) providing the public with the tools and knowledge necessary to understand and shape technologies, and 3) encouraging citizen participation in the development of technologies.

The use of analytical hierarchy process in spatial decision support system for land use management

Geographic information systems give us the possibility to analyze, produce, and edit geographic information. Furthermore, these systems fall short on the analysis and support of complex spatial problems. Therefore, when a spatial problem, like land use management, requires a multi-criteria perspective, multi-criteria decision analysis is placed into spatial decision support systems. The analytic hierarchy process is one of many multi-criteria decision analysis methods that can be used to support these complex problems. Using its capabilities we try to develop a spatial decision support system, to help land use management. Land use management can undertake a broad spectrum of spatial decision problems. The developed decision support system had to accept as input, various formats and types of data, raster or vector format, and the vector could be polygon line or point type. The support system was designed to perform its analysis for the Zambezi river Valley in Mozambique, the study area. The possible solutions for the emerging problems had to cover the entire region. This required the system to process large sets of data, and constantly adjust to new problems’ needs. The developed decision support system, is able to process thousands of alternatives using the analytical hierarchy process, and produce an output suitability map for the problems faced.

Information provision improvement with a geofencing event-bases system

Nowadays there is a big percentage of the population, specially young users, which are smartphone users and there is a lot of information to be provided within the applications, information provision should be done carefully and should be accurate, otherwise an overload of information will be produced, and the user will discard the app which is providing the information. Mobile devices are becoming smarter and provide many ways to filter information. However, there are alternatives to improve information provision from the side of the application. Some examples are, taking into account the local time, considering the battery level before doing an action and checking the user location to send personalized information attached to that location. SmartCampus and SmartCities are becoming a reality and they have more and more data integrated every day. With all this amount of data it is crucial to decide when and where is the user going to receive a notification with new information. Geofencing is a technique which allows applications to deliver information in a more useful way, in the right time and in the right place. It consists of geofences, physical regions delimited by boundaries, and devices that are eligible to receive the information assigned to the geofence. When devices cross one of these geofences an alert is pushed to the mobile device with the information.

Co-criação de valor do consumidor : impacto na fidelização do paciente ao médico

RESUMO - Confrontados por uma procura mais ativa e exigente e pressionados por uma maior restrição orçamental, os prestadores de saúde têm vindo a reconhecer o Marketing de Fidelização como uma solução sustentável para o seu sucesso financeiro. Assim, a autora explora como se desenvolve a cocriação de valor do consumidor no setor de saúde, nomeadamente, as interações, os atores e as atividades envolvidas na gestão e tratamento da doença. O projeto de investigação foca-se particularmente na cocriação de valor entre o médico regular e o paciente. Foi realizada uma pesquisa exploratória de natureza qualitativa. Os dados recolhidos na APDP, a uma amostra de 16 pacientes diabéticos através da técnica de entrevistas aprofundadas, revelaram que os estilos práticos de criação de valor do consumidor (CVCPS) desenvolvido por McColl-Kennedy et al. (2012) adequam-se às características desta doença. Os resultados do estudo sustentam que os pacientes com estilos práticos de cocriação de valor do consumidor “Parceria” e “Gestor de equipa” tendem a estar associados a um nível de fidelização elevado, pelo que se sugere que estes estilos sejam encorajados pelos prestadores. Em contraste, o Estilo de cocriação “Colaboração Passiva” está potencialmente associado a níveis de fidelização reduzidos, o que também sugere que a participação do paciente no seu relacionamento com o médico possa ser um fator potenciador da sua fidelização. O presente projeto de Investigação pretende ser um contributo teórico para investigação futura na área da cocriação e fidelização, com uma aplicação empírica que contribui para uma maior extensividade dos benefícios da cocriação de valor do consumidor para a Gestão em Saúde.

Intervenção breve no tabagismo : abordagem clínica dos médicos portugueses

RESUMO - O tabagismo é o principal factor de risco evitável em saúde nos países europeus, contribuindo para o aumento da mortalidade prematura, estando associado a inúmeras doenças. A epidemia tabágica é uma preocupação em Saúde Pública, sendo essencial o investimento na sua prevenção e controlo. A cessação tabágica é uma das estratégias para o controlo desta epidemia, surgindo a intervenção breve como uma comprovada medida custo-efetiva. Contudo, e apesar das guidelines, a intervenção breve não está amplamente disseminada na prática clínica dos profissionais de saúde. Neste sentido, este estudo teve como objetivo avaliar as práticas clíniicas autoreportadas dos médicos portugueses na intervenção breve em tabagismo. É um estudo observacional descritivo transversal e exploratório. A amostra é constituída por médicos que participaram em duas conferências médicas distintas e que aceitaram responder a um questionário (n=549). O tratamento estatístico foi efetuado recorrendo ao Statistical Package for the Social Sciences (SPSS), versão 21. Foram efetuadas uma análise descritiva e inferencial, assim como uma regressão logística. Analisando os dados, os resultados apontam para a formação pós-graduada e a prática de cessação tabágica como dois fatores que influenciam positivamente a atuação dos médicos na intervenção breve. A intervenção breve é fundamental para aumentar as taxas de cessação tabágica. Para que a implementação seja eficaz é necessário apostar na formação pré e pós-graduada dos médicos e outros profissionais de saúde, associando essa formação ao treino prático que possibilite o desenvolvimento de competências específicas.

Atypical lymphocytosis in leptospirosis: a cohort of hospitalized cases between 1996 and 2009 in State of Rio de Janeiro, Brazil

INTRODUCTION: Leptospirosis is a zoonotic disease found in tropical and temperate countries, and its clinical diagnostic confusion with arboviruses (dengue fever, oropouche fever and yellow fever), Brazilian spotted fever, viral hepatitis and hantaviruses has been an ongoing public health concern. The aim of this observational study was to demonstrate an association between findings of atypical lymphocytosis and the progression of endemic leptospirosis. METHODS: A retrospective analysis was performed on the demographic, epidemiological, clinical and laboratory aspects of 27 human leptospirosis cases that occurred over a period of 13 years (1996-2009) with no reported epidemic outbreaks in Rio de Janeiro, Brazil. RESULTS: The overall mortality rate was 11.1% in our cohort of hospitalized cases. However, there was no mortality among patients with atypical lymphocytosis (OR = 11.1; 95% CI = 1.12-110.9; p = 0.04). Two patients who were in the septicemic phase showed signs of expansion of γδ T cell responses in peripheral blood. CONCLUSIONS: Atypical lymphocytosis may be observed in patients with leptospirosis. Our observations suggest that these atypical leukocyte subsets are associated with partial protection during the disease course of leptospirosis.

Genetic diversity of dengue virus serotypes 1 and 2 in the State of Paraná, Brazil, based on a fragment of the capsid/premembrane junction region

INTRODUCTION: The precise identification of the genetic variants of the dengue virus is important to understand its dispersion and virulence patterns and to identify the strains responsible for epidemic outbreaks. This study investigated the genetic variants of the capsid-premembrane junction region fragment in the dengue virus serotypes 1 and 2 (DENV1-2). METHODS: Samples from 11 municipalities in the State of Paraná, Brazil, were provided by the Central Laboratory of Paraná. They were isolated from the cell culture line C6/36 (Aedes albopictus) and were positive for indirect immunofluorescence. Ribonucleic acid (RNA) extracted from these samples was submitted to the reverse transcription polymerase chain reaction (RT-PCR) and nested PCR. RESULTS: RT-PCR revealed that 4 of the samples were co-infected with both serotypes. The isolated DENV-1 sequences were 95-100% similar to the sequences of other serotype 1 strains deposited in GenBank. Similarly, the isolated DENV-2 sequences were 98-100% similar to other serotype 2 sequences in GenBank. According to our neighbor-joining tree, all strains obtained in this study belonged to genotype V of DENV-1. The DENV-2 strains, by contrast, belonged to the American/Asian genotypes. CONCLUSIONS: The monitoring of circulating strains is an important tool to detect the migration of virus subtypes involved in dengue epidemics.

Epidemiology of malaria in the municipality of Cruzeiro do Sul, State of Acre, Brazil, in 2010: uses of a control chart at the local level

INTRODUCTION: This study describes the uses of a control chart in the malaria surveillance at the local level, signaling whether there is a need to intensify or adapt control measures. METHODS: The districts of Cruzeiro do Sul (n=14), State of Acre, Brazil, were classified into three groups: I) those with an incidence lower than expected; II) those with an incidence within the expected range; and III) those with an epidemic. RESULTS: Thirteen of the fourteen districts had outbreaks of malaria at some point in 2010, and six districts showed persistent malaria epidemic throughout the year. CONCLUSIONS: The control chart may help the malaria control at the local level.

AIDS tendencies in São Mateus microregion, state of Espírito Santo, and Brazil from 1999 to 2008

INTRODUCTION: In Brazil, AIDS has been described as a multi-faceted pandemic. This study aimed to describe the trends of AIDS in São Mateus microregion, in Espírito Santo, and in Brazil, from 1999 to 2008. METHODS: Data were collected from the Notification Offences System, and a trend analysis was made. RESULTS: Microregion-based results are close to the state and national levels but with particular features that indicate the presence of regional sub-epidemics. CONCLUSIONS: Despite progress in nearly thirty years of the epidemic, AIDS remains an incurable disease, and prevention is still the best defense against it together with the implementation of specific public policies.

Serologic assessment of yellow fever immunity in the rural population of a yellow fever-endemic area in Central Brazil

IntroductionThe yellow fever epidemic that occurred in 1972/73 in Central Brazil surprised the majority of the population unprotected. A clinical-epidemiological survey conducted at that time in the rural area of 19 municipalities found that the highest (13.8%) number of disease cases were present in the municipality of Luziânia, State of Goiás.MethodsThirty-eight years later, a new seroepidemiological survey was conducted with the aim of assessing the degree of immune protection of the rural population of Luziânia, following the continuous attempts of public health services to obtain vaccination coverage in the region. A total of 383 volunteers, aged between 5 and 89 years and with predominant rural labor activities (75.5%), were interviewed. The presence of antibodies against the yellow fever was also investigated in these individuals, by using plaque reduction neutralization test, and correlated to information regarding residency, occupation, epidemiological data and immunity against the yellow fever virus.ResultsWe found a high (97.6%) frequency of protective titers (>1:10) of neutralizing antibodies against the yellow fever virus; the frequency of titers of 1:640 or higher was 23.2%, indicating wide immune protection against the disease in the study population. The presence of protective immunity was correlated to increasing age.ConclusionsThis study reinforces the importance of surveys to address the immune state of a population at risk for yellow fever infection and to the surveillance of actions to control the disease in endemic areas.

Analysis of metabolic flux distributions in relation to the extracellular environment in Avian cells

Continuous cell lines that proliferate in chemically defined and simple media have been highly regarded as suitable alternatives for vaccine production. One such cell line is the AG1.CR.pIX avian cell line developed by PROBIOGEN. This cell line can be cultivated in a fully scalable suspension culture and adapted to grow in chemically defined, calf serum free, medium [1]–[5]. The medium composition and cultivation strategy are important factors for reaching high virus titers. In this project, a series of computational methods was used to simulate the cell’s response to different environments. The study is based on the metabolic model of the central metabolism proposed in [1]. In a first step, Metabolic Flux Analysis (MFA) was used along with measured uptake and secretion fluxes to estimate intracellular flux values. The network and data were found to be consistent. In a second step, Flux Balance Analysis (FBA) was performed to access the cell’s biological objective. The objective that resulted in the best predicted results fit to the experimental data was the minimization of oxidative phosphorylation. Employing this objective, in the next step Flux Variability Analysis (FVA) was used to characterize the flux solution space. Furthermore, various scenarios, where a reaction deletion (elimination of the compound from the media) was simulated, were performed and the flux solution space for each scenario was calculated. Growth restrictions caused by essential and non-essential amino acids were accurately predicted. Fluxes related to the essential amino acids uptake and catabolism, the lipid synthesis and ATP production via TCA were found to be essential to exponential growth. Finally, the data gathered during the previous steps were analyzed using principal component analysis (PCA), in order to assess potential changes in the physiological state of the cell. Three metabolic states were found, which correspond to zero, partial and maximum biomass growth rate. Elimination of non-essential amino acids or pyruvate from the media showed no impact on the cell’s assumed normal metabolic state.

Approaches towards tick and tick-borne diseases control

Ticks are obligate haematophagous ectoparasites of wild and domestic animals as well as humans, considered to be second worldwide to mosquitoes as vectors of human diseases. Tick-borne diseases are responsible worldwide for great economic losses in terms of mortality and morbidity of livestock animals. This review concerns to the different tick and tick-parasites control methods having a major focus on vaccines. Control of tick infestations has been mainly based on the use of acaricides, a control measure with serious drawbacks, as responsible for the contamination of milk and meat products, as a selective factor for acaricide-resistant ticks and as an environmental contaminant. Research on alternatives to the use of acaricides is strongly represented by tick vaccines considered a more cost-effective and environmentally safe strategy. Vaccines based on the Bm86 tick antigen were used in the first commercially available cattle tick vaccines and showed good results in reducing tick numbers, affecting weight and reproductive performance of female ticks which resulted in reduction of cattle tick populations over time and consequently lower reduction of the pathogen agents they carry.

The epidemiological scenario of feline sporotrichosis in Rio de Janeiro, State of Rio de Janeiro, Brazil

Introduction Sporotrichosis is a mycosis affecting both humans and animals. Within the context of the ongoing sporotrichosis epidemic in the State of Rio de Janeiro, Brazil, sick cats plays an important role in the zoonotic transmission. The aim of this study was to update the number of feline cases diagnosed at the Fundação Oswaldo Cruz (2005-2011). Methods The medical records of the cats followed were reviewed; the inclusion criterion was the isolation of Sporothrix spp. in culture. Results In total, 2,301 feline cases were identified. Conclusions These results should alert sanitary authorities to the difficulties associated with sporotrichosis control.

Role of sympathetic innervation in obesity

Part of the results presented in this thesis were published in the following reference (DOI 10.1016/j.cell.2015.08.055): Wenwen Zeng*, Roksana M. Pirzgalska*, Mafalda M.A. Pereira, Nadiya Kubasova, Andreia Barateiro, Elsa Seixas, Yi-Hsueh Lu, Albina Kozlova, Henning Voss, Gabriel G. Martins, Jeffrey M. Friedman and Ana I. Domingos. Sympathetic Neuro-adipose Connections Mediate Leptin-Driven Lipolysis. Cell 163, 84-94 (2015). The work was also presented through poster presentations at iMED Conference 6.0 (Lisbon, 2014), Sociedade Portuguesa de Bioquímica Meeting (Coimbra, 2014) and Sociedade Portuguesa de Neurociências Meeting (Póvoa de Varzim, 2015).