ResumoA toxoplasmose, zoonose de distribuição mundial, apresenta importância em medicina veterinária e saúde pública. Os animais podem ser a fonte direta ou indireta da infecção ao homem, e neste, esta doença pode ser responsável por encefalite e óbitos, devido sua forma congênita em neonatos e como coinfecção em pacientes portadores da síndrome da imunodeficiência adquirida. O homem e os animais, hospedeiros intermediários, podem adquirir a doença pelo consumo de alimentos, como carne crua ou mal cozida e água contaminados com cistos e oocistos de T. gondii, respectivamente. Via iatrogênica como transfusões de sangue e transplante de órgãos são outras formas menos frequentes de transmissão. O agente causador desta enfermidade é o Toxoplasma gondii, protozoário coccídio intracelular obrigatório. Em pequenos animais, esta infecção tem sido reportada em diversos países, promovendo manifestações clínicas variadas e incomuns, porém severas e fatais, que constituem em um desafio em diagnóstico na clínica de pequenos animais, principalmente quando no comprometimento do sistema nervoso. Desse modo, constituem no objetivo da presente revisão literária abordar a participação dos pequenos animais na disseminação da doença, os aspectos clínicos a ela relacionados, bem como discutir métodos de diagnóstico, medidas terapêuticas, de profilaxia e controle desta enfermidade. Palavras-chave: Cão, gato, imunossupressão, protozoário, zoonose AbstractToxoplasmosis, a zoonosis of worldwide distribution, has importance in human and veterinary medicine. Animals can be direct or indirect source of infection to man, and this intermediate host, the disease may be responsible for encephalitis and deaths due to congenital form as coinfection in neonates and patients with acquired immunodeficiency syndrome. The man and animals can acquire the disease by eating undercooked meat or cures, infected with tissue cysts, as well as food and water contaminated with oocysts. Iatrogenic, such as, blood transfusion and organ transplantation are other less frequent routes of transmission. The causative agent of this disease is Toxoplasma gondii, a protozoan obligate intracellular coccidian. In small animals, the infection has been reported in several countries, promoting varied clinical manifestations and uncommon but severe and fatal, which is a challenge in the clinical diagnosis of small animals, especially when the nervous system involvement. Thus, constitute the purpose of this review address the participation of small animals in the spread of the disease, clinical aspects related to it, as well as discuss methods of diagnosis, therapeutic measures, prophylaxis and control of this disease.

Objective: To evaluate the need for palliative care in patients with advanced Congestive Heart Failure (CHF) hospitalized in a cardiology ward. Method: Application of the World Health Organization Palliative Needs tool (NECPAL) with the assistant physician, patient and/or caregiver for evaluation of indication of Palliative Care (PC). Results: 82 patients with a diagnosis of class III/IV Heart Failure or ejection fraction less than or equal to 40% in echocardiography of the last 12 months were included: Mean age 68 ± 20 years, 51 male patients and 31 female patients. Forty-three patients (52.4%) were married or in consensual union and ten (12%) lived alone. The death of 46 patients (56.1%) in the subsequent 12 months would not surprise their physician, and forty-five patients (55%) had palliative care indication according to the NECPAL. Conclusion: About half of patients hospitalized for class III/IV Heart Failure would have an indication of Palliative Care for the relief of suffering caused by the disease.

BackgroundResistance of the malaria parasite Plasmodium falciparum to sulfadoxine-pyrimethamine (SP) has evolved worldwide. In the archipelago of São Tomé and Principe (STP), West Africa, although SP resistance is highly prevalent the drug is still in use in particular circumstances. To address the evolutionary origins of SP resistance in these islands, we genotyped point mutations at P. falciparum dhfr and dhps genes and analysed microsatellites flanking those genes.MethodsBlood samples were collected in July and December 2004 in three localities of São Tomé Island and one in Principe Island. Species-specific nested-PCR was used to identify P. falciparum infected samples. Subsequently, SNPs at the dhfr and dhps genes were identified through PCR-RFLP. Isolates were also analysed for three microsatellite loci flanking the dhfr gene, three loci flanking dhps and four loci located at putative neutral genomic regions.ResultsAn increase of resistance-associated mutations at dhfr and dhps was observed, in particular for the dhfr/dhps quintuple mutant, associated with clinical SP failure. Analysis of flanking microsatellites suggests multiple independent introductions for dhfr and dhps mutant haplotypes, possibly from West Africa. A reduced genetic diversity and increased differentiation at flanking microsatellites when compared to neutral loci is consistent with a selective sweep for resistant alleles at both loci.ConclusionsThis study provides additional evidence for the crucial role of gene flow and drug selective pressures in the rapid spread of SP resistance in P. falciparum populations, from only a few mutation events giving rise to resistance-associated mutants. It also highlights the importance of human migration in the spread of drug resistant malaria parasites, as the distance between the islands and mainland is not consistent with mosquito-mediated parasite dispersal.

RESUMOContexto: Nos pacientes recebendo suporte ventilatório invasivo através de tubos endotraqueais é essencial o uso de umidificadores. Objetivo: avaliar os níveis de temperatura (T°C) e de umidade relativa (UR) do gás administrado ao paciente em ventilação mecânica através da umidificação aquosa aquecida (UAA) e do filtro trocador de calor e de umidade (FTCU). Método: Este foi um estudo prospectivo, randomizado, onde foram estudados 20 pacientes divididos em dois grupos: um grupo usou a UAA (n=10) e o outro grupo (n=10) usou FTCU Hygrobac "S", marca Mallinckrodt ® . As variáveis analisadas foram: níveis de temperatura (T) e umidade relativa (UR) do gás, volume minuto (VM), volume corrente (VC) e volume de condensação. Resultados: Verificou-se que o sistema de umidificação aquosa aquecida atingiu temperaturas mais baixas que o filtro trocador (29,01 ± 1,33 °C, versus 30,14 ± 1,24 °C; p<0,001). A umidade relativa foi maior na UAA do que no FTCU (97,45 ± 5,22 %, versus 89,87 ± 11.04 %, p < 0,021). O volume de condensação do circuito do grupo usando UAA foi maior que o do grupo usando o FTCU (p < 0,05). Conclusão: Os resultados demonstram que ambos os sistemas, UAA e o FTCU forneceram umidades absolutas abaixo do valor recomendado, sendo que o sistema de UAA ofereceu uma umidade relativa maior, enquanto que o aquecimento do gás com o FTCU obteve um melhor desempenho.Palavras-chave: umidificadores, trocadores de calor e de umidade, ventilação mecânica. ABSTRACT Comparative Study Between Heated Water Humidifiers and Hygroscopic Heat and Moisture Exchangers in Artificial Airways for Patients Undergoing Invasive Mechanical VentilationBackground: In patients receiving invasive mechanical ventilation through endotracheal tubes, the use of humidifiers is essential. Objective: To evaluate temperature and relative humidity levels in the gas administered to patients undergoing mechanical ventilation by means of heated water humidifiers (HWH) and hygroscopic heat and moisture exchangers (HHME). Method: This was a prospective randomized study on 20 patients divided into two groups: one group using HWH (n=10) and the other using the Hygrobac "S" model of HHME, made by Mallinckrodt ® (n=10). The variables analyzed were: temperature and relative humidity levels of the gas, minute volume (MV), tidal volume (V T ) and condensation volume. Results: It was found that HWH attained lower temperatures than did HHME (29.01 ± 1.33 °C versus 30.14 ± 1.24 °C; p<0.001). The relative humidity was higher in HWH than in HHME (97.45 ± 5.22% versus 89.87 ± 11.04%; p<0.021). The condensation volume in the ventilator circuit for the group using HWH was greater than for the HHME group (p<0.05). Conclusion: The results demonstrate that both systems (HWH and HHME) supplied absolute humidity that was below recommended values, while the HWH offered higher relative humidity. On the other hand, HHME produced better performance regarding gas heating.

Considering the great importance that the infection by Toxoplasma gondii has in public health, the aim of this article was to demonstrate some aspects about this disease in human being. This parasite can cause several behavioral changes and many cases of reactivation of this disease are associated with Acquired Immunodeficiency Syndrome -AIDS. Major cases of human infections by T. gondii are assymptomatic and the main clinical manifestation in the acute phase of this zoonosis is lymphadenopathy, usually in the cervical area. There may also be fever, night sweats, myalgia, maculopapular rash lymphocytic atypia and chorioretinitis. The congenital and/or acquired chronic latent cerebral toxoplasmosis play an important role in the development of some types of neurodegeneration, like Alzheimer disease and Down Syndrome. Humans and animals should not consume raw or undercooked meat, unpasteurized or not boiled dairy products, water without being treated and poorly washed fruits and vegetables. Educational programs focused on reducing T. gondii environmental contamination are essential for the congenital infection control. Due to the severity of this kind of infection and its sequel, it is critical that those responsible for the community's health establish prevention programs to avoid such a situation, obtaining results in the medium and long term, and particularly preserving the involved population's welfare. A lack or incomplete prenatal treatment was identified as an important risk factor for congenital toxoplasmosis, reinforcing the need of improvement of prenatal care. In this study was demonstrated the importance of implementing prevention programs to guide pregnant women to prevent the infection. Preventive measures like information and health education; screening of pregnant women and infants; limiting harm from risk behaviour; treatment of risk cases and vaccination are recommended. Serum monitoring throughout pregnancy, so as detect cases of maternal seroconversion allowing for early maternal treatment is also basic. Some countries have adopted control programs of human toxoplasmosis, however, this issue should be of world attention, considering its relevant aspects of public health, requiring the establishment of community education campaigns and monitoring of pregnant women in the pre and neonatal, especially in a preventive action to reduce the pathogenic effects of this disease.