Automedicação em adultos de baixa renda no município de São Paulo

OBJETIVO: Estimar a proporção de automedicação em adultos de baixa renda e identificar fatores associados. MÉTODOS: Foram utilizados dados de inquérito populacional realizado no município de São Paulo em 2005, cujo plano amostral incluiu dois domínios, favela e não favela, com amostragem por conglomerados em dois estágios, totalizando 3.226 indivíduos elegíveis. Além de características sociodemográficas e econômicas, foram analisados: uso de medicamentos nos 15 dias anteriores à entrevista, tipo de acesso (gratuito, comprado ou outra) aos medicamentos e os tipos de morbidades (crônicas ou agudas) tratadas, em análise de regressão logística múltipla. RESULTADOS: A proporção de automedicação foi de 27% a 32%. Automedicação esteve fortemente associada à morbidade aguda, ao acesso ao medicamento por compra, à idade menor que 47 anos e medicamentos do grupo terapêutico que atuam no sistema nervoso central. O grupo que atua no sistema nervoso central foi o mais utilizado na automedicação. CONCLUSÕES: O acesso gratuito aos medicamentos mostrou-se fator de proteção para a automedicação. A distribuição de medicamentos e o atendimento adequado devem ser considerados para orientação e redução dos riscos que o uso irracional de medicamentos pode gerar à saúde.

Lutzomyia longipalpis (Diptera, Psychodidae) em Cuesta Basáltica, na bacia hidrográfica do Rio Corumbataí, Região Centro-leste do Estado de São Paulo

A incidência das leishmanioses tegumentar e visceral americanas, em especial esta última (LVA), em hospedeiros caninos e humanos, encontra-se em crescente processo de expansão no Estado de São Paulo. Para a vigilância epidemiológica dessas endemias, torna-se fundamental o conhecimento da distribuição e da ecologia das diferentes espécies da fauna flebotomínea vetoras. Assim, a divulgação de novos encontros de seus vetores, sobretudo da Lutzomyia longipalpis, o principal vetor da LVA, é fundamental para apontar novas áreas de risco para a transmissão dessas doenças. Neste estudo, capturas de flebotomíneos foram realizadas em ambiente domiciliar, peridomiciliar e de mata, em diferentes localidades rurais dos municípios de Ipeúna e Itirapina, entre outubro de 2001 e fevereiro de 2004. Foram utilizadas armadilhas luminosas automáticas do tipo CDC, das 18h às 8h, em 14 noites, resultando 420 horas de exposição. Foram capturados 177 flebotomíneos pertencentes a doze espécies. A espécie mais abundante, Nyssomyia neivai, apontada como a principal vetora de LTA no Estado, contribuiu com 85,4% dos espécimes capturados em Ipeúna. O encontro de Lutzomyia longipalpis em uma caverna em Itirapina, aponta para o risco de estabelecimento da LVA na área e a necessidade de mais estudos locais sobre sua ecologia, sobretudo em relação à ocupação de ambientes antrópicos.

Variância intrapessoal para ajuste da distribuição de nutrientes em estudos epidemiológicos

O objetivo do estudo foi apresentar a fração da variância intrapessoal para ajuste da distribuição de nutrientes de adultos e idosos. Utilizaram-se dados de inquérito populacional com amostra representativa (n = 511) de indivíduos com 19 anos ou mais do município de São Paulo, SP, em 2007. A fração da variância intrapessoal foi obtida pelo método proposto pela Iowa State University. Observaram-se diferenças nas frações das variâncias intrapessoais de nutrientes segundo sexo. Esses valores devem ser utilizados para ajustar a distribuição da ingestão de nutrientes, pois sua não utilização pode resultar em viés na análise e interpretação de dados.

Circuitos de uso de crack na região central da cidade de São Paulo (SP, Brasil)

Apesar de o uso de drogas ser uma prática presente desde os primórdios da humanidade, atualmente o seu abuso adquiriu dimensões preocupantes, configurando-se como um problema de saúde pública. O surgimento do crack, droga derivada da pasta de coca, agravou esse quadro ao aumentar os danos sociais e à saúde dos usuários. Visando conhecer o impacto de sua inserção no cotidiano dos usuários, foi realizado um estudo etnográfico em locais de venda e uso de crack na região central da cidade de São Paulo (SP, Brasil). Foi utilizado um diário de campo para registrar as observações e os diálogos informais efetuados com as pessoas que circulavam no local estudado. Os resultados apontaram os circuitos percorridos pelos usuários, suas dinâmicas e as relações que estabelecem com outros atores sociais, as quais são permeadas por permanente tensão, envolvendo a prática de atos violentos nos quais os usuários são tanto agressores quanto vítimas. O estudo também sugere a importância de outros fatores como a história da região pesquisada, as políticas públicas, questões econômicas e ausência de investimentos sociais e em saúde pública. Sugere-se que o alto grau de degradação da região pesquisada não seria consequência apenas das pessoas e atividades exercidas no local, mas principalmente do processo urbano que gerou tal quadro social.

Origem e distribuição dos nervos isquiáticos do preá

O preá do semiárido nordestino (Galea spixii Wagler, 1831) é um roedor pertencente à família Caviidae. Pouca literatura é encontrada sobre essa espécie em relação a sua morfologia e seu comportamento ambiental e reprodutivo. Com o objetivo de entender a morfologia geral, em foco, na inervação do membro pélvico dessa espécie, neste trabalho, foi explorado o nervo isquiático, o qual é o maior de todos os nervos do organismo. Foram utilizados 10 preás (cinco machos e cinco fêmeas) que vieram a óbito por causas naturais, oriundos do Centro de Multiplicação de Animais Silvestres da Universidade Federal Rural do Semiárido (CEMAS/UFERSA). Os animais foram fixados após o óbito em solução aquosa de formaldeído 10% e, após 48 horas de imersão nessa solução, foram dissecados para exposição do nervo isquiático. Dessa forma, os dados obtidos foram compilados em tabelas e expressos em desenhos esquemáticos e fotografias. Os pares de nervos isquiáticos originaram-se de raízes ventrais de L6L7S1 (70%) e de L7S1S2 (30%) e distribuíram-se pelos músculos glúteo profundo, bíceps femural, semitendinoso e semimembranoso.

Sistematização da origem, da distribuição e dos territórios da artéria cerebral caudal na superfície do encéfalo em gatos

Foram estudados 26 encéfalos de gatos, adultos, sem diferenciação de sexo, sem raça definida, corados com látex e fixados por solução aquosa de formaldeído. As artérias cerebrais caudais, direita e esquerda, apresentaram-se únicas em 96,1 e 88,4% dos casos, respectivamente. Em 69,2% dos casos no antímero direito e 80,8% no esquerdo, a artéria cerebral caudal originou-se pela anastomose entre o ramo caudal da artéria carótida interna, com maior contribuição, e o ramo terminal da artéria basilar. Em 88,4% dos casos no antímero direito e em 84,6% no esquerdo, a artéria cerebral caudal originou a artéria tectal rostral e um ramo caudal. O ramo caudal bifurcou-se e vascularizou os colículos rostrais e caudais dos corpos quadrigêmeos e em alguns casos contribuiu na formação do plexo coroide do terceiro ventrículo. A artéria tectal rostral seguiu ventralmente ao lobo piriforme e durante seu trajeto liberou ramos para o hipocampo e, no antímero esquerdo, supriu a superfície dorsal do tálamo, contribuindo para a formação do plexo coroide do terceiro ventrículo.

Acidentes de trânsito no Brasil: um atlas de sua distribuição

O Atlas foi concebido para colocar à disposição do usuário os dados disponíveis sobre acidentes de trânsito no Brasil, já trabalhados sob forma de indicadores e apresentados predominantemente como mapas, gráficos, quadros e tabelas. Neste artigo, são apresentados os principais resultados obtidos, bem como, algumas conclusões, considerações, ponderações e possíveis explicações quanto aos problemas e questões relacionadas a este importante agravo à saúde

Gait kinematic analysis in patients with a mild form of central cord syndrome

Background: Central cord syndrome (CCS) is considered the most common incomplete spinal cord injury (SCI). Independent ambulation was achieved in 87-97% in young patients with CCS but no gait analysis studies have been reported before in such pathology. The aim of this study was to analyze the gait characteristics of subjects with CCS and to compare the findings with a healthy age, sex and anthropomorphically matched control group (CG), walking both at a self-selected speed and at the same speed. Methods: Twelve CCS patients and a CG of twenty subjects were analyzed. Kinematic data were obtained using a three-dimensional motion analysis system with two scanner units. The CG were asked to walk at two different speeds, at a self-selected speed and at a slower one, similar to the mean gait speed previously registered in the CCS patient group. Temporal, spatial variables and kinematic variables (maximum and minimum lower limb joint angles throughout the gait cycle in each plane, along with the gait cycle instants of occurrence and the joint range of motion ROM) were compared between the two groups walking at similar speeds. Results: The kinematic parameters were compared when both groups walked at a similar speed, given that there was a significant difference in the self-selected speeds (p < 0.05). Hip abduction and knee flexion at initial contact, as well as minimal knee flexion at stance, were larger in the CCS group (p < 0.05). However, the range of knee and ankle motion in the sagittal plane was greater in the CG group (p < 0.05). The maximal ankle plantar-flexion values in stance phase and at toe off were larger in the CG (p < 0.05). Conclusions: The gait pattern of CCS patients showed a decrease of knee and ankle sagittal ROM during level walking and an increase in hip abduction to increase base of support. The findings of this study help to improve the understanding how CCS affects gait changes in the lower limbs.

The Effect of Prostaglandin Analogs and Prostamide on Central Corneal Thickness

Objective: The aim of this study was to verify the influence of prostaglandin analogs and prostamide on central corneal thickness (CCT). Methods: A prospective analysis was done of CCT in glautomatous patients submitted to monotherapy with prostaglandin analogs (latanoprost 0.005% or travoprost 0.004%) or prostamide (bimatoprost 0.03%) during an 8-week period. A control group of patients without any ocular medication was also evaluated. CCT measurements were performed with a commercially available ultrasound pachymeter. A total of 73 patients were included in this study. Mean age was 68.5 +/- 9.2 (range, 48-85) years old. Results: A statistically significant reduction in CCT was observed in all groups, except the control group (n = 21): Bimatoprost 0.03% group (n = 21): 544.41 +/- 35.4 vs. 540.35 +/- 35.9 mu m (P = 0.039); travoprost 0.004% group (n = 17): 538.47 +/- 32.0 vs. 532.25 +/- 30.4 mu m (P = 0.009); latanoprost 0.005% group (n = 14): 548.57 +/- 32.4 vs. 543.88 +/- 35.6 mu m (P = 0.036). Conclusion: Topical therapy with prostaglandin analogs and bimatoprost is associated with CCT reduction over a period of at least 8 weeks.

IL-17 Produced during Trypanosoma cruzi Infection Plays a Central Role in Regulating Parasite-Induced Myocarditis

Background: Chagas disease is a neglected disease caused by the intracellular parasite Trypanosoma cruzi. Around 30% of the infected patients develop chronic cardiomyopathy or megasyndromes, which are high-cost morbid conditions. Immune response against myocardial self-antigens and exacerbated Th1 cytokine production has been associated with the pathogenesis of the disease. As IL-17 is involved in the pathogenesis of several autoimmune, inflammatory and infectious diseases, we investigated its role during the infection with T. cruzi. Methodology/Principal Findings: First, we detected significant amounts of CD4, CD8 and NK cells producing IL-17 after incubating live parasites with spleen cells from normal BALB/c mice. IL-17 is also produced in vivo by CD4(+), CD8(+) and NK cells from BALB/c mice on the early acute phase of infection. Treatment of infected mice with anti-mouse IL-17 mAb resulted in increased myocarditis, premature mortality, and decreased parasite load in the heart. IL-17 neutralization resulted in increased production of IL-12, IFN-gamma and TNF-alpha and enhanced specific type 1 chemokine and chemokine receptors expression. Moreover, the results showed that IL-17 regulates T-bet, ROR gamma t and STAT-3 expression in the heart, showing that IL-17 controls the differentiation of Th1 cells in infected mice. Conclusion/Significance: These results show that IL-17 controls the resistance to T. cruzi infection in mice regulating the Th1 cells differentiation, cytokine and chemokine production and control parasite-induced myocarditis, regulating the influx of inflammatory cells to the heart tissue. Correlations between the levels of IL-17, the extent of myocardial destruction, and the evolution of cardiac disease could identify a clinical marker of disease progression and may help in the design of alternative therapies for the control of chronic morbidity of chagasic patients.

Hantavirus Pulmonary Syndrome, Central Plateau, Southeastern, and Southern Brazil

Hantavirus pulmonary syndrome (HPS) is an increasing health problem in Brazil because of encroachment of sprawling urban, agricultural, and cattle-raising areas into habitats of subfamily Sigmodontinae rodents, which serve as hantavirus reservoirs. From 1993 through June 2007, a total of 884 cases of HIPS were reported in Brazil (case-fatality rate 39%). To better understand this emerging disease, we collected 89 human serum samples and 68 rodent lung samples containing antibodies to hantavirus from a 2,500-km-wide area in Brazil. RNA was isolated from human samples and rodent lung tissues and subjected to reverse transcription-PCR. Partial sequences of nucleocapsid protein and glycoprotein genes from 22 human and 16 rodent sources indicated only Araraquara virus and Juquitiba virus lineages. The case-fatality rate of HPS was higher in the area with Araraquara virus. This virus, which may be the most virulent hantavirus in Brazil, was associated with areas that have had greater anthropogenic changes.

Central nitrergic system regulation of neuroendocrine secretion, fluid intake and blood pressure induced by angiotensin-II

Background: Nitric oxide (NO) synthesis has been described in several circumventricular and hypothalamic structures in the central nervous system that are implicated in mediating central angiotensin-II (ANG-II) actions during water deprivation and hypovolemia. Neuroendocrine and cardiovascular responses, drinking behavior, and urinary excretions were examined following central angiotensinergic stimulation in awake freely-moving rats pretreated with intracerebroventricular injections of N omega-nitro-L-arginine methyl ester (L-NAME, 40 mu g), an inhibitor of NO synthase, and L-arginine (20 ug), a precursor of NO. Results: Injections of L-NAME or ANG-II produced an increase in plasma vasopressin (VP), oxytocin (OT) and atrial natriuretic peptide (ANP) levels, an increase in water and sodium intake, mean arterial blood pressure and sodium excretion, and a reduction of urinary volume. L-NAME pretreatment enhanced the ANG-II response, while L-arginine attenuated VP and OT release, thirst, appetite for sodium, antidiuresis, and natriuresis, as well as pressor responses induced by ANG-II. Discussion and conclusion: Thus, the central nitrergic system participates in the angiotensinergic responses evoked by water deprivation and hypovolemia to refrain neurohypophysial secretion, hydromineral balance, and blood pressure homeostasis.

First Report of the Isolation and Molecular Characterization of Rickettsia amblyommii and Rickettsia felis in Central America

During 2010, 15 adult ticks, identified as Amblyomma cajennense, were collected from horses in Cahuita and Turrialba districts, whereas 7 fleas, identified as Ctenocephalides felis, were collected from a dog in San Jose city, Costa Rica. In the laboratory, three A. cajennense specimens, two from Cahuita and one from Turrialba, were individually processed for rickettsial isolation in cell culture, as was a pool of seven fleas. Rickettsiae were successfully isolated and established in Vero cell culture from the three ticks and from a pool of seven fleas in C6/36 cell culture. The three tick isolates were genotypically identified as Rickettsia amblyommii, and the flea isolate was identified as Rickettsia felis through DNA sequencing of portions of the rickettsial genes gltA, ompA, and ompB of each isolate. In addition, other seven ticks were shown to contain rickettsial DNA. Polymerase chain reaction products of at least two of these ticks were sequenced and also showed to correspond to R. amblyommii. Overall, 66.7% (10/15) of the A. cajennense adult ticks were found to be infected with rickettsiae. This is the first report of a successful isolation in cell culture of R. amblyommii and R. felis from Central America.

Molecular and geographic analyses of vampire bat-transmitted cattle rabies in central Brazil

Background: Vampire bats are important rabies virus vectors, causing critical problems in both the livestock industry and public health sector in Latin America. In order to assess the epidemiological characteristics of vampire bat-transmitted rabies, the authors conducted phylogenetic and geographical analyses using sequence data of a large number of cattle rabies isolates collected from a wide geographical area in Brazil. Methods: Partial nucleoprotein genes of rabies viruses isolated from 666 cattle and 18 vampire bats between 1987 and 2006 were sequenced and used for phylogenetic analysis. The genetic variants were plotted on topographical maps of Brazil. Results: In this study, 593 samples consisting of 24 genetic variants were analyzed. Regional localization of variants was observed, with the distribution of several variants found to be delimited by mountain ranges which served as geographic boundaries. The geographical distributions of vampire-bat and cattle isolates that were classified as the identical phylogenetic group were found to overlap with high certainty. Most of the samples analyzed in this study were isolated from adjacent areas linked by rivers. Conclusion: This study revealed the existence of several dozen regional variants associated with vampire bats in Brazil, with the distribution patterns of these variants found to be affected by mountain ranges and rivers. These results suggest that epidemiological characteristics of vampire bat-related rabies appear to be associated with the topographical and geographical characteristics of areas where cattle are maintained, and the factors affecting vampire bat ecology.

Tooth Movement Activates the Central Amygdala and the Lateral Hypothalamus by the Magnitude of the Force Applied

Objective: To determine if the magnitude of the force used to induce incisor tooth movement promotes distinct activation in cells in the central amygdala (CEA) and lateral hypothalamus (LH) of rats. Also, the effect of morphine on Fos immunoreactivity (Fos-IR) was investigated in these nuclei. Materials and Methods: Adult male rats were anesthetized and divided into six groups: only anesthetized (control), without orthodontic appliance (OA), OA but without force, OA activated with 30g or 70g, OA with 70g in animals pretreated with morphine (2 mg/kg, intraperitoneal). Three hours after the onset of the experiment the rats were reanesthetized and perfused with 4% paraformaldehyde. The brains were removed and fixed, and sections containing CEA and LH were processed for Fos protein immunohistochemistry. Results: The results show that in the control group, the intramuscular injection of a ketamine/xylazine mixture did not induce Fos-IR cells in the CEA or in the LH. Again, the without force group showed a little Fos-IR. However, in the 70g group the Fos-IR was the biggest observed (P < .05, Tukey) in the CEA and LH compared with the other groups. In the 30g group, the Fos-IR did not differ from the control group, the without OA group, and the without force group. Furthermore, pretreatment with morphine in the 70g group reduced Fos-IR in these regions. Conclusions: Tooth movement promotes Fos-IR in the CEA and LH according to the magnitude of the force applied. (Angle Orthod. 2010;80:111-115.)