Impressões sobre o teste rápido para o HIV entre usuários de drogas injetáveis no Brasil / Perceptions of HIV rapid testing among injecting drug users in Brazil / Perceptions of HIV rapid testing among injecting drug users in Brazil

OBJETIVO: Descrever as impressões, experiências, conhecimentos, crenças e a receptividade de usuários de drogas injetáveis para participar das estratégias de testagem rápida para HIV. MÉTODOS: Estudo qualitativo exploratório foi conduzido entre usuários de drogas injetáveis, de dezembro de 2003 a fevereiro de 2004, em cinco cidades brasileiras, localizadas em quatro regiões do País. Um roteiro de entrevista semi-estruturado contendo questões fechadas e abertas foi usado para avaliar percepções desses usuários sobre procedimentos e formas alternativas de acesso e testagem. Foram realizadas 106 entrevistas, aproximadamente 26 por região. RESULTADOS: Características da população estudada, opiniões sobre o teste rápido e preferências por usar amostras de sangue ou saliva foram apresentadas junto com as vantagens e desvantagens associadas a cada opção. Os resultados mostraram a viabilidade do uso de testes rápidos entre usuários de drogas injetáveis e o interesse deles quanto à utilização destes métodos, especialmente se puderem ser equacionadas questões relacionadas à confidencialidade e confiabilidade dos testes. CONCLUSÕES: Os resultados indicam que os testes rápidos para HIV seriam bem recebidos por essa população. Esses testes podem ser considerados uma ferramenta valiosa, ao permitir que mais usuários de drogas injetáveis conheçam sua sorologia para o HIV e possam ser referidos para tratamento, como subsidiar a melhoria das estratégias de testagem entre usuários de drogas injetáveis.

OBJECTIVE: To describe perceptions, experiences, knowledge, beliefs and the willingness of injecting drug users to be HIV tested by using rapid tests. METHODS: A qualitative exploratory study was carried out among injecting drug users from December 2003 to February 2004 in five Brazilian cities, located in four regions of Brazil. A semi-structured interview guide containing both closed and open-ended questions was used to address perceptions about non-conventional testing procedures, and non-traditional ways to provide testing access to injecting drug users. A total of 106 interviews, about 26 per region, were conducted. RESULTS: Characteristics of the population studied, common thoughts about HIV rapid testing, preference for using blood or saliva specimens, and other testing preferences, were presented together with reported advantages and disadvantages of each option. The study findings showed that the use of rapid tests among these users is feasible and that they are willing to be tested using rapid HIV tests, especially if some issues related to privacy and reliability of the test could be addressed. CONCLUSIONS: The study findings showed that rapid tests may be well accepted for this population. These tests can be considered a valuable tool, allowing a more injecting drug users to learn their HIV status and possibly be referred to treatment and should support more effective testing strategies for them.

[Perceptions of HIV rapid testing among injecting drug users in Brazil]. / Impressões sobre o teste rápido para o HIV entre usuários de drogas injetáveis no Brasil.

OBJECTIVE: To describe perceptions, experiences, knowledge, beliefs and the willingness of injecting drug users to be HIV tested by using rapid tests. METHODS: A qualitative exploratory study was carried out among injecting drug users from December 2003 to February 2004 in five Brazilian cities, located in four regions of Brazil. A semi-structured interview guide containing both closed and open-ended questions was used to address perceptions about non-conventional testing procedures, and non-traditional ways to provide testing access to injecting drug users. A total of 106 interviews, about 26 per region, were conducted. RESULTS: Characteristics of the population studied, common thoughts about HIV rapid testing, preference for using blood or saliva specimens, and other testing preferences, were presented together with reported advantages and disadvantages of each option. The study findings showed that the use of rapid tests among these users is feasible and that they are willing to be tested using rapid HIV tests, especially if some issues related to privacy and reliability of the test could be addressed. CONCLUSIONS: The study findings showed that rapid tests may be well accepted for this population. These tests can be considered a valuable tool, allowing a more injecting drug users to learn their HIV status and possibly be referred to treatment and should support more effective testing strategies for them.

[The role of the cerebral coherence in the progress of the patient with Alzheimer's disease]. / Papel de la coherencia cerebral en la evolución del paciente con enfermedad de Alzheimer.

INTRODUCTION: Coherence is a quantitative measurement used to express the degree of functional connection between two or more cerebral regions. MATERIAL AND METHODS: We studied 27 patients with Alzheimer's disease (EA), diagnosed according to the criteria of the NINCDS-ADRDA group. Inter and intrahemispheric cerebral coherence was analyzed to evaluate its usefulness for differentiation between different patient sub-groups, according to the GDS and MMSE scales, age and length of illness. The sample was divided into various subgroups. RESULTS AND CONCLUSIONS: We found low values of coherence between the frontal regions as compared with mediotemporal and mediocentral regions of both hemispheres, being most marked on the left side. Equally, there were inter-hemisphere differences, although these were less significant than the intra-hemisphere differences. The intra-regional coherencies showed high values in all the groups studied. This may be explained by the relative conservation of short cortico-cortical association fibres which have been found in neuropathological studies in patients with EA. The factors of frequency, region and hemisphere show a marked effect in relation to coherence values, showing higher significance values for the slower theta and delta bands of the frontal regions compared with the temporal and central regions of the left hemisphere. An analysis of tendencies shows that there are low levels of correlation between the subgroups formed by the GDS and MMSE scales for the different frequencies analyzed and the regions studied, with those patients of the most deteriorated subgroups showing a lower grade of correlation.

[Stunting risk factors in 5-year-old children]. / Factores de riesgo de retardo de crecimiento en niños de cinco años de edad.

A retrospective study of ninety two boys and one hundred and four girls at the age of five years was made with the purpose of identifying Stunting Risk Factors. "Case" was defined as a five years-old child/with height/age < 95% of the median NCHS norm and "control" as a child with height/age > 95% of the median of the same norm. Seventy six biological, psicoaffective, nutritional and socioeconomic-cultural variables were analysed on the children and their families. Data were obtained from interviews and clinical histories' revision. Odds Ratio, at a P confidence interval of 95%, Mantel-Haenszel x2, Wolf Test and Anova were calculated. Significative risk factors were: masculine sex, mother height < 1.50 cm, intergenesic interval less than 33 months referred to the immediate elder born, negligent mother, numerous family, crowded family, unadequate excrete disposition and having one undernourished brother or sister. Variance analysis also showed significant differences for: birth height, negligent mistreaing, physical mistreaing, repeated parasitic episodes, and birth order superior to third son.

A panel based assessment of early versus no nasal correction of the cleft lip nose.

There is a need to be able to assess the overall result in a significant series of cases of a method of management of the cleft lip and nose deformity in order to avoid "best case" reporting often used to introduce new techniques. The present study was performed by a panel placing standardised base view photographs in rank order. The photographs were of 10-year-old subjects of whom 15 were normal controls, 22 were from the Rikshospitalet, Oslo, all of whom had no primary nasal correction and 25 from Frenchay Hospital, Bristol, who all had radical primary nasal correction. Ranking was performed for upper nasal perimeter symmetry, nostril outline symmetry and for overall aesthetic appearance. Analysis of the results showed a significant difference between the three groups, with the corrected noses showing better symmetry. Inter and intraobserver correlations were very close. The limitations of a ranking and marking method of panel assessment are discussed, and a computerised method is presented in subsequent papers.

The cutaneous lesion in American leishmaniasis: leukocyte subsets, cellular interaction and cytokine production.

Interactions between immunocompetent cells require the participation of T cell antigen receptor (TCR) and the integrin lymphocyte function-associated molecule-1 (LFA-1, CD11a/CD18). These interactions are mediated by interlinking cytokines, which are important in determining the type of immune response. In the present study, we have shown that in American cutaneous leishmaniasis (ACL) lesions, most infiltrating T cells expressed the alpha beta TCR including those selectively migrating to the epidermis. In contrast, gamma delta T cells were abundant in localized (LCL) and scarce in muco-cutaneous (MCL) and diffuse (DCL) cutaneous leishmaniasis, suggesting a role in effective granulomas. There were differences in the expression of LFA-1 alpha and beta subunits, with most cells expressing LFA-1 beta. The ratio LFA-1 beta/LFA-1 alpha was higher in LCL (11.8:1) than in MCL (3.3:1) and DCL (2.4:1). Similar results were observed in Leishmania mexicana-infected C57BL/6 mice. DCL lesions showed a higher proportion of LFA-1 alpha+ cells than MCL and LCL lesions. A reverse-transcriptase polymerase chain reaction (RT-PCR) analysis of the cytokine profiles showed that most T cells present in the MCL and DCL lesions secrete a mixture of Type 1 and Type 2 cytokine patterns, but in DCL granulomas predominate the Type 2 cytokines. In LCL the cytokine patterns show a preponderance of INF gamma over IL-4, and low levels of IL-5 and IL-10, suggesting a Type 1 cytokine profile.

The cutaneous lesion in American leishmaniasis: leukocyte subsets, cellular interaction and cytokine production

Interactions between immunocompetent cells require the participation of T cell antigen receptor (TCR) and the integrin lymphocyte function-associated molecule-1 (LFA-1, CD11a/CD18). These interactions are mediated by interlinking cytokines, which are important in determining the type of immune response. In the present study, we have shown that in American cutaneous leishmaniasis (ACL) lesions, most infiltrating T cells expressed the alpha beta TCR including those selectively migrating to the epidermis. In contrast, gamma delta T cells were abundant in localized (LCL) and scarce in muco-cutaneous (MCL) and diffuse (DCL) cutaneous leishmaniasis, suggesting a role in effective granulomas. There were differences in the expression of LFA-1 alpha and beta subunits, with most cells expressing LFA-1 beta. The ratio LFA-1 beta/LFA-1 alpha was higher in LCL (11.8:1) than in MCL (3.3:1) and DCL (2.4:1). Similar results were observed in Leishmania mexicana-infected C57BL/6 mice. DCL lesions showed a higher proportion of LFA-1 alpha+ cells than MCL and LCL lesions. A reverse-transcriptase polymerase chain reaction (RT-PCR) analysis of the cytokine profiles showed that most T cells present in the MCL and DCL lesions secrete a mixture of Type 1 and Type 2 cytokine patterns, but in DCL granulomas predominate the Type 2 cytokines. In LCL the cytokine patterns show a preponderance of INF gamma over IL-4, and low levels of IL-5 and IL-10, suggesting a Type 1 cytokine profile

Tratamiento del carcinoma indiferenciado de pulmon con ARA-C, IFM y CCNU / Treatment of undifferentiated lung carcinoma with cytosina arabinoside, ifosfamide and lomustine

Fueron tratados 21 pacientes portadores de carcinoma indiferenciado de pulmon con un esquema de poliquimioterapia intermitente, de fundamentos citociniticos, en series moduladas incluyendo Citosina Arabinosido 60 MG/M2 S/C C/12 horas dias 1,2 y 3, Ifosfamida 1,5 gr/m2 i/v dias 4,5 y 6 Lomustine 50 mg/m2 v/o dias 4 y 5, con o sin radioterapia pre o post-quimioterapia, resultando evaluable 17 casos, obteniendose un 40% de remisiones objetivas entre RC t RP un 80% de no progresividad tumoral durante por lo menos 3 meses, con un 75% de mejorias subjetivas de una duracion promedio de 4 meses, y un aumento de la sobrevida en relacion con el tratamiento radiante solo, con una media de 6,4 meses.Dicho esquema fue generalmente mal tolerada tanto clinica como hematologicamente, destacandose especialmente su utilidad como terapia inicial inductiva y la ausencia del desarrollo de metastasis encefalicas en el curso del tratamiento, relacionandose este hecho con el efecto quimioprofilactico del CCNU sobre el S.N.C