Flood-pulse disturbances as a threat for long-living Amazonian trees.

The long-lived tree species Eschweilera tenuifolia (O. Berg) Miers is characteristic of oligotrophic Amazonian black-water floodplain forests (igapó), seasonally inundated up to 10 months per year, often forming monodominant stands. We investigated E. tenuifolia' growth and mortality patterns in undisturbed (Jaú National Park - JNP) and disturbed igapós (Uatumã Sustainable Development Reserve - USDR, downstream of the Balbina hydroelectric dam). We analysed age-diameter relationships, basal area increment (BAI) through 5-cm diameter classes, growth changes and growth ratios preceding death, BAI clustering, BAI ratio, and dated the individual year of death (14 C). Growth and mortality patterns were then related to climatic or anthropogenic disturbances. Results were similar for both populations for estimated maximum ages (JNP, 466 yr; USDR, 498 yr, except for one USDR tree with an estimated age of 820 yr) and slightly different for mean diameter increment (JNP: 2.04 mm; USDR: 2.28 mm). Living trees from JNP showed altered growth post-1975 and sparse tree mortality occurred at various times, possibly induced by extreme hydroclimatic events. In contrast with the JNP, abrupt growth changes and massive mortality occurred in the USDR after the dam construction began (1983). Even more than 30 yr after dam construction, flood-pulse alteration continues to affect both growth and mortality of E. tenuifolia. Besides its vulnerability to anthropogenic disturbances, this species is also susceptible to long-lasting dry and wet periods induced by climatic events, the combination of both processes may cause its local and regional extinction.

The effect of home exercise on the posture and mobility of people with HAM/TSP: a randomized clinical trial.

BACKGROUND: Physical therapy has positive results in people with tropical spastic paraparesis (TSP). However, mobility and distance from rehabilitation centers limit the participation in outpatient programs. OBJECTIVE: To evaluate the impact of a home exercise program on the posture and functional mobility of people with TSP. METHODS: A randomized controlled trial comparing three groups of people who performed guided exercises from a guidebook for six months: supervised (SG), unsupervised (WG), and control (CG). Primary outcomes: postural angles (SAPO®) and functional mobility (TUG). SECONDARY OUTCOMES: gait parameters (CVMob®). RESULTS: The protocol described in the guidebook improved postural angles and functional mobility. There were also positive gait parameter effects (p<0.05). SG presented better responses than WG did, but both were preferable to CG. CONCLUSION: Home exercises oriented by a guidebook may benefit posture, functional mobility and gait parameters in people with TSP, and physiotherapist supervision can ensure better results.

The effect of home exercise on the posture and mobility of people with HAM/TSP: a randomized clinical trial / Efeitos de exercícios domiciliares sobre a postura e mobilidade de pessoas com HAM/TSP: ensaio clínico randomizado

Abstract Background: Physical therapy has positive results in people with tropical spastic paraparesis (TSP). However, mobility and distance from rehabilitation centers limit the participation in outpatient programs. Objective: To evaluate the impact of a home exercise program on the posture and functional mobility of people with TSP. Methods: A randomized controlled trial comparing three groups of people who performed guided exercises from a guidebook for six months: supervised (SG), unsupervised (WG), and control (CG). Primary outcomes: postural angles (SAPO®) and functional mobility (TUG). Secondary outcomes: gait parameters (CVMob®). Results: The protocol described in the guidebook improved postural angles and functional mobility. There were also positive gait parameter effects (p<0.05). SG presented better responses than WG did, but both were preferable to CG. Conclusion: Home exercises oriented by a guidebook may benefit posture, functional mobility and gait parameters in people with TSP, and physiotherapist supervision can ensure better results.

Resumo Introdução: A fisioterapia apresenta resultados positivos em pessoas com paraparesia espástica tropical (PET). Entretanto, a dificuldade de locomoção e a distância dos centros de reabilitação limitam a participação em programas ambulatoriais. Objetivo: Avaliar o impacto de um programa de exercícios domiciliares na postura e mobilidade funcional de pessoas com PET. Métodos: Um ensaio clínico randomizado comparou três grupos de pessoas que realizaram exercícios guiados por cartilha: com supervisão (GS), sem supervisão (GN) e controle (GC) durante seis meses. Desfechos primários: ângulos posturais (SAPO®) e mobilidade funcional (TUG). Desfechos secundários: parâmetros da marcha (CVMob®). Resultados: O protocolo descrito na cartilha melhorou os ângulos posturais e a mobilidade funcional. Os resultados também foram positivos para os parâmetros da marcha (p<0,05). O GS apresentou melhores respostas que o GN, porém ambos foram preferíveis ao GC. Conclusão: Exercícios domiciliares orientados por cartilha podem ser úteis para beneficiar a postura, mobilidade funcional e parâmetros de marcha em pessoas com PET, e a supervisão do fisioterapeuta possibilita garantir melhores resultados.

Programas de exercícios domiciliares para incapacidades da atividade de caminhar causadas por distúrbios neurológicos: Revisão sistemática com metanálise / Home-based exercise programs for disabilities of walking activity caused by neurological disorders: Systematic Review with Meta-Analysis

INTRODUÇÃO: Na medida em que a expectativa de vida aumenta, também são necessárias soluções para melhorar a independência funcional em condições cronicamente alteradas, comuns nas disfunções neurológicas. OBJETIVO: Avaliar o efeito de programas de exercícios domiciliares (PED) sobre prejuízos na atividade de caminhar devido a acidente vascular cerebral (AVC), doença de Parkinson (DP), esclerose múltipla (EM) e mielopatia associada ao HTLV-1 ou paraparesia espástica tropical (HAM/TSP). MÉTODOS: As fontes de dados incluíram PubMed, SciELO, Pedro e Cochrane Library e artigos disponíveis em inglês, português, espanhol, alemão ou francês. Nenhuma restrição de tempo foi aplicada e a seleção foi feita por dois pesquisadores independentes em três etapas. Ensaios clínicos com intervenções dos programas PED para adultos com dificuldades de marcha ou equilíbrio decorrentes das condições neurológicas acima foram incluídos. As variáveis foram velocidade ou distância da marcha, força, equilíbrio, mobilidade, funcionalidade e independência funcional. A qualidade metodológica foi avaliada com a escala PEDro, e uma estratégia PICOS orientou extração de dados. Diferenças das médias ponderadas (DMP), intervalos de confiança de 95% (IC) e heterogeneidade foram avaliadas pelo teste I2 com o programa RevMan 5.3. A GRADE foi aplicada na avaliação da qualidade da evidência. RESULTADOS: O PED foi eficaz na melhora do equilíbrio (DMP 2,8;IC 1,5; 4,1) e da capacidade cardiorrespiratória (DMP 29,3m; IC 8,3; 50,2) para pessoas com AVC. Para pessoas com EM, o PED levou a uma melhora no perfil fisiológico (DMP -1,3; IC -0,5; 2,0) e mobilidade (DMP -3,3; IC -5,1; -1,4). CONCLUSÕES: O PED é eficaz na melhora da atividade de caminhada, desempenho e mobilidade funcional das deficiências neurológicas. Sugerimos a aplicação do PED na saúde pública e o uso de escalas funcionais para comparar a mesma incapacidade em diferentes distúrbios neurológicos.

INTRODUCTION: As increase life expectancy, the searches for conducts to improve functional independence in chronically altered conditions as is common in the neurological dysfunction. OBJECTIVES: To evaluate the effect of therapeutic home based exercise programs (HBE) on impairment of walking activity due to stroke, Parkinson's disease (PD), multiple sclerosis and HTLV-1 associated myelopathy or tropical spastic paraparesis (HAM/TSP). METHODS: data sources PubMed, Scielo, Pedro, Cochrane Library; available in English, Portuguese, Spanish, German or French languages; no time restrictions; selection made by two independent researchers, in three stages; included Clinical Trials with interventions of HBE Programs for adults with gait or balance disabilities arising from the above neurological conditions; gait speed or distance, strength, balance, mobility, functionality and functional independence were the variables; methodological quality with PEDro scale; PICOS strategy guided the extraction date. Weighted mean differences (WMD), 95% confidence intervals (CI), and the heterogeneity assessed by the I2 test with RevMan 5.3 program. RESULTS: In balance (WMD 2.8; CI 1.5; 4.1) and in cardiorespiratory capacity (WMD 29.3m; IC 8.3; 50.2) for people with stroke are effectiveness. For people with Multiple Scleroses there is improvement in physiological profile (WMD -1.3; CI -0.5; 2.0) and mobility (WMD -3.3; CI -5.1; -1,4). CONCLUSIONS: The HBE is effective on walking activity, improve performance and functional mobility in neurological impairments. Is suggested HBE on public health to includ elements for management of disabilities on the programs and the use of functional scales such as WHODAS to compare the same disability in different neurological disorders.

The synthesis and in vitro biological evaluation of novel fluorinated tetrahydrobenzo[j]phenanthridine-7,12-diones against Mycobacterium tuberculosis.

Tuberculosis (TB) still has a major impact on public health. In order to efficiently eradicate this life-threatening disease, the exploration of novel anti-TB drugs is of paramount importance. As part of our program to design new 2-azaanthraquinones with anti-mycobacterial activity, various "out-of-plane" tetrahydro- and octahydrobenzo[j]phenanthridinediones were synthesized. In this study, the scaffold of the most promising hits was further optimized in an attempt to improve the bioactivity and to decrease enzymatic degradation. The rudiment bio-evaluation of a small library of fluorinated tetrahydrobenzo[j]phenanthridine-7,12-dione derivatives indicated no significant improvement of the bio-activity against intracellular and extracellular Mycobacterium tuberculosis (Mtb). Though, the derivatives showed an acceptable toxicity against J774A.1 macrophages and early signs of genotoxicity were absent. All derivatives showed to be metabolic stabile in the presence of both phase I and phase II murine or human microsomes. Finally, the onset of reactive oxygen species within Mtb after exposure to the derivatives was measured by electron paramagnetic resonance (EPR). Results showed that the most promising fluorinated derivative is still a possible candidate for the subversive inhibition of mycothione reductase.

Pain and Quality of Life in Human T-cell Lymphotropic Virus Type 1-Associated Myelopathy or Tropical Spastic Paraparesis After Home-Based Exercise Protocol: A Randomized Clinical Trial.

INTRODUCTION: Human T-cell lymphotropic virus type 1-associated myelopathy or tropical spastic paraparesis (HAM/TSP) causes, among other abnormalities, chronic pain that may impair quality of life (QOL). Home protocols can help those who have difficulty attending rehabilitation centers. This study aimed to evaluate the impact of a home-based exercise protocol on pain and QOL in people with HAM/TSP. METHODS: A randomized clinical trial of people with HAM/TSP (World Health Organization criteria) classified as probable or definite. The supervised group (SG) underwent training for 12 weeks and continued the protocol at home for another 12 weeks; the unsupervised group (UG) performed the same protocol at home without physical therapist supervision for 24 weeks; and the control group (CG) maintained the usual care. QOL was assessed by the Short Form-36 health survey and the pain condition by the Brief Pain Inventory (BPI). The Chi-square, analysis of variance, Kruskal-Wallis, and Friedman tests (5% alpha) were used for the analyses. The intention-to-treat method was adopted in case of follow-up losses. Record number RBR-849jyv/UTN: U1111-1176-2858. RESULTS: Of 56 participants, 49 completed the protocol. Mean pain was moderately reduced (>30%) in the UG and CG and mildly reduced (20%) in the SG. Loss in the vitality score of QOL in the CG was noted. CONCLUSIONS: The protocol generated mild and moderate pain relief and reduced losses in the functional QOL in the treatment groups.

Parâmetros para reabilitação da marcha em pessoas com Paraparesia Espástica Tropical: estudo transversal / Parameters for gait rehabilitation in Tropical Spastic Paraparesis: cross sectional study

INTRODUÇÃO: A marcha de pessoas com Mielopatia Associada ao HTLV-1 ou Paraparesia Espástica Tropical (HAM/TSP) é pouco conhecida. OBJETIVO: Avaliar o perfil cinemático da marcha em pessoas com HAM/TSP. MÉTODOS: Estudo transversal com 25 pessoas com HAM/TSP e 25 participantes saudáveis. Os dados espaço-temporais e angulares das filmagens da marcha foram submetidos à análise cinemática utilizando o software CVMob®. A marcha dos participantes com HAM/TSP foi analisada quantitativamente através do teste t-student (alfa de 5% e poder de 80%). O projeto foi aprovado pelo comitê de ética da Escola Bahiana de Medicina e Saúde Pública sob o CAAE 13568213.8.0000.5544. RESULTADOS: O grupo HAM/TSP apresentou alterações significativas em dois domínios distintos da análise biomecânica da marcha quando comparados aos controles saudáveis. As variáveis angulares apresentaram maior inclinação, flexão e extensão do tronco (p <0,05); aumento da flexão do quadril e diminuição da extensão do quadril (p <0,05); diminuição da flexão e extensão do joelho (p <0,05); diminuição da flexão dorsal e plantar do tornozelo (p <0,05). A amplitude de movimento também foi reduzida em todas essas articulações. As variáveis espaço-temporais mostraram diminuição do comprimento da passada, aumento do tempo da passada e velocidade do ciclo da marcha (p <0,001). Essas mudanças apontam para redução nas amplitudes articulares do quadril, joelho e tornozelo, mudanças na base de apoio e assimetria do tempo do duplo apoio entre os lados direito e esquerdo, redução do tempo do pré-balanço, elevação do quadril no balanço médio e queda do pé ao longo do balanço. CONCLUSÃO: As pessoas com HAM/TSP apresentam marcha caracterizada por redução nas amplitudes articulares do quadril, joelho e tornozelo, assimetria do tempo de suporte duplo entre os lados direito e esquerdo, redução do tempo do pré-balanço, elevação do quadril no balanço médio e queda do pé ao longo do balanço.

INTRODUCTION: The gait in people with HTLV-1 Associated Myelopathy or Tropical Spastic Paraparesis (HAM / TSP) is little known. OBJECTIVE: To evaluate the kinematic profile of gait in people with HAM/ TSP. METHODS: A cross-sectional study with 25 people with HAM/TSP and 25 healthy participants. Spatiotemporal and angular data from filming of gait were submitted to kinematic analysis using CVMob® software. The gait of partipants with HAM/TSP was analized quantitatively through t Student test (alpha 5% and Power of 80%). The project was approved by Ethical Committee of the Bahiana School of Medicine and Public Health with CAAE 13568213.8.0000.5544. RESULTS: The HAM/TSP group showed significant changes in two different domains of biomechanical gait analysis when compared to healthy controls. The angular variables showed increased trunk inclination, flexion and extension (p<0.05); increased hip flexion and decreased hip extension (p<0.05); decreased knee flexion and extension (p<0.05); decreased ankle dorsi and plantar flexion (p<0.05). Range of Motion was also reduced in all those joints. The spatiotemporal variables showed decreased stride length, increased stride time and speed gait cycle (p<0.001). Those changes point out to reduction in joint amplitudes of hip, knee and ankle, changes in support base and double support time asymmetry between right and left sides, reduction of pre-swing time, hip lift in the mid-swing, and foot drop throughout the swing. CONCLUSION: People with HAM/TSP have gait characterized by reduction in joint amplitudes of hip, knee and ankle, asymmetry between right and left sides and reduction of pre-swing time, hip lift in the mid-swing, and foot drop throughout the swing.

Clonal expansion across the seas as seen through CPLP-TB database: A joint effort in cataloguing Mycobacterium tuberculosis genetic diversity in Portuguese-speaking countries.

Tuberculosis (TB) remains a major health problem within the Community of Portuguese Language Speaking Countries (CPLP). Despite the marked variation in TB incidence across its member-states and continued human migratory flux between countries, a considerable gap in the knowledge on the Mycobacterium tuberculosis population structure and strain circulation between the countries still exists. To address this, we have assembled and analysed the largest CPLP M. tuberculosis molecular and drug susceptibility dataset, comprised by a total of 1447 clinical isolates, including 423 multidrug-resistant isolates, from five CPLP countries. The data herein presented reinforces Latin American and Mediterranean (LAM) strains as the hallmark of M. tuberculosis populational structure in the CPLP coupled with country-specific differential prevalence of minor clades. Moreover, using high-resolution typing by 24-loci MIRU-VNTR, six cross-border genetic clusters were detected, thus supporting recent clonal expansion across the Lusophone space. To make this data available to the scientific community and public health authorities we developed CPLP-TB (available at http://cplp-tb.ff.ulisboa.pt), an online database coupled with web-based tools for exploratory data analysis. As a public health tool, it is expected to contribute to improved knowledge on the M. tuberculosis population structure and strain circulation within the CPLP, thus supporting the risk assessment of strain-specific trends.

Pain and quality of life in human t-cell lymphotropic virus type 1-associated myelopathy or tropical spastic paraparesis after home-based exercise protocol: a randomized clinical trial

Abstract INTRODUCTION: Human T-cell lymphotropic virus type 1-associated myelopathy or tropical spastic paraparesis (HAM/TSP) causes, among other abnormalities, chronic pain that may impair quality of life (QOL). Home protocols can help those who have difficulty attending rehabilitation centers. This study aimed to evaluate the impact of a home-based exercise protocol on pain and QOL in people with HAM/TSP. METHODS: A randomized clinical trial of people with HAM/TSP (World Health Organization criteria) classified as probable or definite. The supervised group (SG) underwent training for 12 weeks and continued the protocol at home for another 12 weeks; the unsupervised group (UG) performed the same protocol at home without physical therapist supervision for 24 weeks; and the control group (CG) maintained the usual care. QOL was assessed by the Short Form-36 health survey and the pain condition by the Brief Pain Inventory (BPI). The Chi-square, analysis of variance, Kruskal-Wallis, and Friedman tests (5% alpha) were used for the analyses. The intention-to-treat method was adopted in case of follow-up losses. Record number RBR-849jyv/UTN: U1111-1176-2858. RESULTS: Of 56 participants, 49 completed the protocol. Mean pain was moderately reduced (>30%) in the UG and CG and mildly reduced (20%) in the SG. Loss in the vitality score of QOL in the CG was noted. CONCLUSIONS: The protocol generated mild and moderate pain relief and reduced losses in the functional QOL in the treatment groups.

Synthesis and in vitro investigation of halogenated 1,3-bis(4-nitrophenyl)triazenide salts as antitubercular compounds.

The diverse pharmacological properties of the diaryltriazenes have sparked the interest to investigate their potential to be repurposed as antitubercular drug candidates. In an attempt to improve the antitubercular activity of a previously constructed diaryltriazene library, eight new halogenated nitroaromatic triazenides were synthesized and underwent biological evaluation. The potency of the series was confirmed against the Mycobacterium tuberculosis lab strain H37Ra, and for the most potent derivative, we observed a minimal inhibitory concentration of 0.85 µm. The potency of the triazenide derivatives against M. tuberculosis H37Ra was found to be highly dependent on the nature of the halogenated phenyl substituent and less dependent on cationic species used for the preparation of the salts. Although the inhibitory concentration against J774A.1 macrophages was observed at 3.08 µm, the cellular toxicity was not mediated by the generation of nitroxide intermediate as confirmed by electron paramagnetic resonance spectroscopy, whereas no in vitro mutagenicity could be observed for the new halogenated nitroaromatic triazenides when a trifluoromethyl substituent was present on both the aryl moieties.

Bioassay-guided In vitro Study of the Antimicrobial and Cytotoxic Properties of the Leaves from Excoecaria Lucida Sw.

BACKGROUND: Excoecaria lucida Sw. (Euphorbiaceae) is a plant conventionally used throughout the Caribbean in the treatment of infectious diseases. OBJECTIVE: To evaluate, using bioassay-guided fractionation, the in vitro cytotoxicity and antimicrobial activity of E. lucida leaves. MATERIALS AND METHODS: A 95% ethanol crude extract was dried and fractionated by solid-liquid separation in four phases (hexane, dichloromethane, ethyl acetate, and butanol). Antimicrobial activity (3 bacteria, 6 yeasts, and 2 fungi) was evaluated by the dilution method with resazurin (2048, 512, 128, 32, and 8 µg/mL). The cytotoxicity assays were evaluated in two cell lines: MRC-5 and RAW 264.7; calculating the selectivity index. Assays were performed for the total extract, the isolated compound with the highest yield, and the ethyl acetate and butanol phases. Isolated compounds were characterized by nuclear magnetic resonance and mass spectrometry techniques. RESULTS: Fractionation process led to the isolation of ellagic acid (784.29 mg), 3,3',4'-tri-O-methyl ellagic 4-O-ß-D-glucopyranoside acid (6.1 mg), and corilagin (6.91 mg). The most active were ethyl acetate phase and ellagic acid with IC50= 128 µg/mL against seven and five different species of microorganisms, respectively. The total extract (IC50=512 µg/mL) and the ethyl acetate phase (IC50=128 µg/mL) were cytotoxic in both cell lines, while butanol phase and ellagic acid both with IC50>2048 µg/mL seemed to be safer. CONCLUSIONS: The results obtained indicate that the Excoecaria leaves can be conventionally used as antimicrobial, but it should be present that some cytotoxicity could appear. In addition, the three identified compounds were reported for the first time in the species. SUMMARY: Excoecaria lucida leaves (Euphorbiaceae) are used by the Cuban population due to their antimicrobial activity. This ethnopharmacological knowledge is confirmed by the integrated antibacterial and antifungal in vitro screening developed, using the bioassay-guided fractionation method.Abbreviations Used: MRC-5-SV2: Diploid human lung fibroblasts cells, RAW 264.7: Murine macrophages cells, IC50: Inhibitory Concentration 50%, ATCC: American Type Culture Collection, CCEBI: Culture Collection of Industrial Biotechnology Center, CECT: Spanish Culture Collection Type, CFU: Colony forming units, CC50: 50% cytotoxic concentration, CO2: Carbon dioxide, SI: Selectivity index, IR: Infrared spectroscopy, 1H NMR: Nuclear Magnetic Resonance of hydrogen, 13C NMR: Nuclear Magnetic Resonance of carbon, HMQC: Heteronuclear Multiple-Quantum Correlation, HMBC: Heteronuclear Multiple Bond Correlation, COSY: Correlation Spectroscopy, NOESY: Nuclear Overhauser Effect Spectroscopy, KBr: Potassium bromide, DMSO-D6: Deuterated dimethyl sulfoxide, LC.MS: Liquid Chromatography-Mass Spectrometry, [α]D: Optical rotation, EL1: ellagic acid, EL2: 3,3',4'-tri-O-methyl ellagic 4-O-ß-D-glucopyranoside acid, EL3: corilagin, Active (+), inactive (-).

Design, synthesis and antitubercular potency of 4-hydroxyquinolin-2(1H)-ones.

In this study, a 50-membered library of substituted 4-hydroxyquinolin-2(1H)-ones and two closely related analogues was designed, scored in-silico for drug likeness and subsequently synthesized. Thirteen derivatives, all sharing a common 3-phenyl substituent showed minimal inhibitory concentrations against Mycobacterium tuberculosis H37Ra below 10 µM and against Mycobacterium bovis AN5A below 15 µM but were inactive against faster growing mycobacterial species. None of these selected derivatives showed significant acute toxicity against MRC-5 cells or early signs of genotoxicity in the Vitotox™ assay at the active concentration range. The structure activity study relation provided some insight in the further favourable substitution pattern at the 4-hydroxyquinolin-2(1H)-one scaffold and finally 6-fluoro-4-hydroxy-3-phenylquinolin-2(1H)-one (38) was selected as the most promising member of the library with a MIC of 3.2 µM and a CC50 against MRC-5 of 67.4 µM.

Quality of life and pain multidimensional aspects in individuals with HTLV-1.

HTLV-1 creates a chronic health condition that involves moderate to severe pain with a negative impact on quality of life (QoL). There is no consensus on which attitudes to pain are more related to the worsening of QoL in HTLV-1 infected patients. The aim of this study was to investigate the correlation between QoL and multidimensional aspects of pain in patients with HTLV-1. A cross-sectional study was conducted in Salvador, Bahia, Brazil. The study included individuals diagnosed with HTLV-1. The Short Form 36 Questionnaire was used to analyze QoL, and the Brief Pain Inventory was used to assess multidimensional aspects of pain. The mean pain intensity was 4.88±3.06 on the visual pain scale, and the average impact on QoL corresponded to a loss of approximately 40%. Moderate to high correlations between pain intensity and all domains of QoL were observed and compared reaction attitudes for general activity, mood, ability to walk, ability to work, relationships, sleep, and ability to enjoy life (r>0.40; p<0.05). Moderate correlations were found between all domains of QoL, pain intensity, and reactive attitudes to pain. The greatest pain intensity impacts involved difficulty to walk and to work, and interpersonal relationships in the emotional aspect of QoL.

Physiotherapy for human T-lymphotropic virus 1-associated myelopathy: review of the literature and future perspectives.

Human T-lymphotropic virus 1 (HTLV-1) infection may be associated with damage to the spinal cord - HTLV-associated myelopathy/tropical spastic paraparesis - and other neurological symptoms that compromise everyday life activities. There is no cure for this disease, but recent evidence suggests that physiotherapy may help individuals with the infection, although, as far as we are aware, no systematic review has approached this topic. Therefore, the objective of this review is to address the core problems associated with HTLV-1 infection that can be detected and treated by physiotherapy, present the results of clinical trials, and discuss perspectives on the development of knowledge in this area. Major problems for individuals with HTLV-1 are pain, sensory-motor dysfunction, and urinary symptoms. All of these have high impact on quality of life, and recent clinical trials involving exercises, electrotherapeutic modalities, and massage have shown promising effects. Although not influencing the basic pathologic disturbances, a physiotherapeutic approach seems to be useful to detect specific problems related to body structures, activity, and participation related to movement in HTLV-1 infection, as well as to treat these conditions.

Mycobacterium tuberculosis belonging to family LAM and sublineage RD Rio: common strains in Southern Brazil for over 10 years

A sublineage of Mycobacterium tuberculosis called RD Rio was described in 2007. Although only recently described, this strain may have been present previously in the population, and its identification in clinical isolates will elucidate bacterial transmission dynamics and host-pathogen interactions. This study evaluated the clonal diversity of the RD Rio sublineage in clinical isolates from Rio Grande-RS obtained between 1998 and 2001. Among the 45 samples analyzed by the MIRU-VNTR method, there were six clusters with two samples each and 33 orphan strains with unique pattern. The strains were distributed across several different lineages including LAM (34.04%), X (14.89%), Haarlem (12.77%), UgandaI (10.64%), S (4.26%), NEW-1 (2.13%) and Cameroon (2.13%); 14.89% of the strains matched to multiple lineages. RD Rio strains were present in 28.9% of the samples and 81.25% of the identified strains belonged to the LAM family. The high clonal diversity observed in this study is a constant feature in this region. The RD Rio sublineage has been in Rio Grande-RS since 1998. The continued monitoring of RD Rio in clinical isolates will enhance the understanding of its epidemiological significance.

Mycobacterium tuberculosis belonging to family LAM and sublineage RD(Rio): common strains in Southern Brazil for over 10 years.

A sublineage of Mycobacterium tuberculosis called RD(Rio) was described in 2007. Although only recently described, this strain may have been present previously in the population, and its identification in clinical isolates will elucidate bacterial transmission dynamics and host-pathogen interactions. This study evaluated the clonal diversity of the RD(Rio) sublineage in clinical isolates from Rio Grande-RS obtained between 1998 and 2001. Among the 45 samples analyzed by the MIRU-VNTR method, there were six clusters with two samples each and 33 orphan strains with unique pattern. The strains were distributed across several different lineages including LAM (34.04%), × (14.89%), Haarlem (12.77%), UgandaI (10.64%), S (4.26%), NEW-1 (2.13%) and Cameroon (2.13%); 14.89% of the strains matched to multiple lineages. RD(Rio) strains were present in 28.9% of the samples and 81.25% of the identified strains belonged to the LAM family. The high clonal diversity observed in this study is a constant feature in this region. The RD(Rio) sublineage has been in Rio Grande-RS since 1998. The continued monitoring of RD(Rio) in clinical isolates will enhance the understanding of its epidemiological significance.

Nitrate reductase assay using sodium nitrate for rapid detection of multidrug resistant tuberculosis

We validated the nitrate reductase assay (NRA) for the detection of multidrug-resistant Mycobacterium tuberculosis (MDR-TB) using sodium nitrate (NaNO3) in replacement of potassium nitrate (KNO3) as nitrate source. NaNO3 is cheaper than KNO3 and has no restriction on use which facilitates the implementation of NRA to detect MDR-TB.

Improving tuberculosis control through the partnership between university and the health system / Qualificar o controle da tuberculose mediante a parceria entre a Universidade e o Sistema de Saúde

INTRODUCTION: Tuberculosis (TB) control is linked to the availability of qualified methods for microbiological diagnostics; however, microscopy with limited sensitivity is the only method available in many locations. The objective of this study was to evaluate the introduction of culture, drug susceptibility testing (DST), and genotyping in the routine of a Municipal Program of Tuberculosis Control. METHODS: Direct microscopy of sputum and culture in Ogawa-Kudoh were performed on 1,636 samples from 787 patients. DST of positive cultures was performed by resazurin microtiter assay and genotyping by mycobacterial interspersed repetitive units-variable number tandem repeat. RESULTS: A total 91 patients with TB were identified. The culture increased case detection by 32% compared with the microscopy; acquired resistance was 3.3% and the genotyping showed high genetic diversity. CONCLUSIONS: Ogawa-Kudoh contributed significantly to the increase in case detection and is suitable for implementation in poor-resource locations. The acquired resistance rate was lower than that reported in a recent Brazilian survey. The high genetic diversity is possibly related to the high TB prevalence in the population, as well as to early detection and suitable treatment of patients. The interaction between research and health care is important for reorienting the practice, transferring technology, and improving TB control.

INTRODUÇÃO: O controle da tuberculose (TB) está relacionado com a disponibilidade de métodos de diagnóstico microbiológico qualificados, no entanto a microscopia com a sua limitada sensibilidade é o único método disponível em muitos locais.O objetivo deste estudo foi avaliar a introdução da cultura, teste de sensibilidade aos antimicrobianos (TSA) e genotipagem na rotina de um Programa Municipal de Controle da Tuberculose. MÉTODOS:A baciloscopia direta do escarro e cultura em Ogawa-Kudoh foram realizadas em 1.636 amostras de 787 pacientes. O TSA das culturas positivas foi realizado pelo método de microdiluição e a genotipagem por Mycobacterial Interspersed Repetitive Units - Variable Number Tandem Repeat (MIRU-VNTR). RESULTADOS:Foram identificados 91 pacientes com TB, com a cultura aumentando em 32% a detecção de casos em comparação com a microscopia; a resistência adquirida foi de 3,3% e a genotipagem mostrou alta diversidade genética. CONCLUSÕES: O cultivo em Ogawa-Kudoh contribuiu significativamente para o aumento na detecção de casos e é adequado para ser implementado em locais com poucos recursos. A taxa de resistência adquirida foi menor do que a relatada em recente inquérito nacional. A alta diversidade genética está possivelmente relacionada à alevada prevalência de TB na população, detecção precoce e tratamento adequado dos pacientes.A interação entre a pesquisa e serviço de saúde pública é importante para reorientar a prática, transferir tecnologia e melhorar o controle da TB.