Double screening for syphilis and HIV in pregnant women in a priority municipality for the elimination of vertical transmission in Brazil: incidence, risk factors and spatial analysis

BACKGROUND

The Brazilian Ministry of Health (MoH) recommends double screening (DS) for syphilis and HIV during the first and third trimesters of antenatal care (ANC) to mitigate vertical transmission. We surveyed DS outcomes and their associated factors in a priority Brazilian municipality with >100 000 inhabitants who face challenges for both health problems.

METHODS

A total of 399 women were followed up throughout pregnancy using medical records. Spatial and multinomial logistic analyses were performed.

RESULTS

There was an incidence rate of 24.8%, 59.4% and 15.8% for 'full DS', 'partial DS' and 'without DS', respectively. Younger women and those with a history of both prematurity and multiparity were less likely to be in the 'full DS' category. There was an overlap of high-density clusters of 'full DS' and 'ANC in better quality basic health units', adherent to both the Family Health Strategy and the National Program for Access and Quality Improvement in Primary Care.

CONCLUSIONS

The poor DS outcomes presented in 75% of the cases were mostly linked to delays in starting ANC appointments or their discontinuity. Thus, the MoH recommendations, accompanied by ongoing training, technical assistance and the periodic evaluation of their implementation, need to effectively reach providers and promote counseling and awareness about the importance of DS for pregnant women.

Where do we aspire to publish? A position paper on scientific communication in biochemistry and molecular biology

The scientific publication landscape is changing quickly, with an enormous increase in options and models. Articles can be published in a complex variety of journals that differ in their presentation format (online-only or in-print), editorial organizations that maintain them (commercial and/or society-based), editorial handling (academic or professional editors), editorial board composition (academic or professional), payment options to cover editorial costs (open access or pay-to-read), indexation, visibility, branding, and other aspects. Additionally, online submissions of non-revised versions of manuscripts prior to seeking publication in a peer-reviewed journal (a practice known as pre-printing) are a growing trend in biological sciences. In this changing landscape, researchers in biochemistry and molecular biology must re-think their priorities in terms of scientific output dissemination. The evaluation processes and institutional funding for scientific publications should also be revised accordingly. This article presents the results of discussions within the Department of Biochemistry, University of São Paulo, on this subject.

Selection of binding targets in parasites using phage-display and aptamer libraries in vivo and in vitro

Parasite infections are largely dependent on interactions between pathogen and different host cell populations to guarantee a successful infectious process. This is particularly true for obligatory intracellular parasites as Plasmodium, Toxoplasma, and Leishmania, to name a few. Adhesion to and entry into the cell are essential steps requiring specific parasite and host cell molecules. The large amount of possible involved molecules poses additional difficulties for their identification by the classical biochemical approaches. In this respect, the search for alternative techniques should be pursued. Among them two powerful methodologies can be employed, both relying upon the construction of highly diverse combinatorial libraries of peptides or oligonucleotides that randomly bind with high affinity to targets on the cell surface and are selectively displaced by putative ligands. These are, respectively, the peptide-based phage display and the oligonucleotide-based aptamer techniques. The phage display technique has been extensively employed for the identification of novel ligands in vitro and in vivo in different areas such as cancer, vaccine development, and epitope mapping. Particularly, phage display has been employed in the investigation of pathogen–host interactions. Although this methodology has been used for some parasites with encouraging results, in trypanosomatids its use is, as yet, scanty. RNA and DNA aptamers, developed by the SELEX process (Systematic Evolution of Ligands by Exponential Enrichment), were described over two decades ago and since then contributed to a large number of structured nucleic acids for diagnostic or therapeutic purposes or for the understanding of the cell biology. Similarly to the phage display technique scarce use of the SELEX process has been used in the probing of parasite–host interaction. In this review, an overall survey on the use of both phage display and aptamer technologies in different pathogenic organisms will be discussed. Using these techniques, recent results on the interaction of Trypanosoma cruzi with the host will be highlighted focusing on members of the 85 kDa protein family, a subset of the gp85/TS superfamily.

4-aminoquinoline analogues and its platinum (II) complexes as antimalarial agents

The high incidence of malaria and drug-resistant strains of Plasmodium have turned this disease into a problem of major health importance. One of the approaches used to control it is to search for new antimalarial agents, such as quinoline derivates. This class of compounds composes a broad group of antimalarial agents, which are largely employed, and inhibits the formation of β-haematin (malaria pigment), which is lethal to the parasite. More specifically, 4-aminoquinoline derivates represent potential sources of antimalarials, as the example of chloroquine, the most used antimalarial worldwide. In order to assess antimalarial activity, 12 4-aminoquinoline derived drugs were obtained and some of these derivatives were used to obtain platinum complexes platinum (II). These compounds were tested in vivo in a murine model and revealed remarkable inhibition of parasite multiplication values, whose majority ranged from 50 to 80%. In addition they were not cytotoxic. Thus, they may be object of further research for new antimalarial agents.

[Is there any change in the cell adhesion method mediated by e-cadherin in cervical neoplasia of HIV-infected patients?]

PURPOSE

to evaluate the expression of E-cadherin in cervical lesions of patients suffering from HIV infection.

METHODS

we conducted a study with 77 patients with cervical HPV infection, 40 of them were HIV seropositive and 37 HIV seronegative who underwent colposcopy and a biopsy of the cervix. The material obtained by biopsy of the cervix was sent for histopathologic and immunohistochemical study. Sections were obtained and mounted on silanized slides and examined by an observer who was blind to patient serology. E-cadherin antibody, clone NHC-38 diluted 1:400 (DAKO) and the Novolink polymer system (Novocastra) were used. The expression of E-cadherin was determined on the epithelial cell membrane based on the extent of the stained area. The χ2 test with Yates correction or the Fisher's Exact test was used for comparison of the proportion in univariate analysis. All the variables with p<0.25 were included in the logistic regression model, called initial model. The analyses were carried out using the SPSS software, with the level of significance set at 5%.

RESULTS

the expression of E-cadherin was observed in up to the internal 1/3 of the epithelium in 59.3% of cases and in up to 2/3 of the epithelium in 11.1% of cases, but in 29.6% of cases the expression was identified throughout the thickness of the epithelium in HIV-seronegative patients. In contrast, in HIV-seropositive patients, 45.9% showed expression up to 1/3 of the epithelium, 13.5% showed expression in up to 2/3 of the epithelium, and 40.5% showed expression throughout the thickness of the epithelium. E-cadherin expression did not differ between groups (p=0.5). However, the multivariate analysis identified a significant association between high-grade cervical injury and E-cadherin expression in 2/3 and 3/3 of the epithelium (p=0.001; χ2=36.9).

CONCLUSIONS

the expression of E-cadherin in the epithelial cell membrane is not associated with infection by the human immunodeficiency virus, but with the degree of intraepithelial cervical injury.

Mechanism of Trypanosoma cruzi death induced by Cratylia mollis seed lectin

Incubation of T. cruzi epimastigotes with the lectin Cramoll 1,4 in Ca(2+) containing medium led to agglutination and inhibition of cell proliferation. The lectin (50 microg/ml) induced plasma membrane permeabilization followed by Ca(2+) influx and mitochondrial Ca(2+) accumulation, a result that resembles the classical effect of digitonin. Cramoll 1,4 stimulated (five-fold) mitochondrial reactive oxygen species (ROS) production, significantly decreased the electrical mitochondrial membrane potential (Delta Psi(m)) and impaired ADP phosphorylation. The rate of uncoupled respiration in epimastigotes was not affected by Cramoll 1,4 plus Ca(2+) treatment, but oligomycin-induced resting respiration was 65% higher in treated cells than in controls. Experiments using T. cruzi mitochondrial fractions showed that, in contrast to digitonin, the lectin significantly decreased Delta Psi(m) by a mechanism sensitive to EGTA. In agreement with the results showing plasma membrane permeabilization and impairment of oxidative phosphorylation by the lectin, fluorescence microscopy experiments using propidium iodide revealed that Cramoll 1,4 induced epimastigotes death by necrosis.

Fatores associados ao abandono de tratamento em saúde mental em uma unidade de nível secundário do Sistema Municipal de Saúde

A ocorrência de abandono de tratamento psiquiátrico de nível secundário é uma relevante questão clínica e econômica. Taxas de abandono em psiquiatria são mais altas que em outras especialidades médicas. Estudos publicados nos últimos 15 anos têm identificado diversos fatores estatisticamente associados ao não-comparecimento às consultas e/ou ao abandono de tratamento em saúde mental. OBJETIVO: Avaliar variáveis demográficas, psicopatológicas, de diagnóstico e tratamento enquanto possíveis preditores de abandono de tratamento em serviço especializado de saúde mental. MÉTODO: Estudo observacional, avaliando 896 pacientes encaminhados, no período de abril de 2004 a março de 2006, por Unidades Básicas de Saúde da área de abrangência do serviço especializado. RESULTADOS: Pacientes solteiros, com idade abaixo da média do grupo (39,2 anos) e desempregados abandonaram significantemente mais o tratamento. Duas variáveis relativas ao exame psicopatológico se associaram significantemente com abandono de tratamento (memória quanto ao passado recente e relação do humor com fatos reais, atuais). Pacientes adultos que receberam diagnóstico psiquiátrico de oligofrenia abandonaram significantemente menos e pacientes com diagnóstico relativo aos transtornos da infância e adolescência (F80-F98 da CID-10) também abandonaram significantemente mais o tratamento. O registro de comorbidade psiquiátrica e tratamento exclusivamente farmacológico se associaram a não abandono do tratamento. CONCLUSÃO: Os resultados confirmam achados de diferentes autores da evidência de características associadas a abandono ao tratamento. Tais achados sugerem que determinados subgrupos de pacientes necessitem de abordagens customizadas, a fim de influenciar positivamente sua adesão final ao tratamento indicado.

Trypanosoma cruzi strains, Tulahuen 2 and Y, besides the difference in resistance to oxidative stress, display differential glucose-6-phosphate and 6-phosphogluconate dehydrogenases activities

The drugs currently available for Chagas'disease treatment are unsatisfactory due to limited efficacy and toxic side effects, making the search for more specific pharmacological agents a priority. The components of the Trypanosoma cruzi trypanothione-dependent antioxidant system have been pointed out as potential chemotherapeutic targets for the development of more specific drugs. To work properly, this system must have a current supply of NADPH, provided by glucose-6-phosphate dehydrogenase (G6PD) and 6-phosphogluconate dehydrogenase (6PGD). Here, we compare two T. cruzi strains, Tulahuen 2 and Y, regarding growth rate, cytosolic tryparedoxin peroxidase (TcCPX) concentration and pentose phosphate pathway dehydrogenases activities. Tulahuen 2 cells show higher values as compared to the Y strain when the following parameters are compared: TcCPX concentration, resistance to H2O2, growth index and G6PD activity. Different patterns of G6PD and 6PGD activities were observed among strains along the growth curve and when cells were challenged with H2O2. These data reinforce the heterogeneity within T. cruzi populations and also the importance of G6PD in protecting the parasite against reactive oxygen species.

[Prevalence of noise-induced hearing loss in metallurgical company]

OBJECTIVE

To analyze the prevalence of cases suggestive of noise-induced hearing loss (NIHL) among metalworkers who were potentially exposed to occupational noise (from 83 to 102 dB).

METHODS

A cross-sectional study was carried out in a metalworking company providing services in Rio de Janeiro, Brazil. Clinical and occupational data on 182 workers who were active between November 2001 and March 2002 were obtained from the company's Hearing Conservation Program and analyzed. In order to characterize the noise exposure status within the work environment, the acoustic classifications from the operating units of the client companies were used, due to difficulty in quantification at an individual level. Associations between these cases and variables such as age, length of service in the company, length of exposure to occupational noise and degree of use of individual protection equipment were tested by means of prevalence ratios and logistic regression analysis.

RESULTS

The prevalence of cases suggestive of NIHL was 15.9% and significant associations (p<0.05) were identified from multivariate analysis between these cases and the variables of age and degree of use of individual protection equipment.

CONCLUSIONS

The results found contribute towards better understanding of the behavior of some of the main characteristics of NIHL, in a particular situation of the organizing of work that is relatively common in the Brazilian industrial context.

Immunocytochemical and biochemical detection of alpha-L-fucosidase in Trypanosoma cruzi

The aim of the present study was to demonstrate the presence of alpha-L-fucosidase in Trypanosoma cruzi. Immunocytochemical and biochemical techniques were used to localize and characterize a membrane-associated, neutral-pH-optimum, alpha-L-fucosidase from the parasite. Light and electron microscopy localized the alpha-L-fucosidase specifically on the surface of the parasite and on membranes in the posterior region of the epimastigote stage. Although much less intense, labeling was also detected on the surface of trypomastigotes. At least 50% of the alpha-L-fucosidase activity was associated with epimastigote membrane solubilized with 1 M NaCl or 1% Triton X-100, suggesting that alpha-L-fucosidase is peripherally associated with membranes. The enzyme from epimastigotes had a neutral pH optimum (near 7) but displayed low specific activity when p-nitrophenyl-alpha-L-fucoside was employed as substrate (0.028 U/mg protein for epimastigotes and 0.015 U/mg protein for tissue culture-derived trypomastigotes). Polyacrylamide gel electrophoresis and Western blotting analysis both showed an expected 50-kDa polypeptide which was immunoreactive with anti-alpha-L-fucosidase antibodies.