Multicenter study of the natural history and therapeutic responses of patients with chikungunya, focusing on acute and chronic musculoskeletal manifestations - a study protocol from the clinical and applied research in Chikungunya (REPLICK network)

BACKGROUND: Chikungunya is associated with high morbidity and the natural history of symptomatic infection has been divided into three phases (acute, post-acute, and chronic) according to the duration of musculoskeletal symptoms. Although this classification has been designed to help guide therapeutic decisions, it does not encompass the complexity of the clinical expression of the disease and does not assist in the evaluation of the prognosis of severity nor chronic disease. Thus, the current challenge is to identify and diagnose musculoskeletal disorders and to provide the optimal treatment in order to prevent perpetuation or progression to a potentially destructive disease course. METHODS: The study is the first product of the Clinical and Applied Research Network in Chikungunya (REPLICK). This is a prospective, outpatient department-based, multicenter cohort study in Brazil. Four work packages were defined: i. Clinical research; ii) Translational Science - comprising immunology and virology streams; iii) Epidemiology and Economics; iv) Therapeutic Response and clinical trials design. Scheduled appointments on days 21 (D21) ± 7 after enrollment, D90 ± 15, D120 ± 30, D180 ± 30; D360 ± 30; D720 ± 60, and D1080 ± 60 days. On these visits a panel of blood tests are collected in addition to the clinical report forms to obtain data on socio-demographic, medical history, physical examination and questionnaires devoted to the evaluation of musculoskeletal manifestations and overall health are performed. Participants are asked to consent for their specimens to be maintained in a biobank. Aliquots of blood, serum, saliva, PAXgene, and when clinically indicated to be examined, synovial fluid, are stored at -80° C. The study protocol was submitted and approved to the National IRB and local IRB at each study site. DISCUSSION: Standardized and harmonized patient cohorts are needed to provide better estimates of chronic arthralgia development, the clinical spectra of acute and chronic disease and investigation of associated risk factors. This study is the largest evaluation of the long-term sequelae of individuals infected with CHIKV in the Brazilian population focusing on musculoskeletal manifestations, mental health, quality of life, and chronic pain. This information will both define disease burden and costs associated with CHIKV infection, and better inform therapeutic guidelines

Desigualdades contextuais e individuais da prevalencia de dor dentaria em adultos e idosos no Brasil

Abstract published in English and Portuguese English title: Contextual and individual inequalities in dental pain prevalence among Brazilian adults and eldersThis study aimed to assess the prevalence of dental pain among adults and older people living in Brazil’s State capitals. Information was gathered from the Telephone Survey Surveillance System for Risk and Protective Factors for Chronic Diseases (VIGITEL) in 2009 (n = 54,367). Dental pain was the outcome. Geographic region, age, gender, race, schooling, private health coverage, smoking, and soft drink consumption were the explanatory variables. Multilevel Poisson regression models were performed. Prevalence of dental pain was 15.2%; Macapá and São Luís had prevalence rates greater than 20%; all capitals in the South and Southeast, plus Cuiabá, Campo Grande, Maceió, Recife, and Natal had prevalence rates less than 15%. Factors associated with increased prevalence of dental pain were the North and Northeast regions, female gender, black/brown skin color, lack of private health insurance, smoking, and soft drink consumption. Dental pain is a public health problem that should be monitored by health surveillance systems. = O objetivo deste estudo foi conhecer a prevalência de dor dentária e fatores associados em adultos e idosos residentes nas capitais brasileiras usando os dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL), de 2009 (n = 54.367). Dor dentária foi a variável dependente. Macrorregião, idade, sexo, raça, escolaridade, posse de plano de saúde, tabagismo e consumo de refrigerantes foram as variáveis exploratórias. Foram realizadas regressões de Poisson multinível. A prevalência de dor dentária foi de 15,2%; Macapá e São Luís apresentaram prevalências maiores que 20% enquanto em todas as capitais do Sul e Sudeste, em Cuiabá, Campo Grande, Maceió, Recife e Natal foram encontradas prevalências menores que 15%. Residentes no Norte e Nordeste, mulheres, pretos e pardos, aqueles que não possuem plano de saúde, tabagistas e consumidores de refrigerantes apresentaram as maiores prevalências de dor dentária. A dor dentária é um problema de saúde pública que deve ser monitorado pelos sistemas de vigilância em saúde.Marco A. Peres, Betine Pinto Moehlecke Iser, Karen Glazer Peres, Deborah Carvalho Malta, José Leopoldo Ferreira Antune

Influence of sulfur amino acid levels in diets of broiler chickens submitted to immune stress

Several changes in amino acid levels occur during an infection. As a rule, glycine, taurine and serine levels diminish considerably, while cysteine levels increase. Such changes may be attributed to the intense consumption of sulfur amino acids (SAA- methionine+cysteine) during infectious challenge. Methionine plays an important role in humoral and cellular immune responses. It has been suggested that such effect is exerted by intracellular glutathione and cysteine levels. Four-hundred thirty-two day-old Ross male broiler chickens were fed (from 1 to 42 days of age) three SAA levels in the diet (0.72, 0.82, and 0.92% from 1 to 21 days of age; 0.65, 0.75, and 0.85% from 22 to 42 days of age) and submitted to two immunological stimulus series. Vaccines against Marek's disease, Fowlpox, Infectious Bronchitis and Infectious Bursal disease, Freund's Complete Adjuvant, and avian tuberculin were used as immunological stimuli. The experiment comprised 6 treatments, with 6 replications using 12 birds per replicate. Performance data were collected weekly. Gumboro antibodies were measured by ELISA, and the cellular immune response by the tuberculin test. SAA levels tested did not influence immune response. Nevertheless, the vaccines applied on the 1st day impaired chick performance up to the 21 days of age. The SAA levels generally adopted in poultry husbandry may not be enough to assure weight gain, especially when birds are raised if a low-challenge infectious environment