Diana Maul de Carvalho

Os diferentes significados da certificação conferida ao Brasil como estando livre da doença de Chagas

The article discusses Brazils recent certification as free of Chagas disease transmission by Triatoma infestans, analyzing the various meanings ascribed to this position. Resulting mainly from measures by both the Chagas Disease Control Program (PCDCh) established in Brazil in 1975 and the Southern Cone Initiative launched in 1991, this certification has been interpreted in ways that lead to confusion between the elimination of Chagas disease transmission by T. infestans and eradication of the disease. The present status of vector transmission control in Brazil is discussed, with emphasis on the Northeast, in most States of which T. infestans is not the main species involved in transmission. The article highlights the need to broaden the discussion of the readings and consequences involved in the present control achievements in light of possible harm from misinterpretations that might jeopardize further efforts to control the disease.Discutem-se as diferentes repercussoes da certificacao concedida em marco de 2000 a alguns estados do Brasil, em virtude da eliminacao da transmissao da doenca de Chagas pelo Triatoma infestans. Resultado, em grande parte, das acoes do Programa de Controle da Doenca de Chagas (PCDCh), estruturado no Brasil a partir de 1975, e das acoes definidas pela Iniciativa dos Paises do Cone Sul, em 1991, o significado desta certificacao foi incorporado de diferentes formas. A questao principal discutida no artigo e a confusao estabelecida entre eliminacao da transmissao vetorial da doenca de Chagas pelo T. infestans e erradicacao da doenca de Chagas. Discute-se o controle vetorial da endemia chagasica no Pais, em especial na Regiao Nordeste, onde o T. infestans nao representa a principal especie vetora na maioria dos seus estados. Ressalta-se a importância de discutir amplamente a questao do controle dessa endemia no Brasil, no sentido de evitar que informacoes inapropriadas sejam difundidas, confundindo a opiniao publica, com possiveis prejuizos para o efetivo controle da doenca de Chagas.Smallpox has accompanied mankind for centuries, causing deaths and permanent lesions. Used in the past as a biological weapon during wars, it has come into focus again precisely because of this renewed possibility, although the disease has been eradicated in the Americas since 1971 and worldwide since 1977. Data gathered during the eradication campaigns show that the disease spread relatively slowly through close contacts between patients and susceptibles. Sub-clinical infection in non-vaccinated individuals was a rare event, and blockade vaccination surrounding new cases (as long as these cases were confirmed early) was able to prevent the disease from spreading in the community. Even with only one dose, vaccinated individuals rarely developed a serious case of the disease upon reinfection. The use of smallpox as a biological weapon should be considered a real possibility, although according to the available data, highly virulent viral suspensions spread very close to the target population would be necessary to infect a large number of persons.

Paleoepidemiology: is there a case to answer?

Paleopathology is the study of disease, physiological disruptions and impairment in the past. After two centuries of mainly descriptive studies, efforts are being made towards better methodological approaches to the study of diseases in human populations of ancient times whose remains are recovered by archaeology. Paleoepidemiology can be defined as an interdisciplinary area that aims to develop more suitable epidemiological methods, and to apply those in current use, to the study of disease determinants in human populations in the past. In spite of the limits of funerary or other archaeological series of human remains, paleoepidemiology tries to reconstruct past conditions of disease and health in those populations and its relation to lifestyle and environment. Although considering the limits of studying populations of deceased, most of them represented exclusively by bones and teeth, the frequency of lesions and other biological signs of interest to investigations on health, and their relative distribution in the skeletal remains by age and sex, can be calculated, and interpreted according to the ecological and cultural information available in each case. Building better models for bone pathology and bone epidemiology, besides a more complex theoretical frame for paleoepidemiological studies is a big job for the future that will need the incorporation of methods and technology from many areas, including the tools of molecular biology.

The mirror neuron system in post-stroke rehabilitation.

Different treatments for stroke patients have been proposed; among them the mirror therapy and motion imagery lead to functional recovery by providing a cortical reorganization. Up today the basic concepts of the current literature on mirror neurons and the major findings regarding the use of mirror therapy and motor imagery as potential tools to promote reorganization and functional recovery in post-stroke patients. Bibliographic research was conducted based on publications over the past thirteen years written in English in the databases Scielo, Pubmed/MEDLINE, ISI Web of Knowledge. The studies showed how the interaction among vision, proprioception and motor commands promotes the recruitment of mirror neurons, thus providing cortical reorganization and functional recovery of post-stroke patients. We conclude that the experimental advances on Mirror Neurons will bring new rational therapeutic approaches to post-stroke rehabilitation.

Soroprevalência das infecções pelos vírus das hepatites A e B em Macaé, Rio de Janeiro, Brasil

Total HAV and HBc seroprevalence rates in two socioeconomic groups in Macaé, Rio de Janeiro State, Brazil, were estimated in 1,100 surplus serum samples from routine laboratory tests identified by sex, age, neighborhood, and category of medical care, i.e., the public health system or National Unified Health System (SUS) as compared to private health services (NSUS). Seroprevalence rates by age, 95% confidence intervals, and statistical significance tests for differences between SUS and NSUS are presented. Distribution of seroprevalence rates (P) for total HAV (P = 88.8%; 95% CI = 86.8-90.6) and total HBc (P = 15.3%; 13.2-17.6) by age showed an ascending curve. Prevalence rates in the SUS group were significantly higher that in the NSUS group, for both HAV (chi2 = 31.15; p < 0.0001) and HBV (chi2 = 15.41; p < 0.0001). The high prevalence rates reflect the epidemiological pattern of HAV infection in developing countries and the relevance of the social and environmental context. The proportion of susceptible individuals in the < 5 and > 20 year groups highlights the need to vaccinate for hepatitis A and the potential increase in severe cases. High HVB prevalence among adolescents underscores the importance of vaccinating this group. The results serve as a reminder to health professionals concerning biosafety norms.

Microbiological epidemiological history of meningococcal disease in Rio de Janeiro, Brazil

The main objectives of the present study were to investigate the clinical and laboratory features of meningococcal disease in the city of Rio de Janeiro, Brazil, during the overlap of 2 epidemics in the 1990s. We conducted a study of a series of cases of meningococcal disease admitted in a Meningitis Reference Hospital. All clinical isolates available were analyzed by means of microbiological epidemiological markers. In 1990, Neisseria meningitidis serogroup B:4,7:P1.19,15, 1.7,1 sulfadiazine-resistant of the ET-5 complex emerged causing epidemic disease. Despite mass vaccination campaign (VaMengoc B+C®), the ET-5 clone remained hyperendemic after the epidemic peaked. In 1993 to 1995, an epidemic of serogroup C belonged to the cluster A4 overlapped, with a significant shift in the age distribution toward older age groups and an increase of sepsis. Serogroup C epidemics are a recurrent problem in Rio de Janeiro, which can be hindered with the introduction of a conjugate vaccine. We hope the data presented here brings useful information to discuss vaccines strategies and early management of suspected cases.

The Effect of Subcapsular Meningococcal B + C Vaccine on the Prognosis of Patients with Meningococcal Disease

The effectiveness of the meningococcal Cuban vaccine (VaMengoc B + C®) was examined in terms of the prognosis of patients who develop disease. All cases in the vaccinee age category admitted to the Meningococcal Disease Reference Centre, Rio de Janeiro between August 1990 and December 1993 were enrolled. Vaccine effectiveness (VE) was estimated from the relationship 1-OR, where the OR (odds ratio) was the exponential of the logistic regression coefficient for the association between death from meningococcal disease and previous vaccination. The case fatality rate for vaccinees was 6.1% and that for non-vaccinees was 10.6% (relative risk 0.58; 95% confidence interval [CI] 0.33-1.01). An overall protective effect of the vaccine against a fatal outcome was identified (VE 53%; 95% CI 12-75%) controlling for sex, age at time of immunization, elapsed time since vaccination and time between onset of disease and hospital admission. This study suggests that, for some people, even if the vaccine does not protect against the development of disease it may have a beneficial effect in terms of preventing a fatal outcome. This protective effect needs to be further investigated in a prospective cohort study specifically designed to evaluate the new generation of meningococcal vaccines.

Doença meningocócica: epidemiologia e controle dos casos secundários

Epidemiological features of meningococcal disease described as from the second half of the 80s inclusive, have motivated a revision of current guidelines for sporadic disease and outbreak control. The increase of disease among teenagers and linked cases involving schools are the two most significant aspects that have prompted the revision of control measures. Vaccination routines and advice for the disease management of clusters are also relevant features recently revised. This present paper describes the management and some epidemiological features of secondary cases.

Time perception impairs sensory-motor integration in Parkinson’s disease

It is well known that perception and estimation of time are fundamental for the relationship between humans and their environment. However, this temporal information processing is inefficient in patients with Parkinson’ disease (PD), resulting in temporal judgment deficits. In general, the pathophysiology of PD has been described as a dysfunction in the basal ganglia, which is a multisensory integration station. Thus, a deficit in the sensorimotor integration process could explain many of the Parkinson symptoms, such as changes in time perception. This physiological distortion may be better understood if we analyze the neurobiological model of interval timing, expressed within the conceptual framework of a traditional information-processing model called “Scalar Expectancy Theory”. Therefore, in this review we discuss the pathophysiology and sensorimotor integration process in PD, the theories and neural basic mechanisms involved in temporal processing, and the main clinical findings about the impact of time perception in PD.

Reflexões éticas acerca dos estudos de soroprevelência de hepatites virais

INTRODUCAO: A aplicacao de novas tecnologias em pesquisas epidemiologicas sobre hepatites virais (HV) exige discussoes eticas sobre inqueritos domiciliares de soroprevalencia (IDS), estudos sentinelas (ES) e de registros de bancos de sangue (ERBS) e amostras de sorotecas (EAS). METODOS: Discutem-se fatores de forca (FF) e fragilidade (FR) destas abordagens, argumentos/justificativas para sua utilizacao e alternativas, segundo os principios eticos da Resolucao CNS no 196/96. RESULTADOS E DISCUSSAO: As pesquisas sobre HV justificam-se por sua magnitude, gravidade, vulnerabilidade e necessidade de subsidiar protocolos diagnosticos/terapeuticos e estrategias de prevencao/controle. Em relacao aos IDS, discutimos quanto a FF: autonomia do sujeito; representatividade amostral adequada; e FR: custo maior que beneficios; possibilidade de obter a informacao por outros meios. Para os ES, FF: monitoramento das HV com custo operacional inferior ao dos IDS; ausencia de danos adicionais ao sujeito; e FR: limitacao relativa de representatividade. Para os ERBS, FF: monitoramento do VHB/VHC em doadores de sangue com baixo custo, sem risco adicional; e FR: limitacao de representatividade. Quanto aos EAS, FF: preponderância de beneficios sobre riscos/custos; possibilidade de desvendar agravos desconhecidos e de oferecer diagnostico precoce e tratamento; FR: material biologico e dados de uma pesquisa podem ser utilizados em outras. CONCLUSAO: Estas discussoes contribuem para embasar processos eticos, orientar a escolha do tipo de estudo epidemiologico e construir novos conceitos sobre estes temas.

From hepatic diseases and jaundice to viral hepatitis: the configuration of a kaleidoscope

As hepatites virais A, B, C, D e E - viroses sistemicas hepatotropicas - produzem quadros de hepatite aguda. Dependendo do agente etiologico, da carga viral e de condicoes do hospedeiro, podem evoluir para hepatite cronica, cirrose, câncer de figado e formas agudas fulminantes. A versatilidade ecologica desses virus configura uma natureza espectral e cambiante de transmissao no tempo e no espaco; potencializada pelo curso subclinico por vezes prolongado de grande parte das infeccoes, constitui-se em desafio epidemiologico. Com base no curso historico dessas infeccoes foram descritos cenarios e tendencias relativas ao seu comportamento socioepidemiologico, apontando para a necessidade de superar modelos, padroes, protocolos e retornar a investigacao de cada situacao de saude/doenca. Ou seja, assinala para a imprescindivel exploracao das singularidades no sentido de desenvolver acoes gerais modeladas pelas especificidades locais.Viral hepatitis A, B, C, D and E--systemic hepatotropic viral infections--present as acute hepatitis that, depending on the etiological agent, viral load and host conditions, may evolve into chronic hepatitis, cirrhosis, liver cancer and acute fulminant disease. The ecological versatility of these viruses, their spectrum of transmission in time and space, potentialized by the sub-clinical course of a large proportion of infections, comprise an epidemiological challenge. This essay describes scenarios and tendencies in the socioepidemiologic profile, based on the history of these infections, and indicates the need to overcome patterns, models, and protocols and instead investigate each particular situation. In other words, it highlights the need to explore singularities in order to be able to develop new proposals for general actions tailored to local specificities.