ABSTRACT Background: Leprosy is a neglected chronic infection caused by Mycobacterium leprae, that is curable. The magnitude of the disease and severity of the debilitation it causes renders leprosy a public health problem. This study aimed to analyze the endemic profile of leprosy in the Murrupula district and evaluate the socioeconomic, clinical, and serological profiles of leprosy contacts. Methods: A cross-sectional study of patients with leprosy diagnosed between 2013 and 2017 and their household and community contacts was conducted in Murrupula District, Nampula Province, Mozambique. Interviews, simplified dermatoneurological examinations, Mycobacterium leprae flow (ML Flow) tests, and Mitsuda tests were performed. Results: Most of the leprosy cases were multibacillary. The patients had some degree of physical disability. ML Flow positivity was more common in household contacts of the patients diagnosed with leprosy and in community individuals who spontaneously presented for testing. In total, 17 patients were diagnosed with leprosy. Conclusions: This study revealed an active chain of transmission, hidden prevalence, and operational deficiencies in leprosy surveillance and care. The results suggest that the implementation of a public health policy for leprosy prevention and control in Nampula Province is necessary. In future, the possibility of expanding the policy to the entire country should be considered. Background curable problem socioeconomic clinical Methods crosssectional cross sectional 201 District Mozambique Interviews examinations performed Results multibacillary disability testing total 1 Conclusions transmission prevalence care necessary future considered 20 2

ABSTRACT Chagas disease (CD) is a neglected tropical disease associated with poverty in which patients are surrounded by stigma. These factors can contribute to reducing health-related quality of life (HRQoL). Therefore, a broad discussion of HRQoL in the CD population is required. This study aimed to discuss the main findings of HRQoL in patients with CD, focusing on the association between sociodemographic and lifestyle factors, echocardiographic and functional determinants, and the effect of non-invasive interventions on HRQoL. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed with no data or language restrictions. Twenty-two articles were included in this meta-analysis. In general, HRQoL is worse in patients with CD than in healthy individuals, particularly in the presence of cardiovascular and/or gastrointestinal symptoms. Sex, age, functional class, level of physical activity, healthy habits, and medications received could affect HRQoL. Among the echocardiographic and functional determinants, decreased systolic function seems to negatively affect HRQoL. No association with the peak oxygen uptake was observed in the maximal tests. By contrast, well-tolerated field tests with submaximal intensities were associated with HRQoL. Both pharmaceutical care and exercise training have a positive effect on the HRQoL of patients with Chagas cardiomyopathy, and the mental component can be a prognostic marker in this population. In conclusion, assessment of HRQoL can provide important information about the health status of patients with CD, and its use in clinical practice is warranted.

ABSTRACT Chronic Chagas Cardiomyopathy (CCC) is the most prevalent type of myocarditis and the main clinical form of the Chagas disease, which has peculiarities such as focal inflammation, structural derangement, hypertrophy, dilation, and intense reparative fibrosis. Many cellular compounds contribute to CCC development. Galectin-3 is a partaker in inflammation and contributes to myocardial fibrosis formation. Some studies showed the connection between Galectin-3 and fibrosis in Chagas disease but are still inconclusive on the guidance for the early implementation of pharmacological therapy. This systematic review evaluated Galectin-3 as a biomarker for fibrosis intensity in CCC. Two independent reviewers have searched five databases (PubMed, EMBASE, Cochrane Library, Scopus, and Lilacs), using the following search terms: galectin-3, biomarkers, fibrosis, Chagas cardiomyopathy, and Chagas disease. Overall, seven studies met the inclusion criteria and made up this review. There were four trials conducted through animal model experiments and three trials with humans. Experimental data in mice indicate an association between Galectin-3 expression and fibrosis in CCC (75% of studies). Data from human studies showed no direct connection between myocardial fibrosis and Galectin-3 expression (80% of studies). Thus, human findings do not provide significant evidence indicating that Galectin-3 is related to fibrosis formation in Chagas disease. Based on the analyzed studies, it is suggested that Galectin-3 might not be a good fibrosis marker in CCC.

ABSTRACT The Mitsuda test is a skin test based on the individual’s immune response through late and highly specific hypersensitivity reaction to the Mycobacterium leprae bacillus. A negative reaction identifies individuals who present a higher risk of becoming ill if exposed to M. leprae and, if they become ill, to develop the virchowian form of disease. The Mitsuda test reading is performed by means of a millimeter ruler. The dermatoscopy is a method that has not been used in the evaluation of cutaneous tests, although its use has increased in several areas. The study aimed to compare the results between the standardized reading and the total area of the Mitsuda test obtained by a computerized method which was structured by the association of digital dermatoscopy, the Dermatology Web system and the Image Tool 3.0 software. Data collection was performed at the Dermatology Outpatient Clinic of the Eduardo de Menezes Hospital, in Belo Horizonte, from November 2015 to August 2016. The sample consisted of 100 leprosy domiciliary contacts. There was an excellent agreement between the Mitsuda test (diameter and area), with a coefficient greater than 80%, and an excellent correlation with the Spearman’s correlation coefficient (0.936). The intraclass correlation coefficient indicated a low (0.219) but significant agreement between the two measurements. In conclusion, there is a significant correlation between the standardized reading and the total area of the Mitsuda test. Digital dermoscopy can be an alternative instrument of evaluation, allowing the computerization and recording of the Mitsuda test.

Abstract Reduced peak oxygen uptake (VO2peak) is a common clinical finding in progressive Chagas disease. However, the disease stage in which functional impairment is detectable remains uncertain. The present study compared functional capacity between healthy controls and patients with different clinical forms of Chagas disease. A systematic review and meta-analysis (PROSPERO database CRD42017058353) was conducted following a search of the MEDLINE, Web of Science, CINAHL, and LILACS databases from September to December 2017 for articles published in English, Spanish, or Portuguese, with no date restrictions. We included studies that compared the VO2peak between healthy and Chagas disease patients, stratified according to 3 clinical forms [no apparent cardiac disease, non-dilated Chagas heart disease (CHD), and dilated CHD]. Seven cross-sectional studies were included. Chagas disease patients without apparent cardiac disease (n=208) had VO2peak values [mean difference, -1.55ml/kg/min; 95% confidence interval (CI), -4.98ml/kg/min to 1.88ml/kg/min] similar to those of healthy controls (n=105; p=0.38, I2=52%). In non-dilated CHD (n=159), VO2peak was 8.71ml/kg/min lower (95% CI, -13.99 to -3.42ml/kg/min) than in healthy controls (n=59; p=0.001, I2=75%). VO2peak was also significantly lower (mean difference, -9.30ml/kg/min; 95% CI, -11.34 to -7.25ml/kg/min) in dilated CHD patients (n=131) than in healthy controls (n=53; p<0.001, I2=0%). Exercise capacity in Chagas disease patients without apparent cardiac disease is similar to that in healthy controls. Functional impairment in Chagas disease is detectable in the early stages of cardiac involvement, even in the absence of systolic dysfunction and signs of heart failure.

BACKGROUND Serum brain-derived neurotrophic factor (BDNF) levels have been shown to be lower in patients with Chagas cardiomyopathy (ChC) than in patients with non-dilated chagasic cardiomyopathy. However, its prognostic value was not established in patients with ChC. METHODS Forty-nine patients with ChC (50 ± 7 years, New York Heart Association “NYHA” I-III); were evaluated by echocardiography, exercise testing, and blood analysis. Serum BDNF levels were determined using enzyme-linked immunosorbent assay sandwich. Patients were followed-up, and cardiac death was considered the end-point. The survival analyses were performed using Kaplan-Meier and Cox regression. RESULTS After 39 ± 14 months of follow-up, 12 patients (25%) died. The concentration of 2.5 ng/mL was the optimal cut-off value to predict survival with significant difference between the groups with low (≤ 2.5 ng/mL) and high (> 2.5 ng/mL) BDNF levels (p = 0.006). Lower serum BDNF levels (hazards ratio (HR) 1.1, 95% confidence interval (CI) 1.1-1.4; p = 0.001), peak oxygen uptake (HR 1.2, 95% CI 1.0-1.3; p = 0.009), and left ventricular ejection fraction (HR 0.8, 95% CI 0.7-0.9; p = 0.001) were the independent predictors of survival. The combination of low serum BDNF levels and reduced left ventricular ejection fraction were highly predictive of death (HR 5.6, 95% CI: 1.2-9.7; p = 0.026). CONCLUSION In patients with ChC, reduced serum BDNF levels, especially if associated with systolic function, may provide useful prognostic information.

The search for important current themes is a challenge to be overcame in the scientific researches accomplishment. For being a complex subject and it suffers interferences of several factors, the quality of life (QoL) becomes a great interest theme for the health's area. We aimed to analyze the scientific production in the health area about "quality of life" between 2000 and 2005. The bibliographical research felt with national brazilian newspapers QUALIS/CAPES "A" or international "C" or "B", available in Scientific Electronic Library Online (SCIELO). 82 articles were analyzed, and 26 (32%) were published in 2005. The more extensively researched areas of the health had been the Medicine (31 articles) and Nursing (23 articles). The quantitative methodological approach was used in 51 articles (62%) and more of the half of the total (45 articles) didn't make to a quality of life concept relating with chronic diseases. About the use of instruments for QoL avaliation, they had deserved prominence "Short Form Health Survey" and others of the World Organization of Health. Although widely spread out, the quality of life continues a complex term, for the subjective and dynamic characteristics, and for the suffered influence for intrinsic and extrinsic factors to the individual, requesting larger studies.

La búsqueda de temas importantes y actual es un desafío para ser superado en el logro de investigaciones científicas. Por ser un asunto complejo y que sufre interferencias de varios factores, la calidad de vida (CV) se vuelve miedos de gran interés por el área de la salud. Nosotros objectivamos analizar la producción científica en el área de la salud sobre "calidad de vida" entre 2000 y 2005. La investigación bibliográfica se sentía con los periódicos brasileños QUALIS/CAPES nacional "A" o internacional "C" o "B", disponible en Scientific Electronic Library Online (SCIELO). Se habían analizado 82 artículos, siendo 26 (32%) publicó en 2005. Las áreas de la salud más extensivamente investigadas habían sido la Medicina (31 artículos) y Enfermería (23 artículos). El acercamiento metodológico cuantitativo se usó en 51 artículos (62%) y más de la mitad del total (45 artículos) no se hizo a un concepto de calidad de vida, mientras relacionando con las enfermedades crónicas. Sobre el uso de instrumentos para el avaliación de CV, habían merecido la prominencia "Short Form Health Survey" y otros de la Organización Mundial de Salud. Aunque ampliamente el cobertor fuera, la calidad de vida continúa un término complejo, por las características subjetivas y dinámicas, y pela influencia sufrida por los factores intrínsecos y extrínsecos al individuo, pidiendo los estudios más grandes.

A busca por temas relevantes e atuais é um desafio a ser superado na realização de pesquisas científicas. Por ser um assunto complexo e que sofre interferências de vários fatores, a qualidade de vida (QV) torna-se tema de grande interesse para a área da saúde. Objetivamos analisar a produção científica na área da saúde sobre "qualidade de vida", entre 2000 e 2005. A pesquisa bibliográfica se deu com periódicos brasileiros QUALIS/CAPES nacionais "A" ou internacionais "C" ou "B", disponíveis na Scientific Electronic Library Online (SCIELO). Foram analisados 82 artigos, sendo 26 (32%) publicados em 2005. As áreas da saúde que mais pesquisaram a temática foram a Medicina (31 artigos) e a Enfermagem (23 artigos). A abordagem metodológica quantitativa foi utilizada em 51 artigos (62%) e mais da metade do total (45 artigos) não fez referência a um conceito de qualidade de vida, relacionando-a com doenças crônicas. Sobre a utilização de instrumentos avaliativos da QV, destacaram-se o Short Form Health Survey e outros próprios da Organização Mundial da Saúde. Apesar de amplamente difundida, a qualidade de vida ainda é um termo complexo, pelas características subjetivas e dinâmicas, e pela influência sofrida por fatores intrínsecos e extrínsecos ao indivíduo, requisitando maiores estudos.

OBJETIVO: Avaliar a qualidade da certificação médica dos óbitos de mulheres de 10 a 49 anos na região Sul do Município de São Paulo. MÉTODOS: Utilizou-se a metodologia Puffer para investigar as causas de óbito de todas as mulheres de 10 a 49 anos residentes na região e falecidas no ano de 1989 (num total de 664 óbitos). Foram comparadas as causas de morte relatadas nos atestados de óbitos originais com as refeitas. Calculou-se o grau de sensibilidade das causas e o índice de kappa. RESULTADOS: Obteve-se alta sensibilidade entre as declarações de óbito originais e corrigidas nos grupos de causas (CID-9) das "Doenças do Aparelho Circulatório" (91,9%), "Neoplasias" (89,7%) e "Causas Externas" (84,1%). Houve outros com sensibilidades muito baixas. Desses, chama a atenção o capítulo "Transtornos Mentais" (34,3%) que, de 11, passa a ter 32 óbitos em que, na maioria dos casos, não havia sido feito o diagnóstico de alcoolismo. Também o capítulo "Complicações da Gravidez, Parto e Puerpério" apresentou uma sensibilidade baixa (44,9%). O índice de kappa foi de 0,63, o que indica uma concordância total regular. DISCUSSÃO: Ainda é insatisfatória a qualidade da certificação médica dos óbitos na área estudada. Essa má qualidade pode afetar negativamente as propostas de intervenção, tornando pouco visíveis problemas tão sérios para a atenção à saúde da mulher.

OBJECTIVE: To evaluate the quality of the medical certification of deaths of 10-49 year-old women, resident in the Southern region of the city of S. Paulo METHODS: The Puffer methodology was utilized to investigate the causes of death of all 10-49 year-old women, resident in the region, and deceased in the year 1989 (664 deaths in the total). The main causes of death in the original death certificates and the "new" causes of death arisen from the research were compared. The sensitivity and the kappa index were calculated. RESULTS: In some chapters of the International Classification of Diseases and Causes of Death, 9th Revision (CID-9), a high sensitivity was found: "Diseases of the Circulatory System" (91.9%), "Neoplasms" (89.7%) and "External Causes" (84.1 %). In some others, a very low sensitivity was found. The chapter "Mental Illnesses", with a 34.3 percent sensitivity only, must be mentioned. From 11 deaths originally classified in this chapter, 32 cases were found. In most of these "new" cases, the main cause of death was found to be alcoholism. The chapter "Complications of Pregnancy, Delivery and the Puerperium", also showed a low sensitivity (44.9%). The kappa index was found to be 0.63, which indicated a regular concordance. DISCUSSION: The quality of the medical certification of causes of death is still unsatisfactory in the studied area. This poor quality may affect negatively the interventions in the area of women's health, masking the severity of important problems.

OBJETIVO: Avaliar a qualidade da certificação médica dos óbitos de mulheres de 10 a 49 anos na região Sul do Município de São Paulo. MÉTODOS: Utilizou-se a metodologia Puffer para investigar as causas de óbito de todas as mulheres de 10 a 49 anos residentes na região e falecidas no ano de 1989 (num total de 664 óbitos). Foram comparadas as causas de morte relatadas nos atestados de óbitos originais com as refeitas. Calculou-se o grau de sensibilidade das causas e o índice de kappa. RESULTADOS: Obteve-se alta sensibilidade entre as declarações de óbito originais e corrigidas nos grupos de causas (CID-9) das "Doenças do Aparelho Circulatório" (91,9%), "Neoplasias" (89,7%) e "Causas Externas" (84,1%). Houve outros com sensibilidades muito baixas. Desses, chama a atenção o capítulo "Transtornos Mentais" (34,3%) que, de 11, passa a ter 32 óbitos em que, na maioria dos casos, não havia sido feito o diagnóstico de alcoolismo. Também o capítulo "Complicações da Gravidez, Parto e Puerpério" apresentou uma sensibilidade baixa (44,9%). O índice de kappa foi de 0,63, o que indica uma concordância total regular. DISCUSSÃO: Ainda é insatisfatória a qualidade da certificação médica dos óbitos na área estudada. Essa má qualidade pode afetar negativamente as propostas de intervenção, tornando pouco visíveis problemas tão sérios para a atenção à saúde da mulher.

OBJECTIVE: To evaluate the quality of the medical certification of deaths of 10-49 year-old women, resident in the Southern region of the city of S. Paulo METHODS: The Puffer methodology was utilized to investigate the causes of death of all 10-49 year-old women, resident in the region, and deceased in the year 1989 (664 deaths in the total). The main causes of death in the original death certificates and the "new" causes of death arisen from the research were compared. The sensitivity and the kappa index were calculated. RESULTS: In some chapters of the International Classification of Diseases and Causes of Death, 9th Revision (CID-9), a high sensitivity was found: "Diseases of the Circulatory System" (91.9%), "Neoplasms" (89.7%) and "External Causes" (84.1 %). In some others, a very low sensitivity was found. The chapter "Mental Illnesses", with a 34.3 percent sensitivity only, must be mentioned. From 11 deaths originally classified in this chapter, 32 cases were found. In most of these "new" cases, the main cause of death was found to be alcoholism. The chapter "Complications of Pregnancy, Delivery and the Puerperium", also showed a low sensitivity (44.9%). The kappa index was found to be 0.63, which indicated a regular concordance. DISCUSSION: The quality of the medical certification of causes of death is still unsatisfactory in the studied area. This poor quality may affect negatively the interventions in the area of women's health, masking the severity of important problems.

Relata-se a origem, organização, expansão, projeção da Associação Brasileira de Enfermagem (ABEn), associadas à sua filosofia e pondo em evidência suas realizações, desde sua origem, em 1926, até o momento atual, em que se comemora seus 70 anos. O principal objetivo do trabalho foi relatar a história da entidade ao longo dos seus 70 anos e narrar o incentivo propiciado pela mesma para que a enfermagem contribua decididamente para a construção de um corpo de conhecimentos próprios da profissão, a definição legal do exercício da profissão, a regulamentação do ensino através de suas comissões. A metodologia foi composta de pesquisa bibliográfica e entrevista com profissionais atuantes. Conclui-se que a ABEn está cada vez mais forte e consciente de como fazer para alcançar muitos outros objetivos para originar grandes conquistas que contribuirão para garantir o espaço e o poder da enfermagem como profissão voltada para o ser humano, portanto, para uma vida melhor, com mais amor, paz e justiça social.

This work is about the Brazilian Nursing Association (ABEn), its origin, its expansion and projection based on its philosophy and highlighting its achievements from its origin in 1926 until today when its 70th anniversary is being celebrated. This work aims at reporting this institution history and narrating the support provided so that nursing may contribute decisively to the construction of a body of profession knowledge itself, the legal definition of professional practice, teaching regulamentation through its commissions. Methodology has been composed of bibliographic research and interviews with active professionals. It has been concluded that ABEn is stronger and stronger and aware of the way on how to achieve many other goals which will bear great conquests which will contribute for granting nursing power and space as a profession set to the human, therefore, to a better life, with more love, peace and social justice.

This work is about the Brazilian Nursing Association (ABEn), its origin, its expansion and projection based on its philosophy and highlighting its achievements from its origin in 1926 until today when its 70th anniversary is being celebrated. This work aims at reporting this institution history and narrating the support provided so that nursing may contribute decisively to the construction of a body of profession knowledge itself, the legal definition of professional practice, teaching regulamentation through its commissions. Methodology has been composed of bibliographic research and interviews with active professionals. It has been concluded that ABEn is stronger and stronger and aware of the way on how to achieve many other goals which will bear great conquests which will contribute for granting nursing power and space as a profession set to the human, therefore, to a better life, with more love, peace and social justice.

Relata-se a origem, organização, expansão, projeção da Associação Brasileira de Enfermagem (ABEn), associadas à sua filosofia e pondo em evidência suas realizações, desde sua origem, em 1926, até o momento atual, em que se comemora seus 70 anos. O principal objetivo do trabalho foi relatar a história da entidade ao longo dos seus 70 anos e narrar o incentivo propiciado pela mesma para que a enfermagem contribua decididamente para a construção de um corpo de conhecimentos próprios da profissão, a definição legal do exercício da profissão, a regulamentação do ensino através de suas comissões. A metodologia foi composta de pesquisa bibliográfica e entrevista com profissionais atuantes. Conclui-se que a ABEn está cada vez mais forte e consciente de como fazer para alcançar muitos outros objetivos para originar grandes conquistas que contribuirão para garantir o espaço e o poder da enfermagem como profissão voltada para o ser humano, portanto, para uma vida melhor, com mais amor, paz e justiça social.