O impacto da poliquimioterapia no perfil epidemiológico da hanseníase em Juiz de Fora, Brasil

We investigated the impact of multidrug therapy (MDT) on the epidemiological pattern of leprosy in Juiz de Fora, Brazil, from 1978 to 1995. Evaluation of 1,283 medical charts was performed according to the treatment regimen used in two different periods. Following the introduction of MDT in 1987, prevalence of leprosy decreased from 22 patients/10,000 inhabitants to 5.2 patients/10,000 inhabitants in 1995. Incidence rate of leprosy was lower in period II (1987-1995) than in period I (1978-1986). Decreasing prevalence and incidence appear to be related to drug efficacy rather than decreased case identification, since both self-referred and professionally referred treatment increased markedly from period I to period II. For both periods, multibacillary leprosy was the most frequent clinical form of the disease (±68%), and the main infection risk factor identified was household contact. Leprosy is predominantly manifested in adults, but an increase in the number of very old and very young patients was observed in period II. The MDT program has been effective both in combating leprosy and in promoting awareness of the disease.Investigamos o impacto da poliquimioterapia (PQT) no perfil epidemiológico da hanseníase em Juiz de Fora, Brasil, de 1978 a 1995. Fizemos uma avaliação de 1.283 prontuários, de acordo com o esquema terapêutico adotado em dois diferentes períodos. Desde a introdução da PQT, em 1987, a prevalência da hanseníase caiu de 22 pacientes/dez mil habitantes para 5,2 pacientes/dez mil habitantes em 1995. A incidência da doença foi menor no período II (1987-1995) em comparação ao período I (1978-1986). A diminuição da prevalência e da incidência está mais relacionada à eficácia das drogas que a uma queda na identificação da infecção, já que tanto a procura espontânea quanto os encaminhamentos aumentaram significativamente do período I para o período II. Em ambos os períodos, a forma clínica mais freqüente foi a multibacilar (±68%), e o contato intradomicilicar foi o maior fator de risco conhecido associado à infecção. Um aumento de pacientes muito velhos ou muito novos foi observado no período II. Os resultados indicam que o esquema PQT tem sido eficaz no combate à hanseníase e tem aumentado a conscientização e o conhecimento da doença

Prey choice, provisioning behaviour, and effects of early nutrition on nestling phenotype of titmice

[EN] It is generally assumed that blue and great tits (Cyanistes caeruleus, Parus major) compete for the same type of food (Lepidoptera larvae) during the breeding season and that the former have some advantage because they are usually earlier and can exploit small caterpillars that are often more abundant and are not consumed by great tits. However, it is not clear whether, when confronted with similar circumstances (e.g., nestling demand), blue and great tits show similar preferences for a particular caterpillar type. In this 2-y study, we compare the diet of both tit species in detail by controlling for hatching date and brood size. We also examine how the contribution of caterpillars and spiders to the diet is related to nestling development. A positive relationship was found between the percentage of spiders in the diet and nestling tarsus length in both species, reinforcing the idea that neonatal nutrition could have a strong influence on nestling phenotype (e.g., offspring size). Such a correlation may arise because spiders contain a high level of taurine, an essential nutrient in the early development of young, and/or this prey type contains more calcium than other food items, which may affect the rate of nestling bone mineralization. Blue tits fed their young double the number of tortricid larvae in comparison with great tits, whereas the latter showed a clear preference for noctuids and exploited, with a low frequency, a type of larvae not consumed by blue tits, hairy caterpillars (Lasiocampidae). Our results point to resource partitioning by these species in this forest ecosystem and contribute to a better understanding of feeding ecology of titmice, which is particularly timely in a global warming context [FR] Il est généralement admis que les mésanges bleues (Cyanistes caeruleus) et les mésanges charbonnières (Parus major) se font compétition pour le même type de nourriture (larves de lépidoptères) durant la période de reproduction. Il est également admis que les mésanges bleues possèdent un certain avantage, car elles se reproduisent plus tôt et mangent de petites chenilles souvent plus abondantes qui ne sont pas consommées par les mésanges charbonnières. Cependant, il n'est pas clair si dans les mêmes conditions (ex. de demande en nourriture des oisillons), les mésanges bleues et charbonnières préfèrent les mêmes types de chenilles. Dans cette étude de 2 ans, nous avons comparé en détail les régimes alimentaires des 2 espèces de mésanges en contrôlant pour la date de ponte et la taille de la couvée. Nous avons aussi examiné si les contributions des chenilles et des araignées au régime alimentaire étaient reliées au développement des oisillons. Chez les 2 espèces, une relation positive a été trouvée entre le pourcentage d'araignées dans le régime alimentaire et la longueur du tarse des oisillons renforçant ainsi l'idée que la nutrition néonatale peut avoir une grande influence sur le phénotype des oisillons (ex. la taille des jeunes). Une telle corrélation peut résulter du fait que les araignées ont un taux élevé de taurine, un nutriment essentiel au développement précoce des jeunes, et/ou que ce type de proie contient plus de calcium que d'autres aliments ce qui peut influencer le taux de minéralisation des os chez les oisillons. Les mésanges bleues ont nourri leurs jeunes avec deux fois plus de larves de tortricidés que les mésanges charbonnières qui elles ont montré une nette préférence pour les noctuidés. Ces dernières ont aussi consommé, quoique peu fréquemment, des livrées (Lasiocampidae), un type de larves boudé par les mésanges bleues. Nos résultats pointent vers une division des ressources entre ces espèces dans cet écosystème forestier et contribuent à une meilleure compréhension de l'écologie alimentaire des mésanges ce qui est particulièrement utile dans un contexte de réchauffement climatiqueV. García-Navas was supported by a FPI predoctoral fellowship (Spanish Ministry of Science and Innovation (MICINN)-European Social Fund). This study was financed by the MICINN (grant reference: GCL2007-61395)Peer Reviewe

Minimal change nephrotic syndrome after stem cell transplantation: a case report and literature review

Graft-versus-host disease is one of the most frequent complications occurring after haematopoietic stem cell transplantation. Recently, renal involvement has been described as a manifestation of chronic graft-versus-host disease. Immunosuppression seems to play a major role: clinical disease is triggered by its tapering and resolution is achieved with the resumption of the immunosuppressive therapy. Prognosis is apparently favourable, but long term follow up data are lacking