GB virus C/hepatitis G virus infection in dialysis patients and kidney transplant recipients in central Brazil

In order to investigate the prevalence of GB virus C (GBV-C)/hepatitis G virus (HGV) infection in dialysis patients and kidney transplant recipients in Central Brazil and also to analyze the virus genotypes distribution, a total of 123 patients including 98 on hemodialysis, 13 on continuous ambulatory peritoneal dialysis treatment, and 12 who received kidney transplantation were interviewed in one unit of dialysis treatment in Goiânia city. Blood samples were collected and serum samples tested for GBV-C/HGV RNA by polymerase chain reaction. Genotypes were determined by restriction fragment length polymorphism (RFLP) analysis. Eighteen samples were GBV-C/HGV RNA-positive, resulting in an overall prevalence of 14.6% (95% CI: 9.2-21.7). A high positivity for GBV-C/HGV RNA was observed in patients who had received kidney transplant (16.7%), followed by those on hemodialysis (15.3%), and peritoneal dialysis (7.7%). RFLP analysis revealed the presence of genotypes 1, 2, and 3 of GBV-C/HGV; more precisely, 9 (50%) samples were found belonging to the 2b subtype, 4 (22%) to the 2a subtype, 3 (17%) to genotype 1, and 2 (11%) to genotype 3. The present data indicate an intermediate prevalence of GBV-C/HGV infection among dialysis patients and kidney transplant recipients in Central Brazil. Genotype 2 (subtype 2b) seems to be the most prevalent GBV-C/HGV genotype in our region.

Seropositivity for hepatitis B virus, vaccination coverage, and vaccine response in dentists from Campo Grande, Mato Grosso do Sul, Brazil

This study investigated the seropositivity for hepatitis B virus (HBV), the vaccination index, and the vaccine response index in dentists from Campo Grande, MS. Blood samples from 474 dentists (63.7% women and 36.3% men), with a mean age of 38.5 ± 10.5 years were analyzed by enzyme-linked immunosorbent assay to detect the serological markers: HBsAg, anti-HBs, and anti-HBc. The HBsAg positive samples were tested for anti-HBc IgM, HBeAg, and anti-HBe. A total of 51 (10.8%) dentists showed seropositivity for HBV. Three (0.6%) were HBsAg/anti-HBc/anti-HBe positive, 43 (9.1%) were anti-HBc/anti-HBs positive, and 5 (1.1%) had only anti-HBc. Viral DNA was detected by polymerase chain reaction in 9 (17.6%) out of 51 HBV seropositive samples. A vaccination index of 96.6% (458/474) was observed, although 73.1% (335/458)completed the three-dose schedule. Excluding 46 HBV seropositive individuals from 458 that reported vaccination, 412 were analyzed for vaccine response index. It was observed that 74.5% (307/412) were anti-HBs positive; this percentage increased to 79.1% when three doses were administered. The results showed a high vaccination index and a good rate of vaccine response; however, the failure in completing the three-dose schedule and the occurrence of HBV infection reinforce the need for more effective prevention strategies.

Prevalence of hepatitis A virus infection in Goiânia, Goiás, Brazil, by molecular and serological procedures, 1995-2002

In this study, a total of 865 serum samples were collected between 1995 and 2002 from individuals living in Goiânia, Central Brazil, and clinically suspected of hepatitis. After exclusion of 162 samples which were positive for hepatitis B virus or hepatitis C virus, 703 samples were tested for anti-hepatitis A virus (anti-HAV) IgM antibodies by enzyme immunoassay. In addition, 588 of these samples and 22 fecal samples were analyzed by reverse transcription-nested PCR for HAV RNA detection, with positivity indices of 13.1% (77/588) and 54.5% (12/22), respectively. A similar index of viral RNA detection in anti-HAV-IgM positive or negative samples was observed in serum samples. HAV infection is a public health problem worldwide and this study underscores the extent of HAV circulation in our region.

Detection of calicivirus from fecal samples from children with acute gastroenteritis in the West Central region of Brazil

The objective of this study was to describe the circulation of caliciviruses in the West Central region of Brazil and its correlation with children's gender and age, as well as with the year and months of the sample collection. Reverse transcriptase-polymerase chain reaction was performed to detect the human calicivirus genome in 1006 fecal samples that were collected in Goiânia (n = 696) and Brasília (n = 310). Viral RNA was detected in 8.6% of the samples. No significant difference in viral prevalence was found regarding gender, age or year of the sample. However, it was observed that in Goiânia, there is a higher incidence of caliciviruses from September to March. The analysis employing three primer pairs demonstrated that the Ni/E3 or JV12/13 primer pairs, which detect norovirus (NoV), detected 41 positive samples while the 289/290 primer pair, which detects NoV or sapovirus, detected the remaining 46 samples. Calicivirus circulates in the West Central region of Brazil and for better detection of this virus it is important to use more than one primer pair. Also, we conclude that the seasonality presented by this virus is related to higher humidity in the period.

Astrovirus infection in children living in the Central West region of Brazil

This study presents data regarding the circulation of astrovirus in Goiânia-GO and Brasília-DF. These viruses were detected in fecal samples from hospitalized children up to five years old with and without acute gastroenteritis. A total of 1244 fecal samples were collected in two periods, 1994 to 1996 (Brasília) and 1998 to 2002 (Goiânia and Brasília), and were analyzed for viral RNA using the reverse transcription-polymerase chain reaction (RT-PCR). Positivity rates of 4.3 and 0.5% for astrovirus were observed in children with acute gastroenteritis and those without gastroenteritis, respectively. Among children with gastroenteritis no statistically significant difference was seen with regards to viral positivity rates in relation to gender and age. However, a higher incidence rate was observed for children from Brasília aged 36 months or more. Overall, astroviruses occurred predominantly from September to March in the two cities, suggesting a seasonal pattern for these viruses which coincides with the highest relative air humidity period. The results of this study highlight the importance of astrovirus as an etiologic agent of acute gastroenteritis in children of the Central West region of Brazil.

Molecular characterization of the NSP4 gene of human group A rotavirus samples from the West Central region of Brazil

Nonstructural protein 4 (NSP4), encoded by group A rotavirus genome segment 10, is a multifunctional protein and the first recognized virus-encoded enterotoxin. The NSP4 gene has been sequenced, and five distinct genetic groups have been described: genotypes A-E. NSP4 genotypes A, B, and C have been detected in humans. In this study, the NSP4-encoding gene of human rotavirus strains of different G and P genotypes collected from children between 1987 and 2003 in three cities of West Central region of Brazil was characterized. NSP4 gene of 153 rotavirus-positive fecal samples was amplified by reverse transcriptase-polymerase chain reaction and then sequenced. For phylogenetic analysis, NSP4 nucleotide sequences of these samples were compared to nucleotide sequences of reference strains available in GenBank. Two distinct NSP4 genotypes could be identified: 141 (92.2%) sequences clustered with NSP4 genotype B, and 12 sequences (7.8%) clustered with NSP4 genotype A. These results reinforce that further investigations are needed to assess the validity of NSP4 as a suitable target for epidemiologic surveillance of rotavirus infections and vaccine development.

Adenovirus, calicivirus and astrovirus detection in fecal samples of hospitalized children with acute gastroenteritis from Campo Grande, MS, Brazil

We analyzed fecal samples from hospitalized children up to three years of age with acute gastroenteritis at Campo Grande, Mato Grosso do Sul, Brazil, from May 2000-January 2004. Astrovirus and calicivirus were detected by Reverse Transcription-Polymerase Chain Reaction and adenovirus was detected using the Rotavirus and Adenovirus combined immunoenzyme assay. Astrovirus, adenovirus and calicivirus were detected at rates of 3.1%, 3.6% and 7.6%, respectively. These results re-emphasize the need for the establishment of regional vigilance systems to evaluate the impact of enteric viruses on viral gastroenteritis.

Molecular characterization of hepatitis A virus isolates from Goiânia, Goiás, Brazil

Hepatitis A virus (HAV) infection is a public health problem worldwide and the virus has been classified into six genotypes. In Brazil, the only genotype that has been found is genotype I, predominately from subgenotype IA. Here, the HAV genotypes were analyzed of 18 isolates circulating between 1996-2001 in Goiânia, state of Goiás, Brazil. Viral RNA was extracted from 18 serum samples and amplified (RT-PCR/nested-PCR), followed by the genomic sequencing of the VP1/2A junction region of the HAV genome. Sequences of 168 nucleotides were compared and analyzed using the BLAST N, Clustal X and PAUP v. 4.10b programs. All samples were classified as genotype I, with 10 belonging to subgenotype IA and eight to subgenotype IB. The subgenotype IA isolates showed greater diversity than the subgenotype IB isolates at the nucleotide level. Elevated identity values were found between isolates obtained in this study and those from other regions of the world, including Brazil, highlighting the high conservation among different isolates of this virus. However, changes in the HAV subgenotype circulation could also be observed during the evaluated period.

The circulation of human astrovirus genotypes in the Central West Region of Brazil

Out of 1,588 faecal samples of children taken from three locations of the Central West Region of Brazil, 57 were positive for astroviruses (HAstVs) using reverse transcription-polymerase chain reaction (RT-PCR). They were genotyped by nested RT-PCR and/or genomic sequencing. HAstV-1 (42.8%), HAstV-2 (23.2%), HAstV-3 (3.6%), HAstV-4 (14.3%) and HAstVs -5, -6, -7 and -8 (1.8% each) were detected. In Goiânia and Campo Grande, HAstV-1 was the most frequently detected genotype while in Brasília (DF) it was HAstV-2. Shifts in the circulation of astrovirus genotypes were observed in DF and Campo Grande. All samples collected by rectal swabs were viral negative. The astrovirus genotypes were detected in all age groups and there was no correlation between genotype and age group.

Molecular characterization of adenoviruses from children presenting with acute respiratory disease in Uberlândia, Minas Gerais, Brazil, and detection of an isolate genetically related to feline adenovirus

Human adenoviruses (HAdV) are a major cause of acute respiratory diseases (ARD), gastroenteritis, conjunctivitis and urinary infections. Between November 2000-April 2007, a total of 468 nasopharyngeal aspirate samples were collected from children with ARD at the Clinics Hospital of Uberlândia. These samples were tested by immunofluorescence assay (IFA) and 3% (14/468) tested positive for the presence of HAdV. By performing polymerase chain reaction (PCR) to detect HAdV DNA in samples that tested negative or inconclusive for all viruses identifiable by IFA (respiratory syncytial virus, parainfluenza viruses 1, 2 and 3, influenza viruses A and B and HAdV), as well as negative for rhinoviruses by reverse transcription-PCR, additional 19 cases were detected, for a total of 33 (7.1%) HAdV-positive samples. Nucleotide sequences of 13 HAdV samples were analyzed, revealing that they belonged to species B, C and E. Further analyses showed that species C (HAdV-2) was the most prevalent among the sequenced samples. To our knowledge, this is the first report describing the presence of HAdV-4 in Brazil. We also detected an isolate that was 100% identical to a part of the feline adenovirus hexon gene sequence.

Human rhinovirus in the lower respiratory tract infections of young children and the possible involvement of a secondary respiratory viral agent

Human rhinoviruses (HRV) are usually associated with mild respiratory symptoms in children. However, some studies have found that HRV can cause severe disease, especially when the patient is co-infected with a second virus. In this study, 532 nasopharyngeal aspirates (NPAs) were collected over a nine-year period from children at the Clinics Hospital of Uberlândia. The collected NPAs were then tested for HRV RNA using the reverse transcription-polymerase chain reaction. Eighty-three specimens from children diagnosed with lower respiratory tract illness (LRTI) were positive for HRV RNA and were then tested for the presence of eight other respiratory viruses. A second virus was detected in 37.3% (31/83) of the samples. The most frequent clinical diagnosis was bronchiolitis, followed by other LRTI and then pneumonia. The frequency of severe disease in children infected with more than one virus was not significantly different from the frequency of severe disease in children infected with HRV alone. Children infected with both HRV and parainfluenza virus (1.5 m.o.) were significantly younger than those infected by HRV alone (5.0 m.o.) (p = 0.0454). Overall, these results suggest that infection with a second virus does not lead to a higher frequency of severe syndromes in children presenting with LRTI.

Monitoring the circulation of rotavirus among children after the introduction of the RotarixTM vaccine in Goiânia, Brazil

The epidemiological features of rotavirus A (RVA) infection differ between children from developing and developed countries which could result in differences in vaccine efficacy around the world. To evaluate the impact of RotarixTM on RVA prevalence, we monitored RVA genotypes circulating in Goiânia by monitoring virus in faecal samples from children that had or had not been previously vaccinated. From February-November of 2008, 220 faecal samples were collected from children in seven day-care centres. RVA detection was performed by two methodologies and the results were confirmed by polyacrylamide gel electrophoresis. From the 220 samples, eight were RVA-positive (3.6%) and five were from children that had received either one or two doses of the vaccine. All positive samples were collected from children with diarrhoea during August and September. Genotyping of the RVA characterised five of the viral samples as genotype G2P[4] and one as G8P[4], suggesting that G2P[4] was the predominant circulating genotype in Goiânia during the study. The fact that vaccinated children were also infected by RVA suggests that the vaccine does not fully protect against infection by the G2[P4] RVA genotype.

Collectio sermonum de dominicis, de festis et de sanctis, ad usum Fratrum Minorum.

« Sermo adaptabillis b. Laurentio... Dispersit, dedit pauperibus... Quia secundum b. Dionixium in De ecclesiastica Yerarchia... » (1-2) ; — « Sermo de assumptione b. Marie... Quid hoc audio de te... Quid nos tantilly... » (2v-3), suivi d'une note à l'usage des prédicateurs : « Nota quod ne sermo sit deffectuosus... » (3) ; — « Sermo de conceptione b. Marie. Que est ista que progreditur... Karissimi, predicator evangelicus, beatitudinis eterne preco... » (3v-4v) ; — « Sermo de quatuor festis principalibus b. Marie... Que est ista que progreditur... Verba ista sunt tocius curie celestis... » (4v-5v) ; — « Sermo de Purificatione. In mansuetudine suscipite... Secundum b. Gregorium, Mor. 23... » (6-7) ; — « Sermo de b. Francischo... Cujus est ymago hec et superscriptio... Secundum b. Gregorium, omelia 30... » (7v-8v) ; — « Sermo in dominica [in Quinquagesima]. Ecce ascendimus Jerosolimam... Karissimi, sicut scitis, finis est... » (9-10) ; — [Sermo in dominica IIa post Epiphaniam] « Tu servasti vinum bonum usque adhuc... In verbis istis spiritualiter intellectus... » (10-10v) ; — « Sermo de b. Francischo. Ad ymaginem similitudinis sue... Verba ista ad litteram scripta... » (11-12) ; — « Sermo de b. Johane Baptista. Magnus es tu et faciens mirabilia... Secundum Gregorium quia tute... » (12v-13) ; — « Sermo de angelis. Inmittit angelus Domini... Sanctus ille David, acceptus de ovibus... » (13v-14) ; — « In ascensione Domini. Exultavit ut gigas... Duo sunt inter cetera Christi misteria... » (14v-16) ; — « De asumpcione Domine nostre. Ad preceptum tuum elevabitur aquila... Quia, karissimi, Mater Domini... » [FRANCISCUS DE MAYRONIS] ; cf. éd. Bâle, 1498, f. CIV-CIIIV, avec variantes (16v-18) ; — « De Maria Magdalena. Permittuntur [sic pro : Remittuntur] tibi peccata tua... Sicut solent maximi principes... » [Idem], sermon abrégé ; cf. éd. cit., f. LXXXVIIIV-XCI (18-19v) ; — « De s. Johane Evangelista. Dillectus meus michi... Ostenditur b. Johannes prout inflamatus... » [Idem], résumé ; cf. éd. cit., f. XXIX-XXIXV (20) ; — « In festo apostolorum Petri et Pauli. Accepimus gratiam et apostolatum... Gloriosissimi christiane fidei religionis... » (20v-23v) ; — « Sermo de gratia divina acquirenda. Accepimus gratiam etc. Vivat, obsecro, anima mea ... quoniam... » (24) ; — « Accepimus gratiam etc. Restat ostendere via physionomica... » (24v-26) ; — « Sermo de beatitudine, sive gloria celesti, sive in festo Omnium sanctorum. Fons sapientie verbum Dei... Ecce ego sto prope fontem... In hoc festo precipue et anno... » (26-29) ; — « De nativitate Domine nostre. Egredietur virga de radice Jesse... Percutiet terram virga... Clementissimus pastor ovium... » (29v-32) ; — « Sermo de uno confessore pontifice. Rector fratrum et stabilimentum populi... Inter viros eximie sanctitatis... » (32v) ; — « De nativitate Domini. Transeamus usque Bethelem... Innocencius in quodam sermone de predicatione... » (34v-36) ; — « In die nativitatis Domini. Sol ortus est et humiles exaltati sunt... Beatus Augustinus, De Civitate Dei : Anima participacione... » (36-37v) ; — « Dominica infra octavas Nativitatis. Ecce positus est hic in ruinam... Secundum doctrinam Philosophi in diversis locis... » (38-38v) ; — « Dominica quarta in quadragesima. Sequebatur eum multitudo magna... Secundum Damascenum libro primo, capitulo XV°, diversitas actionum... » (39-40v) ; — « De Canane[a], dominica secunda [sic] in quadragesima [Feria 5a post dom. Ia in XLa]. Dimitte illam quia clamat... Si attendamus ordinem generacionis... » (41-42v) ; — « Dominica de Passione. Si veritatem dico vobis... Secundum sententiam Phylosophi primo Metaphysice... » (43-43v) ; — « In cena Domini. Hodie est rex et cras morietur... Omne agens ordinate prius inquirit... » (44-45) ; — « De resurectione. Hec dies quam fecit Dominus... Scilicet est ex dictis Philosophi in diversis locis... » (45v-47) ; — « Dominica in Quadragesima. Ecce nunc tempus acceptabile... Ut dicit Philosophus, secundo de Celo et mundo... » (47-48v) ; — « De b. Clara. Sicut lux meridiana clara est... Secundum Philosophum tertio Methaphysice, si res creatas... » (48v-49v) ; — « Sermo de Cruce. Vidit mulier quod bonum esset lignum... Sicut ex doctrina Philosophi primo Ethicorum... » (50-51) ; — « De s. Anthonio. Misit servum suum hora cene... Sicut in rebus naturalibus docet experiencia... » (51v-52v) ; — « De b. Johane Batista. Tu puer propheta Altissimi... Secundum doctrinam Hugonis in commento de angelica Jerarchia... » (53-54) ; — « De b. Bertholameo [sic]. Dedit illi contra inimicos potenciam... Racio docet et experiencia manifestat... » (54v-55) ; — « De b. Francischo. Amice, ascende superius... Dicit Philosophus quinto Physicorum quod motus... » (55v-56) ; — [De b. Bernardo] « Omnia parata sunt, venite ad nupcias... Sicut videmus in motu naturali... » (56v-57) ; — « De sacerdote novo. Vos elegit Dominus... Ut potest haberi ex dictis Dyonisii... » (57v-58v) ; — « De assumpcione Virginis gloriose. Elevetur tronus David super Israel... Videmus quod triplici racione aliqua corpora... » (58v-59v) ; — « De assumpcione Virginis. Veni de Libano sponsa mea... Secundum testimonium Scripturarum et humane consuetudinis... » (59v-61) ; — « De Trinitate. Tripliciter sol exurens montes... Secundum quod dicit Philosophus, tota nostra noticia... » (61-61v) ; — « De b. Francischo. Hic beatus in facto suo erit... Post doctrinam philosophorum et experienciam... » (62-62v) ; — [De b. Eligio] « Provideat rex virum sapientem... Secundum sententiam (secundum) sapientis primo Metaphysice . » (63-64) ; — « De resurrectione Domini. Tercia dies est hodie... Tripliciter alicujus rei non vise accipimus fidem certam... » (64-65) ; — «Stetit in medio discipulorum et dixit : Pax vobis... Ut dicit b. Augustinus undevicesimo de Civitate Dei... » (65v-67) ; — « De Omnibus sanctis... Gloriosa dicta sunt de te... Aperta est civitas... Doctore egregio Bernardo scilicet attestante... » (67-69) ; — « De b. Johane Batista. Hic venit in testimonium... Sicut potest probari ex dictis Philosophi et exemplis... » (69v-70) ; — « De b. Petro apostolo. Tu pasce populum meum Israel... Secundum sententiam Philosophi tertio Politicorum... » (70v-71) ; — « De assumpcione Virginis gloriose. Transibo in locum tabernaculi... Triplici ratione secundum philosophorum doctrinam aliqua moventur... » (71v-72v) ; — [De b. Francisco] « Adolescens, tibi dico surge... Consideranti sciderum revolucionem... » (73-74v) ; — [De s. Michaele] « Michael et angeli preliabantur... Sicut ex doctrina Phylosophi in pluribus locis patet... » (74v-76) ; — « De b. Nicholao. Petra fundebat michi rivos olei... Secundum philosophicam doctrinam, diversitas effectuum... » (76-77) ; — « In festo apostolorum Petri et Pauli. Fecit Deus duo luminaria magna... Secundum sententiam Philosophi secundo Methaphysice... » (77v-78) ; — « De b. Bertholameo. Vidi angelum fortem... Secundum dictum Philosophi, omnes transferentes... » (78v-79) ; — « Dominica in Quadragesima. Ductus est Jhesus in desertum... Sicut naturalium operationum multiplex experiencia... » (79v-80v) ; — « De s. Thoma apostolo. Ecce cognovi quoniam Deus meus es... Bernardus in sermone : Deus noverim me... » (81-81v) ; — « De sacerdote novo. Misit Dominus servum suum... Secundum quod dicit Philosophus primo Ethicorum, diversarum operationum... » (82-82bis) ; — « In purificatione Virginis. Parasti ante faciem omnium populorum... Si attendamus formationem rerum temporalium... » (82bisv-83v) ; — « De uno martire. Esto vir fortis, et prelia bella Domini... Secundum consuetudinem hominum... » (84-85) ; — « De festo Purificacionis. Lucerna splendens super candelabrum... Doctrina philosophorum et tradit... » (85v-86v) ; — « Feria quarta Cinerum. Cum jejunas unge caput tuum... Morum Philosophi doctrinam perlegens et attendens... » (87-88v) ; — « In quarta feria Cinerum. Cum jejunatis, nolite fieri sicut ypocrite... Sicut ex doctrina Philosophi primo Ethicorum potest colligi... » (88v-89v) ; — « In festo b. Lodovici [episcopi]. Surrexit rex de solio suo... Ut dicit Philosophus quarto Methaphysicorum... » (90-91v) ; — « De b. Jacobo. Vox tonitrui tui in rota... Secundum doctrinam philosophicam formarum naturalium... » (91v-92v) ; — [In festo Annunciationis] « Ecce concipies in utero... Secundum doctrinam Philosophi septimo de Animalibus, ad generationem... » (93-94) ; — « De s. Ludovico [episcopo]. Reposita est michi corona justitie... Secundum sententiam Philosophi secundo Phisicorum, omne agens... » (94-96).

Human bocavirus 1 and 3 infection in children with acute gastroenteritis in Brazil

To determine the positivity rate of human bocavirus (HBoV) 1 and 3 among children who presented with acute gastroenteritis symptoms during the period of 1994-2004 in the Central-West Region of Brazil, 762 faecal samples were tested using polymerase chain reaction (PCR) for the detection of HBoV DNA. Primers for a segment of the non-structural viral protein 1 (NS1) gene of HBoV-1 and HBoV-3 were used. Twelve HBoV-positive samples were further characterised via genomic sequencing and phylogenetic analysis. Of the samples tested, 5.8% (n = 44) were positive for HBoV-1 or HBoV-3 and co-infection was observed in 14 (31.8%) of the 44 HBoV-positive samples. Nine of the 14 samples were also positive for Rotavirus A and five were positive for Aichi virus. The genomic sequencing of the NS1 partial sequence of 12 HBoV-samples showed that 11 samples were characterised as HBoV-1 and that one was characterised as HBoV-3. The phylogenetic analysis showed that the HBoV-1 samples had a high sequence homology to others previously identified in China, Sweden and Brazil. This is the first study conducted in the Central-West Region of Brazil to detect HBoV-1 and HBoV-3 in faecal samples from children with acute gastroenteritis. Further studies are required to define the role of HBoVs as aetiological agents of gastroenteritis.

Vivências de mulheres à dor no infarto do miocárdio

O estudo objetivou compreender os significados da experiência da dor em mulheres que sofreram infarto do miocárdio e identificar as suas ações imediatas diante da mesma. A pesquisa qualitativa utilizou a teoria do Interacionismo Simbólico e a metodologia da Teoria Fundamentada nos Dados. Quarenta e três mulheres foram entrevistadas em Hospital Universitário. A categoria central que expressou o sentido da experiência foi "Tendo uma ruptura com a vida cotidiana". As categorias que revelaram essa ruptura mostraram que diante da dor crescente as mulheres se sentiram dominadas e com medo de morrer, pois perderam o controle pessoal sobre o corpo e a vida. Não reconheceram o infarto e resistiram, a princípio, à procura de atendimento, fazendo tentativas para minorar a dor. Interagindo com a dor insuportável e com a impotência no seu controle, pediram a salvação Divina, ajuda às pessoas e recorreram a tratamento médico.