Serological markers and risk factors for hepatitis B and C viruses in patients infected with human immunodeficiency virus

Both hepatitis B and hepatitis C viruses (HBV and HCV) infection are common in HIV-infected individuals as a result of shared risk factors for acquisition. A serological study for HBV and HCV was performed in 251 HIV-positive individuals from Medellín, Colombia. A qualitative RT-PCR for HCV was done in 90 patients with CD4+ T-cell count < 150 per mm³. Serological markers for HBV infection were present in 97 (38.6%) patients. Thirty six of them (37.1%) had isolated anti-HBc. A multivariate analysis indicated that the following risk factors were significantly associated with the presence of these markers: age (OR = 1.05, 95% CI: 1.01-1.08), pediculosis pubis (OR = 1.83, 95% CI: 1.01-3.33), men who have sex with men and women (OR = 3.23, 95% CI: 1.46-7.13) and men who have sex only with men (OR = 3.73, 95% CI: 1.58-8.78). The same analysis restricted to women showed syphilis as the only significant risk factor. Thus, HBV infection was considerably associated with high risk sexual behavior. HCV was present in only two (0.8%) of HIV patients. Both of them were positive by RT-PCR and anti-HCV. This low frequency of HIV/HCV coinfection was probably due to the uncommon intravenous drug abuse in this population. The frequent finding of isolated anti-HBc warrants molecular approaches to rule out the presence of cryptic HBV infection.

Aspectos clínicos e histopatológicos do linfoma nasossinusal

Os linfomas do trato nasossinusal são neoplasias incomuns, que reconhecidamente causam importantes lesões destrutivas no nariz e terço médio da face. Sua raridade pode levar os profissionais da área médica a erros no diagnóstico clínico, além de representar um verdadeiro desafio aos patologistas, por sua natureza inflamatória. OBJETIVO: O objetivo deste estudo é determinar os aspectos clínicos e histopatológicos do linfoma não-Hodgkin (LNH) do trato nasossinusal, correlacionando sítio tumoral e comportamento biológico com os subtipos do LNH. FORMA DE ESTUDO: Estudo de série. MATERIAL E MÉTODO: Foi realizada uma análise retrospectiva que incluiu 7 pacientes atendidos no ambulatório do serviço de otorrinolaringologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de 1985 a 2003. RESULTADOS: As linhagens de células B e T/NK têm comportamento biológico diferente, assim como o sítio e apresentação clínica, sendo o diagnóstico histopatológico de extrema importância. CONCLUSÃO: A biópsia realizada adequadamente favorecerá um diagnóstico mais precoce e preciso, instituindo rapidamente a terapêutica adequada e melhorando o prognóstico e a sobrevida destes pacientes.

Isolamento e seleção de fungos filamentosos termorresistentes em etapas do processo produtivo de néctar de maçã

Os fungos filamentosos termorresistentes são capazes de sobreviver aos processos de pasteurização aplicados aos produtos de frutas. Este estudo visou isolar e identificar fungos termorresistentes durante o processamento de néctar de maçã (pH 3,4 e 11,6 °Brix), de forma a selecionar o bolor mais termorresistente. O isolamento foi obtido após choque térmico de 70 °C/2 horas e incubação a 30 °C em PDA (3% de ágar) acrescido de rosa de bengala. A identificação foi baseada na morfologia e nas estruturas micro e macroscópicas observadas após incubação das cepas em três diferentes meios (G25N, CYA e MEA) e temperaturas. O fungo mais termorresistente foi selecionado pela aplicação de choques térmicos (de 80 °C/20 minutos até 97 °C/15 minutos). Foram detectadas 11 linhagens de bolores, sendo 5 termorresistentes. Dentre estas, três cepas, isoladas da matéria-prima e do concentrado de maçã, foram identificadas como Neosartorya fischeri; uma cepa isolada da matéria-prima foi identificada como Byssochlamys fulva, e uma cepa isolada do produto após a primeira pasteurização foi identificada como Eupenicillium sp. As cepas mais resistentes foram as de N. fischeri e B. fulva, que sobreviveram ao tratamento de 95 °C/20 minutos. Dentre as seis cepas restantes, uma foi identificada como Aspergillus sp., entretanto, nenhuma destas apresentou termorresistência.

Comparison of two commercial kits and two extraction methods for fecal glucocorticoid analysis in ocelots (Leopardus pardalis) submitted to ACTH challenge

The ocelot (Leopardus pardalis) is included in list of wild felid species protected by CITES and is part of conservation strategies that necessarily involve the use of assisted reproduction techniques, which requires practical and minimally invasive techniques of high reproducibility that permit the study of animal reproductive physiology. The objective of this study was to compare and validate two commercial assays: ImmuChem Double Antibody Corticosterone 125I RIA from ICN Biomedicals, Costa Mesa, CA, USA; and Coat-a-Count Cortisol 125I RIA from DPC, Los Angeles, CA, USA, for assessment of fecal glucocorticoid metabolites in ocelots submitted to ACTH (adrenocorticotropic hormone) challenge. Fecal samples were collected from five ocelots kept at the Brazilian Center of Neotropical Felines, Associação Mata Ciliar, São Paulo, Brazil, and one of the animals was chosen as a negative control. The experiment was conducted over a period of 9 days. On day 0, a total dose of 100 IU ACTH was administered intramuscularly. Immediately after collection the samples were stored at 20C in labeled plastic bags. The hormone metabolites were subsequently extracted and assayed using the two commercial kits. Previously it was performed a trial with the DPC kit to check the best extraction method for hormones metabolites. Data were analyzed with the SAS program for Windows V8 and reported as means ± SEM. The Schwarzenberger extraction method was slightly better when compared with the Wasser extraction method (103,334.56 ± 19,010.37ng/g of wet feces and 59,223.61 ± 12,725.36ng/g of wet feces respectively; P=0,0657). The ICN kit detected an increase in glucocorticoid metabolite concentrations in a more reliable manner. Metabolite concentrations (ng/g wet feces) on day 0 and day 1 were 66,956.28 ± 36,786.93 and 92,991.19 ± 28,555.63 for the DPC kit, and 205,483.32 ± 83,811.32 and 814,578.75 ± 292,150.47 for the ICN kit, respectively. The limit of detection for the ICN kit was 7.7 ng/mL for 100% B/Bo (25ng/mL for 88%B/Bo) and for the DPC kit it was 0.2ug/dL for 90.95% B/Bo (1ug/dL for 81.27% B/Bo). In conclusion it was confirmed that the Schwarzenberger extraction method and the ICN kit are superior for extracting and measuring fecal glucocorticoid metabolites in ocelot fecal samples.

N-terminal-pro-brain natriuretic peptide, but not brain natriuretic peptide, is increased in patients with severe obesity

Elevated body mass index (BMI) has been reported as a risk factor for heart failure. Prevention of heart failure through identification and management of risk factors and preclinical phases of the disease is a priority. Levels of natriuretic peptides as well as activity of their receptors have been found altered in obese persons with some conflicting results. We investigated cardiac involvement in severely obese patients by determining N-terminal-pro-brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP) and attempting to correlate the levels of these peptides in serum and plasma, respectively, with BMI, duration of obesity, waist circumference, and echocardiographic parameters. Thirty-three patients with severe obesity (mean BMI: 46.39 kg/m², mean age: 39 years) were studied. The control group contained 30 healthy age-matched individuals (BMI: <25 kg/m², mean age: 43 years). The t-test and Spearman correlation were used for statistical analysis. Log-NT-proBNP was significantly higher (P = 0.003) in obese patients (mean 1.67, 95% CI: 1.50-1.83 log pg/mL) compared to controls (mean: 1.32, 95% CI: 1.17-1.47 log pg/mL). The Log-NT-proBNP concentration correlated with duration of obesity (r = 0.339, P < 0.004). No difference was detected in the Log-BNP concentration (P = 0.63) of obese patients (mean: 0.73, 95% CI: 0.46-1.00 log pg/mL) compared to controls (mean: 0.66, 95% CI: 0.51-0.81 log pg/mL). NT-proBNP, but not BNP, is increased in severely obese patients and its concentration in serum is correlated with duration of obesity. NT-proBNP may be useful as an early diagnostic tool for the detection of cardiac burden due to severe obesity.

Plasma von Willebrand factor as a predictor of survival in pulmonary arterial hypertension associated with congenital heart disease

Biomarkers have been identified for pulmonary arterial hypertension, but are less well defined for specific etiologies such as congenital heart disease-associated pulmonary arterial hypertension (CHDPAH). We measured plasma levels of eight microvascular dysfunction markers in CHDPAH, and tested for associations with survival. A cohort of 46 inoperable CHDPAH patients (age 15.0 to 60.2 years, median 33.5 years, female:male 29:17) was prospectively followed for 0.7 to 4.0 years (median 3.6 years). Plasma levels of von Willebrand factor antigen (VWF:Ag), tissue plasminogen activator (t-PA) and its inhibitor (PAI-1), P-selectin, reactive C-protein, tumor necrosis factor alpha, and interleukin-6 and -10 were measured at baseline, and at 30, 90, and 180 days in all subjects. Levels of six of the eight proteins were significantly increased in patients versus controls (13 to 106% increase, P < 0.003). Interleukin-10 level was 2.06 times normal (P = 0.0003; Th2 cytokine response). Increased levels of four proteins (t-PA, PAI-1, P-selectin, and interleukin-6) correlated with disease severity indices (P < 0.05). Seven patients died during follow-up. An average VWF:Ag (mean of four determinations) above the level corresponding to the 95th percentile of controls (139 U/dL) was independently associated with a high risk of death (hazard ratio = 6.56, 95%CI = 1.46 to 29.4, P = 0.014). Thus, in CHDPAH, microvascular dysfunction appears to involve Th2 inflammatory response. Of the biomarkers studied, plasma vWF:Ag was independently associated with survival.

Health, sleep and lack of time: relations to domestic and paid work in nurses

OBJECTIVE: To assess whether reported morbidity and complaints of lack of time and sleep are associated with the burden of professional work and housework among nurses. METHODS: A cross-sectional exploratory study was carried out among female nurses and nurse assistants (N=206) of a public hospital in Rio de Janeiro, Brazil. Data were collected by means of a questionnaire. The prevalence ratio and 95% confidence intervals were estimated. RESULTS: Mean duration of professional work and housework time was 40.4 and 31.6 hours/week, respectively. Long professional working time (over 44 hours/week) were associated with mild emotional disorders (PR=1.37; 95% CI: 1.05-1.80), complaints of lack of time for resting/leisure (PR=1.61; 95% CI: 1.31-1.97), housework (PR=1.48; 95% CI: 1.12-1.97), and childcare (PR=1.99; 95% CI: 1.51-2.63). Long housework time (over 28 hours/week) was associated with lower prevalence of lack of time for childcare (PR=0.62; 95% CI: 0.46-0.84). High housework load was associated with lack of personal time and complaints of varicose veins (PR=1.31; 95% CI: 1.14-1.50 and PR=1.31; 95% CI: 1.08-1.58, respectively). Complaints of varicose veins were also frequent among female nurses with a total work load above 84 hours (PR=1.30; 95% CI: 1.05-1.61), though this group has shown a lower prevalence of arterial hypertension and recurrent headaches (PR=0.35; 95% CI: 0.15-0.83 and PR=0.53; 95% CI: 0.32-0.89, respectively). CONCLUSIONS: Results suggest that both professional and home environments are relevant in the evaluation of work overload on nurses' health and their family and social life. It is stressed the need for instruments for analyzing total workload among female populations.

Seroprevalence of Toxoplasma gondii infection among indian people living in Iauareté, São Gabriel da Cachoeira, Amazonas, Brazil

The goal of this survey was to estimate the seroprevalence of Toxoplasma gondii infection in Iauareté, a multiethnic Indian community in the upper Rio Negro basin. We carried out a cross-sectional survey (n = 260), in order to obtain serum samples and demographic data. The sample was randomly selected, by family conglomerate analysis. Serodiagnosis was performed by an enzyme-linked immunosorbent assay and indirect immunofluorescence. Prevalence of reactivity was 73.5% (191/260), being higher in the older-age groups, reaching 95.7% (44/46) in the group aged 50 years or more. The majority of seropositive subjects had titers equal to or less than 1:64. Seroprevalence was greater in Indians belonging to the Hupda ethnic group (p = 0.03). According to the present survey, Indian people living in Iauareté have a high prevalence of antibodies to T. gondii. Demographic concentration and urbanization within low sanitation and poor hygiene backgrounds, as well as unfiltered water consumption, may be related to the high frequency of T. gondii seroprevalence observed in the studied area.

Implante de Stent guiado por ultrassom intracoronariano melhora desfechos: meta-análise de ensaios randomizados

FUNDAMENTO: Ultrassom Intracoronariano (USIC) tem sido usado como um método auxiliar a fim de otimizar o implante de stents. No entanto, o impacto desse método em alguns resultados é controverso. OBJETIVO: Analisar sistematicamente o impacto dos stents coronarianos guiados por USIC, em comparação com os stents guiados angiograficamente, sobre os resultados clínicos e angiográficos. MÉTODOS: Foi realizada uma busca em bases de dados (MEDLINE, Cochrane CENTRAL, EMBASE) e referências de estudos publicados entre 1982 e 2010. Foram incluídos Ensaios Clínicos Randomizados (ECR) que compararam o implante de stents coronarianos guiados por angiografia e USIC versus implante de stents coronarianos guiados apenas por angiografia (ANGIO). O seguimento mínimo foi de seis meses e os resultados avaliados foram eventos cardíacos adversos importantes (MACE), Revascularização da Lesão-alvo (RLA) e reestenose angiográfica. Dois revisores extraíram os dados de forma independente. Razão de risco sumário e intervalos de confiança de 95% (CI) foram calculados com modelos com efeitos aleatórios. A abordagem GRADE foi utilizada para determinar a qualidade geral de evidências para cada resultado. RESULTADOS: Dos 3.631 artigos identificados, oito ECR avaliando um total de 2.341 pacientes foram incluídos. Houve uma redução de 27% na reestenose angiográfica (95% IC: 3% -46%) e uma redução de 38% em RLA (95% IC: 17% -53%) em favor de USIC versus ANGIO. No entanto, os MACE não foram reduzidos por USIC (RR: 0,79; 95%CI: 0,61-1,03). Os dados MACE representam apenas 47% do tamanho ótimo de informações necessárias para detectar com segurança um efeito de tratamento plausível. CONCLUSÕES: Observamos que o implante de stent coronariano guiado por USIC oferece reduções significativas em RLA e reestenose angiográfica em comparação com implante de stent guiado por angiografia, porém não reduz casos de MACE.

Acurácia dos escores GRACE e TIMI na predição da gravidade angiográfica da síndrome coronariana aguda

FUNDAMENTO: A acurácia dos escores GRACE e TIMI em predizer a extensão da doença coronariana em pacientes com síndromes coronarianas agudas sem supradesnivelamento do segmento ST (SCA) não está estabelecida. OBJETIVO: Testar a hipótese de que os escores de risco GRACE e TIMI predizem satisfatoriamente a extensão da doença coronariana, em pacientes com SCA submetidos a coronariografia. MÉTODOS: Indivíduos admitidos com critérios objetivos de SCA e que realizaram coronariografia durante o internamento foram consecutivamente analisados. A doença coronariana angiográfica foi descrita de três formas: quantificação da extensão da doença coronariana pelo escore de Gensini; presença de qualquer obstrução coronariana (> 70% ou > 50% quando tronco de coronária esquerda); presença de doença severa (triarterial ou tronco de coronária esquerda). RESULTADOS: Em 112 pacientes avaliados, observou-se correlação positiva do escore de Gensini com os escores GRACE (p = 0,017) e TIMI (p = 0,02), porém essa associação foi de fraca magnitude (r = 0,23 e r = 0,27; respectivamente). O escore GRACE não foi capaz de predizer doença coronariana obstrutiva (área abaixo da curva ROC = 0,57; 95%IC = 0,46 - 0,69), nem doença coronariana severa (ROC = 0,59; 95%IC = 0,48 -0,70). O Escore TIMI se mostrou modesto preditor em relação à presença de doença coronariana (ROC = 0,65; 95%IC = 0,55 - 0,76) e presença de doença severa (ROC = 0,66; 95%IC = 0,56 - 0,76). CONCLUSÃO: (1) Existe associação positiva entre o valor dos escores TIMI ou GRACE e a extensão da doença coronária em pacientes com SCA; (2) No entanto, o grau dessa associação não é suficiente para que esses escores sejam preditores acurados dos resultados da coronariografia.

Left Atrial Volume Index and Prediction of Events in Acute Coronary Syndrome: Solar Registry

Background: According to some international studies, patients with acute coronary syndrome (ACS) and increased left atrial volume index (LAVI) have worse long-term prognosis. However, national Brazilian studies confirming this prediction are still lacking. Objective: To evaluate LAVI as a predictor of major cardiovascular events (MCE) in patients with ACS during a 365-day follow-up. Methods: Prospective cohort of 171 patients diagnosed with ACS whose LAVI was calculated within 48 hours after hospital admission. According to LAVI, two groups were categorized: normal LAVI (≤ 32 mL/m2) and increased LAVI (> 32 mL/m2). Both groups were compared regarding clinical and echocardiographic characteristics, in- and out-of-hospital outcomes, and occurrence of ECM in up to 365 days. Results: Increased LAVI was observed in 78 patients (45%), and was associated with older age, higher body mass index, hypertension, history of myocardial infarction and previous angioplasty, and lower creatinine clearance and ejection fraction. During hospitalization, acute pulmonary edema was more frequent in patients with increased LAVI (14.1% vs. 4.3%, p = 0.024). After discharge, the occurrence of combined outcome for MCE was higher (p = 0.001) in the group with increased LAVI (26%) as compared to the normal LAVI group (7%) [RR (95% CI) = 3.46 (1.54-7.73) vs. 0.80 (0.69-0.92)]. After Cox regression, increased LAVI increased the probability of MCE (HR = 3.08, 95% CI = 1.28-7.40, p = 0.012). Conclusion: Increased LAVI is an important predictor of MCE in a one-year follow-up.

Hemoglobinometria no sul do estado de Minas Gerais (Caxambu)

Curvas hemoglobinometricas foram realizadas na cidade de Caxambú (Sul do Estado de Minas Gerais). As determinações em internados do Patronato Agrícola Wencelau Braz - individuos de 8 a 18 anos de indade (11.09 ± 1.10; normal 11.47 ± 0.87), na Empreza de Aguas de Caxambú - homens adultos (12.16 ± 1.21 - normal 13.29 ± 1.19), no Centro de Saude-crianças de ambos os sextos de 5 á 15 anos (11.23 ± 0.95 - normal 11.46 ± 0.96) e mulheres de (11.55 ± 0.98 - normal 11.95 - 1.02), diferença estatisticamente significativa em relação ás curvas padrões pré-determinadas.

Neotropical Monogenoidea. 24. Rhinoxenus bulbovaginatus n. sp. (Dactylogyridae, Ancyrocephalinae) from the nasal cavity of Salminus maxillosus (Osteichthyes, Characidae) from the Rio Paraná, Paraná, Brazil

Rhinoxenus bulbovaginatus n. sp. is described from the nose of Salminus maxillosus (Characidae) collected in the basin of the rio Paraná, near the city of Porto Rico, state of Paraná, Brazil. The new species can be differentiated from the other three species in the genus by the morphology of the copulatory complex, vagina, and ventral anchor. The sister group relationship of the known species of Rhinoxenus was determined using techniques of Phylogenetic Systematics (Cladism). The resulting cladogram (C.I.=100%) indicates that the new species is most closely related to R. piranhus Kritsky, Boeger and Thatcher, 1988. The other two species of the genus, R. arietinus Kritsky, Boeger and Thatcher, 1988 and R. nyttus Kritsky, Boeger and Thatcher, 1988, both parasites of Anostomidae fishes, have a paraphyletic position in the cladogram, suggesting that the origin of at least one of them can not be associated to cospeciation.

Atividade de peroxidase e polifenoloxidase na resistência do feijão à antracnose

O objetivo deste trabalho foi avaliar a influência das enzimas peroxidase e polifenoloxidase na resistência à antracnose de quatro cultivares de feijão. Plântulas de feijão foram pulverizadas com ácido salicílico e com a raça delta de Colletotrichum lindemuthianum (fungo indutor) e submetidas à inoculação do patótipo virulento 33/95 de C. lindemuthianum três dias após a aplicação do fungo indutor e do ácido salicílico. Essas plantas foram avaliadas quanto à atividade enzimática e teores de fenóis, três dias após a aplicação do fungo indutor e cinco dias após a inoculação do patótipo virulento. Acréscimos nas atividades dessas enzimas foram maiores nos tratamentos com ácido salicílico e fungo indutor em todas as cultivares. Maiores estímulos nas atividades enzimáticas foram observados nas cultivares com maior resistência à doença. Constatou-se o aparecimento de uma isoperoxidase nos tratamentos com fungo indutor, ácido salicílico, após inoculação do patótipo virulento, e na testemunha, nas cultivares AB 136, Rio Tibagi e Macanudo. Houve correlação positiva entre as atividades da peroxidase e da polifenoloxidase, os teores de compostos fenólicos e a resistência à antracnose.

Indução de resistência sistêmica à antracnose em feijoeiro-comum pela raça delta avirulenta de Colletotrichum lindemuthianum

O objetivo deste trabalho foi avaliar o potencial da raça delta avirulenta do fungo Colletotrichum lindemuthianum, como protetora contra raças virulentas deste fungo e quanto à capacidade de induzir resistência sistêmica em feijoeiro-comum (Phaseolus vulgaris). Quatro cultivares de feijoeiro foram avaliadas quanto às alterações nas atividades de beta 1,3 glucanase e quitinase, em dois estádios de desenvolvimento (V2 e R6), três dias após a aplicação de suspensão de esporos de C. lindemuthianum raça delta avirulenta, em comparação com aplicações de água e ácido salicílico. As plantas foram, então, infectadas com o patótipo virulento 33/95 de C. lindemuthianum em suspensão e, depois de cinco dias, foram reavaliadas quanto à atividade das enzimas. Observaram-se acréscimos significativos nas atividades da beta 1,3 glucanase e quitinase, após inoculação do fungo indutivo, nas duas avaliações, nos dois estádios de desenvolvimento. As atividades da beta 1,3 glucanase e da quitinase variaram entre as cultivares e entre os estádios de desenvolvimento das plantas. A correlação entre o índice de severidade da doença e a atividade das enzimas foi altamente significativa. O uso de C. lindemuthianum raça delta avirulenta diminuiu a severidade da doença e pode ter potencial para controlar a antracnose do feijoeiro.