Dengue: 30 years of cases in an endemic area

The present study aimed to review literature on studies of dengue cases conducted over 30 years in the state of Ceara´. Between November 2015 and January 2016, articles published in Portuguese and English in 7 databases were searched using keywords and a Boolean operator. A total of 191 articles were identified in the databases; 133 were excluded according to the exclusion criteria, and 58 were included in the study. Of the 58 articles analyzed, 6 reported data from Brazil; including the Northeast region and the state of Ceara´; 41 reported data for only the city of Fortaleza; 7 reported data for the state of Ceara´; 4 reported data for cities in the interior of the state; and 3 included only children. The studies adopted different approaches and focused on different aspects of the disease. Study outcomes included the identification of serological, epidemiological, clinical, and laboratory characteristics; potential larvicides and biological predators of mosquitoes; potential antiviral agents; vector density characteristics; and educational dengue prevention and control strategies. Additionally, one vaccine trial was included. Although studies on dengue in the state of Ceara´ are scarce, they are encompassing, including several lines of research, and the number of studies and reports on dengue in the state of Ceara´ continues to increase

O desafio do diagnóstico e tratamento da Tuberculose diante de outras afecções pulmonares - um relato de caso.

A tuberculose é uma doença infecto-contagiosa causada pelo Mycobacterium tuberculosis. O esquema de tratamento padrão é a associação de múltiplas drogas, visando minimizar a resistência bacteriana. O objetivo deste estudo foi descrever o desafio do diagnóstico e do tratamento da tuberculose diante de outras afecções pulmonares através de um relato de caso clínico. Como foi observado no presente estudo, existe dificuldade quanto ao diagnóstico precoce e tratamento, se tornando um desafio na prática em saúde. Mesmo com o programa de atenção à tuberculose na estratégia de saúde da família, existem dificuldades quanto ao conhecimento da patologia e mitos quanto à etiologia e viabilidade de cura. As estratégias aplicadas pelos serviços de saúde embora obtenham resultados satisfatórios na redução da incidência da tuberculose, deve procurar outras possibilidades, visto que ainda ocorrem lacunas quanto ao diagnóstico e tratamento desta infecção. Este estudo demonstra que o desafio diagnóstico perpetua, pois os sinais e sintomas continuam sendo confundidos com diversas afecções pulmonares e requer o comprometimento da equipe de saúde na realização de exames e consultas para um diagnóstico precoce e adequado

DESENVOLVIMENTO SUSTENTÁVEL: UMA PERSPECTIVA INTEGRADA PARA GARANTIR SAÚDE PLANETÁRIA E A SOBERANIA ALIMENTAR

This article is about the interconnection between sustainable development with regard to ensuring planetary health and food sovereignty. In this context, planetary health is understood based on the paradigm shift proposed by the degradation of the environment during the decades preceding the current situation. In the meantime, it can be said that, in addition to excess production towards agribusiness, there is also the formation of the process of food insecurity and disrespect for the cultures of each society, through the violence proposed by the colonial idea of enrichment through economic capital. To this end, this summary studies the interconnection between sustainable development, planetary health and Food Sovereignty, in order to clarify the implications intrinsic to each concept and intertwined with each other. In this sense, secondary sources were chosen, through books, articles and texts that were related to the objective. Thus, as an exclusion criterion, all texts that did not express a strict relationship and were on the margins of the debate were discarded. On the other hand, for inclusion, we sought to collect texts that discuss the topic in a way corresponding to the discussion. Thus, food sovereignty is the right of people to define their own agricultural and food policies according to their needs and cultures, which recognizes the importance of autonomy in the production and access to healthy and sustainable food. Food sovereignty values ​​family farming, fair trade and the preservation of natural resources. In turn, planetary health presents itself as an essential approach to sustainable development and promoting human well-being. Thus, the search for planetary health, sustainable development and food sovereignty is a collective and continuous effort that requires concrete actions at a global, national and individual level. Therefore, the protection and preservation of the environment, the promotion of sustainable agricultural practices, especially within the family, and the guarantee of equitable access to healthy food are essential elements for a healthy and sustainable future for all, so that by recognizing interdependence Between health, the environment and healthy eating, we can talk about sustainable development.O presente artigo versa sobre a interconexão entre o desenvolvimento sustentável no que diz respeito à garantia da saúde planetária e da soberania alimentar. Nesse contexto, a saúde planetária é compreendida a partir da mudança de paradigma proposta pela degradação do meio ambiente durante os decênios que precedem o quadro atual. Nesse ínterim, pode-se dizer que, além do excesso de produção em direção ao agronegócio, tem-se, outrossim, a formação do processo de insegurança alimentar e do desrespeito às culturas de cada sociedade, por meio da violência proposta pela ideia colonial do enriquecimento através do capital econômico. Para tanto, este resumo estuda a interconexão entre desenvolvimento sustentável, saúde planetária e Soberania Alimentar, de forma a clarificar as implicações intrínsecas a cada conceito e entrelaçadas entre si. Nesse sentido, optou-se por fontes secundárias, através de livros, artigos e textos que tivessem relação com o objetivo. Assim, como critério de exclusão, foram descartados todos os textos que não expressassem relação estrita e estivessem à margem do debate. Por outro lado, para inclusão, procurou-se coletar os textos que discutem a temática de forma correspondente à discussão. Destarte, a soberania alimentar é o direito dos povos de definirem suas próprias políticas agrícolas e alimentares de acordo com suas necessidades e culturas que reconhecem a importância da autonomia na produção e no acesso a alimentos saudáveis e sustentáveis. A soberania alimentar valoriza a agricultura familiar, o comércio justo e a preservação dos recursos naturais. Por sua vez, a saúde planetária apresenta-se como abordagem imprescindível no desenvolvimento sustentável e na promoção ao bem-estar do ser humano. Assim, a busca pela saúde planetária, o desenvolvimento sustentável e a soberania alimentar trata-se de um esforço coletivo e contínuo que requer ações concretas em nível global, nacional e individual. Desse modo, a proteção e preservação do meio ambiente, a promoção de práticas agrícolas sustentáveis, mormente no âmbito familiar, a garantia de acesso equitativo a alimentos saudáveis são elementos essenciais para um futuro saudável e sustentável para todos, de forma que ao reconhecer a interdependência entre saúde, meio ambiente e a alimentação saudável, pode-se falar em desenvolvimento sustentável

Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities

Aspectos entomológicos e epidemiológicos das epidemias de dengue em Fortaleza, Ceará, 2001-2012

Resumo Objetivo: descrever os aspectos entomológicos e epidemiológicos das epidemias de dengue ocorridas em Fortaleza, Ceará, Brasil, de 2001 a 2012. Métodos: estudo descritivo com dados dos Sistemas de Informação de Agravos de Notificação (Sinan), de Informações Hospitalares (SIH), do Programa de Febre Amarela e Dengue (2001-2009), do Programa Nacional de Controle da Dengue (2010-2012) e Levantamento Rápido do Índice de Infestação de Aedes aegypti, referentes aos anos quando a incidência da doença superou o percentil 75%. Resultados: De 2001 a 2012 foram notificados 194.446 casos suspeitos de dengue. Os anos epidêmicos foram: 2001, 2006, 2008, 2011 e 2012. Houve aumento progressivo da incidência (587,0/100 mil hab. [2001] e 1.561,1/100 mil hab [2012]), com cocirculação de até três sorotipos e elevada infestação vetorial, principalmente em depósitos para armazenar água. Conclusão: após longo período de circulação do vírus em Fortaleza, a dengue permanece como importante problema de saúde, com casos graves e alta letalidade

Coinfection with influenza A(H1N1)pdm09 and dengue virus in fatal cases

Abstract We report on four patients with fatal influenza A(H1N1)pdm09 and dengue virus coinfections. Clinical, necropsy and histopathologic findings presented in all cases were characteristic of influenza-dengue coinfections, and all were laboratory-confirmed for both infections. The possibility of influenza and dengue coinfection should be considered in locations where these two viruses&#8217; epidemic periods coincide to avoid fatal outcomes. Dengue is a mosquito-borne viral infection caused by one of the four dengue viruses (DENV-1 to 4). Each of these viruses is capable of causing nonspecific febrile illnesses, classic dengue fever and dengue haemorrhagic fever (Gubler 1998). As a result, dengue is often difficult to diagnose clinically, especially because peak dengue season often coincides with that of other common febrile illnesses in tropical regions (Chacon et al. 2015). In April 2009, a new virus, in&#64258;uenza A/H1N1/pandemic (FluA/H1N1/09pdm), caused a severe outbreak in Mexico. The virus quickly spread throughout the world, and in June 2009, the World Health Organization declared a pandemic (WHO 2010). In Brazil, the first laboratory confirmed case of FluA/H1N1/09pdm was in July 2009 (Pires Neto et al. 2013). The state of Ceará, in Northeast Brazil, is a dengue endemic area. In this state, the virus influenza A(H1N1)pdm09 has circulated since 2009, and through the first half of 2012, 11 deaths caused by the virus were confirmed (Pires Neto et al. 2013). The influenza and dengue seasons in Ceará overlap, which led to diagnostic difficulties. We report four cases of laboratory-confirmed coinfection of deadly influenza A(H1N1)pdm09 with DENV, which occurred during the dengue and influenza season in 2012 and 2013 in Ceará

Correction: Occurrence of Natural Vertical Transmission of Dengue-2 and Dengue-3 Viruses in Aedes aegypti and Aedes albopictus in Fortaleza, Ceará, Brazil

BACKGROUND: Aedes aegypti and Aedes albopictus perform an important role in the transmission of the dengue virus to human populations, particularly in the tropical and subtropical regions of the world. Despite a lack of understanding in relation to the maintenance of the dengue virus in nature during interepidemic periods, the vertical transmission of the dengue virus in populations of A. aegypti and A. albopictus appears to be of significance in relation to the urban scenario of Fortaleza. METHODS: From March 2007 to July 2009 collections of larvae and pupae of Aedes spp were carried out in 40 neighborhoods of Fortaleza. The collections yielded 3,417 (91%) A. aegypti mosquitoes and 336 (9%) A. albopictus mosquitoes. Only pools containing females, randomly chosen, were submitted to the following tests indirect immunofluorescence (virus isolation), RT-PCR/nested-PCR and nucleotide sequencing at the C-prM junction of the dengue virus genome. RESULTS: The tests on pool 34 (35 A. albopictus mosquitoes) revealed with presence of DENV-3, pool 35 (50 A. aegypti mosquitoes) was found to be infected with DENV-2, while pool 49 (41 A. albopictus mosquitoes) revealed the simultaneous presence of DENV-2 and DENV-3. Based on the results obtained, there was a minimum infection rate of 0.5 for A. aegypti and 9.4 for A. albopictus. The fragments of 192 bp and 152 bp related to DENV-3, obtained from pools 34 and 49, was registered in GenBank with the access codes HM130699 and JF261696, respectively. CONCLUSIONS: This study recorded the first natural evidence of the vertical transmission of the dengue virus in populations of A. aegypti and A. albopictus collected in Fortaleza, Ceará State, Brazil, opening a discuss on the epidemiological significance of this mechanism of viral transmission in the local scenario, particularly with respect to the maintenance of these viruses in nature during interepidemic periods