De Medicina Tropical Research Articles

Nonlactational Mastitis in Western Brazilian Amazon Mastitis Cases.

Chronic mastitis varies in etiology between its lactational and nonlactational forms and can be challenging to diagnose. This study aimed to assess the epidemiological profile and diverse etiologies of nonlactational mastitis in Amazonas, Brazil, focusing on distinguishing between tuberculous mastitis (TM) and idiopathic granulomatous mastitis (IGM). This is a retrospective and prospective study that was carried out at the mastitis outpatient clinic of Fundação de Medicina Tropical Doutor Heitor Vieira Dourado from 2013 to 2021 and evaluated epidemiological data, imaging, and laboratory tests. Descriptive statistics were performed. In this retrospective and prospective analysis, 124 medical records were initially considered, with 12 excluded for various reasons. The remaining 112 cases underwent thorough evaluation through epidemiological data, imaging, and laboratory tests, by employing descriptive statistics for analysis. The pathology revealed a predominant prevalence of IGM (64.3%), followed by various forms of mastitis, including confirmed TM (4.5%), presumable TM (8.9%), and others. Our findings indicate that IGM, though a rare cause of breast masses and abscesses, accounts for a significant portion of mastitis cases. Histopathological studies were essential for diagnosis, with ultrasound being the primary imaging tool. This study is one of the largest Brazilian series on nonlactational mastitis, highlighting the condition's complexity and diverse manifestations in the Amazon region.

Photobiomodulation Therapy to Treat Snakebites Caused by Bothrops atrox

Bothrops venom acts almost immediately at the bite site and causes tissue damage. To investigate the feasibility and explore the safety and efficacy of low-level laser therapy (LLLT) in reducing the local manifestations of B atrox envenomations. This was a double-blind randomized clinical trial conducted at Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, Brazil. A total of 60 adult participants were included from November 2020 to March 2022, with 30 in each group. Baseline characteristics on admission were similarly distributed between groups. Data analysis was performed from August to December 2022. The intervention group received LLLT combined with regular antivenom treatment. The laser used was a gallium arsenide laser with 4 infrared laser emitters and 4 red laser emitters, 4 J/cm2 for 40 seconds at each application point. Feasibility was assessed by eligibility, recruitment, and retention rates; protocol fidelity; and patients' acceptability. The primary efficacy outcome of this study was myolysis estimated by the value of creatine kinase (U/L) on the third day of follow-up. Secondary efficacy outcomes were (1) pain intensity, (2) circumference measurement ratio, (3) extent of edema, (4) difference between the bite site temperature and that of the contralateral limb, (5) need for the use of analgesics, (6) frequency of secondary infections, and (7) necrosis. These outcomes were measured 48 hours after admission. Disability assessment was carried out from 4 to 6 months after patients' discharge. P values for outcomes were adjusted with Bonferroni correction. A total of 60 patients (mean [SD] age, 43.2 [15.3] years; 8 female individuals [13%] and 52 male individuals [87%]) were included. The study was feasible, and patient retention and acceptability were high. Creatine kinase was significantly lower in the LLLT group (mean [SD], 163.7 [160.0] U/L) 48 hours after admission in relation to the comparator (412.4 [441.3] U/L) (P = .03). Mean (SD) pain intensity (2.9 [2.7] vs 5.0 [2.4]; P = .004), circumference measurement ratio (6.6% [6.6%] vs 17.1% [11.6%]; P < .001), and edema extent (25.8 [15.0] vs 40.1 [22.7] cm; P = .002) were significantly lower in the LLLT group in relation to the comparator. No difference was observed between the groups regarding the mean difference between the bite site temperature and the contralateral limb. Secondary infections, necrosis, disability outcomes, and the frequency of need for analgesics were similar in both groups. No adverse event was observed. The data from this randomized clinical trial suggest that the use of LLLT was feasible and safe in a hospital setting and effective in reducing muscle damage and the local inflammatory process caused by B atrox envenomations. Brazilian Registry of Clinical Trials Identifier: RBR-4qw4vf.

Acute Chagas disease associated with ingestion of contaminated food in Brazilian western Amazon.

To describe clinical, epidemiological and management information on cases of acute Chagas disease (ACD) by oral transmission in the state of Amazonas in western Amazon. Manual and electronic medical records of patients diagnosed with ACD at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD) were included. There were 147 cases of acute CD registered from 10 outbreaks that occurred in the state of Amazonas between 2004 and 2022. The transmission pathway was through oral route, with probable contaminated palm fruit juice (açaí and/or papatuá), and involved people from the same family, friends or neighbours. Of 147 identified cases, 87 (59%) were males; cases were aged 10 months to 82 years. The most common symptom was the febrile syndrome (123/147; 91.8%); cardiac alterations were present in 33/100 (33%), (2/147; 1.4%) had severe ACD with meningoencephalitis, and 12 (8.2%) were asymptomatic. Most cases were diagnosed through thick blood smear (132/147; 89.8%), a few (14/147; 9.5%) were diagnosed by serology and (1/147; 0.7%) by polymerase chain reaction (PCR) and blood culture. In all these outbreaks, 74.1% of the patients were analysed by PCR, and Trypanosoma cruzi TcIV was detected in all of them. No deaths were recorded. The incidence of these foci coincided with the fruit harvest period in the state of Amazonas. The occurrence of ACD outbreaks in the Amazon affected individuals of both sexes, young adults, living in rural and peri-urban areas and related to the consumption of regional foods. Early diagnosis is an important factor in surveillance. There was a low frequency of cardiac alterations. Continuous follow-up of most patients was not carried out due to difficulty in getting to specialised centres; therefore, little is known about post-treatment.

Efficacy of home-based inspiratory muscle training in patients post-covid-19: Protocol for a randomized clinical trial.

Current evidence suggests the emergence of a novel syndrome (long COVID syndrome) due to sequels and persistent COVID-19 symptoms. Respiratory muscle training improves respiratory muscle strength, exercise capacity, diaphragm thickness, and dyspnea, especially in patients with decreased respiratory muscle strength. This study aims to evaluate the effectiveness of a protocol for home-based inspiratory muscle training to improve respiratory muscle strength, dyspnea, and quality of life of patients post-COVID-19. This randomized, controlled, double-blind clinical trial will be conducted at the Instituto de Medicina Tropical of Universidade Federal do Rio Grande do Norte (Brazil). Sample size will be determined using maximal inspiratory pressure after a pilot study with five patients per group (total of 10 patients). Patients included in the study will be evaluated in three moments: pre-training (initial), post-training (three weeks), and retention (24 weeks). The sample will be randomized in two groups: active (IMT using 30% of IMT and load increase of 10% of initial IMT every week. Patients will perform 30 repetitions, twice a day (morning and afternoon), for seven consecutive days, and six weeks) and SHAM (IMT without load). The following measurements will be assessed: anthropometry, respiratory muscle strength, pulmonary volume and capacity, dyspnea, perception of effort and lower limb fatigue, handgrip strength, functional capacity, anxiety, depression, and functional status. After initial evaluation, all patients will receive a POWERbreathe® (POWERbreathe®, HaB Ltd, Southam, UK) device to perform the training. Normality will be verified using Shapiro-Wilk or Kolmogorov-Smirnov, according to the number of patients included. Variables presenting nonparametric distribution will be compared using Wilcoxon (intragroup analysis) and Mann-Whitney test (intergroup analysis), whereas repeated measures two-way ANOVA will be performed in case of parametric distribution. Dunn's post hoc test will be used to identify significant differences in the two-way ANOVA test. Respiratory muscle strength, dyspnea, and quality of life of post-COVID-19 patients. Pulmonary function, dyspnea, exercise tolerance, handgrip strength, anxiety, depression, and functional status. Trial register number NCT05077241.

Immunologic biomarkers, morbidity and mortality among HIV patients hospitalised in a Tertiary Care Hospital in the Brazilian Amazon

BackgroundThe irregular use of antiretroviral therapy (ART) and late diagnosis still account for a large part of HIV-associated mortality in people living with HIV (PLHIV). Herein, we describe HIV-associated morbidity among hospitalised HIV/AIDS patients with advanced immunosuppression and assess the comorbidities, laboratory parameters, and immunological markers associated with mortality.MethodsThe cross-sectional study was conducted at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD) in Manaus, Brazil. In all, 83 participants aged between 12 and 70 years were enrolled by convenience within 72 h of their hospitalisation. Clinical and laboratory data were obtained from electronic medical records. We prospectively measured the cytokines Th1/Th2/Th17 and inflammatory cytokines IL-8, IL-1β, and IL-12 using cytometric bead array, and the soluble CD14 using in-house enzyme-linked immunosorbent assay.ResultsThe HIV/AIDS inpatients presented a scenario of respiratory syndromes as the most prevalent comorbidity. Almost all patients had CD4 T counts below 350 cells/mL and the mortality rate was 20.5%. Pulmonary tuberculosis, neurotoxoplasmosis and oropharyngeal–esophageal candidiasis were the most prevalent opportunistic infections. TB and weight loss were more prevalent in HIV/AIDS inpatients who died. The Mann Whitney analysis showed that those who died had higher platelet distribution width (PDW) on admission, which is suggestive for platelet activation. The Poisson multivariate analysis showed the prevalence of TB, digestive syndrome and increases in IL-8 and lactate dehydrogenase (LDH) associated to death.ConclusionsThe advanced immunosuppression characterized by the opportunistic infections presented in these HIV/AIDS inpatients was the major factor of mortality. The role of platelet activation in worse outcomes of hospitalisation and the IL-8 associated with the context of advanced immunosuppression may be promising markers in the prediction of mortality in HIV/AIDS patients.

A painful journey to antivenom: The therapeutic itinerary of snakebite patients in the Brazilian Amazon (The QUALISnake Study).

Access to antivenoms is not guarranteed for vulnerable populations that inhabit remote areas in the Amazon. The study of therapeutic itineraries (TI) for treatment of snakebites would support strategies to provide timely access to users. A TI is the set of processes by which individuals adhere to certain forms of treatment, and includes the path traveled in the search for healthcare, and practices to solve their health problems. This study aims to describe TIs of snakebite patients in the Brazilian Amazon. This study was carried out at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, state of Amazonas, Brazil. The itinerary from the moment of the bite to the patient's admission to the reference unit was analyzed. Sample size was defined by saturation. After an exploratory survey to collect epidemiological variables, in-depth interviews were conducted following a semi-structured guide. Patients originated from rural areas of 11 different municipalities, including ones located >500 kilometers from Manaus. A great fragmentation was observed in the itineraries, marked by several changes of means of transport along the route. Four themes emerged from the analysis: exposure to snakebite during day-to-day activities, use of traditional therapeutic practices, and personal perception of the severity, as well as the route taken and its contingencies. Access to healthcare requires considerable effort on the part of snakebite patients. Major barriers were identified, such as the low number of hospitals that offer antivenom treatment, poor access to healthcare due to long distances and geographic barriers, low acceptability of healthcare offered in countryside, lack of use of personal protective equipment, common use of ineffective or deleterious self-care practices, late recognition of serious clinical signs and resistance to seeking medical assistance. Health education, promotion of immediate transport to health centers and decentralization of antivenom from reference hospitals to community healthcare centers in the Brazilian Amazon are more effective strategies that would to maximize access to antivenom treatment.

Envenomations by coral snakes in an Amazonian metropolis: Ecological, epidemiological and clinical aspects

Envenomation by coral snakes represents a little known burden in Brazilian Amazonia. So far, details on clinical and epidemiological aspects remain obscure in the region. We gathered data from medical charts and from the scientific collection of snakes from Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, finding 26 cases of envenomation by five species of Micrurus in Manaus region, between 1987 and 2018. They represent 0.7% of the snakebites treated in the hospital since the records began, in 1979. Micrurus lemniscatus was responsible for most of the bites (10), followed by M. hemprichii (five), M. spixii (three), M. surinamensis (three) and M. averyi (one). There was no difference between the sexes of the snakes that caused bites. Patients were mostly males, and most of the cases were reported in urban areas. Bites predominated in dry season, and there was a clear geographical segregation among species. We describe seven cases of envenomation, three mild and four severe, all of which evolved to cure. Paresthesia (six), pain (five) and edema (four) were the most common local symptoms. Systemic features such as dyspnea/shallow breath (four), palpebral ptosis (four), blurred vision (three), dysarthria (three) and difficulty to walk (three) were also detected. Two patients bitten by Micrurus sp. and M. hemprichii, showed slight increased serum levels of creatine kinase (reference level <190 U/L), 1184 U/L and 1229 U/L, respectively, indicative of mild systemic myotoxicity. This is the first report of myotoxic manifestation in the envenomation by M. hemprichii. No patient developed respiratory failure, though one bitten by an adult M. spixii required intubation and mechanical ventilation due to decreased level of consciousness during evolution, probably related to induced sedation caused by concurrent alcohol intoxication. All patients were treated with Brazilian Micrurus antivenom (soro antielapídico, median = 10 vials). Six patients were pretreated intravenously with H1 and H2 antagonists and steroids, with two patients developing early adverse reactions. The median length of hospital stay was four days. Envenomations by coral snakes in Manaus region are clinically severe, but rare and sparsely distributed over time, making the detection of epidemiological and clinical patterns a challenge for public health.

Análisis de citas de cuatro revistas biomédicas latinoamericanas

Las revistas Archivos de Investigación Médica (México), Medicina (Argentina), Revista do Instituto de Medicina Tropical de Sao Paulo (Brasil), y Revista Médica de Chile (Chile) fueron seleccionadas con el fin de hacer un análisis de citas, conocer sus patrones de intercomunicación, y detectar indicadores importantes para continuar investigaciones afines . La selección de las revistas se realizó a través de un análisis de las publicaciones de mayor difusión en seis índices secundarios internacionales (Index Medicus, lndex Medicus Latinoamericano , Excerpta Medica, Science Citation lndex, Biological Ahstracts, y C'hemical Abstracts). Science Citation, lndex Journal Citation Reports 1987, se utilizó como fuente para realizar el análisis de citas, conocer los factores de impacto y los diferentes indices de las revistas mencionadas. Los resultados indican que Medicina (Argentina) es la revista superior en factor de impacto, citas recibidas y rango en su categoría temática. Archivos de lnvestigación Médica (México) por otro lado, es citada por revistas de alto impacto internacional, y cuenta con una vida media de citaciones superior a los diéz años. En general. los resultados obtenidos no concluyen sobre patrones regionales o temáticos significativos: sin embargo, sí ayudan a establecer las bases de investigación específicas a seguir. Dichas líneas de investigación son descritas por el autor.

Performance of rK39-based immunochromatographic rapid diagnostic test for serodiagnosis of visceral leishmaniasis using whole blood, serum and oral fluid.

BackgroundThe development of rK39-based immunochromatographic rapid diagnostic tests represents an important advance for serodiagnosis of visceral leishmaniasis, being cheap and easy to use at the point of care (POC). Although the use of rK39 have considerably improved the sensitivity and specificity of serological tests compared with total antigens, great variability in sensitivity and specificity was reported. This study aimed at the evaluation of “Kalazar Detect™ Rapid Test, Whole Blood” (Kalazar Detect RDT) for Visceral Leishmaniasis (VL) diagnosis using oral fluid, whole blood and serum specimens collected at different endemic areas of VL of Brazil.MethodologyTo evaluate Kalazar Detect RDT, oral fluid, whole blood and serum specimens from 128 VL patients, 85 healthy individuals, 22 patients with possible cross-reactivity diseases and 20 VL/aids coinfected patients were collected and assayed at the POC.Principal findings and conclusionsThe performance of Kalazar Detect RDT in whole blood and serum was similar; however, using oral fluid, the sensitivity was low. Particularly in samples from the city of Natal, Rio Grande do Norte state in Northeastern Brazil, we observed low sensitivity, 80.0% (95% CI: 62.7–90.5), using whole blood and serum, and poor sensitivity, 43.3% (95% CI: 27.4–60.8) with oral fluid. Those values were much lower than in the other regions, where sensitivity ranged from 92.7–96.3% in whole blood and serum, and 80.0–88.9% in oral fluid. Besides, in VL/aids coinfected patients, lower sensitivity was achieved compared with VL patients. In samples from Natal, the sensitivity was 0.0% (95% CI: 0.0–49.0) and 25.0% (95% CI: 4.6–69.9), using oral fluid and serum/whole blood, respectively; in samples from the other regions, the sensitivity ranged from 40.0–63.6% and 80.0–81.8%, respectively. As for specificity, high values were observed across the fluids, 100.0% (95% CI: 96.5–100.0) in whole blood, 96.3% (95% CI: 90.8–98.5) in serum, and 95.3% (95% CI: 89.5–98.0) in oral fluid; across localities, specificity ranged from 85.7–100.0%. Serum samples sent by the collaborating centers to Instituto de Medicina Tropical (n = 250) were tested by Kalazar Detect RDT, Direct Agglutination Test, Indirect immunofluorescence assay, Enzyme-linked immunosorbent assay, and IT-Leish® RDT. The regional difference in the performance of rK39-based RDT and lower sensitivity in Leishmania/HIV coinfected patients raise concern on the routine use of these products for the diagnosis of VL.

Prognostic factors of severity of invasive community acquired Staphylococcus aureus infections in children.

To describe the clinical characteristics of invasive Staphylococcus aureus infections in children and identify the prognostic factors of severity and mortality. Observational study in patients < 16 years old hospitalized between 2010 and 2015 due to invasive S. aureus infections at the Instituto de Medicina Tropical, in Asunción, Paraguay. Patients were distributed based on whether or not they required admission to the intensive care unit, and clinical, laboratory, and evolutionary outcome measures were compared. Out of the 107 included patients, 50 (47 %) developed bacteremia; 50 (47 %), pneumonia; and 21 (19 %), multifocal disease. Among the patients who were admitted to the intensive care unit (41 %), prior antibiotic use (p < 0.05), the presence of bacteremia (p = 0.01), the presence of comorbidities (p < 0.05), and multifocal disease (p < 0.01) were more frequent. The overall mortality rate was 15 %. The mortality-associated risk factors were the presence, at the time of admission, of hypotension (p < 0.01), multifocal disease (p < 0.01), bacteremia (p < 0.01), leukopenia (p < 0.01), severe anemia (p < 0.01), and metabolic acidosis (p < 0.01), among others. The prognostic factors of severity included prior antibiotic use, bacteremia, the presence of comorbidities, and presentation with multifocal disease. Mortality was significant; associated risk factors included the presence, at the time of admission, of hypotension, multifocal disease, leukopenia, severe anemia, and metabolic acidosis.

Dermatological manifestations in patients with human T-cell lymphotropic virus at a reference service in Amazon.

Individuals infected with the human T-cell lymphotropic virus type 1 (HTLV-1) commonly present skin lesions, which may be a warning sign for the diagnosis of infection. This study describes the most prevalent skin manifestations in HTLV carriers attended at the clinic of Núcleo de Medicina Tropical (NMT) of the Universidade Federal do Pará (UFPA) in Belém, Pará, Brazil. This is a study of a series of cases of patients infected with human T-cell lymphotropic virus types 1 and 2 (HTLV-1/2) treated at NMT UFPA between 1999 and 2016. A descriptive analysis of data was applied. Among 788 surveyed medical records in the service, 15.10% (n = 119) were referred to the dermatology clinic. From the series of cases that presented with skin lesions, 66.39% were female and 33.61% were male, and the average age of this group was 48 years. There was a predominance of patients with noninfectious inflammatory manifestations (64.2%), followed by infectious ones (24.6%), and 1.58% with lymphoproliferative diseases. As for the group of lesions, 45.26% of the erythematous-squamous type were observed, followed by dyschromia (24.21%), and eczematous (14.74%). One patient with a diagnosis of adult T-cell leukemia/lymphoma, another with parapsoriasis, and four with infective dermatitis are highlighted. Skin disorders in the HLTV positive patient are important causes of referral to the dermatologist with etiological and skin lesions groups diversity. In the series of cases studied, lymphoproliferatives diseases and infective dermatitis associated with HTLV-1 were presented as a challenge for the diagnosis and clinical management of these patients.

Human parvovirus B19 genotype 1 in suspected dengue patients of Tefé, Amazonas State, Brazil.

Human parvovirus B19 (B19V) is a common pathogen, which on infection causes variety of clinical conditions from benign self-limiting exanthematous disease and other similar pathologies to fetal death. We collected 341 serum samples between the first and fourth day after the onset of symptoms from all patients suspected of dengue fever who were attended at Regional Hospital of Tefé. Initially, patients were screened for malaria by blood smear test and negative samples were sent to Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD) situated in Manaus (AM) for dengue testing using semi-nested multiplex PCR. Further, we investigated 44 malaria and dengue-negative samples of children for B19V DNA by nested-PCR. Positive samples were analyzed by BLAST against entire public non-redundant nucleotide database and genotyped by phylogenetic analyses using neighbor-joining clustering method. Eight samples (18.2%) were found to be PCR positive. Fever, headache, ocular pain, and/or muscle pain were reported as the most frequent symptoms by the patients and none were diagnosed with rash at the time of sample collection. Phylogenetic analysis of major capsid protein 2 (VP2) and VP3 coding region showed high similarity with B19V genotype 1. Our results reveal the spread of B19V genotype 1 in Tefé. Moreover, our results emphasize the significance of laboratorial differential diagnosis using molecular techniques in patients with acute febrile, and thereby aid the health surveillance system in improving patient care even in the remote areas of Amazon.

Epidemiological study of snakebite cases in Brazilian Western Amazonia.

Brazil has the largest number of snakebite cases in South America, of which the large majority is concentrated in the Midwest and North. In this descriptive observational study, we assessed the epidemiological and clinical snakebite cases referred to the Centro de Medicina Tropical de Rondônia from September 2008 to September 2010. We followed up 92 cases from admission until discharge, namely 81 (88%) men and 11 (12%) women, with a mean age of 37 years, and mainly from rural areas (91.3%). The snakebites occurred while performing work activities (63%) during the Amazon rainy season (78.3%). The vast majority of individuals presented from the Porto Velho microregion (84.7%). Approximately 95.6% of the snakebites were caused by snakes of the genus Bothrops, followed by two lachetics and two elapidics cases. Surgery was performed in 10 cases (9 fasciotomies in the lower limb and 1 amputation). No deaths were reported in this study, but 4 cases (4.3%) developed sequelae in the lower limb. This study can contribute to a better understanding of envenomation in the state of Rondônia and thus can be useful for identifying real conditions that can increase the incidence of snakebites in this region. Moreover, the study results can serve as a basis for improving educational campaigns designed to prevent these types of snakebites, as well as for preserving snakes.

Fifteen Years of Toxoplasmosis Screening at the Institute of Tropical Medicine, a Diagnostic Reference Center in Venezuela

Toxoplasmosis serodiagnosis was analyzed in the Instituto de Medicina Tropical in Caracas during 1999–2013. Subjects for toxoplasmosis diagnosis were grouped into five categories: pregnancy, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome, ocular pathology, lymphadenopathy, and others. Testing for specific anti-Toxoplasma IgM/IgG antibodies, as well as IgG avidity, was performed. Analysis of 68,622 individuals resulted in an overall prevalence of 50.9%, with 50.9% in pregnant women, 63.8% in patients with eye lesions, 53.1% in HIV-positive individuals, 33.3% in patients with lymphadenopathy, and 49% in other individuals. Toxoplasma gondii infection in pregnant women aged ≤15 years was 32%, which increased to 64% in the middle age category. Diagnostic tests detected 54 recent infections in pregnant women and their follow-up showed no congenital infection. The present age-related and comorbidity prevalence data should be used to design control measures to prevent congenital transmission, coinfection in immunosuppressed patients, and eye lesions in children.

Benchmarking scientific performance by decomposing leadership of Cuban and Latin American institutions in Public Health

Comparative benchmarking with bibliometric indicators can be an aid in decision-making with regard to research management. This study aims to characterize scientific performance in a domain (Public Health) by the institutions of a country (Cuba), taking as reference world output and regional output (other Latin American centers) during the period 2003---2012. A new approach is used here to assess to what extent the leadership of a specific institution can change its citation impact. Cuba was found to have a high level of specialization and scientific leadership that does not match the low international visibility of Cuban institutions. This leading output appears mainly in non-collaborative papers, in national journals; publication in English is very scarce and the rate of international collaboration is very low. The Instituto de Medicina Tropical Pedro Kouri stands out, alone, as a national reference. Meanwhile, at the regional level, Latin American institutions deserving mention for their high autonomy in normalized citation would include Universidad de Buenos Aires (ARG), Universidade Federal de Pelotas (BRA), Consejo Nacional de Investigaciones Cientificas y Tecnicas (ARG), Instituto Oswaldo Cruz (BRA) and the Centro de Pesquisas Rene Rachou (BRA). We identify a crucial aspect that can give rise to misinterpretations of data: a high share of leadership cannot be considered positive for institutions when it is mainly associated with a high proportion of non-collaborative papers and a very low level of performance. Because leadership might be questionable in some cases, we propose future studies to ensure a better interpretation of findings.

TRIBUTE TO PROF. CARLOS DA SILVA LACAZ.

The Revista do Instituto de Medicina Tropical de Sao Paulo has the honor to present this special issue of the year 2015 that is entirely dedicated to celebrate the centennial anniversary of Prof. Carlos da Silva Lacaz, founder of the Instituto de Medicina Tropical. Simultaneously to the creation of the Institute, the Revista do Instituto de Medicina Tropical de Sao Paulo also began to operate in 1959, initially led by Prof. Luiz Rey, succeeded by Prof. Lacaz himself until 1985, and afterwards by Prof. Thales de Brito for 30 years, until May, 2015. Therefore, it was just recently that I am leading the Revista do Instituto de Medicina Tropical de Sao Paulo. Nonetheless, I would like to give my testimony on the short, but fruitful interaction I had with Prof. Lacaz. Despite being a former student of the Faculdade de Medicina da Universidade de Sao Paulo, I did not have the good fortune to be his undergraduate student. I met him many years later, after returning from abroad (France) where I did my PhD thesis on cellular and molecular biology. I worked for some time in the Immunology Laboratory which is located on the same floor of the Mycology Laboratory that was, at that time, headed by Prof. Lacaz. With him I learned much medicine, history of medicine, the correct use of the Portuguese language, among other things. Prof. Lacaz availability caught my attention and as he requested private tutoring in molecular biology, I must say that he was, as always, a brilliant student. Another of Prof. Lacaz features was his willingness to teach and help people. Prof. Lacaz has always taken the Hippocratic Oath very seriously, and was deeply sorry that medical students and their teachers were moving away from humanistic values that he believed, were essential to all medical doctors. He was a tireless defensor of the Faculdade de Medicina and the Instituto de Medicina Tropical in all important issues for the two institutions. Working in the laboratory next door gave me the opportunity to change ideas with Prof. Lacaz, and these experiences have always been very enriching because he owned a remarkable good humor, wit, creativity, critical thinking, leadership, and an ability to analyze and solve problems revealing an intelligence and dynamism that unfortunately we do not see nowadays. This coexistence left me a legacy represented by several autographed books with formidable dedications, many hand notes with tips of all kinds, on matters of day-to-day and life, or on scientific research. Whenever I feel discouraged, I read these notes and Prof. Lacaz dedications and realize how, even without having had the intention, Prof. Lacaz made me a better person. I thank him for all the nice moments of coexistence, for all the encouragement I received and I hope he enjoys this tribute of the Revista do Instituto de Medicina Tropical de Sao Paulo that he has helped to create and develop. In the following pages our readers will find, initially, a moving testimony on the professional career and achievements of Prof. Lacaz. Next, several review articles on the most stimulating topics of current Medical Mycology, written by highly qualified professionals who work in various countries, many of them former students and friends of Prof. Lacaz. The Revista do Instituto de Medicina Tropical de Sao Paulo thanks all these valuable colleagues and also the researchers who are currently leading the Mycology Laboratory of the Instituto de Medicina Tropical and have selected the topics to be addressed in this special issue, Prof. Gil Benard, Prof. Carlos Pelleschi Taborda and Dra. Gilda M.B. Del Negro. I conclude reproducing one of the famous Professor Lacaz phrases that he has left as a legacy to all those who admire his life and work: it is always necessary to have joie de vivre. And it is with joie de vivre that I will let you read the review articles that follow with the certainty that the privileged people that managed to capture Prof. Lacaz spirit will know how to enjoy them. THIS SUPPLEMENT OF THE REVISTA DO INSTITUTO DE MEDICINA TROPICAL DE SAO PAULO DEDICATED TO THE CENTENNIAL ANNIVERSARY OF PROF. CARLOS DA SILVA LACAZ (1915-2015)

CENTENNIAL ANNIVERSARY OF PROF. CARLOS DA SILVA LACAZ (1915-2015)

CENTENNIAL ANNIVERSARY OF PROF. CARLOS DA SILVA LACAZ (1915-2015)

Epidemiology of infectious meningitis in the State of Amazonas, Brazil.

In the State of Amazonas, particularly in the capital Manaus, meningitis has affected populations of different cultures and social strata over the years. Bacterial meningitis is caused by several different species and represents a major issue of public health importance. The present study reports the meningitis case numbers with different etiologies in Amazonas from January 1976 to December 2012. Since the 1970s, the (currently named) Tropical Medicine Foundation of Doutor Heitor Vieira Dourado [Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD)] has remained a reference center in Amazonas for the treatment of meningitis through the diagnosis and notification of cases and the confirmation of such cases using specific laboratory tests. The foundation has achieved coverage of over 90% of the state medical records for many years. Between 1990 and 2012, meningitis cases caused by Haemophilus influenzae decreased with the introduction of the H. influenzae vaccine. Meningococcal disease previously had a higher frequency of serogroup B disease, but starting in 2008, the detection of serogroup C increased gradually and has outpaced the detection of serogroup B. Recently, surveillance has improved the etiological definition of viral meningitis at FMT-HVD, with enteroviruses, Epstein-Barr virus (EBV) and varicella zoster virus (VZV) prevailing in this group of pathogens. With the advent of acquired immunodeficiency syndrome (AIDS), cryptococcal meningitis has become an important disease in Amazonas. Additionally, infectious meningitis is an important burden in the State of Amazonas. Changes in the epidemiological profile for the different etiology-defined cases are the result of continuous epidemiological surveillance and laboratory capacity improvements and control measures, such as Haemophilus influenzae vaccination.

Association of the LRRK2 genetic polymorphisms with leprosy in a Colombian population.

Event Abstract Back to Event Association of the LRRK2 genetic polymorphisms with leprosy in a Colombian population. Nora Cardona-Castro1*, Viviana A. Cardona Pemberthy2, Gabriel Bedoya-Berrío2, Camilo Beltrán-Alzate1, Marcela Romero1, Vinicius Madeiros Fava3 and Erwin Schurr3 1 Instituto Colombiano de Medicina Tropical - Universidad CES, Microbiology, Colombia 2 Universidad de Antioquia, GENMOL, Colombia 3 McGill, Canada Leprosy is a chronic infection caused by Mycobacterium leprae that affects the skin and peripheral nervous system. LRRK2 (Human leucine-rich repeat kinase 2, OMIM 609007) genetic variants are associated with leprosy susceptibility in the Chinese population. The LRRK2 gene encodes dardarin (PARK8), which is a multifunctional protein which is involved in the host response to pathogens. To validate the association of LRRK2 variants with leprosy in Colombian population, we genotyped 36 LRRK2 variants in 221 leprosy patients and 200 healthy individuals from endemic regions of Colombia. Our results replicated the observations in Chinese patients since we found the same SNP rs1873613 associated with leprosy (p= 0.014). In addition, variants rs10506151 (p=0.037), rs10878434 (p=0.0068), rs11176143 (p=0.012), rs114095370 (p=0.041), rs11465802 (p=0.023), rs1427265 (p=0.00075), and rs10878434 (p=0.0089) were associated with leprosy. Hence, this study provides direct support for a globally important role of LRRK2 in leprosy susceptibility. The authors declare do not have conflict of interest. Acknowledgements This project was financed by COLCIENCIAS grant number 325651928980 to Nora Cardona-Castro, by Estrategia de Sostenibilidad 2010 Universidad de Antioquia to Gabriel Bedoya-Berrío, and to Erwin Schurr by Canadian Institutes of Health Research (CIHR). References Wang D, Xu L, Lv L, Su L-Y, Fan Y, Zhang D-F, Bi R, Yu D, Zhang W, Li X-A, Li Y-Y, Yao G-Y. Association of the LRRK2 genetic polymorphisms with leprosy in Han Chinese from Southwest China. Genes and Immunity (2014), 1–8. Zhang FR, Huang W, Chen SM, Sun LD, Liu H, Li Y et al. Genomewide association study of leprosy. N Engl J Med 2009; 361: 2609–2618. Marcinek P, Jha AN, Shinde V, Sundaramoorthy A, Rajkumar R, Suryadevara NC, et al. LRRK2 and RIPK2 variants in the NOD 2-mediated signaling pathway are associated with susceptibility to Mycobacterium leprae in Indian populations. PLoS One 2013; 8: e73103. Keywords: Mycobacterium leprae, Leprosy, LRRK2, Colombia, Human leucine-rich repeat kinase 2 Conference: IMMUNOCOLOMBIA2015 - 11th Congress of the Latin American Association of Immunology - 10o. Congreso de la Asociación Colombiana de Alergia, Asma e Inmunología, Medellin, Colombia, 13 Oct - 16 Oct, 2015. Presentation Type: Poster Presentation Topic: Immunogenetics Citation: Cardona-Castro N, Cardona Pemberthy VA, Bedoya-Berrío G, Beltrán-Alzate C, Romero M, Madeiros Fava V and Schurr E (2015). Association of the LRRK2 genetic polymorphisms with leprosy in a Colombian population.. Front. Immunol. Conference Abstract: IMMUNOCOLOMBIA2015 - 11th Congress of the Latin American Association of Immunology - 10o. Congreso de la Asociación Colombiana de Alergia, Asma e Inmunología. doi: 10.3389/conf.fimmu.2015.05.00364 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 17 Apr 2015; Published Online: 15 Sep 2015. * Correspondence: Dr. Nora Cardona-Castro, Instituto Colombiano de Medicina Tropical - Universidad CES, Microbiology, Sabaneta, Antioquia, Colombia, ncardona@ces.edu.co Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Nora Cardona-Castro Viviana A Cardona Pemberthy Gabriel Bedoya-Berrío Camilo Beltrán-Alzate Marcela Romero Vinicius Madeiros Fava Erwin Schurr Google Nora Cardona-Castro Viviana A Cardona Pemberthy Gabriel Bedoya-Berrío Camilo Beltrán-Alzate Marcela Romero Vinicius Madeiros Fava Erwin Schurr Google Scholar Nora Cardona-Castro Viviana A Cardona Pemberthy Gabriel Bedoya-Berrío Camilo Beltrán-Alzate Marcela Romero Vinicius Madeiros Fava Erwin Schurr PubMed Nora Cardona-Castro Viviana A Cardona Pemberthy Gabriel Bedoya-Berrío Camilo Beltrán-Alzate Marcela Romero Vinicius Madeiros Fava Erwin Schurr Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Cultura e Extensão em um Instituto de Pesquisa: as Experiências e Propostas do Instituto de Medicina Tropical de São Paulo

Usually, research institutes presented a distant relationship with the laic Society. This fact results in an undervaluation of activities of social promotion or communication. In the Instituto de Medicina Tropical de Sao Paulo, since our foundation there were several actions for social promotion and communication, due to our research type or open field projects, but with challenging and difficult maintenance with frequent interruptions, as a research institute. Here, we present the new initiatives to enhance the interface between Society and IMTSP and we detect that the awareness of scientific staff and the “aggiornamento” of concepts and interactions were extremely beneficial to research institutes. Contradicting the initial thinking of a limited unidirectional knowledge transmission of those contacts and a “downstairs” social promotion or communication, those initiatives were more important to the scientific staff by showing the Society commitments with the support of the research, ratifying the value of the evolving research in those institutes.