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Comunicação e Cuidado na APS-ESF : evidências, reflexões, desafios
No full textEsta pesquisa de doutoramento teve como objetivo enfocar a Comunicação na Atenção Primária à Saúde - Estratégia de Saúde da Família. A investigação privilegiou a análise dos Diagnósticos Situacionais Participativos - DSP, que foram elaborados por profissionais de saúde de Clínicas da Família, alunos da Residência Multiprofissional em Saúde da Família e População, no ano de 2019, no município do Rio de Janeiro. O DSP é uma ferramenta que contribui na percepção e compreensão de problemas e necessidades de saúde, educação, saneamento, segurança, transporte, habitação, informação e comunicação, bem como permite conhecer como é e como está a organização dos serviços de saúde. É, portanto, um instrumento fundamental de gestão, uma vez que propicia a interlocução de três atores sociais com lugares de fala distintos, que representam a academia, o serviço e a população. Esta propriedade é favorável para se obter diferentes pontos de vista sobre as questões concernentes ao processo de sua construção Além de nos permitir traçar um panorama histórico e conceitual da Atenção Primária e seus atributos essenciais na produção do cuidado multiprofissional na orientação individual, familiar e comunitário, o que nos interessou nesse processo foi analisar de que maneira a comunicação é percebida e relacionada às questões apontadas no itinerário do desenvolvimento da produção e conclusão dos DSP. Para tanto, trabalhamos com a perspectiva da Análise de Discursos, recorrendo ao sentido das palavras plenas, palavras investidas de sentidos historicamente, ou teoricamente ou pela prática social. Identificamos palavras que, no âmbito da saúde coletiva, foram consideradas investidas do sentido de comunicação: Comunicação, a palavra mãe de sentido, Participação, Promoção da Saúde, Rede e Território. O corpus textual utilizado para a análise foi formado por três Diagnósticos Situacionais Participativos, aplicados em diferentes lugares. Os resultados apontaram a potência do instrumento para se verificar o lugar e as questões de comunicação no processo de construção do DSPThis doctorate research focused on Communication at the Primary Health Care/Family Health Strategy level. The investigation privileged analysis of Participative Situation Diagnoses (PSD), which were developed by health professionals in Family Clinics and by residents of the Multiprofessional Family Health and Population Residency Program during two periods, 2019 in the municipality of Rio de Janeiro. The PSD is a tool that enhances perception and understanding of health, learning, sanitation, security, transportation, housing, information, and communication problems and needs, and offers inside knowledge on the organization of health services. As such, it is a critical managerial instrument, permitting communication between three social actors with distinct positions and discourses: academia, health services and the population. This attribute favors different outlooks on its development process. In addition to bringing forth the possibility of drafting a historical and conceptual outline of Primary Health Care and its essential characteristics in producing multiprofessional care for individuals, families and communities, this process is of interest because of the way in which communication is perceived and related to queries that surface in the development itineraries of PSDs The perspective of Social Discourse was employed, resorting to elements of discourse analysis for in-depth examination of the corpus. Results indicate insipient, inconsistent, and faded communication in the PSD resorting to the meaning of full words, words invested with meanings historically, either theoretically or by social practice. We identified words that in the scope of collective health, were considered invested with the meaning of communication: Communication, the word mother of meaning, Participation, Health Promotion, Network and Territory. The textual corpus used for the analysis was the Participatory Situational Diagnosis elaborated by the students of the Multiprofessional Family Health Residency, health professionals and population. The results indicated the power of the Instrument to verify the place and communication issues in the DSP construction proces
Congenital Zika syndrome is associated with interferon alfa receptor 1
No full textOs autores externos submeteram sua publicação para apresentação de trabalho no evento “International Symposium on Immunobiologicals”, que foi coordenado e organizado pelo Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos), da Fundação Oswaldo Cruz.Introduction: Congenital Zika Syndrome (CZS) in a myriad of fetal abnormalities caused by Zika Virus (ZIKV). Nevertheless, it is not clear what maternal and/or fetal factors contribute to CZS outcome. Type I and type III interferons have been reported as the main antiviral factor in Zika and other flavivirus infections. Besides, single nucleotide polymorphisms (SNPs) in these genes regulate their expression and are associated with Hepatitis C, and Yellow Fever vaccination outcomes. Objective: Here, we aimed to analyze whether interferon alfa receptor 1 (IFNAR1) and interferon lambda 2 and 4 (IFNL2/4) SNPs could contribute to CZS outcome and its functional consequences in ZIKV congenital infections. Methodology: First, we selected In silico target IFNAR1 and IFNL2/4 SNPs performing Principal Components Analysis using EIGENSOFT 4.2 with data from 1000 Genomes Project phase 3, followed by ANNOVAR analysis. Then, we conducted a case-control study with 143 newborns and 153 mothers with confirmed ZIKV infection during pregnancy, and genotyped the selected SNPs by allelic discrimination. Case-control study was adjusted using a panel of 46-indels ancestry informative markers. Placenta from ZIKV-infected pregnant was analyzed by ZIKV PCR, histology and gene expression by Fluidigm microfluid qRT-PCR system. Results: Newborns carrying CG/CC genotypes of rs2257167 in IFNAR1 presented higher risk of developing CZS (OR=3.58; IC=1.42-9.04; Pcorrected=0.0225). No association between IFNL2/4 SNPs and CZS was observed. Placenta from CZS cases displayed lower levels of IFNL2 and ISG15 along with higher IFIT5. The rs2257167 CG/CC placentas also demonstrated high levels of IFIT5 and inflammationrelated genes. Conclusion: Here we found CZS to be associated with exacerbated type I IFN and insufficient type III IFN in placenta at term, forming an unbalanced response modulated by the IFNAR1 rs2257167 genotype. These findings shed light on the host-pathogen interaction focusing on the genetically regulated type I / type III IFN axis that could lead to better management of Zika and other TORCH (Toxoplasma, Others, Rubella, Cytomegalovirus, Herpes) congenital infections. Additionally, custom pharmacological interventions could be used to modulate immunity and inflammation towards protective responses
Brazilian Aedes aegypti as a Competent Vector for Multiple Complex Arboviral Coinfections
No full textBackground: Aedes aegypti is a highly competent vector in the transmission of arboviruses, such as chikungunya, dengue, Zika, and yellow fever viruses, and causes single and coinfections in the populations of tropical countries.
Methods: The infection rate, viral abundance (VA), vector competence (VC), disseminated infection, and survival rate were recorded after single and multiple infections of the vector with 15 combinations of chikungunya, dengue, Zika, and yellow fever arboviruses.
Results: Infection rates were 100% in all single and multiple infection experiments, except in 1 triple coinfection that presented a rate of 50%. The VC and disseminated infection rate varied from 100% (in single and quadruple infections) to 40% (in dual and triple infections). The dual and triple coinfections altered the VC and/or VA of ≥1 arbovirus. The highest viral VAs were detected for a single infection with chikungunya. The VAs in quadruple infections were similar when compared with each respective single infection. A decrease in survival rates was observed in a few combinations.
Conclusions: A. aegypti was able to host all single and multiple arboviral coinfections. The interference of the chikungunya virus suggests that distinct arbovirus families may have a significant role in complex coinfections
Desenvolvimento de sistemas baseados em amplificação isotérmica em alça (LAMP) para o diagnóstico da doença de Chagas
No full textA doença de Chagas representa um importante problema de saúde pública, principalmente na América Latina. O diagnóstico precoce durante a fase aguda é crucial, pois permite o tratamento imediato, podendo interferir no prognóstico. A técnica de amplificação isotérmica em alça (LAMP) vem demonstrando potencial, por ser sensível, específica, de fácil execução e baixo custo. O presente trabalho teve como objetivo desenvolver sistemas baseados em LAMP para o diagnóstico da doença de Chagas. Inicialmente foram avaliados dois sistemas descritos na literatura: Thekisoe et al. e Ordóñez et al. O sistema de Ordóñez et al. demonstrou elevada sensibilidade e especificidade, sendo utilizado como sistema de LAMP convencional e para o desenvolvimento de um sistema de LAMP em tempo real. O sistema de LAMP convencional foi aplicado em amostras de 77 indivíduos expostos ao surto agudo ocorrido em Ibimirim/PE e comparado ao diagnóstico parasitológico, sorológico e ao sistema de qPCR (TcSAT-IAM). Segundo critérios da Secretaria Estadual de Saúde de Pernambuco, 28 casos foram confirmados pelo critério laboratorial e 10 pelo clínico-epidemiológico. Considerando o critério laboratorial, a sensibilidade e especificidade do sistema de LAMP foi de 39,29% e 83,67%, respectivamente. Considerando o diagnóstico pelo sistema TcSAT-IAM, o sistema de LAMP apresentou sensibilidade de 60,87%, especificidade de 90,74%, acurácia de 81,82% e concordância considerada moderada. A coleta das amostras após o início do tratamento e o tempo de armazenamento representaram importantes limitações do estudo. Estes resultados demonstram a importância da coleta e armazenamento adequados das amostras e sugerem um “padrão-ouro composto”, considerando os testes preconizados em conjunto com técnicas moleculares, sendo a técnica de LAMP mais acessível para áreas de recursos limitados. Para facilitar a implementação na rotina laboratorial, foi desenvolvido um kit baseado em LAMP para o diagnóstico da doença de Chagas aguda .Chagas disease represents an important public health problem, especially in Latin America. Early diagnosis during the acute phase is crucial, as it allows for immediate treatment and may interfere with the prognosis. The Loop-mediated Isothermal Amplification (LAMP) has shown potential, as it is sensitive, specific, easy to perform and low cost. The objective of the present work was to develop LAMP-based systems for the diagnosis of Chagas disease. Initially, two systems described in the literature were evaluated: Thekisoe et al. and Ordóñez et al. The system by Ordóñez et al. showed high sensitivity and specificity, being used as a conventional LAMP system and for the development of a real-time LAMP system. The conventional LAMP system was applied to samples from 77 individuals exposed to the acute outbreak that occurred in Ibimirim/PE and compared to the parasitological and serological diagnosis and to the qPCR system (TcSAT-IAM). According to criteria of the Secretaria Estadual de Saúde de Pernambuco, 28 cases were confirmed by laboratory criteria and 10 by clinical-epidemiological criteria. Considering the laboratory criteria, the sensitivity and specificity of the LAMP system was 39.29% and 83.67%, respectively. Considering the diagnosis by the TcSAT-IAM system, the LAMP system had a sensitivity of 60.87%, specificity of 90.74%, accuracy of 81.82% and agreement considered moderate. The collection of samples after the beginning of the treatment and the storage time represented important limitations of the study. These results demonstrate the importance of proper collection and storage of samples and suggest a “compound gold standard”, considering the tests recommended in conjunction with molecular techniques, being the LAMP technique more accessible for areas with limited resources. To facilitate implementation in laboratory routine, a LAMP-based kit for the diagnosis of acute Chagas disease was developed
Effectiveness of Wolbachia-infected mosquito deployments in reducing the incidence of dengue and chikungunya in Niterói, Brazil: a quasi-experimental study
No full textBackground: The introduction of the bacterium Wolbachia (wMel strain) into Aedes aegypti mosquitoes reduces their capacity to transmit dengue and other arboviruses. Evidence of a reduction in dengue case incidence following field releases of wMel-infected Ae. aegypti has been reported previously from a cluster randomised controlled trial in Indonesia, and quasi-experimental studies in Indonesia and northern Australia.
Methodology/principal findings: Following pilot releases in 2015-2016 and a period of intensive community engagement, deployments of adult wMel-infected Ae. aegypti mosquitoes were conducted in Niterói, Brazil during 2017-2019. Deployments were phased across four release zones, with a total area of 83 km2 and a residential population of approximately 373,000. A quasi-experimental design was used to evaluate the effectiveness of wMel deployments in reducing dengue, chikungunya and Zika incidence. An untreated control zone was pre-defined, which was comparable to the intervention area in historical dengue trends. The wMel intervention effect was estimated by controlled interrupted time series analysis of monthly dengue, chikungunya and Zika case notifications to the public health surveillance system before, during and after releases, from release zones and the control zone. Three years after commencement of releases, wMel introgression into local Ae. aegypti populations was heterogeneous throughout Niterói, reaching a high prevalence (>80%) in the earliest release zone, and more moderate levels (prevalence 40-70%) elsewhere. Despite this spatial heterogeneity in entomological outcomes, the wMel intervention was associated with a 69% reduction in dengue incidence (95% confidence interval 54%, 79%), a 56% reduction in chikungunya incidence (95%CI 16%, 77%) and a 37% reduction in Zika incidence (95%CI 1%, 60%), in the aggregate release area compared with the pre-defined control area. This significant intervention effect on dengue was replicated across all four release zones, and in three of four zones for chikungunya, though not in individual release zones for Zika.
Conclusions/significance: We demonstrate that wMel Wolbachia can be successfully introgressed into Ae. aegypti populations in a large and complex urban setting, and that a significant public health benefit from reduced incidence of Aedes-borne disease accrues even where the prevalence of wMel in local mosquito populations is moderate and spatially heterogeneous. These findings are consistent with the results of randomised and non-randomised field trials in Indonesia and northern Australia, and are supportive of the Wolbachia biocontrol method as a multivalent intervention against dengue, chikungunya and Zika
Crosstalk Between Plasma Cytokines, Inflammation, and Liver Damage as a New Strategy to Monitoring NAFLD Progression
No full textCytokines are involved in the immunopathogenesis of nonalcoholic fatty liver disease (NAFLD), but the relationship between them and clinical parameters of NAFLD progression is still unknown. Using flow cytometry, we evaluated the plasma levels of IL-1β, IL-6, IL-12, TNF and IL-10 and their association with clinical and biochemical parameters of liver function during simple steatosis (NAFL) and nonalcoholic steatohepatitis (NASH) in biopsy-proven patients. The NASH patients showed higher levels of IL-6 associated with a lower IL-10/IL-6 ratio. Besides heatmaps were similar in the NAFL and NASH groups, the same did not occur in signature curves, the NASH patients were high producers to IL-12 and IL-6 while the NAFL patients were not high producers of any cytokines evaluated. Integrative biomarker network analysis revealed that cytokines are differently correlated with clinical parameters, while IL-12, IL-10 presented moderate and negative correlations with glycemic and lipid profile in the NAFL group. The NASH group IL-12 and TNF revealed stronger and positive correlations with transient elastography parameters and NAFLD liver fibrosis score. These data suggest that IL-6 and IL-10 might act in chronic inflammation and insulin resistance whereas IL-12 and TNF may be involved in promoting liver damage and NAFLD progression. Plasma concentration analysis of these molecules and their association with clinical parameters can be used as new biomarkers to monitoring NAFLD progression and to reflect NASH development
Estudio de validación de la fase II del test ELISA rK39 para el diagnóstico de la leishmaniasis visceral canina en Brasil
No full textDogs are the main reservoirs in the domestic transmission cycle of visceral leishmaniasis, and the diagnosis is essential for the effectiveness of the control measures recommended by the Brazilian Ministry of Health. We assessed the diagnostic performance of the ELISA-Vetlisa/BIOCLIN prototype with sérum samples from 200 dogs, in triplicate, including symptomatic, oligosymptomatic, asymptomatic, and healthy dogs, originated by two distinct panels (A and B) characterized by parasitological tests as the reference standard. In this
study, the prototype kit showed a 99% sensitivity (95%CI: 94.5-100.0) and a 100% specificity (95%CI: 96.4-100.0). The sensitivity of the prototype kit did not vary significantly with the clinical status of the dogs. Considering the final result classification (positive or negative), agreement between the results of repeated tests was almost perfect (kappa = 0.99; 95%CI: 0.98-1.00). ELISA-Vetlisa/BIOCLIN is a promising option for the serological diagnosis of canine
visceral leishmaniasis in Brazil
Chagas disease and SARS-CoV-2 coinfection does not lead to worse in-hospital outcomes
No full textChagas disease (CD) continues to be a major public health burden in Latina America. Information on the interplay between COVID-19 and CD is lacking. Our aim was to assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Consecutive patients with confirmed COVID-19 were included from March to September 2020. Genetic matching for sex, age, hypertension, diabetes mellitus and hospital was performed in a 4:1 ratio. Of the 7018 patients who had confirmed COVID-19, 31 patients with CD and 124 matched controls were included (median age 72 (64–80) years-old, 44.5% were male). At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p < 0.05). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). In-hospital management, outcomes and complications were similar between the groups. In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation
Chlamydia pneumoniae and Helicobacter pylori infections and immunological profile of community-dwelling older adults.
No full textChronic bacterial infections are associated with changes in the immunosenescence process and immunological biomarkers can assist in monitoring these changes. The identification of this immunological profile is important because Chlamydia pneumoniae (C. pneumoniae) and Helicobacter pylori (H. pylori) infections are important factors of morbidity and mortality among the older adults. This study aimed to identify changes in the immunological profile in the presence of C. pneumoniae and H. pylori infections among community-dwelling older adults. This is a cross-sectional study that used data from 1432 participants from the Bambuí Cohort Study of Aging, Minas Gerais, Brazil. The presence of immunoglobulin G (IgG) for C. pneumoniae and H. pylori was considered a dependent variable and assessed in the participants' serum using the enzyme-linked immunosorbent assay (ELISA). In assessing the immunological profile, the following inflammatory markers were considered: CXCL8, CXCL9, CXCL10, CCL2, CCL5, IL-1β, IL-6, IL-10, IL-12, TNF, and CRP. Associations were assessed by logistic regression, estimating odds ratios and confidence intervals (95%) using the Stata® V.13.1 software. The seroprevalence of anti-C. pneumoniae and anti-H. pylori antibodies was 55.9% and 70.3%, respectively. While high levels of anti-C. pneumoniae antibodies were associated with higher concentrations of CXCL10 and IL-10, higher levels of IL-1β and IL-6 were inversely associated with the titration of anti-H. pylori antibodies. The results characterize immunological profiles associated with these chronic infections and reinforce the potential effects of biomarkers on infections by these bacteria and on the immunosenescence process
Effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult men who have sex with men and transgender women participating in two PrEP cohort studies in Brazil: COBra study protocol
No full textCOBra is supported by the ANRS - Maladies infectieuses émergentes,
grant number ANRS COV 31 COBra. PrEP1519 is funded by UNITAID (grant number
2017–15-FIOTECPrEP), SVS-MS/CNPq (404055/2018–4) and the Brazilian Ministry
of Health. Combina is funded by the Brazilian Ministry of Health and the Pan
American Health Organization (PAHO).Introduction: The COVID-19 pandemic and its control
measures have impacted health and healthcare provision
in various levels. Physical distancing measures, for
instance, may affect sexual health, impacting access to
HIV prevention supplies and changing sexual behaviour,
as well as mental health, increasing feelings of unsafety
and weakening community support ties. These effects can
be worsened among socially marginalised groups, such
as men who have sex with men (MSM) and transgender
women (TGW). Brazil is among the countries most affected
by COVID-19 in the world, where control measures have
been inconsistently implemented. We aim to investigate
the effects of the COVID-19 pandemic on the sexual and
mental health of adolescent and adult MSM and TGW in
Brazil. Methods: Convergent mixed-method prospective cohort
study, nested in two ongoing HIV pre-exposure prophylaxis
(PrEP) cohorts in Brazil, named PrEP1519 and Combina.
Participants will be invited to answer, at baseline and
after 6months, a questionnaire about the effects of the
COVID-19 pandemic on sexual behaviour, HIV prevention
and mental health. Data on HIV infection and sexually
transmitted infections (STI) will be collected as part
of routine follow-up from the cohorts. Main outcome
measures (HIV infection, STI and depression symptoms)
will be observed within 12 months after baseline. Sample
size is estimated at 426 participants. Complementarily, 50
participants will be invited to in-depth interviews through
video calls or interactive voice response, and 20 will be
invited to chronicle their lives during the pandemic through
digital diaries. Triangulation will be done across qualitative
methods and with the quantitative data.
Ethics and dissemination: The study was approved by
Research Ethics Committees from the Brazilian Universities
coordinating the study. Findings will be published in
scientific journals and presented at meetings. Informative
flyers will be elaborated to communicate study findings to
participants and key stakeholders