ß-adrenergic receptor polymorphisms in susceptibility, response to treatment and prognosis in heart failure: implication of ethnicity.

Common functional polymorphisms in ß-adrenergic receptor (ßAR) genes have been associated with heart failure (HF) phenotypes and pharmacogenetic interactions with ßAR blockers. This study evaluated the association between ßAR polymorphisms and carvedilol drug response and prognosis in patients with HF. In this prospective cohort controlled study, 326 volunteers were enrolled [146 HF patients (ejection fraction (EF)<50% by Simpson) and 180 healthy controls]. Drug response was evaluated by echocardiography and outcomes were mortality and hospitalization. DNA was extracted from peripheral blood leukocytes, fragments were amplified by the polymerase reaction and genotyped by restriction fragment length polymorphism (RFLP) for Ser49Gly and Arg389Gly ßAR-1 polymorphisms and Gln27Glu and Arg16Gly ßAR-2 polymorphisms. The study population was in Hardy­Weinberg equilibrium. The survival rate was adjusted using the Kaplan-Meier method. HF patients showed the following characteristics: EF 35±9%, 69.9% male, age 59±13 years, 50.7% self-identified as black, 46% had ischemic etiology. The mean follow-up of 23 months showed 18 mortalities and 46 hospitalizations. The genotypes Glu27Glu (24.7 vs. 6.1%, p=0.0004) and Arg16Arg (72.6 vs. 22.8, p<0.0001) of ßAR2 polymorphisms and Gly49Gly (33.6 vs. 4.3%, p<0.0001) of the ßAR1 polymorphism were higher in HF patients compared with controls. Patients with hospital admission showed a significantly higher Gly389 allelic frequency (54.9 vs. 42.1%, p=0.039), and the trend prevailed among patients who succumbed to the disease (61.1%, p=0.047). Black patients with the Ser49Ser genotype showed a reduced survival compared with the Gly49Gly or Ser49Gly genotypes (p=0.028). There was no association between improved LVEF >20% and ßAR polymorphisms. HF patients with ß-blocker therapy and the Gly389 allele have reduced event-free survival compared to those carrying the Arg389 allele. Additionally, systolic HF outpatients undergoing ß-blocker therapy, self­identified as black and homozygous for Ser49Ser may have reduced event-free survival, while Glu27Glu, Arg16Arg and Gly49Gly genotypes may be associated with risk for HF.

Avaliação dos serviços de saúde em relação ao diagnóstico precoce da hanseníase / Health services assessment of early leprosy diagnosis

Este estudo avaliou os serviços de saúde em relação à descoberta precoce da hanseníase e as dificuldades enfrentadas pela população para iniciar e dar continuidade ao tratamento. Aplicou-se questionário com perguntas abertas e fechadas por meio deentrevista com 234 doentes que iniciaram tratamento para hanseníase no Município de São José do Rio Preto-SP, no período de 1998 a 2006. A média de consultas para diagnosticar a hanseníase foi de 2,7 em unidades de saúde do serviço público e de 4,5 nosserviços privados. A maioria dos pacientes não relatou dificuldades para iniciar o tratamento. Os pacientes se deslocaram em média 9,2km de suas residências até os locais de tratamento e gastaram em média R$0,30/km. Considerando que a distância máxima docentro de saúde/residência nas áreas de sua abrangência seria de 1,5km, a descentralização do tratamento seria uma opção para melhorar o acesso e a precocidade do tratamento.

In the present study, health services were assessed regarding early diagnosis of leprosy and troubles faced by the population to initiate and remain under treatment. Patients (n=234), who initiated leprosy treatment between 1998 and 2006 in Sao Jose do Rio Preto, State of Sao Paulo, Brazil were interviewed and answered to open and closed questions. The mean number of medical appointments to diagnose the disease was 2.7 in public health units and 4.5 in the private sector. Most patients reported that they did not have problems to initiate treatment. They travelled about 9.2 km from their residences to treatment facilities and spent about R$0.30/km. Considering that the maximum distance from the health centers to private residences should be about 1.5 km, decentralization of treatment would be the best option to improve access and facilitate treatment of leprosy patients.

Accuracy of a self-collection kit for the microbiological study of the vaginal content.

Diagnosis of vaginal discharge is frequently performed in an empirical way, leading to inadequate treatment. This study tested the accuracy of a self-collection kit for microbiological study of the vaginal content. One hundred and forty-two women of Family Health Program units in Niterói and Piraí cities were enrolled in order to have their vaginal content studied. A brief explanation and a self-collection kit were provided in order to sample the vaginal content. The self-collection kit was composed of one empty plastic tube, two glass slides, a long handle cytobrush, an identification card and guideline notes. The vaginal sample was applied on the glass slides by the women and stained by Gram technique. A second sampling was done by the medical personnel. The microbiological diagnosis in a blinded analysis was made under optical microscopy. A validation diagnosis test was done taking the medical collection results as a gold standard. A total of 106 women had followed the protocol and were included in the study. Microbiological analysis was unsatisfactory in 12 cases (6 cases of self-collection material and 6 cases of medical collection). The microbiological analyses in the self-collection and in the medical collection material were respectively: bacterial vaginosis in 21.7% and 17.9%, non bacillar flora in 10.3% and 11.3%, vaginal trichomoniasis in 5.66% and 5.6%, candidiasis in 3.78% and 2.8% and a normal microbiota in 52.8% and 56.6%. The Kappa coefficient suggested a "very good correlation" of the microbiological results between the two methods of collection (K=0.7945). The self-collection kit provides samples for microbiological analysis of the vaginal microbiota as good as medical collection.

Accuracy of a self-collection kit for the microbiological study of the vaginal content

Diagnosis of vaginal discharge is frequently performed in an empirical way, leading to inadequate treatment. This study tested the accuracy of a self-collection kit for microbiological study of the vaginal content. One hundred and forty-two women of Family Health Program units in Niterói and Piraí cities were enrolled in order to have their vaginal content studied. A brief explanation and a self-collection kit were provided in order to sample the vaginal content. The self-collection kit was composed of one empty plastic tube, two glass slides, a long handle cytobrush, an identification card and guideline notes. The vaginal sample was applied on the glass slides by the women and stained by Gram technique. A second sampling was done by the medical personnel. The microbiological diagnosis in a blinded analysis was made under optical microscopy. A validation diagnosis test was done taking the medical collection results as a gold standard. A total of 106 women had followed the protocol and were included in the study. Microbiological analysis was unsatisfactory in 12 cases (6 cases of self-collection material and 6 cases of medical collection). The microbiological analyses in the self-collection and in the medical collection material were respectively: bacterial vaginosis in 21.7 percent and 17.9 percent, non bacillar flora in 10.3 percent and 11.3 percent, vaginal trichomoniasis in 5.66 percent and 5.6 percent, candidiasis in 3.78 percent and 2.8 percent and a normal microbiota in 52.8 percent and 56.6 percent. The Kappa coefficient suggested a "very good correlation" of the microbiological results between the two methods of collection (K=0.7945). The self-collection kit provides samples for microbiological analysis of the vaginal microbiota as good as medical collection.

Classificação de fêmeas de Stomoxys calcitrans (L. ) (Diptera: Muscidae), de acordo com a idade fisiológica / Classification of female of Somoxys calcitrans (L. ) (Diptera: Muscidae), according to the physiological age

With the purpose of maiking easier the determination of the physiological age of Stomosys calcitrans population, a classification based on the oocitary developtment and number of ovipositions was proposed. Female were reared under laboratory conditions, in individual cages and maintained in the presence of male for copulation. On the proper time, ovary and oviduct were removed and the stage of development was observed. Adult female were classified as: 1-New emerged female, 2 - Young nuliparous female, 3 - Old nuliparous female, 4 - Uniparousfemale, 5 - Two or three ovipositions times female, and 6 - Multiparous female.