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La lepra es una enfermedad infecto-contagiosa crónica, no hereditaria, curable y controlable, causada por el Mycobacterium leprae, que afecta principalmente la piel, mucosas y nervios periféricos. En Argentina es un problema regional y nacional, por la migración que abarca a las provincias de Formosa, Chaco, Corrientes, Entre Ríos, Misiones, Santa Fe y Buenos Aires. Objetivo General: determinar el comportamiento clínico-epidemiológico de la lepra en la Provincia de Santa Fe, desde el 1º de Enero del año 2012 al 31 de Agosto del año 2016. Métodos y Materiales: la información se obtuvo de la revisión de las fichas epidemiológicas, de pacientes con diagnóstico de lepra en el período abarcado. Las variables utilizadas fueron: edad y sexo del paciente, residencia, foco epidemiológico, condiciones ambientales y económicas, clínica, tipo de lepra, grado de discapacidad general y tratamiento. Resultados: se diagnosticaron 86 casos de lepra; 59,3% correspondieron al sexo masculino y 40, 7% al sexo femenino. El promedio de edad fue de 56 años. El 86% de los casos fueron multibacilares y la lepra lepromatosa, fue la forma clínica más frecuente. El 26,7% presentó discapacidad al momento del diagnóstico, 16,3% grado 1 y 10,5% grado 2. Conclusión: la detección de nuevos casos en la Provincia de Santa Fe, fue en promedio de 18 casos anuales, excluido el año 2016, en vigencia. Rosario fue el departamento con más casos registrados. El 60% de los casos se comunicó entre los 35 y 66 años; el sexo masculino fue el más afectado. Los casos multibacilares prevalecieron sobre los paucibacilares; la forma clínica más frecuente fue la lepra lepromatosa. Se estableció discapacidad en uno de cada cuatro pacientes.

Leprosy is a chronic disease which, despite having a variable clinic, is diagnosable and treatable when receiving a multidrug therapy (MDT) as the one proposed by the World Health Organization (WHO). In Argentina, it is characterized by moderate endemicity and focus on certain geographic areas (provinces of northeastern, northwest and center of Argentina). General Objective: determine the clinical and epidemiological behavior of leprosy in the province of Santa Fe. Methods and Materials: the cases reported since 1º January 2012 to 31 August 2016, were retrospectively collected from the review of the epidemiological records of the Ministry of Health, Environment and Social Action of the Province of Santa Fe. The variables were: age and sex of the patient, residence, epidemiological focus, environmental and economic conditions, kind of leprosy, degree of disability and finally the treatment. Results: 86 cases of leprosy were diagnosed: 59,3% were male and 40,7% sex, were female. The average age was 56 years. 86% of cases were multibacillary and lepromatous leprosy was the most frequent clinical form. The 26,7% had disability at the moment of diagnosis, 16,3% 10,5% grade 1 and grade 2. Conclusion: in the Province of Santa Fe, the detection of new leprosy cases have been stable in the last years, with a minimun of 17 and a maximum of 29 cases per year. Rosario was the city with more registered cases, followed by: La capital, General Obligado y Nueve de Julio. The most affected patients were male, and 60% of cases reported between 35 and 66 years. Multibacillary cases prevailed over paucibacillary; the most frequent clinical form was lepromatous leprosy. One in four patients had disability at the moment of diagnosis.

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BACKGROUND: Comorbidities are common in COPD and have been associated with reduced health status, increased health care utilization, all-cause hospitalization, and mortality. There is a scarcity of data on the relationship between comorbidities and functional capacity. OBJECTIVE: to evaluate the impact of comorbidities on functional capacity of COPD patients. METHODS: a cross-sectional study was conducted at two teaching hospitals in Fortaleza, Brazil. The functional capacity was assessed by spirometry and the 6-min walking test (6MWT). The health status was assessed by the St. George's respiratory questionnaire (SGRQ) and the COPD assessment test (CAT). The sample was stratified as having "none", "one" and "two or three" comorbidities groups. One-way ANOVA was used to compare means of the three groups and a multiple linear regression was run to predict the impact of comorbidities on 6MWT. RESULTS: Comorbidities (hypertension, coronary disease and diabetes) were found in 54% of the studied patients. The mean age of the 79 patients was 67±8 years and 55% were male. CAT scores increased from "no comorbidity" (17.9±7.7) to "one comorbidity" (22.8±6.8) and "two or three comorbidities" groups (24.2±10.2). A post hoc test showed a significant difference in the "no comorbidity" compared to the "two or three comorbidities" groups (p=0.01). The distance walked by the patients decreased from "no comorbidity" (386.1±83.2m) to "one comorbidity" (350±98m) and "two or three comorbidities" groups (312.6±91m). A post hoc test showed significant difference in the "no comorbidity" compared to "two or three comorbidities" groups (p=0.007). Numbers of comorbidities were independently associated with the 6MWT adjusting for age, severity of COPD and CAT scores. CONCLUSION: in the studied sample, the presence of comorbidities contributed to impair exercise capacity in patients with COPD.

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The aim of this double-blind study was to assess the efficacy and tolerability of propinox administered i.v. and to establish a dose-response relationship according to three dose levels (10 mg, 20 mg and 30 mg), vs. placebo in patients with moderate-to-severe acute intestinal colic pain. Four hundred patients (100 per treatment group) were included and allocated to the following treatment groups: propinox 10 mg, 20 mg, 30 mg and placebo. All treatments induced significant and progressive pain reduction as from the 20 min evaluation of 20.3% in the placebo group, 45% in the group treated with propinox 10 mg; 52% in the group receiving propinox 20 mg and 56% in the propinox 30 mg group. Statistical comparison showed differences between placebo and the three active doses as well as between propinox 10 mg and the 20 mg and 30 mg doses. The 20 min evaluation revealed that 40% of patients receiving placebo had to be excluded from the study due to lack of efficacy; the percentage of which was significantly higher compared with those observed with the three doses of propinox ranging between 10% and 13%. The 120 min evaluation revealed that 47.7% of patients treated with propinox 10 mg were free from pain vs. 68.8% and 73.5% of those receiving 20 mg and 30 mg, respectively. These percentages were considerably higher than the 15% found with placebo. Statistical analysis revealed significant differences between the 10 mg vs. the 20 mg and 30 mg groups with not differences between the latter doses. No differences in blood pressure or heart rate were found among treatments. The incidence of mouth dryness was significantly more frequent with the 20 mg and 30 mg doses of propinox than with the placebo or the 10 mg dose.

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The aim of this study was to assess the efficacy and tolerance of propinox administered i.v., and establish a dose-response relation according to three dose levels (10, 20 and 30 mg), vs. placebo in patients with moderate to severe acute biliary pain. Three hundred and fifty patients were included: 85 received placebo treatment, 81 were treated with propinox 10 mg, 91 with propinox 20 mg and 93 received propinox 30 mg. Spontaneous pain intensity was assessed according to a visual analog and a verbal scale before treatment and 20, 60 and 120 min after. All treatments induced significant and progressive pain reduction at all controls, but patients treated with 20 and 30 mg of propinox showed significantly lower pain intensity after 120 min compared to the placebo group. The last control revealed that 28% of patients receiving placebo had no pain while 60% of patients treated with propinox 30 mg reported absence of pain with a statistically significant difference (p < 0.001). All treatments were very well tolerated and there were no dropouts due to adverse events. Mouth dryness was the adverse effect occurring with a significantly higher frequency than that observed with placebo although it was only seen in patients treated with 20 mg and 30 mg active doses. The results of this study showed that propinox was an effective drug in the treatment of moderate to severe colic pain of biliary origin. Concerning efficacy and side effects, a clear dose-response relation was observed; the 20 mg and 30 mg doses being significantly superior to placebo.

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Objetivos. El decúbito lateral, la toracotomía y la ventilación selectiva unipulmonar producen graves alteraciones de la oxigenación. El objeto del estudio es examinar la utilidad de la monitorizaciónc continua de la saturación venosa mixta (SvO2) en condiciones especiales. Pacientes y Método. A 23 pacientes programados para reseción pulmonar mediante toracotomía en posición de cúbito lateral con ventilación unipulmonar, se les monitorizó continuamente la SvO2 mediante un sistema de oximetría de reflexión y un catéter de arteria pulmonar de fibra óptica (Abbott Oximetris 3). Se obtuvieron perfiles cardiorespiratoriosa los 15 min. de la inducción (M1), 15 min del decúbito lateral (M2), 5 min de la pleurotomía (M3), a los 5 min (M4) y 20 min (M5) del colapso pulmonar, 5 min del cierre de la pared torácica (M6) y 5 min del decúbito supino (M7). La SVO2 desciende de manera no estadísticamente signoficativa y alcanza su valor mínimo en M5, experimentando un ascenso significativo en M6 (p<0.05). Se encuentra una correlación significativa en todas la mediciones entre los valores de la SVO2 medicos con Oximetrix3 y cooxímetro. Con las C(a-v)O2 y EO2 existe correlación significativa en todas las mediciones con la PV=2 y Qva/Qt, excepto en la M6. el IVO2 presenta correlación inversa de M1 a M5 y el IC directa sólo emn M6 y M7, como el IDO2. Con la PaO2 y SaO2 hay correlación significativa durante la ventilación pulmonar (M4 y M5) y posteriormente M6. Los cambios combinados en la SaO2 el IC sólo explican los cambios en la SVO2 durante la ventilación selectiva y después de ésta y más probable que reflejan cambios en la SAO2 que en la IC. Conclusiones. En las condiciones del estudio, la monitorización continua con SVO2 es un método fiable que indica primariamente la oxigenación y secundariamente el GC, en especial durante la ventilación unipulmonar, y refleja el balance aporte/demanda de oxígeno de los tejidos perfundidos. Pero dada su falta de especificidad, ante un descenso brusco de sus valores, se realizarán determinaciones hemodinámicas y gasimétricas para diagnosticar la causa de la alteración de dicho balance aporte/demanda

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This work was performed to study the release of proopiomelanocortin (POMC)-derived peptides from isolated pancreatic islets and the effect of ACTH--a member of that peptide family--on insulin secretion. Islets were incubated with 3,3 and 16.6 mM glucose and insulin and ACTH-like products (ACTH-LP) were measured by radioimmunoassay. Glucose stimulated the simultaneous release of insulin and ACTH-LP, the ACTH-LP concentration being higher when assayed with an antibody reacting with the N-terminus of ACTH. However, the increment in this release in the presence of the higher glucose concentration was larger when measured with an antibody against the ACTH mid-portion. Thus, although the islets would release more of a smaller ACTH-LP, 16.6 mM glucose would selectively increase the release of peptides of larger molecular size. Islets incubated with different concentrations of synthetic ACTH (50-500 pg/ml) increased the release of insulin in a dose-dependent manner. These results suggest that the release of endogenous ACTH-LP could contribute to the paracrine regulation of insulin secretion.

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A mucoepidermoid carcinoma of the lung (ICD classification 8430/3) resected from a patient with no clinical signs of pituitary-adrenal alterations was transplanted into 2-month-old athymic nu/nu nude mice, with the purpose of studying the effects exerted by the human tumour on the host hypothalamo-pituitary-adrenal axis. The tumour produces peptides derived from different regions of pro-opiomelanocortin (POMC: ACTH, 7.6 +/- 0.7; N-terminal POMC, 6.6 +/- 0.6; beta-LPH/endorphin, 7.3 +/- 0.7; and alpha-MSH;3.8 +/- 0.5 pmol/g wet tissue) and the neuropeptides corticotrophin-releasing hormone and arginine vasopressin (CRH: 3.6 +/- 0.4 and AVP: 1.1 +/- 0.2 pmol/g wet tissue). Immunohistochemical staining of consecutive sections of the tumour indicated that staining of tumour cells for the different peptides was not uniform and although some cells co-stained with CRH and AVP, POMC-positive cells appeared to be distinct from CRH and AVP cells. Tumour extracts were chromatographed on Sephadex G-75 and fractions monitored for POMC-derived peptides. A single peak with characteristics of alpha-MSH was detected. The ACTH, N-POMC and beta-LPH/endorphin radioimmunoassays (RIA) detected a peak at large molecular weight, eluting at the position expected for POMC. These RIA systems also revealed an ACTH(1-39) peak and another peak which probably correspond to 13 kDa ACTH, a peak eluting at the position of hN-POMC(1-48), a beta-LPH-like peak, and a smaller sized peak which may represent alpha- or gamma-endorphin. The ACTH, N-POMC and beta-LPH/endorphin contents of anterior lobe (AL) extracts, but not neutrointermediate lobe (NIL) extracts, showed a striking decrease in tumour-bearing (TB) nude mice. However, while no difference was seen in the alpha-MSH content of AL extract between TB and control (C) nude mice, it decreased in NIL extracts of TB animals. The contents of CRH and AVP in stalk-median eminence extracts of TB nude mice was significantly lower than that of C nude mice. Basal plasma corticosteroids were raised in TB nude mice at levels comparable to those in stressed C nude mice, and although adrenal weights did not vary between TB and C nude mice, morphological changes indicating hypertrophy were found in the adrenal glands of the host animals. It was concluded that the tumour dramatically alters the hypothalamo-pituitary-adrenal axis of the host, and that it may be a useful model for studying tumour-host interactions in ectopic hormone-producing tumours.

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In order to investigate the production and secretion of hypothalamic factors by the prolactin and proopiomelanocortin (POMC)-derived, peptide-producing, transplantable rat pituitary tumor 7315a, we determined the concentrations of corticotropin-releasing factor (CRF)- and vasopressin (AVP)-like immunoreactivities (IR) in the tumor extracts [14.0 +/- 1.6 (SE) and 4.2 +/- 0.9 pmol/g, respectively] and incubation media (0.26 +/- 0.01 and 0.07 +/- 0.01 pmol/10(7) cells/h, respectively). Total peptide content correlated well with tumor weight. Moreover, there is a very good correlation between the CRF and AVP IR, but not as good between CRF or AVP IR and POMC peptide IR tumor contents. Tumor extracts were chromatographed on Sephadex G-75 and compared with chromatograms of stalk median eminence (SME) extracts from normal Buffalo rats. CRF IR in tumor chromatograms gave an unusual pattern of peaks. About 31% of the total CRF IR was eluted in the high molecular weight region. The major portion of CRF IR was located in a wide region of lower molecular weight. The AVP radioimmunoassay revealed a similar pattern of peaks in tumor and SME chromatograms. A propressophysin-like peak and a smaller peak coeluting with synthetic AVP were detected. Immunohistochemical staining of consecutive sections of the tumor indicated that AVP and CRF are often found in the same cell, but the CRF and AVP-producing cells are clearly distinct from the POMC peptide-producing cells.

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In order to investigate the role of N-terminal proopiomelanocortin (N-POMC) in adrenal regeneration after bilateral adrenal enucleation (hereafter referred to as enucleation) rats 13 days after enucleation were injected (200 microliters s.c. plus 200 microliters i.p.) at 08.00 and 20.00 h with normal rabbit serum (NRS), an ACTH antiserum or an N-POMC antiserum. On the next day the animals were injected with colchicine, killed and mitotic figures in adrenal histological sections counted. The same treatment was given to rats 20 days after enucleation. Only the N-POMC antiserum significantly diminished adrenal mitotic activity 14 and 21 days after enucleation (P less than 0.01 and 0.05 respectively) when compared with NRS-treated enucleated rats, whereas plasma corticosterone levels in rats 14 days after enucleation were significantly (P less than 0.005) decreased only by treatment with ACTH antiserum. To determine whether the mitogenic N-POMC peptides involved in adrenal regeneration originated from the pituitary intermediate lobe, 0.9% (w/v) NaCl or ergocryptine (10 mg/kg body weight) was administered s.c. twice daily to rats between 7 and 13 days after enucleation. On day 14, adrenal mitotic activity and plasma levels of ACTH and N-POMC were not significantly different between ergocryptine and saline-treated enucleated rats, whereas alpha-MSH levels in ergocryptine-treated enucleated rats were significantly (P less than 0.02) decreased. Increases in N-POMC content of the pituitary lobe accompanied those of ACTH in animals 7, 10, 14 and 21 days after enucleation (P less than 0.01 compared with sham-treatment). Anterior lobes from rats 10 days after enucleation or from adrenalectomized rats showed raised ACTH and N-POMC levels compared with sham-treated animals, whereas alpha-MSH content in the anterior lobe of enucleated rats was significantly (P less than 0.005) decreased. Adrenalectomized animals had raised (P less than 0.005) amounts of alpha-MSH compared with sham-treated animals. Plasma levels of ACTH and N-POMC were significantly (P less than 0.01) raised in rats 10 days after enucleation or in adrenalectomized rats compared with those in sham-treated animals, whereas alpha-MSH levels were raised (P less than 0.005) only in adrenalectomized rats. Sephadex G-75 chromatography of anterior lobe extracts obtained 10 days after surgery from sham-treated, enucleated and adrenalectomized rats was performed.(ABSTRACT TRUNCATED AT 400 WORDS)

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We have pursued with the characterization of ACTH secretagogues from the avian corticomelanotrophic (CM) cell, by testing the ACTH-releasing activity of various monoamines and related drugs, using an in vitro system which uses dispersed perfused duck pituitary cells. The substances used were: noradrenaline (NA), adrenaline (A), dopamine (DA), serotonin (5-HT), phenylephrine (Phe), and isoproterenol (IP). The responses obtained with the substances assayed were compared with those obtained with dilutions of duck median eminence extracts (DME). The order of "intrinsic activities" was: NA = A greater than Phe greater than IP greater than DA = 5-HT. The substances were tested within the range 10(-9)-10(-4) M. All substances tested behaved as partial agonists with respect to DME. The "intrinsic activity" (Vmax) of the most potent agonists tested, A and NA, was 0.66 of that obtained with DME. It is concluded that in the duck, the CM cells secrete ACTH in response to A and NA (and other pharmacological substances) at doses which are compatible with a physiological role of those catecholamines acting directly upon the CM cell of the avian adenohypophysis. 5-HT and DA behaved as very weak agonists in stimulating ACTH release from duck CM cells in the system employed.

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We have pursued with the characterization of ACTH secretagogues from the avian corticomelanotrophic (CM) cell, by testing the ACTH-releasing activity of various monoamines and related drugs, using an in vitro system which uses dispersed perfused duck pituitary cells. The substances used were: noradrenaline (NA), adrenaline (A), dopamine (DA), serotonin (5-HT), phenylephrine (Phe), and isoproterenol (IP). The responses obtained with the substances assayed were compared with those obtained with dilutions of duck median eminence extracts (DME). The order of [quot ]intrinsic activities[quot ] was: NA = A greater than Phe greater than IP greater than DA = 5-HT. The substances were tested within the range 10(-9)-10(-4) M. All substances tested behaved as partial agonists with respect to DME. The [quot ]intrinsic activity[quot ] (Vmax) of the most potent agonists tested, A and NA, was 0.66 of that obtained with DME. It is concluded that in the duck, the CM cells secrete ACTH in response to A and NA (and other pharmacological substances) at doses which are compatible with a physiological role of those catecholamines acting directly upon the CM cell of the avian adenohypophysis. 5-HT and DA behaved as very weak agonists in stimulating ACTH release from duck CM cells in the system employed.