Repositório RCAAP

O artigo esclarece os motivos que têm levado os bancos brasileiros a manterem mais capital do que o mínimo exigido pelo regulador e investiga se um aumento na razão de capital reduz a exposição aos riscos dos bancos. As conclusões indicam que o maior nível de capital aumenta a exposição aos riscos nos bancos brasileiros, reforçando as conclusões de Koehn e Santomero (1980) e Kim e Santomero (1988), e mostra que o parachoque de capital regulatório é a principal variável que explica o excesso de capital. Verifica-se, assim, que o alto nível de capitalização desses bancos não implica, necessariamente, que o sistema financeiro estará mais robusto para enfrentar crises financeiras.

The polyomavirus type BK has been associated to the nephropathy in the patients transplanted renal with an incidence varying among 3 - 4% and in 60% of the cases could take to the loss of the graft. Several studies have been demonstrating the importance of the discovery of the decoy cells in these patients' urine as first selection for the viral replication making it diagnose differential between the sharp cellular rejection and the nephropathy for the BK virus. In this context, the present study aimed at to detect the presence of BKV through the observation of the decoy cells in the urine of the transplanted renal, correlating this discovery with the serum urea levels and creatinine and the histopathology features through the renal biopsy. For so much, the 50 transplanted patients' urine renal (28 men and 22 women) assisted at two hospitals of Fortaleza (Academical Hospital Walter Cantídio and General Hospital of Fortaleza) they were analyzed as for the presence of decoy cells detected through the urinary cytology by the coloration of Papanicolau. Were the cytology analyzed and done classify in negative and positive (≥ 1 decoy cell). Result: Of the 50 cytology analyzed urinary 28 patients they were male and 22 female, alive donor's receivers (n = 43) or cadaverous (n = 7) with assertiveness for decoy cells of 24% (12 patient). Creatinine levels and increased urea, separately, they were not useful to suspect of the nephropathy for BKV or rejection of the transplant (p > 0,05). The correlation of the altered levels of urea and creatinine, with the presence or absence of the decoy cells, was significant for the statistics (p < 0,05). The biopsy revealed nephropathy for BKV in five (20%) of the patients with cells decoy in the urine and the more frequent histological discoveries were fibrose and infiltrated inflammatory mononuclear. The most employed immune suppression in the patients in study was the outline 1 (50%) (ciclosporina / azatioprina / zenapx), following for outlines 2 (16%) (MMF/FK 506/zanapax) 1 outline 3 (16%) (ciclosporina / prednizona / azatioprina). Conclusion: The assertiveness for decoy cells in this study (24%) it is coincident with the literature (8 -26%) suggesting active infection. The presence of the decoy cells in the urine was useful to define the patients' groups with possible nephropathy for BKV of those with nephropathy for rejection, because the negativity for decoy cells in the urine moves away in 100% of the cases the nephropathy for BKV, and his/her presence serves as guide to move forward in the nephropathy investigation for BKV. The biopsy confirmed in 5 of the 12 cases with decoy cells positive in the urine (20%) the nephropathy for the polyomavirus and one of them vein to lose the graft. The immunosuppressive outline used by the patients in study and the nephropathy presence for BKV was not it that more it links in the literature. Also the patients with nephropathy for BKV that used less associated outlines this condition had worse evolution. These last results indicate the need of new studies with larger number of patients, time of larger attendance and study of the stumps turn.

The evaluation of the expression of bax, bcl-2 and p27 proteins at invasive squamous cell carcinoma of oral cavity was done using the immunohistochemistry technique to know about apoptotic profile of these neoplasms. The epidemiological factors and the clinical behavior of the patients were detected, too. Statistical parameters different from odds ratio was employed for future comparisons. Forty-eight patients from Santa Casa da Misericórdia de Fortaleza, Ceará, Brazil was analyzed and with this analysis was possible to know the prognostic factors: sex of patients, instruction grade, familiar gains, tobacco consumption (form of consumption, duration of consumption, period of forsaking and quantity consumed), alcohol consumption (nature of drinking, duration of consumption, period of forsaking, quantity consumed, periodicity). In a posterior moment, with the histopathological report from the surgical specimen was possible to know about localization of neoplasm, size of neoplasm, histological grade, nodes involvement and invasiveness. Pieces of the neoplasm were achieved from surgical specimen and glass slides were done to analyze the invasiveness by hematoxilin-eosin coloration. After the immunohistochemistry reaction by streptoavidin biotin technique was done to evaluate the expression of proteins above. The glass slides with positive reaction were submitted under a counting and, at least, one thousand cells were counted. The results from counting were submitted under the LI(Labelling Index) and HS(H Score) methods. The evaluation of the results was made using descriptive methods and the statistical tests were qui-square and Fisher’s exact test with 10% significance. The results showed the mean age was 57 years old, more males than females, analphabets and one minimum wage the mean familiar gain. The main form of tobacco consumption was industrialized cigarette with 20 years of consumption. The swallow of distillers drinking was bigger than fermentation ones with 20 years of drinking at mean. The floor of the mouth was the anatomic site with more number of cases and the mean size of neoplasm was 1.4 inches. The preponderant pathological staging detected was pT2 and the preponderant histological grade was moderately differentiated. Among the cross tabs realized, there were statistical correlation between size of tumors and age (P=0.084; α=10%), between size of tumors and nodes involvement (P=0,085; α=10%), between sex of patients and nodes involvement (P=0.03; α=10%). The results from immunohistochemical reactions were more positive to bax (77.1% of positive cases), P27(45.9% of positive cases) and bcl-2 (16.6% of positive cases). The mean of LI showed bax at first position (67.766); second bcl-2 (10.804) and P27(7.989). The cross tabs among HS showed statistical positive correlation between bax and P27 (0.245 at Pearson’s correlation). The statistical parameters were: mean and its standard error, median, mode, standard deviation, kurtosis and its standard error, minimum, maximum and percentiles. The conclusions showed apoptosis propensity at oral squamous cell carcinoma

Since the description of the first cases of AIDS, a high prevalence of diarrhea due to parasitic diseases in HIV-infected individuals has been reported. Before the onset of highly active antiretroviral therapy (HAART), the prevalence of enteric parasites in HIV/AIDS patients was high in Brazil; after its introduction, this picture seems to have been modified. The aim of this work was to determine and compare the prevalences of intestinal parasites in HIV/AIDS patients who had been admitted at two public hospitals of Fortaleza-CE, Brazil, in the periods before (from January, 1990 to March, 1995) and after (September. 2005 to January, 2007) the introduction of HAART, to see if this form of anti-retroviral treatment contributed to a significant reduction of parasitic diseases in HIV/AIDS patients. Two groups of HIV/AIDS patients of both the sex, of ages 18 years and above were recruited: GROUP I (before-HAART era) with 482 patients and GROUP II (after-HAART era) with 100 patients. Each patient provided a single fresh stool sample for detection of intestinal parasites. The samples were analyzed by the methods of direct microscopy of the stool-smears in saline and Lugol’s iodine, the Lutz’s method, the Baermann-Moraes’ technique and the modified Ziehl-Neelsen staining. About 8 to 10 smears from each fecal sample were analyzed by light microscopy. Intestinal parasites were prevalent in 63,9% of the patients in GROUP I, as follows: hookworms–13,7%, Ascaris lumbricoides–15,6%, Strongyloides stercoralis–30,1%, Trichuris trichiura–13,1%, Cryptosporidium sp.–8,1%, Entamoeba histolytica/dispar–3,3%, Giardia duodenalis–7,9%, Isospora belli–4,8%, and the non-pathogenic species Chilomastix mesnilii-0,6%, Entamoeba coli-17%, Endolimax nana-7,3% and Iodamoeba butschilii-7,1%. In the GROUP II, the general prevalence of intestinal parasites was 24%, and consisted of the following: hookworms–2%, A. lumbricoides–2%, S. stercoralis–11%, T. trichiura, Hymenolepis nana, E. histolytica/dispar, G. duodenalis e I. belli – each specie in 1% of the samples, and the non-pathogenic protozoa Entamoeba coli–8%, Endolimax nana–3% and Iodamoeba butschilii–3%. The coccidian Cryptosporidium sp. was not detected in this group. There was a significant reduction in the prevalence of enteric parasites after onset of HAART, in comparison with the before-HAART period (p<0.0001). The prevalences of the species S. stercoralis, A. lumbricoides, T. trichiura, hookworms, Cryptosporidium sp. and G. duodenalis were significantly reduced between the before-HAART and after-HAART periods (p<0.05). These findings reveal that a significant improvement resulted in the condition of HIV/AIDS patients, with respect to the occurrence of some important enteric parasites, in the after-HAART era, which may have resulted from the introduction the highly active antiretroviral therapy alone, or from the combined influence of HAART, other medicines, better clinical practices and better awareness of the patients to take care of themselves. This work possibly suggests that periodic evaluations of stools for enteric parasites may be of some importance for the assessment of the general health conditions of HIV/AIDS patients under treatment, particularly in those with low CD4+ cell counts.

Due to government financial incentives, which boost the production of biodiesel, there has been a large scale production of this fuel. However, this growth has proved to be exaggerated, rising a worrying factor: the destination of the glycerol excess from biodiesel production. Such concern is clearly shown to prove an important fact: for every ton of biodiesel produced, 100 kg of glycerol are generated, which leads to adverse effects on the biodiesel economy. In this context, it is feared that the over-produced glycerine, which causes a high level of pollution, can be discarded irresponsibly into the environment. So, researches have been being developed, aiming to find other alternatives for the use of the extra volume of glycerol. The bioconversion of glycerol by fermentation is good option that adds significant value to the productivity of the biodiesel industry. Glycerol can be used by several microorganisms in metabolic processes, as a carbon source. Some yeasts species, such as Yarrowia lipolytica, when grown on a media with a limited source of nitrogen, are able to produce significant amounts of citric acid from glycerol. Citric acid is currently one of the most important organic acids produced by fermentation. Due to its characteristics, it has been widely used in food and beverage industry and also as an additive for detergents, pharmaceuticals, cosmetics and toiletries. Thus, this study aimed to evaluate, through fermentation, bioconversion routes of residual glycerol from biodiesel production with high levels of impurities, in order to obtain citric acid. For this, two potential acid-producing yeast strains (Yarrowia lipolytica NRRL YB 323 and Yarrowia lipolytica NRRL YB 423) were initially used. Using the Methodology of Experimental Design and Response Surface Analysis, it was investigated the initial concentrations of carbon sources as well as organic (yeast extract) and inorganic (ammonium sulfate) nitrogen sources in shake flasks. The results obtained showed that the optimal initial concentration of glycerol from waste biodiesel as carbon source, within the studied range, was 20 g L-1. As to the nitrogen sources, they were proved having no remarkable influence on the acid production. It was also found that thiamine addition to the media did not promote the increase on the amount of the previously accumulated citric acid. Yarrowia lipolytica NRRL YB 423 was proved more effective on the acid production. The tests which were carried out in the fermenter aimed to evaluate the optimal concentration of dissolved oxygen in the media. It was observed that highest concentrations of dissolved oxygen in fermentation media, promotes the production of citric acid. For levels of 50% oxygen, there was a lower yield, while for 70%, citric acid production was favored. The final percentage yield for the production of citric acid obtained from 20 g L-1 of residual glycerol from the biodiesel initially added to the media was 24.80%, at the end of three days of fermentation.

Neste trabalho constata-se a evidência de uma relação não linear entre a taxa de formação bruta de capital fixo e a taxa de crescimento econômico na economia brasileira. Devido a essa não linearidade, a influência de investimentos em capital sobre o crescimento de longo prazo passa a ser limitado. Quanto aos efeitos das políticas públicas, depreende-se que por mais que se amplie a taxa de formação bruta de capital fixo o Brasil alcançaria, no máximo, o crescimento do PIB das economias de renda média baixa, ou o crescimento econômico dos países do leste asiático e do Pacífico. O trabalho também sugere ainda que o montante de recursos necessário para alcançar tal objetivo é da ordem de 786 bilhões de reais, valor bem acima do previsto no atual Programa de Aceleração do Crescimento.

No summary/description provided

Schistosomiasis is still a public health problem in Brazil. The infection is widespread in southeast and northeast. The laboratorial diagnosis of schistosome infection has been based on direct coproscopic examination and by indirect methods for detection of antigen, antibodies and specific DNA fragments that are associated with Schistosoma mansoni infection. The aim of the present study was to evaluate polymerase chain reaction (PCR) designed for detection of Schistosoma mansoni DNA in individuals from a low endemic area in Ceará state. The study was conducted in the Planalto do Cajueiro, Maranguape, Ceará, Brazil. In the laboratory performed the ELISA for detection of IgG antibodies against adult worms antigen of S. mansoni, and stool examinations (Kato-Katz, Lutz, Saline gradient and Helmintex® methods), considering the results obtained, for distribution of 56 stool samples selected among the 125 examined, in the following groups: Group I - ELISA reactive / Others parasites (+ ), Group II- ELISA reactive / Others parasites (-), Group III- ELISA non reactive / Others parasites (+), Group IV- ELISA non reactive / Others parasites (-), Group V- ELISA reactive / Coproscopic examination S. mansoni (+).The PCR was carried out according to a protocol described by Pontes et al.(2002) . Group I, 02 of 10 samples were positive in PCR; Group II, 04 of 10 samples were positive by PCR and in Group III, 01 of 07 samples were positive in PCR. Among the 10 samples of Group IV, 01 was positive in PCR and Group V, 13 of 19 samples were positive in PCR. Among the 39 individuals who showed reactivity by ELISA, 06 samples were positive in coproscopic examination and PCR was reactive in 19 samples. Comparing the results in Group V, with the Kato-Katz, this method detected 06 individuals, while PCR detected 13 individuals were positive. By comparing the PCR of Saline gradient, it is observed that the Saline gradient detected 09 individuals, while PCR detected 11. When comparing PCR to Helmintex®, we found that the Helmintex® detected 10, while PCR detected 08 samples. We conclude that PCR is an important tool to improve the sensitivity in detecting S. mansoni infection in low endemic areas. We emphasize that is very important associate the exams in order to achieve the real diagnosis of the disease.

Rheumatoid arthritis is an inflammatory, chronic and auto-immune disease that develops in degrees of articular destruction and extra-articular changes being able to lead to functional disability. Besides clinical assessment the diagnosis is based on the determination of the rheumatoid factor being this one also positive in healthy people as well as in other infectious and auto-immune diseases. Anticyclic citrullinated peptide (anti-CCP) antibodies have been used in diagnosis of rheumaoid arthritis (RA) and seen to be superior to rheumatoid factor (RF) in early onset RA diagnosis. The target of the study is to demonstrate the presence of anticitrulline antibodies in patients with rheumatoid arthritis diagnostic comparing with laboratory, clinical parameters and with the assessment of the quality of life of these patients. The “Health Assessment Questionnaire” has been used to assess the quality of life. We performed an immunoturbidimetry test for detection of RF (Roche,Indianopolis, USA) and an ELISA for anti-CCP antibodies (Inova, San Diego, USA) in 69 patients presenting, at least, 4 of the American College of Rheumatology criteria for classification of RA and in 20 healthy controls. For statistical analysis we used thr Fisher exact test and the Spearmann test Significance was reached wuth P<0.05. RA patients were aged between 18-75 years (mean = 43.9 years), 66 (95.7%) of then were female, controls age ranged between 20-60 years.The period of RA onset varied from 4 to 384 months (mean = 74.0 and median = 48.0). RF was positive in 48 (69.6%) patients and in 1 (0,5%) control. The anti-CCP was positive in 36 (52.2%) patients and in 2 (10%) controls. A significant correlation of RF and anti-CCP tests was observed with P< 0,0001 and this study suggests that anti-CCP was not superior to RF in diagnosis of established RA.

Previous studies have shown that individuals exposed to Leishmania amazonensis respond differentially with regard to interferon gamma (IFN)_ production. Individuals who have a low production of IFN_ develop a Th2 response, while those who produce high amounts of this cytokine during the early stages of infection show the Th1 response. In order to evaluate the mechanism of suppression induced by L. amazonensis, the profile and kinetics of chemokines and theirs receptors were determined, as also the cytokines in the cultures of peripheral blood mononuclear cells (PBMC) from healthy individuals, stimulated with live promastigotes of L. amazonensis. A semiquantitative analysis of mRNA expression for the chemokines and their receptor was performed by RT-PCR, and the cytokines were quantified by ELISA, at 12, 48 and 120 hours after infection. The two patterns of IFN_ response were studied. Individuals with a production higher than 145,8 pg/mL were classified as high responders (HR), and those with lower levels of production were considered as low responders (LR). Individuals in the HR group developed a mixed response, with a predominance of Th1, which was associated with the expression of relevant quantities of MIP-1_, RANTES, MCP-1, IP-10, IL-8, CCR1, CCR2 and CXCR3, within 12 and 48 hours after infection. IL-12, IL-13 and IL-10 were observed in significant quantities. In the LR group, the suppression of expression of MIP-1_, RANTES, MCP-1, I-309, CCR2, CXCR3 and CCR5 during the entire period of study, and that of IP-10 during the first 48 hours of infection, was observed. IL-10 and IL-13 were found in elevated concentrations from 12 hours of infection onwards, with a peak production at 48 hours. These results suggest that the pattern of response apparently is defined around 48 hours of infection. IL-10 and IL-13 appear to exercise a relevant role in the modulation of suppression of IFN_, induced in the LR group by L. amazonensis.

The human respiratory syncytial virus (HRSV) is the major agent of lower respiratory tract in children under two years old. HRSV is characterized antigenically into two groups: A and B, and each group has several subgroups. Glycoprotein G is primarily responsible for the antigenic variation between and within groups of viruses. The aims of this study were to characterize the epidemic periods and the antigenic and genomic diversity of circulating HRSV in Fortaleza, Ceará - Brazil, for five consecutive epidemic periods (2004-2008). The screening of positive samples to HRSV and other viruses analyzed, as the antigenic characterization of HRSV was carried out by indirect immunofluorescence. RT-nested-PCR followed by partial sequencing of the gene G was used for genomic characterization of HRSV. The HRSV was detected in 456 of 2885 samples (15.8%). The peak of the epidemic periods of HRSV occurred from March to May related to rainfall. A total of 282 HRSV (62.8%) were characterized antigenically, with 170 HRSVA (60.3%) and 112 HRSVB (39.7%). Both groups circulated throughout the period analyzed with a predominance of HRSVA in all years of study. A total of 250 HRSV (54.8%) were submitted to RT-nested-PCR with amplification of 133 and sequencing of 86. The genomic characterization of HRSV identified subgroups GA2 and GA5 for HRSVA and subgroups GB3 and BA for HRSVB. In the years 2004, 2005 and 2007 both subgroups of HRSVA circulated. In 2008 only GA2 circulated. In 2004, 2007 and 2008 only the subgroup BA was present. In 2005 only the GB3 circulated. The HRSV A showed a higher variability in nucleotide sequences, indicating a possible positive selective pressure. There were variations in the beginning, end and duration of each epidemic period of HRSV, as well as in the occurrence of groups and subgroups.

Although several efforts from Ministry of Health have been made in order to eliminate leprosy, Brazil is still the second country with the highest number of cases in world after India and is responsible for 80% of the cases in the American continent, the Ceara state situated in the Norheastern region is considered to have high incidence rates of leprosy cases. According to Ridley and Jopling classification, the clinical forms of leprosy can be divided in lepromatous leprosy, borderline lepromatous leprosy, borderline borderline leprosy, borderline tuberculoid leprosy, and tuberculoid leprosy. This work was done with 87 patients with leprosy, being 51.72 % of the female gender and 48.3% of the male gender; from the total of patients, 77.0% had been vaccinated with BCG once in life. All the patients enrolled in the study were not treated (n=23) or in treatment (n=64). Most of the patients had suffered from leprosy for the first time and some (n=11) had suffered from leprosy recidive. The anti-PGL1 serum IgG serology has been performed in 83 patients, and the most significant differences were found comparing the tuberculoid leprosy and borderline tuberculoid leprosy groups with the borderline lepromatous leprosy group. All DNA samples (n=87) were amplified in respect to the 171 bp highly conserved sequence of the aminoacids 671-692 from the C-terminal intra-cellular domain of Toll-like 2 receptor, and they were submitted to a Single Strain Conformation Polymorphism Technique (SSCP). The eletrophoretic profile found of the samples showed two and three bands, it is essential to the sequencing, this showed heterozygosis at position C2029T, and in addition two other sections of heterozygosity at positions C2006T (found in all four sequenced samples) and 2008 (sample 82). The work showed that the heterozygosity found in the gene exon 3 of the tool-like receptor type 2, unlike the one found by Kang and Chae (2001) which may mean that the susceptibility profile from our population is distinct from those found in India and Korea.

The HIV infection and the tuberculosis (TB) are together the main causes of death for infectious agents in the world, being approximately 13 million people infected with both causative agents. The HIV-infected individuals show increased susceptibility for active tuberculosis, being the imunosupression caused by the virus the main risk factor for the development for active TB. This study investigated the profile of Mycobacterium tuberculosis drug resistance and evaluated the factors related to the development of TB in HIV infected patients who were treated at HSJ, which is a reference hospital in infectious diseases in Fortaleza, Ceará, Brazil. During the period of July 2003 until June 2006, 208 patients with clinical and/or laboratorial diagnosis of micobacteriosis or tuberculosis and infection for the HIV were taken care in this hospital. The TB/HIV co-infected patients were older (average: 40 years, p= 0.0025) than the control group, being approximately 4 years older. The majority of the patients were male (80.8%, p= 0.0005) and they had shown a risk to develop TB of 43.0% greater compared to the female sex. The risk to develop the TB disease was two times higher in the patients with lower educational levels (less than eight years of schooling) and they represented 85.9% of the patients (p=0.000). The history of previous contact with TB patients and previous treatment for TB were also found to be risk factors for TB. The imunosupression level was higher in TB-HIV coinfected patients being the CD4+ lymphocytes count average of 169 cells/mm ³(p=0.000) and the viral load logarithm average of 4,36 (p=0.0013). The clinical forms most frequents were pulmonary (45.7%), extrapulmonary (28.4%) and disseminated (25.9%). Of the samples that were submitted to identification, 81.2% were M. tuberculosis and 12.8% were not M. tuberculosis. The resistance frequency to one drug and multi-resistance were the same (5.9%). Overall, these observations are important for establishing political strategies of public health to improve the conditions at the regional level.

VIRGINIO, Camila Gomes.

This paper deals with the welfare and long run allocation impacts of privatization. There are two types of capital in this model economy, one exclusively private and the other has public good features, denominated infrastructure, which is o¤ered by both public and private sectors. A positive externality due to infrastructure capital is assumed. So the government can improve upon decentralized allocations by way of internalizing the externality. Public investment is nanced through distortionary taxation. It is shown that the welfare net gains of privatization depend on the quality and quantity of the private infrastructure supply. Furthermore, those net gains are strongly related to the quality control of the new private infrastructure supply that emerges after the privatization policy.

Helicobacter pylori is a bacteria that infects about 50% of the world population constituting one of the principal risk factors for the development of gastric cancer. The emergence of this cancer type is associated to the presence of the bacteria and risk elements, such as the alimentary habits, the genetic predisposition and environmental factors. The present work had as objective evaluates the effect of components of the Northeastern diet (salt, vinegar, pepper and potato juice), extracts and essential oils on H. pylori growth. In the study a reference and a clinic strain were used. The chosen method for the accomplishment of the screening test was the inhibitory-zone testing and for determination of the Minimum Inhibitory Concentrations (MIC) it was used the agar dilution method as described by Clinical and Laboratory Standards Institute (CLSI). The strains were inoculated in appropriate culture medium containing different concentrations of the tested substances. The reading was determined macroscopically and the growth confirmed through the accomplishment of the microscopy by the Gram method and biochemical tests. It was verified that the salt did not inhibit the growth and morphology of H. pylori, however, it was able to influence the antimicrobial effect, in vitro. The vinegar and the pepper did not show antimicrobial activity. The potato juice was shown to promote the bacterial growth. The ethanolic extracts of Lippia alba Mill. N.E.B chemotypes I, II, III) and Egletes viscosa L. were active against the bacteria. The essential oils of Ocimum gratissimum L., Ocimum sp, Myracrodruom urundeuva All., L. alba Mill. N.E.B chemotypes I, II, III and E. viscosa L. were also active against H. pylori. The chemical characterization confirmed the majority constituents of the plants. H. pylori constitute, today, a vast research source in several areas. Related studies the transmission prevalence, resistance antimicrobial, new therapeutic alternatives and development of vaccines they are necessary and plenty promising.

BEZERRA, Cristianne Sousa.

The systemic infections caused by yeasts of the genus Candida are considered opportunist mycoses of high risk in hospital environments. These infections represent important therapeutical challenge, by reason of arising of species resistent to some antifungals, associated with high rate of mortality. Therefore, this work sought: To verify the frequency of fungemias at Dr. César Cals Hospital and Albert Sabin Children Hospital; identify the etiological agents implicated; determine the sensitivety profile to antifulgal and evaluate the genotypical profile of the species isolated from patients with recurrency. For this, were recuperated from 4627 hemcultures, 55 yeast-positive hemocultures at HGCC and from 5316 hemocultures 87 yeast-positive hemocultures at HIAS. From them, 23 patients at HGCC and from 43 at HIAS that had clinical histories with complet data entered this study. The mycological diagnosis was performed through biochemical and morphological characteristics of the etiological isolated. The test of sensitivety to antifungal- amphotericin B, fluconazole, itraconazole and cetoconazole- utilized the microdilution method in broth, reported in the document M27-A2 of the NCCLS. The genotyping techniques were performed through PFGE (Pulsed Field Gel Electrophresis), RAPD (Randomly amplified polymorphic DNA analysis). Within the period from june of 2000, to june of 2002 at HGCC, were analysed 4627 hemocultures, being positives 1051, of which 55 (5,2%) were positive for yeast of the genus Candida. On the other hand, in the period from june of 2001 to july of 2002 at HIAS, were analysed 5316 hemocultures, of which 87 (5,72%) were yeast-positive of the genus Candida and Rhodotorula.The main specie involved in the genus Candida, was C. parapsilosis with 36% and 42% of the cases at HGCC and HIAS respectively. The main risk factors associated with candidemia, were: the previous antibiotic therapy, central venous catheter, parenteral nutrition, gastric probe, mechanical ventilation, surgery and prematurity. About the resistance to antifungals drugs was observed that amphotericin B showed a resistance level of 4%, fluconazole-56%, itraconazole-52% and cetoconazole- 86%. The PFGE technique caracterized a cromossomic profile of 6 bands for C. parapsilosis and 4 for C. tropicalis. This technique permited the diferentiation of one cepa with changed pattern of bands for the last episode of the patient 4. The technique of RAPD chacacterized a distribution pattern of predominant bands for C. parapsilosis and was capable of characterize 4 genetical profiles, denoting reinfection in 3 patients and 2 genomic profiles were found for C. tropicalis. This assay shows the emergency of the non- albicans Candida, specially the C. parapsilosis, as main responsible for the cases of candidemia in the two hospitals of tertiary indication of Fortaleza, associated with a high resistance in vitro to antifungals. The genetical variability found in C. parapsilosis and C. tropicalis through the PFGE and RAPD techniques, revealed reinfection pictures, which rises the possibility that these be due to a contamination among patients or indirectly through the healthy workers.

Coccidioidomycosis and histoplasmosis are systemic mycoses that occur in humans and other animals and are caused by the dimorphic fungi Coccidioides posadasii and Histoplasma capsulatum var. capsulatum, respectively. They are considered important deep mycoses that can lead to several secondary complications. In the past years, the improvement of the techniques applied in mycological diagnosis and the increase in the occurrence of immunocompromising diseases have caused a great impact in the incidence of deep and opportunistic mycoses in the world. In spite of the existence of effective antifungal therapy against coccidioidomycosis and histoplasmosis, the pursue of new drugs to treat theses diseases is necessary. Ciprofloxacin is a classic antibacterial drug that belongs to the group of fluoroquinolones, which inhibit the catalytic activity of DNA gyrase and topoisomerase IV, which are essential in bacterial DNA replication and transcription. Some studies have shown that ciprofloxacin can act on fungal DNA gyrase. Thus, the present study aimed at evaluating the in vitro inhibitory effect of ciprofloxacin (CIP), when associated with amphotericin B (AMB), itraconazole (ITC), voriconazole (VRC) or caspofungina (CAS), on C. posadasii and H. capsulatum var. capsulatum. Sixteen strains of C. posadasii in the filamentous phase and 16 and 9 strains of H. capsulatum in the filamentous and yeast-like phase, respectively, were used. Broth macrodilution and microdilution assays were performed, as described in the documents M38-A and M27-A2, respectively, of the Clinical Laboratory Standards Institute (CLSI). Drug interaction was analyzed by calculating the fractional inhibitory concentration index (FICI), which is defined as the sum of the ratios between the minimal inhibitory concentration (MIC) of each combined drug and the MIC of the same drug isolatedly. Values of FICI smaller or equal to 0.5 indicate the occurrence of synergy. Concerning the isolates of C. posadasii, synergistic interactions were observed for all combinations, especially for the associations of CIP (3.125≤CIM≤12.5 ug mL-1) with ITC (0.0078≤CIM≤0.125 ug mL-1) (n=13/16), CIP (3.125≤CIM≤12.5 ug mL-1) with VRC (0.0078≤CIM≤0.0312 ug mL-1) (n=13/16) and CIP (3.125≤CIM≤12.5 ug mL-1) with CAS (2≤CIM≤8 ug mL-1) (n=14/16). For the isolates of H. capsulatum in the filamentous phase synergistic interactions were also observed for all combinations, with emphasis to the associations of CIP (3.906≤CIM≤62.5 ug mL-1) with ITC (0.00006≤CIM≤0.0078 ug mL-1) (n=14/16) and CIP (31.25≤CIM≤125 ug mL-1) with VRC (0.0156≤CIM≤0.125 ug mL-1) (n=16/16). For H. capsulatum in yeast-like phase, few synergistic interactions were observed for the tested drug combinations. None of the tested combinations presented antagonism. The obtained data may point at a new alternative for the treatment of coccidioidomycosis and histoplasmosis. Thus, it is necessary to investigate the mechanisms of action of these drug combinations on the fungal cellular metabolism and to perform in vivo experiments to confirm the relevance of these findings.

In the past years, the improvement of mycological diagnosis methods and immunosuppressive diseases have caused a great impact in the incidence of opportunistic and deep mycoses all around the world, which motivated the performance of new antifungal drugs prospective studies. Histoplasmosis is a systemic mycosis caused by the fungus Histoplasma capsulatum var. capsulatum, which may mimic tuberculosis, in healthy individuals, concerning clinical and radiological aspects.ome cases of histoplasmosis that are refractory to the treatment with conventional antifungal drugs have been described. The aim of this study was to determine the in vitro inhibitory effect of the antituberculosis drugs: isoniazid (INH), pyrazinamide (PZA) and ethambutol (EMB); antifungal drugs: amphotericin B (AMB), fluconazole (FLC), itraconazole (ITC) and voriconazole (VRZ) and chemical analogs of isoniazid against strains of H. capsulatum (n=30), as well as to evaluate the use of different culture media for the performance of the susceptibility tests. For such, first, the antituberculosis agents INH, PZA and EMB and the analogs of isoniazid were tested isolatedely, and then, in association with the antifungal drugs FLC, ITC and VRZ, against 18 strains of H. capsulatum, previously grown onto BHI agar, through broth macrodilution technique. Each of the 12 remaining strains grown onto potato agar, BHI agar, 2% malt extract agar and lactritmel agar were microscopically analyzed, concerning the presence of tuberculate macroconidia, which were quantified as follows: 0-10, 10-50 and >50 macroconidia/field. Fungal cultures were used to determine the susceptibility of H. capsulatum to the antifungal agents AMB, FLC, ITC and VRZ, through broth microdilution methodology. The antituberculosis drugs inhibited the in vitro growth of the fungal strains, with MICs ranging from 0.04 to 0.30 mg/mL for INH; 0.55 to 3.13 mg/mL for PZA and 1.56 to 6.25 mg/mL for EMB. Concerning antifungal drugs, all the strains were susceptible, with MIC values ranging from 0.0625 to 0.25 µg/mL for AMB; 15.62 to 62.5 µg/mL for FLC; 0.0039 to 0.0312 µg/mL for ITC, and 0.00156 to 0.25 µg/mL for VRZ. When associating antituberculosis drugs with azole derivatives, all associations inhibited the in vitro growth of H. capsulatum strains, and synergy was observed for the nine combinations tested. Analogs of isoniazide presented MICs of 2, 4, 8 and 15-fold better than the standard antituberculosis drug. Basing on micromorphological analysis, the lowest quantification of macroconidia/field (0-10) was observed for 11, 10, 6 and 7 strains previously grown onto potato agar, BHI agar, malt agar and lactritmel agar, respectively. Malt agar was the most adequate medium for the production of macroconidia, 10-50 and >50/field, with a total of six strains; followed by lactritmel agar, with 5 strains. Concerning the relationship between MIC and culture medium used during the test, it was observed that inoculum from strains grown onto malt agar and BHI agar allowed the detection of the MIC for 11 strains. On the other hand, for those inocula grown onto potato agar and lactritmel agar, the MIC values were not detected for 8 and 5 strains, respectively. The results of this study provide additional data on the antifungal potential of antituberculosis drugs and their interactions with azole derivatives. However, new studies are necessary in order to determine the mechanism of action of these compounds on fungal cellular metabolism.