ABSTRACT Background: Critical illness is a major ongoing health care burden worldwide and is associated with high mortality rates. Sodium-glucose cotransporter-2 inhibitors have consistently shown benefits in cardiovascular and renal outcomes. The effects of sodium-glucose cotransporter-2 inhibitors in acute illness have not been properly investigated. Methods: DEFENDER is an investigator-initiated, multicenter, randomized, open-label trial designed to evaluate the efficacy and safety of dapagliflozin in 500 adult participants with acute organ dysfunction who are hospitalized in the intensive care unit. Eligible participants will be randomized 1:1 to receive dapagliflozin 10mg plus standard of care for up to 14 days or standard of care alone. The primary outcome is a hierarchical composite of hospital mortality, initiation of kidney replacement therapy, and intensive care unit length of stay, up to 28 days. Safety will be strictly monitored throughout the study. Conclusion: DEFENDER is the first study designed to investigate the use of a sodium-glucose cotransporter-2 inhibitor in general intensive care unit patients with acute organ dysfunction. It will provide relevant information on the use of drugs of this promising class in critically ill patients. ClinicalTrials.gov registry: NCT05558098

RESUMO Antecedentes: A doença crítica é um importante ônus permanente da assistência médica em todo o mundo e está associada a altas taxas de mortalidade. Os inibidores do cotransportador de sódio-glicose do tipo 2 têm demonstrado consistentemente benefícios nos desfechos cardiovasculares e renais. Os efeitos dos inibidores do cotransportador de sódio-glicose do tipo 2 em doenças agudas ainda não foram devidamente investigados. Métodos: O DEFENDER é um estudo de iniciativa do investigador, multicêntrico, randomizado, aberto, desenhado para avaliar a eficácia e a segurança da dapagliflozina em 500 participantes adultos com disfunção orgânica aguda hospitalizados na unidade de terapia intensiva. Os participantes aptos serão randomizados 1:1 para receber 10mg de dapagliflozina e o tratamento padrão por até 14 dias ou apenas o tratamento padrão. O desfecho primário é um composto hierárquico de mortalidade hospitalar, início de terapia renal substitutiva e tempo de internação na unidade de terapia intensiva, até 28 dias. O monitoramento da segurança será rigoroso durante todo o estudo. Conclusão: O DEFENDER é o primeiro estudo desenvolvido para investigar o uso de um inibidor do cotransportador de sódio-glicose do tipo 2 em pacientes de unidade de terapia intensiva geral com disfunção orgânica aguda. O estudo fornecerá informações relevantes sobre o uso de medicamentos dessa classe promissora em pacientes críticos. Registro ClincalTrials.gov: NCT05558098

Resumo Objetivo Avaliar a acurácia dos métodos de diagnóstico interobservadores do tipo de pisada em atletas corredores utilizando três métodos de avaliação: exame físico, podoscopia e baropodometria comparando com a medida radiográfica dos ângulos de Meary e pitch do calcâneo. Métodos Trata-se de estudo transversal de atletas que praticam corrida. Os critérios de inclusão foram: indivídulos com idade mínima de 18 anos e máxima de 65 anos de ambos os sexos; indivídulos hígidos, sem comorbidades que interfiram no desempenho da corrida; praticantes regulares que realizam corrida ao menos duas vezes na semana; índice de massa corpórea entre 18,5 e 29,99 Kg/m2; aceitação dos termos de consentimento livre e esclarecido (TCLE). Os critérios de não inclusão compreenderam: presença de lesões prévias ou ativas que comprometam a atividade esportiva; cirurgias prévias dos pés; obesidade. Foram selecionados 40 pacientes, sendo 29 (72,5%) do sexo masculino e 11 (27,5%) do sexo feminino cuja média das idades foi de 39 anos (mínimo de 19 anos e máximo de 61 anos). O índice de massa corpórea (IMC) dos 40 pacientes variou de 21,00 a 29,99 Kg/m2 (média de 25,48 Kg/m2 com desvio-padrão de 2,39 Kg/m2 e mediana de 25,50 Kg/m2). Excluímos os que apresentaram valor superior a 29,99 Kg/m2. A frequência de corrida variou de 2 a 5 vezes por semana (média de 3,13 vezes por semana com desvio-padrão de 0,79 vezes por semana e mediana de 3 vezes por semana). Foram realizados exame físico, podoscopia e baropodometria, e sua avaliação foi feita por quatro examinadores; além disso, os resultados foram comparados com a classificação radiográfica do tipo de pisada obtida através da mensuração dos ângulos de Meary e pitch do calcâneo. Resultados A concordância interobservadores destes parâmetros foi verificada pelo índice de concordância de Kappa ponderado, segundo o qual obtivemos uma concordância significante entre os participantes, levando-se em consideração o exame físico, podoscopia e baropodometria e de acordo com o índice Kappa. A concordância foi marginal quando comparados os resultados dos três métodos com a classificação angular radiográfica. Conclusão Obtivemos uma concordância excelente entre os observadores ao considerarmos o exame físico, a podoscopia e a baropodometria para o diagnóstico do tipo pisada em corredores. Porém, quando comparados os resultados obtidos com as medidas radiográficas, a concordância para o diagnóstico do tipo da pisada foi baixa.

Abstract Objective To evaluate the accuracy of interobserver diagnostic methods of the type of footprint among running athletes using three evaluation methods: physical examination, podoscopy, and baropodometry compared with radiographic measurement of Meary angles and calcaneal pitch. Methods This is a cross-sectional study of athletes who practice running. The inclusion criteria were: individuals with minimum age of 18 years and maximum age of 65, male or female, healthy and without comorbidities that interfere with running performance; regular practitioners who run at least twice a week; body mass index between 18.5 and 29.99 Kg/m2; acceptance of the written informed consent form (WICF). The non-inclusion criteria included: presence of previous or active injuries that compromise sports activity; previous foot surgeries; obesity. Forty patients were selected, 29 (72.5%) male and 11 (27.5%) female, whose mean age was 39 years (minimum 19 years and maximum 61 years). The body mass index (BMI) of the 40 patients ranged from 21.00 to 29.99 kg/m2 (mean 25.48 kg/m2 with standard deviation of 2.39 kg/m2 and a median of 25.50 kg/m2). We excluded those with values above 29.99. Running frequency ranged from 2 to 5 times per week (average 3.13 times per week, with standard deviation of 0.79 times per week and median of 3 times per week). Physical examination, podoscopy, and baropodometry were performed, and their evaluation was made by 4 examiners. Additionally, the results were compared with the radiographic classification of the footprint type obtained by measuring the Meary angles and the calcaneal pitch. Results The interobserver agreement of these parameters was verified by the weighted Kappa agreement index, in which we obtained a significant agreement between the participants considering physical examination, podoscopy, and baropodometry, and according to the Kappa index. The agreement was marginal when comparing the results of the three methods with the radiographic angular classification. Conclusion We obtained excellent agreement among observers when considering physical examination, podoscopy, and baropodometry for the diagnosis of the footprint type among runners. However, when comparing the results obtained with the radiographic measurements, the agreement for the diagnosis of footprint type was low.

ABSTRACT Objectives: to analyze the incidence of occupational accidents in Brazil, recorded by Social Security according to the geographic regions, age group, gender and their prevalence according to the causes and branch of economic activity. Methods: ecological descriptive study with time series analysis from 2008 to 2014. Data on the beginning and end of the historical series were compared in each ecological unit studied. Results: the South and Southeast regions, male, between 20 and 49 years of age presented the highest falls in incidence. 70.87% of the causes occurred in group XIX of ICD-10. The economic activity with the highest prevalence of accidents was the manufacturing industry. Conclusions: accidents at work have decreased in Brazil, however, the incidence is still high. Advances need to be made in the recording of accidents and in the prevention and surveillance of workers’ health.

RESUMEN Objetivos: analizar la incidencia de los accidentes de trabajo en Brasil, registrados por la Seguro Social, según las regiones geográficas, grupo de edad, sexo y su prevalencia de acuerdo con las causas y rama de actividad económica. Métodos: estudio descriptivo ecológico con análisis de serie temporal en el período de 2008 a 2014. Los datos del inicio y del final de la serie histórica se compararon en cada unidad ecológica estudiada. Resultados: las regiones Sur y Sudeste, el sexo masculino, el grupo de edad entre 20 y 49 años presentaron las mayores caídas de las incidencias. El 70,87% de las causas ocurrieron en el grupo XIX de la CID-10. La actividad económica con mayor prevalencia de accidentes fue la industria de transformación. Conclusiones: los accidentes de trabajo disminuyeron en Brasil, sin embargo, la incidencia aún es alta. Se necesitan avances en el registro de los accidentes y en las acciones de prevención y de vigilancia a la salud del trabajador.

RESUMO Objetivos: analisar a incidência dos acidentes de trabalho no Brasil registrados pela Previdência Social, segundo as regiões geográficas, faixa etária, sexo e sua prevalência, de acordo com as causas e o ramo de atividade econômica. Métodos: estudo descritivo ecológico, com análise de série temporal no período de 2008 a 2014. Os dados do início e do final da série histórica foram comparados em cada unidade ecológica estudada. Resultados: as regiões Sul e Sudeste, o sexo masculino, a faixa etária entre 20 e 49 anos apresentaram as maiores quedas das incidências. 70,87% das causas ocorreram no grupo XIX da CID-10. A atividade econômica com maior prevalência de acidentes foi a indústria de transformação. Conclusões: os acidentes de trabalho diminuíram no Brasil, mas sua incidência ainda é alta. São necessários avanços no registro dos acidentes e nas ações de prevenção e vigilância à saúde do trabalhador.

RESUMO Objetivos: analisar a incidência dos acidentes de trabalho no Brasil registrados pela Previdência Social, segundo as regiões geográficas, faixa etária, sexo e sua prevalência, de acordo com as causas e o ramo de atividade econômica. Métodos: estudo descritivo ecológico, com análise de série temporal no período de 2008 a 2014. Os dados do início e do final da série histórica foram comparados em cada unidade ecológica estudada. Resultados: as regiões Sul e Sudeste, o sexo masculino, a faixa etária entre 20 e 49 anos apresentaram as maiores quedas das incidências. 70,87% das causas ocorreram no grupo XIX da CID-10. A atividade econômica com maior prevalência de acidentes foi a indústria de transformação. Conclusões: os acidentes de trabalho diminuíram no Brasil, mas sua incidência ainda é alta. São necessários avanços no registro dos acidentes e nas ações de prevenção e vigilância à saúde do trabalhador.

ABSTRACT Objectives: to analyze the incidence of occupational accidents in Brazil, recorded by Social Security according to the geographic regions, age group, gender and their prevalence according to the causes and branch of economic activity. Methods: ecological descriptive study with time series analysis from 2008 to 2014. Data on the beginning and end of the historical series were compared in each ecological unit studied. Results: the South and Southeast regions, male, between 20 and 49 years of age presented the highest falls in incidence. 70.87% of the causes occurred in group XIX of ICD-10. The economic activity with the highest prevalence of accidents was the manufacturing industry. Conclusions: accidents at work have decreased in Brazil, however, the incidence is still high. Advances need to be made in the recording of accidents and in the prevention and surveillance of workers’ health.

RESUMEN Objetivos: analizar la incidencia de los accidentes de trabajo en Brasil, registrados por la Seguro Social, según las regiones geográficas, grupo de edad, sexo y su prevalencia de acuerdo con las causas y rama de actividad económica. Métodos: estudio descriptivo ecológico con análisis de serie temporal en el período de 2008 a 2014. Los datos del inicio y del final de la serie histórica se compararon en cada unidad ecológica estudiada. Resultados: las regiones Sur y Sudeste, el sexo masculino, el grupo de edad entre 20 y 49 años presentaron las mayores caídas de las incidencias. El 70,87% de las causas ocurrieron en el grupo XIX de la CID-10. La actividad económica con mayor prevalencia de accidentes fue la industria de transformación. Conclusiones: los accidentes de trabajo disminuyeron en Brasil, sin embargo, la incidencia aún es alta. Se necesitan avances en el registro de los accidentes y en las acciones de prevención y de vigilancia a la salud del trabajador.

The present study aimed to review literature on studies of dengue cases conducted over 30 years in the state of Ceará. Between November 2015 and January 2016, articles published in Portuguese and English in 7 databases were searched using keywords and a Boolean operator. A total of 191 articles were identified in the databases; 133 were excluded according to the exclusion criteria, and 58 were included in the study. Of the 58 articles analyzed, 6 reported data from Brazil; including the Northeast region and the state of Ceará; 41 reported data for only the city of Fortaleza; 7 reported data for the state of Ceará; 4 reported data for cities in the interior of the state; and 3 included only children. The studies adopted different approaches and focused on different aspects of the disease. Study outcomes included the identification of serological, epidemiological, clinical, and laboratory characteristics; potential larvicides and biological predators of mosquitoes; potential antiviral agents; vector density characteristics; and educational dengue prevention and control strategies. Additionally, one vaccine trial was included. Although studies on dengue in the state of Ceará are scarce, they are encompassing, including several lines of research, and the number of studies and reports on dengue in the state of Ceará continues to increase.

Resumo Objetivo: descrever a experiência e os resultados preliminares do Comitê de Investigação de Óbitos por Arboviroses no Ceará, Brasil, em 2017. Métodos: o Comitê investiga e discute todos os casos suspeitos de óbitos por arboviroses notificados pela vigilância epidemiológica. Resultados: foram notificados 443 óbitos suspeitos de arboviroses e 220 (49,7%) foram confirmados; destes, 88,2% por chikungunya e 11,8% por dengue; a mediana de idade dos óbitos por chikungunya foi mais elevada, quando comparada à da dengue (77 versus 56 anos), e o tempo de evolução até o óbito também foi mais prolongado, quando comparado ao da dengue (38 versus 12 dias); para o encerramento dos casos, a mediana foi de 54,5 dias; em 2017, o Ceará confirmou 80,4% dos óbitos por chikungunya no Brasil. Conclusão: a análise dos óbitos mostrou que o CHIKV foi o responsável pela maior parte dos óbitos por arboviroses no estado do Ceará, em 2017.

Abstract Objective: to describe the experience and preliminary results of the Arbovirus Death Investigation Committee in Ceará, Brazil, in 2017. Methods: the Committee investigates and discusses all suspected cases of arbovirus deaths reported by the epidemiological surveillance service. Results: a total of 443 suspected arbovirus deaths were reported, 220 (49.7%) of which were confirmed; of these, 88.2% were from chikungunya and 11.8% from dengue; the median age of chikungunya deaths was higher when compared to dengue (77 versus 56 years) and the time until death was also longer when compared to dengue (38 versus 12 days); median time for case closure was 54.5 days; in 2017, Ceará confirmed 80.4% of Brazilian chikungunya deaths. Conclusion: the investigation of deaths showed that CHIK viruses were responsible for the majority of arboviral deaths in the state of Ceará, in 2017.

Resumen Objetivo: describir la experiencia y los resultados preliminares del Comité de Investigación de Óbitos por Arbovirus desarrollada en Ceará, Brasil, en 2017. Métodos: el comité discute los casos sospechosos de muertes por arbovirus notificados por la vigilancia epidemiológica. Resultados: se notificaron 443 óbitos sospechosos y 220 (49,7%) fueron confirmados; de estos, 88,2% por chikungunya y 11,8% por dengue; el promedio de edad de los fallecimientos por chikungunya fue más elevado (77 versus 56 años) y el tiempo de evolución hasta el óbito más prolongado, en comparación con el dengue (38 versus 12 días); para el cierre de los casos el promedio fue de 54,5 días; en 2017, Ceará confirmó 80,4% de las muertes por chikungunya en Brasil. Conclusión: El análisis de muertes mostró que CHIKV fue responsable de la mayoría de las muertes por arbovirus en el estado de Ceará, en 2017.

Resumo Objetivo: descrever a experiência e os resultados preliminares do Comitê de Investigação de Óbitos por Arboviroses no Ceará, Brasil, em 2017. Métodos: o Comitê investiga e discute todos os casos suspeitos de óbitos por arboviroses notificados pela vigilância epidemiológica. Resultados: foram notificados 443 óbitos suspeitos de arboviroses e 220 (49,7%) foram confirmados; destes, 88,2% por chikungunya e 11,8% por dengue; a mediana de idade dos óbitos por chikungunya foi mais elevada, quando comparada à da dengue (77 versus 56 anos), e o tempo de evolução até o óbito também foi mais prolongado, quando comparado ao da dengue (38 versus 12 dias); para o encerramento dos casos, a mediana foi de 54,5 dias; em 2017, o Ceará confirmou 80,4% dos óbitos por chikungunya no Brasil. Conclusão: a análise dos óbitos mostrou que o CHIKV foi o responsável pela maior parte dos óbitos por arboviroses no estado do Ceará, em 2017.

Abstract Objective: to describe the experience and preliminary results of the Arbovirus Death Investigation Committee in Ceará, Brazil, in 2017. Methods: the Committee investigates and discusses all suspected cases of arbovirus deaths reported by the epidemiological surveillance service. Results: a total of 443 suspected arbovirus deaths were reported, 220 (49.7%) of which were confirmed; of these, 88.2% were from chikungunya and 11.8% from dengue; the median age of chikungunya deaths was higher when compared to dengue (77 versus 56 years) and the time until death was also longer when compared to dengue (38 versus 12 days); median time for case closure was 54.5 days; in 2017, Ceará confirmed 80.4% of Brazilian chikungunya deaths. Conclusion: the investigation of deaths showed that CHIK viruses were responsible for the majority of arboviral deaths in the state of Ceará, in 2017.

Resumen Objetivo: describir la experiencia y los resultados preliminares del Comité de Investigación de Óbitos por Arbovirus desarrollada en Ceará, Brasil, en 2017. Métodos: el comité discute los casos sospechosos de muertes por arbovirus notificados por la vigilancia epidemiológica. Resultados: se notificaron 443 óbitos sospechosos y 220 (49,7%) fueron confirmados; de estos, 88,2% por chikungunya y 11,8% por dengue; el promedio de edad de los fallecimientos por chikungunya fue más elevado (77 versus 56 años) y el tiempo de evolución hasta el óbito más prolongado, en comparación con el dengue (38 versus 12 días); para el cierre de los casos el promedio fue de 54,5 días; en 2017, Ceará confirmó 80,4% de las muertes por chikungunya en Brasil. Conclusión: El análisis de muertes mostró que CHIKV fue responsable de la mayoría de las muertes por arbovirus en el estado de Ceará, en 2017.

RESUMO INTRODUÇÃO E OBJETIVO A aterosclerose cerebral é a principal causa de lesões que contribuem para o comprometimento cognitivo vascular (CCV) e demência vascular, seguida da arteriosclerose de pequenos vasos e da angiopatia amiloide cerebral. Sendo assim, este estudo comparou as alterações radiológicas post mortem de adultos autopsiados com as alterações macroscópicas na região posterior desses encéfalos a fim de estabelecer uma relação entre as duas formas de análise e discutir sobre a relevância da prevenção do CCV em pacientes com aterosclerose encefálica. MATERIAL E MÉTODOS Treze encéfalos foram analisados macroscopicamente para avaliar o grau de aterosclerose das artérias basilar e cerebral posterior. Os pacientes foram autopsiados na disciplina de Patologia Geral no HC-UFTM em Uberaba, Minas Gerais, Brasil. A análise qualitativa da aterosclerose foi realizada com as classificações discreta, moderada ou acentuada. A espessura dos giros e a largura dos sulcos na região posterior dos encéfalos foram analisadas macroscopicamente e por tomografia computadorizada. RESULTADOS E CONCLUSÃO Houve diminuição na largura do sulco calcarino e aumento na espessura do giro occipital temporal medial de acordo com o aumento do grau de aterosclerose macroscopicamente e por tomografia, respectivamente. A baixa oxigenação causada pela aterosclerose provoca a inflamação do parênquima encefálico, provavelmente levando à hipertrofia das células da micróglia e ao consequente aumento dos giros e estreitamento dos sulcos, como observado no presente estudo.

SUMMARY BACKGROUND AND PURPOSE Cerebral atherosclerosis is the main cause of lesions that contribute to vascular cognitive impairment and vascular dementia, followed by arteriosclerosis of small vessels and cerebral amyloid angiopathy. The purpose of this study was to compare the post-mortem radiological alterations of autopsied adults with the macroscopic alterations in the posterior region of these brains in order to establish a relationship between the two forms of analysis and to discuss the relevance of the prevention of vascular cognitive impairment in patients with encephalic atherosclerosis. MATERIALS AND METHODS Thirteen brains were analysed macroscopically to assess the degree of atherosclerosis of the basilar and the posterior cerebral arteries. The patients were autopsied in the Subject of General Pathology at General Hospital of Triângulo Mineiro Federal University in Uberaba, state of Minas Gerais, Brazil. The qualitative analysis of atherosclerosis was performed with classification into mild, moderate or severe. In the posterior region of the brains, width of sulcus and thickness of gyrus were measured by macroscopic analysis and by tomographic analysis. RESULTS AND CONCLUSIONS There was a decrease in calcarine sulcus width and an increase in medial temporal occipital gyrus thickness in patients with a higher degree of atherosclerosis, macroscopically and in tomography, respectively. Low oxygenation caused by atherosclerosis probably leads to an encephalic parenchyma inflammation that causes microglial cells hypertrophy provoking increase in the gyrus thickness and decrease in the sulcus width, as observed in the present study.

BACKGROUND The first dengue cases in Brazil with laboratory confirmation occurred in the northern region of the country, with the isolation of two serotypes, dengue virus 1 (DENV-1) and DENV-4. In Ceará, the introduction of DENV-4 was reported during a DENV-1 epidemic in 2011, with only two isolations. OBJECTIVES The aim of this study was to characterise the first DENV-4 epidemic in the state of Ceará, Brazil. METHODS The study population was composed of patients with suspected dengue that were reported to health care units from January to December 2012. The laboratory confirmation of infection was made by viral isolation, reverse transcription polymerase chain reaction (RT-PCR), AgNS1, immunohistochemistry and IgM enzyme-linked immunosorbent assay (ELISA). MAIN CONCLUSIONS In the study year, 72,211 suspected dengue cases were reported and 51,865 of these cases (71.8%) were confirmed to be positive. Co-circulation of three serotypes, DENV-1, DENV-3 and DENV-4, was detected with a predominance of DENV-4 (95.3%). Most cases were not severe, but there were 44 fatal outcomes. DENV-4 Genotype II was identified for the first time in Ceará.

Resumo Introdução: O alcoolismo é um grande problema de saúde pública, de elevado custo social e que afeta vários aspectos da atividade humana. Hepatopatia é uma das primeiras consequências do abuso de álcool, podendo ocorrer esteatose, cirrose hepática e hepatite. Outros órgãos, porém, também são afetados, ocorrendo alterações patológicas, como pancreatite, cardiomiopatias, dislipidemias e aterosclerose. Objetivo: Identificar a ocorrência e a intensidade de aterosclerose em alcoolistas com cirrose hepática, observando alterações macro e microscópicas do depósito lipídico e de fibras colágenas e fígado. Verificar a associação de depósito lipídico e de fibras colágenas com gênero, idade e índice de massa corporal (IMC). Relacionar alcoolismo, cirrose hepática e aterosclerose. Método: Foi realizado estudo com base em laudos de autópsias de pacientes com cirrose hepática alcoólica, sendo estudados aortas e fígados para verificar a ocorrência e a intensidade de aterosclerose, bem como a quantidade de colágeno encontrada. Resultados: A aterosclerose microscópica foi maior em jovens (lesão inicial) e em pacientes com cirrose hepática alcoólica. A análise macroscópica da aterosclerose nas aortas mostrou que pacientes com faixas etárias mais avançadas apresentaram classificações mais intensas. A aterosclerose, tanto micro quanto macroscopicamente, e a porcentagem de fibrose no fígado e na aorta foram mais expressivas no gênero feminino. Conclusão: Os pacientes cirróticos apresentaram maior porcentagem de fibrose e lipidose, e podem representar um grupo susceptível à acelerada progressão de doenças cardiovasculares. Estudos investigativos contribuem para o direcionamento das intervenções promotoras da saúde, reduzindo a mortalidade e os custos no tratamento das doenças cardiovasculares.

Summary Introduction: Alcoholism is a major public health problem, which has a high social cost and affects many aspects of human activity. Liver disease is one of the first consequences of alcohol abuse, and steatosis, liver cirrhosis and hepatitis may occur. Other organs are also affected with pathological changes, such as pancreatitis, cardiomyopathies, dyslipidemias and atherosclerosis. Objective: To identify the occurrence and degree of atherosclerosis in alcohol-dependent individuals with liver cirrhosis, observing macroscopic and microscopic changes in lipid and collagen deposits and in the liver. We also aimed to verify the association of lipid and collagen fiber deposits with gender, age and body mass index, and to relate alcoholism, liver cirrhosis and atherosclerosis. Method: We performed a study based on autopsy reports of patients with alcoholic liver cirrhosis, with analysis of aorta and liver fragments to verify the occurrence and degree of atherosclerosis, as well as collagen contents. Results: Microscopic atherosclerosis was higher in young subjects (early injury) and in patients with alcoholic liver cirrhosis. The macroscopic analysis of atherosclerosis in aortas showed that patients in more advanced age groups presented more severe classifications. Atherosclerosis, both micro and macroscopically, and the percentage of fibrosis in the liver and aorta were more expressive in females. Conclusion: Cirrhotic patients presented a higher percentage of fibrosis and lipidosis, and may represent a group susceptible to the accelerated progression of cardiovascular diseases. Investigative studies contribute to targeting health-promoting interventions, reducing the mortality and costs of treating cardiovascular disease.

Abstract We report on four patients with fatal influenza A(H1N1)pdm09 and dengue virus coinfections. Clinical, necropsy and histopathologic findings presented in all cases were characteristic of influenza-dengue coinfections, and all were laboratory-confirmed for both infections. The possibility of influenza and dengue coinfection should be considered in locations where these two viruses’ epidemic periods coincide to avoid fatal outcomes. Dengue is a mosquito-borne viral infection caused by one of the four dengue viruses (DENV-1 to 4). Each of these viruses is capable of causing nonspecific febrile illnesses, classic dengue fever and dengue haemorrhagic fever (Gubler 1998). As a result, dengue is often difficult to diagnose clinically, especially because peak dengue season often coincides with that of other common febrile illnesses in tropical regions (Chacon et al. 2015). In April 2009, a new virus, influenza A/H1N1/pandemic (FluA/H1N1/09pdm), caused a severe outbreak in Mexico. The virus quickly spread throughout the world, and in June 2009, the World Health Organization declared a pandemic (WHO 2010). In Brazil, the first laboratory confirmed case of FluA/H1N1/09pdm was in July 2009 (Pires Neto et al. 2013). The state of Ceará, in Northeast Brazil, is a dengue endemic area. In this state, the virus influenza A(H1N1)pdm09 has circulated since 2009, and through the first half of 2012, 11 deaths caused by the virus were confirmed (Pires Neto et al. 2013). The influenza and dengue seasons in Ceará overlap, which led to diagnostic difficulties. We report four cases of laboratory-confirmed coinfection of deadly influenza A(H1N1)pdm09 with DENV, which occurred during the dengue and influenza season in 2012 and 2013 in Ceará.

RESUMO A doença de Chagas é causada pelo Trypanosoma cruzi e atinge cerca de dois a três milhões de pessoas no Brasil, permanecendo como importante problema de saúde pública. Foi realizado um estudo em área rural do município de Limoeiro do Norte - CE, nordeste do Brasil, com o objetivo de conhecer a prevalência da infecção chagásica. Foram examinados 52% dos habitantes, dentre os quais 2,6% (4/154) apresentaram sorologia reagente em pelo menos dois testes sorológicos. Todos os positivos tinham idade superior a 50 anos, eram agricultores, com baixa escolaridade e renda familiar inferior a três salários mínimos. A busca ativa pode ser uma alternativa para o diagnóstico precoce dessa doença.

SUMMARY Chagas disease is caused by Trypanosoma cruzi and affects about two to three million people in Brazil, still figuring as an important public health problem. A study was conducted in a rural area of the municipality of Limoeiro do Norte - CE, northeastern Brazil, aiming to determine the prevalence of T. cruzi infection. Of the inhabitants, 52% were examined, among whom 2.6% (4/154) were seropositive in at least two serological tests. All seropositive individuals were older than 50 years, farmers, with a low education and a family income of less than three minimum wages. Active surveillance may be an alternative for early detection of this disease.

The role played by different mammal species in the maintenance of Trypanosoma cruzi is not constant and varies in time and place. This study aimed to characterise the importance of domestic, wild and peridomestic hosts in the transmission of T. cruzi in Tauá, state of Ceará, Caatinga area, Brazil, with an emphasis on those environments colonised by Triatoma brasiliensis. Direct parasitological examinations were performed on insects and mammals, serologic tests were performed on household and outdoor mammals and multiplex polymerase chain reaction was used on wild mammals. Cytochrome b was used as a food source for wild insects. The serum prevalence in dogs was 38% (20/53), while in pigs it was 6% (2/34). The percentages of the most abundantly infected wild animals were as follows: Thrichomys laurentius 74% (83/112) and Kerodon rupestris 10% (11/112). Of the 749 triatomines collected in the household research, 49.3% (369/749) were positive for T. brasiliensis, while 6.8% were infected with T. cruzi (25/369). In captured animals, T. brasiliensis shares a natural environment with T. laurentius, K. rupestris, Didelphis albiventris, Monodelphis domestica, Galea spixii, Wiedomys pyrrhorhinos, Conepatus semistriatus and Mus musculus. In animals identified via their food source, T. brasiliensis shares a natural environment with G. spixii, K. rupestris, Capra hircus, Gallus gallus, Tropidurus oreadicus and Tupinambis merianae. The high prevalence of T. cruzi in household and peridomiciliar animals reinforces the narrow relationship between the enzootic cycle and humans in environments with T. brasiliensis and characterises it as ubiquitous.

Clinical trial registries are one of the main sources of information concerning health research interventions that have been or are being carried out throughout the world. The World Health Organization (WHO) established a minimum data set to be recorded (20 items), which was agreed upon internationally with the stakeholders, and established a network of primary and associated records. In addition to the register ClinicalTrial.Gov (of the United States of America), there are currently two primary registries in the Americas (from Brazil and Cuba) that meet WHO requirements and provide data to WHO’s International Clinical Trials Registry Platform (ICTRP). Furthermore, there are important advances in the region related to the regulations, development and implementation of national registries and to the support of the ethics committees and editors to this initiative.

Los registros de ensayos clínicos (EC) constituyen una de las mayores fuentes de información de investigaciones en intervenciones en salud que se han o se están llevando a cabo en el mundo. La Organización Mundial de la Salud estableció un conjunto mínimo de datos que se deben registrar (20 ítems), consensuado a nivel internacional con las partes interesadas, y estableció una red de registros primarios y de registros asociados. Existen actualmente dos registros primarios en las Américas (Brasil y Cuba) avalados por la OMS, además del registro ClinicalTrial.Gov (de los Estados Unidos de Norteamérica) que aportan datos a la plataforma internacional de registros de EC de la OMS (ICTRP). Adicionalmente, hay avances importantes en la región relacionados con las regulaciones, el desarrollo e implementación de registros nacionales y la adhesión de comités de ética y editores a la iniciativa.

Clinical trial registries are one of the main sources of information concerning health research interventions that have been or are being carried out throughout the world. The World Health Organization (WHO) established a minimum data set to be recorded (20 items), which was agreed upon internationally with the stakeholders, and established a network of primary and associated records. In addition to the register ClinicalTrial.Gov (of the United States of America), there are currently two primary registries in the Americas (from Brazil and Cuba) that meet WHO requirements and provide data to WHO’s International Clinical Trials Registry Platform (ICTRP). Furthermore, there are important advances in the region related to the regulations, development and implementation of national registries and to the support of the ethics committees and editors to this initiative

Los registros de ensayos clínicos (EC) constituyen una de las mayores fuentes de información de investigaciones en intervenciones en salud que se han o se están llevando a cabo en el mundo. La Organización Mundial de la Salud estableció un conjunto mínimo de datos que se deben registrar (20 ítems), consensuado a nivel internacional con las partes interesadas, y estableció una red de registros primarios y de registros asociados. Existen actualmente dos registros primarios en las Américas (Brasil y Cuba) avalados por la OMS, además del registro ClinicalTrial.Gov (de los Estados Unidos de Norteamérica) que aportan datos a la plataforma internacional de registros de EC de la OMS (ICTRP). Adicionalmente, hay avances importantes en la región relacionados con las regulaciones, el desarrollo e implementación de registros nacionales y la adhesión de comités de ética y editores a la iniciativa