Respiratory and functional tests in the assessment and prognosis of patients with chagas disease

Chagas disease causes an important impact on cardiorespiratory system, functional and working capacity of the patient. Performing a functional assessment on these individuals becomes essential, since the impact of physical limitation is an important factor that is related with other life domains, such as risk of cardiovascular events in a brief period and risk of death. The goal of this work was to perform a literature review to present the evaluative and prognostic value of main valid respiratory and functional tests in patients with Chagas disease, as well as their applicability and reproducibility. A literature search was performed from 1981 to 2020 in Scielo, Pubmed/Medline, Science Direct, Scopus and Web of Science databases. Only complete studies published in English, Portuguese or Spanish were analyzed which specifically discussed the respiratory and functional tests used in patients with Chagas disease. In total, 544 articles were retrieved of which 35 were eligible. The main functional tests approached were Cardiopulmonary Exercise Testing, Incremental Exercise Testing and Six-Minute Walk Test. Several studies show themselves as useful markers for predicting quality of life, mortality and functional impairment, in addition to other patients' characteristics. Several tests can be used to assess the respiratory and functional impact to patients' health, as well as its relationship with important domains of their lives

Indicadores entomológicos de triatomíneos no Estado do Rio Grande do Norte, Brasil / Entomological triatomine indicators in the State of Rio Grande do Norte, Brazil

Resumo Objetivou-se descrever os principais indicadores entomológicos relacionados aos triatomíneos na mesorregião Oeste do Rio Grande do Norte. Trata-se de estudo descritivo, transversal e retrospectivo, desenvolvido com base em análise histórica de informações sobre a captura de triatomíneos realizada pelo Programa de Controle de doença de Chagas, no período de 2008 a 2013. Foram capturadas cinco espécies, das quais se destacaram a Triatoma brasiliensis e a Triatoma pseudomaculata, pela ocupação do ambiente domiciliar e peridomiciliar, sequencialmente, e a Panstrongylus lutzi, pelo maior índice de infecção natural. Observou-se prevalência de ninfas dentre os exemplares capturados, maior densidade triatomínica no peridomicílio, índices de infestação, colonização e infecção natural de 5,6%, 49,6% e 0,8%, respectivamente, diferença significativa na distribuição de espécimes entre os municípios investigados e ausência de declínio dos índices de infestação e colonização entre os anos de 2009 e 2012. Os achados sugerem a necessidade de vigilância contínua, possibilitada pela associação entre as equipes de campo e as comunidades, com ênfase na proposta de educação em saúde para o reconhecimento e notificação dos triatomíneos pela população.

Abstract This study aimed to describe the main entomological triatomine-related indicators in the western mesoregion of Rio Grande do Norte. This is a descriptive cross-sectional retrospective study developed on a historical analysis of information on the triatomine capture carried out by the Chagas Disease Control Program, from 2008 to 2013. Five species were captured, of which the Triatoma brasiliensis and Triatoma pseudomaculata, by occupying the domestic and peridomestic environment, sequentially, and Panstrongylus lutzi by the highest rate of natural infection. A prevalence of nymphs among the captured specimens, a higher triatominal density in the peridomicile, infestation, colonization and natural infection rates of 5.6%, 49.6% and 0.8%, respectively, a significant difference in the distribution of specimens between the municipalities investigated and lack of declining infestation and colonization rates between 2009 and 2012 was observed. Findings suggest the need for continuous surveillance, facilitated by the association between field teams and communities, with emphasis on the proposal of health education for the recognition and notification of triatomines by the population.

Expression of bradykinin in human placenta from healthy and preeclamptic women / Expressão de bradicinina em placentas humanas saudáveis e pré-eclâmpticas

This study evaluated the expression of bradykinin (BK) in human placenta from healthy and preeclamptic women. This is a non -randomized experimental study, in which we performed histological analysis of placental tissue to observe changes that occur in each kind of placenta as well as immunohistochemical analysis to investigate the expression of bradykinin. We used 'Paleontological Statistics software package for education and data analysis' 3.06 and R for the statistical analysis. The Ethics Committee of the University of Rio Grande do Norte State approved this experiment under protocol number 166370, according to the determinations established by Resolutions 466/12 and 441/11.We found differences between the two kinds of placenta concerning the diameter of the vessels and the rate of cytotrophoblastic invasion. Student's t- test evidenced significant difference (p = 7.6395 x 10-5) indicating greater marking of BK per section in the healthy placenta group. The result of more significant expression of bradykinin in healthy placenta can be used as a starting point for deeper researches aiming to better characterize and quantify this expression.

Este estudo avaliou a expressão de bradicinina em placentas humanas saudáveis e pré-eclâmpticas. Trata -se de um estudo de caráter experimental não randomizado, no qual foi feita uma análise histológica dos tecidos placentários, permitindo a observação das alterações ocorridas em cada tipo de placenta, e a técnica de imuno-histoquímica, a fim de investigar a presença de bradicinina. Foi utilizado o Paleontological Statistics software package for education and data analysis 3.06 para a análise estatística. Este estudo foi aprovado pelo Comitê de Ética da Universidade do Estado do Rio Grande do Norte sob o protocolo número 166.370, de acordo com as diretrizes estabelecidas nas Resoluções 466/12 e 441/11. Foi possível observar diferenças no diâmetro dos vasos e na invasão citotrofoblástica entre os dois tipos de placentas. O teste t de Student mostrou significância estatística (p = 7,6395 x 10-5) para uma maior marcação de BK por secção no grupo de placentas saudáveis. O resultado obtido com relação à expressão mais significante de bradicinina em placentas saudáveis pode ser visto como precursor de uma pesquisa mais aprofundada, para melhor caracterizar e quantificar essa expressão.

Characterization of Enzymatic profiles of Aedes aegypti strains from the State of Rio Grande do Norte, Brazil / Caracterização de perfis enzimáticos de cepas do Aedes aegypti do Estado do Rio Grande do Norte, Brasil

Abstract This study was conducted in four strains of Aedes aegypti mosquitoes to evaluate the enzymatic activity profiles in the city of Mossoró, Rio Grande do Norte, and correlate them with biochemical mechanisms of resistance to insecticides. Mosquitos were used to quantify the following detoxification enzymes: Mixed-Function Oxidase (MFO), PNPA-esterase (PNPA-EST), and Acetylcholinesterase (AChE). The profiles were compared statistically with profiles from the Rockefeller strain, through the Kruskal-Wallis test and Dunn's multiple comparisons (p < 0.05). The 99 percentile of the values of enzyme activity from the reference strain was calculated for each enzyme, and the percentage of individuals above the 99 percentile was quantified. The enzyme activities were classified as “Unchanged” (< 15%), “Identified change” (> 15% and < 50%), and “Substantially changed” (> 50%). The statistical analysis revealed significant differences in the MFO and AChE profiles, which are fundamental in the determination of profiles of resistance to insecticides. Three populations were classified as “Substantially changed” for MFO. The altered enzymatic activity showed that the changes could have an important role in exposing resistance to insecticides.

Resumo Este estudo foi realizado em quatro cepas de mosquitos Aedes aegypti da cidade de Mossoró, Rio Grande do Norte, com o intuito de avaliar os perfis de atividade enzimática e correlacioná-los com os mecanismos bioquímicos de resistência a inseticidas. Mosquitos foram utilizados para quantificar as seguintes enzimas de detoxificação: oxidase de Função Mista (MFO), PNPA-esterase (PNPA-EST) e acetilcolinesterase (AChE). Os perfis das populações foram comparados estatisticamente com os da cepa Rockefeller por meio do teste de Kruskal-Wallis e do de comparações múltiplas de Dunn (p < 0,05). O percentil 99 dos valores de atividade enzimática da cepa referência foi calculado para cada enzima, e o percentual de indivíduos acima desse valor foi quantificado. As atividades enzimáticas foram classificadas como “Inalterada” (< 15%), “Alteração Identificada” (> 15% e < 50%), e “Substancialmente Alterada” (> 50%). A análise estatística revelou diferenças significativas nos perfis de MFO e AChE, que são fundamentais na determinação de perfis de resistência a inseticidas. Três populações foram classificadas como “Substancialmente Alteradas” para MFO. Os níveis alterados de atividade enzimática demonstram que essa mudança pode desempenhar um importante papel na resistência a inseticidas.

Chagas disease: morbidity profile in an endemic area of Northeastern Brazil

Abstract: INTRODUCTION : This study evaluated the clinical forms and manifestation severities of Chagas disease among serologically reactive individuals from Western Rio Grande do Norte (Northeastern Brazil). METHODS : This cross-sectional study included 186 adults who were evaluated using electrocardiography, echocardiography, chest radiography, and contrast radiography of the esophagus and colon. A clinical-epidemiological questionnaire was also used. RESULTS : The indeterminate, cardiac, digestive, and cardiodigestive clinical forms of Chagas disease were diagnosed in 51.6% (96/186), 32.2% (60/186), 8.1% (15/186) and 8.1% (15/186) of the participants, respectively. Heart failure (functional classes I-IV) was detected in 7.5% (14/186) of the participants, and 36.4% (24/66), 30.3% (20/66), 15.2% (10/66), 13.6% (9/66), and 4.5% (3/66) of the patients were at stage A, B1, B2, C, and D, respectively. Dilated cardiomyopathy and electrocardiographic changes were detected in 10.2% (19/186) and 48.1% (91/186) of the participants, respectively. Apical aneurysm was diagnosed in 10.8% (20/186) of the participants, and other changes in the segmental myocardial contractility of the left ventricle were diagnosed in 33.9% (63/186) of the participants. Megaesophagus (groups I-IV) was observed in 7% (13/186) of the participants, megacolon (grades 1-3) was detected in12.9% (24/186) of the participants, and both organs were affected in 29.2% (7/24) of the megacolon cases. CONCLUSIONS : We detected various clinical forms of Chagas disease (including the digestive form). Our findings indicate that clinical symptoms alone may not be sufficient to exclude or confirm cardiac and/or digestive damage, and the number of patients with symptomatic clinical forms may be underestimated.

Spatial distribution of dengue disease in municipality of Mossoro, Rio Grande do Norte, using the Geographic Information System / Distribuicao espacial da dengue no municipio de Mossoro, Rio Grande do Norte, utilizando o Sistema de Informacao Geografica

The dengue viral infection is one of the most relevant vector-borne diseases in the world. The disease can manifest in a variety of forms, from asymptomatic to a condition of dengue hemorrhagic fever (DHF). The last reported cases in Brazil correspond to 80% of the cases reported in the Americas, which emphasizes the magnitude of the problem. This study was conducted using Geographic Information System (GIS) techniques, in order to evaluate the spatial distribution of the disease in the urban area of Mossoró, Rio Grande do Norte. In the period between 2001 and 2007, 867 new cases were listed. About 85.7% of the addresses were georeferenced, with a larger number of cases, 14.8%, in the neighborhoods of Santo Antônio and Santa Delmira (north region), and 11.7% in the neighborhoods of Conjunto Vingt-Rosado and Alto de São Manoel (east region). There were 18 confirmed cases of dengue hemorrhagic fever associated with regions with the highest incidence of classic cases of the disease. The use of Geographic Information System (GIS) proved a great benefit for better visualization of the endemic, especially in elucidating the actual distribution of dengue cases in the county and providing an effective tool for planning the monitoring of the disease at a local level.

A infecção viral pelo dengue compreende uma das doenças de transmissão vetorial mais importante do mundo. A doença pode apresentar uma manifestação variada, desde uma forma assintomática até quadros de Febre do Dengue Hemorrágico (FDH). Os últimos casos reportados no Brasil correspondem a 80% dos casos notificados nas Américas, o que enfatiza a magnitude do problema. Este estudo foi realizado utilizando técnicas de geoprocessamento, com o objetivo de avaliar a distribuição espacial da doença na zona urbana do município de Mossoró, Rio Grande do Norte. Foram arrolados 867 casos novos da doença no período de 2001 - 2007. Foram georrefenciados 85,7% dos endereços, apresentando um maior número de casos nos bairros do Santo Antônio e Santa Delmira (zona norte), com 14,8%, Conjunto Vingt-Rosado e Alto de São Manoel (zona leste), com 11,7%. Foram confirmados 18 casos de FHD associados às regiões com maior incidência de casos clássicos da doença. O uso do SIG revelou um grande benefício pela melhor visualização da endemia, sobretudo elucidando a distribuição real dos casos de dengue no município e propiciando um instrumento eficaz para o planejamento da vigilância em nível local.

Prevalência da deficiência da glicose-6-fosfato desidrogenase em doadores de sangue de Mossoró, Rio Grande do Norte / Prevalence of glucose-6-phosphate dehydrogenase deficiency in blood donors of Mossoró, Rio Grande do Norte

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzymopathy. It affects as many as 330 million individuals worldwide. This deficiency may determine neonatal jaundice, chronic nonspherocytic hemolytic anemia and acute hemolytic anemia induced by drugs, infections and broad bean ingestion. The efficacy of blood transfusion is decreased when the donor is G6PD deficient. In this study, we aimed at determining the prevalence of G6PD deficiency in blood donors of Mossoro, Brazil. Samples of 714 blood donors (576 men and 138 women; 343 white and 371 non-white) with ages ranging from 18 to 62 years and that accepted to participate in the study were analyzed. All participants answered a standard questionnaire. G6PD activity was analyzed by the methemoglobin reduction test with deficiency being confirmed by the semiquantitative test. The overall prevalence of G6PD deficiency in blood donors was 3.8 percent, similar to the rate described for others regions of Brazil. There was no significant statistical difference in the frequency of G6PD deficiency between men and women, nor between white and non-white blood donors. This relatively high frequency of G6PD deficiency highlights a need to screen blood donors for this condition.

Comparative study between the effects of hyaluronic acid and acid galactan purified from eggs of the mollusk Pomacea sp in wound healing

PURPOSE: To compare the effect of hyaluronic acid (HA) and of AG on the healing of intestine wounds. METHODS: The semi-purified extract of the eggs of the mollusc was obtained by fractionation with ammonium sulfate and purification for ion-exchange chromatography. The obtained galactans were eluted in water (neutral galactan) and in 0.1 and 0.2M NaCl (acidic galactans). The in vivo study was performed with 45 "Wistar" rats, separated in three groups (n=15). Solutions containing HA 1 percent, GA 1 percent or saline solution 0,9 percent, was placed topically on the sutures of wounds in the small intestine of the rats. After 05, 10 and 21 days the animals were sacrificed and biopsy of the healing tissue was done. RESULTS: The hystologic grading was more significant for HA and AG groups when compared to the group C. AG stimulated the appearance of macrophages, giant cells and increase in the concentration of collagen in the area of the wound when compared to HA. CONCLUSION: The topical use of GA in intestinal wounds promoted the anticipation of events that are important in the wound healing.