Vaccination in post-tuberculosis lung disease management: A review of the evidence.

INTRODUCTION AND OBJECTIVES: Post-tuberculosis lung disease (PTLD), as other chronic respiratory disorders, may have infectious complications; some of them can be prevented with vaccinations. So far, no document has discussed the potential role of vaccination in PTLD. Therefore, the objective of this review was to describe vaccination recommendations to prevent infections potentially capable of complicating PTLD. MATERIALS AND METHODS: A non-systematic review of the literature was conducted. The following keywords were used: tuberculosis, vaccination, vaccines and PTLD. PubMed/MEDLINE and Embase were used as the search engine, focusing on English-language literature only. RESULTS: We identified 9 vaccines potentially useful in PTLD. Influenza, pneumococcal and anti-COVID-19 vaccinations should be recommended. Patients with PTLD can also benefit from vaccination against shingles. Vaccination against pertussis is mainly relevant during childhood. Diphtheria, tetanus and measles vaccination are recommended for general population and should be considered in patients with PTLD not previously vaccinated. Tdap (Tetanus, diphtheria, and pertussis) booster should be repeated in every adult every ten years. Vaccination against BCG retains its importance during early childhood in countries where TB is endemic. CONCLUSIONS: Vaccination deserves to be considered among the strategies to prevent and/or mitigate PTLD complications. Further evidence is necessary to better understand which vaccines have the greatest impact and cost-benefit.

Analysis of relationship of psychosocial factors with patient safety culture in a Brazilian hospital: Study with structural equation modeling analysis.

INTRODUCTION AND OBJECTIVES: The scenario of the health system can develop physical and emotional impacts on health professionals, due to work overload and failure to manage the system. It is necessary to consolidate the theory that the safety of care provided by health services is affected by organizational conditions. The aim of this study is to assess whether safety culture is related to job satisfaction, depressive symptoms, and burnout syndrome among hospital professionals. MATERIALS AND METHODS: This is an analysis with structural equation modeling, conducted in a teaching hospital in Brazil. Data collection was made via psychometric instruments, which sought to analyze job satisfaction (Job Satisfaction Survey), depressive symptoms (Patient Health Questionnaire), burnout syndrome (Maslach Burnout Inventory), as well as the relationship between this factors and patient safety culture (Safety Attitudes Questionnaire). The Pearson correlation coefficient (r) and the partial least squares structural equation modeling (PLS-SEM) were used for analysis. RESULTS: A higher work satisfaction was associated with a higher perception of safety culture (r=0.69; P<0.001). Depressive symptoms and burnout dimensions showed an inverse relationship with the safety culture (P<0.05). PLS-SEM enabled us to understand the behavior of this association. Thus, satisfaction at work and the absence of burnout proved to be predictive factors for the implementation of an ideal patient safety culture (P<0.001). CONCLUSIONS: Patient safety culture is related to job satisfaction and burnout among hospital professionals. These findings suggest that the psychosocial work environment influences the quality of care provided.

Salt stress differentially regulates mobilisation of carbon and nitrogen reserves during seedling establishment of Pityrocarpa moniliformis.

Seedling establishment is a critical step in environment colonisation by higher plants that frequently occurs under adverse conditions. Thus, we carried out an integrated analysis of seedling growth, water status, ion accumulation, reserve mobilisation, metabolite partitioning and hydrolase activity during seedling establishment of the native Caatinga species Piptadenia moniliformis (Benth.) Luckow & R.W. Jobson under salinity. Two-day-old seedlings were cultivated in vitro for 4 days in water agar (control) or supplemented with 50 or 100 mm NaCl. Biochemical determinations were performed according to standard spectrophotometric protocols. We found that 100 mm NaCl stimulated starch degradation, amylase activity and soluble sugar accumulation, but limited storage protein hydrolysis in the cotyledons of P. moniliformis seedlings. Although Na+ accumulation in the seedling affected K+ partitioning between different organs, it was not possible to associate the salt-induced changes in reserve mobilisation with Na+ toxicity, or water status, in the cotyledons. Remarkably, we found that starch content increased in the roots of P. moniliformis seedlings under 100 mm NaCl, probably in response to the toxic effects of Na+ . The mobilisation of carbon and nitrogen reserves is independently regulated in P. moniliformis seedlings under salt stress. The salt-induced delay in seedling establishment and the resulting changes in the source-sink relationship may lead to storage protein retention in the cotyledons. Possibly, the intensification of starch mobilisation in the cotyledons supported starch accumulation in the root as a potential mechanism to mitigate Na+ toxicity.

Carbon disulfide formation in papaya under conditions of dithiocarbamate residue analysis.

Golden, Sunrise Solo and Tainung cultivars of papaya were found to release CS2 when submitted to experimental conditions of dithiocarbamate residue analysis. Three common analytical methods were used to quantitate CS2; one spectrophotometric method and two chromatographic methods. All three methods gave positive CS2 results for all three papaya varieties. Other endogenous compounds present in isooctane extracts of papaya fractions detected via gas chromatography (GC/ITD) using electron ionization (EI) were: carbonyl sulfide, dimethyl sulfide, carbon disulfide, 2-methylthiophene, 3-methylthiophene, 2-ethylthiophene, 3-ethylthiophene, benzylisothiocyanate, benzylthiocyanate and benzonitrile. Control samples were obtained from papaya plantations cultivated in experimental areas, in which no treatment with fungicides of the dithiocarbamate group was applied. Endogenous CS2 levels were compared with true dithiocarbamate residues measured in papaya samples from the field trials following applications of the mancozeb fungicide. Three days after application, true dithiocarbamate residues, measured by the procedure with isooctane partitioning and GC-ITD, were at the average level of 2 mg kg(-1).

Gestational exposure to yellow fever vaccine at different developmental stages induces behavioral alterations in the progeny.

The most effective method to prevent yellow fever and control the disease is a vaccine made with attenuated live virus. Due to the neurological tropism of the virus, preventive vaccination is not recommended for infants under 6 months and for pregnant women. However there is a paucity of data regarding the safety for pregnant women and there are no experimental studies investigating adverse effects to the offspring after maternal exposure to the vaccine. This study aimed to investigate, in mice, the effects of maternal exposure to the yellow fever vaccine at three different gestational ages on the physical and behavioral development of the offspring. Pregnant Swiss mice received a single subcutaneous injection of water for injection (control groups) or 2 log Plaque Forming Units (vaccine-treated groups) of the yellow fever vaccine on gestational days (GD) 5, 10 or 15. Neither maternal signs of toxicity nor alterations in physical development and reflex ontogeny of the offspring were observed in any of the groups. Data from behavioral evaluation indicated that yellow fever vaccine exposure induced motor hypoactivity in 22-day-old females independent of the day of exposure; and in 60-day-old male and female pups exposed at GD 10. Moreover, 22-day-old females also presented with a deficit in habituation memory. Altogether, these results indicate that in utero exposure to the yellow fever vaccine may induce behavioral alterations in the pups that may persist to adulthood in the absence of observed maternal toxicity or disruption of physical development milestones or reflex ontogeny.

Rosuvastatin prevents myocardial necrosis in an experimental model of acute myocardial infarction

Dyslipidemia is related to the progression of atherosclerosis and is an important risk factor for acute coronary syndromes. Our objective was to determine the effect of rosuvastatin on myocardial necrosis in an experimental model of acute myocardial infarction (AMI). Male Wistar rats (8-10 weeks old, 250-350 g) were subjected to definitive occlusion of the left anterior descending coronary artery to cause AMI. Animals were divided into 6 groups of 8 to 11 rats per group: G1, normocholesterolemic diet; G2, normocholesterolemic diet and rosuvastatin (1 mg·kg-1·day-1) 30 days after AMI; G3, normocholesterolemic diet and rosuvastatin (1 mg·kg-1·day-1) 30 days before and after AMI; G4, hypercholesterolemic diet; G5, hypercholesterolemic diet and rosuvastatin (1 mg·kg-1·day-1) 30 days after AMI; G6, hypercholesterolemic diet and rosuvastatin (1 mg·kg-1·day-1) 30 days before and after AMI. Left ventricular function was determined by echocardiography and percent infarct area by histology. Fractional shortening of the left ventricle was normal at baseline and decreased significantly after AMI (P < 0.05 in all groups), being lower in G4 and G5 than in the other groups. No significant difference in fractional shortening was observed between G6 and the groups on the normocholesterolemic diet. Percent infarct area was significantly higher in G4 than in G3. No significant differences were observed in infarct area among the other groups. We conclude that a hypercholesterolemic diet resulted in reduced cardiac function after AMI, which was reversed with rosuvastatin when started 30 days before AMI. A normocholesterolemic diet associated with rosuvastatin before and after AMI prevented myocardial necrosis when compared with the hypercholesterolemic condition.

Rosuvastatin prevents myocardial necrosis in an experimental model of acute myocardial infarction.

Dyslipidemia is related to the progression of atherosclerosis and is an important risk factor for acute coronary syndromes. Our objective was to determine the effect of rosuvastatin on myocardial necrosis in an experimental model of acute myocardial infarction (AMI). Male Wistar rats (8-10 weeks old, 250-350 g) were subjected to definitive occlusion of the left anterior descending coronary artery to cause AMI. Animals were divided into 6 groups of 8 to 11 rats per group: G1, normocholesterolemic diet; G2, normocholesterolemic diet and rosuvastatin (1 mg·kg(-1)·day-1) 30 days after AMI; G3, normocholesterolemic diet and rosuvastatin (1 mg·kg(-1)·day-1) 30 days before and after AMI; G4, hypercholesterolemic diet; G5, hypercholesterolemic diet and rosuvastatin (1 mg·kg(-1)·day-1) 30 days after AMI; G6, hypercholesterolemic diet and rosuvastatin (1 mg·kg(-1)·day-1) 30 days before and after AMI. Left ventricular function was determined by echocardiography and percent infarct area by histology. Fractional shortening of the left ventricle was normal at baseline and decreased significantly after AMI (P < 0.05 in all groups), being lower in G4 and G5 than in the other groups. No significant difference in fractional shortening was observed between G6 and the groups on the normocholesterolemic diet. Percent infarct area was significantly higher in G4 than in G3. No significant differences were observed in infarct area among the other groups. We conclude that a hypercholesterolemic diet resulted in reduced cardiac function after AMI, which was reversed with rosuvastatin when started 30 days before AMI. A normocholesterolemic diet associated with rosuvastatin before and after AMI prevented myocardial necrosis when compared with the hypercholesterolemic condition.

Role of adiponectin in the development of high fat diet-induced metabolic abnormalities in mice.

The adipokine adiponectin is decreased in severe obesity and is inversely associated with adipose mass. Adiponectin is associated with insulin sensitivity and cardioprotection. Obesity frequently results in the development of a "cardiometabolic syndrome" characterized by increased circulating insulin and leptin, and cardiac hypertrophy and dysfunction. This study examined if adiponectin-deficiency affects the development of metabolic and cardiac abnormalities in response to modest obesity. Mice were studied under normal conditions and with mild cardiac pressure-overload induced by abdominal aortic banding. After surgery, wild type and adiponectin-deficient mice were fed a high-fat diet for 8 weeks (45% energy from fat vs. 10%). In wild type mice the high-fat diet increased fat and whole body mass, which corresponded with elevated circulating insulin and leptin and a decrease the glucose/insulin ratio. On the other hand, in adiponectin-deficient mice the high-fat diet had less impact on body mass and no effect on fat mass, insulin, leptin, or glucose/insulin. There was modest cardiac hypertrophy with aortic banding, but no cardiac dysfunction or effects of adiponectin deficiency or diet. The results suggest that the increase in adipose mass, leptin and insulin induced by a high fat diet is dependent on adiponectin. The lack of accelerated cardiac hypertrophy and dysfunction in the adiponectin-deficient mice subjected to aortic banding and the high-fat diet suggest that adiponectin may not play a major role in protecting the heart during the early stages of diet-induced obesity.

Clay charge reversal effects on aqueous polymer sorption on lateritic soils.

The effects of charge reversal about the measured point of zero charge (pH(0) approximately 5.2) of untreated and treated Sete Lagoas lateritic soil of Brazil on aqueous polymer sorption was investigated. The polymers are anionic sodium carboxymethyl cellulose (CMCA), nonionic polyethylene oxide (PEO), and cationic polyacrylamide (PAM). They were prepared at aqueous concentrations and pH ranges of 0.1-2.0 g l(-1) and 2-9, respectively. Soil treatment involved the removal of iron oxides by treatment with dithionate-bicarbonate-citrate. Batch sorption test results show that the presence of iron oxides in lateritic soil tends to suppress sorption of CMCA (especially at pH=pH(0)) and PEO (for the whole pH range) but has uncertain effects on cationic PAM sorption. CMCA sorption on the untreated soil improves on either side of pH(0), in direct proportionality to solution concentration, except at pH<4.0, where disassociation of the polymer molecules may decrease sorption energy. Increase in the sorption of non-cationic polymers (CMCA and PEO) at pH>pH(0) is attributable to dispersion of clay, cation bridging and polymer molecular reconfiguration. For cationic PAM, electrostatic bonding to negatively charged soil particle surfaces accounts for the sorption increase. For treated soil samples, polymer sorption pattern is similar to those expected for the montmorillonitic clayey soils of temperate zones. These results indicate that the pH(0) of lateritic soils, within the regime that exists in the field, should be considered in assessing the potential effectiveness of polymer dust suppressants for tropical lateritic soils.

Soil desiccation rate integration into empirical dust emission models for polymer suppressant evaluation.

Dust constitutes an environmental and human health menace in many regions of the world. The rate of soil desiccation is a significant determinant of the availability of fine soil particles for entrainment in air as dust. Dust suppressants such as polymer solutions can reduce soil desiccation rate, thereby reducing dust emission factor. Herein, a dust emission estimation methodology that involves the integration of desiccation time curves to find the average desiccation rate is formulated. This is combined with soil characteristics, stressor (environmental and possibly vehicle) characteristics and liquid content in soil to estimate potential emission factors. Using this methodology, the dust suppression potential of aqueous polyethylene oxide (PEO) solution was investigated experimentally with Na-montmorillonite (Na-mmt) as the model dust-generating material. PEO with a molecular weight of 8 x 10(6) and at aqueous concentrations ranging from 0.5 to 10 g/L, was mixed with 10 g of Na-mmt (surface area=31.82+/-0.22 m2/g) and desiccated for 700 h in a specially designed chamber at 25 degrees C and 30% relative humidity. The results show that generally, aqueous PEO is superior to distilled water as a dust suppressant for Na-mmt at concentrations in the range of 0.5-2.0 g/L. The experimental data obtained are introduced into the formulated estimation methodology, and potential emissions of dust from PEO-admixed Na-mmt are determined.

Skin reactivity to aeroallergens is reduced in human T-lymphotropic virus type I-infected healthy blood-donors (asymptomatic carriers).

BACKGROUND: A type 2 immune response, characterized by high levels of interleukin-4 and immunoglobulin E synthesis is a hallmark of respiratory allergic diseases. Individuals infected with human T-lymphotropic virus type I (HTLV-I) virus have spontaneous T-cell proliferation and increased interferon gamma production, which are immunological functions associated with a type 1 immune response. OBJECTIVE: To determine the frequency of asthma and rhinitis symptoms and immediate skin reactivity to aeroallergens in HTLV-I infected individuals, compared with noninfected subjects. METHODS: Cross sectional study of 101 HTLV-I infected and 101 control uninfected blood donors, assessed by enzyme-linked immunosorbent assay and Western blot assays. The subjects were age and sex-matched, identified as presenting allergy history by questionnaire, which was complemented by a complete clinical examination and skin prick tests for aeroallergens. RESULTS: The frequency of atopy was lower in infected than uninfected subjects, 14.9 and 29.7% (P = 0.017), respectively. Skin reactivity to Dermatophagoides pteronissynus, Dermatophagoides farinae and Blomia tropicalis were the most frequently observed among all the tested antigens in both groups. Skin reactivity to histamine was also reduced in the infected individuals compared with uninfected subjects (medians 4.0 vs 5.0, respectively; P < 0.0001). Infection by HTLV-I was found to be a factor of protection to atopy (RP 0.44; P = 0.005). CONCLUSIONS: The HTLV-I infection reduces the frequency of respiratory allergy and skin reactivity to aeroallergens.

Paradoxical coexistence of atopic asthma and Human T-Lymphotropic Virus Type I (HTLV-I) infection: a case report.

In this case report, the authors report the presence of two supposedly antagonic immune diseases in the same patient. The patient is a 45-year-old white woman with a history of asthma and allergic rhinitis for the last 10 years. Asthmatic symptoms were present and were triggered after exposure to dust and mold. Her Human T-Lymphotropic Virus Type I (HTLV-I) seropositive status was detected by chance five years ago during a routine screening for blood donation. Skin prick tests were positive for Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis. Cytokine levels in unstimulated cultures were: IFNgamma= 1195 pg/ ml, TNFalpha = 460 pg/ml, IL5 = 41 pg/ml and IL10 = 265 pg/ml.

A technique for cutting brittle undisturbed lateritic soil block samples.

This note describes a technique for cutting undisturbed brittle block samples into smaller specimens for further geotechnical testing. This technique revealed very useful in dealing with collapsible soils, where the sampling is recommended to be done with block soil samples. A further use of this technique as an efficient way for sampling collapsible soils is proposed.

Laparoscopic versus open appendicectomy: a comparative study.

There are many questions regarding the advantages and disadvantages a videolaparoscopic approach in the treatment of acute appendicitis. The authors present the results of a non-randomized, prospective study with 496 patients admitted between January 1992 and March 1998 by the General Surgery Service of São Rafael Hospital Salvador-BA-Brazil. The patients were submitted for appendicectomy by video laparoscopy or by the traditional open method, and variables such as surgery duration, morbidity, mortality, costs, and length of stay (LOS) were compared. The results demonstrate that laparoscopic appendicectomy is a safe alternative for treatment of acute appendicitis; however, there are several disadvantages that gradually must be overcome.

[Systemic arterial hypertension and psychiatric morbidity in the outpatient care setting of a tertiary hospital]. / Hipertensão arterial sistêmica e morbidade psiquiátrica em ambulatório de hospital terciário.

Arterial hypertension is one of the most important risk factor for cardiovascular disease, the main cause of death in Brazil. Hypertensive patients that have treated in tertiary care hospitals have shown elevated co-morbidity including psychiatric disturbances. Our objective is to study psychiatric co-morbidity among severe hypertensive patients. This study was performed in an out-patient clinic of tertiary medical care setting. Forty-one patients were enrolled in this research (26 women, 15 men). They were submitted to a clinical interview and answering the PRIME-MD, a specific questionnaire for diagnosis of psychiatric disturbances (by a general practitioner). Frequencies of psychiatric disturbances were different in men and women: 63.4% of the women in this study showed some type of psychiatric disturbance versus 36.6% of men (p = 0.012). The majority of the diagnosis were mood disturbances, mainly depression associated or not with anxious disturbances. Mean age of psychiatric disturbance patients was 47.1 years versus 59.3 years in the patients without psychiatric disturbances (p = 0.0049), showing the presence of psychiatric disturbances in younger patients. Other factors as systolic arterial blood pressure, diastolic arterial blood pressure and body mass index did not show any differences associated with psychiatric disturbance. We conclude that there is a great co-morbidity between high complexity hospitals hypertensive patients and that this type of disturbance is more frequent in women and in younger patients.

[Antihypertensive treatment. Prescription and cost of drugs. Survey in a tertiary care hospital]. / Tratamento anti-hipertensivo. Prescrição e custo de medicamentos. Pesquisa em hospital terciario.

PURPOSE: To study the most prescribed anti-hypertensive drugs, evaluating their agreement with established guidelines and drug cost. METHODS: One hundred and forty one (101 women, mean age = 53.3 years) hypertensive patients who searched spontaneous attention were interviewed in a tertiary-care hospital. The inclusion criteria were previous diagnosis of hypertension and non cardiovascular complaints. RESULTS: The majority of the 107 (75.9%) patients were on medical treatment. In those receiving monotherapy, thiazides were the most utilized drugs, followed by methyldopa, ACE inhibitors, calcium channel-blockers, and beta-blockers. The association with thiazides (26.3%) followed the same preference. The second most prescribed drug, methyldopa, was the more expensive. Fifty percent of the patients purchased the drugs at their own expense. CONCLUSION: A preference for prescription of expensive drugs for hypertension was detected in this sample in Brazil. This does not agree with major guidelines, mainly the V-JNC, which suggest thiazides and betablockers as first choice drugs for hypertensives with no complications or associated comorbidity.

Tratamento anti-hipertensivo. Prescriçäo e custo de medicamentos. Pesquisa em hospital terciário / Antihypertensive treatment. Prescription and cost of drugs. Survey in a tertiary care hospital

Objetivo - Verificar os medicamentos anti-hipertensivos mais utilizados por pacientes que procuram atendimento em hospital público terciário, avaliando o impacto das diretrizes de atendimento (consensos) e custo de aquisiçäo. Métodos - Foram selecionados 141 pacientes (101 do sexo feminino) de 40 a 72 (média 53,3) anos, que procuraram de forma espontânea, atendimento em hospital terciário, com diagnóstico prévio de hipertensäo arterial feito por médico e ausência de queixas relacionadas ao aparelho cardiovascular. Resultados - Verificou-se que 75,9 "por cento" (n=107) estavam em uso diário de anti-hipertensivos, sendo 60,7 "por cento" (n=86) em monoterapia e os demais em terapia mista. Os medicamentos mais empregados em monoterapia eram: tiazídicos, metildopa, inibidores da ECA, bloqueadores de canal de cálcio e betabloqueadores. A combinaçäo com tiazídicos (26,3 "por cento" do total) seguiu a mesma preferência. O segundo medicamento mais prescrito, metildopa, era o de mair custo. Metade dos pacientes adquiriu os medicamentos por compra direta. Conclusäo - Observou-se maior utilizaçäo de anti-hipertensivos de alto custo, conduta discordante das principais diretrizes das sociedades médicas, sobretudo do V-JNC, que preconizou tiazídicos e betabloqueadores, como anti-hipertensivos de primeira escolha em hipertensos sem complicaçöes ou condiçöes associadas.

[Validation of a questionnaire for the diagnosis of headache in an outpatient clinic at a university hospital]. / Validação de questionário para diagnóstico de cefaléia em ambulatório de hospital universitário.

Headache is a common complaint with a high prevalence in ambulatory settings. The physical and neurological examinations are frequently normal. The use of questionnaires as a screening methods for patients with primary headache could facilitate the diagnosis in non-specialized medical centers. In the present study, we used a questionnaire, based on the IHS criteria and modified by the authors, applied to 204 patients from the outpatient clinic of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Half of the patients were submitted to a clinical interview. We compared the results of the questionnaire with the results of the medical interview (gold standard). Most of the headaches we studied were primary headaches (89.6%). The questionnaire revealed a sensitivity of 90.2% and specificity of 57.9% for migraine detection with a chance corrected agreement (kappa) of 0.47 and a positive predictive (PPV) value of 65.7% and a negative predictive value (NPV) de 86.8%. The sensitivity for tension-type headache detection was 60.8% and the specificity 87.1% with a kappa value of 0.49 and a PPV of 77.8% and a NPV of 75.9%. We conclude that this questionnaire can be used as a screening method for diagnosing headache and that it can be applied by non-medical personnel. This questionnaire could also be used for population studies.