Evaluation the Potential of Onion/Laponite Composites Films for Sustainable Food Packaging with Enhanced UV Protection and Antioxidant Capacity.

Agro-industrial residues have attracted attention for their applications in the field of biodegradable packaging. Recently, our research group has developed onion-based films with promising properties for this type of application due to their non-toxicity, biocompatibility and biodegradability. Therefore, in this study, we investigated the effect of Laponite clay concentration on the physicochemical and antioxidant properties of the onion-based films, which were prepared by a casting method. The XRD and FTIR data confirm the presence of the mineral clay in the onion-based films. These findings are consistent with those obtained from FE-SEM analysis, which revealed the presence of typical Laponite grains. In terms of wettability, the results show that the clay decreases the hydrophilic character of the material but slightly increases the water vapor permeation. Optical characterization revealed that the materials exhibited zero transmittance in the UV region and increased opacity in the visible region for composites containing 5% and 10% Laponite. Furthermore, the antioxidant test demonstrated higher antioxidant potential in the composites compared to the pure films. Consequently, these results suggest that the formation of Laponite and onion composites could be an essential strategy for developing natural polymers in the field of food contact packaging.

Otological findings and other symptoms related to temporomandibular disorders in young people.

In a prospective, observational study between April and November 2017 we evaluated the correlation between temporomandibular disorder (TMD), and otological signs and other symptoms in a sample of 251 patients. First, a simplified anamnestic questionnaire was applied for the diagnosis of TMD and the following symptoms were recorded: otalgia, tinnitus, vertigo, pruritus of the ear, feeling of hearing loss, fullness in the ear, headache, pain in the eye, neck pain, back pain, and dizziness. Some degree of TMD was detected in 177 of the participants (70.5%). Among the otological symptoms studied, significant associations were found with tinnitus (<0.001), ear pain (<0.001), feeling of hearing loss (<0.001), and vertigo (<0.001). There were also significant associations with non-otological symptoms, the most common being back pain (<0.001), headache (<0.001), neck pain (<0.001), pain in the eye (<0.001), and dizziness (0.001). Our findings show that the higher incidence of both otological and non-otological symptoms was associated with a progressive increase in the severity of TMD.

Endometrial expression of estrogen and progesterone receptors in non-cyclic mares treated only with long-acting progesterone.

Administration of progesterone (P4) after estradiol is usually performed to prepare non-cyclic mares as embryo recipients. However, there are successful pregnancy reports after embryo transfer in non-cyclic mares treated only with progestins. The objective of this study was to evaluate endometrial gene expression and immunostaining for estrogen receptor alpha (ERα), beta (ERß) and progesterone receptor (PR) in seasonal anestrous mares treated with long acting P4 (LA P4). Endometrial tissue from eight seasonal anestrous mares was collected immediately before administration of 1.5 g of LA P4 and five days after. The receptors protein expression was evaluated by immunohistochemistry and the percentage of the immunostained area was determined by ImageJ software. Transcripts abundance for ERα, ERß and PR were determined by RT-qPCR. Blood samples were collected daily to measure plasma P4 concentrations. Protein expression for ERα was greater (p < 0.05) after LA P4 administration, although gene expression was not affected by treatment (p > 0.05). There was no difference for ERß protein expression (p = 0.07) and ERß gene expression was reduced (p < 0.05) after treatment. Gene and protein expression for PR was not altered (p > 0.05). In conclusion, endometrial PR and ERα expression patterns after LA P4 administration were similar to those previously found in protocols using estradiol prior to LA P4 to prepare non-cyclic mares as embryo recipients.

Imunogenicidade da proteína M recombinante de Streptococcus equi subsp. equi coadministrada com um adjuvante molecular / Immunogenicity of recombinant M protein of Streptococcus equi subsp. equi co administered with a molecular adjuvant

The strangles is an infectious disease that affects horses from all ages and causes important economic losses in the equine-related business. The aim of this work was to evaluate the immunogenicity of the recombinant M protein from Streptococcus equi (rSeM) co-administered with the recombinant heat-labile enterotoxin B subunit from Escherichia coli (rLTB) in mice and horses. A total of 72 female Balb-c mice were divided into eight groups and 18 horses were divided into six groups. The animals were inoculated by intramuscular (IM) or intranasal (IN) routes with different treatments of rSeM, rLTB and/or Al(OH)3. The results obtained in both species, independent of administration routes, demonstrated that rSeM + rLTB had higher levels of specific serum immunoglobulins, however, in mucosal immunity the increase was not identified. Thus, the use of rSeM as vaccine antigen and rLTB as adjuvant can be a potential tool in the control of equine strangles.(AU)

Outcome of bacteremia caused by extended-spectrum ß-lactamase-producing Enterobacteriaceae after solid organ transplantation.

INTRODUCTION: Although infection with extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-E) has been recognized as an important cause of morbidity after solid organ transplantation, there are limited data on the outcome of this complication among transplant recipients. The objective of this study was to describe the outcome and factors associated with mortality among recipients of abdominal solid organ transplants with bloodstream infection caused by ESBL-E. PATIENTS AND METHODS: This study was a retrospective analysis of a case series of patients who had bacteremia caused by ESBL-E after undergoing renal or liver transplantation between January 2000 and September 2008 at a university-affiliated hospital in Rio de Janeiro, Brazil. The primary end point of the study was death within 30 days of the diagnosis of bacteremia. RESULTS: During the study period, 997 subjects underwent kidney (759 patients) or liver (238 patients) transplantation. Fifty-four episodes of bacteremia caused by ESBL-E were diagnosed in 39 patients (4%). Mortality after the first episode of ESBL-E bacteremia was 26% (10 deaths). In multiple logistic regression analysis, the Pitt bacteremia score (P = .005) and being on mechanical ventilation at the time of infection diagnosis (P = .02) were the only variables associated with mortality. Thirteen episodes of recurrent bacteremia occurred in 8 (28%) of the 29 patients who survived the first episode. Two (25%) of these 8 patients died during the course of a recurrent episode. CONCLUSIONS: Bacteremia caused by ESBL-E was associated with high mortality and high risk of recurrence. Factors associated with clinical severity at the time of infection diagnosis were the main predictors of mortality.

Resistance to thyroid hormone due to mutations in the THRB gene impairs bone mass and affects calcium and phosphorus homeostasis.

CONTEXT: Resistance to thyroid hormone (RTH) is an inherited syndrome of reduced tissue responsiveness to thyroid hormone, which is usually due to mutations in the thyroid hormone receptor ß gene (THRB). Few studies have been conducted to investigate bone and mineral metabolism in RTH. OBJECTIVE: The objective of the study was to evaluate the clinical and biochemical parameters related to bone and mineral metabolism in RTH due to mutations in the THRB gene (RTHß). DESIGN AND PARTICIPANTS: We conducted a cross-sectional study on 14 patients with RTHß (RTHG), eight adults and six children, and 24 control subjects (CG). OUTCOMES: Serum measures included total calcium (TCa), inorganic phosphate (iP), alkaline phosphatase (AP), parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), osteocalcin (OC), carboxyterminal telopeptide (CTX), and fibroblast growth factor 23 (FGF-23). We estimated the renal threshold phosphate concentration (TmPO4/GFR) and assessed bone mass using dual X-ray absorptiometry. RESULTS: Adults and children with RTH showed higher serum levels of TCa than controls (P=.029 and, P=.018 respectively). However, only children with RTH exhibited lower serum levels of iP than controls (P=.048). FGF-23 was higher in RTHß children (P=.04). RTHß adults had lower whole-body (P=.01) and lumbar spine (P=.01) bone mineral density than control subjects. The same pattern was observed when the results were expressed as Z-scores between groups, with a lower value in RTHG than in CG for the lumbar spine of adults (P=.03). No difference was observed between groups in PTH, 25OHD, AP, OC, and CTX. CONCLUSION: Biochemical abnormalities are seen in children with RTH (Low iP, high FGF23), while high calcium (with normal UCa) is seen in RTH subjects of all ages, and later on, in adult life, low BMD is seen. Considering that the TRα1 isoform is the predominant TR in the skeleton, we hypothesize that probably these patients may exhibit enhanced calcium flux from bone to circulation. Our data represent a challenge for new studies to unveil the control of calcium and phosphorus homeostasis and fracture risk in these patients.

Differential expression of immune-modulatory molecule HLA-E in non-neoplastic and neoplastic lesions of the thyroid.

Human leukocyte antigen (HLA)–E is a non-classical molecule of the histocompatibility complex that functions as one of the main ligands of the Natural Killer (NK) cell inhibitory receptor CD94/NKG2A and inhibits its potent cytotoxic activity. Due to the important role of NK cells in combating neoplasm, we hypothesized that the differential expression of HLA-E could favor the progression of heterogeneous thyroid tumors.Using an immunohistochemistry technique in 143 biopsies of thyroid tumors, including benign and malignant neoplasms and goiters, we evaluated the expression of HLA-E among various tumor types and its association with the clinicopathological factors of diseases. We verified high HLA-E expression in all types of neoplastic tumors, although no significant differences between the groups were found. Low expression was observed in 95 percent of the goiter samples, showing significant differences between neoplastic and non-neoplastic lesions. Furthermore, a significant result was found with regard to the tumor size, with high HLA-E expression being related to smaller tumors. Therefore, our data suggest that an increase in HLA-E may be associated with the establishment of thyroid neoplasms, with either benign or malignant features.

[Biomechanical effects of the inclusion of holes to facilitate the integration in monofilament polypropylene meshes: an experimental study]. / Efectos biomecánicos de la inclusión de orificios facilitadores de la integración en mallas de polipropileno monofilamento: estudio experimental.

OBJECTIVE: To evaluate the biomechanical properties of a type of monofilament polypropylene mesh used to repair vaginal prolapse, as well as the effects of the inclusion of standard size orifices, called "helper orifices," on the interface resistance in the receiving area. MATERIAL AND METHODS: Forty female Wistar rats, 3 month-old, received an implant of monofilament polypropylene mesh, measuring 24 x 11 mm with no orifices, on left side of the abdominal wall (block 1). On the right side, a similar mesh with two circular orifices (6 mm diameter) was implanted (block 2). The rats were euthanized 90 days later and their abdominal walls were removed and divided into two blocks. The biomechanical study used a precision tensiometer in which the mesh was uniaxially tensioned until it was loosened from the tissue interface. In order to determine the tissue adherence and elasticity in each group, the following variables were analyzed: maximum load; deflection at maximum load; work to maximum load; stiffness as well as load, deflection and work at detachment the mesh. RESULTS: With the exception of stiffness, all the other variables showed statistical differences between the groups, considering that they were increased in meshes with orifices (p<0.001). The inclusion of standard size orifices reduced 30% of the mesh weigth. CONCLUSION: Besides reducing the weight and amount of material, the inclusion of standard size orifices in the monofilament macroporous polypropylene mesh improved the elasticity and adherence to the tissues when implanted in the interface of the abdominal wall in adult female rats.

Secondary intracardiac Burkitt-like lymphoma in the absence of HIV infection.

Malignant lymphoma can involve the cardiac cavity or myocardium as a mass. Since clinical symptoms of its cardiac involvement are usually absent or non-specific, they may be undetected during life. Burkitt-like lymphoma (BLL) is a highly aggressive B-cell lymphoma with a high proliferative rate. Histopathological characteristics are considered borderline between those of classic Burkitt lymphoma and diffuse large B-cell lymphoma. Extensive cardiac involvement of BLL is rare and poorly documented in the literature. We report the case of a child with BLL, presenting with extensive infiltration of the heart in the absence of HIV infection, and with right-sided heart failure and positional dyspnoea as the major clinical problems. We highlight the challenges for diagnosis and adequate treatment in poor settings like ours.

Un nuevo modelo experimental de inducción de cistitis intersticial mediante estrés oxidativo empleando instilación vesical de un gel donante de óxido nítrico / A new experimental model for inducing interstitial cystitis by oxidative stress using bladder instillation of a nitric oxide donor gel

Objetivo: La principal finalidad de este estudio es el desarrollo de un nuevo modelo experimental para la inducción de cistitis intersticial (CI) mediante la instilación vesical de una solución polimérica que contiene el S-nitrosoglutatión donante de óxido nítrico (GSNO), y su comparación con la cistitis intersticial experimental inducida por instilación vesical de protamina y cloruro potásico. Material y métodos: Para la consecución de nuestro objetivo utilizamos 40 hembras de rata Wistar divididas en cuatro grupos: a) solución salina + GSNO; b) solución salina + solución polimérica (sin GNSO); c) sulfato de protamina + KCl; y d) sulfato de protamina + GSNO. Se realizó bien una aplicación a las ratas (5 animales), bien 3 aplicaciones (5 animales) de la sustancia correspondiente mediante instilación vesical, y al cabo de 6 días (5 animales) o 9 días (5 animales)se les practicó la eutanasia y se les extrajeron las vejigas para su evaluación macroscópica y estudio histológico. Resultados: En términos de evaluación macroscópica observamos edema e hiperemia de la mucosa en dos (22%) de los animales del grupo 1, en 0 (0%) de los del grupo 2, en 10 (100%) de los del 3 y en 5 (50%) de los animales del grupo 4. En el grupo de protamina + KCl y en solución salina + GSNO se observaron efectos similares en la pared vesical. Los animales del grupo 2 (solución salina + polimérica) mostraban congestión vascular, bastante menos significativa que en el resto después de 9 días de instilaciones (p = 0,0035). Se observó un aumento de la fibrosis tras las instilaciones en los grupos 3 y 4 a los 6 días (p = 0,3781) y a los 9 días (p = 0,0459) respectivamente, en comparación con los controles (grupo 2). En todos los grupos aparecía un infiltrado de neutrófilos con intensidad variable a los 6 días de las instilaciones (p = 0,7277). Al cabo de 9 días se producía una regresión del infiltrado, y sin evidencias de reacción neutrofílica marcada en todos los grupos (p = 0,2301). Conclusión: La respuesta inflamatoria a la instilación vesical de una solución acuosa de Snitrosoglutatión fue muy parecida a la inducida por la instilación vesical de protamina y KCl. La instilación de una solución acuosa de GSNO puede considerarse un nuevo modelo para la inducción experimental de cistitis intersticial (AU)

Purpose: The aim of this study is to develop a new experimental model of inducing interstitial cystitis (IC) through vesical instillation of a polymeric solution containing the NO donor S-nitrousglutathione (GSNO) and to compare it to the experimental interstitial cystitis inducedby vesical instillation of protamine and potassium chloride. Material and method: For that purpose 40 female Wistar rats were used, divided in four groups: 1. saline solution + GSNO; 2. saline solution + polymeric solution (without GNSO); 3. Protamine sulphate + KCl; 4. protamine sulphate + GSNO. The rats received one application (5 animals) or 3 applications (5 animals) of the corresponding substance through intravesical instillation, and after 6 days (5 animals) or 9 days (5 animals) they were euthanized and their bladders were removed for macroscopic evaluation and histological study. Results: In the macroscopic evaluation we observed edema and hyperemia of the mucosa in2 (22%) of the animals in group 1, in 0 (0%) of the animals in group 2, in 10 (100%) of the animals in group 3, and in 5 (50%) of the animals in group 4. In the protamine + KCl group and in saline + GSNO similar effects were observed on the bladder wall. The animals in group2 (saline + polymeric) showed vascular congestion, significantly smaller than the rest after9 days instillations (p = 0.0035). Significant increased fibrosis was observed after instillations in groups 3 and 4, after 6 days (p = 0.3781) and 9 days (p = 0.0459) respectively, when compared to control (group 2). All groups presented neutrophilic infiltrate of variable intensity 6 days after instillations (p = 0.7277). After 9 days, there was a regression of the infiltrate, with no evidence of accentuated neutrophilic reaction in all the groups (p = 0.2301). Conclusion: The inflammatory response to bladder instillation of an aqueous solution of Snitrousglutathione was very similar to that induced by bladder instillation of protamine and KCl. Instillation of an aqueous solution of GSNO can be considered a new model for experimental induction of interstitial cystitis (AU)

[A new experimental model for inducing interstitial cystitis by oxidative stress using bladder instillation of a nitric oxide donor gel]. / Un nuevo modelo experimental de inducción de cistitis intersticial mediante estrés oxidativo empleando instilación vesical de un gel donante de óxido nítrico.

PURPOSE: The aim of this study is to develop a new experimental model of inducing interstitial cystitis (IC) through vesical instillation of a polymeric solution containing the NO donor S-nitrousglutathione (GSNO) and to compare it to the experimental interstitial cystitis induced by vesical instillation of protamine and potassium chloride. MATERIAL AND METHOD: For that purpose 40 female Wistar rats were used, divided in four groups: 1. saline solution + GSNO; 2. saline solution + polymeric solution (without GNSO); 3. protamine sulphate + KCl; 4. protamine sulphate + GSNO. The rats received one application (5 animals) or 3 applications (5 animals) of the corresponding substance through intravesical instillation, and after 6 days (5 animals) or 9 days (5 animals) they were euthanized and their bladders were removed for macroscopic evaluation and histological study. RESULTS: In the macroscopic evaluation we observed edema and hyperemia of the mucosa in 2 (22%) of the animals in group 1, in 0 (0%) of the animals in group 2, in 10 (100%) of the animals in group 3, and in 5 (50%) of the animals in group 4. In the protamine + KCl group and in saline + GSNO similar effects were observed on the bladder wall. The animals in group 2 (saline + polymeric) showed vascular congestion, significantly smaller than the rest after 9 days instillations (p=0.0035). Significant increased fibrosis was observed after instillations in groups 3 and 4, after 6 days (p=0.3781) and 9 days (p=0.0459) respectively, when compared to control (group 2). All groups presented neutrophilic infiltrate of variable intensity 6 days after instillations (p=0.7277). After 9 days, there was a regression of the infiltrate, with no evidence of accentuated neutrophilic reaction in all the groups (p=0.2301). CONCLUSION: The inflammatory response to bladder instillation of an aqueous solution of S-nitrousglutathione was very similar to that induced by bladder instillation of protamine and KCl. Instillation of an aqueous solution of GSNO can be considered a new model for experimental induction of interstitial cystitis.

Neonatal screening for cystic fibrosis in São Paulo State, Brazil: a pilot study

Cystic fibrosis is one of the most common autosomal recessive hereditary diseases in the Caucasian population, with an incidence of 1:2000 to 1:3500 liveborns. More than 1000 mutations have been described with the most common being F508del. It has a prevalence of 23-55 percent within the Brazilian population. The lack of population-based studies evaluating the incidence of cystic fibrosis in São Paulo State, Brazil, and an analysis concerning the costs of implantation of a screening program motivated the present study. A total of 60,000 dried blood samples from Guthrie cards obtained from April 2005 to January 2006 for neonatal screening at 4 reference centers in São Paulo State were analyzed. The immunoreactive trypsinogen (IRT)/IRT protocol was used with the cut-off value being 70 ng/mL. A total of 532 children (0.9 percent) showed IRT >70 ng/mL and a 2nd sample was collected from 418 (80.3 percent) of these patients. Four affected children were detected at two centers, corresponding to an incidence of 1:8403. The average age at diagnosis was 69 days, and 3 of the children already showed severe symptoms of the disease. The rate of false-positive results was 95.2 percent and the positive predictive value for the test was 8 percent. The cost of detecting an affected subject was approximately US$8,000.00 when this cystic fibrosis program was added to an existing neonatal screening program. The present study clearly shows the difficulties involved in cystic fibrosis screening using the IRT/IRT protocol, particularly in a population with no long-term tradition of neonatal screening.

Neonatal screening for cystic fibrosis in São Paulo State, Brazil: a pilot study.

Cystic fibrosis is one of the most common autosomal recessive hereditary diseases in the Caucasian population, with an incidence of 1:2000 to 1:3500 liveborns. More than 1000 mutations have been described with the most common being F508del. It has a prevalence of 23-55% within the Brazilian population. The lack of population-based studies evaluating the incidence of cystic fibrosis in São Paulo State, Brazil, and an analysis concerning the costs of implantation of a screening program motivated the present study. A total of 60,000 dried blood samples from Guthrie cards obtained from April 2005 to January 2006 for neonatal screening at 4 reference centers in São Paulo State were analyzed. The immunoreactive trypsinogen (IRT)/IRT protocol was used with the cut-off value being 70 ng/mL. A total of 532 children (0.9%) showed IRT >70 ng/mL and a 2nd sample was collected from 418 (80.3%) of these patients. Four affected children were detected at two centers, corresponding to an incidence of 1:8403. The average age at diagnosis was 69 days, and 3 of the children already showed severe symptoms of the disease. The rate of false-positive results was 95.2% and the positive predictive value for the test was 8%. The cost of detecting an affected subject was approximately US$8,000.00 when this cystic fibrosis program was added to an existing neonatal screening program. The present study clearly shows the difficulties involved in cystic fibrosis screening using the IRT/IRT protocol, particularly in a population with no long-term tradition of neonatal screening.

Mutagenic potential of water from Pelotas Creek in Rio Grande do Sul, Brazil.

Water resource degradation is one of mankind's greatest worries, as it causes direct and indirect damage to the associated biota. We initiated a water monitoring study in Pelotas Creek in 2003 in order to assess the mutagenic effect of the creek's waters. Allium cepa cells exposed to water samples and a chronically exposed macrophyte were analyzed, through evaluation of the mitotic index, mitotic anomalies, interphase anomalies, and total anomalies. Five points were chosen along the lower course of Pelotas Creek, from which water samples and floating pennywort (Hydrocotyle ranunculoides, Apiaceae) were collected in 2006 and 2007. The enteric bacterium Escherichia coli was found at all sampling points; in the physical-chemical analysis, a few variables exceeded permitted limits, pH (from 6 to 9), chloride (250 mg/L), hardness (from 10 to 200 mg CaCO(3)/L), and conductivity (100 microOmega/cm). There was an increased number of cytogenetic anomalies in exposed A. cepa cells and in the pennywort in 2006 relative to 2007, which may be explained by the increased rainfall, which was three times greater in 2007 at some stations than in 2006.Omega/cm). There was an increased number of cytogenetic anomalies in exposed A. cepa cells and in the pennywort in 2006 relative to 2007, which may be explained by the increased rainfall, which was three times greater in 2007 at some stations than in 2006.

How frequently should a patient taking amiodarone be screened for thyroid dysfunction?

Amiodarone-induced thyroid dysfunction (AITD) is a common complication of amiodarone therapy and its prevalence varies according to iodine intake, subclinical thyroid disorders and the definition of AITD. There is no consensus about the frequency of screening for this condition. We evaluated 121 patients on chronic regular intake of amiodarone (mean intake = 248.5 +/- 89 mg; duration of treatment = 5.3 +/- 3.9 years, range = 0.57-17 years) and with stable baseline cardiac condition. Those with no AITD were followed up for a median period of 3.2 years (range: 0.6-6.7) and the incidence rate of AITD, defined by clinical and laboratorial findings as proposed by international guidelines, was obtained (62.8 per 1000 patients/year). We applied the Cox proportional hazard model to adjust for potential confounding factors and used sensitivity analysis to identify the best screening time for follow-up. We detected thyroid dysfunction in 59 (48.7%) of the 121 patients, amiodarone-induced hypothyroidism in 50 (41.3%) and hyperthyroidism in 9 (7.5%). Compared with patients without AITD, there was no difference regarding dosage or duration of therapy, heart rhythm disorder or baseline cardiac condition. During the follow-up of the 62 patients without AITD at baseline evaluation, 11 developed AITD (interquartile range, IR: 62.8 (95%CI: 31.3-112.3) cases per 1000 patients/year), 9 of them with hypothyroidism - IR: 11.4 (95%CI: 1.38-41.2), and 2 hyperthyroidism - IR: 51.3 (95%CI: 23.4-97.5). Age, gender, dose, and duration of treatment were not significant after adjustment. During the first 6 months of follow-up the incidence rate for AITD was 39.3 (9.2-61.9) cases per 1000 patients/year. These data show that AITD is quite common, and support the need for screening at 6-month intervals, unless clinical follow-up dictates otherwise or further information regarding the prognosis of untreated subclinical AITD is available.

How frequently should a patient taking amiodarone be screened for thyroid dysfunction?

Amiodarone-induced thyroid dysfunction (AITD) is a common complication of amiodarone therapy and its prevalence varies according to iodine intake, subclinical thyroid disorders and the definition of AITD. There is no consensus about the frequency of screening for this condition. We evaluated 121 patients on chronic regular intake of amiodarone (mean intake = 248.5 ± 89 mg; duration of treatment = 5.3 ± 3.9 years, range = 0.57-17 years) and with stable baseline cardiac condition. Those with noAITD were followed up for a median period of 3.2 years (range: 0.6-6.7) and the incidence rate of AITD, defined by clinical and laboratorial findings as proposed by international guidelines, was obtained (62.8 per 1000 patients/year). We applied the Coxproportional hazard model to adjust for potential confounding factors and used sensitivity analysis to identify the best screening time for follow-up. We detected thyroid dysfunction in 59 (48.7%) of the 121 patients, amiodarone-induced hypothyroidism in50 (41.3%) and hyperthyroidism in 9 (7.5%). Compared with patients without AITD, there was no difference regarding dosage or duration of therapy, heart rhythm disorder or baseline cardiac condition. During the follow-up of the 62 patients without AITD at baseline evaluation, 11 developed AITD (interquartile range, IR: 62.8 (95%CI: 31.3-112.3) cases per 1000 patients/year), 9 of them with hypothyroidism - IR: 11.4 (95%CI: 1.38-41.2), and 2 hyperthyroidism - IR: 51.3 (95%CI: 23.4-97.5). Age, gender,dose, and duration of treatment were not significant after adjustment. During the first 6 months of follow-up the incidence rate for AITD was 39.3 (9.2-61.9) cases per 1000 patients/year. These data show that AITD is quite common, and support the need for screening at 6-month intervals, unless clinical follow-up dictates otherwise or further information regarding the prognosis of untreated subclinical AITD is available.

Galactosaemia in a Brazilian population: high incidence and cost-benefit analysis.

OBJECTIVES: To study the incidence of galactosaemia in the state of São Paulo and the benefit/cost (B/C) ratio of the introduction of neonatal screening for galactosaemia, comparing it with a selective approach. METHODS: An enzymatic-colorimetric assay was used for the screening of total galactose (TG) in a sample of 10% of the births in São Paulo in one year and positive cases were confirmed by the activity of galactose-1-phosphate uridyltransferase (GALT). Detected and referred cases were genotyped using enzyme restriction studies for Q188R, N314D and S135L mutations of the GALT gene. The economic analysis was determined by calculating the B/C ratio and by analysis of sensitivity as a function of the incidence of the disease detected and the variation of the interest rate in the economy. RESULTS: 59 953 newborns were screened for TG, with 3 cases of galactosaemia being identified (0.26% false positives), corresponding to a frequency of 1:19 984 liveborns (95% confidence interval: 1:7494 to 1:59 953). One classical case and one Duarte 2 variant referred to as a selective approach were confirmed. With an incidence of 1:19 984, the B/C ratio was 1.04 for the 11.75% interest rate in effect in Brazil, with values already decapitalized. With a maximum possible incidence of 1:7494, the B/C ratio was 2.79. DISCUSSION: There is an economic advantage in introducing neonatal screening for galactosaemia in the national neonatal screening programme. This advantage could increase with a reduction of the current interest rates in the economy.

Asthma and allergies in schoolchildren of Maputo.

AIM: The study aimed to determine prevalence and severity of asthma, rhinitis and eczema in Maputo, Mozambique. METHODS: The International Study of Asthma and Allergies (ISAAC) protocol was applied in 27 schools in urban, suburban and semi-rural areas. RESULTS: A total of 2630 completed questionnaires were obtained from students aged 13-14 years, and 2383 from schoolchildren aged 6-7 years. The prevalence of current asthma was 13.3% in the two groups, the prevalence of rhinoconjuctivitis and eczema was 23% and 10% in teenagers and 8.8% and 8.5% respectively in children 6-7 years old. Overall, 35% of the adolescents and 23.8% of children were found to have at least one atopic condition or asthma in the last year. In symptomatic adolescents, the conditions were: rhinoconjuctivitis (41.3%), asthma (20%) and eczema (12.4%). In symptomatic children, asthma was the principal condition (36.2%), followed by eczema (20.3%) and rhinoconjunctivitis (19.1%). In adolescents, asthma was more frequently associated with rhinoconjuctivitis (28%). About 4% of all surveyed children had three atopic conditions associated. In adolescents, past year rhinitis was more frequent and severe in the urban area. Hay fever was commoner in the semi-urban area. Eczema was significantly more recurrent in suburban and semi-rural area. Exercise-induced wheeze, nocturnal cough and ever asthma were more reported in children of suburban area. CONCLUSION: Asthma and allergic diseases are important public health problems in Maputo and improvement in prevention and management plans are required.

Prevalence of asthma-like symptoms by ISAAC video questionnaire in Mozambican schoolchildren.

BACKGROUND: The International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire was developed to overcome the language and cultural differences in the assessment of asthma-like symptoms. METHODS: 27 schools were included in the Maputo Asthma and Allergies in childhood Study (MAPAAS) using ISAAC methods, and a video questionnaire (VQ) was administered to 1614 adolescents 13-14 years old of 20 schools located in urban, suburban and semi-rural areas of Maputo (Mozambique). Simultaneously, they also replied to the ISAAC written questionnaire (WQ). RESULTS: According to the video questionnaire, the prevalence of current asthma was 11.9% (compared with 13.3% using the written questionnaire). Wheezing after exercise in the last year was reported by about 21%. Females reported more frequent wheezing after exercise than males (p < .001). The prevalence of nocturnal cough in the last year was 24.7%, and was more frequent in the suburban area (p < .001). "Severe attacks of asthma" was reported by 11.9% of the individuals. Teenagers instructed in the suburban schools reported more severe asthma-like symptoms than others (p < .05). There was a poor correlation between the WQ and the AVQ3.0 (kappa coefficients varied from 0.09 to 0.24). The lowest agreement was observed for the question regarding severe attacks of asthma. Agreement was better in terms of specificity than in terms of sensitivity. CONCLUSIONS: In spite of the poor agreement between the written and the video questionnaires, the prevalence of asthma symptoms estimated using the video questionnaire confirms that asthma is an important public health problem in Maputo.

Incidence of congenital toxoplasmosis estimated by neonatal screening: relevance of diagnostic confirmation in asymptomatic newborn infants.

Congenital toxoplasmosis is rarely identified by routine clinical examination. The aim of this study was to estimate the incidence of the disease in the region of Ribeirão Preto, south-eastern Brazil. A definitive diagnosis was made on the basis of the persistence of anti-Toxoplasma IgG antibodies beyond 1 year of age. Blood samples obtained from 15,162 neonates and adsorbed onto filter paper were tested for anti-Toxoplasma IgM antibodies. Fifteen samples gave positive results. A definitive diagnosis was confirmed in five of the 13 infants (38.5%) who completed follow-up. These five infants presented with serum IgM and/or IgA antibodies, and clinical abnormalities. Disease incidence was estimated to be 3.3/10,000 (95% CI 1.0-7.7), indicating the need for preventive measures. Neonatal screening is feasible, but screening tests with a better performance are required; positive screening results must be carefully confirmed.