Drug addiction and alcoholism as predictors for tuberculosis treatment default in Brazil: a prospective cohort study.

This study aimed to evaluate the risk factors for tuberculosis (TB) treatment default in a priority city for disease control in Brazil. A cohort of TB cases diagnosed from 2008 to 2009 was followed up from patients' entry into three outpatient sites, in Juiz de Fora, Minas Gerais (Brazil), until the recording of the outcomes. Drug addiction, alcoholism and treatment site appeared to be independently associated with default. Current users of crack as the hardest drug (odds ratio (OR) 12·25, 95% confidence interval (CI) 3·04-49·26) were more likely to default than other hard drug users (OR 5·67, 95% CI 1·34-24·03), former users (OR 4·12, 95% CI 1·11-15·20) and those not known to use drugs (reference group). Consumers at high risk of alcoholism (OR 2·94, 95% CI 1·08-7·99) and those treated in an outpatient hospital unit (OR 8·22, 95% CI 2·79-24·21%) also were more likely to default. Our results establish that substance abuse was independently associated with default. National TB programmes might be more likely to achieve their control targets if they include interventions aimed at improving adherence and cure rates, by diagnosing and treating substance abuse concurrently with standard TB therapy.

Validity of one-repetition maximum predictive equations in men with spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: The study aimed (a) to test the cross-validation of current one-repetition maximum (1RM) predictive equations in men with spinal cord injury (SCI); (b) to compare the current 1RM predictive equations to a newly developed equation based on the 4- to 12-repetition maximum test (4-12RM). SETTING: SARAH Rehabilitation Hospital Network, Brasilia, Brazil. METHODS: Forty-five men aged 28.0 years with SCI between C6 and L2 causing complete motor impairment were enrolled in the study. Volunteers were tested, in a random order, in 1RM test or 4-12RM with 2-3 interval days. Multiple regression analysis was used to generate an equation for predicting 1RM. RESULTS: There were no significant differences between 1RM test and the current predictive equations. ICC values were significant and were classified as excellent for all current predictive equations. The predictive equation of Lombardi presented the best Bland-Altman results (0.5 kg and 12.8 kg for mean difference and interval range around the differences, respectively). The two created equation models for 1RM demonstrated the same and a high adjusted R2 (0.971, P<0.01), but different SEE of measured 1RM (2.88 kg or 5.4% and 2.90 kg or 5.5%). CONCLUSION: All 1RM predictive equations are accurate to assess individuals with SCI at the bench press exercise. However, the predictive equation of Lombardi presented the best associated cross-validity results. A specific 1RM prediction equation was also elaborated for individuals with SCI. The created equation should be tested in order to verify whether it presents better accuracy than the current ones.

Aerobic exercise improves microvascular dysfunction in fructose fed hamsters.

Fructose is a major diet component directly related to severe damages to the microcirculation and to diseases such as obesity, diabetes and hypertension to which physical activity is pointed out as an important non-pharmacological treatment since its positive effects precede anthropometric improvements. In this study we have investigated the effects of a light/moderate aerobic exercise training (AET) on microcirculatory dysfunction elicited by carbohydrate overload during a period of 5 months. Male hamsters (Mesocricetus auratus) whose drinking water was substituted (F) or not (C) by 10% fructose solution, during 20 weeks, associated or not to AET in the last 4 weeks (EC and EF subgroups) had their microcirculatory function evaluated on the cheek pouch preparation, glucose and insulin tolerance (GTT and ITT) tested. Arterial blood was collected for pO2, pCO2, HCO3(-), pH, total CO2, saturated O2 and lactate determinations. Liver fragments were observed using an electron microscope. Microcirculatory responses to acetylcholine [Ach, an endothelium-dependent vasodilator; 10(-8)M - *123.3±7.5% (C), 119.5±1.3% (EC), *98.1±3.2% (F) and 133.6±17.2% (EF); 10(-6)M - *133.0±4.1% (C), 135.6±4.3% (EC), *103.4±4.3% (F) and 134.1±5.9% (EF); 10(-4)M - *167.2±5.0% (C), 162.8±5.4% (EC), *123.8±6.3% (F) and 140.8±5.0% (EF)] and to sodium nitroprusside [SNP, an endothelium-independent vasodilator; 10(-8)M - 118.8±6.8% (C), 114.0±5.0% (EC), 100.2±2.9% (F), 104.9±4.4% (EF); 10(-6)M - 140.6±11.7% (C), 141.7±5.5% (EC), 125.0±4.7% (F), 138.3±2.8% (EF); 10(-4)M - 150.4±10.9% (C), 147.9±6.5% (EC), 139.2±7.3% (F), 155.9±4.7% (EF)] and macromolecular permeability increase induced by 30 min ischemia/reperfusion (I/R) procedure [14.4±3.5 (C), 30.0±1.9 (EC), *112.0±8.8 (F) and *22.4±0.9 leaks/cm(2) (EF)] have shown that endothelium-dependent vasodilatation was significantly reduced and I/R induced macromolecular permeability augmented in sedentary fructose (F) subgroup and both improved after AET. Electron microscopy analysis of the liver showed significant differences between exercised and sedentary subgroups with greater amount of glycogen in F subgroups compared to other ones. No significant changes on mean arterial pressure, heart rate or blood gase between subgroups could be detected. Our results point out that AET could normalize microcirculatory dysfunction elicited by long term substitution of drinking water by 10% fructose solution.

Correspondence between performance of Eucalyptus spp trees selected from family and clonal tests.

We examined the correspondence in performance between trees selected from a family test and their respective clones from a clonal test of Eucalyptus. Full-sib families were obtained from controlled pollination among individuals of Eucalyptus grandis and between E. grandis and E. urophylla. The hybridizations did not follow a factorial scheme. The family tests were carried out at three locations in Eunápolis and Itabela counties, in Bahia, Brazil, in 2003. Four hundred and ninety-seven high-performance trees were selected, by the individual BLUP procedure, in the family tests at two years of age, based on wood volume. The clones from these trees and 14 checks were evaluated in clonal tests carried out in the same region in 2006. The wood volume of the clones was evaluated at two years of age. Trait correlation between the trees selected from the family and clonal tests was low. The estimate of the coincidence between the best trees and the best clones using an average of the different intensities of selection was only 27%. These results demonstrate that the selection of trees in the family test should not be too drastic; otherwise the chance plus clones may be overlooked.

Effects of resistance training on the lipid profile in obese women.

AIM: The aim of the present study was to analyze the effects of resistance training in groups (with music) on the lipid profile in obese women. METHODS: The sample was composed of 28 sedentary obese women. Of these, 13 were submitted to the resistance training in group program (GT) and 15 took part in a control group (GC). The training lasted for 9 weeks, with three weekly sessions. The classes emphasized resistance training through the performance of 10 localized exercises. The analysis evaluated the following variables: total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG) and the TC/HDL ratio in the pre and post-training periods in both groups. The data was analyzed using Anova for repeated measures with one factor, adopting P<0.05. RESULTS: The study found significant differences for the training group between the pre- and post-training period in all the analyzed variables, except for the TG. In contrast, for the control group there was no significant difference between the pre and post-training period in any of the variables, except for the TG in which we found a statistically significant increase. The reductions were from 200.62 ± 39.11 mg·dL-1 to 184.92 ± 28.62 mg·dL-1 for TC; from 137.69 ± 32.09 mg·dL-1 to 110.31 ± 21.92 mg·dL-1 for LDL; from 4.48 ± 1.00 to 3.70 ± 0.90 for the TC/HDL ratio and the improvement in the HDL was from 46.23 ± 12.04 mg·dL-1 to 53.15 ± 16.83 mg·dL-1. CONCLUSION: Thus, it was concluded that the resistance training in groups with music was effective since it provided beneficial modifications to the lipid profile, which may result in lower risk of coronary arterial diseases in the obese female population.

Multi-Layered Films Containing a Biomimetic Stimuli-Responsive Recombinant Protein.

Electrostatic self-assembly was used to fabricate new smart multi-layer coatings, using a recombinant elastin-like polymer (ELP) and chitosan as the counterion macromolecule. The ELP was bioproduced, purified and its purity and expected molecular weight were assessed. Aggregate size measurements, obtained by light scattering of dissolved ELP, were performed as a function of temperature and pH to assess the smart properties of the polymer. The build-up of multi-layered films containing ELP and chitosan, using a layer-by-layer methodology, was followed by quartz-crystal microbalance with dissipation monitoring. Atomic force microscopy analysis permitted to demonstrate that the topography of the multi-layered films could respond to temperature. This work opens new possibilities for the use of ELPs in the fabrication of biodegradable smart coatings and films, offering new platforms in biotechnology and in the biomedical area.

Grade 3 vulvar and anal intraepithelial neoplasia in a HIV seropositive child--therapeutic result: case report.

A case report of a HIV seropositive 8-year-old child with vulvar and anal border neoplasia, both grade 3, and the adopted therapeutic management are presented. The mother reported the history of a progressively growing verrucous lesion in the vulva since the age of three and a half years. On physical examination a pigmented and elevated lesion was observed in the whole vulvar region extending to the anal region and intergluteal sulcus. After biopsies and anatomic pathological examination, antiretroviral therapy, adequate for age, and topical application of podophyllotoxin associated with Thuya officinalis extract was started. Three months afterwards vaporization and CO2 laser excision were performed in five sequential sessions, thereafter associated with topical imiquimod application. After the first two sessions of laser therapy early relapses occurred. After four weeks of imiquimod use, already a significant improvement of the lesions was observed, making the following laser therapy sessions easier. We conclude that antiretroviral therapy associated with podophyllotoxin and Thuya was not effective regarding regression of the lesions. Laser therapy alone led to early relapses. The local use of imiquimod associated with laser was effective in decreasing and controling the lesions.

Low-dose 5-fluorouracil adjuvant in laser therapy for HPV lesions in immunosuppressed patients and cases of difficult control.

The authors established a protocol for the use of 5-fluorouracil (5FU) adjuvant in lasertherapy for clinical and subclinical HPV infection in immunosuppressed patients, persistent lesions and as reinforcement treatment in cases of poor progress. Sixty-four patients were evaluated, of whom 26 were immunosuppressed, 34 presented persistent lesions and four received intravaginal reinforcement treatment with 2.5 g 5% 5FU every two weeks, or biweekly vulvar reinforcement after lasertherapy. On average, five 5FU courses were used, but in the immunossuppressed patients its use was maintained indefinitely. The rate of complete response was 66%, but the immunossuppressed patients showed less response (46.2%) when compared with the persistent lesion/reinforcement treatment group (78.9%). The responses were positive in the two groups when compared to that with no response. We deem the use of low-dose 5FU an excellent alternative in cases of difficult HPV progress, presenting a low cost and minimal side-effects.

The use of 99mTc-phytate for sentinel node mapping in melanoma, breast cancer and vulvar cancer: a study of 100 cases.

Sentinel node mapping reduces surgical morbidity and allows the use of more accurate tumour staging techniques. Radionuclide studies are preferentially performed using small colloids, which have limited availability in our country. The possibility of using phytate for sentinel node mapping was raised because of the similarity between its biodistribution and that of nanocolloids in the reticulo-endothelial system. In this paper we evaluated the use of 99mTc-phytate for sentinel node mapping, correlating the histopathological results with the status of the rest of the lymph node chain in different malignant tumours. A total of 100 patients were studied. group 1 consisted of 62 patients with breast cancer, group 2 of 20 patients with melanoma and group 3 of 18 patients with vulvar carcinoma. Lymph node scintigraphy was carried out after injecting 99mTc-phytate subdermally, and the sentinel node projection was marked on the skin. After 18-24 h, intraoperative sentinel node localisation was performed using a gamma probe (combined with visual localisation using patent blue dye) in 75 patients, and lymph node dissection was then carried out. Radionuclide scintigraphy identified the sentinel node in 98% of all studies. Intraoperative detection using the gamma probe was equally efficient: group 1=93% (38/41), group 2=95% (18/19) and group 3=100% (15/15). The sentinel node was involved in 41%, 31% and 20% of cases in groups 1, 2 and 3, respectively. Among the patients with positive nodes, the sentinel node was the only one affected in 53% of group 1, 50% of group 2 and 67% of group 3 cases. The method's negative predictive value was 91% in group 1 and 100% in the other groups. One false-negative study occurred in a patient who had a multifocal tumour and an intraparenchymatous lymph node; another occurred in a patient with a macroscopically affected node found during surgery. There were no side-effects related to the 99mTc-phytate. It is concluded that scintigraphic and intraoperative sentinel node identification was satisfactorily performed using 99mTc-phytate. The results were comparable to those previously described in the literature using other radiopharmaceuticals. Easy availability and low cost justify the use of phytate in our practice.

The use of (99m)Tc-phytate for sentinel node mapping in melanoma, breast cancer and vulvar cancer: a study of 100 cases.

Sentinel node mapping reduces surgical morbidity and allows the use of more accurate tumour staging techniques. Radionuclide studies are preferentially performed using small colloids, which have limited availability in our country. The possibility of using phytate for sentinel node mapping was raised because of the similarity between its biodistribution and that of nanocolloids in the reticulo-endothelial system. In this paper we evaluated the use of (99m)Tc-phytate for sentinel node mapping, correlating the histopathological results with the status of the rest of the lymph node chain in different malignant tumours. A total of 100 patients were studied. group 1 consisted of 62 patients with breast cancer, group 2 of 20 patients with melanoma and group 3 of 18 patients with vulvar carcinoma. Lymph node scintigraphy was carried out after injecting (99m)Tc-phytate subdermally, and the sentinel node projection was marked on the skin. After 18-24 h, intraoperative sentinel node localisation was performed using a gamma probe (combined with visual localisation using patent blue dye) in 75 patients, and lymph node dissection was then carried out. Radionuclide scintigraphy identified the sentinel node in 98% of all studies. Intraoperative detection using the gamma probe was equally efficient: group 1=93% (38/41), group 2=95% (18/19) and group 3=100% (15/15). The sentinel node was involved in 41%, 31% and 20% of cases in groups 1, 2 and 3, respectively. Among the patients with positive nodes, the sentinel node was the only one affected in 53% of group 1, 50% of group 2 and 67% of group 3 cases. The method's negative predictive value was 91% in group 1 and 100% in the other groups. One false-negative study occurred in a patient who had a multifocal tumour and an intraparenchymatous lymph node; another occurred in a patient with a macroscopically affected node found during surgery. There were no side-effects related to the (99m)Tc-phytate. It is concluded that scintigraphic and intraoperative sentinel node identification was satisfactorily performed using (99m)Tc-phytate. The results were comparable to those previously described in the literature using other radiopharmaceuticals. Easy availability and low cost justify the use of phytate in our practice.