Profile of tuberculosis patients in Manaus - Amazonas (2007)

No Brasil, o Amazonas tem se destacado pela elevada incidência de tuberculose e a capital Manaus chama atenção por diagnosticar mais de 70% dos casos de todo o estado. Este estudo teve o objetivo de analisar o perfil de doentes de tuberculose no município de Manaus - AM, no ano de 2007, considerando as situações de encerramento, óbito por tuberculose, abandono do tratamento, cura e as variáveis sócio-demográficas e clínico-epidemiológicas. Trata-se de um estudo epidemiológico, descritivo, tipo levantamento, tomando como fonte de informação, os casos de tuberculose notificados no Sistema de Informação de Agravos de Notificação (SINAN). A coleta de dados ocorreu entre 01 a 30 de julho de 2009, no Departamento de Epidemiologia da Secretaria Municipal de Saúde de Manaus. A população do estudo constituiu dos casos de tuberculose que evoluíram para óbito por tuberculose, abandono do tratamento e cura. Para caracterização sóciodemográfica dos doentes foram consideradas as variáveis, sexo, idade, raça/cor, escolaridade, procedência, zona de moradia e se possuíam telefone. Dentre as variáveis clínico-epidemiológicas foram consideradas a forma clínica da tuberculose, o tipo de entrada, o tipo de tratamento e os agravos associados à tuberculose. Na análise estatística utilizaram-se técnicas descritivas contemplando frequência, média, mediana e desvio padrão. O teste qui-quadrado foi utilizado na análise de associação entre os grupos. A variável idade foi analisada em relação à situação de encerramento dos doentes utilizando ANOVA (análise de variância) e teste de comparação múltipla (teste de Tukey). O nível de significância adotado foi de 5% (p<0,05) para todos os testes. A análise estatística foi realizada com auxílio do software Statistica 8.0. Em 2007, foram notificados 1.952 casos de tuberculose no município de Manaus. Para o estudo foram selecionados 83 casos de óbitos por TB, 229 que abandonaram o tratamento e 1.268 que tiveram alta por cura, totalizando 1.580 casos. A maioria, 938 (59,4%) indivíduos era do sexo masculino, predominantemente da cor parda, residentes na zona urbana. Em relação à forma clínica, tipo de entrada e tipo de tratamento, verificou-se predominância da forma pulmonar em 1.230 casos (77,6%), 1.362 (86,2%) casos novos e 1.373 (92%) pacientes que realizaram o tratamento auto-administrado. A maioria dos casos, 1.007(63,73%) foi diagnosticada nas unidades de referência e a cobertura do tratamento supervisionado foi de apenas 8,0% dos casos. O agravo associado à tuberculose mais prevalente foi HIV/aids (11,3%) seguido do alcoolismo (9,6%). A idade média entre os doentes foi 37,5 anos e a mediana de 33,7 anos. O estudo mostra a importância da utilização do sistema de informação como ferramenta de avaliação e monitoramento das ações de controle da tuberculose. Nesse sentido, revelou importantes associações no perfil dos doentes de tuberculose e aponta necessidades do fortalecimento da atenção básica para o diagnóstico da tuberculose e o incremento do tratamento supervisionado no controle da tuberculose, assim como maior articulação do Programa de Controle do Trabalho com outros programas.In Brazil the State of Amazon has been highlighted by the high incidence of tuberculosis and its capital, Manaus, calls attention to diagnose more than 70% of cases across the State. This study aimed to analyze the profile of tuberculosis patients in Manaus - AM, in 2007, considering the circumstances of termination, death from tuberculosis, patient dropouts, cure and socio-demographic and clinicalepidemiologic variables. This is an epidemiological, descriptive, survey type study taking as a source of information, cases of tuberculosis reported in the Information System for Notifiable Diseases (SINAN). Data collection took place from 01 to 30 July 2009, on the Department of Epidemiology of the Municipal Health Department of Manaus. The studied population consisted of tuberculosis cases those evolutes to death, interruption of treatment and cure. For socio-demographic characterization of patient were considered the variables: sex, age, race, education, place, area of residence and if had phone. Among the clinical and epidemiological variables were considered the clinical form of tuberculosis, the entry type, the type of treatment and the damages associated with tuberculosis. The statistical analysis used descriptive techniques gazing frequency, mean, median and standard deviation. The chi-square test was used to analyze the association among the groups. The variable age was analyzed in relation to the situation of closure of patients using ANOVA (analysis of variance) and multiple comparison tests (Tukey test). The level of significance adopted was 5% (p <0.05) for all tests. Statistical analysis was performed using the software Statistica 8.0. In 2007, there were 1.952 reported cases of tuberculosis in the city of Manaus. For the study were selected 83 cases of deaths with tuberculosis, 229 who patient dropouts and 1.268 patients who were discharged after being cured, totaling 1.580 cases. The majority, 938 (59.4%) subjects were male, predominantly brown, living in urban areas. Regarding clinical form, input type and type of treatment, there was a predominance of pulmonary tuberculosis in 1.230 cases (77.6%), 1.362 (86.2%) new cases and 1.373 (92%) patients who underwent selfadministered treatment. Most cases, 1.007 (63.73%) was diagnosed in referral units and the coverage of supervised treatment was only 8.0% of cases. The disease associated with tuberculosis most prevalent was HIV/AIDS (11.3%) followed by alcohol (9.6%). The mean age of patients was 37.5 years and median of 33.7 years. The study shows the importance of using the information system as a tool for evaluating and monitoring the actions of tuberculosis control. In this sense, was revealed important associations in the profile of tuberculosis patients and points needs to the strengthening of primary care for diagnosis of tuberculosis and the increase of supervised treatment for tuberculosis control, as well as greater coordination of the Tuberculosis Control Program with other programs

Providing Antivenom Treatment Access to All Brazilian Amazon Indigenous Areas: ‘Every Life has Equal Value’

Snakebites are more frequent in the Brazilian Amazon than in other parts of Brazil, representing a high cost for the health system since antivenoms are only available through medical prescription from central municipal hospitals in most cases. The need for a cold chain and physicians usually restricts access to the only effective treatment of a snakebite, the antivenom. The complex topography of the rivers contributes to delays in treatment, and consequently increases the risk of severe complications, chronic sequelae and death. Thus, decentralization of antivenom treatment to primary healthcare facilities in the interior would increase access by indigenous population groups to proper healthcare. To standardize and evaluate the decentralization to low complexity indigenous healthcare units, we suggest the (i) development and validation of standardized operational procedures, (ii) training of professionals in the validated protocol in a referral health unit, (iii) implementation of the protocol in an indigenous healthcare unit, (iv) assessment of perceptions towards and acceptability of the protocol, and (v) estimation of the impact of the protocol&rsquo;s implementation. We expect that antivenom decentralization would shorten the time between diagnosis and treatment and, as such, improve the prognosis of snakebites. As health cosmology among indigenous populations has an important role in maintaining their way of life, the introduction of a new therapeutic strategy to their customs must take into account the beliefs of these peoples. Thus, antivenom administration would be inserted as a crucial therapeutic tool in a world of diverse social, natural and supernatural representations. The information presented here also serves as a basis to advocate for support and promotion of health policy initiatives focused on evidence-based care in snakebite management

Children Growing Up with Severe Disabilities as a Result of Snakebite Envenomations in Indigenous Villages of the Brazilian Amazon: Three Cases and Narratives

Snakebites are a major public health problem in the Brazilian Amazon and may lead to local complications and physical deficiencies. Access to antivenom treatment is poorer in indigenous populations compared to other populations. In this study, we report three cases of long-term severe disabilities as a result of Bothrops atrox snakebites in indigenous children, according to the narratives of the parents. The three cases evolved to compartment syndrome, secondary bacterial infection and extensive necrosis. The cases are associated with delayed antivenom treatment due to very fragmented therapeutic itineraries, which are marked by several changes in means of transport along the route. The loss of autonomy at such an early stage of life due to a disability caused by a snakebite, as observed in this study, may deprive children of sensory and social experiences and of learning their future roles in the community. In common to all cases, there was precarious access to rehabilitation services, which are generally centralized in the state capital, and which leads to a prolonged hospitalization of patients with severe snakebite, and distances them from their territory and family and community ties. Prospective studies should be conducted in the Amazon that estimate the burden of disabilities from snakebites in order to formulate public policies for the treatment and rehabilitation of patients through culturally tailored interventions

Building an explanatory model for snakebite envenoming care in the Brazilian Amazon from the indigenous caregivers' perspective.

BackgroundIn the Brazilian Amazon, snakebite envenomings (SBE) disproportionately affect indigenous peoples. Communication between indigenous and biomedical health sectors in regards to SBEs has never been explored in this region. This study aims to build an explanatory model (EM) of the indigenous healthcare domain for SBE patients from the perspective of the indigenous caregivers.Methodology/principal findingsThis is a qualitative study involving in-depth interviews of eight indigenous caregivers who are representatives of the Tikuna, Kokama and Kambeba ethnic groups, in the Alto Solimões River, western Brazilian Amazon. Data analysis was carried out via deductive thematic analysis. A framework was built containing the explanations based on three explanatory model (EM) components: etiology, course of sickness, and treatment. To indigenous caregivers, snakes are enemies and present conscience and intention. Snakebites have a natural or a supernatural cause, the last being more difficult to prevent and treat. Use of ayahuasca tea is a strategy used by some caregivers to identify the underlying cause of the SBE. Severe or lethal SBEs are understood as having been triggered by sorcery. Treatment is characterized by four components: i) immediate self-care; ii) first care in the village, mostly including tobacco smoking, chants and prayers, combined with the intake of animal bile and emetic plants; iii) a stay in a hospital, to receive antivenom and other treatments; iv) care in the village after hospital discharge, which is a phase of re-establishment of well-being and reintroduction into social life, using tobacco smoking, massages and compresses to the affected limb, and teas of bitter plants. Dietary taboos and behavioral interdictions (avoiding contact with menstruating and pregnant women) prevent complications, relapses, and death, and must be performed up to three months after the snakebite. Caregivers are in favor of antivenom treatment in indigenous areas.Conclusions/significanceThere is a potential for articulation between different healthcare sectors to improve the management of SBEs in the Amazon region, and the aim is to decentralize antivenom treatment so that it occurs in indigenous health centers with the active participation of the indigenous caregivers

The State-of-the-Art of the Humoral Memory Response to Snakebites: Insights from the Yanomami Population

Snakebite envenomation (SBE)-induced immunity refers to individuals who have been previously bitten by a snake and developed a protective immune response against subsequent envenomations. The notion stems from observations of individuals, including in the indigenous population, who present only mild signs and symptoms after surviving multiple SBEs. Indeed, these observations have engendered scientific interest and prompted inquiries into the potential development of a protective immunity from exposure to snake toxins. This review explores the evidence of a protective immune response developing following SBE. Studies suggest that natural exposure to snake toxins can trigger protection from the severity of SBEs, mediated by specific antibodies. However, the evaluation of the immune memory response in SBE patients remains challenging. Further research is needed to elucidate the immune response dynamics and identify potential targets for therapeutic interventions. Furthermore, the estimation of the effect of previous exposures on SBE epidemiology in hyperendemic areas, such as in the indigenous villages of the Amazon region (e.g., the Yanomami population) is a matter of debate

The State-of-the-Art of the Humoral Memory Response to Snakebites: Insights from the Yanomami Population

Snakebite envenomation (SBE)-induced immunity refers to individuals who have been previously bitten by a snake and developed a protective immune response against subsequent envenomations. The notion stems from observations of individuals, including in the indigenous population, who present only mild signs and symptoms after surviving multiple SBEs. Indeed, these observations have engendered scientific interest and prompted inquiries into the potential development of a protective immunity from exposure to snake toxins. This review explores the evidence of a protective immune response developing following SBE. Studies suggest that natural exposure to snake toxins can trigger protection from the severity of SBEs, mediated by specific antibodies. However, the evaluation of the immune memory response in SBE patients remains challenging. Further research is needed to elucidate the immune response dynamics and identify potential targets for therapeutic interventions. Furthermore, the estimation of the effect of previous exposures on SBE epidemiology in hyperendemic areas, such as in the indigenous villages of the Amazon region (e.g., the Yanomami population) is a matter of debate

Immersing in a Neglected Problem Inside the Amazon Jungle: Abstracts of the 1st International Symposium on Research in Venomous Animals, Manaus, Brazil

The Amazon represents the world’s greatest biodiversity and covers different countries in South America, including Brazil with the largest area. The interaction between the resident population of this area and its ecosystem is responsible for an intense exposure to venomous animals, which are considered an important health issue in the region. Therefore, the 1st International Symposium on Research in Venomous Animals, held from 2 May to 5 May 2023 in the city of Manaus in the state of Amazonas in Brazil, aimed to address animal envenomation aspects in the Brazilian Amazon and the exchange of ideas and knowledge between research groups from around the world. The event was attended by graduate students as well as renowned researchers from the Americas, Europe, and Asia. The event presented a multidisciplinary and translational approach in the area of toxinology, including themes such as clinical envenomation (clinical management, pathophysiology, and public policy strategies), preclinical studies, biological aspects of venomous animals’ venoms (venom composition/variation and geographical distribution), interdisciplinary studies on health anthropology and economics, and bioprospecting aspects (toxins with therapeutic and/or technological potential)

Statement of Peer Review—Immersing in a Neglected Problem Inside the Amazon Jungle: Abstracts of the 1st International Symposium on Research in Venomous Animals, Manaus, Brazil

In submitting conference proceedings to the 1st International Symposium on Research in Venomous Animals, Manaus, Brazil, 2–5 May 2023, the volume editors of the proceedings certify to the publisher that all abstracts published in this volume have been subjected to peer review, performed by a scientific committee administered by the volume editors [...

Version of the minimal requirements checklist created by the steering committee for experts’ validation.

Version of the minimal requirements checklist created by the steering committee for experts’ validation.</p

Characteristics of expert judges in the nominal group meeting.

Characteristics of expert judges in the nominal group meeting.</p