This study aims to analyze the users' access to health services in a Basic Reference Unit (UBR) in a municipality of the metropolitan area of Belo Horizonte, Minas Gerais. The semi-structured interviews and questionnaire were conducted with 15 health professionals and 38 users respectively. The interviews addressed the local service, the health team, the users and the health services delivery network's characteristics. The questionnaire addressed users' sociodemographic and health characteristics. The interviews and questionnaires results analysis were presented on structural (financing, coverage), relational (comprehension of the health-illness process) and operational (service organization) dimensions. In the structural dimension, it was observed that the health system underfunding is a difficulty to the health services access and to the Family Health Strategy (ESF) implementation. In the relational dimension, it was observed that the lack of alignment regarding the structure and the health system operational flow impact negatively on the relationship between health professional and user. On the operational dimension, the health professionals and users reported significant shortcomings, such as the ESF coverage, appointment scheduling, reception, geographical barriers, referral and counter referral. The information obtained in this study is important to understand the factors associated to the health services access for the subject population and to help the developing strategies to improve the access.

An apparently paradoxical role for IFN-g in human Chagas' disease was observed when studying the pattern of cytokine production by peripheral blood mononuclear cells (PBMC) obtained from two groups of chagasic patients after specific stimulation with Trypanosoma cruzi-derived antigens. The groups studied were 1) patients treated with benznidazole during the acute phase of Trypanosoma cruzi infection and 2) chronically infected untreated patients. In the treated group, higher levels of IFN-g were produced by PBMC from individuals cured after treatment when compared to non-cured patients. In contrast, in the chronically infected group (not treated) higher levels of IFN-g were produced by PBMC from cardiac patients in comparison with asymptomatic (indeterminate) patients. This apparently paradoxical role for IFN-g in human Chagas' disease is discussed in terms of the possibility of a temporal difference in IFN-g production during the initial stages of the infection (acute phase) in the presence or absence of chemotherapy. The maintenance of an immune response with high levels of IFN-g production during the chronic phase of the infection may favor cure or influence the development of the cardiac form of the diseas

We recently evaluated the in vitro proliferative response and interferon (IFN)-gamma production of peripheral blood mononuclear cells from a group of 25 people who were treated for Chagas' disease during the acute phase of Trypanosoma cruzi infection and followed up for a period of 14-30 years. On the basis of the parasitological and serological tests, the individuals were classified as cured (C), dissociated, or not cured (NC). Members of group C (the group without cardiac alterations) presented significantly stronger proliferative response against the parasite antigens, with secretion of high levels of IFN-gamma in comparison with the NC group, raising a question about the role of this cytokine in the curing of human T. cruzi infection. Severe cardiac alterations were observed only in 1 of 25 patients, which suggests that treatment benefited the patients.

Ketoconazole, an azole antifungic drug which is already in the market has also been demonstrated to be active against Trypanosoma cruzi experimental infections. In this paper we confirmed the drug effect and investigated its range of activity against different T. cruzi strains naturally resistant or susceptible to both standard drugs Nifurtimox and Benznidazole used clinically in Chagas disease. Moreover, we have shown that the association of Ketoconazole plus Lovastatin (an inhibitor of sterol synthesis), which has an antiproliferative effect against T. cruzi in vitro, failed to enhance the suppressive effect of Ketoconazole displayed when administered alone to infected mice. Finally, administration in chronic chagasic patients of Ketoconazole at doses used in the treatment of deep mycosis also failed to induce cure as demonstrated by parasitological and serological tests. The strategy of identify and test drugs which are already in the market and fortuitously are active against T. cruzi has been discussed.

The sensitivity of hemocultures, performed once or three times, was investigated in 52 patients in the chronic phase of Chagas disease. Modifications were introduced in the technique such as, processing the blood more rapidly, gently homogenizing the cultures and examining them after 120 days of culture. Our results show a high percent age of positivity i.e. 79% and 94% of patients submitted, respectively, to one or three tests. No significant differences related to the patients age were detected, which varied from 14 to 82 years old. Our results demonstrate that hemoculture is a sensitive method for the parasitological diagnosis of Chagas disease and is ideal for monitoring cure in treated patients.

No abstract

Estudo avaliativo do grau de implantação do Sistema de Informações sobre Nascidos Vivos (SINASC) em municípios de Minas Gerais, Brasil, em 2010. Foram avaliados 132 municípios dotados de estabelecimentos de saúde onde ocorriam partos e que tinham o SINASC descentralizado. Para a coleta de dados, utilizou-se um questionário semiestruturado. O grau de implantação foi definido por meio de um sistema de escores, com pesos diferenciados para cada indicador, segundo nível de importância atribuído, sendo classificado como: adequado, não adequado e crítico. Para a análise dos dados, utilizou-se a mediana como medida-resumo e o teste do quiquadrado de Pearson, para a comparação de proporções. O SINASC não está implantado adequadamente na maioria dos municípios avaliados. O porte populacional e a condição de gestão do município não influenciaram o grau de implantação. Na organização da informação do SINASC, a estrutura foi mais bem avaliada que o processo. Como limitações, destacam-se insuficiência de profissional qualificado, coleta e preenchimento da Declaração de Nascidos Vivos insatisfatórios, subutilização dos dados e precária divulgação das informações.

CL has a moderate to large negative effect on QoL.