Recurrent COVID-19 including evidence of reinfection and enhanced severity in thirty Brazilian healthcare workers.

BACKGROUND: There is growing concern about individuals reported to suffer repeat COVID-19 disease episodes, these in a small number of cases characterised as de novo infections with distinct sequences, indicative of insufficient protective immunity even in the short term. METHODS: Observational case series and case-control studies reporting 33 cases of recurrent, symptomatic, qRT-PCR positive COVID-19. Recurrent disease was defined as symptomatic recurrence after symptom-free clinical recovery, with release from isolation >14 days from the beginning of symptoms confirmed by qRT-PCR. The case control study-design compared this group of patients with a control group of 62 patients randomly selected from the same COVID-19 database. RESULTS: Of 33 recurrent COVID-19 patients, 26 were female and 30 were HCW. Mean time to recurrence was 50.5 days which was associated with being a HCW (OR 36.4 (p <0.0001)), and blood type A (OR 4.8 (p = 0.002)). SARS-CoV-2 antibodies were signifcantly lower in recurrent patients after initial COVID-19  (2.4 ±â€¯0.610; p<0.0001) and after recurrence (6.4 ±â€¯11.34; p = 0.007).  Virus genome sequencing identified reinfection by a different isolate in one patient. CONCLUSIONS: This is the first detailed case series showing COVID-19 recurrence with qRT-PCR positivity. For one individual detection of phylogenetically distinct genomic sequences in the first and second episodes confirmed bona fide renfection, but in most cases the data do not formally distinguish between reinfection and re-emergence of a chronic infection reservoir. These episodes were significantly associated with reduced Ab response during initial disease and argue the need for ongoing vigilance without an assumption of protection after a first episode.

Modulation of interleukin expression by medicinal plants and their secondary metabolites: A systematic review on anti-asthmatic and immunopharmacological mechanisms.

BACKGROUND: Asthma is one of the most common chronic inflammatory conditions of the lungs in modern society. Asthma is associated with airway hyperresponsiveness and remodeling of the airways, with typical symptoms of cough, wheezing, shortness of breath and chest tightness. Interleukins (IL) play an integral role in its inflammatory pathogenesis. Medicinal herbs and secondary metabolites are gaining considerable attention due to their potential therapeutic role and pharmacological mechanisms as adjunct tools to synthetic bronchodilator drugs. PURPOSE: To systematically review the literature on the use of single or mixed plants extracts therapy in vivo experimental systems for asthma, emphasizing their regulations on IL production to improve lung. METHODS: Literature searches were performed on PubMed, EMBASE, Scopus and Web of Science databases. All articles in English were extracted from 1999 up to September 2019, assessed critically for data extraction. Studies investigating the effectiveness and safety of plant extracts administered; inflammatory cell count, immunoglobulin E (IgE) production and regulation of pro-inflammatory cytokine and T helper (Th) 1 and Th2-driven cytokine expression in bronchoalveolar lavage fluid (BALF) and lung of asthmatic animals were included. RESULTS: Four hundred and eighteen publications were identified and 51 met the inclusion criteria. Twenty-six studies described bioactive compounds from plant extracts. The most frequent immunopharmacological mechanisms described included reduction in IgE and eosinophilic recruitment, decreased mucus hypersecretion and airway hyperreactivity, enhancement of the balance of Th1/Th2 cytokine ratio, suppression of matrix metallopeptidase 9 (MMP-9) and reversal of structural alterations. CONCLUSION: Plant extract therapies have potential control activities on asthma symptoms by modulating the secretion of pro-inflammatory (IL-1ß, IL-8), Th17 (IL-17), anti-inflammatory (IL-10, IL-23, IL-31, IL-33), Th1 (IL-2, IL-12) and Th2 (IL-4, IL-5, IL-6, IL-13) cytokines, reducing the level of biomarkers of airway inflammation.

Ocular Findings in Infants with Microcephaly Caused by Presumed Congenital Infection by Zika Virus in Sergipe.

This study aims at identifying ocular findings in infants with microcephaly associated with presumed intrauterine infection by ZIKV. A cross-sectional study included 62 outpatient infants with congenital microcephaly, presumably secondary to maternal ZIKV infection. The included infants had head circumference below -2 standard deviations, with negative maternal serology for toxoplasmosis, rubella, cytomegalovirus, syphilis, and HIV. Assessment of ocular alterations was performed through review of their medical records. Forty two (67.7%) of the children analyzed presented some degree of ocular alteration. Findings in the posterior segment occurred in 29 (46.8%) patients, including atrophy of the retinal pigmentary epithelium in 15 (24.2%) patients, chorioretinal scars in 14 (22.6%) patients, retinal coloboma in 6 (9.7%) patients, and punctate retinal hemorrhage in 1 (1.6%) patient. Other ocular alterations were seen in 15 (24.2%) patients, including pathological strabismus in 11 (17.7%) patients, congenital cataracts in 2 (3.2%) patients, and nystagmus in 2 (3.2%) patients. Functional alterations were seen in four (6.5%) children. More than one change occurred in 11 (17.7%) children, eight of whom had head circumferences below -3 standard deviations. Changes in both the eyes occurred in 22 (35.5%) children, while 20 (32.3%) children had unilateral involvement. Among the 42 children with any ocular alteration, 27 (64.3%) children presented with severe microcephaly (head circumference with standard deviation lower than -3). The majority of children with microcephaly, presumably secondary to maternal ZIKV infection, present ocular alterations, with a higher frequency of involvement in the fundus. Severe ocular alterations are related to severe microcephaly.

Pulmonary involvement in human visceral leishmaniasis: Clinical and tomographic evaluation.

Visceral leishmaniasis (VL) is a severe, systemic and potentially lethal parasitosis. The lung, like any other organ, can be affected in VL, and interstitial pneumonitis has been described in past decades. This research aimed to bring more recent knowledge about respiratory impairment in VL, characterizing pulmonary involvement through clinical, radiographic and tomographic evaluation. This is an observational, cross-sectional study that underwent clinical evaluation, radiography and high-resolution computed tomography of the chest in patients admitted with the diagnosis of VL in a university service in Northeast Brazil, from January 2015 to July 2018. The sample consisted of 42 patients. Computed tomography was considered abnormal in 59% of patients. Images compatible with pulmonary interstitial involvement were predominant (50%). The most observed respiratory symptom was cough (33.3%), followed by tachypnea (14.1%). Chest radiography was altered in only four patients. VL is a disease characterized by systemic involvement and broad spectrum of clinical manifestations. The respiratory symptoms and tomographic alterations found show that the involvement of respiratory system in VL deserves attention because it is more common than previously thought. Chest X-ray may not reveal this impairment.

Coronary lesions in patients with COPD (Global Initiative for Obstructive Lung Disease stages I-III) and suspected or confirmed coronary arterial disease.

Background: Systemic inflammation is the pathophysiological link between coronary artery disease (CAD) and COPD. However, the influence of subclinical COPD on patients with suspected or diagnosed CAD is largely unknown. Thus, this study was designed to evaluate the degree of coronary involvement in patients with COPD and suspected or confirmed CAD. Methods: In this cross-sectional study, carried out between March 2015 and June 2017, 210 outpatients with suspected or confirmed CAD were examined by both spirometry and coronary angiography or multidetector computed tomography. These patients were divided into two groups: with and without COPD. Size, site, extent, and calcification of the coronary lesions, and the severity of COPD were analyzed. Results: COPD patients (n = 101) presented with a higher frequency of obstructive coronary lesions ≥50% (n = 72, 71.3%), multivessels (n = 29, 28.7%), more lesions of the left coronary trunk (n = 18, 17.8%), and more calcified atherosclerotic plaques and higher Agatston coronary calcium score than the patients without COPD (P < 0.0001). The more severe the COPD in the Global Initiative for Obstructive Lung Disease stages, the more severe the CAD and the more calcified coronary plaques (P < 0.0001). However, there was no difference between the two groups with respect to the main risk factors for CAD. In the univariate analysis, COPD was an independent predictor of obstructive CAD (odds ratio [OR] 4.78; 95% confidence interval: 2.21-10.34; P < 0.001). Conclusion: In patients with suspected CAD, comorbid COPD was associated with increased severity and extent of coronary lesions, calcific plaques, and elevated calcium score independent of the established risk factors for CAD. In addition, the more severe the COPD, the greater the severity of coronary lesions and calcification present.

Stomatognathic evaluation at five years of age in children born premature and at term.

BACKGROUND: The high frequency of alterations of the stomatognathic system associated with premature birth may suggest that prematurity is an important risk factor in the development of this system. Prematurity has an incidence between 6-11% of births and is associated with factors such as genetic, maternal conditions (obstetric problems, nutritional status, infections) and antenatal care. In addition, undesirable situations, such as changes in enamel and the development of the skeletal structure, also appears to be associated with prematurity. This study aimed to look for changes in the stomatognathic system at five years of age associated with premature birth. METHODS: We estimated the prevalence of developmental disorders of the stomatognathic system in the primary dentition of preschool children at five years of age. Changes in preterm infants (n = 32) compared with term born (n = 381) were evaluated . Clinical examinations and questionnaire with sociodemographic and health of mothers and children information. Gestational age, birth weight, head circumference, Apgar score and mechanical ventilation, were collected from the medical records to birth records. The explanatory variable was preterm (<37 weeks gestational age). RESULTS: Prevalence of 7.7% of preterm infants was found. Of these, 40.6% had atresic palate, 56.2% malocclusion and 21.8% enamel hypoplasia. Forty (9.6%) children were not breastfed at the breast, and 26 (65.0%) had some type of malocclusion, showing association between not breastfeeding with an abnormal development of the stomatognathic system. The group of preterm infants showed five times more changes in head circumference and three times more mechanical ventilation use at birth. Change in head circumference at birth and mechanical ventilation has a significant association between groups of preterm and term infants. CONCLUSIONS: Mechanical ventilation at birth directly contributed to an increased risk of developmental disorders of the stomatognathic system in preterm infants, especially dental hypoplasia. Non-breastfed children had a higher risk of developing malocclusion. Alterations in head circumference were related effective on dental malocclusion. The results suggest that changes in the stomatognathic system are influenced by premature birth and points to the imperative need of using methods of preventive.

Is adolescent pregnancy a risk factor for low birth weight?

OBJECTIVE: The objective of this study was to evaluate whether adolescent pregnancy is a risk factor for low birth weight (LBW) babies. METHODS: This was a cross-sectional study of mothers and their newborns from a birth cohort in Aracaju, Northeastern Brazil. Data were collected consecutively from March to July 2005. Information collected included socioeconomic, biological and reproductive aspects of the mothers, using a standardized questionnaire. The impact of early pregnancy on birth weight was evaluated by multiple logistic regression. RESULTS: We studied 4,746 pairs of mothers and their babies. Of these, 20.6% were adolescents (< 20 years of age). Adolescent mothers had worse socioeconomic and reproductive conditions and perinatal outcomes when compared to other age groups. Having no prenatal care and smoking during pregnancy were the risk factors associated with low birth weight. Adolescent pregnancy, when linked to marital status "without partner", was associated with an increased proportion of low birth weight babies. CONCLUSIONS: Adolescence was a risk factor for LBW only for mothers without partners. Smoking during pregnancy and lack of prenatal care were considered to be independent risk factors for LBW.

Is adolescent pregnancy a risk factor for low birth weight? / Gravidez na adolescência é fator de risco para o baixo peso ao nascer? / Embarazo en la adolescencia es factor de riesgo para el bajo peso al nacer?

OBJECTIVE: The objective of this study was to evaluate whether adolescent pregnancy is a risk factor for low birth weight (LBW) babies. METHODS: This was a cross-sectional study of mothers and their newborns from a birth cohort in Aracaju, Northeastern Brazil. Data were collected consecutively from March to July 2005. Information collected included socioeconomic, biological and reproductive aspects of the mothers, using a standardized questionnaire. The impact of early pregnancy on birth weight was evaluated by multiple logistic regression. RESULTS: We studied 4,746 pairs of mothers and their babies. Of these, 20.6% were adolescents (< 20 years of age). Adolescent mothers had worse socioeconomic and reproductive conditions and perinatal outcomes when compared to other age groups. Having no prenatal care and smoking during pregnancy were the risk factors associated with low birth weight. Adolescent pregnancy, when linked to marital status "without partner", was associated with an increased proportion of low birth weight babies. CONCLUSIONS: Adolescence was a risk factor for LBW only for mothers without partners. Smoking during pregnancy and lack of prenatal care were considered to be independent risk factors for LBW.

OBJETIVO: Avaliar a gravidez na adolescência como fator de risco para baixo peso ao nascer. MÉTODOS: Estudo transversal incluído numa coorte de puérperas e seus respectivos recém-nascidos, nas quatro maternidades de Aracaju, SE, de março a julho de 2005. Os dados foram coletados consecutivamente durante quatro meses. Variáveis sociais, biológicas e assistenciais foram obtidas por meio de questionário padronizado. Foi realizada regressão logística múltipla, com controle de fatores de confusão e de modificação. RESULTADOS: Foram estudados 4.746 pares de mães/recém-nascidos. Dessas, 20,6% eram adolescentes (< 20 anos). As mães adolescentes apresentaram piores condições socioeconômicas, reprodutivas e resultados perinatais mais adversos, quando comparadas com outros grupos etários. Foram identificados como fatores de risco associados ao baixo peso ao nascer a ausência de assistência no pré-natal e tabagismo na gestação. Identificou-se interação da idade materna com a situação conjugal: mães adolescentes sem companheiro tiveram maiores proporções de baixo peso ao nascer. CONCLUSÕES: A adolescência mostrou-se fator de risco para baixo peso ao nascer entre as mães sem companheiro. Tabagismo durante a gestação e ausência de assistência pré-natal associam-se ao baixo peso ao nascer.

OBJETIVO: Evaluar el embarazo en la adolescencia como factor de riesgo para bajo peso al nacer. MÉTODOS: Estudio transversal incluido en una cohorte de puérperas y sus respectivos recién nacidos, en las cuatro maternidades de Aracaju, SE (Brasil), de marzo a julio de 2005. Se estudiaron 4.646 pares de madres/recién nacidos. Los datos se colectaron consecutivamente durante cuatro meses. Variables sociales, biológicas y asistenciales se obtuvieron por medio de cuestionario estandarizado. Se realizó regresión logística múltiple, con control de factores de confusión y de modificación. RESULTADOS: Del total analizadas, 20,6% eran adolescentes (<20 años). Las madres adolescentes presentaron peores condiciones socioeconómicas, reproductivas y resultados perinatales más adversos, al compararse con otros grupos etarios. Se identificaron como factores de riesgo asociados al bajo peso al nacer, la ausencia de asistencia en el prenatal y tabaquismo en la gestación. Se identificó interacción de la edad materna con la situación conyugal: madres adolescentes sin compañero tuvieron mayores proporciones de bajo peso al nacer. CONCLUSIONES: La adolescencia se mostró como factor de riesgo para bajo peso al nacer entre las madres sin compañero. Tabaquismo durante la gestación y ausencia de asistencia prenatal se asocian al bajo peso al nacer.

Asthma and pregnancy: repercussions for neonates.

OBJECTIVE: To describe socioeconomic and behavioral aspects of pregnant women with asthma and to analyze the effects of maternal asthma on certain perinatal parameters in a birth cohort. METHODS: An observational crosssectional analytical study using data regarding the mothers of a birth cohort at maternity hospitals in the greater metropolitan area of Aracaju, Brazil, between the 8th of March and the 15th of July of 2005. In the pregnant women, asthma was self-reported, based on previous medical diagnosis. Epidemiological, obstetric and perinatal variables were studied. RESULTS: Of the 4,757 mothers included in the study, 299 (6.3%) had asthma. The mothers with asthma had lower family incomes and more frequently made use of the public health care system (for prenatal care and delivery) than did those without asthma. Although only 9.4% of the mothers with asthma smoked and only 27.6% consumed alcoholic beverages, these proportions were higher than were those observed for the control group. Asthma was not found to be associated with obstetric problems or with problems involving the neonates. Nor did we find asthma to be associated with cesarean delivery, prematurity or small-for-gestational-age neonates. CONCLUSIONS: Low socioeconomic level seems to be a risk factor for asthma.

Asma e gravidez: repercussões no recém-nascido / Asthma and pregnancy: repercussions for neonates

OBJETIVO: Descrever, numa coorte de nascimentos, aspectos socioeconômicos e comportamentais de gestantes com asma e analisar as repercussões desta sobre alguns parâmetros perinatais. MÉTODOS: Estudo observacional, transversal e analítico a partir de informações de parturientes da coorte de nascimentos ocorridos no período entre 8 de março e 15 de julho de 2005 nas maternidades da Grande Aracaju (SE). A identificação de asma nas gestantes foi obtida segundo informação destas a partir do diagnóstico emitido anteriormente por um médico. Foram analisadas variáveis epidemiológicas, obstétricas e perinatais. RESULTADOS: Das 4.757 parturientes incluídas no estudo, 299 (6,3 por cento) eram asmáticas. As mães asmáticas tinham menor renda familiar e mais frequentemente procuraram assistência no pré-natal e no parto em serviços públicos que as mães sem asma. Embora somente 9,4 por cento das gestantes asmáticas fumaram, e 27,6 por cento ingeriram bebidas alcoólicas, as proporções em relação ao grupo controle foram significativamente maiores. Não se detectou associação entre asma e problemas obstétricos ou do recém-nascido. Não foi encontrada associação entre asma e parto cesariano, prematuridade ou recém-nascido sendo pequeno para a idade gestacional. CONCLUSÕES: O nível socioeconômico inferior parece ser um fator de risco para a asma.

OBJECTIVE: To describe socioeconomic and behavioral aspects of pregnant women with asthma and to analyze the effects of maternal asthma on certain perinatal parameters in a birth cohort. METHODS: An observational crosssectional analytical study using data regarding the mothers of a birth cohort at maternity hospitals in the greater metropolitan area of Aracaju, Brazil, between the 8th of March and the 15th of July of 2005. In the pregnant women, asthma was self-reported, based on previous medical diagnosis. Epidemiological, obstetric and perinatal variables were studied. RESULTS: Of the 4,757 mothers included in the study, 299 (6.3 percent) had asthma. The mothers with asthma had lower family incomes and more frequently made use of the public health care system (for prenatal care and delivery) than did those without asthma. Although only 9.4 percent of the mothers with asthma smoked and only 27.6 percent consumed alcoholic beverages, these proportions were higher than were those observed for the control group. Asthma was not found to be associated with obstetric problems or with problems involving the neonates. Nor did we find asthma to be associated with cesarean delivery, prematurity or small-for-gestational-age neonates. CONCLUSIONS: Low socioeconomic level seems to be a risk factor for asthma.

[Respiratory functional characteristics of human leptospirosis]. / Aspectos funcionais respiratórios na leptospirose humana.

INTRODUCTION: Respiratory impairment may be the main clinical manifestation of human leptospirosis. METHODS: With the aim of describing the respiratory functional characteristics of this disease, 21 patients were evaluated using pulse oximetry and spirometry at two times: an initial evaluation and after around 28 days. RESULTS: Two (9.5%) patients presented peripheral oxygen saturation of less than 95%. Normal spirometric patterns were observed in eight (38.1%); cases restrictive ventilatory disorders were inferred in seven (33.3%), obstructive disorders with reduced forced vital capacity in four (19%), and nonspecific disorders in two (9.5%). Abnormal spirometry findings were associated with worse APACHE II scores (p = 0.02) and abnormalities on chest x-ray (p = 0.05). After clinical resolution, significant functional gain was observed (p < 0.05) in the group of patients with abnormal spirometry findings. CONCLUSIONS: It was concluded that respiratory functional abnormalities were detected during the course of the disease and were associated with greater clinical severity and higher frequency of chest radiographic abnormalities.

Aspectos funcionais respiratórios na leptospirose humana / Respiratory functional characteristics of human leptospirosis

INTRODUÇÃO: O comprometimento respiratório da leptospirose humana pode ser sua principal manifestação clínica e comumente está associado a maior morbimortalidade. MÉTODOS: Objetivando descrever aspectos funcionais respiratórios nessa doença, foram analisados 21 pacientes com oximetrias de pulso e espirometrias em dois momentos: em avaliação inicial e após cerca de 28 dias. RESULTADOS: Dois (9,5 por cento) doentes tinham saturação periférica de oxigênio menor que 95 por cento. Padrões espirométricos normais foram observados em 8 (38,1 por cento) casos; distúrbios ventilatórios restritivos foram inferidos em 7 (33,3 por cento), obstrutivos com capacidade vital forçada reduzida em 4 (19 por cento), e inespecíficos em 2 (9,5 por cento). Espirometrias anormais se associaram a pior escore APACHE II (p=0,02) e anormalidades na radiografia de tórax (p=0,05). Após resolução clínica, verificou-se ganho funcional significativo (p<0,05) no grupo de pacientes com espirometria alterada. CONCLUSÕES: Alterações espirométricas foram detectadas no curso da enfermidade e estiveram associadas a pior gravidade clínica e maior freqüência de anormalidades radiológicas torácicas.

INTRODUCTION: Respiratory impairment may be the main clinical manifestation of human leptospirosis. METHODS: With the aim of describing the respiratory functional characteristics of this disease, 21 patients were evaluated using pulse oximetry and spirometry at two times: an initial evaluation and after around 28 days. RESULTS: Two (9.5 percent) patients presented peripheral oxygen saturation of less than 95 percent. Normal spirometric patterns were observed in eight (38.1 percent); cases restrictive ventilatory disorders were inferred in seven (33.3 percent), obstructive disorders with reduced forced vital capacity in four (19 percent), and nonspecific disorders in two (9.5 percent). Abnormal spirometry findings were associated with worse APACHE II scores (p = 0.02) and abnormalities on chest x-ray (p = 0.05). After clinical resolution, significant functional gain was observed (p < 0.05) in the group of patients with abnormal spirometry findings. CONCLUSIONS: It was concluded that respiratory functional abnormalities were detected during the course of the disease and were associated with greater clinical severity and higher frequency of chest radiographic abnormalities.

Características das gestações, partos e recém-nascidos da região metropolitana de Aracaju, Sergipe, Brasil / Characteristics of pregnancies, deliveries and newborns in the Metropolitan Region of Aracaju, State of Sergipe, Brazil

OBJECTIVES: to describe the characteristics of pregnancies, deliveries and the status of newborns at birth in the Metropolitan Area of Aracaju. The main demographic and socioeconomic characteristics and details of the medical care given to the population under study are presented. METHODS: a cross-sectional study was carried out of all deliveries in the maternity hospitals of Aracaju, in the State of Sergipe, Brazil, from March-July 2005. All mothers who gave birth to a single live baby were interviewed regarding their background, reproductive history and sexual life. Hospital records, including the babies' weight, height and cephalic perimeter, were obtained and all information transferred to a standardised questionnaire. Data were compared to equivalent findings from other studies in Brazil. RESULTS: there were 4746 single live births during the study period in Aracaju. The majority of mothers (69 percent) were considered poor (income <3 minimum wages). Adolescent mothers comprised 20.6 percent of the population. The figures for low birth-weight (7.2 percent) and prematurity (7.7 percent) were similar. Almost all mothers (98.3 percent) received prenatal care, 76.0 percent from public services - the Sistema Único de Saúde (SUS) -which financed most deliveries. Caesarean sections accounted for 31.6 percent of all deliveries. CONCLUSIONS: deliveries in Aracaju's showed good performance with a lower rate for Caesarean sections, prematurity, and low birth-weight than Ribeirão Preto, São Luís and Pelotas. Perinatal health planning may benefit from this kind of study.

OBJETIVOS: descrever as características das gestações, partos e nascimentos da região metropolitana de Aracaju. As principais características demográficas e socioeconômicas e de atenção à saúde da população foram avaliadas. MÉTODOS: estudo transversal dos nascimentos ocorridos entre março e julho de 2005, procedentes da região metropolitana de Aracaju, Sergipe, Brasil. Todas as mães que tiveram parto único nascido vivo foram entrevistadas através de um questionário estruturado, com informações sobre as condições demográficas, socioeconômicas, história sexual/reprodutiva. Registros do peso, comprimento e perímetro cefálico das crianças foram transferidos para o questionário. Foi feita comparação com outros estudos brasileiros de características semelhantes. RESULTADOS: foram analisados 4746 nascimentos de parto único de Aracaju, com 69 por cento das mães referindo renda inferior a três salários mínimos. As mães adolescentes representaram 20,6 por cento da amostra. Entre todos os nascimentos, 7,7 por cento tiveram duração inferior a 37 semanas, percentual semelhante ao de baixo peso ao nascer (7,2 por cento). Prevaleceu a assistência pré-natal oferecida pelo Sistema Único de Saúde (SUS) (76,0 por cento), que custeou 85,2 por cento dos partos. Destes, 31,6 por cento foram cesáreas. CONCLUSÕES: o estudo mostrou menores percentuais de partos cesária, prematuridade e baixo peso ao nascer que os encontrados em Ribeirão Preto, São Luís e Pelotas. Estudos como este podem ser muito úteis ao planejamento de saúde perinatal.

alpha1-acid glycoprotein and alpha1-antitrypsin as early markers of treatment response in patients receiving the intensive phase of tuberculosis therapy.

The identification of early markers that predict the response to anti-tuberculosis treatment would facilitate evaluation of new drugs and improve patient management. This study aimed to determine whether selected acute phase proteins and micronutrients measured at the time of diagnosis and during the first weeks of treatment could predict treatment responses during the 2-month standard intensive phase of therapy. For this purpose, alpha1-antitrypsin, alpha1-acid glycoprotein, alpha2-macroglobulin, C-reactive protein, C3, C4, zinc, copper and selenium concentrations were measured in Brazilian patients with smear-positive tuberculosis at the time of diagnosis and 1, 3, 5 and 8 weeks after initiation of therapy. Patients were classified into fast (n=29), intermediate (n=18) and slow responders (n=10) if they were smear-negative at 3, 5 or 8 weeks of treatment. alpha1-acid glycoprotein on enrolment and 1 week of treatment, alpha1-antitrypsin at week 1 and C-reactive protein and C3 after 3 weeks of therapy were higher in slow responders than in fast responders. alpha1-antitrypsin and alpha1-acid glycoprotein may be helpful in predicting treatment response at the time of initiation of therapy, and could be used as early markers to identify patients with an increased likelihood of treatment failure.

Tuberculosis of the cystic duct lymph node.

Tuberculosis of the cystic duct lymph node associated with cholelithiasis is rare. We report a case of a 40 year-old woman with this pathology. She presented with anorexia, biliary colic, postprandial fullness and fever. Imaging studies revealed cholelithiasis and several visible portal lymph nodes. Cholecystectomy was performed and histopathological examination showed tuberculosis of the cystic duct lymph node without affecting the gallbladder. The presence of gallstones and lymphadenopathy in computed tomography, associated with persistent fever and symptoms that resemble cholecystitis, should cause suspicion of tuberculosis. However, diagnosis is usually achieved by microscopic appearance of caseating granulomas and isolation of Mycobacterium tuberculosis. The treatment in this case consisted of cholecystectomy and antitubercular chemotherapy.

Tuberculosis of the cystic duct lymph node

Tuberculosis of the cystic duct lymph node associated with cholelithiasis is rare. We report a case of a 40 year-old woman with this pathology. She presented with anorexia, biliary colic, postprandial fullness and fever. Imaging studies revealed cholelithiasis and several visible portal lymph nodes. Cholecystectomy was performed and histopathological examination showed tuberculosis of the cystic duct lymph node without affecting the gallbladder. The presence of gallstones and lymphadenopathy in computed tomography, associated with persistent fever and symptoms that resemble cholecystitis, should cause suspicion of tuberculosis. However, diagnosis is usually achieved by microscopic appearance of caseating granulomas and isolation of Mycobacterium tuberculosis. The treatment in this case consisted of cholecystectomy and antitubercular chemotherapy.

Cirurgia valvar na infância: um novo aspecto de açäo / Valvular surgery in childhood: a new aspecto of action

De janeiro de 1978 a dezembro de 199l, 148 crianças (idade igual ou menor a 15 anos) foram operadas pela primeira vez, para correçao de defeitos adquiridos (doença reumática) em uma das valvas cardíacas. A casuística foi dividida em duas épocas, demarcadas pela determinaçao do Serviço em preservar o maior número possível das valvas tratadas, em especial, nesse grupo de pacientes. No último ano, foram operadas 24 crianças, nas quais a valva mitral foi abordada 20 vezes e a aórtica 8 vezes. O índice de aproveitamento da valva mitral foi de 95 por cento (28 por cento no período anterior) e da valva aórtica 62 por cento (20 por cento no período anterior). A mortalidade global foi de 8 por cento no período anterior e nao houve óbitos no último ano da experiência. Nenhum paciente apresentou qualquer complicaçao e todos evoluíram satisfatoriamente. Concluímos que, com determinaçao, é possível preservar a maior parte das valvas acometida por doença reumática na infância e sugerimos que a indicaçao cirúrgica deva ser o mais precoce possível, para evitar alteraçoes no aparelho valvar secundárias à disfunçao, bem como um seguimento tardio efetivo mais duradouro, para julgar se a plastia é realmente superior à substituiçao valvar em pacientes jovens com doença reumática.

Endomiocardiofibrose: tratamento cirúrgico / Endomyocardial fibrosis: surgical treatment

Os autores analisam a experiência adquirida no tratamento cirúrgico da endomiocardiofibrose. Dos quinze pacientes operados nove tinham comprometimento biventricular, quatro do ventrículo direito e dois do ventrículo esquerdo. A cirurgia consistiu em descortificaçäo dos ventrículos (direito em 4, esquerdo em 2 e biventricular em 9) mais substituiçäo das valvas atrioventriculares comprometidas (mitra em 2, tricúspide em 6 e mitrotricuspídea em 7). Em um paciente havia obstruçäo importante da descendente anterior e foi colocada uma ponte de safena. Em três pacientes havia estenose mitral reumática associada. Houve um óbito operatório e três tardios (13,24, 37 meses). Dois pacientes necessitaram de reoperaçäo. O 1§, 33 meses após, para substituiçäo da valva mitral que havia sido preservada no 1§ procedimento e o 2§, 12 meses após por ter apresentado comunicaçäo interventricular por rotura do septo enfraquecido. Dos pacientes operados, onze estäo vivos e, todos menos um, evoluem satisfatoriamente. A análise detalhada do material permite concluir: 1§) a utilizaçäo sistemática do eco bidimensional em pacientes de alto risco, deverá facilitar o diagnóstico precoce em um número crescente de pacientes; 2§) o tratamento cirúrgico deve ser precoce para evitar as lesöes cardíacas e extracardíacas decorrentes da manutençäo da doença; 3§) a valva a ser utilizada deve ser de baixo perfil; 4§) näo existe, até o momento, indícios de recidiva; 5§) o tratamento cirúrgico interfere favoravelmente na...