CLINICAL AND EPIDEMIOLOGICAL PROFILE OF ELDERLY PATIENTS WITH CHAGAS DISEASE FOLLOWED BETWEEN 2005-2013 BY PHARMACEUTICAL CARE SERVICE IN CEARÁ STATE, NORTHEASTERN BRAZIL

By controlling the transmission of Chagas disease, the challenge of providing assistance to millions of infected patients that reach old age arises. In this study, the socioeconomic, demographic and comorbidity records of all elderly chagasic patients followed at the Pharmaceutical Care Service of the Chagas Disease Research Laboratory were assessed. The information related to the clinical form of the disease was obtained from medical records provided by the Walter Cantídio University Hospital. The profile of the studied population was: women (50.5%); mean age of 67 years; retired (54.6%); married (51.6 %); high illiteracy rate (40.2%); and family income equal to the minimum wage (51.5%). The predominant clinical forms of Chagas disease were cardiac (65.3%) and indeterminate (14.7%). The main electrocardiographic changes were the right bundle branch block (41.0%), associated or not with the anterosuperior left bundle branch block (27.4%). The average number of comorbidities per patient was 2.23 ± 1.54, with systemic arterial hypertension being the main one found (67.0%). It was found that the elderly comprise a vulnerable group of patients that associate aging with cardiac and/or digestive disorders resulting from the evolution of Chagas disease and other comorbidities, which requires special attention from health services to ensure more appropriate medical and social care.

Acute myocardial infarction: predictors of mortality at a public hospital in the city of Fortaleza, Ceará state

OBJECTIVE: To identify the clinical and demographic predictors of in-hospital mortality in acute myocardial infarction with elevation of the ST segment in a public hospital, in the city of Fortaleza, Ceará state, Brazil. METHODS: A retrospective study of 373 patients experiencing their first episode of acute myocardial infarction was carried out. Of the study patients, 289 were discharged from the hospital (group A) and 84 died (group B). Both groups were analyzed regarding: sex; age; time elapsed from the beginning of the symptoms of myocardial infarction to assistance at the hospital; use of streptokinase; risk factors for atherosclerosis; electrocardiographic location of myocardial infarct; and Killip functional class. RESULTS: In a univariate analysis, group B had a greater proportion of the following parameters as compared with group A: non-Killip I functional class; diabetes; age >70 years; infarction of the inferior wall associated with right ventricular impairment; time between symptom onset and treatment at the hospital >12 h; anteroseptal or extensive anterior infarction; no use of streptokinase; and no tobacco use. In a multivariate logistic regression analysis, only non-Killip I functional class, diabetes, and age >70 years persisted as independent factors for death. CONCLUSION: Non-Killip I functional class, diabetes, and age >70 years were independent predictors of mortality in acute myocardial infarction with elevation of the ST segment.

Physicochemical properties and mineral and protein content of honey samples from Ceará state, Northeastern Brazil

This study evaluated the physicochemical properties and protein and mineral content of honey samples from Ceará State, Northeastern Brazil, one of the major honey exporters in the country. Nutritional importance of the minerals detected was also analyzed. Physicochemical properties were examined according to the AOAC and CAC official methods; the protein content was determined using the Bradford method, and the minerals were analyzed by atomic absorption spectrometry. All analyses were performed in triplicate. The levels of macrominerals sodium (Na), potassium (K), calcium (Ca), and magnesium (Mg) varied from 1.80-47.20, 21.30-1513.30, 14.58-304.82, and 2.48-28.33 mg/kg, respectively, and the trace elements iron (Fe), copper (Cu), manganese (Mn), zinc (Zn), selenium (Se), and chromium (Cr) varied from 0.12-8.76, 0.07-1.29, 0.06-1.96, 0.07-1.85 mg/kg, 0.36 × 10-3-62.00 × 10-3 and 22.50 × 10-3-170.33 × 10-3 µg/kg, respectively. Myracrodruon urundeuva honey sample had high contents of macrominerals (Na, K, Ca, and Mg). Protein content of the Anacardium occidentale honey sample was the highest (1121.00 µg/g) among the samples analyzed. Among the minerals detected in the honey samples, K showed the highest concentration, followed by Ca, Na, and Mg. The presence of trace elements can show environmental contamination. The honey samples studied were free of trace elements contamination, except for Mn; the Piptadenia moniliformis was the only honey sample that was in compliance with the law requirements. The variations of the chemical constituents in the honey samples are probably related to differences in the floral origin and mineral and protein contents and confirm the nutritional importance of Ceará State honey.

Evidence for Neoproterozoic continental arc magmatism in the Santa Quitéria Batholith of Ceará State, NW Borborema Province, NE Brazil: Implications for the assembly of West Gondwana

Recent field investigations and geochronological studies of Neoproterozoic rocks in the northwestern part of the Borborema Province, Ceará State, NE Brazil provide important clues pertaining to the nature of convergence between the Borborema Province and the West African-São Luis craton during the assembly of West Gondwana. U-Pb zircon data indicate that the earliest evidence of convergent magmatism along the northwest margin of the Borborema Province occurred around 777 Ma, and was followed by the development of a large continental arc batholith (Santa Quitéria batholith) between ca. 665 and 591 Ma within the central part of Ceará State. These findings, along with supporting geophysical data, suggest that convergence between the Borborema Province and the West African-São Luis craton involved closure of an oceanic realm with subduction polarity to the southeast beneath the northwestern part of the province. Consequently, it seems likely that the Pharusian Ocean was continuous from the Hoggar Province in West Africa into South America during the late Neoproterozoic and additional data suggests that it may have even been connected with the Goianides Ocean of the Brasília Belt farther to the southwest.

The flora and vegetation in an area of the Caatinga in Taperuaba, Sobral, Ceará state, Brazil

The Caatinga, covering about 800.000 km2, is the predominant vegetation type of the semi-arid region of Brazil. The Caatinga biome comprises several phytophysiognomies and floristic compositions, with many endemic species, especially in Fabaceae, Cactaceae, Euphorbiaceae, Bignoniaceae e Combretaceae. Despite considerable advances, the Brazilian semi-arid needs more studies and inventories of biodiversity, especially the Ceará state. On the basis of these considerations, the present study aims to identify the flora and vegetation, in order to characterize the phytophysiognomy in an area of the Caatinga, in locality of Taperuaba, municipality of Sobral, Ceará, Brazil. Field work was conducted in March 2015 and 2016 respectively, in three transects. The life-forms were established in accordance of Raunkiaer´s system. The floristic list is composed of 87 species, distributed in 66 genera and 36 families. The flora comprises 22 Brazilian endemic species. The most representative family was Fabaceae with 15 species, followed by Malvaceae (7) Convolvulaceae (6), Euphorbiaceae (5) and Poaceae (5). The biological spectrum had a high proportion of therophytes (29,9%), chamaephytes (29,9%) and phanerophytes (26,4%). In the area were identified two phytophysiognomies: outcrops communities highlighting succulent phanerophytes (Pilosocereus chrysostele (Vaupel) Byles & G.D. Rowley subsp. cearensis P.J. Braun & Esteves and P. gounellei (F.A.C. Weber) Byles & Rowley), chamaephytes (Encholirium spectabile Mart. ex Schult. & Schult. f. and Lepidaploa chalybaea (Mart. ex DC.) H. Rob.) and therophytes (Mitracarpus baturitensis Sucre), mixed with communities including small trees and shrubs on deeper soil, composed of Cereus jamacaru DC., a succulent phanerophyte, and many woody phanerophytes, such as Cordia oncocalyx Allemão, Crateva trapia L., Mimosa caesalpiniifolia Benth., M. tenuiflora (Willd.) Poir., Poincianella bracteosa (Tul.) L.P. Queiroz and P. pyramidalis (Tul.) L.P. Queiroz.

Occurrence and variability of Panstrongylus lutzi in the State of Ceará, Brazil

Panstrongylus lutzi is generally restricted to the "caatinga" areas of north-eastern Brazil. Adult insects are frequently found in local houses, but colonies have not previously been registered in the statistics of the Control Programme of Chagas Disease. In Ceará State, our study revealed increasing occurrence of this species, usually with high infection rates for Trypanosoma cruzi, and always represented by adults that invaded the artificial environment. We also found nymphs in the peridomicile and inside the houses. In silvatic habitats we collected two adult females from hollow tree trunks, which may represent an alternative natural ecotope for the species in this state. Panstrongylus lutzi entomological collections from Sobral and Crateús, studied by morphology and morphometrics, showed great variability; those from Crateús were larger smaller and paler in colour, with individuals showing genital features consistent with those described for Panstrongylus lutzi or Panstrongylus sherlocki, whereas those from Sobral were darker and with genitalia compatible with P. sherlocki, nevertheless, all were considered to be Panstrongylus lutzi.

Fisionomia e organização da vegetação do carrasco no planalto da Ibiapaba, estado do Ceará

Is the carrasco on the Ibiapaba plateau a unique plant formation? To answer this question the vertical height (except of climbers) and the stem basal diameter (from 3cm on) of woody plants were measured, and soil extracts (0-50 and 50-100cm depth) were taken from 100 random plots (10x10m) at Jaburuna (3º54'34S and 40º59'24W, altitudes near 830m), municipality of Ubajara, Ceará State. Data on climate, soil, diameter height, density, basal area, and physiognomy were compared with those surveyed by other researchers from the carrasco, caatinga, and cerrado in Northeastern Brazil. The carrasco occurs under an annual rainfall of between 668 and 1,289mm and temperatures from 22 to 24ºC, on alic Quartz Sand soils, at altitudes between 700 and 900m: it has a larger density and a smaller basal area than the caatinga and the cerrado, small and similar diameters, and an average vertical height between 3,7 and 5,4m. It differs from the caatinga, cerrado (and cerradão) and secondary forest in many items of lhe ecotope, organization and physiognomy, thus being a unique plain formation, which can be characterized as a deciduous, high, closed, and unistratified shrubland intermingled by lianas, with an irregular canopy and sparse, emergent trees.

Presence of Psychodopygus wellcomei (Diptera: Psychodidae), a proven vector of Leishmania braziliensis braziliensis, in Ceara State

Psychodopygus wellcomei, a proven vector of (muco-)cutaneous leishmaniasis, has been found for the first time outside of the Amazon Basin, in Ceará State. Parasitological and entomological evidence suggests that the Leishmania braziliensis braziliensis/Ps. wellcomei zoonosis is widespread on the Brazilian Shield.

A study of sandfly species (Diptera: Psychodidae: Phlebotominae) in a focus of cutaneous leishmaniasis in the municipality of Baturité, Ceará, Brazil

In a study on putative vectors of cutaneous leishmaniasis in Baturité, Ceará State Brazil, six sandfly species were identified: Lutzomya longipalpis, L. wellcomei, L. peresi, L. whitmani, L. shannoni and L. migonei. In general L. whitmani and L. migonei were the predominant species. They were collected in periodomiciliary areas and were attracted by man and equines L. whitmani was the most anthropophilic species. Studies using animals as bait showed that blood-feeding occurs throughout the night. Previously L. whitmani had been found infected with a Leishmania species of the braziliensis complex and L. migoney was infected with peripylarian flagellates. In combination these findings suggest that they may be responsible for periodomestic transmission of cutaneous leishmaniasis.

Gestão estratégica de políticas públicas pelos governos subnacionais: análise da experiência: 'sistemas microrregionais de serviços de saúde' no estado do Ceará

A pesquisa objetiva: a) compreender o novo papel dos Estados subnacionais, especialmente de nível regional, no contexto da globalização, fragmentação, enfraquecimento do estado-nação e emergência de instâncias supranacionais de poder; b) suprir a carência de estudos atuais voltados para a regionalização da gestão da saúde - dado que a ênfase vem recaindo sobre o processo de municipalização; c) analisar experiências inovadoras visando subsidiar a formulação de propostas de reforma que levam em conta as mudanças recentes no padrão de relacionamento estado-sociedade e as novas formas de provisão dos serviços de saúde, as quais demandam um maior esforço de coordenação ao nível regional. É analisado o papel desempenhado pela Secretaria de Estado da Saúde na implantação dos "Sistemas Microrregionais de Serviços de Saúde" no Estado do Ceará a partir de 1998. A escolha deste Estado justifica-se dada sua boa colocação em termos de políticas públicas e sua postura inovadora, além do sucesso de alguns de seus programas - com grande impacto nos indicadores de saúde. A proposta de 'Sistemas Microrregionais de Serviços de Saúde' por sua vez, contribui com a visão intersetorial e inova em termos de regionalização. O referido programa possue o município como protagonista, embora uma atuação mais efetiva do nível estadual no espaço de gestão tenha se mostrado estratégica.

Avaliação da produtividade de biomassa de capim elefante e sorgo sacarino no Estado do Ceará para uso energético

Com a crescente elevação nas possibilidades de utilização da biomassa nos mais diversos setores da indústria, o presente estudo visa identificar uma alternativa para aumentar a produção utilizando, para tanto, o capim elefante (Pennisetum purpureum) e sorgo sacarino (Sorghum bicolor L.). Os experimentos foram realizados na Fazenda Vitória (4°21'36"S 38°5'17"W) em Beberibe – CE, em uma área total de 1.944 m2. A semeadura foi realizada em 36 parcelas de 54 m2, em delineamento inteiramente casualizado, sendo 9 tratamentos (genótipos) e 4 repetições. Foram utilizados seis diferentes genótipos de sorgo sacarino, s_1, s_2, s_3, s_4, s_5 e s_6. Fazem parte do estudo, ainda, um híbrido de capim elefante e milheto (Pennisetum glaucum), comercialmente conhecido como paraíso, e dois tratamentos de capim elefante, Cameroon e Napier. Para o sorgo sacarino, foram realizadas três colheitas, a primeira avaliada semanalmente e as demais com avaliação única. Para o capim elefante foram realizadas duas colheitas, a primeira com intervalo de 186 dias e a segunda com intervalo de 92 dias. Esse intervalo possibilitou a comparação da produtividade de biomassa de cada tratamento de forma trimestral e semestral. Os resultados observados mostraram que os tratamentos de maior destaque de produtividade de biomassa (base seca) foram com capim elefante, independente do período. Com base nessas informações, concluiu-se que, analisando apenas a produtividade de biomassa, o mais indicado dos tratamentos estudados é o capim elefante Napier ou Cameroon. No entanto, constatou-se que o sorgo sacarino apresentou grande potencial de produtividade com um aditivo, seu mosto pode ser utilizado no processo de fermentação para obtenção do etanol.