The impact of COVID-19 on microbiological profile and antibiotic consumption in ICU: a retrospective study in an infectious disease hospital in Brazil

Abstract Background The COVID-19 pandemic has triggered crises in the public health sector that have complex and multifaceted interrelationships with antimicrobial resistance. It is important to evaluate the impact of COVID-19 on microbiological profile, antibiotic and alcohol gel consumption in Intensive Care Units (ICU). Methods This is a retrospective study undertaken in an infectious disease hospital located in Bahia/Brazil during three periods: from March 2019 to February 2020; from March 2020 to February 2021; and from March 2021 to February 2022. It was evaluated the incidence density of Candida spp and of multidrug-resistant Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species (ESKAPE group) in blood, urine and tracheal secretion isolated 48 h after the patient's admission to the ICU, as well as the use of alcohol gel (in milliliters) and consumption of antibiotics in Defined Daily Dose (DDD) per 1,000 ICU patient-days in the previous year and in the first two years of COVID-19 pandemic. Results There was an increase in Candida spp. (5.81, p < 0.001, IRR = 10.47, 95 % CI 2.57‒42.62) and in carbapenem-resistant A. baumannii in clinical cultures (4.71, p < 0.001, IRR = 8.46, 95 % CI 2.07‒34.60), the latter mainly in tracheal secretions (3.18, p =0.02, IRR = 11.47, 95 % CI 1.58‒83.39). A rise in the consumption of ceftriaxone and piperacillin-tazobactam, along with an increase in the utilization of alcohol gel were observed. Conclusion The shifting microbiological profile can be attributed to both the unique characteristics of patients with COVID-19 and the adjustments made to healthcare facilities' structural and work routines. Understanding these changes is essential in addressing the accelerated impact of antimicrobial resistance during the pandemic. Therefore, conducting thorough reviews of institutional practices and routines becomes critical in mitigating the consequences of antimicrobial resistance and its implications for patient care.

Accuracy of the urine point-of-care circulating cathodic antigen assay for diagnosing Schistosomiasis mansoni infection in Brazil: A multicenter study

ABSTRACT Background: The World Health Organization recommends a market-ready, urine-based point-of-care diagnostic test for circulating cathodic antigens (CCA) to determine the prevalence of S. mansoni. This study evaluated the performance of the URINE CCA (SCHISTO) ECO TESTE® (POC-ECO), which is currently available in Brazil. Methods: Residents from eight sites with different prevalence estimates provided one urine sample for POC-ECO and one stool sample for Kato-Katz (KK) and Helmintex® (HTX) testing as an egg-detecting reference for infection status. Results: None of the study sites had significantly higher POC-ECO accuracy than KK. Conclusions: POC-ECO is not currently recommended in Brazilian schistosomiasis elimination programs.

Epidemiological indicators of Chagas disease in the metropolitan region of Salvador, Bahia, Brazil

ABSTRACT Background: Chagas disease (CD) is caused by Trypanosoma cruzi and transmitted by triatomines. Historical information from the 20th century demonstrates T. cruzi records in the metropolitan region of Salvador (MRS), the third largest urban agglomeration in the Brazilian Northeast and the eighth largest in Brazil, an area with intense migratory activity from CD-endemic regions. Therefore, this study aimed to evaluate CD indicators (prevalence and mortality) in the MRS. Methods: A mixed ecological and descriptive study was conducted using secondary data. We analyzed data from 2008 to 2015: deaths due to CD, self-reported cases of CD, and blood donors that were non-negative for T. cruzi infection. Results: São Francisco do Conde was one of the municipalities with the highest mortality rates due to CD. The seroprevalence rates varied by year and municipality; those with the highest values were 2008: Vera Cruz, 2009: Mata de São João, 2010: Dias D'Ávila, 2011 and 2015: São Francisco do Conde, 2012: São Sebastião do Passé, and 2013 and 2014: Pojuca. Spatial correlations between the municipalities were not detected. Conclusions: We conclude that CD is present in the MRS. The indicators analyzed in the MRS are below-state-level data. Given the importance of indicator analysis for the surveillance and control of CD at the state and national levels, it is important to strengthen the surveillance program at the municipal level, including the regions classified as low risk for T. cruzi vector transmission.

Reliability of point-of-care circulating cathodic antigen assay for diagnosing schistosomiasis mansoni in urine samples from an endemic area of Brazil after one year of storage at -20 degrees Celsius

ABSTRACT Background The World Health Organization recommends reliable point-of-care (POC) diagnostic testing to eliminate schistosomiasis. Lateral flow immunoassay that detects schistosome circulating cathodic antigen (CCA) in urine to establish prevalence thresholds for intervention in endemic areas is recommended. Stored urine may be useful if surveying at-risk populations is delayed or interrupted by unforeseen circumstances, such as the current COVID-19 pandemic. This study evaluated the manufacturer's claim that Schistosoma mansoni infection can be reliably diagnosed in urine samples stored at -20°C for one year. Methods Two-hundred-forty-two subjects from an endemic site in Brazil provided one urine sample each for testing with URINE CCA (SCHISTO) ECO TESTE® (POC-ECO) and one stool sample each for testing with Kato-Katz (KK) and Helmintex® (HTX) as a robust reference standard for infection status. At least 2 ml of urine from each participant was stored at -20°C; after one year, 76 samples were randomly selected for POC-ECO retesting. Results: The POC-ECO agreement between freshly collected and stored urine was inadequate considering trace results as positive (Cohen's kappa coefficient κ = 0.08) and negative (κ = 0.36). POC-ECO accuracy was not significantly greater than that of routine KK (54%; 95% confidence interval: 42.1%-65.5%). Conclusions The precision and accuracy of POC-ECO have to be optimized in both freshly collected and stored urine before it can be recommended for use in control programs in Brazil.

Triatomine fauna in the state of Bahia, Brazil: What changed after 40 years of the vector-control program?

ABSTRACT Background: Neglected tropical diseases are a growing threat to global health, and endemic Chagas disease has emerged as one of the most important health problems in America. The main strategy to prevent Trypanosoma cruzi transmission is chemical control of vectors. This study presents a descriptive analysis of synanthropic triatomines before and after the implementation of a vector-control program in Bahia, Brazil. Methods: Descriptive analysis and geospatial statistics were performed on triatomine data, (1) the relative abundance and (2) proportional spatial distribution, from Bahia during two periods: (A) 1957 to 1971 and (B) 2006 to 2019. Results: We observed a decrease in the relative abundance of Panstrongylus megistus (A: n=22.032, 61.9%; B: n=1.842, 1.0%) and Triatoma infestans (A: n=1.310, 3.7%; B: n=763, 0.43%), as well as an increase in the relative abundance of T. sordida (A: n=8.314, 23.4%, B: n=146.901, 81.6%) and T. pseudomaculata (A: n=894, 2.5%, B: n=16.717, 9.3%). Conclusions: Our results indicate a clear reduction in the occurrence of P. megistus and T. infestans (last record in 2015) and an increase in the relative abundance and geographical distribution of T. sordida and T. pseudomaculata after 40 years of the vector-control program. The high frequency of other triatomine species in the municipalities of the state of Bahia and their abundance in recent years highlight the need to reinforce permanent entomological surveillance actions to prevent Chagas disease.

Antimicrobial-resistant enterobacteria in surface waters with fecal contamination from urban and rural communities

Abstract INTRODUCTION: Inadequate wastewater treatment and fecal contamination have a strong environmental impact on antimicrobial resistance (AMR). This study evaluated the profile of AMR enterobacteria and fecal contamination from four surface waters: Jiquiriça-Brejões River and Cabrito, Tororó, and Abaeté Lagoons. METHODS: We analyzed AMR β-lactamase genes using the polymerase chain reaction method and fecal contamination using Coliscan®. RESULTS: We found high levels of fecal contamination, β-lactamase producers, and AMR genes (blaOXA-48, blaSPM, and blaVIM) in all waterbodies. CONCLUSIONS: Poor sanitation evidenced by fecal contamination and human activities around these surface waters contributed to the distribution and increase in AMR enterobacteria.

Seroprevalence of trypanosoma cruzi infection among blood donors in the state of Bahia, Brazil

Abstract INTRODUCTION: Chagas disease (CD) affects 5.7-7.0 million individuals worldwide, and its prevalence reached 25.1% in the state of Bahia, Brazil. There is an association between the prevalence of CD, the socioeconomic status of the population, and the risk of re-emergence due to non-vectorial transmission, such as blood transfusion. This study determined the seroprevalence of T. cruzi infection among blood donors in the state of Bahia, located in northeastern Brazil, and their epidemiological profile during a 10-year period. METHODS: We performed a descriptive cross-sectional study involving a database review. Data were collected from patients with non-negative results for T. cruzi infection during a 10-year period. RESULTS: A total of 3,084 (0.62%) samples were non-negative for T. cruzi infection in an initial serological screening, and 810 (0.16%) samples were non-negative in the second screening. The correlation between infection and age (30 years or older) and between infection and lower educational level (12 years or less) in the first and second screening was statistically significant. The seroprevalence of T. cruzi infection was higher in men in the first screening. In addition, 99.52% of the municipalities of Bahia had at least one case of CD. Livramento de Nossa Senhora and Salvador presented the highest disease prevalence and recurrence, respectively. CONCLUSIONS: The seroprevalence of T. cruzi infection in these populations was lower than that found in other studies in Brazil but was comparatively higher in densely-populated areas. The demographic characteristics of our population agreed with previous studies.

Avaliação do protocolo clínico e diretrizes terapêuticas para o tratamento para hepatite B crônica nas regiões nordeste e norte do Brasil / Analysis of clinical protocol and guidelines therapeutic for treatment for chronic hepatitis B in northeast Brazil and regions north

No Brasil o tratamento para Hepatite B cônica, tem sido disponibilizado pelo Sistema Único de Saúde há mais de 10 anos. O objetivo foi analisar o tratamento dos pacientes com hepatite B crônica, em dois Centros de Referência em Hepatites Virais na Região Nordeste e Norte do Brasil, comparando com o Protocolo Clínico e Diretrizes Terapêuticas da Hepatite B do Ministério da Saúde. Foram incluídos no estudo 527 pacientes em atendimento ambulatorial. No algoritmo 4.1 foi observado que existe uma dificuldade em seguir a recomendação do Ministério da Saúde, nos dois serviços de referência, 78,9% e 72% Região Nordeste e Norte respectivamente. O algoritmo 4.2, foi o algoritmo que apresentou no geral mais de 90% de seguimento na recomendação do Protocolo Clínico, devido que os pacientes são na sua grande maioria AgHBe negativo. O algoritmo 4.3 aproximadamente 85% dos pacientes da Região Nordeste estava dentro da recomendação do Protocolo Clínico para Hepatite B crônica, entretanto, nenhum paciente da Região Norte. O Protocolo Clínico de Diretrizes Terapêuticas para Hepatite B foi um grande passo e avanço. Uma ferramenta importantíssima dentro da realidade do tratamento para Hepatite B e foi possível incorporar novas drogas e indicadores de tratamento embasados na Medicina Baseada em Evidencias e nos Consensos Internacionais pelo Ministério da Saúde.

In Brazil the treatment for Hepatitis B conical, has been provided by the National Health System for over 10 years. The aim was to analyze the treatment of patients with chronic hepatitis B in two reference centers in Viral Hepatitis in the Northeast and North of Brazil, compared to the Clinical Protocol and Therapeutic Guidelines Hepatitis B of the Ministry of Health. The study included 527 patients in outpatient care. In algorithm 4.1 it was observed that there is a difficulty in following the recommendation of the Ministry of Health in two reference centers, 78.9% and 72% northeast and north respectively. The 4.2 algorithm, the algorithm was presented in general more than 90% follow-up on the recommendation of the Clinical Protocol because patients are mostly negative HBeAg. The algorithm 4.3 approximately 85% of patients in the Northeast was in the recommendation of the Clinical Protocol for chronic hepatitis B, however, no patients in the Northern Region. The Clinical Protocol Therapeutic Guidelines for Hepatitis B was a big step and advance. An important tool within the reality of treatment for hepatitis B and it was possible to incorporate new drugs and treatment indicators grounded in Evidence-Based Medicine and the International Consensus by the Ministry of Health.

Heterogenic colonization patterns by Leptospira interrogans in Rattus norvegicus from urban slums

Abstract We evaluated the renal colonization by Leptospira interrogans in Rattus norvegicus (rats), as it is the major natural reservoir of urban leptospirosis. We caught 72 R. norvegicus, out of which 32 were found to be positive for L. interrogans by immunofluorescence assay. From these rats, we selected 17 and divided them into six groups based on the mass-age/sex. We performed the immunohistochemistry test against L. interrogans in the kidney sections of the rats and systematically counted the colonized tubules (CTs) in 20 fields. The proportion of positive fields varied from 5% to 95%. The number of CTs in 20 fields varied from 0.5 to 85.5. These differences were not related to age or sex of the animals. The characterization of leptospiral colonization patterns in the natural reservoirs is important to better understand the host-pathogen interactions in leptospirosis.

Ionic imbalance and lack of effect of adjuvant treatment with methylene blue in the hamster model of leptospirosis

Leptospirosis in humans usually involves hypokalaemia and hypomagnesaemia and the putative mechanism underlying such ionic imbalances may be related to nitric oxide (NO) production. We previously demonstrated the correlation between serum levels of NO and the severity of renal disease in patients with severe leptospirosis. Methylene blue inhibits soluble guanylyl cyclase (downstream of the action of any NO synthase isoforms) and was recently reported to have beneficial effects on clinical and experimental sepsis. We investigated the occurrence of serum ionic changes in experimental leptospirosis at various time points (4, 8, 16 and 28 days) in a hamster model. We also determined the effect of methylene blue treatment when administered as an adjuvant therapy, combined with late initiation of standard antibiotic (ampicillin) treatment. Hypokalaemia was not reproduced in this model: all of the groups developed increased levels of serum potassium (K). Furthermore, hypermagnesaemia, rather than magnesium (Mg) depletion, was observed in this hamster model of acute infection. These findings may be associated with an accelerated progression to acute renal failure. Adjuvant treatment with methylene blue had no effect on survival or serum Mg and K levels during acute-phase leptospirosis in hamsters. .

Surveillance for leptospirosis in the Americas, 1996-2005: a review of data from ministries of health / Vigilancia de la leptospirosis en la Región de las Américas, de 1996 al 2005: análisis de los datos de los ministerios de salud

Objective. To characterize current leptospirosis reporting practices in the Americas.Methods. Information was collected from the official websites of national ministries ofhealth from the Americas region and two international organizations; personal communications;and three international morbidity databases. For all sources other than the morbiditydatabases, the review was limited to official reports citing clinically suspected and laboratoryconfirmed leptospirosis cases or deaths during the period 1996–2005.Results. A total of 73 out of 1 644 reports met the selection criteria and were included inthe analysis. Published leptospirosis data were available from half of the countries/sovereignterritories (24 out of 48), and 18 of them had mandatory notification policies for leptospirosis.The sum of the median number of leptospirosis cases notified annually by the 24 countries/territories was 4 713.5, but just three countries (Brazil, Costa Rica, and Cuba) accounted for83.1% (3 920 cases) of the notifications. Eight (16.7%) countries reported deaths due to leptospirosis.The sum of the median number of deaths reported annually for the eight countrieswas 380, but 349 (91.8%) were reported by Brazil.Conclusions. Notification practices in the Americas for leptospirosis are limited. Therefore,the numbers of cases and deaths reported are not representative for the region. The lack ofleptospirosis data for many countries/territories may reflect weaknesses in certain aspects ofnational surveillance systems, including mandatory reporting policies, clinical laboratory infrastructurefor performing case confirmation, and capacity to collect reported cases. Improvedsurveillance of leptospirosis cases and deaths in the Americas is needed to allow monitoring ofregional epidemiological patterns and to estimate the burden of this important disease.

Biological, biochemical and molecular features of Trypanosoma cruzi strains isolated from patients infected through oral transmission during a 2005 outbreak in the state of Santa Catarina, Brazil: its correspondence with the new T. cruzi Taxonomy Consensus (2009)

We examined strains of Trypanosoma cruzi isolated from patients with acute Chagas disease that had been acquired by oral transmission in the state of Santa Catarina, Brazil (2005) and two isolates that had been obtained from a marsupial (Didelphis aurita) and a vector (Triatoma tibiamaculata). These strains were characterised through their biological behaviour and isoenzymic profiles and genotyped according to the new Taxonomy Consensus (2009) based on the discrete typing unities, that is, T. cruzi genotypes I-VI. All strains exhibited the biological behaviour of biodeme type II. In six isolates, late peaks of parasitaemia, beyond the 20th day, suggested a double infection with biodemes II + III. Isoenzymes revealed Z2 or mixed Z1 and Z2 profiles. Genotyping was performed using three polymorphic genes (cytochrome oxidase II, spliced leader intergenic region and 24Sα rRNA) and the restriction fragment length polymorphism of the kDNA minicircles. Based on these markers, all but four isolates were characterised as T. cruzi II genotypes. Four mixed populations were identified: SC90, SC93 and SC97 (T. cruzi I + T. cruzi II) and SC95 (T. cruzi I + T. cruzi VI). Comparison of the results obtained by different methods was essential for the correct identification of the mixed populations and major lineages involved indicating that characterisation by different methods can provide new insights into the relationship between phenotypic and genotypic aspects of parasite behaviour.

First insights into the genetic diversity of Mycobacterium tuberculosis strains in Salvador, Bahia State, Brazil / Primeiro ensaio sobre diversidade genética das cepas de Mycobacterium tuberculosis em Salvador, Bahia, Brasil

This study constitutes a first attempt to describe the genetic population structure of Mycobacterium tuberculosis circulating in Salvador, Bahia State, Brazil. A total of 56 confirmed cases of pulmonary tuberculosis, identified between March and June 2008, were analyzed using restriction fragment length polymorphism (IS6110-RFLP). The study population was characterized by a predominance of males (71.43 percent) over 30 years of age (68.75 percent). Forty-one isolates were found to belong to a single pattern (73.2 percent), while 15 (26.7 percent) were found in group patterns, forming six clusters. The higher level of diversity observed is much more suggestive of endogenous reactivation than recent transmission.

Este é o primeiro estudo realizado na Bahia, Brasil, visando à descrição da estrutura da população genética circulante do Mycobacterium tuberculosis na cidade de Salvador. Um total de 56 casos confirmados de tuberculose pulmonar, identificados entre março e junho de 2008, foi analisado pelo método Restriction Fragment Lenght Polymorphism (IS6110-RFLP). A população de estudo foi caracterizada como a maioria do sexo masculino (71,43 por cento), idade acima de 30 anos (68,75 por cento). Quarenta e um isolados (73,21 por cento) com padrão único, enquanto 15 (26,75 por cento) apresentaram padrões agrupáveis, formando seis clusters. A alta taxa de diversidade das cepas de M. tuberculosis observada é mais sugestiva de reativação endógena do que transmissão recente.

Associação entre déficit de crescimento e retardo maturacional de crianças e adolescentes infectados / Association between stunting and developmental delay in helminth-infected children and adolescents

OBJETIVO: Avaliar a influência do déficit de crescimento sobre o retardo maturacional de crianças e adolescentes com infecção helmíntica. MÉTODOS: Trata-se de um estudo transversal, em que participaram 1 764 indivíduos de 7 a 17 anos de idade, de ambos os sexos, infectados por Schistosoma mansoni isoladamente ou Schistosoma mansoni associado a geohelmintos, residentes na cidade de Jequié (BA). Os participantes foram submetidos a avaliação antropométrica, dos estágios de desenvolvimento puberal e a exame parasitológico de fezes. Foram coletadas informações referentes às condições sanitárias do domicílio e socioeconômicas da família. Optou-se pela análise de regressão logística multivariada para as análises estatísticas de interesse. RESULTADOS: Os resultados deste trabalho mostraram uma prevalência de 15,4 por cento de déficit estatural entre os integrantes do estudo. O déficit de crescimento físico associou-se ao atraso da puberdade (0R=4,01; IC95 por cento1,01-15,8). Esta associação pode ser explicada pelo impacto negativo que a desnutrição exerce sobre a produção de hormônios associados ao crescimento e sobre a produção dos hormônios sexuais. CONCLUSÃO: Estes achados sugerem que as condições inadequadas de nutrição contribuem para o retardo maturacional. Ressalta-se assim, a importância de estratégias de intervenção que possam garantir melhores condições de vida, saúde e nutrição para o desenvolvimento adequado das potencialidades vitais.

OBJECTIVE: The objective of this study is to assess the influence of stunting on the developmental delay of helminth-infected children and adolescents. METHODS: The sample of this cross-sectional study consisted of 1,764 subjects of both sexes from the city of Jequié (Bahia, Brazil), aged 7 to 17 years, infected with helminths (either Schistosoma mansoni alone or associated with associated with geohelminths). All subjects underwent anthropometric and Tanner stage assessment, and stool testing. Data on the family's socioeconomic status and sanitary conditions of the household were also collected. The data was analyzed by multivariate logistic regression. RESULTS: The results of this study show a prevalence of stunting of 15.4 percent and an association between stunting and pubertal delay (0R=4.01; CI 95 percent 1.01-15.8). The negative impact of malnutrition on the production of both sexual and growth-related hormones may explain this association. CONCLUSION: These findings suggest that inadequate nutrition contributes to developmental delay. This shows the importance of intervention strategies that guarantee better living and health conditions and nutrition for proper development.

Distribution of Hepatitis C virus (HCV) genotypes in seropositive patients in the state of Alagoas, Brazil / Distribuição de genótipos do Vírus da hepatite C (HCV) em pacientes soropositivos no Estado de Alagoas, Brasil

We determined the frequency of hepatitis C virus (HCV) genotypes in anti-HCV seropositive patients in the state of Alagoas, Brazil, by means of nested-reverse transcription-polymerase chain reaction (RT-nested-PCR) followed by restriction fragment length polymorphism (RFLP) of amplified fragments of the 5ïNCR. The nested-PCR with genotype-specific primers from the core region was carried out when detection was not possible by the first approach. Detectable HCV-RNA was present in 115 (74.7 percent) of 154 serum samples. Genotype 1 was the most frequent (77.4 percent), against 20.9 percent of genotype 3 and 0.8 percent of genotype 2. Subtype 1b was predominant (65.2 percent), followed by subtypes 1a (8.7 percent), and 3a (6.1 percent). Coinfection (1a/3a) was detected in 0.8 percent of the samples. Indeed, there was no significant differences in the prevalence of genotype 1 compared to what has been obtained from anti-HCV seropositive patients from other locations in Brazil. Here we report for the first time the genotype 2 in the state of Alagoas.

A frequência de genótipos do vírus da hepatite C (HCV) em pacientes soropositivos anti-HCV no estado de Alagoas, Brasil, foi determinada através da RT-PCR aninhada da região 5'NCR seguida pela análise do polimorfismo de comprimento dos fragmentos de restrição (RFLP). A RT-PCR aninhada utilizando primers genótipo-específicos da região core foi efetuada quando não foi possível determinar o genótipo pelo primeiro método. Níveis detectáveis de HCV-RNA estavam presentes em 115 (74,7 por cento) das 154 amostras de soro. O genótipo 1 foi o mais freqüente (77,4 por cento), contra 20,9 por cento do genótipo 3 e 0,8 por cento do genótipo 2. O subtipo 1b foi predominante (65,2 por cento), seguido pelos subtipos 1a (8,7 por cento) e 3a (6,1 por cento). Co-infecção (1a/3a) foi detectada em 0,8 por cento das amostras. Não foram encontradas diferenças significativas quanto à prevalência do genótipo 1 em relação ao que tem sido obtido de pacientes soropositivos anti-HCV de outras localidades do Brasil. Este é o primeiro relato da presença do genótipo 2 no estado.

Impacto da introdução de mídia eletrônica num curso de patologia geral / Impact of the introduction of electronic media in a general pathology course

Objetivo: Avaliar modificações implementadas recentemente num curso de Patologia Geral (PG), com vistas a incentivar a auto-instrução dos alunos por meio de recursos eletrônicos. Metodologia: Estudantes do curso de PG da Escola Bahiana de Medicina e Saúde Pública foram solicitados a preencher umquestionário sobre modificações implementadas na disciplina, entre elas a utilização de um CD-ROM elaborado e distribuído pela disciplina. Resultados: Foram avaliados 288 estudantes. A importância média dada ao CD-ROM foi de 8,45 ± 1,79, numa escala de 0 a 10, sendo esta a principal fonte de estudoutilizada por 97,2% dos estudantes para a prova prática. Os alunos que estudaram pelo CD apresentarammenor freqüência de notas baixas û consideradas inferiores a 6,0 (39,9% x 87,5%, P = 0,010) û e referiram conseguir identificar os processos gerais com maior freqüência (99,3% x 87,5%, P = 0,012) em relação aos que não utilizaram este método. 95,8% dos alunos acharam que o curso melhorou sua capacidade de reconhecer tecidos e órgãos ao microscópio. Conclusões: O CD-ROM utilizado oferece recursos que podem facilitar o processo ensino-aprendizagem, representando uma alternativa para o ensino integrado de PG.

Aim: To evaluate the modifications implemented in a General Pathology (GP) course, seeking to motivateself-instruction of the students through electronic resources. Methods: Students of the Escola Bahiana de Medicina e Saúde Pública were requested to answer a questionnaire in order to evaluate the modifications implemented in this discipline, specially the use of a CD-ROM elaborated and distributed in the course. Results: 288 students participated in the study. The mean importance given to the CD-ROM was of 8.45 ± 1.79, in a scale from 0 to 10. It was also the main study source for the practical evaluation, used by 97.2% of the students. The students who used the CD-ROM got low scores - considered inferior to 6.0 (39.9% x 87.5%, P = 0.010) - less frequently, and reported to be able of identifying the general pathologic processes more frequently (99.3% x 87.5%, P = 0.012) than the students that did not use this method.95.8% of the students thought that the course improved their capacity to recognize tissues or organs under the microscope. Conclusions: The CD-ROM offers resources that can facilitate the teaching-learning process, representing an alternative for the integrated teaching of GP.

Relação entre os níveis de vitamina A e os marcadores bioquímicos do estado nutricional de ferro em crianças e adolescentes / Relationship between vitamin A and biochemical markers of iron status in children and adolescents

OBJETIVO: Verificar a relação entre vitamina A e os marcadores bioquímicos da situação nutricional do ferro. MÉTODOS: Participaram deste estudo 178 indivíduos com idade entre 7 e 17 anos, residentes na cidade de Jequié (BA). Os indivíduos foram submetidos a exame de sangue para dosagem de retinol e de marcadores bioquímicos do estado nutricional relativo ao ferro. Além disso, foram realizados exames antropométricos, parasitológico de fezes e coletadas informações de consumo dietético de ferro e das condições sócio-ambiental e domiciliar da família. Utilizou-se a análise de regressão linear múltipla como técnica estatística para avaliar a associação de interesse. RESULTADOS: Constatou-se associação positiva e estatisticamente significante entre os níveis de retinol sérico e a concentração de hemoglobina (p=0,007), ferro sérico (p=0,010) e transferrina saturada (p=0,027). Esses efeitos se mantiveram após ajuste dos modelos pelas variáveis demográficas, infecções parasitárias (Schistosoma mansoni, Trichiura trichuris, Ascaris lumbricoides e ancilostomídeos), consumo de ferro alimentar biodisponível e condições ambientais e domiciliares. CONCLUSÃO: A vitamina A parece contribuir para elevar o ferro orgânico da população, em especial, em áreas onde a deficiência de vitamina A e a anemia coexistem.

OBJECTIVE: The objective of this study was to verify the relationship between vitamin A and the biochemical markers of iron status. METHODS: A total of 178 individuals aging from 7 to 17 years participated in this study, all living in Jequié, BA. The individuals were submitted to blood tests to dose retinol and biochemical iron markers. Furthermore, anthropometric measurements and stool analyses were done and dietary information regarding iron intake, socio-environmental and home conditions of the family were collected. Multiple linear regression analysis was done to assess the association of interest. RESULTS: A positive and statistically significant association was found between the levels of serum retinol and hemoglobin (p=0.007), serum iron (p=0.010) and iron-saturated tranferrin (p=0.027). These findings remained unchanged after adjusting the models for demographic variables, parasitic infections (Schistosoma mansoni, Trichiura trichuris, Ascaris lumbricoides and ancylostomiasis), consumption of bioavailable dietary iron and environmental and home conditions. CONCLUSION: Vitamin A seems to contribute to the increase of organic iron of the population, especially in areas were deficiency of vitamin A and iron-deficiency anemia coexist.

Methylenetetrahydrofolate reductase polymorphisms in myeloid leukemia patients from Northeastern Brazil

Methylenetetrahydrofolate reductase (MTHFR: EC 1.5.1.20) polymorphisms are associated to acute lymphoid leukemia in different populations. We used the polymerase chain reaction and the restriction fragment length polymorphism method (PCR-RFLP) to investigate MTHFR C677T and A1298C polymorphism frequencies in 67 patients with chronic myeloid leukemia (CML), 27 with acute myeloid leukemia FAB subtype M3 (AML-M3) and 100 apparently healthy controls. The MTHFR mutant allele frequencies were as follows: CML = 17.2 percent for C677T, 21.6 percent for A1298C; AML-M3 = 22.2 percent for C677T, 24.1 percent for A1298C; and controls = 20.5 percent for C677T, 21 percent for A1298C. Taken together, our results provide evidence that MTHFR polymorphisms have no influence on the development of CML or AML-M3.

A novel c.197T -> A variant among Brazilian neonates with glucose-6-phosphate dehydrogenase deficiency

Glucose-6-phosphate dehydrogenase (G6PD, EC 1.1.1.49) deficiency is the most common enzyme deficiency worldwide, causing a spectrum of diseases including neonatal hyperbilirubinemia and acute or chronic hemolysis. We used the methemoglobin reduction test and G6PD electrophoresis to screen 655 neonates (354 females and 301 males) for common G6PD mutations in the city of Salvador in the Northeastern Brazilian state Bahia and found that 66 (10.1 percent) were G6PD-deficient (41 females and 25 males). The 66 (10.1 percent) G6PD-deficient neonates were assessed for the c.376 A -> G (exon 5) and c.202 G -> A (exon 4) mutations using the polymerase chain reaction and restriction enzyme fragment length polymorphism (PCR-RFLP) analysis and the results validated by DNA sequencing. Of the 66 G6PD-deficient neonates investigated we found that 54 (81.8 percent) presented the c.376 A -> G (p.Asn126Asp) and c.202 G -> A (p.Val68Met) mutations, two (3 percent) had the c.376 A -> G mutation only, two (3 percent) had the c.202 G -> A mutation only, five (7.6 percent) exhibited a previously unrecorded 197T -> A (p.Phe66Thr) substitution in exon 4 and three showed no mutations at any of these sites. Of the five neonates exhibiting the new 197T -> A (p.Phe66Thr) substitution, four (6.1 percent) also presented the c.202 G -> A and c.376 A -> G mutations and one (1.5 percent) had the c.[197T -> A / 202 G -> A] combination. We propose to name the new variant G6PD Bahia.