RESUMO
OBJECTIVE: Test the ability of a brain and spinal cord MRI criteria to differentiate neuromyelitis optica spectrum disorders and MOG-disease from MS. MRI criteria was further tested in patients with CIS and pediatric MS. BACKGROUND: MOG-disease and neuromyelitis optica spectrum disorders can present clinical and radiological features strikingly similar to those of MS. Previously, diagnostic criteria based on brain MRI have been proposed to distinguish between these demyelinating diseases (Matthews-Jurynczik criteria), but spinal cord imaging and its relevance in CIS have not been evaluated. Simple brain and spinal cord MRI criteria may help separate these three inflammatory CNS diseases both in adults and children, aiding in early diagnostic decision-making, such as need for antibody testing. DESIGN/METHODS: We included 150 participants (23 with aquaporin-4-positive neuromyelitis optica spectrum disorder, 14 with MOG-disease, 20 with aquaporin-4-negative neuromyelitis optica spectrum disorder, 48 with adult-onset relapsing remitting MS, 24 with pediatric-onset MS and 21 with clinically isolated syndrome). Brain and spinal cord MRI scans were anonymised and scored by 2 separate raters, based on two sets of criteria: one previously described by Matthews and colleagues (including presence of at least one lesion adjacent to the body of lateral ventricle and in the inferior temporal lobe, or presence of subcortical U-fiber lesion or a Dawson's finger-type lesion), and an extended version including spinal cord features (non-longitudinally extensive cervical lesion). RESULTS: Extended MRI brain and spinal cord lesion criteria were able to separate adult-onset relapsing remitting MS with 100% sensitivity and 87% specificity from aquaporin-4-positive neuromyelitis optica spectrum disorder; and with 100% sensitivity and 79% specificity from MOG-disease. Additionally, brain and spinal cord criteria showed 100% sensitivity and specificity in patients presenting optic neuritis. Brain and spinal cord criteria were less sensitive in patients with CIS and in pediatric MS patients. CONCLUSIONS: Our data suggest radiological criteria can be useful to separate MS from MOG- and aquaporin-4-positive neuromyelitis optica spectrum disorders, in particular in patients with optic neuritis. Further work is needed to support their use in CIS.
Assuntos
Aquaporina 4/imunologia , Encéfalo/diagnóstico por imagem , Esclerose Múltipla/diagnóstico , Glicoproteína Mielina-Oligodendrócito/imunologia , Neuromielite Óptica/diagnóstico , Medula Espinal/diagnóstico por imagem , Adolescente , Adulto , Idoso , Autoanticorpos/sangue , Criança , Pré-Escolar , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
This study aimed to evaluate whether pre-emptive analgesia modifies the tissue expression of tumour necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1ß), and whether there is an association with postoperative surgical outcomes. A triple-blind, randomized, placebo-controlled study of patients undergoing mandibular third molar removal was performed. Volunteers were allocated randomly to receive etoricoxib 120 mg, ibuprofen 400 mg, or placebo 1h before surgery. Twenty-four surgical sites per group were required (95% confidence level and 80% statistical power). Pain scores differed significantly between groups (P<0.001). Etoricoxib and ibuprofen reduced pain scores compared to placebo (P<0.05). Pain scores peaked at 4h postoperative in the experimental groups, but at 2h postoperative in the placebo group (P<0.05). A significant reduction in TNF-α concentration from time 0' to time 30' was seen for ibuprofen (P=0.001) and etoricoxib (P=0.016). The ibuprofen group showed a significant reduction in IL-1ß levels from time 0' to time 30' (P=0.038). In conclusion, TNF-α and IL-1ß levels and the inflammatory events in third molar surgery were inversely associated with the degree of cyclooxygenase 2 selectivity of the non-steroidal anti-inflammatory drugs used pre-emptively. Patients given pre-emptive analgesia showed significant reductions in the clinical parameters pain, trismus, and oedema when compared to the placebo group.
Assuntos
Analgesia/métodos , Anti-Inflamatórios não Esteroides/uso terapêutico , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Ibuprofeno/uso terapêutico , Interleucina-1beta/metabolismo , Dente Serotino/cirurgia , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Piridinas/uso terapêutico , Sulfonas/uso terapêutico , Extração Dentária , Fator de Necrose Tumoral alfa/metabolismo , Adolescente , Adulto , Estudos Cross-Over , Etoricoxib , Feminino , Humanos , Masculino , Medição da Dor , Placebos , Resultado do TratamentoRESUMO
O role-playing é um tipo de atividade que tem inúmeros propósitos, dentre os quais a prática deestratégias militares e a formação de competências nas mais diversas áreas, como medicina, direito,administração, etc. Este relato de pesquisa tem por objetivo analisar a relação entre discurso e cogniçãode surdos quando estes realizavam esse tipo de atividade. O corpus foi obtido a partir da filmagem deuma atividade realizada por surdos. A turma era composta por seis estudantes que estavam realizando umjogo de role-playing. Considerando o fenômeno linguagem em sua amplitude, pôde-se verificar que ocampo metafórico da situação lúdica fornece mais que uma estilística do jogar. O que se percebeu foi queno próprio jogo subjazem metáforas, ordenadas por regras(AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Fala , Cognição , Educação de Pessoas com Deficiência AuditivaRESUMO
OBJECTIVE: To determine whether brain white matter hyperintensities (WMH) influence l-dopa response in Parkinson's disease (PD) patients. METHODS: We prospectively evaluated 60 PD patients with an acute l-dopa challenge test, and assessed motor performance with the Movement Disorders Society revised Unified Parkinson's Disease Rating Scale (MDS-UPDRS) during "ON" and "OFF" medication states. Magnetic resonance images were examined using a visual semi-quantitative rating scale for quantification and distribution analysis of WMH. l-dopa challenge test response was correlated to extent and location of WMH, to determine a potential association between them. RESULTS: Subjects with greater deep WMH burden, showed less response to l-dopa on axial motor symptoms (R = -0.35; p < 0.027), when tested with Part III of the MDS-UPDRS before and after acute levodopa challenge. CONCLUSIONS: Results suggest WMH may affect response to l-dopa on axial function of PD patients, which could be due to either non-dopaminergic (cortico-basal ganglia) motor pathway disruption, or postsynaptic nigrostriatal pathway involvement.
Assuntos
Antiparkinsonianos/uso terapêutico , Levodopa/uso terapêutico , Imageamento por Ressonância Magnética , Doença de Parkinson/tratamento farmacológico , Substância Branca/efeitos dos fármacos , Substância Branca/diagnóstico por imagem , Idoso , Feminino , Transtornos Neurológicos da Marcha/diagnóstico por imagem , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
BACKGROUND: We investigated both the efficacy and the sub-chronic toxicity of Tephrosia toxicariaâ Pers. in the zymosan-induced temporomandibular joint (TMJ) inflammatory hypernociception in rats evaluating the possible role of heme oxygenase-1 (HO-1). METHODS: Rats were pretreated with T. toxicaria (0.2, 2.0 or 20 mg/kg) 60 min before the intra-articular injection of zymosan (2 mg, 40 µL) in the left TMJ. In another series of experiments, rats were treated with ZnPP-IX (3 mg/kg), a specific HO-1 inhibitor, before T. toxicaria (20 mg/kg). Von Frey test was used to evaluate inflammatory hypernociception (g) 4 h after zymosan injection. Six hours after zymosan injection, the synovial lavage was collected for total cell count and myeloperoxidase (MPO) activity, and joint tissue for histopathological analysis and immunohistochemistry for HO-1. To evaluate the sub-chronic toxicity, mice received T. toxicaria (20 mg/kg) or saline once a day for 14 days to analyse body mass, organ weight and biochemical parameters. RESULTS: T. toxicaria partially reversed the zymosan-induced head withdrawal threshold, the number of cells and the MPO activity. T. toxicaria reduced the inflammatory cell influx in the synovial membrane. TMJ immunohistochemical analyses treated with T. toxicaria showed increased HO-1 expression. These effects of T. toxicaria were not observed in the presence of ZnPP-IX. T. toxicaria treatment for 14 days did not show significant signs of toxicity when administrated to mice. CONCLUSIONS: T. toxicaria did not produce any signs of toxicity and effectively decreased zymosan-induced TMJ inflammatory hypernociception dependent, at least in part, upon the HO-1 pathway integrity.
Assuntos
Heme Oxigenase-1/metabolismo , Hiperalgesia/tratamento farmacológico , Fitoterapia , Preparações de Plantas/farmacologia , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Tephrosia , Animais , Modelos Animais de Doenças , Inibidores Enzimáticos/administração & dosagem , Inibidores Enzimáticos/farmacologia , Heme Oxigenase-1/antagonistas & inibidores , Hiperalgesia/induzido quimicamente , Inflamação/induzido quimicamente , Inflamação/tratamento farmacológico , Masculino , Redes e Vias Metabólicas , Camundongos , Preparações de Plantas/administração & dosagem , Preparações de Plantas/efeitos adversos , Protoporfirinas/administração & dosagem , Protoporfirinas/farmacologia , Ratos , Ratos Wistar , Transtornos da Articulação Temporomandibular/induzido quimicamente , Transtornos da Articulação Temporomandibular/fisiopatologia , Zimosan/farmacologiaRESUMO
Peccaries are characterized by a prominent skin gland, known as scent gland, which is located in the middle of the rump. These animals are able to survive in a great variety of habitats, from humid tropical forests to semi-arid areas. They are omnivorous animals, and their diet includes fibrous material, vegetables, fruits, small vertebrates and insects. Collared peccary hard palate and soft palate tonsils were studied, macroscopic morphometric data were collected and tissue samples were paraffin-embedded. Sections were stained with HE, Gomori's trichrome and von Kossa; the first two were used to study general organization and the latter to detect calcium deposits. The hard palate showed one incisive papilla followed by several rugae united by a distinct raphe. The hard palate is lined by a keratinised squamous epithelium resting on a dense connective, whereas in the soft palate, the epithelium is parakeratinised and showed lymphocyte infiltration. The palate showed several pacinian corpuscles in the propria-submucosa. Two ovoid-shaped tonsils were found in the soft palate, and several crypts were observed on its surface. The epithelium was highly infiltrated by lymphocytes, and within the crypts, tonsilloliths were frequently observed. The study showed that the general organization of collared peccary palate is similar to other species, but in its oropharynx, only the soft palate tonsil was present and the pacinian corpuscles formed small aggregates.
Assuntos
Artiodáctilos/anatomia & histologia , Mucosa/anatomia & histologia , Palato Mole/anatomia & histologia , Tonsila Palatina/anatomia & histologia , Animais , Epitélio/anatomia & histologia , Feminino , Linfócitos/citologia , Orofaringe/anatomia & histologia , Tonsila Palatina/citologia , Coloração e Rotulagem/veterinária , Preservação de Tecido/veterináriaRESUMO
Chresta martii (Asteraceae) is a plant found in the Xingó region (semi-arid area) in Northeastearn Brazil, and is recognized by the local population as a traditional herb used to treat gastric diseases. This is the first report of the chemical composition, acute toxicity, and gastroprotective effect in mice of the hydroalcoholic extract (HAE) from the aerial parts (leaves and flowers) of Chresta martii. Animals received HAE doses from 10 to 2000 mg/kg, i.p. or 50 to 3000 mg/kg, p.o.) and were observed over 48 h for toxicity signs and mortality; sub-chronic toxicity was evaluated through 14 days treatment with once-daily HAE doses (400 mg/kg, p.o.). The gastroprotective effect of HAE was demonstrated on the indomethacin-induced gastric ulcer model after the administration of extracts. Data comparison of ulcer index averages between saline and HAE (100 or 400 mg/kg, p.o.) groups showed significant (P < 0.01) inhibition (71.73 and 76.72 %, respectively) of indomethacin-induced gastric lesions. Histological analyses showed significant (P < 0.05) inhibition of leukocyte migration in HAE-treated groups. A fingerprint of the HAE obtained by HPLC/UV/MS analysis showed major peaks characteristic of sesquiterpene lactones. Compound 1 was isolated and elucidated as a new natural product. Its capacity to prevent leukocyte chemotaxis was demonstrated in vitro, corroborating the pharmacological effects observed for C. martii HAE.
Assuntos
Asteraceae/química , Indometacina/toxicidade , Extratos Vegetais/uso terapêutico , Úlcera Gástrica/induzido quimicamente , Úlcera Gástrica/tratamento farmacológico , Animais , Antiulcerosos/química , Antiulcerosos/uso terapêutico , Flores/química , Masculino , Camundongos , Extratos Vegetais/química , Folhas de Planta/química , Gastropatias/tratamento farmacológicoRESUMO
We investigated the association between pulse wave velocity (PWV) and HIV infection, antiretroviral treatment-related characteristics, viral load, immune status, and metabolic changes in a cross-sectional study nested in a cohort of HIV/AIDS patients who have been followed for metabolic and cardiovascular changes since 2007. The study included patients recruited from the cohort (N = 261) and a comparison group (N = 82) of uninfected individuals, all enrolled from April to November 2009. Aortic stiffness was estimated using the carotid-femoral PWV (Complior-Artech, Paris, France). The groups were similar with respect to age, metabolic syndrome, diabetes mellitus, Framingham score, and use of antihypertensive and hypolipidemic medications. Hypertension was more frequent among the controls. Individuals with HIV had higher triglyceride, glucose and HDL cholesterol levels. Among individuals with HIV/AIDS, those with a nadir CD4+ T-cell count <200 cells/mm³ had a higher PWV (P = 0.01). There was no statistically significant difference when subjects were stratified by gender. Heart rate, age, male gender, and blood pressure were independently correlated with PWV. Nadir CD4+ T-cell count did not remain in the final model. There was no significance difference in PWV between HIV-infected individuals and uninfected controls. PWV was correlated with age, gender, and blood pressure across the entire population and among those infected with HIV. We recommend cohort studies to further explore the association between inflammation related to HIV infection and/or immune reconstitution and antiretroviral use and PWV.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Infecções por HIV/fisiopatologia , Rigidez Vascular/fisiologia , Terapia Antirretroviral de Alta Atividade , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Estudos de Casos e Controles , Estudos Transversais , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , Frequência Cardíaca/fisiologia , Fatores de Risco , Carga ViralRESUMO
We investigated the association between pulse wave velocity (PWV) and HIV infection, antiretroviral treatment-related characteristics, viral load, immune status, and metabolic changes in a cross-sectional study nested in a cohort of HIV/AIDS patients who have been followed for metabolic and cardiovascular changes since 2007. The study included patients recruited from the cohort (N = 261) and a comparison group (N = 82) of uninfected individuals, all enrolled from April to November 2009. Aortic stiffness was estimated using the carotid-femoral PWV (Complior-Artech, Paris, France). The groups were similar with respect to age, metabolic syndrome, diabetes mellitus, Framingham score, and use of antihypertensive and hypolipidemic medications. Hypertension was more frequent among the controls. Individuals with HIV had higher triglyceride, glucose and HDL cholesterol levels. Among individuals with HIV/AIDS, those with a nadir CD4+ T-cell count <200 cells/mm³ had a higher PWV (P = 0.01). There was no statistically significant difference when subjects were stratified by gender. Heart rate, age, male gender, and blood pressure were independently correlated with PWV. Nadir CD4+ T-cell count did not remain in the final model. There was no significance difference in PWV between HIV-infected individuals and uninfected controls. PWV was correlated with age, gender, and blood pressure across the entire population and among those infected with HIV. We recommend cohort studies to further explore the association between inflammation related to HIV infection and/or immune reconstitution and antiretroviral use and PWV.
Assuntos
Infecções por HIV/fisiopatologia , Rigidez Vascular/fisiologia , Adulto , Idoso , Terapia Antirretroviral de Alta Atividade , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Contagem de Linfócito CD4 , Estudos de Casos e Controles , Estudos Transversais , Feminino , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Carga Viral , Adulto JovemRESUMO
OBJECTIVES: To evaluate the prevalence of metabolic syndrome (MetS) in patients with rheumatoid arthritis (RA) vs. controls, and to verify possible associations of MetS with specific disease-related factors. METHODS: The subjects were 283 RA patients and 226 healthy controls, frequency matched by age and sex. MetS was defined according to National Cholesterol Education Program (NCEP) criteria. Disease activity was evaluated with the Disease Activity Score using 28 joints (DAS28). A standardized clinical evaluation was performed and cardiovascular risk factors were assessed. RESULTS: The criteria for MetS were met by 39.2% RA patients vs. 19.5% in the control group (p < 0.001). Increased waist circumference, elevated blood pressure (BP), and fasting glucose were more frequent in RA patients than controls (p < 0.001 for all associations). By multiple logistic regression analysis (adjusted for age, sex, and years at school), the risk of having MetS was significantly higher for RA patients than for controls [odds ratio (OR) 1.87, 95% confidence interval (CI) 1.17-3.00, p = 0.009]. The DAS28 was significantly higher in RA patients with MetS than in those without MetS (3.59 ± 1.27 vs. 3.14 ± 1.53; p = 0.01). Disease duration, the presence of rheumatoid factor, and extra-articular manifestations were similar for patients with and without MetS. CONCLUSIONS: MetS frequency was higher in RA patients than in controls. Among RA patients, MetS was associated with disease activity. The higher prevalence of cardiovascular risk factors in RA suggests that inflammatory processes play a notable role in the development of cardiovascular disease (CVD), and indicates that tight control of systemic inflammatory activity and CVD modifiable risk factors should be recommended.
Assuntos
Artrite Reumatoide/epidemiologia , Síndrome Metabólica/epidemiologia , Índice de Gravidade de Doença , Adulto , Idoso , Artrite Reumatoide/fisiopatologia , Glicemia/análise , Pressão Sanguínea/fisiologia , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Circunferência da CinturaRESUMO
BACKGROUND: Periodontitis is the most frequent cause of tooth loss in adults. Nitric oxide (NO) has been linked to bone resorption mechanisms during inflammation processes. The aim of this study was to investigate the effect of NOS (NO synthase) inhibitors in the alveolar bone loss in an experimental periodontitis disease (EPD) model. METHODS: Wistar rats were subjected to a ligature placement around the second upper left molars and were sacrificed at 11 days. Alveolar bone loss was evaluated by the sum of distances between the cusp tips and the alveolar bone along the axis of each molar root, subtracting from the contralateral side. Histopathological analysis was based on cell influx, alveolar bone, and cementum integrity. Leukogram was performed at 6 hours and 1, 7, and 11 days after the EPD induction. Groups were treated with the NOS inhibitors, aminoguanidine (AG) (2.5 to 10 mg/kg/d), or L-arginine methyl ester (L-NAME, 5 to 20 mg/kg/d) intraperitoneally (i.p.), 1 hour before the EPD induction and daily for 11 days. Controls received only saline (EPD group). As controls for L-NAME specificity, groups were co-treated with either L-arginine (150 to 600 mg/kg/d) or D-arginine (600 mg/kg/d) and L-NAME (20 mg/kg/d). Different groups were used for morphometric and histopathological analysis. RESULTS: Both L-NAME and AG significantly and dose-dependently inhibited the alveolar bone loss as compared to EPD group. L-NAME (20 mg/kg/d) reduced the alveolar bone loss by 50%, whereas AG (5 mg/kg/d) reduced it by 47% compared to EPD. This result was coupled to a significant reduction of cell influx to the periodontium, as well as to the preservation of alveolar bone and cementum, seen at histopathology, for both compounds. The co-administration of L-arginine, but not of D-arginine reversed L-NAME effects. CONCLUSION: These data provide evidence that NOS inhibitors prevent inflammatory bone resorption in experimental periodontitis.
Assuntos
Perda do Osso Alveolar/prevenção & controle , Inibidores Enzimáticos/farmacologia , Óxido Nítrico Sintase/antagonistas & inibidores , Periodontite/complicações , Perda do Osso Alveolar/enzimologia , Animais , Guanidinas/farmacologia , Ligadura , NG-Nitroarginina Metil Éster/farmacologia , Periodontite/enzimologia , Ratos , Ratos WistarRESUMO
BACKGROUND: The role of nitric oxide (NO) on bone metabolism is controversial, since it can either stimulate bone formation or resorption. We investigated the effect of local administration of the NO donor isosorbide in an experimental periodontal disease model. METHODS: Wistar rats were subjected to a ligature placement around the cervix of the right second upper molar and were sacrificed after 11 days. Alveolar bone loss was measured in one quadrant as the sum of the distances between the cuspid tip and the alveolar bone along the axis of each molar root, which was subtracted from the contralateral side, used as unligated control. The semiquantitative histopathological scale of the periodontium was based on cell infiltration and alveolar bone and cementum integrity. Groups were treated with a gel containing 1% or 5% isosorbide applied to the vestibular side of the molar gingiva 1 hour before the placement of the ligature and then twice daily until sacrifice. Controls included one group subjected to periodontitis and no treatment (NT) and another that received the gel containing just the vehicle (V). RESULTS: The application of the vehicle gel produced an increase of the alveolar bone resorption, without altering the inflammatory changes, compared to the NT group. The 5% isosorbide produced a significant reduction of the alveolar bone resorption, compared to V and NT. This reduction was confirmed by histological analysis, showing less inflammatory cell infiltration and preservation of the cementum and the alveolar process. CONCLUSION: Local application of isosorbide reduces alveolar bone resorption in experimental periodontal disease in rats, suggesting a local anti-inflammatory effect of isosorbide.
Assuntos
Perda do Osso Alveolar/prevenção & controle , Isossorbida/uso terapêutico , Doadores de Óxido Nítrico/uso terapêutico , Periodontite/prevenção & controle , Perda do Osso Alveolar/patologia , Processo Alveolar/efeitos dos fármacos , Processo Alveolar/patologia , Animais , Cemento Dentário/efeitos dos fármacos , Cemento Dentário/patologia , Dentina/efeitos dos fármacos , Dentina/patologia , Modelos Animais de Doenças , Gengiva/efeitos dos fármacos , Gengiva/patologia , Dente Molar/patologia , Ligamento Periodontal/efeitos dos fármacos , Ligamento Periodontal/patologia , Veículos Farmacêuticos , Ratos , Ratos WistarRESUMO
BACKGROUND: Despite improvements in small bowel transplantation (SBTx), early referral of patients with irreversible intestinal failure (IF) remains a major obstacle. In this study we evaluated the demand for SBTx among seven surgical pediatric centers located at least 200 km from our center. METHODS: From 1997 to 2001, 640 patients have been treated for neonatal diseases, including 248 who underwent a minor or major intestinal resection. Twenty-four patients with major resections presented with short gut syndrome, requiring total parenteral nutrition (TPN). The greatest demand was in postsurgical neonates with necrotizing enterocolitis, gastroschiesis, onphalocoeles, or midgut volvulus, and in three adults with postradiotherapy arteritis (n = 2) and mesenteric vein thromboses (n = 1). The median length of residual bowel after resection was 20 to 30 cm, without an ileocecal valve. Four patients were referred for SBTx evaluation; three died while awaiting a donor; 20 were not referred, among whom 14 died of TPN complications. RESULTS: Approximately 62 children per year require nutritional support for IF, most of whom develop complications related to TPN. Because many patients who are TPN-dependent develop complications, we believe that early referral would reduce mortality. CONCLUSIONS: Greater medical awareness about the feasibility of SBTx procedures and earlier referral may improve results and quality of life after transplant.
Assuntos
Intestino Delgado/cirurgia , Síndrome do Intestino Curto/cirurgia , Demografia , Humanos , Nutrição Parenteral Total/efeitos adversos , Encaminhamento e Consulta , Síndrome do Intestino Curto/mortalidade , Síndrome do Intestino Curto/terapia , Análise de Sobrevida , Resultado do TratamentoRESUMO
La septoplastia es una de las intervenciones endonasales más frecuentemente practicada por los otorrinolaringólogos. La inspección directa de las cavidades nasales y los senos paranasales han sido durante mucho tiempo, un importante inconveniente para el diagnóstico y la erradicación detalladas de las alteraciones obstructivas del septum nasal, sobre todo aquellas de localización más confinada.Tradicionalmente la septoplastia ha sido practicada a través de los orificios nasales,con visión limitada, asistida por frontoluz y con maniobras y procedimientos practicados a ciegas.La limitación de una inspección detallada, trae como resultado que muchas alteraciones obstructivas nasales septales y extraseptales, puedan pasar inadvertidas. El diagnóstico preciso es clave para aplicar un tratamiento exitoso. Una cirugía conservadora con escisión mínima de los componentes esqueléticos septales, es lo más prudente y recomendado en la actualidad para tratar la patología del tabique nasal. La septoplastia con asistencia endoscópica o cirugía funcional endoscópica del septun nasal permite un mejor resultado postoperatorio, ya que es posible evaluar y erradicar o reparar menos cruenta, con escisión mínima de los componen-tes esqueléticos septales, las deformidades y desviaciones, bajo visón directa. En el presente estudio, se hace una revisión de los diversos factores (anatómicos, fisiopatológicos e histopatológicos) de los componentes del septum nasal, responsables de las alteraciones que éste puede sufrir y que deben ser considerados en razón de un manejo quirúrgico con resultados más satisfactorios Realizaremos un repaso de los factores biomecánicos de los componentes del septum nasal que explican que un septum nasal desviado persista en esa posición después de operado y finalmente nos referiremos a nuestra experiencia y seguimiento en 2.730 casos de patología septal obstructiva, operados por cirugía funcional endoscópica del septum nasal con abrader electromecánico
Assuntos
Septo Nasal , Procedimentos Cirúrgicos Operatórios/métodosRESUMO
Presently, the State of Ceará reports the largest percentage of human rabies cases originated from wild animals in Brazil, transmitted by the principal simian species, the tamarin (Callithrix jacchus), found in various locations throughout the State, but concentrated along the coast. Epidemiological studies indicated that possibly the same virus caused the deaths in humans and non-human primates. This rabies virus seem to be different from all other identified so far.
Assuntos
Doenças dos Macacos/virologia , Vírus da Raiva/classificação , Saguinus/virologia , Animais , Brasil , Humanos , Raiva/transmissão , Raiva/veterinária , Vírus da Raiva/isolamento & purificaçãoRESUMO
PURPOSE: Evaluation of the efficacy and tolerability of nifedipine oros in patients with mild to moderate essential hypertension without major target organ damage and the anti-hypertensive effect along the 24 hours. METHODS: Two hundred and three patients were studied. After two weeks placebo running period single dose of nifedipine oros (30 mg/day) was administered for 8 weeks. At the end of the 4th week, the non-responders (diastolic blood pressure > 90 mmHg or reduction in diastolic pressure < 10 mmHg), had the dosage increased to 60 mg/day. Laboratory tests and 24h blood pressure monitoring (60 patients) were performed at the beginning and at the end of the study. RESULTS: One hundred and ninety one patients completed the study. Fifty nine percent were considered responders at the end of the 4th week with nifedipine oros 30 mg/day and 41% needed dosage increment to 60 mg/day. At the end of the 8th week, all patients were considered responders to nifedipine oros. The blood pressure control extended throughout the 24h of the day. The most common adverse events were edema (14.6%) and headache (12.4%). Good and very good tolerability were informed by 85% of the patients. CONCLUSION: Nifedipine oros was able to control blood pressure efficaciously along the 24h period without important side effects. The possibility of once day dosage, increases the patient adherence to anti-hypertensive therapy.
Assuntos
Hipertensão/tratamento farmacológico , Nifedipino/uso terapêutico , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/efeitos dos fármacos , Monitorização Ambulatorial da Pressão Arterial , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: To evaluate clinical efficacy and tolerability of isradipine SRO (I.SRO), 5 mg O.D. in essential hypertensives. METHODS: Eighty-three of 87 selected outpatients with a mean age of 51.3 years (ranging from 25 to 65), 33 male, 48 white, 29 black and others of different races, who had clinical supine and orthostatic diastolic blood pressure (DBP) > or = 95 mmHg and < or = 115 mmHg underwent the study. After a three-week wash-out period, patients received I.SRO 5 mg O.D. at 8:00 am for a six-week period (phase I). After this phase, patients received I.SRO 5 mg O.D. at 8:00 pm for a six-week period (phase II). The patients had a follow-up with an interval of three weeks and the ambulatorial blood pressure monitoring (ABPM) for 24 hours was performed with a SpaceLabs 90207 or Del Mar Avionics devices after the wash-out period and at the end of phases I and II. Measurements were performed at 15-min intervals during the day (6 am to 10 pm) and at 30-min intervals during the night (10 pm to 6 am). RESULTS: a) Heart rate did not show significant changes during the treatment period (phases I and II) when compared with the wash-out period; b) causal blood pressure: at the end of both treatment periods (phases I and II) there were statistically significant decreases (p < 0.001) in supine SBP and DBP compared with wash-out values. The mean SBP decreased from 161.6 +/- 14 to 144.3 +/- 13 mmHg (phase I) and to 141.8 +/- 13 mmHg (phase II). The mean DBP decreased from 103.4 +/- 6 to 91.2 +/- 7 (phase I) and to 89.1 +/- 8 (phase II); c) ABPM: the mean systolic 24-h ambulatory blood pressure was significantly reduced (p < 0.001) from 148.8 +/- 17 to 137.2 +/- 15 mmHg (phase I) and to 133.4 +/- 13 mmHg (phase II). The mean diastolic 24-h ambulatory blood pressure was significantly decreased (p < 0.001) from 94.3 +/- 9 to 87.0 +/- 9 (phase I) and to 85.8 +/- 8 mmHg (phase II). The mean daytime and nighttime, systolic and diastolic 24-h ambulatory blood pressure were: wash-out--152.3 +/- 17, 140.2 +/- 21, 97.4 +/- 9, 86.8 +/- 13; phase I--139.9 +/- 15, 130.0 +/- 17, 89.3 +/- 9, 81.3 +/- 10; phase II--136.7 +/- 13, 125.3 +/- 15, 88.5 +/- 8, 79.1 +/- 10, respectively. Blood pressure load (percentage of systolic blood pressure values > 140 mmHg or of diastolic blood pressure values > 90 mmHg) was significantly reduced from 62.2/62% (SBP/DBP), on the was-out, to 37.9/39.9% (SBP/DBP) on phase I and to 32.3/34.3% (SBP/DBP) on phase II; d) side effects: most frequently related were palpitations (2.3%), headache (1.1%), flush (1%) and ankle oedema (1%). They were in general, mild-to-moderate and disappeared after the first 3 weeks of treatment. Only two patients were withdrawn because of headache (one of them with previous diagnosis of migraine). CONCLUSION: I.SRO, given by oral route, in the dosage of 5 mg O.D. as monotherapy, was effective and well tolerated, promoted significant reduction on 24-h ambulatory blood pressure attenuating the early morning rise and did not interfere with the circadian rhythm of blood pressure. No significant differences were detected in the BP lowering effect when I.SRO was given during the morning or evening. These results may indicate that the drug is as suitable as one of the first choice for treating mild and moderate hypertensive patients.
Assuntos
Hipertensão/tratamento farmacológico , Isradipino/administração & dosagem , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Monitorização FisiológicaRESUMO
The present report describes the karyotypic findings in cells from a Wilms' tumor. The most consistent cytogenetic abnormalities detected consisted of translocations involving break and fusion of chromosomal telomeres and telomeric associations frequently affecting the terminus of the short arms of chromosomes 14 and 17.
Assuntos
Aberrações Cromossômicas , Neoplasias Renais/genética , Telômero/ultraestrutura , Translocação Genética , Tumor de Wilms/genética , Pré-Escolar , Bandeamento Cromossômico , Cromossomos Humanos Par 14 , Cromossomos Humanos Par 17 , Humanos , Cariotipagem , Neoplasias Renais/patologia , Masculino , Tumor de Wilms/patologiaRESUMO
PURPOSE: To evaluate during 12 weeks the effectiveness and safety of once-a-day fosinopril (10 or 20 mg/day comparative to placebo) in mild to moderate hypertensives according to an open design comparative to placebo. METHODS: One hundred and nineteen patients were studied; 52 +/- 11 years (mean +/- sd) range 18 a 76 years, 86 women and 33 men, 57% whites, 26% blacks and 17% mulattos, 71 mild hypertensives (95 < or = diastolic pressure < or = 104mmHg) e 48 moderate hypertensives (101 < diastolic pressure < or = 115mmHg). RESULTS: There was a significant reduction in systolic/diastolic pressure on the 6th week of treatment (from 161 +/- 16/103 +/- 7 before to 148 +/- 16/94 +/- 9mmHg on the 6th week). On the 12th week of treatment there was an additional significant reduction in systolic/diastolic pressure (from 148 +/- 16/94 +/- 9 on the 6th week to 145 +/- 17/89 +/- 8mmHg on the 12th week). There was a "favorable" response in 71% of the patients on the 12th week; 62% showed diastolic pressure < or = 90mmHg and 9% presented diastolic reduction > or = 10mmHg. There was no difference in the normalization rates between whites and non-whites, mild and moderate hypertensive, obese and non-obese patients, under or above 50 years of age and those patients from no drug-treatment to those on 3 drug before the study. There was no clinically relevant changes in laboratory evaluations before and at the end of the study. The number of adverse reactions was reduced in comparison with previous treatment. CONCLUSION: Fosinopril, according to our and others data, is effective and safe for the treatment of mild to moderate hypertensives, in whites or non-whites, obese or non-obese, younger or older than 50 years and receiving 0 or 3 drugs before the study.