New auxiliary indicators for the differential diagnosis of functional cardiorespiratory limitation in patients with chronic obstructive pulmonary disease and congestive heart failure

OBJECTIVE: To differentiate the nature of functional cardiorespiratory limitations during exercise in individuals with chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF) and to determine indicators that may help their classifications. METHODS: The study comprised 40 patients: 23 with COPD and 17 with CHF. All individuals underwent maximal cardiopulmonary exercise testing on a treadmill. RESULTS: The values of peak gas exchange ratio (R peak), peak carbon dioxide production (VCO2 peak), and peak oxygen ventilatory equivalent (V E O2 peak) were higher in the patients with CHF than in those with COPD, and, therefore, those were the variables that characterized the differences between the groups. For group classification, the differentiating functions with the R peak, VCO2 peak (L/min), and V E O2 peak variables were used as follows: group COPD: - 44.886 + 78.832 x R peak + 5.442 x VCO2 peak + 0.336 x V E O2 peak; group CHF: - 69.251 + 89.740 x R peak + 8.461 x VCO2 peak + 0.574 x V E O2 peak. The differentiating function, whose result is greater, correctly classifies the patient's group as 90%. CONCLUSION: The R peak, VCO2 peak, and V E O2 peak values may be used to identify the cause of the functional cardiorespiratory limitations in patients with COPD and CHF.

Remodelagem atrial elétrica reversa após cardioversão de fibrilação atrial isolada de longa duração

FUNDAMENTO: A fibrilação atrial (FA) isolada promove mudanças eletrofisiológicas, chamadas de "remodelamento elétrico", facilitando sua recorrência e manutenção. Há evidência de que o processo de remodelamento seja reversível após a recuperação do ritmo sinusal (RS). Entretanto, o momento para a recuperação das propriedades eletrofisiológicas ainda não foi definido. OBJETIVO: O objetivo desse estudo foi avaliar a ativação elétrica atrial usando o eletrocardiograma de alta resolução de onda P (P-ECGAR) pós-cardioversão da FA de longa duração, concentrando-se no processo de remodelamento reverso para identificar o momento da estabilização do processo. MÉTODOS: Indivíduos com FA isolada persistente, candidatos à cardioversão com conversão bem-sucedida ao RS, foram incluídos no estudo. A P-ECGAR foi realizada imediatamente após a reversão ao ritmo sinusal e repetida após 7 e 30 dias. RESULTADOS: Dentre os 31 indivíduos, 9 apresentaram recorrência precoce da FA, todos nos primeiros 7 dias após a cardioversão, e 22 permaneceram em RS por pelo menos um mês; o ECGAR foi obtido no sétimo e no trigésimo dias após a cardioversão. No 30º dia, a duração da onda P progressivamente diminuiu do primeiro para o terceiro ECGAR (duração da onda P: 185,5±41,9 m/s vs 171,7±40,5 m/s vs 156,7±34,9 m/s, respectivamente, 1º, 2º e 3º ECGAR; p<0,001 para todas as comparações). Na análise de domínio de frequência, a turbulência espectral não foi aparente no ECGAR imediatamente após a cardioversão, mas aumentou de forma aguda no 7º dia e permaneceu inalterada no 30º dia. CONCLUSÃO: O presente estudo sugere que os primeiros sete dias pós-cardioversão, após FA de longa duração, são críticos para o processo de remodelamento reverso e recorrência da arritmia.

Diabetes Mellitus and Glucose as Predictors of Mortality in Primary Coronary Percutaneous Intervention

Background: Diabetes mellitus and admission blood glucose are important risk factors for mortality in ST segment elevation myocardial infarction patients, but their relative and individual role remains on debate. Objective: To analyze the influence of diabetes mellitus and admission blood glucose on the mortality of ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention. Methods: Prospective cohort study including every ST segment elevation myocardial infarction patient submitted to primary coronary percutaneous intervention in a tertiary cardiology center from December 2010 to May 2012. We collected clinical, angiographic and laboratory data during hospital stay, and performed a clinical follow-up 30 days after the ST segment elevation myocardial infarction. We adjusted the multivariate analysis of the studied risk factors using the variables from the GRACE score. Results: Among the 740 patients included, reported diabetes mellitus prevalence was 18%. On the univariate analysis, both diabetes mellitus and admission blood glucose were predictors of death in 30 days. However, after adjusting for potential confounders in the multivariate analysis, the diabetes mellitus relative risk was no longer significant (relative risk: 2.41, 95% confidence interval: 0.76 - 7.59; p-value: 0.13), whereas admission blood glucose remained and independent predictor of death in 30 days (relative risk: 1.05, 95% confidence interval: 1.02 - 1.09; p-value &#8804; 0.01). Conclusion: In ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention, the admission blood glucose was a more accurate and robust independent predictor of death than the previous diagnosis of diabetes. This reinforces the important role of inflammation on the outcomes of this group of patients.

Functional Class in Children with Idiopathic Dilated Cardiomyopathy. A pilot Study

Abstract Background: Idiopathic dilated cardiomyopathy (IDCM), most common cardiac cause of pediatric deaths, mortality descriptor: a low left ventricular ejection fraction (LVEF) and low functional capacity (FC). FC is never self reported by children. Objective: The aims of this study were (i) To evaluate whether functional classifications according to the children, parents and medical staff were associated. (iv) To evaluate whether there was correlation between VO2 max and Weber's classification. Method: Prepubertal children with IDCM and HF (by previous IDCM and preserved LVEF) were selected, evaluated and compared. All children were assessed by testing, CPET and functional class classification. Results: Chi-square test showed association between a CFm and CFp (1, n = 31) = 20.6; p = 0.002. There was no significant association between CFp and CFc (1, n = 31) = 6.7; p = 0.4. CFm and CFc were not associated as well (1, n = 31) = 1.7; p = 0.8. Weber's classification was associated to CFm (1, n = 19) = 11.8; p = 0.003, to CFp (1, n = 19) = 20.4; p = 0.0001and CFc (1, n = 19) = 6.4; p = 0.04). Conclusion: Drawing were helpful for children's self NYHA classification, which were associated to Weber's stratification.

Molt cycle of the natural population of Palaemonetes argentinus (Crustacea, Palaemonidae) from Los Padres Lagoon (Buenos Aires, Argentina)

The molt cycle of the natural population of Palaemonetes argentinus Nobili, 1901 from Los Padres Lagoon, Buenos Aires, Argentina, was studied in relation to age, sex, and environmental factors. A total of 1645 individuals (740 females, 539 males, and 366 juveniles) were collected and analyzed between December 1995 and December 1996. The results indicate that the sex ratio (males:females) remains around 1:1.4 throughout most of the year. The reproductive period extends from September until February (spring and summer), with maximum sexual activity in October and November. Two cohorts originated in the spring and in the summer were differentiated. Ovigerous females arrest their molt cycle during the intermolt period to restart it after oviposition. The duration of the intermolt period does not differ between adults and juveniles. Since the percentage of premolt individuals represents 60% of the total cycle, it was classified as a diecdysic cycle. Within the studied range of water temperatures, the observed variations in the span of the different stages, indicate that this factor does not alter the molt frequency. Like in the rest of decapods, the intermolt duration of P. argentinus is modified by ovarian maturation.

Estrutura populacional de Uca maracoani (Decapoda, Brachyura, Ocypodidae) no Baixio Mirim, Baía de Guaratuba, Paraná

Um estudo sobre a flutuação anual da abundância, composição de tamanho dos indivíduos, proporção de sexos, período reprodutivo e de recrutamento dos juvenis de uma população de Uca maracoani (Latreille, 1802-1803) foi realizado no Baixio Mirim, Baía de Guaratuba, Paraná (48º36'W e 25º52'S). Os animais foram coletados mensalmente, de fevereiro/2005 a janeiro/2006, durante as marés baixas de sizígia, e a sua largura da carapaça (LC) medida. A temperatura pontual do ar variou de 17 a 29ºC, a luminosidade de 8.740 a 151.300 lux, a salinidade de 8 a 25 e a temperatura do solo (superfície, 5 cm, 10 cm, 15 cm e 20 cm de profundidade) de 18,3 a 28,9ºC. Foram analisados 7.120 indivíduos, dos quais, 2.578 juvenis sexualmente indefinidos, 2.377 machos e 2.165 fêmeas. A abundância da população variou de 341 (abril) a 994 indivíduos (janeiro), mas a sua flutuação anual não esteve relacionada com a das variáveis abióticas estudadas. A proporção de sexos foi de 1:1 e a reprodução da espécie é do tipo contínuo, com dois picos de intensidade: um em abril e outro em novembro. O recrutamento de juvenis, também, é contínuo com dois períodos mais intensos no ano, um em julho e outro em dezembro-janeiro. A LC da população variou de 1,14 a 2,62 mm para juvenis sexualmente indefinidos, 2,58 a 17,83 mm para machos juvenis, 2,60 a 11,72 mm para fêmeas juvenis, 17,85 a 35,81 mm para machos maduros e 11,75 a 31,76 mm para fêmeas maduras. Os machos atingem tamanhos maiores do que as fêmeas.

Contribuição para o conhecimento das doenças do grupo tifo exantemático no Brasil

In this work, the author considers that in Brazil, there exist three forms of the disease of the Exanthematic Typhus group, that have been well studied: Neotropic Exanthematic Typhus, Murine Typhus and "Q" fever. The first of these forms has existed in this country, perhaps, for over five hundred years. He says that modern antibiotic, Aureomycin, Chloromycetin and, principally, Terramcin have resolved the problem of the therapeutic treatment of the disease. The modern insecticides, D. D. T., Gammexane and Toxafeno have resolved the prophylactic problem. The author studies minutely the question of denomination, showing, by means of drawing and history, the origin of the diseases, both Norte American and Brazilian. The name Neotropic Exanthematic Typhus (in BRazil, Colombia, United States or India) should substitute the erroneous anme "Spotted Fever"; the disease is exanthematic, a very different thing. He formulates two hypotheses about these diseases: first - it passed from the neotropic to the neartic region, where it acquired individual properties; second - they developed independently in a more rmeote epoch, acquiring each its own characteristics. The disease is today rather of the neotropic than of the neartic region. As it also exists in India it cannot be named American exanthematic Typhus. The author finds it unnecessary to change the name to "Rikettsioses"; we do not call bacillar dysentery "Schigeloses"or malignant edema "Chlostridiose". The name exanthematic typhus is classic, precise, scientific, expressive and the denomination "neotropical" completes the localisation. The author thinks that all the diseases of the exanthematic typhus group, in the world had a simple primitive common origin. At first, the rickettsias or the virus had a free life, perhaps in the waters of the marshes or grass-lands. Later, in the struggle for life, came the parasitism of the plants. They became fitoparatifs. The mode of life...

Sôbre alguns Phlebotomus e Brumptomyia da Colômbia (Diptera, Psychodidae)

The first case of Kala-azar in Colombia was discovered in Soledad, S. Vicente do Chucuri, Dept. Santander, by Gast-Galvis who viscerotomized a three year old girl deceased in December, 1943. In 1944, fifty-three Phlebotominae were collected in the chicken pen of the girl's house, two new species included. Mangabeira helped by A. Gast Galvis, Juan Antonio Montoya and E. Osorno Mesa, collected some Phlebotomus in that country. The geographical distribution of the species of Phlebotomus collected in Colombia (P. abonnenci, P. camposi, P. columbianus, P. dubitans, P. gasti, P. montoyai, P. saulensis, P. serranus, P. triramulus) and two species of Brumptomyia (B. beaupertuyi and b mesari), are included. our description of the male P. columbianus is based on some specimens found in association with females. However, doubts exist about such association of sexes. There is no correspondence between the length of the spicules and the ducts of spermathecae. Besides, the specimens were not obtained by raising. The following new species are described and compared with previously known ones: a) Phlebotomus gasti sp. n. differs from the other species by a protruding tubercle in the gubernaculum. It has also fewer setae in the tuft of the basistyle, a different length of the inferior gonapophyses, and a differently shaped clasper. b) Phlebotomus dubitans sp. n. differs from P. walkeri and P. deanei (according to personal information from O. Theodor, who examined the types, they are identical to P. williamsi and P. sericeus respectively), mainly because these species have the inferior gonapophyses larger than the basistyle and fewer setae in the basistyle. P. evandroi is separated by the shape of the claspers and by the tuft of setae of the basistyle. P. marajoensis is the closest relative to P. dubitans. There is a possibility of their being synonymous. On the other hand, they can be differentiated by the existence of three extra distal spines in P. marajoensis. There is also a difference in their palpal indexes: for marajoensis I - II - IV - III - V, and for dubitans I - IV (III - II) - V. We notice, too, that the inferior gonapophyses in P. marajoensis is a little shorter. P. marajoensis has a long seta in the basistyle (clearly shown in the original drawing), not found in the new species. c) Phlebotomus montoyai sp. n.: The closest relatives are P. noguchii, P. peruensis, P. pescei, P. quinquifer and P. rickardi. They differ from the new species by the number and length of the setae of the basistyle tuft which are more numerous and longer in the new species. The shapes of their claspers are also different. Other differences are: the basal portion of the basistyle in P. noguchii is very wide (in montoyai it is narrower); the intermediate spine of the dististyle is located on a protruding tubercle ( in the new species there is hardly a tubercle); the spicules are long, and the inferior gonapophyses is longer than the basistyle. P. quinquifer and P. rickardi have a shorter dististyle and narrower wings, with different venation. The main difference, however lies, in the M4, which ends almost at the level of the junction of M1 with M2 (in P. montoyai the M4 ends far behind). In P. peruensis and P. pescei the intermediary spine of the dististyle is closer to the distal spine than to the basal one, whereas in the new species it is situated between the two pairs. Their inferior gonapophyses is longer than the basistyle. d) Brumptomyia mesai sp. n. - Closest relatives are: B. hamatus, B. pentacanthus, B. beaupertuyi which are easily separated from the new species because the tufts of their basistyle have thin and differently shaped hairs. Also their claspers are shaped differently. B. avellari is also easily recognized on account of the twisted aspect of its clasper and because the basal tuft of the basistyle has few setae, B. brumpti tuft of setae arise directly from the basistyle; these setae are stronger than those of the new species. It has 8 blade-like setae located on the inner surface of the distal half, whereas the new species has only six setae. In B. brumpti, there are three median and two terminal spines in the dististyle; in the new species, there are two median and two terminal spines and one between them, which is closer to the two median spines. The comparison with B. galindoi is based in a specimen determined by Fairchild and deposited in the entomological collection of the "Faculdade de Higiene e Saúde Pública da Universidade de S. Paulo". The genitalia of the new species is much shorter, in galindoi the inferior gonapophyses is 0,8 mm long whereas in B. mesai it hardly reaches 0,6 mm. The shape of the clasper and the distribution of its setae are different. The sub-median lamellae, besides being longer in B. galindoi are also longer in comparison with the other parts of the genitalia. The gubernaculum of the new species is longer, thinner, and more pointed; in B. galindoi it is shorter and triangular. In the drawing published by Fairchild and Hertig 91947), the basistyle shows 8 blade-like setae on the distal half, whereas in the new species only six are found.

A morphological, isoenzymatic and behavioural study of ten populations of Anopheles(Nyssorhynchus) albitarsis Lynch-Arribalzaga, 1878 (Diptera: culicidae) including from the type-locality - Baradero, Argentina

Anopheles (Nyssorhynchus) albitarsis Lynch-Arribalzaga, 1878 shows morphological and behavioural variations which results in it being sometimes considered as a major malaria vector and at other times as playing no important role in epidemiology. With the aim of clarifying the taxonomy of the species, comparative morphological and isoenzymatic studies were made in populations from the type-locality, Baradero, Argentina and from 9 different localities inBrazil. Morphological studies consisted of the observation of eggs in scanning electron microscopy, of complete chaetotaxy of larvae and pupae and of the detailed drawing of male and female adults. Only Guajara-Mirim and Rio Branco populations, described previously as Anopheles deaneorum sp.n., showed morphological differences. Isoenzymes were studied using 4th instar larvae homogenate and agarosegel electrophoresis. Eleven enzymatic loci were analyzed. By calculation of Nei's Genetic Distance (D), the populations could be separated into 5 groups: i)Baradero, ii)Marajo, iii)Boa Vista, iv)Angra, Itaguai and Paraipaba and v)Guajara-Mirim and Rio Branco. These groups belong to 2 major clusters called I and II, separated by D = 0.345. In the I cluster are groups i, ii and iii and in II clusteriv and v. In I, D=0.246 separates i and ii from iii, while i is separated by D =0.181 from ii. In II, D = 0.223 between iv and v. Only the population of group vcould be distinguished morphologically from the others, leading to the description of an independent species An. deaneorum.

New approaches for the control and eradication of schistosomiasis in Venezuela

Schistosomiasis in Americawith the exception of Brazil, behaves as a chronic mild disease with few clinical manifestations due to low parasite burden. These features restrict the clinical and parasitological diagnosis. The most commonly used stool examination method, Kato-Katz, becomes intensitive when the majority of individuals excrete less than 100 eggs/g of feces. In view that antigen-detecting techniques have not been able to reveal light infections, the antibody detecting assays remain as a very valuable diagnostic tool for epidemiological surveillance. The Venezuelan Schistosomiasis Research group (CECOICE) has designed a mass chemotherapy strategy based on sero-diagnosis. Since blood sampling is one of the important limitating factors for large seroepidemiological trials we developed a simple capillary technique that sucessfully overcomed most of the limitations of blood drawing. In this sense, ELISA seems to be the most adecuate test for epidemiological studies. Soluble egg Schistosoma mansoni antigen (SEA) has been largely used in Venezuela. The sensitivity ELISA-SEA in our hands is 90% moreover its specific reach 92% when populations from non-endemic areas but heavily infected with other intestinal parasites are analyzed. The Schistosomiasis Control Program is currently carrying out the surveillance of endemic areas using ELISA-SEA as the first screening method, followed by the Circumoval Precipitin test for validation assay. The results with these two serological techniques allowed us to defined the criteria of chemotherapy in populations of the endemic areas. On the search of better diagnostic technique, Alkaline Phosphatase Immunoenzyme Assay (APIA) is being evaluated in field surveys.

Morphological Aspects of the Larval Instars of Chrysomya albiceps (Diptera, Calliphoridae) Reared in the Laboratory

In order to study the morphology of young Chrysomya albiceps forms, newly hatched larvae were collected at 2 hr intervals, during the first 56 hr; after this time the collection was made at 12 hr intervals. For identification and drawing, larvae were placed between a slide and a coverslip. The cephalopharyngeal skeletons along with the first and last segments were cut off for observation of their structures and spiracles. The larvae present microspines, which are distributed randomly throughout the 12 segments of the body surface; the cephalopharyngeal skeleton varies in shape and extent of sclerotization according to larval instar; the second and third instars have relatively long processes (tubercles) on the dorsal, lateral and ventral surfaces, with microspine circles on the terminal portion

Multicenter study on the immunogenicity and safety of two recombinant vaccines against hepatitis B

The immunogenicity and safety of a new recombinant hepatitis B vaccine from the Instituto Butantan (Butang®) were evaluated in a multicenter, double-blind, prospective equivalence study in three centers in Brazil. Engerix B® was the standard vaccine. A total of 3937 subjects were recruited and 2754 (70%) met all protocol criteria at the end of the study. All the subjects were considered healthy and denied having received hepatitis B vaccine before the study. Study subjects who adhered to the protocol were newborn infants (566), children 1 to 10 years old (484), adolescents from 11 to 19 years (740), adults from 20 to 30 years (568), and adults from 31 to 40 years (396). Vaccine was administered in three doses on the schedule 0, 1, and 6 months (newborn infants, adolescents, and adults) or 0, 1, and 7 months (children). Vaccine dose was intramuscular 10 µg (infants, children, and adolescents) or 20 µg (adults). Percent seroprotection (assumed when anti-HBs titers were > 10mIU/ml) and geometric mean titer (mIU/ml) were: newborn infants, 93.7% and 351.1 (Butang®) and 97.5% and 1530.6 (Engerix B®); children, 100% and 3600.0 (Butang®) and 97.7% and 2753.1 (Engerix B®); adolescents, 95.1% and 746.3 (Butang®) and 96% and 1284.3 (Engerix B®); adults 20-30 years old, 91.8% and 453.5 (Butang®) and 95.5% and 1369.0 (Engerix B®); and adults 31-40 years old, 79.8% and 122.7 (Butang®) and 92.4% and 686.2 (Engerix B®). There were no severe adverse events following either vaccine. The study concluded that Butang® was equivalent to Engerix B® in children, and less immunogenic but acceptable for use in newborn infants, adolescents, and young adults.

Genetic polymorphism of the serine rich antigen N-terminal region in Plasmodium falciparum field isolates from Brazil

In this work we investigated the frequency of polymorphism in exon II of the gene encoding most of the amino-terminal region of the serine rich antigen (SERA) in Plasmodium falciparum field samples. The blood samples were colleted from P. falciparum infected individuals in three areas of the Brazilian Amazon. Two fragments have been characterized by polymerase chain reaction: one of 175 bp corresponding to the repeat region with 5 octamer units and one other of 199 bp related to the 6 repeat octamer units of SERA protein. The 199 bp fragment was the predominant one in all the studied areas. The higher frequency of this fragment has not been described before and could be explained by an immunological selection of the plasmodial population in the infected individuals under study. Since repeat motifs in the amino-terminal region of SERA contain epitopes recognized by parasite-inhibitor antibodies, data reported here suggest that the analysis of the polymorphism of P. falciparum isolates in different geographical areas is a preliminary stage before the final drawing of an universal vaccine against malaria can be reached.

Non-formal education for schistosomiasis prevention: the experience of the Museu Arqueológico de Central, Bahia, Brazil

The activities described here form part of an extensive programme in place in the Região Arqueológica de Central, state of Bahia, Brazil. After malacological and socio-environmental surveys in the area, a strategy comprising formal and non-formal education with an emphasis on schistosomiasis prevention was developed, introduced, and evaluated. Interviews were conducted of 142 students and 11 teachers, totalling 11 classes at six primary schools. On the basis of those interviews, four display cases and seven panels were prepared. In addition a table was set up where students could participate directly on the subject, drawing and recognising the factors involved in the schistosomiasis cycle. The exhibition was held at the Museu Arqueológico de Central. The endeavours of this paper underline the importance of health education as well as exhibitions to disease prevention activities.

Protein tyrosine kinases in Schistosoma mansoni

The identification and description of signal transduction molecules and mechanisms are essential to elucidate Schistosoma mansoni host-parasite interactions and parasite biology. This mini review focuses on recent advancements in the study of signalling molecules and transduction mechanisms in S. mansoni, drawing special attention to the recently identified and characterised protein tyrosine kinases of S. mansoni.