RESUMEN
BACKGROUND: Reliable mortality data are essential for the development of public health policies. In Brazil, although there is a well-consolidated universal system for mortality data, the quality of information on causes of death (CoD) is not even among Brazilian regions, with a high proportion of ill-defined CoD. Verbal autopsy (VA) is an alternative to improve mortality data. This study aimed to evaluate the performance of an adapted and reduced version of VA in identifying the underlying causes of non-forensic deaths, in São Paulo, Brazil. This is the first time that a version of the questionnaire has been validated considering the autopsy as the gold standard. METHODS: The performance of a physician-certified verbal autopsy (PCVA) was evaluated considering conventional autopsy (macroscopy plus microscopy) as gold standard, based on a sample of 2060 decedents that were sent to the Post-Mortem Verification Service (SVOC-USP). All CoD, from the underlying to the immediate, were listed by both parties, and ICD-10 attributed by a senior coder. For each cause, sensitivity and chance corrected concordance (CCC) were computed considering first the underlying causes attributed by the pathologist and PCVA, and then any CoD listed in the death certificate given by PCVA. Cause specific mortality fraction accuracy (CSMF-accuracy) and chance corrected CSMF-accuracy were computed to evaluate the PCVA performance at the populational level. RESULTS: There was substantial variability of the sensitivities and CCC across the causes. Well-known chronic diseases with accurate diagnoses that had been informed by physicians to family members, such as various cancers, had sensitivities above 40% or 50%. However, PCVA was not effective in attributing Pneumonia, Cardiomyopathy and Leukemia/Lymphoma as underlying CoD. At populational level, the PCVA estimated cause specific mortality fractions (CSMF) may be considered close to the fractions pointed by the gold standard. The CSMF-accuracy was 0.81 and the chance corrected CSMF-accuracy was 0.49. CONCLUSIONS: The PCVA was efficient in attributing some causes individually and proved effective in estimating the CSMF, which indicates that the method is useful to establish public health priorities.
Asunto(s)
Médicos , Adulto , Autopsia/métodos , Brasil , Causas de Muerte , Humanos , Encuestas y CuestionariosRESUMEN
Cerro de Pasco, Peru, has been excessively contaminated with heavy metals due to high mining activities in the region. We investigated the presence of chronic exposure to heavy metals in children living in Cerro de Pasco and its effect on health. Heavy metal concentrations were determined in hair samples collected from 78 children living in a region exposed to an open-pit mine (Paragsha region) and from other 16 children unexposed to mine activities (Carhuamayo region). Children exposed to the mine showed statistically significant higher concentration of aluminum, antimony, arsenic, cadmium, chromium, iron, lead, tin and thallium (p < 0.05) than control children. Hair samples collected from the same children in two occasions (2016 and 2018) showed that the exposure is chronic with higher levels of heavy metals observed in 2018. The concentration of heavy metals was higher in hair tip than in hair root samples. Heavy metals are associated with substantial higher risk of nosebleed (odds ratio, OR = 15.40), chronic colic (OR = 7.30), dermatologic alterations (OR = 6.16), mood alterations (OR = 7.07), presence of white lines on nails (OR = 12.10), reduced visual camp (OR = 3.97) and other symptoms (OR = 5.12). Chronic heavy metal exposure implies various negative consequences on children's health. Preventive measures are crucial to protect children's health.
Asunto(s)
Salud Infantil/estadística & datos numéricos , Cólico/epidemiología , Exposición a Riesgos Ambientales/análisis , Metales Pesados/efectos adversos , Metales Pesados/análisis , Trastornos del Humor/epidemiología , Enfermedades de la Uña/epidemiología , Enfermedades de la Piel/epidemiología , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Niño , Preescolar , Cólico/inducido químicamente , Cólico/patología , Exposición a Riesgos Ambientales/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Humor/inducido químicamente , Trastornos del Humor/patología , Enfermedades de la Uña/inducido químicamente , Enfermedades de la Uña/patología , Perú/epidemiología , Enfermedades de la Piel/inducido químicamente , Enfermedades de la Piel/patologíaRESUMEN
Yellow Fever Virus (YFV) reemergence in Brazil was followed by human suffering and the loss of biodiversity of neotropical simians on the Atlantic coast. The underlying mechanisms were investigated with special focus on distinct landscape fragmentation thresholds in the affected municipalities. An ecological study in epidemiology is employed to assess the statistical relationship between events of YFV and forest fragmentation in municipal landscapes. Negative binomial regression model showed that highly fragmented forest cover was associated with an 85% increase of events of YFV in humans and simians (RR = 1.85, CI 95% = 1.24-2.75, p=0.003) adjusted by vaccine coverage, population size, and municipality area. Intermediate levels of forest cover combined with higher levels of forest edge densities contribute to the YFV dispersion and the exponential growth of YF cases. Strategies for forest conservation are necessary for the control and prevention of YF and other zoonotic diseases that can spillover from the fragmented forest remains to populated cities of the Brazilian Atlantic coast.
Asunto(s)
Fiebre Amarilla , Animales , Brasil/epidemiología , Humanos , Fiebre Amarilla/epidemiología , Virus de la Fiebre Amarilla , ZoonosisRESUMEN
BACKGROUND: Notwithstanding the significant advances in automated imaging techniques in the past 2 decades, subjective evaluation of the optic disc still remains an important part of glaucoma propaedeutic. In places with limited resources and a high demand for ophthalmic care, anatomical evaluation of glaucoma cases often relies solely on slit-lamp-based fundus biomicroscopic examination, which is frequently performed without mydriasis. OBJECTIVE: The aim of this study was to compare metrics related to fundus biomicroscopy examination of the optic nerve head and peripapillary retinal nerve fiber layer (pRNFL) with and without mydriasis. MATERIAL AND METHODS: Healthy individuals, patients with early glaucoma, and glaucoma suspects were prospectively enrolled. Patients were examined before and after mydriasis by three glaucoma specialists, who estimated patients' vertical cup-to-disc ratio (CDR) and evaluated the presence of glaucomatous signs: laminar dot sign, disc hemorrhage, disc saucering, disc notching, peripapillary atrophy, localized pRNFL defect, and loss of the ISNT pattern. Main outcome measures were the intra-observer comparison, the inter-observer agreement, and the abilities to identify glaucomatous signs before and after mydriasis. RESULTS: Thirty patients (60 eyes) were enrolled (mean age, 62.3 ± 11.6 years). Considering the evaluation of the three examiners, the mean vertical CDR increased from 0.41 to 0.44 (p = 0.02), and the median of the coefficient of variation of the measures was reduced from 0.24 to 0.11 (p = 0.01) after mydriasis. Regarding the inter-observer agreement evaluation, the kappa coefficient values ranged from 0.64 to 0.72 before mydriasis and from 0.71 to 0.77 after mydriasis. Dot sign and disc notching were better identified through fundoscopic examination with mydriasis compared to the nonmydriatic examination (p < 0.01). CONCLUSION: Our results suggest that fundus biomicroscopy should be performed with mydriasis whenever possible, as it yells a better intra- and inter-observer agreement and improves the detection of glaucomatous signs. Moreover, examiners seem to underestimate CDR values without mydriasis. Further investigation is warranted to validate these findings by general ophthalmologists and in different populations.
Asunto(s)
Fondo de Ojo , Glaucoma/diagnóstico por imagen , Midriasis/fisiopatología , Oftalmoscopía/métodos , Disco Óptico/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fibras Nerviosas/patología , Estudios Prospectivos , Células Ganglionares de la Retina/patologíaRESUMEN
Extra-Amazonian malaria has been reported to be endemic in Brazil since the end of the 19th century. Currently, only a few cases are reported annually. However, recent findings of unexpected Plasmodium infections with uncertain transmission cycles in the Extra-Amazonian region could pose a threat to the malaria elimination agenda in Brazil.
Asunto(s)
Erradicación de la Enfermedad/tendencias , Malaria/prevención & control , Malaria/transmisión , Animales , Brasil , Erradicación de la Enfermedad/estadística & datos numéricos , Humanos , Malaria/parasitología , Plasmodium/fisiología , Investigación/tendenciasRESUMEN
Mosquitoes have a great epidemiological importance, since females of several species transmit etiological agents of human diseases, such as malaria and arboviruses. In Brazil, the state of Acre has been highlighted in recent years for its high incidence of diseases of relevance to public health, such as malaria, dengue, and leishmaniases, whose etiological agents are transmitted by insect vectors, including mosquitoes. Nevertheless, few studies have been carried out on the mosquito fauna in Acre State; this study aims to identify the culicid fauna of an ecological tourism area of the municipality of Xapuri, Acre State, Brazilian Amazon. Mosquito collections were carried out monthly at the Seringal Cachoeira settlement, between April 2014 and March 2015 using 6 automatic Centers for Disease Control and Prevention light traps, one in each ecotope. During the study period, 1,021 specimens belonging to the genera Aedeomyia, Aedes, Anopheles, Coquillettidia, Culex, Mansonia, Orthopodomyia, Psorophora, Trichoprosopon, and Uranotaenia were collected. The genus Culex was predominant, Culex (Culex) quinquefasciatus being the most frequent species, followed by Cx. (Melanoconion) gnomatos. The importance of these findings is discussed.
Asunto(s)
Distribución Animal , Culicidae , Mosquitos Vectores , Animales , Brasil , EcosistemaRESUMEN
OBJECTIVE: To describe the pain profile of patients with traumatic brachial plexus injury. METHODS: We enrolled 65 patients with traumatic brachial plexus injury. The Douleur Neuropathique 4 questionnaire was used to classify pain and the SF-36 was used to evaluate quality of life. RESULTS: The patients with traumatic brachial plexus injury were predominantly young male victims of motorcycle accidents. Pain was present in 75.4% of the individuals and 79% presented with neuropathic pain, mostly located in the hands (30.41%). The use of auxiliary devices (p = 0.05) and marital status (p = 0.03) were both independent predictors of pain. Pain also impacted negatively on the quality of life (p = 0.001). CONCLUSIONS: Pain is frequent in patients with traumatic brachial plexus injury. Despite the peripheral nervous system injury, nociceptive pain is not unusual. Pain evaluation, including validated instruments, is essential to guide optimal clinical management of patients with the condition.
Asunto(s)
Neuropatías del Plexo Braquial/epidemiología , Mano , Neuralgia/epidemiología , Dolor Nociceptivo/epidemiología , Adulto , Análisis de Varianza , Neuropatías del Plexo Braquial/complicaciones , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Estado Civil , Neuralgia/etiología , Dolor Nociceptivo/etiología , Dimensión del Dolor , Prevalencia , Calidad de Vida , Adulto JovenRESUMEN
ABSTRACT Objective To describe the pain profile of patients with traumatic brachial plexus injury. Methods We enrolled 65 patients with traumatic brachial plexus injury. The Douleur Neuropathique 4 questionnaire was used to classify pain and the SF-36 was used to evaluate quality of life. Results The patients with traumatic brachial plexus injury were predominantly young male victims of motorcycle accidents. Pain was present in 75.4% of the individuals and 79% presented with neuropathic pain, mostly located in the hands (30.41%). The use of auxiliary devices (p = 0.05) and marital status (p = 0.03) were both independent predictors of pain. Pain also impacted negatively on the quality of life (p = 0.001). Conclusions Pain is frequent in patients with traumatic brachial plexus injury. Despite the peripheral nervous system injury, nociceptive pain is not unusual. Pain evaluation, including validated instruments, is essential to guide optimal clinical management of patients with the condition.
RESUMO Objetivo Descrever o perfil de dor de sujeitos com lesão traumática do plexo braquial. Métodos Nós incluímos 65 indivíduos com lesão traumática do plexo braquial. O Douleur Neuropathique 4 foi usado para classificar a dor e o SF-36 foi usado para avaliar a qualidade de vida. Resultados Sujeitos com lesão traumática do plexo braquial eram em sua maioria homens jovens, vítimas de acidentes motociclísticos. A dor esteve presete em 75.4% dos indivíduos e 79% deles apresentaram dor neuropática, mais frequentemente localizada nas mãos (30.41%). O uso de dispositivos auxiliares (p = 0.05) e o estado civil foram, ambos, preditores independentes de dor. A dor ainda impactou negativamente da qualidade de vida (p = 0.001). Conclusões A dor é frequente em sujeitos com lesão traumática do plexo braquial. Apesar de envolver uma lesão do sistema nervoso a dor nociceptiva não é infrequente. A avaliação da dor, incluindo instrumentos validados, é essencial para direcionar as condutas clínicas de sujeitos com esta condição.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Adulto Joven , Neuropatías del Plexo Braquial/epidemiología , Dolor Nociceptivo/epidemiología , Mano , Neuralgia/epidemiología , Calidad de Vida , Dimensión del Dolor , Brasil/epidemiología , Prevalencia , Estudios Transversales , Análisis de Varianza , Estado Civil , Neuropatías del Plexo Braquial/complicaciones , Dolor Nociceptivo/etiología , Neuralgia/etiologíaRESUMEN
Among all glaucoma suspects, eyes with optic nerve head features suspicious or suggestive of early glaucoma are probably those that offer the greatest challenge for clinicians. In contrast with the robust longitudinal data published on ocular hypertension, there is no specific management guideline for these patients. Therefore, evaluating eyes with suspicious optic disc appearance and normal intraocular pressure (IOP), we sought to investigate potential differences in clinical and epidemiological characteristics to differentiate those with normal-tension glaucoma (NTG) from those with presumed large physiological optic disc cups (pLPC). In this observational case-control study, we consecutively enrolled individuals with pLPC and NTG. All eyes had vertical cup-to-disc ratio (VCDR)≥0.6 and untreated IOP<21 mmHg. Glaucomatous eyes had reproducible visual field defects. Eyes with pLPC required normal visual fields and ≥30 months of follow-up with no evidence of glaucomatous neuropathy. Clinical and epidemiological parameters were compared between groups. Eighty-four individuals with pLPC and 40 NTG patients were included. Regarding our main results, NTG patients were significantly older and with a higher prevalence of Japanese descendants (p<0.01). Not only did pLPC eyes have smaller mean VCDR, but also larger optic discs (p≤0.04). There were no significant differences for gender, central corneal thickness, and spherical equivalent (p≥0.38). Significant odds ratios (OR) were found for race (OR = 2.42; for Japanese ancestry), age (OR = 1.05), VCDR (OR = 5.03), and disc size (OR = 0.04; p≤0.04). In conclusion, in patients with suspicious optic disc and normal IOP, those with older age, Japanese ancestry, smaller optic discs, and larger VCDR are more likely to have NTG, and therefore, deserve deeper investigation and closer monitoring.
Asunto(s)
Diagnóstico Diferencial , Glaucoma de Ángulo Abierto/diagnóstico , Glaucoma de Baja Tensión/diagnóstico , Hipertensión Ocular/diagnóstico , Disco Óptico/diagnóstico por imagen , Adulto , Anciano , Ojo/diagnóstico por imagen , Ojo/fisiopatología , Femenino , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Presión Intraocular , Glaucoma de Baja Tensión/fisiopatología , Masculino , Persona de Mediana Edad , Hipertensión Ocular/fisiopatología , Oftalmoscopía , Disco Óptico/fisiopatología , Pruebas del Campo VisualRESUMEN
RATIONALE: Several recent studies suggest that Brazil's Estratégia Saude de Familia (Family Health Strategy-FHS) has contributed to declines in mortality at the national and regional level. Comparatively little is known whether this approach is effective in urban populations with relatively easy access to health services. OBJECTIVES: To use detailed medical data collected as part of São Paulo's Western Region project to examine whether the FHS program had an impact on child health in São Paulo, Brazil. RESULTS: No associations were found between FHS and birth weight (OR 1.03, 95% CI 0.93-1.29), gestational length (OR 0.98, 95% CI 0.83-1.15) or stillbirth (OR 1.51, 95% CI 0.75-3.03). FHS eligibility was associated with a 42% reduction in the odds of child mortality (OR 0.58, 95% CI 0.34, 0.91), with largest effect sizes for the early neonatal period (OR 0.18, 95% CI 0.04-0.79). CONCLUSIONS: Community based health delivery platforms may be a highly effective way to reduce neonatal mortality in urban areas of low and middle income countries, even when access to general health services is almost universal.
RESUMEN
Urban parks are areas designated for human recreation but also serve as shelter and refuge for populations of several species of native fauna, both migratory and introduced. In Brazil, the effect of annual climate variations on Aedes aegypti and dengue epidemics in large cities like São Paulo is well known, but little is known about how such variations can affect the diversity of mosquito vectors in urban parks and the risk of disease transmission by these vectors. This study investigates the influence of larval habitats and seasonal factors on the diversity and abundance of Culicidae fauna in Anhanguera Park, one of the largest remaining green areas in the city of São Paulo. Species composition and richness and larval habitats were identified. Seasonality (cold-dry and hot-rainy periods) and year were considered as explanatory variables and the models selection approach was developed to investigate the relationship of these variables with mosquito diversity and abundance. A total of 11,036 specimens from 57 taxa distributed in 13 genera were collected. Culex nigripalpus, Cx. quinquefasciatus and Aedes albopictus were the most abundant species. Bamboo internodes and artificial breeding sites showed higher abundance, while ponds and puddles showed greater richness. Significant relationships were observed between abundance and seasonality, with a notable increase in the mosquitos abundance in the warm-rainy periods. The Shannon and Berger-Parker indices were related with interaction between seasonality and year, however separately these predictors showed no relationship with ones. The increased abundance of mosquitoes in warm-rainy months and the fact that some of the species are epidemiologically important increase not only the risk of pathogen transmission to people who frequent urban parks but also the nuisance represented by insect bites. The findings of this study highlight the importance of knowledge of culicid ecology in green areas in urban environments.
Asunto(s)
Dengue/epidemiología , Dípteros/fisiología , Insectos Vectores/fisiología , Animales , Brasil/epidemiología , Ciudades , Dengue/prevención & control , Dípteros/clasificación , Ecosistema , Geografía , Humanos , Insectos Vectores/clasificación , Larva/clasificación , Larva/fisiología , Control de Mosquitos , Parques RecreativosRESUMEN
PURPOSE: To investigate the suitability of the visual field index (VFI) in different degrees of disease severity in glaucoma patients. METHODS: In this cross-sectional study, we consecutively enrolled patients with primary open-angle glaucoma and glaucoma suspects (ocular hypertension). All eyes required a reliable standard automated perimetry (SAP) test to be included. Subjects were categorized into five groups based on glaucoma severity using SAP's mean deviation (MD). To evaluate the correlation among VFI, MD and pattern standard deviation (PSD), a linear regression model was built. To evaluate the nature of the correlation (i.e. linear vs nonlinear), results were plotted in a scatterplot graph. RESULTS: One hundred and twenty-two eyes of 81 patients (mean age, 59.8 ± 14.5 years) were included. A strong, positive association was found between MD and VFI values (R(2) = 0.98, p < 0.001), showing a 3.2% reduction in the VFI for each dB loss in the MD index. It was noticed that 15% of eyes with mild glaucoma (average MD of -3.1 dB) had VFI > 99%. Considering only the eyes with mild and moderate damage in the regression, we found a weaker (nonlinear) correlation than the one we found using all eyes (R(2) = 0.85, p < 0.001). There was also a significant, nonlinear correlation between VFI and PSD (R(2) = 0.85, p < 0.001). Although higher PSD values were found with increasing visual field damage, this initial trend was reversed when VFI became smaller than 50%, approximately. CONCLUSION: Visual field index had a strong correlation with MD; however, this correlation was weaker in mild disease, as some patients with early disease had very high VFI values (ceiling effect). Therefore, initial deterioration in visual field status (as assessed by MD values) in patients with early disease may not be detectable using the VFI alone. How to cite this article: Sousa MCC, Biteli LG, Dorairaj S, Maslin JS, Leite M, Prata TS. Suitability of the Visual Field Index according to Glaucoma Severity. J Curr Glaucoma Pract 2015;9(3):65-68.
RESUMEN
New techniques and methods are being sought to try to win the battle against mosquitoes. Recent advances in molecular techniques have led to the development of new and innovative methods of mosquito control based around the Sterile Insect Technique (SIT)(1-3). A control method known as RIDL (Release of Insects carrying a Dominant Lethal)(4), is based around SIT, but uses genetic methods to remove the need for radiation-sterilization(5-8). A RIDL strain of Ae. aegypti was successfully tested in the field in Grand Cayman(9,10); further field use is planned or in progress in other countries around the world. Mass rearing of insects has been established in several insect species and to levels of billions a week. However, in mosquitoes, rearing has generally been performed on a much smaller scale, with most large scale rearing being performed in the 1970s and 80s. For a RIDL program it is desirable to release as few females as possible as they bite and transmit disease. In a mass rearing program there are several stages to produce the males to be released: egg production, rearing eggs until pupation, and then sorting males from females before release. These males are then used for a RIDL control program, released as either pupae or adults(11,12). To suppress a mosquito population using RIDL a large number of high quality male adults need to be reared(13,14). The following describes the methods for the mass rearing of OX513A, a RIDL strain of Ae. aegypti (8), for release and covers the techniques required for the production of eggs and mass rearing RIDL males for a control program.
Asunto(s)
Aedes/crecimiento & desarrollo , Aedes/genética , Animales , Animales Modificados Genéticamente , Brasil , Femenino , Genes Dominantes , Genes Letales , Masculino , Control Biológico de Vectores/métodos , Reproducción/fisiologíaRESUMEN
We conducted an inventory of the mosquito fauna of the internodes of bamboo plants grown in municipal parks in the city of São Paulo, Brazil. During October 2010 to July 2013, a total of 8,541 immature stages belonging to 21 mosquito species were collected from bamboos over 61 municipal parks. Of these, Aedes albopictus was the most abundant species followed by Ae. aegypti found in broken bamboos in most parks. The former species was 7.2 times more abundant than the latter when both species shared the same habitat. Other species collected from bamboos included Culex quinquefasciatus and Haemagogus leucocelaenus. In bamboos with perforated internodes, species of the genus Wyeomyia were the most prevalent. Differences were also observed in species composition and abundance of mosquitoes collected in transversely broken bamboos and those collected from perforated bamboo internodes. Constant surveillance of these breeding sites is crucial due to the epidemiological importance of the species found. Furthermore, these breeding sites may help maintain some native wild mosquito populations along with a variety of other invertebrates found in these urban green areas.
Asunto(s)
Distribución Animal , Biodiversidad , Culicidae/fisiología , Animales , Brasil , Ciudades , Culicidae/clasificación , Culicidae/crecimiento & desarrollo , Ecosistema , Larva/clasificación , Larva/crecimiento & desarrollo , Larva/fisiología , PoaceaeRESUMEN
We evaluated the ability of spectral-domain optic coherence tomography (SD-OCT) to differentiate large physiological optic disc cupping (LPC) from glaucomatous cupping in eyes with intraocular pressure (IOP) within the normal range. We prospectively enrolled patients with glaucoma or presumed LPC. Participants had optic discs with confirmed or suspected glaucomatous damage (defined as a vertical cup-to-disc ratio≥0.6), and all eyes had known untreated IOP<21 mmHg. For glaucomatous eyes, a reproducible glaucomatous visual field (VF) defect was required. LPC eyes required normal VF and no evidence of progressive glaucomatous neuropathy (follow-up≥30 months). Peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell complex (GCC) thicknesses were obtained using SD-OCT. For all studied parameters of pRNFL and GCC thicknesses, eyes with glaucoma (n=36) had significantly thinner values compared to eyes with LPC (n=71; P<0.05 for all comparisons). In addition, pRNFL parameters had sensitivity of 66.7% and specificity of 83.1%, and GCC parameters had sensitivity of 61.2% and specificity of 81.7%. The combination of the two analyses increased the sensitivity to 80.6%. In conclusion, while evaluating patients with large optic disc cupping and IOP in the statistically normal range, SD-OCT had only limited diagnostic ability to differentiate those with and without glaucoma. Although the diagnostic ability of the pRNFL and the GCC scans were similar, these parameters yielded an increase in sensitivity when combined, suggesting that both parameters could be considered simultaneously in these cases.
RESUMEN
Rickettsial spotted fever is common in southeastern Brazil. Differential diagnosis of pathogens can be performed with proper laboratory methods. A traveler arriving from Portugal developed a fatal febrile hemorrhagic syndrome diagnosed as spotted fever rickettsiosis. We isolated the agent, which was identified as Rickettsia conorii conorii by sequencing rickettsial genes.
Asunto(s)
Fiebre Botonosa , ADN Bacteriano , Genes Bacterianos , Rickettsia conorii , Análisis de Secuencia de ADN/métodos , Animales , Fiebre Botonosa/epidemiología , Fiebre Botonosa/microbiología , Fiebre Botonosa/transmisión , Brasil/epidemiología , Reservorios de Enfermedades/microbiología , Perros , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Portugal , Rickettsia conorii/genética , Rickettsia conorii/aislamiento & purificación , Rickettsia conorii/patogenicidad , Homología de Secuencia de Ácido Nucleico , Tiempo de Tratamiento , Viaje , Zoonosis/epidemiología , Zoonosis/microbiología , Zoonosis/transmisiónRESUMEN
Apresenta estudo sobre o Programa de Cartas que tem contribuído para a melhoria da qualidade das informações de mortalidade no Município de São Paulo, promovendo maior especificação das causas de morte e diminuindo a proporção de causas mal definidas ou imprecisas
Asunto(s)
Humanos , Mortalidad , Registros de MortalidadRESUMEN
Apresenta estudo sobre o Programa de Cartas que tem contribuído para a melhoria da qualidade das informações de mortalidade no Município de São Paulo, promovendo maior especificação das causas de morte e diminuindo a proporção de causas mal definidas ou imprecisas
Asunto(s)
Humanos , Mortalidad , Registros de MortalidadRESUMEN
BACKGROUND: We aimed to evaluate the ascorbic acid concentration in secondary aqueous humour (AH) from glaucomatous patients and to compare it with primary AH from primary open-angle glaucoma patients and non-glaucomatous patients. METHODS: Primary AH samples were prospectively obtained from clinically uncontrolled primary open-angle glaucoma patients and senile cataract patients (controls) prior to trabeculectomy and cataract surgery. Secondary AH samples were obtained from eyes with previous intraocular surgery, prior to trabeculectomy or cataract surgery. AH (0.1 mL) was aspirated by inserting a 26-gauge needle into the anterior chamber just before surgery and then immediately stored at -80 degrees C. The ascorbic acid concentration was determined in a masked fashion by high-pressure liquid chromatography. RESULTS: A total of 18 patients with senile cataract, 16 glaucomatous patients with primary AH (no previous intraocular surgery) and 11 glaucomatous patients with secondary AH (previous intraocular surgery) were included. There was no difference in mean age between groups (P = 0.15). The mean +/- standard deviation concentration of ascorbic acid in the secondary AH from glaucomatous patients (504 +/- 213 micromol/L [95% confidence interval {CI}, 383-624]) was significantly lower than the concentration of ascorbic acid found in the primary aqueous of primary open-angle glaucoma (919 +/- 427 micromol/L [95% CI, 709-1128]) and control patients (1049 +/- 433 micromol/L [95% CI, 848-1249]; P < 0.01, Kruskal-Wallis test). CONCLUSIONS: The ascorbic acid concentration in secondary AH of glaucomatous patients was approximately twofold lower in comparison with primary AH of glaucomatous and cataract patients. The implications of a reduced concentration of ascorbic acid in the secondary AH deserve further investigation.