Cláudia Moura de Melo

Série temporal da leishmaniose visceral em Aracaju, estado de Sergipe, Brasil (1999 a 2008): aspectos humanos e caninos

INTRODUCAO: Considerada doenca negligenciada pela OMS, a Leishmaniose visceral (LV) tem se expandido e urbanizado, sendo sua transmissao e expansao associadas a diversos fatores. OBJETIVO: Avaliar aspectos epidemiologicos da LV no municipio de Aracaju/SE, por meio de estudo retrospectivo da serie historica de LV humana e canina no periodo de 1999-2008. METODOS: Foram utilizados dados secundarios do SINAN para os casos humanos, e o resultado dos inqueritos caninos e atendimentos da demanda passiva do Centro de Controle de Zoonoses (CCZ). RESULTADOS: Foram notificados 192 casos autoctones de LV humana, sendo 63,5% do genero masculino. Criancas entre 1 e 4 anos foram mais acometidas (29,2%), seguidas de adultos entre 20-29 anos (15,6%) e de criancas entre 5-9 anos (15,1%). A letalidade geral foi de 8,9%, sendo mais acentuada em pessoas entre 60 a 69 anos (60%); 32,3% dos casos autoctones realizaram sorologia para HIV, com positividade de 6,9%. A confirmacao laboratorial foi realizada principalmente mediante a imunofluorescencia indireta isolada (71,1%). Dos 58.161 caes que realizaram sorologia a positividade foi de 5,4%, sendo 87,0% dos inqueritos realizados anualmente pelo CCZ, com uma positividade de 4,4%. Dos 7.501 caes trazidos ao CCZ por diversas queixas, o exame sorologico foi reagente em 12,0%. CONCLUSAO: Os dados denotam o carater endemico da LV no municipio, mostrando a necessidade de acoes que permitam a diminuicao do risco para a populacao, principalmente aquela onde a incidencia e a letalidade sao maiores, como melhorias no diagnostico da LV, assim como na co-infeccao com HIV e no monitoramento da populacao canina, entre outros.

Inequalities in health: living conditions and infant mortality in Northeastern Brazil

OBJECTIVE To analyze the variation of infant mortality as per condition of life in the urban setting. METHODS Ecological study performed with data regarding registered deaths of children under the age of one who resided in Aracaju, SE, Northeastern Brazil, from 2001 to 2010. Infant mortality inequalities were assessed based on the spatial distribution of the Living Conditions Index for each neighborhood, classified into four strata. The average mortality rates of 2001-2005 and 2006-2010 were compared using the Student’s t-test. RESULTS Average infant mortality rates decreased from 25.3 during 2001-2005 to 17.7 deaths per 1,000 live births in 2006-2010. Despite the decrease in the rates in all the strata during that decade, inequality of infant mortality risks increased in neighborhoods with worse living conditions compared with that in areas with better living conditions. CONCLUSIONS Infant mortality rates in Aracaju showed a decline, but with important differences among neighborhoods. The assessment based on a living condition perspective can explain the differences in the risks of infant mortality rates in urban areas, highlighting health inequalities in infant mortality as a multidimensional issue.

HPV detection using primers MY09/MY11 and GP5+/GP6+ in patients with cytologic and/or colposcopic changes

Introduction: Cervical cancer is one of the most common diseases among women, and cause considerable morbidity and mortality. Considering that cervical cancer is an important neoplasia in northeastern Brazil, and the prevalence of high-risk human papillomavirus (HPV) is directly associated with it, this work had aimed to correlate the cytological and/or colposcopic findings with HPV infection status, and verify the performance of MY09/MY11 and GP5+/6+ primers for HPV detection. Material and method: Patients in this study were from Penedo-AL, a city with high level of poverty (poverty rate of 60.62%). Out of 70 patients with cytological and/or colposcopic changes, 32 agreed to participate in the study. Results: Regarding cytology, 21 (30%) patients presented atypical squamous cells of undetermined significance (ASC-US); 20 (29%), atypical glandular cells of undetermined significance (AGUS); 12 (17%), low-grade intraepithelial lesion (LSIL); five (7%), high-grade intraepithelial lesion (HSIL); and 12 (17%), positive colposcopy. From these, 27 (84%) presented the band gene encoding for human s-globin. From the 27 patients, eight (30%) were positive for HPV. The results showed that the deoxyribonucleic acid (DNA) of HPV was detected in 15% and 30% by using MY-PCR and GP +-PCR, respectively. Conclusion: This study suggests that more than one type of oligonucleotide primer should be used in clinical samples to increase sensitivity for the detection of HPV.

Sandfly fauna in an area endemic for visceral leishmaniasis in Aracaju, State of Sergipe, Northeast Brazil

INTRODUCTION In recent years, visceral leishmaniasis, a major public health problem, has been spreading from the rural to urban areas in many areas of Brazil, including Aracaju, the capital of the State of Sergipe. However, there are no studies of the sandfly fauna in this municipality or its variation over the year. METHODS Phlebotomine sandflies were collected from a rural area of Aracaju from September 2007 to July 2009. Modified CDC ultra-violet (UV) light traps were used to evaluate sandfly monthly distribution and their presence in the domestic and peridomestic environments. RESULTS The most abundant species was Lutzomyia longipalpis (90.4%) followed by Evandromyia lenti (9.6%). A chicken shed trap site had the highest proportion of L. longipalpis (51.1%) and large numbers of L. longipalpis were also collected in the houses closest to the chicken shed. There was a positive correlation between monthly rainfall and L. longipalpis abundance. CONCLUSIONS Lutzomyia longipalpis is the most abundant species and is probably the main vector of the visceral leishmaniasis agent in the rural area of Aracaju. An increase in L. longipalpis frequency was observed during the rainy season. The peridomicile-intradomicile observations corroborate the importance of chicken sheds for the presence of L. longipalpis in the peridomestic environment. The great numbers of L. longipalpis inside the houses confirm the endophilic behaviour of this species and the possibility of visceral transmission in the intradomicile.

Biochemical characterisation of lipase from a new strain of Bacillus sp. ITP-001

Lipases are characterised mainly by catalytic versatility and application in different industrial segments. The aim of this study was to biochemically characterise a lipase from a new strain of Bacillus sp. ITP-001. The isoelectric point and molecular mass were 3.12 and 54 kDa, respectively. The optima lipase activity was 276 U g-1 at pH 7.0 and a temperature of 80 oC, showing greater stability at pH 5.0 and 37 oC. Enzymatic activity was stimulated by various ions and pyridine, and inhibited by Cu+ and ethanol. The values of Km and vmax were 105.26 mmol and 0.116 mmol min-1 g-1, respectively determined by the Eadie-Scatchard method.

Promoção de saúde em população quilombola nordestina - análise de intervenção educativa em anemia falciforme

Objective: The aim was to develop an educational intervention in health for quilombola communities, providing guidance on the genetic risk for having childre...Objective: The aim was to develop an educational intervention in health for quilombola communities, providing guidance on the genetic risk for having children with sickle cell anemia (SCA), the oral manifestations of the disease, general notions of self-care, and genetic counseling. Methods: The pre-intervention sample was 267 individuals, of whom 230 attended the post-intervention phase. A questionnaire was applied pre- and post-intervention and frequency distribution was calculated and analyzed using the Chi-square test, considering a significance level of p < 0.05. Results: Pre-intervention, 72.3% of respondents did not know about SCA or its trait and 94.8% did not know the form of transmission; post-intervention, the latter index decreased to 32.6%, 60% reported having heard about the theme and 36.1% claimed to know about the subject. Conclusion: The intervention was positive and effective, and demonstrated the importance of offering quilombola communities a permanent health education and genetic counseling program.

Triatomines in dwellings and outbuildings in an endemic area of Chagas disease in northeastern Brazil

INTRODUCTION The present study identified the triatomines collected in intra and peri-domestic environments, observed the occurrence of Trypanosoma cruzi infection in triatomines and correlated this information with housing conditions and the fauna associated with the rural areas of the City of Itabaianinha, located in the State of Sergipe, Brazil. METHODS Quarterly visits were conducted between March 2009 and March 2010, and the homes to be visited for the active search of insects were determined by random selection. In each housing unit, the insects were collected by a manual search with a metal clip and flashlight to inspect openings and cavities, with a collection time of one hour/home/individual. The Pirisa® dislodge chemical was used to force the insects to leave their ecotopes. Analysis of the intestinal contents of triatomines was performed in the laboratory to establish the presence of Trypanosomatidae. RESULTS Of the 103 dwellings surveyed, 17.5% were infested with Panstrongylus megistus. The village of Mutuca exhibited the highest infestation rate (38.1%). All the villages with relevant infestation rates were situated in the northern area of the city. The highest percentage of vector infection was found in the village of Água Boa (56.5%). The rural dwellings were found to be primarily brick or wooden house with or without roughcast or plastered walls, and the outbuilding most frequently associated with triatomines was the chicken run. CONCLUSIONS These results emphasise the need for broader vector control and surveillance and for educational campaigns in the context of the Chagas Disease Control Program.

Claustrum sign in a child with refractory status epilepticus after febrile illness: why does it happen?

A 6-year-old female patient with normal psychomotor development was admitted at our hospital with status epilepticus. The patient had been suffering from headache, anorexia and fever in the preceding week. On the day of admission, the patient developed focal tonic–clonic movements in the left superior limb that responded to intravenous diazepam. However, the patient did not recover to normal mental status. Therapy included other anti-epileptic drugs (valproate, phenytoin and levetiracetam), steroids, acyclovir and immunoglobulins. After the second day, these focal tonic–clonic episodes decreased in frequency and there was recovery to normal mental status. Electroencephalography (EEG) at days 6 and 15 revealed occipital intermittent rhythmic delta activity. Blood and cerebrospinal fluid studies did not present abnormalities compatible with inflammatory, infectious or autoimmune disease. Brain magnetic resonance imaging (MRI) at day 15 revealed bilateral claustrum hyperintensity on T2 and FLAIR, hypointensity on T1 inversion recovery (IR), no restriction on diffusion-weighted image (DWI) and no contrast enhancement (Fig. 1). The patient was asymptomatic since day 15 and was discharged at day 21 under levetiracetam, steroids and immunoglobulins. She remained seizure free in the next 6 months of follow-up. At 3 months, EEG was normal and brain MRI showed substantial reduction of the T2 and FLAIR hyperintense signal abnormalities in the claustrum (Fig. 2).

Gill parasites of fish from two estuaries in northeastern Brazil: new hosts and geographical records

Parasites are important components of communities and constitute great part of the biological diversity found in ecosystems, providing valuable information about their hosts and the environment in which they live. However, despite its importance, parasitic diversity is still not well known in some regions of Brazil, especially with respect to fish parasites in the Northeast Region. The present study aims to perform the survey of gill parasites of fish from two tropical estuaries located in northeastern Brazil: Paraíba and Mamanguape rivers. Two collections were made in each estuary, one during the dry period (November / 2013) and the other during the rainy season (July / 2014). The fish were caught using a beach seine net, dragged along the main channel margin. After the identification, biometry and necropsy of the fish, their parasites were collected, stored and identified. For each species of parasite, the values ​​of prevalence, mean intensity and mean abundance were calculated. Of the 882 examined fish, belonging to four species, 145 were parasitized by at least one species of parasite. In total, 18 taxa of parasites of the groups Monogenea, Digenea, Nematoda, Copepoda and Isopoda were recorded, being the copepod Acusicola brasiliensis the most abundant species of parasite.

Protozoário comensal em amostra fecal: parâmetro para prevenção de infecção parasitaria via fecal-oral

Para determinar prevalencias de protozoarios comensais em uma amostra da populacao humana de Aracaju/SE entre 2007 a 2012, realizaram-se buscas em arquivos eletronicos de tres laboratorios clinicos do referido municipio. Nos arquivos deveriam constar as informacoes necessarias para execucao desse estudo. Com os dados calcularam-se as prevalencias dos protozoarios comensais, conforme variaveis de interesse. Das 270.031 pessoas investigadas, 147.132 (54,5%) foram de casos positivos e 122.899 (41,5%) negativos. Dos positivos obtiveram-se 35.216 (22,19%) casos de helmintoses, 21.811 (13,74%) de protozooses e 101.693 (64,07%) possuiam comensais. Os protozoarios comensais detectados foram Endolimax nana, Entamoeba coli, Iodamoeba butschlii, Entamoeba hartmanni e Chilomastix mesnili. A ocorrencia dos comensais intestinais na amostra investigada foi preocupante, posto, suas presencas representam um bom indicador das condicoes socioeconomicas, ambientais e sanitarias de uma comunidade. Sugere-se, que seja intensificada em Aracaju educacao em saude e maior participacao das politicas publicas com investimento financeiro.