Molecular cloning and sequencing of salivary gland-specific cDNAs of the blood-sucking bug Triatoma brasiliensis (Hemiptera: Reduviidae).

Haematophagous insects produce pharmacological substances in their saliva to counteract vertebrate host haemostasis events such as coagulation, vasoconstriction and platelet aggregation. To investigate the bioactive salivary molecules of the triatomine bug Triatoma brasiliensis, we produced subtraction-enriched cDNAs of salivary-gland specific genes using suppression subtractive hybridization. Six full-length differentially expressed cDNAs (Tb113, Tb125, Tb152, Tb169, Tb180 and Tb198) were selected, cloned and sequenced. Sequence similarity searches of the databases using the putative amino acid sequence of our clones gave the following results: Tb152 - Triabin, an antithrombin induced platelet aggregation factor found in salivary gland extracts of T. pallidipennis. Tb169 - Pallidipin, an anticollagen induced platelet aggregation factor also found in T. pallidipennis salivary homogenates. Tb180 - Procalin, the major allergen of T. protracta saliva. The other three salivary-gland specific cDNAs produced no obvious homologies. Comparison of these salivary gland-specific cDNAs of with those of other triatomines combined with functional studies using recombinant proteins will allow a better understanding of the co-evolutionary process occurring between these insects and their vertebrate hosts, and may also lead to the discovery of novel antihaemostatic agents.

Technetium-99m labeling anti-amastigote polyclonal antibodies of Leishmania amazonensis.

Anti-amastigote polyclonal antibody (IgG) was incubated with solutions of stannous chloride and sodium borohidride. After that, 3.7 MBq of technetium-99m (99mTc) was added. A labeling yield of the antibody about 84% was obtained. After filtration of 99mTc-IgG, the radiochemical purity increased from 84 to 95%. The labeling of IgG with 99mTc did not modify the immunoreactivity of the antibody, since it was able to identify in vitro and in vivo the specific antigen of Leishmania amazonensis.

Effects of propranolol on human postoperative ileus.

BACKGROUND: The sympathetic nervous hyperactivity present in response to surgical stress has been implicated as an important component of the postoperative paralytic ileus. A randomized and prospective study was conducted, evaluating the effects of the preoperative beta-adrenergic blockade with propranolol in schistosomotic patients during the period of postoperative ileus. METHODS: The study compared schistosomotic patients submitted, or not, to beta-adrenergic blockade. Basal cardiac frequency was determined and propranolol was used in a dose of 40 mg twice a day. The dose was adjusted weekly until a minimum decrease of 20% in cardiac frequency was achieved. Three coupled bipolar electrodes were placed in the left colon in both groups, and registration of myoelectric activity of the left colon was made twice a day during the period of postoperative ileus using a system of data collection (DATA Q Series 200). The electric signals were previously amplified, filtered and separated into Electric Control Activity (ECA) and Electric Response Activity (ERA). RESULTS: The dose of propranolol varied from 80 to 160 mg/day. The proportional decrease in basal heart frequency varied from 20 to 33%, with an average of 25.4 +/- 3.9% in the propranolol group, maintaining a mean of 24.3 +/- 3.6% decrease in the postoperative period. Differences on clinical recovery of the postoperative ileus were not found. Significant differences on electromyographic patterns were not observed between the groups, except for the presence of a greater number of short-duration contractions in the second postoperative day in the beta-blocked group. CONCLUSION: The authors suggest that the preoperative beta-adrenergic blockade with propranolol does not determine myoelectric activity changes that could contribute to an earlier resolution of postoperative ileus.

PCR-based diagnosis of a case of herpetic whitlow in an AIDS patient.

Herpetic infections are common complications in AIDS patients. The clinical features could be uncommon and antiviral chemotherapy is imperative. A rapid diagnosis could prevent incorrect approaches and treatment. The polymerase chain reaction is a rapid, specific and sensible method for DNA amplification and diagnosis of infectious diseases, especially viral diseases. This approach has some advantages compared with conventional diagnostic procedures. Recently we have reported a new PCR protocol to rapid diagnosis of herpetic infections with suppression of the DNA extraction step. In this paper we present a case of herpetic whitlow with rapid diagnosis by HSV-1 specific polymerase chain reaction using the referred protocol.

Bypass induced liver disease: an experimental study of the effect of post-operative protein supplementation and metronidazole therapy in an animal model.

An animal model of jejuno-ileal bypass (JIB) with post-operative weight loss and liver dysfunction was established in the rat. The role of a protein supplemented diet and post-operative metronidazole was investigated using this model. The use of a protein supplemented diet alone markedly reduced the detrimental effects of JIB. Although a beneficial effect was also noted with post-operative metronidazole, it was less marked and there appeared to be no additive benefit when both were used together. The results of this study would support the routine use of a protein enriched diet post-operatively in patients undergoing JIB.

Internal sphincterotomy for chronic anal fissure: long term effects on anal pressure.

In 28 patients with chronic anal fissure the median anal canal pressure was 98 cmH2O, significantly higher than in control subjects (P less than 0.001). After lateral internal sphincterotomy the pressure dropped by 50 per cent to normal levels and the fissures healed with no change in pressure over 12 months. Ten patients also had normal anal pressures and were asymptomatic 4-6 years after internal sphincterotomy. Adequate internal sphincterotomy appears to reduce permanently anal canal pressure, suggesting that abnormal activity in the sphincter contributes to the development of a fissure.

Proximal gastric vagotomy or truncal vagotomy and drainage for chronic duodenal ulcer?

A comparison has been made between truncal vagotomy and drainage (TVD) and proximal gastric vagotomy (PGV) performed electively for chronic duodenal ulceration from 1968 to 1981 in 209 and 272 patients respectively. The morbidity was 23 per cent after TVD and 19.8 per cent after PGV, with a mortality of 0.5 per cent and 0.4 per cent respectively. Of 163 patients in the former group and 253 patients in the latter group the follow-up was an average of 5.7 and 6.2 years respectively; 128 patients (78.5 per cent) and 198 (78.3 per cent) respectively had a good functional result, graded as Visick I and II, but 35 (21.7 per cent) and 55 (21.7 per cent), respectively, had a poor result owing to recurrent ulceration in 23 (14.1 per cent) after TVD and 44 (17.4 per cent) after PGV. These results were not statistically different. The frequency of diarrhoea was 23 per cent and dumping 6.8 per cent after TVD which was significantly reduced to 2.0 per cent (P less than 0.005) and 1.2 per cent (P less than 0.025), respectively, after PGV. However, only five patients (3.0 per cent) had severe symptoms from diarrhoea and two (1.2 per cent) from dumping after TVD. Both operations seem to carry an equal incidence of unsatisfactory results, though for slightly different reasons it might be concluded that both procedures have an equal degree of acceptability.

Feasibility and efficacy of in-home water chlorination in rural North-eastern Brazil.

The purpose of this study was to assess the feasibility, acceptability and effect of an in-home water chlorination programme in a rural village. Previous studies at this site showed high levels of faecal coliforms in household water, high diarrhoea rates in children, and enterotoxigenic Escherichia coli and rotaviruses were the most common pathogens isolated from patients. Household water came from a pond and was stored in clay pots. No homes had sanitary facilities. A blind, cross-over trial of treatment of household water with inexpensive hypochlorite by a community health worker was carried out over 18 weeks among 20 families. Water in the clay pots was sampled serially, and symptom surveillance was done by medical students. The programme was generally acceptable to the villagers and no change in water use patterns were apparent. The mean faecal coliform level in the chlorinated water was significantly less than in the placebo treated samples (70 vs 16000 organisms/dl, P less than 0.001). People living in houses receiving placebo treatment had a mean of 11.2 days of diarrhoea per year, and the highest rate of 36.7 was among children less than 2 years old. Diarrhoea rates were not significantly different among the participants while exposed to water treated with hypochlorite. We conclude that a low-cost programme of this type, which utilizes community resources, is logistically feasible, appears to be culturally acceptable in this setting, and can result in a marked reduction in water contamination. The lack of effect on diarrhoea rates suggests that improvement in water quality may affect morbidity only when other variables relating to faecal-oral agent transmission are ameliorated at the same time.

Truncal vagotomy and drainage: a comparison of elective and emergency operations.

A comparison has been made between truncal vagotomy and drainage (TV + D) performed from 1968 to 1981 in 209 patients electively and in 68 patients as an emergency. The male:female distribution was 167:42 and 59:9 with a significant difference (P less than 0.001) in the mean ages of 49 years and 55 years respectively. Major postoperative complications following emergency TV + D (22 per cent) were significantly more common (P less than 0.001) than following elective TV + D (6.7 per cent) with seven (10.3 per cent) and one (0.5 per cent) deaths respectively. Of 163 patients in the elective and 54 in the emergency group followed up for an average of 5.7 and 5.9 years respectively, 132 patients (81 per cent) and 46 (82.5 per cent) had a good functional result graded as Visick I and II, but 31 (19 per cent) and 8 (14.8 per cent) patients respectively had a poor result due to recurrent ulceration in 23 (14.1 per cent) after elective TV + D and in all 8 (14.8 per cent) after emergency TV + D. These results are not statistically different. Thus emergency TV + D carries a higher mortality and morbidity than elective TV + D, but the long term results are similar. This conclusion substantiates the equivalent effectiveness of emergency and of elective TV + D.

Adequate internal sphincterotomy for chronic anal fissure: subcutaneous or open technique?

The extent of sphincter division by the subcutaneous or the open technique is examined by comparing the change in anal canal pressure after either method of sphincterotomy in twenty-eight patients with chronic anal fissure randomly allocated. In all patients the fissures healed at one month with significant reduction (P less than 0.01) of anal canal pressures to 52 (17-75) cmH2O after subcutaneous and 47.5 (35-100) cmH2O after open sphincterotomy, a 51 (22-77) and 50 (11-68) per cent reduction of their respective pre-operative measurements. Adequate sphincterotomy can be achieved by both techniques.

Prospective study of diarrheal illnesses in northeastern Brazil: patterns of disease, nutritional impact, etiologies, and risk factors.

Diarrhea is a leading cause of death in tropical countries. One of the highest childhood mortalities is in northeastern Brazil, where little is known about the morbidity, etiology, and risk factors of diarrhea. Prospective village surveillance over 30 months revealed diarrhea attack rates of more than seven episodes per child-year at six to 11 months of age among the children of the poorest families. Other risk factors included early weaning and the lack of toilets. Diarrhea led to weight loss and stunted growth. Enterotoxigenic Escherichia coli and rotaviruses were the most common pathogens, accounting for 21% and 19% of cases, respectively, followed by Shigella species (8.0%), Campylobacter jejuni (7.5%), Giardia species (6.7%), Strongyloides species (5.3%), and enteropathogenic E coli serotypes (4.6%). Most (84%) enterotoxigenic E coli were isolated during the rainy season of October to March (P less than 0.03), whereas 71% of rotaviral illnesses occurred during the drier months of June to October (P less than 0.03). In the present study, the early occurrence and nutritional impact of diarrhea and weaning, as well as the major etiologic agents of diarrhea and their different seasonal patterns have been defined for this region in which life-threatening diarrhea is endemic.

Comparison of paired whole milk and dried filter paper samples for anti-enterotoxin and anti-rotavirus activities.

Milk specimens, 75 from cows immunized against cholera toxin and 35 from a human population in which enterotoxigenic Escherichia coli and rotaviral infections are endemic, were collected as paired filter paper and frozen whole milk samples. Each pair was tested for antibody activity against heat-labile E. coli and Vibrio cholerae enterotoxins. Additionally, 12 of the 35 paired human milk samples stored as frozen whole milk and dried on filter paper were tested for anti-rotavirus immunoglobulin A. Anti-enterotoxin and anti-rotavirus immunoglobulin A titers in milk dried on filter paper compared favorably with those of their frozen whole milk pairs. Filter paper samples offered considerable advantages for field collection, transportation, and storage over frozen liquid samples.

Etiology of childhood diarrhea and oral rehydration therapy in northeastern Brazil.

PIP: This study was conducted from January 1977 to June 1978 in Fortaleza, Brazil, to evaluate the oral rehydration treatment recommended by the World Health Organization for children admitted with acute diarrhea; admission peaked in January-March of both years and children treated came from the lowest socioeconomic strata of the popultion. Initial treatment consisted of intravenous administration of normal saline or 5% glucose with saline solution; intravenous therapy was continued until objective signs of improvement were evident. Of the 53 children observed 24 continued with intravenous therapy, and 29 were administered oral rehydration therapy with a glucose-electrolyte solution containing 90 milliequivalent per liter of sodium ion. Mean age in the intravenous and in the oral groups were 10 and 8 months, respectively. The major symptoms were feverishness and vomiting. Stools from 37 patients were examined for disease agents; enterotoxigenic E. coli were identified in stools from 27% of these patients; ST-producing E. coli in 21.6%, and LT-producing E. coli in the remaining 5.4%. During the initial rehydration period there were no significant differences between the 2 groups as to duration of therapy or amount of fluid given. During the subsequent study period members of the oral treatment group required significantly less fluid and less treatment than members of the intravenous group, average amount of fluid required per kg of body weight being 67.3 ml in the intravenous group, and 32.3 ml in the oral group. Progress toward a normal level of consciousness was significantly greater among members of the oral rehydration group; the mothers of the children were able to administer the oral therapy quite effectively, thus saving time for physicians and nurses.^ieng