Fungi in dialysis water and dialysate: occurrence, susceptibility to antifungal agents and biofilm production capacity.

The aim of this study was to investigate the occurrence of fungi in dialysis water and dialysate, in addition to evaluating the susceptibility to antifungals and the biofilm production capacity of isolated microorganisms. The samples were collected in three hemodialysis units in Bauru (Brazil), every 15 days (July 2017-June 2018) at post-reverse osmosis, reuse, and dialysate points. The fungi were isolated by spread plate on Sabouraud dextrose agar. Filamentous fungi were phenotypically identified and yeasts were subjected to molecular evaluation of the ITS region. Susceptibility test to antifungals was carried out by the broth microdilution method and biofilm production capacity was evaluated in microtiter plates using crystal violet staining. Fungi were isolated in 52/216 (24.1%) samples, with an average count of 16.3 (10-40) CFU/mL. Overall, 61 microorganisms were identified, with 54 (88.5%) filamentous fungi and 7 (11.5%) yeasts. The main genera included were Penicillium, Cladosporium, Scedosporium, Rhinocladiella, Fusarium, and Emmonsia. Most isolates showed high values of minimum inhibitory concentration for 5-flucytosine and fluconazole and 35/45 (77.8%) isolates were classified as strong producers of biofilm. In order to increase the safety of the dialysis process, the adoption of control measures and monitoring of fungi in hemodialysis fluids is suggested.

Biomarkers assessment in patients with Chagas disease and systemic arterial hypertension.

Chagas disease (ChD) and systemic arterial hypertension (SAH) are two severe comorbidities that lead to mortality and a reduction in people's quality of life, with an impact on public health. The aim of this study was to quantify the biomarkers of cardiac injury in patients with ChD and SAH. Eighty patients were divided into four groups: 20 hypertensive patients, 20 ChD-hypertensive patients, 20 ChD patients, and 20 normotensive volunteers; all of them came from outpatient's public health services. Among the evaluated markers for cardiac lesions (creatine kinase, creatine kinase-MB isoform, myoglobin, high-sensitive cardiac troponin T[hs-cTnT], B-type natriuretic peptide [BNP], and C-reactive protein), hs-cTnT and BNP were the most appropriate. Importantly, our results showed that the cut off point for hs-cTnT could be < 0.007 ng/mL, which could lead to the early detection of myocardial lesions. The BNP and hs-cTnT levels were high only in the ChD and ChD-hypertensive patient groups, suggesting that Chagas' disease may play an important role in the increase of these biomarkers. ChD patients, hypertensive or not, with cardiac or cardiodigestive involvement presented significantly higher values of hs-cTnT (p < 0.001) and BNP (p = 0.001) than ChD patients with indeterminate and digestive forms, which strengthens the validation of these markers for the follow-up of clinical cardiac form of ChD. This study suggests that the BNP and hs-cTnT can be used as possible indirect biomarkers of cardiac damage. In addition, the reference values of these biomarkers in Chagas and hypertensive cardiomyopathies should be better understood with further studies.

Fungi in dialysis water and dialysate: occurrence, susceptibility to antifungal agents and biofilm production capacity

The aim of this study was to investigate the occurrence of fungi in dialysis water and dialysate, in addition to evaluating the susceptibility to antifungals and the biofilm production capacity of isolated microorganisms. The samples were collected in three hemodialysis units in Bauru (Brazil), every 15 days (July 2017­June 2018) at post-reverse osmosis, reuse, and dialysate points. The fungi were isolated by spread plate on Sabouraud dextrose agar. Filamentous fungi were phenotypically identified and yeasts were subjected to molecular evaluation of the ITS region. Susceptibility test to antifungals was carried out by the broth microdilution method and biofilm production capacity was evaluated in microtiter plates using crystal violet staining. Fungi were isolated in 52/216 (24.1%) samples, with an average count of 16.3 (10­40) CFU/ mL. Overall, 61 microorganisms were identified, with 54 (88.5%) filamentous fungi and 7 (11.5%) yeasts. The main genera included were Penicillium, Cladosporium, Scedosporium, Rhinocladiella, Fusarium, and Emmonsia. Most isolates showed high values of minimum inhibitory concentration for 5-flucytosine and fluconazole and 35/45 (77.8%) isolates were classified as strong producers of biofilm. In order to increase the safety of the dialysis process, the adoption of control measures and monitoring of fungi in hemodialysis fluids is suggested.

Physicochemical and microbiological quality of the public water supply in 38 cities from the midwest region of the State of São Paulo, Brazil.

The public water supply is a constant subject of concern since its quality depends on many different factors. The intention of this paper was to evaluate the quality of the public water supply in 38 cities from the midwest region of the State of São Paulo, Brazil, during the year of 2016. The parameters investigated included free residual chlorine, pH, apparent color, turbidity, fluoride, nitrate, and the presence of total coliforms and Escherichia coli. In total, from the 2,897 samples of water under analysis, 545 (18.81%) samples conflicted with the country's current legislation. The highest rates of noncompliance were related to fluoride contents and the presence of total coliforms. In addition, high nitrate concentrations (>10 mg/L NO3 -N) were observed in one of the cities' water sample. Our data display the major critical points of the water offered to the population and expose the potential risks for human health, indicating the need of a regular surveillance of the water and the adoption of corrective and preventive measures, in order to avoid the waterborne diseases occurrence, thus contributing to the population's health improvement. PRACTITIONER POINTS: Approximately 20% of the unsatisfactory water samples. High nitrate concentrations in public supply water. Potential risks for human health.

Agreement between diagnostic imaging methods for the evaluation of lymphadenopathies in HIV-infected/AIDS patients.

OBJECTIVE: To assess the percent agreement between diagnostic imaging modalities for the evaluation of lymphadenopathies in HIV-infected/AIDS patients. MATERIALS AND METHODS: This was an open, comparative, prospective study of diagnostic imaging methods for lymphadenopathy evaluation. We evaluated 30 patients (19 men and 11 women). All underwent ultrasound and computed tomography (CT). Twenty of the patients also underwent magnetic resonance imaging (MRI). We determined the percent agreement between two examiners using the various imaging methods to evaluate lymphadenopathies. RESULTS: CT had the highest percent agreement, at 93.3%, with a kappa coefficient of 0.85, corresponding to 28 of the 30 examinations. When we compared the percent agreement between the two examiners and between CT and ultrasound, examiner 1 had an observed rate of 80.0%, with a kappa of 0.49, corresponding to 24 of the 30 examinations, whereas examiner 2 had a rate of 70.0%, with a kappa of 0.31, corresponding to 21 of the 30 examinations. Between MRI and CT, the percent agreement for examiner 1 was 50.0%, with a kappa of -0.18, corresponding to 10 of the 20 examinations, whereas that for examiner 2 was 85.0%, with a kappa of 0.69, corresponding to 17 of the 20 examinations. For MRI and ultrasound, examiner 1 had a percent agreement of 70.0%, with a kappa of 0.20, corresponding to 14 of the 20 examinations, and examiner 2 had a percent agreement of 75.0%, with a kappa of 0.38, corresponding to 15 of the 20 examinations. CONCLUSION: This study indicates that intermethod agreement is highly dependent on the way in which the research is conducted, rather than on the level of experience of the examiner.

OBJETIVO: Avaliar a porcentagem de concordância entre métodos de diagnóstico por imagem na avaliação de linfonodomegalias em pacientes HIV(+)/AIDS. MATERIAIS E MÉTODOS: Foi realizado estudo aberto, comparativo e prospectivo dos métodos de diagnóstico por imagem na avaliação de linfonodomegalias. Foram avaliados 30 pacientes (19 homens e 11 mulheres). Todos foram submetidos a ultrassonografia e tomografia computadorizada (TC) e 20 também foram submetidos a ressonância magnética (RM). Foi determinado o grau de concordância entre dois examinadores usando-se métodos de diagnóstico por imagem. RESULTADOS: A TC obteve o maior grau de concordância, com taxa de 28/30 (93,3%) e coeficiente kappa de 0,85. Quando comparado o grau de concordância para linfonodomegalias entre dois examinadores e entre TC e ultrassonografia, o examinador 1 teve taxa de 24/30 (80,0%) e kappa de 0,49, e o examinador 2 teve taxa de 21/30 (70,0%) e kappa de 0,31. Entre RM e TC, o examinador 1 teve taxa de 10/20 (50,0%) e kappa de -0,18, e o examinador 2 teve taxa de 17/20 (85,0%) e kappa de 0,69. Entre RM e ultrassonografia, o examinador 1 teve taxa de 14/20 (70,0%) e kappa de 0,20, e o examinador 2 teve taxa de 15/20 (75,0%) e kappa de 0,38. CONCLUSÃO: Este estudo indica que a concordância entre métodos depende fortemente da forma como a pesquisa é conduzida e não da capacidade do examinador.

Agreement between diagnostic imaging methods for the evaluation of lymphadenopathies in HIV-infected/AIDS patients / Concordância entre métodos de diagnóstico por imagem na avaliação de linfonodomegalias em pacientes HIV(+)/AIDS

Abstract Objective: To assess the percent agreement between diagnostic imaging modalities for the evaluation of lymphadenopathies in HIV-infected/AIDS patients. Materials and Methods: This was an open, comparative, prospective study of diagnostic imaging methods for lymphadenopathy evaluation. We evaluated 30 patients (19 men and 11 women). All underwent ultrasound and computed tomography (CT). Twenty of the patients also underwent magnetic resonance imaging (MRI). We determined the percent agreement between two examiners using the various imaging methods to evaluate lymphadenopathies. Results: CT had the highest percent agreement, at 93.3%, with a kappa coefficient of 0.85, corresponding to 28 of the 30 examinations. When we compared the percent agreement between the two examiners and between CT and ultrasound, examiner 1 had an observed rate of 80.0%, with a kappa of 0.49, corresponding to 24 of the 30 examinations, whereas examiner 2 had a rate of 70.0%, with a kappa of 0.31, corresponding to 21 of the 30 examinations. Between MRI and CT, the percent agreement for examiner 1 was 50.0%, with a kappa of −0.18, corresponding to 10 of the 20 examinations, whereas that for examiner 2 was 85.0%, with a kappa of 0.69, corresponding to 17 of the 20 examinations. For MRI and ultrasound, examiner 1 had a percent agreement of 70.0%, with a kappa of 0.20, corresponding to 14 of the 20 examinations, and examiner 2 had a percent agreement of 75.0%, with a kappa of 0.38, corresponding to 15 of the 20 examinations. Conclusion: This study indicates that intermethod agreement is highly dependent on the way in which the research is conducted, rather than on the level of experience of the examiner.

Resumo Objetivo: Avaliar a porcentagem de concordância entre métodos de diagnóstico por imagem na avaliação de linfonodomegalias em pacientes HIV(+)/AIDS. Materiais e Métodos: Foi realizado estudo aberto, comparativo e prospectivo dos métodos de diagnóstico por imagem na avaliação de linfonodomegalias. Foram avaliados 30 pacientes (19 homens e 11 mulheres). Todos foram submetidos a ultrassonografia e tomografia computadorizada (TC) e 20 também foram submetidos a ressonância magnética (RM). Foi determinado o grau de concordância entre dois examinadores usando-se métodos de diagnóstico por imagem. Resultados: A TC obteve o maior grau de concordância, com taxa de 28/30 (93,3%) e coeficiente kappa de 0,85. Quando comparado o grau de concordância para linfonodomegalias entre dois examinadores e entre TC e ultrassonografia, o examinador 1 teve taxa de 24/30 (80,0%) e kappa de 0,49, e o examinador 2 teve taxa de 21/30 (70,0%) e kappa de 0,31. Entre RM e TC, o examinador 1 teve taxa de 10/20 (50,0%) e kappa de -0,18, e o examinador 2 teve taxa de 17/20 (85,0%) e kappa de 0,69. Entre RM e ultrassonografia, o examinador 1 teve taxa de 14/20 (70,0%) e kappa de 0,20, e o examinador 2 teve taxa de 15/20 (75,0%) e kappa de 0,38. Conclusão: Este estudo indica que a concordância entre métodos depende fortemente da forma como a pesquisa é conduzida e não da capacidade do examinador.

Fluoretação das águas de abastecimento público: 10 anos de monitoramento em 38 municípios do Centro-Oeste Paulista, São Paulo, Brasil / Public water supply fluoridation: 10 years of monitoring in 38 municipalities of Centro-Oeste Paulista, São Paulo, Brazil

Introdução: No estado de São Paulo, a concentração de flúor na água de abastecimento público deve ser mantida na faixa de 0,6 a 0,8 mg/L, a fim de prevenir a cárie e evitar o risco de fluorose. Objetivo: Avaliar a concentração de fluoretos na água de abastecimento público dos municípios de abrangência do Grupo de Vigilância Sanitária de Bauru. Método: Os dados foram extraídos da rotina do Instituto Adolfo Lutz ­ Bauru e oriundos de 38 municípios monitorados pelo Programa de Vigilância da Qualidade da Água para Consumo Humano (Proágua), no período de 2007­2016. As análises laboratoriais foram realizadas utilizando-se o método potenciométrico com eletrodo íon-seletivo e a interpretação dos resultados baseou-se na Resolução SS nº 250/95 e na classificação proposta pelo Centro Colaborador do Ministério da Saúde em Vigilância da Saúde Bucal (CECOL). Resultados: Das 8.887 amostras analisadas, 31,1% apresentaram teores inadequados de íons fluoretos, sendo que 22,7% estavam abaixo e 8,4% acima do limite estabelecido pela legislação. De acordo com a proposta do CECOL, 59,4% das amostras exibiram benefício máximo para prevenção de cárie e 0,6% revelaram risco muito alto para produção de fluorose dentária. Conclusões: Tais dados apontam a necessidade de aprimorar o controle operacional do processo de fluoretação e enfatiza a importância da vigilância da qualidade da água.

Introduction: In the State of São Paulo, the concentration of fluoride in the public water supply should be maintained in the range of 0.6 to 0.8 mg/L, in order to prevent caries and avoid the risk of fluorosis. Objective: To evaluate the concentration of fluoride in public water supply in the municipalities covered by the Bauru Sanitary Surveillance Group. Method: Data were extracted from the routine of the Adolfo Lutz Institute ­ Bauru, from 38 municipalities monitored by the Proágua Program, in the period 2007­2016. Laboratory analyses were performed using the potentiometric method with ion-selective electrode and the interpretation of the results was based on Resolution SS-250/95 and the classification proposed by the Collaborating Center of the Ministry of Health in Oral Health Surveillance (CECOL) Results: Of the 8,887 samples analyzed, 31.1% had inadequate levels of fluoride ions, with 22.7% being below and 8.4% above the limit established by the legislation. According to the CECOL proposal, 59.4% of the samples showed maximum benefit for caries prevention and 0.6% revealed a very high risk for the production of dental fluorosis. Conclusions: These data point out the need to improve the operational control of the fluoridation process and emphasize the importance of water quality surveillance.

Occurrence of Blastocystis spp. in domestic animals in Triângulo Mineiro area of Brazil.

INTRODUCTION: Currently, there are few studies regarding Blastocystis epidemiology. This study aimed to evaluate the occurrence of Blastocystis in animals in Uberaba, Brazil. METHODS: Fecal samples were examined by parasitological methods and screened for Blastocystis by polymerase chain reaction. RESULTS: Blastocystis spp. were observed in pigs, sheep, cattle, and dogs. Blastocystis polymerase chain reaction was positive in 14/22 samples positive by parasitological methods. CONCLUSIONS: The occurrence of Blastocystis in animals is high, with a predominance of subtype 1 in the region. This is the first study conducted in Brazil showing the genetic profile of Blastocystis isolated from animals.

Occurrence of Blastocystis spp. in domestic animals in Triângulo Mineiro area of Brazil

Abstract INTRODUCTION: Currently, there are few studies regarding Blastocystis epidemiology. This study aimed to evaluate the occurrence of Blastocystis in animals in Uberaba, Brazil. METHODS: Fecal samples were examined by parasitological methods and screened for Blastocystis by polymerase chain reaction. RESULTS: Blastocystis spp. were observed in pigs, sheep, cattle, and dogs. Blastocystis polymerase chain reaction was positive in 14/22 samples positive by parasitological methods. CONCLUSIONS: The occurrence of Blastocystis in animals is high, with a predominance of subtype 1 in the region. This is the first study conducted in Brazil showing the genetic profile of Blastocystis isolated from animals.

Parasitological and immunological evaluation of cattle experimentally infected with Trypanosoma vivax.

Trypanosoma vivax infection causes relevant economical impact due to high morbidity and mortality leading to negative impact on local livestock. Despite parasitological and serological methods are used for the diagnosis of T. vivax infection, gaps regarding sensitivity and specificity of these methods still represent a challenge. The present study aimed to compare the kinetics of parasitological and serological parameters in cattle experimentally infected with T. vivax along with immunophenotypic analysis of whole blood leukocytes. Based on the parasitemia profile the analysis were performed in three distinct periods, referred as pre-patent, patent and post-treatment. Distinct kinetics of anti-T. vivax IgM and IgG were observed during the pre-patent, patent and post-treatment periods. Increased levels of WC1+ γδ T-cells were observed throughout the infection with strong correlations with other biomarkers observed during post-treatment period. Our findings demonstrated that there is a important participation of Monocytes:CD14+; NK-cells:CD335+ and WC1+ γδ T-cells that coincide with the peak of parasitemia and also with the adaptive immunity, specially CD4+ T-cells in T. vivax infection. The knowledge of the immune response is important not only for understanding the biology of the parasite in the host, but for the design of new treatment strategies for trypanosome infections.

Use of Tc-rCRP as a target for lytic antibody titration after experimental Trypanosoma cruzi infection.

Experimental Chagas disease has been used as a model to identify several host/parasite interaction factors involved in immune responses to Trypanosoma cruzi infection. One of the factors inherent to this parasite is the complement regulatory protein (Tc-CRP), a major epitope that induces production of lytic antibodies during T. cruzi infections. Previous studies have evaluated the function of Tc-CRP as an antigenic marker via ELISAs, which demonstrated high sensitivity and specificity when compared to other methods. Therefore, this study aimed to assess and compare the levels of lytic antibodies induced by this protein following experimental infection using different T. cruzi strains. Our results demonstrated that infections induced by strains isolated from vectors resulted in subpatent parasitaemia and low reactivity, as assessed by Tc-rCRP ELISAs. On the other hand, mice inoculated with T. cruzi strains isolated from patients developed patent parasitaemia, and presented elevated lytic antibodies titres, as measured by Tc-rCRP ELISA. In addition, comparison between different mouse lineages demonstrated that Balb/c mice were more reactive than C57BL/6 mice in almost all types of infections, except those infected by the AQ-4 strain. Parasites from the Hel strain generated the greatest lytic antibody response in all evaluated models. Therefore, application of sensitive techniques for monitoring immune responses would enable us to establish growth curves for lytic antibodies during the course of the infection, and allow us to discriminate between T. cruzi strains that originate from different hosts.

Prospective study of patients with persistent symptoms of dengue in Brazil.

Dengue is an arboviral infection clinically recognized as an acute and self-limited disease. Persistence of dengue symptoms is known, but it has been little studied. The aim of this study was to characterize persistent symptoms in 113 patients with dengue followed up clinically and by laboratory testing at a tertiary hospital. Symptoms that persisted for more than 14 days were observed in 61 (54.0%) patients, and six (6.2%) of them had symptoms for 6 months or more. The persistent symptoms identified were myalgia, weakness, hair loss, memory loss, reduced resistance to physical effort, headache, reasoning problems, arthralgia, sleepiness- and emotional lability. The progression to persistent symptoms was significantly associated with hospitalization, older age, more severe disease, the presence of bleeding and comorbidities upon univariate analysis. Upon multivariate analysis, the presence of persistent symptoms continued to be significantly associated only with increased age and dengue with warning signs. The platelet count during the acute phase of the disease was significantly lower in the group with persistent symptoms. In conclusion, the frequency of progression to persistent symptoms in dengue is relevant in patients seen at a tertiary hospital and the persistence of symptoms is more common in patients with dengue with warning signs.

Amiodarone and itraconazole improve the activity of pentavalent antimonial in the treatment of experimental cutaneous leishmaniasis.

Leishmaniasis affect millions of people, causing morbidity and mortality, especially in developing tropical and subtropical countries. Unfortunately, the possibilities of treatment for these infections are still quite limited and most of the available drugs present serious side effects. The objective of this paper was to evaluate the therapeutic role of amiodarone and itraconazole in the treatment of cutaneous leishmaniasis caused by Leishmania (Leishmania) amazonensis. In order to perform this evaluation, hamsters were infected with 1 × 106 metaciclic promastigotes of the parasite in the hind footpad and, after the onset of the lesions, were treated with glucantime, amiodarone, itraconazole, glucantime and amiodarone, glucantime and itraconazole or amiodarone and itraconazole. The treatments' efficacy was evaluated per analysis of the size of the cutaneous lesions and by parasitic investigation of the infected foot (by histopathological examination and PCR) and possible side effects were analyzed taking into account the weight of the animals and some biochemical and metabolic parameters (glucose, urea, creatinine, AST, ALT and ALP). The results have shown that, in hamsters, amiodarone and itraconazole, either used isolated or in combination, are unable to stop the development of cutaneous lesions caused by L. (L.) amazonensis, but improve the activity of glucantime in the treatment of these lesions and seem to present no evident side effects. More studies are necessary in order to investigate the clinical potential of these combinations, so there can be the possibility of broadening the therapeutic options available, especially in resistant cases.

Assistência do cuidador nas habilidades funcionais de autocuidado em crianças com baixa visão de 2 a 3 anos de idade / Caregiver's assistance in the self-care functional skills in children with low vision age 2 to 3 years

RESUMO Objetivo: Avaliar a demanda de assistência do cuidador nas habilidades funcionais de autocuidado nas crianças com baixa visão. Métodos: Participaram 14 crianças com idade entre dois e três anos, ambos sexos, divididas em dois grupos: baixa visão e visão normal. O Inventário de Avaliação Pediátrica de Incapacidade (PEDI) foi aplicado especificamente às partes I (habilidades funcionais) e II (assistência do cuidador) na área de autocuidado. Resultados: Não houve diferença significativa entre crianças com baixa visão e visão normal nas habilidades funcionais (t=0,655; p=0,525) e nível de assistência do cuidador (t=0,902; p=0,385). Porém, houve correlação forte e positiva entre as partes I e II no autocuidado para crianças com baixa visão (r=+0,924; p=0,003) e moderada e positiva para as com visão normal (r=+0,790; p=0,035). Conclusão: A demanda de assistência do cuidador nas habilidades funcionais de autocuidado de crianças com baixa visão, entre dois a três anos de idade, está dentro dos padrões de normalidade do PEDI, apresentando bom desempenho funcional, com auxílio de moderada à mínima.

ABSTRACT Objective: To assess the caregiver assistance demand in the functional self-care skills in children with low vision. Methods: Fourteen children aged between two and three years, both genders, were allocated into two groups, low vision and normal vision. The Pediatric Evaluation of Disability Inventory (PEDI) was applied specifically to parties I (functional skills) and II (caregiver assistance) in the selfcare area. Results: There was no significant difference between children with low vision and normal vision in the functional skills (t=0,655; p=0,525) and caregiver assistance level (t=0,902; p=0,385). However, there was strong and position correlation between parties I and II in the self-care for children with low vision (r=+0,924; p=0,003) and moderate and position normal vision (r=+0,790; p=0,035). Conclusion: The caregiver assistance demand in the self-care functional skills in children with low vision, between age two to three years, is within the normal standards of the PEDI, showing good functional performance, with the assistance of moderate to minimum.

Correlation between the virulence of T. cruzi strains, complement regulatory protein expression levels, and the ability to elicit lytic antibody production.

Trypanosoma cruzi trypomastigotes are able to resist lysis via the complement system, which involves many surface proteins including the complement regulatory protein (CRP). To examine the diversity in CRP recognition among strains of T. cruzi, the expression levels of the translated protein on trypomastigote surfaces were analyzed by flow cytometry, and associations between protein expression and the biological behavior of these strains, especially the ability to induce lytic antibodies in animal models, were assessed. The highly virulent T. cruzi strains Ninoa, INC-5, and Colombiana and the less virulent strains CL-Brener, LGB-231, and JG were used in the experiments. An expression profile analysis showed that the Colombiana and INC-5 strains have higher translated protein levels and induced higher production of antibodies in mice than the other strains. Our results indicated that there are differences in the surface expression of CRP between parasite strains, with a tendency for the most virulent strains to have higher expression levels. Combined, these results contribute to a better understanding of CRP functions and the complexity of host-parasite interactions, considering the large number of virulence factors involved in the process.

Influência dos estímulos ambientais domiciliares na mobilidade de crianças com baixa visão: habilidade funcional e assistência do cuidador / Influence of the home environmental affordances in the mobility of children with low vision mobility: functional skills and caregiver assistance

RESUMO Objetivo: Analisar e correlacionar a influência dos estímulos presentes no ambiente domiciliar nas habilidades funcionais e no nível de assistência do cuidador na mobilidade de crianças com baixa visão e visão normal. Métodos: Participaram sete crianças com diagnóstico de baixa visão (32,29 ± 7,09 meses) e sete com visão normal (31,57 ± 6,90 meses). Os instrumentos utilizados foram Affordances in the Home Environment for Motor Development - Self Report (AHEMD-SR) e Inventário de Avaliação Pediátrica de Incapacidade (PEDI) referente à parte I (habilidades funcionais) e II (assistência do cuidador) da área de mobilidade. Resultados: De acordo com o PEDI, não houve diferença significativa entre crianças com baixa visão e visão normal nas habilidades funcionais (U=13,5; p=0,076) e na assistência do cuidador (U=13,0; p=0,083) na área de mobilidade, porém houve correlação moderada (r=+0,756; p=0,049) entre as partes I e II para crianças com baixa visão. No AHEMD-SR, crianças com baixa visão apresentaram diferenças significativas nas subescalas: motricidade fina (U=7,5; p=0,024), motricidade grossa (U=7,5; p=0,024) e AHEMD total (U=8,0; p=0,035). Porém ambas receberam a classificação "média" para as oportunidades de estimulação do ambiente domiciliar. Conclusão: O ambiente domiciliar das crianças com baixa visão apresentou razoáveis oportunidades de estímulos, no entanto seu desempenho estava dentro dos padrões de normalidade para as habilidades funcionais e assistência do cuidador em mobilidade.

ABSTRACT Objective: To analyse and correlate the influence of the present affordances in the home environment in the functional skills and the level of caregiver assistance for the mobility of children with low vision and normal vision. Methods: Participated seven children with low vision diagnosis (32.29 ± 7.09 months) and seven with normal vision (31.57 ± 6.90 months). The instruments used were Affordances in the Home Environment for Motor Development - Self Report (AHEMD-SR) and Pediatric Evaluation of Disability Inventory (PEDI) relative to the parties I (functional skills) and II (caregiver assistance) for the mobility area. Results: According to PEDI, there was no significant difference between children with low vision and normal vision in functional skills (U=13.5; p=0.076) and caregiver assistance (U=13.0; p=0.083) in the mobility area, however there was moderate correlation (r=+0.756; p=0.049) between the parties I and II for children with low vision. In AHEMD-SR, children with low vision showed significant differences in the subscales: fine-motor (U=7.5; p=0.024), gross-motor (U=7.5; p=0.024), and AHEMD total (U=8.0; p=0.035). However, both children received classification "average" for the affordances in the home environment. Conclusion: Children with low vision showed no differences in functional skills and caregiver assistance in the mobility. And the home environment offered reasonable affordances, which favored the functional skills and caregiver´s assistance in the mobility.

Clonidine-stimulated growth hormone concentrations (cut-off values) measured by immunochemiluminescent assay (ICMA) in children and adolescents with short stature.

OBJECTIVES: To establish cut-off values for growth hormone concentrations using clonidine as a secretagogue and an immunochemiluminescent assay as the method of measurement and to analyze the response time as well as the influence of gender, nutritional status and pubertal stage. METHODS: A total of 225 tests were performed in 3 patient groups, categorized as group 1 (normal), group 2 (idiopathic short stature) and group 3 (growth hormone deficiency). Among the 199 disease-free individuals, 138 were prepubertal, and 61 were pubertal. Clonidine (0.1 mg/m2) was orally administered, and the growth hormone level was measured by immunochemiluminescent assay. The growth hormone peak and the difference between the growth hormone peak and the baseline level were then analyzed. Statistical analyses were performed using Student's t-test or the Mann-Whitney test and Kruskal-Wallis test followed by Dunn's post hoc test. Cut-off values were determined using a receiver operating characteristic curve. RESULTS: Group 1 and group 2 had no difference in growth hormone peak, gender, body mass index standard deviation score, or pubertal stage. Group 3 exhibited a significantly lower growth hormone peak than the other groups did. The receiver operating characteristic curve demonstrated that growth hormone concentrations ≥ 3.0 ng/mL defined responsiveness to clonidine. In total, 3.02% of individuals in group 1 and group 2 were considered false positive, i.e., these children lacked growth hormone deficiency and had a peak below 3.0 ng/mL. CONCLUSION: Clonidine-stimulated growth hormone concentrations ≥3 ng/mL, as measured by immunochemiluminescent assay, suggest responsiveness to the stimulus regardless of gender, body mass index standard deviation score or pubertal stage.

Clonidine-stimulated growth hormone concentrations (cut-off values) measured by immunochemiluminescent assay (ICMA) in children and adolescents with short stature

OBJECTIVES: To establish cut-off values for growth hormone concentrations using clonidine as a secretagogue and an immunochemiluminescent assay as the method of measurement and to analyze the response time as well as the influence of gender, nutritional status and pubertal stage. METHODS: A total of 225 tests were performed in 3 patient groups, categorized as group 1 (normal), group 2 (idiopathic short stature) and group 3 (growth hormone deficiency). Among the 199 disease-free individuals, 138 were prepubertal, and 61 were pubertal. Clonidine (0.1 mg/m2) was orally administered, and the growth hormone level was measured by immunochemiluminescent assay. The growth hormone peak and the difference between the growth hormone peak and the baseline level were then analyzed. Statistical analyses were performed using Student’s t-test or the Mann-Whitney test and Kruskal-Wallis test followed by Dunn’s post hoc test. Cut-off values were determined using a receiver operating characteristic curve. RESULTS: Group 1 and group 2 had no difference in growth hormone peak, gender, body mass index standard deviation score, or pubertal stage. Group 3 exhibited a significantly lower growth hormone peak than the other groups did. The receiver operating characteristic curve demonstrated that growth hormone concentrations ≥ 3.0 ng/mL defined responsiveness to clonidine. In total, 3.02% of individuals in group 1 and group 2 were considered false positive, i.e., these children lacked growth hormone deficiency and had a peak below 3.0 ng/mL. CONCLUSION: Clonidine-stimulated growth hormone concentrations ≥3 ng/mL, as measured by immunochemiluminescent assay, suggest responsiveness to the stimulus regardless of gender, body mass index standard deviation score or pubertal stage.

The Driving of Immune Response by Th1 Adjuvants in Immunization of Mice with Trypanosoma cruzi marinkellei Elicits a Controversial Infection Control.

In previous studies, we have demonstrated that inoculation with a Trypanosoma cruzi marinkellei (avirulent RM1 strain) was able to reduce parasitemia in mice challenged with T. cruzi, although it was not able to prevent histopathological lesions. Th1 response stimulation by immunization is necessary for T. cruzi infection control, but the resistance is also dependent on immunoregulatory mechanisms, which can be induced by adjuvants. Thus, we evaluated whether inoculation of T. cruzi marinkellei associated with administration of different adjuvants would be capable of inducing different patterns of immune response to maximize the immune response against T. cruzi (virulent Romildo strain) infection. Two hundred eighty nonisogenic mice were divided into 14 groups according to the immunization scheme and the subsequent challenge with virulent Romildo T. cruzi strain. Nonimmunized groups and animals inoculated without adjuvants were also included. Immune protection was not observed with Th2 adjuvants (incomplete Freund's adjuvant [IFA] and Alum) due to high parasitemia. Th1/Th2-polarizing adjuvants also did not induce immune protection because inulin was unable to maintain survival, and immune-stimulating complexes induced intense inflammatory processes. Animals sensitized with RM1 strain without adjuvants were able to reduce parasitemia, increase survival, and protect against severe histological lesions, followed by adequate cytokine stimulation. Finally, our results demonstrate that the early and balanced IFN-γ production becomes critical to promote protection and that Th1 adjuvant elicited a controversial infection control due to increased histopathological damage. Therefore, the host's immunomodulation remains one of the most important challenges in the research for effective protection against T. cruzi infection. Similarly, the identification of protective antigens in the RM1 strain of T. cruzi marinkellei may contribute to further studies on vaccine development against human Chagas disease.

OCCURRENCE OF Blastocystis spp. IN UBERABA, MINAS GERAIS, BRAZIL.

Intestinal parasites are a problem for public health all over the world. The infection with Blastocystis, a protozoan of controversial pathogenicity, is one of the most common among them all. In this study, the occurrence of intestinal parasites, with emphasis on Blastocystis, in patients at the Universidade Federal do Triângulo Mineiro was investigated in Uberaba (MG) through microscopy of direct smears and fecal concentrates using Ritchie's method. Feces of 1,323 patients were examined from April 2011 to May 2012. In 28.7% of them at least one intestinal parasite was identified, and the most frequent organisms were Blastocystis spp. (17.8%) and Giardia intestinalis (7.4%). The occurrence of parasitism was higher in children aged 6 -10 years old, and the infection with Blastocystis spp. was higher above the age of six (p < 0.001). The exclusive presence of G. intestinalis and of Blastocystis spp. was observed in 5.4% and 12.2% of the patients, respectively. Regarding patients with diarrheic feces, 8% revealed unique parasitism of Blastocystis spp. Other intestinal parasites observed in children were Ascaris lumbricoides (0.3%) and Entamoeba histolytica/dispar/moshkovskii (1.4%). The Ritchie's method was more sensitive (92.8%) when compared to direct microscopy (89.8%), with high agreement between them (97.7%, kappa = 0.92). In conclusion, the occurrence of Blastocystis spp. in Uberaba is high and the presence of diarrheic feces with exclusive presence of the parasite of Blastocystis spp. was observed.