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BackgroundPost-partum haemorrhage is one of the major causes of maternal mortality in low- and middle-income countries. Oxytocin is the first choice uterotonic for the PPH prevention but it requires cold storage. Heat stable carbetocin appears to be a promising agent for the prevention of PPH. The present study was an ancillary to the WHO CHAMPION Trial conducted to compare the effect of heat-stable carbetocin 100 µg IM versus oxytocin 10 IU IM on post-delivery hemoglobin level in one of the participating facilities in India.MethodsThis was a nested randomized controlled trial designed to compare the effect of heat-stable carbetocin 100 µg IM versus oxytocin 10 IU IM, administered within one minute of vaginal delivery of the baby for prevention of postpartum haemorrhage, on post-delivery 48–72 hours hemoglobin level, adjusted for pre-delivery hemoglobin level. 1,799 women from one hospital in India participated in this study.ResultsPre-delivery hemoglobin and postpartum blood loss were not significantly different between carbetocin and oxytocin. Post-delivery hemoglobin, unadjusted or adjusted for pre-delivery hemoglobin, was slightly lower for carbetocin compared to oxytocin. The drop in hemoglobin was slightly higher for carbetocin, although the difference was very small (1.2 g/dL for carbetocin, 1.1 g/dL for oxytocin). The proportion of participants with a drop in hemoglobin of 2 g/dL or more, adjusted for pre-delivery hemoglobin, was higher for carbetocin (RR = 1.29, 95% CI 1.02 to 1.63). From the regression coefficients it can be derived that post-delivery hemoglobin, adjusted for pre-delivery hemoglobin, decreases on average 0.12g/dL for each dL of blood lost, for the two treatments combined.ConclusionsThe present ancillary study showed that intramuscular administration of 100 µg of heat stable carbetocin can result in a slightly lower post-delivery hemoglobin, slightly higher drop and higher percentage of women having a drop of 2 g/dL or larger, compared to 10 IU of oxytocin, but these differences are not clinically relevant.Study registrationThe trial was registered with Clinical Trial Registry of India CTRI/2016/06/006996.

Background Postpartum hemorrhage is the most common cause of maternal death. Oxytocin is the standard therapy for the prevention of postpartum hemorrhage, but it requires cold storage, which is not available in many countries. In a large trial, we compared a novel formulation of heat-stable carbetocin with oxytocin. Methods We enrolled women across 23 sites in 10 countries in a randomized, double-blind, noninferiority trial comparing intramuscular injections of heat-stable carbetocin (at a dose of 100 μg) with oxytocin (at a dose of 10 IU) administered immediately after vaginal birth. Both drugs were kept in cold storage (2 to 8°C) to maintain double-blinding. There were two primary outcomes: the proportion of women with blood loss of at least 500 ml or the use of additional uterotonic agents, and the proportion of women with blood loss of at least 1000 ml. The noninferiority margins for the relative risks of these outcomes were 1.16 and 1.23, respectively. Results A total of 29,645 women underwe...

BACKGROUND: The safety and efficacy of antenatal glucocorticoids in women in low-resource countries who are at risk for preterm birth are uncertain. METHODS: We conducted a multicountry, randomized trial involving pregnant women between 26 weeks 0 days and 33 weeks 6 days of gestation who were at risk for preterm birth. The participants were assigned to intramuscular dexamethasone or identical placebo. The primary outcomes were neonatal death alone, stillbirth or neonatal death, and possible maternal bacterial infection; neonatal death alone and stillbirth or neonatal death were evaluated with superiority analyses, and possible maternal bacterial infection was evaluated with a noninferiority analysis with the use of a prespecified margin of 1.25 on the relative scale. RESULTS: A total of 2852 women (and their 3070 fetuses) from 29 secondary- and tertiary-level hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan underwent randomization. The trial was stopped for benefit at the second interim analysis. Neonatal death occurred in 278 of 1417 infants (19.6%) in the dexamethasone group and in 331 of 1406 infants (23.5%) in the placebo group (relative risk, 0.84; 95% confidence interval [CI], 0.72 to 0.97; P=0.03). Stillbirth or neonatal death occurred in 393 of 1532 fetuses and infants (25.7%) and in 444 of 1519 fetuses and infants (29.2%), respectively (relative risk, 0.88; 95% CI, 0.78 to 0.99; P=0.04); the incidence of possible maternal bacterial infection was 4.8% and 6.3%, respectively (relative risk, 0.76; 95% CI, 0.56 to 1.03). There was no significant between-group difference in the incidence of adverse events. CONCLUSIONS: Among women in low-resource countries who were at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection. Fil: Oladapo, Olufemi T.. Organizacion Mundial de la Salud; Argentina Fil: Vogel, Joshua P.. Organizacion Mundial de la Salud; Argentina Fil: Piaggio, Gilda. Organizacion Mundial de la Salud; Argentina Fil: Nguyen, My-Huong. Organizacion Mundial de la Salud; Argentina Fil: Althabe, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Metin Gülmezoglu, A.. Organizacion Mundial de la Salud; Argentina Fil: Bahl, Rajiv. Organizacion Mundial de la Salud; Argentina Fil: Rao, Suman P.N.. Organizacion Mundial de la Salud; Argentina Fil: de Costa, Ayesha. Organizacion Mundial de la Salud; Argentina Fil: Gupta, Shuchita. Organizacion Mundial de la Salud; Argentina Fil: Shahidullah, Mohammod. No especifíca; Fil: Chowdhury, Saleha B.. No especifíca; Fil: Ara, Gulshan. No especifíca; Fil: Akter, Shaheen. No especifíca; Fil: Akhter, Nasreen. No especifíca; Fil: Dey, Probhat R.. No especifíca; Fil: Abdus Sabur, M.. No especifíca; Fil: Azad, Mohammad T.. No especifíca; Fil: Choudhury, Shahana F.. No especifíca; Fil: Matin, M.A.. No especifíca; Fil: Goudar, Shivaprasad S.. No especifíca; Fil: Dhaded, Sangappa M.. No especifíca; Fil: Metgud, Mrityunjay C.. No especifíca; Fil: Pujar, Yeshita V.. No especifíca; Fil: Somannavar, Manjunath S.. No especifíca; Fil: Vernekar, Sunil S.. No especifíca; Fil: Herekar, Veena R.. No especifíca; Fil: Bidri, Shailaja R.. No especifíca; Fil: Mathapati, Sangamesh S.. No especifíca; Fil: Patil, Preeti G.. No especifíca; Fil: Patil, Mallanagouda M.. No especifíca; Fil: Gudadinni, Muttappa R.. No especifíca; Fil: Bijapure, Hidaytullah R.. No especifíca; Fil: Mallapur, Ashalata A.. No especifíca; Fil: Katageri, Geetanjali M.. No especifíca; Fil: Chikkamath, Sumangala B.. No especifíca; Fil: Yelamali, Bhuvaneshwari C.. No especifíca; Fil: Pol, Ramesh R.. No especifíca; Fil: Misra, Sujata S.. No especifíca; Fil: Das, Leena. No especifíca

The easy adaptation of Angiostrongylus costaricensis, nematode responsible for abdominal angiostrongyliasis to several species of terrestrial and freshwater molluscs and the differences observed in the interactions of trematodes with their intermediate hosts have induced us to study the concomitant infection of Biomphalaria glabrata with Schistosoma mansoni and A. costaricensis. Prior exposure of B. glabrata to A. costaricensis (with an interval of 48 hours), favored the development of S. mansoni, observing higher infection rate, increased release of cercariae and increased survival of molluscs, when compared to molluscs exposed only to S. mansoni. Prior exposure of B. glabrata to A. costaricensis and then to S. mansoni also enabled the development of A. costaricensis since in the ninth week of infection, higher amount of A. costaricensis L3 larvae was recovered (12 larvae / mollusc) while for molluscs exposed only to A. costaricensis, the number of larvae recovered was lower (8 larvae / mollusc). However, pre-exposure of B. glabrata to S. mansoni (with an interval of 24 hours), and subsequently exposure to A. costaricensis proved to be very harmful to B. glabrata, causing extensive mortality of molluscs, reduced pre-patent period to release cercariae and greater recovery of L3 A. costaricensis larvae. Resumo A facilidade de adaptação do Angiostrongylus costaricensis, nematódeo responsável pela angiostrongiliase abdominal, a diversas espécies de moluscos terrestres e dulciaquícolas e as divergências observadas nas interações dos trematódeos com seus hospedeiros intermediários nos induziu a estudar a infecção concomitante de Biomphalaria glabrata com Schistosoma mansoni e A. costaricensis. A exposição prévia de B. glabrata ao A. costaricensis (com intervalo de 48 horas), favoreceu o desenvolvimento do S. mansoni observando-se elevação da taxa de infecção, maior liberação de cercárias e maior sobrevivência dos moluscos, quando comparado com os moluscos expostos somente ao S. mansoni. A exposição de B. glabrata previamente ao A. costaricensis e posteriormente ao S. mansoni também facilitou o desenvolvimento do A. costaricensis uma vez que na nona semana de infecção foi recuperada maior quantidade de larvas L3 de A. costaricensis, enquanto nos moluscos expostos somente ao A. costaricensis, o número de larvas recuperadas foi menor . Entretanto a pré-exposição de B. glabrata ao S. mansoni (com intervalo de 24 horas), e posteriormente a exposição ao A. costaricensis mostrou-se muito prejudicial à B. glabrata provocando grande mortalidade dos moluscos, redução do período pré-patente para liberação de cercárias e maior recuperação de larvas L3 de A. costaricensis.

Background Perinatal mortality and morbidity continue to be major global health challenges strongly associated with prematurity and reduced fetal growth, an issue of further interest given the mounting evidence that fetal growth in general is linked to degrees of risk of common noncommunicable diseases in adulthood. Against this background, WHO made it a high priority to provide the present fetal growth charts for estimated fetal weight (EFW) and common ultrasound biometric measurements intended for worldwide use. Methods and Findings We conducted a multinational prospective observational longitudinal study of fetal growth in low-risk singleton pregnancies of women of high or middle socioeconomic status and without known environmental constraints on fetal growth. Centers in ten countries (Argentina, Brazil, Democratic Republic of the Congo, Denmark, Egypt, France, Germany, India, Norway, and Thailand) recruited participants who had reliable information on last menstrual period and gestational age confirmed by crown–rump length measured at 8–13 wk of gestation. Participants had anthropometric and nutritional assessments and seven scheduled ultrasound examinations during pregnancy. Fifty-two participants withdrew consent, and 1,387 participated in the study. At study entry, median maternal age was 28 y (interquartile range [IQR] 25–31), median height was 162 cm (IQR 157–168), median weight was 61 kg (IQR 55–68), 58% of the women were nulliparous, and median daily caloric intake was 1,840 cal (IQR 1,487–2,222). The median pregnancy duration was 39 wk (IQR 38–40) although there were significant differences between countries, the largest difference being 12 d (95% CI 8–16). The median birthweight was 3,300 g (IQR 2,980–3,615). There were differences in birthweight between countries, e.g., India had significantly smaller neonates than the other countries, even after adjusting for gestational age. Thirty-one women had a miscarriage, and three fetuses had intrauterine death. The 8,203 sets of ultrasound measurements were scrutinized for outliers and leverage points, and those measurements taken at 14 to 40 wk were selected for analysis. A total of 7,924 sets of ultrasound measurements were analyzed by quantile regression to establish longitudinal reference intervals for fetal head circumference, biparietal diameter, humerus length, abdominal circumference, femur length and its ratio with head circumference and with biparietal diameter, and EFW. There was asymmetric distribution of growth of EFW: a slightly wider distribution among the lower percentiles during early weeks shifted to a notably expanded distribution of the higher percentiles in late pregnancy. Male fetuses were larger than female fetuses as measured by EFW, but the disparity was smaller in the lower quantiles of the distribution (3.5%) and larger in the upper quantiles (4.5%). Maternal age and maternal height were associated with a positive effect on EFW, particularly in the lower tail of the distribution, of the order of 2% to 3% for each additional 10 y of age of the mother and 1% to 2% for each additional 10 cm of height. Maternal weight was associated with a small positive effect on EFW, especially in the higher tail of the distribution, of the order of 1.0% to 1.5% for each additional 10 kg of bodyweight of the mother. Parous women had heavier fetuses than nulliparous women, with the disparity being greater in the lower quantiles of the distribution, of the order of 1% to 1.5%, and diminishing in the upper quantiles. There were also significant differences in growth of EFW between countries. In spite of the multinational nature of the study, sample size is a limiting factor for generalization of the charts. Conclusions This study provides WHO fetal growth charts for EFW and common ultrasound biometric measurements, and shows variation between different parts of the world., Using data from a multinational longitudinal study, Mariana Widmer and colleagues report The World Health Organization fetal growth charts., Author Summary Why Was This Study Done? Small size at birth is associated with perinatal mortality, child morbidity, and adult health risks, all major global health challenges prioritized by the World Health Organization. Ultrasound estimation of fetal weight before birth is today very widely used in clinical practice, and, while essential for the identification and management of high-risk pregnancies, the current reference ranges used worldwide are largely based on single populations from a few high-income countries and are therefore of uncertain general applicability. WHO therefore requested new fetal growth charts based on multiple populations to be made available for general use and at the same time provide a foundation for the growing initiative to prevent noncommunicable diseases and promote a healthy life course starting before birth. What Did the Researchers Do and Find? In all, 1,387 healthy women with low-risk pregnancies and unconstrained nutritional and social background from ten countries in Africa, Asia, Europe, and South America were included in a longitudinal study of fetal growth. During pregnancy, repeated ultrasound measurements were used to establish international fetal growth charts for head and abdominal circumference, length of the thigh bone, and fetal weight, estimated using a combination of the three measurements. Fetal growth showed considerable natural variation, differing significantly between countries. Growth was to a small extent influenced by maternal age, height, weight, and parity, and by fetal sex. Similarly, birthweight varied significantly between countries, even after adjustment for differences in the length of pregnancy. What Do These Findings Mean? We suggest that these WHO charts for growth in estimated fetal weight are more suitable for international use than those commonly applied today. However, the differences between countries, with maternal factors, and with fetal sex mean that these growth charts may need to be adjusted for local clinical use to increase their diagnostic and predictive performance. The considerable variation in fetal growth and birthweight which occurs even under optimal conditions, and which is not explicable in terms of maternal and population factors, may suggest, first, that such natural variation in offspring size is a collective adaptive strategy that has proved extremely successful from an evolutionary point of view and, second, that major determinants of variation in human development before birth are still to be determined. Although the present study encompasses ten countries, it still represents only a small selection when the substantial anthropometric variations existing even within continents are taken into account.

The behaviour of the albino and melanic variants of Biomphalaria glabrata of Belo Horizonte (MG. Brazil) was studied comparatively, in terms of their respective susceptibilities to infection by Schistosoma mansoni of the same origin, through observation of the elimination of cercariae for a three-month period and the calculation of mortality and infection rates, in control and in infected snails. The number of amoebocytes, granulocytes and hyalinocytes in the circulating hemolymph during different periods of infection was analyzed. The evolution of the infection in the tissues was observed by means of histological cross-sections. The melanic variant showed greater susceptibility to infection and a higher mortality rate. The albino variant showed a higher number of circulating amoebocytes, both granulocytes and hyalinocytes. A higher number of degenerated sporocysts were seen in the histological cross-sections of the albino variant. The results suggest that the melanic variant of B. glabrata was more susceptible to infection by S. mansoni than was the albino variant.

Foi avaliado o efeito da hidrocortisona no desenvolvimento do Schistosoma mansoni da linhagem BH em Biomphalaria glabrata. Moluscos escolhidos ao acaso foram tratados com hidrocortisona durante quatro dias. No segundo dia de tratamento, os moluscos foram expostos a 10 miracídios de S. mansoni. Um outro grupo, não tratado com hidrocortisona, foi exposto aos miracídios e observados da mesma forma. Os seguintes dados foram observados: taxa de infecção, tempo de sobrevivência, período pré-patente e número de cercárias liberadas. Os resultados mostraram que os moluscos no grupo tratado com hidrocortisona apresentaram maior taxa de infecção, menor período pré-patente, maior produção de cercárias e maior tempo de sobrevivência. Estas observações sugerem que a hidrocortisona atuou nos moluscos diminuindo a resistência à infecção esquistossomótica, facilitando o desenvolvimento do trematódeo, atenuando os efeitos lesivos da infecção e proporcionando maior sobrevivência. The effect of hydrocortisone on the development of BH strain of S. mansoni in B. glabrata snails is evaluated. Snails in a randomly chosen group were submitted to hydrocortisone during four days. In the second day of hydrocortisone exposure, the snails were exposed, each, to ten S. mansoni miracidia. Another group, not treated with hydrocortisone, was exposed to miracidia and observed in the same manner. Various items of data were observed: the infection rate, survival time, prepatent period and total number of cercariae released. It was found that the snails in the group treated with hydrocortisone had a higher infection rate, shorter prepatent periods, produced more cercariae and also had longer survival times. This suggests that the hydrocortisone in snails induces a decrease in resistance to schistosome infection and facilitates the development of the trematode, while also reducing adverse infection effects, thereby leading to longer snail survival.

The purpose of this study was to compare the serum levels of androgens between hyposexual and non-hyposexual patients with epilepsy. Adult male patients with epilepsy were investigated. Serum levels of testosterone (T) and free-T, estradiol, and sex hormone binding globulin (SHBG) were measured and the free androgen index (FAI) was calculated. While there were no differences between hyposexual and non-hyposexual patients in the serum levels of T, free-T, and estradiol, or to the FAI, the serum levels of SHBG were significantly higher in hyposexual patients than in non-hyposexual patients. Thus, the effects of increased SHBG upon serum levels of testosterone biologically active in patients with epilepsy and hyposexuality were not detected by the methods used in this study. Four (44%) of nine hyposexual patients who were re-evaluated after two years follow-up improved sexual performance. Thus, clinical treatment that results in good seizure control may improve sexual performance in some patients with epilepsy.

Breast feeding and weaning were studied in 76 infants from 3 to 24 months of age in two rural communities in Piracicaba, state of Sao Paulo. Interviews with the children's mothers were conducted at their homes. The average duration of exclusive breast feeding, predominant breast feeding (including only water and tea) and complementary feeding was analyzed by means of life tables. The Wilcoxon test was conducted to verify socioeconomic and demographic variables associated with the duration of breast feeding. The average duration of exclusive breast feeding was 3 days in the community of Anhumas and 30 days in that of Santa Olimpia. Predominant breast feeding and complementary feeding were prolonged for 90 and 180 days in Anhumas and for 120 and 165 days in Santa Olimpia, respectively. Only the sex of the child was associated with the duration of predominant breast feeding, with boys being nursed longer. Insufficient milk was the main reason given for termination of breast feeding. Weaning was generally initiated with liquids such as water, tea, fluid cow milk and sweetened juices.

O aleitamento materno e a prática de desmame foram estudados em 76 crianças de 3 a 24 meses de idade pertencentes a 69 famílias de comunidades rurais de Piracicaba, SP, por meio de entrevistas. Foram analisadas as medianas da duração do aleitamento materno exclusivo, predominante (incluindo somente água e chá) e misto, utilizando-se a tábua de vida. O teste Wilcoxon foi aplicado para verificar as variáveis socioeconômicas e demográficas associadas com o tempo de aleitamento. A mediana da duração de aleitamento materno exclusivo foi de 3 dias para Anhumas e 30 dias para Santa Olímpia. O aleitamento predominante e o aleitamento misto prolongaram-se por 90 e 180 dias em Anhumas e 120 e 165 dias em Santa Olímpia, respectivamente. Somente o sexo da criança apresentou associação com a duração do aleitamento materno. Iniciou-se o processo de desmame especialmente com água, chás, leite de vaca fluido e sucos açucarados.Breast feeding and weaning were studied in 76 infants from 3 to 24 months of age in two rural communities in Piracicaba, state of São Paulo. Interviews with the children's mothers were conducted at their homes. The average duration of exclusive breast feeding, predominant breast feeding (including only water and tea) and complementary feeding was analyzed by means of life tables. The Wilcoxon test was conducted to verify socioeconomic and demographic variables associated with the duration of breast feeding. The average duration of exclusive breast feeding was 3 days in the community of Anhumas and 30 days in that of Santa Olímpia. Predominant breast feeding and complementary feeding were prolonged for 90 and 180 days in Anhumas and for 120 and 165 days in Santa Olímpia, respectively. Only the sex of the child was associated with the duration of predominant breast feeding, with boys being nursed longer. Insufficient milk was the main reason given for termination of breast feeding. Weaning was generally initiated with liquids such as water, tea, fluid cow milk and sweetened juices.

This study aimed to compare dental plaque removal efficacy of three manual toothbrushes.Three toothbrushes (Colgate Flexível - Colgate (T1), Oral B Advantage Control Grip - Oral B (T2), Comfort Clean - JohnsonJohnson - Reach (T3) were evaluated for dental plaque removal in 17 subjects. Dental plaque was scored before and after seven days' use of each toothbrush, employing an adaptation of Quigley-Hein Index modified by Turesky (Plaque Index). Assessments were performed at days 0, 7, 14, 21, 28, and 35. At the end of the trial each subject was asked which toothbrush was preferred.Final dental plaque scores for toothbrush T3 were statistically different from toothbrushes T1 and T2, which in turn did not differ from each other. Subjects showed preference towards toothbrush T3.Toothbrush T3 was more efficient in terms of dental plaque removal when compared with toothbrushes T2 and T1.

The development of cercariae from Schistosoma mansoni strains BH and SJ in Biomphalaria glabrata and Biomphalaria tenagophila treated with saccharose was studied. The molluscs were maintained in dechlorinated tap water containing 0.01% saccharose. After one week of treatment with saccharose, B. glabrata and B. tenagophila were exposed to ten S. mansoni miracidia, from BH and SJ strains respectively. Control snails of both species were maintained in dechlorinated tap water without saccharose and exposed to the same number of miracidia. There was no significant difference between the infection rates of snails treated or not with saccharose. However, the two groups of B. glabrata had significantly greater infection rates than the corresponding B. tenagophila groups. Molluscs treated with saccharose had a lower survival rate, with the greatest mortality occurring immediately before and at the beginning of cercariae release. Treatment with saccharose did not result in the release of more cercariae, but larvae from molluscs so treated showed a greater capacity to penetrate mouse skin, which was attributed to the greater energy supply during larval development in the mollusc. Foi estudado o desenvolvimento de cercárias de Schistosoma mansoni das linhagens BH e SJ em Biomphalaria glabrata e Biomphalaria tenagophila, respectivamente, tratadas com sacarose. Os moluscos foram mantidos em água declorada contendo 0,01% de sacarose. Após uma semana de tratamento com sacarose, B. glabrata e B. tenagophila foram expostas a dez miracídios de S. mansoni das linhagens BH e SJ, respectivamente. Moluscos controles de ambas as espécies mantidos em água declorada sem sacarose foram expostos ao mesmo número de miracídios. Não houve diferença significativa entre as taxas de infecção dos moluscos tratados ou não com sacarose. Entretanto, os dois grupos de B. glabrata tiveram taxas de infecção significativamente maiores que as correspondentes aos grupos de B. tenagophila. Moluscos tratados com sacarose apresentaram menor taxa de sobrevivência, com a maior mortalidade ocorrendo imediatamente depois e no início da liberação de cercárias. O tratamento com sacarose não resultou na maior liberação de cercárias, mas larvas de moluscos tratados com esse açúcar mostraram maior capacidade de penetrar na pele de camundongo, o que foi atribuído ao maior suprimento de energia durante o desenvolvimento larval no molusco.

The effect of hydrocortisone on the development of BH strain of S. mansoni in B. glabrata snails is evaluated. Snails in a randomly chosen group were submitted to hydrocortisone during four days. In the second day of hydrocortisone exposure, the snails were exposed, each, to ten S. mansoni miracidia. Another group, not treated with hydrocortisone, was exposed to miracidia and observed in the same manner. Various items of data were observed: the infection rate, survival time, prepatent period and total number of cercariae released. It was found that the snails in the group treated with hydrocortisone had a higher infection rate, shorter prepatent periods, produced more cercariae and also had longer survival times. This suggests that the hydrocortisone in snails induces a decrease in resistance to schistosome infection and facilitates the development of the trematode, while also reducing adverse infection effects, thereby leading to longer snail survival.

OBJECTIVE: The influence of age and the presence of secondary sporocysts in the miraxonal attraction exercised by Biomphalaria glabrata on miracidia of Schistosoma mansoni of the BH strain were studied. MATERIAL AND METHOD: A glass apparatus containing two compartments joined by a tube and previously tested in other experiments, was used. Specimens of B. glabrata or its snail conditioned water (SCW) selected before the first oviposition (sexually immature), after the first oviposition (adult), with or without secondary sporocysts, were used to attract the miracidia. RESULTS: It was noted that snails or their SCW containing secondary sporocysts lost the ability to attract miracidia. The sexual maturity of the snail did not influence miraxonal attraction. OBJETIVO: Estudou-se a influência da idade e da presença de esporocistos secundários na atração miraxonal exercida por Biomphalaria glabrata sobre miracídios de Schistosoma mansoni da linhagem BH. MATERIAL E MÉTODO: Utilizou-se um aparato de vidro composto de duas câmaras unidas por um canal, previamente testado em outros experimentos. Como atraentes utilizaram-se exemplares de B. glabrata ou a água de condicionamento destes moluscos (SCW) com idade inferior à primeira oviposição (infantil) e com idade superior à primeira oviposição (adulta), contendo ou não esporocistos secundários. RESULTADOS: Verificou-se que os moluscos (ou sua SCW) que continham esporocistos secundários perderam o poder de atrair miracídios. A condição dos moluscos serem infantis ou adultos não interferiu na atração miraxonal.

Foi estudado o comportamento dos amebócitos circulantes de Biomphalaria glabrata e Biomphalaria tenagophila mediante à infecção pelo Schistosoma mansoni, à inoculação de tinta Nanquim e à fratura da concha. Foi realizada contagem diferencial de amebócitos na hemolinfa, dando-se ênfase aos tipos de células encontradas em cada amostra; avaliação histopatológica dos moluscos submetidos à exposição aos miracídios de S. mansoni; e análise da morfologia dos amebócitos através de microscopia de fase. Foi verificada correlação entre a variação do número de amebócitos circulantes e a reação tecidual. Em Biomphalaria tenagophila somente houve aumento do número de amebócitos estrelados quando os moluscos eram infectados por S. mansoni, o que sugere a especificidade da reação ao parasitismo. Comparando os resultados obtidos em B. glabrata e B. teganophila, concluiu-se que esses moluscos apresentam comportamentos amebocitários diferentes frente aos diversos estímulos utilizados. The behavior of the hemolymph amebocytes of Biomphalaria glabrata and Biomphalaria tenagophila was studied by means of the infection by the Schistosoma mansoni, using inoculation with Indian ink and fracture of the shell. A differencial count of the amebocytes in the hemolymph was made with special attention given to the types of cell found in each sample. Histopathological evaluation of the molluscs exposed to the Schistosoma mansoni miracidia and analyses of the amebocytes were made. Correlation between the variance of the number of hemolymph amebocytes and tissue reaction was also made. The morphologycal study of amebocytes was carried out with the help of a phase microscope. An increase in granulocytes in Biomphalaria tenagophila occured only when the molluscs were infected by Schistosoma mansoni, which suggests the specificity of the reaction to the parasitism. Comparing the results obtained with B. glabrata and B. tenagophila it is concluded that these molluscs show different amebocitary behavior in the presence of the diverse stimuli used.

Estudou-se a influência da susceptibilidade de moluscos vetores do S. mansoni no desenvolvimento da patogenicidade do trematódeo no hospedeiro definitivo. Foram utilizadas progênies de moluscos Biomphalaria tenagophila e Biomphalaria glabrata selecionadas para o caráter susceptibilidade ao S. mansoni das linhagens SJ e BH, respectivamente. Cercárias oriundas das gerações P, F1 F2, F3 e F4 foram usadas para a infecção de camundongos Swiss, que foram sacrificados oito semanas após a exposição às larvas. Por esta ocasião verificou-se o número de ovos nas fezes e o número de granulomas no fígado, baço e intestino. Avaliou-se também o tamanho das reações granulomatosas nestas vísceras. Concluiu-se que a maior susceptibilidade de B. tenagophila induziu a uma maior eliminação de ovos do parasita nas fezes. Verificou-se maior número de granulomas por área de tecido hepático em roedores infectados com cercárias oriundas de moluscos mais susceptíveis. Nos mesmos roedores, constatou-se relação inversa entre a área dos granulomas esplênicos, hepáticos e intestinais e a taxa de infecção dos moluscos que forneceram as cercárias para a infecção dos camundongos. The influence of the susceptibility of the vector snails of S. mansoni on the development of the pathogenicity of the worm to the host was studied. Off-spring of snails Biomphalaria glabrata and Biomphalaria tenagophila were used, selected with regard to the susceptibility to S. mansoni of the strains BH and SJ trait, respectively. Parenteral, F1,F2, F3 and F4 generation cercariae were used for the infection of Swiss mice, which were killed eight weeks after infection. The number of eggs in the feces and the number of granulomas in the liver, spleen and intestines were counted. The size of the granulomatous reactions was evaluated. The results led to the conclusion that greater susceptibility of B. tenagophila was associated with a larger egg production in the feces and a higher density of granulomas in the liver. There is a clear inverse relationship between the area of hepatic, spleenic and intestinal granulomas and the rate of infection of the snails which served as intermediate hosts for the S. mansoni.

Foram pesquisadas as possíveis influências que os mecanismos imunes do molusco poderiam exercer no desenvolvimento dos esporocistos e no comportamento do verme adulto no hospedeiro vertebrado. Utilizaram-se duas linhagens de S. mansoni (BH e SJ), selecionadas para o caráter susceptibilidade e mantidas, respectivamente, em Biomphalaria glabrata e Biomphalaria tenagophila, seus hospedeiros invertebrados naturais. Formaram-se grupos experimentais de camundongos infectados com cercárias oriundas de moluscos das duas espécies, pertencentes às gerações P, F1, F2, F3 e F4. Foram calculadas as taxas de infecção dos moluscos, número de cercárias penetrantes e o número de esquistossomos adultos nos roedores. Concluiu-se que a maior susceptibilidade de B. tenagophila determinou maior capacidade das cercárias em se tornarem vermes adultos. A maior susceptibilidade de B. glabrata originou maior capacidade de penetração das cercárias. The possible influence of the immune mechanisms of the molluscs on the developmente of the sporocysts and the resultant behavior of the adult worm in the vertebrate host were studied. Two strains of Schistosoma mansoni (BH and SJ) were used. These were genetically selected for their susceptibility and maintained, respectively, in Biomphalaria glabrata and Biomphalaria tenegophila, the natural invertebrate hosts. Experimental groups of mice infected with cercariae proceeding from the two species of molluscs, belonging to generations P, F1 F2, F3 and F4, were formed. The infection rates of the snails, the number of the penetrant cercariae and the worm burden in mice were evaluated. It was concluded that the higher susceptibility of Biomphalaria tenagophila results in a greater ability on the part of the cercarial to develop into adult worms. The higher susceptibility of B. glabrata results in greater power of penetration into mice tegument on the part of the cercariae.

The attraction of Schistosoma mansoni miracidea by snails genetically selected for susceptibility to infection is considered. Miracidea were exposed to snails or to snail conditioned water in a specially devised three-chamber glass apparatus. Ten miracidea were used for each test and were deposited in the middle chamber (a passage); after 15 minutes, them in each of the number of the three chambers were recorded. In one of the chambers, chosen randomly at each trial, either snails or SCW were used. The snails and the SCW were chosen from cither selected snails (highly susceptible) or unselected. The miracidea were of two groups: they came either from susceptible snails in previous generation or were of unselected traits. The results show that only snail generation has importance for the attraction: selectd molluscs of susceptible traits do attract the miracidea more.

The attraction exercised over Schistosoma mansoni miracidia by Biomphalaria straminea, Lymnaea columella and Physa sp using a specially designed apparatus consisting of two circular glass chambers joined by an open channel were studied. The molluscs or their snail-conditioned water (SCW) was placed in one of the chambers (randomly chosen). In the channel ten miracidia was deposited and the count of miracidia in each of the three compartments (the two chambers and the channel) was recorded during fifteen minutes. Ten replications of each experiment with different specimens of molluscs and miracidia were made. Statistical and ad-hoc exploratory data analysis showed that: a) the three species of molluscs and their SCW attract the miracidia; b) Physa sp attract more miracidia then L. columella. There was an isolated single B. straminea specimen that had a repulsive effect to the miracidia.

Estudou-se comparativamente a viabilidade, em moluscos hospedeiros, de miracídios de Schistosoma mansoni de duas origens: de ovos eliminados com as fezes e de granulomas hepáticos. Procurou-se saber se havia efeito da origem sobre o número total de cercárias obtidas e sobre o período de eliminação de cercárias. Foram também verificados o período pré-patente da infecção dos moluscos, a sobrevivência do caramujo após a infecção e o sexo das cercárias eliminadas. Concluiu-se que: a) o período pré-patente foi maior nos moluscos infectados por miracídios provenientes de granulomas hepáticos; b) a sobrevivência dos moluscos após a infecção foi maior naqueles infectados por miracídios provenientes de granulomas hepáticos; c) o número de cercadas eliminadas por molusco infectado com miracídios provenientes de granulomas hepáticos foi três vezes maior que o número de cercárias eliminadas por moluscos infectados com miracídios provenientes de ovos eliminados com as fezes.

Analisou-se a atração de miracídios de Schistosoma mansoni das linhagens BH e SJ frente a seus vetores simpátricos e alopátricos tendo-se em consideração a possibilidade da presença de substâncias quimiotáxicas emanadas dos moluscos. Estudou-se também o comportamento desses miracídios frente a girinos de Hyla fuscovaria. Foi verificado que houve atração dos miracídios pelos moluscos vetores e que essa atração foi mais evidente quando a larva era colocada frente ao seu hospedeiro simpátrico.As observações realizadas no decorrer da experiência demonstraram a presença de substâncias miraxonais emanadas pelos moluscos. Miracidia tropism to suitable hosts is a subject of much controversy. In this work, we try to determine the possible specificity of Schistosoma mansoni miracidia attraction and also the degree of this specificity. To this end an experiment was carried out to determine the probability of attraction in a given experimental set up, to H. fuscovaria girina or to one of two susceptible snail species. Two strains of S. mansoni were employed and also the corresponding snail species. A specially designed apparatus consisting of two circular glass chambers joined by an open channel was used. One of the girina or a snail was placed in one of the chambers (randomly chosen). In the channel a known number of miracidia were deposited and the count of miracidia in each of the three compartments (the two chambers and the channel) was recorded. The experiment was carried out under strong or subdued lighting. Statistical and ad-hoc exploratory data analysis have shown that: a) the miracidia, when exposed to only one species of snail, show more attraction to the sympatric snail host; b)one strain of miraciadia showed more attraction under strong lighting; the other strain behaved the opposite way, with stronger attraction under weak liht; c) the girina did not attract the miracidia; this seems to imply that sone chemiotropism is present in this phenomenon.

The epidemiology and control of schistosomiasis mansoni in the Municipality of Pedro de Toledo (State of S. Paulo, Brazil) since 1980, has been studied. In 1980 the prevalence evaluated by stool exams (Kato-Katz method) was 22.8% and no statistical difference at 5.0% level was observed between rural and urban zones. The intensity of infection was low (58.5 eggs/g of faeces); the highest prevalence and intensity of infection rates were observed within the group of from 5 to 29 years of age, respectively. The transmission of schistosomiasis usually occurred during leisure time. The majority of the carriers of the parasite were asymptomatic. Of the B. tenagophila examined only 0.4% were found to be infected. The control programme has been intensified from 1981 on resulting in a sharp decrease in the prevalence from 22.8% in 1980 to 6% at the present time. This result shows that, in spite of the control programme there is a residual human prevalence. A beginning has been made on the investigation into the possible causes of this residual prevalence (6.0% was maintained through out 1987).

Several substances isolated from SCW (snail conditioned water and from snail hemolymph were tested for a possible chemiotaxic effect on Schistosoma mansoni miracidia. Two strains of miracidia were considered (SJ and BH). Agar plates prepared with one of the substances were exposed to sixty miracidia for five minutes. The number of contacts and contacts with return were counted. Ten replications were made. Eight types (and four sub types) of agar plates were prepared: normal water (control), SCW (Biomphalaria glabrata and B. tenagophila), hemolymph (B. glabrata and B. tenagophila) and amonia, calcium, magnesium, sodium and potassium. Log-linear models were fitted to the data to study the proportions of attraction to each substance and to compare them. Any possible differences in proportions of attraction between the two S. mansoni strains were tested.

Foi observado o comportamento de larvas de S. mansoni em moluscos prévia e naturalmente infectados por larvas de outros Digenea. Foi verificado que as larvas de S. mansoni não se desenvolveram nos moluscos previamente infectados com purcocercárias longifurcadas com ocelos ou com furcocercárias longifurcadas sem ocelos. Observou-se resistência parcial ao desenvolvimento de S. mansoni nos moluscos previamente infectados por equinostomocercárias ou por distomocercárias com acúleo. A ausência de reação amebocitária em torno dos esporocistos de S. mansoni nos moluscos infectados por outros digenéticos parece indicar a não participação dos amebócitos na resistência oferecida ao desenvolvimento das larvas de S. mansoni. The objective of the present work is to study the development of S. mansoni larvae in snails found naturally infected by other digenetic trematode larvae. It was found that S. mansoni larvae did not develop in snails previoulsy infected by furcicercariae either with or without ocelli. Partial resistance to the development of S. mansoni was observed in snails previously infected by cercariae of Echinostomatidae or by cercariae with aculeus of Distomata. Absence of amoebocitary reaction around the S. mansoni sporocysts in snails previously infected by other digenetic trematodes indicates that amoebocytes did not play any role in the resistance mechanism.

Realizou-se estudo sobre o desenvolvimento da esquistossomose mansônica em camundongos submetidos à dieta hipoprotéica. Foram constituídos 4 grupos de Mus musculus "Swiss" da seguinte forma: 1) não infectados, normoprotéicos; 2) infectados, normoprotéicos; 3) não infectados, hipoprotéicos e 4) infectados, hipoprotéicos. Os animais foram sacrificados com 60 dias de infecção, aos 90 dias de idade. Verificou-se que os esquistossomos sofreram os efeitos da subnutrição do hospedeiro, principalmente os vermes machos, que além de terem seu desenvolvimento prejudicado, tiveram seu número reduzido aproximadamente pela metade. O número de granulomas foi menor nos roedores subnutridos e o tamanho da lesão foi reduzido. Houve acentuada leucopenia nos animais submetidos à dieta hipoprotéica, principalmente nos infectados subnutridos. A linfopenia e a eosinopenia acentuadas sugeriram que o sistema imunológico do hospedeiro foi afetado pela subnutrição. A taxa de mortalidade foi muito mais elevada nos animais infectados submetidos à dieta hipoprotéica. Concluiu-se que os camundongos subnutridos resistiram menos à infecção esquistossomótica apesar de terem apresentado menor número de lesões granulomatosas. Mansoni schistosomiasis was studied in mice fed on a low protein diet. Four groups of the Swiss breed Mus musculus were used in an experiment with two factors, each with two levels: 1-non-infected, normal diet; 2 - infected, normal diet ; 3 - non-infected, low protein diet; 4 - infected, low protein diet. The mice were killed for observation at age 90 days, after 60 days of infection, for those infected. It was found that the worms suffered the effects of malnutrition, mainly males, whose population count was cut by half, in addition to poor individual growth. The hepatic granuloma count was found to be smaller in the undernourished group; while the corresponding lesions were also generally smaller. There was a marked leukopenia in the malnourished mice, even more so in the infected mice. The severe lymphopenia and eosinopenia observed suggest that the immunologic system of the host was affected by malnutrition. Mortality rates were far larger in the infected, low protein diet group. One may then surmise that the malnourished mice offered lower resistance to the infection, their lower number of granuloma notwithstanding.