Use of a high-density DNA probe array for detecting mutations involved in rifampicin resistance in Mycobacterium tuberculosis.

A Mycobacterium high-density DNA probe array designed to detect rpoB mutations conferring rifampicin resistance in Mycobacterium tuberculosis was evaluated. The rpoB hybridisation patterns produced by 41 susceptible (RifS) and 59 rifampicin-resistant (RifR) clinical isolates of M. tuberculosis were compared with the results of conventional dideoxynucleotide sequencing of the rpoB gene. For all the RifR isolates, the rpoB hybridisation patterns correlated with the rpoB sequencing results. Among the 59 isolates, 11 distinct amino-acid changes were detected by the DNA probe array. Of these, 36 (61%) corresponded to replacement of the serine residue found in position 531 (S531L in 34 isolates and S531W in two isolates), 16 (27%) affected histidine 526 (five H526D, five H526Y, four H526L, one H526N and one H526R), four (6.8%) replaced aspartate 516 with a valine, and one (1.7%) replaced glutamine 513 with a leucine. Deletion of the asparagine residue at position 519 was detected in one isolate susceptible to rifampicin, but yielding c. 0.1% resistant colonies on rifampicin-containing medium. No mutation was detected in the rpoB region from one isolate yielding c. 5% of resistant colonies on rifampicin-containing medium. Finally, a D516Y substitution was detected in association with an unexpected mutation, G523W, not tiled on the DNA probe array, but which could be detected by analysing the hybridisation pattern obtained with the wild-type probes covering codon 523. In conclusion, the Mycobacterium probe array is a promising approach to rapid detection of mutations involved in rifampicin resistance in M. tuberculosis.

Dilemas do controle social na constru��o do Sistema �nico de Sa�de (SUS) no �mbito do estado do Rio de Janeiro: um estudo sobre o Conselho Estadual de Sa�de (CES/RJ) / Dilemmas of social control in the construction of the Unified Health System (SUS) in the state of Rio de Janeiro: a study of the State Health Council (CES / RJ)

O objetivo deste trabalho � refletir sobre alguns dos dilemas concernentes ao controle social do SUS no �mbito do Conselho Estadual de Sa�de do Rio de Janeiro (CES/RJ). A pesquisa concentrou-se na atua��o de representantes da sociedade e dos profissionais de sa�de perante os atores estatais (gestores da Secretaria Estadual de Sa�de do Rio de Janeiro), durante a gest�o do governador S�rgio Cabral (2007-2012). Os Conselhos de Sa�de, desde os anos 1990 foram institucionalizados como arenas deliberativas das pol�ticas de sa�de nos tr�s �mbitos da federa��o (nacional, estadual e municipal). Apesar de inaugurarem um novo marco no processo decis�rio de defini��o das pol�ticas de sa�de, diversos impasses s�o apontados no que se refere � forma��o e aprofundamento da cultura pol�tica das institui��es participativas brasileiras. No caso dos Conselhos de Sa�de, a falta de defini��o clara sobre o papel das diversas representa��es conselheiras, a rela��o de indu��o pol�tica dos gestores e a burocratiza��o do controle social s�o alguns dos desafios enfrentados na legitimidade desses f�runs participativos. Al�m disso, a forma��o de n�cleos duros no �mbito do processo de decis�o pol�tica tanto nos Conselhos de Sa�de quanto em outros colegiados (como as Comiss�es Intergestores) leva ao enfraquecimento das arenas de participa��o social. No caso do CES/RJ, os conselheiros representantes da sociedade e dos profissionais de sa�de enfrentam os dilemas pr�prios � autonomiza��o do sujeito pol�tico, que atua em uma arena pol�tica deliberativa fortemente institucionalizada e dirigida politicamente pelos gestores da SES/RJ. O enfraquecimento do papel pol�tico dos conselheiros foi ressaltado, ao longo da pesquisa, ao serem analisados os principais espa�os e produtos do processo deliberativo: as Reuni�es Plen�rias, as Atas de Reuni�es Plen�rias, as Delibera��es e a VI Confer�ncia Estadual de Sa�de. A pesquisa foi realizada atrav�s de variadas t�cnicas de pesquisa.

Enquanto estudo de caso, utilizou-se desde a observa��o direta (nos espa�os de reuni�o dos conselheiros), a an�lise de conte�do (identificando n�cleos de sentidos nos documentos formais produzidos pelo CES/RJ) e a entrevista semiestruturada. Dessa forma, a pesquisa p�de triangular m�todos, de forma a evitar o reducionismo metodol�gico. Ao mesmo tempo em que os conselheiros estaduais mobilizam o espa�o pol�tico do CES/RJ em favor (ou na inten��o) de discutir os impasses do SUS estadual, os avan�os nas pol�ticas de sa�de s�o desvirtuados pela hegemonia claramente impressa pela atua��o dos representantes da SES/RJ. O fato de que o projeto pol�tico do governo estadual seja levado adiante a reboque da participa��o social levou a pesquisa a considerar que os dilemas do controle social referem-se ao exerc�cio de fato de uma contra-hegemonia no processo de tomada de decis�o pol�tica da sa�de; al�m disso, identificam-se os desafios a serem superados nas rela��es entre Estado e Sociedade na constru��o de f�runs ou institui��es participativas da democracia brasileira. (AU)

After five years of chemical control: Colonies of the triatomine Eratyrus mucronatus are still present in Bolivia

Chagas disease, which is caused by the parasite Trypanosoma cruzi, is transmitted to humans by bloodsucking bugs (Triatominae). Eratyrus mucronatus is a well-dispersed triatomine species, found sometimes in dwellings. In the Apolo region of Bolivia, people continue to complain of bites by this bug despite Five years of chemical control. For the first time, the domiciliation process of E. mucronatus was evaluated in a zone treated by insecticide, and it was compared with a previous situation 14 years ago. Both an entomological and a serological study were carried out: 152 dwellings were visited and 491 blood samples were analyzed with Stat-Pack and ELISA tests. In 34 dwellings (23 per cent of the total visited dwellings), 160 triatomines of all stages were collected belonging to two species, E. mucronatus (98 per cent of the capture) and Panstrongylus geniculatus. A domiciliation of E. mucronatus is demonstrated, particularly in the peridomicile. Bugs were captured more frequently in bedrooms in the intradomicile, and in curahuas (boundary walls in rammed mud) in the peridomicile. A P. geniculatus adult was found infected with T. cruzi. No evidence of a local vectorial transmission was found. In particular, the limited effect of the insecticide on the presence of E. mucronatus and the role of the curahuas as a source of intrusion/domiciliation process are discussed.