Avaliação do teste do anel em leite na vigilância epidemiológica da brucelose bovina em rebanhos e em laticínios

Analisaram-se 464 amostras individuais de leite e 54 amostras de leite de latões, oriundos de leite dos mesmos animais, por meio do teste do anel do leite (TAL) visando à sua aplicação no diagnóstico individual e de rebanhos da brucelose bovina. Foram também avaliadas 464 amostras de soro sangüíneo por meio de provas do antígeno tamponado acidificado (ATA), soroaglutinação lenta em tubos (SAL) e 2-mercaptoetanol (2-ME), todas para brucelose. Cento e vinte e três amostras (26,5%) testadas pelo TAL apresentaram resultados positivos. Dessas, 30 resultaram positivas ao ATA, 28 ao ATA, à SAL e ao 2-ME e 18 à SAL. Das amostras positivas ao TAL, 95 pertenciam a animais sorologicamente negativos ao 2-ME, caracterizando 77,2% (95/123) das reações falso-positivas; dos resultados negativos ao TAL, 4 pertenciam a animais sorologicamente positivos, caracterizando 1,2% (4/341) de reações falso-negativas no TAL individual. Das 54 amostras de leite de latões analisadas pelo TAL, 17 foram consideradas positivas, das quais uma foi caracterizada como falso-positivo, pois todos os animais que a compunham foram negativos ao 2-ME. de 37 latões considerados negativos ao TAL, três continham leite de animais positivos ao 2-ME, caracterizando 8,1% de falso-negativos. O TAL individual demonstrou elevado percentual de resultados falso-positivos, enquanto o TAL em amostras de leite obtidas em latões detectou 84,2% de latões contaminados e 75% de rebanhos infectados.The ring test (RT) was analyzed regarding its application for the individual and herd bovine brucellosis diagnoses. Individual samples of milk from 464 cows and 54 composite samples of milk bucket from these animals were evaluated. The results were analyzed considering the serological results obtained by the rose bengal (RBT), tube agglutination (TAT) and 2-mercaptoethanol (2-ME) tests. From the 464 individual milk samples analyzed by the RT, 123 (26.5%) presented positive results. From those, 30 were positive only to the RBT, 28 by the RBT/TAT/2-ME and 18 by the TAT. From the 123 positive samples by the RT, 95 came from the 2-ME seronegative animals, characterizing 77.2% of false-positive reactions and 4/341 negative reactions came from the seropositive animals, characterizing 1.2% of false-negative reactions in the individual RT. From the 54 samples of compositive milk analyzed by the RT, 17 were positive. From these positive samples, one was considered false positive since all the animals that composed it were negative by the 2-ME. Three of the composite milk samples that were negative to RT(3/37) were constituted by milk from positive animals, characterizing 8.1% of false-negative results by the RT. The individual RT showed high percentage of false-positive results, while the RT in samples from bucket detected 84.2% of the contaminated milk and 75% of the infected herds

Acute myocardial infarction: predictors of mortality at a public hospital in the city of Fortaleza, Ceará state

OBJECTIVE: To identify the clinical and demographic predictors of in-hospital mortality in acute myocardial infarction with elevation of the ST segment in a public hospital, in the city of Fortaleza, Ceará state, Brazil. METHODS: A retrospective study of 373 patients experiencing their first episode of acute myocardial infarction was carried out. Of the study patients, 289 were discharged from the hospital (group A) and 84 died (group B). Both groups were analyzed regarding: sex; age; time elapsed from the beginning of the symptoms of myocardial infarction to assistance at the hospital; use of streptokinase; risk factors for atherosclerosis; electrocardiographic location of myocardial infarct; and Killip functional class. RESULTS: In a univariate analysis, group B had a greater proportion of the following parameters as compared with group A: non-Killip I functional class; diabetes; age >70 years; infarction of the inferior wall associated with right ventricular impairment; time between symptom onset and treatment at the hospital >12 h; anteroseptal or extensive anterior infarction; no use of streptokinase; and no tobacco use. In a multivariate logistic regression analysis, only non-Killip I functional class, diabetes, and age >70 years persisted as independent factors for death. CONCLUSION: Non-Killip I functional class, diabetes, and age >70 years were independent predictors of mortality in acute myocardial infarction with elevation of the ST segment

Avaliação da unidade analítica na detecção de Salmonella spp. em frangos varejo

Over 95 % of the cases of human salmonellosis are foodborne. Among the foods involved in transmission of these diseases are the products from animal origin, being the poultry products highly relevant. To deal with this issue, the Ministry of Agriculture, Livestocks Farming and Supply (MAPA – Ministério da Agricultura, Pecuária e Abastecimento) established a program, in order to monitor the contamination by Salmonella spp. in poultry carcasses. This study aimed at comparing the efficiency of two analytical methodologies (rinsing of chicken carcass and skin excision) for recovering the cells from this bacterium and to verify the occurrence of this pathogen in samples collected in Botucatu, SP. Analyzing 100 carcasses, and computing the results by both techniques, contamination by Salmonella spp. was detected in 43% samples. Using the rinsing technique, 81.40% (35/43) showed positive results as well as 51.16% (22/43) using the skin excision methodology. Although the rinsing technique detected high number of positive samples, no statistical difference (p > 0.05) was found between the results obtained from two methodologies. Further studies should be conducted on this issue as the poultry carcasses are crucial source for transmission of Salmonella spp., and the subsequent introduction of this pathogen on food preparation environment.Mais de 95% das salmoneloses humanas são de origem alimentar e, entre os alimentos envolvidos na transmissão estão os produtos de origem animal, especialmente os de maior relevância, os produtos avícolas. Diante desta questão, o Ministério de Agricultura, Pecuária e Abastecimento (MAPA) estabeleceu um programa com a finalidade de reduzir e monitorar a contaminação por Salmonella spp. nas carcaças de aves. Neste estudo, foi comparada a eficiência de duas metodologias de análises (o enxágue da carcaça e a excisão da pele) para recuperação de células da bactéria, bem como para a verificação da ocorrência do agente patogênico em amostras coletadas na região de Botucatu, SP. Em 100 carcaças analisadas, computando-se os resultados de ambas as metodologias, 43% (43/100) estavam contaminadas por Salmonella spp. Por meio de metodologia de enxágue foram detectadas 81,40% (35/43) amostras com resultados positivos e 51,16% (22/43) pela técnica de excisão. Embora a técnica de enxague tenha detectado número superior de amostras positivas, não houve diferença estatística (p > 0,05) entre os resultados obtidos pelas duas metodologias. Estudos adicionais devem ser realizados, dada à importância das carcaças de frango na veiculação de Salmonella spp. e sua consequente introdução no ambiente de preparação de alimentos

Artéria torácica interna enxertada: patência e estado funcional em repouso e após dobutamina Internal thoracic artery graft (ITAG): patency and functional status at rest and during dobutamine-stress echocardiography

FUNDAMENTO: A artéria torácica interna enxertada (ATIE) patente usualmente tem fração diastólica (FD)> 50% do fluxo. O estado funcional pode ser avaliado pelo índice de reserva coronariano (IRC). OBJETIVO: Avaliar, pela ecocardiografia e pelo Doppler em nível supraclavicular, a patência e o estado funcional da ATIE. MÉTODOS: Foram coletados prospectivamente e analisados os dados de 66 pacientes submetidos a ecocardiograma sob estresse com dobutamina (EED). O grupo I (GI) ocorreu com 49 ATIE sem estenose. No grupo II (GII) (10 ATIE) havia estenose significativa (> 50% e <100%). E no grupo III (GIII) (7 ATIE) a oclusão era de 100%. Foram avaliados diâmetros e espectros do Doppler das ATIE no repouso e EED. RESULTADOS: Considerando patência uma FD>50%, ocorreu em 49 ATIE (GI=40, GII=8 e GIII=1) no repouso e em 61 ATIE (GI=49, GII=10 e GIII=2) durante EED. Sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN) e acurácia foram, respectivamente, em repouso, 81%, 86% ,98%, 35 % e 82%; e no EED, 100%, 71%, 97%, 100% e 97%. As ATIE com FD>50% em repouso estavam patentes e as com FD<50% no EED tinham oclusão total. Considerando para bom estado funcional um IRC>1,8, isso ocorreu em 42 ATIE (39 do GI, 2 do GII e 1 GIII), verificando-se sensibilidade = 79%; especificidade = 85,7%; VPP = 94%; VPN = 59%; e acurácia = 80,9%. O IRC no GI foi maior (p=0,02) que em GII e GIII. CONCLUSÃO: Em nosso estudo, a avaliação não-invasiva da ATIE foi efetiva para verificar patência e estado funcional.<br>BACKGROUND: The patent internal thoracic artery graft (ITAG) usually has a diastolic fraction (DF) > 50% of the flow. The functional assessment can be evaluated by the coronary reserve index (CRI). OBJECTIVE: The objective was to evaluate the patency and functional status of the ITAG through echocardiography and Doppler. METHODS: Data from sixty-six patients who underwent dobutamine-stress echocardiography (DSE) were prospectively collected and analyzed. Group I (GI) had 49 ITAG without stenosis, Group II (GII), 10 ITAG with significant stenosis (> 50% and <100%) and Group III (GIII) had 7 ITAG with total occlusion. Diameters and Doppler spectrums from the ITAG at rest and during DSE were evaluated. RESULTS: Considering patency a DF >50%, it was observed in 49 ITAG (GI= 40, GII= 8 and GIII= 1) at rest and in 61 ITAG (GI=49, GII=10 and GIII=2) during DSE. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were respectively, 81%, 86%, 98%, 35% and 82%, and 100%, at rest and 71%, 97%, 100% and 97% in the DSE. The ITAG with DF>50% at rest were patent and the ones with DF<50% in the DSE presented total occlusion. Considering a CRI>1.8 for a good functional status, it was observed in 42 ITAG (39 from GI, 2 from GII and 1 from GIII), determining sensitivity=79%, specificity=85.7%, PPV=94%, NPV=59% and accuracy= 80.9%. The CRI in GI was higher (p= 0.02) than in GII or GIII. CONCLUSION: In our study, the non-invasive assessment of the ITAG was effective to verify the patency and the functional status