Ângela Maria da Silva

Creche: ambiente expositor ou protetor nas infestações por parasitas intestinais em Aracaju, SE

The work aimed to evaluate whether child daycare centers are an environment that protects against or exposes children to intestinal parasite infestation. Stool samples were analyzed from children attending such centers and a control group. It was concluded that attending daycare centers is related to intestinal parasitosis (630% vs. 41.4 %; p <0.01) and the risk of infestation is 1.5 times higher.

Common mental disorders among medical students at Universidade Federal de Sergipe: a cross-sectional study

OBJECTIVE Estimate the prevalence of common mental disorder and its associated factors among medical students of the Universidade Federal de Sergipe. METHOD A cross-sectional study was carried out, applying Self Reporting Questionnaire-20 to 473 students from the 512 medical students enrolled in 2006 and compared with compared with a structured questionnaire by the authors containing information on the socio-demographic characteristics, the teaching-learning process and the psycho-emotional experiences of the students. Freshmen were excluded after initial comparison with the students already exposed to the medical course. Statistical analysis by multiple logistic regression after calculating simple and adjusted odds ratio (OR). RESULTS The general prevalence of common mental disorder was 40% (n = 473); after exclusion of the freshmen it increased to 42.5% among students from the 2nd to the 12th semester. It was higher among those who did not have faith in their acquisition of the skills needed to become a good doctor (OR = 2.82), who felt less comfortable about course activities (OR = 3.75), who considered themselves emotionally stressed (OR = 2.14), among those who did not consider themselves happy (OR = 2.85), who believed that the course did not match their expectations (OR = 1.64) and those who had a prior diagnosis of mental disorder by a psychiatrist (OR = 3.78). CONCLUSION The results suggest the necessity of changes to the teaching-learning process and the establishment of a preventive mental health program for medical students.

Aspectos epidemiológicos e distribuição geográfica da esquistossomose e geo-helmintos, no Estado de Sergipe, de acordo com os dados do Programa de Controle da Esquistossomose

INTRODUCTION: Schistosomiasis is endemic in Brazil, with high prevalence in the State of Sergipe, despite the existence of the Schistosomiasis Control Program (PCE). METHODS: The data from Sergipes PCE between 2005 and 2008 were surveyed. From the raw information, a database was created on a spreadsheet using the Access software. The frequency and geographic distribution of infections due to Schistosoma mansoni and other intestinal parasites were analyzed. These data were exported to the Spring 5.0.5 software for georeferencing and preparation of thematic maps of the spatial and temporal distribution according to year of evaluation. RESULTS: In 2005, 13.6% (14,471/106,287) of the tests were positive for S. mansoni, 11.2% (16,196/145,069) in 2006, 11.8% (10,220/86,824) in 2007 and 10.6% (8,329/78,859) in 2008. Analysis on the maps showed that there was high prevalence of the disease in Sergipe, and particularly in the municipalities of Ilha das Flores, Santa Rosa de Lima, Santa Luzia do Itanhi and Sao Cristovao. Furthermore, we evaluated the association between the frequencies of these parasitic diseases and social and developmental indicators in the different municipalities, according to data from the Brazilian Institute for Geography and Statistics (IBGE) and the Department of Water Resources (SRH). We found that municipalities with schistosomiasis prevalence higher than 15% had lower coverage of sewage systems (hygiene index) (p = 0.05). Additionally, municipalities with hookworm prevalence higher than 10% had lower educational HDI (p = 0.04). CONCLUSIONS: The importance of greater control over environmental risk and educational factors needs to be emphasized in attempts to reduce the prevalence of these parasitic diseases.

Cross-resistance of Leishmania infantum isolates to nitric oxide from patients refractory to antimony treatment, and greater tolerance to antileishmanial responses by macrophages

Visceral leishmaniasis is a life-threatening disease characterized by intense parasitism of the spleen, liver, and bone marrow. Antimonials have served as front-line antileishmanial therapeutics for decades, but the increasing failure rates under antimonial treatment have challenged the continued use of these drugs. Pentavalent antimonials are known to reinforce the killing mechanisms of macrophages, although the associated mechanism remains unclear. Here, for the first time, we determined whether Leishmania infantum strains isolated from patients refractory to antimony treatment (relapse cases) were cross-resistant to antimonials, liposomal amphotericin B, and/or nitric oxide, and also whether these strains modulate macrophage infection. We selected four clinical isolates from relapse cases and two clinical isolates from antimony-responsive patients (control group) for the present study. The L. infantum promastigotes from all four relapse cases were resistant to trivalent antimonial treatment and nitric oxide, while only one isolate was resistant to liposomal amphotericin B. We evaluated whether the resistant strains from relapse cases showed enhanced infectivity and amastigote survival in macrophages, or macrophage-killing mechanisms in macrophages activated by lipopolysaccharide plus interferon gamma. Infection indexes calculated using macrophages infected with isolates from relapse were higher than those observed with control strains that were stimulated independently. Macrophage infection was higher with L. infantum isolates from relapse cases and correlated with enhanced interleukin 1-β production but showed similar nitrite production. Our results demonstrate that L. infantum field isolates from relapse cases were resistant to antimonials and nitric oxide and that these parasites stimulated inflammatory cytokines and were resistant to macrophage-killing mechanisms, factors that may contribute to disease severity.

Espacialização da leptospirose em Aracaju, Estado de Sergipe, no período de 2001 a 2007

Introduction: Leptospirosis, a disease caused by pathogenic spirochetes of the genus Leptospira, is one of the most widespread zoonoses in the world and is considered an important public health problem. This paper aims to describe the spatial pattern of leptospirosis in the city of Aracaju from 2001 to 2007 in an effort to identify areas at risk for leptospirosis. Methods: We used the ratio of Kernel, which represents the ratio between two surfaces, to visualize the surface of disease risk. The numerator corresponds to the number of cases geocoded to the census tract, and the denominator of the kernel corresponds to the population of these areas. Using this method, the areas with the highest density of cases were delineated and compared visually with socioeconomic factors, such as average income. Results: The spatial pattern was different in periods of rain compared with periods of drought and did not coincide with the areas considered most at risk for the disease. This study revealed the importance of applying spatial analysis techniques in the field of public health. Conclusions: These findings indicate that the kernel is a useful tool for obtaining a comprehensive review of the epidemiology of leptospirosis in Aracaju, which supports the kernel’s use by the municipal health departments and by the state.

Soluble CD40 Ligand in Sera of Subjects Exposed to Leishmania infantum Infection Reduces the Parasite Load in Macrophages

Background While CD40L is typically a membrane glycoprotein expressed on activated T cells and platelets that binds and activates CD40 on the surface on antigen presenting cells, a soluble derivative (sCD40L) that appears to retain its biological activity after cleavage from cell membrane also exists. We recently reported that sCD40L is associated with clinical resolution of visceral leishmaniasis and protection against the disease. In the present study we investigated if this sCD40L is functional and exerts anti-parasitic effect in L. infantum-infected macrophages. Methodology/Principal Findings Macrophages from normal human donors were infected with L. infantum promastigotes and incubated with either sera from subjects exposed to L. infantum infection, monoclonal antibodies against human CD40L, or an isotype control antibody. We then evaluated infection by counting the number of infected cells and the number of parasites in each cell. We also measured a variety of immune modulatory cytokines in these macrophage culture supernatants by Luminex assay. The addition of sCD40L, either recombinant or from infected individuals’ serum, decreased both the number of infected macrophages and number of intracellular parasites. Moreover, this treatment increased the production of IL-12, IL-23, IL-27, IL-15, and IL1β such that negative correlations between the levels of these cytokines with both the infection ratio and number of intracellular parasites were observed. Conclusions/Significance sCD40L from sera of subjects exposed to L. infantum is functional and improves both the control of parasite and production of inflamatory cytokines of infected macrophages. Although the mechanisms involved in parasite killing are still unclear and require further exploration, these findings indicate a protective role of sCD40L in visceral leishmaniasis.

Aspectos ultrassonográficos associados à morbidade de formas clínicas crônicas de esquistossomose mansônica, utilizando-se protocolo proposto pela Organização Mundial da Saúde

OBJECTIVE: To evaluate sonographic features associated with morbidity in patients with chronic clinical presentations of schistosomiasis mansoni, according to the protocol proposed by the World Health Organization (WHO). MATERIALS AND METHODS: Two distinctive populations were evaluated: a) patients from an endemic area, and b) patients from a tertiary institution, with histopathologically confirmed periportal fibrosis. Inclusion criteria: diagnosis confirmed by parasitological stool examination for Schistosoma mansoni (Kato-Katz method). Exclusion criteria: positive serology for HIV, HTLV-1, HBV or HCV. The Niamey protocol on ultrasonography proposed by the WHO was utilized. RESULTS: As the measures of periportal spaces were isolatedly evaluated, no alteration was observed in 21% of the tertiary institution patients with advanced disease. As all parameters of the Niamey protocol were considered, 100% of patients from the tertiary institution, with severe disease, presented advanced periportal fibrosis. In hepatosplenic patients from endemic areas, fibrosis was not identified at ultrasonography. CONCLUSION: The sonographic protocol proposed by the WHO can detect advanced periportal fibrosis in patients with severe form of disease with higher sensitivity than the isolated measurement of periportal space. The complexity involved in the sonographic identification of early stages of periportal fibrosis in endemic areas may give rise to the field of diagnostic supplementation and to a continued improvement of sonographic protocols in these areas.

α1-Acid glycoprotein and α1-antitrypsin as early markers of treatment response in patients receiving the intensive phase of tuberculosis therapy.

The identification of early markers that predict the response to anti-tuberculosis treatment would facilitate evaluation of new drugs and improve patient management. This study aimed to determine whether selected acute phase proteins and micronutrients measured at the time of diagnosis and during the first weeks of treatment could predict treatment responses during the 2-month standard intensive phase of therapy. For this purpose, alpha1-antitrypsin, alpha1-acid glycoprotein, alpha2-macroglobulin, C-reactive protein, C3, C4, zinc, copper and selenium concentrations were measured in Brazilian patients with smear-positive tuberculosis at the time of diagnosis and 1, 3, 5 and 8 weeks after initiation of therapy. Patients were classified into fast (n=29), intermediate (n=18) and slow responders (n=10) if they were smear-negative at 3, 5 or 8 weeks of treatment. alpha1-acid glycoprotein on enrolment and 1 week of treatment, alpha1-antitrypsin at week 1 and C-reactive protein and C3 after 3 weeks of therapy were higher in slow responders than in fast responders. alpha1-antitrypsin and alpha1-acid glycoprotein may be helpful in predicting treatment response at the time of initiation of therapy, and could be used as early markers to identify patients with an increased likelihood of treatment failure.

Spirometry with FEV 0.75 Increases the Sensitivity for the Diagnosis of Obstructive Disorder in Children of Asthmatic Mothers

Objective: To evaluate and compare the sensitivity of spirometry in children of asthmatic mothers by the parameters FEV1 and FEV0.75. Methods: An observational cross-sectional analytical study nested in a cohort of 4,757 pregnant women. Clinical evaluation was performed for the diagnosis of asthma, besides the realization of spirometry in the children of asthmatic mothers, evaluating the following parameters and relationships: FEV1, FVC, FEV1/FVC, FEV0.75 and FEV0.75/FVC. Results: A total of 86 children of asthmatic mothers were included in the study, with age mean of 79.8 ± 1.1 month old. Regarding the breathing pattern there was a predominance of normality. When using FEV1, changes were observed in 26 children, representing 30.3% of the sample. Of these, 17 were classified as restrictive and nine as obstructive. Using the FEV0.75 instead of the FEV1 (and its consequent FEV0.75/FVC) 29 ventilatory tests found changed, representing 33.7%. Of these, 27 were classified as obstructive and only two were restrictive. Of the 16 children diagnosed with asthma, only five had presented obstructive pattern when FEV1 customization spirometry was used. In contrast, when we used FEV0.75, 12 of these patients were considered obstructive. The sensitivity was higher in the spirometric test that used FEV0.75, with even greater negative predictive value. On the other hand the test set for the parameter FEV1 showed greater specificity and higher positive predictive value. Conclusions: Spirometry, though with recognized value in the complementary diagnosis of obstructive disturbance, classically presents limitations in the pediatric population, especially in younger children. We observed a significantly higher sensitivity and negative predictive value when we used FEV0.75 in substitution to the FEV1. As a consequence, the parameter FEV0.75 is probably more effective for the diagnosis of obstructive disorder in patients with clinical history or family history of asthma.

Aspectos funcionais respiratórios na leptospirose humana

INTRODUCTION Respiratory impairment may be the main clinical manifestation of human leptospirosis. METHODS With the aim of describing the respiratory functional characteristics of this disease, 21 patients were evaluated using pulse oximetry and spirometry at two times: an initial evaluation and after around 28 days. RESULTS Two (9.5%) patients presented peripheral oxygen saturation of less than 95%. Normal spirometric patterns were observed in eight (38.1%); cases restrictive ventilatory disorders were inferred in seven (33.3%), obstructive disorders with reduced forced vital capacity in four (19%), and nonspecific disorders in two (9.5%). Abnormal spirometry findings were associated with worse APACHE II scores (p = 0.02) and abnormalities on chest x-ray (p = 0.05). After clinical resolution, significant functional gain was observed (p < 0.05) in the group of patients with abnormal spirometry findings. CONCLUSIONS It was concluded that respiratory functional abnormalities were detected during the course of the disease and were associated with greater clinical severity and higher frequency of chest radiographic abnormalities.