Community-based screening of hepatitis C with a one-step RNA detection algorithm from dried-blood spots: Analysis of key populations in Barcelona, Spain.

Alternative strategies are required to enhance the diagnosis of silent hepatitis C virus (HCV) infections in key populations at risk. Among them, HCV prevalence and bio-behavioural data are scarce for HIV-negative men who have sex with men (MSM) and men and trans-women sex workers. We sought to describe and assess the potential benefits of a community-based one-step HCV screening and confirmatory strategy for these populations in Barcelona. The screening strategy based on a real-time RT-PCR assay for HCV-RNA detection in dried-blood spots (DBS) was validated and implemented in addition to an antibody point-of-care test in a community centre. HCV prevalence was assessed, and bio-behavioural data were collected. The molecular assay was precise, reproducible, sensitive and specific. Four HIV-negative MSM reported being currently infected (0.75% HCV self-reported prevalence). Implementation of DBS testing was easy, and acceptability was >95%, but no silent HCV case was diagnosed (N = 580). High-risk sexual practices and drug use for sex were reported frequently. HIV prevalence was 4.7% in MSM and 10% in sex workers. Self-reported prevalence of other STIs ranged from 11.3% to 36.2%. In conclusion, HCV-RNA testing in DBS showed a good performance, but the assessed one-step strategy does not seem beneficial in this setting. Although no silent HCV infections were detected, the observed high-risk behaviours and prevalence of other STIs suggest that HCV spread should be periodically monitored among these populations in Barcelona by means of behavioural surveillance, rapid antibody testing and molecular confirmation in DBS.

A New Light Trap Model as an Alternative for Controlling Pests in Eucalyptus Plantations.

Eucalyptus plantations can be affected by species of defoliating caterpillars. The integrated management of this group primarily involves a monitoring system, natural enemies, and biological products. Alternative control methods, including the use of conventional light traps, have not been adopted, mostly because of their low efficiency. Therefore, a more efficient light trap model was developed. The new model allowed the capture of 3.6 times as many insects as the conventional model, with a 261% gain in control efficiency. The use of this new model represents another integrated management alternative for lepidopteran pests of eucalyptus plantations and other cultured plants.

Accelerated subcutaneous immunotherapy in pediatric population - Systematic review.

BACKGROUND: Accelerated subcutaneous immunotherapy (SCIT) schedules represent an alternative to conventional SCIT, providing immunotherapy benefits in a shorter period of time. The objectives of this systematic review were to assess clinical and immunological efficacy as well as safety of accelerated SCIT build-up schedules for the treatment of respiratory allergy in pediatric patients. METHODS: Studies were located by searching PubMed, using "immunotherapy" and "desensitization" as keywords. The selection of studies, published from January 1st, 2006, to December 31th, 2015, was performed in two stages: screening of titles and abstracts, and assessment of the full papers identified as relevant, considering the inclusion criteria. Data were extracted in a standardized way and synthesized qualitatively to assess efficacy and safety of accelerated schedules in respiratory allergy. RESULTS: Eleven trials were included: two evaluated rush SCIT and nine assessed cluster SCIT. This review demonstrated that rush and cluster schedules are clinically and immunological efficacious, with faster effect than conventional schedules. No relevant difference with respect to clinical outcomes was noticed between subgroups (pediatric, adult and mixed populations). Regarding safety, most local adverse reactions were mild and there were neither life-threatening systemic reactions nor fatal events. No relevant differences in the incidence and severity of either local or systemic reactions between the accelerated schedule group and control group were registered. CONCLUSIONS: Accelerated SCIT build-up schedules are effective in the treatment of respiratory allergy in pediatric patients, representing a safe alternative to the conventional schedules with the advantage of achieving clinical effectiveness sooner.

How medical education can contribute towards the reduction of maternal mortality in Angola: the teaching/learning process of Gynecology and Obstetrics.

BACKGROUND: In Angola the maternal mortality ratio is among the highest in the world. Medical students are an important target for intervention. OBJECTIVES: To evaluate how students perceive the curricular unit of Gynecology and Obstetrics (G&O) in a public institution of reference in Angola. METHODS: The study involved a sample of 147 students of the faculty of Medicine of the University Agostinho Neto, Luanda, Angola, attending the curricular unit of G&O in the 5th and 6th years of the medical course. Data were obtained through surveys of opinion. The information of the scales was summarized through the construction of scores from the original items using the Principal Components Analysis. RESULTS: Students evaluated positively the curricular unit although emphasizing the lack of human and physical resources. The 5th year scored with higher values Teacher Performance and 6th year Students' Performance. Both years considered to have insufficient skills to meet the learning objectives. CONCLUSION: Constraints were identified in the outcomes of the teaching/learning program. Several points emerged as crucial from this study: widespread the areas of teaching/learning, increase the number and quality of teaching staff, improve the monitoring of students and provide adequate infrastructures and medical equipment to support the teaching/learning program.

Are two items sufficient to screen for depression within the hospital context?

OBJECTIVE: to determine the ability of the reduced form of a screening instrument, the Patient Health Questionnaire-2 (PHQ-2), to assess the presence of depressive disorders in patients admitted to a general hospital. METHOD: A sample of 227 patients admitted to the clinical wards of a Brazilian general university hospital were assessed with Module A of the Diagnostic Structured Interview for the DSM-IV (SCID-IV) and filled out the PHQ-9 and PHQ-2. RESULTS: The PHQ-2 demonstrated an area under the ROC curve of 0.89 (p < 0.0001), with a cutoff point of three or more being the one that best equilibrated the sensitivity (0.86) and specificity (0.75) values. The agreement index between the PHQ-2 and module A of SCID-IV was 78.4% and the Kappa value was 0.51. Regarding reliability, the Cronbach alpha value obtained was 0.64 and the intraclass correlation coefficient was 0.52. CONCLUSION: PHQ-2 proved to be an instrument with good psychometric properties comparable to those of PHQ-9, being superior to the latter regarding the rate of false-positive results. In addition, it is a brief instrument that elicits little resistance on the part of the patient, being inexpensive and requiring little time, thus being of important help to the treatment teams for the detection of depressive disorder, being suitable for incorporation into hospital admission protocols and thus possibly favoring more immediate interventions.

Indicadores físico-químicos e atividade antibacteriana de própolis marrom frente à Escherichia coli / Physico-chemical indicators and antibacterial activity of brown propolis against Escherichia coli

The activity of 23 samples of ethanolic brown propolis, from the State of Mato Grosso, was investigated against Escherichia coli ATCC 25922. The values of physical and chemical parameters showed significant variation among samples. The percentage of dry extract ranged from 2.6 to 27.6 percent. The index of oxidation varied from 3 to 519 seconds. All samples showed the percentage of wax higher than the limit preconized by the legislation, with values varying from 3.4 to 74.6 percent. The quantification of phenolic and flavonoid compounds, responsible for antimicrobial activity, ranged from 0.1 to 5.0 (w/w) and 0.02 to 0.66 (w/w), respectively, being that the higher the index of phenolic compounds the larger the zones of inhibition. Antibacterial activity was observed in seven out of the 23 samples, demonstrating zones of inhibition ranging from 10 to 11.3mm. For these active samples, the minimum inhibitory concentration was determined, ranging from 125 to 1000mg/mL. The value of MIC in 42.9 percent of these samples was 250mg/mL. These results contribute to the establishment of physical and chemical parameters for the regulation of brown propolis and indicate possible therapeutic applicability in the development of formulations for the treatment of infections caused by E. coli.

Adequação de dietas para criação de adultos de Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae) / Suitability of diets for rearing of adults of Chrysoperla externa (Hagen) (Neuroptera: Chrysopidae)

Objetivou-se avaliar a resposta de adultos de Chrysoperla externa alimentados com diferentes dietas. Adultos da geração F2 foram individualizados em gaiolas de PVC e alimentados com lêvedo de cerveja+mel (dieta padrão), lêvedo de cana + mel e extrato de soja + mel (1:1). Os bioensaios foram conduzidos a 25 ? 2º C, 60 ? 10% de UR e fotofase de 12 horas. Avaliou-se, durante 60 dias, o período de pré-oviposição, oviposição diária e total, viabilidade dos ovos e índice de aproveitamento (IA). Verificou-se que a dieta composta por lêvedo de cana + mel foi semelhante à dieta padrão. Também se verificou que as dietas não interferiram sobre o período de pré-oviposição e a viabilidade dos ovos. Apenas para os insetos alimentados com extrato de soja + mel observou-se redução significativa na oviposição diária, oviposição total e índice de aproveitamento. A dieta composta por lêvedo de cana + mel foi adequada para criação de adultos de C. externa podendo ser utilizada em substituição à dieta composta por lêvedo de cerveja + mel.

This work was aimed to evaluate the response of adults of Chrysoperla externa fed different diets. Adults from F2 offspring were individualized in PVC cages and received food, formed by yeast + honey (standard diet), sugarcane yeast + honey and soy extract + honey, at 1:1. The bioassays were conducted at 25 ± 2º C, 60 ± 10% of RH and 12-hour photophase. Over a period of 60 days, evaluations were made of the period of pre-oviposition, daily and total oviposition, the viability of the eggs and the exploitation index (EI). It was verified that the diet containing sugarcane yeast + honey was similar to the standard diet. It was also verified that no diet interfered with the pre-oviposition and egg viability. Only for the insects fed soy extract + honey was there a significant reduction in the values of the daily and total oviposition and the exploitation index. Under the tested conditions and proportions, the diet formed by sugarcane yeast + honey was suitable for the rearing of C. externa adults, and can be used to replace the diet formed by yeast + honey.

Sexually transmitted Chlamydia trachomatis, Neisseria gonorrhoeae, and HIV-1 infections in two at-risk populations in Barcelona: female street prostitutes and STI clinic attendees.

OBJECTIVE: To determine the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and HIV-1 infections in female street prostitutes and STI clinic attendees in Barcelona. DESIGN: This was a prospective study carried out in two four-month periods over two years. Urine specimens were tested for CT and NG using a PCR pooling algorithm. Among street prostitutes HIV-1 testing in urine was also carried out. RESULTS: The prevalences of CT, NG, and HIV-1 in female street prostitutes (n=301) were 4.7%, 3.7%, and 1.0%, respectively. Women from Eastern Europe had the highest prevalence of CT (p=0.01). Prevalences of CT, NG, and HIV-1 among all clinic attendees (n=536) were 4.3%, 4.5%, and 4.4%, respectively. Prevalence of HIV-1 infection among homosexual men was higher compared with heterosexual men and women (p<0.001). CONCLUSIONS: Overall CT prevalence is currently lower than in other European countries, although it could increase as a result of immigration. Rates of HIV-1 and of NG are higher among homosexual than among heterosexual men.

Human anaplasmosis: the first Spanish case confirmed by PCR.

We report a case of human anaplasmosis (HA) fulfilling the confirmation criteria: epidemiologic data and clinical picture compatible with HA; presence of a morulae within polymorphonuclear leukocyte; and positive PCR assay for Anaplasma phagocytophilum: This case report shows the presence of HA in Spain.

All about FAX: a Female Adult voXel phantom for Monte Carlo calculation in radiation protection dosimetry.

The International Commission on Radiological Protection (ICRP) has created a task group on dose calculations, which, among other objectives, should replace the currently used mathematical MIRD phantoms by voxel phantoms. Voxel phantoms are based on digital images recorded from scanning of real persons by computed tomography or magnetic resonance imaging (MRI). Compared to the mathematical MIRD phantoms, voxel phantoms are true to the natural representations of a human body. Connected to a radiation transport code, voxel phantoms serve as virtual humans for which equivalent dose to organs and tissues from exposure to ionizing radiation can be calculated. The principal database for the construction of the FAX (Female Adult voXel) phantom consisted of 151 CT images recorded from scanning of trunk and head of a female patient, whose body weight and height were close to the corresponding data recommended by the ICRP in Publication 89. All 22 organs and tissues at risk, except for the red bone marrow and the osteogenic cells on the endosteal surface of bone ('bone surface'), have been segmented manually with a technique recently developed at the Departamento de Energia Nuclear of the UFPE in Recife, Brazil. After segmentation the volumes of the organs and tissues have been adjusted to agree with the organ and tissue masses recommended by ICRP for the Reference Adult Female in Publication 89. Comparisons have been made with the organ and tissue masses of the mathematical EVA phantom, as well as with the corresponding data for other female voxel phantoms. The three-dimensional matrix of the segmented images has eventually been connected to the EGS4 Monte Carlo code. Effective dose conversion coefficients have been calculated for exposures to photons, and compared to data determined for the mathematical MIRD-type phantoms, as well as for other voxel phantoms.

A contribution to the establishment of reference values for total mercury levels in hair and fish in amazonia.

Studies on mercury levels in the Amazonian Region have typically lacked background or reference parameters. A sectional study on Hg concentration in hair and fish was conducted, together with an assessment of the prevalence of signs and symptoms related to Hg poisoning, in four communities in the Amazon Basin not impacted by gold mining, located either by a river course (Santana do Ituqui and Caxiuanã) or by a lake (Aldeia do Lago Grande and Vila do Tabatinga). Mercury determinations in hair and fish were made by flameless atomic absorption spectrophotometry. Mean total Hg in hair was 4.33 microg/g (0.40-11.60 microg/g) in 321 individuals from Santana do Ituqui, 3.98 microg/g (0.40-11.76 microg/g) for 316 persons in Aldeia do Lago Grande, 5.46 microg/g (0.37-49.85 microg/g) for 504 individuals from Vila do Tabatinga and 8.58 microg/g (0.61-45.59 microg/g) for 203 inhabitants from Caxiuanã. Fish consumption was very high in all those communities but no signs or symptoms associated with Hg poisoning were found. Mean Hg concentration in fish varied from 0.006 to 2.529 microg/g for carnivores and from 0.008 to 0.871 microg/g for noncarnivores. These values suggest that further studies including a larger number of communities would eventually lead to values of "normal" Hg concentration in the Amazonian Region quite above the limits suggested by the World Health Organization.

A voxel-based head-and-neck phantom built from tomographic colored images.

Recent progress in computer speed and medical imaging has made possible the development of a new family of anthropomorphic models, based on a volume elements (voxels) approach to phantom design. Such phantoms can represent details of the anatomical structures of the human body more realistically. Tomographic images (CT or MRI) contain the basic information for the construction of voxel-based phantoms. Use of voxel-based phantoms has its most significant application in the planning of individual patients therapy. To be implemented, results must be obtained in a reasonably short period of time. The segmentation of organs and tissues is a critical step in this process. This article presents a new approach in the construction of voxel-based phantoms that was implemented to simplify the segmentation process of organs and tissues, reducing the time used in this procedure. A voxel-based head and neck phantom, called MCvoxEL, was built using this new approach. The volumes and masses of the segmented organs and tissues were compared with data published by other investigators.

[HIV infection and other sexually-transmitted infections among immigrants in Barcelona]. / Infección por el virus de la inmunodeficiencia humana y otras infecciones de transmisión sexual en inmigrantes de Barcelona*

BACKGROUND: Immigration is a recent phenomenon in Spain. Certain subgroups of the immigrant population may be vulnerable to acquiring sexually transmitted infections (STI). MATERIAL AND METHODS: Descriptive study of the seroprevalenceof certain STI (HIV, hepatitis B and syphilis) and the general characteristicsn of persons tested for HIV infection in a specialized clinic in Barcelona during the year 2000. RESULTS: Seroprevalence of HIV was similar in immigrants and native residents(1.8% vs. 1.7% respectively). However, the seroprevalences of hepatitis B virus (anti-HBc) (19.5% vs. 8.3%) and syphilis (RPR 1 TPHA) (3.2% vs. 1.1%), as well as other STI and the practice of prostitution, were higher in immigrants. CONCLUSIONS: Several STI, including hepatitis B and syphilis, were found more frequently in immigrants than in the native population, whereas HIV seroprevalence was similar in the two groups.

Appropriateness of emergency department visits in a Portuguese university hospital.

STUDY OBJECTIVE: There are no studies in Portugal supporting a common claim that most emergency department visits are inappropriate. The aim of this study was to determine the prevalence of and to evaluate factors associated with an appropriate ED visit in a major public hospital. METHODS: A cross-sectional prospective study was performed at a public university hospital ED. Data for demographic variables, duration of complaint, transfer from other medical sources, and previous medical care for the same complaints were collected by interviewing all patients who arrived at the ED within a consecutive period of at least 24 hours. Data for diagnostic tests, treatment performed, and final patient destination were collected by triage records review. An appropriate ED visit was defined by explicit criteria: interhospital transfer, patient death at the ED, hospitalization, and diagnostic tests or treatments performed. RESULTS: The study included 5,818 adult patients. The prevalence of an appropriate ED visit, by use of our criteria, was 68.7%. Sex was an effect modifier. According to this study, determinants of an appropriate visit for men and women were age 60 years or older and complaints of 24 hours or less and in women but not in men, retired from work and with arrival between midnight and 8 AM. CONCLUSIONS: In a university hospital in Oporto, the majority of ED visits were appropriate according to explicit criteria. Some variables may be associated with appropriateness of ED visits. A duration of the complaint 24 hours or less along with an arrival between midnight and 8 AM in women and age 60 years or older in men were the most important determinants.

Mercury exposures in riverside Amazon communities in Pará, Brazil.

Cross-sectional studies were conducted in three riverside communities in the state of Pará in the Amazon Region of Brazil. Two of these communities, Brasília Legal and São Luís do Tapajós, are located in a watershed exposed to mercury pollution from artisanal gold mining, and the third, Santana do Ituqui, is outside this area. The studies were based upon a community census and included all persons volunteering for participation in each community. All participants were surveyed by questionnaire for health history, occupation, residence, and diet. Clinical evaluations were also done on each subject, along with collection of blood, urine, feces, and hair. Fish samples were collected to represent the most frequently consumed species. Mercury was measured in hair and fish. Although no signs or symptoms of overt mercury intoxication were observed, persons in Brasília Legal and São Luís do Tapajós had higher levels of mercury in hair than residents of Santana de Ituqui, located out of the risk area. Levels of mercury in fish were below Brazilian health guidance limits, but the high rates of fish consumption among these populations raise concerns for the possible effects of chronic exposure, especially among young children and women of childbearing age.

[Diagnosis of health conditions in a pan-mining community in the Tapajós River Basin, Itaituba, Par , Brazil, 1992]. / Diagnóstico das condições de saúde de uma comunidade garimpeira na regiõ o do Rio Tapajós, Itaituba, Pará, Brasil, 1992.

The purpose of this article is to describe health conditions in a pan-mining community, in particular the interaction of mercury contamination with other health problems. This study was carried out in a panning mine located on Rato Creek, a tributary of the Tapajó s River Basin in the municipality of Itaituba, State of Par The study population consisted of 223 individuals. An epidemiological questionnaire was applied, medical treatment was given, and biological specimens were collected. Testing of fecal samples showed that 96.1% of the individuals had parasites and 66.4% were anemic. Prevalence of hepatitis B virus was 85.0%, and 11 individuals (6.0%) were virus carriers (HBsAg positive). Of 186 patients tested for malaria, 65 individuals (35.0%) had the infection, of whom 34 (52.3%) were asymptomatic. Prevalence of syphillis was 41.6%. Urine mercury levels were measured in 173 individuals. Some 16 (9.2%) of those tested had mercury levels between 10 and 19 ug/l, while 9 patients (5.2%) had levels above 20 ug/l. An overview of general health conditions showed a combination of problems in individuals, who lacked adequate diagnosis, in addition to a high level of self-medication, given the absence of health facilities. In addition, these individuals are threatened by critical levels of mercury contamination. In conclusion, this article gives a general overview of health conditions in these pan-mining communities, demonstrating the multicausal nature of health conditions in the Amazon region, a fact which should be considered when planning appropriate strategies for clinical treatment.

Effects of frequency and duration of exercise sessions on physical activity levels and adherence.

The purpose of this study was to assess the relations among physical activity, adherence, and frequency and duration of exercise sessions for 33 male and female sedentary university students. Analysis indicated that frequency and duration of the exercise program did not significantly affect adherence. However, frequency and duration of the exercise sessions did significantly affect leisure activity once the structured exercise program terminated.

Disturbios motores gastroesofagianos / Gastroesophageal motors disorders

Neste trabalho de atualizaçao foram selecionadas patologias importantes que apresentam disturbios motores esofagianos e ou gastricos entre as suas manifestaçoes clinicas, com implicaçoes diagnosticas e terapeuticas.As patologias aqui estudadas sao de grande importancia na pratica medica diaria.