Plasmodium vivax malaria: related factors to severity in the State of Maranhão, Brazil

INTRODUCTION: Malaria caused by Plasmodium vivax species has shown signs of severity, recorded with increasing frequency in the medical literature. This study aimed to characterize the signs of severe malaria by Plasmodium vivax in the State of Maranhão, Brazil. METHODS: A descriptive cohort study of patients assisted in the field and a historical and concurrent study of a series of cases among hospitalized patients were undertaken to identify the clinical and laboratory signs of severity. RESULTS: A total of 153 patients were included in the study, 13 of whom were hospitalized. Males made up the majority, numbering 103 (67.3%). The age of the patients ranged from 10 to 70 years, 92.2% were natives of the State of Maranhão, and 65% of the patients had had malaria before. The average time elapsed between symptom onset and diagnosis among outpatients was three days, while among hospitalized patients this average reached 15.5 days, a statistically significant difference (p=0.001). The parasitemia ranged from 500 to 10,000 parasites/µl in 92.8% of cases. The clinical and laboratory manifestations of severity were vomiting and diarrhea, jaundice, drowsiness, mental confusion, seizures, loss of consciousness, agitation, bleeding, pale skin, coughing and dyspnea, thrombocytopenia, anemia, elevation of nitrogenous compounds, and elevated transaminases and bilirubin. CONCLUSIONS: The monitoring of malaria patients with Plasmodium vivax showed the possibility of aggravation, the intensity of which varied in different circumstances, especially the interval time between falling ill and diagnostic confirmation.

Reflux esophagitis and gastroesophageal reflux disease: a cross-sectional study of gastroesophageal reflux disease patients by age group

The purpose of this study was to explore the relationship between the intensity of acid reflux and severity of esophageal tissue damage in a cross-sectional study of patients with gastroesophageal reflux disease (GERD). Seventy-eight patients with were selected in accordance with the strict 24-hour ambulatory esophageal pHmetry (24h-pHM) criteria and distributed into three age groups: Group A: 14 - 24 years of age. Group B: 25 - 54; and Group C: 55 - 64. The 24h-pHM was carried out in accordance with DeMeester standardization, and the Savary-Miller classification for the diagnosis of reflux esophagitis was used. The groups were similar in 24h-pHM parameters (p > 0.05), having above normal values. For the study group as a whole, there was no correlation between age group and intensity of acid reflux, and there was no correlation between intensity of acid reflux and severity of esophageal tissue damage. However, when the same patients were sub-grouped in accordance with the depth of their epithelial injury and then distributed into age groups, there was a significant difference in esophagitis without epithelial discontinuity. Younger patients had less epithelial damage than older patients. Additionally, although there was a significant progression from the least severe to the moderate stages of epithelial damage among the age groups, there was no apparent difference among the age groups in the distribution between the moderate stages and most severe stages. The findings support the conclusion that the protective response of individuals to acid reflux varies widely. Continued aggression by acid reflux appears to lead to the exhaustion of individual mechanisms of epithelial protection in some patients, but not others, regardless of age or duration of the disease. Therefore, the diagnosis and follow-up of GERD should include both measurements of the quantity of refluxed acid and an assessment of the damage to the esophageal epithelium.

Breastfeeding: making the difference in the development, health and nutrition of term and preterm newborns

Breastfeeding is the natural and safe way of feeding small infants, providing nutritional, immunological, psychological and economic recognized and unquestionable advantages. These qualities are especially important in premature infants, because of their vulnerability. Despite highly desirable, there is, in general, little success in breastfeeding preterm infants, especially in special care neonatal units. There are evidences that a high supportive hospital environment, with an interdisciplinary team, makes possible to these infants to be breastfed. In this article, the authors present an up-to-date review about the components of human milk and its unique characteristics, as well as describes aspects that make the breast milk particularly suitable for feeding the premature newborn.

Difference in the in-hospital mortality of unstable angina pectoris between men and women

PURPOSE: To assess differences in the in-hospital mortality (HM) rate between men and women with unstable angina pectoris (UA) according to age, depression of the ST segment, history of previous acute myocardial infarction (AMI), and risk factors for coronary heart disease. METHODS: From October 96 to March 98, 261 patients with UA were selected. Logistic regression models were developed to adjust the association between sex and HM for possible influence of covariables, such as hypertension, diabetes mellitus, dyslipidemia, sedentary lifestyle, smoking, and familial history of early coronary heart disease. RESULTS: HM due to UA was approximately three times higher in women (9.3%; 12/129) than in men (3.0%; 4/132) accounting for a relative risk of 3.07; 95% confidence interval (CI) =1.02-9.27. In logistic regression models, the association between sex and death was not significantly altered when the following parameters were considered: age, depression of the ST segment, history of previous AMI and risk factors for coronary heart disease. The nonadjusted and adjusted odds ratio (OR) for the distinct covariables were 3.28 (CI 95%=1.03-10.45) and 3.14 (CI = 95% = 0.88-11.20), respectively. CONCLUSION: Similarly to AMI, HM in UA is higher in women than in men. Age, risk factors for coronary heart disease, and depression of the ST segment in the electrocardiogram on patients' admission to the hospital did not significantly influence the association between sex and death.

Proposal Intensity Adequacy of Expiratory Effort and Heart Rate Behavior During the Valsalva Maneuver in Preadolescents

Background: When performing the Valsalva maneuver (VM), adults and preadolescents produce the same expiratory resistance values. Objective: To analyze heart rate (HR) in preadolescents performing VM, and propose a new method for selecting expiratory resistance. Method: The maximal expiratory pressure (MEP) was measured in 45 sedentary children aged 9-12 years who subsequently performed VM for 20 s using an expiratory pressure of 60%, 70%, or 80% of MEP. HR was measured before, during, and after VM. These procedures were repeated 30 days later, and the data collected in the sessions (E1, E2) were analyzed and compared in periods before, during (0-10 and 10-20 s), and after VM using nonparametric tests. Results: All 45 participants adequately performed VM in E1 and E2 at 60% of MEP. However, only 38 (84.4%) and 25 (55.5%) of the participants performed the maneuver at 70% and 80% of MEP, respectively. The HR delta measured during 0-10 s and 10-20 s significantly increased as the expiratory effort increased, indicating an effective cardiac autonomic response during VM. However, our findings suggest the VM should not be performed at these intensities. Conclusion: HR increased with all effort intensities tested during VM. However, 60% of MEP was the only level of expiratory resistance that all participants could use to perform VM. Therefore, 60% of MEP may be the optimal expiratory resistance that should be used in clinical practice.

Effects of One Resistance Exercise Session on Vascular Smooth Muscle of Hypertensive Rats

AbstractBackground:Hypertension is a public health problem and increases the incidence of cardiovascular diseases.Objective:To evaluate the effects of a resistance exercise session on the contractile and relaxing mechanisms of vascular smooth muscle in mesenteric arteries of NG-nitro L-arginine methyl ester (L-NAME)-induced hypertensive rats.Methods:Wistar rats were divided into three groups: control (C), hypertensive (H), and exercised hypertensive (EH). Hypertension was induced by administration of 20 mg/kg of L-NAME for 7 days prior to experimental protocols. The resistance exercise protocol consisted of 10 sets of 10 repetitions and intensity of 40% of one repetition maximum. The reactivity of vascular smooth muscle was evaluated by concentration‑response curves to phenylephrine (PHEN), potassium chloride (KCl) and sodium nitroprusside (SNP).Results:Rats treated with L-NAME showed an increase (p < 0.001) in systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) compared to the initial period of induction. No difference in PHEN sensitivity was observed between groups H and EH. Acute resistance exercise reduced (p < 0.001) the contractile response induced by KCl at concentrations of 40 and 60 mM in group EH. Greater (p < 0.01) smooth muscle sensitivity to NPS was observed in group EH as compared to group H.Conclusion:One resistance exercise session reduces the contractile response induced by KCl in addition to increasing the sensitivity of smooth muscle to NO in mesenteric arteries of hypertensive rats.

Competição entre megaspórios em milho

The experiments reported were started as early as 1933, when indications were found in class material that the factor for small pollen, spl, causes not only differences in the size of pollen grains and in the growth of pollen tubes, but also a competition between megaspores, as first observed by RENNER (1921) in Oenothera. Dr. P. C. MANGELSDORF, who had kindly furnished the original seeds, was informed and the final publication delayed untill his publication in 1940. A further delay was caused by other circunstances. The main reason for the differences of the results obtained by SINGLETON and MANGELSDORF (1940) and those reported here, seems to be the way the material was analysed. I applied methods of a detailed statistical analysis, while MANGELSDORF and SINGLETON analysed pooled data. 1) The data obtained on pollen tube competition indicate .that there is about 3-4% of crossing-over between the su and sp factors in chromosome IV. The elimination is not always complete, but from 0 to 10% of the sp pollen tubes may function, instead of the 50% expected without elimination. These results are, as a whole, in accordance with SINGLETON and MANGELSDORF's data. 2) Female elimination is weaker and transmission determined as between 16 to 49,5%, instead of 50% without competition, the values being calculated by a special formula. 3) The variability of female elimination is partially genotypical, partially phenotypical. The former was shown by the difference in the behavior of the two progenies tested, while the latter was very evident when comparing the upper and lower halves of ears. For some unknown physiological reason, the elimination is generally stronger in the upper than in the lower half of the ear. 4) The female elimination of the sp gene may be caused theoretically, by either of two processes: a simple lethal effect in the female gametophyte or a competition between megaspores. The former would lead not only to the abortion of the individual megaspores, but of the whole uniovulate ovary. In the case of the latter, the abortive megaspore carrying the gene sp will be substituted in each ovule by one of the Sp megaspores and no abortion of ovaries may be observed. My observations are completely in favor of the second explication: a) The ears were as a whole very well filled except for a few incomplete ears which always appear in artificial pollinations. b) Row arrangement was always very regular. c) The number of kernels on ears with elimination is not smaller than in normal ears, but is incidentally higher : with elimnation, in back-crosses 354 kernels and in selfed ears 390 kernels, without elimination 310 kernels per ear. d) There is no correlation between the intensity of elimination and the number of grains in individual ears; the coefficient; of linear correlation, equal to 0,24, is small and insignificant. e) Our results are in complete disagreement whit those reported by SINGLETON and MANGELSDORF (1940). Since these authors present only pooled date, a complete and detailed analysis which may explain the cause of these divergences is impossible.

Helminths of introduced house sparrows (Passer domesticus) in Brazil: does population age affect parasite richness?

Species introductions have altered host and parasite diversity throughout the world. In the case of introduced hosts, population age appears to be a good predictor of parasite richness. Habitat alteration is another variable that may impact host-parasite interactions by affecting the availability of intermediate hosts. The house sparrow (Passer domesticus (Linnaeus, 1758)) is a good model to test these predictions. It was introduced in several parts of the world and can be found across rural-urban gradients. A total of 160 house sparrows from Porto Alegre, state of Rio Grande do Sul, Brazil, were necropsied. Thirty house sparrows (19 %) were parasitized with at least one out of five helminth species (Digenea: Tamerlania inopina Freitas, 1951 and Eumegacetes sp.; Eucestoda: Choanotaenia passerina (Fuhrmann, 1907) Fuhrmann, 1932; Nematoda: Dispharynx nasuta (Rudolphi, 1819) Stiles & Hassall, 1920 and Cardiofilaria pavlovskyi Strom, 1937). Overall, there was no difference in prevalence and intensity of infection of any parasite species, parasite richness and community diversity between adult males and females and adults and juveniles. The number of infected sparrows among seasons, the richness of helminths and the abundance of species were also similar between rural and urban landscapes. Only the prevalence of C. passerina varied seasonally (p=0.0007). A decrease in the number of parasite species from the original range of P. domesticus (13) to its port of entrance in Brazil, the city of Rio de Janeiro (nine), to Porto Alegre (five) is compatible with the hypothesis that host population age is a good predictor of parasite richness.

Comparative allometry growth of some marine fish digenetic trematodes

Allometric growth variation was compared for Plagioporus idoneus, Lepocreadium pegorchis, Opecoeloides furcatus, Bacciger israelensis, Aphanurus stossichi and Parahurleytrema trachinoti collected from East Mediterranean fishes. The pharynx, the oral and the ventral sucker diameters always showed a negative allometry. The other parameters tested were variable with the species. We study the effects of some environmental factors: the influence of the host species is analysed in Plagioporus idoneous, wich parasitizes Oblada melanura, Diplodus sargus and D. vulgaris and in Lepocreadium pegorchis, wich parasitizes Pagellus erythrinus, Lithognathus mormyrus and Spicara smaris; the influence of the microhabitat and the intensity of infection is analysed in Bacciger israelensis and Aphanurus stossichi, both parasites of Boops boops. We report significant differences with the host species, for the allometric growth of the testes; the effect of the microhabitat was revealed by the hindbody allometric value; no significant difference was detected in relation with the intensity of infection.

Difference in susceptibility to lysis between clones of the Y strain of Trypanosoma cruzi

Three clones isolated from the Y strain of Trypanosoma cruzi - YP1, YP2 and YP3 - were adapted to in vitro cultivation in VERO cells. The recovery of the parasites from the Y strain and clone YP3 was similar after 24 hr of contact with cells (3.2% and 2.7%, respectively) and much lower than the recovery of clones YP1 and YP2 (56.7% and 60.0% of inoculum, respectively). After five days incubation, the ratio Trypomastigotes/Amastigotes released into the supernatants was about 90/10 for clone YP1, YP3 and Y strain, and 50/50 for clone YP2. After nine days, the ratio was 62/38 for clone YP1, 97/3 for clone YP3, 81/19 for Y strain and 50/50 for clone YP2. The susceptibility of tissue culture derived trypomastigotes (TCT) to lysis in the presence of chronic chagasic human sera and human complement was assessed using Complement Mediated Lysis reaction (CML). Trypomastigotes from clone YP2 were consistently less susceptible to CML (% lysis less than 20), than parasites from the other clones and Y strain. Parasites of clone YP3 had susceptibility to CML comparable to that of the Y strain (about 70%), while TCT of clone YP1 had intermediary susceptibility (40%).

The use and limitations of ultrasonography in the diagnosis of liver morbidity attributable to Schistosoma mansoni infection in community-based surveys

The objective of this population-based study was to estimate the liver morbidity attributable to Schistosoma mansoni infection by ultrasonography adopting the proposed standard protocols of the Cairo Meeting on Ultrasonography, 1991. We examined 2384 individuals representing 20 of the households of the rural population of the Ismailia Governorate, East of Delta, Egypt. Prevalence of S. mansoni and S. haematobium infections were 40.3 and 1.7 respectively. Portal tract thickening (PTT) grade 1, 2 and 3 considered diagnostic of schistosomal liver morbidity was detected in 35.1, 1.3 and 0.2 individuals respectively. Generally, ultrasonographically-detected pathological changes increased with age, but correlated with intensity of infection only in age group 20-59 years. Comparing individuals with and without S. mansoni infections in an endemic and a non-endemic community indicated no significant difference between the former and the latter in either case. In conclusion: ultrasonography had a limited value in estimating schistosomal liver morbidity in our population-based study where early grades of liver morbidly were prevalent. The criteria of diagnosing grade I portal fibrosis need to be revised as well as the staging system proposed by the Cairo Meeting on ultrasonography in schistosomiasis.

An ocellar "pupil" that does not change with light intensity, but with the insect age in Triatoma infestans

The simple eyes (ocelli) of recently emerged adult Triatoma infestans exhibit a narrow elongated "pupil", surrounded by a ring of brown-reddish pigment, the "iris". This pupil does not respond to changes in the illumination, but varies in size after the imaginal ecdysis. This change corresponds, internally, with the growth of the corneal lens and the associated retina up to an age of about 20 days. This has not been previously observed in an insect. The use of this characteristic for recognising young adults of this species is suggested.

Prevalence and intensity of Haemoproteus columbae in three species of wild doves from Brazil

The prevalence and intensity of blood parasites in three species of wild doves were studied in the municipality of Junqueirópolis, in the western region of the State of São Paulo, Brazil. Three species of doves were surveyed: 331 specimens of Zenaida auriculata Des Murs, 1847, 62 specimens of Columbina talpacoti Temminck, 1811 and 57 specimens of Scardafella squammata Lesson, 1831. Haemoproteus columbae Kruse, 1890 was found in blood from all the doves species. The prevalence of this parasite was 100% in Z. auriculata, 51.6% in C. talpacoti and 19.3% in S. squammata. Specimens of Z. auriculata had a higher intensity of infection than the other doves species.

Prevalence and intensity of infections of Ascaris lumbricoides and Trichuris trichiura and associated socio-demographic variables in four rural Honduran communities

Between January and March 1998, a cross-sectional survey was carried out in four rural communities in Honduras, Central America. We examined the prevalence and intensity of Ascaris lumbricoides and Trichuris trichiura infections among 240 fecal specimens, and the association between selected socio-demographic variables and infection for 62 households. The overall prevalence of A. lumbricoides and T. trichiura was 45% (95% CI 39.0-51.9) and 38% (95% CI 31.8-44.4) respectively. The most intense infections for Ascaris and Trichuris were found in children aged 2-12 years old. By univariate analysis variables associated with infections of A. lumbricoides were: number of children 2-5 years old (p=0.001), level of formal education of respondents (p=0.01), reported site of defecation of children in households (p=0.02), households with children who had a recent history of diarrhea (p=0.002), and the location of households (p=0.03). Variables associated with both A. lumbricoides and T. trichiura infection included: number of children 6-14 years old (p=0.01, p=0.04, respectively), ownership of a latrine (p=0.04, p=0.03, respectively) and coinfection with either helminth (p=0.001, p=0.001, respectively). By multivariate analysis the number of children 2-5 years living in the household, (p=0.01, odds ratio (OR)=22.2), children with a recent history of diarrhea (p=0.0, OR=39.8), and infection of household members with T. trichiura (p=0.02, OR=16.0) were associated with A. lumbricoides infection. The number of children 6-14 years old in the household was associated with both A. lumbricoides and T. trichiura infection (p=0.04, p=0.01, OR=19.2, OR=5.2, respectively).

Evaluation of the acarofauna of the domiciliary ecosystem in Juiz de Fora, State of Minas Gerais, Brazil

From August 1999 to January 2000, samples of house dust were collected from 160 domiciles in the city of Juiz de Fora, State of Minas Gerais, Brazil. In 36 of these domiciles kitchen samples were obtained. Prevalence rate was 77.5%, varying according to the geographical sector. There were found 2,278 specimens of mites, with 1,530 (67.2%) in the adult stage and 748 (32.8%) in immature forms. The main species found were Dermatophagoides pteronyssinus, D. farinae, Euroglyphus maynei, Blomia tropicalis and Tyrophagus putrescentiae. In a minor incidence we found Lepidoglyphus destructor, Suidasia pontificiae, Chortoglyphus arcuatus, Cheyletus malaccensis, C. fortis, Ker bakeri, Cheletonella vespertilionis, C. caucasica and others. C. vespertilionis and C. caucasica were identified for the first time in the domiciliary ecosystem and in Brazil. The abundance rate and the infestation intensity were analyzed. There was a varied correlation between climatic conditions and positive domiciles and number of mites. The difference between the number of positive domiciles in the urban area and in the expanding urban area was significant and so was the difference between samples from the domiciles compared to those from the kitchens.