Fragmentos da história da malária em São Paulo

Due to its great incidence in Brazil, malaria is one of the most important transmissible disease studied in the papers that deal with public health today. Although it is present in the Brazilian history since the colonial period, it has hardly been studied from its historic perspective. The present article intends to give a general view of the disease in Brazil, specially in the state of São Paulo. The research is based on historic papers of health and epidemies not only in Brazil but also in the world, found in the legislative documentation of São Paulo. Until 1930, malaria had spread through the country and the health authorities took no care in stablishing especific campaigns to face the disease. This negligence was mostly due to the fact that the mortality rate of malaria was lesser than variola, yellow fever or the many other endemic or epidemic diseases. Eradication seemed to be close to an end but the social and economic transformations after the 70's brought the disease in a proportion ten times worse.

Mortalidade por causas externas no Município de São José do Rio Preto, no período de 1996-1998

Introduction: An epidemiological study of the mortality rates by injuries in São José do Rio Preto, State of São Paulo, Brazil, has been carried out. The period considered is 1996-1998. Objectives: To show injuries mortality rates in São José do Rio Preto-SP in 1996-98. Methods: The study was based on official data from the Mortality Information Service of the Brazilian Ministry of Health, and in a survey based on data from medical forensic examiners (IML). Software Epinfo6.0 and Tabwin was utilized for data analises. Results: The results were compared to values obtained in the literature for the other cities of São Paulo and Brazil. In the case of São José do Rio Preto, was observed a decrease in the number of deaths associated with external causes in the period, but particularly in deaths due to traffic accidents with motor vehicles an increase in cases of pedestrians killed by hit-and-run drivers, that is much larger than the corresponding values for Brazil and for the State of São Paulo. The study showed increase in rates of homicides, mainly in the 15 to 39 years age group. Conclusion: This result suggests that is important to start programs to reduce the number of deaths by injuries, as well as the necessity of monitoring locally all these data.

An outbreak of chlamydiosis in captive blue-fronted Amazon parrots (Amazona aestiva) in Brazil

Fifty-eight blue-fronted Amazon parrot (Amazona aestiva) nestlings, recovered from the illegal trade, became ill at a wildlife rehabilitation center in São Paulo State, Brazil. Clinical signs observed were nonspecific, and the mortality rate was 96.5% despite initial treatment with norfloxacin. Postmortem examinations were performed on 10 birds. Liver and spleen smears showed structures suggestive of Chlamydophila psittaci in four cases. Diagnosis was confirmed by seminested polymerase chain reaction on tissue samples. Other birds from the same location showed no clinical signs of the disease, although high complement fixation titers to C. psittaci were found in 10 adult psittacines. All birds in the facility were treated with doxycycline. The two surviving nestlings did not recover after two doxycycline treatments and were euthanatized. The high mortality rate observed in this outbreak was attributed to poor conditions of husbandry and delays in the diagnosis and treatment of the disease. After diagnosis, improved control measures for chlamydiosis were instituted.

Acute and sustained effects of early administration of inhaled nitric oxide to children with acute respiratory distress syndrome

OBJECTIVE: To determine the acute and sustained effects of early inhaled nitric oxide on some oxygenation indexes and ventilator settings and to compare inhaled nitric oxide administration and conventional therapy on mortality rate, length of stay in intensive care, and duration of mechanical ventilation in children with acute respiratory distress syndrome. DESIGN: Observational study. SETTING: Pediatric intensive care unit at a university-affiliated hospital. PATIENTS: Children with acute respiratory distress syndrome, aged between 1 month and 12 yrs. INTERVENTIONS: Two groups were studied: an inhaled nitric oxide group (iNOG, n = 18) composed of patients prospectively enrolled from November 2000 to November 2002, and a conventional therapy group (CTG, n = 21) consisting of historical control patients admitted from August 1998 to August 2000. MEASUREMENTS AND MAIN RESULTS: Therapy with inhaled nitric oxide was introduced as early as 1.5 hrs after acute respiratory distress syndrome diagnosis with acute improvements in Pao(2)/Fio(2) ratio (83.7%) and oxygenation index (46.7%). Study groups were of similar ages, gender, primary diagnoses, pediatric risk of mortality score, and mean airway pressure. Pao(2)/Fio(2) ratio was lower (CTG, 116.9 +/- 34.5; iNOG, 62.5 +/- 12.8, p <.0001) and oxygenation index higher (CTG, 15.2 [range, 7.2-32.2]; iNOG, 24.3 [range, 16.3-70.4], p <.0001) in the iNOG. Prolonged treatment was associated with improved oxygenation, so that Fio(2) and peak inspiratory pressure could be quickly and significantly reduced. Mortality rate for inhaled nitric oxide-patients was lower (CTG, ten of 21, 47.6%; iNOG, three of 18, 16.6%, p <.001). There was no difference in intensive care stay (CTG, 10 days [range, 2-49]; iNOG, 12 [range, 6-26], p >.05) or duration of mechanical ventilation (TCG, 9 days [range, 2-47]; iNOG, 10 [range, 4-25], p >.05). CONCLUSIONS: Early treatment with inhaled nitric oxide causes acute and sustained improvement in oxygenation, with earlier reduction of ventilator settings, which might contribute to reduce the mortality rate in children with acute respiratory distress syndrome. Length of stay in intensive care and duration of mechanical ventilation are not changed. Prospective trials of inhaled nitric oxide early in the setting of acute lung injury in children are needed.

Astilbin toxicity to leaf-cutting ant Atta sexdens rubropilosa (Hymenoptera: Formicidae)

The toxicity of astilbin, isolated from Dimorphandra mollis, was tested in laboratory ingestion bioassays for the leaf-cutting ant Atta sexdens rubropilosa Forel. Worker ants that were fed an artificial diet daily to which astilbin was added had a higher mortality rate than the controls. The substance astilbin was incorporated into the diet with and without the utilization of a solvent. Results for both methodologies utilized were similar and indicate that astilbin reduces the median survival of ants. All concentrations tested showed toxic effects against ant workers, and the statistical comparison of survivorship rates from control and treated groups was significantly different, confirming the insecticidal properties of the substance astilbin.

Toxicity of Cedrela fissilis to Atta sexdens rubropilosa (Hymenoptera: Formicidae) and its symbiotic fungus

Crude extracts from roots, stems, branches, fruits and leaves of Cedrela fissilis were tested to verify their toxicity to Atta sexdens rubropilosa workers and to their symbiotic fungus Leucoagaricus gongylophorus. The workers that were fed daily on an artificial diet to which crude extracts from this plant were added had a higher mortality rate than the controls, especially for the hexane, dichloromethane and methanol crude extracts from roots (RH, RD and RM) and from leaves (LH, LD and LM). Fungal growth was inhibited by the hexane (RH) and dichloromethane crude extract from roots (RD). The RH, RD and FD crude extracts were fractioned and their fractions were tested. All the fractions tested presented toxicity to the ants and some fractions (RH-H, RH-D, RD-4 and RD-5) completely inhibited fungus development. The possibility of controlling these insects in the future using Cedrela fissilis compounds that can simultaneously target both organisms is discussed.

Intervenções benéficas no pré-natal para prevenção da mortalidade materna

Maternal mortality rate (MM) is a health quality indicator that is directly influenced by the economic, cultural and technological level of a country. Official data of MM in Brazil, although underestimated, point to the lack of quality in pregnancy, childbirth and puerperium care services. This characteristic is common in developing countries, where poorer pregnant women as well as those facing greater difficulty to quality care access are found. Prenatal care cannot prevent major childbirth complications, which are important causes of MM; however, some interventions during the prenatal period can favor maternal prognosis and prevent MM. In this setting, this study brings a scientifically based update concerning effective interventions for maternal mortality prevention during the prenatal period. The most important strategies consist of a tripod with specific interventions related to maternal health promotion, risk prevention and assurance of nutritional support during gestation, in addition to criteria to investigate gestational risk and inclusion of the pregnant woman in the basic component of the prenatal care model. It ends with the definition of priorities in the prevention of MM related to eclampsia/preeclampsia and reinforces the importance of normalization of reference systems for obstetric emergency cases.

Dinâmica populacional de Characidium lauroi e C. alipioi (Teleostei, Crenuchidae) na microbacia do Ribeirão Grande, serra da Mantiqueira Oriental, Estado de São Paulo

In low-order streams, the high and variable water flow rates offer both advantages and disadvantages to the life cycle of fishes. Even closely related species living in similar habitats can show differences in life history patterns. Based on oocyte-size distributions, C. lauroi was classified into the fractional spawning type, and C. alipioi into the total spawning type. The absolute fecundity of C. lauroi ranged from 1,313 to 2,925 oocytes; in C. alipioi the absolute fecundity ranged from 2,213 to 25,550 oocytes. The nonparametric Spearman correlation test showed statistical significance between the gonadosomatic index and fecundity for both species. The growth parameters, natural mortality rate and survival rate for females of C. lauroi were: K = 0.68 yr -1, L ∞ = 8.7 cm, t max = 4.4 years, M= 1.62 yr -1, S = 19.79%, and for males: K = 0.78 yr -1, L ∞ = 6.9 cm, t max = 3.8 years, M = 1.89 yr -1, S = 15.11%. The growth parameters, natural mortality rate and survival rate for females of C. alipioi were: K = 0.90 yr -1, L ∞ = 12.2 cm, t max = 3.3 years, M = 1.81 yr -1, S = 16.37%, and for males: K = 0.76 yr -1, L ∞ = 10.1 cm, t max = 3.9 years, M = 1.71 yr -1, S = 18.10%.

Clinical outcome in chronic myeloid leukemia after allogeneic hematopoietic stem cell transplantation: The experience of the Bone Marrow Transplantation Unit of FUNFARME/BRAZIL using FISH

Investigation of the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in chronic myeloid leukemia patients is essential to predict prognosis and survival. In 20 patients treated at the Bone Marrow Transplantation Unit of São José do Rio Preto (São Paulo, Brazil), we used fluorescence in situ hybridization (FISH) to investigate the frequency of cells with BCR/ABL rearrangement at diagnosis and at distinct intervals after allo-HSCT until complete cytogenetic remission (CCR). We investigated the disease-free survival, overall survival in 3 years and transplant-related mortality rates, too. Bone marrow samples were collected at 1, 2, 3, 4, 6, 12, and 24 months after transplantation and additional intervals as necessary. Success rate of the FISH analyses was 100%. CCR was achieved in 75% of the patients, within on average of 3.9 months; 45% patients showed CCR within 60 days after HSCT. After 3 years of the allo-HSCT, overall survival rate was 60%, disease-free survival was 50% and the transplant-related mortality rate was 40%. The study demonstrated that the BCR-ABL FISH assay is useful for follow-up of chronic myeloid leukemia patients after HSCT and that the clinical outcome parameters in our patient cohort were similar to those described for other bone marrow transplantation units. ©FUNPEC-RP.

Efeito da lavagem peritoneal com bupivacaína na sobrevida de ratos com peritonite fecal

BACKGROUND AND OBJECTIVES: Based on the knowledge of the anti-inflammatory and anti-bacterial actions of local anesthetics (LA), the objective of this study was to determine the effects of peritoneal lavage with bupivacaine on survival of mice with fecal peritonitis. METHODS: Forty-eight Wistar mice, weighing between 300 and 330 g (311.45 ± 9.67 g), undergoing laparotomy 6 hours after induction of peritonitis were randomly divided in 4 groups: 1 - Control, without treatment (n = 12); 2 - Drying of the abdominal cavity (n = 12); 3 - Lavage with 3 mL NS and posterior drying of the abdominal cavity (n = 12); and 4 - Lavage with 8 mg.kg -1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS followed by drying out of the abdominal cavity (n = 12). Animals that died underwent necropsy and the time of death was recorded. Surviving animals were killed on the 11 th postoperative day and underwent necropsy. RESULTS: Group 1 presented a 100% mortality rate in 52 hours, 100% mortality rate in Group 2 in 126 hours, and Group 3 presented a 50% mortality rate in 50 hours. Animals in Group 4 survived. Survival on the 11 th day was greater in groups 3 and 4 than in Groups 1 and 2 (p < 0.001) and greater in Group 4 than in Group 3 (p < 0.01). CONCLUSIONS: Peritoneal lavage with a solution of bupivacaine diluted in NS was effective in preventing death for 11 days in 100% of animals with fecal peritonitis. © Sociedade Brasileira de Anestesiologia, 2008.

Gastrointestinal cytomegalovirus disease in renal transplant recipients: A case series

The purpose of this article was to report a series of 23 renal transplant recipients with histologically proven and immunohistochemically confirmed cytomegalovirus (CMV) lesions in the gastrointestinal tract (GIT) and to assess the risk factors associated with severe disease/mortality. CMV patients (n=23) were allocated into two groups: those who died (n=6) and those considered cured (n=17). Overall mortality rate was 26% (6/23). Initial symptoms suggestive of lower GIT involvement were observed in all death cases and in 35.3% of those cured (p=0.01). Enterorrhagia was seen in 83.3% of the patients who died. Death risk increased twofold (RR 2 [1.13-3.52], p=0.01) when symptoms of lower GIT involvement were initially observed and sixfold when enterrohagia was present (RR 6 [1.1-35.9], p=0.001). Among death cases, mean time at diagnosis was significantly more distant (2002±2.9×2008±1.6, p=0.04). The difference in mortality rates seen as service practices changed along the years demonstrates the importance of early diagnosis. © 2011 John Wiley & Sons A/S.

Necrotizing soft tissue infection of the breast: Case report and literature review

Background: Necrotizing soft tissue infection (NSTI) is characterized by progressive infectious gangrene of the skin and subcutaneous tissue. Its treatment involves intensive care, broad-spectrum antibiotic therapy, and full debridement. Methods: We present two cases of NSTI of the breast, adding these cases to the 14 described in the literature, reviewing the characteristics and evolution of all cases. Case Report: On the fourth day after mastectomy, a 59-year-old woman with ulcerated breast cancer developed Type I NSTI caused by Pseudomonas aeruginosa, which had a favorable evolution after debridement and broad-spectrum antibiotics. The second patient was a 57-year-old woman submitted to a mastectomy and axillary dissection, who had recurrent seromas. On the 32nd post-operative day, after a seroma puncture, she developed Type II NSTI caused by β-hemolytic streptococci. She developed sepsis and died on the tenth day after debridement, intensive care, and broad-spectrum antibiotics. The cases are the first description of breast NSTI after mammary seroma aspiration and the first report of this condition caused by P. aeruginosa. Conclusion: Necrotizing soft tissue infection is rare in breast tissue. It frequently is of Type II, occurring mainly after procedures in patients with breast cancer. The surgeon's participation in controlling the focus of the infection is of fundamental importance, and just as important are broad-spectrum antibiotic therapy and support measures, such as maintenance of volume, correction of electrolytic disorders, and treatment of sepsis and septic shock. Once the infection has been brought under control, skin grafting or soft tissue flaps can be considered. The mortality rate in breast NSTI is 18.7%, all deaths being in patients with the fulminant Type II form. Surgical oncologists need to be alert to the possibility of this rare condition. © 2012, Mary Ann Liebert, Inc.

Multiple brain abscess from dental origin: Case report and literature review

Background: Brain abscess of dental origin is a rare situation and deserves attention due to its high mortality rate even when adequate treatment is done. Few reports are available when dental origin is the main cause of this infection. Case report: We present the case of a 70-year-old man diagnosed with cerebral abscess caused by apical lesions located at superior and inferior teeth. The three lesions containing pus were drained from anterior and posterior brain region and the laboratory evaluation revealed the presence of Streptococcus viridians and Bacteroides. Postoperative period was uneventful with excellent recovery after 1 year of surgery. Final diagnosis was able to be done due to excellent image exams availability like computer tomography and magnetic resonance using diffusion and perfusion techniques. Discussion: The early detection of this pathology with the correct diagnosis essential to give the patient the best treatment including antimicrobial drugs and drainage is of extreme importance. © 2011 Springer-Verlag.

Concentração letal LC50 do extrato aquoso de folhas de terminalia catappa em guaru, phalloceros caudimaculatus

This trial was conducted in order to determine the 50% lethal concentration (LC (I) 50-96h) of the aqueous extract of dried leaves of Terminalia catappa, a plant with antifungal, antibacterial and antiparasitic activity. Due to the increasing use of herbal medicines in aquaculture, its use is an option for controlling diseases in fish. Toxicity tests are important before recommending any treatment, since some products have therapeutic concentration close to lethal. To conduct the study used 135 fish species Guarus (Phalloceros caudimaculatus), exposed to increasing concentrations of: 0.0, 50.0, 100.0, 150.0, 200.0, 250.0, 300.0 mL of stock solution per liter of water. The results were calculated by the method Trimmed Spearman Karbo, demonstrating that the 50% lethal concentration (LC (I) 50-96h) estimated was 208.52 mL / L, with lower limit of 187.79 mL / L and higher 231.54 mL / L. Observed changes in behavior of the test organisms at concentrations above 250 mL / L decrease in the levels of dissolved oxygen and pH. Concentrations below 250 mL /L result in mortality rate near zero, so the aqueous extract shown low toxicity.

Doxorubicin induced dilated cardiomyopathy in a rabbit model: An update

Dilated cardiomyopathy (DCM) is characterized by chamber dilation and cardiac dysfunction. Because of the poor prognosis, models are needed for the investigation of and development of new therapeutic approaches, as well as stem cell therapy. Doxorubicin (DOX), used as chemotherapeutic agent, is reported to be cumulative cardiotoxic causing DCM. The aim of the study was to investigate the onset of systolic dysfunction using echocardiography in rabbits receiving two different doses of DOX (1. mg/kg twice a week and 2. mg/kg once a week). Twenty rabbits were treated with doxorubicin in two different doses for 6. weeks and compared with a control group treated with NaCl 0.9%. The effect of doxorubicin on the myocardium was investigated with histological analysis and scanning electron microscopy of left ventricle (LV), as well as in the interventricular septum (IVS) and right ventricle (RV). The results showed a high mortality rate for rabbits receiving 2. mg/kg once a week. A significant reduction in systolic function was present in animals treated with DOX after 6. weeks, with decreased ejection fraction and shortening fraction. Histology and electron microscopy revealed vacuolization, intracytoplasmic granulation, necrosis and interstitial fibrosis in LV, as well as in the IVS and RV. Doxorubicin induced changes are present in the LV, RV and IVS, and the administration at the dose of 1. mg/kg twice a week for only 6. weeks is safe and sufficient to induce DCM in rabbits. © 2012 Elsevier Ltd.