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Background: Corynebacterium pseudotuberculosis is the etiologic agent of caseous lymphadenitis (CL), a chronic disease that affects goats and sheep. CL is characterized by the formation of granulomas in lymph nodes and other organs, such as the lungs and liver. Current knowledge of CL pathogenesis indicates that the induction of humoral and cellular immune responses are fundamental to disease control. The aim of this study was to evaluate the humoral and cellular immune responses in BALB/c mice inoculated with a C. pseudotuberculosis strain isolated in the state of Bahia, Brazil., Results: The lymphocyte proliferation and in vitro production of IFN-γ, IL-4, IL-10, IL-12 and nitric oxide by spleen cells stimulated with secreted and somatic antigens from the studied strain were evaluated. IgG subclasses were also analyzed. Results showed a significant increase of Th1-profile cytokines after 60 days post-inoculation, as well as an important humoral response, represented by high levels of IgG2a and IgG1 against C. pseudotuberculosis., Conclusion: The T1 strain of C. pseudotuberculosis was shown to induce humoral and cellular immune responses in BALB/c mice, but, even at a dosage of 1x10(7) CFU, no signs of the disease were observed.

A 60-year Brazilian woman, presented with an enlarged lymph node in the neck for one year, and a superficial nonulcerated lesion was observed in the scalp. Fine needle aspiration and biopsy of the lymph node revealed amelanocytic metastasis, and immunohistochemistry study showed Melan-A/ Mart-1 antigen (clone A103 and S-100 protein). The entire suspected area of the scalp was further resected and an amelanotic melanoma without angiolymphatic invasion was diagnosed. Ultrasonography and PET-computed tomography showed hypermetabolic cystic area in the right parotid. Furthermore, aspiration biopsy and surgical samples from parotid cyst confirmed the malignant amelanotic melanoma. Cystic metastases are scarcely reported in parotid gland, and can pose diagnostic challenges.

Methylene blue (MB) has been widely applied in the clinical area and is currently being used in aquaculture as biocide. Some recent studies have emphasized the importance of understanding the action mechanism and the MB cellular targets. In this sense, zebrafish is considered a relevant model to study the intrinsic pathway of apoptosis as well as the cellular responses involving DNA damage and repair. So, the aim of the present study was to compare MB action mechanisms in a zebrafish cell line, both in the absence (MB alone; dark toxicity) and in the presence of photosynthetically active radiation (MB+PAR; phototoxicity). There was a significant increase of the levels of reactive oxygen and nitrogen species 3 h after MB treatment, whereas this increase was only observed 12 h after treatment with MB+PAR. All treatments with MB resulted in an increase in DNA damage after 3 and 6 h. However, cell death by apoptosis was observed from 6 h after treatment with MB+PAR and 12 h after treatment with MB alone. The expression of genes related to apoptosis was altered after MB and MB+PAR treatment. Therefore, this zebrafish cell line is sensitive to the photodynamic action of MB; MB is able to generate DNA damage and induce apoptosis in this cell line both alone and in the presence of PAR. However, the pathways leading to apoptosis in this model appear to be dependent on the type of MB exposure (in the presence or absence of PAR)., (© 2016 International Federation for Cell Biology.)

This original study describes the intra-urban distribution of cases of leprosy in residents under 15 years old in Salvador, Bahia, Brazil; the study also identifies the environment in which Mycobacterium leprae is being transmitted. The cases were distributed by operational classification, clinical forms, type of contact and the addresses were geo-referenced by neighborhood. Between 2007 and 2011, were reported 145 cases of leprosy in target population living in Salvador, corresponding to detection rates of 6.21, 6.14, 5.58, 5.41 and 6.88/100,000 inhabitants, respectively. The spatial distribution of the disease was focal. Of the 157 neighborhoods of Salvador, 44 (28.6%) notified cases of leprosy and in 22 (50%) of these were detected more than 10 cases per 100,000 inhabitants. The infectious forms were found in 40% of cases. Over 90% of cases had been living in Salvador for more than five years. Overall, 52.6% reported having had contact with another infected individual inside the household and 25% in their social circle. In Salvador, M. leprae transmission is established. The situation is a major concern, since transmission is intense at an early age, indicating that this endemic disease is expanding and contacts extend beyond individual households.

We describe the epidemic of microcephaly in Brazil, its detection and attempts to control it, the suspected causal link with Zika virus infection during pregnancy, and possible scenarios for the future. In October 2015, in Pernambuco, Brazil, an increase in the number of newborns with microcephaly was reported. Mothers of the affected newborns reported rashes during pregnancy and no exposure to other potentially teratogenic agents. Women delivering in October would have been in the first trimester of pregnancy during the peak of a Zika epidemic in March. By the end of 2015, 4180 cases of suspected microcephaly had been reported. Zika spread to other American countries and, in February 2016, the World Health Organization declared the Zika epidemic a public health emergency of international concern. This unprecedented situation underscores the urgent need to establish the evidence of congenital infection risk by gestational week and accrue knowledge. There is an urgent call for a Zika vaccine, better diagnostic tests, effective treatment, and improved mosquito-control methods.

Objectives: To describe salient epidemiological characteristics of Zika virus outbreaks across the world and to examine the clinical presentations, complications, and atypical manifestations related to their occurrence in recent history., Methods: We conducted a systematic review of the literature by searching through MEDLINE, Embase, and Global Health Library, as well as the epidemiological bulletins and alerts from the World Health Organization, the Pan American Health Organization, and the European Centre for Disease Prevention and Control over the period 1954 to 2016., Results: The search yielded 547 records. We retained 333 for further analysis, to which we added 11 epidemiological bulletins from various sources. Of these, we systematically reviewed 52 articles and reports, revealing some epidemiological features and patterns of spread of the Zika virus worldwide, as well as pathological outcomes suspected to be linked to Zika outbreaks. Neurologic disorders among zika patients were similar in Brazil and French Polynesia but a causal link is not established. Incidence of zika infection in pregnant women is not known. In Brazil, during the zika outbreak the incidence of microcephaly increased more than 20 times. Among 35 infants with microcephaly, born from women suspected to have Zika infection during pregnancy in northeast Brazil, 74% of the mothers reported rash during the first and second trimester., Conclusions: On February 1, 2016, The World Health Organization declared the ongoing Zika crisis an emergency and that, although not yet scientifically proven, the link between the virus and growing numbers of microcephaly cases was "strongly suspected." However, the causal relationship between zika and microcephaly is not universally accepted. Public Health Implications. The current situation with regard to Zika is not encouraging, because there is no vaccine, no treatment, and no good serological test, and vector control remains a challenge.

Background: Metabolic syndrome (MetS) is a major factor for the occurrence of cardiovascular events. Causal factors for MetS are not well defined or yet unidentified. Preliminary investigations suggest that infections and inflammation may be involved in the etiology of this syndrome. This study aims to estimate the association between the severity of periodontitis (exposure) and MetS (outcome)., Methods: A cross-sectional study was conducted with 419 participants recruited from the Diabetes and Hypertensive Treatment Center, Feira de Santana, Bahia, Brazil. After administration of a questionnaire, general and oral clinical examination and laboratory tests were performed. Diagnosis of periodontitis and MetS was performed according to various criteria. The analysis of the effect of periodontitis on MetS used logistic regression analysis with adjustment for confounders., Results: The prevalence of periodontitis was found to be between 34.61% and 55.37%, depending on the classification definitions used, and the prevalence of MetS ranged from 60.86% to 67.06%. In the group with periodontitis, 14.08% had severe and 41.29% had moderate levels of periodontitis. There was an association between severe periodontitis and MetS after adjustment for sex, age, household density, alcoholic beverage consumption, smoking habit, and cardiovascular disease (odds ratio ORadjusted_6 = 2.11, 95% confidence interval = 1.01 to 4.40, P = 0.05)., Conclusions: The results suggest that periodontitis is associated with MetS, and that MetS prevalence is related to severe periodontitis.

Objective: To investigate the relationship between total and segmental body fat, bone mineral density and bone mineral content in undergraduate students stratified according to nutritional status., Methods: The study included 45 male undergraduate students aged between 20 and 30 years. Total and segmental body composition, bone mineral density and bone mineral content assessments were performed using dual energy X-ray absorptiometry. Subjects were allocated into three groups (eutrophic, overweight and obese)., Results: With the exception of upper limb bone mineral content, significantly higher (p<0.05) mean bone mineral density, bone mineral content, and relative body fat values were documented in the obese group. Total body and segmental relative body fat (lower limbs and trunk) were positively correlated (p<0.05) with bone mineral density in the overweight group. Upper limb fat was negatively correlated (p<0.05) with bone mineral content in the normal and eutrophic groups., Conclusion: Total body and segmental body fat were correlated with bone mineral density and bone mineral content in male undergraduate students, particularly in overweight individuals.

Objective: to analyze the contribution of Portuguese nursing to improving universal health access and coverage by means of the identification of nurses in the health system; evolution of health indicators; and access-promoting systems, in which nurses play a relevant role., Method: this was documentary research of publications from national and international organizations on planning and health outcomes. Statistical databases and legislation on health reforms were consulted., Results: nurses represent 30.18% of human resources in the national health service; the systems of access promotion performed by nurses have good levels of efficacy (95.5%) and user satisfaction (99% completely satisfied); in the local care the creation of Community Care Units (185) occurred, and 85.80% of home consultations were performed by nurses., Conclusion: political strategies, the National Health Service and strengthening of human resources in healthcare are the main determinants. Nursing is the most numerous professional group in the National Health Service, however numbers remain deficient in primary health care. The improvement of academic qualification and self-regulation of this professional group has allowed for better answers in improving health for the Portuguese.

Meningiomas are benign brain tumors that are usually to recur. Studies have shown in vitro and in vivo that meningiomas, regardless of histology and classification, express somatostatin receptors (SSTRs). We investigated the immunohistochemical expression of five SSTR subtypes (SSTR1-SSTR5) in tumor tissue sections from 60 patients with diagnosis of meningioma who underwent surgical resection and relating it to patient age and sex, tumor histology, location, regrowth/recurrence and follow-up. Mean (SD) patients age was 53.18 (12.6) years and 44 were women (73.3%). According to the WHO histological grading criteria, 47 (78.3%) meningiomas were grade I, 11 (18.3%) were grade II, and 2 (3.3%) were grade III. All five SSTRs were expressed in our sample, at frequencies ranging from 61.6 to 100%, with a predominance of SSTR2. SSTR5 was more frequently expressed in tumors benign than in tumors malignant (P<0.013). Recurrence-free survival rate at 2 years was 75.2%. There were no significant differences in SSTR expression regarding age, sex, tumor location and regrowth/recurrence. SSTR expression was detected at a significant frequency in this series. SSTR5 showed higher expression in tumors benign supporting the use of these SSTRs in diagnostic of meningiomas and their influence in process of tumorigenesis in meningiomas recurrence.

The natural hosts of Amblyomma nodosum in the immature stages are a variety of birds and the anteater in the adult stage. However, so far no data have been published about this tick's life cycle. To fill this gap, a record was made of its development under laboratory conditions. All the procedures were controlled in a BOD chamber set at 27±1 °C and 80±10% relative humidity and scotophase. The parasitic stages were raised on rabbits (Oryctolagus cuniculus Linnaeus, 1758), from which more than 50% of larvae and nymphs were recovered, although only a small portion performed ecdysis. The adults did not fixed on the rabbits, which suggests that the experimental conditions were unsuitable for the requirements of this species. The data obtained here indicate that A. nodosum is highly dependent on its host and environment whereas under laboratory conditions and host chosen for the study was not obtained satisfactory results and new studies with different hosts and new environmental conditions should be elaborated.

Introduction: Studies that generate information that may reduce the dengue death risk are essential. This study analyzed time trends and risk factors for dengue mortality and fatality in Brazil from 2001 to 2011., Methods: Time trends for dengue mortality and fatality rates were analyzed using simple linear regression. Associations between the dengue mortality and the case fatality rates and socioeconomic, demographic, and health care indicators at the municipality level were analyzed using negative binomial regression., Results: The dengue hemorrhagic fever case fatality rate increased in Brazil from 2001 to 2011 (β=0.67; p=0.036), in patients aged 0-14 years (β=0.48; p=0.030) and in those aged ≥15 years (β=1.1; p<0.01). Factors associated with the dengue case fatality rate were the average income per capita (MRR=0.99; p=0.038) and the number of basic health units per population (MRR=0.89; p<0.001). Mortality rates increased from 2001 to 2011 (β=0.350; p=0.002).Factors associated with mortality were inequality (RR=1.02; p=0.001) high income per capita (MRR=0.99; p=0.005), and higher proportions of populations living in urban areas (MRR=1.01; p<0.001)., Conclusions: The increases in the dengue mortality and case fatality rates and the associated socioeconomic and health care factors, suggest the need for structural and intersectoral investments to improve living conditions and to sustainably reduce these outcomes.

Understanding the transmission dynamics of infectious diseases is important to allow for improvements of control measures. To investigate the spatiotemporal pattern of an epidemic dengue occurred at a medium-sized city in the Northeast Region of Brazil in 2009, we conducted an ecological study of the notified dengue cases georeferenced according to epidemiological week (EW) and home address. Kernel density estimation and space-time interaction were analysed using the Knox method. The evolution of the epidemic was analysed using an animated projection technique. The dengue incidence was 6.918.7/100,000 inhabitants; the peak of the epidemic occurred from 8 February-1 March, EWs 6-9 (828.7/100,000 inhabitants). There were cases throughout the city and was identified space-time interaction. Three epicenters were responsible for spreading the disease in an expansion and relocation diffusion pattern. If the health services could detect in real time the epicenters and apply nimbly control measures, may possibly reduce the magnitude of dengue epidemics.

Background: Currently, knowledge does not allow early prediction of which cases of dengue fever (DF) will progress to dengue hemorrhagic fever (DHF), to allow early intervention to prevent progression or to limit severity. The objective of this study is to investigate the hypothesis that some specific comorbidities increase the likelihood of a DF case progressing to DHF., Methods: A concurrent case-control study, conducted during dengue epidemics, from 2009 to 2012. Cases were patients with dengue fever that progressed to DHF, and controls were patients of dengue fever who did not progress to DHF. Logistic regression was used to estimate the association between DHF and comorbidities., Results: There were 490 cases of DHF and 1,316 controls. Among adults, progression to DHF was associated with self-reported hypertension (OR = 1.6; 95% CI 1.1-2.1) and skin allergy (OR = 1.8; 95% CI 1.1-3.2) with DHF after adjusting for ethnicity and socio-economic variables. There was no statistically significant association between any chronic disease and progression to DHF in those younger than 15 years., Conclusions: Physicians attending patients with dengue fever should keep those with hypertension or skin allergies in health units to monitor progression for early intervention. This would reduce mortality by dengue.

Objective: to learn the influence of cognitive therapy at home, conducted by the caregivers of older people with Alzheimer's Disease., Method: a case study was developed with fi ve older people with Alzheimer's Disease and their caregivers. The stages of research development were: orientation with the caregivers; selection of older people and caregivers; approach of the study subjects at home; weekly meetings and reapplication of tests to follow up the cognitive function of the participants., Results: in three months it was possible to identify improved cognition, verified by the result of the Mini-Mental State Examination (MMSE). The scores of the other tests (KATZ, LAWTON, CLOCK TEST and VFT) remained the same., Conclusion: this strategy can be considered a light technology of nursing care for older people with dementia. When providing this care with the support of a nurse, caregivers re feel less anxious and understand the disease better.

Estrogen has been shown to play an important role in pituitary tumor pathogenesis. In humans, this biosynthesis is mediated by aromatase, an enzyme that converts androgens to estrogens. Just a few studies about aromatase expression in human pituitary gland, both in normal and pathological ones, are found in the literature. This study aimed to assess aromatase enzyme expression in human pituitary adenomas and associate it with gender, tumor size and tumor subtype. We conducted a cross-sectional study, reviewed clinical data and surgical specimens of consecutive 65 patients (35 women and 30 men) with anatomopathologic diagnosis of pituitary adenoma who underwent adenomectomy at a neurosurgical referral center in southern Brazil. Immunohistochemistry was performed to assess aromatase expression and define tumor subtype, and quantitative reverse transcription-polymerase chain reaction (qRT-PCR) to estimate aromatase gene expression. Mean patient age was 45.6 (±13.3) years (range, 18 to 73 years), 86.2% of our samples were macroadenomas while 13.8% were classified as microadenomas. Based on clinical and immunohistochemical data, 23 (35.4%) patients had non-functioning adenomas, 19 (29.2%) had somatotroph adenomas (acromegaly), 12 (18.5%) had lactotroph adenomas (hyperprolactinemic syndrome), and 11 (16.9%) had corticotroph adenomas (Cushing's disease). Immunohistochemical analysis was performed in 59 cases, and 58 (98.3%) showed no aromatase expression. Quantification by qRT-PCR was performed in 43 samples, and 36 (83.7%) revealed no gene expression. Among tumor specimens examined by both techniques (37 cases), 30 showed no gene or protein expression (concordance index, 0.81). It is possible to mention that aromatase expression was lost in most pituitary adenomas, regardless of gender, tumor subtype, or tumor size., (© 2014 Japanese Society of Neuropathology.)

The aim of this study was to identify factors associated with geographic access to health services by tuberculosis patients in three State capitals in Northeast Brazil. The sample consisted of new tuberculosis cases reported in 2007. The study used data from the Information System on Notifiable Diseases and the National Registry of Healthcare Organizations. Addresses of households and health services were geocoded, and difficult access was defined as a distance greater than 800 meters from the household to the health service. Crude prevalence ratios were estimated, as well as adjusted prevalence ratios using Poisson regression. After adjusting the study variables, the only variable that remained associated with difficult access was primary healthcare units in Salvador, Bahia State (PR = 0.75; 95%CI: 0.720-0.794) and in Recife, Pernambuco State (PR = 0.402; 95%CI: 0.318-0.508). The study concluded that decentralization of primary care can help improve access to health services.

Background & Aims: Chronic HDV/HBV co-infection is perhaps the most intriguing amongst all viral hepatitis. Only few studies focus deeply on this topic, particularly with patients infected with HDV-3. This study aimed to identify predictors of advanced disease, examining a cross-sectional data of 64 patients., Methods: Histological grading was used to characterize the disease stages and viral loads were tested as predictors of necroinflammatory activity and fibrosis., Results: We identified three HDV/HBV co-infection patterns: patients with predominant HDV replication (56.3%), patients with similar viral loads of both viruses (40.6%), and patients with predominant HBV replication (3.1%). Mean HDV-RNA showed a positive trend regarding inflammatory activity and grade of fibrosis. HDV viral load correlated positively with serum levels of liver enzymes and inversely with platelets count. HBV viral load showed no correlation with any of the above parameters. Advanced fibrosis was associated with age, splenomegaly, and HDV viral load of more than 2 log10. Multiple logistic regression confirmed the independent effect of HDV viral predominance. Advanced necroinflammatory activity was independently associated with HDV viral load and splenomegaly., Conclusions: HDV may possibly play an important and direct role in the establishment of necroinflammatory activity and fibrosis. Data show an indigenous HDV genotype, HDV-3, similar to those described in the Amazon region., (Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Background: Caseous lymphadenitis (CL) is a contagious infectious disease of small ruminants caused by Corynebacterium pseudotuberculosis. Is characterized by the formation of abscesses in the lymph nodes and intestines of infected animals, induced by inflammatory cytokines. The production of cytokines, such as IL-10, TNF-α, IL-4 and IFN-γ, is regulated by mitogen-activated protein kinase (MAPK) pathway activation. The present study investigated the involvement of MAPK pathways (MAPK p38, ERK 1 and ERK 2) with respect to the production of cytokines induced by antigens secreted by C. pseudotuberculosis over a 60-day course of infection. CBA mice (n = 25) were divided into three groups and infected with 102 colony forming units (CFU) of attenuated strain T1, 102 CFU of virulent strain VD57 or sterile saline solution and euthanized after 30 or 60 days. Murine splenocytes were treated with specific inhibitors (MAPK p38 inhibitor, ERK 1/2 inhibitor or ERK 2 inhibitor) and cultured with secreted antigens obtained from pathogenic bacteria (SeT1 or SeVD57)., Results: The MAPK pathways evaluated were observed to be involved in the production of IL-10, under stimulation by secreted antigens, while the MAPK p38 and ERK 1 pathways were shown to be primarily involved in TNF-α production. By contrast, no involvement of the MAPK p38 and ERK 1 and 2 pathways was observed in IFN-γ production, while the ERK 2 pathway demonstrated involvement in IL-4 production only in the mouse splenocytes infected with VD57 under stimulation by SeT1., Conclusion: The authors hypothesize that MAPK p38 and ERK 1 pathways with respect to TNF-α production, as well as the MAPK p38 and ERK 1 and 2 pathways in relation to IL-10 production under infection by C. pseudotuberculosis are important regulators of cellular response. Additionally, the lack of the MAPK p38 and ERK 1/2 pathways in IFN-γ production in infected CBA murine cells stimulated with the two secreted/excreted antigens, in IL-4 production showing involvement only via the ERK 2 pathway under stimulation by SeT1 antigen during 60-day infection period with the virulent strain, suggests that these pathways regulated the production of pro-inflammatory and regulatory cytokines in the splenic cells of CBA mice.

The Binary (Bin) toxin from the entomopathogenic bacterium Lysinibacillus sphaericus acts on larvae of the culicid Culex quinquefasciatus through its binding to Cqm1, a midgut-bound α-glucosidase. Specific binding by the BinB subunit to the Cqm1 receptor is essential for toxicity however the toxin is unable to bind to the Cqm1 ortholog from the refractory species Aedes aegypti (Aam1). Here, to investigate the molecular basis for the interaction between Cqm1 and BinB, recombinant Cqm1 and Aam1 were first expressed as soluble forms in Sf9 cells. The two proteins were found to display the same glycosilation patterns and BinB binding properties as the native α-glucosidases. Chimeric constructs were then generated through the exchange of reciprocal fragments between the corresponding cqm1 and aam1 cDNAs. Subsequent expression and binding experiments defined a Cqm1 segment encompassing residues S129 and A312 as critical for the interaction with BinB. Through site directed mutagenesis experiments, replacing specific sets of residues from Cqm1 with those of Aam1, the 159GG160 doublet was required for this interaction. Molecular modeling mapped these residues to an exposed loop within the Cqm1's structure, compatible with a target site for BinB and providing a possible explanation for its lack of binding to Aam1., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

To determine the effects of immersion in water on the biological parameters of engorged females of the tick species Amblyomma auricularium, 60 females were distributed in six groups, each comprising 10 individuals. The control group - G1 (not immersed) was fixed dorsally in a Petri dish and incubated at 27 ± 1°C and 80% RH. The other groups were subjected to immersion periods of 24, 48, 72 and 96 hours, and the sixth group to continuous immersion. After the immersion period, the females were placed in Petri dishes to begin laying. Eggs were collected every 72 hours and kept in biological chambers. All the groups showed significant differences (p <0.05) during the pre-oviposition period. The laying period and the average weight of overall posture did not change. The egg incubation period also did not differ significantly, but the hatching rate in the group immersed for 96h showed a significant difference. Thus, immersion for up to 96 hours does not impair the survival of A. auricularium females, although it may delay egg laying and reduce the number of offspring.

Objective: To investigate spatial tuberculosis (TB) distribution patterns and the association between living conditions and incidence of the disease in Salvador, Bahia, Brazil., Methods: An ecological study with neighborhood as the unit of analysis. Data was collected from the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação, SINAN) and the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE). Rates of TB incidence were transformed and smoothed. Spatial analysis was applied to identify spatial auto-correlation and "hotspot" areas of high and low risk. The relationship between TB and living conditions was confirmed by spatial linear regression., Results: The incidence of TB in Salvador displayed heterogeneous patterns, with higher rates occurring in neighborhoods with poor living conditions in 1995 - 1996. Over the study period, disease occurrence declined, particularly in less-privileged strata. In 2004 - 2005, the association between living conditions and TB was no longer observed., Conclusions: The heterogeneous spatial distribution of TB in Salvador previously reflected inequalities related to living conditions. Improvements in such conditions and health care for the less privileged may have contributed to observed changes.

Introduction: Congenital syphilis is an important health problem in Brazil. This study assessed measures aimed at the prevention and control of syphilis in the State of Mato Grosso and its capital, Cuiabá., Methods: A descriptive study cross-sectional and of time trends assessing the congenital syphilis was performed in Cuiabá and Mato Grosso between 2001 and 2011. We compared maternal sociodemographic characteristics and health care utilization related to cases of congenital syphilis during the periods from 2001 to 2006 and from 2007 to 2011. We assessed the temporal trends in this disease's incidence using a simple linear regression., Results: Between 2001 and 2006 in Mato Grosso, 86.8% of the mothers who had live births with congenital syphilis received prenatal care, 90.6% presented with a nontreponemal test reagent at delivery, 96.2% had no information regarding a treponemal confirmatory test at delivery, and 77.6% received inadequate treatment for syphilis; additionally, 75.8% of their partners were not treated. There was a statistically significant reduction in prenatal visits (p = 0.004) and an increase in the proportion of mothers reactive to nontreponemal tests at delivery (p = 0.031) between the two periods. No other variables were found to differ significantly between the periods. In Cuiabá, we observed a similar distribution of variables. In the state and in the capital, the increasing trend of congenital syphilis was not statistically significant., Conclusions: The high incidence of congenital syphilis in Mato Grosso and the low levels of health care indicators for pregnant women with syphilis suggest the need to improve the coverage and quality of prenatal care.

Paracoccidioidomycosis (PCM) is a systemic mycosis endemic to Latin America. Brazil accounts for approximately 80% of cases, where it represents a major public health issue due to its disabling impact and the number of premature deaths it causes. We present a retrospective cohort study that was conducted in order to better understand factors that relate to cure of the infection in the treatment of 200 patients with PCM. We evaluated the influence of sociodemographic and clinical factors as well as therapeutic regimen (trimethoprim-sulfamethoxazole [TMP-SMX] and itraconazole) on the progress of PCM (cure and noncure). There was a higher incidence of cure (83%) among patients who regularly received treatment for their infections and completed the treatment protocol. Moreover, itraconazole (86.4%) was significantly superior to TMP-SMX (51.3%) in terms of cure rate and had a median treatment period that was significantly shorter (12 months) than that for TMP-SMX (23 months). A Cox proportional hazard regression model showed that use of itraconazole increased the hazard of cure, regardless of sex, age, education, clinical form, completion of treatment, and regularity. Although the results of this study show that itraconazole was the best treatment option for PCM patients, a double-blind, randomized, controlled trial is necessary to confirm this conclusion.

As a consequence of the importance of ticks in forests in protected areas, was conducted survey of species of free-living ticks in the Natural Park Municipal Curió, state of Rio de Janeiro, Brazil. Monthly samples were taken by dragging method, dry ice traps and visual search in two transects. Adults and nymphs of Amblyomma cajennense (n= 147), Amblyomma brasiliense (n= 4) and Amblyomma parvum (n= 1) were collected. This is the first occurrence of A. parvum in the state. No correlation was found between the abundance of stages of A. cajennense and rainfall, temperature and relative humidity. The highest abundances of adults were in the months of January and May, and nymphs in September and October. The low diversity of parasites on Curió Park can be attributed to the proximity of households with pets, which would also explain the higher abundance of A. cajennense that is commonly found in areas impacted by anthropogenic pressure.

Because of the few records of Streblidae on bats, despite extensive study on these mammals in the state of Rio de Janeiro, a survey was carried out in an area of Atlantic Forest, in the municipality of Nova Iguaçu, known as the Tinguá region. Thirteen species were added to the list of Streblidae in the state of Rio de Janeiro, of which two were new records for Brazil. Thirty-one species have now been reported this state.

Introduction: Respiratory diseases (RD) represent a significant cause of hospitalization in Brazil, occupying the first position in the rank by group of diseases., Objective: To identify social determinants (SD) of intra-urban differentials of hospitalizations by RD and their main types (asthma and pneumonia) a study of spatial aggregation was carried out in Salvador (BA), between 2001 and 2007, taking Information Zones (IZ) as unit of analysis., Methods: Data on hospitalizations were provided by the Health Department of Bahia State. Socioeconomic indicators were obtained from the Demographic Census carried out in 2000, and the number of health centers was acquired from the National Register of Health Services., Results: Multiple linear regression analysis indicated association between spatial variation of the rates of hospitalization due to RD and income (β = 0.54, p < 0.001) and rate of health facilities per 10,000 inhabitants (β = 2.91, p < 0.001). Crowding was not associated., Conclusion: The identification of variation in SD in hospitalizations by RD in the IZ of Salvador will help in the decision-making process by public managers in defining goals and effective measures to reduce inequities in health.

Objective: To describe the vertical clinical pharmacist service's interventions in prevention of venous thromboembolism., Methods: This prospective study was done at a private hospital. From January to May 2012, the clinical pharmacist evaluated medical patients without prophylaxis for thromboembolism. If the patient fulfilled criteria for thromboembolism and did not have contraindications, the clinical pharmacist suggested inclusion of pharmacologic agents and/or mechanical methods for venous thromboembolism prevention. In addition, the appropriate dose, route of administration, duplicity and replacement of the drug were suggested., Results: We evaluated 9,000 hospitalized medical patients and carried out 77 pharmaceutical interventions. A total of 71 cases (92.21%) adhered to treatment so that non-adherence occurred in 6 cases (7.79%). In 25 cases pharmacologic agents were included and in 20 cases mechanical prophylaxis. Dose adjustments, route, frequency, duplicity and replacement made up 32 cases., Conclusion: The vertical clinical pharmacist service included the prophylaxis for venous thromboembolism and promotion of appropriate use of medicines in the hospital.

Canine distemper virus (CDV) is the cause of a severe and highly contagious disease in dogs. Practical diagnosis of canine distemper based on clinical signs and laboratory tests are required to confirm CDV infection. The present study aimed to develop a molecular assay to detect and differentiate field and vaccine CDV strains. Reverse transcription followed by nested real time polymerase chain reaction (RT-nqPCR) was developed, which exhibited analytical specificity (all the samples from healthy dogs and other canine infectious agents were not incorrectly detected) and sensitivity (all replicates of a vaccine strain were positive up to the 3125-fold dilution - 10(0.7) TCID50). RT-nqPCR was validated for CDV detection on different clinical samples (blood, urine, rectal and conjunctival swabs) of 103 animals suspected to have distemper. A total of 53 animals were found to be positive based on RT-nqPCR in at least one clinical sample. Blood resulted in more positive samples (50 out of 53, 94.3%), followed by urine (44/53, 83.0%), rectal (38/53, 71%) and conjunctival (27/53, 50.9%) swabs. A commercial immunochromatography (IC) assay had detected CDV in only 30 conjunctival samples of these positive dogs. Nucleoprotein (NC) gene sequencing of 25 samples demonstrated that 23 of them were closer to other Brazilian field strains and the remaining two to vaccine strains. A single nucleotide sequences difference, which creates an Msp I restriction enzyme digestion, was used to differentiate between field and vaccine CDV strains by restriction fragment length polymorphism (RFLP) analysis. The complete assay was more sensitive than was IC for the detection of CDV. Blood was the more frequently positive specimen and the addition of a restriction enzyme step allowed the differentiation of vaccine and Brazilian field strains., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Dilated chronic cardiomyopathy (DCC) from Chagas disease is associated with myocardial remodeling and interstitial fibrosis, resulting in extracellular matrix (ECM) changes. In this study, we characterized for the first time the serum matrix metalloproteinase 2 (MMP-2) and MMP-9 levels, as well as their main cell sources in peripheral blood mononuclear cells from patients presenting with the indeterminate (IND) or cardiac (CARD) clinical form of Chagas disease. Our results showed that serum levels of MMP-9 are associated with the severity of Chagas disease. The analysis of MMP production by T lymphocytes showed that CD8(+) T cells are the main mononuclear leukocyte source of both MMP-2 and MMP-9 molecules. Using a new 3-dimensional model of fibrosis, we observed that sera from patients with Chagas disease induced an increase in the extracellular matrix components in cardiac spheroids. Furthermore, MMP-2 and MMP-9 showed different correlations with matrix proteins and inflammatory cytokines in patients with Chagas disease. Our results suggest that MMP-2 and MMP-9 show distinct activities in Chagas disease pathogenesis. While MMP-9 seems to be involved in the inflammation and cardiac remodeling of Chagas disease, MMP-2 does not correlate with inflammatory molecules.

Among the challenges of esophagectomies, the cervical anastomosis remains challenging for its consequences, the main being the anastomotic stricture. The authors present a technique for an Orringer-fashion mechanical cervical laterolateral esophagogastric anastomosis, which reduces the rate of fistula and stenosis.

Objective: To evaluate the association between the spatial distribution of neonatal mortality and living conditions, and to analyze trends in the social inequalities, related to this mortality, in Salvador, Bahia, Brazil, 2000 - 2006., Methods: The city's Information Zones, the unit of analysis used in this study, were grouped into strata reflecting high, intermediate, low and very low living conditions, based on a living conditions index (LCI). Neonatal mortality rates were calculated for each stratum. Spearman's correlation, linear regression and relative risks were used in the data analysis., Results: Neonatal mortality in Salvador was found to be associated with living conditions, with risks of 53, 56 and 59% greater, respectively, in the intermediate, low and very low strata, when compared to the high living conditions stratum. Only the intermediate living conditions stratum shows a significant decline in neonatal mortality (β = -0.93; p = 0.039). In the stratum of high living conditions, it was observed a stagnation of this mortality., Conclusions: Poorer living conditions were associated to higher risks of neonatal mortality. The slight decline in social inequalities, found in neonatal mortality, was due to a decline in the intermediate living conditions stratum. Although dependent on the access to quality healthcare services and life support technologies, a more consistent reduction in the neonatal mortality and its associated inequalities will only be achieved when broader-reaching public policies are implemented, improving the living conditions, and mainly focusing on priority groups.

This is an experience report on the PRÓ-CUIDEM project, in meetings coordinated by nurse teachers in Niterói-RJ, Brazil. The results are focused on caregivers who need guidance, expressed during the group meetings, where their doubts are clarified, making them feel less anxious and more willing to take care of the elderly, with understanding of the elderly's health problem and, especially, to take care of their own health. One conclude that caring for the elderly with dementia is a difficult task when there is no support and guidance, being of fundamental importance the nursing care aiming to improve the caregivers' quality of life and, in consequence, the quality of life of the elderly with dementia.

To verify social inequalities in hospital admissions due to respiratory diseases in Salvador, Bahia State, Brazil, 2001-2007, an ecological study was conducted with information zones as the units of analysis. Information zones were stratified according to living conditions and analyzed by Poisson regression. Spatial distribution of hospitalization rates due to respiratory diseases ranged from 3.3 to 80.5/10,000. Asthma, pneumonia, and chronic obstructive pulmonary disease (COPD) showed heterogeneous spatial patterns, in which strata with the worst living conditions showed higher hospitalizations rates. The hospitalization rate for respiratory diseases was 2.4 times higher in zones with very low living conditions as compared to the wealthiest zone. There was a reduction in inequalities in hospital admissions for pneumonia and an increase for asthma and COPD. The sharp social gradient supports the hypothesis that socioeconomic factors are determinants of hospitalizations for respiratory diseases.

Background: In the international scientific literature, there are few studies that emphasize the presence or absence of hair in forensic facial reconstructions. There are neither Brazilian studies concerning digital facial reconstructions without hair, nor research comparing recognition tests between digital facial reconstructions with hair and without hair. The miscegenation of Brazilian people is considerable. Brazilian people, and, in particular, Brazilian women, even if considered as Caucasoid, may present the hair in very different ways: curly, wavy or straight, blonde, red, brown or black, long or short, etc. For this reason, it is difficult to find a correct type of hair for facial reconstruction (unless, in real cases, some hair is recovered with the skeletal remains)., Aims and Methods: This study focuses on the performance of three different digital forensic facial reconstructions, without hair, of a Brazilian female subject (based on one international database and two Brazilian databases for soft facial-tissue thickness) and evaluates the digital forensic facial reconstructions comparing them to photographs of the target individual and nine other subjects, employing the recognition method. A total of 22 assessors participated in the recognition process; all of them were familiar with the 10 individuals who composed the face pool., Results and Conclusions: The target subject was correctly recognized by 41% of the 22 examiners in the International Pattern, by 32% in the Brazilian Magnetic Resonance Pattern and by 32% in the Brazilian Fresh Cadavers Pattern. The facial reconstructions without hair were correctly recognized using the three databases of facial soft-tissue thickness. The observed results were higher than the results obtained using facial reconstructions with hair, from the same skull, which can indicate that it is better to not use hair, at least when there is no information concerning its characteristics., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

The objective of this study was to evaluate different strategies for the application of entomopathogenic nematodes (EPN). Three different models of spray nozzles with air induction (AI 11003, TTI 11003 and AD-IA 11004), three spray pressures (207, 413 and 720 kPa), four different additives for tank mixtures (cane molasses, mineral oil, vegetable oil and glycerin) and the influence of tank mixture stirring time were all evaluated for their effect on EPN (Steinernema feltiae) viability and pathogenicity. The different nozzles, at pressures of up to 620 kPa, were found to be compatible with S. feltiae. Vegetable oil, mineral oil and molasses were found to be compatible adjuvants for S. feltiae, and stirring in a motorized backpack sprayer for 30 minutes did not impact the viability or pathogenicity of this nematode. Appropriate techniques for the application of nematodes with backpack sprayers are discussed.

Objective: To determine the prevalence of nutritional deficiency among patients with pulmonary tuberculosis., Methods: This was a cross-sectional study using data obtained from the Brazilian Case Registry Database and from the medical records of patients diagnosed with pulmonary tuberculosis (15-59 years of age) residing in one of the municipalities that make up the 16th Regional Health District of the state of Bahia. We calculated the incidence, lethality, and mortality rates, as well as the prevalence of nutritional deficiency, as evaluated by body mass index. Demographic, social, clinical, and epidemiological data were collected., Results: Of the 72 confirmed cases of tuberculosis, 59 (81.9%) were in males, and 21 (29.2%) of the patients were in the 40-49 year age bracket. The majority (85.3%) described themselves as Mulatto or Black; 55.2% reported using alcohol; and approximately 90% were treated as outpatients. In the district and age bracket studied, the incidence of pulmonary tuberculosis was 30.6/100,000 population. Among the 72 patients, data regarding nutritional status was available for 34. Of those, 50% and 25%, respectively, presented nutritional deficiency at the beginning and at the end of treatment. No statistically significant differences were found between normal-weight and malnourished patients regarding the characteristics studied., Conclusions: The prevalence of nutritional deficiency was high among our sample of patients with pulmonary tuberculosis. This underscores the importance of nutritional follow-up for the assessment of tuberculosis treatment in the decision-making process regarding therapeutic interventions.

Chirnyssoides parasitizes the anterior and posterior edges of bat wing membranes. Possibly due to a lack of studies, its distribution is believed to be restricted to a few countries of Central and South America, but its actual range is probably wider. The purpose of this paper is to report the presence of Chirnyssoides amazonae on the bat Carollia perspicillata in the state of Rio de Janeiro, Brazil, and to present a checklist of hosts and localities for Chirnyssoides. Eleven females and 22 egg clusters of C. amazonae were collected from 11 individuals of C. perspicillata captured in Tinguá Biological Reserve using mist nets. Our search of the literature came up with 69 records of Chirnyssoides. There are reports of Chirnyssoides caparti, Chirnyssoides amazonae, Chirnyssoides brasiliensis and Chirnyssoides phyllostomus in Brazil. This paper reports the first record of Chirnyssoides amazonae in the state of Rio de Janeiro and the second in Brazil, indicating that their known distribution extends to the south. There are records of C. amazonae and C. surinamensis parasitizing C. perspicillata, but this is the first record of C. amazonae on C. perspicillata in Brazil.

This study aimed to analyse the effectiveness of an intervention for the nursing diagnosis of ineffective airway clearance in asthmatic children. A blinded, randomized and controlled clinical trial was developed in a paediatric hospital located on northeast of Brazil with 42 asthmatic children aged ≤ 36 months. The children were randomly divided into two groups (intervention and control) by means of a simple drawing. The applied intervention included actions related to change of positioning and stimulation of cough. The main findings of this study show that before the intervention, no significant difference was observed in the health status of the children. After the intervention, the indicators of choking (16.83 vs. 26.17, P = 0.007) and adventitious breath sounds (16.4 vs. 26.6, P = 0.005) were higher, on average, in the intervention group. It was observed an improvement in obstructive symptoms in children who received the intervention proposed., (© 2013 Wiley Publishing Asia Pty Ltd.)

Objective: To validate an equation to estimate the maximal oxygen consumption (VO2max) of nonexpert adult swimmers., Methods: Participants were 22 nonexpert swimmers, male, aged between 18 and 30 years (age: 23.1 ± 3:59 years; body mass: 73.6 ± 7:39 kg; height 176.6 ± 5.53 cm; and body fat percentage: 15.9% ± 4.39%), divided into two subgroups: G1 - eleven swimmers for the VO2max oximetry and modeling of the equation; and G2 - eleven swimmers for application of the equation modeled on G1 and verification of their validation. The test used was the adapted Progressive Swim Test, in which there occurs an increase in the intensity of the swim every two laps. For normality and homogeneity of data, Shapiro-Wilk and Levene tests were used, the descriptive values of the average and standard deviation. The statistical steps were: (1) reliability of the Progressive Swim Test - through the paired t-test, intraclass correlation coefficient (ICC), and the Pearson linear correlation (R) relative to the reproducibility, the coefficient of variation (CV), and standard error measurement (SEM) for the absolute reproducibility; (2) in the model equation to estimate VO2max, a relative VO2 was established, and a stepwise multiple regression model was performed with G1 - so the variables used were analysis of variance regression (AR), coefficient of determination (R(2)), adjusted coefficient of determination (R(2)a), standard error of estimate (SEE), and Durbin-Watson (DW); (3) validation of the equation - the results were presented in graphs, where direct (G1) and estimated (G2) VO2max were compared using independent t-test, linear regression (stressing the correlation between groups), and Bland-Altman (the bias agreement of the results). All considered a statistical significance level of P < 0.05., Results: On the trustworthiness of the Progressive Swim Test adapted presented as high as observed (R and ICC > 0.80, CV < 10%, and SEM < 2%). In the equation model, VO2max has been considered the third model as recommended due to the values found (AR < 0.01, R = 0795, R(2) = 0633; R(2)a = 0.624, SEE = 7.21, DW = 2.06). Upon validation of the equation, no significant differences occurred between G1 and G2 (P > 0.01), linear regression stressed a correlation between the groups (R > 0.80, P < 0.01), and Bland-Altman plotting of the results was within the correlation limits of 1.96 (95% confidence interval)., Conclusion: The estimating equation for VO2max for nonexpert swimmers is valid for its application through the Progressive Swim Test, providing to contribute in prescribing the swimming lessons as a method of evaluating the physical condition of its practitioners.

Background: Prolactin (PRL) is a hormone synthesized in both the pituitary gland and extrapituitary sites. It has been associated with the occurrence of neoplasms and, more recently, with central nervous system (CNS) neoplasms. The aim of this study was to evaluate prolactin expression in primary central nervous system tumors through quantitative real-time PCR and immunohistochemistry (IH)., Results: Patient mean age was 49.1 years (SD 15.43), and females accounted for 70% of the sample. The most frequent subtype of histological tumor was meningioma (61.5%), followed by glioblastoma (22.9%). Twenty cases (28.6%) showed prolactin expression by immunohistochemistry, most of them females (18 cases, 90%). Quantitative real-time PCR did not show any prolactin expression., Conclusions: Despite the presence of prolactin expression by IH, the lack of its expression by quantitative real-time PCR indicates that its presence in primary tumors in CNS is not a reflex of local production.

Introduction: A decline in hepatitis D virus (HDV) occurrence was described in Europe and Asia. We estimated HDV prevalence in the Brazilian Amazon following hepatitis B vaccination., Methods: This is a cross-sectional survey of HDV measured by total antibodies to HDV (anti-HD T)., Results: HDV prevalence was 41.9% whiting HBsAg carries and was associated with age (PR = 1.96; 95% CI 1.12-3.42; p = 0.01), hepatitis B virus (HBV) infection (PR = 4.38; 95% CI 3.12-6.13; p < 0.001), and clinical hepatitis (PR =1.44; 95% CI 1.03-2.00; p = 0.03). Risk factors were related to HDV biology, clinical or demographic aspects such as underlying HBV infection, clinical hepatitis and age., Conclusions: Our study demonstrated that HDV infection continues to be an important health issue in the Brazilian Amazon and that the implementation of the HBV vaccination in rural Lábrea had little or no impact on the spread of HDV. This shows that HDV has not yet disappeared from HBV hyperendemic areas and reminding that it is far from being a vanishing disease in the Amazon basin.

Autoimmune polyglandular syndromes are rare disorders characterized by failure of several endocrine glands, as well as non-endocrine organs, associated with immune-mediated tissue destruction. We report a rare case of polyglandular syndrome type II in a patient who presented with premature ovarian failure, Hashimoto's thyroiditis and empty sella associated with a diagnosis of differentiated thyroid carcinoma. This case probably represents the first report on this tumor in a patient with polyglandular disorder.

Objective: To estimate the seroincidence of dengue in children living in Salvador, Bahia, Brazil and to evaluate the factors associated., Methods:   A prospective serological survey was carried out in a sample of children 0-3 years of age. A multilevel logistic model was used to identify the determinants of seroincidence., Results: The seroprevalence of dengue was 26.6% in the 625 children evaluated. A second survey detected an incidence of 33.2%. Multilevel logistic regression showed a statistically significant association between the seroincidence of dengue and age and the premises index., Conclusion: In Salvador, the dengue virus is in active circulation during early childhood; consequently, children have heterotypic antibodies and run a high risk of developing dengue haemorrhagic fever, because the sequence and intensity of the three dengue virus serotypes currently circulating in this city are very similar to those that were circulating in Rio de Janeiro, Brazil, in 2008. Therefore, the authors strongly recommend that the health authorities in cities with a similar epidemiological scenario be aware of this risk and implement improvements in health care, particularly targeting the paediatric age groups. In addition, information should be provided to the population and actions should be implemented to combat this vector., (© 2012 Blackwell Publishing Ltd.)