The role of deforestation on American cutaneous leishmaniasis incidence: spatial-temporal distribution, environmental and socioeconomic factors associated in the Brazilian Amazon.

OBJECTIVE: To analyse the temporal and spatial distribution as well as the environmental and socioeconomic factors associated with cutaneous leishmaniasis incidence in the state of Amazonas, Brazil from 2007 to 2015. METHODS: Spatial and temporal distribution was evaluated from sequential thematic maps of the mean incidence rates of the disease. A negative binomial regression analysis was performed to evaluate the association of the factors studied with the mean incidence rate of ACL. RESULTS: The average proportion of deforestation was negatively associated with the average incidence rate of cutaneous leishmaniasis in municipalities (ß = -2.178; P = 0.019; 95%CI -3.996, -0.361), and the health system performance index (effectiveness) (ß = -0.852; P = 0.008; 95%CI -1.481, -0.225). Conversely, the municipal human development index (MHDI) was a factor positively related to the average incidence among the municipalities (ß = 7.728; P = 0.003; 95%CI 2.716, 12.738). CONCLUSION: Our study shows the important impact of socioeconomic and environmental factors on ACL incidence in the Amazonas State.

OBJECTIF: Analyser la distribution temporelle et spatiale ainsi que les facteurs environnementaux et socioéconomiques associés à l'incidence de la leishmaniose cutanée dans l'Etat de l'Amazonas, au Brésil, de 2007 à 2015. MÉTHODES: La distribution spatiale et temporelle a été évaluée à partir de cartes thématiques séquentielles des taux d'incidence moyens de la maladie. Une analyse de régression binomiale négative a été réalisée pour évaluer l'association des facteurs étudiés avec le taux d'incidence moyen de la LCA. RÉSULTATS: La proportion moyenne de déforestation était négativement associée au taux d'incidence moyen de la leishmaniose cutanée dans les municipalités (ß = -2,178; p = 0,019; IC95%: -3,996 à -0,361) et à l'indice de performance du système de santé (efficacité) (ß = -0,852; p = 0,008; IC95%: -1,481 à -0,225). Par contre, l'indice de développement humain municipal (IDHM) était un facteur positivement lié à l'incidence moyenne dans les municipalités (ß = 7,728; p = 0,003; IC95%: 2,716 à 12,738). CONCLUSION: Notre étude montre l'impact important des facteurs socioéconomiques et environnementaux sur l'incidence de la LCA dans l'Etat d'Amazonas.

Hemorrhagic stroke following viper bites and delayed antivenom administration: three case reports from the Western Brazilian Amazon.

Snakebites were included by the World Health Organization in their list of neglected diseases. In Latin America, most snakebites are caused by species of the Viperidae family, notably by the genus Bothrops. Bothrops atrox accounts for 90% of the cases of envenoming in the Brazilian Amazon. In this report, we present a series of three cases of snakebites that evolved with hemorrhagic stroke due to delays in the access to antivenom in the Brazilian Amazon, being fundamental for diagnosis to validate the clinical suspicion and make decisions that would improve the treatment and prognosis of the patients.

Performance of an immuno-rapid malaria Pf/Pv rapid diagnostic test for malaria diagnosis in the Western Brazilian Amazon.

INTRODUCTION: Rapid diagnostic tests (RDTs) for detecting Plasmodium antigens have become increasingly common worldwide. We aimed to evaluate the accuracy of the Immuno-Rapid Malaria Pf/Pv RDT in detecting Plasmodium vivax infection compared to standard thick blood smear (TBS) under microscopy. METHODS: Hundred and eighty-one febrile patients from the hospital's regular admissions were assessed using TBS and RDT in a blinded experiment. RESULTS: RDT showed a sensitivity of 98.9%, specificity of 100%, and accuracy of 99.5% for P. vivax infection when compared to TBS. CONCLUSIONS: The RDT is highly accurate, making it a valuable diagnostic tool for P. vivax infection.

Predicting acute renal failure in Bothrops snakebite patients in a tertiary reference center, Western Brazilian Amazon.

Acute Kidney Injury (AKI) is the main systemic complication and cause of death in viperid envenomation. Although there are hypotheses for the development of AKI, the mechanisms involved are still not established. The aim of this study was to evaluate the clinical-laboratorial-epidemiological factors associated with AKI in victims of Bothrops sp envenomation. This is an observational study carried out at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado. AKI was defined according to the guidelines of the Acute Kidney Injury Network (AKIN). Among the 186 patients evaluated, AKI was observed in 24 (12.9%) after 48 hours of admission. Stage I was present in 17 (70.8%) patients, II in 3 (12.5%) and III in 4 (16.7%). Epidemiological characterization showed predominance of men, occurrence in rural areas, aged between 16-60 years, feet as the most affected anatomical region, and time to medical assistance less than 3 hours. Hypertension and diabetes were the comorbidities identified. Most of the accidents were classified as moderate, and clinical manifestations included severe pain, mild edema, local bleeding and headache. Laboratory results showed blood uncoagulability, hypofibrinogenemia, leukocytosis, increase of creatine kinase, and high lactate dehydrogenase levels. Multivariate analysis showed an association with high LDH levels [AOR = 1.01 (95% CI = 1.01-1.01, p<0.002)], local bleeding [AOR = 0.13 (95%CI = 0.027-0.59, p<0.009)], and the presence of comorbidities [AOR = 60.96 (95%CI = 9.69-383.30; p<0.000)]. Herein, laboratory markers such as high LDH levels along with local bleeding and comorbidities may aid in the diagnosis of AKI.

Hemorrhagic stroke following viper bites and delayed antivenom administration: three case reports from the Western Brazilian Amazon

Abstract Snakebites were included by the World Health Organization in their list of neglected diseases. In Latin America, most snakebites are caused by species of the Viperidae family, notably by the genus Bothrops. Bothrops atrox accounts for 90% of the cases of envenoming in the Brazilian Amazon. In this report, we present a series of three cases of snakebites that evolved with hemorrhagic stroke due to delays in the access to antivenom in the Brazilian Amazon, being fundamental for diagnosis to validate the clinical suspicion and make decisions that would improve the treatment and prognosis of the patients.

Performance of an immuno-rapid malaria Pf/Pv rapid diagnostic test for malaria diagnosis in the Western Brazilian Amazon

Abstract INTRODUCTION: Rapid diagnostic tests (RDTs) for detecting Plasmodium antigens have become increasingly common worldwide. We aimed to evaluate the accuracy of the Immuno-Rapid Malaria Pf/Pv RDT in detecting Plasmodium vivax infection compared to standard thick blood smear (TBS) under microscopy. METHODS: Hundred and eighty-one febrile patients from the hospital's regular admissions were assessed using TBS and RDT in a blinded experiment. RESULTS: RDT showed a sensitivity of 98.9%, specificity of 100%, and accuracy of 99.5% for P. vivax infection when compared to TBS. CONCLUSIONS: The RDT is highly accurate, making it a valuable diagnostic tool for P. vivax infection.

Qualidade de vida em idosos hipertensos e diabéticos acompanhados pela Estratégia Saúde da Família no Município de Manaus, Amazonas

O número de indivíduos com doenças crônicas não transmissíveis (DCNT) vem aumentando, acompanhando o aumento da expectativa de vida no Brasil. A Hipertensão Arterial Sistêmica (HAS) e a Diabetes Mellitus (DM) estão entre as DCNT com maior prevalência entre os idosos. Tais doenças compartilham fatores de risco comuns e estão associadas a redução na qualidade de vida (QV) dos indivíduos. Analisar a qualidade de vida geral de pacientes idosos, diagnosticados com hipertensão arterial sistêmica ou diabete mellitus e acompanhados pela Estratégia Saúde da Família no município de Manaus, Amazonas. Trata-se de estudo transversal, realizado por meio de inquérito domiciliar, utilizando o instrumento World Health Organization Quality of Life (WHOQOL-bref). O cálculo amostral considerou o valor 25 para o desvio-padrão do escore do instrumento, assumiu como » dos valores mínimos e máximo do seu intervalo (0-100), com precisão de 2% e nível de confiança de 95%. Com a correção para população finita o tamanho da amostra foi definido em 591 indivíduos. Foram incluídos pacientes idosos com HAS e DM residentes em Manaus e excluídos os que não eram cadastrados pelas equipes de saúde da família. Os dados foram analisados por meio do software Statistical Package for the Social Sciences (SPSS). Observou-se que 50 indivíduos tinham diagnóstico de DM, 270 de HAS e 188 de ambas, HAS e DM. A idade média dos participantes foi 71 anos, 66,7% era do sexo feminino, a maioria possuía apenas o ensino fundamental (52,8%) e 52,6% viviam com companheiro/cônjuge. O melhor escore geral de QV foi obtido pelos indivíduos com apenas HAS (60,7±12,4). O domínio que obteve melhor escore, para os 3 grupos, foi o psicológico: HAS (68,4±15,0), DM (64,5±13,1) e HAS+DM (66,8±14,6). Os piores escores foram encontrados para o domínio ambiental: HAS (57,0±13,8), DM (54,4±14,4) e HAS+DM (55,5±13,2). Idosos com DM obtiveram piores escores de QV. O diagnóstico tardio e as comorbidades associadas com essa condição podem ser fatores relevantes para o resultado encontrado. O conhecimento dos fatores associados com a qualidade de vida geral e seus domínios nessa população é importante para o planejamento e implementação de ações e políticas públicas que contribuam para minimizar o impacto da HAS e DM na qualidade de vida destes indivíduos.