American visceral leishmaniasis in a state of northeastern Brazil: clinical, epidemiological and laboratory aspects

Abstract In Brazil, American visceral leishmaniasis (AVL) has become a public health concern due to its high incidence and lethality. This study aimed to analyze the clinical, epidemiological, and laboratory aspects of AVL in a state of Brazil. This descriptive, cross-sectional, retrospective, and quantitative study of notified cases of AVL was carried out in Alagoas between 2008 and 2017 from data obtained from DATASUS/SINAN. Sociodemographic, clinical, and laboratory variables were analyzed. A descriptive analysis was performed using absolute values and valid percentages, using tables and/or graphs. Data processing was performed using Stata 12.0®. Results with P 0.05 were considered statistically significant. During the study period, 352 cases of AVL were reported, of which 6.82% died and 38.92% had met a cure criterion. Male patients were predominant (66.76%). Of the total infected patients, 16.76% had attended only the 1st to the 4th grades, with those most affected aged 1 to 4 years (28.69%). Laboratory diagnostic criteria were most commonly used to confirm the notified cases (76.42%), whereas 51.70% and 8.52% of the cases had positive parasitological and immunofluorescence diagnoses, respectively. Finally, the study showed a higher prevalence of the disease in children, men and in rural residents. Although with low lethality, the expressive frequency of AVL in the State of Alagoas was still verified, since there was an increase in the number of cases during the years of the study.

Resumo No Brasil, a leishmaniose visceral americana (LVA) tornou-se uma preocupação de saúde pública devido à sua alta incidência e letalidade. Este estudo teve como objetivo analisar os aspectos clínicos, epidemiológicos e laboratoriais da AVL em um estado brasileiro. Este estudo descritivo, transversal, retrospectivo e quantitativo dos casos notificados de AVL foi realizado em Alagoas entre 2008 e 2017 a partir de dados obtidos do DATASUS/SINAN. Foram analisadas variáveis sociodemográficas, clínicas e laboratoriais. Foi realizada uma análise descritiva utilizando-se valores absolutos e percentuais válidos, utilizando tabelas e/ou gráficos. O processamento dos dados foi realizado por meio do Stata 12.0®. Os resultados com P 0,05 foram considerados estatisticamente significativos. Durante o período de estudo, foram notificados 352 casos de LVA, dos quais 6,82% morreram e 38,92% atenderam a um critério de cura. Os pacientes do sexo masculino foram predominantes (66,76%). Do total de pacientes infectados, 16,76% tinham sido atendidos apenas do 1º ao 4º ano, com os mais afetados entre 1 e 4 anos (28,69%). Os critérios de diagnóstico laboratorial foram mais utilizados para confirmar os casos notificados (76,42%), enquanto 51,70% e 8,52% dos casos apresentaram diagnósticos positivos parasitológicos e imunofluorescência, respectivamente. Por fim, o estudo demonstrou maior prevalência da doença em crianças, homens e nos residentes em zona rural. Embora com letalidade baixa, constatou-se ainda a expressiva frequência da LVA no Estado de Alagoas, uma vez que houve aumento do número de casos durante os anos do estudo.

American visceral leishmaniasis in a state of northeastern Brazil: clinical, epidemiological and laboratory aspects / Leishmaniose visceral americana em estado do nordeste brasileiro: aspectos clínicos, epidemiológicos e laboratoriais

In Brazil, American visceral leishmaniasis (AVL) has become a public health concern due to its high incidence and lethality. This study aimed to analyze the clinical, epidemiological, and laboratory aspects of AVL in a state of Brazil. This descriptive, cross-sectional, retrospective, and quantitative study of notified cases of AVL was carried out in Alagoas between 2008 and 2017 from data obtained from DATASUS/SINAN. Sociodemographic, clinical, and laboratory variables were analyzed. A descriptive analysis was performed using absolute values and valid percentages, using tables and/or graphs. Data processing was performed using Stata 12.0®. Results with P <0.05 were considered statistically significant. During the study period, 352 cases of AVL were reported, of which 6.82% died and 38.92% had met a cure criterion. Male patients were predominant (66.76%). Of the total infected patients, 16.76% had attended only the 1st to the 4th grades, with those most affected aged 1 to 4 years (28.69%). Laboratory diagnostic criteria were most commonly used to confirm the notified cases (76.42%), whereas 51.70% and 8.52% of the cases had positive parasitological and immunofluorescence diagnoses, respectively. Finally, the study showed a higher prevalence of the disease in children, men and in rural residents. Although with low lethality, the expressive frequency of AVL in the State of Alagoas was still verified, since there was an increase in the number of cases during the years of the study.

No Brasil, a leishmaniose visceral americana (LVA) tornou-se uma preocupação de saúde pública devido à sua alta incidência e letalidade. Este estudo teve como objetivo analisar os aspectos clínicos, epidemiológicos e laboratoriais da AVL em um estado brasileiro. Este estudo descritivo, transversal, retrospectivo e quantitativo dos casos notificados de AVL foi realizado em Alagoas entre 2008 e 2017 a partir de dados obtidos do DATASUS/SINAN. Foram analisadas variáveis sociodemográficas, clínicas e laboratoriais. Foi realizada uma análise descritiva utilizando-se valores absolutos e percentuais válidos, utilizando tabelas e/ou gráficos. O processamento dos dados foi realizado por meio do Stata 12.0®. Os resultados com P<0,05 foram considerados estatisticamente significativos. Durante o período de estudo, foram notificados 352 casos de LVA, dos quais 6,82% morreram e 38,92% atenderam a um critério de cura. Os pacientes do sexo masculino foram predominantes (66,76%). Do total de pacientes infectados, 16,76% tinham sido atendidos apenas do 1º ao 4º ano, com os mais afetados entre 1 e 4 anos (28,69%). Os critérios de diagnóstico laboratorial foram mais utilizados para confirmar os casos notificados (76,42%), enquanto 51,70% e 8,52% dos casos apresentaram diagnósticos positivos parasitológicos e imunofluorescência, respectivamente. Por fim, o estudo demonstrou maior prevalência da doença em crianças, homens e nos residentes em zona rural. Embora com letalidade baixa, constatou-se ainda a expressiva frequência da LVA no Estado de Alagoas, uma vez que houve aumento do número de casos durante os anos do estudo.

La píldora anticonceptiva a debate / The contraceptive pill submitted for debate

El propósito de este trabajo es hacer una revisión sobre los riesgos y beneficios de la píldora anticonceptiva y la necesidad de informar desde las consultas de enfermeras/os y de matronas con base en la evidencia científica. Desde su comercialización en los años 60, se ha publicado una gran cantidad de información sobre los riesgos de la píldora , tanto en el ámbito científico como en los medios de comunicación social y sin embargo, los beneficios han sido poco difundidos. La píldora combinada es uno de los métodos anticonceptivos reversibles con mayor eficacia para evitar el embarazo. Se asocia a un aumento de riesgo de tromboembolismo venoso y presenta efectos beneficiosos no anticonceptivos relacionados con la menstruación, la fertilidad, la masa ósea, el acné, y reduce el riesgo de cáncer de ovario y de endometrio. Los profesionales de enfermería, al igual que el resto de profesionales del equipo de salud, deben abordar el derecho a la información de la población basada en datos científicos y deben implicarse en funciones de orientación en planificación familiar para mejorar la salud materno-infantil, promoviendo los embarazos deseados y que el derecho a tener el número de hijos e intervalo entre ellos sea respetado.

The objective of this research is to reflect on the risks and benefits of the contraceptive pill and the need for women to be informed by qualified health care providers including nurse midwives and nurse practitioners based on scientific evidence. Since its commercialization in the 60's, a lot of information has been published about the risks of the pill by both scientists and the social media and yet the benefits have been little known. The combined pill is one of the most effective reversible methods of preventing pregnancy. It is associated with increased risk factors for venous thromboembolism and it has non-contraceptive benefits not related to menstruation, fertility, bone mass, acne, and it reduces the risk of ovarian and endometrial cancer. Nursing professionals, like all other health care team professionals should address the right to inform the population based on scientific data as well as get involved in family planning counseling to improve maternal and child health, promoting unintended pregnancies and the right to decide the number of children and the time interval be respected.

Prevalência de atraso do desenvolvimento neuropsicomotor em pré-escolares / Prevalence of neuropsychomotor development delay in preschool children

O desenvolvimento infantil é um processo de mudanças relacionado com a idade e influenciado pelo ambiente em que a criança vive. Desta maneira, o objetivo é verificar o a prevalência de atraso do desenvolvimento neuropsicomotor (DNPM) em pré-escolares. Procedimentos: tratou-se de um estudo transversal analítico realizado em três abrigos e uma escola particular da Zona Leste de São Paulo-SP, na qual participaram 81 crianças. Aplicou-se um questionário aos responsáveis pelas crianças participantes e para avaliar o desenvolvimento neuropsicomotor das crianças foi utilizado o Teste Denver II. Os resultados revelaram a prevalência de atraso no DNPM em crianças institucionalizadas (31,6 por cento), p=0,06. A linguagem foi a área mais freqüentemente afetada nas crianças com suspeita de atraso. Em relação ao suporte familiar e condições ambientais não houve diferenças estatisticamente significantes nas crianças institucionalizadas. Verificou-se que os resultados não significativos talvez sejam conseqüência da relação de apego que as crianças institucionalizadas adquirem entre si e da convivência com um maior número de crianças. Conclusão: o presente estudo não encontrou diferenças estatisticamente significativas no desenvolvimento neuropsicomotor de crianças institucionalizadas e não-institucionalizadas, porém houve maior prevalência de suspeita de atraso nas crianças institucionalizadas

Bisphosphonate treatment for type III osteogenesis imperfecta in Lady Ridgeway Hospital, Colombo, Sri Lanka.

Objective: To ascertain clinical outcome following cyclical intravenous pamidronate therapy in a group of infants and young children with type III osteogenesis imperfecta (OI). Design, setting and method: A prospective observational study was carried out on infants and young children referred to Ward 9 Lady Ridgeway Hospital (LRH) for assessment and treatment of OI from January 2005 to February 2007. All were treated with cyclical high dose intravenous pamidronate. Data collected included clinical history, treatment history, dose and frequency of treatment, adverse effects of the drug and outcome of treatment. Results: Thirteen patients with clinical presentations compatible with type III OI were referred to Ward 9 LRH during the study period. Ten had fractures during fetal life and three presented with fractures during infancy. Age at commencement of the drug varied from 3 weeks to 42 months (median 10 months). The patients were followed up for periods ranging from 3 to 24 months. Four out of the 13 patients developed new fractures during follow up. Conclusion: Intravenous high dose cyclical pamidronate is a useful form of therapy to prevent recurrent fractures in infants and young children with type III OI.

Desenvolvimento neuropsicomotor de crianças institucionalizadas da zona leste da cidade de São Paulo / Neuropsychomotor development of children institutionalized in the east zone of São Paulo city

Verificar a prevalência do atraso no desenvolvimento neuropsicomotor em crianças de 0 a 4 anos de creches particulares e publicas e a eventual relação entre atraso no desenvolvimento neuropsicomotor e aspectos sócio-econômicos dessas crianças foi o objetivo deste estudo transversal analítico, realizado em quatro instituições (duas particulares e duas publicas) da Zona Leste da cidade de São Paulo. Participaram da pesquisa 158 crianças, cujos responsaveis preencheram questionário composto de perguntas especificas relacionadas ao ambiente escolar. estrutura familiar, alimentação, nascimento e saúde da criança. Para avaliar o desenvolvimento neuropsicomotor das crianças foi aplicado o Teste de Denver II. Quanto ao desenvolvimento neuropsicomotor, 10,7 por cento (n=17) apresentaram suspeita de atraso (p = 0,34), e as mais novas de¬las apresentaram maior índice de suspeita de atraso no desenvolvimento neuropsicomotor (p = 0,02), havendo prevalência significativa dos meninos (p = 0,021), nos quais a área da linguagem foi a mais afetada. A prevalência de suspeita de atraso foi duas vezes maior nas creches publicas do que nas particulares. Não houve significância estatística na prevalência de suspeita de atraso no desenvolvimento neuropsicomotor das crianças avaliadas de creches particulares e publicas e na relação entre aspecto sócio-econômico e suspeita de atraso.

The prevalence of delay in neuropsychomotor development in 0 to 4-year-old institucionalized childen and eventual association between delayed neuropsychomotor development and social-economic aspects were analyzed in this cross analytical study carried out in four (two private and two public) educational institutions in East Zone of Sao Paulo city. The sample was composed by 158 children, whose parents or persons answering for them filled a questionary with specific questions about school environment, family structure, feeding, birth and child health. Denver 11 Test was applied for evaluation of the neuropsychomotor development. Results showed suspected delay in 10.7 per cent (p = 0.34), especially in the younger children (p = 0.02); higher prevalence was observed among boys (p = 0.021), in which the language wasthe most affected area. The prevalence of suspected delay in children following public day-care center was twice the observed in private center. There wasn't significant differences in prevalence of children with suspected neuropsychomotor development delay when compared private and public day-care centers. and there wasn't evident association between social and economic aspects and suspected neuropsychomotor development delay.

Effect of thyroparathyroidectomy on urinary acidification in diabetic rats

In previous studies we have shown stimulation of renal acid excretion in the proximal tubules of rats with diabetes of short duration, with no important alterations in glomerular hemodynamics; on the other hand, in thyroparathyroidectomized rats (TPTX model), a significant decrease in renal acid excretion, glomerular filtration rate (GFR) and renal plasma flow (RPF) was detected. Since important changes in the parathyroid hormone-vitamin D-Ca axis are observed in the diabetic state, the present study was undertaken to investigate the renal repercussions of thyroparathyroidectomy in rats previously made diabetic by streptozotocin (45 mg/kg). Four to 6 days after the induction of diabetes (DM), a group of rats were thyroparathyroidectomized (DM + TPTX). Renal functional parameters were evaluated by measuring the inulin and sodium para-aminohippurate clearance on the tenth day. The decrease in the GFR and RPF observed in TPTX was not reversed by diabetes since the same alterations were observed in DM + TPTX. Net acid (NA) excretion was unchanged in DM (6.19 ± 0.54), decreased in TPTX (3.76 ± 0.25) and returned to normal levels in DM + TPTX (5.54 ± 0.72) when compared to the control group (6.34 ± 0.14 µmol min-1 kg-1). The results suggest that PTH plays an important vasodilator role regarding glomerular hemodynamics, since in its absence the impairment in GFR and RPF was not reversed by the diabetic state. However, with respect to acid excretion, the presence of diabetes was able to overcome the negative stimulus represented by TPTX

Transplante renal en niños: estudio analitico de 25 casos / Renal transplantation: analysis of 25 cases

Se analiza un grupo de 25 pacientes sometidos a trasplante renal, con una edad media de 11=3 años, 9 niñas y 16 varones. Se utilizaron 22 injertos de dador vivo y 3 de cadaver. El peso corporal era menor de 25 kg. En el 60 por ciento de la poblacion y todos tenian deficit pondoestatural. Las uropatias (12/25) y las glomerulopatias (9/25), fueron las enfermedades de base mas frecuentes que llevaron a estos pacientes a la insuficiencia renal. La tasa de mortalidad fue del 12 por ciento (3 casos). Las complicaciones postoperatorias y la tasa de mortalidad fueron mayores para los injertos cadavericos, pero sin significancia estadistica por el numero de casos. Los reimplantes ureterales se realizaron con tecnica de Politano-Leadbetter en 22 y con tecnica de Gregoire en 3. Las complicaciones precoces mas frecuentes fueron la discracia sanguinea (4/25) y el rechazo agudo (5/25). Las tardias fueron la infeccion urinaria (4/25) y el rechazo cronico (3/25). Catorce injertos presentan un clearence > de 80 ml/min y 2 entre 40-45 ml/min. La sobrevida actuarial del injerto fue de 64 por ciento, siendo el rechazo la principal causa de fracaso. Cuatro pacientes tenian reconstrucciones del tracto urinario a traves de un reservorio continente y mecanismo de cateterismo limpio por la tecnica de Mitrofanoff. Se concluye que el trasplante renal es una opcion terapeutica para niños con enfermedades renales, que tiene baja mortalidad y complicaciones locales del facil manejo

Rinosporidiose nasal na infância / Nasal rinosporidiosis in children

A rinosporidiose é uma doença fúngica rara, causada pelo Rhinosporidium seeberi, de contágio por inalaçäo de poeira (esterco de gado infectado) ou inoculaçäo de orifícios corporais pelo contato com água contaminada. Acomete cavidade nasal (mais comum), olhos, nasofaringe, uretra, conduto auditivo externo. Tem curso clínico lento e, como manifestaçöes nasais, obstruçäo, epistaxe, rinorréia, presença de massa tumoral polipóide friável, lobulada, indolor, geralmente de implantaçäo septal. Caracteriza-se histologicamente por cistos globulares contendo endosporos ("sporangia"), recoberto por agrupamentos de eosinófilos, em meio a reaçäo granulomatosa. O tratamento é cirúrgico (com recorrência em 10 por cento dos casos) e medicamentoso, utilizando diamino-difenil-sulfona ou anfotericina para evitar-se recidivas. Apresentamos um caso de rinosporidiose em criança de 10 anos, sexo feminino, com quadro de obstruçäo nasal e epistaxe à esquerda há 3 meses com tumoraçäo em fossa nasal esquerda, submetida à terapêutica cirúrgica

Characterization of a phospholipase C-resistant inositol containing glycolipid from Trypanosoma cruzi

Since glycosylphosphatidylinositol is the most common form of attachment of proteins to membranes in T. cruzi, and that this parasite depends on surface-mediated interactions for survival within the vector and mammalian host, it is probable that a drug which interfers with the metabolism of glycosylphosphatidylinositol (GPI) could be successfully employed in chemotherapy. Over the last few years several groups have been characterizing this mode of attachment in T. cruzi and more recently we have been concentrating our efforts on the identification of candidate precursors for protein anchors in metacyclic trypomastigotes. Previously detected GPI heterogeneity regarding solubilization of a major stage-specific antigen (1G7-Ag) by phospholipase C led us to investigate whether biosynthetic precursors with similar properties could also be identified. Two glycolipid species whose migration properties resemble glycolipids A and C of T. brucei were amenable to biosynthetic radiolabelling with palmitic acid, inositol, ethanolamine, glucosamine and mannose. Following purification, these species were submitted to classical GPI diagnostic treatments. In both cases digestion with GPI-specific phospholipase D (GPIPLD) produced phosphatidic acid and treatment with either mild base or phospholipase A2 (PLA2) produced free fatty acid, indicating an acylation at least at position 2 of the glycerol. The glycolipid A-like species proved to be susceptible to solubilization by PIPLC of B. thuriengiensis and by GPIPLC of T. brucei and the glycolipid C-like material proved to be fully resistant to both lipases. Although the glycolipid A-like species indeed presents these and other properties compatible with a precursor for the chemically characterized 1G7-Ag anchor, the PLC-resistant species which is completely insensitive to nitrous acid deamination might be an exception to the general finding of a non-acetylated glucosamine in the GPI moieties so far described

Further characterization of the acidic GPI-hydrolyzing phospholipase present in human sera

A phospholipase from human serum capable of hydrolyzing glycosylphosphatidylinositol membrane anchors was described and partially characterized by our group some years ago. This activity presented a pH optimum between 5.0 and 6.0 and was inhibited by EDTA, EGTA and 1,10-phenanthroline. Partial purification showed that the enzyme was a glycoprotein with an apparent molecular weight of 140 kDa as judged by gel filtration. Other investigators characterized at the same time a phospholipase D with similar properties but with a pH optimum near 7.5. We now confirm that the human serum enzyme is indeed a phospholipase D capable of hydrolyzing mfVSG and glycolipids A and C from T. brucei. Isoelectric focusing of whole sera suggests the presence of two isoforms, one with a pI of 4.7 which was the form previously purified by our group, and others with pI from 6.2 to 7.4