Integrated transcriptomics uncovers an enhanced association between the prion protein gene expression and vesicle dynamics signatures in glioblastomas

BACKGROUND

Glioblastoma (GBM) is an aggressive brain tumor that exhibits resistance to current treatment, making the identification of novel therapeutic targets essential. In this context, cellular prion protein (PrPC) stands out as a potential candidate for new therapies. Encoded by the PRNP gene, PrPC can present increased expression levels in GBM, impacting cell proliferation, growth, migration, invasion and stemness. Nevertheless, the exact molecular mechanisms through which PRNP/PrPC modulates key aspects of GBM biology remain elusive.

METHODS

To elucidate the implications of PRNP/PrPC in the biology of this cancer, we analyzed publicly available RNA sequencing (RNA-seq) data of patient-derived GBMs from four independent studies. First, we ranked samples profiled by bulk RNA-seq as PRNPhigh and PRNPlow and compared their transcriptomic landscape. Then, we analyzed PRNP+ and PRNP- GBM cells profiled by single-cell RNA-seq to further understand the molecular context within which PRNP/PrPC might function in this tumor. We explored an additional proteomics dataset, applying similar comparative approaches, to corroborate our findings.

RESULTS

Functional profiling revealed that vesicular dynamics signatures are strongly correlated with PRNP/PrPC levels in GBM. We found a panel of 73 genes, enriched in vesicle-related pathways, whose expression levels are increased in PRNPhigh/PRNP+ cells across all RNA-seq datasets. Vesicle-associated genes, ANXA1, RAB31, DSTN and SYPL1, were found to be upregulated in vitro in an in-house collection of patient-derived GBM. Moreover, proteome analysis of patient-derived samples reinforces the findings of enhanced vesicle biogenesis, processing and trafficking in PRNPhigh/PRNP+ GBM cells.

CONCLUSIONS

Together, our findings shed light on a novel role for PrPC as a potential modulator of vesicle biology in GBM, which is pivotal for intercellular communication and cancer maintenance. We also introduce GBMdiscovery, a novel user-friendly tool that allows the investigation of specific genes in GBM biology.

Abstract 3661: Extracellular vesicle derived from neural stem cells as potential vehicles of genetic information to modulate glioblastoma biology

Glioblastoma (GBM) is a deadly brain tumor and its high aggressiveness is partly due to a subpopulation of tumor stem cells known as glioblastoma stem-like cells (GSCs). GBM establishes crosstalk with non-tumoral cells, mediated mainly by extracellular vesicles (EVs) and the interaction between GSCs and neural stem cells (NSCs) from the subventricular zone may influence GBM biology. Literature data suggests that cellular communication is an important process for GSCs stemness maintenance, and some authors consider NSCs as a possible cell of origin for GSCs. However, the specific effects that neural stem cells-derived extracellular vesicles (NSCs-EVs) promote in GSCs are still uncertain. Previous data from our group demonstrated specific groups of microRNAs (hsa-miR -137, -216a-5p, -216b-5p, 217), enriched in NSCs-EVs in contrast to intracellular compartments, suggesting these molecules are being produced for secretion. Our study aims to evaluate the role of the miRs contained in NSCs-EVs in GSCs biology. Human induced pluripotent stem cells (hiPSC) were differentiated into NSCs. NSCs were characterized by western blotting and immunofluorescence by the expression of neural commitment markers, such as nestin and β-III-tubulin. NSCs-EVs were isolated from NSCs’ culture media with a commercial kit and analyzed by NTA (nanosight) for EVs size profiling and western blotting to detect specific markers, such as Alix, CD63, and HSP90. In a first approach, we analyzed the effects played by those miRs through predictive online tools. We identified target genes related to stemness (NANOG, SOX2, KLF4), oncogenesis (KRAS, CDC42, CDK6) and metabolism (CAMK2A), besides the Wnt and Notch signaling pathways. The online predictions also identified transcriptional factors related to vasculogenesis and self-renewal, key processes for GSCs activity. We will expose GSCs to NSCs-EVs and evaluate the expression of neural and stemness markers. In a future step, the GSCs previously exposed to NSCs-EVs will be treated with temozolomide, and viability assays will be performed. Additionally, we intend to modulate the four miRs identified and evaluate if they act as effector molecules of NSCs-EVs. Our data corroborate with our initial hypothesis that NSCs-EVs may act as important signalling modes in GSCs activity and consequently in GBM biology. Supported by FAPESP:22/08106-1.

Citation Format: João Pedro Alves de Araújo, Lilian Cruz, Maria Clara da Silva Souza, Mariana Brandão Prado, Rodrigo Nunes Alves, Bárbara Paranhos Coelho, Samuel Ribeiro Soares, Camila Félix Fernandes, Marilene Hohmuth Lopes. Extracellular vesicle derived from neural stem cells as potential vehicles of genetic information to modulate glioblastoma biology. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3661.

Unconventional Protein Secretion in Brain Tumors Biology: Enlightening the Mechanisms for Tumor Survival and Progression

Non-canonical secretion pathways, collectively known as unconventional protein secretion (UPS), are alternative secretory mechanisms usually associated with stress-inducing conditions. UPS allows proteins that lack a signal peptide to be secreted, avoiding the conventional endoplasmic reticulum-Golgi complex secretory pathway. Molecules that generally rely on the canonical pathway to be secreted may also use the Golgi bypass, one of the unconventional routes, to reach the extracellular space. UPS studies have been increasingly growing in the literature, including its implication in the biology of several diseases. Intercellular communication between brain tumor cells and the tumor microenvironment is orchestrated by various molecules, including canonical and non-canonical secreted proteins that modulate tumor growth, proliferation, and invasion. Adult brain tumors such as gliomas, which are aggressive and fatal cancers with a dismal prognosis, could exploit UPS mechanisms to communicate with their microenvironment. Herein, we provide functional insights into the UPS machinery in the context of tumor biology, with a particular focus on the secreted proteins by alternative routes as key regulators in the maintenance of brain tumors.

Multifaceted WNT Signaling at the Crossroads Between Epithelial-Mesenchymal Transition and Autophagy in Glioblastoma

Tumor cells can employ epithelial-mesenchymal transition (EMT) or autophagy in reaction to microenvironmental stress. Importantly, EMT and autophagy negatively regulate each other, are able to interconvert, and both have been shown to contribute to drug-resistance in glioblastoma (GBM). EMT has been considered one of the mechanisms that confer invasive properties to GBM cells. Autophagy, on the other hand, may show dual roles as either a GBM-promoter or GBM-suppressor, depending on microenvironmental cues. The Wingless (WNT) signaling pathway regulates a plethora of developmental and biological processes such as cellular proliferation, adhesion and motility. As such, GBM demonstrates deregulation of WNT signaling in favor of tumor initiation, proliferation and invasion. In EMT, WNT signaling promotes induction and stabilization of different EMT activators. WNT activity also represses autophagy, while nutrient deprivation induces β-catenin degradation via autophagic machinery. Due to the importance of the WNT pathway to GBM, and the role of WNT signaling in EMT and autophagy, in this review we highlight the effects of the WNT signaling in the regulation of both processes in GBM, and discuss how the crosstalk between EMT and autophagy may ultimately affect tumor biology.

Prion Protein at the Leading Edge: Its Role in Cell Motility

Cell motility is a central process involved in fundamental biological phenomena during embryonic development, wound healing, immune surveillance, and cancer spreading. Cell movement is complex and dynamic and requires the coordinated activity of cytoskeletal, membrane, adhesion and extracellular proteins. Cellular prion protein (PrPC) has been implicated in distinct aspects of cell motility, including axonal growth, transendothelial migration, epithelial-mesenchymal transition, formation of lamellipodia, and tumor migration and invasion. The preferential location of PrPC on cell membrane favors its function as a pivotal molecule in cell motile phenotype, being able to serve as a scaffold protein for extracellular matrix proteins, cell surface receptors, and cytoskeletal multiprotein complexes to modulate their activities in cellular movement. Evidence points to PrPC mediating interactions of multiple key elements of cell motility at the intra- and extracellular levels, such as integrins and matrix proteins, also regulating cell adhesion molecule stability and cell adhesion cytoskeleton dynamics. Understanding the molecular mechanisms that govern cell motility is critical for tissue homeostasis, since uncontrolled cell movement results in pathological conditions such as developmental diseases and tumor dissemination. In this review, we discuss the relevant contribution of PrPC in several aspects of cell motility, unveiling new insights into both PrPC function and mechanism in a multifaceted manner either in physiological or pathological contexts.

Abstract 4956: PrPc depletion in glioblastoma patient derived xenograft cells by CRISPR/Cas9

Glioblastoma (GBM), the most common primary malignant brain tumor, exhibits a highly proliferative cell subpopulation called Glioblastoma stem-like cells (GSCs), presumed to contribute to the aggressive behavior of GBM. Our group has shown that the Prion Protein (PrPC), a cell surface glycoprotein and regulator of several stem cell functions, is enriched in GSCs and co-expresses with conventional GSCs markers. PrPC has been proposed as a scaffold protein, able to govern the assembly of multi-component complexes in the cell membrane. Integrin α6 (ITGA6), a cell surface laminin receptor, is enriched in GSCs as well, and exhibits relevant effects on GSCs biology, related to self-renewal and migration. To investigate a potential association between PrPC and ITGA6, we will perform loss-of-function experiments in GSCs via siRNA and CRISPR/Cas9 to characterize these cell surface molecules expression and their effect on GSCs proliferation, migration and invasion. Preliminary results show that depletion of PrPC perturbates ITGA6 labeling on plasma membrane of GSC. Thus far, cells from patient-derived xenografts (GBM33-PDX2) were transfected a construct for PrPC knockout by CRISPR/Cas9 via Nucleofector Technology. We found around 60% GFP-positive cells via flow cytometry for the CRISPR pool and we are currently isolating clones to confirm PrPC expression. Remarkably, the colonies exhibited distinct morphologies such as neural-like, epithelial-like and stem cell-like, indicating the heterogenous nature of this tumor. Western blotting assays will be performed to assess PrPC and ITGA6 expression in both commercial cell line U87 and GBM33-PDX2. The characterization of PrPC-ITGA6 association might provide insight into GSCs behavior and new anti-GBM therapeutic strategies.

Citation Format: Maria Isabel Melo Escobar, Barbara Paranhos Coelho, Mariana Brandão Prado, Rebeca Iglesia, Marilene Hohmuth Lopes. PrPc depletion in glioblastoma patient derived xenograft cells by CRISPR/Cas9 [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4956.

Heat Shock Proteins in Glioblastoma Biology: Where Do We Stand?

Heat shock proteins (HSPs) are evolutionary conserved proteins that work as molecular chaperones and perform broad and crucial roles in proteostasis, an important process to preserve the integrity of proteins in different cell types, in health and disease. Their function in cancer is an important aspect to be considered for a better understanding of disease development and progression. Glioblastoma (GBM) is the most frequent and lethal brain cancer, with no effective therapies. In recent years, HSPs have been considered as possible targets for GBM therapy due their importance in different mechanisms that govern GBM malignance. In this review, we address current evidence on the role of several HSPs in the biology of GBMs, and how these molecules have been considered in different treatments in the context of this disease, including their activities in glioblastoma stem-like cells (GSCs), a small subpopulation able to drive GBM growth. Additionally, we highlight recent works that approach other classes of chaperones, such as histone and mitochondrial chaperones, as important molecules for GBM aggressiveness. Herein, we provide new insights into how HSPs and their partners play pivotal roles in GBM biology and may open new therapeutic avenues for GBM based on proteostasis machinery.

Chaperones and Beyond as Key Players in Pluripotency Maintenance

Pluripotency is orchestrated by distinct players and chaperones and their partners have emerged as pivotal molecules in proteostasis control to maintain stemness. The proteostasis network consists of diverse interconnected pathways that function dynamically according to the needs of the cell to quality control and maintain protein homeostasis. The proteostasis machinery of pluripotent stem cells (PSCs) is finely adjusted in response to distinct stimuli during cell fate commitment to determine successful organism development. Growing evidence has shown different classes of chaperones regulating crucial cellular processes in PSCs. Histones chaperones promote proper nucleosome assembly and modulate the epigenetic regulation of factors involved in PSCs’ rapid turnover from pluripotency to differentiation. The life cycle of pluripotency proteins from synthesis and folding, transport and degradation is finely regulated by chaperones and co-factors either to maintain the stemness status or to cell fate commitment. Here, we summarize current knowledge of the chaperone network that govern stemness and present the versatile role of chaperones in stem cells resilience. Elucidation of the intricate regulation of pluripotency, dissecting in detail molecular determinants and drivers, is fundamental to understanding the properties of stem cells in order to provide a reliable foundation for biomedical research and regenerative medicine.

Engagement of cellular prion protein with the co-chaperone Hsp70/90 organizing protein regulates the proliferation of glioblastoma stem-like cells

Background

Glioblastoma (GBM), a highly aggressive brain tumor, contains a subpopulation of glioblastoma stem-like cells (GSCs) that play roles in tumor maintenance, invasion, and therapeutic resistance. GSCs are therefore a promising target for GBM treatment. Our group identified the cellular prion protein (PrP^C) and its partner, the co-chaperone Hsp70/90 organizing protein (HOP), as potential target candidates due to their role in GBM tumorigenesis and in neural stem cell maintenance.

Methods

GSCs expressing different levels of PrP^C were cultured as neurospheres with growth factors, and characterized with stem cells markers and adhesion molecules markers through immunofluorescence and flow cytometry. We than evaluated GSC self-renewal and proliferation by clonal density assays and BrdU incorporation, respectively, in front of recombinant HOP treatment, combined or not with a HOP peptide which mimics the PrP^C binding site. Stable silencing of HOP was also performed in parental and/or PrP^C-depleted cell populations, and proliferation in vitro and tumor growth in vivo were evaluated. Migration assays were performed on laminin-1 pre-coated glass.

Results

We observed that, when GBM cells are cultured as neurospheres, they express specific stemness markers such as CD133, CD15, Oct4, and SOX2; PrP^C is upregulated compared to monolayer culture and co-localizes with CD133. PrP^C silencing downregulates the expression of molecules associated with cancer stem cells, upregulates markers of cell differentiation and affects GSC self-renewal, pointing to a pivotal role for PrP^C in the maintenance of GSCs. Exogenous HOP treatment increases proliferation and self-renewal of GSCs in a PrP^C-dependent manner while HOP knockdown disturbs the proliferation process. In vivo, PrP^C and/or HOP knockdown potently inhibits the growth of subcutaneously implanted glioblastoma cells. In addition, disruption of the PrP^C-HOP complex by a HOP peptide, which mimics the PrP^C binding site, affects GSC self-renewal and proliferation indicating that the HOP-PrP^C complex is required for GSC stemness. Furthermore, PrP^C-depleted GSCs downregulate cell adhesion-related proteins and impair cell migration indicating a putative role for PrP^C in the cell surface stability of cell adhesion molecules and GBM cell invasiveness, respectively.

Conclusions

In conclusion, our results show that the modulation of HOP-PrP^C engagement or the decrease of PrP^C and HOP expression may represent a potential therapeutic intervention in GBM, regulating glioblastoma stem-like cell self-renewal, proliferation, and migration.

Electronic supplementary material

The online version of this article (doi:10.1186/s13287-017-0518-1) contains supplementary material, which is available to authorized users.

The growth of glioblastoma orthotopic xenografts in nude mice is directly correlated with impaired object recognition memory

Cognitive dysfunction is found in patients with brain tumors and there is a need to determine whether it can be replicated in an experimental model. In the present study, the object recognition (OR) paradigm was used to investigate cognitive performance in nude mice, which represent one of the most important animal models available to study human tumors in vivo. Mice with orthotopic xenografts of the human U87MG glioblastoma cell line were trained at 9, 14, and 18days (D9, D14, and D18, respectively) after implantation of 5×10(5) cells. At D9, the mice showed normal behavior when tested 90min or 24h after training and compared to control nude mice. Animals at D14 were still able to discriminate between familiar and novel objects, but exhibited a lower performance than animals at D9. Total impairment in the OR memory was observed when animals were evaluated on D18. These alterations were detected earlier than any other clinical symptoms, which were observed only 22-24days after tumor implantation. There was a significant correlation between the discrimination index (d2) and time after tumor implantation as well as between d2 and tumor volume. These data indicate that the OR task is a robust test to identify early behavior alterations caused by glioblastoma in nude mice. In addition, these results suggest that OR task can be a reliable tool to test the efficacy of new therapies against these tumors.

Leachability of automotive shredder residues burned in a fluidized bed system

This paper presents the results of the study of a combustible fraction of automotive shredder residues (CASRs) and the corresponding ashes generated by combustion on a fluidized bed pilot with the aim to understand the influence of thermal treatment regarding properties for final disposal, such as landfilling. The chemical composition was evaluated and the leachability behaviour of ashes and CASR was investigated using the three more commonly used tests: the European Standard EN 12457, the US TCLP-EPA 1311 and the Dutch availability test EA NEN 7371. Different results were obtained depending on the specific conditions of the methods employed. It was found that both the CASR and the ashes contained large amounts of toxic metals and other undesirable elements, such as Cl and S. For the CASR, in addition to the leachability of organic matter above the limit set for hazardous materials, the release of heavy metals, either under alkaline and acidic conditions was significant, revealing the serious risks associated to the landfilling practices still being undertaken worldwide. Release of organic matter from ashes was insignificant, but solubility of sulphates increased and chlorides exceed the hazardous limits in the case of fly ashes. Toxic metals were found to leach from the ashes only under acidic conditions, except Pb and Cu which also leached from finer ashes at alkaline pH. Cr also leached from ashes at alkaline pH values. Both the Dutch availability and TCLP revealed much higher leaching intensities than the European Standard due to the acidity of leachants. However, it was found that ashes may be more resistant to acidification because they exhibit much higher acid neutralization capacity (ANC) than the untreated CASR. The study undertaken shows that thermal valorisation of the combustible fraction of ASR may avoid the risks associated with their landfilling; however, care has to be taken with the ashes because they also behave as hazardous residues. Although, the mass reduction provided by thermal treatment may make landfilling less expensive, a more profitable reutilization of the ashes should be developed.

Evaluation of the vaccination status in pediatric renal transplant recipients

To assess the immunization status of pediatric renal transplant patients followed at a single center in Brazil, vaccination charts of all patients aged between one and 18 yr were analyzed both pre- and post-transplantation. Appropriate immunization was defined according to the National Immunization Program (routine vaccines) - for all Brazilian children - and the Special Immunobiological Agents Program that also includes special vaccines for immunodeficient or other high-risk children. A total of 46 patients was evaluated (mean age 13.7 yr; range 4-17 yr). Vaccination charts were found to be up to date in only two patients (4.3%) pretransplant and in two (4.3%) post-transplant. Although 36 patients (62.2%) in the pretransplant phase and 24 (52.1%) in the post-transplant phase had been vaccinated according to the National Immunization Program, they had not received the special vaccines indicated for their immunocompromised condition. Therefore, despite being followed at a referral center, almost all patients presented an incomplete immunization status pre- and post-transplant. This probably reflects missed opportunities and medical/parental apprehension related to vaccination of patients with chronic renal insufficiency, dialysis or kidney transplantation. Efforts should be made to ensure adequate vaccination in children with kidney diseases, especially before kidney transplantation.

Safety and efficacy of hepatitis B vaccine in systemic lupus erythematosus

Hepatitis B virus (HBV) vaccination has been implicated as a potential trigger for autoimmune diseases but there are no prospective studies in lupus. We therefore assessed prospectively the safety and efficacy of immunization with recombinant DNA HBV vaccine (Euvax B; LG Life Sciences) in systemic lupus erythematosus (SLE) patients. Twenty-eight consecutive inactive SLE patients [Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) <4], age between 18 and 50 years and negative serology for HBV, were selected. Exclusion criteria were prednisone >/=20 mg/day and immunosuppressive drugs. Clinical and laboratorial assessments were obtained at study entry and one month after the three doses. In addition, a previous one year evaluation was performed using a standard electronic protocol. The mean age was 34 +/- 7.7 years and disease duration was 10.4 +/- 6.7 years. An adequate seroconversion was achieved at the end of the study (93%), although a lower frequency after the first (4%) and second dose (54%) was observed. No significant change in mean SLEDAI score was detected after each dose throughout the study (0.14 +/- 0.52 versus 0 versus 0.61 +/- 1.66 versus 0.36 +/- 1.34, P = 0.11). Reinforcing these findings, the 11% flares during vaccination was similar to the 21% observed in the previous year (P = 0.46). Furthermore, the mean prednisone dose at study entry was comparable to the end of the study (2.86 +/- 3.06 versus 4.64 +/- 8.25 mg/day, P = 0.32). In addition, the frequency of immunosuppressive therapy during the vaccination period (11%) was alike to the 14% observed in the previous year before entry (P = 0.66). Hepatitis B vaccination was safe in inactive SLE patients with an adequate vaccine response rate.

Chemical and ecotoxicological characterization of ashes obtained from sewage sludge combustion in a fluidised-bed reactor

In 1999, the DEECA/INETI and the UBiA/FCT/UNL started a researching project on the partition of heavy metals during the combustion of stabilised sewage sludge (Biogran), in a fluidised-bed reactor, and on the quality of the bottom ashes and fly ashes produced. This project was entitled Bimetal and was funded by the Portuguese Foundation for Science and Technology. In this paper only the results on the combustion of Biogran are reported. The combustion process was performed in two different trials, in which different amounts of sewage sludge and time of combustion were applied. Several ash samples were collected from the bed (bottom ashes) and from two cyclones (first cyclone and second cyclone ashes). Sewage sludge, bed material (sand) and ash samples were submitted to the leaching process defined in the European leaching standard EN 12457-2. The eluates were characterized for a set of inorganic chemical species. The ecotoxicological levels of the eluates were determined for two biological indicators (Vibrio fischeri and Daphnia magna). The results were compared with the limit values of the CEMWE French Regulation. The samples were also ranked according to an index based on the chemical characterization of the eluates. It was observed an increase of the concentration of metals along the combustion system. The ashes trapped in the second cyclone, for both combustion trials, showed the highest concentration of metals in the eluates. Chemically, the ashes of the second cyclone were the most different ones. In the ecotoxicological point of view, the ecotoxicity levels of the eluates of the ashes, for both combustion cycles, did not follow the same pattern as observed for the chemical characterization. The ashes of the first cyclone showed the highest ecotoxicity levels for V. fischeri and D. magna. This difference on chemical and ecotoxicological results proves the need for performing both chemical and ecotoxicological characterizations of the sub-products of such type of thermal processes.

Manifestations of Chagas disease (American trypanosomiasis) in patients with HIV/AIDS

Between June 1989 and December 2005, an observational study of adults co-infected with HIV and Trypanosoma cruzi was conducted, to investigate the spectrum of manifestations of chronic Chagas disease (American trypanosomiasis) in the HIV-positive. The 31 men and 22 women investigated were aged 23-59 years. Each subject was investigated by ambulatory (Holter) and non-ambulatory electrocardiography, chest X-ray, oesophagography and echocardiography (to determine the clinical form of trypanosomiasis), by xenodiagnosis, blood culture and the microscopical examination of blood (to explore their T. cruzi parasitaemia), and by counting their CD4 T cells (to stage their HIV infection). The subjects were followed-up for 1-190 months (median = 58 months) and checked for re-activation of their Chagas disease, which was usually defined by the occurrence of unusual clinical manifestations and/or the detection, by microscopical examination, of trypanosomes in the blood or cerebrospinal fluid. Eleven (20.8%) of the subjects showed re-activation, another nine (17.0%) were found to have developed high T. cruzi parasitaemias but these were only detected by xenodiagnosis or culture, and 15 (28.3%) had illnesses typical of chronic Chagas disease in HIV-negative individuals, with low parasitaemias. Anti-T. cruzi therapy (benznidazole), recommended for 17 patients, resulted in the sustained reduction of parasitaemia in 11 of the 12 subjects who completed treatment. Chagas disease was the cause of death of eight of the 14 subjects who died during the study. Four of the women investigated gave birth, each to a single child, during follow-up, and three of the four babies showed evidence of the congenital transmission of T. cruzi.

Immunogenicity of a 23-valent pneumococcal polysaccharide vaccine in Brazilian elderly

Serum antibodies specific for the capsular polysaccharides of Streptococcus pneumoniae provide protection against invasive pneumococcal infection. In Brazil, this vaccine has been used for people over 65 years with clinical risk to develop pneumococcal infection since 1999. We evaluated the immune response of 102 elderly subjects (75.5% females and 24.5% males) with a mean age of 71 years, and 19 young healthy adults (63.2% females and 36.8% males) with a mean age of 27 years. The elderly study group consisted of outpatients who received follow-up care in the Geriatric Department of General Hospital, Faculty of Medicine, University of São Paulo. None had acute illness at the time of vaccination. Both groups were immunized with one intra-deltoid injection with 0.5 ml of a 23-valent pneumococcal polysaccharide vaccine. The total IgG specific antibody concentrations to capsular polysaccharides 1, 3, 5, 6B, 8, and 14 were determined against pre- and 1-month post-vaccination sera. All samples were analyzed according to the second-generation pneumococcal polysaccharide ELISA protocol. We observed that the pneumococcal polysaccharide vaccine evoked consistent antibody increase for serotypes 1, 5, 6B, 8, and 14 (geometric mean concentration increase of 2.46 in the elderly and 2.84 in the young adults). Otherwise, we observed no increase in antibody concentration for serotype 3 in both groups.

Surgical outcome in mesial temporal sclerosis correlates with prion protein gene variant

BACKGROUND

Mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) is the most common surgically remediable epileptic syndrome. Ablation of the cellular prion protein (PrP(c)) gene (PRNP) enhances neuronal excitability of the hippocampus in vitro and sensitivity to seizure in vivo, indicating that PrP(c) might be related to epilepsy.

OBJECTIVE

To evaluate the genetic contribution of PRNP to MTLE-HS.

METHODS

The PRNP coding sequence of DNA from peripheral blood cells of 100 consecutive patients with surgically treated MTLE-HS was compared to that from a group of healthy controls adjusted for sex, age, and ethnicity (n = 180). The presence of PRNP variant alleles was correlated with clinical and presurgical parameters as well as surgical outcome.

RESULTS

A variant allele at position 171 (Asn-->Ser), absent in controls, was found in heterozygosis (Asn171Ser) in 23% of patients (p < 0.0001). The PRNP genotypes were not correlated with any clinical or presurgical data investigated. However, patients carrying the Asn171Ser variant had a five times higher chance of continuing to have seizures after temporal lobectomy (95% CI 1.65 to 17.33, p = 0.005) than those carrying the normal allele. At 18 months after surgery, 91.8% of patients with the normal allele at codon 171 were seizure free, in comparison to 68.2% of those carrying Asn171Ser (p = 0.005).

CONCLUSIONS

The PRNP variant allele Asn171Ser is highly prevalent in patients with medically untreatable MTLE-HS and influences their surgical outcome. The results suggest that the PRNP variant allele at codon 171 (Asn171Ser) is associated with epileptogenesis in MTLE-HS.

Envenoming by Bothrops jararaca in Brazil: association between venom antigenaemia and severity at admission to hospital

The association between the clinical severity of Bothrops jararaca envenoming at admission and serum venom and plasma fibrinogen concentrations before antivenom administration is reported in 137 patients admitted to Hospital Vital Brazil, Instituto Butantan, São Paulo, Brazil, between 1989 and 1990. Other variables such as age, gender, site of the bite, use of tourniquet and the time interval between the bite and start of antivenom therapy, spontaneous systemic bleeding, and the 20 minute whole blood clotting test (20WBCT) at admission showed no association with either severity or serum venom antigen concentration (SVAC). Mean SVAC in patients with mild envenoming was significantly lower than in the group with moderate envenoming (P = 0.0007). Patients with plasma fibrinogen concentrations > 1.5 g/L had a lower mean SVAC than patients with plasma fibrinogen concentrations < or = 1.5 g/L (P = 0.02). Those admitted with a tourniquet in place had significantly higher plasma fibrinogen concentrations than those without a tourniquet (P = 0.002). A multiple logistic regression model showed independent risk factors for severity: bites at sites other than legs or forearms, SVACs > or = 400 ng/mL, and the use of a tourniquet. Rapid quantification of SVAC before antivenom therapy might improve initial evaluation of severity in B. jararaca bites.

Variability of cork from Portuguese Quercus suber studied by solid-state (13)C-NMR and FTIR spectroscopies

A new approach is presented for the study of the variability of Portuguese reproduction cork using solid-state (13)C-NMR spectroscopy and photoacoustic (PAS) FTIR (FTIR-PAS) spectroscopy combined with chemometrics. Cork samples were collected from 12 different geographical sites, and their (13)C-cross-polarization with magic angle spinning (CP/MAS) and FTIR spectra were registered. A large spectral variability among the cork samples was detected by principal component analysis and found to relate to the suberin and carbohydrate contents. This variability was independent of the sample geographical origin but significantly dependent on the cork quality, thus enabling the distinction of cork samples according to the latter property. The suberin content of the cork samples was predicted using multivariate regression models based on the (13)C-NMR and FTIR spectra of the samples as reported previously. Finally, the relationship between the variability of the (13)C-CP/MAS spectra with that of the FTIR-PAS spectra was studied by outer product analysis. This type of multivariate analysis enabled a clear correlation to be established between the peaks assigned to suberin and carbohydrate in the FTIR spectrum and those appearing in the (13)C-CP/MAS spectra.

Effectiveness of influenza vaccination in elderly outpatients in São Paulo city, Brazil

To investigate the effectiveness of the influenza vaccine in a population of elderly outpatients, we compared the occurrence and frequency of influenza like illness (ILI), respiratory illness and hospitalization in vaccinated and non-vaccinated subjects. All the outcomes were clinically defined. The two groups were similar with respect to demographics, health situation and habits. The influenza vaccine contributed to the protection of the elderly investigated, since the vaccinated subjects referred a significantly lower number of ILI than the non-vaccinated. There is a need for more studies about the effectiveness of the influenza vaccine in our country in elderly and other groups of our population.

[The use of intestinal enema in labor preparation: analysis of advantages and disadvantages]

This study aimed at investigating the effects of intestinal cleansers on fecal contamination during labor and delivery amongst women assisted in a university hospital. The subjects were 90 pregnant women (43 normal births, 27 forceps and 20 caesarean sections). The population was divided in two randomized groups: with and without the use of intestinal cleansers. It was possible to conclude that intestinal cleansers did not provide faster labor and did not reduce fecal contamination. However, the women who had used an intestinal cleanser tended to regard it as positive.

Quantitation of aliphatic suberin in Quercus suber L. cork by FTIR spectroscopy and solid-state (13)C-NMR spectroscopy

This work determined that the percentage of suberin in cork may be found by solid-state (13)C cross polarization/magic angle spinning (CP/MAS) NMR spectroscopy and by FTIR with photoacoustic detection (FTIR-PAS) spectroscopy. A linear relationship is found between the suberin content measured through CP/MAS spectral areas and that measured gravimetrically. Furthermore, application of a partial least squares (PLS1) regression model to the NMR and gravimetric data sets clearly correlates the two sets, enabling suberin quantification with 90% precision. Suberin quantitation by FTIR-PAS spectroscopy is also achieved by a PLS1 regression model, giving 90% accurate estimates of the percentage of suberin in cork. Therefore, (13)C-CP/MAS NMR and FTIR-PAS proved to be useful and accurate noninvasive techniques to quantify suberin in cork, thus avoiding the traditional time consuming and destructive chemical methods.

Latex allergy in health care personnel

This article presents a summary of literature published in recent years about latex allergy. The first article on allergic reactions associated with latex was published in Britain in 1979. Since then, the number of reported cases has increased. A wide variety of allergic reactions that range from contact dermatitis to anaphylactic shock are described in literature. Conclusions support that health care team members must be well informed about the implications of latex allergy to better help allergic individuals.

Spectral editing of 13C cp/MAS NMR spectra of complex systems: application to the structural characterisation of cork cell walls

A mathematical method of obtaining 13C CP/MAS subspectra of single components of a complex system is presented and applied to three- and four-component systems. The method is based on previously reported work that exploits different proton relaxation properties for different domains of an heterogeneous system. However, unlike the original method that obtained subspectra through a trial-and-error approach, the method here presented solves the problem mathematically, thus avoiding the time-consuming and non-rigorous trial-and-error step. The method is applied to mixtures of three and four polymers and to a more complex system: cork cell walls. As expected, as the number of components increases, the sharing of relaxation properties between different components is increasingly probable, either due to incidental coincidence of relaxation times or to specific interactions and intimate mixing of compounds. While this hinders the calculation of the subspectra of single chemical components, it may provide useful information about inter-component interactions. This possibility was demonstrated by the application of this method to cork cell walls. Both three-component and four-component approaches showed that three domains exist in cork cell walls: carbohydrate/lignin matrix, mobile suberin close to (probably bonded to) lignin groups (about 42% w/w) and hindered suberin close to (probably bonded to) carbohydrate-OCH2O groups (about 4% w/w).

Composition of suberin extracted upon gradual alkaline methanolysis of Quercus suber L. cork

The monomeric composition of suberin extracts obtained by gradual alkaline methanolysis of Quercus suber cork was determined by gas chromatography-mass spectrometry (GC-MS). Results show that 1-alkanols and alkanoic and alpha,omega-alkanedioic acids are preferentially removed upon mild alkaline conditions, whereas mid-chain-modified omega-hydroxyalkanoic acids are preferentially removed under stronger alkaline conditions. Saturated omega-hydroxyalkanoic acids are found to be abundant in all suberin extracts. These results are consistent with two distinct suberin fractions with different locations in cork cell walls and/or esterification degrees. It is proposed that these fractions correlate with the two main suberin peaks in the solid state (13)C NMR spectra of cork and suberin extracts. Quantitative GC-MS analysis showed that suberin monomers comprise approximately 30% (w/w) of the suberin extracts, the remaining comprising nonvolatile structures with high M(n) values, as measured by vapor pressure osmometry. The presence of a large fraction of high molecular weight aliphatic structures in suberin extracts is supported by the corresponding NMR spectra.

Antimutagenicity of a suberin extract from Quercus suber cork

The possible protective effect of a suberin extract from Quercus suber cork on acridine orange (AO)-, ofloxacin- and UV radiation-induced mutagenicity (bleaching activity) in Euglena gracilis was examined. To our knowledge, the present results are the first attempt to analyse suberin in relation to mutagenicity of some chemicals. Suberin exhibits a significant dose-dependent protective effect against AO-induced mutagenicity and the concentration of 500 micrograms/ml completely eliminates the Euglena-bleaching activity of AO. The mutagenicity of ofloxacin is also significantly reduced in the presence of suberin (125, 250 and 500 micrograms/ml). However, the moderate protective effect of suberin on UV radiation-induced mutagenicity was observed only at concentrations 500 and 1000 micrograms/ml. Our data shows that suberin extract from Q. suber cork possess antimutagenic properties and can be included in the group of natural antimutagens acting in a desmutagenic manner.

[The most frequent nursing diagnoses in a gynecological admission unit]

Our objective was to identify the most frequent nursing diagnoses in a gynecological admission unit. The defining characteristics were surveyed from the data reported in the nursing case history and the patient files of 30 patients. The nursing diagnoses were found according to the revised NANDA Taxionomy I. The five most frequent nursing diagnoses were: risk for infection (30 cases); risk for pain (24 cases); health-seeking behaviors (11 cases); fear (10 cases) and stress incontinence (5 cases).

Motor activity of the gallbladder in systemic sclerosis

OBJECTIVE

We sought to measure gallbladder emptying in scleroderma patients, when stimulated by exogenous cholecystokinin.

METHODS

Twenty-eight consecutive scleroderma patients were evaluated. Ten were excluded for the presence of gallstones. Gallbladder motor function was studied in 18 patients and 18 controls, using specific parameters for the quantification of gallbladder emptying dynamics. Resting gallbladder volumes were compared using the Dodds method with real-time ultrasound. Cholecystokinin (CCK)-stimulated gallbladder function (0.02 microg/kg CCK intravenous infusion/30 min) was assessed by a scintigraphic technique using 99mTc-DISIDA. Five patients presented with CREST syndrome, 13 with the diffuse form of scleroderma. Four were men, 14 women (average age = 46.6+/-15.4 yr). Patients and controls were paired by gender, age, and weight.

RESULTS

Resting gallbladder volumes were larger in the four men with scleroderma than in the women with this disease (p < 0.03, Mann-Whitney). The mean gallbladder resting volume in scleroderma patients was not different from the mean volume detected among controls (p = 0.25), even when controlling for gender (p = 0.78 for women, p = 0.08 for men), scleroderma disease subtype (p = 0.50), or disease duration (p = 0.48). Latency period, ejection period, ejection rate, or ejection fraction as measured during cholecystokinin-stimulated scintigraphic studies were not significantly different between patients and controls. A trend was detected for reduction of the ejection period in scleroderma women (p = 0.70) when compared with scleroderma men. More than 35% of the scleroderma patients presented biliary lithiasis.

CONCLUSIONS

There was no significant difference in gallbladder dynamics measured by a scintigraphic technique in scleroderma patients, compared with controls, when gallbladder motor function was evaluated by intravenous CCK.

[Adoption of standard precautions: a report]

During 1993 and 1994, a recycling program on Standard Precautions was conducted for the nursing personnel at the Women's Health Centre (CAISM). In 1995, an evaluation was obtained through direct observation of these sectors regarding the adoption of these measures, the adequate use, access and availability of gloves and boxes for the disposal of perforating, sharp material. Sixty observations and 232 procedures were reported. One hundred sixty four procedures (71%) adopted these measures and 68 procedures (29%) did not. It was evident that the need to wash hands and not to use needles twice should be emphasized.

Very high-resolution 1H MAS NMR of a natural polymeric material

The use of ultrafast magic angle spinning (> 30 kHz) in tandem with delayed echo acquisition is shown to yield very high-resolution lH MAS NMR spectra of complex natural organic materials. For the first time, very high-resolution 1H MAS NMR spectra are reported for cork and wood components, two natural materials with great economic importance. The effect of the spinning rate on the 1H NMR spectra was evaluated with single-pulse acquisition and delayed-echo acquisition. The delayed-echo acquisition spectra presented linewidths as sharp as 67 and 25 Hz. The narrow peaks, characterised by proton spin-spin and spin-lattice relaxation, were assigned to the isotropic chemical shifts and the general spectral features were shown to correlate with the sample chemical structure. The tentative assignments of cork 1H MAS NMR signals were presented.

[Allergic reactions caused by latex: warning to health workers]

In this study, a bibliographic survey is made of all articles, published during the last few years, dealing with allergic reactions to latex. The first article on allergic reactions associated with latex was published in Britain, in 1979. Since then, the number of cases reported have increased (Barton, 1993). Type I allergic reaction (immediate reaction) and Type IV (delayed reaction) are part of the latex allergic process (Steelman, 1995). Contact allergy is due to inadequate washing during manufacture, which results in the retention of water-soluble proteins that cause allergic reactions in susceptible people. A wide variety of allergic reactions that vary from contact dermatitis to anaphylatic shock are described in literature. These finding show that a health team must know the probable implications of latex allergy.

[Hyperlipemic pancreatitis: clinical course]

Acute pancreatitis is one of the complications associated with severe primary and secondary hypertriglyceridemia. The frequency of hypertriglyceridemia in patients with pancreatitis ranges from 4 to 53%. The elevation in serum triglycerides probably induces the release of free fatty acids, responsible for the pancreatic damage. During a three year study, nine patients with acute pancreatitis due to hypertriglyceridemia were followed up at the University Hospital of Federal University and at the "Hospital Monte Sinai" (Juiz de Fora, MG, Brazil). Suggestive clinical manifestations, especially superior abdominal pain, nausea, vomiting and ileus, were found in all the patients; however, only three showed elevated serum amylase levels. All had triglyceride levels above 1000 mg/dl (11.3 mmol/L). The evolution after clinical treatment was good in eight patients (two needed parenteral nutrition). The only death observed was due to shock and acute respiratory distress, refractory to clinical management. The maintenance treatment aimed at withdrawing the predisposing conditions and reduction of the triglyceride levels prevented recurrence of acute pancreatitis episodes during the 23 months of follow-up.

Reactivation of Chagas' disease in a human immunodeficiency virus-infected patient leading to severe heart disease with a late positive direct microscopic examination of the blood

We report a human immunodeficiency virus (HIV)-infected man with chronic Chagas' disease who developed a congestive heart failure that could not be clinically controlled. Endomyocardial biopsy revealed severe myocarditis and the xenodiagnosis result was positive, but Trypanosoma cruzi by direct microscopic examination of the blood was found only four months after the symptoms had started. Treatment with benznidazole was effective in reducing parasitemia, stabilizing the clinical status, and controlling tissue damage related to the parasite. Although the finding of T. cruzi trypomastigotes by direct microscopic examination of the blood has been considered the mark of Chagas' reactivation in immunocompromised patients with chronic disease, in this case it was a late finding.

[Epidemiology, clinical features and clinical course of Crohn's disease: a study of 60 cases]

The authors present their experience with the follow-up of 60 cases of Crohn's disease, from 1970 until 1998, in the city of Juiz de Fora, Minas Gerais state, a county of the Southeast region of Brazil, and analyse the epidemiology of disease to improve the understanding of its behaviour in the country. The incidence rates increased greatly in the last 28 years. In the group studied 53.3% were men, 90% white, 71.7% non-smokers, 93.3% non-alcoholics, and all, but two, lived in urban area; 58.3% had their symptoms started at the age between 11 and 30 years and 30% were in the second decade of life. Relatives with Crohn's disease were seen in 6.7%, and the most common symptoms observed at the beginning of disease were: abdominal pain (78.3%), diarrhea (68.3%), weight loss (26.7%) and small bowel obstruction or localized peritonitis (15%). The ileum was involved in 90% and five cases (8.3%) with lesions restricted to the colon were observed. Two patients died because they were non-responders despite any therapy schedule and had sepsis after surgery. The effect of several substances used in the treatment is described, being prednisone the most effective in controlling the active disease. Other drugs as aminosalicilates, metronidazol and immunomodulators are also considered to avoid the side-effects of long-term use of steroides. Comments are made about the clinical evolution, surgeries and response to many treatments adopted. The authors conclude that Crohn's disease is increasing its incidence rate in Brazil and probably in South America formerly considered as a region of low frequency.

[An attempt to detect Trypanosoma cruzi in the peripheral blood of patients with Chagas' disease, in chronic phase, using quantitative buffy coat (QBC)]

Taking for granted the sensitivity of the Quantitative Buffy Coat (QBC) system, as documented in a murine experimental model, we assayed to detect Trypanosoma cruzi in the peripheral blood of 100 patients with Chagas disease in its chronic phase. By means of the method, no positivity occurred, evently as a consequence of small parasitemias, undetectable by this technique as assessed by the cases in consideration.

Follow-up of 18 patients with human immunodeficiency virus infection and chronic Chagas' disease, with reactivation of Chagas' disease causing cardiac disease in three patients

A series of 18 patients with chronic Chagas' disease and human immunodeficiency virus infection were followed up for 2 to 66 months (median, 15.5 months). Artificial xenodiagnosis was positive for 81.3% and natural xenodiagnosis was positive for 81.8% of patients for whom they were performed; 81.8% of 11 patients had medium- or high-level parasitemia. Reactivation of Chagas' disease--direct microscopic examination of blood revealing parasites and, clinically, patients presenting with cardiac disease--occurred in three patients (16.7%). Specific antitrypanosomal treatment with benznidazole was effective in reducing the level of parasitemia and improving the clinical condition in three of the four patients treated.

[Hepatic puncture biopsy in the outpatient clinic]

The authors present the results of a prospective study on percutaneous needle biopsy of the liver conducted at the Hepatology Outpatients' Ward of the Gastroenterology Unit of the University Hospital -" Universidade Federal de Juiz de Fora", MG, Brazil. In 16 months 61 biopsies were made in patients with chronic liver disease according to the technique described by menghini. The inclusion criteria were established by The Patient Care Committee of The American Gastroenterological Association. Abdominal ultrasound was done before and after the procedure. The patients stayed six hours under control (blood pressure and pulse rate) in the hospital. After 24 hours other clinical, laboratorial and ultrasonic control were performed. The main complication was local pain or in the right shoulder (32 patients--52.5%). Abdominal ultrasound after 24 hours revealed only one hematoma of the abdominal wall (1.8%). This study shows that the outpatient needle liver biopsy is a safe procedure with low complication rate when performed in a judicious way, by specialized personnel and under strict clinical control.

[The most frequent nursing diagnoses in an oncology admission unit]

The aim of this paper was to survey the most frequent nursing diagnoses by means of the nursing history and medical procedure in order to help the care provided at the Oncology Nursing Service of Women Health Whole Care (Centro de Atenção Integral à Saúde da Mulher-CAISM). The five most common diagnoses were: risk for infection, risk for altered body temperature, risk for aspiration and colonic constipation of the exchanging pattern, and risk for activity intolerance of the moving pattern. Data collection was based on these patterns. Data predominantly involving social, cultural, psychological and spiritual aspects were hardly interpreted, because they were poorly registered or omitted.

[Support for decision making in nursing in cases of altered urinary elimination: Alturin.Exp System]

Lopes, Palombo and Sabbatini have developed a system for computer-aided decision in nursing named ALTURIN.EXP, based on SABBATINI'S EXPERTMD system and the North American Nursing Diagnosis Association (NANDA) nursing diagnosis classification, which is related to nursing diagnosis for altered urinary elimination. The ALTURIN.EXP defines the specific altered urinary elimination diagnosis and indicates the most common nursing interventions. Our purpose was testing the program clinically. Twenty-nine cases of altered urinary elimination in women with gynecological and oncogynecological problems have been described. Three nurses provided the principal and secondary diagnoses when regarded. These diagnoses were compared to those of the program. As previously elaborated, the program, in some cases, provided the secondary diagnosis. The clinical cases use has led to a review on the program structure in order to decrease error possibility.

[Educational program in universal precaution measures: a methodological approach]

An updating program on measures of universal precautions (M.U.P.) was developed at the Center of Whole Care of Woman's Health (Centro de Atenção Integral à Saúde da Mulher-CAISM). These measures and the procedures in the case of work accident were published in a booklet. First, servants should be aware of the matter of stress and its influence on the quality of life. Then, updating was carried through encouraging the reflection on the consequences of the non-adoption of M.U.P. The answers to 286 pre-tests and 242 post-tests were analyzed and the results showed a significantly higher index of correct answers (p < 0.01), mainly regarding the appropriate use of glove.

[Opinion of alumni about the teaching of nursing diagnosis according to North American Nursing Diagnosis Association]

In accordance to North American Nursing Diagnosis Association (NANDA), nursing diagnosis is a clinical judgement of the individual, family or community answers to the vital process or to the actual or potential health problems. These gives the basis for the intervention selection by which the nurse is responsible. Believing in the importance of nursing diagnosis, its teaching was introduced 4 years ago in the subjects of Woman s Health Assistance and Perinatal Nursing, in the 6o. period of the undergraduate course in nursing at UNICAMP. Aiming at evaluating these experience, we proposed to get the students opinion and obtain subsides to perfect teaching. Teoric teaching of 4 hours was given and it was indicated the basic bibliography. The supervised practical application was developed during 21 hours in a neonatal unit and 45 hours in health centers. At the end of the subjects, 16 students answered a form with closed and open questions. All the students considered valid the study of the nursing diagnoses. Most of the students considered more proper to introduce the teaching in the 3o. semester, when the nursing basic procedures is begun. As to the difficult of learning in the use of diagnoses, 68.7% of the students reported a difficult level higher to 25% and lower to 75%. The students group considers that the study of nursing diagnoses brought modifications in its concept of nursing assistance.

[Inactivated vaccine against hepatitis A: review of the literature and considerations on its use]

A new, safe, highly immunogenic and probably long term effective inactivated hepatitis A virus vaccine has been licensed for clinical use. Clinical trials in developed countries have demonstrated its efficacy in preventing hepatitis A in high risk groups, such as travelers to regions where HAV infection is endemic and day care children and staff, its efficacy in postexposure conditions and in community outbreaks. The authors review the basic and changing features of the disease and its epidemiology in specific geographical regions trying to elucidate its use in the control of the disease in developing countries, especially in Brazil. Taking in consideration its efficacy, safety and immunogenicity, the inactivated hepatitis A vaccine may be of extreme value in terms of individual protection. Because this vaccine is so new, there are no formal recommendations for its use in developing countries, and appropriate public health use of hepatitis A vaccine requires up-to-date epidemiological information.

[Intestinal parasitosis and hepatic cirrhosis]

The authors describe their experience, in a prospective survey, with the prevalence rates of intestinal parasites in patients with hepatic cirrhosis admitted to the Gastroenterology Unit of University Hospital of Federal University in Juiz de Fora, Brazil, whose fresh stools were examined by Hoffman-Pons-Janner, Baermann-Moraes and Willis methods. They compare the results of stool exams with two control groups and look for a relation with cirrhosis' etiology. A higher prevalence of some parasites was observed in cirrhosis than in people with other digestive diseases (group I). mainly for the Strongyloides stercoralis, found in 40.2%, chiefly in alcoholic cirrhosis. Oddly no one of the group I admitted in the same period had strongyloidiasis. Another group including all the people who had stool samples examined in the same period at the hospital had 1.91% of that helmintic infection (group II). A comparison is also made with the prevalence in schoolchildren between the ages of 7 and 14 studies eight years before (13.16%). Other parasites were also observed in different incidence between those with cirrhosis and the other groups and the results are presented. They conclude that hepatic cirrhosis must be included in the list of conditions which increases the risk of Strongyloides stercoralis infection.

Simultaneous occurrence of acute myocarditis and reactivated Chagas' disease in a patient with AIDS

Myocarditis is not an uncommon finding in autopsy series of patients with AIDS, although clinically important myocarditis is rarely noted. We describe a 50-year-old woman with AIDS and chronic chagasic megaesophagus, without previous cardiac abnormalities, who experienced reactivation of Chagas' disease, characterized by the finding of Trypanosoma cruzi via direct microscopic examination of the buffy coat, xenodiagnosis, and blood culture; she developed fatal acute myocarditis. Reactivation of Chagas' disease in patients with AIDS has been reported, but in the great majority of cases it has been associated with central nervous system involvement. In areas where Chagas' disease is endemic, reactivation may occur in patients with AIDS.

Paracoccidioidomycosis in a renal transplant recipient

Paracoccidioidomycosis is a fungal infection rarely described in immunodeficient patients. We report a severe case of pulmonary paracoccidioidomycosis in a renal transplant recipient and demonstrate deficiencies of in vitro lymphocytic transformation assays, skin hypersensitivity tests, as well as low levels of antibodies to Paracoccidioides brasiliensis.

[Typology of performance of graduate course disciplines in medicine at the Medical School of the University of São Paulo]

The results of the program for the evaluation of the curriculum of the graduation course of the Medical Faculty of the University of São Paulo are presented and discussed. Following disciplines received special attention: practice in a hospital for infections diseases, orthopedics and traumatology, medical imagery, propedeutics and preventive and social pediatrics. These disciplines were chosen in an aleatory way among those that correspond to the four models of the behaviour: increasing, decreasing, decreasing/increasing and increasing/decreasing.