Financial constraints and incentives for the prevention and control of obesity in the state of Rio de Janeiro, Brazil. / Constrangimentos e incentivos financeiros para a prevenção e o controle da obesidade no estado do Rio de Janeiro, Brasil.

The present study aimed to analyze how these changes, both at the national and state levels, could affect the conditions of the implementation of obesity prevention and control (OCP) actions in primary health care (PHC) in the Rio de Janeiro State from 2014 to 2021. This study was based on policy analysis methods that emphasize the understanding of the implementation contexts, as well as the induction mechanisms and government incentives for the development of actions and integration of two projects that analyzed the OPC actions in PHC in the 92 municipalities of RJS between 2014 and 2018 (PPSUS-RJS) and between 2019 and 2021 (PEO-RJS). The results indicate that, by 2016, it was possible to observe the positive impacts of the structuring of PHC and the federal induction mechanisms in RJS. However, inflections in the expansion and funding of PHC contributed to the weakening of units, teams, and strategies, and led to retraction of resources for both state and municipal actions. Between 2016-2018, RJS's political and financial scenario deteriorated due to national crises, and the positive counterpoints since then were the induction mechanisms and federal resources that remained, in addition to the technical areas of the RJS-HD and state co-financing resources.

O estudo analisou como as inflexões político-econômicas de financiamento e de estruturação do Sistema Único de Saúde podem ter afetado as condições de implementação de ações de prevenção e controle da obesidade (PCO) na atenção primária à saúde (APS) no estado do Rio de Janeiro (ERJ) entre 2014 e 2021. Fundamentou-se em referenciais de análise de políticas, considerando contexto de implementação, antecedentes históricos, mecanismos de indução e incentivos governamentais para o desenvolvimento das ações de PCO. Baseou-se em dois projetos realizados nos 92 municípios do ERJ entre 2014 e 2018 (PPSUS-ERJ) e 2019-2021 (PEO-ERJ), pautados em análise documental, entrevistas e grupos focais com profissionais e gestores da APS. Até 2016, percebe-se os impactos positivos da estruturação da APS e dos mecanismos de indução federais. No entanto, as inflexões na expansão e no financiamento da APS contribuíram para o enfraquecimento de unidades, equipes e estratégias, além de uma retração de recursos para as ações estaduais e municipais. Entre 2016-2018, a crise política e financeira do ERJ foi potencializada pelas crises nacionais, e os contrapontos positivos desde então foram os mecanismos de indução e recursos federais que permaneceram, além das áreas técnicas da SES-ERJ e do cofinanciamento estadual.

Infectious etiology and indicators of malabsorption or intestinal injury in childhood diarrhea. / Etiología infecciosa e indicadores de malabsorción o daño intestinal en diarrea infantil

INTRODUCTION: The multifactorial etiology of gastroenteritis emphasizes the need for different laboratory methods to identify or exclude infectious agents and evaluate the severity of diarrheal disease. OBJECTIVE: To diagnose the infectious etiology in diarrheic children and to evaluate some fecal markers associated with intestinal integrity. MATERIALS AND METHODS: The study group comprised 45 children with diarrheal disease, tested for enteropathogens and malabsorption markers, and 76 children whose feces were used for fat evaluation by the traditional and acid steatocrit tests. RESULTS: We observed acute diarrhea in 80% of the children and persistent diarrhea in 20%. Of the diarrheic individuals analyzed, 40% were positive for enteropathogens, with rotavirus (13.3%) and Giardia duodenalis (11.1%) the most frequently diagnosed. Among the infected patients, occult blood was more evident in those carrying pathogenic bacteria (40%) and enteroviruses (40%), while steatorrhea was observed in infections by the protozoa G. duodenalis (35.7%). Children with diarrhea excreted significantly more lipids in feces than non-diarrheic children, as determined by the traditional (p<0.0003) and acid steatocrit (p<0.0001) methods. Moreover, the acid steatocrit method detected 16.7% more fecal fat than the traditional method. CONCLUSIONS: Childhood diarrhea can lead to increasingly severe nutrient deficiencies. Steatorrhea is the hallmark of malabsorption, and a stool test, such as the acid steatocrit, can be routinely used as a laboratory tool for the semi-quantitative evaluation of fat malabsorption in diarrheic children.

Introducción. La etiología multifactorial de la gastroenteritis enfatiza la necesidad de usar diferentes métodos de laboratorio para identificar o excluir agentes infecciosos y evaluar la gravedad de la enfermedad diarreica. Objetivo. Diagnosticar la etiología infecciosa de la diarrea en niños y evaluar algunos marcadores fecales asociados con la integridad intestinal. Materiales y métodos. Se estudiaron 45 niños con enfermedad diarreica, en los cuales se evaluaron la presencia de enteropatógenos y los marcadores de malabsorción. Se analizaron las muestras fecales de 76 niños, mediante las pruebas de esteatocrito tradicional y esteatocrito ácido, para la cuantificación de la grasa. Resultados. Se observó diarrea aguda en el 80 % de los niños y diarrea persistente en el 20 %. De los individuos con diarrea, el 40 % fue positivo para enteropatógenos; los más diagnosticados fueron rotavirus (13,3 %) y Giardia duodenalis (11,1 %). Entre los pacientes infectados, la sangre oculta fue más evidente en aquellos portadores de bacterias patógenas (40 %) o enterovirus (40%), mientras que la esteatorrea se observó en infecciones por el protozoo G. duodenalis (35,7 %). Los niños con diarrea excretaron significativamente más lípidos en las heces que aquellos sin diarrea, según lo determinado por los métodos de esteatocrito tradicional (p<0,0003) y esteatocrito ácido (p<0,0001). Conclusiones. La diarrea infantil puede provocar deficiencias graves de nutrientes. La esteatorrea es distintiva de la malabsorción intestinal y puede detectarse mediante la estimación del esteatocrito ácido. Esta prueba podría utilizarse de forma rutinaria como una herramienta de laboratorio para la evaluación semicuantitativa de la malabsorción de grasas en niños con diarrea.

Detection of IgG Anti-Giardia duodenalis Antibodies in Sera by Indirect Immunofluorescence and Western Blotting Assays.

INTRODUCTION: Serological assays are alternative laboratory tools for the diagnosis of parasitic infections. The aim of this work was to evaluate the performance of the indirect fluorescent antibody test (IFAT) and Western blotting (WB) for the detection of IgG anti-Giardia antibodies in human sera. METHODOLOGY: Sera from individuals infected with Giardia duodenalis, other parasites or non-parasitized were selected for serological assays. Ninety-seven sera were tested by IFAT at 1:20 and 1:40 dilutions and of these, 40 samples were also analyzed by WB. RESULTS: The sensitivity and specificity of the IFAT was 97% and 46.9% at 1:20 sera dilution, and 39.4% and 59.4% at 1:40 sera dilution. The low molecular weight polypeptides fractions of 25 kDa, 27-31 kDa and 45-55 kDa were the most frequently identified by the sera of individuals infected with G. duodenalis, along with low cross-reactivity, presenting an individual sensitivity of 42.8%, 50.0% and 57.1%, and specificity of 83.3%, 83.3% and 91.7%, respectively. The highest overall sensitivity of WB (85.7%) was based on the immunoreactivity of sera with at least one of those proteins. The concordance between the detection of G. duodenalis in feces by microscopy and the WB results was considered substantial (Kappa = 0.61). CONCLUSION: Constant exposure to Giardia infection throughout a lifetime can maintain high levels of specific antibodies in serum, even without active infection. Moreover, proteins found in intestinal amoebas may hinder the serological diagnosis of giardiasis in endemic areas due to cross-reactivity, which can be partially solved using Giardia low molecular weight proteins.

Anthelmintic treatment follow up in a rural community in Camamu, Bahia, Brazil.

Enteroparasites are an important public health problem and the treatment seeks to cure and reduce transmission. The aim of this study was to evaluate the therapeutic efficacy of anthelmintic treatment in individuals living in a rural community area in Camamu, Bahia, Brazil. The parasitological diagnosis was performed by spontaneous sedimentation, Baermann-Moraes and Agar Plate Culture methods. A total of 212 individuals were evaluated. The most frequent helminth was Trichuris trichiura, 24.5% (52/212), followed by Ascaris lumbricoides, 21.2% (45/212), hookworms, 16.5% (35/212), and S. stercoralis, 4.7% (10/212). In the anthelmintic treatment follow up, T. trichiura infection presented the lowest parasitological cure rate, only 60.6% (20/33). Hookworm, Ascaris lumbricoides and Strongyloides stercoralis infections demonstrated cure rates of 70.5 (12/17), 78.1 (25/32) and 100% (5/5), respectively. Individuals who remained infected underwent a new drug therapy. The second parasitological cure rate for T. trichiura was 38.5% (5/13), and 66.7% (2/3) and 75% (3/4) for hookworms and Ascaris lumbricoides, respectively. Trichuris trichiura infection presented the lowest parasitological cure rate at this second evaluation. This reinforces the need to perform a follow-up of all treated individuals. The possibility of drug resistance denotes the necessity for studies to clarify the mechanisms and to evaluate new therapeutic approaches.

Seroepidemiological Survey of Chronic Chagas Disease in a Rural Community in Southern Bahia, Brazil, Using Recombinant Chimeric Antigens.

Chagas disease (CD), caused by the parasite Trypanosoma cruzi, is a neglected tropical disease with life-threatening implications. In this study, we conducted a seroepidemiological survey to determine the prevalence and clinical profiles of CD in 217 individuals from an impoverished rural community in Southern Bahia, Brazil. The overall prevalence of CD in the studied community was 0.92%, detected through latent class analysis (LCA). Two individuals tested positive for anti-T. cruzi IgG, both being male farmers. One case was a 22-year-old man born in Camamu, with no evidence of congenital transmission, suggesting other routes of transmission such as vector-borne transmission due to migratory activities. The other case was a 69-year-old man born in São Felipe, who had lived in an adobe/brick house and had a pacemaker due to cardiac involvement caused by CD. The prevalence in this community was lower than expected, given the socioeconomic conditions and environmental factors that contribute to T. cruzi transmission. This could be attributed to the implementation of preventive measures and vector control programs by the Brazilian Government. However, continuous monitoring and surveillance are essential to sustain control efforts and detect any potential re-emergence of the disease. While the overall prevalence was low, the detection of positive cases underscores the need for continued surveillance and control measures in vulnerable populations, such as rural communities. Active surveillance, early diagnosis, and timely treatment are crucial in preventing disease progression and complications, thereby enhancing the effectiveness of screening and treatment programs.

Modulation of circulating cytokine production in alcoholic patients infected with Strongyloides stercoralis.

Strongyloidiasis control is associated with a Th2 immune response. However, alcohol ingestion plays an important role in modulating the immune system. The aim of this study is to evaluate the occurrence of Strongyloides stercoralis infection in alcoholic patients, the levels of circulating cytokines (IFN-γ, IL-2, IL-4, IL-5, IL-10, IL-15 and IL-17), and its correlation with modulation of parasitic load in alcoholic individuals infected with S. stercoralis. A total of 336 alcoholic patients, treated at the Alcoholic Care and Treatment Center were included in this study. The cytokine levels were measured by a commercial ELISA in 80 sera divided into four groups with 20 individuals each: alcoholics infected (ASs+) and not infected (ASs-) with S. stercoralis and non-alcoholics infected (NASs+) and not infected (NASs-) with the helminth. S. stercoralis frequency in alcoholic patients was 16.1% (54/336). The parasitic load varied from 1 to 546 larvae/g of faeces, median and interquartile range (IQR) of 9 and 1.0-62.5 larvae/g of faeces, while in non-alcoholic individuals the parasitic load was less than 10 larvae/g of faeces. Levels of circulating IL-4 were significantly higher in ASs+ when compared with NASs- group (p < .05). An inverse correlation between serum levels of IFN-γ and parasitic load in alcoholic patients infected with S. stercoralis was observed (r = -601; p < 0.01). These results suggest that modulation of IFN-γ production occurs in alcoholic individuals with high parasitic burden.

GenEye24: Novel rapid screening test for the top-3 Leber's Hereditary Optic Neuropathy pathogenic sequence variants.

Leber's Hereditary Optic Neuropathy (LHON) has been mainly (90-95 %) associated to one of three variants: m.3460G>A, m.11778G>A, m.14484T>C. Herein, a screening method was developed for its detection, supporting clinical/therapeutics decision. It relies on real-time PCR with High-Resolution Melting (HRM) analysis. Variant classification is made using HRM Software and quality controls. A total of 101 samples were analyzed. All samples were correctly assigned: 58 wild-type, 35 positive for m.11778G>A, 6 positive for m.14484T>C, 2 positive for m.3460G>A. Results presented sensitivity = 1, specificity = 1, Positive Predictive Value = 1 and Negative Predictive Value = 1. A new Real-Time PCR/HRM screening method cost-efficient, simple, robust and quick, detecting LHON's top-3 is described.

Cryptosporidium diagnosis in different groups of children and characterization of parasite species.

BACKGROUND: Microscopy and enzyme-linked immunosorbent assay (ELISA) are routinely used for Cryptosporidium diagnosis, without differentiating the parasite species. METHODS: Children's feces were analyzed by modified Ziehl-Neelsen (mZN) and ELISA for Cryptosporidium diagnosis and by polymerase chain reaction-restriction fragment length polymorphism for species identification. RESULTS: Cryptosporidium frequency was 2.6%. The sensitivity and specificity of ELISA were 85.7% and 99.7%, respectively, with excellent concordance with mZN (kappa=0.854). Parasite species were characterized as Cryptosporidium hominis (78.3%), Cryptosporidium felis (17.4%), and Cryptosporidium parvum (4.3%). CONCLUSIONS: Coproantigen ELISA is as efficient as mZN for Cryptosporidium diagnosis. Cryptosporidium genotyping suggests anthroponotic and zoonotic transmission to children.

Evaluation of Strongyloides stercoralis infection in patients with HTLV-1. / Evaluación de la infestación por Strongyloides stercoralis en pacientes con HTLV-1

INTRODUCTION: Individuals infected with the human T-lymphotropic virus type 1 (HTLV-1) may present severe and disseminated forms of Strongyloides stercoralis infection with low therapeutic response. OBJECTIVE: To investigate the S. stercoralis infection and the seroprevalence of IgG anti-S. stercoralis antibodies in individuals infected with HTLV-1 attending the Reference Center for HTLV-1 (CHTLV) in Salvador, Bahia, Brazil. MATERIALS AND METHODS: We conducted a cross-sectional study in 178 HTLV-1-infected individuals treated at the HTLV specialized center between January, 2014, and December, 2018. The parasitological diagnosis of S. stercoralis was performed using the Hoffman, Pons and Janer, agar plate culture, and Baermann-Morais methods. The IgG anti-S. stercoralis detection was performed using an in house enzyme-linked immunosorbent assay (ELISA). The HTLV-1 infection was diagnosed using a commercial ELISA and confirmed by Western blot. RESULTS: The frequency of S. stercoralis infection was 3.4% (6/178). Individuals infected with S. stercoralis from rural areas (50.0%; 3/6) also showed S. stercoralis hyperinfection (>3,000 larvae/gram of feces). The frequency of circulating anti-S. stercoralis IgG antibodies was 20.8% (37/178). CONCLUSIONS: HTLV-1-infected people living in precarious sanitary conditions are more prone to develop severe forms of S. stercoralis infection. Considering the high susceptibility and unfavorable outcome of the infection in these individuals, the serological diagnosis for S. stercoralis should be considered when providing treatment.

Introducción. Los individuos infectados por el virus linfotrópico T humano tipo 1 (HTLV-1) pueden presentar formas graves y diseminadas de infestación por Strongyloides stercoralis con poca mejoría terapéutica. Objetivo. Investigar la infestación por S. stercoralis y la seroprevalencia de IgG anti-S. stercoralis en individuos infectados por HTLV-1 atendidos en el Centro de Referencia para HTLV-1 (CHTLV), en Salvador, Bahía, Brasil. Materiales y métodos. Se hizo un estudio transversal con 178 individuos infectados por HTLV-1 atendidos en el centro especializado de HTLV entre enero de 2014 y diciembre de 2018. El diagnóstico parasitológico de S. stercoralis se hizo mediante los métodos de Hoffman, Pons y Janer, cultivo en placa de agar y Baermann-Morais. Para la detección de IgG anti-S. stercoralis, se utilizó una prueba casera de inmunoabsorción ligada a enzimas (ELISA). La infección por HTLV-1 se diagnosticó usando un ELISA comercial y se confirmó mediante Western blot. Resultados. La frecuencia de infestación por S. stercoralis fue del 3,4 % (6/178). Además, los individuos infestados por S. stercoralis provenientes de la zona rural (50,0 %; 3/6) también mostraron hiperinfestación por S. stercoralis (>3.000 larvas/gramo de heces). La frecuencia de anticuerpos IgG anti-S. stercoralis fue del 20,8 % (37/178). Conclusiones. Las personas infectadas por HTLV-1 que viven en condiciones sanitarias precarias son más propensas a desarrollar formas graves de infestación por S. stercoralis. Teniendo en cuenta la gran vulnerabilidad y el resultado desfavorable de la infección en estos individuos, se debe considerar el diagnóstico serológico de S. stercoralis para administrar el tratamiento.

Evaluation of Strongyloides stercoralis infection in patients with HTLV-1 / Evaluación de la infestación por Strongyloides stercoralis en pacientes con HTLV-1

Introduction: Individuals infected with the human T-lymphotropic virus type 1 (HTLV-1) may present severe and disseminated forms of Strongyloides stercoralis infection with low therapeutic response. Objective: To investigate the S. stercoralis infection and the seroprevalence of IgG anti-S. stercoralis antibodies in individuals infected with HTLV-1 attending the Reference Center for HTLV-1 (CHTLV) in Salvador, Bahia, Brazil. Materials and methods: We conducted a cross-sectional study in 178 HTLV-1-infected individuals treated at the HTLV specialized center between January, 2014, and December, 2018. The parasitological diagnosis of S. stercoralis was performed using the Hoffman, Pons and Janer, agar plate culture, and Baermann-Morais methods. The IgG anti-S. stercoralis detection was performed using an in house enzyme-linked immunosorbent assay (ELISA). The HTLV-1 infection was diagnosed using a commercial ELISA and confirmed by Western blot. Results: The frequency of S. stercoralis infection was 3.4% (6/178). Individuals infected with S . stercoralis from rural areas (50.0%; 3/6) also showed S. stercoralis hyperinfection (>3,000 larvae/gram of feces). The frequency of circulating anti-S. stercoralis IgG antibodies was 20.8% (37/178). Conclusions: HTLV-1-infected people living in precarious sanitary conditions are more prone to develop severe forms of S. stercoralis infection. Considering the high susceptibility and unfavorable outcome of the infection in these individuals, the serological diagnosis for S. stercoralis should be considered when providing treatment.

Introducción. Los individuos infectados por el virus linfotrópico T humano tipo 1 (HTLV-1) pueden presentar formas graves y diseminadas de infestación por Strongyloides stercoralis con poca mejoría terapéutica. Objetivo. Investigar la infestación por S. stercoralis y la seroprevalencia de IgG anti-S. stercoralis en individuos infectados por HTLV-1 atendidos en el Centro de Referencia para HTLV-1 (CHTLV), en Salvador, Bahía, Brasil. Materiales y métodos. Se hizo un estudio transversal con 178 individuos infectados por HTLV-1 atendidos en el centro especializado de HTLV entre enero de 2014 y diciembre de 2018. El diagnóstico parasitológico de S. stercoralis se hizo mediante los métodos de Hoffman, Pons y Janer, cultivo en placa de agar y Baermann-Morais. Para la detección de IgG anti-S. stercoralis, se utilizó una prueba casera de inmunoabsorción ligada a enzimas (ELISA). La infección por HTLV-1 se diagnosticó usando un ELISA comercial y se confirmó mediante Western blot. Resultados. La frecuencia de infestación por S. stercoralis fue del 3,4 % (6/178). Además, los individuos infestados por S. stercoralis provenientes de la zona rural (50,0 %; 3/6) también mostraron hiperinfestación por S. stercoralis (>3.000 larvas/gramo de heces). La frecuencia de anticuerpos IgG anti-S. stercoralis fue del 20,8 % (37/178). Conclusiones. Las personas infectadas por HTLV-1 que viven en condiciones sanitarias precarias son más propensas a desarrollar formas graves de infestación por S. stercoralis. Teniendo en cuenta la gran vulnerabilidad y el resultado desfavorable de la infección en estos individuos, se debe considerar el diagnóstico serológico de S. stercoralis para administrar el tratamiento

Ineffectiveness of TF-Test® and Coproplus® Methods in Strongyloides stercoralis Infection Diagnosis.

PURPOSE: S. stercoralis diagnosis is currently performed by parasitological methods, mainly by Baermann-Moraes (BM), although Agar Plate Culture (APC) presents a higher sensitivity. New techniques, such as TF-Test® and Coproplus® have been suggested as more practical alternatives. The aim of this study was to evaluate the sensitivity of TF-Test® and Coproplus®, compared with APC, BM and Spontaneous Sedimentation (SS) methods. METHODS: One-hundred and forty male alcoholic patients, who provided three stools samples collected on alternate days, were included in this study. The most frequently found parasite was S. stercoralis, 20% (28/140), and the most sensitive method was APC, 96.4% (27/28), followed by BM, 89.3% (25/28) and SS, 57.1% (16/28). TF-Test® and Coproplus® presented a sensitivity of 46.4 (13/28) and 39.3% (11/28), respectively. In samples with a parasitic load of 1-10 larvae/g of feces, which occurred in 39.3% (11/28) of the infected patients, both the TF-Test® and Coproplus® methods demonstrated sensitivities of 18.2% (2/11), while APC and BM methods reached a sensitivity of 100% (11/11) (p < 0.05). For other intestinal helminth infections, TF-Test® and Coproplus® sensitivities were 22.2 (4/18) and 11.1% (2/18), respectively, this being lower than the SS, 66.7% (12/18) (p < 0.05). On the other hand, for protozoa infection diagnosis, TF-Test® and Coproplus® presented the highest sensitivities, 62.2 (46/74) and 43.2% (32/74), respectively. CONCLUSION: TF-Test® and Coproplus® methods presented the lowest sensitivities for S. stercoralis and other helminth infection diagnosis; therefore, they can be indicated for use in parasitological diagnosis, only when associated with other more effective methods of helminth identification.

Origem, trajetória e atuação política conjunta das entidades médicas nacionais brasileiras de 1999 a 2015 / Origin, trajectory and joint political action of Brazilian national medical entities from 1999 to 2015

Resumo O artigo aborda a atuação política conjunta de entidades médicas nacionais brasileiras de 1999 a 2015, destacando elementos de sua origem, trajetória e configuração institucional. Foram analisados temas, bandeiras de luta, posicionamentos e estratégias na agenda dessas organizações. O estudo envolveu revisão bibliográfica e análise documental, ancoradas no institucionalismo histórico. Os resultados indicam processos de surgimento inter-relacionados, mais evidentes entre a Associação Médica Brasileira e o Conselho Federal de Medicina, repercutindo nas trajetórias e configurações institucionais. Observaram-se conexões entre aspectos históricos, institucionais e a atuação política das entidades. A ênfase na unidade representativa contribuiu para a conformação de uma agenda conjunta influenciada pela parceria entre as entidades, com incorporação posterior da Federação Nacional dos Médicos. Sua atuação foi voltada para o Legislativo, e simultaneamente para os setores público e privado de saúde, com crescimento de posicionamentos contrários às políticas de saúde do governo federal. A ação política se desenvolveu sem alterações de arranjo representativo trino, composto por conselho, associação e sindicato, favorecendo a definição de acordos em espaços intermediários de representação. A agenda corporativa dúbia e a defesa do exercício liberal influenciam a atuação contraditória das entidades médicas brasileiras, com desdobramentos no apoio político e incorporação desses profissionais ao SUS.

Abstract The article addresses the joint political action of Brazilian national medical entities from 1999 to 2015, highlighting elements of their origin, trajectory and institutional configuration. Themes, flags of struggle, positions and strategies in the agenda of these organizations were analyzed. The study involved bibliographic review and documentary analysis, anchored in historical institutionalism. The results indicate interrelated processes of creation, more evident between the Brazilian Medical Association and the Federal Council of Medicine, reflecting on the trajectories and institutional configurations. There were connections between historical and institutional aspects and the political action. The emphasis on the representative unit contributed to a joint agenda influenced by the partnership between the entities, with subsequent incorporation of the National Federation of Physicians. Its performance was focused on the Legislature, and simultaneously to the public and private health sectors, with growth of positions contrary to the federal health policies. The political action developed without changes of trine representative arrangement, composed of council, association and union, favoring the definition of agreements in intermediate spaces. The dubious corporate agenda and the defense of the liberal practice influence the contradictory performance of Brazilian medical entities, with consequences in political support and incorporation of these professionals to the SUS.

Cryptosporidium diagnosis in different groups of children and characterization of parasite species

ABSTRACT Background: Microscopy and enzyme-linked immunosorbent assay (ELISA) are routinely used for Cryptosporidium diagnosis, without differentiating the parasite species. Methods: Children's feces were analyzed by modified Ziehl-Neelsen (mZN) and ELISA for Cryptosporidium diagnosis and by polymerase chain reaction-restriction fragment length polymorphism for species identification. Results: Cryptosporidium frequency was 2.6%. The sensitivity and specificity of ELISA were 85.7% and 99.7%, respectively, with excellent concordance with mZN (kappa=0.854). Parasite species were characterized as Cryptosporidium hominis (78.3%), Cryptosporidium felis (17.4%), and Cryptosporidium parvum (4.3%). Conclusions: Coproantigen ELISA is as efficient as mZN for Cryptosporidium diagnosis. Cryptosporidium genotyping suggests anthroponotic and zoonotic transmission to children.

Asymmetric "partners": work and health of app drivers in Rio de Janeiro, Brazil. / "Parceiros" assimétricos: trabalho e saúde de motoristas por aplicativos no Rio de Janeiro, Brasil.

This paper is the product of an ongoing research's preliminary results with app drivers and aims to discuss how the game of forces has occurred in the relationships established between companies, workers, regulatory bodies, and society. This exploratory qualitative study employed document analysis, a questionnaire, and semi-structured interviews with drivers linked to associations in Rio de Janeiro (RJ), Brazil. The analysis was conducted from a tripolar perspective based on the theoretical-methodological framework of Ergology and social life's micro and macroscopic spaces, encompassing the poles referring to human activity, the market, and politics. The results show a background of norms built on this work about the relationship with companies, passengers, and the drivers themselves, besides issues raised from the COVID-19 pandemic. We can conclude that it is necessary not to counteract technological evolution to achieve workers' rights and health. We should recall that no action aimed at ensuring the reconciliation of health, work, and rights will advance without relying on a fruitful and balanced trend between the three poles mentioned.

Este artigo é fruto de resultados preliminares de uma pesquisa em andamento com motoristas por aplicativo e tem por objetivo discutir sobre como tem se dado o jogo de forças nas relações que se estabelecem entre as empresas, os trabalhadores, os órgãos reguladores e a sociedade. O estudo exploratório, com abordagem qualitativa, utilizou análise documental, questionário e entrevistas semiestruturadas com motoristas ligados a associações do Rio de Janeiro/RJ. Tendo como base o referencial teórico-metodológico da Ergologia, e a partir dos espaços micro e macroscópico da vida social, a análise se deu em uma perspectiva tripolar, abarcando os polos referentes à atividade humana, ao mercado e à política. Os resultados apresentam normas antecedentes que vêm sendo construídas sobre este trabalho na relação com as empresas, com os passageiros e entre os próprios motoristas, além de questões trazidas a partir da pandemia de COVID-19. Conclui-se ser necessário não contrapor a evolução tecnológica à conquista de direitos e da saúde dos trabalhadores, sendo imperativo lembrar que nenhuma ação que vise garantir a conciliação entre saúde, trabalho e direitos conseguirá avançar sem contar com uma dinâmica frutífera, e tendencialmente equilibrada, entre os três polos mencionados.

"Parceiros" assimétricos: trabalho e saúde de motoristas por aplicativos no Rio de Janeiro, Brasil / Asymmetric "partners": work and health of app drivers in Rio de Janeiro, Brazil

Resumo Este artigo é fruto de resultados preliminares de uma pesquisa em andamento com motoristas por aplicativo e tem por objetivo discutir sobre como tem se dado o jogo de forças nas relações que se estabelecem entre as empresas, os trabalhadores, os órgãos reguladores e a sociedade. O estudo exploratório, com abordagem qualitativa, utilizou análise documental, questionário e entrevistas semiestruturadas com motoristas ligados a associações do Rio de Janeiro/RJ. Tendo como base o referencial teórico-metodológico da Ergologia, e a partir dos espaços micro e macroscópico da vida social, a análise se deu em uma perspectiva tripolar, abarcando os polos referentes à atividade humana, ao mercado e à política. Os resultados apresentam normas antecedentes que vêm sendo construídas sobre este trabalho na relação com as empresas, com os passageiros e entre os próprios motoristas, além de questões trazidas a partir da pandemia de COVID-19. Conclui-se ser necessário não contrapor a evolução tecnológica à conquista de direitos e da saúde dos trabalhadores, sendo imperativo lembrar que nenhuma ação que vise garantir a conciliação entre saúde, trabalho e direitos conseguirá avançar sem contar com uma dinâmica frutífera, e tendencialmente equilibrada, entre os três polos mencionados.

Abstract This paper is the product of an ongoing research's preliminary results with app drivers and aims to discuss how the game of forces has occurred in the relationships established between companies, workers, regulatory bodies, and society. This exploratory qualitative study employed document analysis, a questionnaire, and semi-structured interviews with drivers linked to associations in Rio de Janeiro (RJ), Brazil. The analysis was conducted from a tripolar perspective based on the theoretical-methodological framework of Ergology and social life's micro and macroscopic spaces, encompassing the poles referring to human activity, the market, and politics. The results show a background of norms built on this work about the relationship with companies, passengers, and the drivers themselves, besides issues raised from the COVID-19 pandemic. We can conclude that it is necessary not to counteract technological evolution to achieve workers' rights and health. We should recall that no action aimed at ensuring the reconciliation of health, work, and rights will advance without relying on a fruitful and balanced trend between the three poles mentioned.

Effect of dexamethasone on experimental enteritis produced by Giardia lamblia in a Meriones unguiculatus model.

Our aim was to evaluate the impact of immunosuppression on the development of giardiasis. Thirty-six gerbils (4-6 weeks old) were distributed in four groups containing nine animals each: Control (CT); Control-Infected by Giardia lamblia (CTIn), Immunosuppressed (IS), and Immunosuppressed-Infected by G. lamblia (ISIn). Animals in the IS and ISIn groups received intramuscular dexamethasone solution for 25 days. On the 11th day, the animals in the CTIn and ISIn groups were inoculated with G. lamblia. After 14 days of infection, the 25th day of the experiment, all groups were euthanized. Four hours after euthanasia, the intestinal permeability was evaluated and sections of the duodenum and spleen were harvested for morphometric and histopathological analyses. Immunosuppressed groups showed a significant increase in intestinal permeability compared to control and infected groups. Considering that the infection can become chronic in immunosuppressed groups, we should be alert to the possibilities of chronic inflammatory changes, both locally and systemically, due to the loss of the intestinal barrier. Lesions were observed in the duodenal mucosa of the gerbils of the CTIn group, with reduced villi size, crypt hyperplasia, edema, and the presence of inflammatory infiltrate in the lamina propria. In the ISIn group, we observed no inflammation, long and intact villi, and a significant increase in the area of intestinal mucins, despite the large number of trophozoites identified. Our results suggest that exacerbation of the immune response has a direct relationship with the appearance of lesions during enteritis produced by G. lamblia in the assessed model.

Expressões da precarização do trabalho nas regras do jogo: Organizações Sociais na Atenção Primária do município do Rio / Expressions of precarious working conditions in the rules of the game: Social Organizations in Primary Care in the municipality of Rio

RESUMO Objetivou-se analisar as relações de trabalho no âmbito da Atenção Primária (AP) operada pelas Organizações Sociais (OSs) no município do Rio de Janeiro no período de 2009 a 2019. Foram utilizadas contribuições do neoinstitucionalismo histórico para analisar as regras formais das relações de trabalho e sua relação com a precarização a partir dos documentos elaborados pelas instâncias legislativa, executiva e prestadora de serviços. Foram consideradas as modalidades de contratação; contribuições previdenciárias ou trabalhistas; modalidades de recrutamento e seleção; representação dos trabalhadores; plano de cargos, salários e benefícios; remuneração; escopo de práticas e composição das equipes. Destacaram-se como expressões da precarização as incertezas na garantia de direitos trabalhistas, a insegurança quanto ao futuro profissional, a sobrecarga de trabalho, entre outros. O estudo da trajetória da política de AP no período considerado permitiu reconstruir argumentos, dimensões legislativas e regulamentares, bem como as inflexões e a evolução da política. As regras do jogo contidas nas normativas expressam a flexibilização e a precarização do trabalho na AP do município, colocando em questão a sustentabilidade dos serviços baseados no modelo das OSs.

ABSTRACT The objective was to analyze the labor relations in the scope of Primary Care operated by Social Organizations in the city of Rio de Janeiro in the period from 2009 to 2019. The contributions of historical neoinstitutionalism were used to analyze the formal rules of labor relations and their relationship with precarious working conditions based on documents prepared by the legislative, executive and service providers. The following hiring modalities were considered: social security or labor contributions; recruitment and selection modalities; worker representation; job, salary and benefits plan; remuneration; scope of practices and team composition. The uncertainties in guaranteeing labor rights, insecurity about the professional future, work overload, among others, stood out as expressions of precarious working conditions. The study of the trajectory of Primary Care policy in the considered period reconstructs arguments, legislative and regulatory dimensions, as well as the inflections and evolution of the policy. The rules of the game contained in the regulations express the flexibility and precarious working conditions in Primary Care in the municipality, calling into question the sustainability of services based on the model of Social Organizations.

Perfil epidemiológico das parasitoses intestinais em moradores de uma comunidade da Ilha de Boipeba, Bahia, Brasil / Epidemiological profile of intestinal parasites in residents of a community on the island of Boipeba, Bahia, Brazil

Introdução: as parasitoses intestinais constituem-se um importante problema de saúde pública mundial. Estas infecções são mais prevalentes em regiões tropicais impactando na morbimortalidade e aumento nos custos para o sistema de saúde. Objetivo: avaliar a prevalência das enteroparasitoses e sua associação com as condições socioeconômicas, sanitárias, ambientais e hábitos de vida em uma comunidade costeira do Nordeste brasileiro. Metodologia: estudo epidemiológico, descritivo e transversal, realizado de modo não probabilístico entre março a junho de 2017, com 105 moradores da Ilha de Boipeba, localizada no Sul da Bahia. O exame parasitológico de fezes foi realizado pelos métodos de sedimentação espontânea, Baermann-Moraes e FAUST. Um questionário foi aplicado para avaliar o perfil sociodemográfico da população. Resultados: do total de indivíduos avaliados, 52,4% eram do sexo feminino e 57,1% tinham entre 15 a 59 anos. Todos os indivíduos possuíam água encanada, porém não tratada, enquanto 91,4% referiu ingerir vegetais crus e 45,7% não higienizavam as mãos antes as refeições. Sintomas gastrointestinais foram relatados em 82,8% dos indivíduos e infecções enteroparasitárias foram diagnosticadas em 69,6%. Os parasitos mais frequentemente encontrados foram Ancilostomídeo (18,1%) e Entamoeba coli (43,8%). O principal fator de risco potencial para contrair a infecção por ancilostomídeos foi a não existência de poço artesiano na residência (RP=4,35), enquanto para Trichuris trichiura foi não dispor de pia no banheiro (RP=3,82). Conclusão: a comunidade analisada apresentou elevada prevalência de enteroparasitoses. Os hábitos precários de higiene e de acesso à água tratada, associados às condições ambientais e climáticas do local, podem ter contribuído para a elevada transmissão de geohelmintos observada.

Introduction: Intestinal parasitic infections are an important public health problem worldwide. They are more prevalent in tropical regions impacting in morbidity and mortality and costs for the health system. Objective: To evaluate the prevalence of enteroparasitosis and its association with socioeconomic, sanitary and environmental conditions and lifestyle habits in a coastal community in the Northeast Brazil. Methodology: This is an epidemiological, descriptive and cross-sectional study, carried out in a non-probabilistic manner between March and June 2017, with 105 residents of Boipeba Island in the Southern Bahia. The parasitological examination of feces was carried out by the methods of spontaneous sedimentation, Baermann-Moraes and FAUST. A questionnaire was applied to assess the sociodemographic profile of the population. Results: Of the total of individuals evaluated, 52.4% were female and 57.1% were between 15 and 59 years old. All individuals had piped, but untreated water, while 91.4% reported eating raw vegetables and 45.7% did not wash their hands before meals. Gastrointestinal symptoms were observed in 82.8% individuals and 69.6% were diagnosed with enteroparasitic infections. The most frequent parasites were the hookworm (18.1%) and Entamoeba coli (43.8%). The main potential risk factor for hookworm infection was the non-existence of an artesian well in the residence (PR=4.35) and Trichuris trichiura it was not having a sink in the toilet (PR=3.82). Conclusion: The analyzed community has a high prevalence of enteroparasitosis, in addition to environmental and climatic conditions that contribute to the transmission of these infections.

The Predominance of Giardia duodenalis AII sub-assemblage in young children from Salvador, Bahia, Brazil. / Predominio del subconjunto AII de Giardia duodenalis en niños pequeños de Salvador, Bahía, Brasil

INTRODUCTION: Giardia duodenalis is an intestinal protozoan with a high prevalence in children of developing countries. Molecular studies revealed a great genetic diversity of G. duodenalis, with assemblages A and B found mainly in humans. Despite its importance, the information on the molecular epidemiology of human giardiasis is still limited in Brazil. OBJECTIVE: To characterize G. duodenalis molecular isolates in children from Salvador, Bahia, Brazil. MATERIALS AND METHODS: Giardia duodenalis positive fecal samples were obtained from 71 children from two day care centers and 39 users of a clinical analysis laboratory. Samples were analyzed by PCR-RFLP of the glutamate dehydrogenase (gdh) and beta-giardin genes and by the sequencing of beta-giardin. RESULTS: Of the 110 G. duodenalis samples, 80 (72.7%) amplified one or both target genes. Of these, 62 (77.5 %) were identified as assemblage A and 18 (22.5%) as assemblage B. The subassemblage AII was identified in 58.8% (n=47) of isolates followed by the sub-assemblage AI (18.8%, n=15), BIV (11.2%, n=9), and BIII (5.0%, n=4). The AII sub-assemblage was the most frequent in children of both day care centers whereas AI was found only in the group attended at the clinical laboratory. Sub-assemblage AII predominated in children under two years. CONCLUSIONS: The higher frequency of AII sub-assemblage suggests that anthroponotic transmission is more common in Salvador, but that zoonotic transmission pathways are also present and a change in susceptibility to different molecular patterns of Giardia may occur during child growth.

Introducción. Giardia duodenalis es un protozoo intestinal de gran prevalencia en los niños de los países en desarrollo. En estudios moleculares se ha evidenciado la gran diversidad genética de G. duodenalis y se han identificado los conjuntos A y B, principalmente en humanos. A pesar de su importancia, el conocimiento de la epidemiología molecular de la giardiasis humana aún es limitado en Brasil. Objetivo. Caracterizar los aislamientos moleculares de G. duodenalis de muestras tomadas a niños de Salvador, Bahía, Brasil. Materiales y métodos. Las muestras fecales positivas para G. duodenalis se obtuvieron de 71 niños de dos guarderías y de 39 usuarios de un laboratorio de análisis clínicos. Las muestras se analizaron mediante PCR-RFLP de los genes gdh y beta-giardin, y secuenciación de beta-giardin. Resultados. De las 110 muestras de G. duodenalis, en 80 (72,7 %) se amplificaron uno o ambos genes. De estos, 62 (77,5 %) se identificaron como pertenecientes al conjunto A y 18 (22,5 %) al B. El subconjunto AII se identificó en el 58,8 % (n=47) de los aislamientos, seguido del AI en el 18,8% (n=15), el BIV en el 11,2% (n=9) y el BIII en el 5,0% (n=4). El subconjunto AII fue el más frecuente en los niños de ambas guarderías, en tanto que el AI solo se encontró en el grupo atendido en el laboratorio clínico. El subconjunto AII predominó en los niños menores de dos años. Conclusiones. La mayor frecuencia del subconjunto AII sugiere que la transmisión antroponótica es más común en Salvador, pero también existen vías de transmisión zoonóticas, y que pueden ocurrir cambios en la sensibilidad frente a diferentes patrones moleculares de Giardia durante el crecimiento infantil.

Predominance of Giardia duodenalis AII sub-assemblage in young children from Salvador, Bahia, Brazil / Predominio del subconjunto AII de Giardia duodenalis en niños pequeños de Salvador, Bahía, Brasil

Introduction. Giardia duodenalis is an intestinal protozoan with a high prevalence in children of developing countries. Molecular studies revealed a great genetic diversity of G. duodenalis, with assemblages A and B found mainly in humans. Despite its importance, the information on the molecular epidemiology of human giardiasis is still limited in Brazil. Objective. To characterize G. duodenalis molecular isolates in children from Salvador, Bahia, Brazil. Materials and methods. Giardia duodenalis positive fecal samples were obtained from 71 children from two day care centers and 39 users of a clinical analysis laboratory. Samples were analyzed by PCR-RFLP of the glutamate dehydrogenase (gdh) and beta-giardin genes and by the sequencing of beta-giardin. Results. Of the 110 G. duodenalis samples, 80 (72.7%) amplified one or both target genes. Of these, 62 (77.5 %) were identified as assemblage A and 18 (22.5%) as assemblage B. The subassemblage AII was identified in 58.8% (n=47) of isolates followed by the sub-assemblage AI (18.8%, n=15), BIV (11.2%, n=9), and BIII (5.0%, n=4). The AII sub-assemblage was the most frequent in children of both day care centers whereas AI was found only in the group attended at the clinical laboratory. Sub-assemblage AII predominated in children under two years. Conclusions. The higher frequency of AII sub-assemblage suggests that anthroponotic transmission is more common in Salvador, but that zoonotic transmission pathways are also present and a change in susceptibility to different molecular patterns of Giardia may occur during child growth.

Introducción. Giardia duodenalis es un protozoo intestinal de gran prevalencia en los niños de los países en desarrollo. En estudios moleculares se ha evidenciado la gran diversidad genética de G. duodenalis y se han identificado los conjuntos A y B, principalmente en humanos. A pesar de su importancia, el conocimiento de la epidemiología molecular de la giardiasis humana aún es limitado en Brasil. Objetivo. Caracterizar los aislamientos moleculares de G. duodenalis de muestras tomadas a niños de Salvador, Bahía, Brasil. Materiales y métodos. Las muestras fecales positivas para G. duodenalis se obtuvieron de 71 niños de dos guarderías y de 39 usuarios de un laboratorio de análisis clínicos. Las muestras se analizaron mediante PCR-RFLP de los genes gdh y beta-giardin, y secuenciación de beta-giardin. Resultados. De las 110 muestras de G. duodenalis, en 80 (72,7 %) se amplificaron uno o ambos genes. De estos, 62 (77,5 %) se identificaron como pertenecientes al conjunto A y 18 (22,5 %) al B. El subconjunto AII se identificó en el 58,8 % (n=47) de los aislamientos, seguido del AI en el 18,8% (n=15), el BIV en el 11,2% (n=9) y el BIII en el 5,0% (n=4). El subconjunto AII fue el más frecuente en los niños de ambas guarderías, en tanto que el AI solo se encontró en el grupo atendido en el laboratorio clínico. El subconjunto AII predominó en los niños menores de dos años. Conclusiones. La mayor frecuencia del subconjunto AII sugiere que la transmisión antroponótica es más común en Salvador, pero también existen vías de transmisión zoonóticas, y que pueden ocurrir cambios en la sensibilidad frente a diferentes patrones moleculares de Giardia durante el crecimiento infantil.