Resumo Introdução: O processo de desnutrição-inflamação é uma das principais causas de morbimortalidade em pacientes com DRC, influenciando a qualidade de vida. O objetivo deste estudo foi identificar o estado inflamatório e nutricional de idosos em hemodiálise (HD) e sua associação com qualidade de vida. Métodos: Estudo realizado em serviços de saúde de três cidades diferentes. O Escore de Desnutrição-Inflamação (MIS, por sua sigla em inglês) foi utilizado para avaliar estado inflamatório e nutricional, com medidas antropométricas, estado proteico, massa magra e funcionalidade. A qualidade de vida foi avaliada com KDQOL-SFTM. Os dados foram analisados utilizando análise multivariada e modelo de Poisson para avaliar fatores que aumentaram o risco de desenvolver desnutrição e inflamação. Resultados: O MIS identificou prevalência de 52,2% de desnutrição e inflamação na população. Na análise univariada, a maioria dos domínios do KDQOL-SFTM apresentou escores maiores para idosos nutridos. Medidas antropométricas associadas à massa muscular e funcionalidade foram menores em idosos desnutridos. A modelagem multivariada revelou maior risco nutricional de 50,6% para mulheres e idosos pois o risco de desnutrição aumentou em 2,4% para cada ano adicional de vida e em 0,4% para cada mês adicional de HD. Maior circunferência muscular do braço (CMB) e maior albumina sérica foram fatores de redução da desnutrição em 4,6% e 34,7%, respectivamente. Conclusão: Demonstrou-se que albumina sérica mais elevada e CMB preservada são bons indicadores de melhor estado nutricional. Maior MIS foi associado a pior qualidade de vida, idade mais avançada, menor renda e escolaridade, maior tempo em diálise e presença de comorbidades. Introdução desnutriçãoinflamação DRC HD (HD Métodos diferentes DesnutriçãoInflamação Desnutrição Inflamação MIS, (MIS inglês proteico KDQOLSFTM. KDQOLSFTM KDQOL SFTM. SFTM Resultados 522 52 2 52,2 população univariada nutridos desnutridos 506 50 6 50,6 24 4 2,4 04 0 0,4 (CMB 46 4,6 347 34 7 34,7% respectivamente Conclusão Demonstrouse Demonstrou se avançada escolaridade comorbidades 5 52, 50, 2, 0, 4, 3 34,7 34,

Abstract Introduction: The malnutrition-inflammation process is one of the main causes of morbidity and mortality in patients with chronic kidney disease (CKD), influencing quality of life. The aim of this study was to identify the inflammatory and nutritional status of elderly hemodialysis (HD) and its association with quality of life. Methods: This study was carried out in health services in three different cities. The Malnutrition-Inflammation Score (MIS) was used to assess the inflammatory and nutritional status, with anthropometric measurements, protein status, lean mass and function. The quality of life was assessed using KDQOL-SFTM. Data were analyzed using multivariate analysis and the Poisson model to evaluate the factors that increased the risk of developing malnutrition and inflammation. Results: The MIS identified a 52.2% prevalence of malnutrition and inflammation in the population. In univariate analysis, most KDQOL-SFTM domains presented higher scores for nourished elderly. Anthropometric measures associated with muscle mass and functionality were lower in the malnourished elderly. Multivariate modeling revealed a higher nutritional risk of 50.6% for women and older age, since with each additional year of life the risk of malnutrition increased by 2.4% and by 0.4% with each additional month on HD. Greater arm muscle circumference (AMC) and higher serum albumin were factors for reducing malnutrition by 4.6% and 34.7%, respectively. Conclusion: Higher serum albumin and preserved AMC have been shown to be good indicators of better nutritional status. Higher MIS was associated with poorer quality of life, older age, lower income and education, longer time on dialysis, and presence of comorbidities. Introduction malnutritioninflammation CKD, CKD , (CKD) HD (HD Methods cities MalnutritionInflammation Malnutrition Inflammation (MIS measurements function KDQOLSFTM. KDQOLSFTM KDQOL SFTM. SFTM Results 522 52 2 52.2 population 506 50 6 50.6 age 24 4 2.4 04 0 0.4 (AMC 46 4.6 347 34 7 34.7% respectively Conclusion education dialysis comorbidities (CKD 5 52. 50. 2. 0. 4. 3 34.7 34.

Abstract Introduction Auditory-evoked potentials are influenced by several factors, including polarity, filter, stimulus intensity and stimulation rate. The presentation of higher rates of stimuli per second enables the collection of a greater number of responses in a given period of time, promoting a shorter testing time; however, the collected recordings are subject to changes related to wave morphology. Objectives To compare the brainstem auditory-evoked-potential responses with click stimulus with the most commonly used stimulation rates in the clinical practice. Methods The present cross-sectional analytical study was performed with fifteen participants of both genders and normal hearing thresholds. The brainstem auditoryevoked potential was performed at four different stimulation rates (21.1, 26.7, and 27.7 stimuli/s, and a rate determined based on a mathematical calculation using the a measurement of the transmission frequency of the power grid at the time of the examination). Results We observed that the rate of 21.1 stimuli/s showed the highest amplitudes for waves I, III, and V when compared with the other rates. The rate of 26.7 stimuli/s, when compared with 27.7 stimuli/s, showed a higher amplitude for wave V. The latency if wave V was significantly lower with the rate of 21.1 stimuli/s than with 27.7 stimuli/s. Conclusions The stimulation rate interferes with wave latencies and amplitudes; its decrease from 27.7 to 21.1 stimuli/s decreases the latency of wave V and increases the amplitues and improves the morphology of waves I, III and V. In addition, we found evidence that suggests an improvement in the visualization of wave III by adjusting the stimulation rate based on a measurement of the local transmission frequency of the power grid. Auditoryevoked Auditory evoked factors polarity filter however auditoryevokedpotential auditory practice crosssectional cross sectional thresholds 21.1, 211 21 1 (21.1 267 26 7 277 27 27. stimulis s examination. examination . examination) 21. I 26. addition 2 (21. (21 (2 (

OBJECTIVE: To evaluate the relationship between cognitive performance and long-latency auditory evoked potentials in an elderly population. METHODS: The sample consisted of adults between 20 and 58 years of age and elderly adults between 60 and 70 years of age. The screening procedures adopted were an inspection of the external auditory canal, tonal and vocal audiometry, tympanometry, brain stem auditory evoked potential, the Montreal Cognitive Assessment test, and long-latency auditory evoked potential. RESULTS: The latency and amplitude values of cortical components by age group showed significant differences under the following conditions: (i) signals evoked by the speech stimulus /da/ and by the pure-tone stimulus at 2,000 Hz for the N2 amplitude (p=0.008 and p=0.001, respectively) , which were both higher for adults, and (ii) signals evoked by the speech stimulus /da/ for N1 latency (p=0.018) and by the pure-tone stimulus at 2,000 Hz for P2 latency (p=0.017), which were both higher in the elderly population. The cognitive component (P300) showed a significant difference when evoked by speech stimuli, with higher latency in the elderly population (p=0.013). When correlated with cognitive processes, the latency and amplitude of cortical potentials showed direct and medium-strength correlations between abnormal scores obtained on the Montreal Cognitive Assessment test and P2 amplitude (p<0.001 and r=0.452). CONCLUSION: There is a relationship between long-latency potentials and cognitive performance in the elderly, which was observed by the increase in the P2 amplitude and the impairment of the process of sound decoding.

Objective:This study was aimed to evaluate the prevalence of pertussis in adolescents and adults with cough lasting more than 14 days and less than 30 days.Methods:This is a prospective observational study in interepidemic period of pertusis. Ten public health outpatient clinics in the city of Recife, Brazil, were randomly selected for the study. The study population consisted of individuals aged 10 years and over with cough that had lasted between 14 and 30 days. Nasopharyngeal swabs were collected for culture and PCR in order to identify Bordetella pertussis. We adopted the Centers for Disease Control and Prevention in the US (CDC) definition of cases of pertussis.Results:A total of 192 individuals were identified as suspected cases. Their mean age was 40.7 years. Pertussis was confirmed in 10 of the 192 suspected cases, with an estimated prevalence of 5.21% (95% confidence interval 2.03-8.38). All cases met the clinical case definition for pertussis; one suspect had both culture and PCR positive. PCR confirmed 100% of the cases, 7/10 by PCR and 3/10 by epidemiological linkage with a case confirmed by PCR.Conclusion:During an interepidemic period, 1 in 20 cases of prolonged cough had pertussis, suggesting this is an important cause of prolonged cough in adolescents and adults.

Objective: To assess quantitative real-time polymerase chain reaction (q-PCR) for the sputum smear diagnosis of pulmonary tuberculosis (PTB) in patients living with HIV/AIDS with a clinical suspicion of PTB.Method: This is a prospective study to assess the accuracy of a diagnostic test, conducted on 140 sputum specimens from 140 patients living with HIV/AIDS with a clinical suspicion of PTB, attended at two referral hospitals for people living with HIV/AIDS in the city of Recife, Pernambuco, Brazil. A Löwenstein-Jensen medium culture and 7H9 broth were used as gold standard.Results: Of the 140 sputum samples, 47 (33.6%) were positive with the gold standard. q-PCR was positive in 42 (30%) of the 140 patients. Only one (0.71%) did not correspond to the culture. The sensitivity, specificity and accuracy of the q-PCR were 87.2%, 98.9% and 95% respectively. In 39 (93%) of the 42 q-PCR positive cases, the CT (threshold cycle) was equal to or less than 37.Conclusion: q-PCR performed on sputum smears from patients living with HIV/AIDS demonstrated satisfactory sensitivity, specificity and accuracy, and may therefore be recommended as a method for diagnosing PTB.

Objetivo: Evaluar la Reacción en Cadena de Polimerasa en tiempo real cuantitativa (qPCR) para el diagnóstico de tuberculosis pulmonar (TBP) en esputo de pacientes con sida y sospecha clínica de TBP.Método: Se trata de un estudio prospectivo para evaluación de precisión de prueba diagnóstica, realizado en 140 muestras de esputo provenientes de 140 pacientes con sida y sospecha clínica de TBP atendidos en dos hospitales de referencia para atención VIH/sida en Recife-PE, Brasil. Se utilizó el cultivo en medios Löwenstein-Jensen y 7H9 como estándar de oro.Resultados: De las 140 muestras de esputo, 47 (33,6%) fueron positivas por el estándar de oro. La qPCR fue positiva en 42 (30%) de los pacientes. En apenas un (0.71%) caso no correspondió con el cultivo. La sensibilidad, especificidad y precisión de la qPCR fueron 87,2%, 98,9% y 95% respectivamente. De las 42 qPCR positivas en 39 (93%) el CT (threshold cycle) fue igual o inferior a 37.Conclusión: La qPCR realizada en muestra de esputo de pacientes con sida demostró sensibilidad, especificidad y precisión satisfactoria, pudiendo ser recomendada como método de diagnóstico de TBP.

Little is known about the etiology of progressive macular hypomelanosis, although it has been suggested that Propionibacterium acnes plays an important role. While microbiological culture is commonly employed to identify Propionibacterium acnes, new identification methods have been under investigation, amongst them polymerase chain reaction. To determine the cut-off point for the number of genome copies of Propionibacterium acnes in the lesional skin of patients with progressive macular hypomelanosis as a positive marker, employing quantitative real-time polymerase chain reaction and anaerobic culture, considered gold standard. An observational study with a comparison group, included 35 patients with dermatosis, attended at the Oswaldo Cruz University Hospital, Pernambuco, Brazil, between March and May 2008. Lesional skin was compared to non-lesional skin through positive testing with real-time polymerase chain reaction and culture. The Statistical Package for Social Sciences, version 12.0, was employed for the association analysis with the McNemar test, and the cut-off point with the ROC curve for maximum values. Propionibacterium acnes was most frequently encountered in lesional areas (p<0,025). The cut-off point of Propionibacterium acnes in lesional skin was 1,333 genome copies, with a sensitivity of 87,9% and a specificity of 100,0%. Since Propionibacterium acnes is a saprophyte, identifying the cut-off point may assist in determining its positivity in lesional skin in patients suffering with this dermatosis.

CONTEXTO: Claritromicina é a droga mais eficaz usada na erradicação da infecção pelo H. pylori. Devido ao aumento mundial da resistência, o teste de susceptibilidade à claritromicina pré-tratamento é recomendado. OBJETIVO: Determinar a prevalência de H. pyloriclaritromicina resistente em Recife, PE, Brasil. MÉTODO: De janeiro de 2006 a dezembro de 2007, 114 biopsias gástricas positivas à cultura para H. pylori foram diretamente analisadas pela reação em cadeia da polimerase (PCR), para detectar a frequência das mutações em ponto que envolvem a resistência à claritromicina. Os resultados foram comparados com os obtidos pelos E-testes. RESULTADO: Os métodos molecular e fenótipo fenotípico mostraram 111 (97.4%) resultados concordantes, sensíveis ou resistentes. A PCR detectou três (2.6%) espécimes de H. pyloricom genótipo resistente, diagnosticados erroneamente como sensíveis pelo E-teste. No Recife, baseando-se nos resultados da PCR, a resistência primária à claritromicina foi encontrada em 15 (16.5%) pacientes, esta prevalência também foi observada no sudeste do Brasil. Entre os pacientes previamente tratados, a resistência elevou-se para 52%. A mutação em ponto A2143G foi observada em 20 (71.4%) dos espécimes e a A2142G, em 8 (28.6%). A mutação A2142C não foi encontrada. CONCLUSÃO: No Recife, a prevalência da resistência a claritromicina, 16.5%, mostrou a necessidade de realização dos testes de susceptibilidade prétratamento nas infecções por H. pylori.

CONTEXT: Clarithromycin is the most effective drug used in the eradication of infection by Helicobacter pylori. Due to worldwide increase in resistance, pre-treatment susceptibility testing for clarithromycin is recommended. OBJECTIVES: To evaluate the prevalence of clarithromycin resistance of H. pylori in Recife, a city in Northeast Brazil. METHODS: From January 2006 to December 2007, 114 gastric biopsy samples positive for H. pylori at culture were directly assayed by polymerase chain reaction (PCR) to detect the most frequent point mutations involved in clarithromycin resistance. Results were compared with those obtained by Etests. RESULT: Molecular and phenotypic methods showed 111 (97.4%) susceptible or resistant concordant results. PCR detected 3 (2.6%) biopsy specimens with H. pylori-resistant genotypes, which were misdiagnosed as susceptible by Etests. In Recife, based on PCR results, primary clarithromycin resistance was found in 15 (16.5%) patients, prevalence close to that observed in Southeast Brazil. Resistance increased to 52% among previously treated patients. The point mutation A2143G was present in 20 (71.4%) of specimens and A2142G, in 8 (28.6%) of specimens. A2142C was not found. CONCLUSION: In Recife, the prevalence of primary clarithromycin resistance, 16.5%, showed the need for pretreatment susceptibility testing in H. pylori infections.

Analisou-se a percepção de mães ou responsáveis sobre a saúde-doença bucal de seus filhos, com idade de 2 a 6 anos, matriculados em uma creche filantrópica de Bauru (SP). Foram realizadas 26 entrevistas, analisadas por metodologia qualitativa. Os entrevistados foram ouvidos sobre a presença de cárie dentária em suas crianças e como compreendiam sua causalidade. Foi realizado o exame de cárie das crianças, utilizando critérios epidemiológicos para o diagnóstico. Na maioria das entrevistas (65,4%) houve concordância de respostas com a condição bucal verificada no exame das crianças. A percepção dos entrevistados sobre a presença da cárie dentária foi relacionada à aparência do dente ("furadinho") e à dor. A compreensão quanto à causalidade da doença fez referência ao cuidado dispensado às crianças pelos entrevistados, acesso ao cirurgião-dentista, ingestão de doces e à fatalidade ("Todo mundo tem cárie, pelo menos um pouquinho tem"). A maneira pela qual as pessoas percebem o processo saúde-doença influencia as práticas e os cuidados em saúde bucal. Buscar compreender estas construções e valores é essencial para se trabalhar, de forma contextualizada, a falta de informação e os conceitos que ainda persistem, como a crença que a cárie dentária é um fenômeno "natural" e não um processo patológico.

The aim of this study was to verify the perception of parents about oral health conditions of their sons, from a day nursery in Bauru, São Paulo, Brazil. The study population was compound by 26 2-6 aged year's children and their mothers. The children were examined in their school and it was done an interview with the mother, father or responsible. The parents were asked about the presence of dental caries in their children and the possible causes of this oral disease. The answers were evaluated by means of qualitative analysis. Most of the answers (65.4%) showed concordance with the child clinical examination. The parents' perception about presence of dental caries was related to tooth appearance ("tooth leaky") and to ache. According to the parents, some causes of dental caries were related to the child dental care, dental assistance access, sugar ingestion, and to the fatality ("All people have dental caries"). The perception about oral health may influence the daily practices concerning oral health care. Thus, it is important to understand these ideas and perceptions in order to improve oral attention to children, against the belief that dental caries is a "natural" phenomenon and not a pathological process.

Analisou-se a percepção de mães ou responsáveis sobre a saúde-doença bucal de seus filhos, com idade de 2 a 6 anos, matriculados em uma creche filantrópica de Bauru (SP). Foram realizadas 26 entrevistas, analisadas por metodologia qualitativa. Os entrevistados foram ouvidos sobre a presença de cárie dentária em suas crianças e como compreendiam sua causalidade. Foi realizado o exame de cárie das crianças, utilizando critérios epidemiológicos para o diagnóstico. Na maioria das entrevistas (65,4%) houve concordância de respostas com a condição bucal verificada no exame das crianças. A percepção dos entrevistados sobre a presença da cárie dentária foi relacionada à aparência do dente ("furadinho") e à dor. A compreensão quanto à causalidade da doença fez referência ao cuidado dispensado às crianças pelos entrevistados, acesso ao cirurgião-dentista, ingestão de doces e à fatalidade ("Todo mundo tem cárie, pelo menos um pouquinho tem"). A maneira pela qual as pessoas percebem o processo saúde-doença influencia as práticas e os cuidados em saúde bucal. Buscar compreender estas construções e valores é essencial para se trabalhar, de forma contextualizada, a falta de informação e os conceitos que ainda persistem, como a crença que a cárie dentária é um fenômeno "natural" e não um processo patológico.

The aim of this study was to verify the perception of parents about oral health conditions of their sons, from a day nursery in Bauru, São Paulo, Brazil. The study population was compound by 26 2-6 aged year's children and their mothers. The children were examined in their school and it was done an interview with the mother, father or responsible. The parents were asked about the presence of dental caries in their children and the possible causes of this oral disease. The answers were evaluated by means of qualitative analysis. Most of the answers (65.4%) showed concordance with the child clinical examination. The parents' perception about presence of dental caries was related to tooth appearance ("tooth leaky") and to ache. According to the parents, some causes of dental caries were related to the child dental care, dental assistance access, sugar ingestion, and to the fatality ("All people have dental caries"). The perception about oral health may influence the daily practices concerning oral health care. Thus, it is important to understand these ideas and perceptions in order to improve oral attention to children, against the belief that dental caries is a "natural" phenomenon and not a pathological process.

De 24 linhagens hospitalares de Pseudomonas aeruginosa provenientes de Recife, Brasil, 15 (62%) produziram metalo-beta-lactamase. Tais isolados foram resistentes às principais drogas antipseudomonas, exceto polimixina B e aztreonam. A enzima responsável pela resistência aos carbapanêmicos pertence à classe SPM-1 e o gene envolvido, blaspm-1, provavelmente é plasmidial.

Out of 24 nosocomial strains of Pseudomonas aeruginosa from Recife, Brazil, 15 (62%) were metallo-beta-lactamase producers. Such isolates were resistant to main antipseudomonas drugs, except polymixyn B and aztreonam. The enzyme responsible for the carbapenem-resistance belongs to SPM-1 class, and the gene involved, blaspm-1, is likely plasmid located.