Clinical and endoscopic findings in the mucosae of the upper respiratory and digestive tracts in post-treatment follow-up of paracoccidioidomycosis patients

Systematic examination of the upper respiratory and digestive tracts (URDT) was performed in a group of 80 paracoccidioidomycosis (PCM) patients submitted to post-treatment follow-up ranging from 8 months to 17 years. Mucosae of the URDT had been involved prior to specific treatment in 74 patients, distributed as follows: oropharynx, 50 (41 alone, 7 in association with the larynx, and 2 with the nasal mucosa); larynx, 30 (23 alone and 7 in association); and nasal mucosa, 3(1 alone and 2 in association). Inactive lesions were observed in all the 50 patients with lesions of the oropharynx, 3 of whom with deforming scars (1 with retraction of the tongue and 2 with narrowing of the oral orifice). One case presented a destructive lesion, with perfuration of the palate. Of the other 46 cases, examination showed nacreous white striated scars which were nearly imperceptible in some cases and in others displayed partial retraction of anatomical structures without any alteration of their features. Patients presented a high rate of missing teeth. In 3 patients with involvement of the nasal mucosa, none of whom presented active PCM lesions, 2 still had nasal voices. In 30 patients with lesions of the larynx, 1 suffered a relapse of PCM and 2 developed epidermoid carcinoma. Of the other 27 cases, none of whom had active PCM lesions, 15 presented dysphonia, 3 were tracheotomized, and 9 were asymptomatic.

Dental caries experience in Indians of the Upper Xingu, Brazil

The present study describes the experience of dental caries in Indians communities of the Xingu, in order to supply parameters for further analysis of trends of the disease in Indians. We performed oral health examination in 288 Indians from four communities (Yawalapiti, Aweti, Mehinaku and Kamaiura) living in the southern part of the Xingu National Park, using international criteria defined by the World Health Organization. The outcome measures were the DMFT and dmft scores, and the care index. Indians of the Upper Xingu presented high levels of caries, in all age groups. The average DMFT for 11 to 13-year-old children - 5.93 - was lower than the index measured in 1993 for 12-year-old schoolchildren in nearby cities - 8.23 -, whose United Nations' human development index ranked medium. However, Indians presented a much lower care index, per age group, than these cities, and a high ratio of missing teeth for persons above 20 years old. These observations indicate low incorporation of dental care services. The irregularity of the services programmed for these communities, and the changing dietary and cultural patterns, mainly derived from their contact with the non-indigenous population of Brazil, reinforce the pressing need for health promotion initiatives aimed at these groups.

Reflux esophagitis and gastroesophageal reflux disease: a cross-sectional study of gastroesophageal reflux disease patients by age group

The purpose of this study was to explore the relationship between the intensity of acid reflux and severity of esophageal tissue damage in a cross-sectional study of patients with gastroesophageal reflux disease (GERD). Seventy-eight patients with were selected in accordance with the strict 24-hour ambulatory esophageal pHmetry (24h-pHM) criteria and distributed into three age groups: Group A: 14 - 24 years of age. Group B: 25 - 54; and Group C: 55 - 64. The 24h-pHM was carried out in accordance with DeMeester standardization, and the Savary-Miller classification for the diagnosis of reflux esophagitis was used. The groups were similar in 24h-pHM parameters (p > 0.05), having above normal values. For the study group as a whole, there was no correlation between age group and intensity of acid reflux, and there was no correlation between intensity of acid reflux and severity of esophageal tissue damage. However, when the same patients were sub-grouped in accordance with the depth of their epithelial injury and then distributed into age groups, there was a significant difference in esophagitis without epithelial discontinuity. Younger patients had less epithelial damage than older patients. Additionally, although there was a significant progression from the least severe to the moderate stages of epithelial damage among the age groups, there was no apparent difference among the age groups in the distribution between the moderate stages and most severe stages. The findings support the conclusion that the protective response of individuals to acid reflux varies widely. Continued aggression by acid reflux appears to lead to the exhaustion of individual mechanisms of epithelial protection in some patients, but not others, regardless of age or duration of the disease. Therefore, the diagnosis and follow-up of GERD should include both measurements of the quantity of refluxed acid and an assessment of the damage to the esophageal epithelium.

Assessment of fish assemblages in streams of different orders in the Upper Paraná River basin, Central Brazil

The aim of this study was to test whether the richness observed and the biomass per trophic group of fish assemblages vary depending on the order (1st and 2nd) of the streams located in three different basins of the Upper Paraná River Basin, Central Brazil. Samples were collected between April and September, 2009, in 27 streams of the Meia Ponte, Piracanjuba and Santa Maria River basins. A total of 4,879 specimens were collected distributed in 59 species and 19 families. The statistical analyses carried out indicate that the observed richness and biomass of omnivore fish were influenced by the interaction of two factors: stream order and basin. The 2nd order streams located in the Santa Maria basin presented significant differences in the observed richness and omnivore biomass when compared to i) 1st order streams in the same basin (only richness) or in the Piracanjuba and Meia Ponte basin; ii) 2nd order streams in the Piracanjuba (only omnivore biomass) and Meia Ponte Rivers basins. Results are discussed considering the influence of geomorphic processes on fish assemblages and food availability.

Vector bionomics and malaria transmission in the Upper Orinoco River, Southern Venezuela

A longitudinal epidemiological and entomological study was carried out in Ocamo, Upper Orinoco River, between January 1994 and February 1995 to understand the dynamics of malaria transmission in this area. Malaria transmission occurs throughout the year with a peak in June at the beginning of the rainy season. The Annual Parasite Index was 1,279 per 1,000 populations at risk. Plasmodium falciparum infections accounted for 64% of all infections, P. vivax for 28%, and P. malariae for 4%. Mixed P. falciparum/P. vivax infections were diagnosed in 15 people representing 4% of total cases. Children under 10 years accounted for 58% of the cases; the risk for malaria in this age group was 77% higher than for those in the greater than 50 years age group. Anopheles darlingi was the predominant anopheline species landing on humans indoors with a biting peak between midnight and dawn. A significant positive correlation was found between malaria monthly incidence and mean number of An. darlingi caught. There was not a significant relationship between mean number of An. darlingi and rainfall or between incidence and rainfall. A total of 7295 anophelines were assayed by ELISA for detection of Plasmodium circumsporozoite (CS) protein. Only An. darlingi (55) was positive for CS proteins of P. falciparum (0.42%), P. malariae (0.25%), and P. vivax-247 (0.1%). The overall estimated entomological inoculation rate was 129 positive bites/person/year. The present study was the first longitudinal entomological and epidemiological study conducted in this area and set up the basic ground for subsequent intervention with insecticide-treated nets.

Highlands of the upper Jequitinhonha valley, Brazil: II - mineralogy, micromorphology, and landscape evolution¹

Palm swanp formations, the so-called veredas, typically occur in the Brazilian biome known as "Cerrado" (savanna-like vegetation), especially on flattened areas or tablelands (chapadas). The aim of this study was to characterize the mineralogy and micromorphology of soil materials from a representative toposequence of the watershed of the vereda Lagoa do Leandro, located in Minas Novas, state of Minas Gerais, Brazil, on plains in the region of the upper Jequitinhonha valley, emphasizing essential aspects of their genesis and landscape evolution. The toposequence is underlain by rocks of the Macaúbas group and covered with detrital and metamorphic rocks (schists of Proterozoic diamictites). The soil profiles were first pedologically described; samples of the disturbed and undisturbed soils were collected from all horizons for further micromorphological and mineralogical analyses. The mineralogical analysis was mainly based on powder X ray diffractometry (XRD) and micromorphological descriptions of thin sections under a petrographic microscope. The soils from the bottom to the top of this toposequence were classified as: Typic Albaquult (GXbd), Xanthic Haplustox, gray color, here called "Gray Haplustox" ("LAC"), Xanthic Haplustox (LA) and Typic Haplustox (LVA). The clay mineralogy of all soils was found to be dominated by kaolinite. In soil of LA and LVA, the occurrence of goethite, gibbsite, and anatase was evidenced; "LAC" also contained anatase and the GXbd, illite, anatase, and traces of vermiculite. The micromorphological analyses of the LVA, LA and "LAC" soils showed the prevalence of a microaggregate-like or granular microstructure, and aggregate porosity has a stacked/packed structure, which is typical of Oxisols. A massive structure was observed in GXbd material, with the presence of illuviation cutans of clay minerals and iron compounds. Paleogleissolos, which are strongly weathered, due to the action of the excavating fauna , and resulted in the present "LAC". The GXbd at the base of the vereda preserved the physical, mineralogical and micromorphological properties that are typical of a pedogenesis with a strong influence of long dry periods.

Upper esophageal sphincter pressure in patients with Chagas' disease and primary achalasia

The most important component of the upper esophageal sphincter (UES) is the cricopharyngeal muscle. During the measurement of sphincter pressure the catheter passed through the sphincter affects the pressure value. In Chagas' disease and primary achalasia there is an esophageal myenteric plexus denervation which may affect UES pressure. We measured the UES pressure of 115 patients with Chagas' disease, 28 patients with primary achalasia and 40 healthy volunteers. We used a round manometric catheter with continuous perfusion and the rapid pull-through method, performed in triplicate during apnea. Pressures were measured in four directions, and the direction with the highest pressure (anterior/posterior) and the average of the four directions were measured. The highest UES pressure in Chagas' disease patients without abnormalities upon radiologic esophageal examination (N = 63) was higher than in normal volunteers (142.8 ± 47.4 mmHg vs 113.0 ± 46.0 mmHg, mean ± SD, P<0.05). There was no difference in UES pressure between patients with primary achalasia and patients with Chagas' disease and similar esophageal involvement and normal volunteers (P>0.05). There was no difference between patients with or without esophageal dilation. In the group of subjects less than 50 years of age the UES pressure of primary achalasia (N = 21) was lower than that of Chagas' disease patients with normal radiologic esophageal examination (N = 41), measured at the site with the highest pressure (109.3 ± 31.5 mmHg vs 149.6 ± 45.3 mmHg, P<0.01) and as the average of the four directions (64.2 ± 17.1 mmHg vs 83.5 ± 28.6 mmHg, P<0.05). We conclude that there is no difference in UES pressure between patients with Chagas' disease, primary achalasia and normal volunteers, except for patients with minor involvement by Chagas' disease, for whom the UES pressure at the site with the highest pressure was higher than the pressure of normal volunteers and patients with primary achalasia.

Effect of age on upper and lower eyelid saccades

To study the effect of age on the metrics of upper and lower eyelid saccades, eyelid movement of two groups of 30 subjects each were measured using computed image analysis. The patients were divided on the basis of age into a younger group (20-30 years) and an older group (60-91 years). Eyelid saccade functions were fitted by the damped harmonic oscillator model. Amplitude and peak velocity were used to compare the effect of age on the saccades of the upper and lower eyelid. There was no statistically significant difference in saccade amplitude between groups for the upper eyelid (mean ± SEM; upward, young = 9.18 ± 0.32 mm, older = 8.93 ± 0.31 mm, t = 0.56, P = 0.58; downward, young = 9.11 ± 0.27 mm, older = 8.86 ± 0.32 mm, t = 0.58, P = 0.56) However, there was a clear decline in the peak velocity of the upper eyelid saccades of older subjects (upward, young = 59.06 ± 2.34 mm/s, older = 50.12 ± 1.95 mm/s, t = 2.93, P = 0.005; downward, young = 71.78 ± 1.78 mm/s, older = 60.29 ± 2.62 mm/s, t = 3.63, P = 0.0006). In contrast, for the lower eyelid there was a clear increase of saccade amplitude in the elderly group (upward, young = 2.27 ± 0.09 mm, older = 2.98 ± 0.15 mm, t = 4.33, P < 0.0001; downward, young = 2.21 ± 0.10 mm, older = 2.96 ± 0.17 mm, t = 3.85, P < 0.001). These data suggest that the aging process affects the metrics of the lid saccades in a different manner according to the eyelid. In the upper eyelid the lower tension exerted by a weak aponeurosis is reflected only on the peak velocity of the saccades. In the lower eyelid, age is accompanied by an increase in saccade amplitude which indicates that the force transmission to the lid is not affected in the elderly.

Effects of sedation during upper gastrointestinal endoscopy on endocrine response and cardiorespiratory function

Upper gastrointestinal endoscopy is often accompanied by tachycardia which is known to be an important pathogenic factor in the development of myocardial ischemia. The pathogenesis of tachycardia is unknown but the condition is thought to be due to the endocrine response to endoscopy. The purpose of the present study was to investigate the effects of sedation on the endocrine response and cardiorespiratory function. Forty patients scheduled for diagnostic upper gastrointestinal endoscopy were randomized into 2 groups. While the patients in the first group did not receive sedation during upper gastrointestinal endoscopy, the patients in the second group were sedated with intravenous midazolam at the dose of 5 mg for those under 65 years or 2.5 mg for those aged 65 years or more. Midazolam was administered by slow infusion. In both groups, blood pressure, ECG tracing, heart rate, and peripheral oxygen saturation (SpO2) were monitored during endoscopy. In addition, blood samples for the determination of cortisol, glucose and C-reactive protein levels were obtained from patients in both groups prior to and following endoscopy. Heart rate and systolic arterial pressure changes were within normal limits in both groups. Comparison of the two groups regarding the values of these two parameters did not reveal a significant difference, while a statistically significant reduction in SpO2 was found in the sedation group. No significant differences in serum cortisol, glucose or C-reactive protein levels were observed between the sedated and non-sedated group. Sedation with midazolam did not reduce the endocrine response and the tachycardia developing during upper gastrointestinal endoscopy, but increased the reduction in SpO2.

Cardiac autonomic modulation during progressive upper limb exercise by patients with coronary artery disease

The purpose of this study was to investigate the behavior of heart rate (HR) and HR variability (HRV) during different loads of resistance exercise (incline bench press) in patients with coronary artery disease (CAD) and healthy sedentary controls. Ten healthy men (65 ± 1.2 years, control group, CG) and 10 men with clinically stable CAD (66 ± 2.4 years, CADG) were recruited. A discontinuous progressive protocol was applied with an initial load of 10% of the maximum load achieved in the 1RM (1 repetition maximum) with increases of 10% until 30% 1RM was reached, which was followed by subsequent increases of 5% 1RM until exhaustion. HRV was analyzed by linear and non-linear methods. There was a significant reduction in rMSSD (CG: 20 ± 2 to 11 ± 3 ms; CADG: 19 ± 3 to 9 ± 1 ms) and SD1 indexes (CG: 14 ± 2 to 8 ± 1 ms; CADG: 14 ± 2 to 7 ± 1 ms). An increase in HR (CG: 69 ± 5 to 90 ± 5 bpm; CADG: 62 ± 4 to 75 ± 4 bpm) and in systolic blood pressure (CG: 124 ± 3 to 138 ± 3 mmHg; CADG: 122 ± 6 to 126 ± 9 bpm) were observed (P < 0.05) when comparing pre-effort rest and 40% 1RM in both groups. Furthermore, an increase in RMSM index was also observed (CG: 28 ± 3 to 45 ± 9 ms; CADG: 22 ± 2 to 79 ± 33 ms), with higher values in CADG. We conclude that loads up to 30% 1RM during incline bench press result in depressed vagal modulation in both groups, although only stable CAD patients presented sympathetic overactivity at 20% 1RM upper limb exercise.

Three-dimensional kinematic analysis of upper and lower limb motion during gait of post-stroke patients

The aim of this study was to analyze the alterations of arm and leg movements of patients during stroke gait. Joint angles of upper and lower limbs and spatiotemporal variables were evaluated in two groups: hemiparetic group (HG, 14 hemiparetic men, 53 ± 10 years) and control group (CG, 7 able-bodied men, 50 ± 4 years). The statistical analysis was based on the following comparisons (P ≤ 0.05): 1) right versus left sides of CG; 2) affected (AF) versus unaffected (UF) sides of HG; 3) CG versus both the affected and unaffected sides of HG, and 4) an intracycle comparison of the kinematic continuous angular variables between HG and CG. This study showed that the affected upper limb motion in stroke gait was characterized by a decreased range of motion of the glenohumeral (HG: 6.3 ± 4.5, CG: 20.1 ± 8.2) and elbow joints (AF: 8.4 ± 4.4, UF: 15.6 ± 7.6) on the sagittal plane and elbow joint flexion throughout the cycle (AF: 68.2 ± 0.4, CG: 46.8 ± 2.7). The glenohumeral joint presented a higher abduction angle (AF: 14.2 ± 1.6, CG: 11.5 ± 4.0) and a lower external rotation throughout the cycle (AF: 4.6 ± 1.2, CG: 22.0 ± 3.0). The lower limbs showed typical alterations of the stroke gait patterns. Thus, the changes in upper and lower limb motion of stroke gait were identified. The description of upper limb motion in stroke gait is new and complements gait analysis.

Property and age organisation among an East African pastoralist group

Estudos sobre sistemas etários na África Oriental têm focado principalmente as regras que regulam recrutamento, com ênfase ao modo em que se mantém a autoridade e os cargos políticos, assim como à natureza não-militar e não-política dos sistemas etários. Apesar de contribuírem enormemente para a nossa compreensão das organizações etárias na região, esses estudos não lidam explicitamente com a questão da propriedade e com o modo em que ela constitui um dos principais focos para atividades de organizações etárias. De fato, quando se menciona a propriedade, ela é vista em função das famílias e, portanto, do parentesco. Apresentando e discutindo uma variedade de casos envolvendo o modo em que a propriedade é tratada por lideranças de um conjunto etário/geracional e residentes Hor e não-Hor do território Hor, este estudo conclui que a posse, o uso e controle de recursos não constitui um assunto que pertence exclusivamente à esfera de grupos de parentesco; trata-se também de uma questão central para organizações etárias. Apesar de haver, aparentemente, alguma ambigüidade decorrente da ênfase equilibrada que os Hor dedicam ao parentesco e às categorias etárias e suas complementaridades em assuntos relacionados à economia, à religião e ao direito, dados referentes aos Hor revelam uma tendência a tratar questões referentes ao uso de recursos cruciais em termos de organização etária. Trata-se de um estudo sobre os Hor (Arbore), um povo pastoril do Sudoeste da Etiópia.

Health knowledge of prostitutes in Saigon, Vietnam: a study of health attitudes and habits relating to venereal diseases taken from a group of prostitutes

A study of health knowledge and practices of prostitutes is presented here. The study took place at the V. D. Center in Saigon, Vietnam. It was designed with the objective of obtaining information to be used in preparing an educational program to be offered to the prostitutes at the Center, and for using, in preparing educational materials with focus on V. D. prevention. The outline of a course is also presented.

Cognitive deficit and depressive symptoms in a community group of elderly people: a preliminary study

Since the number and proportion of old people increases worldwide, health professionals and systems should be made aware and prepared to deal with their problems. Cognitive deficit and symptoms of depression are commom among the elderly, and may occur in relation to various risk factors such as health conditions and psychosocial variables. In order to study cognitive deficit and the presence of signs and symptoms of depression, 62 elderly community subjects enrolled at a Community Health Unit in Porto Alegre, southern Brazil, were interviewed. They were evaluated by means of the Mini Mental State Exam, the Montgomery-Asberg Depression rating scale, and a questionnaire on health conditions, living arrangements and social variables. Higher levels of symptoms of depression were observed among subjects exposed to major risk factors for cerebrovascular diseases (diabetes and coronary disease), while impaired cognitive performance was seen among individuals who could not count on the presence of a confidant (social network variable). The results suggest that the early identification of major risk groups among old people can help to prevent institutionalization and keep individuals in the community.

Mid-upper arm circumference in pregnant women and its relation to birth weight

OBJECTIVE: In order to determine the relationship between some maternal anthropometric indicators and birth weight, crown-heel length and newborn's head circumference, 92 pregnant women were followed through at the prenatal service of hospital in S. Paulo, Brazil. MATERIAL AND METHOD: The following variables were established for the mother: weight, height, mid-upper arm circumference, pre-pregnancy weight, gestational weight gain and Quetelet's index. For the newborn the following variables were recorded: birth weight, crown-heel length, head circumference and gestational age by Dubowitz's method. RESULTS: Significant associations were noted between gestational age and newborn variables. In addition, maternal mid-arm circumference (MUAC) and pre-pregnancy weight were found to be positively correlated to birth weight (r=0.399; r=0.378, respectively). The multivariate linear regression shows that gestational age, mother's arm circumference and pre-pregnancy weight continue to be significant predictors of birth weight. On the other hand, only gestational age and mother's age was associated with crown-heel length. Similarly MUAC was significantly associated with crown-heel length (r= 0.306; P=0.0030). CONCLUSION: Maternal mid-upper arm circumference is a potential indicator of maternal nutritional status. It could be used in association with other anthropometric measurements, instead of pre-pregnancy weight, as an alternative indicator to assess women at risk of poor pregnancy outcome.