A scoring tool to predict mortality and dependency after cerebral venous thrombosis

BACKGROUND

We developed a prognostic score to predict dependency and death after cerebral venous thrombosis (CVT) to identify patients for targeted therapy in future clinical trials..

METHODS

We used data from the International CVT Consortium. We excluded patients with pre-existent functional dependency. We used logistic regression to predict poor outcome (modified Rankin Scale 3-6) at 6 months and Cox regression to predict 30-day and 1-year all-cause mortality. Potential predictors derived from previous studies were selected with backward stepwise selection. Coefficients were shrunken using Ridge regression to adjust for optimism in internal validation.

RESULTS

Of 1454 patients with CVT, the cumulative number of deaths was 44 (3%) and 70 (5%) for 30 days and 1 year, respectively. Of 1126 patients evaluated regarding functional outcome, 137 (12%) were dependent or dead at 6 months. From the retained predictors for both models, we derived the SI₂ NCAL₂ C score utilizing the following components: absence of female Sex-specific risk factor, Intracerebral hemorrhage, Infection of the central nervous system, Neurologic focal deficits, Coma, Age, lower Level of hemoglobin (g/L), higher Level of glucose (mmol/L) at admission, and Cancer. C-statistics were 0.80 (95%CI 0.75-0.84), 0.84 (95%CI 0.80-0.88) and 0.84 (95%CI 0.80-0.88) for the poor outcome, 30 days and 1 year mortality model, respectively. Calibration plots indicated good model fit between predicted and observed values. The SI₂ NCAL₂ C score calculator is freely available at www.cerebralvenousthrombosis.com.

CONCLUSIONS

The SI₂ NCAL₂ C score shows adequate performance for estimating individual risk of mortality and dependency after CVT but external validation of the score is warranted.

JS03.5.A Pediatric Neurofibromatosis type 1- associated Malignant Peripheral Nerve Sheath Tumors: a national experience

Background

Malignant peripheral nerve sheath tumors (MPNST) are rare soft tissue sarcomas and although less that 10% occur in the pediatric age, they are the most feared complication in the follow-up of Neurofibromatosis Type 1 (NF1) patients. NF1-children tend to have larger tumors and worse prognosis than non-NF1 patients. There is a lack of data regarding MPNST in pediatric populations with NF1, and the present work aims to characterize a Portuguese population of pediatric NF1 patients who developed a MPNST.

Material and Methods

Retrospective analysis of all NF1-pediatric patients diagnosed with MPNST between 2000 to 2021, from three centers in Portugal. Patient characteristics, treatment modalities and clinical outcomes were reviewed.

Results

12 patients (6 males and 6 females) met the inclusion criteria. 7 had no family history of NF1. Median age at diagnosis was 14.1 years (range 10-18). 5 had been diagnosed previously with Plexiform Neurofibroma and were treated with selumetinib (2) and partial surgery (2). MPNSTs were mostly located in the retroperitoneum (7) and in the proximal lower limbs (2). Only 1 patient had a resectable tumor at diagnosis and 3 patients had metastatic disease. In the FDG-PET scan of evaluated patients (7), the mean maximum standardized uptake value of the main lesion was 6 (range 3.6-9.7).Neoadjuvant ifosfamide plus doxorubicin chemotherapy was used in 4 patients. The median overall survival in this population was 10.3 months (95% CI 0.1-20.6) 2 patients remain alive.

Conclusion

The prognosis of MPNSTs in NF1 pediatric patients is very poor. In a subset of patients, MPNSTs develop from known Plexiform Neurofibromas. Current surveillance ant treatment protocols need to be improved.

Providing inoculum for Didymella bryoniae studies: the effect of light spectrum and storing at low temperature

The in vitro sporulation of Didymella bryoniae is of great importance for studies that require pure inoculum and in large quantities. Thus, the objectives of this study were to identify the best condition for D. bryoniae sporulation combining different light spectra (UV-A or UV-B light, white light, and continuous dark), with distinct culture media (PDA, V8, ML, and PDAB) and, to evaluate fungus' survivability stored at -20°C over time. The fungus samples were only able to sporulate when subjected to the UV-B light treatment, regardless of the culture medium. The highest appearance of spores conidium type was observed in the PDAB medium, and the lowest production occurred in the ML medium. Reproductive structures, such as perithecia and pycnidia, were observed in all culture media. However, there was considerable variation in the amount of each structure between the different culture media. The ML and V8 media showed a greater number of perithecia and the PDA and PDAB media presented a greater proportion of pycnidia compared to perithecia. The storage duration at -20°C did not affect mycelial growth or mycelial growth rate. In conclusion, the UV-B light is essential for D. bryoniae in vitro sporulation. Moreover, the culture medium composition influences the type of fungal structure produced, as well as spores' size and quantity. Freezing at -20°C is an efficient technique that can be used to store D. bryoniae for at least five months without loss of viability.

Street Medical Consultation: health access of the Homeless People and intersectoral articulation

Background

The Homeless People is marked by serious social vulnerability, related to the absence of human dignity. Requirements of personal and residential documents, reception and inadequate approaches are barriers to access these people. The creation of Street Medical Consultation (CnaR), based on the logic of harm reduction in association with the other services, is a strategy that seeks to expand access to the services of the Public Healthcare System (SUS) in Brazil. The research aimed to analyze the characteristics and vulnerabilities of this population, the performance of CnaR and its articulation with services from the health care and the social assistance care network.

Methods

Study of a qualitative approach using 8 semi-structured interviews and the Thematic Content Analysis method. The study scenario was the CnaR multiprofissional team in a city in the interior of São Paulo.

Results

Three categories were found: (1) Population in Street Situation - complexity of those who live on the street: prejudices, violence and barriers in society and health institutions constitute a process of invisibility. (2) CnaR's work in the perspective of harm reduction: it is organized to meet the clinical and alcohol and other drugs demands through fixed fields, mobile fields and team meeting. (3) Beyond CnaR - network relationships: bringing dynamics to relationships, being strengthened or weakened. Ignorance of the service and their performance also generates CnaR invisibility process. The strategies developed include coping, dialogue, building partnerships and the process of visibility and fighting for the rights of the Homeless Persons.

Conclusions

CnaR finds itself as an insufficient service to meet all the demands of this vulnerable population in isolation, needing the network to expand access to health and other goods. It is necessary to combat prejudice against this population among health professionals and develop more efficient intersectoral articulation.

Key messages

The Homeless People have serious vulnerability and need humanization, guaranteeing equity in assistance in all sectors of society, especially the health care and the social assistance. The Street Medical Consultation faces performance difficulties to guarantee access to the Homeless People within the intersectoral network, often being the sole responsible for this population.

Scaffold and Parasite Hopping: Discovery of New Protozoal Proliferation Inhibitors

Utilizing a target repurposing and parasite-hopping approach, we tested a previously reported library of compounds that were active against Trypanosoma brucei, plus 31 new compounds, against a variety of protozoan parasites including Trypanosoma cruzi, Leishmania major, Leishmania donovani, and Plasmodium falciparum. This led to the discovery of several compounds with submicromolar activities and improved physicochemical properties that are early leads toward the development of chemotherapeutic agents against kinetoplastid diseases and malaria.

Efeito de Inibidores de MMPs Incorporados em um Sistema Adesivo Convencional na Estabilidade da União à Dentina Superficial e Profunda

O objetivo deste trabalho foi avaliar o grau de conversão (GC), absorção (WS), solubilidade (SO), resistência de união à dentina (µSBS) e nanoinfiltração (AG%) de um sistema adesivo [Adper Single Bond 2 (ASB2)] contendo inibidores de metaloproteinases [GM1489 (GM), Batimastat (BAT) e diacetato de clorexidina (CHX)] em duas profundidades dentinárias [superficial (DS) e profunda(DP)] após estocagem (imediata e 12 meses). ASB2 sem inibidor (SI) foi usado como controle. WS e SO foram calculadas com base na ISO4049. Para µSBS, 64 molares humanos (HUAP-1.972.896) foram cortados em discos com duas superfícies planas (DS e DP) e distribuídos em 8 grupos. Restaurações foram construídas nas superfícies dos discos e a μSBS foi avaliada. Para AG%, 16 molares humanos foram restaurados, cortados em palitos e preparados para análise em MEV. Os dados foram submetidos a ANOVA e teste Tukey. CHX apresentou o menor GC (84,32%), a menor WS (77,19 μg/mm3) e a maior SO (10,81 μg/mm3). A µSBS imediata variou de 24,86 a 34,06 MPa em DS e de 19,67 a 29,50MPa em DP. GM obteve a maior µSBS em DS, diferente apenas de CHX. BAT e GM apresentaram maiores μSBS em DP e foram diferentes de CHX. Após 12 meses em DS, GM e BAT obtiveram maiores μSBS que SI e CHX. Em DP após 12 meses, GM obteve a maior μSBS, diferente de SI e CHX. SI em DP e DS e CHX em DP não mantiveram a estabilidade de união dentina-resina após estocagem. Após 12 meses BAT e GM reduziram AG% em DS, enquanto apenas GM diminuiu AG% em DP. A incorporação de Batimastat e GM1489 no ASB2 manteve a estabilidade de união resina-dentina após 12 meses, sem prejudicar a WS, SO e GC.Palavras-chave: Adesivos. Metaloproteases. Dentina.

Influência do Uso de Inibidores de Proteases em Superfície Dentinária

A finalidade trabalho foi avaliar a influência de diferentes inibidores de proteases (IP) na avaliação dos seguintes fatores ângulo  de contato (AC), associado ao sistema adesivo Adper Single Bond 2 (SB), bem como a análise da superfície dentinária (ASD) e a influência de sua atividade antimicrobiana. Soluções de (Diacetato de Clorexidina DCLX, 1,10-Fenantrolina FEN, E-64 e epigalocatequina-3-galato EGCG) foram utilizadas como tratamento prévio (TP) à dentina após o condicionamento ácido, exceto o grupo controle (GC) que não recebeu o TP. Para os testes realizados no presente estudo foi utilizado um total de 60 terceiros molares humanos hígidos recém extraídos. Nos testes de ASD e AC foram confeccionados discos de dentina de 1mm de espessura, a ASD foi analisada por Microscopia de Varredura (MEV). O ângulo de contato foi avaliado por goniômetro. Para os testes antimicrobianos, foram confeccionados 30 discos de dentina para tratamento com as soluções dos IP e a indução do BC. A quantificação foi feita através dos ensaios de redução do MTT e dosagem de ácido lático produzido pelo biofilme. Os dados foram analisados através de análise de variância de dois fatores e teste de Tukey HSD para contraste entre as médias (a0.05). O PT com os IP demonstrou maior teor de carbono na ASD e diminuição do AC. A atividade metabólica e a produção de ácido lático pelo biofilme de S. mutans foi estatísticamente inferior nos discos com os IP, comparados ao GC (p < 0.05).Palavras-chave: Inidores. Proteases. Dentina. Biofilme.

Síntese e Caracterização de Compósitos Restauradores Remineralizantes com Partículas de Ionômero de Vidro-Ca Pré-Reagidas (PRG-Ca)

O objetivo desta pesquisa foi sintetizar e caracterizar compósitos restauradores experimentais (CRE) com partículas de ionômero de vidro-cálcio pré-reagidas (PRG-Ca). As PRG-Ca foram obtidas a partir da síntese de um vidro de cálcio fluoraluminosilicato e sua reação com ácido poliacrílico. As PRG-Ca foram silanizadas e CRE foram produzidos: E0, E1, E2, E3, E4, E5 e E6. A matriz orgânica (40% p/p) foi composta de Bis-GMA / TEGDMA e canforoquinona / etil N,N-dimetil-4aminobenzoato. O compósito base (E0) continha 60% p/p de partículas de bário-boro-silicato (BaBSi), sendo o controle. Em E1, E2, E3, E4, E5 e E6, o BaBSi foi parcialmente substituído por 10, 20, 30, 40, 50 e 60% p/p de PRG-Ca, respectivamente. O Empress Direct (ED) foi a referência comercial utilizada. Foram avaliadas as seguintes propriedades: grau de conversão (GC), rugosidade (Ra), dureza Knoop (DK), resistência à flexão (RF), módulo de flexão (MF), absorção (Ab), solubilidade (Sl), brilho (GU), translucidez (PT), cor (OE) e o potencial remineralizante (PR) através de microtomografia. Os dados foram submetidos à análise de variância e teste de Tukey HSD (a 0,05). Quanto à Ra, DK e GU, não houve diferença entre os CRE. O aumento de PRG-Ca diminuiu GC, RF, MF e PT e aumentou Ab, Sl, OE e PR. Na maioria das propriedades avaliadas, ED apresentou comportamento intermediário aos CRE. E0 e ED não apresentaram PR. Os CRE com PRG-Ca demonstraram ser materiais bioativos promissores, apresentando bom desempenho nas propriedades avaliadas e um potencial remineralizante que aumenta com uma maior concentração de PRG-Ca.Palavras-chave: Resinas Compostas. Remineralização Dentária. Propriedades Físicas e Químicas.

Influência da Morfologia de Esmalte na ação de Sistemas Adesivos Autocondicionantes com Diferentes Acidez Aplicados em uma ou Duas Camadas

O objetivo deste estudo foi verificar a espessura da camada de esfregaço (CE) e a rugosidade (Sa) em esmalte, utilizando instrumentos rotatórios de diferentes granulações e analisar a influência de sua morfologia na eficácia adesiva de sistemas autocondicionantes experimentais com diferentes acidez, aplicados em uma ou duas camadas. Para análise da Sa e CE, após planificação da face vestibular de dentes bovinos, estas foram desgastadas com diferentes instrumentos: R (ponta diamantada de granulação regular 3101) e FF (ponta diamantada de granulação extra fina 3101FF). A medição da rugosidade (n5) foi efetuada por um perfilômetro tridimensional (Sa). Após sua clivagem, foram feitas medições da espessura da CE. 80 dentes bovinos tiveram a superfície vestibular de esmalte planificada e distribuídas nos grupos de acordo com a superfície de esmalte tratada (R e FF), com os adesivos (Suave – M Intermediário - I forte – S Clearfil SE Bond - C) e com o número de camadas (Uma camada -1 e Duas camadas - 2), formando os grupos: MR1, MR2, MFF1, MFF2, IR1, IR2,IFF1,IFF2, SR1, SR2, SFF1, SFF2, CR1, CR2. CFF1, CFF2. A resistência de união RU foi realizada por microcisalhamento. O grupo R teve a maior Sa e CE que FF. Somente para o sistema autocondicionante de maior pH, o tipo de ponta influenciou valores de (RU) que foram menores para a ponta diamantada R. O número de camadas aplicadas não teve influência. Instrumentos rotatórios de maior granulação produziram uma maior CE e Sa. Para adesivos suaves, em esmalte é recomendada a utilização de pontas de granulação extrafina para melhorar a união.Palavras-chave: Esmalte Dental. Camada de Esfregaço Colagem Dentária

Influência dos Inibidores de Proteases na Estabilidade da Resistência de União e Nanoinfiltração

O objetivo deste trabalho foi avaliar a influência de diferentes inibidores de proteases (IP) na avaliação dos seguintes fatores: resistência de união (RU) e nanoinfiltração (NI), associados ao sistema adesivo Adper Single Bond 2 (SB). Soluções de (Diacetato de Clorexidina DCLX, 1,10-Fenantrolina FEN, E-64 e epigalocatequina-3-galato EGCG) foram utilizadas como tratamento prévio (TP) à dentina após o condicionamento ácido, exceto o grupo controle (GC) que não recebeu o TP. Para os testes realizados no presente estudo foi utilizado um total de 80 terceiros molares humanos hígidos recém extraídos, aprovados pelo CEP (1.960.587/2017). Para avaliar a RU e a NI, foram confeccionados palitos de 1,0 mm², armazenados em dois tempos de estocagem: água destilada por 24h (AD), e, como comparação, a exposição ao biofilme cariogênico por 48h (EBC). Os dados foram analisados através de análise de variância de dois fatores e teste de Tukey HSD para contraste entre as médias (a0.05). Após EBC, os PT com os IP, em todos os grupos, demonstraram redução da NI, comparados ao GC (p < 0.05). O resultado de RU foi: GCCB < GCSB GDCLXCB GDCLXSB < GFENCB GE-64CB GEGCGCB GFENSB GE-64SB GEGCGCB GEGCGSB (p < 0.05). A análise de regressão mostrou uma forte correlação de equivalência entre a penetração de nitrato de prata e pigmentação de metanamina de prata (r + 0.76 p 0,0347).Palavras-chave: Inidores. Proteases. Dentina. Biofilme. Degradação.

Síntese e Caracterização de Adesivos Autocondicionantes com Sistema Tampão de Hidróxido de Cálcio e Avaliação da Estabilidade de Adesão

O objetivo deste estudo foi sintetizar e caracterizar adesivos autocondicionantes com sistema tampão de hidróxido de cálcio (Ca(OH)2). A composição do adesivo base (%p/p) foi: Primer: 10-MDP (30%), TEGDMA (30%), etanol (35%), água (5%), canforoquinona (0,5%), EDMAB (0,5%) e Adesivo: Bis-GMA (50%), TEGDMA (30%), HEMA (20%), canforoquinona (0,5%) e EDMAB (0,5%). As formulações experimentais tiveram as seguintes concentrações de Ca(OH)2 no adesivo: A0 (0), A1 (1%), A2 (2%) e A4 (4%). O Clearfil SE Bond foi usado como controle comercial. O potencial tamponante foi avaliado através de curvas de pH em função  do tempo e o grau de conversão dentro da camada híbrida, através da análise espectroscópica dispersiva usando um micro-Raman. Barras de dentina-compósito produzidas em quarenta molares humanos após a hibridização com os adesivos experimentais (n 8) foram imersas em saliva artificial e submetidas ao ensaio de microtração: metade após 24 h e a outra metade após 1 ano. O padrão de ruptura e a fractografia das interfaces adesivas foram avaliados através de microscopia óptica e eletrônica de varredura (MEV). O fenômeno de nanoinfiltração foi avaliado através do MEV e Espectroscopia de Energia Dispersiva. Os dados foram submetidos à analise de variância e teste de Tukey (a 0,05). O potencial tampão dos adesivos aumentou com o aumento da concentração de Ca (OH)2 (p <0,05). A incorporação de Ca(OH)2 não comprometeu a adesão à dentina e o fator tempo não foi significante (p > 0,05). O adesivo com 4% de Ca(OH)2 apresentou a menor nanoinfiltração.Palavras-chave: Adesivos Dentinários. Hidróxido de Cálcio. pH

Adesão em Cerâmica Y-TZP Submetida a Plasma não Térmico de Argônio por Diferentes Tempos

O objetivo deste estudo foi avaliar a influência de diferentes tempos de aplicação de plasma não térmico de argônio (PNTA) na energia de superfície e na resistência de união entre um cimento resinoso autoadesivo e uma cerâmica Y-TZP. Blocos sinterizados da cerâmica Y-TZP foram divididos em dois grupos: S (sinterizado) e J (jateamento com Al2O3 de 50 μm). Em seguida, os blocos foram subdivididos em quatro grupos (n5) de acordo com o tempo (s) de aplicação de PNTA: 0, 20, 60 e 120. A energia de superfície foi avaliada através de goniometria. Blocos de compósito foram cimentados nas superfícies de cerâmica com um cimento resinoso autoadesivo. Após armazenagem em água destilada a 37 °C / 24 h, os blocos de compósito-cerâmica foram cortados em palitos e submetidos a teste de microtração (50 N / 1,0 mm/min). Os dados foram submetidos a análise de variância de dois fatores e ao teste de Tukey HSD (a0.05). Nos dois grupos (S e J), a aplicação de PNTA aumentou a energia de superfície, sem diferença significante entre os tempos: 0 s < 20 s 60 s 120 s. Para os dois grupos (S e J), o resultado de resistência de união foi: 0 s < 20 s < 60 s 120 s, (p< 0.05). Somente após 120 s de PNTA, a resistência de união do grupo J (44,2 ± 7,8 MPa) foi estatisticamente superior a do S (31,0± 2,2 MPa), (p < 0.05). Houve correlação positiva entre a resistência de união e o tempo de deposição de PNTA (r 0.80 p 0.0247). A deposição de PNTA aumentou a energia de superfície da cerâmica Y-TZP e a resistência de união entre esta e o cimento resinoso autoadesivo, sendo este efeito maior após maiores tempos de aplicação de PNTA.Palavras-chave: Cerâmica Y-TZP. Plasma não Térmico de Argônio. Resistência de União.

Remineralizing potential of CPP-ACP creams with and without fluoride in artificial enamel lesions

BACKGROUND

This study evaluated the effect of pastes containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) with and without fluoride on enamel demineralization.

METHODS

Human enamel blocks were used and after incipient caries-like lesions were formed, they were assigned to four groups: G1 - saliva; G2 - MI Paste (Recaldent^TM ); G3 - MI Paste Plus (Recaldent^TM 900 ppm as NaF); and G4 - Crest^™ (1.100 ppm as NaF). The specimens were soaked in demineralizing solution for 6 hours and remineralized in artificial saliva for 18 hours alternatively for 10 days. The dentifrice was prepared with deionized water in a 1:3 proportion (w/w) or applied undiluted in the case of the CPP-ACP formula. Demineralized enamel changes were analysed by surface microhardness (SMH), 3D-profilometry and SEM. Data were analysed by non-parametric Kruskal-Wallis and Mann-Whitney test comparisons and one-way ANOVA and Tukey's HSD post hoc test (α = 0.05).

RESULTS

The SMH values observed in the G2 (47.8 ± 28.5) and G3 (53.6 ± 27.6) groups were different from that of G4 (90.2 ± 17.1), which were significantly higher than that found in G1 (39.4 ± 14.2). The %SMH was significantly lower in G4 when compared to G1 (p < 0.001) and G3 (p < 0.05).

CONCLUSIONS

MI Paste Plus demonstrated a greater protective effect against demineralization than MI Paste and showed smoother surfaces.

Hemocytes of Rhipicephalus sanguineus (Acari: Ixodidae): Characterization, Population Abundance, and Ultrastructural Changes Following Challenge with Leishmania infantum

Few studies have examined the cellular immune response of ticks, and further research on the characterization of the hemocytes of ticks is required, particularly on those of Rhipicephalus sanguineus (Latreille) because of the medical and veterinary importance of this tick. The aims of this study were to characterize the morphology and the ultrastructure of the different types of hemocytes of adult R. sanguineus and to determine the population abundance and the ultrastructural changes in the hemocytes of ticks infected with Leishmania infantum. The hemocytes were characterized through light and transmission electron microscopy. Within the variability of circulating cells in the hemolymph of adult R. sanguineus, five cell types were identified, which were the prohemocytes, plasmatocytes, granulocytes, spherulocytes, and adipohemocytes. The prohemocytes were the smallest cells found in the hemolymph. The plasmatocytes had polymorphic morphology with vesicles and cytoplasmic projections. The granulocytes had an elliptical shape with the cytoplasm filled with granules of different sizes and electrodensities. The spherulocytes were characterized by several spherules of uniform shapes and sizes that filled the entire cytoplasm, whereas the adipohemocytes had an irregular shape with multiple lipid inclusions that occupied almost the entire cytoplasmic space. The total counts of the hemocyte population increased in the group that was infected with L. infantum. Among the different cell types, the numbers increased and the ultrastructural changes occurred in the granulocytes and the plasmatocytes in the infected group of ticks.

Should ascitis volume and anthropometric measurements be estimated in hospitalized alcoholic cirrotics?

INTRODUCTION

Ascitis and undernutrition are frequent complications of cirrhosis, however ascitis volume and anthropometric assessment are not routinely documented or considered in prognostic evaluation. In a homogeneous cohort followed during two years these variables were scrutinized, aiming to ascertain relevance for longterm outcome.

METHODS

Population (N = 25, all males with alcoholic cirrhosis) was recruited among patients hospitalized for uncomplicated ascitis. Exclusion criteria were refractory or tense ascitis, cancer, spontaneous bacterial peritonitis, bleeding varices and critical illness. Measurements included ultrasonographically estimated ascitis volume, dry body mass index/BMI , upper arm anthropometrics, hematologic counts and liver function tests.

RESULTS

Population (age 48.3 ± 11.3 years, BMI 21.1 ± 3.5 kg/m², serum albumin 2.5 ± 0.8 g/dL) was mostly in the Child-Pugh C category (77.8%) but clinically stable. During the follow-up period of 22.6 ± 3.8 months, additional hospitalizations numbered 1.7 ± 1.0 and more than one quarter succumbed. Admission ascitis volume corresponded to 7.1 ± 3.6 L and dry BMI to 18.3 ± 3.5 kg/m². Child Pugh index was relevant for both mortality and rehospitalization. Nevertheless, similar matches for mortality were documented with ascitis volume and dry BMI, and arm circumference below the 5th percentile was highly significantly associated with rehospitalization.

CONCLUSIONS

A greater association than hitherto acknowledged, between ascitis volume and anthropometric measurements from one side, and long-term rehospitalization and mortality from the other, was demonstrated in male stable alcoholic cirrhotics. Further studies with alcoholic and other modalities of cirrhosis including women are recommended.

Cardiorespiratory and neuromuscular responses during water aerobics exercise performed with and without equipment

The aim of the study was to compare the cardiorespiratory and neuromuscular responses to water aerobics exercise performed with and without equipment. 15 women performed stationary jogging combined with elbow flexion/extension without equipment, with water-drag forces equipment and with water-floating equipment, at 2 submaximal cadences and at maximal cadence. Heart rate, oxygen uptake and electromyographic signal from biceps brachii, triceps brachii, biceps femoris and rectus femoris were collected during the exercise. The heart rate and oxygen uptake showed significantly higher values during the execution of the water aerobics exercise with either equipment compared to the execution without equipment. In addition, significant difference was found between submaximal cadences. For neuromuscular responses, no significant differences were found between the submaximal cadences for all muscles analyzed; however, significant differences were found between these submaximal cadences and the maximal cadence. Similarly, the results showed no significant differences between the execution of the exercise with or without equipment, except in the muscle activation of triceps brachii and biceps femoris, which was higher when using water-floating and water-drag forces equipment, respectively. In conclusion, the water aerobics exercise presented higher cardiorespiratory responses with equipment and also increased the cadence of execution. Nevertheless, neuromuscular responses were higher only at maximal cadence.

Mutagenic potential and modulatory effects of the medicinal plant Luehea divaricata (Malvaceae) in somatic cells of Drosophila melanogaster: SMART/wing

Luehea divaricata is a native plant of the Brazilian Cerrado, known as "açoita-cavalo". It is used as a popular herbal medicine in the treatment of dysentery, bleeding, arthritis, tumors, ulcers, and gangrenous wounds. Considering that herbal medicines sometimes provoke tumors and/or may prevent mutational events, it is important to study the action of these natural drugs on DNA. Aqueous extract of the bark of L. divaricata was evaluated at three different concentrations (0.10, 0.30, 0.50 mg/mL), individually and in combination with the neoplastic drug doxorubicin (DXR), by the somatic mutation and recombination test (SMART/wing) in Drosophila melanogaster. Distilled water was included as a negative control. The mutation frequency in the treatments with L. divaricata extract alone was not significantly higher than in the negative control for standard (ST) and high bioactivation (HB) crosses. When L. divaricata extract was combined with DXR, there was a significant reduction in the frequency of spots when compared to DXR alone, in both crosses. Further studies with other experimental models would be useful to confirm that L. divaricata extract is not harmful and that it could be used in the prevention of cancer.

Physiological effects of concurrent training in elderly men

The aim of the present study was to investigate the effects of concurrent strength and endurance training on neuromuscular and hormonal parameters in elderly men. 23 healthy men (65±4 years) were randomly assigned to 1 of 3 groups: concurrent (CG, n=8), strength (SG, n=8) or endurance group (EG, n=7). The programs consisted, of strength training, endurance training on a cycle ergometer or a combination of both in the same session 3 times per week over a duration of 12 weeks. Subjects were evaluated on parameters related to muscle strength, muscle activation and serum hormones. There were significant increases in lower-body strength in all groups (P<0.05), with higher increases in SG (67%) than CG (41%) and both were higher than EG (25%) (p<0.01). Only SG and CG increased upper-body strength (p<0.01), with no significant difference between the 2 groups. Furthermore, there were significant decreases in free testosterone in EG after training. Significant increases in isometric strength and maximal muscle activation (p<0.05) as well as decreases in the submaximal muscle activation to the same load, were only seen in SG (p<0.05). The present results suggest that the interference effect observed due to concurrent strength and endurance training could be related to impairment of neural adaptations.

Modulatory effect of Byrsonima verbascifolia (Malpighiaceae) against damage induced by doxorubicin in somatic cells of Drosophila melanogaster

Byrsonima verbascifolia, popularly known in Brazil as murici, is a medicinal plant widely used in the treatment of bacterial and viral infections, Chagas's disease, diarrhea, bronchitis, cough and fever, as well as for protection of the intestinal mucosa. Since chemotherapy and radiotherapy, broadly employed in the treatment of cancer, can have undesirable side effects, such as inducing DNA damage in normal cells, it would be useful to investigate compounds that inhibit or reduce these effects. A lyophilized water extract of murici, used at three different concentrations (25, 50, and 100 mg/mL), was tested to determine if it could reduce damage induced by the antineoplastic compound doxorubicin in somatic cells of Drosophila melanogaster, analyzed by SMART/wing. The frequency of mutant spots in descendants from standard and high bioactivation crosses was significantly reduced by treatment with murici extract. Further studies are needed using other experimental models, to determine if murici has the potential to be employed by cancer patients receiving chemotherapy.

Optimisation of the solvent extraction of phenolic antioxidants from fruits of Euterpe oleracea using Response Surface Methodology

Fruits of Euterpe oleracea (FEO) are currently known as elements that present a very high antioxidant activity (AAO), as measured by the Oxygen Radical Absorbance Capacity. They are particularly rich in total phenolics (TP) and total anthocyanins (TA). Response Surface Methodology was used to optimise the solvent extraction of phenolic antioxidants from FEO, using a second-order polynomial equation to describe the experimental data for TP, TA, and AAO. In order to determine the best solid-to-liquid ratio and time of extraction, some preliminary studies were conducted. A rotatable central composite design with three variables (ethanol proportion, hydrochloric acid concentration and temperature) was then used. The results showed a good fit to the proposed model (R(2)>0.89). TP and TA, as well as TA and AAO, showed significant correlations (P<0.05). The optimised conditions that maximized the yields of phenolic compounds (TP and TA) and AAO from FEO were: ethanol proportion between 70% and 80%, hydrochloric acid concentration between 0.065 and 0.074 mol/L and a temperature of 58 degrees C.

Extraction of manganese peroxidase produced by Lentinula edodes

Lentinula edodes, commonly called shiitake, is considered a choice edible mushroom with exotic taste and medicinal quality. L. edodes grows very well and produces a range of enzymes when cultivated on eucalyptus residues. Development of appropriate experimental procedures for recovery and determination of enzymes became a widely important cash crop. In this work, enzymes produced by L. edodes were extracted using different pH buffer and determined regarding peroxidases and proteases. Lignin peroxidase (LiP) was not detected in the extracts based on veratryl alcohol or azure B oxidation. Proteases were very low while Mn-peroxidases (MnP) predominated. The optimal pH for MnP recovery was 5.0, under agitation at 25 degrees C. The oxidation of phenol red decreased after dark-colored small compounds or ions were eliminated by dialysis. The extract of L. edodes contained components of high molecular weight, such as proteases or high polyphenol, that could be involved in the LiP inactivation. L. edodes sample previously submitted to dialysis was also joined to LiP of Phanerochaete chrysosporium and a total inhibition of LiP was observed.

Identification of nutrient-dependent changes in extracellular pH and acid phosphatase secretion in Aspergillus nidulans

The present study was designed to identify nutrient-dependent changes in extracellular pH and acid phosphatase secretion in the biA1 palC4 mutant strain of Aspergillus nidulans. The palC4 mutant was selected as lacking alkaline phosphatase, but having substantially increased acid phosphatase activity when grown on solid minimal medium under phosphate starvation, pH 6.5. Gene palC was identified as a putative member of a conserved signaling cascade involved in ambient alkaline sensing whose sole function is to promote the proteolytic activation of PacC at alkaline pH. We showed that both poor growth and conidiation of the palC4 mutant strain on solid medium, alkaline pH, were relative to its hypersensitivity to Tris (hydroxymethyl) aminomethane buffer. Also, the secretion of acid phosphatase was repressed when both the wild-type and palC4 mutant strains were grown in low-phosphate yeast extract liquid medium, pH 5.0, indicating that the secretion of this enzyme is not necessary to regenerate inorganic phosphate from the organic phosphate pool present in yeast extract.

Blood pressure regulation in the three-toed sloth, Bradypus variegatus

The aim of this study was to elucidate the role of the baroreflex in blood pressure control in sloths, Bradypus variegatus, since these animals show labile levels in this parameter. Unanesthetized cannulated sloths were positioned in an experimental chair and the arterial catheter was coupled to a strain gauge pressure transducer. Blood pressure was monitored before, during and after the administration of phenylephrine (0.0625 to 4 microg/kg) and sodium nitroprusside (0.0625 to 2 microg/kg), bringing about changes in mean blood pressure from +/-30 mmHg in relation to control values. The relation between heart rate changes due to blood pressure variation was estimated by linear regression analysis. The slope was considered the reflex baroreceptor gain. The results (means+/-SD) showed that the reflex baroreceptor gain was -0.3+/-0.1 bpm/mmHg (r=0.88) to phenylephrine and -0.5+/-0.1 bpm/mmHg (r=0.92) to sodium nitroprusside, denoting a reduced reflex baroreceptor gain when compared with other mammals, suggesting that in sloths the baroreceptors are minimally involved in the buffering reflex response to these drugs. These findings suggest that the labile blood pressure could be influenced or be a result of this lowering in the reflex baroreceptor gain.

Degradation of eucalypt waste components by Lentinula edodes strains detected by chemical and near-infrared spectroscopy methods

There are many changes, both qualitative and quantitative, in eucalypt waste during growth and fructification of Lentinula edodes. Wet chemical analysis and near-infrared (NIR) spectroscopy were used in conjunction with multivariate regression and principal components analysis to monitor biodegradation of eucalyptus waste during growth of several L. edodes strains. Weight and component losses of eucalypt residue after biodegradation by L. edodes strains were compared for periods of 1 to 5 mo. Decrease in cellulose, hemicellulose, and lignin contents occurred, however it was not concomitant. Measurement of lignin degradation by NIR and wet chemical analysis indicated its attack in the early stages of biodegradation. Selective lignin degradation by L. edodes was observed up to 2 mo of biodegradation for strains DEBIQ and FEB-14. One group of degraded substrate was identified based on the principal component analysis (PCA) of the data on their biodegradation time. Samples treated for 5 months by L. edodes strains (DEBIQ, UFV or FEB-14) differed from other, but no discrimination was observed among them. By the end of 5 mo, NIR analyses showed decrease of about 18-47% cellulose, 35-47% polyose and 39-60% lignin. These data were used for comparison with those obtained by wet chemical method for the degradation of the substrate by other five L. edodes strains cultivated at the same conditions. NIR calibration developed in this study was proven to be perfectly suitable as an analytical method to predict the changes in lignocellulose composition during biodegradation.

Electrocardiographic studies of the three-toed sloth, Bradypus variegatus

Electrocardiograms (ECG) obtained with standard limb leads and augmented unipolar limb leads were recorded from 17 unanesthetized adult sloths. The animals were held in their habitual position in an experimental chair. We determined heart rate and rhythm from the R-R intervals, the amplitude and duration of each wave, and the duration of the segments and intervals of the ECG. The mean electrical axes of P and T waves and QRS complex were calculated on the basis of the amplitude of these waves in leads I, II, III, aV R, aV L, and aV F. The P wave appeared positive in most tracings with low amplitude in lead II, the QRS complex was generally negative in leads aV R, III and aV F, and no arrhythmias were observed. With a mean +/- SD heart rate for all recordings of 81 +/- 18 bpm, the duration of P and T waves, QRS complex, and PR, QT and RR intervals averaged 0.05 +/- 0.02, 0.15 +/- 0.05, 0.07 +/- 0.02, 0.13 +/- 0.02, 0.38 +/- 0.04, and 0.74 +/- 0.17 s, respectively. The ECG shape had a definite configuration on each lead. The angles of the mean +/- SD electrical axes for atrial and ventricular depolarization and ventricular repolarization in the horizontal plane were +34 +/- 68 masculine, -35 +/- 63 masculine, and -23 +/- 68 masculine, respectively. All electrical axes showed great variations and their mean values suggest that, when the sloth is in a seated position, the heart could be displaced by the diaphragm to a semi-horizontal position.

Effect of cereal brans on Lentinula edodes growth and enzyme activities during cultivation on forestry waste

AIMS

To develop strategies for increasing the growth of Lentinula edodes in eucalyptus residues. To this end, we have examined the effects of cereal brans additions on production of mycelial biomass and enzymes.

METHODS AND RESULTS

Three isolates of the mushroom shiitake, L. edodes (Berk. Pegler), were evaluated for enzyme and ergosterol production on eucalyptus residue supplemented with 5, 10, 15 and 20% (w/w) of soya, wheat or rice brans. Nitrogen imput on eucalyptus residues accelerated mycelial growth by supplying the L. edodes with this limiting nutrient. High levels of enzymes activities were produced in eucalyptus residues supplemented by soya bran. Comparison of cellulose and xylanase production with manganese peroxidase (MnP) at 20% soya bran indicated that hydrolytic enzymes, but oxidative enzymes were reduced.

CONCLUSIONS

Mycelial growth measurements revealed that eucalyptus residues supplemented with cereal brans supported fast growth of L. edodes, indicating that mycelium extension is related to the bioavailability of nitrogen. The type and concentration of nutrient supplement has a considerable effect both on substrate colonization and on the type of hydrolytic and oxidative enzymes produced. These characteristics may be useful for mushroom growing.

SIGNIFICANCE AND IMPACT OF THE STUDY

Lentinula edodes is commercially important for edible mushroom production and supplements which enhance growth and enzymes production might also be beneficial for mushroom yields.

[Nursing practice and public health policy in Campinas, São Paulo, Brazil]

Redemocratization in the 1970s brought about changes in the public health system in Brazil. The Unified National Health System (SUS) was implemented in 1988, based on local and regional administrative systems. This was an important step that resulted in greater local control and the introduction of new technologies. This study focuses on the local health system in Campinas, a relatively affluent and technologically advanced region some 100km from the city of São Paulo in Southeast Brazil. Qualitative and quantitative methods were used to evaluate the work of 233 nurses in the local health system. The first nurse was hired in 1977, and now there are 53 nurses working in specific areas: 10 in the central health administration, 36 in district administrations, and the rest in local services. Nursing services are organized in six main areas: administration, coordination of human resources, education, information technology, health surveillance, and health administration. Nursing intervention may be found in various areas, but it generally focuses on medical consultations, and there is little emphasis on collective activities and health promotion. Local health objectives can only be achieved by creating new practices that promote collective health.

Short report: seroprevalence of Taenia solium cysticercosis in pigs in Bahia State, northeastern Brazil

To determine the prevalence and etiologic factors of Taenia solium cysticercosis in pigs in the state of Bahia, northeastern Brazil, we performed serological surveys in Salvador, the capital of the state, and in two local towns, Santo Amaro and Jequié. Residents raising free-roaming pigs in the study areas were randomly selected. Sera were obtained from the pigs and examined by the enzyme-linked immunoelectrotransfer blot assay (EITB). The prevalence of antibodies to T. solium was 4.4% (2 of 45) in Salvador, 3.2% (3 of 93) in Santo Amaro, and 23.5% (24 of 102) in Jequié. A significantly high seroprevalence in Jequié was associated with poor sanitary conditions, such as an open sewer system and no inspection process of pork before marketing.

A method to evaluate the isothermal effectiveness factor for dynamic oxygen into mycelial pellets in submerged cultures

Several models have been developed simulating O2 transfer in bioreactors, but three limitations are often found: (i) an inadequate kinetic representation of O2 consumption or wrong boundary conditions, (ii) unrealistic parameter values, and (iii) inadequate experimental systems. In our study we minimized those possible sources of error. Oxygen uptake rate, void fraction of the pellet, and external O2 mass transfer coefficient were experimentally obtained from bioreactor studies in which pellets of Gibberella fujikuroi were naturally formed. Michaelis-Menten kinetics and diffusion equations were used to describe the O2 consumption rate and to evaluate the effectiveness factor in dynamic mode. The nonlinear mathematical model proposed was solved by the orthogonal collocation technique. The O2 consumption rate in pellets of G. fujikuroi of 1.7-2.0 mm is only marginally inhibited by diffusion constraints under conditions tested. Simulation analysis showed that the effectiveness factor decreased as the Thiele modulus and pellet diameter increased. The proposed model was applied to experimental data reported for other fungal pellets and allowed to predict optimal conditions for O2 transfer into mycelial pellets.

Human leukocyte antigen class II alleles in white Brazilian patients with celiac disease

BACKGROUND

Celiac disease (CD) is a permanent gluten intolerance disorder characterized by malabsorption, intestinal mucosa villus atrophy, and crypt hyperplasia. Clinical and histologic features improve in persons consuming a gluten free diet. The pathogenesis of CD involves environmental, genetic, and immunologic factors.

METHODS

The frequencies of human leukocyte antigen (HLA) class II alleles were evaluated in white Brazilian patients who had CD and compared with those observed in healthy individuals from the same geographical area (Ribeirão Preto, São Paulo) and of similar ethnic background. Twenty-five patients with CD, 11 females and 14 males, and 91 control individuals were studied. The HLA class II alleles were typed using amplified DNA hybridized with sequence-specific primers. Statistical analysis was performed using the two-tailed Fisher exact test. The relative risk (RR), etiologic fraction (EF), and preventive fraction (PF) were also estimated. The EF represents the attributable risk for the development of CD at the population level, whereas PF represents the protective risk.

RESULTS

The frequency of the HLA-DRB1*03, HLA-DRB1*07, and HLA-DQB1*02 alleles was significantly increased in patients. The RR conferred by these alleles was 5.35, 7.15, and 10.6, respectively, and the EF was 48.7%, 44.7%, and 76%, respectively. The frequency of HLA-DQB1*06 alleles was significantly decreased in CD patients, conferring an RR of 0.08 and a PF of 48%.

CONCLUSIONS

The results show that HLA-DRB1*03, HLA-DRB1*07, and HLA-DQB1*02 alleles conferred susceptibility to CD in Brazilian patients. In contrast, HLADQB1*06 alleles conferred protection against development of the disease.

[Knowledge obtained in the master's program of public health nursing at the Nursing School of Ribeirao Preto - USP and its relationship with health practices]

The purpose of this study was to analyze the research objects of the theses produced in the Master Program on Public Health offered by the Department of Maternal-Infant Nursing and Public Health--University of São Paulo at Ribeirão Preto College of Nursing and their relationship with the problems originated from health care practice. These practices were classified within six major areas: Health Care Organization, Health Promotion, Health-Disease Process, Nutrition-Feeding, Professional Practice and Immunology. The contribution of works focussing on the crisis of health paradigms, gender relations and Social Movements in Health were emphasized. Authors concluded that the themes are closely related to the students' professional context, enabling them to present suggestions regarding interventions in health practices.

Day care centres as an institution for health promotion among needy children: an analytical study in São Paulo, Brazil

OBJECTIVE

To evaluate the role of day care centres in the nutritional state of children belonging to a low-income population, comparing the nutritional state of the children in the day care centres with children in the same population who were given other types of day care.

DESIGN

Analytical cross-sectional study.

SETTING

Public day care centres/primary health care.

PARTICIPANTS

Children aged 0-6 yr attending in 4 public day care centres (n=446) and sample of population obtained during vaccination campaign (n=1626).

MEASUREMENT

Nutritional evaluation was conducted through weight and height measurements, using as a standard the NCHS (USA) table and Gomez and Waterlow methodology. The type of daily care received by the children was assessed through a questionnaire answered by the responsible persons during the vaccination campaign.

RESULTS

The nutritional status of children attended in the day care centers was better than children of the same community receiving other types of daily care (OR=0.48; CI 95%=0.36-0.65;P>0.0001). The improvement was related to more than 1 year of enrollment in the day care (OR=0.74; CI 95%=0.57-0.96;P=0.02).

[Admitting patients: a study in basic health units in the city of Ribeirão Preto, Brazil]

This study was based on the analysis of the relationship established between nursing auxiliaries and their clientele in two Basic Health Units at the time of clients' reception. The theoretical framework used was that of the "help model", whose elements are: attending, responding, personalizing, giving directions, becoming involved, exploring, understanding and acting. Four typical cases are presented, which show that the relationships are not always personalized, the client and the auxiliary do not become involved in the relationship and that there is more concern about the development of technical abilities than about reception. There are different communication attitudes at the same unit. The reception process must be incorporated to the health unit procedures at the same time it must transcend the routine character of daily activities.

Effect of nectar composition and nectar concentration on honey bee (Hymenoptera: Apidae) visitations to hybrid onion flowers

Floral nectar characteristics of nine inbred lines of onion (Allium cepa L.) were examined to determine their influence on the attractiveness of the onion flowers to honey bees (Apis mellifera L.). Potassium concentrations and sugar concentrations of the nectar did not significantly correlate with the number of bee visits received by an umbel. The average amount of nectar produced by both the umbels and the individual florets was significantly positively correlated with the number of bee visits. Our results suggest that selection for flowers with high nectar production may lead to a higher rate of pollination of the onion seed crop.

[Nursing training and municipal management of health in Brazil: significance of policies and practices]

In order to clarify central aspects to be considered in undergraduate education both in health sciences and in nursing, regarding contemporary health policies, this article presents a historical approach with emphasis on municipal health management. The authors point out the characteristic of the Sanitary Reform movement and of the neoliberal project in health, followed by a presentation of the National Health System (SUS). Using as starting point the concept of decentralization (only one command at each level of government)--the authors discuss the elaboration and implementation of public social policies and services at the local level. Which depend on an increase of local decision-making capacity, autonomy, control and social participation. The experiences of the cities of Campinas and Ribeirão Preto are described, with emphasis on aspects related to human resources and nursing, and organization of services.

[Notes on fleas (Siphonaptera) of the fox Cerdocyon thous (Canidae) from an endemic area of visceral leishmaniasis in Jacobina, Bahia, Brazil]

From July to September of 1998, 152 fleas were collected from 18 specimens of the fox Cerdocyon thous captured in the visceral leishmaniasis endemic area of Jacobina, State of Bahia, Brazil. The fleas were identified as: 136 Rhopalopsyllus lutzi lutzi, 11 Pulex irritans, 2 Ctenocephalides canis, 1 Ctenocephalides felis felis and 2 Xenopsylla cheopis.

[Morbidity and malnutrition risk factors in children followed up by a child health care program]

OBJECTIVE

The objective of this study was to identify risk factors associated with malnutrition and morbidity in the population of children accompanied by the Child Health Care Program in Embu, São Paulo (Brazil), with the aim of giving a better direction to health activities.

METHODS

The case-study was constituted by a cross-section of 1,024 children, corresponding to 25.0% (probabilistic sistematic sample) of the total of children under 12 months registered in six primary health care centers in the Municipality, during the period from July 1988 to July 1989. The risk factors were analyzed according to the presence or absence of hospitalization and weight evolution - favorable or unfavorable - until two years of age. For the statistical analysis the multivaried approach was used, through the tecnique of logistic regression.

RESULTS

Of a total of 1,024 children, 428 (39.1%) were classified as high risk, 658 (60.1%) as low risk and 8 (0.8%) presented pathologies at their first appointment, being excluded from the analysis. Prematurity (adjusted RR = 3.35), serious illness in the newborn (adjusted RR = 4.12) and the death of a younger brother or sister of less than five years (adjusted RR = 2.70) constituted risk factors for hospitalization in the first two years of life. Weight at birth between 2,500 and 2,750 g (adjusted RR = 2.46), brother or sister with malnutrition (adjusted RR = 4.17) and maternal age of 18 years old or less (adjusted RR = 1.87) constituted risk factors for unfavourable weight evolution.

CONCLUSIONS

These results, as well as the process of carrying out this study, supported the reformulation of the Child Health Care Program in Embu, permitting differentiated action for the highest risk group, thus garanteeing the essential for all.

HTLV-I and HTLV-II infections in hematologic disorder patients, cancer patients, and healthy individuals from Rio de Janeiro, Brazil

To clarify the seroprevalence of human T-cell lymphotropic virus type I (HTLV-I) among hematologic and cancer patients in the State of Rio de Janeiro, Brazil, we investigated sera from 2430 individuals from the following groups: 152 patients with T-cell diseases, 250 with B-cell disorders, 67 with myeloid leukemia, 41 with Hodgkin's disease, 351 with a history of multiple blood transfusions, 235 patients with solid tumors of different types, and 109 family members of HTLV-I-infected patients. Antibodies to HTLV-I were screened by enzyme-linked immunosorbent assay or particle agglutination assays (or both). Repeatedly reactive samples were tested by Western blot and polymerase chain reaction assay to differentiate HTLV-I from HTLV-II. We found an increased seroprevalence rate of HTLV-I among those with lymphoid malignancies, mainly in T-cell diseases (28.9%), and these results were important in characterizing 44 cases of adult T-cell leukemia/lymphoma. We confirmed the presence of HTLV-I and HTLV-II infections in blood donors (0.4% and 0.1%, respectively), in patients exposed to multiple blood transfusions (10.2% and 0.8%, respectively), and in 30 (27.5%) of 109 family members of HTLV-I- or HTLV-II-infected patients. We also confirmed the high rate occurrence of adult T-cell leukemia/lymphoma among lymphoproliferative disorders in Rio de Janeiro, Brazil.

[Information systems in the management process of the health services. Reflections]

The present study aims at reflecting about the organization of the information system as an important tool in the management of health services, especially in the process of municipalization.

Therapeutic effect of oral Kalanchoe pinnata leaf extract in murine leishmaniasis

The effect of a leaf extract from Kalanchoe pinnata (Kp) was investigated in BALB/c mice infected with Leishmania amazonensis. Oral treatment with Kp significantly delayed onset of disease as compared to untreated mice or mice receiving Kp by the intravenous or topical routes. When initiated at early stages of infection, daily oral doses of 8 mg prevented lesion growth and the effect was long-lasting, comparable to the reference antileishmanial drug Glucantime. The decreased lesion growth using the oral route was accompanied by a significant decrease in the number of viable parasites. Protection was accompanied by a diminished capacity of animals to develop delayed-type hypersensitivity and to produce specific antibodies.

Novel products and new technologies for use of a familiar carbohydrate, milk lactose

The cheese industry produces large amounts of lactose in the form of cheese whey and whey permeate, generating approximately 27 million tonnes/yr in the US alone. Many uses have been found for whey and lactose, including uses in infant formula; bakery, dairy, and confectionery products; animal feed; and feedstocks for lactose derivatives and several industrial fermentations. Lactose use in food products, however, is somewhat limited because of its low solubility and indigestibility in many individuals. For this reason, lactose is often hydrolyzed before use. Still, demand is insufficient to use all available whey lactose. The result is a low market value for lactose; almost half of the whey produced each year remains unused and is a significant waste disposal problem. Several approaches are possible for transforming lactose into value-added products. For example, galactooligosaccharides can be produce through enzymatic treatments of lactose and may be used as a probiotic food ingredient. Organic acids or xanthan gum may be produced via whey fermentation, and the fermented whey product can be used as a food ingredient with special functionality. This paper reviews the physical characteristics, production techniques, and current uses of lactose, whey, and lactose derivatives. Also examined are novel fermentation and separation technologies developed in our laboratory for the production of lactate, propionate, acetate, and xanthan gum from whey.

Effect of in vivo depletion of CD4+ T cells on experimental infection of susceptible BALB/c mice with Leishmania amazonensis

The role played by CD4+ T lymphocytes in susceptible BALB/c mice infected with Leishmania amazonensis was investigated. Depletion of CD4+ T cells was achieved in experimentally infected mice by means of treatment with anti-CD4 monoclonal antibody (mAb), resulting in significant reductions in the size of lesions and in mortality when compared with control animals. Moreover, the parasite load in the depleted mice, as quantified by limiting dilution analysis, was about 10-times lower than in the control groups. In addition, the incidence of metastases in the depleted mice was significantly reduced, and their appearance delayed as compared to the control animals. These effects correlated with a selective depletion of CD4+ T cells in the spleens of the mAb-treated mice, suggesting a role for CD4+ T cells in the aggravation of L. amazonensis infection in BALB/c mice.

[Nursing: the reality and future in care and management]

The authors discuss the activities developed by Nursing in two general orientations: the assistance and the management, concerning the concrete work and its perspectives. Therefore, they engage in polemics around the administrative versus assistance functions and attract the attention to the impossibility of thinking the nursing work inarticulated of different health practices, as a whole they accomplish each other in attempting the necessities of health of the population in a social level.

[Structural changes in composite resins identified using Lugol's solution]

The authors studied the staining of specimens of composite resins, when they were immersed in Lugol solution. In this study, we related chemical and photo-activated resins, and the estructure modifications were analysed in relation to the consulted bibliography. The use of Lugol solution showed a practical way to identify the possible modifications in the polymeric structure of the composite resins.