Rita da Graça Carvalhal Frazão Corrêa

Epidemiological, clinical, and operational aspects of leprosy patients assisted at a referral service in the state of Maranhão, Brazil

INTRODUCTION Leprosy is an infectious disease caused by Mycobacterium leprae. The aim of this study was to describe the epidemiological, clinical, and operational aspects of leprosy carriers. METHODS A cross-sectional study leprosy patients assisted in São Luis, MA, was performed. RESULTS Of the 85 cases analyzed, 51.7% were male participants, and 60% were brown. Concerning the age, 54.8% of women were between 35 and 49 years, and 57.6% of men were between 20 and 34 years. Lepromatous leprosy was found in 42.3% of cases, and the multibacillary form was found in 72.9%. The skin smear was positive in 42.3%. The occurrence of reaction was found in 43.5% of cases, and 83.5% had no Bacillus Calmette-Guérin scar. Leprosy in the family was reported by 44.7% of the patients. Most of the individuals (96.4%) lived in houses made of brick with more than three rooms (72.6%) and two persons per room (65.1%). Concerning the level of education, 41.4% of women and 34.1% of men had more than one to three years of education. The most evaluated age group in the beginning of the treatment was that of 35 to 49 years with a Grade 0 incapability (64.5%), and that in the end was the age group of 20 to 34 (29.9%) with Grade 0, 30.7% Grade 1, and 11.5% Grade 2. CONCLUSIONS The frequency of multibacillary forms found in this study and the cases in family members point out delayed diagnoses. Thus, early diagnosis and appropriate treatment are important in decreasing the outcome of disabilities.

Perfil epidemiológico dos indivíduos HIV positivo e coinfecção HIV-Leishmania em um serviço de referência em São Luís, MA, Brasil

A Aids e um problema de saude publica e a Leishmaniose visceral (LV) a forma mais frequente de coinfeccao. O objetivo e descrever aspectos epidemiologicos dos individuos HIV positivo e investigar a ocorrencia de coinfeccao HIV-Leishmania. Trata-se de estudo descritivo realizado com 287 individuos HIV positivo atendidos no Centro de Referencia para DST/Aids em Sao Luis (MA). Foi realizado teste de Intradermorreacao de Montenegro, aspirado de medula ossea para deteccao da infeccao por Leishmania sp e aplicado um questionario na coleta dos dados epidemiologicos. O teste qui-quadrado foi usado para diferencas entre genero, com p < 0,05 de significância. Houve significância estatistica entre os homens relacionados ao uso de fossa septica e renda ate dois salarios. Quanto a exposicao, foi predominante a categoria heterossexual para ambos os sexos, sendo observado um aumento entre as mulheres. Entre os individuos HIV positivo 4,2% apresentavam sintomatologia sugestiva de LV sendo identificadas formas amastigotas para Leishmania sp no aspirado de medula ossea. O perfil dos individuos HIV positivo nao diferiu de outras regioes do Brasil com predominio de jovens em idade produtiva, sendo constatada uma sobreposicao das areas de transmissao para a coinfeccao HIV-LV.Burnoffs (intentional fires for agricultural purposes) and forest fires of large proportions have been observed in various regions of the planet. Exposure to high levels of air pollutants emitted by fires can be responsible for various harmful effects on human health. In this article, the literature on estimating acute effects of air pollution on human health by fires in the regions with the highest number of fires on the planet, using a time series approach is summarized. An attempt was made to identify gaps in knowledge. The study consisted of a narrative review, in which the characteristics of the selected studies were grouped by regions of the planet with a higher incidence of burnoffs: Amazon, America, Australia and Asia. The results revealed a large number of studies in Australia, few studies in the Amazon and great heterogeneity in the results on the significant effects on human health.

[The epidemiological profile of HIV-positive individuals and HIV-Leishmaniasis co-infection in a referral center in São Luis, Maranhão, Brazil].

AIDS is a public health problem and visceral leishmaniasis (VL) is the most frequent co-infection. This study seeks to describe the epidemiological aspects of HIV-positive individuals and to investigate the occurrence of HIV-Leishmania co-infection. It is a descriptive study with 287 HIV=positive individuals assisted at the reference center for HIV/AIDS in São Luís, MA. Montenegros intradermal reaction and bone marrow aspiration were performed for detecting the Leishmania sp. infection. Epidemiological data were collected by means of a questionnaire. The chi-square test was used for gender differences, with p < 0.05 of statistical significance level. There was statistical significance among men regarding the use of septic tanks, and income of up to two salaries. Regarding exposure, heterosexual orientation was the most frequent category for both genders, and we observed an increase in this category among women. Among HIV-positive individuals, 4.2% had suggestive symptoms of VL with identification of Leishmania amastigotes in bone marrow aspirate (myelogram). The profile of HIV-positive individuals did not differ from what is commonly found in Brazil, with predominance of young people of productive age. Furthermore, a superposition of the transmission areas for HIV-LV co-infection was found.

Temporal relationship between rainfall, temperature and occurrence of dengue cases in São Luís, Maranhão, Brazil

This study analyzed the relationship between rainfall, temperature and occurrence of dengue cases. Ecological study performed with autochthonous dengue cases reported during 2003 to 2010 in São Luís, Maranhão. Data of rainfall and temperature were collected monthly. The monthly incidence of dengue cases was calculated by year/100,000 inhabitants. In order to identify the influence of climate variables and dengue cases different distributed lag models using negative binomial distribution were considered. Model selection was based on the lowest AIC (Akaike Information Criterion). Thirteen thousand, four hundred forty-four cases of dengue between 2003 and 2010 were reported, with peaks in 2005, 2007 and 2010. The correlation between rainfall and the occurrence of dengue cases showed increase in the first months after the rainy months. Occurrence of dengue cases was observed during all the period of study. Only rainfall-lag per three months showed a positive association with the number of cases dengue. Thus, this municipality is considered as an endemic and epidemic site. In addition, the relation between rainfall and dengue cases was significant with a lag of three months. These results should be useful to the future development of politics healthy for dengue prevention and control.

Association analysis of human leukocyte antigen class II (DRB1) alleles with leprosy in individuals from São Luís, state of Maranhão, Brazil

Epidemiological studies have demonstrated that the variability of the clinical response to infection caused by Mycobacterium leprae is associated with host genetic factors. The present study investigated the frequency of human leukocyte antigen (HLA) class II (DRB1) alleles in patients with leprosy from São Luís, Maranhão, Brazil. A case-control study was performed in 85 individuals with leprosy and 85 healthy subjects. All samples were analysed via polymerase chain reaction-sequence specific oligonucleotide probes. The HLA-DRB1*16 allele showed a higher frequency in the group with leprosy [(9.41% vs. 4.12%) odds ratio (OR) = 2.41 95% confidence interval (CI) (0.96-6.08) p = 0.05], whereas the HLA-DRB1*11 allele was less frequent in the group with leprosy [(6.47% vs. 11.76%) OR = 0.51 95% CI (0.23-1.12) p = 0.09]. The frequency of HLA-DRB1* alleles between the control group and leprosy patient subgroups presenting different forms of the disease showed that the HLA-DRB1*16 (16.13% vs. 8.24%, OR = 4.10, CI = 1.27-13.27, p = 0.010) and HLA-DRB1*14 (5% vs. 3.53%, OR = 4.63, CI = 1.00-21.08, p = 0.032) alleles were significantly more frequent in patients with different clinical subtypes of leprosy. The sample size was a limitation in this study. Nevertheless, the results demonstrated the existence of a genetic susceptibility associated with the clinical forms of leprosy. The low frequency of the HLA-DRB1*11 allele should be further studied to investigate the possible protective effect of this allele.

Knowledge of adolescents regarding sexually transmitted infections and pregnancy

Objective: To investigate the knowledge of adolescents related to sexually transmitted infections (STIs), AIDS, and pregnancy, and understand the role of school in sex education. Method: A qualitative descriptive study, developed through a semi-structured interview and a form for participant characterization, with 22 high school students from a public school aged 16 to 19 years. Data were submitted to content analysis. Results: After analysis, four thematic categories were developed: sexuality and sex education; understanding of risk behaviors; knowledge of STI/AIDS; and knowledge of and practices for prevention. Final considerations: This study showed the need for preventive educational actions for adolescents, because the lack of information contributes to their vulnerability. The adolescents recognize the importance of sex education; therefore it is important to implement strategies to promote and protect health in the school environment to encourage and strengthen self-care in health. Objetivo: investigar o conhecimento de adolescentes relacionado às Infecções Sexualmente Transmissíveis (IST), AIDS e gravidez, além de conhecer a compreensão sobre o papel da escola na educação sexual. Método: estudo qualitativo, descritivo, desenvolvido por meio de entrevista semiestruturada e formulário para caracterização dos participantes, com 22 adolescentes entre 16 e 19 anos de idade, estudantes do Ensino Médio em uma escola pública. Os dados foram submetidos à análise de conteúdo. Resultados: da análise emergiram quatro categorias temáticas: Sexualidade e educação sexual; Compreensão de comportamentos de risco; Conhecimento de IST/AIDS; Conhecimento e práticas de prevenção. Considerações finais: revelou-se a necessidade de ações educativas de prevenção para os adolescentes, pois a falta de informações contribui para a sua vulnerabilidade. Os adolescentes reconhecem a importância da educação sexual; consequentemente, é importante a implementação de estratégias de promoção e de proteção à saúde no ambiente escolar para contribuir e fortalecer o autocuidado na saúde.

[HLA alleles association and recurrent spontaneous abortion in a Sao Luis/Maranhao population, in Brazilian Northeastern region].

PURPOSE To investigate the association of the HLA-A, -B and -DRB1 alleles with the occurrence of Recurrent Spontaneous Abortion. METHODS A case-control study of 200 women aged 18 to 35 years, consisting of a convenience sample of 100 women who had idiopathic recurrent spontaneous abortion and 100 women without abortion and with two or more children. Peripheral blood genomic DNA was extracted from 500l of Buffy Coat stored at -20°C. HLA typing was performed by the PCR-SSOP method (Polymerase Chain Reaction - Specific Sequence of Oligonucleotides Probes, One Lambda(r), CA, USA). The regions of the amplified DNA were exon 2 and 3 for the A and B loci and only exon 3 for the DRB1 locus. The HLA FUSIONTM program (One Lambda, Canoga Park, CA, USA, version 3.0) was used for HLA-A, HLA-B and HLA-DRB1 genotyping. Absolute frequencies and percentages and calculation of mean and standard deviation were used for standard statistical analysis. The qualitative variables were compared by the χ2 test with Yates correction or by Fishers exact test. The odds ratio with the 95%CI was used for the comparisons, with the level of significance set at p<0.05. RESULTS The frequency of the A*34 allele was significantly higher in the case group compared to control (4.0 versus 0.5%; p<0.05). Alleles A*24 (6.0 versus 12.5%; p<0.05) and B*35 (8.0 versus 20.5%; p<0.05) were significantly less frequent in the case group. Among the class II alleles, DRB1*03 showed a slightly higher frequency in the case group (11.0 versus 5.5%, p = 0.056). CONCLUSIONS It was shown that the HLA-A*34 allele is a risk factor for recurrent spontaneous abortion, while the HLA-A*24 and HLA-B*35 alleles are associated with protection, and no allele of the DRB1 locus was associated with RSA.