Evolutionary pattern of reemerging influenza B/Victoria lineage viruses in São Paulo, Brazil, 1996-2012: Implications for vaccine composition strategy.

Since the 1980s, 2 antigenically distinct influenza B lineages have cocirculated in the world: B/Victoria/2/87 (first appeared in the 1980s) and B/Yamagata/16/88 (became predominant in the 1990s). B/Victoria/2/87 isolates were geographically restricted to eastern Asia during 1991-2000. During 2000-2001 and 2001-2002, B/Victoria/2/87 isolates reemerged in North America, Europe, and South America, and then spread globally. During influenza virus surveillance, season 2002, an outbreak of acute respiratory illness, which quickly spread among the population, has been notified by public health authorities living in Araraquara, São Paulo, Brazil. Instituto Adolfo Lutz and Secretariat of Health of São Paulo state teams initiate an investigation towards to describe the pattern of infection in this population temporally and by age and to characterize the strains by virus isolation and hemagglutination inhibition assay. The outbreak lasted approximately 10 weeks; many cases occurred between mid-August and mid-September. Children younger than 13 years were the most affected; the elderly were mostly immune to infection. Analysis of the clinical respiratory samples helped in identifying the B/Hong Kong/330/2001 and B/Brisbane/32/2002 subtypes-recent variants of B/Victoria/02/88, a lineage restricted to Southeast Asia until 2001. The Araraquara outbreak confirms the reemergence of the B/Victoria viruses in South America and highlights the importance of monitoring local circulating strains, especially in light of the absence of cross-protection between antigenically distinct influenza lineages. Based on influenza virus surveillance, public health authorities worldwide should decide whether trivalent vaccines or quadrivalent vaccines (containing both influenza virus B lineages) are to be used in each country.

ABR evaluation of ototoxicity in cancer patients receiving cisplatin or carboplatin.

The development of ototoxicity was evaluated using auditory brainstem response (ABR) in cancer patients randomized to receive a cisplatin-based chemotherapy (cisplatin dose: 70 mg/m2) or a carboplatin-based chemotherapy (carboplatin dose: 250 mg/m2). The ABR measurements were performed in a sound-treated room using 2000 clicks of alternating polarity at an intensity of 100 dB PESPL presented to the patients at a rate of 21 clicks per second. Of 59 patients, 21 (9 in the cisplatin group and 12 in the carboplatin group) met our pre-established criteria and were included in the ototoxicity study. Two patients of the cisplatin group developed evidence of clinically occult ototoxicity after two cycles of chemotherapy; the latency of wave V of the ABR increased significantly from 5.874 to 6.336 msec and from 5.826 to 6.458 msec in both patients; these patients had a hearing loss detected by conventional audiometry (125 to 8,000 Hz) after five and six cycles of chemotherapy, respectively. None of the 12 examined carboplatin patients developed ABR-measured ototoxicity or abnormal audiograms during treatment. Our results suggest that ABR might prove to be useful in detecting early hearing deterioration from cisplatin.

The management of horizontal-canal paroxysmal positional vertigo.

Horizontal-canal paroxysmal positional vertigo (HC-PPV) is a vestibular syndrome due to canalolithiasis of the horizontal canal. The more common posterior-canal paroxysmal positional vertigo has a well defined and effective therapy, while there have been few reports on physical therapy for HC-PPV, and these have been tried in relatively few patients. We report the results of two different types of treatment of HC-PPV in 92 patients. A group of 21 untreated patients acted as a control group. One method, known as forced prolonged position (FPP), proposes liberating the affected canal by gravitation, and involves having the patient lie on the healthy side for many hours. The other method (the barbecue rotation) is a liberatory manoeuvre which proposes to expel the otoconia from the canal by rotating the patient 270 degrees around the longitudinal axis of the body in rapid steps of 90 degrees. FPP was successful in more than 70% of our patients; the barbecue rotation had slightly less successful but more immediate results. Both methods enable otoconial debris to migrate into the posterior canal. We suggest treating all patients with the two methods in succession.

[Iatrogenic and non-iatrogenic factors as causes of progressive sensorineural hearing loss]. / Fattori iatrogeni e non come causa di ipoacusia neurosensoriale progressiva.

The aim of our study was to analyze factors such as noise, chemical drugs, industrial solvents and radiotherapy, which can cause cochlear lesions with progressive sensorineural hearing loss. Although an acute overstimulation by acoustic energy may induce an irreversible hearing loss, in most cases the noise-induced deafness is related to the duration of the exposure and to the level of the acoustic stimulation. A permanent hearing deficit occurs when the acoustic level exceeds 85 dBs. Also several classes of drugs are described as having ototoxic potential: aminoglycoside antibiotics, loop diuretics, antimalarial drugs such as quinine, salicylates, some chemotherapeutic antineoplastic agents. Their potential ototoxic effect seems to be related not only to the molecule, but also to individual predisposition, dose and route of administration. Regarding the benzene derivatives, there is a relationship between their ototoxicity and factors such as duration of exposure and concentration in the local environment. Finally, radiotherapy to areas near the temporal bone may produce a degenerative insult to the vascular stria and the hair cell causing a progressive sensorineural hearing loss.

Dust exposure, respiratory symptoms, and longitudinal decline of lung function in young coal miners.

OBJECTIVES: To study the role of dust exposure on incidence of respiratory symptoms and decline of lung function in young coal miners. METHODS: The loss of lung function (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory flow (MEF), carbon monoxide transfer factor (TLCO)) with time and the incidence of respiratory symptoms in 909 Sardinian coal miners (followed up between 1983 and 1993 with seven separate surveys) has been compared with the past and current individual exposures to respirable mixed coal dust. Multiple linear and logistic regression models were used simultaneously controlling for age, smoking, past occupational exposures, and other relevant covariates. RESULTS: According to the relatively low dust exposures experienced during the follow up few abnormal chest x ray films were detected. In the cross sectional analysis of initial data, significant associations between individual cumulative exposure to dust, decrements in FEV1 and MEFs, and increasing prevalence of respiratory symptoms were detected after allowing for the covariates included in the model. The yearly decline of FVC, FEV1, and single breath carbon monoxide transfer factor (TLCO/VA) was still significantly related to the individual exposure to dust experienced during the follow up, even after allowing for age, smoking, initial cumulative exposure to dust, and initial level of each functional variable. In logistic models, dust exposure was a significant predictor of the onset of respiratory symptoms besides age and smoking. CONCLUSIONS: The results show that even moderate exposures to mixed coal dust, as in our study, significantly affect lung function and incidence of symptoms of underground miners. Although the frequency of chest x ray examination might be fixed at every three or four years, yearly measurements of lung function (spirometry, MEFs, and TLCO) are recommended for evaluation of the respiratory risk from the coal mine environment to assess the need for further preventive interventions.

[Trigemino-vegetative physiopathology in the central dysnociceptive biorhythms in primary headache]. / La fisiopatologia neurovascolare trigemino-vegetativa nei bioritmi disnocicettivi centrali delle cefalee primarie.

The Headache is a common symptom: 80% of the population suffers from headache at least one time per year. This work is a review of new theories on neurovascular pathophysiology of primary headaches in a particular manner on rhinogenic headache. Besides, the authors report the results of a study carried out in 2262 children, who where attending the primary school, in order to investigate the relation between allergic rhinitis and headache in children. The present study suggests that the headache in allergic patients is related to nasal dysfunction always present in these cases.

[Not Available]. / La fisiopatologia neurovascolare trigemino-vegetativa nei bioritmi disnocicettivi centrali delle cefalee primarie.

The Headache is a common symptom: 80% of the population suffers from headache at least one time per year.This work is a review of new theories on neurovascular pathophysiology of primary headaches in a particular manner on rhinogenic headache.Besides, the authors report the results of a study carried out in 2262 children, who where attending the primary school, in order to investigate the relation between allergic rhinitis and headache in children. The present study suggests that the headache in allergic patients is related to nasal dysfunction always present in these cases.

[Bicycle ergometry exercise tests: a comparison between 3 protocols with an increasing load]. / Prove da sforzo al cicloergometro: confronto tra tre protocolli a carico crescente.

A group of 26 male long-distance runners performed 3 cycle ergometer tests of progressively increasing intensity up to exhaustion. The tests were performed on 3 different days. The workload increased as follows: 30 Watts every 3 min (test I), 10 Watts every min (test II), and 30 Watts every min (test III). Ventilatory and gas exchange measurements were averaged every 30 sec during each test. The heart rate (HR) was monitored continuously by ECG. In each test the anaerobic threshold (AT) was determined using ventilatory and gas exchange indices (VE, VCO2, VE/VO2). The work load on exhaustion and power at AT were the same comparing test I with test II, but these values were significantly higher in the 30 Watts/1 minute test. Conversely, maximal oxygen uptake (VO2 max) and the VO2 observed at anaerobic threshold were comparable in the 3 protocols. The slopes of VO2, VCO2, VE and HR against the work load (Watts) were identical in test I and II, but were slower in test III. However, no differences in the ventilatory and heart rate patterns versus oxygen uptake were observed comparing the three exercise tests. These results suggest a good comparability between the 30 Watts/3 min test and the 10 Watt/1 min protocol. Furthermore, for workloads below AT, a steady state was attained at the 3rd minute of each phase during test I, while oxygen uptake and other cardio-respiratory variables were underestimated during the protocol in which phases of 30 Watts were maintained only for 1 minute.(ABSTRACT TRUNCATED AT 250 WORDS)

[Population policy and women: the relevance of previous studies]. / Politicas de poblacion y la mujer: antecedentes para su estudio.

PIP: Although Mexico has had high rates of population growth since the 1930s caused by continuing high fertility but declining infant and general mortality, and has undergone deep structural change including declining agricultural production, rapid industrialization, urbanization, and increasing urban umemployment, it was not until the 1970s that the government began to adopt measures aimed at controlling population growth. Opponents of family planning argued that economic and social development would lead to fertility decline, but its proponents believed that reducing population growth would free resources for productive investment that otherwise would have to be used to finance services for the ever-growing population. At the same time that the constitution and laws were changed to allow or promote family planning, Mexican civil and labor laws were changed to provide for equality of men and women. Some background is necessary to understand the effect of such changes in the role and status of the Mexican woman. A relationship has been noted between demographic models--the form in which a society reproduces over a given time--and the social condition of women. Women have generally been subordinated to men during known history, but recent research indicates that their history has not been as uniform as once supposed. The particular form in which each society defines the natural-biological basis of sex roles varies; social definitions of sex and gender vary depending on the extension of "natural-biological" character to specific areas and tasks. The cases of French women in the 16th-18th centuries and German women under Hitler illustrate different ways in which demographic models and the condition of women have varied within a general framework of subordination of women. But when attempts are made to change a given demographic model, the condition of women is redefined at the level of practice as well as of value orientations concerning motherhood, female labor force participation, and the role of women in society. Moreover, the literature concerning fertility decline contains numerous statements by both those opposed to and in favor of birth control, that improving the status of women is 1 of the most effective means of reducing population growth. It can then be asked what changes in the role of women in Mexico will attend application of a fertility reduction policy. The crude birth rate declined from 44.2 in 1970 to 34.4 in 1980, with fertility falling among all age groups but especially among women over 40. The decline occurred primarily among urban nonmanual occupations. More research must be done on recent fertility change in Mexico and on related changes in the role orientations of men and women in different classes and life cycle stages, that have occurred at various stages of the population debate.^ieng