Waist circumference as high blood pressure predictor in school age children

Childhood hypertension is becoming more common with the increasing numbers of child obesity, which has encouraged new studies to identify a good anthropometric marker for high blood pressure levels. The objective this study was to identify the best anthropometric predictor of risk of hypertension in children between 8-10 years of age. The Children were evaluated for socioeconomic status and their blood pressure (BP), weight, height, waist circumference (WC) and percentage of body fat (PBF) were measured. The study included 445 children, of which 50.1% were females. The prevalence of obesity defined by body mass index (BMI) was 14.6%. Increased BP was found in 3.4% and 2.2% of the children, considering the pre-hypertension and hypertension classifications respectively. The arithmetic mean of BP value correlated significantly with BMI, WC and PBF. After height control, the correlations that were maintained significant were between WC and systolic blood pressure (SBP) and between WC and diastolic blood pressure (DBP). The variable with the highest predictive power of the occurrence of hypertension was WC. The results indicate that, in this population of children between 8 and 10 years old, WC is a measurement of higher value in predicting increased BP.

Effective Heisenberg Model and Exchange Interaction for Strongly Correlated Systems

We consider the extended Hubbard model and introduce a corresponding Heisenberg-like problem written in terms of spin operators. The derived formalism is reminiscent of Anderson's idea of the effective exchange interaction and takes into account nonlocal correlation effects. The results for the exchange interaction and spin susceptibility in the magnetic phase are expressed in terms of single-particle quantities. This fact not only can be used for realistic calculations of multiband systems but also allows us to reconsider a general description of many-body effects in the most interesting physical regimes, where the physical properties of the system are dominated by collective (bosonic) fluctuations. In the strongly spin-polarized limit, when the local magnetic moment is well defined, the exchange interaction reduces to a standard expression of the density functional theory that has been successfully used in practical calculations of magnetic properties of real materials.

Determining the health-related quality of life in individuals with haemophilia in developing economies: results from the Brazilian population

INTRODUCTION

Several studies show the negative impact of haemophilia in health-related quality of life (HRQOL). This issue is not well explored in developing countries.

OBJECTIVES

This cross-sectional study aimed to evaluate the HRQOL and its associated factors in patients with haemophilia A/B in Brazil. Data were collected by questionnaire and in medical records, including a Portuguese version of Haem-A-Qol.

RESULTS

Brazilian patients were invited to the study and 175 participants (147 haemophilics A and 28 haemophilics B) were included. The total score of the Haem-A-QoL had a median of 36.96 (range of 0-100), with worse performance in 'sport and leisure' and best on 'relationships' fields. HRQOL was worst among the older participants, the less educated, non-white, non-working, who were hospitalized in the last year, who did not have a single medical consultation and among those with the highest number of affected joints. Moreover, patients with hepatitis B had a significantly worse HRQOL in the domain 'sports and leisure', also observed in married patients. Otherwise, married individuals reported better HRQOL on 'dealing with the disease' domain. Patients with haemophilia B reported worse HRQOL in the domain 'self-perception'.

CONCLUSION

The results obtained could be helpful in guidance of haemophilia treatment which is determinant to improve HRQoL of the most vulnerable groups of patients. This work also reinforced the relevance of joint bleeds in all aspects of HRQoL in haemophilic patients. The use of prophylactic factor concentrates and multidisciplinary treatments could contribute to improve the quality of life in haemophilia.

Intrinsic Charge Carrier Mobility in Single-Layer Black Phosphorus

We present a theory for single- and two-phonon charge carrier scattering in anisotropic two-dimensional semiconductors applied to single-layer black phosphorus (BP). We show that in contrast to graphene, where two-phonon processes due to the scattering by flexural phonons dominate at any practically relevant temperatures and are independent of the carrier concentration n, two-phonon scattering in BP is less important and can be considered negligible at n≳10^{13}  cm^{-2}. At smaller n, however, phonons enter in the essentially anharmonic regime. Compared to the hole mobility, which does not exhibit strong anisotropy between the principal directions of BP (μ_{xx}/μ_{yy}∼1.4 at n=10^{13} cm^{-2} and T=300  K), the electron mobility is found to be significantly more anisotropic (μ_{xx}/μ_{yy}∼6.2). Absolute values of μ_{xx} do not exceed 250 (700)  cm^{2} V^{-1} s^{-1} for holes (electrons), which can be considered as an upper limit for the mobility in BP at room temperature.

Transient Elastography for Assessment of Liver Fibrosis and Steatosis: An Evidence-Based Analysis

BACKGROUND

Liver fibrosis is a sign of advanced liver disease and is often an indication for treatment. The current standard for diagnosing liver fibrosis and steatosis is biopsy, but noninvasive alternatives are available; one of the most common is transient elastography (FibroScan).

OBJECTIVES

The objective of this analysis was to assess the diagnostic accuracy and clinical utility of transient elastography alone for liver fibrosis and with controlled attenuation parameter (CAP) for steatosis in patients with hepatitis C virus, hepatitis B virus, nonalcoholic fatty liver disease, alcoholic liver disease, or cholestatic diseases. The analysis also aimed to compare the diagnostic accuracy of transient elastography with two alternative noninvasive technologies: FibroTest and acoustic force radiation impulse (ARFI).

DATA SOURCES

Ovid MEDLINE, Ovid MEDLINE In-Process, Ovid Embase, and all EBM databases were searched for all studies published prior to October 2, 2014.

REVIEW METHODS

An overview of reviews was conducted using a systematic search and assessment approach. The results of the included systematic reviews were summarized, analyzed, and reported for outcomes related to diagnostic accuracy and clinical utility as a measure of impact on diagnoses, therapeutic decisions, and patient outcomes.

RESULTS

Fourteen systematic reviews were included, summarizing more than 150 studies. The reviews demonstrated that transient elastography (with or without CAP) has good diagnostic accuracy compared to biopsy for the assessment of liver fibrosis and steatosis. Acoustic force radiation impulse and FibroTest were not superior to transient elastography.

LIMITATIONS

None of the included systematic reviews reported on the clinical utility of transient elastography.

CONCLUSIONS

Transient elastography (with or without CAP) offers a noninvasive alternative to biopsy for the assessment of liver fibrosis and steatosis, given its comparable diagnostic accuracy.

Sickle Cell Disease: quality of life in patients with hemoglobin SS and SC disorders

Objective

Sickle cell disease comprises chronic, genetically determined disorders, presenting significant morbidity and high prevalence in Brazil. The goal of this study was to evaluate the quality of life of sickle cell disease patients (hemoglobin SS and SC) and their sociodemographic and clinical characteristics.

Methods

Data was collected from clinical records and semi-structured interviews consisting of clinical questionnaires and the World Health Organization Quality of Life-brief questionnaire.

Results

Interviews were conducted with 400 patients, aged between 18 and 72, treated in the Fundação HEMOMINAS in Belo Horizonte. The participants predominantly had sickle cell disease hemoglobin SS variant (65.5%), were female (61.8%), single (55.3), with up to 8 years of schooling (49.6%), and self-defined as mulattos (50%). Pain crises, hospitalizations, blood transfusions, and other morbidities of sickle cell disease had a significant impact on the quality of life of these patients.

Conclusion

Within this group, the social profile was that of low income and unemployed with sickle cell disease considered to be a significant impediment to finding a job. Evaluating quality of life as a determining factor of health is essential for the creation of specific policies and measures, appropriate for the specific characteristics and social context of sickle cell disease.

Health technologies for the improvement of chronic disease management: a review of the Medical Advisory Secretariat evidence-based analyses between 2006 and 2011

BACKGROUND

As part of ongoing efforts to improve the Ontario health care system, a mega-analysis examining the optimization of chronic disease management in the community was conducted by Evidence Development and Standards, Health Quality Ontario (previously known as the Medical Advisory Secretariat [MAS]).

OBJECTIVE

The purpose of this report was to identify health technologies previously evaluated by MAS that may be leveraged in efforts to optimize chronic disease management in the community.

DATA SOURCES

The Ontario Health Technology Assessment Series and field evaluations conducted by MAS and its partners between January 1, 2006, and December 31, 2011.

REVIEW METHODS

Technologies related to at least 1 of 7 disease areas of interest (type 2 diabetes, coronary artery disease, atrial fibrillation, chronic obstructive pulmonary disease, congestive heart failure, stroke, and chronic wounds) or that may greatly impact health services utilization were reviewed. Only technologies with a moderate to high quality of evidence and associated with a clinically or statistically significant improvement in disease management were included. Technologies related to other topics in the mega-analysis on chronic disease management were excluded. Evidence-based analyses were reviewed, and outcomes of interest were extracted. Outcomes of interest included hospital utilization, mortality, health-related quality of life, disease-specific measures, and economic analysis measures.

RESULTS

Eleven analyses were included and summarized. Technologies fell into 3 categories: those with evidence for the cure of chronic disease, those with evidence for the prevention of chronic disease, and those with evidence for the management of chronic disease.

CONCLUSIONS

The impact on patient outcomes and hospitalization rates of new health technologies in chronic disease management is often overlooked. This analysis demonstrates that health technologies can reduce the burden of illness; improve patient outcomes; reduce resource utilization intensity; be cost-effective; and be a viable contributing factor to chronic disease management in the community.

PLAIN LANGUAGE SUMMARY

People with chronic diseases rely on the health care system to help manage their illness. Hospital use can be costly, so community-based alternatives are often preferred. Research published in the Ontario Health Technology Assessment Series between 2006 and 2011 was reviewed to identify health technologies that have been effective or cost-effective in helping to manage chronic disease in the community. All technologies identified led to better patient outcomes and less use of health services. Most were also cost-effective. Two technologies that can cure chronic disease and 1 that can prevent chronic disease were found. Eight technologies that can help manage chronic disease were also found. Health technologies should be considered an important part of chronic disease management in the community.

Participation in proficiency programs and promotion of quality in transfusion services of Minas Gerais

OBJECTIVE

This study aimed at identifying associations between the participation of transfusion services in immunohematology external quality control programs and their accuracy in immunohematology testing and adaptation to technical and legal operational procedures.

METHODS

From 2007 to 2009, a cross-sectional study was conducted in 219 transfusion services of the State of Minas Gerais who participated in this investigation by responding to a questionnaire and conducting a proficiency test comprising: ABO and RhD phenotyping, irregular RBC antibody screening and cross-matching. Frequencies and bivariate analysis followed by binary logistic regression were used for statistical analysis.

RESULTS

Transfusion services who participated in external quality control programs (32.4%) and those that did not (67.6%) obtained worrying error percentages in proficiency tests which may significantly increase blood transfusion risks. Shortfalls related to the establishment of protocols, standards and internal quality control were also significant. On comparing the two groups, transfusion services that participated in these programs had a 2.35 times higher chance of correct results in the proficiency panel testing, a 3.16 higher chance of having transfusional records and a 2.81 higher chance of performing preventive maintenance of equipment.

CONCLUSION

The study showed that independent factors associated to participation in external quality control programs suggest that more investment in internal quality control procedures is necessary and that more attention should be paid to current legislation.

Assessment of performance of professionals in immunohematology proficiency tests of the public blood bank network of the state of Minas Gerais

BACKGROUND

Despite significant advances, the practice of blood transfusion is still a complex process and subject to risks. Factors that influence the safety of blood transfusion include technical skill and knowledge in hemotherapy mainly obtained by the qualification and training of teams.

OBJECTIVE

This study aimed to investigate the relationship between professional categories working in transfusion services of the public blood bank network in the State of Minas Gerais and their performance in proficiency tests.

METHODS

This was an observational cross-sectional study (2007-2008) performed using a specific instrument, based on evidence and the results of immunohematology proficiency tests as mandated by law.

RESULTS

The error rates in ABO and RhD phenotyping, irregular antibody screening and cross-matching were 12.5%, 9.6%, 43.8% and 20.1%, respectively. When considering the number of tests performed, the error rates were 4.6%, 4.2%, 26.7% and 11.0%, respectively. The error rates varied for different professional categories: biochemists, biologists and biomedical scientists (65.0%), clinical pathology technicians (44.1%) and laboratory assistants, nursing technicians and assistant nurses (74.6%). A statistically significant difference was observed when the accuracy of clinical pathology technicians was compared with those of other professionals with only high school education (p-value < 0.001). This was not seen for professionals with university degrees (p-value = 0.293).

CONCLUSION

These results reinforce the need to invest in training, improvement of educational programs, new teaching methods and tools for periodic evaluations, contributing to increase transfusion safety and improve hemotherapy in Brazil.

Urban daily life routines and human exposure to environmental discomfort

This study suggests a shift in focus from studying environmental discomfort in urban strategic stations, from which average results for the city or specific results for selected sites are deduced, and from measuring environmental conditions in fixed monitoring stations to a study in which we monitor, with mobile portable sensors, the exposure of people to environmental sources of discomfort while performing their daily life activities. Significant variations in sense of discomfort were measured in this study, and almost half of this variability was found to be explained while four independent environmental variables were considered: air quality (concentrations of CO), noise level, climatic variables (thermal load), and social loads. The study conducted in the city of Tel Aviv, which suffers from hot, humid summers and cool winters, and noise levels that reach the average levels of 85 dB, and relatively lower levels of exposure to the other potential stressors. These levels of combined exposures result in moderate levels of discomfort for young, healthy people once they experience the more stressing environments in the city. It is shown also that noise from other people is the most salient source of discomfort in Tel Aviv. Levels of discomfort accumulate during the working hours, either due to the impact of social loads or noise, but the subjects showed good coping abilities that enabled them to recover in late afternoons. It seems that thermal load does not have immediate impact, but rather cumulative ones, mainly during transitional seasons when subjects are less adaptive to extreme changes in weather.

Transfusion Practices Committee of a public blood bank network in Minas Gerais, Brazil

OBJECTIVE

This study aimed to verify the performance of blood transfusion committees in transfusion services linked to the public blood bank network of the state of Minas Gerais.

METHODS

A cross-sectional observational study was conducted between 2007 and 2008 using questionnaires and proficiency tests to evaluate the reporting and investigation of transfusion reactions comparing transfusion services with and without transfusion committees in the public transfusion services of the state of Minas Gerais.

RESULTS

Nineteen of Hemominas own transfusion services and 207 that contracted the services of the foundation located in 178 municipalities were visited between 2007 and 2008. Established transfusion committees were present in 63.4% of the services visited. Transfusion incidents were reported by 53 (36.8%) transfusion services with transfusion committees and by eight (9.6%) without transfusion committees (p < 0.001) with 543 (97.5%) and 14 (2.5%) notifications, respectively. Of the reported transfusion incidents, 40 (75.5%) transfusion services with transfusion committees and only two (25%) of those without transfusion committees investigated the causes.

CONCLUSION

The incidence of notification and investigation of the causes of transfusion reactions was higher in transfusion services where a transfusion committee was present. Despite these results, the performance of these committees was found to be incipient and a better organization and more effective operation are required.

[Spatial-temporal distribution of potential blood donors at the Hemominas Foundation, Belo Horizonte, Minas Gerais State, Brazil, in 1994 and 2004]

The main goal of this study was to describe the spatial and temporal distribution of candidates for blood donation in Belo Horizonte, Minas Gerais State, Brazil, who appeared at the Hemominas Foundation in 1994 and 2004. The study also compared the candidates for age, gender, and clinical approval for blood donation in space and space-time. Data were obtained from a cross-sectional study for 1994 and were randomly selected from all donor candidates for 2004. The samples were georeferenced using the residential address. The spatial analysis techniques employed were: Kernel maps, thematic maps of Bayesian empirical rates and crude rates, and Moran Global. According to the findings, spatial distribution of candidates was non-random. The Kernel maps helped detect points with higher or lower concentration of candidates. Thematic maps described the concentration of candidates in relation to the population for the various categories. The results could help detect areas for actions targeting donor recruitment and areas with specific blood donation public campaign needs.

Substance P and NK-1R expression in oral precancerous epithelium

The objectives of this study were to investigate the presence and distribution of substance P and neurokinin 1 receptor in oral premalignant epithelium and their relation with the presence of dysplasia, and to analyze whether the expression of substance P can be considered an early oncogenic event in oral carcinogenesis. substance P and neurokinin 1 receptor expression was immunohistochemically studied in 83 oral carcinomas and adjacent non-tumor epithelia. The presence and degree of epithelial dysplasia was assessed according to WHO criteria. The nuclear, cytoplasmic, and membrane expression of substance P and the cytoplasmic and membrane expression of neurokinin 1 receptor were assessed in tumor and adjacent non-tumor epithelium. Nuclear and cytoplasmic expression of substance P in non-tumor epithelium was significantly associated with the presence of epithelial dysplasia (p<0.001) and carcinoma in situ (p=0.021). Nuclear, cytoplasmic, and membrane expressions of substance P in non-tumor epithelium were significantly (p<0.001) associated with its expression in the corresponding tumor. These findings suggest that substance P plays a role in early oral carcinogenesis by promoting the proliferation and growth of premalignant fields.

Understanding the electronic structure and magnetism of correlated nanosystems

In this paper we review recent developments towards a realistic description of the electronic structure and magnetism of correlated nanosystems. A new class of so-called continuous-time solvers for the quantum impurity problem is discussed, which provides a numerically exact solution without systematic errors due to imaginary time discretization. These solvers are able to handle general interactions, like the full Coulomb vertex. We further show how four-point or higher-order correlation functions of the impurity problem can be computed. This allows the calculation of dynamical susceptibilities which provide information about spin excitations. Moreover, we discuss a principally new many-body scheme recently proposed for the description of non-local correlations in strongly correlated systems. This approach provides a basis for a many-body description of extended correlated nanostructures on a substrate.

A role for the substance P/NK-1 receptor complex in cell proliferation and apoptosis in oral lichen planus

OBJECTIVES

To determine whether substance P (SP) and NK-1 receptor (NK-1R) are expressed in oral lichen planus (OLP) and are related to cell proliferation and apoptosis in this disease.

MATERIAL AND METHODS

Tissue samples from 50 OLP patients and 26 healthy controls were studied. Immunohistochemistry was performed with anti-SP, anti-NK-1R, anti-ki-67 and anti-caspase-3 monoclonal antibodies and the clinical and pathological data of the OLP patients were evaluated.

RESULTS

With the exception of NK-1R expression in epithelial cell membrane and cytoplasm, all markers were more frequently present in OLP patients than in controls (P < 0.05). Higher cytoplasmatic expression of NK-1R was associated with higher epithelial expression of caspase-3 (P < 0.05). Higher epithelial expression of NK-1R and SP was associated with higher suprabasal and basal epithelial expression of ki-67 (P < 0.05 and P < 0.005, respectively).

CONCLUSIONS

Actions of the SP/NK-1R complex may contribute to the immune disorder underlying OLP and trigger stimuli to induce cell proliferation. These results indicate that this complex might play a role in the malignant transformation of OLP.

Significance of Preventing Primary Infections by Didymella rabiei and Development of a Model to Estimate the Maturity of Pseudothecia

The significance of preventing primary infections resulting from the teleomorph stage of Didymella rabiei was tested in field experiments in 1998 and 2000. Control efficacy was greater and yield and its components were higher in plots where the fungicide difenoconazole had been sprayed in time to protect the plants from infections resulting from airborne ascospores than in plots where sprays were not applied on time. Forty empirical models reflecting the influence of temperature and interrupted wetness on initial maturation of D. rabiei pseudothecia were developed and verified by using data recorded in chickpea fields in 1998. Seven of the models then were validated with data recorded in 1999 and 2000. The following model provided the best predictions: starting at the beginning of the rainy season (October to December), the predictor of the model was assigned one severity value unit when there was a rain event (1 day or more) with ≥10 mm of rain and an average daily temperature (during the rainy days) of ≤15°C. According to the model, pseudothecia mature after accumulation of six severity values and ascospores will be discharged during the following rain.

Rational Management of Didymella rabiei in Chickpea by Integration of Genotype Resistance and Postinfection Application of Fungicides

ABSTRACT Various aspects of the integration of genotype resistance and chemical control of Ascochyta blight (caused by Didymella rabiei) in chickpea were examined in field experiments from 1993 to 1999 and in greenhouse experiments. Four commercially available chickpea cultivars representing a range of resistance to D. rabiei were used. The efficacy of chemical control in a highly susceptible cultivar was significantly (P < 0.01) related to the conduciveness of the environment to the pathogen. Adequate disease suppression (>80% control) was achieved when weather supported mild epidemics, but insufficient control (<20%) was achieved when weather supported severe epidemics. The contribution of genotype resistance to disease suppression in a moderately susceptible cultivar varied from <10% when weather supported severe epidemics to approximately 60% when weather supported mild epidemics. Spraying a moderately resistant cultivar resulted in 95% control when weather supported mild epidemics, but only 65% control was achieved when weather supported severe epidemics. The existing level of resistance in a moderately resistant cultivar resulted in 70% control when weather supported severe epidemics; fungicides improved control efficacy significantly to >95%. Under mild epidemics, moderate resistance alone provided >95% control. The level of genotype resistance available in a highly resistant cultivar was sufficient to suppress the disease under all weather conditions, even without application of fungicides. The possibility of relying on postinfection rather than prophylactic application of fungicides was tested in the greenhouse and in four field experiments. Activity of the systemic fungicide tebuconazole was detected when the fungicide was applied up to 3 days postinfection, and application of tebuconazole or difenoconazole in the field as a postinfection treatment (i.e., after rain or overhead irrigation) suppressed the disease as effectively as preventive applications and required fewer sprays. In two experiments, the interaction between genotype resistance and chemical control at various amounts of irrigation applied via overhead sprinklers (as a simulation of rain) was tested. The results show that both the level of genotype resistance and the quantity of water should be taken into account in deciding whether to apply a postinfection spray.

Immediate and delayed effects of treatment at the Dead Sea in patients with psoriatic arthritis

The purpose of this study was to evaluate the immediate and delayed effects of balneotherapy at the Dead Sea on patients with psoriatic arthritis (PsA). A total of 42 patients with PsA were treated at the Dead Sea for 4 weeks. Patients were randomly allocated into two groups: group 1 (23 patients) and group 2 (19 patients). Both groups received daily exposure to sun ultraviolet rays and regular bathing at the Dead Sea. Group 1 was also treated with mud packs and sulfur baths. Patients were assessed by a dermatologist and a rheumatologist 3 days before arrival, at the end of treatment, and at weeks 8, 16, and 28 from the start of treatment. The clinical indices assessed were morning stiffness, right and left hand grip, number of tender joints, number of swollen joints, Schober test, distance from finger to floor when bending forward, patient's self-assessment of disease severity, inflammatory neck and back pain and psoriasis area and severity index (PASI) score. Comparison between groups disclosed a similar statistically significant improvement for variables such as PASI, morning stiffness, patient self-assessment, right and left grip, Schober test and distance from finger to floor when bending forward. For variables such as tender and swollen joints, and inflammatory neck and back pain, improvement over time was statistically significant in group 1. Addition of mud packs and sulfur baths to sun ultraviolet exposure and Dead Sea baths seems to prolong beneficial effects and improves inflammatory back pain.

Chest pain--a strong predictor of adverse cardiac events following precutaneous intervention (from the Evaluation of Platelet IIb/IIIa Inhibitor for Stenting Trial [EPISENT])]

Postprocedural chest pain remains a common problem, and irrespective of electrocardiographic changes, is associated with a higher incidence of early cardiac events. A return to the catheterization laboratory is unlikely to benefit patients with postprocedural chest pain without electrocardiographic changes with documented irreversible intraprocedural complications, or those with late postprocedural pain.

Angiographic correlates of cardiac death and myocardial infarction complicating major nonthoracic vascular surgery

In a case-control study of 63 patients undergoing major nonthoracic vascular surgery with prior cardiac catheterization, we found total coronary occlusion serving viable myocardium and "nonobstructive" lesions to be the most common proximate cause of perioperative myocardial infarction or death. The extent of coronary disease by several measures was significantly correlated with adverse outcome, and prior bypass surgery appeared to be protective.

Value of tongue biting in the diagnosis of seizures

BACKGROUND

Seizures are rarely witnessed by physicians, and the diagnosis is usually made on the basis of the history. Tongue biting is classically considered to favor a diagnosis of epileptic seizure. The usefulness of tongue biting in the differential diagnosis of seizures was evaluated.

METHODS

A prospective study of the presence of oral lacerations in 106 consecutive patients admitted to our Epilepsy Monitoring Unit and a retrospective study of a population of 45 patients with syncope were performed. The relationship between tongue biting and diagnosis (epileptic vs nonepileptic events) was analyzed.

RESULTS

Of the 106 monitored patients, 63 had episodes characterized by bilateral motor activity, complete loss of consciousness, or both; 34 patients had epileptic seizures, while 29 patients had exclusively nonepileptic episodes. Eight patients suffered an oral laceration; all involved the side of the tongue, and all had documented epileptic seizures. Of the 45 patients with syncope, in only one was the tongue lacerated, and this was at the tip. Tongue biting had a sensitivity of 24% and a specificity of 99% for the diagnosis of generalized tonic-clonic seizures. Lateral tongue biting was 100% specific to grand mal seizures.

CONCLUSION

Tongue biting, particularly if it is lateral, is highly specific to generalized tonic-clonic seizures.

[Hemotherapy and transfusional Chagas' disease in Brazil]

With the increased presence of Chagas' disease in urban areas and the rising importance of transfusional transmission of Trypanosoma cruzi, a proper and realistic approach to hemotherapeutic treatment has become crucial in Brazil. Bringing together data from various institutions, this study analyzed hemotherapy and the problem of transfusional Chagas' disease in 850 Brazilian municipalities from 1988 to 1989. It was found that some type of hemotherapy was practiced in 68.8% of these municipalities at the time, this practice being qualitatively and quantitatively proportional to the population size of the municipality. The official blood bank system supplied the blood used in 13% of these services. In relation to prevention of the main diseases transmissible by transfusion, prior screening of donors was carried out by 75.2% of the services for syphilis, 65.4% for hepatitis, 53.8% for AIDS, and 66.9% for Chagas' disease. These percentages vary by region and by size of the municipality. The majority of donors are classified as voluntary, with only 2% categorized as paid donors. In the case of Chagas' disease, most services used only one serologic technique to screen donors, most commonly hemagglutination or immunofluorescence, while only 10.3% of services had previous experience with chemoprophylaxis using gentian violet. The proportion of potential donors with positive serology for anti-Trypanosoma cruzi antibodies was around 1%. These data were confirmed by information from blood banks and Brazilian hemotherapy professionals.