Evidência de melhora na qualidade do cuidado assistencial no infarto agudo do miocárdio

FUNDAMENTO: A monitoração dos indicadores de qualidade no cuidado com a saúde (IQS) é um processo de fundamental importância na atenção à saúde dos pacientes. OBJETIVO: Avaliar se a monitoração dos IQS e a análise da causa-raiz melhoram a qualidade do cuidado no infarto agudo do miocárdio (IAM). MÉTODOS: Foi realizada uma análise transversal e comparativa dos IQS em pacientes com IAM nos anos de 2006 e 2007. Dos 1.461 pacientes admitidos com dor torácica, 172 (11,7%) tiveram o diagnóstico de IAM e foram incluídos na análise. RESULTADOS: A taxa de angioplastia primária foi 8,47% maior em 2007 (97,3%) do que em 2006 (89,7%), mas esta diferença não alcançou significado estatístico (p = 0,35). Também não houve diferença estatística no tempo de hospitalização (4 vs 5 dias, p = 0,15) e na mortalidade intra-hospitalar (7,8% vs 5,1%, p = 0,67) entre 2007 e 2006, respectivamente. No entanto, o tempo até o resultado da primeira troponina foi 27% menor em 2007 (69 min.; IC 95% = 44-94 min.) do que em 2006 (95 min.; 53-136 min.) (p = 0,025). O tempo porta-balão foi 12% menor (72 ± 29 min. vs 109 ± 85 min.; p = 0,03), a taxa de prescrição de aspirina na alta foi 35% maior (94,7% vs 70,3%; p = 0,002) e a taxa de APCP, menor do que 90 minutos, foi 52% maior (78,3 vs 51,4%; p = 0,03) em 2007, quando comparada a 2006. CONCLUSÃO: Nossos resultados sugerem que a estratégia de monitorar os IQS e a de implementação da metodologia de análise da causa-raiz melhora o processo de cuidado com a saúde no IAM.

Perfil dos pacientes com hipertensão arterial incluídos em uma coorte com HIV/AIDS em Pernambuco, Brasil

FUNDAMENTO: Hipertensão arterial sistêmica (HAS) é fator de risco modificável, cujo controle pode reduzir doença cardiovascular nos pacientes com vírus da imunodeficiência adquirida (HIV). OBJETIVO: Estimar a prevalência de HAS e descrever as características dos pacientes com HAS e pré-hipertensão infectados pelo HIV/AIDS. MÉTODOS: Estudo seccional alinhado a uma coorte de pacientes com HIV/AIDS. Considerou-se hipertensão em níveis > 140/90 mmHg ou uso de anti-hipertensivos e pré-hipertensão em níveis > 120/80 mmHg. RESULTADOS: Dos 958 pacientes, 388 (40,5%) eram normotensos, 325 (33,9%) pré-hipertensos e 245 (25,6%) hipertensos. Desses 245 pacientes, 172 (70,2%) sabiam ser hipertensos e 36 (14,8%) apresentavam pressão arterial controlada. Tiveram diagnóstico de HAS após o diagnóstico do HIV 62 pacientes (54,4%). Lipodistrofia ocorreu em 95 (46,1%) dos pacientes, já sobrepeso/obesidade em 129 (52,7%). Utilização de antirretrovirais ocorreu em 184 (85,9%), 89 (41,6%) com inibidores de protease (IP) e 95 (44,4%) sem IP. Utilizavam antivirais > 24 meses 74,7%. Idade, antecedentes familiares de hipertensão, circunferência abdominal, índice de massa corporal e triglicerídeos foram maiores entre pacientes hipertensos. Tempo de infecção pelo HIV, contagem de linfócitos CD4, carga viral, tempo e tipo de esquema antirretroviral foram semelhantes nos hipertensos e pré-hipertensos. CONCLUSÃO: A elevada frequência de hipertensos não controlados e de riscos cardiovasculares nos infectados pelo HIV apontam a necessidade de medidas preventivas e terapêuticas contra HAS nesse grupo.

Novas variedades de Cana-de-Açúcar

The authors carried out joint analyses of data referring to six experiments with varieties of sugar cane, carried out by SEGALLA and ALVAREZ in six locations in the State of S. Paulo, Brasil. The analyses showed that for cane or sugar yield, either for plant-cane or for plant-cane together with the first two ratoons, the best five varieties were CB 40-69, CB 41-76, CB 40-13, CB 40-19 and Co 419. The yield of sugar cane/for all varieties studied is given below, in metric tons produced in plant cane and the first two ratoons. Varieties Yield of sugar cane (tons/hectare) CB 40-69 205.2 CB 41-76 204.5 CB 40-13 199.4 CB 40-19 192.4 Co 419 192.1 CB 38-30 182.1 CB 41-70 181.5 Co 413 177.5 CB 38-22 174.4 CB 36-14 172.8 Co 290 166.6 CB 41-35 147.9 The least significant difference by Tukey's test, at the 5% level of probability, is A = 28.3 metric tons/hectare.

Effect of Niclosamide (Bayluscide WP 70 (R)), Anacardium occidentale hexane extract and Euphorbia splendens latex on behavior of Biomphalaria glabrata (Say, 1818), under laboratory conditions

The repellent effect of the molluscicides Niclosamide (Bayluscide WP 70 (R)), Anacardium occidentale and the latex of Euphorbia splendens on Biomphalaria glabrata was observed through the investigation of the occurrence of escape behavior among molluscs that were exposed to dosages lower than the LD 50. The total number of individuals out of water among the surviving snails in the control group provided a "Natural Escape Index". The comparison between this total and the total number of surviving snails in each group exposed to the different dosages of the molluscicides after 24 hr provided the "Molluscicide Escape Index" and the detection of a "Repellency Range" to these snails. The escape indexes for Niclosamide, A. occidentale and E. splendens were 10, 6.22 and 6.44 respectively. Repellency occurred at the following concentration ranges: 0.01, 0.02 and 0.03 ppm Bayluscide, 0.1, 0.2 and 0.3 ppm A. occidentale and 0.05, 0.10, 0.15 and 0.20 ppm E. splendens. The Natural Escape Index obtained in the control group was zero.

Biological characterization of clones derived from the edmonston strain of measles virus in comparison with schwarz and CAM-70 vaccine strains

Four virus clones were derived from the Edmonston strain of measles virus by repeated plaque purification. These clones were compared with the vaccine strains Schwarz and CAM-70 in terms of biological activities including plaque formation, hemagglutination, hemolysis and replication in Vero cells and chick embryo fibroblasts (CEF). Two clones of intermediate plaque yielded mixed plaque populations on subcultivation whereas the other two, showing small and large plaque sizes, showed stable plaque phenotypes. The vaccine strains showed consistent homogeneous plaque populations. All the Edmonston clones showed agglutination of monkey erythrocytes in isotonic solution while both vaccine strains hemagglutinated only in the presence of high salt concentrations. Variation in the hemolytic activity was observed among the four clones but no hemolytic activity was detected for the vaccine virus strains. Vaccine strains replicated efficiently both in Vero cells and CEF. All four clones showed efficient replication in Vero cells but different replication profiles in CEF. Two of them replicated efficiently, one was of intermediate efficiency and the other showed no replication in CEF. Two of the clones showed characteristics similar to vaccine strains. One in terms of size and homogeneity of plaques, the other for a low hemolytic activity and both for the efficiency of propagation in CEF.

Effects of Bayluscide WP 70® on the Survival and Water-leaving Behaviour of Biomphalaria straminea, Snail Host of Schistosomiasis in Northeast Brazil

The toxic and behavioural effects of niclosamide (Bayluscide WP 70®) on Biomphalaria straminea from a highly endemic area of schistosomiasis in northeastern Brazil were investigated through laboratory bioassays. The LD50 and LD90 were 0.114 mg/l and 0.212 mg/l, respectively. Water-leaving behaviour occurred among 14% to 30% of the snails in the presence of sublethal doses of niclosamide and among 16% of the controls. It was concluded that both the relatively low susceptibility to niclosamide and water-leaving behaviour of local B. straminea may be responsible for the recolonization of transmission foci after mollusciciding. It was suggested that recently improved measures of snail control, such as controlled-release formulations of niclosamide and plant molluscicides should be considered in areas where snail control is recommended

Molecular karyotype and chromosomal localization of genes encoding ß-tubulin, cysteine proteinase, hsp 70 and actin in Trypanosoma rangeli

The molecular karyotype of nine Trypanosoma rangeli strains was analyzed by contour-clamped homogeneous electric field electrophoresis, followed by the chromosomal localization of ß-tubulin, cysteine proteinase, 70 kDa heat shock protein (hsp 70) and actin genes. The T. rangeli strains were isolated from either insects or mammals from El Salvador, Honduras, Venezuela, Colombia, Panama and southern Brazil. Also, T. cruzi CL-Brener clone was included for comparison. Despite the great similarity observed among strains from Brazil, the molecular karyotype of all T. rangeli strains analyzed revealed extensive chromosome polymorphism. In addition, it was possible to distinguish T. rangeli from T. cruzi by the chromosomal DNA electrophoresis pattern. The localization of ß-tubulin genes revealed differences among T. rangeli strains and confirmed the similarity between the isolates from Brazil. Hybridization assays using probes directed to the cysteine proteinase, hsp 70 and actin genes discriminated T. rangeli from T. cruzi, proving that these genes are useful molecular markers for the differential diagnosis between these two species. Numerical analysis based on the molecular karyotype data revealed a high degree of polymorphism among T. rangeli strains isolated from southern Brazil and strains isolated from Central and the northern South America. The T. cruzi reference strain was not clustered with any T. rangeli strain.

Schistosoma mansoni heat shock protein 70 elicits an early humoral immune response in S. mansoni infected baboons

A study was undertaken to search for DNA recombinant Schistosoma mansoni proteins responsible for eliciting an antibody response from the host at a very early phase after infection. A S. mansoni adult worm cDNA expression library was screened using pooled sera from baboons with four weeks of infection. Based on their specific reactivity with the S. mansoni infected sera and no reactivity when tested against the pre-infection sera from the same baboons, four clones were selected for further studies. Sequence analysis revealed that they were homologous to the S. mansoni heat shock protein 70 (hsp70). The insert sizes of the four selected clones varied from 1150 to 2006 bp. The preliminary characterization for antibody reactivity against a panel of baboon sera showed that the longest clone was the most reactive, eight out of eight acute and three out of four chronic sera reacting positively to this clone. The shortest clone was the least reactive. Our results suggest that the S. mansoni hsp70 elicits an early and strong antibody response in baboons and that antibodies to this protein can be detected in chronically infected animals. Therefore S. mansoni hsp70 may be a valid target for immunodiagnosis. However further studies are needed to identify the portion of the hsp70 that best fits the requirements for a valuable diagnostic antigen.

Small intestinal inflammation following oral infection with Toxoplasma gondii does not occur exclusively in C57BL/6 mice: review of 70 reports from the literature

Small intestinal immunopathology following oral infection with tissue cysts of Toxoplasma gondii has been described in C57BL/6 mice. Seven days after infection, mice develop severe small intestinal necrosis and succumb to infection. The immunopathology is mediated by local overproduction of Th1-type cytokines, a so-called "cytokine storm". The immunopathogenesis of this pathology resembles that of inflammatory bowel disease in humans, i.e., Crohn's disease. In this review, we show that the development of intestinal pathology following oral ingestion of T. gondii is not limited to C57BL/6 mice, but frequently occurs in nature. Using a Pubmed search, we identified 70 publications that report the development of gastrointestinal inflammation following infection with T. gondii in 63 animal species. Of these publications, 53 reports are on accidental ingestion of T. gondii in 49 different animal species and 17 reports are on experimental infections in 19 different animal species. Thus, oral infection with T. gondii appears to cause immunopathology in a large number of animal species in addition to mice. This manuscript reviews the common features of small intestinal immunopathology in the animal kingdom and speculates on consequences of this immunopathology for humankind.