Efficacy of sodium hypochlorite and peracetic acid against Aspergillus nomius in Brazil nuts.

The objective of this work was to assess the efficacy of sodium hypochlorite and peracetic acid for sanitization of Brazil nuts. To evaluate the natural microbiota of the nuts, the total bacteria and fungi as well as the Aspergillus section Flavi were counted. The moisture, water activity and the presence of aflatoxins was quantified. The response surface method was used to determine the influence of exposure time and sanitizers concentration on the reduction of Aspergillus nomius inoculated on the nuts. Microbiological, sensory and quantification analyzes of aflatoxins were performed under optimum conditions The evaluation of the initial contamination of the nuts, despite presenting high microbiological contamination, humidity and water activity, was not detected aflatoxins in any samples. In artificially inoculated samples, the response surface and the desirability function were obtained to determine the optimal point of use for each sanitizer. The nuts had high microbiological contamination, moisture content and water activity. Aflatoxins were not detected in any samples. The response surface and desirability function indicated the optimal sanitization conditions were 250 mg/L and 8.5 min and 140 mg/L and 15 min for sodium hypochlorite and peracetic acid, respectively. Reductions greater than 2 log CFU/g were obtained with sodium hypochlorite and of 1 log CFU/g for peracetic acid. In the tests performed with new Brazil nuts samples under the optimized conditions, reductions of less than 2 log CFU/g were obtained. Aflatoxin B1 was detected in one untreated sample (1.51 µg/kg), one sample treated with sodium hypochlorite (0.60 µg/kg) and two samples treated with peracetic acid (0.64 and 0.72 µg/kg). Demonstrating that the sanitizers in the concentrations used had no action on aflatoxins, despite being efficient for fungal control. The treatments did not cause an unacceptable sensorial impact on the samples.

Assessment of the stretched penile length in Sri Lankan newborns

Introduction: Evaluation of the external genitalia is important in the routine neonatal examination, since abnormalities of the genitalia give clues to underlying endocrine disorders or structural malformations. Objectives: The objectives of the study were to document the stretched penile length (SPL) of healthy term neonates born following an uncomplicated delivery at a tertiary care hospital in Sri Lanka, and to establish the normative data for the SPL for Sri Lankan neonates. Method: This was a cross sectional observational study, carried out at post natal wards of the Castle Street Hospital for Women, Sri Lanka. The study was done on 369 stable newborns delivered at the gestational age of 37 to 42 weeks. A complete neonatal examination was performed by the principal investigator and the measurements of the weight, length, head circumference and stretched penile length were obtained. Mean penile length and statistically significant difference of penile length (SD) values were calculated. The correlation of mean penile length, period of gestation, birth weight and length were analysed. Result: The SPL positively correlated with the length of the baby. There is no statistically significant correlation of birth weight, head circumference and gestational age with the SPL. The mean SPL for term Sri Lankan new-borns was 3.03cm ± 0.37cm and the -2SD value was 2.29cm. Conclusions: Since the -2SD of SPL was 2.29cm, measurements less than this should be considered as micropenis.

Randomized, double-blind study on intralesional metronidazole versus intralesional sodium stibogluconate in Leishmania donovani cutaneous leishmaniasis.

OBJECTIVES: The aim of our study was to assess the efficacy of intralesional metronidazole on Leishmania donovani cutaneous leishmaniasis (CL). MATERIAL AND METHODS: A total of 188 patients with CL were randomly allocated to intralesional sodium stibogluconate (SSG) and intralesional metronidazole. Cure was assessed after 1-10 injections. Cure rates were assessed for statistical significance using chi-square test at p = .05 level (SLCTR/2014/028). RESULTS: When the treatment cutoff was taken at 100%, the rate of cure for SSG (n = 64, 65.6%) was higher than that of metronidazole (n = 45, 48.9%): statistically significant at p < .05 level (Yates corrected chi-square 5.37, df = 1, p < .5). When the treatment cutoff was taken at >80%, the rate of cure for SSG (n = 75, 77.1%) was also higher than that of metronidazole (n = 58, 63.0%): statistically significant at p < .05 level (Yates corrected chi-square 4.46, df = 1, p < .5). Since it is based on a smaller sample, we estimated the statistical power of the test at a cutoff of 100% [above 80%] results identified a risk ratio of 1.4 [1.3], and a statistical power based on normal approximation at 74.8% [70.0%], respectively. CONCLUSION: This study showed that intralesional SSG has the best response against CL, while intralesional metronidazole was an effective alternative treatment.

Factors influencing cure rates of non-dermatophyte mold and Candida onychomycosis: analysis of outcomes in 81 patients who completed treatment.

OBJECTIVES: Onychomycosis shows a poor response to current topical, oral, or device-related antifungal therapies. The aim of this study was to identify factors influencing the cure rates of non-dermatophyte mold and Candida onychomycosis. METHODS: Eighty-one patients who completed treatments were divided into "cured" and "non-cured" groups. The statistical significance of differences between the two groups was studied. RESULTS: Male gender (P < 0.01), long duration of disease before the initiation of treatment (P < 0.02), three or more infected nails (P < 0.0002), continuous exposure to water and detergents (P < 0.05), frequent exposure to mud and soil (P < 0.01), barefoot walking (P < 0.025), concomitant diabetes and hypertension (P < 0.04), eczema (P < 0.03), and associated paronychia (P < 0.01) had negative effects on cure rates of onychomycosis. Patient age, occupation, site of illness (hand, foot or big toe), type of disease (distal and lateral subungual onychomycosis, proximal subungual onychomycosis or total dystrophic onychomycosis), pathogenic fungi, and treatment modality had no statistically significant impact on cure rate. CONCLUSIONS: To minimize the failure rate of antifungal therapies in the treatment of onychomycosis, patients are advised to start treatment as soon as possible, and to avoid predisposing factors such as exposure to water, detergents, mud and soil, and barefoot walking.

Randomized, double-blind, comparative study on efficacy and safety of itraconazole pulse therapy and terbinafine pulse therapy on nondermatophyte mold onychomycosis: A study with 90 patients.

BACKGROUND: Nondermatophyte mold (NDM) onychomycosis shows poor response to current topical, oral or device-related antifungal therapies. This study was aimed to determine the efficacy and safety of itraconazole and terbinafine pulse therapy on NDM onychomycosis. METHODS: Mycologically proven subjects were treated with itraconazole 400 mg daily or terbinafine 500 mg daily for 7 days/month; two pulses for fingernails and three pulses for toenails(SLCTR/2013/013). RESULTS: One-hundred seventy-eight patients underwent mycological studies and 148 had positive fungal isolates. NDM were the prevailing fungi, 68.2%, followed by candida species 21.6%, and dermatophytes made up only 10.1%. Out of NDM Aspergillus spp (75.1%) predominated followed by 8.9% Fusarium spp and 4.95% Penicillium spp. The clinical cure at completion of pulse therapy was statistically significant 9.2% versus 2.0% (p < 0.05) in itraconazole group. But no statistically significant difference was detected between the two regimens at the end of 12 months; 65.1% versus 54.64%. Recurrences observed in both groups (6.5% vs. 4.1%) were not statistically significant. With itraconazole pulse 68.22% Aspergillus spp, 50.0% Fusarium spp and 84.6% Penicillium spp showed clinical cure, while terbinafine pulse cured 55.0% Aspergillus spp and 50.0% Fusarium spp. CONCLUSIONS: NDM was the prevailing fungi in onychomycosis in Sri Lanka. Both itraconazole and terbinafine were partially effective on NDM onychomycosis showing a clinical cure of 54-65%. Future research should focus on searching more effective antifungal for NDM onychomycosis.

Enraizamento de estacas de genótipos de Camellia sinensis L. em meio ácido, presença de alumínio e ácido indolbutírico / Rooting of Camellia sinensis L. in acid medium, the presence of aluminum and indolebutyric acid

RESUMO Experimentos foram conduzidos para avaliar o efeito do meio ácido e do alumínio, assim como para determinar a concentração mais apropriada de ácido indolbutírico (AIB) para o enraizamento de estacas de diferentes genótipos de Camellia sinensis L (planta de chá). Para tal, foram coletados ramos de plantas-matrizes em Pariquera-Açu-SP, Brasil, no inverno de 2012 e preparadas estacas semi-lenhosas, contendo uma gema e uma folha, que foram mantidas em viveiro com 70% de sombreamento. A irrigação do substrato foi feita com água e soluções contendo ácido fosfórico e sulfato de alumínio a pH 5,5, 4,5; 3,5. No primeiro experimento, o delineamento experimental foi o inteiramente casualizado em esquema fatorial 3 x 7, três genótipos (F 15, IAC 259 e Comum) e sete condições diferentes de enraizamento (vermiculita a pH 6,5, vermiculita acidificada com ácido fosfórico a pH 3,5; 4,5 e 5,5 ou vermiculita acidificada com sulfato de alumínio a pH 3,5; 4,5 e 5,5). No segundo experimento, o tratamento que promoveu o maior enraizamento no primeiro experimento (vermiculita acidificada com sulfato de alumínio a pH 3,5) foi combinado ao tratamento com AIB. O delineamento experimental utilizado foi o inteiramente casualizado em esquema fatorial 3 x 6, sendo três genótipos e seis concentrações de AIB (0, 2000, 4000, 6000, 8000 e 1000 mg L-1). A vermiculita acidificada com sulfato de alumínio a pH 3,5, combinada a aplicação de 10000 mg L-1 de AIB por 30 segundos, foi o tratamento mais adequado para o enraizamento de estacas semi-lenhosas dos genótipos F15, IAC 259 e Comum.

ABSTRACT The experiments were carried out to evaluate the effect of medium acidic and aluminum, as well as determine the most suitable concentration of indolebutyric acid (IBA) for rooting cuttings of different genotypes of Camellia sinensis L (tea plant). Such, stems were collected from mother plants in Pariquera-Açu, São Paulo state, Brazil, in winter 2012 and prepared semi-hardwood cuttings, with one bud and one leaf, which were kept in a nursery with 70% of shading. Irrigation substrate was taken with water and solutions containing phosphoric acid and aluminum sulfate at pH 5.5, 4.5; 3,5. In the first experiment, the experimental design was completely randomized in a factorial scheme 3x7, three genotypes (F 15, IAC 259 and Comum) and seven different conditions of rooting (vermiculite at pH 6.5, acidified with phosphoric acid or aluminum sulfate vermiculite at pH 3.5, 4.5 and 5.5). In the second experiment, the treatment that promoted the highest rooting in the first experiment (vermiculite acidified with aluminum sulfate at pH 3.5) was combined with treatment with IBA The experimental design was completely randomized in a factorial scheme 3x6, three genotypes and six concentrations of IBA (0, 2.000, 4.000, 6.000, 8.000 and 10.000 mg L-1). Vermiculite acidified with aluminum sulphate to pH 3.5, combined application of 10.000 mg L-1 IBA for 30 seconds was the most appropriate treatment for cutting propagation of genotypes F15, IAC 259 and Comum. Vermiculite acidified with aluminum sulfate at pH 3.5, combined treatment with 10,000 mg L-1 IBA for 30 seconds, was the most suitable conditions for the rooting of cuttings Camellia sinensis L.

Randomized, double-blind, controlled, comparative study on intralesional 10% and 15% hypertonic saline versus intralesional sodium stibogluconate in Leishmania donovani cutaneous leishmaniasis.

BACKGROUND: Intralesional 7% hypertonic saline (HS) has been shown to be effective and safe against Leishmania donovani and Leishmania major cutaneous leishmaniasis (CL), with cure rates of 92% and 96%, respectively. This study was designed to assess the efficacy and safety of 10% and 15% HS in CL. METHODS: A total of 444 patients (643 lesions) were randomly allocated to sodium stibogluconate (SSG), 10% HS and 15% HS at a ratio of 2 : 2 : 1, taking into consideration any unwanted side effects that might arise with 15% HS. The follow-up period was 18 months. Survival analysis using Cox proportional hazard regression was performed to assess the effectiveness of the three treatment modalities. The clinical trial was registered at the Sri Lanka Clinical Trial Registry (SLCTR/2013/024). RESULTS: Treatment with SSG resulted in a cure rate of 96.3% within one to seven injections (mean: 3.6 injections); the mean (median) duration of treatment was six weeks (6 weeks) per lesion. Treatment with 10% HS showed a cure rate of 93.0% within one to 10 injections (mean: 5.28 injections); the mean (median) duration of treatment was 9.3 weeks (9 weeks) per lesion. Treatment with 15% HS showed a cure rate of 93.6% within two to 10 injections (mean: 5.3 injections); the mean (median) duration of treatment was 11.3 weeks (10.0 weeks) per lesion. Treatment with 10% HS and 15% HS caused cutaneous necrosis in 3.1% and 30.6% of lesions, respectively. Despite continuous data collection for 14 months, we were unable to recruit a sample of sufficient size. Seventeen (3.8%) patients were lost to follow-up, and 24 (5.4%) were partial or non-responders. CONCLUSIONS: This study found 10% HS to be an effective and safe alternative to SSG. Treatment with HS at concentrations of 15% or above was not safe as a result of cutaneous necrosis. Safety was not studied for concentrations of 11-14%, and these concentrations should be avoided pending further evidence. Hypertonic saline is very cheap (< US$1 per 100 ml, whereas SSG is priced at US$160 per 100 ml), is prepared locally and has no systemic side effects and minimal local side effects.

The quality of life of Sri Lankan patients with cutaneous leishmaniasis.

The effect of cutaneous leishmaniasis on the quality of life (QoL) in Sri Lankan patients' had not been evaluated before. This study was done to identify the factors resulting poor QoL in cutaneous leishmaniasis. The standard one-week Dermatology Life Quality Index (DLQI) questionnaire was used on 146 patients. The children <15 years of age, illiterates, who could not understand the questionnaire were excluded. Twenty one percent had no effect; overall 86% had DLQI ≤10 indicating low/moderate effect. The least affected area was sexual function with some 92% stating they were not affected at all, while the areas of feelings, shopping, social, partner and treatment, (in descending order), being endorsed as the most affected areas. Facial lesions, lesions ≥25mm diameter, 21-40 age group were identified as being associated with poor QoL. Overall cutaneous leishmaniasis in Sri Lanka was a mild disease having low/moderate impact on 86% of patient's, in which 'feelings' being the most affected and 'sexual function' being the least affected domain.

Sensitivity and specificity of combined perimetric and volumetric evaluations in the diagnosis of arm lymphedema.

The objective of the current study was to evaluate the sensitivity and the specificity of perimetry combined with volumetry in the treatment of lymphedema. Ninety women, who had been submitted to breast cancer surgery, were randomly selected in the Government Healthcare Clinic for this study. Only patients who underwent surgical treatment of breast cancer with some degree of lymphadenectomy were included in the study cohort. Individuals with active disease, whether local or otherwise, functional alterations of the upper limbs before breast cancer surgery were not included. The following possibilities were considered: 1--the perimetry evaluation was considered positive when the difference between the affected and unaffected sides was > or =2 cm for any one of the seven measurements and volumetry was > or = 100 mL; 2--perimetry > or =2 cm and volumetry > or =200 mL; 3--a difference > 10% between the two limbs in volumetry and perimetry. Prevalence, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were evaluated statistically with an alpha error of 5% considered acceptable (p-value < 0.05). The mean age of the women was 54.8 +/- 11.7 years. The sensitivity, negative predictive value and accuracy were higher using perimetry when a volume > or =2 cm were considered. The specificity and positive predictive values were better when the difference was greater than 10% between the two limbs by both perimetry and volumetry. Perimetry is a reliable method in the diagnosis of lymphedema when differences > or =2 cm between the two limbs should be considered.

Characterization of the gene expression related to the process of DNA damage tolerance in Schistosoma mansoni

In the course of its complex life cycle, the parasite Schistosoma mansoni need to adapt to distinct environments, and consequently is exposed to various DNA damaging agents. The Schistosoma genome sequencing initiative has uncovered sequences from genes and transcripts related to the process of DNA damage tolerance as the enzymes UBC13, MMS2, and RAD6. In the present work, we evaluate the importance of this process in different stages of the life cycle of this parasite. The importance is evidenced by expression and phylogenetic profiles, which show the conservation of this pathway from protozoa to mammalians on evolution.

Influence of narrow-band UVB phototherapy on cutaneous microbiota of children with atopic dermatitis.

OBJECTIVE: In the present work, the effect of narrow-band ultraviolet B (UVB) phototherapy on a cutaneous microbial population was evaluated in patients with atopic dermatitis (AD) and compared with control patients (vitiligo). METHODS: Count, isolation and identification of cutaneous microbiota from anticubital fossa were performed in 10 controls and 10 AD patients, both submitted to similar levels (P > 0.05) of UVB phototherapy (4.3 +/- 0.9 and 4.3 +/- 0.8 accumulated joules, respectively). Additionally, Staphylococcus aureus isolates were screened for the production of exotoxins. RESULTS: The total and staphylococcal cutaneous microbial population levels were higher (P < 0.05) in AD patients than in the controls. All these population levels decreased (P < 0.05) for both AD and control patients after UVB phototherapy, which also decreased the SCORAD for AD patients. All patients with AD and 50% of controls were carriers of S. aureus, and harboured the bacteria simultaneously on skin and anterior nares. All of the S. aureus strains recovered from AD patient skin produced toxin and the B type was the most frequently detected (70%), followed by C (20%) and A (10%) toxins. Only 40% of the S. aureus isolates from control patients produced toxin. After UVB treatment, microbial population levels of AD patients were similar (P > 0.05) to the ones found in control patients before phototherapy, and toxin production ability of S. aureus isolates decreased drastically. CONCLUSION: The results of the present study show the beneficial effect of UVB phototherapy on AD and suggest that this may be attributable not only to reduction of skin surface bacteria but also to the suppression of superantigen production from S. aureus.

Characterization of the gene expression related to the process of DNA damage tolerance in Schistosoma mansoni.

In the course of its complex life cycle, the parasite Schistosoma mansoni need to adapt to distinct environments, and consequently is exposed to various DNA damaging agents. The Schistosoma genome sequencing initiative has uncovered sequences from genes and transcripts related to the process of DNA damage tolerance as the enzymes UBC13, MMS2, and RAD6. In the present work, we evaluate the importance of this process in different stages of the life cycle of this parasite. The importance is evidenced by expression and phylogenetic profiles, which show the conservation of this pathway from protozoa to mammalians on evolution.

Improvement of the specificity of an enzyme-linked immunosorbent assay for diagnosis of paracoccidioidomycosis.

In an attempt to improve the specificity of an enzyme-linked immunosorbent assay (ELISA) for the diagnosis of paracoccidioidomycosis (PCM), sera from patients with PCM were tested using various approaches, such as sodium metaperiodate antigen (gp43) treatment, a serum absorption process with Candida albicans or Histoplasma capsulatum antigens, and dilution of serum in galactose, the main common epitope among pathogenic fungi. The maximum specificity found in this ELISA was 84%. All of these procedures proved inefficient for eliminating all cross-reacting antibodies and obtaining an ELISA specific for PCM diagnosis.

Simplified method for producing Paracoccidioides brasiliensis exoantigens for use in immunodiffusion tests.

A simplified method to produce Paracoccidioides brasiliensis exoantigens for immunodiffusion testing is proposed. It uses technology accessible for small laboratories with few resources in Latin America, where paracoccidioidomycosis is endemic. This procedure may replace the more complex procedure, originally proposed by Camargo et al. in 1988, that is currently commonly used. It is based on the production of exoantigen by P. brasiliensis isolate B339, a good secretor of the characteristic 43000-Da glycoprotein gp43.

Antagonism against Vibrio cholerae by diffusible substances produced by bacterial components of the human faecal microbiota.

Cholera vibrios sometimes survive, probably in low-level silent populations, in the small intestine of chronic carriers or pass through the gastrointestinal tract of a few individuals without causing diarrhoea or colonisation. To understand these situations, the present study used plate cultures (ex-vivo test) to investigate the frequency of appearance of an inhibitory halo against Vibrio cholerae produced by faecal specimens from 92 healthy volunteers (40 females, 52 males) aged 4-61 years. The frequency of inhibitory halo was 20.6% in the whole group. An apparently higher percentage (27.3%) was observed in the age range 20-40 years when compared with the range 4-19 years (10.7%), but not the range 41-61 years (20.0%). Frequency was significantly higher in males (30.8%) than females (7.5%). The dominant microbiota of a volunteer whose faeces produced an inhibitory halo was isolated by plate culture of decimal dilutions in an anaerobic chamber. Potential isolates of 26 apparently different morphologies were associated with germ-free NIH mice. One week later, the inhibitory test showed an antagonistic halo around the faeces from the associated animals, but not from the axenic mice. Of the 26 bacteria isolated, two (Lactobacillus sp. and Peptostreptococcus sp.) produced a compound antagonistic against V. cholerae in an in-vitro assay. When bi-associated with germ-free mice those strains eliminated the vibrio from the intestinal ecosystem in c. 5 days.

Mortalidade por nematódeos filarióides em passeriformes da espécie Oryzoborus maximiliani no Brasil / Mortality by filarial nematodes in passeriformes of species Oryzoborus maximiliani in Brazil

Descreve-se a ocorrência de filariose em passeriformes da espécie Oryzoborus maximiliani (bicudo) mantidos em cativeiro. Os sinais clínicos incluiram insuficiência respiratória e prostraçäo, evoluindo para decúbito lateral e morte. Todos os indivíduos adoeceram e morreram em poucos dias. As lesöes mais significativas foram encontradas nos pulmöes, que estavam acinzentados na regiäo adjacente ao saco aéreo abdominal. Impressöes do pulmäo observadas ao microscópio em 100 aumentos permitiram a visualizaçäo de grande número de formas alongadas típicas de nematódeo. Considerando suas dimensöes e os relatos da literatura consultada, especulou-se a possibilidade de filariose. As condiçöes de estresse de captura e cativeiro podem ser determinantes do quadro agudo observado, o que permite sugerir esta suspeita em casos semelhantes. Considera-se importante, entretanto, a possibilidade de a manifestaçäo clínica na forma crônica ou assintomática poder ser mais comum que a aguda

[Modality of support for research in the field of nursing]. / Modalidade de fomento à pesquisa na área assistencial.

This paper deals with the organization of the Operational Research Committee implemented at the University Hospital of the University of Säo Paulo in 1993 with the objective of giving logistic support to nurses in the development of their scientific work. It shows the strategies adopted to encouage research among nurses to reach the success of the proposal.

[The nursing audit: its introduction and development in the University Hospital of the University of São Paulo]. / Auditoria em enfermagem: implantação e desenvolvimento no Hospital Universitário da Universidade de São Paulo.

The study reports an experience carried out by the Departamento de Assistência de Enfermagem do Hospital Universitário da USP, the implantation and development of the retrospective auditory process for the evaluation of their activities as an instrument for control and maintenance of the quality of nursing care given the community. It describes the various steps, instruments and reports used, as well as the use of the auditory's findings for reviewing the assistential and educational programs developed by the department.

[The introduction and development of the nursing process in the teaching hospital]. / Implantação e desenvolvimento do processo de enfermagem no hospital-escola.

The work relates the implantation and development of the nursing process in school-hospital, analyzed by a point of changing in the nursing department organization. Assuming an innovating nature, the proposal demands an adaptative behavior of the nurse, the nursing and multi-professional staffs, so that implementation of the assistance, in this perspective, can be effective and come to a high quality level. The work still points out, the establishing of the training program and up-to-date nurses program in order to make them cut out for accomplishment of their roles as coordinator of nursing assistance.