Evaluation of the acute toxicity of ellagic acid and gallic acid incorporated in Poloxamer407® gel, in Zophobas morio larvae.

Gallic acid (GA) has antioxidant, anti-inflammatory and antimicrobial properties, while ellagic acid (EA) demonstrates anticancer, antiviral and photoprotective activity. In this study, the combination of these substances incorporated into a poloxamer gel was tested to verify the individual effect of the substances, in addition to taking advantage of a probable complementary effect, aiming to provide additional therapeutic benefits. As a result of the incorporation, formulations containing GA, EA and GA + EA were obtained, which were evaluated for the effects of the Freeze-thaw cycle on pH, which revealed a significant decrease (p < 0.05) in most samples, including the vehicle (without drug) and the gel containing both drugs. No sample showed variation outside the normal pH range for the skin, with values ranging from 4.8 to 6.0. Regarding conductivity, the GA, EA and GA + EA formulations showed a reduction (p < 0.05) after the freeze-thaw cycle. The drug content in the formulations ranged from 95.86% to 101.35% initially to 91.30% to 101.51% after the freeze-thaw cycle. Regarding the drug release, the results revealed the following cumulative percentages: GA-3% - 92.58% after 1.5 h; AE-3% - 51.60% after 6 h; GA + EA (1.5% = 1.5%) - 99.91% after 2 h; GA + EA- (1.5% = 1.5%) released 57.06%, after 6 h. Regarding toxicity, it was observed that the group treated with GA showed a lower survival rate of the larvae (40%) at the dose 3000 mg/Kg in the formulation. Following the same trend, in the acute lethal concentration (ALC50) test performed using Zophobas morio larvae, an ALC50 of 2191.51 mg/Kg was observed for GA at 48 h. Melanin analysis showed a decrease in concentrations of 30 mg/Kg in the GA group, 3 mg/Kg of EA and 3, 300, 3000 mg/Kg of GA + EA, of the pure drugs. In the groups with the drugs incorporated into the gel, there was a significant decrease (P < 0.05) in melanin in the vehicle (gel), at concentrations of 300 and 3000 mg/Kg of GA and EA. On the other hand, in the combination of GA + EA, a reduction was observed at concentrations of 3 and 30 mg/Kg when compared to the control group. Thus, the gel showed good quality as a pharmaceutical formulation for topical use and low toxicity, making it promising for use in skin therapies.

Intravitreal bevacizumab plus propranolol for neovascular age-related macular degeneration (the BEVALOL study): a phase I clinical trial.

BACKGROUND: Given the persistently large public health impact of neovascular age-related macular degeneration (nARMD) despite many years of anti-VEGF therapy as the first-line treatment and the demonstrated ability of b-blockers to reduce neovascularization, a synergistic effect between an anti-VEGF agent and an intravitreal beta-blocker is important to investigate in the quest for therapeutic alternatives that maximize efficacy and/or reduce costs. The main purpose of this study is to investigate the safety of a 0.1 ml intravitreal injection of a combination of bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) to treat nARMD. METHODS: Prospective phase I clinical trial that included patients with nARMD. Comprehensive ophthalmic evaluation was performed at baseline and included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA), biomicroscopy of the anterior and posterior segments, binocular indirect ophthalmoscopy, color fundus photography, spectral domain optical coherence tomography (OCT), OCT angiography (OCT-A), fluorescein angiography (Spectralis, Heidelberg), and full-field electroretinography (ERG). All eyes were treated with a 0.1 ml intravitreal injection of a combination of bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) within 1 week of baseline evaluation. The patients were reexamined at weeks 4, 8 and 12, and clinical evaluation and SD-OCT were performed at all follow-up visits. Additional injections of combination bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) were administered at weeks 4 and 8. At the final study evaluation (week 12), color fundus photography, OCT-A, fluorescein angiography, and full-field ERG were repeated. RESULTS: Eleven patients (11 eyes) completed all study visits of the 12 week study. Full field ERG b-waves did not show significant (p < 0.05) changes at week 12 compared to baseline. During the 12 week follow-up period, none of the study eyes developed intraocular inflammation, endophthalmitis or intraocular pressure elevation more than 4 mmHg over baseline. Mean ± SE BCVA (logMAR) was 0.79 ± 0.09 at baseline and was significantly (p < 0.05) improved to 0.61 ± 0.10 at week 4; 0.53 ± 0.10 at week 8; and 0.51 ± 0.09 at week 12. Mean ± SE central subfield thickness (CST) (µm) was 462 ± 45 at baseline and was significantly (p < 0.05) lower at 4, 8 and 12 weeks (385 ± 37; 356 ± 29 and 341 ± 24, respectively). CONCLUSIONS: In this 12 week trial of a combination of intravitreal bevacizumab and propranolol for treatment of nARMD, no adverse events or signals of ocular toxicity were observed. Further studies using this combination therapy are warranted. Trial Registration Project registered in Plataforma Brasil with CAAE number 28108920.0.0000.5440 and approved in ethics committee of Clinics Hospital of Ribeirao Preto Medicine School of São Paulo University-Ribeirão Preto, São Paulo, Brazil (appreciation number 3.999.989 gave the approval).

Combined intravitreal dexamethasone and bevacizumab injection for the treatment of persistent diabetic macular edema (DexaBe study): a phase I clinical study.

PURPOSE: The aim of this study is to investigate the safety of combined intravitreal injection of dexamethasone aqueous-solution (IVD) and bevacizumab (IVB) in patients with refractory diabetic macular edema (DME) and its effect on intraocular pressure (IOP), best-corrected visual acuity (BCVA) and central subfield thickness (CSFT). METHODS: This prospective study included 10 patients (10 eyes) with DME refractory to laser photocoagulation and/or anti-vascular endothelial growth factor (anti-VEGF) therapy. A complete ophthalmological examination was performed at baseline, during the first week of treatment, and monthly through week 24. Therapy consisted of monthly injections of combined IVD and IVB "pro re nata" (PRN) if CST > 300 µm. We investigated the impact of the injections on intraocular pressure (IOP), cataract development, Early Treatment Diabetic Retinopathy Study (ETDRS) best corrected visual acuity (BCVA), and central sub-foveal thickness (CSFT) measured by spectral-domain optical coherence tomography (OCT). RESULTS: Eight patients (80%) completed 24 weeks of follow-up. Compared to baseline, mean IOP increased significantly (p < 0.05) and anti-glaucomatous eye drops were necessary for 50% of the patients, CSFT was significantly reduced at all follow-up visits (p < 0.05), although mean BCVA showed no significant improvement. One patient developed dense cataract progression and another showed vitreoretinal traction at week 24. No inflammation or endophthalmitis was observed. CONCLUSION: Treatment of DME refractory to laser and/or anti-VEGF therapy with combined PRN IV dexamethasone aqueous solution and bevacizumab was associated with adverse effects related to the use of corticosteroids. However, there was a significant improvement in CSFT meantime best-correct visual acuity remained stable or improved in 50% of patients.

Intravitreal bevacizumab (IVB) versus IVB in combination with pars plana vitrectomy for vitreous hemorrhage secondary to proliferative diabetic retinopathy: a randomized clinical trial.

BACKGROUND: The main purpose of this study is to compare the vitreous hemorrhage (VH) score reduction and visual acuity outcomes in patients with VH secondary to proliferative diabetic retinopathy (PDR) treated with intravitreal injections of bevacizumab (IVB) versus IVB and pars plana vitrectomy (IVB and PPV). METHODS: Patients with VH secondary to PDR were randomized into 2 groups: in Group A, patients were treated with a total of 3 IVB (1.5 mg/0.06 ml) at 8-week intervals; and in Group B, patients received a single IVB (1.5 mg/0.06 ml) and, 7 days later, underwent PPV. Patients received an ophthalmic evaluation that included best-corrected visual acuity (BCVA), indirect ophthalmoscopy, and mode B echography at weeks 8, 16 and 24. VH was classified according to the Diabetic Retinopathy Vitrectomy Study classification as grade 1, 2 or 3. Change in VH score was the primary outcome measure and change in BCVA was the secondary outcome. RESULTS: Seventy-three eyes of 66 patients were randomized and 70 eyes completed the 24-week follow-up visit. Mean VH score reduction (± SEM) of 0.4571 ± 0.0283 (p = 0.0014), 1.3429 ± 0.0393 (p < 0.0001) and 1.8286 ± 0.0438 (p < 0.001) was observed in Group A at 8, 16 and 24 weeks after treatment, respectively (Table 2; Fig. 2). In Group B, the reduction of VH score (± SEM) was 2.2571 ± 0.0720 (p = 0.0014), 2.2857 ± 0.0606 (p < 0.0001) and 2.2286 ± 0.0726 (p < 0.001) at 8, 16 and 24 weeks after treatment, respectively. Group comparison revealed a significantly greater reduction in mean VH score in Group B at 8 and 16 weeks after treatment (p < 0.0001). However, at 24 weeks this difference was no longer statistically significant (p = 0.1854). In Group A, mean (± SEM) BCVA showed an improvement of 0.00285 ± 0.0004 (p = 0.971), 0.5371 ± 0.0072 (p < 0.0001), 0.8143 ± 0.0001 (p < 0.0001) and 0.8543 ± 0.0008 (p < 0.0001) compared to baseline at 1, 8, 16 and 24 weeks after treatment, respectively. In Group B, mean (± SEM) BCVA showed an improvement of 0.3657 ± 0.0507 (p = 0.0002), 0.8857 ± 0.0385 (p < 0.0001), 0.9457 ± 0.0499 (p < 0.0001) and 0.9629 ± 0477 (p < 0.0001) compared to baseline at 1, 8, 16 and 24 weeks after treatment, respectively. No significant difference in BCVA improvement was observed between groups at 24 weeks after treatment. CONCLUSION: PPV with preoperative IVB is associated with more rapid clearance of VH and improvement in BCVA than IVB injections alone. However, after 24 weeks of follow-up, the reduction in VH score and BCVA were similar between both treatment strategies. Trial Registration The project is registered in Plataforma Brasil with CAAE number 927354.7.0000.5440 and was approved by the Ethics Committee of the Clinics Hospital of Ribeirao Preto Medicine School of São Paulo University-Ribeirão Preto, São Paulo, Brazil (appreciation number 3.053.397 gave the approval).

Pedicle internal limiting membrane flap technique for very large macular holes: a preliminary report.

BACKGROUND: Conventional vitrectomy technique for macular hole surgery has a good outcome in small and medium macular holes, but for very large macular holes (minimum linear diameter higher than 700 µm) other techniques were developed aiming to achieve greater rates of closure and visual acuity gain. The purpose of this article is to report the anatomical and functional outcomes of four very large macular hole (MH) cases which have undergone vitrectomy with the pedicle internal limiting membrane (ILM) flap technique. METHODS: This is a retrospective series of four patients with large MH who were treated with vitrectomy and the pedicle ILM flap technique. Comprehensive ophthalmologic evaluation was performed before surgery and included ETDRS best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT) for MH measures: height, minimum linear diameter (MLD) and external base diameter. The particular detail of this technique is related to ILM flap creation. During the peeling, the ILM was not removed completely from the retina but was left attached to the edges of the macular hole and subsequently trimmed with the vitrectomy probe using the scissors mode. RESULTS: Four patients with very large MH underwent PPV and the pedicle ILM flap technique was used to pursue macular closure. Median preoperative BCVA was 20/400 (range: 20/320 to 20/400) and median postoperative BCVA was 20/200 (range: 20/320 to 20/200). Of the 4 cases reported, 3 obtained anatomical closure (75%), and also presented BCVA improvement after surgery, considering the last follow-up visit of each case. No additional procedures were performed in either case. One patient demonstrated no anatomic and functional improvement. CONCLUSION: The present study describes the first Brazilian case series of very large MH treated by the inverted pedicle ILM flap technique. This technique was associated with anatomic and visual improvement in most cases, and represents an alternative therapeutic approach for large macular holes.Trial Registration Project registered in Plataforma Brasil with CAAE number 30163520.0.0000.5440 and approved in ethics committee   from  Ribeirão Preto Medical School Clinics Hospital, University of São Paulo-Ribeirão Preto, São Paulo, Brazil (appreciation number 3.948.426 gave the approval).

Avaliação das Práticas de Higienização por Estudantes de Medicina da Universidade Federal da Bahia (Brasil) durante Atendimento Clínico / Assessment of Hygiene Practices Employed by Medical Students at the Federal University of Bahia (Brazil) during Clinical Service

RESUMO A adesão às normas de higienização é um aspecto importante na prática clínico-hospitalar dos profissionais de saúde. Este estudo avaliou a conduta de 160 estudantes de Medicina do Internato da Faculdade de Medicina da Bahia, da Universidade Federal da Bahia, por meio de um questionário com 22 questões objetivas. Dos 160 questionários incluídos na pesquisa, 76% dos entrevistados autoavaliaram seu conhecimento sobre as normas de higienização como “excelente” e “bom”; contudo, apenas 50% realizam a higienização das mãos antes e após contato com o paciente. Cerca de 55% não concordam com a criação de um novo componente curricular específico para essa temática. As características demográficas da amostra foram diferentes quanto ao sexo em relação a outros estudos, prevalecendo no presente estudo o sexo masculino e faixa etária de 20 a 40 anos. Observam-se resultados divergentes quanto ao conhecimento dos estudantes sobre as normas de higiene e à sua conduta na prática médica. Alguns fatores que levam à não adesão à técnica asséptica pelos estudantes são a abordagem teórica sobre higienização e biossegurança em período diferente do da prática, falta de fiscalização, carência de insumos e materiais, e má conduta de alguns profissionais de saúde.

ABSTRACT Adherence to hygiene standards is an important aspect of health professionals’ clinical and hospital practice. In this study, we evaluated the behavior of 160 students completing a medical internship at the Faculty of Medicine of Bahia of the Federal University of Bahia, by means of a questionnaire containing 22 objective questions. Of the 160 participants in the survey, 76% assessed their own knowledge of hygiene standards as “excellent” or “good”; however only 50% performed hand hygiene before and after patient contact. Around 55% did not agree with the suggestion of creating a new specific curricular component on the theme. The demographic characteristics of the sample varied in gender in terms of other studies, with a prevalence of male students and an age range of 20-40. We observed divergent results regarding the students’ knowledge of the hygiene standards and their conduct thereof in medical practice. Several factors leading to the students’ failure to undertake aseptic practice are the fact that the theory of Hygiene and Biosafety is taught at a different time to its practice, as well as the lack of supervision, lack of supplies and materials and misconduct on the part of some health professionals.

Lesões oculares em trabalhadores da pesca comercial: uma revisão de literatura / Ocular injuries in commercial fishing workers: a literature review

Resumo Introdução: a pesca é uma atividade perigosa, associada à elevada morbimortalidade. Entretanto, são escassos os estudos sobre lesões oculares em trabalhadores desta atividade. Objetivo: identificar lesões oculares relacionadas à exposição ocupacional na pesca comercial e possíveis fatores de risco e de proteção relacionados. Métodos: revisão de literatura nas bases bibliográficas MedLine, LILACS-BIREME, SCOPUS, Web of Science e Cochrane, utilizando os termos de busca "pesca" e "lesão ocular". Foram incluídos: artigos completos disponíveis escritos em inglês, português ou espanhol, publicados de abril de 1993 a abril de 2013; e estudos em seres humanos. Resultados: foram incluídos 18 artigos, provenientes de 12 países. O desenho de estudo mais prevalente foi o de corte transversal. Discussão: as lesões mais frequentes se relacionavam com a exposição solar excessiva, como a catarata e a degeneração macular senil, e com traumas oculares, principalmente as lesões perfurantes pelo gancho de pesca ou por fragmentos de animais marinhos. Esses agravos foram relacionados com fatores de risco como o manuseio de peixes e frutos do mar e as jornadas prolongadas de trabalho. De acordo com os estudos, a maioria das doenças oftalmológicas relacionadas ao trabalho da pesca é prevenível, o que indica a necessidade de políticas de promoção de saúde direcionadas para a população envolvida com esse ramo.

Abstract Introduction: commercial fishing is a dangerous activity which is associated with high morbimortality. However, there are few studies on fishing workers' eye injuries. Objective: to identify occupational ocular injuries in commercial fishing and possible related risk and protection factors. Methods: literature review on the databases MedLine, LILACS-BIREME, SCOPUS, Web of Science, and Cochrane through the searching terms "fishing" and "ocular/eye injury". Both were taken into account: full articles available in English, Portuguese or Spanish, published from April 1993 to April 2013, and research involving human beings. Results: 18 articles from 12 countries were included. Most studies were cross-sectional. Discussion: the most frequent injuries were due to excessive solar exposure, such as cataract and senile macular degeneration, and to ocular trauma, mainly perforations by fishhook or by fragments of marine animals. These injuries were associated with risk factors like fish and other seafood handling and long working time. According to the studies, most of the eye injuries related to fishing can be prevented, indicating the need for health promoting policies aimed at the population involved in this activity.

Pattern, clinical features and response to corticoids of glomerular diseases in a Brazilian population. An analytical cross-sectional study / Perfil, características clínicas e resposta a corticoides das doenças glomerulares em uma população brasileira. Um estudo transversal analítico

CONTEXT AND OBJECTIVE: Glomerular disease registries are increasing all around the world. The aim of this study was to evaluate the clinical characteristics and treatment response among patients with glomerular diseases followed up in a tertiary hospital in Brazil. DESIGN AND SETTING: Analytical cross-sectional study; tertiary-level public hospital. METHODS: This study included patients with glomerular diseases followed up at a tertiary hospital in Fortaleza, northeastern Brazil. Clinical and laboratory data on each patient were registered. The response to specific treatment was evaluated after 3, 6 and 12 months. RESULTS: The study included 168 patients of mean age 37 ± 14 years. The most prevalent glomerular diseases were focal segmental glomerulosclerosis FSGS] (19.6%), minimal change disease MCD] (17.9%), membranous nephropathy MN] (16.7%) and lupus nephritis LN] (11.9%). The main clinical presentations were nephrotic proteinuria (67.3%) and renal insufficiency (17.9%). The mean proteinuria value decreased after the treatment began. Regarding 24-hour proteinuria on admission, there was no significant difference between patients with a good response and those with no response (7,448 ± 5,056 versus 6,448 ± 4,251 mg/24 h, P = 0.29). The glomerular disease with the highest remission rate was MCD (92%). Absence ...

CONTEXTO E OBJETIVO: Registros de glomerulopatias estão aumentando em todo o mundo. O objetivo deste estudo é avaliar as características clínicas e a resposta do tratamento de pacientes com glomerulopatias acompanhados em um hospital terciário no Brasil. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico. Hospital público terciário. MÉTODOS: O estudo incluiu pacientes com glomerulopatias acompanhados em um hospital terciário de Fortaleza, Ceará, Brasil. Foi realizado registro dos dados clínicos e laboratoriais para cada paciente. A resposta ao tratamento específico foi avaliada após 3, 6 e 12 meses. RESULTADOS: Foram incluídos 168 pacientes, com média de idade de 37 ± 14 anos. A glomerulopatia mais prevalente foi a glomerulosclerose segmentar e focal GESF] (19,6%), seguida pela doença de lesão mínima DLM] (17,9%), nefropatia membranosa NM] (16,7%) e nefrite lúpica NL] (11,9%). As principais manifestações clínicas foram proteinúria nefrótica (67,3%) e insuficiência renal (17,9%). A média dos valores de proteinúria diminuiu após o início do tratamento. Com relação à proteinúria de 24 horas na admissão, não houve diferença significativa entre os pacientes com boa resposta ao tratamento ...

Pattern, clinical features and response to corticoids of glomerular diseases in a Brazilian population. An analytical cross-sectional study.

CONTEXT AND OBJECTIVE: Glomerular disease registries are increasing all around the world. The aim of this study was to evaluate the clinical characteristics and treatment response among patients with glomerular diseases followed up in a tertiary hospital in Brazil. DESIGN AND SETTING: Analytical cross-sectional study; tertiary-level public hospital. METHODS: This study included patients with glomerular diseases followed up at a tertiary hospital in Fortaleza, northeastern Brazil. Clinical and laboratory data on each patient were registered. The response to specific treatment was evaluated after 3, 6 and 12 months. RESULTS: The study included 168 patients of mean age 37 ± 14 years. The most prevalent glomerular diseases were focal segmental glomerulosclerosis FSGS] (19.6%), minimal change disease MCD] (17.9%), membranous nephropathy MN] (16.7%) and lupus nephritis LN] (11.9%). The main clinical presentations were nephrotic proteinuria (67.3%) and renal insufficiency (17.9%). The mean proteinuria value decreased after the treatment began. Regarding 24-hour proteinuria on admission, there was no significant difference between patients with a good response and those with no response (7,448 ± 5,056 versus 6,448 ± 4,251 mg/24 h, P = 0.29). The glomerular disease with the highest remission rate was MCD (92%). Absence of interstitial fibrosis presented a strong correlation with remission (remission in patients without fibrosis = 83.4% versus 16.3% in those with fibrosis, P = 0.001). CONCLUSIONS: The present study found that the most frequent glomerular disease was FSGS, followed by MCD, MN and LN. The presence of interstitial fibrosis was a predictor of poor therapeutic response.

Definition and use of the variable "race" by medical students in Salvador, Brazil.

CONTEXT AND OBJECTIVE: The lack of a clear definition for human "race" and the importance of this topic in medical practice continue to create doubt among scholars. Here, we evaluate the use of the variable "race" by medical students in Salvador, Brazil. DESIGN AND SETTING: Cross-sectional study at a Brazilian federal public university. METHODS: 221 randomly selected subjects were included. A semi-structured questionnaire was used for data collection. The results were expressed as means and standard deviations of the mean, proportions and frequencies. The χ2 (chi-square) test was used for the statistical calculations. RESULTS: Approximately half of the students (45.4%) used the racial group variable in their studies on clinical practice. Of these, 86.8% considered it to be relevant information in the medical records and 92.7%, important for diagnostic reasoning; 95.9% believed that it influenced the cause, expression and prevalence of diseases; 94.9% affirmed that it contributed towards estimating the risk of diseases; 80.5% thought that the therapeutic response to medications might be influenced by racial characteristics; 41.9% considered that its inclusion in research was always recommendable; and 20.3% thought it was indispensable. The main phenotypic characteristics used for racial classification were: skin color (93.2%), hair type (45.7%), nose shape (33.9%) and lip thickness (30.3%). CONCLUSIONS: Despite the importance of different racial groups in medical practice, the majority of the professionals do not use or know how to classify them. It is necessary to add to and/or expand the discussion of racial and ethnic categories in medical practice and research.

Molecular epidemiology of Saint Louis encephalitis virus in the Brazilian Amazon: genetic divergence and dispersal.

Saint Louis encephalitis virus (SLEV), a member of the genus Flavivirus (family Flaviviridae), is an encephalitogenic arbovirus broadly distributed in the Americas. Phylogenetic analysis based on the full-length E gene sequences obtained for 30 Brazilian SLEV strains was performed using different methods including Bayesian and relaxed molecular clock approaches. A new genetic lineage was suggested, hereafter named genotype VIII, which co-circulates with the previously described genotype V in the Brazilian Amazon region. Genotypes II and III were restricted to São Paulo state (South-east Atlantic rainforest ecosystem). The analysis also suggested the emergence of an SLEV common ancestor between 1875 and 1973 (mean of 107 years ago), giving rise to two major genetic groups: genotype II, more prevalent in the North America, and a second group comprising the other genotypes (I and III-VIII), broadly dispersed throughout the Americas, suggesting that SLEV initially emerged in South America and spread to North America. In conclusion, the current study demonstrates the high genetic variability of SLEV and its geographical dispersion in Brazil and other New World countries.

Definition and use of the variable "race" by medical students in Salvador, Brazil / Definição e utilização da variável "raça" por estudantes de medicina em Salvador, Bahia, Brazil

CONTEXT AND OBJECTIVE: The lack of a clear definition for human "race" and the importance of this topic in medical practice continue to create doubt among scholars. Here, we evaluate the use of the variable "race" by medical students in Salvador, Brazil. DESIGN AND SETTING: Cross-sectional study at a Brazilian federal public university. METHODS: 221 randomly selected subjects were included. A semi-structured questionnaire was used for data collection. The results were expressed as means and standard deviations of the mean, proportions and frequencies. The χ2 (chi-square) test was used for the statistical calculations. RESULTS: Approximately half of the students (45.4 percent) used the racial group variable in their studies on clinical practice. Of these, 86.8 percent considered it to be relevant information in the medical records and 92.7 percent, important for diagnostic reasoning; 95.9 percent believed that it influenced the cause, expression and prevalence of diseases; 94.9 percent affirmed that it contributed towards estimating the risk of diseases; 80.5 percent thought that the therapeutic response to medications might be influenced by racial characteristics; 41.9 percent considered that its inclusion in research was always recommendable; and 20.3 percent thought it was indispensable. The main phenotypic characteristics used for racial classification were: skin color (93.2 percent), hair type (45.7 percent), nose shape (33.9 percent) and lip thickness (30.3 percent). CONCLUSIONS: Despite the importance of different racial groups in medical practice, the majority of the professionals do not use or know how to classify them. It is necessary to add to and/or expand the discussion of racial and ethnic categories in medical practice and research.

CONTEXTO E OBJETIVO: A falta de uma definição clara da raça humana e a importância desse tema na prática médica continua a ser fonte de dúvidas para estudiosos. No presente artigo nós avaliamos o uso da variável raça por estudantes de medicina em Salvador, Brasil. TIPO DE ESTUDO E LOCAL: corte transversal, realizado numa universidade pública federal. MÉTODO: 221 estudantes, , foram incluídos. Um questionário semi-estruturado foi utilizado para a coleta dos dados. Os resultados são expressos como média e desvio-padrão da média, proporções e frequências. O teste do χ2 (qui-quadrado) foi utilizado para o cálculo estatístico. RESULTADOS: Aproximadamente metade dos estudantes (45,4 por cento) usava a variável grupo racial na sua prática clínica em estudos. Desses, 86,8 por cento a consideravam uma informação relevante no prontuário médico; 92,7 por cento no raciocínio diagnóstico; 95,9 por cento acreditavam que ela influenciava a causa, expressão e prevalência das doenças; 94,9 por cento afirmaram que ela contribuía para estimar o risco de doenças; 80,5 por cento informaram que a resposta terapêutica a medicamentos pode ser influenciada pelas características raciais; 41,9 por cento consideravam que sua inclusão nas pesquisas era sempre recomendável; e 20,3 por cento a avaliavam como indispensável. As principais características fenotípicas usadas para a classificação racial foram: cor da pele (93,2 por cento), tipo de cabelo (45,7 por cento), formato do nariz (33,9 por cento) e espessura dos lábios (30,3 por cento). CONCLUSÃO: Apesar de sua importância na prática médica, a maioria dos profissionais não usa e não sabe classificar os diversos grupos raciais. É necessário adicionar e/ou ampliar a discussão sobre as categorias raciais e étnicas no exercício da medicina e nas pesquisas médicas.

Exposição ocupacional a material biológico por pessoal de saúde: construção e proposição de instrumentos avaliativos / Healthcare personnelïs occupational exposure to biological material: elaboration and proposition of assessment instruments

No Brasil, os indicadores de exposição aos agentes biológicos apresentam lacunas acerca dos conhecimentos, das atitudes e dos comportamentos do pessoal de saúde e não há instrumento validado para avaliação desses aspectos. Neste trabalho, o objetivo foi elaborar questionários para a avaliação institucional e do pessoal de saúde sobre a exposição ocupacional a material biológico utilizando a literatura como fonte. Foram utilizadas as bases Medline, Lilacs e Scopus a partir de palavras-chave, termos análogos e descritores associados ao tema. Dos 557 artigos pré-selecionados, 91 (16,3%) foram efetivamente incluídos no estudo. Para obtenção, análise e interpretação dos dados, foram utilizadas técnicas de análise de conteúdo e de análise de dados secundários. Com base nesse estudo, foram definidas categorias e subcategorias temáticas que orientaram a construção de dois questionários: um para avaliação institucional e outro dirigido ao pessoal de saúde. A validade aparente dos instrumentos foi realizada por sete avaliadores ad hoc e independentes. Esses questionários, após estudo de validação em campo, poderão ser aplicados na investigação científica e na avaliação de aspectos associados ao tema aqui estudado, assim como fornecer dados à elaboração, à implantação e ao monitoramento de práticas profissionais e de gestão.

In Brazil, biologic agents exposure lack information about healthcare workers knowledge, attitudes and behavior, and there is no valid instrument to assess these issues. The purpose of the present work was to develop questionnaires to assess institutions and health care workers about their occupational exposure to biological material, using literature as a data source. Medline, Scopus and Lilacs databases were searched by key words, analogous expressions, and descriptors related to the subject. From the 557 preselected articles, 91 (16.3%) were effectively included in the study. To obtain, analyze, and interpret data, contend and secondary data analysis techniques were selected. Thematic categories andsub-categories were defined based on this study, and they guided the construction of two questionnaires one for institutional assessment and the other to assess healthcare workers. Seven independent ad hoc reviewers evaluated the apparent validity of the instruments. After the validation of these questionnaires in the , they can be used for scientific research and for assessment of the aspects associated to the issues studied in this paper, as well as provide data for elaboration,implementation, and monitoring of professional practices and management.

Epidemiology of Saint Louis encephalitis virus in the Brazilian Amazon region and in the State of Mato Grosso do Sul, Brazil: elevated prevalence of antibodies in horses / Epidemiologia do vírus da encefalite Saint Louis na Amazônia brasileira e no Estado do Mato Grosso do Sul, Brasil: elevada prevalência de anticorpos em equinos

The immunity of horses (n = 1401) against Saint Louis encephalitis virus (SLEV) was investigated in the Brazilian Amazon region (Bragança/Pará, Salvaterra/Pará, Macapá/Amapá and Rio Branco/Acre) and Maracaju, State of Mato Grosso do Sul, by the hemagglutination inhibition (HI) and plaque reduction neutralization (PRNT) tests. HI and neutralizing antibodies specific (monotypic reactivity, MR) for SLEV and other flaviviruses included in the tests were detected, as was cross-reactivity (CR) against flaviviruses. In the HI test, MR was observed in 248 (17.7 percent) serum samples, 137 of which were (55.2 percent) againstSLEV; CR was detected in 380 (27.1 percent). The frequency of MR against SLEV was significantly higher in Macapá and CR was significantly higher in Salvaterra. In the PRNT, neutralization of SLEV was observed in 713 (50.9 percent) samples, and the prevalence of neutralizing antibodies was significantly higher in Macapá than in Salvaterra (p = 0.0083). This study adds new data regarding the immunity of horses against SLEV in Brazil, and it confirms the wide distribution of SLEV and the diversity of flaviviruses in the country, as well as the apparent absence of disease in SLEV-infected horses.

A imunidade de equinos (n = 1401) contra o vírus da encefalite Saint Louis (SLEV) foi investigada na Amazônia brasileira (Bragança/PA, Salvaterra/PA, Macapá/AP e Rio Branco/AC) e Maracaju, no Estado do Mato Grosso do Sul, por meio detestes de inibição da hemaglutinação (IH) e neutralização por redução de placas (PRNT). Foram detectados anticorpos IH e neutralizantes específicos (reações monotípicas – RM) para SLEV e outros flavivírus incluídos nos testes, assim como reações cruzadas para flavivírus. Pelo teste de IH, RM foram observadas em 248 (17,7 por cento) amostras de soro, 137 (55,2 por cento) para SLEV, e RC para flavivírus foram detectadas em 380 (27,1 por cento). A frequência de RM para SLEV e de RC foi significativamente maior em Macapá e Salvaterra, respectivamente. Pelo PRNT, foi observada a neutralização do SLEV em 713 (50,9 por cento) amostras, e a prevalência de anticorpos neutralizantes foi significativamente maior em Macapá, em comparação com Salvaterra (p = 0,0083). Este estudo traz novos dados a respeito da imunidade de equinos contra SLEV no Brasil, e confirma a ampla distribuição de SLEV e a diversidade de flavivírus no País, bem como a aparente ausência de doenças em equinos infectados por SLEV.

[Ethics relevance in Brazilian medical journals]. / Destaques éticos nos periódicos nacionais das áreas médicas.

OBJECTIVE: To evaluate the Brazilian journals cited by the four CAPES medical areas, qualified as 'A' national or 'I' international, regarding the relevance given to ethics in the instructions for authors. METHODS: The instructions for authors of twenty Brazilian journals were studied and 36 types of ethical concerns were identified allowing the following categorization: I - Ethics in human research; II - Scientific integrity; III - Editorial policy. RESULTS: The results on Category I show that the most frequent instructions (50%) requires previous approval of the research by a institutional Ethics Committee (CEP), followed by indication on how to cite this approval in the body of the article (35%), plus presentation of a copy of the CEP approval (30%). However, none advert on the importance of the CEP being recognized by the CONEP. On Category II, 55% of the journal require declarations of conflict of interest, and 40% of them inquire about the type of interest; however, all (100%) journal do not mention prevention conflict of interests between authors and peer reviewers, neither on frauds, plagiarisms or data fabrication. Finally, in Category III, 65% of the journals require the authors to transfer publications rights to them, while the remaining 35% do not mention copyright CONCLUSION: These results are discussed in relations to the Brazilian present situation regarding ethics in the scientific production of researches using human subjects for the prevention of scientific dishonesty.

Destaques éticos nos periódicos nacionais das áreas médicas / Ethics relevance in Brazilian medical journals

OBJETIVO: Avaliar os destaques éticos existentes nas instruções aos autores de periódicos nacionais citados conjuntamente pelas quatro áreas médicas da CAPES e qualificados nível "A" nacional ou "I" internacional. MÉTODOS: As instruções aos autores de 20 revistas nacionais foram estudadas e 36 tipos de preocupações éticas foram identificados, permitindo a seguinte categorização: I - Ética na pesquisa com seres humanos; II - Integridade científica; III - Política editorial. RESULTADOS: Os resultados mostraram que na categoria I a instrução mais freqüente (50 por cento) é a exigência de aprovação da pesquisa por um CEP institucional, seguida da indicação no corpo do artigo referir-se a esta aprovação (35 por cento), e a apresentação de cópia do parecer do CEP (30 por cento). Todavia, nenhum periódico adverte sobre a importância do CEP ser credenciado pela CONEP. Na categoria II, 55 por cento dos periódicos exigem declaração de conflitos de interesse e 40 por cento deles interrogam sobre qual tipo de interesse; todavia, todos (100 por cento) os periódicos são omissos quanto à verificação de conflitos de interesse entre autores e revisores assim como prevenção de fraudes, plágios e fabricação de dados. Finalmente, na categoria III, 65 por cento dos periódicos exigem que os direitos autorais sejam-lhes cedidos e os demais 35 por cento nada dizem sobre o assunto. CONCLUSÃO: Os resultados são discutidos em relação à situação atual do Brasil em relação à ética da pesquisa em seres humanos e à prevenção de desonestidade científica.

OBJECTIVE: To evaluate the Brazilian journals cited by the four CAPES medical areas, qualified as "A" national or "I" international, regarding the relevance given to ethics in the instructions for authors. METHODS: The instructions for authors of twenty Brazilian journals were studied and 36 types of ethical concerns were identified allowing the following categorization: I - Ethics in human research; II - Scientific integrity; III - Editorial policy. RESULTS: The results on Category I show that the most frequent instructions (50 percent) requires previous approval of the research by a institutional Ethics Committee (CEP), followed by indication on how to cite this approval in the body of the article (35 percent), plus presentation of a copy of the CEP approval (30 percent). However, none advert on the importance of the CEP being recognized by the CONEP. On Category II, 55 percent of the journal require declarations of conflict of interest, and 40 percent of them inquire about the type of interest; however, all (100 percent) journal do not mentione prevention conflict of interests between authors and peer reviewers, neither on frauds, plagiarisms or data fabrication. Finally, in Category III, 65 percent of the journals require the authors to transfer publications rights to them, while the remaining 35 percent do not mention copyright CONCLUSION: These results are discussed in relations to the Brazilian present situation regarding ethics in the scientific production of researches using human subjects for the prevention of scientific dishonesty.

Occult B infection in the Brazilian northeastern region: a preliminary report.

A sentinel study on viral hepatitis is currently being carried out in the village of Cavunge in a semiarid rural region of the state of Bahia, northeastern Brazil. This study has identified individuals in whom anti-HBc IgG was the only serological marker for hepatitis B virus (HBV). This serological pattern may constitute evidence of occult HBV infection. This study Investigated the possibility of occult hepatitis B virus infection in individuals in a rural community who tested positive for anti-HBc IgG alone. A cross-sectional population-based study. ELISA III was performed on serum samples to test for serological viral markers, and ultrasensitive PCR (US-PCR) was used to assess viremia. Among the 1,536 serum samples, 3.6% (n=55) were positive for anti-HBc alone. Four years after this first serological survey, 31 of those 55 individuals (56.3%) were retested, and 11 (35.5%) remained anti-HBc positive alone. Two of these 31 (6.5%) were HBV-DNA positive based on US-PCR, with normal aminotransferase levels in both cases. Cases of occult hepatitis B infection were identified in this semiarid rural community of northeastern Brazil, where endemicity of HBV is moderate.

HTLV-1 infection in blood donors from the Western Brazilian Amazon region: seroprevalence and molecular study of viral isolates.

To determine the seroprevalence of HTLV-1 in Brazil, and to review the virus molecular epidemiology in this Amazon population (Rio Branco-Acre), 219 blood donors were screened for HTLV-1. Only one case of infection (0.46% seroprevalence) was detected during July 2004 screening at the Acre Hospital Foundation (FUNDACRE). Neighbor-joining and Maximum Likelihood phylogenetic analyses of two (n = 2) complete LTR region sequences were performed with the PAUP* software. Since the HTLV-1 envelope surface (gp46) and transmembrane (gp21) glycoproteins are important for virus fitness, three envelope glycoproteins sequences (n = 3) were analyzed using the Prosite tool to determinate potential protein sites. Phylogenetic analysis demonstrated that the new isolate described in this study, and the unpublished LTR strain described in a previous report belong to the Transcontinental subgroup of the Cosmopolitan subtype, inside the Latin American cluster. A similar result was obtained when submitting, to the Automated Genotyping System, three LTR partial sequences from a previous study of the seroprevalence of HTLV-1 in the same Amazon population. In all analyzed env sequences, the potential protein site was found: two PKC phosphorylation sites at amino acid (aa) positions 310-312 and 342-344, one CK2 phosphorylation site at 194-197aa, three N-glycosylation sites at 222-225aa, 244-247aa and 272-275aa, and a single N-myristylation site at 327-338aa. In conclusion, potential protein sites described in HTLV-1 gp46 and gp21 confirm the presence of conserved sites in the HTLV-1 envelope proteins, likewise phylogenetic analysis suggests a possible recent introduction of the virus into North Brazil.

Occult B infection in the Brazilian northeastern region: a preliminary report

A sentinel study on viral hepatitis is currently being carried out in the village of Cavunge in a semiarid rural region of the state of Bahia, northeastern Brazil. This study has identified individuals in whom anti-HBc IgG was the only serological marker for hepatitis B virus (HBV). This serological pattern may constitute evidence of occult HBV infection. This study Investigated the possibility of occult hepatitis B virus infection in individuals in a rural community who tested positive for anti-HBc IgG alone. A cross-sectional population-based study. ELISA III was performed on serum samples to test for serological viral markers, and ultrasensitive PCR (US-PCR) was used to assess viremia. Among the 1,536 serum samples, 3.6 percent (n=55) were positive for anti-HBc alone. Four years after this first serological survey, 31 of those 55 individuals (56.3 percent) were retested, and 11 (35.5 percent) remained anti-HBc positive alone. Two of these 31 (6.5 percent) were HBV-DNA positive based on US-PCR, with normal aminotransferase levels in both cases. Cases of occult hepatitis B infection were identified in this semiarid rural community of northeastern Brazil, where endemicity of HBV is moderate.