Identification of bacteriophages in the vagina of pregnant women: a descriptive study.

OBJECTIVE: To determine the presence and identity of extracellular bacteriophage (phage) families, genera and species in the vagina of pregnant women. DESIGN: Descriptive, observational cohort study. SETTING: São Paulo, Brazil. POPULATION: Pregnant women at 21-24 weeks' gestation. METHODS: Vaginal samples from 107 women whose vaginal microbiome and pregnancy outcomes were previously determined were analysed for phages by metagenomic sequencing. MAIN OUTCOME MEASURES: Identification of phage families, genera and species. RESULTS: Phages were detected in 96 (89.7%) of the samples. Six different phage families were identified: Siphoviridae in 69.2%, Myoviridae in 49.5%, Microviridae in 37.4%, Podoviridae in 20.6%, Herelleviridae in 10.3% and Inviridae in 1.9% of the women. Four different phage families were present in 14 women (13.1%), three families in 20 women (18.7%), two families in 31 women (29.1%) and one family in 31 women (29.1%). The most common phage species detected were Bacillus phages in 48 (43.6%), Escherichia phages in 45 (40.9%), Staphylococcus phages in 40 (36.4%), Gokushovirus in 33 (30.0%) and Lactobacillus phages in 29 (26.4%) women. In a preliminary exploratory analysis, there were no associations between a particular phage family, the number of phage families present in the vagina or any particular phage species and either gestational age at delivery or the bacterial community state type present in the vagina. CONCLUSIONS: Multiple phages are present in the vagina of most mid-trimester pregnant women. TWEETABLE ABSTRACT: Bacteriophages are present in the vagina of most pregnant women.

Serological and molecular markers of hepatitis E virus infection in HIV-infected patients in Brazil.

In Brazil, the circulation of hepatitis E virus (HEV) has been demonstrated in distinct groups of individuals and some animals, but its prevalence among individuals with human immunodeficiency virus (HIV) infection is unknown. This study aimed to assess the frequency of serological and molecular HEV markers in individuals infected with HIV from São Paulo, Brazil. Serum and plasma samples of 354 HIV-infected patients collected between 2007 and 2013 were included. All samples were tested for anti-HEV IgG and IgM antibodies and HEV RNA. Anti-HEV IgG and IgM antibodies were detected in 10.7% (38/354) and 1.4% (5/354) of the samples, respectively. Both antibodies were detected simultaneously in only two samples. HEV RNA was not detected in any sample. There was no significant correlation of anti-HEV serological status (positivity to anti-HEV IgG and/or IgM) with sex, age, CD4+ T cell count, HIV viral load, antiretroviral therapy, liver enzyme levels, or coinfection with hepatitis B virus and/or hepatitis C virus. Our study provides serological evidence of past and recent HEV infections in HIV-infected patients from São Paulo, Brazil. However, the occurrence of ongoing HEV infection appears be a rare event in this population.

The present and future disease burden of hepatitis C virus (HCV) infection with today's treatment paradigm.

The disease burden of hepatitis C virus (HCV) is expected to increase as the infected population ages. A modelling approach was used to estimate the total number of viremic infections, diagnosed, treated and new infections in 2013. In addition, the model was used to estimate the change in the total number of HCV infections, the disease progression and mortality in 2013-2030. Finally, expert panel consensus was used to capture current treatment practices in each country. Using today's treatment paradigm, the total number of HCV infections is projected to decline or remain flat in all countries studied. However, in the same time period, the number of individuals with late-stage liver disease is projected to increase. This study concluded that the current treatment rate and efficacy are not sufficient to manage the disease burden of HCV. Thus, alternative strategies are required to keep the number of HCV individuals with advanced liver disease and liver-related deaths from increasing.

Actividad física y salud percibida en pacientes con enfermedad coronaria / Physical activity and perceived health in patients with coronary artery disease / Actividade física e saúde percebida em pacientes com doença coronaria

La enfermedad coronaria es una de las principales causas de morbilidad y mortalidad en el mundo y se asocia con importantes consecuencias emocionales y sociales. La actividad física parece ralentizar el inicio y la progresión de las enfermedades cardiovasculares pero también presenta beneficios sobre la salud psicosocial. El presente estudio tiene como objetivo el análisis de la relación entre la práctica de actividad física y la calidad de vida, el bienestar psicológico y la depresión en pacientes con enfermedad coronaria. La muestra estaba compuesta por 275 personas, con edades entre 54 a 98 años. Se aplicó un Cuestionario Sociodemográfico, el Cuestionario de Salud SF-36, la Escala de Depresión Geriátrica (GDS), la Escala de Bienestar Psicológico (EBP) y el Cuestionario de Actividad Física de Yale (YPAS). Los resultados obtenidos pusieron de manifiesto que la práctica de actividad física se asociaba en pacientes con enfermedad coronaria a una mejora en las distintas escalas del Cuestionario de Salud SF-36 y en la Escala de Depresión Geriátrica, confirmando su importancia para el mantenimiento de la calidad de vida relacionada con la salud en estos pacientes (AU)

Coronary artery disease is one of the main causes of morbidity and mortality in the world and associates with important emotional and social consequences. Physical activity seems to slow down the start and the progression of the cardiovascular illnesses but also presents benfits on psychosocial health. The present study is amied to analyze the relationship between the practice of physical activity and quality of life, psychological wellbeing and depression in patients with coronary illness. The sample was composed by 275 subjects, aged between 54 to 98 years. They were applied a Sociodemograpahic Questionnaire, the Questionnaire of Health SF-36,the Scale of Geriatric Depression (GDS), the Scale of Psychological Welbeing (EBP) and the Yale Physical Activity Scale (YPAS). Results obtained indicated that the practice of physical activity associated in patients with coronary illness to an improvement in the distinct scales of the Questionnaire of Health SF-36 and in the Scale of Geriatric Depression, confirming his importance for the maintenance of health-related quality of life in these patients (AU)

A doença coronaria é uma das principais causas de morbilidad e mortalidade no mundo e associa-se com importantes consequências emocionais e sociais. A actividade física parece reduzir o início e a progressão das doenças cardiovasculares mas também apresenta benefícios sobre a saúde psicosocial. O presente estudo tem como objectivo a análise da relação entre a prática de actividade física e a qualidade de vida, o bem-estar psicológico e a depressão numa mostra de pacientes com doença coronaria. A mostra estava composta por 275 pessoas, com idades entre 54 a 98 anos. Aplicou-se um Cuestionario Sociodemográfico, o Cuestionario de Saúde SF-36, a Escala de Depressão Geriátrica (GDS), a Escala de Bem-estar Psicológico (EBP) e o Cuestionario de Actividade Física de Yale (YPAS). Os resultados obtidos puseram de manifesto que a prática de actividade física se associava em pacientes com doença coronaria a uma melhora nas difrentes escalas do Cuestionario de Saúde SF-36 e na Escala de Depressão Geriátrica, confirmando sua importância para a manutenção da qualidade de vida relacionada com a saúde nestes pacientes (AU)

Characterization of microsatellite DNA libraries from three mealybug species and development of microsatellite markers for Pseudococcus viburni (Hemiptera: Pseudococcidae).

Mealybugs (Hemiptera: Pseudococcidae) are important pests for crops worldwide. Different species, cryptic taxa under the same species name or even populations within a species can differ in biological characteristics, such as phenology, resistance to insecticides, virus transmission and susceptibility to natural enemies. Therefore, their management efficacy depends on their accurate identification. Microsatellite genetic markers are efficient in revealing the fine-scale taxonomic status of insects, both at inter- and intra-specific level. Despite their potential uses, microsatellites have been developed only for one mealybug species so far. Hence, it is unclear whether microsatellites may be useful to assess mealybug population differentiation and structuring. In this work, we tested the feasibility of developing microsatellite markers in mealybugs by: (i) producing and characterizing microsatellite DNA libraries for three species: Pseudococcus viburni, Pseudococcus comstocki and Heliococcus bohemicus, and (ii) by developing and testing markers for Ps. viburni. The obtained libraries contained balanced percentages of dinucleotide (ranging from 15 to 25%) and trinucleotide (from 5 to 17%) motifs. The marker setup for Ps. viburni was successful, although 70% of the primers initially tested were discarded for a lack of polymorphism. Finally, 25 markers were combined in two multiplex polymerase chain reactions with 21 displaying no evidence of deviation from Hardy-Weinberg equilibrium. Ps. viburni markers were tested on one population from France and one from Chile. The markers revealed a significant genetic differentiation between the two populations with an Fst estimate of 0.266.

Molecular and morphological characterization of mealybugs (Hemiptera: Pseudococcidae) from Chilean vineyards.

Mealybugs are major pests of grapevines worldwide. They cause economic losses by lowering the cosmetic value of fruits, reducing yields, transmitting viruses and resulting in the quarantine or rejection of produce in international trade. Knowledge of the species present in a vineyard is important for the adjustment of management strategies. We surveyed and accurately characterized the mealybugs infesting vineyards in one of the main production areas of Chile; 164 mealybugs were sampled from 26 vineyards in four regions of Chile and identified by DNA sequencing for two markers (cytochrome oxidase I and internal transcribed spacer 2) and morphological examination. Pseudococcus viburni (Signoret) was the most common species, followed by Pseudococcus meridionalis Prado and Pseudococcus cribata González. Molecular variability at the COI and ITS2 loci was observed in both P. viburni and P. cribata. A comparison of haplotypes of P. viburni worldwide provides support for a recent hypothesis that this species is native to South America, a finding with direct consequences for management. Neither Pseudococcus longispinus (Targioni & Tozzetti) nor Planococcus ficus Signoret were found.

Hepatitis Delta virus genotype 8 infection in Northeast Brazil: inheritance from African slaves?

Hepatitis Delta virus (HDV) is endemic worldwide, but its prevalence varies in different geographical areas. While in the Brazilian Amazon, HDV is known to be endemic and to represent a significant public health problem, few studies have assessed its prevalence in other regions in the country. This study evaluated the seroprevalence of HDV among HBsAg chronic carriers from Maranhão state, a region located in the Northeast of Brazil. Among 133 patients, 5 had anti-HD, of whom 3 had HDV RNA. HDV genotypes were characterized by Bayesian phylogenetic analysis of nucleotide sequences from the HDAg coding region. HDV-3 was identified in one patient who lives in Maranhão, but was born in Amazonas state (Western Amazon basin). Phylogenetic analysis shows that this HDV-3 sequence grouped with other HDV-3 sequences isolated in this state, which suggests that the patient probably contracted HDV infection there. Surprisingly, the other two patients were infected with HDV-8, an African genotype. These patients were born and have always lived in Urbano Santos, a rural county of Maranhão state, moreover they had never been to Africa and denied any contact with people from that continent. This is the first description of the HDV-8 in non-native African populations. This genotype may have been introduced to Brazil through the slaves brought to the country from the West Africa regions during the 16-18th centuries. Our results indicate that the need of clinical and epidemiological studies to investigate the presence of this infection in other areas in Brazil.

High frequency of lamivudine resistance mutations in Brazilian patients co-infected with HIV and hepatitis B.

This study analyzed the genotype distribution and frequency of lamivudine (LAM) and tenofovir (TDF) resistance mutations in a group of patients co-infected with HIV and hepatitis B virus (HBV). A cross-sectional study of 847 patients with HIV was conducted. Patients provided blood samples for HBsAg detection. The load of HBV was determined using an "in-house" real-time polymerase chain reaction. HBV genotypes/subgenotypes, antiviral resistance, basal core promoter (BCP), and precore mutations were detected by DNA sequencing. Twenty-eight patients with co-infection were identified. The distribution of HBV genotypes among these patients was A (n = 9; 50%), D (n = 4; 22.2%), G (n = 3; 16.7%), and F (n = 2; 11.1%). Eighteen patients were treated with LAM and six patients were treated with LAM plus TDF. The length of exposure to LAM and TDF varied from 4 to 216 months. LAM resistance substitutions (rtL180M + rtM204V) were detected in 10 (50%) of the 20 patients with viremia. This pattern and an accompanying rtV173L mutation was found in four patients. Three patients with the triple polymerase substitution pattern (rtV173L + rtL180M + rtM204V) had associated changes in the envelope gene (sE164D + sI195M). Mutations in the BCP region (A1762T, G1764A) and in the precore region (G1896A, G1899A) were also found. No putative TDF resistance substitution was detected. The data suggest that prolonged LAM use is associated with the emergence of particular changes in the HBV genome, including substitutions that may elicit a vaccine escape phenotype. No putative TDF resistance change was detected after prolonged use of TDF.

Propriedades mecânicas do cimento ósseo e da poliuretana de mamona com e sem catalisador / Mechanical properties of bone cement and castor oil-based polyurethane with and without a catalyst

Avaliou-se o comportamento mecânico do polímero de mamona, tendo por variáveis o tempo de produção e a presença de catalisador, e utilizando como padrão comparativo o cimento ósseo (polimetilmetacrilato). Foram estabelecidos três grupos experimentais, de acordo com o tipo de corpo de prova (cilindro ou barra) e polímero utilizado, que foram posteriormente subdivididos em subgrupos conforme o tempo após produção, ou seja, 24, 48 e 72 horas. O ensaio de compressão analisou a carga máxima e a tensão e o ensaio de dobramento estudou o módulo de dobramento e a resistência. Estatisticamente não houve diferenças nos valores de resistência à compressão ou ao dobramento às 24, 48 e 72 horas após a produção do polimetilmetacrilato e da poliuretana, com ou sem catalisador. A poliuretana com catalisador foi a mais resistente nos ensaios de compressão, apresentando módulo de dobramento semelhante ao do polimetilmetacrilato e resistência ao dobramento superior à da poliuretana sem catalisador. Conclui-se que: o tempo não alterou as propriedades mecânicas dos compósitos avaliados; o catalisador melhorou o desempenho mecânico da poliuretana de mamona; na resistência mecânica à compressão, a poliuretana com catalisador suportou mais carga que o polimetilmetacrilato.

The mechanical properties of castor oil-based polyurethane was evaluated considering post-production time and the presence of a catalyst as variables and using bone cement (polymethylmetacrylate) as a comparative pattern. According to proof body type (cylinders or bars) and the used polymer, three experimental groups were established. Such groups were later subdivided according to post-production time, namely, 24, 48, and 72 hours. A compression assay analyzed maximum load and tension, and a folding assay evaluated the folding module and resistance. There were no statistical differences in the values for resistance to compression or folding at 24, 48, and 72 hours after the production of polymethylmetacrylate and polyurethane with or without a catalyst. Castor oil-based polyurethane with a catalyst showed to be the most resistant during the compression assays as its folding module was similar to that of polymethylmetacrylate, and its folding resistance was higher than that of polyurethane without a catalyst. In conclusion, time did not change the mechanical properties of the evaluated composites; the catalyst improved the mechanical performance of castor oil-based polyurethane; castor oil-based polyurethane with a catalyst supported more load during the assay for mechanical resistance to compression than did polymethylmetacrylate.

Genotypic distribution of hepatitis C among hepatitis C and HIV co-infected patients in Brazil.

Information on hepatitis C virus (HCV) genotypic distribution among HIV-HCV co-infected patients is lacking in Brazil as well as other Latin American countries. The objective of this study was to evaluate the level of exposure to different risk factors associated with HCV transmission among a group of co-infected patients and to characterize the genotypic distribution of HCV in this cluster. A series of 100 HIV-HCV co-infected patients was analysed. The data to be analysed were collected from specific laboratory tests. Information was collected through a questionnaire. HCV genotyping was carried out by sequencing the 5' non-coding region of HCV. Chi-square and Fischer association tests or Kruskal-Wallis test were used to study the association between HCV transmission-related variables and the established genotypes. In conclusion, exposure to multiple risk factors associated with HCV transmission was common among HIV co-infected patients and an association between HCV genotype 3 and intravenous drug user was observed.

Effect of long-term exposure to aluminum on the acetylcholinesterase activity in the central nervous system and erythrocytes.

Aluminum (Al), a neurotoxic agent, has been associated with Alzheimer's disease (AD), which is characterized by cholinergic dysfunction in the central nervous system. In this study, we evaluated the effect of long-term exposure to aluminum on acetylcholinesterase (AChE) activity in the central nervous system in different brain regions, in synaptosomes of the cerebral cortex and in erythrocytes. The animals were loaded by gavage with AlCl(3) 50 mg/kg/day, 5 days per week, totalizing 60 administrations. Rats were divided into four groups: (1) control (C); (2) 50 mg/kg of citrate solution (Ci); (3) 50 mg/kg of Al plus citrate (Al + Ci), and (4) 50 mg/kg of Al (Al). AChE activity in striatum was increased by 15% for Ci, 19% for Al + Ci and 30% for Al, when compared to control (P < 0.05). The activity in hypothalamus increased 23% for Ci, 26% for Al + Ci and 28% for Al, when compared to control (P < 0.05). AChE activity in cerebellum, hippocampus and cerebral cortex was decreased by 11%, 23% and 21% respectively, for Al, when compared to the respective controls (P < 0.05). AChE activity in synaptosomes was increased by 14% for Al, when compared to control (P < 0.05). Erythrocyte AChE activity was increased by 17% for Al + Ci and 11% for Al, when compared to control (P < 0.05). These results indicate that Al affects at the same way AChE activity in the central nervous system and erythrocyte. AChE activity in erythrocytes may be considered a marker of easy access of the central cholinergic status.

Occult hepatitis B virus infection in the setting of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection: clinically relevant or a diagnostic problem?

The clinical relevance of occult hepatitis B virus (HBV) infection, defined as detectable HBV DNA serum/liver, in the absence of hepatitis B surface antigen (HBsAg), is unclear. We determined the prevalence of serum occult HBV infection in HIV/HCV co-infected patients enrolled in APRICOT, a randomized multinational trial that investigated the efficacy and safety of peginterferon alfa-2a (40 kDa) plus ribavirin for treatment of HCV. We also examined the effect of prior HBV exposure to liver histology at baseline. Only HBsAg-negative patients were eligible. At screening, serum HBV DNA was assessed by commercial assay (detection limit = 200 copies/mL). Patients were divided into four serological groups: anti-HBs+/anti-HBc+; anti-HBs-/anti-HBc+; anti-HBs+/ anti-HBc-; anti-HBs-/anti-HBc-. Baseline liver biopsy grade and stage were compared among groups. Serum HBV DNA was undetectable in all patients, (n = 866). Results of anti-HBs and anti-HBc was available for 176 patients: 60 (34.1%) anti-HBs+/anti-HBc+; 60 (34.1%) anti-HBs-/anti-HBc+; 11 (6.3%) anti-HBs+/anti-HBc-; 45 (25.6%) anti-HBs-/anti-HBc-. There were no differences among the groups in the histological grade or stage at baseline liver biopsies. Occult HBV infection in serum was not detected in this large immunocompetent cohort. Moreover, prior exposure to HBV did not appear to have any affect on baseline liver histology.

Inhibition of NTPDase, 5'-nucleotidase, Na+/K+-ATPase and acetylcholinesterase activities by subchronic treatment with Casearia sylvestris.

The aqueous extract of Casearia sylvestris was tested in cortical membrane preparations. C. sylvestris was obtained commercially from two different sources, designated as Sample A and Sample B. The enzymes studied in this work were NTPDase-like, 5'-Nucleotidase, Na(+)/K(+)-ATPase and acetylcholinesterase (AChE). Adult rats received aqueous extracts from C. sylvestris in a dose of 20mg/kg body wt. daily for a 75-day-period, by oral administration (gavage). Our study showed that this treatment caused an inhibition of NTPDase-like activity with both, ATP (19.41% with Sample A and 25.03% with Sample B) and ADP (41.57% with Sample A and 31.20% with Sample B) as substrates. This treatment also caused an inhibition of 5'-nucleotidase activity (28.34% with Sample A and 31.46% with Sample B) and Na(+)/K(+)-ATPase (25.08% with Sample A and 24.81% with Sample B). The rate of acetylcholine degradation was reduced, as shown by the inhibition of AChE (31.65% and 26.74%, Samples A and B, respectively). These results suggest that extracts of C. sylvestris can cause neurochemical alterations in the purinergic and cholinergic systems of the central nervous system.

Hepatitis C virus seroprevalence and risk factors among patients with HIV infection.

The objective of this study was to evaluate the prevalence and risk factors associated with HCV infection in a group of HIV seropositive patients. We analyzed the medical records of 1,457 patients. All patients were tested for HCV infection by third generation ELISA. Whenever possible, a sample of the positive patients was also tested for HCV by PCR. HCV positive patients were analyzed according to their risk factors for both infections. The prevalence of anti-HCV positive patients was 17.7% (258 patients). Eighty-two (82) of these patients were also tested by PCR and 81 were positive for HCV virus (98%). One hundred fifty-one (58.5%) were intravenous drug users (IDU); 42 (16.3%) were sexual partners of HIV patients; 23 (8.9%) were homosexual males; 12 (4.7%) had received blood transfusion; 61 (17.5%) had promiscuous sexual habits; 14 (5.4%) denied any risk factor; 12 (4.7%) were sexual partners of IDU. Two hundred four patients mentioned only one risk factor. Among them, 28 (10.9%) were sexual partners of HIV-positive patients. Although intravenous drug use was the most important risk factor for co-infection, sexual transmission seemed to contribute to the high HCV seroprevalence in this group of patients.

Prevalence of hepatitis B and C in the sera of patients with HIV infection in São Paulo, Brazil.

The objective of this study was to evaluate the prevalence of hepatitis B and C viruses in a group of HIV infected patients, followed at a single institution since 1996. 1,693 HIV positive patients (1,162 male, 531 female) were tested for HBV infection. Virological markers for HBV included HBsAg and total anti-HBc by ELISA. 1,457 patients (1,009 male, 448 female) were tested for HCV infection. Detection of HCV antibodies was carried out by ELISA. A sample of HCV antibody positive patients was tested for HCV by PCR to confirm infection. Of 1,693 patients tested for HBV, 654 (38.6%) and 96 (5.7%) were anti-HBc and HBsAg positive, respectively. Of 1, 457 patients tested for HCV, 258 (17.7%) were anti-HCV positive. 82 of these patients were also tested by PCR and 81 were positive (98%). Of 1,411 patients tested for HBV and HCV 26 (1.8%) were positive for both viruses.

[Alpha-fetoprotein: normal values in amniotic fluid between 14 and 21 weeks]. / Alfafetoproteína: valores normais no líquido amniótico entre 14 e 21 semanas.

BACKGROUND: To define the normal values of amniotic fluid alphafetoprotein in pregnant women, whose gestational ages range from 14 to 21 weeks, in the Hospital de Clínicas de Porto Alegre. MATERIAL AND METHOD: One hundred thirty seven women with indication for amniocentesis were studied. The alphafetoprotein was measured in all samples using enzyme immunoassay. One hundred and nine normal pregnancies were selected. All of these fetuses had normal karyotype and had no malformation. They were not twins and their amniotic fluid samples were not bloody. These samples were divided by their gestational ages. Then the medians of the alphafetoprotein values and their multiples were calculated. RESULTS: The medians of alphafetoprotein (KUI/ml) for each gestational age were as follows: 14 weeks: 16.32; 15 weeks: 14.36; 16 weeks: 13.43; 17 weeks: 10.93; 18 weeks: 8.22; 19 weeks: 7.35; 20 weeks: 5.62; 21 weeks: 4.47. CONCLUSION: The establishment of alphafetoprotein normal values in our service allows us to use this assay for patients at risk of neural tube defects. It also makes possible to analyze samples sent for cytogenetic or metabolic studies, in order to identify elevated levels of alphafetoprotein, so that these fetuses could have a more detailed sonography study to look for malformations.

Prevalence and etiology of gastroduodenal ulcer in HIV-positive patients: a comparative study of 497 symptomatic subjects evaluated by endoscopy.

OBJECTIVE: In 497 HIV-positive (+) patients with upper digestive tract symptoms, 23 (5%) had gastroduodenal ulcers (GDU) at upper endoscopy. METHODS: To establish the causes of GDU in this setting, 16 of these patients who had had comprehensive histological evaluation (group I) were compared with 20 HIV+ subjects with upper gastrointestinal symptoms but without ulcer (group II), and with 16 seronegative patients with GDU (group III). Eighty-one percent of group I subjects and 90% of group II patients had C3 AIDS. The presence of gastritis and Helicobacter pylori, fungi, mycobacteria, viruses (especially cytomegalovirus [CMV] and herpes simplex [HSV]), and parasites was determined in all three groups by histopathological and microbiological studies. RESULTS: The prevalence of chronic active gastritis was 13/16 (81%) in group I, 12/20 (60%) in group II, and 15/16 (94%) in group III. It was associated with H. pylori in group III, and with opportunistic pathogens in groups I and II and with none in group III. H. pylori was detected in 5/16 patients (31%) in group I, in 12/20 (60%) in group II, and 11/16 (69%) in group III. Cytomegalovirus was histologically diagnosed in 8/16 patients (50%) in group I and in 1/20 (5%) in group II. This virus was the only factor shown to be significantly associated with GDU in these cases (p = 0.0046). Cryptosporidium was found in 2/16 (12.5%) patients in group I, in 1/20 (5%) in group II, and in none in group III. Differences between groups I and II were not statistically significant. No other organisms were observed in the three groups. CONCLUSIONS: Gastroduodenal ulcers were infrequent in HIV+ subjects with upper digestive tract symptoms and CMV was the only organism significantly associated with GDU in HIV+ patients. Among HIV+ patients, H. pylori was an uncommon cause of ulcer. Among HIV+ subjects with ulcer, chronic active gastritis was more common than H. pylori and it was associated with other pathogens. Finally, HIV+ patients with GDU should have endoscopic biopsies to detect opportunistic infections, especially CMV, because H. pylori infection is uncommon.

Enxertos paramaleolares a partir da artéria poplítea: resultados imediatos e tardios / Popliteal-paramalleolar artery bypass: erly and late results

Os autores analisam os resultados a curto e a longo prazo de 20 enxertos poplíteo paramaleolares em 18 pacientes realizados no período de janeiro de 1989 a novembro de 1994 com um acompanhamento variando de um mês a 60 meses. Os pacientes tinham um bom pulso poplíteo e pulsos podálicos ausentes, apresentavam lesão trófica de artelhos ou ante-pé tendo sido submetidos a antibioticoterapia, desbridamento e ou amputação e artelhos com má evolução. A perviedade imediata foi de 82 'por cento' (16 membros). Os quatro membros restantes com enxerto não funcionante necessitaram de amputação transtibial. A perviedade acumulada após 60 meses, baseada na curva atuarial foi de 73 'por cento'. Um paciente apesar do enxerto funcionante evoluiu para amputação ao nível da coxa por infecção ascendente com óbito. Os demais encontraram-se pérvios. Três pacientes morreram neste período, todos com enxerto funcionante. Esse tipo de enxerto é uma boa opção terapêutica a curto e a longo prazo para pacientes que apresentam isquemia devido a lesöes da artéria poplítea distal e artérias tibiais.