Diversity of biting midges Culicoides (Diptera: Ceratopogonidae), potential vectors of disease, in different environments in an Amazonian rural settlement, Brazil

Abstract INTRODUCTION: The Culicoides transmit a variety of pathogens. Our aim was to survey the Culicoides species occurring in an Amazonian rural settlement, comparing abundance, richness, and diversity in different environments. METHODS: Culicoides were captured using CDC light traps. The Shannon-Wiener (H') and Rényi indices were used to compare species diversity and evenness between environments, the equitability (J') index was used to calculate the uniformity of distribution among species, and similarity was estimated using the Jaccard similarity index. A permutational multivariate analysis of variance was applied to assess the influence of environment on species composition. A non-metric dimensional scale was used to represent the diversity profiles of each environment in a multidimensional space. RESULTS: 6.078 Culicoides were captured, representing 84 species (45 valid species/39 morphotypes). H' values showed the following gradient: forest > capoeira > peridomicile > forest edge. The equitability J' was greater in capoeira and forests compared to peridomiciles and the forest edge. The population compositions of each environment differed statistically, but rarefaction estimates indicate that environments of the same type possessed similar levels of richness. Species of medical and veterinary importance were found primarily in peridomiciles: C. paraensis, vector of Oropouche virus; C. insignis and C. pusillus, vectors of Bluetongue virus; C. filariferus, C. flavivenula, C. foxi, and C. ignacioi, found carrying Leishmania DNA. CONCLUSIONS: This study indicates that diversity was higher in natural environments than in anthropized environments, while abundance and richness were highest in the most anthropized environment. These findings suggest that strictly wild Culicoides can adapt to anthropized environments.

Genomic and phylogenetic characterisation of an imported case of SARS-CoV-2 in Amazonas State, Brazil

A new coronavirus [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] is currently causing a life-threatening pandemic. In this study, we report the complete genome sequencing and genetic characterisation of a SARS-CoV-2 detected in Manaus, Amazonas, Brazil, and the protocol we designed to generate high-quality SARS-CoV-2 full genome data. The isolate was obtained from an asymptomatic carrier returning from Madrid, Spain. Nucleotide sequence analysis showed a total of nine mutations in comparison with the original human case in Wuhan, China, and support this case as belonging to the recently proposed lineage A.2. Phylogeographic analysis further confirmed the likely European origin of this case. To our knowledge, this is the first SARS-CoV-2 genome obtained from the North Brazilian Region. We believe that the information generated in this study may contribute to the ongoing efforts toward the SARS-CoV-2 emergence.

Infecção puerperal / Puerperal infection

Em 1992, a Organização Mundial da Saúde (OMS) propôs a seguinte definição: Sepse puerperal é uma infecção do trato genital ocorrendo, em qualquer momento, entre a ruptura das membranas ou o trabalho e o 42º dia após o parto, no qual estão presentes dois ou mais dos seguintes eventos: • Dor pélvica; • Febre (temperatura oral de 38,5 °C ou superior em qualquer ocasião); • Corrimento vaginal anormal, por exemplo, presença de pus; • Cheiro anormal/mau cheiro do corrimento vaginal; • Atraso na redução do tamanho do útero (<2 cm/dia durante os primeiros oito dias). 1. O conceito de infecção puerperal deve ser complementado com o de morbidade febril puerperal, pela dificuldade de caracterizar a infecção que ocorre logo após o parto. 2. Outras definições que se fazem necessárias são: • Bacteremia: presença de bactérias na corrente sanguínea; • Sepse: síndrome clínica caracterizada pela resposta da hospedeira a um processo infeccioso, acompanhada de uma resposta inflamatória sistêmica; • Sepse grave: sepse associada à disfunção de um ou mais órgãos (sistema nervoso central, renal, pulmonar, hepática, cardíaca, coagulopatia, acidose metabólica); • Choque séptico: sepse com hipotensão refratária à ressuscitação volêmica. 3. A OMS incluiu o termo "infecção puerperal", pois hoje estão morrendo mulheres com infecções de outros locais do corpo.

Avaliação de cloradores simplificados por difusão para descontaminação de água de poços em assentamento rural na Amazônia, Brasil / Evaluation of simple diffusion chlorinators for decontamination of wells in a rural settlement in Amazonia, Brazil

Resumo Apesar da região amazônica abrigar a maior reserva de água doce do planeta, a falta de saneamento e de tratamento de água, sobretudo na zona rural, causa problemas ambientais e de saúde. Em assentamentos rurais isolados, o abastecimento geralmente é feito por poços rasos (cacimbões) e a qualidade da água é uma preocupação dos moradores. Nestes casos, as opções de tratamento de água são restritas. O objetivo deste estudo foi avaliar o uso de cloradores simplificados por difusão como método alternativo de tratamento de água. Foram realizadas análises bacteriológicas de 100 amostras de água dos poços, antes e após a aplicação dos cloradores, no Assentamento Rural do Rio Pardo, Presidente Figueiredo (AM). As fontes analisadas foram consideradas inadequadas para consumo sem tratamento prévio, e o uso dos cloradores zerou a contaminação por coliformes termotolerantes, na grande maioria dos casos. Além disso, o método teve boa receptividade pelos moradores por não conferir sabor à água de consumo, por ter relativo baixo custo e ser de fácil manuseio. Discutimos as vantagens e as limitações do uso deste método de tratamento para esse contexto socioambiental e apresentamos sugestões de melhoria e adaptação para a aplicação desta metodologia em outros assentamentos.

Abstract While the Amazon region has the world’s largest reserve of fresh water, the lack of water services and water treatment, especially in non-urban regions, causes environmental and health problems. In isolated rural settlements supply is usually by shallow wells, and the quality of water is a concern for residents. These are situations where there are restricted options for water treatment. This study aimed to assess the use of simplified diffusion chlorinators as an alternative water treatment method. Bacteriological analyses were made of 100 samples of water from the wells, before and after application of the chlorinators, in the Rural Settlement of Rio Pardo, Presidente Figueiredo in the Brazilian State of Amazonas. The sources that were analyzed were considered inappropriate for consumption without prior treatment, and the use of the chlorinators eliminated all contamination by thermotolerant coliforms in the great majority of cases. Also, the method was well received by residents, because it does not leave a taste in the water, is relatively low-cost and handling is easy. We discuss the advantages and limitations of the use of this method of treatment for this social-environmental context and present suggestions for improvement and adaptation, for application of this methodology in other settlements.

Outstanding insecurities concerning the use of an Ov16-based ELISA in the Amazonia onchocerciasis focus

In a recent issue of Memórias do Instituto Oswaldo Cruz, published in Rio de Janeiro in February 2014 (109: 87-92), Adami et al. have published a survey reporting Mansonella parasite prevalence in the Amazon Region. This report makes a useful contribution to the existing knowledge of filarial parasite distribution within the Amazon area, parasite prevalence rates in relation to age and occupation and provides observations on the possible clinical impact of Mansonella ozzardi. Their publication also provides an account of what appears to be a novel ELISA that has recently been used in the Simuliidae and Onchocerciasis Laboratory of the Oswaldo Cruz Institute, Rio de Janeiro, Brazil. We are concerned that the publication of this ELISA may have created an excessively positive impression of the effectiveness of the onchocerciasis recrudescence serological surveillance tools that are presently available for use in the Amazonia onchocerciasis focus. In this letter we have, thus, sought to highlight some of the limitations of this ELISA and suggest how continuing insecurities concerning the detection of antibodies to Onchocerca volvulus within the Amazonia onchocerciasis focus might be minimised.

Declining prevalence of hepatitis A virus antibodies among children from low socioeconomic groups reinforces the need for the implementation of hepatitis A vaccination in Brazil

Age-related seroprevalence studies that have been conducted in Brazil have indicated a transition from a high to a medium endemicity of hepatitis A virus (HAV) infection in the population. However, most of these studies have focused on urban populations that experience lower incidence rates of HAV infection. In the current study, the prevalence of anti-HAV antibodies was investigated in children with a low socioeconomic status (SES) that live on the periphery of three capital cities in Brazil. A total of 1,162 dried blood spot samples were collected from individuals whose ages ranged from one-18 years and tested for anti-HAV antibodies. A large number of children under five years old (74.1-90%) were identified to be susceptible to HAV infection. The anti-HAV antibody prevalence reached ≥ 50% among those that were 10-14 years of age or older. The anti-HAV prevalence rates observed were characteristics of regions with intermediate level of hepatitis A endemicity. These data indicated that a large proportion of children with a low SES that live at the periphery of urban cities might be at risk of contracting an HAV infection. The hepatitis A vaccine that is currently offered in Brazil is only available for high-risk groups or at private clinics and is unaffordable for individuals with a lower SES. The results from this study suggest that the hepatitis A vaccine should be included in the Brazilian National Program for Immunisation.

Prêmio gestão com qualidade: contribuição para melhoria da prática gerencial / Management with quality award: contribution to improved management practice

Esse artigo teve por objetivo relatar a experiência do processo de construção e implementação do Prêmio Gestão com Qualidade, idealizado pelo Conselho Regional de Enfermagem de São Paulo no período de 2008/2011, tendo por finalidade evidenciar desempenhos de mérito de responsáveis técnicos de instituições hospitalares a partir de iniciativas capazes de qualificar práticas em constante mobilização. Trata-se de um relato de experiência, incluindo as etapas de elaboração das diretrizes que nortearam o processo seletivo, os resultados dessa dinâmica, culminando na premiação dos profissionais e instituições selecionados. Concluindo, cabe reconhecer o êxito da iniciativa, motivo pelo qual retrataremos os caminhos percorridos pela equipe técnica na viabilização do projeto.

Nested PCR to detect and distinguish the sympatric filarial species Onchocerca volvulus, Mansonella ozzardi and Mansonella perstans in the Amazon Region

We present filaria-nested polymerase chain reaction (PCR), which is based on amplification of first internal transcribed spacer rDNA to distinguish three parasitic filarial species (Onchocerca volvulus, Mansonella ozzardiand Mansonella perstans) that can be found in the Amazon Region. Nested PCR-based identifications yielded the same results as those utilizing morphological characters. Nested PCR is highly sensitive and specific and it detects low-level infections in both humans and vectors. No cross-amplifications were observed with various other blood parasites and no false-positive results were obtained with the nested PCR. The method works efficiently with whole-blood, blood-spot and skin biopsy samples. Our method may thus be suitable for assessing the efficacy of filaria control programmes in Amazonia by recording parasite infections in both the human host and the vector. By specifically differentiating the major sympatric species of filaria, this technique could also enhance epidemiological research in the region.

A ligadura das artérias uterinas e ovarianas no manejo do sangramento pós-parto / Management of postpartum hemorrhage by ligature of the uterine and ovarian arteries

O sangramento pós-parto é causa importante de mortalidade materna no Brasil e no restante do mundo. A sua prevenção inclui o manejo ativo do terceiro período do parto. O tratamento medicamentoso mediante o uso de ocitocina, prostaglandinas e metilergonovina é a primeira escolha, sendo eficaz na maioria das vezes. Nos raros casos em que haja necessidade cirúrgica deve-se preservar o futuro reprodutivo. Existem várias técnicas cirúrgicas que mantêm a fertilidade. No Brasil, as principais escolas preconizam o uso da histerectomia puerperal como resolução dos casos de sangramento pós-parto. Os autores relatam um caso de sangramento pós-cesariana, que foi controlado com a ligadura das artérias uterinas e ovarianas. Descrevem e ilustram essa técnica de execução simples e com poucas complicações, tendo como objetivo divulgar a técnica entre os obstetras brasileiros.

Postpartum hemorrhage is a major cause of maternal mortality in Brazil and the world over. Its prevention includes active management of the third stage of childbirth. Drug treatment through the use of oxytocin, prostaglandin, and methylergonovin is the first choice and is effective in most cases. In the rare cases in which surgery is needed the reproductive future should be preserved. There are many surgical techniques which maintain fertility. In Brazil, the main schools recommend the use of puerperal hysterectomy for management of the cases of postpartum bleeding. The authors report a case of post-caesarian bleeding, which was controlled by ligation of the uterine and ovarian arteries. They describe and illustrate this technique of simple execution and few complications, in order to publicize this technique among Brazilian obstetricians.

Seasonal dynamics of Aedes aegypti (Diptera: Culicidae) in the northernmost state of Brazil: a likely port-of-entry for dengue virus 4

Roraima is the northernmost state of Brazil, bordering both Venezuela and Guyana. Appropriate climate and vector conditions for dengue transmission together with its proximity to countries where all four dengue serotypes circulate make this state, particularly the capital Boa Vista, strategically important for dengue surveillance in Brazil. Nonetheless, few studies have addressed the population dynamics of Aedes aegypti in Boa Vista. In this study, we report temporal and spatial variations in Ae. aegypti population density using ovitraps in two highly populated neighbourhoods; Centro and Tancredo Neves. In three out of six surveys, Ae. aegypti was present in more than 80 percent of the sites visited. High presence levels of this mosquito suggest ubiquitous human exposure to the vector, at least during part of the year. The highest infestation rates occurred during the peak of the rainy seasons, but a large presence was also observed during the early dry season (although with more variation among years). Spatial distribution of positive houses changed from a sparse and local pattern to a very dense pattern during the dry-wet season transition. These results suggest that the risk of dengue transmission and the potential for the new serotype invasions are high for most of the year.

Infecção natural por tripanosomatídeos (Kinetoplastida: Trypanosomatidae) em Lutzomyia umbratilis (Diptera: Psychodidae) em áreas de leishmaniose tegumentar americana no Amazonas, Brasil / Natural infection rate of Lutzomyia umbratilis (Diptera: Psychodidae) by trypanosomatids (Kinetoplastida: Trypanosomatidae) in endemic areas of American Tegumentary Leishmaniasis in the Amazonas State, Brazil

Durante o período de 2002 a 2003 foram realizadas coletas de flebotomíneos em duas áreas do estado do Amazonas (Base de treinamento militar - BI1 e Tarumã Mirim). Nessas coletas foram capturadas um total de 1.440 fêmeas de Lutzomyia (Nyssomyia) umbratilis. Lu.umbratilis é a principal responsável pela transmissão da Leishmaniose Tegumentar Americana (LTA) ao norte do Rio Amazonas. Do total coletado apenas 15 espécimens (ou 1,04 por cento) apresentaram infecção natural por tripanosomatídeos, sendo 12 na BI1 e 3 em Tarumã-Mirim. Isso representou uma taxa de infecção de 1,66 por cento (12 dos 720 capturados em BI1) e 0,42 por cento (3 dos 720 em Tarumã-Mirim). Estes resultados confirmam as informações prévias por outros autores de reduzidos valores de infecção natural por tripanosomatídeos em flebotomíneos, mesmo em áreas altamente endêmicas para leishmaniose.

During the period of 2002 to 2003, there were collected sand flies in two areas of Amazon State (Forest Combat Training Base - BI1 and Tarumã-Mirim). Were collected the 1440 L. (Nyssomyia) umbratilis female. Lu. umbratilis is the main responsible for the transmission of American Tegumentary Leishmaniasis (ATL) in the northern of Amazon River. Only 15 specimens (or 1,04 percent) presented natural infection with trypanosomatids, being 12 at Bl1 and 3 at Tarumã-Mirim. The infection rate was 1,66 percent (12 of the 720 collected at BI1) and 0,42 percent (3 of the 720 at Tarumã-Mirim). These results confirm the previous informations described by other authors that insects have low rates of natural infection by trypanosomatids even in high endemic areas for Leishmaniasis.

Distribution of dengue vectors in neighborhoods with different urbanization types of Manaus, state of Amazonas, Brazil

Aedes aegypti and Ae. albopictus are vectors of dengue viruses, which cause endemic disease in the city of Manaus, capital of the state of Amazonas, Brazil. More than 53 thousand cases have been registered in this city since the first epidemic in 1998. We evaluated the hypothesis that different ecological conditions result in different patterns of vector infestation in Manaus, by measuring the infestation level in four neighborhoods with different urbanization patterns, during the rainy (April), dry (August), and transitional (November) seasons. Ae. aegypti predominated throughout the study areas and sampling periods, representing 86 percent of all specimens collected in oviposition traps. High frequencies of houses positive for both species were observed in all studied sites, with Ae. aegypti present in more than 84 percent of the houses in all seasons. Ae. albopictus, on the other hand, showed more spatial and temporal variation in abundance. We found no association between infestation level and house traits. This study highlights the homogeneity of dengue vector distribution in Manaus.

Cytotaxonomy of Simulium cauchense Floch & Abonnenc and Simulium quadrifidum Lutz (Diptera: Simuliidae) in Brazilian Amazonia

Simulium cauchense Floch & Abonnenc and Simulium quadrifidum Lutz are widely distributed in the Amazon region and are morphologically similar at the larval and pupal stages. Chromosomally, these species are readily distinguished by the position of the nucleolar organizer, which is in the short arm of chromosome I in S. cauchense and in the long arm of chromosomes III in S. quadrifidum. They also differ by three fixed inversions. Sex chromosomes are undifferentiated in both species. Chromosomal resolution of the two species allowed us to evaluate four structural features previously used as diagnostic aids at the larval stage. Characters that distinguish larvae of the two species are the number of branches and branching patterns of the dorsal abdominal setae and the dark band on each primary fan. Branching patterns of the gill histoblasts were often diagnostic, with S. quadrifidum exhibiting more proximal branching and S. cauchense more distal branching. Sites where both species occurred sometimes had larvae with one petiole branching proximally and the other distally; in these cases examination of the chromosomes permitted assignment of the specimen to species. Pigmentation patterns of larvae, on the other hand, are highly variable. Color typically is sex linked in both species.

Description of Simulium damascenoi (Diptera: Simuliidae) male and the black-fly species from the State of Amapá, Brazil

Five species are included in the Simulium siolii group, which is placed in the subgenus Psaroniocompsa (Diptera: Simuliidae). Of these five species, only two (Simulium siolii Py-Daniel and Simulium tergospinosum Hamada) have been described in all their life stages, except eggs. Knowledge of the taxonomic characters of all life stages of a species is important in order to clarify interspecific and higher-level taxonomic relationships. The objectives of the present study are to describe the male of Simulium damascenoi Py-Daniel, to provide a list of black-fly species their bionomics and distributions in the state of Amapá, Brazil, and to provide an identification key for larvae and pupae for these species

A avaliaçäo da importância da estética bucal na seleçäo de funcionários, em estabelecimentos comerciais da cidade de Niterói - RJ / Evaluation of the importance of oral esthetics in the selection of employees

Com o objetivo de avaliar a importância da estética bucal na inserçäo no mercado de trabalho, aplicou-se um questionário a gerentes ou responsáveis por contrataçäo em dois grupos de estabelecimentos comerciais de Niterói - RJ: Grupo A - Plaza Shopping; Grupo B - Barcas Shopping, Shopping José Carreteiro e lojas próximas a esses dois últimos "shoppings". O questionário abordou os seguintes aspectos: prioridade para a boa aparência no processo de seleçäo de funcionários; importância da estética bucal na aparência do candidato; razöes para a importância dessa avaliaçäo e sua validade para todos os casos de contrataçäo; oferta de assistência odontológica pelo estabelecimento contratante; possibilidade de contrataçäo de candidato com comprometimento em sua estética bucal; normalidade da perda de elementos dentários por cárie. Concluiu-se que: 1) a boa aparência foi um aspecto levado em consideraçäo no processo de seleçäo de funcionários; 2) a estética bucal está fortemente relacionada à boa aparência do candidato a um emprego; 3) a razäo preponderantemente apontada para a importância da avaliaçäo da estética bucal foi o fato de a mesma estar associada a boa higiene; 4) a avaliaçäo da estética bucal na boa aparência do candidato foi considerada importante para todos os casos de seleçäo de funcionários, sendo tal avaliaçäo significativamente mais freqüente no Grupo A do que no Grupo B; 5) há o predomínio da näo-oferta de qualquer forma de assistência odontológica, por parte dos estabelecimentos comerciais contratantes, a seus funcionários; 6) funcionários com a estética bucal comprometida näo seriam contratados; e 7) a perda dentária por cárie näo foi considerada normal

Educação continuada: estudo descritivo de instituições hospitalares / Continued Education - Descriptive Study of Hospital Institutions

O presente artigo demonstra dados parciais extraídos da dissertação de mestrado onde se realizou um levantamento da situação dos serviços de educação continuada nas instituições vinculadas à Sociedade Brasileira de Educação Continuada em Enfermagem - SOBRECen, tendo como base a proposta de Silva et al (1989), através de sua obra Educação Continuada - estratégia para o desenvolvimento do pessoal de enfermagem, tendo como objetivo: descrever as atividades desenvolvidas nos serviços de educação continuada do município de São Paulo, e oferecer dados atualizados para o desenvolvimento de pesquisas na área de Educação Continuada. Foram pesquisados 22 hospitais do município de São Paulo, durante o 2§ semestre de 1998, entrevistando-se os enfermeiros responsáveis pelo setor de educação continuada, coletando-se dados sobre as estratégias de recrutamento, seleção, treinamento, aperfeiçoamento e avaliação de desempenho, implantadas atualmente nas instituições. Evidenciou-se, a partir dos resultados, a necessidade de revisão de alguns processos em sua operacionalização, porém quanto aos objetivos, finalidades e áreas de atuação, constatamos que os dados obtidos estão em consonância com a proposta de Silva et al (1989)

Parâmetros utilizados na avaliaçäo do sêmen congelado ovino para inseminaçäo laparoscópica / Parameters to evaluate ovine frozen semen for laparoscopic insemination

Com a finalidade de verificar o valor de alguns atributos para avaliaçäo da qualidade do sêmen congelado, através da prenhez, duzentas e noventa e sete ovelhas da raça Corriedale foram inseminadas, intra-uterinamente, por laparoscopia. Utilizou-se cio sincronizado, com pessários vaginais contendo 50 mg de MAP (acetato de medroxiprogesterona), por 12 dias, e 400 UI de eCG (Equine chorionic gonadotrophin) no 12§ dia. O sêmen, proveniente de 32 carneiros, foi congelado em pellets. Para a inseminaçäo, utilizaram-se amostras de sêmen com diferentes padröes de qualidade preestabelecida, de motilidade progressiva (MP) ao descongelamento, média da MP durante todo o período de incubaçäo (0, 1, 2, 3, 4 e 5 horas), a 37§C, MP após cinco horas de incubaçäo e percentagem de células, morfologicamente, íntegras. O diagnóstico de gestaçäo foi realizado por ecografia 40 dias após a inseminaçäo. Obtiveram-se percentuais de prenhez entre 60 e 80 por cento somente quando as amostras apresentaram um movimento progressivo superior a 40 por cento (68,0 por cento), uma MP média e após 5 horas de incubaçäo mínima de 20 por cento (64,4 e 72,3por cento) e uma MP às 5 horas de incubaçäo quando superior a 10 por cento (61,1 e 78,5 por cento). Com relaçäo ao percentual de células íntegras, as amostras com um mínimo de 40 por cento proporcionaram prenhez de 61,7 e 66,4 por cento, enquanto nas com menos de 40 por cento o percentual foi de apenas 15,2 por cento. Os parâmetros estudados demonstraram eficiência para estimar a capacidade fecundante do sêmen congelado para utilizaçäo em inseminaçäo laparoscópica

Simian malaria at two sites in the Brazilian Amazon - II. Vertical distribution and frequency of anophline species inside and outside the forest

An anopheline survey was carried out in two simian areas in the Brazilian Amazon, Balbina and Samuel, to determine the potencial vectors of Plasmodium brasilianum. The most abundant and/or acrodendrophilic anophelines in the forest and the most likely vector were Anopheles mediopunctatus, An. nuneztovari, An. oswaldoi, An. triannulatus and An. shannoni. An. darlingi and An. marajoara were captured essentially in anthropic habitats outside the forest and are unlikely to be involved in the transmission of P. brasilianum among monkeys within the forest and from monkeys to man in their surroundings in the Amazon.

Gestaçäo em mulheres com mais de 40 anos / Pregnancy in women with more than 40 years

Realizou-se um estudo retrospectivo pela análise de 62 prontuários de gestantes com mais de 40 anos que deram a luz no período de janeiro de 1982 a dezembro de 1984, comparando seus achados com os da literatura