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A new alternative for hydrodynamic cavitation-assisted pretreatment of sugarcane bagasse was proposed, along with a simultaneous saccharification and co-fermentation (SSCF) process performed in interconnected columns. Influential variables in the pretreatment were evaluated using a statistical design, indicating that an ozone flow rate of 10 mg min-1 and a pH of 5.10 resulted in 86 % and 72 % glucan and xylan hydrolysis yields, respectively, in the subsequent enzymatic hydrolysis process. Under these optimized conditions, iron sulfate (15 mg L-1) was added to assess Fenton pretreatment, resulting in glucan and xylan hydrolysis yields of 92 % and 71 %, respectively, in a material pretreated for 10 min. In SSCF, ethanol volumetric productivities of 0.33 g L-1 h-1 and of 0.54 g L-1 h-1 were obtained in batch and fed-batch operation modes, achieving 26 g L-1 of ethanol in 48 h in the latter mode.

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O exercício físico reduz risco de doenças cardiovasculares, metabólicas e está relacionada a aumento do bem-estar e longevidade. Alguns estudos sugerem redução do risco de arritmias, como a fibrilação atrial, em até 19% em homens e 9% em mulheres. Contudo, observa-se prevalência superior, de até 3,5 vezes, de desenvolvimento de fibrilação atrial em praticantes de exercícios de muito alta intensidade ou competitiva, tornando essa a arritmia mais frequente no atleta. Os indivíduos sob maior risco são homens, praticantes de endurance de alta intensidade e com alto volume. A presença de fibrilação atrial, ainda que paroxística, impacta negativamente sobre a capacidade funcional e performance nesses indivíduos, seja pela redução do débito cardíaco pela perda da contração atrial ou pela perda de controle da frequência cardíaca pelo sistema nervoso autônomo. A evidência atual disponível para guiar o manejo desses pacientes se baseia em estudos randomizados em pacientes portadores de FA não atletas, estudos menores em atletas ou em consenso de especialista e o tratamento se baseia nos pilares de controle de ritmo farmacológico ou intervencionista por meio de ablação por radiofrequência ou destrainamento. Esse relato de caso tem como objetivo apresentar a evolução de paciente atleta com fibrilação atrial tratado de forma não invasiva, com destreinamento, de forma a revisar e ampliar o conhecimento sobre o tema. RELATO DE CASO: Paciente, sexo masculino, 42 anos, sem comorbidades prévias, pratica esporte competitivo desde os 15 anos nas modalidades: mountain bike, triátlon e maratona. Procura atendimento médico, sem queixas, solicitando liberação para realização de prova triathlon ironman. Ao exame físico apresentava ausculta cardíaca com frequência de 50 bpm e ritmo irregular, sem outras alterações. O eletrocardiograma apresentava ritmo de fibrilação atrial com baixa resposta ventricular. Foi realizada investigação de cardiopatia estrutural com ecocardiograma que revelou átrio esquerdo aumentado, com volume indexado de 40ml/ m2. Função biventricular preservada. Sem outros achados. Em teste ergométrico, apresentava resposta adequada da frequência cardíaca ao esforço, com excelente capacidade funcional e sem alterações sugestivas de isquemia. Holter evidenciava apenas presença de fibrilação atrial. Foi optado então por tratamento com destreinamento por 3 meses. Após, paciente realizou holter que apresentava ritmo sinusal. Foi mantido seguimento por um ano, com repetição de holter 24h que se manteve em ritmo sinusal.

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Avaliaram-se a biocompatibilidade e a biodegradabilidade do sistema de liberação controlada de poli-lactato-co-glicolato (PLGA) no tratamento com ciprofloxacina das ceratites por Staphylococcus aureus em coelhos. Foram utilizados 20 coelhos, distribuídos em quatro grupos (G). Os animais dos G1, G3 e G4 foram inoculados com 2,5µL da bactéria - 108UFC, no estroma corneano. Os do G2 não receberam a aplicação do inóculo. O tratamento foi realizado com solução salina básica para os animais do G1, micropartículas de PLGA contendo ciprofloxacina nos animais dos G2 e G4 e colírio de ciprofloxacina naqueles do G3. Suabe e biópsia da superfície ocular foram coletados para cultura. Apenas um animal do G1 apresentou cultura positiva para S. aureus. Exame histológico revelou a presença bacteriana em todos os animais do G1 e em dois animais do G3. Também foi constatada reação inflamatória no local da aplicação do sistema de liberação controlada. O tratamento com micropartículas de PLGA foi eficiente no tratamento de ceratites bacterianas, ao eliminar por completo a presença do S. aureus, mas entretanto não foi completamente biocompatível e biodegradável após cinco dias.

The biocompatibility and biodegradability of the controlled delivery system of Poly-Latic-Co-Glucolatic (PLGA) in the treatment of Staphylococcus aureus keratitis with ciprofloxacin in rabbits were evaluated. Twenty rabbits divided into four groups (G) were used. G1, G3 and G4 animals were inoculated with bacterial 2.5µL (108CFU) in the corneal stroma, and G2 animals did not receive the application of inoculum. The treatment was performed with basic saline solution in G1 rabbits, micro particles of PLGA containing ciprofloxacin in G2 and G4 animals, and ciprofloxacin eye drops in G3 rabbits. Swab and biopsy of the ocular surface were collected for culture. Only one animal in G1 had positive culture for S. aureus in the processed material. Histological examination showed a bacterial presence in all animals in G1 and two animals in G3. Inflammatory reaction was noted at the application site of the controlled release. Data analysis showed that treatment with micro particles of PLGA was effective in treating bacterial keratitis, completely eliminating the presence of S. aureus, but it was not being completely biocompatible and biodegradable after five days.

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Keeping snakes in captivity to produce venom for scientific research and production of inputs is now a worldwide practice. Maintaining snakes in captivity involves capture, infrastructure investments, management techniques, and appropriate qualified personnel. Further, the success of the project requires knowledge of habitat, nutrition, and reproduction, and control of opportunistic infections. This study evaluated the management of snakes in three types of captivity (quarantine, intensive, and semiextensive) and diagnosed bacterial and fungal contaminants. A bacteriological profile was obtained by swabbing the oral and cloacal cavities, scales, and venoms of healthy adult snakes from Bothrops jararaca (Bj) and Crotalus durissus terrificus (Cdt). There was predominance of Enterobacteriaceae, especially non-fermenting Gram-negative bacilli excluding Pseudomonas spp and Gram- positive bacteria. Statistically, intensive captivity resulted in the highest number of bacterial isolates, followed by recent capture (quarantine) and by semiextensive captivity. No statistical difference was found between Bj and Cdt bacterial frequency. In vitro bacterial susceptibility testing found the highest resistance against the semisynthetic penicillins (amoxicillin and ampicillin) and highest sensitivity to amicacin and tobramycin aminoglycosides. To evaluate mycological profile of snakes from intensive captivity, samples were obtained from two healthy Bj and one B. moojeni, one B. pauloensis, and one Cdt showing whitish lesions on the scales suggestive of ringworm. Using conventional methods and DNA-based molecular procedures, five samples of Trichosporon asahii were identified. Despite the traditional role of intense captivity in ophidian venom production, semiextensive captivity was more effective in the present study by virtue of presenting superior control of bacterial and fungal transmission, easier management, lowest cost, and decreased rate of mortality; therefore, it should be considered as a good alternative for tropical countries.

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Avaliaram-se a biocompatibilidade e a biodegradabilidade do sistema de liberação controlada de poli-lactato-co-glicolato (PLGA) no tratamento com ciprofloxacina das ceratites por Staphylococcus aureus em coelhos. Foram utilizados 20 coelhos, distribuídos em quatro grupos (G). Os animais dos G1, G3 e G4 foram inoculados com 2,5µL da bactéria - 108UFC, no estroma corneano. Os do G2 não receberam a aplicação do inóculo. O tratamento foi realizado com solução salina básica para os animais do G1, micropartículas de PLGA contendo ciprofloxacina nos animais dos G2 e G4 e colírio de ciprofloxacina naqueles do G3. Suabe e biópsia da superfície ocular foram coletados para cultura. Apenas um animal do G1 apresentou cultura positiva para S. aureus. Exame histológico revelou a presença bacteriana em todos os animais do G1 e em dois animais do G3. Também foi constatada reação inflamatória no local da aplicação do sistema de liberação controlada. O tratamento com micropartículas de PLGA foi eficiente no tratamento de ceratites bacterianas, ao eliminar por completo a presença do S. aureus, mas entretanto não foi completamente biocompatível e biodegradável após cinco dias.(AU)

The biocompatibility and biodegradability of the controlled delivery system of Poly-Latic-Co-Glucolatic (PLGA) in the treatment of Staphylococcus aureus keratitis with ciprofloxacin in rabbits were evaluated. Twenty rabbits divided into four groups (G) were used. G1, G3 and G4 animals were inoculated with bacterial 2.5µL (108CFU) in the corneal stroma, and G2 animals did not receive the application of inoculum. The treatment was performed with basic saline solution in G1 rabbits, micro particles of PLGA containing ciprofloxacin in G2 and G4 animals, and ciprofloxacin eye drops in G3 rabbits. Swab and biopsy of the ocular surface were collected for culture. Only one animal in G1 had positive culture for S. aureus in the processed material. Histological examination showed a bacterial presence in all animals in G1 and two animals in G3. Inflammatory reaction was noted at the application site of the controlled release. Data analysis showed that treatment with micro particles of PLGA was effective in treating bacterial keratitis, completely eliminating the presence of S. aureus, but it was not being completely biocompatible and biodegradable after five days.(AU)

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Staphylococcus aureus and coagulase-negative Staphylococcus (CoNS) are frequently found in nosocomial environments as the main pathogen in several infections. In 1961, reports of nosocomial S. aureus resistant to methicillin, the drug of choice against penicillin-resistant strains, required new alternatives and vancomycin started being used to treat infections caused by methicillin-resistant S. aureus (MRSA). Community-acquired methicillin-resistant S. aureus (CA-MRSA) was first reported in 1990 affecting patients without risk factors for infection with MRSA of hospital origin. MRSA of community origin harbor the genes responsible for the synthesis of Panton-Valentine leukocidin (PVL), a toxin associated with skin and soft tissue infections and that carries the staphylococcal cassette chromosome mec (SCCmec) type IV. CA-MRSA emergence has caused great impact on the worldwide medical community since the presence of this pathogen in patients without risk factors represents a high risk to public health.

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Staphylococcus aureus and coagulase-negative Staphylococcus (CoNS) are frequently found in nosocomial environments as the main pathogen in several infections. In 1961, reports of nosocomial S. aureus resistant to methicillin, the drug of choice against penicillin-resistant strains, required new alternatives and vancomycin started being used to treat infections caused by methicillin-resistant S. aureus (MRSA). Community-acquired methicillin-resistant S. aureus (CA-MRSA) was first reported in 1990 affecting patients without risk factors for infection with MRSA of hospital origin. MRSA of community origin harbor the genes responsible for the synthesis of Panton-Valentine leukocidin (PVL), a toxin associated with skin and soft tissue infections and that carries the staphylococcal cassette chromosome mec (SCCmec) type IV. CA-MRSA emergence has caused great impact on the worldwide medical community since the presence of this pathogen in patients without risk factors represents a high risk to public health.(AU)

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Avaliou-se a concentração de ofloxacina liberada por uma lente de contato de membrana de celulose biossintética, para tratamento de ceratite bacteriana experimental em cães, pela inoculação de Staphylococcus aureus intraestromal. Comparou-se o tratamento com a lente de contato biossintética impregnada com ofloxacina à terapia tópica convencional. Realizou-se avaliação microbiológica e dosagem de ofloxacina no humor aquoso por meio do método de cromatografia líquida de alto rendimento (HPLC). Houve diferença estatística na contagem de colônias bacterianas entre os olhos com ceratite e os demais grupos, no primeiro dia de coleta. O biomaterial, impregnado com ofloxacina, promoveu liberação gradual durante o período de avaliação, aos três e sete dias; no terceiro dia, o grupo tratado com a lente de contato obteve mediana de 3,72μg/mL, enquanto o grupo tratado com colírio resultou em 49,56μg/mL. Apesar do valor inferior, o grupo com lente de contato atingiu a concentração inibitória mínima, sendo eficaz no controle da infecção bacteriana.

The concentration of ofloxacin released by contact lens made of biosynthetic cellulose membrane was evaluated for the treatment of experimental bacterial keratitis in dogs by intrastromal inoculation of Staphylococcus aureus. The biosynthetic contact lens impregnated with ofloxacin was compared with the conventional topical therapy. The microbiological evaluation and the determination of ofloxacin in aqueous humor were evaluated by high performance liquid chromatography (HPLC). There was not statistical difference in the counting of bacterial colonies among the eyes with keratitis and other groups, on the first day of collection. The biomaterial, impregnated with ofloxacin, promoted gradual release during the evaluation period, at three and seven days; on the third day, the group treated with the contact lens obtained a median of 3.72μg/mL, while the group treated with eye drops resulted in 49.56μg/mL. Despite the lower value, the group with contact lens reached the minimum inhibitory concentration, which was effective in controlling the bacterial infection.

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Avaliou-se a concentração de ofloxacina liberada por uma lente de contato de membrana de celulose biossintética, para tratamento de ceratite bacteriana experimental em cães, pela inoculação de Staphylococcus aureus intraestromal. Comparou-se o tratamento com a lente de contato biossintética impregnada com ofloxacina à terapia tópica convencional. Realizou-se avaliação microbiológica e dosagem de ofloxacina no humor aquoso por meio do método de cromatografia líquida de alto rendimento (HPLC). Houve diferença estatística na contagem de colônias bacterianas entre os olhos com ceratite e os demais grupos, no primeiro dia de coleta. O biomaterial, impregnado com ofloxacina, promoveu liberação gradual durante o período de avaliação, aos três e sete dias; no terceiro dia, o grupo tratado com a lente de contato obteve mediana de 3,72μg/mL, enquanto o grupo tratado com colírio resultou em 49,56μg/mL. Apesar do valor inferior, o grupo com lente de contato atingiu a concentração inibitória mínima, sendo eficaz no controle da infecção bacteriana.(AU)

The concentration of ofloxacin released by contact lens made of biosynthetic cellulose membrane was evaluated for the treatment of experimental bacterial keratitis in dogs by intrastromal inoculation of Staphylococcus aureus. The biosynthetic contact lens impregnated with ofloxacin was compared with the conventional topical therapy. The microbiological evaluation and the determination of ofloxacin in aqueous humor were evaluated by high performance liquid chromatography (HPLC). There was not statistical difference in the counting of bacterial colonies among the eyes with keratitis and other groups, on the first day of collection. The biomaterial, impregnated with ofloxacin, promoted gradual release during the evaluation period, at three and seven days; on the third day, the group treated with the contact lens obtained a median of 3.72μg/mL, while the group treated with eye drops resulted in 49.56μg/mL. Despite the lower value, the group with contact lens reached the minimum inhibitory concentration, which was effective in controlling the bacterial infection.(AU)

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Staphylococcus aureus is the main agent of infections during peritoneal dialysis (PD). The presence of S. aureus in the nasal cavity has been extensively studied and suggested as a risk factor of dialysis-related infections, whereas coagulase-negative Staphylococcus (CNS) species are frequently considered part of the normal human microbiota. The aim of this study was to identify Staphylococcus in the nasal cavity, pericatheter skin and peritoneal effluent from PD patients, as well as to evaluate the antimicrobial activity evolution in vitro. Thirty-two chronic PD patients were observed during 12 months and had nasal and pericatheter skin samples collected for culture. When peritonitis was detected, samples were also collected from the peritoneal effluent for culture. The activity of several antimicrobial drugs (penicillin G, oxacillin, cephalothin, ofloxacin, netilmicin and vancomycin) against different Staphylococcus species was measured by using the agar drug diffusion assay (Kirby-Bauer method). Staphylococcus was separated into S. aureus, S. epidermidis and other CNS species in order to determine the in vitro resistance level. S. epidermidis resistance to oxacillin progressively increased during the study period (p < 0.05). Resistance to ofloxacin was inexpressive, whereas resistance to netilmicin and vancomycin was not detected. Of the oxacillin-resistant species (n = 74), 83 percent were S. epidermidis, 13 percent other CNS and 4 percent S. aureus (p < 0.05). Regarding multi-drug resistant strains (n = 45), 82 percent were S. epidermidis, 13 percent other CNS, and 5 percent S. aureus (p < 0.05). This study shows the relevance of resistance to oxacillin and CNS multi-drug resistance, particularly concerning S. epidermidis, in PD patients.

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Staphylococcus aureus is the main agent of infections during peritoneal dialysis (PD). The presence of S. aureus in the nasal cavity has been extensively studied and suggested as a risk factor of dialysis-related infections, whereas coagulase-negative Staphylococcus (CNS) species are frequently considered part of the normal human microbiota. The aim of this study was to identify Staphylococcus in the nasal cavity, pericatheter skin and peritoneal effluent from PD patients, as well as to evaluate the antimicrobial activity evolution in vitro. Thirty-two chronic PD patients were observed during 12 months and had nasal and pericatheter skin samples collected for culture. When peritonitis was detected, samples were also collected from the peritoneal effluent for culture. The activity of several antimicrobial drugs (penicillin G, oxacillin, cephalothin, ofloxacin, netilmicin and vancomycin) against different Staphylococcus species was measured by using the agar drug diffusion assay (Kirby-Bauer method). Staphylococcus was separated into S. aureus, S. epidermidis and other CNS species in order to determine the in vitro resistance level. S. epidermidis resistance to oxacillin progressively increased during the study period (p < 0.05). Resistance to ofloxacin was inexpressive, whereas resistance to netilmicin and vancomycin was not detected. Of the oxacillin-resistant species (n = 74), 83 percent were S. epidermidis, 13 percent other CNS and 4 percent S. aureus (p < 0.05). Regarding multi-drug resistant strains (n = 45), 82 percent were S. epidermidis, 13 percent other CNS, and 5 percent S. aureus (p < 0.05). This study shows the relevance of resistance to oxacillin and CNS multi-drug resistance, particularly concerning S. epidermidis, in PD patients.(AU)

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Malnutrition may be a consequence of energy deficit or micronutrient deficiency. It is considered the most relevant risk factor for illness and death, particularly in developing countries. In this review we described the magnitude of this problem, as well as its direct effect on the immune system and how it results in higher susceptibility to infections. A special emphasis was given to experimental models used to investigate the relationship between undernutrition and immunity. Malnutrition is obviously a challenge that must be addressed to health authorities and the scientific community.(AU)

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In addition to their capacity to attach to surfaces, various groups of microorganisms also produce an extracellular polymeric substance known as "slime". This slime forms a thin layer around cells known as biofilm. Thus, biofilm structure comprises bacterial cells and an extracellular polymeric substance. It also presents a defined architecture, providing the microorganisms with an excellent protective environment and favoring the exchange of genetic material between cells as well as intercellular communication. The ability to produce biofilm is observed in a large group of bacteria, including coagulase-negative staphylococci (CNS) which are the predominant microorganisms of normal skin flora and have been implicated as the causative agents of hospital infections. Bacteremia caused by these agents is common in immunodepressed persons, in patients with cancer, in adult and neonatal intensive care units (ICU) and in patients using catheters or other prosthetic devices. The pathogenicity of CNS infections is probably related to the production of slime, which adheres preferentially to plastic and smooth surfaces, forming a biofilm that protects against attacks from the immune system and against antibiotic treatment, a fact hindering the eradication of these infections. The main objective of the present review was to describe basic and genetic aspects of biofilm formation and methods for its detection, with emphasis on biofilm creation by CNS and its relationship with diseases caused by these microorganisms which are becoming increasingly more frequent in the hospital environment.

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The presence of Staphylococcus aureus in the nasal cavities and pericatheter skin of peritoneal dialysis patients put them at high risk of developing peritonitis. However, it is not clear whether the presence of coagulase-negative staphylococci (CNS) in the nasal passages and skin of patients is related to subsequent occurrence of peritoneal infection. The aim of the present study was to verify the relationship between endogenous sources of S. aureus and CNS and occurrence of peritonitis in patients undergoing peritoneal dialysis. Thirty-two patients on peritoneal hemodialysis were observed for 18 months. Staphylococcus species present in their nasal passage, pericatheter skin and peritoneal effluent were identified and compared based on drug susceptibility tests and dendrograms, which were drawn to better visualize the similarity among strains from extraperitoneal sites as well as their involvement in the causes of infection. Out of 288 Staphylococcus strains isolated, 155 (53.8 percent) were detected in the nasal cavity, 122 (42.4 percent) on the skin, and 11 (3.8 percent) in the peritoneal effluent of patients who developed peritonitis during the study. The most frequent Staphylococcus species were CNS (78.1 percent), compared with S. aureus (21.9 percent). Among CNS, S. epidermidis was predominant (64.4 percent), followed by S. warneri (15.1 percent), S. haemolyticus (10.7 percent), and other species (9.8 percent). Seven (64 percent) out of 11 cases of peritonitis analyzed presented similar strains. The same strain was isolated from different sites in two (66 percent) out of three S. aureus infection cases. In the six cases of S. epidermidis peritonitis, the species that caused infection was also found in the normal flora. From these, two cases (33 percent) presented highly similar strains and in three cases (50 percent), it was difficult to group strains as to similarity. Patients colonized with multidrug-resistant S. epidermidis...

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Enterococcus faecalis is considered a pathogen responsible for hospital infections and, due to its frequent multi-resistant profile, has caused preoccupations among many medical authorities. The objective of this study was to determine the antimicrobial susceptibility of 74 strains isolated from blood cultures and purulent secretions to vancomycin and ciprofloxacin through the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) by using the Microdilution test. The results showed a greater efficacy of vancomycin compared to ciprofloxacin (98.6% of the strains were inhibited by vancomycin at lower concentrations: 0.06 - 1 mg/ml). However, in the MBC analysis 73% of the strains showed a MBC of vancomycin only at high concentrations (equal to or higher than 64 mg/ml). For ciprofloxacin, the strains showed a broad sensitivity with MICs and MBCs distributed along all the MIC classes. Results also revealed a probability that some strains are tolerant to vancomycin, which indicates the need of other tests to confirm this characteristic

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Coagulase-negative staphylococci (CNS), components of the normal flora of neonates, have emerged as important opportunistic pathogens of nosocomial infections that occur in neonatal intensive care units. Some authors have reported the ability of some CNS strains, particularly Staphylococcus epidermidis, to produce a toxin similar to S. aureus delta toxin. This toxin is an exoprotein that has a detergent action on the membranes of various cell types resulting in rapid cell lysis. The objectives of the present study were to standardize the Polymerase Chain Reaction (PCR) technique for the detection of the gene responsible for the production of delta toxin (hld gene) in staphylococcal species isolated from catheters and blood cultures obtained from neonates, and to compare the results to those obtained with the phenotypic synergistic hemolysis method. Detection of delta toxin by the phenotypic and genotypic method yielded similar results for the S. aureus isolates. However, in S. epidermidis, a higher positivity was observed for PCR (97.4 por cento) compared to the synergistic hemolysis method (86.8 por cento). Among CNS, S. epidermidis was the most frequent islate and was a delta toxin producer. Staphylococcus simulans and S. warneri tested positive by the phenotypic method, but their positivity was not confirmed by PCR for the hld gene detection. These results indicate that different genes might be responsible for the production of this toxin in different CNS species, requiring highly specific primers for their detection. PCR was found to be rapid and reliable method for the detection of the hld gene in S. aureus and S. epidermidis

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A própolis é muito utilizada na chamada medicina popular devido as suas propriedades terapêuticas, com destaque para a ação antibacteriana. Estudos mostram que a composição do extrato de própolis (EP) pode influenciar tal propriedade. Assim, a ação antibacteriana da própolis foi verificada em um total de 61 linhagens de Staphylococcus aureus, isoladas de recém-nascidos. Foram preparados onze EP, variando-se a proporção de etanol como agente extrator, desde 0 por cento (extrato aquoso) até etanol 100 por cento. Em todos os EP foram utilizados 25g de própolis bruta em 100 mL de solvente. O teste de sensibilidade foi o da diluição (por cento V/V) dos EP em ágar e obtenção da Concentração Inibitória Mínima (CIM). Foram realizados ensaios controle de ação antibacteriana do etanol. A ação antiestafilocócica foi diretamente proporcional ao etanol contido na solução solvente, atingindo valores não estatisticamente distintos e máximos para as soluções entre 70 e 90 por cento de etanol, sendo os valores de CIM 90 por cento entre 0,4 e 0,6 por cento V-V, com destaque para o EP preparado com etanol 70 por cento, que foi o mais eficiente (CIM 90 por cento = 0,42 por cento V/V). Assim concluiu-se que a ação antiestafilocócica da própolis é influenciada pela composição do extrato e, consequentemente, pela concentração do etanol usado para a sua preparação.

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In areas of drug-resistant malaria, control programs may restrict chemotherapy until malaria has been confirmed via microscopy to contain costs and toxicity. In Brazil, patients travel to centralized laboratory posts (FNS) at great cost for diagnosis and treatment. A program was established through the bars of a mining town offering free dipstick diagnosis and mefloquine treatment on a 24-hr basis; falciparum malaria dipstick tests are accurate and easy to use. Outcomes were compared with historical data and results of a neighboring non-intervention village. Guidelines for dipstick use and treatment were followed for 98% of visits. The number of FNS visits was reduced from 2,316 (expected) to 1,097 (observed) with 626 dipstick tests applied. Ninety-five percent of those who visited the FNS experienced onset of malaria symptoms in the town where the FNS was located. There was an unexpected doubling of the malaria hospital admission rate. We demonstrate that dipstick testing can be used in a sustainable, community-based program that should be applicable in a wide variety of settings.

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OBJECTIVE: To evaluate the effect of cisapride and chest physical therapy on the gastroesophageal reflux of wheezing babies. METHODS: We prospectively assessed the presence of technetium ((99)Tc) in the upper, middle, and lower esophagus of 25 wheezing babies (13 with GERD and 12 without GERD) using scintigraphy. Both groups underwent clinical investigation, including laboratory, X-ray and scintigraphy tests, for the etiology of the wheezing baby syndrome (WBS) and GERD. Expiratory Flow Acceleration (EFA) was performed before and after treatment with cisapride. The total time of GER episodes was accounted for each portion of the esophagus during scintigraphy and during EFA. RESULTS: Cisapride significantly reduced the total reflux time in the upper esophagus (P<0.05), but showed no influence during EFA. After cisapride therapy, EFA increased the total reflux time in the upper and medium esophagus; however, no statistical significance was found. Infants with GERD presented a shorter total reflux time in the distal esophagus (P<0.05) during EFA. After cisapride treatment, no statistical significance was found. Infants without GERD also presented reduced total reflux time in the distal esophagus during EFA (P<0.05). Those with GERD had increased total reflux time in the distal esophagus (P<0.05) before and after cisapride treatment during EFA and scintigraphy. CONCLUSIONS: Cisapride was effective in reducing the total reflux time, mainly in the upper esophagus. EFA apparently increased the number of episodes of GER, without achieving statistical significance. Further studies are necessary to investigate the effects of chest physical therapy according to body positions.

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Gender-related differences in gastric emptying are still controversial. The aims of this study were: to confirm the sex-related difference in gastric emptying of a solid meal and to investigate its association with different patterns of meal distribution between the proximal and distal gastric compartments. Eighteen healthy volunteers (nine males, mean age 35 +/- 9 years; nine females, mean age: 41 +/- 11 years) were studied in the morning, after ingestion of the solid test-meal (an omelette labeled with 185MBq of 99mTc-sulfur colloid). Simultaneous anterior and posterior images of the stomach were acquired immediately after ingestion of the meal and every 10 minutes for 120 minutes. Time versus activity curves were obtained for the whole, proximal and distal stomach. Gastric T1/2 was longer in women (96.1 +/- 17.2 min) than in men (79.9 +/- 17.8 min; P = 0.02). The analysis of the meal distribution inside the stomach showed no differences between males and females in proximal gastric emptying, but the meal retention in the distal compartment was significantly increased among women (P = 0.04). In conclusion, gastric emptying of a solid meal is slower in pre-menopausal women than in age-matched men, probably due to an increased retention of the meal in the distal compartment. This should be taken into consideration to avoid misleading diagnosis of gastroparesis for female patients.

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