Repositório RCAAP

Rapid assessment methods are needed to delimitation of risk communities and to enable implementation and evaluation of impact interventions. Objective: To develop and assess a rapid epidemiologic method to estimate the overall prevalence of tungiasis and severity of disease in endemic communities with distinct demographic, socio-cultural and environment characteristics. Material and Methods: Analysis data from ten population-based surveys on tungiasis, performed in five endemic communities – three in Brazil (secondary data) and two Nigeria (primary data) – between 2001 and 2008. In all surveys, tungiasis was clinically diagnostic by presence of Tunga penetrans into epidermis of participants. To elaborate rapid assessment method six topographic sites of the feet were selected as potential infestation indicator in community level. Linear regression analyses were performed as well strength of associations (R2) and p values were calculated. Estimated prevalences were calculated for each of the ten surveys and compared to true prevalences. The most useful topographic localization to define a rapid assessment method was select based on the strength of association and operational aspects. Result: In total, 7121 individuals of the five communities were examined. Prevalence of tungiasis varied between 21.1% and 54.4%. In the two Nigerian communities the combined overall prevalence was 47% (142/302; 95% confidente intervale: 41%-53%). Tungiasis were more common in males than in females (51,5% vs. 46,3%; p=0,2). Children prevalence (<14 years) was statistically higher then adolescents and adults prevalence (60% vs. 33%, p<0,0001). In the ten surveys, all strength coefficients were high for the six localizations (ranged between 70% and 96%) and p values were significant (all <0,002). The presence of periungual lesions on the toes showed the highest strength coefficient (R2=96%; P<0.0001) and it was identified as the most useful and rapid localization to estimate the prevalence of tungiasis. Estimating prevalence of tungiasis by equation [estimated prevalence] = 1,12 x [prevalence on periungual sites] + 5,0), the mean absolute error was 1,9%. Tungiasis on this topographic site also reliably estimated prevalence of severe disease (>20 lesions) using the equation [estimated prevalence] = 0,24 x [prevalence on periungual sites] – 3,4); mean absolute error was 0,9%. Conslusion: Tungiasis is a public health problem in the fishing communities in Nigeria. Identification of T. penetrans in the periungual area of the feet can be used as a rapid and reliable method to assess the epidemiological situation of endemic areas. This approach will help to delimit endemic communities and to plan control measures aimed at the reduction of tungiasis. Key-words: Tungiasis; Tunga penetrans; Epidemiology; Rapid assessment method; Public Health; Africa; Brazil

Dengue fever remains an important public health problem in northeast Brazil. Large domestic containers used to store water are important breeding sites of Aedes aegypti, the main vector. The use of alternatives to chemical vector control has increased in the last years. The objectives of this study were: to evaluate the inhibition of oviposition by female Ae. aegypti in domestic containers with larvivorous fish; to describe the survival of larvivorous fish to different chlorine concentrations; and to describe the efficacy of Betta splendens fish under field conditions. Oviposition was assessed in a cage of 6 m3 of size. The fish species Poecilia reticulata and B. splendens were used in the laboratory assays. In the cage, eight water containers were placed - four with fish, four without fish (control), and 100 mosquitoes. In each container with 15 l water eucatex strips were placed to facilitate oviposition. At the end of each week, eggs laid on these strips were counted. For each species, the assays were repeated for seven consecutive weeks. Survival of B. splendens and P. reticulata to different concentrations of chlorine (1.0, 1.5 and 2.0 mg / L) was assessed in drums with 35 liters of water. We used 105, 140 and 175 fish for each concentration: six test containers with chlorine for each control without chlorine. Secondary data of the Municipal Dengue Control Program of the city of Fortaleza were analyzed to assess the efficacy of B. splendens under field conditions. The presence of fish in household containers was verified after several weeks. Infestation of containers with mosquito larvae was compared to containers with the larvicide Bacillus thuringiensis israelensis. The presence of B. splendens inhibited oviposition by Ae. aegypti with an activity oviposition index of -0.627. The mean number of eggs laid in deposits with B. splendens (32.5 / week) was lower than in deposits with P. reticulata (200.5 / week) and controls (186.5 / week, p <0.0001). All B. splendens specimens survived a chlorine concentration of 1.0 mg / L, and 72.5% and 39.3% survived concentrations of 1.5 and 2.0 mg / L, respectively. On the other hand, only 4.4% of P. reticulata survived a concentration of 1.0 mg / L. Under field conditions, three containers were encountered with B. splendens and mosquito larvae (1.6%), significantly less than infested deposits with Bti (10.9%; p <0.001). In containers where the fish died or disappeared, infestation was 27.8% higher than in deposits with Bti (p <0.010). In deposits where the fish remained, efficacy was 85% better than Bti. The permanence of fish was higher in concrete tanks (48.5%), located outside the house (47.5%) and at ground level (53.3%). We conclude that B. splendens may be suitable for biological control of Ae. aegypti larvae in large domestic water containers

Periodontitis is a chronic inflammatory disease in which alveolar bone resorption and cementum associated with collagen fibers destruction are important events. It configures as a serious problem of public health in the world, being an important risk factor for cardiovascular diseases and to teeth loss in adults. Bacteria and host factors are necessary to the development of this pathology. The natural products can constitute a new alternative of treatment, being described to be effective as a natural mouthrinse by our research group. The objective of the present study was to investigate the mechanisms involved on the effect of gels based on natural products and its derivatives in the experimental periodontal disease (EPD): gel elaborated from the essential oil of Alecrim pimenta 0.5% (GAl) (Lippia sidoides), associated (GAA) or not to the gel of the extract of the Aroeira 5% (GAr) (Myracrodruon urundeuva); gel elaborated from carvacrol 300µg/g (GCa), associate (GCC) or not to the gel of Dimeric Chalcones 600µg/g (GCh); comparing its effects with the doxycycline, used as positive control (GDX). Periodontitis was induced by a nylon thread ligature surgically placed around the cervix of the second left maxillary molars of male Wistar rats. Animals were treated with locally applied gels in the gingival region immediately after the EPD induction three times a day during 11 days. The parameters analysed were alveolar bone loss, histopathologic and microbiological analysis, myeloperoxidase (MPO); levels of TNF-α and IL-1β (by ELISA) and body mass variation. GAA and GCC reduced the alveolar bone loss similar to GDX. Histopatologically, the periodontium of animals treated with GAA and GCC showed preservation of alveolar bone, cementum and collagen fibers of periodontal ligament and reduced neutrophilic and mononuclear cell infiltrate. The effect on neutrophilic infiltrate was confirmed by MPO. There was a significant reduction of TNF-α and IL-1β levels in the group treated with GAA compared to the vehicle group. All natural gels inhibited the growth of bacteria involved in periodontitis and were able to increased body mass compared to vehicle group. These results support clinical trials of these phytochemicals in the treatment of periodontal disease

GOTLIB, Nádia Battela. Depoimento de uma leitora: José de Alencar e o livro “De cada uma de minhas vidas”. Revista de Letras, Fortaleza, v. 1, n. 29, pt. 2 , p. 96-100, 2009.

Pharmacological investigations on the mechanisms of gastroenteroprotective of centipedic acid, a diterpene from Egletes viscosa Less. in experimental models. Author: Marjorie Moreira Guedes. Advisor: Prof. Dr. Vietla Satyanarayana Rao. Doctoral thesis. Post-Graduate Program in Medical Science. Departamento of Clinic Medicine, UFC, 2008. Centipedic Acid (CA), a diterpene isolated from Egletes viscosa Less. (Asteraceae) was evaluated in experimental models of acute and chronic gastric injury and intestinal injury. CA (50 and 100mg/kg, po) significantly attenuated the gastric lesions induced by ethano. In the mechanistic study, (CA 50 mg/kg) its gastroprotection was shown to involve nitric oxide, prostaglandins, potassium channels ATP-dependent, but not TRPV1 receptors. The diterpene was able to decrease significantly the ethanol associated depletion of NP-SH and SOD levels, and increased MDA formation. Besides, CA enhanced the gastric mucus significantly. In the model of acidified ethanol orally administreted CA (50 and 100mg/kg, po) and lansoprazol (30mg/kg po) markedely attenuated the gastric lesions. In this model, the combination of AC (50 mg/kg) with lansoprazole (30 mg/kg) showed the potentiation on their effects. In the study of action mechanism, CA shown involvement of opioid receptors and α2-adrenergic receptors. CA (50 mg/kg po) decreased significantly the secretory volume and gastric acidity but failed to modify the gastric emptying in rats. CA (7.9, 15.8 e 31.6 mM) did not demonstrate anti-Helicobacter pylori activity in vitro. In the model of chronic gastric ulcer induced by acetic acid, CA (50 mg/kg po) decreased significantly the injured area as much as in 7 to 14 days of treatment. The histological findings evidenced greater fibroblastic activity in the group treated with CA, indicating that it aids in healing process as judged from the recorded parameters of hemorrhage, edema, congestion, exfoliation, infiltration, necrosis and angiogenesis. In the model of intestinal ulcers induced by indomethacin (10mg/kg po) for three days, no changes in the kidneys function (urea and creatinine) or liver enzymes (AST and ALT) were observed. CA (50mg/kg) treatment decreased significantly the number of longitudinal ulcers (>5mm), but not the number of pointed ulcers (<5mm). CA demonstrated an antioxidant effect by reducing the levels of MDA and MPO and by restoring the levels of NP-SH and catalase activity. In intestinal cells (IEC-6) culture, CA (12.5, 25, 50 and 100 μM) showed pro-migratory action, and its association (25, 50 and 100μM) with 250 μM indomethacin, but not with 1000 μM, mitigated the toxicity of indomethacin. CA (6.25, 12.5, 25, 50, 100 and 200 μM) alone showed no statistical difference on cell proliferation of IEC-6. However, in association, CA (12.5, 25, 50, 100 mM) significantly protected the IEC-6 cells from indomethacin (250 and 1000 μM) toxicity. These data suggest that CA diterpene has the gastroenteroprotective potential possibly related to an antioxidant mechanism and it could be an effective therapeutic agent for the treatment of gastrointestinal ulcerations and side effects to NSAIDs.

Kidney transplantation is the therapy that offers longest lifetime and best quality of life (QL) in patients with chronic kidney disease (CKD). However, worldwide there is lack of organs to transplant, causing the need for long-term dialysis therapy. Objectives: To identify changes in QL level and verify the association between variables and initial level and changes in QL in CKD patients undergoing hemodialysis (HD) during a follow-up of 24 months. Materials and methods: The sample consisted of patients undergoing regular HD in the only renal unit in the north of Ceará state, Brazil. We included those older than 18 years who never had kidney transplant and had been under dialysis at for least three months. Hundred and sixty-four patients were submitted to one evaluation and their data composed a transversal analysis. Ninety-two were submitted at least to two evaluations and were studied by longitudinal analysis. At baseline we collected demographic, clinical and laboratory data; classified the patients according to comorbidity by the Khan index; and submitted them to the SF-36 questionnaire in order to measure QL. Every year the patients were re-evaluated with laboratory tests and submitted again to the SF-36. Linear regression by the stepwise method was used to estimate the correlation between variables and initial level of QL. Change in QL level was detected by analysis of variance using co-variables (ANCOVA), considering the initial and final scores, and by the monthly variation rate (final minus initial score divided by number of months of follow-up). Continuous variables were tested for their association with change in QL by linear regression, and the categorical variables were stratified according to monthly variation rate into three groups: improving, worsening, and no change. Results: QL level improved with respect to Social functioning (63.8 vs. 75.0; p=0.001), Role-emotional (39.7 vs. 63.1; p<0.001) and Mental health (63.1 vs. 69.0; p=0.009). Among low comorbidity patients, besides improvement in these dimensions, there was improvement in Physical functioning (56.7 vs. 63.5; p=0.014) and Bodily pain (56.7 vs. 66.5; p=0.009). Age and albumin were strong correlators due to the initial QL level. Age was negatively associated with all eight QL dimensions: Physical functioning (r=-0,312; p<0,001), Role-physical (r=-0,262; p<0,001), Bodily pain (r=-0,157; p=0,049), General health (r=-0,232; p=0,003), Vitality (r=-0,298; p<0,001), Social functioning (r=-0,293; p=<0,001), Role-emotional (r=-0,260; p=0,001) and Mental health (r=-0,217; p=0,006). Albumin was positively associated with: Physical functioning (r=0,218; p=0,006), Bodily pain (r=0,276; p<0,001), General health (r=0,268; p<0,001), Vitality (r=0,270; p<0,001) and Social functioning (r=0,250; p=0,001). Age and creatinine level were associated with changes in QL estimated by monthly variation rate. Age was negatively associated with Bodily pain (r=-0,031; p=0,024), responsible for 9.0% of its variation, and creatinine was positively correlated with General health (r=0,096; p=0,040), responsible for 4.6% in its variation. More women than men worsened in Physical functioning [19 (50.0%) vs. 11 (21.2%); p=0.006]. Conclusions: There was improvement in mental aspects of QL among the patients. This improvement should be seen as a favorable factor to implement interventions aimed at the physical aspects of QL, with special attention to women and high-grade comorbidity patients. Ageing and low level of the laboratory markers related to nutritional status (albumin and creatinine) should be considered as risk markers of poorer QL level.

Prostitution can be found in any country, regardless of their level of development. This occupation exposes the individual to a wide range of health risks. This study documents, sectional investigated risk factors for HIV and other STDs among female sex workers in three geographical areas of Ceara. Factors related to socio-demographic profile, knowledge and practices concerning STD / AIDS, prevalence of infection by HIV and Treponema palidum were related to engaging in unprotected sex. The sample consisted of 819 women who reported sexual practice paid within 180 days preceding the survey recruited through snowball in the cities of Fortaleza, Sobral, Juazeiro and Crato, between February and November 2003. The analysis was performed using STATA, version 10.0. The prevalence of HIV and syphillis was 2.1% and 19.5%, respectively. Most are young women (<28anos; 64.6%), brown (61.1%) with incomplete primary education (56.6%), with stable relationships past (44.1%), working in bars (54 2%) and brothels (17.5%) with high frequency of alcohol weekly (44.2%). Sexual behavior reveals involvement in unprotected sex (35.1%). Prostitution was characterized by an average of seven different partners in the last seven (7) days of realiação the study, collection of low values.

The periodontal disease is described as an inflammatory/imunological disease of multifactorial nature that results from an interaction between pathogenic microorganisms and host defense, whose development can be modified by local factors, systemic diseases or genetic factors. Psychosocial events such as stress, anxiety and depression, are few factors which can contribute for the aggravation of the clinical prognostic of many illnesses, including the chronic periodontitis, once it causes an immunological disequilibrium, being able to increase directly the production of proinflammatory cytokines. Oxidative stress has also been related to PD and depression, because of the damages caused to the cellular structures and for compromising the immunological competence. In order to have a greater insight, the present study evaluated the effects of venlafaxine, an antidepressant, and of vitamin E, a known antioxidant, in rat model of ligature-induced experimental periodontitis (EP). The state of anxiety, depression and alveolar bone loss were assessed. Wistar Rats (180-220g) were divided into ten groups: false-operated (SO); EP (vehicle-water); SO and EP + venlafaxine (10 mg/kg e 50 mg/kg); SO and EP (vehicle-oil); SO and EP + vitamin E (500 mg/kg). EP was induced by the insertion of a nylon wire 3.0, around the second upper left molar which remained there for 11 days. Venlafaxine (10 and 50 mg/kg) and vitamin E (500 mg/kg) were administered daily, orally, during 9 days. The behavioral evaluation was made in the 10th day of EP induction by tests of labyrinth in high cross (anxiety) and of immobility in forced swim (depression). The animals were killed by cervical dislocation on day-11 and their jaws removed, for later evaluations. The morphometric analysis showed that the animals submitted to the EP had significant alveolar bone loss (ABL, p<0.001) when compared to the false-operated ones (SO). Venlafaxine (10 mg/kg) attenuated ABL, but it was not statistically significant; on the other hand, it was observed a greater ABL in the group of animals submitted to EP and treated with venlafaxine (50 mg/kg). The histopathological analysis showed in the group submitted to the EP and treated with vehicle (water), significant mononuclear infiltrate (lymphocytes and macrophages), reabsorption of alveolar process (with only bone fragment left) and cement destruction score of 2 (2-3). The group submitted to the EP and treated with venlafaxine (10 mg/kg) also showed similar alterations of the alveolar bone and cementum, with a score of 2 (1-3), otherwise there was no statistical difference. The group SO showed a small or negligible inflammatory infiltrate, score 0 (0-0). Oxidative stress was also the object of evaluation in this study. Increased lipid peroxidation (TBARS) was evident in the group submitted to EP. Venlafaxine (10 mg/kg) reverted it, showing an antioxidant role. Immuno-histochemmical tests were performed (TNF-α and iNOS) in the gingival and periodontal tissues of the animals revealed an increased immunoreactivity scores in the group of animals submitted to EP, compared to SO group. Venlaflaxine treatment did not reduce these scores. Morphometric analysis of the jaws from EP rats treated with vitamin E (500mg/kg) showed no protection from ABL, when compared to EP controls. The histopathological analysis showed less mononuclear infiltrate in the group submitted to the EP and treated with vitamin E, score 2(0-3) when compared with the group EP, 3 (2-3). The oxidant stress evaluation through the measurement of lipid peroxidation (TBARS) and the activity of the enzyme superoxide dismutase (SOD) showed a significant increase in the concentration of MDA (µM) as well as SOD in animals on EP. Treatment with vitamin E (500 mg/kg) prevented the lipid peroxidation (p<0.05), and also showed a small decrease in SOD activity. The evaluation for TNF-α and iNOS immunoreactivities, EP rats showed an increased immunoreactivity scores for both TNF-α and iNOS, treatment with vitamin E reduced the immunoscores for iNOS only. The behavioral evaluation demonstrated that EP was not associated with anxiety or depression. As regards to body weight changes, rats on EP gained less body weights in the first days of induction of EP. Venlafaxine and vitamin E treatments did not change these results. These data allow us to conclude that venlafaxine as well as vitamin E treatments do not prevent ABL. Venlafaxine (IRSNs) is susceeptible to exarcerbate the ABL in EP when used in high dose. Attention should also be given to the indiscriminate use of antioxidants. The use of vitamin E showed anxiogenic effect.

Coccidiodomycosis is a systemic infection caused by the dimorphic fungi species Coccidioides immitis and C. posadasii. The disease affects both humans and animals, and is considered endemic in the semiarid areas of Ceará State (Northeast Brazil), where it is caused by C. posadasii. The aims of this study were to analyse the phenotypical characteristics of C. posadasii and to develop culture independent methods for improving of the laboratorial diagnosis of coccidioidomycosis. The phenotypical study was conducted with 10 strains (7 from clinical and 3 from ambiental sources) by macro and micromorphology analyses; in vitro growth under different conditions of salinity, temperature and pH; nutritional analysis and antimicrobial susceptibility tests. In addition, methods of antigens extraction and amplification of C. posadasii DNA directly in sputum were also tested. The mycological analysis showed three morphological variations of C. posadasii strains cultivated in potato agar, Sabouraud agar and YEG agar. Regarding to micromorphology, it was observed that arthroconidia counts were related to colony aging and texture. Growth rates of C. posadasii strains were inhibited by high salt concentrations, temperatures above 40° C, but were not affected by the range of pH. Nutritional analyses showed that several compounds, including the oxidized ions, nitrite and nitrate, were efficiently metabolized by C. posadasii strains as carbon and/ or nitrogen sources. The antifungal susceptibility analysis showed that all of the strains of C. posadasii were sensitive to amphotericin B, caspofungin and the azoles ketoconazole, itraconazole, fluconazole, and voriconazole. With the exception of pyrazinamide, all of the tested drugs interfered with the in vitro growth of C. posadasii. Combined antituberculosis drugs also inhibit fungal growth in vitro. Experimental protocols produced a stable and immunoreactive antigen, suitable in presumptive serologic tests for the diagnosis of coccidioidomycosis. Molecular identification of C. posadasii was achieved by PCR amplification of the specific pra gene directly from filamentous cultures and sputum with fungal parasitic structures. The data obtained by phenotypical analyses may be useful in future studies for biological distinction of C. immitis and C. posadasii species. The results of this study provided approaches for a better understanding of coccidioidomycosis in Brazil

This study evaluated the triterpene pentaclycle α- ß-amyrin anti-inflammatory potential on the stages of periodontitis, acute and chronic, in rats. The periodontitis was induced through ligature placement around the second left upper molar. Rats (n=8) were treated with α, β-amyrin (5 and 10 mg/kg, v.o). Sham-operated and positive-controls (lumiracoxibe 20 mg/kg, v.o. and dexametasone, 1 mg/kg, i.p.) were included. The TNF-alfa levels in the plasma were evaluated and gingival tissues analyzed for myeloperoxidase (MPO) and thiobarbituric acid-reactive substances (TBARS). Both α, β-amyrin and dexametasone decreased the levels of TNF-alfa, MPO and TBARS. In chronic stage, the animals were observed and treated for a period of 11 days, in which the rats received the same drugs and were evaluated regarding their body mass variation and bone loss index, besides, were submitted to histopathological study of bone and gingival tissues. In the evaluation of the body mass variation, α, β-Amyrin and lumiracoxibe caused an increase in the weight gain, while a decrease occurred in rats treated with dexametasone when compared with the normal group (p<0.05). In relation to bone loss index, it was observed that α, β-Amyrin 5 mg/kg did not prevent bone loss, whereas a concentration of 10 mg/kg displayed an increase in bone loss; this increase also was perceived in the positive controls, lumiracoxibe and dexametasone, in relation to the sham-operated rats group (p<0.01). In conclusion, α, β-amyrin modulates acute phase periodontal inflammation and presents anti-inflammatory activity in both acute and chronic phases, but do not have the capacity to prevent bone loss. In parallel to this study, we also investigated the α, β-amyrin effect in model of orofacial pain induced in rats by formalin and capsaicin. The animals were pre-treated with α, β-amyrin (10, 30, and 100 mg/kg, i.p.), or vehicle (Tween 80, 3%), and than received either formalin (20 μl, 1.5%) or capsaicin (20 µl, 1.5 μg) injection into the vibrissa central right side. After data analysis, it was concluded that α, β-amyrin exerts antinociception effect in experimental model of orofacial pain.

Immune cells activation is modulated by balancing the signals triggered by a variety of cell surface receptors, including receptor activators, co-stimulating receptors and inhibitory receptors. Receptor-related signaling molecule in lymphocyte activation (SLAM) influences the immune cell activation. In this study we investigated the role of SLAM in immune response of cutaneous leishmaniasis caused by L. braziliensis, as well as if the response of individuals high (HP) or low (LP) IFN-γ producers is modulated by SLAM signaling pathway. Peripheral blood monocuclear cells (PBMC) isolated from 43 health individuals were cultured in vitro with anti-SLAM, rIFN-γ, rIL-12 and phytohemagglutinin in the presence or in the absence of L. braziliensis. It was found that L. braziliensis promoted a significantly reduced SLAM expression in T cells, after 120 h of cultured, possibly indicating activation of this pathway in the initial immune response. SLAM expression behaved differently in HP and LP groups. In LP group, L. braziliensis did not modify SLAM expression in T cells in early immune response. The effect of anti-SLAM on SLAM pathway reduced the expression of this protein in the early stages of the immune response of PBMC stimulated with L. braziliensis. After 120 h the effect of anti-SLAM did not alter CD3+SLAM+ expression in both groups. The proinflammatory cytokines, rIFN-γ and rIL-12, present in the microenvironment with L. braziliensis, reduced SLAM expression only in HP group after 6 h of culture and did not change this response after 120 h. Anti-SLAM at a concentration of 10 μg/ml presented no effect on production of cytokines IFN-γ and IL-13 in both groups, but significantly increased IL-10 production in the HP group. Furthermore anti-SLAM associated with L. braziliensis and rIFN-γ simultaneously did not modify IFN-γ, IL-13 and IL-10 productions. Anti-SLAM associated with L. braziliensis and rIL-12 simultaneously induced an increase of IFN-γ in LP group, and increased IL-13 in HP group. These results suggest that in vitro immune response of PBMC exposed to L. braziliensis, the SLAM signaling pathway acts in modulating Th1 response in HP group and induces a condition of temporary immunosuppression in LP group, not previously described in literature.

This work consists of two parts. In the first part we deal with a compact hypersurface without boundary immersed in to the Euclidean space with the quotient of anisotropic mean curvatures constant. Such a hypersurface is a critical point for the variational problem preserving a linear combination of the (k,F)-area and (n + 1)-volume enclosed by M. We show that it is (r, k,a,b)-stable if, and only if, up to translations and homotheties, it is the Wulff shape, under some assumptions on a,b € R. In the second part we obtain further characterizations for the Wulff shape involving the anisotropic mean curvatures of higher order of a hypersurface M in Rn+1 and the set W = Rn+1-Up€M Tp. Results are obtained for non-convex compact hypersurfaces satisfying W ╪ Ø.

Quality of life (QOL) is an important outcome among end-stage renal disease patients and can be associated with modifiable behaviors. We analyzed the correlation between coping style and QOL among hemodialysis patients. We studied 166 end-stage renal disease patients undergoing hemodialysis. They were older than 18 years, under hemodialysis for at least 3 months, and had never received a transplant. Quality of life was assessed by SF-36 and coping style was scored by the Jalowiec Coping Scale. Emotion-oriented coping and problem-oriented coping scores were compared according to sex, comorbidity, and socioeconomic status by the Mann-Whitney test. Correlations between QOL and 2 coping styles (emotion-oriented coping and problem-oriented coping) were adjusted for age, time on dialysis, hemoglobin, creatinine, albumin, calcium–phosphorus product, and Kt/V by backward stepwise linear regression. There was no difference between coping scores according to sex, comorbidity, and socioeconomic status. Emotion-oriented coping was independently and negatively associated with 4 QOL dimensions: physical functioning, role-physical, role-emotional, and mental health. Our results indicate that patients with high emotion-oriented coping scores should be seen at risk for poor QOL. Patient education in coping skills may be used to change the risk of poor QOL.

RIBEIRO, Maria Aparecida. O saí e a serpente: diálogos entre José de Alencar e Pinheiro Chagas.Revista de Letras, Fortaleza, v. 1, n. 29, pt. 2, p. 75-82, 2009.

Based on the recent work by Andrews and Bryan [2] we present a new proof of the celebrated Grayson's theorem [4], which describes the asymptotic behavior of simple curves evolving by the curve shortening flow. The proof represents a remarkable simplification over the previous methods and consist of normalizing the flow in order to preserve the length (equal to 2 ). It is then established an isoperimetric inequality which provides a lower bound for the length of chords in terms of the corresponding arcs and elapsed time. This estimate is suficiently strong to uniformly control the curvature in time, implying, without many difficulties, that the curvature of the normalized flow converges in the C∞ topology to the function identically equal to 1.

HELENA , Lucia. Nação e invenção. Revista de Letras, Fortaleza, v.1, n. 29, pt. 2, p. 62-68, 2009.

A acidose metabólica tem complexas e múltiplas etiologias em pacientes em hemodiálise (HD), como os ânions não-mensuráveis e a hipercloremia. O objetivo desse estudo foi de observar a influência do cloro no dialisato no controle da acidose metabólica dessa população. O estudo de intervenção aberto foi realizado em único centro de diálise na cidade de Fortaleza, no período de abril a julho de 2009. Trinta pacientes foram submetidos a uma concentração de cloro no dialisato de 111 mEq/L por quatro semanas, e depois a uma concentração de 107 mEq/L por mais quatro semanas. Sangue arterial foi colhido imediatamente antes da segunda sessão de diálise da semana, de acordo com a fase do estudo, e a abordagem de físico-química de Stewart foi aplicada. O “gap” de íons fortes (SIG) diminuiu (7.5±2.0 mEq/L vs. 6.2± 1.9 mEq/L, p=0.006) e o excesso de base standard (SBE) aumentou após o uso de do dialisato com menor concentração de cloro (-6.64±1.7 vs. -4.73±1.9, p<0.0001). A variação do SBE (∆SBE) teve uma correlação inversa com a variação do SIG (∆SIG) entre as fases do estudo (r= -0.684, p<0.0001) e não teve correlação com a variação do cloro (∆cloro). Ao aplicar o modelo de Stewart, a menor contração de cloro no dialisato pode interferir no controle da acidose metabólica em pacientes em HD, surpreendentemente por efeitos nos ânions não-mensuráveis.

It establishes isoperimetric inequalities and exit mean time estimates for minimal submanifolds of N x R, where N is a complete Riemannian manifold with sectional curvature non-positive. It proves isoperimetric inequalities for submanifolds with tamed second fundamental form in Hadamard spaces with bounded sectional curvature.

Background. There are few studies of renal function evaluation in visceral leishmaniasis (Kala-azar). The aim of this study was to investigate the clinical manifest and the risk factors associated with acute kidney injury (AKI) based on RIFLE criteria in patients with visceral leishmaniasis (VL). Methods. A retrospective study of medical records from patients over 14 years old, without previous kidney disease, with VL, treated at São José Infectious Diseases Hospital, from 2002 to 2008. Clinical manifestations and risk factors for AKI (defined by using RIFLE criteria) were studied. A multivariate analysis was performed to analyze the risk factors for AKI. Results. A total of 224 patients were included. The mean age was 36±15 years and 76.8% were males. AKI was observed in 76 patients (33.9% of cases) and % 52.6 (40) were class F on RIFLE criteria. The main clinical symptoms were dyspnea, edema and jaundice in patients with VL and AKI (p<0.05). Oliguria was observed in 6.5% of patients with AKI. Risk factors associated with AKI were male gender (OR=2.2, 95% CI= 1.0-4.7, p=0.03), age > 40 years (OR = 1.05, 95% CI= 1.02-1.08, p < 0.001) and jaundice (OR=2.9, 95% CI= 1.5-5.8 p=0.002). There was an strong association between amphotericin B use and AKI (OR=18.4, 95% CI=7.9-42.8, p<0.0001), whereas glucantime® use was associated with a lower incidence of AKI when compared to amphotericin B users (OR=0.05, 95% CI=0.02-0.12, p<0.0001). Mortality was 13.3% and it was higher in AKI patients (30.2% vs. 4.7%, p<0.0001). RIFLE criteria presented mortality 40%, 20.8% e 35% in R, I and F respective class. Conclusions. The risk factors associated with AKI in patients with VL were male gender, advanced age, jaundice and amphotericin B. The last one was the most important factor of AKI in VL.

This master thesis aims to study some of the work of the Italian mathematician Ennio De Giorgi which refer to the existence and regularity of minimal surfaces but they do not fully contextualized within the framework of differential geometry but rather focused on a field of mathematics that implemented a few decades Geometric Measure Theory. According to the definitions of Ennio De Giorgi will study surfaces, which gave to the same as certain boundarys of sets, which are denoted sets Caccioppoli, this honor given by De Giorgi the Italian mathematician Renato Caccioppoli. These sets have many interesting geometric properties, such as adimits canonical tangent plan almost everywhere, and have "perimeter" finite. The above results will see that even the size 7 all the solutions to the problem of Plateau are regular and in general their regular class is C1,α. Finally, the results of this study are mostly based on the work: Minimal Surface and Function of Bounded Variation of the author Enrico Giusti, which summarizes the techniques of Geometric Measure Theory relating to the work of Ennio De Girogi on a regularity theory of minimal surfaces Theorem (De Giorgi- Federer- Massari - Miranda) Let Ω contains in R^n, n>1 an open set and E contains in R^n a Caccioppoli set satisties to α in (0, 1) ψ(E, Bρ(x)) < cρ^(n-1+2α) for every x in Ω and every ρ in (0, R), with c and R positive constants. Then the reduced boundary is a hipersurface analitic C1,α in Ω, e H^s((∂ E - ∂E) Ω) = 0 for every s > n - 8. Furthemore, suppose that Ej is a sequence of minimal sets in B1 locally converging at minimal set C. Let x in ∂ C and xj in Ej , xj converging at x. Then, if j is enough large , xj is a regular point for ∂Ej and νEj(xj) converges to ν(x), where ν(x) is a normal vector relative at Ej, ∂ E denots the boundary reduced of E and H^s denots the Hausdorff measure.