Perinatal factors associated with early deaths of preterm infants born in Brazilian Network on Neonatal Research centers

Objective: To evaluate perinatal factors associated with early neonatal death in preterm infants with birth weights (BW) of 400-1,500 g.Methods: A multicenter prospective cohort study of all infants with BW of 400-1,500 g and 23-33 weeks of gestational age (GA), without malformations, who were born alive at eight public university tertiary hospitals in Brazil between June of 2004 and May of 2005. Infants who died within their first 6 days of life were compared with those who did not regarding maternal and neonatal characteristics and morbidity during the first 72 hours of life. Variables associated with the early deaths were identified by stepwise logistic regression.Results: A total of 579 live births met the inclusion criteria. Early deaths occurred in 92 (16%) cases, varying between centers from 5 to 31%, and these differences persisted after controlling for newborn illness severity and mortality risk score (SNAPPE-II). According to the multivariate analysis, the following factors were associated with early intrahospital neonatal deaths: gestational age of 23-27 weeks (odds ratio - OR = 5.0; 95%CI 2.7-9.4), absence of maternal hypertension (OR = 1.9; 95%CI 1.0-3.7), 5th minute Apgar 0-6 (OR = 2.8; 95%CI 1.4-5.4), presence of respiratory distress syndrome (OR = 3.1; 95%CI 1.4-6.6), and network center of birth.Conclusion: Important perinatal factors that are associated with early neonatal deaths in very low birth weight preterm infants can be modified by interventions such as improving fetal vitality at birth and reducing the incidence and severity of respiratory distress syndrome. The heterogeneity of early neonatal rates across the different centers studied indicates that best clinical practices should be identified and disseminated throughout the country.

A Brazilian registry of juvenile dermatomyositis: onset features and classification of 189 cases

ObjectiveTo describe onset features, classification and treatment of juvenile dermatomyositis (JDM) and juvenile polymyositis (JPM) from a multicentre registry.MethodsInclusion criteria were onset age lower than 18 years and a diagnosis of any idiopathic inflammatory myopathy (IIM) by attending physician. Bohan & Peter (1975) criteria categorisation was established by a scoring algorithm to define JDM and JPM based oil clinical protocol data.ResultsOf the 189 cases included, 178 were classified as JDM, 9 as JPM (19.8: 1) and 2 did not fit the criteria; 6.9% had features of chronic arthritis and connective tissue disease overlap. Diagnosis classification agreement occurred in 66.1%. Medial? onset age was 7 years, median follow-up duration was 3.6 years. Malignancy was described in 2 (1.1%) cases. Muscle weakness occurred in 95.8%; heliotrope rash 83.5%; Gottron plaques 83.1%; 92% had at least one abnormal muscle enzyme result. Muscle biopsy performed in 74.6% was abnormal in 91.5% and electromyogram performed in 39.2% resulted abnormal in 93.2%. Logistic regression analysis was done in 66 cases with all parameters assessed and only aldolase resulted significant, as independent variable for definite JDM (OR=5.4, 95%CI 1.2-24.4, p=0.03). Regarding treatment, 97.9% received steroids; 72% had in addition at least one: methotrexate (75.7%), hydroxychloroquine (64.7%), cyclosporine A (20.6%), IV immunoglobulin (20.6%), azathioprine (10.3%) or cyclophosphamide (9.6%). In this series 24.3% developed calcinosis and mortality rate was 4.2%.ConclusionEvaluation of predefined criteria set for a valid diagnosis indicated aldolase as the most important parameter associated with de, methotrexate combination, was the most indicated treatment.

Accuracy of sagittal abdominal diameter as predictor of abdominal fat among Brazilian adults: a comparation with waist circumference

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Frequency of Leptospira spp. in sheep from Brazilian slaughterhouses and its association with epidemiological variables

A leptospirose é uma antropozoonose mundialmente distribuída que infecta animais de produção, incluindo as ovelhas como carreadores para outros animais e o homem. O presente estudo objetivou determinar a prevalência de Leptospira spp. em ovinos de dois abatedouros do estado de São Paulo e sua associação com algumas variáveis epidemiológicas estudadas. Amostras de soro de 182 ovinos foram pesquisadas para a presença de anticorpos para Leptospira spp. pela soroaglutinação microscópica (SAM). Os resultados indicaram 34/182 (18,68%; IC95% 13,70-24,98%) amostras positivas, principalmente para o sorovar Copenhageni (17/34; 50%; IC95% 33,99-66,01%). Crescimento bacteriano no meio de Fletcher foi observado em amostras de 13/34 (38,24%; CI95% 23.87-55.08%) animais, e confirmados pela Reação em Cadeia pela Polimerase (PCR) e seqüenciamento para somente duas amostras renais de dois animais. Assim, o tratamento e vacinação dos ovinos, além do controle de roedores, pode ser útil na prevenção da infecção na região estudada, visto que os ovinos são importantes carreadores de Leptospira spp. para o homem, e sua transmissão aos trabalhadores de abatedouros ocorre principalmente pela manipulação das vísceras.

Using the current Brazilian value for the biological exposure limit applied to blood lead level as a lead poisoning diagnostic criterion

Tradicionalmente, os limites de tolerância biológica são utilizados exclusivamente para a promoção e a preservação da saúde dos trabalhadores, não sendo aplicados com fins diagnósticos. Entretanto, com relação a algumas intoxicações profissionais, o assunto é polêmico. Neste artigo, defende-se a utilização do limite de tolerância aplicado atualmente no Brasil à plumbemia como um critério importante para a realização do diagnóstico da intoxicação profissional pelo chumbo. Argumenta-se que, em oposição ao tradicional critério clínico, deve-se abordar o problema do diagnóstico da intoxicação pelo chumbo sob um ponto de vista epidemiológico, utilizando-se o atual valor do limite de tolerância para a plumbemia como um marcador de risco relativo significativamente aumentado.

Prevalence and risk factors for urinary incontinence in healthy pregnant Brazilian women

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Polymorphisms of CYP17A1, CYP19, and androgen in Brazilian women with uterine leiomyomas

Background: Uterine leiomyomas are common, benign, smooth muscle tumors representing a significant public health problem. The aim of this study was to investigate CYP17A1, CYP19, and androgen (AR) polymorphisms, their relative risks for uterine leiomyomas and possible associations with clinical parameters.Methods: Uterine leiomyoma tissues and blood samples were obtained from 87 patients, as were peripheral blood samples from 68 control women. Clinical data were recorded in both groups. The CYP17A1 (rs743572) polymorphism was analyzed by PCR-RFLP, and the CYP19 [TTTA](n) repeat and AR [CAG](n) repeat were analyzed using PCR-based GeneScan analysis. AR loss of heterozygosity (LOH) and microsatellite instability were also evaluated, while samples exhibiting LOH were analyzed for X inactivation.Results: Clinical parameters related to disease development did not differ between cases and controls. CYP17A1 *A2/*A2 genotype was prevalent in non-white women. CYP17A1, CYP19, and AR genotypes and alleles did not differ between groups. However, alleles presenting [TTTA](7) repeats in intron 4 of CYP19 were more frequent in the control group (p=0.0550). Shorter and longer [CAG]n repeat alleles of AR were exclusive to the leiomyoma group. The LOH assay showed allele losses at AR locus in four informative tumors and X chromosome inactivation analysis revealed that these tumors retained the active allele.Conclusions: The overall lack of association between uterine leiomyomas with polymorphisms involved in steroidogenesis or steroid metabolism is consistent with the hypothesis that these polymorphisms do not substantially contribute to the development of these tumors.

Prevalence and risk factors for urinary and fecal incontinence in brazilian women

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Prevalence of antibodies against Toxoplasma gondii among Brazilian white-eared opossums (Didelphis albiventris)

Considering that Toxoplasma gondii is a parasite of global importance which affects several animal species including humans, the current study aimed to investigate the prevalence of antibodies against T. gondii among 72 white-eared opossums (Didelphis albiventris) from Botucatu Municipality (22 degrees 53'S 48 degrees 26'W), São Paulo State, Brazil. The investigation was carried out from January 2008 to December 2009, when the animals had their blood samples collected and subjected to the modified agglutination test (MAT); 12 specimens had brain samples bioassayed in mice. Seroprevalence was 5.5% (n = 4) and bioassays were negative. Older animals had higher prevalence of antibodies against T. gondii. Opossums in closer contact with the urban environment are likely more exposed to T. gondii than animals from the sylvatic environment. (C) 2011 Elsevier B.V. All rights reserved.

Rapid Prototyping applied to surgical planning for correcting craniofacial malformations in wild animals. A case study of a brazilian fox

Veterinary surgery for treatment of wild animals is becoming an increasingly demanding task because it involves animals of different anatomy, many of them are already stressed and treatment must be performed to the highest standard in the minimum period of time. Craniofacial alterations may occur for three main reasons: genetic, functional or a combination of both. It is possible to modify the functional cause using intraoral devices like inclined plane. The treatment planning can be made based on virtual 3D models and rapid prototyping. An approximately 9 months old, 3.7 kg male Brazilian fox (Lycalopex vetulus) was referred to the Veterinary Hospital. Physical examination showed malocclusion with a deviation of the mandible to the right side. The virtual 3D model of the head was generated based on CT image data. The 3D models and rapid prototyping opened up new possibilities for the surgical planning and treatment of wild animals.

Slaframine toxicosis in Brazilian horses causing excessive salivation

Ingestion of food contaminated with slaframine, an alkaloid produced by Rhizoctonia leguminicola, causes a mycotoxicosis, characterised by excessive salivation. Twenty-eight horses demonstrated this clinical sign after the consumption of alfalfa hay which on inspection showed dark patches on many of the stems. The presence of slaframine (1.5 ppm) in this hay was confirmed by gas chromatography and mass spectroscopy. This is the first equine slaframine toxicosis case reported in Brazil.

Use of three rapid detection systems to evaluate the prevalence and dissemination of Salmonella in a Brazilian poultry slaughterhouse

Prevalence and dissemination of Salmonella in a Brazilian poultry slaughterhouse were evaluated by three rapid detection systems (SS/SV(TM), VICAM, OSRT(TM), Unipath/Oxoid, and REVEAL(TM), Neogen), plus the conventional procedure. The carcasses were sampled after bleeding (P1), defeathering (P2), evisceration (P3), washing (P4), chilling (P5) and the packaged end-product (P6). In the first set of carcasses, the Salmonella incidence determined by the conventional method was 38.3% and 22.5% by SS/SV(TM). In the set for evaluation of OSRT(TM), the number of positive samples was the same detected by the cultural procedure (49.0%). In the third set, the positivity by the conventional procedure was 33.3%, and 5.0% by REVEAL(TM). The comparisons of positives in the first and third sets of carcasses were significantly different (P < 0.05). The positivity for Salmonella, in carcasses at P1 to P6, as determined by at least one of the methods, was 47.5%, 47.5%, 32.5%, 30.0%, 30.0% and 37.7%, respectively.

Genotypic characterization of Toxoplasma gondii in sheep from Brazilian slaughterhouses: New atypical genotypes and the clonal type II strain identified

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Brazilian spotted fever: A reemergent zoonosis

Brazilian spotted fever is caused by the bacterium Rickettsia rickettsii, which is the most pathogenic species of the spotted-fever rickettsiae group and is transmitted by the bite of infected ticks. Amblyomma cajennense is the most important tick species involved in the cycle of this zoonosis in Brazil as it presents low host specificity, great number of natural reservoirs and wide geographic distribution. It was first described in the state of São Paulo in 1929 and later in Rio de Janeiro, Minas Gerais and Bahia. The number of cases decreased in the 1940's with the development of new plague control techniques and antibiotics. In the last decades, the number of new cases has increased. The current review aimed at reporting some of the epidemiological and public health aspects of this reemergent disease with new foci, mainly in the southeastern region of Brazil.