Israel Figueiredo

A technique for the intra-gastric administration of live larvae of Anisakis simplex in mice

To understand the mechanisms of infection and to attempt to simulate human infection by the Anisakidae family, many in vivo experimental approaches have been developed. The aim was to develop and present a technique for the induction of an oral infection through the use of an intra-gastric gavage of live Anisakis simplex in mice. A commercial pediatric gastric tube (No. 4) was cut longitudinally to produce a 3-cm slit at the distal end where the larva was placed to then be administered to the stomach of the mouse. There were no abnormal clinical complications before, during or after the procedure. In conclusion oral infection through the direct delivery of larvae in the stomach is simple and effective.

Experimental anisakid infections in mice.

Anisakidosis is a human parasitic disease caused by infections with members of the Anisakidae family. Accidental infection after fish intake affects the gastrointestinal tract as a consequence of mechanical damage caused by migrating larvae. Infections can also trigger allergies, hives, severe asthma or anaphylaxis with angioedema. Although mouse models of intraperitoneal antigenic stimulation exist, enabling immunological studies, few models using gastric introduction of live larvae are available for the study of immunological and gastrointestinal damage in mice. This study was designed to characterize serum reactivity against Anisakis spp. and Contracaecum spp. in Balb/c mice following orogastric inoculation and to assess gastrointestinal damage. These anisakid species were classified at the Universidade Federal Fluminense (UFF) School of Veterinary Medicine and materials for live larval inoculation were developed at the UFF Immunobiology laboratory. Live larvae were inoculated following injection with a NaCl solution. Blood samples were collected and sera screened for immunoglobulin (Ig)E and IgG anti-larva responses to both nematodes, specific for somatic and excretory/secretory antigens, by enzyme-linked immunosorbent assay (ELISA). The means of the optical densities were analysed using analysis of variance (ANOVA) with Tukeys post-hoc test and the general linear model. This analysis identified the presence of anti-IgG seroreactivity to both somatic and excretory/secretory Anisakis antigens in inoculated animals compared with controls (P< 0.001), and no gastric or intestinal damage was observed. These experiments demonstrated that introduction of live Contracaecum spp. into the gastrointestinal tract did not elicit serum sensitization in animals.

Association of midtrimester short femur and short humerus with fetal growth restriction

To investigate the association between the midtrimester presence of short femur and short humerus and intrauterine growth restriction.

Access to the tracheal pulmonary pathway in small rodents

As vias de acesso traqueopulmonar vem sendo utilizadas em diversos modelos experimentais que estudam a acao de farmacos e agentes infecciosos, alem de enfermidades. Tendo em vista a sua importância e as dificuldades associadas, o presente artigo de atualizacao propoe-se a dar ao pesquisador as informacoes necessarias para o emprego das tecnicas de acesso traqueopulmonar em pequenos roedores.

Evaluation of the adequacy of Hadlock’s reference chart for identification of fetuses with growth restriction

Abstract Objective: This study aimed to verify whether Hadlock’s reference values for fetal weight identify fetuses below the 10th percentile in our population correctly. Methods: The fitness of the Hadlock reference range to our study population was tested by assessment of Z scores. We evaluated differences between the reference weight ranges proposed in our study and those recommended by Hadlock. Results: Z scores for Hadlock reference values were non-normally distributed. The difference between the 50th percentile fetal weight proposed by our study model and that proposed by Hadlock was ≤1% at GAs ≥22 weeks and 2–3% at 19–21 weeks. For the 90th percentile level, the maximum difference at GAs ≥17 weeks was 1.5%. For the 10th percentile level, the differences were 2–4% in the third trimester, reaching 8% in week 20 and 13% at a GA of 14 weeks. Conclusions: The weight reference ranges of this study virtually overlap with the Hadlock ranges. We believe that only at lower gestational ages in the second trimester might some FGR diagnoses be missed in the population study with Hadlock’s reference.

Mobile emergency care service: A time-course assessment and characterization of demand

INTRODUCTION Prehospital care is defined as any medical attention provided outside the hospital environment. This study aims to study the operation of a regional SAMU by assessing electronic records of cases managed and to evaluate demand patterns over time. METHODS A retrospective, cross-sectional study was conducted through an analysis of emergency calls handled between the years of 2009 and 2013 by the SAMU Metropolitan 2 Region mobile emergency care service, located in Niterói, Brazil. Nonparametric tests were used to evaluate differences in the variables of interest between the two halves of the 5-year period of analysis and annually. RESULTS The total call volume during the period of analysis was 590,902 (monthly mean [SD], 9848 [3764]; 95%CI = 8875 to 10,820). Analysis of calls over time revealed a significant decline in call volume (p = 0.008), mainly between the year 2009 and subsequent years (p < 0.001). The vast majority of patients were adults with clinical conditions (average = 2311). Predominantly, calls were made to request prehospital assistance at the patients home, and the most prevalent age range was 41-50 years. CONCLUSION The SAMU Metropolitan 2 regional emergency medical service predominantly attended to middle-aged women at their homes. Total call volume has been decreasing, perhaps reflecting a multifactorial phenomenon and improvements in the primary health care network.

Seroreactivity to Anisakis spp. in the perinatal period

Background This study had sought to assess the seroreactivity to the fish nematode Anisakis spp. in a puerperal population, as well as to ascertain whether a correlation exists between maternal and cord blood levels. Methods Blood samples were obtained from puerperal women and cord blood to measure specific anti-Anisakis antigen IgG and IgE by ELISA. Non-parametric tests were used to compare two or more independent and related samples. Results Of the 99 maternal serum samples assessed, 21 were positive on ELISA (21.2%). There were no significant differences in the mean ranks of IgG optical density levels between women who ate fish and those who did not (p = 0.456), those who ate raw fish and those who did not (p = 0.479), or between those who had allergic complaints and those who did not (p = 0.431). Conclusion Transplacental passage of antibodies occurred, leading to moderate correlation between maternal and cord blood serum levels.

Abdominal lymphadenopathy in an adolescent with Kawasaki disease: a major sign?

Abstract In adolescence, Kawasaki disease (KD) may present with varied clinical pictures, and the classic clinical criteria are often insufficient to establish the diagnosis. This report presents a clinical case of KD in an adolescent and a brief review of the relevant literature, based on a PubMed search using the terms “adolescence” and “KD”. A 13-year-old girl presented with fever, rash, hepatomegaly, and ultrasonographic evidence of abdominal lymphadenopathy. On week 2 after onset of symptoms, the patient developed desquamation of the extremities and thrombocytosis. Echocardiography was normal during the acute illness and remained unchanged at 2-year follow-up. Clinicians should be aware that, in adolescents, KD poses a diagnostic challenge and rarely corresponds to the classic presentation. On retrospective analysis, we believe that abdominal lymphadenopathy should have been recognized as a substitute manifestation of the classic symptom of cervical lymphadenopathy to establish the diagnosis of this fearsome systemic vasculitis syndrome.

Principal component analysis of factors for sensitization to Anisakis spp. in postpartum women

Introduction Immunoreactivity to Anisakis spp. is believed to be associated with frequency of fish intake. The objective of this study was to evaluate, using principal component analysis, the main factors potentially involved in reactivity to these nematodes in postpartum women. Methods Retrospective study conducted on a database of 309 postpartum women. All completed a structured questionnaire and had blood samples collected for ELISA analysis of specific immunoglobulins against total Anisakis spp. antigens and assessment of reactivity. Parametric and nonparametric tests were used to assess factors for sensitization in the reactive and nonreactive groups, and a principal component analysis was performed. A Pearson correlation matrix with varimax rotation was used to assess the variables of interest (place of residence, age, number of prenatal visits, type of birth facility, fish intake and frequency, raw fish intake, fish handling, history of allergies). Results After exclusions, samples from 203 women were assessed. Of these, 52 (25.6%) were reactive for anti-Anisakis IgG. Most women claimed not to handle fish (n = 121) and eat fish only sporadically (n = 71). Significant differences in age were seen between the reactive and nonreactive groups (p = 0.001). The first two components explained 32.55% and 38.94% of variances in the nonreactive and reactive groups respectively. The adjusted matrix assigned greater probabilistic weight to weekly intake frequency (0.804), followed by raw fish intake (0.759), with differences in relation to the nonreactive group. Conclusion Correlation matrices revealed a direct relationship between seroreactivity to Anisakis spp. and frequency of fish intake in a sample of postpartum women.

Evaluation of the adequacy of reference charts for the accurate identification of fetuses with bone length below the 5th percentile.

Abstract Aim: To identify reference charts for femoral and humeral lengths enabling appropriate identification of fetuses <5th percentile in one population. Methods: Two samples of fetuses aged 14–40 weeks were selected from our institution’s ultrasonographic database. Regression analysis was used to construct reference charts of femoral and humeral lengths based on the local population (n=901). Femur and humerus length measurements from a second sample (n=1240) were transformed into Z-scores using local and previously published equations. Z-score distributions were used to assess the appropriateness of reference curves for our population. Fetuses aged 18–24 weeks with measurements <5th percentile were identified using each reference equation. Results: For femoral length, one equation other than the local equation yielded Z-score values within the standard normal distribution (P=0.10), but the histogram was skewed to the right. All Z-score distributions for humeral length fell within the normal distribution (P>0.05), but one was skewed to the right. The numbers of fetuses with femoral and humeral lengths <5th percentile in second-trimester ultrasound examinations varied widely among reference equations used. Conclusion: Most reference charts assessed underestimated the number of fetuses with long bone lengths <5th percentile in second-trimester ultrasound examinations and were thus unfit for interpretations of biometric data from the study population.