ÁGUA DE CONSUMO HUMANO PROVENIENTE DE POÇOS RASOS COMO FATOR DE RISCO DE DOENÇAS DE VEICULAÇÃO HÍDRICA

A água é fundamental à manutenção da vida, porém, tem-se caracterizado como um veiculador de doenças causadas por bactérias, protozoários e vírus. A água de consumo pode ser obtida de diversas fontes, entre elas os poços rasos, mais suscetíveis a contaminação devido à menor profundidade. Este  trabalho objetivou avaliar o  risco potencial de veiculação de doenças em amostras de água utilizada para consumo, provenientes de poços rasos. Foram avaliadas amostras de água provenientes de 168 poços rasos no período de 2005-2010, em de Londrina-PR, através da pesquisa de coliformes totais e do  indicador de contaminação  fecal a Escherichia coli, pelo método do  substrato cromogênico Colilert. Em 26 amostras (15,5%) os microrganismos estavam ausentes, já 142 amostras (84,5%) foram positivas para coliformes totais e 93 amostras (55,3%) foram positivas para coliformes totais e Escherichia coli. De acordo com os resultados encontrados, a população que utiliza água de poço raso tem grande probabilidade de contrair doenças de veiculação hídrica. Esses resultados demonstram a importância do controle microbiológico da água fornecida à população para prevenção de surtos de doenças de veiculação hídrica e preservação da saúde pública o que pode ser feito através do tratamento da água de poços rasos com cloro.Descritores: Doenças transmitidas pela água. Poços rasos. Água potável.AbstractDrinking water from shallow well as a risk factor for waterborne diseases. Water is essential for the maintenance of life, however, it can become a carrier of diseases caused by bacteria, protozoa and virus. Drinking water can be obtained from several sources what it include shallow wells that are more susceptible to contamination due to the shallower depth. This study aimed to evaluate the potential risk of transmission of diseases in samples of drinking water used for consumption from shallow wells. It were analyzed water samples from 168 shallow wells in the period 2005-2010, in Londrina, Paraná, through the  research of  indicators of  total  coliforms  and Escherichia  coli by Colilert  chromogenic  substrate method. The  results showed that the indicators were absent in 26 samples (15,5%), 142 samples (84,5%) were positive for total coliforms and 93 samples (55,3%) were positive for not only total coliforms but also E. coli. According to the results, the population that uses water from shallow wells may have high probability of contracting waterborne diseases. This demonstrates the importance of microbiological control of water supplied to the population to prevent outbreaks of waterborne diseases and preservation of public health what can be made by treatment of the water from shallow wells with chlorine.Descriptors: Waterborne diseases. Shallows wells. Drinking water

Caracterização genotípica de fatores de virulência de Escherichia Coli enterotoxigênica isoladas de água para consumo humano

Introdução: As doenças veiculadas pela água são principalmente causadas por patógenos entéricos, sendo o patotipo Escherichia coli enterotoxigênica (ETEC) de grande importância em países em desenvolvimento. Objetivo: Detectar a presença de genes de virulência relacionados à ETEC em cepas de E. coli isoladas de água para consumo humano. Metodologia: 295 cepas de E. coli obtidas de água de 27 municípios do norte do Estado do Paraná, Brasil, entre fevereiro e dezembro de 2005, foram testadas quanto a presença de genes que codificam para as enterotoxinas LT-I (lt-I), ST-a (st-a) e ST-b (st-b) e para os fatores de colonização CFA/I (cfa/I), CFA/II (cfa/ II), K88 (faeG) e K99 (fanC) através da técnica da PCR. Resultados: Das 295 cepas de E. coli estudadas, 36 (12,2%) apresentaram o gene lt-I, uma (0,34%) o gene st-a e três (1,02%) o st-b. Quanto aos fatores de colonização, três cepas (1,02%) foram positivas para o gene faeG, quatro (1,36%) para cfa/I, duas (0,68%) para cfa/II e nenhuma apresentou o gene fanC. Uma cepa (0,34%) foi positiva simultaneamente para os genes lt-I e st-b e outra (0,34%) para os genes lt-I e faeG. Conclusão: Logo, cinquenta e uma (17,29%) cepas apresentaram, pelo menos, um gene que codifica enterotoxina e/ou fator de colonização relacionado à ETEC. Sendo assim, o cuidado com a qualidade microbiológica da água para consumo humano é fundamental, evitando que a mesma torne-se veículo de transmissão de bactérias potencialmente patogênicas, como ETEC

CARACTERIZAÇÃO MICROBIOLÓGICA E FÍSICO-QUÍMICA DO LODO DE DECANTADORES DAS ESTAÇÕES DE TRATAMENTO DE ÁGUA APÓS DESAGUAMENTO EM LEITO DE DRENAGEM COM MANTA GEOTÊXTIL

Nas estações de  tratamento de água  (ETas) o principal  resíduo é o  lodo de decantadores, que pode apresentar microrganismos e metais tóxicos. foi avaliado o tratamento de lodos provenientes de duas ETas de londrina-Pr (Tibagi e Cafezal) pelo sistema de desaguamento em leito de drenagem com manta geotêxtil. No lodo e nos produtos do desaguamento de lodos: água drenada e a torta (sólidos retidos na manta), foram pesquisados os indicadores microbiológicos coliformes totais  e Escherichia  coli,  além  de Enterococcus  faecalis, E.  faecium,  e Clostridium  perfringens. No  lodo  e  no  drenado foram pesquisados os parâmetros físico-químicos, tais como, metais, demanda Bioquímica de oxigênio (dBo), demanda Química de oxigênio (dQo), turbidez, Ph e cor aparente. os resultados demonstraram a ausência do indicador C. perfringens e  elevados  índices microbiológicos no  lodo  in natura. após o desaguamento  foi observado na ETa Tibagi uma  redução de  95%  dos  indicadores  encontrados  e  79%  na  ETa Cafezal. Nos  parâmetros  físico-químicos  a  redução  foi  de  89%  e 58%,respectivamente, nas duas ETas. Na torta após a exposição à luz solar por 5 dias em ambiente natural, na ETa Tibagi C. perfringens não foi  identifcado, Enterococcus não apresentou redução e nos outros  indicadores a redução foi 99.99%. Na ETa Cafezal C. perfringens não foi  identifcado, e a redução mínima foi de 47.83% para os  indicadores encontrados. Foi evidenciado o potencial poluente do despejo in natura deste resíduo, a necessidade e viabilidade do tratamento do lodo, visando à proteção dos corpos receptores e a saúde da população.Descritores: Estação de tratamento de água. lodo. Microrganismos. Parâmetros físico-químicos. Tratamento do lodo.Abstractin water treatment plants (WTP) the main residue is the sludge found in decanters which may have microorganisms and toxic metals. The treatment of sludgefrom two WTP of londrina-Pr (Tibagi and Cafezal) was evaluated by dewatering system in drainage bed with geotextile blanket. in the sludge and sludge dewatering products: water drained and the cake (solids retained in the geotextile blanket) were surveyed the microbiological indicators total coliforms and Escherichia coli, besides Enterococcus  faecalis, E.  faecium,  and Clostridium  perfringens.  in  the  sludge  and  drained were  researched  the physical and chemical parameters such as, metals, biochemical oxygen demand (Bod), chemical oxygen demand (Cod), turbidity, ph and apparent color. The results showed the absence of the indicator C. perfringens and high microbiological indices  in  the  in naturasludge. after dewatering was observed  in Tibagi WTP a reduction of 95% of  the  indicators found and of 79% in Cafezal WTP. in the physical and chemical parameters the reductionwas 89% and 58%, respectively, in both WTP. In relation  to cake, after exposure to sunlight for fve days in a natural environment, C. perfringens was not identifed, Enterococcus did not decrease and other indicators the reduction was 99.99%, inTibagi WTP. in Cafezal WTP,C. perfringens was not identifed and the minimal reduction was of 47.83% for the indicators found. It was shown the polluting potential of in natura discharge of this residue, the need and feasibility of sludge treatment, in order to protect the receiving bodies and the health of population.Descriptors: Water treatment plants. Sludge. Microorganisms. Physical and chemical parameters. Sludge treatment

Real-Time PCR in HIV/Trypanosoma cruzi Coinfection with and without Chagas Disease Reactivation: Association with HIV Viral Load and CD4+ Level

Chagas disease is endemic in Latin America and is caused by the flagellate protozoan T. cruzi. The acute phase is asymptomatic in the majority of the cases and rarely causes inflammation of the heart or the central nervous system. Most infected patients progress to a chronic phase, characterized by cardiac or digestive involvement when not asymptomatic. However, when patients are also exposed to an immunosuppressant (such as chemotherapy), neoplasia, or other infections such as HIV, T. cruzi infection may develop into a severe disease (Chagas disease reactivation) involving the heart and central nervous system. The current microscopic methods for diagnosing Chagas disease reactivation are not sensitive enough to prevent the high rate of death observed in these cases. Therefore, we propose a quantitative method to monitor blood levels of the parasite, which will allow therapy to be administered as early as possible, even if the patient has not yet presented symptoms

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016

Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. FINDINGS: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. INTERPRETATION: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. FUNDING: Bill & Melinda Gates Foundation

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : a novel analysis from the Global Burden of Disease Study 2015

Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Microbiological water quality of Igapó Lake Londrina - PR and genotypic characterization of virulence factors associated with enteropathogenic Escherichia coli (EPEC) and Shiga toxin-producing E. coli (STEC)

This work aimed at the detection and quantification of Total Coliforms and Escherichia coli in Igapó Lake, in order to evaluate the quality of these waters as proper or unfit for recreation, in addition to the genotypic characterization of virulence factors associated with EPEC and STEC by PCR. The study area was the Igapó Lake I, II, III and IV. Samples were collected monthly from March 2011 to February 2012. The technique used for the detection and quantification of Total Coliforms and E. coli was the Colilert chromogenic substrate. In the technique of PCR, the eae and bfp genes were tested to characterize the typical EPEC pathotype; stx1, stx2, eae and hlyA the STEC pathotype and the samples that presented only the eae gene were characterized as atypical EPEC. According to CONAMA Resolution 357/2005, it has been observed that only Igapó Lake III was rated inappropriate for primary contact recreation, while for secondary contact recreation, all lakes were considered appropriate. Moreover, a strong relationship between rainfall and E. coli indices in Igapó Lake can be observed, which in dry months the quantity drastically decreases, while in rainy months the opposite relationship was observed. Of the 97 strains of E. coli isolated, two had the eae gene (atypical EPEC). None of the isolates contained genes stx1, stx2, bfp and hlyA. Thus, we hope to educate the population and public agencies of the importance of microbiological monitoring of recreational waters to prevent outbreaks of waterborne infections