ABSTRACT Background: The World Health Organization recommends a market-ready, urine-based point-of-care diagnostic test for circulating cathodic antigens (CCA) to determine the prevalence of S. mansoni. This study evaluated the performance of the URINE CCA (SCHISTO) ECO TESTE® (POC-ECO), which is currently available in Brazil. Methods: Residents from eight sites with different prevalence estimates provided one urine sample for POC-ECO and one stool sample for Kato-Katz (KK) and Helmintex® (HTX) testing as an egg-detecting reference for infection status. Results: None of the study sites had significantly higher POC-ECO accuracy than KK. Conclusions: POC-ECO is not currently recommended in Brazilian schistosomiasis elimination programs.

ABSTRACT Background The World Health Organization recommends reliable point-of-care (POC) diagnostic testing to eliminate schistosomiasis. Lateral flow immunoassay that detects schistosome circulating cathodic antigen (CCA) in urine to establish prevalence thresholds for intervention in endemic areas is recommended. Stored urine may be useful if surveying at-risk populations is delayed or interrupted by unforeseen circumstances, such as the current COVID-19 pandemic. This study evaluated the manufacturer’s claim that Schistosoma mansoni infection can be reliably diagnosed in urine samples stored at -20°C for one year. Methods Two-hundred-forty-two subjects from an endemic site in Brazil provided one urine sample each for testing with URINE CCA (SCHISTO) ECO TESTE® (POC-ECO) and one stool sample each for testing with Kato-Katz (KK) and Helmintex® (HTX) as a robust reference standard for infection status. At least 2 ml of urine from each participant was stored at -20°C; after one year, 76 samples were randomly selected for POC-ECO retesting. Results: The POC-ECO agreement between freshly collected and stored urine was inadequate considering trace results as positive (Cohen’s kappa coefficient κ = 0.08) and negative (κ = 0.36). POC-ECO accuracy was not significantly greater than that of routine KK (54%; 95% confidence interval: 42.1%-65.5%). Conclusions The precision and accuracy of POC-ECO have to be optimized in both freshly collected and stored urine before it can be recommended for use in control programs in Brazil.

RESUMO Objetivo: Avaliar a razão neutrófilo-linfócito na predição de sepse e mortalidade em pacientes admitidos em uma unidade de terapia intensiva. Métodos: Estudo de caso-controle de pacientes adultos admitidos em terapia intensiva. Foram incluídos como casos pacientes que tiveram sepse como razão de admissão e possuíam exame laboratorial de hemograma prévio. As análises estatísticas realizadas foram curva ROC, regressão logística binária, Mann Whitney e qui-quadrado de Pearson. Foi considerado significativo valor de p < 0,05. Resultados: Os valores de curva ROC foram 0,62 para razão neutrófilo-linfócito, 0,98 para neutrófilos bastonados e 0,51 para leucócitos totais. A presença de razão neutrófilo-linfócito superior a 5,0, o número de leucócitos acima de 12.000mm3/mL e número de neutrófilos bastonados acima 10% foram fatores de risco para sepse, entretanto somente os escores SAPS 3 e SOFA estavam relacionados a mortalidade dos pacientes. Conclusão: A razão neutrófilo-linfócito e os neutrófilos bastonados em combinação com outros parâmetros podem ser marcadores na detecção precoce de sepse em terapia intensiva.

ABSTRACT Objective: To evaluate the neutrophil-lymphocyte ratio as a predictor of sepsis and mortality in patients admitted to an intensive care unit. Methods: Case-control study of adult patients admitted to an intensive care unit. Patients who had sepsis as the reason for admission and who had a previous complete blood count examination were included as case patients. The following statistical analyses were performed: ROC curves, binary logistic regression, and Mann-Whitney and Pearson's chi-square tests. p < 0.05 was considered significant. Results: The ROC curve values were 0.62 for neutrophil-lymphocyte ratio, 0.98 for band neutrophils and 0.51 for total leukocytes. The presence of a neutrophil-lymphocyte ratio greater than 5.0, leukocyte count above 12,000mm3/mL and band neutrophil percentage above 10% were risk factors for sepsis; however, only the SAPS 3 and SOFA score were related to patient mortality. Conclusion: The neutrophil-lymphocyte ratio and band neutrophils in combination with other parameters may be markers for the early detection of sepsis in intensive care units.

Abstract: INTRODUCTION Risk of schistosomiasis expansion to semi-arid northeastern Brazil under the influence of the Integration Project of the São Francisco River (IPSFR) was assessed. METHODS: Stool examinations of schoolchildren, epidemiological investigation, and survey of the local host snail Biomphalaria straminea were performed in five IPSFR municipalities. RESULTS Six of 4,770 examined schoolchildren were egg-positive for Schistosoma mansoni. Biomphalaria straminea was widespread, but not naturally infected with S. mansoni. Snails experimentally exposed to two laboratory S. mansoni strains yielded infection indices of 1-4.5%. CONCLUSIONS: There is evidence of active schistosomiasis transmission in the area; thus, intensive surveillance actions are required.

School-aged children (6-15 years) from the endemic area of Pernambuco were evaluated both as a target group for and an indicator of schistosomiasis control in the community. Parasitological data were drawn from baseline stool surveys of whole populations that were obtained to diagnose Schistosoma mansoni infection. Nineteen representative localities were selected for assessing the prevalence of schistosomiasis among individuals in the following age groups: 0-5, 6-15, 16-25, 26-40 and 41-80 years. For each locality, the prevalence in each age group was compared to that of the overall population using contingency table analysis. To select a reference group, the operational difficulties of conducting residential surveys were considered. School-aged children may be considered to be the group of choice as the reference group for the overall population for the following reasons: (i) the prevalence of schistosomiasis in this age group had the highest correlation with the prevalence in the overall population (r = 0.967), (ii) this age group is particularly vulnerable to infection and plays an important role in parasite transmission and (iii) school-aged children are the main target of the World Health Organization in terms of helminth control. The Schistosomiasis Control Program should consider school-aged children both as a reference group for assessing the need for intervention at the community level and as a target group for integrated health care actions of the Unified Health System that are focused on high-risk groups.

This study, based on Beck's¹ dissertation about nurses who work in the critical units, has as aim to identify the presence and to characterize the Arousal in the Fire Brigade workers. Besides that, it has the aim to establish relations with the diseases come from the job as well as to identify strategies of intervention suggested by firefighters to improve the quality of life. These people develop activities submitted to unexpected situational events whose physical and psychological load can start the Arousal. This research is characterized as an exploratory study that belongs to the human-social area and that uses a qualitative approach that involved 24 workers. To the data collect, it was done a semi-structured interview with general and specific questions. In the data analysis, the Arousal as well as its relation with identified diseases was mapped by the workers, pointing out the need of changes that enable the improvement of the quality of life in the work.

Este estudio, inspirado en la tesis de doctorado de Beck¹ con los enfermeros que actúan en unidades críticas, tuvo como objetivo identificar la presencia y caracterizar el Estado de Alerta en los trabajadores del Cuerpo de Bomberos, así como establecer relaciones con las enfermedades provenientes del trabajo, además de identificar estrategias de intervención sugeridas por los trabajadores para mejorar su calidad de vida. Éstos desarrollan actividades sometidos a eventos conyunturales inesperados en los que la carga física y psíquica puede predisponer al Estado de Alerta. Se caracteriza como una investigación del área humano-social, exploratoria, con abordaje cualitativo que involucró 24 trabajadores. Para la colecta de datos, se realizó entrevista semiestructurada, compuesta por cuestiones generales y específicas. En el análisis de los datos, fue esquematizado el Estado de Alerta y su relación con enfermedades identificadas por los trabajadores, señalando la necesidad de cambios que favorezcan la mejora de la calidad de vida en el trabajo.

Este estudo, inspirado na tese de doutorado de Beck¹, com os enfermeiros que atuam em unidades críticas, teve como objetivo identificar a presença e caracterizar o Estado de Alerta nos trabalhadores do Corpo de Bombeiros, bem como estabelecer relações entre doenças provenientes do trabalho e Estado de Alerta, além de identificar estratégias de intervenção sugeridas pelos trabalhadores para melhorar sua qualidade de vida. Estes desenvolvem atividades submetidos a eventos situacionais inesperados nos quais a carga física e psíquica pode predispor o Estado de Alerta. Caracteriza-se como uma pesquisa da área humano-social, exploratória, com abordagem qualitativa que envolveu 24 trabalhadores. Para a coleta de dados, realizou-se entrevista semi-estruturada, composta por questões gerais e específicas. Na análise dos dados, foram mapeados o Estado de Alerta e sua relação com doenças identificadas pelos trabalhadores, apontando a necessidade de mudanças que favoreçam a melhoria da qualidade de vida no trabalho.

Este estudo, inspirado na tese de doutorado de Beck¹, com os enfermeiros que atuam em unidades críticas, teve como objetivo identificar a presença e caracterizar o Estado de Alerta nos trabalhadores do Corpo de Bombeiros, bem como estabelecer relações entre doenças provenientes do trabalho e Estado de Alerta, além de identificar estratégias de intervenção sugeridas pelos trabalhadores para melhorar sua qualidade de vida. Estes desenvolvem atividades submetidos a eventos situacionais inesperados nos quais a carga física e psíquica pode predispor o Estado de Alerta. Caracteriza-se como uma pesquisa da área humano-social, exploratória, com abordagem qualitativa que envolveu 24 trabalhadores. Para a coleta de dados, realizou-se entrevista semi-estruturada, composta por questões gerais e específicas. Na análise dos dados, foram mapeados o Estado de Alerta e sua relação com doenças identificadas pelos trabalhadores, apontando a necessidade de mudanças que favoreçam a melhoria da qualidade de vida no trabalho.

This study, based on Beck's¹ dissertation about nurses who work in the critical units, has as aim to identify the presence and to characterize the Arousal in the Fire Brigade workers. Besides that, it has the aim to establish relations with the diseases come from the job as well as to identify strategies of intervention suggested by firefighters to improve the quality of life. These people develop activities submitted to unexpected situational events whose physical and psychological load can start the Arousal. This research is characterized as an exploratory study that belongs to the human-social area and that uses a qualitative approach that involved 24 workers. To the data collect, it was done a semi-structured interview with general and specific questions. In the data analysis, the Arousal as well as its relation with identified diseases was mapped by the workers, pointing out the need of changes that enable the improvement of the quality of life in the work.

Este estudio, inspirado en la tesis de doctorado de Beck¹ con los enfermeros que actúan en unidades críticas, tuvo como objetivo identificar la presencia y caracterizar el Estado de Alerta en los trabajadores del Cuerpo de Bomberos, así como establecer relaciones con las enfermedades provenientes del trabajo, además de identificar estrategias de intervención sugeridas por los trabajadores para mejorar su calidad de vida. Éstos desarrollan actividades sometidos a eventos conyunturales inesperados en los que la carga física y psíquica puede predisponer al Estado de Alerta. Se caracteriza como una investigación del área humano-social, exploratoria, con abordaje cualitativo que involucró 24 trabajadores. Para la colecta de datos, se realizó entrevista semiestructurada, compuesta por cuestiones generales y específicas. En el análisis de los datos, fue esquematizado el Estado de Alerta y su relación con enfermedades identificadas por los trabajadores, señalando la necesidad de cambios que favorezcan la mejora de la calidad de vida en el trabajo.

Este estudo teve como objetivo estabelecer relações entre o trabalho da enfermagem em unidades críticas e sua repercussão sobre a saúde dos trabalhadores. Foi realizada uma pesquisa exploratório-descritiva, do tipo qualitativa, que envolveu 46 trabalhadores de enfermagem (enfermeiros e auxiliares). Foram selecionados dois hospitais, um público e um filantrópico, sendo realizada a pesquisa nas unidades críticas de pronto-atendimento, unidade de terapia intensiva, unidade e ambulatório de hematoncologia e centro cirúrgico. Os instrumentos de coleta de dados utilizados foram a entrevista semi-estruturada e a observação do trabalho nos três turnos aplicadas no período de janeiro a junho de 1999. Teve como resultado o mapeamento de diversas doenças crônicas expressas por estes trabalhadores, bem como a verbalização da dificuldade dos mesmos em se cuidarem, assumindo a responsabilidade que lhes cabe sobre sua saúde.

This study had as objective to establish relations between the work of the nursing in critical units and its repercussion on the health of the workers. A exploratory-descriptive research was carried through, of the qualitative type, that involved 46 workers of nursing (nurses and assistant). Two hospitals had been selected, a public and a philanthropic, being carried through the research in the critical units of soon-attendance, unit of intensive therapy, unit and clinic of hemathoncology and surgical center. The instruments of data collection used had been the half-structuralized interview and the observation of the work in the three turns applied in the period between January and June of 1999. It had as resulted the mapping of diverse express chronic illnesses for these workers, as well as the verbalization of the difficulty of the same ones in to taking care of themselves, assuming the responsibility that fits to them on their health.

Este estudio tuvo como objetivo establecer relaciones entre el trabajo de enfermería en unidades críticas y su repercusión sobre la salud de los trabajadores. Fue realizada una investigación exploratorio-descriptiva, del tipo cualitativa, eso implicó a 46 trabajadores de enfermería (las enfermeras y ayudante). Habían sido seleccionados dos hospitales, un público y un filantrópico, siendo realizada la investigación en las unidades críticas de pronto-atención, unidad de terapia intensiva, unidad y ambulatorio de hematoncología y centro quirúrgico. Los instrumentos de colección de datos usados habían sido la entrevista semi-estructuralizada y la observación del trabajo en los tres turnos aplicadas en el período entre enero y junio de 1999. Tenía como resultado el mapeamento de las enfermedades crónicas expresas por estos trabajadores, bien como la verbalización de la dificultad de ellos a tomar cuidado de sí mismos, asumiendo la responsabilidad que cabe a ellos sobre su salud.

This study had as objective to establish relations between the work of the nursing in critical units and its repercussion on the health of the workers. A exploratory-descriptive research was carried through, of the qualitative type, that involved 46 workers of nursing (nurses and assistant). Two hospitals had been selected, a public and a philanthropic, being carried through the research in the critical units of soon-attendance, unit of intensive therapy, unit and clinic of hemathoncology and surgical center. The instruments of data collection used had been the half-structuralized interview and the observation of the work in the three turns applied in the period between January and June of 1999. It had as resulted the mapping of diverse express chronic illnesses for these workers, as well as the verbalization of the difficulty of the same ones in to taking care of themselves, assuming the responsibility that fits to them on their health.

Este estudio tuvo como objetivo establecer relaciones entre el trabajo de enfermería en unidades críticas y su repercusión sobre la salud de los trabajadores. Fue realizada una investigación exploratorio-descriptiva, del tipo cualitativa, eso implicó a 46 trabajadores de enfermería (las enfermeras y ayudante). Habían sido seleccionados dos hospitales, un público y un filantrópico, siendo realizada la investigación en las unidades críticas de pronto-atención, unidad de terapia intensiva, unidad y ambulatorio de hematoncología y centro quirúrgico. Los instrumentos de colección de datos usados habían sido la entrevista semi-estructuralizada y la observación del trabajo en los tres turnos aplicadas en el período entre enero y junio de 1999. Tenía como resultado el mapeamento de las enfermedades crónicas expresas por estos trabajadores, bien como la verbalización de la dificultad de ellos a tomar cuidado de sí mismos, asumiendo la responsabilidad que cabe a ellos sobre su salud.

Este estudo teve como objetivo estabelecer relações entre o trabalho da enfermagem em unidades críticas e sua repercussão sobre a saúde dos trabalhadores. Foi realizada uma pesquisa exploratório-descritiva, do tipo qualitativa, que envolveu 46 trabalhadores de enfermagem (enfermeiros e auxiliares). Foram selecionados dois hospitais, um público e um filantrópico, sendo realizada a pesquisa nas unidades críticas de pronto-atendimento, unidade de terapia intensiva, unidade e ambulatório de hematoncologia e centro cirúrgico. Os instrumentos de coleta de dados utilizados foram a entrevista semi-estruturada e a observação do trabalho nos três turnos aplicadas no período de janeiro a junho de 1999. Teve como resultado o mapeamento de diversas doenças crônicas expressas por estes trabalhadores, bem como a verbalização da dificuldade dos mesmos em se cuidarem, assumindo a responsabilidade que lhes cabe sobre sua saúde.

INTRODUÇÃO: Monitorização terapêutica de imunossupressores ciclosporina A (CsA) e tacrolimus (FK506) é indispensável para manter níveis estáveis das drogas, evitando para o transplantado a perda do enxerto, no caso de baixas doses, ou a toxicidade, em altas doses, permitindo ajustes individuais. HISTÓRICO: Na década de 80, foi introduzida a utilização dos potentes imunossupressores CsA e FK506, revolucionando o transplante de órgãos com a diminuição da rejeição. MECANISMO DE AÇÃO: A CsA e o FK506 são inibidores da transcrição do primeiro sinal para ativação dos linfócitos T, apresentando estruturas químicas diferentes, mas mecanismos semelhantes. TOXICIDADE: Os principais efeitos relacionados à dose da CsA e do FK506 são a nefro e a neurotoxicidade. Estudos apontam o FK506 como droga alternativa à utilização da CsA porque aquele demonstrou menor nefrotoxicidade e uma reversibilidade dos efeitos neurotóxicos diante da redução da dose. METODOLOGIA ANALÍTICA: Na monitorização de rotina para a CsA, os imunoensaios, radioimunoensaio (RIA) e imunoensaio monoclonal com fluorescência polarizada (FPIAm) ocuparam o lugar da cromatografia líquida de alta eficiência (CLAE), detecção ultravioleta (UV). O método de referência para o FK506 é a CLAE com detecção por espectrometria de massa (LC/MS). Porém, metodologias como ensaio imunoenzimático de micropartículas (MEIA) ou enzyme linked imunosorbent assay (ELISA) têm sido utilizadas na rotina laboratorial. CONCLUSÃO: Parece existir uma tendência para a substituição terapêutica da CsA pelo FK506 no tratamento imunossupressor, porém ainda não se estabeleceu consenso nessa conduta. A metodologia analítica para a análise da CsA encontra-se bem estabelecida; para o FK506, estudos ainda são necessários.

INTRODUCTION: Therapeutic monitoring of immunosuppressants cyclosporine A (CsA) and tacrolimus (FK506) is indispensable to maintain stable levels of these drugs, avoiding graft rejection in the transplanted patient in the case of low dosage, or toxicity in high dosage, and allowing monitoring of individual treatment. BACKGROUND: In the 80's, the introduction of the potent immunosuppressive drugs CsA and FK506 reduced the incidence of rejection episodes after solid organ transplantation. MECHANISM OF ACTION: CsA and FK506 have distinct chemical structures but similar mechanisms of action, inhibiting the transcription of the first signal for T-lymphocyte activation. TOXICITY: The major side effects associated with CsA and FK506 therapies are nephrotoxicity and neurological disturbances. However, clinical studies demonstrate that FK506 is a potent alternative to CsA due to its lower nephrotoxicity and reversible neurotoxicity when the dosage is decreased. ANALYTICAL METHODOLOGY: For routine monitoring of CsA, the high-performance liquid chromatography with ultraviolet detection (HPLC-UV) was replaced by the radioimmunoassay (RIA) and monoclonal antibody-based fluorescence polarization immunoassay (mFPIA). For the assessment of FK506, it is consensus that highly specific liquid chromatography/tandem mass spectrometry (LC/MS/MS) is the reference method, although the microparticle enzyme immunoassay (MEIA) and the enzyme-linked immunosorbent assay (ELISA) are currently used for routine monitoring. CONCLUSION: There is a tendency to substitute CsA by FK506 at immunosuppressive regimens, but this is not a consensus yet. The analytical methodology for CsA analysis is well established in the clinical laboratory, but further studies are needed to define the best methodologies for routine FK506 analysis.

Specific IgG and IgM responses to soluble egg antigen (SEA) and keyhole limpet haemocyanin (KLH) were measured by ELISA in patients with acute and chronic schistosomiasis. The tests based upon IgM and IgG antibodies responses to KLH presented the best diagnostic discrimination, and can be used in conjunction with clinical and epidemiological data to the differential diagnosis of acute schistosomiasis.

The abundance of snail hosts and the rates of infection with Schistosoma mansoni were monitored monthly for four years in two representative localities subjected to repeated chemotherapy of infected persons. Snail abundance varied from 1.0 to 4.4 collected per person/minute/station for Biomphalaria straminea and from 0.1 to 7.0 for B. glabrata. Infection rates of snails in nature varied from 0% to 15% for the former and from 0% to 70% for the latter species. Human infection increased from 35.5% to 61.9% in the locality occupied by B. straminea, and decreased from 40.3% to 20.8% in that occupied by B. glabrata. No relationship could be detected between human infection and the snail variables. Despite seasonal variations, natural infection persisted throughout the monitoring period in both snail species. It reached remarkably high levels in B. straminea when compared to those obtained by other authors probably because of differences in methodology. It is recommended that longitudinal studies should be carried out focally and periodically to avoid underestimating the prevalence of schistosome infection in snails.

Este estudo discute a evolução da esquistossomose na área endêmica de Pernambuco utilizando dados secundários levantados pelos programas nacionais de saúde entre 1977 e 1996, período em que foram realizadas cinco campanhas de controle quimioterápico. A análise dos dados mostrou que: a) os municípios com prevalência acima de 25% foram proporcionalmente em maior número na zona Litoral-Mata do que no Agreste; b) a prevalência diminuiu em ambas as zonas mesmo quando o intervalo entre as campanhas era superior a cinco anos. Apesar de a última avaliação (1996) ter indicado uma predominância de municípios com prevalência abaixo de 25%, a maioria destes ainda possui localidades com prevalência acima de 50%. Uma proposta é apresentada para identificar as localidades problemáticas, onde medidas complementares à quimioterapia, tais como controle sistemático de moluscos vetores, saneamento ambiental, educação para a saúde e mobilização comunitária ainda são necessárias.

This study assesses the evolution of schistosomiasis in the endemic area of Pernambuco, using data from five campaigns of chemotherapy control carried out by national health programmes from 1977 to 1996. Analysis of the data showed that: a) the proportion of municipalities with prevalence above 25% was significantly higher in the coastal-forest zone than in the zone of transitional vegetation Agreste in the four evaluations made in the endemic area; b) the prevalence of infection decreased in both zones even when the interval between campaigns were more than five years. The last survey (1996) indicated a predominance of municipalities with prevalences below 25%. However, the majority of these municipalities had localities with prevalence above 50%. A proposal is presented for the identification of the problematic localities, where complementary measures to chemotherapy, such as systematic snail control, improved sanitation, health education and community mobilization, are still necessary.

A group of 52 villagers was followed-up for three years regarding Schistosoma mansoni infection. All villagers were periodically surveyed by the Kato-Katz method. In March 1997 and March 1998 the positives were treated with oxamniquine (15-20 mg/kg), and in March 1999, with praziquantel (60 mg/kg). All infection indices decreased substantially between March 1999 and March 2000: prevalence of infection (from 32.7% to 21.2%), prevalence of moderate/heavy infection (from 7.7% to 1.9%), intensity of infection (from 23.1 epg to 7.4 epg) and reinfection (from 35.7% to 14.3%). Negativation increased from 53.8 to 82.4. An optimistic prognostic is assumed in the short term for the introduction of praziquantel in the study area.

Experiments with Squamatoides trivitattus were carried out in two different controlled temperatures (16±1°C/50-60% RH and 27±1°C/70-80% RH). The viability of larvae and pupae at 27°C was 89.82% and 92.75% respectively. Larvae did not develop at 16°C. Larval development lasted for 20±4 hr, 16±8 hr and 60±7 hr for the first, second and third instars, respectively, completing a total of 96±6 hr. The mean pupal period lasted for 15.7±1.6 days. In longevity tables for the adults, life-expectancy for 50% of the colony submitted to 16°C was of 1.78 weeks for males and 2.42 for females. At 27°C a life-expectancy of 1.15 weeks for males and 0.78 week for females was recorded. The average life-spans for males and females at 16°C were 3.5±2.0 and 3.8±2.6 weeks, respectively, and 1.9±1.2 weeks for both sexes. At 27°C, the longevity recorded was of 2.1±1.3 weeks for males and 1.7±1.1 week for females.