Effects of long-lasting insecticidal nets and zooprophylaxis on mosquito feeding behaviour and density in Mwea, central Kenya.

Background & objectives: Zooprophylaxis is a strategy that can control malaria by attracting mosquitoes to domestic animals that act as dead-end hosts. The objective of this study was to establish the effects of zooprophylaxis and long-lasting insecticidal nets (LLINs) on malaria transmission in an agro-based ecosystem with seasonal transmission. Methods: The mosquito samples were collected indoors using the space spray catch method before and after intervention between October 2005 and March 2006 to determine the mosquito densities and the feeding patterns of Anopheles spp in Mwea, Kenya. Results: A total of 4148 mosquito samples were collected, out of which 11 (0.2%) were tested positive for sporozoites. Ten were Anopheles gambiae species and one was An. funestus species. Results on blood meal ELISA showed that in the household categories that used bednets and kept one cow there was a decrease in relative change ratio (post-/pre-intervention) of 87.5 and 19.6% (p <0.05) in human and cattle blood intake respectively. For households that kept 2–4 cattle and used bednets, there was a decrease in cattle blood index (CBI) by 61.9% and an increase in human blood index (HBI) by 2%, which was not significant (p >0.05). In households with >4 cattle and bednet, there was significant reduction (p <0.05) in CBI of 37.5% as compared to the reduction of 10.3% in HBI. The ratios of man biting rates (MBR) decreased significantly, as you move up from households with one cattle with or without LLINs to households with more than four cattle with or without LLINs with a regression coefficient of –0.96; SE = 0.834; p = 0.017. Similarly, the HBI decreased significantly with the regression coefficient of 0.239; SE = 0.039; p = 0.015 (p <0.05) especially in households with >4 cattle. Interpretation & conclusion: This study demonstrated that there were additive effects of zooprophylaxis and LLINs in the control of mosquito density and reduction of human risk to the mosquito bites. However, in Integrated Vector Management (IVM), the number of animals per household should not be more than four.

TNF-a and IL-10 levels in tracheobronchial lavage of ventilated preterm infants and subsequent lung function

The role of airway inflammation in ventilated preterm newborns and the risk factors associated with the development of chronic lung disease are not well understood. Our objective was to analyze the association of the airway inflammatory response in ventilated preterm infants by serial measurements of TNF-a and IL-10 in tracheobronchial lavage (TBL) with perinatal factors and lung function measured early in life. A series of TBL samples were collected from ventilated preterm infants (less than 32 weeks of gestational age) and concentrations of TNF-a and IL-10 were measured by ELISA. Pulmonary function tests were performed after discharge by the raised volume rapid compression technique. Twenty-five subjects were recruited and 70 TBL samples were obtained. There was a significant positive association between TNF-a and IL-10 levels and length of time between the rupture of the amniotic membranes and delivery (r = 0.65, P = 0.002, and r = 0.57, P < 0.001, respectively). Lung function was measured between 1 and 22 weeks of corrected age in 10 patients. Multivariable analysis with adjustment for differences in lung volume showed a significant negative association between TNF-a levels and forced expiratory flow (FEF50; r = -0.6; P = 0.04), FEF75 (r = -0.76; P = 0.02), FEF85 (r = -0.75; P = 0.03), FEF25-75 (-0.71; P = 0.02), and FEV0.5 (r = -0.39; P = 0.03). These data suggest that TNF-a levels in the airways during the first days of life were associated with subsequent lung function abnormalities measured weeks or months later.

Avaliação e acompanhamento psicológico em pacientes submetidos à cirurgia plástica / Psychological evaluatio and follow-up of patients submitted to plastic surgery

São apresentados alguns aspectos, fruto de um trabalho de 21 anos, que consideramos importantes na avaliação e no acompanhamento psicológico de pacientes que se submetem à cirurgia plástica. Abordamos a construção do vínculo, a compreensão e a discriminação entre narcisismo saudável e patológico e a abordagem da família no processo cirúrgico

Th-1 and Th-2 cytokine production in infants with virus-associated wheezing

Wheezing associated with respiratory viral infections in infancy is very common and results in high morbidity worldwide. The Th1/Th2 pattern of immune response in these patients remains unclear and previous studies have shown controversial results. The aim of the present study was to compare the type of Th1/Th2 cytokine response between infants with acute bronchiolitis, recurrent wheezing and upper respiratory infections from a developing country. Infants younger than 2 years of age admitted to Hospital São Lucas, Porto Alegre, RS, Brazil, between May and November 2001, with an acute episode of wheezing associated with viral respiratory infection were selected. Subjects with upper respiratory infections from the emergency department were selected for the control group. Interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) levels from nasal aspirates were determined by ELISA from peripheral mononuclear cell cultures. Twenty-nine subjects with acute bronchiolitis, 18 with recurrent wheezing and 15 with upper respiratory infections were enrolled. There were no differences in family history of atopy or parental smoking between groups. Oxygen requirement was similar for the acute bronchiolitis and recurrent wheezing groups. The percentage of positive tests for the cytokines studied and the IFN-gamma/IL-4 ratio was similar for all groups. Comparison of the polarized Th1/Th2 cytokine results for the various groups showed no specific pattern of cytokine production. Infants with wheezing from a developing country do not show any specific predominant pattern of Th1/Th2 cytokine production, suggesting that multiple factors may be involved in the pathogenesis of this illness.

Sindrome de mobius por lesiones de tronco cerebral en un lactante con defectos congénitos multiples. Hallazgos neuropatológicos / Mobius syndrome due to brain stem damage in a milk-fed baby with multiple congenital defects. Neuropathological findings

Se presenta un caso de síndrome de mobius caracterizado clínicamente por parálisis facial y paresia del velo del paladar y cuerdas vocales del lado derecho, congénitos, asociados a hipoplasia ósea de la hemicara derecha y trastornos de conducción cardíacos (bloqueo de rama derecha y hemibloqueo anterior izquierdo). El estudio neuropatológico reveló una hipoplasia del hemibulbo y hemiprotuberancia derechos con ausencia de los núcleos del facial y del núcleo ambiguo. Se halló además ausencia del 1er. par, hipoplasia del núcleo del 6to. derecho y ausencia del núcleo del fasículo solitario. En el corazón se encontró una comunicación tipo ostium primun y anormalidades microscópicas del haz de his y sus ramas. El conjunto malformativo sugiere el efecto de una noxa que actuó entre la 5ta. y 6ta. semanas de edad gestacional (aproximadamente día 38 de la gestación), indicando una patogenia disruptiva para este caso. La revisión de la literatura reveló que si bien el síndrome de mobius puede tener además otras etiologías (genética esporádica, genética familiar, hipóxica periparto) su estudio neuroanatómico no es un hecho muy frecuente.

Necrosis cerebral masiva en el recién nacido / Massive cerebral necrosis in the newborn infant

Se presenta el resultado del estudio neuropatológico del sistema nervioso central de 6 recién-nacidos con necrosis cerebral masiva y su correlación clínico-patológica. Dos pacientes fallecieron dentro de la primera semana de vida. El cerebro de éstos se presentó como una masa edematosa sumamente friable, con necrosis difusa. En los otros 4, de mayor sobrevida, se halló una lesión de necrosis córtico-subcortical microcavitada (en "encaje" o "tela de araña") con astrocitosis reactiva, indicando una evolución del proceso anterior. También se hallaron zonas de hemorragia. Las causas de la hipoxia-isquemia fueron placentarias, obstétricas, pulmonares, maternas y médicas. Frecuentemente varias de éstas aparecieron combinadas. La semiología clínica y los datos humorales al ingreso fueron casi siempre claros indicadores de la severa y extensa alteración cerebral, a pesar de lo cual varios casos fueron mantenidos con "vida". Este estudio sugiere que deberían establecerse actitudes clínicas de tratamiento en los casos en que se realice el diagnóstico de muerte cerebral en este período de vida