Single ulcers on the tongue dorsum: differential diagnosis between paracoccidioidomycosis and squamous cell carcinoma.

BACKGROUND: Paracoccidioidomycosis (PCM) is the leading cause of death among systemic mycoses in Brazil. On the other hand, oral squamous cell carcinoma (OSCC) is the most prevalent malignant neoplasm of the mouth. Both lesions rarely affect the tongue dorsum and may share similar clinical characteristics. This study aimed to retrieve cases of single oral ulcers diagnosed as PCM or OSCC. MATERIAL AND METHODS: A cross-sectional retrospective study was conducted. All patients who had a single ulcer on dorsum of the tongue and confirmed diagnosis of PCM or OSCC were evaluated. RESULTS: A total of 9 patients (5 women and 4 men) were evaluated, 5 patients had OSCCs (mean age = 69,8 years old), and 4 patients PCM (mean age = 51 years old). Most of the lesions were infiltrated and indurated in the palpation exam. Duration ranged from 1 to 12 months (mean time of 5.2 months and 4.7 months for OSCC and PCM, respectively). OSCC was the main clinical diagnosis hypothesis. CONCLUSIONS: Although uncommon, PCM and OSCC should be considered as a diferential diagnosis hypothesis in infiltrated ulcers on the tongue dorsum. Iincisional biopsy is mandatory to confirm the diagnosis and indicate the appropriate treatment.

Effect of supplementation of soft drinks with green tea extract on their erosive potential against dentine.

BACKGROUND: Matrix metalloproteinase (MMP) inhibitors reduce dentine erosion. This in vitro study evaluated the effect of the supplementation of soft drinks with green tea extract, a natural inhibitor of MMPs, on their erosive potential against dentine. METHODS: For each drink tested (Coca-Cola, Kuat guarana, Sprite and light Coca-Cola), 40 dentine specimens were divided into two subgroups differing with respect to supplementation with green tea extract at 1.2% (OM24, 100%Camellia sinensis leaf extract, containing 30 ± 3% of catechin; Omnimedica, Switzerland) or not (control). Specimens were subjected to four pH cycles, alternating de- and remineralization in one day. For each cycle, samples were immersed in pure or supplemented drink (10 minutes, 30 mL per block) and in artificial saliva (60 minutes, 30 mL per block) at 37 °C, under agitation. Dentine alterations were determined by profilometry (µm). Data were analysed by two-way ANOVA and Bonferroni's test (p < 0.05). RESULTS: A significant difference was observed among the drinks tested with Sprite leading to the highest surface loss and light Coca-Cola to the lowest. Supplementation with green tea extract reduced the surface loss by 15% to 40% but the difference was significant for Coca-Cola only. CONCLUSIONS: Supplementation of soft drinks with green tea extract might be a viable alternative to reduce their erosive potential against dentine.

Neutrophil oxidative metabolism and haemogram of sheep experimentally infected with Haemonchus contortus and supplemented with selenium and vitamin E.

The objective of this study was to evaluate neutrophil oxidative metabolism and haemogram in sheep experimentally infected with Haemonchus contortus and supplemented with selenium and vitamin E. Twenty male Corriedale sheep were utilised and distributed into four experimental groups each with five animals infected with larvae: G1--supplemented with sodium selenite, 0.2 mg/kg body weight (bw) given intramuscularly (IM); G2--supplemented with sodium selenite and vitamin E, 0.2 mg/kg bw and 2000 IU per animal, respectively, both IM; G3--supplemented with vitamin E, 2000 IU per animal IM; G4--not supplemented. A haemogram and the number of parasite eggs were determined in samples of blood and faeces, respectively, on days zero (T0), 20 (T1), 40 (T2) and 60 (T3) and nitroblue tetrazolium (NBT) assays were performed on heparinized blood samples taken on days zero, 30 and 60. A lower total leucocyte count was detected in G1 in relation to G4 at T4. Lymphocytes were reduced in G1 in relation to G3 and G4 at T3. In both non-stimulated (NBT-NS) and stimulated (NBT-S) dye reduction assays, there was reduced activity at 60 days, in relation to other times in the groups treated with selenium (G1 and G2). On the basis of results obtained, we conclude that supplementation with selenium provides better antioxidant protection to neutrophils.

Endothelial function in normotensive and high-normal hypertensive subjects.

To evaluate the impact of a mild increment in blood pressure level on endothelial function, we evaluated 61 healthy volunteers (24 women, 37 men, and aged 35-50 years). All subjects underwent a blood chemistry panel to exclude any metabolic abnormalities and were submitted to a Doppler ultrasound of the brachial artery to assess endothelial function. We assessed the endothelial response to reactive hyperaemia and exogenous nitric oxide administration considering an increase in systolic blood pressure (SBP) at each 10-mm Hg interval. Our study population was divided as follows: SBP <115 mm Hg (SG1, n=13), SBP > or =115 mm Hg and <125 mm Hg (SG2, n=20), SBP > or = 125 mm Hg and <135 mm Hg (SG3, n=13) and SBP > or = 135 mm Hg and < 140 mm Hg (SG4, n=15). We found a significant difference in flow-mediated dilation among SG2, SG3 and SG4, 16.2+/-5.6, 13.4+/-5.2 and 11.5+/-3.6%, P<0.05, respectively). After nitrate administration, we observed a nonsignificant decrease in brachial artery dilation among groups, P=0.217. Our data showed in a healthy normotensive population, without any risk factor for atherosclerotic disease that small increases in SBP but not in diastolic blood pressure may impair endothelial function even in subjects considered as high-normal, meaning that this population deserves more attention than usually ascribed to intervene and prevent complications, as endothelial dysfunction may represent an early change in those who develop hypertension later in life.

Spatial distribution of schistosomiasis foci on Itamaracá Island, Pernambuco, Brazil.

Acute cases of schistosomiasis have been found on the coastal area of Pernambuco, Brazil, due to environmental disturbances and disorderly occupation of the urban areas. This study identifies and spatially marks the main foci of the snail host species, Biomphalaria glabrata on Itamaracá Island. The chaotic occupation of the beach resorts has favoured the emergence of transmission foci, thus exposing residents and tourists to the risk of infection. A database covering five years of epidemiological investigation on snails infected by Schistosoma mansoni in the island was produced with information from the geographic positioning of the foci, number of snails collected, number of snails tested positive, and their infection rate. The spatial position of the foci were recorded through the Global Positioning System (GPS), and the geographical coordinates were imported by AutoCad. The software packages ArcView and Spring were used for data processing and spatial analysis. AutoCad 2000 was used to plot the pairs of coordinates obtained from GPS. Between 1998 and 2002 5009 snails, of which 12.2% were positive for S. mansoni, were collected in Forte Beach. A total of 27 foci and areas of environmental risk were identified and spatially analyzed allowing the identification of the areas exposed to varying degrees of risk.

Spatial distribution of schistosomiasis foci on Itamaracá Island, Pernambuco, Brazil

Acute cases of schistosomiasis have been found on the coastal area of Pernambuco, Brazil, due to environmental disturbances and disorderly occupation of the urban areas. This study identifies and spatially marks the main foci of the snail host species, Biomphalaria glabrata on Itamaracá Island. The chaotic occupation of the beach resorts has favoured the emergence of transmission foci, thus exposing residents and tourists to the risk of infection. A database covering five years of epidemiological investigation on snails infected by Schistosoma mansoni in the island was produced with information from the geographic positioning of the foci, number of snails collected, number of snails tested positive, and their infection rate. The spatial position of the foci were recorded through the Global Positioning System (GPS), and the geographical coordinates were imported by AutoCad. The software packages ArcView and Spring were used for data processing and spatial analysis. AutoCad 2000 was used to plot the pairs of coordinates obtained from GPS. Between 1998 and 2002 5009 snails, of which 12.2 percent were positive for S. mansoni, were collected in Forte Beach. A total of 27 foci and areas of environmental risk were identified and spatially analyzed allowing the identification of the areas exposed to varying degrees of risk.

Evolutionary relationships and biogeography of Biomphalaria (Gastropoda: Planorbidae) with implications regarding its role as host of the human bloodfluke, Schistosoma mansoni.

The wide geographic distribution of Schistosoma mansoni, a digenetic trematode and parasite of humans, is determined by the occurrence of its intermediate hosts, freshwater snails of the genus Biomphalaria (Preston 1910). We present phylogenetic analyses of 23 species of Biomphalaria, 16 Neotropical and seven African, including the most important schistosome hosts, using partial mitochondrial ribosomal 16S and complete nuclear ribosomal ITS1 and ITS2 nucleotide sequences. A dramatically better resolution was obtained by combining the data sets as opposed to analyzing each separately, indicating that there is additive congruent signal in each data set. Neotropical species are basal, and all African species are derived, suggesting an American origin for the genus. We confirm that a proto-Biomphalaria glabrata gave rise to all African species through a trans-Atlantic colonization of Africa. In addition, genetic distances among African species are smaller compared with those among Neotropical species, indicating a more recent origin. There are two species-rich clades, one African with B. glabrata as its base, and the other Neotropical. Within the African clade, a wide-ranging tropical savannah species, B. pfeifferi, and a Nilotic species complex, have both colonized Rift Valley lakes and produced endemic lacustrine forms. Within the Neotropical clade, two newly acquired natural hosts for S. mansoni (B. straminea and B. tenagophila) are not the closest relatives of each other, suggesting two separate acquisition events. Basal to these two species-rich clades are several Neotropical lineages with large genetic distances between them, indicating multiple lineages within the genus. Interesting patterns occur regarding schistosome susceptibility: (1) the most susceptible hosts belong to a single clade, comprising B. glabrata and the African species, (2) several susceptible Neotropical species are sister groups to apparently refractory species, and (3) some basal lineages are susceptible. These patterns suggest the existence of both inherent susceptibility and resistance, but also underscore the ability of S. mansoni to adapt to and acquire previously unsusceptible species as hosts. Biomphalaria schrammi appears to be distantly related to other Biomphalaria as well as to Helisoma, and may represent a separate or intermediate lineage.

Replacing oxamniquine by praziquantel against Schistosoma mansoni infection in a rural community from the sugar-cane zone of Northeast Brazil: an epidemiological follow-up.

A group of 52 villagers was followed-up for three years regarding Schistosoma mansoni infection. All villagers were periodically surveyed by the Kato-Katz method. In March 1997 and March 1998 the positives were treated with oxamniquine (15-20 mg/kg), and in March 1999, with praziquantel (60 mg/kg). All infection indices decreased substantially between March 1999 and March 2000: prevalence of infection (from 32.7% to 21.2%), prevalence of moderate/heavy infection (from 7.7% to 1.9%), intensity of infection (from 23.1 epg to 7.4 epg) and reinfection (from 35.7% to 14.3%). Negativation increased from 53.8 to 82.4. An optimistic prognostic is assumed in the short term for the introduction of praziquantel in the study area.

Specific situations related to acute schistosomiasis in Pernambuco, Brazil.

The present work reports on two epidemiological episodes resulting in acute schistosomiasis involving wealthy persons living in the State of Pernambuco, Brazil. The authors discuss the epidemiological, clinical and serologic characteristics of the acute infections and also the way in which the conditions for transmission occurred.

[An outbreak of acute schistosomiasis at Porto de Galinhas beach, Pernambuco, Brazil]. / Epidemia de esquistossomose aguda na praia de Porto de Galinhas, Pernambuco, Brasil.

We recently confirmed several cases of acute schistosomiasis in Porto de Galinhas beach, Northeast Brazil. A total of 662 patients were diagnosed by parasitological and clinical examinations. The infection likely occurred during the September 7 national holiday, when heavy rainfall flooded the Ipojuca River and people were infected when the water covered their yards. Families were continuously exposed to infection for a period of three weeks until the water had completely dried up. Previous investigation suggests that snail vectors were introduced as a result of landfill in marshy areas. The swamp-flooding of such areas facilitated the emergence of slums surrounded by snail breeding sites. Heavy rainfall caused open-air sewage ditches to overflow, allowing for infection of snails by Schistosoma mansoni. Thus, continuous floods were responsible for the spread of human infection. Clinical and laboratory results identified 62% of acute cases of S. mansoni. Complementary studies are being conducted to define the impact and epidemiological meaning of the acute schistosomiasis outbreak.

[Evaluation of control measures implemented from 1977 to 1996 in the endemic area of schistosomiasis in Pernambuco, Brazil]. / Avaliação das ações de controle da esquistossomose implementadas entre 1977 e 1996 na área endêmica de Pernambuco, Brasil.

This study assesses the evolution of schistosomiasis in the endemic area of Pernambuco, using data from five campaigns of chemotherapy control carried out by national health programmes from 1977 to 1996. Analysis of the data showed that: a) the proportion of municipalities with prevalence above 25% was significantly higher in the coastal-forest zone than in the zone of transitional vegetation Agreste in the four evaluations made in the endemic area; b) the prevalence of infection decreased in both zones even when the interval between campaigns were more than five years. The last survey (1996) indicated a predominance of municipalities with prevalences below 25%. However, the majority of these municipalities had localities with prevalence above 50%. A proposal is presented for the identification of the problematic localities, where complementary measures to chemotherapy, such as systematic snail control, improved sanitation, health education and community mobilization, are still necessary.

[Ecoepidemiology of urban schistosomiasis in Itamaracá Island, Pernambuco, Brazil]. / Ecoepidemiologia da esquistossomose urbana na ilha de Itamaracá, Estado de Pernambuco.

INTRODUCTION: In 1988, 22 autochthonous cases from accidental exposure were registered in Forte Orange beach, Itamaracá Island, Pernambuco, Brazil. All cases occurred in middle-to-upper class individuals who were vacationing in the island. After the cases were identified, the major objective was to find breeding sites of schistosomiasis vectors and correlate the biological factors with the environmental conditions. METHODS: The environmental characteristics of the beach before human occupation were obtained from several documents. Also, a one-year malacological survey was conducted with monthly collection of mollusks, and the determination of their infectivity rates. RESULTS/CONCLUSIONS: The malacological survey was able to identify 20 breeding sites of Biomphalaria glabrata and 28 capture station were set up. Snails were collected and examined each month throughout a whole year. The results show a seasonal variation in the mollusk population density associated with infection rates and types of breeding sites. The importance of this new epidemiological profile of schistosomiasis in the State of Pernambuco relies on the fact that it can be related with the drastic human interference on the environment. Ecological, environmental, and demographic factors as well as the epidemiological characteristics of the disease have social and economic repercussions.

[Intestinal schistosomiasis and its control in North-East Brazil]. / La schistosomose intestinale et son contrôle dans le Nord-Est du Brésil.

Intestinal schistosomiasis is endemic in the sugar cane belt near the coast of North-East Brazil. The environment and poor living conditions of the agricultural workers of this area combine to perpetuate the transmission of this disease. However, a new epidemiological pattern is emerging on the coast of Pernambuco State, where workers from the endemic area are building weekend homes without proper drainage. National control programs have led to a dramatic reduction in severe infections. However, they have not yet succeeded in stopping disease transmission altogether. The transfer of responsibility for control to local public health structures, which is currently underway, should improve the situation.

[Occurrence of snail vectors of schistosomiasis in a dam of the semi-arid region of Pernambuco State, Brazil]. / Registro de ocorrência de vetores da esquistossomose mansônica em açude do Sertão de Pernambuco.

The semi-arid region of Pernambuco state is not an endemic or focal area for schistosomiasis. The present work registers the occurrence of Biomphalaria straminea in a local dam with favorable chemical-physical characteristics to the proliferation of these mollusks. This observation gets the attention for the possibility of the introduction of the disease in this semi-arid region due to the growing multiplication of these dams.

Primary leiomyosarcoma of bone: report of two cases in extragnathic bones.

Primary leiomyosarcoma of extragnathic bone is rare; fewer than 50 cases are found in the literature. We report on two patients, adult men, with tumors located on the long bones (close to the knee joint). Radiographically, the tumors were shown as purely destructive, osteolytic, and infiltrative lesions. The diagnosis was based on light microscopy, including immunohistochemistry and ultrastructural examination. The tumor cells were uniformly positive for vimentin and muscle actin, but not for desmin. In one case, the cells were also positive for alpha-smooth muscle actin. Electron microscopy showed definitive smooth muscle differentiation, including cytoplasmic filaments with focal densities. Both patients died of pulmonary metastases.

Epidemiology and anthropology: an integrated approach dealing with bio-socio-cultural aspects as strategy for the control of endemic diseases.

The control of endemic diseases has not attained the desired level of effectiveness in spite of the use of modern efficient technologies. The classic interventionist approach for the control of schistosomiasis is centered on systemic control of the snail hosts combined to large scale medical treatment and is usually carried out without social preoccupation due to the assisted communities. It is easy to understand the interest and the ethical compromise of public health research while producing studies in which the biological and social determinants as well as the cultural components should be considered and also encompass the historical dimensions and symbolic representations. In face of the recent political decision in favor of decentralizations of health administration to municipal level, we suggest, in the present paper, an integrated approach for the epidemiological diagnosis of an endemic situation at local level. Theoretical and methodological aspects from both, epidemiology and anthropology are discussed. Epidemiological methods can be used to detect the dependent variables (those related to the human infection) and the independent variables (demographic, economic, sanitary and social). Another methodological approach of anthropological/ethnographic nature can be conducted in order to make an articulation of the knowledge on the various dimensions or determinant levels of the disease. Mutual comprehension, between researchers and the people under investigation, on the dynamic transmission process would be relevant for a joint construction, at local level, of programmed actions for the control of endemic diseases. This would extend reflections on the health/disease process as a whole.

Schistosomiasis control based on repeated chemotherapy in a rural village of the sugar-cane zone in northeast Brazil.

A schedule of repeated chemotherapy with oxamniquine, consisting of biannual treatment of school-aged (7-13 years) children and annual treatment of all other age groups, was used in a representative rural village from a highly endemic area of schistosomiasis in Pernambuco. Significant reductions in infection were obtained only after two cycles of treatment, as the overall prevalence decreased from 72.6% to 41.7% and the geometric mean egg counts per gram of faeces among positives fell from 188.4 to 76. In a school-aged cohort (n = 29) three treatments at six-month intervals were necessary to significantly reduce the proportion of positives (from 75.9% to 51.7%). In a cohort of children under 7 years of age (n = 20) the proportion of positives actually increased (from 30% to 45%) despite two annual treatments. Water contact was intense and host snail density was relatively high. As there is no short-term perspective of improved sanitation, auxiliary measures such as focal mollusciciding are needed for an adequate control of schistosomiasis in this and alike areas.