Acidentes com aranhas e escorpiões no Alto Juruá, Acre - Brasil

Introduction: Epidemiological information on poisonings by venomous animals is fundamental in order to elaborate proposals for educational campaigns for prevention of poisonings, and may contribute to the improvement of the care of patients admitted to health facilities. Objective: Thus, the objective is to analyze the epidemiological profile of spider and scorpion poisoning in the Upper Juruá region, Western Amazonia, Brazil, from 2012 to 2017. Methods: Epidemiological data were obtained from the records of SINAN (Information System of Notifiable Diseases) in the Epidemiological Surveillance Sector of the Juruá Regional Hospital located in Cruzeiro do Sul. Results: There were 207 cases of accidents with arachnids, predominantly stinging by scorpions (148 cases, 71.9%), in the Regional Epidemiological Surveillance Sector of the Juruá Regional Hospital located in Cruzeiro do Sul. The average morbidity coefficient during the study period was 12 cases per 100,000 inhabitants for spider bites and 29.28 for scorpion stings. There was no correlation between spider and scorpion incidents with rainfall over the months during the study period. Conclusion: The average incidence of spider and scorpion incidents in the Upper Juruá region is one of the highest recorded for the Brazilian Amazon and is higher than the averages for Brazil, the Northern region and the state of Acre. Incidents with spiders and scorpions were not correlated with rainfall, and other factors associated with species biology or with human activities related to the temporal distribution, therefore there could be a risk of an arachnid incident throughout the year.  Introdução: Informações epidemiológicas sobre envenenamentos por animais peçonhentos são fundamentais para elaborar propostas de campanhas educativas para prevenção e podem contribuir para a melhoria do atendimento de pacientes admitidos nas unidades de saúde. Objetivo: Assim, o objetivo é Analisar o perfil epidemiológicos sobre o envenenamento por aranhas e escorpiões ocorridos na região do Alto Juruá, Amazônia Ocidental, Brasil no período de 2012 a 2017. Método: Os dados epidemiológicos foram obtidos a partir das fichas do SINAN (Sistema de Informação de Agravos de Notificação) no Setor de Vigilância Epidemiológica do Hospital Regional do Juruá localizado em Cruzeiro do Sul. Resultados: Foram registrados 207 casos de acidentes com aracnídeos, predominando as picadas por escorpiões (148 casos; 71,9%). A média do coeficiente de morbidade durante o período de estudo foi de 12 casos por 100.000 habitantes para o araneísmo e de 29,28 para o escorpionismo. Não houve correlação entre os acidentes com aranhas e escorpiões com a pluviosidade ao longo dos meses durante o período de estudo. Conclusão: A média da incidência de acidentes com aranhas e escorpiões na região do Alto Juruá é uma das maiores registradas para a Amazônia brasileira e é maior do que as médias para o Brasil, região Norte e para o estado do Acre. Os acidentes com aranhas e escorpiões não estiveram correlacionados com a pluviosidade, podendo outros fatores associados a biologia das espécies ou com as atividades humanas relacionados com a distribuição temporal, estando assim o risco de acidente com aracnídeos durante todo o ano. &nbsp

Safety of oral ivermectin during pregnancy: a systematic review and meta-analysis

Background: About 3·7 billion doses of ivermectin have been distributed in mass drug administration (MDA) campaigns globally over the past 30 years. At 10–100 times higher than current human doses, ivermectin is a known teratogen in mammals. During these campaigns with recommended doses, pregnant women might be inadvertently exposed. We therefore aimed to evaluate the existing evidence for serious and non-serious adverse events after ivermectin exposure in pregnant women. Methods: For this systematic review and meta-analysis, we searched relevant databases and trial registry platforms on July 15, 2018, for randomised controlled trials (RCTs) and observational studies that reported adverse events in pregnant women. We did not use language or date restrictions. Outcomes of interest were spontaneous abortions, stillbirths, congenital anomalies, and neonatal death (serious adverse events), as well as maternal morbidity, preterm births, and low birthweight (adverse events). The risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias Tool for RCTs. We did the meta-analysis of observational studies and RCTs separately. The quality of evidence was assessed using the GRADE approach. The study protocol is registered with PROSPERO, protocol CRD42016046914. Findings: We identified 147 records, of which only five observational studies and one RCT were included for quantitative analysis; these studies were published between 1990 and 2008, and were done in six African countries. 893 women with 899 pregancy outcomes were included, of whom 496 pregnant women (500 pregnancy outcomes) received ivermectin inadvertently during MDA campaigns in the observational studies and 397 pregnant women (399 pregnancy outcomes) purposely received ivermectin as part of the open-label RCT. No study reported neonatal deaths, maternal morbidity, preterm births, or low birthweight. It is unclear whether exposure to ivermectin during pregnancy increases the risk of spontaneous abortions and stillbirths (odds ratio [OR] 1·15 [95% CI 0·75–1·78] with very low certainty of evidence for the four observational studies and 0·62 [0·18–2·14] with very low certainty of evidence for the RCT) or congenital anomalies (OR 1·69 [95% CI 0·83–3·41] with very low certainty of evidence for the five observational studies and 1·10 [0·07–17·65] with very low certainty of evidence for the RCT). Interpretation: There is insufficient evidence to conclude on the safety profile of ivermectin during pregnancy. Treatment campaigns should focus additional efforts on preventing inadvertent treatment of pregnant women

Estudo dos hábitos alimentares de flebotomíneos em área rural no sul do Brasil

OBJETIVO: Investigar a composição específica e aspectos da preferência alimentar de flebotomíneos em relação aos animais domésticos existentes em área endêmica de leishmaniose tegumentar americana. MÉTODOS: Os flebotomíneos foram coletados nos meses de janeiro a abril de 2004, das 20 às 24h, numa área situada a 40 m de uma das residências de um sítio localizado no município de Mandaguari, PR, sul do Brasil. Foram usadas quatro armadilhas luminosas de Falcão, instaladas a 5 m de distância uma da outra, ao lado de uma gaiola, cada uma delas contendo isca animal (suíno, cão, coelho e galinha). RESULTADOS: Foram coletados 1.697 exemplares de flebotomíneos, das espécies: Nyssomyia whitmani, Pintomyia fischeri, Migonemyia migonei, Nyssomyia neivai, Pintomyia pessoai e Psathromyia shannoni, predominando N. whitmani. Não houve preferência alimentar dos flebotomíneos em relação aos animais investigados. CONCLUSÕES: Verificou-se que N. whitmani e P. fischeri são oportunistas e, provavelmente, as fêmeas ajustam os seus hábitos alimentares à disponibilidade de hospedeiros, sugerindo o ecletismo alimentar desstes insetos nos ambientes antrópicos.OBJECTIVE: To investigate the fauna and host feeding preferences of sandflies as for domestic animals in an endemic area of American cutaneous leishmaniasis. METHODS: The sandflies collections were carried out from 8:00 pm to 12:00 am in an area 40 meters away from one of the residences in a farm in Southern Brazil, between January and April, 2004. Collection was performed using four Falcão light traps, placed 5 m apart from each other beside a cage, each one of them containing an animal bait (swine, dog, rabbit, and chicken). RESULTS: A total of 1,697 specimens of sandflies were collected as follows: Nyssomyia whitmani, Pintomyia fischeri, Migonemyia migonei, Nyssomyia neivai, Pintomyia pessoai and Psathromyia shannoni. The prevalent species was N. whitmani. There were no feeding preferences of sandflies as for the animals studied. CONCLUSIONS: N. whitmani and P. fischeri are opportunistic species and female insects probably adjust their eating habits to host availability, suggesting eating eclecticism of these insects in anthropic environments

An evaluation of generic medicines availability in pharmacies and drugstores in Maringá (PR) and comparison of their prices in relation with the similars and the references

O debate sobre a implementação de genéricos vem sendo realizado no Brasil desde 1976. Entretanto, somente em 1991, foi elaborado um projeto, visando à implantação dos medicamentos genéricos. A lei nº 9787 ("Lei dos genéricos") só foi publicada no Diário Oficial da União em 11 de fevereiro de 1999. Os objetivos deste trabalho foram verificar a disponibilidade de medicamentos genéricos em farmácias e drogarias, bem como comparar os preços destes medicamentos em relação aos similares e aos de referência. Verificou-se a disponibilidade dos medicamentos genéricos em 22 farmácias e drogarias do município de Maringá, estado do Paraná, de 30 de outubro a 22 de novembro de 2002. Dos 222 princípios ativos disponibilizados no Brasil como genéricos, foram encontrados 71 (32%). Os medicamentos genéricos não sujeitos a controle especial são em média 42% mais baratos do que os de referência e 15% mais baratos que os similares. Os medicamentos genéricos de venda controlada com tarja vermelha são, em média, 36% mais baratos que os de referência e 12% mais baratos que os similares. Os medicamentos genéricos com tarja preta são, em média, 37% mais baratos que os de referência e 14% mais baratos que os similares.The discussion about the implementation of generics has being carried trough since 1976 in Brazil. However, just in 1991 a project which proposes the implantation of generic medicines has been elaborated. The Law 9787 (called Law of the Generic medicines) has been only published in Diário Oficial da União in February 11th, 1999. The objectives of this work had been to verify generic medicine availability in pharmacies and drugstores, as well as comparing their prices in relation with the similars and the references. The generic availability was verified in 22 pharmacies and drugstores in Maringá city, state of Paraná, from October, 30th to November, 20th ,2002. In a total of 222 active principles available in Brazil as generic, 71 (32%) had been found. Those generic medicines sold not under special control are in average 42% cheaper than the reference and 15% cheaper than the similar ones. Those generic medicines with red label, sold under special control, are in average 36% cheaper than the reference and 12% cheaper than the similar ones. The generic medicines with black label are 37% cheaper than the reference and 14% cheaper than the similars ones

Sudden spleen rupture in a Plasmodium vivax-infected patient undergoing malaria treatment

BACKGROUND: Splenomegaly is one of the most common features of malaria. However, spontaneous splenic rupture, although unusual, represents a severe complication often leading to death. It is mostly seen in acute infection and primary attack, and it is most commonly associated with Plasmodium vivax. Here, a case of spontaneous splenic rupture diagnosed with a portable ultrasound apparatus shortly after starting treatment and with recurrent parasitaemia after splenectomy, is reported. CASE DESCRIPTION: In November 2015, a 45-year-old Brazilian man presented to the hospital in Manaus with fever, headache and myalgia. He was diagnosed with P. vivax malaria and, after a normal G6PD test, he started treatment with chloroquine and primaquine and was discharged. Two days later, he went back to the hospital with abdominal pain, dyspnea, dry cough, pallor, oliguria and fever. Using a portable ultrasound, he was diagnosed of rupture of the spleen, which was removed by emergency surgery. After this episode, he suffered two more malaria episodes with high parasitaemia at approximately 2-month intervals. DNA from different portions of the spleen was extracted and a qualitative PCR was performed to detect P. vivax. CONCLUSIONS: The splenic rupture suffered by this patient occurred 2 days after starting the treatment. Having a portable ultrasound apparatus may have saved the patient's life, as it revealed a haemorrhage needing an urgent surgery. Parasites were detected by PCR in the extracted spleen. This patient suffered two more vivax malaria diagnosed episodes in spite of receiving and completing treatment with chloroquine and primaquine for each clinical attack. Splenic rupture during acute malaria is uncommon, but it is likely underdiagnosed and underreported, because the lack of means and equipment hinders diagnostic confirmation, especially in endemic areas

Severe hemolysis during primaquine radical cure of Plasmodium vivax malaria: two systematic reviews and individual patient data descriptive analyses

Primaquine (PQ) kills Plasmodium vivax hypnozoites but can cause severe hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. We conducted two systematic reviews. The first used data from clinical trials to determine the variety of definitions and frequency of hematological serious adverse events (SAEs) related to PQ treatment of vivax malaria. The second used data from prospective studies and case reports to describe the clinical presentation, management, and outcome of severe PQ-associated hemolysis necessitating hospitalization. In the first review, SAEs were reported in 70 of 249 clinical trials. There were 34 hematological SAEs among 9,824 patients with P. vivax malaria treated with PQ, nine of which necessitated hospitalization or blood transfusion. Criteria used to define SAEs were diverse. In the second review, 21 of 8,487 articles screened reported 163 patients hospitalized after PQ radical cure; 79.9% of whom (123 of 154) were prescribed PQ at ≥ 0.5 mg/kg/day. Overall, 101 patients were categorized as having probable or possible severe PQ-associated hemolysis, 96.8% of whom were G6PD deficient (< 30% activity). The first symptoms of hemolysis were reported primarily on day 2 or 3 (45.5%), and all patients were hospitalized within 7 days of PQ commencement. A total of 57.9% of patients (77 of 133) had blood transfusion. Seven patients (6.9%) with probable or possible hemolysis died. Even when G6PD testing is available, enhanced monitoring for hemolysis is warranted after PQ treatment. Clinical review within the first 5 days of treatment may facilitate early detection and management of hemolysis. More robust definitions of severe PQ-associated hemolysis are required

COVID-19 in Brazil: advantages of a socialized unified health system and preparation to contain cases

oai:ops.preprints.scielo.org:preprint/7The outbreak of new coronavirus disease 2019 (COVID-19) reported for the first time in Wuhan, China in late December 2019 have rapidly spread to other countries and it was declared on January 30, 2020 as a public health emergency of international concern (PHEIC) by the World Health Organization. Before the first COVID-19 cases were reported in Brazil, several measures have been implemented including the adjustment of legal framework to carry out isolation and quarantine. As the cases increased significantly, new measures, mainly to reduce mortality and severe cases, have also been implemented. Rapid and robust preparedness actions have been undertaken in Brazil while first cases have not yet been identified in Latin-American. The outcome of this early preparation should be analyzed in future studies

Association of TLR variants with susceptibility to Plasmodium vivax malaria and parasitemia in the Amazon region of Brazil

BACKGROUND: Plasmodium vivax malaria (Pv-malaria) is still considered a neglected disease despite an alarming number of individuals being infected annually. Malaria pathogenesis occurs with the onset of the vector-parasite-host interaction through the binding of pathogen-associated molecular patterns (PAMPs) and receptors of innate immunity, such as toll-like receptors (TLRs). The triggering of the signaling cascade produces an elevated inflammatory response. Genetic polymorphisms in TLRs are involved in susceptibility or resistance to infection, and the identification of genes involved with Pv-malaria response is important to elucidate the pathogenesis of the disease and may contribute to the formulation of control and elimination tools. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective case-control study was conducted in an intense transmission area of Pv-malaria in the state of Amazonas, Brazil. Genetic polymorphisms (SNPs) in different TLRs, TIRAP, and CD14 were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis in 325 patients infected with P. vivax and 274 healthy individuals without malaria history in the prior 12 months from the same endemic area. Parasite load was determined by qPCR. Simple and multiple logistic/linear regressions were performed to investigate association between the polymorphisms and the occurrence of Pv-malaria and parasitemia. The C/T (TLR5 R392StopCodon) and T/T (TLR9 -1486C/T) genotypes appear to be risk factors for infection by P. vivax (TLR5: C/C vs. C/T [OR: 2.116, 95% CI: 1.054-4.452, p = 0.031]; TLR9: C/C vs. T/T [OR: 1.919, 95% CI: 1.159-3.177, p = 0.010]; respectively). Fever (COEF = 7599.46, 95% CI = 3063.80-12135.12, p = 0.001) and the C/C genotype of TLR9 -1237C/T (COEF = 17006.63, 95% CI = 3472.83-30540.44, p = 0.014) were independently associated with increased parasitemia in patients with Pv-malaria. CONCLUSIONS: Variants of TLRs may predispose individuals to infection by P. vivax. The TLR5 R392StopCodon and TLR9 -1486C/T variants are associated with susceptibility to Pv-malaria. Furthermore, the TLR9 variant -1237C/C correlates with high parasitemia