Evaluation of the acute toxicity of ellagic acid and gallic acid incorporated in Poloxamer407® gel, in Zophobas morio larvae.

Gallic acid (GA) has antioxidant, anti-inflammatory and antimicrobial properties, while ellagic acid (EA) demonstrates anticancer, antiviral and photoprotective activity. In this study, the combination of these substances incorporated into a poloxamer gel was tested to verify the individual effect of the substances, in addition to taking advantage of a probable complementary effect, aiming to provide additional therapeutic benefits. As a result of the incorporation, formulations containing GA, EA and GA + EA were obtained, which were evaluated for the effects of the Freeze-thaw cycle on pH, which revealed a significant decrease (p < 0.05) in most samples, including the vehicle (without drug) and the gel containing both drugs. No sample showed variation outside the normal pH range for the skin, with values ranging from 4.8 to 6.0. Regarding conductivity, the GA, EA and GA + EA formulations showed a reduction (p < 0.05) after the freeze-thaw cycle. The drug content in the formulations ranged from 95.86% to 101.35% initially to 91.30% to 101.51% after the freeze-thaw cycle. Regarding the drug release, the results revealed the following cumulative percentages: GA-3% - 92.58% after 1.5 h; AE-3% - 51.60% after 6 h; GA + EA (1.5% = 1.5%) - 99.91% after 2 h; GA + EA- (1.5% = 1.5%) released 57.06%, after 6 h. Regarding toxicity, it was observed that the group treated with GA showed a lower survival rate of the larvae (40%) at the dose 3000 mg/Kg in the formulation. Following the same trend, in the acute lethal concentration (ALC50) test performed using Zophobas morio larvae, an ALC50 of 2191.51 mg/Kg was observed for GA at 48 h. Melanin analysis showed a decrease in concentrations of 30 mg/Kg in the GA group, 3 mg/Kg of EA and 3, 300, 3000 mg/Kg of GA + EA, of the pure drugs. In the groups with the drugs incorporated into the gel, there was a significant decrease (P < 0.05) in melanin in the vehicle (gel), at concentrations of 300 and 3000 mg/Kg of GA and EA. On the other hand, in the combination of GA + EA, a reduction was observed at concentrations of 3 and 30 mg/Kg when compared to the control group. Thus, the gel showed good quality as a pharmaceutical formulation for topical use and low toxicity, making it promising for use in skin therapies.

Combined intravitreal dexamethasone and bevacizumab injection for the treatment of persistent diabetic macular edema (DexaBe study): a phase I clinical study.

PURPOSE: The aim of this study is to investigate the safety of combined intravitreal injection of dexamethasone aqueous-solution (IVD) and bevacizumab (IVB) in patients with refractory diabetic macular edema (DME) and its effect on intraocular pressure (IOP), best-corrected visual acuity (BCVA) and central subfield thickness (CSFT). METHODS: This prospective study included 10 patients (10 eyes) with DME refractory to laser photocoagulation and/or anti-vascular endothelial growth factor (anti-VEGF) therapy. A complete ophthalmological examination was performed at baseline, during the first week of treatment, and monthly through week 24. Therapy consisted of monthly injections of combined IVD and IVB "pro re nata" (PRN) if CST > 300 µm. We investigated the impact of the injections on intraocular pressure (IOP), cataract development, Early Treatment Diabetic Retinopathy Study (ETDRS) best corrected visual acuity (BCVA), and central sub-foveal thickness (CSFT) measured by spectral-domain optical coherence tomography (OCT). RESULTS: Eight patients (80%) completed 24 weeks of follow-up. Compared to baseline, mean IOP increased significantly (p < 0.05) and anti-glaucomatous eye drops were necessary for 50% of the patients, CSFT was significantly reduced at all follow-up visits (p < 0.05), although mean BCVA showed no significant improvement. One patient developed dense cataract progression and another showed vitreoretinal traction at week 24. No inflammation or endophthalmitis was observed. CONCLUSION: Treatment of DME refractory to laser and/or anti-VEGF therapy with combined PRN IV dexamethasone aqueous solution and bevacizumab was associated with adverse effects related to the use of corticosteroids. However, there was a significant improvement in CSFT meantime best-correct visual acuity remained stable or improved in 50% of patients.

Intravitreal bevacizumab plus propranolol for neovascular age-related macular degeneration (the BEVALOL study): a phase I clinical trial.

BACKGROUND: Given the persistently large public health impact of neovascular age-related macular degeneration (nARMD) despite many years of anti-VEGF therapy as the first-line treatment and the demonstrated ability of b-blockers to reduce neovascularization, a synergistic effect between an anti-VEGF agent and an intravitreal beta-blocker is important to investigate in the quest for therapeutic alternatives that maximize efficacy and/or reduce costs. The main purpose of this study is to investigate the safety of a 0.1 ml intravitreal injection of a combination of bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) to treat nARMD. METHODS: Prospective phase I clinical trial that included patients with nARMD. Comprehensive ophthalmic evaluation was performed at baseline and included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA), biomicroscopy of the anterior and posterior segments, binocular indirect ophthalmoscopy, color fundus photography, spectral domain optical coherence tomography (OCT), OCT angiography (OCT-A), fluorescein angiography (Spectralis, Heidelberg), and full-field electroretinography (ERG). All eyes were treated with a 0.1 ml intravitreal injection of a combination of bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) within 1 week of baseline evaluation. The patients were reexamined at weeks 4, 8 and 12, and clinical evaluation and SD-OCT were performed at all follow-up visits. Additional injections of combination bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) were administered at weeks 4 and 8. At the final study evaluation (week 12), color fundus photography, OCT-A, fluorescein angiography, and full-field ERG were repeated. RESULTS: Eleven patients (11 eyes) completed all study visits of the 12 week study. Full field ERG b-waves did not show significant (p < 0.05) changes at week 12 compared to baseline. During the 12 week follow-up period, none of the study eyes developed intraocular inflammation, endophthalmitis or intraocular pressure elevation more than 4 mmHg over baseline. Mean ± SE BCVA (logMAR) was 0.79 ± 0.09 at baseline and was significantly (p < 0.05) improved to 0.61 ± 0.10 at week 4; 0.53 ± 0.10 at week 8; and 0.51 ± 0.09 at week 12. Mean ± SE central subfield thickness (CST) (µm) was 462 ± 45 at baseline and was significantly (p < 0.05) lower at 4, 8 and 12 weeks (385 ± 37; 356 ± 29 and 341 ± 24, respectively). CONCLUSIONS: In this 12 week trial of a combination of intravitreal bevacizumab and propranolol for treatment of nARMD, no adverse events or signals of ocular toxicity were observed. Further studies using this combination therapy are warranted. Trial Registration Project registered in Plataforma Brasil with CAAE number 28108920.0.0000.5440 and approved in ethics committee of Clinics Hospital of Ribeirao Preto Medicine School of São Paulo University-Ribeirão Preto, São Paulo, Brazil (appreciation number 3.999.989 gave the approval).

Intravitreal bevacizumab (IVB) versus IVB in combination with pars plana vitrectomy for vitreous hemorrhage secondary to proliferative diabetic retinopathy: a randomized clinical trial.

BACKGROUND: The main purpose of this study is to compare the vitreous hemorrhage (VH) score reduction and visual acuity outcomes in patients with VH secondary to proliferative diabetic retinopathy (PDR) treated with intravitreal injections of bevacizumab (IVB) versus IVB and pars plana vitrectomy (IVB and PPV). METHODS: Patients with VH secondary to PDR were randomized into 2 groups: in Group A, patients were treated with a total of 3 IVB (1.5 mg/0.06 ml) at 8-week intervals; and in Group B, patients received a single IVB (1.5 mg/0.06 ml) and, 7 days later, underwent PPV. Patients received an ophthalmic evaluation that included best-corrected visual acuity (BCVA), indirect ophthalmoscopy, and mode B echography at weeks 8, 16 and 24. VH was classified according to the Diabetic Retinopathy Vitrectomy Study classification as grade 1, 2 or 3. Change in VH score was the primary outcome measure and change in BCVA was the secondary outcome. RESULTS: Seventy-three eyes of 66 patients were randomized and 70 eyes completed the 24-week follow-up visit. Mean VH score reduction (± SEM) of 0.4571 ± 0.0283 (p = 0.0014), 1.3429 ± 0.0393 (p < 0.0001) and 1.8286 ± 0.0438 (p < 0.001) was observed in Group A at 8, 16 and 24 weeks after treatment, respectively (Table 2; Fig. 2). In Group B, the reduction of VH score (± SEM) was 2.2571 ± 0.0720 (p = 0.0014), 2.2857 ± 0.0606 (p < 0.0001) and 2.2286 ± 0.0726 (p < 0.001) at 8, 16 and 24 weeks after treatment, respectively. Group comparison revealed a significantly greater reduction in mean VH score in Group B at 8 and 16 weeks after treatment (p < 0.0001). However, at 24 weeks this difference was no longer statistically significant (p = 0.1854). In Group A, mean (± SEM) BCVA showed an improvement of 0.00285 ± 0.0004 (p = 0.971), 0.5371 ± 0.0072 (p < 0.0001), 0.8143 ± 0.0001 (p < 0.0001) and 0.8543 ± 0.0008 (p < 0.0001) compared to baseline at 1, 8, 16 and 24 weeks after treatment, respectively. In Group B, mean (± SEM) BCVA showed an improvement of 0.3657 ± 0.0507 (p = 0.0002), 0.8857 ± 0.0385 (p < 0.0001), 0.9457 ± 0.0499 (p < 0.0001) and 0.9629 ± 0477 (p < 0.0001) compared to baseline at 1, 8, 16 and 24 weeks after treatment, respectively. No significant difference in BCVA improvement was observed between groups at 24 weeks after treatment. CONCLUSION: PPV with preoperative IVB is associated with more rapid clearance of VH and improvement in BCVA than IVB injections alone. However, after 24 weeks of follow-up, the reduction in VH score and BCVA were similar between both treatment strategies. Trial Registration The project is registered in Plataforma Brasil with CAAE number 927354.7.0000.5440 and was approved by the Ethics Committee of the Clinics Hospital of Ribeirao Preto Medicine School of São Paulo University-Ribeirão Preto, São Paulo, Brazil (appreciation number 3.053.397 gave the approval).

Molecular epidemiology of Saint Louis encephalitis virus in the Brazilian Amazon: genetic divergence and dispersal.

Saint Louis encephalitis virus (SLEV), a member of the genus Flavivirus (family Flaviviridae), is an encephalitogenic arbovirus broadly distributed in the Americas. Phylogenetic analysis based on the full-length E gene sequences obtained for 30 Brazilian SLEV strains was performed using different methods including Bayesian and relaxed molecular clock approaches. A new genetic lineage was suggested, hereafter named genotype VIII, which co-circulates with the previously described genotype V in the Brazilian Amazon region. Genotypes II and III were restricted to São Paulo state (South-east Atlantic rainforest ecosystem). The analysis also suggested the emergence of an SLEV common ancestor between 1875 and 1973 (mean of 107 years ago), giving rise to two major genetic groups: genotype II, more prevalent in the North America, and a second group comprising the other genotypes (I and III-VIII), broadly dispersed throughout the Americas, suggesting that SLEV initially emerged in South America and spread to North America. In conclusion, the current study demonstrates the high genetic variability of SLEV and its geographical dispersion in Brazil and other New World countries.

Pedicle internal limiting membrane flap technique for very large macular holes: a preliminary report.

BACKGROUND: Conventional vitrectomy technique for macular hole surgery has a good outcome in small and medium macular holes, but for very large macular holes (minimum linear diameter higher than 700 µm) other techniques were developed aiming to achieve greater rates of closure and visual acuity gain. The purpose of this article is to report the anatomical and functional outcomes of four very large macular hole (MH) cases which have undergone vitrectomy with the pedicle internal limiting membrane (ILM) flap technique. METHODS: This is a retrospective series of four patients with large MH who were treated with vitrectomy and the pedicle ILM flap technique. Comprehensive ophthalmologic evaluation was performed before surgery and included ETDRS best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT) for MH measures: height, minimum linear diameter (MLD) and external base diameter. The particular detail of this technique is related to ILM flap creation. During the peeling, the ILM was not removed completely from the retina but was left attached to the edges of the macular hole and subsequently trimmed with the vitrectomy probe using the scissors mode. RESULTS: Four patients with very large MH underwent PPV and the pedicle ILM flap technique was used to pursue macular closure. Median preoperative BCVA was 20/400 (range: 20/320 to 20/400) and median postoperative BCVA was 20/200 (range: 20/320 to 20/200). Of the 4 cases reported, 3 obtained anatomical closure (75%), and also presented BCVA improvement after surgery, considering the last follow-up visit of each case. No additional procedures were performed in either case. One patient demonstrated no anatomic and functional improvement. CONCLUSION: The present study describes the first Brazilian case series of very large MH treated by the inverted pedicle ILM flap technique. This technique was associated with anatomic and visual improvement in most cases, and represents an alternative therapeutic approach for large macular holes.Trial Registration Project registered in Plataforma Brasil with CAAE number 30163520.0.0000.5440 and approved in ethics committee   from  Ribeirão Preto Medical School Clinics Hospital, University of São Paulo-Ribeirão Preto, São Paulo, Brazil (appreciation number 3.948.426 gave the approval).

[Ethics relevance in Brazilian medical journals]. / Destaques éticos nos periódicos nacionais das áreas médicas.

OBJECTIVE: To evaluate the Brazilian journals cited by the four CAPES medical areas, qualified as 'A' national or 'I' international, regarding the relevance given to ethics in the instructions for authors. METHODS: The instructions for authors of twenty Brazilian journals were studied and 36 types of ethical concerns were identified allowing the following categorization: I - Ethics in human research; II - Scientific integrity; III - Editorial policy. RESULTS: The results on Category I show that the most frequent instructions (50%) requires previous approval of the research by a institutional Ethics Committee (CEP), followed by indication on how to cite this approval in the body of the article (35%), plus presentation of a copy of the CEP approval (30%). However, none advert on the importance of the CEP being recognized by the CONEP. On Category II, 55% of the journal require declarations of conflict of interest, and 40% of them inquire about the type of interest; however, all (100%) journal do not mention prevention conflict of interests between authors and peer reviewers, neither on frauds, plagiarisms or data fabrication. Finally, in Category III, 65% of the journals require the authors to transfer publications rights to them, while the remaining 35% do not mention copyright CONCLUSION: These results are discussed in relations to the Brazilian present situation regarding ethics in the scientific production of researches using human subjects for the prevention of scientific dishonesty.

HTLV-1 infection in blood donors from the Western Brazilian Amazon region: seroprevalence and molecular study of viral isolates.

To determine the seroprevalence of HTLV-1 in Brazil, and to review the virus molecular epidemiology in this Amazon population (Rio Branco-Acre), 219 blood donors were screened for HTLV-1. Only one case of infection (0.46% seroprevalence) was detected during July 2004 screening at the Acre Hospital Foundation (FUNDACRE). Neighbor-joining and Maximum Likelihood phylogenetic analyses of two (n = 2) complete LTR region sequences were performed with the PAUP* software. Since the HTLV-1 envelope surface (gp46) and transmembrane (gp21) glycoproteins are important for virus fitness, three envelope glycoproteins sequences (n = 3) were analyzed using the Prosite tool to determinate potential protein sites. Phylogenetic analysis demonstrated that the new isolate described in this study, and the unpublished LTR strain described in a previous report belong to the Transcontinental subgroup of the Cosmopolitan subtype, inside the Latin American cluster. A similar result was obtained when submitting, to the Automated Genotyping System, three LTR partial sequences from a previous study of the seroprevalence of HTLV-1 in the same Amazon population. In all analyzed env sequences, the potential protein site was found: two PKC phosphorylation sites at amino acid (aa) positions 310-312 and 342-344, one CK2 phosphorylation site at 194-197aa, three N-glycosylation sites at 222-225aa, 244-247aa and 272-275aa, and a single N-myristylation site at 327-338aa. In conclusion, potential protein sites described in HTLV-1 gp46 and gp21 confirm the presence of conserved sites in the HTLV-1 envelope proteins, likewise phylogenetic analysis suggests a possible recent introduction of the virus into North Brazil.

[Liver injury in visceral leishmaniasis in children: systematic review]. / Alteraciones hepáticas en la Leishmaniasis Visceral (Kalazar) en niños: revisión sistemática de la literatura.

UNLABELLED: Visceral Leisshimaniosis or Kalazar is a parasitic infection caused by Leishimania Donovani subspecies. It is transmitted by phlebotomineos and may lead to liver and spleen enlargements as well as immunological impairment. Sometimes it is described liver injury simulating acute or chronic viral hepatitis and even portal hypertension. The liver injury makes difficult the diffencial diagnosis of Kalazar and other liver diseases in endemic regions. OBJECTIVE: To define and clarify the liver injury spectrum described in published cases reports. METHODS: Systematic revision of published data on Kalazar and liver injury using the following databank: LILACS, MEDLINE and EMBASE. Only paper published in French, English, Portuguese and Spanish were taken into consideration. The procedures for systematic review recommended by the NHS Centre for Reviews and Dissemination, University of Cork, were adopted. The paper quality classification was based on the number of reported variables previously defined in our study RESULTS: Only 11/28 (55%) publications were included in our analysis because they filled the minimal required data. Acute and chronic liver disease were well documented in these articles. Serum albumin and prothombine time were associated with severity of liver disease (P < .05). CONCLUSION: "Liver involvement, even when it is severe, may occur at tha begining of the disease. Kalazar should be considered as a differential diagnosis of cholestasis, acute and chronic liver injury as well as portal hypertension in children.

HDV genotypes in the Western Brazilian Amazon region: A preliminary report.

In Brazil, hepatitis delta virus (HDV) is only reported in Western Amazonia, where severe cases of acute and chronic HDV hepatitis have been described. The study area was chosen in the States of Acre and Rondonia where most cases of hepatitis B virus (HBV)/HDV are reported. From December 2003 to October 2004, 40 HBsAg carriers with anti-HDV IgM were selected. An epidemiologic questionnaire, including demographic and clinical/epidemiologic variables was filled out. HDV amplification and genotyping were performed. Genotype I was detected in 22 patients (55.0%), whereas genotype III was identified in 18 (45.0%). Patients who were infected with genotype I were older (45.1 +/- 17.8 years) than patients infected with genotype III (32.8 +/- 10.9 years; P = 0.01). No symptoms were reported by 21 (52.5%) patients. Otherwise, 19 (47.5%) had symptoms (fatigue, abdominal pain, weight loss, and decompensated liver disease) that motivated them to seek medical care. Genotype III carriers were more symptomatic, but no statistical significance was achieved. Our preliminary results show that HDV genotypes I and III are present in Brazilian Amazonia and that HDV genotype III is not limited to the Amerindian population.

Serological markers of hepatitis A, B and C viruses in rural communities of the semiarid Brazilian northeast.

In the village of Cavunge, located in a dry tropical, semiarid rural region of the state of Bahia, Brazil, a sentinel study on viral hepatitis is underway. We report on the first part of the study. The objective of this study was to determine the prevalence of serological markers for hepatitis A, B and C in the village. Cross sectional study. Blood samples were tested for serological markers of hepatitis A (HAV), B (HBV) and C (HCV) through ELISA-III assay. In HBsAg and anti-HCV carriers, HCV-RNA and HBV-DNA were checked by PCR. The prevalence of anti-HAV IgG was 83.3% (1,210/1,452), being higher among residents from the village (87.4%) than in residents from the rural area (79.5%); it also higher among individuals older than 10 years of age. The prevalence of HBsAg was 2.6% (38/1,476), 9.3% anti-HBc (137/1,476) and 10.5% (155/1,476) anti-HBs of. In more than half (58.1%; 90/155) of anti-HBs carriers, this was the only serological marker found. In 3.7% of the population, (55/1,476), anti-HBc was the only serological marker found. All HBV carriers were infected by genotype A. Only 0.4% (6/1,536) presented anti-HCV antibodies and only one of them was viremic, being infected with genotype 1. The prevalence of patients with antibodies against hepatitis A virus in the village of Cavunge was high, but the prevalence of B virus was moderate, with only genotype A among HBV carriers. The prevalence of C virus was very low, contrasting with the situation in large Brazilian urban centers.

[Urban transmission of schistosomiasis in children from a neighborhood of Salvador, Bahia]. / Transmissão urbana de esquistossomose em crianças de um bairro de Salvador, Bahia.

In the Subúrbio Ferroviário region of Salvador (Bahia, Brasil) occurrences of schistosomiasis were found. This fact motivated the investigation of the prevalence of the eggs in a group of 268 resident students in one of its neighborhoods (São Bartolomeu). The parasitological test analyzed by the Kato-Katz methodology, showed positive results in 30.2% of the children, ranging from 24 to 2,160 eggsSchistosoma mansoni/gram of feces. Infection was predominant in boys and in those 10 years old and over. Observation revealed that infection predominated in children that live close to natural water bodies. This region was where the three registered cases of hepatosplenicos occurred. Moreover, all the 81 children infected with Schistosoma mansoni eggs were born and live in the study area. Since this neighborhood presents all the elements of the epidemiological chain of Schistosoma mansoni, the evidences strongly suggests the urban transmission of this infection.

[Sociodemographical aspects of seroprevalence of hepatitis A virus in the settlement of Cavunge, a semi-arid region of Bahia State]. / Aspectos sociodemográficos da soroprevalência de marcadores do vírus da hepatite A no povoado de Cavunge, região do semi-árido do Estado da Bahia.

In Cavunge community, a rural village of the dry tropic in Bahia State, Brazil, a sentinel study on viral hepatitis was developed to characterize the seroprevalence of hepatitis A. The presence of IgG anti-HAV was analyzed in 891 citizens and 85.9% were positive. The prevalence was similar between genders and increased with age.

[Evaluation of the ocular globe compression sign in infectious meningeal syndromes]. / Avaliação do sinal de dor à compressão do globo ocular nas síndromes meníngeas infecciosas.

Infectious meningeal syndromes represent a serious medical emergency whose clinical-epidemiologic diagnosis must be immediately established for early initiation of appropriate treatment. However, in many cases data from the clinical exam are insufficient to confirm or rule out the diagnosis. Therefore, the aim of this work was to assess the value of the ocular globe compression sign in 57 patients with suspicion of infectious meningeal syndrome, both male and female and aged four years or older. The sensitivity (34.5%), specificity (78.6%) and positive (62.5%) and negative (53.7%) predictive values of ocular globe compression sign were similar to nuchal rigidity, and the agreement between two independent observers was fair (Kappa=0.65). Ocular globe compression sign in conjunction with other findings of the clinical examination could be of great value in the diagnostic process of patients with infectious meningeal syndromes.

[Clinical and epidemiological characteristics of snakebites in Rio Branco, Acre]. / Características clínicoepidemiológicas dos acidentes ofídicos em Rio Branco, Acre.

This study aimed to determine the clinical epidemiological profile of the snake bites attended at the reference hospital of Acre. One hundred-forty four patients were studied prospectively, from January to December 2002. One hundred-thirteen (78.5%) cases were classified as accidents by venomous snakes. The genera Bothrops, Lachesis and Micrurus were responsible, respectively, for 75.7%, 2.1% e 0.7% cases. The accidents predominated in males (78.5%), rural workers (51.4%) and between 10 and 29 years old (43.8%). The distribution according to the severity of poisoning by genera Bothrops was: moderate (48.6%), mild (31.2%) or severe (20.2%). Two cases of Bothrops accident did not receive serum therapy. However, the antivenom was administered in twenty-three patients without envenoming. In conclusion, the results obtained were different of the observed by another authors with respect to the severity of accidents and suitable treatment.

Very low prevalence of hepatitis C virus infection in rural communities of northeastern Brazil with a high prevalence of schistosomiasis mansoni.

The association of hepatitis C virus infection and the hepatosplenic form of schistosomiasis mansoni has been claimed to result in the concomitant evolution of the two pathologies, with a poor prognosis due to aggravated liver disease. Recently, however, some authors have begun to reject the hypothesis of a higher susceptibility of hepatosplenic schistosomal patients to HCV. The aim of the present transverse study carried out between July and August 1990 was to determine the possible association between SM and HCV markers in residents of Catolândia, Bahia State. Anti-HCV markers were assayed by ELISA-II and RIBA-II in serum samples obtained from 1,228 residents (85.8%). The anti-HCV antibody (ELISA-II) was positive in six (0.5%) individuals, eight (0.6%) cases were inconclusive and 1,214 (98.9%) were negative. However, only in one ELISA-positive serum sample (0.08%) were antibodies confirmed by RIBA-II, while two other samples assayed by RIBA-II were indeterminate. These three patients presented the hepatointestinal form of SM during the follow-up period (1976 to 1996). In conclusion, no association was observed between HCV and SM in the endemic area studied, especially among patients with the hepatosplenic form of the disease.

[Investigation of enterovirus in cases of aseptic meningitis syndrome of Belém, PA]. / Pesquisa de enterovírus em casos de síndrome de meningite asséptica de Belém, PA.

With the objective of isolating and identifying enteroviral serotypes, which are the most frequent etiologic agents of aseptic meningitis syndrome, cerebrospinal fluid samples were studied from patients referred to the health unit in the City of Belém (State of Pará, Brazil), from March 2002 to March 2003. The samples were inoculated in RD and HEp-2 cells line, and the positive were identified by neutralization test or indirect immunofluorescence. Out of 249 samples, 33 (13.2%) were positive 57.6% (n = 19) in patients under 11 years of age (p < 0.03) and predominantly (72.7%) in males (p < 0.008). The serotypes isolated were: Echovirus 30 (n = 31), Coxsackievirus B5 (n = 1) and Echovirus 30 and 4. In conclusion, this type of study also serves to determine the national picture, which is still little defined, regarding the most prevalent viral agents in AMS cases.

Pattern, clinical features and response to corticoids of glomerular diseases in a Brazilian population. An analytical cross-sectional study.

CONTEXT AND OBJECTIVE: Glomerular disease registries are increasing all around the world. The aim of this study was to evaluate the clinical characteristics and treatment response among patients with glomerular diseases followed up in a tertiary hospital in Brazil. DESIGN AND SETTING: Analytical cross-sectional study; tertiary-level public hospital. METHODS: This study included patients with glomerular diseases followed up at a tertiary hospital in Fortaleza, northeastern Brazil. Clinical and laboratory data on each patient were registered. The response to specific treatment was evaluated after 3, 6 and 12 months. RESULTS: The study included 168 patients of mean age 37 ± 14 years. The most prevalent glomerular diseases were focal segmental glomerulosclerosis FSGS] (19.6%), minimal change disease MCD] (17.9%), membranous nephropathy MN] (16.7%) and lupus nephritis LN] (11.9%). The main clinical presentations were nephrotic proteinuria (67.3%) and renal insufficiency (17.9%). The mean proteinuria value decreased after the treatment began. Regarding 24-hour proteinuria on admission, there was no significant difference between patients with a good response and those with no response (7,448 ± 5,056 versus 6,448 ± 4,251 mg/24 h, P = 0.29). The glomerular disease with the highest remission rate was MCD (92%). Absence of interstitial fibrosis presented a strong correlation with remission (remission in patients without fibrosis = 83.4% versus 16.3% in those with fibrosis, P = 0.001). CONCLUSIONS: The present study found that the most frequent glomerular disease was FSGS, followed by MCD, MN and LN. The presence of interstitial fibrosis was a predictor of poor therapeutic response.

Accidental tetanus: prognosis evaluation in a historical series at a hospital in Salvador, Bahia, Brazil.

A total of 868 (84.89%) patients diagnosed with tetanus were studied, out of the 1,024 tetanus patients hospitalized at Couto Maia Hospital (Salvador, Bahia, Brazil), during the period between 1986 and 1997. Of this group (n = 868), 63.5% (n = 551) were discharged, 35.4% (n = 307) died, and 1.1% (n = 10) were transferred. The average age of the deceased patients (38.73 +/- 23.31 years) was significantly greater (p < 0.0001) than the age of those who survived (29.21 +/- 20.05 years). Analyzing the variables of the logistic regression model with statistic significance (p < or = 0.25) for univariate analysis, we observed a greater association of risk for worst prognosis (death) in patients aged > or = 51 years; time of illness < 48 hours; time of incubation < 168 hours; neck rigidity; spasms; opisthotonos; body temperature > or = 37.7 degrees C; heart beat > or = 111 beats/minute; sympathetic hyperactivity and association with pneumonia. Among the group of those who survived, patients with 1 to 5 of those variables (n = 398; 76.8%) were more frequent, while among patients of the group of the deceased, 70.3% (n = 206) presented 6 to 10 of those variables, with a highly significant difference (p < 10(-8)). In conclusion, the indicators described provide early information that may guide the prognosis and medical and nurse care.

[Leptospiral infection and subclinical presentation among children in Salvador, Bahia]. / Leptospirose-infecção e forma subclínica em crianças de Salvador, Bahia.

The purposes of this investigation were to identify the frequency and risk factors of leptospiral infection among children aged between 2 and 15 years in Salvador, Bahia, household contacts of patients (index-cases) hospitalized at Couto Maia Hospital due to Leptospira interrogans (ELISA IgM positive). Among 148 household contacts from 25 selected index-cases, clinical and epidemiological data were collected and ELISA IGM and IgG were performed in paired sera (between 20 days) from 73 (49.3%). This diagnostic method divided the 73 household contacts into three groups: group A (acute or recent leptospiral infection), 30 (41.1%) children, group B (not- infected ) 34 (46.6%) and group C, (past infection) nine (12.3%) children. In group A five (16.7%) had cold syndrome simile. No statistically significant difference was found between groups A and B for sex, race, age and presence of pet dog. However, in group A there was a statistically significant predominance (p < 0.05%) of: contact with natural water courses; index-case sibling aged under fifteen years; female sex and over 9 years old; and principally lack of appropiate trash disposal in the residential area. In conclusion, leptospiral infection in children (from 2 to 15 years of age) in Salvador is underestimated, because it is asymptomatic or presents as a cold syndrome simile.