HB D Los Angeles in a Brazilian family

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação eletroforética, cromatográfica e molecular da Hb D Los Angeles no Brasil

A variante de hemoglobina (Hb) D mais comum, Hb D Los Angeles ou D Punjab, é originada de uma transversão GAA->CAA no códon 121 da globina beta; essa mutação resulta na substituição do ácido glutâmico por glutamina na proteína. É a terceira variante de hemoglobina mais freqüente da população brasileira. Como as hemoglobinas D apresentam migração similar à hemoglobina S em pH alcalino, e com a hemoglobina A em pH ácido, são necessários vários testes para o correto diagnóstico. No presente estudo objetivou-se relacionar os diferentes procedimentos laboratoriais de rotina diagnóstica, além da análise molecular, para estabelecer o perfil de Hb D Los Angeles no Brasil. Foram analisados 47 indivíduos da população brasileira com provável Hb D Los Angeles, por vários procedimentos eletroforéticos em diferentes condições de pH, além da cromatografia líquida de alta pressão, e testes moleculares para confirmação da mutação. Foram encontrados quatro tipos de combinações de hemoglobinas: 42 indivíduos portadores de hemoglobina AD Los Angeles, dois indivíduos com doença de Hb S/D Los Angeles, dois indivíduos com Hb D Los Angeles e talassemia beta e um indivíduo com Hb D Los Angeles e Hb Lepore. Os indivíduos heterozigotos para D Los Angeles são assintomáticos, entretanto, em associação com outras variantes e talassemias podem apresentar graus variáveis de manifestações clínicas. Os resultados apresentados enfatizaram a necessidade da associação de várias metodologias para a identificação da Hb D Los Angeles, além de auxiliar na elucidação de combinações raras.

Electrophoretic and chromatographic profile for S-like hemoglobin

Hemoglobin variants originate mainly by simple amino acid substitutions, the result of nucleotide sequence changes. Recently, the number of known abnormal hemoglobins has increased due to improvement in analysis methodologies; however, many laboratories are not prepared to correctly identify mutants. Hb S is a very well-characterized hemoglobin variant that varies in prevalence in different regions of Brazil. However, there is a type of Hb that presents electrophoretic migration in alkaline pH similar to Hb S, named S-like Hb, which can be incorrectly diagnosed; therefore, its frequency is underestimated. We obtained reference ranges for Hb S by HPLC, and we examined the electrophoretic and chromatographic profiles of S-like Hb. Hb Hasharon, Hb D-Los Angeles, Hb Korle-Bu, Hb Lepore, Hb D-Iran, Hb G-like, Hb Queens, Hb Montgomery, and Hb Q-India were found. Cases of association between two beta chain mutants were also found. Electrophoresis in alkaline and acid pH was utilized to initially screen these Hb variants, and globin chain electrophoresis at both high and low pH was performed to identify the globin chain mutant. Chromatographic analysis permitted the identification of the hemoglobin variant and also facilitated the quantification of these variants. Therefore, an association of classical laboratory diagnostic methodologies is fundamental for the correct identification of suspect Hb variants. The S and S-like hemoglobin profiles determined in this study will help in the diagnosis of these variants in health care services.

Escola em tempo de inclusão: ensino comum, educação especial e ação do fonoaudiólogo

This article refl ects about the action of the school speech therapist presented in a panel discussion proposed by the Public Health Department entitled: “School time of inclusion: common teaching, special education and speech therapist’s action” during the 19th SBFa’s Congress at the WTC Sheraton in São Paulo. The refl ections triggered aimed to provide elements for the systematization of actions from different sectors guided by ethical principles, theory and practice that enable collaborative relationships between educators and speech therapists. The text mantained the order of presentations that have focused on: 1) the challenges of speech-language intervention in the processes of inclusion and exclusion of the school: from the promotion of oral and written language, to the approaches of the so-called language disorders; 2) the interface between Speech Therapy and Education; 3) the role of the speech therapist in the context of Inclusive and Special Education. The authors support the position that the work done at the interface Speech Therapy and Education has the potential to contribute to school’s inclusion processes that will be capable to subvert the discriminatory logic that imposes in daily school the binomium inclusion / exclusion. The theoretical and methodological approaches presented by the authors are supported in a humane and civic vision care, training and social participation.

Manuais de conduta em mídias sociais e sua contribuição para a democracia digital: um estudo de manuais brasileiros

Information and communication technology have contributed to the realization of the ideals of citizen participation in public decisions, as well as to help in fighting corruption and wrongdoing in government. After all, democracy entails the right to information. The government, in many spheres, has encouraged the responsible use of the internet. Conduct manuals and standards have been published for public segments to direct the responsible use of these tools by their agents. This article aims to determine whether the manuals comply with the principles of digital democracy. Conduct manuals were analyzed in digital media from four Brazilian public organizations: Embrapa; Department of Communication of the Federal Government; Judiciary and Health Department of the Federal District. As a methodology, content analysis, based on criteria focused on transparency and encouraging civic engagement was used.

Palmistichus elaeisis (Hymenoptera: Eulophidae) parasitizing pupae of Citioica anthonilis (Lepidoptera: Saturniidae) collected on Piptadenia gonoacantha (Fabaceae)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

QualiAB: desenvolvimento e validação de uma metodologia de avaliação de serviços de atenção básica

Este artigo apresenta o desenvolvimento, validação e utilização de uma metodologia de avaliação da qualidade dos serviços de atenção primária do Sistema Único de Saúde (SUS), o Questionário de Avaliação da Qualidade de Serviços de Atenção Básica (QualiAB). Destina-se aos serviços de atenção básica, organizados segundo diferentes modelos de atenção, incluindo a Saúde da Família. Contém 50 indicadores sobre oferta e organização do trabalho assistencial e programático e 15 sobre gerenciamento, na forma de questões de múltipla escolha, autorespondidas via web pela equipe local do serviço. Confere a cada resposta valor zero, um ou dois; a média geral atribui ao serviço um grau de qualidade expresso pela distância do melhor padrão correspondente à média dois. Foi construído por processo de consenso interativo, que incluiu metodologias qualitativas, teste-piloto, aplicação em 127 serviços, validação de construto e confiabilidade. Respondido, em 2007, por 598 (92%) dos serviços de 115 municípios paulistas, mostrou bom poder para discriminar níveis de qualidade. Adotado em 2010 como parte de um programa de apoio à Atenção Básica da Secretaria de Estado da Saúde de São Paulo, foi respondido por 95% (2.735) dos serviços de 586 municípios (90,8% do Estado). Os resultados foram encaminhados aos municípios. O QualiAB fornece uma avaliação válida, simples e com a possibilidade de retorno imediato para gerentes e profissionais. Mostrou factibilidade, aceitabilidade, bom poder de discriminação e utilidade para auxiliar a gestão da rede de atenção básica do SUS em São Paulo. A experiência indica aplicabilidade nas redes de atenção básica do Brasil.

Contextualização da pesca mundial de lagostas e características de comercialização de Scyllarides spp. E Panulirus spp. na Baixada Santista, estado de São Paulo, Brasil

This study aimed to contextualize the world's lobster fishing and identify the characteristics of their trades in Santos region (SP). For this purpose, were realized surveys about the captures of 56 years referring the families traded in the world through the informations supplied by the FAO (Food and Agriculture Organization). To State of São Paulo, consults were made in the data base Propesq (Fishing Institute) about the fishing and prices. Besides interviews in fishmonger, businessmen of fishing and restaurant, we observed the trade and the economical potential compared the lobsters Scyllarides spp. and Panulirus spp. The worldwide the family Nephropidae is the one that has been presenting bigger growth in the captures from 1950 and the one that has the biggest observed captures, the Palinuridae showed a little growth of the captures up to the 80' years, and leaving from there it is oscillating without many expressive changes; Scyllarides began to stand out as fisheries only 70' in Asia, precisely where the other two Families had low catches proportional. In the State of São Paulo, two types of lobsters are sold in Baixada Santista, with conspicuous differences in prices between them. There is also a difference in the flow of trade in relation to active fishing gear. Traders notice a decrease in both abundance and size of individuals of both genders and a clear preference to sell the slippers lobsters (Scyllarides spp.) both for the quality of meat as the lowest price.

Cooperação e apoio técnico entre estado e municípios: a experiência do programa articuladores da atenção básica em São Paulo

Com os processos de regionalização no final dos anos 1990, os estados iniciam um resgate de seu papel político para enfrentamento da fragmentação do sistema público de saúde. Nesse processo, as secretarias estaduais de saúde, representadas pelo Conselho Nacional de Secretários de Saúde, passam a redefinir as funções do Estado junto à Atenção Básica. Na histórica atuação da Secretária de Estado da Saúde de São Paulo (SES-SP) na atenção primária, uma das marcas refere-se à expertise profissional nesse campo, que com o processo de municipalização migrou para os municípios, especialmente os de maior porte, ou redefiniu suas áreas de atuação no interior da própria SES-SP, em áreas como a vigilância epidemiológica e sanitária, a de avaliação e controle, entre outras. Esse capital humano foi em parte resgatado a partir de 2009, com o Programa Articuladores de Atenção Básica. O Programa representa uma política de apoio da SES-SP para os municípios, priorizando aqueles com população inferior a 100 mil habitantes, com o objetivo de auxiliar os gestores municipais na qualificação dos serviços de Atenção Básica e fortalecer esse nível de atenção no sistema público de saúde. Toma como objeto de trabalho o reconhecimento de prioridades de saúde locais e dos obstáculos para a melhoria da atenção à saúde, na construção conjunta de estratégias e alternativas de enfrentamento dos problemas identificados. Este artigo apresenta o processo de implantação desse Programa, bem como alguns resultados referentes às principais frentes de atuação desses profissionais na busca da qualificação da atenção básica no estado.

Simultaneous determination of As, Cu, Mn, Sb, and Se in drinking water by GRAS with transversely heated graphite atomizer and longitudinal Zeeman-effect background correction

A method has been developed for the direct and simultaneous determination of As, Cu, Mn, Sb, and Se in drinking water by electrothermal atomic absorption spectrometry (ETAAS) using a transversely heated graphite tube atomizer (THGA) with longitudinal Zeeman-effect back- ground correction. The thermal behavior of analytes during the pyrolysis and atomization stages was investigated in 0.028 mol L-1 HNO3, 0.14 mol L-1 HNO3 and 1 + 1 (v/v) diluted water using mixtures of Pd(NO3)(2) + Mg(NO3)(2) as the chemical modifier, With 5 mug Pd + 3 mug Mg as the modifier, the pyrolysis and atomization temperatures of the heating program of the atomizer were fixed at 1400degreesC and 2100degreesC, respectively, and 20 muL of the water sample (sample + 0.28 mol L-1 HNO3, 1 + 1, v/v), dispensed into the graphite tube, analytical curves were established ranging from 5.00 - 50.0 mug L-1 for As, Sb, Se; 10.0 - 100 mug L-1 for Cu; and 20.0 - 200 mug L-1 for Mn. The characteristic masses were around 39 pg As, 17 pg Cu, 60 pg Mn, 43 pg Sb, and 45 pg Se, and the lifetime of the tube was around 500 firings. The limits of detection (LOD) based on integrated absorbance (0.7 mug L-1 As, 0.2 mug L-1 Cu, 0.6 mug L-1 Mn, 0.3 mug L-1 Sb, 0.9 mug L-1 Se) exceeded the requirements of the Brazilian Food Regulations (decree # 310-ANVS from the Health Department), which established the maximum permissible level for As, Cu, Mn, Sb, and Se at 50 mug L-1, 1000 mug L-1, 2000 mug L-1, 5 mug L-1, and 50 mug L-1, respectively. The relative standard deviations (n = 12) were typically < 5.3% for As, < 0.5% for Cu, < 2.1% for Mn, < 11.7% for Sb, and < 9.2% for Se. The recoveries of As, Cu, Mn, Sb, and Se added to the mineral water samples varied from 102-111%, 91-107%, 92-109%, 89-97%, and 101-109%, respectively. Accuracy for the determination of As, Cu, Mu Sb and Se was checked using standard reference materials NIST SRM 1640 - Trace Elements in Natural Water, NIST SRM 1643d - Trace Elements in Water, and 10 mineral water samples. A paired t-test showed that the results were in agreement with the certified values of the standard reference materials at the 95% confidence level.

Simultaneous determination of cadmium and lead in wine by electrothermal atomic absorption spectrometry

A method has been developed for the direct simultaneous determination of Cd and Pb in white and red wine by electrothermal atomic absorption spectrometry (ET-AAS) using a transversely heated graphite tube atomizer (THGA) with longitudinal Zeeman-effect background correction. The thermal behavior of both analytes during pyrolysis and atomization stages were investigated in 0.028 mol l(-1) HNO3 and in 1 + 1 v/v diluted wine using mixtures of Pd(NO3)(2) + Mg(NO3)(2) and NH4H2PO4 + Mg(NO3)(2) as chemical modifiers. With 5 mug Pd + 3 mug Mg as the modifiers and a two-step pyrolysis (10 s at 400 degreesC and 10 s at 600 degreesC), the formation of carbonaceous residues inside the atomizer was avoided. For 20 mul of sample (wine + 0.056 mol l(-1) HNO3, 1 + 1, v/v) dispensed into the graphite tube, analytical curves in the 0.10-1.0 mug l(-1) Cd and 5.0-50 mug l(-1) Pb ranges were established. The characteristic mass was approximately 0.6 pg for Cd and 33 pg for Pb, and the lifetime of the tube was approximately 400 firings. The limits of detection (LOD) based on integrated absorbance (0.03 mug l(-1) for Cd, 0.8 mug l(-1) for Pb) exceeded the requirements of Brazilian Food Regulations (decree #55871 from Health Department), which establish the maximum permissible level for Cd at 200 mug l(-1) and for Pb at 500 mug l(-1). The relative standard deviations (n = 12) were typically < 8% for Cd and < 6% for Pb. The recoveries of Cd and Pb added to wine samples varied from 88 to 107% and 93 to 103%, respectively. The accuracy of the direct determination of Cd and Ph was checked for 10 table wines by comparing the results with those obtained for digested wine using single-element ET-AAS, which were in agreement at the 95% confidence level. (C) 2001 Elsevier B.V. B.V. All rights reserved.

Simultaneous determination of As, Cu, Mn, Sb, and Se in drinking water by GFAAS with transversely heated graphite atomizer and longitudinal zeeman-effect background correction

A method has been developed for the direct and simultaneous determination of As, Cu, Mn, Sb, and Se in drinking water by electrothermal atomic absorption spectrometry (ETAAS) using a transversely heated graphite tube atomizer (THGA) with longitudinal Zeeman-effect background correction. The thermal behavior of analytes during the pyrolysis and atomization stages was investigated in 0.028 mol L-1 HNO3, 0.14 mol L-1 HNO3 and 1 + 1 (v/v) diluted water using mixtures of Pd(NO3)2 + Mg(NO3)2 as the chemical modifier. With 5 μg Pd + 3 μg Mg as the modifier, the pyrolysis and atomization temperatures of the heating program of the atomizer were fixed at 1400°C and 2100°C, respectively, and 20 μL of the water sample (sample + 0.28 mol L-1 HNO3, 1 + 1, v/v), dispensed into the graphite tube, analytical curves were established ranging from 5.00 -50.0 μg L-1 for As, Sb, Se; 10.0 - 100 μg L-1 for Cu; and 20.0 - 200 μg L-1 for Mn. The characteristic masses were around 39 pg As, 17 pg Cu, 60 pg Mn, 43 pg Sb, and 45 pg Se, and the lifetime of the tube was around 500 firings. The limits of detection (LOD) based on integrated absorbance (0.7 μg L-1 As, 0.2 μg L-1 Cu, 0.6 μg L-1 Mn, 0.3 μg L-1 Sb, 0.9 μg L-1 Se) exceeded the requirements of the Brazilian Food Regulations (decree # 310-ANVS from the Health Department), which established the maximum permissible level for As, Cu, Mn, Sb, and Se at 50 μg L-1, 1000 μg L-1, 2000 μg L-1, 5 μg L-1, and 50 μg L-1, respectively. The relative standard deviations (n = 12) were typically < 5.3% for As, < 0.5% for Cu, < 2.1% for Mn, < 11.7% for Sb, and < 9.2% for Se. The recoveries of As, Cu, Mn, Sb, and Se added to the mineral water samples varied from 102-111%, 91-107%, 92-109%, 89-97%, and 101-109%, respectively. Accuracy for the determination of As, Cu, Mn, Sb, and Se was checked using standard reference materials NIST SRM 1640 - Trace Elements in Natural Water, NIST SRM 1643d - Trace Elements in Water, and 10 mineral water samples. A paired t-test showed that the results were in agreement with the certified values of the standard reference materials at the 95% confidence level.

Associação entre o achado de cárdia incompetente à endoscopia digestiva alta e presença de esofagite de refluxo

Incompetent cardia (IC) or loose cardia is not uncommon at endoscopic examination but its meaning is not clear. Such incompetence could facilitate gastroesophageal reflux and the appearance of esophagitis as a consequence. The aim of this study is to investigate if there is an association between IC and reflux esophagitis (RE). A review was made of 395 consecutive endoscopic reports of adult males and females performed at the Botucatu Clinics Hospital, of the Unesp - University of the State of São Paulo. Diagnosis of IC is defined by the endoscopic image in which the cardia is partially opened and/or involves the endoscope in a loose manner. Esophagitis characterization was based in the Los Angeles classification. The statistical analysis showed a significant association between CI and RE (p < 0.0001). Although there is not a clear explanation for this association, some hypotheses could be suggested involving hypotonic LES, diaphragmatic crura ineffectiveness and TLESR disorders as conditions able not only to keep the cardia relaxed but also to the reflux followed by esophagitis.