Detection of psychiatric morbidity in the primary medical care setting in Brazil

The aims of this study were a) to assess the ability of primary care doctors to make accurate ratings of psychiatric disturbance and b) to evaluate the use of a case-finding questionnaire in the detection of psychiatric morbidity. The estudy took place in three primary care clinics in the city of São Paulo, Brazil, during a six-month survey. A time sample of consecutive adult attenders were asked to complete a case-finding questionnaire for psychiatric disorders (the Self Report Questionnaire - SRQ) and a subsample were selected for a semi-structured psychiatric interview (the Clinical Interview Schedule - CIS). At the end of the consultation the primary care doctors were asked to assess, in a standardized way, the presence or absence of psychiatric disorder; these assessments were then compared with that ratings obtained in the psychiatric interview. A considerable proportion of minor psychiatric morbidity remained undetected by the three primary care doctors: the hidden morbidity ranged from 22% to 79%. When these were compared to those of the case-finding questionnaire, they were consistently lower, indicating that the use of these instruments can enhance the recognition of psychiatric disorders in primary care settings. Four strategies for adopting the questionnaire are described, and some of the clinical consequences of its use are discussed.

Gerenciamento do setor saúde na década de 80, no Estado de São Paulo, Brasil

Foi analisado o processo de gerenciamento colegiado implementado pelas Ações Integradas de Saúde (AIS), no Estado de São Paulo, na década de 80. A base de dados foi constituída por informações coletadas junto à Comissão Interinstitucional de Saúde (CIS-SP). Foram também investigadas a participação dos diversos representantes, as decisões e as resoluções originadas nessa instância de gerenciamento do sistema de saúde. A análise conjunta das informações coletadas mostrou que houve mudança substancial no papel de gerenciamento do setor saúde no Estado, principalmente a partir de 1987. O processo de gestão colegiada, iniciada com as AIS, foi sendo substituído paulatinamente pela gestão única, com a separação nítida das responsabilidades entre os níveis de governo municipal, estadual e federal. Esta mudança dificultou o processo de negociação e de definição de objetivos comuns entre os responsáveis pela política de saúde, que vinham sendo constituídos no Estado desde as AIS.

Transtornos do humor em enfermaria de clínica médica e validação de escala de medida (HAD) de ansiedade e depressão

Para estimar a prevalência de transtornos do humor, foram utilizadas a entrevista estruturada, "Clinical Interview Schedule" (CIS-R), e a escala "Hospital Anxiety and Depression" (HAD) em 78 pacientes internados em uma enfermaria geral de adultos (43 homens e 35 mulheres, média de idade = 43,2 anos). Foi encontrada prevalência instantânea de 39% de transtornos do humor. Dezesseis (20,5%) pacientes preencheram critérios para ansiedade, a maioria dos casos sendo de gravidade leve. Vinte e seis (33%) casos de depressão foram detectados, 7 dos quais de gravidade moderada. Observou-se uma combinação de sintomas de preocupação, depressão, ansiedade e insônia. A HAD mostrou-se de fácil compreensão pelos pacientes. As subescalas de ansiedade e de depressão tiveram consistência interna de 0,68 e 0,77, respectivamente. A correlação dos itens com as respectivas subescalas sugere que essas possuem validades convergentes, não discriminantes. Com ponto de corte 8/9, a sensibilidade e a especificidade foram 93,7% e 72,6%, para ansiedade, e 84,6% e 90,3%, para depressão. Na prática clínica, a utilização da HAD poderia auxiliar na detecção de casos de transtornos do humor que necessitam de tratamento.

Contributions of culture and antimicrobial susceptibility tests to the retreatment of patients with pulmonary tuberculosis

Introduction This study evaluated the efficacy of retreatment of pulmonary tuberculosis (TB) with regard to treatment outcomes and antimicrobial susceptibility testing (ST) profiles. Methods This retrospective cohort study analyzed 144 patients treated at a referral hospital in Brazil. All of them had undergone prior treatment, were smear-positive for TB and received a standardized retreatment regimen. Fisher's 2-tailed exact test and the χ2 test were used; RRs and 95% CIs were calculated using univariate and multivariate binary logistic regression. Results The patients were cured in 84 (58.3%) cases. Failure was associated with relapsed treatment and abandonment (n=34). Culture tests were obtained for 103 (71.5%) cases; 70 (48.6%) had positive results. ST results were available for 67 (46.5%) cases; the prevalence of acquired resistance was 53.7%. There were no significant differences between those who achieved or not therapeutic success (p=0.988), despite being sensitive or resistant to 1 or more drugs. Rifampicin resistance was independently associated with therapeutic failure (OR: 4.4, 95% CI:1.12-17.37, p=0.034). For those cases in which cultures were unavailable, a 2nd model without this information was built. In this, return after abandonment was significantly associated with retreatment failure (OR: 3.59, 95% CI:1.17-11.06, p=0.026). Conclusions In this cohort, the general resistance profile appeared to have no influence on treatment outcome, except in cases of rifampicin resistance. The form of reentry was another independent predictor of failure. The use of bacterial culture identification and ST in TB management must be re-evaluated. The recommendations for different susceptibility profiles must also be improved.

Identificação de bergenina e carotenóides no fruto de uchi (Endopleura uchi, Humiriaceae)

O extrato obtido em metanol da polpa de frutos Endopleura uchi foi submetido a fracionamento utilizando-se técnicas cromatográficas convencionais levando ao isolamento de bergenina. Na análise da composição dos carotenóides foi evidenciada a predominância de beta-caroteno (16,57 mig.g-1). Os isômeros do beta-caroteno foram detectados, trans-beta-caroteno (89,3%), 13-cis-beta-caroteno (8%) e 9-cis-beta-caroteno (3%). Considerando a importância do papel nutricional dos carotenóides e a bioatividade do glicosídeo bergenina, esse estudo sugeriu o potencial desse fruto como alimento funcional.

Isomerização do óleo essencial de pimenta-longa (Piper hispidinervium C. DC) para a obtenção de isosafrol

As piperáceas brasileiras apresentam propriedades para serem utilizadas, entre outras aplicações, como inseticidas e antifúngicos. Dentre as piperáceas, pode-se citar a Piper hispidinervum C. DC. De suas folhas e dos talos finos extrai-se um óleo essencial rico em safrol, que é utilizado pela indústria como matéria-prima na manufatura, por exemplo, do piperonal. A sequência natural do processo para a obtenção do piperonal é o de submeter o safrol obtido da concentração do óleo essencial à isomerização para seu correspondente isômero estável chamado isosafrol. Apresenta-se neste artigo, por sua vez, a síntese do isosafrol diretamente do óleo essencial de pimenta-longa (Piper hispidinervium C. DC). Este óleo essencial apresenta o safrol como constituinte majoritário, possibilitando a sua isomerização para a produção de isosafrol, que é empregado nas indústrias farmacêuticas e de fragrâncias. O objetivo deste trabalho é o de apresentar a obtenção do isosafrol sem a necessidade da etapa de separação do safrol do óleo essencial de pimenta-longa. Para tanto, foram realizados ensaios de isomerização do óleo essencial, obtendo-se uma solução contendo 79,4 % da mistura cis, trans-isosafrol. Ressalte-se que o óleo essencial continha 86,4 % de safrol, resultando em alto rendimento na sua conversão a cis, trans-isosafrol de 97,1 %.

Síntese do piperonal a partir do óleo essencial de pimenta longa (Piper hispidinervium C. DC.)

O óleo essencial de pimenta longa (Piper hispidinervum C. DC) é rico em safrol, tornando-o suscetível à reação de isomerização para a obtenção de cis, trans-isosafrol. O presente artigo apresenta a etapa de eletroxidação dos isômeros cis, trans-isosafrol advindos da isomerização direta do óleo essencial de pimenta longa, apresentando 99,7% de conversão em isosafrol glicol, o qual é sujeito à oxidação com conversão de 99% em piperonal, este apresentando 84,9% de pureza.

Effects of Yoga in Patients with Chronic Heart Failure: A Meta-Analysis

The use of yoga as an effective cardiac rehabilitation in patients with chronic heart failure (CHF) remains controversial. We performed a meta-analysis to examine the effects of yoga on exercise capacity and health-related quality of life (HRQOL) in patients with CHF. Methods: We searched MEDLINE, Cochrane Central Register of Controlled Trials, Excerpta Medica database, LILACS, Physiotherapy Evidence Database, The Scientific Electronic Library Online, and Cumulative Index to Nursing and Allied Health (from the earliest date available to December 2013) for randomized controlled trials (RCTs) examining the effects of yoga versus exercise and/or of yoga versus control on exercise capacity (peakVO2) and quality-of-life (HRQOL) in CHF. Two reviewers selected studies independently. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I2 test. Two studies met the selection criteria (total: 30 yoga and 29 control patients). The results suggested that yoga compared with control had a positive impact on peak VO2 and HRQOL. Peak VO2, WMD (3.87 95% CI: 1.95 to 5.80), and global HRQOL standardized mean differences (-12.46 95% CI: -22.49 to -2.43) improved in the yoga group compared to the control group. Yoga enhances peak VO2 and HRQOL in patients with CHF and could be considered for inclusion in cardiac rehabilitation programs. Larger RCTs are required to further investigate the effects of yoga in patients with CHF.

Antileishmanial action of organometallic complexes of Pt(II) and Rh(I)

The three organometallic complexes [(Cis-PtII (DDH) (2,5-Dihidroxibenzensulfonic)2, RhI (CO)2 Cl(2-Aminobenzothiazole) and RhI (CO)2 Cl(5-Cl-2-Methilbenzothiazole)] used in this study had been previously found to have a high in vitro activity against promastigote and amastigote like forms of Leishmania donovani. Here, the cytotoxic effect of these new organometallic complexes on the J-774 macrophages were studied. Only the RhI(CO)2 Cl (2-Aminobenzothiazole) complex induced substantial toxicity in the cells. Also, we assayed the effect of this complex on the parasite's biosynthesis of macromolecules. The RhI(CO)2Cl (5-Cl-2-Methylbenzothiazole) complex inhibited DNA, RNA, and protein synthesis. On the other hand, the two other compounds tested did not inhibit the incorporation of radioactive precursors. Finally important ultrastructural alterations in the parasites treated with the two non-cytotoxic complexes were observed.

Incoordination, Paralysis and Recovery after Pyrethroid Treatment on Nymphs III of Triatoma infestans (Hemiptera: Reduviidae)

Symptoms of poisoning for deltamethrin and cis-permethrin on nymphs III of Triatoma infestans were described. The time required for incoordination and paralysis were determined. Deltamethrin was equal or more rapid in the onset of the first effect (accordingly to dose), and cis-permethrin in the onset of the second one. There were no significant differences between incoordination doses 50% (IncD50s) at different times for the two pyrethroids. They showed equivalent incoordination power, but the nymphs treated with deltamethrin recovered slightly more rapid and in greater amount than the nymphs treated with cis-permethrin. The recovery was inhibited by the simultaneus application of piperonyl butoxide. This result suggests that biotransformation by mixed-function microsomal oxidases are involved in the process of recovery

Mechanisms of formation and function of eosinophil lipid bodies: inducible intracellular sites involved in arachidonic acid metabolism

Lipid bodies, inducible lipid-rich cytoplasmic inclusions, are characteristically abundant in cells associated with inflammation, including eosinophils. Here we reviewed the formation and function of lipid bodies in human eosinophils. We now have evidence that the formation of lipid bodies is not attributable to adverse mechanisms, but is centrally mediated by specific signal transduction pathways. Arachidonic acid and other cis fatty acids by an NSAID-inhibitable process, diglycerides, and PAF by a 5-lipoxygenase dependent pathway are potent stimulators of lipid body induction. Lipid body formation develops rapidly by processes that involve PKC, PLC, and de novo mRNA and protein synthesis. These structures clearly serve as repositoires of arachidonyl-phospholipids and are more than inert depots. Specific enzymes, including cytosolic phospholipase A2, MAP kinases, lipoxygenases and cyclooxygenases, associate with lipid bodies. Lipid bodies appear to be dynamic, organelle-like structures involved in intracellular pathways of lipid mobilization and metabolism. Indeed, increases in lipid body numbers correlated with enhanced production of both lipoxygenase- and cyclooxygenase-derived eicosanoids. We hypothesize that lipid bodies are distinct inducible sites for generating eicosanoids as paracrine mediators with varied activities in inflammation. The capacity of lipid body formation to be specifically and rapidly induced in leukocytes enhances eicosanoid mediator formation, and conversely pharmacologic inhibition of lipid body induction represents a potential novel and specific target for anti-inflammatory therapy.

Understanding mechanisms and the role of differentiation in pathogenesis of Toxoplasma gondii: a review

Parasite differentiation from proliferating tachyzoites into latent bradyzoites is central to pathogenesis and transmission of the intracellular protozoan pathogen Toxoplasma gondii. The presence of bradyzoite-containing cysts in human hosts and their subsequent rupture can cause life-threatening recrudescence of acute infection in the immunocompromised and cyst formation in other animals contributes to zoonotic transmission and widespread dissemination of the parasite. In this review, we discuss the evidence showing how the clinically relevant process of bradyzoite differentiation is regulated at both transcriptional and post-transcriptional levels. Specific regulatory factors implicated in modulating bradyzoite differentiation include promoter-based cis-elements, epigenetic modifications and protein translation control through eukaryotic initiation factor -2 (eIF2). In addition to a summary of the current state of knowledge in these areas we discuss the pharmacological ramifications and pose some questions for future research.

Oxidative stress response to menadione and cumene hydroperoxide in the opportunistic fungal pathogen Candida glabrata

Candida glabrata is an opportunistic fungal pathogen that can cause severe invasive infections and can evade phagocytic cell clearance. We are interested in understanding the virulence of this fungal pathogen, in particular its oxidative stress response. Here we investigated C. glabrata, Saccharomyces cerevisiae and Candida albicans responses to two different oxidants: menadione and cumene hydroperoxide (CHP). In log-phase, in the presence of menadione, C. glabrata requires Cta1p (catalase), while in a stationary phase (SP), Cta1p is dispensable. In addition, C. glabrata is less resistant to menadione than C. albicans in SP. The S. cerevisiae laboratory reference strain is less resistant to menadione than C. glabrata and C. albicans; however S. cerevisiaeclinical isolates (CIs) are more resistant than the lab reference strain. Furthermore, S. cerevisiae CIs showed an increased catalase activity. Interestingly, in SP C. glabrata and S. cerevisiae are more resistant to CHP than C. albicans and Cta1p plays no apparent role in detoxifying this oxidant.

New insights into trypanosomatid U5 small nuclear ribonucleoproteins

Several protozoan parasites exist in the Trypanosomatidae family, including various agents of human diseases. Multiple lines of evidence suggest that important differences are present between the translational and mRNA processing (trans splicing) systems of trypanosomatids and other eukaryotes. In this context, certain small complexes of RNA and protein, which are named small nuclear ribonucleoproteins (U snRNPs), have an essential role in pre-mRNA processing, mainly during splicing. Even though they are well defined in mammals, snRNPs are still not well characterized in trypanosomatids. This study shows that a U5-15K protein is highly conserved among various trypanosomatid species. Tandem affinity pull-down assays revealed that this protein interacts with a novel U5-102K protein, which suggests the presence of a sub-complex that is potentially involved in the assembly of U4/U6-U5 tri-snRNPs. Functional analyses showed that U5-15K is essential for cell viability and is somehow involved with the trans and cis splicing machinery. Similar tandem affinity experiments with a trypanonosomatid U5-Cwc21 protein led to the purification of four U5 snRNP specific proteins and a Sm core, suggesting U5-Cwc-21 participation in the 35S U5 snRNP particle. Of these proteins, U5-200K was molecularly characterized. U5-200K has conserved domains, such as the DEAD/DEAH box helicase and Sec63 domains and displays a strong interaction with U5 snRNA.

Regulatory elements involved in the post-transcriptional control of stage-specific gene expression in Trypanosoma cruzi: a review

Trypanosoma cruzi, a protozoan parasite that causes Chagas disease, exhibits unique mechanisms for gene expression such as constitutive polycistronic transcription of protein-coding genes, RNA editing and trans-splicing. In the absence of mechanism controlling transcription initiation, organized subsets of T. cruzi genes must be post-transcriptionally co-regulated in response to extracellular signals. The mechanisms that regulate stage-specific gene expression in this parasite have become much clearer through sequencing its whole genome as well as performing various proteomic and microarray analyses, which have demonstrated that at least half of the T. cruzi genes are differentially regulated during its life cycle. In this review, we attempt to highlight the recent advances in characterising cis and trans-acting elements in the T. cruzi genome that are involved in its post-transcriptional regulatory machinery.