Comparative analysis of diagnostic methods and risk factors for Aelurostrongylus abstrusus infection in brazilian cats.

This study aimed to prospectively evaluate the risk factors of infection by Aelurostrongylus abstrusus in Brazilian cats with cough and/or radiographic changes, using as diagnostic tools the Baermann method (BM), polymerase chain reaction (PCR) of feces, bronchoalveolar lavage fluid (BALF), and cytology. Forty-three cats that were presented with cough or lung radiographic abnormalities compatible with bronchoalveolar disease were included in the study. After clinical evaluation, feces samples were collected to investigate lungworm parasitism through BM and PCR. BALF was performed to provide samples for cytology, bacteriology, and fungal culture. Stool PCR was considered the gold standard for diagnosis tests, and the other methods were evaluated by their agreement. PCR presented 74% (32/43) of positivity for A. abstrusus, while in the BM, 41% (18/43) were positive. BM showed sensitivity of 56.25% and specificity of 100% when compared with PCR. No larva was found in the cytological evaluation of 21 BALF samples. Lungworm is an important cause of bronchopulmonary disease in domestic cats in Brazil and should be included as a differential diagnosis when a cat is presented with cough or radiographic abnormalities. BM is a sensitive, non-invasive, and cheap technique to diagnose the disease, but it is not as sensitive as PCR.

Antimicrobial resistance of Pseudomonas aeruginosa isolated from patients with pneumonia during the COVID-19 pandemic and pre-pandemic periods in Northeast Brazil.

Healthcare-related infections caused by resistant microorganisms are a severe public health problem and are becoming increasingly prevalent in the hospital environment, especially Pseudomonas aeruginosa. This work aimed to evaluate the resistance profile of Pseudomonas aeruginosa to antimicrobials before the COVID-19 pandemic and during the pandemic period. Bacteria strains were obtained from tracheal aspiration, sputum, and bronchoalveolar lavage for diagnosis and phenotypic characterization. Matrix assisted laser-desorption ionization-time of flight mass spectrometry (MALD-TOF MS) was used to identify strains. Automated Phoenix and VITEK® 2 Compact system and the disc diffusion method were performed to determine the antimicrobial susceptibility profile. A total of 41,000 medical reports from adult patients with pneumonia were analyzed. Of these, 951 patients were positive for P. aeruginosa, of which 373 were related to the pre-pandemic period and 578 to the pandemic period. Older men (≥60 years) were more prevalent in both periods. P. aeruginosa strains were resistant to imipenem in both periods: 38.8 and 42.5%, respectively, followed by meropenem (34.2 and 39.2%), ciprofloxacin (33.6 and 36.7%), and levofloxacin (34.9 and 43.5%). Intensive care units had the highest percentage of affected patients (62 and 65%) compared with other sectors, with a prevalence of 71% in the public network before COVID-19 and 59% during the pandemic. Our data showed a prevalence of P. aeruginosa in elderly patients in both the pre-pandemic and pandemic periods. In addition, an increase in P. aeruginosa resistance to beta-lactams, quinolones, carbapenems, and cephalosporins was observed during the COVID-19 pandemic compared with the period before the pandemic, especially in ICUs.

Hypoglycemic effect of Coffea arabica leaf extracts and major bioactive constituents.

The present study focused on investigating the antioxidant, antiglycation activity, digestive enzymes inhibition, bioaccessibility and hypoglycemic effect of C. arabica leaves extracts. The extracts deactivated the O2•-, ROO•, H2O2, HOCl reactive oxygen species. Coffee leaves showed strong inhibition of α-glucosidase (IC50 = 40.30 µg mL-1) greater than the isolated metabolites and acarbose. There was also inhibition of pancreatic lipase (IC50 = 56.43 µg mL-1) in addition to a hypoglycemic effect in zebrafish similar to acarbose and metformin. With the exception of rutin, all biocompounds were detected at all stages of in vitro digestion. Finally, these results suggest that C. arabica leaf extracts possess antidiabetic and anti-obesity properties that can be attributed to the main metabolites and the synergistic action between them.Communicated by Ramaswamy H. Sarma.

Antimicrobial resistance of Pseudomonas aeruginosa isolated from patients with pneumonia during the COVID-19 pandemic and pre-pandemic periods in Northeast Brazil

Healthcare-related infections caused by resistant microorganisms are a severe public health problem and are becoming increasingly prevalent in the hospital environment, especially Pseudomonas aeruginosa. This work aimed to evaluate the resistance profile of Pseudomonas aeruginosa to antimicrobials before the COVID-19 pandemic and during the pandemic period. Bacteria strains were obtained from tracheal aspiration, sputum, and bronchoalveolar lavage for diagnosis and phenotypic characterization. Matrix assisted laser-desorption ionization-time of flight mass spectrometry (MALD-TOF MS) was used to identify strains. Automated Phoenix and VITEK® 2 Compact system and the disc diffusion method were performed to determine the antimicrobial susceptibility profile. A total of 41,000 medical reports from adult patients with pneumonia were analyzed. Of these, 951 patients were positive for P. aeruginosa, of which 373 were related to the pre-pandemic period and 578 to the pandemic period. Older men (≥60 years) were more prevalent in both periods. P. aeruginosa strains were resistant to imipenem in both periods: 38.8 and 42.5%, respectively, followed by meropenem (34.2 and 39.2%), ciprofloxacin (33.6 and 36.7%), and levofloxacin (34.9 and 43.5%). Intensive care units had the highest percentage of affected patients (62 and 65%) compared with other sectors, with a prevalence of 71% in the public network before COVID-19 and 59% during the pandemic. Our data showed a prevalence of P. aeruginosa in elderly patients in both the pre-pandemic and pandemic periods. In addition, an increase in P. aeruginosa resistance to beta-lactams, quinolones, carbapenems, and cephalosporins was observed during the COVID-19 pandemic compared with the period before the pandemic, especially in ICUs.

Small-scale environmental enrichment and exercise enhance learning and spatial memory of Carassius auratus, and increase cell proliferation in the telencephalon: an exploratory study.

Carassius auratus is a teleost fish that has been largely used in behavioral studies. However, little is known about potential environmental influences on its performance of learning and memory tasks. Here, we investigated this question in C. auratus, and searched for potential correlation between exercise and visuospatial enrichment with the total number of telencephalic glia and neurons. To that end, males and females were housed for 183 days in either an enriched (EE) or impoverished environment (IE) aquarium. EE contained toys, natural plants, and a 12-hour/day water stream for voluntary exercise, whereas the IE had none of the above. A third plus-maze aquarium was used for spatial and object recognition tests. Different visual clues in 2 of its 4 arms were used to guide fish to reach the criteria to complete the task. The test consisted of 30 sessions and was concluded when each animal performed three consecutive correct choices or seven alternated, each ten trials. Learning rates revealed significant differences between EE and IE fish. The optical fractionator was used to estimate the total number of telencephalic cells that were stained with cresyl violet. On average, the total number of cells in the subjects from EE was higher than those from subjects maintained in IE (P=0.0202). We suggest that environmental enrichment significantly influenced goldfish spatial learning and memory abilities, and this may be associated with an increase in the total number of telencephalic cells.

Small-scale environmental enrichment and exercise enhance learning and spatial memory of Carassius auratus, and increase cell proliferation in the telencephalon: an exploratory study

Carassius auratus is a teleost fish that has been largely used in behavioral studies. However, little is known about potential environmental influences on its performance of learning and memory tasks. Here, we investigated this question in C. auratus, and searched for potential correlation between exercise and visuospatial enrichment with the total number of telencephalic glia and neurons. To that end, males and females were housed for 183 days in either an enriched (EE) or impoverished environment (IE) aquarium. EE contained toys, natural plants, and a 12-hour/day water stream for voluntary exercise, whereas the IE had none of the above. A third plus-maze aquarium was used for spatial and object recognition tests. Different visual clues in 2 of its 4 arms were used to guide fish to reach the criteria to complete the task. The test consisted of 30 sessions and was concluded when each animal performed three consecutive correct choices or seven alternated, each ten trials. Learning rates revealed significant differences between EE and IE fish. The optical fractionator was used to estimate the total number of telencephalic cells that were stained with cresyl violet. On average, the total number of cells in the subjects from EE was higher than those from subjects maintained in IE (P=0.0202). We suggest that environmental enrichment significantly influenced goldfish spatial learning and memory abilities, and this may be associated with an increase in the total number of telencephalic cells.

Diversity of rickettsiae and potential vectors of spotted fever in an area of epidemiological interest in the Cerrado biome, midwestern Brazil.

The Brazilian state of Goiás, untouched by spotted fever (SF) until 2012, has subsequently reported cases of the disease in several regions. This study aimed to survey the diversity of potential vectors and rickettsia in areas of Goiás under environmental surveillance or case investigation for SF. Collected specimens were assayed with molecular biology technology using DNA extraction, amplification and sequencing of fragments of the genes gltA, ompA, ompB and sca4 to detect rickettsia in ticks and fleas. Amplification of cytochrome oxidase subunit II and 16S rRNA was performed to assist tick identification. Rickettsia felis (Rickettsiales: Rickettsiaceae) was found in Ctenocephalides felis (Bouché, 1835) (Siphonaptera: Pulicidae). Rickettsia bellii was found in Amblyomma rotundatum Koch, 1844 (Ixodida: Ixodidae) and in Amblyomma cajennense sensu lato. Rickettsia sp. strain NOD was found in Amblyomma nodosum Neumann, 1899. Of the Amblyomma cajennense complex, Amblyomma sculptum Berlese, 1888 was confirmed in the northern, northeast, midwest and southeast regions of Goiás, whereas Amblyomma cajennense sensu stricto (Fabricius, 1787) was found only in the northern region of the state. Amblyomma dubitatum Neumann, 1899 associated with a species of the A. cajennense complex was the most common epidemiological finding, although Rickettsia rickettsii was not detected. This is the first report of Rickettsia sp. strain NOD in Goiás.

The Brazilian identified human osteological collections.

This short communication aims to inform the scientific community of the existence of seven identified osteological collections in Brazil, most of which are housed in universities: 21st Century Collection of the Center for Studies in Forensic Anthropology, Recife; Identified Skeletal Collection of Sergipanos of the University Tiradentes, Aracaju; Identified Skull Collection of the State of Bahia, Aracaju; Osteological and Tomographic Collection - Prof. Dr. Eduardo Daruge, Piracicaba; Osteological Collection of the Institute of Teaching and Research in Forensic Sciences, Guarulhos; Identified Skull Collection of the Anatomy Museum Alfonso Bovero, São Paulo; and the Identified Skull Collection, São Paulo. Three of these collections are from a northeast population, whereas the others are from individuals from the southeast region. Altogether, there are 925 skeletons and more than 998 skulls (three of the referenced collections have only skulls). Data on the number of individuals, sex, age, origin, and dates of inhumation and exhumation are available. This large quantity of identified skeletal remains is a fundamental source of research material that can be used to characterize the Brazilian population and facilitate the development of forensic anthropology. When contextualized within the reference series from South and Central America, it is clear that the Brazilian skeletal reference series hold a position of prominence.

Duplicidad no ectópica del uréter: implicancias clínicas / Non-ectopic duplicity of the ureter: clinical implications

La duplicación del sistema colector renal es la variación más frecuente del sistema urinário y se puede presentar como duplicación completa o incompleta, así como la inserción ectópica en todas las partes del sistema urinario a partir de la parte distal hacia la vejiga. Este artículo presenta uma duplicación completa no ectópica del ureter en el riñón izquierdo de un cadáver de un individuo brasileño, de sexo masculino. Ambos uréteres tenían origen en el hilio renal y continuaban hasta la vejiga urinaria separadamente, desembocando en ostios diferentes, en el área del trígono vesical, donde el ostio perteneciente al uréter que drenaba el polo superior presentó posición distal y lateral en relación al ostio del uréter que drenaba el polo inferior. Esta disposición es uma excepción a la regla de Weigert-Meyer, que indica que el uréter del polo superior, por el hecho de permanecer fijo por más tiempo al conducto mesonéfrico, presenta mayor migración, terminando medial e inferiormente al uréter que drena el polo inferior en 97 % de los casos.

Duplication of the urinary tract is the most frequent variation of this system and may present as complete or incomplete duplication, as well as ectopic insertion throughout all parts of the urinary system from distal to the bladder. This article presents a complete non-ectopic duplication of the ureter in the left kidney of a cadaver of one Brazilian individual of male sex. In this study, both ureters originated in the renal hilum and continued to the urinary bladder separately, opening into different ostia, in the area of the bladder trigone, where the ostium belonging to the ureter that draining the upper pole presented a distal and lateral position in relation to the ostium of the ureter draining the lower pole. This arrangement is an exception to the Weigert-Meyer rule, which indicates that the ureter of the upper pole, due to its longer fixation to the mesonephric duct, presents a greater migration, ending medial and inferior to the ureter draining the inferior pole in 97 % of cases.

Responses of skeletal muscle hypertrophy in Wistar rats to different resistance exercise models.

This study aimed to compare the effects of three different resistance exercise models on the quadriceps muscle cross-sectional area, as well as on mTOR phosphorylation and other pivotal molecules involved in the upstream regulation of mTOR. Twenty-four male Wistar rats were divided into untrained (control), endurance resistance training, strength resistance training, and hypertrophy resistance training (HRT) groups (n=6). After 12 weeks of training, the red portion of the quadriceps was removed for histological and Western blot analyses. The results showed that the quadriceps weight and cross-sectional areas in the exercised groups were higher than those of the untrained rats. However, the HRT group presented better results than the other two experimental groups. This same pattern was observed for mTOR phosphorylation and for the most pivotal molecules involved in the upstream control of mTOR (increase of PKB, 14-3-3, ERK, p38 MAPK, and 4E-BP1 phosphorylation, and reduction of tuberin, sestrin 2, REDD1, and phospho AMPK). In summary, our study showed that HRT leads to high levels of mTOR phosphorylation as well as of other proteins involved in the upstream regulation of mTOR.

Association of exercise training and angiotensin-converting enzyme 2 activator improves baroreflex sensitivity of spontaneously hypertensive rats.

The present study sought to determine cardiovascular effects of aerobic training associated with diminazene aceturate (DIZE), an activator of the angiotensin converting enzyme 2, in spontaneously hypertensive rats (SHRs). Male SHRs (280-350 g) were either subjected to exercise training or not (sedentary group). The trained group was subjected to 8 weeks of aerobic training on a treadmill (five times a week, lasting 60 min at an intensity of 50-60% of maximum aerobic speed). In the last 15 days of the experimental protocol, these groups were redistributed into four groups: i) sedentary SHRs with daily treatment of 1 mg/kg DIZE (S+D1); ii) trained SHRs with daily treatment of 1 mg/kg DIZE (T+D1); iii) sedentary SHRs with daily treatment of vehicle (S+V); and iv) trained SHRs with daily treatment of vehicle (T+V). After treatment, SHRs were anesthetized and subjected to artery and femoral vein cannulation prior to the implantation of ECG electrode. After 24 h, mean arterial pressure (MAP) and heart rate (HR) were recorded; the baroreflex sensitivity and the effect of double autonomic blockade (DAB) were evaluated in non-anesthetized SHRs. DIZE treatment improved baroreflex sensitivity in the T+D1 group as compared with the T+V and S+D1 groups. The intrinsic heart rate (IHR) and MAP were reduced in T+D1 group as compared with T+V and S+D1 groups. Hence, we conclude that the association of exercise training with DIZE treatment improved baroreflex function and cardiovascular regulation.

Apoptotic CD8 T-lymphocytes disable macrophage-mediated immunity to Trypanosoma cruzi infection.

Chagas disease is caused by infection with the protozoan Trypanosoma cruzi. CD8 T-lymphocytes help to control infection, but apoptosis of CD8 T cells disrupts immunity and efferocytosis can enhance parasite infection within macrophages. Here, we investigate how apoptosis of activated CD8 T cells affects M1 and M2 macrophage phenotypes. First, we found that CD8 T-lymphocytes and inflammatory monocytes/macrophages infiltrate peritoneum during acute T. cruzi infection. We show that treatment with anti-Fas ligand (FasL) prevents lymphocyte apoptosis, upregulates type-1 responses to parasite antigens, and reduces infection in macrophages cocultured with activated CD8 T cells. Anti-FasL skews mixed M1/M2 macrophage profiles into polarized M1 phenotype, both in vitro and following injection in infected mice. Moreover, inhibition of T-cell apoptosis induces a broad reprogramming of cytokine responses and improves macrophage-mediated immunity to T. cruzi. The results indicate that disposal of apoptotic CD8 T cells increases M2-macrophage differentiation and contributes to parasite persistence.

Age and growth of the mutton hamlet Alphestes afer, with a review of the size and age of sex change among epinephelids.

This paper presents results on the age, growth and population structure of a small grouper, the mutton hamlet Alphestes afer, and discusses the observed size and age structure patterns in relation to reproductive strategies among the epinephelids. Ages were determined by examination of sectioned otoliths, which showed a distinct pattern of alternating translucent and opaque zones that formed annually, as validated with tetracycline labelling. The von Bertalanffy growth function was adjusted to the length-at-age data of the males and females, but no significant differences were observed between the resulting parameters. The females, however, were older at given sizes and attained larger sizes and ages, with a maximum observed longevity of 13 years and a total length (LT ) of 26 cm, while the males attained maximum longevities of only 10 years and a 22 cm maximum LT . The LT and age range for the sex change was 16-25 cm and 3-11 years. The total mortality rate (Z) was estimated to be 0·55 for females and 0·82 for males. With the males younger and smaller than the females, this species differed from the pattern commonly observed for protogynous epinephelids. Males had slower growth after maturation, probably due to energy allocation to sperm production during sexual development. This study shows that demography is an important tool to understand the pathways for reproductive strategies in grouper populations.

Nisin and lysostaphin activity against preformed biofilm of Staphylococcus aureus involved in bovine mastitis.

AIMS: The biofilm produced by Staphylococcus aureus isolates involved in clinical or subclinical bovine mastitis and the activity of nisin and lysostaphin against the preformed biofilm produced by these strains were investigated. METHODS AND RESULTS: Eighteen strains were tested and all produced biofilm. Eight strains with distinct biofilm composition were selected for the antimicrobial activity assays. The minimal inhibitory concentration of each bacteriocin was determined against the planktonic cells and ranged from 15·6 to 500 µg ml(-1) for nisin, and from 3·9 to 50 µg ml(-1) , for lysostaphin. Lysostaphin treatment (0·4 µg ml(-1) ) for 4 h caused a strong Staph. aureus 4181 biofilm detachment and death of the majority of the sessile cells, while nisin treatment (100 µg ml(-1) ) for the same time caused only a great reduction in cell viability. Additionally, combination of both bacteriocins for 4 h resulted in significant death of the sessile cells but no biofilm detachment. CONCLUSIONS: The treatment with lysostaphin alone or in combination with nisin was effective in killing most biofilm sessile cells. SIGNIFICANCE AND IMPACT OF THE STUDY: The action of lysostaphin, either alone or in combination with nisin, against established staphylococcal biofilm may represent an alternative to bovine mastitis control. However, the duration of the treatment should be considered for its application so that the best effectiveness can be achieved.

Intestinal parasites of wild boar (Sus scrofa) raised in Southern Brazil / Parasitos intestinais de javalis (Sus scrofa) criados na região sul do Brasil

The aim of the present study was to identify the intestinal parasites that infect wild boars destined for slaughter in Southern Brazil. The intestines of 40 wild boars were collected from a slaughtering and meat-packing facility for evaluation of each intestinal segment and fecal samples were collected from the final portion of the large intestine and processed by two methods of parasitological diagnosis. The necropsy revealed adult parasites in 14 (35%) wild boars, Ascaris suum (17.5%) and Trichuris suis (25%); and the stool analysis indicated the presence of parasites in 10 (25%) animals, Trichuris suis (5%), Isospora suis (20%), and Giardia spp. (10%). This is the first report of Giardia intestinalis in wild boars in the State of Rio Grande do Sul, which also showed that Trichuris suis was present in most samples.

O objetivo do presente trabalho foi identificar a fauna parasitária intestinal de javalis de abate comercial, criados no Sul do Brasil. Foram coletados em matadouro-frigorífico, intestinos de 40 animais, para avaliação de cada segmento intestinal separadamente e amostras fecais foram coletadas da porção final do intestino grosso e processados por dois métodos coproparasitológicos. À necropsia foram identificados parasitos adultos em 14 (35%) javalis, Ascaris suum (17,5%) e Trichuris suis (25%); ao exame coprológico 10 (25%) animais foram positivos para, Trichuris suis (5%), Isospora suis (20%) e Giardia intestinalis (10%). Este relato representa o primeiro caso confirmado de Giardia intestinalis em javalis no Rio Grande do Sul e Trichuris suis foi o helminto que apresentou maior número de espécimes.

PARASITOS INTESTINAIS DE JAVALIS (Sus scrofa) CRIADOS NA REGIÃO SUL DO BRASIL

O objetivo do presente trabalho foi identificar a fauna parasitária intestinal de javalis de abate comercial, criados no Sul do Brasil. Foram coletados em matadouro-frigorífico, intestinos de 40 animais, para avaliação de cada segmento intestinal separadamente e amostras fecais foram coletadas da porção final do intestino grosso e processados por dois métodos coproparasitológicos. À necropsia foram identificados parasitos adultos em 14 (35%) javalis, Ascaris suum (17,5%) e Trichuris suis (25%); ao exame coprológico 10 (25%) animais foram positivos para, Trichuris suis (5%), Isospora suis (20%) e Giardia intestinalis (10%). Este relato representa o primeiro caso confirmado de Giardia intestinalis em javalis no Rio Grande do Sul e Trichuris suis foi o helminto que apresentou maior número de espécimes.

Intestinal parasites of wild boar (Sus scrofa) raised in Southern Brazil / Parasitos intestinais de javalis (Sus scrofa) criados na região sul do Brasil

The aim of the present study was to identify the intestinal parasites that infect wild boars destined for slaughter in Southern Brazil. The intestines of 40 wild boars were collected from a slaughtering and meat-packing facility for evaluation of each intestinal segment and fecal samples were collected from the final portion of the large intestine and processed by two methods of parasitological diagnosis. The necropsy revealed adult parasites in 14 (35%) wild boars, Ascaris suum (17.5%) and Trichuris suis (25%); and the stool analysis indicated the presence of parasites in 10 (25%) animals, Trichuris suis (5%), Isospora suis (20%), and Giardia spp. (10%). This is the first report of Giardia intestinalis in wild boars in the State of Rio Grande do Sul, which also showed that Trichuris suis was present in most samples.(AU)

O objetivo do presente trabalho foi identificar a fauna parasitária intestinal de javalis de abate comercial, criados no Sul do Brasil. Foram coletados em matadouro-frigorífico, intestinos de 40 animais, para avaliação de cada segmento intestinal separadamente e amostras fecais foram coletadas da porção final do intestino grosso e processados por dois métodos coproparasitológicos. À necropsia foram identificados parasitos adultos em 14 (35%) javalis, Ascaris suum (17,5%) e Trichuris suis (25%); ao exame coprológico 10 (25%) animais foram positivos para, Trichuris suis (5%), Isospora suis (20%) e Giardia intestinalis (10%). Este relato representa o primeiro caso confirmado de Giardia intestinalis em javalis no Rio Grande do Sul e Trichuris suis foi o helminto que apresentou maior número de espécimes.(AU)

Association of exercise training and angiotensin-converting enzyme 2 activator improves baroreflex sensitivity of spontaneously hypertensive rats

The present study sought to determine cardiovascular effects of aerobic training associated with diminazene aceturate (DIZE), an activator of the angiotensin converting enzyme 2, in spontaneously hypertensive rats (SHRs). Male SHRs (280–350 g) were either subjected to exercise training or not (sedentary group). The trained group was subjected to 8 weeks of aerobic training on a treadmill (five times a week, lasting 60 min at an intensity of 50–60% of maximum aerobic speed). In the last 15 days of the experimental protocol, these groups were redistributed into four groups: i) sedentary SHRs with daily treatment of 1 mg/kg DIZE (S+D1); ii) trained SHRs with daily treatment of 1 mg/kg DIZE (T+D1); iii) sedentary SHRs with daily treatment of vehicle (S+V); and iv) trained SHRs with daily treatment of vehicle (T+V). After treatment, SHRs were anesthetized and subjected to artery and femoral vein cannulation prior to the implantation of ECG electrode. After 24 h, mean arterial pressure (MAP) and heart rate (HR) were recorded; the baroreflex sensitivity and the effect of double autonomic blockade (DAB) were evaluated in non-anesthetized SHRs. DIZE treatment improved baroreflex sensitivity in the T+D1 group as compared with the T+V and S+D1 groups. The intrinsic heart rate (IHR) and MAP were reduced in T+D1 group as compared with T+V and S+D1 groups. Hence, we conclude that the association of exercise training with DIZE treatment improved baroreflex function and cardiovascular regulation.

Doctors' awareness concerning primary immunodeficiencies in Brazil.

BACKGROUND: PIDs are a heterogeneous group of genetic illnesses, and delay in their diagnosis is thought to be caused by a lack of awareness among physicians concerning PIDs. The latter is what we aimed to evaluate in Brazil. METHODS: Physicians working at general hospitals all over the country were asked to complete a 14-item questionnaire. One of the questions described 25 clinical situations that could be associated with PIDs and a score was created based on percentages of appropriate answers. RESULTS: A total of 4026 physicians participated in the study: 1628 paediatricians (40.4%), 1436 clinicians (35.7%), and 962 surgeons (23.9%). About 67% of the physicians had learned about PIDs in medical school or residency training, 84.6% evaluated patients who frequently took antibiotics, but only 40.3% of them participated in the immunological evaluation of these patients. Seventy-seven percent of the participating physicians were not familiar with the warning signs for PIDs. The mean score of correct answers for the 25 clinical situations was 48.08% (±16.06). Only 18.3% of the paediatricians, 7.4% of the clinicians, and 5.8% of the surgeons answered at least 2/3 of these situations appropriately. CONCLUSIONS: There is a lack of medical awareness concerning PIDs, even among paediatricians, who have been targeted with PID educational programmes in recent years in Brazil. An increase in awareness with regard to these disorders within the medical community is an important step towards improving recognition and treatment of PIDs.