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Fascioliasis is caused by the genetically and phenotypically very close Fasciola hepatica and F. gigantica. The latter, always considered secondary in human infection, appears nowadays increasingly involved in human endemic areas of Africa and Asia. Unfortunately, little is known about the pathogenicity of this liver fluke species, mainly due to difficulties assessing the moment of a patient's infection in the anamnesis and in the differential diagnosis with F. hepatica. This is the first experimental study comparing F. hepatica and F. gigantica in a long-term study of up to 24 weeks with genotypically and phenotypically standardised fluke strains in the same animal model host, the Guirra sheep breed susceptible to both species. Serum biochemical parameters of liver damage (aspartate aminotransferase AST, alanine aminotransferase ALT, γ-glutamyl transferase GGT, total bilirubin, alkaline phosphatase AP), serum electrolytes (calcium, chloride, phosphore), protein metabolism (creatinine, blood urea nitrogen), plasma proteins (albumin, total proteins), carbohydrate metabolism (glucose, amylase), hepatic lipid metabolism (total cholesterol, triglycerides) and inflammation (C-reactive protein), were analysed on a biweekly basis as morbidity indicators. Serum anti-Fasciola IgG, coproantigen and egg shedding were simultaneously followed up. DNA sequencing of rDNA ITS-2 and ITS-1 and mtDNA cox1 and nad1, as well as the morphometric study by CIAS, showed the two fasciolid strains used to fit respective standard species characteristics. Results demonstrated that F. gigantica is more pathogenic than F. hepatica, mostly due to its bigger size. Fasciola gigantica shows a delayed development of 1-2 weeks regarding both biliary phase and beginning of egg laying, with the respective consequences on the biochemical marker profile modifications in both the acute and chronic periods. A review on the physiopathogenicity by F. gigantica compared to that by F. hepatica is made. A biochemical marker baseline for human infection by F. gigantica is proposed to help physicians and health officers in F. gigantica human endemic areas. Fascioliasis is caused by the genetically and phenotypically very close Fasciola hepatica and F. gigantica. The latter, always considered secondary in human infection, appears nowadays increasingly involved in human endemic areas of Africa and Asia. Unfortunately, little is known about the pathogenicity of this liver fluke species, mainly due to difficulties assessing the moment of a patient's infection in the anamnesis and in the differential diagnosis with F. hepatica. This is the first experimental study comparing F. hepatica and F. gigantica in a long-term study of up to 24 weeks with genotypically and phenotypically standardised fluke strains in the same animal model host, the Guirra sheep breed susceptible to both species. Serum biochemical parameters of liver damage (aspartate aminotransferase AST, alanine aminotransferase ALT, γ-glutamyl transferase GGT, total bilirubin, alkaline phosphatase AP), serum electrolytes (calcium, chloride, phosphore), protein metabolism (creatinine, blood urea nitrogen), plasma proteins (albumin, total proteins), carbohydrate metabolism (glucose, amylase), hepatic lipid metabolism (total cholesterol, triglycerides) and inflammation (C-reactive protein), were analysed on a biweekly basis as morbidity indicators. Serum anti-Fasciola IgG, coproantigen and egg shedding were simultaneously followed up. DNA sequencing of rDNA ITS-2 and ITS-1 and mtDNA cox1 and nad1, as well as the morphometric study by CIAS, showed the two fasciolid strains used to fit respective standard species characteristics. Results demonstrated that F. gigantica is more pathogenic than F. hepatica, mostly due to its bigger size. Fasciola gigantica shows a delayed development of 1-2 weeks regarding both biliary phase and beginning of egg laying, with the respective consequences on the biochemical marker profile modifications in both the acute and chronic periods. A review on the physiopathogenicity by F. gigantica compared to that by F. hepatica is made. A biochemical marker baseline for human infection by F. gigantica is proposed to help physicians and health officers in F. gigantica human endemic areas.

The relationship between sanitation policies (access and quality) and health in Brazilian municipalities was estimated from 2003 to 2010 using a panel data model with corrections for missing data. The results suggest a limited effect of sanitation policy on health. Compared with results from the literature, we found that the worsening quality of water appears to be associated with increased rates of mortality and hospitalization for children up to one month of age. Improvements in sewage sanitation have reduced the mortality and morbidity rates in children aged one to four. Improved access to piped water is associated with decreased hospitalization related to dysentery and acute respiratory infections (ARI) and does not have an effect on child mortality. Finally, epidemiological transition is only supported by weak evidence, including a more intense effect of reduced access to sanitation in municipalities with the worst mortality and morbidity indicators. In most models, this theory has been rejected

This paper investigates the effects of sanitation policies on health indicators in a panel of Brazilian municipalities. Specifically, we use DataSUS, the IBGE, and the SNIS to assess whether the indicators of sanitation affect the health indicators of mortality and morbidity by age group and by different diseases in the municipalities from 2001 to 2008. We work with different samples due to an unbalanced panel because there are missing data on sanitation in smaller municipalities and for lower income people. The results show that we cannot ignore the importance of sanitation. Our results indicate that for the entire sample, a 1% reduction in the incidence of total coliform implies a decline of 0.12 deaths for children under one year of age, including the neonatal period, for every thousand live births. Regarding hospitalization due to illness, only improvement in access to water and a reduction in total coliforms seem to reduce hospitalization for dysentery (for access to water) and hepatitis and tuberculosis (for total coliforms). Access to sewage services seems to reduce the mortality of children up to four years of age and hospitalizations of children aged five to nine years in poor municipalities. Finally, access to water and sewers appears to reduce hospitalizations due to dysentery and hepatitis in municipalities with an income above the median in Brazil.

Neste estudo, foi avaliado o desempenho isolado e combinado de parâmetros laboratoriais, percentual de linfócitos B (%LB), a razão entre células T/B e o %CD8+HLA-DR+/CD8+, na identificação de indivíduos assintomáticos-AS ou portadores de HAM/TSP-HT numa população de casos soropositivos para HTLV-1. Índices expressos em porcentagem demonstram que cada parâmetro, isoladamente, apresenta desempenho moderado, com co-negatividade=83% e 91% para %LB e razão entre células T/B, respectivamente e co-positividade=78% para %CD8+HLA-DR+/CD8+. A análise combinada (%CD8+HLA-DR+/CD8+ e razão T/B) não revelou ganho significativo no desempenho (co-positividade=75%, co-negatividade=74%). A análise das razões de verossimilhança em diferentes faixas de valores, para os parâmetros isolados, revelou que um indivíduo soropositivo para HTLV-1 com %LB11 e %CD8+HLA-DR+/CD8+>70% possui, respectivamente, 11, 19 e quase 10 vezes mais chances de pertencer ao grupo HT. Portanto, recomenda-se o uso desses indicadores fenótipos na propedêutica laboratorial complementar de monitoração da progressão clínica da infecção crônica pelo HTLV-1. This study evaluated the performance of single and combined laboratory parameters, B-lymphocyte percentages (%LB), T/B cell ratio and %CD8+HLA-DR+/CD8+, to differentiate asymptomatic cases (AS) from HAM/TSP patients (HT) within a population of HTLV-1 seropositive cases. Percentage indices demonstrated that each parameter alone presented moderate performance, with co-negativity of 83 and 91% for %LB and T/B cell ratio, respectively, and co-positivity of 78% for %CD8+HLA-DR+/CD8+. Combined analysis (%CD8+HLA-DR+/CD8+ and T/B cell ratio) did not show any substantial performance enhancement (co-positivity = 75% and co-negativity = 74%). Likelihood ratio analysis using different value ranges for the separate parameters revealed that HTLV-1 seropositive cases with %LB11 and %CD8+HLA-DR+/CD8+>70% would have, respectively, 11, 19 and 10 times greater chance of belonging to the HT group. Therefore, use of these phenotypic indicators as complementary laboratory methods for monitoring the clinical progression of chronic HTLV-1 infection is recommended.