Epidemiological aspects of acute viral hepatitis in S��o Paulo, Brazil

As few reports on the prevalence of each type of viral hepatitis have been published in our country, we studied 154 patients with acute viral hepatitis consecutively seen at the Liver Unit from November 1980 to November 1984. The frequency of hepatitis A, B and non-A, non-B was 52.6%, 27.3% and 20.1% respectively. Greater frequency in young people, previous contact with infected patients and ingestion of suspected foods were the predominant epidemiological features in the hepatitis A group. Hepatitis B was characterized by the parenteral, non-transfusional exposure, previous contact and a high occurence in health-care workers. A history of blood transfusion was a significant finding in the hepatitis non-A, non-B group. Finally, the routes of transmission were unknown in 30-40% of the three groups of patients.

Histological and immunohistochemical aspects of cutaneous leishmaniasis in nicaragua

Sixty skin biopsies of fifty-eight non-treated patients with cutaneous leishmaniasis from Nicaragua were studied. Biopsies were classified according to Ridley's histopathologic groups: 36 (60%) were included in group B (diffuse necrosis), 14 in group C (focal necrosis), 7 (11.6%) in group D (reactive tuberculoid). Only three biopsies remained unclassified. None of our cases could be included in groups A and E. Immunohistochemistry disclosed in 17 cases Russel's bodies secreting IgM and only one IgG positive. There was no correlation between the histopathologic groups and the presence of Russel's bodies. However, we believe the presence of Russel's bodies help the diagnosis of leishmaniasis. Correlation between morphological patterns and the different leishmania species was also considered.

Histological and microbiological aspects of actinomycetoma cases in Venezuela

A ten year (1976-1986) review study of cases of Actinomycetoma in Venezuela was made through personal interview and clinical examinations, analysis of medical records of patients with actinomycetoma, histological studies of biopsy samples, as well as microbiological studies of isolates strain, also through out personal interviews with researchers and dermatologists who were sources of information on mycetoma cases. A total of 47 cases were recorded. As etiologic agent Actinomadura madurae was found in 20 cases - (42.5%), Nocardia brasiliensis in 13 cases (27.6%), Nocardia spp 7 cases (14.8%), Streptomyces somaliensis in 4 cases (8.5%), N. asteroides in 2 cases (4.2%) and N. otitidis caviarum, (N. caviae) in 1 case (2.1%). Most of the reported cases involved individuals living and working in rural areas, mostly males who outnumber females 4:1. The patients were 18 to 80 years old. A. madurae was reported as the most frequent etiologic agent. Most of the clinical cases were seen when the disease was well established. Twenty four of the forty seven cases reported were observed in Lara State, which represents a 51.0% of all the cases studied.

Ecological aspects of American cutaneous leishmaniasis: 6. Man-biting sandfly fauna of a patch of residual forest in the middle and north-eastern region of the S��o Paulo State, Brazil

This report shows the phlebotomine vectorial role in the endemic cutaneous leishmaniasis situated in the middle and north-eastern region of the S��o Paulo, Brazil. Analysis of information encloses a sandfly man-biting fauna of four different patches of residual forest. So, using the human-bait and Shannon trap for a period of one year we have caught 16,869 sandflies. The predominance of Lutzomyia intermedia (85,6%) was clear. Moreover, the low density of Lutzomyia whitmani and Lutzomyia pessoai and their epidemiological implications at present and in the past are discussed. Information about the daily activity of some species is given and we emphasize for the first time, the diurnal activity of Lutzomyia firmatoi in the S��o Paulo State.

Psychological impact of diagnostic exams

Introduction: Anxiety is a common problem in primary care and specialty medical settings. Treating an anxious patient takes more time and adds stress to staff. Unrecognized anxiety may lead to exam repetition, and impedance of exam performance. Objective: The aim of the study was to examine the anxiety levels of patients who are to undergo diagnostic exams related to cancer diagnostic: PET/CT and mammography. Methods: Two hundred and thirty two patients who undergo PET/CT and one hundred thirteen women who undergo mammography filled out one questionnaire after the procedure to determine their concerns, expectations and perceptions of anxiety. Results: Our results show that the main causes of anxiety in patients who are having a PET/CT is the fear of the procedure itself and fear of the results. Patients who suffered from greater anxiety were those who were scanned during the initial stage of an oncological disease. On the other hand, the diagnostic is the main cause of anxiety in women who are requiring a mammography. 28% of the women reported having experienced pain or intense pain. Conclusions: The performance of diagnostic exams related to cancer diagnostic like a PET/CT and a mammography are important and statistically generators of anxiety. Patients are often poorly informed and present with a range of anxieties that may ultimately affect examination quality. These results provide expertise that can be used in the development of future training programs to integrate post-graduate courses of health professionals.

Le retable majeur de la S�� velha de Coimbra et la polychromie dans le dioc��se de Coimbra �� l�����poque baroque: aspects techniques et esth��tiques

Doutoramento em Conserva����o e Restauro, especialidade Teoria, Hist��ria e T��cnicas

Hepatobiliary alterations in massive biliary ascariasis: histopathological aspects of an autopsy case

Hepatobiliary alterations found in an autopsy case of massive Biliary Ascariasis, are reported on histological grounds. Severe cholangitis was the main finding, but other changes were also detected, such as pyloric and intestinal metaplasia, hyperplasia of the epithelial lining, with intraductal papillomas and adenomatous proliferation. Remnants of the worm were observed tightly adhered to the epithelium, forming microscopic intrahepatic calculi. Mucopolysaccharides, especially acid, showed to be strongly positive on the luminal border, and in proliferated glands around the ducts. The authors discuss the similarity between such findings and Oriental Cholangiohepatitis, and suggest that inflammation and the presence of the parasitic remnants are responsible for the hyperplastic and metaplastic changes, similarly with what occurs in chlonorchiasis, fascioliasis and schistosomiasis.

Clinical and epidemiological aspects of abdominal angiostrongyliasis in Southern Brazil

Most of the cases of abdominal angiostrongyliasis in Brazil were reported from the southern States of S��o Paulo, Paran��, Santa Catarina and Rio Grande do Sul (RS). A study in 27 cases from RS revealed a distinct local epidemiology. Peasants were usually affected, either adults or children, from the mountainous areas in the north of the Suite. There was a seasonal increase in the number of cases, from late spring to autumn, that does not coincide with the rainy season. Besides the most common clinical features of abdominal pain, fever and cosinophilia in the leucogram, painful relapsing episodes were detected in some patients. The abdominal pain could be either localized or diffuse during the rapid evolution to a surgical abdominal condition, with a letality of 7.4%. The use of a serological test and the greater awareness of physicians working in endemic areas is expected to improve the recognition of uncomplicated and benign courses of the disease. This study confirms the known clinical manifestations of abdominal angiostrongyliasis and demonstrates the diversity of its epidemiology.

Evolution of the application and database with aspects

Generally, the evolution process of applications has impact on their underlining data models, thus becoming a time-consuming problem for programmers and database administrators. In this paper we address this problem within an aspect-oriented approach, which is based on a meta-model for orthogonal persistent programming systems. Applying reflection techniques, our meta-model aims to be simpler than its competitors. Furthermore, it enables database multi-version schemas. We also discuss two case studies in order to demonstrate the advantages of our approach.

Estudo sobre o insight em pessoas com psicose

Para al��m das vari��veis cl��nicas e sociodemogr��ficas existem concerteza importantes componentes individuais que desempenham um contributo importante no n��vel de insight apresentado por cada pessoa doente, por exemplo, o n��vel de intelig��ncia, personalidade, cultura, experi��ncias passadas, mem��ria, etc. A natureza cl��nica, emocional e/ou intelectual do termo ajuda-nos a compreender a complexidade da dificuldade que existe na sua tradu����o e, inclusive, na sua compreens��o. Da�� que as defini����es atribu��das ao conceito sejam muito distintas e variem consoante a forma����o te��rica do autor/investigador. Pretende-se, a partir dessa identifica����o/compreens��o, promover a qualidade de vida destas pessoas atrav��s do desenvolvimento de novas aprendizagens que possibilitem uma coopera����o activa. �� igualmente fundamental ir ao encontro das capacidade intactas de maneira a possibilitar a aquisi����o de novos(s) comportamento(s) que tenham um impacte positivo nas queixas, sinais, sintomas, incapacidade e disfuncionalidade apresentados pelo/a utente. Uma vez que a pr��pria conceptualiza����o do termo traduzir�� aquilo que se pretende avaliar,ser�� efectuada uma reflex��o detalhada acerca dos instrumentos e defini����es que t��m sido mais utilizadas para explorar o insight nas psicoses.Procurei, no meu trabalho de investiga����o, real��ar e promover a import��ncia que cada sujeito, alvo de interven����o, desempenha ao longo do seu processo de recupera����o e na preven����o de reca��das. No seguimento dos objectivos acima descritos, para al��m da revis��o te��rica efectuada ao fen��meno em termos de conceptualiza����o e estudos desenvolvidos na ��rea de investiga����o, foi,neste estudo, realizada a contribui����o para a valida����o do instrumento ���Assessment of Insight in Psychosis: a re-standartization of a New Scale��� de Markov�� & Berrios (2003).O fen��meno de insight escolhido pela Insight Scale, relata menos as mudan��as vividas em rela����o �� doen��a mental, e mais a actual consci��ncia e articula����o de tais mudan��as. Tendo como base uma abordagem psicopedag��gica, o fen��meno do insight aqui explorado assentou numa perspectiva reabilitativa, actual e multidimensional, que fosse para al��m das dimens��es cl��nicas tradicionais. Neste sentido �� apresentada uma escala original, intitulada ���Escala de Avalia����o do Insight e Identifica����o das Necessidades em Pessoas com Psicose���, bem como um modelo de interven����o psicopedag��gico breve, assente nos pressupostos descritos ao longo do trabalho.-----------------------------------------ABSTRACT: The importance of insight in people with mental illnesses was first studied in psychiatry, in the first decades of the 20th century, by people as important as Lewis (1934) and Jaspers (1959). However, this field of investigation was left unexplored for many years. Only in the last decade has this phenomenon become the object of numerous scientific investigations, having been given special attention by its investigators. For this reason a significant number of instruments for evalauting insight in psychotic disorders were developed. Since then many papers have been published, which has allowed for a more in depth knowledge on the subject. Therefore, in recent years, the concept of insight has been developed in an attempt to clarify its compexity. A once dichotomic phenomenon, described in terms of presence or absence, became considered multidimensional, which made the identification of different levels of insight and different dimensions possible. Current concepts categorize insight into five dimensions: the awareness of the patient in relation to his/her mental illness, the awareness of the patient in relation to the social consequences of his/her illness, the awareness of the need for treatment, the awareness of the symptoms and the explanation of those symptoms in relation to the illness. The lack of insight in psychiatry, in general terms, and as this phenomenon has been described, the lack of awareness of having a mental illness, represents one of the most common symptoms of schizophrenia and affects a big part of the population that suffer from this illness. It is estimated that bewteen 50 and 80 per cent of patients with schizophrenia do not believe that they are ill, which, consequently has a big impact in the process of adherence to treatment. It is still not possible, however, to identify all the factors that determine the lack of insight in schizophrenics. There are psychological, social and cultural influences that almost certainly play their role in the lack of insight registered in this pathology.Since the impact of scizophrenia is felt in many aspects of the individual���s life, its effective treatment should be directed at various levels, including the improvement of insight. One of the objectives of this study is to explore the relationship between the level of insight in psychosis and the clinical and sociodemographic variables, the psychopathology and its global functioning. As well as the clinical and sociodemographic variables, there are of course important individual components that contribute to the level of insight seen in each patient, for example, their level of inteligence, personality, culture, past experiences, memory, etc. The clinical, emotional and/or intelectual nature of the term helps us understand the difficulty that lies in its interpretation as well as in its comprehension. Therefore, the definitions attributed to the term are very different and vary according to the theoretical training of the investigator. It is intended, from this identification/understanding, to promote the quality of life of these people through the development of new findings that might enable an active cooperation. It is equally fundamental to observe their unimpaired capacities in order to enable the acquisition of new behaviour(s) that have a positive impact on the complaints, signs, symptoms, incapacity and disfunctioning seen in the patient.As the actual comprehension of the term explains what we intend to evaluate, a detailed reflection is made on the instruments and definitions that have been used the most to explore insight in psychosis.In this investigation I tried to underline and promote the importance that each subject, undergoing medical intervention, plays during his/her process of recovery and prevention of relapses. Considering the above mentioned objectives, as well as a theoretical review of the phenomenon in terms of conceptualization and investigative studies developed, this study contributed to the validation of the instrument.The insight phenomenon chosen by the ���Insight Scale���, records less changes experienced in relation to the mental illness and more actual awareness and articulation of these changes. Based on a psychopedagogical approach, the insight phenomenon explored here settled on a rehabilitation, current and multidimensional perspective that would go beyond the traditional clinical dimensions. For this reason an original scale entitled ���Insight Evaluation Scale and Need Identification in Psychosis Patients��� is presented, as well as a psychopedagogical intervention model soon to be used with admitted patients based on the presuppositions described in this study.

Preval��ncia do consumo de drogas il��citas nas For��as Armadas estudo epidemiol��gico num dos ramos

RESUMO: Desde 1976 que as For��as Armadas desenvolvem ac����es de preven����o do consumo de drogas e ��lcool. Na d��cada de 80 foi criada capacidade laboratorial e deu-se in��cio a um programa de rastreios toxicol��gicos. No quinqu��nio 2001 a 2005, as propor����es de resultados positivos, associando todos os tipos de rastreio, variaram entre 3,7% e 1,5%. De Outubro de 2006 a Julho de 2007 realizou-se um estudo anal��tico transversal, para estimar a preval��ncia do consumo de drogas (canabin��ides, opi��ceos, coca��na e anfetaminas) num dos Ramos das For��as Armadas, com base nos despistes realizados pelo seu laborat��rio. Foi utilizada uma amostra aleat��ria simples de 1039 militares, profissionais (QP) e contratados (RC), no activo e de ambos os sexos. Desde a nomea����o dos militares a rastrear, passando pela cadeia de cust��dia das amostras at�� �� obten����o do resultado foi utilizado apoio inform��tico espec��fico. O processo de pesquisa utilizou duas t��cnicas de triagem por imunoensaio e tecnologia de confirma����o por GC/MS, de acordo com as recomenda����es europeias, permitindo estabelecer uma metodologia standard para organiza����es e empresas. A preval��ncia estimada, de consumidores de droga, foi de 3,8/1.000, para um erro de 0,37%. O n��mero de casos registado (4) n��o permitiu a utiliza����o de testes estat��sticos que conduzissem �� identifica����o de caracter��sticas determinantes da positividade, mas n��o deixou de revelar aspectos inesperados. A observa����o de s��ries de casos e a realiza����o regular de estudos epidemiol��gicos, que ajudem a redefinir grupos alvo e a perceber a dimens��o, as determinantes e as consequ��ncias do consumo de drogas �� sugerida, em conclus��o.--------------------------------------- R��SUM��: Depuis 1976, les Forces Arm��es mettent au point des mesures visant �� pr��venir la consommation de drogues et d'alcool. En 1980, fut cr���� capacit�� laboratoriel et ont ensuite commenc�� un programme de d��pistage toxicologique. Au cours des cinq ann��es allant de 2001 �� 2005, les proportions de consommateurs, impliquant tous les types de d��pistage, allaient de 3,7% �� 1,5 %. D'octobre 2006 �� juillet 2007, une ��tude analytique transversale a ��t�� organis��e pour ��valuer la pr��valence de l���usage de drogues (cannabis, opiac��s, coca��ne et amph��tamines) dans une branche de les Forces Arm��es, bas��e sur les d��pistages faites par un laboratoire militaire, �� l'aide d'un ��chantillon al��atoire de 1039 militaires, professionnels (QP) et sous contract (RC), �� l���actif et des deux sexes. Tout au long du proc��s, de la nomination des donneurs, en passant par la chaine de garde des ��chantillons, jusqu����� obtention du r��sultat, il fut employ�� un appui informatique s��curis��. Le processus de recherche employa deux techniques de tri par imunoessay et la technologie de confirmation GC/MS, selon les recommandations europ��ennes, permettant d'��tablir une m��thodologie standard pour les organisations et les entreprises. La pr��valence estim��e fut de 3,8/1.000 pour une marge d���erreur de 0,37%. Le nombre de cas enregistr��s (4) n'autorise pas l'utilisation de testes statistiques de menant �� l'identification de caract��ristiques d��terminant de la positivit��, mais il permet �� r��v��ler des aspects inattendus. L'observation de s��ries de cas et la tenue r��guli��re d�����tudes ��pid��miologiques, qui contribuent �� red��finir les groupes cibles et de comprendre l'ampleur, les d��terminants et les cons��quences de l'usage de drogues, est sugg��r��, en fin de compte.--------------------------------------- ABSTRACT: Since 1976, the Armed Forces, have been developing measures to prevent the use of drugs and alcohol. In 1980, was created laboratory facility which then started a program of toxicological screenings. In the five years running from 2001 to 2005, the proportions of consumers, involving all types of screening, ranged from 3,7% to 1,5%. From October 2006 to July 2007, a cross-sectional study was held to estimate the prevalence of drug use (cannabinoids, opiates, cocaine and amphetamines) in one branch of the Portuguese Armed Forces, based on laboratory screenings, using a random sample of 1039 military, professional (QP) and enlisted (RC), active-duty and of both sexes. Specific computer support was used all the way, from the appointment, including the chain of custody of samples, to the obtaining of the result. The process of search used two techniques for sorting by immunoassay and confirmation technology GC/MS, according to European recommendations, allowing to establish a standard methodology for organizations and companies. The estimated prevalence of drug users was 3.8/1.000 for a 0.37% error (95% confidence interval). The number of cases registered (4) does not permit use of statistical testing leading to the identification of characteristics weighing in the establishing to extrapolate for the population, but it allows revealing unexpected aspects. The observation of series of cases and the regular holding of epidemiological studies, which help redefine target groups and to understand the extent, the determinants and consequences of drug use, is suggested, in conclusion.

Dengue epidemic in the state of Rio de Janeiro, Brazil: virological and epidemiological aspects

Laboratorial studies were carried out on 3178 patients with signs and symptoms suggestive of dengue infection from April 1986 to December 1987 in the State of Rio de Janeiro, Brazil. The epidemic had two peaks following the first virus isolation and affected the inhabitants of 17 counties. Both sex and all age groups were affected. Dengue virus type 1 was isolated from 1039 sera and the number of confirmed cases was increased to 1874 (59%) by MAC-ELISA. Isolation rate confirmed cases reached 80% in the specimens obtained until the 4th day after the onset of disease and viraemia ranged from 10 3.0 to 10(8.5) TCID50/ml.

Severe scorpion envenomation in Brazil: clinical, laboratory and anatomopathological aspects

Scorpion stings in Brazil are important not only because of their incidence but also for their potential ability to induce severe, and often fatal, clinical situations, especially among children. In this report we present the clinical and laboratory data of 4 patients victims of scorpion stings by T. serrulatus, who developed heart failure and pulmonary edema, with 3 of them dying within 24 hours of the sting. Anatomopathologic study of these patients revealed diffuse areas of myocardiocytolysis in addition to pulmonary edema. The surviving child presented enzymatic, electrocardiographic and echocardiographic changes compatible with severe cardiac involvement, which were reversed within 5 days. These findings reinforce the need for continuous monitoring of patients with severe scorpion envenoming during the hours immediately following the sting.

Central nervous system virion detection in acute measles: histopathological, ultrastructural and pathogenetic aspects

Histopathological and ultrastructural studies of 23 patients who died with clinical diagnosis of measles were carried out. In 12 cases viral nucleocapsids were searched by electron microscopy and detected in 100% of the cases in the lungs and in 50% of the cases in the central nervous system. They were mostly intranuclear. Histopathological changes associated to neurological alterations and the detection of virion are discussed in relation to acute and delayed clinical manifestations.

Human enterovirus infection in stray dogs. Some aspects of interest to public health

To investigate the possible role of domestic animals as reservoirs of human enteroviruses, we studied 212 stray dogs captured in different areas of the municipality of S��o Paulo. The captured animals were divided into 19 groups of 10 to 20 dogs each; faeces of 126 of the 212 dogs were processed for enterovirus isolation. The following viruses were isolated from 12 dogs: poliovirus type 1 (2 dogs), poliovirus type 3 (1 dog), echovirus type 7 (8 dogs) and echovirus type 15 (1 dog). Of the 12 infected animals, four had specific homotypic neutralizing antibody titres > 16. All 212 animals were tested for the presence of neutralizing antibodies to human enteroviruses. The frequency of neutralizing antibodies present in titres of > 16 was 10.3%, 3,8% and 4.3% for vaccinal prototypes of polioviruses 1, 2 and 3 respectively; 1,9%, 1.4% and 1.5% for wild prototypes of the same viruses, 11.3% for echovirus 7, and 2.4% for echovirus 15. The proportion of dogs with neutralizing antibodies varied with the virus studied. Some indication of the susceptibility of dogs to infection with human enteroviruses was demonstrated, and the importance of this fact for the Plan for Global Eradication of the Wild Poliovirus is discussed.