Secondary dengue infection in schoolchildren in a dengue endemic area in the State of Rio de Janeiro, Brazil

A seroepidemiologic survey was carried out in schoolchildren from public schools of the Niterói municipality, state of Rio de Janeiro, Brazil, after a period of sequential epidemics by dengue virus type 1 and 2 (DEN-1 and DEN-2). 450 blood samples were obtained by fingertip puncture and collected on filter paper discs. The hemagglutination inhibition (HAI) test was carried out using DEN-1 and DEN-2 antigens. HAI titres were demonstrated in 66% (297/450) of the sera and the geometric means of the titres were 1/182 and 1/71 for DEN-1 and DEN-2, respectively. Secondary infections were observed in 61% (181/297) of positive cases. Among these, 75% (135/181) were under fifteen years old. No dengue haemorrhagic fever (DHF) was reported in these children. Asymptomatic or oligosymptomatic infections were detected in 56% of the studied population. The absolute and relative frequencies of positive tests by age group and sex did not evidence statistically significant difference. The number of individuals infected probably produced a immunologic barrier responsible for the non occurrence of dengue epidemic in the latter years.

One-step preparation of optically transparent Ni-Fe oxide film electrocatalyst for oxygen evolution reaction

Optically transparent cocatalyst film materials is very desirable for improved photoelectrochemical (PEC)oxygen evolution reaction (OER) over light harvesting photoelectrodes which require the exciting light to irradiate through the cocatalyst side, i.e., front-side illumination. In view of the reaction overpotential at electrode/electrolyte interface, the OER electrocatalysts have been extensively used as cocatalysts for PEC water oxidation on photoanode. In this work, the feasibility of a one-step fabrication of the transparent thin film catalyst for efficient electrochemical OER is investigated. The Ni-Fe bimetal oxide films, 200 nm in thickness, are used for study. Using a reactive magnetron co-sputtering technique, transparent(> 50% in wavelength range 500-2000 nm) Ni-Fe oxide films with high electrocatalytic activities were successfully prepared at room temperature. Upon optimization, the as-prepared bimetal oxide film with atomic ratio of Fe/Ni = 3:7 demonstrates the lowest overpotential for the OER in aqueous KOH solution, as low as 329 mV at current density of 2 mA cm 2, which is 135 and 108 mV lower than that of as-sputtered FeOx and NiOx thin films, respectively. It appears that this fabrication strategy is very promising to deposit optically transparent cocatalyst films on photoabsorbers for efficient PEC water splitting.

Nutritonal evaluation of pemphigus foliaceus patients on long term glucocorticoid therapy

Our objective was to compare food intake and nutritional status of Pemphigus Foliaceus patients (PG) on long term glucocorticoid therapy to a Control Group (CG). Fourteen PG female inpatients receiving prednisone (0.33 ± 0.22mg/kg) for at least 12 months and twelve CG subjects were submitted to nutritional evaluation, including anthropometry, urinary creatinine determination and serum biochemical measurements, besides 48-h-based food intake records. Groups were compared by Chi-square, Mann-Whitney and "t" tests. PG patients and CG were paired, respectively, in relation to age (24.7 ± 14.1 vs. 22.0 ± 12.0 years), body mass index (25.8 ± 6.4 vs. 24.0 ± 5.6kg/m2), daily protein intake (132.9 ± 49.8 vs. 95.2 ± 58.9g), and serum albumin (median; range) (3.8; 3.5-4.1 vs. 3.8; 3.6-5.0g/dl). However, PG patients had lower height-creatinine index (64.8 ± 17.6 vs. 90.1 ± 33.4%), and higher daily energy (3080 ± 1099 vs. 2187 ± 702kcal) and carbohydrate (376.8 ± 135.8 vs. 242.0 ± 80.7g) intakes. Despite high food, protein and energy consumption, PG patients on long term glucocorticoid therapy had lower body muscle mass than controls, while showing high body fat stores. These findings are possibly related to combined metabolic effects of long term corticotherapy and inflammatory disease plus corticosteroid-induced increased appetite.

The impact of firm-promoted accreditation of prior learning processes on the worker-organization relationship

The process of Competences Recognition, Validation and Certification , also known as Accreditation of Prior Learning (APL), is an innovative means of attaining school certificates for individuals without an academic background. The main objective of this process is to validate what people have learned in informal contexts, in order to attribute academic certificates. With the increasing interest of the qualification of workers and governmental support, more and more Portuguese organizations promote this process within their facilities and their work hours. This study explores the relationship between the promotion of this Human Resource Development Programme and employee’s attitudes (Job Satisfaction and Organizational Commitment) and behaviours (Extra-role Organizational Citizenship Behaviours) towards the organization they work for. Results of a cross-sectional survey of Portuguese Industrial Workers (N=135) showed that statistical significant results are in the higher levels of Voice Behaviours (a dimension of Extra-role Organizational Citizenship Behaviour in the groups of workers who were involved or had graduated from the firm promoted APL process.

Hepatitis B vaccine in infants: a randomized controlled trial comparing gluteal versus anterolateral thigh muscle administration

A significantly diminished antibody response to hepatitis B vaccine has been demonstrated in adults when the buttock is used as the injection site. However, in Brazil, the buttock continues to be recommended as site of injection for intramuscular administration of vaccines in infants. In this age group, there are no controlled studies evaluating the immunogenicity of the hepatitis B vaccine when administered at this site. In the present study, 258 infants were randomized to receive the hepatitis B vaccine either in the buttock (n = 123) or in the anterolateral thigh muscle (n = 135). The immunization schedule consisted of three doses of hepatitis B vaccine (Engerix Bâ, 10 mug) at 2, 4 and 9 months of age. There were no significant differences in the proportion of seroconversion (99.3% x 99.2%), or in the geometric mean titer of ELISA anti-HBs (1,862.1 x 1,229.0 mIU/mL) between the two groups. This study demonstrates that a satisfactory serological response can be obtained when the hepatitis B vaccine is administered intramuscularly into the buttock.

Outbreak of influenza type A (H1N1) in Iporanga, São Paulo State, Brazil

From June to July 1999 an outbreak of acute respiratory illness occurred in the town of Iporanga. Out of a total of 4,837 inhabitants, 324 cases were notified to the Regional Surveillance Service. Influenza virus was isolated from 57.1% of the collected samples and 100% seroconversion to influenza A (H1N1) was obtained in 20 paired sera tested. The isolates were related to the A/Bayern/07/95 strain (H1N1). The percentages of cases notified during the outbreak were 28.4%, 29.0%, 20.7%, 6.2% and 15.7% in the age groups of 0-4, 5-9, 10-14, 15-19 and older than 20 years, respectively. The highest proportion of positives was observed among children younger than 14 years and no cases were notified in people older than 65 years, none of whom had been recently vaccinated against influenza. These findings suggest a significant vaccine protection against A/Bayern/7/95, the H1 component included in the 1997-98 influenza vaccine for elderly people. This viral strain is antigenically and genetically related to A/Beijing/262/95, the H1 component of the 1999 vaccine. Vaccines containing A/Beijing/262/95 (H1N1) stimulated post-immunization hemagglutination inhibition antibodies equivalent in frequency and titre to both A/Beijing/262/95-like and A/Bayern/7/95-like viruses. Thus, this investigation demonstrates the effectiveness of vaccination against influenza virus in the elderly.

Piedade popular. Um repertório bibliográfico, um projecto de investigação

pp. 135-173

Prevalence of human papillomavirus infection in rural villages of the Bolivian Amazon

Cervical cancer constitutes a major health problem in developing countries like Bolivia. The roles of certain genotypes of human papillomaviruses (HPVs) in the pathogenesis of cervical cancer is well established. The prevalence of HPV infection among sexually active women varies greatly. Information regarding HPV infection in Bolivia is very much scarce, specially in regions like the Amazonian lowland. We studied 135 healthy women living in four rural localities of the Bolivian Amazon. Presence of HPV in DNA extracted from cervical swabs was analyzed using a reverse line hybridization assay. The estimated overall HPV infection prevalence among the studied rural localities was 5.9% (ranging from 0-16.6%). These values were unexpectedly low considering Bolivia has a high incidence of cervical cancer. The fact that Amazonian people seem to be less exposed to HPV, makes it likely that some other risk factors including host lifestyle behaviors and genetic background may be involved in the development of cervical cancer in this population.

O elogio da imagiologia ou da memória científico-didáctica

pp. 119-135

A Terapêutica Crónica com Nitratos está Associada a uma Diferente Apresentação Clínica de Síndroma Coronária Aguda?

A terapêutica com nitratos pode induzir pré-condicionamento isquémico, com consequente aumento da tolerância a isquémia. No contexto de síndromes coronárias agudas (SCA), os nitratos podem condicionar uma diferente forma de apresentação, com maior protecção. Objectivos: Estudar numa população de doentes com SCA se a administração crónica prévia ao evento, de nitratos condiciona a forma de apresentação do SCA. Métodos: Estudo de 287 doentes (65 +- 13 anos, 66% sexo masculino) admitidos no nosso serviço por SCA (com e sem elevação do segmento ST) no primeiro semestre de 2005. Destes, 8% estavam sob terapêutica com nitratos prévia à admissão. Neste grupo 27% apresentaram-se como SCA com elevação do segmento ST e no grupo sem nitratos, este valor foi de 58% (p=0,005). Por análise univariada, a utilização de nitratos foi preditora da ocorrência preferencial de "SCA sem elevação do segmento ST" (OR 0,27, IC 95% 0,10-0,71, p=0,005). Após correcção para variáveis potencialmente influentes (idade, sexo, revascularização prévia, tabagismo) por análise multivariada de regressão logística, a terapêutica com nitratos foi preditora limiar da apresentação clínica "SCA sem elevação do segmento ST" (OR 0,37, IC 95% 0,13-1,04), p=0,059. Conclusão: A utilização prévia à ocorrência de SCA associou-se com um desvio da apresentação para a forma de SCA sem elevação do segmento ST. Este achado pode ser justificado pela hipótese de que os nitratos podem induzir um pré-condicionamento farmacológico, reduzindo a extensão transmural do enfarte.

Prevalência de Doença Carotídea na Patologia Cérebro-Vascular Isquémica. O Papel do Eco-Doppler

BACKGROUND: Atherosclerotic carotid disease represents approximately 20% of the causes of ischemic stroke. Effective treatment options, such as endovascular or surgical revascularization procedures, are available. Doppler Ultrasound (DUS) is a non-invasive, inexpensive, routine exam used to evaluate the presence of internal carotid artery (ICA) stenosis. We retrospectively analysed the prevalence of severe atherosclerotic carotid disease in a population of patients with acute ischemic stroke/transitory ischemic attacks (TIAs), and the role of DUS in the detection of ICA stenosis and treatment decisions in these patients. METHODS: A total of 318 patients with ischemic stroke or TIAs was admitted to our stroke unit, and 260 patients were studied by DUS. ICA stenosis was evaluated by DUS according to peak systolic velocity. All DUS exams were performed by the same operator. ICA stenosis was further assessed in 43 patients by digital subtraction angiography (DSA) using NASCET criteria. RESULTS: Of the total 318 patients, 260 (82%) had DUS evaluation. Of the total 520 ICAs studied by DUS, degrees of ICA stenosis were: 0-29% n= 438 (84%); 30-49% n= 8 (2%); 50-69% n= 27 (5%); 70-89% n= 15 (3%); 90-99% n= 20 (4%); oclusão n= 14 (2%). Of the total 260 patients studied, 43 (16.5%) underwent DSA. Sensibility and specificity of DUS in the diagnosis of carotid stenosis over 70% were, respectively, 91% e 84%. Of the total 31 patients with significant carotid stenosis (70-99%), 23 (74%) underwent subsequent carotid revascularization procedures. DISCUSSION: DUS is an important screening test in our stroke unit, justifying its use as a routine exam for all patients with ischemic stroke/TIAs. Moreover, our results show the relevance of severe carotid disease in a population with acute ischemic stroke/TIAs (16.5%), with a total of 9% of patients being submitted to carotid revascularization procedures.

Human herpesvirus-7 as a cause of exanthematous ilnesses in Belém, Pará, Brazil

We screened sera from 370 patients suffering from exanthematous illnesses in Belém, North Brazil, for the presence of human herpesvirus-7 (HHV-7) IgM and IgG antibodies. Samples were obtained from January 1996 to December 2002 and were processed by a HHV-7-specific indirect immunofluorescence assay (IFA). HHV-7-specific IgM and/or IgG antibodies were found in 190 (51.4%) of these patients, with similar prevalence rates (IgM+ and IgG+ subgroups taken together) for female and male subjects: 52.5% and 50.3%, respectively. Serological status as defined by IgG was identified in 135 (36.5%) patients. In 55 (14.9%) of the patients HHV-7 IgM antibodies were detected. HHV-7 IgM- and- IgG antibody rates were similar (p > 0.05) when male and female subjects are compared: 14.4% versus 15.3% and 38.1% versus 35.0%, respectively. Statistically significant difference (p = 0.003) was noted when HHV-7-IgM-positive female and male patients aged 5-8 months are compared. Prevalence rates ranging from 4.6% (female, 5-8 months of age) to 93.3% (female, > 10 years of age) and 12.2% (male, 5-8 months) to 80.0% (male, 8-10 years of age) were noted in the IgG- positive subgroups. A subgroup (n = 131) of patients with IgM or IgG HHV-7 antibodies were examined for the presence of DNA using a polymerase chain reaction/nested PCR. Recent/active HHV-7 infection occurred at a rate of 11.0% (6/55) among patients whose samples presented IgM+ specific antibodies. In a subgroup (n = 76) of patients with high HHV-7-IgG antibody levels (titre > 1:160) DNA could not be detected in sera examined by PCR/nested PCR. Of the six recent/active infections, four subjects with less than 1 year and two with 3 and 6 years of age, presented typical exanthem subitum (E.S), as defined by higher fever (> 38.0 ºC) with duration of 24 to 72 hours, followed by a maculopapular skin rash. Our results underscore the need for searching HHV-7 infection in patients with exanthematous diseases, particularly those presenting with typical E.S. HHV-7 appears therefore to emerge as a newly recognized pathogen of exanthem in our region.

Abcesso Mediastínico Após Laceração Iatrogénica do Seio Piriforme - Caso Clínico

A hipofaringe e o esófago cervical são áreas particularmente vulneráveis a traumatismos por entubação oro-traqueal. Estes acidentes anestésicos são raros, pouco relatados e com maior incidência em situações de emergência. As perfurações faringoesofágicas podem passar despercebidas até ao aparecimento de sinais e sintomas característicos. Estes incluem dor cervical, febre, disfagia, leucocitose, enfisema subcutâneo e pneumomediastino. O tratamento cirúrgico vs conservador é controverso. É no entanto consensual que o intervalo de tempo entre o traumatismo e o diagnóstico e tratamento é, por si só, o factor mais importante para o prognóstico. Os autores apresentam um caso de uma parturiente submetida a cesariana de urgência em que ocorreu um acidente anestésico por entubação difícil, com laceração do seio piriforme e posterior formação de abcesso mediastínico.

Rastreio Neonatal de Hemoglobinopatias numa População Residente em Portugal

The primary objective of newborn screening of hemoglobinopathies is the early identification of infants with sickle cell disease, as they are at increased clinical risk. Other goals include the identification of other types of clinically significant hemoglobinopathies and the detection of heterozygous carriers followed by the screening and counselling of family members. We performed a pilot study for the neonatal screening of hemoglobinopathies in 400 samples of cord blood taken from a maternity in Lisbon. We did not find any newborn with sickle cell disease. Six samples were from sickle cell heterozygotes, the respective families were studied and informed. We looked for the presence of alpha-thalassemia at birth in 100 consecutive samples of cord blood, by the presence of Hb Bart's, abnormal red blood cell indices and alpha-globin genotype. The results show an incidence of 10% of alpha-thalassemia (-alpha) carriers and 4% of triple alpha-globin gene carriers. The authors discuss the feasibility of neonatal screening of hemoglobinopathies in a Portuguese-speaking population consisting of a low prevalence of Hb S trait autoclonous group and a high prevalence immigrant minority

Postaerobic Exercise Blood Pressure Reduction in Very Old Persons With Hypertension.

BACKGROUND AND PURPOSE: A single bout of aerobic exercise acutely decreases blood pressure, even in older adults with hypertension. Nonetheless, blood pressure responses to aerobic exercise in very old adults with hypertension have not yet been documented. Therefore, this study aimed to assess the effect of a single session of aerobic exercise on postexercise blood pressure in very old adults with hypertension. METHODS: Eighteen older adults with essential hypertension were randomized into exercise (N = 9, age: 83.4 ± 3.2 years old) or control (N = 9, age: 82.7 ± 2.5 years old) groups. The exercise group performed a session of aerobic exercise constituting 2 periods of 10 minutes of walking at an intensity of 40% to 60% of the heart rate reserve. The control group rested for the same period of time. Anthropometric variables and medication status were evaluated at baseline. Heart rate and systolic and diastolic blood pressures were measured at baseline, after exercise, and at 20 and 40 minutes postexercise. RESULTS: Systolic blood pressure showed a significant interaction for group × time (F3,24 = 6.698; P = .002; ηp = 0.153). In the exercise group, the systolic blood pressure at 20 (127.3 ± 20.9 mm Hg) and 40 minutes (123.7 ± 21.0 mm Hg) postexercise was significantly lower in comparison with baseline (135.6 ± 20.6 mm Hg). Diastolic blood pressure did not change. Heart rate was significantly higher after the exercise session. In the control group, no significant differences were observed. CONCLUSIONS: A single session of aerobic exercise acutely reduces blood pressure in very old adults with hypertension and may be considered an important nonpharmacological strategy to control hypertension in this age group.