RESUMO
This retrospective case-control study compared inflammatory and structural damage in the temporomandibular joint of patients with juvenile idiopathic arthritis (JIA) and its subtypes and healthy patients using the Outcome Measures in Rheumatology Clinical Trials (OMERACT) and EuroTMjoint classifications. Correlations between the scores of the two classifications and time of diagnosis were evaluated. Twenty-nine JIA patients and 48 age-matched healthy participants were examined. TMJ images on each side were considered individually. Oligoarticular and polyarticular subtypes were present in 44.8% and 55.2% of patients, respectively. The JIA group presented a higher frequency and more severe signs of inflammatory and structural changes (P < 0.05), except for effusion (P = 0.83). The polyarticular subtype showed a higher change intensity. The time of JIA diagnosis was not correlated with inflammatory and structural changes. Positive correlations between inflammation and bone deformity scores were observed for the EuroTMjoint classification (r = 0.462, P < 0.001; low correlation) and OMERACT classification (r = 0.737, P < 0.001; high correlation). Positive correlations between the OMERACT and EuroTMjoint classifications were found for inflammation score (r = 0.907, P < 0.001; very high correlation) and bone deformity score (r = 0.854, P < 0.001; high correlation). Both classifications showed a higher frequency and intensity of inflammation and bone deformity in JIA patients. The results of this study suggest that the appropriate management of inflammation may reduce the potential for structural damage to the TMJ.
Assuntos
Artrite Juvenil , Humanos , Artrite Juvenil/diagnóstico por imagem , Estudos Retrospectivos , Estudos de Casos e Controles , Articulação Temporomandibular/patologia , Imageamento por Ressonância Magnética/métodos , Inflamação/patologiaRESUMO
Objetivou-se avaliar um programa de controle da artrite encefalite caprina (AEC), por meio de testes diagnósticos sensíveis, separação de mãe e cria após o parto e medidas de manejo, com o intuito de formar rebanho livre do vírus. Utilizou-se um total de 47 cabritos da raça Saanen, mantidos isoladamente até o resultado dos primeiros testes de reação em cadeia de polimerase nested (PCR nested) e Western Blotting (WB), com base na coleta de sangue no momento do nascimento (M0). No PCR nested, quatro animais foram positivos, no M0, e foram eutanasiados. Posteriormente, os demais 43 cabritos foram submetidos à coleta de sangue aos 60 (M60) e 270 (M270) dias de vida para realização de novos testes de WB e PCR nested, que não detectaram animais positivos. Pode-se afirmar que a metodologia adotada neste estudo foi efetiva no controle da doença, nas fases de aleitamento e pós-aleitamento, e que a combinação do sistema de manejo, a fim de propiciar diminuição de risco de transmissão horizontal, com técnicas de diagnóstico mais apuradas, como o WB e a PCR nested, é relevante para elaboração de plano estratégico de controle da enfermidade.(AU)
We aimed to evaluate a program to control Caprine Arthritis Encephalitis (CAE), using diagnostic tests, separation of the mother and postpartum and other management measures, in order to form a free flock of the virus. We used a total of 47 Saanengoats in isolation until the results of the first nested Polymerase Chain Reaction (nested PCR) and Western Blotting (WB) tests, based on blood collection at the time of birth (M0). In the nested PCR, 4 animals were positive, at M0, and were eliminated. Later, the other 43goats were submitted to blood collection at 60 (M60) and 270 (M270) days of life to perform new tests of WB and nested PCR, which did not detect positive animals. We can affirm that the methodology adopted in this study was effective in the control of the disease, in the phase of breastfeeding and post-breastfeeding, and that the combination of the management system, which allows a reduction of risk of horizontal transmission, with more accurate diagnostic techniques, such as WB and nested PCR, is relevant for the elaboration of a strategic plan for the disease control.(AU)
Assuntos
Animais , Cabras/virologia , Infecções por Lentivirus/prevenção & controle , Vírus da Artrite-Encefalite Caprina/isolamento & purificação , Reação em Cadeia da Polimerase/veterináriaRESUMO
AIMS: This study evaluates the action of Weissella paramesenteroides WpK4 on amoebic colitis. METHODS AND RESULTS: Weissella paramesenteroides WpK4 was administered in Entamoeba dispar infected and noninfected mice and clinical parameters were evaluated. Following 7 days, the caeca were collected for histopathology, morphometry and immunohistochemical staining of MUC-2, CDC-47 and IgA. The treatment reduced diarrhoea and the presence of blood in the faeces and diminished the area of necrosis, also causing weight gain. Also, the addition of this bacterium enhanced the expression of the mucin (MUC-2). The reduction in necrosis and increased CDC-47 expression indicates significant epithelial regeneration. The negative correlation between CDC-47 and the necrosis area reveals that the bacterium favoured the recovery of the necrotic regions and the positive correlation found between the expression of MUC-2 and CDC-47 indicates that the epithelial regeneration also supports the synthesis of MUC-2. CONCLUSIONS: Weissella paramesenteroides WpK4 was able to increase the protection of the intestinal mucosa against experimental amoebic colitis through the increase of MUC-2 and epithelial regeneration. SIGNIFICANCE AND IMPACT OF THE STUDY: Weissella paramesenteroides WpK4 presents the potential to become a complementary tool in the treatment of amoebic colitis.
Assuntos
Disenteria Amebiana/prevenção & controle , Mucosa Intestinal/fisiologia , Mucina-2/metabolismo , Regeneração , Weissella/fisiologia , Animais , Modelos Animais de Doenças , Disenteria Amebiana/patologia , Mucosa Intestinal/metabolismo , Mucosa Intestinal/parasitologia , Camundongos , Componente 7 do Complexo de Manutenção de Minicromossomo/metabolismo , ProbióticosRESUMO
Obesity is a public health problem present in both developed and developing countries. The white adipose tissue (WAT) is the main deposit of lipids when there is an excess of energy. Its pathological growth is directly linked to the development of obesity and to a wide number of comorbidities, such as insulin-resistance, cardiovascular disease, among others. In this scenario, it becomes imperative to develop new approaches to the treatment and prevention of obesity and its comorbidities. It has been documented that the browning of WAT could be a suitable strategy to tackle the obesity epidemic that is developing worldwide. Currently there is an intense search for bioactive compounds with anti-obesity properties, which present the particular ability to generate thermogenesis in the brown adipose tissue (BAT) or beige. The present study provide recent information of the bioactive nutritional compounds capable of inducing thermogenesis and therefore capable of generate positive effects on health.
Assuntos
Tecido Adiposo Branco/metabolismo , Obesidade/metabolismo , Tecido Adiposo Marrom/metabolismo , Animais , Metabolismo Energético/fisiologia , Humanos , Termogênese/fisiologiaRESUMO
Aedes aegypti mosquitoes are highly adaptable to abiotic stimuli. To evaluate the influence of shading and pedestrian traffic on the preference of Ae. aegypti for oviposition microenvironments, 20 sites were sampled weekly using ovitraps within the perimeter of Universidade Federal do Espírito Santo, located in São Mateus, Espírito Santo, Brazil. A spatial and statistical analysis was performed in order to assess the relationship between shading time, pedestrian traffic, and the presence of biological forms of Ae. aegypti. A temporal analysis of temperature and precipitation influence on oviposition was also made. Between June, 2013 and June, 2014, 7,362 Ae. aegypti eggs were collected. Over a 12-month period, we made weekly collections of Ae. aegypti eggs from ovitraps. Pedestrian traffic and shading time influenced the number of positive ovitraps; precipitation and temperature were correlated with the number of positive ovitraps (p <0.05). We conclude that the influence of temperature and precipitation was not significant for the oviposition index, and the frequency of oviposition was directly proportional to the number of individuals moving close to the traps during periods of greater shading.
Assuntos
Aedes/fisiologia , Luz , Oviposição , Pedestres , Animais , Brasil , Feminino , Humanos , Chuva , TemperaturaRESUMO
BACKGROUND: Restless Legs Syndrome (RLS) or Willis-Ekbom Disease (WED) is highly prevalent, but patients and healthcare providers alike know little about it. Furthermore, controversy persists as to the best way of diagnosing this nosological entity. OBJECTIVE: To verify whether the term used to refer to this disease entity (Restless Legs Syndrome or Willis-Ekbom Disease) affects the prevalence of self-diagnosed RLS/WED in a sample of newly graduated physicians. METHODS: Newly graduated physicians were asked to self-evaluate for the presence of RLS/WED. Briefly, participants were allocated randomly across two groups. One was asked to self-assess for RLS, while the other was asked to self-assess for WED. The evaluation form given to one group asked 'Do you have Restless Legs Syndrome?' whereas the form given to participants in the other group asked 'Do you have Willis-Ekbom Disease?'. Both forms also contained the four criteria for diagnosing RLS proposed by the International Restless Legs Syndrome Study Group (IRLSSG) and instructions for self-diagnosis according to these criteria. RESULTS: The study sample comprised 1413 newly graduated physicians. Of the 708 participants who were given the form that used the term RLS, 87 (12.28%) diagnosed themselves with the condition. Conversely, of 705 physicians given the form with the term WED, 13 (1.84%) diagnosed themselves with the condition (p <0.0001). CONCLUSION: A greater proportion of newly graduated physicians diagnosed themselves with RLS/WED when presented with the term Restless Legs Syndrome than when presented with the term Willis-Ekbom Disease. This suggests that the term Restless Legs Syndrome may not be the most appropriate term to denote this nosological entity.
Assuntos
Internato e Residência , Síndrome das Pernas Inquietas/diagnóstico , Adulto , Brasil , Competência Clínica , Diagnóstico Diferencial , Autoavaliação Diagnóstica , Feminino , Humanos , Masculino , Prevalência , Síndrome das Pernas Inquietas/epidemiologia , Síndrome das Pernas Inquietas/psicologia , Adulto JovemRESUMO
Peanut grains are very susceptible to aflatoxin contamination. Aflatoxins are toxic metabolites produced by Aspergillus flavus, A. nomius and A. parasiticus. The aflatoxin B1 is most frequently found in peanuts, posing a high toxicological risk due to its carcinogenic, teratogenic and mutagenic properties. Alternative methods to fungicides can be used to protect grains. GRAS (Generally Regarded As Safe) substances can be an interesting option to avoid contamination, specially glycerol. In the present work, the ability of glycerol films to prevent aflatoxin production by A. parasiticus in peanuts was evaluated. Glycerol was established in two different ways: by immersion and aspersion. Aspersion was more efficient in reducing aflatoxin production (86.3%) than was the immersion process (66.9%) (P < 0.05). At the same time, a progressive reduction in A. parasiticus colony diameters was observed (from 38.6 ± 0.9 to 34.4 ± 1.7 mm) when the fungus was grown on GYEP medium supplemented with glycerol (0 to 5%). However, varying concentrations did not influence the production of spores, colonies, conidiophores or spore condition. Peanuts coated with 5% glycerol (by immersion or aspersion) had improved characteristics, with a cleaner and more shiny appearance, which can make the resulting product more acceptable to the population. In conclusion, the reduction of aflatoxin production in peanut grains with glycerol, particularly by aspersion, was satisfactory, and this GRAS substance shows promising potential to be used to prevent mycotoxin contamination in grains.(AU)
O amendoim é muito suscetível à contaminação por aflatoxinas, que são metabólitos tóxicos produzidos por Aspergillus flavus, A. parasiticus e A. nomius. A aflatoxina B1 é a mais frequentemente encontrada nos amendoins e apresenta risco toxicológico devido às suas propriedades carcinogênicas, teratogênicas e mutagênicas. Entre os métodos de prevenção da contaminação, o uso de substâncias GRAS (substâncias geralmente consideradas seguras) pode apresentar grande potencial de exploração, especialmente o glicerol. No presente trabalho, foi avaliada a capacidade de filmes de glicerol para o controle da produção de aflatoxinas em amendoins. O glicerol foi inoculado por imersão ou aspersão, sendo a aspersão mais eficiente na redução da produção de aflatoxina (86,3%) que a imersão (66,9%) (P < 0,05). Ao mesmo tempo, foi observada uma redução nos diâmetros das colônias de A. parasiticus (38,6 ± 0,9 para 34,4 ± 1,7 mm) quando cultivado em meio GYEP suplementado com glicerol (0 a 5%). Apesar disto, diferentes concentrações não influenciaram a produção ou morfologia dos esporos e conidióforos. Amendoins revestidos com 5% de glicerol apresentaram características interessantes, tais com: maior brilho e coloração mais intensa, o que pode tornar o produto mais atraente para o consumidor. Em conclusão, a redução da produção de aflatoxinas em amendoim pelo glicerol, principalmente por aspersão foi satisfatória. Sendo assim, esta substância apresenta um potencial promissor para utilização para a prevenção da contaminação do amendoim por aflatoxinas.(AU)
Assuntos
Arachis , Conservação de Alimentos/métodos , Glicerol , Micotoxinas/toxicidadeRESUMO
Treatment of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae infections (KPC-EI) remains a challenge. Combined therapy has been proposed as the best choice, but there are no clear data showing which combination therapy is superior. Our aim was to evaluate the effectiveness of antimicrobial regimens for treating KPC-EI. This was a retrospective cohort study of KPC-EI nosocomial infections (based on CDC criteria) between October 2009 and June 2013 at three tertiary Brazilian hospitals. The primary outcomes were the 30-day mortality for all infections and the 30-day mortality for patients with bacteraemia. Risk factors for mortality were evaluated by comparing clinical variables of survivors and nonsurvivors. In this study, 118 patients were included, of whom 78 had bacteraemia. Catheter-related bloodstream infections were the most frequent (43%), followed by urinary tract infections (n = 27, 23%). Monotherapy was used in 57 patients and combined treatment in 61 patients. The most common therapeutic combination was polymyxin plus carbapenem 20 (33%). Multivariate analysis for all infections (n = 118) and for bacteremic infections (n = 78) revealed that renal failure at the end of treatment, use of polymyxin and older age were prognostic factors for mortality. In conclusion, polymyxins showed suboptimal efficacy and combination therapy was not superior to monotherapy.
Assuntos
Antibacterianos/uso terapêutico , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/enzimologia , Polimixinas/uso terapêutico , beta-Lactamases/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Brasil , Criança , Pré-Escolar , Estudos de Coortes , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/mortalidade , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Centros de Atenção Terciária , Resultado do Tratamento , Adulto JovemRESUMO
El Instituto Universitario de Ciencias de las Salud ha mostrado un particular compromiso con la formación de sus estudiantes en la estrategia de Atención Primaria de la Salud, con las prácticas asistenciales dedicadas al 1er nivel de atención ambulatoria y a las patologías prevalentes en ese ámbito. Del mismo modo se han desenvuelto las actividades de formación en investigación. Como exponente de esa orientación, la revista Ciencias de la Salud publicó en el Vol. 2, N°1, 2011:4-9, el artículo Prevalencia de la Enfermedad de Chagas de Érica G. Morais, que había obtenido el premio Futuros Líderes, otorgado por el Curso Anual Internacional de Investigación en Ciencias de la Salud (IUCS-AMA, Prof. Carlos Álvarez Bermúdez). Aquella investigación formaba parte de un proyecto más amplio realizado en el Hospital Teodoro Álvarez entre 2004 y 2012, en el que participaron un conjunto de investigadores, que compartieron la autoría de la actual publicación. El Dr. Jorge Mitelman, Prosecretario de Ciencia y Técnica del IUCS e integrante de ese equipo, preparó además una reseña sobre la jornada del INCOSUR, realizada en abril del presente año, describiendo asimismo el proceso de desarrollo de la Ciudad de Buenos Aires, como área no endémica, para encarar las consecuencias de la enfermedad de Chagas
Assuntos
Doença de Chagas , Doença de Chagas/epidemiologia , Doença de Chagas/patologia , Doença de Chagas/prevenção & controleRESUMO
INTRODUCTION: Acinetobacter baumannii is a leading agent of healthcare-associated infection. The objective of this study was to evaluate cases of colonization or infection with polymyxin-resistant A. baumannii (PRAB) in liver transplant recipients and to identify the risk factors for the acquisition of PRAB. METHODS: We evaluated all patients undergoing liver transplantation (LT) between January and November of 2011. The exclusion criterion was death within the first 72 h after transplant. Patients were screened for PRAB through weekly rectal and inguinal swabs during their stay in the intensive care unit (ICU) and at ICU discharge. Patients who came from other hospitals or had been treated in the emergency room for >72 h were screened at ICU admission. The minimum inhibitory concentrations (MICs) for polymyxins were determined by broth microdilution, and clonality was determined by pulsed-field gel electrophoresis. The stepwise logistic regression was used to identify risk factors related to acquisition of PRAB, and Cox forward regression used to identify risk factors for 60-day mortality. RESULTS: We evaluated 65 patients submitted to LT, among whom PRAB was isolated in 7, 4 of whom developed infection. The MICs for polymyxin E ranged from 16 to 128 mg/mL. All patients with PRAB required dialysis. The median time of polymyxin use before PRAB isolation was 21 days. These 4 included 1 case of primary bloodstream infection (BSI), which was treated with the carbapenem-polymyxin combination; 1 case of surgical site infection, which was treated with gentamicin, polymyxin, ampicillin-sulbactam, and tigecycline; and 2 cases of pneumonia, treated with the combination of carbapenem-polymyxin. In the case of BSI and in 1 of the cases of pneumonia, the treatment was considered successful. Mortality was 71% among the cases, compared with 33% among the non-cases. CONCLUSION: In the final model of the survival analysis, PRAB colonization or infection after LT was independently associated with mortality. One predominant clone was identified. The only risk factor identified in the multivariate analysis was polymyxin use. PRAB was an agent with high mortality, and the most important risk factor associated with colonization or infection for such bacterium was polymyxin use.
Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/uso terapêutico , Transplante de Fígado , Polimixinas/uso terapêutico , Portador Sadio , Estudos de Casos e Controles , Farmacorresistência Bacteriana , Quimioterapia Combinada , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-IdadeRESUMO
The aim of this study was to evaluate the orthodontic retention of maxillary skeletal stability after surgically assisted rapid palatal expansion (SARPE). Ninety digitized plaster casts from 30 adult patients who underwent SARPE were assessed. Thirty patients were divided equally into two groups: the No Retention Group (n = 15) and the Retention Group (n = 15) with a Transpalatal Arch [TPA]). After the end of expansion, the expander appliance was stabilized and remained in place for 4 months. The additional retention period began in the Retention Group as soon as the expander was removed and replaced by a TPA. During the same period, the No Retention Group remained without retention. The casts were created pre-operatively, at 4 months and 10 months post-expansion. The models were digitized by means of a 3D Vivid 9i laser scanner. The palatal area and volume were assessed. Both variables increased after 4 months compared with pre-operative values (p < .05). At 10 months, patients' palatal areas and volumes were stable in both groups (p > .05). In conclusion, no retention other than the expander appliance is needed after SARPE.
Assuntos
Maxila/cirurgia , Técnica de Expansão Palatina , Adulto , Cefalometria/métodos , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Lasers , Masculino , Maxila/patologia , Modelos Dentários , Septo Nasal/cirurgia , Desenho de Aparelho Ortodôntico , Contenções Ortodônticas , Osteotomia de Le Fort/métodos , Técnica de Expansão Palatina/instrumentação , Palato Duro/patologia , Palato Duro/cirurgia , Osso Esfenoide/cirurgia , Resultado do TratamentoRESUMO
This study evaluated different techniques for surgically assisted rapid maxillary expansion (SARME) according to the type of transverse maxillary deficiency using computed tomography (CT). Six adult patients with bilateral transverse maxillary deficiencies underwent SARME. The patients were equally divided into three groups: Group I, maxillary atresia in both the anterior and posterior regions; Group II, greater maxillary atresia in the anterior region; and Group III, increased maxillary atresia in the posterior region. In Group I, a subtotal Le Fort I osteotomy was used. In Group II, a subtotal Le Fort I osteotomy was used without pterygomaxillary suture disjunction. In Group III, a subtotal Le Fort I osteotomy was used with pterygomaxillary suture disjunction and fixation of the anterior nasal spine with steel wire. The midpalatal suture opening was evaluated preoperatively and immediately after the activation period using CT. For Group I, the opening occurred parallel to midpalatal suture; for Group II, the opening comprised a V-shape with a vertex on the posterior nasal spine; and for Group III, the opening comprised a V-shape with a vertex at the anterior nasal spine. The conclusion was that the SARME technique should be individualized according to the type of transverse maxillary deficiency.
Assuntos
Maxila/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Técnica de Expansão Palatina , Adulto , Cefalometria/instrumentação , Feminino , Humanos , Masculino , Maxila/anormalidades , Maxila/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
Aflatoxin B(1) is a toxigenic and carcinogenic compound produced by Aspergillus flavus and Aspergillus parasiticus. To inhibit aflatoxin contamination of peanuts, seeds of two peanut breeds, IAC Caiapó and IAC Runner 886, were inoculated with A. parasiticus (1.0 × 10(6) spores per ml) and the yeast Saccharomyces cerevisiae (3.2 × 10(7) cells per ml) and incubated at 25°C for 7 and 15 days. Two experiments were conducted for each incubation period separately. The treatments were completely randomized, with three replications per treatment. Treatments included the two cultivars and three types of inoculation (pathogen alone, yeast and pathogen, and yeast 3 h before pathogen). Aflatoxin B(1) was quantified with a densitometer at 366 nm after thin layer chromatography. Aflatoxin B(1) contamination in peanuts was reduced after the addition of S. cerevisiae. The concentration of aflatoxin B(1) decreased by 74.4 and 55.9% after 7 and 15 days, respectively. The greatest aflatoxin reduction was observed when S. cerevisiae was inoculated 3 h before the pathogen in IAC Caiapó seeds and incubated for 7 days at 25°C. The use of S. cerevisiae is a promising strategy for biological control of aflatoxin contamination in peanuts.
Assuntos
Aflatoxina B1/biossíntese , Arachis/química , Aspergillus/crescimento & desenvolvimento , Aspergillus/metabolismo , Controle Biológico de Vetores/métodos , Saccharomyces cerevisiae/crescimento & desenvolvimento , Qualidade de Produtos para o Consumidor , Humanos , Saccharomyces cerevisiae/metabolismo , Temperatura , Fatores de TempoRESUMO
We investigated chronic incorporation of metals in individuals from poor families, living in a small, restrict and allegedly contaminated area in São Paulo city, the surroundings of the Guarapiranga dam, responsible for water supply to 25% of the city population. A total of 59 teeth from individuals 7 to 60 years old were collected. The average concentrations of Pb, Cd, Fe, Zn, Mn, Ni and Cr were determined with an Atomic Absorption Spectrophotometer. The concentrations of all metals as function of the individuals' age exhibited a remarkable similarity: peaks between 7 and 10 years and sharply decreasing at higher ages, which could be attributed to alimentary habits and persistence to metals exposure all along the individuals' life span. From all the measured metals, lead and cadmium were a matter of much more concern since their measured values are close to the upper limits of the world wide averages.
Assuntos
Saúde Ambiental/métodos , Poluentes Ambientais/metabolismo , Poluição Ambiental/análise , Metais/metabolismo , Dente/química , Adolescente , Adulto , Brasil , Criança , Humanos , Pessoa de Meia-Idade , Espectrofotometria Atômica , Adulto JovemRESUMO
The south region of Sao Paulo city hosts the Guarapiranga dam, responsible for water supply to 25% of the city population. Their surroundings have been subject to intense and irregular occupation by people from very low socioeconomics classes. Measurements undertaken on sediment and particulate materials in the dam revealed concentrations of lead, copper, zinc and cadmium above internationally accepted limits. Epidemiological and toxicological studies undertaken by the World Health Organization in individuals exhibiting lead concentrations in blood, near or below the maximum recommended (10 microg dl(-1)), surprisingly revealed that toxic effects are more intense in individuals belonging to low socioeconomics classes. Motivated by these facts, we aimed at the investigation of chronic incorporation of lead, as well as the use of our BIOKINETICS code, which is based on an accepted ICRP biokinetics model for lead, in order to extrapolate the results from teeth to other organs. The focus of our data taking was children from poor families, living in a small, restrict and allegedly contaminated area in São Paulo city. Thus, a total of 74 human teeth were collected. The average concentration of lead in teeth of children 5 to 10 years old was determined by means of a high-resolution inductively coupled plasma mass spectrometer (ICP-MS). For standardization of the measurements, an animal bone certified material (H-Animal Bone), from the International Atomic Energy Agency, was analyzed. The amount of lead in children living in the surroundings of the dam, was approximately 40% higher than those from the control region, and the average lead concentration was equal to 1.3 microg g(-1) approximately. Grouping the results in terms of gender, tooth type and condition, it was concluded that a carious molar of boys is a much more efficient contamination pathway for lead, resulting in concentrations 70% higher than in the control region. We also inferred the average concentrations of lead in other organs of these children, by making use of our BIOKINETIC code.
Assuntos
Exposição Ambiental , Chumbo/análise , Chumbo/toxicidade , Dente/química , Adolescente , Disponibilidade Biológica , Brasil , Criança , Pré-Escolar , Simulação por Computador , Fator F , Feminino , Humanos , Masculino , Espectrometria de Massas/métodos , Espectrometria de Massas/normasRESUMO
BACKGROUND: There has been an increase in worldwide infections caused by carbapenem-resistant Acinetobacter. This poses a therapeutic challenge as few treatment options are available. OBJECTIVES: The aim of this study was to evaluate the efficacy and safety of polymyxins and ampicillin/sulbactam for treating infections caused by carbapenem-resistant Acinetobacter spp. and to evaluate prognostic factors. METHODS: This was a retrospective review of patients from two teaching hospitals who had nosocomial infections caused by carbapenem-resistant Acinetobacter spp. from 1996 to 2004. Diagnosis of infection was based on CDC criteria plus the isolation of Acinetobacter from a usually sterile site or from bronchoalveolar lavage. Urinary tract infections were not included. Data on demographic and clinical features and treatment were collected from medical records. Prognostic factors associated with two outcomes (mortality during treatment and in-hospital mortality) were evaluated. RESULTS: Eighty-two patients received polymyxins and 85 were treated with ampicillin/sulbactam. Multiple logistic regression analysis revealed that independent predictors of mortality during treatment were treatment with polymyxins, higher Acute Physiological and Chronic Health Evaluation II (APACHE II) score, septic shock, delay in starting treatment and renal failure. On multivariate analysis, prognostic factors for in-hospital mortality were older age, septic shock and higher APACHE II score. CONCLUSIONS: This is the first study comparing current therapeutic options for infections due to carbapenem-resistant Acinetobacter. The most important finding of the present study is that ampicillin/sulbactam appears to be more efficacious than polymyxins, which was an independent factor associated with mortality during treatment.
Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter/efeitos dos fármacos , Carbapenêmicos/farmacologia , Polimixinas/uso terapêutico , Resistência beta-Lactâmica , APACHE , Acinetobacter/isolamento & purificação , Infecções por Acinetobacter/complicações , Infecções por Acinetobacter/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Ampicilina/efeitos adversos , Ampicilina/uso terapêutico , Líquido da Lavagem Broncoalveolar/microbiologia , Criança , Pré-Escolar , Infecção Hospitalar/complicações , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Feminino , Hospitais de Ensino , Humanos , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Polimixinas/efeitos adversos , Prognóstico , Insuficiência Renal , Estudos Retrospectivos , Fatores de Risco , Choque Séptico/tratamento farmacológico , Choque Séptico/microbiologia , Choque Séptico/mortalidade , Sulbactam/efeitos adversos , Sulbactam/uso terapêutico , Fatores de Tempo , Resultado do TratamentoRESUMO
The Southwest region of the Bahia state in Brazil hosts the largest uranium reserve of the country (100 kton in uranium, only), plus the cities of Caetité, Lagoa Real and Igaporã. In this work, aim was at the investigation of uranium burdens on residents of these cities by using teeth as bioindicators, as a contribution for possible radiation protection measures. Thus, a total of 41 human teeth were collected, plus 50 from an allegedly uranium free area (the control region). Concentrations of uranium in teeth from residents of 5- to 87-y old were determined by means of a high-resolution inductively coupled plasma mass spectrometer (ICP-MS). The highest uranium concentration in teeth was measured from samples belonging to residents of Caetité (median equal to 16 ppb). Assuming that the uranium concentrations in teeth and bones are similar within 10-20% (for children and young adults), it concluded that uranium body levels in residents of Caetité are at least one order of magnitude higher than the worldwide average. This finding led to conclude that daily ingestion of uranium, from food and water, is equally high.
Assuntos
Monitoramento Ambiental/métodos , Contaminação Radioativa de Alimentos/análise , Dente/química , Urânio/análise , Urânio/farmacocinética , Poluentes Radioativos da Água/análise , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Humanos , Masculino , Pessoa de Meia-Idade , Modelos BiológicosRESUMO
PURPOSE: The clinical efficacy of the ketogenic diet as therapy for patients with difficult-to-treat epilepsy prompted us to investigate the glucose metabolism of these patients under an oral overload of glucose, that is, in the oral glucose tolerance test (OGTT). METHODS: Thirty patients (12 males, 18 females; age range: 17-59, mean: 35.1) with difficult-to-treat epilepsy, 23 patients with controlled epilepsy (11 males, 12 females; age range: 14-66, mean: 36.9), and 39 control subjects (18 males, 21 females; age range: 16-58, mean: 33.3) were evaluated with the OGTT. For patients with epilepsy, we also measured C-peptide and glycosylated hemoglobin in the fasting state. Glucose levels lower than 70 mg/dL at any point of the curve were considered to be abnormal. RESULTS: All subjects in the control group and the group with controlled epilepsy had a normal OGTT. In contrast, all 30 patients with difficult-to-treat epilepsy had at least one point on the OGTT curve below the normal range (P<0.001), most often 180 and 240 minutes after the oral glucose load (P<0.001). C-peptide levels were significantly lower in the group with difficult-to-treat epilepsy as compared with the group with controlled epilepsy. Fasting glycohemoglobin and insulin levels did not differ between the two patient groups. CONCLUSIONS: We suggest that undiagnosed metabolic disturbances in patients with difficult-to-treat epilepsy may somehow contribute to their refractoriness to conventional pharmacological therapy. We propose the hypothesis that calorie-restricted diets aimed at correcting OGTT curves may prove beneficial in treating patients with difficult-to-treat epilepsy. Our hypothesis generates a clear endpoint for the diet, and its demonstration would provide new standards for diet-based antiepileptic regimens. Accordingly, our results may help in understanding the positive consequences of ketogenic or calorie-restricted diets in persons with seizures.
Assuntos
Anticonvulsivantes/uso terapêutico , Glicemia/metabolismo , Resistência a Medicamentos , Epilepsia/metabolismo , Adolescente , Adulto , Idoso , Glicemia/efeitos dos fármacos , Interações Medicamentosas , Epilepsia/tratamento farmacológico , Feminino , Teste de Tolerância a Glucose , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Several infectious etiologies are related to cerebral venous thrombosis (CVT), but a review of literature showed only few cases related to tuberculosis (TB), and only one with neurological manifestations.We report an unusual case of CVT related to TB and mutation in prothrombin gene. A 38-man black presented abrupt right hemiparestesis, and hemiparesis. Investigations revealed CVT. Cerebral spinal fluid (CSF) examination evidenced an infection by Mycobacterium. He was heterozygous for G20210A prothrombin mutation. Probably, hypercoagulability mechanisms of TB, added to mutation of prothrombin gene increase the risk of CVT.
As mais variadas etiologias infecciosas estão relacionadas a trombose venosa cerebral (TVC), mas revisando-se a literatura há apenas poucos relatos de casos que se devem à tuberculose (TB), sendo que em apenas um deles havia manifestações no sistema nervoso central.Relatamos um caso de TVC associado a TB e a mutação do gene da protrombina. Homem 38 anos, negro, apresentou hemiparestesia de instalação súbita à direita, evoluindo com hemiparesia homolateral. Durante a internação, foi coletado líquor que evidenciou infecção por micobactéria. A pesquisa de trombofilias mostrou positividade somente para mutação do gene da protrombina(G20210A). Provavelmente os mecanismos de hipercoagulabilidade intrínsecos à tuberculose somados à mutação do gene da protrombina, potencializam o risco de TVC.
Assuntos
Adulto , Humanos , Masculino , Trombose Intracraniana/microbiologia , Trombose Venosa/microbiologia , Tuberculose do Sistema Nervoso Central/complicações , Imageamento por Ressonância Magnética , Mutação Puntual , Protrombina/genéticaRESUMO
CONTEXT: Sleep has an important function in the physical and emotional development of children. Some studies suggest an association between impulsivity and sleep disorders. However, little is known about this association in schoolchildren aged 8 to 10 years. METHOD: We studied 1180 children, 547 with sleep disorders (SD) and 633 without SD (control group), classified with SD questionnaires. Within the SD group, 53 children with sleep-related respiratory disorders (SRRD) and 521 children with non-respiratory sleep disorders (NRSD) were analyzed. We assessed emotional indicators of impulsivity with Bender test. RESULTS: More SD children presented impulsivity than control group (p<0.05). More NRSD and 10 years old children presented impulsivity than control group of the same age (p=0.001). Impulsivity and SRRD were associated with 8 years old children (p<0.05). CONCLUSION: Children with SD, 8 years old children with SRRD, and 10 years old children with NRSD presented higher proportion of impulsivity than control children.
CONTEXTO: O sono tem função importante no desenvolvimento físico e emocional das crianças. Alguns estudos sugerem a associação de impulsividade e distúrbios do sono, sendo pouco conhecida esta associação em escolares na faixa etária de 8 a 10 anos. MÉTODO: Estudamos 1180 crianças, 547 com distúrbio do sono (DS) e 633 normais (grupo controle), classificadas através de questionários sobre distúrbios do sono. Dentro do grupo DS, analisamos separadamente as crianças com distúrbio respiratório relacionado ao sono (DRRS) e com distúrbios não respiratórios do sono (DNRS). Aplicamos o Teste Gestáltico de Bender (TB) para detectar os indicadores emocionais de impulsividade. RESULTADOS: Maior número de crianças com DS apresentaram impulsividade em relação às crianças do grupo controle (p<0,05). Mais crianças de 10 anos de idade do grupo DNRS apresentaram impulsividade em relação ao grupo controle da mesma idade (p=0,001). Impulsividade e DRRS estiveram associados apenas entre as crianças de 8 anos de idade (p<0,05). CONCLUSÃO: Crianças com DS em geral, crianças com DRRS de 8 anos de idade, e crianças com 10 anos de idade do grupo DNRS apresentaram maior proporção de indicadores de impulsividade do que crianças do grupo controle.