Overview of Chagas disease surveillance in an endemic region in Southeastern Brazil

Chagas disease (CD) is a neglected disease caused by the protozoan Trypanosoma cruzi. It has high morbidity and mortality rates and mainly affects socially vulnerable populations. This is a cross-sectional study, with retrospective and prospective data collection. Using questionnaires applied to environmental surveillance coordinators, we characterized the status of CD surveillance activities in municipalities endemic for the disease in Northern Minas Gerais State (MG) and Jequitinhonha Valley (Vale do Jequitinhonha). Moreover, we spatialized the vulnerability index for chronic CD in the study area. The population consisted of 22 environmental surveillance coordinators, active in 2020, from Northern MG and Jequitinhonha Valley, 21 municipalities included in the SaMi-Trop research project, and Montes Claros municipality. After applying the questionnaires to the coordinators, a descriptive analysis of the variables was performed. To characterize the active municipalities, the explanatory variables collected in the questionnaire were compared with the dichotomous variable. Bivariate descriptive analysis was performed. Finally, geoprocessing techniques were used to spatialize the data and prepare maps. Regarding the team of endemic combat agents (ECA), 90.9% reported the lack of a specific team for CD vector control actions. Of the 22 municipalities participating in this study, nine were active (41.1%). Only 25% (n=2) of active municipalities (9% of the municipalities studied) met the target of visiting 50% of households per year. Finally, 81.1% of the coordinators stated that in their municipality, they developed actions linked to primary health care (PHC). The implementation of CD surveillance activities weakened in the endemic region. Few municipalities have a surveillance team, with low regularity of active surveillance and noncompliance with the program’s goal. The results suggest insufficient recording of activities in the information system, considering that there are municipalities that report performing the activities, but no production record was observed in the system

Serological screening for Chagas disease in an endemic region of Northern Minas Gerais, Brazil: the SaMi-Trop project

Chagas disease (CD) is still a neglected disease. Infected individuals are diagnosed late, being treated in worse clinical conditions. Thus, this study aimed to analyze the prevalence and the factors associated with new confirmed cases of CD identified by serological screening in an endemic region of Minas Gerais State, Brazil. This is an analytical cross-sectional study with data from a project of the Research Center in Tropical Medicine of Sao Paulo- Minas Gerais (SaMi-Trop) conducted in two municipalities. Data collection included a questionnaire with closed questions, a venous blood collection and an ELISA serological test for CD. A total of 2,038 individuals with no previous diagnosis of CD participated in the study. The result of the serological test for CD was adopted as the dependent variable. The independent variables addressed personal issues, health conditions and lifetime housing. A descriptive analysis of individual variables was performed. Subsequently, a bivariate analysis was performed using the Pearson’s chi-square test. Households sheltering individuals positive for CD were georeferenced, and the analysis of spatial distribution was performed using the quartic function to estimate the density of the nucleus. Among the participants, 188 (9.2 %) were positive for CD. The profile of participants with CD was associated with place of residence, age, relative/family member with CD and living conditions. It is noteworthy that there are still patients with CD who are unaware of their diagnosis in both, rural and urban areas

Profilaxia pré-exposição ao HIV (PrEP) como estratégia de prevenção combinada e sua eficácia clínica: Uma revisão integrada da Literatura.

This study aims to highlight the importance of Pre-Exposure Prophylaxis (PrEP) as an essential part of the combined HIV prevention strategy. To this end, an integrative review was conducted from June to September 2023, with research carried out in the SciELO and PubMed databases, using descriptors such as "PrEP/Pre-Exposure Prophylaxis", "HIV", "profilaxis/prophylaxis" and "effectiveness." The initial search resulted in 42 articles, which were subsequently subjected to rigorous selection criteria, resulting in the choice of 30 relevant articles. After applying the selection criteria, the 30 selected articles were subjected to a thorough reading by all members of the research team, aiming to collect effectiveness data. Seven large studies that evaluated the effectiveness of PrEP were identified and represented in a unified table, addressing the thematic categories of daily and on-demand pre-exposure prophylaxis. This made these studies easier to view and understand, providing a comprehensive view of PrEP effectiveness in different contexts. In summary, PrEP represents a significant advance in HIV prevention and plays a fundamental role in the fight against the epidemic. However, your success is intrinsically linked to awareness, education and ongoing support. Furthermore, PrEP must be integrated with other prevention strategies to optimize its impact in reducing the spread of HIV. The challenge now lies in ensuring equitable and effective access to PrEP, especially for vulnerable populations, in order to achieve goals related to ending the HIV epidemic. Consequently, PrEP plays a crucial role in the evolution of HIV prevention and the search for a future free from this epidemic.Este estudo tem como objetivo destacar a importância da Profilaxia Pré-Exposição (PrEP) como parte essencial da estratégia de prevenção combinada do HIV. Para isso, foi conduzida uma revisão integrativa no período de junho a setembro de 2023, com pesquisa realizada nas bases de dados SciELO e PubMed, utilizando descritores como "PrEP/Pre-Exposure Prophylaxis", "HIV", "profilaxia/ Prophylaxis" e "eficácia/effectiveness". A pesquisa inicial resultou em 42 artigos, que foram posteriormente submetidos a critérios de seleção rigorosos, resultando na escolha de 30 artigos relevantes. Após a aplicação dos critérios de seleção, os 30 artigos selecionados foram submetidos a uma leitura minuciosa por todos os membros da equipe de pesquisa, visando a coleta de dados de eficácia. Sete grandes estudos que avaliaram a eficácia da PrEP foram identificados e representados em uma tabela unificada, abordando as categorias temáticas de profilaxia pré-exposição de uso diário e sob demanda. Isso facilitou a visualização e compreensão desses estudos, fornecendo uma visão abrangente da eficácia da PrEP em diferentes contextos. Em resumo, a PrEP representa um avanço significativo na prevenção do HIV e desempenha um papel fundamental na luta contra a epidemia. No entanto, seu sucesso está intrinsecamente ligado à conscientização, educação e apoio contínuo. Além disso, a PrEP deve ser integrada a outras estratégias de prevenção para otimizar seu impacto na redução da disseminação do HIV. O desafio agora reside em garantir um acesso equitativo e eficaz à PrEP, especialmente para populações vulneráveis, a fim de alcançar as metas relacionadas ao término da epidemia de HIV. Consequentemente, a PrEP desempenha um papel crucial na evolução da prevenção do HIV e na busca por um futuro livre dessa epidemia

Left ventricular systolic dysfunction predicted by artificial intelligence using the electrocardiogram in Chagas disease patients-The SaMi-Trop cohort

BACKGROUND: Left ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and reduce mortality. Recently, an artificial intelligence (AI)-enabled ECG algorithm showed excellent accuracy to detect LVSD in a general population, but its accuracy in ChD has not been tested. OBJECTIVE: To analyze the ability of AI to recognize LVSD in patients with ChD, defined as a left ventricular ejection fraction determined by the Echocardiogram ≤ 40%. METHODOLOGY/PRINCIPAL FINDINGS: This is a cross-sectional study of ECG obtained from a large cohort of patients with ChD named São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) Study. The digital ECGs of the participants were submitted to the analysis of the trained machine to detect LVSD. The diagnostic performance of the AI-enabled ECG to detect LVSD was tested using an echocardiogram as the gold standard to detect LVSD, defined as an ejection fraction <40%. The model was enriched with NT-proBNP plasma levels, male sex, and QRS ≥ 120ms. Among the 1,304 participants of this study, 67% were women, median age of 60; there were 93 (7.1%) individuals with LVSD. Most patients had major ECG abnormalities (59.5%). The AI algorithm identified LVSD among ChD patients with an odds ratio of 63.3 (95% CI 32.3-128.9), a sensitivity of 73%, a specificity of 83%, an overall accuracy of 83%, and a negative predictive value of 97%; the AUC was 0.839. The model adjusted for the male sex and QRS ≥ 120ms improved the AUC to 0.859. The model adjusted for the male sex and elevated NT-proBNP had a higher accuracy of 0.89 and an AUC of 0.874. CONCLUSION: The AI analysis of the ECG of Chagas disease patients can be transformed into a powerful tool for the recognition of LVSD

MÍDIA E REELABORAÇÃO DE GÊNEROS DO DISCURSO: DIÁLOGO ENTRE O MEIO IMPRESSO E A INTERNET

A língua, em seus mais diversos usos e convenções, não é estática, mas é intensamente viva, maleável e dinâmica, porque aqueles que dela fazem uso também o são. As mudanças ocorridas com e através do ser humano fazem surgir a necessidade de novas palavras, num ininterrupto rearranjar de conceitos, classificações e categorizações. Partindo desse pressuposto, o presente artigo tem como intuito analisar como gêneros discursivos  podem ser reelaborados e transitar em diferentes esferas da comunicação humana, a depender da forma como são utilizados. Para tanto, tomamos como objeto de análise a coluna “Blogs do Além”, publicada na revista Carta Capital de 11 de abril de 2012, Ano XVII, nº 692, intitulado “Blog do Costa e Silva”, criada e assinada pelo publicitário Vitor Knijnik