Nutritional assessment and lipid profile in HIV-infected children and adolescents treated with highly active antiretroviral therapy

INTRODUCTION: HIV-infected children and adolescents treated with highly active antiretroviral therapy (HAART) regimens that include a protease inhibitor (PI) can show significant improvements in clinical outcomes, nutritional status and quality of life. The study aimed to report nutritional and metabolic alterations for pediatric patients continuously exposed to HAART and for healthy controls for up to 1 year. METHODS: Clinical, anthropometric, lipid profile and food intake data were collected prospectively over approximately 12-months for each patient. RESULTS: Fifty-one individuals were studied, of these, 16 were healthy. After 12 months follow-up, HIV-positive individuals remained below the healthy control group parameters. No change was observed concerning food intake. Triglyceride serum levels were higher in patients using protease inhibitor at the onset of the study [PI groups: 114 (43 - 336), and 136 (63 - 271) versus control group: 54.5 (20 - 162); p = 0.003], but after twelve months follow-up, only the group using protease inhibitor for up to two months presented higher values [140 (73 - 273) versus 67.5 (33 - 117); p = 0.004]. HDL-cholesterol was lower in HIV-positive individuals [HIV-positive groups: 36 (27 - 58) and 36 (23 - 43); control 49.5 (34 - 69); p = 0.004]. CONCLUSIONS: HIV-infected children and adolescents treated with highly active antiretroviral therapy showed compromised nutritional parameters compared to a paired healthy control group. Individuals using protease inhibitor presented worse triglyceride serum levels compared to their healthy counterparts.

Enteric parasites in HIV-1/AIDS-infected patients from a Northwestern São Paulo reference unit in the highly active antiretroviral therapy era

INTRODUCTION: We describe the epidemiology of intestinal parasites in patients from an AIDS reference service in Northeastern São Paulo, Brazil. METHODS: Retrospective evaluation was done for all HIV-1/AIDS-positive patients whose Hospital de Base/São José do Rio Preto laboratorial analysis was positive for enteroparasites after diagnosis of HIV-1 infection, from January 1998 to December 2008. Statistical analysis was performed using the R statistical software version 2.4.1. The level of significance adopted was 5%. RESULTS: The most frequent protozoan was Isospora belli (4.2%), followed by Giardia lamblia (3.5%), Entamoeba coli (2.8%), and Cryptosporidium parvum (0.3%). Ancylostoma duodenale (1.4%) was the most frequently detected helminth, while Taenia saginata and Strongiloides stercoralis were found in 0.7% of the samples. The results showed that diarrhea was significantly associated with giardiasis and isosporiasis. However, no association was observed between CD4+ cell counts, viral load, and the characteristics of any particular parasite. CONCLUSIONS: Our data may be useful for further comparisons with other Brazilian regions and other developing countries. The data may also provide important clues toward improving the understanding, prevention, and control of enteric parasites around the world.

S100, CD68, and MHC class II molecule expression in cervical high- and low-grade HPV-induced lesions

INTRODUCTION: Some human papillomavirus (HPV) types are involved in malignant processes in the cervical epithelium, with 99% of cases attributed to oncogenic HPV infection. This study aimed to detect S100, CD68, and major histocompatibility complex class II (MHC-II) molecules in cervical uterine epithelial samples in patients with high- and low-grade lesions induced by HPV. METHODS: Fifty-eight samples from patients who were confirmed positive or negative for high-risk oncogenic HPV DNA, had histopathological diagnosis of cervical intraepithelial neoplasia (CIN) of grades I, II, or III, or were negative for intraepithelial lesion or malignancy were subjected to immunohistochemistry reaction to S100 protein, CD68, and MHC-II (HLA-DR alpha chain). RESULTS: The presence of MHC-II predominated in samples exhibiting histopathological alterations (p < 0.05). S100 detection was more numerous in carcinoma samples (CIN III) (75%). Presence of this protein correlated significantly (p < 0.05) with histopathological findings and viral load. CONCLUSIONS: A small expression of CD68 was observed, which may be explained by the observation in our study having been made on random microscopic fields and not on specific areas. The findings, such as the presence of S100 protein and MHC-II expression in samples with histological alterations, could suggest that the immune system fails to control HPV replication at the early stages of infection. Further studies with larger prospective data are necessary to confirm this result.

Late diagnosis and HIV infection in children attending a service of specialized care for pediatric AIDS in Brazil

Introduction: This study describes the frequency of late diagnosis and HIV among children attending a pediatric AIDS clinic. Methods: Cross-sectional study in children exposed to HIV from 2005-2008. A questionnaire was given that included questions on demographics and clinical information. Results: Two-hundred twenty-one (97.8%) children were exposed to HIV during pregnancy/childbirth. A total of 193 (87.3%) children had late enrolment in the service and late access to HIV serology. The frequency of HIV was 21.3% (95% confidence interval [CI] 15.9%-26.7%). Protective factors were earlier diagnosis [odds ratio (OR)=0.17 (0.08-0.37)] and receiving complete prophylaxis [OR=0.29 (0.09-0.97)]; being born by vaginal delivery was a risk factor [OR=4.45 (1.47-13.47)]. Conclusions: There was a high frequency of late diagnosis in this patient cohort. Earlier diagnosis is an important measure for controlling HIV among children.

Could hantavirus circulation superpose areas of highly endemic vaccinia virus outbreaks? A retrospective seroepidemiological study in State of Minas Gerais

Introduction Hantavirus infections have been described in several regions in Brazil through seroepidemiological studies. Usually, populations are associated with rural and wild environment mainly due to close contact to species of Sigmodontinae rodents, considered hantavirus reservoirs. Methods A retrospective serosurvey was conducted to access the hantavirus seroprevalence in people living in regions affected by bovine vaccinia outbreaks. Results Sera from 53 patients were analyzed and none of them presented anti-hantavirus IgG antibodies. Conclusions This study presents an opportunity to analyze seronegativity despite close and recurrent contact with known hantavirus reservoirs. Aspects of hantavirus and bovine vaccinia emergence are also discussed.

Opportunistic infections among individuals with HIV-1/AIDS in the highly active antiretroviral therapy era at a Quaternary Level Care Teaching Hospital

INTRODUCTION : In this study, clinical-laboratory and epidemiological characteristics are described for a group of 700 individuals with HIV (human immunodeficiency virus)/AIDS (acquired immunodeficiency syndrome) in the ART (antiretroviral therapy) era at a teaching hospital that provides a quaternary level of care, with an emphasis on opportunistic infections (OIs), co-infections and immune profile. METHODS : A retrospective cross-sectional study of AIDS cases was conducted from 1998 to 2008 by reviewing medical records from the Base Hospital/FUNFARME (Fundação Faculdade Regional de Medicina), São José do Rio Preto, São Paulo, Brazil. RESULTS: The individuals were 14 to 75 years of age, and 458 were males. Heterosexuals accounted for 31.1% of all patients. Eighty-three percent were on ART, and 33.8% of those presented difficulties with treatment adherence. OIs were analyzed from medical records, and Pneumocystis jiroveci pneumonia was the most prevalent, regardless of the LTCD4+ (TCD4+ Lymphocytes) levels. Individuals whose viral loads were ≥10,000 showed a 90% greater chance of neurotoxoplasmosis. For P. jiroveci pneumonia, neurotoxoplasmosis, esophageal candidiasis, pulmonary tuberculosis and neurocryptococcosis, the chances of infection were higher among patients with LTCD4+ levels below 200 cells/mm3. HIV/hepatitis C virus (HCV) and HIV/hepatitis B virus (HBV) co-infections were significantly associated with death. CONCLUSIONS : OIs remain frequent in the ART era even in populations where the access to medical care is considered satisfactory.

Conization, frozen section examination, and planned hysterectomy in the treatment of high-grade cervical intraepithelial neoplasia

PURPOSE: We tested the role of frozen section examination of the cone specimen in the evaluation of the resection margin status and to rule out invasion in patients with high-grade cervical intraepithelial neoplasia. METHODS: Twenty-five patients with cervical intraepithelial neoplasia underwent conization followed by frozen section examination and planned hysterectomy. The results of the definitive paraffin exam were compared with frozen section examination. RESULTS: In the evaluation of the margins by frozen section examination, 16 patients (64%) had positive cone margins and 9 (36%) had negative margins. The definitive paraffin examination of margin status was concordant in all the cases. Intraoperative diagnosis of invasion was made in 5 cases, and 1 of these was microinvasive. Among the remaining 20 cases, we detected 2 additional microinvasive carcinomas after paraffin study, so the diagnosis of the frozen section examination was concordant with the paraffin sections in 23/25 cases (92%). Two cases of microinvasive carcinoma were diagnosed as cervical intraepithelial neoplasia by frozen section examination and had less than 2 mm stromal invasion. CONCLUSIONS: In high-grade cervical intraepithelial neoplasia, frozen section examination can provide immediate and precise evaluation of the cone margin status in high-grade cervical intraepithelial neoplasia. It can identify frank invasion and permit adequate treatment in a one-stage procedure. In early microinvasive disease, frozen section examination fails to detect the area of invasion but reliably detects clear resection margins.

Proteocephalidea from Amazonian Freshwater Fishes: New Systematic Arrangement for the Species Described by Woodland as ANTHOBOTHRIUM (Tetraphyllidea)

The, taxonomic status of the Brazilian species Anthobothrium pristis, A. piramutab, A. mandubé and A. karuatayi has been reappraised. A. pristis from an elasmobranch in the Amazon, is confirmed as a member of the tetraphyllidean genus Anthobothrium, but the others, from siluroid teleosts, are transferred to Proteocephalidea. A. piramutab is transferred to Proteocephalus as a new combination. Gibsoniela n.g. is erected in Zygobothriinae for A. mandubé and Brayela n.g. is erected in a new subfamily, Brayelainae for A. Karuatayi.

Determination of fat soluble vitamins from amazonian fresh-water fishes. I. HPLC analysis of tambaqui, pirarucu and cuiu-cuiu livers .

It was found that fish livers from the Amazon have considerable amounts of vitamins A, D and E compared with the values of the standartized cod-liver oil. Tambaqui liver oil has high concentration of vitamin A1(retinol) and vitamin A2 (degidroretinol) whereas the liver oils of pirarucu and cuiu-cuiu have preferently the vitamin A2. The contents of the vitamins D and E observed in the liver oils of tambaqui and cuiu-cuiu was extremely high.

Miracetyma etimaruya gen. et sp. n. (COPEPODA, POECILOSTOMATOIDA, ERGASILIDAE) FROM FRESHWATER FISHES OF THE BRAZILIAN AMAZON

Miracetyma etimaruyagen. et sp. n. is proposed from the gills filaments of Curimata cyprinoides(Linnaeus, 1758), Potamorhina latior(Spix, 1829) and Psectrogaster essequibensis(Gunther, 1864). The species of the new genus is characterized by having a more complex latching antenna. The claw is greatly reduced and has a groove; the third segment has one or two grooves; the first, second and third segments have one or two cuticular extensions. The legs have pectinate setae and the first endopod is greatly modified, very long, and without setae. The first segment of the first endopod is large, strong and elongate and the second segment is subcylindrical, slender and elongate. These modifications imply in a loss of swimming capacity which is linked to secure fixation on the gill filament. As a result, the leg morphology has evolved other functions.

Two new Bucephalidae (Trematoda) from Fishes of the Brazilian Amazon

Two new species of Bucephalidae (Trematoda) are described from fishes of the Brazilian Amazon. Glandulorhynchus turgidus gen. et sp. n. from Hydrolycus sp. differs from all others in the family by having conspicuous glands near the anterior extremity and an expanded uterus used for storing eggs. Prosorhynchus piranhus sp. n. from Serrasalmus rhombeus is characterized as having a small rhynchus and pharynx, and a large cirrus sac.

Two new Haploporidae (Trematoda) of Fishes from the Brazilian state of Rondônia

Two new Haploporidae (Trematoda) are described from fishes of the State of Rondônia, Brazil. Rondotrema microvitellarum gen. et sp. n., an intestinal parasite of Hemiodus microlepis, is characterized as having intercecal vitellaria limited to one small cluster on either side postero-lateral to the ovary. Lecithobotrioides elongatus sp. n., from Prochilodus nigricans, has an elongate, cylindrical body, short thick ceca, a small hemaphroditic sac and extensive vitellaria.

Surface morphology of some Amphistomes (Trematoda) of Amazonian Fishes and the description of a new genus and species

The surface morphology of specimens from ten different genera of amphistomes (Trematoda, Cladorchiidae) from Amazonian fishes is described and illustrated. The importance of body shape as a generic character is considered. Morphological changes as a result of growth are shown and explained in relation to the species Dadaytrema oxycephala. Additionally, Doradamphistoma bacuensis gen. et sp. n. is described from the catfish, Megalodoras irwini Eigenmann, 1925.The new genus and species is elongate and flattened, with external pharyngeal pouches, an esophageal bulb, a spherical cirrus sac, a post-bifurcal genital pore and pre-equatorial testes.

Physiographic and floristic gradients across topography in transitional seasonally dry evergreen forests of southeast Pará, Brazil

Seasonally dry evergreen forests in southeast Pará, Brazil are transitional between taller closed forests of the interior Amazon Basin and woodland savannas (cerrados) of Brazil's south-central plains. We describe abiotic and biotic gradients in this region near the frontier town of Redenção where forest structure and composition grade subtly across barely undulating topography. Annual precipitation averaged 1859 mm between 1995-2001, with nearly zero rainfall during the dry season months of June August. Annual vertical migrations of deep-soil water caused by seasonal rainfall underlie edaphic and floristic differences between high- and low-ground terrain. Low-ground soils are hydromorphic, shaped by perching water tables during the wet season, pale gray, brown, or white in color, with coarse texture, low moisture retention during the dry season, and relatively high macro-nutrient status in the surface horizons. Forest canopies on low ground are highly irregular, especially along seasonal streams, while overstory community composition differs demonstrably from that on high ground. High-ground soils are dystrophic, well-drained through the wet season, brown or red-yellow in color, with finer texture, higher moisture retention, and low macro-nutrient status in the surface horizons compared to low-ground soils. Forest canopies are, on average, taller, more regular, and more closed on high ground. Low-ground areas can be envisioned as energy and nutrient sinks, where, because of hydrologic cycles, canopy disturbance likely occurs more frequently than at high-ground positions if not necessarily at larger scales.

A description of mercury in fishes from the Madeira River Basin, Amazon, Brazil

Over the last 20 years several projects carried on the Madeira River basin in the Amazon produced a great amount data on total Hg concentration in different fish species. In this paper we discuss temporal trends in Hg contamination and its relation to body weight in some of those fishes, showing that even within similar groups, such as carnivorous and non-migratory fish, the interspecies variability in Hg accumulation is considerable.