Single ulcers on the tongue dorsum: differential diagnosis between paracoccidioidomycosis and squamous cell carcinoma.

BACKGROUND: Paracoccidioidomycosis (PCM) is the leading cause of death among systemic mycoses in Brazil. On the other hand, oral squamous cell carcinoma (OSCC) is the most prevalent malignant neoplasm of the mouth. Both lesions rarely affect the tongue dorsum and may share similar clinical characteristics. This study aimed to retrieve cases of single oral ulcers diagnosed as PCM or OSCC. MATERIAL AND METHODS: A cross-sectional retrospective study was conducted. All patients who had a single ulcer on dorsum of the tongue and confirmed diagnosis of PCM or OSCC were evaluated. RESULTS: A total of 9 patients (5 women and 4 men) were evaluated, 5 patients had OSCCs (mean age = 69,8 years old), and 4 patients PCM (mean age = 51 years old). Most of the lesions were infiltrated and indurated in the palpation exam. Duration ranged from 1 to 12 months (mean time of 5.2 months and 4.7 months for OSCC and PCM, respectively). OSCC was the main clinical diagnosis hypothesis. CONCLUSIONS: Although uncommon, PCM and OSCC should be considered as a diferential diagnosis hypothesis in infiltrated ulcers on the tongue dorsum. Iincisional biopsy is mandatory to confirm the diagnosis and indicate the appropriate treatment.

Neutrophil oxidative metabolism and haemogram of sheep experimentally infected with Haemonchus contortus and supplemented with selenium and vitamin E.

The objective of this study was to evaluate neutrophil oxidative metabolism and haemogram in sheep experimentally infected with Haemonchus contortus and supplemented with selenium and vitamin E. Twenty male Corriedale sheep were utilised and distributed into four experimental groups each with five animals infected with larvae: G1--supplemented with sodium selenite, 0.2 mg/kg body weight (bw) given intramuscularly (IM); G2--supplemented with sodium selenite and vitamin E, 0.2 mg/kg bw and 2000 IU per animal, respectively, both IM; G3--supplemented with vitamin E, 2000 IU per animal IM; G4--not supplemented. A haemogram and the number of parasite eggs were determined in samples of blood and faeces, respectively, on days zero (T0), 20 (T1), 40 (T2) and 60 (T3) and nitroblue tetrazolium (NBT) assays were performed on heparinized blood samples taken on days zero, 30 and 60. A lower total leucocyte count was detected in G1 in relation to G4 at T4. Lymphocytes were reduced in G1 in relation to G3 and G4 at T3. In both non-stimulated (NBT-NS) and stimulated (NBT-S) dye reduction assays, there was reduced activity at 60 days, in relation to other times in the groups treated with selenium (G1 and G2). On the basis of results obtained, we conclude that supplementation with selenium provides better antioxidant protection to neutrophils.

Endothelial function in normotensive and high-normal hypertensive subjects.

To evaluate the impact of a mild increment in blood pressure level on endothelial function, we evaluated 61 healthy volunteers (24 women, 37 men, and aged 35-50 years). All subjects underwent a blood chemistry panel to exclude any metabolic abnormalities and were submitted to a Doppler ultrasound of the brachial artery to assess endothelial function. We assessed the endothelial response to reactive hyperaemia and exogenous nitric oxide administration considering an increase in systolic blood pressure (SBP) at each 10-mm Hg interval. Our study population was divided as follows: SBP <115 mm Hg (SG1, n=13), SBP > or =115 mm Hg and <125 mm Hg (SG2, n=20), SBP > or = 125 mm Hg and <135 mm Hg (SG3, n=13) and SBP > or = 135 mm Hg and < 140 mm Hg (SG4, n=15). We found a significant difference in flow-mediated dilation among SG2, SG3 and SG4, 16.2+/-5.6, 13.4+/-5.2 and 11.5+/-3.6%, P<0.05, respectively). After nitrate administration, we observed a nonsignificant decrease in brachial artery dilation among groups, P=0.217. Our data showed in a healthy normotensive population, without any risk factor for atherosclerotic disease that small increases in SBP but not in diastolic blood pressure may impair endothelial function even in subjects considered as high-normal, meaning that this population deserves more attention than usually ascribed to intervene and prevent complications, as endothelial dysfunction may represent an early change in those who develop hypertension later in life.

Phaeohyphomycotic cyst: a clinicopathologic study of the first four cases described from Brazil.

Four cases of phaeohyphomycosis in the form of chronic and isolated cysts are presented. The cysts were strictly confined to the subcutaneous tissue, with no involvement of the corresponding skin. Patients were asymptomatic, without satellite lesions or regional lymphadenopathy. The clinicopathologic importance of this type of phaeohyphomycosis is discussed. As far as we know, our cases are the first described from Brazil.

[Evaluation of control measures implemented from 1977 to 1996 in the endemic area of schistosomiasis in Pernambuco, Brazil]. / Avaliação das ações de controle da esquistossomose implementadas entre 1977 e 1996 na área endêmica de Pernambuco, Brasil.

This study assesses the evolution of schistosomiasis in the endemic area of Pernambuco, using data from five campaigns of chemotherapy control carried out by national health programmes from 1977 to 1996. Analysis of the data showed that: a) the proportion of municipalities with prevalence above 25% was significantly higher in the coastal-forest zone than in the zone of transitional vegetation Agreste in the four evaluations made in the endemic area; b) the prevalence of infection decreased in both zones even when the interval between campaigns were more than five years. The last survey (1996) indicated a predominance of municipalities with prevalences below 25%. However, the majority of these municipalities had localities with prevalence above 50%. A proposal is presented for the identification of the problematic localities, where complementary measures to chemotherapy, such as systematic snail control, improved sanitation, health education and community mobilization, are still necessary.

[Occurrence of snail vectors of schistosomiasis in a dam of the semi-arid region of Pernambuco State, Brazil]. / Registro de ocorrência de vetores da esquistossomose mansônica em açude do Sertão de Pernambuco.

The semi-arid region of Pernambuco state is not an endemic or focal area for schistosomiasis. The present work registers the occurrence of Biomphalaria straminea in a local dam with favorable chemical-physical characteristics to the proliferation of these mollusks. This observation gets the attention for the possibility of the introduction of the disease in this semi-arid region due to the growing multiplication of these dams.

The bioecology of snail vectors for schitosomiasis in Brazil.

This paper describes the ecology of two species of Biomphalaria: B. glabrata and B. straminea. These species have been intensively studied in Brazil and in other countries since the 1950s. The literature in this area can be broadly subdivided into three categories, linked to three distinct historical periods: 1) an accumulated store of early studies carried out in the laboratory and in the field; 2) the development of quantitative ecological models; and 3) the development of an alternative methodology for breeding snails under seminatural conditions.

Long-term controlled field experiment on the competition between two species of Biomphalaria (Mollusca, Basommatophora), the snail vectors of Schistosoma mansoni in Northeastern Brazil.

A long-term controlled field experiment on the interactions of the populations of Biomphalaria glabrata (target population) and B. straminea (competitor) was carried out in the county of Alhandra, state of Paraíba, Brazil, during the period 1980 through 1989. Results obtained in the current paper show that the snail B. straminea has strong competitive advantages over B. glabrata. In six out of nine streams the native population of B. glabrata were totally excluded and replaced by B. straminea. There is evidence showing that seasonal dryness has marked influence on the phenomenon studied in this paper. In all the streams were B. straminea already predominated, return of B. glabrata was never observed.

[An outbreak of acute schistosomiasis at Porto de Galinhas beach, Pernambuco, Brazil]. / Epidemia de esquistossomose aguda na praia de Porto de Galinhas, Pernambuco, Brasil.

We recently confirmed several cases of acute schistosomiasis in Porto de Galinhas beach, Northeast Brazil. A total of 662 patients were diagnosed by parasitological and clinical examinations. The infection likely occurred during the September 7 national holiday, when heavy rainfall flooded the Ipojuca River and people were infected when the water covered their yards. Families were continuously exposed to infection for a period of three weeks until the water had completely dried up. Previous investigation suggests that snail vectors were introduced as a result of landfill in marshy areas. The swamp-flooding of such areas facilitated the emergence of slums surrounded by snail breeding sites. Heavy rainfall caused open-air sewage ditches to overflow, allowing for infection of snails by Schistosoma mansoni. Thus, continuous floods were responsible for the spread of human infection. Clinical and laboratory results identified 62% of acute cases of S. mansoni. Complementary studies are being conducted to define the impact and epidemiological meaning of the acute schistosomiasis outbreak.

[Vincamine in patients with cerebral vascular insufficiency]. / Vincamina em pacientes com insuficiencia vascular cerebral

The effects of the treatment with vincamine in 20 patients with cerebral vascular insufficiency are reported. The patients were previously submitted to the following tests: neurologic examination, electroencephalography, laboratory tests, psychometry (memory, intellective capability, concentrated attention, abstract reasoning and personality tests). Patients were medicated with vincamin in a 40 mg dose within 24 hours during approximately a 150 days period, after which were again submitted to an identical analysis. The results obtained revealed that in a reasonable percentage of the cases vincamin is an useful medication in controlling the clinical manifestations of the cerebral vascular insufficiency, an improvement being demonstrated in the retrograde and anterograde deficit rate observed in objective tests. An improvement was also noticed in the electroencephalograpric pattern of a few patients.

[Schistosomiasis: reproduction and expansion of the endemia to the state of Pernambuco in Brazil]. / Esquistossomose: reprodução e expansão da endemia no Estado de Pernambuco no Brasil.

Schistosomiasis mansoni can be considered an important public health problem in Northeastern Brazil, in spite of the reduction in the prevalence of the hepatosplenic clinical forms which have been attributed to the large scale use of chemotherapy in this country. However, the rise in the prevalence rates and the spread of this endemic disease to new areas show that schistosomiasis is assuming its must cruel expression: less lethal but more greatly incapacitating in terms of irreversible physical and moral damage to human beings. The state of Pernambuco presents growing rates for schistosomiasis infection in humans. The epidemiological profile of this disease displays high and consistent prevalence rates (up to 80%) in rural areas, and new cases of acute infection on the coast, where schistosomiasis has recently been introduced. The reproduction and expansion of this endemic disease can be better understood on the basic of a conception of structural and historical causation. The disease construction process should be reconstructed in the light of biological as well as the social, political and cultural factors which are jointly responsible for the present endemic situation. Within that frame work, the historical and socioeconomic features that interact with the parasite and give rise to the present proportions of the schistosomiasis epidemic in Pernambuco are discussed. The mode of occupation and use of the land, unemployment, under-nutrition, migration, etc., raise the question of the growing difficulties confronting the control of the disease, both in rural areas where populations are extremely mobile as well as in the poorly organized urban population. Epidemiological investigation is fulfilling its role in its attempts to understand the complex relationships of an intrinsecally social nature of the health/disease process between health problems and the quality of life for the purpose of producing consistent disease control models.

[Ecoepidemiology of urban schistosomiasis in Itamaracá Island, Pernambuco, Brazil]. / Ecoepidemiologia da esquistossomose urbana na ilha de Itamaracá, Estado de Pernambuco.

INTRODUCTION: In 1988, 22 autochthonous cases from accidental exposure were registered in Forte Orange beach, Itamaracá Island, Pernambuco, Brazil. All cases occurred in middle-to-upper class individuals who were vacationing in the island. After the cases were identified, the major objective was to find breeding sites of schistosomiasis vectors and correlate the biological factors with the environmental conditions. METHODS: The environmental characteristics of the beach before human occupation were obtained from several documents. Also, a one-year malacological survey was conducted with monthly collection of mollusks, and the determination of their infectivity rates. RESULTS/CONCLUSIONS: The malacological survey was able to identify 20 breeding sites of Biomphalaria glabrata and 28 capture station were set up. Snails were collected and examined each month throughout a whole year. The results show a seasonal variation in the mollusk population density associated with infection rates and types of breeding sites. The importance of this new epidemiological profile of schistosomiasis in the State of Pernambuco relies on the fact that it can be related with the drastic human interference on the environment. Ecological, environmental, and demographic factors as well as the epidemiological characteristics of the disease have social and economic repercussions.

[Precancerous lesions associated with atrophic chronic gastritis and gastric peptic ulcer]. / Lesões pré-cancerosas associadas à gastrite crônica atrófica e à úlcera péptica gástrica.

Among the gastric lesions related to an increased risk for gastric cancer (precancerous conditions) two have deserved special attention, i.e., atrophic gastritis and peptic ulcer. In this paper the authors study the incidence of glandular dysplasia in atrophic gastritis and gastric peptic ulcer. In 148 cases of atrophic gastritis dysplastic lesions were diagnosed in 92 (62,0%): 63 cases (68,4%) with mild dysplasia, 25 cases (27,0%) with moderate dysplasia and 4 cases (4,3%) with severe dysplasia. In 329 gastric peptic ulcers examined there were 51 (15,5%) with dysplastic lesions: in 34 cases (66,6%) there was mild dysplasia, 12 cases (23,5%) moderate dysplasia and (9,8%) severe dysplasia. A prospective study with histological multiple sections from the stomach would be helpful for better understanding of these precancerous lesions.

[Intestinal schistosomiasis and its control in North-East Brazil]. / La schistosomose intestinale et son contrôle dans le Nord-Est du Brésil.

Intestinal schistosomiasis is endemic in the sugar cane belt near the coast of North-East Brazil. The environment and poor living conditions of the agricultural workers of this area combine to perpetuate the transmission of this disease. However, a new epidemiological pattern is emerging on the coast of Pernambuco State, where workers from the endemic area are building weekend homes without proper drainage. National control programs have led to a dramatic reduction in severe infections. However, they have not yet succeeded in stopping disease transmission altogether. The transfer of responsibility for control to local public health structures, which is currently underway, should improve the situation.

Effect of supplementation of soft drinks with green tea extract on their erosive potential against dentine.

BACKGROUND: Matrix metalloproteinase (MMP) inhibitors reduce dentine erosion. This in vitro study evaluated the effect of the supplementation of soft drinks with green tea extract, a natural inhibitor of MMPs, on their erosive potential against dentine. METHODS: For each drink tested (Coca-Cola, Kuat guarana, Sprite and light Coca-Cola), 40 dentine specimens were divided into two subgroups differing with respect to supplementation with green tea extract at 1.2% (OM24, 100%Camellia sinensis leaf extract, containing 30 ± 3% of catechin; Omnimedica, Switzerland) or not (control). Specimens were subjected to four pH cycles, alternating de- and remineralization in one day. For each cycle, samples were immersed in pure or supplemented drink (10 minutes, 30 mL per block) and in artificial saliva (60 minutes, 30 mL per block) at 37 °C, under agitation. Dentine alterations were determined by profilometry (µm). Data were analysed by two-way ANOVA and Bonferroni's test (p < 0.05). RESULTS: A significant difference was observed among the drinks tested with Sprite leading to the highest surface loss and light Coca-Cola to the lowest. Supplementation with green tea extract reduced the surface loss by 15% to 40% but the difference was significant for Coca-Cola only. CONCLUSIONS: Supplementation of soft drinks with green tea extract might be a viable alternative to reduce their erosive potential against dentine.

Epidemiology and anthropology: an integrated approach dealing with bio-socio-cultural aspects as strategy for the control of endemic diseases.

The control of endemic diseases has not attained the desired level of effectiveness in spite of the use of modern efficient technologies. The classic interventionist approach for the control of schistosomiasis is centered on systemic control of the snail hosts combined to large scale medical treatment and is usually carried out without social preoccupation due to the assisted communities. It is easy to understand the interest and the ethical compromise of public health research while producing studies in which the biological and social determinants as well as the cultural components should be considered and also encompass the historical dimensions and symbolic representations. In face of the recent political decision in favor of decentralizations of health administration to municipal level, we suggest, in the present paper, an integrated approach for the epidemiological diagnosis of an endemic situation at local level. Theoretical and methodological aspects from both, epidemiology and anthropology are discussed. Epidemiological methods can be used to detect the dependent variables (those related to the human infection) and the independent variables (demographic, economic, sanitary and social). Another methodological approach of anthropological/ethnographic nature can be conducted in order to make an articulation of the knowledge on the various dimensions or determinant levels of the disease. Mutual comprehension, between researchers and the people under investigation, on the dynamic transmission process would be relevant for a joint construction, at local level, of programmed actions for the control of endemic diseases. This would extend reflections on the health/disease process as a whole.