High prevalence of clinically unsuspected dengue disease among children in Ribeirao Preto city, Brazil.

The aim of this study was to analyze the characteristics of Dengue virus (DENV)-infected children and the accuracy of dengue diagnosis based on clinical presentations. The inclusion criteria were children ≥1-year-old presenting febrile illness with 1-7 days of onset. Children (n = 110) aged 2-15 years were included in this study. DENV infection was confirmed with virological tests using serum, salvia, and/or urine samples. The attending pediatricians classified 56/110 (50.91%) of the children as suspected dengue cases. The DENV infection was confirmed by specific laboratory tests in 52/56 (92.9%) of the suspected dengue cases but also in 44/54 (81.5%) of the unsuspected dengue cases; total of 96/110 (87.27%) confirmed dengue cases. The clinical diagnosis gave an overall sensitivity of 54.2% (52/96) and a specificity of 71.4% (10/14). The positive predictive value of the clinical diagnosis was 92.8% and negative predictive value was 18.5%. After the third day of onset of symptoms, the DENV genome detection rate was similar in serum and saliva samples, suggesting that saliva samples represent an alternative to blood samples for early dengue diagnosis. Vaccination against Yellow fever virus did not influence the antibody response against DENV-1, DENV-2, and DENV-3, which circulated during the study period. Although the signs and symptoms were compatible with dengue, the attending pediatricians did not suspect the disease in several children. Therefore, the inclusion of virological tests for early diagnosis in the protocols for dengue surveillance would help in the implementation of prompt treatment of patients and epidemic containment strategies. J. Med. Virol. 88:1711-1719, 2016. © 2016 Wiley Periodicals, Inc.

Virulence attributes and genetic variability of oral Candida albicans and Candida tropicalis isolates.

The wide spectrum of candidiasis and its clinical importance encourage the research with the purpose of clarifying the mechanisms of pathogenicity and identification of virulence factors of Candida sp. Therefore, the aim of this study was to verify the adhesion capacity, protease activity and genotypic diversity of oral C. albicans and C. tropicalis isolates. The adhesion ability to the extracellular matrix glycoproteins laminin and fibronectin was evaluated using the ELISA technique. The research of proteases was carried out in agar plate containing bovine albumin and through a quantitative method in buffer solution containing haemoglobin. Intra and interspecies polymorphisms was verified through random amplified polymorphic DNA (RAPD) technique. All C. albicans and C. tropicalis isolates binded to immobilised laminin and fibronectin. Ca33 and Ct13 isolates had relative adhesion index significantly higher than the other isolates for both glycoproteins (P < 0.001). Protease activity was observed in all isolates of C. albicans using either the semi-quantitative or quantitative assay. The protease activity of C. tropicalis was better detected through the quantitative assay. The genotypic diversity by RAPD revealed a heterogeneous population in both species. Nevertheless, C. tropicalis presented higher genetic variability than C. albicans strains.

Evaluation of the experimental inoculation of Cryptococcus albidus and Cryptococcus laurentii in normal mice: virulence factors and molecular profile before and after animal passage.

The genus Cryptococcus includes free-developing species, a few of which are of medical importance. Some, such as C. neoformans and C. gattii, cause infections in man frequently and C. albidus and C. laurentii cause less so. The aims of this study were to evaluate organ colonization after inoculation of C. albidus and C. laurentii isolates in normal BALB/c mice, the virulence factors (growth at 37 degrees C, capsule, melanin, proteinase, and phospholipase production) and the molecular profile (PCR-fingerprinting) of the yeasts before and after infection. The importance of different profiles (virulence and molecular) was considered in relation to the distribution in different organs and to the time intervals of isolation from organs. C. albidus was isolated from animal organs 2 to 10 days after inoculation and C. laurentii from 2 to 120 days. Most isolates of the two species kept the virulence factors showed before inoculation. The high homogeneity of the molecular profile of C. albidus and the high heterogeneity of C. laurentii were kept through the passages in animals. It is concluded that most isolates of both species were recovered from the animal organs after 5 or more days, and phenotypes were not altered by inoculation. No molecular alteration was detected and the virulence factors were not related to the time intervals before isolation from organs.

Dermatophyte susceptibilities to antifungal azole agents tested in vitro by broth macro and microdilution methods.

The in vitro susceptibility of dermatophytes to the azole antifungals itraconazole, fluconazole and ketoconazole was evaluated by broth macro and microdilution methods, according to recommendations of the CLSI, with some adaptations. Twenty nail and skin clinical isolates, four of Trichophyton mentagrophytes and 16 of T. rubrum were selected for the tests. Itraconazole minimal inhibitory concentrations (MIC) varied from < 0.03 to 0.25 microg/mL in the macrodilution and from < 0.03 to 0.5 microg/mL in the microdilution methods; for fluconazole, MICs were in the ranges of 0.5 to 64 microg/mL and 0.125 to 16 microg/mL by the macro and microdilution methods, respectively, and from < 0.03 to 0.5 microg/mL by both methods for ketoconazole. Levels of agreement between the two methods (+/- one dilution) were 70% for itraconazole, 45% for fluconazole and 85% for ketoconazole. It is concluded that the strains selected were inhibited by relatively low concentrations of the antifungals tested and that the two methodologies are in good agreement especially for itraconazole and ketoconazole.

Dermatophyte susceptibilities to antifungal azole agents tested in vitro by broth macro and microdilution methods / Suscetibilidade in vitro de dermatófitos a azóis pelos métodos macro e microdiluição em caldo

The in vitro susceptibility of dermatophytes to the azole antifungals itraconazole, fluconazole and ketoconazole was evaluated by broth macro and microdilution methods, according to recommendations of the CLSI, with some adaptations. Twenty nail and skin clinical isolates, four of Trichophyton mentagrophytes and 16 of T. rubrum were selected for the tests. Itraconazole minimal inhibitory concentrations (MIC) varied from < 0.03 to 0.25 µg/mL in the macrodilution and from < 0.03 to 0.5 µg/mL in the microdilution methods; for fluconazole, MICs were in the ranges of 0.5 to 64 µg/mL and 0.125 to 16 µg/mL by the macro and microdilution methods, respectively, and from < 0.03 to 0.5 µg/mL by both methods for ketoconazole. Levels of agreement between the two methods (± one dilution) were 70 percent for itraconazole, 45 percent for fluconazole and 85 percent for ketoconazole. It is concluded that the strains selected were inhibited by relatively low concentrations of the antifungals tested and that the two methodologies are in good agreement especially for itraconazole and ketoconazole.

Foi avaliada a suscetibilidade in vitro de dermatófitos aos antifúngicos itraconazol, fluconazol e cetoconazol, pelos métodos macro e microdiluição em caldo, de acordo com as recomendações do CLSI, com algumas modificações. Foram estudados 20 isolados clínicos de lesões de unha e pele, sendo quatro Trichophyton mentagrophytes e 16 T. rubrum. A concentração inibitória mínima (CIM) para itraconazol variou de < 0,03 a 0,25 µg/mL pelo método da macrodiluição, e de < 0,03 a 0,5 µg/mL pela microdiluição em caldo; de 0,5 a 64 µg/mL e de 0,125 a 16 µg/mL para fluconazol, respectivamente, pela macro e microdiluição; e de < 0,03 a 0,5 µg/mL por ambos os métodos para cetoconazol. A concordância entre os dois métodos (considerando ± uma diluição) foi de 70 por cento para itraconazol, 45 por cento para fluconazol e 85 por cento para cetoconazol. Conclui-se que os isolados estudados foram inibidos por concentrações relativamente baixas dos antifúngicos testados, e os dois métodos apresentam boa concordância, especialmente para itraconazol e cetoconazol.

Copper filter for dental radiography: evaluation of radiographic contrast / Filtro de cobre para radiografias odontológicas: avaliação do contraste radiográfico

Objective To study the effects of alternative copper filtration in a dental X-ray machine and evaluate possible changes in radiographic contrast. Methods An aluminum step-wedge was radiographed using aluminum (1.5mm) and copper (0.1mm) filters. Physical radiation factors (exposure time, kilovoltage and air-kerma rate) were controlled. After processing, the densitometer readings of the step-wedge step images were measured. For each radiograph, optical density and contrast curves were determined. The values of the areas under the contrast curves for the two groups (aluminum and copper filters) were compared by the two-tailed Mann-Whitney test, with a level of significance of 0.05. Results The mean areas under the contrast curves were -1.956 and -2.115 for the aluminum and copper filters respectively. According to the statistical test, these values were significantly different: copper filtration yielded better contrast. Conclusion The use of copper filter requires longer exposure times; it reduces the air-kerma rate and results in higher contrast values than those obtained with aluminum filter.

Objetivo Estudar o efeito da filtração alternativa de cobre em um aparelho de raios X odontológico e avaliar as possíveis alterações no contraste radiográfico. Métodos Uma escala de densidade de alumínio foi radiografada utilizando-se filtros de alumínio (1,5mm) e cobre (0,1mm). Os fatores físicos da radiação (tempo de exposição, quilovoltagem e taxa de kerma no ar) foram controlados. Após o processamento radiográfico, foram realizadas as leituras densitométricas das imagens dos degraus da escala de densidade. Para cada radiografia, foram determinadas as curvas de densidade óptica e de contraste. Os valores das áreas sob as curvas de contraste para os dois grupos (filtros de alumínio e cobre) foram comparados pelo teste bicaudal de Mann-Withney, com nível de significância de 0,05. Resultados A média das áreas sob as curvas de contraste foram: -1,956 e -2,115, para os filtros de alumínio e cobre, respectivamente. Esses valores, quando comparados por teste estatístico, apresentaram diferença estatisticamente significativa, com o maior contraste para as imagens obtidas com o filtro de cobre. Conclusão O uso do filtro de cobre requer maiores tempos de exposição, reduz a taxa de kerma no ar e determina maiores valores de contraste do que aqueles obtidos com o filtro de alumínio.

Comparação entre os filtros de alumínio e cobre no diagnóstico da cárie dentária / Comparison between aluminum and copper filters on the diagnosis of the dental caries

A ocorrência de cárie dentária tem diminuído grandemente e sua forma de manifestação tem se alterado, exigindo melhor desempenho dos métodos utilizados para o seu diagnóstico, entre eles, o exame radiográfico. Na tentativa de remover do feixe de raios X os fótons que não auxiliam na produção da imagem e ainda a degradam, filtros são adicionados ao aparelho de raios X em substituição ao filtro convencional de alumínio. O objetivo deste trabalho foi avaliar a influência da utilização do filtro de cobre na qualidade da imagem, particularmente no que se refere ao diagnóstico da cárie dentária. Para isso, foram confeccionados "phantoms" constituídos de dentes humanos, hígidos ou portadores de pequenas lesões cariosas nas faces proximais. Após o preparo dos "phantoms", foram realizadas 80 radiografias: 40 com o feixe de radiação filtrado por 1,5 mm de alumínio e 40 com o feixe de radiação filtrado por 0,1 mm de cobre. As imagens obtidas foram avaliadas por 22 cirurgiões-dentistas quanto à presença ou ausência de cáries. Terminadas as avaliações, os dentes foram seccionados e avaliados microscopicamente ("padrão ouro"). As respostas dos examinadores foram comparadas com as obtidas pela análise histológica. A sensibilidade encontrada para o filtro de alumínio foi de 48,53% e, para o filtro de cobre, 46,62%. Esses resultados não apresentaram diferenças estatisticamente significativas para concluir que o primeiro filtro tenha uma melhor qualidade da imagem para diagnosticar lesões de cárie que o segundo filtro. Os valores de especificidade foram os mesmos para ambos os filtros, sendo de 86,47%.

Performance of selective and differential media in the primary isolation of yeasts from different biological samples.

In view of the increase in yeast infections, especially polymicrobial ones, differential culture media have acquired increasing importance. The present study evaluated the Sabouraud chloramphenicol, Biggy agar, Pagano Levin agar and CHROMagar Candida media in terms of isolation, number of yeast colony forming units per plate, and inhibition of bacteria and filamentous fungi. To this end, we used 223 biological samples, including feces, and oral, vaginal and anal mucosae from 86 patients presenting or not symptoms of fungal infections. The four media did not differ significantly in terms of detection of yeast-positive cultures. The number of colony forming units per plate ranged from zero to 2.380, with a predominance of counts of 1 to 9 colonies per plate. No significant differences were observed among the four culture media in terms of number of colonies counted, for each kind of biological material. Fifteen species belonging to the genera Candida, Saccharomyces, Cryptococcus, Trichosporon and Rhodotorula were isolated, with C. albicans being the predominant species, followed by C. parapsilosis and R. rubra. CHROMagar Candida and Biggy agar were complementary in the isolation of the different species and favored a greater recovery of polymicrobial cultures. Pagano Levin agar isolated the smallest variety of species. Sabouraud chloramphenicol agar was the least effective in terms of bacterial inhibition and favored a greater development of filamentous fungi. The results suggest that more than one culture medium should be used for an adequate primary isolation.

Substâncias químicas, trabalho e alteraçöes neurológicas: possíveis relaçöes entre estas variáveis / Chemical substances, work and neurological alterations: possible relationship among these variables

Foram investigados 239 prontuários de pacientes atendidos em um hospital, portadores de patologias neurológicas de etiologias desconhecidas, buscando-se alguma relaçäo entre a doença apresentada e o uso ocupacional de substâncias químicas. Em 32 prontuários havia registros sobre ocupaçäo: 37,50 por cento dos pacientes trabalhavam na agricultura; 34,37 por cento eram empregadas domésticas/donas de casa; 12,50 por cento eram pedreiros; um era sapateiro; um seleiro; um montador de móveis e os demais trabalhavam com máquinas. Em decorrência de sua atividade, possivelmente utilizaram substâncias químicas. As poucas informaçöes relacionando o uso destes produtos e a doença apresentada pelos pacientes demonstram a reduzida importância conferida a estas variáveis.

Associação do BERA ao escore de Glasogow (Índice GB): novo método de auxílio na decisão de predição de óbito em UTI / Association of BASER to Glasgow score scale (index GB): new method for staging coma in ICU

Os autores propõem um novo método de estadiamento do coma (índice GB) que consiste na associação do escore da escala de Gasgow com o BERA (potenciais evocados auditivos de tronco cerebral). Utilizando-se do índice GB como método de avaliação da função do tronco cerebral, os autores aferiram seu impacto no prognóstico do coma e no diagnóstico precoce da morte cerebral. Desde que o colapso funcional do tronco encefálico tornou-se critério de morte cerebral e indicador para os transplantes de orgãos, propomos uma nova metodologia (índice GB) que se revelou de extrema utilidade na monitorização do coma e no diagnóstico precoce da morte cerebral, condição sine qua non para o desenvolvimento dos programas de transplantes de orgãos