Impact of parental attributes on the oral health-related quality of life of Brazilian preschool children

PURPOSE

Considering the importance of parental attitudes and their influence on children's oral health, it is important to know which characteristics may impact it. The aim of this population study was to evaluate the impact of the parental sociodemographic characteristics on the oral health-related quality of life (OHRQoL) of preschool children from southeastern Brazil.

METHODS

A population-based study was conducted with a sample of 321 children aged 2 to 5 years old who underwent a calibrated clinical oral examination to assess oral health status and their parents were asked to answer the two following questionnaires: (1) sociodemographic conditions and (2) Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). Descriptive analysis, Mann-Whitney and Kruskal-Wallis tests and adjusted Poisson regression models were used.

RESULTS

Younger mothers (RP: 1.47; 95% CI: 1.11-1.95), lower household income (RP: 1.47; 95% CI: 1.11-1.96) and the presence of dental caries (RP: 2.28; 95% CI: 1.74-3.0) were more likely to have a negative impact on the OHRQoL B-ECOHIS total scores (P < 0.01).

CONCLUSION

The characteristics of mothers, such as age, schooling and salary, influenced the mean B-ECOHIS total score; however, paternal attributes were not associated with a negative impact on the children's quality of life. Also, dental caries and household income influenced the children's oral health-related quality of life.

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data.

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data.

Effects of Hyperosmolality on Hypothalamic Astrocytic Area, mRNA Expression and Glutamate Balance In Vitro

During prolonged dehydration, body fluid homeostasis is challenged by extracellular fluid (ECF) hyperosmolality, which induce important functional changes in the hypothalamus, in parallel with other effector responses, such as the activation of the local renin-angiotensin system (RAS). Therefore, in the present study we investigated the role of sodium-driven ECF hyperosmolality on glial fibrillary acid protein (GFAP) immunoreactivity and protein expression, membrane capacitance, mRNA expression of RAS components and glutamate balance in cultured hypothalamic astrocytes. Our data show that hypothalamic astrocytes respond to increased hyperosmolality with a similar decrease in GFAP expression and membrane capacitance, indicative of reduced cellular area. Hyperosmolality also downregulates the transcript levels of angiotensinogen and both angiotensin-converting enzymes, whereas upregulates type 1a angiotensin II receptor mRNA. Incubation with hypertonic solution also decreases the immunoreactivity to the membrane glutamate/aspartate transporter (GLAST) as well as tritiated-aspartate uptake by astrocytes. This latter effect is completely restored to basal levels when astrocytes previously exposed to hypertonicity are incubated under isotonic conditions. Together with a direct effect on two important local signaling systems (glutamate and RAS), these synaptic rearrangements driven by astrocytes may accomplish for a coordinated increase in the excitatory drive onto the hypothalamic neurosecretory system, ultimately culminating with increased AVP release in response to hyperosmolality.

Abstract P2-08-13: Survival in women with de novo metastatic breast cancer: Comparison of real-world evidence from publicly-funded Canadian province and the United States by insurance status

Background: Access to cancer screening, diagnosis and treatment in the United States (US) is affected by insurance status; whereas, access within a publicly-funded health care system is similar across the whole population. The aim of this study was to compare overall survival (OS) of de novo stage IV (metastatic) breast cancer (BC) pts in a Canadian province and in the US according to insurance status.

Methods: All female pts 18-64 yrs of age diagnosed with de novo stage IV BC from Jan 1, 2010 through Dec 31, 2014 with available biomarker information were included. Pts diagnosed by death certificate or autopsy and pts ≥ 65 yrs were excluded due to unreliable insurance status classification in the US SEER database. The Alberta cohort (AB) was obtained from the Alberta Health Services CancerControl Breast Data Mart (BDM), a repository of information on all pts diagnosed with their first BC diagnosis from Jan 1, 2004 onwards in the province of Alberta, Canada. The U.S. cohort was obtained from the US Surveillance, Epidemiology, and End Results (SEER) program cancer database. A total of 9,604 pts from the SEER database and 294 pts from the BDM were analyzed. OS was evaluated over a 2 yr period and median and 2 yr OS were estimated. Unadjusted associations were compared using the log-rank test, and hazard ratios (HR) were estimated using the Cox proportional hazards model with US insured set as reference group.

Results: Comparison of AB and US cohorts showed no differences based on age group (18-49 vs 50-64), yr of diagnosis or receipt of primary surgery. The AB cohort had a higher incidence of hormone receptor positive (HR+), similar frequency of HER2+, and a lower incidence of triple negative (TN) BC relative to the US cohort: HR+ 60.5% vs 56.4%; HER2+ 30.6% vs 28.8%; and TN 8.8% vs 14.8%, respectively [p=0.017]. The distribution of HR+, HER2+ and TN BC was consistent between the SEER insured, Medicaid and uninsured groups. AB cohort estimated 2 yr OS was 70.1%, similar to the insured group of 66.0% and significantly better than the Medicaid or uninsured pts [53.2% and 50.9%; p&lt;0.0001]. Subgroup analysis based on biomarker status, surgery and age group showed similar results. Adjusting for these variables, AB OS remained similar to the insured group [HR=0.92 (0.74-1.15) p=0.474] with worse OS noted in the Medicaid and uninsured populations [HR=1.44 (1.32-1.56) and HR=1.53 (1.33-1.77) p&lt;0.001, respectively].

 HR+HER2+TNNo SurgerySurgery18-4950-64InsuredReference Group: HR=1.00AB0.92 (0.68-1.24) p=0.5841.15 (0.76-1.72) p=0.5090.84 (0.49-1.42) p=0.5070.91 (0.71-1.17) p=0.4660.71 (0.45-1.11) p=0.1330.84 (0.56-1.27) p=0.4080.87 (0.67-1.12) p=0.284Medicaid1.43 (1.27-1.61) p&lt;0.0011.57 (1.32-1.87) p&lt;0.0011.37 (1.18-1.60) p&lt;0.0011.46 (1.33-1.59) p&lt;0.0011.55 (1.33-1.81) p&lt;0.0011.75 (1.52-2.00) p&lt;0.0011.47 (1.34-1.61) p&lt;0.001Uninsured1.76 (1.44-2.15) p&lt;0.0011.64 (1.20-2.22) p&lt;0.0011.56 (1.20-2.05) p=0.0011.56 (1.34-1.80) p&lt;0.0011.59 (1.16-2.18) p=0.0041.76 (1.35-2.29) p&lt;0.0011.67 (1.43-1.94) p&lt;0.001

Conclusion: OS in women with de novo stage IV BC in AB was similar to US insured. AB and US insured experienced superior OS compared with US Medicaid and uninsured.

Citation Format: Kornaga EN, Matutino AR, Pereira AA, Verma S, Lupichuk S. Survival in women with de novo metastatic breast cancer: Comparison of real-world evidence from publicly-funded Canadian province and the United States by insurance status [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-13.

Anti-EGFR-resistant clones decay exponentially after progression: implications for anti-EGFR re-challenge

BACKGROUND

Colorectal cancer (CRC) has been shown to acquire RAS and EGFR ectodomain mutations as mechanisms of resistance to epidermal growth factor receptor (EGFR) inhibition (anti-EGFR). After anti-EGFR withdrawal, RAS and EGFR mutant clones lack a growth advantage relative to other clones and decay; however, the kinetics of decay remain unclear. We sought to determine the kinetics of acquired RAS/EGFR mutations after discontinuation of anti-EGFR therapy.

PATIENTS AND METHODS

We present the post-progression circulating tumor DNA (ctDNA) profiles of 135 patients with RAS/BRAF wild-type metastatic CRC treated with anti-EGFR who acquired RAS and/or EGFR mutations during therapy. Our validation cohort consisted of an external dataset of 73 patients with a ctDNA profile suggestive of prior anti-EGFR exposure and serial sampling. A separate retrospective cohort of 80 patients was used to evaluate overall response rate and progression free survival during re-challenge therapies.

RESULTS

Our analysis showed that RAS and EGFR relative mutant allele frequency decays exponentially (r2=0.93 for RAS; r2=0.94 for EGFR) with a cumulative half-life of 4.4 months. We validated our findings using an external dataset of 73 patients with a ctDNA profile suggestive of prior anti-EGFR exposure and serial sampling, confirming exponential decay with an estimated half-life of 4.3 months. A separate retrospective cohort of 80 patients showed that patients had a higher overall response rate during re-challenge therapies after increasing time intervals, as predicted by our model.

CONCLUSION

These results provide scientific support for anti-EGFR re-challenge and guide the optimal timing of re-challenge initiation.

Comparison of Two Models of Frailty for the Prediction of Mortality in Brazilian Community-Dwelling Older Adults: The FIBRA Study

BACKGROUND

Prevalence of frailty is significant in Latin America. However, no previous study evaluated mortality prediction using the two most used frailty models in Brazil.

OBJECTIVES

The aim of the present study was to compare the frailty phenotype and the frailty index with regard to accuracy in the prediction of mortality among community-dwelling older adults.

METHODS

A cohort study was conducted involving 674 older adults. Thirty-five variables (signs, symptoms, chronic diseases and disabilities) were used for the construction of the frailty index (FI). The frailty phenotype index (FPI) was defined based on the criteria proposed in the Cardiovascular Health Study. Periodic verifications were performed in the databank of the Mortality Information System. Cox regression was used to estimate the relative risk (RR) of mortality and Kaplan-Meier survival curves were used in the analysis.

RESULTS

The prevalence of frailty was greater based using the FI (16.3%) compared to the FPI (5.34%). Older adults classified as frail by the FPI had a greater risk of death (RR: 10.03; 95% CI: 4.43-22.74) that those classified as frail by the FI (RR: 0.87; 95% CI: 0.25-3.00). The lowest survival rate was found in the group of older adults classified as frail based on the FPI and classified as pre-frail and robust based on the FI.

CONCLUSION

The FPI demonstrated greater accuracy in predicting the risk of mortality among Brazilian older adults than the FI. The validation of frailty measures is fundamental to the identification of older adults who are more vulnerable to adverse health events.

Real-time three-dimensional jaw tracking in temporomandibular disorders

When a dysfunction occurs in any component of the stomatognathic system, temporomandibular disorders (TMD) may originate. The aim of this study was to compare the deviations, displacement and the execution speed of mandibular movements among asymptomatic participants and those with TMD. Convenience sampling was used; forty participants diagnosed by clinical evaluation following the Research Diagnostic Criteria for Temporomandibular Disorders were divided into three groups: arthropathy (GART, 10 participants, 40% men), myopathy (GMYO, 10 participants, 30% men), and the control group (CG, 20 asymptomatic participants, 25% men). Participants were asked to perform the movements of free maximal mouth opening and closing, right and left lateral excursions, and protrusion with sliding teeth contacts. The mandibular trajectory was recorded using opto-electronic devices tracking reflective markers placed in front of the 'soft tissue pogonion point'. The movements were analysed on the following axis: x - medial-lateral, y - vertical, z - antero-posterior. Significative differences were found in CGxGART - unassisted maximal mouth opening and closing projection on y-axis (OCY), CGxGMYO - unassisted maximal mouth opening and closing projection on x-axis (OCX), and in the measures Opening lateral deviation on x-axis (OLDX), closing lateral deviation on x-axis (CLDX) and in the measures of speed for both. In regard to GARTxGMYO, a significative difference was found in Protrusion lateral deviation on x-axis (PLDX) 'Conover-Iman Test of Multiple Comparisons Using Rank Sums' using Bonferroni correction (P < 0·05). In conclusion, the total opening movements in individuals with TMD tended to have higher deviation than in those asymptomatic individuals and a reduction in the speed of movements.

Chloroplast diversity of Casearia grandiflora in the Cerrado of Piauí State

Casearia grandiflora (Salicaceae) is a typical Cerrado species adapted to disturbed environments, making it useful for restoration projects. Knowledge of genetic diversity is important for establishing conservation strategies for this species. This study aimed to compare chloroplast haplotype diversity and structure of C. grandiflora, under the assumption that protected areas hold greater genetic diversity than disturbed areas. The populations studied are from Parque Nacional de Sete Cidades Conservation Unit and from the surroundings of the city of Cocal de Telha, both located in the State of Piauí. Molecular analyses were performed with seven chloroplast microsatellite loci. The number of private haplotypes and haplotype diversity were higher in the conservation unit, which reinforces the importance of these areas in maintaining biodiversity. Analysis of molecular variance showed that most of the genetic variation is found within populations, with a moderate divergence between them (F_ST = 0.14). The Bayesian analysis and discriminant analysis of principal components suggested that populations are not structured, revealing that a set of individuals from Parque Nacional de Sete Cidades were more divergent within populations than between them. Since literature has little information on C. grandiflora, the results of this study provide important contribution to a better understanding of the specie's genetic diversity.

Oxidative status of the myocardium in response to different intensities of physical training

The intensity of exercise determines the metabolic pathway and the energetic substrate that is spent. Our study sought to identify the effects of different intensities of swimming on myocardial oxidative status and the blood lipid profile. Eighty Wistar rats (male and female) submitted to different intensities of a swimming regimen (low, LS; moderate, MS; or high, HS) for 16 weeks. Samples of blood and myocardium from the left ventricle were collected to determine lipid profiles and oxidative status. Reactive oxygen species (ROS) and antioxidant capacity against peroxyl radicals (ACAP), lipid profiles and lipid peroxidation was analyzed. ROS levels and ACAP were higher in male rats than in female rats overall (p<0.05). However, ACAP in the myocardium was significantly elevated in LS female rats compared to the MS and HS female rats, which had a significantly lower ACAP compared to all other groups. LS and MS training in both sexes and HS training (in females) led to significant decreases in the heart's lipid peroxidation. Amelioration of the lipid profile and reduction in oxidative damage contributed to a physiological state that benefits cardiovascular function in exercised animals. The results show that low and moderate intensity exercise promotes beneficial adaptations.

On the use of evoked potentials for quantification of pain

Pain is a subjective and individual sensation causing major discomfort. So, it is necessary to put into practice methods to objectively quantify it. Several studies indicate that evoked potentials (EP) generate responses which may reflect painful processes. This study reports the results of the application of two different protocols by using biopotentials to objectively measure pain. The first (protocol 1) evaluates the relation between pain, induced by electrical stimulation, and subjective perception and also with nociceptive flexion reflex (NFR) represented by muscle activity (electromyography) detected on the femoral biceps after sural nerve stimulation. The second protocol (protocol 2) verifies whether there is some correlation between M-wave parameters and subjective pain sensation. The results obtained from protocol 1 suggest that the area of the EMG envelope and entropy estimated from the EMG activity are correlated with subjective sensation of pain. The analysis of data obtained from protocol 2 shows a correlation between the global minimum of the M-wave and pain increase. These results contribute to studies which seek to objective measures for pain quantification based on the analysis of biopotentials.

Measurement of jaw motion: the proposal of a simple and accurate method

The analysis of jaw movements has long been used as a measure for clinical diagnosis and assessment. A number of strategies are available for monitoring the trajectory; however most of these strategies make use of expensive tools, which are often not available to many clinics in the world. In this context, this research proposes the development of a new tool capable of quantifying the movements of opening/closing, protrusion and laterotrusion of the mandible. These movements are important for the clinical evaluation of both the temporomandibular function and muscles involved in mastication. The proposed system, unlike current commercial systems, employs a low-cost video camera and a computer program, which is used for reconstructing the trajectory of a reflective marker that is fixed on the jaw. In order to illustrate the application of the devised tool a clinical trial was carried out, investigating jaw movements of 10 subjects. The results obtained in this study were compatible with those found in the literature with the advantage of using a low-cost, simple, non-invasive and flexible solution customized for the practical needs of clinics. The average error of the system was less than 1.0%.

Trace elements and carbon and nitrogen stable isotopes in organisms from a tropical coastal lagoon

Trace elements (Fe, Mn, Al, Zn, Cr, Cu, Ni, Pb, Cd, Hg, and As) and stable isotope ratios (delta(13)C and delta(15)N) were analyzed in sediments, invertebrates, and fishes from a tropical coastal lagoon influenced by iron ore mining and processing activities to assess the differences in trace element accumulation patterns among species and to investigate relations with trophic levels of the organisms involved. Overall significant negative relations between trophic level (given by (15)N) and trace element concentrations in gastropods and crustaceans showed differences in internal controls of trace element accumulation among the species of different trophic positions, leading to trace element dilution. Generally, no significant relation between delta(15)N and trace element concentrations was observed among fish species, probably due to omnivory in a number of species as well as fast growth. Trace element accumulation was observed in the fish tissues, with higher levels of most trace elements found in liver compared with muscle and gill. Levels of Fe, Mn, Al, and Hg in invertebrates, and Fe and Cu in fish livers, were comparable with levels in organisms and tissues from other contaminated areas. Trace element levels in fish muscle were below the international safety baseline standards for human consumption.

Lignin from sugar cane bagasse: extraction, fabrication of nanostructured films, and application

Four lignin samples were extracted from sugar cane bagasse using four different alcohols (methanol, ethanol, n-propanol, and 1-butanol) via the organosolv-CO2 supercritical pulping process. Langmuir films were characterized by surface pressure vs mean molecular area (Pi-A) isotherms to exploit information at the molecular level carrying out stability tests, cycles of compression/expansion (hysteresis), subphase temperature variations, and metallic ions dissolved into the water subphase at different concentrations. Briefly, it was observed that these lignins are relatively stable on the water surface when compared to those obtained via different extraction processes. Besides, the Pi-A isotherms are shifted to smaller molecular areas at higher subphase temperatures and to larger molecular areas when the metallic ions are dissolved into the subphase. The results are related to the formation of stable aggregates (domains) onto the water subphase by these lignins, as shown in the Pi-A isotherms. It was found as well that the most stable lignin monolayer onto the water subphase is that extracted with 1-butanol. Homogeneous Langmuir-Blodgett (LB) films of this lignin could be produced as confirmed by UV-vis absorption spectroscopy and the cumulative transfer parameter. In addition, FTIR analysis showed that this lignin LB film is structured in a way that the phenyl groups are organized preferentially parallel to the substrate surface. Further, these LB films were deposited onto gold interdigitated electrodes and ITO and applied in studies involving the detection of Cd+2 ions in aqueous solutions at low concentration levels through impedance spectroscopy and electrochemical measurements. FTIR spectroscopy was carried out before and after soaking the thin films into Cd+2 aqueous solutions, revealing a possible physical interaction between the lignin phenyl groups and the heavy metal ions. The importance of using nanostructured systems is demonstrated as well by comparing both LB and cast films.

European recommendations for the management of healthcare workers occupationally exposed to hepatitis B virus and hepatitis C virus

Exposure prevention is the primary strategy to reduce the risk of occupational bloodborne pathogen infections in healthcare workers (HCW). HCWs should be made aware of the medicolegal and clinical relevance of reporting an exposure, and have ready access to expert consultants to receive appropriate counselling, treatment and follow-up. Vaccination against hepatitis B virus (HBV), and demonstration of immunisation before employment are strongly recommended. HCWs with postvaccinal anti-HBs levels, 1-2 months after vaccine completion, &gt;10 mIU/mL are considered as responders. Responders are protected against HBV infection: booster doses of vaccine or periodic antibody concentration testing are not recommended. Alternative strategies to overcome non-response should be adopted. Isolated anti-HBc positive HCWs should be tested for anti-HBc IgM and HBV-DNA: if negative, anti-HBs response to vaccination can distinguish between infection (anti-HBs &gt;50 mUI/ml 30 days after 1st vaccination: anamnestic response) and false positive results(anti-HBs &gt;10 mUI/ml 30 days after 3rd vaccination: primary response); true positive subjects have resistance to re-infection. and do not need vaccination The management of an occupational exposure to HBV differs according to the susceptibility of the exposed HCW and the serostatus of the source. When indicated, post-exposure prophylaxis with HBV vaccine, hepatitis B immunoglobulin or both must be started as soon as possible (within 1-7 days). In the absence of prophylaxis against hepatitis C virus (HCV) infection, follow-up management of HCV exposures depends on whether antiviral treatment during the acute phase is chosen. Test the HCW for HCV-Ab at baseline and after 6 months; up to 12 for HIV-HCV co-infected sources. If treatment is recommended, perform ALT (amino alanine transferase) activity at baseline and monthly for 4 months after exposure, and qualitative HCV-RNA when an increase is detected.

European recommendations for the management of healthcare workers occupationally exposed to hepatitis B virus and hepatitis C virus

Exposure prevention is the primary strategy to reduce the risk of occupational bloodborne pathogen infections in healthcare workers (HCW). HCWs should be made aware of the medicolegal and clinical relevance of reporting an exposure, and have ready access to expert consultants to receive appropriate counselling, treatment and follow-up. Vaccination against hepatitis B virus (HBV), and demonstration of immunisation before employment are strongly recommended. HCWs with postvaccinal anti-HBs levels, 1-2 months after vaccine completion, >or=10 mIU/mL are considered as responders. Responders are protected against HBV infection: booster doses of vaccine or periodic antibody concentration testing are not recommended. Alternative strategies to overcome non-response should be adopted. Isolated anti-HBc positive HCWs should be tested for anti-HBc IgM and HBV-DNA: if negative, anti-HBs response to vaccination can distinguish between infection (anti-HBs >or=50 mUI/ml 30 days after 1st vaccination: anamnestic response) and false positive results(anti-HBs >or=10 mUI/ml 30 days after 3rd vaccination: primary response); true positive subjects have resistance to re-infection. and do not need vaccination The management of an occupational exposure to HBV differs according to the susceptibility of the exposed HCW and the serostatus of the source. When indicated, post-exposure prophylaxis with HBV vaccine, hepatitis B immunoglobulin or both must be started as soon as possible (within 1-7 days). In the absence of prophylaxis against hepatitis C virus (HCV) infection, follow-up management of HCV exposures depends on whether antiviral treatment during the acute phase is chosen. Test the HCW for HCV-Ab at baseline and after 6 months; up to 12 for HIV-HCV co-infected sources. If treatment is recommended, perform ALT (amino alanine transferase) activity at baseline and monthly for 4 months after exposure, and qualitative HCV-RNA when an increase is detected.

Susceptibility of S. pneumoniae to various antibiotics aong strains isolated from patients and healthy carriers in different regions of Brazil(1999-2000)

Resistance of microbes to commonly used antibiotics became a major concern at the end of the last century. Because Streptococcus pneumoniae is the most common pathogen in respiratory infections, we conducted microbiological assessment of drug susceptibility patterns among strains collected from two different population groups: 1) adult and pediatric patients (375 isolates) with different infections, and 2) healthy children in day care centers (<5 years old; 350 isolates). High level resistance to penicillin was not identified in either group. Intermediate resistance levels were similar in both groups (adults: 9.9%; children: 9.2%). The Central West region of Brazil tended to have lower susceptibility of S. Pneumoniae from infected adults and children to penicillin (81% vs. 93% in the South and 90% in the Southeast), tetracycline (64% vs. 80% and 76%), and trimethoprim/sulfamethoxazole (14% vs. 34%). Susceptibility was similar among strains from nasal cultures of healthy children tested in each of 4 regions of Brazil. All isolates were susceptible to cefaclor, cefotaxime and amoxacillin/clavulanate. This study, in two distinct populations, allowed characterization of local microbiological resistance patterns. This data is expected to be of use in guiding empiric therapy in the different regions of Brazil.

Transfer of clarithromycin to gastric juice is enhanced by omeprazole in Helicobacter pylori-infected individuals

BACKGROUND

The effects of proton-pump inhibitors and Helicobacter pylori infection on the distribution of drugs employed for the eradication of H. pylori are poorly understood. The aim of this study was to investigate the effects of a 7-day oral administration of 20 mg omeprazole on the distribution of clarithromycin in the gastric juice of individuals with H. pylori infection.

METHODS

Eighteen H. pylori-infected dyspeptic male volunteers without endoscopic lesions were enrolled in a study with an open, randomized, two-period crossover design and a 21-day washout period between phases. Plasma and gastric juice concentrations of clarithromycin in subjects with and without omeprazole pretreatment were measured by means of liquid chromatography coupled to tandem mass spectrometry.

RESULTS

The maximum concentration of clarithromycin (Cmax) and the area under the time-concentration curve from 0 to 2 h (AUC0-2h) were significantly higher in gastric juice than in plasma. Omeprazole treatment further augmented clarithromycin Cmax and AUC0-2h in gastric juice approximately 2-fold (P < 0.05).

CONCLUSIONS

Short-term treatment with omeprazole in H. pylori-positive volunteers increases the amount of clarithromycin transferred to the gastric juice, confirming a synergism between these drugs. Our results suggest the presence of an active transport mechanism for clarithromycin from plasma to the gastric lumen, which is influenced by omeprazole.

Effect of spores of saprophytic fungi on phytoalexin accumulation in seeds of frog-eye leaf spot and stem canker-resistant and -susceptible soybean (Glycine max L.) cultivars

Two saprophytic fungi (Mucor ramosissimus and Rhizopus sp.) were tested for their ability to induce phytoalexin production by seeds of frog-eye leaf spot and stem canker-resistant and -susceptible soybean (Glycine max L.) cultivars. Only M. ramosissimus was shown to elicit a response and qualitative differences in phytoalexin accumulation were found between the susceptible and resistant cultivars. Glyceollins I, II, and III and glycinol were isolated from the susceptible cultivar, whereas Glyceollins I, II, and III, glycinol, glyceocarpin, genistein, isoformononetin, and N-acetyltyramine accumulated in the resistant cultivar in response to the same fungal elicitor. Genistein was found to be an inducibly formed isoflavonoid instead of a constitutive metabolite in the resistant cultivar, whereas N-acetyltyramine is described for the first time as a soybean phytoalexin. All the compounds, except genistein, showed fungitoxic activity against Cladosporium sphaerospermum. Spectral data of the pterocarpan phytoalexins, genistein, and N-acetyltyramine are also given in this work.

Transfer of metronidazole to gastric juice: impact of Helicobacter pylori infection and omeprazole

BACKGROUND

The effects of Helicobacter pylori infection associated with inhibition of gastric acid secretion on the distribution of medications used for H. pylori eradication are poorly understood. The aim of this study was to investigate the effects of a 7-day administration of 20 mg omeprazole on the transfer of metronidazole from plasma to the gastric juice of individuals with and without H. pylori infection.

METHODS

Fourteen H. pylori-positive and 14 H. pylori-negative male volunteers were enrolled in a study with an open, randomized, two-period crossover design with a 21-day washout period between phases. Plasma, salivary, and gastric juice concentrations of metronidazole in subjects with and without omeprazole treatment were measured with reversed-phase high-performance liquid chromatography/liquid chromatography.

RESULTS

Metronidazole peak concentration (Cmax) was similar in plasma and saliva and was approximately threefold higher in gastric juice in all groups. Omeprazole treatment increased gastric pH and did not affect metronidazole Cmax or the time required for this to be reached (tmax) in plasma, saliva, or gastric juice. However, omeprazole significantly reduced metronidazole transfer from plasma to gastric juice in H. pylori-positive but not H. pylori-negative subjects, as shown by statistical analysis of AUC(0-2 h).

CONCLUSION

Short-term treatment with omeprazole in H. pylori- positive volunteers reduces the amount of metronidazole transferred from plasma to gastric juice. This seems to occur in a pH-independent form.

[Activities at an Infectious Disease Intensive Care Unit (1988-1997)]

The practice of an Infectious Diseases Intensive Care Unit for a period of ten years (1988-1997) is reviewed. In this time 1,191 patients were treated--822 had more than 15 years of age and 369 were younger. The occupation rate ranged between 74.4% and 90.8%, and the mean patient stay in the UCI ranged between 6.7 and 12.5 days. Nine hundred and forty-four patients were discharged cured or improved during the stay and 247 (20.7%) died. The most frequent pathologies were: meningitis--371 patients (33.6%); encephalitis--103 (8.6%); and tetanus 143 (12.0%) patients. The morbidity and mortality of different pathologies admitted to the Intensive Care Unit are presented. The mortality rate of the two most common diseases (meningitis and tetanus) is discussed. The need for Intensive Care in the field of Infectious Diseases is stressed.

[Proposal of residency integrated with medical masters degree at the UFMG Medical School: an evaluation among residents]

A project which integrates medical RESIDENCY with medical masters degree has been discussed and is expected to be set up at UFMG Medical School in the near future. Such project is optional for the entering residents and aims those who are interested in becoming researchers. This paper's objective is to raise the residents' opinion on the project as well as their interests in post graduation level. A 240 university hospital residents (HC-UFMG) and a 114 non-university hospital (IPSEMG) were studied through questionnaire application. From the total population of 354 residents we had a 50% questionnaire devolution, 120 (68%) from HC-UFMG and 57 (32%) from IPSEMG. Residents of different clinical and surgical areas were included, 55% male and 45% female. Most of them work exclusively in residency activities, 69% have interest in specialize after residency, 55% in taking medical masters degree, 52% in taking up academic life and 67% in applying for the integrated residency-master degree program. Twelve (7%) are not particularly interested in join the program because they are not sure whether they are able to carry on adequately both residency and research activities at the same time. This study shows that residents are highly receptive to the UFMG's program and that more detailed information concerning its contents should be handed out in order to generate further discussion.

Computed tomography and ultrasonography of the adrenal glands in paracoccidioidomycosis. Comparison with cortisol and aldosterone responses to ACTH stimulation

Fifteen patients with proven disseminated paracoccidioidomycosis (PCM) had computed tomography (CT) and ultrasonography (US) performed to evaluate the form, shape, density and size of their adrenal glands. Plasma and urinary cortisol were determined and adrenal reserve assessed by measuring the cortisol and aldosterone responses to synthetic ACTH. The adrenal CT showed unilateral lesions in two cases and bilateral in another four. The US study showed more frequent alterations, unilateral in seven and bilateral in three subjects. Combining both methods increased the sensitivity to 85% of the cases. All patients had normal plasma cortisol concentrations and normal or increased urinary cortisol excretion. Plasma aldosterone concentration was also normal except in one patient with hypokalemia. Seven patients showed diminished cortisol responses, five had subnormal aldosterone responses and in five plasma aldosterone concentration increased more than normally after stimulation by ACTH. There was an incidence of limited adrenal reserve in 53% of the patients on ACTH stimulation. No correlation was evident between the disorders in adrenal steroid responses to ACTH and changes in morphology revealed by CT and/or US.

Comparative kinetics of arginine and lysine transport by epimastigotes and trypomastigotes from two strains of Trypanosoma cruzi

Three-day-old cultures of Y and MR strains of Trypanosoma cruzi ahd a higher rate of lysine and arginine uptake than 10-day cultures. Amino acid uptake by cells of the MR strain was consistently higher than that of the Y strain. Flagellates separated on DEAE-cellulose columns have normal structure, motility, and infectivity; they have the higher rates of lysine and arginine uptake than the original 3- and 10-day cultures. In addition passage through DEAE-cellulose columns modified the kinetic behavior of amino acid transport systems in the flagellate membranes.

[Epidemiological aspects of schistosomiasis mansoni in the Americana reservoir area, State of S ao Paulo, Brazil]

Após conhecimento de casos humanos de esquistossomose mansônica supostamente autóctones da Represa de Americana (São Paulo, Brasil) procedeu-se ao estudo epidemiológico da região. Foram constatados seis focos localizados junto à Represa. Foram encontradas as seguintes espécies de moluscos: Biomphalaria tenagophila; B. straminea; B. peregrina; Drepanotrema cimex; D. lucidum; |Lymnaeidae; Ancylidae e Physidae. Exemplares de Biomphalaria tenagophila coletados nos focos apresentaram índices de infecção para cercárias de S. mansoni que variaram de 0,9 a 45%. Mus musculus albinos foram infectados com cercárias no laboratório e nos focos, sendo reproduzido o ciclo do S. mansoni em ambas as condições. Foram registrados 82 casos humanos autóctones de esquistossomose mansônica, na região da Represa de Americana.