Eco-epidemiological study on sandflies and environmental aspects related to the transmission of leishmaniasis in a municipality of Minas Gerais, Brazil, 2015-2016 / Estudo eco-epidemiológico da fauna flebotomínica e dos aspectos ambientais relacionados à transmissão das leishmanioses em um município de Minas Gerais, Brasil, 2015 - 2016

Diante da escassez de dados sobre a topografia e a sintopia das vísceras abdominopélvicas do tamanduá-bandeira (Myrmecophage tridactyla - Linnaeus, 1758), o presente estudo teve como objetivo elucidar essas características e compará-las com as demais espécies animais, mormente as domésticas. Utilizaram-se três espécimes, dois machos e uma fêmea, provenientes de doação da Polícia Militar Ambiental de Franca ao Laboratório de Anatomia Veterinária da Universidade de Franca, após óbitos por atropelamentos. Os animais foram fixados e mantidos em solução aquosa de formaldeído a 10%, seguidos de dissecação convencional das cavidades abdominopélvicas para posterior inspeção direta e descrição topográfica das vísceras, visando a análises comparativas com outras espécies, cujo posicionamento e cujas particularidades já são bem estabelecidos na literatura. Observou-se que a maioria das vísceras dessas cavidades possuem localização e sintopia similares aos animais domésticos, exceto os rins e os testículos. Diante da metodologia estabelecida e dos resultados obtidos, admite-se que mais espécimes de tamanduás-bandeiras, de ambos os gêneros, devam ser avaliados e registrados cientificamente, visando à confirmação dos dados da atual pesquisa e à preconização anatômica da cavidade abdominopélvica, visto que variações anatômicas individuais são passíveis entre animais da mesma espécie.(AU)

Objetivou-se avaliar a fauna vetorial e os aspectos ambientais e climáticos relacionados à transmissão das leishmanioses. Foi realizado um estudo eco-epidemiológico prospectivo de coleta sistemática de flebotomíneos e inquérito censitário sorológico canino em áreas de um município do Brasil. Para determinar a taxa de prevalência de LVC, foram examinadas amostras de sangue de 1752 cães. Na avaliação entomológica, foram instaladas 24 armadilhas luminosas em 12 residências distribuídas, instaladas no ambiente de peridomicílio e intradomicílio durante 12 meses. Para análise dos aspectos climáticos, utilizou-se a correlação simples de Spearman e para análise espacial foram utilizadas a Lógica Fuzzy e a Função K. A taxa de prevalência em cães foi de 4,1% e 7,1%. No estudo entomológico, foram capturados 431 flebotomíneos. A maior parte (74%) dos espécimes foi capturada no peridomicílio. Em relação à infecção natural, 5,6 % das amostras analisadas por biologia molecular apresentaram positividade à infecção por Leishmania spp.. Em 100% das amostras positivas, encontrou-se infecção por Leishmania infantum. Na análise espacial uma Área apresentou maior concentração de pontos de sobreposição de alta densidade de Lutzomyia longipalpis e cães sororreagentes, indicando maior risco na ocorrência concomitante dos dois eventos. Os resultados mostram que a interface parasito-reservatório-vetor está ativa nas áreas estudadas.(AU)

Accuracy of Magnetic Resonance Arthrography in Detecting Rotator Cuff Tears / Precisión de la artrografía por resonancia magnética en la detección de desgarros del manguito rotador

ABSTRACT Objective: Shoulder pain, a common cause of productivity loss and health-related expense, is commonly due to rotator cuff tears. Magnetic resonance (MR) imaging with intra-articular gadolinium, MR arthrography, is accepted internationally as an excellent modality for evaluating the rotator cuff. Ultrasound is cheaper and only slightly less sensitive in detecting rotator cuff tears, but MR is superior in detecting ancillary lesions. Magnetic resonance arthrography was introduced at the University Hospital of the West Indies (UHWI), Jamaica, in July 2003. This study aimed to evaluate our experience with MR arthrography and assess its accuracy. Methods: A retrospective study was carried out. All MR arthrography cases performed at UHWI between July 2003 and July 2006 were reviewed. Medical records were reviewed to determine surgical correlation. Results: A total of 140 MR arthrograms were performed; 55% of the patients were female. Ages ranged from the second to the ninth decade, having a distribution approaching but not attaining a normal distribution (p = 0.03) with clustering in the middle years. Magnetic resonance arthrography demonstrated torn rotator cuffs in 40 patients, none of whom was under the age of 40 years (p < 0.001). Fifteen patients had surgery which confirmed torn rotator cuffs in all 15. Conclusion: Magnetic resonance arthrography was found to be accurate in detecting rotator cuff tears. It should be considered in the evaluation of patients with suspected rotator cuff tears. For patients under the age of 40 years, sonography could be used as an alternative.

RESUMEN Objetivo: El dolor en el hombro, el cual es causa común de pérdida de productividad y gastos relacionados con la salud, se debe comúnmente a desgarros del manguito rotador. La imagen por resonancia magnética (IRM) con gadolinio intra-articular - conocida como artrografía RM - se acepta internacionalmente como una excelente modalidad para evaluar el manguito rotador. El ultrasonido es más barato y sólo ligeramente menos sensible a la hora de detectar desgarros del manguito rotador, pero la RM es superior en la detección de lesiones secundarias. La artrografía por resonancia magnética se introdujo en el Hospital Universitario de West Indies (HUWI), Jamaica, en julio de 2003. Este estudio tuvo como objetivo evaluar nuestra experiencia con la artrografía RM y evaluar su precisión. Métodos: Se realizó un estudio retrospectivo. Se revisaron todos los casos de artrografías RM realizadas en HUWI entre julio de 2003 y julio de 2006. Se revisaron las historias clínicas a fin de determinar la correlación quirúrgica. Resultados: Un total de 140 artogramas RM fueron realizados. El 55% de los pacientes eran mujeres. Las edades variaron del segundo al noveno decenio, con una distribución que se acercaba pero no llevaba a alcanzar una distribución normal (p = 0.03), concentrándose en los años intermedios. La artrografía de resonancia magnética mostró desgarros de los manguitos rotadores en 40 pacientes, ninguno de los cuales tenía menos de 40 años (p < 0.001). Quince pacientes tuvieron cirugía que confirmaba desgarros de los manguitos rotadores en los 15. Conclusión: Se halló que la artrografía por resonancia magnética era exacta a la hora de detectar los desagarros del manguito rotador. Debe considerarse en la evaluación de pacientes con sospecha de desgarros del manguito rotador. Para los pacientes menores de 40 años de edad, la sonografía podría ser utilizada como alternativa.

Transmission of visceral leishmaniasis in dogs in a risk area of the metropolitan region of Belo Horizonte, Minas Gerais, Brazil / Transmissão da leishmaniose visceral em cães em área de risco da Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil

Visceral leishmaniasis (VL) has spread rapidly across cities in the metropolitan region of Belo Horizonte. The aim of this study was to investigate VL dynamics in a prospective cohort study of dogs in Juatuba, between 2010 and 2011, to confirm the incidence of Leishmania infantum, and to assess possible risk factors associated with infection. An observational and prospective closed cohort study was performed using serology testing in dogs, randomly selected from the whole municipality. All seronegative dogs, or dogs with inconclusive results were monitored using indirect immunofluorescence (IIF) at 6-month intervals. The dog's owners completed a semi-structured questionnaire to assess possible causal factors of seroconversion, and the responses were assessed using logistic regression. The canine incidence coefficient was 206/1,000 dogs per year (CI: 178-238), and a cluster was identified in an area with a high concentration of seropositive dogs, but a low overall canine population. Large dogs were identified as a risk factor and the following variables were identified as protection factors: dogs aged over 4 years, daily peridomicile cleaning, and better socioeconomic conditions. VL is spreading over a large area in Juatuba in a short period of time.(AU)

A leishmaniose visceral (LV) expandiu-se de forma rápida e extensa pelos municípios da Região Metropolitana de Belo Horizonte. Objetivou-se estudar a dinâmica da LV em uma coorte prospectiva de cães em Juatuba, entre 2010 e 2011, para verificar a incidência e fatores de risco associados à infecção por Leishmania infantum. Foi feito um estudo observacional e prospectivo de coorte fechada por meio de análise sorológica em cães selecionados aleatoriamente em todo o município, com acompanhamento semestral dos resultados soronegativos e indeterminados na imunofluorescência indireta (IFI). Usou-se questionário semiestruturado junto aos proprietários de cães para avaliação da soroconversão e dos fatores determinantes a essa, por meio da regressão logística. O coeficiente de incidência canina foi de 206/1000 cães.ano (IC: 178 - 238), e foi identificado cluster em área com elevada concentração de cães soropositivos, mas com baixa densidade populacional canina. A variável cão de porte grande foi identificada como fator de risco, e as variáveis idade do cão superior a quatro anos, limpeza diária do peridomicílio e melhores condições socioeconômicas como fatores de proteção. A infecção por LV está ocorrendo em curto período de tempo e com ampla distribuição em Juatuba.(AU)

Inflammatory cytokines and plasma redox status responses in hypertensive subjects after heat exposure

Hypertension is characterized by a pro-inflammatory status, including redox imbalance and increased levels of pro-inflammatory cytokines, which may be exacerbated after heat exposure. However, the effects of heat exposure, specifically in individuals with inflammatory chronic diseases such as hypertension, are complex and not well understood. This study compared the effects of heat exposure on plasma cytokine levels and redox status parameters in 8 hypertensive (H) and 8 normotensive (N) subjects (age: 46.5±1.3 and 45.6±1.4 years old, body mass index: 25.8±0.8 and 25.6±0.6 kg/m2, mean arterial pressure: 98.0±2.8 and 86.0±2.3 mmHg, respectively). They remained at rest in a sitting position for 10 min in a thermoneutral environment (22°C) followed by 30 min in a heated environmental chamber (38°C and 60% relative humidity). Blood samples were collected before and after heat exposure. Plasma cytokine levels were measured using sandwich ELISA kits. Plasma redox status was determined by thiobarbituric acid reactive substances (TBARS) levels and ferric reducing ability of plasma (FRAP). Hypertensive subjects showed higher plasma levels of IL-10 at baseline (P<0.05), although levels of this cytokine were similar between groups after heat exposure. Moreover, after heat exposure, hypertensive individuals showed higher plasma levels of soluble TNF receptor (sTNFR1) and lower TBARS (P<0.01) and FRAP (P<0.05) levels. Controlled hypertensive subjects, who use angiotensin-converting-enzyme inhibitor (ACE inhibitors), present an anti-inflammatory status and balanced redox status. Nevertheless, exposure to a heat stress condition seems to cause an imbalance in the redox status and an unregulated inflammatory response.

Intensive chemotherapy as salvage treatment for solid tumors: focus on germ cell cancer

Germ cell tumors present contrasting biological and molecular features compared to many solid tumors, which may partially explain their unusual sensitivity to chemotherapy. Reduced DNA repair capacity and enhanced induction of apoptosis appear to be key factors in the sensitivity of germ cell tumors to cisplatin. Despite substantial cure rates, some patients relapse and subsequently die of their disease. Intensive doses of chemotherapy are used to counter mechanisms of drug resistance. So far, high-dose chemotherapy with hematopoietic stem cell support for solid tumors is used only in the setting of testicular germ cell tumors. In that indication, high-dose chemotherapy is given as the first or late salvage treatment for patients with either relapsed or progressive tumors after initial conventional salvage chemotherapy. High-dose chemotherapy is usually given as two or three sequential cycles using carboplatin and etoposide with or without ifosfamide. The administration of intensive therapy carries significant side effects and can only be efficiently and safely conducted in specialized referral centers to assure optimum patient care outcomes. In breast and ovarian cancer, most studies have demonstrated improvement in progression-free survival (PFS), but overall survival remained unchanged. Therefore, most of these approaches have been dropped. In germ cell tumors, clinical trials are currently investigating novel therapeutic combinations and active treatments. In particular, the integration of targeted therapies constitutes an important area of research for patients with a poor prognosis.

Aproveitamento de soro de queijo para produção de iogurte probiótico / The use of cheese whey for probiotic yogurt production

Desenvolveu-se um iogurte natural aproveitando o soro de queijo de coalho, avaliando diferentes processos de pasteurização e concentração de leite em pó. Os iogurtes submetidos a 90ºC/5min nas concentrações de 8 por cento e 10 por cento de leite em pó não apresentaram diferenças entre si (P>0,05) quanto à aceitação sensorial. Os produtos foram caracterizados como integral, atenderam às exigências de proteínas e forneceram mais de 15 por cento do requisito diário recomendado de cálcio para crianças de um a 10 anos, satisfazendo as exigências de cálcio. Em ambas as formulações, o pH decresceu de aproximadamente 4,6 para 4,2 e a acidez aumentou de 0,7g a 1,0g de ácido láctico/100g do produto durante 28 dias de armazenamento. Não houve contaminação por Staphilococcus aureus, coliformes fecais, bolores e leveduras. A contagem de bactérias láticas variou de 5,6x10(9) a 8,0x10(8)UFC/g durante a vida de prateleira, sugerindo a promoção de efeitos benéficos por este alimento probiótico. Concluiu-se que a utilização do soro para a produção de iogurte é uma alternativa viável ao agregar valor econômico, nutricional e funcional ao subproduto.

The objective of this work was to develop a natural yogurt utilizing the resultant whey of a "coalho" cheese production, assaying different processes of pasteurization and powdered milk concentrations. The yogurt submitted to 90ºC/5min with 8 and 10 percent of powdered milk achieved the highest grade on sensorial analysis, with no significant difference (P>0,05). Products were characterized as integral, attended the request for protein, and supplied over 15 percent of the daily feed intake of calcium for children aged 1 to 10, characterizing it as calcium enriched. In both formulations, the pH decreased from 4.6 to 4.2 approximately and the acidity increased from 0.7g to 1.0g lactic acid/100g of product during 28 days of storage. There was no contamination by S. aureus, fecal coliforms, molds and yeasts. The counting of lactic bacteria varied from 5.6x10(9) to 8.0x10(8)CFU/g during shelf life, suggesting the promotion benefits from this probiotic product. It was concluded that whey utilization for yogurt production is a viable alternative to increase economic, nutritional, and functional value.

Ocorrência de oocistos de Cryptosporidium spp. em águas superficiais na região metropolitana de Recife-PE / Occurrence of Cryptosporidium spp. oocysts in surface water from Recife Metropolitan area, Brazil

The occurrence of Cryptosporidium spp. in superficial waters at the Metropolitan Region of Recife, PE, was studied. Raw and treated water were analyzed by filtration of the samples on a membrane (47mm, 3µm) under negative pressure, by the direct immunofluorescence assay (IFA), and by the 4'6'-diamidino-2-phenylindole (DAPI) method. The samples were analyzed during drought (September to February) and raining (March to August) seasons. Oocysts were not found in treated water. Cryptosporidium spp. oocysts were found in non-treated water by IFA/DAPI technique in 40% (2/5) of the locations and in 5% (3/60) of the samples investigated, with the number varying from 16 oocysts/l to 40/l, in dry and raining seasons, respectively. This is the first report of Cryptosporidium spp. in surface water in the state of Pernambuco, Northeast of Brazil.

Current imaging of cerebrospinal fluid leaks / Imágenes médicas actuales de pérdidas de fluido cerebroespinal

A CSF leak results from a defect in the dura and skull base. Due to the risk of potentially devastating central nervous system infection, it is an important entity. Timely diagnosis of CSF leaks is crucial. Laboratory testing of nasal or aural fluid drainage for the presence of the protein Beta(β)-2 transferrin plays a key role in establishing the presence of a CSF leak. Such assays are not always available, making imaging pivotal in the diagnosis of this entity. The development of minimally invasive endoscopic repair further underscores the importance of imaging as precise anatomic localization is important for repair. In this article, we review the literature and make suggestions for the appropriate radiological investigation ofpatients with suspected CSF leaks.

Las pérdidas de fluido cerebroespinal (FCE) son el resultado de un defecto en la dura y la base craneal. Debido a que tales pérdidas presentan el riesgo de infecciones capaces de devastar potencialmente el sistema nervioso central, las mismas constituyen una entidad importante. El diagnóstico a tiempo de pérdidas del FCE es crucial. Las pruebas de laboratorio realizadas al drenaje del fluido de la nariz y los oídos a fin de detectar la proteína Beta (β) 2 transferrina, desempeñan un papel clave a la hora de determinar la presencia de pérdida de FCE. Estos ensayos no se hallan siempre a disposición, con lo cual la imagen médica se hace fundamental para el diagnóstico de esta entidad. El desarrollo de reparaciones endoscópicas mínimamente invasivas subraya aún más la importancia de la imagen médica, por cuanto se requiere una localización anatómica precisa para realizar la reparación. En el presente artículo, se revisa la literatura y se hacen sugerencias a fin de lograr una investigación radiológica adecuada de los pacientes con sospecha de pérdida de FCE.

Normal flow-mediated vasodilatation of the brachial artery and carotid artery intima-media thickness in subclinical hypothyroidism

Subclinical hypothyroidism (SHT) is a disease for which exact therapeutic approaches have not yet been established. Previous studies have suggested an association between SHT and coronary heart disease. Whether this association is related to SHT-induced changes in serum lipid levels or to endothelial dysfunction is unclear. The aim of this study was to determine endothelial function measured by the flow-mediated vasodilatation of the brachial artery and the carotid artery intima-media thickness (IMT) in a group of women with SHT compared with euthyroid subjects. Triglycerides, total cholesterol, HDL-C, LDL-C, apoprotein A (apo A), apo B, and lipoprotein(a) were also determined. Twenty-one patients with SHT (mean age: 42.4 ± 10.8 years and mean thyroid-stimulating hormone (TSH) levels: 8.2 ± 2.7 µIU/mL) and 21 euthyroid controls matched for body mass index, age and atherosclerotic risk factors (mean age: 44.2 ± 8.5 years and mean TSH levels: 1.4 ± 0.6 µIU/mL) participated in the study. Lipid parameters (except HDL-C and apo A, which were lower) and IMT values were higher in the common carotid and carotid bifurcation of SHT patients with positive serum thyroid peroxidase antibodies (TPO-Ab) (0.62 ± 0.2 and 0.62 ± 0.16 mm for the common carotid and carotid bifurcation, respectively) when compared with the negative TPO-Ab group (0.55 ± 0.24 and 0.58 ± 0.13 mm, for common carotid and carotid bifurcation, respectively). The difference was not statistically significant. We conclude that minimal thyroid dysfunction had no adverse effects on endothelial function in the population studied. Further investigation is warranted to assess whether subclinical hypothyroidism, with and without TPO-Ab-positive serology, has any effect on endothelial function.

Sociocultural deterrents to mammographic screening in Jamaica / Elementos socioculturales de disuasión en el pesquisaje mamográfico en Jamaica

OBJECTIVE: Less than five per cent of eligible Jamaican women had mammograms in 2003. The sociocultural determinants and the perceptual barriers modulating screening behaviour in Jamaican women are unclear. We sought to investigate sociocultural effects, in particular, knowledge and fear of the procedure on mammographic screening behaviour in Jamaican women. METHOD: One hundred and forty-seven women attending the breast imaging units at the University Hospital of the West Indies and 127 attending Radiology West were interviewed to determine the factors relating to participation in mammographic screening. Knowledge level, deterring factors as well as the experience during mammography were recorded. RESULTS: The mean age ± SD of participants was 51 ± 10.4 years. Eighty-eight of the 274 women (32%) were having a mammogram for the first time. Of these, the major determinants of the mammographic experience were the expectation that the procedure would be painful (OR = 0.08, p < 0.001) and the pain intensity (OR = 1.4, p < 0.030) experienced during mammography. There were 188 women who had repeat mammograms. Seventy-five of these women had delayed mammography for greater than one year. There was a significant association between being late for mammography and the perception that a doctor's referral was necessary (p < 0.001). The factors associated with improved mammographic experience were pain intensity (OR = 0.84, p < 0.04), interval status of previous mammography (OR = 2.24, p = 0.059) and knowing someone with breast cancer (OR = 0.35, p < 0.04). Although 97% of all women found mammography painful, only seven (2.5%) said pain would prevent a repeat mammogram. CONCLUSIONS: Fear, pain during mammography, subjective indifference, inertia and reliance on physician referrals were identified as barriers to complying with mammographic screening guidelines.

OBJETIVO: Menos del cinco por ciento de las mujeres jamaicanas elegibles recibieron mamogramas en 2003. No están claras las determinantes socioculturales y las barreras preceptuales que modulan el comportamiento de pesquisaje en la mujer jamaicana. Buscamos investigar los efectos socioculturales - en particular, el conocimiento y el miedo al procedimiento - sobre la conducta ante el pesquisaje mamográfico en las mujeres jamaicanas. MÉTODO: Ciento cuarenta y siete mujeres que asistían a las unidades de imágenes de mamas en el Hospital Universitario de West Indies, y 127 que asistían a Radiology West, fueron entrevistadas a fin de determinar los factores relacionados con su participación en el pesquisaje mamográfico. Se registraron el nivel de conocimientos, los factores de disuasión así como la experiencia durante la mamografía. RESULTADOS: La edad promedio ± SD de los participantes fue 51 ± 10.4 años. Ochenta y ocho de las 274 mujeres (32%) recibían un mamograma por primera vez. De estas, las mayores determinantes de la experiencia mamográfico fueron la expectativa de que el procedimiento sería doloroso (OR = 0.08, p < 0.001) y la intensidad del dolor (OR = 1.4, p < 0.030) experimentado durante la mamografía. Hubo 188 mujeres que tuvieron mamografías repetidas. Setenta y siete de estas mujeres tuvieron sus mamografías retrasadas por más de un año. Hubo una asociación significativa entre estar tarde para la mamografía y la percepción de que era necesaria una remisión médica (p < 0.001). Los factores asociados con el mejoramiento de la experiencia mamográfica fueron: la intensidad del dolor (OR = 0.84, p < 0.04), el estatus del intervalo de la mamografía previa (OR = 2.24, p = 0.059), y el conocer a alguien con cáncer de mamas (OR = 0.35, p < 0.04). Aunque el 97% de todas las mujeres encontraron la mamografía dolorosa, sólo siete de ellas (2.5%) dijeron que el dolor sería un impedimento para hacerse una nueva mamografía. CONCLUSIONES: El miedo, el dolor durante la mamografía, la indiferencia subjetiva, la inercia, y la dependencia de las remisiones médicas, fueron identificadas como los obstáculos que impiden el cumplimiento de las guías para el pesquisaje mamográfico.

Breast imaging update

Screening mammography has been shown to reduce the number of deaths due to breast cancer. Recent data have shown that there is low patient and physician participation in screening mammography in Jamaica. Breast imaging is concerned primarily with early detection of breast cancer. Despite technological advances, mammography continues to play a pivotal role. In this report, the authors will review the available imaging modalities and their role in screening patients for breast cancer as well as the evaluation of the symptomatic patient with particular reference to the situation in Jamaica.

Mammographic referral patterns for two breast imaging units in Jamaica / Patrones de remisión para mamografías en dos unidades de imágenes de mamas en Jamaica

OBJECTIVE: In countries that have instituted national mammographic screening programmes, mortality from breast cancer has decreased by as much as 63%. Although mortality rates from breast cancer in Jamaica are high, there is no national mammographic screening programme. In this context, opportunistic screening, which depends on contact between healthcare provider and patient, as well as self-referral become important. Therefore, the authors sought to determine the source of referrals for women who had mammography. SUBJECTS AND METHODS: The variables of age, indication for mammography, source of referral and referring physician area of specialty if applicable were extracted from the attendance records for all patients who had mammography at the breast imaging unit at the University Hospital of the West Indies (UHWI) and Radiology West (RadWest) in the year 2003. RESULTS: There were 779 bilateral mammograms done at UHWI of which 452 (58%) were screening and 1223 mammograms done at RadWest of which 657 (54%) were screening. The difference in proportion of self-referral between the two facilities was significantly different (p < 0. 001). Of the 452 screening mammograms performed at UHWI, 329 (73%) were self-referred, 31 (7%) were from primary care, 18 (4%) from gynaecologists and 17 (4%) from general surgeons. In contrast, of the 657 screening mammograms, at Radwest, 92 (14%) were self-referred, 323 (49%) were from primary care, 47 (7%) from gynaecologists and 37 (6%) from general surgeons. CONCLUSION: To increase the utilization and hence effectiveness of screening mammography, programmes targeting healthcare professionals, particularly gynaecologists and the public are needed.

OBJETIVO: En países que han instituido programas nacionales de pesquisaje mamográfico, la mortalidad por cáncer de mamas ha disminuido tanto como un 63%. Aunque las tasas de mortalidad por cáncer de mama en Jamaica son altas, no existe un programa nacional de pesquisaje mamográfico. En este contexto, el pesquisaje oportunista – que depende del contacto entre el proveedor de la atención médica a la salud y el paciente – así como la autoremisión, se hacen importantes. Por lo tanto, los autores buscan determinar las fuentes de las autoremisiones de mujeres que tuvieron mamografías. SUJETOS Y MÉTODOS: Las variables de edad, indicación de mamografía, fuente de remisión, y – si fuese necesario – el área de especialidad del médico que remite, fueron extraídas de los registros de asistencia de todas las pacientes a las que se les realizaron mamografías en la unidad de imágenes de mamas del Hospital Universitario de West Indies (UHWI), y en la de Radiology West (Rad West) en el año 2003. RESULTADOS: Se realizaron 779 mamogramas bilaterales en UHWI – de los cuales 452 (58%) fueron pesquisajes – y 1223 mamogramas en RadWest – de los cuales 657 (54%) fueron pesquisajes. La diferencia en proporción de autoremisiones entre las dos instalaciones, fue significativa (p < 0.001). De los 452 mamogramas de pesquisaje realizados en UHWI, 329 (73%) fueron autoremisiones, 31 (7%) provenían de atención primaria, 18 (4%) de ginecólogos, y 17 (4%) de cirujanos. En contraste con esto, en RadWest, de los 657 mamogramas de pesquisaje, 92 (14%) fueron autoremisiones, 323 (49%) provenían de atención primaria, 47 (7%) de ginecólogos, y 37 (6%) de cirujanos generales. CONCLUSIÓN: A fin de aumentar la utilización, y por ende la efectividad de la mamografía de pesquisaje, se necesitan programas dirigidos a captar la participación de los profesionales de atención médica a la salud – en particular los ginecólogos – así como del público.

Pituitary Apoplexy associated with Ptosis / Apoplejía Pituitaria asociada con Ptosis

Pituitary tumours are the most common sellar masses, frequently presenting with visual impairment and endocrine abnormalities. Two cases of pituitary tumour presenting with ptosis are reported

Los tumores pituitarios son las masas selares más comunes, que frecuentemente se presentan con problemas de visión y anormalidades endocrinas. Se presentan dos casos de tumor de la pituitaria, acompañados de ptosis izquierda

Ionizing radiation. The question of responsible use: Pandora's box revisited

For over one hundred years, ionizing radiation has assisted in medical diagnostics. Recently, there have been reports of radiation injury in patients undergoing fluoroscopic procedures. It is time to review some of the risks of ionizing radiation as well as some of our practices at the University Hospital of West Indies (UHWI). In this review, we discuss the relative risks associated with common radiological examinations as well as explore the relative merits of various clinical protocols for the radiological investigation of common diseases seen at the UHWI

Alcalóides de Aspidosperma auriculatum Standl

Espécies do gênero Aspidosperma apresentam alcalóides do tipo indólico. A partir da espécie Aspidosperma quebracho-blanco Schlecht isolou-se a quebracamina1, de A. olivaceum obteve-se a olivacina2, entre outras. O presente trabalho relata a determinação do perfil cromatográfico por Cromatografia em Camada Delgada e Cromatografia Líquida de Alta Eficiência de frações alcaloídicas de Aspidosperma auriculatum, espécie conhecida no Pará como carapanaúba e indicada popularmente para tratar febre e outras afecções, inclusive malária. O material vegetal foi extraído com ácido clorídrico a 5 por cento. Três frações alcaloídicas foram extraídas a pH 7, pH 8 e pH 11, que analisadas em sistemas adequados apresentaram perfis distintos.

Species from genus Aspidosperma show the presence of indol alkaloids. From Aspidosperma quebracho-blanco Schlecht quebracacidine was obtained1, from A. olivaceum. Schmutz and Hunziker2 isolated olivacine, among others substances. This work reports the determination of the chromatographic profile of alkaloid fractions from Aspidosperma auriculatum, by Thin Layer Chromatography and High Performance Liquid Chromatography. At the Brazilian state Pará this plant species has the vernacular name carapanaúba and is traditionally indicated to heal fever and others affections and also malaria. The plant material - stem bark - was extracted with hydrochloridric acid 5 percent. Three principal alkaloid fractions were extracted at pH 7, pH 8 and pH 11, which were analysed in suitable systems showing characteristic profiles.

Computed Tomography in the evaluation of seizures at the University Hospital of the West Indies

A retrospective evaluation of the Computed Tomography (CT) findings in three hundred and forty-four patients with seizures, presenting over a one-year period, was carried out to determine the value of this examination in the assessment of these patients. Eighty-four per cent of patients had non-contrast studies only. Of the remaining patients, two had contrast studies only and the rest had both non-contrast and contrast studies. All cerebral abnormalities detected on contrast studies were evident on non-contrast scans. Forty-two per cent of all patients presenting with seizures were found to have a demonstrable abnormality on CT. There was a greater detection rate in patients with seizures secondary to trauma, cerebrovascular incidents, infection, metabolic causes and suspected tumours. Computed tomography continues to have a place in the evaluation of certain types of seizure patients. The routine use of intravenous contrast does not appear to be justifiable.

On-line detection system of Escherichia coli O157:H7: A new support for Public Health / Sistema de detección en línea de Eschericha coli O157: H7: Un nuevo apoyo para la Salud Pública

Sistema de detección en línea de Escherichia coli O157: H7: Un nuevo apoyo para la Salud Pública.Introducción. Motivado por los casos innumerables de infecciones de diarrea que frecuentemente ocurren, en los países en vías de desarrollo, se calibró un biosensor a fibra optica con intensidad modulada usando como ejemplar Escherichia coli O157: H7. Material y métodos. La sensibilidad del dispositivo se ha calibrado para las unidades formadoras de colonia (CFU) de 10 a 800 rindiendo un error más pequeño que 11 por ciento.Resultados. Se obtuvo una correlación entre la respuesta óptica y el número instantáneo de bacterias. El signo del rendimiento óptico fue 0.016 (ñ 0.001) dB por hora por bacteria. En todo los casos la detección empezó después de 270 ñ 4 minutos, 5-10 veces más rápido que las técnicas bacteriológicas convencionales.Discusión. Los resultados obtenidos pueden contribuir al problema de monitoreo de patógenos que representen problemas en el campo de la salud pública.

Orbital psuedotumour with intracranial extension: a case report

Inflammatory pseudotumour of the orbit is an unusual condition of unknown aetiology which rarely extends beyond the orbit. To our knowledge 19 cases with intracranial extension have been reported, none of which involved the pituitary fossa or sphenoid sinus. Most required cytotoxic agents, surgery or radiotherapy in addition to corticosteroids. We present a case of orbital pseudotumour with extension into the pituitary fossa, sphenoid sinus and cavernous sinuses with vascular compression. Marked clinical improvement occurred on steroid therapy alone.

Resistência de Biomphalaria glabrata à infecção pelo Schistosoma mansoni: variaçoes no período pré-patente e na compatibilidade / The resistance of Biomphalaria glabrata to Schistosoma mansoni infection: variations in the prepatent period and in compatibility

Biomphalaria glabrata de Belo Horizonte, Minas Gerais, Brasil, criada no laboratório, apresenta 90% de taxa de infecção com 20 miracídios da cepa LE, autóctone. O período pré-patente normal varia de 5 a 7 semanas enquanto 5 a 10% dos moluscos expostos não eliminam cercárias. Os descendentes de exemplares negativos foram novamente submetidos à infecção individual com 20 miracídios. A média de infecção da F14 a F20 foi de 43,6%. Cortes histológicos de moluscos da F12, F14 e F15 mostraram reações teciduais nos exemplares eliminando menos de 10 cercárias. Um período pré-patente prolongado, 17 a 32 semanas, foi observado em 35 (17,9%) dos 195 exemplares infectados. Os índices de cercárias da F12, F13 e F15 baixaram de extremamente compatíveis (classe VI) para muito compatíveis e compatíveis (classes V e III) mostrando a compatibilidade menor dos moluscos selecionados.

Biomphalaria glabrata from Belo Horizonte, Minas Gerais, Brazil, reared in laboratory, has a level of infection of 90% when exposed to 20 miracidia of the autochibonous LE strain. The prepatent period was of 5 to 7 weeks whereas 5 to 10% of exposed snails do not shed cercariae. The eggs of negative snails were collected and the progeny was again submitted to individual infection with 20 miracidia. The mean of infection from F14 to F20 was of 43.6%. Histological sections from F12, F14 and F15 snails showed tissue reactions in those specimens shedding less than 10 cercariae. A prepatent period of 17 to 32 weeks was observed in 35 (17.9%) of 195 infected snails. The index of cercariae of control was extremely compatible and for F12, F13 and F15 snails varied from very compatible class V to compatible class III, showing less compatibility in selected snails.

Effects of caffeine on the rate of perceived exertion

The role of caffeine in improving performance in endurance exercises is controversial and its mechanism of action is not well understood. The purpose of the present study was to evaluate the effects of caffeine on the rate of perceived exertion (RPE) by exercising athletes. Six male non-smoking runners, aged 26.8 ñ 4.9 years (mean ñ SD), who had been in training continuously for at least two years before the experiment were studied. Mean maximum oxygen consumption (VO2max) was 61.21 ñ 5.36 ml kg**-1 min**-1. The subjects were asked to exercise on a bicycle ergometer for 3 min each at 300 and 600 kg m min**-1, after which the work load was elevated to 1200 kg m min**-1 and they exercised until exhaustion. In order to evaluate the effects of caffeine, the exercicse was performed twice following the ingestion of 200 ml decaffeinated coffee with and without caffeine (5 mg/kg body veight). Caffeine had no significant effect on exercise time, pulmonary ventilation, oxygen consumption, carbon dioxide extraction or exchange respiratory ratio, but the RPE was significantly lower (P<0.05) at the work load of 1200 kg m min**-1 after the ingestion of caffeine for both trials I and II. The present results suggest that metabolic acidosis and glycogen depletion were not the main causes of exhaustion