Estratégia multidisciplinar na prevenção e controle de doenças de manifestação clínica na infância / Multidisciplinary strategy for preventing and controlling diseases which manifest themselves clinically in early childhood

Objetivo: Apresentar os resultados do projeto multidisciplinar que consolidou um programa de manutenção de saúde a partir de procedimentos individuais e coletivos para o diagnóstico e prevenção de doenças na infância. Métodos: As atividades se pautaram na análise das condições de saúde de escolares de 6 a 12 anos, pertencentes à rede municipal de ensino da região rural de Campo Largo e metropolitana de Curitiba, Paraná, Brasil. As doenças foram investigadas por meio de anamnese, exame clínico, análise microbiológica de secreção orofaríngea e de saliva; além de exame parasitológico de fezes. Atividades interativas e educacionais apresentando informações sobre transmissão e diagnóstico de doenças como cárie, febre reumática e parasitoses foram realizadas envolvendo a comunidade estudantil e familiar. Os casos clínicos foram encaminhados para tratamento e acompanhamento. Resultados: Dentre 4 837 crianças analisadas, observou-se que 81% apresentaram alto risco de desenvolver cárie dental considerando a correlação entre concentração de Streptococcus mutans na saliva e epidemiologia da doença. Os exames copro-parasitológicos revelaram índices de positividade de 70% em crianças de área rural e de 55% em escolares de área metropolitana. Cinco crianças foram diagnosticadas como portadoras de febre reumática. Conclusão: A elevada ocorrência da doença cárie e parasitoses, bem como a existência de indivíduos portadores de febre reumática, demonstraram a demanda desta população por ações de promoção de saúde que visem à educação sanitária, a profilaxia e tratamento. Atividades de extensão desta natureza são de grande importância para as comunidades escolares assistidas.

Objective: This work was conducted to present the results of a multidisciplinary project which established a health program through individual and collective procedures for the diagnosis and prevention of childhood illnesses. Methods: The health status was evaluated of children between the ages of six and twelve in the rural district of Campo Largo and schools in metropolitan Curitiba in the state of Paraná, Brazil. Students were submitted to anamnesis and clinical examination. Samples of saliva and oropharyngeal secretions were collected for microbiological analysis. In addition, fecal exams were performed to detect intestinal parasites. Information about transmission, diagnosis and prevention of dental caries, rheumatic fever and parasites was imparted to the school community by way of lectures, flyers and play activities. All clinical cases were referred for treatment and follow-up. Results: Out of the 4 837 children analyzed, 81% were at high risk of acquiring dental caries, based on the correlation between the concentration of Streptococcus mutans in the saliva and the epidemiology of the disease. The parasitological tests showed that 70% of the children from the rural areas and 56% of those from metropolitan areas, were infected. Five children tested positive for rheumatic fever.Conclusion: The high prevalence of caries, parasitic infections and the occurrence of rheumatic fever in children point to the urgency for initiatives to promote health through actions aimed at sanitary education, prophylaxis and treatment. Educational actions of this nature are of majorimportance to the school communities attended to.

Activating killer cell immunoglobulin-like receptor genes' association with recurrent miscarriage.

PROBLEM: Natural killer (NK) cells are regulated through NK cell receptors such as killer cell immunoglobulin-like receptors (KIRs). KIRs are suspected of being involved in the causes of recurrent miscarriage (RM) as a higher proportion of activated NK cells were observed in women with RM when compared with that in controls. The aim of this study was to investigate if KIR genes coding for receptors known to have as ligands HLA class I molecules are correlated with RM. METHOD OF STUDY: A matched case-control study was carried out in 68 south Brazilian Caucasian patient couples with RM and 68 control fertile couples. KIR genes were typed by PCR-Reverse SSO method. RESULTS: The rate of possession of an elevated number of activating KIR genes (positive for five or six activating KIR genes out of six different activating KIR genes analyzed) in RM patient women was significantly higher (P = 0.0201) when compared with that in control fertile women. These data suggest that women carrying a high content of activating KIR genes have about threefold increased probability to develop RM [OR = 2.71; 95% CI (1.23-6.01)]. CONCLUSION: Our results indicate that RM could be associated with NK cell activation mediated by a profile rich in activating KIR genes.

A case-control study in IL6 and TGFB1 gene polymorphisms and recurrent spontaneous abortion in southern Brazilian patients.

PROBLEM: A high proportion of recurrent spontaneous abortions (RSA) remains unexplained. Cytokine genotyping has been investigated. We studied the relationship between unexplained RSA, IL6 (-174 G-->C) and TGFB1 (+869, T-->C; +915, G-->C) gene polymorphisms. METHOD OF STUDY: The case-control study composed of 57 south Brazilian women, with unexplained RSA and 74 controls carefully matched was performed. Cytokine genotyping was performed by the polymerase chain reaction-sequence specific primer method, using the 'Cytokine Genotyping Tray'. RESULTS: The results showed that the genotypic frequencies did not differ from samples for TGFB1 gene. In relation to IL6 gene polymorphism there was a statistical difference in genotypic distribution between samples (P < or = 0.025). The frequency of the C/C genotype was increased in women with RSA in comparison with the frequency observed in controls: 18% versus 4% (P = 0.01). CONCLUSIONS: This result strengthened the importance of IL6 genotypes in the pathogenesis of RSA of unknown cause in the south Brazilian population.

Lack of association between parenchymal neurocysticercosis and HLA Class I and Class II antigens

Neurocysticercosis, caused by encysted larvae of the tapeworm Taenia solium, is the most common infection of the central nervous system and a major public health problem in many countries. Prevalence in the region of Curitiba, located in the southern Brazilian State of Paraná, is one of the highest in the world. The genetics of host susceptibility to neurocysticercosis (NCC) is still obscure. To investigate if major histocompatibility complex (MHC) genes influence individual susceptibility to NCC, we performed a case-control association analysis. Fifty-two Caucasoid patients and 149 matched controls were typed for antigens of the HLA-A, B, C, DR and DQ loci. All patients had computerized tomography and clinical features compatible with parenchymal NCC. Indirect immunofluorescence of cerebrospinal fluid showed that 19 (37 per cent) of the patients presented anti-cysticercus antibodies at titers > or = 1:10. Frequencies of HLA specificities in the whole group of patients and in the subgroup with antibodies in cerebrospinal fluid were compared to those of the control group. No significant difference was found. These results do not support the hypothesis of HLA gene participation in susceptibility to parenchymal neurocysticercosis.