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SETTING: Host defense factors may influence the development of active tuberculosis (TB). OBJECTIVE: To test variants in solute carrier family 11A, member 1 (SLC11A1), for an association with TB. METHODS: A mixed case-control study of TB cases, relatives or close contact controls, consisting of 474 African-Americans (243 families) and 381 Caucasians (192 families), examined 13 SLC11A1 polymorphisms for association with pulmonary TB using generalized estimating equations adjusting for age and sex. RESULTS: Two associations were observed in Caucasians (rs3731863, P = 0.03, and rs17221959, P = 0.04) and one in African-Americans (rs3731865, P = 0.05). Multilocus analyses between polymorphisms in SLC11A1 and 11 TB candidate genes detected interactions between SLC11A1 and inducible nitric oxide synthase (NOS2A) in Caucasians (rs3731863 [SLC11A1] x rs8073782 [NOS2A], P = 0.009; rs3731863 [SLC11A1] x rs17722851 [NOS2A], P = 0.007) and toll-like receptor 2 (TLR2) in African-Americans (rs3731865 [SLC11A1] x rs1816702, P = 0.005). CONCLUSIONS: No association was detected with 5'(GT)(n) promoter polymorphism previously associated with lower SLC11A1 expression, rs17235409 (D543N), or rs17235416 (3' TGTG insertion/deletion polymorphism). SLC11A1 polymorphism rs3731865 was associated with TB in African-Americans, consistent with previous findings in West Africans. These results suggest that variants in SLC11A1 increase susceptibility to pulmonary TB and interact with other variants that differ by race.
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Negro ou Afro-Americano/genética , Proteínas de Transporte de Cátions/genética , Óxido Nítrico Sintase Tipo II/genética , Polimorfismo de Nucleotídeo Único , Receptor 2 Toll-Like/genética , Tuberculose/genética , População Branca/genética , Adolescente , Adulto , Idoso , Argentina , Estudos de Casos e Controles , Feminino , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Humanos , Imunidade Inata/genética , Masculino , Pessoa de Meia-Idade , North Carolina , Razão de Chances , Linhagem , Tuberculose/enzimologia , Tuberculose/etnologia , Tuberculose/imunologia , Adulto JovemRESUMO
INTRODUCTION: The appropriate physiological response to an acute bout of progressive aerobic exercise requires proper functioning of the pulmonary, cardiovascular and skeletal muscle systems. Unfortunately, these systems are all negatively impacted in patients with heart failure (HF), resulting in significantly diminished aerobic capacity compared with apparently healthy individuals. Cardiopulmonary exercise testing (CPX) is a noninvasive assessment technique that provides valuable insight into the health and functioning of the physiological systems that dictate an individual's aerobic capacity. The values of several key variables obtained from CPX, such as peak oxygen consumption and ventilatory efficiency, are often found to be abnormal in patients with HF. In addition to the ability of CPX variables to acutely reflect varying degrees of pathophysiology, they also possess strong prognostic significance, further bolstering their clinical value. Once thought to be contraindicated in patients with HF, participation in a chronic aerobic exercise program is now an accepted lifestyle intervention. Following several weeks/months of aerobic exercise training, an abundance of evidence now demonstrates an improvement in several pathophysiological phenomena contributing to the abnormalities frequently observed during CPX in the HF population. These exercise-induced adaptations to physiological function result in a significant improvement in aerobic capacity and quality of life. CONCLUSIONS: Furthermore, there is initial evidence to suggest that aerobic exercise training improves morbidity and mortality in patients with HF. This paper provides a review of the literature highlighting the clinical significance of aerobic exercise testing and training in this unique cardiac population.
INTRODUÇÃO: A resposta fisiológica aguda ao exercício aeróbio progressivo demanda funcionamento adequado dos sistemas pulmonares, cardiovasculares e músculo-esquelético. Infelizmente, todos estes sistemas estão negativamente afetados em pacientes com insuficiência cardíaca (IC), resultando numa redução significativa da capacidade aeróbia comparada com indivíduos aparentemente saudáveis. O teste de exercício cardiopulmonar (TCP) representa uma técnica não-invasiva de avaliação que fornece compreensão valiosa sobre a saúde e funcionamento dos sistemas fisiológicos que ditam a capacidade aeróbia de um indivíduo. Os valores de várias variáveis-chave obtidas através do TCP, como consumo pico de oxigênio e eficiência ventilatória são encontrados frequentemente como anormais em pacientes com IC. Além da capacidade das variáveis do TCP refletir de maneira aguda os graus variáveis da fisiopatologia, também possuem forte significância prognóstica, aumentando ainda mais o seu valor clínico. A participação num programa de exercícios aeróbios crônicos, anteriormente era contra-indicada em pacientes com IC. Agora é uma intervenção aceitável de estilo de vida. Após um período de treinamento com exercícios aeróbios, durante várias semanas/meses, tem sido evidenciada uma melhora em vários fenômenos fisiopatológicos que contribuem às anormalidades constatadas frequentemente durante TCP na população com IC. CONCLUSÕES: As adaptações fisiológicas induzidas por exercícios aeróbios resultam em uma melhora significativa de capacidade aeróbia e de qualidade de vida. Além disso, há evidências sugerindo que treinamento com exercícios aeróbios melhora a morbidade e a mortalidade em pacientes com IC. Este artigo fornece uma revisão da literatura que destaca a significância clínica dos testes de exercícios aeróbios e treinamento nesta população cardíaca única.
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Testes Respiratórios , Exercício Físico , Modalidades de Fisioterapia , Sobrevida , Sistema MusculoesqueléticoRESUMO
Nonlinear refraction spectroscopy has been performed in Yb3+-doped phosphate glass to determinate the line shape of real and imaginary parts of n2 (n2' and n2"). The n2' spectrum presented an asymmetric feature due to the interference of resonant and nonresonant contributions, where the nonresonant term arises from the polarizability difference between excited and ground states (delta alpha). The measurements were performed in the transient regime to determine population dynamics and the pump saturation intensity at 975 nm (peak of the absorption spectrum). Because of the small quantum defect of Yb3+, we estimated that the magnitude of the thermal lens effect is approximately 20 times smaller than the population lens effect, caused by n2.
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OBJECTIVE: To describe the evaluation, management, and rehabilitation of an acute, supraspinatus tendon injury in an intercollegiate football player. BACKGROUND: While attempting to block a defender, a 19-year-old collegiate football player slipped on the artificial turf and landed on his right elbow, causing an injury to his right shoulder. The athlete was initially seen by the head athletic trainer and then referred to the team physician for further evaluation. DIFFERENTIAL DIAGNOSIS: acromioclavicular joint sprain, brachial plexopathy, subacromial impingement syndrome, supraspinatus lesion. TREATMENT: The athlete was managed surgically with an open acromioplasty and a 3-bone tunnel repair of the supraspinatus tendon. After surgery, the athlete underwent a 4-month rehabilitation protocol in preparation for return to competition. UNIQUENESS: This case involved a teenage athlete rather than the older individuals who normally sustain rotator cuff lesions. Also, the mechanism was a compressive force on the supraspinatus tendon rather than the tensile force common to rotator cuff lesions. CONCLUSIONS: By presenting this case report, we hope to give sports medicine clinicians a better understanding of rotator cuff injuries and how to successfully manage and rehabilitate supraspinatus lesions.
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OBJECTIVE: To discuss the role of the sensorimotor system as it relates to functional stability, joint injury, and muscle fatigue of the athletic shoulder and to provide clinicians with the necessary tools for restoring functional stability to the athletic shoulder after injury. DATA SOURCES: We searched MEDLINE, SPORT Discus, and CINAHL from 1965 through 1999 using the key words "proprioception," "neuromuscular control," "shoulder rehabilitation," and "shoulder stability." DATA SYNTHESIS: Shoulder functional stability results from an interaction between static and dynamic stabilizers at the shoulder. This interaction is mediated by the sensorimotor system. After joint injury or fatigue, proprioceptive deficits have been demonstrated, and neuromuscular control has been altered. To restore stability after injury, deficits in both mechanical stability and proprioception and neuromuscular control must be addressed. A functional rehabilitation program addressing awareness of proprioception, restoration of dynamic stability, facilitation of preparatory and reactive muscle activation, and implementation of functional activities is vital for returning an athlete to competition. CONCLUSIONS/RECOMMENDATIONS: After capsuloligamentous injury to the shoulder joint, decreased proprioceptive input to the central nervous system results in decreased neuromuscular control. The compounding effects of mechanical instability and neuromuscular deficits create an unstable shoulder joint. Clinicians should not only address the mechanical instability that results from joint injury but also implement both traditional and functional rehabilitation to return an athlete to competition.
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Between November 1991 and June 1993, approximately 11,000 Haitian migrants were screened for active tuberculosis and human immunodeficiency virus type 1 (HIV-1) infection at the U.S. Naval Base in Guantánamo Bay, Cuba. Cultures of specimens from 37 of these patients yielded Mycobacterium tuberculosis; eight (22%) of these isolates were resistant to standard medications, including isoniazid (22%), rifampin (0), ethambutol (3%), and streptomycin (3%). Two isolates (5.4%) were resistant to two drugs simultaneously. All but one of 340 patients who were treated for presumptive active tuberculosis and who were followed up for about 1 month had a favorable initial clinical response to a standard four-drug regimen. Among 259 HIV-1-infected patients who had normal findings on screening chest radiographs and who received prophylaxis with isoniazid, there were 1.8 incident cases of active tuberculosis per 100 person-years; this rate was 76% lower than that (reported by others) among HIV-1-infected Haitian patients who were not treated with isoniazid. No serious toxic effects due to standard four-drug regimens or to prophylaxis with isoniazid were observed. These data suggest that standard empirical therapeutic interventions for tuberculosis are adequate and well tolerated in Haitian migrants.
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Mycobacterium tuberculosis/efeitos dos fármacos , Resistência Microbiana a Medicamentos , Haiti , Humanos , Testes de Sensibilidade Microbiana , MigrantesRESUMO
Serotonergic responsivity was assessed in 20 psychiatric patients by the prolactin response to a fenfluramine challenge test. During the fenfluramine challenge 6 of 20 patients (30%) spontaneously reported psychopathologic reactions that included: increased anxiety/agitation, psychotic symptoms, illusions, mood elevation, and anergia. The time of peak behavioral symptoms (2.5 +/- 0.8 hrs) corresponded closely to the time of peak increase in prolactin levels (3.0 +/- 1.1 hr). Abnormal behavioral responders had statistically significant greater increases in prolactin 1 to 4 hr after fenfluramine when compared to normal responders. Patients who developed an abnormal psychopathologic response to fenfluramine were characterized by higher levels of anxiety and agitation at the time of admission to the hospital but otherwise were not distinguishable on the basis of severity of other psychiatric symptoms. This study suggests that increased serotonergic transmission may trigger anxiety, psychosis, and mood elevation in specific vulnerable individuals, whereas other patients with similar psychiatric illnesses are not affected.
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Transtorno Depressivo/diagnóstico , Fenfluramina , Transtornos da Personalidade/diagnóstico , Serotonina/fisiologia , Adulto , Ansiedade/induzido quimicamente , Ansiedade/fisiopatologia , Ansiedade/psicologia , Nível de Alerta/efeitos dos fármacos , Nível de Alerta/fisiologia , Encéfalo/efeitos dos fármacos , Encéfalo/fisiopatologia , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/psicologia , Feminino , Fenfluramina/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Determinação da Personalidade , Transtornos da Personalidade/fisiopatologia , Transtornos da Personalidade/psicologia , Prolactina/sangue , Escalas de Graduação Psiquiátrica , Receptores de Serotonina/efeitos dos fármacos , Receptores de Serotonina/fisiologiaRESUMO
Because of the AIDS epidemic and the protections afforded individuals with AIDS under the Americans with Disabilities Act (ADA), employers are well advised to ensure compliance under applicable law to reduce exposure to employee claims of discrimination and to efficiently manage workplace issues associated with AIDS. Employers should implement AIDS policies and programs designed to educate their workforce to reduce the spread of AIDS and to clear up any misunderstandings about the disease which could wreak havoc in the workplace. This article summarizes suggested action steps for employers and outside resources to consult for guidance.
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Síndrome da Imunodeficiência Adquirida/prevenção & controle , Pessoas com Deficiência/legislação & jurisprudência , Readaptação ao Emprego/legislação & jurisprudência , Gestão de Recursos Humanos/legislação & jurisprudência , Síndrome da Imunodeficiência Adquirida/economia , Síndrome da Imunodeficiência Adquirida/transmissão , Educação em Saúde , Humanos , Responsabilidade Legal , Exposição Ocupacional/legislação & jurisprudência , Exposição Ocupacional/prevenção & controle , Política Organizacional , Gestão de Recursos Humanos/métodos , Técnicas de Planejamento , Estados Unidos , Local de TrabalhoRESUMO
Evidence exists that the eosinophil plays an important role in mediating injury to bronchial epithelium in chronic asthma. Here, the role of the eosinophil in chronic inflammatory disease of the paranasal sinuses was studied with tissue from patients who underwent surgery for chronic sinusitis. Paranasal tissue from patients with chronic asthma and/or allergic rhinitis was extensively infiltrated with eosinophils. Immunofluorescent studies demonstrated a striking association between the presence of extracellular deposition of major basic protein and damage to sinus mucosa. The histopathology of paranasal respiratory epithelium appeared similar to that described in bronchial asthma. These findings suggest that the eosinophil acts as an effector cell in chronic inflammatory disease of paranasal respiratory epithelium. Thus, sinus disease in patients with asthma may be due to the same mechanisms that cause damage to bronchial epithelium.
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Eosinófilos/fisiologia , Ribonucleases , Sinusite/patologia , Adolescente , Adulto , Idoso , Asma/complicações , Asma/metabolismo , Asma/patologia , Proteínas Sanguíneas/metabolismo , Doença Crônica , Proteínas Granulares de Eosinófilos , Eosinófilos/metabolismo , Eosinófilos/patologia , Epitélio/metabolismo , Epitélio/patologia , Feminino , Imunofluorescência , Humanos , Masculino , Pessoa de Meia-Idade , Rinite Alérgica Sazonal/complicações , Rinite Alérgica Sazonal/metabolismo , Rinite Alérgica Sazonal/patologia , Sinusite/etiologia , Sinusite/metabolismoRESUMO
The authors presents the results of their studies on the peruvian coast of the sand pipe (caladris alba), reporting on its distribution, its general characteristics, its activity patterns and individual behavior patterns.
Los autores presentan los resultados de sus estudios en la costa del Perú, reportando la distribución y abundancia, las características generales, los patrones de actividad y los movimientos individuales del playero blanco.
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Animais , Aves , Charadriiformes , Ecologia , Especificidade da Espécie , Costa , PeruAssuntos
Maus-Tratos Infantis , Papel do Médico , Papel (figurativo) , Criança , Humanos , JurisprudênciaRESUMO
Diarrheal disease is a primary cause of childhood mortality and morbidity in developing countries. Significant reduction depends on the identification of high-risk households which can be targetted for proven-effective interventions, such as oral rehydration therapy. This paper describes the development of a household risk assessment model in the context of an on-going diarrheal disease control in Grenada. Contingency and logit analyses of household survey data are used to identify easily observed markers of high-risk households. A three-variable logit model gives accurate predictions of self-reported diarrhea, showing that the approach can be used to develop an effective and efficient risk assessment tool.
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Diarreia/epidemiologia , Criança , Estudos Transversais , Diarreia/prevenção & controle , Humanos , Modelos Teóricos , Risco , Índias OcidentaisRESUMO
Diarrheal disease is a primary cause of childhood mortality and morbidity in developing countries. Significant reduction depends on the identification of high-risk households which can be targetted for proven-effective interventions, such as oral rehydration therapy. This paper describes the development of a household risk assessment model in the context of an on-going diarrheal disease control in Grenada. Contingency and logit analyses of household survey data are used to identify easily observed markers of high-risk households. A three-variable logit model gives accurate predictions of self-reported diarrhea, showing that the approach can be used to develop an effective and efficient risk assessment tool.(AU)