Challenges faced by the HIV testing system in low- and middle-income countries

Introduction: Determining the HIV status of some individuals remains challenging due to multidimensional factors such as flaws in diagnostic systems, technological challenges, and viral diversity. This report pinpoints challenges faced by the HIV testing system in Cameroon. Case presentation: A 53-year-old male received a positive HIV result by a rapid testing algorithm in July 2016. Not convinced of his HIV status, he requested additional tests. In February 2017, he received a positive result using ImmunoComb® II HIV 1 & 2 BiSpot and Roche cobas electrochemiluminescence assays. A sample sent to France in April 2017 was positive on the Bio-Rad GenScreen™ HIV 1/2, but serotyping was indeterminate, and viral load was < 20 copies/mL. The Roche electrochemiluminescence immunoassay and INNO-LIA HIV I/II Score were negative for samples collected in 2018. A sample collected in July 2019 and tested with VIDAS® HIV Duo Ultra enzyme-linked fluorescent assay and Geenius™ HIV 1/2 Confirmatory Assay was positive, but negative with Western blot; CD4 count was 1380 cells/mm3 and HIV proviral DNA tested in France was 'target-not-detected'. Some rapid tests were still positive in 2020 and 2021. Serotyping remained indeterminate, and viral load was 'target-not-detected'. There were no self-reported exposure to HIV risk factors, and his wife was HIV-seronegative.Management and outcome: Given that the patient remained asymptomatic with no evidence of viral replication, no antiretroviral therapy was initiated. Conclusion: This case highlights the struggles faced by some individuals in confirming their HIV status and the need to update existing technologies and develop an algorithm for managing exceptional cases.

Choix thérapeutiques des hypertendus et diabétiques en milieu rural: Une étude mixte dans deux zones de santé de l'Est de la République Démocratique du Congo / Therapeutic choices of hypertensive and diabetics in rural areas: A mixed study in two health zones in the East of the Democratic Republic of Congo

Background: One third of patients in the Democratic Republic of Congo (DRC) do not use the formal health system to access healthcare. Aim: In this manuscript we analyse the therapeutic decisions of hypertensive and diabetic patients in rural eastern DRC and the reasons for these decisions. Setting: The study was conduct in two health zones (HZ) in South Kivu (Bagira and Walungu), DRC. Methods: A mixed-methods convergent study was conducted from November 2018 to December 2018. Quantitative data were collected using a questionnaire and qualitative data were collected using focus groups. The quantitative data were analysed using descriptive statistics and a Fischer exact test, while the qualitative data were analysed using thematic analysis. Results: Out of 382 subjects declaring a chronic pathology, hypertensives and diabetics represented 21.5% and 7.9%, respectively. Health facilities were the first therapeutic choice of the chronically affected persons. The alternative therapeutic choices found were the use of prayer rooms, consultation with traditional healers and self-medication. Poverty, ignorance, the pharmaceutical business, and the socio-cultural dimension of the disease are the main causes of alternative therapeutic choices for hypertensives and diabetics. Conclusion: To ensure appropriate care for patients with chronic diseases in rural areas, it is important to establish a bridge of regulated collaboration between the formal and informal health sector.

Damage control resuscitation

The United States Navy originally utilized the concept of damage control to describe the process of prioritizing the critical repairs needed to return a ship safely to shore during a maritime emergency. To pursue a completed repair would detract from the goal of saving the ship. This concept of damage control management in crisis is well suited to the care of the critically ill trauma patient, and has evolved into the standard of care. Damage control resuscitation is not one technique, but, rather, a group of strategies which address the lethal triad of coagulopathy, acidosis, and hypothermia. In this article, we describe this approach to trauma resuscitation and the supporting evidence base.

Sperm agglutinating activity of Saccharomyces cerevisiae and Candida albicans as a potential causative factor of infertility in mice (Mus musculus)

@#<p style="text-align: justify;"><strong>BACKGROUND AND OBJECTIVE:</strong> Vaginal yeast infections in women are usually caused by Candida albicans and, to a lesser extent, by Saccharomyces cerevisiae. Studies on C. albicans have shown that it can cause sperm agglutination which can lead to lowered fertility. This study was conducted to compare the effect of S. cerevisiae and C. albicans on the fertility of ICR mouse (Mus musculus) through sperm agglutination.</p><p style="text-align: justify;"><strong>METHODOLOGY:</strong> Sperm agglutinating activity was examined by mixing different concentrations of S. cerevisiae (10, 10°, and 10 CFU/mL) and C. albicans (10", 10°, and 10 CFU/mL) separately with semen from male mice of ICR strain. Determination of the effect of S. cerevisiae and C. albicans on the fertility outcome of female mice was done by intravaginal inoculation of 20 uL of 104, 106, and 108 CFU/ml of the two yeast organisms and later allowed to mate.</p><p style="text-align: justify;"><strong>RESULTS AND CONCLUSION:</strong> The study showed a statistically significantly higher percent sperm agglutination by S. cerevisiae than C. albicans at 10* CFU/ml but no difference was observed at 10° and 10 CFU/ml. No significant difference was observed in the number of sperm per agglutinate between the two yeast species at a=0.05. The concentration that exhibited the highest percentage of agglutinated sperm is 10° CFU/mL for both yeast. The most frequent type of agglutination observed in S. cerevisiae is the mixed type, while head-to-head type is most frequent in C. albicans. Both yeasts were able to cause a decline in the number of births in mice starting at 10 CFU/ml. While sperm agglutination could be one of the reasons for the infertility observed in mice, there may be other processes, mechanisms, and/or activities that could contribute to such an outcome.</p>

A Brazilian Portuguese cross-cultural adaptation of the modified JOA scale for myelopathy

OBJECTIVES: To develop a version of the modified Japanese Orthopaedic Association (mJOA) scale that had been translated into Portuguese and cross-culturally adapted for the Brazilian population. METHODS: The well-established process of forward-backward translation was employed along with cross-cultural adaptation. RESULTS: Three bilingual translators (English and native Portuguese) performed the forward translation of the mJOA scale from English to Portuguese based on iterative discussions used to reach a consensus translation. The translated version of the mJOA scale was then back-translated into English by a native English-speaking translator unaware of the concepts involved with the mJOA scale. The original mJOA scale and the back-translated version were compared by a native North American neurosurgeon, and as they were considered equivalent, the final version of the mJOA scale that had been translated into Portuguese and cross-culturally adapted was defined. CONCLUSION: To facilitate global and cross-cultural comparisons of the severity of cervical myelopathy, this study presents a version of the mJOA scale that was translated into Portuguese and cross-culturally adapted for the Brazilian population.

Effects of habitat management on different feeding guilds of herbivorous insects in cacao agroforestry systems / Efecto del manejo de hábitat en diferentes gremios alimentarios de insectos herbívoros en sistemas agroforestales de cacao

AbstractHuman pressure on natural habitats increases the importance of agroforests for biodiversity conservation. The objective of this study was to evaluate the role of cacao traditional cultivation system (CTCS) on the conservation of the herbivorous insect community when compared with a monodominant rubber agroforest, a type of agricultural system for cacao cultivation. The insects were sampled in three habitats in Southeastern Bahia, Brazil: native forests, CTCS and rubber agroforests. In each habitat, 18 plots of 10 m2 were established, and the structural measures were collected and herbivorous insects were sampled with a Malaise/window trap. The diversity of folivorous decreased with the simplification of vegetation structure, but species composition was similar among habitats. In addition to a decrease in the availability of resources in monodominant rubber agroforests, the latex present in these systems have limited the occurrence of species that cannot circumvent latex toxicity. The diversity of sap-sucking insects was similar among habitats, but species composition was similar only in the CTCS and native forest, and it was different in the rubber agroforest. We observed turnover and a higher frequency of individuals of the family Psyllidae in the rubber agroforest. The biology and behavior of Psyllids and absence of natural enemies enable their diversity to increase when they are adapted to a new host. We observed a shift in the composition of xylophagous insects in the rubber agroforest compared to that in other habitats. Moreover, this agroforest has low species richness, but high individual abundance. Latex extraction is likely an important additional source of volatile compounds discharged into the environment, and it increases the attraction and recruitment of coleoborers to these sites. We concluded that CTCS has an herbivorous insect community with a structure similar to the community found in native forests of the region, and they present a more interesting conservation strategy when compared to rubber agroforests. We also emphasized the potential risk of local pest outbreaks in rubber agroforests for both the rubber and associated cacao trees. Rev. Biol. Trop. 64 (2): 763-777. Epub 2016 June 01.

ResumenLa presión humana sobre los hábitats naturales aumenta la importancia de los sistemas agroforestales para la conservación de la biodiversidad. El objetivo de este estudio fue evaluar el papel del sistema tradicional de cultivo de cacao en la conservación de la comunidad de insectos herbívoros en comparación con el agrobosque monodominante de caucho, un tipo de sistema agrícola para el cultivo de cacao. Los insectos fueron muestreados en tres hábitats en el sureste de Bahia, Brasil: bosque nativo, sistema tradicional de cultivo de cacao y agrobosque de caucho. En cada hábitat, se establecieron 18 parcelas de 10 m2, se tomaron medidas estructurales y se muestrearon los insectos herbívoros con una trampa tipo Malaise. La diversidad de folívoros disminuyó con la simplificación de la estructura de la vegetación, pero la composición de especies fue similar entre hábitats. Además se presentó una disminución de la disponibilidad de recursos en agrobosques de caucho, el látex presente en estos sistemas han limitado la aparición de especies que no pueden evadir la toxicidad de látex. La diversidad de insectos chupadores de savia fue similar entre los hábitats, pero la composición de especies fue similar sólo en el sistema tradicional de cultivo de cacao y el bosque nativo, y diferente en el agrobosque de caucho. Hemos observado que hay una mayor frecuencia de individuos de la familia Psyllidae en el agrobosque de caucho. La biología y el comportamiento de los psílidos y ausencia de enemigos naturales permiten que su diversidad aumente cuando se adaptan a un nuevo huésped. Hemos observado un cambio en la composición de los insectos xilófagos en el agrobosque de caucho en comparación con la de otros hábitats. Por otra parte, este agrobosque tiene una baja riqueza de especies, pero gran abundancia individual. La extracción de látex probablemente es una fuente adicional importante de compuestos volátiles que son vertidos en el ambiente, y aumenta la atracción y el reclutamiento de curculiónidos en estos sitios. Hemos llegado a la conclusión de que el sistema tradicional de cultivo de cacao tiene una comunidad de insectos herbívoros con una estructura similar a la comunidad que se encuentra en los bosques nativos de la región, y presenta una estrategia de conservación más interesante si se compara con los sistemas agroforestales de caucho. También hicimos hincapié en el riesgo potencial de aparición de plagas locales en sistemas agroforestales de caucho, tanto para el caucho como para los árboles de cacao asociados.

Análise combinada de casos homeopáticos de alta qualidade / Combined analysis of high-quality homeopathic cases

Um protocolo para Relato de Casos Clínicos Homeopáticos de Alta Qualidade (RCCHAQ) foi desenvolvido por C.N. Cámpora, tendo coerência interna como critério principal, além de categorizar a documentação clínico-patológica que fundamenta o diagnóstico e a pretensão de sucesso terapêutico. A análise conjunta de 4 estudos, no presente trabalho, permitiu elucidar como RCCHAQs podem ser utilizados para avaliar os efeitos da homeopatia hahnemanniana clássica em doenças crônicas de longa evolução. Todos os casos foram tratados de acordo com o método desenvolvido por Cámpora, denominado Fórmula Homeopática de Diagnóstico do Simillimum (FHDS). A duração média das queixas antes d tratamento homeopático foi de 5,4 anos e os casos foram acompanhados por 3 anos em média. Os casos estão completamente documentados em vídeo, atestados assinados, registros de testemunhas, resultados laboratoriais e escalas de dor e qualidade de vida. Todas as pacientes relataram mudanças substanciais, definidas como cura (melhora de mais de 90%) dos sintomas locais, gerais e mentais acompanhando uma profunda transformação de sua atitude vital, descrita como uma sensação de paz, liberdade ou felicidade, segundo a definição do Banco de Relato e Estudo de Casos Homeopáticos de Argentina (BRECHA]. Em todos os casos a medicação convencional prévia foi suspensa num período de 1 a 3 meses. Os resultados mostram que RCCHAQs contribuem a tornar os relatos de cais um recurso confiável no contexto da moderna medicina baseada em evidências, assim como podem ajudar a melhorar o desenho de estudos homeopáticos prospectivos, incluindo ensaios clínicos placebo-controlados.

A High Quality Homeopathic Clinical Case Report (HHQCR) Protocol exhaustively including requisites to constitute a reliable documented clinical report was developed by C.N. Cámpora. The protocol requires measuring homeopathic internal coherence and categorizes clinicalpathological backing documentation. Through joint analysis of 4 cases the present study elucidates how HHQCRs can be used to assess the effects of classical Hahnemannian homeopathy on longstanding chronic diseases. The mean duration of complaints before homeopathic treatment was 5.4 years and the duration of follow up 3 years on average. Cases are fully documented with complete video-recordings of consultations, signed certifications, third party recorded statements, laboratory results and pre-post treatment pain and quality-of-life scales. All the patients reported substantial change, defined as cure (>90% improvement) of local, general and mental symptoms accompanying a deep transformation their life attitude described as a feeling of peace, freedom or happiness. Also all of them were able to discontinue previous conventional treatment within the first 1 to 3 months of homeopathic treatment. The results show that HHQCRs contributes to make case reports a reliable resource within the context of modern evidence-based medicine and might help improving the design of prospective homeopathic studies, including randomized placebo-controlled trials.

In vitro Anti-plasmodial Activity of Rubia cordifolia, Harrizonia abyssinica, Leucas calostachys Olive and Sanchus schweinfurthii Medicinal Plants.

Plasmodium falciparum is becoming increasingly resistant to conventional antimalaria drugs. Rapid increase of parasite resistant strains, resistance of the vector to insecticides and the difficulty in creating efficient vaccines has lead to an urgent need for new anti-malarial drugs. To determine anti-plasmodial activity of Rubia cordifolia, Harrizonia abyssinica, Sachus schweinfurthii and Leucas calostachys Olive plants. Aqueous and methanolic crude extracts were prepared from R. cordifolia, H. abyssinica, S. schweinfurthii and L. calostachys plants. The extracts were then prepared into appropriate concentrations for anti-plasmodial activities. In vitro anti-plamsodial activities of herbal drugs were analysed according to the methods of Tona et al., 1999. Methanolic extracts were more efficacious than aqueous extracts. S. schweinfurthii and L. calostachys had IC50 (Inhibition Concentration) of between 1.10μg/ml and 3.45μg/ml and had highest parasite inhibition ranging between 3.5% and 5.2%. R. cardifolia and H. abyssinica had IC50 of between 1.5μg/ml and 3.0μg/ml and it had moderate parasitaemia ranging between 5.20% and 7.22%. Vernonia lasiopa and Erythrina abysinnica had insufficient yields. S. schweinfurthii and L. calostachys had the highest parasite inhibition while R. cardifolia and H. abyssinica had moderate inhibition.

Avaliação da sensibilidade e especificidade dos exames não invasivos no diagnóstico da estenose de artéria renal / Analysis of the sensitivity and specificity of noninvasive imaging tests for the diagnosis of renal artery stenosis

FUNDAMENTO: O envelhecimento e a aterosclerose estão relacionados à hipertensão renovascular em indivíduos idosos. Independentemente das comorbidades, a estenose de artéria renal é, por si só, importante causa de morbidade e mortalidade cardiovascular. OBJETIVO: Definir a sensibilidade, a especificidade, o valor preditivo positivo e o valor preditivo negativo dos exames não invasivos utilizados no diagnóstico de estenose da artéria renal. MÉTODOS: Um grupo de 61 pacientes recrutados permitiram a análise de 122 artérias e a definição de sensibilidade, especificidade e da contribuição relativa de cada exame realizado (Doppler, cintilografia e angiotomografia, comparados a arteriografia renal). RESULTADOS: A média das idades foi de 65,43 (desvio padrão: 8,7) anos. Das variáveis relacionadas à população do estudo e comparadas à arteriografia, duas estiveram correlacionadas à estenose da artéria renal, à disfunção renal e aos triglicerídeos. A mediana do ritmo de filtração glomerular foi de 52,8 mL/min/m². O Doppler identificou sensibilidade de 82,90%, especificidade de 70%, valor preditivo positivo de 85% e valor preditivo negativo de 66,70%. Para a tomografia, encontraram-se sensibilidade de 66,70%, especificidade de 80%, valor preditivo positivo de 87,50% e valor preditivo negativo de 55,20%. Esses achados permitiram identificar os exames que melhor detectavam a estenose. CONCLUSÃO: A tomografia e o Doppler mostraram qualidade e grande possibilidade no diagnóstico de estenose da artéria renal, com vantagem para o segundo, pois não há necessidade do uso de meio de contraste na avaliação de uma doença que, frequentemente, ocorre em diabéticos e associa-se à disfunção renal e à disfunção ventricular esquerda grave.

BACKGROUND: Aging and atherosclerosis are related to renovascular hypertension in elderly individuals. Regardless of comorbidities, renal artery stenosis is itself an important cause of cardiovascular morbidity and mortality. OBJECTIVE: To define the sensitivity, specificity, positive predictive value, and negative predictive value of noninvasive imaging tests used in the diagnosis of renal artery stenosis. METHODS: In a group of 61 patients recruited, 122 arteries were analized, thus permitting the definition of sensitivity, specificity, and the relative contribution of each imaging study performed (Doppler, scintigraphy and computed tomographic angiography in comparison to renal arteriography). RESULTS: The mean age was 65.43 years (standard deviation: 8.7). Of the variables related to the study population that were compared to arteriography, two correlated with renal artery stenosis, renal dysfunction and triglycerides. The median glomerular filtration rate was 52.8 mL/min/m². Doppler showed sensitivity of 82.90%, specificity of 70%, a positive predictive value of 85% and negative predictive value of 66.70%. For tomography, sensitivity was 66.70%, specificity 80%, positive predictive value 87.50% and negative predictive value 55.20%. With these findings, we could identify the imaging tests that best detected stenosis. CONCLUSION: Tomography and Doppler showed good quality and efficacy in the diagnosis of renal artery stenosis, with Doppler having the advantage of not requiring the use of contrast medium for the assessment of a disease that is common in diabetics and is associated with renal dysfunction and severe left ventricular dysfunction.

Surtos de infecção por Piscinoodinium pillulare e Henneguya spp. em pacus (Piaractus mesopotamicus) criados intensivamente no Sudoeste de Goiás / Outbreaks of Piscinoodinium pillulare and Henneguya spp. infection in intensively raised Piaractus mesopotamicus in Southwestern Goiás, Brazil

Três surtos de infecção por Piscinoodinium pillulare e Henneguya spp. em Piaractus mesopotamicus criados intensivamente no Sudoeste de Goiás são descritos. Dois surtos ocorreram no inverno e um no verão. As taxas de morbidade (58,57%-90%) e mortalidade (100%) foram determinadas. Episódios de estresse ocorreram previamente em todos os casos. Sinais clínicos incluíam mudanças comportamentais e movimentos erráticos com perda de equilíbrio. Os principais achados macroscópicos foram tumefação das brânquias com exsudato mucoso esbranquiçado. Microscopicamente, as brânquias apresentaram inflamação linfoplasmocítica e necrosante, multifocal, leve a moderada, com hipertrofia e fusão de lamelas secundárias. Adicionalmente, numerosos trofontes intralesionais de P. pillulare e cistos de Henneguya spp. foram notados. Para o conhecimento dos autores, essa parece ser a primeira descrição de infecção por P. pillulare e Henneguya spp. em peixes criados no Sudoeste de Goiás.

Three outbreaks of infection by Piscinoodinium pillulare and Henneguya spp. in Piarac tus mesopotamicus intensively raised in Southwestern Goiás, Brazil, are described. Two outbreaks occurred in the winter and another one in summer. Morbidity (58.57%-90%) and mortality (100%) rates were determined. Stress episodes occurred previously in all cases. Clinical signs included behavior changes and erratic movements with loss of equilibrium. Main gross findings were swelling of the gills with white mucus exudate. Microscopically, gills had mild to moderate multifocal necrotizing and lympho-plasmocytic inflammation with hypertrophy and fusion of secondary lamellae. In addition, numerous intralesional trophonts of P. pillulare and cysts of Henneguya spp. were noted. According to our knowledge, this seems to be the first description of Piscinoodinium pillulare e Henneguya spp. infection in fishes reared in Southwestern Goiás, Brazil.

Influência dos sintomas pré-procedimentos na evolução hospitalar e tardia das angioplastias carotídeas com implante de stent e sistemas de proteção cerebral / Influence of symptoms pre-procedure in hospital and late evolution of carotid angioplasty with stent implantation and cerebral protection systems

Introdução: A doença carotídea aterosclerótica (DCA) é responsável por 40 por cento dos acidentes vasculares cerebrais (AVC). Apesar de a intervenção carotídea percutânea (ICP) ser uma alternativa à endarterectomia, ainha há poucos dados disponíveis comparando a ICP em pacientes assintomáticos (PAS) versus sintomáticos (PS). O objetivo desta análise foi avaliar essa questão em um grupo consecutivo de pacientes. Métodos: Foram realizadas 262 ICP em 230 pacientes consecutivos, 61 (26,5 por cento) PAS versus 169 (73,5 por cento) PS. A angioplastia carotídea quantitativa (ACQ) foi realizada pré e pós-procedimento e o seguimento clínico, na fase hospitalar e aos 6 e 12 meses. Resultados: As características demográficas foram similares entre os dois grupos, sendo 31 por cento diabéticos. Obtivemos sucesso primário em 100 por cento dos casos, com ausência de complicações maiores em ambos os grupos. Na análise com ACQ, o diâmetro de estenose foi maior no grupo PAS (83,4 maior ou menos 7,6 por cento vs. 74,9 mais ou menos 12,5 por cento; p menor 0,01), mas o grupo PS apresentou lesões mais longas (18,3 mais ou menos 5,7 por cento vs. 21,7 mais ou menos 7,4 por cento; p menor 0,01). Aos 30 dias não houve diferença na incidência de AVC maior...

Background: Carotid atherosclerotic disease (CAD) is responsible for 40% of strokes. Despite percutaneous carotid intervention (PCI) is an alternative to endarterectomy, there is little data available comparing the PCI in asymptomatic vs. symptomatic patients. The purpose of this analysis was to evaluate this issue in a consecutive group of cases. Methods: 262 PCIs were conducted on 230 consecutive patients, 61 (26.5%) in asymptomatic vs. 169 (73.5%) in symptomatic patients. Quantitative carotid angiography (QCA) was performed before and after the procedure and the clinical follow-up obtained in-hospital and at 6 and 12 months. Results: The demographic characteristics were similar between groups; 31% were diabetics. Primary success was obtained in all cases, with no major complications in both groups. QCA analysis revealed a higher diameter stenosis in asymptomatics (83.4% ± 7.6% vs. 74.9% ± 12.5%; p < 0.01), but symptomatic patients had longer lesions (18.3% ± 5.7% vs. 21.7% ± 7.4%; p < 0.01). At 30 days there was no difference in the incidence of major (1.8% vs. 2.0%; p = 0.45) or minor strokes (0 vs. 1.4%; p = 0.19) for both groups. Between 1 and 12 months there have been no additional strokes. A late target vessel revascularization was observed in symptomatic patients but no neurologic deaths in both groups. Conclusion: PCI is safe and effective, with low incidence of complications at 1 and 12 months. The incidence of death, stroke and target vessel revascularization was similar between groups.

Terapia de recanalização endovascular de oclusão da artéria carótida em paciente com acidente vascular cerebral agudo / Percutaneous recanalization of carotid artery occlusion in patient with and acute stroke

Relatamos o caso de uma paciente de 69 anos, que, após a realização de arteriografia carotídea apresentou trombose sintomática da bifurcação carotídea. A paciente foi submetida imediatamente a reperfusão endovascular mecânica, com implante bem-sucedido de stent carotídeo, obtendo reversão completa do déficit neurológivo.

A 69 year-old woman developed symptomatic internal carotid artery thrombosis after carotid angiography. She was immediately submitted to mechanical endovascular reperfusion with successful carotid stent implantation and complete neurological recovery.

Reliability of the Social Phobia and Anxiety Inventory (SPAI) Portuguese version in a heterogeneous sample of Brazilian university students

OBJETIVO: Avaliar consistência interna e estabilidade temporal, através de fidedignidade teste-reteste, da versão em português do Inventário de Ansiedade e Fobia Social (SPAI), em uma amostra brasileira heterogênea. MÉTODOS: Após consentimento informado, a versão traduzida e adaptada para o português do SPAI foi testada e re-testada, com 14 dias de intervalo, em uma amostra de 225 estudantes universitários de ambos os gêneros, de quatro cursos de graduação. Após dupla entrada de dados, a análise estatística incluiu Alfa de Cronbach e os coeficientes de correlação de Pearson e Intra-classe. RESULTADOS: A amostra estudada consistiu de 213 estudantes de quatro sub-amostras: 95 estudantes de Direito, 31 de Comunicação Social, 54 de Engenharia Civil e 33 de Odontologia. A média de idade foi de 23 anos (± 6) e 110 (51,6%) eram do gênero feminino. O Alpha de Cronbach foi de 0,96, sem diferenças entre os gêneros. O escore diferencial (total) do SPAI português apresentou coeficiente de Pearson de 0,83 (IC95% 0,78-0,87) e coeficiente Intra-classe de 0,83 (IC95% 0,78-0,86). Não houve diferença estatística nos coeficientes de Pearson entre os gêneros (p = 0,121) ou entre as quatro sub-amostras (p = 0,258). CONCLUSAO: Os resultados não asseguram validade; a versão do SPAI português apresentou boa homogeneidade de conteúdo com nível satisfatório consistência interna. A estabilidade temporal avaliada foi consistente. Os dados demonstram que o SPAI português apresenta fidedignidade perfeitamente aceitável para ambos os gêneros e sugerem sua utilização na população brasileira.

Resultados imediatos e de seguimento a médio prazo da valvoplastia com cateter balão para estenose aórtica congênita / Short- and midterm follow-up results of valvuloplasty with balloon catheter for congenital aortic stenosis

OBJECTIVE: To report short and midtem follow-up results of balloon aortic valvuloplasty to treat congenital aortic stenosis. METHODS: Seventy-five patients (median age: 8 years) underwent the procedure through the retrograde femoral or carotid route. RESULTS: The procedure was completed in 74 patients (98.6 percent). The peak-to-peak systolic gradient dropped from 79.6±27.7 to 22.3±17.8 mmHg (P<0.001), the left ventricular systolic pressure dropped from 164±39.1 to 110±24.8 mmHg (P<0.001), and the left ventricular end diastolic pressure dropped from 13.3±5.5 to 8.5±8.3 mmHg (P< 0.01). Four patients (5.3 percent) died due to the procedure. Aortic regurgitation (AoR) appeared or worsened in 27/71 (38 percent) patients, and no immediate surgical intervention was required. A mean follow-up of 50±38 months was obtained in 37 patients. Restenosis and significant AoR were observed in 16.6 percent of the patients. The estimates for being restenosis-free and for having significant AoR in 90 months were 60 percent and 50 percent, respectively. CONCLUSION: Aortic valvuloplasty was considered the initial palliative method of choice in managing congenital aortic stenosis, with satisfactory short- and midterm results

Eletroneuromiografia em neuropatia: falso-positividade diagnóstica por erro de calibraçäo / Electroneuromyography in neuropathy: diagnostic false positivity for calibration error

No presente estudo, valores da latência de conduçäo motora foram avaliados em vinte e três pacientes em um total de vinte e nove nervos, usando diferentes calibraçöes (1mV/2ms por divisäo e 5mV/2ms por divisäo) em um ponto distal e outro proximal de um mesmo nervo.O objetivo do trabalho foi comparar os valores de latências obtidos com as duas calibraçöes distintas e estabelecer a possibilidade de um erro diagnóstico induzido pela escolha do parâmetro usado. Os resultados mostram diferenças significativas entre os valores obtidos com as calibraçöes de 1mV e5mV por divisäo, acima de 12 por cento. Uma alternativa de cálculo foi a velocidade de conduçäo motora feita com duas calibraçöes diferentes

The role of nitric oxide (NO) in control of hypothalamic-pituitary function

Neurons containing neural nitric oxide synthase (nNOS) are found in various locations in the hypothalamus and, in particular, in the paraventricular and supraoptic nuclei with axons which project to the median eminence and extend into the neural lobe where the highest concentrations of NOS are found in the rat. Furthermore, nNOS is also located in folliculostellate cells and LH gonadotropes in the anterior pituitary gland. To define the role of NO in the release of hypothalamic peptides and pituitary hormones, we inected an inhibitor of NOS, Ng- monomethyl-L-arginine (NMMA) or a releasor of NO, nitroprusside (NP) into the third ventricle (3V) of conscious castrate rats and determined the effect on the release of various pituitary hormones. In vitro, we incubated medial basal hypothalamic (MBH) fragments and studied inhibitors of NO synthase and also releasors of NO. The results indicate that NOergic neurons play an important role in stimulating the release of corticotrophin-releasing hormone (CRH), luteinizing hormone releasing-hormone (LHRH), prolactin-RH's, particularly oxytocin, growth hormone-RH (GHRH) and somatostatin, but not FSH-releasing factor from the hypothalamus. NO stimulates the release of LHRH, which induces sexual behavior, and causes release of LH from the pituitary gland. The intrahypothalamic pathway by which NO controls LHRH release is as follows: glutamergic neurons synapse with noradrenergic terminals in the MBH which release nonepinephrine (NE) that acts on alpha1 receptors on the NOergic neuron to increase intracellular free Ca++ which combines with calmodulin to activate NOS. The NOS diffuses to the LHRH terminal and activates guanylate cyclase (GC), cyclooxygenase and lipoxygenase causing release of LHRH via release of cyclic GMP, PGE2 and leukotrienes, respectively. Alcohol and cytokines can block LHRH release by blocking the activation of cyclooxygenase and lipoxygenase without interfering with the activation of GC. GABA also blocks the response of the LHRH neurons to NO and recent experiments indicate that granulocyte macrophage colony-stimulating factor (GMCSF) blocks the response of the LHRH neuron to NP by activation of GABA neurons since the blockase can be reversed by the competitive inhibitor of GABAa receptors, bicuculine.

Posto de saúde do Jardim Leonor-Plantäo 24 horas: da atuaçäo real à ideal / Jardim Leonor Health Center: 24 hours: from reality to ideal

O trabalho se propöe a identificar entre elementos daárea da saúde os objetivos de um centro de saúde com seus serviços e profissionais, pesquisar junto a populaçäo suas necessidades em relaçäo ao centro de saúdee questionar a resolutividade e qualidade do serviço prestado. Foram entrevistados profissionais e pacientes que frequentavam o centro antes de sua transformaçäo para 24 horas e pacientes que continuam frequentando. Foi eleito o atendimento primário da atividade a ser priorizada e pesquisas apontaram falhas no sistema como: falta de funcionários, medicamentos e demora no atendimento

Severe scorpion envenomation in Brazil: clinical laboratory and anatomopathological aspects

Os acidentes escorpionicos no Brasil, assumem grande importancia nao so pela sua incidencia como pela sua potencialidade em induzir quadros clinicos graves, muitas vezes fatais, principalmente em criancas. Apresentamos neste relato os dados clinicos e laboratoriais de 4 pacientes vitimas de escorpionismo, causado pelo T. serrulatus, que evoluiram com falencia cardiaca e edema pulmonar, sendo que tres foram a obito dentro das primeiras 24 horas apos acidente...