Spatial distribution and temporal trends of AIDS in Brazil and regions between 2005 and 2020

OBJECTIVE

To analyze the spatial distribution and the temporal trend of the AIDS incidence rate in Brazil from 2005 to 2020.

METHODS

This is an ecological, temporal, and spatial study on AIDS cases in Brazil. Data from the Notifiable Diseases Information System were stratified by year of diagnosis, region of the country/municipalities of residence, and age group (over 13 years). Incidence rates were calculated for temporal estimation using the Joinpoint model, as well as Spatial Empirical Bayes (SEB) for spatial distribution, using the Kernel density estimator.

RESULTS

The incidence rate in Brazil, in 2020, was 17.69 cases per 100 thousand inhabitants. The general trend (2005-2020) was decrease in Brazil (Annual Percent Change - APC=-2.0%), in the Southeast (APC=-4.4%) and South (APC=-3.0%) regions. The North (APC=2.3%) showed an increase trend, whereas the Southeast and Midwest regions were stationary (p>0.05). Brazil, Southeast, South, and Midwest regions showed a decrease trend in most age groups. The Northeast and North regions showed an increase in the age groups of 13-29 years and 13-24 years, respectively. The Kernel estimator showed clusters with SEB above 30/10 thousand inhabitants in the states of Paraíba, Sergipe, Alagoas, Pernambuco, São Paulo, Minas Gerais, Pará, Rio Grande do Sul, and Santa Catarina.

CONCLUSION

Brazil, the Southeast, and South regions showed a decrease in the incidence rate, whereas the North region increased and the Northeast and Midwest regions were stationary. The Southeast, South, and Northeast regions presented the largest clusters of SEB.

Distribuição espacial e tendência temporal da AIDS no Brasil e regiões entre 2005 e 2020

RESUMO: Objetivo: Analisar a distribuição espacial e a tendência temporal da taxa de incidência de AIDS no Brasil no período de 2005 a 2020. Métodos: Estudo ecológico, temporal e espacial sobre os casos de AIDS no Brasil. Dados provenientes do Sistema de Informação de Agravos de Notificação do Departamento de Informática do Sistema Único de Saúde foram estratificados por ano do diagnóstico, região do país/municípios de residência e faixa etária (acima de 13 anos). Foram calculadas as taxas de incidência (TI) para a estimativa temporal por meio do modelo de joinpoint, bem como as taxas bayesianas empíricas espaciais (TBEE) para a distribuição espacial pelo estimador de densidade de Kernel. Resultados: A TI no Brasil no ano de 2020 foi de 17,69 casos para cada 100 mil habitantes. A tendência geral (2005–2020) foi de diminuição no Brasil (variação percentual anual — VPA=-2,0%), Sudeste (VPA=-4,4%) e Sul (VPA=-3,0%). O Norte (VPA=2,3%) demonstrou aumento, enquanto o Sudeste e Centro-oeste foram estacionários (p>0,05). O Brasil, Sudeste, Sul e Centro-oeste apresentaram tendência de diminuição na maioria das faixas etárias. O Nordeste e Norte apresentaram aumento nas faixas etárias de 13 a 29 anos e 13 a 24 anos, respectivamente. O estimador de Kernel demonstrou conglomerados com TBEE acima de 30/10 mil habitantes nos estados de Paraíba, Sergipe, Alagoas, Pernambuco, São Paulo, Minas Gerais, Pará, Rio Grande do Sul e Santa Catarina. Conclusão: O Brasil e as Regiões Sudeste e Sul apresentaram diminuição da TI, enquanto o Norte aumentou e o Nordeste e Centro-oeste foram estacionários. As Regiões Sudeste, Sul e Nordeste apresentaram os maiores conglomerados das TBEE.

Mild-to-moderate COVID-19 impact on the cardiorespiratory fitness in young and middle-aged populations

The goal of the present study was to compare pulmonary function test (PFT) and cardiopulmonary exercise test (CPET) performance in COVID-19 survivors with a control group (CG). This was a cross-sectional study. Patients diagnosed with COVID-19, without severe signs and symptoms, were evaluated one month after the infection. Healthy volunteers matched for sex and age constituted the control group. All volunteers underwent the following assessments: i) clinical evaluation, ii) PTF; and iii) CPET on a cycle ergometer. Metabolic variables were measured by the CareFusion Oxycon Mobile device. In addition, heart rate responses, peak systolic and diastolic blood pressure, and perceived exertion were recorded. Twenty-nine patients with COVID-19 and 18 healthy control subjects were evaluated. Surviving patients of COVID-19 had a mean age of 40 years and had higher body mass index and persistent symptoms compared to the CG (P<0.05), but patients with COVID-19 had more comorbidities, number of medications, and greater impairment of lung function (P<0.05). Regarding CPET, patients surviving COVID-19 had reduced peak workload, oxygen uptake (V̇O₂), carbon dioxide output (V̇CO₂), circulatory power (CP), and end-tidal pressure for carbon dioxide (P_ETCO₂) (P<0.05). Additionally, survivors had depressed chronotropic and ventilatory responses, low peak oxygen saturation, and greater muscle fatigue (P<0.05) compared to CG_. Despite not showing signs and symptoms of severe disease during infection, adult survivors had losses of lung function and cardiorespiratory capacity one month after recovery from COVID-19. In addition, cardiovascular, ventilatory, and lower limb fatigue responses were the main exercise limitations.

The correlation of different methods for the assessment of bone quality in vivo: an observational study

Different methods for the assessment of bone quality were evaluated in this study. Sixty alveolar bone areas were investigated. Peri-apical and panoramic radiographs were obtained with an aluminium scale to assess optical density. The Lekholm and Zarb (L&Z) classification was determined through radiographic analysis and the surgeon's tactile perception. A trephine was used to obtain a bone biopsy for assessment by micro-computed tomography (micro-CT) and histomorphometry. Primary stability of the implants was assessed using insertion torque (IT) and the implant stability quotient (ISQ). The optical density on peri-apical radiographs was correlated with IT, ISQ, and micro-CT (BV, BV/BT, Tb.Th, Tb.N, BS/BV, Tb.Pf, and SMI) (rho ≤ 0.471, P ≤ 0.028). Panoramic radiography showed a correlation only with bone surface (BS) and bone surface/volume ratio (BS/TV) (rho ≤ 0.290, P ≤ 0.031). IT showed a correlation with ISQ, histometry, and micro-CT (BV, BS/TV, Tb.Th, Tb.N, BS/BV, Tb.Pf, Tb.Sp, BV/BT) (rho ≤ 0.550, P ≤ 0.022). ISQ did not show any correlation with micro-CT. The L&Z classification showed correlations with the optical density obtained in the peri-apical radiographs, histometry, osteocyte count, IT, and micro-CT (BS/BV, Tb.Sp, Tb.Pf, BV, BS/TV, Tb.Th, Tb.N) (rho ≤ 0.344, P ≤ 0.042). The L&Z bone classification and IT are reliable methods, peri-apical radiographs and ISQ are acceptable, and panoramic radiography is not a reliable method for the assessment of bone quality.

Production of fructooligosaccharides by Bacillus subtilis natto CCT7712 and their antiproliferative potential

AIMS

Fructooligosaccharides (FOSs) known for their health properties and β-(2→6)-levan-type FOSs have shown prebiotic and immunomodulatory activities that overcome those of commercial β-(2→1)-FOSs, but costs do not favour their use. Moreover, FOSs can reach the bloodstream through the diet, and little is known about their direct effect on cells. The aim of this work was to produce high-content FOSs by Bacillus subtilis natto CCT7712 in a bioreactor using commercial sucrose and to evaluate their antiproliferative effects in OVCAR-3 cells.

METHODS AND RESULTS

FOS production reached 173·60 g l^-1 , 0·2 vvm aeration and uncontrolled pH. Levan-type FOSs, composed of β-(2 → 6) links and mainly GF₃ (6-nystose), were identified using RMN spectroscopy, FT-IR and ESI-MS. FOSs decreased the viability and proliferation of OVCAR-3 cells, and the effects were associated with an increased pro-inflammatory response by the induction of IL-8 and TNF-α, and the repression of ER-β genes. The metabolic profiles showed disruption of cellular homeostasis that can be associated with a decrease in proliferation.

CONCLUSIONS

The high production of levan-type FOSs from B. subtilis natto CCT7712 in a bioreactor was achieved, and they showed antiproliferative potential in OVCAR-3 cells.

SIGNIFICANCE AND IMPACT OF THE STUDY

FOS could be a good target for future therapeutic studies and commercial use.

Quality of life in mucopolysaccharidoses: construction of a specific measure using the focus group technique

OBJECTIVE

To describe the perceptions of patients, their caregivers, and their healthcare providers to the development of a new specific instrument for assessment of the quality of life (QoL) in patients with mucopolysaccharidoses (MPS) using a qualitative focus group (FG) design. FGs were held in two Brazilian states (Rio Grande do Sul and Rio de Janeiro).

RESULTS

Three versions of the new instrument were developed, each for a different age group: children (age 8-12 years), adolescents (age 13-17), and adults (age ≥ 18). The FGs mostly confirmed the relevance of items. All FGs unanimously agreed on the facets: School, Happiness, Life Prospects, Religiosity, Pain, Continuity of Treatment, Trust in Treatment, Relationship with Family, Relationship with Healthcare Providers, Acceptance, and Meaning of Life. The overall concept of QoL (as proposed by the WHO-World Health Organization) and its facets apply to this patient population. However, other specific facets-particularly concerning clinical manifestations and the reality of the disease-were suggested, confirming the need for the development of a specific QoL instrument for MPS.

Gonad development and reproduction of the ballyhoo half beak, Hemiramphus brasiliensis from the coastal waters of Rio Grande do Norte, Brazil

The gonad development and reproductive aspects of Hemiramphus brasiliensis from the coastal waters of Rio Grande do Norte, Brazil were verified. This paper presents data on the length-weight relationship, sex ratio, length at first sexual maturity, gonad development, reproductive period and fecundity of H. brasiliensis. Females of this species predominated in the sampled population and were larger in size than the males. The length at the first sexual maturation of males was 20.8 cm and that of females was 21.5 cm. The macroscopic characteristics of the gonads indicated four maturation stages. Histological studies of gonads of H. brasiliensis showed six phases of oocyte development and four phases of spermatocyte development. The batch fecundity of this species is 1153 (± 258.22) oocytes for 50 g body weight of female. The microscopic characteristics of gonad development indicate that H. brasiliensis is a multiple spawner, with active reproductive period during the months of January to June and October. The reproductive period of this species is independent of the rainy period of the region.

Reproductive aspects of the flyingfish, Hirundichthys affinis from the Northeastern coastal waters of Brazil

The epipelagic flyingfish, Hirundichthys affinis is a major artisanal fishery resource from the Northeastern coastal waters of Brazil. However, biological information about this species has been poorly documented. This paper presents data on the length-weight relationship, sex ratio, length at first sexual maturity, gonadal development and fecundity of H. affinis sampled from the coastal waters of Rio Grande do Norte, Brazil. The total body length and weight for both sexes ranged from 23.4 to 29.4 cm and from 89 to 188g, respectively. The allometric coefficient of males was 2.208 and that of females was 2.985, indicating negatively allometric growth. The sex ratio was 1M:1.6F thus differing from the expected ratio of 1:1 (χ2 = 18.63). The total length at first sexual maturity was estimated at 27.3 cm for males and 27.1 cm for females. The macroscopic characteristics of the gonads indicated four maturation stages. Histological studies of gonads of H. affinis showed seven phases of oocyte development and four phases of spermatocyte development. The mean absolute fecundity was 9092 vitelogenic oocytes. Spawning occurred during the months of March to July. The microscopic descriptions of the stages of gonad maturation indicate that the study area is an important spawning ground of H. affinis.

Influence of the association between platelet-rich fibrin and bovine bone on bone regeneration. A histomorphometric study in the calvaria of rats

This study aimed to investigate the effects of platelet-rich fibrin (PRF) associated or not with Bio-Oss on bone defects in the calvaria of rats. A critical-size defect of 5-mm diameter was performed in the calvaria of 48 rats. These animals were divided into six groups of eight animals each, according to the treatment received: homogeneous clot, autogenous clot, autogenous PRF, homogeneous PRF, Bio-Oss, or Bio-Oss associated with PRF. The animals were euthanized after 30 or 60 days. Bone regeneration was evaluated by histomorphometric analysis. The highest mean percentages of new bone formation at 30 days (54.05% ± 5.78) and 60 days (63.58% ± 5.78) were observed in the Bio-Oss associated with PRF group; in particular, the percentage of new bone at 30 days was significantly higher than that of all of the other groups (P<0.01). At 60 days, the Bio-Oss associated with PRF (63.58% ± 5.78) and Bio-Oss (57.34% ± 5.78) groups had similar results, and both showed a statistical difference compared to the other groups. PRF had a positive effect on bone regeneration only when associated with Bio-Oss.

Immunomodulatory activity of ouabain in Leishmania leishmania amazonensis-infected Swiss mice

Ouabain is a cardiotonic steroid identified as an endogenous substance of human plasma, being produced by the adrenal, pituitary, and hypothalamus. Despite the studies demonstrating the ability of ouabain to modulate inflammation and other aspects of the immune response, the effects of this substance in Leishmaniasis is unknown. The purpose of this work was to understand the immunomodulatory activity of ouabain in experimental Leishmaniasis in Swiss mice. It was demonstrated that ouabain reduced total cell numbers in the peritoneal cavity as a reflex of the inhibition of neutrophil migration induced by Leishmania (L.) Amazonensis. Furthermore, ouabain reduced TNF-α and IFN-γ levels, without cytotoxicity against peritoneal macrophages. These data showed the anti-inflammatory role of ouabain in the early events of the immune response triggered by Leishmania (L.) Amazonensis infection in murine model.

Protective effects of Passiflora alata extract pretreatment on carbon tetrachloride induced oxidative damage in rats

The leaf extract of Passiflora alata Dryander (P. alata) has been demonstrated to possess antioxidant activity in vitro. The aim of this study was to investigate the effects of P. alata leaf extract pretreatment on carbon tetrachloride-treated rats. Male Wistar rats were randomly allocated into four groups: group 1 (control - vehicle), group 2 and 3 (P. alata extract - 1 and 5mg/kg, respectively) and group 4 (trolox - 0.18mg/kg). Rats received daily pretreatment by oral gavage for 30 days followed by a single dose of CCl(4) (3ml/kg i.p. in vegetable oil) on the 30th day and were killed after 6h. The pretreatment with the P. alata extract provided significant protection to liver, evidenced by lower degree of necrosis, decreased lipid peroxidation (TBARS) and higher catalase and superoxide dismutase activities. Additionally, pretreated-rats with P. alata (5mg/kg) showed significantly decreased cardiac TBARS levels. Our results indicate that a low oral dose of P. alata leaf extract has both hepato and cardioprotective effects on rats treated with CCl(4).

Germ-free mice produce high levels of interferon-gamma in response to infection with Leishmania major but fail to heal lesions

In order to investigate the importance of the host microbiota on differentiation of T cell subsets in response to infection, Swiss/NIH germ-free mice and conventional (microbiota-bearing) mice were infected with Leishmania major, and lesion development, parasite loads, and cytokine production were assessed. Germ-free mice failed to heal lesions and presented a higher number of parasites at the site of infection than their conventional counterparts. In addition, histopathological analysis indicated a higher density of parasitized macrophages in lesions from germ-free mice than in conventional mice. The initial production of interleukin (IL)-12 and interferon-gamma (IFN-gamma) in germ-free mice was comparable to the conventional controls. Also, germ-free mice produced elevated levels of IFN-gamma and lower levels of IL-4 throughout the course of infection, suggesting the development of a Th1 response. Macrophages from germ-free mice exposed to IFN-gamma and infected with amastigotes in vitro were not as efficient at killing parasites as macrophages from conventional animals. These observations indicate that the microbiota is not essential for the development of Th1 immune responses, but seems to be important for macrophage activation.

Evaluation of an Internet-based teledermatology system

We established a Website which allowed clinical dermatology cases to be submitted, with digital images, through a simple online form. The case could then be managed within the public health service. A database containing 6000 drug interactions was also available on the Website to help clinical management. The Website was tested by 10 junior doctors, who examined dermatology patients, filled in the electronic form with their clinical observations and descriptions, and forwarded digital images. Five dermatologists then evaluated the 71 cases stored on the Website. The agreement between the virtual evaluation and the definitive diagnosis (on face-to-face examination) was 95%. The Website could be used in national health strategies, as a tool for promoting voluntary medical attendance, and for multicentre epidemiological surveillance.

Application of Hazard Analysis Critical Control Points system to enteral tube feeding in hospital

An HACCP system was implemented for the quality assurance of preparation, storage and delivery of enteral feeds to patients in hospital. Routine methods of feed preparation, storage and delivery to patients were studied and a flow chart was initially made. After identifying hazards, an HACCP team was assembled, a flow chart was modified and critical control points were defined using a decision tree. Control measures for each step of the process and its monitoring and corrective measures to be applied were also defined. In addition, feed samples were analysed for microbiological quality and feed storage temperatures were also recorded, before and after the implementation of the HACCP system. When the control measures were applied and monitored, the hazard was reduced. Bacterial counts in feed were reduced from 105 cfu mL-1 to < 101 cfu mL-1. The results show that contamination of enteral feed may be reduced or eliminated if a systematic approach such as HACCP is applied effectively.

Interferon-alpha therapy increases type I insulin-like growth factor receptors expression on lymphoid cells from patients with chronic myelogenous leukemia

Aiming to verify if insulin-like growth factor type I and its receptor (IGF-IR) are implicated on pathophysiology of chronic myelogenous leukemia (CML), we studied 35 patients with CML in chronic phase at diagnosis or during interferon-alpha (IFN-A) or hydroxyurea treatments. Cytometry flow analysis and reverse transcription PCR (RT-PCR) molecular assay for IGF-IR expression on peripheral blood cells from CML patients diagnosed didn't show statistical differences from the control group. Hydroxyurea treated patients had lower expression of IGF-IR in granulocytes, lymphocytes and monocytes (P<0.01). We found statistical higher percentage of T and B lymphocytes positive for IGF-IR on IFN-A treated patients (P<0.001). Also an increase of IGF-IR mRNA expression could be detected in this group when compared with patients in hydroxyurea therapy (P<0.05). Our study suggest that IGF-IR is not directly implicated on CML installation and that the increased expression of IGF-IR on lymphoid cells of IFN-A treated patients could contribute to the immune recognition of malignant cell clone by enhancing immunocompetent cell proliferation and action.

[Psychiatric nursing research: concepts and expectations of nurses in psychiatric institutions]

This research has as objects of study the conceptions and expectations of the clinical nurses in psychiatric institutions about the research developed in this area. It has the purpose to identify conceptions and expectations, enabling the identification of the process of dissemination and utilization of the research in the attention and administration of psychiatric nursing care. It was developed with nurses that work in psychiatric institutions at Salvador, in March, 1997. 25 nurses who worked in the period were interviewed expressing their opinions concerning the theme in study, through semi-structured interview. Results were quantitatively analysed, based on the theoretical-methodological design of the Social Representations. It was possible to conclude that the great part of the nurses interviewed mentioned that they did not have access to research in this area, as well as demonstrated difficulty of find the relations and influence of these research in their service, however they admit its importance to personal and professional development, that certainly, reflects on nursing care.

Clinical observations of unresponsive mucosal leishmaniasis

We report the long-term clinical follow-up of two patients with unresponsive mucosal leishmaniasis due to Leishmania (Viannia) braziliensis from the Três Braços area in Bahia State, Brazil. Both were agricultural male workers with extensive upper respiratory mucosal involvement that was not cured with conventional and experimental therapy.

[Prevalence of dyslipidemias in adult ambulatory laboratory tests from different health care providers]

OBJECTIVE

To detect differences in the prevalence of dyslipidemia in adult ambulatory laboratory tests from three different health care providers, in Salvador-Brazil, 1995.

METHODS

The study was carried out using a probabilistic sample of 24 out of 104 laboratories (approximately equal to 25%) which performed the same enzymatic method for lipid tests with the same quality control. Laboratory tests results were separated into three groups, according to health care provider: Sistema Unico de Saúde (SUS, governamental), Health Maintenance Organizations (HMO), and Private or Patients Health Insurance (PHI). Criteria for dyslipidemias in mg/dl were: total cholesterol > or = 240; LDL-c > or = 160; HDL-c < 35 and triglycerides > or = 200. Prevalence rates, 95% confidence intervals (CI) and chi (2) test were used in the analysis.

RESULTS

From the 5464 adult subjects, 14.8% were from SUS, 31.6%. from HMO and 53.6% PHI. The highest prevalence for hypercholesterolemia--28.0% (CI 24.0; 32.0) and for LDL-c > or = 160mg/dL--30.4% (CI 27.6; 33.2), were found in the HMO group. PHI had the highest prevalence for HDL-c < 35mg/dL--12.3% (CI 10.0; 13.8), and for hypertrygliceridemia--17.8% (CI 16.3; 19.3). Most of the differences among health providers were statistically significant.

CONCLUSION

The best lypid profile observed in subjects from SUS suggests social differences in the prevalence of dyslipidemias. As compared to other dyslipidemias, HDL-c < 35mg/dL prevalence was lower than expected in all three groups. The data may provide insights to medical doctors and other health care professionals regarding the questions of dyslipidemias. It can also provide objective information to the patients and encourage them to change their life styles.

Parasitic infections in germfree animals

The association of vertebrate hosts with the indigenous microbiota and its effect on the response to infections has long been a subject of scientific curiosity. From the first theory supported by Louis Pasteur that life would be impossible in the absence of associated microorganisms to the development of germfree mammals for research, a lot was learned about how the normal microbiota influences the environment in which pathogens may find themselves. In the present review, we attempt to summarize the more recent results from our group and others on the influence of the normal microbiota on the outcome of parasitic infections. Our results and those of others point to a complex relationship between the mammalian system and its indigenous microbiota, leading to greater resistance to some infections and enhanced susceptibility to others.

[Prevalence of dyslipidemias in adults in laboratory tests from Salvador, Brazil]

PURPOSE

To determine the prevalence of dyslipidemia in non-hospital laboratory tests of adults from Salvador, Brazil.

METHODS

The study was carried out in subjects from a probabilistic sample of 25% of a total of 104 local laboratories that used the same enzymatic method for lipid analysis with the quality control as recommended by the Brazilian Society of Clinical Analyses. These represented 93% of all non-hospital laboratories of Salvador in 1995. The odd months of 1995 were selected for sampling in the present study. Criteria for dyslipidemias were: total cholesterol > or = 240; LDL > or = 160; HDL < 35 and triglycerides > or = 200 mg/dl. Prevalence rates and their 95% confidence intervals (CI) and chi 2 test were used in the analyses.

RESULTS

Tests from two of the 26 laboratories were not used in the analyses due to file problems or refusal. 7,392 adults were screened, 65% female. We observed prevalence (95% CI) of hypercholesterolemia in 30.0 (27.8; 32.2)%, high LDL in 30.1 (30.8; 35.4)% and hypertriglyceridemia in 30.4 (29.0; 31.4)% of the females. As to the male subjects, prevalences were; 24.0 (20.5; 27.5)% for hypercholesterolemia, 26.1 (22.4; 29.3)% for high LDL, 27.6 (25.7; 29.5)% for hypertriglyceridemia. All gender differences were significant. Low HDL occurred in 15.9 (14.2; 17.8)% of males and in 8.0 (7.1; 8.9)% of females.

CONCLUSION

Dyslipidemia is an important risk factor observed in non-hospital laboratory tests of men and women in Salvador. Our data may provide physicians and other health care professionals with objective information to encourage life-style changes.

[Spontaneous spinal extradural hematoma. A rare complication during anticoagulant therapy]

A 42-year-old woman with metallic valve prosthesis in aortic position, in use of oral anticoagulant, presented a sudden syndrome of medullary compression, characterized by intense dorsal pain and partial paralysis of the inferior portion of the body, progressing to flaccid paraplegia of the arms and legs with level of sensibility in T-2. Large extradural spinal hematoma of the thoracic spine was diagnosed by magnetic resonance with medulla compression in the proximal portion. The patient was underwent to surgery (decompressive laminectomy), however with little motricity improvement and the level of sensibility. Due to respiratory insufficiency the patient died.

Distribution of the number of Eurytrema sp. eggs per gram of feces in naturally infected cattle

Eurytrema sp. egg counts (epg) in the feces of naturally infected cattle were performed and the technique employed showed 94.2% probability of detecting positive cases of the infection with a single examination independently of the host parasite burden. It was also demonstrated that the epg of Eurytrema sp. follows a negative binomial distribution model and is characterized by its small magnitude.

[Gamma-glutamyltransferase and alcoholic hepatic disease]

Accepting the principle that Gama-gt values are elevated in alcoholic patients, the authors attempted to find out if that enzyme might be helpful in distinguishing alcoholics with or without hepatic morphologic lesion. 110 alcoholic patients with and 57 without histologically proved hepatic lesion were studied. The authors conclude that a single determination of Gama-gt lacks specificity to detect, among the alcoholic individuals, those who already carry a morphologic, nonreversible lesion.

Factors associated with AIDS and AIDS-like syndrome among homosexual and bisexual men in Minas Gerais, Brazil

A case-control study to determine factors associated with AIDS and AIDS-like syndrome among homosexual/bisexual men was conducted in the State of Minas Gerais (Brazil). Eighty-three per cent (45 patients) of all AIDS/AIDS-like syndrome cases in homosexual/bisexual men reported in Minas Gerais between February, 1986 and June, 1987 were compared to 133 seronegative controls seen at the same clinic. Blood samples were tested by ELISA and confirmed by Western blot. Sex with men from the USA, sex with someone who developed AIDS, number of male partners (greater than or equal to 100 lifetime), age (greater than or equal to 30 years old) and ethnicity (white) were independently associated with AIDS/AIDS-like syndrome (Odds Ratios = 5.5, 4.3, 3.9, 3.5 and 2.7, respectively). Thirty-nine per cent of cases and 44% of controls reported bisexual activity during the previous two years. From these, a high proportion reported anal intercourse with women in the same period (53% of bisexual cases and 33% of bisexual controls). Bisexual men had more male partners than female partners in the previous two years (median male partners = 20 for cases and five for controls; median female partners = three for both cases and controls). This explains in part why the epidemic has increased more rapidly among men then among women in Minas Gerais, despite the large proportion of bisexuals with the disease.

Endoscopic percutaneous gastrostomy without laparotomy

Observation and manipulation through the endofiberscope, have resulted in a new method of establishing gastrostomy without laparotomy. Subsequent to experimental studies with dogs, the new method was employed to substitute nasogastric tube in patients. In this new procedure, endoscopic application permits the placing of stitches in close contact with the abdominal and gastric walls. The fact that no complications were observed in the patients submitted to operative treatment, is largely attributed to this type of suture. From the results obtained it would seem that this procedure can be routinely employed instead of gastrostomy with laparotomy, since it offers the advantage of being a simpler method and is more likely to be associated with a lower rate of complications.

[Toxoplasma gondii: indirect immunofluorescence diagnosis in swine in the State of São Paulo, Brazil]

The frequency of anti-Toxoplasma antibodies in apparently healthy swine from Botucatu and from São Paulo industrial abattoir was assessed through the indirect immunofluorescence test using blood smears collected in filter paper. 225 (22.5%) of the 1000 samples examined were reagent with titles varying between 1:20 and 1:640.