Prevalence of Mycobacterium leprae and Mycobacterium lepromatosis in roadkill armadillos in Brazil.

To evaluate the prevalence of Mycobacterium leprae and Mycobacterium lepromatosis in road killed armadillos identified along Brazilian regions, samples of liver, spleen, muscle, ear, nose and tail were collected on highways from 78 animals. The armadillos were of four different species, Cabassous tatouay, Dasypus novemcinctus, Dasypus septemcinctus and Euphractus sexcinctus. After DNA extraction from two tissues, specific primers were used for the detection of each pathogen using SYBR green qualitative Real-Time PCR, and amplicons were sequenced. The species with the highest prevalence was D. novemcinctus, mainly in the Central-West, South, and Southeast regions of Brazil. We detected M. leprae DNA in 32 (41 %) of the 78 individuals and M. lepromatosis DNA was not identified in any of the examined samples. The zoonotic component of leprosy may play a role in the transmission of the disease in endemic areas in which environmental conditions and contact with reservoirs must be investigated.

Síncope cardioinibitória 2b com pausa de 48 segundos em paciente com síndrome de down e defeito do septo av corrigido: descrição do caso e do plano terapêutico / Cardioinhibitory syncope 2b with a 48-second pause in a patient with down syndrome and corrected AV septal defect: case description and therapeutic plan

INTRODUÇÃO: Os quadros de Síncope habitualmente se iniciam na adolescência. Aproximadamente 20% da população experimenta o primeiro episódio de desmaio entre 10 e 20 anos. Apesar de extremamente angustiantes estes nem sempre são investigados. Apenas 25 a 50% dos pacientes são avaliados nos serviços de saúde. Entretanto alguns casos merecem tratamento pelo risco de eventos e necessitam de acompanhamento especializado, inclusive para monitorização da indicação de dispositivos de marcapasso (MP) em caso de refratariedade ao tratamento clínico. Isto ocorre em alguns caos de síncope de padrão neuromediado do tipo cardioinibitória com pausa (Síncope cardioinibitória 2b ao Teste de Inclinação) OBJETIVO: Descrever o caso de uma paciente púbere pós com Síndrome de Down e síncopes de repetição de início recente com teste de inclinação (TI) positivo (resposta 2b). DESCRIÇÃO DO CASO: Paciente 13 anos feminina, Síndrome de Down portadora de defeito do septo AV total em fase pós operatória de correção total com bom resultado cirúrgico. Iniciou concomitante a menarca quadro de sincope recorrente com pródromos (dor abdominal e palidez). Apresenta Holter sem alterações arrítmicas e ecocardiograma com FEVD no limite inferior da normalidade. Analise do ECG com sinais de bloqueio divisional ântero superior direito. Foi submetido a avaliação por TI. Realizou protocolo de inclinação passivo a 70 graus não sensibilizado. Após 5 minutos de repouso foi inclinada e se manteve estável por 7 minutos e no oitavo minuto de inclinação apresentou dor abdominal, seguida de sincope com resposta cardioinibitória 2b e pausa de 48 segundos (fig 1) apesar do retorno a posição de Trendelenburgo (-30 graus). Houve retorno dos batimentos cardíacos com recuperação imediata do nível de consciência. Iniciado tratamento clínico com orientação de aumento da ingesta hídrica, suspender fatores desencadeantes (ortostase prolongada, ambientes quentes por exemplo) e mantido a monitorização rigorosa com intuito de avaliar a refratariedade e a necessidade de indicação de MP. CONCLUSÃO: 1) Os quadros de síncope neuromediada são particularmente frequentes durante a adolescência, principalmente após o estirão do crescimento 2) As respostas cardioinibitórias podem se instalar subitamente e serem de grande repercussão. Apesar deste fato o tratamento clínico deve ser sempre priorizado; 3) O paciente deve ser monitorizado quanto as recorrências e refratariedade ao tratamento clínico para indicação precisa de MP em pacientes com síncope cardioinibitória 2b com grandes pausas refratária à medidas gerais.

Bovine thyroglobulin gene polymorphisms and their association with sexual precocity in Guzerat bulls.

Puberty is a stage of sexual development determined by the interaction of environmental factors and genetic mechanisms. Among them, thyroid function plays a key role in sexual development and spermatogenic function and is under the control of several genes, including the well-described thyroglobulin gene (TG). Previous reports have shown genetic association between thyroid function and selected single nucleotide polymorphisms (SNPs) in taurine cattle. Therefore, the identification of genetic mechanisms involved in the regulation of this trait can assist with the selection for early pubertal bulls, thus improving genetic progress in livestock breeding. The aim of this study was to validate the association between TG SNPs and age at puberty in zebuine bulls. Three SNPs (rs110406764, rs109662686, rs109057985) were genotyped in 159 Guzerat animals using SEQUENOM technology. Results showed a significant association (p < .05) between the studied SNPs and puberty age, in agreement with our previous reports in a taurine breed. Interestingly, allele frequencies were different from those already reported, being GAT the most favourable allele for age at puberty in Guzerat (94.4 days lower). Overall, our findings corroborate previous reports and reinforce the importance of genetic influence in the regulation of sexual development and puberty through a thyroid pathway in zebuine cattle.

Genetic diversity and differentiation of exotic and American commercial cattle breeds raised in Brazil.

The Brazilian cattle population is mainly composed of breeds of zebuine origin and their American derivatives. Comprehensive knowledge about the genetic diversity of these populations is fundamental for animal breeding programs and the conservation of genetic resources. This study aimed to assess the phylogenetic relationships, levels of genetic diversity, and patterns of taurine/zebuine admixture among 9 commercial cattle breeds raised in Brazil. Analysis of DNA polymorphisms was performed on 2965 animals using the 11 microsatellite markers recommended by the International Society of Animal Genetics. High genetic diversity was detected in all breeds, even though significant inbreeding was observed within some. Differences among the breeds accounted for 14.72% of the total genetic variability, and genetic differentiation was higher among taurine than among zebuine cattle. Of note, Nelore cattle presented with high levels of admixture, which is consistent with the history of frequent gene flow during the establishment of this breed in Brazil. Furthermore, significant genetic variability was partitioned within the commercial cattle breeds formed in America, which, therefore, comprise important resources of genetic diversity in the tropics. The genetic characterization of these important Brazilian breeds may now facilitate the development of management and breeding programs for these populations.

A new concept of relatedness and its significance to the theory of social evolution

Dados de campo de espécies de Hymenoptera primitivamente sociais têm se mostrado contraditórios quanto ao papel do reconhecimento de parentes e do grau de parentesco na evoluçäo social. Nesse trabalho um novo conceito de "coeficiente de parentesco" foi desenvolvido. Esta nova hipótese foi chamada de "parentesco agregado". Nesse conceito, genes compartilhados por dois indivíduos quaisquer têm importância significativa na formaçäo das unidades familiares, dependendo de suas freqüências e da forma como estäo distribuídos na populaçäo circunvizinha a esta unidade familiar.

Control of Herbaspirillum seropedicae NifA activity by ammonium ions and oxygen.

The activity of a truncated form of Herbaspirillum seropedicae NifA in different genetic backgrounds showed that its regulatory domain is involved in nitrogen control but not in O2 sensitivity or Fe dependence. The model for nitrogen control involving PII could thus apply to the proteobacteria at large. NifA may have a role in controlling ADP-ribosylation of nitrogenase in Azospirillum brasilense.

Acceptance for chronic dialysis treatment: insufficient and unequal.

BACKGROUND: Evidence suggests that a number of end-stage renal disease (ESRD) patients die without receiving dialysis. We investigated and compared ESRD patients who died without receiving treatment and those who were accepted for dialysis. METHODS: All patients starting chronic dialysis in 1991 in the city of Sao Paulo and prospectively registered in the Health Secretariat files were studied. From death certificates we obtained data from all patients dying with an underlying cause associated with chronic renal failure. Medical records from a sample of patients who died without receiving dialysis were reviewed. RESULTS: Of 2127 patients, 1582 (74.7%) received dialysis and 545 (25.6%) did not. The best chance of being dialysed occurred in the 20-29 age group. The age groups with the least chance of receiving dialysis were 0-9 years and over 79 years old. The odds ratio (95% Cl) of not receiving dialysis was 12.42 (6.63-23.82) times greater for patients over 60 years old compared to those aged 10-19 years. Patients with renal failure due to congenital diseases, chronic pyelonephritis, unknown cause, and hypertension were less likely to receive dialysis than those with glomerulonephritis or diabetes. CONCLUSIONS: Our results suggest that many ESRD patients die without receiving dialysis. Age and cause of renal disease influence the chance of being accepted for treatment. Restrictions of treatment need to be corrected to guarantee that maintenance dialysis will be accessible to ESRD patients.

Acesso ao tratamento dialítico crônico: deficiente e desigual / Access to chronic dialysis treatment: deficient and unequal

OBJETIVO. Determinar a fraçao de pacientes com insuficiência renal crônica (IRCT) tratada por meio de diálise no Município de Sao Paulo e investigar a influência da idade em relaçao ao acesso a diálise. MATERIAL E MÉTODOS. Foram estudados todos os pacientes que receberam diálise para IRCT durante o ano de 1991, registrados junto à Secretaria de Saúde do Estado. No mesmo ano, foram também coletadas informaçoes dos indivíduos que morreram tendo com causa básica de óbito doença relacionada a insuficiência renal crônica. Estes últimos dados foram obtidos do Serviço Funerário da Prefeitura de Sao Paulo. Cruzando-se os dados destes bancos de dados foi possível descobrir os pacientes que morreram de IRCT sem ter realizado diálise e calcular a fraçao tratada nas diversas faixas etárias. RESULTADOS. De forma global, 25,6 por cento dos pacientes com IRCT nao receberam tratamento. A partir da idade de 40 anos, houve reduçao progressiva e significante (p<0,001) da fraçao de pacientes tratados conforme aumentou a idade. Até os nove anos de idade a percentagem de tratamento também foi reduzida (29 por cento). Indivíduos nas faixas etárias de 60-69 e 70-79 anos apresentaram chance cerca de 5 e 11 vezes maior, respectivamente, de morrer sem receber tratamento dialítico do que aqueles no grupo etário de 20-29 anos. CONCLUSOES. Os autores estimam que pelo menos um quarto dos pacientes com IRCT morreram em Sao Paulo, em 1991, sem ter recebido tratamento dialítico. Idade é um fator importante de discriminaçao para aceitaçao em programas de diálise crônica.

[Access to chronic dialysis treatment: deficient and unequal]. / Acesso ao tratamento dialítico crônico: deficiente e desigual.

OBJECTIVE: To determine the fraction of patients with end-stage renal disease (ESRD) who received dialysis treatment in the city of São Paulo in 1991 and to investigate the influence of age in the access to dialysis. MATERIAL AND METHODS: All patients who received dialysis for ESRD in the city of São Paulo during 1991, and were registered in the Secretary of Health of São Paulo files were included in the study. In the same year, information was also collected on individuals who died having as basic cause of death a disease related to chronic renal failure. These data were obtained from death certificates files. Using simultaneously information from both data bases it was possible to ascertain the patients who died without receiving dialysis and to calculate the treated fraction in several age groups. RESULTS: Overall 25.6% of ESRD patients did not receive treatment. There was a progressive reduction in the fraction of patients treated for those older than 40 years. In children less or equal to 9 years of age the percentage of treatment was also reduced (29%). Individuals in the age groups 60-69 and 70-79 years had a chance about 5 and 11 times greater, respectively, of dying without receiving dialysis than those in the 20-29 years group. CONCLUSIONS: We estimate that at least one fourth of the ESRD patients died in São Paulo in 1991 without receiving dialysis treatment. Age is a major factor of discrimination for acceptance in chronic dialysis programs.

Cost effectiveness of antituberculosis interventions.

The treatment of tuberculosis (TB) is ranked as the most cost effective of all therapeutic programmes in terms of cost per year of life saved. Nevertheless, TB kills or debilitates more adults aged between 15 and 59 years than any other disease in the world; furthermore, about 2 to 4% of the burden of disease, 7% of all deaths and 26% of all preventable deaths are directly attributable to TB. About one-third of the world's population is infected with the TB bacillus. In the developing world, more women of childbearing age die from TB than from causes directly associated with pregnancy and childbirth. The death of adults in their prime, who are parents, community leaders and producers in most societies, causes a particularly onerous burden besides being a serious public health problem. In the poorest countries, where the magnitude of the TB problem is greatest, those TB control strategies that are economically feasible tend to be less effective. Therefore, in low and middle income countries, cost-effectiveness considerations aimed at prioritising resource allocation in the health sector in general, and in TB control programmes in particular, are of paramount importance. Operationally, the main components of a TB control programme are: (i) detection and treatment of TB; and (ii) prevention of TB through BCG vaccination and chemoprophylaxis. Priority should be given to ensuring that TB patients complete their prescribed course of chemotherapy. Adequate treatment is the most effective way of preventing the spread of TB and the emergence of drug resistance. This article reviews evidence of the effectiveness and cost effectiveness of different approaches to TB care, particularly those that are applicable to low income countries, in both HIV-infected and noninfected patients. Financial implications and ways to implement directly observed therapy for TB in large urban areas are discussed, and the need to address some relevant operational issues is highlighted. The current role of chemoprophylaxis and BCG vaccination is also reviewed.

Assessing the cost effectiveness of NSAID: an international perspective.

A number of factors may affect the cost effectiveness of treatments and can cause this to vary by location. These factors include the patient population, relative price levels, clinical practice patterns and incentives to health professionals and institutions such as hospitals. This paper illustrates these issues by assessing the relative cost effectiveness of 3 nonsteroidal antiinflammatory drugs (NSAID), with different levels of gastrointestinal side effects, in 3 countries. We conclude that the relative cost effectiveness of drugs is not only dependent on drug price but may also vary by country.

Male pseudohermaphroditism due to nonsalt-losing 3 beta-hydroxysteroid dehydrogenase deficiency: gender role change and absence of gynecomastia at puberty.

Adrenal and gonadal functions were evaluated on two adult cousins with male pseudohermaphroditism due to congenital 3 beta-hydroxysteroid dehydrogenase deficiency (3 beta-HSD) without clinical salt-losing. Both patients had been reared as females since birth. Case 1 presented at age 17 with perineal hypospadias virilization without gynecomastia and a female to male gender role change at puberty. Case 2 had previously undergone bilateral orchidectomy in childhood and presented "primary amenorrhea", absence of virilization and a female gender role at the age of 24. In the basal state, as well as after ACTH and hCG stimulation, 3 beta-hydroxy-5-ene-steroid levels were disproportionately elevated, resulting in abnormal 3 beta-hydroxy-5-ene: 3-oxi-4-ene steroids ratios. Normal basal serum cortisol with inadequate cortisol response to ACTH was observed in both patients. Elevated basal plasma renin activity (PRA) and normal basal serum aldosterone (ALDO) were present in both subjects. After ACTH stimulation serum ALDO rose adequately in Case 1 but subnormally in Case 2. Salt restriction resulted in an increase in serum ALDO and no salt loss in Case 1 whereas in Case 2 the substantial rise in PRA and serum ALDO were unable to prevent slight urinary sodium loss. Case 1 had normal basal serum testosterone with subnormal response to hCG stimulation. Incubation of testicular tissue in vitro with [3H]DHEA resulted in large Androstenediol production but diminished testosterone conversion confirming the 3 beta-HSD deficiency in the testes. We conclude that (1) absence of gynecomastia and a female to male gender role change may be observed in the male pubertal presentation of nonsalt-losing 3 beta-HSD deficiency and (2) the different functional behavior of zona glomerulosa in our patients suggests the presence of variable degrees of 3 beta-HSD deficiency in the zona glomerulosa of the nonsalt-losing form.

[Spinal cord involvement in Burkitt-type lymphoma: report of a case]. / Comprometimento medular por linfoma tipo Burkitt: relato de um caso.

Case report of Burkitt's type lymphoma with involvement of the spinal cord in a three years-old child. An epidural tumoral mass (T11-L1) was removed surgically (Fig. 2), and clinical conditions improved for a short period of time (1 and 1/2 months) after which symptoms reappeared. At this occasion a computerized tomography showed a tumoral mass occupying the spinal canal with high density at the L2 level. The patient died 6 months after the beginning of the disease. General considerations are made on Burkitt's lymphoma.

[Fibromyxosarcoma in a child; report of a case]. / Fibromixosarcoma em criança; registro de um caso.

The case of a six-year old boy's with intracranial hypertension and cranial deformities is reported. Radiological examination showed signs of intracranial hypertension and a large osteolitic area in the left posterior parietal region. Cerebral cintilography showed many abnormal captation areas. Pneumoencephalography showed deformation of the ventricular system without dilatation. Angiographic study gave images of tumoral compression by meningitic processes. Craniotomy in the osteolytic area showed an infiltrating tumoration between dura and piamater, reaching frontal, temporal and bilateral parietal areas. Histopathological examination confirmed the diagnostic of fibromixosarcoma.

[Hemangioblastoma of supra-tentorial location]. / Hemangioblastoma de localização supra-tentorial

A case of hemangioblastoma with supra-tentorial localization is reported. General considerations are made.