Cardiovascular rhythmicity in overweight and obese children / Ritmicidade cardiovascular em crianças com sobrepeso e obesidade

Abstract Introduction: Obesity is thought to play a role in the disruption of cardiac rhythmicity in obese children, but this is mostly an unexplored field of investigation. We aimed to evaluate the impact of overweight and obesity on circadian and ultradian cardiovascular rhythmicity of prepubertal children, in comparison with normal weight counterparts. Methods: We performed a cross sectional study of 316 children, followed in the birth cohort Generation XXI (Portugal). Anthropometrics and 24-hour ambulatory blood pressure were measured and profiles were examined with Fourier analysis for circadian and ultradian blood pressure (BP) and heart rate (HR) rhythms. Results: Overweight/obese children presented more frequently a non-dipping BP pattern than normal weight counterparts (31.5% vs. 21.6%, p = 0.047). The prevalence of 24-hour mean arterial pressure (MAP) and 8-hour HR rhythmicity was significantly lower in obese children (79.3% vs. 88.0%, p = 0.038 and 33.3% vs. 45.2%, p = 0.031, respectively). The prevalence of the remaining MAP and HR rhythmicity was similar in both groups. No differences were found in the median values of amplitudes and acrophases of MAP and HR rhythms. Discussion: The alterations found in rhythmicity suggest that circadian and ultradian rhythmicity analysis might be sensitive in detecting early cardiovascular dysregulations, but future studies are needed to reinforce our findings and to better understand their long-term implications.

Resumo Introdução: Acredita-se que a obesidade desempenhe um papel na desregulação da ritmicidade cardíaca em crianças obesas, mas esse é um campo de investigação ainda pouco explorado. O objetivo deste trabalho foi avaliar o impacto do sobrepeso e da obesidade na ritmicidade cardiovascular circadiana e ultradiana de crianças pré-púberes, em comparação com crianças com peso normal. Métodos: Realizamos um estudo transversal com 316 crianças, acompanhadas na coorte de nascimentos Geração XXI (Portugal). Foram medidos dados antropométricos e a pressão arterial ambulatorial de 24 horas, e os perfis foram examinados com uma análise de Fourier para ritmos circadianos e ultradianos de pressão arterial (PA) e frequência cardíaca (FC). Resultados: Crianças com sobrepeso/obesidade apresentaram mais frequentemente um padrão de PA não-dipper em comparação com crianças com peso normal (31,5% vs. 21,6%; p = 0,047). A prevalência da pressão arterial média (PAM) de 24 horas e da ritmicidade da FC de 8 horas foi significativamente menor em crianças obesas (79,3% vs. 88,0%; p = 0,038 e 33,3% vs. 45,2%; p = 0,031, respectivamente). A prevalência das restantes ritmicidades da PAM e da FC foi semelhante em ambos os grupos. Não foram encontradas diferenças nos valores medianos das amplitudes e acrofases dos ritmos de PAM e FC. Discussão: As alterações encontradas na ritmicidade sugerem que a análise da ritmicidade circadiana e ultradiana pode ser sensível na detecção de desregulações cardiovasculares precoces, mas são necessários novos estudos para reforçar nossos achados e entender melhor suas implicações a longo prazo.

Escola sem partido e conservadorismo moral: instrumentalização da religião, sexualidade e gênero / School without party and moral conservatism: the instrumentalization of religion, sexuality and gender / Escuela sin partido y conservadurismo moral: la instrumentalización de la religión, sexualidad y género

Este artigo tem por objetivo identificar e discutir alguns estratagemas psicológicos utilizados por movimentos conservadores e autoritários recentemente difundidos no Brasil - em especial, pelo Movimento Escola sem Partido -, em relação a temas como sexualidade e gênero, que atualmente foram incluídos como essenciais à formação escolar. Com esse propósito, empenhamo-nos em compreender a perspectiva cultural em que se apoiam e o modo como a articulam, ideologicamente, para inviabilizar o debate sobre eles. A partir da análise dos Projetos de Lei 246/2019 e 1859/2015, identificamos estratégias conservadoras que, autoritariamente, deslegitimam sua inclusão na formação escolar. Dentre elas, pareceu-nos urgente investigar a instrumentalização da religião, pois favorece a subordinação da crença religiosa, sobretudo associada ao conservadorismo moral imbricado na tradição cristã brasileira, ao discurso político autoritário. Assim como os movimentos fascistas que, nos Estados Unidos da década de 1930, reivindicavam um ordenamento autoritário e opressor da sociedade por meio do apelo a conteúdos religiosos instrumentalizados para esse fim, atualmente, o discurso religioso também é utilizado como forma de suscitar adesão ao conservadorismo social e político e de justificar preconceitos arraigados. Constatamos que a instrumentalização da religião é uma forma de justificar a permanência de valores conservadores na escola e na sociedade, bem como de reiterar o modelo de família heterossexual monogâmica e a ordem patriarcal. Por meio de estratagemas como esses, os movimentos conservadores e autoritários, articulados em função da negação da diversidade sexual e de gênero, impedem que a escola se constitua como espaço democrático e diverso.(AU)

This paper identifies and discusses the psychological ploys employed by recent conservative and authoritarian movements in Brazil, particularly the School without Party movement, against topics like sexuality and gender, which are currently included as essential to school education. To do so, we sought to understand their cultural basis and how they are ideologically articulated to prevent school debate around these topics. By analyzing Bills 246/2019 and 1859/2015, we identified some conservative strategies that authoritatively delegitimize their inclusion in school education. Chief among them is the instrumentalization of religion, since it favors subordinating religious belief, mainly associated with traditional Christian moral conservatism, to authoritarian political discourse. Similar to the fascist movements in the 1930s United States that claimed an authoritarian and oppressive ordering of society by appealing to religious content, religious speech is currently instrumentalized to encourage social and political conservatism adherence and to justify deep-seated prejudices. Religion instrumentalization is used to justify upholding conservative values at school and in society, as well as to reiterate the monogamous heterosexual family model and patriarchy. Through such ploys, authoritarian and conservative movements, articulated around denying sexual and gender diversity, prevent the school from becoming a democratic and diverse environment.(AU)

Este artículo tiene por objetivo identificar y discutir algunas de las estratagemas psicológicas que utilizan los movimientos conservadores y autoritarios, difundidas recientemente en Brasil, en particular por el Movimiento Escuela sin Partido, con relación a temas como sexualidad y género, que actualmente se incluyeron en la formación escolar. Con este propósito, se pretende comprender la base cultural en la que se han apoyado y cómo la articulan ideológicamente para hacer inviable el debate sobre ellas. A partir de análisis de los Proyectos de Ley 246/2019 y 1859/2015, se identificaron estrategias conservadoras que, autoritariamente, deslegitiman la inclusión de estos temas en la formación escolar. Entre ellas, parece urgente analizar la instrumentalización de la religión, porque favorece la subordinación de la creencia religiosa al discurso político autoritario, sobre todo asociada al conservadurismo moral presente en las vertientes del cristianismo brasileño. Al igual que los movimientos fascistas en los Estados Unidos en los años 1930 que reivindicaban una planificación autoritaria de la sociedad mediante un llamado a contenidos religiosos instrumentalizados, actualmente se utiliza el discurso religioso como forma de promover la adhesión al conservadurismo social y político y de justificar los prejuicios. Se constata que la instrumentalización de la religión es un modo de justificar la permanencia de valores conservadores en la escuela, así como de confirmar el modelo de familia heterosexual monógama y el orden patriarcal. Estos estratagemas que son utilizados por los movimientos conservadores y autoritarios, articulados en función de la negación de la diversidad sexual y de género, impiden que la escuela sea democrática y diversa.(AU)

Oleoresins and naturally occurring compounds of Copaifera genus as antibacterial and antivirulence agents against periodontal pathogens.

Invasion of periodontal tissues by Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans can be associated with aggressive forms of periodontitis. Oleoresins from different copaifera species and their compounds display various pharmacological properties. The present study evaluates the antibacterial and antivirulence activity of oleoresins obtained from different copaifera species and of ten isolated compounds against two causative agents of periodontitis. The following assays were performed: determination of the minimum inhibitory concentration (MIC), determination of the minimum bactericidal concentration (MBC), and determination of the antibiofilm activity by inhibition of biofilm formation and biofilm eradication tests. The antivirulence activity was assessed by hemagglutination, P. gingivalis Arg-X and Lis-X cysteine protease inhibition assay, and A. actinomycetemcomitans leukotoxin inhibition assay. The MIC and MBC of the oleoresins and isolated compounds 1, 2, and 3 ranged from 1.59 to 50 µg/mL against P. gingivalis (ATCC 33277) and clinical isolates and from 6.25 to 400 µg/mL against A. actinomycetemcomitans (ATCC 43717) and clinical isolates. About the antibiofilm activity, the oleoresins and isolated compounds 1, 2, and 3 inhibited biofilm formation by at least 50% and eradicated pre-formed P. gingivalis and A. actinomycetemcomitans biofilms in the monospecies and multispecies modes. A promising activity concerning cysteine protease and leucotoxin inhibition was also evident. In addition, molecular docking analysis was performed. The investigated oleoresins and their compounds may play an important role in the search for novel sources of agents that can act against periodontal pathogens.

Physiological response, antioxidant enzyme activities and conservation of banana treated with ethanol vapor.

Ethanol can inhibit ethylene and retard decay of several fruit. However, the effect of ethanol on ethylene and oxidative stress has not yet been observed in bananas. In this work, the effect of ethanol (vapor phase) on physiology and conservation of the banana cv. 'Prata' was investigated. Initially, a group of bananas was analyzed during 8 h of exposure to ethanol, and then another group of bananas was exposed to ethanol for 4 h and then analyzed during 12 days of storage. Ethanol and ethylene concentrations, respiration rate, superoxide dismutase and catalase activities, physico-chemical characteristics and fruit decay were evaluated. Ethanol reduced ethylene production and respiration rate of the banana only when it reached 4 h of exposure, and this was associated with a maximum absorption of ethanol in the fruit peel. Ethanol increased superoxide dismutase and catalase activities from fruit peel only in the first 2 h of exposure to ethanol, i.e. ethanol did not generate significant oxidative stress. During storage, ethanol inhibited ethylene production and was also able to delay fruit decay, but it was not able to influence the respiration rate, conversion of sugars, and fresh weight loss of the fruits. This study showed that ethanol vapor has an inhibitory effect on ethylene metabolism, but it has no potential to control post-harvest ripening of the banana cv. 'Prata'. On the other hand, ethanol delays decay, and this extends fruit shelf life, which is commercially advantageous.

Early myocardial changes induced by doxorubicin in the nonfailing dilated ventricle.

Several studies have demonstrated that administration of doxorubicin (DOXO) results in cardiotoxicity, which eventually progresses to dilated cardiomyopathy. The present work aimed to evaluate the early myocardial changes of DOXO-induced cardiotoxicity. Male New Zealand White rabbits were injected intravenously with DOXO twice weekly for 8 wk [DOXO-induced heart failure (DOXO-HF)] or with an equivolumetric dose of saline (control). Echocardiographic evaluation was performed, and myocardial samples were collected to evaluate myocardial cellular and molecular modifications. The DOXO-HF group presented cardiac hypertrophy and higher left ventricular cavity diameters, showing a dilated phenotype but preserved ejection fraction. Concerning cardiomyocyte function, the DOXO-HF group presented a trend toward increased active tension without significant differences in passive tension. The myocardial GSSG-to-GSH ratio and interstitial fibrosis were increased and Bax-to- Bcl-2 ratio presented a trend toward an increase, suggesting the activation of apoptosis signaling pathways. The macromolecule titin shifted toward the more compliant isoform (N2BA), whereas the stiffer one (N2B) was shown to be hypophosphorylated. Differential protein analysis from the aggregate-enriched fraction through gel liquid chromatography-tandem mass spectrometry revealed an increase in the histidine-rich glycoprotein fragment in DOXO-HF animals. This work describes novel and early myocardial effects of DOXO-induced cardiotoxicity. Thus, tracking these changes appears to be of extreme relevance for the early detection of cardiac damage (as soon as ventricular dilation becomes evident) before irreversible cardiac function deterioration occurs (reduced ejection fraction). Moreover, it allows for the adjustment of the therapeutic approach and thus the prevention of cardiomyopathy progression. NEW & NOTEWORTHY Identification of early myocardial effects of doxorubicin in the heart is essential to hinder the development of cardiac complications and adjust the therapeutic approach. This study describes doxorubicin-induced cellular and molecular modifications before the onset of dilated cardiomyopathy. Myocardial samples from doxorubicin-treated rabbits showed a tendency for higher cardiomyocyte active tension, titin isoform shift from N2B to N2BA, hypophosphorylation of N2B, increased apoptotic genes, left ventricular interstitial fibrosis, and increased aggregation of histidine-rich glycoprotein.

DNA (cytosine-5)-methyltransferase 3B (DNMT 3B) polymorphism and risk of Down syndrome offspring.

Down syndrome (DS) is the most common form of human genetic mental retardation. Several polymorphisms in genes coding folic acid cycle enzymes have been associated to the risk of bearing a DS child; however, the results are controversial. S-adenosyl-l-methionine (SAM) is an important intermediate of folic acid pathway and acts as methyl donor and substrate for DNA (cytosine-5)-methyltransferase 3B (DNMT3B - EC 2.1.1.37) de novo methylation processes during embryogenesis. Recent studies suggest that a functional polymorphism of DNMT 3B in maternal genotype may be associated with a decreased risk of having a DS child. We herein investigate the association of this polymorphism with the occurrence of DS in a Brazilian population. We have genotyped 111 mothers of DS infants (MDS) and 212 control mothers (CM) through PCR-RFLP. The observed genotypic frequencies were CC = 0.22; CT = 0.49 and TT = 0.29 in CM, and CC = 0.30; CT = 0.52 and TT = 0.18 in MDS. Allelic frequencies were C = 0.47 and T = 0.53 in CM and C = 0.56 and T = 0.44 in MDS. No deviation of HWE was observed, and both DNMT 3B rs2424913 genotype (χ2 = 4.53; DF = 1; P = 0.03) and allelic (χ2 = 4.90; DF = 1; P = 0.03) frequencies show significant differences between MDS and CM. The presence of the mutant DNMT 3B T allele decreases 30% the risk of bearing a DS child (OR = 0.69; 95% CI: 0.50-0.96; P = 0.03), and the risk is diminished up to 45% in association with the homozygous genotype (OR = 0.54; 95% CI: 0.31-0.96; P = 0.04). Our results suggest that women harboring the single nucleotide polymorphism DNMT 3B rs2424913 have a decreased risk of a DS pregnancy, and further studies are necessary to confirm this protective effect.

Early cardiac changes induced by a hypercaloric Western-type diet in "subclinical" obesity.

"Obesity cardiomyopathy" effects have been widely described; however, the specific contribution of metabolic changes and altered adipokine secretion are still uncharacterized. Moreover, a diagnosis based on body mass index might not be the most accurate to identify increased adiposity and its outcomes. In this study, we aimed to determine the impact of a Western-type diet [hypercaloric diet (HCD)] ingestion on biventricular structure and function, as well as the metabolic and endocrine changes that occur before the establishment of overt obesity. Wistar rats were fed for 6 wk with a regular diet or HCD. At the end of the protocol, metabolic tests, cardiac structure, and functional evaluation were performed, and blood and tissue samples collected to perform histological, molecular biology, and functional studies. The animals that ingested the HCD presented increased adiposity and larger adipocyte cross-sectional area, but similar body weight compared with the regular diet group. At the cardiac level, HCD induced biventricular cardiomyocyte hypertrophy, fibrosis, increased stiffness, and impaired relaxation. Galectin-3 plasma expression was likewise elevated in the same animals. The nutritional modulation also altered the secretory pattern of the adipose tissue, originating a proinflammatory systemic environment. In this study, we observed that before "clinical" overweight or frank obesity is established, the ingestion of a HCD-induced cardiac remodeling manifests by increased biventricular stiffness and diastolic dysfunction. The mechanism triggering the cardiac alterations appears to be the proinflammatory environment promoted by the adipose tissue dysfunction. Furthermore, galectin-3, a profibrotic molecule, might be a potential biomarker for the myocardial alterations promoted by the HCD before overweight or obesity.

Incidência de infecção por citomegalovirus em pacientes portadores de síndrome da imunodeficiência dquirida atendidos em Jundiaí, SP / Incidence of cytomegalovirus infection in patients with acquired immunodeficiency syndrome atended in Jundiaí, SP

Objetivo ­ Identificar a incidência de Citomegalovírus (CMV) em pacientes HIV (Vírus da Imunodeficiência Adquirida) positivos, através de levantamento de dados arquivados de pacientes que apresentaram produção de Imunoglobulina IgG e IgM para CMV e provável positividade para ambos. Métodos ­ Os resultados foram obtidos através de análise de prontuários de pacientes HIV positivos, atendidos em um laboratório de análises clínicas de Jundiaí, São Paulo, cujo atendimento consiste em pacientes da rede particular e do Sistema Único de Saúde (SUS). Os dados foram levantados num retrospecto de 46 meses, entre janeiro de 2011 e outubro de 2014 e foram analisados três parâmetros principais: a média de solicitações de sorologia para HIV, a incidência para CMVM (IgM para Citomegalovírus) e CMVG (IgG para Citomegalovírus) em pacientes HIV positivos e o percentual destes pacientes infectados tanto na rede particular como na rede pública. Resultados ­ No período analisado, 88 pacientes foram diagnosticados com HIV confirmados através de Western Blotting. Destes confirmou-se que 2,27% apresentaram IgM positiva para CMV. Tais pacientes foram atendidos pela rede particular de saúde. Conclusão ­ Isto posto, apesar da TARV (Terapia antirretroviral), ainda há pacientes que se infectam com o CMV. Foi possível avaliar que independente da rede de atendimento o paciente imunocomprometido pelo HIV necessita de atenção especial e acompanhamento minucioso para sobrevida e bem-estar.

Objective ­ To identify the incidence of cytomegalovirus in patients seropositive for HIV, up examinations of patients with IgG and IgM for CMV positivity and possible for both. Methods ­ Through medical records of HIV-positive patients, the data were performed after prior approval of a clinical laboratory in Jundiai, São Paulo, which is to serve the public private network and public network. The data were collected in a retrospective of 46 months between January 2011 and October 2014 and there were three data analysis: the average requests for HIV testing, the incidence for E CMVG CMVM and the percentage of these infected patients in private institutions and the public network. Results ­ Through the medical records, it was found 88 patients with HIV confirmed by Western blotting, it was confirmed that 2.27% were infected with CMV, is have positive IgM and are treated at private. Conclusion ­ That said, despite the HAART (antiretroviral therapy), there are still patients who became infected with CMV, it is possible to assess whether the service network immunocompromised HIV patients need special attention and careful monitoring for survival and well-being.

[Psychosocial adjustment, psychiatric morbidity and quality of life in adolescents and young adults with congenital heart disease]. / Ajustamento psicossocial, morbilidade psiquiátrica e qualidade de vida em adolescentes e jovens adultos com cardiopatias congénitas.

OBJECTIVES: We aimed to study the psychosocial adjustment (PSA), psychiatric morbidity and quality of life of adolescents and young adults with congenital heart disease (CHD) to determine which demographic and clinical variables negatively affect adjustment and which increase resilience. METHODS: The study included 74 patients with CHD, 41 male and 33 female, aged between 12 and 26 years (mean 18.76±3.86). Demographic information and a complete clinical history were obtained. The participants were interviewed regarding social support, family environment, self-image and physical limitations. A standardized psychiatric interview was conducted, and self-report questionnaires were administered for assessment of PSA (Youth Self Report and Adult Self Report) and quality of life (World Health Organization Quality of Life - Short Version). A caregiver completed an observational version of the PSA questionnaire (Child Behavior Checklist or Adult Behavior Checklist). RESULTS: Female participants showed more feelings of anxiety and depression (U=952.500; p=0.003), thought problems (U=929.500; p=0.005) and aggressive behavior (U=999.000; p=0.000). They also showed a higher rate of psychopathology. Patients with complex forms of CHD reported more thought problems (U=442.000; p=0.027) and internalization (U=429.000; p=0.021). Compared to the Portuguese population as a whole, participants showed better quality of life in the domains of social relationships (t=2.333; p=0.022) and environment (t=3.754; p=0.000). Patients who had undergone surgery had worse quality of life in physical terms (t=-1.989; p=0.050), social relationships (t=-2.012; p=0.048) and general quality of life (U=563.000; p=0.037), compared to those who were not operated. Better social support was associated with better quality of life in physical terms (t=3.287; p=0.002) and social relationships (t=3.669; p=0.000). Better school performance was also associated with better overall quality of life (U=457.000; p=0.046), less withdrawn behavior (U=812.500; p=0.031), fewer feelings of anxiety and depression (U=854.000; p=0.009), fewer attention problems (U=903.500; p=0.001), and lower scores for internalization (U=817.000; p=0.029) and externalization (U=803.500; p=0.042). Physical limitations had a detrimental effect on quality of life (U=947.500; p=0.001). DISCUSSION: Female participants were more prone to worse psychological adjustment and to psychopathology. Patients with complex forms of CHD showed worse PSA, as they need regular care, which restricts social contact with peers and family and integration in school and leisure activities. Patients who had undergone surgery showed worse quality of life as they often have long hospital stays, during which social activities are restricted, making it more difficult for them to develop a good social support network. They require close medical care, and the restrictions on their activities may be life-limiting. Their sense of survival may also be threatened. CONCLUSIONS: Patients with CHD appear to be more prone to psychopathology and female patients are more likely to show worse PSA. Social support was shown to play a crucial role in buffering stress and promoting patients' adjustment.

Identification of new flagellin-encoding fliC genes in Escherichia coli isolated from domestic animals using RFLP-PCR and sequencing methods / Identificação de novas flagelinas codificadas por fliC em Escherichia coli isoladas de animais domésticos utilizando RFLP-PCR e sequenciamento

Identification of Escherichia coli requires knowledge regarding the prevalent serotypes and virulence factors profiles allows the classification in pathogenic/non-pathogenic. However, some of these bacteria do not express flagellar antigen invitro. In this case the PCR-restriction fragment length polymorphism (RFLP-PCR) and sequencing of the fliC may be suitable for the identification of antigens by replacing the traditional serology. We studied 17 samples of E. coli isolated from animals and presenting antigen H nontypeable (HNT). The H antigens were characterized by PCR-RFLP and sequencing of fliC gene. Three new flagellin genes were identified, for which specific antisera were obtained. The PCR-RFLP was shown to be faster than the serotyping H antigen in E. coli, provided information on some characteristics of these antigens and indicated the presence of new genes fliC.

A identificação da Escherichia coli requer conhecimento sobre os sorotipos e fatores de virulência prevalentes permitindo a classificação em patogênico/não patogênico. No entanto, algumas destas bactérias não expressam o antígeno flagelar in vitro. Neste caso, o PCR-restriction fragment length polymorphism (RFLP-PCR) e o sequenciamento do gene fliC podem ser adequados para a identificação desses antígenos, substituindo a sorologia tradicional. Nesta pesquisa foram estudadas 17 amostras de E. coli isoladas de animais e que apresentavam antígeno H não tipável (HNT). Os antígenos H foram caracterizados por PCR-RFLP e sequenciamento do gene fliC. Três novos genes da flagelina foram identificados, para os quais anti-soros específicos foram obtidos. A técnica PCR-RFLP mostrou-se mais rápida que a sorotipagem do antígeno H em E. coli, fornecendo informações sobre algumas características desses antígenos e indicou a presença de novos genes fliC.

Coronary fistula to the right atrium: a challenge for the interventional cardiologist.

Congenital coronary fistulas are rare conditions, frequently diagnosed as an incidental finding when a patient is referred for cardiac surgery for another reason. Treatment can be conservative, surgical or more recently through transcatheter closure, depending on local experience and the morphology of the fistula. The authors present the case of a pediatric patient with a large coronary artery fistula from the aorta to the right atrium. Transcatheter closure with a 16 mm Amplatzer(®) vascular plug II and a 6 mm Amplatzer(®) duct occluder was performed, with complete occlusion.

Comportamento alimentar de idosos residentes na área urbana do município de São Paulo e variáveis sociodemográficas e culturais - Estudo SABE: Saúde, Bem-estar e Envelhecimento / Feeding behavior refered by elderly residing in the urban area of São Paulo city and sociodemographic and cultural variables SABE Survey - Health, Wellbeing and Aging

Introdução: Segundo a literatura científica, o comportamento alimentar de idosos está relacionado a variáveis sociodemográficas e culturais.Objetivo: Verificar a associação entre comportamento alimentar de idosos, residentes no município de São Paulo, e variáveis sociodemográficas e culturais. Métodos: Estudo transversal, com idosos ( 60 anos), de ambos os sexos, do Estudo SABE: Saúde, Bem-estar e Envelhecimento, realizado em 2000, no município de São Paulo, selecionados por amostra probabilística. As variáveis de estudo foram referidas: comportamento alimentar (número de refeições < 3/dia, ausência de costume para preparar refeições quentes e comprar alimentos, e frequência de ingestão de alimentos.

Quality of life of patients with congenital heart diseases.

OBJECTIVES: To assess the perception of the quality of life of adolescents and young adults with congenital heart disease and to examine the variables that have a negative impact on it and that add a resilience effect. METHODS: A total of 22 male and 18 female patients, aged 12-26 years, of whom 27 were admitted to surgery and 13 were not, participated in this study. All patients had complete medical records and were interviewed once; demographic and clinical data were collected, and patients filled a questionnaire on quality of life, the WHOQOL-BREF, and underwent an interview on social support, educational style, self-image, functional limitations, and emotional adjustment. RESULTS/CONCLUSIONS: Our patients showed a better perception of quality of life than did the general population, on the basis of psychological, social relationship and environment scales. Older patients hold a better perception of quality of life on the psychological scale. Cyanosis did not show any significant impact over perception of quality of life decay; however, the number of surgical procedures and the persistence of moderate-to-severe residual injuries had considerable detrimental effect. Social support had an impact on increasing resilience, promoting adjustment to illness. Several factors may play a role in adjustment to congenital heart disease, either improving the perception of quality of life or worsening it. We may conclude that some buffer variables on congenital heart disease may play roles in increasing the perception of quality of life of patients during their lifetime, social support probably explaining why the perception of quality of life is better than in the normal population. The number of surgeries and the moderate-to-severe residual injuries, however, reverted that effect.

Quality of life experienced by adolescents and young adults with congenital heart disease.

This study aimed to assess the quality of life (QOL) experienced by adolescents and young adults with congenital heart disease (CHD) and to determine which factors negatively affect adjustment and which factors increase resilience. The participants in the study were 74 patients with CHD (41 males and 33 females) ranging in age from 12 to 26 years (mean age, 18.76 ± 3.86 years). Demographic information and a complete clinical history were obtained. The participants were interviewed regarding topics such as social support, family educational style, self-image, and physical limitations. They responded to questions in a standardized psychiatric interview (SADS-L) and completed a self-report questionnaire (WHOQOL-BREF) for assessment of QOL. Compared with the Portuguese population as a whole, the study patients had better QOL, especially with regard to the environmental dimension (t = 3.754; P = 0.000) and social relationships (t = 2.333; P = 0.022). Patients who had undergone surgery experienced poorer QOL in the physical dimension (t = -1.989; P = 0.050), in social relationships (t = -2.012; P = 0.048) and overall (Mann-Whitney U = 563.000; P = 0.037). Social support played a positive role in the QOL of the patients, both in the physical dimension (t = 3.287; P = 0.002) and in social relationships (t = 3.669; P = 0.000). A higher school achievement also was associated with higher levels of QOL overall (Mann-Whitney U = 457.000; P = 0.046) as well as in the physical (t = 2.045; P = 0.045) and environmental (t = 2.413; P = 0.018) dimensions. Physical limitations had a detrimental impact on general QOL (Mann-Whitney U = 947.500; P = 0.001) and on the physical (t = -2.910; p = 0.005) and psychological (t = -2,046; P = 0.044) dimensions. Patients with CHD tended to perceive QOL as better when their social networks were supportive.

Identification of putative new Escherichia coli flagellar antigens from human origin using serology, PCR-RFlP and DNA sequencing methods

Escherichia coli has been isolated frequently, showing flagellar antigens that are not recognized by any of the 53 antisera, provided by the most important reference center of E. coli, The International Escherichia and Klebsiella Center (WHO) of the Statens Serum Institute, Copenhagen, Denmark. The objective of this study was to characterize flagellar antigens of E. coli that express non-typeable H antigens. The methods used were serology, PCR-RFLP and DNA sequencing. This characterization was performed by gene amplification of the fliC (flagellin protein) by polymerase chain reaction in all 53 standards E.coli strains for the H antigens and 20 E. coli strains for which the H antigen was untypeable. The amplicons were digested by restriction enzymes, and different restriction enzyme profiles were observed. Anti-sera were produced in rabbits, for the non-typeable strains, and agglutination tests were carried out. In conclusion,the results showed that although non-typeable and typable H antigens strains had similar flagellar antigens, the two types of strains were distinct in terms of nucleotide sequence, and did not phenotypically react with the standard antiserum, as expected. Thirteen strains had been characterized as likely putative new H antigen using PCR-RFLP techniques, DNA sequencing and/or serology.

Sydenham's chorea in a family with Huntington's disease: case report and review of the literature / Coreia de Sydenham numa família com doença de Huntington: relato de caso e revisão da literatura

CONTEXT: Sydenham's chorea affects almost 30 percent of patients with acute rheumatic fever. It is more frequent in females and is rare in the first decade of life, and genetic vulnerability underlies it. Because of easy access to antibiotics, it is now rare in so-called developed countries. CASE REPORT: A 6-year-old boy with a family history of Huntington's disease, who was the only child of an unscreened and asymptomatic mother, was brought for a consultation because of migratory arthralgia, depressed mood, and rapid, abrupt and unintentional movements of his right arm and leg, that had evolved over a three-week period. On physical examination, he presented a grade III/VI systolic heart murmur and right-side choreic movements, giving rise to a deficit of active mobilization. Laboratory tests revealed elevated erythrocyte sedimentation rate (63 mm/h), C-reactive protein (25 mg/l) and antistreptolysin O titer (1,824 U/ml). Cardiovascular evaluation showed mild aortic insufficiency, moderate mitral insufficiency and a prolonged PR interval. A clinical diagnosis of Sydenham's chorea/acute rheumatic fever was made, and therapy consisting of penicillin, haloperidol, captopril and furosemide was instituted, with excellent results. CONCLUSION: In developed countries, Sydenham's chorea seems forgotten and, because of this, little is known about its clinical course and controversy surrounds the therapeutic options available. This occurrence of rheumatic chorea in a family with Huntington's disease highlights the importance of the differential diagnosis for the different forms of chorea.

CONTEXTO: A coreia de Sydenham surge em cerca de 30 por cento dos casos de febre reumática aguda. É mais frequente no sexo feminino, é rara na primeira década de vida e tem por base uma vulnerabilidade genética. Devido ao fácil acesso aos antibióticos, é uma doença rara atualmente nos países ditos desenvolvidos. RELATO DO CASO: Criança de seis anos, sexo masculino, com história familiar de coreia de Huntington, único filho de mãe assintomática e não rastreada, foi trazido à consulta por artralgias migratórias, humor deprimido e movimentos rápidos, abruptos e não intencionais dos membros superior e inferior direitos, com três semanas de evolução. Ao exame físico, apresentava um sopro cardíaco sistólico grau III/VI, e foram presenciados movimentos coreicos à direita, condicionando um défice de mobilização activa. Os exames laboratoriais mostraram aumento da velocidade de sedimentação (63 mm/h), proteína C-reativa (25 mg/L) e título de antiestreptolisina O (1.824 U/mL). O exame cardiovascular revelou insuficiência aórtica ligeira e insuficiência mitral moderada e aumento do intervalo PR. Foi feito o diagnóstico de coreia de Sydenham/febre reumática aguda, tendo sido instituída terapêutica com penicilina, haloperidol, captopril e furosemida, com excelente resultado. CONCLUSÃO: Nos países desenvolvidos, a coreia de Sydenham parece esquecida e, por isso, pouco se sabe quanto ao seu curso clínico e as opções terapêuticas disponíveis são controversas. A ocorrência de um caso de coreia reumática numa família com doença de Huntington realça a importância do diagnóstico diferencial das diferentes formas de coreia.

Rede de apoio social ao familiar cuidador de pessoa com atrofia muscular espinhal I e II / Social support network to family caregiver of a patient with spinal muscular atrophy I and II

Objetivo: Analisar a rede formal e informal de apoio ao familiar cuidador de pessoa com Atrofia Muscular Espinhal tipos I e II. Método: Trabalho de delineamento qualitativo desenvolvido em 2008, nas residências dos informantes e nas dependências do Hospital Infantil Albert Sabin, em Fortaleza-Ceará, realizado com 13 mães, cuidadoras principais de seus filhos doentes. Para coleta de dados, utilizaram-se a entrevista e o instrumento gerador de nomes e qualificador da relação, adaptados para este estudo. Os dados quantitativos foram processados através dos programas UCINET 6.123 e NetDraw 2.38, enquanto os dados qualitativos foram organizados com base na técnica do Discurso do Sujeito Coletivo. As análises se deram em função dos mapas de rede e dos discursos coletivos suscitados pelas ideias centrais. Resultados: A rede social formal dos Familiares Cuidadores foi composta de 72 atores, entre profissionais das áreas da saúde, educação e outros, vinculados a 12 instituições. A rede informal total era composta por 83 atores. Constatou-se que o gerenciamento do cuidado, mesmo quando o familiar cuidador tem suporte de outras pessoas, é motivo de estresse e sobrecarga. Conclusões: Está evidente a importância da aplicação da Análise de Redes Sociais como ferramenta para conhecimento dos aspectos estruturais e da dinâmica das relações sociais do familiar cuidador de pessoa com Atrofia Muscular Espinhal. A análise realizada sugere necessidade de intervenção junto ao grupo estudado como forma de contribuir para o reconhecimento e utilização dos suportes existentes, potencializando o significado de ajuda das interações em rede.

Objective: To assess the formal and informal support given to the family caregiver of a patient with Spinal Muscular Atrophy I and II. Method: This was a study with a qualitative approach developed in 2008 in the homes of informants and in the premises of the Hospital Infantil Albert Sabin in Fortaleza, Ceara, conducted with 13 mothers, primary caregivers for their ill children. For data collection we used both the interview and the instrument generator of the names and qualifier of the relations, adapted for this study. Quantitative data were processed using the programs UCINET NetDraw 6.123 and 2.38, while the qualitative data were organized based on the technique of the Collective Subject Discourse. The analyses were conducted by means of network maps and collective discourses raised by central ideas. Results: The formal social network of family caregivers was composed of 72 actors, among professionals in the areas of health, education and others, linked to 12 institutions. The informal network was comprised of 83 actors. It was found that the management of care, even when the caregiver has support from other people is a cause of stress and overload. Conclusion: It is evident the importance of applying Social Network Analysis as a tool for understanding structural features and the dynamics of social relations of family caregiver. Of a patient with spinal muscular atrophy. The analysis suggests the need for intervention in the study group as a way to contribute to the recognition and use of existing services, increasing the significance of the help provided by network interactions.

Correlation between plasma levels of apelin and myocardial hypertrophy in rats and humans: possible target for treatment?

OBJECTIVE: To investigate the effects of left ventricular (LV) pressure overload and diabetes on the apelinergic system. RESEARCH DESIGN/METHODS: Pressure overload was established in rats by supra-renal aortic-banding. Six weeks later, diabetes was induced by streptozotocin (65 mg/kg, intraperitoneal), resulting in four groups: sham, banded (BA), diabetic (DM) and diabetic-banded (DM-BA). Twelve weeks later, LV function and structure were evaluated by echocardiography and biopsies and plasma samples collected. Furthermore, plasma samples and LV-endomyocardial biopsies were procured from aortic stenosis and mitral stenosis patients during surgery to evaluate myocardial expression of apelin and APJ-receptor and plasma levels of apelin. RESULTS: Direct correlations between apelin plasma levels and LV-mass index and between apelin and APJ myocardial expression were observed both in humans and rats. Expression of apelin and APJ was not significantly altered by pressure-overload in humans, being downregulated by pressure overload and even more by diabetes in rats. Finally, an inverse correlation between apelin rat plasma levels and its myocardial expression was observed. CONCLUSIONS: While apelin/APJ myocardial expression decreases, apelin plasma levels increase in LV hypertrophy. Considering apelin's positive inotropic and vasodilator properties, this elevation in apelin plasma levels may represent a compensatory mechanism to maintain inotropism and cardiac output during pressure-overload or diabetic cardiomyopathy.

Efeito da lavagem e cocção em batatas contaminadas por pesticidas organofosforados e carbamatos / Effect of the washing and cooking in potatos contaminated by organophosphate pesticides and carbamates

Os pesticidas organosfosfados e carbamatos são utilizados em cultura de frutas e hortaliças e são substâncias muito tóxicas para o ambiente e o organismos humano e ainda podem causar distúrbios neurológicos. O estudo teve por objetivo avaliar a eficácia da lavagem em água corrente e da cocção por fervura para remover resíduos de pesticidas na casca e na polpa de batatas. Foram escolhidas batatas cultivadas por processo tradicional e orgânico compradas em organizações comerciais na cidade do Rio de Janeiro. Foram analisadas doze amostras: oito de supermercados, duas de hortifruti, uma de feira livre e uma de mercearia. Cada amostra representativa analisada pesou 2 kg. O método aplicado foi o método enzimático desenvolvido no Laboratório de Biologia CeluLar – ENZITOX;UERJ. Os resultados mostraram que a amostra de batatas originada da mercearia tinha a maior concentração em resíduo de carbamato e que o cozimento por fervura é um processo muito importante para reduzir a concentração dessas substâncias tóxicas.

Patients with aortic coarctation operated during the first year of life, different surgical techniques and prognostic factors--21 years of experience.

UNLABELLED: The authors reviewed the clinical files of all patients with coarctation of the aorta (CoAo) operated during the first year of life, in a tertiary center, in order to assess the outcome of different surgical techniques and prognostic factors. MATERIAL AND METHODS: The study included all patients operated from 1 June 1980 to 1 June 2001. They were divided into three groups according to diagnosis: Group I--isolated CoAo (with or without persistent ductus arteriosus (PDA), group II--CoAo plus ventricular septal defect (VSD), and group III--CoAo associated with complex heart defects. The surgical techniques were divided into four groups: Group A--resection of the CoAo with end-to-end anastomosis, group B--Waldhausen technique (subclavian flap), group C--enlargement of the aorta with a patch, and group D--Waldhausen technique plus resection of the CoAo with end-to-end anastomosis. Several parameters were analyzed: sex, age at surgery, other surgical procedures during surgery, reoperation, mortality and outcome (good result, recoarctation). RESULTS: 156 patients were operated during the study period (84.5% of them since 1989). 61.5% were male. Surgery was performed between 3 and 336 days of life. 60.9% patients were included in group I, 32.7% in group II and 6.4% in group III. 25.0% of the patients had group A surgery, 60.2% group B surgery, 7.0% group C surgery and 7.7% group D surgery. The PDA was sectioned in 48.0% of the patients. It was necessary to perform banding of the pulmonary artery, during the first surgery, in 19.9% of cases. 18.6% needed a second operation to close the VSD and for debanding or repair of associated defects. Total mortality was 19.2%. Mortality rate per groups was: Group I--15.8%, group II--21.5%, group III--30.0%, group A--18.0%, group B--19.1%, group C--27.2% and group D--16.7%. In 7.6% of the patients recoarctation was found during follow-up. 40% of the patients are doing well with no medication and minor or no residual defects. 29.4% were lost to follow-up. CONCLUSIONS: Total mortality has decreased over the years with the highest mortality found in Group C and Group III. The best results were achieved in patients with isolated CoAo. Long-term results were generally good with few recoarctations and a good quality of life.