Prevalência de hanseníase em São Luís–Maranhão entre os anos de2013 a 2015 / Prevalence of leprosy in São Luís-Maranhão from 2013 to 2015

Objetivo: analisar e representar, espacialmente, a evolução da distribuição geográfica dasocorrências de Hanseníase no Maranhão entre os anos de 2013 a 2015, utilizando técnicas degeoprocessamento. Método: realizou-se análise, utilizando mapas e tabelas temáticas, com base nosregistros do Sistema de Informação de Agravos de Notificação. Resultados: foram identificados 1.879casos, somados entre 219 bairros residenciais. Para o ano de 2013, o distrito mais afetado foi oTirirical; em 2014, aumentou a prevalência nos Distritos de Bequimão e Coroadinho e em 2015, houveuma redução de prevalências nos distritos de Tirirical Cohab, Coroadinho e Itaqui Bacanga.Conclusão: apesar de algumas localidades estudadas terem apresentado uma diminuição daprevalência entre 2013 e 2014, de 2014 a 2015 houve um aumento na quantidade de casos. O estudode prevalências possibilitou essa identificação de casos, podendo ser observada a imprescindibilidadede subsidiar estratégias de controle.

Objective: to analyze and spatially represent the evolution of the geographic distribution ofoccurrences of Leprosy in Maranhão between the years 2013 to 2015 using geoprocessing techniques.Method: the analysis was performed using maps and thematic tables, based on the records of theNotifiable Diseases Information System. Results: 1.879 cases were identified, among 219 residentialdistricts. For the year 2013, the district most affected was Tirirical; in 2014, increased prevalencein the Districts of Bequimão and Coroadinho and in 2015, there was a reduction of prevalences in thedistricts of Tirirical Cohab, Coroadinho and Itaqui Bacanga. Conclusion: although some localitiesstudied showed decrease in their prevalence between 2013 and 2014; there was increase in thenumber of cases from 2014 to 2015. The prevalence study made it possible to identify cases, and itis possible to observe the necessity of subsidizing control strategies.

Data on the phosphorylation of p38MAPK and JNK induced by chlorpyrifos in Drosophila melanogaster.

Exposure to organophosphate compounds, such as chlorpyrifos, has been linked to disturbances on cell signaling pathways. Mitogen activated protein kinases (MAPK) are a family of protein kinases involved in a range of cellular processes, including stress response, apoptosis and survival. Therefore, changes in the activation state of these kinases may characterize key mechanisms of toxicity elicited by xenobiotics. Here we report data on the phosphorylation of p38MAPK and JNK, members of the MAPK family, in Drosophila melanogaster exposed to chlorpyrifos, as characterized by western blotting assays.

A Study on the Quality and Identity of Brazilian Pampa Biome Honey: Evidences for Its Beneficial Effects against Oxidative Stress and Hyperglycemia.

We characterized, for the first time, the quality and identity of Brazilian Pampa biome honey and its antioxidant properties in vitro (FRAP, DDPH and ABTS). The potential protective effect of honey against oxidative stress induced by iron (Fe) and paraquat, (PQ) in a Drosophila melanogaster model (in vivo) was also tested. The results indicated that all honey samples tested showed antioxidant activity in vitro. Flies treated with honey showed increased lifespan and were protected against oxidative stress induced by Fe and PQ. Despite the high concentration of sugars in honey (approximately 70-80%), our results demonstrate a hypoglycemic-like effect of honey in Drosophila. Thus, this study demonstrates the high quality of Brazilian Pampa biome honey as well as its significant antioxidant activity in vitro and in vivo, pointing to the potential use of this natural product as an alternative in the therapy of oxidative stress-associated diseases.

Recovery and screening for antibiotic susceptibility of potential bacterial pathogens from the oral cavity of shark species involved in attacks on humans in Recife, Brazil.

The number of incidents involving sharks and humans at beaches in Recife, on the north-eastern Brazilian coast, is among the highest worldwide. In addition, wound infections in survivors are common; but the nature and risk of the aetiological agents is unknown. In the present study, 81 potential bacterial pathogens were identified in the oral cavity of sharks involved in attacks in Recife, and were subjected to antibiotic susceptibility tests using the standardized disc-diffusion method. The majority were enterobacteria such as Enterobacter spp., Citrobacter spp., Proteus spp., Providencia alcalifaciens, Escherichia coli, Moellerella wisconcensis and Leclercia adecarboxylata. Other Gram-negative bacteria included Vibrio spp., Burkholderia cepacia, Acinetobacter spp. and Pseudomonas spp. In addition, coagulase-positive and coagulase-negative Staphylococcus spp., Enterococcus spp. and Micrococcus spp. were identified, besides Streptococcus spp. from the viridans group. Resistance was especially found in the Proteus mirabilis and Citrobacter freundii, and ranged from 4 to 6 antibiotics out of the 13 tested. Gentamicin and vancomycin were the most effective against Gram-positive cocci strains, whereas levofloxacin was fully inhibitory against Gram-positive and Gram-negative bacteria. These data are discussed in light of a retrospective evaluation of the medical records of three shark victims treated at Restauração Hospital in Recife.

Bladder blood flow and de-obstructive open prostatectomy: correlation with clinical and urodynamic parameters.

PURPOSE: To assess the relation between tissue blood flow changes during surgery with clinical and urodynamic parameters in obstructed patients. MATERIAL AND METHODS: A prospective study was conducted in 18 symptomatic patients with bladder outlet obstruction undergoing retropubic prostatectomy. A symptom assessment and a preoperative urodynamic study were performed. To measure bladder blood flow a BLF-10 laser Doppler flowmeter and a blunt-tipped probe were used intraoperatively. Tissue flow was measured in TPU units (1 TPU unit=1 ml per minute per 100 mg of tissue). Six measurements were taken: two control in the rectus abdominis muscle and four in the detrusor, two before the incision of the prostatic capsule and two after closure. For the statistical analysis, Wilcoxon test and a regression analysis were performed. RESULTS: Mean age was 70 years (range: 56-84). Six patients had an episode of acute urinary retention (AUR). No differences were found in the initial and final values of bladder blood flow of the rectus muscle and the bladder dome. A decrease of bladder blood flow in the anterior bladder wall was observed after prostate enucleation. AUR patients showed no differences in bladder blood flow values. Bladder blood flow (BBF) changes showed no correlation with any urodynamic or clinical parameter. CONCLUSIONS: Laser Doppler flowmetry is useful to study BBF with low morbidity, ease of use and reproducibility. Following de-obstructive surgery, a decrease in BBF occurs, probably associated with surgery. These changes are similar in patients with and without AUR and show no correlation with other parameters studied.

Zea mays L. extracts modify glomerular function and potassium urinary excretion in conscious rats.

Diuretic and uricosuric properties have traditionally been attributed to corn silk, stigma/style of Zea mays L. Although the diuretic effect was confirmed, studies of the plant's effects on renal function or solute excretion were lacking. Thus, we studied the effects of corn silk aqueous extract on the urinary excretion of water, Na+, K+, and uric acid. Glomerular and proximal tubular function and Na+ tubular handling were also studied. Conscious, unrestrained adult male rats were housed in individual metabolic cages (IMC) with continuous urine collection for 5 and 3 h, following two protocols. The effects of 25, 50, 200, 350, and 500 mg/kg body wt. corn silk extract on urine volume plus Na+ and K+ excretions were studied in water-loaded conscious rats (2.5 ml/100 g body wt.) in the IMC for 5 h (Protocol 1). Kaliuresis was observed with doses of 350 (100.42 +/- 22.32-120.28 +/- 19.70 microEq/5 h/100 g body wt.; n = 13) and 500 mg/kg body wt. (94.97+/- 29.30-134.32 +/- 39.98 microEq/5h/100 g body wt.; n = 12; p<0.01), and the latter dose resulted in diuresis as well (1.98 +/- 0.44-2.41 +/- 0.41 ml/5 h/100 g body wt.; n = 12; p<0.05). The effects of a 500 mg/kg body wt. dose of corn silk extract on urine volume, Na+, K+ and uric acid excretions, and glomerular and proximal tubular function, were measured respectively by creatinine (Cler) and Li+ (ClLi) clearances and Na+ tubular handling, in water-loaded rats (5 ml/100 g body wt.) in the IMC for 3 h (Protocol 2). Clcr (294.6 +/- 73.2, n = 12, to 241.7 +/- 48.0 microl/ min/100 g body wt.; n = 13; p<0.05) and the Na+ filtered load (41.9 +/- 10.3, n = 12, to 34.3 +/- .8, n = 13, p<0.05) decreased and ClLi and Na+ excretion were unchanged, while K+ excretion (0.1044 +/- 0.0458, n=12, to 0.2289 +/- 0.0583 microEq/min/100 body wt.; n = 13; p<0.001) increased. For Na+ tubular handling, the fractional proximal tubular reabsorption (91.5 +/- 3.5, n = 12, to 87.5 +/- 3.4%; n = 13; p<0.01) decreased, and both fractional distal reabsorptions--I and II--increased (96.5 +/- 1.5, n = 12, to 97.8 +/- 0.9%; n = 13; p<0.01; and 8.2 +/- 3.5, n = 12, to 12.2 +/- 3.4%, n = 13, p<0.01, respectively). To summarize, in water-loaded conscious rats (2.5 ml/100 body wt.), corn silk aqueous extract is diuretic at a dose of 500 mg/kg body wt. and kaliuretic at doses of 350 and 500 mg/kg body wt. In water-loaded conscious rats (5.0 ml/100 g body wt.), corn silk aqueous extract is kaliuretic at a dose of 500 mg/kg body wt., but glomerular filtration and filtered load decrease without affecting proximal tubular function, Na+, or uric acid excretion.

Urodynamic evaluation and management prior to renal transplantation.

OBJECTIVES: To evaluate the indications for urodynamics studies (UDS) previous to renal transplantation (RT) and the results of bladder cycling (BC), performed in selected cases. METHODS: Among 475 RT, 33 patients (6.9%) required UDS according our protocol. Indications were: (1) low urinary tract symptoms (LUTS); (2) defunctionalized bladder (DB), and (3) complex urologic history (reflux, neurogenic bladder, urethral valves, etc.). DB was defined as a total urinary output of <300 ml/24 h. Patients with DB underwent BC through a suprapubic catheter, undergoing UDS after BC. The rate and type of urodynamic anomalies were compared among the 3 groups. Cystometric capacity (CysCap) and compliance were evaluated according to the etiology of renal failure, diuresis, and number of previous bladder surgeries. RESULTS: Fifteen patients (45%) showed abnormal UDS, Increased pressure at cystometry was the most frequent finding (46%). The rate of abnormal UDS among the 3 groups was not statistically significant (66.6% in DB, 42.8% in LUTS, and 35% in those with complex urologic history). Compliance and CysCap were significantly lower in the patients with DB, showing a significant correlation with diuresis. These parameters did not correlate with the number of previous bladder surgeries. BC resulted in normal UDS in 3 patients (33%) and a change in diagnosis in 2 patients (22%). CONCLUSION: Our indications gave a good diagnostic yield. Patients with DB represent a group with different urodynamic findings. BC provides a more precise diagnosis or normalization of UDS in some cases.

Papel de la Terazosina en el tratamiento de los síntomas de obstrucción prostática benigna / Role of Terazosine in the treatment of the symptoms of benign prostatic obstruction

Revisamos los nuevos conceptos en Hiperplasia Benigna de la próstata de acuerdo con las definiciones del comité internacional de consenso en HBP. Se prefiere la expresión obstrución prostática benigna que implica: ausencia de cáncer de próstata, obstrucción intravesical demostrada por urodinamia y presencia de síntomas del tramo urinario inferior (STUI) evaluados mediante cuestionarios. La estandarización de los STUI y de los parámetros de obstrucción ha permitido evaluar de forma sistemática la respuesta a los distintos tratamientos. El momento de iniciar el tratamiento y la decisión de cuál de ellos realizar varían, debido al carácter fluctuante de la enfermedad. Entre los tratamientos farmacológicos, los alfabloqueantes selectivos han demostrado un perfil satisfactorio de seguridad y eficacia en pacientes moderadamente sintomáticos y sin complicaciones. La Terazosina está avalada por múltiples ensayos clínicos y sin complicaciones. La Terazosina está avalada por múltiples ensayos clínicos y larga experiencia de uso, incluso en pacientes hipertensos (en los que no debe modificarse su tratamiento antihipertensivo y ancianos) (AU)

The reliability of cysto-urethrographic signs in the diagnosis of detrusor instability in children.

OBJECTIVE: To assess whether the signs associated with detrusor instability (DI), as assessed by video-urodynamic studies, can be evaluated by conventional voiding cysto-urethrography (VCUG). PATIENTS AND METHODS: Fifty-nine children who underwent cystometry and VCUG were reviewed and divided into two groups; group 1 comprised 51 neurologically normal children who had DI (47 girls and four boys, mean age 7.9 years, range 4-14), with no malformations or previous surgery. Most had mixed symptoms, including urinary tract infections (44) and nocturnal enuresis with daytime symptoms (20); group 2 (control) comprised eight children (seven girls, mean age 9.7 years, range 6-15) with a stable bladder and the same clinical presentation. The interval between VCUG and cystometry ranged from 1 day to 5 months (mean 47 days) and was similar in both groups. Signs considered suspicious of DI were sought in the findings of VCUG. RESULTS: In group 1, VCUG was normal or showed no specific signs (only vesico-ureteric reflux or vaginal voiding) in 25 (49%) of patients, whereas 26 (51%) had some signs suspicious of DI. Suspicious signs were urethral ballooning (in 11), bladder trabeculation or a constricting ring (eight), a 'spinning-top' urethra (three), urethral notching (two) and Mercier's bar (one). In group 2, five patients had no abnormal findings on VCUG and three had suspicious signs. The positive predictive value of VCUG was high (0.89) but the diagnostic yield of suspicious signs was low, because the sensitivity (0.5), specificity (0.62) and overall accuracy (0.52) were low. CONCLUSION: Radiological signs suspicious of DI cannot be regarded as such in conventional VCUG, as although they were detected in half the patients with DI, they also occurred in three of eight children with a stable bladder.

Collagen for female genuine stress incontinence after a minimum 2-year follow-up.

OBJECTIVE: To evaluate the medium-term outcome of gluteraldehyde cross-linked (GAX) collagen in the treatment of genuine stress incontinence in women. PATIENTS AND METHODS: The study comprised 111 women (age range 33-90 years) with genuine stress incontinence who were treated with para-urethral collagen injections between 1990 and 1995. The patients were followed prospectively and their clinical outcome documented. Pre- and post-operative urodynamic data were examined to determine any prognostic indicators. RESULTS: The overall results at a minimum 2-year follow-up (mean 3.3) showed 25% of patients to be dry and a further 40% improved. Although there were significant changes in some urodynamic values, no predictive factors of success were identified. Previous surgery for stress incontinence did not influence the final outcome. CONCLUSION: Para-urethral collagen injection is a safe and relatively simple procedure with acceptable results at the medium-term follow-up. It could be offered as a primary or secondary procedure to women with genuine stress incontinence who are unable or unwilling to undergo surgical treatment. Objective urodynamic assessment revealed no factors of prognostic significance.

[Ingelman intervention (transvaginal bladder denervation) with treatment of bladder instability]. / Intervención de Ingelman (denervación vesical transvaginal) con tratamiento de la inestabilidad vesical.

OBJECTIVES: To evaluate the clinical and urodynamic results achieved by transvaginal bladder denervation (the Ingelman technique) for bladder instability refractory to anticholinergic therapy. METHODS: The Ingelman procedure was performed in 14 female patients in whom anticholinergic therapy was unsuccessful or contraindicated. The mean age was 53.3 years (range 21-71 yrs.) and the most common presenting symptom was urge incontinence. Bladder instability persisted in 7 patients (involuntary contractions throughout the filling phase), bladder compliance was less than 30 ml/cm H20 in 7 and bladder capacity less than 300 ml in 8 patients. RESULTS: There were no intra or postoperative complications. The mean postoperative follow-up was 10.9 months (range 2-41). One patient was lost to follow-up. CLINICAL RESULTS: 10 patients (71%) reported cessation or decrease of symptoms ('clinical improvement'), 2 referred the same symptoms and 1 claimed to be worse. Urodynamic results: Some urodynamic parameters had improved in 6 of the 10 patients with clinical improvement; however, only 3 had a normal urodynamic study. Some urodynamic parameters (bladder capacity, compliance and first micturition sensation) had become worse in the 3 patients that showed no clinical improvement. There was no statistically significant improvement of the mean values of any urodynamic parameter. CONCLUSION: Transvaginal bladder denervation is a simple and safe procedure. In this series, it has achieved symptomatic improvement in 70% of patients with bladder instability. Urodynamic improvement was observed in only 3 of these patients (21%). Patients with no clinical improvement also showed worse urodynamic data postoperatively.

Direct measurement of blood flow in the human bladder.

PURPOSE: We evaluated blood flow in the human bladder. MATERIALS AND METHODS: In 8 surgical cases a laser Doppler flow probe was placed in the bladder dome and anterior wall. In 10 endoscopic cases the flow probe was placed in the bladder trigone and lateral wall. RESULTS: Bladder filling resulted in reduced mean blood flow in the dome and anterior wall. After prostatectomy blood flow decreased in the dome but not the anterior wall. During endoscopy bladder filling resulted in diminished blood flow. CONCLUSIONS: Laser Doppler flowmetry can measure blood flow changes in the human bladder.

Polytetrafluoroethylene sling for failure in female stress incontinence surgery.

Surgery for stress urinary incontinence (SUI) in women with previous interventions is often difficult and yields poor results. A total of 33 women with recurrent SUI underwent placement of a polytetrafluoroethylene (PTFE) sling after a mean of 1.5 (range, 1-3) unsuccessful operations. Preoperative bladder instability (BI) was ruled out in all cases. The patients' mean age was 54 (range, 34-79) years. In all, 64% had SUI and 36% had SUI and incontinence at rest. The Aldrige-Stoeckel technique is used with insertion of a 2 x 30 cm sling instead of fascia lata. Mean operating time was reduced in 40 minutes. After a mean follow-up period of 13 months, 72% of the patients achieved continence without retention (complete success). Altogether, 16 patients (48%) required self-catheterization after discharge, with the voiding imbalance lasting for more than 3 months in only 4 cases (12% of the total). Three patients underwent surgery for outlet obstruction. There were five abdominal wound infections but no vaginal wound infection. Two slings have since been removed (one partially), but none has eroded through the urethra. The PTFE sling is a reasonable option for this group of patients. Retention is usually self-limited, and most complications can be managed successfully.

Urodynamic findings in children with spinal cord ischemia.

PURPOSE: We identified urodynamic patterns of lower urinary tract dysfunction in children after anterior spinal artery injury. MATERIALS AND METHODS: Between 1981 and 1993, 6 boys and 1 girl in whom ischemic spinal cord injuries developed after umbilical artery catheterization (4), cardiovascular surgery (2) and spontaneous bleeding from an arteriovenous fistula (1) were evaluated radiologically, neurologically and urodynamically. RESULTS: Neurological assessment revealed a motor level from T8 to S1 in all 7 children, whereas only 3 had sensory denervation ranging from T8 to L4. Urodynamic studies demonstrated a mixed upper and lower motor neuron pattern in 3 patients, a lower motor neuron lesion only in 3 and a pure upper motor neuron deficit in 1. Treatment consisted of oxybutynin in 5 cases, Credé voiding in 1 and close observation in 1. All children are dry and kidney function has remained stable. CONCLUSIONS: Spinal cord ischemia in children is a rare condition that can arise from a variety of causes, the most common of which are embolism from umbilical artery catheterization and surgical repair of a patent ductus arteriosus. The urodynamic patterns are variable but characteristically they can be upper or lower motor neuron in nature. Precise testing will lead to appropriate therapy to prevent upper urinary tract disease and minimize incontinence.

[Survey on information provided to hospitalized patients at a monographic center]. / Encuesta sobre información a los pacientes hospitalizados en un centro monográfico.

To assess the information of patients, eight interviewers surveyed simultaneously 103 of the 130 in patients of a monographic (Urology and Nephrology) Hospital. Answers to the 10 questions can be grouped in: a) Physician identification: 72% identified the visiting physician and 61% knew his/her name; b) Information about disease: 94% declared to be informed and thought information was adequate (92%) and understandable (83%); c) Information about procedures or interventions had been given to 82% and not given to 18% of them. 43% had been inquired their opinion about treatment; d) Information to relatives had been given to 97% of patients surveyed, although 16% couldn't recall who gave it. The level of information in our Center is similar to others reported, but two aspects could be improved: 1) identification of all members of the team and 2) increasing patient participation in decision making. The need of the knowledge by the patient of the Hospitals hierarchy should be defined.

[Bladder neck sclerosis after transurethral resection of the prostate. "Study Group of the Puigvert Foundation"]. / Esclerosis de cuello vesical tras resección transuretral de próstata. "Grupo de Estudio de la de la Fundación Puigvert".

We reviewed 623 patients who underwent trans-urethral resection of the prostate (TURP) and 18 (2.8%) developed bladder neck contracture (BNC), in most cases symptomatic. Sclerosis appeared between 2 and 100 months after TURP (mean 9 months, median 19 months). Most were small prostates at the time of resection, with a mean resected weight of 10.5 g (SD 5.9), although there were no statistically significant differences between patients with and without contracture. Patients have been followed for a mean of 44.5 months. Three patients were not operated: two were asymptomatic and another one died one month postoperatively due to unrelated causes. The overall success rate was 75% and cold knife incision of the bladder neck accounted for a 90% success rate. Cold knife incision provides good long term satisfaction in patients with post-operative BNC. The difficulties in the study of this complication are analyzed.

Significance of ureteral carcinoma in situ in specimens of cystectomy.

In a retrospective review of 242 cystectomy specimens performed for bladder carcinoma, ureteral carcinoma in situ was found in 14 patients (5.7%), unilateral in 12 and bilateral in 2. Pathology of the bladder specimen was pT4 (6 cases), pT3 (3 cases), pT2 (1 case), pT1 (3 cases), and pT0 (1 case). In the cystectomy specimen and in previous biopsies, they all had grade 3 tumor, and 85% had bladder CIS. Two patients were lost during follow-up. Seven patients (58.4%) died of metastatic disease without evidence of upper tract recurrence (UTR). Their average survival was 15.8 months (range 4-60). Five patients (41.6%) are alive after an average follow-up of 33.6 months (range 18-72 months). In one case an UTR appeared 53 months after cystectomy. In patients with ureteral CIS and long-term survival, a careful follow-up is advisable. The incidence of UTR is increased in this subgroup (8% global and 20% of survivors) but mortality is due to progressive bladder disease.