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OBJECTIVE: Nonsyndromic cleft lip with or without cleft palate (NSCL±P) is a common craniofacial anomaly with multifactorial etiology. Evidence suggests that variations in WNT pathway genes contribute to an increased susceptibility to NSCL±P. The aim of this study was to investigate the association of AXIN1, APC, CTNNB1, DVL2, and GSK3ß gene variants with NSCL±P in a case-control data set from Brazil. PATIENTS: 471 individuals with NSCL±P and 504 unrelated control individuals of Caucasian ethnicity. DESIGN: Twenty single-nucleotide polymorphisms (SNPs) in/nearby AXIN1, APC, CTNNB1, DVL2, and GSK3B genes were genotyped using Taqman chemistry in a Viia7 sequence detection instrument. Genotype, allele, and haplotype frequencies were compared among NSCL±P patients and controls using Fisher exact test, implemented in PLINK software. The level of significance was established at P ≤.002 under Bonferroni correction. In silico analysis of SNP function was assessed using MirSNP database. RESULTS: Significant association was found between GSK3B rs13314595 genotypes and NSCL±P ( P = .0006). Additionally, nominal associations were found between DVL2 (rs35594616) and APC (rs448475) with NSCL±P ( P = .02 and P = .03, respectively). SNP haplotypes for GSK3B and APC genes showed nominal associations with NSCL±P ( P < .05). In silico analysis predicted that APC rs448475 harbors a binding site for the microRNA miR-617 and that the switch from a G allele to C allele enhances binding, whereas DVL2 rs35594616 did not appear to harbor microRNA-binding sites. CONCLUSION: This study shows for the first time the association between GSK3B and NSCL±P and confirms the role of additional WNT pathway genes as candidates for NSCL±P.

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In the present study, persistent organic pollutants (POPs) were determined in 14 livers from specimens of the Brazilian sharpnose shark (Rhizoprionodon lalandii), which is an important economic resource for small-scale fisheries on the southeastern coast of Brazil. The following concentrations (lipid weight) of POPs were found: ∑PCBs: 1019±267 ng g(-1); ∑DDTs: 111±40 ng g(-1) and ∑PBDEs: 10.4±4.78. PCB 153 made the greatest contribution to ∑PCB (21.4%), followed by PCB 138 (14.6%) and PCB 180 (9.94%). Among chlorinated pesticides, only the p,p'-DDE and p,p'-DDD isomers had concentrations above the detection limit. Moreover, levels above the detection limit were found only for PBDE congeners 47 and 100 (BDEs 47>99). On average, BDE 47 accounted for 88% of the total PBDE load. The feeding habits of the Brazilian sharpnose shark close to the Brazilian coastline are likely the most important difference regarding the accumulation of POPs in comparison to oceanic species that feed in deeper waters. Thus, this species may be used to evaluate the pollution of coastal areas as well as human exposure to contaminants, as the Brazilian sharpnose shark is a frequently used for human consumption. Further studies in other areas of Brazil and involving other species are needed to clarify the mechanisms and potential impact of POPs, which can affect the biology of different organisms and cause population declines.

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OBJECTIVE: This study aimed to evaluate the effect of adenotonsillectomy on visual attention and daytime sleepiness in children with sleep-disordered breathing. DESIGN: This was a controlled prospective cohort study. SETTING: Outpatients from the Otorhinolaryngology Division of Edmundo Vasconcelos Hospital Complex, São Paulo, Brazil. PARTICIPANTS: Patients aged 6-17 years with upper airway obstruction scheduled to undergo adenotonsillectomy (treatment group) in the Otorhinolaryngology Division of Edmundo Vasconcelos Hospital Complex, in São Paulo, Brazil. Participants of control group were consecutively selected from another outpatient clinic of paediatric surgery, but those with symptoms of sleep-disordered breathing were excluded. MAIN OUTCOME MEASURES: Children were submitted to visual attention tests (TAVIS-3) that discriminates normal subjects from those with attentional disorders in advance of the surgery and 2 months later, and in the same period for the control group. Parents were interviewed about lifestyle, sleep characteristics and daytime sleepiness. RESULTS: The analysis included 27 patients in the adenotonsillectomy group and 30 controls, who had similar age (10.0 ± 3.3 versus 10.3 ± 3.7 years; P = 0.8), gender (41% boys versus 57%, respectively) and body mass index. There was marked decrease in daytime sleepiness after surgery (delta between groups: -4.7 ± 3.8; P < 0.001), as well as reductions in reaction time, errors of omission and errors of commission in the treatment compared with the control group at both time points, before and after surgery. CONCLUSIONS: This study shows that adenotonsillectomy in children and adolescents with sleep-disordered breathing reduces daytime sleepiness and improves the performance in tests of visual attention.

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Hexachlorocyclohexane (HCH) isomers (α-, ß- and γ- HCH [lindane]) were recently added to the list of persistent organic pollutants regulated by the Stockholm Convention, and therefore, the legacy of HCH and lindane production has become an issue of global relevance. The production of lindane with the much larger quantities of associated waste isomers has generated large waste deposits and contaminated sites. This article presents an overview of HCH-polluted sites in Brazil as a basis for further activities related to the Stockholm Convention. The locations of HCH stockpiles and contaminated sites in Brazil arising from production and formulation have been compiled and mapped. This shows that the measures taken over the past 25 years have not resulted in remediation of the HCH pollution. An exposure risk study has been summarised for one major site and is included to demonstrate the contemporary relevance of the contamination. Major site remediation efforts are planned at one site but people live close to several other sites, and there is an urgent need of further assessments and remediation to ensure the protection of human health and the environment. The Stockholm Convention requires a systematic approach and should be adopted for the assessment of all sites and appropriate isolation/remediation measures should be facilitated. The appropriate planning of these activities for the production site in Rio de Janeiro could be a positive contribution for Rio+20 highlighting that green economy and sustainable production also include the appropriate management of legacies of historic production of an industrial sector (here the organochlorine industry).

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OBJECTIVES: The aim of the study was to estimate the rates of cardiovascular disease (CVD) events after stopping smoking in patients with HIV infection. METHODS: Patients who reported smoking status and no previous CVD prior to enrolment in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study were included in this study. Smoking status is collected at each visit as current smoker (yes/no) and ever smoker (yes/no). Time since stopping smoking was calculated for persons who had reported current smoking during follow-up and no current smoking subsequently. Endpoints were: myocardial infarction (MI); coronary heart disease (CHD: MI plus invasive coronary artery procedure or death from other CHD); CVD (CHD plus carotid artery endarterectomy or stroke); and all-cause mortality. Event rates were calculated for never, previous and current smokers, and smokers who stopped during follow-up. Incidence rate ratios (IRRs) were determined using Poisson regression adjusted for age, sex, cohort, calendar year, family history of CVD, diabetes, lipids, blood pressure and antiretroviral treatment. RESULTS: A total of 27 136 patients had smoking status reported, with totals of 432, 600, 746 and 1902 MI, CHD, CVD and mortality events, respectively. The adjusted IRR of CVD in patients who stopped smoking during follow-up decreased from 2.32 within the first year of stopping to 1.49 after >3 years compared with those who never smoked. Similar trends were observed for the MI and CHD endpoints. Reductions in risk were less pronounced for all-cause mortality. CONCLUSION: The risk of CVD events in HIV-positive patients decreased with increasing time since stopping smoking. Smoking cessation efforts should be a priority in the management of HIV-positive patients.

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OBJECTIVE: To assess changes in the prevalence of otitis media, associated with the use of highly active antiretroviral therapy, in Brazilian human immunodeficiency virus (HIV) infected children. SETTING: Division of otorhinolaryngology, Hospital das Clínicas, Sao Paulo University Medical School, Brazil. PATIENTS: A cohort of 459 HIV-infected children aged below 13 years. MAIN OUTCOME MEASURES: The prevalence of otitis media and the serum cluster of differentiation four glycoprotein T lymphocyte count were compared for children receiving highly active antiretroviral therapy (with protease inhibitors) and those receiving standard antiretroviral therapy (without protease inhibitors). RESULTS: Otitis media was present in 33.1 per cent of the children. Children aged from zero years to five years 11 months receiving highly active antiretroviral therapy had a higher prevalence of acute otitis media (p=0.02) and a lower prevalence of chronic otitis media (p=0.02). Children who were receiving highly active antiretroviral therapy had a mean serum cluster of differentiation four glycoprotein T lymphocyte count greater than that of those who were receiving standard antiretroviral therapy (p<0.001). CONCLUSIONS: The use of highly active antiretroviral therapy in Brazilian HIV-infected children was associated with a lower prevalence of chronic otitis media.

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INTRODUCTION: Oral candidosis (OC) and hairy leukoplakia (OHL) are important markers of Human Immunodeficiency Virus (HIV) infection immune status. OBJECTIVES: to evaluate if OC and/or OHL should be considered clinical predictors of immune and virologic failure on HIV-infected Brazilian adults undergoing Highly Active Antiretroviral Therapy (HAART). METHODS: 124 HIV-infected patients who used HAART for a minimum of six months were prospectively evaluated. All of them under-took oral examination and serum CD4+ count and viral load (VL), being divided in two groups, P and A, respectively according to the presence or absence of OC and/or OHL. During a six month period, patients belonging to group A were followed. They were re-examined for new oral lesions. New blood samples were collected and they were subdivided into groups P6 and A6. CD4+ count and VL were compared between groups at baseline and after the six months period. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and relative risk (RR) were obtained in order to assess the accuracy of using OC and OHL as predictors of immune and virologic failure, at baseline and after a six month period. RESULTS: At baseline and after six months, patients with OC and OHL have mean CD4+ count lower and mean VL higher than patients of group A and A6 (p < 0.001). OC had high PPV for immune failure and a moderated PPV for virologic failure. OHL had low PPVs for both measures. DISCUSSION AND CONCLUSIONS: OC and OHL still indicate low serum CD4+ count and high VL, but OC seems to be a better predictor of immune and virologic failure in patients undergoing HAART than OHL.

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Polychlorinated biphenyls (PCBs) are ubiquitous anthropogenic compounds found even in the polar regions, mainly due to long-range atmospheric transport. In order to assess the occurrence of atmospheric PCBs in the vicinity of the Brazilian Antarctic Research Station (62 degrees 05'S, 58 degrees 23'W), a sampling survey was undertaken in the austral summer of 1995-1996. The concentrations of the PCB congeners in the air ranged from not detected to 33.2 pgm(-3). The lower chlorinated congeners (PCB-101 and below), which are more volatile and subject to long-range transport, predominated in the air samples and represented 66.7% of the total PCB concentrations. Atmospheric levels of PCBs were correlated with meteorological conditions and the highest levels were associated with the passage of the frontal systems coming from South America.

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Selected polychlorinated biphenyl (PCB) congeners were measured in Desmarestia sp., an abundant algae in the Antarctica Peninsula and South Shetlands. Samples were collected from various points of Admiralty Bay, King George Island, Antarctic Peninsula, during the 1993-1994 austral summer. Total PCB concentrations ranged from 0.46 to 3.86 ng g(-1) (dry weight). Predominant PCB congeners were 52, 101, 110, 138 and 153. The low levels of PCBs found on all samples and the predominance of low molecular weight congeners indicate that there are no significant local PCBs sources in the area of study.

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Sediment samples from Santos and Cananéia, São Paulo Brazil were analysed by GC-FID and GC-MS for aliphatic and aromatic hydrocarbons in order to gather information on the degree of contamination by oil and other biogenic contributions. Concentrations of total n-alkanes in Santos varied from 1.05 to 4.29 microg g(-1) and aromatic hydrocarbons from 0.08 to 42.39 microg g(-1). In Cananéia total n-alkanes varied from 4.37 to 157.90 microg g(-1). However, aromatic hydrocarbons were not detected. In Cananéia n-alkanes of terrestrial plants with high molecular weight predominate (n-C25, n-C27, n-C29, n-C31 and n-C33). In Santos, a more uniform distribution of the n-alkanes and aromatic hydrocarbons was found at all the sediment stations. The hydrocarbon data from stations close to the Saboó Wharf, at Alemoa and in the COSIPA Channel revealed alarming levels of acenaphthylene, fluorene, phenanthrene, anthracene, fluoranthene, pyrene and chrysene.

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Se presenta un caso de un lipoma localizado en el dorso de la lengua, de una paciente de sexo femenino, de 8 años de edad. El lipoma es una neoplasia benigna que, a nivel general, se presenta más frecuentemente en mujeres adultas, mayores de cuarenta años. Se caracteriza por ser una tumoración de crecimiento lento, indolora, amarillenta y de superficie lisa. Rar vez se observa en la cavidad oral y, cuando existe su ubicación preferencial es una mucosa yugal y fondo del vestíbulo. Nos parece interesante presentar este caso por lo atípico de su prensentación etárea y ubicación anatómica, además, se anexa una revisión que considera aspectos epidemiológica y características clínicas e histológicas

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PIP: This work describes the history and principles of the community development agency Service Volunteered for All (Servol) of Trinidad and Tobago. The founder, Father Gerard Pantin, a Catholic priest, began work with communities 23 years ago to overcome the problems of extreme poverty and hopelessness. Servol has established an island-wide network of 150 preschool centers and 40 adolescent training centers. The principles upon which Pantin founded his program included insistence on the inherent dignity of all participants. Servol programs appear to be dedicated primarily to preschool children and adolescents, but in fact they are oriented to parent and community education and to strengthening and assisting families. The preschool centers have come to resemble community centers, as they prepare children aged 3 to 5 to attend school in conditions of equality with middle class children. The adolescents displaced from public schools are equipped with technical training and knowledge of human relations they need to maintain stable employment. The knowledge gained from Servol's activities has gradually been combined into a unified force to repair the damage of a society in disintegration. The increased economic problems resulting from structural adjustment programs are being confronted in part through the parent outreach program, which seeks contacts with the poorest families. Recently UNESCO honored Servol as one of the 20 best popular education programs in the world.^ieng

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As new treatment options become available for patients with cancer or primary bone marrow failure, the additional economic burden that these treatments may place on the already stressed health care system raises concerns. Neutropenia is a major complication of these conditions and can add substantially to patient care costs. Granulocyte-macrophage colony-stimulating factor (GM-CSF), a cytokine that enhances neutrophil production and function, has recently been recommended as an effective treatment for neutropenia. Selected clinical studies suggest that GM-CSF can reduce the costs associated with the management of neutropenic patients by reducing the need for antibiotics and the duration of hospitalization. Treatment with GM-CSF also may be associated with an improved quality of life. Pharmacoeconomic and quality-of-life studies are required, however, to document these benefits. Based on currently available data, GM-CSF represents an economically and clinically appropriate treatment approach for neutropenia in patients who have undergone bone marrow transplantation or experience chemotherapy-induced neutropenia.

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Measurements of FEV1 and PEFR performed on a Jones Pulmonor Spirometer (JPF) were compared with PEFR obtained with a mini-Wright peak flow meter (WPF) in 102 patients. Data were converted to percent predicted. Standard deviations of triplicate measurements were: FEV1, 3.01 percent; JPF, 7.22 percent; and WPF, 5.12 percent. Correlation of best of three measurements was FEV1-JPF r = .758; FEV1-WPF r = .744; and JPF-WPF r = .846. The mean percent predicted of the best of three values of FEV1 was 74.8 percent, JPF 91.4 percent, and WPF 94 percent. These higher values for percent predicted PEFR were obtained throughout the range of FEV1 values. Studies on nine normal volunteers in an atmospheric chamber suggested that higher altitudes may account for higher PEFR values. We conclude that PEFR, measured by either waterless spirometer or mini-Wright peak flow meter, has greater intrasubject variability than FEV1, and it tends to underestimate the degree of pulmonary impairment.

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The hemoglobin of the Free-Tailed Bat Tadarida brasiliensis (Microchiroptera) comprises two components (Hb I and Hb II) in nearly equal amounts. Both hemoglobins have identical beta-chains, whereas the alpha-chains differ in having glycine (Hb I) or aspartic acid (Hb II) in position 115 (GH3). The components could be isolated by DEAE-Sephacel chromatography and separated into the globin chains by chromatography on carboxymethyl-cellulose CM-52. The sequences have been determined by Edman degradation with the film technique or the gas phase method (the alpha I-chains with the latter method only), using the native chains and tryptic peptides, as well as the C-terminal prolyl-peptide obtained by acid hydrolysis of the Asp-Pro bond in the beta-chains. The comparison with human hemoglobin showed 18 substitutions in the alpha-chains and 24 in the beta-chains. In the alpha-chains one amino-acid exchange involves an alpha 1/beta 1-contact. In the beta-chains one heme contact, three alpha 1/beta 1- and one alpha 1/beta 2-contacts are substituted. A comparison with other chiropteran hemoglobin sequences shows similar distances to Micro- and Megachiroptera. The oxygenation characteristics of the composite hemolysate and the two components, measured in relation to pH, Cl-, and 2,3-bis-phosphoglycerate, are described. The effect of carbon dioxide on oxygen affinity is considerably smaller than that observed in human hemoglobin, which might be an adaptation to life under hypercapnic conditions.

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The five main hemoglobins of the South Brazilian bimodal breathing teleost, Callichthys callichthys were separated, and their oxygenation properties and those of the unfractionated hemolysate were measured at 10, 20 and 30 degrees C. The cathodal Hb component had a higher O2 affinity than the other components and a lower Bohr effect (phi = delta log P 50/delta pH), which is reversed at low and high pH values (6.8 greater than pH greater than 7.8). The other, anodal hemoglobins had normal Bohr effects and similar functional properties. The erythrocytic cofactor ATP had no significant effects on the O2 affinities of the hemolysate and the isolated anodal components at physiological pH conditions, but decreased the affinity of the cathodal Hb over the entire pH range tested (6.5-8.2). All hemoglobins showed high thermal dependence of O2 affinity (delta H values between -62 and -74 kJ mol-1 at pH 8.0), which decreased with falling pH, in accordance with an inverse relation between the Bohr effect and temperature. The possible adaptive significance of the oxygenation patterns of the hemoglobins and their temperature dependences are discussed comparatively with special reference to the closely-related bimodal breather Hoplosternum littorale, and to breathing habit (gill breathing in winter when the fish is a benthic feeder and "gut" air breathing in the warm reproductive season when they nest at the surface).

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