Cost-effectiveness analysis of PCR for the rapid diagnosis of pulmonary tuberculosis

Background: Tuberculosis is one of the most prominent health problems in the world, causing 1.75 million deaths each year. Rapid clinical diagnosis is important in patients who have comorbidities such as Human Immunodeficiency Virus (HIV) infection. Direct microscopy has low sensitivity and culture takes 3 to 6 weeks [1-3]. Therefore, new tools for TB diagnosis are necessary, especially in health settings with a high prevalence of HIV/TB co-infection. Methods: In a public reference TB/HIV hospital in Brazil, we compared the cost-effectiveness of diagnostic strategies for diagnosis of pulmonary TB: Acid fast bacilli smear microscopy by Ziehl-Neelsen staining (AFB smear) plus culture and AFB smear plus colorimetric test (PCR dot-blot). From May 2003 to May 2004, sputum was collected consecutively from PTB suspects attending the Parthenon Reference Hospital. Sputum samples were examined by AFB smear, culture, and PCR dot-blot. The gold standard was a positive culture combined with the definition of clinical PTB. Cost analysis included health services and patient costs. Results: The AFB smear plus PCR dot-blot require the lowest laboratory investment for equipment (US$ 20,000). The total screening costs are 3.8 times for AFB smear plus culture versus for AFB smear plus PCR dot blot costs (US$ 5,635,760 versus US$ 1,498, 660). Costs per correctly diagnosed case were US$ 50,773 and US$ 13,749 for AFB smear plus culture and AFB smear plus PCR dot-blot, respectively. AFB smear plus PCR dot-blot was more cost-effective than AFB smear plus culture, when the cost of treating all correctly diagnosed cases was considered. The cost of returning patients, which are not treated due to a negative result, to the health service, was higher in AFB smear plus culture than for AFB smear plus PCR dot-blot, US$ 374,778,045 and US$ 110,849,055, respectively. Conclusion: AFB smear associated with PCR dot-blot associated has the potential to be a cost-effective tool in the fight against PTB for patients attended in the TB/HIV reference hospital.

Optimização e Validação da Produção de [13n]-Nh3 para Estudos Clínicos de Tomografia por Emissão de Positrões na Avaliação da Perfusão Miocárdica

A par das patologias oncológicas, as doenças do foro cardíaco, em particular a doença arterial coronária, são uma das principais causas de morte nos países industrializados, devido sobretudo, à grande incidência de enfartes do miocárdio. Uma das formas de diagnóstico e avaliação desta condição passa pela obtenção de imagens de perfusão miocárdica com radionuclídeos, realizada por Tomografia por Emissão de Positrões (PET). As soluções injectáveis de [15O]-H2O, [82Rb] e [13N]-NH3 são as mais utilizadas neste tipo de exame clínico. No Instituto de Ciências Nucleares Aplicadas à Saúde (ICNAS), a existência de um ciclotrão tem permitido a produção de uma variedade de radiofármacos, com aplicações em neurologia, oncologia e cardiologia. Recentemente, surgiu a oportunidade de iniciar exames clínicos com [13N]-NH3 para avaliação da perfusão miocárdica. É neste âmbito que surge a oportunidade do presente trabalho, pois antes da sua utilização clínica é necessário realizar a optimização da produção e a validação de todo o processo segundo as normas de Boas Práticas Radiofarmacêuticas. Após uma fase de optimização do processo, procedeu-se à avaliação dos parâmetros físico-químicos e biológicos da preparação de [13N]-NH3, de acordo com as indicações da Farmacopeia Europeia (Ph. Eur.) 8.2. De acordo com as normas farmacêuticas, foram realizados 3 lotes de produção consecutivos para validação da produção de [13N]-NH3. Os resultados mostraram um produto final límpido e ausente de cor, com valores de pH dentro do limite especificado, isto é, entre 4,5 e 8,5. A pureza química das amostras foi verificada, uma vez que relativamente ao teste colorimétrico, a tonalidade da cor da solução de [13N]-NH3 não era mais intensa que a solução de referência. As preparações foram identificadas como sendo [13N]-NH3, através dos resultados obtidos por cromatografia iónica, espectrometria de radiação gama e tempo de semi-vida. Por examinação do cromatograma obtido com a solução a ser testada, observou-se que o pico principal possuia um tempo de retenção aproximadamente igual ao pico do cromatograma obtido para a solução de referência. Além disso, o espectro de radiação gama mostrou um pico de energia 0,511 MeV e um outro adicional de 1,022 MeV para os fotões gama, característico de radionuclídeos emissores de positrões. O tempo de semi-vida manteve-se dentro do intervalo indicado, entre 9 e 11 minutos. Verificou-se, igualmente, a pureza radioquímica das amostras, correspondendo um mínimo de 99% da radioactividade total ao [13N], bem como a pureza radionuclídica, observando-se uma percentagem de impurezas inferiores a 1%, 2h após o fim da síntese. Os testes realizados para verificação da esterilidade e determinação da presença de endotoxinas bacterianas nas preparações de [13N]-NH3 apresentaram-se negativos.Os resultados obtidos contribuem, assim, para a validação do método para a produção de [13N]-NH3, uma vez que cumprem os requisitos especificados nas normas europeias, indicando a obtenção de um produto seguro e com a qualidade necessária para ser administrado em pacientes para avaliação da perfusão cardíaca por PET.

Estudo do teste de Scott via técnicas espectroscópicas: um método alternativo para diferenciar cloridrato de cocaína e seus adulterantes

Cocaine is usually seized mixed with a wide variety of adulterants such as benzocaine, lidocaine, caffeine, and procaine. The forensic identification of cocaine in these street drug mixtures is normally performed using colorimetric testing kits, but these tests may suffer from interferences, producing false-positive results. Here, we describe the use of analytical techniques including attenuated total reflection Fourier transform infrared (ATR-FTIR) and ultraviolet-visible (UV-VIS) spectroscopies to distinguish between cocaine and other adulterants (lidocaine, promethazine, powdered milk and yeast) that yield positive results on the Scott test using the thiocyanate cobalt reagent. A further 13 substances were also analyzed using the Scott test.

Qualidade de vida, eficiência mastigatória e presença de disfunção temporomandibular em usuários de prótese parcial removível com arco dental curto inferior

Even nowadays there is in Brasil a large number of edentulous and a precarious financial condition of most of the population. In addition, World Health Organization aims for oral health, which consists on the maintenance of a natural dentition, functional and aesthetic composed of at least 20 teeth, without need of prosthetic intervention throughout life. From this and considering the lack of researches about the permanence of edentulous spaces in the oral cavity, and also avoiding overtreatment, this research has been proposed. Thus, the aim was to evaluate the effect of different lengths of the shortened lower dental arch in the presence or absence of a removable partial denture (RPD) on masticatory function, quality of life and occurrence of temporomandibular dysfunction. To achieve this goal, we compared the masticatory efficiency (colorimetric test), the oral comfort through the analysis of the impact of oral health in quality of life (OHIP-14), the presence of temporomandibular dysfunction (RDC/TMD) and the general quality of life (WHOQOL) of patients with shortened dental arches (SDA) (n=60), which is an arch with a reduction of teeth starting posteriorly, and patients with complete dental arch (Complete DA) (n = 34). The group of patients whit SDA was divided among PPR wears (PPD + SDA) (n = 17) and non-wears (n = 43). The population of this study consisted on patients who received or looked for treatment at the clinics of the Department of Dentistry of UFRN, from clinical analysis and records. The sample was chosen by convenience. For statistical analysis, it was a database in SPSS 17.0, followed by descriptive analysis with frequencies, absolute values, tests of central tendency and variability. The statistical tests used were chi-squared and analysis of variance as well as Tukey s post test, when applicable, all with a 95% confidence level. The results shown a prevalence of TMD of 47,1% among patients using PRP and 69,8% among those who didn t, but this result wasn t statistically significant. The mean of the results of masticatory efficiency, WHOQOL and OHIP didn t show association to the presence or absence of PPR and to the lower number of occlusal units of the patients (0, 1, 2 or more occlusal). The association only occurred among the different groups of SDA and the patients with complete dental arch. Taking into account the results, it could be observed that studied patients with low posterior support using lower PRP didn t have better masticatory efficiency, general quality of life, less impacts of their oral conditions in quality of life or not even less temporomandibular dysfunction or better masticatory efficiency when compared to those who didn t use the prosthesis

Evaluation of some properties of fermented milk beverages that affect the demineralization of dental enamel

The aim of this in vitro study was to evaluate the erosive capacity of fermented milk beverages, as well as some of their properties that affect the demineralization of dental enamel (pH, buffering capacity, fluoride, calcium and phosphorus contents). Three different batches of 6 commercial brands of fermented milk beverages were analyzed. pH evaluation was accomplished using a potentiometer. The buffering capacity was measured by adding 1 mol L -1 NaOH. Fluoride concentration was assessed by an ion specific electrode after hexamethyldisiloxane-facilitated diffusion, and calcium and phosphorus concentrations were assessed by a colorimetric test using a spectrophotometer. Sixty specimens of bovine enamel were randomly assigned to 6 groups (n = 10). They were exposed to 4 cycles of demineralization in the fermented milk and remineralization in artificial saliva. Enamel mineral loss was determined by surface microhardness (%SMHC) and profilometric tests. The samples' pH ranged from 3.51 to 3.87; the buffering capacity ranged from 470.8 to 804.2 μl of 1 mol L -1 NaOH; the fluoride concentration ranged from 0.027 to 0.958 μgF/g; the calcium concentration ranged from 0.4788 to 0.8175 mgCa/g; and the phosphorus concentration ranged from 0.2662 to 0.5043 mgP/g. The %SMHC ranged from-41.0 to -29.4. The enamel wear ranged from 0.15 μm to 0.18 μm. In this in vitro study, the fermented milk beverages did not promote erosion of the dental enamel, but rather only a superficial mineral loss.

Detecção do gene de peroxidase em sementes de soja pela reação da polimerase em cadeia (PCR)

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

Prospecção de rizobactérias promotoras de crescimento em quatro espécies arbóreas nativas do Brasil

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Isolamento e caracterização de bactérias promotoras de crescimento em milho (Zea mays)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação da capacidade de mineralização e citotoxicidade do MTA, Sealapex e Sealapex plus

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Use of EP(Peroxidase) allele in soybean varietal characterization

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

Efeito de diferentes gomas de mascar sobre o pH salivar de crianças

Objective: To evaluate the effect of different chewing gum brands on the salivary pH of children with primary dentition. Method: Forty children were selected and assigned to four groups: control (no chewing gum); sugarless chewing gum; chewing gum with casein phosphopeptide-amorphous calcium phosphate; and chewing gum with xylitol. The first saliva collection was made after supervised tooth brushing for stabilization of the oral pH. Next, all children were instructed to drink slowly 100 mL of a cola-based soft drink (Coca-Cola®) and a new saliva collection was made 10 min later. Then, each group chewed on the chewing gum for 5 min and discarded it after this time. Saliva was collected again at 5, 10 and 15 min intervals after start using the chewing gum. Measurement of salivary pH was made with colorimetric test papers and a digital pH-meter. Data were analyzed statistically by analysis of variance and Tukey’s test at a 5% significance level. Results: The use of chewing gums accelerated the increase of salivary pH to considerably alkaline levels after consumption of an acidic beverage, especially within the first minutes. The highest levels were obtained in the groups of children that used chewing gums containing xylitol and casein phosphopeptide-amorphous calcium phosphate. Conclusion: Children that used the chewing gums after ingestion of an acidic soft drink presented an increase in salivary pH, with the best results in the groups that used chewing gums containing casein phosphopeptide-amorphous calcium phosphate and xylitol.

Efeito de diferentes gomas de mascar sobre o pH salivar de crianças

Objective: To evaluate the effect of different chewing gum brands on the salivary pH of children with primary dentition. Method: Forty children were selected and assigned to four groups: control (no chewing gum); sugarless chewing gum; chewing gum with casein phosphopeptide-amorphous calcium phosphate; and chewing gum with xylitol. The first saliva collection was made after supervised tooth brushing for stabilization of the oral pH. Next, all children were instructed to drink slowly 100 mL of a cola-based soft drink (Coca-Cola®) and a new saliva collection was made 10 min later. Then, each group chewed on the chewing gum for 5 min and discarded it after this time. Saliva was collected again at 5, 10 and 15 min intervals after start using the chewing gum. Measurement of salivary pH was made with colorimetric test papers and a digital pH-meter. Data were analyzed statistically by analysis of variance and Tukey’s test at a 5% significance level. Results: The use of chewing gums accelerated the increase of salivary pH to considerably alkaline levels after consumption of an acidic beverage, especially within the first minutes. The highest levels were obtained in the groups of children that used chewing gums containing xylitol and casein phosphopeptide-amorphous calcium phosphate. Conclusion: Children that used the chewing gums after ingestion of an acidic soft drink presented an increase in salivary pH, with the best results in the groups that used chewing gums containing casein phosphopeptide-amorphous calcium phosphate and xylitol.

Estudio de la utilización de las cenizas de cenicero de centrales termoeléctricas de carbón como adición del cemento portland : análisis comparativo con las cenizas volantes

El empleo de nuevas adiciones en el cemento se plantea como una vía para que éste sea un material más sostenible. En este contexto, las cenizas de fondo o cenicero de las centrales termoeléctricas de carbón actualmente se están llevando a vertederos creando un problema medioambiental o se están empleando con usos minoritarios. Sin embargo, la presente Tesis doctoral demuestra cómo este material puede ser empleado como un componente principal de los cementos portland mezclado en una proporción optimizada con las cenizas volantes o solo. Por tanto, este estudio se puede considerar como un trabajo prenormativo que cubre las demandas de la sociedad tanto económicas como ambientales. Se han estudiado las propiedades químicas, físicas y mecánicas de las cenizas de fondo o cenicero de las centrales termoeléctricas de carbón como una adición potencial de los cementos portland (con adiciones) en comparación con los cementos portland con cenizas volantes. En consecuencia, el objeto de la presente Tesis Doctoral es el análisis de las prestaciones de morteros elaborados con clínkeres de cemento portland y cenizas de fondo o cenicero con cenizas volantes de las centrales termoeléctricas de carbón en unos porcentajes similares a los correspondientes a los CEM II/A-V, CEM II/B-V y CEM IV/A (V) de la UNE-EN 197-1:2011. La caracterización de las cenizas de fondo o cenicero y de las cenizas volantes de las centrales termoeléctricas de carbón se ha realizado mediante las técnicas analíticas de FRX, ICP, análisis químicos, DRX, densidad, granulometría láser, superficie específica Blaine, ATD, TG, puzolanicidad, MEB y EDX; mientras que la caracterización de las mezclas se ha realizado mediante análisis químico (análisis químico, FRX e ICP y), DRX, MIP, granulometría láser, puzolanicidad, MEB y EDX, agua de consistencia normal, inicio y final de fraguado, estabilidad de volumen, colorimetría, calor de hidratación, DTA y TG, asícomo ensayos de resistencia; resistencia a flexión y compresión y ensayos de durabilidad (carbonatación natural, resistencia al hielo-deshielo, resistencia a la acción de los sulfatos y resistencia a la reacción árido-álcali). Finalmente, se han comprobado las propiedades de las cenizas de cenicero y cenizas volantes en hormigones, realizando ensayos de resistencia a compresión y resistividad. Los resultados obtenidos indican que la sustitución parcial o completa de las cenizas volantes por las de cenicero no tiene un efecto tecnológicamente importante en las propiedades ni mecánicas ni durables, incluso los mejora en determinados aspectos. Por tanto, se recomienda la normalización de las cenizas de fondo o cenicero de las centrales termoeléctricas de carbón como componente principal de los cementos portland comunes de la UNE-EN 197-1:2011. Actualmente, la mayoría de las cenizas de fondo se consideran como un residuo que no tiene un posible uso. Sólo se han encontrado algunos datos relativos a la aplicación de este material combinado con cenizas volantes como un componente principal de los cementos portland. Por tanto, la realización de un estudio integrado considerando aspectos que van desde la caracterización de las cenizas hasta las mezclas de conglomerante y la hidratación de éstas, desarrollo de resistencias y demás prestaciones y durabilidad (carbonatación natural, resistencia al hielo-deshielo, resistencia a la acción de los sulfatos y resistencia a la reacción árido-álcali), así como los ensayos de resistencia en hormigón es totalmente novedoso. Como resultado final se propone incorporar estas nuevas adiciones en aplicaciones particulares y en la norma más apropiada para ello. Los resultados han demostrado que la sustitución completa o parcial de las cenizas volantes por cenizas de fondo o cenicero de las centrales termoeléctricas de carbón en cementos de los tipos CEM II/A-V, CEM II/B-V y CEM IV/A no afecta de forma significativa en la resistencia a compresión a 1, 3 ,7, 28 ni 90 días ni a la durabilidad. En parte esto se debe a que la composición química de ambas cenizas es muy similar en la mayoría de los elementos tales como Fe2O3, TiO2, P2O5, SrO2, aunque en algún caso, como en el ZnO, se encuentra alguna ligera diferencia. Por tanto, se pueden esperar unas ligeras diferencias en el mecanismo de hidratación de las diferentes mezclas estudiadas. La presencia de los óxidos mencionados afectará a la composición de la fase acuosa y, en consecuencia, podrían ser elementos lixiviables. Asimismo, influyen de distinta manera en propiedades tales como los tiempos de fraguado y en la durabilidad. New additions to the cement are needed to achieve a more sustainable construction material. Within this context, bottom ashes produced in coal-fired power stations are currently wastes which are dumped provoking an environmental problem. Only in few cases are being used in minor applications. However, the present PhD Thesis shows how this material can be used as a main constituent of Portland cement when it is mixed in an optimised proportion with fly ashes or added to the Portland clinker alone. Therefore, this study may also be considered as a pre-standardization work which covers both the environmental and economic demands of society. Chemical, physical and mechanical characteristics of pulverized coal combustion bottom ash used as a potential constituent of Portland cements (with additions) are studied in comparison to Portland cements with fly ashes. Therefore, the aim of this experimental PhD Thesis is the analysis of the performance of mortars made of clinker of Portland cement and bottom and/or fly ashes in similar proportions to those of CEM II/A-V, CEM II/B-V and CEM IV/A (V) according to EN 197-1:2011. Characterisation of bottom and fly ashes has been done by XRF, ICP, chemical analyses, XRD, density, laser granulometry, Blaine, ATD, TG, pozzolanity, SEM and EDS. Characterisation of bottom and fly ashes mixes has been perform by chemical analyses, XRF, ICP, XRD, MIP, laser granulometry, pozzolanity, SEM, EDS, setting time, soundness, colorimetric test, heat of hydration, ATD, TG, compressive strength, and durability tests (natural carbonation, frost-thaw resistance, sulphate resistance and silica-alkali resistance). In conclusion, it can be established that partial or complete replacement of fly ash by bottom ash has neither significant effect on mechanical nor durability properties. Even, they are improved in several aspects. Therefore, it is recommended to standardise the bottom ash as a main cement constituent of the European standard EN 197-1:2011. Nowadays, most bottom ashes are considered as waste without any potential re-use. Only a few papers deal with the study of this material and its use mixed with fly ashes to be employed as a main constituent of Portland cement. Therefore, the execution of an integrated study considering together aspects from the initial characterization of the ashes and blinder mixes to the hydration steps, strength achievement, leading behaviour and durability (natural carbonation, sulphate attack, aggregate-alcali reaction and freeze-thaw resistance) is totally new. As result, it is proposed to include this new addition for particular applications in the appropriate cement standard. The results have shown that with regard to the compressive strength at 1, 3, 7, 28 and 90 days, partial or complete replacement of fly ash by bottom ash in CEM II/A-V, CEM II/B-V and CEM IV/A has no more significant effects. Partially, this can be explained because the bottom ash contains a similar amount of most of the elements, Fe2O3, TiO2, P2O5, SrO2, and so on, instead of ZnO. Therefore, slight hydration differences are expected. The presence of such oxides might have a significant effect on pore solution concentration and so will be leachable constituents. They will also play an important role in the cement properties such as setting times and durability.

The effect of coal particle size on colorimetric analysis of roadway dust

Colorimetric analysis of roadway dust is currently a method for monitoring the incombustible content of mine roadways within Australian underground coal mines. To test the accuracy of this method, and to eliminate errors of judgement introduced by human operators in the analysis procedure, a number of samples were tested using scanning software to determine absolute greyscale values. High variability and unpredictability of results was noted during this testing, indicating that colorimetric testing is sensitive to parameters within the mine that are not currently reproduced in the preparation of reference samples. This was linked to the dependence of colour on particle surface area, and hence also to the size distribution of coal particles within the mine environment. (C) 2001 Elsevier Science Ltd. All rights reserved.

A low-cost method to test cytotoxic effects of Crotalus vegrandis (Serpentes: Viperidae) venom on kidney cell cultures

The pathogenesis of the renal lesion upon envenomation by snakebite has been related to myolysis, hemolysis, hypotension and/or direct venom nephrotoxicity caused by the venom. Both primary and continuous cell culture systems provide an in vitro alternative for quantitative evaluation of the toxicity of snake venoms. Crude Crotalus vegrandis venom was fractionated by molecular exclusion chromatography. The toxicity of C. vegrandis crude venom, hemorrhagic, and neurotoxic fractions were evaluated on mouse primary renal cells and a continuous cell line of Vero cells maintained in vitro. Cells were isolated from murine renal cortex and were grown in 96 well plates with Dulbecco's Modified Essential Medium (DMEM) and challenged with crude and venom fractions. The murine renal cortex cells exhibited epithelial morphology and the majority showed smooth muscle actin determined by immune-staining. The cytotoxicity was evaluated by the tetrazolium colorimetric method. Cell viability was less for crude venom, followed by the hemorrhagic and neurotoxic fractions with a CT50 of 4.93, 18.41 and 50.22 µg/mL, respectively. The Vero cell cultures seemed to be more sensitive with a CT50 of 2.9 and 1.4 µg/mL for crude venom and the hemorrhagic peak, respectively. The results of this study show the potential of using cell culture system to evaluate venom toxicity.