RESUMO
BACKGROUND: Leptospirosis is a re-emerging zoonosis with protean clinical manifestations. Recently, the importance of pulmonary hemorrhage as a lethal complication of this disease has been recognized. In the present study, five human necropsies of leptospirosis (Weil's syndrome) with extensive pulmonary manifestations were analysed, and the antibodies expressed in blood vessels and cells involved in ion and water transport were used, seeking to better understand the pathophysiology of the lung injury associated with this disease. PRINCIPAL FINDINGS: Prominent vascular damage was present in the lung microcirculation, with decreased CD34 and preserved aquaporin 1 expression. At the periphery and even inside the extensive areas of edema and intraalveolar hemorrhage, enlarged, apparently hypertrophic type I pneumocytes (PI) were detected and interpreted as a non-specific attempt of clearence of the intraalveolar fluid, in which ionic transport, particularly of sodium, plays a predominant role, as suggested by the apparently increased ENaC and aquaporin 5 expression. Connexin 43 was present in most pneumocytes, and in the cytoplasm of the more preserved endothelial cells. The number of type II pneumocytes (PII) was slightly decreased when compared to normal lungs and those of patients with septicemia from other causes, a fact that may contribute to the progressively low PI count, resulting in deficient restoration after damage to the alveolar epithelial integrity and, consequently, a poor outcome of the pulmonary edema and hemorrhage. CONCLUSIONS: Pathogenesis of lung injury in human leptospirosis was discussed, and the possibility of primary non-inflammatory vascular damage was considered, so far of undefinite etiopathogenesis, as the initial pathological manifestation of the disease.
Assuntos
Pneumopatias/patologia , Pneumopatias/fisiopatologia , Doença de Weil/patologia , Doença de Weil/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Células Epiteliais Alveolares/metabolismo , Células Epiteliais Alveolares/patologia , Vasos Sanguíneos/metabolismo , Vasos Sanguíneos/patologia , Estudos de Casos e Controles , Conexina 43/metabolismo , Canais Epiteliais de Sódio/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Pulmão/metabolismo , Pulmão/patologia , Masculino , Microcirculação , Microscopia Confocal , Pessoa de Meia-Idade , Adulto JovemRESUMO
The present study aimed to verify the time course of the effects of environmental levels of urban air pollution toxicity on lung arterioles. BALB/c mice (n=56) were continuously exposed to selective chambers equipped with (filtered, F) or without (non-filtered, NF) filter devices for particles and toxic gases for 24h/day, over 14, 21, 30 or 45 days. After exposure, we evaluated the lumen-wall relationship (an estimator of arteriolar narrowing), endothelial nitric oxide synthase (eNOS) and endothelin type A receptor (ETAr) expression in the vascular wall and inflammatory influx of the peribronchiolar area. Concentrations of fine particulate matter (PMAssuntos
Poluentes Atmosféricos/toxicidade
, Pulmão/irrigação sanguínea
, Pulmão/efeitos dos fármacos
, Receptor de Endotelina A/metabolismo
, Vasoconstrição/efeitos dos fármacos
, Animais
, Arteríolas/efeitos dos fármacos
, Arteríolas/metabolismo
, Câmaras de Exposição Atmosférica
, Cidades
, Exposição por Inalação/análise
, Pulmão/metabolismo
, Masculino
, Camundongos
, Camundongos Endogâmicos BALB C
, Dióxido de Nitrogênio/toxicidade
, Material Particulado/toxicidade
, Receptor de Endotelina A/efeitos dos fármacos
, Fumaça
, Tempo
, Testes de Toxicidade
RESUMO
STUDY OBJECTIVE: To estimate the relationship between the depth of lesions of rectal endometriosis and the percentage of the circumference of the bowel segment affected by the disease. DESIGN: A prospective pathologic analysis of 45 surgical specimens of bowel endometriosis obtained by laparoscopic segmental resection of the rectosigmoid (Canadian Task Force classification II-1). SETTING: Tertiary referral hospital. PATIENTS: forty-five patients were submitted to a segmental resection of the rectum due to endometriosis between July 2004 and September 2006. INTERVENTIONS: Morphometric aspects of endometriotic lesions were analyzed, such as size and thickness of the lesion, deepest layer of bowel affected by lesion, and percentage of circumference of bowel affected by endometriosis. MEASUREMENTS AND MAIN RESULTS: Results showed that in lesions that reached the submucous layer of the bowel, the circumference affected was 31.6% greater than in lesions that reached only the outer muscular layer, whereas in lesions that reached the mucous layer, the circumference affected was 52.5% greater than in those that reached the outer muscular layer of the bowel. In addition, 89.3% of lesions with an affected circumference greater than 40% were those affecting the submucous or mucous layers of the bowel. These results suggest that when a lesion reaches these 2 deepest layers of the rectosigmoid, risk increases that the circumference affected will be greater than 40% (relative risk = 1.5; 95% CI: 1.0-2.3; p = .03). CONCLUSION: In endometriotic lesions affecting the rectosigmoid beyond the inner muscular layer of the bowel wall, more than 40% of the circumference of the rectosigmoid is affected by the disease, confirming the recommendation of segmental resection of the bowel for this form of the disease.
Assuntos
Colo Sigmoide/patologia , Endometriose/patologia , Reto/patologia , Adulto , Estudos de Coortes , Procedimentos Cirúrgicos do Sistema Digestório , Endometriose/cirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Pessoa de Meia-Idade , Reto/cirurgiaRESUMO
PURPOSE: This study was carried out in Monte Negro (state of Rondônia), a village in the Brazilian western Amazon region, where a University of São Paulo Medical School program for medical student training in rural assistance took place. It aimed to determine the prevalence of hepatitis B virus and hepatitis C virus, to investigate risk factors for infection, and to evaluate the State immunization program against hepatitis B virus in the region. METHODS: The study is a cross-sectional seroprevalence survey, comprising 267 volunteers who answered a comprehensive questionnaire and had blood samples collected, which were analyzed in São Paulo for the presence of antibodies against hepatitis B virus (Hbs Ag, anti-Hbs, and anti-Hbc) and hepatitis C virus using commercial kits. Data were stored in a specific data bank, and the association between seropositivity and potential risk factors was analyzed by means of uni-, bi-, and multi-variate analysis, considering +/- 5%. RESULTS: The seroprevalence of hepatitis B virus was 61.79% and of hepatitis C virus was 0.38%. Statistical analysis on the data bank showed that the prevalence of hepatitis B virus rose significantly with age, especially after adolescence. Infection was higher in those coming from outside the state of Rondônia. Exposure to vaccination against hepatitis B virus was higher in younger individuals and in those who were born in Rondônia. CONCLUSION: Monte Negro is a highly endemic region for hepatitis B virus but not for hepatitis C virus. Our results also provide indirect evidence indicating a significant improvement in the immunization program in Rondônia in recent years.
Assuntos
Hepacivirus/imunologia , Anticorpos Anti-Hepatite/sangue , Vírus da Hepatite B/imunologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Programas de Imunização/normas , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Brasil/epidemiologia , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Métodos Epidemiológicos , Feminino , Hepatite B/sangue , Hepatite B/imunologia , Anticorpos Anti-Hepatite B/sangue , Vacinas contra Hepatite B/imunologia , Hepatite C/sangue , Hepatite C/imunologia , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , População Rural , Fatores SocioeconômicosRESUMO
OBJETIVOS: O presente estudo foi realizado em Monte Negro, Rondônia, Amazônia Oriental, onde um projeto de acadêmicos de Medicina da Universidade de São Paulo promoveu assistência médica à população rural. O objetivo foi determinar a soroprevalência de Hepatite B e Hepatite C, investigar os fatores de risco para sua infecção e avaliar o status imunológico vacinal contra Hepatite B nesta região. MÉTODOS: O estudo é uma pesquisa de corte transversal de soroprevalência, compreendendo 267 voluntários que tiveram suas amostras sanguíneas coletadas após preenchimento de um questionário. As amostras foram analisadas em São Paulo usando kits comerciais pesquisando anticorpos contra Hepatite B (AgHBs, Anti-HBs e Anti-HBc) e Hepatite C . Um banco de dados montado através do questionário foi analisado em relação aos resultados sorológicos com testes uni-, bi-, e multivariado, considerando ± = 5%. RESULTADOS: A soroprevalência do VHB encontrada foi de 61.79% e do Hepatite C, 0.38%. A análise dos possíveis fatores de risco mostrou que a prevalência de Hepatite B aumenta com a idade, especialmente após a adolescência, além de ser maior em aqueles nascidos em Rondônia. A exposição à vacinação contra Hepatite B foi maior em indivíduos jovens e aqueles nascidos em Rondônia. CONCLUSÃO: Monte Negro é uma região altamente endêmica para Hepatite B , mas não para Hepatite C . Ademais, os resultados obtidos evidenciam uma significativa melhora no programa de imunizações em Rondônia nos anos recentes.