High prevalence of GB Virus C/Hepatitis G Virus RNA among Brazilian blood donors

The aim of this study was to investigate the presence of the Hepatitis G Virus on a population of blood donors from S��o Paulo, Brazil and to evaluate its association to sociodemographic variables. Two RT-PCR systems targeting the putative 5'NCR and NS3 regions were employed and the former has shown a higher sensitivity. The observed prevalence of HGV-RNA on 545 blood donors was 9.7% (CI 95% 7.4;12.5). Statistical analysis depicted an association with race/ethnicity, black and mulatto donors being more frequently infected; and also with years of education, less educated donors presenting higher prevalences. No association was observed with other sociodemographic parameters as age, gender, place of birth and of residence. DNA sequencing of nine randomly chosen isolates demonstrated the presence of genotypes 1, 2 and 3 among our population but clustering of these Brazilian isolates was not detected upon phylogenetic analysis.

PARACOCCIDIOIDOMYCOSIS IN A RENAL TRANSPLANT RECIPIENT

Paracoccidioidomycosis (PCM) is the most common endemic mycosis in Latin America. The etiological agents, which comprise two species, Paracoccidioides brasiliensis and P. lutzii, are thermodimorphic fungi that usually affect previously healthy adults. They primarily involve the lungs and then disseminate to other organs. Such mycosis is rare in organ transplant recipients; there have been only three cases reported in literature, until now. We report a case of PCM in a renal transplant recipient with an unusual dermatological presentation.

Resist��ncia do Aedes aegypti ao temef��s em Munic��pios do Estado do Cear��

Avaliou-se a suscetibilidade de Aedes aegypti ao temef��s atrav��s de amostras de ovos e larvas procedentes de quatro munic��pios de grande porte do estado do Cear�� (Fortaleza, Barbalha, Juazeiro do Norte e Crato). Empregou-se a t��cnica padronizada pela Organiza����o Mundial de Sa��de para ensaios com larvicidas. Determinou-se a CL50 de oito amostras provenientes de popula����es de Aedes e suas respectivas raz��es de resist��ncia, comparada �� CL50 da cepa suscet��vel Rockefeller. Todas as popula����es submetidas ao experimento apresentaram resist��ncia ao temef��s, com raz��es de resist��ncia variando entre 8 e 16. A an��lise destes resultados refor��a evid��ncias anteriores sobre a dissemina����o de resist��ncia ao temef��s em diferentes localidades do estado submetidas a grande press��o de controle nas ��ltimas d��cadas. O larvicida poder�� perder a sua efic��cia caso n��o se busque, com urg��ncia, o restabelecimento da suscetibilidade do Aedes aegypti nestas ��reas, afetando sobremaneira as campanhas de controle atualmente em curso.

Estabelecimento de metodologia para alimenta����o de Aedes aegypti (Diptera-Culicidae) em camundongos swiss e avalia����o da toxicidade e do efeito residual do ��leo essencial de Tagetes minuta L (Asteraceae) em popula����es de Aedes aegypti

Objetivou-se desenvolver um procedimento de alimenta����o de f��meas de Aedes aegypti que n��o cause estresse em camundongo swiss e avaliar a toxicidade e o efeito residual do ��leo essencial de Tagetes minuta L (Asteraceae) em popula����es de Aedes aegypti. Camundongos anestesiados: um observado tempo de seda����o e outro colocado em gaiola para alimenta����o de f��meas. ��leo essencial, dilu��do em acetona, foi utilizado em bioensaios para avalia����o das concentra����es letais em larvas de Bauru, SP e S��o Jos�� do Rio Preto, SP, respectivamente, sens��veis e resistentes ao temephos. Os dados obtidos foram comparados com a cepa Rockefeller-EUA. O procedimento com camundongos foi aprovado. N��o houve diferen��a entre as popula����es quanto �� susceptibilidade a Tagetes minuta e os ensaios demonstraram CL50 de 0,24, 0,25 e 0,21mL L-1 e CL99,9 em 0,35, 0,39 e 0,42mL L-1, respectivamente, para Rockfeller, Bauru e S��o Jos�� do Rio Preto. N��o foi observado efeito residual da solu����o.

Altera����es morfol��gicas na parede de art��ria muscular em pacientes hipertensas

OBJETIVO: Identificar les��es estruturais na parede arterial uterina em mulheres com hipertens��o arterial (HA). M��TODOS: Vinte e seis pacientes com indica����o de histerectomia eletiva foram divididas em dois grupos. O grupo 1, constitu��do por mulheres normotensas e, o grupo 2, por hipertensas sem tratamento regular. Foram obtidos dois segmentos da art��ria uterina de cada paciente imediatamente ap��s a cirurgia. Os fragmentos foram preparados em l��minas e submetidos ao estudo morfol��gico �� microscopia ��ptica. RESULTADOS: Os grupos foram homog��neos em rela����o �� idade, com m��dia de 46,8+7,6 e 46,7+6,4 anos nos grupos 1 e 2, respectivamente. As m��dias de press��o arterial sist��lica e diast��lica m��ximas durante o per��odo de interna����o foram de 130,0+3,4 x 83,8+6,5mmHg no grupo 1 e de 163,8+4,3 x 105,8+9,9mmHg no grupo 2 (p<0,0001). As pacientes hipertensas apresentaram espessamentos maiores da camada ��ntima (p<0,05). As fibras do complexo el��stico encontravam-se mais numerosas e homog��neas no grupo com press��o arterial elevada e a hipertrofia celular mais freq��ente (53,8%) que no das normotensas (23,1 %). CONCLUS��O: HA parece acelerar o espessamento intimal relacionado �� idade. As pacientes hipertensas apresentam elevada tend��ncia para um aumento quantitativo e maior homogeneidade das fibras el��sticas intimais na parede arterial uterina, indicando que a HA pode determinar altera����es estruturais semelhantes ao processo de envelhecimento vascular.

Preditores independentes de resultados intra-hospitalares p��s-implante de stent coronariano

OBJETIVO: Identificar preditores cl��nicos e angiogr��ficos independentes, determinantes de resultados imediatos p��s-implante de stent coron��rio. M��TODOS: Novecentos e quarenta e seis pacientes com idade m��dia de 61,04 &plusmn; 10,98 anos (31 a 91 anos), foram submetidos a implante de stents, sendo 580 do sexo masculino (61,3%). Sucesso do procedimento foi definido quando pelo menos um vaso era dilatado com sucesso, com estenose residual < 20%. Sucesso cl��nico ocorreu quando se obteve ��xito no procedimento na aus��ncia de complica����es maiores (IAM, necessidade de RM ou ��bito) na fase intra-hospitalar. Caracter��sticas cl��nicas e angiogr��ficas foram analisadas. Todas as vari��veis relacionadas aos resultados imediatos pela an��lise univariada foram inclu��das no modelo de regress��o log��stica. RESULTADOS: Sucesso do procedimento foi obtido em 98,9%, sucesso cl��nico em 95,7%, insucesso n��o-complicado em 0,1% e complica����es maiores em 4,2%. A an��lise multivariada evidenciou que les��o resten��tica, calcifica����o e contorno irregular se relacionaram com sucesso do procedimento; diabetes mellitus, choque cardiog��nico, s��ndromes coron��rias agudas, idade, disfun����o ventricular esquerda, calcifica����o e oclus��o total foram preditores de sucesso cl��nico. Diabetes mellitus, choque cardiog��nico, s��ndromes coron��rias agudas, idade, doen��a multiarterial, disfun����o ventricular esquerda, calcifica����o, les��es longas e oclus��o total foram preditores de complica����es maiores; enquanto que choque cardiog��nico, s��ndromes coron��rias agudas, idade, hipertens��o arterial sist��mica e disfun����o ventricular esquerda foram preditores de mortalidade intra-hospitalar. CONCLUS��O: Nossos resultados sugerem que os resultados imediatos p��s-implante de stents foram significativamente relacionados com choque cardiog��nico, disfun����o ventricular esquerda, idade, calcifica����o e oclus��o total.

Estudo ecocardiogr��fico evolutivo das altera����es an��tomo-funcionais do cora����o em obesos submetidos �� cirurgia bari��trica

OBJETIVO: Avaliar com a Dopplerecocardiografia a reversibilidade das altera����es estruturais e funcionais do cora����o em obesos submetidos �� cirurgia bari��trica. M��TODOS: Foram estudados 23 obesos (19 mulheres: 82,6%) com idade m��dia de 37,9 anos. Tinham obesidade classe III ou classe II com co-morbidades. Realizaram avalia����o cl��nica e ecocardiogr��fica no pr��-operat��rio, 6 meses e 3 anos ap��s a cirurgia. RESULTADOS: Antes da opera����o o peso era de 128,7 &plusmn; 25,8 kg e a press��o arterial (PA) 142,2 &plusmn; 16,2/92,2 &plusmn; 10,4 mmHg. No p��s-operat��rio houve redu����o do peso aos 6 meses (97,6 &plusmn; 18,3 Kg) e aos 3 anos (83,6 &plusmn; 13,5 Kg), e da PA aos 6 meses (128,5 &plusmn; 16,1/80,7 &plusmn; 9,9 mmHg) com resultado mantido em 3 anos. Ao ecocardiograma, antes da cirurgia havia hipertrofia da parede posterior do ventr��culo esquerdo (VE) e septo interventricular, com dimens��o diast��lica do VE normal e padr��o geom��trico predominante de remodelamento conc��ntrico (74%). Ap��s 6 meses, diminu��ram as espessuras do septo e da parede posterior, e aumentou a dimens��o diast��lica do VE. Em 3 anos o padr��o geom��trico predominante era o normal (69%), com redu����o da massa de VE e do ��ndice de massa do VE/altura&sup2; . Observou-se tamb��m melhora da fun����o diast��lica de VE, com aumento da rela����o E/A em 6 meses, mantendo-se em 3 anos e diminui����o do tempo de relaxamento isovolum��trico do VE em 6 meses e em 3 anos. Houve melhora do ��ndice de Desempenho Mioc��rdico em 6 meses, mantendo-se em 3 anos, em 13 pacientes estudados retrospectivamente. Notou-se aumento do tempo de eje����o em 6 meses, mantendo-se em 3 anos, e discreto aumento da fra����o de eje����o em 3 anos, sugerindo melhora da fun����o sist��lica de VE. CONCLUS��O: A redu����o de peso obtida atrav��s da cirurgia para obesidade promove modifica����es estruturais e funcionais ben��ficas ao cora����o.

Cirurgia da endocardite em valva a��rtica: op����o para tratamento de abscesso a��rtico

FUNDAMENTO: A grande diversidade de apresenta����es anat��micas encontradas em pacientes com endocardite infecciosa, especialmente nos que desenvolvem abscessos do anel a��rtico ou fistulas intracard��acas, tem sido um complicador para o tratamento cir��rgico dessa doen��a. Por esse motivo, os cirurgi��es t��m desenvolvido op����es t��ticas para sua corre����o. A consci��ncia geral de que a retirada do tecido infectado promove uma limpeza radical, o aparecimento de colas biol��gicas que facilitam o fechamento dos abscessos e o surgimento de novos substitutos valvares melhoraram o resultado do tratamento. OBJETIVO: Demonstrar mais uma op����o no tratamento do abscesso a��rtico, para casos selecionados, tubo valvulado em posi����o infra-coronariana. M��TODOS: Empreendemos a t��cnica em tr��s pacientes: em dois, empregamos tubo valvulado com pr��tese mec��nica, e em um, com pr��tese biol��gica. Dois pacientes necessitaram procedimentos associados com troca da valva mitral em um deles e pl��stica da valva tric��spide no outro. Todos eram reopera����es de pr��teses em posi����o a��rtica. RESULTADOS: A evolu����o cir��rgica e p��s-operat��ria imediata foi satisfat��ria com os tr��s recebendo alta da Unidade de Terapia Intensiva para o quarto. Um dos pacientes evoluiu para ��bito durante a interna����o em raz��o de co-morbidades graves que j�� apresentava no pr��-operat��rio, relacionadas a varizes de es��fago e comprometimento hep��tico. Os outros dois apresentam boa evolu����o no p��s-operat��rio tardio. CONCLUS��O: Acreditamos que essa op����o seja mais uma alternativa para o tratamento de abscessos com grande comprometimento de estruturas do anel a��rtico e da continuidade mitro-a��rtica.

Progression of Blood Pressure and Cardiovascular Outcomes in Hypertensive Patients in a Reference Center

Background: Hypertension is a public health problem, considering its high prevalence, low control rate and cardiovascular complications. Objective: Evaluate the control of blood pressure (BP) and cardiovascular outcomes in patients enrolled at the Reference Center for Hypertension and Diabetes, located in a medium-sized city in the Midwest Region of Brazil. Methods: Population-based study comparing patients enrolled in the service at the time of their admission and after an average follow-up of five years. Participants were aged &#8805;18 years and were regularly monitored at the Center up to 6 months before data collection. We assessed demographic variables, BP, body mass index, risk factors, and cardiovascular outcomes. Results: We studied 1,298 individuals, predominantly women (60.9%), and with mean age of 56.7&#177;13.1 years. Over time, there was a significant increase in physical inactivity, alcohol consumption, diabetes, dyslipidemia, and excessive weight. As for cardiovascular outcomes, we observed an increase in stroke and myocardial revascularization, and a lower frequency of chronic renal failure. During follow-up, there was significant improvement in the rate of BP control (from 29.6% to 39.6%; p = 0.001) and 72 deaths, 91.7% of which were due to cardiovascular diseases. Conclusion: Despite considerable improvements in the rate of BP control during follow-up, risk factors worsened and cardiovascular outcomes increased.

Correlation of Insulin Resistance with Anthropometric Measures and Blood Pressure in Adolescents

Abstract Background: Blood pressure is directly related to body mass index, and individuals with increased waist circumference have higher risk of developing hypertension, insulin resistance, and other metabolic changes, since adolescence. Objective: to evaluate the correlation of blood pressure with insulin resistance, waist circumference and body mass index in adolescents. Methods: Cross-section study on a representative sample of adolescent students. One group of adolescents with altered blood pressure detected by casual blood pressure and/or home blood pressure monitoring (blood pressure > 90th percentile) and one group of normotensive adolescents were studied. Body mass index, waist circumference were measured, and fasting glucose and plasma insulin levels were determined, using the HOMA-IR index to identify insulin resistance. Results: A total of 162 adolescents (35 with normal blood pressure and 127 with altered blood pressure) were studied; 61% (n = 99) of them were boys and the mean age was 14.9 �� 1.62 years. Thirty-eight (23.5%) adolescents had altered HOMA-IR. The group with altered blood pressure had higher values of waist circumference, body mass index and HOMA-IR (p<0.05). Waist circumference was higher among boys in both groups (p<0.05) and girls with altered blood pressure had higher HOMA-IR than boys (p<0.05). There was a significant moderate correlation between body mass index and HOMA-IR in the group with altered blood pressure (&#961; = 0.394; p < 0.001), and such correlation was stronger than in the normotensive group. There was also a significant moderate correlation between waist circumference and HOMA-IR in both groups (&#961; = 0.345; p < 0.05). Logistic regression showed that HOMA-IR was as predictor of altered blood pressure (odds ratio - OR = 2.0; p = 0.001). Conclusion: There was a significant association of insulin resistance with blood pressure and the impact of insulin resistance on blood pressure since childhood. The correlation and association between markers of cardiovascular diseases was more pronounced in adolescents with altered blood pressure, suggesting that primary prevention strategies for cardiovascular risk factors should be early implemented in childhood and adolescence.

Serological evidence of hantavirus infection in rural and urban regions in the state of Amazonas, Brazil

Hantavirus disease is caused by the hantavirus, which is an RNA virus belonging to the family Bunyaviridae. Hantavirus disease is an anthropozoonotic infection transmitted through the inhalation of aerosols from the excreta of hantavirus-infected rodents. In the county of Itacoatiara in the state of Amazonas (AM), Brazil, the first human cases of hantavirus pulmonary and cardiovascular syndrome were described in July 2004. These first cases were followed by two fatal cases, one in the municipality of Mau��s in 2005 and another in Itacoatiara in 2007. In this study, we investigated the antibody levels to hantavirus in a population of 1,731 individuals from four different counties of AM. Sera were tested by IgG/IgM- enzyme-linked immune-sorbent assay using a recombinant nucleocapsid protein of the Araraquara hantavirus as an antigen. Ten sera were IgG positive to hantavirus (0.6%). Among the positive sera, 0.8% (1/122), 0.4% (1/256), 0.2% (1/556) and 0.9% (7/797) were from Atalaia do Norte, Careiro Castanho, Itacoatiara and L��brea, respectively. None of the sera in this survey were IgM-positive. Because these counties are distributed in different areas of AM, we can assume that infected individuals are found throughout the entire state, which suggests that hantavirus disease could be a local emerging health problem.

Plasmodium simium/Plasmodium vivax infections in southern brown howler monkeys from the Atlantic Forest

Blood infection by the simian parasite, Plasmodium simium, was identified in captive (n = 45, 4.4%) and in wild Alouatta clamitans monkeys (n = 20, 35%) from the Atlantic Forest of southern Brazil. A single malaria infection was symptomatic and the monkey presented clinical and haematological alterations. A high frequency of Plasmodium vivax-specific antibodies was detected among these monkeys, with 87% of the monkeys testing positive against P. vivax antigens. These findings highlight the possibility of malaria as a zoonosis in the remaining Atlantic Forest and its impact on the epidemiology of the disease.

Evaluation of the role of ATP-binding cassette transporters as a defence mechanism against temephos in populations of Aedes aegypti

The role of ATP-binding cassette (ABC) transporters in the efflux of the insecticide, temephos, was assessed in the larvae of Aedes aegypti. Bioassays were conducted using mosquito populations that were either susceptible or resistant to temephos by exposure to insecticide alone or in combination with sublethal doses of the ABC transporter inhibitor, verapamil (30, 35 and 40 &#956;M). The best result in the series was obtained with the addition of verapamil (40 &#956;M), which led to a 2x increase in the toxicity of temephos, suggesting that ABC transporters may be partially involved in conferring resistance to the populations evaluated.

A public health risk assessment for yellow fever vaccination: a model exemplified by an outbreak in the state of S��o Paulo, Brazil

We propose a method to analyse the 2009 outbreak in the region of Botucatu in the state of S��o Paulo (SP), Brazil, when 28 yellow fever (YF) cases were confirmed, including 11 deaths. At the time of the outbreak, the Secretary of Health of the State of S��o Paulo vaccinated one million people, causing the death of five individuals, an unprecedented number of YF vaccine-induced fatalities. We apply a mathematical model described previously to optimise the proportion of people who should be vaccinated to minimise the total number of deaths. The model was used to calculate the optimum proportion that should be vaccinated in the remaining, vaccine-free regions of SP, considering the risk of vaccine-induced fatalities and the risk of YF outbreaks in these regions.