Diagnosing lymphoma in a setting with a high burden of infection: a pediatric case of Epstein-Barr virus-associated aggressive B-cell lymphoma with t(8;14) (q23;q32) and extensive necrosis mimicking tuberculosis

The association of lymphoma with necrotic granuloma can pose diagnostic challenges and delay treatment, especially in settings with a high burden of infection. In these settings, the timely use of cytogenetic and molecular methods is most relevant. Here, we report a case of B-cell lymphoma with t (8;14) in a 5-year-old male child. The lymphoma was associated with necrotic granuloma and was initially misdiagnosed as tuberculosis. Polymerase chain reaction was used to detect clonal lymphoproliferation and to rule out Mycobacterium tuberculosis infection. Tumor cells harbored Epstein-Barr virus and expressed CD20, CD10, BCL6, and Ki67 (30%), leading to the diagnosis of B-cell lymphoma with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma.

The intermediate snail-host: an agenda for future study

The strategy for the control of schistosomiasis has shifted from one directed towards the interruption of transmission to one of reducing morbidity. As a consequence of this change, it appears prudent to reassess the role of the malacologist and malacology and identify the future direction to be taken by the discipline. The present paper addresses these concerns; first, by reviewing the role of the snail-hosts in the epidemiology and control of schistosomiasis, and, secondly, by suggesting areas for future study. The possible application of newer methods in biotechnology for the resolution of malacological problems are discussed.

Genotyping of Mycobacterium tuberculosis isolates from alow-endemic setting in northwestern state of Paraná in Southern Brazil

The purpose of this study was to provide information about the genetic diversity and prevalent genotype of Mycobacterium tuberculosis in a low-endemic setting in northwestern state of Paraná in Southern Brazil. We employed spoligotyping and mycobacterial interspersed repetitive units-variable number tandem repeat (MIRU-VNTR) techniques to genotype M. tuberculosisisolates from patients with pulmonary tuberculosis (TB). The 93 isolates analyzed by spoligotyping were divided into 36 different patterns, 30 of which were described in the SITVIT database. Latin American and Mediterranean, Haarlem and T families were responsible for 26.9%, 17.2% and 11.8% of TB cases, respectively. From the 84 isolates analyzed by MIRU-VNTR, 58 shared a unique pattern and the remaining 26 belonged to nine clusters. The MIRU loci 40, 23, 10 and 16 were the most discriminatory. A combination of MIRU-VNTR and spoligotyping resulted in 85.7% discriminatory power (Hunter-Gaston index = 0.995). Thus, combining spoligotyping and MIRU-VNTR typing proved to be most useful for epidemiological study in this low-endemic setting in Southern Brazil. The current study demonstrated that there is significant diversity in circulating strains in the city of Maringá and the surrounding regions, with no single genotype of M. tuberculosispredominating.

The combination of three faecal parasitological methods to improve the diagnosis of schistosomiasis mansoni in a low endemic setting in the state of Ceará, Brazil

Laboratory diagnosis of intestinal schistosomiasis mansoni can be accomplished through various methods of stool examination to detect parasites, ranging from the most classic tests (Kato-Katz) to several methods that are still undergoing validation. This study was conducted to assess two new parasite identification methods for diagnosing schistosomiasis mansoni in residents of a low endemic area in the municipality of Maranguape, in the state of Ceará, Brazil using the Kato-Katz method as a reference and serology (enzyme-linked immunosorbent assay) for the screening of patients. The Kato-Katz, the saline gradient method and the Helmintex® method parasite identification methods were employed only in subjects who exhibited positive serologic tests. The test results were then analysed and treatment of positive individuals was subsequently performed. After comparing the test results, we observed that the saline gradient method and the Helmintex® method were more effective in diagnosing schistosomiasis mansoni in the study area compared with the Kato-Katz method.

Evaluation of a chemiluminescent enzyme-linked immunosorbent assay for the diagnosis of Trypanosoma cruzi infection in a nonendemic setting

The disappearance of lytic, protective antibodies (Abs) from the serum of patients with Chagas disease is accepted as a reliable indicator of parasitological cure. The efficiency of a chemiluminescent enzyme-linked immunosorbent assay based on a purified, trypomastigote-derived glycosylphosphatidylinositol-anchored mucin antigen for the serologic detection of lytic Abs against Trypanosoma cruzi was evaluated in a nonendemic setting using a panel of 92 positive and 58 negative human sera. The technique proved to be highly sensitive {100%; 95% confidence interval (CI) = 96-100} and specific (98.3%; 95% CI = 90.7-99.7), with a kappa score of 0.99. Therefore, this assay can be used to detect active T. cruzi infection and to monitor trypanosomicidal treatment.

The use of rapid dengue diagnostic tests in a routine clinical setting in a dengue-endemic area of Colombia

There is insufficient evidence of the usefulness of dengue diagnostic tests under routine conditions. We sought to analyse how physicians are using dengue diagnostics to inform research and development. Subjects attending 14 health institutions in an endemic area of Colombia with either a clinical diagnosis of dengue or for whom a dengue test was ordered were included in the study. Patterns of test-use are described herein. Factors associated with the ordering of dengue diagnostic tests were identified using contingency tables, nonparametric tests and logistic regression. A total of 778 subjects were diagnosed with dengue by the treating physician, of whom 386 (49.5%) were tested for dengue. Another 491 dengue tests were ordered in subjects whose primary diagnosis was not dengue. Severe dengue classification [odds ratio (OR) 2.2; 95% confidence interval (CI) 1.1-4.5], emergency consultation (OR 1.9; 95% CI 1.4-2.5) and month of the year (OR 3.1; 95% CI 1.7-5.5) were independently associated with ordering of dengue tests. Dengue tests were used both to rule in and rule out diagnosis. The latter use is not justified by the sensitivity of current rapid dengue diagnostic tests. Ordering of dengue tests appear to depend on a combination of factors, including physician and institutional preferences, as well as other patient and epidemiological factors.

Educação, cidadania e competividade: questões em torno de uma nova agenda

Há alguns anos tem-se firmado o debate em torno de uma agenda política e teórica que procura defender e sustentar uma articulação possível entre a procura de competitividade das economias e a manutenção e desenvolvimento dos direitos, nomeadamente sociais, que viabilizam e constituem condições de cidadania. Neste debate, que é atravessado por distintas posições, argumentos e propostas, a educação e formação são apontadas como eixos decisivos daquela articulação. A nossa argumentação vai no sentido de mobilizar análises e investigações em Ciências Sociais, trazendo para o centro da discussão questões e problemas que freqüentemente têm sido omitidos. Defendemos que, pelo contrário, é do confronto dessas questões e problemas que depende a possibilidade de constituir uma agenda política e teórica merecedora de crédito para uma via de desenvolvimento humana, social e ecologicamente sustentável.

Después de los 90: agenda de cuestiones educativas

El artículo propone una agenda de "cuestiones educativas" orientada a la reconstitución del lazo entre educación y democracia después de las reformas implementadas en los años 90. Construye previamente un estado de situación caracterizado por la presencia de tres procesos: a. un proceso de des-institucionalización escolar que se expresa tanto en la dificultad de la escuela para sostener un marco normativo sancionado socialmente, como en la crisis de identidad por la que atraviesan las instituciones; b. un proceso de fragmentación del sistema educativo que se diferencia de la tradicional segmentación de los sistemas; c. el agotamiento del instrumental teórico-conceptual con el que tradicionalmente nos hemos propuesto organizar y dar sentido a los fenómenos de la realidad. En este marco el artículo propone: 1. discutir los limites de la modernidad educativa en países periféricos como el nuestro y, en este marco, los de la pedagogía moderna para superar las problemáticas de discriminación y exclusión educativa; 2. rediscutir el concepto de ciudadanía y el papel de la escuela en la formación ciudadana; 3. repensar y discutir el papel del conocimiento y la investigación en la modificación de las practicas políticas y pedagógicas.

O renovado conservadorismo da agenda pós-moderna

O artigo tem como objetivo discutir aspectos da agenda pós-moderna e a permanência de sua vitalidade nos dias de hoje. Seu ponto de partida são as idéias desenvolvidas pela autora em artigos anteriores, nos quais privilegia a crítica às principais propostas das tendências "pós": o relativismo epistemológico, a suspeita em relação ao conhecimento objetivo e ao caráter estruturado das coisas e do mundo. Na primeira parte, retomam-se os textos de 1996 e 1998, que apresentam, ainda que rapidamente, as origens da "agenda pós" e indicam alguns de seus desdobramentos, notadamente a virada lingüística e a supressão das fronteiras entre História e Literatura; na segunda, recuperam-se as idéias expostas nos textos de 1998 e 2003, com vistas a mostrar algumas características do pensamento neopragmático de Richard Rorty. Finalmente, assinalam-se as principais repercussões desta ampla agenda na pesquisa e em práticas educacionais.

Combate ao sexismo em livros didáticos: construção da agenda e sua crítica

O artigo tem por objetivo descrever e problematizar a construção da agenda sobre "sexismo no livro didático" em cenário internacional e nacional. Para tanto, efetua uma revisão crítica da literatura desde a década de 1960 até a contemporaneidade, dando especial ênfase a permanências e mudanças, bem como a tensões detectadas na implementação de políticas que visam o combate ao "sexismo" nos livros didáticos.

Interesse dos estudantes pela medicina de família: estado da questão e agenda de pesquisa

Com a criação e a expansão do Programa Saúde da Família no Brasil, a Medicina de Família e Comunidade (MFC), como especialidade médica, ganhou destaque por ser a mais adequada a esse trabalho. Recentes parcerias entre os ministérios da Saúde e da Educação têm procurado regular a formação de recursos humanos em saúde para atender às demandas de consolidação do Sistema Único de Saúde (SUS) no âmbito da graduação e da pós-graduação. Houve investimento no aumento no número de vagas de residência em MFC, mas parece haver uma incongruência entre o que os futuros médicos almejam em suas carreiras e as necessidades do SUS, o que é demonstrado pelo número de vagas ociosas nesses programas. Com o objetivo de elencar hipóteses explicativas do desinteresse por essa especialidade, fizemos uma revisão de trabalhos que enfocaram essa temática. Encontramos que pouco prestígio, baixos salários, pouca vivência em atenção primária durante a graduação e elevada dívida com a universidade foram os fatores mais recorrentes. Concluímos que é necessário investigar essas hipóteses em nossa realidade, motivo pelo qual propomos uma agenda de pesquisa nessa direção.

Setting efficiency indicators for center pivots

In this study, it was discussed the efficiency criteria in each of the elements that compose a central pivot, and this analysis was applied to two sets of systems located in regions of Cruz Alta and Santo Augusto, state of Rio Grande do Sul, Brazil. The methodology used combines water and energy assessment through an indicator called Normalized Specific Consumption in Irrigation (C ENI), allowing thus a comparison between equipment and projects. The C ENI in Cruz Alta region showed 72% of the equipment above the standard (8.68 kWh mm-1 ha-1 100m-1), and in Santo Augusto region 64.28% with consumption above the standard. The mean irrigation efficiency for Cruz Alta region was 29.85%, with standard deviation of 5.41%, and for Santo Augusto region, it was 29.02%, with standard deviation of 5.15%.