Paracoccidioidomycosis: an epidemiologic survey in a pediatric population from the Brazilian Amazon using skin tests.

Since Paracoccidioides brasiliensis and Histoplasma capsulatum are known to be present in similar environments, there have been many epidemiologic investigations regarding the prevalences of these two organisms. However, cross-reactivity can occur in paracoccidioidin and histoplasmin skin tests, and this usually results in the overestimation of the prevalence of P. brasiliensis. The prevalence of infection with P. brasiliensis was evaluated in a cross-sectional study of 298 asymptomatic school children in the Brazilian Amazon region (Mato Grosso State). In this investigation, the reactivity of children to two different P. brasiliensis antigen preparations, paracoccidioidin and a purified 43-kD glycoprotein (gp43), was compared with or without the co-administration of histoplasmin. In the group of individuals receiving paracoccidioidin who had a positive histoplasmin skin test result, the prevalence of exposure to P. brasiliensis was 44% (16 of 36). This reactivity to P. brasiliensis was significantly higher than that observed in other groups, which ranged from 4% to 6% (P < 5 x 10(-4) for each). Overall prevalence was 4.6% (95% confidence interval = 2.5-7.7%). These data suggest that gp43 provides a better estimate of exposure to P. brasiliensis when the co-administration of histoplasmin is desired.

The association of genetic markers and malaria infection in the Brazilian Western Amazonian region.

Almost all individuals (182) belonging to an Amazonian riverine population (Portuchuelo, RO, Brazil) were investigated for ascertaining data on epidemiological aspects of malaria. Thirteen genetic blood polymorphisms were investigated (ABO, MNSs, Rh, Kell, and Duffy systems, haptoglobins, hemoglobins, and the enzymes glucose-6-phosphate dehydrogenase, glyoxalase, phosphoglucomutase, carbonic anhydrase, red cell acid phosphatase, and esterase D). The results indicated that the Duffy system is associated with susceptibility to malaria, as observed in other endemic areas. Moreover, suggestions also arose indicating that the EsD and Rh loci may be significantly associated with resistance to malaria. If statistical type II errors and sample stratification could be ruled out, hypotheses on the existence of a causal mechanism or an unknown closely linked locus involved in susceptibility to malaria infection may explain the present findings.

The association of genetic markers and malaria infection in the Brazilian Western Amazonian region

Almost all individuals (182) belonging to an Amazonian riverine population (Portuchuelo, RO, Brazil) were investigated for ascertaining data on epidemiological aspects of malaria. Thirteen genetic blood polymorphisms were investigated (ABO, MNSs, Rh, Kell, and Duffy systems, haptoglobins, hemoglobins, and the enzymes glucose-6-phosphate dehydrogenase, glyoxalase, phosphoglucomutase, carbonic anhydrase, red cell acid phosphatase, and esterase D). The results indicated that the Duffy system is associated with susceptibility to malaria, as observed in other endemic areas. Moreover, suggestions also arose indicating that the EsD and Rh loci may be significantly associated with resistance to malaria. If statistical type II errors and sample stratification could be ruled out, hypotheses on the existence of a causal mechanism or an unknown closely linked locus involved in susceptibility to malaria infection may explain the present findings

Prevalence and risk factors associated with Helicobacter pylori infection in native populations from Brazilian Western Amazon.

We evaluated the prevalence of, and factors associated with, Helicobacter pylori infection in 222 subjects from 3 distinct communities of native populations (Uru-Eu-Wau-Wau Indians and 2 riverine communities living on the banks of the Machado river and in Portuchuelo) living in isolation in the rainforest of Brazilian Western Amazon. The overall prevalence was 78.8% (95% CI 72.7-83.9). The prevalence was higher in the Machado river community compared with Portuchuelo (chi2 = 3.84, P = 0.05), but no significant difference was observed between the Machado river community and the Uru-Eu-Wau-Wau Indians. Logistic regression showed that residential crowding and age were factors associated with the presence of H. pylori infection. Acquisition of the bacterium started early in life and by the age of 2 years 50% of children were infected. The prevalence increased with age, reaching near universal levels during adulthood (97.9%). Residential crowding was high with a global index of 3.3 persons/room (SD = 1.8), varying significantly between the 3 communities (P = 0.001). These data provide further evidence supporting direct person-to-person spread of the bacterium.

Ethnic admixture composition of two western Amazonian populations.

A small riverine community, Portuchuelo (8 degrees 37'S, 63 degrees 49'W), and a rural county, Monte Negro (10 degrees 15'S, 63 degrees 18'W), both in the state of Rondjnia, Brazil, were studied for the purposes of ascertaining health conditions and the causes of the variability of some infectious diseases. The sample included 181 inhabitants of Portuchuelo and 924 of Monte Negro. Data on 11 blood polymorphisms (ABO, Rh, MNSs, Kell, Fy, haptoglobin, hemoglobin, ACP1, PGM1, GLO1, and CA2) were used to determine the ethnic composition of the inhabitants of Portuchuelo and Monte Negro. The contributions of Africans, Amerindians, and Europeans to the ethnic composition of the studied populations were, respectively, 0.21 +/- 0.046, 0.44 +/- 0.064, and 0.35 +/- 0.069 in Portuchuelo; and 0.25 +/- 0.032,0.12 +/- 0.046, and 0.63 +/- 0.054 in Monte Negro.

[Citizen training in nursing: myth or potential utopia?]. / Formação cidadã em enfermagem: mito ou possibilidade utópica?

The objective of this study is to verify to what extent the concepts of university, citizenship, social compromise and health system influence the nursing practice. These topics were analysed through questionnaires answered by senior nursing students. The pedagogical project of the this course was used as reference to analyse students' speech. The study showed that these prospective professionals didn't have a satisfying advance concerning their view on education, health and conception of the world. This result suggested that this pedagogical proposal has to be constantly reexamined in order to broaden students' view on the aspects mentioned. It was noticed that students' discourses were heterogeneous, and contrasted with the apparent homogeneity in the understanding of specific contents. The research highlights the dialectical movement that affects the teaching practice, which oscillates between a critical formation and Descartes' logic. It was concluded that a continuous evaluation of the educational project is a vital strategy to consolidate a formation compromised with citizenship.

Atovaquone and proguanil for the treatment of malaria in Brazil.

The purpose of this study was to compare an experimental regimen of atovaquone plus proguanil with the standard regimen of quinine plus tetracycline for the treatment of uncomplicated falciparum malaria. The study was designed as an open, randomized study of men presenting with symptoms of uncomplicated malaria and thick-smear slide confirmation of parasitemia (1000-100,000 ring forms/microL). Subjects were hospitalized for 28 days to insure medication compliance and to rule out the possibility of reinfections. With 77 patients in each group, the cure rates were 98.7% and 100% for atovaquone plus proguanil and quinine plus tetracycline, respectively. The parasite clearance times (mean, 56 h) and fever clearance times (mean, 19 h) were significantly shorter in the atovaquone plus proguanil group, and there were significantly fewer side effects in the atovaquone plus proguanil group. Atovaquone plus proguanil is an efficacious, easily administered, safe regimen for the treatment of uncomplicated, multidrug-resistant falciparum malaria in Brazil.

[Severe combined immunodeficiency: description of a clinical case]. / Imunodeficiência combinada severa: descrição de caso clínico.

A Severe Combined Immunodeficiency (SCID) is a rare disease, with recessive autosomic or X linked inheritance. The clinical phenotype is related to the defect of specific antigen response. The authors describe a patient presenting recurrent infections, affected by SCID, with multiple hospitalizations. Immunologic evaluation was performed and adenosine deaminase deficiency was excluded. The patient was submitted to herniography and he died seven days after the surgery. The preparation for bone marrow transplantation was provided. The anatomo-pathological findings had showed immunologic system alterations. The early clinical diagnosis and the therapy are discussed.