Alberto Novaes Ramos Júnior

Resistência do Aedes aegypti ao temefós em Municípios do Estado do Ceará

The susceptibility of Aedes aegypti to temefos was evaluated by means of samples of eggs and larvae from four large counties in the state of Ceara (Fortaleza, Barbalha, Juazeiro do Norte and Crato). The technique standardized by the World Health Organization for tests with larvicides was used. The CL50 of eight samples from populations of Aedes was determined, as were their respective resistance ratios, compared to the CL50 of the susceptible Rockefeller strain. All populations submitted to the experiment showed resistance to temefos, with resistance ratios varying between 8 and 16. Analysis of these results reinforces prior evidence regarding the dissemination of temefos resistance in different locations in the state, subjected to considerable pressure for control in recent decades. The larvicide may lose its effectiveness if an urgent attempt is not made to reestablish the susceptibility of Aedes aegypti in these areas, profoundly affecting control campaigns currently under way.

Co-infection Trypanosoma cruzi/HIV: systematic review (1980 - 2010)

INTRODUCTION The co-infection Trypanosoma cruzi/HIV has been described as a clinical event of great relevance. The objective of this study was to describe clinical and epidemiological aspects published in literature. METHODS It is a systematic review of a descriptive nature from the databases Medline, Lilacs, SciELO, Scopus, from 1980 to 2010. RESULTS There were 83 articles (2.8 articles/year) with a total of 291 cases. The co-infection was described in 1980 and this situation has become the defining AIDS clinical event in Brazil. This is the country with the highest number of publication (51.8%) followed by Argentina (27.7%). The majority of cases are amongst adult men (65.3%) native or from endemic regions with serological diagnosis in the chronic stage (97.9%) and indeterminate form (50.8%). Both diseases follow the normal course, but in 41% the reactivation of the Chagas disease occurs. The most severe form is the meningoencephalitis, with 100% of mortality without specific and early treatment of the T. cruzi. The medication of choice was the benznidazole on doses and duration normally used for the acute phase. The high parasitemia detected by direct or indirect quantitative methods indicated reactivation and its elevation is the most important predictive factor. The lower survival rate was related to the reactivation of the Chagas disease and the natural complications of both diseases. The role of the antiretroviral treatment on the co-infection cannot yet be defined by the knowledge currently existent. CONCLUSIONS Despite the relevance of this clinical event there are still gaps to be filled.INTRODUCAO: A coinfeccao Trypanosoma cruzi/HIV vem sendo sistematicamente descrita como um evento clinico de grande relevância. O objetivo deste estudo foi descrever aspectos clinicos e epidemiologicos publicados na literatura cientifica. METODOS: Trata-se de revisao sistematica, de natureza descritiva, a partir da busca nas bases Medline, Lilacs, SciELO, Scopus, de 1980 a 2010. RESULTADOS: Identificou-se 83 artigos (2,8 artigos/ano), com um total de 291 casos registrados. A coinfeccao foi descrita em 1980 e, no Brasil, tornou-se evento clinico definidor de AIDS. Este e o pais com maior numero de publicacoes (51,8%), seguido pela Argentina (27,7%). A maioria dos casos e de homens adultos (65,3%), naturais ou procedentes de regioes endemicas, com diagnostico sorologico, na fase cronica (97,9%) e na forma indeterminada (50,8%). As duas doencas evoluem naturalmente, mas em 41% dos casos ocorreu reativacao da doenca de Chagas. A forma mais grave e a meningoencefalite, com 100% de letalidade nos casos sem tratamento especifico e precoce do T. cruzi. O medicamento indicado foi benznidazole, nas doses e duracao utilizadas na fase aguda em imunocompetentes. O diagnostico da reativacao foi comprovado por alta parasitemia, detectada por metodos diretos ou indiretos quantitativos, sendo a sua elevacao considerada fator preditivo para reativacao. A menor sobrevida nacoinfeccao esteve relacionada a reativacao da doenca de Chagas e as complicacoes naturais de ambas as doencas. O papel do tratamento antirretroviral sobre a evolucao da coinfeccao ainda nao pode ser definido pelo conhecimento existente. CONCLUSOES: Apesar da relevância deste evento clinico, ainda persistem lacunas a serem preenchidas.

Transmissão vertical do HIV em Fortaleza: revelando a situação epidemiológica em uma capital do nordeste

PURPOSE: to analyze the management for reduction of HIV transmission from mother to infant in infected pregnant women who delivered in public maternity hospitals of the municipality of Fortaleza, Ceara, from 1999 to 2001. METHODS: a descriptive study where data of SINASC, SINAN and LACEN data bank systems were cross-checked looking for HIV-infected pregnant women, followed by an active search for complementary information on the subject through medical records of the maternity hospitals. RESULTS: a hundred and thirty-eight pregnant women infected with HIV were identified. It was observed that 35.5% knew their serum status before pregnancy and 48.6% (67/138) were diagnosed during the prenatal visits. Of those 101 women that knew their serum status before or during pregnancy, only 47.5% followed all steps of prophylaxis, including the management of the newborns. The previous knowledge of the serum status was found to be significantly related to following the correct steps of prophylaxis (p<0.001). CONCLUSIONS: an increasing number of women who had no access to the different strategies for the reduction of vertical transmission were found in Fortaleza, Ceara, especially among those who became pregnant without knowing their serum status. Continuous awareness and training are very important for all health care providers involved in attending the pregnant women for the application of correct management in order to reduce HIV transmission from mother to infant.

Caracterização do zumbido em idosos e de possíveis transtornos relacionados

Population aging it is a current reality in Brazil and tinnitus appears as a very prevalent symptom, having a high impact on the quality of life of elderly patients. AIM: to evaluate and to characterize tinnitus in this group. MATERIALS AND METHODS: A research questionnaire randomly given to 100 elderly patients in a tertiary hospital, asking about tinnitus characteristics, its impact on the life of the patient, and personal medical history. RESULTS: 61% of the participants were female, average age average was 69.53 years. The results associated with tinnitus features were: no-pulsatile 76%, continuous 54%, bilateral 57%, recent 62% and alone 83%;32,5% had emotional disorders, 31.8% had sleep disorders, 22.5% had difficulties concentration and 13.2% had social problems; 39% classified their tinnitus in moderate; 35% had intense tinnitus and 26% considered it a mild one: as to comorbidities: relation with neurotology symptoms and hypertension; as for associations with audiometry findings: descending, sensorineural and symmetrical curves prevailed. CONCLUSIONS: Tinnitus has a relevant impact on the lives of the elderly; there was no correlation between the level of hearing loss and the level of patient dissatisfaction caused by tinnitus; and presbycusis was the most common finding in the audiometric tests.

Characterization of tinnitus in the elderly and its possible related disorders

UNLABELLED Population aging it is a current reality in Brazil and tinnitus appears as a very prevalent symptom, having a high impact on the quality of life of elderly patients. AIM To evaluate and to characterize tinnitus in this group. MATERIALS AND METHODS A research questionnaire randomly given to 100 elderly patients in a tertiary hospital, asking about tinnitus characteristics, its impact on the life of the patient, and personal medical history. RESULTS 61% of the participants were female, average age average was 69.53 years. The results associated with tinnitus features were: no-pulsatile 76%, continuous 54%, bilateral 57%, recent 62% and alone 83%;32,5% had emotional disorders, 31.8% had sleep disorders, 22.5% had difficulties concentration and 13.2% had social problems; 39% classified their tinnitus in moderate; 35% had intense tinnitus and 26% considered it a mild one: as to comorbidities: relation with neurotology symptoms and hypertension; as for associations with audiometry findings: descending, sensorineural and symmetrical curves prevailed. CONCLUSIONS Tinnitus has a relevant impact on the lives of the elderly; there was no correlation between the level of hearing loss and the level of patient dissatisfaction caused by tinnitus; and presbycusis was the most common finding in the audiometric tests.

Brazilian Network of Attention and Studies on Trypanosoma cruzi/HIV Co-infection and others immunossupression conditions

1. Universidade Estadual de Campinas, Campinas, SP. 2. Universidade Federal do Triângulo Mineiro, Uberaba, MG. 3. Universidade Federal do Ceara, Fortaleza, CE. 4. Universidade de Sao Paulo, Sao Paulo, SP. Endereco para correspondencia: Dr. Eros Antonio de Almeida. Dept de Clinica Medica/FCM/UNICAMP. Rua Alexander Fleming 40, Cidade Universitaria Zeferino Vaz, 13083-970 Campinas, Sao Paulo, SP. Tel: 55 19 3521-7803/55; 19 9257-9269; Fax: 55 19 3289-4107. e-mail: eros@fcm.unicamp.br Recebido para publicacao em 07/08/2009 Aceito em 28/08/2009 Rede Brasileira de Atencao e Estudos na Co-infeccao Trypanosoma cruzi/HIV e em outras condicoes de imunossupressao

Nova definição de casos de sífilis congênita para fins de vigilância epidemiológica no Brasil, 2004

.A definicao de caso em epidemiologia constitui-se em uma dessas estrategias, possibilitando aidentificacao de individuos que apresentam um agravo ou doenca de interesse de forma a padronizarcriterios para o monitoramento das condicoes de saude e para a descricao da ocorrencia desseevento. O objetivo principal e tornar comparaveis os criterios diagnosticos que regulam a entradade casos no sistema, tanto no nivel nacional quanto internacional

Pandemic influenza A (H1N1) 2009: epidemiological analysis of cases in a tropical/semi-arid region of Brazil

INTRODUCTION The year 2009 marked the beginning of a pandemic caused by a new variant of influenza A (H1N1). After spreading through North America, the pandemic influenza virus (H1N1) 2009 spread rapidly throughout the world. The aim of this study was to describe the clinical and epidemiological characteristics of cases of pandemic influenza in a tropical/semi-arid region of Brazil. METHODS A retrospective study analyzed all suspected cases of pandemic influenza (H1N1) 2009 reported in the Ceará State through the National Information System for Notifiable Diseases during the pandemic period between 28 April, 2009 and November 25, 2010. RESULTS A total of 616 suspected cases were notified, 58 (9.4%) in the containment phase and 558 (90.6%) in the mitigation phase. Most cases were of affected young people resident in the City of Fortaleza, the largest urban center in the State of Ceará. The most frequent symptoms presented by the cases with confirmed infection were fever, cough, myalgia, arthralgia, and nasal congestion. Mortality rate was 0.0009/1,000 inhabitants and lethality was 5.6%. Deaths were observed only in the mitigation phase. Mortality rates were similar for both sexes but were higher in the age group under 5 years. CONCLUSIONS The study suggests that the influenza A (H1N1) pandemic in this tropical/semi-arid region had a lower magnitude when compared to states in the Southern and Southeastern regions of Brazil.

Tendência temporal da hanseníase em uma capital do Nordeste do Brasil: epidemiologia e análise por pontos de inflexão, 2001 a 2012

The objective of this study was to characterize epidemiological and temporal trends of leprosy in the city of Fortaleza, Ceará, Brazil, from 2001 to 2012. A total of 9,658 new cases were reported. Their temporal trend was analyzed by the jointpoint regression model. The overall detection rate showed a declining trend, with annual percent change (APC) of -4.0 and 95% confidence interval (95%CI) -5.6 - -2.3. The detection rate in children under 15 years of age (APC = -1.4; 95%CI -5.4 - 2.8) and the detection rate of disability grade 2 (APC = -0.8; 95%CI -4.5 - 3.1) were stable. The proportion of female patients was descending (APC = -1,5; 95%CI -2.3 - -0.8). The proportion of multibacillary cases from 2005 to 2012 (APC = 1.4; 95%CI 0.6 - 2.3) and among them, lepromatous cases from 2004 to 2012 (APC = 6.0; 95%CI 3.4 - 8.6) were increasing. There was stability in the proportion of cases with grade 1 (APC = 1.4; 95%CI -0.9 - 3.7) and grade 2 disability (APC = 3.7; 95%CI -0.1 - 7.8). Despite the trend towards a reduction in detection, the disease transmission persists in the city. The data also suggest late diagnosis.The objective of this study was to characterize epidemiological and temporal trends of leprosy in the city of Fortaleza, Ceara, Brazil, from 2001 to 2012. A total of 9,658 new cases were reported. Their temporal trend was analyzed by the jointpoint regression model. The overall detection rate showed a declining trend, with annual percent change (APC) of -4.0 and 95% confidence interval (95%CI) -5.6 - -2.3. The detection rate in children under 15 years of age (APC = -1.4; 95%CI -5.4 - 2.8) and the detection rate of disability grade 2 (APC = -0.8; 95%CI -4.5 - 3.1) were stable. The proportion of female patients was descending (APC = -1,5; 95%CI -2.3 - -0.8). The proportion of multibacillary cases from 2005 to 2012 (APC = 1.4; 95%CI 0.6 - 2.3) and among them, lepromatous cases from 2004 to 2012 (APC = 6.0; 95%CI 3.4 - 8.6) were increasing. There was stability in the proportion of cases with grade 1 (APC = 1.4; 95%CI -0.9 - 3.7) and grade 2 disability (APC = 3.7; 95%CI -0.1 - 7.8). Despite the trend towards a reduction in detection, the disease transmission persists in the city. The data also suggest late diagnosis.

Atenção pós-alta em hanseníase no Sistema Único de Saúde: aspectos relativos ao acesso na região Nordeste

Universal access to health services represents a complex process of inter-relationships between users and health services. In a broader sense it includes economic, technical, political and symbolic aspects. For neglected diseases such as leprosy, this is a major challenge. This cross-sectional study aims to characterize access to health care services for people affected by leprosy after release from treatment in the cities of Sobral and Fortaleza. The study included a representative sample 10% of those concluding treatment from 2003 to 2005 (304 cases). Participants were characterized regarding socio demographic and clinical variables and access to health services after release from treatment. The study population was mostly male (58%), physical disabilities (34%) and with leprosy reactions (37%). The biomedical approach of leprosy reactions contemplated in large part to search for and supply of care in this period. The access to care after discharge was particularly weak in rehabilitative interventions such as surgery and psychological attention. We identified important gaps in the operationalization of attention to people affected after release from treatment in both cities. The date also shows the negligence of leprosy as a chronic condition and the resulting difficulties regarding on integrated distance to the comprehensive approach to people with leprosy after release from treatment in the Unified Health System (SUS).