Imported Malaria In A Non-endemic Area: The Experience Of The University Of Campinas Hospital In The Brazilian Southeast.

Although malaria in Brazil almost exclusively occurs within the boundaries of the Amazon Region, some concerns are raised regarding imported malaria to non-endemic areas of the country, notably increased incidence of complications due to delayed diagnoses. However, although imported malaria in Brazil represents a major health problem, only a few studies have addressed this subject. A retrospective case series is presented in which 263 medical charts were analysed to investigate the clinical and epidemiological characterization of malaria cases that were diagnosed and treated at Hospital & Clinics, State University of Campinas between 1998 and 2011. Amongst all medical charts analysed, 224 patients had a parasitological confirmed diagnosis of malaria. Plasmodium vivax and Plasmodium falciparum were responsible for 67% and 30% of the infections, respectively. The majority of patients were male (83%) of a productive age (median, 37 years old). Importantly, severe complications did not differ significantly between P. vivax (14 cases, 9%) and P. falciparum (7 cases, 10%) infections. Severe malaria cases were frequent among imported cases in Brazil outside of the Amazon area. The findings reinforce the idea that P. vivax infections in Brazil are not benign, regardless the endemicity of the area studied. Moreover, as the hospital is located in a privileged site, it could be used for future studies of malaria relapses and primaquine resistance mechanisms. Finally, based on the volume of cases treated and the secondary complications, referral malaria services are needed in the non-endemic areas of Brazil for a rapid and efficient and treatment.

Comparative study of human exposure to mercury in riverside communities in the Amazon region

Four populations in the Amazon area were selected for a comparative study of mercury-exposed and non-exposed populations: São Luiz do Tapajós, Barreiras, Panacauera, and Pindobal Grande. The highest mercury levels in human hair samples were found in São Luiz do Tapajós and Barreiras, greatly exceeding the limits established by the World Health Organization. Panacauera showed an intermediate level below 9 µg/g. This was the first comparative and simultaneous evaluation of mercury exposure in the Amazon area. Also, thanks to this type of monitoring, we were able to eliminate the uncertainties about the reference dose. On the basis of these data, we can conclude that the mercury levels detected in exposed populations of the Tapajós River basin may be dangerous not only because they are above the World Health Organization limits, but also because the simultaneous mercury detection in non-exposed populations with similar characteristics provided a valid control and revealed lower mercury levels. Our results support the importance of continuous monitoring in both exposed and non-exposed populations.

Radiation balance in a soybean ecosystem in the Amazon

O avanço da fronteira agrícola na Amazônia, da forma como vem sendo realizado, tem deixado a comunidade cada vez mais preocupada ante os possíveis impactos ambientais decorrentes desta mudança no uso da terra, devido à grande importância que a Amazônia representa para o clima global. Neste trabalho avaliaram-se os componentes do balanço de radiação à superfície, ao longo do ciclo da soja (Glycine Max (L.) Merryl), em uma área de avanço da fronteira agrícola na Amazônia. Os componentes do balanço de radiação foram monitorados continuamente durante o ciclo da soja, em 2006 e 2007, em uma área de 200 ha de extensão. O monocultivo da soja na Amazônia apresentou uma contínua mudança nos componentes do balanço de radiação, tendo como consequência uma redução na energia disponível para o ambiente devido o aumento na reflexão da superfície. Observou-se uma importante contribuição da radiação solar difusa na interceptação da soja durante dias nublados, mesmo sob condições de dossel incompleto. Por outro lado, após o fechamento do dossel, a interação da soja com a radiação acontece de forma semelhante, independente da condição de nebulosidade.

Comparative study of human exposure to mercury in riverside communities in the Amazon region

Four populations in the Amazon area were selected for a comparative study of mercury-exposed and non-exposed populations: São Luiz do Tapajós, Barreiras, Panacauera, and Pindobal Grande. The highest mercury levels in human hair samples were found in São Luiz do Tapajós and Barreiras, greatly exceeding the limits established by the World Health Organization. Panacauera showed an intermediate level below 9 µg/g. This was the first comparative and simultaneous evaluation of mercury exposure in the Amazon area. Also, thanks to this type of monitoring, we were able to eliminate the uncertainties about the reference dose. On the basis of these data, we can conclude that the mercury levels detected in exposed populations of the Tapajós River basin may be dangerous not only because they are above the World Health Organization limits, but also because the simultaneous mercury detection in non-exposed populations with similar characteristics provided a valid control and revealed lower mercury levels. Our results support the importance of continuous monitoring in both exposed and non-exposed populations.

Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities

Background: Studies in South-East Asia have suggested that early diagnosis and treatment with artesunate (AS) and mefloquine (MQ) combination therapy may reduce the transmission of Plasmodium falciparum malaria and the progression of MQ resistance. Methods: The effectiveness of a fixed-dose combination of AS and MQ (ASMQ) in reducing malaria transmission was tested in isolated communities of the Jurua valley in the Amazon region. Priority municipalities within the Brazilian Legal Amazon area were selected according to pre-specified criteria. Routine national malaria control programmatic procedures were followed. Existing health structures were reinforced and health care workers were trained to treat with ASMQ all confirmed falciparum malaria cases that match inclusion criteria. A local pharmacovigilance structure was implemented. Incidence of malaria and hospitalizations were recorded two years before, during, and after the fixed-dose ASMQ intervention. In total, between July 2006 and December 2008, 23,845 patients received ASMQ. Two statistical modelling approaches were applied to monthly time series of P. falciparum malaria incidence rates, P. falciparum/Plasmodium vivax infection ratio, and malaria hospital admissions rates. All the time series ranged from January 2004 to December 2008, whilst the intervention period span from July 2006 to December 2008. Results: The ASMQ intervention had a highly significant impact on the mean level of each time series, adjusted for trend and season, of 0.34 (95% CI 0.20 - 0.58) for the P. falciparum malaria incidence rates, 0.67 (95% CI 0.50 - 0.89) for the P. falciparum/P. vivax infection ratio, and 0.53 (95% CI 0.41 - 0.69) for the hospital admission rates. There was also a significant change in the seasonal (or monthly) pattern of the time series before and after intervention, with the elimination of the malaria seasonal peak in the rainy months of the years following the introduction of ASMQ. No serious adverse events relating to the use of fixed-dose ASMQ were reported. Conclusions: In the remote region of the Jurua valley, the early detection of malaria by health care workers and treatment with fixed-dose ASMQ was feasible and efficacious, and significantly reduced the incidence and morbidity of P. falciparum malaria.

AIDS along Brazil`s borders, 1990-2003

Objective. To study the AIDS epidemic in Brazil`s border areas, from the spatial and temporal perspective. Methods. This was an ecological study in which the cases of AIDS reported to the Ministry of Health of Brazil from 1990-2003 were grouped according to ""hunger areas"" as defined by Josue de Castro in the 1940s and according to 19 cultural subregions. Spatial assessment was based on incidence rates for border municipalities; temporal assessment considered the absolute number of cases occurring quarterly from 1990-2003 in each of the hunger areas studied (Extreme South, Midwest, and Amazon). Results. During the study period, 7 973 cases of AIDS were reported from the Brazilian border areas: 648 in the Amazon area, 1 579 in the Midwest, and 5 746 in the Extreme South (populations of 668 098, 895 489, and 2 769 361, respectively). The subregions with the highest AIDS incidence rates in each of the three border areas were those near triple-borders, between more than two Latin American countries. Sexual transmission was predominant, with heterosexual transmission being the most frequent, followed by transmission by male homosexuality. These two categories accounted for 87.2% of the cases reported. The estimates of the trend parameter in the temporal analysis were 0.53 (P < 0.0001), 0.83 (P < 0.0001), and 3.47 (P < 0.0001), respectively, for the Amazon, Midwest, and Extreme South areas. Conclusion. The improvement of health care services along Brazil`s borders may be a strategy for territorial integration and for dealing with the AIDS epidemic, as long as social, economic, and cultural differences are taken into account.

In vitro evaluation of quinidine sensitivity in brazilian Plasmodium falciparum isolates: comparative analysis to quinine and chloroquine

Falciparum malaria represents a serious and an increasing world public health problem due to the acquired parasite's resistance to the most available drugs. In some endemic areas, quinidine, a diastereoisomer of the antimalarial quinine, has been employed for replacing the latter. In order to evaluate the use of quinidine as an alternative to the increasing loss of quinine effectiveness in Brazilian P. falciparum strains, as has been observed in the Amazon area, we have assayed quinidine, quinine and chloroquine. The in vitro microtechnique was employed. All isolates showed to be highly resistant to chloroquine. Resistance to quinine was not noted although high MIC (minimal inhibitory concentration) values have been observed. These data corroborate the decreasing sensitivity to quinine in strains from Brazil. Quinidine showed IC50 from 0.053 to 4.577 mumol/L of blood while IC50 from 0.053 to 8.132 mumol/L of blood was estimated for quinine. Moreover, clearance of the parasitemia was observed in concentrations lower than that used for quinidine in antiarrhythmic therapy, confirming our previous data. The results were similar to African isolate.

Cross-reactive anti-PfCLAG9 antibodies in the sera of asymptomatic parasite carriers of Plasmodium vivax

The PfCLAG9 has been extensively studied because their immunogenicity. Thereby, the gene product is important for therapeutics interventions and a potential vaccine candidate. Antibodies against synthetic peptides corresponding to selected sequences of the Plasmodium falciparum antigen PfCLAG9 were found in sera of falciparum malaria patients from Rondônia, in the Brazilian Amazon. Much higher antibody titres were found in semi-immune and immune asymptomatic parasite carriers than in subjects suffering clinical infections, corroborating original findings in Papua Guinea. However, sera of Plasmodium vivax patients from the same Amazon area, in particular from asymptomatic vivax parasite carriers, reacted strongly with the same peptides. Bioinformatic analyses revealed regions of similarity between P. falciparum Pfclag9 and the P. vivax ortholog Pvclag7. Indirect fluorescent microscopy analysis showed that antibodies against PfCLAG9 peptides elicited in BALB/c mice react with human red blood cells (RBCs) infected with both P. falciparum and P. vivax parasites. The patterns of reactivity on the surface of the parasitised RBCs are very similar. The present observations support previous findings that PfCLAG9 may be a target of protective immune responses and raises the possibility that the cross reactive antibodies to PvCLAG7 in mixed infections play a role in regulate the fate of Plasmodium mixed infections.

Outstanding insecurities concerning the use of an Ov16-based ELISA in the Amazonia onchocerciasis focus

In a recent issue of Memórias do Instituto Oswaldo Cruz, published in Rio de Janeiro in February 2014 (109: 87-92), Adami et al. have published a survey reporting Mansonella parasite prevalence in the Amazon Region. This report makes a useful contribution to the existing knowledge of filarial parasite distribution within the Amazon area, parasite prevalence rates in relation to age and occupation and provides observations on the possible clinical impact of Mansonella ozzardi. Their publication also provides an account of what appears to be a novel ELISA that has recently been used in the Simuliidae and Onchocerciasis Laboratory of the Oswaldo Cruz Institute, Rio de Janeiro, Brazil. We are concerned that the publication of this ELISA may have created an excessively positive impression of the effectiveness of the onchocerciasis recrudescence serological surveillance tools that are presently available for use in the Amazonia onchocerciasis focus. In this letter we have, thus, sought to highlight some of the limitations of this ELISA and suggest how continuing insecurities concerning the detection of antibodies to Onchocerca volvulus within the Amazonia onchocerciasis focus might be minimised.

The South American Plasmodium falciparum var gene repertoire is limited, highly shared and possibly lacks several antigenic types

The Plasmodium falciparum var gene family encodes large variant antigens, which are important virulence factors, and also targets of the humoral host response. The frequently observed mild outcomes of falciparum malaria in many places of the Amazon area prompted us to ask whether a globally restricted variant (var) gene repertoire is present in currently circulating and older isolates of this area. By exhaustive analysis of var gene tags from 89 isolates and clones taken during many years from all over the Brazilian Amazon, we estimate that there are probably no more than 350-430 distinct sequence types, less than for any similar sized area studied so far. Detailed analysis of the var tags from genetically distinct clones obtained from single isolates revealed restricted and redundant repertoires suggesting either a low incidence of infective bites or restricted variant gene diversity in inoculated parasites. Additionally, we found a structuring of var gene repertoires observed as a higher pairwise typing sharing in isolates from the same microregion compared to isolates from different regions. Fine analysis of translated var tags revealed that certain Distinct Sequence Identifiers (DSIDs) were differently represented in Brazilian/South American isolates when compared to datasets from other continents. By global alignment of worldwide var DBL alpha sequences and sorting in groups with more than 76% identity, 125 clusters were formed and more than half of all genes were found in nine clusters with 50 or more sequences. While Brazilian/South American sequences were represented only in 64 groups, African sequences were found in the majority of clusters. DSID type 1 related sequences accumulated almost completely in one single cluster, indicating that limited recombination occurs in these specific var gene types. These data demonstrate the so far highest pairwise type sharing values for the var gene family in isolates from all over an entire subcontinent. The apparent lack of specific sequences types suggests that the P. falciparum transmission dynamics in the whole Amazon are probably different from any other endemic region studied and possibly interfere with the parasite`s ability to efficiently diversify its variant gene repertoires. (C) 2010 Elsevier B.V. All rights reserved.

Emprego industrial no pólo industrial de Manaus na década de 90: expectativas, resultados e possibilidades

A década de 90 representou significativas mudanças no panorama político econômico brasileiro, especificamente no projeto de desenvolvimento regional denominado Zona Franca de Manaus. Esse projeto foi concebido, primordialmente para integrar essa imensa região Amazônica ao restante do Brasil, em termos de complexa ordem geopolítica dominante nos anos 60. A análise que objetiva essa dissertação trata da evolução do emprego industrial no Pólo Industrial de Manaus na década de 90, com a conotação de expectativas, resultados e possibilidades. A implementação do projeto Zona Franca de Manaus, no que concerne seu Pólo Industrial permitiu que contingentes de mão-de-obra abundante na capital do Estado do Amazonas, tivesse a oportunidade de inserir-se no mercado de trabalho do processo de industrialização moderna. Todavia, essa mão-de-obra abundante não estava preparada para o que as indústrias demandavam, sendo necessários intensivos programas de adequação profissional para que possibilitasse o aproveitamento em processos produtivos de linhas de montagem. o Pólo Industrial de Manaus, apesar de todas as mudanças havidas na economia brasileira no período analisado, obteve significativos alcance de competências na capacitação desse contingente de trabalhadores que foram absorvidos, quando o paradigma da intensividade do fator trabalho imperava no Pólo. Entretanto, o processo de mudança que a globalização econômica e industrial provocou no sistema de produção global, trouxe para o modelo industrial da Zona Franca de Manaus acelerada mudança desse paradigma, resultando variações na demanda por mão-de-obra e acarretando significativo desemprego estrutural. É desse contexto de mudanças que trata o estudo apresentado, analisando a evolução das variáveis que influenciaram no nível de emprego industrial e no mercado de trabalho, as expectativas de novos perfis e as demandas específicas que o novo paradigma de capital intensivo, adotado pelas empresas de classe mundial desse Pólo exigem.

Da Amazônia ao Pacífico cruzando os Andes

A Área Amazônica (AA) é compartilhada por oito países sul-americanos independentes. Desde os tempos coloniais sentiu-se a necessidade da construção de uma via de união da AA com o Oceano Pacífico. Mas os Andes, em termos técnicos e econômicos, foram barreira insuperável até as últimas décadas do século XIX. Nos últimos anos, para o Brasil - país que tem perto de 60% da AA -, esta via vem se tornando cada vez mais importante em termos de exportação, especialmente para o mercado japonês, de grãos, madeira, polpa de madeira etc., ao mesmo tempo em que o Japão também deseja acesso direto à AA. Brasil e Peru, segundo país da AA, com a maior e mais ocidental costa no Pacífico, têm desenvolvido projetos para a construção de uma estrada, contando para isso com apoio financeiro oferecido pelo Japão em diversas oportunidades. Tais projetos tentam conciliar não apenas os interesses de Brasil e Peru, mas também os da Bolívia, país mediterrâneo que poderia finalmente ter acesso livre à costa do Pacífico. Os Estados Unidos, porém, opõem-se a construção da mencionada via e, o projeto está a espera de que o financiamento anteriormente aventado permita sua concretização. Parece que, na construção da projetada estrada, interesses estratégicos das grandes potências mundiais estão envolvidos.

Biomass production and chemical composition of essential oil of Piper callosum as affected by spacing in Manaus, Amazonas State, Brazil

The family Piperaceae contains nearly 2000 species, most of them distributed in two genera, Piper and Peperomia. In Brazil circa 170 Piper species are found, mainly in tropical areas Their use ranges from flavoring and culinary to raw material for pharmaceutical and cosmetic industry. One of these species, Piper callosum, is used in folk medicine in the Amazon area. The objective of this study was to evaluate the production of biomass (aerial parts) as well as yield and composition of the essential oil from the leaves, according to different spacing between cultivated plants at Embrapa Western Amazon, in Manaus, State of Amazonas, Brazil. The experimental design was randomized blocks, with four treatments and seven replicates with six plants. Biomass production was inversely proportional to the spatial arrangements, with the greatest biomass production (1034.93 kg/ha) in the shortest spacing (E1), although no statistical difference was verified between E3 and E4. The same response was observed for the production of essential oil. The chemical composition of the oil was not affected by spacing, and major compounds found were safrole (59.1%), beta-pinene (8.3%), alpha-pinene (6.5%), methyl eugenol (6.3%) and 1,8-cineole (4.1).