Molecular evidence for a spotted fever group Rickettsia species in the tick Amblyomma longirostre in Brazil

Two Amblyomma longirostre adult male ticks were collected from a Brazilian porcupine Coendou prehensilis L. in the state of Rondonia, Western Amazon, Brazil. The two ticks were pooled for DNA extraction and tested for the presence of rickettsial DNA by amplifying portions of the gltA, 17-kDa, ompA, and ompB rickettsial genes by polymerase chain reaction (PCR). Portions of the four genes were amplified from the sample and subsequently sequenced. These results indicated the presence of a Rickettsia strain infecting A. longirostre, which was designated as strain Aranha. Compared with homologous ompA rickettsial sequences, "Rickettsia amblyommii" ompA seemed to be the closest relative to Aranha (similarity values: 99.0-99.3%). Phylogenetic analyses of more conserved genes including 17-kDa and gtlA partial sequences indicated that this Rickettsia sp. is a spotted fever group rickettsia. The partial ompB sequence of strain Aranha was distinct from all homologous sequences available in GenBank. Although our ompA analysis suggested a very close molecular phylogenetic relationship of Aranha with "R. amblyommii," we cannot at this time determine if Aranha is a new strain of "R. amblyommii" or a new Rickettsia species in South America.     

Secretion of tumor necrosis factor-alpha by mouse peritoneal macrophages in the presence of dental sealers, sealapex and endomethasone

After filling root canals, the healing process depends on the chemical composition or physical-chemical properties of the material used, among other factors. All root canal sealers, whether solid or plastic, are foreign matter for the body if they remain in permanent contact with apical and periapical tissues. As a result, the first organic reaction that occurs is an attempt to phagocytize the material. During phagocytosis, macrophages release a large number of cell mediators into the area, among which are cytokines that are essential in intercellular communication and in many physiological and pathophysiological processes. One of these cytokines is tumor necrosis factor-alpha (TNF-alpha), which acts through links to specific receptors on the cell membrane initiating a cascade of events leading to induction, activation, or inhibition of numerous cytokine-regulated genes in the cell nucleus. The release of TNF-alpha in a cell culture of mouse peritoneal macrophages incubated with three concentrations (25, 50, and 100 mg/ml) of two endodontic sealers was measured. The solutions containing the calcium hydroxide-based root canal sealer (Sealapex) released fewer units of TNF-alpha than solutions containing the zinc oxide and eugenol-based sealer (Endomethasone).     

In vitro evaluation of the effectiveness of irrigants and intracanal medicaments on microorganisms within root canals

AIM: To evaluate in vitro the effectiveness of sodium hypochlorite (NaOCl), chlorhexidine (CHX) and five intracanal medicaments on microorganisms within root canals. METHODOLOGY: Ninety-six human single-rooted extracted teeth were used. After removing the crowns, canal preparation was completed and the external root surfaces were coated with epoxy resin. Following sterilization, the teeth were contaminated with Candida albicans and Enterococcus faecalis, and were incubated at 37 +/- 1 degrees C for 7 days. The teeth were divided according to the irrigant solution or intracanal medicament: group 1, sterile physiologic solution (SPS) and calcium hydroxide (Ca(OH)2) paste; group 2, SPS and camphorated paramonochlorophenol (CPMC); group 3, SPS and tricresol formalin; group 4, SPS and CaOH2 + CPMC paste; group 5, SPS and PMC furacin; group 6, 2.5% NaOCl without intracanal medication; group 7, 2.0% CHX without intracanal medication and group 8, SPS without intracanal medication (control group). Microbiological samples were collected with sterile paper points, and bacterial growth was determined. The data were submitted to the analysis of variance (anova, P = 0.05). RESULTS: For C. albicans, groups 3 and 8 were statistically less effective than groups 1, 2, 4 and 5 (Kruskal-Wallis (K-W) = 65.241; gl = 7; P = 0.001). For E. faecalis, groups 6 and 8 were statistically less effective than groups 1-4 and 7 (K-W = 61.048; gl = 7; P = 0.001). CONCLUSIONS: Ca(OH)2 + CPMC paste was the most effective intracanal medicament for the elimination of the two microorganisms; 2.0% CHX solution was more effective than 2.5% NaOCl against E. faecalis.     

Neurophysiologic monitoring and pharmacologic provocative testing for embolization of spinal cord arteriovenous malformations

BACKGROUND AND PURPOSE: Embolization of a spinal cord arteriovenous malformation (SCAVM) is still considered risky. We evaluated the efficacy and reliability of pharmacologic provocative testing with neurophysiologic monitoring in the embolization of SCAVMs. METHODS: We retrospectively analyzed results of 60 provocative tests during 84 angiographic procedures (in 52 patients) with intended endovascular embolization. Tests included 47 sodium amytal and 56 lidocaine injections. All procedures were performed with general anesthesia and monitoring of cortical somatosensory evoked potentials (SEPs) and transcranial motor evoked potentials (MEPs). For provocative testing, 50 mg of amytal and 40 mg of lidocaine were consecutively injected through a microcatheter placed at the position of intended embolization. If SEPs and MEPs did not change, embolization was performed with N-butyl-cyanoacrylate (NBCA). If SEPs or MEPs changed, NBCA embolization was not performed from that catheter position. RESULTS: One false-negative result occurred, with an increase in spasticity after embolization. Nineteen positive results occurred: four after amytal injection and 15 after lidocaine injections. Seven injections in a posterior spinal artery feeder resulted in loss of SEPs or MEPs. Eleven injections in the anterior spinal artery feeder and one in the posterior inferior cerebellar artery feeder resulted in loss of MEPs. CONCLUSION: Provocative testing with amytal and lidocaine combined with neurophysiologic monitoring had a high negative predictive value and was a useful adjunct for SCAVM embolization. Both amytal and lidocaine should be used as provocative agents, and both SEPs and MEPs should be monitored.     

Southwick's head-shaft angles: normal standards and abnormal values observed in obesity and in patients with epiphysiolysis

Southwick's angles measured in the anteroposterior and Lauenstein frog-leg views have been used for planning surgical treatment of deformities caused by slipped capital femoral epiphysis (SCFE). Clinically established epiphysiolysis is associated with a decrease in anteroposterior angles and an increase in Lauenstein angles. Obesity is one of the factors involved in the development of SCFE, but its influence in Southwick's angles has not been previously described. Additionally, few reports describe normal values adjusted for sex and bone age. In this study, we determined Southwick's angles in normal control participants (n=70), in patients with obesity (n=31) and in patients with epiphysiolysis (n=33). The intra-observer variations were 1.7 and 23.3% for the anteroposterior and Lauenstein angles, respectively. No significant differences were detected in the control group when these individuals were compared according to sex or chronological age. Obese patients showed a significant increase in the anterposterior angle when compared with control individuals. The hip with epiphysiolysis presented a significant reduction in the anteroposterior angle and an increase in the Lauenstein angle, when the same was compared with the contralateral hip or with the control values. In patients with unilateral SCFE the Lauenstein angle of the normal hip was detected as increased, which was possibly related to the obesity associated with decreased insulin resistance presented by these patients. We conclude that the detection of risk for developing SCFE should include an expanded clinical and radiological profile characterized by pubertal males who present obesity associated with insulin resistance and an increase in Southwick's anteroposterior angle.     

World health system performance revisited: the impact of varying the relative importance of health system goals

Background

In 2002, the World Health Organization published a health system performance ranking for 191 member countries. The ranking was based on five indicators, with fixed weights common to all countries.

Methods

We investigate the feasibility and desirability of using mathematical programming techniques that allow weights to vary across countries to reflect their varying circumstances and objectives.

Results

By global distributional measures, scores and ranks are found to be not very sensitive to changes in weights, although differences can be large for individual countries.

Conclusions

Building the flexibility of variable weights into calculation of the performance index is a useful way to respond to the debates and criticisms appearing since publication of the ranking.     

Quality of life in renal transplant patients: impact of a functioning graft

Objective measures to evaluate quality of life are gaining importance as an adjuvant in assessing therapeutic interventions. The study purpose was to compare quality of life in renal transplant patients with functioning graft and those who restarted dialysis after graft loss. Quality of life was measured using the World Health Organization Quality of Life questionnaire (WHOQOL-Bref). One hundred and thirty two patients were interviewed, and divided into two groups: group I, 100 patients on regular follow-up in outpatient clinics and stable graft functioning; and group II, 32 patients who restarted dialysis after graft loss. The WHOQOL-Bref showed better quality of life in those renal transplant patients with a functioning graft, especially regarding the physical and psychological domains assessed in the general questions. There were no differences between the groups in the social relationship and environmental domains. WHOQOL-Bref is an efficient tool and can be useful for better approaching these patients, not only on a medical basis.     

Ocular manifestations in Dengue fever

PURPOSE: To report a case of Dengue fever resulting in permanent visual loss in both eyes due to retinal capillary occlusion. METHODS: Case report. RESULTS: Severe permanent visual loss occurred in a patient with Dengue fever. Dilated fundus exam showed vascular sheathing with associated retinal hemorrhages at the equator and cotton wool spots in the maculae of both eyes. Fluorescein angiography revealed areas of capillary nonperfusion at the equator and in the macula. The diagnosis of Dengue fever was confirmed by serology detecting IgM antibodies to the Dengue virus. CONCLUSION: Ocular abnormalities may be seen in patients with Dengue fever, therefore ophthalmoscopy should be performed in patients presenting with severe forms of the disease.