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Cryptococcus neoformans is primarily responsible for cases of cryptococcal meningitis in individuals with HIV/AIDS. This study evaluated the susceptibility of C. neoformans obtained from individuals with cryptococcal meningitis associated with HIV/AIDS in Manaus, Amazonas, Brazil, against the action of the antifungals amphotericin B, flucytosine, fluconazole, itraconazole and posaconazole and analyzed it using Multilocus Sequence Typing (MLST) in order to identify the Sequence Types (STs). We analyzed 30 isolates of C. neoformans, from 24 HIV/AIDS patients diagnosed with cryptococcosis from 2017 to 2019 in a reference hospital, in addition to 3 environmental isolates: 1 isolate obtained in the home of a patient and 2 isolates obtained from neighboring homes of patients. 86.6% (n = 26/30) of the clinical isolates were identified as C. neoformans VNI ST93, 6.6% (n = 2/30) as C. neoformans VNI ST5, 3.3% (n = 1/30) as C. neoformans VNI ST32 and 3.3% (n = 1/30) as C. neoformans VNB ST232. The environmental isolates were identified as C. neoformans VNI ST93 (n = 3/3). 96.6% (n = 29/30) isolates were sensitive to amphotericin B, though there was variation in the MIC. 60% (n = 18/30) presented a MIC above the proposed epidemiological cutoff values for one or more antifungals. All environmental isolates were sensitive to the tested antifungals. The MLST showed that there is an important relationship between C. neoformans VNI ST93 and individuals with HIV/AIDS, including in the environmental isolates analyzed. C. neoformans VNB ST232 was observed for the first time in Amazonas. Amphotericin B was proven to be the best drug, but fluconazole and posaconazole also showed relevant action.
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Resumo Objetivo Avaliar o uso dos serviços de saúde por pessoas idosas residentes em áreas urbanas e rurais do Brasil. Método Estudo transversal que analisou dados da Pesquisa Nacional de Saúde 2019, referentes aos moradores idosos (≥60 anos) selecionados nos domicílios, totalizando 22.728 entrevistas (3.300 em área rural e 19.426 em área urbana). Foram estimadas para as áreas rurais e urbanas as prevalências de cadastro na Estratégia Saúde da Família, intervalo de tempo da última consulta médica e odontológica, procura do serviço nas últimas duas semanas, última aferição da pressão arterial e da glicemia e avaliados os fatores associados à utilização dos serviços de saúde médicos e odontológicos nos últimos 12 meses. Resultados A autopercepção da saúde como 'muito boa' ou 'boa' foi maior na área urbana (47,32%), assim como a proporção de pessoas idosas que relataram consulta médica e odontológica nos últimos 12 meses (90,54%). Evidenciou-se menor frequência do acompanhamento da aferição de pressão arterial (81,30%) e da glicemia (45,83%) em áreas rurais. As pessoas idosas que possuem baixa escolaridade, residem em áreas rurais, na região Norte são as que possuem menor chance de utilização dos serviços. Conclusão A população idosa residente em área rural apresenta piores condições de saúde em relação à população residente em área urbana.
Abstract Objective To assess health services utilization by older adults in urban and rural areas of Brazil. Method A cross-sectional study was conducted analyzing data from the 2019 National Health Survey on older adults (≥60 years) selected from households based on 22,728 interviews (3,300 in rural and 19,426 in urban areas). For rural and urban areas, the prevalence of Family Health Strategy enrolment, time since last medical and dental visit, service use in past 2 weeks, and last blood pressure and blood glucose measurements were estimated. Also, the factors associated with medical and dental health services utilization in the past 12 months were explored. Results Self-rated health of "Very good" or "Good" was greater in urban areas (47.32%), as was the proportion of older adults reporting a medical or dental visit within the last 12 months (90.54%). Rates of blood pressure (81.30%) and glucose (45.83%) monitoring were lower in rural areas. Older individuals that had low education, resided in rural areas, and the North region, had a lower likelihood of using health services Conclusion The older population living in rural areas had poorer health status compared with the urban population.
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Resumo Objetivo Estimar a prevalência de sinais sugestivos de sarcopenia, bem como seus fatores associados, em pessoas idosas residentes em comunidades rurais ribeirinhas de Manaus. Método Estudo transversal de base domiciliar conduzido de abril a junho de 2021 com o universo de pessoas idosas (≥60 anos) que residiam em nove comunidades rurais ribeirinhas do rio Negro, Manaus, Amazonas, Brasil. Os sinais sugestivos de sarcopenia foram identificados por meio do Sarcopenia Formulary combinado à circunferência da panturrilha. Os aspectos sociodemográficos, o desempenho físico (equilíbrio estático em pé, velocidade de marcha em passo habitual e força muscular dos membros inferiores), a força de preensão palmar e as condições de saúde autorreferidas (hipertensão, diabetes, acidente vascular encefálico, dor lombar crônica e multimorbidade) representaram as variáveis explicativas. Utilizou-se regressão de Poisson com variância robusta para avaliação dos fatores associados aos sinais sugestivos de sarcopenia. Resultados Foram analisados os dados de 98 pessoas idosas (55,1% do sexo masculino), com idade média de 69,6±7,4 anos. Identificou-se que 50,5% apresentavam diminuição de força de preensão palmar, 52,6% incapacidade/baixo desempenho físico e 43,0% apresentaram multimorbidade. A ocorrência de sinais sugestivos de sarcopenia foi observada em 28,9% das pessoas idosas e associou-se à idade mais elevada (RP=1,1; IC95%=1,1-1,1) e ao maior número de moradores no domicílio (RP=1,2; IC95%=1,0-1,3). Conclusão Os achados do estudo evidenciaram elevada prevalência de sinais sugestivos de sarcopenia (28,9%) na população de pessoas idosas de localidades rurais ribeirinhas da Amazônia, sendo que maiores médias de idade e maior número de moradores no domicílio aumentaram a probabilidade de ocorrência dessa condição clínica.
Abstract Objective To estimate the prevalence of signs suggestive of sarcopenia and its associated factors in an older rural riverside population of the Amazon. Method A cross-sectional household-based study was carried out from April to June 2021 involving the universe of older people (age ≥60 years) living in nine rural communities on the banks of the Rio Negro, Manaus city, Amazonas state, Brazil. Signs suggestive of sarcopenia were identified using the Sarcopenia Formulary combined with calf circumference. Sociodemographic aspects, physical performance (static standing balance, gait speed at usual pace, and chair sit and stand), handgrip strength and self-reported health conditions (hypertension, diabetes, stroke, chronic low-back pain and multimorbidity) represented the explanatory variables. Poisson regression with robust variance was used to assess factors associated with signs suggestive of sarcopenia. Results Data from 98 older individuals (55.1% male) with a mean age of 69.6±7.4 years were analyzed. Results revealed that 50.5% had low handgrip strength, 52.6% disability/low physical performance and 43.0% multimorbidity. Sarcopenia was identified in 28.9% of participants and associated with higher age (PR=1.1; 95%CI=1.1-1.1) and greater number of residents in the household (PR=1.2; 95%CI=1.0-1.3). Conclusion The findings of the study showed a high prevalence of signs suggestive of sarcopenia (28.9%) among the population of older people in rural riverside areas of the Amazon, where higher mean age and greater number of residents in the household increased the probability of occurrence of this clinical condition.
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Cryptococcus neoformans and Cryptococcus gattii are the main causative agents of cryptococcosis, a systemic fungal disease that affects internal organs and skin, and which is acquired by inhalation of spores or encapsulated yeasts. It is currently known that the C. neoformans/C. gattii species complex has a worldwide distribution, however, some molecular types seem to prevail in certain regions. Few environmental studies of Cryptococcus have been conducted in the Brazilian Amazon. This is the first ecological study of the pathogenic fungi C. neoformans/C. gattii species complex in the urban area of Manaus, Amazonas, Brazil. A total of 506 samples from pigeon droppings (n = 191), captive bird droppings (n = 60) and tree hollows (n = 255) were collected from June 2012 to January 2014 at schools and public buildings, squares, pet shops, households, the zoo and the bus station. Samples were plated on niger seed agar (NSA) medium supplemented with chloramphenicol and incubated at 25°C for 5 days. Dark-brown colonies were isolated and tested for thermotolerance at 37°C, cycloheximide resistance and growth on canavanine-glycine-bromothymol blue agar. Molecular typing was done by PCR-RFLP. Susceptibility to the antifungal drugs amphotericin B, fluconazole, itraconazole and ketoconazole was tested using Etest(®) strips. In total, 13 positive samples were obtained: one tree hollow (C. gattiiVGII), nine pigeon droppings (C. neoformansVNI) and three captive bird droppings (C. neoformansVNI). The environmental cryptococcal isolates found in this study were of the same molecular types as those responsible for infections in Manaus.
