Quality of life of women from a quilombola community in northeastern Brazil

Abstract Quilombola communities are present in many Brazilian states living in precarious health conditions. This is due to geographic isolation, limitations to the access of the area in which they live in, and the lack of quality in the service when it is needed to be provided. Therefore, the aim of this study was to analyze the quality of life of women from a quilombola community in northeastern Brazil. It is an observational, cross-sectional and descriptive study. 160 adult women were first interviewed through a form to collect a profile and then it was applied the WHOQOL Quality of Life questionnaire – bref. It was observed that the women were on average 40.7 years old (±17.25), married, self-declared black, who did not finish elementary school, housewife, had no income, with their own masonry house, with up to 6 rooms, supplied by a box of community treated water. Quality of Life had median scores in the domains: physical (3.18), psychological (3.4), social relationships (3.45) and environment (2.59). With this research, it was possible to characterize the quilombola community of Santa Luzia do Norte-AL regarding the difficulties of access to health and income generation, issues that affect their health condition. The problems described in this study can contribute to health actions being planned and carried out in order to improve socioeconomic and health conditions in this community, considering the social, political and environmental context, valuing their traditional knowledge and practices.

Epidemiological, clinical and laboratory aspects of Angiostrongylus cantonensis infection: an integrative review

This integrative literature review study analyzes the findings of the last 5 years of the parasite Angiostrongylus cantonensis. It is known that this nematode is found in the pulmonary arteries of rats, where it remains as a definitive host. From mice, the cycle spreads to animals, such as snails, which in contact with humans can trigger the disease. In humans, the parasite causes several neurological, abdominal manifestations and mainly meningitis. Based on the review of studies, its epidemiology shows worldwide distribution, although there are endemic cases for this parasite, such as asian countries. Laboratory findings generally showed altered CSF with turbidity, increased protein and eosinophilia, which generated meningeal signs in the patient, moreover MRI exams showed multiple alterations. Rare findings of the nematode in the eyeball, lung and signs of peritoneal inflammation were reported, which requires further studies to understand the whole pathophysiology. Finally, conservative treatment based on anthelmintics and anti-inflammatories brought good responses, although there are reports of deaths, which demonstrates the importance in the prevention and therapy of this disease.

Physicochemical, microbiological and parasitological analysis of water for human consumption in a quilombola community in Alagoas

Water is the indispensable natural resource for all living beings. For human consumption, it must be potable, so as not to pose a risk to health, and can be used for ingestion, food preparation and personal hygiene. Knowing this importance, this study aimed to carry out physical-chemical, microbiological and parasitological analyzes of water for human consumption in a quilombola community of Santa Luzia do Norte in Alagoas. A cross-sectional, experimental and quantitative study was carried out between January and December 2019. The physical-chemical parameters of residual chlorine, turbidity, fluoride, fluoridation, color and pH were analyzed, microbiological analyses were based on the research of total and thermotolerant coliforms (E. coli) and parasitological analyses were performed based on the research of protozoa and intestinal helminths. Some physical-chemical parameters (turbidity and pH) were observed outside the limits required by the Ministry of Health, and the presence of total coliforms in some of the analyzed samples (17.85%), characterizing this community at risk related to waterborne diseases. The samples analyzed did not present infecting forms of parasitic species. Regarding the variables evaluated, the results found showed that the lack of adequate basic sanitation affects the quality of water used for human consumption by the quilombola population of Santa Luzia do Norte-AL.

Environmental characteristics, nutritional and executive functions in children of 6 to 7 years

This study aimed to analyze the socio-environmental characteristics, executive and nutritional functions in children aged 6 to 7 years, from public schools in Alagoas, Brazil. A quantitative, cross-sectional and descriptive study was performed involving 64 children of the mentioned age group, from public schools located in Alagoas: Maceió, on the coast; Major Isidoro, in the hinterland and Palmeira dos Índios, in the country. Such analyzes were made through the application of neuropsychological tests and anthropometric assessment with children and food and socio-environmental surveys with their parents. As for the type of housing, 100% were made of masonry, with a bathroom present in 98.4%. All children reported with the habit of bathing in the river / lagoon, presented some pathology. There was no significant difference between cities in terms of the sociodemographic characteristics evaluated, with the same result occurring with the factors associated with the occurrence of diseases in children. The subtests of WISC-IV, were below the average in all municipalities, and the TAC and SCC were classified within the average. However, even though the ranking were divided between below average and average, it is possible to identify from the subtests of WISC-IV, that the general IQ showed a cognitive level below the average. There was also no significant difference in the anthropometric assessment (weight, height, BMI and IMCI) between the evaluated students. The average weight was 23.3 kg to 25 kg, the height between 1.23 m to 1.24 m, the BMI between 16.4 to 17; the IMCI from 2.8 to 3.0. Children were classified within the average. Regarding micronutrients (Ca, Fe, K, Mg and Na, and vitamins A, C, D, B1, B9 and B12) and calories, there was also no significant difference between the cities evaluated. The same occurred with macronutrients (proteins, carbohydrates and lipids). This study showed that in general there was no difference between the students of the three municipalities. Probably, even though they are all public schools and from different cities, children have similar social conditions.

Phytochemical characterization, antioxidant potential and antibacterial activity of the Croton argyrophylloides Muell. Arg. (Euphorbiaceae)

Croton argyrophylloides Muell. Arg., from the Euphorbiaceae family, popularly known as marmeleiro prateado or sacatinga, is a plant from the Caatinga biome commonly found in Brazil's northeastern region. The present study aimed to evaluate the antioxidant activity of the species. The phytochemical study was performed through qualitative analysis of chemical constituents and quantitative determination of the total phenol content through the Folin-Ciocalteu test. The qualitative and quantitative antioxidant tests were performed using the DPPH method (2.2 diphenyl-1-picryl hydrazil) and ferric reducing antioxidant power (FRAP). The minimum inhibitory concentration (MIC) was determined by microdilution in 96-well plates. The ethanolic extract of the leaves of C. argyrophylloides manifested antioxidant action in the quantitative DPPH test with a significant bioactivity of 84.70 AAO% in 500 µg/mL, with an EC50 of 236.79. The content of total phenolic compounds was 946.06 mg of gallic acid equivalents/g of sample, and total flavonoids was 58.11 mg of quercetin equivalents/g of sample, the result obtained for FRAP was 15294.44 µM Trolox/g of sample and ABTS was 718 μM Trolox of sample. The prospecting of the chemical constituents of the leaves of C. argyrophylloides revealed the presence of the main compounds that manifests the antioxidant activity and it was proven by the DPPH method that there is antioxidant activity in the analyzed sample, in addition to demonstrating a significant content of phenolic compounds and total flavonoid content in the species, which corroborates the antioxidant activity of the plant sample. The leaf extracts presented growth inhibition halos of 10 and 12 mm upon Staphylococcus aureus ATCC 25923.

A NECESSIDADE DE MANTER AS DOAÇÕES DE SANGUE DURANTE A PANDEMIA: RELATO DE EXPERIÊNCIA NO HEMOCENTRO REGIONAL DE GOVERNADOR VALADARES

Introdução

É inegável o impacto negativo que a pandemia de Covid-19 ocasionou em todos os âmbitos dos serviços de saúde no mundo, da mesma forma aconteceu com as doações de sangue que tiveram uma significativa queda nesse período pandêmico. Tal queda pode ter vindo como consequência de recomendações de isolamento social e pelo medo de se locomover para as doações, portanto, foi necessário criar estratégias novas de recrutamento de doadores, para que assim, pudesse haver disponibilidade de bolsas de sangue suficientes para o período conturbado vivido.

Objetivo

Orientar e incentivar a comunidade acadêmica da Universidade Vale do Rio Doce (UNIVALE) acerca da importância da doação de sangue, bem como contribuir com o aumento do número de doadores no Hemominas Governador Valadares (GV) – MG.

Metodologia

A Liga Acadêmica de Hematologia de GV (LAHEM-GV), entendendo a necessidade da doação de sangue nesse período, com apoio do Hemominas, se uniu com entidades da própria UNIVALE, como Centro acadêmico da UNIVALE, Federação Internacional das Associações de Estudantes de Medicina do Brasil (IFMSA-Univale), e a Liga acadêmica de cirurgia, trauma e emergência GV, para elaboração de uma campanha por meio de uma página na rede social do Instagram que visou a capitalização de mais doadores.

Resultados

Inicialmente, a campanha foi programada para dois meses, maio e junho de 2021, dando início quando a cidade estava na onda roxa da pandemia do Covid-19, ou seja, os leitos de UTI da cidade estavam em aproximadamente 100% de ocupação. Vale ressaltar que a Fundação Hemominas é composta por 23 unidades, sendo a de GV responsável pelo atendimento de 50 outros municípios e mais de 60 hospitais na região, visto assim a necessidade de manter o número de doadores e do estoque de sangue nesse período. O planejamento da campanha teve início em abril, quando representantes da LAHEM-GV se reuniram com representantes do Hemominas GV, para estabelecer como e quando a campanha teria início, logo após começaram semanalmente as reuniões com os demais envolvidos para o planejamento e confecção das artes que iriam ser postados nos meses da campanha, na qual foram enviadas para o Hemominas, via e-mail, para serem aprovadas e só posteriormente serem postadas, passando, portanto, por um processo rigoroso de fiscalização, de forma a garantir que nenhuma informação equivocada fosse passada para o público. Assim, o Instagram da campanha intercalou as postagens sobre informações necessárias, como restrições de doações, lembretes, com fotos de voluntários da doação, entre outros. Além disso, como a página na rede social conseguiu atingir um público maior do que o esperado, disseminou, também,  informações sobre a importância da doação de medula óssea, visto que essa foi conjuntamente atingida durante o período da COVID-19.

Conclusão

A promoção da campanha se mostrou eficaz, visto que o intuito de captar mais doadores no período de pandemia foi atingido, impedindo que ocorresse o desabastecimento dos estoques de sangue do hemocentro em GV e auxiliou na disseminação de informações fundamentais para candidatos a doação, além do maior estímulo à comunidade ao ato de doar sangue. Por tudo isso, o Hemominas GV, em parceria com a LAHEM-GV, decidiu estender a campanha até o final do ano de 2021, visto que a pandemia ainda assola o Brasil.

Ethnobotanical and ethnopharmacological study of medicinal plants used by a traditional community in Brazil's northeastern

The aim of this research is to make a survey of the socio-environmental characteristics and the ethnobotanical study of medicinal plants used in a traditional community in the Brazilian Northeast, Alagoas. The study was made based on visits with the application of a questionnaire with questions related to the socio-economic element and on the diversity of plants used in herbal medicine. The research was made from March/2019 to February/2020, where families and interviewed plant exhibitors were interviewed for botanical identification. The studied community, which were 24 interviewees, was compiled by residents of the Quilombola community from Pau D'arco in Arapiraca city - Alagoas. Residents interviewed, 15 (62.5%) attended between 56 to 80 years, 11 interviewees about 46% were born in the community and 13 (54%) had a fundamentally incomplete nature. At the end, there were mentioned 30 plant species used for phytotherapeutic purposes, from which presents bigger usage as plants against arterial hypertension (Salvia rosmarinus Schleid), diabetes Mellitos (Croton heliotropiifolius Kunth), pain and inflammation (Alternanthera tenella Colla), present the biggest number of species in the community. The species cited are related to numerous medicinal uses, among which there will be predominant associations associated with cardiovascular and inflammatory processes. The tea is the main way of preparing plants. It is perceived that medicinal plants are only widely used by this Quilombola community of and growth of the crops in the backyard are considered a tradition.

Detection of enteropathogens and research of pesticide residues in Lactuca sativa from traditional and agroecological fairs

Agroecological production represents a new reality in vegetable farming. Thus, the study aimed to search for the presence of pesticides in agroecological samples and microbiological and parasitological contamination in Lactuca sativa L. of agroecological and conventional fairs in Alagoas. Thirty-two samples were collected, a hygienic-sanitary checklist was performed, along with coliform, Salmonella spp., Staphylococcus aureus research and Gas Chromatography with Mass Spectrometer (GC-MS) for pesticide research; using two methodologies for parasitological studies. Thirty-two samples were analyzed, with a sanitary adequacy level at 45% and 38% for fairs (agroecological and conventional) respectively, with three samples (9.4%) in total, being adequate to the microbiological pattern according to RDC no. 12/2001. Among the 23 samples which were tested positive for parasites, 69.5% originated from samples extracted at conventional fairs, and 53% of every positive samples presented Entamoeba coli as the main contaminant. All together, no traces of deltamethrin were detected, but in two of the samples a peak retention for diphenoconazole was detected. In conclusion, the fairs represent an adequate environment for human pathogens and indicators. Therefore greater hygiene training of vegetable traders and consumers in the state of Alagoas is required, especially in conventional fairs, which presented more critical microbiological and parasitological indexes comparing to fairs with agroecological products; however, the presence of difenoconazole in two samples of agricultural fairs suggests accidental contamination or indiscriminate use of this chemical in the production of Lactuca sativa, however, products with agroecological origin represents a better choice for the consumers.

Epidemiological aspects of scorpionic accidents in a municipality in Brazil's northeastern

Scorpionic accidents are a major public health problem due to the high occurrence with potential seriousness. In this manner, the research aimed to analyze the occurrence of scorpionic accidents in a municipality in the northeastern of Brazil. An exploratory, descriptive study was made, with a quantitative approach, using secondary data which was gotten from the Notifiable Diseases Information System (SINAN), from 2008 to 2018. Data such as neighborhood, presence of street markets were also used, and the existence of sanitation and climatic data such as temperature and season. Geoprocessing was used to identify possible changes in the environment. In the analyzed period, 9,330 cases of scorpion accidents were recorded, with an average of 848 annual notifications. Scorpionic accidents occurred more frequently in women (5,686; 60.94%). Individuals aged 20 to 29 years (1.727; 18.51%) were more frequent to scorpion stings. Regarding the body parts where the stings were made, the highlights were on the foot (3.515; 37.67%) followed by the hand (2.818; 30.20%). No statistically significant relation was observed between climatic factors and scorpionic accidents. However, the high number of cases of scorpionic accidents was observed in the last 11 years studied. It was evident that during the study period there was no statistical relationship when climatic factors were correlated to scorpionic accidents. On its turn, when it was verified the results of the geoprocessing analysis, it was seen that anthropic factors have been motivating the potentiation of the occurrence of these accidents.

Phytochemical characterization, antioxidant potential and antimicrobial activity of Averrhoa carambola L. (Oxalidaceae) against multiresistant pathogens

The objective of this work was to perform the phytochemical characterization, to determine total phenols, antioxidant (AAO%) and antimicrobial potential of the ethanolic extracts of carambola. The phytochemical study was carried out through a qualitative analysis of the chemical constituents and quantitative determination of the phenol content By the Folin-Ciocalteu test. Qualitative and quantitative antioxidant tests were performed using the DPPH method (2,2 diphenyl-1-picryl-hydrazila) and iron reduction (FRAP). The minimum inhibitory concentration (MIC) was determined by microdilution in 96-well plates. The presence of pyrogallic tannins, steroids and saponins has been identified. The highest total phenol content, quantified in the samples, was found in the stem bark (0.0866 mgEAG/g) and in the fruit (0.0734 mgEAG/g). In the antioxidant evaluation, the extracts of the green fruit bagasse (AAO% 71.9%,) and stem bark at 50 μg/mL (AAO% 94%) with CE50 23.7 μg/mL. Leaf extracts, stem bark, ripe fruit bagasse and green fruit bagasse presented MICs of 100 μg/mL against multiresistant pathogenic bacteria and fungi.

The acetylcholinesterase as indicative of intoxication for pesticide in farmers of conventional and organic cultivation

In this sense the objective of assessing the levels of pesticide poisoning in rural farmers of San Sebastian and take AL, using acetylcholinesterase enzymes Erythrocyte and plasma as biological indicator of intoxication. This is a prospective, transversal and descriptive variables analyzed were: year whose, sex, age group, education, location, condition, route of exposure. The data were acquired by collecting blood samples and socio demographic information of farmers. Was put as the determining factor the type of conventional and organic farming, and periods of drought and rainy. 56 volunteers were analyzed. The analyses were performed in the automatic biochemical Analyzer Cobas Integra 400 plus®. According to the results of the analyses, it was the largest number of individuals with reduced values of cholinesterase, specifically the Group of conventional farming, the period of greatest change index was in the rainy season, where the activity of AChE, expressive values presented in the city of São Sebastião, with 80% result of intoxicated, in the city of the foot - take, 21.73% over the same period. On analysis of the AChP, São Sebastião has obtained the highest number of contaminated with 18.75% and 30% respectively, in the District Take Foot stood between 10 and 21.73% of reduced levels of cholinesterase. This sets the organic system of cultivation, as the best alternative for prevention of future diseases, in addition to bringing quality of life for rural workers, as well as for consumers.

Ethnodirigid study of Medicinal plants used by the population assisted by the “Programa de Saúde da Família” (Family Health Program) in Marechal Deodoro - AL, Brazil

Abstract This study aimed to assess diagnosis of Unique Health System (SUS) users profile with regard to herbal medicine. This is a cross-sectional study with observational data collection conducted in the city of Marechal Deodoro, through a semi-structured questionnaire with questions related to socioeconomic data, use, and knowledge of medicinal plants and herbal medicines and satisfaction with the use of medicinal herbs (MH) and interactions of phytotherapeutic drugs (PD). Among the topics, 86.89% of users used herbal medicines often, especially lemon balm (Melissa officinalis L.). It was also observed that the plants are generally used as a sedative (21.74%) and as tea (87.84%). 82.32% of respondents claim to have acquired the knowledge of herbal medicine through a family member and 85.36% make use of medicinal plants without having received any information on the use of MH and PD. 61% of the plants described that coincided with the form of use and therapeutic properties found in the literature. With regard to satisfaction by treatment with MH and PD, it was found that 56.67% are satisfied. Therefore, it is necessary to pay attention to this aspect of usage, in order to avoid possible drug interactions or adverse reactions resulting from the incorrect use.

Histopathological and Immunohistochemical Characteristics of Thyroid Carcinoma in the Dog

Thyroid carcinomas are a common form of endocrine neoplasia in dogs. In the present study, we combined histopathology with immunohistochemistry (IHC) to search for the presence of oestrogen receptor alpha (ORα), Cox-2 and Ki67 in canine thyroid carcinomas. Forty-eight thyroid carcinomas were diagnosed throughout the study period. Thyroglobulin and calcitonin IHC distinguished between thyroid tumours with a follicular and medullary (C-cell) origin, respectively. IHC-based diagnosis showed that 42 (87.50%) of the cases were follicular cell carcinoma. In these cases, the follicular-compact pattern was the most frequent (n = 20/42; 47.62%) and six cases (12.5%) were medullary cell (C-cell) carcinomas. Both medullary (C-cell) and follicular carcinomas expressed Ki67 and Cox-2. No differences were observed between medullary and follicular carcinomas with respect to expression of Ki67 (P = 0.34) and Cox-2 (P = 0.9523) markers. A total of 4.17% (n = 2/48) of thyroid carcinomas showed positive nuclear labelling for ORα, suggesting that oestrogen does not directly participate in the pathogenesis of canine thyroid neoplasia.

Vascular endothelial growth factor as an angiogenesis biomarker for the progression of autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary nephropathy characterized by abnormal growth of epithelial cells. Genetic factors, including the vascular endothelial growth factor (VEGF) gene, play an important role in its progression. The main aim of this study was to evaluate the influence of VEGF-C936T polymorphism in the development and progression of ADPKD. In total, 302 individuals were studied and divided into two groups: G1 (73 patients with ADPKD) and G2 (229 individuals without the disease). Among the patients, 46 (63%) progressed to end-stage renal disease (ESRD), and required hemodialysis and/or renal transplant. These patients were re-grouped into G1-A for progression analysis. A peripheral blood sample was obtained from all subjects; the DNA was extracted and the VEGF-C936T polymorphism analyzed using polymerase chain reaction/restriction fragment length polymorphism. The significance level was set at P < 0.05. The homozygous wild-type genotype (C/C) was predominant in G1 (78%) and G2 (79%; P = 0.9249). We observed a significant reduction in the mean age of patients with the risk allele (C/T + T/T = 44.3 ± 13.4 years) compared to the C/C genotype (52.2 ± 9.6 years; P = 0.047) in G1-A. In conclusion, the VEGF-C936T polymorphism does not discriminate patients from controls. However, the presence of the T allele appears to accelerate the progression of ADPKD, anticipating ESRD, thereby suggesting its importance in the prognosis of the disease. However, the importance role played by VEGF gene variants in different populations and larger sample sizes must be verified.

Nosocomial bloodstream infections in a nationwide study: comparison between solid organ transplant patients and the general population

BACKGROUND

The incidence of bloodstream infection (BSI) varies according to the transplanted organ. Mortality can be as high as 24%, with a significant impact on graft survival. Transplantation is a risk factor for multidrug-resistant (MDR) organisms, but comparison with a non-transplanted population in a single large cohort has not been described.

METHODS

This is a prospective nationwide study (16 centers) reporting data on 2364 monomicrobial nosocomial BSIs, comparing 83 episodes in solid organ transplant patients with 2447 BSIs occurring in the general hospital population.

RESULTS

The prevalence of groups of infecting organisms (gram-positive, gram-negative, and fungi) was similar between transplant patients and the general population and a similar crude mortality rate was observed (34.9% in transplant vs. 43.3% in non-transplant patients). Staphylococcus aureus was the single most frequently isolated organism in both groups, and Acinetobacter species was more frequently isolated in the general population. Regarding MDR organisms, Klebsiella species, and Enterobacter species resistant to cefepime, as well as Acinetobacter species resistant to meropenem, were significantly more frequent in transplant patients.

CONCLUSION

Antimicrobial resistance is higher, particularly among gram-negative bacteria in the transplant population, although the overall mortality rate between transplant and non-transplant patients with nosocomial BSI is similar.

American tegumentary leishmaniasis: cytokines and nitric oxide in active disease and after clinical cure, with or without chemotherapy

The influence of immune response on the treatment of American tegumentary leishmaniasis is pointed by several authors, and the existence of protective immunity in self-healed patients (SH) is also suggested. Thus, interferon-gamma (IFN-γ), tumour necrosis factor-alpha (TNF-α), interleukin (IL-) 10, IL-17, IL-22 and nitric oxide (NO) production was determined in PBMC culture supernatants from patients with active disease (AD) and after therapy, SH patients and healthy subjects, in response to the soluble antigen of Leishmania (Viannia) braziliensis. It was demonstrated that, during the active disease, there is a predominance of IFN-γ and TNF-α, indicating a proinflammatory phase of the response; IL-17 is also highlighted at this clinical state. Also, TNF-α was slightly increased in patients after therapy. NO secretion was noticed in SH individuals, while IL-17 appeared in low levels in these patients and seems to be regulated by NO. The presence of IL-10 was observed in all groups of patients. From this study, we can suggest that in the active disease and after clinical cure, with or without chemotherapy, specific cellular immunity takes part against Leishmania, but with some similarities between the clinical states. Thus, it indicates that the mediators herein described are necessary for the cure to occur.

BeWo Trophoblasts are Unable to Control Replication of Toxoplasma gondii, Even in the Presence of Exogenous IFN-γ

The ability of RH strain of Toxoplasma gondii to invade and grow into BeWo cells was investigated in the present study using IFN-gamma, l-tryptophan, or alpha-methyl-tryptophan treatments. HeLa cells were used in the same conditions for comparison purposes. It was demonstrated that BeWo cells are more permissive to T. gondii infection, making them more susceptible to this pathogen when compared to HeLa cells. Infection rates of BeWo cells do not show any significant alteration in different protocols using IFN-gamma. In addition, BeWo treated with l-tryptophan was unable to significantly increase parasite growth. In contrast, HeLa cells treated with IFN-gamma or IFN-gamma plus l-tryptophan are able to impair or increase, respectively, parasite replication, providing evidence that this indoleamine-2,3-dioxygenase-dependent phenomenon is operant in these cells, whereas it is inactive in BeWo. Therefore, our data support the hypothesis that the immunological mechanisms controlling infection at the maternal-fetal interface are different from those occurring in the periphery. At the same time that operating regulatory mechanisms work inside and outside the cells located at that microenvironment to prevent maternal rejection of the concept, these events might facilitate the progression of infection caused by intracellular pathogens, as T. gondii.

Chagas' disease: application of TESA-blot in inconclusive sera from a Brazilian blood bank

BACKGROUND AND OBJECTIVES

The procedure used for screening Trypanosoma cruzi-infected blood donors by using two serological techniques has frequently led to discordant results. The TESA-blot, a confirmatory test for Chagas' disease, was applied in a survey of inconclusive sera from a Brazilian blood bank.

MATERIALS AND METHODS

Four hundred and forty-eight sera, obtained from blood donors at the HRU-Fundação Hemominas, were tested by using the TESA-blot assay, a Western blotting method. Of these 448 sera, 348 had previously been determined as inconclusive for Chagas' disease owing to discordance between the indirect immunofluorescence assay (IFA) and the enzyme-linked immunosorbent assay (ELISA).

RESULTS

The TESA-blot was positive for 2.87% (10/348) of the inconclusive sera, and 100% positive and negative for the sera from chagasic (n=50) and non-chagasic (n=50) donors, respectively.

CONCLUSIONS

Our results clearly indicate the need to improve the diagnosis of Chagas' disease in blood banks by using new confirmatory diagnostic test(s). The TESA-blot, a new test with trypomastigote fractions of the T. cruzi Y strain, has made new approaches to the confirmation of Chagas' disease possible.

KM(+), a lectin from Artocarpus integrifolia, induces IL-12 p40 production by macrophages and switches from type 2 to type 1 cell-mediated immunity against Leishmania major antigens, resulting in BALB/c mice resistance to infection

The outcome and severity of some diseases correlate with the dominance of either the T helper 1 (Th1) or Th2 immune response, which is stimulated by IL-12 or IL-4, respectively. In the present study we demonstrate that gamma interferon (IFN-gamma) secretion by murine spleen cells stimulated with KM(+), a mannose-binding lectin from Artocarpus integrifolia, is due to IL-12 induction, because (1) macrophages from several sources (including cell lines) produced IL-12 p40 in response to KM(+), and (2) lectin-free supernatants from J774 cell line cultures stimulated with KM(+) induced the secretion of IFN-gamma by spleen cell cultures, an effect blocked by the supernatant pretreatment with anti-IL-12 antibody. The known pattern of susceptibility of BALB/c mice to infection with Leishmania major, attributed to high levels of IL-4 production leading to a Th2 nonprotective immune response, was modified by administration of KM(+). Draining lymph node cells from these immunized BALB/c mice (in contrast to cells from animals immunized only with soluble leishmanial antigen [SLA]) secreted high levels of IFN-gamma and low levels of IL-4, which characterized a Th1 rather than a Th2 response pattern. The footpad thickness of BALB/c mice immunized with SLA plus KM(+) and challenged with L. major was similar to that of uninfected mice. This beneficial effect against leishmanial infection was blocked by pretreatment of these mice with anti-IL-12 antibody. These observations indicate that KM(+) induces IL-12 p40 in vivo and has a protective effect against L. major infection.

Detection of IgG antibodies to Neospora caninum and Toxoplasma gondii in dogs examined in a veterinary hospital from Brazil

A total of 163 dogs with neuromuscular, respiratory and/or gastrointestinal disorders, was admitted at the Veterinary Hospital, Federal University of Uberlândia, Brazil, and submitted to serology for Toxoplasma gondii and Neospora caninum. Assays for T. gondii included indirect haemagglutination (IHA), indirect fluorescent antibody (IFAT-Tg), immunoenzymatic (ELISA), and immunoblotting (IB-Tg). Assays for N. caninum included IFAT-Nc and immunoprecipitation (IP-Nc). Based on concordant results by three serological tests (IHA, IFAT-Tg and ELISA) for T. gondii, and divergent results further confirmed by IB-Tg for reactivity to TgSAG1, the 163 sera were divided into two groups: 59 (36%) Tg-seropositive samples and 104 (64%) Tg-seronegative samples. Antibodies to Neospora were detected in 11 (6.7%) out of 163 analyzed dog sera, with 5 (3.1%) samples reactive to both parasites (Tg+/Nc+), and 6 (3.7%) reactive only to Neospora (Tg-/Nc+). Antibodies only to T. gondii were found in 54 (33%) samples. Among the 11 Neospora-positive sera analyzed by IB-Tg, the five sera Tg+/Nc+ showed strong reactivity to Toxoplasma antigens, especially to TgSAG1 (p30). No reactivity was observed to TgSAG1 in the six samples Tg-/Nc+. By IP-Nc, two highly immunodominant antigens (29 and 35kDa proteins) were recognized by all 11 IFAT-Nc positive sera. Our results suggest that the infection by N. caninum can be concomitantly present in dogs from this area, although less common, and therefore should be considered in the differential clinical diagnosis with T. gondii in dogs presenting neuromuscular, respiratory and/or gastrointestinal disorders.

Incidence of Gardnerella vaginalis, Candida sp and human papilloma virus in cytological smears

CONTEXT

In spite of the wide-ranging literature on the microbiology of normal and abnormal flora of the vagina, there are few studies on the relationship between human papilloma virus (HPV) and other vaginal microorganisms.

OBJECTIVE

To analyze the frequency of infection by human papilloma virus (HPV) and other agents like Candida sp., Gardnerella vaginalis and Trichomonas vaginalis in cytological smears.

DESIGN STUDY

Retrospective study

SETTING

A public tertiary referral center.

SAMPLE

An analysis of 17,391 cytologies from outpatients seen between January 1997 and August 1998. The control group was made up of patients in the same age group and same period with no cytological evidence of HPV infection. Patients with a diagnosis of cervical intraepithelial neoplasia (CIN) II or III were excluded from this analysis.

MAIN MEASUREMENTS

The diagnosis of HPV infection was made in accordance with the criteria of Schneider et al. and the diagnosis of Gardnerella vaginalis was made with a finding of clue cells.

RESULTS

390 (2. 24%) had alterations consistent with infection by HPV, sometimes associated with CIN I. The results showed that Gardnerella vaginalis was the most frequent agent in women with HPV infection (23.6% versus 17.4%; P <0.05), while in the control group the most frequent agent was Candida sp. (23.9% versus 13.8%; p <0.001).

CONCLUSION

In spite of this study being based solely on cytological criteria, in which specific HPV and Gardnerella diagnostic tests were not used, the cytological smear is widely used in clinical practice and the data presented in this investigation show that there is an association between Gardnerella vaginalis and HPV infection. It remains to be established whether the microorganisms favor each other.

Importance of surgical margins in conization for cervical intraepithelial neoplasia grade III

We conducted a retrospective study on 201 conizations for CIN III done over the last 14 years. Of these, 53 (26.4%) had involvement of the margins, 114 (56.7%) had margins free of neoplasia, and 34 (16.9%) were not evaluated. Of the 53 cases with margin involvement, 28 (52.8%) had complementary surgery and 25 (47.2%) cytological follow-up. Residual CIN was identified in the surgical specimen in 15 cases (53.6%) and microinvasion was present in 2 cases (7.1%). Of the 114 patients with margins free of neoplasia in the cone, 12 had a hysterectomy during follow-up for CIN III diagnosed by cytology and biopsy. Seven of these 12 patients (58.3%) had CIN in the surgical specimen and none had microinvasive cancer.

Detection of Toxoplasma gondii soluble antigen, SAG-1(p30), antibody and immune complex in the cerebrospinal fluid of HIV positive or negative individuals

Active infection by T. gondii was evaluated by immunoassay for soluble SAG-1 (p30), the major surface antigen from T. gondii, specific antibodies and immune complexes in human cerebrospinal fluid (CSF) samples. A total of 263 samples of CSF were collected from hospitalized patients presenting neurological disorders and analyzed for antibodies to HIV. Patients were divided into two groups: HIV positive (n = 96) or HIV negative (n =167). The results of the assays showed that 45% of all samples were positive for soluble SAG-1. Toxoplasma Ag/Ab immune complexes were detected in 19% of the CSF samples and 62% were positive for T. gondii- specific IgG. A combination of these assays in the presence of clinical findings consistent with active Toxoplasma infection may predict the presence of toxoplasmic encephalitis. Moreover, detection of soluble SAG-1 in the CSF of these individuals appears consistent with active infection.

Cyto-histological correlation of 219 patients submitted to surgical treatment due to diagnosis of cervical intraepithelial neoplasia

CONTEXT

Cervical cytology continues to be the most appropriate method for investigating cervical neoplasia and its precursors. Greater diagnostic acuity is obtained by combining cytology, colposcopy and guided biopsy methods.

OBJECTIVE

To analyze the diagnostic acuity of cyto- and histopathological exams and causes of diagnostic error.

DESIGN

Retrospective study.

SETTING

A public tertiary referral center.

SAMPLE

Reports on 219 patients submitted to cone biopsy and/or hysterectomy due to diagnosis of cervical intraepithelial neoplasia (CIN) in the period between January 1982 and March 1997 were reviewed, comparing.

MAIN MEASUREMENTS

Cytological and histological exams (guided biopsy and surgically-removed tissue). In cases of discordance, the cyto- and histological preparations were reviewed to try to evaluate the causes of errors.

RESULTS

In 193 cases (88.1%) there was cyto-histological agreement but none in 26 (11.9%). Review of the discordant cases showed that in 2 (0.9%) there was invasion of the stromata to a depth greater than 3 mm, and in 7 (3.2%) microinvasion, unsuspected via cytology; in 2 (0.9%) microinvasion was suspected via cytology but not confirmed by the final histological exam; and in 15 (6.8%) there was disagreement about the degree of CIN.

CONCLUSION

The principal causes of error in the cytological exam were the lack of reliable morphological criteria for microinvasion, absence of sampling of the squamocolumnar junction, and scarcity of neoplastic cells in the sample. As for the histological exam, the errors were related to inadequate technical processing and underestimation of focal lesions.

Variations in gastric emptying of liquid elicited by acute blood volume changes in awake rats

We have observed that acute blood volume expansion increases the gastroduodenal resistance to the flow of liquid in anesthetized dogs, while retraction decreases it (Santos et al. (1991) Acta Physiologica Scandinavica, 143: 261-269). This study evaluates the effect of blood volume expansion and retraction on the gastric emptying of liquid in awake rats using a modification of the technique of Scarpignato (1980) (Archives Internationales de Pharmacodynamie et de Therapie, 246: 286-294). Male Wistar rats (180-200 g) were fasted for 16 h with water ad libitum and 1.5 ml of the test meal (0.5 mg/ml phenol red solution in 5% glucose) was delivered to the stomach immediately after random submission to one of the following protocols: 1) normovolemic control (N = 22), 2) expansion (N = 72) by intravenous infusion (1 ml/min) of Ringer-bicarbonate solution, volumes of 1, 2, 3 or 5% body weight, or 3) retraction (N = 22) by controlled bleeding (1.5 ml/100 g). Gastric emptying of liquid was inhibited by 19-51.2% (P < 0.05) after blood volume expansion (volumes of 1, 2, 3 or 5% body weight). Blood volume expansion produced a sustained increase in central venous pressure while mean arterial pressure was transiently increased during expansion (P < 0.05). Blood volume retraction increased gastric emptying by 28.5-49.9% (P < 0.05) and decreased central venous pressure and mean arterial pressure (P < 0.05). Infusion of the shed blood 10 min after bleeding reversed the effect of retraction on gastric emptying. These findings suggest that gastric emptying of liquid is subject to modulation by the blood volume.

Gender effects on esophageal motility

It has been suggested that there are no gender effects on esophageal motility. However, in previous studies the subjects did not perform multiple swallows and the quantitative features of esophageal contractions were not evaluated. In order to investigate the gender effects on esophageal motility we studied 40 healthy normal volunteers, 20 men aged 37 +/- 15 years (mean +/- SD), and 20 women aged 38 +/- 14 years. We used the manometric method with an eight-lumen polyvinyl catheter and continuous perfusion. The upper and lower esophageal sphincter pressures were measured by the rapid pull-through method. With the catheter positioned with one lumen opening in the lower esophageal sphincter, and the others at 5, 10 and 15 cm above the sphincter, ten swallows of a 5-ml water bolus alternated with ten dry swallows were performed. Statistical analysis was done by the Student t-test and Mann-Whitney test. Gender differences (P < 0.05) were observed for wet swallows in the duration of contractions 5 cm above the lower esophageal sphincter (men: 3.7 +/- 0.2 s, women: 4.5 +/- 0.3 s, mean +/- SEM), and in the velocity of contractions from 15 to 10 cm above the lower esophageal sphincter (men: 4.7 +/- 0.3 cm/s, women: 3.5 +/- 0.2 cm/s). There was no difference (P > 0.05) in sphincter pressure, duration and percentage of complete lower esophageal sphincter relaxation, amplitude of contractions, or in the number of failed, multipeaked and synchronous contractions. We conclude that gender may cause some differences in esophageal motility which, though of no clinical significance, should be taken into consideration when interpreting esophageal motility tests.

[Iatrogeny in hospitalized elderly patients]

PURPOSE

To evaluate the iatrogenic complications in hospitalized elderly patients.

MATERIAL AND METHOD

Review of the medical records of 96 patients, 48 men and 48 women, aged 60 to 93 years (75.7 years on average), hospitalized in a geriatric ward during 1995.

RESULTS

The study of the medical records of the patients showed: 1) forty-two (43.7%) of the elderly had one or more iatrogenic illnesses, with a total of 56 occurrences; 2) complications due to diagnostic tests corresponded to 17.9% of the iatrogenic disorders; 3) complications relating to therapeutic procedures corresponded to 58.9% of the iatrogenic disorders, 32.1% being caused by drugs and 26.8% caused by other therapeutic measures; 4) complications not directly related to diseases, like pressure sores, falls and fractures, corresponded to 23.2% of iatrogenic disorders, 5) iatrogenic illnesses were associated with an extended hospital stay; 6) in five elderly patients the iatrogenic complication was believed to have contributed to the death of the patient.

CONCLUSION

Iatrogenic disorders occur frequently in elderly hospitalized patients and sometimes cause major and even fatal complications. As many of these complications are potentially preventable, we must identify the causes and develop technics to prevent or reduce their effects.

The role of IL-12 in experimental Trypanosoma cruzi infection

Host resistance to Trypanosoma cruzi infection is dependent on both natural and acquired immune responses. During the early acute phase of infection in mice, natural killer (NK) cell-derived IFN-gamma is involved in controlling intracellular parasite replication, mainly through the induction of nitric oxide biosynthesis by activated macrophages. We have shown that IL-12, a powerful inducer of IFN-gamma production by NK cells, is synthesized soon after trypomastigote-macrophage interaction. The role of IL-12 in the control of T. cruzi infection in vivo was determined by treating infected mice with anti-IL-12 monoclonal antibody (mAb) and analyzing both parasitemia and mortality during the acute phase of infection. The anti-IL-12 mAb-treated mice had higher levels of parasitemia and mortality compared to control mice. Also, treatment of infected mice with mAb specific for IFN-gamma or TNF-alpha inhibited the protective effect of exogenous IL-12. On the other hand, TGF-beta and IL-10 produced by infected macrophages inhibited the induction and effects of IL-12. Therefore, while IL-12, TNF-alpha and IFN-gamma correlate with resistance to T. cruzi infection, TGF-beta and IL-10 promote susceptibility. These results provide support for a role of innate immunity in the control of T. cruzi infection. In addition to its protective role, IL-12 may also be involved in the modulation of T. cruzi-induced myocarditis, since treatment of infected mice with IL-12 or anti-IL-12 mAb leads to an enhanced or decreased inflammatory infiltrate in the heart, respectively. Understanding the role of the cytokines produced during the acute phase of T. cruzi infection and their involvement in protection and pathogenesis would be essential to devise new vaccines or therapies.

Detection of Toxoplasma gondii-specific antibodies in dogs. A comparative study of immunoenzymatic, immunofluorescent and haemagglutination titers

We evaluated the titers of anti-T. gondii antibodies by various serological tests in 40 serum samples from dogs exhibiting clinical signs of infectious diseases. Indirect immunofluorescence (IgG-IFI), indirect haemagglutination (IHA and M-Toxo) and immunoenzymatic (ELISA and PA-ELISA) tests were carried out. Titers > or = 64 were considered as positive. Anti-Toxoplasma antibodies were found in 9 (22.5%), 14 (35%), 14 (35%) and 12 (30%) samples, respectively for IHA, IgG-IFI, ELISA and PA-ELISA. The results showed that 57% were negative in all tests and 43% of the dogs presented antibodies to T. gondii; from these, 20% were positive in all three tests with high titers of antibodies and 23% were positive in only one or two tests with low titers of antibodies and mainly related to the IFI and ELISA tests. We observed 5 (12.5%) and 1 (2.5%) reactive samples, respectively, by M-Toxo and IHA with or without 2-mercapthoethanol, in the attempt to detect specific IgM. We can conclude that serodiagnosis of toxoplasmosis in dog have to be based on the combination of serological tests (IFI and ELISA) and with emphasis at the determination of the titers and the classes of the specific antibodies.

[Postoperative mortality in infective endocarditis: determinant factors]

The factors leading to high postoperative mortality in active infectious endocarditis (IE) are poorly defined. We studied patients operated at an University Hospital between March 1978 and April 1992. We hypothesized that the summation of potential adverse factors would strongly increase mortality after surgery. We studied 39 patients (28 men), age range 13-70 years (mean +/- SD = 32 +/- 16) operated during active IE (time from onset 52 +/- 48 days). Predisposing factor: rheumatic valvar disease in 14 cases, intravenous drug use in 5. Affected valves: aortic in 14, mitral in 10, tricuspid in 8, multiple structures in 7. In most cases, S aureus (12) or Streptococcus sp (10) was isolated in blood cultures. Surgery was indicated in most patients because of heart failure (30), multiple embolic complications (17) or treatment failure (14). The possible adverse influence of specific demographic characteristics, clinical features and surgical variables was assessed by the Student t test or the chi 2 test. Also, multiple regression analysis was performed in order to identify independent adverse factors for increased mortality. Positive correlations were further investigated with the chi 2 test to assess whether an increasing number of adverse factors could identify a special subset of patients with markedly elevated death risk. Fourteen patients (36%) died after surgery. Emergency surgery (p = 0.001), the presence of coma 6 hours after surgery (p = 0.0015) and S. aureus infection (p = 0.023) were all associated with increased mortality. The presence of neurological complications was correlated with a high mortality (54% vs. 27%). However this increase was of dubious statistical significance (p = 0.097). Multiple regression analysis confirmed S. aureus and emergency surgery as independent adverse factors for increased mortality. When put together, an increasing number of adverse factors was highly predictive of a fatal outcome, even after exclusion of that evaluated after surgery (level of consciousness). Patients with two or three adverse factors had a very high mortality rate (> 76.9%). Mortality following surgery for active IE is increased in patients operated on an emergency basis especially if the infection is caused by S. aureus. The presence of neurological complications may also be associated with worse outcome. Early consideration of surgery should reduce the high mortality in patients with active IE.

Association between an early humoral response to Mycobacterium tuberculosis antigens and later development of tuberculosis in human immunodeficiency virus-infected individuals

OBJECTIVE

To evaluate the association between an early humoral response to Mycobacterium tuberculosis antigens and the later development of tuberculosis (TB) disease in human immunodeficiency virus (HIV)-infected individuals.

METHODS

Using an ELISA test, IgG antibodies against 4 M. tuberculosis antigens--purified protein derivative (PPD); 2,3 diacyl trehalose (DAT); a lipooligosaccharide (LOS) and a trehalose dicarboxylic acid bis N,N-dioctadecylamide (BDA.TDA)--were measured in sera from 25 HIV-infected tuberculous patients and 52 HIV-infected persons without TB.

RESULTS

With the DAT and LOS antigens, a positive result in sera obtained in the 12 months preceding the onset of TB was significantly associated with later development of TB. Using the BDA.TDA antigen, the same association was observed in sera collected during the 6 months before the diagnosis of TB. No significant association was found with the PPD antigen.

CONCLUSIONS

These results suggest that specific antibody markers may be useful to evaluate the risk of active TB in HIV-infected individuals, and a helpful indicator for preventive treatment.

Invasive technique of pit and fissure sealants in primary molars: a SEM study

One of the alternatives used when the clinical inspection of the fissure is doubtful is the invasive technique. This study used the SEM, to investigate two kinds of burs in doing the invasive technique upon primary molars, as well as to test the suitability of two kinds of sealants (with and without filler particles) to penetrate into such preparations. The points hereby tested revealed to be adequate in obtaining a minimal opening in the enamel, allowing the inspection of the fissure, and at the expense of a slight removal of dubious tissue, permitting a preparation of easy clinical performance. In regard to sealant penetration, no difference was seen between the self-cured sealant and the light-cured sealant.

Acute volaemic changes modify the gastroduodenal resistance to the flow of saline in anaesthetized dogs

The effect of acute and sequential volaemic changes on the gastroduodenal flow of saline was assessed in 23 anaesthetized dogs following two different experimental protocols. Hypervolaemia, by i.v. infusion of saline, induced a gradual decrease on gastroduodenal flow which amounted to 76% below control values (P less than 0.001) when volaemic expansion attained 5% of body weight. This effect was volume dependent (17% increase on gastroduodenal flow per volume of infused saline equivalent to 0.5% of body weight, P less than 0.001), lasted for at least 90 minutes after infusion was completed and was also obtained by expanding previously bled animals. Hypovolaemia due to bleeding was followed by an increase on gastroduodenal flow of about 88% above control values (P less than 0.05) when haemorrhage was equal to 3% of body weight. This effect was also volume dependent (23% increase on gastroduodenal flow per volume of blood shed equivalent to a 0.5% of body weight, P less than 0.01) and was reversed after blood volume was restored. These modifications in the resistance of the gastroduodenal segment to the flow of liquid due to acute volaemic changes suggest that the extracellular fluid volume modulates the contractile activity of the gastroduodenal portion of the gut possibly to set a gastroduodenal handling of liquid adequate to cope with volaemic imbalances.