Perfil clínico e epidemiológico de pacientes idosos com doença de Chagas atendidos entre 2005-2013 por um serviço de atenção farmacêutica no estado do Ceará, nordeste do Brasil

Controlando-se a transmissão da doença de Chagas, surge o desafio de prestar assistência a milhões de pacientes infectados que chegam à velhice. Neste estudo, foram avaliados os registros socioeconômicos, demográficos e de comorbidades de todos os pacientes chagásicos idosos acompanhados no Serviço de Atenção Farmacêutica do Laboratório de Pesquisa em Doença de Chagas. As informações relacionadas à forma clínica da doença foram obtidas a partir de registros médicos disponibilizados pelo Hospital Universitário Walter Cantídio. O perfil da população estudada foi de: mulheres (50,5%); idade média de 67 anos; aposentados (54,6%); casados (51,6%); alta taxa de analfabetismo (40,2%); e renda familiar de um salário mínimo (51,5%). As formas clínicas predominantes da doença de Chagas foram a cardíaca (65,3%) e a indeterminada (14,7%). As principais alterações eletrocardiográficas foram o bloqueio de ramo direito (41,0%), associado ou não ao bloqueio ântero superior esquerdo (27,4%). O número médio de comorbidades por paciente foi de 2,23 ± 1,54, sendo a hipertensão arterial sistêmica a principal encontrada (67,0%). Verificou-se que os idosos constituem grupo vulnerável de pacientes que associam o envelhecimento com as alterações cardíacas e/ou digestivas resultantes da evolução da doença de Chagas e outras comorbidades, o que exige atenção especial dos serviços de saúde para um atendimento médico e social mais adequado.By controlling the transmission of Chagas disease, the challenge of providing assistance to millions of infected patients that reach old age arises. In this study, the socioeconomic, demographic and comorbidity records of all elderly chagasic patients followed at the Pharmaceutical Care Service of the Chagas Disease Research Laboratory were assessed. The information related to the clinical form of the disease was obtained from medical records provided by the Walter Cantídio University Hospital. The profile of the studied population was: women (50.5%); mean age of 67 years; retired (54.6%); married (51.6 %); high illiteracy rate (40.2%); and family income equal to the minimum wage (51.5%). The predominant clinical forms of Chagas disease were cardiac (65.3%) and indeterminate (14.7%). The main electrocardiographic changes were the right bundle branch block (41.0%), associated or not with the anterosuperior left bundle branch block (27.4%). The average number of comorbidities per patient was 2.23 ± 1.54, with systemic arterial hypertension being the main one found (67.0%). It was found that the elderly comprise a vulnerable group of patients that associate aging with cardiac and/or digestive disorders resulting from the evolution of Chagas disease and other comorbidities, which requires special attention from health services to ensure more appropriate medical and social care

Differential microRNA Profile in Operational Tolerance: A Potential Role in Favoring Cell Survival

Background: Operational tolerance (OT) is a state of graft functional stability that occurs after at least 1 year of immunosuppressant withdrawal. MicroRNAs (microRNA) are small non-coding RNAs that downregulate messenger RNA/protein expression of innumerous molecules and are critical for homeostasis. We investigated whether OT in kidney transplantation displays a differential microRNA profile, which would suggest that microRNAs participate in Operational Tolerance mechanisms, and may reveal potential molecular pathways.Methods: We first compared serum microRNA in OT (n = 8) with chronic rejection (CR) (n = 5) and healthy individuals (HI) (n = 5), using a 768-microRNA qPCR-panel. We used the Thermo Fisher Cloud computing platform to compare the levels of microRNAs in the OT group in relation to the other study groups. We performed validation experiments for miR-885-5p, by q-PCR, in a larger number of study subjects (OT = 8, CR = 12, HI = 12), as individual samples.Results: We detected a differential microRNA profile in OT vs. its opposing clinical outcome—CR—suggesting that microRNAs may integrate transplantation tolerance mechanisms. Some miRNAs were detected at higher levels in OT: miR-885-5p, miR-331-3p, miR-27a-5p vs. CR; others, we found at lower levels: miR-1233-3p, miR-572, miR-638, miR-1260a. Considering highly predicted/experimentally demonstrated targets of these miRNAs, bioinformatics analysis revealed that the granzyme B, and death receptor pathways are dominant, suggesting that cell death regulation integrates transplantation tolerance mechanisms. We confirmed higher miR-885-5p levels in OT vs. CR, and vs. HI, in a larger number of subjects.Conclusions: We propose that epigenetics mechanisms involving microRNAs may integrate human transplantation tolerance mechanisms, and regulate key members of the cell death/survival signaling. miR-885-5p could favor cell survival in OT by diminishing the levels of CRADD/RAIDD and CASP3. Nonetheless, given the nature of any complex phenomenon in humans, only cumulative data will help to determine whether this microRNA differential profile may be related to the cause or consequence of operational tolerance

SARS-CoV-2 reinfection caused by the P.1 lineage in Araraquara city, Sao Paulo State, Brazil

Reinfection by the severe acute respiratory syndrome coronavirus type 2 (SARS-COV-2) has been reported in many countries, suggesting that the virus may continue to circulate among humans despite the possibility of local herd immunity due to massive previous infections. The emergence of variants of concern (VOC) that are more transmissible than the previous circulating ones has raised particular concerns on the vaccines effectiveness and reinfection rates. The P.1 lineage was first identified in December 2020 in Manaus city and is now globally spread. We report the first case of reinfection of SARS-CoV-2 caused by the P.1 variant outside of Manaus. The potential of these new variants to escape naturally and vaccine- induced immunity highlights the need for a global vigilance

PREVALENCE OF CHAGAS DISEASE IN A RURAL AREA IN THE STATE OF CEARA, BRAZIL

SUMMARY Chagas disease is caused by Trypanosoma cruzi and affects about two to three million people in Brazil, still figuring as an important public health problem. A study was conducted in a rural area of the municipality of Limoeiro do Norte - CE, northeastern Brazil, aiming to determine the prevalence of T. cruzi infection. Of the inhabitants, 52% were examined, among whom 2.6% (4/154) were seropositive in at least two serological tests. All seropositive individuals were older than 50 years, farmers, with a low education and a family income of less than three minimum wages. Active surveillance may be an alternative for early detection of this disease

PREVALENCE OF CHAGAS DISEASE IN A RURAL AREA IN THE STATE OF CEARA, BRAZIL

A doença de Chagas é causada pelo Trypanosoma cruzi e atinge cerca de dois a três milhões de pessoas no Brasil, permanecendo como importante problema de saúde pública. Foi realizado um estudo em área rural do município de Limoeiro do Norte - CE, nordeste do Brasil, com o objetivo de conhecer a prevalência da infecção chagásica. Foram examinados 52% dos habitantes, dentre os quais 2,6% (4/154) apresentaram sorologia reagente em pelo menos dois testes sorológicos. Todos os positivos tinham idade superior a 50 anos, eram agricultores, com baixa escolaridade e renda familiar inferior a três salários mínimos. A busca ativa pode ser uma alternativa para o diagnóstico precoce dessa doença.Chagas disease is caused by Trypanosoma cruzi and affects about two to three million people in Brazil, still figuring as an important public health problem. A study was conducted in a rural area of the municipality of Limoeiro do Norte - CE, northeastern Brazil, aiming to determine the prevalence of T. cruzi infection. Of the inhabitants, 52% were examined, among whom 2.6% (4/154) were seropositive in at least two serological tests. All seropositive individuals were older than 50 years, farmers, with a low education and a family income of less than three minimum wages. Active surveillance may be an alternative for early detection of this disease

SARS-CoV-2 non-pharmaceutical interventions in Brazilian municipalities

Brazil has one of the fastest-growing COVID-19 epidemics worldwide. Non-pharmaceutical interventions (NPIs) have been adopted on a municipal level, with asynchronous actions taken across 5,568 municipalities and the Federal District. This paper addresses this complexity reporting on a novel dataset with survey responses from 4,027 mayors, 72.3% of the total municipalities in the country. This dataset responds to the urgency to track and share findings on fragmented policies to tackle health crises like the COVID-19 pandemic. Quantifying NPIs can allow for understanding the effectiveness of interventions in reducing transmission. We offer temporal details for a range of measures aimed at generating social distancing as well as when local governments started to relax those measures.,Information on local NPI policies related to COVID-19 were collected through a phone-based survey conducted directly with mayors, with an option to receive a protected password to respond to the questionnaire online at a later time or to update previous answers. We focused on information that has a direct impact on the mobility of residents; that was associated with a specific date of implementation; and that, as policies, are of public domain but were not yet tabled together. We collected information on policies adapting a classification system that included: (1) adoption of cordon sanitaire, (2) prohibition of agglomeration, (3) closure of all but essential services, and (4) compulsory use of face covers, (5) reduction in public transportation offer and if so, what was the percentage of the reduction, and (6) if there was already any easing of the above distancing measures. For all questions there was a side column asking when the action was adopted, and that field was populated in the format DD/MM/YYYY. In order to collect these data, we started a collaboration with the Brazilian Confederation of Municipalities (CNM). This cooperation was established through a meeting followed by a written agreement signed by the first and last authors of this paper with CNM on April 9, 2020. The authors were allowed to describe, deposit and analyse the dataset. The public availability of these data also extends to other scholars the right to analyse the data. CNM has a call centre and as the largest municipal association in Brazil, they possess the email and telephone number of all Brazilian elected mayors. The capillarity of that organisation makes it an ideal partner for such large-scale data collection. The partnership was established because of the need to understand the impact of decentralized measures in Brazil and what decentralisation causes to the spread of infectious diseases. Upon the establishment of this collaboration, CNM designed further questions to the questionnaire that are of interest to their monitoring of municipalities, such as budgetary information possibly affected by the pandemic. In total, the questionnaire had 47 questions; our database has 5 columns related to the identification of the municipality and 13 of the 47 questions that were part of our collaboration to document NPI policy strategies. The 13 questions that form this dataset (6 thematic questions with respective 6 dates of implementation and 1 question pertaining to percentage) were discussed through coordinated orientation.,Because not all municipal authorities answered to all questions, we suggest users to consider additional sources of information to document missing policy implementation using preferably official source of information such as local decrees. However, as decrees are not always available online, secondary sources such as media reports may need to be consulted. As the pandemic progresses and as Brazil is a highly affected country, we invite researchers to use the data to best understand the pandemic and support health policymakers in their efforts.,</span

Insect vectors of Chagas disease (Trypanosoma cruzi) in Northeastern Brazil

Abstract INTRODUCTION: Chagas disease remains a public health problem in the rural and urban areas of 19 countries in the Americas. METHODS: The aim of the present study was to investigate the Trypanosoma cruzi infection rate of triatomines collected from both intra- and peridomiciliary areas in eleven municipalities of Southeastern Ceará, Brazil, from 2009 to 2015. RESULTS: A total of 32,364 triatomine specimens, including nymphs and adults, were collected, and 31,736 (98.06%) of these were examined. More nymphs were collected than adults, and the greatest number of triatomines (n = 8,548) was collected in 2010, for which the infection rate was 1.3%, with the highest rate of infections observed for specimens from Quixere. The species collected during the study were identified as Triatoma pseudomaculata, Triatoma brasiliensis, Panstrongylus megistus, Panstrongylus lutzi, and Rhodnius nasutus, with T. pseudomaculata being the most abundant (n = 19,962). CONCLUSIONS: These results verify the presence of triatomines in both intra- and peridomiciliary areas, thereby ensuring persistence of the pathogen and consequently, the disease, as the presence of infected vectors in households is an important risk factor. According to these findings, the Chagas Disease Control Program should intensify its efforts in order to prevent the spread of the disease