Response rate in the Study of Cardiovascular Risks in Adolescents – ERICA

ABSTRACT OBJECTIVE To describe the response rate and characteristics of people who either took part or not in from the Study of Cardiovascular Risks in Adolescents (ERICA) , according to information subsets. METHODS ERICA is a school-based, nation-wide investigation with a representative sample of 12 to 17-year-old adolescents attending public or private schools in municipalities with over 100,000 inhabitants in Brazil. Response rate of eligible subjects were calculated according to macro-regions, sex, age, and type of school (public or private). We also calculated the percentages of replacement schools in comparison with the ones originally selected as per the sample design, according to the types of schools in the macro-regions. The subjects and non-subjects were compared according to sex, age, and average body mass indices (kg/m2). RESULTS We had 102,327 eligible adolescents enrolled in the groups drawn. The highest percentage of complete information was obtained for the subset of the questionnaire (72.9%). Complete information regarding anthropometric measurements and the ones from the questionnaire were obtained for 72.0% of the adolescents, and the combination of these data with the 24-hour dietary recall were obtained for 70.3% of the adolescents. Complete information from the questionnaire plus biochemical blood evaluation data were obtained for 52.5% of the morning session adolescents (selected for blood tests). The response percentage in private schools was higher than the one in public schools for most of the combination of information. The ratio of older and male adolescents non-participants was higher than the ratio among participants. CONCLUSIONS The response rate for non-invasive procedures was high. The response rate for blood collection – an invasive procedure that requires a 12-hour fasting period and the informed consent form from legal guardians – was lower. The response rate observed in public schools was lower than in the private ones, and that may reflect lower school frequency of registered students.

Fracionamento do veneno Crotalus durissus terrificus por cromatografia de exclusão molecular

Através da técnica de cromatografia de exclusão molecular utilizando Sephadex G-75 foram estudadas as diferentes frações do veneno de Crotalus durissus terrificus, uma das serpentes peçonhentas mais comuns no Brasil. Foram obtidos 4 picos (correspondentes às frações 32, 60, 86 e 103) com peso molecular variando de 4.000 a 150.000. As frações de todo o diagrama de gel filtração foram triadas através de reação de imunoeletroforese a fim de se verificar suas cargas e velocidade de migração. As linhas de precipitação encontradas foram comparadas às 11 linhas apresentadas pela reação de imunoeletroforese do veneno total contra o soro anti-crotálico. Constatou-se que as frações de um mesmo pico apresentavam características próprias com exceção da fração 54 (subida do pico II) que mostrou diferenças significativas em relação à fração 60. Após a triagem foram escolhidas as frações de cada pico onde as linhas de precipitação foram mais nítidas e intensas, para estudo de identidade através da reação de difusão radial dupla e letalidade comparada a concentração de 0,0625 mg/ml do veneno total que corresponde a DL50 em camundongo pelo método de SPEARM & KÄRBER. As frações 32, 86 e 103 correspondentes respectivamente aos picos I, III e IV apresentaram letalidade nula ou negligenciada e a fração II foi a mais tóxica.

Estudo da etiologia das pneumopatias agudas da infância através da aspiração pulmonar transtorácica, São Paulo, Brasil

No período de abril de 1979 a julho de 1980 foram estudadas 45 crianças, de ambos os sexos, na faixa etária de 2 meses a 5 anos de idade, selecionadas entre as atendidas no Instituto da Criança "Pedro Alcântara" do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, e acometidas de pneumopatias agudas. Dos 45 pacientes estudados, a maioria (46,7%) encontrava se na faixa de 2-12 meses de idade e, quanto ao estado nutricional, 42,2% eutróficos e 57,8% desnutridos, variando essa desnutrição do grau I ao grau III. Empregando amostras obtidas por aspiração pulmonar e examinando-as pelo método de coloração de Gram e cultura, foi possível identificar o agente etiológico de 26 (57,7%) pneumonias bacterianas nos 45 casos estudados. A identificação direta pelo método de Gram mostrou-se útil como orientação inicial para antibioticoterapia em 44,4% dos casos. Houve nítida predominância do Streptococcus pneumoniae como agente etiológico bacteriano nas pneumopatias agudas da criança nas várias faixas etárias estudadas seguido do Haemophilus influenzae e o Staphylococcus aureus. O estudo comparativo da cultura do aspirado pulmonar e da hemocultura permitiu maior precisão diagnostica (56,7%), revelando-se a hemocultura positiva em apenas 30,0% dos casos. Não foi constatada nenhuma participação de germes anaeróbios nas pneumopatias da amostragem estudada.

Aspectos ecológicos da leishmaniose tegumentar americana: 8. avaliação da atividade enzoótica de Leishmania (Viannia) braziliensis, em ambiente florestal e peridomiciliar, região do Vale do Ribeira, Estado de São Paulo, Brasil

A evidência da transmissão extraflorestal da leishmaniose cutâneo-mucosa na região do Vale do Ribeira ensejou o presente estudo epidemiológico prospectivo, visando avaliar a atividade enzoótica de L. (V.) braziliensis. A pesquisa paratisológica da infecção natural em pequenos mamíferos e população canina foi complementada com o teste de imunofluorescência indireta (IFI) para cães e captura de flebotomíneos em ambiente florestal e peridomiciliar. A positividade para o teste sorológico e exame parasitológico somente foi observada para cães residentes e com taxas de 5,6 e 2,4%, respectivamente. Entre animais silvestres e sinantrópicos capturados, destacam-se os pertencentes a Oryzomys (Oligoryzomys) e Rattus rattus, ambos assinalados em proporções equivalentes (29,3%), em ambiente peridomiciliar. Foram capturados apenas 166 exemplares femininos de Lutzomyia intermedia, fato atribuído à borrifação das habitações humanas e anexos com DDT. No contexto epidemiológico mais amplo, discute-se a fragilidade do ciclo extraflorestal da L. (V.) braziliensis; o papel do cão e de pequenos mamíferos, como fonte de infecção domiciliar, além de analisar o potencial deles na dispersão do parasita na área estudada.

Lagoquilascaríase humana: sobre três casos encontrados nos Distrito Federal, Brasil

Três novos casos humanos de infecção por Lagochilascaris minor são apresentados. Todos os pacientes eram oriundos do Estado do Pará, Brasil, e viviam em zona rural ou próximo à mata. As lesões, no momento da consulta, localizavam-se no pescoço, mastóide e ouvido, estando já fistulizadas; em dois casos havia também envolvimento do sistema nervoso central. Amostras de tecidos, retiradas das lesões, revelaram, ao exame histológico, ovos e vermes em vários estádios de sua evolução. A identificação da espécie foi confirmada através do estudo de larvas e adultos eliminados, pelas fístulas cutâneas, de mistura com pus. O tratamento consistiu em excisão cirúrgica das tumorações e administração de antihelmínticos, com bons resultados. Em dois pacientes, no entanto, houve recidiva das lesões, após cura aparente, indicando que as drogas utilizadas não destroem os ovos do parasito.

Frequency of suspected cases of neurocysticercosis detected by computed skull tomography in Santa Maria, RS, Brazil

Due to the lack of studies about neurocysticercosis in the South of Brazil, an investigation was conducted to determine the percentage of suspected cases of neurocysticercosis in computed tomography diagnoses in Santa Maria, RS, from January 1997 to December 1998. Of 6300 computed tomographies (CT) of the skull performed at the private Hospital de Caridade Astrogildo de Azevedo, 80, i.e., 1.27% were suspected of neurocysticercosis. Fifty were women (62.5%) and 30 were men (37.5%). The most frequent radiological manifestation indicating neurocysticercosis was the presence of calcifications (isolated or associated), with a 95% rate (76 cases), while the presence of hypodense lesions reached a 5% rate (4 cases). After routine analysis, each CT was evaluated again and the suspected cases were confirmed. The percentage of suspected cases of neurocysticercosis detected by CT in the present study carried out in Santa Maria was considered low (1.27%). This can be explained by the fact that tomography is not accessible to the economically underprivileged population of Santa Maria. We hope that the present study can alert the population and the professionals to the fact that neurocysticercosis is a more frequent disease than indicated by the few diagnoses made.

Acute renal failure after massive honeybee stings

Two clinical cases of patients who survived after numerous attacks of Africanized bees (600 and 1500 bee stings, respectively) are reported. Clinical manifestation was characterized by diffuse and widespread edema, a burning sensation in the skin, headache, weakness, dizziness, generalized paresthesia, somnolence and hypotension. Acute renal failure developed and was attributed to hypotension, intravascular hemolysis, myoglobinuria due to rhabdomyolysis and probably to direct toxic effect of the massive quantity of injected venom. They were treated with antihistaminic, corticosteroids and fluid infusion. One of them had severe acute renal failure and dialysis was required. No clinical complication was observed during hospital stay and complete renal function recovery was observed in both patients. In conclusion, acute renal failure after bee stings is probably due to pigment nephropathy associated with hypovolemia. Early recognition of this syndrome is crucial to the successful management of these patients.

Erythema induratum of Bazin and renal tuberculosis: report of an association

Erythema induratum of Bazin is a disease that usually affects women, in whom erythematous subcutaneous nodules and plaques appear on the posterior part of the lower extremities, some of which ulcerate. In many countries, tuberculosis is still the main etiologic factor. We report a case of a 40-year-old woman who presented a course of protracted and recurrent episodes over five years of cutaneous lesions on her legs. These tend to involute, but new crops appear at irregular intervals. It was painful, erythematous-violaceous nodules, some of which drained a reddish secretion. The histopathologic features of the lesions demonstrated inflammatory infiltration, with predominance of neutrophils in dermis and hypodermis, necrotizing vasculitis in the arterioles and septal fibrosis. There was no granuloma. The Ziehl-Neelsen stain did not revealed acid-fast bacilli, and the culture of biopsy specimen was negative. The tuberculin skin test was strongly positive (17 mm). The chest X-ray was normal. Few months later she presented adynamia and urinary complaints, such as polacyuria and dysuria. It has been done an urynalysis, which demonstrated acid pH urine, sterile pyuria and microscopic hematuria. It was then raised the diagnostic hypothesis of renal tuberculosis. The urine culture for M. tuberculosis was positive in two out of ten samples. The treatment was instituted with rifampin, isoniazid and pyrazinamide, with complete regression. This case illustrates a clear association between erythema induratum and renal tuberculosis, demonstrated by the remission of the cutaneous lesions after the treatment of the renal tuberculosis.

Seroprevalence of toxoplasmosis in a low-income community in the São Paulo municipality, SP, Brazil

Toxoplasmosis is one of the most common zoonoses worldwide. The seroprevalence for T. gondii in human population from Brazil might range from 40 to 80%. The aim of this paper was to study the seroprevalence of T. gondii infection in children from age one to 15 living in a low socioeconomic community, named community of Jardim São Remo in the year of 2002. The community is located in the West area of São Paulo municipality, São Paulo State, Brazil. Antibodies to T. gondii were found in 110 (32.4%, CI 95%: 27.5 - 37.7) of the 339 children tested with indirect immunofluorescent antibody test. The titration of the samples revealed 29 children with serum titer equal to 16, 14 children with 32, 18 children with 64, 21 children with 128, 20 children with 256 and eight children with serum titer > 512. The age dependence of the prevalence of T. gondii infection and the association between seroprevalence for T. gondii and seroprevalence for T. canis suggest that the infection is chiefly postnatal. Seroconversion in infant population of community Jardim São Remo occurs in children as young as two years old, earlier than in the children attended at health centers of São Paulo city. The seroprevalence of T. gondii in children from Jardim São Remo was compared to the prevalence in children from other urban centers of Brazil.

Clinical and epidemiological analysis of patients with HIV/AIDS admitted to a reference hospital in the northeast region of Brazil

The AIDS epidemic has become a worldwide phenomenon of enormous magnitude and extension, deeply transforming medical practices and public health initiatives. This retrospective survey aimed to analyze clinical and epidemiological characteristics of patients with HIV/AIDS admitted to the Institute of Tropical Diseases Natan Portella, Teresina, Piauí, Brazil, from January, 2001 through December, 2004. Of the 828 patients, 43% were from other states and 71.3% were men. Average patient age was 35.4 ± 11.5 years-old and 85.5% were illiterate or had primary education. The main form of exposure to HIV was heterosexual behavior (54.1%), while injectable drug use was confirmed by only 2.7% of registered cases. The most frequent infectious complications were candidiasis (42.4%) and pneumocystosis (22.2%). Sixty-eight cases (8.2%) of visceral leishmaniasis were registered. Using multivariate analysis, individuals aged over 40 years-old, patients with active tuberculosis, Pneumocystis carinii pneumonia and central nervous system cryptococcosis showed increased risk of death. In this study, young male adults with low educational levels predominated and the most frequent opportunistic infections were candidiasis and pneumocystosis.

TOXOPLASMOSIS-RELATED KNOWLEDGE AMONG PREGNANT AND POSTPARTUM WOMEN ATTENDED IN PUBLIC HEALTH UNITS IN NITERÓI, RIO DE JANEIRO, BRAZIL

The present study conducted a toxoplasmosis-related knowledge level survey with 400 pregnant and puerperal women attended in public health units in the municipality of Niterói, Rio de Janeiro. Only 111 (27.8%) women claimed to know about the disease. Most of them (n = 289; 72.2%) had never heard about toxoplasmosis nor knew how to prevent the infection by Toxoplasma gondii. A significant difference (p = 0.013) regarding the presence of anti-T. gondii IgG was observed between women who claimed to know about the disease and those who had never heard about it. These results highlight the importance of a systematic serological screening process for toxoplasmosis, as well as the importance of primary prevention by accurate information during prenatal care, an important Public Health action to be implemented.

Atividade moluscicida de Pithecelobium multiflorum

No presente trabalho são descritas as propriedades moluscicidas de Pithecelobium multiflorum Benth, planta abundante na flora brasileira. Algumas variáveis como concentração e tempo de exposição, toxidade para peixes e animais domésticos, atividade sobre caramujos adultos e desova são fatores aqui apresentados como etapa preliminar dos estudos sobre atividade moluscicida de produtos naturais.

Caso fatal de balantidíase intestinal

Caso fatal de balantidíase em mulher desnutrida de 63 anos, criadora de porcos, da zona rural de Uberaba. A doença evoluiu em oito dias com disenteria, náusea e vômitos, culminando em óbito por enterorragia. A necropsia constatou-se colite ulcerada causada por B. coli, facilmente identificado ao exame histológico do intestino grosso.