Systematic review and meta-analysis of the visual mismatch negativity in schizophrenia.

Mismatch negativity (MMN) is an event-related potential component automatically elicited by events that violate predictions based on prior events. To elicit this component, researchers use stimulus repetition to induce predictions, and the MMN is obtained by subtracting the brain response to rare or unpredicted stimuli from that of frequent stimuli. Under the Predictive Processing framework, one increasingly popular interpretation of the mismatch response postulates that MMN represents a prediction error. In this context, the reduced MMN amplitude to auditory stimuli has been considered a potential biomarker of Schizophrenia, representing a reduced prediction error and the inability to update the mental model of the world based on the sensory signals. It is unclear, however, whether this amplitude reduction is specific for auditory events or if the visual MMN reveals a similar pattern in schizophrenia spectrum disorder. This review and meta-analysis aimed to summarise the available literature on the vMMN in schizophrenia. A systematic literature search resulted in 10 eligible studies that resulted in a combined effect size of g = -.63, CI [-.86, -.41], reflecting lower vMMN amplitudes in patients. These results are in line with the findings in the auditory domain. This component offers certain advantages, such as less susceptibility to overlap with components generated by attentional demands. Future studies should use vMMN to explore abnormalities in the Predictive Processing framework in different stages and groups of the SSD and increase the knowledge in the search for biomarkers in schizophrenia.

Autistic traits and event-related potentials in the general population: A scoping review and meta-analysis.

BACKGROUND: Differences in short and long-latency Event-Related Potentials (ERPs) can help us infer abnormalities in brain processing, considering early and later stages of stimuli processing across tasks and conditions. In autism research, the adult population remains largely understudied compared to samples at early stages of development. In this context, this scoping review briefly summarises what has been described in community and subclinical adult samples of autism. METHOD: The current scoping review and meta-analysis includes 50 records (N = 1652) and comprehensively explores short and long-latency ERP amplitudes and their relationship with autistic traits in adult community samples. RESULTS: This meta-analysis identified, with small to medium effect sizes, distinctive patterns in late ERP amplitudes, indicating enhanced responses to visual stimuli and the opposite patterns to auditory tasks in the included sample. Additionally, a pattern of higher amplitudes was also found for the component P3b in autistic traits. DISCUSSION: Differential effects in visual and auditory domains are explored in light of the predictive processing framework for Autism. It remains possible that different brain mechanisms operate to explain symptoms related with different sensory modalities. P3b is discussed as a possible component of interest in future studies as it revealed a more robust effect for differentiating severity in the expression of autistic traits in adulthood.

More than one century of schizophrenia: an evolving perspective.

Schizophrenia is a very complex psychiatric disorder of unknown etiology, and there is controversy as to whether its name is even appropriate to describe the associated variety of clinical presentations and symptoms. Currently, the diagnosis is essentially based on clinical criteria. These enable a clinical profile to be recognized as encompassing positive symptoms, negative symptoms, disorganization of thinking and behavior, cognitive impairment, mood abnormalities, motor abnormalities, chronic clinical course, and incomplete remissions. The concept has evolved during the past century, and schizophrenia is currently questioned as a single disease entity. Established diagnostic criteria do not mirror the heterogeneity of the disorder. A strategy to deal with clinical heterogeneity in schizophrenia is, perhaps, the adoption of a classification system based on dimensions and stages. An additional strategy to deal with etiological and pathophysiological heterogeneity is to try to identify biomarkers, namely, on the basis of intermediate phenotypes. Despite extensive biological research, the biomarkers for schizophrenia are still lacking.

Effects of Concomitant Benzodiazepines and Antidepressants Long-Term Use on Social Decision-Making: Results From the Ultimatum Game.

Benzodiazepines and antidepressants have been shown to change responses to unfairness; however, the effects of their combined use on unfairness evaluation are unknown. This study examines the effects of concomitant benzodiazepines and antidepressants long-term use on the evaluation of fair and unfair offers. To analyze behavioral changes on responses to unfairness, we compared the performance of medicated participants and healthy controls in the Ultimatum Game (UG), both in the proposer and in the respondent role. The results showed that long-term psychotropic users had the worse economic strategy by accepting less offers than control subjects. However, in the proposer role, the unfair offers made by participants were similar between groups. The present results suggest that long-term use of psychotropic medication, specifically the combination of benzodiazepines and antidepressants, may increase the sensitivity to unfairness, resulting in higher rejection rates in conditions where this strategy is the most disadvantageous.

Abnormal Habituation of the Auditory Event-Related Potential P2 Component in Patients With Schizophrenia.

Auditory event-related potentials (ERP) may serve as diagnostic tools for schizophrenia and inform on the susceptibility for this condition. Particularly, the examination of N1 and P2 components of the auditory ERP may shed light on the impairments of information processing streams in schizophrenia. However, the habituation properties (i.e., decreasing amplitude with the repeated presentation of an auditory stimulus) of these components remain poorly studied compared to other auditory ERPs. Therefore, the current study used a roving paradigm to assess the modulation and habituation of N1 and P2 to simple (pure tones) and complex sounds (human voices and bird songs) in 26 first-episode patients with schizophrenia and 27 healthy participants. To explore the habituation properties of these ERPs, we measured the decrease in amplitude over a train of seven repetitions of the same stimulus (either bird songs or human voices). We observed that, for human voices, N1 and P2 amplitudes decreased linearly from stimulus 1-7, in both groups. Regarding bird songs, only the P2 component showed a decreased amplitude with stimulus presentation, exclusively in the control group. This suggests that patients did not show a fading of neural responses to repeated bird songs, reflecting abnormal habituation to this stimulus. This could reflect the inability to inhibit irrelevant or redundant information at later stages of auditory processing. In turn schizophrenia patients appear to have a preserved auditory processing of human voices.

Effects of benzodiazepines administration on identification of facial expressions of emotion: a meta-analysis.

RATIONALE: Benzodiazepines, a class of commonly prescribed drugs, were shown to cause cognitive impairments in several domains. However, the effect of benzodiazepines on social cognition is still unclear. OBJECTIVES: In order to clarify how benzodiazepines administration affects the identification of facial expressions of emotion (FEE), we conducted a meta-analysis of 8 empirical studies (N = 153 benzodiazepines, N = 153 placebo). RESULTS: Results showed that participants receiving benzodiazepines were less accurate at identifying facial expressions of anger compared with those receiving placebo (M = - 0.52). Regarding the remaining facial expressions, the meta-analysis did not reveal significant differences between the groups. CONCLUSIONS: We discuss several factors that may explain the differences in the identification of emotions in facial expressions associated with benzodiazepines administration. Additionally, the relevance of assessing the effects of benzodiazepines when used on a long-term basis is addressed.

Neuropsychiatric Symptoms of Multiple Sclerosis: State of the Art.

Multiple Sclerosis (MS) is a chronic disabling neuroinflammatory disease. Psychiatric manifestations have a high prevalence in MS patients and may worsen the illness progression and the patients' quality of life (QoL). Depression is a highly prevalent condition in MS patients, associated with poorer adherence to treatment, decreased functional status and QoL, and increased suicide risk. Diagnosis and treatment of this disorder is challenging because of symptom overlap. Other prevalent psychiatric comorbidities are anxiety disorders, bipolar disorder, psychotic disorders, substance misuse and personality disorders. As the illness progresses, personality changes can happen, as well as affect abnormalities. Cognitive changes occur frequently in MS patients, and affect features like processing speed, attention, learning, memory, visual spatial capabilities, and some language deficits. Disease-modifying treatments may reduce cognitive impairment because of their container action on the brain's lesion burden. Other QoL determinants such as fatigue, pain, sexual dysfunction, exercise, resilience and social support should be taken into account, in order to promote the individuals' well-being. Further studies are needed in order to elucidate the effectiveness of pharmacotherapy and more neuroimaging studies are required to clarify the relationship between structural changes and psychiatric comorbidities.

Course of serological tests in treated subjects with chronic Trypanosoma cruzi infection: A systematic review and meta-analysis of individual participant data.

OBJECTIVE: To determine the course of serological tests in subjects with chronic Trypanosoma cruzi infection treated with anti-trypanosomal drugs. METHODS: A systematic review and meta-analysis was conducted using individual participant data. Survival analysis and the Cox proportional hazards regression model with random effects to adjust for covariates were applied. The protocol was registered in the PROSPERO database (http://www.crd.york.ac.uk/PROSPERO; CRD42012002162). RESULTS: A total of 27 studies (1296 subjects) conducted in eight countries were included. The risk of bias was low for all domains in 17 studies (63.0%). Nine hundred and thirteen subjects were assessed (149 seroreversion events, 83.7% censored data) for enzyme-linked immunosorbent assay (ELISA), 670 subjects (134 events, 80.0% censored) for indirect immunofluorescence assay (IIF), and 548 subjects (99 events, 82.0% censored) for indirect hemagglutination assay (IHA). A higher probability of seroreversion was observed within a shorter time span in subjects aged 1-19 years compared to adults. The chance of seroreversion also varied according to the country where the infection might have been acquired. For instance, the pooled adjusted hazard ratio between children/adolescents and adults for the IIF test was 1.54 (95% confidence interval 0.64-3.71) for certain countries of South America (Argentina, Bolivia, Chile, and Paraguay) and 9.37 (95% confidence interval 3.44-25.50) for Brazil. CONCLUSIONS: The disappearance of anti-T. cruzi antibodies was demonstrated along the course of follow-up. An interaction between age at treatment and country setting was found.

[Prevalence and bacterial susceptibility of community acquired urinary tract infection in University Hospital of Brasília, 2001 to 2005]. / Prevalência e suscetibilidades bacterianas das infecções comunitárias do trato urinário, em Hospital Universitário de Brasília, no período de 2001 a 2005.

Urinary tract infection is among the most common infectious diseases in clinical medicine, and knowledge of its epidemiology and the sensitivity profile of the etiological agents is mandatory. The aim of this study was to identify the most frequent etiological agents and the profile of sensitivity to antimicrobial agents of the bacteria isolated from urine cultures from outpatients at the University Hospital of Brasília between 2001 and 2005. From analyses at the hospitals microbiology laboratory, there were 2,433 positive urine cultures. Escherichia coli was the most commonly isolated bacteria (62.4%), followed by Klebsiella pneumoniae (6.8%) and Proteus mirabilis (4.7%). Escherichia coli showed the highest sensitivity to amikacin (98.6%), gentamicin (96.2%), nitrofurantoin (96.3%) and the quinolones ciprofloxacin (90.9%) and norfloxacin (89.8%), with low sensitivity to sulfamethoxazole-trimethoprim (50.6%). The others bacteria presented similar sensitivity profiles. In conclusion, Escherichia coli was the most commonly isolated bacteria, and it was highly sensitive to aminoglycosides, nitrofurantoin and quinolones.

Similar sound intensity dependence of the N1 and P2 components of the auditory ERP: Averaged and single trial evidence.

OBJECTIVE: The literature suggests that the N1 and P2 waves of the auditory ERP are dissociable at the developmental, experimental, and source levels. At the experimental level, inconsistent findings suggest different effects of intensity on the amplitudes of the auditory N1 and P2. Our main goal was to analyze the intensity dependence of the auditory N1 and P2 while controlling for habituation effects. METHODS: We examined the intensity dependence of both averaged and single-trial auditory N1 and P2 waves elicited in a repeated-stimulation protocol. RESULTS: N1 and P2 revealed similar intensity dependence on both standard and filter denoised ERP, with a linear tendency for higher intensities to elicit higher absolute peak amplitudes. At the single-trial level, both waves covary irrespective of stimulus intensity and trial order. CONCLUSIONS: Our results suggest that stimulus intensity variation induces similar effects on both and N1 and P2 and partially contradict previous data that classified the P2 as a non-habituating component. SIGNIFICANCE: Our findings contribute to the ongoing discussion on the functional significance of the auditory P2 deflection. In addition, the present work demonstrated the applicability of a filter denoising method for single-trial estimation in the analysis of the experimental effects on auditory ERP components.

Dysconnectivity within the default mode in first-episode schizophrenia: a stochastic dynamic causal modeling study with functional magnetic resonance imaging.

We report the first stochastic dynamic causal modeling (sDCM) study of effective connectivity within the default mode network (DMN) in schizophrenia. Thirty-three patients (9 women, mean age = 25.0 years, SD = 5) with a first episode of psychosis and diagnosis of schizophrenia--according to the Diagnostic and Statistic Manual of Mental Disorders, 4th edition, revised criteria--were studied. Fifteen healthy control subjects (4 women, mean age = 24.6 years, SD = 4) were included for comparison. All subjects underwent resting state functional magnetic resonance imaging (fMRI) interspersed with 2 periods of continuous picture viewing. The anterior frontal (AF), posterior cingulate (PC), and the left and right parietal nodes of the DMN were localized in an unbiased fashion using data from 16 independent healthy volunteers (using an identical fMRI protocol). We used sDCM to estimate directed connections between and within nodes of the DMN, which were subsequently compared with t tests at the between subject level. The excitatory effect of the PC node on the AF node and the inhibitory self-connection of the AF node were significantly weaker in patients (mean values = 0.013 and -0.048 Hz, SD = 0.09 and 0.05, respectively) relative to healthy subjects (mean values = 0.084 and -0.088 Hz, SD = 0.15 and 0.77, respectively; P < .05). In summary, sDCM revealed reduced effective connectivity to the AF node of the DMN--reflecting a reduced postsynaptic efficacy of prefrontal afferents--in patients with first-episode schizophrenia.

[Comparative study between artificial xenodiagnosis performed immediately and four hours after venous punch]. / Estudo comparativo entre o xenodiagnóstico artificial realizado imediatamente e quatro horas após a coleta de sangue.

Artificial xenodiagnosis was performed immediately after blood venous punch and then four hours later on 63 patients; 29 (46%) were male and 34 (54%) female, mean age 39 years (range 18 to 68 years). Eleven (17.5%) patients presented positive exams, of which eight (12.7%) were from immediate xenodiagnosis and 7 (11.1%) xenodiagnosis four hours after. Eight patients showed 17 positive pools from immediate xenodiagnosis and 7 patients with xenodiagnosis four hours later showed 11 positive pools (p = 0.34). Four patients were positive only on immediate xenodiagnosis, three only on xenodiagnosis 4 hours after and four were positive in both. The data demonstrate that xenodiagnosis can be performed up to four hours after blood collection without impairing the test results.

Forty years of a psychiatric day hospital.

INTRODUCTION: Day hospitals in psychiatry are a major alternative to inpatient care today, acting as key components of community and social psychiatry. OBJECTIVE: To study trends in the use of psychiatric day hospitals over the last decades of the 20th century and the first decade of the 21st century, focusing on patient age, sex, and diagnostic group, using data from Centro Hospitalar São João, Porto, Portugal. METHODS: Data corresponding to years 1970 to 2009 were collected from patient files. Patients were classified into seven diagnostic groups considering their primary diagnoses only. RESULTS: Mean age upon admission rose from 32.7±12.1 years in the second half of the 1970s to 43.5±12.2 years in 2005-2009 (p for trend < 0.001). Most patients were female (63.2%), however their proportion decreased from nearly 70% in the 1970s to 60% in the first decade of the 21st century. In males, until the late 1980s, neurotic disorders (E) were the most common diagnosis, accounting for more than one third of admissions. In the subsequent years, this proportion decreased, and the number of admissions for schizophrenia (C) exceeded 50% in 2004- 2009. In females, until the late 1980s, affective disorders (D) and neurotic disorders (E), similarly distributed, accounted for most admissions. From the 1990s on, the proportion of neurotic disorders (E) substantially decreased, and affective disorders (D) came to represent more than 50% of all admissions. CONCLUSIONS: Mean age upon admission rose with time, as did the percentage of female admissions, even though the latter tendency weakened in the last 10 years assessed. There was also an increase in the proportion of patients with schizophrenia.

Effects of inter-stimulus interval (ISI) duration on the N1 and P2 components of the auditory event-related potential.

The N1 and P2 components of the event-related potential are relevant markers in the processing of auditory information, indicating the presence of several acoustic phenomena, such as pure tones or speech sounds. In addition, the expression of these components seems to be sensitive to diverse experimental variations. The main purpose of the present investigation was to explore the role of inter-stimulus interval (ISI) on the N1 and P2 responses, considering two widely used experimental paradigms: a single tone task (1000 Hz sound repeated in a fixed rhythm) and an auditory oddball (80% of the stimuli were equal to the sound used in the single tone and the remaining were a 1500 Hz tone). Both tasks had four different conditions, and each one tested a fixed value of ISI (600, 1000, 3000, or 6000 ms). A sample of 22 participants performed these tasks, while an EEG was recorded, in order to examine the maximum amplitude of the N1 and P2 components. Analysis of the stimuli in the single tone task and the frequent tones in the oddball task revealed a similar outcome for both tasks and for both components: N1 and P2 amplitudes were enhanced in conditions with longer ISIs regardless of task. This response pattern emphasizes the dependence of both the N1 and P2 components on the ISI, especially in a scenario of repetitive and regular stimulation. The absence of task effects suggests that the ISI effect reported may depend on refractory mechanisms rather than being due to habituation effects.

[Mental health of college students: experience of the university psychiatric outpatient clinic of Hospital de São João]. / Saúde mental em estudantes do ensino superior: experiência da consulta de psiquiatria do centro Hospitalar São João.

The mental health of college students has been raising major awareness, due to the increased prevalence and severity of psychiatric disorders in this population. Higher education is associated with significant stressors that contribute to the development of mental health disturbances, and most college students are in the high-risk age group for the emergence of symptoms of major psychiatric disorders. Early diagnosis and treatment of these disorders in college students are important areas of effort, since they pose a high impact at the educational, economic, and social levels. Thus, specifically planned mental health services play a major role in the management of this population, should be specialized and have easy accessibility. The purpose of this study is to describe and characterize the College Students' psychiatric outpatient clinic of the Department of Psychiatry, Hospital de São João.

Exploring the dynamics of P300 amplitude in patients with schizophrenia.

This study investigated the time-frequency dynamics of P300 generation in patients with first-onset schizophrenia. A group of 40 patients with first-onset schizophrenia and 40 controls performed an auditory oddball task. Wavelet analysis of the single-trial data was used to compute the Event-Related Spectral Perturbation (ERSP) and the Inter-Trial Phase Coherence (ITC) for the delta, theta, alpha, beta and gamma bands on the 50ms window around peak P300 amplitude. The contribution of power and synchrony for P300 amplitudes was studied through correlation and regression analysis. Further, two sub-samples in which patients had lower or higher P300 amplitudes than their control match were contrasted. P300 amplitude did not differ between patients and controls. The frequency domain analysis revealed that controls display larger reductions on gamma power than patients. However, this gamma activity might be the result of micro-saccadic muscular artifacts. Regression analysis shows that P300 amplitude is highly dependent on delta power and synchronization. The analysis of the subsamples confirmed that while gamma power differences are dependent on the diagnosis, delta and theta synchronization are related to P300 amplitude, irrespective of diagnosis.

Forty years of a psychiatric day hospital / Quarenta anos de um hospital de dia de psiquiatria

INTRODUCTION: Day hospitals in psychiatry are a major alternative to inpatient care today, acting as key components of community and social psychiatry. Objective: To study trends in the use of psychiatric day hospitals over the last decades of the 20th century and the first decade of the 21st century, focusing on patient age, sex, and diagnostic group, using data from Centro Hospitalar São João, Porto, Portugal. METHODS: Data corresponding to years 1970 to 2009 were collected from patient files. Patients were classified into seven diagnostic groups considering their primary diagnoses only. RESULTS: Mean age upon admission rose from 32.7±12.1 years in the second half of the 1970s to 43.5±12.2 years in 2005-2009 (p for trend < 0.001). Most patients were female (63.2%), however their proportion decreased from nearly 70% in the 1970s to 60% in the first decade of the 21st century. In males, until the late 1980s, neurotic disorders (E) were the most common diagnosis, accounting for more than one third of admissions. In the subsequent years, this proportion decreased, and the number of admissions for schizophrenia (C) exceeded 50% in 2004- 2009. In females, until the late 1980s, affective disorders (D) and neurotic disorders (E), similarly distributed, accounted for most admissions. From the 1990s on, the proportion of neurotic disorders (E) substantially decreased, and affective disorders (D) came to represent more than 50% of all admissions. CONCLUSIONS: Mean age upon admission rose with time, as did the percentage of female admissions, even though the latter tendency weakened in the last 10 years assessed. There was also an increase in the proportion of patients with schizophrenia. .

INTRODUÇÃO: Os hospitais de dia em psiquiatria representam atualmente uma das principais alternativas ao internamento, atuando como componentes chave na psiquiatria comunitária e social. OBJETIVO: Avaliar tendências na utilização de um hospital de dia no período compreendido entre as últimas décadas do século 20 e a primeira década do século 21, com foco em idade, sexo e grupo diagnóstico, usando dados do Centro Hospitalar São João, Porto, Portugal. MÉTODOS: Dados correspondentes aos anos 1970 a 2009 foram coletados dos prontuários clínicos. Os pacientes foram classificados em sete grupos diagnósticos, tendo em conta o diagnóstico principal. Resultados: A idade média na admissão aumentou de 32.7±12.1 anos na segunda metade da década de 1970 para 43.5±12.2 anos em 2005-2009 (p < 0.001). A maioria dos pacientes era do sexo feminino (63.2%), no entanto sua proporção diminuiu de cerca de 70% na década de 1970 para 60% na primeira década do século 21. Nos homens, até o final dos anos 1980, o grupo das perturbações neuróticas (E) era o diagnóstico mais comum, representando mais de um terço das admissões. Durante os anos seguintes, essa proporção diminuiu, e o número de admissões por esquizofrenia (C) alcançou mais de 50% no período de 2004-2009. Nas mulheres, até o final dos anos 1980, as perturbações afetivas (D) e as perturbações neuróticas (E), distribuídas similarmente, respondiam pela maioria das admissões. A partir dos anos 1990, a proporção das perturbações neuróticas (E) diminuiu substancialmente, e as perturbações afetivas (D) passaram a corresponder a mais de 50% do total das admissões. Conclusões: A idade média na admissão ...

Prevalência e suscetibilidades bacterianas das infecções comunitárias do trato urinário, em Hospital Universitário de Brasília, no período de 2001 a 2005 / Prevalence and bacterial susceptibility of community acquired urinary tract infection in University Hospital of Brasília, 2001 to 2005

A infecção do trato urinário é uma das afecções mais comuns da clínica médica, sendo mandatório o conhecimento epidemiológico da mesma e do perfil de sensibilidade dos agentes etiológicos. O estudo teve como objetivo identificar os agentes etiológicos mais freqüentes e o perfil de sensibilidade aos antimicrobianos das bactérias isoladas de uroculturas de pacientes ambulatoriais atendidos no Hospital Universitário de Brasília no período de 2001 a 2005. Foram analisadas 2.433 uroculturas positivas realizadas no laboratório de microbiologia do Hospital Universitário de Brasília. A Escherichia coli foi a bactéria mais isolada (62,4 por cento), seguida de Klebsiella pneumoniae (6,8 por cento) e Proteus mirabillis (4,7 por cento). A Escherichia coli apresentou maior sensibilidade à amicacina (98,6 por cento), gentamicina (96,2 por cento), nitrofurantoína (96,3 por cento), e às quinolonas ciprofloxacina (90,9 por cento) e norfloxacina (89,8 por cento), com baixa sensibilidade ao sulfametoxazol-trimetoprima (50,6 por cento). As outras bactérias apresentaram similar padrão de sensibilidade. Em conclusão, a Escherichia coli foi a bactéria mais isolada, sendo altamente sensível aos amiglicosídeos, nitrofurantoína e quinolonas.

Urinary tract infection is among the most common infectious diseases in clinical medicine, and knowledge of its epidemiology and the sensitivity profile of the etiological agents is mandatory. The aim of this study was to identify the most frequent etiological agents and the profile of sensitivity to antimicrobial agents of the bacteria isolated from urine cultures from outpatients at the University Hospital of Brasília between 2001 and 2005. From analyses at the hospital’s microbiology laboratory, there were 2,433 positive urine cultures. Escherichia coli was the most commonly isolated bacteria (62.4 percent), followed by Klebsiella pneumoniae (6.8 percent) and Proteus mirabilis (4.7 percent). Escherichia coli showed the highest sensitivity to amikacin (98.6 percent), gentamicin (96.2 percent), nitrofurantoin (96.3 percent) and the quinolones ciprofloxacin (90.9 percent) and norfloxacin (89.8 percent), with low sensitivity to sulfamethoxazole-trimethoprim (50.6 percent). The others bacteria presented similar sensitivity profiles. In conclusion, Escherichia coli was the most commonly isolated bacteria, and it was highly sensitive to aminoglycosides, nitrofurantoin and quinolones.

Estudo comparativo entre o xenodiagnóstico artificial realizado imediatamente e quatro horas após a coleta de sangue / Comparative study between artificial xenodiagnosis performed immediately and four hours after venous punch

Foi realizado xenodiagnóstico artificial, imediatamente e quatro horas após a coleta do sangue, em 63 pacientes, sendo 29 (46 por cento) do sexo masculino e 34 (54 por cento) do sexo feminino. A idade mínima foi 18 anos e a máxima 68, sendo a idade média 39 anos. Onze (17,5 por cento) pacientes apresentaram resultados positivos, sendo 8 (12,7 por cento) no exame imediato e 7 (11,1 por cento) no exame 4 horas após. Os oito pacientes do exame imediato apresentaram 17 pools positivos e os sete do xenodiagnóstico de quatro horas mostraram 11 pools positivos (p =0,34). Quatro pacientes foram positivos exclusivamente no xenodiagnóstico imediato, três somente no exame de 4 horas e quatro positivos em ambos. Os dados autorizam realizar o xenodiagnóstico, até quatro horas após a extração do sangue, sem prejuízo no resultado do exame.

Avaliaçäo do tratamento especifíco para Trypanosoma cruzi em crianças, na evoluçäo da fase indeterminada / Specific treatment evaluation for Trypanosoma cruzi in children, in the evolution of the indeterminate phase

Doze pacientes com idades entre 7 a 12 anos, na forma indeterminada da doença de Chagas, com sorologia e xenodiagnóstico positivos, receberam tratamento específico. Dois pacientes tomaram 7mg/kg de nifurtimox durante 60 e 90 dias e 10 usaram 5-7mg/kg de benznidazol durante 60 dias. A evoluçäo clínica foi verificada através de exame clínico, eletrocardiograma, exame radiológico contrastado do esôfago. Após o tratamento somente uma (8,3 por cento) paciente apresentou todos os exames negativos. Oito deles foram avaliados após oito anos do tratamento e 4 acompanhados durante 20 anos. Sete (58,4 por cento) permaneceram na forma indeterminada e 4 (33,3 por cento) chagásicos progrediram clinicamente para cardiopatia grau II e/ou esofagopatia, apesar do tratamento precoce. Säo necessários estudos com maior número de crianças na fase indeterminada e acompanhamento a longo prazo para se estabelecer a influência do tratamento específico na evoluçäo da doença de Chagas