Zika virus (ZIKV) infection is spreading rapidly within the Americas after originating from an outbreak in Brazil. We describe the current ZIKV infection epidemic in Brazil and the neurological symptoms arising. First cases of an acute exanthematic disease were reported in Brazil’s Northeast region at the end of 2014. In March 2015, autochthonous ZIKV was determined to be the causative agent of the exanthematic disease. As cases of neurological syndromes in regions where ZIKV, dengue and/or Chikungunya viruses co-circulate were reported, ZIKV was also identified in the cerebrospinal fluid of patients with acute neurological syndromes and previous exanthematic disease. By the end of September 2015, an increasing number of infants with small head circumference or microcephaly were noted in Brazil’s Northeast which was estimated to be 29 cases between August and October. ZIKV was identified in blood and tissue samples of a newborn and in mothers who had given birth to infants with microcephaly and ophthalmological anomalies. In 2015, there were an estimated 440,000 - 1,300,000 Zika cases in Brazil. There have been 4,783 suspected cases of microcephaly, most of them in the Northeast of Brazil associated with 76 deaths. The Ministry of Health is intensifying control measures against the mosquito Aedes aegypti and implemented intensive surveillance actions. Further studies are needed to confirm the suspected association between ZIKV infection and microcephaly; to identify antiviral, immunotherapy, or prophylactic vaccine; to introduce diagnostic ELISA testing. Clinical and epidemiological studies must be performed to describe viral dynamics and expansion of the outbreak.

RESUMO INTRODUÇÃO Apesar dos altos índices de depressão e ansiedade, os profissionais de saúde ainda têm dificuldades em lidar com essas enfermidades, principalmente quando envolvem os estudantes universitários e profissionais da área da saúde. OBJETIVO Estimar a prevalência e os fatores associados à depressão e ansiedade em estudantes universitários da área da saúde. MÉTODOS Foi realizado um estudo transversal analítico com alunos do primeiro ano dos cursos da saúde (Biomedicina, Enfermagem, Fisioterapia, Medicina e Odontologia) de um Centro Universitário no Ceará. Foram aplicados três questionários. O primeiro envolvia aspectos sociodemográficos; o segundo foi o Inventário de Depressão Beck (BDI) (adaptação e padronização brasileira); e o terceiro, o Inventário de Ansiedade Beck (BAI) (adaptação e padronização brasileira). Os dados foram digitados utilizando-se o software Epi-info, versão 3.5.1. e analisados no Stata 11.2. Análise bivariada foi realizada para as associações entre as variáveis por meio da Razão de Prevalência (RP), sendo calculados seus respectivos intervalos de confiança e considerados significativos aqueles que apresentaram um p < 0,05. O projeto foi aprovado pelo CEP, por meio do CAAE nº 1.132.140, de 30 de junho de 2015. RESULTADOS Responderam aos questionários 476 estudantes. Predominou o sexo feminino (71,6%), estudantes com menos de 20 anos de idade (69,3%) e solteiros (92,0%). As prevalências de depressão e ansiedade foram de 28,6% e 36,1%, respectivamente. Estudantes menos satisfeitos com o curso apresentaram chance quase quatro vezes maior de terem depressão (p < 0,001). Destacaram-se ainda fatores de risco como relacionamento familiar insatisfatório (p < 0,001), quantidade insuficiente de sono (p = 0,006) e relacionamento com amigos insatisfatório (p < 0,001). A prevalência de ansiedade esteve mais associada ao sexo feminino (p < 0,001) e entre os estudantes que apresentaram relacionamento insatisfatório com familiares (p < 0,001), amigos (p = 0,005) e colegas (p < 0,001). Apresentar insônia (p < 0,001), não fazer atividade física (p = 0,040) e maior preocupação com o futuro (p = 0,002) também apresentaram associação significativa com um quadro de ansiedade. CONCLUSÃO As prevalências de ansiedade e depressão entre os estudantes da área da saúde foram muito superiores às da população em geral, tendo os estudantes do curso de Fisioterapia apresentado o resultado mais alto.

Chikungunya (CHIK) is a re-emerging viral infection endemic in tropical and subtropical areas. While the typical clinical presentation is an acute febrile syndrome, long-term articular complications and even death can occur. This review characterizes the global epidemiological and economic burden of chikungunya. The search included studies published from 2007 to 2022 in MEDLINE, Embase, LILACS, and SciELO for a thorough evaluation of the literature. Rayyan software was used for data analysis, and data were summarized descriptively and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventy-six publications were included. Chikungunya is widely distributed in the tropics, including Africa, Asia, South America, and Oceania/the Pacific Islands, and co-circulates with other simultaneous arboviruses such as DENV, ZIKV, and YFV. Chikungunya infection can lead to chronic articular manifestations with a significant impact on the quality of life in the long term. In addition, it generates absenteeism and economic and social losses and can cause fatal infections in vulnerable populations, mainly in high-risk patients with co-morbidities and at the extremes of age. Reported costs associated with CHIKV diseases are substantial and vary by region, age group, and public/private delivery of healthcare services. The chikungunya disease burden includes chronicity, severe infections, increased hospitalization risks, and associated mortality. The disease can impact the economy in several spheres, significantly affecting the health system and national economies. Understanding and measuring the full impact of this re-emerging disease is essential.

The role played by different mammal species in the maintenance of Trypanosoma cruzi is not constant and varies in time and place. This study aimed to characterise the importance of domestic, wild and peridomestic hosts in the transmission of T. cruzi in Tauá, state of Ceará, Caatinga area, Brazil, with an emphasis on those environments colonised by Triatoma brasiliensis. Direct parasitological examinations were performed on insects and mammals, serologic tests were performed on household and outdoor mammals and multiplex polymerase chain reaction was used on wild mammals. Cytochrome b was used as a food source for wild insects. The serum prevalence in dogs was 38% (20/53), while in pigs it was 6% (2/34). The percentages of the most abundantly infected wild animals were as follows: Thrichomys laurentius 74% (83/112) and Kerodon rupestris 10% (11/112). Of the 749 triatomines collected in the household research, 49.3% (369/749) were positive for T. brasiliensis, while 6.8% were infected with T. cruzi (25/369). In captured animals, T. brasiliensis shares a natural environment with T. laurentius, K. rupestris, Didelphis albiventris, Monodelphis domestica, Galea spixii, Wiedomys pyrrhorhinos, Conepatus semistriatus and Mus musculus. In animals identified via their food source, T. brasiliensis shares a natural environment with G. spixii, K. rupestris, Capra hircus, Gallus gallus, Tropidurus oreadicus and Tupinambis merianae. The high prevalence of T. cruzi in household and peridomiciliar animals reinforces the narrow relationship between the enzootic cycle and humans in environments with T. brasiliensis and characterises it as ubiquitous.

Hydroxychloroquine (HCQ) has been used for the treatment of novel coronavirus disease (COVID-19) cases. However, evidence of efficacy remains limited, and adverse events can be associated with its use. Here, we report a case of a patient with severe COVID-19 who, after being administered HCQ, exhibited a 10-fold increase in serum levels of transaminases, followed by a rapid decrease after HCQ was withdrawn. Considering the significantly increased use of HCQ during the COVID-19 pandemic, this case alerts us to the potential for HCQ to be associated with hepatotoxicity and the need to monitor liver function during HCQ therapy.

INTRODUCTION: The dengue hemorrhagic dengue (DHF) remains an important public health problem in Brazil. The objective of this study was to analyze the epidemiological characteristics of DHF cases during the 2003 epidemic in Ceará. METHODS: Suspected DHF cases with onset of symptoms between January and December 2003 were investigated. RESULTS: 37,964 classic dengue cases and 291 DHF cases were reported. Among the cases discarded, 75.5% were serologically positive but did not meet the criteria recommended by the World Health Organization (WHO). The DHF patients' median age was 30 years (2 - 88). Among the hemorrhagic manifestations, petechiae were the most (32.6%) frequent. Cases of gastrointestinal bleeding, ascites, pericardial pleural effusion, hepatomegaly, hypotension and shock showed higher risk of progression to death (p <0.05). CONCLUSIONS: The introduction of a new serotype (DENV-3) in Ceará, which encountered a susceptible population and high vector density, may have been the primary agent responsible for the magnitude of the epidemic. Timely and appropriate medical care, along with an organized care structure are essential for reducing its lethality.