Subclinical signs of podocyte injury associated with Circulating Anodic Antigen (CAA) in Schistosoma mansoni-infected patients in Brazil

ABSTRACT Background: The long-term effects of schistosomiasis on the glomerulus may contribute to the development of chronic kidney disease. This study aimed to investigate baseline Schistosoma mansoni-Circulating Anodic Antigen (CAA) levels and their association with kidney biomarkers related to podocyte injury and inflammation in long-term follow-up after praziquantel (PZQ) treatment. Methods: Schistosoma infection was diagnosed by detecting CAA in urine using a quantitative assay based on lateral flow using luminescent up-converting phosphor reporter particles. A cutoff threshold of 0.1 pg/mL CAA was used to diagnose Schistosoma infection (baseline) in a low-prevalence area in Ceará, Northeast, Brazil. Two groups were included: CAA-positive and CAA-negative individuals, both of which received a single dose of PZQ at baseline. Urinary samples from 55 individuals were evaluated before (baseline) and at 1, 2, and 3 years after PZQ treatment. At all time points, kidney biomarkers were quantified in urine and adjusted for urinary creatinine levels. Results: CAA-positive patients had increased baseline albuminuria and proteinuria and showed greater associations between kidney biomarkers. CAA levels correlated only with Vascular Endothelial Growth Factor (VEGF) (podocyte injury) levels. Increasing trends were observed for malondialdehyde (oxidative stress), monocyte chemoattractant protein-1 (inflammation marker), and VEGF. In the follow-up analysis, no relevant differences were observed in kidney biomarkers between the groups and different periods. Conclusions: S. mansoni-infected individuals presented subclinical signs of glomerular damage that may reflect podocyte injury. However, no causal effect on long-term renal function was observed after PZQ treatment.

Accuracy of the urine point-of-care circulating cathodic antigen assay for diagnosing Schistosomiasis mansoni infection in Brazil: A multicenter study

ABSTRACT Background: The World Health Organization recommends a market-ready, urine-based point-of-care diagnostic test for circulating cathodic antigens (CCA) to determine the prevalence of S. mansoni. This study evaluated the performance of the URINE CCA (SCHISTO) ECO TESTE® (POC-ECO), which is currently available in Brazil. Methods: Residents from eight sites with different prevalence estimates provided one urine sample for POC-ECO and one stool sample for Kato-Katz (KK) and Helmintex® (HTX) testing as an egg-detecting reference for infection status. Results: None of the study sites had significantly higher POC-ECO accuracy than KK. Conclusions: POC-ECO is not currently recommended in Brazilian schistosomiasis elimination programs.

High schistosomiasis-related mortality in Northeast Brazil: trends and spatial patterns

ABSTRACT Background: We analyzed the trends and spatial patterns of schistosomiasis-related mortality in Northeast Brazil in 2000-2019. Methods: A mixed population-based ecological study was conducted, using information on the underlying or associated causes of death. We used Joinpoint regression analysis to calculate the trends. The spatial analysis included rates, spatial moving averages, and standardized mortality rates. The spatial dependence analysis was based on Getis-Ord's G and Gi* indices (Gi star) and local Moran's index to check for autocorrelation. Results: A total of 5,814,268 deaths were recorded, of which 9,276 (0.16%) were schistosomiasis-related; 51.0% (n=4,732, adjusted rate 0.90/100,000 inhabitants [95% confidence interval (CI) 0.88-0.93]) were males; 40.0% (n=3,715, adjusted rate 7.40/100.000 inhabitants [95%CI: 7.16-7.64]) were ≥70 years old; 54.8% (n=5,087, crude rate 0.80/100,000 inhabitants) were of mixed/Pardo-Brazilian ethnicity; and 77.9% (n=7,229, adjusted rate 0.86/100,000 inhabitants [95%CI: 0.84-0.88]) lived outside state capitals. The highest proportion of deaths was in the state of Pernambuco (53.9%, n=4,996, adjusted rate 2.72/100,000 inhabitants [95%CI: 2.64-2.79]). Increasing mortality rate was verified in the state of Sergipe. On the coast of the state of Rio Grande do Norte and Bahia, there was spatial dependence of spatio-temporal risk patterns with clusters. Throughout the study period, we found positive spatial autocorrelation and cluster formation. Conclusions: In Northeast Brazil, schistosomiasis persists with a high mortality rate, especially in the coastal region, with heterogeneous spatial and temporal patterns. To eliminate schistosomiasis by 2030, it is necessary to strengthen the financing and management of the unified health system (SUS).

Reliability of point-of-care circulating cathodic antigen assay for diagnosing schistosomiasis mansoni in urine samples from an endemic area of Brazil after one year of storage at -20 degrees Celsius

ABSTRACT Background The World Health Organization recommends reliable point-of-care (POC) diagnostic testing to eliminate schistosomiasis. Lateral flow immunoassay that detects schistosome circulating cathodic antigen (CCA) in urine to establish prevalence thresholds for intervention in endemic areas is recommended. Stored urine may be useful if surveying at-risk populations is delayed or interrupted by unforeseen circumstances, such as the current COVID-19 pandemic. This study evaluated the manufacturer's claim that Schistosoma mansoni infection can be reliably diagnosed in urine samples stored at -20°C for one year. Methods Two-hundred-forty-two subjects from an endemic site in Brazil provided one urine sample each for testing with URINE CCA (SCHISTO) ECO TESTE® (POC-ECO) and one stool sample each for testing with Kato-Katz (KK) and Helmintex® (HTX) as a robust reference standard for infection status. At least 2 ml of urine from each participant was stored at -20°C; after one year, 76 samples were randomly selected for POC-ECO retesting. Results: The POC-ECO agreement between freshly collected and stored urine was inadequate considering trace results as positive (Cohen's kappa coefficient κ = 0.08) and negative (κ = 0.36). POC-ECO accuracy was not significantly greater than that of routine KK (54%; 95% confidence interval: 42.1%-65.5%). Conclusions The precision and accuracy of POC-ECO have to be optimized in both freshly collected and stored urine before it can be recommended for use in control programs in Brazil.

Epidemiology and predictors of occurrence of SCHISTOSOMA MANSONI infection in a low-endemicity area in northeast Brazil

In Latin America 96% of the cases of schistosomiasis occur in Brazil in low-socioeconomic status populations. The epidemiological characteristics and occurrence predictors of Schistosoma mansoni infection were determined in the Bananeiras community, located in Capistrano, a town in Ceará state, Brazil. Sanitary, environmental, socioeconomic, and behavioral data were collected using a semi-structured questionnaire. An investigation to assess S. mansoni infection was conducted using the Kato-Katz and Point-of-Care Circulating Cathodic Antigen (POC-CCA) methods. From the 258 subjects were analyzed, 54.3% (n=140) were women, median age 30 years. Thirty-three (12.8%) individuals were positive by either egg- and/or CCA-positivity. The highest positivity rate was found in the 30-39 year old group. There was no piped water supply, sewage network or municipal refuse collection service. Most individuals were illiterate or had not finished elementary school (66.3%). About 29.1% of the families had a monthly income below one Brazilian minimum wage and 91.1% reported contact with natural water sources. We found an association between infection and age group of 20-40 years, illiteracy, household with 7 inhabitants or more, household with up to 3 rooms and an outhouse. Contrarily, being 40 years old or older and household with up to 6 inhabitants were not risk factors. Schistosomiasis remains a public health problem in this municipality, evidencing a strong association with low socioeconomic conditions and high vulnerability. These findings reinforce the importance of identifying the factors associated with the infection for more effective guidance in actions in control programs targeting schistosomiasis prevention and control.

Detection of schistosomiasis in an area directly affected by the São Francisco River large-scale water transposition project in the Northeast of Brazil

Abstract INTRODUCTION: The development of the São Francisco River Integration Project [Projeto de Integração do Rio São Francisco (PISF)] in the State of Ceará, Brazil, has resulted in environmental and socioeconomic changes with potential risks to public health. We aimed to determine the presence of Schistosoma mansoni infections in schoolchildren (aged 7-14 years) and workers from the construction site in an area under the direct influence of the PISF in the municipality of Brejo Santo-CE, to aid in the prevention and control of schistosomiasis. METHODS: We conducted a cross-sectional study using two S. mansoni-detection methods: detection of S. mansoni eggs by the Kato-Katz parasitological method in stool samples (assessed in triplicate for each sample) and S. mansoni circulating cathodic antigen by the point-of-care immunochromatographic rapid test (POC-CCA) in urine. RESULTS In general, the positivity rates for S. mansoni detection were 1.9% (2/106) among schoolchildren and 2.9% (4/138) among workers. No child had evidence of S. mansoni eggs in their stools; 1.9% tested positive by the POC-CCA method. Among workers, two (1.4%) tested positive by the Kato-Katz test and three (2.2%) by the POC-CCA test. If the POC-CCA test results that were scored as traces were considered negative, then the positivity rates dropped to 0.9% and 0.7% for schoolchildren and workers, respectively. CONCLUSIONS: The active transmission of schistosomiasis in a region covered by the PISF was recognized, reinforcing the necessity to consolidate surveillance and control actions, as well as structural sanitation measures to reverse the social determinants of the disease.

Evolução eletrocardiográfica e sorológica de pacientes com doença de Chagas crônica acompanhados por seis anos após o tratamento com benzonidazol / Electrocardiographic and serological evolution of patients with chronic Chagas disease followed-up for six years after treatment with benzonidazole

Introdução: O tratamento com benzonidazol na fase crônica da doença de Chagas ainda permanece controverso. O presente estudo objetiva avaliar a efetividade da quimioterapia com benzonidazol em pacientes chagásicos crônicos por meio de análises sorológica e eletrocardiográfica. Método: Estudo prospectivo histórico, com acompanhamento eletrocardiográfico e sorológico pelos métodos imunoenzimático (ELISA) e de imunofluorescência indireta uma vez por ano, antes e após o tratamento, entre 2005 e 2011. No perfil sociodemográfico dos 30 pacientes acompanhados o predomínio era do sexo masculino, faixa etária entre 25-64 anos, com primeiro grau incompleto e em sua maioria agricultores. Resultados: A análise sorológica por ELISA demonstrou queda significativa da densidade óptica das amostras coletadas antes (2005) e após o tratamento com benzonidazol (2011). Em relação à imunofluorescência indireta, os pacientes se mantiveram inalterados durante o acompanhamento (variação de no máximo uma diluição entre as amostras basal e final). Na avaliação eletrocardiográfica, 76,2% (16/21) dos pacientes apresentaram manutenção dos laudos eletrocardiográficos ao longo do estudo. Conclusão: Foram observadas regressões nas análises sorológicas dos pacientes tratados com benzonidazol, acompanhados por 6 anos, além da manutenção dos padrões eletrocardiográficos iniciais na maioria dos casos, o que pode sugerir um efeito benéfico do fármaco no tratamento desses pacientes na fase crônica da doença de Chagas.

Background: Treatment with benzonidazole in the chronic phase of Chagas disease remains controversial. This study is aimed at evaluating the effectiveness of chemotherapy with benzonidazole in chronic Chagas disease using serological and electrocardiographic analysis. Method: Historical prospective study with electrocardiographic and serological monitoring by enzyme immunoassay (ELISA) and indirect immunofluorescence once a year, before and after the treatment, from 2005 to 2011. In the socio-demographic profile of the 30 patients followed-up, there was a prevalence of males, ages ranged between 25-64 years, incomplete school education and most of them farmers. Results: ELISA serology showed a significant decrease in the optical density of the samples collected before (2005) and after treatment with benzonidazole (2011). Indirect immunofluorescence demonstrated patients remained unchanged during follow-up (maximum variation of one dilution between the baseline sample and 2011). In the electrocardiographic assessment, 76.2% (16/21) of the patients maintained their electrocardiographic reports throughout the study. Conclusion: Patients treated with benzonidazole and followed-up for 6 years presented a regression in serological analysis and maintenance of their baseline ECG patterns in most cases, which may suggest a beneficial effect of the drug in the chronic treatment of Chagas disease.

HIV and dementia: prevalence and risk factors / HIV e demência: prevalência e fatores de risco / VIH y demencia: prevalencia y factores de riesgo

Objective: To determine the prevalence of patients at risk of developing HIV-associated neurocognitive disorder (HAND) and identify factors possibly associated with its occurence. Methods: Quantitative cross-sectional study conducted at the Specialized Care Service (Serviço de Atendimento Especializado - SAE) for HIV/Aids of the Integrated Medical Care Center (Núcleo de Atendimento Médico Integrado - NAMI) of the University of Fortaleza (Universidade de Fortaleza - UNIFOR), Fortaleza, Ceará, Brazil. We reviewed medical records of all 249 patients that started medical follow-up at SAE/NAMI since its foundation (August/2010) until January/2014, including in the analysis those who completed the international HIV dementia scale - IHDS during routine medical visits. Epidemiological, clinical and laboratory variables were collected in addition to IHDS score and the sample was classified in two groups: patients with IHDS≥10 (Group 1) and IHDS<10 (Group 2). Chisquared test was used for categorical variables and student t test, mann whitney test and linear regression were used for numerical variables. Results: The study population consisted of 178 patients with mean IHDS score of 9.5 (+/- 1.6). HAND prevalence was 41.6% (74/178) (IHDS<10). These patients presented older mean age (37.4 years) and longer mean time from HIV diagnosis to medical follow-up than the others (10.1 months) when compared to Group 2 (31 years old and 4.6 months, respectively), suggesting that these two variables were possibly associated with HAND occurrence. Conclusion: The IHDS application showed a high prevalence of HAND in the study population. More advanced age and longer time from HIV diagnosis to medical follow-up are possibly associated with its occurence.

Objetivo: Determinar a prevalência de pacientes sob risco de desenvolver desordem cognitiva relacionada ao HIV (HAND ­ HIV associated neurocognitive disorder) e identificar fatores que possivelmente estariam associados à sua ocorrência. Métodos: Estudo quantitativo, transversal, conduzido no Serviço de Atendimento Especializado (SAE) em HIV/AIDS do Núcleo de Atenção Médica Integrada (NAMI), Universidade de Fortaleza (UNIFOR), Fortaleza/Ceará/Brazil. Foram revisados todos os 249 prontuários de pacientes que iniciaram acompanhamento no SAE/NAMI desde a sua criação (agosto/2010) até janeiro/2014, incluindo-se na análise aqueles que apresentavam o registro da aplicação da escala de demência do HIV (IHDS ­ international HIV dementia scale) nas consultas de rotina. Coletaram-se variáveis epidemiológicas, clínicas e laboratoriais, além do valor do IHDS, classificando-se a amostra em dois grupos: pacientes com IHDS≥10 (Grupo 1) e IHDS<10 (Grupo 2). Utilizaram-se testes Qui-quadrado para variáveis categóricas, e T de Student, Mann Whitney e regressão linear para variáveis numéricas. Resultados: A população do estudo consistiu em 178 pacientes, com escore médio da IHDS de 9.5 (+/-1.6). A prevalência de HAND foi de 41,6% (74/178) (IHDS<10). Nesses pacientes, a idade média era mais elevada (37,4 anos) e o intervalo médio de tempo entre o diagnóstico do HIVe o início do acompanhamento era maior que os demais (10,1 meses), quando comparados com o Grupo 2 (31 anos e 4,6 meses respectivamente), sugerindo que essas duas variáveis possivelmente estavam associadas com a ocorrência da HAND. Conclusão: A utilização do IHDS demonstrou uma elevada prevalência de HAND na população estudada. A idade mais elevada e o intervalo de tempo maior entre o diagnóstico do HIV e o início do acompanhamento estão possivelmente relacionados com essa ocorrência.

Objetivo: Determinar la prevalencia de pacientes con riesgo para el desarrollo del desorden cognitivo relacionado al VIH (HAND ­ HIV associated neurocognitive disorder) y identificar los factores que posiblemente estarían asociados a su ocurencia. Métodos: Estudio cuantitativo, transversal realizado en el Servicio de Atención Especializada (SAE) en VIH/SIDA del Núcleo de Atención Médica Integrada (NAMI), Universidad de Fortaleza (UNIFOR), Fortaleza/Ceará/Brasil. Se revisó todos los 249 historiales clínicos de pacientes que iniciaron seguimiento em el SAE/NAMI desde su creación (agosto/2010) hasta enero/2014, incluyéndose en el analisis aquellos que presentabam el registro de la aplicación de la escala de demencia del VIH (IHDS ­ international HIV dementia scale) en las consultas de rutina. Se recogieron variables epidemiológicas, clinicas y de laboratório además del valor del IHDS clasificando la muestra en dos grupos: pacientes con IHDS≥10 (Grupo 1) y IHDS<10 (Grupo 2). Se utilizó las pruebas Chi-cuadrado para las variables categóricas y la prueba T de Student, Mann Whitney y regresión linear para las variables numericas. Resultados: La población del estudio fue de 178 pacientes con puntuación media para la IHDS de 9.5 (+/- 1.6). La prevalencia de HAND fue del 41,6% (74/178) (IHDS<10). En eses pacientes la edad media fue más elevada (37,4 años) y el intervalo de tiempo medio entre el diagnostico del VIH y el inicio del seguimiento fue mayor que los demás (10,1 meses) al comparar con el Grupo 2 (31 años y 4,6 meses respectivamente) lo que sugiere que esas dos variables posiblemente estaban asociadas a la ocurrencia de la HAND. Conclusión: La utilización del IHDS demonstró una elevada prevalencia de HAND en la población estudiada. La edad más elevada y el intervalo de tiempo mayor entre el diagnostico del VIH y el inicio del seguimiento están posiblemente relacionados con esta ocurrencia.

Association between allergic responses and Schistosoma mansoni infection in residents in a low-endemic setting in Brazil

Introduction Schistosomiasis is endemic in 76 countries and territories. Several studies have found an inverse correlation between parasitic disease and the development of allergies. The purpose of the present study was to determine whether infection with Schistosoma mansoni in subjects with a low parasite load is protective against allergy. The final sample consisted of 39 S. mansoni-positive and 52 S. mansoni-negative residents of a small community in northeastern Brazil. Methods All subjects were submitted to the Kato-Katz test, anti-S. mansoni IgG measurement, the prick test for aeroallergens, eosinophil counts and serum IgE measurement. Results Subjects who reacted to one or more antigens in the prick test were considered allergic. Only 7 S. mansoni-positive subjects (17.9%) reacted to one or more antigens, whereas 20 S. mansoni-negative subjects (38.5%) tested positive for allergy. Conclusions Our findings suggest that, in areas of low endemicity, infection with S. mansoni significantly reduces the risk of the development of allergy in subjects with a low parasite load. .

Dietas larvais alternativas para criação massal da mosca da bicheira, Cochliomyia hominivorax / Alternative larval diets for mass rearing of screwworm, Cochliomyia hominivorax

A criação massal da mosca da bicheira, Cochliomyia hominivorax (Diptera: Calliphoridae), para programas que utilizam a Técnica do Inseto Estéril nas Américas faz parte de um dos maiores programas do mundo de criação de insetos em larga escala. A maior parte do custo e do trabalho necessários para a produção massal está relacionada com a dieta larval, o que torna importante o seu aprimoramento levando-se em conta sua eficiência, custo e praticidade. Neste trabalho, foram realizados dois bioensaios com dietas alternativas feitas a partir de produtos disponíveis no mercado brasileiro com o objetivo de avaliar a viabilidade e eficiência dessas dietas para criações de mosca da bicheira no Brasil. Foram testadas duas dietas líquidas (tendo como bulking agents bagaço de cana ou fibra de coco), uma de carne, e outra de gel. Os parâmetros biológicos (peso das larvas, viabilidade larval, peso de pupas, porcentagem de emergência de adultos e razão sexual) estiveram, em todos os casos, dentro de parâmetros satisfatórios para a criação laboratorial de C. hominivorax e as dietas não diferiram estatisticamente entre si. Devido a vantagens importantes, como alta viabilidade larval e menor custo, recomenda-se a dieta de gel para as criações de larvas da mosca da bicheira no Brasil.

The mass rearing of the screwworm fly, Cochliomyia hominivorax (Diptera: Calliphoridae), for programs that integrate the Sterile Insect Technique in the Americas is part of one of the largest insect mass rearing programs in the world. Most of the cost and labor required in mass rearing systems is related to the larval diet, what enhances the relevance of the constant development of novel diets taking into account their effectiveness, cost and practicability. In this research, two bioassays with alternative diets made using local products were performed in order to evaluate the feasibility and efficiency of these diets for screwworm rearing in Brazil. Two liquid diets (having sugarcane bagasse or coconut fiber as bulking agents), a meat diet, and a gelled diet were tested. The biological parameters evaluated (larval weight, larval viability, pupal weight, adult emergence, and sex ratio) were satisfactory according to mass rearing standards and the diets did not differ statistically (P > 0.05). Due to its higher number of advantages, as high larval viability and lower cost, the gelled diet developed is recommended for screwworm larvae rearing in Brazil.

Determinação da temperatura base para o desenvolvimento embrionário da mosca-da-bicheira / Assessment of the threshold temperature for the embryonic development of the screwworm fly

Após sucessivas campanhas de erradicação da mosca-da-bicheira, Cochliomyia hominivorax (Coquerel), através da utilização de insetos estéreis, sua distribuição geográfica atual abrange apenas áreas do Caribe e dos países da América do Sul, com exceção do Chile. Para o planejamento de novos programas de controle nos países do MERCOSUL, deve-se contar com o máximo de informações possíveis relacionadas à ecologia desse parasita, como suas exigências térmicas. O objetivo deste estudo foi determinar a constante térmica (K), as temperaturas base (Tb), ótima (To) e a influência de temperaturas entre 15 e 35°C sobre a duração do período embrionário de C. hominivorax. Depois de separados das massas, os ovos foram inoculados sobre papel de filtro umedecido em placas de Petri, as quais foram colocadas em câmaras climatizadas do tipo B.O.D. Considerando o menor período de desenvolvimento e máxima viabilidade de ovos, a temperatura ótima foi estimada em 35°C. A temperatura base foi estimada em 13,1°C, com uma constante térmica de 9,17GD.

After successful eradication campaigns against the screwworm fly, Cochliomyia hominivorax (Coquerel), through the release of sterile insects, its current geographical distribution comprehends only some Caribbean islands and South American countries, except Chile. Before planning new control programs in MERCOSUR countries, information related to the ecology of this parasite, as its thermal requirements, are necessary. This research aimed to assess the thermal constant (K), the threshold (Tb) and optimal (To) temperatures, as the influence of temperature between 15 and 35°C over the length of the embryonic period of C. hominivorax. Eggs were separated from the masses and inoculated on moistened filter paper in Petri dishes, which were held in acclimatized chambers. Considering the shortest development period and the highest egg hatch values, the optimal temperature was 35°C. The threshold temperature was 13.1°C and the estimated thermal constant was 9.17 degrees-days.

A conventional polymerase chain reaction-based method for the diagnosis of human schistosomiasis in stool samples from individuals in a low-endemicity area

The aim of this study was to evaluate the efficacy of a polymerase chain reaction (PCR)-based method to detect Schistosoma mansoni DNA in stool samples from individuals living in a low-endemicity area in Brazil. Of the 125 initial stool samples, 80 were ELISA reactive and eggs were identified in 19 of the samples by parasitological examination. For the PCR evaluations, 56 stool samples were selected and divided into five groups. Groups I-IV were scored negative for S. mansoni eggs by parasitological examination. Groups I and II were ELISA reactive, whereas Groups III and IV were ELISA nonreactive. Groups II and III were positive for other intestinal parasites. PCR testing scored eight samples as positive from these four groups. Group V represented the S. mansoni -positive group and it included ELISA-reactive samples that were scored positive for S. mansoni by one or more parasitological examinations (6/19 were positive by Kato-Katz method, 9/17 by saline gradient and 10/13 by Helmintex®). PCR scored 13 of these 19 samples as positive for S. mansoni . We conclude that while none of these methods yielded 100% sensitivity, a combination of techniques should be effective for improving the detection of S. mansoni infection in low-endemicity areas.

The combination of three faecal parasitological methods to improve the diagnosis of schistosomiasis mansoni in a low endemic setting in the state of Ceará, Brazil

Laboratory diagnosis of intestinal schistosomiasis mansoni can be accomplished through various methods of stool examination to detect parasites, ranging from the most classic tests (Kato-Katz) to several methods that are still undergoing validation. This study was conducted to assess two new parasite identification methods for diagnosing schistosomiasis mansoni in residents of a low endemic area in the municipality of Maranguape, in the state of Ceará, Brazil using the Kato-Katz method as a reference and serology (enzyme-linked immunosorbent assay) for the screening of patients. The Kato-Katz, the saline gradient method and the Helmintex® method parasite identification methods were employed only in subjects who exhibited positive serologic tests. The test results were then analysed and treatment of positive individuals was subsequently performed. After comparing the test results, we observed that the saline gradient method and the Helmintex® method were more effective in diagnosing schistosomiasis mansoni in the study area compared with the Kato-Katz method.

Increased detection of schistosomiasis with Kato-Katz and SWAP-IgG-ELISA in a Northeastern Brazil low-intensity transmission area / Aumento da detecção da esquistossomose com Kato-Katz e SWAP-IgG-ELISA, em área de baixa endemicidade, no nordeste do Brasil

INTRODUCTION: The laboratory diagnosis of schistosomiasis is based mainly on the detection of parasite eggs in stool samples through the Kato-Katz (KK) technique, reading one slide by test. However, a widely known limitation of parasitological methods is reduced sensitivity, particularly in low endemic areas. METHODS: To increase sensitivity, we conducted further slide readings from the same stool sample using the parasitological method associated with a serological test. We used the KK method (three slides) and the IgG anti-Schistosoma mansoni-enzyme-linked immunosorbent assay (ELISA) technique to diagnose schistosomiasis in low endemic areas in the Brazilian State of Ceará. Fecal samples and sera from 250 individuals were analyzed. RESULTS: Sixteen percent and 47.2% of samples were positive in parasitological tests and serological tests, respectively. Parasitological methods showed that 32 (80%) individuals tested positive on the first slide, 6 (15%) on the second slide, and 2 (5%) on the third. The performance of the ELISA test in the diagnosis, using the KK method as diagnostic reference, showed a negative predictive value of 100%, with specificity and positive predictive values of 62.8% and 33.9%, respectively. CONCLUSIONS: In this study, the increase from one to three slides analyzed per sample using the KK technique was shown to be a useful procedure for increasing the diagnostic sensitivity of this technique.

INTRODUÇÃO: O diagnóstico laboratorial da esquistossomose é baseada principalmente na detecção de ovos do parasito nas fezes, realizada pela técnica de Kato-Katz (KK), com a leitura de uma lâmina por teste. No entanto, uma limitação conhecida dos métodos coproscópicos é a reduzida sensibilidade, especialmente nas áreas de baixa endemicidade. MÉTODOS: A fim de reduzir essa limitação, realizamos mais leituras da mesma amostra de fezes pelo método coproscópico e associamos a um teste sorológico.Utilizamos o método de KK (três lâminas) e a técnica de IgG-ELISA, buscando aumentar a sensibilidade do diagnóstico da esquistossomose em área de baixa endemicidade, no Estado Brasileiro do Ceará. Amostras de fezes e soro de 250 indivíduos foram analisadas. RESULTADOS: Destas, 40 e 118 foram positivas nos testes coproscópico e sorológico, respectivamente. Na coproscopia, 32 (80%) indivíduos tiveram testes positivos na primeira lâmina, 6 (15%) na segunda e 2 (5%) apenas na terceira lâmina. O desempenho do teste de ELISA no diagnóstico utilizando-se o método KK como referência de diagnóstico, demonstrou valor preditivo negativo de 100% mas a especificidade e o valor preditivo positivo foram de 62,8% e 33,9%, respectivamente. CONCLUSÕES: Neste estudo, o aumento de uma para três lâminas analisadas por amostra pelo KK, mostrou ser um procedimento útil para o aumento da sensibilidade diagnóstica desta técnica.

Enxerto de pele parcial para tratamento de sequela de queimadura cáustica em cavidade oral: relato de caso / Partial-thickness skin graft for treatment of sequelae of caustic burn in oral cavity: case report

Introdução: As queimaduras estão entre as principais causas de morbimortalidade em nossa sociedade, com 2 milhões de casos por ano e 2.500 óbitos no Brasil. Apesar de menos comuns, as queimaduras químicas são mais graves, principalmente quando causadas por agentes alcalinos. A cavidade oral raramente é afetada, mas, quando ocorre, pode deixar sequelas incapacitantes e permanentes. A literatura apresenta várias opções de tratamento, incluído órteses, fisioterapia, enxertos de pele, retalhos de mucosa e promissores agentes químicos inibidores de fibrose. Relato do caso: Relato de queimadura cáustica grave em face de paciente jovem, com evolução aguda para estenose oral importante, no qual foram realizadas comissuroplastia e enxertia de pele parcial com tratamento das áreas cruentas da mucosa jugal e das comissuras. Conclusão: Foi alcançada evolução satisfatória com recuperação da função estomatognática.

Introduction: Burns are one of the main causes of morbidity and mortality in our society, occurring two million cases per year and 2,500 deaths in Brazil. Although less common, chemical burns are more serious, especially when caused by alkaline agents. The oral cavity is rarely affected, but when it happens, permanent and disabling sequelae may occur. The literature presents various treatment options, including bracing, physical therapy, total skin grafts, flaps of mucosa and promising chemical inhibitors to prevent fibrosis. Case report: Case report of a severe caustic burn in the face in a young patient with acute progression to severe oral stenosis, which were performed commissuroplasties and partial skin graft as a treatment of the cruentae areas of the buccal mucosa and the commissures. Conclusion: Satisfactory outcome with recovery of the stomatognathic function were achieved.

Determinação de captopril por HPLC acoplado a espectômetro de massa: aplicação em estudo de bioequivalência / Determination of captopril by hplctandem mass spectrometry: application in a bioequivalence study

Objetivo: Avaliar a bioequivalência de três diferentes formulações de captopril 25mg (Capoten® como formulação de referência e Captopril produzido pela FURP e Farmanguinhos como formulações testes) em 24 voluntários saudáveis de ambos os sexos. Métodos: Os voluntários selecionados eram livres de doenças, como confirmado pelo exame físico, psiquiátrico, ECG e exames laboratoriais. O estudo foi do tipo aberto, cruzado, em três períodos com 5 dias de intervalo entre eles. As amostras plasmáticas foram obtidas num intervalo de 24 horas e as concentrações de Captopril foram determinadas por cromatografia líquida de fase reversa acoplada à espectrometria de massa (LC-MS-MS). Resultados: A média geométrica para Capoten®/Captopril-FURP 25mg foi 96.9% para AUC0-24, 95.58 % para AUC0-?, e 98.17% for Cmax. O intervalo de confiança (IC) de 90% foi de 84.8-100.65%, 88.5-109.42% e 82.52 116.8%, respectivamente. A média geométrica para Capoten®/ Captopril-Farmanguinhos 25mg foi 99.63 % para AUClast, 98.52% para AUC0-?, e 95.52 para Cmax. O IC de 90% foi de 87.23-113.8%, 86.06-112.79% e 80.29-113.64%, respectivamente. Portanto, os IC de 90% para Cmax, AUClast, AUC0-? estavam dentro da variação de 80-125% proposta pelo Food and Drug Administration. Conclusão: Os comprimidos de 25mg Captopril-FURP e Captopril Farmanguinhos foram bioequivalentes ao Capoten® 25mg em sua taxa e extensão de absorção.

Objective: To assess three different captopril tablet formulations of 25mg for their bioavailability (Capoten® as the reference formulation and Captopril from FURP and Farmanguinhos as the test formulations) in 24 healthy volunteers of both sexes. Methods: The volunteers were free from serious disease, as assessed by physical and psychiatric examination, EKG, and laboratory tests. The study was open, with a three-period crossover design and a five-day washout period. Plasma samples were obtained over a 24-hour interval. Captopril concentrations were determined by reversed phase liquid chromatography tandem mass spectrometry (LC-MS-MS). Results: The geometric mean for Capoten® /Captopril - FURP 25 mg was 96.9 % for AUC0-24, 95.58 % for AUC0-?, and 98.17% for Cmax. The 90% confidence intervals (CI) were 84.8-100.65%, 88.5-109.42% and 82.52-116.8%, respectively. The geometric mean for Capoten®/Captopril-Farmanguinhos 25 mg was 99.63 % for AUClast, 98.52% for AUC0-?, and 95.52 for Cmax. The 90% CI were 87.23-113.8%, 86.06-112.79% and 80.29-113.64%, respectively. Therefore, the 90% CI for Cmax, AUClast, AUC0-? were within the 80-125% interval proposed by the Food and Drug Administration. Conclusion: Captopril- FURP and Captopril-Farmanguinhos 25 mg tablets were bioequivalent to Capoten® 25 mg, according to both the rate and extent of absorption.

Toxicology and safety of the tincture of Operculina alata in patients with functional constipation

The tincture of Operculina alata, popularly known as "tincture of jalapa", is used in Northeast Brazil to treat constipation and encephalic vascular accident, but it has not yet been adequately tested for safety and efficacy. The aim of this study was to evaluate the toxicology and safety of the tincture of O. alata in patients with functional constipation. This was a double-blind, randomized, placebo-controlled clinical trial. The study consisted of three phases: pre-treatment, treatment and post-treatment, each phase with duration of seven days. Arterial pressure, heart rate, body weight, adverse events, hematological, metabolic, liver and kidney functions were monitored. Forty patients were randomized to receive tincture of O. alata and 43 patients to receive placebo. There were statistical differences in the clinical aspects between groups, but these changes were not considered clinically significant. Adverse events were considered not serious and of mild intensity, especially dizziness, headache, abdominal pain and nausea. This clinical trial confirmed the safety of the tincture of O. alata in the pharmaceutical form and dosage tested, allowing the product to be safely used in a larger population for the assessment of its clinical efficacy.

A tintura de Operculina alata, popularmente conhecida como "tintura de jalapa", é usada no Nordeste do Brasil para tratar constipação intestinal e acidente vascular encefálico, mas sua eficácia e segurança ainda não foram confirmadas. O objetivo deste estudo foi avaliar a toxicologia e segurança da tintura de O. alata em pacientes com constipação intestinal funcional. Este foi um ensaio clínico duplo-cego, randomizado e controlado por placebo. O estudo consistiu de três fases: pré-tratamento, tratamento e pós-tratamento, cada fase com duração de sete dias. Foram monitorizados a pressão arterial, frequência cardíaca, peso corporal, eventos adversos e funções hematológica, metabólica, hepática e renal. Quarenta pacientes foram randomizados para receber tintura de O. alata e 43 pacientes para receber placebo. Houve diferenças estatísticas nos aspectos clínicos entre os grupos, contudo, estas mudanças não foram consideradas clinicamente significativas. Eventos adversos foram considerados não sérios e de leve intensidade, especialmente, cefaléia, tontura, dor abdominal e náusea. Este ensaio clínico confirmou a segurança da tintura de O. alata na forma farmacêutica e dosagem testada, permitindo que o produto seja testado em população maior para determinar sua eficácia clínica.

Efficacy and safety of cumaru syrup as complementary therapy in mild persistent asthma: a double-blind, randomized, placebo-controlled study

Amburana cearensis is a medicinal plant known as "cumaru". It is used in Northeast Brazil in the treatment of respiratory diseases. This was a randomized, double-blind, placebo-controlled study, with the aim of evaluating the efficacy and safety of cumaru syrup as complementary therapy in mild persistent asthma. The study consisted of 3 phases, pre-treatment, treatment and post-treatment. The primary efficacy outcome was comparison of the changes reported by patients of the cumaru and placebo groups after treatment, using the "Asthma Quality of Life Questionnaire" (AQLQ). The secondary outcome was the effect of cumaru syrup on lung function based on spirometry. The results showed that in the cumaru group, the proportion of patients who had global improvement in asthma symptoms was significantly greater (61.90%, P=0.0009) than in the placebo group (9.52%). Only the spirometric parameters Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 second (FEV1) showed significant intergroup differences in post-treatment (P<0.05). The hematological and serum chemistry tests performed in the pre-treatment and post-treatment showed no statistically significant differences (P>0.05). Adverse events were reported by 3 patients (14.29%) in the cumaru group and 3 patients (14.29%) in the placebo group. All adverse events were considered non-serious and mild.

Amburana cearensis é uma planta medicinal conhecida como "cumaru". No Nordeste do Brasil é usada no tratamento de doenças respiratórias. Este é um estudo randomizado, duplo-cego e controlado por placebo, com o objetivo de avaliar a eficácia e segurança do xarope de cumaru como terapia complementar da asma persistente leve. O estudo consistiu de três fases, pré-tratamento, tratamento e pós-tratamento. A variável primária para determinação da eficácia foi a comparação das mudanças referidas pelos pacientes dos grupos cumaru e placebo após o tratamento, usando o "Questionário sobre Qualidade de Vida na Asma" (QQVA). A variável secundária foi o efeito do xarope de cumaru na função pulmonar baseado na espirometria. Os resultados mostraram que no grupo cumaru, a proporção de pacientes com melhora global dos sintomas da asma foi significativamente maior (61,90%, P=0.0009) que no grupo placebo (9,52%). Somente os parâmetros espirométricos, capacidade vital forçada (CVF) e volume expiratório forçado no primeiro segundo (VEF1), mostraram diferença intergrupo significtivas no pós-tratamento (P<0.05). Os testes hematológicos e do soro realizados no pré-tratamento e pós-tratamento não mostraram diferenças estatisticamente significativas (P>0.05). Eventos adversos foram reportados por 3 pacientes (14,29%) no grupo cumaru e 3 (14,29%) no grupo placebo. Todos os eventos adversos foram não sérios e leves.

Determination of nimodipine in plasma by HPLC-MS/MS and pharmacokinetic application

To develop and validate a rapid, specific and highly sensitive method to quantify nimodipine in human plasma using dibucaine as the internal standard (IS). The analyte and IS were extracted from plasma samples by liquid-liquid extraction using hexane-ethyl acetate (1:1 v/v). The chromatographic separation was performed on a Varian® Polaris C18 analytical column (3 μm, 50 x 2.0 mm) and pre-column SecurityguardTM C18 (4.0 x 3.0 mm) with a mobile phase of Acetonitrile-Ammonium acetate 0.02 ml/L (80:20v/v). The method had a chromatographic run time of 4.5 min and linear calibration curve over the range of 0.1- 40 ng/mL (r > 0.9938). The limit of quantification was 100 pg/mL. Acceptable precision and accuracy were obtained for concentrations over the standard curve ranges. This validated method was successfully applied in determining the pharmacokinetic profile of nimodipine tablets of 30 mg administered to 24 healthy volunteers. The proposed method of analysis provided a sensitive and specific assay for nimodipine determination in human plasma. The time for the determination of one plasma sample was 4.5 min. This method is suitable for the analysis of nimodipine in human plasma samples collected for pharmacokinetic, bioavailability or bioequivalence studies in humans.

Um método rápido, específico e sensível para quantificar nimodipino em plasma humano usando dibucaína como padrão interno (IS) é descrito. O analito e o IS foram extraídos das amostras de plasma por extração líquido-líquido usando hexano-acetato de etila (1:1 v/v). A separação cromatográfica foi realizada utilizando-se uma coluna analítica C18 Varian® Polaris (3 μm, 50 x 2,0 mm) e uma pré-coluna SecurityguardTM C18 (4,0 x 3,0 mm) e acetonitrila-acetato de amônia 0,02 mol/L (80:20 v/v) como fase móvel. O método apresentou tempo total de corrida de 4,5 min e curva de calibração linear com concentrações entre 0,1-40 ng/mL (r > 0,9938). O limite de quantificação foi de 100 pg/mL. Os valores de precisão e exatidão foram obtidos por meio da análise das amostras de controle de qualidade. A análise de uma única amostra de plasma foi realizada em 4,5 minutos. A metodologia validada foi aplicada na determinação do perfil farmacocinético do nimodipino, comprimido de 30 mg administrado em 24 voluntários saudáveis. O método para quantificar nimodipino em plasma é adequado para aplicação em estudos farmacocinéticos, biodisponibilidade e bioequivalência em humanos.