BackgroundThe physiopathology of dengue hemorrhagic fever (DHF), a severe form of Dengue Fever, is poorly understood. We are unable to identify patients likely to progress to DHF for closer monitoring and early intervention during epidemics, so most cases are sent home. This study explored whether patients with selected co-morbidities are at higher risk of developing DHF.MethodsA matched case-control study was conducted in a dengue sero-positive population in two Brazilian cities. For each case of DHF, 7 sero-positive controls were selected. Cases and controls were interviewed and information collected on demographic and socio-economic status, reported co-morbidities (diabetes, hypertension, allergy) and use of medication. Conditional logistic regression was used to calculate the strength of the association between the co-morbidities and occurrence of DHF.Results170 cases of DHF and 1,175 controls were included. Significant associations were found between DHF and white ethnicity (OR = 4.70; 2.17–10.20), high income (OR = 6.84; 4.09–11.43), high education (OR = 4.67; 2.35–9.27), reported diabetes (OR = 2.75; 1.12–6.73) and reported allergy treated with steroids (OR = 2.94; 1.01–8.54). Black individuals who reported being treated for hypertension had 13 times higher risk of DHF then black individuals reporting no hypertension.ConclusionsThis is the first study to find an association between DHF and diabetes, allergy and hypertension. Given the high case fatality rate of DHF (1–5%), we believe that the evidence produced in this study, when confirmed in other studies, suggests that screening criteria might be used to identify adult patients at a greater risk of developing DHF with a recommendation that they remain under observation and monitoring in hospital.

BackgroundCurrently, knowledge does not allow early prediction of which cases of dengue fever (DF) will progress to dengue hemorrhagic fever (DHF), to allow early intervention to prevent progression or to limit severity. The objective of this study is to investigate the hypothesis that some specific comorbidities increase the likelihood of a DF case progressing to DHF.MethodsA concurrent case-control study, conducted during dengue epidemics, from 2009 to 2012. Cases were patients with dengue fever that progressed to DHF, and controls were patients of dengue fever who did not progress to DHF. Logistic regression was used to estimate the association between DHF and comorbidities.ResultsThere were 490 cases of DHF and 1,316 controls. Among adults, progression to DHF was associated with self-reported hypertension (OR = 1.6; 95% CI 1.1-2.1) and skin allergy (OR = 1.8; 95% CI 1.1-3.2) with DHF after adjusting for ethnicity and socio-economic variables. There was no statistically significant association between any chronic disease and progression to DHF in those younger than 15 years.ConclusionsPhysicians attending patients with dengue fever should keep those with hypertension or skin allergies in health units to monitor progression for early intervention. This would reduce mortality by dengue.

The degree of admixture in Brazil between historically isolated populations is complex and geographically variable. Studies differ as to what the genetic and phenotypic consequences of this mixing have been. In Northeastern Brazil, we enrolled 522 residents of Salvador and 620 of Fortaleza whose distributions of self-declared color were comparable to those in the national census. Using the program Structure and principal components analysis there was a clear correlation between biogeographic ancestry and categories of skin color. This correlation with African ancestry was stronger in Salvador (r=0.585; P<0.001) than in Fortaleza (r=0.236; P<0.001). In Fortaleza, although self-declared blacks had a greater proportion of European ancestry, they had more African ancestry than the other categories. When the populations were analyzed without pseudoancestors, as in some studies, the relationship of 'race' to genetic ancestry tended to diffuse or disappear. The inclusion of different African populations also influenced ancestry estimates. The percentage of unlinked ancestry informative markers in linkage disequilibrium, a measure of population structure, was 3-5 times higher in both Brazilian populations than expected by chance. We propose that certain methods, ascertainment bias and population history of the specific populations surveyed can result in failure to demonstrate a correlation between skin color and genetic ancestry. Population structure in Brazil has important implications for genetic studies, but genetic ancestry is irrelevant for how individuals are treated in society, their health, their income or their inclusion. These track more closely with perceived skin color than genetic ancestry.

intoxicação por raticidas foi mais incidente na zona urbana e no sexo feminino e, teve a tentativa de suicídio como circunstância predominante. Embora a maioria dos casos tenha evoluído para a cura, observou-se quase 40% de cura não confirmada na Região Sul e 57% de evolução ignorada na Sudeste. Os óbitos causados pela ingesta de raticidas foram abaixo de 5%. A intoxicação por raticidas vem se mantendo no Brasil com um problema de saúde pública importante e, apesar das diferenças existentes no país, o perfil das intoxicações não se alterou significativamente entre as distintas regiões.Descritores: envenenamento; rodenticidas; epidemiologia; saúde pública. Abstract:This work aims to analyze the epidemiological profile of human poisoning by rodenticides in Brazil and Regions, in the period 2000 to 2008. This is a descriptive epidemiological study based on secondary data from the National System of Toxic-Pharmacological Information. Calculations were performed in the incidence rate and fatality rate. The North and Northeast regions had the highest mortality rates for the period. Children from 1 to 4 years had high incidence in all regions except in Northeast, where teenagers were most affected. The rodenticide poisoning was more incident in urban areas and among females, and had attempt suicide as predominant circumstance. Although most cases have evolved for healing, there was almost 40%

RESUMORelato de dois casos, incluindo um óbito, associados ao botulismo, onde houve dificuldade no diagnóstico da doença e falta de integração entre a vigilância sanitária e a vigilância epidemiológica. O objetivo é alertar profissionais para a seriedade deste agravo e refletir sobre as práticas de vigilância da saúde encontradas. Palavras-chaves: Botulismo. Vigilância epidemiológica. Vigilância sanitária. ABSTRACTA report on two cases of botulism, one fatal, in which disease diagnosis was difficult and collaboration between public health and epidemiological surveillance services was poor. The objective of this report is to warn professionals of the seriousness of this disease and to reflect on existing public health surveillance practices. Key-words: Botulism. Epidemiological surveillance. Public health surveillance.O botulismo tem distribuição mundial. Acomete pessoas isoladas ou causa surtos familiares, geralmente relacionados à produção e a conservação dos alimentos. É considerado um problema de saúde pública devido a sua gravidade e alta letalidade.Do latim botulus que significa embutido, o nome botulismo deve-se ao fato de no Século VIII esta doença ter sido associada ao consumo de embutidos 4 . Apesar de ainda ser considerada, pelo senso comum, como uma doença causada pelo consumo de embutidos ou enlatados, o botulismo pode acontecer, também, por contaminação de outros tipos de alimentos e por outras formas de contaminação. O Centers for Disease Control and Prevention (CDC) classifica o botulismo em quatro categorias epidemiológicas: a) botulismo por intoxicação alimentar; b) botulismo infantil; c) botulismo por lesão; d) botulismo indeterminado 2 . É uma doença de início súbito, causada pela toxina de um bacilo anaeróbio denominado Clostridium botulinum. Atualmente são conhecidas oito variedades de toxinas botulínicas com características imunológicas distintas: A, B, C1, C2, D, E, F e G. Dentre essas, são patogênicas para o homem: as do tipo A, B, E e F. A evolução do quadro clínico está relacionada à quantidade de toxinas circulantes, e a letalidade se relaciona ao período de incubação: quanto mais curto, maior o risco de morte 3 .A toxina botulínica atua sobre o sistema nervoso periférico bloqueando a transmissão neuromuscular, atingindo as membranas pré-sinápticas, onde atua impedindo a liberação da acetilcolina nas terminações nervosas, ocasionando a paralisia 4 .Em todas as formas o quadro clínico é basicamente o mesmo. Inicialmente, os sinais e sintomas são gastrintestinais: náuseas, vômitos, diarréia e dor abdominal. O quadro neurológico se instala com manifestações de cefaléia, vertigem,