Raising the red flag for malaria elimination and integrated fever surveillance in the Brazilian amazon

In the past decade, Brazil has achieved considerable progress in malaria control, with 140 000 cases reported in 2015, the lowest numbers since 1980.1 Part of this success has been attributed to the establishment of a large network of around 3000 diagnostic and treatment units for malaria.1 A remarkable feature is that these services are provided for free as part of the public universal health-care system (Sistema Único de Saúde [SUS]) and cover rural and riverine areas in the Amazon region—where more than 83% of malaria transmission occurs

Content Analysis on the imbrications of geometry in the New ENEM exams

Neste artigo, realizamos uma investigação sobre como o Campo Conceitual da Geometria está imbricado a outros Campos Conceituais nos enunciados das questões de Matemática das provas do Novo ENEM. Assim, operamos uma pesquisa documental nos enunciados de todas as 1.305 questões de Matemática do Novo ENEM, desde o ano de 2009 até 2021, utilizando os passos metodológicos da Análise de Conteúdo e ? como bases teóricas da análise ? a Teoria dos Campos Conceituais e a Teoria das Imbricações entre Campos Conceituais. Com este estudo, percebemos que o número de conceitos e de imbricações conceituais nos enunciados das questões do Novo ENEM podem estar diretamente associados ao nível de complexidade das situações propostas nas provas, o que poderá ser confirmado a partir de uma investigação futura que inclua as resoluções das questões aqui analisadas.In this article, we conduced an investigation into how the Conceptual Field of Geometry is inbricated with other Conceptual Fields in the statements of the Mathematics questions of the New ENEM exams. Thus, we operated a documentary research on the statements of all 1.305 Mathematics questions of the New ENEM, from the year 2009 to 2021, using the methodological steps of Content Analysis and ? as theoretical foundations of the analysis ? the Theory of Conceptual Fields and the Theory of Imbrications between Conceptual Fields. Through this study, we realized that the number of concepts and conceptual inbrications in the statements of the New ENEM questions can be directly associated with the level of complexity of the situations proposed in the exams, which could confirmed from a future investigation that includes the resolutions of the issues analyzed here

Fixed-Dose Artesunate-Amodiaquine Combination vs Chloroquine for Treatment of Uncomplicated Blood Stage P. vivax Infection in the Brazilian Amazon: An Open-Label Randomized, Controlled Trial

BACKGROUND: Despite increasing evidence of the development of Plasmodium vivax chloroquine (CQ) resistance, there have been no trials comparing its efficacy with that of artemisinin-based combination therapies (ACTs) in Latin America. METHODS: This randomized controlled trial compared the antischizontocidal efficacy and safety of a 3-day supervised treatment of the fixed-dose combination artesunate-amodiaquine Winthrop(R) (ASAQ) versus CQ for treatment of uncomplicated P. vivax infection in Manaus, Brazil. Patients were followed for 42 days. Primary endpoints were adequate clinical and parasitological responses (ACPR) rates at day 28. Genotype-adjustment was performed. RESULTS: From 2012 to 2013, 380 patients were enrolled. In the per-protocol (PP) analysis, adjusted-ACPR was achieved in 100% (165/165) and 93.6% (161/172) of patients in the ASAQ and CQ arm (difference 6.4%, 95% CI 2.7%; 10.1%) at day 28 and in 97.4% (151/155) and 77.7% (129/166), respectively (difference 19.7%, 95% CI 12.9%; 26.5%), at day 42. Apart from ITT D28 assessment, superiority of ASAQ on ACPR was demonstrated. ASAQ presented faster clearance of parasitaemia and fever. Based on CQ blood level measurements, CQ resistance prevalence was estimated at 11.5% (95% CI: 7.5-17.3) up to day 42. At least one emergent adverse event (AE) was recorded for 79/190 (41x6%) in the ASAQ group and for 85/190 (44x7%) in the CQ group. Both treatments had similar safety profiles. CONCLUSIONS: ASAQ exhibited high efficacy against CQ resistant P. vivax and is an adequate alternative in the study area. Studies with an efficacious comparator, longer follow-up and genotype-adjustment can improve CQR characterization

Alternative transmission routes in the malaria elimination era: an overview of transfusion-transmitted malaria in the Americas

Submitted by Janaína Nascimento ([email protected]) on 2019-02-21T11:59:00Z No. of bitstreams: 1 ve_Alho_Regina_etal_INI_2017.pdf: 1190158 bytes, checksum: 8937322faefa31c89eb1bbd2f7d134a3 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-02-25T11:34:33Z (GMT) No. of bitstreams: 1 ve_Alho_Regina_etal_INI_2017.pdf: 1190158 bytes, checksum: 8937322faefa31c89eb1bbd2f7d134a3 (MD5)Made available in DSpace on 2019-02-25T11:34:33Z (GMT). No. of bitstreams: 1 ve_Alho_Regina_etal_INI_2017.pdf: 1190158 bytes, checksum: 8937322faefa31c89eb1bbd2f7d134a3 (MD5) Previous issue date: 2017Universidade do Estado do Amazonas. Manaus, AM, Brasil / Fundação de Hematologia e Hemoterapia do Amazonas. Manaus, AM, Brasil.Fundação de Medicina Tropical Dr. Heitor Vieira Dourado. Manaus, AM, Brasil.Universidade do Estado do Amazonas. Manaus, AM, Brasil / Fundação de Medicina Tropical Dr. Heitor Vieira Dourado. Manaus, AM, Brasil.Fundação de Hematologia e Hemoterapia do Amazonas. Manaus, AM, Brasil.Universidade do Estado do Amazonas. Manaus, AM, Brasil.Universidade do Estado do Amazonas. Manaus, AM, Brasil / Fundação de Medicina Tropical Dr. Heitor Vieira Dourado. Manaus, AM, Brasil.Sem afiliação.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto de Pesquisas Leônidas e Maria Deane. Manaus, AM, Brasil.Universidade do Estado do Amazonas. Manaus, AM, Brasil / Fundação de Medicina Tropical Dr. Heitor Vieira Dourado. Manaus, AM, Brasil.Universidade do Estado do Amazonas. Manaus, AM, Brasil / Fundação de Medicina Tropical Dr. Heitor Vieira Dourado. Manaus, AM, Brasil / Fundação Oswaldo Cruz. Instituto de Pesquisas Leônidas e Maria Deane. Manaus, AM, Brasil.Background: Transfusion-transmitted (TT) malaria is an alternative infection route that has gained little attention from authorities, despite representing a life-threatening condition. There has been no systematic review of this health problem in American countries. The aim of this study was to describe the clinical and epidemiological characteristics of TT malaria in the Americas and identify factors associated with lethality based on the studies published in the literature. Methods: Potentially relevant papers in all languages were retrieved from MEDLINE and LILACS. Additional articles were obtained from reviews and original papers. Publications on screening of candidate blood donors and on surveillance of TT malaria cases were included. Odds ratios with respective 95% confidence intervals (95% CI) were calculated. Epidemiological characteristics of blood donors of TT malaria cases, including a pooled positivity of different tests for malaria diagnosis, were retrieved. Results: A total of 63 publications regarding TT malaria from seven countries were included, from 1971 to 2016. A total of 422 cases of TT malaria were recorded. Most TT malaria cases were in females (62.0%) and 39.5% were in the ≥61 years-old age group. About half of all cases were from Mexico (50.7%), 40.3% from the United States of America (USA) and 6.6% from Brazil. Gyneco-obstetrical conditions (67.3%), surgical procedures (20.6%) and complications from neoplasias (6.1%) were the most common indications of transfusion. Packed red blood cells (RBCs) (50.7%) and whole blood (43.3%) were the blood products mostly associated with TT malaria. Cases were mostly caused by Plasmodium malariae (58.4%), followed by Plasmodium vivax (20.7%) and Plasmodium falciparum (17.9%). A total of 66.6% of cases were diagnosed by microscopy. Incubation period of 2–3 weeks was the most commonly observed (28.6%). Lethality was seen in 5.3% of cases and was associated with living in non-endemic countries, P. falciparum infection and concomitant neoplastic diseases. Conclusion: There is an important research and knowledge gap regarding the TT malaria burden in Latin American countries where malaria remains endemic. No screening method that is practical, affordable and suitably sensitive is available at blood banks in Latin American countries, where infections with low parasitaemia contribute greatly to transmission. Lethality from TT malaria was not negligible. TT malaria needs to be acknowledged and addressed in areas moving toward elimination

Declining malaria transmission in rural Amazon: changing epidemiology and challenges to achieve elimination

BACKGROUND: In recent years, considerable success in reducing its incidence has been achieved in Brazil, leading to a relative increase in the proportion of cases caused by Plasmodium vivax, considered a harder-to-eliminate parasite. This study aim is to describe the transmission dynamics and associated risk factors in a rural settlement area in the Western Brazilian Amazon. METHODS: A prospective cohort was established in a rural settlement area for 3 years. Follow-up included continuous passive case detection and monthly active case detection for a period of 6 months. Demographic, clinical and transmission control practices data were collected. Malaria diagnosis was performed through thick blood smear. Univariable and multivariable analyses of factors associated with malaria incidence were performed using negative binomial regression models. Factors associated with recurrence of P. vivax and Plasmodium falciparum malaria within 90 days of a previous episode were analysed using univariable and multivariable Cox-Proportional Hazard models. RESULTS: Malaria prevalence decreased from 7 % at the study beginning to 0.6 % at month 24, with P. vivax predominating and P. falciparum disappearing after 1 year of follow-up. Malaria incidence was significantly higher in the dry season [IRR (95 % CI) 1.4 (1.1-1.6); p < 0.001)]. Use of ITN was associated to malaria protection in the localities [IRR (95 % CI) 0.7 (0.6-0.8); p = 0.001)]. A recurrent P. vivax episode within 90 days was observed in 29.4 % of individuals after an initial diagnosis. A previous P. vivax [IRR (95 % CI) 2.3 (1.3-4.0); p = 0.006)] or mixed P. vivax + P. falciparum [IRR (95 % CI) 2.9 (1.5-5.7); p = 0.002)] infections were significantly associated to a vivax malaria episode within 90 days of follow-up. CONCLUSIONS: In an area of P. falciparum and P. vivax co-endemicity, a virtual disappearance of P. falciparum was observed with P. vivax increasing its relative contribution, with a large proportion of recurring episodes. This finding reinforces the perception of P. falciparum being more responsive to early diagnosis and treatment and ITN use and the contribution of relapsing P. vivax to maintain this species' transmission. In areas of P. vivax endemicity, antihypnozoite treatment effectiveness assessment in different transmission intensity may be a fundamental activity for malaria control and elimination

Spleen rupture in a case of untreated Plasmodium vivax infection

We report the unique case of a 19-yearold nonimmune patient with Plasmodium vivax monoinfection, confirmed by PCR in the peripheral blood and in the spleen section, who was splenectomized due to spleen rupture two days prior to the diagnosis and treatment of the malarial infection. Microscopic analyses evidenced white pulp expansion and a diffuse hypercellularity in the splenic red pulp, with intense proliferating plasmablasts in the subcapsular and perivascular compartments as well as large numbers of intact P. vivax-infected reticulocytes in the cords, in the absence of other concomitant infectious diseases. To our knowledge, this is the first full detailed immunohistopathological characterization of a nontreated P. vivax-infected spleen

Are respiratory complications of Plasmodium vivax malaria an underestimated problem?

BACKGROUND: Respiratory complications are uncommon, but often life-threatening features of Plasmodium vivax malaria. This study aimed to estimate the prevalence and lethality associated with such complications among P. vivax malaria patients in a tertiary hospital in the Western Brazilian Amazon, and to identify variables associated with severe respiratory complications, intensive care need and death. Medical records from 2009 to 2016 were reviewed aiming to identify all patients diagnosed with P. vivax malaria and respiratory complications. Prevalence, lethality and risk factors associated with WHO defined respiratory complications, intensive care need and death were assessed. RESULTS: A total of 587 vivax malaria patients were hospitalized during the study period. Thirty (5.1%) developed respiratory complications. Thirteen (43.3%) developed severe respiratory complications, intensive care was required for 12 (40%) patients and 5 (16.6%) died. On admission, anaemia and thrombocytopaenia were common findings, whereas fever was unusual. Patients presented different classes of parasitaemia and six were aparasitaemic on admission. Time to respiratory complications occurred after anti-malarials administration in 18 (60%) patients and progressed very rapidly. Seventeen patients (56.7%) had comorbidities and/or concomitant conditions, which were significantly associated to higher odds of developing severe respiratory complications, need for intensive care and death (p < 0.05). CONCLUSION: Respiratory complications were shown to be associated with significant mortality in this population. Patients with comorbidities and/or concomitant conditions require special attention to avoid this potential life-threatening complication

Association of TLR variants with susceptibility to Plasmodium vivax malaria and parasitemia in the Amazon region of Brazil

BACKGROUND: Plasmodium vivax malaria (Pv-malaria) is still considered a neglected disease despite an alarming number of individuals being infected annually. Malaria pathogenesis occurs with the onset of the vector-parasite-host interaction through the binding of pathogen-associated molecular patterns (PAMPs) and receptors of innate immunity, such as toll-like receptors (TLRs). The triggering of the signaling cascade produces an elevated inflammatory response. Genetic polymorphisms in TLRs are involved in susceptibility or resistance to infection, and the identification of genes involved with Pv-malaria response is important to elucidate the pathogenesis of the disease and may contribute to the formulation of control and elimination tools. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective case-control study was conducted in an intense transmission area of Pv-malaria in the state of Amazonas, Brazil. Genetic polymorphisms (SNPs) in different TLRs, TIRAP, and CD14 were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis in 325 patients infected with P. vivax and 274 healthy individuals without malaria history in the prior 12 months from the same endemic area. Parasite load was determined by qPCR. Simple and multiple logistic/linear regressions were performed to investigate association between the polymorphisms and the occurrence of Pv-malaria and parasitemia. The C/T (TLR5 R392StopCodon) and T/T (TLR9 -1486C/T) genotypes appear to be risk factors for infection by P. vivax (TLR5: C/C vs. C/T [OR: 2.116, 95% CI: 1.054-4.452, p = 0.031]; TLR9: C/C vs. T/T [OR: 1.919, 95% CI: 1.159-3.177, p = 0.010]; respectively). Fever (COEF = 7599.46, 95% CI = 3063.80-12135.12, p = 0.001) and the C/C genotype of TLR9 -1237C/T (COEF = 17006.63, 95% CI = 3472.83-30540.44, p = 0.014) were independently associated with increased parasitemia in patients with Pv-malaria. CONCLUSIONS: Variants of TLRs may predispose individuals to infection by P. vivax. The TLR5 R392StopCodon and TLR9 -1486C/T variants are associated with susceptibility to Pv-malaria. Furthermore, the TLR9 variant -1237C/C correlates with high parasitemia

A segurança do paciente cirúrgico na perspectiva da vigilância sanitária — uma reflexão teórica

With the aim of preventing healthcare risks, improving health, and promoting patient safety, various measures have been implemented. Patient safety is equated to the re-duction of risk of unnecessary harm associated with healthcare to an acceptable mi-nimum. An incident that results in harm to a patient is known as Adverse Event (AE). Surgery-related AEs remain to be a global public health challenge. In Brazil, the National Health Surveillance Agency (ANVISA) and Ministry of Health have delineated actions, po-licies, and health regulation to prevent AEs, including those resulting from surgical pro-cedures. In 2013, the National Patient Safety Program was established and the actions of patient safety were regulated by ANVISA. Despite progresses in the recently established national security policy for patients, further measures are still required to improve the quality and safety of surgical care. The creation and maintenance of a safety culture in healthcare services will assure safer surgical procedures. Thus, this study aimed to discuss the primary components related to healthcare quality and patient safety that are considered as priority in healthcare services and discuss strategies employed by the government to promote safe surgical care.Diversas medidas de prevenção dos riscos relacionados à assistência e à melhoria da saúde são desenvolvidas em favor da segurança do paciente. A segurança do paciente é entendida como a redução, a um mínimo aceitável, do risco de dano desnecessário associado à atenção à saúde. Danos desnecessários são conhecidos como Eventos Ad-versos (EAs). A preocupação com a segurança cirúrgica constitui um desafio mundial de saúde pública. No Brasil, a Agência Nacional de Vigilância Sanitária (ANVISA) e o Ministério da Saúde delinearam ações, política e regulamentação sanitária para prevenir EAs, incluindo aqueles decorrentes de procedimentos cirúrgicos. Em 2013 foi instituído o Programa Nacional de Segurança do Paciente (PNSP), e a ANVISA regulamentou as ações de segurança do paciente. Apesar dos avanços da política nacional de segurança do pa-ciente, recentemente instituída no país, ainda são necessárias medidas visando a busca da qualidade e da segurança nos cuidados cirúrgicos. A instituição e a sustentação de cultura de segurança pode asseverar a cirurgia segura nos serviços de saúde. O objetivo deste artigo é discutir os principais componentes envolvidos na qualidade do cuidado e da segurança do paciente, como prioridades nos serviços de saúde e nas estratégias nacionais empregadas para a promoção da assistência cirúrgica segura