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Inadequate relationships between humans and animals harm animal welfare, productivity and food quality. Thus, this research aimed to evaluate, in a general way, the understanding of animal welfare according to the perception of family farmers immersed in the milk production chain in the municipality of Unaí, MG. For this, 50 interviews were carried out using a structured form and later the data obtained were organized in a spreadsheet using the Microsoft Excel program, for descriptive statistical analysis of the results. A cluster analysis was performed using the hierarchical method, using the Ward model. Based on the results analyzed in this research, it can be affirmed, in general, that the family farmers who produce milk in the Unaí region have, for the most part, basic notions about animal welfare and the benefits it provides in the milk production chain. However, it is still not noticeable for most, as there are contradictory reports and different understandings among those surveyed. Thus, it is important that these producers have access to technical assistance on animal welfare, which provides a significant improvement in milk production in the region. [ABSTRACT FROM AUTHOR]

Background: Type 1 Neurofibromatosis (NF1) is an autosomal dominant genetic disease that affects one in each 2500 individuals and results in important cognitive impairment, such as learning disorders and auditory processing disorders. In a previous study, we found that 70% of NF1 patients presented some deficit in music perception (amusia), mainly rhythmic and associated to pre-attentional electrophysiological deficits detected with Mismatch Negativity (MMN). Objectives: In the present study, we investigated how musical training may change music perception and MMN. Material and methods: Six teenagers diagnosed with NF1 aged between 12 and 16 years, 4 females and 2 males, with normal audiometric thresholds, were studied. A six-month program of musical training was proposed, directed to rhythmic learning. Assessment battery before and after training included Montreal Battery of Evaluation of Amusia (MBEA) -- short version to evaluate music processing; Gaps in Noise test to evaluate temporal auditory processing; and MMN to investigate pre attentional auditory perception. Results: All participants showed improvement in temporal auditory processing, with a reduction in mean values of gap thresholds from 10.25 to 5.41 (95% CI=1.77--7.89; p=0.006). From the six teenagers studied, only three presented detectable MMN in the pre-training evaluation. After training, all participants had detectable MMN (95% CI=0.02--0.10; p=0.049). An improvement was also observed in the mean global and specific music perception to melodic, rhythmic and musical memory, though statistically significant to the latest component (95% CI=1.62--0.04; p=0.042). Conclusions: Results obtained corroborate our hypothesis that rhythmic music training may result in improvement of temporal auditory processing, and this may be present also in the pre attentional level of auditory perception. This is a pilot study still in course. [ABSTRACT FROM AUTHOR]

This study investigated the ability of cholesterol-phosphatidylcholine liposomes loaded with chloride aluminum phthalocyanine (CL-AlClPc) to discriminate between healthy (MCF-10A) and neoplastic (MCF-7 and MDA-MB-231) breast cells for breast cancer diagnosis and treatment by photodynamic therapy (PDT) using a new drug delivery system consisting of CL-AlClPc. When PDT treatment was applied at an energy fluence of 700 mJ/cm², CL-AlClPc was more cytotoxic to neoplastic cells than to healthy breast cells because CL-AlClPc was better internalized by the tumor cells. An even higher fluorescence signal is expected for neoplastic cells during clinical treatment than for healthy cells, which will be useful for precise and targeted tumor cell detection. CL-AlClPc also facilitated better drug distribution and targeting of essential organelles inside the cells. This selectivity is critical for future in vivo diagnosis and treatment; it prevents side effects because it prioritizes tumor cells and tissues instead of healthy ones. The CL-AlClPc system designed herein had a small size (150 nm), low zeta potential (-6 mV), low polydispersity (0.16), high encapsulation rate efficiency (82.83%), and high shelf stability (12 months)., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: While pedicled intranasal flaps, such as the nasoseptal flap (NSF), successfully reduce postoperative CSF leaks following endoscopic endonasal approaches (EEA) to the skull base, morbidity remains prevalent. This study describes the first cadaveric description and radiographic analysis of the posterior septal nasal floor mucosal flap (PSNF) designed to reduce pedicled nasal flap morbidity. A case series is also detailed., Study Design: Cadaveric dissection, radiographic analysis, and case series., Methods: Seven cadaver specimens underwent harvest of the PSNF. PSNF flap dimensions were measured on the thirty deidentified sinus computed tomography (CT) scans. A retrospective case series was performed on the first set of patients who received the PSNF for reconstruction of a sellar base defect. Information concerning complications, symptoms, and the appearance of the flap was recorded from records of the patient's postoperative inpatient stay, 1-week postop visit, and 1-month postop visit., Results: Cadaver dissection of the PSNF flap demonstrated good arc rotation along its pedicle with ability to cover both sellar and planum defects. Cadaveric flap measurements and CT-derived measurements estimated a mean surface area of 16.7 and 18.3 cm 2 , respectively. 15 patients underwent reconstruction of a sellar or planum defect using the PSNF technique. Only one CSF leak was encountered postoperatively. Minimal crusting of the flap and donor site was seen 1 month postoperatively., Conclusion: The PSNF flap provides a sizeable pedicled region for reconstruction comparable to other pedicled nasal flaps. Our case series demonstrated good postoperative outcomes without reduced donor site morbidity., Level of Evidence: 4 Laryngoscope, 132:1561-1568, 2022., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: The purpose of this study was to describe a detailed investigation of craniofacial and dental characteristics in a group of Brazilian Rubinstein-Taybi syndrome (RSTS) patients., Methods and Results: Thirteen RSTS patients treated in a special care dental clinic after 10 years were studied. Panoramic radiographs were obtained from all patients, and cephalometric analysis was performed in eight patients. Five male and eight white female patients with a median age of 11.7 years were analyzed. All the RSTS patients were mouth breathers and presented malocclusion, transverse hypoplastic maxilla, nine subjects (9/13; 69.2%) had posterior crossbite, and eight (61.53%) exhibited talon cusps. Most patients presented class II skeletal pattern and were brachycephalic. Regarding systemic disorders, one patient (7.69%) reported seizure episodes during childhood, and four patients (30.76%) presented heart valve disorders. All patients presented reduced attention span, low intolerance to dental interventions, impulsiveness, and irritability., Conclusions: Since RSTS exhibits oral and skeletal changes, early dental treatment is essential for these patients. Dentists must be aware of medical problems related to heart disease and persist in conditioning techniques to obtain cooperation and avoid dental care under general anesthesia., (© 2021 Special Care Dentistry Association and Wiley Periodicals LLC.)

Photobiomodulation (PBM) is a promising medical treatment modality in the area of photodynamic therapy (PDT). In this study, we investigated the effect of combined therapy in a 3D microenvironment using aluminum chloride phthalocyanines (AlClPc) as the photosensitizing agent. Normal human fibroblast-containing collagen biomatrix was prepared and treated with an oil-in-water (o/a) AlClPc-loaded nanoemulsion (from 0.5 to 3.0 μM) and irradiated at a range of fluences (from 0.1 to 3.0 J/cm 2 ) using a continuous-wave light-emitting diode (LED) irradiation system (660 nm). PBM at 1.2 J/cm 2 and AlClPc/NE at 0.5 μM modified the fibroblast signaling response under 3D conditions, promoting collagen synthesis, ROS production, MMP-9 secretion, proliferation of the actin network, and facile myofibroblastic differentiation. PBM alone (at 1.2 J/cm 2 and 0.3 J/cm 2 ) had no significant effect on any of these parameters. The combined therapy affected myofibroblastic differentiation, inflammatory response, and extracellular matrix pliability, and should thus be examined further in subsequent studies considering that no side effects of PBM have been reported. Even though significant progress has been made in the field of phototherapy in recent years, it is necessary to further elucidate the detailed mechanisms underlying its effects already shown in 2D conditions to increase the acceptance of this beneficial and non-invasive therapeutic approach., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The widely accepted resazurin-based assay can be used, prior to in vivo studies, as an inexpensive method to determine cytotoxicity. The aim of this study was to evaluate and standardize the assay conditions for oral squamous cancer cell (OSCC) and glioblastoma (U87-MG) lines by UV-vis spectroscopy. The cells were treated with 25 μgmL -1 of resazurin sodium salt and then incubated for 4 h, 6 h, and 6.5 h. All absorbance measurements were carried out at 21 ± 1 °C on a spectrophotometer with a microplate reader. After 4-hs of incubation, resazurin was completely reduced by OSCC cells, as demonstrated by the suppression of the absorbance at 380 nm. However, the U87-MG cells needed 6.5 h of incubation to demonstrate the same behavior. The Statistical analysis did not indicate significant differences between the OSCC and U87-MG cell lines' viability after 4 and 6.5 h respectively. We concluded that spectroscopic analysis is an efficient method for the standardization of the resazurin assay. In addition, without the implementation of suitable protocols, there could be an increase in the chance of errors or false positives or negatives that would reduce the usefulness of the data., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Bone marrow mesenchymal stem cells (BM-MSCs) are undifferentiated cells that can proliferate and differentiate into specialized cells for tissue self-repair. Low-level laser (LLL) can induce biomodulatory effects such as cellular proliferation, differentiation, and migration. We investigated the biomodulatory effects of the photoactive compound chloroaluminum phthalocyanine nanoemulsion (AlClPc/NE) on the adipogenic differentiation of BM-MSCs, when combined with LLL (AlClPc/NE-LLL)., Methods: The BM-MSCs used in this work were isolated from green fluorescent protein-positive (GFP + ) C57BL6 mice. Cells were first treated with AlClPc/NE, a well-designed photoactive nano-drug and were then subjected to in vitro expansion, morphological and immunophenotypic characterization, and cellular cytotoxicity analysis. Subsequently, BM-MSCs were induced to differentiate into adipocytes by photo-induced biomodulation with AlClPc/NE-LLL., Results: Our results showed that the isolated cell population was consistent with murine BM-MSCs. The cellular cytotoxicity analysis revealed that the optimal nanoemulsion dose to induce BM-MSC biomodulation was 5.0 μmol/L. Twenty-four hours following treatment with AlClPc/NE, BM-MSC were subjected to visible light irradiation of 20 mJ/cm 2 at 670 nm. Six days after photo-induced biomodulation, cells maintained high GFP expression level, and expressed detectable mRNA levels of adipogenic genes (lipoprotein lipase and PPARγ); formation of lipid vacuoles was observed, and the cells did not show any tumorigenic potential in vivo., Conclusions: Our results indicated that photo-induced biomodulation via visible light using AlClPc/NE and LLL can induce adipogenic differentiation of murine BM-MSCs. Therefore, cell therapy with BM-MSCs and photo-induced biomodulation may contribute to the development of new therapeutic strategies that are faster and more effective than traditional methods to trigger MSC differentiation., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: Chitosan nanoparticles (ChNPs) have antifungal effects, however there is a lack of information about the effects of ChNPs against Candida biofilm on denture base surface. This study investigated the ChNPs effect against C. albicans biofilm adhesion and formation, and against Candida spp. biofilm on heat-cured acrylic resin., Design: The ChNPs were synthetized (3800 μg/mL) and characterized by infra-red spectrophotometry and transmission electron microscopy. The minimum inhibitory/fungicidal concentrations (MIC/MFC) against Candida spp. were determined. The time-kill assay and changes on C. albicans micromorphology were evaluated. The % inhibition of ChNPs on C. albicans biofilm formation and reduction were investigated using 1 min and 8 h exposure. Candida biofilm was developed on resin surfaces and ChNPs were applied every 8 h for 5 days. After, fungal cells were counted (CFU/mL) and the surface roughness (Ra) and vickers microhardness (HV) of resin were analysed. For all experiments, sodium hypochlorite (NaOCl) was used as control. Data were analyzed by ANOVA, Tukey and paired t-tests (α = 0.05)., Results: The MIC 80% of ChNPs was 30.1 μg/mL. ChNPs at 4 MIC showed complete inhibition in the time-kill assays. Blastoconidia cells were predominant after ChNPs application. The % inhibition ChNPs on C. albicans was proportional to its concentration, regardless of the exposure time. ChNPs decreased the CFU/mL of Candida spp. and showed lower alteration of HV and Ra values of resin surface compared to NaOCl., Conclusions: The ChNPs inhibited C. albicans biofilm, reduced Candida biofilm on resin and caused small changes in roughness and hardness of acrylic resin surface., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

DNA polymeric films (DNA-PFs) are a promising drug delivery system (DDS) in modern medicine. In this study, we evaluated the growth behavior of oral squamous cell carcinoma (OSCC) cells on DNA-PFs. The morphological, biochemical, and cytometric features of OSCC cell adhesion on DNA-PFs were also assessed. An initial, temporary alteration in cell morphology was observed at early time points owing to the inhibition of cell attachment to the film, which then returned to a normal morphological state at later time points. MTT and resazurin assays showed a moderate reduction in cell viability related to increased DNA concentration in the DNA-PFs. Flow cytometry studies showed low cytotoxicity of DNA-PFs, with cell viabilities higher than 90% in all the DNA-PFs tested. Flow cytometric cell cycle analysis also showed average cell cycle phase distributions at later time points, indicating that OSCC cell growth is maintained in the presence of DNA-PFs. These results show high biocompatibility of DNA-PFs and suggest their use in designing "dressing material," where the DNA film acts as a support for cell growth, or with incorporation of active or photoactive compounds, which can induce tissue regeneration and are useful to treat many diseases, especially oral cancer., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To evaluate the body composition and nutritional status of neurofibromatosis type 1 (NF1) adult patients., Method: A cross-sectional study of 60 NF1 patients (29 men, 31 women) aged ≥ 18 years who were evaluated from September 2012 to September 2013 in a Neurofibromatosis Outpatient Reference Center. Patients underwent nutritional assessment including measurements of weight, stature, waist circumference (WC), upper-arm circumference (UAC), and skinfolds (biceps, triceps, subscapular, suprailiac). Body mass index (BMI), upper-arm total area (UATA), upper-arm muscle area (UAMA), upper-arm fat area (UAFA), body fat percentage (BFP), fat mass, fat-free mass, fat mass index, and fat-free mass index were also calculated., Results: The mean age of the study population was 34.48±10.33 years. The prevalence of short stature was 28.3%. Low weight was present in 10% of the sample and 31.7% of patients had a BMI ≥ 25 kg/m2. Reduced UAMA (<5th percentile) was present in 43.3% and no difference was found in UAFA between the sexes. The BFP was considered high in 30% and 17 (28.3%) patients had a WC above the World Health Organization cutoffs., Conclusion: In this study, NF1 patients had a high prevalence of underweight, short stature, and reduced UAMA, with no difference between the sexes. Reduced UAMA was more prevalent in underweight patients; however, this was also observed in the normal and overweight patients. Further studies should investigate the distribution of body tissues in NF1 patients, including differences between men and women, and the influence of diet and nutrition on clinical features in NF1.

Objective: This article attests the association between self-rated health and health care utilization in a retired population by a narrative review., Method: A systematic review was carried out from 1967 to 2007 to identify studies on self-rated health, in the databases MEDLINE, LILACS e SCIELO. The OVID software was used to Medline research. Contacts with experts were used. The key words retirement, self-rated health, health care utilization and narrative review were used in Portuguese, Spanish and English versions. Al the abstracts were analyzed, but only trials that associated self-rated health in retirement and health care utilization were fully analyzed., Results: Thirty one out of 443 abstracts were selected to be fully analyzed. Current data indicates that health deterioration, poor self-rated health and increased health care utilization are associated with early retirement, due to disability, but not with individuals who worked until retirement by age., Conclusion: Retirement is probably associated with increased public expenses and increased health care utilization in retired with a poor self-rated health.

Objectives: To measure muscular force in neurofibromatosis type 1 (NF1) patients., Methods: The maximal voluntary muscular force (F(max)) was measured in the first 21 volunteer patients without acute health problems at the routine annual examination in the Neurofibromatosis Outpatient Reference Center during October-November (2007). The NF1 individuals were 9 males and 12 females, aged from 7 to 60 years and physically sedentary. The healthy control group was 21 healthy subjects matched to NF1 group by age, sex and physical activity. A handgrip test instrument was used to measure maximal force. To allow comparisons between physically different patients, forearm circumference (cm) was measured with a tape and forearm cross sectional area was derived to express the force per unit of forearm area. Data were compared using a t Student test (P<0.05)., Results: The mean F(max) of NF1 male (260-/+136 N) and NF1 female (217-/+76 N) were lower than expected for their sex and age. Healthy men showed greater F(area) (9.8-/+3.2 N x cm(-2)) than NF1 men (5.7-/+2.6 N x cm(-2)) and healthy women (6.7-/+1.6 N x cm(-2)) showed greater F(area) than NF1 females (5.7-/+1.9 N x cm(-2))., Conclusion: Maximal voluntary muscle force was reduced in NF1 patients.

Aim: To assess the efficacy of a medicated dressing in the socket on the healing after dental extractions in HIV positive patients., Patients and Methods: Forty HIV positive patients with CD4 counts below 200 cells/mm(3) who were to have molar teeth extracted were randomly allocated to have the socket dressed with a medicated paste (Rifocort) with camphorated parachlorophenol and iodoform) and sutured (treated group), or merely sutured (control group)., Results: The sockets in the treated group healed more quickly than in the control group.

The South American tropical rattlesnake (Crotalus durissus subspp) is responsible for approximately 10% of bites from venomous snakes in Brazil. We studied 24 victims of bites by this species over 3 years, in south-eastern Brazil, particularly investigating haemostatic alterations. Thirteen patients were defined as moderately envenomed and 11 as severe. There were two deaths, which were not attributed to venom-induced haemostatic disturbances. However, envenoming by C. durissus is frequently associated with haemostatic disorders, which are probably attributable mainly to the action of the thrombin-like enzyme, with possible additional effects secondary to the powerful myotoxic activity of the venom.

This study was carried out to evaluate changes in infection rates following the adoption of three measures for controlling a Staphylococcus aureus outbreak in a nursery. In late April and early May, 1995, an outbreak of pustular dermatitis and conjunctivitis caused by S. aureus was documented. Case patients were identified by both in-hospital and post-discharge surveillance. In-hospital surveillance included daily review of data gathered by the hospital's infection control committee; use of microbiology laboratory results; requesting charts for antibiotic prescriptions; nurses' notes, and ward rounds surveillance as indicators of S. aureus infection (SAi). Post-discharge surveillance was done by telephone survey around the 30th day after a baby's birth date. During the epidemic period, reinforcement of handwashing, daily bathing, and cord care with antiseptics combined with a cohort system of admissions, and nasal mupirocin ointment were introduced sequentially in an attempt to control the outbreak. The efficacy of these three strategies was measured through the decrease of SAi rates, detected by both in-hospital and post-discharge surveillance. A total of 5,639 babies were included in the study. In-hospital surveillance information was obtained from all patients and post-discharge surveillance in 3,506 (62.7%) patients. A total of 534 SAi were detected during the study, 47 in-hospital and 487 at post-discharge surveillance. A progressive decrease in the SAi rates could be observed after the institution of the control strategies, both in-hospital (7.6% to 0.5%) and after discharge (68.9%. to 11.7%). During the study period, the rates of infection detected in out-patients were consistently higher than those diagnosed in-hospital. Improving handwashing and nasal mupirocin ointment seem to be more effective than cohort admissions and bath and cord care with antiseptics. The high SAi rates detected only after discharge from the hospital indicate that data from post-discharge surveillance should be included to estimate the true rates of infections in newborns.

The use of saliva samples to detect the anti-HIV antibody has been described recently as an interesting alternative in relation to blood samples. We have analyzed 172 saliva samples from HIV positive and negative patients assisted at CASP, 108 of them adults and 64 children, in order to assess the specificity and sensitivity of the GACELISA test. A specificity was found of 85% and 80% respectively for the adult and children groups and sensitivity of 97.7% and 100% respectively for the adult and children groups. The statistical analysis revealed no differences in specificity and in sensitivity between these groups. We concluded that GACELISA test is useful for children.

Seventeen patients stung by Tityus serrulatus scorpion were classified as mild (pain at the site of the sting, n = 6), moderate (local pain and one of the following manifestations: vomiting, psychomotor agitation, prostration, sweating, tachypnea, tachycardia and mild arterial hypertension, n = 10) and severe cases (equal moderate cases plus cardiac failure, pulmonary edema and shock, n = 1). Venous blood was sampled for biochemical and hematological analysis and for IL-1alpha, IL-6, IL-10, TNF-alpha, IFN-gamma and GM-CSF ELISAs at the time of hospital admission, 6 h (moderate and severe cases), and 12, 18, 36 and 72 h (severe case) later. Ten age-matched healthy volunteers were used as control. Increased serum levels of IL-1alpha was noticed in all patients, high levels of IL-6, IFN-gamma and GM-CSF were observed only in a patient with severe envenomation. Our data suggest that a systemic inflammatory response-like syndrome is triggered during severe envenomation caused by T. serrulatus sting and that release of cytokines may be involved in this response.

A South American rattlesnake bite without clinical manifestations of envenoming (termed 'dry-bite') has not been recognized to occur by the Brazilian Ministry of Health, which recommends the administration of antivenom to all bitten patients. During 36 months of an observational study on South American rattlesnake bites in Minas Gerais, Brazil, 12% of 41 patients with fang marks at the bite-site did not present clinical or laboratory features of envenoming and had no plasma venom detected before specific serotherapy, fulfilling the criteria for the diagnosis of true 'dry-bite'. Data from these preliminary observations suggest that these patients should be correctly diagnosed since they should not be treated with unnecessary and sometimes hazardous and expensive serotherapy.

Using the ELISA we have shown that in rats subcutaneously injected with Tityus serrulatus scorpion venom there is a fast absorption rate, a fast and high distribution of venom to tissues, a great affinity of the venom for the tissues and a slow elimination half-life. Because of these experimental data, i.v. immunotherapy should be given to patients stung by scorpions as soon as possible after hospital admission. The severity of scorpion envenoming is related to plasma venom concentration (ELISA). The high levels of plasma scorpion venom antigens (ELISA) were cleared 1 h after the infusion of antivenom (5-30 ml of Fab2 fragment) and high concentrations of circulating antivenom persisted for at least 24 h, confirming the efficacy of immunotherapy to neutralise circulating venom. Some symptoms (e.g. local pain and vomiting) decreased 1 h after the starting of immunotherapy, whereas the other symptoms disappeared from 12-48 h later. Using our tripartite approach of treating scorpion envenoming (symptomatic measures, support of vital functions and serotherapy), the mortality rate was very low (0.28%).

Clinical and laboratory data from patients who applied a tourniquet (tourniquet group, n = 45) and who did not apply it (non-tourniquet group, n = 52) after being bitten by Crotalus durissus were compared. The patients were treated with 100-200 ml of Crotalus durissus antivenom. The gender, age, time elapsed between bite and hospital admission, dose of antivenom and the frequency of local paresthesia, myalgia and palpebral ptosis did not differ between the two groups. Plasma creatine kinase enzyme activity and partial thromboplastin time, plasma whole venom and crotoxin concentrations and the frequency of acute renal and respiratory failure and number of deaths also did not differ between both groups. Data from this study show the ineffectiveness of tourniquet applied by patients in the fields to reduce the severity of Crotalus durissus envenoming.

Thirty-seven patients envenomed by Crotalus durissus were classified into three groups according to the interval between the bite and hospital admission (delta T): group 1 (n = 14, delta T < 4 hr), group 2 (n = 14, delta T > 4 hr < 8 hr) and group 3 (n = 9, delta T > 8 hr). Venous blood from these patients was sampled for biochemical and hematological analysis and for whole venom, crotoxin and antivenom enzyme-linked immunosorbent assays before antivenom treatment (T0) and at 1 hr (T1), 6 hr (T6), 12 hr (T12) and 24 hr (T24) after the start of antivenom therapy. The patients were treated with 100-200 ml (10-20 ampules) of C. durissus antivenom. Whole venom and crotoxin were detected in 13 (92.8%) and 11 (78.6%) of 14 group 1 patients, respectively, in 11 (78.6%) and six (42.9%) of 14 group 2 patients, respectively, and in two (22.2%) and one (11.1%) of nine group 3 patients, respectively, before antivenom treatment. Data from this study show that whole venom and crotoxin were not detected in most of patients when the time elapsed between the bite and hospital admission was greater than 8 hr, and crotoxin was not detected in most of the patients who were admitted to the hospital at times ranging from 4 to 8 hr after the snakebite. Plasma whole venom, crotoxin and antivenom levels measured over time in these patients show the efficacy of antivenom treatment, since circulating venom and crotoxin were no longer detected 1 hr after antivenom therapy and high antivenom titers persisted for at least 24 hr after serotherapy.

Objective: To determine the frequency of asymptomatic perianal shedding of herpes simplex virus (HSV) in adult patients with acquired immunodeficiency syndrome (AIDS)., Design: Cross-sectional study., Setting: A 1000-bed, state-supported hospital in Brazil that provides comprehensive health care., Patients: Eighty-two consecutively hospitalized patients with AIDS (Centers for Disease Control and Prevention class C)., Main Outcome Measurement: Specimens for HSV culture were obtained with premoistened swabs of the perianal region at approximately 7-day intervals during the hospitalization of each patient. After the specimens were inoculated into cultures of human foreskin and Vero cells, supernatants of cultures showing the cytopathic effect characteristic of HSV infection were tested for virus in a confirmatory immunoenzymatic assay. Typing of HSV was performed by polymerase chain reaction amplification of HSV-1- and HSV-2-specific DNA polymerase sequences., Results: On early into the study, 12 (15%) of 82 patients had perianal ulceration and 70 did not. None of the patients in the latter group developed perianal ulcers during the study period, but HSV was isolated at least once from 17 (24%) of them. Nine of the 17 asymptomatic perianal shedders had a mean of 3 perianal swabs collected before the first HSV isolation, and 11 (65%) of 17 had a total of 18 perianal swabs collected 8 to 62 days after the HSV isolation. All postpositive samples were negative for HSV except 1 obtained from a patient 13 days after the first positive sample. Twelve of the 17 asymptomatic perianal shedders of HSV were followed up clinically for 8 to 62 days after the first episode of shedding and none developed perianal ulceration., Conclusions: We conclude that asymptomatic perianal shedding of HSV is common in patients with AIDS, even among those without a history of perianal HSV lesions. This shedding appears to be short-lived, intermittent, and not associated with early subsequent development of perianal ulcers. These findings present a new perspective on the natural course of perianal HSV infection in patients with AIDS.

Enzyme-linked immunosorbent assays (ELISAs) were developed to detect specific antigens from Bothrops sp. and Crotalus durissus snake venoms in Brazil. Cross-reactive immunoglobulins from hyperimmune horse anti-Bothrops and anti-Crotalus sera were removed by immunoaffinity chromatography. Specific IgGs for Bothrops sp. and C. durissus venom antigens were prepared and used to set up a sandwich-type ELISA. The specificity of the assay was demonstrated by its capacity to identify correctly the circulating antigens in mice experimentally inoculated with both venoms. Measurable absorbance signals were obtained with 5 ng of venom per assay. The ELISA was also used to identify circulating antigens in the sera of humans bitten by Bothrops sp. and C. durissus. These ELISAs could be valuable for clinicians and epidemiologists if they prove to have both the high sensitivity and specificity required for such tests.

Plasma venom concentrations were measured by enzyme-linked immunosorbent assay at the time of hospital admission in 56 patients stung by the scorpion Tityus serrulatus. According to clinical and laboratory manifestations patients were classified into two groups: patients with only local pain at the site of the sting (n = 37), and patients with systemic manifestations of envenoming (n = 19). Circulating venom concentrations of these two groups of patients were cross-tabulated and the results showed that patients with systemic manifestations of envenoming had significantly higher plasma venom concentrations than patients with only local pain at the site of the sting.

Enzyme-linked immunosorbent assays for detection of Tityus serrulatus venom antigen and of horse anti-T. serrulatus venom antibodies were carried out before antivenom treatment and at 1, 6, 12, and 24 hr after antivenom therapy in 18 patients with systemic manifestations following T. serrulatus scorpion sting. Increased levels of circulating venom antigens were detected in the patients before antivenom treatment, but were no longer detected 1 hr after specific antivenom therapy. High titers of antivenom persisted for at least 24 hr after treatment with antivenom. The evolution of clinical and laboratory manifestations of envenoming showed that vomiting and local pain decreased within 1 hr and hyperglycemia was no longer detected 12 hr after antivenom therapy. The cardiorespiratory manifestations disappeared 6-24 hr after the administration of antivenom and all patients recovered completely. This study demonstrates the efficacy of antivenom therapy in neutralizing circulating venom antigens and supports the prompt administration of a potent antivenom to patients with systemic manifestations of envenoming.

The sensitivity and specificity of an enzyme-linked immunosorbent assay (ELISA) for the detection of circulating antigens from toxic components of Tityus serrulatus scorpion venom was determined in patients stung by T. serrulatus before antivenom administration. Thirty-seven patients were classified as mild cases and 19 as moderate or severe cases. The control absorbance in the venom assay was provided by serum samples from 100 individuals of same socioeconomic group and geographical area who had never been stung by scorpions or treated with horse antisera. The negative cutoff value (mean + 2 SD) corresponded to a venom concentration of 4.8 ng/ml. Three out of the 100 normal sera were positive, resulting in a specificity of 97%. The sensitivity of the ELISA when all cases of scorpion sting were included was 39.3%. When mild cases were excluded, the sensitivity increased to 94.7%. This study showed that this ELISA can be used for the detection of circulating venom toxic antigens in patients with systemic manifestations following. T. serrulatus sting but cannot be used for clinical studies in mild cases of envenoming since the test does not discriminate mild cases from control patients.

A 16-year-old boy died with acute pulmonary oedema and shock after Tityus serrulatus scorpion sting. The patient showed evidence of cardiac dysfunction and damage, an increase in tracheobronchial aspirate/plasma protein concentration, light microscopic features of the lung compatible with the adult respiratory distress syndrome and electron microscopic findings compatible with acute lung injury and increased alveolocapillary membrane permeability.