Tecnologia par de cobre – ITED 3. Para além da transmissão de voz e dados

A secção 3 da 3ª edição do Manual ITED estabelece que as redes de cabos (ou simplesmente cablagem) caracterizam-se como o elemento das ITED que permite o transporte e distribuição dos sinais de telecomunicações nos edifícios nas três tecnologias de cabos definidas para o transporte físico da informação: cabos de par de cobre, cabo coaxial e fibra ótica. No que respeita à tecnologia de par de cobre os seus requisitos e caraterísticas mínimas estão também endereçadas nessa terceira seção.

Prevalence of human herpesvirus 8 antibodies in the population of Belém, Pará, Brazil

Serum samples from 497 children and adults inhabiting two neighbourhoods (Guamá and Terra Firme) in Belém, Pará, North Brazil were screened for the presence of human herpesvirus 8 (HHV-8) antibody using an enzyme-linked immunosorbent assay. An overall 16.3% prevalence was found for these urban communities. Taken both genders together, prevalence rates of HHV-8 antibody increase gradually, across age-groups, ranging from 12.0% to 33.3%. When seroprevalence is analysed by gender, similar rates are found for female (18.4%) and male (14.0%) individuals. In the former gender group, seroprevalence rates increased from 10.3%, in children £ 10 years of age, to 30.0% in adults 41-50 years of age. Conversely, among male subjects, the prevalence of HHV-8 antibodies decreased from 13.3% in children/young adults aged £ 10 to 20 years of age to 6.1% in adults aged 21-30 years. From the 31-40 year-old group male onwards, seropositivity rates increased gradually, ranging from 8.3% to 66.7%. A significant difference in seropositivity rates was noted when comparing 21-30 age groups for female and male subjects: 23.3% and 6.1%, respectively (P = 0.03). Geometric mean optical densities were found to increase slightly from the lower to the higher age-groups. Our data suggest that transmission of HHV-8 occurs frequently in the general urban population of Belém, and that prevalence of antibody seems to increase with age.

The venomous toadfish Thalassophryne nattereri (niquim or miquim): report of 43 injuries provoked in fishermen of Salinópolis (Pará State) and Aracaju (Sergipe State), Brazil

Fishes of family Batrachoididae are responsible for great number of injuries in fishermen in North and Northeast regions of Brazil. The genus Thalassophryne presents various venomous species of fishes found in the Brazilian coast, T. nattereri being the most common of them. The venom is ejected through two hollow spines on the dorsal fin and two on pre-opercular regions, which present a venomous gland in the base and can be erected or depressed by the fish. The manifestations of the envenoming were intense local pain, edema and erythema in 43 patients observed in Salinópolis (Pará State) and Aracaju (Sergipe State). There were no systemic manifestations, but necrosis was detected in eight and bacterial infection in ten injured fishermen. The circumstances of the contacts and therapeutic aspects are discussed. Envenoming by the genus Thalassophryne is important and frequent and should be considered of moderate severity grade, since there are not the excruciating pain or the massive local necrosis provoked by scorpionfishes (Scorpaena) or stingrays injuries nor the systemic manifestations that are the most important marker of severe envenoming.

Evidence of active herpesvirus 6 (variant-A) infection in patients with lymphadenopathy in Belém, Pará, Brazil

A total of 323 patients with lymphadenopathy were selected in Belém, Brazil, between January 1996 and December 2001, and screened for the presence of human herpesvirus-6 (HHV-6) IgM- and- IgG antibodies by enzyme-linked immunosorbent assay (ELISA). When seroprevalence is analyzed by gender, similar rates are found for female (60.6%) and male (55.7%) individuals. Seventy-seven (23.8%) patients were HHV-6-IgM-and- IgG-positive (IgM+ subgroup), with positivity rates of 29.7% and 17.7% (p = 0.0007) for female- and male individuals, respectively. Sera from a subgroup (n = 120) of these subjects, with high HHV-6 antibody levels (either IgM+ or IgG+ reactivities), were subsequently processed for the presence of HHV-6 DNA by polymerase chain reaction (PCR)/nested PCR. Active infections (IgM+ and/or IgG+ high levels specific antibodies plus detection of viral DNA) were diagnosed in 20/77 (20.0%) and 8/43 (18.6%); subgroup of the 120 individuals suspected of having HHV-6 suggestive recent infection. All (n = 28) cases of active infection were found to be associated with HHV-6 variant-A (HHV-6A), as detectable by PCR/nested PCR, using variant-specific primer that amplify regions of 195 base pairs (bp) (HHV-6A) and 423 bp (HHV-6B). Rates of HHV-6 DNA detection between female and male patients were similar (p > 0.05) in the IgM+ and IgG+ groups: 20.4% versus 35.7% and 25.0% versus 13.0%, respectively. HHV-6 DNA was detected across < 5 through 41-50-year age-groups for patients whose serum samples were IgM+, with rates ranging from 7.7% (female subjects aged < 5 years) to 80.0% (male, 11-20 years). Among patients whose serological status was IgG+, HHV-6 DNA was detected in < 5, 6-10, 21-30 and > 50 age-groups at rates that ranged from 15.4% (male, < 5 years of age) to 100.0% (female aged 11-20 years). Swelling cervical lymph nodes were the most common sign, accounting for 9 (32.0%) cases in each gender group. Among patients (n = 28) with active infection by HHV-6A variant, duration of symptoms lasted 1-5 days in 35.7% of subjects, whereas in 64.3% of them the disease lasted 6-20 days. Our data suggest that it is worth seeking for HHV-6 infection whenever a patient (infant or adult) presents with lymphadenopathy as a prominent symptom in the course of an acute febrile illness.

Human T-cell lymphotropic virus types I and II infections in a cohort of patients with neurological disorders in Belém, Pará, Brazil

Serum- and/or- cerebrospinal fluid (CSF) samples obtained from 190 patients suffering from chronic, progressive neurological disease were screened for the presence of human T-cell lymphotropic viruses type I (HTLV-I) and type II (HTLV-II) antibodies over a six-year period (1996 to 2001) in Belém, Pará, Brazil. Patients were of both sexes (male subjects, 52%) with ages ranging from 2 to 79 years (mean, 35.9). Overall, 15 (7.9%) subjects - of whom 12 (80%) were female adults - reacted HTLV-I/II-seropositive when screened by enzyme-linked immunosorbent assay (ELISA). Serum samples from 14 of these patients were also analyzed using a recombinant Western blot (WB) assay that yielded HTLV-I-, HTLV-II-, and HTLV-I/II- reactivities for 10 (71.4%), 3 (21.4%) and 1 (7.2%) of them, respectively. The yearly rates of HTLV-I/II antibodies ranged from 2.6% (2001) to 21.7% (2000), with progressively increasing seropositivities from 1998 to 2000. Altogether, walking difficulty (n = 5 subjects), spasticity (n = 4) and leg weakness (n = 3) accounted for 80% of symptoms recorded among the 15 patients whose sera had antibodies to HTLV-I/II as detected by ELISA. These findings provide evidence that both HTLV-I and HTLV-II play a role in the development of chronic myelopathy in Belém, Pará, Northern Brazil.

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.

Molecular and seroepidemiologic studies of Enterovirus 71 infection in the State of Pará, Brazil

In many countries, the Enterovirus 71 (EV-71) Picornaviridae family is associated to hand, foot and mouth disease in addition to acute neurological diseases while in Brazil these viruses are more closely associated to the latter group. The aim of this research was to use the first EV-71 isolate of the Northern region of Brazil in molecular and seroepidemiologic studies. Two (2.2%) out of 88 stool samples (44 cases of AFP), collected from January 1998 to December 2000 were positive for EV-71 isolation (73442/PA/99). Nucleotide sequence of the gen that codifies the VP1 protein showed that isolate 73442/PA/99 was similar to the EV-71 strains belonging to genotype B - more closely identified with EV-71 from North America. Neutralization test with 389 sera samples collected from January 1998 to November 2001, from individuals ranging from 0 to 15 years of age living in the city of Belém, State of Pará showed the following results in relation to isolate 73442/PA/99 and prototype BrCr: a total of 207 individuals (53.2%) had neutralization antibodies to both viruses, 167 (42.9%) had no antibodies and 15 showed the presence of neutralizing antibodies to one of the two viruses. Only 20.2% of the children aged 0 to 3 had neutralizing antibodies to EV-71, indicating that these children were more susceptible to the infection. Both the seroprevalence study and VP1 sequencing were important to demonstrate the spread and the molecular pattern of the EV-71 circulating in the Northern Region of Brazil.

Alcohol Septal Ablation in Obstructive Hypertrophic Cardiomyopathy: Four Years of Experience at a Reference Center

INTRODUCTION: We describe our center's initial experience with alcohol septal ablation (ASA) for the treatment of obstructive hypertrophic cardiomyopathy. The procedure, its indications, results and clinical outcomes will be addressed, as will its current position compared to surgical myectomy. OBJECTIVE: To assess the results of ASA in all patients treated in the first four years of activity at our center. METHODS: We retrospectively studied all consecutive and unselected patients treated by ASA between January 2009 and February 2013. RESULTS: In the first four years of experience 40 patients were treated in our center. In three patients (7.5%) the intervention was repeated. Procedural success was 84%. Minor complications occurred in 7.5%. Two patients received a permanent pacemaker for atrioventricular block (6% of those without previous pacemaker). The major complication rate was 5%. There were no in-hospital deaths; during clinical follow-up (22 ± 14 months) cardiovascular mortality was 2.5% and overall mortality was 5%. DISCUSSION AND CONCLUSION: The results presented reflect the initial experience of our center with ASA. The success rate was high and in line with published results, but with room to improve with better patient selection. ASA was shown to be safe, with a low complication rate and no procedure-related mortality. Our experience confirms ASA as a percutaneous alternative to myectomy for the treatment of symptomatic patients with obstructive hypertrophic cardiomyopathy refractory to medical treatment.

How To Follow Atrial Fibrillation Ablation Patients?

Catheter ablation is an established treatment option for symptomatic atrial fibrillation (AF), with circumferential pulmonary vein isolation being considered the cornerstone of the procedure. However, this is a complex intervention with potential major complications and with common arrhythmia recurrences. There is consensus among experts that all patients should be seen in follow-up regularly after AF ablation. To date there are limited data regarding the best methodology for routine clinical follow-up of this population. This review summarizes a contemporary insight into management of late complications following AF ablation, post-procedural anticoagulation and arrhythmia monitoring strategies, in order to prevent thromboembolic events, detect and treat arrhythmia recurrences, and discuss the use of upstream therapies after AF ablation.

Epidemiologia de um caso de doença de Chagas na Ilha do Mosqueiro - Pará

Os autores apresentam os resultados do estudo epidemiológico de um caso autóctone da fase aguda da doença de Chagas na ilha do Mosqueiro, Estado do Pará, aproximadamente 75km da capital, Belém. 0 caso já havia sido objeto de uma publicação anterior. Agora são apresentadas informações epidemiológicas. Nas proximidades da casa do paciente foram capturados em duas palmeiras de Inajá ('Maximilian regi ay e em uma de Mucajá (Acrocomia sclerocarpia) 114 triatomíneos: Rhodnius pictipes, R. robustus, Panstrongylus lignarius, P. geniculatus e Microtriatoma trinidadensis, com tripanossomas em 31 deles. Na casa do paciente foram encontrados exemplares de Rhodnius pictipes, infectados com formas metacíclicas do Trypanosoma cruzi. Em 14 marsupiais, capturados na localidade, haviam 3 infectados com organismos semelhantes ao T. cruzi. A eletroforese dos isoenzimas nos tripanossomas isolados do paciente, de R. pictipes e de Didelphis marsupialis os classificou como zimodema 1. Os autores concluem que a doença de Chagas do paciente teve origem silvestre.

Donovanose no Pará

Foram estudados 259 casos de donovanose registrados no Serviço de Dermatologia do Departamento de Medicina Tropical/UFPA entre 1954-1990. Observa-se que no período 1954-1974 existiam nos arquivos apenas 56 prontuários da doença, enquanto que no último quinquénio estudado (1986-1990) foram identificados 133 casos. Para os autores esse crescimento está ligado a excessiva liberalidade sexual, ao homossexualismo e as precárias condições sócio-econômicas, acentuada nos últimos tempos.

Resistência in vitro de cepas do Plasmodium falciparum isoladas no sul do estado do Pará, em diferentes períodos: emergência de casos de multirresistência

O presente estudo avalia a resposta de cepas de Plasmodium falciparum às drogas antimaláricas, através de testes in vitro, isoladas em 7 municípios do sul do Estado do Pará. Foram efetuados 69 testes para cloroquina e mefloquina, 62 para amodiaquina e 61 para quinino. Os resultados mostram elevada resistência para cloroquina (71%), relativamente baixa resistência para amodiaquina com (25,8%) e para o quinino apenas 8,2%. Mefloquina revela ampla sensibilidade (100%), mas, demonstrando perda da mesma quando comparada em dois períodos distintos. Evidenciou-se também cepas multirresistentes em dois dos municípios estudados.

Teste de aglutinação direta no sorodiagnóstico da leishmaniose visceral no estado do Pará

Avaliou-se o teste de aglutinação direta (TAD) no sorodiagnóstico da leishmaniose visceral (LV) humana e de canídeos (cão e raposa Cerdocyon thous), sendo os resultados comparados com aqueles obtidos em imunofluorescência indireta (IFI) e ensaio imunoenzimático (ELISA). Utilizaram-se soros: humanos (303): indivíduos com LV confirmada (16), suspeitos de LV (65), em outras condições (102), controles negativos (15), indivíduos em área endêmica (105): de cães (82): de área endêmica (68), Salvaterra/Marajó/PA. (21 parasitologicamente positivos), e controles negativos (14), de Belém; de raposas (9): espécimes capturados na Ilha do Marajó. Antígenos para o TAD foram preparados a partir de promastigotas de Leishmania (Leishmania) donovani e L. (L.) chagasi. Aqueles utilizados em ELISA e IFI, respectivamente, de promastigotas (antígeno solúvel) e amastigotas deL. (L.) chagasi. Em humanos, a especificidade e sensibilidade do TAD, utilizando-se antígeno deL. (L.) donovani, foram altas (98,4% e 100%, respectivamente) e comparáveis às de IFI (97,5% e 100%). ELISA foi menos específico (84,8%), embora igualmente sensível. Em cães, o TAD foi mais específico com antígeno de L. (L.) donovani do que com aquele preparado a partir de L. (L.) chagasi. Entretanto, ELISA e TAD foram menos sensíveis (ambos 71,4%) que IFI (100%). Essa diferença foi reflelida nos resultados de cães de área endêmica, 87% dos quais foram positivos para IFI, mas somente 54% para ELISA e 49% para o TAD. Resultados similares foram observados com raposas, quando todos os 9 soros foram positivos para IFI, 7 de 9 (78% ) positivos para ELISA, enquanto que o TAD não revelou nenhum resultado positivo. Concluiu-se que o TAD, usando antígeno de L. (L.) donovani é um teste útil para LV humana; sua utilização em ampla escala é indicada, desde que monitorada por um laboratório de referência que garanta qualidade dos antígenos. Contudo, não é a melhor opção em inquéritos sorológicos caninos, já que foi menos específico que ELISA e, especialmente, IFI, na detecção de anticorpos em casos infecção canina.

Estudo da eficácia e tolerância do artesunato oral isolado e em associação com mefloquina, no tratamento da malária falciparum não complicada em área endêmica do Pará, Brasil

Com o objetivo de avaliar a eficácia e tolerância do artesunato no tratamento da malária falciparum não complicada em área endêmica do Estado do Pará, 153 pacientes foram randomizados e estudados em três grupos, distribuídos por esquema terapêutico (I recebeu mefloquina lOOOmg; II utilizou artesunato lOOOmg; III usou a combinação de 600mg de artesunato seguida de 500 de mefloquina). A avaliação constou de exame clínico e parasitológico diariamente nos primeiros 7 dias e semanalmente até o 35º dia do acompanhamento e de análise bioquímica e hematológica realizada antes e no 7º dia, visando o controle de ema e a identificação de possíveis efeitos associados á admmistração das drogas. Os grupos estudados foram homogêneos quanto ao sexo, parasitemia e presença de febre. O tempo para desaparecimento da parasitemia foi mais curto nos grupos II e III, respectivamente, cujos esquemas terapêuticos empregaram artesunato. O desaparecimento da febre foi mais rápido no grupo tratado com a combinação das drogas. Alterações clínicas e bioquímicas associadas a administração das drogas não mostraram diferenças significativas entre os grupos estudados. O desaparecimento precoce da febre e parasitemia, e a ausência de importantes efeitos indesejáveis, sugerem que artesunato administrado isoladamente ou em combinação com mefloquina constituem medidas terapêuticas capazes de contribuir para o controle da doença na região.