Epidemiological situation of visceral leishmaniasis on the Island of São Luis, State of Maranhão

Apresenta-se o resultado de um estudo de campo sobre a leishmaniose visceral autóctone da Ilha de São Luís. Com início em 2004 e término em 2006, a pesquisa visou conhecer aspectos epidemiológicos e clínicos determinantes da endemia. Foram analisados 299 casos autóctones, sendo 83,6% em menores de 9 anos e 54,1% do sexo masculino. O agravo ocorreu em todos os meses do ano com pico em junho. O coeficiente de incidência foi reduzido de 46,1 para 35,2 casos por 100.000 habitantes nos anos estudados. O diagnóstico teve confirmação laboratorial em 93,3% dos casos. O tratamento de escolha foi à base de N-metilglucamina com percentual de cura de 96,1%. A letalidade média foi de 3,7%. Em função da inexistência de ações mais sistemáticas de controle, propõe-se a criação de um programa a ser desenvolvido pelos municípios sob a coordenação da Secretaria de Estado da Saúde.The results from a field study on autochthonous visceral leishmaniasis on the island of São Luís are presented. This study started in 2004 and finished in 2006 and had the aim of ascertaining the determinant epidemiological and clinical characteristics of this endemic disease. Two hundred ninety nine autochthonous cases were analyzed, of which 83.6% were children younger than 9 years old and 54.1% were male. The disease occurred in all months of the year, with a peak in June. The coefficient of incidence decreased from 46.1 to 35.2 cases per 100,000 inhabitants over the years studied. The diagnosis was confirmed by laboratory tests in 93.3% of the cases. The treatment of choice was based on N-methylglucamine, with a cure rate of 96.1%. The mean lethality rate was 3.7%. Because of the absence of systematic control actions, the authors propose the creation of a specific program to be developed by the municipalities under the coordination of the State Department of Health

Risk factors associated with death in Brazilian children with severe dengue: a case-control study

Objective: The purpose of this case-control study was to evaluate risk factors associated with death in children with severe dengue. Methods: The clinical condition of hospitalized patients with severe dengue who died (cases, n = 18) was compared with that of hospitalized patients with severe dengue who survived (controls, n = 77). The inclusion criteria for this study were age under 13 years; hospital admission in São Luis, northeastern Brazil; and laboratory-confirmed diagnosis of dengue. Results: Severe bleeding (hemoptysis), a defining criterion for dengue severity, was the factor most strongly associated with death in our study. We also found that epistaxis and persistent vomiting, both included as warning signs in the World Health Organization (WHO) classification of dengue, were strongly associated with death. No significant association was observed between any of the laboratory findings and death. Conclusions: The finding that epistaxis and persistent vomiting were also associated with death in children with severe dengue was unexpected and deserves to be explored in future studies. Because intensive care units are often limited in resource-poor settings, any information that can help to distinguish patients with severe dengue with a higher risk to progress to death may be crucial

Risk factors associated with death in Brazilian\ud children with severe dengue: a case-control study

Objective:\ud \ud The purpose of this case-control study was to evaluate risk factors associated with death in children with severe dengue.\ud \ud Methods:\ud \ud The clinical condition of hospitalized patients with severe dengue who died (cases, n = 18) was compared with that of hospitalized patients with severe dengue who survived (controls, n = 77). The inclusion criteria for this study were age under 13 years; hospital admission in São Luis, northeastern Brazil; and laboratory-confirmed diagnosis of dengue.\ud \ud Results:\ud \ud Severe bleeding (hemoptysis), a defining criterion for dengue severity, was the factor most strongly associated with death in our study. We also found that epistaxis and persistent vomiting, both included as warning signs in the World Health Organization (WHO) classification of dengue, were strongly associated with death. No significant association was observed between any of the laboratory findings and death.\ud \ud Conclusions:\ud \ud The finding that epistaxis and persistent vomiting were also associated with death in children with severe dengue was unexpected and deserves to be explored in future studies. Because intensive care units are often limited in resource-poor settings, any information that can help to distinguish patients with severe dengue with a higher risk to progress to death may be crucial.This research was funded by grants BICUFMA 00366/07, BIC-UFMA 00377/07 and BD-00266/09 from Fundac¸a˜o de Amparo a` Pesquisa e ao Desenvolvimento Cientı´fico e Tecnolo´gico do Maranha˜o (FAPEMA), Sa˜o Luı´s, Maranha˜ o, Brazil. GFS was the recipient of a junior research fellowship in 2007-2008 from the Universidade Federal do Maranha˜o, Sa˜o Luı´s, Maranha˜ o, Brazil. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript

Spatial analysis of probable cases of dengue fever, chikungunya fever and zika virus infections in Maranhao State, Brazil

Dengue fever, chikungunya fever, and zika virus infections are increasing public health problems in the world, the last two diseases having recently emerged in Brazil. This ecological study employed spatial analysis of probable cases of dengue fever, chikungunya fever, and zika virus infections reported to the National Mandatory Reporting System (SINAN) in Maranhao State from 2015 to 2016. The software GeoDa version 1.10 was used for calculating global and local Moran indices. The global Moran index identified a significant autocorrelation of incidence rates of dengue (I=0.10; p=0.009) and zika (I=0.07; p=0.03). The study found a positive spatial correlation between dengue and the population density (I=0.31; p<0.001) and a negative correlation with the Performance Index of Unified Health System (PIUHS) by basic care coverage (I=-0.08; p=0.01). Regarding chikungunya fever, there were positive spatial correlations with the population density (I=0.06; p=0.03) and the Municipal Human Development Index (MHDI) (I=0.10; p=0.002), and a negative correlation with the Gini index (I=-0.01; p<0.001) and the PIUHS by basic care coverage (I=-0.18; p<0.001). Lastly, we found positive spatial correlations between Zika virus infections and the population density (I=0.13; p=0.005) and the MHDI (I=0.12; p<0.001), as well as a negative correlation with the Gini index (I=-0.11; p<0.001) and the PIUHS by basic care coverage (I=-0.05; p=0.03). Our results suggest that several socio-demographic factors influenced the occurrence of dengue fever, chikungunya fever, and zika virus infections in Maranhao State

Absorção intestinal de D-xilose em crianças infectadas pelo vírus da imunodeficiência humana

Objetivos - Avaliar a absorção intestinal em crianças de 18 meses a 14 anos infectadas pelo HIV, atendidas em uma unidade de ambulatório e verificar se existe associação entre má absorção, diarréia, estado nutricional, alteração imunológica, parasitas entéricos clássicos e Cryptosporidium. Metodologia - A absorção intestinal foi investigada utilizando-se a medida da D-xilose sérica. Amostras fecais foram colhidas para a pesquisa de pátogenos entéricos clássicos e Cryptosporidium. O tamanho da amostra foi calculado considerando a prevalência de 30% com precisão de 5% de alteração na absorção da D-xilose em crianças infectadas pelo HIV. Os procedimentos estatísticos utilizados foram: medidas descritivas, análise de correspondência múltipla e regressão logística. Resultados - Das 104 crianças estudadas, somente 8 (7,7%) apresentaram o teste da D-xilose alterado e 33 (31,73%) foram positivas para Cryptosporidium. A análise de correspondência múltipla aplicada aos dados encontrados sugeriu a associação entre o teste da D-xilose alterado e a presença de Cryptosporidium. Não se encontrou associação entre o teste alterado e diarréia, estado nutricional, alteração imunológica e parasistas entéricos clássicos. Conclusões - A má absorção intestinal avaliada pelo teste da D-xilose foi infreqüente nas crianças HIV positivas estudadas. O comprometimento intestinal, quando presente, parece estar relacionado com a presença de Cryptosporidium, porém não com diarréia, estado nutricional, alteração imunológica e parasistas entéricos clássicos

Calibration of time domain reflectometers in “Latossolo”

Dentre os diversos métodos existentes para estimar o conteúdo de água no solo, a técnica de reflectometria no domínio do tempo (TDR) vem despertando grande interesse nos últimos anos, por apresentar características desejáveis como medição em tempo real e possibilidade de automação além de não de não destruir o solo amostrado, no entanto, vários autores recomendam o levantamento de uma curva de calibração para cada tipo de solo. O presente trabalho teve por objetivo determinar a curva de calibração do TDR para um Latossolo Vermelho distroférrico oriundo da bacia experimental do arroio Donato, no município de Pejuçara-RS. Para isto, utilizou-se duas metodologias: uma de campo e outra baseada no uso de amostras indeformadas em laboratório. A calibração do TDR no campo mostrou uma grande dispersão nos dados, impossibilitando o ajuste de uma curva. A opção de utilizar amostras indeformadas em laboratório se apresentou como uma alternativa viável, pois possibilita maior controle das variáveis envolvidas (constante dielétrica e conteúdo de água no solo) além de preservar as características estruturais do solo. Não foram observadas diferenças significativas nas camadas de 5 a 15 cm e de 30 a 40 cm, diferindo estas da profundidade 50 a 60 cm. As equações que melhor se ajustaram aos dados de conteúdo de água no solo (q) e constante dielétrica (ka), para profundidades de 5 a 40 cm e 50 a 60 cm, foram polinômios de terceiro grau com coeficiente de determinação R2 = 0.896 e 0,983. Estas equações diferem das apresentadas por Topp et al. (1980) e Souza et al. (2001).Among the various existing methods to estimate the soil water content, the Time-Domain Reflectometry (TDR) technique has raised great interest in recent years, due to many desirable characteristics, such as real time and automatic measurements, besides being a non-destructive method. Many authors, however, recommend the determination of a calibration curve for each type of soil. The main goal of this paper was to determine the TDR calibration curve for a “Latossolo Vermelho distroférrico” soil from the Donato experimental basin, at Pejuçara, Brazil. Two different methodologies were applied: a field technique and a laboratory method based on the use of undisturbed soil samples. The TDR field calibration showed big scatter, and did not allow the adjustment of a single curve. The use of soil samples that had not been disturbed in the laboratory proved to be a feasible alternative, allowing a greater control of the measured variables (soil dielectric constant and soil water content) and maintaining the original structural soil characteristics. No significant differences were observed among the different soil layers studied. The best fit to the soil water content (θ) and soil dielectric constant (ka) was obtained by the use of a third degree polynomial equation, presenting a determination coefficient (R2) equal to 0.992. This adopted equation is significantly different from those previously developed by Topp et al. (1980) and Souza et al (2001)