Stroke awareness in Brazil - Alarming results in a community-based study

Background and Purpose-Stroke is the leading cause of death in Brazil. This community-based study assessed lay knowledge about stroke recognition and treatment and risk factors for cerebrovascular diseases and activation of emergency medical services in Brazil. Methods-The study was conducted between July 2004 and December 2005. Subjects were selected from the urban population in transit about public places of 4 major Brazilian cities: S (a) over tildeo Paulo, Salvador, Fortaleza, and Ribeir (a) over tildeo Preto. Trained medical students, residents, and neurologists interviewed subjects using a structured, open-ended questionnaire in Portuguese based on a case presentation of a typical patient with acute stroke at home. Results-Eight hundred fourteen subjects were interviewed during the study period (53.9% women; mean age, 39.2 years; age range, 18 to 80 years). There were 28 different Portuguese terms to name stroke. Twenty-two percent did not recognize any warning signs of stroke. Only 34.6% of subjects answered the correct nationwide emergency telephone number in Brazil (# 192). Only 51.4% of subjects would call emergency medical services for a relative with symptoms of stroke. In a multivariate analysis, individuals with higher education called emergency medical services (P=0.038, OR=1.5, 95%, CI: 1.02 to 2.2) and knew at least one risk factor for stroke (P<0.05, OR=2.0, 95% CI: 1.2 to 3.2) more often than those with lower education. Conclusions-Our study discloses alarming lack of knowledge about activation of emergency medical services and availability of acute stroke treatment in Brazil. These findings have implications for public health initiatives in the treatment of stroke and other cardiovascular emergencies.

Analysis of marine bivalve shellfish from the fish market in Santos city, Sao Paulo state, Brazil, for Toxoplasma gondii

The aim of this study was to determine if Toxoplasma gondii are present in oysters (Crassostrea rhizophorae) and mussels (Mytella guyanensis) under natural conditions using a bioassay in mice and molecular detection methods. We first compared two standard protocols for DNA extraction, phenol-chloroform (PC) and guanidine-thiocyanate (GT), for both molluscs. A total of 300 oysters and 300 mussels were then acquired from the fish market in Santos city, Sao Paulo state, Brazil, between March and August of 2008 and divided into 60 groups of 5 oysters and 20 groups of 15 mussels. To isolate the parasite, five mice were orally inoculated with sieved tissue homogenates from each group of oysters or mussels. For molecular detection of T. gondii, DNA from mussels was extracted using the PC method and DNA from oysters was extracted using the GT method. A nested-PCR (Polymerase Chain Reaction) based on the amplification of a 155 bp fragment from the B1 gene of T. gondii was then performed. Eleven PCR-RFLP (Restriction Fragment Length Polymorphism) markers, SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, CS3 and Apico, were used to genotype positive samples. There was no isolation of the parasite by bioassay in mice. T. gondii was not detected in any of the groups of mussels by nested-PCR. DNA of T. gondii was apparently detected by nested-PCR in 2 groups of oysters (3.3%). Genotyping of these two positive samples was not successful. The results suggest that oysters of the species C. rhizophorae, the most common species from the coast of Sao Paulo, can filter and retain T. gondii oocysts from the marine environment. Ingestion of raw oysters as a potential transmission source of T. gondii to humans and marine mammals should be further investigated. (C) 2010 Elsevier B.V. All rights reserved.