Angiostrongiliase abdominal. Estudo anatomo-patologico de quatro casos observados no Rio Grande do Sul, Brasil

Os autores descrevem as lesões anatômicas de quatro casos de angiostrongilíase abdominal, destacando as modificações arteriais peculiares a esta parasitose.

Angiostrongiloidíase abdominal: seis casos observados no Paraná e em Santa Catarina, Brasil

Apresenta-se o estudo clínico e anatomopatológico de seis casos de angiostrongiloidíase abdominal, observados no sudoeste do Paraná e oeste de Santa Catarina, Brasil. Enfatiza a importância da divulgação da doença, a fim de que a mesma passe a fazer parte do diagnóstico diferencial do abdômen agudo, tanto em crianças como em adultos na citada região, devido ao aumento do número de casos nos últimos dois anos. O uso indiscriminado de agrotóxicos na lavoura talvez esteja implicado com o surgimento, em maior escala, desta patologia.

Abdominal Angiostrongylosis in Southern Brazil - Prevalence and Parasitic Burden in Mollusc Intermediate Hosts from Eighteen Endemic Foci

Angiostrongylus costaricensis is a parasitic nematode of rodents and molluscs are the intermediate hosts. Nocturnal collection of molluscs and search for infective third stage larvae of A. costaricensis was carried out in 18 endemic foci identified by the notification of a confirmed diagnosis in human biopsies or surgical specimens. Molluscs were digested in acidic solution and isolation of larvae eventually present was done in a Baermann funnel. Larvae identified by the presence of a delicate groove in the tail were counted to assess the individual parasitic burden. Four species were found infected, with ranges of prevalence in parenthesis: Phyllocaulis variegatus (7% to 33.3%); Bradybaena similaris (11.7% to 24.1%); Belocaulus angustipes (8.3% ) and Phyllocaulis soleiformis (3.3% to 14.2%). Parasitic burden varied from 1 to 75 with P. variegatus, 1 to 98 with B. similaris, 1 to 13 with B. angustipes and 1 larvae in each of two specimens of P. soleiformis. P. variegatus was present in all sites and was found infected with the highest prevalence figures and the highest individual parasitic burdens. These data stress the importance of veronicellid slugs as intermediate hosts for A. costaricensis in the endemic areas in Rio Grande do Sul, Brazil

Detection of the acute phase of abdominal angiostrongyliasis with a parasite-specific IgG enzyme linked immunosorbent assay

Angiostrongylus costaricensis may cause intestinal lesions of varied severity when it accidentally infects man in Central and South America. First-stage larvae have never been detected in stools. Therefore, a parasite-specific IgG ELISA was evaluated for the determination of the acute phase of infection. The specificity and the sensitivity of the immunoassay was shown to be 76.2% and 91.1%, respectively. Eight serum samples taken from patients with histopathological diagnosis, at different time points (3 to 15 months) after surgical treatment, showed a sharp and early decline in antibody reactivity. The titration of anti-A. costaricensis antibodies has proved to be a useful method for the diagnosis of acute abdominal angiostrongyliasis.

Schistosomiasis mansoni in low transmission areas: abdominal ultrasound

In endemic areas with low prevalence and low intensity of infection, the diagnosis of hepatic pathology due to the Schistosoma mansoni infection is very difficult. In order to establish the hepatic morbidity, a double-blind study was achieved in Venezuelan endemic areas, with one group of patients with schistosomiasis and the other one of non-infected people, that were evaluated clinically and by abdominal ultrasound using the Cairo classification. Schistosomiasis diagnosis was established based on parasitologic and serological tests. The increase of the hepatic size at midclavicular and midsternal lines (in hepatometry) and the hard liver consistency were the clinical parameters able to differentiate infected persons from non infected ones, as well as the presence of left lobe hepatomegaly detected by abdominal ultrasound. The periportal thickening, especially the mild form, was frequent in all age groups in both infected and uninfected patients. There was not correlation between the intensity of infection and ultrasound under the current circumstances. Our data suggest that in Venezuela, a low endemic area of transmission of schistosomiasis, the hepatic morbidity is mild and uncommon. The Cairo classification seems to overestimate the prevalence of periportal pathology. The specificity of the method must be improved, especially for the recognition of precocious pathology. Other causes of hepatopathies must be investigated.

Effect of blood components, abdominal distension, and ecdysone therapy on the ultrastructural organization of posterior midgut epithelial cells and perimicrovillar membranes in Rhodnius prolixus

The effects of blood components, nerve-cord severance, and ecdysone therapy on the posterior midgut epithelial cells of 5th-instar Rhodnius prolixus nymphs 10 days after feeding were analyzed by transmission electron microscopy. Cutting the nerve-cord of the blood-fed insects partially reduced the development of microvilli and perimicrovillar membranes (PMM), and produced large vacuoles and small electrondense granules; insects fed on Ringer's saline diet exhibited well developed microvilli and low PMM production; swolled rough endoplasmatic reticulum and electrondense granules; Ringer's saline meal with ecdysone led to PMM development, glycogen particles, and several mitochondria in the cytoplasm; epithelial cells of the insects fed on Ringer's saline meal whose nerve-cord was severed showed heterogeneously distributed microvilli with reduced PMM production and a great quantity of mitochondria and glycogen in the cytoplasm; well developed microvilli and PMM were observed in nerve-cord severed insects fed on Ringer's saline meal with ecdysone; Ringer's saline diet containing hemoglobin recovered the release of PMM; and insects fed on human plasma showed slightly reduced PMM production, although the addition of ecdysone in the plasma led to a normal midgut ultrastructural organization. We suggest that the full development of microvilli and PMM in the epithelial cells depends on the abdominal distension in addition to ingestion of hemoglobin, and the release of ecdysone.

Individual serological follow-up of patients with suspected or confirmed abdominal angiostrongyliasis

Abdominal angiostrongyliasis (AA) is a zoonotic nematode infection caused by Angiostrongylus costaricensis, with widespread occurrence in the Americas. Although the human infection may be highly prevalent, morbidity is low in Southern Brazil. Confirmed diagnosis is based on finding parasitic structures in pathological examination of biopsies or surgical resections. Serology stands as an important diagnostic tool in the less severe courses of the infection. Our objective is to describe the follow up of humoral reactivity every 2-4 weeks up to one year, in six individuals with confirmed (C) and ten suspected (S) AA. Antibody (IgG) detection was performed by ELISA and resulted in gradually declining curves of reactivity in nine subjects (56%) (4C + 5S), that were consistently negative in only three of them (2C + 1S) after 221, 121 and 298 days. Three individuals (2C + 1S) presented with low persistent reacitivity, other two (1C + 1S) were serologically negative from the beginning, but also presenting a declining tendency. The study shows indications that abdominal angiostrongyliasis is usually not a persistent infection: although serological negativation may take many months, IgG reactivity is usually declining along time and serum samples pairing may add valuable information to the diagnostic workout.

Use of heterologous antigens for the immunodiagnosis of abdominal angiostrongyliasis by an enzyme-linked immunosorbent assay

Angiostrongylus costaricensis has a broad geographic distribution spanning from North to South America and the infections of vertebrates with this nematode can result in abdominal complications. Human infections are diagnosed by histological or serological methods because the isolation of larvae from feces is not feasible, as most parasites become trapped in intestinal tissues due to intense eosinophilic inflammation. Because A. costaricensis is difficult to maintain in the laboratory, an immunodiagnostic IgG enzyme-linked immunosorbent assay (ELISA) using antigens from the congeneric Angiostrongylus cantonensis species was evaluated against a panel of serum samples from patients who were histologically diagnosed with A. costaricensis infections. Sera from uninfected individuals and individuals infected with other parasites were used as controls. The sensitivity and specificity of the assay were estimated at 88.4% and 78.7%, respectively. Because the use of purified or cloned antigens has not been established as a reliable diagnostic tool, the use of heterologous antigens may provide a viable alternative for the development of an ELISA-based immunodetection system for the diagnosis of abdominal angiostrongyliasis.

An indirect immunofluorescence antibody test employing whole eggs as the antigen for the diagnosis of abdominal angiostrongyliasis

Abdominal angiostrongyliasis is a potentially fatal zoonotic disease with a broad geographical distribution throughout Central and South America. This study assessed the performance of Angiostrongylus costaricensis eggs as the antigen in an indirect immunofluorescence assay for the determination of parasite-specific IgG and IgG1 antibodies. For prevalence studies, an IgG antibody titre > 16 was identified as the diagnostic threshold with the best performance, providing 93.7% sensitivity and 84.6% specificity. Cross reactivity was evaluated with 65 additional samples from patients with other known parasitic infections. Cross reactivity was observed only in samples from individuals infected with Strongyloides stercoralis. For clinical diagnosis, we recommend the determination of IgG only as a screening test. IgG1 determination may be used to increase the specificity of the results for patients with a positive screening test.

Fatores de risco para incontinência urinária na mulher

Trata-se de um estudo de revisão bibliográfica com o objetivo de identificar os principais fatores de risco ou associados à incontinência urinária (IU) na mulher. Utilizou-se a base de dados MEDLINE e LILACS e pesquisa em bibliotecas dos artigos publicados entre 1983 e 2003. Foram analisadas trinta e oito publicações em inglês e português, as quais relataram como os principais fatores de risco: idade, trauma do assoalho pélvico, fatores hereditários, raça, menopausa, obesidade, doenças crônicas, uso de alguns simpaticomiméticos e parasimpaticolíticos, constipação, tabagismo, consumo de cafeína e exercícios intensos na região abdominal. A enfermeira pode, por meio de anamnese, identificar estes fatores e realizar intervenções para a prevenção e tratamento da IU, contribuindo para melhorar a qualidade de vida da mulher incontinente.

Percepção do adolescente obeso sobre as repercussões da obesidade em sua saúde

O objetivo deste estudo é avaliar a percepção do adolescente obeso sobre as repercussões da obesidade em sua saúde. Baseou-se no relato de quinze adolescentes obesos, acompanhados no Ambulatório do Hospital das Clínicas da Universidade Federal de Pernambuco, no período de abril a julho de 2007. Os depoimentos, obtidos através de entrevista semi-estruturada, foram submetidos à análise de conteúdo, modalidade temática transversal. Foram identificadas quatro temáticas relacionadas com os objetivos do estudo: 1. A percepção do conceito de obesidade; 2. A obesidade afetando a auto-imagem; 3. Obesidade versus Saúde e 4. O difícil retorno à saúde. Os adolescentes perceberam a obesidade como doença, repercutindo negativamente sobre sua saúde, apresentando uma baixa auto-estima e a sensação de isolamento. Reconhecem que ser saudável é ter uma alimentação correta e praticar atividade física, sendo imprescindível o apoio formal e informal, sobrepujando as dificuldades para manter uma qualidade de vida satisfatória.

Obesidade como fator de risco para a hipertensão entre profissionais de enfermagem de uma instituição filantrópica

Analisou-se a presença de obesidade relacionada com níveis de pressão alterados entre os profissionais de enfermagem de uma instituição filantrópica, tendo em vista a detecção precoce de possíveis hipertensos. A população constituiu-se de 147 profissionais de enfermagem com idade de 20-70 anos. Realizou-se entrevista estruturada, individual, pelo pesquisador no local de trabalho desses profissionais. 91,8% eram mulheres; 29,2% possuíam idade superior a 40 anos; 11,6% apresentaram PAS>140mmHg e 6,8% PAD>90mmHg; 12,2% apresentaram obesidade grau I-II; 38,1% das mulheres, RCQ>0,85, 12,2% com idade 40-49 anos; 2,1% dos homens apresentaram RCQ>1,0, 1,4% encontravam-se na faixa etária 40-49 anos. É possível identificar que, embora os profissionais de enfermagem conheçam a gravidade da doença e a importância da mudança nos hábitos de vida, ainda apresentam dificuldade para tal comportamento, o que sugere a necessidade de implementação de programas educativos no local de trabalho, de modo a contribuir e favorecer a mudança de comportamento destes profissionais.

Qualidade de vida de cuidadores de crianças e adolescentes com sobrepeso ou obesidade

Este estudo avaliou a qualidade de vida relacionada à saúde (QVRS) de cuidadores de crianças e adolescentes com sobrepeso e obesidade. Trezentos e sessenta cuidadores de crianças e adolescentes com idade entre 9 e 12 anos, com diagnóstico de sobrepeso (n=96; idade média=11,1 anos), obesidade (n=62; idade média de 10,9 anos) e eutrofia (n=202; idade média de 10,7 anos), matriculadas em escolas públicas e particulares da cidade de Uberlândia (MG), foram convidados a responder o questionário The 36 item Short Form Questionnaire (SF-36). Os escores obtidos pelo questionário foram comparados segundo o índice de massa corpórea (IMC) das crianças e adolescentes e não foram encontradas diferenças significativas entre os cuidadores de crianças e adolescentes com sobrepeso, obesidade e eutrofia.Logo, os cuidadores de crianças e adolescentes com sobrepeso ou obesidade não apresentam prejuízo na sua QVRS.