Prevalence of intestinal parasitic infections in Brazil: a systematic review.

INTRODUCTION: Parasitic infections are considered a major public health problem due to their associated morbimortality and negative impact on physical and intellectual development, especially in the at-risk pediatric group. Periodic prophylactic administration of antiparasitic agents against soil-transmitted helminths is recommended by the World Health Organization (WHO) to control parasitic infections and disease burden. We aimed to evaluate the prevalence of intestinal parasitic infections in Brazil. METHODS: We performed a systematic review by searching the literature found in the PubMed, LILACS, and SciELO databases, followed by a meta-analysis of the proportions from studies published in English, Portuguese, and/or Spanish from January 2000 to May 2018. This systematic review was registered in the PROSPERO database (CRD42018096214). RESULTS: The prevalence of intestinal parasitic infections (protozoa and/or helminths) in Brazil was 46% (confidence interval: 39-54%), with 99% heterogeneity. Prevalence varied by region: 37%, 51%, 50%, 58%, and 41% in the Southeast, South, Northeast, North, and Central-West regions, respectively. Most studies (32/40) evaluated children (<18 years) and found an average prevalence of 51%. Children also had the highest prevalence in all four regions: Central-West (65%), South (65%), North (58%), Northeast (53%), and Southeast (37%). However, most studies evaluated specific populations, which may have created selection bias. Presumably, this review of intestinal parasitic diseases in Brazil includes the most studies and the largest population ever considered. CONCLUSIONS: The prevalence of intestinal parasitic infections is high in Brazil, and anthelmintic drugs should be administered periodically as a prophylactic measure, as recommended by the WHO.

Prevalence of intestinal parasitic infections in Brazil: a systematic review

Abstract INTRODUCTION: Parasitic infections are considered a major public health problem due to their associated morbimortality and negative impact on physical and intellectual development, especially in the at-risk pediatric group. Periodic prophylactic administration of antiparasitic agents against soil-transmitted helminths is recommended by the World Health Organization (WHO) to control parasitic infections and disease burden. We aimed to evaluate the prevalence of intestinal parasitic infections in Brazil. METHODS: We performed a systematic review by searching the literature found in the PubMed, LILACS, and SciELO databases, followed by a meta-analysis of the proportions from studies published in English, Portuguese, and/or Spanish from January 2000 to May 2018. This systematic review was registered in the PROSPERO database (CRD42018096214). RESULTS: The prevalence of intestinal parasitic infections (protozoa and/or helminths) in Brazil was 46% (confidence interval: 39-54%), with 99% heterogeneity. Prevalence varied by region: 37%, 51%, 50%, 58%, and 41% in the Southeast, South, Northeast, North, and Central-West regions, respectively. Most studies (32/40) evaluated children (<18 years) and found an average prevalence of 51%. Children also had the highest prevalence in all four regions: Central-West (65%), South (65%), North (58%), Northeast (53%), and Southeast (37%). However, most studies evaluated specific populations, which may have created selection bias. Presumably, this review of intestinal parasitic diseases in Brazil includes the most studies and the largest population ever considered. CONCLUSIONS The prevalence of intestinal parasitic infections is high in Brazil, and anthelmintic drugs should be administered periodically as a prophylactic measure, as recommended by the WHO.

A list of land plants of Parque Nacional do Caparaó, Brazil, highlights the presence of sampling gaps within this protected area.

BACKGROUND: Brazilian protected areas are essential for plant conservation in the Atlantic Forest domain, one of the 36 global biodiversity hotspots. A major challenge for improving conservation actions is to know the plant richness, protected by these areas. Online databases offer an accessible way to build plant species lists and to provide relevant information about biodiversity. A list of land plants of "Parque Nacional do Caparaó" (PNC) was previously built using online databases and published on the website "Catálogo de Plantas das Unidades de Conservação do Brasil." Here, we provide and discuss additional information about plant species richness, endemism and conservation in the PNC that could not be included in the List. We documented 1,791 species of land plants as occurring in PNC, of which 63 are cited as threatened (CR, EN or VU) by the Brazilian National Red List, seven as data deficient (DD) and five as priorities for conservation. Fifity-one species were possible new ocurrences for ES and MG states. NEW INFORMATION: "Parque Nacional do Caparaó" houses 8% of the land plant species endemic to the Brazilian Atlantic Forest, including 6% of its angiosperms, 31% of its lycophytes and ferns and 14% of its avascular plants. Twelve percent of the threatened species listed for the State of Espírito Santo and 7% listed for the State of Minas Gerais are also protected by PNC. Surprisingly, 79% of the collections analysed here were carried out in Minas Gerais, which represents just 21% of the total extension of the Park. The compiled data uncover a huge botanical collection gap in this federally-protected area.

Translation and adaptation of "Perception of Severity of Chronic Illness" to the Brazilian culture for adolescents. / Tradução e adaptação do "Perception of Severity of Chronic Illness" à cultura brasileira em adolescentes.

OBJECTIVE: To translate, adapt, and evaluate the applicability of the "Perception of Severity of Chronic Illness" questionnaire to the Brazilian culture for diabetic adolescents. METHODS: This is a methodological study consisting of the stages of translation, synthesis of translations, back translation, review by an expert committee, and pre-test. The expert judges evaluated semantic, idiomatic, conceptual, and cultural equivalences. The judges' concordance was quantified using the Content Validity Index. RESULTS: The translation and back translation were performed successfully. After the synthesised translation was reviewed by the committee, the items were altered to ensure equivalence between the original and translated instrument. After the pre-test, some statements were reformulated to make them clearer and easier to understand. The preliminary data of the instrument's reliability calculated using Cronbach's alpha was 0.66. CONCLUSION: The Brazilian version of the instrument Perception of Severity of Chronic Illness proved satisfactory in terms of the translation, cultural adaptation, and practicality, and it was considered an easily applicable and viable tool for clinical practice.

Tradução e adaptação do "Perception of Severity of Chronic Illness" à cultura brasileira em adolescentes / Traducción y adaptación del "Perception of Severity of Chronic Illness" a la cultura brasileña en adolescentes / Translation and adaptation of "Perception of Severity of Chronic Illness" to the Brazilian culture for adolescents

RESUMO Objetivo Traduzir, adaptar e avaliar a aplicabilidade do instrumento “Perception of Severity of Chronic Illness” para a cultura brasileira em adolescentes diabéticos. Métodos Estudo metodológico que seguiu etapas de tradução, síntese das traduções, retrotradução, avaliação por comitê de juízes e pré-teste. Os juízes avaliaram as equivalências semânticas, idiomáticas, conceituais e culturais. A concordância entre juízes foi quantificada pelo Índice de Validade de Conteúdo. Resultados As etapas de tradução e retrotradução foram bem-sucedidas. Após avaliação da versão síntese pelo comitê, foram feitas alterações no instrumento para assegurar equivalência entre versão original e traduzida. Após o pré-teste, algumas questões foram reformuladas visando torná-las mais claras e de fácil compreensão. O dado preliminar de confiabilidade pelo coeficiente alfa de Cronbach foi de 0,66. Conclusão A versão brasileira do Perception of Severity of Chronic Illness mostrou resultados satisfatórios quanto à tradução, adaptação cultural e praticabilidade, sendo considerado um instrumento de fácil aplicação e viável na prática clínica.

RESUMEN Objetivo Traducir, adaptar y evaluar la aplicabilidad del instrumento “Perception of Severity of Chronic Illness” a la cultura brasileña en adolescentes diabéticos. Métodos Estudio metodológico que siguió los pasos de traducción, síntesis de las traducciones, retrotraducción, evaluación por comité de expertos y pretest. Los jueces evaluaron equivalencias semántica, idiomática, conceptual y cultural. El acuerdo entre jueces se cuantificó por Índice de Validez de Contenido. Resultados Etapas de traducción y retrotraducción fueron realizadas con éxito. Después de la versión síntesis de evaluación por el comité, se hicieron cambios en los ítems para garantizar equivalencia entre instrumento original y traducido. Después del pretest, se reformularon algunas preguntas para hacerlas más comprensibles. Análisis de confiabilidad por el coeficiente de alfa Cronbach fue 0,66. Conclusión La versión brasileña del “Perception of Severity of Chronic Illness” mostró resultados satisfactorios para traducción, adaptación cultural y practicabilidad, considerándose una herramienta fácil de usar y viable para la práctica clínica.

ABSTRACT Objective To translate, adapt, and evaluate the applicability of the “Perception of Severity of Chronic Illness” questionnaire to the Brazilian culture for diabetic adolescents. Methods This is a methodological study consisting of the stages of translation, synthesis of translations, back translation, review by an expert committee, and pre-test. The expert judges evaluated semantic, idiomatic, conceptual, and cultural equivalences. The judges’ concordance was quantified using the Content Validity Index. Results The translation and back translation were performed successfully. After the synthesised translation was reviewed by the committee, the items were altered to ensure equivalence between the original and translated instrument. After the pre-test, some statements were reformulated to make them clearer and easier to understand. The preliminary data of the instrument’s reliability calculated using Cronbach’s alpha was 0.66. Conclusion The Brazilian version of the instrument Perception of Severity of Chronic Illness proved satisfactory in terms of the translation, cultural adaptation, and practicality, and it was considered an easily applicable and viable tool for clinical practice.

Integrated ecological risk assessment of pesticides in tropical ecosystems: a case study with carbofuran in Brazil.

The aim of the present study is to contribute an ecologically relevant assessment of the ecotoxicological effects of pesticide applications in agricultural areas in the tropics, using an integrated approach with information gathered from soil and aquatic compartments. Carbofuran, an insecticide/nematicide used widely on sugarcane crops, was selected as a model substance. To evaluate the toxic effects of pesticide spraying for soil biota, as well as the potential indirect effects on aquatic biota resulting from surface runoff and/or leaching, field and laboratory (using a cost-effective simulator of pesticide applications) trials were performed. Standard ecotoxicological tests were performed with soil (Eisenia andrei, Folsomia candida, and Enchytraeus crypticus) and aquatic (Ceriodaphnia silvestrii) organisms, using serial dilutions of soil, eluate, leachate, and runoff samples. Among soil organisms, sensitivity was found to be E. crypticus < E. andrei < F. candida. Among the aqueous extracts, mortality of C. silvestrii was extreme in runoff samples, whereas eluates were by far the least toxic samples. A generally higher toxicity was found in the bioassays performed with samples from the field trial, indicating the need for improvements in the laboratory simulator. However, the tool developed proved to be valuable in evaluating the toxic effects of pesticide spraying in soils and the potential risks for aquatic compartments.

Suitability of five cladoceran species from Mexico for in situ experimentation.

Although they are highly suited for site-specific risk assessment, little attention has been given to in situ ecotoxicological experimentation in tropical regions. This study intended to assess the suitability of five freshwater cladocerans from Mexico for in situ experiments. Juveniles of Ceriodaphnia cornuta, Macrothrix triserialis group, Simocephalus vetulus, Diaphanosoma birgei, and Pseudosida cf. ramosa, from two populations, were used to perform seven day laboratory and in situ experiments. Pseudosida cf. ramosa was very sensitive to handling and was discarded from further evaluations. Ceriodaphnia cornuta reproduced significantly more neonates, with smaller coefficients of variation, than M. triserialis and S. vetulus. Also due to its worldwide distribution in the tropics, C. cornuta is suggested to be highly suitable for in situ experiments.

Correlação entre a composição corporal e força, resistência da musculaura respiratória e capacidade de exercícios em pacientes com doença pulmonar obstrutiva crônica / Correlation between body composition and respiratory muscle strength, endurance, and exercise capacity in patients with chronic obstrutive pulmonary disease

Este estudo buscou correlações entre a composição corporal (aferida por métodos indiretos) e força, resistência da musculatura respiratória e capacidade de exercício em portadores de doença pulmonar obstrutiva crônica (DPOC). Os 30 voluntários, idosos, foram divididos em três grupos, dois de pacientes com DPOC, estáveis e controlados clinicamente, e um grupo controle, com indivíduos sem doenças pulmonares, selecionados na mesma faixa etária e biótipo daqueles com DPOC. Todos foram submetidos a espirometria e medidas das pressões respiratórias máximas para avaliação da força dos músculos respiratórios, teste de resistência dos músculos respiratórios, teste de caminhada de seis minutos (TC6'), medidas de dobras cutâneas e índice de massa corporal (IMC). Os sujeitos (6 mulheres e 24 homens) foram divididos em: grupo A, n=11, com DPOC moderado a grave (idade 69,5±10,5 anos, IMC 24,00±3,66 kg/m2); grupo B, n=10, com DPOC leve (71,1±8,1 anos, IMC 24,41±0,58 kg/m2); e grupo C controle, n=9 (70,1±5,9 anos, IMC 27,44±1,33 kg/m2). Apenas os valores de porcentagem de gordura corporal e distância caminhada (no TC6') apresentaram diferenças significativas entre os grupos. Os resultados não indicaram correlação significativa entre as variáveis analisadas. Embora a literatura aponte o estado nutricional como um dos fatores do comprometimento respiratório na DPOC, não foi encontrada correlação entre a composição corporal e os parâmetros respiratórios nos pacientes estudados...

This study searched for correlations between body composition (assessed by indirect methods) and respiratory muscle strength, endurance and exercise capacity in patients with chronic obstructive pulmonary disease (COPD). Thirty elderly subjects were divided into two groups of COPD patients, in clinically stable condition, and a control group, of subjects with no respiratory disease, selected so as to match COPD patients’ age and biotype. All subjects were submitted to spirometry, maximal respiratory pressures for assessing respiratory muscle strength, respiratory muscle endurance test, the six minute walking test (TC6'), and to skin folds and body mass index (BIM) measurements. Subjects (6 women, 24 men) were divided into: group A, with moderate to severe COPD, n=11 (aged 69.5±10.5, BIM 24.00±3.66 kg/m2); group B with mild COPD, n=10 (aged 71.1±8.1, BIM 24.41±0.58 kg/m2); and control group C, n=9 (aged 70.1±5.9, BMC 27.44±1.33 kg/m2). Significant differences between the groups were found only in body fat percent and distance walked in the TC6'. Results showed no significant correlations between the analysed variables. Though literature consensually points to the nutritional status as a factor for respiratory impairment in COPD patients, no significant correlations could be found between body composition and the analysed respiratory parameters among this study subjects...

O coral cênico cidadãos cantantes: um espaço de encontro entre a música e a saúde / The theatrical choral singing citizens: a place of encounter between music and health

Este artigo relata a experiência do Coral Cênico Cidadãos Cantantes, criado em 1992 como desdobramento das atividades dos Centros de Convivência e Cooperativa da Secretaria de Saúde do Município de São Paulo, com apoio da Associação SOS Saúde Mental, Ecologia e Cultura. O Coral possui uma composição heterogênea, reunindo portadores de sofrimento mental, pessoas em situação de vulnerabilidade e pessoas da população em geral, interessados na construção artística, tendo como local de trabalho as dependências da Galeria Olido da Secretaria Municipal de Cultura de São Paulo. Desde 2006 o Coral estabelece parceria com o Laboratório de Estudos e Pesquisa Arte e Corpo em Terapia Ocupacional. A prática do Coral recupera o sentido da arte como um atributo humano capaz de transformar atitudes, lugares de saber, lugares de existência e, por conseqüência, capaz de alterar a qualidade de vida. A ferramenta de trabalho dos Cidadãos Cantantes é a promoção de encontros nos quais se possa cantar buscando a harmonização das dissonâncias para afinar diferenças e sustentando uma experimentação na interface entre canto coral, arte e saúde na contemporaneidade. A prática musical em grupos que apresentam esse perfil mostra-se, não só possível, como instigadora, para se pensar novas possibilidades para o canto coral, além de propor novos agenciamentos relacionais e territoriais.

This article presents the experience of the Theatrical Choral Singing Citizens, created in 1992 as an extension of the activities developed at the Convivence and Cooperative Centers of the Health Secretary of São Paulo, and supported by the NGO "SOS Mental Health, Ecology and Culture". The Choral is a heterogeneous group formed by interest on artistic construction, which gather people suffering from mental illness, people in vulnerability, and others from general population, having been established as a workplace Galeria Olido, in São Paulo. From 2006, the Choral has worked in a partnership with the Laboratory of Studies and Research in Art, Body and Occupational Therapy. This practice recovers the sense of art as a human attribute capable of transforming attitudes, knowledge spaces, and existential spaces in orther to alter one's quality of life. The Coral's tool is the promotion of encounters in which the singers could harmonize dissonances and tune differences, supporting an experience on the interface between choral singing, art and health on contemporaneity. Musical practice in groups who present this profile installs itself, therefore, not only as possible, but instigative in fomenting new possibilities for choral music, new establishment of relations and territories.

Angiotensin-converting enzyme in pericardial fluid: comparative study with serum activity.

BACKGROUND: The characterization of an angiotensin-converting enzyme (ACE) in human pericardial fluid is relevant, considering its role in the angiotensin II release and thus, the role of the pericardium in cardiovascular homeostasis. OBJECTIVE: To isolate and characterize an ACE from human pericardial fluid and to compare the angiotensin I converting activities of the pericardial fluid with that of the serum in patients submitted to cardiovascular surgery. METHODS: The enzyme from human pericardial fluid was purified through chromatographic steps and characterized by polyacrylamide gel electrophoresis (SDS-PAGE), hydrolysis of angiotensin I, bradykinin, Hip-His-Leu and synthetic substrates with internal fluorescence suppression. Lisinopril was used as inhibitor. The ACE activity was measured in blood and pericardial fluid samples of 23 patients submitted to cardiovascular surgery. RESULTS: The purified ACE (MM = 140 kDa), releases angiotensin II, hydrolyses bradykinin and the Hip-His-Leu substrate. The kinetic parameters k cat,(s-1) and k cat/Km (microM-1. s-1) were, respectively: Hip-His-Leu (1.14 and 7 x 10 -4) ; Abz-YRK(Dnp)P-OH (2.60 and 0.77), Abz-LFK(Dnp)-OH (2.77 and 0.36) and Abz-SDK(Dnp)P-OH (1.92 and 0.19). The angiotensin I converting activities (mean +/- SD) in the pericardial fluid and in blood, were, respectively: 3.16 +/- 0.90 mU x mg -1x min-1 and 0.33 +/- 0.11 mU x mg -1x min-1. The difference was significant between the two fluids. CONCLUSION: An ACE that bears great similarity with the somatic enzyme was isolated from human pericardial fluid. The angiotensin I converting activity is higher in the pericardial fluid when compared to the serum activity. These data are important evidence of the role of the pericardial fluid in the metabolism of active peptides.

Enzima conversora de angiotensina no líquido pericárdico: estudo comparativo com a atividade sérica / Angiotensin-converting enzyme in pericardial fluid: comparative study with serum activity

FUNDAMENTO: A caracterização de uma enzima conversora de angiotensina (ECA) no líquido pericárdico humano é relevante diante do seu papel na liberação de angiotensina II e, portanto, do papel do pericárdio na homeostase cardivascular. OBJETIVO: Isolar e caracterizar uma ECA do líquido pericárdico humano. Comparar as atividades conversoras de angiotensina I do fluido pericárdico e do soro de pacientes submetidos à cirurgia cardiovascular. MÉTODOS: A enzima do líquido pericárdico humano foi purificada por meio de etapas cromatográficas e caracterizada por eletroforese em gel de poliacrilamida (SDS-PAGE), hidrólise de angiotensina I, bradicinina, Hip-His-Leu e substratos sintéticos com supressão interna de fluorescência. Lisinopril foi usado como inibidor. A atividade de ECA foi determinada em amostras de sangue e líquido pericárdico de 23 pacientes submetidos à cirurgia cardiovascular. RESULTADOS: A ECA purificada (MM = 140 kDa) libera angiotensina II, hidrolisa a bradicinina e o substrato Hip-His-Leu. Os parâmetros cinéticos k cat,(s-1) e k cat/Km (µM-1. s-1) foram respectivamente: Hip-His-Leu (1,14 e 7 x 10 -4), Abz-YRK(Dnp)P-OH (2,60 e 0,77), Abz-LFK(Dnp)-OH (2,77 e 0,36) e Abz-SDK(Dnp)P-OH (1,92 e 0,19). As atividades conversoras de angiotensina I (média ± DP) do líquido pericárdico e no soro foram, respectivamente, 3,16 ± 0,90 mU x mg -1x min-1 e 0,33 ± 0,11 mU x mg -1x min-1 . A diferença foi significativa entre os dois fluidos. CONCLUSÃO: Uma ECA com grande similaridade com a enzima somática foi isolada do fluido pericárdico humano. A atividade conversora de angiotensina I é maior no líquido pericárdico quando comparada com a atividade do soro. Esses dados constituem importante evidência do papel do líquido pericárdico no metabolismo de peptídeos ativos.

BACKGROUND: The characterization of an angiotensin-converting enzyme (ACE) in human pericardial fluid is relevant, considering its role in the angiotensin II release and thus, the role of the pericardium in cardiovascular homeostasis. OBJECTIVE: To isolate and characterize an ACE from human pericardial fluid and to compare the angiotensin I converting activities of the pericardial fluid with that of the serum in patients submitted to cardiovascular surgery. METHODS: The enzyme from human pericardial fluid was purified through chromatographic steps and characterized by polyacrylamide gel electrophoresis (SDS-PAGE), hydrolysis of angiotensin I, bradykinin, Hip-His-Leu and synthetic substrates with internal fluorescence suppression. Lisinopril was used as inhibitor. The ACE activity was measured in blood and pericardial fluid samples of 23 patients submitted to cardiovascular surgery. RESULTS: The purified ACE (MM = 140 kDa), releases angiotensin II, hydrolyses bradykinin and the Hip-His-Leu substrate. The kinetic parameters k cat,(s-1) and k cat/Km (µM-1. s-1) were, respectively: Hip-His-Leu (1.14 and 7 x 10 -4) ; Abz-YRK(Dnp)P-OH (2.60 and 0.77), Abz-LFK(Dnp)-OH (2.77 and 0.36) and Abz-SDK(Dnp)P-OH (1.92 and 0.19). The angiotensin I converting activities (mean ± SD) in the pericardial fluid and in blood, were, respectively: 3.16 ± 0.90 mU x mg -1x min-1 and 0.33 ± 0.11 mU x mg -1x min-1. The difference was significant between the two fluids. CONCLUSION: An ACE that bears great similarity with the somatic enzyme was isolated from human pericardial fluid. The angiotensin I converting activity is higher in the pericardial fluid when compared to the serum activity. These data are important evidence of the role of the pericardial fluid in the metabolism of active peptides.

[HIV prevention using the operative group approach among men who have sex with men in São Paulo, Brazil]. / Prevenção de infecção pelo HIV por intermédio da utilização do grupo operativo entre homens que fazem sexo com homens, São Paulo, Brasil.

This study aimed to evaluate the operative group as a preventive approach among men who have sex with men that use two public health services in the city of São Paulo, Brazil. One hundred volunteers were randomly allocated to two groups (intervention and control, with 50 each). All participants answered questionnaires in two phases: before the intervention and six months after its conclusion. Effect was measured by comparing the groups for the following outcomes: median number of anal sex acts without condoms and responses from the participants to questions about HIV infection. 69 participants completed the study (34 in the prevention group and 35 in the control group). Analysis showed a decrease in the number of unprotected anal sex acts (p = 0.029) and an increase in the number of answers favoring prevention in the intervention group. The results indicate that the study group was responsive to a safer sex operative group intervention. Further research is necessary to evaluate the feasibility of this prevention approach as a public health strategy, including other social groups.

Prevenção de infecção pelo HIV por intermédio da utilização do grupo operativo entre homens que fazem sexo com homens, São Paulo, Brasil / HIV prevention using the operative group approach among men who have sex with men in São Paulo, Brazil

Este estudo focaliza o grupo operativo como intervenção preventiva de HIV para HSH (homens que fazem sexo com homens), usuários de serviços de saúde pública de São Paulo, Brasil. Foram distribuídos, por sorteio aleatório, 100 voluntários em dois grupos (intervenção e controle - 50 cada um). Todos eles responderam a questionários em duas fases distintas: antes da intervenção e seis meses depois de serem submetidos a ela. A avaliação do efeito da intervenção foi obtida pela variação do número médio de relações sexuais anais sem preservativo e análise de respostas sobre infecção pelo HIV. Terminaram o estudo 69 participantes (34 - grupo de intervenção; 35 - grupo de controle). No grupo de intervenção, observou-se, pelos dados obtidos, uma diminuição da prática de sexo anal desprotegida (p = 0,029) e aumento do número médio de respostas favoráveis à prevenção. Esses índices indicam ser a população estudada sensível à mudança em favor da adoção da prática de sexo mais seguro mediante participação no grupo operativo. Novos estudos são necessários para avaliar a possibilidade de utilização dessa abordagem nos serviços públicos de saúde e para outras populações.

This study aimed to evaluate the operative group as a preventive approach among men who have sex with men that use two public health services in the city of São Paulo, Brazil. One hundred volunteers were randomly allocated to two groups (intervention and control, with 50 each). All participants answered questionnaires in two phases: before the intervention and six months after its conclusion. Effect was measured by comparing the groups for the following outcomes: median number of anal sex acts without condoms and responses from the participants to questions about HIV infection. 69 participants completed the study (34 in the prevention group and 35 in the control group). Analysis showed a decrease in the number of unprotected anal sex acts (p = 0.029) and an increase in the number of answers favoring prevention in the intervention group. The results indicate that the study group was responsive to a safer sex operative group intervention. Further research is necessary to evaluate the feasibility of this prevention approach as a public health strategy, including other social groups.

In situ assays with tropical cladocerans to evaluate edge-of-field pesticide runoff toxicity.

Tropical regions' economy is usually based on agriculture, which involves an intensive use, and even frequent overuse, of pesticides. Nevertheless, not much research has been done on the impact of pesticides on tropical aquatic ecosystems, which are often contaminated by runoff-related pesticide inputs due to unpredictable and torrential rainfalls. This study aimed to: (i) adapt and evaluate a short-term sublethal in situ assay using post-exposure feeding as an endpoint, to the tropical cladoceran species Diaphanosoma brachyurum (collected at the Pedra do Cavalo dam in the Paraguaçu River basin, Bahia, Brazil), and, (ii) assess the role of the standard species Daphnia magna as an adequate laboratory surrogate. Lethal and sublethal (post-exposure feeding) responses were assessed for the two species. To evaluate these responses under environmentally realistic exposure conditions, a runoff event was simulated in an agricultural area previously contaminated with different deltamethrin concentrations. The resultant runoff water was used to set up microcosms with different dilutions, simulating the entrance of runoff water in an adjacent lentic system. An in situ assay with D. brachyurum was performed inside the microcosms, allowing to discriminate the effects due to deltamethrin from those due to other potential stressors associated with the experimental design (e.g. organism handling, load of suspended particles, microcosm design). Water samples were collected from microcosms to conduct a laboratory assay with D. magna. The in situ methodologies revealed to be suitable to conduct assays with D. brachyurum under tropical conditions, since all exposed organisms were successfully retrieved from the chambers. Furthermore, none of the potential stressors associated with the experimental design influenced the daphnids' performance. The tropical cladoceran species, exposed under more realistic conditions, revealed to be more sensitive than the laboratory standard species: lethal effects were only observed for D. brachyurum and sublethal effects were noticed at a lower deltamethrin concentration for this species than for D. magna.

Correlations between the collagen content of the human left ventricular myocardium, measured by biochemical and morphometric methods.

OBJECTIVE: To assess, in myocardium specimens obtained from necropsies, the correlation between the concentration of hydroxyproline, measured with the photocolorimetric method, and the intensity of fibrosis, determined with the morphometric method. METHODS: Left ventricle myocardium samples were obtained from 45 patients who had undergone necropsy, some of them with a variety of cardiopathies and others without any heart disease. The concentrations of hydroxyproline were determined with the photocolorimetric method. In the histologic sections from each heart, the myocardial fibrosis was quantified by using a light microscope with an integrating ocular lens. RESULTS: A median of, respectively, 4.5 and 4.3 microgram of hydroxyproline/mg of dry weight was found in fixed and nonfixed left ventricle myocardium fragments. A positive correlation occurred between the hydroxyproline concentrations and the intensity of fibrosis, both in the fixed (Sr=+0.25; p=0.099) and in the nonfixed (Sr=+0.32; p=0.03) specimens. CONCLUSION: The biochemical methodology was proven to be adequate, and manual morphometry was shown to have limitations that may interfere with the statistical significance of correlations for the estimate of fibrosis intensity in the human myocardium.

Correlações entre o teor de colágeno no miocárdio ventricular esquerdo humano medido através de métodos / Correlations between the collagen content of the human left ventricular myocardium, measured by biochemical and morphometric methods

OBJECTIVE: To assess, in myocardium specimens obtained from necropsies, the correlation between the concentration of hydroxyproline, measured with the photocolorimetric method, and the intensity of fibrosis, determined with the morphometric method. METHODS: Left ventricle myocardium samples were obtained from 45 patients who had undergone necropsy, some of them with a variety of cardiopathies and others without any heart disease. The concentrations of hydroxyproline were determined with the photocolorimetric method. In the histologic sections from each heart, the myocardial fibrosis was quantified by using a light microscope with an integrating ocular lens. RESULTS: A median of, respectively, 4.5 and 4.3 mug of hydroxyproline/mg of dry weight was found in fixed and nonfixed left ventricle myocardium fragments. A positive correlation occurred between the hydroxyproline concentrations and the intensity of fibrosis, both in the fixed (Sr=+0.25; p=0.099) and in the nonfixed (Sr=+0.32; p=0.03) specimens. CONCLUSION: The biochemical methodology was proven to be adequate, and manual morphometry was shown to have limitations that may interfere with the statistical significance of correlations for the estimate of fibrosis intensity in the human myocardium

Comparación de la seguridad y eficacia de los dispositivos intrauterinos colocados por médicos y personal de enfermería en el Brasil / Comparative study of safety and efficacy of IUD insertions by physicians and nursing personnel in Brazil

Con el objeto de determinar si en el Brasil miembros adiestrados del personal de enfermería podían prestar servicios de inserción de dispositivos intrauterinos (DIU) con el mismo grado de seguridad y eficacia que los médicos, se llevó a cabo un estudio experimental en la clínica principal del Centro de Investigaciones de Atención Integrada a la Mujer y al Niño en Rio de Janeiro. De noviembre de 1984 a abril de 1986, 1711 mujeres que acudieron a la clínica para la inserción de un DIU fueron asignadas aleatoriamente a uno de sus 11 médicos o 13 miembros del personal de enfermería para la inserción de una T de cobre 200. Todos los médicos y miembros del personal de enfermería que prestaron esos servicios habían asistido al curso normal de formación clínica en planificación familiar en el Centro. De las 860 inserciones intentadas por los médicos y por el personal de enfermería, 1,3 y 3,3 porciento, respectivamente, fueron un fracaso, diferencia que resultó muy significativa en términos estadísticos (P0,01). Debido, principalmente, al tamaño pequeño del cuello uterino y a la falta de dilatación, las multíparas tuvieron una tasa de fracaso en la inserción de 8 porciento, cifra relativamente alta en comparación, con la observada en primíparas (1,0 porciento). Se observó una tasa global de complicaciones durante la inserción de 1,8 porciento y entre las complicaciones se observaron diaforesis, vómitos, síncope, laceración cervical y un caso de perforación uterina...(AU)

Se publica en inglés en el Bull. PAHO. Vol. 29(3):206-15, 1995

Comparative study of safety and efficacy of IUD insertions by physicians and nursing personnel in Brazil

This article will also be published in Spanish in the BOSP. Vol. 120(2):87-97, 1996

Flutter atrial com bloqueio de saida do 2§ grau: um indicativo de automatismo ectópico: relato de caso / Atrial flutter with 2§ exit block: an indicative of ectopic automatism: a case report

Os autores apresentam um caso de flutter atrial em um paciente portador de cardiopatia isquêmica, que se alternava com episódios de taquicardia atrial paroxística. Levantam a possibilidade de representarem a mesma arritmia, sendo a taquicardia atrial apenas uma manifestaçäo do flutter atrial em presença de um bloqueio de saída do 2§ grau no foco de origem. Da mesma forma, defendem a teoria do foco octópico na gênese do flutter atrial, baseados na impossibilidade de coexistir uma onda de movimento circular com um bloqueio de saída. Consideraçöes säo feitas a respeito do bloqueio multinível na junçäo atrioventricular (fenômeno de Wenckeach de batimentos alternados) como responsável pela existência de relaçöes de conduçäo AV variáveis e por vezes bizzaras complicando a interpretaçäo destas arritmias. Concluem-se que embora seja o movimento circular intra-atrial o mecanismo eletrofisiológico primordial do flutter atrial, a demonstraçäo de um bloqueio de saída reforça a possibilidade de um foco automático como mecanismo alternativo na gênese desta arritmia