Complicaçöes clínicas e hemaológicas da greve de fome / Clinical and hemaologic complicaions of hunger strike

Antecedenes e objeivos - O jejum prolongado em pacienes näo obesos é uma situaçäo potencialmene crítica porém, há muitos anos, näo se documenta seu curso clínico em grandes grupos. Em uma casuística de oito pacientes que recusaram alimentaçäo por 43 dias, as desordens clínicas e hematológicas foram analisadas retrospectivamente. Métodos - As contagens hematológicas documentadas incluíram hemoglobina, leucócitos, linfócitos, eosinófilos e plaquetas. As complicaçöes foram classificadas como gastrointestinais, infecciosas, orodentais e miscelânea. Queixas pré-existentes ou recidivantes foram desconsideradas, computando-se apenas aberraçöes hematológicas e clínicas recém diagnosticadas. Resultados - O total de anormalidades por pacientes foi de 7,5 mais ou menos 1,8 (4-10), conforme enumerado. Hematológicas: Hb menor que 12 g/100 ml 8/8 (100 porcento), leucócitos menor que 4000/mm3 7/8 (87,5 porcento), linfócitos menor que 1000/mm3 7/8(87,5 porcento), plaquetas menor que 150.000/mm3 6/8 (75 porcento). Gastrointestinais: náuseas e vômitos 8/8 (100 porcento), diarréia 4/8 (50 porcento), dor abdominal 1/8 (12,5 porcento), gastrite hemorrágica 1/8 (12,5 porcento). Infecciosas: vias aéreas 1/8 (12,5 porcento), herpes simples 2/8 (25 porcento), herpes zoster 1/8 (12,5 porcento); Orodentais: gengivites hemorrágicas 6/8 (75 porcento), periodontite 2/8 (25 porcento); Miscelânea: brabdicardia e síncope 3/8 (37,5 porcento), erupçäo cutânea 2/8 (25 porcento), reduçäo da acuidade visual 1/8 (12,5 porcento). Conclusöes - 1) A depressäo hematológica afetou as principais linhagens celulares na maioria dos pacientes; 2)A labilidade cardiovascular foi responsável por episódios de brandicardia e hipotensäo; 3) As queixas gastrointestinais foram as mais freqüentes e em um caso (gastrite hemorrágica) atingiram moderada gravidade; 4) A ocorrência de problemas virais foi sugestiva de resposta imonológica diminuída; 5) A maioria das complicaçöes foi progressiva e foi diagnosticada ou se agravou na fase tardia do jejum.(au)

Increasing trend of HIV seroprevalence among pulmonary tuberculosis patients in Pune, India.

A total of 4618 tuberculosis patients attending the TB clinic at the Sassoon General Hospitals, Pune between 1991 and 1996 were screened for anti-HIV antibodies. Of these 694 were found reactive in enzyme immuno assay (EIA) and 624 were further confirmed by a second test, either rapid EIA or Western blot. HIV-1 reactivity was predominant among tuberculosis patients with HIV-2 reactivity appearing only in 1995. HIV-2 seroreactivity accounted for 0.54 and 1.02 per cent of all HIV reactive samples in 1995 and 1996. HIV-1 and HIV-2 dual reactivity accounted for 1.63 and 2.04 per cent of all infections in 1995 and 1996. The overall seroprevalence of HIV among newly diagnosed tuberculosis patients rose from 3.2 per cent in 1991 to 20.1 per cent in 1996.

Evidence for high prevalence & rapid transmission of HIV among individuals attending STD clinics in Pune, India.

Prevalence and incidence of HIV-1 infection among persons attending two STD clinics in Pune between May 1993 and October 1995 are reported. On screening 5321 persons, the overall prevalence of HIV-1 infection was found to be 21.2 per cent, being higher in females (32.3%) than in males (19.3%). Analysis of behavioural and biological factors showed that old age, sex work, lifetime number of sexual partners, receptive anal sex, lack of circumcision, genital diseases and lack of formal education were related to a higher HIV-1 seroprevalence. The observed incidence rate of 10.2 per cent per year was very high, much higher in women than in men (14.2% and 9.5% per year respectively) and over three times higher among the sex workers. Females in sex work, males having recent contacts with female sex workers (FSWs) and living away from the family and persons with previous or present genital diseases had a higher risk of seroconversion. Condom usage was shown to have a protective effect in seroprevalence and seroincidence analysis. With limited available resources and lack of a suitable vaccine or a drug, long-term prevention policy of creating awareness in the community must be supplemented by strengthening STD control measures and promotion of condom use and safe sex. Factors related to availability and utilization of condoms must be carefully investigated.

Absence of wild poliovirus circulation among healthy children in a rural area with high oral poliovirus vaccination coverage.

Poliovirus circulation in a rural community was studied by a stool sample survey. No acute paralytic poliomyelitis case had been reported from the study area during the previous 5 months. Immunization coverage in age groups 7 to 12 months and 12 to 60 months was 95.8 and 94 per cent, respectively. Of the 257 children from whom stool samples were collected (about 6% of the child population), 161 (62.6%) were positive for virus isolation. Poliovirus was isolated from 60 (23.3%) children. All three poliovirus types were detected (41 type 1, 16 type 2 and 3 type 3). Intratypic differentiation tests classified these isolates as vaccine-like. Among the children excreting poliovirus, the proportion of those who did not receive polio vaccine within 30 days prior to the sample collection was 46.3, and 68.7 per cent for poliovirus type 1 and 2, respectively. It was concluded that these poliovirus excreting children were infected by the vaccine strains circulating in the environment. The survey showed that wild poliovirus was not detectable within five months after the last case of acute poliomyelitis. Displacement of the wild virus from the environment and circulation of vaccine virus was achieved by high vaccination coverage in this area.

Polipectomia esdoscópica em pólipo de grande dimensäo / Endoscopic polypectomy in large dimension polyps

Paciente com 66 anos, do sexo feminino, que apresentava queixas de dor epigástrica, náuseas e emagrecimento, cujo exame endoscópico revelou lesäo polipóide, pediculada, medindo cerca de 6cm. A biópsia, realizada durante o ato endoscópico revelou tratar-se de pólipo adenomatoso tubuloviloso com atipias intensas, devendo-se considerar no diagnótico diferencial a hipótese de adenocarcinoma tubulopapilífero bem diferenciado. A paciente foi submetida a ressecçäo endoscópica, sem intercorrências, com retirada completa do material. O estudo histológico integral do material mostrou tratar-se de adenoma tubular sem indícios de malignidade. A paciente encontra-se em acompanhamento

An evaluation of cold chain in Maharashtra & Karnataka states by potency testing of field samples of oral poliovirus vaccine.

The cold chain for oral poliovirus vaccine was monitored in Maharashtra and Karnataka by potency testing of vaccine vials collected from various stages of the delivery system. Results showed that cold chain maintenance improved in the state of Maharashtra within a period of three years as the monitoring began in 1987. Of the 6289 samples of trivalent OPV collected from all 30 districts of the state during 1990 to 1992, 5834 (92.8%) had retained virus titre of at least 10(5.81) TCID50/dose. In comparison, 72 per cent of the 1660 samples collected from the state of Karnataka during the same period were found to contain this minimum required virus titre. Defects in cold chain maintenance in Karnataka could be demonstrated by plotting virus titre of samples of individual batches collected from different outlets. It was concluded that potency retesting of OPV samples for cold chain monitoring will ensure proper storage, transport and use of potent vaccine in the field.

Prevalence of antibodies to polioviruses & enteroviruses excreted by healthy children in Bombay.

A total of 132 healthy children between the ages one month and 12 yr were surveyed to determine the prevalence of antibodies to the three poliovirus serotypes. Among infants up to six months of age, 73.2, 85.4 and 56.1 per cent had antibodies to poliovirus types 1, 2 and 3, respectively. In children of age groups 7 months to 3 yr and above 3 yr, antibody prevalence to the three poliovirus serotypes was 90.2, 86.9 and 57.4, and 83.3, 96.7 and 76.7 per cent, respectively. Immunization coverage with three doses of OPV exceeded 85 per cent in children above 7 months of age. Low seroprevalence to type 3 poliovirus in the children was conspicuous. Of the 80 faecal samples studied from these children, 24 (30%) were positive for virus. Among these isolates, 16 were poliovirus type 1 and three type 2. Intratypic differentiation revealed that 15 of the 16 poliovirus type 1 isolates were of wild origin. Two out of the three poliovirus type 2 isolates were of oral poliovaccine origin. Our data indicate that in spite of good vaccination coverage wild poliovirus type 1 circulation was endemic in Bombay and; that a large number of children were susceptible to poliovirus type 3 infections.

Diverticulo de Meckel: complicacoes e metodologia diagnostica. Analise de 12 casos / Meckel's diverticulum: complications and diagnosis methodology. Analysis of 12 cases

O Diverticulo de Meckel(DM) e a anomalia congenita maisfrequente do trato gastrointestinal. Foram analisados 12 casos de DM. As complicacoes foram: Hemorragias em 03 casos, sendo que em 2 havia lesao peptica, obstrucao intestinal em 03 casos, inflamacao e perfuracao em 01 caso. Nos 05 casosrestantes os DM constituiram achado de Laparotomia durante o tratamento de afeccao associada. Encontrou-se portanto a maioria das complicacoes referidas na literatura, conquanto em nenhum caso houvesse transformacao neoplastica. A literatura refere a dificuldade de correlacionar pre-operatoriamente qualquer destascomplicacoes com DM. Na presente casuistica o mesmo fato foi notado, de vez queem apenas 03 casos, todos devido a sangramento, foi possivel comprovar o DM peloestudo angiografico, cintilografico com emprego de tecnesio e transito intestinal radiologico. Comprovou-se frequencia semelhante das complicacoes entre estespacientes e as referidas na literatura. Ressaltou-se a incidencia da ectopia damucosa no DM e sua participacao na genese das complicacoes. Analisou-se a eficiencia dos metodos de diagnostico do DM destacando-se que nem sempre e possivelrealiza-los pois a instalacao de certas complicacoes exige tratamento cirurgico imediato como ocorreu em 04 dos presentes casos.

Serological studies on subacute sclerosing panencephalitis.

This study reports the clinical picture and measles virus antibody titres in 32 patients with cases of suspected subacute sclerosing panencephalitis (SSPE). The history of myoclonic jerks, mental regression, inability to walk and slurred speech, were noted in these cases. The EEG showed generalised periodic complexes in twenty nine patients and only in three patients the EEG was not available. In all the above mentioned patients measles occurred at an early age (within a year).

Molecular cloning and characterization of the ribosomal RNA genes of the cestode Echinococcus granulosus

The analysis of total protoscolex DNA and some rDNA recombinats of Echinococcus granulosus by restriction endonuclease mapping and hybridization to rDNA probes indicated the complex organization of the ribosomal RNA genes and that some repeat units are larger than 15 kb. The nontranscribed spacer can be up to 13 kb in length in some repeat units. Restriction site polymorphisms was detected mainly in the nontranscribed spacer regions although some polymorphisms was also observed in the 28S rRNA coding region. On the basis of Southern blot hybridization using EcoRi-digested genomic DNA, we conclude that the repeat units containing an extra EcoRI site are present almost in the same proportion as the repeat units without the extra EcoRi site in the 28S rRNA coding region

Localization of arboviral antigen in brain tissues from patients with encephalitis.

Brain tissues from 38 patients with a clinical suspicion of encephalitis or encephalopathy were examined by two immunoenzymatic techniques for the detection of arboviral antigen. Group B arboviral antigen was identified in 23 of these tissues. This simple method could be used for the diagnosis of the causal agent of encephalitis.