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Adherence to treatment is a challenge in controlling tuberculosis. The protection factors (interest in treatment and information about the disease) and recognition that drug use is a risk factor must form part of the strategies for patient care in order to reduce dropout rates and restore health.

ResumoA maioria dos casos de tentativa de suicídio é atendida em serviços médicos de emergência, o que deveria ser uma excelente oportunidade para que os profissionais de saúde realizassem alguma intervenção preventiva e terapêutica. No entanto, nem sempre essa oportunidade é aproveitada pela equipe, que geralmente exibe condutas caracterizadas por hostilidade e rejeição. Este trabalho pretende investigar, a partir da percepção do usuário, como se dá o acolhimento ao indivíduo que tenta suicídio e sugerir estratégias que possam favorecer o vínculo com a equipe de saúde. Trata-se de um estudo descritivo com abordagem qualitativa, desenvolvido com pacientes ambulatoriais referenciados pelo serviço de urgência de Barbacena, Minas Gerais. Foram entrevistadas 28 mulheres com histórico de tentativa de suicídio. A identificação e a classificação das unidades de análise fizeram emergir três categorias: discriminação, negação do ato, encaminhamento. Cada categoria foi submetida à análise qualitativa. A baixa capacitação das equipes de atendimento e as deficiências estruturais dos serviços induzem os profissionais a se posicionarem de maneira impessoal e com dificuldade de atuação de forma humanizada. A análise dos dados indica a necessidade de melhorar a formação dos profissionais da saúde, em especial os que trabalham nos serviços de pronto atendimento.Palavras-chave: tentativa de suicídio; pesquisa qualitativa; saúde mental; medicina de emergência. AbstractMost cases of suicide attempt are attended in emergency medical services, which should be an excellent opportunity for health professionals to carry out any preventive and therapeutic intervention. However, this kind of opportunity is not always used by the team, which usually exhibits behaviors characterized by hostility and rejection. This study intends to investigate, from the user perception, how is the support to the individual who attempts suicide and suggest strategies that can promote bonding with the healthcare team. This is a descriptive study with a qualitative approach, developed in outpatients referenced by the emergency department of Barbacena, Minas Gerais. We interviewed 28 women with suicide attempt history. The units identification and classification analysis have raised three categories: discrimination, the act of denial, referral. Each category was submitted to qualitative analysis. The low level of training of the care teams and the structural weaknesses of the services induce the professionals to act impersonally, with many difficulties on acting in a humane way. Data analysis indicates the need of improvement on training of health professionals, especially those working in emergency care.

Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.

Herein we have employed an alternative strategy to assess the cytokine patterns of circulating leukocytes and correlate dominant cytokine profiles with indeterminate‐IND and cardiac‐CARD clinical forms of Chagas disease. We have first calculated median percentages of cytokine‐positive leukocytes of our study sample to establish, for each cytokine‐positive cell population, the cut‐off edge that would segregate ‘low’ and ‘high’ cytokine producers to build colour diagrams and draw a panoramic cytokine chart. Using this approach we demonstrated that most IND individuals presented a dominant regulatory cytokine profile, whereas CARD individuals displayed a dominant inflammatory cytokine pattern. In addition, radar chart analysis confirmed the dichotomic cytokine balance between IND and CARD groups and further allowed the identification of the relative contribution of each cell population for the global cytokine pattern. Data analysis demonstrated that CD4+ T cells were the major cell population defining the regulatory profile in IND, whereas monocytes and CD4+ T cells determined the inflammatory cytokine pattern in CARD individuals. Interestingly, in vitro stimulation with trypomastigote Trypanosoma cruzi antigen was able to invert the cytokine balances in IND and CARD groups. Upon antigenic stimulation, changes in the frequencies of IL‐10‐producing CD4+ T cells and monocytes drove IND individuals towards an inflammatory pattern and CARD towards a regulatory cytokine profile. A similar inversion could be found after in vivo treatment of IND and CARD individuals with benzonidazole. Altogether, these findings shed some light into the complex cytokine network underlying the immunopathogenesis of Chagas disease and provide putative immunological biomarkers of disease severity and therapeutic response.

Therapeutic failure of benznidazole (BZ) is widely documented in Chagas disease and has been primarily as-

RESUMO O estudo caracterizou a violência contra idosos, a partir de denúncias e notificações registradas no Disque Direitos Humanos e Sistema de Informação de Agravos de Notificações (Sinan) em 2011 e 2012. Ocorreram 2.337 denúncias (13%) e 1.886 notificações (5%) contra idosos. A taxa de denúncia aumentou três vezes, e a de notificação duplicou no período. Verificou-se que as vítimas, na maioria, são mulheres, agredidas no domicílio (90%) por conhecidos (90%), com predomínio (80%) da tipologia por negligência/abandono, nas duas fontes. O aprimoramento da vigilância contribui para revelar a violência em todos os seus disfarces, efetivar políticas públicas e estimular reflexão/ação da sociedade.

Our research aimed to characterize the genetic profiles of 102 Trypanosoma cruzi isolates recently obtained from 44 chronic chagasic patients from different regions of the states of Minas Gerais and Goiás in Brazil. At least two isolates were obtained from each patient at different times in order to study the parasite population dynamics during disease progression in the chronic phase. The isolates were characterized molecularly by genotyping the 3 region of the 24S␣ rRNA, the mitochondrial cytochrome oxidase subunit 2 (COII) gene, and the intergenic region of the spliced leader intergenic region (SL-IR) gene. Seventy-seven isolates were analyzed for nine microsatellite loci. The data presented here show a strong correlation between the T. cruzi lineage II (T. cruzi II) and human infection in these regions of Brazil. Interestingly, isolates from two patients were initially characterized (by rRNA genotyping) as T. cruzi I and hybrid strains, but subsequent analyses of the COII and SL-IR genes confirmed that those isolates belonged to T. cruzi III and a hybrid group, respectively. Our results confirm the risk of misclassifying T. cruzi isolates on the basis of analysis of a single molecular marker. The microsatellite profiles showed that different isolates obtained from the same patient were genetically identical and monoclonal. Exceptions were observed for T. cruzi isolates from two patients who presented differences for the SCLE11 locus and also from two other patients who showed amplification of three peaks for a microsatellite locus (TcAAAT6), implying that they were multiclonal. On the basis of the findings of the studies described here, we were not able to establish a correlation between the clinical forms of Chagas' disease and the genetic profiles of the T. cruzi isolates.