Lumbar Facet Syndrome and the Use of Radiofrequency Ablation Technique as an Alternative Therapy: A Systematic Review.

Lumbar facet syndrome stands out as a significant cause for the increasing prevalence of back pain complaints. Alternatives such as radiofrequency (RF) ablation may be a therapeutic option to relieve the chronic pain associated with this condition. It is critical to analyze the effectiveness of lumbar facet syndrome treatment using the traditional RF ablation technique and the relief generated by it in chronic low back pain (CLBP). This study is a systematic review using the following inclusion criteria: title, observational studies, clinical trials, controlled clinical trials, clinical studies, and publications over the last 17 years (from 2005 to 2022). The exclusion criteria included papers addressing other themes and review articles. The databases used for data collection included the Medical Literature Analysis and Retrieval System Online (Medline), PubMed, Scientific Electronic Library Online (SciELO), Lilacs, and Biblioteca Virtual em Saúde (Virtual Health Library in Portuguese). The query used the following terms: facet, pain, lumbar, and radiofrequency. The application of these filters yielded 142 studies, and 12 were included in this review. Most studies indicated that the traditional RF ablation technique was beneficial in relieving CLBP refractory to conservative treatment.

Lumbar Facet Syndrome and the Use of Radiofrequency Ablation Technique as an Alternative Therapy: A Systematic Review / Síndrome facetária lombar e a utilização da técnica de ablação por radiofrequência como terapia alternativa: uma revisão sistemática

Abstract Lumbar facet syndrome stands out as a significant cause for the increasing prevalence of back pain complaints. Alternatives such as radiofrequency (RF) ablation may be a therapeutic option to relieve the chronic pain associated with this condition. It is critical to analyze the effectiveness of lumbar facet syndrome treatment using the traditional RF ablation technique and the relief generated by it in chronic low back pain (CLBP). This study is a systematic review using the following inclusion criteria: title, observational studies, clinical trials, controlled clinical trials, clinical studies, and publications over the last 17 years (from 2005 to 2022). The exclusion criteria included papers addressing other themes and review articles. The databases used for data collection included the Medical Literature Analysis and Retrieval System Online (Medline), PubMed, Scientific Electronic Library Online (SciELO), Lilacs, and Biblioteca Virtual em Saúde (Virtual Health Library in Portuguese). The query used the following terms: facet, pain, lumbar, and radiofrequency. The application of these filters yielded 142 studies, and 12 were included in this review. Most studies indicated that the traditional RF ablation technique was beneficial in relieving CLBP refractory to conservative treatment.

Resumo Em um contexto de aumento da prevalência de queixas de dores na coluna, a síndrome facetária se destaca como um importante causador. Alternativas como a ablação por radiofrequência (RF) podem ser uma opção de terapia para alívio da dor crônica que essa patologia pode causar. É necessário analisar a eficácia do tratamento da síndrome facetária pela técnica de ablação por radiofrequência tradicional e o alívio gerado nas dores lombares crônicas (DLC). O presente estudo trata-se de uma revisão sistemática cujo os critérios de inclusão para análise foram: título; estudos observacionais; ensaios clínicos; ensaio clínico controlado; estudos clínicos e publicação nos últimos dezessete anos (2005-2022). Já os critérios de exclusão foram: artigos que abordavam outras temáticas e artigos de revisão. As bases utilizadas para coleta de dados incluíram Medical Literature Analysis and Retrieval System online (Medline), Pubmed, Scientific Electronic Library Online (SciELO), Lilacs, Biblioteca Virtual em Saúde. Os termos utilizados para a pesquisa foram: facet; pain; lumbar; radiofrequency. Aplicando-se os filtros foram encontrados 142 estudos, 12 foram incluídos. Os estudos em sua maioria apontaram ser benéfica a técnica de ablação por radiofrequência tradicional no alívio das dores lombares crônicas refratárias ao tratamento conservador.

Effect of session order in combined aerobic and resistance training on glycemic control in older adults with type 2 diabetes: a crossover study / Efeito da ordem da sessão de treinamento aeróbio e resistido no controle glicêmico em idosos com diabetes tipo 2: um estudo cruzado

The session order of aerobic and resistance training seems to be important for glycemic behavior, as when performed in isolation they help to reduce glycosylated hemoglobin. The purpose of the present study was to compare the acute effect of aerobic and resistance training session orders on glycemia levels of older adults with type 2 diabetes mellitus. A counterbalanced crossover design was used in this study. Eighteen older adults with type 2 diabetes, 13 men and 5 women, non-insulin and beta-blocker dependents, were recruited. All participants performed two training sessions in different orders: aerobic + resistance (AER) and resistance + aerobic (RES). There was a seven-day interval between sessions. In the AER session, a significant (p < 0.001) decrease in blood glucose was observed between training (Mid moment: p < 0.001) and after each session (Post moment: p = 0.003) compared to the baseline (Pre moment). In the RES session, no difference (p = 0.731) was found at the Mid moment in relation to the Pre moment, but a significant (p < 0.001) decrease in blood glucose was observed in the Post moment. A comparison of the different training sessions showed a significant difference (p = 0.012) at the Mid moment, whereas the blood glucose showed a sharper reduction the AER session. In conclusion, we observed that combined training, regardless of the order, was effective for acute glycemic behavior in older people with type 2 diabetes, and aerobic training was the main factor responsible for the reduction blood glucose

A ordem da sessão de treino aeróbio e resistido parece ser importante para a resposta glicêmica, uma vez que quando realizados isoladamente ajudam a reduzir a hemoglobina glicosilada. O objetivo do presente estudo foi comparar a ordem da sessão de treinamento aeróbio e resistido na resposta glicêmica agudo em idosos com diabetes tipo 2. A amostra foi composta por idosos, diagnosticados com diabetes do tipo 2, 13 homens e 5 mulheres, não tratados com insulina e betabloqueadores. Todos realizaram duas sessões de treinamentos com diferentes ordens: aeróbio + resistido (AER) e resistido + aeróbio (RES). As sessões foram separadas por sete dias. Na sessão AER, foi observado uma diminuição significativa (p < 0,001) da glicemia entre as sessões (ENTRE: p < 0,001) e após cada sessão (PÓS: p = 0,003) em comparação com a linha de base (PRÉ). Na sessão RES, nenhuma diferença (p > 0,731) foi encontrada no momento ENTRE em relação ao momento PRÉ, mas uma diminuição significativa (p < 0,001) da glicose no sangue foi observada no momento PÓS. Uma comparação das diferentes sessões de treinamento mostrou uma diferença significativa (p = 0,012) no momento ENTRE, enquanto a glicemia mostrou uma queda mais acentuada na sessão AER. Concluiu-se que o treinamento combinado, independente da ordem, foi eficaz na resposta glicêmica aguda em idosos com diabetes do tipo 2 e o treinamento aeróbico foi o principal responsável pela queda de glicose no sangue

Dolutegravir and pregnancy outcomes in women on antiretroviral therapy in Brazil: a retrospective national cohort study.

BACKGROUND: Dolutegravir has been widely available in Brazil since 2017. Following the signal that infants born to women with dolutegravir exposure at conception in Botswana had a higher risk of neural tube defects (NTDs), public health leaders initiated a national investigation to evaluate periconception dolutegravir exposure among all pregnant Brazilian women with HIV and its potential association with risk of NTDs, stillbirth, or miscarriage before 22 weeks (also called spontaneous abortion). METHODS: In this retrospective, observational, national, cohort study, we identified all women with pregnancies and possible dolutegravir exposure within 8 weeks of estimated date of conception between Jan 1, 2017, and May 31, 2018, and approximately 3:1 matched pregnant women exposed to efavirenz between Jan 1, 2015, and May 31, 2018, using the Brazilian antiretroviral therapy database. We did detailed chart reviews for identified women. The primary outcomes were NTD and a composite measure of NTD, stillbirth, or miscarriage. NTD incidences were calculated with 95% CI. The composite outcome was examined with logistic regression using propensity score matching weights to balance confounders. FINDINGS: Of 1427 included women, 382 were exposed to dolutegravir within 8 weeks of estimated date of conception. During pregnancy, 183 (48%) of 382 dolutegravir-exposed and 465 (44%) of 1045 efavirenz-exposed women received folic acid supplementation. There were 1452 birth outcomes. There were no NTDs in either dolutegravir-exposed (0, 95% CI 0-0·0010) or efavirenz-exposed groups (0, 95% CI 0-0·0036). There were 23 (6%) stillbirths or miscarriages in 384 dolutegravir-exposed fetuses and 28 (3%) in the 1068 efavirenz-exposed fetuses (p=0·0037). Logistic regression models did not consistently indicate an association between dolutegravir exposure and risk of stillbirths or miscarriages. After study closure, two confirmed NTD outcomes in fetuses with periconception dolutegravir exposure were reported to public health officials. An updated estimate of NTD incidence incorporating these cases and the estimated number of additional dolutegravir-exposed pregnancies between Jan 1, 2015 and Feb 28, 2019, is 0·0018 (95% CI 0·0005-0·0067). INTERPRETATION: Neither dolutegravir nor efavirenz exposure was associated with NTDs in our national cohort; incidence of NTDs is probably well under 1% in dolutegravir-exposed HIV-positive women but still slightly above HIV-uninfected women (0·06%) in Brazil. FUNDING: The Brazilian Ministry of Health and the United States' National Institutes of Health.

An Internet-Based HIV Self-Testing Program to Increase HIV Testing Uptake Among Men Who Have Sex With Men in Brazil: Descriptive Cross-Sectional Analysis.

BACKGROUND: Approximately 30% of people living with HIV worldwide are estimated to be unaware of their infection. HIV self-testing (HIVST) is a strategy recommended by the World Health Organization to increase access to and uptake of testing among key populations who are at high risk for HIV infection. OBJECTIVE: This study aimed to describe the development and feasibility of a free, anonymous, internet-based HIVST strategy designed for men who have sex with men in Curitiba, Brazil (electronic testing [e-testing]). METHODS: The project was developed under the scope of the "A Hora é Agora" (The Time is Now) program. Individuals aiming to request an HIVST package (two tests each) answered an anonymous 5-minute questionnaire regarding inclusion criteria and sexual risk behavior. Eligible individuals could receive one package every 6 months for free. Website analytics, response to online questionnaires, package distribution, and return of test results were monitored via a platform-integrated system. RESULTS: Between February 2015 and January 2016, the website documented 17,786 unique visitors and 3218 completed online questionnaires. Most individuals self-reported being white (77.0%), young (median age: 25 years, interquartile range: 22-31 years), educated (87.3% completed secondary education or more), and previously tested for HIV (62.5%). Overall, 2526 HIVST packages were delivered; of those, 542 (21.4%) reported a result online or by mail (23 reactive and 11 invalid). During the study period, 37 individuals who reported using e-testing visited the prespecified health facility for confirmatory testing (30 positive, 7 negative). CONCLUSIONS: E-testing proved highly feasible and acceptable in this study, thus supporting scale-up to additional centers for men who have sex with men in Brazil.

The Brazilian experience of implementing the active pharmacovigilance of dolutegravir.

In 2017, the Ministry of Health Brazilian started using dolutegravir (DTG) 50 mg to all people living with HIV who began antiretroviral therapy (ART) or rescue regimens. Although DTG is thought to have better tolerability levels and a lower possibility of causing adverse reactions, it is necessary to continuously evaluate the safety profile of the drug in the population. Therefore, an active pharmacovigilance project for DTG was implemented. The objective of this study was to describe the Brazilian experience of implementing pharmacovigilance and the results obtained during the period between April and December 2017.Active pharmacovigilance was implemented through patient interviews and an online questionnaire developed in the Medication Logistics Control System (SICLOM).Of the total number of people on DTG in Brazil (79,742) 90.33% participated in the project, and 2.24% of those who participated reported adverse reactions to the drug; of those who reported adverse reactions, 73.86% were on first-line ART regimens, and 26.13% were on third-line regimens. The mean age of the patients who had adverse reactions to DTG was 39 years; 68.79% were male, and 31.21% were female. Of the adverse reactions reported, 50.39% were considered persistent. The 3 most frequent reactions were nausea (13.34%), diarrhea (9.83%), and headaches (9.23%).The Brazilian experience with this project has been deemed successful by federal and local managers, and the online tool to collect data has proved to be an important strategy for the pharmacovigilance of DTG as well as that of other drugs.

The Brazilian comprehensive response to hepatitis C: from strategic thinking to access to interferon-free therapy.

BACKGROUND: Hepatitis C affects over 185 million people around the world. This silent disease is responsible for up to 700,000 deaths per year. Despite the scientific revolution in diagnosis and treatment, hepatitis C control remains a huge challenge due to the cost of effective medications. In response to the global outcry of hepatitis epidemic and the need to improve the nation's public health response, the Ministry of Health of Brazil revolutionized hepatitis C treatment by incorporating highly effective drugs that can be accessed through sustainable and universal means. DISCUSSION: This paper describes the unique process of implementing evidence-informed policy to respond to hepatitis C epidemic through the update of hepatitis C treatment in Brazil based on the estimate of disease prevalence, current international guidelines, and the cost-effectiveness impact in the Brazilian Unified Health System. Through a debate of an experience report, the authors underlie the strategic plan implemented according to the situation analysis that emphasized the need to improve its current response over a relatively short-term period. The comprehensive response is detailed comprising three main objectives: improve treatment outcomes by evaluating and incorporating new and effective medications at a sustainable price; elaborate on clinical guidelines to treat hepatitis C patients; and develop awareness and diagnosis campaigns targeted at the population of interest. In this scenario, Brazil was able to obtain an unprecedented discount for a high-medium income country; provided treatment to more than 7000 individuals in the last 2 months of 2015; and expects to treat 38,000 new patients in 2016. The remarkable process applied in Brazil was developed according to epidemiological data and scientific evidence, and it was motivated by the engagement of the country in the Sustainable Development Goals, which may inspire other developing countries to identify ways to achieve these goals by 2030.

The Men Who Have Sex with Men HIV Care Cascade in Rio de Janeiro, Brazil.

Brazil has a concentrated HIV epidemic and men who have sex with men (MSM) are disproportionately affected. Yet, no data is available on the HIV care cascade for this population. This study aimed to assess the HIV care cascade among MSM newly diagnosed through innovative testing strategies in Rio de Janeiro. Data from 793 MSM and travestites/transgender women (transwomen) tested for HIV at a non-governmental LGBT organization and a mobile testing unit located at a gay friendly venue were analyzed. A 12-month-after-HIV-diagnosis-censored cohort was established using CD4, viral load and combination antiretroviral therapy (cART) longitudinal data from those diagnosed with HIV. A cross-sectional HIV care cascade was built using this data. The relative risks of achieving each cascade-stage were estimated using generalized linear models according to age, self-declared skin-color, education, history of sexually transmitted diseases (STD), drug use and prior HIV testing. From Jan-2013 to Jan-2014, 793 MSM and transwomen were tested, 131 (16.5%) were HIV-infected. As of January 2015, 95 (72.5%) were linked to HIV care, 90 (68.7%) were retained in HIV care, 80 (61.1%) were on cART, and 50 (38.2%) were virally suppressed one year after HIV diagnosis. Being non-white (Relative risk [lower bound; upper bound of 95% confidence interval] = 1.709 [1.145; 2.549]) and having a prior HIV-test (1.954 [1.278; 2.986]) were associated with an HIV-positive diagnosis. A higher linkage (2.603 [1.091; 6.211]) and retention in care (4.510 [1.880; 10.822]) were observed among those who were older than 30 years of age. Using community-based testing strategies, we were able to access a high-risk MSM population and a small sample of transwomen. Despite universal care coverage and the test-and-treat policy adopted in Brazil, the MSM cascade of care indicates that strategies to increase linkage to care and prompt cART initiation targeted to these populations are critically needed. Interventions targeting non-white and young MSM should be prioritized.

Applicability of the Appropriate use Criteria for Myocardial Perfusion Scintigraphy / Aplicabilidade dos Critérios de Adequação em Cintilografia Miocárdica

Background: Appropriateness Criteria for nuclear imaging exams were created by American College of Cardiology (ACC) e American Society of Nuclear Cardiology (ASNC) to allow the rational use of tests. Little is known whether these criteria have been followed in clinical practice. Objective: To evaluate whether the medical applications of myocardial perfusion scintigraphy (MPS) in a private nuclear medicine service of a tertiary cardiology hospital were suitable to the criteria of indications proposed by the American medical societies in 2005 and 2009 and compare the level of indication of both. Methods: We included records of 383 patients that underwent MPS, November 2008 up to February 2009. Demographic characteristics, patient's origin, coronary risk factors, time of medical graduation and appropriateness criteria of medical applications were studied. The criteria were evaluated by two independent physicians and, in doubtful cases, defined by a medical expert in MPS. Results: Mean age was 65 ± 12 years. Of the 367 records reviewed, 236 (64.3%) studies were performed in men and 75 (20.4%) were internee. To ACC 2005, 255 (69.5%) were considered appropriate indication and 13 (3.5%) inappropriate. With ACC 2009, 249 (67.8%) were considered appropriate indications and 13 (5.2%) inappropriate. Conclusions: We observed a high rate of adequacy of medical indications for MPS. Compared to the 2005 version, 2009 did not change the results. .

Fundamento: Os critérios de adequação para os exames de imagem nuclear foram criados pelo American College of Cardiology (ACC) e pela American Society of Nuclear Cardiology (ASNC) com o objetivo de permitir o uso racional dos exames. Pouco se sabe se esses critérios têm sido seguidos nas indicações da prática clínica. Objetivo: Avaliar se os pedidos médicos de cintilografia de perfusão miocárdica (CPM), em serviço privado de medicina nuclear de um hospital cardiológico terciário, adequavam-se aos critérios de indicações propostos pelas sociedades médicas americanas em 2005 e 2009 e comparar o grau de indicação entre ambos. Métodos: Foram incluídos 383 prontuários de pacientes submetidos à CPM de novembro de 2008 a fevereiro de 2009. As características demográficas, a origem do paciente, os fatores de risco coronariano, o tempo de formatura do médico e os critérios de adequação dos pedidos foram considerados. Os critérios foram avaliados por dois médicos independentes e, nos casos duvidosos, definidos por um especialista em CPM. Resultados: A média de idade foi de 65 ± 12 anos. Dos 367 prontuários analisados, 236 (64,3%) exames foram realizados em homens e 75 (20,4%) foram em pacientes internados. Aplicando-se os critérios do ACC de 2005, 255 (69,5%) das indicações foram consideradas adequadas e 13 (3,5%) inadequadas. Aplicando-se os critérios do ACC de 2009, 249 (67,8%) das indicações foram consideradas adequadas e 13 (5,2%) inadequadas. Conclusões: Foi observada uma elevada taxa de adequação das indicações médicas de CPM. Comparada com a edição de 2005, a versão de 2009 não alterou a taxa de exames adequados ou inadequados. .

Applicability of the Appropriate use Criteria for Myocardial Perfusion Scintigraphy.

Background: Appropriateness Criteria for nuclear imaging exams were created by American College of Cardiology (ACC) e American Society of Nuclear Cardiology (ASNC) to allow the rational use of tests. Little is known whether these criteria have been followed in clinical practice. Objective: To evaluate whether the medical applications of myocardial perfusion scintigraphy (MPS) in a private nuclear medicine service of a tertiary cardiology hospital were suitable to the criteria of indications proposed by the American medical societies in 2005 and 2009 and compare the level of indication of both. Methods: We included records of 383 patients that underwent MPS, November 2008 up to February 2009. Demographic characteristics, patient's origin, coronary risk factors, time of medical graduation and appropriateness criteria of medical applications were studied. The criteria were evaluated by two independent physicians and, in doubtful cases, defined by a medical expert in MPS. Results: Mean age was 65 ± 12 years. Of the 367 records reviewed, 236 (64.3%) studies were performed in men and 75 (20.4%) were internee. To ACC 2005, 255 (69.5%) were considered appropriate indication and 13 (3.5%) inappropriate. With ACC 2009, 249 (67.8%) were considered appropriate indications and 13 (5.2%) inappropriate. Conclusions: We observed a high rate of adequacy of medical indications for MPS. Compared to the 2005 version, 2009 did not change the results.

Observações sobre insetos e protozoários que podem danificar a criação de triatomíneos e a diagnose do Trypanosoma cruzi nas fezes desses hemípteros / Some observations on insects and protozoan capable of inhibiting the breeding of triatomines and the detection of Trypanosoma cruzi in faeces of triatomidae

São feitas pesquisas para verificar a incidência de Blastocrithidia triatominae que foi encontrada nas fezes de triatomíneos de insetários ou da natureza. Foram examinadas 2943 lâminas positivas para Blastocrithidia e Trypanosoma. As formas evolutivas mais ocorrentes foram as de TC, isto é, tripomastigota e epimastigota. Para maiores detalhes consultar as tabelas I e II que fornecem dados sobre a distribuição geográfica dos triatomíneos e protozoários.

Observações sobre o encontro de tripanossomatídeos do gênero Blastocrithidia, infetando naturalmente triatomíneos em insetário e no campo / Observations on some tripanosomatides from genus Blastocrithidia, naturally infecting triatomines in the laboratory and the field

Comprovada a presença de tripanossomatídeos, não pertencentes ao gênero Trypanosoma, no tubo intestinal dos triatomíneos, o serviço especializado no combate desses insetos hematófagos vetores (SUCEN) da Secretaria da Saúde do Estado de São Paulo (Brasil), passou a adotar como rotina em seus laboratórios, a coloração do material fecal dos exemplares infectados por flagelados. Relatam-se os resultados alcançados com a introdução dessa medida, destacando-se os primeiros achados em nosso meio, no campo, do P. megistus e T. sórdida, encontrados infectados por flagelados do gênero Blastocrithidia.

Observações sobre a infestação domiciliar residual por Triatoma infestans / Residual house infestations by Triatoma infestans

Na região do Bairro da Ilha no município de Salto de Pirapora no Estado de São Paulo, Brasil, procurou-se observar a utilidade do método de Gómez-Nuñez, no selecionamento das casas a serem submetidas ao expurgo seletivo pela aplicação de BHC. Dos edifícios considerados como negativos a inspeção rotineira, foram selecionados 21 nos quais foram instaladas as caixas-abrigo. Além disso, concluiu-se a observação do ecópoto artificial para atração de triatomíneo, e o seu exame, após demolição completa, revelou a presença 2 adultos e 198 ninfas daquela espécie. Concluiu-se pela deficiência da inspeção manual, com ou sem a utilização de substância desalojante, na seleção dos edifícios para o rociado. O método Gómez-Nuñez poderá trazer valiosa contribuição para a melhoria do critério de seleção. Chama-se ainda a atenção do possível poder de dispersão ativa de T.infestans que poderá atingir valores ponderáveis.

Estudo sobre o raio de vôo do Anopheles (Kerteszia) cruzii e do Anopheles (Kerteszia) bellator em Guaratuba, litoral do Estado do Paraná, Brasil / Flying range of Anopheles (Kerteszia) cruzi and Anopheles (Kerteszia) bellator in Guaratuba, coast line of the State of Paraná, Brazil

Em área do município de Guaratuba, Estado do Paraná, Brasil, foram realizadas observações para verificar a dispersão ativa do Anopheles (Kerteszia) cruzii e Anopheles (Kerteszia) bellator, que são os vetores de malária na região. Com os resuletados obtidos comproveou-se que: a)Tanto o A.(K) cruzii como o A (K) bellator que chegavam ao centro do bairro de Piçarras procediam do Campo de Aviação: b)as duas espécies tiveram uma dispersão de 1.000 metros,cujo vôo foi feito contando a direção dos ventos predominantes. Assim proteger o centro de Piçarras da invasão de Kerteszia torna-se necessário destruir também as bromélias da Área do Campo de Aviação.

Infestação domiciliar por Triatoma infestans e alguns aspectos epidemiológicos da tripanossomose Americana em área do Estado de São Paulo, Brasil / House infestation by Triatoma infestans and some epidemiologic aspects of American tripanosomiasis in a certain area of the State of São Paulo, Brazil

São relatados os resultados das investigações sobre epidemiologia da tripanossomose americana, levadas a efeito no Bairro da Ilha, município de Salto de Pirapora, Estado de São Paulo, Brasil. Em conjunto de 28 edifícios submetidos ao expurgo seletivo pela aplicação de BHC, procurou-se pesquisar a infestação por Triatoma infestans, através o método das caixas de Gómez-Nuñez. O resultado revelou a persistência de edifícios infestados, em proporção semelhante àquela observada antes do expurgo. Contudo, houve redução da intensidade, revelada pela queda do índice geral de infestação. A pesquisa de focos naturais do parasito mostrou a existência da infecção de roedores Akodon arviculoides e Oryzomys nigripes. Levando-se a efeito xenodiagnósticos em cães e gatos, nascidos ou introduzidos logo depois do rociado seletivo, pode-se evidenciar a persistência da transmissão, pelo menos por via congênita. Ao lado disso, observou-se a introdução precoce de animais infestados, procedentes de outras áreas. Conclui-se pela necessidade de revisão na profilaxia da doença de Chagas, baseada no simples combate aos triatomíneos pelo uso de inseticidas.

Informes sobre o programa de erradicação da malária do Estado de São Paulo / Report on the malaria eradication program, of the State of São Paulo, Brazil

A experiência e os resultados obtidos em erradicação da malária pelo Serviço de Erradicação da Malária e Profilaxia das Doenças de Chagas do Estado de São Paulo, (hoje com a denominação de Superintendência de Controle de Endemias-SUCEN), demonstram que as medidas adotadas inicialmente e durante toda a fase de ataque, foram adequadas de acordo com extensão e situação epidemiológica de sua área malárica. No referente à fase de consolidação, foram sempre solucionados os problemas originados pela importação de casos e em algumas ocasiões, o restabelecimento da transmissão em pequenos focos. Atualmente, continua-se com o seguimento dos focos embora sejam inativos. O futuro do programa de erradicação da malária do Estado de São Paulo é favorável em virtude do progresso na cobertura total do programa de erradicação da malária federal. Também contribuirão para acelerar o desaparecimento dos casos de malária federal. Também contribuirão para acelerar o desaparecimento dos casos de malária a cobertura com DDT em três ciclos anuais e a adoção do tratamento de cura radical “familiar” nas ilhas situadas nos Rio Paraná e Grande, fronteiras com os Estados de Mato Grosso e Minas Gerais. Tendo em conta as possibilidades do Programa entrar em manutenção e solicitar a OMS em 1971 o Certificado de Malária Erradicada, serão aproveitados os anos de 1969 e 1970 para intensificar a busca de casos, a coordenação com os serviços de saúde, o estabelecimento de áreas de demonstração para integração desses serviços e a malária, em um aprimoramento das operações.

Medida da infestação domiciliar por Triatoma infestans / Housing infestation research by Triatoma infestans

Em conjunto de 27 edifícios situados na localidade denominada Bairro da Ilha, no Município de Salto de Pirapora, Estado de São Paulo, procurou-se aplicar o método de Gómez-Núñes para a seleção de casas infestadas pelo Triatoma infestans. Comparando com o processo de inspeção domiciliar mediante a captura manual, porém sem o emprego de substâncias insetífugas, o método revelou-se equivalente. Contudo, ele traz vantagens que não podem ser desprezadas. Entre outras, ressaltam a sua uniformidade e o baixo custo. Através o levantamento da percentagem de caixas positivas até a segunda semana de observação, pode-se também estimar o grau de infestação local. Nesta pesquisa revelou índice de Tipo III. O significado e classificação desses índices deverá ser objeto de maiores investigações. Contudo, no que pese a necessidade de maior número de ensaios, o método poderá vir a ser de bastante utilidade na avaliação de localidades submetidas a expurgos, sejam eles seletivos ou não.

Informe sobre a doença de Chagas no Brasil e em especial no Estado de São Paulo / Report on Chagas' disease in Brasil and especially in the State of São Paulo

A Doença de Chagas ou tripanossomose americana é uma moléstia infecciosa cujo agente causal é o Trypanosoma (Schizotrypanum) cruzi e os vetores biológicos são hemípteros da subfamília Triatominae. É uma anfixenose, pois é uma infecção que de início se restringiu à transmissão de animal a animal, atingindo depois o homem e completanto o seu ciclo tanto no homem como em outros mamíferos...