The global prevalence of apical periodontitis: a systematic review and meta-analysis.

BACKGROUND: Apical periodontitis (AP) frequently presents as a chronic asymptomatic disease. To arrive at a true diagnosis, in addition to the clinical examination, it is mandatory to undertake radiographic examinations such as periapical or panoramic radiographs, or cone-beam computed tomography (CBCT). Thus, the worldwide burden of AP is probably underestimated or unknown. Previous systematic reviews attempted to estimate the prevalence of AP, but none have investigated which factors may influence its prevalence worldwide. OBJECTIVES: To assess: (i) the prevalence of AP in the population worldwide, as well as the frequency of AP in all teeth, nontreated teeth and root filled teeth; (ii) which factors can modify the prevalence of AP. METHODS: A search was conducted in the PubMed-MEDLINE, EMBASE, Cochrane-CENTRAL, LILACS, Google scholar and OpenGrey databases, followed by hand searches, until September 2019. Cross-sectional, case-control and cohort studies reporting the prevalence of AP in humans, using panoramic or periapical radiograph or CBCT as image methods were included. No language restriction was applied. An adaptation of the Newcastle-Ottawa Scale was used to evaluate the quality of the studies. A meta-analysis was performed to determine the pooled prevalence of AP at the individual level. Secondary outcomes were the frequency of AP in all teeth, nontreated teeth and rootfilled teeth. Subgroup analyses using random-effect models were carried out to analyse the influence of explanatory covariables on the outcome. RESULTS: The search strategy identified 6670 articles, and 114 studies were included in the meta-analysis, providing data from 34 668 individuals and 639 357 teeth. The prevalence of AP was 52% at the individual level (95% CI 42%-56%, I2  = 97.8%) and 5% at the tooth level (95% CI 4%-6%; I2  = 99.5%). The frequency of AP in root-filled teeth and nontreated teeth was 39% (95% CI 36%-43%; I2  = 98.5%) and 3% (95% CI 2%-3%; I2  = 99.3%), respectively. The prevalence of AP was greater in samples from dental care services (DCS; 57%; 95% CI 52%-62%; I2  = 97.8%) and hospitals (51%; 95% CI 40%-63%; I2  = 95.9%) than in those from the general population (GP; 40%; 95% CI 33%-46%; I2  = 96.5%); it was also greater in people with a systemic condition (63%; 95% CI 56%-69%, I2  = 89.7%) compared to healthy individuals (48%; 95% CI 43%-53%; I2  = 98.3%). DISCUSSION: The subgroup analyses identified explanatory factors related to the variability in the prevalence of AP. However, the high clinical heterogeneity and high risk of bias across the primary studies indicate that the findings must be interpreted with caution. CONCLUSIONS: Half of the adult population worldwide have at least one tooth with apical periodontitis. The prevalence of AP is greater in samples from the dental care services, but it is also high amongst community representative samples from the general population. The present findings should bring the attention of health policymakers, medical and dental communities to the hidden burden of endodontic disease in the population worldwide.

Association between pulp and periapical conditions and dental emergency visits involving pain relief: epidemiological profile and risk indicators in private practice in Australia.

AIM: To assess the prevalence of dental emergency visits (DEV) involving pain relief and their relationship with socio-economic and clinical factors in an Australian representative sample in the primary care setting. METHODOLOGY: Data on reason for visit and patient characteristics were collected from a representative random sample of Australian dentists in private practice surveyed in 2009-2010. Information regarding socio-economic (gender, age, health insurance) and clinical factors (number of teeth, number of decayed teeth, diagnosis and reason for visit [DEV, check-up, other reasons not involving pain relief]) were retrieved from compiled questionnaires. Descriptive statistics were reported, and Poisson regression models were used to assess the association between socio-economic and clinical factors and DEV. Prevalence ratio (PR) and 95% confidence interval (CI) were calculated. RESULTS: A total of 1148 dentists responded (67%), resulting in records from 6504 patients. The overall prevalence of DEV was 20.8%. The unadjusted analysis, according to the reason of visit, revealed the following predictors for DEV: male gender (PR = 1.18; 95% CI = 1.08-1.29), age 18-64 years (PR = 2.70; 95% CI = 2.19-3.33) and over 65 years (PR = 2.64, 95% CI = 2.10-3.32), uninsured patients (PR = 1.36; 95% CI = 1.24-1.49), patients with <20 teeth (PR = 1.19; 95% CI = 1.06-1.33), decayed teeth (PR = 1.64; 95% CI = 1.48-1.81). After adjustment for confounding factors (gender, age, insurance status, number of teeth and decayed teeth) apart from 'dental trauma' (PR = 1.37), all remaining diagnoses had lower PR ('other' PR = 0.19, 'decay' PR = 0.34, 'periodontal' PR = 0.51, 'failed restoration' PR = 0.45) compared with 'pulp/periapical disease'. CONCLUSIONS: In the primary care setting, the diagnoses 'pulp/periapical' and 'dental trauma' had a stronger association with DEV compared with visits not involving relief of pain. Both socio-economic (male gender, older age and uninsured individuals) and clinical factors (tooth loss, decayed teeth, endodontic diseases and dental trauma) were identified as independent risk indicators for DEV in this population. Future public health policies should include specific preventive strategies addressing these factors, aiming to reduce the need for DEV.

Protective device to reduce aerosol dispersion in dental clinics during the COVID-19 pandemic.

AIM: To describe the use of a new protective device to reduce aerosol dispersion in dental clinics during the COVID-19 pandemic. METHODOLOGY: The device consists of a rigid translucent acrylic structure (methyl polymethacrylate), adjusted to the dental chair, involving the patient's head, neck and chest. There is also a piping system to generate negative pressure, for aspiration and filtering of the air inside the device chamber. The operator works through small holes in the acrylic structure, to reduce contact with the microparticles arising from aerosols during dental procedures. Simulated dental procedures using a fluorescent dye in the water of the dental equipment were carried out, with and without the use of the device. The presence of the dye was analysed at various locations, such as on personal protective equipment (PPE), the dental chair and on the clinic floor. RESULTS: In the simulated dental procedure without the device, the dye was obvious on surgical gloves, aprons (waist, chest, legs, fists) and face shields, as well as on the dental chair (backrest, light reflector) and clinic floor. In the simulated dental procedure using the device, the dye was observed only on surgical gloves, apron (fists), inside the pipe system and internal walls of the acrylic chamber. There was a certain limitation of movement and visualization by the dentist whilst using the device. CONCLUSIONS: The present device is a low-cost complementary resource for use in conjunction with standard PPE, to reduce the transmission of SARS-CoV-2 in the dental setting. Further clinical trials should be carried out to test the efficacy of this device to reduce aerosol dispersion and the consequent vector of contamination, as well as the ergonomic impacts related to its use.

Methods for measurement of root canal curvature: a systematic and critical review.

The assessment of root canal curvature is essential for clinical and research purposes. This systematic review presents an overview of the published techniques for the measurement of root canal curvature features using imaging and to provide a critique of their clinical application. A database search in PubMed, PubMed Central, Embase, Scopus, EBSCO Dentistry & Oral Sciences Source and Virtual Health Library was conducted, using appropriate key words to identify measurement methods for root canal curvatures. The search strategy retrieved 10594 records in total, and 31 records fulfilled the inclusion criteria. From 2D image acquisitions, eleven studies measured exclusively the angle of curvature, an additional thirteen measured other curvature features (level, height, radius, length and shape). Seven reports described methods from 3D imaging (CBCT, µCT). Root canal curvatures should be measured, for clinical proposes, to facilitate endodontic treatment planning, and in research, to reduce the risk of selection bias. This review has revealed that there are many methods described in the literature; however, no consensus exists on which method should be used. Some of the methodologies have potential clinical translation, whereas others are suitable for research purpose only, as they require a specific software or radiographic exposure in the mesiodistal direction.

Influence of apical enlargement on the repair of apical periodontitis in rats.

AIM: To evaluate the influence of different apical enlargement protocols on the radiographic and histological healing of apical periodontitis in rats. METHODOLOGY: Apical periodontitis was induced bilaterally in the mandibular right and left first molars of 24 Wistar rats by pulp exposure to the oral cavity for 3 weeks. A standard serial root canal preparation technique was performed in the molar of one side, whilst the opposite side was the control group. Rats were randomly divided into three experimental groups (n = 8), according to the diameter of apical enlargement during root canal preparation: K-files size 20 (EG1), size 25 (EG2) and size 30 (EG3). Each animal was its own positive control, because the opposite arch remained untreated. Root canals were filled with a standard technique. After 3 weeks, the animals were euthanized. The main outcome of apical periodontitis healing was evaluated radiographically (mm2 ) and histologically (ordinal scores of inflammation) using a HE staining technique. The measurement of effect was obtained between the three experimental groups by carrying out generalized estimating equations, with Poisson regression with robust variance, pairing each experimental group with its respective control group within animals, adjusted for the mean within animal differences, with α = 5%. RESULTS: The mean and standard deviations of radiographic apical periodontitis size (mm2 ) and intensity of histological inflammatory scores were, respectively: EG1 (0.44 ± 0.27; 2.25 ± 0.46), EG2 (0.33 ± 0.10; 2.50 ± 0.53) and EG3 (0.22 ± 0.08; 2.63 ± 0.74). After 3 weeks, a significantly more favourable radiographic repair was observed when larger apical enlargement was performed (EG3), compared to EG1 and EG2 (P = 0.001). All experimental groups were associated with a significant difference on the radiographic and histological healing of apical periodontitis compared with its respective control group. CONCLUSION: Under the experimental conditions of this study, a larger apical enlargement protocol favoured a more rapid radiographic repair of apical periodontitis in rats after a 3-week follow-up.

Association between chronic oral inflammatory burden and physical fitness in males: a cross-sectional observational study.

AIM: To evaluate the association between chronic oral inflammatory burden (OIB) - as the combination of periodontal and endodontic disease load - and physical fitness. METHODOLOGY: One hundred and twelve nonsmoker male police officers who performed a standardized physical fitness test (PFT) were analysed. Participants underwent oral clinical and periapical radiographic examinations. Periodontal disease was assessed by probing depth (PD) and clinical attachment loss (AL). For radiographic analysis, both apical periodontitis (AP) and root canal treatment (RCT) variables were analysed. Endodontic Burden (EB) was calculated merging the total number of teeth with AP and/or RCT per individual. OIB was calculated combining EB and AL. The outcome of physical fitness was dichotomized according to whether the highest PFT score was 'achieved' or 'not-achieved'. Multivariable logistic regression models were adjusted for age, body mass index and frequency of daily exercise. RESULTS: There was no significant association between AP, RCT and EB with physical fitness whereas PD, AL and OIB were significantly associated with low physical fitness (P < 0.05). Multivariate regression analysis revealed that individuals with OIB = EB ≥ 3 and AL ≥ 4 mm had a 81% lower chance of reaching the highest PFT score (OR = 0.19, 95%CI = 0.04-0.87, P = 0.03) compared to individuals with EB < 3 and and no AL ≥ 4 mm. Individuals with unfavourable periodontal parameters but with low EB (OIB = EB < 3 & AL ≥ 4 mm) showed no significant differences on the chance to reach the highest PFT score compared to participants with favourable periodontal status and low EB (OIB = EB < 3 & no AL ≥ 4 mm). CONCLUSIONS: The OIB - higher levels of EB in periodontal patients - was independently associated with poor physical fitness in males.

Predicting pre- and postoperative pain of endodontic origin in a southern Brazilian subpopulation: an electronic database study.

AIM: To determine the prevalence of preoperative endodontic pain (PREP) and the incidence of postoperative endodontic pain (POEP), identifying the predictors of PREP and POEP in a southern Brazilian subpopulation, using clinical data from an electronic chart database (ECD). METHODOLOGY: This retrospective observational study included 563 consecutive individuals presenting for root canal treatment (RCT). Patients were treated by undergraduate and graduate students, following standard RCT protocols. Demographic, medical and dental variables were extracted from a pre-structured and standardized ECD. The main outcomes PREP and incident POEP were collected through a 0-10 numeric rating scale, dichotomized as none/mild (<4) or moderate/severe (≥4) pain. Predictive models calculating the prevalence ratios (PR) of PREP and the relative risks (RR) of incident POEP were carried out with Poisson regression analysis, estimating the relationship between clinical factors, PREP and incident POEP. RESULTS: Mean age at baseline was 49.2 ± 17.1 years, with 68.4% women. The prevalence and incidence of moderate/severe PREP and POEP were 44.4% and 3.8%, respectively. RCT intervention significantly reduced PREP (P < 0.001). Multivariate analysis revealed that group of teeth, location (mandibular teeth), pulpitis, necrotic pulp, preoperative swelling and periapical radiolucency were independently associated with moderate/severe PREP, whilst age ≥60 years and root canal retreatments were independent protective factors to PREP (P < 0.05). No demographic, medical or dental variables were associated with POEP, although molar teeth (RR = 4.23, 95%CI = 0.93-19.2, P = 0.056) had a borderline nonsignificant association. CONCLUSIONS: Moderate/severe PREP was independently associated with age, group of teeth, location, preoperative swelling, retreatments and pulp and periapical status. No demographic, medical or dental variable predicted moderate/severe POEP following RCT amongst this subpopulation.

Effects of injectable trace mineral supplementation in lactating dairy cows with elevated somatic cell counts.

Objectives of this clinical trial were to evaluate the effects of injectable trace mineral supplementation (ITMS) on somatic cell count (SCC), linear score (LS), milk yield, milk fat and protein contents, subclinical mastitis cure, and incidence of clinical mastitis in cows with elevated SCC. Holstein cows from a commercial dairy farm in New York were evaluated for subclinical mastitis, defined as SCC ≥200×10(3) cells/mL on the test day preceding enrollment. Cows with a history of treatment for clinical mastitis in the current lactation and those pregnant for more than 150d were not eligible for enrollment. Cows fitting inclusion criteria were randomly allocated to 1 of 2 treatment groups. Cows assigned to ITMS (n=306) received 1 subcutaneous injection containing zinc (300mg), manganese (50mg), selenium (25mg), and copper (75mg) at enrollment (d 0). Control cows (CTRL; n=314) received 1 subcutaneous injection of sterile saline solution. Following treatment, visual assessment of milk was performed daily, and cows with abnormal milk (i.e., presence of flakes, clots, or serous milk) were diagnosed with clinical mastitis (CM). Chronic clinical mastitis was defined as cows with 3 or more cases of CM. Milk yield, milk fat and protein contents, SCC, and LS were evaluated once monthly. Additionally, randomly selected animals were sampled to test serum concentrations of selected minerals on d0 and 30 (n=30 cows/treatment). Treatment did not affect serum concentrations of calcium, magnesium, phosphorus, potassium, copper, iron, manganese, selenium, and zinc on d30. Injectable supplementation with trace minerals did not improve overall cure of subclinical mastitis (CTRL=42.8 vs. ITMS=46.5%), although a tendency was observed in cows with 3 or more lactations (CTRL=27.1 vs. ITMS=40.0%). Supplementation did not reduce treatment incidence of CM (CTRL=48.2 vs. ITMS=41.7%); however, it tended to reduce the proportion of cows diagnosed with chronic CM (CTRL=16.9 vs. ITMS=12.0%), particularly among first-lactation cows (CTRL=18.4 vs. ITMS=7.6%). Cure of subclinical mastitis was associated with higher serum concentrations of phosphorus and selenium on d30. Supplementing trace minerals to cows with elevated SCC had no effect on milk yield, milk fat and protein contents, SCC, and LS.

Apical periodontitis and incident cardiovascular events in the Baltimore Longitudinal Study of Ageing.

AIM: To evaluate whether the presence of apical periodontitis (AP), root canal treatment (RCT) and endodontic burden (EB) - as the sum of AP and RCT sites - were associated with long-term risk of incident cardiovascular events (CVE), including cardiovascular-related mortality, using data on participants in the Baltimore Longitudinal Study of Ageing (BLSA). METHODOLOGY: This retrospective cohort included 278 dentate participants in the BLSA with complete medical and dental examinations. Periodontal disease (PD) and missing teeth were recorded. The total number of AP and RCT sites was determined from panoramic radiographs. EB was calculated as the sum of AP and RCT sites. Oral inflammatory burden (OIB) was calculated combining PD and EB. The main outcome was incident CVE including angina, myocardial infarction and cardiovascular-related death. Participants were monitored for up to 44 years (mean = 17.4± 11.1 years) following dental examination. Relative risks (RRs) were calculated through Poisson regression models, estimating the relationship between AP, RCT, EB, PD, OIB and incident CVE. RESULTS: Mean age at baseline was 55.0 ±16.8 years and 51.4% were men. Sixty-two participants (22.3%) developed CVE. Bivariate analysis showed that PD, EB, number of teeth and OIB were associated with incident CVE. Multivariate models, adjusted for socio-demographic and medical variables, showed that age ≥60 years (RR = 3.07, 95% CI =1.68-5.62), hypertension (RR = 2.0, 95% CI = 1.16-3.46) and EB ≥3 (RR = 1.77, 95% CI = 1.04-3.02) were independently associated with incident CVE. The association between OIB and incident CVE was reduced to nonsignificance after adjustments (RR = 1.97, 95% CI = 0.83-4.70). CONCLUSIONS: EB in midlife was an independent predictor of CVE amongst community-dwelling participants in the BLSA. Prospective studies are required to evaluate cardiovascular risk reduction with the treatment of AP.

N-cinnamoylated aminoquinolines as promising antileishmanial agents.

A series of cinnamic acid conjugates of primaquine and chloroquine were evaluated for their in vitro antileishmanial activities. Although primaquine derivatives had modest activity, chloroquine conjugates exhibited potent activity against both promastigotes (50% inhibitory concentration [IC50] = 2.6 to 21.8 µM) and intramacrophagic amastigotes (IC50 = 1.2 to 9.3 µM) of Leishmania infantum. Both the high activity of these chloroquine analogues and their mild-to-low toxicity toward host cells make them promising leads for the discovery of new antileishmanial agents.

Characterization and mRNA expression analysis of PI31, an endogenous proteasome inhibitor from Schistosoma mansoni.

The proline-rich inhibitor of 31 kDa (PI31) is highly conserved through metazoan evolution, and its activity in the proteasome inhibition is well-established although the precise mechanism of inhibition is unclear. The coding DNA sequence of Schistosoma mansoni PI31 (SmPI31) was cloned, and the recombinant protein was expressed in bacterial system. The correct amino acid sequence was confirmed by mass spectrometry and circular dichroism suggests that SmPI31 contains both α-helix and non-structured regions. Inhibition assays, using the Suc-Leu-Leu-Val-Tyr-4-MCA substrate for proteasome degradation, showed that the S. mansoni proteasome may be regulated by the inhibitory activity of SmPI31. A gene expression assay using qRT-PCR at various stages during the S. mansoni life cycle has shown that SmPI31 transcripts are expressed in all studied stages, suggesting that PI31 plays an important role during the developmental processes of the parasite. In this study first evidence is presented that PI31 has a conserved structure and plays a role as proteasome inhibitor in adult worms and it is expressed through life cycle.

How likely is Brazil to achieve its NDC commitments in the energy sector? A review on Brazilian low-carbon energy perspectives.

This paper offers perspectives on the development of low-carbon energy technology in Brazil, pinpointing changes that have occurred since our former publication in 2011. It takes a fresh approach in terms of how likely Brazil will achieve its Nationally Determined Contributions Commitments in the energy sector. Many countries have implemented national climate policies to accomplish their pledged NDC and contribute to the temperature objectives of the Paris Agreement on climate change. Based on official reports and databases of energy development projections in Brazil and the socioeconomic context, we discuss what can be expected for the future of the Brazilian energy sector, the probability of implementing selected technologies, and the prospects of reaching the NDC targets for 2025 and 2030. In addition, this paper provides an overview of the current stage of development of these technologies, main directions, and bottlenecks in Brazil. Analyses have shown that the Brazilian renewable matrix tends to remain significant, driven by the development of solar and mostly small hydroelectric power sources, as well as different types of biomass. In addition, the system will include the replacement of thermoelectric plants powered by diesel and fuel oil by natural gas plants. The prospects for Brazil's official energy plan for 2027 are aligned with the reference technology scenario, which represents the business as usual scenario. Despite this, low-carbon technologies could be implemented far beyond the NDC's goals, given the abundance of renewable natural resources in the country.

Nandrolone decanoate in induced fracture nonunion with vascular deficit in rat model: morphological aspects.

BACKGROUND: The nonunion fracture is a relatively frequent complication in both human and veterinary medicine. Specifically, atrophic fracture nonunions are difficult to treat, with revision surgery usually providing the best prognosis. Anabolic steroids, such as nandrolone decanoate (ND), have been reported to have beneficial clinical effects on bone mass gain during osteoporosis; however, their utility in promoting regeneration in atrophic nonunions has not been documented. Our objective was to examine morphological changes induced by the ND in experimental fracture nonunion with vascular deficit in the rat model. METHODS: Fourteen adult Wistar rats had an atrophic fracture nonunion induced in the diaphysis of their left femur. Rats were allocated into two groups: control group and nandrolone decanoate group. Rats in the latter group were given nandrolone decanoate (1.5 mg/kg IM, once a week, during 4 weeks after confirmation of fracture nonunion radiographically). Radiographic and anatomopathological examination, micro-tomography and histological analysis were assessed to characterize the morphological changes promoted by the nandrolone decanoate use. RESULTS: Based on radiology, anatomopathological evaluation, computed micro-tomography and conventional microscopy, nandrolone decanoate promoted bone regeneration at the fracture nonunion site by increasing the cellularity at the fracture site. Percentage of collagen was not significantly different between groups, consistent with high-quality regenerated bone. CONCLUSION: The anabolic steroid nandrolone decanoate improved bone mass and regeneration without affecting collagen production and therefore has potential for improving outcomes for atrophic fracture nonunion.

Physical localization of the retrotransposons Boudicca and Perere 03 in Schistosoma mansoni.

Schistosoma mansoni is 1 of the causative agents of schistosomiasis, an endemic disease in 76 countries of the world. The study of its genome, estimated to be 270 Mb, is very important to understanding schistosome biology, the mechanisms of drug resistance, and immune evasion. Repetitive elements constitute more than 40% of the S. mansoni genome and may play a role in the parasite evolution. The retrotransposons Boudicca, a long terminal repeat (LTR), and Perere 03, a non-LTR, are present in a high number in the S. mansoni genome and were localized with the use of fluorescence in situ hybridization (FISH) and primed in situ labeling (PRINS). Bacterial artificial chromosomes (BAC) clones containing the retrotransposons Boudicca and Perere 03 were selected by bioinformatic analysis and used as probes in FISH. Using metaphase chromosomes from sporocysts and the FISH and PRINS techniques, we were able to map these retrotransposons. Perere 03 was localized in the euchromatic regions of the short arm of chromosome 2 and Boudicca in the euchromatic regions of the short arm of chromosomes 2 and Z.

The influence of functional groups on the permeation and distribution of antimycobacterial rhodamine chelators.

We formerly hypothesized a mechanism whereby the antimycobacterial efficiency of a set of rhodamine labelled iron chelators is improved via the rhodamine fluorophore which enhances the chelators' permeation properties through membranes. To validate our hypothesis in a cellular context and to understand the influence of the structure of the fluorophore on the chelator's uptake and distribution within macrophages we now report comparative confocal microscopy studies performed with a set of rhodamine labelled chelators. We identify the functional groups of the chelator's framework that favor uptake by macrophages and conclude that the antimycobacterial effect is strongly related with the capacity of the chelator to distribute within the host cell and its compartments, a property that is closely related with the chelators' ability to interact with membranes. The quantification of the chelators' interaction with membranes was assessed through measurement of the corresponding partition constants in liposomes. The overall results support that the compounds which are preferentially taken up are the most efficient antimycobacterial chelators and for that reason we infer that the biological activity is modulated by the structural features of the fluorophore.

Comparative study of human exposure to mercury in riverside communities in the Amazon region.

Four populations in the Amazon area were selected for a comparative study of mercury-exposed and non-exposed populations: São Luiz do Tapajós, Barreiras, Panacauera, and Pindobal Grande. The highest mercury levels in human hair samples were found in São Luiz do Tapajós and Barreiras, greatly exceeding the limits established by the World Health Organization. Panacauera showed an intermediate level below 9 microg/g. This was the first comparative and simultaneous evaluation of mercury exposure in the Amazon area. Also, thanks to this type of monitoring, we were able to eliminate the uncertainties about the reference dose. On the basis of these data, we can conclude that the mercury levels detected in exposed populations of the Tapajós River basin may be dangerous not only because they are above the World Health Organization limits, but also because the simultaneous mercury detection in non-exposed populations with similar characteristics provided a valid control and revealed lower mercury levels. Our results support the importance of continuous monitoring in both exposed and non-exposed populations.

Mercury and selenium concentrations in hair samples of women in fertile age from Amazon riverside communities.

The aim of the present study was to evaluate mercury and selenium concentrations in hair samples of reproductive age women from riverside communities of the Tapajós River basin. We studied 19 pregnant and 21 non-pregnant women, 13 to 45 years old, living in the region for at least 2 years, and having a diet rich in fish. The analysis of Se and total Hg were performed in the Instituto de Pesquisas Energéticas e Nucleares (IPEN, São Paulo, Brazil) by using a Varian AA220-FS atomic absorption spectrometer with a flow injection system. There were no differences between the two groups - pregnant and non-pregnant -- concerning age (23.80 +/- 6.92 and 26.60 +/- 9.60 years old, respectively) and residential time (20.21 +/- 8.30 and 22.20 +/- 10.90 years, respectively). The geometric means and ranges for total Hg concentration were similar (p > 0.05): 8.25 microg/g (1.51-19.43) in pregnant and 9.39 microg/g (5.25-21.00) in non-pregnant women, respectively. Total Hg concentrations were also similar in different gestational stages. However, there was a significant difference between the two groups (p < 0.05, Student t test) in relation to Se concentration: 0.61 microg/g (0.40-2.33) in pregnant and 2.46 microg/g (0.92-5.74) in non-pregnant women, respectively. We concluded that Hg exposure levels in reproductive age women were only slightly higher than a provisional tolerable weekly intake of MeHg would provide, that Hg concentration in maternal hair samples was independent of gestational age, and that low Se concentration in pregnant women indicates high mineral consumption by fetal organism to satisfy their metabolic requirements raised during pregnancy, including as a protective mechanism for Hg cytotoxic effects.

Role of iron in experimental Mycobacterium avium infection.

BACKGROUND: Acquired immunodeficiency syndrome (AIDS) patients exhibit alterations in the metabolism of iron that lead to increased deposition of this element in the tissues. Such alterations may underlie an increased susceptibility of AIDS patients to mycobacterial infections, namely by Mycobacterium avium. OBJECTIVES: The understanding of the role of iron metabolism during M. avium infections in mouse models may allow the design of new therapies based on the manipulation of iron stores. STUDY DESIGN: In vitro macrophage cultures and in vivo mouse studies of iron depletion and iron overload are used to assess mycobacterial multiplication and testing of the efficacy of iron depletion strategies such as the use of iron chelators. RESULTS AND CONCLUSIONS: The levels of iron loading of macrophages in vitro or in vivo affect the growth of M. avium. The currently available iron chelators have poor efficacy in depleting the macrophage iron stores and, therefore, have a poor impact on the infection. Therefore, newer drugs are required that may be used in the context of in vivo infections such as in the case of affected AIDS patients.

Isolation in Brazil of nosocomial Staphylococcus aureus with reduced susceptibility to vancomycin.

OBJECTIVE: To evaluate the possible presence of vancomycin-resistant Staphylococcus aureus (VRSA) in a Brazilian hospital. DESIGN: Epidemiological and laboratory investigation of nosocomial VRSA. METHODS: 140 methicillin-resistant S aureus strains isolated between November 1998 and October 1999 were screened for susceptibility to vancomycin. The screening was carried out by using brain-heart infusion agar (BHIA) supplemented with 4, 6, and 8 microg/mL of vancomycin. The minimum inhibitory concentration (MIC) determination was carried out as standardized by the National Committee for Clinical Laboratory Standards using the broth macrodilution, agar-plate dilution, and E-test methods. PATIENTS: Hospitalized patients exposed to vancomycin. RESULTS: 5 of the 140 isolates had a vancomycin MIC of 8 microg/mL by broth macrodilution, agar plate dilution, and E-test methods. Four VRSA strains were isolated from patients in a burn unit who had been treated with vancomycin for more than 30 days, and one from an orthopedic unit patient who had received vancomycin treatment for 7 days. Pulsed-field gel electrophoresis characterized four of the VRSA strains as belonging to the Brazilian endemic clone. All five strains were negative for vanA, vanB, and vanC genes by polymerase chain reaction. Transmission electron microscopy of the five strains revealed significantly thickened cell walls. One patient died due to infection caused by the VRSA strain. CONCLUSIONS: This is the first report of isolation of VRSA in Brazil and the first report of isolation of multiple VRSA strains from one facility over a relatively short period of time. This alerts us to the possibility that VRSA may be capable of nosocomial transfer if adequate hospital infection control measures are not taken.

[An evaluation of the knowledge, perceptions and feelings of cancer patients in relation to their disease and the health team]. / "Avaliação dos conhecimentos, percepções e sentimentos dos pacientes oncológicos com relação à sua doença e equipe de saúde."

The authors through individual interviews have analyzed the way cancer patients got to know about their illness and how these information influenced their lives, family and their feelings. Suggestions have been made after evaluating the results reached in this research.