Conhecimento sobre Leishmaniose Visceral entre alunos da rede pública

Introdução: A leishmaniose visceral humana é uma doença infecciosa, grave, negligenciada mundialmentee endêmica no Brasil, especialmente, no oeste do Estado de São Paulo. Assim, o conhecimento popular acerca de doenças endêmicas é contributário nas ações de intervenção de controle da enfermidade. Objetivo: Avaliar o conhecimento de alunos da rede pública do estado de São Paulo, Brasil, moradores em área endêmica de leishmaniose visceral humana (LVH). Métodos: Estudantes de escolas da rede pública do município de Marília - SP, Brasil, responderam um questionário com dados demográficos e perguntas para identificar o conhecimento sobre aspectos gerais da doença, seus possíveis hospedeiros, vetores, medidas de prevenção e controle da LVH, além das fontes utilizadas para a obtenção desse conhecimento. A análise quantitativa foi expressa pela média e seus valores mínimos e máximos. A associação entre variáveis qualitativas foi analisada pelo teste do Qui-quadrado. Resultados: De um total de 300 questionários aplicados, foram incluídos os respondidos por 227 participantes (54,6% do sexo feminino), com média de idade de 15,5±1,0 anos. Destes, 53,3% afirmaram ter conhecimento prévio sobre leishmaniose visceral, porém a análise de associação não apresentou diferença significativa ao relacionar o número de alunos que responderam ter conhecimento prévio sobre LVH e o número de respostas corretas no questionário, observando-se um maior número de acertos nas questões sobre conhecimentos gerais da doença sobre as questões sobre medidas de prevenção e controle. A escola foi referida como o principal local de obtenção de conhecimento. Conclusão: Ações preventivas de educação em saúde são de extrema necessidade, pois este local foi considerado como importante veículo de propagação do conhecimento e pode auxiliar no controle epidemiológico de doenças endêmicas

HISTÓRICO E REESTRUTURAÇÃO DAS LINHAS DE PESQUISA DO PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE E ENVELHECIMENTO

Esta revisão narrativa apresenta estudos desenvolvidos no curso de mestrado acadêmico do Programa de Pós-graduação em Saúde e Envelhecimento, da Faculdade de Medicina de Marília (Famema), o qual foi aprovado pela CAPES em 2011, com início em 2012. Atualmente, possui duas linhas de pesquisa: (1) Educação e cuidado à saúde no ciclo da vida, (2) Aspectos biológicos e clínicos do binômio saúde-doença no processo de envelhecimento. Integra a Rede dos Programas de Pós-Graduação Interdisciplinares em Envelhecimento (REPRINTE) desde a sua implementação. Importante ressaltar que o Programa de Pós-graduação em Saúde e Envelhecimento não está voltado exclusivamente à formação acadêmico-científica em Geriatria ou Gerontologia, mas também ao “cuidado à saúde e ao enfrentamento de doenças ao longo do processo do envelhecimento", ou seja, do nascimento até a morte. Nos primeiros oito anos de funcionamento do Programa (2012 a 2020), três linhas de pesquisa estavam vigentes, tendo sido configuradas desde o envio da Apresentação de Propostas de Cursos Novos (APCN) à CAPES. Com o transcorrer do curso e as experiências adquiridas, ficou evidente a necessidade de uma profunda reestruturação das linhas e dos projetos de pesquisa cadastrados no programa. Assim, esta narrativa descreve o histórico e o processo de reestruturação das linhas de pesquisa do programa e a revisão dos projetos a elas vinculados

Severe visceral leishmaniasis and COVID-19 coinfection in an immunosuppressed patient

Visceral leishmaniasis (VL) is an opportunistic disease in immunosuppressed individuals, who may present severe clinical conditions, such as the ones described in this patient. She lived in an endemic region for VL, and was possibly infected with L. (L.) infantum chagasi through the bite of a contaminated sand fly. This initial infection has triggered a pemphigus vulgaris condition by immunogenic proteins present in the mosquito's saliva. The immunosuppression caused by the use of high doses of corticosteroids to control the disease promoted a severe VL condition, with hepatosplenomegaly, thrombocytopenia and hemorrhages, requiring hospitalization and the onset of a subsequent SARS-CoV-2 infection. Due to the intensity of clinical manifestations related to VL, aggravated by COVID-19, she died two days after admission to the Clinical Hospital of Marilia Medical School (HC–Famema)

Antioxidant effect of Morus nigra on Chagas disease progression

Considering the widespread popular use of Morus nigra and the amount of scientific information on its antioxidant and anti-inflammatory activity, the effectiveness of this phytotherapeutic compound in the parasitemia progression during the acute phase of Chagas disease and its role in the development of the inflammatory process as well as its effects on the oxidative damage in the chronic phase of infection were evaluated. Thus, 96 male Swiss mice were randomly divided into eight groups, four groups were uninfected controls, and four groups were intraperitoneally infected with 5.0 x 104 blood trypomastigotes forms of T. cruzi QM2 strain. Four batches composed of one uninfected and one infected group were respectively treated with 70% alcohol solution and 25 μL, 50 μL and 75 μL of the phytotherapeutic compound. Levels of antioxidant elements (TBARS, FRAP, GSH and Sulfhydryl groups) were measured in plasma samples. The phytotherapeutic compound’s antioxidant activity was measured by polyphenol and total flavonoid quantification, DPPH, NO, and FRAP method. Our results showed that the vehicle influenced some of the results that may have physiological relevance in Chagas disease. However, an important action of M. nigra tincture was observed in the progression of Chagas disease, since our results demonstrated a reduction in parasitemia of treated groups when compared to controls, especially in the group receiving 25 µL. However, in the chronic phase, the 50-µL dosage presented a better activity on some antioxidant defenses and minimized the tissue inflammatory process. Results indicated an important action of M. nigra tincture on the Chagas disease progression

INTESTINAL AND PULMONARY INFECTION BY Cryptosporidium parvum IN TWO PATIENTS WITH HIV/AIDS

We describe two patients with HIV/AIDS who presented pulmonary and intestinal infection caused by Cryptosporidium parvum, with a fatal outcome. The lack of available description of changes in clinical signs and radiographic characteristics of this disease when it is located in the extra-intestinal region causes low prevalence of early diagnosis and a subsequent lack of treatment

Isolamento e caracterização de cepas de Trypanosoma cruzi Chagas,1909 (Kinetoplastida, Trypanosomatidae) a partir de triatomíneos silvestres do Estado do Rio Grande do Sul

Embora a incidência da doença de Chagas tenha diminuído, os estudos sobre o Trypanosoma cruzi devem continuar, dada a dificuldade para o efetivo controle dos seus vetores. Triatoma infestans o principal vetor da doença de Chagas está praticamente eliminado no Brasil, entretanto outras espécies de Triatominae estão em processo de domiciliação, como o Triatoma rubrovaria no Rio Grande do Sul, constituindo-se em um fator de risco para o recrudescimento da infecção chagásica. Com o intuito de caracterizar cepas de T. cruzi que circulam na área rural, foram feitas buscas ativas de triatomíneos para isolamento desse protozoário em bairros do município de Quaraí, RS. Para tanto as fezes dos triatomíneos coletados foram obtidas por compressão abdominal para pesquisa de tripomastigotas metacíclicos. As fezes que se encontraram positivas foram inoculadas em animais de experimentação e em meio de cultura (LIT). Foram isoladas cinco cepas de T. cruzi, assim denominadas: QB1, QJ1, QJ3, QM1 e QM2, que apresentaram as seguintes características: predominância de formas tripomastigotas intermediárias após mensuração no 15º dia pósinfecção, picos parasitêmicos ao redor do17º dia pós-infecção, miotropismo na fase aguda e miosite na fase crônica da infecção. A análise do DNA que codifica a fração 24Sa do rRNA mostrou fragmentos de 110 pb, agrupando-as em T. cruzi I. Os serviços de vigilância epidemiológica foram informados sobre os resultados obtidos.Although the decrease in the incidence of Chagas' disease, the studies concerning T. cruzi shall continue, due to the difficulty in controlling its vector. Triatoma infestans the main vector of Chagas'disease is nearly eliminated in Brasil, nevertheless other Triatominae species are on domiciliate process, like Triatoma rubrovaria in Rio Grande do Sul State, representing a hazard factor for increasing Chagas infection. In order to characterize T. cruzi strains that naturally occur in the rural area, active searches were performed in order to isolated these strains in the district of Quarai, RS. Triatomine feces were collected by abdominal compression and the presence of metacyclic tripomastigotes was evaluated. The feces positive for metacyclic triatomines were inoculated in experimental animals and in the culture medium (LIT). Five T. cruzi strains were isolated: QB1, QJ1, QJ3, QM1 and QM2. The strains displayed a predominance of intermediate forms on 15th day post-infection. Parasitimia peak occurred on 17th day post-infection. Myotropism during acute phase and myositis in the chronic phase was oberved. The DNA analysis coding the 24 Sa r RNA fraction has displayed fragments of 110 pb, grouping them in T. cruzi I. The Epidemiologic Vigilance Services have been warmed about the achieved results

Clinical and epidemiological profile of patients in the chronic phase of Chagas disease treated at a reference center in the Southeast region of Brazil

Introduction: After implementing measures to control vector transmission by Triatoma infestans in Brazil, the number of new cases of Chagas disease decreased. Currently, the American continent has an annual incidence of 28 000 cases, but there are still a large number of older adults affected by the chronic phase of this disease. Objective: To characterize the clinical and epidemiological profile of patients in the chronic phase of Chagas disease treated at a reference center of São Paulo (State), Brazil. Materials and methods: Cross-sectional, descriptive study based on the analysis of the clinical histories of 62 patients in the chronic phase of Chagas disease and treated at Hospital das Clínicas de Marília. Results: No significant differences were found regarding sex, age and time of diagnosis. Cardiac problems were the most reported symptom. A significant difference was observed in the case of the indeterminate form of the disease, which was more predominant in males. In addition, functional class B1 was more common in women, while B2 predominated in men. Conclusion: A late diagnosis of Chagas disease may increase the chances of presenting digestive symptoms. However, the classic manifestations of the disease and its comorbidities can be successfully managed as long as comprehensive (multidisciplinary) medical care is provided, since this would help delay the course of the disease and, consequently, improve the patients’ quality of life.Introducción. Luego de la implementación de medidas de control de la transmisión vectorial por Triatoma infestans en Brasil, hubo una reducción en el número de nuevos casos de la enfermedad de Chagas (EC). Actualmente, en el continente americano la incidencia anual de EC es de 28 000 casos, pero cabe señalar que aún existe una gran cantidad de adultos mayores que padecen los síntomas y signos de la fase crónica de esta enfermedad. Objetivo. Caracterizar el perfil clínico y epidemiológico de pacientes chagásicos en fase crónica atendidos en un centro de referencia ubicado en el estado de São Paulo, Brasil. Materiales y métodos. Estudio transversal y descriptivo. Se analizaron las historias clínicas de 62 pacientes chagásicos crónicos atendidos en el Hospital das Clínicas de Marília. Resultados. No hubo diferencias significativas con respecto a sexo, edad y tiempo de diagnóstico. Los problemas cardiacos fueron el signo clínico más reportado. Se observó una diferencia significativa en el caso de la forma indeterminada de la enfermedad, siendo más predominante en los hombres. Por otra parte, el estadio B1 fue más frecuente en las mujeres, mientras que el estadio B2 fue predominante en los hombres. Conclusión. El diagnóstico tardío de la EC puede aumentar la probabilidad de presentar complicaciones digestivas. Sin embargo, las manifestaciones clásicas de esta enfermedad y sus comorbilidades pueden ser controladas siempre que se cuente con atención médica integral (multidisciplinar), ya que de esta forma se retrasa su evolución y, en consecuencia, se mejora la calidad de vida de estos pacientes

Spatio-temporal distribution of human American visceral leishmaniasis in the Western region of Sao Paulo State, from 2004 to 2018

Leishmaniasis comprises a group of zoonotic diseases caused by protozoa belonging to the Leishmania genus, noting that the visceral form is the most severe and lethal, if untreated. Nowadays visceral leishmaniasis is widespread in Brazil and the Adamantina microregion, located in the west of Sao Paulo State, has been affected by Human American Visceral Leishmaniasis (HAVL) since 2004. We evaluated the epidemiological profile of HAVL in the Adamantina microregion through a Geographic Information Systems (GIS) and established its incidence rate by location and time. Notified cases were provided by the Sao Paulo State Epidemiological Surveillance Center. Home addresses of patients who tested positive to HAVL were converted into geographic coordinates through the Google Geocoding Application Programming Interface submitted to ArcMap 10.5 System for georeferencing. Kernel spatial analyses were performed to obtain the incidence distribution and the total area involvement rate. From 2004 to 2018, 325 cases of HAVL were diagnosed in 11 of the 12 municipalities belonging to the of Adamantina microregion. The disease has disseminated to the Northwest and East-Southeast directions, taking place along the Comandante Joao Ribeiro de Barros highway, with higher incidences rates in the municipalities where the highway passes. HAVL incidence was higher in children aged between 0 to 9 years and in the elderly; there was no difference in relation to sex and the majority of cases were located in urban areas. The determination of the epidemiological profile and the the spread of disease patterns can indicate possible areas of vulnerability, in order to contribute to the management and prevention of the disease through a strategic resources optimization