ABH and Lewis antigen distributions in blood, saliva and gastric mucosa and H pylori infection in gastric ulcer patients

AIM:To investigate the ABH and Lewis antigen expres-sion in erythrocytes,saliva and gastric epithelium,aswell as the association between H pylori and the pres-ence of gastric epithelial lesions.METHODS:The distribution of ABH and Lewis bloodgroup antigens in erythrocytes,saliva and gastric mu-cosa of H pylori-infected gastric ulcer patients was ana-lyzed.Forty-two patients with gastric ulcer were studied,and fifty healthy individuals were used as control group.The blood group antigens were determined by directhemagglutination,dot-ELISA and immunohistochemi-cal methods in erythrocytes,saliva and gastric mucosaspecimens,respectively.Diagnosis for H pylori infectionwas performed by conventional optical microscopy andELISA.RESULTS:A higher seroprevalence of IgG H pylori spe-cific antibodies was observed in gastric ulcer patients(90%)compared to the control group(60%).We ob-served a significant increase of phenotypes O,A_2 andLewis b in H pylori-infected patients.The expression ofthese antigens had progressive alterations in areas of ul-cerous lesions and intestinal metaplasia. CONCLUSION:ABH and Lewis blood group antigensare a good indicator for cellular alterations in the gastricepithelium.     

Low-risk differentiated thyroid carcinoma--literature review and management guidelines

The trend of increasing thyroid cancer has been recognized in Brazil as well as all over the world for several decades. The large use of simple and effective diagnostic tools has significantly contributed to this trend. It is estimated that small carcinomas found at surgery for benign thyroid disorders and by ultrasonography will be identified at greater frequency in the further years. Part of these tumors occurs in low-risk patients that may benefit of less aggressive management strategies. However, the characterization of low-risk patient is still confusing and we lack adequate markers to tell apart patients that may present a troublesome progression of the disease. Furthermore, the use of new follow-up methods has recently changed some guidelines. A multidisciplinary team, including basic scientists, endocrinologists, nuclear medicine physicians, thyroid surgeons and endocrine pathologists reviewed the pertinent literature and, based on their experience, propose some management guidelines for Brazilian patients with low-risk thyroid carcinomas.     

Clinical and radiological study of swallowing in patients with deglutition disorders, classified into two age groups: adults and older people

BACKGROUND: The abnormalities of swallowing process have multifactor and complex etiologies. The videofluoroscopy has been pointed as the exam of greater utility in diagnostic investigation for these cases. This method, when preceded of an adequate anamnesis, can characterize conveniently the level of the dysfunction and usually identify the cause of abnormality with great precision. AIMS: To study the clinical complaints and findings of the videofluoroscopy examination in patients with deglutition disorders and no clinical evidence associated with neurological disorder, classified into two age groups: adults and older people, and to analyze: symptomatic manifestations, kinds of disorders (oropharyngeal or esophageal) and the capacity of clarifying the clinical complaints through the method of images. MATERIALS AND METHODS: Seventy patients with complaint of the capacity of deglutition were analyzed. They had no clinical evidence of associated neurological syndromes or disorders and were classified into two age groups: adults (GI)-- < or = 65 years (n = 36) and older (GII) > 65 years (n = 34). All patients were submitted to anamnesis to obtain the information about their complaints concerning deglutition. The complaints were characterized as high or low, according to their predominant location of manifestation. All the patients were submitted to videofluoroscopy of the deglutition; these alterations were characterized as oropharyngeal or esophageal. The capacity of clarifying the clinical complaints by videofluoroscopy was evaluated in both groups. RESULTS: Among the complaints analyzed, the only one in which the statistical analysis presented a significant difference between the groups was the complaint of heartburn, which occurred more often in the group GI-- eight patients (22.2%) and GII--one patient (2.9%). In the study of videofluoroscopy, it was observed a higher incidence in the oropharyngeal disorder in group GII--41.2% while in group GI--13.9%. As for the esophageal disorder, the incidence was similar in both groups GI - 35.3% and GII--33.3%. Nineteen patients (52.8%) in GI and 23 (67.6%) in GII had their complaints clarified through the videofluoroscopy. CONCLUSIONS: Under the conditions of this study, it can be concluded that: 1.The clinical complaints associated with the difficulty of deglutition occur at a similar frequency in adults and older people, with the exception of heartburn that occurs in larger number among adults; 2. Older people present a higher incidence of oropharyngeal deglutition problems; 3. The videofluoroscopy of the deglutition represents a method of great importance for the diagnosis, because it allows the identification of morphofunctional disorders that cannot be adequately identified by anamnesis; 4. The capacity of clarifying diagnosis of the videofluoroscopy of the deglutition is higher in the older people group.     

Caring for tuberculosis patients in the Family Health Strategy: the nurses' perceptions

The objective of this study was to analyze the nurses' perceptions regarding tuberculosis control, according to the theoretical axis of comprehensive healthcare and the concepts of attachment and teamwork. This qualitative study involved 13 nurses from the Family Health Strategy of a priority city in the metropolitan region of Jo?o Pessoa, Paraíba, Brazil. Data were collected in focal groups and subjected to thematic content analysis. Factors that strengthen tuberculosis control were: supervised treatment, free medication and the provision of supplies. Weakening factors were: worker's turnover, the lack of encouragement for patients and incipient educational actions. The factors that, according to the nurses, weaken tuberculosis patient care should be reviewed by administrators, workers, users and educators with a view to redefining healthcare activities that strengthen attachment, comprehensive healthcare and teamwork.     

Molecular epidemiology of the SH (small hydrophobic) gene of human respiratory syncytial virus (HRSV), over 2 consecutive years

Human respiratory syncytial virus (HRSV) strains were isolated from nasopharyngeal aspirates collected from 965 children between 2004 and 2005, yielding 424 positive samples.We sequenced the small hydrophobic protein (SH) gene of 117 strains and compared them with other viruses identified worldwide. Phylogenetic analysis showed a low genetic variability among the isolates but allowed us to classify the viruses into different genotypes for both groups, HRSVA and HRSVB. It is also shown that the novel BA-like genotype was well segregated from the others, indicating that the mutations are not limited to the G gene.     

Intersectorality and bonding in tuberculosis control in Family Health

This is a qualitative study which aims to analyze the performance of the Family Health teams in the control of tuberculosis according to the relationship between bonding and the development of intersectoral actions in the metropolitan region of Jo?o Pessoa, Paraíba, Brazil. To construct the empirical material focus group techniques were used. Seven focus groups were conducted, involving 37 professionals of the Family Health teams. For analysis, the discourse analysis technique was used. It was concluded that the lack of intersectoral action weakens the bond between tuberculosis patients, their families and the Family Health team. It is noteworthy that intersectoral measures are fundamental in the development of integral care for tuberculosis patients in the context of Primary Health Care.     

Accessibility to tuberculosis treatment: assessment of health service performance

The aim of this study was to assess the accessibility of patients to the treatment of tuberculosis in Ribeir?o Preto, countryside of S?o Paulo State. Evaluation study type, with a quantity approach. Interviews with 100 patients initiated on anti-tuberculosis chemotherapy between 2006-2007 were conducted, using a structured questionnaire based on the Primary Care Assessment Tool (PCAT). Data were analyzed through variance analysis. There was a positive feedback regarding to organizational accessibility, however, the performance of health services has been unsatisfactory in providing transportation vouchers and in addressing the need to use transport for displacement to the health unit, resulting in indirect costs to patients. The services with the highest number of patients treated were those with higher irregularity in the conduct of home visits, showing that the availability of resources (human, material and time) and the organization of care may influence the accessibility to treatment.     

Tuberculosis control: decentralization, local planning and management specificities

The goal was to analyze, according to the perception of health managers, the practices that guide tuberculosis control actions in cities in the metropolitan region of Jo?o Pessoa - PB, Brazil. This qualitative study involved eight professionals in management functions. Testimonies were collected through semi-structured interviews between May and June 2009 and organized through content analysis. Despite the acknowledged benefits of tuberculosis control action decentralization, local planning indicates the predominance of a bureaucratic model that is restricted to negotiation and supplies. Local programming is centered on the coordinator, which shows a command line and vertical management that lead to the fragmentation of the work process. Management action should follow an innovative and transformative route that surpasses bureaucratic barriers and faces the biggest challenge it is proposed: to balance professional interrelations with a view to improving health work performance.