Domestic sewage treatment in full-scale UASBB plant at Mangueira, Recife, Pernambuco.

The anaerobic technology application for domestic sewage treatment in Pernambuco State (Brazil) is relatively recent. Some UASB reactors of less than 250 m3 were built in the Recife Metropolitan Region (RMR) in the 1990s. Mangueira (18,000 inhabitants) was the first neighborhood where the municipality built a plant with a bigger UASB reactor of 810 m3. It was intended to evaluate the performance and verify if such technology would be feasible. The objective would be the possible application of UASB reactors to the RMR, according to the new sewage master-plan under elaboration that would benefit about 3 million inhabitants. The monitoring of the Mangueira UASB reactor over 30 months showed that satisfactory results were obtained. Three distinct operational phases occurred, in which efficiency varied from 60% up to 90% based on COD removal. The results were very dependent on the operation and maintenance, either in the plant or in the sewage collection. Significant amount of inert solids was measured inside the reactor. Despite the operational problems, the UASB was shown to be very robust and stable. Under high fluctuation of influent concentrations (150-750 mg COD/L) during the period, resulting in applied organic loading rate of 0.5 to 2.5 kg COD/m3.d, the average values of COD removal efficiency did not change significantly. An active biomass with specific methanogenic activity varying from 0.18 to 0.25 g COD/g VSS.d was measured at the end of the period.

Serosubtypes and PorA types of Neisseria meningitidis serogroup B isolated in Brazil during 1997--1998: overview and implications for vaccine development.

Meningococcal disease caused by N. meningitidis serogroup B (MenB) has been endemic in Brazil since 1997. In this study, we determined the prevalence of serosubtypes of MenB isolated in 10 Brazilian states and the Federal District during 1997 and 1998 and investigated the extent of PorA VR sequence variation among the most prevalent serosubtypes to evaluate the possible use of an outer membrane vesicle (OMV)-, PorA-based vaccine to prevent meningococcal disease in Brazil. During this period, a total of 8,932 cases of meningococcal disease were reported. Only 42% (n = 3,751) of the reported cases were laboratory confirmed, and about 60% (n = 2,255) of those were identified as MenB. Among 1,297 MenB strains selected for this study, the most prevalent serosubtypes were P1.19,15 (66%), P1.7,1 (11%), and P1.7,16 (4%). PorA VR typing showed that 91% of the P1.19,15 strains analyzed had VR1 and VR2 sequences identical to those of the prototype strain. No sequence variation was detected among the 40 strains representing all isolated MenB P1.7,16 strains in the three southern states, where this serosubtype accounts for 75% of the serosubtypes identified. Similarly, all P1.7,1 strains were identified by PorA typing as P1.7-1,1. Although further improvements in the reporting of cases and collection of strains in Brazil are needed, our data suggest that a trivalent OMV-based vaccine prepared with PorA types P1.19,15, P1.7-1,1, and P1.7,16 may be appropriate to control serogroup B meningococcal disease in most of the Brazilian states.

Clinical factors predictive of bone marrow involvement in Hodgkin's disease.

The role of bone marrow biopsy in the staging of Hodgkin's disease is undergoing reevaluation. We have studied the relationship of clinical factors to the presence of bone marrow involvement in 130 previously untreated patients with Hodgkin's disease. The presence of fever, spleen enlargement, anemia, leukopenia, poor performance status and poor histologic subgroups were positively correlated with the presence of bone marrow involvement in the univariate analysis. In the multivariate analysis, only fever, spleen involvement, leukopenia and poor histologic subgroups were significant. The predictive value of the absence of fever in regard to the absence of bone marrow involvement was 98%. The likelihood of bone marrow involvement in the absence of all four significant factors was only 0.05%. Patients without these clinical factors should probably not be submitted to a bone marrow biopsy as part of the staging procedures performed in Hodgkin's disease.

Spinal cord compression due to extramedullary hematopoiesis in the proliferative phase of polycythemia vera.

Extramedullary hematopoiesis is a common accompaniment of a variety of hematologic diseases such as hereditary spherocytosis, thalassemia and myelofibrosis. The association of extramedullary hematopoiesis with polycythemia vera in the proliferative phase is much less usual. We report a patient who presented with paraplegia due to spinal cord compression; clinical investigation revealed a paravertebral hematopoietic tumor, and the diagnosis of polycythemia vera was then established.

The treatment of acute myeloid leukemia in Brazil: progress and obstacles.

BACKGROUND: Substantial progress has been made in the treatment of acute myeloid leukemia in the last two decades. We wanted to evaluate the outcome of intensive chemotherapy and the influence of recent therapy changes in underprivileged patients treated in a large urban public university hospital. METHODS: The records of all patients treated for acute myeloid leukemia from 1980 to 1993 were analyzed. RESULTS: 109 patients were identified; 41 did not receive any treatment for the leukemia because of infectious and/or hemorrhagic complications of advanced disease. Median survival in this group was 4 days. The other 68 patients received one of two induction protocols: TAD from 1980 to 1985 (n = 23) and ara-C plus daunorubicin from 1985 to 1992 (n = 45). The complete remission rate was 56%, disease-free survival 24% and overall survival 15% at 13 years. Overall survival was better for patients treated with ara-C plus daunorubicin than with TAD (19% versus 8%, p = 0.01). This is attributed to a reduction in infection mortality after ceftazidime and amikacin replaced cephalotin, carbenicillin and amikacin as the antibiotic regimen. CONCLUSIONS: The most effective intervention in our population would probably be an improvement in the primary health care system, so that earlier diagnosis could allow the treatment of a larger fraction of patients.

C-MOPP/ABV yields good results in a public hospital population with Hodgkin disease in Brazil.

BACKGROUND: Over the last 15 years, a number of combination chemotherapy regimens have been reported to induce more than 80% complete remissions (CR) in patients with advanced Hodgkin disease (HD). Almost all such studies have been conducted in large institutions from North America and Europe. It remains to be proven, however, that those regimens are equally effective for the larger population of patients with HD who live in very different social conditions in third-world countries. METHODS: Fifty-nine patients with advanced-stage or early bulky HD were treated in two public hospitals with the C-MOPP/ABV hybrid program, in which cyclophosphamide was substituted for mechlorethamine. RESULTS: The median number of cycles administered was six, and the median follow-up was 32 months. Fifty patients (85%) reached a CR. The actuarial failure-free survival (FFS) rate was 69%, and the actuarial overall survival rate was 78% at 68 months. The only significant prognostic factor that predicted for improved FFS rate was the absence of B symptoms (P = 0.02). Overall survival was better for patients who reached a CR (P = 0.0003) and those with no systemic symptoms (P = 0.007). Toxic effects were moderate, with one treatment-related death and six episodes of serious infection. CONCLUSIONS: The target population consisted of lower-class Brazilians, many living in poor social conditions. Nevertheless, these results compare equitably with other results reported in the literature. C-MOPP/ABV is an adequate treatment for HD in third-world populations.

Low-grade lymphoma following intensive treatment of large-cell lymphoma.

Progression of a low-grade non-Hodgkin's lymphoma into a more aggressive histologic pattern is a well-described phenomenon. The converse phenomenon, often called downgrading, is much less frequent. We report 2 patients in whom relapse with an indolent lymphoma was noted after chemotherapy for higher-grade disease. Other previously reported cases are reviewed. The implications for appropriate management and pathogenesis are discussed.

[Infant mortality]. / Mortalidade infantil.

PIP: The coefficient of infant mortality is one of the most useful indicators of the level of health in a country. The author presents data of infant mortality for residents of the state and municipality of Sao Paulo. From 1971 to 1975 there were only small fluctuations with a tendency for an increase in infant mortality. From 1975 to 1979, however, there was a steady decline of 28%. Nevertheless, a comparison with countries such as Africa, Asia and Europe shows that infant mortality in Sao Paulo is still very high. Some of the reasons for the high rate are diarrhea and fetal anoxia, each of which is responsible for 21% of infant mortality. A major decline (46%) was observed in deaths caused by intestinal and parasitic diseases. While enteritis was the principle cause of death in 1975, it was only responsible for 21% in 1979. An analysis of the factors responsible for the decline is complex, but improvement of basic sanitation is definitely a factor. Application of the coefficient reveals that the improvement of the basic water supply alone reduces the number of deaths by 8100. Another factor in the prevention of infant mortality is vaccination against diphtheria, tetanus, whooping cough, and polio. Economic factors such as minimum income are statistically insignificant.^ieng