Late diagnosis and vulnerabilities of the elderly living with HIV/AIDS

OBJECTIVE To identify vulnerabilities of elderly people with HIV/AIDS and the trajectory that they follow until reaching the diagnosis of the disease. METHOD Qualitative research conducted in specialized clinics in the state of São Paulo, from January to June 2011. Semi-structured interviews were conducted with 11 elderly people who were found to be infected with the virus at the age of 60 years or older. The interviews were analyzed using content analysis. RESULTS In this process four categories emerged, then analyzed with reference to the theoretical framework of vulnerability. CONCLUSION Late diagnosis of HIV infection or AIDS among the elderly happens in the secondary or tertiary service. Issues related to sexual life of the elderly are only questioned by health professionals after the diagnosis, also the time that condom use becomes absolute. It is believed that the investigation of the vulnerability of the elderly to HIV/AIDS allows for carrying out appropriate interventions for this population.

Occurrence and Structure of Arbuscular Mycorrhizal Fungal Communities in Cassava after Cultivation of Cover Crops as Observed by the “PCR-DGGE” Technique

ABSTRACT Cassava (Manihot esculenta Crantz) is a highly mycotrophic crop, and prior soil cover may affect the density of arbuscular mycorrhizal fungi (AMFs), as well as the composition of the AMFs community in the soil. The aim of this study was to evaluate the occurrence and the structure of AMFs communities in cassava grown after different cover crops, and the effect of the cover crop on mineral nutrition and cassava yield under an organic farming system. The occurrence and structure of the AMFs community was evaluated through polymerase chain reaction (PCR) and denaturing gradient gel electrophoresis (DGGE). A randomized block experimental design was used with four replications. Six different cover crop management systems before cassava were evaluated: black oats, vetch, oilseed radish, intercropped oats + vetch, intercropped oats + vetch + oilseed radish, plus a control (fallow) treatment mowed every 15 days. Oats as a single crop or oats intercropped with vetch or with oilseed radish increased AMFs inoculum potential in soil with a low number of propagules, thus benefiting mycorrhizal colonization of cassava root. The treatments did not affect the structure of AMFs communities in the soil since the AMFs communities were similar in cassava roots in succession to different cover crops. AMFs colonization was high despite high P availability in the soil. The cassava crop yield was above the regional average, and P levels in the leaves were adequate, regardless of which cover crop treatments were used. One cover crop cycle prior to the cassava crop was not enough to observe a significant response in variables, P in plant tissue, crop yield, and occurrence and structure of AMFs communities in the soil. In the cassava roots in succession, the plant developmental stage affected the groupings of the structure of the AMF community.

POPULATION STRUCTURE AND SPATIAL DISTRIBUTION OF Bauhinia cheilantha (Bong.) Steud. IN TWO FRAGMENTS AT DIFFERENT REGENERATION STAGES IN THE CAATINGA, IN SERGIPE, BRAZIL

ABSTRACTThis study aimed to analyze the vertical and diameter structure and the spatial distribution pattern of Bauhinia cheilantha in two Caatinga fragments in Sergipe, Brazil, at different regeneration stages. Thirty plots were demarcated in area I (Canindé de São Francisco and Poço Redondo), which has vegetation regeneration, and 25 plots in area II (Porto da Folha) with preserved vegetation, both having 400 m2. All B. cheilanthaindividuals had their height and circumference (circumference at breast height > 6 cm) measured. Possible differences in height and diameter at breast height were tested in the two populations by using Student’s T-test. The distribution pattern of species was calculated through Payandeh’s index. We sampled 154 B. cheilantha individuals, equivalent to 33.3% of the plots in area I and in 1,027 individuals in area II, totaling 100% frequency. Height and the diameter of the two populations were statistically different, where AI achieved all values lower than AII. The spatial distribution pattern of B. cheilantha found in both areas was aggregate, with values of 11.85 and 9.00, respectively. Thus, it became clear that the population in AII is at a more advanced successional status than AI, due to its longer conservation time.

Structure and dynamics of a woody plant community of a tropical semi-deciduous seasonal forest in the "Estação Ecológica do Panga", municipality of Uberlândia, Minas Gerais, Brazil

Studies of plant community dynamics are essential in understanding the demographic patterns of species since changes in demographic rates can affect the floristic composition and future structure. The purpose of the present study was to analyze the changes in the community structure and floristic composition of woody plants in a tropical semi-deciduous forest in Uberlândia in central Brazil, during a 10-years period. The data were collected in 1989 and in 2000 in 50 quadrats (10 m x 10 m) where all trees with a minimum circumference at breast height of 10 cm were sampled. In 1989, 93 species and 1103 individuals were registered. Over a period of 10 years, seven new species were added to the community, although eight disappeared. The main change that occurred during this period in the floristic composition was the replacement of savannah species occurring in forest gaps by those from the forest understory.

Floristics, structure and soil of insular vegetation in four quartzite-sandstone outcrops of "Chapada Diamantina", Northeast Brazil

Soil islands on rocky surfaces often harbor aggregated vegetation that consists of insular plant communities. These islands are typical of the rocky outcrops and in various parts of Brazil form the so-called "campos rupestres" vegetation. Four of such sites have been selected in the state of Bahia, Northeast Brazil, for this comparative study on floristics and vegetation structure: three areas situated inside the "Parque Nacional da Chapada Diamantina" (Guiné, Fumaça and "Gerais da Fumaça") and one is at the border of the Environmental Protection Area of "Marimbus-Iraquara" ("Mãe Inácia"). All occurring vegetation islands were studied in four random plots of 10 × 10 m per site. Soil was often shallow, sandy and acidic. Vascular plant species were determined, with respective life forms and canopy coverage areas. The total number of species when all four sites were added was 135, and the number of species per island varied from 2 to 32. The areas of the 214 soil islands varied from 0.015 to 91.9 m², totaling 568 m² in the four sites. Monocotyledon families were dominant, essentially Velloziaceae, as well as Orchidaceae, Bromeliaceae, Amaryllidaceae and Cyperaceae. Among the eudicotyledons, dominant families were mainly Clusiaceae, Asteraceae and Melastomataceae. The biological spectra revealed that phanerophytes and hemicryptophytes predominated among the life forms, while chamaephytes had the largest coverage area. Epilithic and desiccant chamaephytes composed the most conspicuous interspecific associations, and were probably related to early successional processes. Sites closest to one another were not the most similar in structure, indicating that other factors more relevant than distance might be involved in the abundance of species in space.

Tillering and forage accumulation in Marandu grass under different grazing intensities

Studies of plant responses to defoliation are important to develop pasture management strategies. The objective of this study was to evaluate the population density of basal, aerial and reproductive tillers, tiller appearance and mortality rates, forage accumulation and sward structure in Marandu grass pastures under different grazing intensities. The experimental period was from January to June 2006, divided in three seasons: summer, autumn and winter. The pastures were continuously grazed using variable stocking rates. The grazing intensities corresponded to 15, 30 and 45 cm of sward height. The experiment was arranged in a complete randomized block design with three treatments and two replicates. The sward heights were measured twice a week. The response variables were: forage accumulation, forage mass and its morphological components; and population densities of basal (TPDb), aerial (TPDa) and reproductive (TPDr) tillers. The highest TPDb (P > 0.05) was recorded for the shortest sward pasture, and the highest TPDr (P<0.05) for the tallest sward pasture. Swards showed a tiller size/density compensation mechanism and, consequently, the forage accumulation was similar (P > 0.05) among the grazing intensities. Pasture with a sward height of 35 cm had 94% of sun light interception. The highest variations in forage accumulation and sward structure were more influenced by seasonal differences than by grazing intensities. Pastures of Marandu grass showed large flexibility in grazing management, which allowed it to be maintained at sward heights between 15 and 35 cm.

Prevalence rates of infection in intensive care units of a tertiary teaching hospital

OBJECTIVE: To determine the prevalence rates of infections among intensive care unit patients, the predominant infecting organisms, and their resistance patterns. To identify the related factors for intensive care unit-acquired infection and mortality rates. DESIGN: A 1-day point-prevalence study. SETTING:A total of 19 intensive care units at the Hospital das Clínicas - University of São Paulo, School of Medicine (HC-FMUSP), a teaching and tertiary hospital, were eligible to participate in the study. PATIENTS: All patients over 16 years old occupying an intensive care unit bed over a 24-hour period. The 19 intensive care unit s provided 126 patient case reports. MAIN OUTCOME MEASURES: Rates of infection, antimicrobial use, microbiological isolates resistance patterns, potential related factors for intensive care unit-acquired infection, and death rates. RESULTS: A total of 126 patients were studied. Eighty-seven patients (69%) received antimicrobials on the day of study, 72 (57%) for treatment, and 15 (12%) for prophylaxis. Community-acquired infection occurred in 15 patients (20.8%), non- intensive care unit nosocomial infection in 24 (33.3%), and intensive care unit-acquired infection in 22 patients (30.6%). Eleven patients (15.3%) had no defined type. The most frequently reported infections were respiratory (58.5%). The most frequently isolated bacteria were Enterobacteriaceae (33.8%), Pseudomonas aeruginosa (26.4%), and Staphylococcus aureus (16.9%; [100% resistant to methicillin]). Multivariate regression analysis revealed 3 risk factors for intensive care unit-acquired infection: age > 60 years (p = 0.007), use of a nasogastric tube (p = 0.017), and postoperative status (p = 0.017). At the end of 4 weeks, overall mortality was 28.8%. Patients with infection had a mortality rate of 34.7%. There was no difference between mortality rates for infected and noninfected patients (p=0.088). CONCLUSION: The rate of nosocomial infection is high in intensive care unit patients, especially for respiratory infections. The predominant bacteria were Enterobacteriaceae, Pseudomonas aeruginosa, and Staphylococcus aureus (resistant organisms). Factors such as nasogastric intubation, postoperative status, and age ³60 years were significantly associated with infection. This study documents the clinical impression that prevalence rates of intensive care unit-acquired infections are high and suggests that preventive measures are important for reducing the occurrence of infection in critically ill patients.

Amazon landforms and soils in relation to biological diversity

Thirteen main landform units are distinguished for the whole of the forested Amazon region, each with its specific soil pattern and vegetation structure. These landform-soil-vegetation units are delineated on a small-scale map and illustrated by a schematic cross-section. Floristic diversity of the gamma type is to be highest on the steepland-and-valley complexes of the Andean fringe, on the crystalline shield uplands, on the inselberg complexes, and on the eutric variant of the western sedimentary plains. Endemism is expected to be highest on the sandy plains, and parts of the table lands and inselberg complexes. Speciation, linked to the concept of forest refuge areas, is likely to be highest on the sandstone table lands, on the stretches of Amazon planalto, and in the areas of relict valleys, in view of the prolonged geomorphological stability of these units.

Tree species diversity in a seasonally-dry forest: the case of the Pinkaití site, in the Kayapó Indigenous Area, Southeastern limits of the Amazon

This study investigates patterns of forest structure and tree species diversity in an anthropogenic palm grove and undisturbed areas at the seasonally-dry Pinkaití research station, in the Kayapó Indigenous Area. This site, managed by the Conservation International do Brasil, is the most southeastern site floristically surveyed in the Amazon until now. The secondary and a nearby undisturbed forest were sampled in a group of 52 floristic plots of 0.0625-ha (25x25-m) where all trees with DBH > 10 cm were measured and identified. The analyses were complemented with other two floristic plots of 1-ha (10x1000-m). The present study has shown that the Pinkaití, like other seasonally-dry forests, have great heterogeneity in forest structure and composition, associated with biotic characteristics of the most important tree species, natural disturbance and history of land-use. The palm grove, moderately dominated by the arborescent palm Attalea maripa (Aubl.) Mart., presented high tree species diversity and was floristically similar to undisturbed forests at the study site. It is discussed the importance of large arborescent palms for the seasonally-dry Amazon forests regeneration.

The morphology of the foregut of larvae and postlarva of Sesarma curacaoense De Man, 1892: a species with facultative lecithotrophy during larval development

Previous study on the resistance of larvae of Sesarma curacaoense submitted to starvation has revealed a facultative lecithotrophy during zoeal stages, but megalopa and first juvenile stages are exclusively feeding stages. In the present study, the gross morphology and fine structure of the foregut of S. curacaoense were investigated during larval, megalopa and first juvenile stages. The foregut of the zoea I show specific setae and a filter press apparently functional. The foregut undergoes changes in the zoea II (last larval stage) with increment of setae number, mainly on the cardiopyloric valve and complexity of the filter press. After metamorphosis to megalopa stage the foregut become rather complex, with a gastric mill supporting a medial and two lateral teeth well-developed. The foregut of the first juvenile is more specialized compared to the previous stage, showing similar characteristics of the decapod adults. These results provide further evidence of facultative lecithotrophic development in the larvae of S. curacaoense.

Close relationship between diameters at 30cm height and at breast height (DBH)

This paper proposes the establishment of a second diameter measuring standard at 30cm shoot extension ('diam30') as input variable for allometric biomass estimation of small and mid-sized plant shoots. This diameter standard is better suited than the diameter at breast height (DBH, i.e. diameter at 1.30m shoot extension) for adequate characterization of plant dimensions in low bushy vegetation or in primary forest undergrowth. The relationships between both diameter standards are established based on a dataset of 8645 tree, liana and palm shoots in secondary and primary forests of central Amazonia (ranging from 1-150mm dbh). Dbh can be predicted from the diam(30) with high precision, the error introduced by diameter transformation is only 2-3% for trees and palms, and 5% for lianas. This is well acceptable for most field study purposes. Relationships deviate slightly from linearity and differ between growth forms. Relationships were markedly similar for different vegetation types (low secondary regrowth vs. primary forests), soils, and selected genera or species. This points to a general validity and applicability of diameter transformations for other field studies. This study provides researchers with a tool for the allometric estimation of biomass in low or structurally heterogeneous vegetation. Rather than applying a uniform diameter standard, the measuring position which best represents the respective plant can be decided on shoot-by-shoot. Plant diameters measured at 30cm height can be transformed to dbh for subsequent allometric biomass estimation. We recommend the use of these diameter transformations only for plants extending well beyond the theoretical minimum shoot length (i.e., >2m height). This study also prepares the ground for the comparability and compatability of future allometric equations specifically developed for small- to mid-sized vegetation components (i.e., bushes, undergrowth) which are based on the diam(30) measuring standard.

Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System

Background:Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial.Objective:To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective.Methods:We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied.Results:Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios.Conclusions:Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.

Study of a population of Biomphalaria tenagophila (Orbigny, 1835) and of schistosomiasis transmission in "Alto da Boa Vista", Rio de Janeiro

The present study was performed using data from a Biomphalaria tenagophila population located in a water cress garden in the Alto da Boa Vista region representing an isolated focal point of schistosomiasis in the city of Rio de Janeiro. The density and age structure of this B. tenagophila population and its rate of intection by Schistosoma mansoni were studied for a period of 15 months. The snail population showed seasonal variation in density, with a decrease in number of individual at the begining of the rainy season. At the end of this season, the population consisted mainly of adults (92.8% in May 1985 and 82.8% in April 1986). The population growth curve was logistic and of sigmoidal configuration. Shiscotoma mansoni cercariae were eliminated over a short period of time (March, April and May 1986). The release of cercariae of S. mansoni and of birds seems to depend on environmental temperature, which during certain months would show a daily variation of up to 13ºC, with the lower thermal limit approaching the limit value for sporocyte development.

Some new species of Caryospora (Apicomplexa: Eimeriidae) from brazilian snakes, and a re-description of C. jararacae Carini, 1939

The mature ooxysts of six new species of Caryospora are described from the faeces of Brazilian snakes. They are differentiated from other species previously recorded from reptiles, largely on the size and shape of the oocyst and sporocyst, structure of the oocyst wall, and presence or absence of a polar body. C. paraensis n. sp., and C. carajasensis n. sp., are from the "false coral", Oxyrhopus petola digitalis; C. pseustesi n. sp., from the "egg-eater", Pseustes sulphureus sulphureus; C. epicratesi n. sp., from the "red boa", Epicrates cenchria cenchria; and C. micruri n. sp., and C. constancieae n. sp., from the "coral snake", Micrurus spixii spixii. A re-description is given of C. jararacae Carini, 1939, from the "jararaca" Bothrops atrox, embodying some additional morphological features.

Morphological comparison of axenic amastigogenesis of trypomastigotes and metacyclic forms of Trypanosoma cruzi

Amastigogenesis occurs first when metacyclic trypomastigotes from triatomine urine differentiate into amastigotes inside mammalian host cells and a secondary process when tissue-derived trypomastigotes invade new cells and differentiate newly to amastigotes. Using scanning electron microscopy, we compared the morphological patterns manifested by trypomastigotes and metacyclic forms of Trypanosoma cruzi during their axenic-transformation to amastigotes in acidic medium at 37°C. We show here that in culture MEMTAU medium, secondary and primary axenic amastigogenesis display different morphologies. As already described, we also observed a high differentiation rate of trypomastigotes into amastigotes. Conversely, the transformation rate of in vitro-induced-metacyclic trypomastigotes to amastigotes was significantly slower and displayed distinct patterns of transformation that seem environment-dependent. Morphological comparisons of extracelullar and intracellular amastigotes showed marked similarities, albeit some differences were also detected. SDS-PAGE analyses of protein and glycoprotein from primary and axenic extracelullar amastigotes showed similarities in glycopeptide profiles, but variations between their proteins demonstrated differences in their respective macromolecular constitutions. The data indicate that primary and axenic secondary amastigogenesis of T. cruzi may be the result of different developmental processes and suggest that the respective intracellular mechanisms driving amastigogenesis may not be the same.