RESUMO
This study investigated the value of oxygen (O(2)) pulse curves obtained during cardiopulmonary exercise testing (CPET) for the diagnosis of coronary artery disease (CAD). Forty patients with known coronary anatomy (35.0 % normal, 27.0 % single-vessel and 38.0 % multivessel CAD) underwent CPET with radiotracer injection at peak exercise, followed by myocardial scintigraphy. O(2) pulse curves were classified as: A-normal, B-probably normal (normal slope with low peak value); C-probably abnormal (flat, with low peak value); or D-definitely abnormal (descending slope). Sensitivity, specificity, positive and negative predictive values of the O(2) pulse curve pattern (A or B vs. C or D) for the diagnosis of CAD were, respectively, 38.5 %, 81.3 %, 76.9 %, and 44.8 %. The concordance rate between the abnormal O(2) pulse curve pattern and ischemia in myocardial scintigraphy was 38.1 %. Age and the extent of scintigraphic perfusion defect, but not the abnormal O(2) pulse curve patterns (B or C or both combined) were independently associated with CAD. In conclusion, the O(2) pulse curve pattern has low diagnostic performance for the diagnosis of obstructive CAD, and the abnormal curve pattern was not associated with myocardial ischemia defined by scintigraphy.
Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/metabolismo , Teste de Esforço/métodos , Imagem de Perfusão do Miocárdio/métodos , Consumo de Oxigênio/fisiologia , Idoso , Doença da Artéria Coronariana/fisiopatologia , Teste de Esforço/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio/normasRESUMO
Emerging evidence suggests a role for purinergic signaling in the activation of multiprotein intracellular complexes called inflammasomes, which control the release of potent inflammatory cytokines, such as interleukin (IL) -1ß and -18. Porphyromonas gingivalis is intimately associated with periodontitis and is currently considered one of the pathogens that can subvert the immune system by limiting the activation of the NLRP3 inflammasome. We recently showed that P. gingivalis can dampen eATP-induced IL-1ß secretion by means of its fimbriae in a purinergic P2X7 receptor-dependent manner. Here, we further explore the role of this purinergic receptor during eATP-induced IL-1ß processing and secretion by P. gingivalis-infected macrophages. We found that NLRP3 was necessary for eATP-induced IL-1ß secretion as well as for caspase 1 activation irrespective of P. gingivalis fimbriae. Additionally, although the secretion of IL-1ß from P. gingivalis-infected macrophages was dependent on NLRP3, its adaptor protein ASC, or caspase 1, the cleavage of intracellular pro-IL-1ß to the mature form was found to occur independently of NLRP3, its adaptor protein ASC, or caspase 1. Our in vitro findings revealed that P2X7 receptor has a dual role, being critical not only for eATP-induced IL-1ß secretion but also for intracellular pro-IL-1ß processing. These results were relevant in vivo since P2X7 receptor expression was upregulated in a P. gingivalis oral infection model, and reduced IFN-γ and IL-17 were detected in draining lymph node cells from P2rx7(-/-) mice. Furthermore, we demonstrated that P2X7 receptor and NLRP3 transcription were modulated in human chronic periodontitis. Overall, we conclude that the P2X7 receptor has a role in periodontal immunopathogenesis and suggest that targeting of the P2X7/NLRP3 pathway should be considered in future therapeutic interventions in periodontitis.
Assuntos
Infecções por Bacteroidaceae/metabolismo , Porphyromonas gingivalis/patogenicidade , Receptores Purinérgicos P2X7/fisiologia , Animais , Infecções por Bacteroidaceae/microbiologia , Proteínas de Transporte/fisiologia , Caspase 1/metabolismo , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Proteína 3 que Contém Domínio de Pirina da Família NLR , Fator de Necrose Tumoral alfa/metabolismoRESUMO
OBJECTIVES: This study aims to identify birth weight variation according to maternal characteristics and gestational weight gain. METHODS: It is a cross-sectional descriptive study with 433 puerperal women (> or = 20 years old) who attended a public maternity hospital in Rio de Janeiro. The data were collected through interviews with the women and access to their medical records. Several models were tested using linear regression, using the stepwise method to identify the predictive variables of birth weight. RESULTS: The mean maternal age and gestational age at the end of pregnancy were 27 years old (+/- 5.09 years) and 39 weeks (+ 1.68 weeks), respectively. The data shows that the mean number of prenatal and nutritional prenatal care appointments were 8.24 (+/- 2.98) and 2.26 (+/- 2.33), respectively. Among the predictor variables of birth weight, total gestational weight gain (beta = 25.29; p = 0.000), pre-gestational BMI (beta =13.02; p = 0.037), and the number of pre-natal care appointments (beta = 28.21; p = 0.007) were highlighted. The association of weight gain in the three trimesters was also verified. CONCLUSIONS: This study confirms the interface between adequacy of the pre-gestational and gestational nutritional status and some maternal characteristics with birth weight. Nutritional care should be recognised as part of the actions during pre-natal assistance.
Assuntos
Peso ao Nascer , Aumento de Peso , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Recém-Nascido , GravidezRESUMO
The use of the latex of Euphorbia splendens var. hislopii was considered as an effective control method for Biomphalaria glabrata in Sumidouro, Rio de Janeiro. However, the appearance and expansion of the snail Melanoides tuberculata since August 1997, with the concomitant reduction of the population of B. glabrata suggest that competitive exclusion might be taking place. Depending on the susceptibility of the thiarid to the E. splendens toxin, the natural control that is occurring could be interrupted by the employment of the latex if the planorbid were less susceptible to the toxin. The aim of this study is to investigate the molluscicidal activity of the latex on M. tuberculata. We used 420 M. tuberculata, from Sumidouro. Fourteen different latex concentrations were tested using World Health Organization general methodology. Probit analysis was used for LD90 and LD50 determination. The LD50 was 3.57 mg/l and LD90 was 6.22 mg/l. At the highest concentration (10 mg/l) there was no survival. No significant differences among replicas (chi2 = 8.31; gl = 13; p > 0.05) were found. The LD90 dose for M. tuberculata was 13.8 times greater than that for B. glabrata, so that the molluscicide in the presence of the thiarid may have a synergic effect on reduction of Biomphalaria populations.
Assuntos
Látex/farmacologia , Caramujos/fisiologia , Animais , Fenômenos Biológicos , Biomphalaria/efeitos dos fármacos , Biomphalaria/fisiologia , Controle de Insetos/métodos , Extratos Vegetais/farmacologia , Esquistossomose/prevenção & controleRESUMO
Candida parapsilosis is an increasingly important bloodstream pathogen in neonatal intensive care units (NICU). We investigated a cluster of bloodstream infections in a NICU to determine whether nosocomial transmission occurred. During a 3-day period, 3 premature infants hospitalized in the same unit presented with sepsis caused by C. parapsilosis. Electrophoretic karyotype of the organisms was performed by using pulsed field gel electrophoresis in a countour-clamped homogeneous electric field system. The isolate from 1 newborn could not be typed, and the isolates from the remaining 2 infants had identical patterns. All 3 cases are described. We conclude that nosocomial transmission of C. parapsilosis occurred and that neonates under intensive care may represent a risk group for this pathogen.
Assuntos
Candida/classificação , Candidíase/microbiologia , Infecção Hospitalar/microbiologia , Fungemia/microbiologia , Doenças do Prematuro/microbiologia , Unidades de Terapia Intensiva Neonatal , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Candida/genética , Candidíase/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Doenças em Gêmeos/etiologia , Eletroforese em Gel de Campo Pulsado , Fungemia/tratamento farmacológico , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/tratamento farmacológico , Cariotipagem , Fatores de RiscoRESUMO
Determination of Cu, Pb, Cd and Zn was performed in sediment extracts obtained according to the three steps sequential extraction procedure proposed by the European Community Standards, Measurements and Testing Program. The metal content was determined by anodic stripping voltammetry with a thin mercury film electrode controlled by a sequential injection (SIA) system. The proposed method improved the reproducibility of conventional anodic stripping voltammetry, as well as the sample throughput, allowing analysis of 30 to 45 samples per hour. The influence of flow rate and sample volume was studied to achieve an adequate sensitivity for the leachate studied. No interferences due to adsorption of organic matter, colloids, or complexes with slow rate of dissociation were observed. The intermetallic formation of Cu-Zn was avoided by forming the mercury film in presence of Ga(III) ions in the SIA system, resulting in low consumption of reagent in comparison to flow injection or continuous flow systems. Results were in good agreement with those obtained by Induced Coupled Plasma - Atomic Emission Spectroscopy (ICP-AES).
Assuntos
Água Doce/análise , Sedimentos Geológicos/análise , Metais Pesados/análise , Brasil , Cádmio/análise , Cobre/análise , Eletroquímica/métodos , Eletroquímica/normas , Eletrodos Seletivos de Íons/normas , Chumbo/análise , Padrões de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Urbanização , Poluentes Químicos da Água/análise , Abastecimento de Água/análise , Zinco/análiseAssuntos
Hepatite B/epidemiologia , Hospitais , Resíduos de Serviços de Saúde , Ocupações , Brasil/epidemiologia , Estudos Transversais , Hepatite B/transmissão , Antígenos do Núcleo do Vírus da Hepatite B/isolamento & purificação , Antígenos de Superfície da Hepatite B/isolamento & purificação , Humanos , Prevalência , Saneamento , População UrbanaRESUMO
Starting with a brief contextual analysis of the social scenario in which the AIDS epidemic is occurring in Brazil, the article focuses on the formation of the country's first nongovernmental organizations in the struggle against AIDS. There are peculiarities to AIDS NGOs to the extent that they display an ambivalence between the characteristics of a professional institution and a lobbying group, apart from the fact that dealing with sexuality and death breaks down the line between the public and the private spheres. The case in point is the Grupo Pela Vidda (For Life Group) in Rio de Janeiro, which seeks to represent the enhancement of a group of individuals and the principle of universality. The study supports the hypothesis that AIDS NGOs renew ties of social solidarity through the relationships established between various researchers involved in this sector and other NGOs with governmental spheres.
Assuntos
Síndrome da Imunodeficiência Adquirida/prevenção & controle , Apoio Social , Instituições Filantrópicas de Saúde , Síndrome da Imunodeficiência Adquirida/epidemiologia , Brasil/epidemiologia , Participação da Comunidade , Democracia , Surtos de Doenças/prevenção & controle , Homossexualidade Masculina , Humanos , Masculino , SociologiaRESUMO
The human immunodeficiency virus (HIV) type 1 is the retrovirus which is responsible for the human immunodeficiency syndrome (AIDS) described in infancy in 1983. It is the most serious disorder caused by HIV, by a neurotropic virus, and is particularly severe in infancy. In children infected by vertical transmission of HIV, there is a shorter clinical latent period than in adults, and more viraemia than in children over the age of three months infected by blood transfusion. The neurological disorder caused by HIV is a complex clinical syndrome in which there may be varying degrees of retardation of cognition, movement or behaviour. A growing number of HIV+ children are being followed-up in the Hospital de Clinicas de Porto Alegre (HCPA) to treat the neuropsychomotor development and the presence of neurological behaviour in these children. The neurological, analytical (laboratory), electro-encephalographic and tomographic changes seen in a sample of 344 HIV+ children were studied. Analysis of these results showed a significant difference between affected and non-affected children. Encephalopathy occurred in 36% of the cases, being progressive in 29% and static in 17%. There was a relationship between neurological involvement at the first consultation and progress to encephalopathy. The RDNPM showed a tendency towards encephalopathy, usually between 1 and 5 years of age, which might also be the first sign of the disease. We found a significant relationship between being infected and having alterations not seen in cerebrospinal fluid, EEG, TCC and neurological progress.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Encefalopatias/etiologia , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/transmissão , Antivirais/uso terapêutico , Western Blotting , Encefalopatias/diagnóstico , Eletroencefalografia , Ensaio de Imunoadsorção Enzimática , Humanos , Imunoglobulina A , Imunoglobulina G , Imunoglobulina M , Lactente , Transmissão Vertical de Doenças Infecciosas , Reação em Cadeia da Polimerase , Tomografia Computadorizada por Raios XRESUMO
A group of 10 patients, nine of them seriously infected with Paracoccidioides brasiliensis (G1), received glucan (beta-1,3 polyglucose) as an immunostimulant intravenously once a week for one month, followed by monthly doses (10 mg) over an 11-month period, together with a specific anti-fungal agent as an immunostimulant. A second group of eight moderately infected patients (G2) was treated with only the anti-fungal agent. Among the patients in G1, there was only one case of relapse compared with five in G2. Values for the erythrocyte sedimentation rate (ESR) showed a significant difference (P < 0.001) post-treatment in G1 patients, when compared with the pretreatment levels. There was also a significant reduction (P < 0.001) in the level of serum antibodies to P. brasiliensis in the G1 patients in post-treatment examinations. The phytohemagglutinin (PHA) skin test showed a positive reaction among the patients in G1 (P < 0.01) post-treatment and there was a tendency towards an increase in the number of CD4+ T lymphocytes in both groups after treatment. The serum level of tumor necrosis factor (TNF) proved to be significantly higher (P < 0.02) in the G1 patients during treatment. In the G1 patients, the correlation between ESR and TNF tended to be negative whereas that between ESR and serum antibodies was positive. The present results indicate that the patients who received glucan, in spite of being more seriously ill, had a stronger and more favorable response to therapy.
Assuntos
Adjuvantes Imunológicos/uso terapêutico , Glucanos/uso terapêutico , Imunização , Paracoccidioidomicose/tratamento farmacológico , Paracoccidioidomicose/imunologia , beta-Glucanas , Adjuvantes Imunológicos/administração & dosagem , Adolescente , Adulto , Idoso , Anfotericina B/uso terapêutico , Anti-Infecciosos/uso terapêutico , Anticorpos Antifúngicos/análise , Antifúngicos/uso terapêutico , Sedimentação Sanguínea , Complexo CD3/análise , Antígenos CD4/análise , Contagem de Linfócito CD4 , Relação CD4-CD8 , Antígenos CD8/análise , Quimioterapia Combinada , Glucanos/administração & dosagem , Humanos , Cetoconazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Paracoccidioides/imunologia , Paracoccidioidomicose/sangue , Fito-Hemaglutininas/imunologia , Testes Cutâneos , Sulfadiazina/uso terapêutico , Sulfanilamidas/uso terapêutico , Subpopulações de Linfócitos T/imunologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Fator de Necrose Tumoral alfa/análiseRESUMO
The risk of schistosomiasis infection and heavy infection in the locality of Sabugo was evaluated in relation to housing in areas with different urbanization development and to residential supply with snail-infested water. Critical sanitary conditions were found in areas of incomplete urbanization, where healthy water supply sources were scarce, and draining of sewage, without previous treatment, was made directly to the water-bodies used for domestic and leisure activities, despite being Biomphalaria tenagophila snail breeding-places. Stool examinations (Kato-Katz and Lutz methods) showed prevalence of 2.9% mean intensity of 79 eggs per gram of stool and 47% of positive cases presenting intense infection. The use of snail-contaminated water for domestic purposes was considered a risk factor for infection. It is concluded that incomplete urbanization would facilitate transmission, probably enhancing the intensity of infection and that a low prevalence could hide a highly focal transmission. The relevance of these facts upon the efficiency of epidemiologic study methods and disease control planning are then discussed.
Assuntos
Esquistossomose/epidemiologia , Urbanização , Animais , Brasil/epidemiologia , Humanos , Contagem de Ovos de Parasitas , Prevalência , Fatores de Risco , Saneamento , Esquistossomose/transmissão , Fatores SocioeconômicosRESUMO
The pandemic expansion of AIDS demands that all health care staff and institutions are prepared to diagnose and control this disease. The HIV virus destroys the immune response and causes a series of other organ and system dysfunctions, leading to diverse clinical manifestations. This article reviews the pathophysiology, clinical manifestations, diagnosis, treatment and prevention of HIV infection. The role of the health care worker as an educator is also reviewed.
RESUMO
The authors observed specimens of Biomphalaria glabrata climbing up the vertical wall of a ditch against the current. The snails that showed this behavior during application of a molluscicide in the breeding site survived and probably played a role in repopulation, which was observed three months later. These observations motivated field and laboratory investigations which led the authors to conclude that: a) this species is able to climb vertical surfaces both in field and laboratory situations; b) the current of water, as a physical stimulus, is sufficient to trigger this behavior (rheotaxis); c) rheotaxis on vertical surfaces depends on the presence of a necessarily moderate current; d) there are indications that B. glabrata may undergo habituation with respect to rheotaxis on vertical walls; e) the relationship between rheotaxis and habituation should be considered as a factor causing snail grouping in water bodies which may contribute to their localization in the field; f) rheotaxis on vertical surfaces may facilitate population dispersal, and its occurrence should be considered when campaigns for the control of schistosomiasis transmission are planned. The authors present some proposals to avoid the manifestation of this behavior in some field situations.