A historical overview of leprosy epidemiology and control activities in Amazonas, Brazil.

Leprosy is an ancient infectious disease caused by Mycobacterium leprae. According to comparative genomics studies, this disease originated in Eastern Africa or the Near East and spread with successive human migrations. The Europeans and North Africans introduced leprosy into West Africa and the Americas within the past 500 years. In Brazil, this disease arrived with the colonizers who disembarked at the first colonies, Rio de Janeiro, Salvador and Recife, at the end of the sixteenth century, after which it was spread to the other states. In 1854, the first leprosy cases were identified in State of Amazonas in the north of Brazil. The increasing number of leprosy cases and the need for treatment and disease control led to the creation of places to isolate patients, known as leprosaria. One of them, Colonia Antônio Aleixo was built in Amazonas in 1956 according to the most advanced recommendations for isolation at that time and was deactivated in 1979. The history of the Alfredo da Matta Center (AMC), which was the first leprosy dispensary created in 1955, parallels the history of leprosy in the state. Over the years, the AMC has become one of the best training centers for leprosy, general dermatology and sexually transmitted diseases in Brazil. In addition to being responsible for leprosy control programs in the state, the AMC has carried out training programs on leprosy diagnosis and treatment for health professionals in Manaus and other municipalities of the state, aiming to increase the coverage of leprosy control activities. This paper provides a historical overview of leprosy in State of Amazonas, which is an endemic state in Brazil.

A historical overview of leprosy epidemiology and control activities in Amazonas, Brazil

Leprosy is an ancient infectious disease caused by Mycobacterium leprae. According to comparative genomics studies, this disease originated in Eastern Africa or the Near East and spread with successive human migrations. The Europeans and North Africans introduced leprosy into West Africa and the Americas within the past 500 years. In Brazil, this disease arrived with the colonizers who disembarked at the first colonies, Rio de Janeiro, Salvador and Recife, at the end of the sixteenth century, after which it was spread to the other states. In 1854, the first leprosy cases were identified in State of Amazonas in the north of Brazil. The increasing number of leprosy cases and the need for treatment and disease control led to the creation of places to isolate patients, known as leprosaria. One of them, Colonia Antônio Aleixo was built in Amazonas in 1956 according to the most advanced recommendations for isolation at that time and was deactivated in 1979. The history of the Alfredo da Matta Center (AMC), which was the first leprosy dispensary created in 1955, parallels the history of leprosy in the state. Over the years, the AMC has become one of the best training centers for leprosy, general dermatology and sexually transmitted diseases in Brazil. In addition to being responsible for leprosy control programs in the state, the AMC has carried out training programs on leprosy diagnosis and treatment for health professionals in Manaus and other municipalities of the state, aiming to increase the coverage of leprosy control activities. This paper provides a historical overview of leprosy in State of Amazonas, which is an endemic state in Brazil.

Adherence of obstructive sleep apnea syndrome patients to continuous positive airway pressure in a public service.

INTRODUCTION: The standard therapy for obstructive sleep apnea syndrome (OSAS) is continuous positive airway pressure (CPAP), but its correct and frequent use is essential to control the disease. PURPOSE: To analyze adherence to CPAP among patients with OSAS treated in a multidisciplinary outpatient clinic of a public tertiary hospital. METHODS: This was a retrospective study evaluating 156 patients with OSAS who underwent polysomnography for CPAP titration from 2008 to 2011. The patients were divided into two groups, those with good adherence to CPAP (a mean use of four or more hours per night) and those with poor adherence. The groups were compared regarding the following data: gender, age, body mass index, associated diseases, AHI at diagnostic polysomnography, and pressure (cmH2O) suggested by titration polysomnography. RESULTS: 125 patients were analyzed, and it was observed that 82 of the patients (65%) had good adherence, whereas 43 (35%) showed poor adherence. Comparison between groups revealed that patients with a higher apnea-hypopnea index (AHI) were those who better adhered to treatment with CPAP. CONCLUSIONS: the rate of adherence to CPAP among OSAS patients undergoing clinical monitoring at a public service was 65%. Patients with a higher AHI were those who adhered better to treatment with CPAP.

Adesão de pacientes com síndrome da apneia obstrutiva do sono à pressão positiva contínua em via aérea em um serviço público / Adherence of obstructive sleep apnea syndrome patients to continuous positive airway pressure in a public service

Introdução: A terapia padrão para tratamento da síndrome da apneia obstrutiva do sono (SAOS) é o aparelho de pressão positiva contínua em via aérea (CPAP); todavia, seu uso correto e frequente é determinante para o controle da doença. Objetivo: Analisar a adesão ao CPAP entre pacientes com SAOS tratados em um ambulatório multidisciplinar em um hospital público. Métodos: Estudo retrospectivo avaliando 156 pacientes com SAOS que foram submetidos à polissonografia para titulação de CPAP de 2008 a 2011. Os pacientes foram divididos em dois grupos: os com boa e os com má adesão. Os grupos foram comparados entre si em relação aos seus dados: sexo, idade, IMC, doenças associadas, IAH à polissonografia diagnóstica e pressão em (cmH20) sugerida à polissonografia de titulação. Resultados: Foram analisados 125 pacientes, demonstrando que 82 dels (65%) tinham boa adesão, enquanto 43 (35%) eram maus usuários. A comparação entre os grupos mostrou que os pacientes com maior índice de apneia e hipopneias (IAH) eram os com melhor adesão ao tratamento com CPAP. Conclusões: A taxa de adesão ao CPAP entre os pacientes com SAOS monitorizados regularmente em um serviço público foi de 65%. Os pacientes com pior IAH foram os mais aderentes ao tratamento com CPAP. .

Introduction: The standard therapy for obstructive sleep apnea syndrome (OSAS) is continuous positive airway pressure (CPAP), but its correct and frequent use is essential to control the disease. Purpose: To analyze adherence to CPAP among patients with OSAS treated in a multidisciplinary outpatient clinic of a public tertiary hospital. Methods: This was a retrospective study evaluating 156 patients with OSAS who underwent polysomnography for CPAP titration from 2008 to 2011. The patients were divided into two groups, those with good adherence to CPAP (a mean use of four or more hours per night) and those with poor adherence. The groups were compared regarding the following data: gender, age, body mass index, associated diseases, AHI at diagnostic polysomnography, and pressure (cmH2O) suggested by titration polysomnography. Results: 125 patients were analyzed, and it was observed that 82 of the patients (65%) had good adherence, whereas 43 (35%) showed poor adherence. Comparison between groups revealed that patients with a higher apnea-hypopnea index (AHI) were those who better adhered to treatment with CPAP. Conclusions: the rate of adherence to CPAP among OSAS patients undergoing clinical monitoring at a public service was 65%. Patients with a higher AHI were those who adhered better to treatment with CPAP. .

Younger siblings play a major role in Helicobacter pylori transmission among children from a low-income community in the Northeast of Brazil.

BACKGROUND AND AIMS: To further evaluate intrafamilial transmission of H. pylori infection during childhood, we investigated the prevalence of H. pylori in family members from a poor H. pylori high-prevalence urban community in the Northeast of Brazil. METHODS: H. pylori infection was investigated in 570 members of 128 households, by (13) C-urea breath test in children and by ELISA in mothers and other adult relatives. RESULTS: The overall prevalence of H. pylori infection (376/570) increased with age (p < .001) and ranged from 28.9%, in children aged 6 months to 5 years, to 82% in adults over 40 years. An H. pylori positive mother and the number of infected siblings are independent risk factors for childhood H. pylori infection (OR = 2.2, 95% CI = 1.0-4.6 and OR = 4.3, 95% CI = 2.3-8.1, respectively) The number of siblings, number of younger siblings, and number of infected younger siblings were also associated with the infection in the univariate analysis. The number of infected younger siblings remained independently associated with the infection (p = .000), even after controlling for all the above cited variables, in addition to the H. pylori status of siblings and mothers, age, number of people per room, and number of children in the household. CONCLUSION: The transmission of H. pylori occurs from infected mothers to their offspring and among siblings, notably from younger siblings to the older ones.

Leprosy and HIV coinfection: a clinical, pathological, immunological, and therapeutic study of a cohort from a Brazilian referral center for infectious diseases.

BACKGROUND: Although awareness of the relevance of leprosy and human immunodeficiency virus (HIV) coinfection is increasing worldwide, several aspects of this co-occurrence are not fully understood. METHODS: We describe clinical, pathological, immunological, and therapeutic long-term follow-up of a cohort of 25 individuals with leprosy and HIV infection from Manaus, Amazonas. RESULTS: Careful description of our cohort indicates a higher prevalence of leprosy in an HIV-positive population than that in the general population. We also observed upgrading shifting of leprosy clinical forms after initiation of highly active antiretroviral therapy and multidrug therapy and an impact of HIV infection on leprosy granuloma formation, among other features. CONCLUSION: Taken together, these new insights allow the proposition of a classification system that includes (1) leprosy and HIV true coinfection, (2) opportunistic leprosy disease, and (3) leprosy related to highly active antiretroviral therapy.

NOC-9, a selective nitric oxide donor, induces flight reactions in the dorsolateral periaqueductal gray of rats by activating soluble guanylate cyclase.

Previous studies have showed that SIN-1, a nitric oxide (NO) donor, injected into the dorsolateral column of the periaqueductal gray (dlPAG) induces flight reactions. This drug, however, can also produce peroxynitrite, which may interfere in this effect. In addition, it is also unknown if this effect is mediated by local activation of soluble guanylate cyclase (sGC). The aims of this study, therefore, were (1) to investigate if NOC-9 (6-(2-Hydroxy-1-methyl-2-nitrosohydrazino)-N-methyl-1-hexanamine), a NO donor that does not produce peroxynitrite, would produce flight reactions after intra-dlPAG administration similar to those induced by SIN-1; (2) to verify if these responses could be prevented by local injection of a selective guanylate cyclase inhibitor (ODQ). Male Wistar rats (n=5-12) with cannulae aimed at the dlPAG received injections of TRIS (pH 10.0, 0.5 microl), NOC-9 (75 and 150 nmol), saline or SIN-1 (200 nmol) and were placed in an open arena for 10 min. In a subsequent experiment animals (n=7-8) were pretreated with ODQ (1 nmol/0.5 microl) before receiving NOC-9 150 nmol. NOC-9 induced a significant dose-dependent increase in flight reactions in the first minute after injection (% of animals displaying flight: vehicle=0%, NOC 75=67%, NOC 150=75%). SIN-1 had a similar effect (100% of animals showing flight) but the effects lasted longer (10 min) than those of NOC-9. The effect of NOC-9 (150 nmol) was prevented by pretreatment with ODQ (% of animals displaying flight: vehicle+NOC 150=71%, ODQ+NOC 150=37%). The results suggest that NO donors injected into the dlPAG induce defensive responses that are not mediated by secondary peroxynitrite production. Moreover, they also indicate that these defensive responses depend on activation of local sGC. The data strengthen the proposal that NO can modulate defensive reactions in the dlPAG.

Role of retinol in protecting epithelial cell damage induced by Clostridium difficile toxin A.

Vitamin A (retinol), a fat-soluble vitamin, is an essential nutrient for the normal functioning of the visual system, epithelial cell integrity and growth, immunity, and reproduction. Our group has investigated the effect of high doses of oral vitamin A on early childhood diarrhea in our prospective community-based studies from Northeast Brazil and found a beneficial role in reducing the mean duration but not incidence of diarrheal episodes. In this study, we explored the role of retinol supplementation in intestinal cell lines following Clostridium difficile toxin A (TxA) challenge. C. difficile is the most common anaerobic pathogen borne with antibiotic-borne diarrhea and pseudomembranous colitis. Since retinol is critical for the integrity of tight junctions and to modulate the cell cycle, we have focused on changes in transepithelial electrical resistance (TEER) in Caco-2, a more differentiated intestinal cell line, and on models of cell proliferation, migration and viability in IEC-6 cells, an undifferentiated crypt cell line, following TxA injury. In this model, retinol therapy reduced apoptosis, improved cell migration and proliferation, and prevented the reduction in TEER, following C. difficile TxA challenge in a glutamine-free medium. These results suggest the role of retinol in protecting intestinal epithelial barrier function from C. difficile TxA enterotoxic damage.

Helicobacter pylori colonization among children up to 6 years: results of a community-based study from Northeastern Brazil.

AIM: To determine the prevalence and risk factors associated with Helicobacter pylori infection among children up to 6 years. METHODS: Cross-sectional study carried out in a poor urban community in Fortaleza Northeast Brazil. A standardized questionnaire was applied. Helicobacter pylori status was evaluated by (13)C-urea breath test ((13)C-UBT) in children up to 48 months and by ELISA in the mothers. Sera were assayed by the Cobas Core anti-H. pylori IgG EIA. RESULTS: The overall prevalence of H. pylori infection was 40% (88/217), 41% (46/112) boys and 40% (42/105) girls were infected. The prevalence rate of infection by H. pylori increased significantly with age, from 29% (27/93) in the youngest group (3 months to 2 years) to 59% (35/59) in the oldest group (6 years), (p < 0.001). There was no significant difference in the prevalence of infection between gender, height and weight adjusted for age, history of breastfeeding, mother's education, number of people per room, number of people per bed, smoking habit of the mother and children's history of antibiotic intake. A significant difference was found in the prevalence of H. pylori infection and H. pylori status of mother (p = 0.02; odds ratio (OR) 2.98; 95% confidence interval (CI): 1.19-7.46) that remained significant after adjustment for covariates in multivariate analysis (p = 0.012; OR 4.65; 95%CI: 1.39-15.58). CONCLUSIONS: This study shows that children living in low socioeconomic status and poor hygienic conditions are infected very early in childhood. It identifies age and H. pylori positive mother as independent risk factors for infection.

The association between Helicobacter pylori infection and height in children from an urban community in north-east Brazil.

BACKGROUND: An association between Helicobacter pylori infection and short stature in children has been described recently. AIM: To describe differences in stature between H. pylori-infected and non-infected children in a low-income community in north-east Brazil. METHODS: H. pylori status was evaluated by 13C-urea-breath test; centile values for weight and height were calculated for each child. RESULTS: The prevalence of H. pyloni was 55.8% (197/353) and increased with age. Of 197 H. pylori-positive children, 62% were below the 25th centile for height compared with 48% of H. pylori-negative children (75/156) [AOR (adjusted odds ratio) 1.61, 95% CI 1.04-2.49, p=0.03] after adjustment for variables with p < 0.25 in univariate analysis (gender, number of residents, of children per household and of persons per bed). These results were significant only when older children were included. Thus, in children aged 8-14 years, 80% (89/111) of H. pylori-positive were <25th centile for height compared with 63% (35/56) of H. pylori-negative children (p=0.01). Compared with children with a height >25th centile, the AOR for H. pylori infection increased from 2.42 in the crude analysis to 6.62 after adjustment (p=0.006). CONCLUSIONS: H. pylori is associated with short stature in older children living in a poor urban community in Brazil.

History of breastfeeding and Helicobacter pylori infection in children: results of a community-based study from northeastern Brazil.

The aim of this study was to evaluate the role of breastfeeding and the infection status of the mother in the acquisition of Helicobacter pylori infection in a poor urban community in northeastern Brazil. Helicobacter pylori status was evaluated by 13C-urea breath test in individuals under the age of 14 years and by ELISA in the mothers. The prevalence of H. pylori infection was 55.8% (197/353) in the children and it increased with age (P<0.0001). Of the children in whom breastfeeding status was known, 93.2% (316/339) were breastfed. The H. pylori prevalence did not differ between breastfed and never breastfed children (55% vs. 52%) even when children were breastfed for >6 months. The prevalence of infection was much higher in children whose mothers were H. pylori infected than in children whose mothers were not infected, resulting in a crude odds ratio (OR) of 3.11 (95% CI 1.57-6.19) and 2.40 after adjustment for potential confounders (95% CI 1.12-5.15). This study suggests that breastfeeding does not protect against acquisition of H. pylori in northeastern Brazil; conversely, an infected mother may have an important role in transmission of the disease to the child.

O que tem de ser tem força: narrativa sobre a doença e a internação de Pedro Baptista, leproso, meu avô (1933-1955) / The power of what has to be: a narrative on the disease and hospitalization of Pedro Baptista, leper, my grandfather (1933-1955)

Analisa a rede asilar paulista de combate à lepra, constituída como parte integrante de um projeto de políticas públicas no período do isolamento compulsório (1929-1967), tendo como foco principal a trajetória de vida de Pedro Baptista, internado nos leprosários paulistas entre 1934 e 1955. Apresenta a conceituação da lepra como doença infecto-contagiosa e a discussão sobre a política de isolamento dos doentes; esta política foi fundamentada através das resoluções aprovadas nas Conferências Internacionais de Lepra, ocorridas entre 1897 e 1958. Investiga ainda o estigma sobre a lepra e o leproso através da perspectiva histórica desenvolvida no decorrer do trabalho. (AU)

O que tem de ser tem força: narrativa sobre a doença e a internação de Pedro Baptista, leproso, meu avô (1933-1955) / The power of what has to be: a narrative on the disease and hospitalization of Pedro Baptista, leper, my grandfather (1933-1955)

Analisa a rede asilar paulista de combate à lepra, constituída como parte integrante de um projeto de políticas públicas no período do isolamento compulsório (1929-1967), tendo como foco principal a trajetória de vida de Pedro Baptista, internado nos leprosários paulistas entre 1934 e 1955. Apresenta a conceituação da lepra como doença infecto-contagiosa e a discussão sobre a política de isolamento dos doentes; esta política foi fundamentada através das resoluções aprovadas nas Conferências Internacionais de Lepra, ocorridas entre 1897 e 1958. Investiga ainda o estigma sobre a lepra e o leproso através da perspectiva histórica desenvolvida no decorrer do trabalho.

Avaliação da pressão intra-ocular após cirurgia combinada de facoemulsificação e trabeculectomia sem uso de antimetabólitos / Intraocular tension after combined surgery of phacoemulsification and trabeculectomy without antimetabolities

Objetivo: Avaliar a pressão intra-ocular (PO) e o número de medicações tópicas hipotensoras após a cirurgia combinada de facoemulsificação com implante de lente intra-ocular (LIO) e trabeculectomia sem mitomicina C. Material e Método: Foram avaliados, retrospectivamente, 50 olhos submetidos à cirurgia combinada sem uso de mitomicina em 44 pacientes com catarata e glaucoma primário de ângulo aberto. Considerou-se sucesso cirúrgico absoluto níveis de PO inferior a 21mmHg sem medicação, sucesso relativo com PO inferior a 21mmHg com uso de medicações, e insucesso valores acima de 21mmHg com ou sem uso de medicações. Resultados: O decréscimo de medicações foi de 1.62 com DP de +/- 0.63 para 0.42 com DP de +/- 0.75 após a cirurgia. Trinta e seis olhos (72 porcento) apresentaram uma PO abaixo de 21mmHg e sem uso de medicação, enquanto 12 (24 porcento) olhos mantiveram os mesmos níveis tensionais (inferior a 21mmHg), porém, com uso de medicação tópica. Somente dois olhos mantiveram níveis de PO superior a 21mmHg mesmo com uso de medicações hipotensoras. A redução da PO e uso de colírios, depois da facoemulsificação com implante de LIO e trabeculectomia, foi estatisticamente significativa com valores de p <0.001. Conclusão: a cirurgia combinada de facoemulsificação e trabeculectomia sem mitomicina C mostrou-se efetiva no controle da PO em pacientes com glaucoma e catarata.