RESUMO
In São Paulo, Brazil, the first case of coronavirus disease 2019 (CoViD-19) was confirmed on 26 February, the first death due to CoViD-19 was registered on 16 March, and on 24 March, São Paulo implemented the isolation of persons in non-essential activities. A mathematical model was formulated based on non-linear ordinary differential equations considering young (60 years old or less) and elder (60 years old or more) subpopulations, aiming to describe the introduction and dissemination of the new coronavirus in São Paulo. This deterministic model used the data collected from São Paulo to estimate the model parameters, obtaining R0 = 6.8 for the basic reproduction number. The model also allowed to estimate that 50% of the population of São Paulo was in isolation, which permitted to describe the current epidemiological status. The goal of isolation implemented in São Paulo to control the rapid increase of the new coronavirus epidemic was partially succeeded, concluding that if isolation of at least 80% of the population had been implemented, the collapse in the health care system could be avoided. Nevertheless, the isolated persons must be released one day. Based on this model, we studied the potential epidemiological scenarios of release by varying the proportions of the release of young and elder persons. We also evaluated three different strategies of release: All isolated persons are released simultaneously, two and three releases divided in equal proportions. The better scenarios occurred when young persons are released, but maintaining elder persons isolated for a while. When compared with the epidemic without isolation, all strategies of release did not attain the goal of reducing substantially the number of hospitalisations due to severe CoViD-19. Hence, we concluded that the best decision must be postponing the beginning of the release.
Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Previsões/métodos , Modelos Teóricos , Pandemias/prevenção & controle , Isolamento de Pacientes/métodos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Fatores Etários , Brasil/epidemiologia , COVID-19 , Humanos , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Pessoa de Meia-Idade , Isolamento de Pacientes/tendências , Política Pública , Design de SoftwareRESUMO
UNLABELLED: This 12-week study compared the efficacy and safety of a fixed combination of fluticasone propionate plus formoterol (FL/F) 250/12 µg b.i.d. administered via a dry powder inhaler (DPI) (Libbs Farmacêutica, Brazil) to a combination of budesonide plus formoterol (BD/F) 400/12 µg b.i.d. After a 2-week run-in period (in which all patients were treated exclusively with budesonide plus formoterol), patients aged 12-65 years of age (N = 196) with uncontrolled asthma were randomized into an actively-controlled, open-labeled, parallel-group, multicentre, phase III study. The primary objective was to demonstrate non-inferiority, measured by morning peak expiratory flow (mPEF). The non-inferiority was demonstrated. A statistically significant improvement from baseline was observed in both groups in terms of lung function, asthma control, and the use of rescue medication. FL/F demonstrated a statistical superiority to BD/F in terms of lung function (FEV(1)) (p = 0.01) and for asthma control (p = 0.02). Non-significant between-group differences were observed with regards to exacerbation rates and adverse events. In uncontrolled or partly controlled asthma patients, the use of a combination of fluticasone propionate plus formoterol via DPI for 12-weeks was non-inferior and showed improvements in FEV(1) and asthma control when compared to a combination of budesonide plus formoterol. ( CLINICAL TRIAL NUMBER: ISRCTN60408425).
Assuntos
Antiasmáticos/administração & dosagem , Asma/prevenção & controle , Administração por Inalação , Adolescente , Adulto , Idoso , Androstadienos/administração & dosagem , Androstadienos/efeitos adversos , Antiasmáticos/efeitos adversos , Asma/fisiopatologia , Budesonida/administração & dosagem , Budesonida/efeitos adversos , Criança , Combinação de Medicamentos , Inaladores de Pó Seco , Etanolaminas/administração & dosagem , Etanolaminas/efeitos adversos , Feminino , Fluticasona , Volume Expiratório Forçado/efeitos dos fármacos , Fumarato de Formoterol , Humanos , Masculino , Pessoa de Meia-Idade , Pico do Fluxo Expiratório/efeitos dos fármacos , Resultado do Tratamento , Adulto JovemRESUMO
Analisaram-se as qualidades física, química e sensorial, bem como o perfil de ácidos graxos da carne de fêmeas suínas alimentadas com dietas com concentrações crescentes de ractopamina. Foram utilizadas 468 fêmeas, com peso inicial de 84,77±7,20kg, alojadas em 36 baias e alimentadas com dietas contendo 0, 5, 10 ou 15mg de ractopamina/kg. Após o período de 28 dias, dois animais de cada baia, depois de passarem por 15 horas de jejum sólido, foram abatidos. Uma amostra do músculo Longissimus da meia carcaça direita foi colhida para se avaliar as características de qualidade da carne. Não houve efeito (P>0,05) da adição de ractopamina às dietas sobre o pH, capacidade de retenção de água, força de cisalhamento, cor e oxidação lipídica da carne. Observou-se efeito quadrático (P<0,05) para perdas por cocção da carne, e não foi observada diferença (P>0,05) na análise sensorial da carne. Também não foi observado efeito (P>0,05) sobre a composição em ácidos graxos e sobre a relação entre ácidos graxos saturados:insaturados. A adição de até 15mg de ractopamina/kg de dieta não altera as características físicas, sensoriais e o perfil de ácidos graxos da carne de fêmeas suínas abatidas com 110kg de peso.
A study was conducted to evaluate the physical, chemical and sensorial quality and fat acids profile of meat from gilts fed diets containing increasing concentration of ractopamine. A total of 468 gilts with initial weight of 84.77±7.20kg were allotted into 36 pens and fed diets containing 0, 5, 10 or 15mg of ractopamine/kg. After an experimental period of 28 days, two animals from each pen were chosen and slaughtered after 15 hours of fasting. A sample of the Longissimus muscle was collected to evaluate the quality of the pork meat. There was no effect (P>0.05) of ractopamine inclusion in pH, water holding capacity, shear force, color and lipid oxidation. However, a quadratic trend was observed (P<0.05) for cooking loss by increasing concentration of ractopamine in diets. For sensorial analysis of the Longissimus muscle, no differences were noted (P>0.05). No effects were observed (P>0.05) for fat acids profile and saturated and unsaturated fat acids ratio. In conclusion, the increase of up to 15mg of ractopamine/kg concentration in the diet does not change the physical and sensorial characteristics and the fat acids profile of meat from gilts slaughtered at 110kg of body weight.
Assuntos
Animais , Qualidade dos Alimentos , Suínos/metabolismo , Carne/análise , Dieta/veterinária , Ácidos Graxos , OxidaçãoRESUMO
Analisaram-se as qualidades física, química e sensorial, bem como o perfil de ácidos graxos da carne de fêmeas suínas alimentadas com dietas com concentrações crescentes de ractopamina. Foram utilizadas 468 fêmeas, com peso inicial de 84,77±7,20kg, alojadas em 36 baias e alimentadas com dietas contendo 0, 5, 10 ou 15mg de ractopamina/kg. Após o período de 28 dias, dois animais de cada baia, depois de passarem por 15 horas de jejum sólido, foram abatidos. Uma amostra do músculo Longissimus da meia carcaça direita foi colhida para se avaliar as características de qualidade da carne. Não houve efeito (P>0,05) da adição de ractopamina às dietas sobre o pH, capacidade de retenção de água, força de cisalhamento, cor e oxidação lipídica da carne. Observou-se efeito quadrático (P<0,05) para perdas por cocção da carne, e não foi observada diferença (P>0,05) na análise sensorial da carne. Também não foi observado efeito (P>0,05) sobre a composição em ácidos graxos e sobre a relação entre ácidos graxos saturados:insaturados. A adição de até 15mg de ractopamina/kg de dieta não altera as características físicas, sensoriais e o perfil de ácidos graxos da carne de fêmeas suínas abatidas com 110kg de peso.(AU)
A study was conducted to evaluate the physical, chemical and sensorial quality and fat acids profile of meat from gilts fed diets containing increasing concentration of ractopamine. A total of 468 gilts with initial weight of 84.77±7.20kg were allotted into 36 pens and fed diets containing 0, 5, 10 or 15mg of ractopamine/kg. After an experimental period of 28 days, two animals from each pen were chosen and slaughtered after 15 hours of fasting. A sample of the Longissimus muscle was collected to evaluate the quality of the pork meat. There was no effect (P>0.05) of ractopamine inclusion in pH, water holding capacity, shear force, color and lipid oxidation. However, a quadratic trend was observed (P<0.05) for cooking loss by increasing concentration of ractopamine in diets. For sensorial analysis of the Longissimus muscle, no differences were noted (P>0.05). No effects were observed (P>0.05) for fat acids profile and saturated and unsaturated fat acids ratio. In conclusion, the increase of up to 15mg of ractopamine/kg concentration in the diet does not change the physical and sensorial characteristics and the fat acids profile of meat from gilts slaughtered at 110kg of body weight.(AU)
Assuntos
Animais , Suínos/metabolismo , Qualidade dos Alimentos , Carne/análise , Dieta/veterinária , Oxidação , Ácidos GraxosAssuntos
Anafilaxia/etiologia , Bothrops , Mordeduras de Serpentes/complicações , Adulto , Animais , Humanos , MasculinoRESUMO
BACKGROUND: The site and distribution of inflammation in the airways of asthmatic patients has been largely investigated. Inflammatory cells are distributed in both large and small airways in asthma. It has been demonstrated that distal lung inflammation in asthma may significantly contribute to the pathophysiology of the disease. The upper airways have also been implicated in the overall asthmatic inflammation. Although it is now accepted that lung inflammation is not restricted to the intrapulmonary airways in asthma, little is known about cell distribution in the other lung compartments and their relation to the intrapulmonary airways. OBJECTIVE: We aimed to map the inflammatory process in fatal asthma (FA), from the upper airways to the lung parenchyma. METHODS: Eosinophil, neutrophil, mast cell and lymphocyte content were determined in nasal mucosa, the trachea, intrapulmonary airways and parenchyma (peribronchiolar and distal) of 20 patients with FA and 10 controls. RESULTS: Eosinophil content was higher in all studied areas in FA compared with controls (P<0.02). Mast cell content was higher in the outer area of larger airways, small membranous bronchioles and in peribronchiolar parenchyma of FA compared with controls (P<0.04). CD3+, CD4+and CD20+cells showed increased content in FA intrapulmonary airways compared with controls (P<0.05). There was a positive correlation between CD4+cell content in nasal mucosa and larger airways in asthmatics. Increased neutrophil content was observed only in peribronchiolar parenchyma of FA (P=0.028). CONCLUSION: Eosinophils present a widespread distribution within the respiratory tract in FA, from the nasal mucosa to the distal lung. The outer wall of small membranous bronchioles is the main site of inflammatory changes in FA. There is a localized distribution of alveolar inflammation at the peribronchiolar region for mast cells and neutrophils. Our findings provide further evidence of the importance of the lung periphery in the pathophysiology of FA.
Assuntos
Inflamação/patologia , Sistema Respiratório/patologia , Estado Asmático/patologia , Adolescente , Adulto , Idoso , Antígenos CD/imunologia , Brônquios/química , Brônquios/imunologia , Brônquios/patologia , Contagem de Células , Criança , Eosinófilos/química , Eosinófilos/imunologia , Feminino , Humanos , Imuno-Histoquímica/métodos , Inflamação/imunologia , Pulmão/química , Pulmão/imunologia , Pulmão/patologia , Linfócitos/química , Linfócitos/imunologia , Masculino , Mastócitos/química , Mastócitos/imunologia , Pessoa de Meia-Idade , Mucosa Nasal/química , Mucosa Nasal/imunologia , Mucosa Nasal/patologia , Neutrófilos/química , Neutrófilos/imunologia , Sistema Respiratório/imunologia , Estado Asmático/imunologia , Estado Asmático/mortalidade , Traqueia/química , Traqueia/imunologia , Traqueia/patologiaRESUMO
A inflamação da asma não está limitada às vias aéreas e pode comprometer também o parênquima pulmonar periférico, no entanto, não há estudos na literatura que enfoquem a participação do parênquima pulmonar na asma. Objetivo: Caracterizar o infiltrado inflamatótrio do parênquima peribronquiolar e distal em vítimas de asma fatal, comparando-o ao de outras regiões de vias aéreas e a de tecido pulmonar de não asmáticos. Fragementos de tecido pulmonar obtidos de 20 pacientes com asma fatal e 10 controles, necropsiados no Serviço de verificacão de óbito da capital - São Paulo, foram submetidos a estudo de imuno-histoquímica e marcados com anticorpos anti-proteína básica principal (eosinófilos), anti-triptase (mastócitos), anti-elastase neutrofílica (neutrófilos) e anti-marcadores de superfície de linfócitos (CD3, CD$, CD* e CD20). Foram determinadas as densidades celulares no parênquima pulmonar periférico peribronquiolar e distal e nas áreas interna e externa das vias aéreas de grande e de pequeno calibre. Resultados: A densidade de eosinófilos foi significativamente maior nas duas regiões do parênquima pulmonar de asmáticos comparados aos controles, bem como as vias aéreas (p<0,02). Nos pacientes asmáticos a densidade eosinófilica se mostrou menos no parênquima distal em relação à da área interna da via aérea grande apenas (p<0,01). A densidade dos mastócitos foi maior no parênquima peribronquiolar bem como na área externa das vias aéreas de grande e de pequeno calibre de asmáticos comparados aos controles (p<0.04). Diferenças significativas quanto à densidade de linfócitos se restringiram às vias aéreas de asmáticos comparadas as de controles. Maior densidade de neutrófilos foi observada apenas no parênquima pulmonar de asmáticos (p=0.029). Conclusões: O parênquima pulmonar participa do processo inflamatório na asma fatal com aumento de células efetoras (mastócitos, neutrófilos e eosinófilos). A área externa da via aérea foi a região que melhor diferenciou o asmáticodo controle e com o maior número de diferenças significativas. A inflamação do parênquima peribronquiolar, associado ao da área externa da via áerea pequena, reforça o papel do pulmão distal na patofisiologia da asma.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Asma/fisiopatologia , Asma/imunologia , Eosinófilos/imunologia , Mastócitos/imunologia , Neutrófilos/imunologia , Pneumonia/fisiopatologia , Pneumonia/imunologia , Análise de Variância , Autopsia , Estudos de Casos e Controles , Contagem de Células , Imuno-Histoquímica , Infiltração de Neutrófilos/imunologiaRESUMO
BACKGROUND: Isolated ileocecal involvement by tuberculosis in the absence of pulmonar disease is rare in Brasil, therefore causes a diagnostic dilemma as it mimics colonic malignancy and Crohn's disease. METHODS: Between 1969 and 1989, eight patients with isolated hypertrophic ileocecal tuberculosis were treated by surgery in the Gastroenterology Surgery Department of the HSPE-FMO. The most common complaint among them was abdominal pain (100%) with associated symptoms of weight loss (62.5%); nausea, vomiting, fever and general weekness appeared in half of the patients. A right iliac fossa mass was present in seven (87.5% ) of them. The mean duration of symptoms was 14.7 month (range 5-36 months). In all eight patients chest x-rays were negative for tuberculosis. Barium contrast studies showed abnormalities in all cases, but these could not be distinguished from carcinoma. Colonoscopy was helpful in establishing the diagnosis of suboclusive lesions of the ileocecal regions in three patients. Tuberculosis diagnosis was suspected in two of them because ofr the presence of granulomas in colonic biopsy material. RESULTS: Six patients were submitted to elective right hemicolectomy. The two remaining with suspect of tuberculosis were operated with signals of intestinal occlusion, and underwent a limited ileocaecal resection. The positive diagnosis of intestinal tuberculosis was made in all the patients by identification of acid-fast bacilli and by the presence of caseating granulomas in intestinal or lymph node tissue on histological examination. The outcome in all of them was favorable. They received treatment with three antituberculosis drugs over a twelve month period. CONCLUSION: Hypertrophic ileocecal tuberculosis must still be considered in the differential diagnosis of abdominal pathology localized in the right lower quadrant.
Assuntos
Doença de Crohn/diagnóstico , Doenças do Íleo/diagnóstico , Neoplasias Intestinais/diagnóstico , Tuberculose Gastrointestinal/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose Gastrointestinal/cirurgiaRESUMO
BACKGROUND: The aim of the present study was to determine the existence of sensitization to the fungus Hemileia vastatrix (coffee leaf rust) in a sample of the Brazilian population. This fungus attacks coffee plantations, and in some regions of Brazil the concentration of its spores in the air can be very high. METHODS: A total of 378 individuals underwent skin tests (prick and intradermal tests) with H. vastatrix extract. The subjects were divided into four groups according to the occurrence of atopy and the region where they lived (coffee-growing or non-coffee-growing regions), and another group (V) consisted of 50 rural workers employed on coffee plantations. The presence of specific IgE against the fungus H. vastatrix in sensitized individuals was demonstrated in vitro by immunoblotting. RESULTS: There was no statistical difference in comparing the results with intradermal or prick tests. The incidence of positive tests was significantly higher among atopic individuals residing in coffee-growing regions (14.7%). Among rural workers, 10% showed positive tests. Immunoblotting revealed specific IgE against 20 protein bands of H. vastatrix. CONCLUSION: The fungus H. vastatrix may be an important allergen in coffee-producing countries. The sensitization is more frequent among atopic individuals residing in coffee-growing regions.
Assuntos
Basidiomycota , Imunização , Especificidade de Anticorpos , Basidiomycota/efeitos dos fármacos , Basidiomycota/imunologia , Brasil/epidemiologia , Feminino , Humanos , Immunoblotting , Imunoglobulina E/imunologia , Incidência , Masculino , Testes Cutâneos , Extratos de Tecidos/química , Extratos de Tecidos/imunologiaRESUMO
OBJETIVO: No Brasil, a tuberculose ileocecal isolada, na ausência de tuberculose pulmonar ativa ou cicatrizada, é rara, sendo freqüentemente confundida com neoplasia e a doença de Crohn. MÉTODOS: Os autores apresentam oito doentes com essas características, tratados por cirurgia, em período de 20 anos. A dor abdominal na fossa ilíaca direita foi o principal sintoma (100 por cento), seguido da presença de perda de peso (62,5 por cento), febre, náuseas e vômitos e fadiga em 50 por cento dos doentes. Sete enfermos (87,5 por cento) apresentaram massa palpável na fossa ilíaca direita. A duraçäo média dos sintomas foi de 14,7 meses, variando de 5 a 36 meses. Todas as lesöes foram detectadas pelo enema opaco e mimetizavam aspecto neoplásico. A colonoscopia foi realizada em três doentes, evidenciando lesöes sub-oclusivas da regiäo íleo-cecal em dois; as biópsias foram sugestivas de tuberculose, näo sendo possível diferenciá-las da doença de Crohn. RESULTADOS: Seis enfermos com diagnóstico presuntivo de neoplasia foram submetidos a cirurgia eletiva, realizando-se neles a colectomia direita clássica. Os outros dois, com suspeita de tuberculose, foram operados na vigência de obstruçäo intestinal, sendo submetidos a ressecçäo limitada (ileocecectomia). O estudo anatomopatológico estabeleceu o diagnóstico final pelo encontro de necrose caseosa e de bacilos álcool ácido-resistentes no intestino ou nos linfonodos. A evoluçäo pós-operatória foi satisfatória, com pequena morbidade resolvida clinicamente. Posteriormente, todos os doentes receberam o esquema tríplice por 12 meses, variando a droga de acordo com a época do tratamento. CONCLUSÄO: Apesar de rara, a tuberculose hipertrófica ileocecal isolada freqüentemente é confundida com neoplasias e com a doença de Crohn, devendo ser lembrada no diagnóstico diferencial das lesöes localizadas no quadrante inferior direito do abdome
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Tuberculose Gastrointestinal , Doença de Crohn , Doenças do Íleo , Neoplasias Intestinais , Tuberculose Gastrointestinal , Diagnóstico DiferencialRESUMO
Fifty-nine beekeepers who had been practicing apiculture for more than 2 years were selected in order to determine the distribution of bee venom specific IgG subclasses using ELISA. The assays were standardized into arbitrary units. For comparison, IgG subclasses were determined in eight individuals allergic to bee stings who did not receive specific treatment. No correlation was detected between beekeeping time and specific IgG1, IgG2 or IgG4 levels. There was a correlation between IgG2 levels and mean number of stings per month received by the beekeepers. Twenty-five percent of the beekeepers presented bee venom specific IgE class II or more in an ELISA assay. The IgG1 levels detected in beekeepers were similar to those detected in allergic individuals. IgG2 and IgG4 levels were significantly higher in beekeepers than in allergic individuals. IgG3 was not detected in any group studied. In conclusion, the maintenance of high levels of bee venom specific IgG2 and IgG4 represents a characteristic of beekeepers. These subclasses may be related to a modulatory effect of IgG on allergic reactions.
Assuntos
Agricultura , Venenos de Abelha/imunologia , Hipersensibilidade/imunologia , Imunoglobulina G/sangue , Mordeduras e Picadas de Insetos/imunologia , Exposição Ocupacional , Adulto , Idoso , Anticorpos/sangue , Brasil , Feminino , Humanos , Imunoglobulina G/classificação , Masculino , Pessoa de Meia-IdadeRESUMO
Seventy-eight Brazilian beekeepers who had been stung on average six times per month were studied. Sixty-eight beekeepers (87.1%) showed restricted local clinical reactions; nine individuals (11.5%) had extensive local reactions, and only one (1.2%) suffered anaphylactic shock. The humoral immunologic pattern of these individuals were studied by using immunoenzymatic methods to determine the serum titles of specific IgE and specific IgG4. Three groups of beekeepers presenting different humoral immunologic patterns were identified, in which the predominant pattern was the absence of specific IgE and high levels of specific IgG4 (38.4%). There was a positive correlation between the high levels of specific IgG4 and the number of bee stings. This correlation was not found in either specific or total IgE. The results of the present study suggest: i) the immunologic response to the number of exposures to Africanized honey-bee venom is not related to the number of exposures; and, ii) other nonhumoral and/or nonimmunologic factors may be involved in the reaction to the insect sting, which are responsible for both the clinical symptoms and protection.