The services for women victims of sexual violence: a qualitative study

OBJECTIVE: To assess public services attending female victims of sexual violence in the city of Sao Paulo. METHODS: This is a qualitative study conducted in two public services attending female victims of sexual violence. Interviews with 42 women were conducted, 13 of whom had sought these services for assistance and 29 were professionals working in these services. Evaluation of the services was based on the categories: reception, access, resolvability and sanitary responsibility. RESULTS: The analysis of the interviews per category has shown that there was reception in both services, problems with respect to access due to the lack of information concerning these services, and quality resolvability with a multi-professional team. As to the sanitary responsibility, it is present in these specialized services but is deficient in the emergency services and basic health care units. Many women are unaware of the rights they are entitled to with respect to specialized services. Frequently their late arrival compromises the efficacy of care. There are deficiencies both in terms of reference and counter reference. CONCLUSIONS: The results ratify the importance of these services and the need for their decentralized expansion. Health courses should introduce the theme of sexual violence at the undergraduate level.     

Clinical evaluation of multisurface ART restorations

The aim of this study was to evaluate the performance of two different glass-ionomer cements: a high-density (Ketac Molar - ESPE) and a resin-modified cement (Fuji VIII - GC) using the Atraumatic Restorative Treatment technique to restore multisurface cavities in permanent teeth. A total of 60 ART restorations (30 with each material) were placed in schoolchildren (9-16 years of age) by two operators. After a period of 6 months, two independent examiners evaluated 59 restorations according to the criteria used in previous ART studies. Data were submitted to McNemar and Fischer tests. The success rate of the treatment was 98.3%. One restoration (Ketac Molar) was replaced by another material and was recorded as failure. The success rates of the restorations were 100% and 96.6% for Fuji VIII and Ketac Molar, respectively. There was no statistically significant difference in the restorations success between baseline and 6 months (p>0.05). In the same way, no significant differences were found between materials, cavity types or operators (p>0.05). The ART approach was highly appropriate and effective in restorations involving two or more tooth surfaces, after 6 months. The results showed a promising performance of the ART technique with both materials.     

Ciprofloxacin, but not levofloxacin, affects cyclosporine blood levels in a patient with pure red blood cell aplasia

A 38-year-old man diagnosed with pure red blood cell aplasia was undergoing treatment with cyclosporine 200 mg/day. On day 41, the cyclosporine dose was increased to 250 mg/day. On day 45, the patient was hospitalized with fever, and ciprofloxacin 200 mg IV tid was begun. The level of cyclosporine was 297 ng/mL, which obliged us to reduce cyclosporine to 200 mg/day. On day 59, ciprofloxacin was discontinued. On day 80, the patient was hospitalized with fever, and levofloxacin 500 mg/d IV was begun. The patient was continued on cyclosporine 250 mg/day. On day 90, levofloxacin was discontinued. The cyclosporine dose-to-blood level ratio was maintained constant in subsequent controls. In this patient, the substantial and sustained increase in cyclosporine blood levels after ciprofloxacin was added to the patient's therapy and the decrease in cyclosporine blood levels after the withdrawal of ciprofloxacin suggest a potential interaction. Levofloxacin therapy could be a therapeutic alternative, although pharmacokinetic/pharmacodynamic studies should be conducted.     

Decreased gonadotropin-releasing hormone neuronal activity is associated with decreased fertility and dysregulation of food intake in the female GPR-4 transgenic rat

Expression of a cAMP-specific phosphodiesterase in GnRH neurons in the GPR-4 transgenic rat resulted in decreased LH levels and pulse frequency and diminished fertility. We have characterized changes in fertility, adiposity, and reproductive and metabolic hormones with age. Although LH levels were decreased in 3-, 6-, and 9-month-old GPR-4 females relative to wild-type (WT) controls, GPR-4 females did not become anovulatory until 6 months of age. No differences were observed in FSH, estradiol, or androstenedione levels in 3-, 6-, or 9-month-old GPR-4 and WT females. At 9 months of age, GPR-4 females had significantly increased abdominal and sc fat depot weights that were associated with increased leptin and insulin levels not observed in WT females. We tested the hypothesis that metabolic changes observed at 9 months of age were the result of dysregulation of the mechanisms controlling energy balance. Two-month-old female GPR-4 rats placed on a high-energy diet gained weight at a rate significantly greater than WT females and, after 24 d, developed the same metabolic phenotype observed in 9-month-old GRP-4 females (increased abdominal and sc fat associated with elevated leptin and insulin concentrations). Overeating did not correlate with changes in estradiol or androstenedione levels. We conclude that decreased GnRH neuronal activity is closely associated with decreased reproductive function and dysregulation of food intake.     

Amantadine reduces the duration of levodopa-induced dyskinesia: a randomized, double-blind, placebo-controlled study

We evaluated the effects of amantadine on levodopa-induced dyskinesia (LID) in eighteen consecutive Parkinson's disease (PD) patients in a randomized, double-blind, placebo-controlled study. The primary outcomes were the Clinical Dyskinesia Rating Scale (CDRS) and the Unified Parkinson's Disease Rating Scale (UPDRS) part IVa score changes. The secondary outcomes were the UPDRS II and III score changes. Amantadine did not change the CDRS score for hyperkinesia or dystonia, but decreased the duration of LID and its influence on daily activities (p=0.04) and the UPDRS II score (p=0.01) more than placebo. These findings show that amantadine reduces the duration of LID and improves motor disability in PD.     

Fluoxetine treatment of prepubescent rats produces a selective functional reduction in the 5-HT2A receptor-mediated stimulation of oxytocin

Various childhood mood disorders are being treated with serotonin selective reuptake inhibitors (SSRIs) such as fluoxetine (Prozac(R)), yet limited data are available on their effects on serotonergic systems prior to maturation. This study investigated the effects of chronic fluoxetine treatment on 5-HT2A serotonin receptor-mediated neuroendocrine responses in young male rats. Prepubescent male rats were treated with saline or fluoxetine (10 mg/kg/day, i.p.) for 14 days, a treatment regimen producing maximal changes in postsynaptic 5-HT2A function in adults. Eighteen hours post-treatment, the rats received saline or increasing doses (0.5, 2.0, or 5.0 mg/kg, i.p.) of the 5-HT2 receptor agonist (+/-)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane HCl ((+/-)-DOI). Trunk blood was obtained to determine changes in oxytocin, ACTH, corticosterone, and renin responses. Fluoxetine produced a small ( approximately 6%) but significant reduction in body weight gain, but no changes were observed in basal hormone levels. In both saline- and fluoxetine-treated rats, (+/-)-DOI increased plasma oxytocin levels in a dose-dependent manner. However, the magnitude of the oxytocin responses to all doses of (+/-)-DOI were markedly attenuated ( approximately 50%) in the fluoxetine-treated rats, indicating a functional reduction in the E(max) of 5-HT(2A) receptor-mediated oxytocin responses. In contrast, fluoxetine did not alter the (+/-)-DOI-induced increases in plasma ACTH, corticosterone, or renin. These data provide the first demonstration of selective neuroadaptive responses in 55-HT2A serotonin receptor function due to prepubescent treatment with fluoxetine. These data may be clinically relevant with respect to the use of selective serotonin reuptake inhibitors in children and adolescents.     

Biotic and abiotic determinants of seroprevalence of antibodies against Trypanosoma cruzi in Palmar de Bravo, Puebla, Mexico

OBJECTIVE: To establish the relationship between seroprevalence for antibodies against Trypanosoma cruzi and its relationship with biotic and abiotic factors. MATERIAL AND METHODS: A cross-sectional study was conducted between August 2000 and September 2001. The study population consisted of a simple random sample of 390 volunteers residing in Palmar de Bravo, Puebla, Mexico. Sample and data collection procedures included assaying antibodies against T. cruzi with validated assays, and searching for domestic reservoirs and triatomine bugs. The relationship between biotic and abiotic factors with seropositivity was assessed. Statistical analysis was conducted using Kappa values for diagnostic tests; statistical significance was assessed with 2 x 2 tables, chi-squared test with Yates' correction, Fisher exact test, and odds ratios. RESULTS: The seroprevalence of T. cruzi infection in humans was 4%; in domestic reservoirs (horses, pigs, and dogs) only 10% of canine reservoirs were positive. Vector species recognized were T. borberi and T. pallidipennis, with a Dispersion Area Index and a Colonization Index of 55% and 40%, respectively. The most important risk factors associated with positive serology were altitude (>2,150 and <2,180 meters above sea level), presence of triatomines, age, time of residence, and participation in a social assistance program. CONCLUSIONS: T. cruzi infection was identified in human beings, vectors, and possibly in domestic reservoirs, in communities located over 2,000 meters above sea level.