Understanding the clinical spectrum of complicated Plasmodium vivax malaria: a systematic review on the contributions of the Brazilian literature

The resurgence of the malaria eradication agenda and the increasing number of severe manifestation reports has contributed to a renewed interested in the Plasmodium vivax infection. It is the most geographically widespread parasite causing human malaria, with around 2.85 billion people living under risk of infection. The Brazilian Amazon region reports more than 50% of the malaria cases in Latin America and since 1990 there is a marked predominance of this species, responsible for 85% of cases in 2009. However, only a few complicated cases of P. vivax have been reported from this region. A systematic review of the Brazilian indexed and non-indexed literature on complicated cases of vivax malaria was performed including published articles, masters' dissertations, doctoral theses and national congresses' abstracts. The following information was retrieved: patient characteristics (demographic, presence of co-morbidities and, whenever possible, associated genetic disorders); description of each major clinical manifestation. As a result, 27 articles, 28 abstracts from scientific events' annals and 13 theses/dissertations were found, only after 1987. Most of the reported information was described in small case series and case reports of patients from all the Amazonian states, and also in travellers from Brazilian non-endemic areas. The more relevant clinical complications were anaemia, thrombocytopaenia, jaundice and acute respiratory distress syndrome, present in all age groups, in addition to other more rare clinical pictures. Complications in pregnant women were also reported. Acute and chronic co-morbidities were frequent, however death was occasional. Clinical atypical cases of malaria are more frequent than published in the indexed literature, probably due to a publication bias. In the Brazilian Amazon (considered to be a low to moderate intensity area of transmission), clinical data are in accordance with the recent findings of severity described in diverse P. vivax endemic areas (especially anaemia in Southeast Asia), however in this region both children and adults are affected. Finally, gaps of knowledge and areas for future research are opportunely pointed out

Validation of Self-Reported Information on Dental Caries in a Birth Cohort at 18 Years of Age

Estimate the prevalence of dental caries based on clinical examinations and self-reports and compare differences in the prevalence and effect measures between the two methods among 18-year-olds belonging to a 1993 birth cohort in the city of Pelotas, Brazil.Data on self-reported caries, socio-demographic aspects and oral health behaviour were collected using a questionnaire administered to adolescents aged 18 years (n = 4041). Clinical caries was evaluated (n = 1014) by a dentist who had undergone training and calibration exercises. Prevalence rates of clinical and self-reported caries, sensitivity, specificity, positive and negative predictive values, absolute and relative bias, and inflation factors were calculated. Prevalence ratios of dental caries were estimated for each risk factor.The prevalence of clinical and self-reported caries (DMFT>1) was 66.5% (95%CI: 63.6%-69.3%) and 60.3% (95%CI: 58.8%-61.8%), respectively. Self-reports underestimated the prevalence of dental caries by 9.3% in comparison to clinical evaluations. The analysis of the validity of self-reports regarding the DMFT index indicated high sensitivity (81.8%; 95%CI: 78.7%-84.7%) and specificity (78.1%; 95%CI: 73.3%-82.4%) in relation to the gold standard (clinical evaluation). Both the clinical and self-reported evaluations were associated with gender, schooling and self-rated oral health. Clinical dental caries was associated with visits to the dentist in the previous year. Self-reported dental caries was associated with daily tooth brushing frequency.Based on the present findings, self-reported information on dental caries using the DMFT index requires further studies prior to its use in the analysis of risk factors, but is valid for population-based health surveys with the aim of planning and monitoring oral health actions directed at adolescents

Biogeochemical cycling in terrestrial ecosystems of the Caatinga Biome

The biogeochemical cycles of C, N, P and water, the impacts of land use in the stocks and flows of these elements and how they can affect the structure and functioning of Caatinga were reviewed. About half of this biome is still covered by native secondary vegetation. Soils are deficient in nutrients, especially N and P. Average concentrations of total soil P and C in the top layer (0-20 cm) are 196 mg kg-1 and 9.3 g kg-1, corresponding to C stocks around 23 Mg ha-1. Aboveground biomass of native vegetation varies from 30 to 50 Mg ha-1, and average root biomass from 3 to 12 Mg ha-1. Average annual productivities and biomass accumulation in different land use systems vary from 1 to 7 Mg ha-1 year-1. Biological atmospheric N2 fixation is estimated to vary from 3 to 11 kg N ha-1 year-1and 21 to 26 kg N ha-1 year-1 in mature and secondary Caatinga, respectively. The main processes responsible for nutrient and water losses are fire, soil erosion, runoff and harvest of crops and animal products. Projected climate changes in the future point to higher temperatures and rainfall decreases. In face of the high intrinsic variability, actions to increase sustainability should improve resilience and stability of the ecosystems. Land use systems based on perennial species, as opposed to annual species, may be more stable and resilient, thus more adequate to face future potential increases in climate variability. Long-term studies to investigate the potential of the native biodiversity or adapted exotic species to design sustainable land use systems should be encouraged