Tempo de clampeamento e fatores associados à reserva de ferro de neonatos a termo

OBJETIVO : Analisar o impacto do tempo de clampeamento e parâmetros obstétricos, biológicos e socioeconômicos sobre a reserva de ferro de neonatos nascidos a termo. MÉTODOS : Estudo transversal pelo qual foram avaliados os parâmetros hematológicos de neonatos de Viçosa, MG, de outubro de 2011 a julho de 2012. Foram coletados 7 mL de sangue do cordão umbilical de 144 neonatos a termo e sem baixo peso. Os parâmetros investigados foram: hemograma completo, ferro sérico, ferritina e proteína C-reativa. O tempo de clampeamento do cordão umbilical foi mensurado utilizando cronômetro digital sem interferir nos procedimentos do parto. Os dados de nascimento foram coletados nas Declarações de Nascidos Vivos e as demais informações foram obtidas com a mãe do neonato por aplicação de questionário no primeiro mês pós-parto. Realizou-se análise de regressão linear múltipla visando a estimar a influência de variáveis obstétricas, biológicas e socioeconômicas nos níveis de ferritina ao nascer. RESULTADOS : A mediana de ferritina foi 130,3 µg/L (n = 129, mínimo de 16,4 e máximo 420,5 µg/L), a média de ferro sérico foi 137,9 μg/dL (n = 144, dp = 39,29) e de hemoglobina, 14,7 g/dL (n = 144, dp = 1,47). O tempo mediano de clampeamento do cordão foi 36 segundos, variando entre sete e 100. A análise bivariada detectou associação entre os níveis de ferritina e a cor da criança, tempo de clampeamento de 60 segundos, tipo de parto, a presença de diabetes gestacional e a renda per capita da família. Renda per capita, número de consultas pré-natais e o comprimento ao nascer contribuíram com 22,0% da variação dos níveis de ferritina na análise múltipla. CONCLUSÕES : A reserva de ferro ao nascer sofreu influência de características biológicas, obstétricas e sociais. O combate à anemia deve envolver a implementação de um critério de clampeamento tardio do cordão umbilical para as diretrizes de trabalho de parto, bem como a criação de políticas voltadas para a redução das desigualdades sociais e melhoria da qualidade do atendimento pré-natal.

Atividade física de mulheres no climatério: comparação entre auto-relato e pedômetro

OBJETIVO Comparar dois métodos de avaliação de atividade física entre mulheres na pré, transição e pós-menopausa. MÉTODOS Estudo transversal aninhado à coorte de mulheres na pré, peri e pós-menopausa em uma cidade do sul do Brasil. As participantes responderam a um questionário com dados sociodemográficos e clínicos. A atividade física foi avaliada utilizando-se o Questionário Internacional de Atividade Física – versão curta e a contagem do número de passos com o uso de pedômetro. As participantes foram classificadas em estratos de atividade física de acordo com o instrumento utilizado. Para análise estatística foram realizados os testes de correlação de Spearman, índice de Kappa, coeficiente de concordância e análise das medidas contínuas de Bland-Altman. RESULTADOS A concordância (k = 0,110; p = 0,007) e a correlação (rho = 0,136; p = 0,02) entre o Questionário Internacional de Atividade Física – versão curta e o pedômetro foram fracas. No gráfico de Bland-Altman, observou-se que as diferenças se afastam do valor zero tanto quanto a atividade física é mínima ou mais intensa. Comparando-se os dois métodos, a frequência de mulheres inativas é maior quando avaliadas pelo pedômetro do que pelo Questionário Internacional de Atividade Física. O oposto ocorre entre as ativas. CONCLUSÕES A concordância entre os métodos foi fraca. Embora de fácil aplicação, o Questionário Internacional de Atividade Física superestima a atividade física em relação à avaliação por pedômetro.

Rotavírus, adenovírus, astrovírus, calicivírus e "Small Round Virus Particles" em fezes de crianças, com e sem diarréia aguda, no período de 1987 a 1988, na Grande São Paulo

No período de agosto de 1987 a setembro de 1988, 193 amostras de fezes de crianças, com e sem sintomatologia diarréica aguda, foram submetidas às provas diagnósticas do ensaio imunoenzimático (EIE), eletroforese em gel de poliacrilamida (EGPA) e microscopia eletrônica (ME) para a detecção de vírus. A positividade para Rotavírus, Adenovírus, Astrovírus, Calicivírus e "Small Round Virus Particles" (SRVP) foi encontrada nas 97 crianças com diarréia aguda em 11,3%, 3,1%, 2,1%, l,0%e4,l%, respectivamente. Das 96 crianças sem diarréia, 4,2% foram positivas para Rotavírus, 1,0% para Calicivírus e 7,3% para SRVP. Das 15 amostras positivas para Rotavírus, 14 apresentaram perfil eletroforético característico do Grupo A e 1 amostra do Grupo C. A análise dos eletroforotipos demonstrou a grande heterogeneidade de perfis e a predominância do perfil "longo". A associação de vírus, bactéria e parasita foi encontrada tanto em crianças com diarréia como em crianças sem diarréia.

Evaluacion de la tecnica de contraimmunoelectroforesis para determinar la potencia antigena de las vacunas antirrabicas

El método recomendado por la Organización Mundial de la Salud (OMS) para la prueba de potencia de vacunas antirrábicas como producto final es la prueba NIH. Algunas técnicas in vitro se han propuesto para el control durante el proceso de produción y complementan el ensayo in vivo antes mencionado. Este trabajo presenta los resultados obtenidos cuando se utilizó la técnica de contrainmunoelectroforésis (CIE) para determinar el contenido de antígenos en muestras de 84 y 40 lotes de vacunas antirrábicas producidas en tejido nervioso de cerebro de ratón lactante mediante cultivo de tejidos, respectivamente. La evaluación de las muestras en, y en torno de, las 0.3 UI por ambos métodos muestran que, en la práctica, un título CIE de 1:4 cumpliría con un mínimo de potencia de la prueba NIH. Un bajo grado de variabilidad de la prueba CIE fue observada en nuestro laboratorio cuando dos lotes de vacunas de referencia de trabajo y 7 lotes de vacunas antirrábicas, de diferente origen y actividad, fueron ensayadas en cinco pruebas independientes. Todos los títulos se ubicaron dentro de una dilución doble, lo que es indicativo de su reproducibilidad. Se observó buena sensibilidad para detectar el deterioro del antígeno en el ensayo de degradación térmica, cuando muestras de 3 lotes de vacuna líquida de cerebro de ratón lactante fueron mantenidas a4 y 37ºC cada una, por 28 días. Se evaluaron semanalmente por los ensayos de CIE y NIH. Finalmente, se observó que el ensayo de CIE podría ser utilizado por los productores para estimar el punto final de los procesos de concentración para que se corresponda con un valor antigénico deseado en la prueba de potencia NIH.

HANTAVIRUS PULMONARY SYNDROME IN THE PROVINCE OF RIO NEGRO, ARGENTINA, 1993-1996

Early in 1995 the first case of Hantavirus Pulmonary Syndrome was serologically confirmed in El Bolsón (Province of Río Negro, Argentina), corresponding to the third outbreak reported in Argentina. A total of 26 cases of HPS related to the Andean region of Rio Negro Province, were reported from 1993 to 1996, 17 in El Bolsón, 4 in San Carlos de Bariloche, and 5 in Buenos Aires. The incidence rate was 5.03 x 100000 with a mortality rate of 51.85 x 100. The occurrence of cases was mainly seasonal, with a significantly greater number in the spring, and the persons affected mainly lived in urban or periurban areas. In four cases, the affected individuals were members of a couple, spouses or live-in contacts. Seven cases were Health workers (physicians, nurses or administrative staff). Twelve cases were related among them, due to an outbreak of 80 days. Two of them did not visit the Andean region. A total of 139 rodents were captured and seven of them, Olygoryzomys longicaudatus, were found to be serologically positive. The possibility of infection by contact with rodents or fecal matter is being analyzed and also hypothesis related with interhuman transmission

Characterization and optimization of bovine Echinococcus granulosus cyst fluid to be used in immunodiagnosis of hydatid disease by ELISA

The aim of this work was to assess the influence in the diagnostic value for human hydatid disease of the composition of bovine hydatid cyst fluid (BHCF) obtained from fertile (FC) and non-fertile cysts (NFC). Eight batches from FC and 5 from NFC were prepared and analysed with respect to chemical composition: total protein, host-derived protein, carbohydrate and lipid contents. No differences were observed in the first two parameters but carbohydrate and lipid contents were shown to be higher in batches from FC than in those from NFC. Bands of 38 and 116 kD in SDS-PAGE profiles were observed to be present in BHCF from FC only. Two pools were prepared from BHCF batches obtained from FC (PFC) and NFC (PNFC), respectively. Antigen recognition patterns were analysed by immunoblot. Physicochemical conditions for adsorption of antigens to the polystyrene surface (ELISA plates) were optimized. The diagnostic value of both types of BHCF as well as the diagnostic relevance of oxidation of their carbohydrate moieties with periodate were assessed by ELISA using 42 serum samples from hydatid patients, 41 from patients with other disorders, and 15 from healthy donors. Reactivity of all sera against native antigen were tested with and without free phosphorylcholine. The best diagnostic efficiency was observed using BHCF from periodate-treated PFC using glycine buffer with strong ionic strength to coat ELISA plates.

Candidemia in a Brazilian tertiary care hospital: species distribution and antifungal susceptibility patterns

Recent studies have shown differences in the epidemiology of invasive infections caused by Candida species worldwide. In the period comprising August 2002 to August 2003, we performed a study in Santa Casa Complexo Hospitalar, Brazil, to determine Candida species distribution associated with candidemia and their antifungal susceptibility profiles to amphotericin B, fluconazole and itraconazole. Antifungal susceptibility was tested according to the broth microdilution method described in the NCCLS (M27A-2 method). Only one sample from each patient was analyzed (the first isolate). Most of the episodes had been caused by species other than C. albicans (51.6%), including C. parapsilosis (25.8%), C. tropicalis (13.3%), C. glabrata (3.3%), C. krusei (1.7%), and others (7.5%). Dose-dependent susceptibility to itraconazole was observed in 14.2% of strains, and dose-dependent susceptibility to fluconazole was found in 1.6%. Antifungal resistance was not found, probably related to low use of fluconazole. Further epidemiological surveillance is needed.

Sensitivity of an immunoenzymatic test for detection of ant-L. brasiliensis antibodies compared to other tests used for the diagnosis of American cutaneous leishmaniasis

The diagnosis of American cutaneous leishmaniasis (ACL) is frequently based on clinical and epidemiological data associated with the results of laboratory tests. Some laboratory methods are currently being applied for the diagnosis of ACL, among them the indirect immunofluorescence reaction (IIFR), the Montenegro skin test (MST), histopathological examination, and the polymerase chain reaction (PCR). The performance of these methods varies in a considerable proportion of patients. After the standardization of an immunoenzymatic test (ELISA) for the detection of IgG in the serum of patients with ACL using a crude Leishmania braziliensis antigen, the results obtained were compared to those of other tests routinely used for the diagnosis. The tests revealed the following sensitivity, when analyzed separately: 85% for ELISA IgG, 81% for PCR, 64.4% for MST, 58.1% for IIFR, and 34% for the presence of parasites in the biopsy. ELISA was positive in 75% of patients with ACL presenting a negative MST, in 84.8% of ACL patients with negative skin or mucous biopsies for the presence of the parasite, and in 100% of cases with a negative PCR. Thus, ELISA presented a higher sensitivity than the other tests and was useful as a complementary method for the diagnosis of ACL.

Feeding sources and trypanosome infection index of Rhodnius pallescens in a Chagas disease endemic area of Amador County, Panama

The sylvatic triatomine Rhodnius pallescens is considered to be the most important and widespread vector of Trypanosoma cruzi and Trypanosoma rangeli in Panama. However, its behavior and biological characteristics have only been partially investigated. Thus, to achieve sustainable and efficient control over Chagas disease in Panama, a better understanding of the ecology and biology of R. pallescens is essential. In this study we evaluated R. pallescens host feeding sources using a dot-blot assay, and the trypanosome infection index by PCR analysis in a Chagas disease endemic area of central Panama. It was found that in peridomestic palm trees, 20.3% of the examined bugs had fed on opossums (Didelphis marsupialis). However, we observed an increased anthropophagy (25.4%) for those bugs collected inside houses. Considering the domestic and peridomestic habitats as a whole, the proportion of collected R. pallescens infected with trypanosomes was 87.4%. In the two habitats the predominant infection was with T. cruzi (80-90%). Between 47-51% of the analyzed triatomines were infected with T. rangeli. Mixed infections (40-51%) were also detected. These findings provide a better basis for the implementation of a rational control and surveillance program for Chagas disease in regions where R. pallescens is endemic.

Ulcera cutanea provocada por hongos del genero Fusarium

Se presenta el caso de un paciente oriundo y procedente del Paraguay, de 40 años de edad, portador de una ulceración crónica en cara externa del pie izquierdo, de 2 meses de evolución, debida a una hialohifomicosis por Fusarium oxysporum. Se destacan las características clínicas, métodos de diagnóstico y terapeútica de esta micosis, además de las diferentes etiologías a considerar en el diagnóstico diferencial de una úlcera en personas procedentes del área tropical o subtropical.

Phlebotominae sand flies associated with a tegumentary leishmaniasis outbreak, Tucumán Province, Argentina

The distribution of sand flies and cases of tegumentary leishmaniasis in the area surrounding JB Alberd city, and the proximities of Catamarca province were studied, after an increase of reported cases from JB Alberdi, Tucumán province, in 2003. Of 14 confirmed cases, 57% were females and 57% were less than 15 years old, suggesting peridomestic transmission. However, 86% of them lived close to the Marapa river forest gallery and related wooded areas. Over 1,013 sand flies were collected; Lutzomyia neivai (Pinto, 1926) was prevalent at all the sites (92.3%), while Lutzomyia migonei (França, 1920) (6.7%) and Lu. cortelezzii (Brèthes, 1923) (1%) were also found. The spatial distribution of Lu. neivai overlapped that of the cases, with higher abundance in microfocal hot spots close to the river in stable vegetated habitats or modified habitats with shadow and animal blood sources. The cumulative outcome of anthropic, ecological and climatic factors could have contributed to the onset of the outbreak.

Extended-spectrum β-lactamase-producing Salmonella enterica serovar Oranienburg (CTX-M-2 group) in a pediatric hospital in Tucumán, Argentina

INTRODUCTION: Salmonella sp infections have been reported over recent years in hospitals in Argentina and other countries due to multiresistant strains. The aim of this study was to characterize the extended-spectrum β-lactamases in third-generation cephalosporin-resistant strains of Salmonella enterica serovar Oranienburg. METHODS: We studied 60 strains isolated from children with gastroenteritis and/or extraintestinal complications. The antibiotic susceptibility patterns of the isolates were analyzed and the β-lactamases were characterized using phenotyping and genotyping methods. RESULTS: All the strains were resistant to ampicillin, cefotaxime, cefepime and aztreonam and partially susceptible to ceftazidime, thus corresponding well with the resistance phenotype conferred by CTX-M-type β-lactamases. An isoelectric point enzyme (pI = 7.9) was detected in all of the strains, and this was confirmed by PCR as a member of the CTX-M-2 group. CONCLUSIONS: This is the first report of Salmonella enterica serovar Oranienburg producing β-lactamases of the CTX-M-2 group in a pediatric hospital in Tucumán, Argentina.

American tripanosomiasis: a study on the prevalence of Trypanosoma cruzi and Trypanosoma cruzi-like organisms in wild rodents in San Luis province, Argentina

INTRODUCTION: Chagas disease is caused by Trypanosoma cruzi. Wild and perianthropic mammals maintain the infection/transmission cycle, both in their natural habitat and in the peridomestic area. The aim of this paper was to present the results from a study on wild rodents in the central and northern regions of San Luis province, Argentina, in order to evaluate the prevalence of this infection. METHODS: Sherman traps were set up in capture areas located between latitudes 32º and 33º S, and longitudes 65º and 66º W. The captured rodents were taxonomically identified and hemoflagellates were isolated. Morphological, biometric and molecular studies and in vitro cultures were performed. Infection of laboratory animals and histological examination of the cardiac muscle and inoculation area were also carried out. Parasites were detected in circulating blood in Calomys musculinus, Graomys griseoflavus, Phyllotis darwini and Akodon molinae. The parasites were identified using biological criteria. Molecular PCR studies were performed on some isolates, which confirmed the characterization of these hemoflagellates as Trypanosoma cruzi. RESULTS AND CONCLUSIONS: Forty-four percent of the 25 isolates were identified as Trypanosoma cruzi, and the remaining 56% as Trypanosoma cruzi-like. These findings provide evidence that wild rats infected with Trypanosoma cruzi and Trypanosoma cruzi-like organisms are important in areas of low endemicity.

Intrahospital spread of carbapenem-resistant Pseudomonas aeruginosa in a University Hospital in Florianópolis, Santa Catarina, Brazil

INTRODUCTION: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) has been isolated with increasing frequency in Brazilian hospitals. Since June 2003, its detection in a teaching hospital in the city of Florianópolis, Brazil, has increased. This study aimed to investigate the minimal inhibitory concentration (MIC), presence of Metallo-β-lactamase (MβL) and a possible clonal relationship among the isolates. METHODS: The study included 29 CRPA and seven isolates with reduced susceptibility. The MIC was determined by agar-dilution. Detection of MβL was performed by Double Disk Sinergism (DDS) and Combined Disk (CD). The MβL gene was verified by PCR and nucleotide sequence analysis. Epidemiological typing was performed by pulsed-field gel electrophoresis. RESULTS: Among the 29 carbapenem-resistant isolates, polymyxin B presented 100% susceptibility and piperacillin/tazobactam 96.7%. Seventeen (62%) strains were verified as clonal (A clone) and among these, six isolates indicated phenotypically positive tests for MβL and harbored the blaSPM-1 gene. The first CRPA isolates were unrelated to clone A, harbored blaIMP-16 and were phenotypically positive only by CD. CONCLUSIONS: The spread of a high-level of resistance clone suggests cross transmission as an important dissemination mechanism and has contributed to the increased rate of resistance to carbapenems. This study emphasizes the need for continuous surveillance and improved strategies.