José Rubens Costa Lima

Hanseníase: subnotificação de casos em Fortaleza - Ceará, Brasil

BACKGROUND: To eliminate leprosy as a public health problem in Brazil, the Ministry of Health aims to achieve a prevalence rate of less than 1.0 case/10,000 inhabitants, encouraging diagnosis and treatment of patients and reducing dissemination of the disease. The National Disease Notification System (SINAN) is in charge of verify the elimination plan results. OBJECTIVE: To verify the proportion of leprosy cases diagnosed and reported to SINAN by health centers of the city of Fortaleza, in Ceara, Northeastern region of Brazil. METHODS: Comparison between cases registered in health centers and those reported to the Municipal Secretariat of Health of Fortaleza (HDF) from 2002 to 2004. Cases registered in health care centers but not in SINAN were considered underreported and retrieved. RESULTS: Fifteen (64%) health care centers informed at least one case in the period. From them 411 cases were retrieved (17.5% of total informed). About 342 retrieved cases were reported to the SINAN data base in the health center, but not to the database at the Municipal Health Secretariat. CONCLUSIONS: The surveillance system needs to be improved to prevent lack of information and to show the true frequency of diagnosed cases.

Interpretation of the presence of IgM and IgG antibodies in a rapid test for dengue: analysis of dengue antibody prevalence in Fortaleza City in the 20th year of the epidemic

INTRODUCTION The diagnosis of dengue and the differentiation between primary and secondary infections are important for monitoring the spread of the epidemic and identifying the risk of severe forms of the disease. The detection of immunoglobulin (Ig)M and IgG antibodies is the main technique for the laboratory diagnosis of dengue. The present study assessed the application of a rapid test for dengue concerning detection of new cases, reinfection recognition, and estimation of the epidemic attack rate. METHODS This was a retrospective, cross-sectional, descriptive study on dengue using the Fortaleza Health Municipal Department database. The results from 1,530 tested samples, from 2005-2006, were compared with data from epidemiological studies of dengue outbreaks in 1996, 2003, and 2010. RESULTS The rapid test confirmed 52% recent infections in the tested patients with clinical suspicion of dengue: 40% detected using IgM and 12% of new cases using IgG in the non-reactive IgM results. The positive IgM plus negative IgG (IgM+ plus IgG-) results showed that 38% of those patients had a recent primary dengue infection, while the positive IgG plus either positive or negative IgM (IgG+ plus IgM+/-) results indicated that 62% had dengue for at least a second time (recent secondary infections). This proportion of reinfections permitted us to estimate the attack rate as >62% of the population sample. CONCLUSIONS The rapid test for dengue has enhanced our ability to detect new infections and to characterize them into primary and secondary infections, permitting the estimation of the minimal attack rate for a population during an outbreak.

Resgate de casos subnotificados de tuberculose em Fortaleza-CE, 2000-2002

A incidência, a prevalência e o número de casos de tuberculose notificados pelo município de Fortaleza vêm apresentando tendência decrescente desde 1995. Essa redução poderia ser devida à ação de controle da tuberculose no município, à subdetecção de casos ou à subnotificação. Para avaliar a existência de subnotificação e resgatar os casos não notificados, foi feita a comparação entre os casos informados ao Sistema Nacional de Agravos de Notificação e os anotados no livro de registros das unidades de saúde com programa de controle de tuberculose, no período entre 2000 e 2002, no município de Fortaleza. Cinqüenta e oito unidades de saúde notificaram 5.206 casos, sendo que 4.743 (91,1%) foram informados por aquelas com PCT. Resgataram-se 962 casos, em média, 320 casos por ano, o que representa 18,5% do total de notificações. Diante dessa proporção de casos subnotificados, sugere-se que seja feita a revisão dos fluxos de notificação e a conferência dos casos notificados com os atendidos regularmente.

Utilidade da triagem dos anticorpos anti-dsDNA por quimioluminescência, seguida de confirmação por imunofluorescência indireta

OBJECTIVE: The purpose of this study was to evaluate the performance of a chemiluminescent immunoassay (CLIA) to detect anti-dsDNA antibodies, using the indirect immunofluorescence test (IIF) on Crithidia luciliae as a reference. METHODS: The automation system demonstrated 81% efficiency, 100% sensitivity and 82% specificity according to the intrinsic validation process performed using 179 consecutive samples from 169 patients in the beginning of 2011. These patients were subsequently divided into 3 groups according to the co-reactivity of anti-dsDNA results using the 2 methods (reactive, non-reactive and discrepant results). RESULTS: Upon data analysis, 77% (129/169) of the tests were requested by rheumatologists, and 57% (97/169) of the samples were from lupus patients. Both the reactive and non-reactive results of the CLIA were well defined and standardised, and automation reduced the manual labor required by 70% in a safe and high-quality manner. Furthermore, the high prevalence of patients with lupus and nephritis among the CLIA false-positive results corroborates the hypothesis that the actual index of CLIA false positivity is lower than that initially found in this study.

Usefulness of anti-dsDNA antibody screening with chemiluminescence followed by confirmation by indirect immunofluorescence

OBJECTIVE The purpose of this study was to evaluate the performance of a chemiluminescent immunoassay (CLIA) to detect anti-dsDNA antibodies, using the indirect immunofluorescence test (IIF) on Crithidia luciliae as a reference. METHODS The automation system demonstrated 81% efficiency, 100% sensitivity and 82% specificity according to the intrinsic validation process performed using 179 consecutive samples from 169 patients in the beginning of 2011. These patients were subsequently divided into 3 groups according to the co-reactivity of anti-dsDNA results using the 2 methods (reactive, non-reactive and discrepant results). RESULTS Upon data analysis, 77% (129/169) of the tests were requested by rheumatologists, and 57% (97/169) of the samples were from lupus patients. Both the reactive and non-reactive results of the CLIA were well defined and standardised, and automation reduced the manual labor required by 70% in a safe and high-quality manner. Furthermore, the high prevalence of patients with lupus and nephritis among the CLIA false-positive results corroborates the hypothesis that the actual index of CLIA false positivity is lower than that initially found in this study.

Estudo da mortalidade pelas principais causas de violência em Fortaleza, 1998-2007 - doi:10.5020/18061230.2008.p246

Objective: To describe the mortality from external causes in Fortaleza (Brazil), including homicides, suicides, falls and traffic violence. Methods: A descriptive study about the mortality of residents in Fortaleza, in which 105,000 deaths occurring in the period of 1999 to 2007 were evaluated. The deaths were registered and available in the Mortality Information System (SIM) of the Municipal Health Secretariat (SMS). Death distribution by year of occurrence and gender were compared. To measure the population’s growth and the increase of deaths and of mortality rates in time we used linear regression. The correlations with coefficients of determination equal or above 70% (R2 ? 0.70) were considered significant. Results: It was found that, for the entire period, deaths from all external causes showed to be higher in men than in women, either in attacks or in traffic accidents or in cases of selfinflicted injuries. In the period, deaths from external causes presented a growth with level of significance above 70%, at a rate of 49.5 deaths per year, reaching 1.774 deaths in 2007 (R2 = 0.74). Regarding the absolute numbers of deaths, growth occurred at the expense of increase of homicides and suicides in men (R2 ? 0.73) and not in women (R2 ? 0.56) and was not observed in mortality rates, indicating a correlation with population growth. Conclusion: By the study of trends in mortality rates, there are signs, albeit weak, of a trend to the reduction of deaths from external causes, which, probably, is reflecting the gains achieved by the efforts of resources mobilization and the organization of society against violence.