Cross-cultural adaptation of the Brazilian-Portuguese version of the chronic urticaria quality-of-life questionnaire - CU-Q2oL.

BACKGROUND: Chronic urticaria (CU) is a debilitating skin disorder that affects patients' health related quality of life and the only questionnaire prepared specifically to CU is the Chronic Urticaria Quality of Life Questionnaire (CU-Q(2)oL). OBJECTIVE: The purpose of this study was to cross-culturally adapt and validate the CU-Q(2)oL Brazilian-Portuguese version. METHODS: Forward and back translation by three bilingual translators followed by pre-test was used to adapt the questionnaire. The CU-Q(2)oL was self-administered along with the Dermatology Life Quality Index (DLQI) in 112 patients with CU. Disease activity was assessed using the Urticaria Activity Score. Factor analysis was used to identify scales of the Brazilian portuguese CU-Q(2)oL. Internal consistency, convergent validity and known-group validity was determined. Reproducibility was evaluated by interclass correlation coefficient (ICC). Multiple linear regression was used to determine the predicting factors of CU-Q(2)oL results. RESULTS: Factor analysis revealed a three-dimensional structure: sleep/mental status/eating (I), pruritus/impact on life activities (II) and swelling/limits/look (III), which explained 52.49% of the total variance. All scales showed excellent internal consistency. External construct validity was supported by correlations between the CU-Q(2)oL and DLQI. The tool was found to be able to differentiate between patients with high and low levels of urticaria activity. Test-retest reliability was good to excellent (ICC = 0.69-0.86). Disease severity and urticaria type were the only factors predicting results. CONCLUSIONS: The CU-Q(2)oL Brazilian portuguese version was easily filled out, well accepted by the patients, demonstrated an acceptable validity and reliability and might be used to evaluate treatment outcomes and in clinical research.

Colonisation by extended-spectrum beta-lactamase-producing Klebsiella spp. in a paediatric intensive care unit.

A prospective cohort study was performed in order to study the incidence and risk factors for bacterial colonisation with extended-spectrum producing beta-lactamase (ESBL) Klebsiella spp. in children. The study took place in a paediatric intensive care unit (PICU) in Recife, Brazil over a five-month period in 2008. Rectal swabs were collected during the first 24h of admission and on the 2nd, 5th, 7th and 14th days of PICU stay. ESBL-producing strains of Klebsiella spp. were detected by Kirby-Bauer disc diffusion and confirmed by double disc synergy testing. A total of 186 children were enrolled with a median age of three years. The overall colonisation rate with ESBL-producing Klebsiella spp. was 14%, but 13 (7%) children were already colonised upon admission. The incidence density of colonisation during PICU admission was 14.2 per 1000 patient-days. On multivariable analysis, the use of third generation cephalosporins (P=0.008) was a risk factor for colonisation. Survival analysis revealed an increase in the accumulated risk of colonisation with an increase in length of stay in the PICU. The present study provides baseline information to guide improved practices in similar settings and direct future studies in relation to the magnitude of cross-infection and effectiveness of infection control interventions.

The larval midgut of Anticarsia gemmatalis (Hübner) (Lepidoptera: Noctuidae): light and electron microscopy studies of the epithelial cells.

The morphology of the midgut epithelium cells of Anticarsia gemmatalis (Hübner) larvae is described by light and transmission electron microscopy. The midgut of A. gemmatalis is the largest portion of the digestive tract, with three distinct regions: proximal, media and distal. Its wall is formed by pseudostratified columnar epithelial tissue having four cell types: columnar, goblet, regenerative, and endocrine cells. The columnar cells are numerous and long, with the apical portion showing many lengthy microvilli and the basal portion invaginations forming a basal labyrinth. The goblet cells have a large goblet-shaped central cavity delimited by cytoplasmic projections filled with mitochondria. The regenerative cells present electron-dense cytoplasm and few organelles. The endocrine cells are characterized by electron-dense secretory granules, usually concentrated in the cytoplasm basal region.

The larval midgut of Anticarsia gemmatalis (Hübner) (Lepidoptera: Noctuidae): light and electron microscopy studies of the epithelial cells

A morfologia das células epiteliais do intestino médio de larvas de Anticarsia gemmatalis (Hübner) é descrita em microscopia de luz e eletrônica de transmissão. O intestino médio de A. gemmatalis é a maior porção do trato digestivo, apresentando três regiões distintas: proximal, média e distal. Sua parede é formada por um tecido epitelial pseudo-estratificado colunar, com quatro tipos celulares: células colunares, caliciformes, regenerativas e endócrinas. As células colunares, observadas em maior quantidade, são altas, apresentam longas e numerosas microvilosidades na porção apical e na porção basal as invaginações da membrana formam o labirinto basal. As células caliciformes apresentam uma grande câmara central delimitada por projeções citoplasmáticas repletas de mitocôndrias no interior. As células regenerativas têm o citoplasma mais elétron-denso e com poucas organelas. As células endócrinas são caracterizadas pela presença de grânulos secretores bastante elétron-densos concentrados principalmente no citoplasma basal da célula.

The larval midgut of Anticarsia gemmatalis (Hübner) (Lepidoptera: Noctuidae): light and electron microscopy studies of the epithelial cells

The morphology of the midgut epithelium cells of Anticarsia gemmatalis (Hübner) larvae is described by light and transmission electron microscopy. The midgut of A. gemmatalis is the largest portion of the digestive tract, with three distinct regions: proximal, media and distal. Its wall is formed by pseudostratified columnar epithelial tissue having four cell types: columnar, goblet, regenerative, and endocrine cells. The columnar cells are numerous and long, with the apical portion showing many lengthy microvilli and the basal portion invaginations forming a basal labyrinth. The goblet cells have a large goblet-shaped central cavity delimited by cytoplasmic projections filled with mitochondria. The regenerative cells present electron-dense cytoplasm and few organelles. The endocrine cells are characterized by electron-dense secretory granules, usually concentrated in the cytoplasm basal region.

A morfologia das células epiteliais do intestino médio de larvas de Anticarsia gemmatalis (Hübner) é descrita em microscopia de luz e eletrônica de transmissão. O intestino médio de A. gemmatalis é a maior porção do trato digestivo, apresentando três regiões distintas: proximal, média e distal. Sua parede é formada por um tecido epitelial pseudo-estratificado colunar, com quatro tipos celulares: células colunares, caliciformes, regenerativas e endócrinas. As células colunares, observadas em maior quantidade, são altas, apresentam longas e numerosas microvilosidades na porção apical e na porção basal as invaginações da membrana formam o labirinto basal. As células caliciformes apresentam uma grande câmara central delimitada por projeções citoplasmáticas repletas de mitocôndrias no interior. As células regenerativas têm o citoplasma mais elétron-denso e com poucas organelas. As células endócrinas são caracterizadas pela presença de grânulos secretores bastante elétron-densos concentrados principalmente no citoplasma basal da célula.

The larval midgut of Anticarsia gemmatalis (Hübner) (Lepidoptera: Noctuidae): light and electron microscopy studies of the epithelial cells

The morphology of the midgut epithelium cells of Anticarsia gemmatalis (Hübner) larvae is described by light and transmission electron microscopy. The midgut of A. gemmatalis is the largest portion of the digestive tract, with three distinct regions: proximal, media and distal. Its wall is formed by pseudostratified columnar epithelial tissue having four cell types: columnar, goblet, regenerative, and endocrine cells. The columnar cells are numerous and long, with the apical portion showing many lengthy microvilli and the basal portion invaginations forming a basal labyrinth. The goblet cells have a large goblet-shaped central cavity delimited by cytoplasmic projections filled with mitochondria. The regenerative cells present electron-dense cytoplasm and few organelles. The endocrine cells are characterized by electron-dense secretory granules, usually concentrated in the cytoplasm basal region.

A morfologia das células epiteliais do intestino médio de larvas de Anticarsia gemmatalis (Hübner) é descrita em microscopia de luz e eletrônica de transmissão. O intestino médio de A. gemmatalis é a maior porção do trato digestivo, apresentando três regiões distintas: proximal, média e distal. Sua parede é formada por um tecido epitelial pseudo-estratificado colunar, com quatro tipos celulares: células colunares, caliciformes, regenerativas e endócrinas. As células colunares, observadas em maior quantidade, são altas, apresentam longas e numerosas microvilosidades na porção apical e na porção basal as invaginações da membrana formam o labirinto basal. As células caliciformes apresentam uma grande câmara central delimitada por projeções citoplasmáticas repletas de mitocôndrias no interior. As células regenerativas têm o citoplasma mais elétron-denso e com poucas organelas. As células endócrinas são caracterizadas pela presença de grânulos secretores bastante elétron-densos concentrados principalmente no citoplasma basal da célula.

Efficacy of celecoxib in treating symptoms of viral pharyngitis: a double-blind, randomized study of celecoxib versus diclofenac.

This study compared the efficacy and safety of the cyclooxygenase-2 specific inhibitor celecoxib with the conventional non-steroidal anti-inflammatory drug diclofenac in the symptomatic treatment of viral pharyngitis. Adult patients from 27 study centers in Latin America were treated with oral doses of celecoxib 200 mg once daily or 200 mg twice daily, or diclofenac 75 mg twice daily for 5 days in a double-blind, randomized study. The primary efficacy assessment was 'Throat Pain on Swallowing' on day 3. In addition, secondary quality-of-life assessments were performed on days 3 and 5. All adverse events and treatment-emergent signs and symptoms were recorded. Data from 313 patients were evaluable for efficacy (105 celecoxib 200 mg once daily, 107 celecoxib 200 mg twice daily, 101 diclofenac 75 mg twice daily). The upper 95% confidence limits for the visual analog scale of 'Throat Pain on Swallowing' on day 3 for celecoxib 200 mg once daily relative to diclofenac 75 mg twice daily, and celecoxib 200 mg twice daily relative to diclofenac 75 mg twice daily were 9.26 and 7.83, respectively. All secondary efficacy and quality-of-life measures were clinically similar for the three treatment groups, and no statistically significant differences were detected. The incidences of treatment-emergent adverse events and withdrawals due to adverse events were similar for all groups, but numerically higher among patients taking diclofenac than celecoxib. More patients in the diclofenac group reported gastrointestinal complaints (7.3%) compared with those in the celecoxib groups (4.3% in the celecoxib 200 mg once-daily group and 3.4% in the celecoxib 200 mg twice-daily group). In conclusion, 5 days of treatment with celecoxib 200 mg once daily is as effective as diclofenac 75 mg twice daily in the symptomatic treatment of viral pharyngitis. Celecoxib 200 mg once daily is also as effective as celecoxib 200 mg twice daily in this condition.

Ambigüedad sexual orgánica. Vicisiitudes en la constitución de la identidad sexual / Organic sexual ambiguity. Vicissitudes in the constitution of the sexual identity

En las adolescentes con ambigüedad sexual el handicap del conflicto biológico dificulta el proceso de asunción de la idoneidad sexual. Se exponen los caos en donde los procesos fueron diferentes y pensamos que la resolución de la subjetividad femenina dependió en gran medida de la estructura psicopatológica individual y familiar, de la historia y de las vivencias ifantiles

Ambig³edad sexual orgánica. Vicisiitudes en la constitución de la identidad sexual / Organic sexual ambiguity. Vicissitudes in the constitution of the sexual identity

En las adolescentes con ambig³edad sexual el handicap del conflicto biológico dificulta el proceso de asunción de la idoneidad sexual. Se exponen los caos en donde los procesos fueron diferentes y pensamos que la resolución de la subjetividad femenina dependió en gran medida de la estructura psicopatológica individual y familiar, de la historia y de las vivencias ifantiles

Developmental patterns of normal nutritive sucking in infants.

The purpose of this investigation was to quantify normal nutritive sucking, using a microcomputer-based instrument which replicated the infant's customary bottle-feeding routine. 86 feeding sessions were recorded from infants ranging between 1.5 and 11.5 months of age. Suck height, suck area and percentage of time spent sucking were unrelated to age. Volume per suck declined with age, as did intersuck interval, which corresponded to a more rapid sucking rate. This meant that volume per minute of sucking time was fairly constant. The apparatus provided an objective description of the patterns of normal nutritive sucking in infants to which abnormal sucking patterns may be compared.

Persistently low natural killer cell activity, age, and environmental stress as predictors of infectious morbidity.

In recent studies of 'low natural killer (NK) cell syndrome', low NK activity was measured in individuals who were symptomatic, and therefore a causal relationship between low NK activity and infectious or other disease manifestations could not be concluded. However, preliminary work by members of our collaborative team (S.L. and R.H.) provided some indications for chronic low NK activity preceding and predicting subsequent infectious morbidity. This present study was designed to address this causal question in a larger sample, using a longitudinal design. Subjects were 106 healthy normal volunteers from the community. They were examined medically and psychosocially at baseline, and were then followed over a 6-month interval, with serial monthly assessments over the study period. The results supported our hypothesis that individuals who were currently healthy, but who exhibited a pattern of natural immunity characterized by persistently low NK cytotoxicity would be at risk for development of infectious sequelae over a 6-month follow-up period. The results also showed that younger age and the perception of more severe 'hassles' or stressors also predicted more infectious morbidity during the 6-month study period. Chronological age appeared to have both a direct, as well as indirect (via NK activity) association with illness outcome. Contrary to our expectation, the report of environmental stressors was directly associated with illness outcome, but not indirectly associated with outcome via natural immunity.

Persistently low natural killer cell activity and circulating levels of plasma beta endorphin: risk factors for infectious disease.

Beta endorphin levels were quantitated in plasma samples obtained from normal subjects (n = 81, 37% males and 63% females, age range 18-45 years) as a component of a prospective study examining the relationship of illness morbidity to natural killer cell activity and psychological indices of stress. The present study was designed to test whether beta endorphin levels contributed additionally to the explanation of illness outcome variance. In the larger study, persistently low NK (LNK) activity was associated prospectively with higher illness morbidity. The findings reported here suggest that the observed LNK activity might be affected by circulating levels of plasma beta endorphin, as lower endorphin levels predicted the LNK pattern, which in turn, predicted higher illness morbidity.

[Digno Stagno and the home for the rural pregnant]. / Digno Stagno y la casa de la embarazada rural

PIP: This article is dedicated to Dino Stagno Maccioni because of his pioneering work in developing the field of maternal and child health in Chile as well as his outstanding work in health care in Chile's Ninth Region. He is also renowned because he developed community health indicators and projects that were used as the basis of health policies in local and national programs. One of his most famous programs is "The Home for Pregnant Women in Rural Traiguen," or "La Casita." IN 1975 this home became the 1st home for high-risk pregnant rural peasants in Chile with the aim of lowering the high mortality rates of women and infants and increasing professional control over the process of pregnancy and delivery. In 1984 an evaluation was done on the program's first 9 years. 1579 cases were reviewed and compared to statistics from other hospitals in Chile. The results demonstrated an increase from 136 patients in 1975 to 456 in 1983; its coverage was 100% of the rural population of which 36% were those from Traiguen; attendance of high risk pregnancies increased from 32% in 1975 to 62.7% in 1983. The philosophy was to keep rural high risk patients and their babies "in hand" to minimize their complications; 26% of deliveries were complicated and ended up in cesarean sections, predicting that these patients outside of this setting would have died. Professional deliveries increased from 80% in 1975 to 91% in 1983 demonstrating the success of the program. In 1990 the program remains a success.^ieng

Ethnobotanical inventory of medicinal plants used by the Guaymi Indians in western Panama. Part II.

A list of newly identified plants is presented to supplement Part I (Joly et al. (1987) Journal of Ethnopharmacology 20, 145-171). A comparative analysis is made between our work and two other recent inventories of plants used by the Guaymi Indians of Panama and Costa Rica. As in Part I, the results of a literature survey are also provided, including medicinal uses, known constituents and pharmacological effects.

Estrogen receptor concentration and social factors as predictors of natural killer cell activity in early-stage breast cancer patients. Confirmation of a model.

Previous work of ours has demonstrated that a significant amount of natural killer (NK) activity variance after surgery in stage I and II breast cancer patients could be accounted for by both the estrogen receptor (ER) status of the tumor and by social factors, namely, perceived social support and seeking social support as a general coping strategy. As considerable evidence has accumulated that social support in both animal and human populations may have survival value, we sought to test the reliability of this regression model, using coping and perceived support factor values obtained at 3 months after surgery to account for concurrent follow-up NK activity in this serially assessed group of patients. It was found that the most significant variable predicting NK activity at follow-up was tumor ER concentration, with higher NK activity associated with ER- status. In addition, seeking social support as a coping strategy, as well as the perceived quality of support, also entered the model to account for a significant amount of NK activity variance (multivariate F = 5.25, p less than 0.001). If, as the literature suggests, NK activity is relevant to breast cancer control, and since ER- tumors have a worse prognosis, we suggest here that perhaps such tumors are resistant to control by NK cells because they lack the ability to attract an accumulation of effector cells to the tumor site, or because blocking factors at the site of the tumor prevent local tumor control at the site of action. The finding related to social support also replicates results from an independent sample of breast cancer patients. This finding, taken together with other evidence that this social variable is associated with longer survival in breast cancer populations, underscores the potential importance of this social support variable. Our findings also suggest one possible immunological variable involved, with potential clinical significance, for this patient population.

Persistently low natural killer cell activity in normal adults: immunological, hormonal and mood correlates.

This current study is concerned with the identification of the incidence of persistently low natural killer (NK) cell activity in an essentially healthy population of young adults, and the characterization of the psychological profile associated with this pattern of NK activity. Eighty-eight individuals, between the ages of 18 and 44 years, were accrued to this project. Subjects were tested serially, at baseline induction into the study, and at 2 and 4 weeks follow-up. Baseline assessment included a complete physical examination and laboratory work-up in order to exclude anyone ill at the time of enrollment, and to have complete physical status information on all subjects at the time of accrual. NK activity, urinary catecholamine levels and psychological status were also assessed at baseline, and at the specified follow-up intervals. Individuals with low NK activity were operationally defined as those having NK function either below the group mean, or below the group lowest quartile, at baseline and at two follow-up assessments. Results showed that in both univariate analyses, as well as in logistic regression models, age and the perception of environmental stressors or 'hassles' predicted persistently low NK activity. Younger subjects, who perceived environmental events to which they were exposed as more serious in nature, were more likely to exhibit a persistently low NK profile over time than older individuals who perceived daily events as less important to them.