Raquel V. C. Oliveira

Systematic review of the adverse effects of cutaneous leishmaniasis treatment in the New World

Pentavalent antimonials are first-line drugs for the treatment of the cutaneous form of American tegumentary leishmaniasis. Second-line drugs include amphotericin B and pentamidine. Although these drugs have been used for decades, there are no systematic reviews about their safety. The objective of this review was to identify and classify the main adverse effects associated with these drugs and to estimate the frequency of these effects, whenever possible. Intervention studies, case series and case reports containing information regarding clinical, laboratory or electrocardiographic adverse effects of drugs used for the treatment of cutaneous leishmaniasis were systematically retrieved from 10 databases searched between August 13, 2008 and March 31, 2009. The 65 studies included in this review had treated a total of 4359 patients from 12 countries infected with eight different Leishmania species. Despite the small number of drugs used in these studies, a wide variability in the therapeutic regimens was observed. As a consequence, the adverse effects of pentavalent antimonials and pentamidine needed to be classified jointly according to system, irrespective of formulation, daily dose, duration of treatment, and route of administration. The frequencies of adverse effects were calculated based on the data of 32 articles involving 1866 patients. The most frequently reported clinical adverse effects of pentavalent antimonials and pentamidine were musculoskeletal pain, gastrointestinal disturbances, and mild to moderate headache. Electrocardiographic QTc interval prolongation and a mild to moderate increase in liver and pancreatic enzymes were additional adverse effects of pentavalent antimonials. Patients treated with liposomal amphotericin B had mild dyspnea and erythema. The adverse effects associated with miltefosine were vomiting, nausea, kinetosis, headache, diarrhea, and a mild to moderate increase in aminotransferases and creatinine. Although closer surveillance is needed for the treatment of cutaneous leishmaniasis, antileishmanial drugs are basically safe and severe side effects requiring the discontinuation of treatment are relatively uncommon.

Regional pattern of the molecular types of Cryptococcus neoformans and Cryptococcus gattii in Brazil

The molecular types of 443 Brazilian isolates of Cryptococcus neoformans and Cryptococcus gattii were analyzed to determine their geographic distribution within Brazil and their underlying host conditions. The following data, imported from previous epidemiological studies as well as two culture collections, were analyzed for: place of isolation, source (clinical or environmental), host risk factors, species, serotype, mating type, and molecular type. Molecular typing by PCR-fingerprinting using primers for the minisatellite-specific core sequence of the wild-type phage M13 or microsatellites [(GACA)4, (GTG)5], restriction fragment length polymorphism of URA5 gene analysis, and/or amplified fragment length polymorphism (AFLP) identified eight major genotypes: VNI/AFLP1, VNII/AFLP1A, VNIII/AFLP2, and VNIV/AFLP3 for C. neoformans, and VGI/AFLP4, VGII/AFLP6, VGIII/AFLP5, and VGIV/AFLP7 for C. gattii. The most common molecular type found in Brazil was VNI (64%), followed by VGII (21%), VNII (5%), VGIII (4%), VGI and VNIV (3% each), and VNIII (< 1%). Primary cryptococcosis caused by the molecular type VGII (serotype B, MAT alpha) prevails in immunocompetent hosts in the North and Northeast regions, disclosing an endemic regional pattern for this specific molecular type in the Northern Brazil.

Violência e representação social na adolescência no Brasil

OBJETIVO: Investigar a associacao entre a representacao que os adolescentes tem de si e a violencia fisica severa, psicologica e sexual que sofrem de pessoas que lhes sao importantes, sobretudo os pais; e analisar a associacao entre a vitimizacao na familia e em outros espacos sociais. METODO: Inquerito epidemiologico com 1 685 estudantes selecionados aleatoriamente nas escolas publicas e particulares do Municipio de Sao Goncalo (RJ), Brasil, em 2002. Para aferir cada uma das formas de violencia foram usadas escalas de avaliacao de taticas para lidar com conflito, de abuso e trauma infantil e de violencia psicologica. RESULTADOS: Constatou-se que 14,6% dos estudantes sofriam violencia fisica severa de pai ou mae; 11,8% testemunharam ou vivenciaram violencia sexual na familia; 48,0% relataram sofrer violencia psicologica de pessoas significativas. Os adolescentes que sofrem essas formas de violencia sao mais frequentemente vitimas de violencia na comunidade e na escola, relatando-se tambem mais transgressores da lei. Em geral, possuem uma representacao positiva de si proprios, embora mencionem atributos negativos com maior frequencia. CONCLUSAO: A representacao social predominantemente positiva entre jovens necessita ser estimulada nas atividades de promocao a saude. A constatacao de que os indices de violencia estao associados as varias esferas de atuacao dos adolescentes indica que a resolucao do problema depende de estrategias que englobem todas essas esferas.

Violência escolar e auto-estima de adolescentes

Este artigo procura estudar a associacao entre auto-estima e violencias que ocorrem no ambiente escolar. Apresenta resultados obtidos em pesquisa realizada em escolas publicas e particulares de Sao Goncalo, Estado do Rio de Janeiro. Emprega basicamente metodologia quantitativa (inquerito epidemiologico com uma amostra de 1.686 alunos) com alunos das 7a e 8a series do ensino fundamental e 1o e 2o anos do ensino medio. Os resultados indicam que alunos com baixa auto-estima relacionam-se de forma pior com colegas e professores que os pares de elevada auto-estima, alem de se colocarem mais frequentemente na posicao de vitimas de violencia na escola e terem mais dificuldade de se sentir bem no espaco escolar. Sao apontados alguns programas nacionais que tem tentado abordar o problema da violencia na escola.

Fatores associados aos problemas de saúde mental em adolescentes

This article aims at investigating the mental health problems of school adolescents and identifying individual, social and family aspects associated with its development. It is based on an epidemical survey with 1923 students of the 7th and 8th grades of Elementary School and 1st and 2nd years of High School of public and private schools of municipality of Sao Goncalo, RJ. The scale Self-Reported Questionnaire was used to evaluate Minor Psychiatric Morbidity. Individual, social and family aspects were evaluated. Simple Logistic Regression was utilized and the odds ratio was the measure to interpret the results. Psychological violence, difficult family life events, self-esteem, satisfaction with life, sex and school competence were maintained in the final model, indicating their potential to compromise mental health. The presentation of the data can subsidize the development of public policies for the attendance of the adolescent, especially in the preventive level and in the promotion of health in the mental health area.

Sintomas depressivos na adolescência: estudo sobre fatores psicossociais em amostra de escolares de um município do Rio de Janeiro, Brasil

This studys objective was to identify individual, social, and familial risk factors for depressive symptoms in adolescent students. The study included 1,923 seventh and eighth-grade (junior high) students and first and second-year high school students in public and private schools from a city in Rio de Janeiro State, Brazil. Depressive symptoms were evaluated with the SRQ-20 scale (Harding, 1980) and resilience scale (Wagnild & Young, 1993). Hierarchical logistic regression was the analytical method used. Symptoms of depression were present in 10% of adolescents. Girls had more than twice the odds of presenting these symptoms (CI: 1.58-3.67); adolescent children of divorced parents had 73% greater odds of depression (CI: 1.16-2.57); victims of serious physical abuse by mothers had 6.49 times the odds (CI: 2.07-20.30); those with low self-esteem, 6.43 greater odds (CI: 2.63-15.68); and those displaying dissatisfaction with their lives, 3.19 greater odds (CI: 2.08-4.89). The findings highlight the urgent need to improve public health policies for adolescents, especially at the preventive level, including psychosocial strategies with the development of a treatment network.

Sensitivity and Specificity of In Situ Hybridization for Diagnosis of Cutaneous Infection by Leishmania infantum in Dogs

ABSTRACT An accurate diagnosis of infection by Leishmania infantum in dogs is fundamental for the control of zoonotic visceral leishmaniasis (VL). Histopathology (HP) and immunohistochemistry (IHC) are frequently used for the histological diagnosis of L. infantum in dogs but have shown limited accuracy. To improve the sensitivity and specificity of the histological diagnosis of VL, we evaluated automated in situ hybridization (ISH) using a generic probe for Leishmania and a specific probe for L. infantum in surgical skin biopsy specimens of dogs. The ISH results were compared with those of HP and IHC, using parasitological culture as the reference standard. Skin samples from 51 dogs with cutaneous L. infantum infection and 51 noninfected dogs were randomly selected from samples of dogs from various cities in Brazil where canine VL is endemic. These samples were processed for parasitological culture, HP, IHC, and ISH using both probes. The sensitivities of ISH using the specific probe, ISH using the generic probe, IHC, and HP were, respectively, 74.5%, 70.6%, 69.5%, and 57.6%. The specificity of both ISH probes tested was 100%, and there was no cross-hybridization of the generic and specific probes with selected pathogenic fungi and protozoa. The specific probe discriminated L. infantum from the other species of Leishmania that infect dogs in the New World. ISH is highly sensitive and specific for the diagnosis of L. infantum in histologic samples of skin from infected dogs and can be used on routine biopsy material to make a diagnosis of leishmaniasis.

Violência e transtorno de estresse pós-traumático na infância

This study presents the prevalence of symptoms of Posttraumatic Stress Disorder (PTSD) in 500 schoolchildren (6-13 years old) in Sao Goncalo, Rio de Janeiro. It also investigates the association between PTSD, violence and other adverse events in the lives of these children. The multi-stage cluster sampling strategy involved three selection stages. Parents were interviewed about their childrens behavior. The instrument used to screen symptoms of PTSD was the Child Behavior Checklist-Posttraumatic Stress Disorder Scale (CBCL-PTSD). Conflict Tactics Scales (CTS) were applied to evaluate family violence and other scales to investigate the socioeconomic profile, familiar relationship, characteristics and adverse events in the lives of the children. Multivariate analysis was performed using a hierarchical model with a significance level of 5%. The prevalence of clinical symptoms of PTSD was of 6.5%. The multivariate analysis suggested an explanation model of PTSD characterized by 18 variables, such as the childs characteristics; specific life events; family violence; and other family factors. The results reveal that it is necessary to work with the child in particularly difficult moments of his/her life in order to prevent or minimize the impact of adverse events on their mental and social functioning.

Evaluation of immunohistochemistry for the diagnosis of sporotrichosis in dogs

The aim of this study was to apply immunohistochemistry (IHC) for the diagnosis of canine sporotrichosis and to compare this method with the Grocotts silver stain (GSS) and periodic acid Schiff (PAS) techniques. Eighty-seven dogs with sporotrichosis (group 1) and 35 with American tegumentary leishmaniosis (ATL) (group 2) were studied. The fungus was detected in group 1 by GSS, PAS and IHC. IHC was also applied to group 2 to evaluate the occurrence of cross-reactions. PAS, GSS and IHC detected yeast cells in 19.5%, 43.7% and 65.5% of the group 1 cases, respectively. The detection of intracellular antigens of Sporothrix schenckii by IHC increased the sensitivity of the histological diagnosis to 80.5%. No positive reaction was observed in ATL lesions. The results suggest that IHC may be indicated for the diagnosis of sporotrichosis because of its higher diagnostic sensitivity.

A cross-sectional analysis of women’s mental health problems: examining the association with different types of violence among a sample of Brazilian mothers

BackgroundMental health problems are the major cause of disability in poor countries, and women are the individuals most affected. The World Health Organization points out that violence against women is the leading cause of mental health problems. This study seeks to identify explanatory factors for women’s mental health problems, highlighting situations of violence suffered by them during childhood, when living with a partner and in the community.MethodA cross-sectional analysis was conducted with 389 mothers with schoolchildren in a city in the state of Rio de Janeiro (Brazil). Profile variables and childhood and adult life experiences were researched and organized in three analytical blocks. A binary logistic regression model was used, divided into hierarchical blocks.ResultsThe final model shows that women who were the victims of severe physical violence by their partner were more likely (OR = 8.2) to suffer from mental health problems than those who had never been exposed to this type of violence. The mothers of children with behavior problems are more likely to have mental health problems (OR = 3.0) than mothers whose children do not manifest behavioral problems.ConclusionThis study shows that women’s mental health problems are particularly related to the experience of physical violence, especially that occurring in intimate partner relationships. Based on this premise, this work recommends that multidimensional issues need to be included in women’s health assistance programs duly incorporating the specificity of victimization by violence.