Miopericardite tuberculosa associado a QT longo e torsades de pointes: relato de caso / Tuberculous myopericarditis associated with long QT and torsades de pointes: case report

INTRODUÇÃO: A tuberculose cardíaca é uma doença rara Estima-se que 1% de todos os casos de tuberculose têm envolvimento cardíaco produzido por disseminação linfática, contígua do pericárdio ou por via hematogênica. Miocardite tuberculosa pode permanecer clinicamente assintomática (com diagnóstico feito em autópsia), ou pode se apresentar com morte, arritmias ventriculares intratáveis, síndrome do QT longo, bloqueio cardíaco ou insuficiência cardíaca. Complicações cardíacas, como taquiarritmias ventriculares, são ainda mais raras, mas são potencialmente tratáveis se reconhecimento imediato. RELATO DE CASO: S.A.F.R., 55 anos, sexo feminino, com dispneia e palpitações há cerca de três meses da admissão no pronto socorro. ECG evidenciando QT longo (figura 1) Ecocardiograma mostrou derrame pericárdico com repercussão hemodinâmica. Realizada drenagem de Marfan de urgência. No 2 dia de pós-operatório, apresentou Taquicardia Ventricular (TV) Sustentada Monomórfica Instável. Após cardioversão elétrica, evoluiu com múltiplos episódios de TV com Torsades de Pointes. A arritmia ventricular foi atribuída a QT longo congênito. Medicada com lidocaína EV, passado fio de marcapasso provisório com persistência da arritmia. Análise do líquido pericárdico evidenciou adenosina deaminase de 110 U/l e ressonância magnética (figura 2) apresentando edema miocárdico e sinais de processo inflamatório. Feito diagnóstico de Miopericardite tuberculósica e iniciado esquema RIPE. Após 15 dias, observou-se normalização do intervalo QT e desaparecimento dos sintomas e das arritmias ventriculares, sem recidiva de derrame pericárdico. Evoluiu na sequência com quadro séptico, por endocardite infecciosa, trombo em fio de marcapasso e insuficiência tricúspide. Foi submetida a cirurgia para retirada de fio de marca-passo provisório e troca valvar tricúspide de urgência, evoluindo a óbito no pós-operatório. CONCLUSÃO: O QT longo, inicialmente pensado como congênito, foi considerado a causa das arritmias. O papel da inflamação na gênese do QT longo tem sido descrito e foi comprovado neste caso, pela normalização do intervalo e desaparecimento das arritmias com o tratamento específico da tuberculose. Alto grau de suspeição é importante para diagnóstico precoce, já que alguns casos de miocardite tuberculosa foram relatados no último anos na literatura inglesa, francesa e espanhola, todos eles diagnosticados na necropsia. A terapia antituberculose pode resultar em sucesso com regressão da doença e resolução de arritmias malignas. (AU)

Strategies for Establishing a Rearing Technique for the Fruit Fly Parasitoid: Doryctobracon brasiliensis (Hymenoptera: Braconidae).

Anastrepha fraterculus (Wiedemann) (Diptera: Tephritidae) is the most important pest in South American orchards. When control measures are not adopted, this pest can cause losses of up to 100%. Doryctobracon brasiliensis (Szépligeti) (Hymenoptera: Braconidae) is a larval-pupal endoparasitoid that can be used as a native biological control agent against A. fraterculus. This study aimed to develop a rearing technique for D. brasiliensis in larvae of A. fraterculus. Trials were carried out to: 1) determine the optimal instar for parasitism, 2) define the exposure time of larvae to parasitoids, 3) determine the density requirements of A. fraterculus larvae offered to each parasitoid, and 4) evaluate the effect of diet on adults of D. brasiliensis. In all trials, we evaluated the number of offspring, parasitism rate, and sex ratio. Moreover, in the experiment to investigate the effects of diet, we determined the longevity of males and females. In both choice and nonchoice parasitism tests, the parasitoids preferred third-instar larvae of A. fraterculus over second- and first-instar larvae. An exposure time of 12 h of A. fraterculus larvae produced larger numbers of parasitoids and higher parasitism rates. The density of 15 larvae of A. fraterculus to each female of D. brasiliensis produced a larger number of offspring. A supply of honey solution (20 and 50%) to the parasitoids yielded the highest number offspring and resulted in greater longevity. Our findings can be used to support the development of a mass rearing protocol for D. brasiliensis.

Basis for the Development of a Rearing Technique of Aganaspis pelleranoi (Hymenoptera: Figitidae) in Anastrepha fraterculus (Tephritidae: Diptera).

Anastrepha fraterculus (Wiedemann) (Diptera: Tephritidae) is among the most important pests of fruit trees in South America, where it can cause losses of up to 100% in fruit orchards. The endoparasitoid Aganaspis pelleranoi (Brèthes) (Hymenoptera: Figitidae) is one of the main natural enemies of A. fraterculus in Neotropical countries and can be used as a biological control agent against this pest. This study aimed to provide background biological information for the development of a method for mass rearing of A. pelleranoi in larvae of A. fraterculus . We determined the effects of diet on the longevity and parasitism capacity of A. pelleranoi adults, the optimal instar of A. fraterculus for parasitism, the ideal exposure time of the larvae to the parasitoid, and the parasitism capacity of females of A. pelleranoi . The results showed that a 30% honey:water solution maximized parasitoid longevity. Third-instar larvae of A. fraterculus should be used in parasitoid multiplication. An exposure time of 4 h of A. fraterculus larvae produced a larger number of parasitoid offspring, with the highest proportion of females. In addition, the estimated mean parasitism capacity of females of A. pelleranoi was 10 larvae per day. This information can help to develop a mass-rearing method for A. pelleranoi in larvae of A. fraterculus .

Effect of constant temperatures on the biology, life table, and thermal requirements of Aganaspis pelleranoi (Hymenoptera: Figitidae), a parasitoid of Anastrepha fraterculus (Diptera: Tephritidae).

Aganaspis pelleranoi (Brèthes, 1924) (Hymenoptera: Figitidae) is a koinobiont endoparasitoid of larvae of species of the genus Anastrepha and of Ceratitis capitata. It is a candidate for use as a biological control agent, as under field conditions, it may reach a parasitism rate of 62%. The objective of this study was to determine the effect of different constant temperatures on biological parameters of A. pelleranoi when parasitizing the larva of Anastrepha fraterculus (Wiedemann, 1830) (Diptera: Tephritidae), as well as to determine its thermal requirements. The study was conducted in environmental chambers at 18, 20, 22, 25, 28, and 30 ± 1°C; 70 ± 10% relative humidity; and a 12-h photophase. Females maintained at 18 and 20°C produced more progeny than females at other temperatures tested. The longevity of males and females was inversely proportional to temperature, ranging from 49.1 to 3.73 d for females and from 32.1 to 3.8 d for males at temperatures of 18-30°C, respectively. The duration of the biological cycle (egg-to-adult) was influenced by temperature, and ranged from 69.1 d at 18°C to 30 d at 25°C. No preimaginal development of A. pelleranoi occurred at 28 and 30°C. The relationship between temperature and the demographic parameters of A. pelleranoi showed a linear effect over the temperature range of 18-25°C. The lower temperature threshold and thermal constant were 11.69°C and 391.70 degree days, respectively.

Investigation of PM10 sources in Santa Catarina, Brazil through graphical interpretation analysis combined with receptor modelling.

Epidemiological studies have documented that elevated airborne particulate matter (PM) concentrations, especially those with an aerodynamic diameter less than 10 microm (PM10), are associated with adverse health effects. Two receptor models, UNMIX and positive matrix factorization (PMF), were used to identify and quantify the sources of PM10 concentrations in Tubarão and Capivari de Baixo, Santa Catarina, Brazil. This region is known for its high pollution levels due to intense industrial activity and exploitation of natural resources. PM10 samples were collected using high volume samplers at two sites in the region and statistical exploratory analysis techniques were applied to identify and assess PM10 sources. The two primary PM10 sources were identified as soil re-suspension/road dust emissions and coal burning emissions, contributing 65-75% and 15-25% of the PM10, respectively. The study confirmed the significance of the influence of local PM10 emissions (power plants, soil re-suspension and road dust emissions) on regional air quality, although no violations of the Brazilian PM10 standards (limit of 150 microg/m3) were observed, with a mean concentration of 27.6 microg/m3 measured in this study. This study demonstrated the usefulness of statistical exploratory analysis techniques in assessing the validity of modelling results and contributing to the interpretation of ambient air quality data.

Characterization of melanin pigment produced by Aspergillus nidulans.

Although most of the Ascomycetes present DHN-melanin, some reports suggest that A. nidulans does not produce this type of melanin. In this study, we analyzed the pigment extracted from highly melanized strains (MEL1 and MEL2) of Aspergillus nidulans to determine the type of melanin present in this fungus. Our results showed that the pigment produced by MEL1 and MEL2 mutants possesses physical and chemical properties and UV- and IR-spectra very similar to synthetic DOPA-melanin. The characterization of this pigment in terms of its degradation products indicated the presence of indolic units, which were also found in synthetic DOPA-melanin. The analyses of the elemental composition showed that the pigment extracted from these mutants has a high percentage of nitrogen and, therefore, it cannot be DHN-melanin, which presents only trace of nitrogen. This observation was confirmed in the test with tricyclazole because this inhibitor of DHN-melanin biosynthesis did not suppress pigment production in the MEL1 and MEL2 strains. On the other hand, in a medium containing tropolone, an inhibitor of DOPA-melanin biosynthesis, the dark pigmentation of the colonies was not observed indicating that this compound inhibited melanin production in these strains. Taken together, the results obtained in this study indicate that melanin produced by these mutants is DOPA type, representing the first report on characterization of this type of melanin in A. nidulans.

Vascular complications of black patients with type 2 diabetes mellitus in Southern Brazil.

Ethnicity has been shown to be associated with micro- and macrovascular complications of diabetes in European and North American populations. We analyzed the contribution of ethnicity to the prevalence of micro- and macrovascular complications in Brazilian subjects with type 2 diabetes attending the national public health system. Data from 1810 subjects with type 2 diabetes (1512 whites and 298 blacks) were analyzed cross-sectionally. The rates of ischemic heart disease, peripheral vascular disease, stroke, distal sensory neuropathy, and diabetic retinopathy were assessed according to self-reported ethnicity using multiple logistic regression models. Compared to whites, black subjects [odds ratio = 1.72 (95%CI = 1.14-2.6)] were more likely to have ischemic heart disease when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, smoking habit, and serum creatinine. Blacks were also more likely to have end-stage renal disease [3.2 (1.7-6.0)] and proliferative diabetic retinopathy [1.9 (1.1-3.2)] compared to whites when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, and smoking habit. The rates of peripheral vascular disease, stroke and distal sensory neuropathy did not differ between groups. The higher rates of ischemic heart disease, end-stage renal disease and proliferative diabetic retinopathy in black rather than in white Brazilians were not explained by differences in conventional risk factors. Identifying which aspects of ethnicity confer a higher risk for these complications in black patients is crucial in order to understand why such differences exist and to develop more effective strategies to reduce the onset and progression of these complications.

Vascular complications of black patients with type 2 diabetes mellitus in Southern Brazil

Ethnicity has been shown to be associated with micro- and macrovascular complications of diabetes in European and North American populations. We analyzed the contribution of ethnicity to the prevalence of micro- and macrovascular complications in Brazilian subjects with type 2 diabetes attending the national public health system. Data from 1810 subjects with type 2 diabetes (1512 whites and 298 blacks) were analyzed cross-sectionally. The rates of ischemic heart disease, peripheral vascular disease, stroke, distal sensory neuropathy, and diabetic retinopathy were assessed according to self-reported ethnicity using multiple logistic regression models. Compared to whites, black subjects [odds ratio = 1.72 (95 percentCI = 1.14-2.6)] were more likely to have ischemic heart disease when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, smoking habit, and serum creatinine. Blacks were also more likely to have end-stage renal disease [3.2 (1.7-6.0)] and proliferative diabetic retinopathy [1.9 (1.1-3.2)] compared to whites when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, and smoking habit. The rates of peripheral vascular disease, stroke and distal sensory neuropathy did not differ between groups. The higher rates of ischemic heart disease, end-stage renal disease and proliferative diabetic retinopathy in black rather than in white Brazilians were not explained by differences in conventional risk factors. Identifying which aspects of ethnicity confer a higher risk for these complications in black patients is crucial in order to understand why such differences exist and to develop more effective strategies to reduce the onset and progression of these complications.

Proliferative diabetic retinopathy is associated with microalbuminuria in patients with type 2 diabetes.

Diabetic retinopathy is one of the leading causes of blindness in working-age individuals. Diabetic patients with proteinuria or those on dialysis usually present severe forms of diabetic retinopathy, but the association of diabetic retinopathy with early stages of diabetic nephropathy has not been entirely established. A cross-sectional study was conducted on 1214 type 2 diabetic patients to determine whether microalbuminuria is associated with proliferative diabetic retinopathy in these patients. Patients were evaluated by direct and indirect ophthalmoscopy and grouped according to the presence or absence of proliferative diabetic retinopathy. The agreement of diabetic retinopathy classification performed by ophthalmoscopy and by stereoscopic color fundus photographs was 95.1% (kappa = 0.735; P < 0.001). Demographic information, smoking history, anthropometric and blood pressure measurements, glycemic and lipid profile, and urinary albumin were evaluated. On multiple regression analysis, diabetic nephropathy (OR = 5.18, 95% CI = 2.91-9.22, P < 0.001), insulin use (OR = 2.52, 95% CI = 1.47-4.31, P = 0.001) and diabetes duration (OR = 1.04, 95% CI = 1.01-1.07, P = 0.011) were positively associated with proliferative diabetic retinopathy, and body mass index (OR = 0.90, 95% CI = 0.86-0.96, P < 0.001) was negatively associated with it. When patients with macroalbuminuria and on dialysis were excluded, microalbuminuria (OR = 3.3, 95% CI = 1.56-6.98, P = 0.002) remained associated with proliferative diabetic retinopathy. Therefore, type 2 diabetic patients with proliferative diabetic retinopathy more often presented renal involvement, including urinary albumin excretion within the microalbuminuria range. Therefore, all patients with proliferative diabetic retinopathy should undergo an evaluation of renal function including urinary albumin measurements.

Proliferative diabetic retinopathy is associated with microalbuminuria in patients with type 2 diabetes

Diabetic retinopathy is one of the leading causes of blindness in working-age individuals. Diabetic patients with proteinuria or those on dialysis usually present severe forms of diabetic retinopathy, but the association of diabetic retinopathy with early stages of diabetic nephropathy has not been entirely established. A cross-sectional study was conducted on 1214 type 2 diabetic patients to determine whether microalbuminuria is associated with proliferative diabetic retinopathy in these patients. Patients were evaluated by direct and indirect ophthalmoscopy and grouped according to the presence or absence of proliferative diabetic retinopathy. The agreement of diabetic retinopathy classification performed by ophthalmoscopy and by stereoscopic color fundus photographs was 95.1 percent (kappa = 0.735; P < 0.001). Demographic information, smoking history, anthropometric and blood pressure measurements, glycemic and lipid profile, and urinary albumin were evaluated. On multiple regression analysis, diabetic nephropathy (OR = 5.18, 95 percent CI = 2.91-9.22, P < 0.001), insulin use (OR = 2.52, 95 percent CI = 1.47-4.31, P = 0.001) and diabetes duration (OR = 1.04, 95 percent CI = 1.01-1.07, P = 0.011) were positively associated with proliferative diabetic retinopathy, and body mass index (OR = 0.90, 95 percent CI = 0.86-0.96, P < 0.001) was negatively associated with it. When patients with macroalbuminuria and on dialysis were excluded, microalbuminuria (OR = 3.3, 95 percent CI = 1.56-6.98, P = 0.002) remained associated with proliferative diabetic retinopathy. Therefore, type 2 diabetic patients with proliferative diabetic retinopathy more often presented renal involvement, including urinary albumin excretion within the microalbuminuria range. Therefore, all patients with proliferative diabetic retinopathy should undergo an evaluation of renal function including urinary albumin measurements.

The presence of allele D of angiotensin-converting enzyme polymorphism is associated with diabetic nephropathy in patients with less than 10 years duration of Type 2 diabetes.

AIM: To investigate the association between angiotensin-converting enzyme gene I/D polymorphism and diabetic nephropathy (DN) in patients with Type 2 diabetes mellitus (DM) taking into consideration the known duration of DM. METHODS: Cross-sectional study with 982 patients categorized according to urinary albumin excretion (UAE) into normoalbuminuria (UAE < 20 microg/min or < 17 mg/l, 24-h timed urine or spot random sterile urine, respectively), incipient DN (UAE 20-199 microg/min or 17-174 mg/l) and overt DN (UAE > 200 microg/min or > 174 mg/l or dialysis). Patients were further grouped regarding presence of the D allele (DD/ID vs. II) and DM duration (< or = 10 years or > 10 years). RESULTS: Incipient DN was diagnosed in 17.3% (n = 170), and 20.7% (n = 203) had overt DN (macroalbuminuria, n = 129; dialysis, n = 74). Genotype distribution (DD/ID/II) was similar in patients with incipient (49/92/29) or overt DN (77/89/37) if compared with patients without DN (181/308/120, P = 0.172). In patients with DM < or = 10 years, having the D allele (DD/ID) resulted in an odds ratio (OR) of 2.66 (95% CI: 1.12-6.58, P = 0.015) for incipient DN, and 3.19 (95% CI: 1.18-9.30, P = 0.012) for overt DN. In patients with longer DM duration, the D allele did not increase the risk for incipient (OR 0.68, 95% CI 0.36-1.29, P = 0.206) or overt DN (OR 0.67, 95% CI 0.39-1.17, P = 0.138). CONCLUSION: The DD/ID genotypes were associated with incipient or overt DN in patients with DM < or = 10 years.

Aggregation of features of the metabolic syndrome is associated with increased prevalence of chronic complications in Type 2 diabetes.

AIMS: To investigate the association of features of the metabolic syndrome with the prevalence of chronic complications. METHODS: A cross-sectional study was conducted with 548 patients with Type 2 diabetes mellitus (DM). Metabolic syndrome was diagnosed in the presence of at least two of the following: hypertension, dyslipidaemia, obesity, and microalbuminuria. RESULTS: Patients with the metabolic syndrome (85%) had a higher prevalence of peripheral vascular disease (PVD) (35% vs. 18%), retinopathy (44% vs. 20%), distal sensory neuropathy (DSN) (44% vs. 24%), micro- and macroalbuminuria (38% vs. 28%) and coronary artery disease (CAD) (53% vs. 36%). The more metabolic syndrome features (none/one, two, three or four), the higher the proportion of diabetes complications: PVD 18%, 31%, 37% and 38%; stroke 1.0%, 4.5%, 5.9% and 11.3%; retinopathy 20%, 38%, 42% and 64%; DSN 24%, 32%, 49% and 57%; micro- and macroalbuminuria 28%, 36% and 41%; and CAD 36%, 44%, 52% and 60% (P < 0.05). CONCLUSIONS: The metabolic syndrome and the aggregation of its components were significantly associated with macro- and microvascular complications in Type 2 DM patients.

Ultrasonographic determination of goiter prevalence in southern Brazilian schoolchildren.

The aim of the present study was to estimate the prevalence of goiter in schoolchildren in a formerly iodine-deficient region in southern Brazil by assessing the relationship between body surface area (m2 ) and thyroid volume (ml) measured by ultrasonography. A population-based sample of 1,094 randomly selected schoolchildren (6 to 14 years; 556 boys and 538 girls) underwent clinical evaluation. A total of 119 (10.9%) children were diagnosed with goiter upon clinical examination according to WHO criteria (grade Ia: 65, grade Ib: 24, grade II: 29, grade III: 1). Of these, 85 underwent ultrasonography. In order to ascertain the absence of goiter in the 975 schoolchildren with a negative result upon clinical examination, one of ten children was randomly selected for ultrasonography. Sixty-two children agreed to be submitted to the exam. Thus, 147 schoolchildren were evaluated by ultrasonography (7.5-MHz transducer). Goiter was considered to be present when the thyroid volume:body surface area index was >6.2 ml/m . The estimated prevalence of goiter if all schoolchildren had been submitted to thyroid volume measurement by ultrasound was 7.2%; it was higher in the lower socioeconomic class (8.2%) than in the upper (7.8%) and middle classes (6.5%). In conclusion, the prevalence of goiter in schoolchildren of this region was higher than in other iodine-sufficient areas, especially in lower socioeconomic classes. Goiter in this region may be associated with naturally occurring goitrogens that operate more intensively among less privileged individuals.

Ultrasonographic determination of goiter prevalence in southern Brazilian schoolchildren

The aim of the present study was to estimate the prevalence of goiter in schoolchildren in a formerly iodine-deficient region in southern Brazil by assessing the relationship between body surface area (mý) and thyroid volume (ml) measured by ultrasonography. A population-based sample of 1,094 randomly selected schoolchildren (6 to 14 years; 556 boys and 538 girls) underwent clinical evaluation. A total of 119 (10.9 percent) children were diagnosed with goiter upon clinical examination according to WHO criteria (grade Ia: 65, grade Ib: 24, grade II: 29, grade III: 1). Of these, 85 underwent ultrasonography. In order to ascertain the absence of goiter in the 975 schoolchildren with a negative result upon clinical examination, one of ten children was randomly selected for ultrasonography. Sixty-two children agreed to be submitted to the exam. Thus, 147 schoolchildren were evaluated by ultrasonography (7.5-MHz transducer). Goiter was considered to be present when the thyroid volume:body surface area index was >6.2 ml/mý. The estimated prevalence of goiter if all schoolchildren had been submitted to thyroid volume measurement by ultrasound was 7.2 percent; it was higher in the lower socioeconomic class (8.2 percent) than in the upper (7.8 percent) and middle classes (6.5 percent). In conclusion, the prevalence of goiter in schoolchildren of this region was higher than in other iodine-sufficient areas, especially in lower socioeconomic classes. Goiter in this region may be associated with naturally occurring goitrogens that operate more intensively among less privileged individuals

Daily birth numbers in Passo Fundo, South Brazil, 1997-1999: trends and periodicities.

Between October 6, 1997 and April 30, 1999, 5011 births (mean: 8.76 per day) were registered in the city of Passo Fundo, South Brazil. The sequence of 572 daily birth numbers was not random (iteration test). Neyman distribution (m = yen ) showed the best fit. Clusters of days with higher birth numbers alternated with days with low numbers of births. Periodogram analysis revealed a significant periodicity of 6.98 days. The cosinor regression, testing 10 a priori supposed period lengths, found significant seasonality peaking in August-September and significantly highest birth numbers on Thursdays. Among the lunar and solar rotation cycles, the tropic lunar cycle and its 4th harmonic were most pronounced, in agreement with results concerning natality in Germany obtained by Svante Arrhenius in the 19th century. These findings confirm Derer-Halberg's concept of multiseptans. In addition to cycling, a significantly increasing linear trend with a daily increase of 0.0045 births was encountered. This documents a growth of the population in agreement with national statistical data.

Daily birth numbers in Passo Fundo, South Brazil, 1997-1999: trends and periodicities

Between October 6, 1997 and April 30, 1999, 5011 births (mean: 8.76 per day) were registered in the city of Passo Fundo, South Brazil. The sequence of 572 daily birth numbers was not random (iteration test). Neyman distribution (m = Ñ) showed the best fit. Clusters of days with higher birth numbers alternated with days with low numbers of births. Periodogram analysis revealed a significant periodicity of 6.98 days. The cosinor regression, testing 10 a priori supposed period lengths, found significant seasonality peaking in August-September and significantly highest birth numbers on Thursdays. Among the lunar and solar rotation cycles, the tropic lunar cycle and its 4th harmonic were most pronounced, in agreement with results concerning natality in Germany obtained by Svante Arrhenius in the 19th century. These findings confirm Derer-Halberg's concept of multiseptans. In addition to cycling, a significantly increasing linear trend with a daily increase of 0.0045 births was encountered. This documents a growth of the population in agreement with national statistical data

Incidence of type 1 diabetes mellitus in Passo Fundo, RS, Brazil

To establish the incidence of type 1 diabetes among children (infants to 14 years of age) in the city of Passo Fundo, Rio Grande do Sul, Brazil (population under 15 years = 50,098), during the period of January to December 1996, a retrospective and prospective population-based registry was established, using physician reports of newly diagnosed patients under 15 years of age with type 1 diabetes as the primary source of case identification. Primary and nursery schools and a general call through the media (newspapers, radio and television) was the secondary source. Data were calculated according to the methods recommended by the WHO (1990). Six new cases were identified. Case ascertainment was estimated at 100 percent. The incidence of type 1 diabetes in the year 1996 was 12/100,000 inhabitants. These data indicate that the incidence of childhood type 1 diabetes in a subtropical region in the Southern part of Brazil was similar to that observed in developed countries throughout the world. The inability to demonstrate the North-South gradient is probably due to the European origin of inhabitants of the city

Incidence of type 1 diabetes mellitus in Passo Fundo, RS, Brazil.

To establish the incidence of type 1 diabetes among children (infants to 14 years of age) in the city of Passo Fundo, Rio Grande do Sul, Brazil (population under 15 years = 50,098), during the period of January to December 1996, a retrospective and prospective population-based registry was established, using physician reports of newly diagnosed patients under 15 years of age with type 1 diabetes as the primary source of case identification. Primary and nursery schools and a general call through the media (newspapers, radio and television) was the secondary source. Data were calculated according to the methods recommended by the WHO (1990). Six new cases were identified. Case ascertainment was estimated at 100%. The incidence of type 1 diabetes in the year 1996 was 12/100,000 inhabitants. These data indicate that the incidence of childhood type 1 diabetes in a subtropical region in the Southern part of Brazil was similar to that observed in developed countries throughout the world. The inability to demonstrate the North-South gradient is probably due to the European origin of inhabitants of the city.

Clinical examination is not an accurate method of defining the presence of goitre in schoolchildren.

OBJECTIVE: There are few published data on thyroid size and body size variables in children. We aimed to develop an index for normal thyroid size in schoolchildren using ultrasonography and to evaluate the accuracy of clinical examination in the diagnosis of goitre. DESIGN: A study to screen and diagnose goitre. SUBJECTS: A population based sample of 1094 schoolchildren aged 6-14 years (556 boys and 538 girls) were submitted to clinical examination of the thyroid. One hundred and nineteen were considered to have goitre. Ultrasonography was performed in 85 who agreed to participate in the study and in 62 schoolchildren selected randomly from those thought to have no goitre. MEASUREMENTS: Clinical examination and definition of goitre were performed according to WHO criteria. Thyroid volume was measured by ultrasonography (7-5 MHz transducer). RESULTS: The gland volume of 62 schoolchildren without goitre on clinical examination showed a positive correlation with body surface area, age and skinfold thickness. When these factors were entered in multiple regression analysis, only body surface area remained associated with thyroid volume. The upper limit (95th percentile) of the ratio of thyroid volume to body surface area (Ecobody index) was 6.2 ml/m2. Taking this index as the standard criterion, the performance parameters of clinical examination for the defection of goitre in the 1094 schoolchildren were: sensitivity 41%, specificity 91%, positive predictive value 27% and negative predictive value 95%. CONCLUSIONS: Clinical examination of the thyroid is unreliable in establishing the presence of goitre in schoolchildren because it lends to overestimate thyroid size. Nevertheless, it can be used as a screening test. Ultrasonography should be performed when the thyroid gland is thought to be enlarged.