Comparative study of ethical problems on national board exams in Japan for healthcare professions - specific examples of physicians, pharmacists, and speech therapists.

Background: In medical practice, a team approach becomes more important, so a shared awareness of the ethical viewpoint is demanded. Aims & Objective: The present study was conducted to clarify problem points in the evaluation of ethical awareness of medical specialists via the national exams. Material and Methods: This study focused on national board exams for physicians, pharmacists, and speech therapists (STs), specifically targeting the problems posed to exam takers by the 2007 national exams in Japan. Seven researchers first extracted from the exams what were referred to as “ethical problems,” and then they categorized these problems by forms and contents. Results: The percentages of ethical problems were 5.8% for the physicians’ exam, 3.8% for the pharmacists’ exam, and 1.0% for the STs’ exam. The results showed that the exams for physicians, compared to other specialists, contained a greater number of ethical problems and the proportion of ethical problems is also relatively large for the physicians’ exam. Moreover, in terms of taxonomy, problems posed to physicians not only elicited acquired knowledge but also required the exam taker to make decisions about specific cases. These ethical problems vary in forms and contents among the three exams. Conclusion: The results suggest that standardized criteria are necessary for national exams to raise a shared awareness of the ethical viewpoint among medical specialists.

Resposta imune humoral na paracoccidioidomicose experimental em camundongos ddY / Humoral immune response in experimental ddY mice paracoccidioidomycosis

A paracoccidioidomicose (PCM) é uma micose sistêmica, restrita à América Latina, com maior incidência noBrasil. O camundongo ddY tem sido empregado como modelo murino de PCM e, no entanto, não há informaçõesa respeito da resposta imune desse animal frente à infecção. O presente estudo tem como objetivo avaliar aresposta imune humoral específica para o principal antígeno, gp43, do fungo Paracoccidioides brasiliensis,em camundongos ddY infectados com a cepa virulenta Pb 18. Foram realizadas análises da antigenemia ehistopatológico em vários órgãos e em diferentes tempos pós-infecção. Os resultados obtidos demonstraramaumento nos níveis de IgG anti-gp43 nos dias 14, 17, 21, 24, 28 e 56 pós-infecção e aumento no nível de gp43solúvel aos 28 dias pós-infecção. As células fúngicas foram detectadas em todos os órgãos analisados(cérebro, coração, pulmão, fígado, baço e rim) e em todos os períodos. As lesões granulomatosas tornaramsepredominantes 14 dias pós-infecção. Os resultados evidenciaram que o camundongo ddY produz respostaimune humoral frente ao principal antígeno de P. brasiliensis, apresentando-se elevado até 56 dias pósinfecção.A redução do nível de gp43 solúvel na fase crônica, supostamente devido ao início do controle dainfecção, requer estudos complementares adicionais.

Paracoccidioidomycosis (PCM) is a systemic mycosis, restrict to Latin America, with higher incidence inBrazil. ddY mice have been used as experimental PCM model, although there is no data regarding immuneresponse. The aim of the present study was evaluated specific humoral response against the main specificantigen of the fungal Paracoccidioides brasiliensis, the gp43, in ddY mice infected with virulent Pb 18.Antigenemia analysis and histophatological exam in several organs were performed in different time post-infection The results showed increased levels of anti-gp43 IgG on days 14, 17, 21, 24, 28 and 56 post-infectionand increased levels of soluble gp-43 on day 28 post-infection. The fungal cells were detected in all organsanalyzed (brain, heart, lung, liver, spleen and kidney) in all investigated periods. The granulomatous lesionsbecame predominant 14 days after infection. The results evidence that ddY mice produce humoral immuneresponse to main P. brasiliensis antigen, with high levels until 56 days after infection. Further studies areneeded to show that reduction of soluble gp43 in chronic phase correlates with infection control.

Determinação da freqüência de Candida spp na cavidade oral de pacientes graves internados no Hospital das Clínicas - Unicamp, através de testes fenotípicos / Detection and frequency of Candida spp in oral cavity from serious patients hospitalized in Teaching Hospital of Unicamp, by phenotypic tests

Os métodos fenotípicos tradicionais e os testes comerciais utilizados na identificação das espécies do gênero Candida são úteis na averiguação da colonização oral, especialmente se utilizados em conjunto. O presente estudo foi realizado no Hospital de Clínicas da Unicamp com o objetivo de averiguar a diversidade das espécies de Candida na cavidade oral de 225 pacientes gravemente enfermos, internados nas unidades de Moléstias Infecciosas, Cirurgia do Trauma, Emergência Clínica e Transplante de Medula Óssea. A coleta do material ocorreu quinzenalmente no período compreendido entre novembro de 2000 e dezembro de 2002. Foram utilizados cinco testes: temperatura de crescimento, assimilação da xilose, CHROMagar Candida®, Candida Check® e ID 32®. Dentre os 349 “swabs” orais colhidos, obtiveram-se 141/349 (40,4%) culturas positivas de 126/225 (56,0%) pacientes. Os resultados obtidos com o teste de CHROMagar Candida® deixaram dúvidas quanto à diferenciação entre as amostras de C. albicans e C. dubliniensis, mas os demais testes confirmaram a ausência dessa segunda espécie. A espécie predominante detectada no presente estudo foi C. albicans, com 91 (64,5%), seguida de C. tropicalis com 17 (12,0%), C. glabrata com 9 (6,4%), C. parapsilosis com 7 (5,0%), C. krusei com 6 (4,2%), C. lusitaniae 5 (3,5%) e C. humicola, C. norvegiensis e C. kefyr com 2 (1,4%) cada. Os dados obtidos indicam que o conjunto de testes utilizados foi útil e suficientemente discriminatório na determinação das espécies colonizadoras da cavidade oral dos pacientes em estudo.

HIV-1 anti-retroviral drug effect on the C. albicans hyphal growth rate by a Bio-Cell Tracer system

Declining incidence of oropharyngeal candidosis and opportunistic infections over recent years can be attributed to the use of highly active anti-retroviral therapy (HAART). Infection with C. albicans generally involves adherence and colonization of superficial tissues. During this process, budding yeasts are able to transform to hyphae and penetrate into the deep tissue. Using the biocell tracer system, C. albicans hyphal growth was dynamically observed at the cellular level. Ritonavir was effective in the inhibition of hyphal growth with growth rate of 0.8 mum/min. This study showed the in vitro effect of HIV anti-retroviral drug on the growth rate of the C. albicans hyphae.

O declínio na incidência de candidose orofaríngea e infecções oportunistas associadas a infecção pelo HIV tem sido atribuído a introdução da terapia antiretroviral combinada (HAART). Infecção por C. albicans envolve aderência e colonização da mucosa superficial. Durante este processo leveduras são capazes de transformar-se na forma de hifas e penetrar nos tecidos mais profundos. Usando o sistema "Bio-Cell Tracer", o crescimento de hifas de C. albicans foi observado dinamicamente a nível celular. Ritonavir, inibidor de protease do HIV, foi efetivo na inibição do crescimento de hifas com media de 0.8 mim/min.O presente estudo demonstrou o efeito in vitro de um agente anti-retroviral HIV sobre o crescimento de hifas de C. albicans.

Candida dubliniensis in a Brazilian family with an HIV 1- infected child: identification, antifungal susceptibility, drug accumulation and sterol composition

This study investigated the prevalence of C. dubliniensis in a Brazilian family with an HIV - infected child. A total of 42 oral isolates were obtained from eight family members. The identification of C. dubliniensis was performed by polymerase chain reactions (PCR) using primers against a specific sequence of the C. dubliniensis cytochrome b gene. Only the HIV-infected child and his grandmother were colonized by C. dubliniensis. In this study C. dubliniensis isolated from the HIV-infected child exhibited high susceptibility for azoles tested with MICs of 0.125 and 0.5 æg/mL for voriconazole and fluconazole, respectively. Accumulation of [³H] fluconazole in C. dubliniensis isolated from the HIV-infected child was slightly reduced in comparison to the reference susceptible strain. C. dubliniensis isolates had significantly lower ergosterol levels in comparison to C. albicans reference strains.

O presente estudo investigou a prevalência de C. dubliniensis em uma família brasileira com uma criança infectada pelo vírus HIV. Um total de 42 isolados orais foram obtidos de 8 membros da família. A identificação de C. dubliniensis foi realizada por polymerase chain reactions (PCR) usando primers contra a sequência específica para o gene C. dubliniensis cytochrome b. Apenas a criança infectada pelo vírus HIV e a avó estavam colonizados por C. dubliniensis. Neste estudo C. dubliniensis isolado da criança infectada pelo vírus HIV exibiu alta susceptibilidade para azoles com concentração mínima inibitória de 0.125 and 0.5 æg/mL para voriconazole and fluconazole respectivamente. Acúmulo de [³H] fluconazol intra-celular foi ligeiramente reduzido em C. dubliniensis isolado da criança infectada pelo vírus HIV em comparação com a cepa referência sensível ao fluconazole. Isolados de C. dubliniensis neste estudo apresentaram níveis significantemente reduzidos de ergosterol da membrane celular em comparação com C. albicans.

Production of extracellular proteases by Mucor circinelloides using d-glucose as carbon source / substrate

Recently, some Mucorales species have been reported as protease producers. The production of extracellular proteases by Mucor circinelloides using glucose as substrate was studied. Experiments were carried out with different D-glucose concentrations (40, 60 and 80 g/L). Biomass, pH and protease activity were determined. Although biomass production had reached best yields for the medium containing D-glucose in a concentration of 80 g/L, the enzymatic production was higher when the substrate concentration was reduced to 40 g/L. The yield factor for product on cell growth and the yield factor for product on carbon substrate were higher when the microorganism grew in medium containing 40 g/L glucose. The kinetics parameters suggest that this strain seems to be promising as an alternative microorganism for protease production.

Isolation of Paracoccidoides brasiliensis from armadillos (Dasypus novemcinctus) captured in an endemic area of paracoccidioidomycosis

Paracoccidioides brasiliensis, the causative agent of paracoccidioidomycosis (PCM), was first isolated from the Amazonian gerion where the mycosis is uncommon. In the present study, we report on the high incidence of PCM infection in armadillos from a hyperendemic region of the disease. Four nine-banded armadillos (Dasypus novemcinctus) were captured in the endemic area of Botucatu, Sao Paulo, Brazil, killed by manual cervical dislocation and autopsied under sterile conditions. Fragments of lung, spleen, liver and mesenteric lymph nodes were precessed for histology, cultured on Mycosel agar at 37ºC, and homogenized for inoculation into the testis and peritoneum of hamster. The animals were killed from week 6 to week 20 postinoculation and fragments of liver, lung, spleen, testis, and lymph nodes were cultured on brain heart infusion agar at 37ºC. Paracoccidioides brasiliensis was isolated from three armadillos both by direct organ culture and from the liver, spleen, lung, and mesenteric lymph node hamster. In addition, one positive armadillo presented histologically proven PCM disease in a mesenteric lymph node. The three aramdillos isolates (Pb-A1, Pb-A2, and Pb-A4) presented thermodependent dimorphism, urease activity, and casein assimilation, showed amplification of the gp43 gene, and were highly virulent in intratesticulary inoculation hamster. The isolates expressed the gp43 glycoprotein, the immunodominant antigen of the fungus, and reacted with a pool of sera from PCM patients. Taken together, the present data confirm that armadillos are a natural reservoir of P. brasiliensis and demonstrate that the animal is a sylvan host to the fungus

Chlamydospore formation by Paracoccidioides brasiliensis mycelial form

O papel do conteúdo nutritivo do meio de cultura e de oxigênio na produçäo de clamidósporos pela fase micelial do Pracoccidioides brasiliensis foi investigado. Quatro cepas do fungo (18, Bt4, 1183, Pb9) foram cultivadas, a 25-C, em meio sólido rico e pobre em nutrientes. As cepas 18 e 1183 foram também cultivadas em anerobiose em atmosfera de nitrogênio. A cepa 18 produziu grande número de clamidósporos terminais e intercalares após 7-10 dias de cultura em meio sólido pobre em nutrientes (agar 2%, com dextrose e polipeptona 0,1%). As outras três cepas produziram número significativamente menor de esporos. A cepa 18 näo produziu clamidósporos quando cultivada em dois meios ricos em nutrientes (infusäo de cérebro e coraçäo, e agar destrose de batata). A incubaçäo anaeróbica da cepa 18 em atmosfera de nitrogênio apresentou pequeno crescimento micelial com a presença de numerosos clamidósporos. A nivel ultraestrutural, os clamidósporos apresentam um ou mais núcleos e numerosas mitocôndrias, indicativos de potencial para posterior desenvolvimento. Assim, os esporos produziram gemulaçäo múltipla 1 dia após incubaçäo a 35-C. Os resultados demonstraram que, sob condiçöes ambientais adversas, a fase micelial do P. brasiliensis produz clamidósporos em curto período de tempo. É possível que o fungo encontre condiçöes semelhantes no solo, produzindo os esporos, que poderiam desempenhar papel na propagaçäo da paracoccidioidomicose