Natural Resistance of Leishmania infantum to Miltefosine Contributes to the Low Efficacy in the Treatment of Visceral Leishmaniasis in Brazil

In India visceral leishmaniasis (VL) caused by Leishmania donovani has been successfully treated with miltefosine with a cure rate of > 90%. To assess the efficacy and safety of oral miltefosine in L. infantum-causing Brazilian VL patients, a phase II, open-label, dose-escalation study of oral miltefosine was conducted in children (ages 2-12) and adolescent-adults (ages 13-60). Definitive cure was assessed at a 6 month follow-up visit. The cure rate was only 42% (6 out of 14 patients) with the recommended 28 days of therapy and 68% (19 out of 28 patients) with an extended treatment of 42 days. The in vitro miltefosine susceptibility profile of intracellular amastigote stages of the pre-treatment isolates, from cured and relapsed patients, showed a positive correlation with clinical outcome. The IC50 mean (SEM) of eventual cures was 5.1 (0.4) µM whereas that of eventual failures was 12.8 (1.9) µM (P = 0.0002). An IC50 below or above 8.0 µM predicts cure or failure, respectively with 82% sensitivity and 100% specificity. The finding of L. infantum amastigotes resistant to miltefosine in isolates from patients who eventually failed treatment, strongly suggests natural resistance to this drug, as miltefosine had never been used in Brazil before this trial was carried out

Postpartum women’s use of medicines and breastfeeding practices: a systematic review

The objectives of this article are to systematically review i) the extent of medicine use in postpartum women, and ii) the impact of maternal medicine use (excluding contraceptives and galactogogues) on breastfeeding outcomes (initiation and/or duration). PubMed, Medline (Ovid), Scopus (Elsevier), Cinahl (EBSCO), PsycINFO (Ovid), Embase (Ovid) and Web of Science (ISI) databases were searched to find original studies on medicine use in women after the birth. Additional studies were identified by searching Google Scholar, Wiley Online Library, Springer Link, selected journals and from the reference list of retrieved articles. Observational studies with information about postpartum women’s use of any type of medicine either for chronic or acute illnesses with or without breastfeeding information were included. The majority of relevant studies suggest that more than 50 % of postpartum women (breastfeeding or not) required at least one medicine. Due to the lack of uniform medication use reporting system and differences in study designs, settings and samples, the proportion of medicine use by postpartum women varies widely, from 34 to 100 %. Regarding the impact of postpartum women’s medicine use on breastfeeding, a few studies suggest that women’s use of certain medicines (e.g. antiepileptics, propylthiouracil, antibiotics) during lactation can reduce initiation and/ or duration of breastfeeding. These studies are limited by small sample size, and with one exception, all were conducted in Canada more than a decade ago. Large scale studies are required to establish the relationship between maternal medicine use and breastfeeding, considering type of illness, period of use and total duration of medicine use

Voto econômico retrospectivo e sofisticação política na eleição presidencial de 2002

Este artigo aborda o tema do voto econômico a partir da perspectiva da desigualdade de sofisticação política entre os eleitores. Diversos estudos mostram que os eleitores brasileiros tendem a se basear na economia para votar e avaliar os presidentes. Essas evidências algumas vezes servem de suporte para a afirmação de que, mesmo não utilizando os partidos, os rótulos ideológicos e outras questões politicamente relevantes como referências para suas escolhas, o eleitorado de massa no Brasil seria capaz de tomar decisões criteriosas na política. Utilizando dados de pesquisa de painel coletados ao longo de 2002 em Caxias do Sul e Juiz de Fora, o artigo testa até que ponto o efeito da avaliação retrospectiva da economia (tanto do país quanto pessoal) sobre o voto para presidente depende do nível de sofisticação política do respondente. Os resultados mostram que a avaliação da economia tende a ser uma opinião instável ao longo do período analisado, e tem impacto sobre a escolha do candidato a presidente apenas entre os eleitores mais politicamente sofisticados. As implicações dos achados são discutidas e aponta-se para a relevância de se levar em conta o impacto da desigualdade de sofisticação política entre os eleitores no entendimento da dinâmica das eleições e da opinião pública no Brasil