[Sonographic evaluation of Achilles tendon healing in tenotomies for congenital clubfoot and Ponsetis treatment. A 12-week follow-up]. / Evaluación ultrasonográfica del tendón de Aquiles en niños con pie equino varo aducto congénito posterior a tenotomía de Aquiles con el método de Ponseti. Seguimiento a 12 semanas.

OBJECTIVE: The aim of this study was to determine the healing time of Achilles tendon in pediatric patients treated with Achilles tenotomy with the Ponseti method in Shriners Childrens Hospital of Mexico, AC. MATERIAL AND METHODS: Experimental, analytical, prospective, longitudinal study of patients with a diagnosis of idiopathic congenital clubfoot treated with the Ponseti method with serial static and dynamic evaluation by ultrasound in real time with a Siemens Diagnostic Ultrasound System Sonoline 650, linear transducer 10.5 MHz of Achilles tendon before tenotomy and at three, six, nine and 12 weeks after the surgical treatment. RESULTS: A sample of 23 patients, 16 male and seven female, 16 with unilateral and seven with bilateral pathology was obtained, for a total of 39 feet, 18 right and 21 left, with a mean age of 8.3 ± 2.3 months. Before tenotomy, the width was 2.7 ± 0.42 mm; in week three, the average was 3 ± 0.39 mm; at six weeks, 2.92 ± 0.36 mm; ultrasound at nine weeks reported an average of 0.38 ± 2.84 mm, and 2.82 ± 0.39 mm at twelve weeks. They were compared using Students t presurgical width and at twelve weeks, without finding difference p 0.03. CONCLUSIONS: Although there is integrity at three weeks after Achilles tenotomy, complete repair is achieved at 12 weeks.

OBJETIVO: Determinar el tiempo de curación del tendón de Aquiles en pacientes pediátricos tratados mediante tenotomía de Aquiles con método Ponseti en el Hospital Shriners para Niños de México, AC. MATERIAL Y MÉTODOS: Estudio experimental, analítico, prospectivo, longitudinal de pacientes con diagnóstico de pie equino varo aducto congénito idiopático en tratamiento con método Ponseti con evaluación estática y dinámica mediante ecógrafo en tiempo real Siemens Diagnostic Ultrasound System Sonoline 650 con transductor lineal de 10.5 mHz seriada del tendón de Aquiles previa a la tenotomía y a las tres, seis, nueve y 12 semanas tras el tratamiento quirúrgico. RESULTADOS: Se obtuvo una muestra de 23 pacientes, 16 masculinos y siete femeninos, 16 con patología bilateral y siete unilateral, para un total de 39 pies, 18 derechos y 21 izquierdos, con una media de edad de 8.3 ± 2.3 meses. Previamente a la tenotomía, la anchura en corte longitudinal ultrasonográfico media fue de 2.7 ± 0.42 mm; en la semana tres, la media fue 3 ± 0.39 mm; a las seis semanas, 2.92 ± 0.36 mm; el ultrasonido de las nueve semanas reportó media de 2.84 ± 0.38 mm y a las 12 semanas, 2.82 ± 0.39 mm. Se compararon mediante t de Student el ancho prequirúrgico y a las 12 semanas, sin encontrarse diferencia p 0.03. CONCLUSIONES: La valoración ecográfica muestra integridad a las tres semanas posteriores a la tenotomía de Aquiles. Sin embargo, la reparación completa se logra a las 12 semanas.

Hepatitis C and lipid metabolism, hepatic steatosis, and NAFLD: still important in the era of direct acting antiviral therapy?

Chronic hepatitis C (CHC) and nonalcoholic fatty liver disease (NAFLD) have an individual prevalence of 1.8-3% and at least 30%, respectively, in the United States. It is therefore not surprising that there is overlap between these two common chronic liver diseases, although the relationship appears to go beyond isolated co-existence. Hepatic steatosis is a common feature of CHC infection and can be related to both metabolic and viral specific factors. Steatosis in the setting of nongenotype 3 CHC has been predictive of response to therapy prior to the advent of the direct acting antiviral medications (DAAs). Similarly, lipid metabolism appears important in response to CHC treatment. The pathways for both lipid homeostasis and NAFLD as it pertains to CHC infection as well as the utilization of statin therapy in CHC infection will be reviewed with a focus on the relevance of these topics in the era of DAA therapy.

Nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is fast becoming the most common chronic liver condition in many parts of the world. It is a heterogeneous disease encompassing a broad spectrum of histologic states characterized universally by macrovesicular hepatic steatosis. NAFLD is now recognized as the hepatic manifestation of the metabolic syndrome and is a major cause of liver-related morbidity and mortality. The prevalence of the disease is increasing, tied closely to the increased prevalence of insulin resistance in industrialized countries. Risk factors for NAFLD include obesity, diabetes, insulin resistance, and hypertriglyceridemia. The clinical course of NAFLD depends upon the histologic subtype. Patients with simple hepatic steatosis generally are thought to have a benign long-term prognosis. However, nonalcoholic steatohepatitis can progress to cirrhosis and may have a similar prognosis as cirrhosis from other liver disease with progression to end stage liver disease and hepatocellular carcinoma. The decision to obtain a biopsy is determined by weighing the risks of the biopsy against the information obtained from the biopsy. No standardized therapeutic approach exists although many promising modalities are under investigation. This paper presents an overview of the incidence and prevalence of disease, diagnosis, histologic spectrum, natural history, pathogenesis, clinical course, and current treatment of nonalcoholic fatty liver disease.

Ascaris-Trichuris association and malnutrition in Brazilian children.

This work was designed to evaluate the role of intestinal parasites on nutritional status in three rural areas of Brazil. A total of 520 children aged 1-12 years were studied through a questionnaire concerning housing, socio-economic conditions and a 24-h food intake recall. Measurements of weight and height were also performed, and three stool samples were collected on consecutive days for parasitological analysis. Scores of the standard deviation (z-scores) for the weight-for-height and height-for-age were used to characterise the growth profile. A high prevalence of intestinal parasites was detected, with Giardia lamblia (44%), Endolimax nana (43%), Ascaris lumbricoides (41%) and Trichuris trichiura (40%) being the most prevalent. Eleven per cent of the children were classified as showing stunting. Inadequate daily caloric intake was observed in 78% of the population and the proportion of those with inadequate protein intake was 34%. Logistic regression analysis was employed for the multivariate study. Stunting was significantly associated with estimators of low economic income, inadequate protein intake and polyparasitism, especially the association between Ascaris lumbricoides and Trichuris trichiura.

PIP: This study was designed to assess the association between stunting and helminthic infections by studying children aged 1-12 years living in a rural area near Sao Paolo, Brazil. A total of 520 children were studied through a questionnaire concerning housing, socioeconomic conditions and a 24-hour food intake recall. Measurement of weight and height were also performed, and three stool samples were collected on consecutive days for parasitological analysis. The study has demonstrated a positive association between intestinal parasites and stunting in children. Intestinal parasites were present in 79% and stunting in 11.5% of children from the sample. 56.7% of the children with stunting were between 5 and 12 years of age, which justified the unusual inclusion of children above 5 years of age. The most prevalent intestinal parasites detected were Giardia lamblia (44%), Endolimax nana (43%), Ascaris lumbricoides (41%), and Trichuris trichiura (40%). In the study, no children reported diarrhea and/or fever. Nevertheless, the mechanism of parasitic infections includes anorexia, type of food intake, intestinal villus damage, competition for nutrients, facilitation of bacterial colonization, increase in energy requirements, decrease in hepatic protein synthesis, protein-losing enteropathy, and blood loss. Inadequate daily caloric intake was observed in 78% of the population, and the proportion of those with inadequate protein intake was 34%. Stunting was significantly associated with estimators of low economic income, inadequate protein intake and polyparasitism.

Caso de Moniliformis Moniliformis (Acanthocephala) em criança na Cidade de Säo Paulo / Moniliformis moniliformis (Acanthocephala) from a child in Säo Paulo, Brazil

Em abril de 1994 foi encaminhado ao Laboratório de Enteroparasitoses do Instituto Adolfo Lutz, para identificaçäo, um verme eliminado por criança do sexo feminino, de 12 meses de idade, que vinha apresentando quadro de diarréia, vômito e perda de peso. O exemplar foi examinado em miscroscópio estereoscópio e após estudos biométricos morfológicos, foi classificado como fêmea do gênero Moniliformis moniliformis, Acanthocephala, parasita comum do rato e que pode, acidentalmente, parasitar o homem. O objetivo do presente trabalho é relatar o segundo caso de parasitismo humano no Brasil e chamar a atençäo para a ocorrência eventual do parasita em nosso meio.

Diagnóstico laboratorial de Pneumocystis carinii em vários tipos de amostras de materiais de secreçäo pulmonar proveniente de indivíduos portadores do vírus HIV / Laboratory diagnosis of Pneumocystis carinii on varied specimens of bronchial secretions from individuals infected with HIV

Vários tipos de amostras de materiais de secreçäo pulmonar proveniente de indivíduos portadores do vírus HIV foram analisadas no intuito de se detectar P. carinii, importante agente etiológico de pneumonia, em indivíduos imunocomprometidos. Durante o período de junho de 1990 a maio de 1992, 612 amostras foram analisadas, sendo 560 de homens e 52 de mulheres. As amostras foram submetidas à técnica de coloraçäo de azul de toluidina O. Das 251 amostras de escarro näo induzido recebidas, apenas 11 (4,38 porcento) foram positivas, dentre as 298 amostras de lavado brônquico, 25 (8,39 porcento) mostraram-se positivas e em 63 lavados broncoalveolar, 10 (15,87 porcento) revelaram a presença do parasita. Dentre as amostras analisadas o lavado broncoalveolar apresentou maior índice de positividade, estando de acordo com os relatos da literatura

Human infection by Phagicola sp. (Trematoda, Heterophyidae) in the municipality of Registro, São Paulo State, Brazil.

In 1988, nine cases of human parasitism by Phagicola sp. were diagnosed in the municipality of Registro (São Paulo State, Brazil) by stool examinations, in patients who ate raw mullet (Mugil sp.). Six (66%) of the nine patients suffered from flatulence and four (44%) had diarrhoeal episodes; six (66%) showed slight eosinophilia. On the same occasion, 61 dogs and 11 cats from Registro were also submitted to stool examination. Only one dog (1.6%) showed Phagicola eggs in the stool. All patients were treated with a single dose of praziquantel (50 mg kg-1 body weight) and control stool tests performed on the 15th, 30th and 60th days post-treatment showed no trematode eggs.

[Cryptosporidium parasitism in children with acute diarrhea]. / Parasitismo por Cryptosporidium sp. em crianças com diarréia aguda.

During the period from August 1987 to July 1990, 241 fecal samples collected from 1 to 48 months old children with acute diarrhea and examined in the Child's Institute of Hospital das Clínicas of Faculdade de Medicina da Universidade de São Paulo, were submitted to parasitological tests in the Enteroparasitosis Section of the Instituto Adolfo Lutz. Fourty two (17.43%) fecal samples showed Cryptosporidium sp. oocysts by carbol-fucsin stain. Parasitism by Cryptosporidium sp. was more frequent during the period comprised from March to May, in the studied three years. The authors discussed the Cryptosporidium sp. in association with other agents.

[Occurrence of Strongyloides stercoralis in patients with acquired immunodeficiency syndrome (AIDS)]. / Ocorrência de Strongyloides stercoralis em pacientes portadores da síndrome de imunodeficiência adquirida (AIDS).

A comparative study on the occurrence of Strongyloides stercoralis larvae in 554 patients with AIDS and in 142 patients suffering from infectious diseases other than AIDS was conducted during the period from January 1987 to December 1988. The two groups was constituted by male individuals in-patients at Emílio Ribas Hospital--São Paulo. Faeces samples from 696 patients were submitted to spontaneous sedimentation method and Rugai method. The data obtained from the present investigation demonstrated a similar prevalence of Strongyloides stercoralis in both groups (p > 0.05) indicating no significant statistical differences.

Giardiase em creches mantidas pela Prefeitura do Municipio de Sao Paulo, 1982/1983 / Giardiasis in nurseries supported by Säo Paulo Municipal Prefecture, 1982/1983

Durante os anos de 1982 e 1983, foram realizados exames parasitologicos de fezes em 3.076 criancas de 0-6 anos, matriculadas em 52 creches mantidas pela Prefeitura do Municipio de Sao Paulo e em 50 manipuladores de alimentos (funcionarios da cozinha), relativos a 18 creches. Estudou-se a prevalencia de infeccao por Giardia lamblia conforme sexo e faixa etaria do hospedeiro e sazonalidade da infeccao. A giardiase foi mais frequente nas faixa etarias compreendidas entre 1-4 anos. A prevalencia media foi 32,8 por cento entre as criancas e 4,0 por cento entre os manipuladores de alimentos. O estudo da sazonalidade de infeccao revelou ser a giardiase, em 1982, mais prevalente no Outono e Primavera; em 1983, as maiores prevalencias ocorreram no Outono e Verao. Estudos estatistico revelaram nao haver associacao entre sexo e prevalencia de infeccao, nao ocorrendo tambem nehuma diferenca significativa entre as quatro regioes metropolitanas estudadas (p>0,05). O modo mais provavel de aquisicao de G. lamblia nas creches estudadas foi atraves do contato inter-humano, uma vez que tanto os fatores ambientais, como outros, incriminados na veiculacao da giardiase atraves da agua em outros paises, diferem dos encontrados em nosso Municipio. Os manipuladores de alimentos tiveram papel pouco expressivo como fonte de infeccao, pois a prevalencia de infeccao nesses individuos foi de apenas 4,0 por cento.

Ocorrencia de Taenia sp. na populacao atendida no laboratorio central do Instituto Adolfo Lutz, Sao Paulo, SP, Brasil (1960/1989) / Occurrence of Taenia sp. in the population seen at the Central Laboratory of the Adolfo Lutz Institute, Sao Paulo, SP, Brazil (1960/1989)

Foram examinados retrospectivamente os relatorios mensais e anuais da Secao de Enteroparasitoses do Laboratorio Central do Instituto Adolfo Lutz, Sao Paulo, SP, no periodo de 1960 a 1989, perfazendo uma serie historica de 30 anos, com 1.519.730 exames protoparasitologicos e 355 identificacoes de proglotes de Taenia. Pelo metodo da sedimentacao espontanea foram diagnosticados 7.663 (0,5 por cento) casos de presenca de ovos de Taenia sp. nas fezes. Das 355 proglotes enviadas para identificacao, 311 (87,60 por cento) estavam em condicoes de serem especificadas, e dessas, 273 (87,80 por cento) eram proglotes de Taenia saginata e 38 (12,22 por cento) de T. solium.

[Giardiasis in nurseries supported by the São Paulo Municipal Prefecture, 1982/1983]. / Giardíase em creches mantidas pela prefeitura do Município de São Paulo, 1982/1983.

Parasitological analysis was carried out during 1982 and 1983 in 3,076 children aged under 7 years, who were enrolled in 52 day nurseries supported by Municipal Prefecture of São Paulo and 50 food handlers (cooking employees) working at 18 day nurseries. The prevalence of Giardia lamblia infection was studied according to sex, age group and seasonal variations, and attained 32.80% among children and 4.0% among adult population. The occurrence of giardiasis was most frequent in age group corresponding to 1-4 years old. The study of seasonal variations showed that, in 1982, the prevalence of G. lamblia was high in the autumn and in the spring and, in 1983, giardiasis was more prevalent in the autumn and in the summer. Statistical analysis indicated non association between sex and prevalence for Giardia infection, and there was also no significative difference on the distribution of G. lamblia prevalence in the four regions analysed in the present study (p > 0.05). The most probable mode of acquisition of Giardia infection, in the nurseries analysed in the present study was person-to-person, as factors, like environmental contamination and others, associated with the spreading of giardiasis through water, reported in other countries, are unlike from those verified in our Municipality. On the other hand, there is evidence of no significant role of food handlers in Giardia transmission, because of the rate of infection in this group was very low.

[Occurrence of Taenia sp. in the population seen at the Central Laboratory of the Adolfo Lutz Institute, São Paulo, SP, Brazil (1960/1989)]. / Ocorrência de Taenia sp. na população atendida no Laboratório Central do Instituto Adolfo Lutz, São Paulo, SP, Brasil (1960/1989).

Monthly and yearly reports of the Seção de Enteroparasitoses of the Instituto Adolfo Lutz (São Paulo, SP, Brazil) from 1960 to 1989 with 1,519,730 parasitological stool examinations were studied. There were also 355 identifications of Taenia sp. proglottids. Using Hoffman, Pons & Janer's method, 7,663 (0.5%) cases of taeniasis were diagnosed, and 311 (87.60%) of the 355 proglottids were on easy terms to be specified, 273 (87.80%) of them were from Taenia saginata.

Human parasitism by Phagicola sp (trematoda, heterophyidae) in Cananeia, Sao Paulo State Brazil

Relata-se o primeiro caso de parasitismo humano por Phagicola sp. registrado no Brasil em paciente do sexo feminino e de 31 anos de idade que viajara, no iniciop de 1987, para Cananeia, no litoral sul do Estado de Sao Paulo, permanecendo alguns meses nesse municipio, por motivos profissionais. A paciente queixava-se dores em colica no abdomem; no exame parasitologico de fezes encontraram-se ovos de Phagicola sp. e dicreto aumento da quantidade de eosinofilos (8 por cento) no hemograma. A paciente admitiu a ingestao de pedacos crus da tainha (Mugil sp.), em diversas ocasioes, durante sua permanencia em Cananeia. O tratamento com praziquantel (75 mg/Kg/dia/3 dias) resultou em cura clinica e parasitologica. Nao existem outros relatos de parasitismo humano por Phagicola sp. no Brasil. Em outros paises, cuidadosa revisao da literatura nao logrou encontrar referencias de acometimento humano, salvo vaga citacao acerca da possivel ocorrencia de alguns casos no sudeste dos Estados Unidos da America do Norte

Human parasitism by Phagicola sp (Trematoda, Heterophyidae) in Cananéia, São Paulo state, Brazil.

We report one case of parasitism by Phagicola sp. (Trematoda, Heterophyidae) in a 31 year-old woman who, in 1987, travelled and stayed several months in the municipality of Cananéia (SP), where she ingested, in various occasions, raw mullet (Mugil sp.). The patient referred mild intestinal pain and laboratory examinations showed eggs of Phagicola sp. in the stools and a slight increase in eosinophil blood levels (8%). After treatment with praziquantel (75 mg/kg per day for three days) all the symptoms and signs disappeared. This is, certainly, the first record of human infection by Phagicola sp. in Brazil and, perhaps, in countries other than the U.S.A. where unclear references to a few human cases were reported in the South-eastern region.

Infecçäo por Clonorchis sinensis em imigrantes asiáticos no Brasil: tratamento com praziquantel / Clonorchis sinensis infections in Asian immigrants in Brazil: treatment with praziquantel

Estudaram-se quinze pacientes com infecçäo assintomática por Clonorchis sinensis, revelada através de exame parasitológico de fezes. Todos eram de origem asiática e procuraram o Laboratório Central do Instituto Adolfo Lutz para se submeterem a exames laboratoriais necessários a regularizaçäo de sua situaçäo, face a nova legislaçäo sobre imigrantes. Eram todos indivíduos adultos, seis pertencendo ao sexo feminino e nove ao masculino. Os quinze pacientes comn clonorquíase foram internados no Hospital das Clínicas da FMUSP e tratados com Praziquantel, na dosagem de 60 mg/Kg de peso corporal, dividida em duas tomadas. Foram realizados exames coprológicos quantitativos (método de Kato-Katz), antes do tratamento específico e no 15§, 30§ e 60§ dias após a terapêutica. Na última avaliaçäo (60§ dias após terapêutica), em nove pacientes (60,0%) näo se encontraram ovos do treamatódeo nas fezes e nos seis (40,0%), que continuavam eliminando ovos, notou-se reduçäo na quantidade eliminada (superior a 90% em cinco e a 30% no paciente restante). Os pacientes foram também submetidos a exames subsidiários, para avaliaçäo do estado geral e funçäo hepática, antes da administraçäo de Praziquantel e, posteriormente, no seguimento ambulatorial. A medicaçäo foi relativamente bem tolerada pelos pacientes, verificando-se a ocorrência de efeitos colaterais representados por náuseas e vômitos (dois casos), vertigens e tonturas (dois casos), epigastralgia (dois casos) e diarréia no 3§ dia após tratamento (um caso)

[Infection by Clonorchis sinensis in Asian immigrants in Brazil. Treatment with praziquantel]. / Infecção por Clonorchis sinensis em imigrantes asiáticos no Brasil. Tratamento com praziquantel.

Fifteen adult patients with assymptomatic infection due to Clonorchis sinensis, diagnosed by coprological examination, were studied. They all came from Asia (twelve from Taiwan, two from South Korea and one from Hong Kong) and were examined at the Adolfo Lutz Institute and the Department of Infectious Diseases, School of Medicine, University of São Paulo, in São Paulo, Brazil. Six patients were women and nine men. All studied patients were admitted to hospital and treated with praziquantel (60 mg/kg). Previous to treatment and on the 15th, 30th and 60th days after praziquantel administration, patients were submitted to quantitative stool examinations, according to Kato-Katz's technique and to hematological and biochemical serum analysis. After a 60 day follow-up nine patients (60%) were negative for C. sinensis eggs in stools. Those not cured after praziquantel administration (six patients, 40%) revealed a sharp decline in faecal elimination of C. sinensis eggs.

[Headache in childhood: diagnosis and therapy. A prospective study of 77 cases]. / Cefaléia na infância: diagnóstico e terapêutica. Estudo prospectivo de 77 casos.

Seventy seven cases of migraine in children were studied. Age average was 9 years +/- 2; there were any sex differences. The frontal localization was found in roughly 49% of cases, whereas hemicrania was just found in 9% of cases. The most frequent factors associated were nausea, vomiting and dizziness. The most common triggering factor was the stress. Family history of migraine occurred in 76.5%. Out of 36 patients suffering migraine, 31 underwent a prophylactic treatment with pizotifen or propranolol. There was satisfactory clinical responses in roughly 90% of cases.