Comparison of pneumococcal vaccination response in children with sickle cell disease: HbSS and HbSC.

INTRODUCTION: Sickle cell disease (SCD) children are at increased risk of invasive pneumococcal disease and rely on penicillin prophylaxis and vaccination for infection prevention. Post-vaccination antibody levels in SCD may wane overtime. HbSC are believed to have better immunological response than HbSS. OBJECTIVE: To compare antibody response to 23-valent pneumococcal polysaccharide vaccine (PPSV-23) between HbSS and HbSC. METHODS: Patients with HbSS (n=33) and HbSC (n=11), aged 7-18 years, were prospectively recruited. Luminex pneumococcal antibody levels were measured for 23-serotypes, after two PPSV-23 doses. RESULTS: Absolute median titer for 20 of the 23 serotypes was higher in HbSC than HbSS and significantly higher for serotypes 22 (3.9 vs. 1.6mcg/ml; p=0.039) and 43 (2.9 vs. 0.8mcg/ml; p=0.007). HbSC mounted a better immune anti-pneumococcal response compared to HbSS (≥1.3mcg/ml) for 18 of 23 serotypes, albeit not significant for any of the serotypes. More HbSC (64%) than HbSS (42%) were good vaccine responders (p=0.303). Two of 21 (10%) good vaccine responders and nine of 23 (39%) poor vaccine responders SCD participants subsequently developed acute chest syndrome or pneumonia (p=0.036). None of the HbSC patients developed ACS after receiving PPSV-23. HbSS poor vaccine responders were at increased future recurrence risk for ACS (p=0.003), pneumonia (p=0.036) or both (p=0.011), compared to good vaccine responders. CONCLUSION: HbSC possess better pneumococcal vaccine response than HbSS. Poor vaccine response is concerning for future acute pulmonary events. Current vaccination strategy for SCD sub-types are lacking, therefore further study to evaluate utility of vaccine boosters is necessary.

Fluid pressurization and tractional forces during TMJ disc loading: A biphasic finite element analysis.

OBJECTIVES: To investigate the ploughing mechanism associated with tractional force formation on the temporomandibular joint (TMJ) disc surface. SETTING AND SAMPLE POPULATION: Ten left TMJ discs were harvested from 6- to 8-month-old male Yorkshire pigs. MATERIALS AND METHODS: Confined compression tests characterized mechanical TMJ disc properties, which were incorporated into a biphasic finite element model (FEM). The FEM was established to investigate load carriage within the extracellular matrix (ECM) and the ploughing mechanism during tractional force formation by simulating previous in vitro plough experiments. RESULTS: Biphasic mechanical properties were determined in five TMJ disc regions (average±standard deviation for aggregate modulus: 0.077±0.040 MPa; hydraulic permeability: 0.88±0.37×10-3 mm4 /Ns). FE simulation results demonstrated that interstitial fluid pressurization is a dominant loading support mechanism in the TMJ disc. Increased contact load and duration led to increased solid ECM strain and stress within, and increased ploughing force on the surface of the disc. CONCLUSION: Sustained mechanical loading may play a role in load carriage within the ECM and ploughing force formation during stress-field translation at the condyle-disc interface. This study further elucidated the mechanism of ploughing on tractional force formation and provided a baseline for future analysis of TMJ mechanics, cartilage fatigue and early TMJ degeneration.

A pilot study of nocturnal temporalis muscle activity in TMD diagnostic groups of women.

Temporomandibular disorder (TMD) incidences are believed to be related to parafunctional behaviours like teeth clenching. This pilot study aimed to (i) develop an automated clench-detection algorithm, and (ii) apply the algorithm to test for differences in nocturnal clenching in women with and without TMD. Subjects gave informed consent to participate. Adult women were categorised using Diagnostic Criteria for TMD according to presence/absence (+/-) of both TM joint disc placement (DD) and chronic pain (P) into two groups (+DD+P, -DD-P) with 12 subjects each. Surface temporalis electromyography was recorded during oral tasks performed by subjects at two laboratory sessions. The data were used to characterise muscle activity per N of bite force (µV/N) for each subject, develop the clench-detection algorithm and test its accuracy. Ambulatory surface temporalis electromyography was self-recorded by each subject over three nights and analysed using the algorithm and bite force (N) versus muscle activity µV/N calibrations. Bonferroni-adjusted homoscedastic t-tests assessed for significant between-group differences in clenching (P < 0·05). Sensitivity, specificity and accuracy of algorithm-detected laboratory clenches were all ≥96%. During self-recordings 95% of clenches had durations of <4 s and peak forces of <10 N in both groups. Mean clench durations were significantly longer (P = 0·042) in +DD+P (1·9 ± 0·8 s) than -DD-P subjects (1·4 ± 0·4 s). Mean temporalis duty factors (%clench time/total recording time) were significantly larger (P = 0·041) in +DD+P (0·47 ± 0·34%) than -DD-P (0·26 ±0·22%) subjects. Nocturnal temporalis muscle activities detected by a validated algorithm were longer per clench and recording time in +DD+P compared to -DD-P women.

Proprioceptively guided reaching movements in 3D space: effects of age, task complexity and handedness.

Aging is associated with impaired upper limb proprioceptive acuity, as reflected by decreased position matching accuracy with increasing task complexity and movement extent. Most studies have primarily used single-joint or planar paradigms to examine age-related changes in proprioception. It is unclear whether these changes can be generalized to more complex multi-joint movements, where additional sensory feedback may affect performance. Since age-related declines in cognitive function may impair the ability to integrate multiple sources of sensory feedback, deficits in position matching ability in older adults may persist when tasks are performed in three-dimensional space. The accuracy with which young and older participants reproduced remembered reference hand positions was assessed under different experimental conditions. Participants matched target locations located directly to the front or 45° to the side relative to the midline using the preferred and non-preferred arms. Either the same (i.e., ipsilateral matching) or the opposite (i.e., contralateral matching) arm was used to reproduce the target location. No differences in matching accuracy were found between young and older participants when matching ipsilaterally. When matching contralaterally, accuracy was worse in older participants for target locations located to the side, which may reflect age-related changes in the perception of peripersonal space. In contrast to previous studies, accuracy did not differ between the preferred and non-preferred arms in either group. These results extend previous findings demonstrating age-related impairments in proprioceptively guided arm movements when interhemispheric transfer is required.

Transmission of Escherichia coli O157:H7 in cattle is influenced by the level of environmental contamination.

A pen infection-transmission experiment was conducted to elucidate the role of pathogen strain and environmental contamination in transmission of Escherichia coli O157:H7 (ECO157) in cattle. Five steers were inoculated with a three-strain mixture of ECO157 and joined with five susceptible steers in each of two experimental replicates. Faecal and environmental samples were monitored for ECO157 presence over 30 days. One ECO157 strain did not spread. Transmission rates for the other two strains were estimated using a generalized linear model developed based on a modified 'Susceptible-Infectious-Susceptible' mathematical model. Transmission rates estimated for the two strains (0·11 and 0·14) were similar. However, the rates significantly (P = 0·0006) increased 1·5 times for every 1-unit increase in the level of environmental contamination measured as log10 c.f.u. Depending on the level of environmental contamination, the estimated basic reproduction numbers varied from <1 to 8. The findings indicate the importance of on-farm measures to reduce environmental contamination for ECO157 control in cattle that should be validated under field conditions.

Bacterial aminopeptidases: properties and functions.

Aminopeptidases are exopeptidases that selectively release N-terminal amino acid residues from polypeptides and proteins. Bacteria display several aminopeptidasic activities which may be localised in the cytoplasm, on membranes, associated with the cell envelope or secreted into the extracellular media. Studies on the bacterial aminopeptide system have been carried out over the past three decades and are significant in fundamental and biotechnological domains. At present, about one hundred bacterial aminopeptidases have been purified and biochemically studied. About forty genes encoding aminopeptidases have also been cloned and characterised. Recently, the three-dimensional structure of two aminopeptidases, the methionine aminopeptidase from Escherichia coli and the leucine aminopeptidase from Aeromonas proteolytica, have been elucidated by crystallographic studies. Most of the quoted studies demonstrate that bacterial aminopeptidases generally show Michaelis-Menten kinetics and can be placed into either of two categories based on their substrate specificity: broad or narrow. These enzymes can also be classified by another criterium based on their catalytic mechanism: metallo-, cysteine- and serine-aminopeptidases, the former type being predominant in bacteria. Aminopeptidases play a role in several important physiological processes. It is noteworthy that some of them take part in the catabolism of exogenously supplied peptides and are necessary for the final steps of protein turnover. In addition, they are involved in some specific functions, such as the cleavage of N-terminal methionine from newly synthesised peptide chains (methionine aminopeptidases), the stabilisation of multicopy ColE1 based plasmids (aminopeptidase A) and the pyroglutamyl aminopeptidase (Pcp) present in many bacteria and responsible for the cleavage of the N-terminal pyroglutamate.

A randomised Phase II trial to evaluate the toxicity of high-dose rifampicin to treat pulmonary tuberculosis.

SETTING: Randomised Phase IIB clinical trial. OBJECTIVES: To assess whether increasing the dose of rifampicin (RMP) from 10 mg/kg to 15 or 20 mg/kg results in an increase in grade 3 or 4 hepatic adverse events and/or serious adverse events (SAE). METHODS: Three hundred human immunodeficiency virus negative patients with newly diagnosed microscopy-positive pulmonary tuberculosis (TB) were randomly assigned to one of three regimens: 1) the control regimen (R10), comprising daily ethambutol (EMB), isoniazid (INH), RMP and pyrazinamide for 8 weeks, followed by INH and RMP daily for 18 weeks; 2) Study Regimen 1 (R15), as above, with the RMP dose increased to 15 mg/kg body weight daily for the first 16 weeks; and 3) Study Regimen 2 (R20), as above, with RMP increased to 20 mg/kg. Serum alanine transferase (ALT) levels were measured at regular intervals. RESULTS: There were seven grade 3 increases in ALT levels, 1/100 (1%) among R10 arm patients, 2/100 (2%) in the R15 arm and 4/100 (4%) in the R20 arm (trend test P = 0.15). One (R15) patient developed jaundice, requiring treatment modification. There were no grade 4 ALT increases. There was a non-significant increase in culture negativity at 8 weeks with increasing RMP dosage: 75% (69/92) in R10, 82.5% (66/80) in R15 and 83.1% (76/91) R20 patients (P = 0.16). CONCLUSIONS: No significant increase in adverse events occurred when the RMP dose was increased from 10 mg/kg to 15 mg/kg or 20 mg/kg.

Daily left prefrontal repetitive transcranial magnetic stimulation for medication-resistant burning mouth syndrome.

Burning mouth syndrome (BMS) is a persistent and chronic burning sensation in the mouth in the absence of any abnormal organic findings. The pathophysiology of BMS is unclear and its treatment is not fully established. Although antidepressant medication is commonly used for treatment, there are some medication-resistant patients, and a new treatment for medication-resistant BMS is needed. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technology approved by the US Food and Drug Administration (FDA) for the treatment of depression. Recent studies have found beneficial effects of TMS for the treatment of pain. A case of BMS treated successfully with daily left prefrontal rTMS over a 2-week period is reported here. Based on this patient's clinical course and a recent pain study, the mechanism by which TMS may act to decrease the burning pain is discussed.

Characterization of the pcp gene encoding the pyrrolidone carboxyl peptidase of Bacillus subtilis.

Pyrrolidone carboxyl peptidase (EC 3.4.11.8) (Pcp) is an enzyme that catalyzes the removal of the N-terminal pyroglutamyl group from some peptides or proteins. Its value in protein chemistry and bacterial diagnosis makes this enzyme an interesting subject of study. The present paper reports for the first time the cloning and characterization of a pyrrolidone carboxyl peptidase gene (pcp). This gene is present in a single copy in the genome of Bacillus subtilis as indicated by Southern blot hybridization analysis. The pcp transcripts were analyzed in Escherichia coli by Northern blot hybridization and S1 nuclease mapping. The deduced amino acid sequence predicts a protein of 215 amino acids with a calculated molecular weight of 23,777 Da. The pcp gene has been over-expressed in E. coli, allowing the identification and partial characterization of Pcp protein.

One step purification and characterization of the pyrrolidone carboxyl peptidase of Streptococcus pyogenes over-expressed in Escherichia coli.

Pyrrolidone carboxyl peptidase (EC 3.4.11.8) (Pcp), an enzyme which selectively removes pyrrolidone carboxylic acid (PCA) from some PCA-peptides and -proteins, was demonstrated in bacteria and in plant, animal and human tissues. In this paper we describe the purification to homogeneity of the enzyme of Streptococcus pyogenes, over-expressed in Escherichia coli. This was achieved, for the first time in one step, by hydrophobic interaction chromatography. Analysis under non-denaturing conditions revealed a molecular mass of 85 kDa and in the presence of sodium dodecyl sulfate gave a molecular mass of 23.5 kDa. Investigations on enzymatic properties showed that the Pcp over-expressed in E. coli disclosed properties similar to those found for the enzyme extracted from S. pyogenes or for some other Pcps studied previously. Thus the over-expressed enzyme should serve as a suitable source for N-terminal unblocking prior to some PCA protein sequencing.

Influence of Melatonin on the Rate of Rana pipiens Tadpole Metamorphosis In Vivo and Regression of Thyroxine-Treated Tail Tips In Vitro: (tadpole/metamorphosis/thyroxine/melatonin/tissue culture).

Metamorphosis of Rana pipiens tadpoles may be retarded when the light phase of the light/dark (LD) cycle is shortened or when thyroxine (T4 ) is given in the dark because melatonin peaks during the dark. Injection of premetamorphic tadpoles in spontaneous metamorphosis with melatonin (15 µg) retarded tail growth and hindlimb development on 18L:6D but had no significant effect on 6L:18D. During induced metamorphosis (30 µg/liter T4 ), melatonin injections retarded tail resorption on 18L:6D and accelerated it on 6L:18D, but did not affect the hindlimb. When melatonin was injected during T4 immersion at different times in the photophase on 18L:6D (L onset 0800 hr), tail regression was retarded by melatonin at 1430 or 2030 hr. At 0830 hr, shrinkage of tail length was accelerated whereas tail height was not affected. Tail tips in vitro induced to resorb by 0.2 µg/ml T4 in Niu-Twitty solution regressed more slowly in the presence of melatonin (10 or 15 µg/ml) than with T4 alone on both 6L:18D and 18L:6D. The findings implicate melatonin in LD cycle effects on tadpole metamorphic rate in vivo, show the importance of the time of melatonin injections, and indicate that melatonin antagonizes the metamorphic action of T4 at the tissue level.

An empirical study of economies of scope in home healthcare.

OBJECTIVE: To apply the economic theory of economies of scope to the home healthcare industry. DATA SOURCES: Data on 488 observations obtained from the Cost Report (HCFA Form 1728-86) of all Connecticut state-licensed, Medicare-certified home health agencies. STUDY DESIGN: The Cost Report was the primary source of data for this study. Information on total cost, scope, and other related factors was collected. Logarithmic and nonlinear regression analyses were used to identify factors related to scope and also to test for economies of scope. DATA COLLECTION METHOD: Data collected were both cross-sectional and time series (from 1988-1992). Data accuracy was verified using description of frequencies, measures of central tendency and variation, and a calculation package so that a computer calculation on the data could be compared with the agency's calculation. PRINCIPAL FINDINGS: It was determined that initially as scope increases, costs go down, thus proving economies of scope. For larger values of scope, it was determined that costs go up, proving diseconomies of scope. CONCLUSIONS: Many of the home health agencies included in this study provide more services than is cost effective given the economic theory of economies of scope.

Bioimpedance or anthropometry?

The ability of bioimpedance (BIA) to predict body composition in comparison with anthropometric measurements (weight and height) was assessed on three groups of adult young women (n = 99) and one group of adult young men (n = 49). Body fat (BF) and fat-free mass (FFM) by densitometry were used as the reference data. Resistance and reactance separately or together were poor predictors of BF and FFM, explaining from 0 to a maximum of 21 per cent of the FFM variation in the different groups. BF followed the same pattern, though the percentage of variance explained by both variables was even lower. Height squared divided by resistance (H2/R) explained from 22 to 68 per cent of the FFM variation and from 0 to 40 per cent of BF variation. Height alone was comparable to H2/R explaining from 11 to 53 per cent of the FFM variance in the four groups studied. Body weight was found to be the best single predictor of body composition; it explained from 56 to 78 per cent of FFM and 37 to 82 per cent of BF variability. Using stepwise regression analysis with all women combined, weight accounted for 70 per cent of the total FFM variation, with height and H2/R contributing only another 5 per cent. The same was found in men (68 vs 73 per cent respectively). The reported equation of Segal et al. was applied to our group, yielding almost the same high FFM prediction (r2 greater than 0.7 and SEE less than 2.5 kg).(ABSTRACT TRUNCATED AT 250 WORDS)

Intraocular pressure control after contact transscleral diode cyclophotocoagulation in eyes with intractable glaucoma.

PURPOSE: The effect of contact transscleral diode cyclophotocoagulation (TDC) on intraocular pressure (IOP) and its safety was determined in eyes with intractable glaucoma. METHODS: The charts of 41 consecutive patients (43 eyes) who underwent the laser procedure were reviewed. After surgery, data were collected from chart entries at I hour, 1 day, 4 to 6 weeks, 4 to 6 months, and at the final visit (6-24 months). Mean differences in IOP before and after treatment were compared using the paired Student t test. Associated complications also were assessed. RESULTS: The mean +/- standard deviation follow-up period was 11.9+/-5.3 months (range, 6-24 months). One patient who died after 1 month of follow-up and another patient with neovascular glaucoma who underwent an anterior chamber washout 1 week after laser to treat an uncontrolled IOP spike were excluded from the study. Repeat treatment was done in 12 (28%) eyes. At each follow-up visit postoperatively, a significant reduction from preoperative IOP was obtained (mean reduction of 50% at the final visit). At the final visit, 64% of patients achieved an IOP of <22 mmHg and a reduction of > or =20%. An IOP spike occurred in three (7%) eyes. Long-term complications included loss of vision (> or =2 lines) in eight (22%) patients, corneal decompensation in one (2%), phthisis bulbi in one (2%), and corneal graft rejection in one (2%). CONCLUSION: Although effective IOP reduction was demonstrated in eyes with intractable glaucoma after TDC, a significant proportion (26%) of eyes had severe long-term complications.

[Total or partial electrical interruption of the atrioventricular pathway. Evaluation of clinical results and indications]. / Interruption électrique totale ou partielle de la voie auriculo-ventriculaire. Appréciation des résultats cliniques et des indications.

After checking on the efficacy and innocuity of catheter ablation of the His bundle in an experimental study in the sheep, 22 patients with supraventricular tachycardia resistant to an average of 5.5 +/- 1.7 antiarrhythmic drugs per patient underwent this procedure. The most common arrhythmias were atrial fibrillation or flutter (poorly tolerated in 14 cases), and reciprocating tachycardia (8 cases, including 3 with accessory atrioventricular pathways). In 3 of the 5 patients with intranodal tachycardia, an initial attempt was made to modify one of the two AV nodal conduction pathways. Although complete atrioventricular block was obtained in all patients, atrioventricular conduction returned in 15 patients between the 30th minute and 4th day after the procedure. A second attempt at His bundle ablation was carried out in 9 patients. During follow-up ranging from 1 to 38 months, complete or an advanced degree of atrioventricular block persisted in 5 patients, the other patients being in sinus rhythm (12 cases) or slow atrial fibrillation (2 cases). The remaining patient who was in complete atrioventricular block died of septicaemia 2 months after the procedure. The clinical results were evaluated by electrophysiological investigation, exercise testing and Holter monitoring. There were 15 satisfactory clinical results (83.3 p. 100) and 3 poor results. This series shows that interruption or modification of the normal atrioventricular conduction pathway may be performed at low risk and with good results in a high percentage of cases. It is a valuable therapeutic option in patients with supraventricular tachycardia resistant to antiarrhythmic therapy.

[False subaortic aneurysm after surgery of calcified aortic stenosis. Apropos of a case treated successfully]. / Faux anévrysme sous-aortique après chirurgie d'un rétrécissement aortique calcifié.

The authors report a case of false aneurysm of the posterior subaortic region of the left ventricle after a technically difficult surgical decalcification in a case of aortic stenosis. At reoperation, the surgeon used the femoral artery and both vena cavae for canulation. A direct approach of this "vascular" tumour, which was exterior to the great vessels, confirmed the diagnosis and enabled the localisation of the internal orifice inside the left ventricle. This was closed simply by suturing. No previous cases of this kind were found in the literature. This report underlines the necessity of taking the greatest care when decalcifying this region in order to avoid this type of serious complication.

[Blood pressure variability and morbidity]. / Variabilité tensionnelle et morbidité.

In a previous study (resting blood pressure profile, Dinamap) we have confirmed the correlations between blood pressure and left ventricular mass (myocardial hypertrophy being one of the morbidity criteria in Hypertension) and we have demonstrated the absence of significant difference (Fisher's z Test) with the results of ambulatory recordings found in literature. Furthermore, we have showed a weaker correlation between absolute variability (AV) and left ventricular mass (LVM). If indeed there exists a cause-effect relationship between the AV increase and the LVM increase, a relative independence between VA and blood pressures mean (mBP) should still be demonstrated. In order to do that we have used the factorial analysis (main components analysis) with which a small number of independent factors can be isolated from a large number of correlated variables. A resting blood pressure (Dinamap, 8AM-8PM, one reading every 15 minutes) has been recorded among 551 patients (259 females, 292 males; 109 normotensive WHO, 442 hypertensive WHO) and an echocardiogram TM and two-dimensional in order to measure the interventricular septum thickness (IVST), the posterior wall thickness (PWT) and the left ventricular internal diameter (LVID) with which we can calculate the myocardial mass (MM, Devereux formula) and the myocardial mass index (MMI) using the body surface (BS). The blood pressure variables are the means of the recordings (mBP): systolic (mSBP), diastolic (mDBP), mean (mMBP) and their standard deviations (SSD, DSD, MSD) corresponding to the AV. We have studied the heart rate (HR) with its standard deviation (HRSD) and age.(ABSTRACT TRUNCATED AT 250 WORDS)

[Relationship between heart mass and semi-ambulatory pressure profiles]. / Relation masse cardiaque et profils tensionnels semi-ambulatoires.

This work was undertaken with 420 patients (90 normotensives: casual blood pressure less than or equal to 140/90 mmHg and 330 hypertensives) in which was recorded a semi ambulatory blood pressure profile (Dinamap 8AM-8PM, a reading every fifteen minutes). On the same day an echocardiogram was performed. We have correlated the left ventricular mass, the left ventricular mass index, the interventricular septum, the left ventricular cavity volume and the left ventricular posterior wall with casual blood pressure, average daily blood pressure standard deviation and variation coefficient for mean blood pressure, systolic blood pressure and diastolic blood pressure. Analysis by sex, left ventricular mass index and blood pressure level (normotensive, hypertensive): we observe a left ventricular hypertrophy in normotensive males (18 p. 100) and hypertensive ones (39.8 p. 100), in normotensive females (15 p. 100) and hypertensive ones (33.3 p. 100). Overall in 420 patients: excellent correlation (p less than 0.001) between average daily blood pressure, casual blood pressure and the four echocardiographic parameters except for left ventricular cavity volume. But correlation is better (z test of Fisher) with average daily blood pressure than with casual blood pressure. No difference exists between results obtained in women (194) and men (226). Concerning variability, four observations: there exists a correlation between standard deviation, left ventricular mass index, interventricular septum, left ventricular posterior wall (only for standard deviation of MBP). No correlation with coefficient correlation except for the MBP with septum in women. The correlation for the standard deviation are weaker than with average daily blood pressure. They are better with the septum than with other echocardiographic parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Bad news and good news: what the dentist needs to know about transmissible spongiform encephalopathies.

Since reports of the "mad cow disease" epidemic in Great Britain erupted in the international press, sensational and intimidating articles about the risk that bovine spongiform encephalopathy and related diseases may pose to humans have appeared. The bad news is that compelling scientific evidence suggests so-called prion disease can and has infected humans, although the overall risk appears to be low. Furthermore, at present, there is no reliable antemortem diagnosis, specific treatment, or vaccine to prevent the disease. The agent thought to be responsible for this unusual class of disease is a rogue protein (called a prion) that, unlike all other agents known to cause infectious disease, contains neither DNA nor RNA. According to a popular hypothesis, normal membrane-associated prion proteins undergo conformational changes that can cause disease. The "bad" prion forms cause holes or a spongy appearance in the brain in all disease variants, hence the generic designation of spongiform encephalopathy. The good news is that risk for exposure to prion disease is exceedingly remote in the dental practice and that current universal infection control procedures are probably sufficient.

[Control of hemotherapy and transfusional Chagas disease: 1988 and 1990]. / Controle da hemoterapia e da doença de Chagas transfusional: 1988 e 1990.

An inquiry with the objective of bringing the study of the hemotherapy situation in the state of S. Paulo, up-to-date was undertaken in 1990 and compared with that carried out in 1988. In 1990 research was undertaken in 62 counties, 48 of which performed blood transfusions through 104 services, with hemocenter participation in 13.5% of these latter. In 1988 the respective figures were 57, 40, 71 and 8.5%. The number of donors and transfusions and prevalence of serological positivity for Chagas' disease were, respectively: 105,170; 79,544 and 1.24%, while in 1988 the corresponding numbers were: 51,614; 49,211 and 1.52%. Evaluating the serological selection it was found that the following percentages of the services performed serological tests: for Chagas' disease (94.2%), syphilis (94.2%), hepatitis (94.2%), HIV (92.3%) and malaria (20.2%) while in 1988 only 69.0%; 70.4%; 67.6%, 63.4% and 16.9%, respectively, of the services utilized these same tests. In respect of the serological trial specific for Chagas' disease the results were: complement fixation-4.9%; latex-4.0%; indirect immunofluoresce-80%; direct hemaglutination-24.0%, indirect hemaglutination-69.0% and ELISA-59.0% of all services. In the preceding inquiry only 14.3% of the services performed the ELISA test, and complement fixation was utilized in 28.6%. The results show that the services are utilizing ever more sensitive techniques in the serological routine. Further it was observed that in 1988, 77.6% of all the services studied used only one technique for the diagnosis of Chagas' disease while in 1990 92.9% utilized two or more different techniques. It is concluded that the quality of the hemotherapy undertaken in the state of S. Paulo has improved significantly.