Soroprevalência da infecção por Helicobacter pylori em crianças de baixo nível sócio-econômico em São Paulo

CONTEXT AND OBJECTIVE: Helicobacter pylori infection is mainly acquired during childhood, and is associated with significant morbidity in adults. The aim here was to evaluate the seroprevalence and risk factors of H. pylori infection among children of low socioeconomic level attended at a public hospital in São Paulo, Brazil. DESIGN AND SETTING: Cross-sectional study, among patients attended at an outpatient clinic. METHODS: 326 children were evaluated (150 boys and 176 girls; mean age 6.82 ± 4.07 years) in a cross-sectional study. Patients with chronic diseases or previous H. pylori treatment, and those whose participation was not permitted by the adult responsible for the child, were excluded. The adults answered a demographic questionnaire and blood samples were collected. The serological test used was Cobas Core II, a second-generation test. Titers > 5 U/ml were considered positive. RESULTS: H. pylori infection was diagnosed in 116 children (35.6%). Infected children were older than uninfected children (7.77 ± 4.08 years versus 5.59 ± 3.86 years; p 5 U/ml. RESULTADOS: Infecção por H. pylori foi diagnosticada em 116 (35,6%). A idade dos pacientes infectados foi maior que a dos demais (7,77 ± 4,08 anos versus 5,59 ± 3,86 anos; p < 0,0001). A prevalência aumenta de 20,8% entre dois e quatro anos de idade para 58,3% entre maiores de 12 anos. Não houve relação significativa entre soropositividade e sexo, raça, aleitamento materno, número de pessoas ou de cômodos na casa, compartilhamento de camas, domicílio em favela, escolaridade materna, renda familiar ou estado nutricional. Na análise multivariada, a única variável significativamente associada a soropositividade foi idade. CONCLUSÃO: A infecção possui prevalência intermediária na população estudada, e a idade foi associada a maior prevalência.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Division of Pediatric GastroenterologyUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of PediatricsUNIFESP, EPM, Division of Pediatric GastroenterologyUNIFESP, EPM, Department of PediatricsSciEL

Understanding the potential-induced activation of a cobalt MOF electrocatalyst for the oxygen evolution reaction

Metal–organic frameworks (MOFs) are attractive porous materials for electrocatalytic applications associated with carbon-free energy storage and conversion. This type of material usually requires a post-treatment to be used as electrocatalyst. The present work comprehensively investigates the electrochemical activation of a cobalt-MOF@Nafion composite that produces outstanding electrocatalytic performance for the water oxidation reaction at neutral pH. A detailed electrochemical characterization reveals that the electroactivation of the composite requires the participation of the oxygen evolution reaction (OER) and leads to a significant increase in the electroactive population of cobalt centers. It is shown that an increase of the applied activation potential in the OER region results in a faster electroactivation of the Co-MOF without affecting the intrinsic electrocatalytic properties of the active cobalt centers, as evidenced by the unique linear correlation between the electrocatalytic OER current and the population of electroactive cobalt. In addition, at structural level, it is shown that the electrochemical activation causes the partial disruption of the Nafion adlayer, as well as morphological changes of the Co–MOF particles from a compact, rounded morphology, before electrochemical activation, to a more open and expanded structure, after electroactivation; with the concomitant increase of the number of surface–exposed cobalt centers. Interestingly, these cobalt centers retain their coordinative chemistry and their laminar distribution in the nanosheets at the nanoscale, which is consistent with the preservation of their intrinsic electrocatalytic activity after potential–induced activation. In this scenario, these results suggest that only the electroactivated cobalt centers with good accessibility to the electrolyte are electrochemically active. This work provides a better understanding of the processes and structural changes underlying the electrochemical activation at neutral pH of a Co–MOF for boosting the electrocatalytic water oxidation reaction9 página

Partial reconstruction of the pinna due to blunt traumatic injury

Introduction: The pinna, due to its anatomical situation is susceptible to a series of traumatic or pathological injuries, making its reconstruction a real challenge for the surgeon in charge of maintaining symmetry with the contralateral pinna as its complex structure. Objective: To present a patient who underwent partial reconstruction of the pinna due to blunt traumatic injury. Case Report: Patient attended in emergency with loss of the helical border, after a fight, suffered blunt trauma with avulsive injury of the pinna. Reconstruction was performed with a versatile and simple technique, which requires compliance with all the requirements of asepsis, adequate suturing and anatomical repair, to expect good postoperative results, including from the aesthetic point of view. Conclusions: Early care, aseptic and antisepsis conditions, with a surgical technique according to Weerda's classification, are important to achieve adequate aesthetic results, without complications

Non-invasive diagnostic tests for Helicobacter pylori infection

BACKGROUND: Helicobacter pylori (H pylori) infection has been implicated in a number of malignancies and non-malignant conditions including peptic ulcers, non-ulcer dyspepsia, recurrent peptic ulcer bleeding, unexplained iron deficiency anaemia, idiopathic thrombocytopaenia purpura, and colorectal adenomas. The confirmatory diagnosis of H pylori is by endoscopic biopsy, followed by histopathological examination using haemotoxylin and eosin (H & E) stain or special stains such as Giemsa stain and Warthin-Starry stain. Special stains are more accurate than H & E stain. There is significant uncertainty about the diagnostic accuracy of non-invasive tests for diagnosis of H pylori. OBJECTIVES: To compare the diagnostic accuracy of urea breath test, serology, and stool antigen test, used alone or in combination, for diagnosis of H pylori infection in symptomatic and asymptomatic people, so that eradication therapy for H pylori can be started. SEARCH METHODS: We searched MEDLINE, Embase, the Science Citation Index and the National Institute for Health Research Health Technology Assessment Database on 4 March 2016. We screened references in the included studies to identify additional studies. We also conducted citation searches of relevant studies, most recently on 4 December 2016. We did not restrict studies by language or publication status, or whether data were collected prospectively or retrospectively. SELECTION CRITERIA: We included diagnostic accuracy studies that evaluated at least one of the index tests (urea breath test using isotopes such as13C or14C, serology and stool antigen test) against the reference standard (histopathological examination using H & E stain, special stains or immunohistochemical stain) in people suspected of having H pylori infection. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the references to identify relevant studies and independently extracted data. We assessed the methodological quality of studies using the QUADAS-2 tool. We performed meta-analysis by using the hierarchical summary receiver operating characteristic (HSROC) model to estimate and compare SROC curves. Where appropriate, we used bivariate or univariate logistic regression models to estimate summary sensitivities and specificities. MAIN RESULTS: We included 101 studies involving 11,003 participants, of which 5839 participants (53.1%) had H pylori infection. The prevalence of H pylori infection in the studies ranged from 15.2% to 94.7%, with a median prevalence of 53.7% (interquartile range 42.0% to 66.5%). Most of the studies (57%) included participants with dyspepsia and 53 studies excluded participants who recently had proton pump inhibitors or antibiotics.There was at least an unclear risk of bias or unclear applicability concern for each study.Of the 101 studies, 15 compared the accuracy of two index tests and two studies compared the accuracy of three index tests. Thirty-four studies (4242 participants) evaluated serology; 29 studies (2988 participants) evaluated stool antigen test; 34 studies (3139 participants) evaluated urea breath test-13C; 21 studies (1810 participants) evaluated urea breath test-14C; and two studies (127 participants) evaluated urea breath test but did not report the isotope used. The thresholds used to define test positivity and the staining techniques used for histopathological examination (reference standard) varied between studies. Due to sparse data for each threshold reported, it was not possible to identify the best threshold for each test.Using data from 99 studies in an indirect test comparison, there was statistical evidence of a difference in diagnostic accuracy between urea breath test-13C, urea breath test-14C, serology and stool antigen test (P = 0.024). The diagnostic odds ratios for urea breath test-13C, urea breath test-14C, serology, and stool antigen test were 153 (95% confidence interval (CI) 73.7 to 316), 105 (95% CI 74.0 to 150), 47.4 (95% CI 25.5 to 88.1) and 45.1 (95% CI 24.2 to 84.1). The sensitivity (95% CI) estimated at a fixed specificity of 0.90 (median from studies across the four tests), was 0.94 (95% CI 0.89 to 0.97) for urea breath test-13C, 0.92 (95% CI 0.89 to 0.94) for urea breath test-14C, 0.84 (95% CI 0.74 to 0.91) for serology, and 0.83 (95% CI 0.73 to 0.90) for stool antigen test. This implies that on average, given a specificity of 0.90 and prevalence of 53.7% (median specificity and prevalence in the studies), out of 1000 people tested for H pylori infection, there will be 46 false positives (people without H pylori infection who will be diagnosed as having H pylori infection). In this hypothetical cohort, urea breath test-13C, urea breath test-14C, serology, and stool antigen test will give 30 (95% CI 15 to 58), 42 (95% CI 30 to 58), 86 (95% CI 50 to 140), and 89 (95% CI 52 to 146) false negatives respectively (people with H pylori infection for whom the diagnosis of H pylori will be missed).Direct comparisons were based on few head-to-head studies. The ratios of diagnostic odds ratios (DORs) were 0.68 (95% CI 0.12 to 3.70; P = 0.56) for urea breath test-13C versus serology (seven studies), and 0.88 (95% CI 0.14 to 5.56; P = 0.84) for urea breath test-13C versus stool antigen test (seven studies). The 95% CIs of these estimates overlap with those of the ratios of DORs from the indirect comparison. Data were limited or unavailable for meta-analysis of other direct comparisons. AUTHORS' CONCLUSIONS: In people without a history of gastrectomy and those who have not recently had antibiotics or proton ,pump inhibitors, urea breath tests had high diagnostic accuracy while serology and stool antigen tests were less accurate for diagnosis of Helicobacter pylori infection.This is based on an indirect test comparison (with potential for bias due to confounding), as evidence from direct comparisons was limited or unavailable. The thresholds used for these tests were highly variable and we were unable to identify specific thresholds that might be useful in clinical practice.We need further comparative studies of high methodological quality to obtain more reliable evidence of relative accuracy between the tests. Such studies should be conducted prospectively in a representative spectrum of participants and clearly reported to ensure low risk of bias. Most importantly, studies should prespecify and clearly report thresholds used, and should avoid inappropriate exclusions

El Toreo de Sevilla : revista semanal de intereses locales, literatura, espectáculos y anuncios: Año II Número 47 - 29 Enero 1882

Copia digital. Ministerio de Educación, Cultura y Deporte. Subdirección General de Coordinación Bibliotecaria : Madrid, 201

Evaluation of enzyme-linked immunosorbent assay for the diagnosis of Helicobacter pylori infection in children and adolescents

A infeccao por Helicobacter pylori (Hp) e reconhecida como a causa mais frequente de gastrite cronica em adultos e criancas. O seu diagnostico e realizado com metodos invasivos em fragmentos de mucosa gastrica obtidos com pinca endoscopica e os metodos nao invasivos. O metodo imunoenzimatico constitui exame simples, rapido e de baixo custo apresentando alta sensibilidade em pacientes adultos. O objetivo do estudo foi avaliar o metodo ELISA para o diagnostico da infeccao por Hp em criancas e adolescentes. Considerou-se Hp positivo quando o teste rapido da urease (TRU) e a histologia (H) foram ambos positivos ou quando a cultura (C) foi positiva e Hp negativo quando todos os testes foram negativos. Foram estudados 111pacientes , com idade compreendida entre 3 meses e 16 anos, (media= 8a 7m n4.0; M= 9 a 5m)sendo 45 por cento do sexo masculino e 55 por cento do sexo feminino. Infeccao por Hp foi diagnosticada em 47.7 por cento (52/111). A sensibilidade da sorologia foi de 83 por cento e 86 por cento e a especificidade foi de 70.6 por cento e 71 por cento, utilizando o ponto de corte de 7 U/ml e 5 U/ml respectivamente. Em pacientes maiores de 10 anos de idade, a sensibilidade foi de 90.6 por cento e 96.8 por cento e a especificidade foi de 71.0 por cento e 61.9 por cento, com ponto de corte de 7 U/ml e 5 U/ml respectivamente. Quando foi utilizada somente a cultura positiva como padrao ouro e ponto de corte em 5 U/ml, a sensibilidade foi de 93.3 por cento, Conclui-se que o metodo ELISA apresentou boa sensibilidade em criancas maiores de 10 anos, utilizando o ponto de corte de 5 U/ml, porem a especificidade foi baixaBV UNIFESP: Teses e dissertaçõe

Natural evaluation of Helicobacter pylori infection in asyntomatic students by the Helicobacter pylory antigen stool

Objetivos: Determinar a evolução da natural da infecção, prevalência e fatores sociodemográficos associados à infecção pelo Helicobacter pylori através do antígeno fecal do Helicobacter pylori (HpSA) em coorte de crianças escolares durante três anos consecutivos. Métodos: Estudo de corte transversal e estudo de coorte longitudinal. Casuística: 213 escolares de 6 meses a 7 anos de idade, de ambos os sexos, da Escola Paulistinha de Educação, que atende exclusivamente filhos de funcionários do complexo hospitalar vinculado à UNIFESP/Escola Paulista de Medicina, São Paulo/SP. Realizou-se questionário sociodemográfico e clínico e coletaram-se amostras de fezes para realização do teste HpSA. Posteriormente analisou-se coorte de 109 escolares em três anos consecutivos. O teste HpSA (Meridian Diagnostics Inc) foi feito de acordo com a técnica descrita pelo fabricante com algumas modificações. Resultado positivo amostras com DO >= 0,160; negativo com DO 0,140 e < 0,160. Métodos estatísticos: Teste t-Student e teste do Qui Quadrado para comparação de médias e tabelas de contingência. Análise de regressão logística com as variáveis selecionadas e teste de razão de verosimilhança. O nível de significancia considerado foi de 5 por cento. Resultados: A idade das 213 crianças variou de 0,5 - 7,69 anos (Média +/- DP= 3,88+/-2,OOa; Mediana= 3,69a); 45,5 por cento masculino e 54,5 por cento feminino. O teste foi positivo em 13,2 por cento, negativo em 79,3 por cento e inconclusivo em 7,5 por cento. O risco de contrair a infecção foi 2,6 vezes maior nos primeiros 4 anos em relação aos maiores de 4 anos de idade (p= 0,036/OR= 2,6), crianças de cor não branca (p= 0,086/OR= 2,1) e do sexo masculino (p= 0,126/OR= 1,96). 0 estudo de coorte …(au).BV UNIFESP: Teses e dissertaçõe

Evaluación de impactos a la salud del manglar en el municipio Guamá, Santiago de Cuba, Cuba

The aim of this study was to characterize the health status of mangroves in the Guamá municipality in Santiago de Cuba, Cuba. The methodology included the evaluation of the physiognomic aspects of the forest and its health index. Seventy-eight interviews were conducted with people of settlements neighboring the areas studied in order to assess the knowledge and community behavior regarding the mangroves. Fourteen environmental stressors were identified, among which are reported for the first time in Cuban studies, the sedimentation or accretion of sediments, as well as road construction, the advance of the agricultural frontier, cattle ranching, timber extraction and illegal logging. It is concluded that the health of the nine mangroves studied ranged from very high to low, according to the number of environmental stressors in each one. A total of 85% of environmental stressors in the area are of human origin, specifically related to socioeconomic development, while 15% are related to natural events. Finally, ecosystem health in the Guamá municipality is low, in spite of which they still maintain their environmental services.El objetivo del presente artículo fue caracterizar el estado de salud de los manglares en el municipio Guamá, Santiago de Cuba, Cuba. Se evaluaron aspectos fisonómicos del bosque y su índice de salud. Se realizaron 78 entrevistas a personas en los asentamientos próximos a las áreas estudiadas para evaluar el conocimiento y comportamiento comunitario sobre los manglares. Se identificaron 14 tensores ambientales entre los cuales se documenta por primera vez en los estudios cubanos la sedimentación o acreción de sedimentos además de la construcción de viales, el avance de la frontera agrícola, la ganadería, la extracción de madera y la tala furtiva. Se concluye que, en los nueve manglares estudiados, la salud varió de muy alta a baja de acuerdo con el número de tensores ambientales en cada uno de ellos. De los tensores ambientales en la zona, 85% son de origen antrópico, específicamente relacionado con el desarrollo socioeconómico y 15% relacionado con eventos naturales. De manera general, la salud del ecosistema en el municipio Guamá es baja, a pesar de lo cual mantienen sus servicios ambientales