Marcadores sorológicos de hepatite B em indivíduos submetidos a exames de sangue em unidades de saúde

OBJECTIVE: To study some of the epidemiological aspects of hepatitis B in a non-representative sample of patients seen in health care clinics. METHODS: The study population comprised 632 patients who were seen at health care clinics in the city of Ribeirão Preto, Brazil, for the purpose of blood testing, regardless the reason. After signing a written consent, an additional amount of blood was drawn from the same venous puncture site used to collect the original sample for the testing assigned to the patient at the health care clinic. A questionnaire was applied to each participant, looking for the presence of risk factors for hepatitis B. The blood samples were tested for HBV markers, using immunoenzimatic techniques. RESULTS: The prevalences of HBsAg and anti-HBcAg were 0.3% and 13.9%, respectively. By a logistic regression model, the following variables were significantly associated with the infection: age, time of residency in the city (higher risk among those living for a period less than one year), past history of hepatitis, incarceration and sexual behavior (higher risk among homosexual and bisexual males). CONCLUSIONS: The growing difficulties in obtaining blood samples from a representative group of patients, as done in classic surveys, make it necessary to look for alternative methodologies which can provide information concerning the presence of infectious agents in a community. Though the results cannot be generalized to the population as a whole, the methodology used conveyed some knowledge regarding the circulation of hepatitis B virus. In addition, it makes much easier to obtain agreement from the participants, since it does not add any invasive procedure. Despite the limitations, this methodology may be helpful in epidemiological surveillance of infectious agents known as producing asymptomatic infections in much of the population.OBJETIVO: Estudar aspectos da epidemiologia da hepatite B em pessoas submetidas à coleta de sangue em unidades de saúde. MÉTODOS: Indivíduos dos quais se coletou sangue em unidades de saúde de Ribeirão Preto, independentemente do motivo, foram solicitados a fornecer uma quantidade adicional de material, obtida no momento da coleta e submetida à detecção de marcadores de hepatite B. Simultaneamente, por meio de questionário padronizado, foram obtidas informações de possíveis fatores de risco para a doença. Os dados foram analisados por meio de um modelo de regressão logística. RESULTADOS: As prevalências de HBsAg e de anti-HBcAg foram de 0,3% e 13,9%, respectivamente. Os fatores de risco associados à infecção foram: idade, residência na cidade há menos de um ano, antecedente de hepatite, exposição prévia a casas de correção e homo/bissexualismo masculino. CONCLUSÕES: Devido a dificuldades crescentes de obtenção de sangue de indivíduos sadios, essa pode ser uma alternativa para estudos que objetivem fornecer informações sobre a circulação de agentes infecciosos na população. Embora não se possa generalizar os dados obtidos pela metodologia usada, ela traz conhecimento referente à circulação do vírus de hepatite B

Antimicrobial activity of Byrsonima species (Malpighiaceae)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Byrsonima species, family Malpighiaceae, is popularly known as 'murici'. There are several properties attributed to the leaves of Byrsonima species including febrifuge, to treat gastrointestinal dysfunctions and skin diseases. In this work, the antimicrobial activity of Byrsonima fagifolia, B. basiloba and B. intermedia extracts obtained from the leaves were evaluated by using the disc-diffusion method. The results obtained showed that the methanol extracts of leaves had presented antimicrobial activity against all the microorganisms tested.18690695Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Distinguishing Asthma Phenotypes Using Machine Learning Approaches.

Asthma is not a single disease, but an umbrella term for a number of distinct diseases, each of which are caused by a distinct underlying pathophysiological mechanism. These discrete disease entities are often labelled as asthma endotypes. The discovery of different asthma subtypes has moved from subjective approaches in which putative phenotypes are assigned by experts to data-driven ones which incorporate machine learning. This review focuses on the methodological developments of one such machine learning technique-latent class analysis-and how it has contributed to distinguishing asthma and wheezing subtypes in childhood. It also gives a clinical perspective, presenting the findings of studies from the past 5 years that used this approach. The identification of true asthma endotypes may be a crucial step towards understanding their distinct pathophysiological mechanisms, which could ultimately lead to more precise prevention strategies, identification of novel therapeutic targets and the development of effective personalized therapies

Sentimientos de adolescentes con Diabetes Mellitus delante del proceso de vivir con la enfermedad

Qualitative research conducted in a diabetes service in the countryside of the state of Ceará, Brazil, with 11 teenagers with diabetes mellitus. The study aimed to understand the experience of adolescents facing the process of living with diabetes. Data were collected in 2007 May and June, through semi-structured interviews. It was observed that the teenager faces difficulties since the moment of diagnosis, especially because their food habits and lifestyles need to change, triggering feelings like fear, insecurity and anger. Over time, they incorporate the necessary changes to treatment and care, and begin to see the disease as normal. One concludes that it is necessary to understand teenagers, their behaviors, fears and desires and support them in the different areas of this experience.Investigación cualitativa, llevada a cabo en un servicio de diabetes del interior del estado de Ceará, Brasil, con 11 adolescentes con diabetes mellitus. El objetivo fue comprender la experiencia del adolescente delante del proceso de vivir con diabetes. Los datos fueron recolectados entre mayo y junio de 2007 a través de entrevistas semi estructuradas. Se observó que el adolescente enfrenta dificultades desde el momento del diagnóstico, sobre todo en el plan alimentar y cambios en el estilo de vida, desencadenando sentimientos como miedo, inseguridad e ira. Con el tiempo, incorporan los cambios necesarios al tratamiento y atención, y llegan a ver la enfermedad como algo normal. En conclusión, que es necesario entender los adolescentes, sus comportamientos, miedos y deseos, y apoyarlos en las diferentes áreas de esta experiencia.Pesquisa de natureza qualitativa, realizada em um serviço de diabetes do interior do Ceará com 11 adolescentes portadores de diabetes mellitus. O estudo objetivou compreender a experiência do adolescente frente ao processo de viver com o diabetes. Os dados foram coletados nos meses de maio e junho de 2007 por meio de entrevista semiestruturada. Constatou-se que o adolescente enfrenta dificuldades desde o momento do diagnóstico, principalmente no plano alimentar e nas mudanças no estilo de vida, desencadeando sentimentos como medo, insegurança e revolta. Com o passar do tempo, incorporam as mudanças necessárias ao tratamento e cuidados; e passam a ver a doença de forma normal. Conclui-se que é necessário compreender os adolescentes, seus comportamentos, medos e anseios e apoiá-los nos diversos âmbitos dessa experiência.Secretaria Municipal de Saúde de Pio IX-PI Programa de Saúde da FamíliaUniversidade Federal do Ceará Faculdade de Farmácia Odontologia e Enfermagem Departamento de EnfermagemUniversidade Federal de São Paulo (UNIFESP) Programa de Pós-Graduação em Saúde ColetivaUNIFESP, Programa de Pós-Graduação em Saúde ColetivaSciEL

Early clinical and laboratory risk factors of intensive care unit requirement during 2004–2008 dengue epidemics in Singapore: a matched case–control study

Background: Dengue infection can result in severe clinical manifestations requiring intensive care. Effective triage is critical for early clinical management to reduce morbidity and mortality. However, there is limited knowledge on early risk factors of intensive care unit (ICU) requirement. This study aims to identify early clinical and laboratory risk factors of ICU requirement at first presentation in hospital and 24 hours prior to ICU requirement. Method: A retrospective 1:4 matched case–control study was performed with 27 dengue patients who required ICU, and 108 dengue patients who did not require ICU from year 2004–2008, matched by year of dengue presentation. Univariate and multivariate conditional logistic regression were performed. Optimal predictive models were generated with statistically significant risk factors identified using stepwise forward and backward elimination method. Results: ICU dengue patients were significantly older (P=0.003) and had diabetes (P=0.031), compared with non-ICU dengue patients. There were seven deaths among ICU patients at median seven days post fever. At first presentation, the WHO 2009 classification of dengue severity was significantly associated (P<0.001) with ICU, but not the WHO 1997 classification. Early clinical risk factors at presentation associated with ICU requirement were hematocrit change ≥20% concurrent with platelet <50 K [95% confidence-interval (CI)=2.46-30.53], hypoproteinemia (95% CI=1.09-19.74), hypotension (95% CI=1.83-31.79) and severe organ involvement (95% CI=3.30-331). Early laboratory risk factors at presentation were neutrophil proportion (95% CI=1.04-1.17), serum urea (95% CI=1.02-1.56) and alanine aminotransferase level (95% CI=1.001-1.06). This predictive model has sensitivity and specificity up to 88%. Early laboratory risk factors at 24 hours prior to ICU were lymphocyte (95% CI=1.03-1.38) and monocyte proportions (95% CI=1.02-1.78), pulse rate (95% CI=1.002-1.14) and blood pressure (95% CI=0.92-0.996). This predictive model has sensitivity and specificity up to 88.9% and 78%, respectively. Conclusions: This is the first matched case–control study, to our best knowledge, that identified early clinical and laboratory risk factors of ICU requirement during hospitalization. These factors suggested differential pathophysiological background of dengue patients as early as first presentation prior to ICU requirement, which may reflect the pathogenesis of dengue severity. These risk models may facilitate clinicians in triage of patients, after validating in larger independent studies.Published versio

Effects of chronic ascariasis and trichuriasis on cytokine production and gene expression in human blood: a cross-sectional study.

Background Chronic soil-transmitted helminth (STH) infections are associated with effects on systemic immune responses that could be caused by alterations in immune homeostasis. To investigate this, we measured the impact in children of STH infections on cytokine responses and gene expression in unstimulated blood. Methodology/Principal Findings Sixty children were classified as having chronic, light, or no STH infections. Peripheral blood mononuclear cells were cultured in medium for 5 days to measure cytokine accumulation. RNA was isolated from peripheral blood and gene expression analysed using microarrays. Different infection groups were compared for the purpose of analysis: STH infection (combined chronic and light vs. uninfected groups) and chronic STH infection (chronic vs. combined light and uninfected groups). The chronic STH infection effect was associated with elevated production of GM-CSF (P = 0.007), IL-2 (P = 0.03), IL-5 (P = 0.01), and IL-10 (P = 0.01). Data reduction suggested that chronic infections were primarily associated with an immune phenotype characterized by elevated IL-5 and IL-10, typical of a modified Th2-like response. Chronic STH infections were associated with the up-regulation of genes associated with immune homeostasis (IDO, P = 0.03; CCL23, P = 0.008, HRK, P = 0.005), down-regulation of microRNA hsa-let-7d (P = 0.01) and differential regulation of several genes associated with granulocyte-mediated inflammation (IL-8, down-regulated, P = 0.0002; RNASE2, up-regulated, P = 0.009; RNASE3, up-regulated, p = 0.03). Conclusions/Significance Chronic STH infections were associated with a cytokine response indicative of a modified Th2 response. There was evidence that STH infections were associated with a pattern of gene expression suggestive of the induction of homeostatic mechanisms, the differential expression of several inflammatory genes and the down-regulation of microRNA has-let-7d. Effects on immune homeostasis and the development of a modified Th2 immune response during chronic STH infections could explain the systemic immunologic effects that have been associated with these infections such as impaired immune responses to vaccines and the suppression of inflammatory diseases