Initial diagnostic errors in children suspected of having heart disease: prevalence and long-term consequences

OBJECTIVE: To access the incidence of diagnostic errors in the initial evaluation of children with cardiac murmurs. METHODS: We evaluated our 7-years of experience in a public pediatric cardiology outpatient clinic. Of 3692 patients who were sent to the hospital, 2603 presented with a heart murmur and were investigated. Patients for whom a disagreement existed between the initial and final diagnoses were divided into the following 2 groups: G1 (n=17) with an initial diagnosis of an innocent murmur and a final diagnosis of cardiopathy, and G2 (n=161) with an initial diagnosis of cardiopathy and a final diagnosis of a normal heart. RESULTS: In G1, the great majority of patients had cardiac defects with mild hemodynamic repercussions, such as small ventricular septal defect and mild pulmonary stenosis. In G2, the great majority of structural defects were interventricular communication, atrial septal defect and pulmonary valve stenosis. CONCLUSION: A global analysis demonstrated that diagnostic error in the initial evaluation of children with cardiac murmurs is real, reaching approximately 6% of cases. The majority of these misdiagnoses were in patients with an initial diagnosis of cardiopathy, which was not confirmed through later complementary examinations. Clinical cardiovascular examination is an excellent resource in the evaluation of children suspected of having cardiopathy. Immediate outpatient discharge of children with an initial diagnosis of an innocent heart murmur seems to be a suitable approach.

Histology of the liver of Oligosarcus jenynsii (Ostariophysi, Characidae) from Los Padres Lake, Argentina

The liver is an organ notable for its sensitivity to a great variety of environmental factors. It is composed of a parenchyma divided into irregular lobules by the exocrine pancreas or hepatopancreas; the pancreatic cells are arranged around a branch of the portal vein. The hepatocytes are radially arranged in cords around a central sinusoid. The liver histomorphology and the organization of exocrine pancreatic tissue of O. jenynsii (Günther, 1864) is similar to the acinar morphology of many teleosts, including freshwater and marine species. The aim of the present work was to carry out the histological analysis of the liver of Oligosarcus jenynsii, one of the most common species inhabiting Los Padres Lake (Buenos Aires Province, Argentina).

Bromeliad-associated mosquitoes from Atlantic forest in Santa Catarina Island, southern Brazil (Diptera, Culicidae), with new records for the State of Santa Catarina

Bromeliad-associated mosquitoes (Diptera: Culicidae) in Atlantic Forest in Florianópolis, Santa Catarina, southern Brazil, were studied, examining plants of Vriesea philippocoburgi Wawra and Aechmea lindenii (E. Morren) Baker var. lindenii at secondary Atlantic rain forest, and A. lindenii and Vriesea friburgensis Mez var. paludosa (L. B. Smith) at "restinga" per month, during 12 months. No immature forms of mosquitoes were collected from A. lindenii in the secondary forest. Collections obtained 368 immature mosquitoes, none of them from A. lindenii from rain forest. Culex (Microculex) spp. constituted 79.8% of the total, Wyeomyia (Phoniomyia) spp. 17.93%, and Anopheles (Kerteszia) cruzii (Dyar & Knab, 1908) only 1.36%. The study shows the great predominance of species of medical importance not yet proved, and the small number of immature stages of anopheline mosquitoes. The rainfall, but not the mean temperatures, significantly influenced the quantity of mosquitoes from V. philippocoburgi. Significant differences between the quantities of immature forms of all the bromeliad species were found, and the shape of the plants could be important to the abundance of mosquitoes. All six species of Cx. (Microculex) found are recorded for the first time in the State of Santa Catarina, and all six species of Wyeomyia (Phoniomyia) are recorded for the first time in bromeliads in this state.

Diet of the ichthyofauna associated with marginal vegetation of a mangrove forest in southeastern Brazil

The objective of this study was to analyze the diet of fish species that use the mangrove vegetation for shelter and feeding in a river southeastern Brazil. The fieldwork, including collecting and underwater observations, was carried out in the dry (July and August 2004) and in the rainy season (February and March 2005) in order to assess the existence of seasonal variation in the diets. Seven kinds of food items were consumed, two of plant origin and five of animal origin. Crustaceans predominated in the diet of most species, either in the form of unidentified fragments or discriminated in eight groups. The predominance of species using mainly a single food source (crustaceans, principally Ostracoda and Tanaidacea) and the existence of seasonal variation in the diets of some species became very evident in the analysis food niche breadth, with a predominance of dietary specialists. In the Rio da Fazenda mangrove, the submersed marginal vegetation was used by the ichthyofauna as a locale for foraging, and principally as cover by bottom-feeding species. These species may be using the vegetation for protection from aerial and aquatic predators, or even from the pull of the current during the turn of the tide. In the study area, the great diversity of crustaceans constitutes an important food source for most fish species which adjusted their diet according to seasonal changes in food availability and to interactions with other species.

Diversity of social wasps (Hymenoptera, Vespidae) in Cerrado biome of the southern of the state of Minas Gerais, Brazil

An inventory of social wasps in Cerrado biome of the southern of the state of Minas Gerais was performed. A comparison between field and Riparian Forest areas was made in relation to species richness; correlations between diversity, sample methods and environmental factors were conducted. A total of 32 species was registered and Polybia fastidiosuscula de Saussure, 1854 was the most abundant species. The higher richness was in the Cerrado Field, as well as the highest diversity index. The temperature and rainfall had significant correlation with species richness and a significant variation in richness between dry and wet seasons was observed. Polybia fastidiosuscula was more abundant in the Riparian Forest during the dry season and in the Cerrado Field during wet season. The study area showed a great diversity of social wasps, with record both widely distributed species such as rare species, which indicates the quality and potential area for future studies.

Diel vertical migration of predators (planktivorous fish larvae) and prey (zooplankton) in a tropical lagoon

ABSTRACT Based on the hypothesis that diel vertical migration (DVM) is a mechanism of predator avoidance, the objective of the present study was to test for the occurrence of DVM in planktivorous fish larvae of Hypophthalmus edentatus (Spix, 1829) (Siluriformes, Pimelodidae) and Plagioscion squamosissimus (Heckel, 1840) (Perciformes, Sciaenidae), and zooplankton (rotifers, cladocerans and copepods) in an isolated tropical lagoon in the floodplain of the Upper Paraná River, Brazil (region of Parque Nacional de Ilha Grande). We investigated spatial overlap between predators (planktivorous fish larvae) and prey (zooplankton), and tested which physical and chemical variables of the water are related to the DVM of the studied communities. We performed nocturnal (8:00 pm and 4:00 am) and diurnal sampling (8:00 am and 4:00 pm) in the limnetic region of the lagoon for six consecutive months, from October 2010 to March 2011, which comprises the reproductive period of the fish species analyzed. During the day the larvae tried to remain aggregated in the bottom of the lagoon, whereas at night they tried to disperse in the water column. Especially for cladocerans, the diel vertical migration is an important behavior to avoid predation larvae of H. edentatus and P. squamosissimus once decreased spatial overlap between secured and its potential predators, which corroborates the hypothesis that DVM is a mechanism of predator avoidance. Although significant correlations were observed between the abiotic factors and WMD of microcrustaceans at certain times of day, the effect of predation of fish larvae on zooplankton showed more important in this environment, because the small depth and isolation not allow great variation of abiotic factors seasonally and between strata the lagoon.

Myeloid Metaplasia of Spleen in Hookworm Disease

We investigated, in the liver and the spleen of ten pures cases of ankylostomiasis haemocytopoietic elements. We verified the weight of spleen in 23 cases of individuals from 3 to 60 years old. In no case did we meet with haemopoietic cells in liver. In seven cases we found in spleen elements of the red series at an advanced evolutional stage (orthochromatic erythroblasts with pyknotic nucleus). In some of these cases we observed megakaryocytes and numerous eosinophilous myelocytes.The three cases which did not show any myeloid metaplasia in spleen were from individuals of over 50 years. Nevertheless, in another case of an individual 59 years old this metaplasia was verified. In individuals of over 20 years, the average weight of spleen in nine cases appeared to be equal to the normal weight. In 14 other cases, between 3 and 14 years of age, the weight of this organ was always sensibly higher than in normal individuals of the corresponding age. These results suggest the possibility of the myeloid metaplasia being the fact responsible for the weight increase of spleen in young individuals victimatized by hookworm anaemia. The remarkable proliferation of orthochromatic erythroblasts shows that the degree and quickness of blood regeneration after iron administration are due, essentially, to the great quantity of haemoglobin previously formed in the spleen and bone marrow of ankylostomized organisms.

Efficiency and quality in local government management: the case of Spanish local authorities

This study analyses efficiency levels in Spanish local governments and their determining factors through the application of DEA (Data Envelopment Analysis) methodology. It aims to find out to what extent inefficiency arises from external factors beyond the control of the entity, or on the other hand, how much it is due to inadequate management of productive resources. The results show that on the whole, there is still a wide margin within which managers could increase local government efficiency levels, although it is revealed that a great deal of inefficiency is due to exogenous factors. It is specifically found that the size of the entity, per capita tax revenue, the per capita grants or the amount of commercial activity are some of the factors determining local government inefficiency.

On the regional impact of public capital formation in Spain

The objective of this paper is to investigate, in a methodologically consistent manner, the regional effects of public capital formation and the possible existence of regional spillover effects in Spain. The empirical results are based on VAR estimates at both the aggregate and regional levels using output, employment, and private capital, as well as different measures of public capital. Empirical results suggest that public capital affects output positively at the aggregate level as well as in all but one region. For most regions, the effects of public capital installed in the region itself are important but the spillover effects induced from public capital installed elsewhere are also very important. In fact, the spillover effects account for over half of the total effects of public capital formation in Spain. Furthermore, these spillover effects have a clear geographical pattern in that they tend to be more important in the peripheral regions of the country. We also find that relative to their share of the Spanish output, the biggest beneficiaries of public capital formation are the largest regions in the country. This suggests that public capital formation has contributed to concentration of output in these regions. Finally, in terms of the effects of public capital formation on the private inputs we find that both private capital and employment are affected positively at the aggregate level as well as for most of the regions. Nevertheless, the effects on private capital seem to be larger. Also, the spillover effects are very important for private capital but not for employment. This reflects a great degree of dynamism and mobility in the capital markets as opposed to the labor markets.

A study of the endocervical columnar cells I - morphology and frequency

After the observation of many thousands of histological sections of the endocervical mucosa it became evident that its columnar cells present a great variety of aspects not only those of the surface of the canal but also those of the glands. A classification of these cells was made taking into account the staining affinity, the intensity staining of the cytoplasm, the presence or absence of cilia, the shape and location of the nucleus. The various combinations of these different data made possible the characterization of 26 types of cells which we labelled by the alphabetical letters. Two hundred and fifty cervices obtained by cervical amputation and by hysterectomy were studied. The uteri presented lesions in the course of routine laboratory examination. In each of the 250 histological sections there were specifically counted 2,000 columnar cells which cover the cervical canal and 2,000columnar cells which form the glands. A graphic representation of the frequency of both the superficial and glandular columnar cells was presented; this was given the name EPITHELIOGRAM. The variation of the cellular "composition" of each epithelium is discussed and the frequency of the various cellular types after the count of one million of cells is presented.

The roles of haemolymphatic lipoproteins in the oogenesis of Rhodnius prolixus

The fates of purified 32P-vitellin and 32P-lipophorin were followed in vitellogenic females of Rhodnius prolixus. While the radioactivity from 32P-vitellin 6 hours after injection was found almost exclusively in the ovary, the radioactivity from injected 32P-lipophorin was found distributed among several organs. In the ovary, the radioactivity from 32P-vitellin was associated with the contents of the yolk granules. 32P-lipophorin delivered a great amount of radioactive phospholipids to the ovary with no accumulation of its protein moiety, as observed after its iodination with 131I. The delivery of phospholipids was inhibited at 0ºC and by the metabolic inhibitors, sodium azide and sodium fluoride. Comparison of the radioactivity incorporation from 32P-lipophorin with that of 14C-inulin suggests that the 32P-phospholipids from lipophorin are not taken up by fluid phase endocytosis. The data presented here are compatible with the concept of lipophorin as a carrier of lipids in insects and provide evidence that lipophorin transports phospholipids as shown previously for other classes of lipids. The utilization by the oocytes of the phospholipids transported by lipophorin is discussed.

Molecular estimation of dispersal for ecology and population genetics

The dispersal process, by which individuals or other dispersing agents such as gametes or seeds move from birthplace to a new settlement locality, has important consequences for the dynamics of genes, individuals, and species. Many of the questions addressed by ecology and evolutionary biology require a good understanding of species' dispersal patterns. Much effort has thus been devoted to overcoming the difficulties associated with dispersal measurement. In this context, genetic tools have long been the focus of intensive research, providing a great variety of potential solutions to measuring dispersal. This methodological diversity is reviewed here to help (molecular) ecologists find their way toward dispersal inference and interpretation and to stimulate further developments.

The significance of variation in the susceptibility of Schistosoma mansoni to the antischistosomal drug oxamniquine

Clinical and laboratory evidence is reviewed which shows that there is a great deal of variation in the susceptibility of Schistosoma mansoni to oxamniquine. This variation occurs both among endemic regions and within endemic regions in Brazil and Kenya. It is genetically controlled. It is suggested that the parasite possesses a large capacity for developing resistance to the drug and that resistance will develop where sufficient drug pressure is maintained.

Epidemiological traits of the malaria-like parasite Polychromophilus murinus in the Daubenton¿s bat Myotis daubentonii.

BackgroundThe great diversity of bat haemosporidians is being uncovered with the help of molecular tools. Yet most of these studies provide only snapshots in time of the parasites discovered. Polychromophilus murinus, a malaria-like blood parasite, specialised on temperate-zone bats is a species that is being `rediscovered¿. This study describes the infection dynamics over time and between host sex and age classes.MethodsFor three years we followed the members of three breeding colonies of Myotis daubentonii in Western Switzerland and screened them for the prevalence and parasitemia of P. murinus using both molecular tools and traditional microscopy. In order to identify more susceptible classes of hosts, we measured, sexed and aged all individuals. During one year, we additionally measured body temperature and haematocrit values.ResultsJuvenile bats demonstrated much higher parasitemia than any other age class sampled, suggesting that first exposure to the parasite is very early in life during which infections are also at their most intense. Moreover, in subadults there was a clear negative correlation between body condition and intensity of infection, whereas a weak positive correlation was observed in adults. Neither body temperature, nor haematocrit, two proxies used for pathology, could be linked to intensities of infection.ConclusionIf both weaker condition and younger age are associated with higher infection intensity, then the highest selection pressure exerted by P. murinus should be at the juvenile stage. Confusion over the identities and nomenclature of malarial-like parasites requires that molecular barcodes are coupled to accurate morphological descriptions.

Specific treatment of advanced Schistosomiasis liver disease in man: favourable results

One hundred eighty-four patients with hepatosplenic schistosomiasis mansoni from the northeast of Brazil were studied. All were treated with a single dose of Oxamniquine or Praziquantel, and were observed over 6 to 12 months. Special attention was given to the evolution of severe hepatopathy. Favourable results were obtained, particularly with the compensated hepatosplenic form. Hepatic function showed great improvement. Hepatomegaly and splenomegaly were significantly reduced in size, to a greater or lesser extent, in the great majority of patients. The implications of the results obtained are considered below.