The Distribution of Dengue Virus Serotype in Quang Nam Province (Vietnam) during the Outbreak in 2018.

Objectives: Quang Nam province in the Centre of Vietnam has faced an outbreak of dengue hemorrhagic fever (DHF) in 2018. Although DHF is a recurrent disease in this area, no epidemiological and microbiological reports on dengue virus serotypes have been conducted mainly due to lack of facilities for such a kind of advanced surveillance. The aim of this study was to detect different dengue virus serotypes in patients' blood samples. Design and Methods: Suspected cases living in Quang Nam province (Vietnam) and presenting clinical and hematological signs of dengue hemorrhagic fever were included in the study. The screening was performed, and the results were compared by using two methodologies: RT real-time PCR (RT-rPCR) and the Dengue NS1 rapid test. Results: From December 2018 to February 2019, looking both at RT-rPCR [+] and NS1 [+] methodologies, a total of 488 patients were screened and 336 were positive for dengue virus detection (74 children and 262 adults); 273 of these patients (81.3%) underwent viral serotype identification as follows: 12.82% (35/273) D1 serotype, 17.95% (49/273) D2, 0.37% (1/273) D3, 68.50 (187/283) D4, and 0.37% (1/273) D2+D4 serotypes. The RT-rPCR outcomes showed higher sensitivity during the first three days of infection compared to NS1 (92.3% vs. 89.7%). The NS1 increased sensitivity after the first 3 days whilst the RT-rPCR decreased. Conclusions: Advanced surveillance with dengue virus serotypes identification, if performed routinely, may help to predict and prevent further DHF epidemics based on the exposure of the different serotypes during different periods that lead to the intensification of disease severity as a consequence of antibody-dependent enhancement (ADE).

Kidney transplantation with corticosteroid-free maintenance immunosuppression: a single center analysis of graft and patient survivals.

The purpose of this study was to assess the impact of a corticosteroid-free maintenance immunosuppression on graft survival in kidney transplantation. We analyzed 79 patients who were transplanted between June 1, 2006 and May 31, 2007. We excluded hyperimmunized patients, second transplantations, living donors, and black recipients. Patients underwent induction with thymoglobulin or basiliximab, followed by treatment with mycophenolate mofetil (MMF), tacrolimus, and methylprednisolone. On the 5th day, the patients were divided into 2 groups: group A (n = 45) discontinued steroid therapy; group B (n = 34) continued prednisone therapy. We performed a comparative analysis of incidence of delayed graft function (DGF), acute rejection episodes (ARE), renal function at 6 and 12 months, graft and patient survivals, causes of graft loss, and mortality. The 2 groups were similar for donor, recipient, and graft characteristics. The incidences of DGF were 8.9% in group A and 14.7% in group B; those for ARE were 2.3% in group A and 13.8% in group B (P = .077). The mean serum creatinine levels at 6 and 12 months were similar. There were 8 graft losses: 3 in group A (3 deaths with functioning grafts) and 5 in group B (1 death, 3 vascular causes, 1 kidney nonfunction). The 4 deaths were due to infection (n = 3) or neoplasia (n = 1). Graft survivals at 1 year were 98% in group A and 85% in group B, and patient survivals were 98% and 97%, respectively. An immunosuppressive regimen using antibody induction and steroid-free treatment proved to be effective in low-risk patients.

Neurocysticercosis in Ceará State, northeastern Brazil: a review of 119 cases.

Relatively little is known about the occurrence of neurocysticercosis in northeastern Brazil. There have been no published reports from the state of Ceará, but a review of the records at the Hospital São José in Fortaleza, Brazil identified 119 patients with neurocysticercosis diagnosed between January 1988 and April 1994. Patients came from 43 municipalities in Ceará. Their ages ranged from five to 74 years; the greatest number of cases were in persons 10-40 years of age; 63% were males. Seizures were the presenting complaint in 64% of the patients and headache in 22%. Two patients, each with several hundred intracranial lesions, presented with mental status changes; one was initially given the clinical diagnosis of viral meningoencephalitis. Computed tomography scans showed that 44% of the patients had five or more lesions. Cysts were found throughout the brain. The parietal lobe was the most frequent site of involvement; 85% of patients had one or more lesions there. The brain stem was involved in 8%. There was no consistent association between the severity of the clinical abnormalities and the radiologic findings. Computed tomography of the thighs was done in 10 persons; cysts were identified in nine.

Primary antiphospholipid syndrome presented by total infarction of right kidney with nephrotic syndrome.

We report the case of a young woman with primary antiphospholipid syndrome (APS), which presented with acute renal failure, hypoproteinemia, hypoalbuminemia and nephrotic proteinuria. Investigations showed total infarction of right kidney by extensive arterial and vein thrombosis and presence of anticardiolipin antibodies IgG isotype (anti-beta2-glycoprotein I-positive). She was submitted to right nefrectomy and initiated anticoagulant therapy. After nefrectomy, the postoperative period was marked by the development of arterial hypertension and persistence of nephrotic syndrome. Hypertension was treated with antihypertensive drugs (IECA, beta-blocker and calcium antagonist). As the nephrotic syndrome persisted despite anticoagulant and antihypertensive therapy, the patient was treated with oral corticosteroids. Her renal function improved, hypoproteinemia and hypoalbuminemia corrected to normal values and proteinuria decreased to subnephrotic value. We discuss the unusual presentation of this case of primary antiphospholipid syndrome with total unilateral renal thrombosis and nephrotic syndrome that respond to anticoagulant, antihypertensive and corticosteroid therapy.

Prevalence of HIV-1, HIV-2 and HTLV antibody, in Fortaleza, Ceara, Brazil, 1993-1994.

To evaluate the respective part of HIV-1, HIV-2, and human T lymphotropic virus (HTLV) infection in Fortaleza, the principal city of the Ceara state (Northeast of Brazil), a cross-sectional seroepidemiological survey was conducted from July 1993 to February 1994 in 6 selected groups: pregnant women, tuberculosis (Tb) patients, sexually transmitted disease (STD) patients, female and male commercial sex workers (CSWs) and prisoners. Sera were screened by Mixt HIV-1/HIV-2 commercial enzyme immunoassay and ELISA HTLV I/II. Each serum found positive by ELISA was confirmed by Western blot. A total of 2917 persons were interviewed, of whom 2754 (94.4%) agreed to participate and gave a blood sample. Twenty-eight were found to be HIV-1 antibody positive. The prevalence ranged from 0.25% in pregnant women to 2.9% in male CSWs. The prevalence was 1% in STD patients and 0.44% in Tb patients. None of the sera was found positive for HIV-2. The prevalence of antibodies to HTLV-1 varied from 0.12% in pregnant women to 1.21% in female CSWs. Five sera were positive for HTLV-II. These results confirm the hypothesis that the HIV epidemic in Northeastern Brazil is still limited to high risk groups. Repeated cross-sectional surveys of this type should be performed as a surveillance tool to study the dynamics of this epidemic in low prevalence areas. Defining risk factors should allow targeting of intervention strategies.

PIP: During July 1993 to February 1994, in Ceara state, Brazil, researchers conducted a cross-sectional seroepidemiological survey of 814 pregnant women, 451 tuberculosis patients, 395 sexually transmitted disease (STD) patients, 496 female and 171 male commercial sex workers (CSWs), and 427 prisoners. They aimed to determine the prevalence of HIV-1, HIV-2, and human T lymphotropic virus (HTLV). All subjects lived in Fortaleza, where the HIV epidemic is recent. They tended to be poorly educated, poor, and not married. 28 persons were positive for HIV-1. The HIV-1 prevalence rate ranged from 0.25% in pregnant women to 2.92% in male CSWs. It was 0.44% for tuberculosis patients, 1.01% for STD patients, 1.61% for female CSWs, and 1.64% for prisoners. Indeterminate results occurred in 0.4% of all subjects. They were more common in tuberculosis patients than in other groups (1.1% vs. 0.3%; p = 0.023). No one tested positive for HIV-2. The prevalence of HTLV-I ranged from 0.12% in pregnant women to 1.21% in female CSWs. It was 0.44% for tuberculosis patients, 0.51% for STD patients, 0.58% for male CSWs, and 0.47% for prisoners. Five people (1 pregnant woman, 1 tuberculosis patient, 1 female CSW, and 2 prisoners) tested positive for HTLV-II. A 45-year-old, homosexual CSW, intravenous drug user who had tuberculosis was coinfected with HIV-1 and HTLV-I. The most common risk factor for HIV-1 infection was never used condoms (48% for female CSWs to 89% for STD patients). These findings indicate that Fortaleza has a low endemicity for HIV-1 infection and that HIV-1 is still limited to high risk groups (e.g., CSWs). The authors recommend that periodic cross-sectional surveys be conducted to study the dynamics of HIV-1 infection in this low prevalence area.

Problem-based learning: application and possibilities in Brazil.

The Ministry of Health launched the Family Health Program (FHP) with the aim of establishing comprehensive primary care for families and communities. The Public Health School of Ceará has been applying problem-based learning as the instructional method for the training of the family health teams. The importance of this method and the possibility of applying it in the implementation of a new and effective approach to the continuing education of Brazilian health professionals are emphasized.

[Perinatal deaths in the city of Fortaleza: how many deaths could be prevented?]. / Mortes perinatais no município de Fortaleza, Ceará: o quanto é possível evitar?

OBJECTIVE: The main objective of this study was to explore the relationship between perinatal care and neonatal mortality as a component of the infant mortality. Indicators were selected to analyze some aspects of the quality of perinatal care attendance offered to pregnant women and their newborns. Specific attention was given to the avoidable perinatal deaths in the city of Fortaleza, Ceará. METHODS: Population-based, prospective study on incidence. The study was carried out collecting data of seventeen maternity units and two referral pediatric hospitals of the public health system in Fortaleza, the capital of the State of Ceará. All births, alive or dead, weighting 500 grams or more, along the whole year of 1995, were included in the study. The perinatal deaths' causes were studied according to the modified Wigglesworth classification (1989). RESULTS: Along the whole study period, 40,712 children were born and 1,337 perinatal deaths occurred. Among them 730 occurred during the fetal life and 607 during the first week of life. In spite of the low incidence of low-weight newborns (7.4%), the coefficients of fetal mortality were high (17.9 per thousand), as well as the perinatal mortality (32.8 per thousand) and neonatal mortality (15.1 per thousand). The number of avoidable perinatal deaths related to adequate perinatal care was estimated to be one third of the total deaths studied (458/1,323). CONCLUSIONS: The results indicate that the perinatal assistance in the city of Fortaleza is of low quality, with problems related to the health system organization and to the low quality of the care offered to women during pregnancy, at delivery and to the newborns in the delivery room as well as in neonatal wards.

Uncommon cause of chest pain in a renal transplantation patient with autosomal dominant polycystic kidney disease: a case report.

Autosomal dominant polycystic kidney disease (ADPKD) is a common cause of end-stage renal disease (ESRD) and, because of its intrinsic systemic involvement, its treatment can be a medical and surgical challenge. This condition is often associated with the presence of hepatic cysts and their prevalence generally increases with age. Most patients remain asymptomatic, but some of these will develop complications associated with enlargement and infection of their cysts. Chest pain is a rare manifestation of these complications and, after exclusion of more common cardiovascular and pulmonary causes, should raise the suspicion of an infected hepatic cyst in these patients. We report the case of a 62-year-old male who underwent a kidney transplantation from a cadaveric donor in 1997 (etiology of the ESRD was ADPKD), and was admitted to the emergency department with complaints of chest pain radiating to both shoulders and the interscapular region. An echocardiogram was showed compression of the right atrium by a large liver cyst without associated ventricular dysfunction. Computer tomography-guided drainage of the cyst was performed and an Enterobacter aerogenes sensitive to carbamapenemes was isolated from respective cultures. The patient presented a favorable clinical outcome with prolonged administration of antibiotic therapy according to the antibiotic susceptibility testing. There was no need for surgical intervention.

Delayed renal graft function: risk factors and impact on the outcome of transplantation.

OBJECTIVES: The objectives of this study were to determine whether delayed graft function (DGF) implied a higher incidence of poor prognostic markers and to determine its impact on renal transplantation outcomes, particularly graft and patient survivals. METHODS: This retrospective study included 997 cadaveric kidney transplantations between January 1, 1996 and December 31, 2007. Two groups were created: immediate diuresis (ID; n = 803; 80.5%) and DGF (n = 194; 19.5%). RESULTS: These donor related variables showed significant differences (P < .05): age (ID, 35.20 ± 15.681; DGF, 42.49 ± 16.316), weight (ID, 70.54 ± 12.896; DGF, 74.86 ± 14.402), death cause (stroke: ID, 24.9%; DGF, 42.6%), hourly urinary output (ID, 225.55 ± 168.107; DGF, 187.29 ± 125.623), and creatinine (ID, 1.004 ± 0.3737; DGF, 1.075 ± 0. 4148). The significant recipient-related age (ID, 42.95 ± 13.095; DGF, 45.57 ± 13.138), dialysis time ID, 39.41 ± 38.172; DGF, factors were as follows 56.14 ± 44.243), dialysis type, and comorbidities. The significant transplant-related variables were follows: cold ischemia time (ID, 19.489 ± 4.841; DGF, 21.469 ± 5.297) and surgery duration (ID, 2.549 ± 1.105; DGF, 3.028 ± 1.738). Acute rejection and chronic allograft nephropathy (CAN) were greater among the DGF group (ID, 27.3% and 15.0% and DGF, 55.2% and 34.0%, respectively). Average graft (ID, 127.8 months; DGF, 93.9 months) and patient survival (ID, 143.2 months; DGF, 125.6 months) were higher in patients with ID. Multivariate analysis identified these independent risk factors for graft loss: CAN (hazard ratio [HR], 3.30) and DGF (HR, 2.30) but neither had an influence on patient survival. CONCLUSIONS: DGF was associated with multiple risk factors and contributed to worse graft outcomes. It is an independent risk factor for graft loss and an important marker of other factors that affect decisively the outcome of renal transplantation.

Somatosensory function in patients with and without pain after traumatic peripheral nerve injury.

Why traumatic injuries to the peripheral nervous system infrequently result in neuropathic pain is still unknown. The aim of this study was to examine the somatosensory system in patients with traumatic peripheral nerve injury with and without pain to try to unravel possible links to mechanisms underlying development and maintenance of pain. Eighteen patients with spontaneous ongoing pain and 16 patients without pain after unilateral partial peripheral traumatic nerve injury were studied. In the area of partial denervation and in the corresponding contralateral area perception thresholds to warmth, cold, light touch, pressure pain, cold- and heat pain were assessed as were pain intensities at suprathreshold heat pain stimulation. Comparing sides patients with pain reported allodynia to cold (p=0.03) and pressure (p=0.016) in conjunction with an increase in the perception threshold to non-painful warmth (p=0.024) on the injured side. Pain-free patients reported hypoesthesia to light touch (p=0.002), cold (p=0.039) and warmth (p=0.001) on the injured side. There were no side differences in stimulus-response functions using painful heat stimuli in any of the groups. In addition, no significant difference could be demonstrated in any sensory modality comparing side-to-side differences between the two groups. In conclusion, increased pain sensitivity to cold and pressure was found on the injured side in pain patients, pointing to hyperexcitability in the pain system, a finding not verified by a more challenging analysis of side-to-side differences between patients with and without pain.

Clinical manifestations and treatment of retinoblastoma in Korea.

BACKGROUND/AIMS: To analyse the clinical manifestations and results of treatment for patients with retinoblastoma in Korea. METHODS: The medical records of 70 children (92 eyes) diagnosed as having retinoblastoma and treated between 2000 and 2006 were retrospectively analysed. Data on gender, age at diagnosis, laterality, presenting sign, classification of tumour, treatment modality and prognosis were collected. RESULTS: The most common presenting sign was leucocoria (80%). 31.4% developed bilateral retinoblastoma. Using the International Classification of Retinoblastoma, 7.5% were group A, 23.8% were group B, 6.3% were group C, 38.8% were group D, and 23.8% were group E. 26.1% of eyes were treated with chemoreduction and/or focal therapy, namely, they achieved globe preservation, and all other eyes were enucleated. The globe preservation was achieved in 100% of group A, 77.8% of group B, 66.7% of group C, and 26.7% of group D. CONCLUSIONS: In Korea, most children with retinoblastoma showed an advanced stage of tumour at the time of diagnosis and although they were treated with an updated therapeutic approach according to the newly introduced classification, the rate of globe preservation did not reach that of developed countries. Increased surveillance should be performed.

Comportamento ingestivo de ovinos alimentados com diferentes fontes de fibra / Ingestive behavior of sheep fed with different sources of fiber

Avaliou-se o efeito de dietas distintas sobre o comportamento ingestivo (alimentação, ruminação e ócio) em ovinos. Dezesseis carneiros, castrados, confinados em gaiolas de metabolismo, com peso médio de 45,1kg, foram distribuídos aleatoriamente em quatro tratamentos: T1- silagem de cana + concentrado; T2- silagem de cana + concentrado + 15% de caroço de algodão; T3- silagem de cana e T4- feno de Tifton 85. Os animais foram submetidos à observação visual durante 24 horas a intervalos de 10 minutos. Houve diferença entre os tratamentos com relação aos tempos despendidos com alimentação e ócio, sendo que o tratamento com feno de Tifton 85 apresentou os mais altos valores, 6,04 h/dia, para o tempo de alimentação, e os mais baixos valores para o tempo de ócio, 7,50 h/dia.

The effects of different diets on the ingestive feeding behavior in wethers (feeding, ruminating and idle) were evaluated. Sixteen wethers with an average weight of 45.1kg were housed in metabolic cages and were randomly assigned to four treatments (T1- sugarcane silage + concentrate; T2- sugarcane silage + concentrate + 15% whole cottonseed; T3- sugarcane and T4- hay Tifton 85). The ingestive behavior was assessed by visual observation at 10 minute intervals for 24 hours. There were differences between treatments for time spent feeding and idle, and the treatment with Tifton 85 hay showed the highest values for feeding time, 6.04 h/day, and lower values for idle time, 7.50h/day.

Surgical hepatosplenic mansonic schistosomiasis in adolescents: repercussions of the post-treatment schistosomotic burden on the hepatic functional reserve.

Schistosomiasis mansoni affects the hepatic functional reserve. Clinical treatment with oxamniquine is not 100% effective and there has been found strain of this parasite resistant to this drug. The aims of this investigation were: (1) to examine the presence of residual parasite burden after medical and surgical treatment on adolescents with surgical schistosomiasis mansoni and (2) to assess the effect on the hepatic functional reserve in patients with and without residual infection. Twenty nine children with hepatosplenic schistosomiasis mansoni and bleeding esophageal varices were treated with oxamniquine. They underwent splenectomy, ligature of the left gastric vein and autologous implantation of spleen tissue into the greater omentum. After a mean post-operative follow up of five years they underwent rectal biopsy for schistosomotic egg search. They were divided in patients with and without infection. In 20 patients the submucosal egg search was negative, however, in 9 it was positive. The hepatic functional reserve in the patients without infection was as follows: 17 were Child-Pugh A and 3 Child-Pugh B. In the patients who were still infected 6 were Child-Pugh A and 3 Child-Pugh B. The chi2 analysis of the hepatic functional reserve showed chi2 = 3.19 - p= 0.07. From the results the following conclusion can be drawn: residual infection or reinfection in the follow up period had not interfered with the distribution of the hepatic functional reserve of the patients in this series. However, there was a trend for a decrease of this parameter in patients with residual infection.

Leukocyte, platelet and endothelial activation in patients with acute renal failure treated by intermittent hemodialysis.

BACKGROUND: Using different types of dialysis membranes to treat acute renal failure (ARF), clinical and experimental studies have demonstrated discordant results relatively to the effect of membrane bioincompatibility on patient outcome. Nevertheless, there are few data on the biocompatibility indices in patients with ARF who need to be treated by hemodialysis. OBJECTIVE: To characterize the impact of intermittent hemodialysis (IHD) on indices of leukocyte, platelet and endothelial activation in patients with ARF. PATIENTS AND METHODS: We prospectively studied 27 patients with severe ARF treated by IHD. They were characterized relatively to gender, age, ARF etiology, urinary output per 24 h, Simplified Acute Physiology Score (SAPS), number of dialysis sessions and outcome. We evaluated the effect of hemodialysis with two types of low-flux dialyzers (cuprophane and polysulfone dialyzers) on plasma concentrations of soluble TNF-RI (TNF-sR55), TNF-RII (TNF-sR75), interleukin (IL)-6, soluble CD23 molecule, soluble P-selectin and von Willebrand factor (vWF). RESULTS: There were no significant differences between the two groups of patients dialyzed with cellulose-based and synthetic membranes in terms of age, sex, urinary output per 24 h, SAPS, number of dialysis sessions and mortality. We verified high plasma concentrations of TNF-sR55, TNF-sR75, IL-6, sCD23, sP-selectin and vWF in the global population studied. Patients dialyzed with cuprophane membranes showed significantly lower pre- and postdialysis concentrations of sP-selectin than patients dialyzed with polysulfone membranes. After a hemodialysis session, with correction for differences of blood hematocrit, we did not observe any significant modification in the concentrations of TNF-sR55, TNF-sR75, IL-6, sP-selectin and vWF of the plasma. On the other hand, a significant increase of sCD23 molecule was found in the group dialyzed with polysulfone membranes (p = 0.009). CONCLUSIONS: The group of 27 patients with ARF who needed IHD, showed increased plasma concentrations of some leukocyte, platelet and endothelial activation markers (TNF-sR55, TNF-sR75, IL-6, sCD23, sP-selectin and vWF). These mediators characterize the inflammatory and procoagulant state associated with this pathologic condition. After a hemodialysis session with these low-flux membranes (cellulose-based and polysulfone membranes), we did not observe any significant variation in the concentrations of TNF-sR55, TNF-sR75, IL-6, sP-selectin and vWF of the plasma. Patients dialyzed with polysulfone membranes presented higher basal plasma concentrations of sP-selectin and significant postdialysis increase of plasma concentrations of CD23 molecule compared to patients dialyzed with cuprophane dialyzers.