Sacroiliac joint dysfunction and lumbar pain. Evaluation in a Brazilian population

The study intended to evaluate the incidence and evolution of sacroiliac joint dysfunction (SIJD). To reach 50 patients with SIJD diagnosis, 192 patients with low back pain and failure in conservative approach were consecutively examined (26% incidence). Initially patients underwent intra-articular (IA) corticosteroid sacroiliac joint (SIJ) block followed, if necessary, by cooled SIJ radiofrequency or referred to surgical intervention, in order of complexity. From the 50 patients submitted to IA SI block, 41 (82%) referred pain and quality of life improvement and lesser rescue analgesics consumption for 25 weeks. The block induced a prompt onset of pain relief and there was a drop in mean pain score from 8 to 2 cm (p < 0.001) maintained up to 25 weeks. Rescue analgesic consumption also significantly dropped (p < 0.05). However, nine patients (18%) did not refer long lasting improvement in the third week evaluation and underwent cooled radiofrequency. From this population of nine, seven were successful (78%) while two were recommended surgery. In view of the 50 patients, 82% were comfortable after IA block, 18% were submitted to radiofrequency, with a success rate of 78%. The final incidence of surgery suggestion was 4%.

Apical versus septal pacing - can we chose the localization of ventricular lead in order to prevent upgrade to cardiac resynchronization therapy?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Right ventricular apical pacing (RVAp) may be deleterious to ventricular function and hemodynamics due to pacing induced dyssynchrony. In the last decades, some studies showed that RVAp has been associated with heart failure, deterioration of left ventricular function and high mortality. Some patients (pts) may need, during the follow up (FUP), an upgrade to cardiac resynchronizaon therapy (CRT). New techniques have emerged such as RV lead implantation in the high septum or outflow RV tract (RVOT) and, more recently, His bundle/LB pacing.

Purpose

To compare the need for upgrade to CRT in patients with RVAp versus septal/RVOT pacing.

Methods

Retrospective single-center study of consecutive pts that implanted pacemakers in a tertiary center between January 1995 and December 2020. We collected data regarding pacing indication, RV pacing site (apex versus septum/RVOT) and need for an upgrade to CRT during follow up (FUP).

Our primary endpoint was upgrade to CRT during the FU period. In the model, the impact of localization of the implanted lead on the survival free from upgrade was estimated assuming a neutral effect on mortality. Statistical analysis was performed using T-student test and logistic regression.

Results

We included 8761 pts, 60.2% (n=5275) were male, with a mean age of 76.5±10.7 years. The main indications for pacemaker implantation were (1) complete atrioventricular (AV) block (2239, 25.6%), (2) sick sinus syndrome (2211, 25.2%), (3) atrial fibrillation with AV block or bradycardia with significant pauses (17.4%) and (4) Mobitz II 2nd degree AV block (1467, 16.7%).

RVAp was performed in 1746 (20%) patients and RVOT/septal pacing in 6933 patients (80%; RVOT in 657 (9,5%)). During FUP, 26 (1,5%) RVAp pts and 52 (0,8%) RVOT/septal pacing pts underwent upgrade to CRT, in a total of 78 pts (CRT-P in 54 patients and CRT-D in 24 patients).

We observed that patients with RVAp had twice the risk of CRT upgrade during FUP (OR: 2,0 (IC 95% 1,25-3,21), p=0,004) when compared to patients with RVOT/septal pacing.

Conclusions

Patients with RVAp presented a 2-fold higher risk for upgrade to CRT when compared to patients with RVOT/septal pacing in our center. This retrospective analysis shows that lead implantation in the septum/RVOT should be preferred instead of the apex to reduce pacing induced dyssynchrony and need for CRT upgrade.

Methylene blue-mediated Photodynamic Therapy in human retinoblastoma cell lines

Retinoblastoma is a malignant tumor of the retinal precursor cells and one of the rarest types of pediatric tumor, often occurring in the earliest years of life. Symptoms are conditioned by tumor size and location; one of the most recurrent symptoms is a white reflex in the pupillary area, called leukocoria or cat's eye reflex. In the present work, we studied the in vitro effectiveness of Photodynamic treatment (Pdt) in two types of human retinoblastoma, Y79 and WERI-Rb cell lines, using methylene blue (MB), a photosensitizer (PS) from the phenothiazine group. The two cell lines were incubated with varying concentrations of MB (3, 7, 10, 15, 20, 25, 30, 40, and 50 μM), in the absence of light (dark cytotoxicity) and, in the presence of 664 nm laser light (phototoxicity) with fluences of 1, 1.5, 3, 5, 7, 10, and 15 J/cm². The Y79 cell line showed higher cellular uptake values for MB than the WERI-Rb cell line. After three hours of incubation, the Y79 and WERI-Rb took up 48% and 34% of the total photosensitizer present in the medium, respectively. Using MTT assay, the results showed that the Y79 cell line was more affected by the photo treatment as demonstrated by the combination of MB concentration and light doses compared with WERI-Rb cell line. The results were correlated with the more pronounced singlet oxygen emission observed in Y79 cells. While MB does show efficacy for eradication of retinoblastoma in vitro, only studies in appropriate animal models will reveal whether the selectivity of photokilling at tolerable drug and light doses is sufficient to suggest clinical trials.

One for all and all for one: retention of colour-unchanged old flowers increases pollinator attraction in a hermaphroditic plant

Long-lived flowers increase pollen transfer rates, but these entail high water and carbon maintenance costs. The retention of pollinated and reward-free old flowers enhances pollinator visitation to young receptive flowers by increasing floral display size. This mechanism is associated with acropetal inflorescences or changes in flower colour and openness, but the retention of unchanging solitary flowers remains overlooked. We examined pollination-dependent variation in floral longevity and determined stigmatic receptivity, pollen viability and pollen removal rates among flower ages in Kielmeyera regalis, a Neotropical savanna shrub. We also evaluated the effects of floral display size on pollinator visitation rates. Lastly, we determined whether old flowers are unvisited and exclusively increase pollinator attraction to young flowers through flower removal experiments. Regardless of pollination treatment, flowers lasted fully open with no detectable physical changes for 3 days. Over time, stigmas remained receptive but >95% of pollen was removed. Pollinator visitation significantly increased with floral display size and intermediate percentages (15-30%) of newly opened flowers. Accordingly, the retention of reward-free and unvisited old flowers increased young flower-pollinator interaction. Our results reveal the importance of a prolonged floral longevity in increasing pollinator attraction toward newly opened receptive flowers without changes in flower colour and form. We conclude that the retention of pollinated, reward-free and unvisited colour-unchanged old flowers in K. regalis is a strategy that counteracts the water use costs associated with the maintenance of large flowers with increased mate opportunities in a pollen-limited scenario.

Kinetics data from bovine sex-specific embryo development from three different bulls

Here we present kinetics data from bovine sex-specific embryo development. Embryos were originated using sex-sorted semen from three different Nelore bulls, and semen from the same batch was used for X-and Y-chromosome spermatozoa sorting. Data was obtained for six time points (24, 48, 96, 120, and 144 h.p.i.). Analyses for each bull׳s embryos (1, 2 and 3) is presented for female and male groups separately. Also, grouped data analysis, considering bull and sex interaction, is shown. For further interpretation and discussion, see "Cell death is involved in sexual dimorphism during preimplantation development" (Oliveira et al., 2015 [1]).

Phenotypic correlations between ovum pick-up in vitro production traits and pregnancy rates in Zebu cows

The growth of the Gyr breed in Brazil in terms of genetic gain for milk, along with conditions for market, has led to the use of ovum pick-up in vitro production (OPU-IVP) as a leader in biotechnology for the multiplication of genetic material. The aim of this study was to investigate phenotypic correlations between OPU-IVP-linked characteristics and pregnancy rates registered in an embryo transfer program using Gyr cows as oocyte donors. Data collected from 211 OPU sessions and 298 embryo transfers during the years 2012 and 2013 were analyzed and statistical analysis was performed. Estimates of simple Pearson correlations were calculated for NVcoc and PVcoc (number and proportion of viable cumulus-oocyte complexes, respectively); NcleavD4 and PcleavD4 (number and proportion of cleaved embryos on day 4 of culture, respectively); NTembD7 and PTembD7 (number and proportion of transferable embryos on day 7 of culture, respectively); NPrD30 and PPrD30 (number and proportion of pregnancies 30 days after transfer, respectively); and NPrD60 and PPrD60 (number and proportion of pregnancies 60 days after transfer, respectively). Moderate to moderately high correlations were found for all numerical characteristics, suggesting these as the most suitable parameters for selection of oocyte donors in Gyr programs. NVcoc is proposed as a selection trait due to positive correlations with percentage traits and pregnancy rates 30 and 60 days after transfer.

Renal transplantation in lupus nephritis: a Brazilian cohort

OBJECTIVE

To determine the epidemiological profile and outcome of patients with lupus nephritis (LN) undergoing renal transplantation.

METHODS

The archival records of 50 patients with LN and end-stage renal disease (ESRD) treated by kidney transplantation from March 1992 to December 2010 were reviewed. All patients met the American College of Rheumatology criteria for systemic lupus erythematosus (SLE).

RESULTS

Fourteen patients were included in the study. The majority were women (85.7%) and non-Caucasian (85.7%); the mean age at diagnosis of SLE and LN was 24 ± 8 and 25 ± 8 years, respectively. Renal biopsy was performed in 12 patients, with 75% of them showing proliferative lesions (class III and IV according to the World Health Organization and International Society of Nephrology/Renal Pathology Society classification). Thirteen patients (93%) underwent intermittent hemodialysis or peritoneal dialysis before transplantation. The median time between the start of dialysis and transplantation was 30 months (range 3-103 months); 67% of the procedures involved deceased donors and 33% involved living-related donors. The graft survival rates were 93.3%, 90.9%, and 85.7% at 1, 5 and 10 years, respectively. Post-transplant immunosuppressive agents were mycophenolate mofetil (84%), azathioprine (17%), tacrolimus (25%), sirolimus (58%) and cyclosporine (8%). Eight episodes of acute rejection were noted in six patients. There was a graft loss due to renal vein thrombosis in the one patient with secondary antiphospholipid syndrome. The mean SLICC by the time of kidney transplantation was 5 ± 2. In total, 13 patients (92.8%) developed at least one infectious event during the follow-up, with one dying in the immediate post-transplant period because of sepsis. Two patients (14%) had a lupus flare. There was no clinical or histological evidence of LN recurrence.

CONCLUSION

LN is the major cause of morbidity in SLE, with progression to ESRD in 10-22% of cases. Despite concerns about LN recurrence after renal transplantation, the data obtained in our sample indicate this procedure as a safe alternative therapy for ESRD in this population.

In vitro culture of bovine embryos in murine ES cell conditioned media negatively affects expression of pluripotency-related markers OCT4, SOX2 and SSEA1

Despite extensive efforts, establishment of bovine embryonic stem (ES) cell lines has not been successful. We hypothesized that culture conditions for in vitro-produced (IVP) embryos, the most used source of inner cell mass (ICM) to obtain ES cells, might affect their undifferentiated state. Therefore, the aim of this work was to improve pluripotency of IVP blastocysts to produce suitable ICM for further culturing. We tested KSR and foetal calf serum (FCS) supplements in SOF medium and ES cell conditioned medium (CM) on IVC (groups: KSR, KSR CM, FCS and FCS CM). Cleavage and blastocyst rates were similar between all groups. Also, embryonic quality, assessed by apoptosis rates (TUNEL assay), total cell number and ICM percentage did not differ between experimental groups. However, expression of pluripotency-related markers was affected. We detected down-regulation of OCT3/4, SOX2 and SSEA1 in ICM of FCS CM blastocysts (p < 0.05). SOX2 gene expression revealed lower levels (p < 0.05) on KSR CM blastocysts and a remarkable variation in SOX2 mRNA levels on FCS-supplemented blastocysts. In conclusion, pluripotency-related markers tend to decrease after supplementation with ES cell CM, suggesting different mechanisms regulating mouse and bovine pluripotency. KSR supplementation did not differ from FCS, but FCS replacement by KSR may produce blastocysts with stable SOX2 gene expression levels.

Delayed biochemical changes induced by mercury intoxication are prevented by zinc pre-exposure

This work evaluated the delayed effects of mercury and the effectiveness of zinc in preventing such effects. Pups were pre-treated with 1 daily dose of ZnCl(2) (27 mg/kg/day, by subcutaneous injections) from 3rd to 7th postnatal day and received 1 daily dose of 5 mg/kg of HgCl(2), for 5 subsequent days (8-12 days old). Animals were euthanized 21 days after the end of Hg-exposure. Porphobilinogen-synthase activity as well as zinc and mercury contents was determined in the liver and kidneys. Alanine aminotransferase, aspartate aminotransferase and lactic dehydrogenase activities as well as urea, creatinine and glucose levels were analyzed in plasma or serum. Some animals were considered more sensitive to mercury, since they did not recover the body weight gain and presented an increase of renal and hepatic mercury content, urea and creatinine levels; a decrease in renal porphobilinogen-synthase and alanine aminotransferase activities, as well as a decrease in the liver and an increase in kidney weights. Some animals were considered less sensitive to mercury because they recovered the body weight and presented no biochemical alterations in spite of mercury in the tissues. Zinc prevents partially or totally the alterations caused by mercury even those that persisted for a long time after the end of exposure. These findings suggest that there is difference among the animals regarding the sensitivity to mercury.

Impact of WWOX alterations on p73, ΔNp73, p53, cell proliferation and DNA ploidy in salivary gland neoplasms

OBJECTIVE

WWOX gene is altered in a variety of neoplasms. Wwox is pro-apoptotic through interaction with p73 and may be involved in chromosomal stability by interaction with p73 and p53. The aims of this study were to characterize WWOX transcription, methylation status and immunoexpression in salivary neoplasms and to determine whether these were associated with p73, p53, cell proliferation and DNA ploidy.

MATERIALS AND METHODS

Seven malignant and 21 benign fresh salivary neoplasms were included. WWOX expression was determined by RT-PCR and sequencing of transcripts, quantitative PCR and immunohistochemistry. Methylation-specific PCR was used to assess the methylation of its first exon. For p73, ΔNp73, p53 and ki67 immunohistochemistry and ploidy analysis, 29 malignant samples from archives were included.

RESULTS

No consistent pattern of WWOX exon 1 methylation was found, but aberrant and novel transcripts were observed in 17/28 neoplasms; 55% of tumours showed reduced WWOX RNA. WWOX RNA levels were associated with p53 immunopositivity. Immunohistochemical Wwox expression did not correlate with methylation status, p53 or p73 expression or proliferation. p73, proliferation and DNA ploidy were associated with malignant phenotype.

CONCLUSION

Aberrant WWOX transcription and decreased expression are frequent in salivary neoplasms and WWOX transcription is associated with p53 staining.

Analysis of postural oscillation in children with cerebral palsy

It is believed that static balance undergoes changes in children with cerebral palsy (CP). Thus, we analyzed postural oscillation in 19 children with the aim of comparing balance between healthy children and those with CP. The sample was divided into two groups--one with 10 children diagnosed with diparetic CP (CPG) and a control group (CG) with nine healthy children, all capable of remaining in an orthostatic position without support and obeying spoken commands. The assessment of postural oscillation was performed with the children barefoot, arms alongside the body and looking toward a fixed point while standing on an unrestricted base for the feet. Data collection was performed using a TEKScan force platform with 30-second duration for each condition. The children had an average age of 7.9 years (+/- 2.07) in the CPG and 7.5 years (+/- 1.58) for the CG. Postural oscillation data in the anterior-posterior and medial-lateral directions were analyzed using the Data Analysis and Technical Graphics Origin 6.0 program. Statistical analysis of the mean oscillation value in the conditions of eyes open and eyes closed did not differ significantly between groups. However, there was a significant difference in mean anterior-posterior oscillation between groups (p = 0.00). The groups behaved similarly with regard to the visual deprivation. We conclude that children with CP exhibit less postural oscillation in comparison to healthy children under the same conditions.

The effect of manual therapy on masseter muscle pain and spasm

INTRODUCTION

Orofacial pain and pain in the muscles of mastication are frequent symptoms of temporomandibular disorder. The masseter is the closet masticatory muscle to the surface and has the function of raising and retracting the mandible. This muscle has considerable strength and is one of the main muscles involved in the shredding of food It is therefore of utmost importance in the masticatory cycle and generally the most affected by pain and spasms.

OBJECTIVES

The aim of the present study was to analyze the effect of manual therapy with transversal and circular movements on pain and spasm in the masseter muscle, using electromyography and a visual analogue pain scale (VAPS). Eight women who experienced pain upon palpation of the masseter greater than 6 on the VAPS were selected for participation in the study, which employed electromyography and a VAPS for assessment, followed by manual oral physiotherapy and reevaluation.

RESULTS

The statistical analysis revealed a reduction in pain, but there was no significant difference in electromyographic activity (p < 0.05).

CONCLUSION

It was concluded that massage therapy was effective on pain symptoms, but was not capable of altering the electrical activity of the masseter muscle.

Electromyographic analysis of biceps brachii muscle following neural mobilization in patients with stroke

OBJECTIVES

The proposal of the present study is based on mobilizing the nervous system of the upper hemiplegic limb of stroke victims using the Upper Limb Neurodynamic Test (ULNT 1) and electromyographic analysis of the biceps brachii muscle.

METHODS

A pre-experimental study was carried out with pretest and posttest repeated measurements on five stroke victims (4 men and 1 woman; mean age: 52.8 +/- 11 years), with Grade 1 and + 1 spasticity, according to the modified Ashworth scale. Electromyographic analysis of the biceps brachii muscle was performed with the elbow flexed at 90 degrees, following by complete extension.

RESULTS

The neurodynamic test led to a decrease in electromyographic activity in the biceps brachii muscle (p < or = 0.05).

CONCLUSION

Neural mobilization was efficient in reducing myoelectric activity in the biceps brachii muscle in patients with stroke and may used by physiotherapists as an efficient method for treating patients with this pathology.

Functional implication of gait after left or right-sided stroke

OBJECTIVE

To quantify and compare parameters of muscle electrical activity and ground reaction force of lower limb during gait in post-stroke patients with left or right side functional involvement.

METHOD

Fifteen post-stroke volunteers with left side functional involvement were age, gender and weight matched and compared to fifteen post-stroke volunteers with right side functional involvement. Comparison was executed by means of electromyography with four pairs of surface electrodes positioned on the affected side (spastic side), on the muscles rectus femoris, tibialis anterior, soleus, and medial portion of the hamstrings, and with a ground reaction force plate.

RESULTS

There was no statistically significant difference on electromyographic activity of analyzed muscles (p = 0.6), nor on the analysis of ground reaction vertical forces, stride duration, weight bearing index, gait velocity, cadence and stride length (p = 0.53).

CONCLUSION

According to the electromyographic parameters and to the ground reaction force during gait among the post-stroke volunteers with right or left side involvement; we could suggest that functional rehabilitation presented no differences for these individuals.

Osteogenic index of step exercise depending on choreographic movements, session duration, and stepping rate

BACKGROUND

Step exercise has been promoted as a low impact physical activity recommended for the improvement of cardiorespiratory and muscular fitness. This recreational activity might also be recommended to improve bone health since mechanical load plays an important role in the normal development of the skeleton.

METHODS

Our main purpose was to characterised 100 step sessions and to calculated osteogenic index (OI) according to Turner and Robling: OI (one session) = peak ground reaction force(BW)*ln(number of loading cycles+1).

RESULTS

Main results (mean+/-SD) were as follows: OI was 12.0+/-0.8; peak ground reaction force (GRF) was 1.40+/-0.10 times body weight (BW); session duration was 38.6+/-8.3 min; stepping rate was 134.6+/-4.7 beats per minute (bpm); the movements performed most often were marching, knee hop, side leg, L step, and over the top; and the number of loading cycles was 4194.1+/-1055.2. OI and GRF increased significantly when stepping rate was higher than 135 bpm. This stepping rate might be used as a reference for higher intensity classes. A frequency of two to three sessions per week of step exercise is recommended.

CONCLUSIONS

Despite the benefits that have been stated when step classes are structured correctly and adapted to the participants, further research is needed concerning biomechanical load, exercise prescription, and injury prevention.

Casualty treatment after earthquake disasters: development of a regional simulation model

This paper presents a new approach to the casualty treatment problem following a large-scale disaster, based on a mathematical model of how a regional health-care system responds to an earthquake event. The numbers and locations of casualties rescued alive, the scale of pre-hospital care, the post-earthquake hospital capacity, and the transport system are inputs to the model. The model simulates the movement of casualties from the stricken areas to hospitals. It predicts the number of casualties that die as well as other statistics about the health-care system response, such as waiting time before treatment. The model can be run with varying input assumptions to simulate alternative disaster response strategies. Preliminary runs demonstrate the potential of the model as a tool for planning and training.

Liver pseudotumor: a rare manifestation of hepatic granulomata caused by Ascaris lumbricoides ova

A rare case of hepatic granulomata caused by Ascaris lumbricoides ova is reported. The patient presented clinically with hepatic mass simulating malignancy, and final diagnosis was performed after surgery, which provided enough material for histopathological examination.

[Rotavirus: clinical features and prevention]

OBJECTIVES: This report was prepared with the main objective of making an extensive review of both clinical features and prevention of rotavirus gastroenteritis. In addition, it provides an evaluation about the potential for introduction of the tetravalent rhesus-human reassortant rotavirus vaccine (RRV-TV) in the developing countries. METHODS: The main source of information was the most relevant articles published in both national and international journals, as well as selected official reports from the World Health Organization. With regard to rotavirus vaccines, particular emphasis has been placed on the results available from studies carried out during the past five years. Notice we have stressed the epidemiological features of rotavirus infections in Brazil. RESULTS: As a background for the main subjects of this report - clinical features and prevention - available general information on rotavirus infections are briefly discussed in the Introduction. This includes an overview of the etiological agent, epidemiology, immunity and laboratory diagnosis. A detailed description of the typical symptomatic syndrome is made, as well as of other (unusual) clinical manifestations of rotavirus illness. We also discuss the rotavirus candidate vaccines that have been evaluated to date, highlighting the most significant observations which resulted from field trials with the RRV-TV in several countries. The potential for large-scale use of RRV-TV in developing countries is also discussed, focusing mainly on the epidemiological characteristics of rotavirus disease in these regions. CONCLUSION: Rotaviruses are the leading cause of severe gastroenteritis in infants and young children in both industrialized and lessdeveloped countries; in the latter regions, rotavirus diarrhoeal disease represents a major cause of mortality. There is currently a consensus that attempts at prevention need to be directed toward the development of an effective rotavirus vaccine, for large-scale use, that would primarily protect children (aged 0 to 2 years) against severe rotavirus gastroenteritis. In this regard, results from a recent reevaluation of the Peruvian and Brazilian lower-titer RRV-TV efficacy data are promising. Although the RRV-TV ("Rotashield(R)") (recently licensed for general use in U.S.A.) seems to be currently the most promising rotavirus vaccine, it has been suggested that further trials with this vaccine should be conducted in Africa and Asia (efficacy studies) and Latin America [immunogenicity and effectiveness (efficacy under real conditions in a given setting)]. In addition, it is of paramount importance to establish in these regions a surveillance system to monitor the circulating rotavirus strains.

An outbreak of group C rotavirus gastroenteritis among children attending a day-care centre in Belém, Brazil

In August 1993, an outbreak of group C rotavirus-associated gastroenteritis occurred among children attending a day-care centre in Belém, Brazil. Of the 64 children, 21 (33%) became ill. Group C rotavirus was identified in faecal specimens from 8 (38%) children with diarrhoea by electron microscopy (EM) and an enzyme immunoassay (EIA), using antibodies specific to the Cowden strain of porcine group C rotavirus. By polyacrylamide gel electrophoresis (PAGE), a pattern similar to that of group C rotavirus was observed in 5 (62.5%) of the 8 EM- and EIA-positive samples. These 5 faecal samples were confirmed to be positive for group C rotavirus by reverse transcriptase-polymerase chain reaction, using specific VP6 and VP7 primers. This is the first report of an outbreak of diarrhoea in North Brazil associated with group C rotavirus. These findings suggest that group C rotavirus may be an important aetiological agent of diarrhoea in this region, which requires further study.

Immunogenicity, safety and efficacy of tetravalent rhesus-human, reassortant rotavirus vaccine in Belém, Brazil

A tetravalent rhesus-human reassortant rotavirus (RRV-TV) vaccine (4 x 10(4) plaque-forming units/dose) was evaluated for safety, immunogenicity and efficacy in a prospective, randomized, double-blind, placebo-controlled trial involving 540 Brazilian infants. Doses of vaccine or placebo were given at ages 1, 3 and 5 months. No significant differences were noted in the occurrence of diarrhoea or vomiting in vaccine and placebo recipients following each dose. Low-grade fever occurred on days 3-5 in 2-3% of vaccinees after the first dose, but not after the second or third doses of vaccine. An IgA antibody response to rhesus rotavirus (RRV) occurred in 58% of vaccinees and 33% of placebo recipients. Neutralizing antibody responses to individual serotypes did not exceed 20% when measured by fluorescent focus reduction, but exceeded 40% when assayed by plaque reduction neutralization. There were 91 cases of rotavirus diarrhoea among the 3-dose (vaccine or placebo) recipients during two years of follow-up, 36 of them among children given the vaccine. Overall vaccine efficacy was 8% (P = 0.005) against any diarrhoea and 35% (P = 0.03) against any rotavirus diarrhoea. Protection during the first year of follow-up, when G serotype 1 rotavirus predominated, was 57% (P = 0.008), but fell to 12% in the second year. Similar results were obtained when analysis was restricted to episodes in which rotavirus was the only identified pathogen. There was a tendency for enhanced protection by vaccine against illness associated with an average of 6 or more stools per day. These results are sufficiently encouraging to warrant further studies of this vaccine in developing countries using a higher dosage in an attempt to improve its immunogenicity and efficacy.

Association of human herpesvirus 6 infection with exanthem subitum in Belem, Brazil

Recent human herpesvirus 6 (HHV-6) infection was detected in cases of exanthem subitum (ES) involving four children, aged 10 to 24 months, between April and August 1994, in Belém, Brazil. By using the indirect immunofluorescence antibody assay (IFA), significant increases (at least eight times) in antibody concentrations were noted from the acute to the convalescent serum samples, with titers ranging from < 1:10/1:80 to < 1:10/1:640 (patients 3 and 2, respectively). All children had high fever (over 39 degrees C) for three days, followed by generalized, maculo-papular skin rash. A physical examination of the children also revealed concomitant, cervical lymph node swelling and tonsillar pharyngitis in two of them.

[Prospective study of rotavirus infections in Belém, Pará, Brazil: clinical and epidemiological features]

A prospective study of acute diarrhoeal diseases was carried out from April 1990 to September 1992 with the purpose of assessing the immunogenicity, safety and efficacy of a Rhesus-human reassortant rotavirus ("RRV-TV") vaccine, involving 540 children living in Belém, Pará, Brazil. As half of the children received placebo, this trial provided the opportunity of broadening the knowledge on both clinical and epidemiological aspects of rotavirus infection in the Amazon region. There were 2,789 diarrhoeal episodes during the above mentioned period, of which 86 (3.1%) associated with rotavirus; serotype 1 was the more prevalent, accounting for 67.9% of serotyped strains. Rates of 5.9 and 0.2 episodes of diarrhoea per child/year were noted for all cases and the rotavirus-related ones, respectively. This agent was the only pathogen found in 70.9% of the 86 rotavirus-related episodes of acute diarrhoea, whereas the most frequent associations involved Giardia intestinalis and enteropathogenic Escherichia coli, accounting for 7.0% and 11.6% of mixed infections,respectively. The monthly rates of rotavirus-related episodes of diarrhoea ranged from 0.8% to 9.6%, reaching the highest peaks during the dry months of the year. Means of clinical severity scores of 9.4 and 5.3 were recorded for the rotavirus-related episodes of diarrhoea and those of other aetiology, respectively.