In an attempt to improve the specificity of an enzyme-linked immunosorbent assay (ELISA) for the diagnosis of paracoccidioidomycosis (PCM), sera from patients with PCM were tested using various approaches, such as sodium metaperiodate antigen (gp43) treatment, a serum absorption process with Candida albicans or Histoplasma capsulatum antigens, and dilution of serum in galactose, the main common epitope among pathogenic fungi. The maximum specificity found in this ELISA was 84%. All of these procedures proved inefficient for eliminating all cross-reacting antibodies and obtaining an ELISA specific for PCM diagnosis.Paracoccidioidomycosis (PCM) is a mycotic disease caused by the dimorphic fungus Paracoccidioides brasiliensis and causes a deep mycosis, resulting in a severe chronic granulomatous infection of the skin, mucous membranes, lymph nodes, and internal organs. Almost all South and Central America countries have large regions where PCM is endemic. The definitive diagnosis of PCM includes direct observation of the characteristic multiple-budding cells in biological fluids and tissue sections or isolation of the fungus from clinical materials. For cases in which P. brasiliensis is not observed through direct examination, several serological tests have been used to detect antibodies against the fungus in order to establish the diagnosis (2). gp43, a 43,000-Da glycoprotein from P. brasiliensis, is a major diagnostic antigen in serological assays (1,3,15,18,23,24). It has been demonstrated that gp43 is as good as crude exoantigen preparations (concentrated, dialyzed culture supernatants) (3, 4) for detecting precipitating antibody in immunodiffusion tests, and purified gp43 has also been adapted to several other serological tests, such as immunoprecipitation of 125 I-labeled gp43 (IPP), conventional enzymelinked immunosorbent assay (ELISA), capture enzyme immunoassay (EIA), and passive hemagglutination (5,20,23). Cross reactivity in serological assays from patients with histoplasmosis depends on the test used and seems to involve a carbohydrate epitope. While IPP and capture EIA using gp43 appear specific for PCM diagnosis, experiments were performed to determine the nature of the cross reactivity in sera from those patients with histoplasmosis that reacted with gp43 in the IPP tests. Treatment of gp43 with 0.2 M D-galactose inhibited such cross reactivity, and no cross reactivity was observed with the deglycosylated form of gp43, with EH38, or with the 38,000-Da protein which had been treated with periodate (18). Owing to the N-linked high-mannose nature of the gp43 glycan, deglycosylation was efficiently carried out with endo-␤-N-acetylglucosaminidase H. Since sera from patients with histoplasmosis generally reacted with the high-molecular-weight glycocomplex present in the crude antigen of P. brasiliensis, this reactivity and that with gp43 likely involved recognition of terminal ␤-galactofuranosyl units (24).Travassos et al. (24) related that in general, specific reactions with gp43 are obtained when the ant...

Objetivo : analisar a efetividade na progressão da alimentação via oral de pacientes com sintomas de disfagia, que sofreram acidente vascular encefálico prévio ou atual, internados em um hospital federal do Rio de Janeiro.Métodos : foi feito estudo retrospectivo do prontuário de 20 pacientes com acidente vascular encefálico, para os quais foi solicitada fonoterapia para disfagia. Para comparação do nível de ingestão oral de cada paciente, antes e depois da terapia, foi utilizada uma escala funcional. Foram estudados os possíveis fatores de interferência na progressão na escala como: idade, intercorrências clínicas, tempo e incidência prévia do AVE. Os seguintes indicadores de resultado foram analisados: tempo para retirada de via alternativa de alimentação e tempo para reintrodução de alimentação via oral.Resultados : dos 20 pacientes, 15 apresentaram melhora na escala de ingestão oral após a fonoterapia. As intercorrências clínicas foram consideradas estatisticamente significantes para a não evolução da alimentação via oral. Os outros fatores analisados não demonstraram significância estatística, sugerindo não interferir na melhora ou piora do paciente. Foi possível reintroduzir alimentação via oral e retirar via alternativa de alimentação antes de 10 dias.Conclusão : a fonoterapia é efetiva para melhorar a ingestão de alimentos por via oral nos pacientes com AVE e disfagia neurogênica, atendidos em ambiente hospitalar, salvo se apresentarem intercorrências clínicas e rebaixamento do nível de consciência durante o processo.

It was possible to observe a significant relationship between tracheal aspiration incidence and pressure controlled ventilation mode, which means the inclusion of those patients in the risk group for oropharyngeal dysphagia and their insertion in prevention protocols. The relationship between tracheal aspiration and sedation level, as well as tracheal aspiration and mechanical ventilation, were not statistically significant in this sample, needing further research.

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