Immunogenicity of a 23-valent pneumococcal polysaccharide vaccine in Brazilian elderly

Serum antibodies specific for the capsular polysaccharides of Streptococcus pneumoniae provide protection against invasive pneumococcal infection. In Brazil, this vaccine has been used for people over 65 years with clinical risk to develop pneumococcal infection since 1999. We evaluated the immune response of 102 elderly subjects (75.5 percent females and 24.5 percent males) with a mean age of 71 years, and 19 young healthy adults (63.2 percent females and 36.8 percent males) with a mean age of 27 years. The elderly study group consisted of outpatients who received follow-up care in the Geriatric Department of General Hospital, Faculty of Medicine, University of São Paulo. None had acute illness at the time of vaccination. Both groups were immunized with one intra-deltoid injection with 0.5 ml of a 23-valent pneumococcal polysaccharide vaccine. The total IgG specific antibody concentrations to capsular polysaccharides 1, 3, 5, 6B, 8, and 14 were determined against pre- and 1-month post-vaccination sera. All samples were analyzed according to the second-generation pneumococcal polysaccharide ELISA protocol. We observed that the pneumococcal polysaccharide vaccine evoked consistent antibody increase for serotypes 1, 5, 6B, 8, and 14 (geometric mean concentration increase of 2.46 in the elderly and 2.84 in the young adults). Otherwise, we observed no increase in antibody concentration for serotype 3 in both groups.

Evaluation of diagnostic tests for human leptospirosis

The IgM-PK-ELISA, an enzyme-linked immunosorbent assay for immunoglobulin M employing a proteinase K-treated antigen, and the "Leptoteste-S" macroagglutination test were evaluated for use in a rapid serodiagnosis of human leptospirosis. The microscopic agglutination test (MAT) was used as reference. The three serological tests were applied to serum samples from patients with leptospirosis (N=89), typhoid fever (N=8), malaria (N=19), syphilis (N=20), hepatitis (N=16) and from clinically healthy donors (N=92). The overall results of the IgM-PK-ELISA and the "Leptoteste-S"are comparable to those of the MAT. However, both tests differed statistically from MAT in terms of the positivity of the acute-phase sera, with approximately 38 per cent of the patients with leptospirosis being identified earlier than when MAT was used. The IgM-PK-ELISA, with 89,9 per cent sensitivity and 97,4 per cent specificity, could be the test of choice for those laboratories which are equipped to perform ELISA. The "Leptoteste-S", with 89.9 per cent sensitivity and 94.8 per cent specificity, seems to be easier to perform and the most accessible to peripheral laboratories for rapid screening of human sera. Both techniques present the important characteristic of detecting early antibodies against leptospires, thus providing a diagnosis during the early stages of the disease.

Estudo multicêntrico nacional para avaliação da eficácia e tolerabilidade da nifedipina oros em hipertensão arterial leve a moderada / Multicenter National Study for the evaluation of the efficacy and tolerance of nifedipine oral release osmotic system in mild to moderate hypertension

PURPOSE--Evaluation of the efficacy and tolerability of nifedipine oros in patients with mild to moderate essential hypertension without major target organ damage and the anti-hypertensive effect along the 24 hours. METHODS--Two hundred and three patients were studied. After two weeks placebo running period single dose of nifedipine oros (30 mg/day) was administered for 8 weeks. At the end of the 4th week, the non-responders (diastolic blood pressure > 90 mmHg or reduction in diastolic pressure < 10 mmHg), had the dosage increased to 60 mg/day. Laboratory tests and 24h blood pressure monitoring (60 patients) were performed at the beginning and at the end of the study. RESULTS--One hundred and ninety one patients completed the study. Fifty nine percent were considered responders at the end of the 4th week with nifedipine oros 30 mg/day and 41 needed dosage increment to 60 mg/day. At the end of the 8th week, all patients were considered responders to nifedipine oros. The blood pressure control extended throughout the 24h of the day. The most common adverse events were edema (14.6) and headache (12.4). Good and very good tolerability were informed by 85 of the patients. CONCLUSION--Nifedipine oros was able to control blood pressure efficaciously along the 24h period without important side effects. The possibility of once day dosage, increases the patient adherence to anti-hypertensive therapy.

Search for agglutinating antibodies to Leptospira and Leptospira and Leptonema in horses, Sao Paulo, Brazil

Soros de 922 equinos aparentemente sadios, mantidos na Fazenda do Instituto Butantan (Säo Roque, SP) para produçäo de soros hiperimunes, foram analisados quanto à presença de anticorpos para sorovares de Leptospira interrogans e para Leptonema illini, através da reaçäo de aglutinaçäo microscópica (MA). Entre os 807 (87,5 por cento) animais positivos, 659 (81,7 por cento) reagiram com mais de um sorovar, com títulos entre 1:100 e 1:6.400, havendo predomínio de títulos baixos (<= 1:400), 84 por cento dos soros positivos reagiram com representantes do sorogrupo Icterohaemorrhagiae e 79,2 por cento com Leptonema illini. Dos 23 sorovares utilizados, apenas o tarassovi näo reagiu

O sistema renina angiotensina aldosterona no ciclo gravídico-puerperal normal e na doença hipertensiva própria da gestação / The renin-angiotensin-aldosterone system in the normal gravidopuerperal cycle and in hypertensive disease proper of pregnancy

Os autores consideram os ajustamentos circulatorios e os mecanismos envolvidos na manutencao da homeostase do sodio durante a evolucao da getacao normal como um modelo importante para o estudo do sistema renina-angiotensina-aldosterona.Os componentes do sistema sao analisados, demosntrando-se que os niveis da pressao arterial, durante a gravidez, sao mantidos por alteracoes nas concentracoes plasmaticas de angiotensina II e aldosterona. A enzima conversora de angiotensina (ECA) nao guarda porem uma relacao linear com a atividade de reina plasmatica (ARP) existindo por outro lado, evidencias que demonstram que o equilibrio funcional entre a renina e as angiotensinases deve existir de modo a manter adequeada a concentracao de angiotensina II. A possibilidade de que o complexo utero-placentario contribui para a ARP e enfatizada, demosntrando-se que extratos humanos de placenta tem atividade vasoconstrictora e vasopressora

Os sistemas prostaglandinas e calicreina-cininas no ciclo gravidico-puerperal normal e na doença hipertensiva própria da gravidez / Prostaglandins and kallikrein - kinins systems in normal gravido-puerperal cycle and in hypertensive disease proper to pregnancy

As alterações hemodinâmicas e da função renal que ocorrem durante a gravidez normal, fazem desse período um interessante modelo clinico para o estudo das interações que ocorrem entre os sistemas biológicos responsáveis pela homeostase da pressão arterial e do metabolismo do sódio. Os autores fazem uma revisão sobre os sistemas prostaglandinas e calicreina-cininas, incluindo-se informações básicas sobre as funções de cada um deles, considerando a importância da ação vasodepressora desses sistemas em oposição aos efeitos dos sistemas nervoso adrenérgico e renina-angiotensina-aldosterona durante a gestação normal. Revê-se também a influencia a eles atribuídas a gênese e manutenção dos eventos fisiopatológicos da doença hipertensiva própria da gravidez

Tratamento da hipertensao arterial: estudo comparativo do atenolol + clortalidona versus associacao maleato de timolol - hidroclorotiazida - amilorida. / Treatment of arterial hypertension: comparative study of atenolol + chlorthalidone vs. timolol maleate-hydrochlorthiazide-amiloride association

Foram estudados 30 pacientes portadores de hipertensao arterial com niveis diastolicos entre 100 e 120 mm Hg, divididos em dois grupos: grupo I - 15 pacientes tratados com uma droga unica composta de maleato de timolol, hidroclorotiazida e amilorida; grupo II - 15 pacientes tratados com atenolol + clortalidona. Ambos os grupos foram tratados por um periodo de 10 semanas e, ao fim deste periodo, a pressao diastolica no grupo I - 89,2 +/ 6,2 mm Hg foi significativamente menor que a do grupo II - 99,6 +/- 11 (p< 0,01)

Novo indice ecocardiografico para a avaliacao da obstrucao intraventricular direita na comunicacao interventricular isolada. / A new echocardiographic index for evaluation of right intraventricular obstruction in isolated intraventricular communication

Foram estudados, do ponto de vista ecocardiografico, 30 pacientes portadores de comunicacao interventricular isolada e 28 normais que serviram como controle. Os autores propoem um novo indice ecocardiografico para avaliar o trato de saida do ventriculo direito, permitindo separar os pacientes com obstrucao a este nivel. A correlacao deste indice com o gradiente de pressao intraventricular direita foi significativa (r = 0,84; P<0,001)