Enhancing the epidemiological surveillance of SARS-CoV-2 using Sanger sequencing to identify circulating variants and recombinants.

Since the emergence of SARS-CoV-2 in December 2019, more than 12,000 mutations in the virus have been identified. These could cause changes in viral characteristics and directly impact global public health. The emergence of variants is a great concern due to the chance of increased transmissibility and infectivity. Sequencing for surveillance and monitoring circulating strains is extremely necessary as the early identification of new variants allows public health agencies to make faster and more effective decisions to contain the spread of the virus. In the present study, we identified circulating variants in samples collected in Belo Horizonte, Brazil, and detected a recombinant lineage using the Sanger method. The identification of lineages was done through gene amplification of SARS-CoV-2 by Reverse Transcription-Polymerase Chain Reaction (RT-PCR). By using these specific fragments, we were able to differentiate one variant of interest and five circulating variants of concern. We were also able to detect recombinants. Randomly selected samples were sequenced by either Sanger or Next Generation Sequencing (NGS). Our findings validate the effectiveness of Sanger sequencing as a powerful tool for monitoring variants. It is easy to perform and allows the analysis of a larger number of samples in countries that cannot afford NGS.

Peptide Microarrays for Flavivirus Diagnosis.

Flavivirus are the most alarming prevalent viruses worldwide due to its vast impact on public health. Most early symptoms of diseases caused by Flavivirus are similar among each other and to other febrile illnesses making the clinical differential diagnosis challenging. In addition, due to cross-reactivity and a relatively limited persistence of viral RNA in infected individuals, the current available diagnosis strategies fail to efficiently provide a differential viral identification. In this context, virus-specific tests are essential to improve patient care, as well as to facilitate disease surveillance and the effective control of transmission. Here, we describe the use of protein microarrays as an effective tool for screening peptides differentially recognized by anti-Yellow Fever virus antibodies induced by vaccination or by natural viral infection.

Monitoring the Establishment of VOC Gamma in Minas Gerais, Brazil: A Retrospective Epidemiological and Genomic Surveillance Study.

Since its first identification in Brazil, the variant of concern (VOC) Gamma has been associated with increased infection and transmission rates, hospitalizations, and deaths. Minas Gerais (MG), the second-largest populated Brazilian state with more than 20 million inhabitants, observed a peak of cases and deaths in March-April 2021. We conducted a surveillance study in 1240 COVID-19-positive samples from 305 municipalities distributed across MG's 28 Regional Health Units (RHU) between 1 March to 27 April 2021. The most common variant was the VOC Gamma (71.2%), followed by the variant of interest (VOI) zeta (12.4%) and VOC alpha (9.6%). Although the predominance of Gamma was found in most of the RHUs, clusters of Zeta and Alpha variants were observed. One Alpha-clustered RHU has a history of high human mobility from countries with Alpha predominance. Other less frequent lineages, such as P.4, P.5, and P.7, were also identified. With our genomic characterization approach, we estimated the introduction of Gamma on 7 January 2021, at RHU Belo Horizonte. Differences in mortality between the Zeta, Gamma and Alpha variants were not observed. We reinforce the importance of vaccination programs to prevent severe cases and deaths during transmission peaks.

Molecular characterization of a new SARS-CoV-2 recombinant cluster XAG identified in Brazil.

Recombination events have been described in the Coronaviridae family. Since the beginning of the SARS-CoV-2 pandemic, a variable degree of selection pressure has acted upon the virus, generating new strains with increased fitness in terms of viral transmission and antibody scape. Most of the SC2 variants of concern (VOC) detected so far carry a combination of key amino acid changes and indels. Recombination may also reshuffle existing genetic profiles of distinct strains, potentially giving origin to recombinant strains with altered phenotypes. However, co-infection and recombination events are challenging to detect and require in-depth curation of assembled genomes and sequencing reds. Here, we present the molecular characterization of a new SARS-CoV-2 recombinant between BA.1.1 and BA.2.23 Omicron lineages identified in Brazil. We characterized four mutations that had not been previously described in any of the recombinants already identified worldwide and described the likely breaking points. Moreover, through phylogenetic analysis, we showed that the newly named XAG lineage groups in a highly supported monophyletic clade confirmed its common evolutionary history from parental Omicron lineages and other recombinants already described. These observations were only possible thanks to the joint effort of bioinformatics tools auxiliary in genomic surveillance and the manual curation of experienced personnel, demonstrating the importance of genetic, and bioinformatic knowledge in genomics.

Mapping and Validation of Peptides Differentially Recognized by Antibodies from the Serum of Yellow Fever Virus-Infected or 17DD-Vaccinated Patients.

Yellow Fever disease is caused by the Yellow Fever virus (YFV), an arbovirus from the Flaviviridae family. The re-emergence of Yellow Fever (YF) was facilitated by the increasing urbanization of sylvatic areas, the wide distribution of the mosquito vector, and the low percentage of people immunized in the Americas, which caused severe outbreaks in recent years, with a high mortality rate. Therefore, serological approaches capable of discerning antibodies generated from the wild-type (YFV-WT) strain between the vaccinal strain (YFV-17DD) could facilitate vaccine coverage surveillance, enabling the development of strategies to avoid new outbreaks. In this study, peptides were designed and subjected to microarray procedures with sera collected from individuals infected by WT-YFV and 17DD-YFV of YFV during the Brazilian outbreak of YFV in 2017/2018. From 222 screened peptides, around ten could potentially integrate serological approaches aiming to differentiate vaccinated individuals from naturally infected individuals. Among those peptides, one was synthesized and validated through ELISA.

Tracking the turnover of SARS-CoV-2 VOCs Gamma to Delta in a Brazilian state (Minas Gerais) with a high-vaccination status.

The emergence and global dissemination of Severe Acute Respiratory Syndrome virus 2 (SARS-CoV-2) variants of concern (VOCs) have been described as the main factor driving the Coronavirus Disease 2019 pandemic. In Brazil, the Gamma variant dominated the epidemiological scenario during the first period of 2021. Many Brazilian regions detected the Delta variant after its first description and documented its spread. To monitor the introduction and spread of VOC Delta, we performed Polymerase Chain Reaction (PCR) genotyping and genome sequencing in ten regional sentinel units from June to October 2021 in the State of Minas Gerais (MG). We documented the introduction and spread of Delta, comprising 70 per cent of the cases 8 weeks later. Comparing the viral loads of the Gamma and Delta dominance periods, we provide additional evidence that the latter is more transmissible. The spread and dominance of Delta did not culminate in the increase in cases and deaths, suggesting that the vaccination may have restrained the epidemic growth. Analysis of 224 novel Delta genomes revealed that Rio de Janeiro state was the primary source for disseminating this variant in the state of MG. We present the establishment of Delta, providing evidence of its enhanced transmissibility and showing that this variant shift did not aggravate the epidemiological scenario in a high immunity setting.

Gene Expression Signatures in AML-12 Hepatocyte Cells upon Dengue virus Infection and Acetaminophen Treatment.

Dengue is an acute viral disease caused by Dengue virus (DENV) and is considered to be the most common arbovirus worldwide. The clinical characteristics of dengue may vary from asymptomatic to severe complications and severe organ impairment, particularly affecting the liver. Dengue treatment is palliative with acetaminophen (APAP), usually known as Paracetamol, being the most used drug aiming to relieve the mild symptoms of dengue. APAP is a safe and effective drug but, like dengue, can trigger the development of liver disorders. Given this scenario, it is necessary to investigate the effects of combining these two factors on hepatocyte homeostasis. Therefore, this study aimed to evaluate the molecular changes in hepatocytes resulting from the association between DENV infection and treatment with sub-toxic APAP concentrations. Using an in vitro experimental model of DENV-2 infected hepatocytes (AML-12 cells) treated with APAP, we evaluated the influence of the virus and drug association on the transcriptome of these hepatocytes by RNA sequencing (RNAseq). The virus-drug association was able to induce changes in the gene expression profile of AML-12 cells and here we highlight and explore these changes and its putative influence on biological processes for cellular homeostasis.

Design and production of dengue virus chimeric proteins useful for developing tetravalent vaccines.

Dengue virus (DENV) is a Flavivirus estimated to cause 390 million infections/year. Currently, there is no anti-viral specific treatment for dengue, and efficient DENV vector control is still unfeasible. Here, we designed and produced chimeric proteins containing potential immunogenic epitopes from the four DENV serotypes in an attempt to further compose safer, balanced tetravalent dengue vaccines. For this, South American DENV isolate sequences were downloaded from the NCBI/Virus Variation/Dengue virus databases and intraserotype-aligned to generate four consensuses. Four homologous DENV sequences were retrieved using BLAST and then interserotype-aligned. In parallel, sequences were subjected to linear B epitope prediction analysis. Regions of the envelope and NS1 proteins that are highly homologous among the four DENV serotypes, non-conserved antigenic regions and the most antigenic epitopes found in the C, prM, E and NS1 DENV proteins were used to construct 11 chimeric peptides. Genes encoding the chimeric proteins were commercially synthesized, and proteins were expressed, purified by affinity chromatography and further subjected to ELISA assays using sera from individuals infected with DENVs 1, 2, 3 or 4. As a proof-of-concept, the chimeric EnvEpII protein was selected to immunize BALB/c and C57BL/6 mice strains. The immunization with EnvEpII protein associated with aluminum induced an increased number of T CD4+ and CD8+ cells, high production of IgG1 and IgG2 antibodies, and increased levels of IL-2 and IL-17 cytokines, in both mouse strains. Because the EnvEpII protein associated with aluminum induced an efficient cellular response by stimulating the production of IL-2, IL-4, IL-17 and induced a robust humoral response in mice, we conclude that it resembles an efficient specific response against DENV infection. Although further experiments are required, our results indicate that epitope selection by bioinformatic tools is efficient to create recombinant proteins that can be used as candidates for the development of vaccines against infectious diseases.

Mutation screening of TP53, CHEK2 and BRCA genes in patients at high risk for hereditary breast and ovarian cancer (HBOC) in Brazil.

BACKGROUND: Few studies related to hereditary breast and ovarian cancer syndrome (HBOC) have been conducted in Brazil, and they are restricted to only small areas of the country. Here, we report the mutation profile of BRCA1/2, CHEK2 and TP53 genes in a cohort from Minas Gerais state. METHODS: These genes from 44 patients at high risk for HBOC were screened through high-resolution melting and/or sequencing. The pathogenicity of the alterations was checked using ClinVar database and bioinformatics programs. RESULTS: In BRCA genes we identified 46 variants, 38 without clinical significance and 8 pathogenic mutations including a new pathogenic mutation in BRCA1 gene (c.4688_4694delACCTGGAinsG). The most prevalent pathogenic mutation was c.4829_4830delTG, in the BRCA2 gene. This mutation was not described in the Brazilian population up to now and in this study, it was described with a prevalence of 6.8%. The p.R337H mutation in TP53 gene was found in one patient clinically diagnosed as HBOC and without clinical criteria for Li-Fraumeni syndrome. In CHEK2 gene, the undescribed variant c.485A > G was found and it presents as probably pathogenic through in silico analyses. Pathogenic mutations were found in 29.5% of the patients, 11.3% in BRCA1, 15.9% in BRCA2 and 2.3% in TP53 gene. CONCLUSIONS: Brazilian population is one of the most heterogeneous in the world and the mutational profile knowledge of genes related to HBOC from different regions can contribute to the definition of more cost-effective strategies for the prevention, identification and treatment of cancer.

Increased Levels of Txa2 Induced by Dengue Virus Infection in IgM Positive Individuals Is Related to the Mild Symptoms of Dengue.

The inflammatory process plays a major role in the prognosis of dengue. In this context, the eicosanoids may have considerable influence on the regulation of the Dengue virus-induced inflammatory process. To quantify the molecules involved in the cyclooxygenase and lipoxygenase pathways during Dengue virus infection, plasma levels of thromboxane A2, prostaglandin E2 and leukotriene B4; mRNA levels of thromboxane A2 synthase, prostaglandin E2 synthase, leukotriene A4 hydrolase, cyclooxygenase-2 and 5-lipoxygenase; and the levels of lipid bodies in peripheral blood leukocytes collected from IgM-positive and IgM-negative volunteers with mild dengue, and non-infected volunteers, were evaluated. Dengue virus infection increases the levels of thromboxane A2 in IgM-positive individuals as well as the amount of lipid bodies in monocytes in IgM-negative individuals. We suggest that increased levels of thromboxane A2 in IgM-positive individuals plays a protective role against the development of severe symptoms of dengue, such as vascular leakage.

Avaliação da aceitabilidade do usuário/família sobre a estratégia saúde da família / Evaluation of family health strategy acceptability by the user/family

O objetivo deste estudo foi avaliar a aceitabilidade do usuário/família sobre a Estratégia Saúde da Família (ESF). Realizou-se um estudo avaliativo de abordagem quantitativa em uma Unidade de Saúde da Família onde foram entrevistados 217 usuários, durante o mês de novembro de 2007. Para análise dos resultados utilizou-se o SPSS® for Windows, Versão 11.0. Identificou-se uma população adulta com idade média de 41 anos, com baixa escolaridade e com maior proporção de mulheres. A maioria dos usuários está satisfeita com a informação recebida sobre a doença, o tratamento, a forma de obter a ficha, o tempo dedicado à consulta e de espera para o atendimento. Todos profissionais da equipe receberam nota maior que sete. Identificou-se que a maioria dos usuários aceita a ESF, sugerindo que esta estratégia apresenta potencialidades para qualificar a atenção primária à saúde. Entretanto, os problemas estruturais da unidade foram os mais apontados pelos participantes.

The objective of this study was to evaluate the acceptability of the Family Health Strategy (FHS) by the user/family. We did an evaluative study with a quantitative approach at a Family Health Unit, where 217 users were interviewed during the month of November 2007. SPSS® for Windows, Version 11.0, was used to analyze the results. We identified an adult population with a mean age of 41 years, with low education levels, and with a higher proportion of women. Most users are satisfied with the information they have received about: disease, treatment, how to get an appointment, the time spent during consultations and in waiting to be seen. All the professional staff received grades higher than seven. It was found that most users accept the FHS, suggesting that this strategy has the potential to qualify the health care service in primary care. However, the unit's structural problems were those most often mentioned by the participants.

Screening of the BRCA1 gene in Brazilian patients with breast and/or ovarian cancer via high-resolution melting reaction analysis.

The aim of this study was to evaluate the profile of BRCA1 mutations among cancer-affected Brazilian women from the Midwest region of Minas Gerais state with clearly defined risk factors for hereditary breast and ovarian cancer (HBOC) syndrome. In this Brazilian region, the first Center for Hereditary Cancer Control began operation in 2011, and 90% of patients receive assistance from the public health service. Eighteen patients at high risk for HBOC were subjected to molecular analysis. Primers were designed for 22 coding exons of the gene; DNA was extracted; and real-time PCR followed by high-resolution melting reaction was performed. The amplicons were sequenced to confirm the identified profiles. Only exon 11 was directly sequenced due its length. Multiplex ligation-dependent probe amplification (MLPA) was performed for those patients in whom no pathogenic mutations were found. Among the 14 alterations identified in this study, the c.5263_5264insC pathogenic mutation was present in two patients (11.1%). Four alterations showed no clinical relevance; one exhibited inconclusive clinical relevance according to the examined databases; and eight alterations presented a divergent classification between the databases. No deletions or duplications were found using the MLPA technique. The HRM methodology was highly sensitive in identifying variants in the BRCA1 gene and can dramatically reduce the amount of sequencing required to identify germline mutations in BRCA genes, enabling cheaper tests and increasing their availability to Brazilian women assisted by the public health service.

Effects of Iron Overload on the Activity of Na,K-ATPase and Lipid Profile of the Human Erythrocyte Membrane.

Iron is an essential chemical element for human life. However, in some pathological conditions, such as hereditary hemochromatosis type 1 (HH1), iron overload induces the production of reactive oxygen species that may lead to lipid peroxidation and a change in the plasma-membrane lipid profile. In this study, we investigated whether iron overload interferes with the Na,K-ATPase activity of the plasma membrane by studying erythrocytes that were obtained from the whole blood of patients suffering from iron overload. Additionally, we treated erythrocytes of normal subjects with 0.8 mM H2O2 and 1 µM FeCl3 for 24 h. We then analyzed the lipid profile, lipid peroxidation and Na,K-ATPase activity of plasma membranes derived from these cells. Iron overload was more frequent in men (87.5%) than in women and was associated with an increase (446%) in lipid peroxidation, as indicated by the amount of the thiobarbituric acid reactive substances (TBARS) and an increase (327%) in the Na,K-ATPase activity in the plasma membrane of erythrocytes. Erythrocytes treated with 1 µM FeCl3 for 24 h showed an increase (132%) in the Na,K-ATPase activity but no change in the TBARS levels. Iron treatment also decreased the cholesterol and phospholipid content of the erythrocyte membranes and similar decreases were observed in iron overload patients. In contrast, erythrocytes treated with 0.8 mM H2O2 for 24 h showed no change in the measured parameters. These results indicate that erythrocytes from patients with iron overload exhibit higher Na,K-ATPase activity compared with normal subjects and that this effect is specifically associated with altered iron levels.

Diabetes melito como fator associado às disfunções do trato urinário inferior em mulheres atendidas em serviço de referência / The association between diabetes mellitus and lower urinary tract dysfunctions in women assisted in a reference service

OBJETIVO: Descrever as disfunções do trato urinário inferior e as características demográficas e clínicas de mulheres com queixas urinárias, estimando a prevalência de diabetes melito e de alterações urodinâmicas nestas mulheres. MÉTODOS: Estudo observacional, transversal, retrospectivo, com análise de 578 prontuários. As prevalências de diabetes melito e de cada diagnóstico urodinâmico nas pacientes com disfunções do trato urinário inferior foram estimadas, com seus respectivos intervalos de confiança de 95 por cento. Foram calculadas as razões de prevalência das alterações urodinâmicas segundo o diagnóstico de diabetes. RESULTADOS: Setenta e sete pacientes (13,3 por cento) eram diabéticas e a maioria (96,1 por cento) tinha diabetes tipo 2. O diagnóstico urodinâmico mais frequente nas pacientes diabéticas foi o de incontinência urinária de esforço (39 por cento), seguido de hiperatividade do detrusor (23,4 por cento). A prevalência de urodinâmica alterada foi associada à de diabetes melito (RP=1,31; IC95 por cento=1,17-1,48). As alterações de contratilidade do detrusor (hiper ou hipoatividade) estiveram presentes em 42,8 por cento das pacientes diabéticas e em 31,5 por cento das não diabéticas. CONCLUSÕES: As mulheres diabéticas apresentaram maior prevalência de alterações urodinâmicas do que as não diabéticas. Não houve associação entre o diabetes e as alterações de contratilidade do detrusor (p=0,80).

PURPOSE: to describe lower urinary tract dysfunctions and clinical demographic characteristics of patients with urinary symptoms. This study assessed the prevalence of diabetes mellitus and urodynamic changes in these women. METHODS: We conducted a cross-sectional, retrospective study on 578 women. The prevalence of diabetes mellitus and urodynamic diagnoses was assessed in patients with lower urinary tract dysfunctions, with their respective 95 percent confidence intervals. The prevalence ratios of urodynamic alterations were calculated according to the diabetes mellitus diagnoses. RESULTS: Seventy-seven patients (13.3 percent) had diabetes and type 2 diabetes was predominant (96.1 percent). Stress urinary incontinence was the most frequent urodynamic diagnosis (39 percent) in diabetic patients, followed by detrusor overactivity (23.4 percent). The prevalence of urodynamic alterations was associated with diabetes (PR=1.31; 95 percentCI=1.17-1.48). Changes in detrusor contractility (over- or underactivity) were diagnosed in 42.8 percent diabetic patients and in 31.5 percent non-diabetic patients. CONCLUSIONS: Diabetic women had a greater prevalence of urodynamic alterations than the non-diabetic ones. There was no association between diabetes mellitus and detrusor contractility alterations (p=0.80).

[The association between diabetes mellitus and lower urinary tract dysfunctions in women assisted in a reference service]. / Diabetes melito como fator associado às disfunções do trato urinário inferior em mulheres atendidas em serviço de referência.

PURPOSE: to describe lower urinary tract dysfunctions and clinical demographic characteristics of patients with urinary symptoms. This study assessed the prevalence of diabetes mellitus and urodynamic changes in these women. METHODS: We conducted a cross-sectional, retrospective study on 578 women. The prevalence of diabetes mellitus and urodynamic diagnoses was assessed in patients with lower urinary tract dysfunctions, with their respective 95% confidence intervals. The prevalence ratios of urodynamic alterations were calculated according to the diabetes mellitus diagnoses. RESULTS: Seventy-seven patients (13.3%) had diabetes and type 2 diabetes was predominant (96.1%). Stress urinary incontinence was the most frequent urodynamic diagnosis (39%) in diabetic patients, followed by detrusor overactivity (23.4%). The prevalence of urodynamic alterations was associated with diabetes (PR=1.31; 95%CI=1.17-1.48). Changes in detrusor contractility (over- or underactivity) were diagnosed in 42.8% diabetic patients and in 31.5% non-diabetic patients. CONCLUSIONS: Diabetic women had a greater prevalence of urodynamic alterations than the non-diabetic ones. There was no association between diabetes mellitus and detrusor contractility alterations (p=0.80).

Validade dos sintomas urinários para o diagnóstico da instabilidade em mulheres incontinentes / Validity of the patient's symptoms in detecting instability in female urinary incontinence

Objetivo: Estudar a validade de cada pergunta do questionário de Hodgkinson modificado por Conceiçäo para o diagnóstico da instabilidade vesical. Pacientes e Métodos: Foi realizado um estudo retrospectivo dos dados de questionário e cistometrias de 473 mulheres encaminhadas para avaliaçäo urodinâmica. Os sintomas urinários obtidos através do questionário foram comparados com o resultado das cistometrias. A associaçäo foi pesquisada através do teste do X2, considerando-se significativo o valor de p<0,05. Foram também calculados os valores de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo para as perguntas estatisticamente significativas. Resultados: Nossas análises revelaram que os sintomas de freqüência, urgência, incontinência por urgência, nictúria e enurese, a necessidade de acordar para urinar, a incapacidade de interromper o jato urinário, a ausência de sensaçäo de enchimento vesical e o grande volume de urina perdido associaram-se significativamente com a instabilidade do destrusor ("p"<0,05). Nenhum dos sintomas mostrou valores preditivos significativos. Os sintomas de urgência, incontinência por urgência, e a necessidade de acordar para urinar mostraram sensibilidade > 90 por cento, e a ausência de sensaçäo de enchimento vesical mostrou especificidade de 98 por cento. Conclusäo: Os sintomas pesquisados pelo questionário de Hodgkinson modificado por Conceiçäo näo säo um instrumento acurado para o diagnóstico da instabilidade vesical em mulheres com sintomas mistos

Validade dos sintomas urinários para o diagnóstico da incontinência de esforço genuína em mulheres com queixas mistas / Validity of the patient's symptoms in detecting genuine stress urinary incontinence in women with mixed symptoms

Objetivo: Estudar a validade das perguntas do questionário de Hodgkinson modificado por Conceiçäo para o diagnóstico da incontinência urinária de esforço. Método: foi realizado um estudo retrospctivo dos dados de questionários, cistometrias e teste de esforço de 473 mulheres encaminhadas para avaliaçäo urodinâmica. Os sintomas urinários obtidos através do questionário foram comparados com o resultado das cistometrias e testes de esforço. A associaçäo foi pesquisada através do teste do X2, considerando-se significativo o valor de p<0,05. Foram também calculados os valores de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo para as perguntas estatitsticamente significativas. Resultados: Os sintomas de perda urinária aos esforços, freqüência da perda aos esforços, o uso de benzodiazepínicos e a percepçäo do enchimento visical associaram-se significativamente com a incontinência urinária de esforço genuína (p<0,05). Nenhum dos sintoma mostrou vslor preditivo positivo significativo; a resposta à pergunta FA 1 tem valor preditivo negativo de 88 por cento. O sintoma de incontinência urinária aos esforços e a percepçäo do enchimento vesical têm alta sensibilidade (>95 por cento), e o uso de benzodiazepínicos mostrou especificidade de 93 por cento. Conclusäo: Os sintomas pesquisados pelo questionário de Hodgkinson modificado por Conceiçäo näo devem ser o único instrumento para o diagnóstico da incontinência urinária de esforço em mulheres com queixas mistas

Uso da análise multivariável na identificaçäo dos conjuntos de sintomas urinários significativos para o diagnóstico da instabilidade vesical e da incontinência urinária de esforço / The use of multivariable analysis in identifying the significants complexes of patient's symptoms for diagnosing dtrusor instability and stress urinary incontinence

Objetivo: Identificar os conjuntos de sintomas significativos para o diagnóstico da instabilidade e da incontinência urinária de esforço. Método: Foi realizado um estudo retrospectivo dos dados de questionários de Hodgkinson modificado, cistometrias e etestes de esforço de 473 prontuários de pacientes com incontinência urinária. Aqueles sisntomas que mostraram associaçäo estatisticamente significativa com o diagnóstico final foram submetidos a análise múltipla, utilizando-se o software SSPD for Windows Release 6.0. Resultados: Para o diagnóstico de instabilidade do destrusor, o complexo de sintomas mais significstivo foi o que incluía os sintomas de enurese, incontinência urinária de esforço, o complexo de sintomas mais significativos foi o que incluía a freqüência da perda urinária aos esforços e o uso de benzodiazepínicos. Devem ser realizados novos trabalhos para estudar a validade do uso clínico destes conjuntos

Tratamento cirúrgico da incontinência urinária de esforço por via vaginal: Análise de 5 casos / Surgical treatment of stress urinary incontinence by vaginal route

Foram analisados os resultados do tratamento cirúrgico para incontinência urinária de esforço (IUE) em 55 pacientes, no período de 1979 a 1985. Todas foram submetidas a cirurgia por via vaginal. Em 49 foi realizada colporrafia anterior com pontos de Kelly-Kennedy. Em outras seis pacientes que apresentavam algum grau de prlapso genital associado à IUE, foi realizada em cinco a operaçåo de Manchester-Fothergil e em uma a histerectomia vaginal. Quarenta e cinco pacientes nåo apresentaram recidiva da IUE até a época deste estudo, o que representa um índice de cura de 81,8 por cento, embora algumas tenham apresentado outros sintomas urinários, como urgência e freqüência urinárias. Treze pacientes referiram recidiva da IUE em um período que variou de seis meses a seis anos após a cirurgioa. Em três delas nåo foi evidenciado a perda de urina com o teste de esforço, e foram dadas como curadas