Resumo Objetivo: Avaliar a porcentagem de concordância entre métodos de diagnóstico por imagem na avaliação de linfonodomegalias em pacientes HIV(+)/AIDS. Materiais e Métodos: Foi realizado estudo aberto, comparativo e prospectivo dos métodos de diagnóstico por imagem na avaliação de linfonodomegalias. Foram avaliados 30 pacientes (19 homens e 11 mulheres). Todos foram submetidos a ultrassonografia e tomografia computadorizada (TC) e 20 também foram submetidos a ressonância magnética (RM). Foi determinado o grau de concordância entre dois examinadores usando-se métodos de diagnóstico por imagem. Resultados: A TC obteve o maior grau de concordância, com taxa de 28/30 (93,3%) e coeficiente kappa de 0,85. Quando comparado o grau de concordância para linfonodomegalias entre dois examinadores e entre TC e ultrassonografia, o examinador 1 teve taxa de 24/30 (80,0%) e kappa de 0,49, e o examinador 2 teve taxa de 21/30 (70,0%) e kappa de 0,31. Entre RM e TC, o examinador 1 teve taxa de 10/20 (50,0%) e kappa de -0,18, e o examinador 2 teve taxa de 17/20 (85,0%) e kappa de 0,69. Entre RM e ultrassonografia, o examinador 1 teve taxa de 14/20 (70,0%) e kappa de 0,20, e o examinador 2 teve taxa de 15/20 (75,0%) e kappa de 0,38. Conclusão: Este estudo indica que a concordância entre métodos depende fortemente da forma como a pesquisa é conduzida e não da capacidade do examinador.

Abstract Objective: To assess the percent agreement between diagnostic imaging modalities for the evaluation of lymphadenopathies in HIV-infected/AIDS patients. Materials and Methods: This was an open, comparative, prospective study of diagnostic imaging methods for lymphadenopathy evaluation. We evaluated 30 patients (19 men and 11 women). All underwent ultrasound and computed tomography (CT). Twenty of the patients also underwent magnetic resonance imaging (MRI). We determined the percent agreement between two examiners using the various imaging methods to evaluate lymphadenopathies. Results: CT had the highest percent agreement, at 93.3%, with a kappa coefficient of 0.85, corresponding to 28 of the 30 examinations. When we compared the percent agreement between the two examiners and between CT and ultrasound, examiner 1 had an observed rate of 80.0%, with a kappa of 0.49, corresponding to 24 of the 30 examinations, whereas examiner 2 had a rate of 70.0%, with a kappa of 0.31, corresponding to 21 of the 30 examinations. Between MRI and CT, the percent agreement for examiner 1 was 50.0%, with a kappa of −0.18, corresponding to 10 of the 20 examinations, whereas that for examiner 2 was 85.0%, with a kappa of 0.69, corresponding to 17 of the 20 examinations. For MRI and ultrasound, examiner 1 had a percent agreement of 70.0%, with a kappa of 0.20, corresponding to 14 of the 20 examinations, and examiner 2 had a percent agreement of 75.0%, with a kappa of 0.38, corresponding to 15 of the 20 examinations. Conclusion: This study indicates that intermethod agreement is highly dependent on the way in which the research is conducted, rather than on the level of experience of the examiner.

Abstract INTRODUCTION: Currently, there are few studies regarding Blastocystis epidemiology. This study aimed to evaluate the occurrence of Blastocystis in animals in Uberaba, Brazil. METHODS: Fecal samples were examined by parasitological methods and screened for Blastocystis by polymerase chain reaction. RESULTS: Blastocystis spp. were observed in pigs, sheep, cattle, and dogs. Blastocystis polymerase chain reaction was positive in 14/22 samples positive by parasitological methods. CONCLUSIONS: The occurrence of Blastocystis in animals is high, with a predominance of subtype 1 in the region. This is the first study conducted in Brazil showing the genetic profile of Blastocystis isolated from animals.

Resumo O objetivo do presente estudo foi comparar diferentes técnicas para a contagem de fungos filamentosos em molhos de tomate industrializados, comercializados no Brasil. Para isso, foram colhidas 42 amostras do produto do tipo “molho de tomate tradicional”, de 21 marcas diferentes, comercializadas em supermercados do município de Bauru-SP, no período de abril a junho de 2016. A contagem de filamentos micelianos pelo método de Howard foi realizada segundo a metodologia oficial, recomendada pela Association of Official Analytical Chemists (AOAC), aplicando-se as técnicas 965.41 e 945.92. Notadamente, a aplicação da técnica 945.92, que utiliza hidróxido de sódio (NaOH) para eliminar o amido presente nas amostras, facilitou a contagem das hifas e, consequentemente, as porcentagens de campos positivos observadas foram significativamente maiores (mediana = 10%), quando comparadas com as porcentagens obtidas após a utilização da técnica 965.41 (mediana = 6%) (p < 0,001). Nossos achados apontam a necessidade de se ampliar a discussão sobre a aplicação de diferentes técnicas para a contagem de fungos filamentosos em molhos de tomate industrializados, especialmente no Brasil e em outros países que não proíbem a adição de amido nesse tipo de produto.

Abstract The objective of this study was to compare different techniques for counting mould filaments in industrialized tomato sauces available on the Brazilian market. In order to do so, 42 samples of the product “traditional tomato sauce” (from 21 different brands), sold in supermarkets in the municipality of the city of Bauru, Brazil, were collected during the period from April to June, 2016. The mycelial moulds were counted by the Howard method according to the official methodology recommended by the Association of Official Analytical Chemists (AOAC), applying techniques 965.41 and 945.92. Notably, the application of technique 945.92 using sodium hydroxide (NaOH) to eliminate the starch in the samples, facilitated counting of the hyphae and, consequently, the percentages of positive fields observed were significantly higher (median = 10%) when compared with the percentages obtained after using technique 965.41 (median = 6%) (p < 0.001). The present findings reveal the need to expand the discussion concerning the application of different techniques for the counting of mould filaments in industrialized tomato sauces, especially in Brazil and in other countries that do not prohibit the addition of starch to this kind of product.

RESUMO Objetivo: Avaliar a demanda de assistência do cuidador nas habilidades funcionais de autocuidado nas crianças com baixa visão. Métodos: Participaram 14 crianças com idade entre dois e três anos, ambos sexos, divididas em dois grupos: baixa visão e visão normal. O Inventário de Avaliação Pediátrica de Incapacidade (PEDI) foi aplicado especificamente às partes I (habilidades funcionais) e II (assistência do cuidador) na área de autocuidado. Resultados: Não houve diferença significativa entre crianças com baixa visão e visão normal nas habilidades funcionais (t=0,655; p=0,525) e nível de assistência do cuidador (t=0,902; p=0,385). Porém, houve correlação forte e positiva entre as partes I e II no autocuidado para crianças com baixa visão (r=+0,924; p=0,003) e moderada e positiva para as com visão normal (r=+0,790; p=0,035). Conclusão: A demanda de assistência do cuidador nas habilidades funcionais de autocuidado de crianças com baixa visão, entre dois a três anos de idade, está dentro dos padrões de normalidade do PEDI, apresentando bom desempenho funcional, com auxílio de moderada à mínima.

ABSTRACT Objective: To assess the caregiver assistance demand in the functional self-care skills in children with low vision. Methods: Fourteen children aged between two and three years, both genders, were allocated into two groups, low vision and normal vision. The Pediatric Evaluation of Disability Inventory (PEDI) was applied specifically to parties I (functional skills) and II (caregiver assistance) in the selfcare area. Results: There was no significant difference between children with low vision and normal vision in the functional skills (t=0,655; p=0,525) and caregiver assistance level (t=0,902; p=0,385). However, there was strong and position correlation between parties I and II in the self-care for children with low vision (r=+0,924; p=0,003) and moderate and position normal vision (r=+0,790; p=0,035). Conclusion: The caregiver assistance demand in the self-care functional skills in children with low vision, between age two to three years, is within the normal standards of the PEDI, showing good functional performance, with the assistance of moderate to minimum.

ABSTRACT Dengue is an arboviral infection clinically recognized as an acute and self-limited disease. Persistence of dengue symptoms is known, but it has been little studied. The aim of this study was to characterize persistent symptoms in 113 patients with dengue followed up clinically and by laboratory testing at a tertiary hospital. Symptoms that persisted for more than 14 days were observed in 61 (54.0%) patients, and six (6.2%) of them had symptoms for 6 months or more. The persistent symptoms identified were myalgia, weakness, hair loss, memory loss, reduced resistance to physical effort, headache, reasoning problems, arthralgia, sleepiness- and emotional lability. The progression to persistent symptoms was significantly associated with hospitalization, older age, more severe disease, the presence of bleeding and comorbidities upon univariate analysis. Upon multivariate analysis, the presence of persistent symptoms continued to be significantly associated only with increased age and dengue with warning signs. The platelet count during the acute phase of the disease was significantly lower in the group with persistent symptoms. In conclusion, the frequency of progression to persistent symptoms in dengue is relevant in patients seen at a tertiary hospital and the persistence of symptoms is more common in patients with dengue with warning signs.

RESUMO Objetivo: Analisar e correlacionar a influência dos estímulos presentes no ambiente domiciliar nas habilidades funcionais e no nível de assistência do cuidador na mobilidade de crianças com baixa visão e visão normal. Métodos: Participaram sete crianças com diagnóstico de baixa visão (32,29 ± 7,09 meses) e sete com visão normal (31,57 ± 6,90 meses). Os instrumentos utilizados foram Affordances in the Home Environment for Motor Development - Self Report (AHEMD-SR) e Inventário de Avaliação Pediátrica de Incapacidade (PEDI) referente à parte I (habilidades funcionais) e II (assistência do cuidador) da área de mobilidade. Resultados: De acordo com o PEDI, não houve diferença significativa entre crianças com baixa visão e visão normal nas habilidades funcionais (U=13,5; p=0,076) e na assistência do cuidador (U=13,0; p=0,083) na área de mobilidade, porém houve correlação moderada (r=+0,756; p=0,049) entre as partes I e II para crianças com baixa visão. No AHEMD-SR, crianças com baixa visão apresentaram diferenças significativas nas subescalas: motricidade fina (U=7,5; p=0,024), motricidade grossa (U=7,5; p=0,024) e AHEMD total (U=8,0; p=0,035). Porém ambas receberam a classificação "média" para as oportunidades de estimulação do ambiente domiciliar. Conclusão: O ambiente domiciliar das crianças com baixa visão apresentou razoáveis oportunidades de estímulos, no entanto seu desempenho estava dentro dos padrões de normalidade para as habilidades funcionais e assistência do cuidador em mobilidade.

ABSTRACT Objective: To analyse and correlate the influence of the present affordances in the home environment in the functional skills and the level of caregiver assistance for the mobility of children with low vision and normal vision. Methods: Participated seven children with low vision diagnosis (32.29 ± 7.09 months) and seven with normal vision (31.57 ± 6.90 months). The instruments used were Affordances in the Home Environment for Motor Development - Self Report (AHEMD-SR) and Pediatric Evaluation of Disability Inventory (PEDI) relative to the parties I (functional skills) and II (caregiver assistance) for the mobility area. Results: According to PEDI, there was no significant difference between children with low vision and normal vision in functional skills (U=13.5; p=0.076) and caregiver assistance (U=13.0; p=0.083) in the mobility area, however there was moderate correlation (r=+0.756; p=0.049) between the parties I and II for children with low vision. In AHEMD-SR, children with low vision showed significant differences in the subscales: fine-motor (U=7.5; p=0.024), gross-motor (U=7.5; p=0.024), and AHEMD total (U=8.0; p=0.035). However, both children received classification "average" for the affordances in the home environment. Conclusion: Children with low vision showed no differences in functional skills and caregiver assistance in the mobility. And the home environment offered reasonable affordances, which favored the functional skills and caregiver´s assistance in the mobility.

OBJECTIVES: To establish cut-off values for growth hormone concentrations using clonidine as a secretagogue and an immunochemiluminescent assay as the method of measurement and to analyze the response time as well as the influence of gender, nutritional status and pubertal stage. METHODS: A total of 225 tests were performed in 3 patient groups, categorized as group 1 (normal), group 2 (idiopathic short stature) and group 3 (growth hormone deficiency). Among the 199 disease-free individuals, 138 were prepubertal, and 61 were pubertal. Clonidine (0.1 mg/m2) was orally administered, and the growth hormone level was measured by immunochemiluminescent assay. The growth hormone peak and the difference between the growth hormone peak and the baseline level were then analyzed. Statistical analyses were performed using Student’s t-test or the Mann-Whitney test and Kruskal-Wallis test followed by Dunn’s post hoc test. Cut-off values were determined using a receiver operating characteristic curve. RESULTS: Group 1 and group 2 had no difference in growth hormone peak, gender, body mass index standard deviation score, or pubertal stage. Group 3 exhibited a significantly lower growth hormone peak than the other groups did. The receiver operating characteristic curve demonstrated that growth hormone concentrations ≥ 3.0 ng/mL defined responsiveness to clonidine. In total, 3.02% of individuals in group 1 and group 2 were considered false positive, i.e., these children lacked growth hormone deficiency and had a peak below 3.0 ng/mL. CONCLUSION: Clonidine-stimulated growth hormone concentrations ≥3 ng/mL, as measured by immunochemiluminescent assay, suggest responsiveness to the stimulus regardless of gender, body mass index standard deviation score or pubertal stage.

<title>Resumo:</title><p>A toxoplasmose é uma enfermidade parasitária que afeta o desempenho reprodutivo de pequenos ruminantes. Apesar de o ciclo de vida do <italic>Toxoplasma gondii</italic>ser bem conhecido desde 1960, alguns aspectos relacionados com a infecção permanecem obscuros. Este estudo objetivou determinar os efeitos da infecção experimental por <italic>T. gondii</italic> e a influência sobre parâmetros clínicos, hematológicos, parasitêmicos e seminais de machos da espécie caprina. Nove animais foram selecionados e distribuídos em três grupos: GI (n=3) – grupo controle (placebo) oralmente inoculados com solução salina; GII (n=3) – subcutaneamente inoculados com 1 x 10⁶ taquizoítos de <italic>T. gondii;</italic> e GIII (n=3) – oralmente inoculados com 2 x 10⁵ oocistos de <italic>T. gondii</italic>. Posteriormente, foram realizados exames clínicos, testes sorológicos, hemogramas, determinação de parasitemia e avaliação seminal. Em ambos os grupos infectados com o parasita, a maior titulação sorológica observada foi 4096, confirmando a ocorrência da infecção. Entretanto, não foram observadas alterações clínicas (exceto por hipertermia no 5º DPI em um dos animais - GIII) ou nos parâmetros hematológicos. Apesar de ocorrer diferença estatística significativa (P <0,05) na porcentagem de patologias e concentração espermática em algumas datas entre os animais controle e infectados, essas alterações não foram associadas ao parasitismo, mas a fatores ambientais e de manejo dos animais.</p>

<title>Abstract:</title><p>Toxoplasmosis is a parasitic disease that affects reproductive performance in small ruminants. Although the <italic>Toxoplasma gondii</italic> life cycle is well understood since 1960s, several aspects related to its infection remains unclear. This study aimed to determine the effects of <italic>T. gondii</italic>experimental infection, and the influence on clinical, hematological, parasitemia and seminal parameters in male goats. Nine animals were selected and distributed in three groups: GI (n=3) – control group (placebo) orally inoculated with saline solution; GII (n=3) – subcutaneously inoculated with 1 x 106 tachyzoites of <italic>T. gondii</italic>; and GIII (n=3) – orally inoculated with 2 x 10⁵ oocysts of <italic>T. gondii</italic>. After that, clinical exams, serological tests, hemograms, parasitemia determination and semen evaluation were performed. Reciprocal serological titers had highest values of 4096 in both groups of goats infected with <italic>T. gondii,</italic>confirming the experimental infections. However, we could not observe clinical changes (except for mild hyperthermia on the 5^th DAI in one of the animals - GIII) or in hematimetric parameters. Although there were some statistically significant changes (P <0.05) on the percentages of pathology and sperm concentrations in some of the dates between the infected and control animals, these changes were not associated with toxoplasmic infection. Infection was associated with animal handling methods and environmental factors.</p>

Parasitos intestinais são um problema de saúde pública no mundo e a infecção por Blastocystis, protozoário de patogenicidade controversa, é uma das mais frequentes. Nesse estudo foi investigada a ocorrência de parasitos intestinais em pacientes atendidos na Universidade Federal do Triângulo Mineiro, em Uberaba (MG), com ênfase em Blastocystis, pelos métodos parasitológicos direto e de Ritchie. Foram examinadas fezes de 1.323 pacientes de abril/2011 a maio/2012. Em 28,7% deles foi identificado um parasito intestinal, sendo Blastocystis spp. (17,8%) e Giardia intestinalis(7,4%) os mais frequentes. A ocorrência de parasitismo foi maior em crianças de 6-10 anos e a infecção por Blastocystis spp. foi maior acima de seis anos (p < 0,001). Presença exclusiva de G. intestinalis e de Blastocystis spp. foi observada em 5,4% e 12,2% dos pacientes, respectivamente, sendo que dos pacientes com fezes diarreicas, 8% apresentavam parasitismo exclusivo por Blastocystisspp. Outros parasitos intestinais observados em crianças foram Ascaris lumbricoides (0,3%) e Entamoeba histolytica/dispar/moshkovskii (1,4%). O método de Ritchie foi mais sensível (92,8%) que o direto (89,8%), com alta concordância entre eles (97,7%, kappa = 0,92). Em conclusão, a ocorrência de Blastocystis spp. em Uberaba é elevada e foi observada a presença de fezes diarreicas com parasitismo exclusivo por Blastocystis spp.

Intestinal parasites are a problem for public health all over the world. The infection with Blastocystis, a protozoan of controversial pathogenicity, is one of the most common among them all. In this study, the occurrence of intestinal parasites, with emphasis on Blastocystis, in patients at the Universidade Federal do Triângulo Mineiro was investigated in Uberaba (MG) through microscopy of direct smears and fecal concentrates using Ritchie’s method. Feces of 1,323 patients were examined from April 2011 to May 2012. In 28.7% of them at least one intestinal parasite was identified, and the most frequent organisms were Blastocystis spp. (17.8%) and Giardia intestinalis (7.4%). The occurrence of parasitism was higher in children aged 6 -10 years old, and the infection with Blastocystis spp. was higher above the age of six (p < 0.001). The exclusive presence of G. intestinalis and of Blastocystis spp. was observed in 5.4% and 12.2% of the patients, respectively. Regarding patients with diarrheic feces, 8% revealed unique parasitism of Blastocystis spp. Other intestinal parasites observed in children were Ascaris lumbricoides(0.3%) and Entamoeba histolytica/dispar/moshkovskii (1.4%). The Ritchie’s method was more sensitive (92.8%) when compared to direct microscopy (89.8%), with high agreement between them (97.7%, kappa = 0.92). In conclusion, the occurrence of Blastocystis spp. in Uberaba is high and the presence of diarrheic feces with exclusive presence of the parasite of Blastocystis spp. was observed.

OBJETIVOS:Identificar a frequência do polimorfismo no gene IL-10, rs1800896 (-1082 A/G), em mulheres com pré-eclâmpsia (PE) e em mulheres do grupo controle e associar a presença deste polimorfismo com a proteção contra o desenvolvimento da PE.MÉTODOS:Estudo do tipo caso-controle, no qual foram selecionadas 54 mulheres com PE, classificadas de acordo com os critérios da National High Blood Pressure Education Program e 172 mulheres do grupo controle, com pelo menos duas gestações saudáveis. O polimorfismo proposto foi estudado utilizando-se a técnica de reação em cadeia da polimerase em tempo real (qPCR), com sondas de hidrólise. A análise estatística foi realizada utilizando-se o teste de associação do χ2. Odds ratio e seu intervalo de confiança de 95% foram usados para medir a força de associação entre o polimorfismo estudado e o desenvolvimento da PE.RESULTADOS:Foi observado aumento significativo da frequência do genótipo AG entre mulheres do grupo controle (85 versus 15% nas mulheres com PE). O alelo G é significativamente mais frequente entre as mulheres do grupo controle do que nas com PE (Teste χ2; p=0,01). Oodds ratio para as portadoras do alelo G foi de 2, 13, indicando que apresentam menor risco de desenvolver PE do que as não portadoras.CONCLUSÕES:Sugere-se associação entre a presença do alelo G do polimorfismo no geneIL-10, rs1800896 (-1082 A/G), e a proteção contra o desenvolvimento da PE. Mais estudos sobre a contribuição dessas variações e os mecanismos pelos quais afetam o risco de desenvolver PE ainda necessitam de ser realizadas.

PURPOSE:To identify the frequency of polymorphism in the IL-10 gene, rs1800896 (-1082 A/G), in women with preeclampsia (PE) and in women in a control group and to associate the presence of this polymorphism with protection against the development of PE.METHODS:This was a case-control study conducted on 54 women with PE, classified according to the criteria of the National High Blood Pressure Education Program, and on 172 control women with at least two healthy pregnancies. The proposed polymorphism was studied by the technique of real time polymerase chain reaction (qPCR), with hydrolysis probes. Statistical analysis was performed using the χ2 test. Odds ratio and confidence interval of 95% were used to measure the strength of association between the studied polymorphism and the development of PE.RESULTS:Statistically increased frequency of the AG genotype was observed among control women (85 versus 15% in women with PE). The G allele was significantly more frequent among control women than PE women (χ2test, p = 0.01). The odds ratio for carriers of the G allele was 2.13, indicating a lower risk of developing PE compared to non-carriers.CONCLUSIONS:Thus, an association is suggested to occur between the presence of the G allele of the polymorphism in the IL-10 rs1800896 (-1082 A/G) gene and protection against the development of PE. More studies investigating the contribution of these variations and the mechanisms by which they affect the risk of developing PE still need to be undertaken.

INTRODUÇÃO: Durante muito tempo, foi questionada a importância da doença de Chagas no México onde muitos a consideravam um padecimento exótico. Considerando a grande diversidade genética existente, entre os isolados de Trypanosoma cruzi, a importância da caracterização biológica desses e o escasso número de informações sobre os aspectos clínicos e biológicos da doença de Chagas no México, o objetivo deste trabalho foi realizar a caracterização biológica e molecular de isolados de Trypanosoma cruzi originários de diferentes áreas endêmicas deste país, principalmente do Estado de Jalisco. MÉTODOS: Oito cepas mexicanas de Trypanosoma cruzi foram caracterizadas biologicamente e geneticamente (PCR específica para Trypanosoma cruzi, PCR-multiplex, amplificação do espaço não transcrito dos genes do mini-exon, amplificação das regiões polimórficas do gene do mini-exon, classificação pela amplificação de regiões intergênicas dos genes do spliced leader, RAPD - random amplified polymorphic DNA). RESULTADOS: Foram observados dois tipos de parasitemia: patente com picos máximos de parasitemia entre 4,6x10(6) e 10(7) parasitas/mL e subpatente. Além disso, todos os isolados foram capazes de infectar 100% dos animais. Observou-se tropismo predominante pelo músculo estriado (cardíaco e esquelético). As técnicas de PCR do gene do mini-éxon classificaram as oito cepas como TcI e a técnica de RAPD mostrou variação intra-especifica das mesmas, separando as cepas isoladas de humanos daquelas de triatomíneos e por origem geográfica. CONCLUSÕES: As cepas mexicanas de Trypanosoma cruzi são miotrópicas e correspondem ao TcI.

INTRODUCTION: For a long time, the importance of Chagas disease in Mexico, where many regarded it as an exotic malady, was questioned. Considering the great genetic diversity among isolates of Trypanosoma cruzi, the importance of this biological characterization, and the paucity of information on the clinical and biological aspects of Chagas disease in Mexico, this study aimed to identify the molecular and biological characterization of Trypanosoma cruzi isolates from different endemic areas of this country, especially of the State of Jalisco. METHODS: Eight Mexican Trypanosoma cruzi strains were biologically and genetically characterized (PCR specific for Trypanosoma cruzi, multiplex-PCR, amplification of space no transcript of the genes of the mini-exon, amplification of polymorphic regions of the mini-exon, classification by amplification of intergenic regions of the spliced leader genes, RAPD - (random amplified polymorphic DNA). RESULTS: Two profiles of parasitaemia were observed, patent (peak parasitaemia of 4.6×10(6) to 10(7) parasites/mL) and subpatent. In addition, all isolates were able to infect 100% of the animals. The isolates mainly displayed tropism for striated (cardiac and skeletal) muscle. PCR amplification of the mini-exon gene classified the eight strains as TcI. The RAPD technique revealed intraspecies variation among isolates, distinguishing strains isolated from humans and triatomines and according to geographic origin. CONCLUSIONS: The Mexican T. cruzi strains are myotrophic and belong to group TcI.

OBJETIVOS: Avaliar implicações do diabetes melito (DM) na morbimortalidade materno-fetal, segundo experiência da Universidade Federal do Triângulo Mineiro. MATERIAIS E METODOS: Procedeu-se à análise retrospectiva dos prontuários de gestantes diabéticas assistidas entre 1990 e 2009 focando dados e complicações maternas e neonatais. RESULTADOS: A última gestação de 93 diabéticas foi avaliada, sendo 34 com DM tipo 1, em que se observou maior ocorrência de tocotrauma (p = 0,023) e retinopatia (p = 0,023). Vinte e uma pacientes tinham DM tipo 2; suas necessidades de insulina aumentaram progressivamente (p < 0,01) e observou-se maior prevalência de tabagismo (p = 0,004). Trinta e oito tiveram diabetes gestacional e iniciaram acompanhamento do diabetes em idade gestacional mais tardia (p < 0,001), tiveram mais antecedentes de macrossomia fetal (p = 0,028) e maior prevalência de fatores de risco cardiovascular. CONCLUSÕES: Não obstante melhora do controle glicêmico durante a gestação, nenhum dos grupos atingiu alvos glicêmicos ideais. Ainda assim, a maioria das gestações em diabéticas, conduzidas em nosso meio, evoluiu favoravelmente.

OBJECTIVES: Evaluation of the consequences of diabetes mellitus (DM) on maternal and fetal morbidity and mortality at Universidade Federal do Triângulo Mineiro. MATERIALS AND METHODS: A retrospective review of medical records of pregnant women with diabetes was carried out at the hospital between 1990-2009, focusing on maternal and neonatal data and complications. RESULTS: The last pregnancy of 93 diabetics was evaluated. In thirty-four patients with type 1 diabetes a higher incidence of birth trauma (p = 0.023) and retinopathy (p = 0.023) was observed. Twenty-one type 2 DM subjects required progressively increased insulin therapy (p < 0.01) and showed a higher prevalence of smoking (p = 0.004). Thirty-eight had gestational diabetes. Their diabetic follow-up started at a later gestational age (p < 0.001), had more fetal macrosomia histories (p = 0.028) and cardiovascular risk factors. CONCLUSIONS: Despite improvement of glycemic control during pregnancy neither group attained the glycemic target. However, the majority of DM pregnancies evaluated in our group presented successful outcomes.

O quadro clínico clássico de dengue caracteriza-se por duração máxima de 14 dias, embora freqüentemente pacientes refiram prolongamento dos sintomas. Este estudo avaliou a ocorrência de sinais e sintomas persistentes (> 14 dias) e seu impacto no cotidiano do indivíduo doente. Foram entrevistados 118 pacientes, cujos principais sintomas ao diagnóstico foram mialgia (98,3%), febre (97,5%) e fraqueza (95,8%). A presença de pelo menos um sintoma persistente foi referida por 77 (65,2%) entrevistados, sendo que 10 (8,5%) relataram sua permanência de maneira intensa e por 30 dias ou mais. Os sintomas persistentes mais mencionados foram fraqueza (58 casos), hiporexia (49) e sonolência (40), ocorrendo mais no gênero feminino, com odds ratio: 5,4 (IC95%: 2,3-12,3). Houve associação significativa entre a persistência dos sintomas e o relato de gastos adicionais (p = 0,02), e com o retorno às atividades habituais (p < 0,001). Assim, foi verificado que o dengue apresentou impacto na vida dos indivíduos, mesmo depois de 14 dias, sendo tal fato associado à presença de sintomas persistentes da doença.

The clinical picture of dengue is characterized by a maximum duration of 14 days despite frequent complaints of longer symptoms. This study evaluated the occurrence of persistent symptoms (> 14 days) and its impact on daily life. A hundred eighteen patients were interviewed, and the main symptoms at diagnosis were mialgia (98.3%), fever (97.5%) and weakness (95.8%). The presence of at least a persistent symptom was related by 77 (65.2%) individuals of wich 10 (8.5%) described it as intense and lasting for 30 days or more. The most persistent symptoms mentioned were weakness (58 cases), hiporexia (49) and sleepiness (40), occurring mostly in women, with odds ratio: 5.4 (IC95%: 2.3-12.3). A significant association between the persistence of the symptoms and the history of extra expenses (p = 0,02) was found, as well as a delay to return to normal activities (p < 0.001). Thus, it was verified that dengue presented a relevant impact on every day life, even after 14 days, a fact wich was associated with the presence of persistent symptoms of the illness.

O quadro clínico clássico de dengue caracteriza-se por duração máxima de 14 dias, embora freqüentemente pacientes refiram prolongamento dos sintomas. Este estudo avaliou a ocorrência de sinais e sintomas persistentes (> 14 dias) e seu impacto no cotidiano do indivíduo doente. Foram entrevistados 118 pacientes, cujos principais sintomas ao diagnóstico foram mialgia (98,3%), febre (97,5%) e fraqueza (95,8%). A presença de pelo menos um sintoma persistente foi referida por 77 (65,2%) entrevistados, sendo que 10 (8,5%) relataram sua permanência de maneira intensa e por 30 dias ou mais. Os sintomas persistentes mais mencionados foram fraqueza (58 casos), hiporexia (49) e sonolência (40), ocorrendo mais no gênero feminino, com odds ratio: 5,4 (IC95%: 2,3-12,3). Houve associação significativa entre a persistência dos sintomas e o relato de gastos adicionais (p = 0,02), e com o retorno às atividades habituais (p < 0,001). Assim, foi verificado que o dengue apresentou impacto na vida dos indivíduos, mesmo depois de 14 dias, sendo tal fato associado à presença de sintomas persistentes da doença.

The clinical picture of dengue is characterized by a maximum duration of 14 days despite frequent complaints of longer symptoms. This study evaluated the occurrence of persistent symptoms (> 14 days) and its impact on daily life. A hundred eighteen patients were interviewed, and the main symptoms at diagnosis were mialgia (98.3%), fever (97.5%) and weakness (95.8%). The presence of at least a persistent symptom was related by 77 (65.2%) individuals of wich 10 (8.5%) described it as intense and lasting for 30 days or more. The most persistent symptoms mentioned were weakness (58 cases), hiporexia (49) and sleepiness (40), occurring mostly in women, with odds ratio: 5.4 (IC95%: 2.3-12.3). A significant association between the persistence of the symptoms and the history of extra expenses (p = 0,02) was found, as well as a delay to return to normal activities (p < 0.001). Thus, it was verified that dengue presented a relevant impact on every day life, even after 14 days, a fact wich was associated with the presence of persistent symptoms of the illness.

Este trabalho avaliou a possibilidade da inoculação e reinoculação de um tripanossomatídeo isolado de morcego, morfológica, biológica e molecularmente semelhante ao Trypanosoma cruzi, na proteção contra a infecção por cepas virulentas. Camundongos não-isogênicos foram divididos em 24 grupos, que receberam de zero a três inóculos da cepa RM1 de Trypanosoma cruzi-like, na presença ou ausência de adjuvante de Freund e desafiados com as cepas de Trypanosoma cruzi VIC ou JG. Acompanhou-se a parasitemia e a sobrevida e os camundongos foram sacrificados para análise histopatológica. Os animais imunizados com a cepa RM1 de Trypanosoma cruzi-like apresentaram redução da parasitemia, independente do número de inóculos ou presença de adjuvante. Apesar dessa redução, os animais não apresentaram proteção contra lesões histopatológicas e observaram-se intensos infiltrados eosinofílicos que foram correlacionados com o número de inóculos da cepa RM1 de Trypanosoma cruzi-like. Sugere-se que a inoculação prévia dessa cepa, ao invés de proteger contra a infecção, agravou o processo inflamatório tecidual.

This study evaluated the possibility of inoculation and reinoculation with a trypanosomatid isolated from bats that is morphologically, biologically and molecularly similar to Trypanosoma cruzi, to protect against infection by virulent strains. Non-isogenic mice were divided into 24 groups that received from zero to three inoculations of Trypanosoma cruzi-like strain RM1, in the presence or absence of Freund's adjuvant, and were challenged with the VIC or JG strains of Trypanosoma cruzi. Parasitemia and survival were monitored and animals were sacrificed for histopathological analysis. Animals immunized with Trypanosoma cruzi-like strain RM1 presented decreased parasitemia, independently of the number of inoculations or the presence of adjuvant. In spite of this reduction, these animals did not present any protection against histopathological lesions. Severe eosinophilic infiltrate was observed and was correlated with the number of inoculations of Trypanosoma cruzi-like strain RM1. These findings suggest that prior inoculation with this strain did not protect against infection but, rather, aggravated the tissue inflammatory process.