Sub-registro de nascimentos vivos em localidade do Estado de Piauí, Brasil

Decorrente de falta de dados que informem de modo fidedigno aos planejadores da área de Saúde, objetivou-se estimar a taxa mínima de sub-registro de nascimentos vivos na cidade de Piripiri, Piauí, no período de 1 de julho de 1983 a 30 de junho de 1984. O método utilizado para medir o sub-registro foi a comparação dos dados oficiais (Cartório de Registro Civil) com os não oficiais (Fundação Serviço Especial de Saúde Pública - FSESP e Igreja Católica), cujo resultado mostrou uma taxa mínima de sub-registro muito alta (68,4%) quando comparada com taxas de outras localidades brasileiras. Estudou-se a associação entre registro civil e variáveis interveníentes como local do parto, sexo da criança, estado civil e zona de residência da mãe. Concluiu-se ser o sub-registro um problema de Saúde Pública cujos fatores fundamentais como a educação, a conscientização da população e a gratuidade do registro, dentre outros, poderão contribuir para sua diminuição, com a conseqüente melhoria do planejamento das ações na área da Saúde Pública, de benéfica repercussão na vida da população.

Sub-registro de nascimentos vivos hospitalares em área urbana da região sul do Brasil, em 1989

Com o objetivo de avaliar a real situação do Registro Civil, no Município de Maringá, PR, Brasil, foram estudados 4.876 nascimentos vivos ocorridos nos seus hospitais, em 1989, filhos de mulheres nele residentes. São apresentadas as etapas que permitiram identificar, dentre a população de estudo, os nascimentos registrados (mesclagem de dois arquivos). A estimativa máxima da taxa de sub-registro, no primeiro ano de vida, foi igual a 9,1%, variando segundo idade da mãe (quanto mais jovem, maior a taxa), situação previdenciária (indigentes com a maior estimativa) e paridade (primíparas, menor valor), permitindo aventar a hipótese de associação entre sub-registro e piores níveis socioeconômicos.

Sub-registro de acidentes do trabalho em localidade do Estado de São Paulo, 1997

OBJETIVO: Estimar o número de acidentes do trabalho ocorridos em determinada localidade e intervalo de tempo e a extensão do sub-registro de casos. MÉTODOS: Amostraram-se 4.782 domicílios residenciais do município de Botucatu, SP, contendo 17.219 moradores, em primeiro de julho de 1997. Em cada um dos domicílios, um morador adulto era entrevistado para identificar ocorrência de acidentes do trabalho nos três meses precedentes à entrevista. Nos casos positivos, os acidentados foram entrevistados. Para cálculo do intervalo de confiança utilizou-se a formula de Cochran. RESULTADOS: Confirmaram ter sofrido acidente do trabalho 76 indivíduos, estimando-se em 1.810 o número desses eventos em Botucatu no ano de 1997 e a proporção de incidência em 4,1% (IC95% 3,0%-5,3%). Dos 76 acidentados, 39 não eram cobertos pelo seguro acidente previdenciário (51,3% IC95% 41,1%-61,6%), não se enquadrando na obrigatoriedade de emissão de Comunicação de Acidente do Trabalho (funcionários públicos estatutários, autônomos, assalariados sem registro em carteira, proprietários e outros). Dentre os 37 casos com obrigatoriedade de emissão desse documento, 20 casos não possuíam (54,1% IC39,4%-68,7%). Houve maior proporção de sub-registro de casos em trabalhadores de micro, pequenas e médias empresas, do que entre grandes empresas. Apenas 22,4% (IC13,8%, 30,9%) dos acidentes do trabalho informados nas entrevistas domiciliares foram captados pelos registros previdenciários CONCLUSÕES: Os achados indicam a necessidade de melhoria de utilização de outras fontes de informação, além das Comunicações de Acidentes do Trabalho, para elaboração das estatísticas oficiais sobre acidentes do trabalho.

Correção de sub-registros de óbitos e proporção de internações por causas mal definidas

OBJETIVO: Propor técnicas de correção de sub-registro e redistribuição de causas mal definidas para o Sistema de Informações sobre Mortalidade e o Sistema de Informações Hospitalares do SUS. MÉTODOS: Para a correção de sub-registro foram utilizados os estimadores bayesianos empíricos de James-Stein modificados para eventos em áreas geográficas delimitadas, aplicadas nos municípios brasileiros, no ano de 2001. RESULTADOS: Em relação aos dados de mortalidade, obteve-se um acréscimo de 55.671 óbitos, resultando num percentual de correção de sub-registro de 5,9%, mais efetivo nas faixas etárias de menores de cinco anos (8,1%) e de 70 anos e mais (6,4%); nas causas perinatais (8,7%) e causas mal definidas (8,0%); e nos Estados do Maranhão (10,6%), Bahia (9,5%) e Alagoas (8,8%). A redistribuição das causas mal definidas de óbito modificou a estrutura da mortalidade proporcional das regiões Norte e Nordeste, com aumento da proporção de óbitos por doenças do aparelho circulatório e redução para as causas externas e perinatais. A redistribuição das causas mal definidas de internação não alterou a morbidade hospitalar proporcional. CONCLUSÕES: Os resultados da correção de sub-registro apresentaram consistência em relação aos achados da literatura, quanto as faixas etárias, causas e regiões do País mais acometidas. Em relação à redistribuição das causas mal-definidas de morte, observou-se coerência espacial na reordenação da mortalidade proporcional. Considera-se este método aplicável aos Sistemas de Informação em Saúde nacionais, já que pode ser implementado em rotinas computacionais. Entretanto, alguns aprimoramentos podem ser considerados, como a distribuição espaço-temporal dos eventos na aplicação dos estimadores.

Validity of self-reported hearing loss in adults: performance of three single questions

OBJECTIVE: To estimate the validity of three single questions used to assess self-reported hearing loss as compared to pure-tone audiometry in an adult population. METHODS: A validity study was performed with a random sub-sample of 188 subjects aged 30 to 65 years, drawn from the fourth wave of a population-based cohort study carried out in Salvador, Northeastern Brazil. Data were collected in household visits using questionnaires. Three questions were used to separately assess self-reported hearing loss: Q1, "Do you feel you have a hearing loss?"; Q2, "In general, would you say your hearing is 'excellent,' 'very good,' 'good,' 'fair,' 'poor'?"; Q3, "Currently, do you think you can hear 'the same as before', 'less than before only in the right ear', 'less than before only in the left ear', 'less than before in both ears'?". Measures of accuracy were estimated through seven measures including Youden index. Responses to each question were compared to the results of pure-tone audiometry to estimate accuracy measures. RESULTS: The estimated sensitivity and specificity were 79.6%, 77.4% for Q1; 66.9%, 85.1% for Q2; and 81.5%, 76.4% for Q3, respectively. The Youden index ranged from 51.9% (Q2) to 57.0% (Q1) and 57.9% (Q3). CONCLUSIONS: Each of all three questions provides responses accurate enough to support their use to assess self-reported hearing loss in epidemiological studies with adult populations when pure-tone audiometry is not feasible.

Estimação de sub-registro de nascidos vivos pelo método de captura e recaptura, Sergipe

OBJETIVO: Estimar o número de ocorrências de nascidos vivos e, por conseqüência, o sub-registro civil de nascidos vivos. MÉTODOS: As bases de dados do Sistema Nacional de Informação sobre Nascidos Vivos e do Registro Civil do Instituto Brasileiro de Geografia e Estatística, nos segundo e terceiro trimestres de 2006 do estado de Sergipe, foram pareadas por relacionamento determinístico a partir do número da Declaração de Nascido Vivo. A desagregação geográfica adotada foi a de microrregião de residência da mãe. Os modelos de Huggins para populações fechadas foram aplicados para estimar as probabilidades de captura em cada base e o total de nascidos vivos ocorrido no período, dentro de cada desagregação geográfica. O aplicativo utilizado para as estimações foi o Software MARK®. RESULTADOS: O sub-registro civil no período analisado foi de 19,3%. A aplicação do método de captura-recaptura para estimar sub-registro de nascidos vivos é factível, inclusive para desagregações geográficas menores do que unidade da federação. O relacionamento determinístico foi prejudicado em quatro microrregiões, devido à falta de preenchimento do número da Declaração de Nascido Vivo na base do Instituto Brasileiro de Geografia e Estatística. Identificou-se que a idade da mãe afeta a probabilidade de captura pelo Registro Civil, característica de heterogeneidade na população de nascidos vivos. CONCLUSÕES: O método de captura-recaptura mostrou-se viável para a estimação de sub-registro de nascidos vivos.

Immunomodulatory effect of cimetidine on the proliferative responses of splenocytes from T. cruzi-infected rats

The immunomodulatory effect of cimetidine (CIM), a histamine type-2 receptor antagonist, was evaluated in respect to the blastogenic response to Con A of Wistar Furth (WF) rats infected by the Y strain of Trypanosoma cruzi (T. cruzi). Enhancement of blastogenesis of normal splenocytes was observed at a concentration of 10-3M. However, the splenocytes from infected animals responded to concentrations of CIM ranging from 10-8 to 10-3M. The mitogenic response to Con A of cells from infected animals was restored in the presence of CIM. The results show that CIM modulates the "in vitro" proliferative response of cells from T. cruzi-infected rats and suggest an immunoregulatory role of histamine and/or of cells that express H2 receptors in this infection.

Cardiac sympathetic-parasympathetic balance in rats with experimentally-induced acute chagasic myocarditis

To clarify the mechanism responsible for the transient sinus tachycardia in rats with acute chagasic myocarditis, we have examined the cardiac sympathetic-parasympathetic balance of 29 rats inoculated with 200,000 parasites (Trypanosoma cruzi). Sixteen infected animals and 8 controls were studied between days 18 and 21 after inoculation (acute stage). The remaining 13 infected animals and 9 controls were studied between days 60 and 70 after inoculation (sub-acute stage). Under anesthesia (urethane 1.25 g/kg), all animals received intravenous atenolol (5 mg/kg) and atropine (10 mg/kg). Acute stage: The baseline heart rate of the infected animals was significantly higher than that of the controls (P < 0.0001). The magnitude of the negative chronotropic response to atenolol was 4 times that of the controls (P < 0.00001). This response correlated with the baseline heart rate (r= - 0.72, P < 0.001). The heart rate responses to the beta-blocker and to atropine, of the infected animals studied during the sub-acute stage, were not different from controls. These findings suggest that cardiac sympathetic activity is transiently enhanced and cardiac parasympathetic activity is not impaired, in rats with acute chagasic myocarditis. The transient predominance of cardiac sympathetic activity could explain, in part, the sinus tachycardia observed in the acute stage of experimentally-induced chagasic myocarditis.

Immune responses induced by a Leishmania (Leishmania) amazonensis recombinant antigen in mice and lymphocytes from vaccinated subjects

In the search for Leishmania recombinant antigens that can be used as a vaccine against American Cutaneous Leishmaniasis, we identified a Leishmania (Leishmania) amazonensis recombinant protein of 33 kD (Larp33) which is recognized by antibodies and peripheral blood leukocytes (PBL) from subjects vaccinated with Leishvacin ®, Larp33 was expressed in Escherichia coli after cloning of a 2,2 kb Sau3A digested genomic fragment of L. (L.) amazonensis into the pDS56-6 His vector. Immunoblotting analysis indicated that Larp33 corresponds to an approximately 40-kD native protein expressed in promastigotes of L.(L.) amazonensis and L. (Viannia) braziliensis. Northern blots of total RNA also demonstrated that the gene coding for this protein is expressed in promastigotes of the major lineages of Leishmania causing American Cutaneous Leishmaniasis. Larp33 induced partial protection in susceptible mouse strains (BALB/c and C57BL/10) against L. (L.) amazonensis after vaccination using Bacille Calmette-Guerin (BCG) as adjuvant. In vitro stimulation of splenocytes from BALB/c protected mice with Larp33 elicited the secretion of IL-2 and IFN-g, suggesting that a Th1 cell-mediated protective response is associated with the resistance observed in these mice. As revealed by its immunogenic and antigenic properties, this novel recombinant antigen is a suitable candidate to compose a vaccine against cutaneous leishmaniasis

IgM and IgA Antibody Responses in 12 Cases of Human Acquired Toxoplasmosis

The persistence, in some subjects, of specific IgM antibodies to Toxoplasma gondii for several months after the acute phase of infection has complicated the interpretation of serological test results for toxoplasmosis. Several reports have emphasized the value of the detection of Toxoplasma-specific IgA antibodies for the diagnosis of acute toxoplasmosis. In this article, we report the follow-up profiles of Toxoplasma-specific IgM and IgA antibodies in serum samples obtained from 12 patients at various intervals after the onset of the clinical manifestations of infection. IgM antibodies were detected by the indirect immunofluorescence (IIF) test, antibody capture enzyme-linked immunosorbent assay (cELISA) and enzyme-mediated chemilluminescent technique (CmL). IgA antibodies were quantified by the direct ELISA (dELISA) and cELISA procedures. As defined by the manufacturer of the cELISA test for IgA used, most patients with acute toxoplasmosis have antibody levels > 40 arbritary units per ml (AU/ml). At values > 40 AU/ml, the cELISA for IgA detected significant antibody levels for a shorter time than the other techniques used for IgM and IgA detection. However, IgA levels £ 40 AU/ml do not exclude the possibility of acute toxoplasmosis since such levels can be reached very soon after infection with T. gondii. The results obtained in the present study show that the serological diagnosis of acute toxoplasmosis may not be such an easy task. Our data suggest that use of the IgA-cELISA concomitantly with IgM antibody screening could permit, in some circumstances, a more efficient diagnosis of acute acquired toxoplasmosis

Heart rate responses to a muscarinic agonist in rats with experimentally induced acute and subacute chagasic myocarditis

We administered arecoline to rats, with experimentally induced chagasic myocarditis, in order to study the sinus node sensitivity to a muscarinic agonist. Sixteen month old rats were inoculated with 200,000 T. cruzi parasites ("Y" strain). Between days 18 and 21 (acute stage), 8 infected rats and 8 age-matched controls received intravenous arecoline as a bolus injection at the following doses: 5.0, 10.0, 20.0, 40.0, and 80.0 mug/kg. Heart rate was recorded before, during and after each dose of arecoline. The remaining 8 infected animals and 8 controls were subjected to the same experimental procedure during the subacute stage, i.e., days 60 to 70 after inoculation. The baseline heart rate, of the animals studied during the acute stage (349 ± 68 bpm, mean ± SD), was higher than that of the controls (250 ± 50 bpm, p < 0.005). The heart rate changes were expressed as percentage changes over baseline values. A dose-response curve was constructed for each group of animals. Log scales were used to plot the systematically doubled doses of arecoline and the induced-heart rate changes. The slope of the regression line for the acutely infected animals (r = - 0.99, b =1.78) was not different from that for the control animals (r = - 0.97, b = 1.61). The infected animals studied during the subacute stage (r = - 0.99, b = 1.81) were also not different from the age-matched controls (r = - 0.99, b = 1.26, NS). Consequently, our results show no pharmacological evidence of postjunctional hypersensitivity to the muscarinic agonist arecoline. Therefore, these results indirectly suggest that the postganglionic parasympathetic innervation, of the sinus node of rats with autopsy proved chagasic myocarditis, is not irreversibly damaged by Trypanosoma cruzi.

Intranasal sensitization with Blomia Tropicalis antigens induces allergic responses in mice characterized by elevated antigen-specific and non-specific serum ige and peripheral blood eosinophil counts

In order to evaluate the potential allergenicity of Blomia tropicalis (Bt) antigen, IgE production of both specific and non-specific for Bt antigen was monitored in BALB/c mice after exposure to the antigen by nasal route. It was evidenced that B. tropicalis contains a functional allergen in its components. The allergenic components, however, when administered intranasally without any adjuvant, did not function to induce IgE response within a short period. On the other hand, intranasal inoculation of Bt antigens augmented serum IgE responses in mice pretreated by a subcutaneous priming injection of the same antigens. Inoculation of Bt antigen without subcutaneous priming injections induced IgE antibody production only when the antigen was continuously administered for a long period of over 24 weeks. Even when the priming injection was absent, the Bt antigen inoculated with cholera toxin (CT) as a mucosal adjuvant also significantly augmented the Bt antigen-specific IgE responses depending on the dose of CT co-administered. The present study also demonstrated that Bt antigen/CT-inoculated mice showed increased non-specific serum IgE level and peripheral blood eosinophil rates without noticeable elevations of the total leukocyte counts. The immunoblot analysis demonstrated 5 main antigenic components reactive to IgE antibodies induced. These components at about 44-64 kDa position were considered to be an important candidate antigen for diagnosis of the mite-related allergy.

Description of an injury in a human caused by a false tocandira (Dinoponera gigantea, Perty, 1833) with a revision on folkloric, pharmacological and clinical aspects of the giant ants of the genera Paraponera and Dinoponera (sub-family Ponerinae)

The authors observed an injury caused by the sting of a false tocandira ant in the hand of an amateur fisherman and they describe the clinical findings and the evolution of the envenoming, which presented an acute and violent pain, cold sweating, nausea, a vomiting episode, malaise, tachycardia and left axillary's lymphadenopathy. About three hours after the accident, still feeling intense pain in the place of the sting, he presented an episode of great amount of blood in the feces with no history of digestive, hematological or vascular problems. The intense pain decreased after eight hours, but the place stayed moderately painful for about 24 hours. In that moment, he presented small grade of local edema and erythema. The authors still present the folkloric, pharmacological and clinical aspects related to the tocandiras stings, a very interesting family of ants, which presents the largest and more venomous ants of the world.

Simultaneous quantitation of serum HBV DNA and HBeAg can distinguish between slow and fast viral responses to antiviral therapy in patients with chronic hepatitis B

BACKGROUND: The quantitation of serum HBeAg is not commonly used to monitor viral response to therapy in chronic hepatitis B. METHODS: In this study, 21 patients receiving varying therapies were followed and their viral response monitored by concomitant viral load and HBeAg quantitation in order to study the meaning and the kinetics of both parameters. RESULTS: It was possible to distinguish between three different patterns of viral response. The first was characterized by a simultaneous decrease in serum HBV DNA and HBeAg. The second pattern was characterized by a decrease in serum HBeAg but persistent detection of HBV DNA. The third pattern was characterized by undetectable HBV DNA with persistent HBeAg positivity, which points to a non-response (Pattern III-B) except when HBeAg levels showed a slow but steady drop, characterizing a "slow responder" patient (Pattern III-A). CONCLUSIONS: The first pattern is compatible with a viral response. A long-term HBeAg seropositivity with a slow and persistent decrease (Pattern III-A) is also compatible with a viral response and calls for a prolongation of anti-viral treatment.

Prevalence of discordant immunologic and virologic responses in patients with AIDS under antiretroviral therapy in a specialized care center in Brazil

Some patients under antiretroviral therapy (ART) do not reach immune recovery when the viral load becomes undetectable. This is called discordant immunologic and virologic responses. Its prevalence varies between 8% and 24%. This study describes its prevalence and the characteristics of the affected subjects in the outpatient clinic of a Brazilian specialized-care center. Of 934 patients on ART, 536 had undetectable viral loads. Prevalence was 51/536 or 9% (95% confidence interval: 6.6% to 11.4%). Median age at the beginning of ART was 37 years (interquartile range - IQR: 31 to 45). Male gender and mixed race predominated (76.5% and 47.1% respectively). AIDS-defining illnesses were absent at the beginning of ART in 60.8%. Fifty-one percent were taking protease inhibitors, 43.2% Efavirenz and 5.8% both. Median time on ART was 36 months (IQR: 17-81 months). Irregular treatment was recorded for 21.6%. ART had been modified for 63% prior to the study, and 15.7% had used monotherapy or double therapy. Median CD4 count was 255 cells/mm³ (IQR: 200-284). Median viral load before ART was 4.7 log10 copies/mL (IQR: 4.5-5.2). Discordant responders were not different from AIDS patients in general, but there was a high frequency of multiple schedules of treatment.