Research progress of leprosy and its control status in Hainan Province / 中国热带医学

@#Abstract: Leprosy, as an important neglected tropical disease (NTDs), has a tremendous impact on the patients’body and psychology, families and society. In this paper, we reviewed the progress of epidemiology, genetic factors, immune mechanisms, diagnosis and treatment of leprosy, and introduced the changes of national prevention and control policies and the prevention and control process of Hainan Province, so as to improve the clinical understanding among healthcare professionals. According to the World Health Organization's (WHO) global annual leprosy situation report data, the number of new cases and the incidence rate of leprosy have been showing a downward trend worldwide. In China, the epidemic situation of leprosy remains in an overall low-endemic state. However, the long-standing low-endemic status of leprosy and its wide and uneven distribution pose challenges to the prevention and control of leprosy. The pathogenesis of leprosy is mainly related to skin barrier, immune deficiency, and related signaling pathways. Serological testing, cytokines, and microRNA markers can all be used to assist in the early diagnosis of leprosy, while also helping to distinguish different types of leprosy, predict leprosy reactions, evaluate efficacy, and monitor family contacts. The main treatment plan for leprosy involves combination chemotherapy with drugs recommended by the WHO, such as rifampicin, dapsone, clofazimine and other drugs. Currently, the main prevention and treatment strategies for leprosy are early detection, early diagnosis and early treatment, controlling the source of infection, protecting the healthy population, preventing the occurrence of deformity, and improving the quality of life after recovery. At present, Hainan Province as well as the whole country is in a low-epidemic state, but healthcare professionals still need to improve their awareness of prevention, reduce their incidence rate, and strive to achieve the goal of "zero leprosy" as soon as possible.

Scientometric review of research on Neglected Tropical Diseases: a 31-year perspective from the Journal of the Brazilian Society of Tropical Medicine

ABSTRACT Background: To analyze the temporal evolution of research on Neglected Tropical Diseases (NTDs) published by the Journal of the Brazilian Society of Tropical Medicine (JBSTM). Methods: We performed an analysis of the scientific production in JBSTM on NTDs using an advanced search, which included authors' descriptors, title, and abstract, and by combining specific terms for each NTDs from 1991 to 2021. Data related to authors, countries of origin, institutions, and descriptors, were evaluated and analyzed over time. Bibliographic networks were constructed using VOSviewer 1.6.16. Results: The JBSTM published 4,268 scientific papers during this period. Of these 1,849 (43.3%) were related to NTDs. The number of publications on NTDs increased by approximately 2.4-fold, from 352 (total 724) during 1991-2000 to 841 (total 2,128) during 2011-2021, despite the proportional reduction (48.6% versus 39.5%). The most common singular NTDs subject of publications included Chagas disease (31.4%; 581/1,849), leishmaniasis (25.5%, 411/1,849), dengue (9.4%, 174/1,849), schistosomiasis (9.0%; 166/1,849), and leprosy (6.5%, 120/1,849), with authorship mostly from Brazil's South and Southeast regions. Conclusions: Despite the proportional reduction in publications, JBSTM remains an important vehicle for disseminating research on NTDs during this period. There is a need to strengthen the research and subsequent publications on specific NTDs. Institutions working and publishing on NTDs in the country were concentrated in the South and Southeast regions, requiring additional investments in institutions in other regions of the country.

Perfil dos agravos com animais potencialmente transmissores da raiva, Mato Grosso do Sul, Brasil, 2019 a 2021 / Profile of injury by potential rabies-transmitting animals in Mato Grosso do Sul, Brazil, from 2019 to 2021 / Perfil de enfermedades con animales potencialmente transmisores de rabia en Mato Grosso do Sul, Brasil, de 2019 a 2021

Considerada uma das mais graves doenças tropicais negligenciadas (DTN) do mundo, a raiva promove grande impacto à saúde pública devido a sua evolução letal e ao elevado custo social e econômico. O objetivo desta pesquisa foi descrever o perfil epidemiológico das agressões por animais potencialmente transmissores de raiva, no estado de Mato Grosso do Sul, durante os anos de 2019 a 2021. Foi realizado um estudo epidemiológico retrospectivo, transversal, qualiquantitativo, com dados secundários codificados do Sistema de Informação de Agravos de Notificação: ano e mês, município e zona de ocorrência, idade, sexo, raça, escolaridade, tipo de exposição, região anatômica atingida, características do ferimento, espécie e condição do animal agressor e tratamento preconizado. Foram registradas 24.362 notificações de agressões, com prevalência média de 8,7/1.000 hab. Janeiro apresentou o maior número de notificações. Destacaram-se, entre os agredidos, crianças entre 1 e 9 anos de idade do sexo masculino. A zona de ocorrência de 89,5% dos agravos foi urbana e 81,7% foram provocados por cães. Dentre os indivíduos agredidos, 79,2% receberam tratamento antirrábico pós-exposição com uso de imunobiológico. O estado registrou baixa prevalência de agravos por animais. Notaram-se falhas de preenchimento das fichas de notificação e nos critérios de inclusão de agravos com animais potencialmente transmissores da raiva.

Considered as one of the most serious neglected tropical diseases (NTD) worldwide, rabies greatly impacts public health due to its lethal evolution and high social and economic cost. Given this scenario, this study describes the epidemiological profile of attacks by potential rabies-transmitting animals in the state of Mato Grosso do Sul, Brazil, from 2019 to 2021. A retrospective, cross-sectional, qualitative-quantitative epidemiological study was conducted with secondary data obtained from the Information System for Notifiable Diseases, namely: year and month; municipality and area of occurrence; age; gender; race; education; type of exposure; anatomical region affected; characteristics of the wound; species and condition of the animal; and recommended treatment. A total of 24,362 notifications of animal attacks were reported, with average prevalence of 8.7/1000 inhabitants. January registered the highest number of notifications. Among the victims, male children aged one to nine years stood out. Of the total injuries reported, 89.5% occurred in urban areas and 81.7% were done by dogs. Among the attacked individuals, 79.2% received post-exposure anti-rabies treatment with immunobiological drugs. The state recorded a low prevalence of animal attacks. Results revealed poorly filled out forms and issues with the inclusion criteria used for classifying injuries caused by potential rabies-transmitting animals.

Considerada una de las enfermedades tropicales desatendidas (ETD) más graves del mundo, la rabia tiene un gran impacto en la salud pública debido a su evolución letal y alto costo social y económico. El objetivo de esta investigación es describir el perfil epidemiológico de las agresiones por animales potencialmente transmisores de la rabia, en el estado de Mato Grosso do Sul (Brasil), durante los años de 2019 a 2021. Se realizó un estudio epidemiológico retrospectivo, transversal, cualicualitativo, con datos secundarios codificados del Sistema de Información de Enfermedades de Declaración Obligatoria que contienen: año y mes, municipio y zona de ocurrencia, edad, sexo, raza, nivel de educación, tipo de exposición, región anatómica afectada, características de la herida, especie y condición del animal agresor y tratamiento recomendado. Se registraron 24.362 notificaciones de agresiones, con una prevalencia media de 8,7/1.000 hab. Enero tuvo el mayor número de notificaciones. Entre las víctimas se destacaron niños de entre 1 y 9 años de edad y varones. El área donde ocurrieron el 89,5% de las lesiones fue urbana, y el 81,7% de ellas fueron causadas por perros. Entre los agredidos, el 79,2% recibió tratamiento antirrábico postexposición con uso de inmunobiológicos. El estado registró una baja prevalencia de lesiones causadas por animales. Se observaron fallas en el llenado de los formularios de notificación y en los criterios de inclusión de enfermedades con animales potencialmente transmisores de la rabia.

NTD Health: An electronic medical record system for neglected tropical diseases / NTD Health: un sistema de historias clínicas electrónicas para enfermedades tropicales desatendidas

Introduction: The use of technological resources to support processes in health systems has generated robust, interoperable, and dynamic platforms. In the case of institutions working with neglected tropical diseases, there is a need for specific customizations of these diseases. Objectives: To establish a medical record platform specialized in neglected tropical diseases which could facilitate the analysis of treatment evolution in patients, as well as generate more accurate data about various clinical aspects. Materials and methods: A set of requirements to develop state of the art forms, concepts, and functionalities to include neglected tropical diseases were compiled. An OpenMRS distribution (version 2.3) was used as reference to build the platform, following the recommended guidelines and shared-community modules. Results: All the customized information was developed in a platform called NTD Health, which is web-based and can be upgraded and improved by users without technological barriers. Conclusions: The electronic medical record system can become a useful tool for other institutions to improve their health practices as well as the quality of life for neglected tropical disease patients, simplifying the customization of healthcare systems able to interoperate with other platforms.

Introducción. El uso de recursos tecnológicos destinados a apoyar procesos en los sistemas de salud ha generado plataformas sólidas, interoperables y dinámicas. En el caso de las instituciones que trabajan con enfermedades tropicales desatendidas, existe la necesidad de personalizaciones específicas en las herramientas de uso médico. Objetivos. Establecer una plataforma para historias clínicas especializada en enfermedades tropicales desatendidas, con el fin de facilitar el análisis de la evolución del tratamiento de los pacientes, además de generar datos más precisos sobre diversos aspectos clínicos. Materiales y métodos. Se compiló un conjunto de requisitos para implementar formularios, conceptos y funcionalidades que permitan incluir enfermedades tropicales desatendidas. Se utilizó una distribución de OpenMRS (versión 2.3) como referencia para construir la plataforma, siguiendo las pautas recomendadas y módulos compartidos por la comunidad. Resultados. Toda la información personalizada se implementó en una plataforma llamada NTD Health, la cual se encuentra almacenada en la web y los usuarios pueden actualizarla y mejorarla sin barreras tecnológicas. Conclusiones. El sistema de historias clínicas electrónicas puede convertirse en una herramienta útil para que otras instituciones mejoren sus prácticas en salud, así como la calidad de vida de los pacientes con enfermedades tropicales desatendidas, simplificando la personalización de los sistemas de salud capaces de interoperar con otras plataformas.

American Tegumentary Leishmaniasis: case series describing an enigmatic and neglected disease / Leishmaniasis americana tegumentaria: series de casos describiendo una enigmática y olvidada enfermedad

Abstract American Tegumentary Leishmaniasis (ATL) is an infectious disease affecting the skin and mucous membranes. ATL is caused by parasites of the Leishmania genus with around one million cases are reported each year worldwide. This paper describes three rare cases of tegumentary leishmaniasis treated at a tropical disease research center.

Resumen La Leishmaniasis Tegumentaria Americana es una enfermedad infecciosa que afecta la piel y las mucosas. La ATL es causada por parásitos del género Leishmania y cada año se reportan alrededor de un millón de casos en todo el mundo. Este artículo describe tres casos raros de leishmaniasis tegumentaria tratados en un centro de investigación de enfermedades tropicales.

Las TICs aplicada a la salud mental comunitaria y enfermedades endémicas / ICTs applied to community mental health and endemic diseases

Las enfermedades tropicales desatendidas suelen presentar una evolución crónica y se caracterizan por producir discapacidad física y mental a quienes las padecen, siendo asociadas a la estigmatización social. Se realizó un estudio descriptivo en 182 pacientes con enfermedades tropicales en regiones endémicas para leishmania, enfermedad de Chagas, filariasis linfática, oncocercosis, dengue y parasitosis intestinales; con el fin de evaluar la salud mental comunitaria, aplicando las tecnologias de información y comunicación (TIC), mediante el uso de telefónos móviles y telefonía fija. Se aplicó una encuesta para valorar el conocimiento y disposición de los pacientes respecto a las TIC, se valoró la salud mental calificada y la percibida por los pacientes mediante una escala de Likert. A partir de la calificación de la salud mental comunitaria se asociaron los estigmas sobre las enfermedades endémicas y luego se aplicó una encuesta para conocer la percepción de los pacientes, respecto a la influencia de los estigmas en la salud mental comunitaria. La mayor proporción de los participantes coincidieron en ser evaluados por parte del personal de salud, mediante herramientas de TIC y manifestaron tener problemas emocionales. Asimismo, el rechazo social como las secuelas de la enfermedad resultaron ser las manifestaciones más frecuentes de los participantes. En conclusión, el empleo de las TIC, en el área de salud mental comunitaria, supone un avance importante en el intercambio de información entre terapeutas y pacientes con enfermedades tropicales desatendidas, contribuyendo a disminuir el estigma social al que se ven sometidos y reestablecer su bienestar mental(AU)

Neglected tropical diseases usually present a chronic evolution and are characterized by causing physical and mental disability to those who suffer from them, being associated with social stigmatization. A descriptive study was carried out in 182 patients with tropical diseases in endemic regions for leishmania, Chagas disease, lymphatic filariasis, onchocerciasis, dengue and intestinal parasites; in order to assess community mental health, applying information and communication technologies (ICT), through the use of mobile phones and landlines. A survey was applied to assess the knowledge and disposition of the patients regarding ICT, the qualified mental health and that perceived by the patients was assessed using a Likert scale. From the qualification of community mental health, stigmas about endemic diseases were associated and then a survey was applied to know the perception of patients regarding the influence of stigmas in community mental health. The largest proportion of the participants agreed to be evaluated by health personnel, using ICT tools, and reported having emotional problems. Likewise, social rejection as the sequelae of the disease turned out to be the most frequent manifestations of the participants. In conclusion, the use of ICTs in the area of community mental health represents an important advance in the exchange of information between therapists and patients with neglected tropical diseases, helping to reduce the social stigma to which they are subjected and reestablish their mental health(AU)

¿Es posible la coinfección o un diagnóstico erróneo por dengue y COVID-19? Una revisión de reporte de casos / Is dengue and COVID-19 coinfection or misdiagnosis possible? A review on reported cases

INTRODUCCIÓN: El nuevo coronavirus ha continuado propagándose por todo el mundo donde existen otras enfermedades endémicas que han sido una carga para la salud pública durante muchos años. Como cualquier infección, se habría esperado encontrar en coinfección con algunas de éstas. Específicamente, los países tropicales y subtropicales han venido manejando la carga del dengue a medida que aumentan los picos con períodos de tiempo más cortos. OBJETIVO: Resumir la evidencia que existe en la coinfección relacionada con el SARS-CoV-2 y el virus del dengue. METODOLOGÍA: Se realizó una revisión narrativa en bases de datos sobre reportes de coinfección y diagnóstico erróneo de SARS-CoV-2 y el dengue dado que la temporada de lluvias cada año aumenta la prevalencia de infecciones virales en países endémicos. Informes recientes incluso han descrito casos positivos en uno de estas infecciones que luego resultaron en falso positivo. Una prueba positiva para COVID-19 o fiebre del dengue en áreas endémicas no debe excluir la otra infección. CONCLUSIÓN: A partir de ahora, estos dos deberían ser considerados como un diagnóstico diferencial y esto debe generar preocupación de salud pública por su coinfección en países endémicos para reforzar la promoción y prevención a las comunidades y mitigar estas enfermedades.

BACKGROUND: Novel coronavirus has continued to spread throughout the world where there are other endemic diseases that have been a burden to public health for many years. As any infection, it was expected there could be coinfection between these. Tropical and subtropical countries are currently managing with dengue as peaks increase with shorter periods of time. AIM: To summarize the evidence that exists in the co-infection related to SARS-CoV-2 and the dengue virus. METHOD: We conducted a narrative review in data bases about reports of coinfection and misdiagnosis of SARS-CoV-2 and dengue virus given the fact that rainy season every year increase the prevalence of viral infections in endemic countries. Recent reports have even described positive cases in one of these infections that later resulted in false positive. A positive test for COVID-19 or dengue fever in endemic areas should not exclude the other infection. CONCLUSION: From now on, these two should be considered as a differential diagnosis and this should raise public health concern for COVID-19 and dengue coinfection in endemic countries to reinforce promotion and prevention to communities to prevent these diseases.

Significance of a neglected tropical disease: lessons from a paradigmatic case of 'success in translation'

In a previous publication, I stressed the fundamental importance of research for improving health using as an example the control of Chagas disease in the Americas.(1) For that purpose, I analysed the major scientific breakthroughs and public health events from the 1909 discovery of Chagas disease and its causative pathogen, Trypanosoma cruzi, by Carlos Chagas,(2) through the successful control of its transmission by insect vectors in large regions of the Southern Cone countries in the 90s.(3) In the twenty years since that publication, Brazil and Latin American countries had to cope with a number of serious public health threats, old and new: (i) recrudescence of well-known diseases, such as dengue and yellow fever; (ii) emergence of viral diseases that had been restricted to other continents (Zika, Chikungunya); (iii) new epidemics (H1N1) or (iv) pandemics (COVID-19). Are there still some lessons from that success story against a neglected disease of the 90s that would be relevant today in the context of these recent challenges?

Report of autochthonous cases of localized cutaneous leishmaniasis caused by Leishmania (Leishmania) mexicana in vulnerable, susceptible areas of Southeastern Mexico

ABSTRACT Localized cutaneous leishmaniasis (LCL) is an endemic disease in several Mexican States with the main endemic areas located in the South-Southeast region of the country, where 90% of Leishmania (Leishmania) mexicana cases are registered. The Southeast region is located in the Yucatan Peninsula, including Campeche, Quintana Roo and Yucatan States. Campeche and Quintana Roo register more than 60% of the cases in the country each year, while in Yucatan the reports are of imported cases due to residents traveling to endemic areas. However, since 2015, autochthonous cases have been diagnosed by health authorities in municipalities with no previous transmission records. We aimed to identify Leishmania parasite species involved in autochthonous cases by means of the PCR technique. The present study included 13 autochthonous cases of LCL with clinical and parasitological diagnoses during 2018 and 2019 by health authorities, without specific identification of the causal agent. Tissue samples were taken by scraping the margins of active lesions and then they were spotted onto an FTATM Elute Microcard. Next, DNA was eluted and used for PCR amplification of specific Leishmania genus and L. (L.) mexicana species-specific fragments. Molecular analysis showed evidence that L. (L.) mexicana was the causal agent of LCL in 12 of the 13 patients; in one patient, PCR was not performed due to the patient's refusal to participate in the study. Identifying Leishmania species that cause LCL is necessary to define efficient treatment schemes and control strategies for the disease in vulnerable and susceptible areas of the Yucatan State's municipalities.

Experiencias suramericanas en telemedicina de enfermedades desatendidas / South American experiences on telemedicine of neglected diseases

Las enfermedades tropicales desatendidas (ETD) son aquellas que comúnmente se encuentran en varios países de bajos ingresos en África, Asia y América Latina, provocadas básicamente, por el escaso acceso la higiene, agua limpia o sistemas de alcantarillado. Las ETD comprenden una diversidad de enfermedades de alta prevalencia en los países tropicales causadas por una variedad de patógenos, incluyendo bacterias, virus, parásitos y hongos. La epidemiología de las ETD es bastante compleja y se relacionan con las condiciones ambientales del entorno. Muchas son transmitidas por vectores, tienen un origen zoonótico con reservorios animales bien caracterizados y están asociadas con ciclos de vida complejos. Todos estos factores hacen que su control en salud pública sea un desafío; desafío que se caracteriza por la falta de financiamiento en investigación y control. En ese sentido, la telemedicina, o el uso de las telecomunicaciones para brindar servicios de salud, es una tecnología que ha venido ganando cuerpo durante los últimos veinte años, ya que ayudan, con una relativa baja inversión, el acceso a la atención médica por parte de los más necesitados o que vieven en lugares remotos. Esta investigación se centra en el estudio y conocimiento de las las enfermedades olvidadas presentes en suramérica y cómo la telemedicina ha ayudado en su prevención, diágnótico y tratamiento(AU)

Neglected topical diseases (NTDs) are those that are commonly found in several low-income countries in Africa, Asia en Latin America, basically caused by poor access to hygiene, clean water, or sewage systems. NTDs comprise a diversity of highly prevalent diseases in tropical countries caused by a variety of pathogens, including bacteria, viruses, parasites, and fungi. The epidemiology of NTDs is quite complex and is related to the surrounding environmental conditions. Many are vector-borne, zoonotic in origin with well-characterized animal reservoirs, and associated with complex life cycles. All these factors make its control in public health a challenge; challenge that is characterized by the lack of funding for research and control. In this sense, telemedicine, or the use of telecommunications to provide health services, is a technology that has been gaining ground over the last twenty years, since it helps, with a relatively low investment, access to medical care by part of those most in need or who live in remote places. In this sense, telemedicine, or the use of telecommunications to provide health services, is a technology that has been gaining ground over the last twenty years, since it helps, with a relatively low investment, access to medical care by part of those most in need or who live in remote places. This research focuses on the study and knowledge of neglected diseases present in South America and how telemedicine has helped in their prevention, diagnosis, and treatment(AU)

Hanseníase virchowiana e eritema nodoso hanseníco em gestante de 34 semanas sem diagnóstico prévio / Virchowian leprosy and erythema nodosum leprosum in a 34-week pregnant woman without any previous diagnosis

Relatamos um caso de uma paciente feminina, gestante de terceiro trimestre, em acompanhamento pré-natal regular na unidade básica de saúde, com boa evolução gestacional, porém apresentando lesões de pele há cerca de um ano, acompanhadas de alteração de sensibilidade, além de fáscies infiltrada e madarose. Sendo o Brasil um país endêmico em Hanseníase, ocupando o 2º lugar no mundo em número de novos casos, chama a atenção o diagnóstico tardio da paciente em questão. Aproveitamos este emblemático relato de caso para discutir aspectos importantes em relação à terapêutica no período gestacional (poliquimioterapia conforme manual do ministério, sem nenhuma alteração por conta da gestação), desfecho obstétrico, orientações quanto à lactação (não contra-indicada com a mãe em tratamento; pelo contrário, devendo ser estimulada) e cuidado ao recém nato. [au]

We report a case of a pregnant female patient in the third trimester undergoing regular prenatal care at a Basic Health Unit, with good gestational evolution, but presenting skin lesions for approximately a year accompanied by changes in sensitivity, in addition to facial infiltration and madarosis. Considering Brazil as an endemic country for leprosy, ranking 2nd in the world concerning the number of new cases, late diagnosis of the patient in question stands out. We use this emblematic case report to discuss important aspects concerning the treatment of leprosy during the gestational period (multidrug therapy according to the Ministry of Health manual, without any changes due to pregnancy), obstetric outcome, guidelines regarding breastfeeding (not contraindicated with the mother in treatment; on the contrary, it should be stimulated) and care for the newborn. [au]

Competencias para la gestión educativa universitaria online: La epidemiología de enfermedades infecciosas tropicales / Competencies for online university educational management: The epidemiology of tropical infectious diseases

El enfoque por competencias se ha venido aplicando en todo el sector educativo, y ha tomado el rumbo universitario donde ha pisado fuertemente. Esto se debe a las ofertas de trabajo en donde las competencias son de carácter esencial. El enfoque por competencia ha logrado reorientar la formación profesional desde la elaboración de los perfiles de ingreso, de egreso, diseños curriculares, estrategias metodológicas y sistema de evaluación que son distintos a los enfoques tradicionales. Es por ello que, la gerencia online se perfila como herramienta novedosa que podría la problemática de la presencialidad en estos tiempos coyunturales que se vive, no solamente por efectos de pandemias, como el coronavirus, sino también por la dinámica de la sociedad actual. Como la gestión de la educación es una realidad que requiere de competencias, entonces se estaría hablando de las competencias digitales, para poder asumir el reto y la realidad de poder gerenciar de manera virtual u online. Por otra parte, el desarrollo de las competencias primarias unidas hoy en día con las competencias digitales ha hecho que ciertas disciplinas científicas hayan logrado avances significativos, y una de ellas son las enfermedades epidemiológicas asociadas a las enfermedades tropicales. En este trabajo se establecen y asignas las competencias necesarias para enfrentar las enfermedades infecciosas tropicales, y además se evalúa el efecto de la gerencia online en este mismo sector. Los resultados demostraron que el sistema peruano se encuentra preparado para estos nuevos retos, y se acepta la participación de las nuevas tecnologías digitales(AU)

The competency-based approach has been applied throughout the educational sector, and has taken the university course where it has stepped strongly. This is due to job offers where skills are essential. The competency-based approach has managed to reorient professional training from the preparation of entry and exit profiles, curricular designs, methodological strategies and evaluation systems that are different from traditional approaches. That is why online management is emerging as a novel tool that could address the problem of attendance in these current times, not only due to the effects of pandemics, such as the coronavirus, but also due to the dynamics of today's society. As the management of education is a reality that requires skills, then we would be talking about digital skills, to be able to take on the challenge and the reality of being able to manage virtually or online. On the other hand, the development of primary skills combined today with digital skills has meant that certain scientific disciplines have made significant progress, and one of them is the epidemiological diseases associated with tropical diseases. In this work, the necessary skills to face tropical infectious diseases are established and assigned, and the effect of online management in this same sector is also evaluated. The results showed that the Peruvian system is prepared for these new challenges, and the participation of new digital technologies is accepted(AU)

Translational research in Chagas disease: perspectives in nutritional therapy emerging from selenium supplementation studies as a complementary treatment

Translational research (TR) is an interdisciplinary branch of the biomedical field that seeks to connect its three supporting pillars: basic research on the bench, the hospital beds and other health system services, and the delivery of products for the well-being and health of the community. Here, we review the five transition stages of the TR spectrum, registering the lessons learned during > 20 years leading to the first clinical trial designed and performed in Brazil for testing a complementary treatment for Chagas disease (CD): the selenium trial (STCC). Lessons learned were: (1) to consider all the TR spectrum since the beginning of the project; (2) to start simultaneously animal studies and translation to humans; (3) to ensure a harmonious interaction between clinical and basic research teams; (4) to include MSc and PhD students only in pre-clinical and basic studies (TR0) or vertical clinical studies using retrospective samples and data (TR1); (5) to identify potential suppliers in the national commercial market for a future final treatment since the pre-clinical stage; (6) to keep an international network of experts as permanent advisers on the project. In the whole process, some perspectives were created: a complementary clinical trial for the opened questions and the construction of a Brazilian clinical CD platform.

Enfermedades tropicales desatendidas y su impacto sobre la salud cardiovascular (The NET-heart project) / Neglected tropical diseases and their impact on cardiovascular health. (The NET-Heart Project)

Resumen Las enfermedades tropicales desatendidas (ETD) constituyen un conjunto de afecciones altamente prevalentes en regiones tropicales y subtropicales, asociadas a pobreza y subdesarrollo. Constituyen una verdadera crisis sanitaria, incapacitando y llevando a la muerte a millones de personas anualmente. Esto se ve potenciado por las dificultades socioeconómicas que cursan estos países, mayormente en vías de desa rrollo, lo cual repercute en la calidad de la asistencia sanitaria que pueden proveer a la población. La morbilidad de estas enfermedades se explica por la amplia afectación orgánica que generan. El aparato cardiovascular resulta particularmente afectado, lo que explica en gran medida la morbimortalidad de las ETD. En el presente artículo se revisan los aspectos fundamentales de un proyecto llevado a cabo por los Líderes Emergentes de la Sociedad Interamericana de Cardiología (SIAC), cubriendo diferentes aspectos del impacto sobre el aparato cardiovascular de las ETD: el Proyecto NET-Heart (del inglés, Neglected Tropical Diseases and other Infectious Diseases Affecting the Heart).

Abstract Neglected tropical diseases (NTD) are a group of diseases with high prevalence in tropical and subtropi cal countries. They are associated to poverty and underdevelopment. Due to its high morbimortality, these conditions are considered a health crisis. The impact of these diseases can be worsened by the poor socioeconomic status of the affected countries, most of them under-developed, which affects the health care provided to patients. The morbidity of these diseases is explained by the wide organic impairment that they produce. The cardiovascular system is par ticularly affected, which explains the high morbimortality of NTD. In this article, we review the key issues of a project elaborated by Emerging Leaders of the Interamerican Society of Cardiology (SIAC), about the cardiovascular impact of NTD: the NET-Heart Project (Neglected Tropical Diseases and other Infectious Diseases affecting the Heart).

Chemical composition and biological activities of essential oil from flowers of Psidium guajava (Myrtaceae) / Composição química e atividades biológicas do óleo essencial das flores de Psidium guajava (Myrtaceae)

Abstract Xylella fastidiosa is a plant-pathogenic bacterium that lives inside host xylem vessels, where it forms biofilm which is believed to be responsible for disrupting the passage of water and nutrients. Pectobacterium carotovorum is a Gram-negative plant-specific bacterium that causes not only soft rot in various plant hosts, but also blackleg in potato by plant cell wall degradation. Chagas disease, which is caused by Trypanosoma cruzi, has been commonly treated with nifurtimox and benzonidazole, two drugs that cause several side effects. As a result, the use of natural products for treating bacterial and neglected diseases has increased in recent years and plants have become a promising alternative to developing new medicines. Therefore, this study aimed to determine, for the first time, the chemical composition of essential oil from Psidium guajava flowers (PG-EO) and to evaluate its in vitro anti-Xylella fastidiosa, anti-Pectobacterium carotovorum, anti-Trypanosoma cruzi and cytotoxic activities. PG-EO was obtained by hydrodistillation in a Clevenger apparatus while its chemical composition was determined by gas chromatography-flame ionization detection (GC-FID) and gas chromatography-mass spectrometry (GC-MS). Major compounds identified in PG-EO were α-cadinol (37.8%), β-caryophyllene (12.2%), nerolidol (9.1%), α-selinene (8.8%), β-selinene (7.4%) and caryophyllene oxide (7.2%). Results showed that the PG-EO had strong trypanocidal activity against the trypomastigote forms of Trypanosoma cruzi (IC50 = 14.6 μg/mL), promising antibacterial activity against X. fastidiosa (MIC = 12.5 μg/mL) and P. carotovorum (MIC = 62.5 μg/mL), and moderate cytotoxicity against LLCMK2 adherent epithelial cells in the concentration range (CC50 = 250.5 μg/mL). In short, the PG-EO can be considered a new source of bioactive compounds for the development of pesticides and trypanocide drugs.

Resumo Xylella fastidiosa é uma bactéria patogênica que vive dentro dos vasos do xilema hospedeiro, onde forma um biofilme responsável por interromper a passagem de água e nutrientes. Pectobacterium carotovorum é uma bactéria Gram-negativa que causa não só podridão macia em várias plantas hospedeiras, mas também canela-preta na batata por degradação da parede celular da planta. A doença de Chagas, causada pelo Trypanosoma cruzi, é comumente tratada com nifurtimox e benzonidazol, duas drogas que causam vários efeitos colaterais. Como resultado, o uso de produtos naturais para o tratamento de doenças bacterianas e negligenciadas aumentou nos últimos anos e as plantas continuam sendo uma alternativa promissora para o desenvolvimento de novos medicamentos. Portanto, este estudo teve como objetivo determinar, pela primeira vez, a composição química do óleo essencial de flores de Psidium guajava (PG-EO) e avaliar suas propriedades anti-Xylella fastidiosa, anti-Pectobacterium carotovorum, anti-Trypanosoma cruzi e citotóxica in vitro. PG-EO foi obtido por hidrodestilação em um aparelho Clevenger, enquanto sua composição química foi determinada por cromatografia em fase gasosa com detecção por ionização por chama (CG-DIC) e por cromatografia em fase gasosa acoplada à espectrometria de massa (CG-EM). Os principais compostos identificados no PG-EO foram α-cadinol (37,8%), β-cariofileno (12,2%), nerolidol (9,1%), α-selineno (8,8%), β-selineno (7,4%) e óxido de cariofileno (7,2%). Os resultados mostraram que o PG-EO apresentou forte atividade tripanocida contra as formas tripomastigotas de T. cruzi (CI50 = 14,6 μg/mL), promissora atividade antibacteriana contra X. fastidiosa (MIC = 12,5 μg/mL) e P. carotovorum (MIC = 62,5 μg/mL) e citotoxicidade moderada contra células epiteliais aderentes (LLCMK2) na faixa de concentração (CC50 = 250,5 μg/mL). Em suma, o PG-EO pode ser considerado uma nova fonte de compostos bioativos para o desenvolvimento de pesticidas e drogas tripanocidas.

Análisis de las temáticas y enfoques de los artículos publicados en la Revista NOVA en el periodo comprendido entre 2014 y 2019 / Analysis of the topics and approaches of the articles published in the Scientific Publication NOVA in the period between 2014 and 2019

Resumen Objetivo. Identificar los enfoques y temáticas publicadas en la Revista Nova en los últimos 5 años y realizar una descripción narrativa de los mismos. Metodología. Revisión documental y análisis de las contribuciones teóricas y empíricas producidas durante el periodo comprendido entre 2014 y 2019 de publicación de la Revista NOVA. Resultados. Se identificaron dos enfoques: área médica y ciencias biológicas y seis temáticas relevantes: 1. Enfermedades infecciosas y resistencia bacteriana, 2. Enfermedades raras y neurodegenerativas, 3. Enfermedades tropicales, 4. Enfermedades metabólicas y diagnóstico prenatal, 5. Enfermedades cardiovasculares y hematológicas, 6. Biotecnología y calidad del agua. Conclusiones. La Revista NOVA ha realizado importantes contribuciones a la divulgación científica desde las áreas de la salud y biológicas, particularmente en seis temáticas de relevancia para el país y el mundo.

Abstract Objective. Identify the approaches and topics published in Nova in the last 5 years and make a narrative description of them. Methodology. Documentary review and analysis of the theoretical and empirical contributions produced during the period of the last 5 years of publication of the NOVA. Results. Two approaches were identified: medical and biological sciences area and six relevant topics: 1. Infectious diseases and bacterial resistance, 2. Rare and neurodegenerative diseases, 3. Tropical diseases, 4. Metabolic diseases and prenatal diagnosis, 5. Cardiovascular and hematological diseases, 6. Biotechnology and water quality. Conclusions. NOVA Scientific Publication has made important contributions to scientific dissemination from the health and biological areas, particularly on six topics of relevance to the country and the world.

Enfermedad de Chagas: actualización de un desafío vigente / Chagas disease: update of a current challenge

El objetivo de este artículo de revisión narrativa fue generar un documento de consulta con la información actualizada existente respecto a la Enfermedad de Chagas. La enfermedad de Chagas causada por el protozoo Trypanosoma cruzi, es identificado en la primera década del siglo XX. Seguida a la infección aguda, se puede desarrollar una enfermedad crónica. Hasta en el 30-40% de los casos se caracteriza por miocardiopatía, arritmias y megavísceras. La progresión a la miocardiopatía es devastadoramente rápida y se manifiesta con insuficiencia cardíaca y muerte súbita. Hoy continúa siendo un importante problema de salud pública, no sólo en países endémicos, como consecuencia de la movilidad poblacional entre Latino América, y otros países del mundo.

The objective of this narrative review article was to generate a consultation document with the existing updated information regarding Chagas disease. Chagas disease caused by the protozoan Trypanosoma cruzi, is identified in the first decade of the 20th century. Following acute infection, a chronic disease can develop. In up to 30-40% of cases it is characterized by cardiomyopathy, arrhythmias, and mega viscera. The progression to cardiomyopathy is devastatingly rapid, manifesting with heart failure and sudden death. Today it continues to be an important public health problem, not only in endemic countries, as a consequence of population mobility between Latin America and other countries in the world.

Prevalence and intensity of soil-transmitted helminth infections among school-age children in the Cagayan Valley, the Philippines

Objective: To identify the prevalence of soil-transmitted helminthiasis (STH) among school-age children in the Cagayan Valley, the Philippines, assess their level of awareness on the disease, and determine predisposing factors of the disease. Methods: A total of 478 Grades III-V school-age children in Pamplona and Sanchez-Mira School Districts in the Cagayan Valley answered the questionnaire assessing their knowledge, attitude, and practices on STH, subjected to anthropometric measurements, and provided faecal samples for parasitologic assessment (direct smear, Kato-Katz, and formol-ether concentration techniques). Results: The participants of the study, with 55.86% females, were 8 to 14 years old. Their nutritional status was assessed 'normal' (84.31%), 'severely wasted' (6.49%), 'wasted' (5.23%), 'overweight' (2.72%), and 'obese' (1.26%). The prevalence of infection with at least 1 STH species was 25.99% in Pamplona and 19.40% in Sanchez- Mira. Overall, the prevalence of heavy intensity was 7.11% for Ascaris lumbricoides and 1.67% for Trichuris trichiura. All hookworm infections had light intensities. The majority of the school-age children had a low score in the KAP test. In knowledge of STH, 'stunted growth as a symptom of infection' was associated with a lower risk of Ascaris lumbricoides infection (OR 0.448; 95% CI 0.212, 0.945; P=0.035) while 'playing with soil as a mode of transmission' was associated with an increased risk of Ascaris lumbricoides infection (OR 2.067; 95% CI 1.014, 4.212; P=0.046). In attitude towards STH, 'I think I have intestinal worm now' was associated with a higher risk of Ascaris lumbricoides infection (OR 1.681; 95% CI 1.061, 2.662; P=0.027). Conclusions: The prevalence rate of Ascaris lumbricoides among the school-age children in the Cagayan Valley shows the need to further intensify intervention in the area to meet the threshold set by the World Health Organization. The identified predictors of infection, which concerns the school-age children's knowledge and attitude toward STH, can be used in augmenting intervention programs in the future.

Seroprevalencia de anticuerpos anti-Leptospira spp. en estudiantes de Medicina Veterinaria y Zootecnia de la Costa Grande de Guerrero, México / Seroprevalence of anti-Leptospira spp. antibodies among Veterinary Medicine and Zootechnics students from Costa Grande of Guerrero, Mexico

Introducción: La leptospirosis humana es una enfermedad zoonótica con manifestaciones clínicas inespecíficas (cefalea y mialgia), las cuales pueden confundirse con otras enfermedades febriles como: gripe, malaria, dengue, fiebre amarilla, hepatitis vírica y rickettsiosis. Objetivo: Determinar la prevalencia de anticuerpos anti-Leptospira en estudiantes de la carrera de Medicina Veterinaria y Zootecnia de la Costa Grande de Guerrero. Métodos: Se aplicó un cuestionario a los estudiantes de la Escuela Superior de Medicina Veterinaria y Zootecnia No. 3 con la finalidad de conocer algunos factores de riesgo asociados a la presencia de anticuerpos anti-Leptospira spp. La determinación de anticuerpos anti-Leptospira y la identificación de las serovariedades se realizaron con la técnica de microaglutinación. Se consideró un suero positivo cuando se observó una aglutinación en una dilución igual o mayor a 1:100. Resultados: En el estudio la seroprevalencia de anticuerpos anti-Leptospira spp. fue de 12,1 por ciento (8/66). Se detectaron anticuerpos a 8 serovariedades de Leptospira spp. El 62,5 por ciento (5/8) de los sueros presentó más de una serovariedad. Las serovariedades y frecuencia fueron icterohaemorrhagiae 25 por ciento (4/16), hardjo 18,8 por ciento (3/16), pyrogenes 18,8 por ciento (3/16), pomona 12,5 por ciento (2/16), canicola 6,2 por ciento (1/16) wolffi 6,2 por ciento (1/16) tarassovi 6,2 por ciento (1/16) y bratislava 6,2 por ciento (1/16). Los factores de riesgo estudiados no se relacionaron con la presencia de anticuerpos anti-Leptospira. Conclusiones: En el presente estudio se encontraron anticuerpos a Leptospira spp. en estudiantes de Medicina Veterinaria y Zootecnia. Por tanto, es pertinente proporcionar información a los estudiantes para prevenir el contacto con el agente causal de la leptospirosis(AU)

Introduction: Human leptospirosis is a zoonotic disease of unspecific clinical manifestations (headache and myalgia) which may be confused with those of other febrile diseases, such as influenza, malaria, dengue, yellow fever, viral hepatitis and rickettsiosis. Objective: Determine the prevalence of anti-Leptospira antibodies among Veterinary Medicine and Zootechnics students from Costa Grande de Guerrero. Methods: A questionnaire was applied to students from the Higher Education Veterinary Medicine and Zootechnics School No. 3 to obtain information about risk factors associated to the presence of anti-Leptospira spp. antibodies. Microagglutination technique was used to determine anti-Leptospira antibodies and identify serovars. A serum sample was considered positive when agglutination was observed at a dilution equal to or greater than 1:100. Results: Seroprevalence of anti-Leptospira spp. antibodies was found to be 12.1 percent (8/66). Antibodies were detected for 8 serovars of Leptospira spp. Of the serum samples analyzed, 62.5 percent (5/8) contained more than one serovar. The serovars and their frequency were the following: icterohaemorrhagiae 25 percent (4/16), hardjo 18.8 percent (3/16), pyrogenes 18.8 percent (3/16), pomona 12.5 percent (2/16), canicola 6.2 percent (1/16), wolffi 6.2 percent (1/16), tarassovi 6.2 percent (1/16) and bratislava 6.2 percent (1/16). The risk factors studied were not related to the presence of anti-Leptospira antibodies. Conclusions: Leptospira spp. antibodies were found in Veterinary Medicine and Zootechnics students. It is therefore advisable to provide students with the information required to prevent contact with the causative agent of leptospirosis(AU)

Efecto inhibitorio in vitro de la ftalocianina de aluminio tetrasulfonada clorada frente a Leishmania (Viannia) peruviana y Leishmania (Viannia) braziliensis / In vitro inhibitory effect of aluminum phthalocyanine tetrasulfonate chloride against Leishmania (Viannia) Peruviana and Leishmania (Viannia) Braziliensis

RESUMEN Objetivos: Evaluar la actividad fotodinámica in vitro de la ftalocianina de aluminio tetrasulfonada clorada (AlPcClS4) sobre promastigotes y amastigotes de Leishmania (Viannia) peruviana y Leishmania (Viannia) braziliensis. Materiales y métodos: La actividad del tratamiento fotodinámico empleando AlPcClS4 sobre promastigotes y amastigotes de Leishmania fue determinada mediante el método colorimétrico Metil Tiazol Tetrazolium (MTT) y PCR cuantitativo, respectivamente. Resultados: El tratamiento fotodinámico presentó un efecto inhibitorio sobre promastigotes, principalmente sobre Leishmania (V.) peruviana, en menor proporción sobre Leishmania (V.) braziliensis y sobre las formas intracelulares de ambas especies. En Leishmania (V.) peruviana, a las 24 horas posirradiación a 200 µM y 350 µM el efecto inhibitorio fue del 72,9% y 73,9%, respectivamente y a las 96 horas fue del 78,8% y 80,6%, respectivamente. En las formas intracelulares, empleando 200 µM y evaluado a las 72 horas postratamiento, se observó una inhibición del 57,8% de amastigotes de Leishmania (V.) peruviana. El IC50 fue del 56,5; 50; 44; y 39,7 µM, que corresponde a las 24, 48, 72 y 96 horas posirradiación, respectivamente. Conclusiones: El tratamiento fotodinámico empleando AlPcClS4 frente a las especies de Leishmania presentó resultados alentadores principalmente sobre Leishmania (V.) peruviana, lo cual sugiere su potencial uso como alternativa o complemento del tratamiento convencional de la leishmaniasis tegumentaria. Sin embargo, aún se requiere continuar con nuevos ensayos para determinar el índice de selectividad sobre el parásito en su forma intracelular, y desarrollar estrategias que faciliten el ingreso eficiente de la molécula hacia la célula hospedera y al parásito.

ABSTRACT Objectives: To evaluate the in vitro photodynamic activity of aluminum phthalocyanine tetrasulfonate chloride (AlPcClS4) on promastigotes and amastigotes of Leishmania (Viannia) peruviana and Leishmania (Viannia) braziliensis. Materials and methods: The activity of photodynamic therapy using AlPcClS4 on Leishmania promastigote and amastigotes was determined by the Methyl Thiazole Tetrazolium (MTT) colorimetric method and quantitative PCR, respectively. Results: Photodynamic treatment showed an inhibitory effect on promastigotes, particularly on Leishmania (V.) peruviana, to a lesser extent on Leishmania (V.) braziliensis and also on intracellular forms of both species. At 24 hours post-radiation, using concentrations of 200 μM and 350 μM, the inhibitory effect on Leishmania (V.) peruviana was 72.9% and 73.9% respectively; at 96 hours the inhibitory effect was of 78.8% and 80.6%, respectively. Regarding intracellular forms, the inhibitory effect on Leishmania (V.) peruviana amastigotes was 57.8% at 72 hours post-treatment, using a concentration of 200 μM. The IC50 was 56.5, 50, 44 and 39.7 μM, at 24, 48, 72 and 96 hours post-radiation, respectively. Conclusions: Photodynamic therapy using AlPcClS4 against Leishmania species showed encouraging results, mainly on Leishmania (V.) peruviana, suggesting a potential use as an alternative or complement to the usual treatment of tegumentary leishmaniasis. However, new trials are still required to determine the selectivity index for the intracellular form of the parasite, and to develop methods to facilitate the efficient entry of the molecule into the host cell and the parasite.