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Low quality drinking water has been directly correlated to the occurrence of waterborne illnesses in northern Brazil. To minimize health risks related to the water supply, the Ministry of Health has proposed the implementation of the National Program for the Surveillance of Drinking Water Quality (VIGIAGUA) in Brazilian municipalities. Focusing on the Legal Amazon region, the present study demonstrates a historical account of the percentage of municipalities included in the VIGIAGUA program in place, which in 2013 reached 45.1% of the region municipalities. This study also identifies vulnerable areas in terms of the water quality in the states of Amapá, Amazonas and Maranhão. With this analysis of the current status of the drinking water supply, this study intends to support and direct the strategic efforts of environmental health monitoring in the region. Resumo A baixa qualidade da água para consumo humano está diretamente relacionada à ocorrência de doenças de transmissão hídrica. Para minimizar riscos à saúde e vulnerabilidades relacionadas ao abastecimento de água, o Ministério da Saúde propõe a implantação do Programa Nacional de Vigilância da Qualidade da Água para Consumo Humano (Vigiagua) aos municípios brasileiros. Focando na região da Amazônia Legal, o presente estudo demonstra uma série histórica do percentual de municípios com o programa Vigiagua implantado, atingindo em 2013 a marca de 45,1% dos municípios dessa região. O estudo ainda identifica áreas muito vulneráveis nos estados do Amapá, Amazonas e Maranhão para a questão da qualidade da água. Com esta análise da situação do abastecimento de água para consumo humano pretende-se subsidiar e direcionar as ações estratégicas da vigilância em saúde ambiental na região.

Paracoccidioidomycosis (PCM) is an endemic mycosis in Latin America caused by the dimorphic fungus Paracoccidioides brasiliensis. The pattern of the immune responses to P. brasiliensis determines the disease progression and clinical outcome. Innate immune response is mediated by phagocytic cells, such as macrophage and neutrophils, which ingest and kill invading pathogens and then trigger the adaptive immune system through the secretion of cytokines and chemokines. The C-type like lectin receptors (CLR) and Toll-like receptors (TLRs) are the two main pattern recognition receptors in phagocytic cells that recognize fungal components. Therefore, the purpose of the present study was to evaluate the expression of TLR-1, TLR-2, TLR-4 and dectin-1 (CLR) in monocytes and neutrophils from healthy individuals after stimulation with Pb18 (high virulence) and Pb265 (low virulence) yeasts of P. brasiliensis. As positive controls we used specific ligands to TLR-4 (LPS), TLR-2 and dectin-1 (zymosan). Our results demonstrated a decreased of TLRs and dectin-1 expression mainly on monocytes as opposes on neutrophils, as soon as 30 minutes after yeast cells stimulation. This decrease was similar to the one caused by zymosan stimulation and indicates that up binding the complexes are rapidly internalized. There was a tendency towards an increased TLR2 and dectin-1 mRNA expression in response to fungal cells, mainly to Pb265. P. brasiliensis yeast cells induced the production of pro-inflammatory and anti-inflammatory cytokines, but the low ratio between TNF-alpha and IL-10 in response to zymosan and Pb265 indicates a balanced production of IL-10 and TNF-alpha, while Pb18 predominantly induced TNF-alpha secretion. Fungal cells also induced an elevated production of PGE(2) by monocytes and neutrophils showing their potential to provoke an intense inflammatory response. Altogether our results suggest the participation of TLR2, TLR-4 and dectin-1 in P. brasiliensis recognition, internalization and consequent activation of the immune response against the fungus. Moreover, the preferential recognition of zymosan and Pb265 by TLR-2 and dectin-1 would result in the production of adequate concentration of IL-10, which would be able to counterbalance the excessive inflammatory response mediated by TNF-alpha and PGE2. With these attributes the low virulence strain of P. brasiliensis would induce a controlled immune response beneficial to the host.

Water is essential for the socio-economic development of a region and also for the survival of human beings. Water scarcity has direct and indirect impacts on the environment, the economy and human health. It can change the profile of morbidity and mortality of diseases, as well as having an impact on the supply of services that are essential public to the quality of life. This study aims to contextualize the occurrence of drought in Brazil, its effects on human health, as well as actions to be developed by the health sector to reduce the risk to those living in affected areas, with an emphasis on the monitoring of the quality of drinking water. This is a descriptive, qualitative study with a documental basis. The documents that were researched were related to initiatives by the Health Surveillance Secretariat of the Ministry of Health up until 2014. It is necessary to strengthen the performance capacity of the Unified Health System (SUS) in order to develop timely responses to reduce the risk to public health.

Orientadores: Maria Heloisa Souza Lima Blotta, Ronei Luciano Mamoni Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas Resumo: A paracoccidioidomicose é uma micose sistêmica causada pelo fungo dimórfico Paracoccidioides brasiliensis, que pode apresentar-se sob diferentes formas clínicas, dependendo da resposta imunológica do hospedeiro. Trabalhos recentes têm demonstrado a importância da resposta inata no direcionamento da resposta adaptativa. Células do sistema imune inato reconhecem patógenos por meio de receptores de reconhecimento padrão (PRRs). Dentre esses, podemos destacar a família dos receptores do tipo Toll (TLRs) e dos receptores de lectina do tipo C (CLRs), que possuem membros capazes de reconhecer antígenos fúngicos. Nosso trabalho teve por objetivo avaliar a expressão de TLR-1, TLR-2, TLR-4 e dectina-1 (CLR) em macrófagos e neutrófilos de indivíduos saudáveis, após exposição a células leveduriformes das cepas de alta (Pb 18) e baixa (Pb265) virulência de P. brasiliensis. Como controle positivo foram utilizados os ligantes específicos para TLR-4 (LPS) e TLR-2 e dectina-1 (zimosan). A análise por citometria de fluxo revelou a redução da expressão de TLRs e dectina-1, mais evidente em monócitos do que em neutrófilos e após 30 minutos de estimulação, indicando que o reconhecimento dos antígenos fúngicos resulta na rápida internalização dos receptores. Houve uma tendência a um aumento da expressão relativa do RNAm de TLR-2 e dectina-1 em resposta à estimulação fúngica, em especial à cepa Pb265. A análise da produção de citocinas (RNAm e proteína) mostrou que as células fúngicas induzem a produção de citocinas inflamatórias e anti-inflamatórias, mas razão TNF-a/IL-10 diminuída em resposta ao zimosan e leveduras Pb265 indica uma produção relativa maior IL-10 nestas condições, enquanto que o estímulo com Pb18 privilegia a produção de TNF-a. Leveduras de P. brasiliensis também estimulam a elevada produção de PGE2 tanto por macrófagos como por neutrófilos, indicando a importância deste mediador na relação parasita-hospedeiro. Em conjunto, nossos resultados sugerem a participação do TLR-2, TLR-4 e dectina-1 no reconhecimento e internalização do fungo, e conseqüente ativação da resposta imunológica ao P. brasiliensis. Além disso, no caso da infecção por Pb265 a indução de uma resposta inflamatória exacerbada seria contrabalançada pela maior produção de IL-10, o que levaria a um melhor controle da infecção pelo hospedeiro. Abstract: Paracoccidioidomycosis (PCM) is an endemic mycosis in Latin America caused by the dimorphic fungus Paracoccidioides brasiliensis. The pattern of the immune responses to P. brasiliensis determines the disease progression and clinical outcome. Innate immune response is mediated by phagocytic cells, such as macrophage and neutrophils, which ingest and kill invading pathogens and then trigger the adaptive immune system through the secretion of cytokines and chemokines. The C-type like lectin receptors (CLR) and Toll-like receptors (TLRs) are the two main PRRs for fungal cells. The purpose of the present study was to evaluate the expression of TLR-1, TLR-2, TLR-4 and dectin-1 (CLR) in monocytes and neutrophils from healthy individuals after stimulation with Pb18 (high virulence) and Pb265 (low virulence) yeasts of P. brasiliensis. As positive controls we used specific ligands to TLR-4 (LPS), TLR-2 and dectin-1 (zymosan). Our results demonstrated a decreased of TLRs and dectin-1 expression more evident on monocytes than on neutrophils as soon as 30 minutes after yeast cells stimulation. This decrease was similar to the one caused by zymosan stimulation and indicates that up binding the complexes are rapidly internalized. There was a tendency towards an increased TLR2 and dectin-1 mRNA expression in response to fungal cells, mainly Pb265. P. brasiliensis yeast cells induced the production of proinflammatory and antinflammatory cytokines (mRNA and protein) but the low ratio between TNF-a and IL-10 in response to zymosan and Pb265 point out to a preferential production of IL-10, while Pb18 predominantly induced TNF-a secretion. P. brasiliensis yeast cells also induced an elevated PGE2 production by monocytes and neutrophils showing the important role of this mediator in fungushost relationship. Altogether our results suggest the participation of TLR2, TLR-4 and dectin-1 in P. brasiliensis recognition and internalization and consequent activation of the immune response against the fungus. Moreover, concerning Pb265 stimulation the induction of an exacerbate inflammatory response could be counterbalanced by an increased IL-10 production, resulting in an efficient control of the infection by the host. Mestrado Ciências Biomédicas Mestre em Ciências Médicas