Marco Aurélio Pereira Horta

Risk factors for adverse prognosis and death in American visceral leishmaniasis: a meta-analysis.

Background In the current context of high fatality rates associated with American visceral leishmaniasis (VL), the appropriate use of prognostic factors to identify patients at higher risk of unfavorable outcomes represents a potential tool for clinical practice. This systematic review brings together information reported in studies conducted in Latin America, on the potential predictors of adverse prognosis (continued evolution of the initial clinical conditions of the patient despite the implementation of treatment, independent of the occurrence of death) and death from VL. The limitations of the existing knowledge, the advances achieved and the approaches to be used in future research are presented. Methods/Principal Findings The full texts of 14 studies conforming to the inclusion criteria were analyzed and their methodological quality examined by means of a tool developed in the light of current research tools. Information regarding prognostic variables was synthesized using meta-analysis. Variables were grouped according to the strength of evidence considering summary measures, patterns and heterogeneity of effect-sizes, and the results of multivariate analyses. The strongest predictors identified in this review were jaundice, thrombocytopenia, hemorrhage, HIV coinfection, diarrhea, age <5 and age >40–50 years, severe neutropenia, dyspnoea and bacterial infections. Edema and low hemoglobin concentration were also associated with unfavorable outcomes. The main limitation identified was the absence of validation procedures for the few prognostic models developed so far. Conclusions/Significance Integration of the results from different investigations conducted over the last 10 years enabled the identification of consistent prognostic variables that could be useful in recognizing and handling VL patients at higher risk of unfavorable outcomes. The development of externally validated prognostic models must be prioritized in future investigations.

Impact of 10-valent pneumococcal conjugate vaccine on pneumococcal meningitis in children up to two years of age in Brazil

The objective of this study was to analyze the impact of vaccination against Streptococcus pneumoniae on the morbidity and mortality from pneumococcal meningitis in children ≤ 2 years in Brazil, from 2007 to 2012. This is a descriptive study and ecological analysis using data from the Information System on Notifiable Diseases. Pre-vaccination (2007-2009) and post-vaccination (2011-2012) periods were defined to compare incidence rates and mortality. A total of 1,311 cases and 430 deaths were reported during the study period. Incidence decreased from 3.70/100,000 in 2007 to 1.84/100,000 in 2012, and mortality decreased from 1.30/100,000 to 0.40/100,000, or 50% and 69% respectively, with the greatest impact in the 6-11 month age group. This decrease in Pneumococcal meningitis morbidity and mortality rates two years after introduction of the 10-valent pneumococcal conjugate vaccine suggests its effectiveness.Dissertacao (mestrado)—Universidade de Brasilia, Faculdade UnB Ceilândia, Programa de Pos-Graduacao em Ciencias e Tecnologias em Saude, 2013.

Temporal relationship between environmental factors and the occurrence of dengue fever.

To determine the time-lag effect of meteorological factors on the relative risk (RR) of dengue incidence in Coronel Fabriciano city, Brazil, we applied a distributed lag nonlinear model, a modeling framework that can simultaneously represent nonlinear exposure–response dependencies and delayed effects, to establish the association between dengue incidence and weather predictors. The weekly number of notified dengue cases during the period 2004–2010 was used for analysis. When considering the rainfall, the highest RR (1.2) was observed for lag 10. Observing the cumulative effect of the precipitation, the RR for 12th and 13th week was RR = 4. The highest risk, 1.25, was observed at 25 °C, denoting that the risk of dengue transmission increases with temperature. Climate-based models that take into account the time lag between rainfall, temperature, and dengue can be useful in dengue control programs to be applied in tropical countries.

Impacto da vacina pneumocócica conjugada 10-valente na meningite pneumocócica em crianças com até dois anos de idade no Brasil

The objective of this study was to analyze the impact of vaccination against Streptococcus pneumoniae on the morbidity and mortality from pneumococcal meningitis in children ≤ 2 years in Brazil, from 2007 to 2012. This is a descriptive study and ecological analysis using data from the Information System on Notifiable Diseases. Pre-vaccination (2007-2009) and post-vaccination (2011-2012) periods were defined to compare incidence rates and mortality. A total of 1,311 cases and 430 deaths were reported during the study period. Incidence decreased from 3.70/100,000 in 2007 to 1.84/100,000 in 2012, and mortality decreased from 1.30/100,000 to 0.40/100,000, or 50% and 69% respectively, with the greatest impact in the 6-11 month age group. This decrease in Pneumococcal meningitis morbidity and mortality rates two years after introduction of the 10-valent pneumococcal conjugate vaccine suggests its effectiveness.Dissertacao (mestrado)—Universidade de Brasilia, Faculdade UnB Ceilândia, Programa de Pos-Graduacao em Ciencias e Tecnologias em Saude, 2013.

Avaliação da vigilância epidemiológica ampliada do rotavírus

Objective: To assess the practices of Rotavirus surveillance, identifying the positive aspects and the difficulties found through the evaluation model from the Enhanced Surveillance of Rotavirus Diarrheal Diseases. Method: This is an evaluative and qualitative research performed in two different Brazilian states between March and November 2010. Participated in the evaluation 14 subjects in total (from central, state and municipal level), which were submitted to tape-recorded interviews using semi-structured questionnaires, along with conduction of document analysis and direct observation of routine service within their respective units. This information allowed to feed a judgment matrix, thus highlighting the various aspects comprising the system operation. Results: Positive aspects were observed (the sensitivity to capture cases, the system acceptability by the technicians involved, the proper physical structure and the training and updating of technicians), and operational difficulties when conducting surveillance activities (the shortage of human and financial resources and the low opportunity of the information system). Conclusion: The results suggest the low effectiveness of the monitoring system adopted, indicating that the sentinel type of surveillance may not be the most appropriate for the health system in the studied states. doi:10.5020/18061230.2014.p140

The use of modified mosquitoes in Brazil for the control of Aedes aegypti: methodological and ethical constraints

. These harmless mosquitoes, known in Brazil as “do-gooders”, are reared in laboratory to be released in the field in order to transmit their laboratory-acquired fea-tures or pathogens into the wild urban mosqui-toes population, thus promoting the control of mosquito populations or the control of disease transmission in the areas they were released. With the Brazilian media publishing positive results, two of such mosquito plants were in-stalled, in Juazeiro (Bahia) and Campinas (Sao Paulo). Esses mosqui-tos inofensivos, vulgarmente denominados “do bem”, sao criados em laboratorio para que sejam liberados no campo com objetivo de transmi-tirem seus caracteres geneticos ou patogenos adquiridos no laboratorio para os mosquitos urbanos selvagens promovendo ou o controle populacional nas areas liberadas, ou o controle das doencas transmitidas. Propalando resulta-dos positivos na midia brasileira, duas fabricas desses mosquitos foram instaladas em Juazeiro (Bahia) e Campinas (Sao Paulo)

Impacto de la vacuna neumocócica conjugada 10-valente en la meningitis neumocócica en niños de hasta dos años de edad en Brasil

The objective of this study was to analyze the impact of vaccination against Streptococcus pneumoniae on the morbidity and mortality from pneumococcal meningitis in children ≤ 2 years in Brazil, from 2007 to 2012. This is a descriptive study and ecological analysis using data from the Information System on Notifiable Diseases. Pre-vaccination (2007-2009) and post-vaccination (2011-2012) periods were defined to compare incidence rates and mortality. A total of 1,311 cases and 430 deaths were reported during the study period. Incidence decreased from 3.70/100,000 in 2007 to 1.84/100,000 in 2012, and mortality decreased from 1.30/100,000 to 0.40/100,000, or 50% and 69% respectively, with the greatest impact in the 6-11 month age group. This decrease in Pneumococcal meningitis morbidity and mortality rates two years after introduction of the 10-valent pneumococcal conjugate vaccine suggests its effectiveness.Dissertacao (mestrado)—Universidade de Brasilia, Faculdade UnB Ceilândia, Programa de Pos-Graduacao em Ciencias e Tecnologias em Saude, 2013.

A liberação de mosquitos "do bem" na agenda brasileira para o controle do Aedes aegypti: restrições metodológicas e éticas

. These harmless mosquitoes, known in Brazil as “do-gooders”, are reared in laboratory to be released in the field in order to transmit their laboratory-acquired fea-tures or pathogens into the wild urban mosqui-toes population, thus promoting the control of mosquito populations or the control of disease transmission in the areas they were released. With the Brazilian media publishing positive results, two of such mosquito plants were in-stalled, in Juazeiro (Bahia) and Campinas (Sao Paulo). Esses mosqui-tos inofensivos, vulgarmente denominados “do bem”, sao criados em laboratorio para que sejam liberados no campo com objetivo de transmi-tirem seus caracteres geneticos ou patogenos adquiridos no laboratorio para os mosquitos urbanos selvagens promovendo ou o controle populacional nas areas liberadas, ou o controle das doencas transmitidas. Propalando resulta-dos positivos na midia brasileira, duas fabricas desses mosquitos foram instaladas em Juazeiro (Bahia) e Campinas (Sao Paulo)

La liberación de los mosquitos “buenos” en la agenda brasileña para el control de Aedes aegypti: restricciones metodológicas y éticas

. These harmless mosquitoes, known in Brazil as “do-gooders”, are reared in laboratory to be released in the field in order to transmit their laboratory-acquired fea-tures or pathogens into the wild urban mosqui-toes population, thus promoting the control of mosquito populations or the control of disease transmission in the areas they were released. With the Brazilian media publishing positive results, two of such mosquito plants were in-stalled, in Juazeiro (Bahia) and Campinas (Sao Paulo). Esses mosqui-tos inofensivos, vulgarmente denominados “do bem”, sao criados em laboratorio para que sejam liberados no campo com objetivo de transmi-tirem seus caracteres geneticos ou patogenos adquiridos no laboratorio para os mosquitos urbanos selvagens promovendo ou o controle populacional nas areas liberadas, ou o controle das doencas transmitidas. Propalando resulta-dos positivos na midia brasileira, duas fabricas desses mosquitos foram instaladas em Juazeiro (Bahia) e Campinas (Sao Paulo)

Os efeitos do crescimento urbano sobre a dengue

Objective: To analyze the spatial and temporal dynamics of dengue in Coronel Fabriciano, Minas Gerais State, Brazil, and to associate cases to the growth of urban areas and loss of natural areas in recent years. Methods: This is a descriptive, exploratory study, with a quantitative approach. Dengue cases of 2009 were obtained from the Health Municipal Secretariat, including the suspected and confirmed cases. Shape files were obtained, containing information about the municipal boundary, boundary of the urban area, census tracts, areas with buildings and natural areas. Based on the distribution of dengue cases, the Kernel estimator was used to measure data dispersion. Results: Dengue cases reported were georeferenced in GIS (Geographic Information System) environment. The landscape showed changes in the units of urban area and pasture, as an urban growth over the pasture matrix. No changes were observed in the areas of remaining forest and eucalyptus. There are cases spatially spread with a tendency to form clusters. Conclusion: Cases of dengue were observed spatially clustered in the northern region of the city, where new neighborhoods have emerged in recent years, following the population growth without proper structure of urbanization and urban planning. In addition, urban growth have reduced the margin of watercourses providing a bare soil, suitable for accumulation of trash and formation of breeding sites for mosquitoes. Efficient public policies and appropriate urban planning might reduce the impact of dengue in endemic regions. doi: http://dx.doi.org/10.5020/18061230.2013.p539