Ten years of a hantavirus disease emergency in the Federal District, Brazil.

INTRODUCTION: Hantavirus diseases are emerging human diseases caused by Hantavirus spp. of the Bunnyaviridae family. Hantavirus pulmonary syndrome (HPS) has been detected in the Federal District (DF) of Brazil since 2004. Among the 27 Brazilian Federal Units, DF has the highest fatality rate. More than 10 years have already passed since then, with confirmation of cases caused by the Araraquara and Paranoa species. The reservoir is Necromys lasiurus. METHODS: Local surveillance data of the confirmed cases were analyzed, including age, sex, month and year of occurrence, clinical symptoms, syndromes and outcomes, and probable transmission place (PTP). The cases were mainly confirmed by IgM detection with a capture enzyme immunoassay. The cases were classified as autochthonous if PTPs were in the DF area. RESULTS: From 2004 to 2013, in the DF, 126 cases of hantavirus were confirmed, and the cumulative incidence was 5.0 per 100,000 inhabitants. The occurrence of cases was predominantly from April to August. At least 75% of the cases were autochthonous. Acute respiratory failure was reported in 47.5% of cases, and the fatality rate was 40%. CONCLUSIONS: In the DF, the cumulative incidence of HPS was one of the highest worldwide. A seasonal pattern of hantavirus disease in the dry season is clear. There was a high frequency of severe clinical signals and symptoms as well as a high fatality rate. For the near future, visitors and inhabitants of DF rural areas, particularly male adults, should receive continuous education about hantavirus transmission and prevention.

Ten years of a hantavirus disease emergency in the Federal District, Brazil

Abstract: INTRODUCTION: Hantavirus diseases are emerging human diseases caused by Hantavirus spp. of the Bunnyaviridae family. Hantavirus pulmonary syndrome (HPS) has been detected in the Federal District (DF) of Brazil since 2004. Among the 27 Brazilian Federal Units, DF has the highest fatality rate. More than 10 years have already passed since then, with confirmation of cases caused by the Araraquara and Paranoa species. The reservoir is Necromys lasiurus. METHODS: Local surveillance data of the confirmed cases were analyzed, including age, sex, month and year of occurrence, clinical symptoms, syndromes and outcomes, and probable transmission place (PTP). The cases were mainly confirmed by IgM detection with a capture enzyme immunoassay. The cases were classified as autochthonous if PTPs were in the DF area. RESULTS: From 2004 to 2013, in the DF, 126 cases of hantavirus were confirmed, and the cumulative incidence was 5.0 per 100,000 inhabitants. The occurrence of cases was predominantly from April to August. At least 75% of the cases were autochthonous. Acute respiratory failure was reported in 47.5% of cases, and the fatality rate was 40%. CONCLUSIONS: In the DF, the cumulative incidence of HPS was one of the highest worldwide. A seasonal pattern of hantavirus disease in the dry season is clear. There was a high frequency of severe clinical signals and symptoms as well as a high fatality rate. For the near future, visitors and inhabitants of DF rural areas, particularly male adults, should receive continuous education about hantavirus transmission and prevention.

[Actual indications for day-surgery in the treatment of lung neoplasms]. / Attuali indicazioni per il trattamento delle affezioni neoplastiche del polmone in regime di day surgery.

AIM OF THE STUDY: To point out the actual possibilities to apply surgical treatments (diagnostic and therapeutics) for the cure of neoplastic disease of the lungs into an outpatient procedure. After a review of the recent literature, the authors show problems and limits of such a program. The analysis of the invasive diagnostic procedures (video-mediastinoscopy, anterior mediastinotomy, and thoracoscopy) shows that in most cases, a part from the kind of anesthesia, could be done in a short-term hospitalization. On the contrary, for pulmonary resection, all the experiences prove the practicability of the program, but only after careful selection of the patient, deep information of the patient and of his family and mostly, a proved integration between hospital and territory to warranty the continuation of the cures. CONCLUSION: The Authors believe that, mostly in their country, it is too early for a wide diffusion of new form of hospitalization different from the traditional one for the treatment of neoplastic disease of the lung.

Concomitant pulmonary carcinoma and abdominal aortic aneurysm: therapeutic strategies.

PURPOSE: A diagnosis of concomitant pulmonary carcinoma and abdominal aortic aneurysm is rare (<1% of treated cases). However, such an association makes the therapeutic decisions critical, especially regarding the priority and timing of treatment. This article reports on our experience of 14 cases of concomitant pulmonary carcinoma and abdominal aortic aneurysm. METHODS: From April 1987 to June 2006 we observed 14 cases of concomitant pulmonary carcinoma and abdominal aortic aneurysm. In patients for whom simultaneous treatment was not indicated due to a poor general condition, priority was given to lung cancer except for cases in which the aneurysm needed an urgent approach. Patients observed after 2000 and scheduled for a two-stage treatment were treated with endovascular procedures whenever possible. RESULTS: Only one patient was treated by a simultaneous aneurysmectomy and a left lower lobectomy, while in the other 13 patients two-stage treatment was performed. Lung carcinoma was operated on first in 7 cases but one patient underwent an urgent aneurysmectomy after chest surgery due to a rupture of the aneurysm. Priority was given to an aneurysmectomy in 2 patients. An endovascular approach was performed in 4 patients, thus allowing a pulmonary resection during the same period of hospitalization, 2 days after 2 uneventful endovascular procedures and on the 6th and 7th postoperative days in 2 cases due to an intraoperative rupture of right iliac artery and type I postoperative endoleak, respectively. CONCLUSION: An endovascular exclusion of the aneurysm may therefore be proposed in order to achieve a concomitant treatment of both diseases. Such an approach excludes complications due to a postoperative rupture of the aneurysm when a pulmonary resection would be first performed; moreover, it does not delay the performance of a pulmonary resection when treatment of the aneurysm is considered to have priority.

Inquérito sorológico para rubéola em mulheres em idade fértil na cidade de Taguatinga, Distrito Federal, 2003 / Rubella serologic survey among women in childbearing age in the city of Taguatinga, Distrito Federal, 2003

Introdução: em 1993 realizou-se no Distrito Federal, a primeira campanha de vacinação contra rubéola, com a vacina tríplice viral, em crianças entre 12 meses e 11 anos de idade, como parte da rotina do Programa de Imunização. Em 1996 foi implementada a vacinação no puerpério e em 1998 nas mulheres em idade fértil. Estimativa realizada em Taguatinga em 2002, por meio de monitoramento rápido, indicou baixa cobertura vacinal contra rubéola em mulheres em idade fértil (2,6 por cento a 34,2 por cento). O objetivo deste estudo foi determinar a imunidade contra rubéola em mulheres em idade fértil da cidade de Taguatinga. Método: estudo de soroprevalência realizado com técnica por amostragem por conglomerados. Foram escolhidos 30 setores censitários com seleção aleatória do ponto de partida em cada setor. Título de anticorpos da classe IgG contra rubéola foi determinado pelo método ELISA. Total da amostra de 391 mulheres em idade fértil. A medida utilizada foi a proporção de pessoas com sorologia positiva. Resultado: soroprevalência contra rubéola IgG das mulheres em idade fértil na cidade de Taguatinga foi de 91,8 por cento (IC95 por cento 89,1 - 94,5). Por faixa etária obtivemos: 96,1 por cento (IC95 por cento 93,0 - 99,2) de 12 a 19 anos, 85,2 por cento (IC95 por cento 79,2 - 91,2) de 20 a 29 anos e 94,2 por cento (IC95 por cento 89,7 - 98,7) de 30 a 39 anos. Conclusão: entre mulheres em idade fértil de 12 a 39 anos, a proporção de imunidade para rubéola é alta. Palavras-chave: mulheres, estudos soroepidemiológicos, amostragem por conglomerados, vacina contra rubéola, rubéola.

Using the angio-seal to achieve hemostasis in prosthetic endovascular surgery: report of three cases.

At least 10% of patients who undergo bilateral aortofemoral bypass are at risk of needing a reoperation for late prosthetic thrombosis because of reduced outflow as the disease progresses. To prevent occlusion of the prostheses, we performed endovascular surgery with transprosthetic access for distal stenosis. We report our experience of using the Angio-Seal with transprosthetic access after angioplasty in three patients who had undergone bilateral aortofemoral bypass. Hemostasis was achieved in all three patients. There were no complications, such as hemorrhage, hematoma, or prosthetic infection, and all three patients were discharged within 24 h. At the 12-, 15-, and 24-month follow-up, none of the patients had any sign of recurrent claudication. Using the Angio-Seal in bilateral aortofemoral bypass provided the means of treating distal stenosis by endovascular surgery with transprosthetic access. This method is both rapid and safe, and may broaden the indications for the endovascular treatment of distal arteriopathies in patients with vascular prostheses.

Aspectos ecoepidemiológicos da dengue e do Aedes aegypti no Distrito Federal, Brasil / Eco-epidemiological aspects of dengue and Aedes aegypti in the Distrito Federal

Casos de dengue alóctones foram notificados e confirmados laboratorialmente no DF a partir de 1991. A partir de 1993, o número de casos aumentou, com aparição de casos autóctones a partir de 1997. O número de casos durante o primeiro quadrimestre de 1998 superou os números dos anos anteriores, refletindo os seguintes aspectos: o sistema de notificação está sendo mais eficaz, os intercâmbios entre o DF e outros Estados são mais intensos e a prevalência da dengue aumenta globalmente no país. Após um período de presença esporádica, de 1986 a 1993, o vetor Aedes aegypti instalou-se de maneira definitiva em todas as localidades do DF, com índice global aumentando de 1994 a 1997. A partir de 1998, o controle conseguiu conter a sua proliferação. No entanto, pesquisas integradas são necessárias para tornar esses resultados sustentáveis a longo prazo e impedir a aparição de resistência a inseticidas ou mudanças genéticas nas populações de vetores