bluuebunny/crossref_metadata_2025 huggingface dataset:
What Pediatricians Should Know About Child-Related Malpractice Payments in the United States
Authors: Kain Zeev N. , Caldwell-Andrews Alison A.
Published: August 2006

OBJECTIVE. The purpose of this study was to examine child-related National Practitioner Data Bank data.

METHODS. Data were obtained from the National Practitioner Data Bank.

RESULTS. the period from February 1, 2004, through December 31, 2005, a total of 30195 malpractice payments were made on behalf of practitioners in the United States; 14% of those payments (4107 of 30195 payments) were child related. During the period analyzed, $1.73 billion were paid for malpractice cases involving children. More than 95% of all payments were the result of settlements and only ∼5% the result of judgments. The average child-related malpractice payment was significantly greater than an adult-related malpractice payment ($422000 vs $247000); however, child-related malpractice payments were only one half as likely to occur, compared with adult-related malpractice payments. Significant geographic variability was found in the numbers and sizes of child-related malpractice payments. Failure to diagnose was the leading reason for child-related payments (18%), followed by improper performance (9%), delay in diagnosis (9%), and improper management (6%). Finally, we found that ∼40% of all malpractice awards were the result of surgical or obstetrical issues.

CONCLUSIONS. Practicing pediatricians should be aware of the existence of a mandatory electronic depository that documents all malpractice settlements and judgments involving practitioners.
Longitudinal Associations Between Blood Lead Concentrations Lower Than 10 μg/dL and Neurobehavioral Development in Environmentally Exposed Children in Mexico City
Authors: Téllez-Rojo Martha M. , Bellinger David C. , Arroyo-Quiroz Carmen , Lamadrid-Figueroa Héctor , Mercado-García Adriana , Schnaas-Arrieta Lourdes , Wright Robert O. , Hernández-Avila Mauricio , Hu Howard
Published: August 2006

OBJECTIVE. Increasing evidence suggests that 10 μg/dL, the current Centers for Disease Control and Prevention screening guideline for children's blood lead level, should not be interpreted as a level at which adverse effects do not occur. Using data from a prospective study conducted in Mexico City, Mexico, we evaluated the dose-effect relationship between blood lead levels and neurodevelopment at 12 and 24 months of age.

METHODS. The study population consisted of 294 children whose blood lead levels at both 12 and 24 months of age were <10 μg/dL; blood lead levels were measured by graphite furnace atomic absorption spectroscopy; Bayley Scales of Infant Development II were administered at these ages. The outcomes of interest were the Mental Development Index and the Psychomotor Development Index.

RESULTS. Adjusting for covariates, children's blood lead levels at 24 months were significantly associated, in an inverse direction, with both Mental Development Index and Psychomotor Development Index scores at 24 months. Blood lead level at 12 months of age was not associated with concurrent Mental Development Index or Psychomotor Development Index scores or with Mental Development Index at 24 months of age but was significantly associated with Psychomotor Development Index score at 24 months. The relationships were not altered by adjustment for cord blood lead level or, in the analyses of 24-month Mental Development Index and Psychomotor Development Index scores, for the 12-month Mental Development Index and Psychomotor Development Index scores. For both Mental Development Index and Psychomotor Development Index at 24 months of age, the coefficients that were associated with concurrent blood lead level were significantly larger among children with blood lead levels <10 μg/dL than it was among children with levels >10 μg/dL.

CONCLUSIONS. These analyses indicate that children's neurodevelopment is inversely related to their blood lead levels even in the range of <10 μg/dL. Our findings were consistent with a supralinear relationship between blood lead levels and neurobehavioral outcomes.
Air Pollution and Infant Death in Southern California, 1989–2000
Authors: Ritz Beate , Wilhelm Michelle , Zhao Yingxu
Published: August 2006

OBJECTIVE. We evaluated the influence of outdoor air pollution on infant death in the South Coast Air Basin of California, an area characterized by some of the worst air quality in the United States.

METHODS. Linking birth and death certificates for infants who died between 1989 and 2000, we identified all infant deaths, matched 10 living control subjects to each case subject, and assigned the nearest air monitoring station to each birth address. For all subjects, we calculated average carbon monoxide, nitrogen dioxide, ozone, and particulate matter <10 μm in aerodynamic diameter exposures experienced during the 2-week, 1-month, 2-month, and 6-month periods before a case subject's death.

RESULTS. The risk of respiratory death increased from 20% to 36% per 1-ppm increase in average carbon monoxide levels 2 weeks before death in early infancy (age: 28 days to 3 months). We also estimated 7% to 12% risk increases for respiratory deaths per 10-μg/m3 increase in particulate matter <10 μm in aerodynamic diameter exposure experienced 2 weeks before death for infants 4 to 12 months of age. Risk of respiratory death more than doubled for infants 7 to 12 months of age who were exposed to high average levels of particulates in the previous 6 months. Furthermore, the risk of dying as a result of sudden infant death syndrome increased 15% to 19% per 1-part per hundred million increase in average nitrogen dioxide levels 2 months before death. Low birth weight and preterm infants seemed to be more susceptible to air pollution-related death resulting from these causes; however, we lacked statistical power to confirm this heterogeneity with formal testing.

CONCLUSIONS. Our results add to the growing body of literature implicating air pollution in infant death from respiratory causes and sudden infant death syndrome and provide additional information for future risk assessment.
Long-term Height Gain of Prematurely Born Children With Neonatal Growth Restraint: Parallellism With the Growth Pattern of Short Children Born Small for Gestational Age
Authors: Finken Martijn J.J. , Dekker Friedo W. , de Zegher Francis , Wit Jan M. ,   for the Dutch Project on Preterm and Small-for-Gestational-Age-19 Collaborative Study Group
Published: August 2006

BACKGROUND. It is unknown whether children born very preterm (<32 weeks' gestation) with appropriate size for gestational age, who grow poorly in the first postnatal months (ie, preterm growth restraint), show a similar growth pattern as children born small for gestational age.

OBJECTIVE. Childhood growth and adult height of children with preterm growth restraint were compared to those of very preterm small-for-gestational-age and non–preterm-growth-restraint children.

METHODS. Data were drawn from the Project on Preterm and Small-for-Gestational-Age Infants cohort. Preterm growth restraint was considered to have occurred after appropriate-size-for-gestational-age birth and if length and/or weight was below −2 SD score at 3 months postterm.

RESULTS. Among 380 very preterm children, 274 experienced no preterm growth restraint and showed near-normal growth, whereas 79 (21%) experienced preterm growth restraint and subsequently displayed a growth pattern similar to that of very preterm small-for-gestational-age children (n = 27). Adult height of these children was −1.1 to −1.2 SD score. Very preterm small-for-gestational-age and preterm-growth-restraint children with a height below −2 SD score at 5 years had an adult height of approximately −2.5 SD score.

CONCLUSIONS. Childhood growth and adult height were similar in very preterm small-for-gestational-age and preterm-growth-restraint children. These long-term findings further strengthen the plausibility of extending the small-for-gestational-age indication for growth hormone therapy in such a way that preterm-growth-restraint children are no longer excluded if they have a short stature persisting beyond the age of ∼5 years.
The AlaskaHaemophilus influenzaeType b Experience: Lessons in Controlling a Vaccine-Preventable Disease
Authors: Singleton Rosalyn , Hammitt Laura , Hennessy Thomas , Bulkow Lisa , DeByle Carolynn , Parkinson Alan , Cottle Tammy E. , Peters Helen , Butler Jay C.
Published: August 2006

OBJECTIVE. Before 1991, Alaska Native children experienced one of the highest rates of invasive Haemophilus influenzae type b disease. H influenzae type b vaccine has led to a near-elimination of invasive H influenzae type b disease in the United States. We describe challenges encountered in controlling H influenzae type b disease in Alaska and update the current status of H influenzae disease and carriage in Alaska as lessons to other populations.

PATIENTS AND METHODS. We reviewed data from statewide H influenzae disease surveillance conducted during 1980–2004. Vaccine coverage data were based on audits from tribal facilities and the National Immunization Survey. H influenzae type b colonization data were based on 6 carriage studies.

RESULTS. After universal infant vaccination in 1991, H influenzae type b disease among Alaska Native and non-Native children <5 years of age decreased by 94% and 96%, respectively. After a 1996 change in H influenzae type b vaccine from polyribosylribitol phosphate-outer membrane protein conjugate vaccine to H influenzae type b oligosaccharide-CRM197 vaccine, the incidence of H influenzae type b disease increased in rural Alaska Natives from 19.8 to 91.1 cases per 100000 per year <5 years of age. During 2001–2004, with use of polyribosylribitol phosphate-outer membrane protein conjugate vaccine, the rate of H influenzae type b disease in Alaska Native and non-Native children aged <5 years decreased to 5.4 and 0 per 100000 per year, respectively. In postvaccine studies, H influenzae type b carriage has decreased in Alaska Native children <5 years of age.

CONCLUSIONS. H influenzae type b vaccination has resulted in a dramatic decrease in invasive H influenzae type b disease in Alaska; however, despite high rates of H influenzae type b vaccine coverage, H influenzae type b disease rates among rural Alaska Native children <5 years of age remain higher than the rates among non-Native Alaska and other US children. Equity in disease rates may not be achieved in indigenous populations with the current vaccines unless other environmental and household factors contributing to disease transmission are addressed.
Variations in Management of Common Inpatient Pediatric Illnesses: Hospitalists and Community Pediatricians
Authors: Conway Patrick H. , Edwards Sarah , Stucky Erin R. , Chiang Vincent W. , Ottolini Mary C. , Landrigan Christopher P.
Published: August 2006

OBJECTIVE. The goal was to test the hypothesis that pediatric hospitalists use evidence-based therapies and tests more consistently in the care of inpatients and use therapies and tests of unproven benefit less often, compared with community pediatricians.

METHODS. A national survey was administered to hospitalists and a random sample of community pediatricians. Hospitalists and community pediatricians reported their frequency of use of diagnostic tests and therapies, on 5-point Likert scales (ranging from never to almost always), for common inpatient pediatric illnesses. Responses were compared in univariate and multivariable logistic regression analyses controlling for gender, race, years out of residency, days spent attending per year, hospital practice type, and completion of fellowship/postgraduate training.

RESULTS. Two hundred thirteen pediatric hospitalists and 352 community pediatricians responded. In multivariable regression analyses, hospitalists were significantly more likely to report often or almost always using the following evidence-based therapies for asthma: albuterol and ipratropium in the first 24 hours of hospitalization. After the first urinary tract infection, hospitalists were more likely to report obtaining the recommended renal ultrasound and voiding cystourethrogram. Hospitalists were significantly more likely than community pediatricians to report rarely or never using the following therapies of unproven benefit: levalbuterol, inhaled steroid therapy, and oral steroid therapy for bronchiolitis; stool culture and rotavirus testing for gastroenteritis; and ipratropium after 24 hours of hospitalization for asthma.

CONCLUSION. Overall, in comparison with community pediatricians, hospitalists reported greater adherence to evidence-based therapies and tests in the care of hospitalized patients and less use of therapies and tests of unproven benefit.
Presentation and Echocardiographic Markers of Neonatal Hypertensive Cardiomyopathy
Authors: Peterson Amy L. , Frommelt Peter C. , Mussatto Kathy
Published: August 2006

BACKGROUND. Systemic hypertension is a rare but important cause of neonatal heart failure. It is critical that this etiology be recognized and distinguished from other causes of myocardial dysfunction in young infants, because diagnostic studies, treatments, and prognoses are quite different.

METHODS. Between 1991 and 2005, 11 neonates were diagnosed as having neonatal cardiomyopathy and systemic hypertension through retrospective review of the Children's Hospital of Wisconsin database.

RESULTS. All infants in the cohort were found to have systemic hypertension (blood pressure of >95th percentile for gestational age and weight). Causes included renovascular disease (n = 9), aortic obstruction secondary to thrombus (n = 1), and steroid use (n = 1). Echocardiography was performed at presentation for all patients because of cardiomegaly and/or hypertension. Echocardiographic findings were consistently striking for (1) left ventricular systolic dysfunction without chamber dilation, (2) concentric left ventricular hypertrophy, (3) left atrial dilation, and (4) aortomegaly. No anatomic aortic arch obstruction was identified, but Doppler findings for the descending thoracic aorta were uniformly consistent with elevated systemic vascular resistance. One patient died as a result of overwhelming thrombotic disease; all other patients responded to afterload reduction therapy with normalization of left ventricular systolic function during infancy.

CONCLUSIONS. Hypertensive cardiomyopathy can present in neonates with nonspecific symptoms and systemic hypertension. Because sometimes hypertension in infants is ignored or misinterpreted as agitation, echocardiography can provide critical markers of the disease.
Improving Safety-Restraint Use by Children in Shopping Carts: Evaluation of a Store-Based Safety Intervention
Authors: Smith Gary A.
Published: August 2006

OBJECTIVE. Approximately 20700 children who are <5 years old are treated in US hospital emergency departments annually for shopping cart–related injuries. The objective of this study was to evaluate the effectiveness of an in-store intervention to increase the use of restraints in shopping carts by children who are <5 years old.

METHODS. The study intervention consisted of greeters at the store entrance who encouraged the use of appropriate shopping cart restraints plus the use of a small cash coupon incentive. The study used a preintervention and postintervention design with an untreated “control” group. Three stores served as intervention stores, and 4 stores served as nonintervention stores. Trained study personnel conducted the observations unobtrusively in all 7 stores simultaneously, recording the status of children's restraint use in the shopping cart as caregivers approached store checkout areas. The main outcome measure of the study was the change in the proportion of children who were <5 years old, riding in a shopping cart, and restrained correctly.

RESULTS. There were a total of 967 observations, 57% of which were in the 4 nonintervention stores and 43% of which were in the 3 intervention stores. There were 442 observations on the baseline day and 525 on the follow-up day. Interrater reliability was good. Overall, among the 761 cases in which a shopping cart was used, 38% of children were transported in the shopping cart seat with the restraint off or used improperly, and 24% were seated with the restraint used correctly. In the 4 nonintervention stores, the percentage of children who were in shopping carts and restrained correctly increased from 19% at baseline to 31% during the follow-up observation period 1 week later. In the 3 intervention stores, the percentage of correct restraint use among children in shopping carts went from 15% at baseline to 49% after the intervention during the second observation period. The change in correct restraint use among children in shopping carts in intervention stores was significantly greater than that in nonintervention stores.

CONCLUSIONS. A safety intervention, consisting of a $2 incentive coupon plus greeters at the store entrance who encouraged the use of appropriate shopping cart restraints, significantly increased the correct use of restraints among young children who rode in shopping carts. The correct use rate increased to 49% in stores with this modest intervention. However, half of the young children in shopping carts remained unrestrained or restrained incorrectly. Higher rates of correct restraint use may occur with a more comprehensive and sustained shopping cart safety intervention. Shopping cart designs that seat children close to the floor and that do not rely on caregiver behavior change and vigilance for injury protection also should be implemented and evaluated as a passive strategy to prevent shopping cart–related injuries to young children.
Financing of Pediatric Home Health Care
Authors:   Committee on Child Health Financing, Section on Home Care
Published: August 2006

In certain situations, home health care has been shown to be a cost-effective alternative to inpatient hospital care. National health expenditures reveal that pediatric home health costs totaled $5.3 billion in 2000. Medicaid is the major payer for pediatric home health care (77%), followed by other public sources (22%). Private health insurance and families each paid less than 1% of pediatric home health expenses. The most important factors affecting access to home health care are the inadequate supply of clinicians and ancillary personnel, shortages of home health nurses with pediatric expertise, inadequate payment, and restrictive insurance and managed care policies. Many children must stay in the NICU, PICU, and other pediatric wards and intermediate care areas at a much higher cost because of inadequate pediatric home health care services. The main financing problem pertaining to Medicaid is low payment to home health agencies at rates that are insufficient to provide beneficiaries access to home health services. Although home care services may be a covered benefit under private health plans, most do not cover private-duty nursing (83%), home health aides (45%), or home physical, occupational, or speech therapy (33%) and/or impose visit or monetary limits or caps. To advocate for improvements in financing of pediatric home health care, the American Academy of Pediatrics has developed several recommendations for public policy makers, federal and state Medicaid offices, private insurers, managed care plans, Title V officials, and home health care professionals. These recommendations will improve licensing, payment, coverage, and research related to pediatric home health services.
Cerebrovascular disorders in childhood: etiology, clinical presentation, and neuroimaging findings in a case series study
Authors: Matta André P.C. , Galvão Keila R.F. , Oliveira Betânia S.
Published: August 2006

OBJECTIVE: To describe the main etiologies, neurological manifestations and neuro-imaging findings among children with sequelae of cerebrovascular disorders. METHOD: Case series study of children whose diagnosis was stroke sequelae. Variables studied were age at the time of first episode, number of episodes, etiology, motor deficits, epilepsy, and effected vascular territory. RESULTS: Twenty three patients were studied. Average age at first episode was 6.91 (±2.08) years. Fourteen patients were female. The number of stroke events per patient ranged from one to five. The most frequent etiologies were heart disease and sickle cell anemia. The most frequent neurological deficit was right hemiparesis. Nine patients experienced seizures. The left middle cerebral artery was the most affected vascular area. CONCLUSION: Our findings are similar to those described in the literature. Despite a careful investigation, some causes of stroke remain unidentified.
Occipital intermittent rhythmic delta activity in absence epilepsy
Authors: Guilhoto Laura M.F.F. , Manreza Maria Luíza G. , Yacubian Elza M.T.
Published: August 2006

Occipital intermittent rhythmic delta activity (OIRDA) is considered good prognostic factor in typical absences (TA). We report electroclinical evolution in 14 patients with TA and OIRDA, which performed video-EEG. Seven patients were female; 9 had childhood absence epilepsy and the others did not present electroclinical characteristics for syndromic classification according to ILAE's classification (1989). Pyknolepsy was referred to in 13; TA was the only seizure type in 13; one had generalized tonic-clonic seizures (GTCS) and three had myoclonic jerks during TA. VPA monotherapy controlled seizures in 11, diVPA and ESM, in one each. After seizure control EEG normalized in 10 while in three, spike-wave complexes (SWC) persisted, accompanied by OIRDA in one. Finally in another, seizures were not controlled and SWC and OIRDA persisted. In conclusion, we observed in this series of TA and OIRDA with onset before 10 years, pyknolepsy as common finding and few GTCS. VPA controlled seizures in most cases and EEG normalized in 76.92%. We suggest that OIRDA could be considered good prognostic factor in TA associated with SWC and of epileptiform nature leading to appropriate investigation.
Pharmacovigilance in epileptic patients using antiepileptic drugs
Authors: Mei Paulo Afonso , Montenegro Maria Augusta , Guerreiro Marilisa M. , Guerreiro Carlos A.M.
Published: August 2006

OBJECTIVE: To investigate the occurrence of adverse effects of antiepileptic drugs (AED) in chronic epileptic patients in mono or polytherapy. METHOD: We evaluated consecutive patients that met the following inclusion criteria: age of 18 years or older, diagnosis of epilepsy for at least one year, stable dose of AED for at least three months. Patients were asked if they had any adverse event related to the AED. After that, they were interviewed according to a detailed semi-structure questionnaire. We also assessed specifically the adverse events in the last four weeks. The data were analyzed regarding the use of monotherapy x polytherapy, and the presence of probable depression (score >15) according to the Center for Epidemiologic Studies Depression Scale. RESULTS: Sixty-five patients were evaluated, 35 women, mean age 38.3 years; 35 patients were in use of monotherapy and 35 in polytherapy. Only 45 (69.2%) patients spontaneously reported adverse effects. After the formal questionnaire, 63 (97%) patients referred experiencing an adverse event (p<0.001). Seventeen men had adverse events, as opposed to 28 women (p=0.042). When the last four weeks were evaluated, patients with probable depression presented adverse events more frequently (p<0.0001). CONCLUSION: Our data suggest that adverse events are highly prevalent when a detailed questionnaire is applied and that depression may aggravate the number and intensity of side effects in patients using AEDs.
Theory of mind and the frontal lobes
Authors: Igliori Glauco C. , Damasceno Benito P.
Published: August 2006

BACKGROUND: Theory of mind (ToM) is the ability to attribute mental states to other individuals. Its cerebral organization is not enough established, even though the literature suggests the relevant role of the frontal lobes. OBEJECTIVE: To evaluate frontal lobe patients and controls in ToM tests. METHOD:We studied 20 patients with lesions limited to the frontal lobes (as shown by CT or MRI), and 10 normal control subjects by means of ToM tests (recognizing himself in mirrors, false belief, first and second order ToM tasks), as well as tests of other cognitive functions (counter-proofs). RESULTS: Patients and controls performed similarly in ToM tests. There was significant difference between frontal subgroups (left, right, bifrontal) in the double-bluff task (second order ToM) (p=0.021), without relation to verbal fluency (p=0.302) or delayed recall ability (p=0.159). The only two patients with deficits in ToM tasks had impairment of social behavior. CONCLUSION: Frontal lesions do not necessarily implicate in ToM deficits, which may occur when such lesions are associated to disturbance of social behavior.
Neurocysticercosis and microscopic hippocampal dysplasia in a patient with refractory mesial temporal lobe epilepsy
Authors: Silva Alexandre Valotta da , Martins Heloise Helena , Marques Carolina Mattos , Yacubian Elza Marcia Targas , Sakamoto Américo Ceiki , Carrete Jr. Henrique , Centeno Ricardo da Silva , Stavale João Norberto , Cavalheiro Esper Abrão
Published: August 2006

Epidemiologic studies suggest that neurocysticercosis (NC) is the main cause of symptomatic epilepsy in developing countries. The association between NC and mesial temporal lobe epilepsy (MTLE) has been reported by several authors. Recent data have shown that the presence of NC does not influence the clinical and pathological profile in MTLE patients and suggest that not all cysticercotic lesions are inevitably epileptogenic. We describe a 50-years-old woman with partial seizures due to NC which evolve to MTLE. The patient was submitted to a corticoamygdalohippocampectomy to treat refractory epilepsy. An immunohistochemical study using neuronal markers was made on hippocampal formation. Besides the typical aspects of Ammon's horn sclerosis (AHS), the microscopic examination demonstrates cellular features of hippocampal malformation including dysmorphic neurons and focal bilamination of granular cell layer. We suggest that, in this case, a developmental disorder lowered the threshold for the NC-induced seizures and contributed to the establishment of refractory epilepsy.
Biologia do Triatoma brasiliensis: II. Observações sobre a autogenia
Authors: Perondini André Luiz Paranhos , Costa Maria José , Brasileiro Vera Lúcia Ferreira
Published: August 2006

Fêmeas virgens de Triatoma brasiliensis produzem ovos mesmo que não recebam alimento após a muda imaginal. Em geral, existe uma ampla variação no peso corpóreo das fêmeas, quando alcançam o estádio adulto. O peso do adulto é proporcional à quantidade de sangue ingerido no 5.º estádio e os animais mais pesados são aqueles que sobrevivem mais tempo em jejum. A produção total de ovos durante o jejum é proporcional ao peso corpóreo, aumentando em relação ao aumento de peso dos animais. A capacidade de oviposição, medida através de taxa diária de produção de ovos, é variável e também positivamente correlacionada com o peso dos animais. Variou, em nossa amostra, de 0,01 a 0,2 ovos/fêmea/dia para fêmeas cujos pesos variaram entre 150 e 290 mg, respectivamente. A capacidade média de oviposição foi de 0,14 ± 0,02 ovos/fêmea/dia. Esta variação de capacidade de oviposição em relação ao peso dos insetos, mostra que a produção de ovos durante o jejum depende do estado nutricional dos animais e, provavelmente, está correlacionado com o sangue ingerido durante o 5.º estádio.
Investigação epidemiológica do tétano no Rio Grande do Sul, Brasil
Authors: Fischmann Airton , Silveira Cláudio M. da , Tigre Clóvis H. F. , Lima José T. Fiusa , Barcelos Lucio B. , Libel Marlo , Becker Roberto A.
Published: August 2006

Descreve-se o comportamento epidemiológico do tétano no Rio Grande do Sul, através da análise de 136 fichas epidemiológicas de pacientes acometidos pela doença em todo o Estado. As gestantes e os escolares foram detectados como os principais grupos populacionais a serem vacinados, reduzindo-se com esta medida, a longo prazo, 80% do problema.
Risco de infecção tuberculosa em município do interior do Estado de São Paulo e suas aplicações
Authors: Ruffino Netto Antonio , Arantes Gilberto Ribeiro
Published: August 2006

Foi proposto estimar o risco de infecção tuberculosa na população de Ribeirão Preto, SP (Brasil), a partir de estudo transversal, assim como a incidência anual de casos bacilíferos nessa comunidade. As estimativas foram efetuadas com dados de 35.680 pessoas residentes no município e que foram cadastradas na Unidade Sanitária local. Foi estimado o risco de infecção para diferentes grupos etários e para a população geral, bem como analisadas suas variações e implicações.
Serviço social: objetivos, funções e atividades em uma unidade sanitária
Authors: Herrera Nereide Amadeo
Published: August 2006

A partir das experiências desenvolvidas no Centro de Saúde Experimental da Barra Funda, São Paulo (Brasil), foram definidas quatro funções básicas do serviço social em uma unidade sanitária expermiental: função de serviços de atendimento direto à clientela, função administrativa, função de ensino e aperfeiçoamento profissional e função de pesquisa. Juntamente à especificação de suas funções procurou-se determinar seus objetivos e atividades, bem como atribuições do Assistente Social e do Auxiliar Social. Apesar de estarem baseadas nas atividades de um Centro de Saúde Escola, sua aplicabilidade nas demais unidades da rede sanitária não se invalida.
Estudio clinico micologico de onimicosis en ancianos
Authors: Rodriguez-Soto Mayda Elena , Fernandez-Andreu Carlos Manuel , Moya Duque Sonia , Rodriguez Diaz Rosa María , Martinez-Machin Gerardo
Published: August 2006

Se realizó examen físico de las uñas a 210 ancianos y a aquellos que presentaron lesiones sugestivas de onicomicosis se les realizó toma de muestra con el objetivo de conocer los principales agentes causales, las características e incidencia de las lesiones. Se confirmó el diagnóstico mediante el aislamiento del agente causal en 74 de los casos procedentes principalmente de las uñas de los pies, para una incidencia de 35,2. La tinea pedis se presentó en el 25,7% de los casos, mientras que la enfermedad asociada más frecuente fue la Diabetes mellitus; entre las características clínicas de las uñas predominaron el engrosamiento, la pérdida del brillo y la aparición de estrías longitudinales. Existió una correspondencia significativa entre el examen microscópico directo y el cultivo. La especie de dermatofito predominate fue Trichophyton rubrum, mientras que Candida parapsilosis fue la más aislada entre las especies de Candida.
Febre purpúrica brasileira, virulência em modelo animal do Haemophilus Aegyptius (H. influenzae biogrupo aegyptius)
Authors: Brandileone M.C.C. , Zanella R.C. , Tondella M.L.C. , Gheesling L. , Vieira V.S.D. , Carlone G.M.
Published: August 2006

Febre Purpúrica Brasileira (FPB) é causada por cepas invasoras de Haemophilus aegyptius (H. influenzae biogrupo aegyptius, Hae). Estas cepas invasoras foram diferenciadas de cepas de Hae associadas apenas a conjuntivites (cepas não invasoras) através de marcadores moleculares específicos. Modelo de ratos recém nascidos depletados de complemento foi aplicado ao estudo de cepas de Hae, associadas e não associadas a FPB, com o objetivo de se caracterizar seus potenciais de virulência. Com dose infectante de 10(5) células, as cepas invasoras causaram bacteriemia em 80-100% dos ratos inoculados,.e a magnitude da bacteriemia variou de 10(2,5±0,49) a > 10(4,69) ufc/ml de sangue. Usando a mesma dose infectante as cepas controles não causaram bacteriemia frequente (0 a 50%) e a magnitude variou de 0 a 10(3,69±0,53) ufc/ml de sangue. As doses infectantes capazes de causar bacteriemia em 50% dos ratos inoculados (DB50%) para as cepas invasoras de Hae variaram de < 10³ a 10(4,2) bactérias, enquanto que para as cepas não invasoras, as DB50% variaram de 10(6,2) a > 10(7,3) bactérias. Imunização passiva com antissoros produzidos com cepas invasoras demonstrou que os ratos foram protegidos das bacteriemias causadas pelas cepas homólogas, mas não da infecção causada pela cepa heteróloga. Comparando a bacteriemia causada pelas cepas de Hae com a bacteriemia causada pelo H. influenzae b, cepa Eagan (Hib), foi demonstrado o maior potencial de invasibilidade de Hib. Este modelo animal demonstrou ser útil para esclarecer o maior potencial de virulência das cepas invasoras de Hae.
The frequency of blood-born viral infections in a population of multitransfused Brazilian patients
Authors: Covas Dimas T. , Boturão Neto Edmir , Zago Marco A.
Published: August 2006

The frequency of viral markers for hepatitis B (HBV) and C (HCV), human immunodeficiency virus-1 (HIV-1) and human T-lymphotropic virus-1 (HTLV-1) was evaluated in 32 Brazilian ß-thalassemia multitransfused patients. Additionaly the serum concentrations of ferritin and alanine aspartate transaminase (ALAT) were determined. The results show a high prevalence of markers of infection by HBV (25.0%) and HCV (46.8%) and a low prevalence of markers for HIV-1 and HTLV-1. No correlations were demonstrated between the presence of the hepatitis markers and the number of units transfused or the serum concentrations of ferritin and ALAT.
Herpes simplex virus type 2 infection in pregnancy: asymptomatic viral excretion at delivery and seroepidemiologic survey of two socioeconomically distinct populations in São Paulo, Brazil
Authors: Weinberg Adriana , Canto Cynthia L.M. , Pannuti Claudio S. , Kwang Wu N. , Garcia Sidney A.L. , Zugaib Marcelo
Published: August 2006

The objective of the present study was to estimate the prevalence of herpes simplex virus type 2 (HSV 2) antibodies in child bearing women of 2 Brazilian populations with different socioeconomic status and to determine the risk of neonatal HSV exposure by means of maternal cultures at the onset of labor. The study was conducted at 2 hospitals: A, serving very low income patients and B, serving middle socioeconomic class. 173 participants from group A and 127 from B answered a questionnaire which showed that the patients had similar ages (27.7 and 26.8 years, respectively) but differed with regard to socioeconomic status, age at first intercourse (18.6 vs 20.6 years), number of sex partners (1.5 vs 1.2) and previous sexually transmitted diseases (15% vs. 1.5%). History of genital herpes was given by 11% of group A participants and by a similar number, 7%, of patients from group B. In addition, 200 serum samples from population A and 455 from B were tested by ELISA for and HSV antibodies and 92% and 86%, respectively, were found to be positive. Sixty seropositive samples from group A and 90 from B were further analyzed by Western blot, which showed the presence of type 2 specific antibodies in 46% and 36%, respectively, suggesting an overall HSV 2 prevalence of 42% in group A and 31% in B. Cervical specimens were obtained for culture from 299 asymptomatic patients of population A and 313 of B. HSV was isolated from one specimen in each group, indicating a 0.3% incidence of asymptomatic viral excretion in both populations. In conclusion, the prevalence of type 2 antibodies in childbearing women was very high, but it did not differ with the socioeconomic status. The risk of HSV perinatal transmission was also similar in the 2 study populations and it was comparable with the data from developed countries. Our findings do not indicate the need of special screening programs for asymptomatic HSV excretion in Brazilian pregnant women.
Circulation of Eastern equine encephalitis, Western equine encephalitis, Ilhéus, Maguari and Tacaiuma viruses in equines of the Brazilian Pantanal, South America
Authors: Iversson Lygia Busch , Silva Roberto Aguilar M.S. , Rosa Amélia P.A. Travassos da , Barros Vera Lúcia R.S.
Published: August 2006

Neutralizing antibodies to EEE (6.7%), WEE (1.2%), ILH (26.6%), MAG (28.2%) and TCM (15.7%) viruses were found in sera of 432 equines of the Brazilian Pantanal, area where undiagnosed horse deaths are frequently observed. A 4-fold rise in CF titer to EEE virus was detected in acute and convalescent sera of an encephalitis horse sacrified in 1992. Antibodies to EEE, ILH, MAG and TCM viruses were detected in horses less than 2 years old indicating recent circulation of these viruses in the Pantanal. The evidence of recent equine encephalitis associated with rising CF titer to EEE warrants a more intensive study with attempts to isolate virus from horses with clinical manifestations of encephalitis.
Human lagochilascariasis treated sucessfully with ivermectin: a case report
Authors: Bento Ricardo Ferreira , Mazza Celso do Carmo , Motti Eduardo Franco , Chan Yang Tsou , Guimarães José Renato Roxo , Miniti Aroldo
Published: August 2006

A 15 year old male patient was diagnosed as being infected with the nematode Lagochilascaris minor, presenting as abscesses over the left mastoid region, and invading the temporal bone, mastoid sinuses and possibly the CNS. Surgical drainage and administration of cambendazole and levamisole led to improvement, followed by an early relapse and poor tolerance to the antihelminthic drugs. Repeated doses of ivermectin (an animal preparation) were used for the first time to treat this condition and resulted in complete remission of signs of infection, maintained for 15 months after the end of drug therapy, indicating cure of the disease.
Nocardia asteroides peritonitis during continuous ambulatory peritoneal dialysis
Authors: Lopes Jorge O. , Alves Sydney H. , Benevenga Jeni P. , Salla Adenilde , Tatsch Ines
Published: August 2006

This paper reports a case of peritonitis by Nocardia asteroides during continuous ambulatory peritoneal dialysis in a man who had systemic lupus erythematous and chronic renal failure. Diagnosis was established by microscopic examination (Gram and Kinyoun) and culture of centrifuged dialysis fluid and the patient was treated with Trimethoprin-Sulfamethoxazole by intraperitoneal route.
Lance-headed viper (Bothrops moojeni) bite wounding the eye
Authors: Brandão Érico Otaviano , Bastos Helder Castro de , Nishioka Sérgio de Andrade , Silveira Paulo Vitor Portella
Published: August 2006

A 5-year-old girl was bitten in her left eye by a lance-headed viper identified as Bothrops moojeni, measuring 115 cm of length. There was severe facial swelling and left exophthalmus, and enucleation of the eye was necessary. The patient apparently had mild systemic envenoming, but local inflammatory signs and histological evidence of necrosis suggest that both the mechanical trauma and the local action of the venom had a role in the genesis of the eye lesion. It is arguable if the loss of the eye could be prevented even if the antivenom was administered earlier.
The effect of chronic ingestion of ethanol on modulation of granulomatous inflammation in experimental schistosomiasis in mice
Authors: Castro L.P.F. , Bambirra E.A. , Coelho P.M.Z. , Silva M.E.
Published: August 2006

We studied the role of ethanol on the modulation of liver granulomata around Schistosoma mansoni eggs in mice. Albino mice, receiving 7% ethanol as the sole drinking liquid, at 60 and 90 days post-infection, presented smaller granulomata than controls did, when sacrificed at 120 days post-infection. No differences in diameters could be observed, when ethanol was given 4 months before up to 120 days after infection. The results suggested that modulation of schistosome granulomata by ethanol ingestion varies with time and duration of drug consumption.
Nocardia infection in renal transplant recipient: diagnostic and therapeutic considerations
Authors: Santamaria Saber L.T. , Figueiredo J.F.C. , Santos S.B. , Levy C.E. , Reis M.A. , Ferraz A.S.
Published: August 2006

In the present report the authors discuss the diagnostic difficulties, therapeutic measures and the clinical course of Nocardia infection which occurred among renal transplant recipients at the University Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (UH-FRP), from 1968 to 1991. Among 500 individuals submitted to renal transplant, 9 patients developed Nocardiosis at varying times after transplant (two months to over two years). All the patients had pulmonary involvement and their most common symptoms were fever, cough and pleural pain. Dissemination of the process is common and three patients presented cutaneous abscesses, four CNS involvement and one had pericarditis due to Nocardia. The diagnostic is quite difficult since there is no specific clinical picture, concomitant infections are frequent and the microorganism presents slow growth in culture (ranging from four to forty days, in our experience). In this report, three cases were only diagnosed by necropsy. The treatment of choice is a combination of Sulfamethoxazole and Trimethoprim (SMX-TMP). In the present series, overall mortality was 77% (7 cases) and in five of the patients who died the diagnosis was late. All the patients who had CNS involvement died.
Cutaneous Nocardia asteroides infection of nontraumatic origin
Authors: Lopes Jorge O , Bassanesi Maria C , Alves Sydney H , Salla Adenilde , Benevenga Jeni P , Castro Milton S.
Published: August 2006

This paper reports a case of cutaneous infection of nontraumatic origin caused by Nocardia asteroides in a hospitalized patient with chronic obstructive pulmonary disease. Diagnosis was established by direct and histological examination, cultures from exudate and biopsy specimen. We discuss the classification of clinical forms of Nocardia infections affecting the skin.
Prevalencia de infección toxoplásmica en gestantes de la Provincia la Habana
Authors: Martinez Sanchez Raydel , Bacallao Gordo Roberto , Alberti Amador Esteban , Alfonso Berrio Lazara
Published: August 2006

Se realizó un estudio seroepidemiológico de Toxoplasma gondii en cuatro Municípios de la Provincia La Habana en el periodo comprendido entre el mes de Octubre de 1990 y Abril de 1991, utilizando una técnica de ultramicro ELISA de 10 µL. Se examinaron un total de 362 muestras de mujeres embarazadas y se obtuvo una prevalencia de infección de 71,0%. La infección toxoplásmica fue más frecuente en las embarazadas que residían en zona rural y convivian con gatos. Se estudió la relación entre la infección toxoplásmica y el antecedente de abortos espontáneos sin encontrar diferencias estadísticamente significativas.
Usefulness of the detection of Toxoplasma gondii antigens in AIDS patients
Authors: Fachado Alberto , Fonte Luis , Alberti Esteban , Hadad Pablo , Fonseca Lisset , Machin Rodolfo , Finlay Carlos
Published: August 2006

Toxoplasmic encephalitis (TE) is a mayor cause of central nervous system infection in patients with acquired immunodeficiency syndrome (AIDS). Toxoplasma antibodies were detected in 56 of 79 patients with AIDS (71%), in the present study. Fourteen out of 57 seropositive patients developed TF (25%) and had Toxoplasma gondii antigen detected in their urine. For this, most of them received an effective therapy, with the subsequent disappearance of the symptoms and discontinuity of excretion of the T. gondii antigens. Our results suggest that the monitoring of T. gondii antigen in the urine of AIDS patients may be useful to decide on the proper time for therapy, as well as to avoid the beginning of neurologic signs in these patients.
Dot-enzyme-linked immunosorbent assay (Dot-ELISA) for detection of pneumococcal polysaccharide antigens in pleural fluid effusion samples.: Comparison with bacterial culture, counterimmunoelectrophoresis and latex agglutination
Authors: Requejo Henry I.Z. , Alkmin Maria das Graças A. , Almeida Regina G. , Casagrande Silvana T. , Cocozza Ana Maria , Lotufo João Paulo B. , Waetge Aurora R.P. , Rodrigues Joaquim C.
Published: August 2006

A dot-enzyme-linked immunosorbent assay (Dot-ELISA) for pneumococcal antigen detection was standardized in view of the need for a rapid and accurate immunodiagnosis of acute pneumococcal pneumonia. A total of 442 pleural fluid effusion samples (PFES) from children with clinical and laboratory diagnoses of acute bacterial pneumonia, plus 38 control PFES from tuberculosis patients and 20 negative control serum samples from healthy children were evaluated by Dot-ELISA. The samples were previously treated with 0.1 M EDTA pH 7.5 at 90°C for 10 min and dotted on nitrocellulose membrane. Pneumococcal omniserum diluted at 1:200 was employed in this assay for antigen detection. When compared with standard bacterial culture, counterimmunoelectrophoresis and latex agglutination techniques, the Dot-ELISA results showed relative indices of 0.940 to sensitivity, 0.830 to specificity and 0.760 to agreement. Pneumococcal omniserum proved to be an optimal polyvalent antiserum for the detection of pneumococcal antigen by Dot-ELISA. Dot-ELISA proved to be a practical alternative technique for the diagnosis of pneumococcal pneumonia.
Pattern of mycobacterial antigen detection in leprosy
Authors: Pagliari C. , Duarte M. I. S. , Sotto M. N.
Published: August 2006

Immunohistochemistry reaction (Peroxidase anti-peroxidase - PAP) was carried out on fifty-two skin biopsies from leprosy patients with the purpose to identify the antigenic pattern in mycobacteria and to study the sensitivity of this method. Five different patterns were found: bacillar, granular, vesicular, cytoplasmatic and deposits, classified according to the antigenic material characteristics. Deposits (thinely particulate material) appeared more frequently, confirming the immunohistochemistry sensitivity to detect small amounts of antigens even when this material is not detected by histochemical stainings.
Serodiagnosis of strongyloidiasis. The application and significance
Authors: Sato Yoshiya , Kobayashi Jun , Shiroma Yoshiyuki
Published: August 2006

Parasitological diagnosis based on the faecal examination is frequently difficult in cases of chronic, low-level S. stercoralis infection. Even when a newly developed sensitive method (an agar plate culture) is applied, it is essential to examine faecal samples repeatedly to achieve a correct diagnosis. Additionally, it is important to note that a negative result does not necessarily indicate the unequivocal absence of the infection. On the other hand, several serological tests which have recently been developed for strongyloidiasis have proven reliable when used to complement parasitological examination. We have developed two serological tests, ELISA and GPAT, to demonstrate Strongyloides infection and possible applications of the serological tests for diagnosis, mass-screening, epidemiological study and postchemotherapy evaluation of strongyloidiasis were reviewed based on our recent studies.
Paracoccidioides brasiliensis: a mycologic and immunochemical study of a sample isolated from an armadillo (Dasipus novencinctus)
Authors: Vidal Monica Scarpelli Martinelli , Melo Natalina Takahashi de , Garcia Nilma Maciel , Del Negro Gilda Maria Barbaro , Assis Cezar Mendes de , Heins-Vaccari Elizabeth Maria , Naiff Roberto D. , Mendes Rinaldo Poncio , Lacaz Carlos da Silva
Published: August 2006

A sample of P. brasiliensis isolated from the spleen and the liver of an armadillo (Dasipus novencinctus) has been analysed under a mycological and immunochemical viewpoint. The armadillo was captured in an area of Tucuruí (State of Pará, Brazil), the animal being already established as an enzootic reservoir of P. brasiliensis at that region of the country. This sample maintained in the fungal collection of the Tropical Medicine Institute of São Paulo (Brazil) numbered 135, has got all the characteristics of P. brasiliensis, with a strong antigenic power and low virulence for guinea-pigs and Wistar rats. The specific exoantigen of P. brasiliensis - the glycoprotein with a molecular weight of 43 kDa - was easily demonstrated with double immunodiffusion, immunoelectrophoresis, SDS-PAGE and immunobloting techniques.