Evolution of Chagas’ disease in Brazil. Epidemiological perspective and challenges for the future: a critical review

Aims: This paper aimed to provide a critical review of the evolution of Chagas’ disease in Brazil, its magnitude, historical development and management, and challenges for the future. Methods: A literature search was performed using PubMed, SciELO and Google Scholar and throughout collected articles’ references. Narrative analysis was structured around five main themes identified: vector transmission, control program, and transfusion, oral and congenital transmission. Results: In Brazil, the Chagas’ disease Control Program was fully implemented in the 1980s, when it reached practically all the endemic areas, and in 1991, the Southern Cone Initiative was created, aiming to eliminate the disease transmission through eliminating the Triatoma infestans and controlling blood banks. As a result, the prevalence of chagasic donors in blood banks reduced from 4.4% in the 80s to 0.2% in 2005. In 2006, PAHO certified the interruption of transmission of Chagas’ disease through this vector in Brazil. However, there are still challenges, such as the domiciliation of new vector species, the need for medical care of the infected individuals, the prevention of alternative mechanisms of transmission, the loss of political concern regarding the disease and, the weakening of the control program. Conclusion: Despite the progress towards control, there are still many challenges ahead to maintain and expand such control and minimise the risk of re-emergence

A breakthrough on Amanita phalloides poisoning: an effective antidotal effect by polymyxin B

Amanita phalloides is responsible for more than 90 % of mushroom-related fatalities, and no effective antidote is available. a-Amanitin, the main toxin of A. phalloides, inhibits RNA polymerase II (RNAP II), causing hepatic and kidney failure. In silico studies included docking and molecular dynamics simulation coupled to molecular mechanics with generalized Born and surface area method energy decomposition on RNAP II. They were performed with a clinical drug that shares chemical similarities to a-amanitin, polymyxin B. The results show that polymyxin B potentially binds to RNAP II in the same interface of a-amanitin, preventing the toxin from binding to RNAP II. In vivo, the inhibition of the mRNA transcripts elicited by a-amanitin was efficiently reverted by polymyxin B in the kidneys. Moreover, polymyxin B significantly decreased the hepatic and renal a-amanitin-induced injury as seen by the histology and hepatic aminotransferases plasma data. In the survival assay, all animals exposed to a-amanitin died within 5 days, whereas 50 % survived up to 30 days when polymyxin B was administered 4, 8, and 12 h post-a-amanitin. Moreover, a single dose of polymyxin B administered concomitantly with a-amanitin was able to guarantee 100 % survival. Polymyxin B protects RNAP II from inactivation leading to an effective prevention of organ damage and increasing survival in a-amanitin-treated animals. The present use of clinically relevant concentrations of an already human-use-approved drug prompts the use of polymyxin B as an antidote for A. phalloides poisoning in humans.Juliana Garcia, Vera Marisa Costa, Ricardo Dinis-Oliveira and Ricardo Silvestre thank FCT-Foundation for Science and Technology-for their PhD grant (SFRH/BD/74979/2010), Post-doc grants (SFRH/BPD/63746/2009 and SFRH/BPD/110001/2015) and Investigator grants (IF/01147/2013) and (IF/00021/2014), respectively. This work was supported by the Fundacao para a Ciencia e Tecnologia (FCT) - project PTDC/DTPFTO/4973/2014 - and the European Union (FEDER funds through COMPETE) and National Funds (FCT, Fundacao para a Ciencia e Tecnologia) through project Pest-C/EQB/LA0006/2013

Quality of life of a person with Parkinson's disease and the relationship between the time of evolution and the severity of the disease

Parkinson's disease can cause disability and decrease the quality of life in its sufferers. The aim of this study was to evaluate the quality of life of a group of people with Parkinson's disease and whether a relationship exists between time of evolution and severity of the disease. Secondary analysis was carried out on transversal data collected from 40 individuals with Parkinson's disease registered in the Parkinson's Association of Maringá, in Maringá-PR-Brazil. Measures: three instruments were applied: a socio-demographic questionnaire, the Hoenh and Yahr Scale and the Parkinson's Disease Questionnaire (PDQ-39). According to PDQ-39, men referred to a lower quality of life, although, statistically, there was no significant difference between the two genders. Differences were only observed in the dimensions of "activities of daily living" and "social support", in which men presented higher impairment, and "emotions" and "bodily discomfort", where women showed higher impairment. Furthermore, severity of disease tended to lead to a perception of lower quality of life regarding the dimensions of "activities of daily living" and "cognition", which is relevant to improve clinical guidance and intervention.La enfermedad de Parkinson puede llegar a ser incapacitante y afectar a la calidad de vida de los pacientes. El objetivo de este estudio fue evaluar la calidad de vida de las personas con Parkinson e identificar las relaciones con el transcurso del tiempo y la gravedad de la enfermedad. Los datos fueron recogidos en la ciudad de Maringá-PR-Brasil, con 40 personas indexadas en la "Associação Maringaense de Parkinson", a través de la aplicación de tres instrumentos: cuestionario sociodemográfico, escala de Hoenh e Yahr y PDQ-39. De acuerdo con el PDQ-39, los hombres reportaron peor calidad de vida, aunque no hubo diferencias estadísticas entre los sexos. Las diferencias apenas se observaron en la dimensión "actividades de vida diaria" y "apoyo social", con los hombres presentando una mayor participación y "bienestar emocional" e "incomodidad física" con una más grave entre las mujeres. Por otra parte, la gravedad de la enfermedad mostró una tendencia a empeorar la percepción en la calidad de vida en las dimensiones de las actividades de la vida diaria y cognición, puntos importantes para una mejor orientación e intervención clínica.A doença de Parkinson pode ser incapacitante e prejudicar a qualidade de vida de seus portadores. O objetivo do estudo foi avaliar a qualidade de vida de indivíduos com Parkinson e identificar relações com o tempo de evolução e gravidade da doença. Os dados foram coletados na cidade de Maringá, PR, Brasil, com 40 indivíduos cadastrados na Associação Maringaense de Parkinson, por meio da aplicação de três instrumentos: questionário sociodemográfico, escala de Hoenh e Yahr e PDQ-39. De acordo com o PDQ-39, os homens referiram pior qualidade de vida, embora sem diferenças estatísticas entre os sexos. Diferenças foram observadas apenas na dimensão "atividades de vida diária" e "apoio social", com os homens apresentando maior acometimento e "bem-estar emocional" e "desconforto corporal", com maior comprometimento entre as mulheres. Por outro lado, a gravidade da doença apresentou tendência a pior percepção na qualidade de vida nas dimensões atividades de vida diária e cognição, pontos relevantes para melhor orientação clínica e intervenção

Immunogenic Salivary Proteins of Triatoma infestans: Development of a Recombinant Antigen for the Detection of Low-Level Infestation of Triatomines

Chagas disease, caused by Trypanosoma cruzi, is a neglected disease with 20 million people at risk in Latin America. The main control strategies are based on insecticide spraying to eliminate the domestic vectors, the most effective of which is Triatoma infestans. This approach has been very successful in some areas. However, there is a constant risk of recrudescence in once-endemic regions resulting from the re-establishment of T. infestans and the invasion of other triatomine species. To detect low-level infestations of triatomines after insecticide spraying, we have developed a new epidemiological tool based on host responses against salivary antigens of T. infestans. We identified and synthesized a highly immunogenic salivary protein. This protein was used successfully to detect differences in the infestation level of T. infestans of households in Bolivia and the exposure to other triatomine species. The development of such an exposure marker to detect low-level infestation may also be a useful tool for other disease vectors