Complete Pericardial Agenesis in a Pregnant Patient: A Clinical Dilemma

Abstract Pericardial agenesis is a rare congenital anomaly found predominantly in men, and its complete form is extremely rare and difficult to diagnose. This report describes the case of a pregnant patient with complete pericardial agenesis in which mode of delivery and sterilization raised debate among specialists.

Molecular Techniques to Study Microbial Wastewater Communities

Abstract wastewater treatment (WT) is of major importance on modern cities, removing wastewater pollutants resultant from anthropogenic activities. The unique abilities of microbes to degrade organic matter, remove nutrients and transform toxic compounds into harmless products make them essential players in waste treatment. The microbial diversity determines the metabolic pathways that may occur in WT and quality of treated wastewater. Therefore, understanding WT microbial community structure, distribution, and metabolic functioning is essential for development and optimization of efficient microbial engineering systems. Since cultivation methods can only detect a small fraction of the microbial diversity, the use of culture-independent molecular methods has circumvented this issue, allowing unprecedented access to genes and genomes used for microbial composition and function evaluation. Traditional approaches like RAPD, DGGE, ARDRA, RISA, SSCP, T-RFLP, and FISH and modern approaches like microarray, qPCR, and metagenomics are essential techniques for identifying and depicting the total microbial community structure and their interaction with environmental and biotic factors. Thus, this review describes traditional and state of the art molecular techniques which provide insights into phylogenetic and functional activities of microbial assemblages in a WT system.

Multiple Effect of Different Plant Growth Promoting Microorganisms on Beans (Phaseolus vulgaris L. ) Crop

Abstract We evaluated the effect of combined Rhizobium tropici, Trichoderma asperellum and plant growth-promoting rhizobacteria (PGPR) in beans crop. The hypothesis that strains of T. asperullum, R. tropici and PGPR combined could improve growth, biomass accumulation and beans yield was tested under greenhouse and field conditions. The treatments consisted of control, mineral nitrogen application and inoculation, isolated and associated with the following microorganisms: Rhizobium tropici, Bacillus subtilis, Trichoderma asperellum and Burkholderia sp. 10N6. Results were evaluated by shoot dry weight (SDW) and root dry weight (RDW), number of nodules and yield components. In greenhouse environment all the microorganisms behaved similarly, and the treatments inoculated with Burkholderia sp. 10N6 (IBu) and R. tropici (IR) stood out regarding the production components. In field conditions the treatments IR and IRTBa presented the highest values of SDW and RDW. Our results suggest that inoculation with R. tropici, T. asperellum and PGPR may promote beans growth and bring benefits to shoot and root accumulation, increase the number of nodules as well as improve yield components, contributing to a sustainable agriculture.

Liming and Nitrogen Fertilization Effects on Soil Microbial Community in Long Term No-till

Abstract Soil management influences organic matter decomposition rates as well soil microbial community functional behavior. No-till (NT) is the most used management system by farmers due to its conservation practices and high productivity. The main objective of this study was to evaluate the impact of surface-applied lime, nitrogen (N) application, and black oat residues on soil microbial community of a Typic Hapludox under continuous NT. Therefore, soil chemical attributes, microbial biomass carbon, basal respiration, metabolic quotient, most probable number of diazotrophs, as well as bacterial functional analysis were performed. The effect of liming and N fertilization amendments inputs were saw in soil respiration and metabolic quotient measurements, showing them to be good indicators of soil quality. Further studies should be carried out in order to molecularly identify microbial communities present in soils with different liming and N fertilization management to evaluate the behavior of specific bacterial taxa under such conditions.

Epidemiological profile of patients co-infected with visceral leishmaniasis and HIV/AIDS in Northeast, Brazil

Abstract INTRODUCTION: Visceral leishmaniasis (VL) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) co-infection has been a research topic of interest worldwide. In Brazil, it has been observed that there is a relative underreporting and failure in the understanding and management of this important association. The aim of this study was to analyze epidemiological and clinical aspects of patients with VL with and without HIV/AIDS. METHODS: We conducted an observational and analytical study of patients with VL followed in a Reference Service in the State of Maranhão, Brazil from 2007-2013. RESULTS: In total 126 patients were enrolled, of which 61 (48.4%) were co-infected with HIV/AIDS. There were more males among those with HIV/AIDS (85.2%, P>0.05) or with VL only (81.5%, P>0.05). These findings significantly differed based on age group (P<0.003); the majority of patients were aged 31-40 years (41.0%) and 21-30 years (32.3%) among those with and without HIV/AIDS co-infection, respectively. The incidence of diarrhea and splenomegaly significantly differed between the two groups (P=0.0014 and P=0.019, respectively). The myelogram parasitic examination was used most frequently among those with HIV/AIDS (91.8%), followed by those with VL only (69.2%). VL recurrences and mortality were significantly higher in the HIV/AIDS co-infected patients (P<0.0001 and P=0.012, respectively). CONCLUSIONS: Patients with VL with or without HIV/AIDS co-infection were mostly adult men. Diarrhea was more frequent in HIV/AIDS co-infected patients, whereas splenomegaly was more common in patients with VL only. In the group of HIV/AIDS co-infected patients, there was a higher rate of VL recurrence and mortality.

Quinolone resistance and ornithine decarboxylation activity in lactose-negative Escherichia coli

Quinolones and fluoroquinolones are widely used to treat uropathogenic Escherichia coli infections. Bacterial resistance to these antimicrobials primarily involves mutations in gyrA and parC genes. To date, no studies have examined the potential relationship between biochemical characteristics and quinolone resistance in uropathogenic E. coli strains. The present work analyzed the quinolone sensitivity and biochemical activities of fifty-eight lactose-negative uropathogenic E. coli strains. A high percentage of the isolates (48.3%) was found to be resistant to at least one of the tested quinolones, and DNA sequencing revealed quinolone resistant determining region gyrA and parC mutations in the multi-resistant isolates. Statistical analyses suggested that the lack of ornithine decarboxylase (ODC) activity is correlated with quinolone resistance. Despite the low number of isolates examined, this is the first study correlating these characteristics in lactose-negative E. coli isolates.

Multiple gene sequence analysis using genes of the bacterial DNA repair pathway

The ability to recognize and repair abnormal DNA structures is common to all forms of life. Physiological studies and genomic sequencing of a variety of bacterial species have identified an incredible diversity of DNA repair pathways. Despite the amount of available genes in public database, the usual method to place genomes in a taxonomic context is based mainly on the 16S rRNA or housekeeping genes. Thus, the relationships among genomes remain poorly understood. In this work, an approach of multiple gene sequence analysis based on genes of DNA repair pathway was used to compare bacterial genomes. Housekeeping and DNA repair genes were searched in 872 completely sequenced bacterial genomes. Seven DNA repair and housekeeping genes from distinct metabolic pathways were selected, aligned, edited and concatenated head-to-tail to form a super-gene. Results showed that the multiple gene sequence analysis using DNA repair genes had better resolution at class level than the housekeeping genes. As housekeeping genes, the DNA repair genes were advantageous to separate bacterial groups at low taxonomic levels and also sensitive to genes derived from horizontal transfer.

Seroprevalence of HTLV-1/2 among blood donors in the state of Maranhao, Brazil

Background: Infection with human T-lymphotropic virus 1 or 2 (HTLV-1/2) is a major health problem. There is a public health policy defining measures for state hematology and hemotherapy centers in Brazil, in order to avoid virus transmission through blood donors. Objective: This study aimed to evaluate the seroprevalence of HTLV -1/2 in blood donors in the State of Maranhão, Brazil, during routine blood unit screening. Methods: Screening tests of blood donors using the enzyme-linked immunosorbent assay (ELISA) to detect seropositivity for HTLV-1/2 performed at the Hematology and Hemotherapy Center of the State of Maranhão (HEMOMAR) between July of 2003 and December of 2009 were retrospectively evaluated. Results: Of the 365,564 blood donors, 561 (0.15%) were HTLV-1/2-positive, of whom 72 (12.8%) performed the confirmatory test (Western blot). In donors who had a confirmatory test, 53 (73.6%) were positive. The ages of the infected individuals ranged from 18 to 65 years; 305 (54%) were aged over 40 years. Among the infected individuals, 309 (55%) were male, 399 (71%) were mixed-race, and 259 (46%) were single. Co-infections were frequently found, especially with hepatitis B (in 68.6% of the cases). Conclusion: The results obtained will contribute to the planning and implementation of control measures by the epidemiological surveillance agency of Maranhão, and will also contribute to reducing morbidity. The high seropositivity in a small sample in donors who had confirmatory tests indicates the need for confirmatory tests for all donors who initially test as seropositive. .

Oral injuries as syphilis diagnosis: case report / Lesão oral como diagnóstico de sífilis: relato de caso

Syphilis can present a variety of clinical manifestations as a consequence of the tropism that Treponema pallidum causes to various organs and body tissues.The oral cavity can be affected in all stages of the disease, therefore diagnosis requires knowledge of multidisciplinary health professionals. Even with the introduction of penicillin in the last century and initiatives of sexually transmitted diseases prevention, an increase in the incidence of syphilis has been observed, which indicates a public health issue. This paper presented the case of a patient with syphilitic chancre in the oral cavity, whose dental surgeon diagnosed an injury and referred her to the city sexually transmitted diseases ambulatory for treatment.

A sífilis pode apresentar uma variedade de manifestações clínicas, justificada pelo tropismo que o Treponema pallidum tem para vários órgãos e tecidos do corpo. A cavidade oral pode ser acometida em todas as fases da doença; portanto, seu diagnóstico exige conhecimento de diferentes profissionais de saúde.Mesmo com a introdução da penicilina no século passado e com as iniciativas de prevenção das doenças sexualmente transmissíveis, observa-se aumento na incidência de sífilis, o que representa um problema para a saúde pública. Neste trabalho, apresentou-se o caso de uma paciente com cancro sifilítico em cavidade oral que fora diagnosticada e encaminhada por um cirurgião-dentista ao ambulatório de doenças sexualmente transmissíveis do município para tratamento da lesão.

Alterações neonatais de sífilis congênita em um hospital universitário do município de Niterói, Rio de Janeiro / Congenital syphilis neonatal alterations in a university hospital in Niterói-RJ

A prevalência da infecção pelo Treponema pallidum diminuiu sensivelmente com a penicilina, porém se observa tendência mundial no recrudescimento da sífilis, em particular dos casos de sífilis congênita (SC). Objetivos: Descrever as repercussões neonatais da SC nos recém-nascidos (RN) notificados como caso de SC em um hospital público de Niterói, Rio de Janeiro, no período de janeiro de 2005 a junho de 2006; observar o peso ao nascer e a sorologia dos RN com notificação de SC; descrever o tratamento dos casos de SC. Métodos: Amostra constituída de 35 fichas de notificação de SC do Centro de Vigilância Hospitalar do Hospital Universitário Antônio Pedro (HUAP). Utilizaram-se dados da notificação e realizou-se visita domiciliar para coleta de sangue. esultados: A população foi constituída por 29 pacientes nascidos vivos, 4 nascidos mortos e 2 abortamentos. Apenas dois casos (6,9%) evidenciavam alterações ósseas de SC. O teste Veneral Disease Research Laboratory (VDRL) realizado no líquido cefalorraquidiano (LCR) demonstrou-se não reator para todos os pacientes avaliados. O VDRL do soro dos RN no nascimento foi positivo para 23 (79,31%) pacientes. A penicilina G cristalina (PGC) foi administrada em 26 (89,65%) casos, a penicilina G procaína (PGP) em dois (6,9%) e um individuo utilizou PGC e PGP. Conclusão:O óbito fetal e aborto foram o desfecho mais ominoso como repercussão da SC. A alteração dos ossos longos foi pouco encontrada na amostra. O baixo peso ao nascer foi observado em poucos casos. O VDRL do LCR foi não reator em todos os casos. A utilização de diversos esquemas de antibiótico estava em desacordo com o protocolo proposto pelo Ministério da Saúde.

Syphilis is a sexually transmitted disease caused due to bacterium Treponema pallidum.The prevalence of this infection decreased significantly by the use of penicillin, but it is observed that it reappears particularly in cases of congenital syphilis (CS).Objective:to describe the effects of neonatal CS in newborns (NB) in a public hospital in Niterói - RJ, from January 2005 to June 2006 and to observe the birth weight and serology of newborns with CS notification.The purpose of this study is also to describe the CS treatment in each case.Methods:a sample of 35 CS notifications was recorded from the Center for Hospital Surveillance at the Antonio Pedro University Hospital (HUAP), Niterói - RJ, from January 2005 to June 2006. Data from the notifications was used and homevisit was done to collect blood samples.Results:the study population is comprised of 29 live birth patients, four miscarriages and two stillbirths. Only two cases(6.9%) had evidence of CS bone abnormalities. The VDRL test performed in cerebrospinal fluid (CSF) of the cases proved to be non-reactive for all patients.VDRL serum of newborns at birth was positive for 23 (79.31 %) patients. The crystalline penicillin G was administered in 26 (89.65 % cases,) procaine penicillinG in two (6.9%) and for one individual both crystalline penicillin G and procaine penicillin G was used.Conclusion:fetal death and abortion were the mostominous outcome and impact of CS. Long bones alterations were scarcely found in few samples. Low birth weight was observed in a few cases. CSF VDRL was not reactive in all cases. The use of several antibiotic regimens was in disagreement with the proposed protocol issued by the Ministry of Health.

Ardra profiles of bacteria and archaea in mangrove sediments with different levels of contamination in the estuarine complex of Paranaguá, Brazil

The mangrove's sediments from the coastal areas under human activities may contain significant contaminations by hydrocarbons, even when there are no visual evidences of it. The microorganisms are essential to these ecosystems, especially in the control of their chemical environment. Sediment samples were collected in two regions under different environment conditions (pristine and contaminated) of the Paranaguá Estuarine Complex (Paranaguá Bay and Laranjeiras Bay), Brazil. Aliphatic hydrocarbons were determined by the GC-FID to assess the status of contamination of the studied areas. The total DNA was extracted from these samples. The 16S rRNA gene was amplified by the PCR reactions with the pair of primers 21F and 958R for the archaeal domain, and 27F and 1492R for the bacterial domain. Comparisons of communities were made by the ARDRA technique, using the HinfI restriction enzyme. The phosphate concentration showed significant differences between the two regions. The aliphatic hydrocarbons analysis showed the presence of unresolved complex mixture (UCM), an indicator of oil contamination, in the samples from the Paranaguá Bay, which was corroborated by the concentration of total aliphatic hydrocarbons. The ARDRA profile indicated that the structure of archaeal and bacterial communities of the sampled areas was very similar. Therefore, the anthropogenic influences in the Paranaguá Bay showed to be not sufficient to produce disturbances in the prokaryotic dominant groups.

Relationship between rainfall and temperature: observations on the cases of visceral leishmaniasis in São Luis Island, State of Maranhão, Brazil / Relações entre pluviometria e temperatura: observações sobre a ocorrência de casos de leishmaniose visceral na Ilha de São Luis, Estado do Maranhão, Brasil

INTRODUCTION: Visceral leishmaniasis is a serious public health problem that requires global control strategies, especially with respect to factors that may intervene in reducing the incidence of endemicity. In this work, rainfall density and temperature were correlated with the incidence of human cases in an area endemic for leishmaniasis in São Luis do Maranhão, Northeastern Brazil. METHODS: Notification of human cases by the National Health Foundation/Regional Coordination of Maranhão (FUNASA/COREMA) from 2002 to 2010 was used. Ecological data (mean temperature and rainfall density) were provided by the Meteorological Office of State. RESULTS: A significant association was verified between the number of VL cases and rainfall rate but not in the analysis concerning mean temperatures. CONCLUSIONS: These data suggest that the control actions in visceral leishmaniasis should be performed during rainy season in the State of Maranhão, which is in the first half of the year.

INTRODUÇÃO: A leishmaniose visceral por ser um importante problema de saúde pública mundial requer estratégias de controle, notadamente em relação a fatores que possam intervir na redução da incidência dessa endemia. A densidade pluviométrica e a temperatura são aqui correlacionadas com a incidência de casos humanos em uma área endêmica de calazar na Ilha de São Luis do Maranhão, nordeste brasileiro. MÉTODOS: Utilizou-se notificações dos casos humanos pela Fundação Nacional de Saúde/Coordenação Regional do Maranhão (FUNASA/COREMA) durante o período de 2002 a 2010. Os dados ecológicos (temperatura e densidade pluviométrica) foram cedidos pela Universidade Estadual do Maranhão. RESULTADOS: Associação significante foi verificada entre o número de casos e a pluviometria, o que não foi verificado com a temperatura média. CONCLUSÕES: Esses dados sugerem que as ações de controle na leishmaniose visceral devem ser executadas durante o período chuvoso em nosso Estado, ou seja, no primeiro semestre do ano.

Evaluation of laboratory markers of progression of HIV disease to death / Avaliação de marcadores laboratoriais de progressão da doença HIV para óbito

INTRODUCTION: One of the important current problems in HIV/AIDS infection is the establishment of epidemiological and laboratorial prognostic parameters during patient follow-up. This study aimed at analyzing the evolution of laboratory tests: CD4 lymphocyte count, viral load, hemoglobin (Hb), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and the epidemiological variables sex and age as prognostic factors for survival in progression to death among AIDS patients. METHODS: A retrospective study was conducted using analysis of medical records, and prospective 24-month follow-up of patients with HIV/ AIDS attended at the President Vargas Hospital Outpatient Clinic, a reference center in HIV/ AIDS attendance in the State of Maranhão, Brazil. The study analyzed patients aged 10 to 60 years old, who manifested AIDS and who were not using antiretroviral therapy or had used it for less than 5 years. The Chi-square test was used for statistical analysis. RESULTS: The sample included 100 patients - 57 were current outpatients, and 43 had died. The variables viral load (p=0.726), ALT (p=0.314), sex (p=0.687), and age (p=0.742) were analyzed, and no evidence of association between them and worst prognosis was observed. CONCLUSIONS: A significant relation was verified between low Hb levels (p=0.000) and CD4 (p=0.000) and shorter survival.

INTRODUÇÃO: Uma das importantes dificuldades atuais na infecção HIV/AIDS é estabelecer parâmetros epidemiológicos e laboratoriais prognósticos no seguimento dos pacientes. Esse trabalho objetivou analisar a evolução dos exames laboratoriais: contagem de linfócitos CD4, carga viral, dosagem de hemoglobina (Hb), de aspartato aminotransferase (AST), de alanino aminotransferase (ALT) e as variáveis epidemiológicas: sexo e idade, como fatores prognósticos de sobrevida na evolução para o óbito em pacientes com AIDS. MÉTODOS: Foi realizado um estudo retrospectivo a partir da análise de prontuários e um prospectivo por seguimento de pacientes portadores de HIV/AIDS, no Serviço Ambulatorial da referência assistencial em HIV/AIDS, no Estado do Maranhão, durante 24 meses. Os pacientes analisados tinham faixa etária compreendida entre 10 e 60 anos, apresentavam quadro clínico manifesto e não faziam uso de antirretroviral ou ainda o faziam há menos de 5 anos. Para análise estatística, foi adotado o teste qui-quadrado. RESULTADOS: A amostra compreendeu 100 pacientes, dos quais 57 se encontravam em tratamento ambulatorial e 43 já tinham ido a óbito. Variáveis como carga viral (p= 0,726), ALT (p=0,314), sexo (p=0,687) e faixa etária (p=0,742) foram analisadas e nenhuma evidência de associação entre elas com o pior prognóstico foi verificada. CONCLUSÕES: Constatou-se uma significante relação entre baixos níveis de Hb (p=0,000) e de CD4 (p=0,000) com menor sobrevida.

Reação de Jarisch-Herxheimer em gestante com sífilis: relato de caso / Jarisch-Herxheimer reaction in pregnant woman with syphilis: case report

Introdução: a sífilis é uma doença relatada desde o século XV e que ainda hoje representa um sério desafio para a Saúde Pública. Mais de 12 milhões de novos casos são registrados por ano, especialmente nos países em desenvolvimento. Com a comercialização da penicilina, à qual o Treponema pallidum é suscetível, acreditou-se na possibilidade de sua erradicação, o que não se concretizou. Em certas doenças infecciosas a primeira dose de um tratamento antimicrobiano eficaz pode desencadear uma resposta inflamatória no hospedeiro. Neste trabalho apresenta-se o caso de uma gestante, de classe socioeconômica baixa, nulípara, com feto morto com 24 semanas por sífilis congênita, que ao receber o tratamento para sífilis recente apresentou Reação de Jarisch-Herxheimer, ocorrida na maternidade do Hospital da Mulher Heloneida Stuart, em São João do Meriti, Rio de Janeiro.

Introduction: syphilis is a disease which has been reported since the fifteenth century and still represents a reasonable challenge to public health care sistem. More than 12 million new cases are reported every year, especially in developing countries. With the commerce of penicillin, to which Treponema pallidum is susceptible, the possibility of eradication had been considered true, which however, did not happen. In certain infectious diseases, the first dose of an effective antimicrobial treatment can initiate an inflammatory response in the host. This work presents the case of a pregnant woman, low socioeconomic status, nulllipara, with a dead fetus with 24 weeks, upon receiving therapy for early syphilis, triggered Jarisch-Herxheimer reaction, which occurred at the Hospital for Women Heloneida Stuart, in São João de Meriti, Rio de Janeiro.