Anemia em crianças menores de dois anos atendidas nas unidades básicas de saúde no Estado de São Paulo, Brasil

The present study sought to determine the prevalence of anemia in 2,992 children, aged between 6 and 23 months, who voluntarily attended 160 Basis Health Care Units, located in 63 cities of the 5 Regional Health Coordinating areas of the State of S. Paulo, Brazil. Blood samples were collected by venous puncture and hemoglobin was measured by the cianometahemoglobin method. The WHO criteria for the diagnosis of anemia (Hb < 11.0 g/dl) were used: 59.1% of the children were shown to be anemic, with prevalence varying from 47.8% to 68.7% in the 5 RHCs. RHC 1, which comprises the Greater S. Paulo Region, presented a prevalence of anemia significantly lower than the other 4 RHCs, which cover the rest of the State. Hemoglobin levels 9.5 g/dl were found in 25.1% of the children. Anemia was more frequent in male children in male children, in those born, with a weight of less than 3,000 gr, in those who were breastfed for less than 2 months and in those that who presented some degree of energy deficient proteic malnutrition, according to Gomez's criteria. This is the first of a series of 4 articles whose purpose is the determining the prevalence of anemia in the State of S. Paulo and of testing the intervention alternatives with a view to curtailing the incidence of this pathology which today is the most prevalent nutritional disturbance in the world.

Uso de macroalgas para avaliação da Poluição orgânica no Rio Preto, noroeste do estado de São Paulo.

The Preto River, located in the northwest of São Paulo State, receives a total wastewater load of 15.150 kg DBO day-1, from which 13.685 kg DBO day-1 (90.5%) corresponds to domestic sewage, and the city of São José do Rio Preto contributes with 12.400 kg DBO day-1 (90% of domestic sewage). During the period from August 1990 through January 1991, monthly sampling was carried out to evaluate the use of macroalgae as bioindicator of organic pollution. Five sampling sites were established along the main river and the following variables were analised: temperature, conductance, turbidity, dissolved oxygen, BOD, COD, total and fecal coliforms, and composition and abundance of macroalgal communities. Data were submitted to analysis of variance, correlation coefficient, cluster analysis (four different approaches) and converted to biological indices (species deficit, relative pollution, saprobity, diversity and uniformity indices). A wide range in water quality was found (particularly for conductance, oxygen, BOD and COD) among the sampling sites, which were classified into three groups (polluted, moderately polluted and unpolluted/weakly polluted). As regards the occurrence and abundance of macroalgae the Rhodophyta were found only in unpolluted or weakly polluted sites, whereas Cyanophyta occurred mostly under high pollution load; the Chlorophyta species were observed under a wide range of conditions. Among the biological indices, saprobity was the most sensitive and correlated to all water variables and the other indices. Cluster analyses showed that the composition of macroalgal communities was consistent with the levels of organic pollution in the Preto River.

HIPERTENSAO ARTERIAL EM PACIENTES OBESOS COM HIPERTROFIA CARDIACA. EFEITOS DO CAPTOPRIL SOBRE A SENSIBILIDADE A INSULINA E HORMONIO DE CRESCIMENTO

Purpose. To evaluate the effects of captopril (Cpt) on carbohydrate metabolism and growth hormone (GH) in adults hypertensive obese patients with normal (NGT) or impaired (IGT) glucose tolerance and left ventricular hypertrophy. Methods. Ten patients (53 ± 8 years), 8 women and 2 men, white, body mass index (BMI) ≥ 26 kg/m2, left ventricular mass index (LVMI) > 135 g/m2 in man and > 110 g/m2 in woman, with diastolic blood pressure (DBP) 95-115 mmHg after 3 weeks of placebo, were identified by oral glucose tolerance test (OGTT-75 g) as either with NGT or IGT, and treated with Cpt 25 mg t.i.d. for 8 weeks. At the 8 weeks, dosage was increased to 50 mg b.i.d. if DBP > 90 mmHg or the decrease of the DBP < 10%, during the next 8 weeks. OGTT and clonidine tests (0,04 mg/kg) with determinations, every 30 minutes of glucose, insulin, and GH during 2 hours, were performed. Results. Cpt lowered SBP and DBP in the NGT group and IGT group. The LVMI and the left ventricular mass (LVM) decreased in the IGT group with no significant change in the NGT group. Cpt promoted in the IGT group decrease in the area under the curve (AUC) of glucose, and AUC of insulin, with increase of the AUC of the percent of the β cell function, AUC of HC, and insulin sensitivity index with no significantly change in the NGT group. Conclusion. Adults hypertensive obese patients with IGT had decreased significantly in mean fasting level of GH concentrations compared to age, race, and BMI matched hypertensive patients with NGT. Treatment with Cpt induced a significant increased of the GH, with improvement of the metabolism in patients with IGT.

INFLUENCIA DO ACRESCIMO DE MANITOL A SOLUCAO NUTRIENTE NO DESEMPENHO MECANICO E NO GRAU DE EDEMA MIOCARDICO DE CORACOES ISOLADOS DE RATOS

Purpose - To analyse the influence of mannitol added to Krebs-Henseleit (KH) solution on the myocardium edema and myocardial function. Methods - Isolated rat heart under isovolumetric contractions studied according to Langendorff's technique were perfused with KH solution at constant flow during 90 min. The coronary perfusion pressure, diastolic and systolic pressures were recorded at every 15 min. At the end of the experiment, myocardium water content was measured in hearts perfused with KH solution (group I, n = 9) and in hearts perfused with KH solution plus 8 mM mannitol (group II, n = 8). These results were compared to non-perfused control heart (n = 9). Results - Myocardial water content was statistically higher in group I (80.8 ± 1.3%) compared to group II (78.1 ± 0.7%) and control group (75.5 ± 0.5%). Systolic arterial pressure was statistically higher in group I (86.2 ± 11.5 mmHg) compared to group II (72.7 ± 21.1 mmHg). There was no difference in the diastolic pressure between the two groups. Coronary perfusion pressure (Pp) increased progressively during the experiment in both groups. However, Pp was lower in group II than in group I. Conclusion - Mannitol added to KH solution significantly attenuates the myocardium edema in the isolated perfused rat heart.

Infecção hospitalar--aspectos éticos.

The author focuses the question of hospital infection, analysing the background on which the control committees were created. The hospital infection is discussed under bioethical principles and the Medical Ethics Code, examining the aspects related to the government, the Hospital Directorship, the Committee and the Control Service of Hospital Infection, and the assisting physician. A closer integration between the activities of the Program of Control of Hospital Infections and those of the Medical Ethics Committee is proposed, aiming at the patient and at the community, targets of total medical attention.

Flora do delgado em megas chagásicos: estudo pelo teste do H2 respiratório.

The author use the H2 breath test to study the small bowel microflora of chagasic patients with megaesophagus and/or megacolon. Compare this group with a control one. Find a significant increase (P < 0.05) in the small bowel flora of chagasic group. It is concluded that H2 breath is a simple and useful test to detect alteration in intestinal flora.

Experimental surgery of the facial nerve. Assessment of the intraperitoneal use of exogenous gangliosides

Compression and section of the facial nerve were performed in 48 rats in order to study the anatomopathological alterations occurring after daily intraperitoneal injections of 100 mg of exogenous gangliosides (Sinaxial®) for 45, 90, 180 days. In groups submitted to nerve compression, the histopathological changes were discrete and in the 180-day subgroups the nerve was practically normal. In animals submitted to section and neurorrhaphy there was formation of an amputation neuroma, a granuloma around the suture, axonal unstructuration and inter and perineural fibrosis. No significant differences were observed between the groups submitted or not to injection of exogenous gangliosides, indicating that the major factors involved in the quality of nerve regeneration were the technique and the formation of fibrosis and of an amputation neuroma.

Programa de controle de surto de escorpião Tityus serrulatus, Lutz e Mello 1922, no município de Aparecida, SP (Scorpiones, Buthidae).

A scorpion control program was proposed for the town of Aparecida (SP), an endemic region of Tityus serrulatus. Clusters of scorpions in urban and rural areas, environmental degradation of the town's outskirts and new scorpion procreation and dispersal habitats were studied. In addition, infrastructure problems such as the disposal and collection of residential and municipal refuse, sanitation (sewage and storm sewer), condition of vacant lots and constructions in the urban area were evaluated. After an epidemiological study, educational measures such as the distribution of pamphlets, cleaning group work, visits to residences and cooperation from High School teachers and students were also suggested. Chemical control was indicated in high-risk sites, especially those of near-school buildings. Furthermore, the use of natural predators was also mentioned within the present sanitation regulations for urban areas. The authors assert that these procedures must be integrated and continued uninterruptedly for several years. They also suggest a collaborative work with those responsible for the dengue eradication program, as well as the institution of the scorpion study week, which would greatly contribute to the education of the population, to preventive programs and to scorpion control.

Distribución geográfica etaria y racial de la hemoglobina S en Brasil.

OBJECTIVES: This paper was meant to analyse distribution of HbS carriers in Brazil, comprising its regional prevalence and the relationship with racial settlement and age groups. MATERIAL AND METHODS: 67,667 blood samples from 48 Brazilian towns were analysed from 1976 to 1988. Such samples were classified as Caucasoid and Negroid. The diagnosis was defined by means of qualitative electrophoresis in alkaline and acid pH, quantification of haemoglobin fractions, cytological studies and some cases were confirmed after examination of the parents. RESULTS: The study of those 67,667 samples allowed us to detect 1,492 HbS carriers (2.2%). That frequency is higher among Negroids (5.16%) than among Caucasoids (1.22%): Z = 22.1397 (Zcritical; 0.05 = 1.9600). Taking the HbS carrier distribution into consideration, we noticed that it is relatively homogeneous among Negroids and higher than 5% in 9 out of the 16 areas involved in the study. By classifying the age group of the areas in the general sample and by comparing the proportions, we found out that there are significant differences (chi 2 = 50.88; chi 2 critical; 0.05; 5 gl = 11.070). CONCLUSIONS: Sickle-cell anaemia diseases play an important role among the pathologies found in several countries, including Brazil. This paper shows that the carriers prevalence varies in the several areas under study and is higher among Negroids in almost all of them. The decreasing frequency occurring from North to South in the general samples and among Caucasoids may be assigned to the contribution of the Negroes in the interracial crossing, particularly in the Northeast.

El tabaco y las periodontopatías.

The purpose of this research, which is part of a study on periodontal disease and its risk factors among workers in Araraquara, São Paulo, Brazil, was to determine the association between smoking and its frequency, on the one hand, and the presence of periodontal cavities on the other. A sample of 528 sugar and alcohol refinery employees from Araraquara between the ages of 18 and 64 was examined in March and April of 1992 by a trained examiner who applied the Index of Periodontal Treatment Needs in the Community. Questionnaires were used to record the individuals' age, smoking habits, and the number of cigarettes smoked daily. An oral examination was also performed to assess the presence of dental plaque and to determine the bacterial colony index. Data analysis revealed a positive association between the presence of periodontal cavities and smoking. After adjusting the data for age, presence of dental plaque, and bacterial colony index, the odds ratio for having periodontal cavities increased directly with the number of cigarettes smoked. These results suggest that smoking and its frequency should be taken into account when planning programs for the primary prevention and treatment of periodontal disease.

Estudo comparativo dos métodos de ultra-sonografia, tomografia computadorizada e ressonância magnética no estadiamento e invasão das estruturas adjacentes por tumores renais.

BACKGROUND: Ultrasonography (US), Computed Tomography (CT), and Magnetic Resonance imaging (MR) were compared for the staging of renal tumors. The differences between these imaging techniques were also studied for their ability to detect adenopathies, vascular invasion, distant intra-abdominal metastases, and particularly adjacent organ invasion. METHODS: Thirty-one patients with solid or complex renal masses were prospectively studied using US, CT, and MR. Differences between the results obtained were studied using the COCHRAN G test and the McNEMAR test. The sensitivity and specificity of each diagnostic technique were compared against a gold standard of the surgical and histopathological findings. RESULTS: The following sensitivities were obtained: For the detection of adenopathy, US 63.6%, CT and MR 90.9%. For vascular invasion, US 42.8%, CT and MR 85.7%. For the adjacent organ invasion, US 28.5%, CT 85.7%, and MR 71.4%. Some of the criteria that suggest invasion of adjacent structures include: the envelopment of the adjacent structures by the tumor, tumor extension into the adjacent structures with an irregular appearance, and alterations in shape, size, and density of adjacent structures. Loss of fat planes between the tumor and adjacent structures is not a sign of tumor invasion. CONCLUSIONS: Significant differences were found in the detection capacity of US in relation to CT and MR, which were similar. All three techniques were highly sensitive and specific only in the detection of distant abdominal metastases. In addition to the accuracy of these diagnostic modalities for the detection and staging of tumors, invasiveness, risks and cost should be considered in relation to relative costs and benefits.

Determinantes da evolução do peso e altura em crianças de 3 meses a 6 anos assistidas em creche: Análise por modelo linear não hierarquizado em ensaio quase-experimental

Objective. To assess factors determining growth in a group of children between 3 months and 6 years old enrolled in a public municipal (i.e., government-supported, not private) day-care center, in comparison to a group of children with similar characteristics but who were not enrolled in the center. Methods. A quasi-experimental study was designed to observe 444 children aged 3 to 72 months from a low-income neighborhood in the city of Sorocaba, in the state of São Paulo, Brazil. Two groups were studied: 164 children enrolled in a local municipal day-care center (intervention group) and 280 not receiving care at the center (nonintervention, comparison group) but instead being cared for at home. Both groups were seen four times over a period of 16 months. At each observation session, the children's weight and height were measured. Information was also collected on the mother's sociodemographic characteristics and the illnesses she had suffered as well as the child's weight and other health characteristics at birth, the child's illnesses in the 15 days before each observation, and any hospitalizations. Results. The children in both groups were from low-income families, with 65% of the families having an average monthly income below US$ 100; 80% of the mothers had received 8 years of schooling or less. Multivariate linear regression analysis showed that at the first observation (just before enrollment in the day-care center), birth weight was the only factor that explained the nutritional differences between the two groups. Subsequent analyses showed that being in day care was the factor that best explained the differences between the groups, especially in terms of the adequacy of weight for age, after controlling for birthweight, sex, age at the beginning of the study, and illnesses in the 15 days before an observation session. The nutritional impact of the intervention was significant as early as 3 months after being enrolled in day care. Conclusions. The nutritional benefits of the care provided at the center outweighed the negative effects sometimes seen in such centers, such as the greater morbidity that children in day-care centers often experience in comparison to children receiving care at home.

Observations on Chromosomes of Dicrostonyx torquatus stevensoni Nelson and Chromosomal Diversity in Varying Lemmings = Untersuchungen an den Chromosomen von Dicrostonyx torquatus stevensoni Nelson und chromosomale Unterschiede bei Halsbandlemmingen

English abstract: The cytogenetic characteristics of the varying lemming, Dicrostonyx torquatus stevensoni, (2n = 34), were investigated, and diploid chromosomal numbers were reported for four other nominal subspecies (exsul, nelsoni, richardsoni, and rubricatus) of the torquatus-group in North America. The diploid complements ranged from 30 to 44 chromosomes, and the fundamental number from 50 to 55. Chromosomal polymorphism was observed in all forms. In cross-breeding experiments, the mating of F1 progeny was not productive. The findings support the zoogeographic concept that populations of Dicrostonyx became fragmented or displaced southward during Würm time, with relict stocks persisting in unglaciated refugia or periglacial tundra. Speciation in the isolates led to chromosomal evolution, with the result that populations spreading from refugia in post-glacial time are reproductively isolated. The torquatus-group in North America appears to be a superspecies. German title: Untersuchungen an den Chromosomen von Dicrostonyx torquatus stevensoni Nelson und chromosomale Unterschiede bei Halsbandlemmingen German abstract: Die cytogenetischen Merkmale des Halsbandlemmings, Dicrostonyx torquatus stevensoni, (2n = 34) wurden eingehend untersucht, und für vier andere nordamerikanische Unterarten der torquatus-Gruppe wurden die somatischen Chromosomensätze festgestellt. Die Chromosomenzahl der untersuchten Populationen schwankte zwischen 30 und 44, der NF (Nombre Fondamental) zwischen 50 und 55. Zuchttiere der verschiedenen Populationen wurden erfolgreich gekreuzt, aber Sterilität der F1 Unterartbastarde war typisch. Die Halsbandlemminge wiesen Karyotypenverschiedenheiten auf, die sich durch Variationen des Robertsonschen Typus, Deletionen oder möglicherweise durch perizentrische Inversionen erklären. Die Ergebnisse sprechen dafür, daß das ursprüngliche Verbreitungsgebiet von Dicrostonyx in Nordamerika durch die letzte (Würm) Vereisung getrennt wurde, und daß die Reliktpopulationen die letzte Glazial-Phase in eisfreien Refugien oder in periglazialer Tundra überlebten, wo Karyotypevolution durch lokale Anpassungsbedürfnisse gefördert wurde. Die in der Postglazialzeit aus den Refugien sich verbreitenden Populationen von Dicrostonyx scheinen reproduktiv isoliert zu sein. Die torquatus-Gruppe in Nordamerika gilt also als Superspecies.

Contribution à l'étude des Microphallidae Travassos, 1920 (Trematoda). XXVI. -De quelques espèces d'Alaska

French abstract: La faune des Trématodes Microphallidés d'Alaska étudiée comporte neuf espèces différentes, distribuées en quatre genres: 1° Microphallus oblonga Ching, 1965, M. pygmaeum (Levinsen, 1881) et M. similis (Jaegerskioeld, 1900). 2° Levinseniella (Lev.) propinqua Jaegerskioeld, 1907. 3° Maritrema acadiae (Swales, 1933). M. afanassjewi Belopolskaia, 1952. M. gratiosum Nicoll, 1907. M. megametrios Deblock et Rausch, 1968 et enfin, 4° Pseudospelotrema sp. n° 1. Les caractéristiques morphologiques essentielles de ces Trématodes sont décrites, sauf celles de la dernière espèce citée qui a déjà fait l'objet d'une étude antérieure. English abstract: Microphallid trematodes of nine species, representing four genera, have been studied from birds and mammals collected in Alaska: 1° Microphallus oblonga Ching, 1965, M. pygmaeum (Levinsen, 1881) and M. similis (Jaegerskioeld, 1900). 2° Levinseniella (Lev.) propinqua Jaegerskioeld, 1907. 3° Maritrema acadiae (Swales, 1933), M. afanassjewi Belopolskaia, 1952, M. gratiosum, Nicoll, 1907 and M. megametrios Deblock and Rausch, 1968 and 4° Pseudospelotrema sp. n° 1. Morphological characteristics of these trematodes are described, with the exception of Pseudospelotrema sp. to be considered elsewhere.

Dynamics of the Arctic Fox Population on St. Lawrence Island, Bering Sea

English abstract: We hypothesized that the arctic fox, Alopex lagopus (Linnaeus), population on St. Lawrence Island was cyclic and that its fluctuations in size. structure, and productivity were correlated with the relative size of the population of northern voles, Microtus oeconomus Pallas, the primary prey. Based on a nine-year study, we determined that the variations in size of the fox and vole populations were similar, but they both were of low amplitude and not closely correlated. The high pregnancy rate (mean, 86%/yr) and numbers of young conceived (mean, 11.5/pregnancy) did not vary significantly among years, probably because of the consistently abundant and diverse food supply available to the foxes. The age composition of the trappers' catch of foxes each winter also was comparatively stable, but it was closely correlated with the size of the vole population in the previous summer. The survival of the young foxes during the summer probably was dependent on the availability of the voles, The composition of the catch also appeared to be influenced by immigration of faxes from the adjacent continents via the pack ice. French abstract: Nous avons émis I'hypothèse que la population du renard arctique, Alopex lagopus (Linnaeus), sur I'île Saint Lawrence était cyclique el que les fluctuations concernant sa tailIe, sa structure et sa productivité étaient corrélées à la taille relative de la population du campagnol nordique. Microtus oeconomus Pallas, sa principale proie. En nous appuyant sur une étude menée sur neuf ans, nous avons déterminé que les variations dans la taille des populations du renard et du campagnol étaient semblables. mais que toutes deux avaient une faible amplitude et n'étaient pas corrélées de façon étroite. Le taux de grossesse élevé (moyenne 86 p. cent/an) et Ie nombre dc petits conçus (moyenne 11,5/grossesse) ne variaient pas de façon significative au cours des ans, probablement à cause de I'abondance et de la variété de sources de nourriture pour les renards. La composition d'âge des prises des trappeurs était également stable d'un hiver à I'autre, mais elle était corrélée de façon étroite avec la taille de la population dc campagnols au cours de I'été précédent. La survie des renardeaux au cours de I'été dépendait probablement de la disponibilité des campagnols. La composition des prises semblait aussi être influencée par I'immigration des renards venant des terres continentales adjacentes par la voie de la banquise.