Interferon-induced sarcoidosis

Interferons (IFNs) are widely used for the treatment of various medical diseases. They have marked immunomodulatory effects, and many reports have been published associating IFN therapy with the induction of autoimmune phenomena and other disorders of immune regulation such as sarcoidosis. The clinical presentation of IFN-induced sarcoidosis (IIS) is insidious and can be confused with common constitutional side effects of these drugs. The age of onset of IIS is later than that of naturally occurring sarcoidosis. The most common organs involved are the lungs and skin. In the majority of cases, IIS follows a benign course. As we show in an illustrative case report, complete resolution after discontinuation of IFN therapy can be expected. This review summarises 65 cases of IIS reported in the literature and highlights the pathophysiology, clinical features, diagnostic modalities and therapeutic options for this increasingly recognised phenomenon.     

Multilevel assessment of determinants of dental caries experience in Brazil

OBJECTIVE: To examine contextual and individual determinants of dental caries experience, documenting levels of the disease in Brazil. METHODS: The dental status of 34 550 12-year-old schoolchildren was informed by a country-wide survey of oral health comprising 250 towns and performed in 2002-2003. Indices assessing dental caries experience were compared by sociodemographic characteristics of examined children (gender, ethnic group, localization and type of school), and geographic characteristics of participating towns [the human development index (HDI), and access to fluoridated tap water]. A multilevel model fitted the adjustment of untreated caries to individual and contextual covariates. RESULTS: Better-off Brazilian regions presented an improved profile of dental health, besides having a less unequal distribution of restorative dental treatments between blacks and whites, rural and urban areas, and public and private schools. Girls [odds ratio (OR)=1.1; 95% confidence interval (CI): 1.0-1.1], blacks (OR=1.6; 95% CI: 1.5-1.7), and children studying in rural areas (OR=1.9; 95% CI: 1.7-2.0) and public schools (OR=1.7; 95% CI: 1.6-1.9) presented higher odds of having untreated decayed teeth. The multilevel model identified the fluoride status of tap water (beta=-0.3), the proportion of households linked to the water network (beta=-0.3), and the HDI (beta=-0.2), as town-level variables associated with caries levels. CONCLUSION: Dental caries experience is prone to sociodemographic and geographic inequalities. The monitoring of contrasts in dental health outcomes is relevant for programming socially appropriate interventions aimed both at overall improvements and at the targeting of resources for groups of population presenting higher levels of needs.     

Identification of elastic fibers and lamellae in porcine pericardium and aorta by confocal, fluorescence and polarized light microscopy

Pericardial connective tissue has been used to construct bioprostheses to repair various types of injuries, including aortic wall repairs. The arrangement and the distribution of elastic and collagen staple fibers are related directly to the biomechanical properties of the tissue and thus determine the choice tissue for the construction of bioprostheses. Although elastic fibers can be visualized using several histochemical methods, the specificity and mechanism of binding involved remain to be clarified. In this work, we compared the elastic net of the porcine pericardial matrix with that of the aortic wall using 1-anilino-8-naphthalene sulfonate (ANS) and dansyl chloride (DCl) as fluorescent probes and the permanganate-bisulfite-toluidine (PBT) method. Polarized light and fluorescence microscopy were simultaneously used to analyze the tissues. Some samples also were examined using confocal microscopy. Aorta and pericardium treated with ANS and DCl showed elastic fibers and lamellae with an intense blue fluorescence. When stained with the PBT method, the aortic elastic lamellae were clearly metachromatic and, under polarized light, they showed a greenish birefringence. DCl provided clearer fluorescent labelling of elastic fibers when examined using confocal microscopy.     

Anoxic encephalopathy after ultraviolet radiation session: follow-up and results

Anoxic encephalopathy is the consequence of acute cerebral oxygen deprivation usually generated by cardiac arrest and/or respiratory failure. Recently an interesting case of one patient with cerebral anoxia after ultraviolet radiation session has been published. This paper shows the clinical evolution of this patient after inclusion in a multidisciplinary rehabilitation program, which included treatment of the psychopathological, neuropsychological and functional impairments that this pathology often generates. Over successive decades cerebral anoxia has come to be identified principally as one of the most significant causes of an isolated amnesia syndrome. Our patient presented at baseline intense difficulties in every verbal and visual memory processes associated with moderate impairments in sustained, selective and shifting attention as well as temporal disorientation. Compensation of memory deficit was the main rehabilitation strategy used in this case. This rehabilitation approach was possible thanks to the high degree of self-awareness of memory deficits shown by the patient and the selective impairment of memory with partial preservation of the rest of cognitive functions. This particular case gives us the opportunity to show the multidisciplinary approach of cognitive rehabilitation and the process of reintegration to social activities and to productive work even when deficits persist.     

Drinking and driving in southeastern Brazil: Results from a roadside survey study

Objective

The objective of this study is to present data from a roadside survey study on drinking and driving and alcohol consumption in southeastern Brazil.

Methods

A cross-sectional roadside survey study using a questionnaire and breathalyzer data is the method used to determine the prevalence of drinking and driving and to examine whether socio-demographic characteristics and drivers' behavior, attitude and alcohol consumption predicted positive blood alcohol content (BAC). The data were gathered from 2005 to 2007 through roadside surveys conducted on high volume public roads in four cities in southeastern Brazil. A total of 4182 randomly selected drivers took part in the research. Of these drivers, 3488 (83.4%) completed the questionnaire and agreed to take a breath test.

Results

Overall, 24.6% of drivers had a detectable blood alcohol concentration (BAC) and 15.9% had a BAC above the legal limit (0.6 g/l) at the time of the study. Logistic regression controlling for locale (city), sex, age and marital status was used to predict whether each driver would present a positive breath test. Socio-demographic characteristics, driving behaviors and attitudes, and alcohol consumption patterns were included as predictors. These analyses indicated that those who believed drinking and driving was a serious offense were about two-thirds as likely to have a positive breath test, and that drivers reporting a pattern of regular alcohol use were three times as likely to have a positive breath test.

Conclusions

These findings indicate that drinking and driving is relatively common in Brazil, and that it occurs considerably more frequently than similar surveys suggest, is the case in other countries.     

Development and physicochemical characterization of saquinavir mesylate solid dispersions using Gelucire 44/14 or PEG 4000 as carrier

Solid dispersions of saquinavir mesylate containing either Gelucire^® 44/14 or poly(ethylene glycol) (PEG) 4000, or mixtures of each carrier with Tween 80 or polyvinyl pyrrolidone (PVP) K30 were prepared in order to enhance the drug dissolution rate. These systems were prepared by the melting method and characterized by X-ray powder diffraction, microscopical techniques, and Raman spectroscopy aiming to establish a relationship between physicochemical and dissolution properties under different cooling conditions. Modifications in degree of crystalline order/disorder over time were observed in preparations with both carriers. Overall, formulations cooled and stored at ?20 °C showed less variation in dissolution rates than those at 25 °C. Although Tween 80 has enhanced the known self-emulsifying properties of Gelucire^® 44/14, its combination with PEG 4000 displayed miscibility problems. The addition of PVP K30 was not the most effective approach in enhancing the dissolution in early steps; however, the drug dissolution was stable after 7 days of storage at 25 °C. The combination of PEG 4000 and PVP K30 maintained the dissolution properties for 60 and 90 days at 25 °C/95 % relative humidity and 40 °C/75 % (f ₂ values >50), respectively.