Chagas Disease in the Western Brazilian Amazon: Epidemiological Overview from 2007 to 2018 / Doença de Chagas na Amazônia Ocidental Brasileira: panorama epidemiológico no período de 2007 a 2018

INTRODUCTION: Chagas disease (CD) is a disease caused by the protozoan flagellates of the Kinetoplastid order Trypanosoma cruzi. Approximately 8,000,000 people are infected worldwide, mainly in Latin America, causing disabilities and more than 10,000 deaths per year OBJECTIVE: This study aimed to describe the epidemiological panorama of CD in the Western Brazilian Amazon from 2007 to 2018. METHODS: In this ecological study, secondary data regarding the confirmed cases of T. cruzi infection in the states of Acre, Amazonas, Rondônia, and Roraima were collected from the Single Health System Notification Information System of the Department of Informatics of the Single Health System and were analyzed. The data were used to characterize the epidemiological profile of T. cruzi infection and to determine the frequency of infection in Western Amazonia. RESULTS: A total of 184 cases of CD were reported in Western Amazonia, and the highest number of cases was reported in the states of Amazonas and Acre. CONCLUSION: The epidemiological panorama of the Western Brazilian Amazon from 2007 to 2018 includes a greater number of cases of T. cruzi infection in men aged 20-39 years and those living in rural areas. Oral transmission was prevalent in the region during the study, and the highest number of cases was reported in the months of April and December. Epidemiological data are an important resource for understanding the dynamics of CD and the main aspects related to the health-disease process.

INTRODUÇÃO: A doença de Chagas (DC) é uma enfermidade causada pelo protozoário flagelado da ordem Kinetoplastida denominado Trypanosoma cruzi. Estima-se que oito milhões de pessoas estejam infectadas em todo o mundo, principalmente na América Latina, causando incapacidades e mais de dez mil mortes por ano. OBJETIVO: Descrever o panorama epidemiológico da doença de Chagas na Amazônia Ocidental brasileira no período de 2007 a 2018. MÉTODO: Trata-se de um estudo ecológico e com coleta e análise de dados referentes aos casos confirmados de infecção por T. cruzi nos estados do Acre, Amazonas, Rondônia e Roraima, por meio de fontes secundárias oriundos do Sistema de Informação de Agravos de Notificação do Sistema Único de Saúde (SINAN) do Departamento de Informática do Sistema Único de Saúde (DATASUS). Os dados foram utilizados para caracterizar o perfil epidemiológico dos infectados por T. cruzi e determinar a frequência da infecção na Amazônia Ocidental RESULTADOS: Houve a notificação de 184 casos de doença de Chagas na Amazônia Ocidental com mais registros nos estados do Amazonas e Acre. CONCLUSÃO: O panorama epidemiológico da Amazônia Ocidental Brasileira no período de 2007 a 2018, compreende uma maior quantidade de casos em indivíduos do sexo masculino, na faixa etária dos 20-39 anos, e provenientes de zona rural. A forma de contágio prevalente na região durante o estudo foi a oral e a maior sazonalidade compreendeu os meses de abril e dezembro. Dados epidemiológicos são um importante recurso para a compreensão da dinâmica da DC e os principais aspectos relacionados no processo saúde-doença.

Tetanus in horses: an overview of 70 cases / Tétano em equinos: um panorama de 70 casos

Tetanus is characterized by high case fatality rates in horses. Comprehensive case series studies involving equine tetanus from different geographic areas enable the evaluation of prognosis, efficacy of treatment, and control measures. We retrospectively investigated some selected epidemiological data (breed, age, gender, use of the horses, history of vaccination, seasonality, presence of wound/history of surgical procedures, clinical outcomes) and main clinical aspects (clinical signs, incubation period, length of hospitalization, and period between onset signs and hospitalization) in 70 cases of equine tetanus over 1990-2015, with emphasis in the association between these data and the clinical outcomes. High mortality rate (72.9%) was observed in this study. Forty (57.1%) horses presented history of wounds or surgical procedures related with tetanus, represented mainly by lesions in the hind limbs (42.5%), front limbs (15.0%), umbilical infections (7.1%), castration (4.3%), and face wounds (4.3%). Hyperesthesia, limb spasticity, cervical stiffness, tetanic spasms, and restriction of jaw movement were the main consistent clinical signs. Besides no statistical association, all the horses with umbilical infections, wounds in face, prolonged recumbency, sweating, dysphagia/aphagia died, and together with delay between onset of first clinical signs and prompt veterinary assistance (< 5 days) were considered indicative of poor prognosis; whereas there was a significant association (p=0.001) between survival and length of hospitalization > 7 days, seemed as an evidence of good prognosis. The high mortality rate of tetanus, even in horses under specific treatment, highlight the need for early diagnosis, prompt veterinary assistance, and establishment of prophylatic measures in equine farms.(AU)

Tétano é caracterizado por elevada mortalidade em equinos. Estudos envolvendo séries de casos da doença provenientes de diferentes áreas geográficas possibilitam avaliar o prognóstico, eficácia do tratamento e ações de controle. Foram avaliados, retrospectivamente, os principais achados epidemiológicos (raça, idade, sexo, uso dos equinos, história de vacinação, sazonalidade, presença de lesões/histórico de procedimentos cirúrgicos e evolução dos casos) e aspectos clínicos (sinais clínicos, período de incubação, tempo de hospitalização e período entre início dos sinais e hospitalização) em 70 casos de tétano em equinos atendidos entre 1990 e 2015, com ênfase na associação entre os dados clínico-epidemiológicos e a evolução dos casos (mortalidade). Foi observada alta mortalidade (72,9%) nos equinos. Do total de equinos, 57,1% apresentavam lesões ou histórico de procedimentos cirúrgicos relacionados com tétano, representados principalmente por lesões em membros posteriores (42,5%), membros anteriores (15,0%), infecções umbilicais (7,1%), castração (4,3%) e lesões de face (4,3%). Hiperestesia, espasticidade dos membros, rigidez de pescoço, espasmos tetânicos e restrição aos movimentos de mandíbula foram os principais sinais clínicos observados. Apesar da ausência de significância estatística, todos os animais com presença de infecções umbilicais, lesões na face, decúbito prolongado, sudorese e disfagia/afagia evoluíram para óbito e, associado ao início dos sinais clínicos e a demora no atendimento (< 5 dias), foram considerados indicativos de prognóstico reservado. Em contraste, foi observada associação significante (p=0,001) entre a sobrevivência dos animais e o tempo de hospitalização maior que 7 dias, considerado uma indicação de bom prognóstico. A elevada mortalidade do tétano, mesmo em equinos tratados, enfatiza a necessidade do diagnóstico precoce, do rápido atendimento veterinário e adoção de medidas profiláticas nos criatórios.(AU)

Gastrointestinal Helminth Infections in HIV Seropositive and Seronegative Patients in Dschang, Cameroon.

Background: Helminth infections are widely spread around the world and constitute a major public health problem. They present one of the most common parasitic infections worldwide with a greater proportion occurring in the less developed areas of the world like Sub-Saharan Africa. This area has the highest regional prevalence of Human Immunodeficiency Virus (HIV) in the world. Due to the overlapping geographical distribution of these infections, coinfection between helminths and HIV are likely to be common. Little has been reported on the relationship between HIV status and the presence of these parasites in Dschang. Aim: This study was undertaken to determine and compare prevalence and intensity of helminth infections between Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome (HIV/AIDS) infected (seropositives) or non infected (seronegatives) patients. Methods: Patients were recruited using the registration number at their arrival in the District and Saint Vincent de Paul hospitals of Dschang. For each subject, stool and blood samples were collected. Qualitative and quantitative analysis of stool samples were carried out using Willis and McMaster techniques respectively. As for serological analysis of HIV/AIDS, the test was done using DETERMINE HIV1/HIV2 rapid test and IMMUNOCOMB test for confirmation. Results: Five hundred and seventy (570) patients were recruited following inclusion criteria. One hundred and seven (107) were seropositives and four hundred and sixty three (463) seronegatives. The overall prevalence of helminthic infections was 23.11%. Ascaris lumbricoides, Trichuris trichiura, hookworm and Capillaria hepatica were found with respective prevalences of 10.9%, 6.8%, 3.2% and 0.2%. The general prevalences were 10.28% and 20.73% for HIV seropositives and seronegatives respectively. The mean intensities of infection were 182.25±566.12, 130.95±153.79, 91.66±104.67 and 50±0.00 epg for A. lumbricoides, T. trichiura, hookworm and C. hepatica respectively. In seropositives, these values were 50±0.00, 68.75±88.30, 50±0.00 and 0±0.00 epg while in seronegatives; they were 282.41±831.46, 145.59±167.59, 94.11±107.35 and 50±0.00 epg for A. lumbricoides, T. trichiura, hookworm and C. hepatica, respectively. Seropositives were statistically significant (p<0.05) less infected with helminths than seronegatives. Elsewhere, the mean intensities of infection were lower in seropositives than in seronegatives. Conclusion: The prevalence and parasite loads are fewer in seropositives than in seronegatives. Therefore, harboring HIV is not associated with increasing in helminths prevalence.

Epidemiología de las leucemias en Bolivia: 1473 casos enero 1999 a mayo de 2012 / Epidemiology of leukemias in Bolivia: 1473 cases from January 1999 to May 2012

Introducción La leucemia es la neoplasia hematológica más frecuente, su incidencia se ha incrementado en diferentes regiones del mundo. Bolivia está experimentando el fenómeno de la "transición epidemiológica", de una alta incidencia de enfermedades infecciosas a una creciente prevalencia de las enfermedades oncológicas. El presente trabajo describe las características epidemiológicas de las leucemias en Bolivia. Métodos Se analizaron los datos epidemiológicos y resultados de diagnósticos de 1473 muestras de pacientes con leucemia procedentes de diferentes Centros Oncohematológicos de Bolivia, en fechas comprendidas entre enero de 1999 a mayo de 2012. Todas las muestras fueron evaluadas con estudio morfológico e inmunofenotípico. Los diagnósticos de Leucemia Mieloide Crónica y Leucemia Mieloide Aguda M3 fueron confirmados con estudios biomoleculares. Resultados Los pacientes fueron divididos en dos grupos: Se consideraron pacientes pediátricos a menores de 18 años y pacientes adultos a mayores de 18 años y un día. De los 1473 pacientes con leucemia, 896 (61%) fueron niños y 577 (39%) fueron adultos. De los pacientes pediátricos 47% fueron niñas y 53% fueron niños. La distribución según diagnóstico fue la siguiente: Leucemia Linfoblástica Aguda 706 (79%), Leucemia Mieloblástica Aguda 172 (19%) y Leucemia Mieloide Crónica 18 (2%). De los pacientes adultos 43% fueron mujeres y 57% fueron varones. La distribución según diagnóstico fue la siguiente: Leucemia Linfoblástica Aguda 188 (33%), Leucemia Mieloblástica Aguda 176 (30%), Leucemia Linfocítica Crónica 31 (5%) y Leucemia Mieloide Crónica 182 (32%). Conclusión Los resultados obtenidos presentaron características epidemiológicas propias para Bolivia, probablemente por la estructura multiétnica, pluricultural y la expectativa de vida menor en relación a otros países.

Introduction Leukemia is the most common hematological neoplasm, their incidence was increased in different regions of the world. Bolivia is experiencing the phenomenon of "epidemiological transition", from a high incidence of infectious diseases to an increasing prevalence of oncological diseases. This paper describes the epidemiological features of leukemia in Bolivia. Methods Patients were grouped into two groups: The pediatric patients under 18 years and adult patients over 18 years and one day. We studied the diagnostic results and epidemiological data of 1473 samples of leukemia patients from different centers for oncohematologic disease of Bolivia, in dates between January 1999 to May 2012. All the samples were tested with morphologic and immunophenotypical studies. The diagnoses of Chronic Myeloid Leukemia and Acute Promyelocitic Leukemia (AML-M3) were confirmed with biomolecular studies. Results Of 1473 patients with leukemia, 896 (61%) were pediatric patients and 577 (39%) were adults patients. In pediatric patients were 47% girls and 53% were children. The distribution according to the diagnosis was the following: acute lymphoblastic leukemia 706 (79%), acute myeloblastic leukemia 172 (19%) and chronic myeloid leukemia 18 (2%). In adult patients 43% were women and 57% were male. The Distribution according to the diagnosis was the following: acute lymphoblastic leukemia 188 (33%), acute myeloblastic leukemia 176 (30%), chronic lymphocytic leukemia 31 (5%) and chronic myeloid leukemia 182 (32%). Conclusion The results obtained showed different epidemiological characteristics, probably due to the structure multiethnic, multicultural and lower life expectancy in relation to other countries.

Implementation of Medical Diagnostic System Based on Epidemiological Data / 대한의료정보학회지

OBJECTIVE: We implemented automatic online medical consultation software. It infers disease of patients with knowledge about symptoms and the epidemiologic data. And we compared its performance of inference with that of human doctors. METHODS: This software accepts information about users' age, sex, and symptoms, lists up diseases compatible with these information, and sorts diseases by probability. We implement this software with Ruby and C. RESULTS: We compared diseases listed up by this software with those that by two human doctors, and found that 1) 90% of confirmed diagnoses was included in the list this software inferred, and 2) more than 50% of diseases in the list this software inferred are same diseases as ones both of two human doctors inferred. CONCLUSION: This software can not determine final diagnosis. But this software lists up probable diseases only by interview. Then we believe this software will be useful for patients when they want to check themselves before consulting their doctor. We believe that this software will be useful for patients to check their health status.

TB & Tobacco.

One third of the world population is infected with tuberculosis, and over 8 millions people were developing each year. On the other hand tobacco is responsible for 3 millions death in the world. For Indonesia, our country has the third biggest TB cases in the world. Whereas Indonesia is ranked as having the fourth largest number of smokers in the world. A relationship between smoking and TB has been suspected for a long time, even though the epidemiological evidence has not been convincing so far, as well as the pathophysiology and the biomolecullar changes. At present time there are more and more epidemiological data to suggest relationship between TB and tobacco. Further research should be done to get more indepth relationship as well as avoiding the confounder factor. To be able to perform TB control as well as tobacco control successfully there should be emphasize on synergistic public health approaches. Tuberculosis –which Indonesia got 3rd rank in the world- as well as smoking problem –which Indonesia got 4th rank in the world- are two important public health problem for the country. If there are relationship between tobacco and tuberculosis, health problem faced by Indonesian even become bigger. Knowledge about tuberculosis as well as tobacco among Indonesian population is very essential to improve the public health situation. Tuberculosis control programme as well as smoking control programme are essential tools for the well being of Indonesian people.