Trends in rheumatic fever: clinical aspects and perspectives in prophylactic treatments

Introduction: Rheumatic fever (RF), a systemic illness that may occur following Group A beta-hemolytic streptococcal (GABHS) pharyngitis in children, is a major problem in countries with limited resources. Because of its long track record and low cost, an injection of benzathine penicillin G (BPG) suspension every 3 or 4 weeks has been used as secondary prophylaxis. Despite its excellent in vitro efficacy, the inability of BPG to eradicate GABHS has been frequently reported.Areas covered: This work reviews the possible causes of failure, as well as the inconvenience of the current prophylactic treatment of acute RF and suggests a new pharmacotherapeutic system that could replace the current one.Expert opinion: RF is a major problem concerning only countries with limited resources and could be considered as a neglected disease. The dose regimen using BPG suspension results in failures, which could be avoided by the use of nanocarrier-based systems. To meet this ultimate goal, the research should be transposed from the laboratory scale to an industrial and clinical application level. This research should be conducted to produce a pharmaceutical dosage form that will be commercially available, consumed by and affordable for patients. However, health, environmental and socioeconomic hazards should be considered.

Edentulismo funcional e seus fatores de risco em adultos

The purpose of this study was to investigate the risk factors to the functional edentulism in adults aged 35 a 44 years old of Natal-RN, 278 adults took part in the study. They were all selected from a previous dental loss prevalence study thus being complemented by an active research. The study was a case-control based and data collection was made though a survey as well as with a clinical examination. The cases were identified through individuals with 20 or more teeth. Age and gender were used as variables of pairing off. The data was analyzed through chi-square, significant level of 95% to the checking of its force associations. The independent variables were grouped in three levels. The first one, more macro, is related to the region where the individual lives, which was also related to the second level, the family-based one, linked with a third level, at this low socio-economical level, where the domiciliary density was favorable, living in capital cities, regions with prime sanitary condicitions, with predominant possibility of accessing the public dental service, but in despite of this, only looking for this service when tooth ache is felt, where preferentially an aid dressing treatment is executed in detriment of preventive procedures. From all the samples, less than 25% of the individuals make use of tobacco and alcoholic beverages for quite a number of years. There was an association of functional edentulism with all the studied variables in a regional method. In the family-based with Critério Brasil (OR=4,45) and monthly wages (OR=9,62) and to an to an individual level, the associations took place with the current use of kind of attendance (OR=1,78), looks for dressing treatment (OR=2,51), does not look for preventive treatment (OR=3,31), pain as the main cause of demand (OR=1,92), previous treatment as the demanding reason for dental service (OR+0,28), interval of the last visit to the dental service (OR=1,35) and when advise was received (OR=1,66). It was noticed from the results that the functional edentulism is much more expressive in those families which live in environments with precarious social economical sanitary conditions. Such conditions seem to have a direct influence upon the family social economical conditions which are also shown in detriment to functional edentulism. In the same way, the collection of variants influence the social economical conditions of the individual, as well as the kind of dental service searched by them, the reason of the search and the interval of the last visit to the dental service were strong determiners to the functional edentulism. Beyond that, individual habits like the use of tobacco and its frequency on its previous use influenced in a significant way the existence of functional edentulism in the studied population

Atividades comportamentais e comportamento alimentar de rã touro, Lithobates catesbeianus (Shaw, 1802), de pigmentação normal e albina em cativeiro

The behavior of bullfrogs reared in captivity must be well understood to support management practices that use efficient feeding regimes. In general, bullfrogs reared in captivity have normal pigmentation, but to develop an enhanced product, some studies have investigated the introduction of albino individuals in frog farms. The present study characterized the behavior of both pigmented and albino bullfrogs reared in captivity. In an initial experiment, 48 bullfrogs (70.5 ± 25.6 g) housed in small stalls were fed once a day at random times. Frogs were filmed and the images showed that both the pigmented and albino varieties behaved similarly: food intake was more frequent at dawn followed by light periods; moving and resting in dry areas may be associated to feeding events; frogs appeared to anticipate feeding time and to rest in the water more frequently in periods other than feeding time; daylight is the recommended period for feeding both pigmented and albino frogs. In a second experiment, 72 albino bullfrogs were fed at fixed times (10 a.m. or 4 p.m.) in small stalls. An initial weight of 23.8 ± 7.6 g was considered to evaluate frog performance, and after the animals reached 60.0 ± 20.0 g, they were filmed for behavior analyses. Food intake varied as a function of feeding time, and frogs were more likely to eat during the early hours of the day and immediately after receiving fresh food. Frogs fed only in the afternoon changed their behavior. Food supplied twice a day stimulated the albino frogs to eat at different times, but did not increase growth. Although fresh food stimulated feeding behavior, food intake was more frequent at dawn. Food supplied at this time of day should therefore be further investigated. The results did not indicate a more suitable feeding time (10 a.m. or 4 p.m.) for albino bullfrogs, or any advantage in using two feedings per day. The results provide xvi important information about bullfrogs in terms of food supply regime and activity preferences throughout the day. This novel information will contribute to future studies in this area

Condição peri-implantar e fatores associados às doenças peri-implantares em pacientes reabilitados no serviço odontológico da faculdade de odontologia da UFRN

A introdução dos implantes dentários osseointegrados como uma ferramenta na reabilitação oral de pacientes edêntulos e parcialmente edêntulos é uma realidade no cotidiano do cirurgião-dentista. Estudos reportam uma alta taxa de sucesso da utilização de implantes no tratamento reabilitador. Entretanto, outras investigações têm mostrado a perda desses implantes devido a infecções peri-implantares, como a mucosite e a peri-implantite. O objetivo deste trabalho foi avaliar a frequência das doenças peri-implantares e seus fatores associados em pacientes com implantes dentais em função reabilitados no serviço odontológico da Faculdade de Odontologia da UFRN. Foram examinados 155 indivíduos portadores de 523 implantes e 2718 dentes. Dentes e implantes foram avaliados por meio de sondagem periodontal, observando-se a profundidade de sondagem, retração gengival, bem como foram avaliados índices de placa visível (IPV) e sangramento gengival (ISG) e presença de supuração. Os dados foram armazenados em fichas clínicas e avaliados estatisticamente por meio da estatística descritiva e inferencial. A idade média dos pacientes foi de 54,05 (± 12,61) anos, sendo 79,4% do sexo feminino. As frequências da mucosite, peri-implantite e periodontite em indivíduos foram 54%, 28% e 50%, respectivamente. Dos 523 implantes avaliados, 43% tinham mucosite, 14% peri-implantite e 43% saúde. Os testes Qui-quadrado de Pearson e Exato de Fisher mostraram que as doenças peri-implantares estão associadas as doenças periodontais, uso de medicação, alterações sistêmicas número de implantes, IPV, ISG, ao tempo de função das próteses, região do implante, número de roscas expostas e faixa de mucosa queratinizada (p<0,05). A análise de regressão múltipla, através da regressão binária logística, constatou que indivíduos que faziam uso de medicação (OR = 1,784), com um ISG > 10% (OR = 1,742), com implantes instalados na maxila (OR = 2,654), onde a prótese sobre o implante tinham mais de 2 anos em função (OR = 3,144) e que radiograficamente apresentavam uma perda óssea atingindo a terceira rosca do implante (OR = 4,701) mostram uma associação positiva com as doenças peri-implantares de maneira que esses indivíduos têm mais chances de ter essas doenças. Os resultados sugerem que a frequência das doenças peri-implantares na população em estudo foi de 82% dos pacientes e que estas doenças estão associadas a fatores relacionados aos indivíduos como: a presença da doença periodontal, piores IPV e IS, alterações sistêmicas, uso de medicação e maior número de implantes; e a fatores locais relacionados aos implantes como: ausência ou faixa de mucosa menor que 2mm, implantes na maxila e na região anterior, perda óssea atingindo a terceira rosca do implante e a um tempo de reabilitação prótetica maior que 2 anos

Alterações ambientais em Parelhas, Rio Grande do Norte: metais pesados em sedimentos de drenagens e percepção de comunidades rurais em relação a mudanças na paisagem

The conservation of natural resources is essential and constitutes the main subject of many researches, which characterize important aspects concerning the environmental alterations in the ground, water, landscape and socioeconomic information. This study aimed to investigate the anthropogenic input of heavy metals in the environment, in the area of the Parelhas dump site and in part of the Seridó River and to determine the concentration of heavy metals in the sediments. This can result in risk to the environment and human health. In addition, we sought to establish the socioeconomic profile of rural communities adjacent to Seridó River and to comprehend the perception of these dwellers about the changes in the places they live. The area of this study is located in the city of Parelhas/RN, in the centralsouthern part of the State, in the micro-region of the Oriental Seridó. This area comprehends the place where the dump site is located, next to RN 086, the Caldeirão dam, the Quintos river called by local citizens Caldeirão creek and part of Seridó river, perpetuated by the Boqueirão dam, which crosses the city and it includes the rural communities of Almas, Domingas, Sussuarana II and Colonos. Regarding the study with bottom sediments, the samples were collected and taken to the laboratory of geochemistry, where they were dried, sieved, weighted and submitted to weak acid attack. The analysis of heavy metals was held by Atomic Absorption Spectrophotometer - Flame AAS. We applied 23 closed questionnaires constituted by 38 questions to collect informations in the rural communities, oriented to establish the socioeconomic profile and the environmental perception of the participants. The participants were distributed in the communities of Almas (1), Domingas (2), Sussuarana II (10) and Colonos (10). Most of them presented similar socioeconomic profiles. They are from 45 to 60 years old and live in these localities for 20 to 30 years or more. The families are composed by 3 or 4 people; the agriculture is the main activity, livestock is the secondary and 48% of them earn the minimal wage. Regarding the environmental perception, the participants can realize some changes in vegetation, soil, water and landscape. People living longer in the community, and with more years of experience on the local reality can perceive the depletion of the soil, pastures and changes in the landscape. These changes portray how the place was previously and what it represents today. The perception of these changes, besides the environmental ones, includes others concerning the increasing number of dwellers in the last years, as well as the number of houses. The changes happened through activities developed by the dwellers over the years, including agricultural practices, livestock, grass planting and even the cultivation of cotton. The study provided the acquisition of new data about the environmental reality of this region. It can subsidize the definition of public policies that can be implemented from the perspective of conservation of water resources and of the coexistence and survival of man in the semi-arid

A suplementação de ácidos graxos ômega 3 e triglicérides de cadeia média não alteram os indicadores metabólicos em um teste de exaustão

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Grupos sanguíneos e lúpus eritematoso crônico discoide

FUNDAMENTOS: Lesão discoide é a manifestação cutânea mais comum do lúpus eritematoso, e formas cutâneas crônicas apresentam características imunológicas próprias, direcionadas ao polo Th1. Diversas doenças possuem associação com grupos sanguíneos, o que não foi ainda estudado no lúpus discoide. OBJETIVO: Investigar a associação entre tipos sanguíneos (ABO e Rh) e lúpus eritematoso discoide. MÉTODOS: Estudo prospectivo tipo transversal envolvendo tipagem sanguínea ABO e Rh, inquérito de dados clínicos e dosagem de FAN e C4 de portadores de lúpus discoide sem critérios de doença sistêmica, atendidos em hospital universitário. RESULTADOS: Foram incluídos no estudo 69 pacientes, sendo 71,0% do sexo feminino (p 1:160, em 31,9%; e níveis baixos de C4, em 8,7%. Não houve diferença significativa entre as frequências dos grupos sanguíneos dos pacientes e da população local; entretanto, o grupo A foi associado às formas disseminadas da doença (OR 4,1 e p < 0,05). CONCLUSÕES: Grupos sanguíneos de pacientes com lúpus discoide apresentam frequência semelhante à da população; porém, formas clínicas disseminadas foram mais prevalentes entre portadores do grupo A.

Venous ulcer: clinical characteristics and risk factors

BackgroundLower limb venous ulceration ranks among the 10 most common medical problems in Western countries and has significant socioeconomic impact. The aim of this study was to identify the risk factors for unhealed, recurrent, and large ulcers and to characterize patients with active or recently healed venous ulcers.MethodsWe identified 97 patients and assessed 103 ulcerated limbs in 90 patients. All patients underwent clinical examination, arterial and venous system evaluation, ankle-brachial index determination, and ultrasound of the affected limb. Clinical characteristics included age, gender, race, ulcer duration, time since first episode, history of recurrence, localization of ulcer, ulcer area, eczema, ochre dermatitis, lipodermatosclerosis, pain, body mass index, and medical history data. Risk factors were identified by univariate analysis and estimated odds ratios.ResultsWe assessed 90 patients (103 limbs) with active or healed venous leg ulcers, of whom 84.4% were Caucasian and 68.9% were female. Mean age was 56.0 +/- 13.3 years. Ulcers had remained unhealed for < 1 year in 40.7%. Lipodermatosclerosis, lower limb hyperpigmentation, edema, and eczema were seen in 96.7%, 95.6%, 94.4%, and 51.1% of patients, respectively. Pain was a frequent symptom in 74.4%. Body mass index was assessed in 85 patients: 30.6% were slightly, 36.5% moderately, and 7% severely obese. Patient age > 60 years (odds ratio [OR] 4.0), extensive lipodermatosclerosis (OR 8.7), and previous history of ulceration (OR 19.9) were risk factors for unhealed ulcers. Time since first ulcer episode >= 2 years (OR 29.2) and incompetence of venous systems (OR 1.6) were risk factors for recurrence.ConclusionsLongstanding and large ulcers and recurrences are the main problems encountered by venous ulcer patients. Severe lipodermatosclerosis, previous ulcer history, and time since first ulcer episode >= 2 years are significant risk factors.

Risk factors of oropharyngeal carriage of Pseudomonas aeruginosa among patients from a Medical-Surgical Intensive Care Unit

Oropharyngeal carriage of Pseudomonas aeruginosa is associated with increased risk of infection and may provide a source for spread of drug-resistant strains. In order to assess the incidence and risk factors of oropharyngeal carriage, we conducted a retrospective cohort study based on results of surveillance cultures (oropharyngeal swabs) from a medical-surgical intensive care unit, collected from March 2005 through May 2006. Variables investigated included demographic characteristics, comorbid conditions, invasive procedures, use of devices and use of antimicrobials. Thirty case patients with P. aeruginosa carriage were identified. Other 84 patients with surveillance cultures negative to P. aeruginosa were enrolled as control subjects. Case patients were more likely to have a solid malignancy (Odds Ratio [OR] = 12.04, 95% Confidence Interval [CI] = 1.93-75.09, p=0.008), Acquired Immunodeficiency Syndrome (AIDS, OR = 7.09, 95% CI=1.11-45.39, p = 0.04), central nervous system disease (OR = 4.51, 95% CI = 1.52-13.39, p = 0.007), or to have a central venous catheter placed (OR = 7.76, 95% CI = 1.68-35.79, p=0.009). The use of quinolones was a protective factor (OR = 0.13, 95% CI = 0.03-0.47, p = 0.002). The predominance of comorbidities as risk factors points out a group of patients to whom preventive measures should be directed.

Metabolic syndrome and its associated risk factors in Brazilian postmenopausal women

Objective To evaluate the prevalence of metabolic syndrome (MetS) and its associated risk factors in Brazilian postmenopausal women.Methods In this cross-sectional study, a total of 368 postmenopausal women, aged 40-75 years, seeking health care at a public outpatient center in Southeastern Brazil, were included. According to the US National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines, MetS was diagnosed in subjects with three or more of the following: waist circumference >= 88 cm, blood pressure >= 130/85 mHg, triglycerides >= 150 mg/dl, high density lipoprotein cholesterol <50 mg/dl and glucose >= 110 mg/dl. Data on past medical history, tobacco use, anthropometric indicators, and values of C-reactive protein (CRP) were collected. Multivariate analysis, using a logistic regression model (odds ratio, OR) was used to evaluate the influence of various simultaneous MetS risk factors.Results The prevalence of having at least three, four and five MetS diagnostic criteria were met in 39.6%, 16.8% and 3.8% of the cases, respectively. The most prevalent risk factor was abdominal obesity, affecting 62.5% of women. The risk of MetS increased with a personal history of diabetes (OR 5.95, 95% confidence interval (CI) 2.82-12.54), hypertension (OR 4.52, 95% CI 2.89-7.08), cardiovascular disease (OR 2.16, 95% CI 1.18-3.94) and high CRP (>1 mg/dl) (OR 3.35, 95% CI 1.65-6.79). Plasma CRP levels increased with the number of MetS components present. Age, time since menopause and smoking had no influence, while hormone therapy reduced MetS risk (OR 0.64, 95% CI 0.42-0.97).Conclusion Metabolic syndrome was highly prevalent among Brazilian postmenopausal women seeking gynecologic health care. Abdominal obesity, diabetes, hypertension and high CRP were strong MetS predictors and hormone therapy appeared to play a protective role for this condition.

Prevalence of hysteroscopic findings and histologic diagnoses in patients with abnormal uterine bleeding

Objective: To describe the prevalence of hysteroscopic findings and histologic diagnoses inpatients with abnormal uterine bleeding (AUB).Design: Retrospective series of consecutive patients.Setting: Tertiary care University hospital and private office.Patient(s): Four thousand fifty-four hysteroscopies with biopsy in patients with AUB evaluated between June 1993 and December 2004.Intervention(S): Hysteroscopies were performed using 2.9-mm or 4-mm telescopes with CO2 or saline as the distension media. Biopsies were (lone with a 5-mm grasper or with a Novak's curette.Main Outcome Measure(s): Prevalence of hysteroscopic findings and histologic analysis of biopsies.Result(S): Endometrial polyp was the most frequent hysteroscopic finding, accounting for 1,374 (33.9%) cases. Normal uterine cavity and cervical canal were found in 814 (20.1%) patients. Submucous fibroids were diagnosed in 302 (7.5%) women. Normal endometrium was the most frequent histologic diagnosis, accounting for 1,888 (46.6%) cases. Endometrial polyp was found in 1, 115 (27.5%) patients. Endometrial hyperplasia was diagnosed in 613 (15.1%) and endometrial cancer in 105 (2.6%) women.Conclusion(s): Endometrial polyps are the most frequent hysteroscopic findings in patients with AUB, whereas normal endometrium is the most frequent histologic diagnosis.

Prevalência e fatores de risco para transtornos mentais comuns entre estudantes de medicina

OBJETIVO: Estimar a prevalência de transtornos mentais comuns entre estudantes de medicina e respectivos fatores de risco. MÉTODOS: Estudo transversal realizado com 551 universitários de um curso de medicina de Botucatu, SP. Utilizou-se questionário auto-aplicável investigando aspectos sócio demográficos, relacionados ao curso e o Self Reporting Questionnaire. Para análise dos dados empregaram-se os testes de qui-quadrado e regressão logística. RESULTADOS: Participaram 82,6% dos alunos matriculados no curso, predominando mulheres (61%), jovens (60% 20-23 anos), procedentes de outros municípios (99%). A prevalência de transtornos mentais comuns foi de 44,7% associando-se independentemente a: dificuldade para fazer amigos (RC=2,0), avaliação ruim sobre desempenho escolar (RC=1,7), pensar em abandonar o curso (RC=5,0), não receber o apoio emocional de que necessita (RC=4,6). Embora na primeira análise a prevalência tenha se mostrado associada ao ano do curso, esta associação não se manteve na análise multivariada. CONCLUSÕES: A prevalência de transtornos mentais comuns mostrou-se elevada entre os estudantes de medicina, associando-se a variáveis relacionadas à rede de apoio. As experiências emocionalmente tensas como o contato com pacientes graves, formação de grupos, entre outras, vividas nos últimos anos do curso, são provavelmente potentes estressores, especialmente para sujeitos com uma rede de apoio considerada deficiente. Sugere-se que instituições formadoras estejam atentas a esse fato, estabelecendo intervenções voltadas ao acolhimento e ao cuidado com o sofrimento dos estudantes.

Modifying effect of propolis on dimethylhydrazine-induced DNA damage but not colonic aberrant crypt foci in rats

Propolis is a honeybee product with several biological and therapeutic properties, including antimutagenic and anticarcinogenic activities. The effects of an aqueous extract of propolis (AEP) were evaluated on the formation of 1,2-dimethylhydrazine (DMH)-induced aberrant crypt foci (ACF) and DNA damage in the colon of male Wistar rats by the ACF and Comet assays, respectively. AEP was administered orally at 0.01%, 0.03%, 0.1%, and 0.3% in the drinking water, which resulted in doses of approximately 12, 34, 108, and 336 mg/kg body weight/day. Animals were also given a single subcutaneous injection of 40 mg/kg DMH and sacrificed 4 hr later for evaluating DNA damage, or 4 doses of 40 mg/kg DMH, administered 2 doses/week for 2 weeks, and sacrificed 12 weeks after the last injection for evaluating ACF development in the distal colon. Administration of AEP either simultaneously with or after the DMH treatment resulted in no statistically significant reduction of ACF. In contrast, 0.01%, 0.03%, and 0.3% AEP, given simultaneously with DMH, reduced DNA damage induction in the mid and distal colon. However, 0.3% AEP alone increased DNA damage in the colon. In conclusion, AEP had no effect on the formation of DMH-induced ACF in rat colon, but it modulated DMH-induced DNA damage in colon cells. Further investigations are recommended in order to establish the conditions under which propolis produces either protective or deleterious effects. (C) 2004 Wiley-Liss, Inc.

Progression of articular and extraarticular damage in oligoarticular juvenile idiopathic arthritis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Fatores associados à recorrência da infecção do trato urinário em crianças

OBJETIVOS: verificar a freqüência de infecção urinária recorrente (ITU) e avaliar os fatores associados à recorrência da ITU em crianças. MÉTODOS: estudo retrospectivo de 95 pacientes com seguimento de um ano (68 meninas e 27 meninos, mediana de idade três anos). As variáveis estudadas foram: sexo, idade, febre, constipação, tipo de bactéria, refluxo vésico-ureteral (RVU), anormalidades na cintilografia renal com ácido dimercaptosuccínico (DMSA). RESULTADOS: infecção urinária recorrente ocorreu em 49,5% crianças (19 com trato urinário normal, 19 com RVU e 9 com estenose da junção pielocalicial). Comparando o grupo com ITU recorrente com o grupo sem ITU recorrente não se encontrou diferença significativa entre sexos, presença de febre, constipação e anormalidades na cintilografia renal com DMSA. A ITU recorrente foi significativamente maior nas crianças com um ano ou menos, naquelas menores de dois anos com RVU, nas com bactéria diferente da Escherichia coli e sem profilaxia antibacteriana. Os fatores de risco significativos para a recorrência ITU foram idade < 2 anos (OR = 3,83) e refluxo vésico-ureteral (OR = 4,95). CONCLUSÕES: por causa da elevada freqüência de ITU recorrente é importante o seguimento regular de grupo de crianças com fatores de risco para ITU recorrente.