Short duration of neutralizing antibody titers after pre-exposure rabies vaccination with suckling mouse brain vaccine

The human anti-rabies pre-exposure treatment currently used in Brazil, employing a 1-ml dose of suckling mouse brain vaccine (SMBV) administered on days 0, 2, 4 and 28, was compared to an alternative treatment with two 1 ml-doses on day 0, and one 1 ml-dose injected on days 7 and 21. The latter induced higher virus-neutralizing antibody (VNA) titers on day 21. Both Brazilian rabies vaccines produced with PV or CVS rabies virus strains were tested. Two additional volunteer vaccinee groups, receiving the pre-exposure and the abbreviated post-exposure schedules recommended by the WHO using cell-culture vaccine (CCV) produced with PM rabies virus strain, were included as reference. The VNA were measured against both PV and CVS strains on days 21, 42 and 180 by the cell-culture neutralization microtest. The PV-SMBV elicited higher seroconversion rates and VNA by day 21 than the CVS-SMBV. Both, however, failed to induce a long-term immunity, since VNA titers were <0.5 IU/ml on day 180, regardless of the schedule used. Cell-culture vaccine always elicited very high VNA on all days of collection. When serum samples from people receiving mouse brain tissue were titrated against the PV and CVS strains, the VNA obtained were similar, regardless of the vaccinal strain and the virus used in the neutralization test. These results contrast with those obtained with sera from people receiving PM-CCV, whose VNA were significantly higher when tested against the CVS strain.

Atendimento miltiprofissional as criancas com incontinencia fecal pos-cirurgia colo-proctologica. / Multiprofessional assistance of children with fecal incontinence after colon-proctologic surgery

Os autores relatam a experiencia de uma equipe multiprofissional (pediatra, cirurgiao pediatra, assistente social, enfermeira e nutricionista) no atendimento a 17 criancas com incontinencia fecal pos-cirurgia colo-proctologica (9 por megacolo e 8 por anomalia anorretal). Foram realizados estudos morfofuncionais que revelaram somente alteracoes de absorcao de lactose e sacarose, o que motivou emprego de dietas especiais. O esquema basico de tratamento foi: a) diminuir o numero de evacuacoes e/ou aumentar a consistencia das fezes; b) promover disciplina da exoneracao intestinal; c) fortalecer a musculatura abdominoperineal; d) proporcionar apoio a crianca e e) orientar os familiares. Os resultados foram considerados muito satisfatorios