Acute toxicity of total ammonia to Macrobrachium rosenbergii postlarvae at different salinity levels

Nitrogen compounds, particularly ammonium, nitrite and nitrate, are a major problem in shrimp production systems. These compounds can accumulate in the aquatic environment and reach harmful or even lethal levels. Thus, monitoring the levels of nitrogenous compounds such as ammonia and studying their effects on the animals are essential. One tool used for this purpose is acute toxicity testing based on the evaluation of LC50 values. Furthermore, tools that can help improve the performance of aquatic organisms in culture are needed. The present study aimed to evaluate the effect of salinity on the toxicity of total ammonia to postlarvae of the freshwater prawn Macrobrachium rosenbergii. For this purpose, acute toxicity testing (LC50-96h) was performed using 540 postlarvae with a mean weight of 0.13 g and a mean total length of 2.47 cm, divided into 54 experimental units of two liters each. A completely randomized design in a 3×6 factorial scheme was used, combining three salinities (0, 5, and 10 g.L-1) and six total ammonia concentrations (0, 8, 16, 32, 64, and 128 mg.L-1), with three replicates per combination. The LC50 values for M. rosenbergii postlarvae at 24, 48, 72, and 96 h and their respective confidence intervals (95%) were estimated using the trimmed Spearman-Karber method. The results showed that salinities of 5 or 10 g.L-1 did not reduce the acute toxicity of total ammonia.

Evaluation of the antimicrobial activity of Eucalyptus radiata essential oil against Escherichia coli strains isolated from meat products

The present study sought to evaluate the antimicrobial and anti-adherent potential of Eucalyptus radiata essential oil against food-borne strains of Escherichia coli. The study was performed using the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC). In addition, the disk diffusion technique was used to evaluate the association of Eucalyptus radiata essential oil with synthetic antimicrobials. The Minimum Inhibitory Adherence Concentration (MIC) was also performed. The results revealed that E. radiata showed antimicrobial activity against the E. coli strains tested, with MIC values ranging from 500 μg/mL to 1000 μg/mL and MBC values ranging from 500 μg/mL to 1,024 μg/mL. As for the associations, it was observed that E. radiata oil exhibited a synergistic effect for some antibiotics, especially Ceftriaxone, with greater interference from the essential oil. Furthermore, it was effective in inhibiting the adherence of bacterial strains of E. coli, showing a more significant antibiofilm effect than the antibacterial agent 0.12% chlorhexidine digluconate. In summary, the essential oil of E. radiata showed antimicrobial potential against strains of E. coli of food origin, and can therefore, through in-depth studies, be used alone or in association with synthetic antimicrobials to combat infections caused by this pathogen.

Abstract P1-03-10: The implementation of a patient referral service in a Brazilian cancer center

BACKGROUND: Healthcare systems face problems of cost increases and poor delivery organization. Integrated delivery may reduce costs and improve quality and health outcomes.

OBJECTIVE: To describe how the A.C. Camargo Cancer Center, aiming at greater integration, implemented a referral service for breast cancer patients.

METHODS AND RESULTS: The process was divided in three phases: 1) AS IS ANALYSIS, 2) BENCHMARKING, 3) PILOT & IMPLEMENTATION.

1) AS IS ANALYSIS

A.C. Camargo was responsible for treating 16% of all breast cancer cases that arose from 2000 to 2012 in São Paulo State. Prior to implementation of the program, there was no special patient classification at the initial appointments.

2) BENCHMARKING

As proposed by MD Anderson Cancer Center, we used the patient's classification at the time of an appointment request (regular screenings, undiagnosed or breast cancer patient).

As proposed by Memorial Sloan Kettering Cancer Center, we used a "Physician Referral Service" staffed by "Referral Specialists" and "Trained Oncology Nurses" to collect patient information prior to the first appointment.

As suggested by Princess Margaret Cancer Center, we collected patient care data (e.g., abnormal imaging, palpable lump).

3) PILOT & IMPLEMENTATION

Phase I: Feb. 13, 2017 to Dec. 28, 2017. We reached 7% of new patients in the Breast Surgery Department (BSD): 48% were in the Cancer Group, 45% in the Abnormal Imaging Group (Undiagnosed) and 7% in the Palpable Lump Group.

New patients were classified by the Call Center. Electable cases were referred to the Nurse Navigator, who proceeded with appointments according to protocol.

Root cause analysis of non-captured patients led to the following improvements: extension of participant Call Center cells, script review, and implementation of a training program.

The Phase I results led to the following improvements: 1) reclassification of a subgroup with highly suspicious images as the "Cancer Group"; 2) Transfer of the new referral and scheduling functions to the Call Center; and 3) Implementation of new "first appointment items", personalized for each patient group. This information was displayed to the physician and operations staff in advance of the consultation.

Phase II: Dec. 29,2017 to June 28, 2018. We reached 100% of new patients in the BSD: 17% were in the Cancer Group, 23% in the Abnormal Imaging Group, 8% in the Palpable Lump Group, and 53% in the Regular Screening Group.

Phase II results led to the following improvement: 1.) Distribution of the cancer groups'first appointment items equally among surgeons.

Phase III: From June 29, 2018 to the operation. Implemented new appointment items for new clinical patients and for pre-treatment returns.

CONCLUSION: With implementation of the Referral Service, the BSD at A.C. Camargo is now able to identify the reason for each appointment before the first consultation. This practice promotes operational predictability and more effectively organizes the personalized journey of each patient, including care on the part of Nurse Navigators for the most critical cases.

REFERENCE: Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001

Citation Format: Makdissi FB, Costa Filho ER, Conti EC, Santos LC. The implementation of a patient referral service in a Brazilian cancer center [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-03-10.

Profile of cell proliferation and apoptosis activated by the intrinsic and extrinsic pathways in the prostate of aging rats

BACKGROUND

Estrogens acting through the receptors ERα and ERβ participate in prostate normal growth and cancer. ERβ is highly expressed in the prostate epithelium, playing pro-apoptotic, anti-proliferative, and pro-differentiation roles. Apoptosis is activated by the intrinsic pathway after castration and by the extrinsic pathway after ERβ agonist treatment. This differential activation of apoptotic pathways is important since a major problem in the treatment of prostate cancer is the recurrence of tumors after androgen withdrawal. However, a comprehensive study about the pattern of apoptosis in the aging prostate is lacking, a knowledge gap that we aimed to address herein.

METHODS

Cellular age-related proliferative and apoptotic profiles of prostate tissue obtained from aging Wistar rats were evaluated. Cell death (caspase-3, -8, -9, TNFα) was assessed by immunohistochemistry, immunofluorescence, and TUNEL. Cell proliferation (MCM7) and cell survival factors (ERK1/2, p-ERK1/2, p-Akt, and NF-κB) were determined by immunohistochemistry.

RESULTS

As the rats aged, the number of proliferating cells gradually reduced in the normal epithelium of all prostate lobes, while increasing in focal areas of intraepithelial proliferation. Interestingly, in areas of intraepithelial proliferation, we observed a reduction in the number of cells positive for caspase-3, -8, and -9. Regardless the animal's age, few prostate epithelial cells were positive for caspase-3, caspase-9, and TUNEL. In contrast, a progressive increase was seen in the positivity for caspase-8, especially in the atrophic epithelium of ventral prostate, which coincided with a reduction in TNFα immunoreaction. However, morphology of most caspase-8 positive cells suggests that they were not apoptotic. We also found reduced ERβ expression in the same areas. Possibly, low levels of the pro-apoptotic inductors TNFα and ERβ direct caspase-8 activity to an alternative pro-survival role in the atrophic epithelium. This hypothesis is supported by the increased expression of the key survival factors (ERK1/2, p-ERK1/2, p-Akt, and NF-κB) in these areas.

CONCLUSIONS

Our findings reveal that, as the animals age, there is an increase of proliferation in restricted areas of the prostate epithelium, and a concomitant reduction of the apoptosis rate with an increase in cell survival induced by caspase-8, indicating a focused and spontaneous disruption of tissue homeostasis.

What determines continuing grey matter changes in first-episode schizophrenia and affective psychosis?

BACKGROUND

Magnetic resonance imaging (MRI) studies have shown that brain abnormalities in psychosis might be progressive during the first years of illness. We sought to determine whether first-episode psychosis (FEP) subjects show progressive regional grey matter (GM) changes compared with controls, and whether those changes are associated with diagnosis, illness course or antipsychotic (AP) use.

METHOD

Thirty-two subjects with first-episode schizophrenia-spectrum disorders (FESZ), 24 patients with first-episode affective psychoses (FEAP) and 34 controls recruited using a population-based design underwent structural MRI scanning at baseline and at a 5-year follow-up. Regional GM volumes were assessed with voxel-based morphometry (VBM). Patients were treated at community settings, and about half of them remained mainly untreated.

RESULTS

No significant progressive changes in GM regional volumes were observed in either the FESZ or FEAP group overall. However, FESZ subjects with a non-remitting course showed GM decrements in the left superior temporal gyrus (STG) and insula relative to remitted FESZ subjects. Non-remitted FEAP subjects exhibited a GM decrease in the dorsolateral prefrontal cortex (DLPFC) bilaterally in comparison to remitted FEAP subjects. Among FESZ subjects, AP use was associated with regional GM decrements in the right insula and increments in the cerebellum.

CONCLUSIONS

Our results suggest that the progression of brain abnormalities in FEP subjects is restricted to those with a poor outcome and differs between diagnosis subgroups. AP intake is associated with a different pattern of GM reductions over time.

HLA-G 5' URR SNPs and 3' UTR 14-bp insertion/deletion polymorphism in an Afro-Brazilian population from Paraná State

The present study investigated 23 SNPs in the 5'URR promoter region and the 14 bp ins/del polymorphism at the 3'UTR region of the HLA-G gene in 150 individuals with Afro-Brazilian ancestry. Three haplotypes were found to be the most frequent. Comparing these polymorphisms in other samples, our data suggest that Afro-Brazilians are more similar to the Euro-Brazilians than to Hutterite population.

Longitudinal follow-up of cavum septum pellucidum and adhesio interthalamica alterations in first-episode psychosis: a population-based MRI study

BACKGROUND

Neurodevelopmental alterations have been described inconsistently in psychosis probably because of lack of standardization among studies. The aim of this study was to conduct the first longitudinal and population-based magnetic resonance imaging (MRI) evaluation of the presence and size of the cavum septum pellucidum (CSP) and adhesio interthalamica (AI) in a large sample of patients with first-episode psychosis (FEP).

METHOD

FEP patients (n=122) were subdivided into schizophrenia (n=62), mood disorders (n=46) and other psychosis (n=14) groups and compared to 94 healthy next-door neighbour controls. After 13 months, 80 FEP patients and 52 controls underwent a second MRI examination.

RESULTS

We found significant reductions in the AI length in schizophrenia FEP in comparison with the mood disorders and control subgroups (longer length) at the baseline assessment, and no differences in any measure of the CSP. By contrast, there was a diagnosis×time interaction for the CSP length, with a more prominent increase for this measure in the psychosis group. There was an involution of the AI length over time for all groups but no diagnosis×time interaction.

CONCLUSIONS

Our findings suggest that the CSP per se may not be linked to the neurobiology of emerging psychotic disorders, although it might be related to the progression of the disease. However, the fact that the AI length was shown to be shorter at the onset of the disorder supports the neurodevelopmental model of schizophrenia and indicates that an alteration in this grey matter junction may be a risk factor for developing psychosis.

Longitudinal brain volumetric changes during one year in non-elderly healthy adults: a voxel-based morphometry study

Previous cross-sectional magnetic resonance imaging (MRI) studies of healthy aging in young adults have indicated the presence of significant inverse correlations between age and gray matter volumes, although not homogeneously across all brain regions. However, such cross-sectional studies have important limitations and there is a scarcity of detailed longitudinal MRI studies with repeated measures obtained in the same individuals in order to investigate regional gray matter changes during short periods of time in non-elderly healthy adults. In the present study, 52 healthy young adults aged 18 to 50 years (27 males and 25 females) were followed with repeated MRI acquisitions over approximately 15 months. Gray matter volumes were compared between the two times using voxel-based morphometry, with the prediction that volume changes would be detectable in the frontal lobe, temporal neocortex and hippocampus. Voxel-wise analyses showed significant (P < 0.05, family-wise error corrected) relative volume reductions of gray matter in two small foci located in the right orbitofrontal cortex and left hippocampus. Separate comparisons for males and females showed bilateral gray matter relative reductions in the orbitofrontal cortex over time only in males. We conclude that, in non-elderly healthy adults, subtle gray matter volume alterations are detectable after short periods of time. This underscores the dynamic nature of gray matter changes in the brain during adult life, with regional volume reductions being detectable in brain regions that are relevant to cognitive and emotional processes.

Lack of progression of brain abnormalities in first-episode psychosis: a longitudinal magnetic resonance imaging study

BACKGROUND

Some neuroimaging studies have supported the hypothesis of progressive brain changes after a first episode of psychosis. We aimed to determine whether (i) first-episode psychosis patients would exhibit more pronounced brain volumetric changes than controls over time and (ii) illness course/treatment would relate to those changes.

METHOD

Longitudinal regional grey matter volume and ventricle:brain ratio differences between 39 patients with first-episode psychosis (including schizophrenia and schizophreniform disorder) and 52 non-psychotic controls enrolled in a population-based case-control study.

RESULTS

While there was no longitudinal difference in ventricle:brain ratios between first-episode psychosis subjects and controls, patients exhibited grey matter volume changes, indicating a reversible course in the superior temporal cortex and hippocampus compared with controls. A remitting course was related to reversal of baseline temporal grey matter deficits.

CONCLUSIONS

Our findings do not support the hypothesis of brain changes indicating a progressive course in the initial phase of psychosis. Rather, some brain volume abnormalities may be reversible, possibly associated with a better illness course.

A quantitative TaqMan PCR assay for the detection of Mycoplasma suis

AIM

To develop a TaqMan probe-based, highly sensitive and specific quantitative PCR (qPCR) assay for the detection and quantification of Mycoplasma suis in the blood of pigs.

METHODS AND RESULTS

Primers and probes specific to Myc. suis 16S rRNA gene were designed. The qPCR assay's specificity, detection limit, intra- and inter-assay variability were evaluated and its performance was compared with a Myc. suis conventional PCR assay (cPCR). Blood of two experimentally infected pigs, 40 Indiana pigs, 40 Brazilian sows and 28 peccaries were tested. The assay detected as few as ten copies of Myc. suis plasmids and was 100-fold more sensitive than the cPCR. No cross-reactivity with nontarget pig mycoplasmas was observed. An average of 1·62 × 10(11) and 2·75 × 10(8) target copies ml(-1) of blood were detected in the acutely and chronically infected pigs, respectively. Three (7·5%) pigs and 32 (80·0%) sows were positive while all peccaries were negative for Myc. suis.

CONCLUSION

The developed qPCR assay is highly sensitive and specific for Myc. suis detection and quantification.

SIGNIFICANCE AND IMPACT OF THE STUDY

TaqMan qPCR is an accurate and quick test for detection of Myc. suis infected pigs, which can be used on varied instrumentation platforms.

High-resolution imaging of the immunological synapse and T-cell receptor microclustering through microfabricated substrates

T-cell activation via antigen presentation is associated with the formation of a macromolecular membrane assembly termed the immunological synapse (IS). The genesis of the IS and the onset of juxtacrine signalling is characterized by the formation of cell membrane microclusters and the organization of such into segregated microdomains. A central zone rich in T-cell receptor (TCR)-major histocompatibility complex microclusters termed the central supramolecular activation cluster (cSMAC) forms the bullseye of this structure, while the cellular interface surrounding the cSMAC is characterized by regions enriched in adhesion and co-stimulatory molecules. In vitro, the study of dynamic TCR microcluster coalescence and IS genesis in T-cell populations is hampered by cell migration within the culture system and resolution constraints resulting from lateral cell-cell contact. Here, we detail a novel system describing the fabrication of micropit arrays designed to sequester single T-cell-antigen presenting cell (APC) conjugates and promote IS formation in the horizontal imaging plane for high-resolution studies of microcluster dynamics. We subsequently use this system to describe the formation of the cSMAC in T-cell populations and to investigate the morphology of the interfacial APC membrane.

Brain structural variability due to aging and gender in cognitively healthy Elders: results from the Sao Paulo Ageing and Health study

BACKGROUND AND PURPOSE

Several morphometric MR imaging studies have investigated age- and sex-related cerebral volume changes in healthy human brains, most often by using samples spanning several decades of life and linear correlation methods. This study aimed to map the normal pattern of regional age-related volumetric reductions specifically in the elderly population.

MATERIALS AND METHODS

One hundred thirty-two eligible individuals (67-75 years of age) were selected from a community-based sample recruited for the São Paulo Ageing and Health (SPAH) study, and a cross-sectional MR imaging investigation was performed concurrently with the second SPAH wave. We used voxel-based morphometry (VBM) to conduct a voxelwise search for significant linear correlations between gray matter (GM) volumes and age. In addition, region-of-interest masks were used to investigate whether the relationship between regional GM (rGM) volumes and age would be best predicted by a nonlinear model.

RESULTS

VBM and region-of-interest analyses revealed selective foci of accelerated rGM loss exclusively in men, involving the temporal neocortex, prefrontal cortex, and medial temporal region. The only structure in which GM volumetric changes were best predicted by a nonlinear model was the left parahippocampal gyrus.

CONCLUSIONS

The variable patterns of age-related GM loss across separate neocortical and temporolimbic regions highlight the complexity of degenerative processes that affect the healthy human brain across the life span. The detection of age-related limbic GM decrease in men supports the view that atrophy in such regions should be seen as compatible with normal aging.

Validation of a food frequency questionnaire for women with osteoporosis

The importance of nutrient intakes in osteoporosis prevention in treatment is widely recognized. The objective of the present study was to develop and validate a FFQ for women with osteoporosis. The questionnaire was composed of 60 items, separated into 10 groups. The relative validation was accomplished through comparison of the 3-Day Food Record (3DR) with the FFQ. The 3DR was applied to 30 elderly women with confirmed osteoporosis, and after 45 days the FFQ was administrated. Statistical analysis comprised the Kolmogorov-Smirnov, Student T test and Pearson correlation coefficient. The agreement between two methods was evaluated by the frequency of similar classification into quartiles, and by the Bland-Altman method. No significant differences between methods were observed for the mean evaluated nutrients, except for carbohydrate and magnesium. Pearson correlation coefficients were positive and statistically significant for all nutrients. The overall proportion of subjects classified in the same quartile by the two methods was on average 50.01% and in the opposite quartile 0.47%. For calcium intake, only 3% of subjects were classified in opposite extreme quartiles by the two methods. The Bland-Altman analysis demonstrated that the differences obtained by the two methods in each subject were well distributed around the mean of the difference, and the disagreement increases as the mean intake increases. These results indicates that the FFQ for elderly women with osteoporosis presented here is highly acceptable and is an accurate method that can be used in large-scale or clinical studies for evaluation of nutrient intakes in a similar population.

Qualea grandiflora, a Brazilian "Cerrado" medicinal plant presents an important antiulcer activity

Qualea grandiflora is one of the species widely used in folk medicine to treat gastric ulcers in Cerrado of the central region of Brazil. The hydroalcoholic extract of bark (HE) of Qualea grandiflora was investigated for their ability to prevent and heal lesions in the gastric mucosa. The oral administration of HE exhibited antiulcer activity decreasing the ulcerative index induced by HCl/ethanol solution, indomethacin/bethanechol and stress. In the Shay model, results showed that HE (p.o.) only reduced the severity of gastric lesions without effects on pH, gastric acidity or volume. When given by intraduodenal route, HE changed the pH, but did not modify the other parameters of the gastric juice. These data were in accordance with those obtained when HE was administered orally for 14 days after gastric ulcers were induced by acetic acid in rats. HE presented healing process in subacute gastric ulcer induced by acetic acid in rats. Moreover, histological examinations showed the simple columnar epithelium, lamina propria with simple branched tubular glandules with dilated lumen and large amounts of mucus secretion. Phytochemical investigation of HE led to the detection of terpenes, steroids, saponins, phenolic compounds and tannins in this extract, which may be involved in the observed activity.

Detection of antibodies to Neospora caninum in two species of wild canids, Lycalopex gymnocercus and Cerdocyon thous from Brazil

Domestic dog (Canis domesticus) and the coyote (Canis latrans) are the only known definitive hosts for the protozoan Neospora caninum that causes abortion in dairy cattle. In the present study, antibodies to N. caninum were sought in three species of wild canids, Cerdocyon thous, Lycalopex gymnocercus and Dusicyon vetulus from Brazil. Antibodies to N. caninum were assayed by the indirect fluorescent antibody test (IFAT) and the Neospora agglutination test (NAT). N. caninum antibodies were found in five of 12 L. gymnocercus with IFAT titers of 1:50 in three, 1:100 in one, and 1:1600 in one, and NAT titers of 1:40, 1:80, 1:160, 1:320, and 1:640 in five animals. Antibodies to N. caninum were found in four of 15 C. thous with IFAT titers of 1:50 in one, and 1:100 in three, and NAT titer of 1:40 in one animal. All 30 D. ventulus were seronegative by IFAT and NAT.

Intermediate reactive oxygen and nitrogen from macrophages induced by Brazilian lichens

The activity of ten compounds isolated from Brazilian lichen over the release of hydrogen peroxide and nitric oxide was evaluated in the culture of peritoneal macrophage cells from mice. Salazinic, secalonic A and fumarprotocetraric acids were the compounds that induced the greatest release of H2O2, whereas 12R-usnic and diffractaic acids induced the release of NO. These results indicate that lichen products have potential immunological modulating activities.

Contribution of vision and cutaneous sensation to the control of centre of mass (COM) during gait termination

This study employed manipulation of sensory inputs (vision and plantar-surface cutaneous sensation) during gait termination to elicit insight into the roles played by these sensory systems in the control of gait termination. Attenuation of cutaneous sensation was achieved through hypothermic anesthesia. Visual information was occluded using special glasses. The subjects were asked to walk along an 8 m walkway and during randomly selected trials (25% of trials) to terminate their gait in a predetermined area. The centre of mass (COM) was obtained in order to provide an indication of the efficiency and stability during termination when sensory inputs were manipulated. Lack of visual information delayed the initiation of the slowing down of the COM forward progression and increased the step length of the last step of termination. Additionally, lack of vision resulted in the COM moving closer to the base of support (BOS) during double support and more variability, in the COM, when attempting to achieve a final stable position. Insensitivity of the plantar-surface mechanoreceptors led to a longer second step and a more variable foot placement of the first step, and increased the loading rate during the final two steps of termination. Additionally when vision and cutaneous information were absent the resolution of the final stable position was not as effectively controlled. The results demonstrated that visual information about self-motion and object-motion and sensation from the plantar surface of the foot play phase-specific roles in the control of COM during gait termination.

Oral manifestations related to immunosuppression degree in HIV-positive children

Oral manifestations often found in HIV-infected children are frequently the first clinical sign of the infection. This article aims to report the prevalence of oral manifestations in soft tissues and their relationship with the degree of immunosuppression in 80 HIV-infected patients (average age 6.30 +/- 3.32 years old) at the IPPMG-UFRJ. Thirty children (38%) presented some type of oral lesion and the percentage of CD4 was lower than that found in lesion-free children (p < 0.05); 22.5% presented candidiasis, 17.5% gingivitis, 8.8% enlargement of parotids, 1.3% herpes simplex and 1.3% hairy leukoplakia. Of the 30 children with lesions, 70% showed severe immunosuppression, 23.3% moderate immunosuppression and in only 6.7% was immunosuppression absent. Oral manifestations were directly related to the degree of immunosuppression and such lesions can be considered as indicators of the progression of the HIV infection in children.

Cervical cancer detection by hybrid capture and evaluation of local risk factors

The city of Recife, northeastern Brazil, is reported to have the highest incidence of cervical cancer worldwide (83.2/100000 women).

OBJECTIVE

To evaluate the efficacy of Hybrid Capture I (HC I) in cervical cancer detection and some risk factors in Recife.

METHOD

Cervical scrapes for HC I analysis followed by colposcopy were collected from 140 women (70 with cervical cancer and 70 with normal cervix) from three screening services in Recife.

RESULT

HC I sensitivity and specificity were 82.9 and 41.4%, respectively. The odds ratios for cervical cancer when Gesta > or = 5 and vaginal parity > or = 4 were, respectively, 5.30 and 4.27.

CONCLUSION

HC I is a moderately sensitive method to detect cervical cancer, but it does not seem to be useful as a primary screening tool for it's low specificity. Early pregnancy, high Gesta/Para and living in rural areas were important local risk factors.

Xanthones and flavonoids from Leiothrix curvifolia and Leiothrix flavescens

8-Carboxymethyl-1,6-dihydroxy-3,5-dimethoxyxanthone, 8-carboxymethyl-1,5,6-trihydroxy-3-methoxyxanthone and 8-carboxymethyl-1,3,5,6-tetrahydroxyxanthone were isolated from the capitula of Leiothrix curvifolia and Leiothrix flavescens and characterized by spectroscopic methods, mainly 1D and 2D NMR experiments, as well as by electrospray mass spectrometry. Eight known flavonoids were also isolated and they were identified by 1D and 2D NMR experiments and comparison with literature data.

Risk factors for adverse outcome of newborns with gastroschisis in a Brazilian hospital

BACKGROUND/PURPOSE

The aim of this study was to determine the frequency of postoperative death and to identify factors associated with adverse prognosis in cases of gastroschisis managed in a tertiary hospital of Brazil.

METHODS

A retrospective transverse study was conducted including all cases of gastroschisis managed at Instituto Materno-Infantil De Pernambuco (IMIP), Recife, Brazil, between January 1995 and December 1999 (n = 31). Prevalence risk (PR) was determined for several prenatal, intraoperative, and postoperative factors.

RESULTS

Overall mortality rate was 52% (16 cases), and sepsis was the main cause of death (93.8%). Prenatal diagnosis reduced about 70% the risk of death. Preterm and low birth weight babies had about 3 times increase in the risk of death. Risk of death was increased twice among outborn babies, but there was no association with delivery route. Increase in risk of neonatal death was related to these other factors: birth-to-admission interval longer than 2 hours and birth-to-surgery interval longer than 4 hours. Prevalence risk also was greater with staged silo repair, poor clinical conditions before surgery, and when mechanical ventilation was needed.

CONCLUSIONS

A high mortality rate was associated with absence of prenatal diagnosis, prematurity, low birth weight, delivery outside the tertiary center, and delayed surgery, worsening clinical conditions that preclude primary closure and increases need of mechanical ventilation. J Pediatr Surg 36:559-564.

Planifolin, a new naphthopyranone dimer and flavonoids from Paepalanthus planifolius

A new naphthopyranone dimer (1) named planifolin was isolated from a methylene chloride extract of the capitula of Paepalanthus planifolius. The structure of 1 has been determined by chemical and spectroscopic means. In addition, a known dihydronaphthopyranone glycoside and seven known flavonoids were isolated from an ethanolic extract of the leaves of P. planifolius.

Application of HPLC-NMR coupling using C30 phase in the separation and identification of flavonoids of taxonomic relevance

The on-line separation and identification of two important taxonomic markers for plant species of the Paepalanthus genus, the flavonoids 6-methoxykaempferol-3-O-beta-D-glucopyranoside and 6-methoxykaempferol-3-O-beta-D-6"(p-coumaroyl)glucopyranoside, has been performed with an HPLC-NMR coupling using C30 phase. 1D spectra have been recorded in the stopped-flow mode for the two predominant chromatographic peaks. This is the first application of HPLC-NMR coupling using C30 phase to a taxonomic problem. The technique drastically reduces the required amount of sampling for structure determination.

[The phylogenesis of language. New approaches of old questions]

The philogenesis and the anthropogenesis of language are the primary elements for the anatomic and physiologic understanding about the mechanisms of human communication, as well as their clinical applicability. During the process of primates'evolution, significant changes in the animal's body, specially on the heads, has occurred since the arboricole life that influences the genesis of language. The adaptation of a semi-vertical body posture, the exploratory use of the hands and the improvement of vision at the expenses of olfaction have caused the enlargement of the cranium and the encephalon. Furthermore, as the primates went back to the floor, and from the development of the biped march in the Australopithecus, a progressive "fan-like" increase of the frontal, parietal and temporal regions took place allowing the simultaneous development of the neuroanatomical centers of language, facial expression and manual motor activity.

Corticosteroid therapy for prevention of respiratory distress syndrome in severe preeclampsia

OBJECTIVE

The objective of the study was to determine the efficacy and side effects of corticosteroid therapy for pregnant women with severe preeclampsia in the prevention of respiratory distress syndrome in their premature neonates.

STUDY DESIGN

A prospective double-blind randomized trial enrolled 218 pregnant women with severe preeclampsia and gestational age between 26 and 34 weeks. One hundred ten received betamethasone (12 mg administered intramuscularly, repeated after 24 hours and then once a week) and 108 received placebo. Relative risks and 95% confidence intervals of respiratory distress syndrome and other neonatal and maternal complications were calculated for corticosteroid use.

RESULTS

Frequency of respiratory distress syndrome was significantly reduced in the corticosteroid group (23%) with respect to the placebo group (43%), with a relative risk of 0.53 (95% confidence interval 0.35-0. 82). Relative risks of intraventricular hemorrhage, patent ductus arteriosus, and perinatal infection were significantly decreased in the corticosteroid group: 0.35 (95% confidence interval 0.15-0.86), 0.27 (95% confidence interval 0.08-0.95), and 0.39 (95% confidence interval 0.39-0.97), respectively. There was no significant difference in the frequency of stillbirth, but the neonatal mortality rate was lower in the corticosteroid group (14%) than in the placebo group (28%), with a relative risk of 0.5 (95% confidence interval 0.28-0.89). There was increased risk of gestational diabetes but of no other maternal complication after corticosteroid therapy, and mean blood pressures were similar in the 2 groups.

CONCLUSIONS

Antenatal corticosteroid therapy with betamethasone for acceleration of fetal lung maturity is a safe and efficient treatment in patients with severe preeclampsia at between 26 and 34 weeks' gestation.

Reasons for hospitalization due to abortion and pregnancy termination

The aim of this study was to identify the reasons for hospitalization associated with abortion and pregnancy termination among women attending the Maternity Unit of IMIP, Recife, Brazil. In a case-control study, 230 women who were hospitalized consecutively between August 1994 and June 1995 due to causes related to pregnancy termination or abortion were chosen as cases. Four controls per case were selected randomly out of a total of 920 women who delivered at the same hospital. For each potential cause considered, the odds ratio (OR) and respective 95 per cent confidence interval (CI) were calculated. Multiple logistic regression analysis was then used to control for confounders. Among all potential causes studied, those that showed significant association with pregnancy termination or abortion were: being single, absence of emotional support from partner, being a working woman, literacy up to the fourth year of school, failure of contraceptive method employed, and experience of previous pregnancies, children, and abortions.

Contraceptive use and pregnancy before and after introducing lactational amenorrhea (LAM) in a postpartum program

There is good evidence that lactational amenorrhea (LAM) is an effective method of fertility regulation during the first 6 months postpartum, provided no other food is given to the baby and the mother remains amenorrheic. However, although breast-feeding is strongly promoted in many maternity hospitals that also run postpartum family planning programs, LAM is rarely included among the contraceptive options being offered. This paper presents the results of an operational study which compared the prevalence of contraceptive use and the cumulative pregnancy rate at 12-months postpartum among 350 women observed before and 348 women studied after introducing LAM as an alternative contraceptive option offered to women following delivery at the Instituto Materno Infantil de Pernambuco (IMIP), in Recife, Brazil. The percentage of women not using any contraceptive method was significantly lower (p<0.0001) after the intervention (7.4%) than before (17.7%). This difference remained statistically significant after controlling for age, number of living children, marital status and years of schooling. The proportion pregnant one year postpartum was also significantly lower (p<0.0001) after the introduction of LAM (7.4%) than before (14.3%), but the difference was no longer significant after controlling for the same variables. It is concluded that LAM is a useful addition to family planning postpartum programs.

Pregnancy-induced hypertension and hyaline membrane disease

OBJECTIVES

(1) To determine whether the incidence of hyaline membrane disease (HMD) is different among premature babies of pre-eclamptic women and those of normotensive controls; (2) to determine the relative risk (RR) of HMD according to the severity of pre-eclampsia and gestational age.

METHODS

A retrospective and prospective cohort of 271 pre-eclamptic women and 271 normotensive controls, with gestational age between 28 and 34 weeks was studied, including only singleton pregnancies, live fetuses and well-documented gestational age. Exclusion criteria were ruptured membranes > 24 h, other maternal diseases and previous use of corticosteroids. Statistical analysis included relative risk and multiple logistic regression model.

RESULTS

The RR of HMD for babies of pre-eclamptic women was 0.96 (95% CI: 0.78-1.17), and remained unchanged after controlling for gestational age and multiple logistic regression analysis.

CONCLUSION

Preterm babies of pre-eclamptic mothers had the same probability of having HMD as newborns of normotensive mothers.

[Xenodiagnosis in chronic Chagas' disease. I. The sensitivity of Panstrongylus megistus and Triatoma infestans]

From January 1986 to February 1994, 563 xenodiagnosis (XD) were applied in 563 chronic chagasic patients from different areas of Brazil; 292 were women and 271 were men between 6 and 89 years (average: 41.4 +/- 14.7 years). To each XD 40 nymphs on the 4th stage were used: 20 from Panstrongylus megistus (Pm) and 20 from Triatoma infestans (Ti) in fast, during at least 14 days. The exam in each nymph was made 45 days after being applied on the patient, by observation in optical microscopy of the drugs and/or the grinded from the digestive tube. The results are: a) 205 (36.4%) positive XD, including 85 (15.1%) due only nymphs of Pm, 44 (7.8%) Ti and 76 (13.5%) Pm and Ti; b) positively in 4.9% of the nymphs from Pm and in 3.0% of the Ti nymphs examined. These results' analysis showed that the Pm nymphs were more sensitive that Ti's ones to the infection by Trypanosoma cruzi, increasing considerably the xenopositivity, independently from birthplace, sex or age of the patients. These results point out that to increase the efficacy of XD in chronic Chagas' disease, the exam must have more than a species of triatomine with different sensibilities to the T. cruzi infection, and in case of using one species on XD, Pm must substitute Ti.

Post-abortion complications after interruption of pregnancy with misoprostol

The high incidence of abortion in Brazil and the increased use of misoprostol among women having clandestine/unsafe abortions has led to an interest in evaluating whether there is an association between the use of misoprostol and the incidence of septic complications post-abortion. To test this association, a retrospective cohort study was conducted with 1840 women treated post-abortion at the Instituto Materno-Infantil de Pernambuco (IMIP) between 1988 and 1992. Incidence of infection (4.2%) was lower in women stating they had used misoprostol than in those stating that the abortion was not induced (7.9%) and twelve times lower than in women stating that they had used other methods (49.4%). These results suggest that misoprostol is a safe, inexpensive method for inducing abortion, and leads to fewer complications and consequently shorter hospital stays. Misoprostol should be considered a viable option in situations where induction of abortion is legal or medically indicated.

[Epidemiological study of patients with spinal cord injuries and neurologic deficit, admitted to the Institute of Orthopedics and Traumatology at the Hospital das Clinicas of the School of Medicine of the University of São Paulo]

The authors present an epidemiologic study concerning the spinal cord injuries treated at the Department of Orthopaedics and Traumatology of the School of Medicine of the University of São Paulo from 1982 to 1987. Out of 428 patients 94.3% were male, their age being mainly between 21 and 30 years. The segment more frequently affected was the cervical spine. The more frequent causes were the gunshot wounds and the traffic accidents. The incidence of death was 21%, caused mostly by respiratory failure.

[Efficacy of moxalactam in the treatment of purulent meningitis caused by Haemophilus influenzae and Neisseria meningitidis]

Foi avaliada a eficácia do moxalactam no tratamento de meningites em crianças, causadas por H. influenzae (27 casos) e N.meningitidis (6 casos). Dos 33 doentes tratados na dose de 100mg/Kg de peso (dose de ataque) e 50mg de 12/12 horas por via venosa, 32 curaram-se. A tolerância ao produto foi muito boa, havendo alterações transitórias de transaminases e fosfatase alcalina; em um caso, houve hematoma posapendectomia, provavelmente relacionado ao uso deste antibiotico. Os níveis séricos e liquóricos do produto foram elevados; as concentrações no liquor excederam de muito a concentração bactericida mínima dos germes infectantes. O moxalactam se mostrou seguro e eficaz como terapia primária da meningite causada por H. influenzae e N.meningitidis em crianças.

In vitro antibiotic susceptibility of salmonellae

In vitro antibiotic susceptibilities were determined for 101 strains of salmonellae. Resistance to chloramphenicol and ampicillin was low. Cefamandole was active against the majority of strains and deserves further evaluation.