Transradial approach for coronary interventions

OBJECTIVE: To assess the feasibility and safety of coronary interventions performed through the radial artery. METHODS: We studied 103 patients with ages from 38 to 86 years (57±8.7), 90 (87%) males, and: radial pulse with a good amplitude, presence of ulnar pulse, a good collateral flow through the palmar arch assessed with the Allen's test. RESULTS: The vascular approach was obtained in 97 (94%) patients, 88 (91%) treated electively and 9 (9%) during acute myocardial infarction, for primary angioplasty; 56 (64%) unstable angina; 22 (25%) stable angina; 10 (11%) were asymptomatic, 6 referred for recanalization of chronic occlusion and 4 silent ischemia in the first week after acute myocardial infarction. We approached 107 arteries: anterior descending artery, 49 (46%); right coronary artery, 27 (25%); circumflex artery, 25 (23%); diagonal artery, 6 (6%); and 2 saphenous vein bypass grafts. We treated 129 lesions: 80 (62%) B2 type; 23 (18%) B1 type; 17 (13%) C type; and 9 (7%). A type. There were 70 stents , and 59 balloon angioplasties performed. Thirty-two (33%) patients used GP IIb/IIIa inhibitors. The mean duration of the elective procedure was 42.3±12.8 min. Success, correct stent deployment and residual lesion <20%, was reached in 100% of the lesions treated with stent implantation; arterial dilation with residual lesion <50% was obtained in 96% of the lesions treated with transluminal coronary angioplasty (TCA). Complications, were: 1 (1.0%) non-Q-wave acute myocardial infarction; 2 (2%) hematomas in the forearm; and 2 losses of radial pulse. CONCLUSION: Radial artery aproach is practical and safe for percutaneous coronary interventions there was a low incidence of complications.

Climate paradox of the G-8: legal obligations, policy declarations and implementation gap

This article analyzes the climate policy performance of the G-8 from 1992 to 2012 based on their legal commitments (Annex-1 and Annex-B countries) under the UNFCCC (1992) and the Kyoto Protocol (1997) and their policy declarations on their GHG reduction goals until 2050. A climate paradox has emerged due to a growing implementation gap in Canada, USA and Japan, while Russia, Germany, UK, France and Italy fulfilled their GHG reduction obligation.

CPO e MID: alguns resultados obtidos em meninos brancos, de 8 a 12 anos

São apresentados alguns dados sobre CPO e MID (Índice de ataque ao 1° molar permanente inferior direito). São estudadas as distribuições do MID e do CPO /MID = 0, ajustando-se a binomial e binomial negativa, respectivamente, tendo o teste de aderência acusado bom ajuste em 10 casos, dos 12 testados.

Estudo sorológico sobre a cepa A/New Jersey/8/76 em grupos populacionais brasileiros: nota prévia

O estudo sorológico de vários grupos populacionais brasileiros, pela pesquisa de anticorpos inibidores da hemaglutinação para a cepa de vírus da influenza A/New Jersey/8/76, deu os seguintes resultados preliminares: 7,8% do total de crianças normais e 75% do total de indivíduos adultos normais já estudados mostraram possuir títulos de anticorpos inibidores da hemaglutinação para aquela cepa > 80; num grupo de índios da região do Xingu, todos os soros testados apresentaram título < 40.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment: 8- Survey of adult behaviour of Spissipes Section species of Culex (Melanoconion) in South-Eastern Brazil

A study of Spissipes Section of Culex (Melanoconion) adults behaviour was carried out from August 1992 through December 1993 in human dominated (anthropic) environment in the Ribeira Valley, S.Paulo State, Brazil. By sampling at several sites it the dominance of Culex ribeirensis and Cx. sacchettae became evident even through a total number of ten species was recorded. Those two mosquitoes showed a clear tendency to frequent the domiciliary environment where they were caught, both indoor and outdoor, through the use of the human bait. In the outside environments, the residual patchy forests seems to display a concentration role, from which these adults spread to the open land and reach the dwellings. As their vector competence has been demonstrated through the virus isolations in natural conditions, it is advisable to pay attention to the presence of these mosquitoes in the man-made environment.

Encontro de imaturos de Anopheles cruzii em bromélias de área urbana, litoral de São Paulo

Primeiro relato da ocorrência de larvas de Anopheles (Kerteszia) cruzii, mosquito essencialmente silvestre, em bromélias de solo em área urbana do município de Ilhabela, litoral norte do estado de São Paulo. De março de 1998 a julho de 1999 foram capturadas 312 formas imaturas de An. cruzii, sendo 8,6% em bromélias do ambiente urbano, 40,1% em bromélias do periurbano e 51,3% na mata. O número médio de bromélias com An. cruzii foi de 4,0% dentre o total de pesquisadas, com valores próximos de positividade para ambiente periurbano e mata. A presença de An. cruzii no ambiente urbano provavelmente é resultante da sua ocorrência prévia na mata, aliada à elevada presença desse criadouro na área urbana, de fonte alimentar e abrigos disponíveis. Alerta-se para a possibilidade de transferência de infecções entre esses ambientes.

Performance of a Brazilian population on the test of functional health literacy in adults

OBJECTIVE: To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS: The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS: The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not significant when the effects of education were held constant (rp=-0.031, p=0.584). A significant association (B=3.877, Beta =0.733; p<0.001) was found between schooling and scores. Age was not a significant predictor in this model (B=-0.035, Beta=-0.22; p=0.584). CONCLUSIONS: The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classified as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.

Estudo comparativo da imuno-antigenicidade de 8 amostras de Paracoccidioides brasiliensis

Para se detectar diferenças imuno-antigênicas entre 8 amostras de P. brasiliensis isoladas de diferentes áreas endêmicas (Botucatu: Pb 1, 2 e 3; São Paulo: Pb: 18, 192 e 265; Venezuela: Pb 9 e 73), esutdaram-se: 1. A reatividade antigênica de cada amostra nas reações de imunofluorescência indireta (II) e de imunodifusão dupla em gel de agar (ID) contra painel de 20 soros controles positivos para paracoccidioidomicose; 2. A capacidade de induzir resposta imune humoral (medida por imunodifusão) e celular (medida pelo teste de coxim plantar) em camundongos imunizados com an-tígenos de cada amostra. Observamos: 1. As amostras Pb 265 e Pb 9 mostraram-se mais reativas na II; 2. Os antígenos das amostras Pb 192 e Pb 73 foram significativamente mais reativas na ID; 3. Estes dados demonstram diferenças de antigenicidade entre estas amostras; 4. A amostra Pb 18 mostrou baixo poder indutor de resposta imune celular e alta capacidade de indução de resposta imune humoral em camundongos imunizados, revelando dissociação de sua imunogenicidade. Estas diferenças podem indicar a existência de cepas distintas do fungo ou refletir modificações do parasita no hospedeiro ou du rante seu cultivo.

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.

Levantamento planorbídico do Estado de São Paulo: 8ª Região Administrativa (grande área de São José do Rio Preto)

Para reconhecer a distribuição dos planorbídeos na 8ª Região Administrativa do Estado de São Paulo, 286 lotes de caramujos procedentes dos 85 municípios que a constituem foram examinados e identificados no Laboratório de Malacologia da SUCEN. Biomphalaria straminea, que ocorre em quatro criadouros - um em Altair e três em S. José do Rio Preto, foi a única espécie identificada capaz de vir a comportar-se naturalmente como hospedeira intermediária de S.mansoni. Isto demonstra que são mínimas as probabilidades da esquistossomose vir a instalar-se na área estudada.

Production of Shistosoma mansoni cercariae by Biomphalaria glabrata from a focus in Belo Horizonte, Minas Gerais

The snail density, levels of infection and the monthly production of Schistosoma mansoni cercariae by Biomphalaria glabrata were determined in a focus of Barreiro de Baixo (Belo Horizonte, MG, Brazil). During a period of 38 months (1984 to 1987) 5,366 snails were collected of which 324 (6.03%) were infected with S. mansoni. The total number of cercariae shed was 5,667,312. Each snail shed an average of 17,422 cercariae during the time that it was under study in the laboratory. The greatest longevity of infected snails was 218 days. Natural cure was observed in 42 (12.9%) of the infected specimens about 130 days after collection. The average snail density in the focus during the period of study was 16.3 snails per scoop. The shedding of cercariae by snails collected from the field was compared with laboratory bred specimens infected in mass with the LE strain of S. mansoni from Belo Horizonte. The laboratory infected snails shed an average of 6,061 cercariae each, a value 2.8 times less than the field specimens due to a shorter life span. The prevalence of schistosomiasis in the focus was 14.3%.

Fungal infections in neutropenic patients: a 8-year prospective study

In this paper we report a eight-year prospective study designed to further characterize incidence, epidemiology, specific syndromes, treatment and prognosis associated with fungal infections in neutropenic patients. During the study period 30 fungal infections were diagnosed in 30 patients among 313 episodes of fever and neutropenia (10%). There were 15 cases of candidiasis, 5 pulmonary aspergillosis, 3 sinusitis by Aspergillus fumigatus, 5 infections by Fusarium sp., one infection by Trichosporon sp., and one infection due to Rhodotorula rubra. Blood cultures were positive in 18 cases (60%). The predisposing factors for fungal infection in multivariate analysis were the presence of central venous catheter (p<0.001), longer duration of profound (<100/mm³) neutropenia (p<0.001), the use of corticosteroids (p<0.001), gram-positive bacteremia (p=0.002) and younger age (p=0.03). In multivariate analysis only recovery of the neutropenia (p<0.001) was associated with good prognosis whereas the diagnosis of infection by Fusarium sp. (p=0.006) was strongly associated with a poor outcome. The death rate was 43%. There was no statistically significant difference in the death rate between patients who did receive (52%) or did not receive (50%) antifungal treatment. Identifying patients at risk, specific syndromes and prognostic factors may help to reduce the high mortality associated with disseminated fungal infections in neutropenic patients.

INTRACELLULAR Leishmania amazonensis KILLING INDUCED BY THE GUANINE NUCLEOSIDE 8-BROMOGUANOSINE

In this study we investigated the effect of 8-Bromoguanosine, an immunostimulatory compound, on the cytotoxicity of macrophages against Leishmania amazonensis in an in vitro system. The results showed that macrophages treated with 8-Bromoguanosine before or after infection are capable to reduce parasite load, as monitored by the number of amastigotes per macrophage and the percentage of infected cells (i.e. phagocytic index). Since 8-Bromoguanosine was not directly toxic to the promastigotes, it was concluded that the ribonucleoside induced macrophage activation. Presumably, 8-Bromoguanosine primed macrophages by inducing interferon alpha and beta which ultimately led to L. amazonensis amastigote killing. The results suggest that guanine ribonucleosides may be useful to treat infections with intracellular pathogens.