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Maize consists of a cereal widely used in the preparation of different food products. Brazil is one of the world's largest maize producers. Several types of pesticides have been applied in maize crop, which can lead to the contamination of the derived products. The present work aims at the validation of multiresidue method to analyze the matrix effect and level of pesticides in maize flour. Twenty residues were investigated in samples commercialized in the state of Ceará, Brazil. The method was satisfactorily validated, according to parameters recommended by European Union. About 55% of the pesticides had an intense negative matrix effect. Multiresidue analyzes showed the presence of traces of fenitrotion in 20% of maize flour samples. Detected levels were below maximum residue limits recommended for maize. The results indicate that maize products need continuous monitoring to ensure food security. [ABSTRACT FROM AUTHOR]

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Soils of tropical forests are important to the global budgets of greenhouse gases. The Brazilian Atlantic Forest is the second largest tropical moist forest area of South America, after the vast Amazonian domain. This study aimed to investigate the emissions of nitrous oxide (N2O), carbon dioxide (CO2) and methane (CH4) fluxes along an altitudinal transect and the relation between these fluxes and other climatic, edaphic and biological variables (temperature, fine roots, litterfall, and soil moisture). Annual means of N2O flux were 3.9 (± 0.4), 1.0 (±0.1), and 0.9 (± 0. 2) ng N cm-2 h-1 at altitudes 100, 400, and 1000m, respectively. On an annual basis, soils consumed CH4 at all altitudes with annual means of - 1.0 (± 0.2), - 1.8 (± 0.3), and -1.6(±0.1) mg m-2 d-1 at 100m, 400 m and 1000 m, respectively. Estimated mean annual fluxes of CO2 were 3.5, 3.6, and 3.4 µmol m-2 s-1 at altitudes 100, 400 and 1000m respectively. N2O fluxes were significantly influenced by soil moisture and temperature. Soil-atmosphere exchange of CH4 responded to changes in soil moisture. Carbon dioxide emissions were strongly influenced by soil temperature. While the temperature gradient observed at our sites is only an imperfect proxy for climatic warming, our results suggest that an increase in air and soil temperatures may result in increases in decomposition rates and gross inorganic nitrogen fluxes that could support consequent increases in soil N2O and CO2 emissions and soil CH4 consumption. [ABSTRACT FROM AUTHOR]

Soils of tropical forests are important to the global budgets of greenhouse gases. The Brazilian Atlantic Forest is the second largest tropical moist forest area of South America, after the vast Amazonian domain. This study aimed to investigate the emissions of Nitrous Oxide (N2O) and Carbon Dioxide (CO2) as well as methane (CH4) emissions and consumptions along an altitudinal transect and the relation between these fluxes and other climatic, edaphic and biological variables (temperature, fine roots, litterfall, and soil moisture). Annual means of N2O flux were 2.6 (±0.5), 0.9 (±0.1), and 0.7 (±0.2) ng N cm-2 h-1 at altitudes 100, 400, and 1000 m, respectively. On an annual basis, soils consumed CH4 at all altitudes with annual means of -1.0 (±0.2), -1.8 (±0.1), and -1.6 (±0.3)mg m-2 d-1 at 100 m, 400 m and 1000 m, respectively. Although not sampled in the hottest and wettest portion of the year because of instrument malfunctions, mean fluxes of CO2 averaged 3.6 (±0.2), 3.5 (±0.3), and 3.1 (±0.3) μmol m-2 s-1 at altitudes 100, 400 and 1000 m, respectively. N2O fluxes were significantly influenced by soil moisture and temperature. Soil-atmosphere exchange of methane responded to changes in soil moisture. Carbon dioxide emissions were strongly influenced by soil temperature. While the temperature gradient observed at our sites is only an imperfect proxy for climate warming, our results suggest that increasing temperatures will result in increased in microbial activity with a consequent increase in soil N2O and CO2 emissions and soil CH4 consumption. [ABSTRACT FROM AUTHOR]

Sumare City does not have sewage treatment, leading to the deterioration of water resources and public health conditions. There is a sewage treatment plan for the city's urbanized area. However, difficulties of financing delay the plan's implementation. Meanwhile, new small communities of low income population are built surrounding the city. That was not foreseen in the city's plan. So, the sanitation problem is constantly aggravated. The city's Water and Wastewater Department (Departamento de A'guas e Esgotos - DAE), worried by this situation tried out a new scheme to overcome this problem. One of these communities (235 houses) was chosen and a proposal was made to its inhabitants, which was accepted, to use an anaerobic digester to treat the sewage, DAE being the financer agent and the inhabitants reimbursing DALE. The UASB technology was made available by means of an agreement between DAE-Sumare and CETESB for technology transfer. DAE was responsible for the management and plant construction. The plant was started-up in May 1992. This is a successful experience in view of the non-existence of finance for the construction of sewage systems. A 67.5 m³ UASB reactor was built. The difficulties to establish the real costs for this were extremely high, and lead to cost reduction recommendation. Data collected for performance evaluation, over a period of fourteen months showed a difference compared to the 120 m³ UASB reactor experience, at CETESB, in Sao Panlo City. The influent and effluent Biochemical Oxygen Demand (BOD), Chemical Oxygen Demand (COD) and Total Suspended Solids (TSS) values, are higher than were experienced at CETESB. The average removal rates of BOD, COD and TSS are also higher, respectively 80%, 74% and 87%. [ABSTRACT FROM AUTHOR]

We retrospectively analysed 33 children and adolescents who had been hospitalized in a liver transplant unit within the previous 10 years for acute liver failure (ALF). The patients’ age varied between 2 months and 15 years of age (median 6.2 ± 5.3), and 21 (63%) were male. Thirteen patients (39%) were immunoglobulin-M anti-hepatitis A virus (HAV) sero-positive. Eleven cases (33%) had an undetermined aetiology. The 13 children with HAV ALF were between 17 months and 15.6 years of age (median 5.8 ± 4.6) and eight were male (61.5%). All were on a list for urgent liver transplant. Of these, five (38%) died while waiting for a liver. Only one patient recovered spontaneously. Seven patients received a liver transplant; three died in the immediate postoperative period and one died 45 days after transplant. Three children are alive 1, 2 and 5 years after transplant. We conclude that HAV was the most frequent cause of ALF, which had high mortality even when a liver transplant was possible. The results support universal HAV vaccination in this area. [ABSTRACT FROM AUTHOR]

The world has been searching for clean and renewable alternatives to provide new materials and energy and, consequently reducing the dependence on petroleum fossil fuels. Sugarcane has become an important raw material as a solution for this demand since it is grown in more than 100 countries and can potentially reduce greenhouse gas (GHG) emissions. In this context, the production of biomaterials and biofuels and their effective use are promising ways to reach these goals. Brazilian government policies have created the optimal scenario to consolidate the first sugarcane 1G biorefinery with biofuels, sugar and bioelectricity production, trying to reach sustainable and low-cost solutions. After the establishment of the 1G technology, the 2G and 3G technologies are being developed, bringing new possibilities for value-added biochemicals production, in integrated systems with minimized emissions with a non-waste vison and circular bioeconomy. This review presents the current status and future perspectives of sugarcane as a potential biofactory. The present and future of Brazilian sugarcane biorefinery are discussed in terms of the exploitation of sugarcane, research and innovation with the integrated production of sugar, biofuels, bioelectricity, biopolymers, organic acids, enzymes and other biomolecules, as well as the use of process-generated liquid and solid by-products and/or wastes. [Display omitted] • Sugarcane Brazilian biofactories' future and perspectives. • Biorefinery concept as a sustainable tool for sugarcane circular bioeconomy. • Brazilian governmental incentives to help sugarcane biofuels competition with fossil fuels. • Re-use of liquid and solid sugarcane wastes for high value bioproducts production. • Raising number of innovative and development of new sugarcane chain processes. [ABSTRACT FROM AUTHOR]

Fungal diseases, especially those that affect the root systems of plants, caused by Rhizoctonia and Macrophomina are limiting factors for achieving high crop yields. Alternatives to controlling fungi with chemical products drive the search for new options for bioactive compounds from plants. Attalea geraensis, a palm tree from the Brazilian Cerrado, is rich in flavonoids with antifungal actions. The objective of this work is to identify the chemical classes present in the ethanolic extract of green leaves of A. geraensis and determine the antifungal potential of the extract against isolates of Macrophomina phaseolina (Tassi) Goid. and Rhizoctonia solani JG Kühn. Phytochemical prospection, flavonoid dereplication, and antifungal activity were carried out of the ethanolic extract of the green leaves of A. geraensis harvested in the Cerrado area of Brazil. Steroids, triterpenes, saponins, and anthraquinones are described here for the first time for the leaves of A. geraensis. The flavonoids quercetin, isorhamnetin, 3,7-dimethylquercetin, quercetin 3-galactoside, 5,7-dihydroxy-2-(4-hydroxy-3-methoxyphenyl)-3-{[3,4,5-trihydroxy-6-(hydroxymethyl)oxan-2-yl]oxy}-4H-chromen-4-one, rhamnazin 3-galactoside, keioside, and rhamnazin 3-rutinoside were identified. Of these, only quercetin and isorhamnetin had already been identified in the leaves of A. geraensis. The results show a fungistatic potential for the species. The diversity of flavonoids present in the leaves of A. geraensis may be the result of a synergistic action between fungus and plant or there could be an antagonistic effect between flavonoids and the other identified chemical classes.

Snakebite envenoming is currently considered a neglected tropical disease, which affects over 5 million people worldwide, and causes almost 150 000 deaths every year, as well as severe injuries, amputations and other sequelae. Snakebite envenoming in children, although proportionally less frequent, is generally more severe, and represents an important challenge for pediatric medicine, since they often result in worse outcomes. In Brazil, given its ecological, geographic and socioeconomic characteristics, snakebites are considered an important health problem, presenting approximately 30 000 victims per year, approximately 15% of them in children. Even with low snakebite incidence, children tend to have higher snakebite severity and complications due to the small body mass and same venom volume inoculated in comparison to adults, even though, due to the lack of epidemiological information about pediatric snakebites and induced injuries, it is difficult to measure the treatment effectiveness, outcomes and quality of emergency medical services for snakebites in children. In this review, we report how Brazilian children are affected by snakebites, describing the characteristics of this affected population, clinical aspects, management, outcomes and main challenges., (© The Author(s) [2023]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: The present study evaluated the effect of training on dental students' ability for matching two different shade guides., Materials and Methods: The study was conducted in 2012. The participants were 88 male and female undergraduate dental students from Brazil and Portugal, with or without previous color education and vision refractive errors (response rate of 73.33%). They were asked to match a pair set of the shade guides Vita Classical (VC) and Vitapan 3D Master (3DM), with a 20-minutes' rest between each match. The sets were assembled over a neutral gray background and under controlled light. About 7-10 days later, all participants watched a video lecture on color education and repeated the matching procedure. The percentage of matches was calculated and submitted to statistical analysis for the variables gender, geographic region, shade guide and previous color education (Mann-Whitney tests), vision refractive errors (Kruskal-Wallis), and training (Wilcoxon signed rank). All tests were performed at a confidence level of 95%., Results: Training increased the percentage of matches for all groups, except for Portuguese and hyperopic individuals (VC and 3DM) and men (3DM). Previous color education affected VC shade matching before training. Gender, refractive errors, and geographic region did not affect shade matching ability., Conclusions: Previous education and training in color positively affected shade-matching ability of dental students on shade guide pairing tests., Clinical Significance: The subjectivity of the visual method might not be a clinical concern in daily practice. The human eye can detect small differences in color and visualize the tooth with all its complex geometry, multilayered tissues, and secondary color parameters. Therefore, any color-matching task will be judged by the patient and/or other observers with consideration to this complexity. In other words, visual assessment is paramount to the success/failure of esthetic restorative procedures. The efficiency of the visual color method may be improved by color education through the development of professional color discrimination ability. This would make the students responsible for color selection, reproduction, and evaluation and lead to increased capability over a layperson observer receiving the restorative treatment. (J Esthet Restor Dent 29:E24-E32, 2017)., (© 2017 Wiley Periodicals, Inc.)

Atmospheric carbon dioxide records indicate that the land surface has acted as a strong global carbon sink over recent decades, with a substantial fraction of this sink probably located in the tropics, particularly in the Amazon. Nevertheless, it is unclear how the terrestrial carbon sink will evolve as climate and atmospheric composition continue to change. Here we analyse the historical evolution of the biomass dynamics of the Amazon rainforest over three decades using a distributed network of 321 plots. While this analysis confirms that Amazon forests have acted as a long-term net biomass sink, we find a long-term decreasing trend of carbon accumulation. Rates of net increase in above-ground biomass declined by one-third during the past decade compared to the 1990s. This is a consequence of growth rate increases levelling off recently, while biomass mortality persistently increased throughout, leading to a shortening of carbon residence times. Potential drivers for the mortality increase include greater climate variability, and feedbacks of faster growth on mortality, resulting in shortened tree longevity. The observed decline of the Amazon sink diverges markedly from the recent increase in terrestrial carbon uptake at the global scale, and is contrary to expectations based on models.

Background: Several studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill patients, but there is no clear evidence to support the superiority of any perioperative transfusion strategy in patients with cancer., Methods: In a randomized, controlled, parallel-group, double-blind (patients and outcome assessors) superiority trial in the intensive care unit of a tertiary oncology hospital, the authors evaluated whether a restrictive strategy of erythrocyte transfusion (transfusion when hemoglobin concentration <7 g/dl) was superior to a liberal one (transfusion when hemoglobin concentration <9 g/dl) for reducing mortality and severe clinical complications among patients having major cancer surgery. All adult patients with cancer having major abdominal surgery who required postoperative intensive care were included and randomly allocated to treatment with the liberal or the restrictive erythrocyte transfusion strategy. The primary outcome was a composite endpoint of mortality and morbidity., Results: A total of 198 patients were included as follows: 101 in the restrictive group and 97 in the liberal group. The primary composite endpoint occurred in 19.6% (95% CI, 12.9 to 28.6%) of patients in the liberal-strategy group and in 35.6% (27.0 to 45.4%) of patients in the restrictive-strategy group (P = 0.012). Compared with the restrictive strategy, the liberal transfusion strategy was associated with an absolute risk reduction for the composite outcome of 16% (3.8 to 28.2%) and a number needed to treat of 6.2 (3.5 to 26.5)., Conclusion: A liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major postoperative complications in patients having major cancer surgery compared with a restrictive strategy.

Bromeliaceae is an important botany family that includes many species with economic value; demand for members of this family is increasing. However, illegal collection frequently occurs, drastically reducing the species populations; thus, it is necessary to collect and store Bromeliaceae genetic material. In this study, we identified and quantified genetic variability of the Bromeliad family using dominant markers to create the first Germplasm Bank in the northeast region of Brazil. Molecular tools were used to characterize the collected accessions. The combination of 11 inter-simple sequence repeats and 13 random amplified polymorphic DNA markers were used to detect the genetic variability of wild bromeliad accessions.

Objective: To assess the visual quality of life in patients with multiple sclerosis (MS), and to observe whether this parameter could be correlated to the findings of the ophthalmologic examination., Method: The translated and validated 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) was used to assess the visual quality of life. Clinical data on MS, visual acuity, visual fields, optic coherence tomography (OCT) and disc cupping were used for assessing correlation with VFQ-25., Results: The mean VFQ-25 value was 78.6 ± 18.2% in 27 patients. VFQ-25 did not correlate with patients' ages, with disability (EDSS), disease duration or medication use. Visual acuity showed a relatively poor (<60%) correlation to VFQ-25, while no correlation could be established between visual fields, OCT and disc cupping with VFQ-25., Conclusion: MS patients present several alterations in their eyes and sight that cannot be assessed by isolated measures. Ophthalmological examination of these patients must include many parameters not usually used in standard ophthalmologic consultations.

Niemann-Pick disease type C (NPC) is an autosomal recessive neurovisceral lysosomal lipid storage disorder that leads to variable symptoms that include cognitive decline, ataxia, dystonia, cataplexy, vertical supranuclear gaze palsy, and seizures. Currently, there is no specific treatment for NPC other than palliative care. Substrate reduction therapy represents a potential strategy for treating this debilitating neurodegenerative disorder. Miglustat (Zavesca) is a reversible inhibitor of the enzyme glucosylceramide synthase, which catalyses the first step in the biosynthesis of most glycosphingolipids. Miglustat has pharmacokinetic properties that allow it to cross the blood-brain barrier, thus making it a potential therapeutic agent for treating neurological symptoms in NPC patients. We present here a case report of a Brazilian child treated with miglustat. Before treatment, the patient presented with difficulties walking and swallowing, slurred speech, moderate cognitive impairments, ataxia, ptosis, and vertical supranuclear ophthalmoplegia. On a disability scale, the patient obtained a score of 15 before treatment and 8 after treatment. Following 12 months of treatment, the patient remained stable with improvements in speech, ptosis, ophthalmoplegia, ataxia, hypotonia and seizures. The Child Behavior Checklist (CBCL) was used to assess psychopathological, behavioural and social problems before and after treatment. The CBCL showed that indices for depression, affective and attention problems were all in the normal range following treatment. Thus, for this individual miglustat was an effective, well-tolerated and efficacious medication for treatment of NPC symptoms. Follow-up maintenance studies are vital to establish whether both the efficacy and safety of miglustat persist with time.

In Brazil since October 1996 there have been guidelines for research involving human subjects. Now human subjects know when their treatment is part of research. Deceit is no longer tolerated. But is not enough to say we offer an explanation to the potential subject and we offer a choice before he or she is confronted with an informed consent form. As in all professional activity, scientific investigation needs social controls. In Brazil, the ultimate responsibility of an investigation lies on the investigator, but in every institution where research is carried out there is a Committee for Ethics in Research. All Committees are subordinated to the National Commission of Ethics in Research, which is submitted to the Brazilian Institute of Health. During 2005 around 17,000 protocols involving 700,000 human subjects were revised by 475 Committees distributed all over the country. Approximately 7,000 people are now working in these Committees.

Objective: Detection of the eight most common respiratory viruses: human respiratory syncytial virus (HRSV), influenza virus A and B (IA and IB), parainfluenza viruses 1, 2 and 3 (HPIV1, 2 and 3), adenovirus (Ad) and human metapneumovirus (HMPV), in order to establish the etiology of acute respiratory infections (ARIs) and the epidemiology of these viruses in young children seen at Hospital Universitário, Universidade de São Paulo, in São Paulo, Brazil, during 2003., Methods: The epidemiological surveillance was conducted in all children younger than 5 years hospitalized at the Hospital for lower respiratory tract infections (LRTI) from January 1, 2003 to December 30, 2003. Nasal and throat samples were scanned for respiratory viruses by polymerase chain reaction and detected by the GeneScan assay., Results: Of 336 samples collected from 336 patients, 187 (55.6%) were positive for at least one of the respiratory viruses studied. Of all the children, HRSV was identified in 24.1%, HMPV in 17.8%, HPIV3 in 8.3%, Ad in 6.8%, IA in 5%, HPIV1 in 0.6%, but no virus could be detected in 44.1%. Dual virus infections were detected in 7.1% of all samples (12.8% of positive samples). HPIV2 and IB were not detected in the present study., Conclusions: This study confirms that children younger than 5 years and particularly younger than 1 year have a high hospitalization rate due to HRSV, HMPV, HPIV, influenza and adenovirus. We were able to determine the etiology and epidemiology of most ARIs and trace the seasonal profile of the commonest respiratory viruses among young children.

Summary. Background. This report describes the case of a patient with focal epithelial hyperplasia (FEH), a rare but distinctive entity of viral aetiology with characteristic clinical and histopathological features. Case report. The condition is usually seen in children and adolescents of American Indian and Eskimo background. Surgical removal of papillomatous lesions is the treatment of choice, either for aesthetic reasons, or when the lesions interfere with function or are readily traumatized. Recurrence and the site of new lesions are unpredictable, and continued review of the patient is often necessary. The patient described here has been followed for 24 months without recurrences or changes in the aspect of the remaining lesions. Conclusion. This case highlights a possible genetic predilection for FEH, since the patient is a descent of a Brazilian Xavante Indian.

Quantifying age structure and tree growth rate of Amazonian forests is essential for understanding their role in the carbon cycle. Here, we use radiocarbon dating and direct measurement of diameter increment to document unexpectedly slow growth rates for trees from three locations spanning the Brazilian Amazon basin. Central Amazon trees, averaging only approximately 1 mm/year diameter increment, grow half as fast as those from areas with more seasonal rainfall to the east and west. Slow growth rates mean that trees can attain great ages; across our sites we estimate 17-50% of trees with diameter >10 cm have ages exceeding 300 years. Whereas a few emergent trees that make up a large portion of the biomass grow faster, small trees that are more abundant grow slowly and attain ages of hundreds of years. The mean age of carbon in living trees (60-110 years) is within the range of or slightly longer than the mean residence time calculated from C inventory divided by annual C allocation to wood growth (40-100 years). Faster C turnover is observed in stands with overall higher rates of diameter increment and a larger fraction of the biomass in large, fast-growing trees. As a consequence, forests can recover biomass relatively quickly after disturbance, whereas recovering species composition may take many centuries. Carbon cycle models that apply a single turnover time for carbon in forest biomass do not account for variations in life strategy and therefore may overestimate the carbon sequestration potential of Amazon forests.

Living trees constitute one of the major stocks of carbon in tropical forests. A better understanding of variations in the dynamics and structure of tropical forests is necessary for predicting the potential for these ecosystems to lose or store carbon, and for understanding how they recover from disturbance. Amazonian tropical forests occur over a vast area that encompasses differences in topography, climate, and geologic substrate. We observed large differences in forest structure, biomass, and tree growth rates in permanent plots situated in the eastern (near Santarém, Pará), central (near Manaus, Amazonas) and southwestern (near Rio Branco, Acre) Amazon, which differed in dry season length, as well as other factors. Forests at the two sites experiencing longer dry seasons, near Rio Branco and Santarém, had lower stem frequencies (460 and 466 ha(-1) respectively), less biodiversity (Shannon-Wiener diversity index), and smaller aboveground C stocks (140.6 and 122.1 Mg C ha(-1)) than the Manaus site (626 trees ha(-1), 180.1 Mg C ha(-1)), which had less seasonal variation in rainfall. The forests experiencing longer dry seasons also stored a greater proportion of the total biomass in trees with >50 cm diameter (41-45 vs 30% in Manaus). Rates of annual addition of C to living trees calculated from monthly dendrometer band measurements were 1.9 (Manaus), 2.8 (Santarém), and 2.6 (Rio Branco) Mg C ha(-1) year(-1). At all sites, trees in the 10-30 cm diameter class accounted for the highest proportion of annual growth (38, 55 and 56% in Manaus, Rio Branco and Santarém, respectively). Growth showed marked seasonality, with largest stem diameter increment in the wet season and smallest in the dry season, though this may be confounded by seasonal variation in wood water content. Year-to-year variations in C allocated to stem growth ranged from nearly zero in Rio Branco, to 0.8 Mg C ha(-1) year(-1) in Manaus (40% of annual mean) and 0.9 Mg C ha(-1) year(-1) (33% of annual mean) in Santarém, though this variability showed no significant relation with precipitation among years. Initial estimates of the C balance of live wood including recruitment and mortality as well as growth suggests that live wood biomass is at near steady-state in Manaus, but accumulating at about 1.5 Mg C ha(-1) at the other two sites. The causes of C imbalance in living wood pools in Santarém and Rio Branco sites are unknown, but may be related to previous disturbance at these sites. Based on size distribution and growth rate differences in the three sites, we predict that trees in the Manaus forest have greater mean age (approximately 240 years) than those of the other two forests (approximately 140 years).

We have evaluated the cellular and humoral immune response to primary respiratory syncytial virus (RSV) infection in young infants. Serum specimens from 65 patients <=12 months of age (39 males and 26 females, 28 cases <3 months and 37 cases > or = 3 months; median 3 3.9 months) were tested for anti-RSV IgG and IgG subclass antibodies by EIA. Flow cytometry was used to characterize cell surface markers expressed on peripheral blood mononuclear cells (PBMC) from 29 RSV-infected children. There was a low rate of seroconversion in children <3 months of age, whose acute-phase PBMC were mostly T lymphocytes (63.0 +/- 9.0%). In contrast, a higher rate of seroconversion was observed in children >3 months of age, with predominance of B lymphocytes (71.0 +/- 17.7%). Stimulation of PBMC with RSV (2 x 10(5) TCID50) for 48 h did not induce a detectable increase in intracellular cytokines and only a few showed a detectable increase in RSV-specific secreted cytokines. These data suggest that age is an important factor affecting the infants' ability to develop an immune response to RSV.

Introduction: Tetanus is still a significant health hazard in developing countries, with high associated mortality., Objective: Describe the management of patients with severe tetanus in intensive care units (ICUs), in two different periods., Setting: ICUs of two general hospitals., Design: Concurrent cohort study., Methods: Follow-up of all patients hospitalized with the diagnosis of severe tetanus in the ICUs from October 1981 to March 2001. We collected data prospectively, regarding the site of injury, clinical features, frequent clinical and infectious complications, concomitant illnesses, and mortality. The patients were divided into two groups according to the treatment protocol used; before 1993 and after 1993., Results: There were 126 patients in group 1 (93 males) with a mean age of 39.0 +/- 18.8 years. There were 110 patients in group 2 (95 males) with a mean age of 48.4+/-17.8 years. Incubation period, onset period, and symptomatic period were higher in group 2 ( P < or = 0.02). The duration of neuromuscular junction blockade, benzodiazepine administration, mechanical ventilation, and ICU stay were longer in group 2, P < 0.001. Infectious complications were more frequent in group 2 ( P < 0.001). The mortality rate in group 1 was 36.5% and in group 2, 18.0% ( P = 0.002). Mortality was directly associated with symptomatic period, acute renal failure cardiac arrest and hypotension, and inversely associated with onset period in the multivariate analyses., Conclusions: The reduced mortality in severe accidental tetanus patients in group 2 is probably related to advances in ICU management, despite the higher incidence of infectious complications, which are probably related to the longer ICU stay.

The respiratory viruses are recognized as the most frequent lower respiratory tract pathogens for infants and young children in developed countries but less is known for developing populations. The authors conducted a prospective study to evaluate the occurrence, clinical patterns, and seasonal trends of viral infections among hospitalized children with lower respiratory tract disease (Group A). The presence of respiratory viruses in children's nasopharyngeal was assessed at admission in a pediatric ward. Cell cultures and immunofluorescence assays were used for viral identification. Complementary tests included blood and pleural cultures conducted for bacterial investigation. Clinical data and radiological exams were recorded at admission and throughout the hospitalization period. To better evaluate the results, a non- respiratory group of patients (Group B) was also constituted for comparison. Starting in February 1995, during a period of 18 months, 414 children were included- 239 in Group A and 175 in Group B. In Group A, 111 children (46.4%) had 114 viruses detected while only 5 children (2.9%) presented viruses in Group B. Respiratory Syncytial Virus was detected in 100 children from Group A (41.8%), Adenovirus in 11 (4.6%), Influenza A virus in 2 (0.8%), and Parainfluenza virus in one child (0.4%). In Group A, aerobic bacteria were found in 14 cases (5.8%). Respiratory Syncytial Virus was associated to other viruses and/or bacteria in six cases. There were two seasonal trends for Respiratory Syncytial Virus cases, which peaked in May and June. All children affected by the virus were younger than 3 years of age, mostly less than one year old. Episodic diffuse bronchial commitment and/or focal alveolar condensation were the clinical patterns more often associated to Respiratory Syncytial Virus cases. All children from Group A survived. In conclusion, it was observed that Respiratory Syncytial Virus was the most frequent pathogen found in hospitalized children admitted for severe respiratory diseases. Affected children were predominantly infants and boys presenting bronchiolitis and focal pneumonias. Similarly to what occurs in other subtropical regions, the virus outbreaks peak in the fall and their occurrence extends to the winter, which parallels an increase in hospital admissions due to respiratory diseases.

Incidence of Vibrio cholerae O1 was studied in 2,585 samples from different aquatic environments and 91 from foods in Pernambuco State, northeastern Brazil, from 1992 to 1994. A total of 193 (7.21%) samples of V. cholerae were isolated with a higher prevalence of the Inaba serovar (183-94.8%) than the Ogawa serotype (10-5.1%). All isolates were classified as biotype El Tor, and resistance patterns to antibiotics showed that all strains were susceptible tetracycline. Some 70 random samples of Vibrio cholerae proved toxigenic, including all the Ogawa serovars. Incidence of V. cholerae O1 in river water and sewage (86.0%) pointed to fecal contamination as the most common source and vehicle for rapid spread of the microorganism in the aquatic environment. The vibrio was isolated in 2.1% of all food examined, which was less than expected.

The authors studied the prevalence of dental caries in white and black schoolchildren of Piracicaba, State of São Paulo, Brazil. The Student t-test, applied to the coefficient of prevalence of caries, revealed means significantly greater at the 5% level in whites than in blacks in the following groups: 7 years, both sexes; 8 years, both sexes; 9 years, males; 10 years, both sexes; 11 years, males.