Critical analysis of the allocation policy for liver transplantation in Brazil

Liver transplantation is now the standard treatment for end-stage liver disease. Given the shortage of liver donors and the progressively higher number of patients waiting for transplantation, improvements in patient selection and optimization of timing for transplantation are needed. Several solutions have been suggested, including increasing the donor pool; a fair policy for allocation, not permitting variables such as age, gender, and race, or third-party payer status to play any role; and knowledge of the natural history of each liver disease for which transplantation is offered. To observe ethical rules and distributive justice (guarantee to every citizen the same opportunity to get an organ), the "sickest first" policy must be used. Studies have demonstrated that death has no relationship with waiting time, but rather with the severity of liver disease at the time of inclusion. Thus, waiting time is no longer part of the United Network for Organ Sharing distribution criteria. Waiting time only differentiates between equally severely diseased patients. The authors have analyzed the waiting list mortality and 1-year survival for patients of the State of São Paulo, from July 1997 through January 2001. Only the chronological criterion was used. According to "Secretaria de Estado da Saúde de São Paulo" data, among all waiting list deaths, 82.2% occurred within the first year, and 37.6% within the first 3 months following inclusion. The allocation of livers based on waiting time is neither fair nor ethical, impairs distributive justice and human rights, and does not occur in any other part of the world.

Anatomic study of the dorsal arterial system of the hand

Historically, the dorsal arterial system of the hand received less attention than the palmar system. The studies concerning dorsal arterial anatomy present some controversies regarding the origin and presence of the dorsal metacarpal artery branches. Knowledge of the anatomy of dorsal metacarpal arteries is especially applied in the surgical planning for flaps taken from the dorsum of the hand. The purpose of this study is to analyze the arterial anatomy of the dorsum of the hand, compare our observations with those of previous studies from the literature, and therefore to define parameters for surgical planning for flaps supplied by the dorsal metacarpal arteries. METHOD: Twenty-six dissections were performed at the dorsum of the right hand of 26 cadavers by making a distal-based U-shaped incision. After catheterization of the radial artery at the wrist level, a plastic dye solution with low viscosity and quick solidification was injected to allow adequate exposure of even small vessels. The radial artery and its branches, the dorsal arterial arch, the dorsal metacarpal arteries, the distal and proximal communicating branches of the palmar system, and the distal cutaneous branches were carefully dissected and identified. RESULTS: The distal cutaneous branches originating from the dorsal metacarpal arteries were observed in all cases; these were located an average of 1.2 cm proximal from the metacarpophalangeal joint. The first dorsal metacarpal artery presented in 3 different patterns regarding its course: fascial, subfascial, and mixed. The branching pattern of the radial artery at the first intermetacarpal space was its division into 3 branches. We observed the presence of the dorsal arterial arch arising from the radial artery in 100% of the cases. The distance between the dorsal arterial arch and the branching point of the radial artery was an average of 2 cm. The first and second dorsal metacarpal arteries were visualized in all cases. The third and fourth dorsal metacarpal arteries were visualized in 96.2% and 92.3% of cases, respectively. There was proximal and distal communication between the dorsal arterial arch and the palmar system through the communicating branches contributing to the dorsal metacarpal artery formation. CONCLUSION: At the dorsum of the hand there is a rich arterial net that anastomoses with the palmar arterial system. This anatomical characteristic allows the utilization of the dorsal aspect of the hand as potential donor site for cutaneous flaps.

Myxomycetes collection preserved in the herbarium of the Federal University of Roraima (Brazil)

First records of myxomycetes in the North region of Brazil go back to the 19th century. Nevertheless, the myxobiota of this region is still largely unexplored, with only 42 species recorded, distributed in 20 genera and seven families. The objectives of this paper were to characterize the Myxomycetes collection of the Herbarium of the Federal University of Roraima (UFRR) and to add new records for the myxobiota of this State. The collection holds specimens collected in fragments of Open Ombrophilous Forest, Seasonal Semi-deciduous Forest, Riparian Forest, deforested areas and urban home gardens in the state of Roraima. The 157 exsiccates were analyzed and identified or redetermined based on identification keys, descriptions and illustrations. The collection is in good conditions of preservation and includes all subclasses of Myxomycetes, 83% of its orders, 50% of its families, and 20 species. Trichiales, with one family, three genera and six species, represents 62% of all exsiccates. Cribraria aff. splendens, Metatrichia vesparia, Physarella oblonga, Stemonaria longa and Stemonitis splendens are new records for Roraima and Arcyria obvelata, Comatricha pulchella, Stemonitis pallida and Stemonitopsis aequalis are referred for the first time in the Northern Region, enlarging the knowledge of the Brazilian geographic distribution of these species.

Plasmodium falciparum proteinases: cloning of the putative gene coding for the merozoite proteinase for erythrocyte invasion (MPEI) and determination of hydrolysis sites of spectrin by Pf37 proteinase

Numerous proteinase activities have been shown to be essential for the survival of Plasmodium falciparum. One approach to antimalarial chemotherapy, would be to block specifically one or several of these activities, by using compounds structurally analogous to the substrates of these proteinases. Such a strategy requires a detailed knowledge of the active site of the proteinase, in order to identify the best substrate for the proteinase. Aiming at developing such a strategy, two proteinases previously identified in our laboratory, were chosen for further characterization of their molecular structure and properties: the merozoite proteinase for erythrocytic invasion (MPEI), involved in the erythrocyte invasion by the merozoites, and the Pf37 proteinase, which hydrolyses human spectrin in vitro.

The identification and characterization of new immunogenic egg components: implications for evaluation and control of the immunopathogenic T cell response in schistosomiasis

In schistosomiasis, granuloma formation to parasite eggs signals the beginning of a chronic and potentially life-threatening disease. Granulomas are strictly mediated by CD4+ T helper (Th) cells specific for egg antigens; however, the number and identity of these T cell-sensitizing molecules are largely unknown. We have used monoclonal T cell reagents derived from egg-sensitized individuals as probes to track down, isolate and positively identify several egg antigens; this approach implicitly assures that the molecules of interest are T cell immunogens and, hence, potentially pathogenic. The best studied and most abundant egg component is the Sm-p40 antigen. Sm-p40 and its peptide 234-246 elicit a strikingly immunodominant Th-1-polarized response in C3H and CBA mice, which are H-2k strains characterized by severe egg-induced immunopathology. Two additional recently described T cell-sensitizing egg antigens are Schistosoma mansoni phosphoenolpyruvate carboxykinase (Sm-PEPCK) and thioredoxin peroxidase-1 (Sm-TPx-1). In contrast to Sm-p40, both of these molecules induce a more balanced Th-1/Th-2 response, and are relatively stronger antigens in C57BL/6 mice, which develop smaller egg granulomas. Importantly, Sm-p40 and Sm-PEPCK have demonstrated immunogenicity in humans. The findings in the murine model introduce the important notion that egg antigens can vary significantly in immunogenicity according to the host's genetic background. A better knowledge of the principal immunogenic egg components is necessary to determine whether the immune responses to certain antigens can serve as indicators or predictors of the form and severity of clinical disease, and to ascertain whether such responses can be manipulated for the purpose of reducing pathology.

The first report of the main vector of visceral leishmaniasis in America, Lutzomyia longipalpis (Lutz & Neiva) (Diptera: Psychodidae: Phlebotominae), in the state of Rio Grande do Sul, Brazil

Visceral leishmaniasis (VL) is a widespread zoonosis in Brazil and, up to now, there has been no record of the main vector of its agent, Lutzomyia longipalpis, in the Southern Region. Due to the diagnosis of VL in a dog in October 2008 in the city of São Borja, in the southernmost Brazilian state of Rio Grande do Sul, a collection of phlebotomines was undertaken to detect the presence of the vector Lu. longipalpis. The captures were carried out with CDC light traps on three consecutive nights in 2008. A total of 39 specimens of Lu. longipalpis were captured, thereby increasing the knowledge of the geographical distribution of this important vector.

Toxicological and biochemical analysis of the susceptibility of sylvatic Triatoma infestans from the Andean Valley of Bolivia to organophosphate insecticide

To increase our knowledge of the natural susceptibility of Triatoma infestans to an organophosphate insecticide, we performed toxicological and biochemical studies on three sylvatic populations from Bolivia and two populations from domestic dwellings from Bolivia and Argentina. Fifty-per-cent lethal doses (LD50) were determined based on the topical application of fenitrothion on first instar nymphs and mortality was assessed at 24 h. Both type of populations exhibited LD50ratios significantly higher than 1 with a range of the values (1.42-2.47); the maximum value were found in a sylvatic (-S) population, Veinte de Octubre-S. Samples were biochemically analysed using a glutathione S-transferase activity assay. The highest significant activity was obtained for Veinte de Octubre-S and the lowest activity was obtained for the reference population (102.69 and 54.23 pmol per minute per mg of protein respectively). Two out of the three sylvatic populations (Veinte de Octubre-S and Kirus Mayu-S) exhibited significantly higher glutathione S-transferase activity than that of the reference population. Based on this analysis of the natural susceptibility of this organism to organophosphate insecticides, continental and focal surveys of organophosphate susceptibility should be conducted to evaluate the evolution and distribution of this phenomenon.

Development of the immature stages of Culex (Culex) saltanensis Dyar (Diptera, Culicidae) under laboratory conditions

Development of the immature stages of Culex (Culex) saltanensis Dyar (Diptera, Culicidae) under laboratory conditions. Culex (Culex) saltanensis Dyar, 1928 is becoming frequent and abundant in natural and artificial breeding sites in urban and rural areas of Brazil. This study contributes to the knowledge of the biology of a Brazilian strain of C. saltanensis. The development of specimens reared individually or grouped was observed. The study was conducted at a constant temperature of 27 ± 2°C, 14L:10D photoperiod and 80 ± 5% relative humidity. The immature stages were observed every 6 hours until adult emergence, which occurred in 12.29 days among individually reared specimens and in 13.12 days among group-reared specimens. Egg rafts for the experiment were obtained from the laboratory and field. Eggs hatched at a rate of 97.48 ± 2.32%. More eggs per egg raft were obtained from the field than from the laboratory. Males from individually reared specimens emerged in 12.29 ± 1.11 days and females in 13.12 ± 1.58 days. The male-female ratio was 1:1. Larval survival rate was higher than 85% for larvae reared isolated and higher than 95% for group-reared larvae. The Culex saltanensis life cycle was completed within 12 to 14 days, where larval instars I and IV took the most time to develop and the pupae, the shortest.

Mineralogy of the clay fraction of Alfisols in two slope curvatures: III - spatial variability

A good knowledge of the spatial distribution of clay minerals in the landscape facilitates the understanding of the influence of relief on the content and crystallographic attributes of soil minerals such as goethite, hematite, kaolinite and gibbsite. This study aimed at describing the relationships between the mineral properties of the clay fraction and landscape shapes by determining the mineral properties of goethite, hematite, kaolinite and gibbsite, and assessing their dependence and spatial variability, in two slope curvatures. To this end, two 100 × 100 m grids were used to establish a total of 121 regularly spaced georeferenced sampling nodes 10 m apart. Samples were collected from the layer 0.0-0.2 m and analysed for iron oxides, and kaolinite and gibbsite in the clay fraction. Minerals in the clay fraction were characterized from their X-ray diffraction (XRD) patterns, which were interpreted and used to calculate the width at half height (WHH) and mean crystallite dimension (MCD) of iron oxides, kaolinite, and gibbsite, as well as aluminium substitution and specific surface area (SSA) in hematite and goethite. Additional calculations included the goethite and hematite contents, and the goethite/(goethite+hematite) [Gt/(Gt+Hm)] and kaolinite/(kaolinite+gibbsite) [Kt/(Kt+Gb)] ratios. Mineral properties were established by statistical analysis of the XRD data, and spatial dependence was assessed geostatistically. Mineralogical properties differed significantly between the convex area and concave area. The geostatistical analysis showed a greater number of mineralogical properties with spatial dependence and a higher range in the convex than in the concave area.

Characterization of the effects of macronutrient deficiencies in mangabeira seedlings

Knowledge of the mineral nutrition requirements of mangabeira (Hancornia speciosa Gomes) is relatively scarce and rudimentary because there is a lack of consistent data concerning its nutritional demands at different developmental stages. The aim of this research was to characterize the visual symptoms of macronutrient deficiencies and to evaluate the effects of these deficiencies on the growth, the production of dry matter, and the leaf content of mangabeira. To achieve this goal, a greenhouse experiment was conducted at the Goiano Federal Institute (Instituto Federal Goiano) in Rio Verde - GO, from January to June 2011 in which mangabeira plants were arranged in a random block design and grown in nutrient solutions. This experiment was replicated four times. The plants were treated with either a complete nutrient solution or a nutrient solution from which the individual macronutrient of interest (nitrogen (N), phosphorous (P), potassium (K), magnesium (Mg), calcium (Ca), or sulfur (S) had been omitted. The omission of a macronutrient from the nutrient solution resulted in morphological alterations that were characteristic symptoms of the particular nutritional deficiency and caused decreases in growth and dry matter mass production. The accumulation of macronutrients displayed the following order in mangabeira leaves: N>K>Ca>P>S>Mg.

Sequences of the coat protein gene from brazilian isolates of Papaya ringspot virus

Papaya ringspot virus (PRSV) is the causal agent of the main papaya (Carica papaya) disease in the world. Brazil is currently the world's main papaya grower, responsible for about 40% of the worldwide production. Resistance to PRSV on transgenic plants expressing the PRSV coat protein (cp) gene was shown to be dependent on the sequence homology between the cp transgene expressed in the plant genome and the cp gene from the incoming virus, in an isolate-specific fashion. Therefore, knowledge of the degree of homology among the cp genes from distinct PRSV isolates which are present in a given area is important to guide the development of transgenic papaya for the control of PRSV in that area. The objective of the present study was to assess the degree of homology among the PRSV cp genes of several Brazilian isolates of this virus. Papaya and PRSV are present in many different ecosystems within Brazil. Twelve PRSV isolates, collected in eight different states from four different geographic regions, were used in this study. The sequences of the cp gene from these isolates were compared among themselves and to the gene used to generate transgenic papaya for Brazil. An average degree of homology of 97.3% at the nucleotide sequence was found among the Brazilian isolates. When compared to 27 isolates from outside Brazil in a homology tree, the Brazilian isolates were clustered with Australian, Hawaiian, and Central and North American isolates, with an average degree of homology of 90.7% among them.

Knowledge of common pediatric cancers among medical students in northeast Brazil

BACKGROUND: In recent decades, early diagnosis of childhood cancer has taken an important place on the international agenda. The authors of this study evaluated a group of medical students in Recife, Brazil, regarding knowledge and practices related to early diagnosis of common childhood cancers. METHODS: Cross-sectional study with a sample of 82 medical students, from a total of 86 eligible subjects. Data were collected using self-completed questionnaires. Subgroups were defined according to knowledge of the theme and students' perceptions of their own skills and interest in learning. RESULTS: 74.4% of the sample demonstrated a minimum level of knowledge. The group without minimum knowledge or self-perceived competence to identify suspected cases (23.3%) was in the worst position to perform early diagnosis. All subjects expressed interest in learning more about this topic. CONCLUSIONS: Despite acceptable levels of knowledge among these medical students, the definition of central aspects of the teaching and learning processes would be useful for training physicians with the skills for diagnosing and treating pediatric cancers

Knowledge of Guidelines for Cardiopulmonary Resuscitation among Brazilian Medical Students

ABSTRACT Introduction Sudden death is a substantial public health problem, representing a major cause of mortality worldwide. Suitable initial care is essential for a good prognosis of these patients. Objectives To assess the knowledge of the 2010 guidelines for cardiopulmonary resuscitation (CPR) among medical students in their final year of undergraduate training. Methods This was a cross-sectional study with a sample of 217 medical students enrolled in the sixth year of accredited medical schools in Brazil. A structured questionnaire with 27 items was used to record the sociodemographic characteristics of the participants and to assess their knowledge base of the 2010 ILCOR guidelines for CPR. Results Only fifty (23.04%) out of 217 students achieved results considered as satisfactory in the written evaluation. The average score obtained was 56.74% correct answers. Seventeen percent of the students had never performed CPR maneuvers and 83.80% had never performed cardioversion or defibrillation. Conclusions The knowledge base of medical students regarding cardiopulmonary resuscitation is low. Considering these medical students are in their final year of medical school, this study reveals a worrisome scenario.

The role of B-mode ultrasonography in the musculoskeletal anatomical evaluation of the cervical region of the dog spine

This study characterized the normal musculoskeletal anatomy of the cervical segment of the spine of dogs by means of B-mode ultrasonography. The objective was to establish the role of B-mode ultrasonography for the anatomical evaluation of the cervical spine segment in dogs, by comparing the ultrasonographic findings with images by computed tomography and magnetic resonance imaging. The ultrasound examination, in transverse and median sagittal sections, allowed to identify a part of the epaxial cervical musculature, the bone surface of the cervical vertebrae and parts of the spinal cord through restricted areas with natural acoustic windows, such as between the atlanto-occipital joint, axis and atlas, and axis and the third cervical vertebra. The images, on transverse and sagittal planes, by low-field magnetic resonance imaging, were superior for the anatomical identification of the structures, due to higher contrast between the different tissues in this modality. Computed tomography showed superiority for bone detailing when compared with ultrasonography. As for magnetic resonance imaging, in addition to the muscles and cervical vertebrae, it is possible to identify the cerebrospinal fluid and differentiate between the nucleus pulposus and annulus fibrosus of the intervertebral discs. Although not the scope of this study, with knowledge of the ultrasonographic anatomy of this region, it is believed that some lesions can be identified, yet in a limited manner, when compared with the information obtained mainly with magnetic resonance imaging. The ultrasound examination presented lower morphology diagnostic value compared with the other modalities.

Occurrence of the rare genus Microcrocis P. Richter (Chroococcales, Cyanobacteria) in a coastal lagoon from southern Brazil

The paper records the first occurrence of the genus Microcrocis P. Richter (Chroococcales, Cyanobacteria), represented by M. pulchella (Buell) Geitler, in Brazil. The species was found in two zones, one with freshwater and the other with brackish water, of a coastal lagoon of Rio Grande do Sul State (31°15’-31°30’ S and 50°54’-51°09’ W). Comparison between M. pulchella and its most closely related species is presented. Up to now this species had occurrence records limited to freshwater systems in temperate regions. Its presence in a subtropical coastal lagoon from southernmost Brazil, either in fresh or in brackish water, broadened the knowledge of the distribution area of M. pulchella.