Percepção e conscientização de universitários sobre o sistema único de saúde / Perception and conscience-raising of undergraduates on the brazilian health care system

O objetivo desse estudo foi avaliar a percepção dos acadêmicos participantes do Programa de Educação Tutorial (PET) da Universidade Estadual de Maringá (UEM) sobre o Sistema Único de Saúde (SUS) e elucidá-los sobre os serviços disponibilizados pelo sistema, bem como seus direitos e deveres enquanto usuários. Um questionário semiestruturado foi aplicado e simultaneamente desenvolveu-se um processo de conscientização dos acadêmicos sobre a importância e funções do sistema para o Brasil por meio de dinâmicas e debates. Ao final do processo de conscientização, 97,97% dos petianos afirmaram ser usuário do SUS, comparado aos 72,97% que inicialmente declararam fazer uso do sistema. O conhecimento dos acadêmicos do PET-UEM sobre o SUS, embora satisfatório, é ainda limitado e carece de informações a respeito dos direitos e deveres enquanto usuários, sendo influenciado pela perspectiva midiática.

The perception of undergraduates participating in the Program for Tutorial Education (PET) of the State University of Maringá on the Brazilian Health Care System (SUS) was evaluated. The discussion also includes information on services available and on the rights and duties of clients. A half-structured questionnaire was applied and a conscience-raising process was developed with undergraduates on the system´s importance and functions through several discussions and debates. At the end of the process, 97.97% of the participants stated they were SUS clients when compared with 72.97% who initially stated they used the system. Knowledge on SUS by PET-UEM undergraduates, although satisfactory, is still limited and lacks information on clients´ rights and duties, influenced by social media.

Diagnostic methods to cutaneous leishmaniasis detection in domestic dogs and cats

Abstract: Cutaneous leishmaniasis is caused by different species of Leishmania. In domestic animals such as dogs and cats, the diagnostic consists of clinical, epidemiological and serological tests, which changes among countries all around the world. Because of this diversity in the methods selected, we propose this systematic literature review to identify the methods of laboratory diagnosis used to detect cutaneous leishmaniasis in domestic dogs and cats in the Americas. Articles published in the last 5 years were searched in PubMed, ISI Web of Science, LILACS and Scielo, and we selected 10 papers about cutaneous leishmaniasis in dogs and cats in the Americas. In Brazil, often the indirect immunofluorescence and enzyme immunoassay (ELISA) have been applied. Other countries like United States and Mexico have been using antigenic fractions for antibodies detections by Western blot. ELISA and Western blot showed a higher sensitivity and efficacy in the detection of leishmaniasis. Analysis of sensibility and specificity of the methods was rarely used. Although confirmatory to leishmaniasis, direct methods for parasites detection and polymerase chain reaction showed low positivity in disease detection. We suggested that more than one method should be used for the detection of feline and canine leishmaniasis. Serological methods such as Western blot and enzyme immunoassay have a high efficacy in the diagnosis of this disease.

Antileishmanial activity of the essential oil from Tetradenia riparia obtained in different seasons

The herbaceous shrub Tetradenia riparia has been traditionally used to treat inflammatory and infectious diseases. Recently, a study showed that T. riparia essential oil (TrEO) obtained in summer has antileishmanial effects, although these results could be influenced by seasonal variation. This study evaluated the activity of the TrEO obtained in different seasons against Leishmania (Leishmania) amazonensis, in vitro and in vivo. The compounds in the TrEO were analysed by gas chromatography-mass spectrometry; terpenoids were present and oxygenated sesquiterpenes were the majority compounds (55.28%). The cytotoxicity and nitric oxide (NO) production were also tested after TrEO treatment. The TrEO from all seasons showed a 50% growth inhibitory concentration for promastigotes of about 15 ng/mL; at 30 ng/mL and 3 ng/mL, the TrEO reduced intracellular amastigote infection, independently of season. The TrEO from plants harvested in summer had the highest 50% cytotoxic concentration, 1,476 ng/mL for J774.A1 macrophages, and in spring (90.94 ng/mL) for murine macrophages. NO production did not change in samples of the TrEO from different seasons. The antileishmanial effect in vivo consisted of a reduction of the parasite load in the spleen. These results suggest that the TrEO has potential effects on L. (L.) amazonensis, consonant with its traditional use to treat parasitic diseases.

Evaluation of the reference value for the Montenegro skin test

The Montenegro skin test (MST) has good clinical applicability and low cost for the diagnosis of American tegumentary leishmaniasis (ATL). However, no studies have validated the reference value (5mm) typically used to discriminate positive and negative results. We investigated MST results and evaluated its performance using different cut-off points.

Antileishmanial activity of amides from Piper amalago and synthetic analogs

Two natural amides isolated from the chloroform extract of Piper amalago L., Piperaceae, leaves, a hydrogenated derivative and seven synthetic analogs were tested against the promastigote and intracellular amastigote forms of Leishmania amazonensis. The antileishmanial activity was evaluated in terms of growth inhibitory concentration for 50% of protozoa (IC50). The cytotoxicity toward the J774A1 macrophages was evaluated in terms of the cytotoxic concentrations for 50% of macrophages (CC50). The ability to induce nitric oxide production was also investigated for all compounds. The saturated amide 7-(1,3-benzodioxol-5-yl)-1-(1-pyrrolidinyl)-1-heptanone was obtained by hydrogenation of the natural compound N-[7-(3',4'-methylenedioxyphenyl)-2(Z),4(Z)-heptadienoyl]pyrrolidine. Synthetic amides were prepared by addition of the appropriate amine to the corresponding acyl chloride. The natural compound, N-[7-(3',4'-methylenedioxyphenyl)-2(E),4(E)-heptadienoyl]pyrrolidine, was the most active of all tested compounds against the promastigote and intracellular amastigote forms with IC50 values of 15 µM and 14.5 µM, respectively. None of the compounds modulated the production of nitric oxide.

Prevalência de sorologia positiva para HIV, hepatite B, toxoplasmose e rubéola em gestantes do noroeste paranaense / Prevalence of positive sorology for HIV, hepatitis B, toxoplasmosis and rubella in pregnant women from the northwestern region of the state of Paraná

OBJETIVO: Verificar a soroprevalência do vírus da imunodeficiência humana (HIV), hepatite B (VHB), toxoplasmose e rubéola em gestantes do noroeste paranaense. MÉTODOS: Foi realizado um estudo retrospectivo a partir dos resultados de exames sorológicos de triagem no pré-natal de 1.534 pacientes atendidas durante o primeiro semestre de 2010. Foram incluídos somente resultados do primeiro exame de pré-natal e aqueles com pesquisa simultânea de IgG e IgM para toxoplasmose e rubéola. A sorologia foi realizada por enzimaimunoensaio em micropartículas (MEIA). Para análise estatística foi empregado o teste do χ², com nível de significância de 5%. RESULTADOS: A positividade para o HIV foi de 0,3%, a sorologia para VHB pelo marcador HBsAg foi positiva em 0,5% das gestantes, enquanto a reatividade para anticorpos IgM anti-Toxoplasma gondii foi de 1,1% e para IgG de 59%. Em relação à rubéola nenhuma sorologia mostrou positividade para IgM, e para IgG a reatividade foi de 99,6%. A análise dos resultados mostrou que não há associação entre as soroprevalências estudadas e a idade das pacientes, exceto quanto à frequência de IgG anti-T. gondii, que foi mais elevada na faixa etária entre 30 e 44 anos. CONCLUSÃO: A soroprevalência dessas doenças infecciosas em gestantes do noroeste do Paraná é compatível com outras regiões do Brasil.

PURPOSE: To ascertain the seroprevalence of human immunodeficiency virus (HIV), hepatitis B (HBV), toxoplasmosis and rubella infections in pregnant women in northwestern Paraná. METHODS: We conducted a retrospective study based on the results of serological screening during prenatal care of 1,534 patients during the first half of 2010. We included only results from the first prenatal exam and with a simultaneous search for IgG and IgM antibodies to rubella and toxoplasmosis. Serology was performed by microparticle enzyme immunoassay (MEIA). Data were analyzed statistically by the χ² test, with the level of significance set at 5%. RESULTS: HIV positivity was 0.3%, positivity of HBV serology (HbsAg) was 0.5%, reactivity to IgM antibodies to Toxoplasma gondii was 1.1%, and reactivity to IgG antibodies was 59.0%. For rubella, no patient was positive for IgM, and IgG reactivity was 99.6%. Data analysis showed no statistical association between seroprevalence and patient age, except for the frequency of anti-T. gondii IgG, which was higher in the 30 to 44 year age group. CONCLUSION: The prevalence of these infectious diseases in pregnant women from northwestern Paraná is comparable to that observed in other regions of Brazil.

Activity of antiretroviral drugs in human infections by opportunistic agents

Highly active antiretroviral therapy (HAART) is used in patients infected with HIV. This treatment has been shown to significantly decrease opportunist infections such as those caused by viruses, fungi and particularly, protozoa. The use of HAART in HIV-positive persons is associated with immune reconstitution as well as decreased prevalence of oral candidiasis and candidal carriage. Antiretroviral therapy benefits patients who are co-infected by the human immunodeficiency virus (HIV), human herpes virus 8 (HHV-8), Epstein-Barr virus, hepatitis B virus (HBV), parvovirus B19 and cytomegalovirus (CMV). HAART has also led to a significant reduction in the incidence, and the modification of characteristics, of bacteremia by etiological agents such as Staphylococcus aureus, coagulase negative staphylococcus, non-typhoid species of Salmonella, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Mycobacterium tuberculosis. HAART can modify the natural history of cryptosporidiosis and microsporidiosis, and restore mucosal immunity, leading to the eradication of Cryptosporidium parvum. A similar restoration of immune response occurs in infections by Toxoplasma gondii. The decline in the incidence of visceral leishmaniasis/HIV co-infection can be observed after the introduction of protease inhibitor therapy. Current findings are highly relevant for clinical medicine and may serve to reduce the number of prescribed drugs thereby improving the quality of life of patients with opportunistic diseases.

A terapia HAART (terapia antirretroviral altamente ativa) é usada em pacientes infectados pelo vírus da imunodeficiência humana (HIV) e demonstrou diminuição significativa de infecções oportunistas, tais como as causadas por vírus, fungos, protozoários e bactérias. O uso da HAART está associado com a reconstituição imunológica e diminuição na prevalência de candidíase oral. A terapia antirretroviral beneficia pacientes co-infectados pelo HIV, vírus herpes humano 8 (HHV-8), vírus Epstein-Barr (EBV), vírus da hepatite B (HBV), parvovírus B19 e citomegalovírus (CMV). A HAART também apresentou redução significativa da incidência e modificou as características da bacteremia por agentes etiológicos, tais como Staphylococcus aureus, espécies não-tifóides de Salmonella, Streptococcus pneumoniae, Pseudomonas aeruginosa, Mycobacterium tuberculosis. A HAART é capaz de modificar significativamente a história natural da criptosporidiose e microsporidiose. HAART pode efetivamente restaurar a imunidade da mucosa, levando à erradicação de Cryptosporidium parvum. Semelhante restauração da resposta imune ocorre em infecções por Toxoplasma gondii. O declínio na incidência de co-infecção leishmaniose visceral/HIV pode ser observada após a introdução da terapia com inibidores da protease. Os resultados atuais são altamente relevantes para a medicina clínica e podem proporcionar diminuição no número de prescrições medicamentosas e, consequentemente, melhor qualidade de vida para pacientes com doenças oportunistas.