Comparative study of the accuracy of different technique for the laboratory diagnosis of schistosomiasis mansoni in areas of low endemicity in Barra Mansa City, Rio de Janeiro State, Brazil

Schistosomiasis constitutes a major public health problem, with an estimated 200 million people infected worldwide. Many areas of Brazil show low endemicity of schistosomiasis, and the current standard parasitological techniques are not sufficiently sensitive to detect the low-level helminth infections common in areas of low endemicity (ALEs). This study compared the Kato-Katz (KK); Hoffman, Pons, and Janer (HH); enzyme-linked immunosorbent assay- (ELISA-) IgG and ELISA-IgM; indirect immunofluorescence technique (IFT-IgM); and qPCR techniques for schistosomiasis detection in serum and fecal samples, using the circumoval precipitin test (COPT) as reference. An epidemiological survey was conducted in a randomized sample of residents from five neighborhoods of Barra Mansa, RJ, with 610 fecal and 612 serum samples. ELISA-IgM (21.4%) showed the highest positivity and HH and KK techniques were the least sensitive (0.8%). All techniques except qPCR-serum showed high accuracy (82­95.5%), differed significantly from COPT in positivity , and showed poor agreement with COPT. Medium agreement was seen with ELISA-IgG (Kappa = 0.377) and IFA (Kappa = 0.347). Parasitological techniques showed much lower positivity rates than those by other techniques. We suggest the possibility of using a combination of laboratory tools for the diagnosis of schistosomiasis in ALEs.

Evaluation of the sensitivity of IgG and IgM ELISA in detecting Schistosoma mansoni infections in a low endemicity setting.

Schistosomiasis is a major public health concern, with 200 million people infected worldwide. In Brazil, this disease has been reported in 19 states, and its prevalence in the city of Barra Mansa in Rio de Janeiro State is 1 %. The parasitological diagnostic methods currently available in these areas lack sensitivity; however, enzyme-linked immunosorbent assays (ELISAs) have been employed successfully for the diagnosis of schistosomiasis by using antibodies against antigens of Schistosoma mansoni adult worms and eggs, and for the detection of circulating antigens. The objective of this study was to determine systematically the prevalence of S. mansoni infection in the peripheral areas of Barra Mansa. A cross-sectional study was conducted from April to December 2011 by using probabilistic sampling that collected 610 fecal samples and 612 serum samples. ELISA-IgG with total extracts and ELISA-IgM with trichloroacetic acid-soluble fractions were employed to detect antibodies against S. mansoni and were compared with the Kato-Katz and Hoffman parasitological techniques. Among the individuals studied, anti-S. mansoni antibodies were detected in 11.16 % (n = 71) by ELISA-IgG and in 20.75 % (n = 132) by ELISA-IgM, while the parasitological techniques showed 0.82 % (n = 5) positivity. The agreement between the two ELISA tests was 85.38 % (n = 543), and 8.65 % (n = 55) of the serum samples showed positive results in both tests. The higher positivity of the ELISA-IgM test corroborates the results of previous reports and indicates that the test may be a useful tool in epidemiological studies, particularly in areas of low endemicity for S. mansoni.

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.

Identificación preoperatoria de factores psicológicos predictivos de riesgo en el paciente pediátrico / Preoperative identification of psychological risk factors in pediatric patients

El objetivo de este estudio es identificar en el período preoperatorio,la prevalencia de posibles factores psicológicos predictivos de buen o mal pronóstico en la evolución postoperatoria a corto plazo en niños sometidos a cirugía de corta estancia hospitalaria y de su familia.Se analizan psicológicamente,antes y a los 7 días de la intervención,100 niños de edades entre 6-14 años,y sus familias,sometidos a cirugía electiva bajo anestesia general,en régimen de hospitalización de día.Evaluación preoperatoria del niño:STAIC,HFRS,EPQ-J,CDS y TAMAI y de sus padres:Faces -III,SCRS y FILE.Evaluación postoperatoria del niño:STAIC y CDS.Agrupación de variables mediante análisis factorial: Factor 1:Estado clinico psicopatológico(CDS y STAIC-E)Factor 2:Personalidad(EPQ-J y STAIC-R) y capacidad de atención(TAMAI)Factor 3:ansiedades y temores específicos(HFRS)Test Student muestras apareadas comparación variables clínicas.Análisis de regresión múltiple por pasos(STAIC-E y CDS postoperatorio/variables preoperatorias)De todos los pacientes(83V/17M)el 66 por ciento tenían entre 6-8 años de edad.Existe disminución en STAIC-E y STAIC-R postoperatorios.Existen diferencias significativas al comparar STAIC-E postoperatorio con STAIC-R,CDS-PS y CDS-RA preoperatoria,y el CDS-TD postoperatorio con CDS con STAIC-R y CDS-PS preoperatorio.Existen diferencias significativas(p<0,001)al comparar CDS-TP postoperatorio con CDS-AA,SCRS,STAIC-E y Faces-Adaptabilidad preoperatorios.La cirugía de corta estancia hospitalaria provoca niveles de ansiedad en niños,no observando valores del STAIC-R,o STAIC-E sugestivos de alteraciones de ansiedad o neurosis.Se consideran factores psicológicos predictivos de mal pronóstico en el período preoperatorio la dificultad de integración y el aislamiento social,los rasgos ansiosos de personalidad y un estado de humor negativo.Por el contrario,son factores de buen pronóstico,un estado emocional positivo,un elevado grado de autocontrol,una adecuada cohesión y adaptabilidad familiar y un menor grado de ansiedad preoperatoria

Identificación preoperatoria de factores psicológicos predictivos de riesgo en el paciente pediátrico / Preoperative identification of psychological risk factors in pediatric patients

El objetivo de este estudio es identificar en el período preoperatorio,la prevalencia de posibles factores psicológicos predictivos de buen o mal pronóstico en la evolución postoperatoria a corto plazo en niños sometidos a cirugía de corta estancia hospitalaria y de su familia.Se analizan psicológicamente,antes y a los 7 días de la intervención,100 niños de edades entre 6-14 años,y sus familias,sometidos a cirugía electiva bajo anestesia general,en régimen de hospitalización de día.Evaluación preoperatoria del niño:STAIC,HFRS,EPQ-J,CDS y TAMAI y de sus padres:Faces -III,SCRS y FILE.Evaluación postoperatoria del niño:STAIC y CDS.Agrupación de variables mediante análisis factorial: Factor 1:Estado clinico psicopatológico(CDS y STAIC-E)Factor 2:Personalidad(EPQ-J y STAIC-R) y capacidad de atención(TAMAI)Factor 3:ansiedades y temores específicos(HFRS)Test Student muestras apareadas comparación variables clínicas.Análisis de regresión múltiple por pasos(STAIC-E y CDS postoperatorio/variables preoperatorias)De todos los pacientes(83V/17M)el 66 por ciento tenían entre 6-8 años de edad.Existe disminución en STAIC-E y STAIC-R postoperatorios.Existen diferencias significativas al comparar STAIC-E postoperatorio con STAIC-R,CDS-PS y CDS-RA preoperatoria,y el CDS-TD postoperatorio con CDS con STAIC-R y CDS-PS preoperatorio.Existen diferencias significativas(p<0,001)al comparar CDS-TP postoperatorio con CDS-AA,SCRS,STAIC-E y Faces-Adaptabilidad preoperatorios.La cirugía de corta estancia hospitalaria provoca niveles de ansiedad en niños,no observando valores del STAIC-R,o STAIC-E sugestivos de alteraciones de ansiedad o neurosis.Se consideran factores psicológicos predictivos de mal pronóstico en el período preoperatorio la dificultad de integración y el aislamiento social,los rasgos ansiosos de personalidad y un estado de humor negativo.Por el contrario,son factores de buen pronóstico,un estado emocional positivo,un elevado grado de autocontrol,una adecuada cohesión y adaptabilidad familiar y un menor grado de ansiedad preoperatoria

Estudio comparativo de distintos métodos de drenaje pleural en un modelo experimental de neumotórax / Comparison of several methods of pleural drainage in an experimental model of pneumothorax

Objetivos: Conocer, en animales de experimentación, la utilidad de distintas formas de drenaje torácico para evacuar neumotórax y poder seleccionar qué tipo de sistema de drenaje produce menores alteraciones sobre la función respiratoria. Método: Se utilizan 34 conejos de raza Nueva Zelanda blancos, con peso medio de 1.687 ñ 78 g y edad media de 59 días, sometidos al siguiente diseño experimental: grupo problema (P) dividido en 2 grupos: P1 (n = 10): neumotórax unilateral y drenaje, y P2 (n = 10): neumotórax bilateral y drenaje. Grupo control (C), dividido en C1 (n = 7): drenaje pleural unilateral, y C2 (n = 7): drenaje pleural bilateral. El tubo pleural (número 8 para recién nacidos) se conecta en cada animal sucesivamente, cada 7 min, a sistemas de drenaje bajo "sello de agua", con un volumen entre cavidad pleural y sello de 35,58 ml (sistema de Bülau neonatal) y de 3.940 ml (sistema de triple cámara comercializado), así como a aspiraciones de -5 y -20 cm de agua. Se valora en cada animal los siguientes parámetros: mortalidad, fluctuaciones de la columna del "sello de agua", frecuencia cardíaca (FC), frecuencia respiratoria (FR), pH y gases en sangre arterial. Resultados: La mortalidad intraoperatoria es significativamente mayor (p < 0,001) durante la conexión a sistema de gran volumen sin aspiración, sobre todo en P2, coincidiendo con mínimas fluctuaciones de la columna del "sello de agua", junto con un incremento de la PaCO2 y un descenso de la FC, FR, PaO2, SaO2 y pH. La recuperación, tras la producción del neumotórax, es mayor al conectar a aspiraciones de -5 y -20 cm de agua. Conclusiones: La utilización de sistemas de drenaje pleural que crean un espacio muerto aéreo voluminoso entre la cavidad pleural y el "sello de agua", en ausencia de aspiración continua, en esta experiencia, es causa frecuente de mortalidad o de insuficiencia respiratoria. Creemos que el drenaje torácico bajo "sello de agua" sin aspiración debe utilizarse mediante sistema de Bülau con el menor volumen posible. (AU)

[Lymphangioma of the spermatic cord]. / Linfangioma de cordón espermático.

We report a new case of spermatic cord lymphangioma in a infant 2 years old. The initial diagnosis was funicular hydrocele. The treatment was the local excision of tumor and the diagnostic was histological. Postoperative course was excellent. Must be explored the transillumination of the mass which would have led us to think other the diagnosis different from that of the cord hydrocele before the operation since it would have given negative. During the operation, must the assured that the cystic anomaly is limited to spermatic cord, to evite recurrences in the postoperative course.

[Comparative study of different methods of pleural drainage in an experimental model of pneumothorax]. / Estudio comparativo de distintos métodos de drenaje pleural en un modelo experimental de neumotórax.

OBJECTIVE: To observe the usefulness of several procedures for draining pneumothorax in an animal model and to identify the best pleural drainage system with minimal impairment of respiratory function. METHOD: Thirty-four New Zealand white rabbits weighting 1687 +/- 78 g and aged a mean 59 days were randomly placed in groups as follows. Unilateral pneumothorax was induced in the first problem group (P1) rabbits (n = 10) by thoracostomy, with pleural drainage. In the second problem group (P2) of rabbits (n = 10), bilateral pneumothorax was similarly induced by thoracostomy with pleural drainage. The control groups underwent unilateral (C1; n = 7) and bilateral (C2; n = 7) thoracostomy and drainage. Every 7 minutes the chest tube was connected successfully in each animal to an underwater seal with a dead-space volume of 35.58 ml (neonatal Bülau unit) or to a 3,940 ml system (chest drainage unit) and to pleural aspirations of -5 and -20 cmH2O. We analyzed mortality, fluctuations of the hydrostatic column of the underwater seal, heart rate (HR), respiratory rate (RR), PaCO2, SaO2, pH and arterial blood gas measures. RESULTS: Intraoperative mortality was significantly higher (particularly in the P2 group) when connection was to a large volume system without aspiration. Recovery after pneumothorax was more satisfactory with aspiration of -5 and -20 cmH2O. CONCLUSIONS: The results suggest that a pleural drainage unit with a large dead space between the pleural cavity and the underwater seal is a frequent cause of respiratory failure or insufficiency. We believe that when an underwater seal without pleural suction is applied, the Bülau unit should be used with the smallest possible volume.

[Testicular teratoma and epididymal adrenal choristoma]. / Teratoma testicular y coristoma adrenal epididimario.

We report a case of mature testicular cystic teratoma in a 28-month old boy. Due to the characteristics of the palpation and its partial transillumination, it may be confused with a hydrocele. They emphasize on the rarity and benign nature of the peculiarities and refer to its prognosis, usually benign, when is diagnosed at about 2 years of age, providing that a very careful examination of the histological sections rules out the presence of anaplastic cells. A left inguinal orchiectomy was performed because it was not possible to establish a line of cleavage between the tumor and the normal tissue. The pathologic examination revealed a benign lesion. An adrenal choristoma in the caput epididymis was also observed. Postoperative course was satisfactory.